原发性肝癌患者术后复发、转移再次手术切除的疗效分析

目的:探讨原发性肝癌术后患者肝内复发与肝外转移再手术切除的疗效。方法:选取原发性肝癌术后肝内复发与肝外转移再手术患者30例,依据患者实际肿瘤情况选择最佳手术切除法,主要为局部根治性切除、左外叶切除、左右三叶或者半肝切除、亚段术式等,观察其复发率与生存率。结果:所有患者术中无死亡现象,也未出现肝功能衰竭、大出血以及腹腔感染等并发症。随访1年后发现,有9例患者复发,复发率为30.0%,生存率为86.6%。结论:对原发性肝癌术后复发患者需视其具体情况选择再切除术式,同时在行根治性切除术后应做好随访工作,以尽早发现肝内复发与肝外转移现象,尽早治疗,以提高临床疗效与生存率,降低复发率。

腹腔镜切除术和开腹切除手术治疗结石性胆囊炎疗效对比研究

目的对比结石性胆囊炎应用腹腔镜切除术和开腹切除手术治疗的临床疗效。方法选择我院结石性胆囊炎患者92例,随机分为研究组和参照组各46例,分别给予腹腔镜切除术和传统开腹切除术治疗,对比2组的疗效。结果研究组的手术时间等均明显少于参照组,且并发症的发生率和总有效率显著优于参照组,差异均有统计意义(P<0.05)。结论结石性胆囊炎应用腹腔镜切除术治疗的疗效显著,且创伤小、恢复快、并发症少、安全性高,值得临床推广。

An Analysis of Prospective Outcome of Re-resection for Recurrent Live Cancer and Extrahepatic Metastases,a Follow-up of 267\Cass

Objective To evaluate the prospective outcome and summarize experience in re-resection for recurrent liver cancer and extrahepatic metastases. Methods The clinical data of 267 patients with recurrent primary liver cancer (PLC) after re-resection from January 1960 to July 2000 were retrospectively analyzed. Re-hepatectomy was performed on 205 cases, resection of extrahepatic metastases on 51 cases and combined resection of recurrent liver cancer and extrahepatic metastases on 11 cases. The clinico-pathologic features, operation type and survival were compared. Results The types of liver re-resection included left lateral lobectomy in 11.2% of patients, hemihepatetomy and extended hemi-hepatectomy in 4.4%, local radical resection in 68.3%, other subsegmentectomy in 17.1%. The peak recurrence rate (64.4%) occurred at 1–2 years. The overall 1-, 3, 5- and 10-year survival rates after second resection were 81.0%, 40.3%, 19.4% and 9.0% respectively, while they were 77.5%, 29.8%, 13.2% and 6.61% respectively after the third resection. The median survival time was 44 months. The re-resection with extrahepatic metastases also provided the possibility of longer survival. Conclusion The results suggest that subsegmentectomy and local excision is appropriate for the hepatic repeat resection. The peak recurrence may be correlated with portal thrombus and operative factor. The re-resection can be indicated not only in intrahepatic recurrent metastases but also in extrahepatic metastases in selected patients. Re-resection has become the treatment of choice for recurrence of PLC, as neither chemotherapy nor other nonsurgical therapies can achieve such favorable results. Key words prospective outcome - re-resection - primary liver cancer - recurrence - extrahepatic metastases

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

Practical approaches to effective management of intestinal radiation injury:Benefit of resectional surgery

AIM:To study the outcome of patients undergoing surgical resection of the bowel for sustained radiation-induced damage intractable to conservative management.METHODS:During a 7-year period we operated on 17 cases (5 male,12 female) admitted to our surgical department with intestinal radiation injury (IRI).They were originally treated for a pelvic malignancy by surgical resection followed by postoperative radiotherapy.During follow-up,they developed radiation enteritis requiring surgical treatment due to failure of conservative management.RESULTS:IRI was located in the terminal ileum in 12 patients,in the rectum in 2 patients,in the descending colon in 2 patients,and in the cecum in one patient.All patients had resection of the affected region(s).There were no postoperative deaths,while 3 cases presented with postoperative complications (17.7%).All patients remained free of symptoms without evidence of recurrence of IRI for a median follow-up period of 42 mo (range,6-96 mo).CONCLUSION:We report a favorable outcome without IRI recurrence of 17 patients treated by resection of the diseased bowel segment.

Efficacy of surgical resection in management of isolated extrahepatic metastases of hepatocellular carcinoma

AIM:To clarify the benefit of surgical excision for patients with extrahepatic metastases of hepatocellular carcinoma(HCC). METHODS:We retrospectively reviewed the medical records of 140 patients with pathologically proven extrahepatic metastases of HCC and evaluated the outcomes of those who had undergone surgical resection(SR)for extrahepatic metastatic lesions.Prognoses made on the basis of extrahepatic metastatic sites were also examined. RESULTS:The survival rates of patients who underwent SR of extrahepatic metastases were significantly better than those of patients who did not receive SR. For the SR group,1-and 3-year survival rates were 24%and 7%,respectively,while for the non-resection group,the survival rates were 8%and 0%,respec- tively(P<0.0001).Survival rates related to metastatic sites were also significantly superior after SR of extrahepatic metastases:median survivals were 32 mo with lung metastasis,10 mo with bone metastasis,6.1 mo with brain metastasis. CONCLUSION:SR can provide survival benefits forpatients with 1 or 2 isolated extrahepatic metastases and who concurrently exhibit good hepatic functional reserve and general performance status as well as successful treatment of intrahepatic HCC.

Clinical usefulness of ^(18) F-FDG PET/CT in the restaging of esophageal cancer after surgical resection and radiotherapy

AIM： To evaluate the clinical usefulness of lSF-fluorodeoxyglucose positron emission and computed tomography QSF-FDG PET/CT） in restaging of esophageal cancer after surgical resection and radiotherapy. METHODS： Between January 2007 and Aug 2008, twenty histopathologically diagnosed esophageal cancer patients underwent 25 PET/CT scans （three patients had two scans and one patient had three scans） for restaging after surgical resection and radiotherapy. The standard reference for tumor recurrence was histopathologic confirmation or clinical follow-up for at least ten months after ^18F-FDG PET/CT examinations. RESULTS： Tumor recurrence was confirmed histopathologically in seven of the 20 patients （35%） and by clinical and radiological follow-up in 13 （65%）. ^18F-FDG PET/CT was positive in 14 patients （68.4%） and negative in six （31.6%）. ^18F-FDG PET/CT was true positive in 11 patients, false positive in three and true negative in six. Overall, the accuracy of ^18F-FDG PET/CT was 85%, negative predictive value （NPV） was 100%, and positive predictive value （PPV） was 78.6%.The three false positive PET/CT findings comprised chronic inflammation of mediastinal lymph nodes （n = 2） and anastomosis inflammation （n = 1）. PET/ CT demonstrated distant metastasis in 10 patients. ^18F-FDG PET/CT imaging-guided salvage treatment in nine patients was performed. Treatment regimens were changed in 12 （60%） patients after introducing ^18F-FDG PET/CT into their conventional post-treatment follow-up program. CONCLUSION： Whole body ^18F-FDG PET/CT is effective in detecting relapse of esophageal cancer after surgical resection and radiotherapy. It could also have important clinical impact on the management of esophageal cancer, influencing both clinical restaging and salvage treatment of patients.

Carotid endoarterectomy for extracranial cerebrovascular disease in 26 patients

To evaluate the effects of carotid endoarterectomy in the treatment of extracranial cerebrovascular disease, 26 cases with internal carotid stenosis were performed by three different kinds of surgical endoarterectomy. The satisfactory results were achieved in all the patients, with no complications and mortality occurring. Endoarterectomy is the effective way to treat the extracranial cerebrovascular disease.

Efficacy comparison between hepatic arterial infusion chemotherapy plus systemic chemotherapy used as first-line and non-first-line treatments for the patients of colorectal cancers with unresectable hepatic metastases

Objective: The combination of hepatic arterial chemotherapy(HAIC) and systemic chemotherapy(SYC) has potential effect on colorectal cancer(CRC) patients with unresectable hepatic metastasis. The aim of this retrospective study was to investigate the efficacy and safety of this combined therapeutic regimen on Chinese patients based on single institute experiences. Methods: All 54 patients of this retrospective analysis were diagnosed with CRC with unresectable liver metastasis and received combined HAIC and SYC. Among the patients, 23 of them received HAIC plus SYC when they developed liver metastases as first-line treatment(Group 1), and 31 patients received HAIC plus SYC as non-first-line treatment(Group 2). The different efficacy in two groups was analyzed by SPSS 19.0. Results: The overall response rate(ORR) were 52.2% and 25.8% respectively in Groups 1 and 2(P = 0.047), and the disease control rate(DCR) were 65.2% and 35.5% respectively in Groups 1 and 2(P = 0.031). The median progression-free survival(PFS) were 6.8 and 3.3 months(P = 0.002), the median hepatic progression-free survival(H-PFS) were 8.8 and 3.7 months(P = 0.001), and the median overall survival(OS) were 18.8 and 13.7 months(P = 0.121) in Groups 1 and 2, respectively. No fatal reaction was observed and no significant difference of adverse reaction was found in two groups. Grade 3/4 toxic effects included neutropenia(9.7% in Group 2 only), gastrointestinal reaction(8.7% in Group 1 and 6.5% in Group 2), stomatitis(6.5% in Group 2 only) and hyperbilirubinemia(4.3% in Group 1 only). Conclusion: HAIC combined with SYC showed promising efficacy and safe profiles on CRC patients with unresectable liver metastases.

COMPARISON OF CT-GUIDED LESS INVASIVE SURGERIES WITH WIDE SURGICAL EXCISION IN TREATMENT OF OSTEOID OSTEOMAS

Objective To report the results of treatment of osteoid osteomas with wide surgical excision and CT-guided less invasive surgeries.Methods Forty-two patients were entered into this prospective study between Jan.1998 and Jan.2008.Nineteen patients underwent wide surgical excision.The lesions were in the femur(n=9),tibia(n=7),and humerus(n=3).The mean lesion diameter was(9.2±2.3)mm(range,7-16mm).Twenty-three patients(15 males and 8 females)underwent CT-guided less invasive surgeries procedures.The lesions were in the femur(n=9),tibia(n=6),acetabulum(n=4)and humerus(n=4).The mean lesion diameter was(8.1±2.7)mm(range,6-15mm).Among these 23 patients,20 patients were performed by core drill excision.Three patients were performed by radiofrequency ablation.Follow-up ranged from 16 to 68 months(mean,35 months)to assess pain,neurovascular damage,pathological fracture,movement,and recurrence.Results were categorized as success(persistent complete relief of pain)and failure(absent or incomplete relief of pain,requiring additional treatment).Results The success rates were 89%(17/19)after wide surgical excision and 96%(22/23)after less invasive surgeries,respectively,and the difference was not significant(P>0.05).Patients were hospitalized for average 8.3 d(5-15d)after wide surgical excision and 3.2d(3-5d)after less invasive surgeries(P<0.05).There were no complications such as sepsis,pathological fracture,or neurovascular damage.No further recurrences were observed during follow-up.Conclusion Less invasive surgeries has obvious advantages such as reduced cost,shorter stay in hospital and rapid convalescence.Core-drill excision can obtain sufficient material for pathologic examination.

Clinical analysis of 45 cases of surgical treatment for inner thigh primary soft tissue sarcoma

Objective: We aimed to study the relationship between clinical effect and surgical methods of inner thigh primary soft tissue sarcomas. Methods: Wide or radical resection were performed in 45 cases of soft tissue sarcomas, including 20 cases of postoperative recurrence after radiation therapy, 7 cases of first treatment. Thirty-six cases received 4–6 cycles of postoperative chemotherapy. Results: Thirty-eight of 45 cases were followed up for 1–5 years, with 5 case of recurrence and 6 cases of distant metastasis. Conclusion: The inner thigh primary soft tissue sarcoma can be effectively treated with wide or radical resection.

小切口胆囊切除与腹腔镜切除胆囊治疗胆结石比较研究

目的探讨对比小切口胆囊切除术与腹腔镜切除胆囊两种方式治疗胆结石的疗效.方法：选取2013年6月至2014年6月在我院治疗的50例胆囊切除手术患者,随机分为观察组和对照组,每组25例,观察组患者采用腹腔镜胆囊方式,对照组使用小切口胆囊切除手术的治疗方式,对比两组患者的治疗效果.结果：治疗后发现观察组患者在出血量、住院时间、并发症的发生情况等方面均好于对照组,两组有效率差异具有统计学意义（即P〈0.0）结论：腹腔镜切除手术与小切口胆囊切除手术比较更具有优势,值得临床推广.

Chest wall abscess due to Prevotella bivia

Prevotella bivia is associated with pelvic inflammatory disease. A 77-year-old man developed a rapidly growing chest wall abscess due to P. bivia within days. He underwent surgical resection of the infected area; his postoperative course was uneventful. This is the first case of chest wall abscess due to P. bivia infection. Its correct diagnosis cannot be underestimated because fulminant infections can occur in aged or immunocompromised patients if treated incorrectly. Prompt,appropriate surgical management,and antibiotic therapy affect treatment outcome.

肝癌局部消融治疗规范的专家共识

局部消融治疗是在影像技术的引导下对肿瘤靶向定位,用物理或化学的方法杀死肿瘤细胞;影像引导技术包括超声、CT和MRI;治疗途径有经皮、经腹腔镜手术和经开腹手术三种.局部消融治疗的特点：一是直接作用于肿瘤,具有高效快速的优势;二是治疗范围局限于肿瘤及其周围组织,对机体影响小,可以反复应用.局部消融治疗在过去20年左右发展迅速,已经成为继手术切除、介入治疗后的第三大肝癌治疗手段,而且由于其疗效确切,特别是在小肝癌的治疗方面,射频消融治疗的疗效与手术切除相近,因此,被认为是小肝癌的根治性治疗手段之一.