耳廓基底细胞癌应用手术切除并耳后带蒂肌皮瓣一期修复效果观察

目的 分析耳廓基底细胞癌患者的治疗效果。方法 选取2012年1月至2016年1月本院收治的耳廓基底细胞癌患者24例,在安全缘范围带软骨完整切除,选择耳后乳突上对应缺损组织大小肌皮瓣转移一期修复。术后病理确定切除范围安全,不进行放疗。结果 24例患者术后均一期治愈,转移肌皮瓣修复形态完整,手术痕迹隐蔽。术后随访2年及以上均未见复发。结论 耳廓基底细胞癌掌握安全缘切除可以一期达到治愈效果,避免增加放疗,转移肌皮瓣修复组织缺损最大程度保证了形态美观,且选材方便,达到病理和心理双向治疗,在耳廓肿瘤治疗中医疗优势突出。

脊髓海绵状血管畸形的研究进展

脊髓海绵状血管畸形是脊髓血管畸形的一种,约占所有脊髓血管病的5%-12%-（[1]）,其病理改变是紧密充填的血窦样良性血管瘤结构,内衬以血管内皮细胞-（[2]）。海绵状血管畸形多发生于脑及脑干,在脊髓内罕见,但随着MRI的普及,脊髓海绵状血管畸形的检出率明显增加-（[3-4]）,

Efficacy and Safety of a Continuous Wound Catheter in Open Abdominal Partial Hepatectomy

Objective To investigate the efficacy and safety of continuous local anesthetic wound infiltration following open abdominal partial hepatectomy. Methods We performed a prospective, non-randomized, concurrent and controlled study. Patients undergoing open abdominal partial hepatectomy, according to their willingness, accepted one of the following managements for the postoperative pain： continuous wound catheter （CWC） infiltration, patient-controlled epidural analgesia （PCEA）, patient-controlled intravenous analgesia of morphine （PCIAM）, and patient-controlled intravenous analgesia of sufentanil （PCIAS）. The primary outcome was postoperative visual analogue scale （VAS） scores at rest and on movement. Secondary outcomes included consumption of rescue medication, side effects, and complications associated with postoperative pain management. Results From August 2013 to December 2013, 80 patients were allocated to receive CWC （n=10）, PCEA （n=22）, PCIAM （n=29）, or PCIAS （n=19）. After adjusting for age, sex, body mass index, percentage of resected liver, operation time, and Amsterdam Preoperative Anxiety and Information Scale, there was no significant difference in the VAS scores at rest or on movement between Group CWC and the other groups, namely PCEA, PCIAM, and PCIAS, at 4, 12, 48, and 72 hours postoperatively （all P〉0.05）. The need for rescue medication was not significantly different between Group CWC and the other three groups at 48 and 72 hours postoperatively （all P〉0.05）. There was no significant difference in the incidence of postoperative nausea and vomiting or anal exsufflation time between group CWC and the other three groups （all P〉0.05）. No severe adverse effects associated with continuous wound infiltration were observed during the study period. Conclusions CWC has a comparable analgesic effect compared with traditional analgesia methods at most time points postoperatively. CWC is a safe alternative for the postoperative analgesic management of open liver surgery.

Original single-incision laparoscopic cholecystectomy for acute inflammation of the gallbladder

AIM： To investigate the safety and feasibility of our original single-incision laparoscopic cholecystectomy （SII_C） for acute inflamed gallbladder （AIG）.

Improved laparoscopic transanal pull-through technique for low-rectal cancer resection

Objective： We described the applicability and evaluated the advantages of improved laparoscopic transanal pull-through （ILTPT） for low-rectal cancer resection. Materials： ILTPT was performed in 4 patients. Five or 4 ports were used. After isolation and section of the inferior mesenteric vessels, the rectum and sigmoid colon was mobilized. Total mesorectal excision and dissection of the distal rectum from the puborectalis muscle was carried out under laparoscopic guidance. The sigmoid colon and rectum were exteriorized via the anus. The rectum was divided proximally. Next, a purse-string suture was placed in the proximal segment, and the distal end of the sigmoid colon was returned to the pelvic cavity. The distal rectum was divided with Curved cutter staplermade by Jonson-Jonson company. Dislodging specimen, the continuity of the intestinal tract was restored using PROXIMATE ILS Curved and Straight Intraluminal Staplers CDH29/33 （Ethicon） through the rectum. Results： None of the cases were converted to open surgery. Average operation time was 180 min （range, 160-210 min）. No blood loss or any other complications were noted. Average postoperative stay was 9 days. Complications such as necrosis, anastomotic leakage and stricture, and genitoudnary disorders were not found in any of the patients at the 1 m follow-up. Conclusion： This report suggests that ILTPT is feasible and safe in Anus-Conserving Operation for low Rectal Cancer without auxiliary incision. If only we hold the applicability of ILTPT less trauma, more beautiful.

Hemi-semi Laminectomy Approach for the Microsurgical Treatment of Spinal Schwannomas

Objective To evaluate the safety and efficiency of hemi-semi laminectomy approach for the micro- surgical treatment of spinal schwannomas. Methods A total of 22 patients underwent hemi-semi laminectomy for the microsurgical removal of spinal schwannomas during a period of 2009 and 2011 in Affiliated Hospital of Nantong University. We ret- rospectively analyzed the clinical outcomes of these patients. Results Of them, 5 cases were diagnosed with cervical schwannomas, 9 with thoracic schwarmomas, and 8 with lumbar schwannomas. All the tumors including two dumbbell schwannomas were totally removed without major complications. Postoperatively, all patients were followed up from 6 to 36 months. The symp- toms and signs were obviously improved, and no tumor recurrence or spinal deformity occurred. Conclusion Hemi-semi laminectomy is a safe and effective method for resection of spinal schwan- nomas

Hepatic Resection is Safe for Metachronous Hepatic Metastases from Ovarian Cancer

Objective To explore the efficacy of hepatic resection(HR) in a relatively unselected group of patients with ovarian cancer liver metastases(OCLM). Methods A study was conducted between September 2000 and September 2011 on 60 ovarian cancer patients with hepatic metastases(24 solitary and 36 multiple),40 of whom had extrahepatic metastases.HR was done in all patients provided that curative hepatic resection was feasible,and extrahepatic disease was controlled with medical and/or surgical therapy. Results Most patients(n=54;90.0% ) had a negative hepatic margin(R0),whereas 6 patients(10.0% ) had microscopic disease at the margin(R1).The prognostic value of each study variable was assessed using log rank tests for univariate analysis and Cox proportional hazard models for multivariate analysis.The result was a median survival of 39 months and 5-year overall survival rate of 30% .Univariate analysis showed that surgery result(P=0.001),disease free interval(P=0.018) and the number of hepatic lesions (P=0.018) were significantly related to survival.Furthermore,the surgery result(P=0.004) remained significant for prognosis in multivariate analysis. Conclusions For patients with OCLM,HR is safe and may provide a significant survival benefit compared with medical therapy alone.A long interval time,the number of hepatic lesions,and surgery results are key prognostic factors.Favorable outcomes can be achieved even in patients with medically controlled or surgically resectable extrahepatic disease,indicating that surgery should be considered more frequently in the multidisciplinary care of patients with OCLM.

Synchronous bilateral laparoendoscopic single-site urological surgeries via the umbilicus:a report of 2 cases

Objective： To describe two cases of bilateral transumbilical laparoendoscopic single-site（LESS） surgeries in a single operative session and assess the safety, feasibility and efficacy. Methods： One patient underwent right ureterolithotomy and left varicocelectomy, and the patient was performed with right simple nephrectomy for nonfunctioning kidney due to ureteral calculus and left ureterolithotomy using a novel multichannel TriPortTM via a single 2-3 cm transumbilical incision Results： The right-side ureterolithotomy and left-side varicocelectomy were finished in 229 minutes, with a total estimated blood loss of 50 hal. The right-side simple nephrectomy and left-side ureterolithotomy in the other patient were finished in 340 minutes, with a total estimated blood loss of 100 ml. There were no major complications. At the latest follow-up, both patients remained symptom-free and there were no evidences of recurrence. Both of them were delighted for the single scarConclusion： Synchronous LESS urologic procedure via a single umbilical incision is technically feasible, safe and efficacious with a promising potential

CLINICAL STUDY OF PATIENT-CONTROLLED EPIDURAL ANALGESIA WITH TETRACAINE HYDROCHLORIDE AFTER PULMONARY LOBECTOMY

Objective. To investigate the efficacy and safety of tetracaine hydrochloride in patient-controlled epidural analgesia (PCEA) after pulmonary lobectomy.Methods. Forty-three patients scheduled for elective pulmonary lobectomy under general anesthesia were randomly allocated into either tetracaine group (22 patients) or ropivacaine group (21 patients) . In the tetracaine group, 0. 15% tetracaine was used for postoperative PCEA, while 0. 3% ropivacaine was used in the ropivacaine group. The duration of postoperative analgesia was 48 h. The PCEA included a bolus of 6 ml with a lockout time of 1 h. Postoperative pain score was measured by visual analogue scale (VAS). Forced expired volume at the 1st second (FEV1.0), forced vital capacity (FVC), FEV1.0/ FVC and peak expired flow (PEF) were measured preoperatively and daily after surgery. Hemodynamics were monitored and recorded before and after each administration of local anesthetics during the period of the study.Results. VAS scores in both groups decreased significantly after a bolus injection of local anesthetics. There was no significant difference between the two groups in VAS either before or after the administration of PCEA. On the 1st and 2nd days after the operation, pulmonary function was reduced in both groups. However, there were no significant differences between the percentage of the changes of FEV1.0, FEV1.0/FVC and PEF in the two groups. There were also no significant differences between the percentage of the changes of heart rate, mean arterial blood pressure and SpO2 after administration of local anesthetics. There was no significant difference in overall satisfaction with pain relief.Conclusions. The analgesic effect of 0. 15% tetracaine is similar to that of 0. 3% ropivacaine used in patient-controlled epidural analgesia after thoracotomy. No serious side effects were observed.

Systematic review of feasibility and safety of laparoscopic gastrectomy for gastric cancer

Objective： The purpose of the present study was to retrospectively and systematically evaluate the feasibility and safety of laparoscopic gastrectomy for gastric cancer. Methods： Research of prospective, randomized, controlled studies addressing laparoscopic gastrectomy versus open gastrectomy was screened through computer-based online system. Meta-analysis of acquired data was performed. The inverse variance method was used to test the significance of continuous data, while the ManteI-Haenszel method was used for dichotomous data. The chi-square test was used for evaluation of data heterogeneity. Homogenous data were calculated using the fixed effect model, and heterogeneous data were calculated using freedom model. Statistical data were expressed as 95% confidence interval （95% CI）. Funnel plot was used for sensitivity analysis to show potential publication bias. Results： Five papers met the inclusion criteria, 164 cases underwent laparoscopic gastrectomy and 162 cases received open gastrectomy. Meta-analysis revealed that laparoscopic gastrectomy took longer operating time and removed fewer lymph nodes than open gastrectomy （both P 〈 0.01）, but for early-stage gastric cancer, laparoscopic gastrectomy was superior to open gastrectomy in terms of blood loss and hospital stay （P 〈 0.01）. But there were no significant differences in terms of time to resumption of oral intake, postoperative complications, postoperative morbidity rate, and tumor recurrence. Sensitive analysis demonstrated that publication bias existed in all indices to different extents with the exception of lymph node. Subgroup analysis showed that for D1 lymph node dissection, laparoscopic gastrectomy took significantly reduced blood loss than open gastrectomy. Conclusion： All these findings indicate that laparoscopic gastrectomy for early stage gastric cancer is feasible and safe.