腹腔镜辅助胃癌根治术临床疗效分析

目的探讨腹腔镜辅助胃癌根治术在胃癌治疗中的临床应用。方法回顾性分析108例胃癌患者的临床资料,其中45例接受腹腔镜辅助胃癌根治术(腹腔镜组),另63例接受开腹胃癌根治术(开腹组)。对比分析两组患者手术情况、术后恢复情况及随访情况等。结果两组切口长度、术中失血差异均有统计学意义(均<0.05);两组术后排气时间、术后住院天数差异均有统计学意义(均<0.05);两组手术淋巴结清扫数及肿瘤近远端边缘长度差异均无统计学意义(均>0.05);两组术后1、3年生存曲线及癌症复发转移率差异均无统计学意义(均>0.05)。结论腹腔镜胃癌根治术是一种安全、可行及有效的手术方法,且创伤较小,值得临床推广使用。

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

OBSERVATION OF CLINICAL THERAPEUTIC EFFECTS ON HEMIPLEGIA INDUCED BY NEUROSURGICAL OPERATION TREATED WITH ACUPUNCTURE

Objective To probe into the optimum therapy for hemiplegia induced by neurosurgical operation. Methods 50 cases were randomized into treatment group （25 cases） and control group （25 cases）. In control group, the routine western drugs in internal medicine were applied; in treatment group, on the basis of the treatment in control group, acupuncture was supplemented 3 days after the operation. Acupoints were Neiguan （内关 PC 6）, Shuigou （水沟 GV26）, QSchi （ 曲池LI 11）, Hégü （合谷 LI 4）, Sanyinjiao （三阴交 SP 6）, Jiquan （极泉 HT 1）, Weizhong （委中BL 40）, etc. The scalp acupuncture was applied in combination. Such treatment was given for 30 days （once per day）. The functional evaluation was conducted based on neurological functional defect scale （NDS） before and after treatment. Results Acupuncture improved re markably NDS, the total effective rate was 76.0% in treatment group and was 42.4% in control group, indicating significant difference by statistical management （P〈0.05）. Conclusion The therapeutic effect in treatment group is superior to that in control group. The coordinative action is achieved in the combination of acupuncture with western medicine for hemiplegia after neurosurgical operation and the therapeutic effect is much improved.

Iatrogenic bile duct injuries:Etiology,diagnosis and management

Iatrogenic bile duct injuries (IBDI) remain an important problem in gastrointestinal surgery. They are most frequently caused by laparoscopic cholecystectomy which is one of the commonest surgical procedures in the world. The early and proper diagnosis of IBDI is very important for surgeons and gastroenterologists, because unrecognized IBDI lead to serious complications such as biliary cirrhosis, hepatic failure and death. Laboratory and radiological investigations play an important role in the diagnosis of biliary injuries. There are many classifications of IBDI. The most popular and simple classification of IBDI is the Bismuth scale. Endoscopic techniques are recommended for initial treatment of IBDI. When endoscopic treatment is not effective, surgical management is considered. Different surgical reconstructions are performed in patients with IBDI. According to the literature, Roux- en-Y hepaticojejunostomy is the most frequent surgical reconstruction and recommended by most authors. In the opinion of some authors, a more physiological and equally effective type of reconstruction is end- to-end ductal anastomosis. Long term results are the most important in the assessment of the effectiveness of IBDI treatment. There are a few classifications for the long term results in patients treated for IBDI; the Terblanche scale, based on clinical biliary symptoms, is regarded as the most useful classification. Proper diagnosis and treatment of IBDI may avoid many serious complications and improve quality of life.

Experience with gemcitabine and cisplatin in the therapy of inoperable and metastatic cholangiocarcinoma

AIM： To study the activity of gemcitabine and cisplatin in a cohort of patients with inoperable or metastatic cholangiocarcinoma.METHODS： Chemotherapy-naive patients with pathologically proven cholangiocarcinoma, receiving treatment that consisted of gemcitabine at 1250 mg/m^2 in a 30-rain infusion on d 1 and 8, and cisplatin at 75 mg/m^2 at every 21-d cycle, were retrospectively analyzed.RESULTS： From .lune 2003 to December 2005, 42 patients were evaluated. Twelve patients （28%） had unresectable disease and 30 （72%） had metastatic disease. There were 28 males and 14 females with a median age of 51 years （range 33-67） and median ECOG PS of 1 （range 0-2）. A total of 171 cycles were given with a median number of cycles of 4 （range 1-6）. There were 0 CR, 9 PR, 11 SD and 13 PD （response rate 21%）. Grade 3-4 hematologic toxicities were： anemia in 33%, neutropenia in 22% and thrombocytopenia in 5%. Non-hematologic toxicity was generally mild. No cases of febrile neutropenia or treatment-related death were noted. The median survival was 10.8 mo （range 8.4-13 mo） and progression free survival was 8.5 mo. One-year survival rate was 40%.CONCLUSION： Our results indicate that the combination of gemcitabine and cisplatin had consistent efficacy in patients with unresectable or metastatic cholangiocarcinoma.

THE MANAGEMENT OF EPITHELIAL INGROWTHAFTER LASER IN SITU KERATOMILEUSIS

Objective. To investigate the treatment of corneal epithelial ingrowth with flap melt after LASIK. Patients and method. Thirteen eyes of 13 patients with corneal epithelial ingrowth and flap melt after LASIK were treated based on the thickness and the extent of melting of the flap. Nine eyes were treated by lifting the flap and scraping the epithelium in the interface. Three eyes underwent allogenic keratomileusis. The flap was removed in one eye. Results. Recurrence occurred in 2 eyes treated by lifting the flap. The flaps, however, healed normally after retreatment. The grafts healed normally in the allogenic keratomileusis group, except for one eye in which the flap was lost. The corneal epithelium healed over the stromal bed after the flap was removed. Corneal haze of grade 2 was present at 6 months. The uncorrected visual acuity was between 0.3 and 1.0, and the best corrected visual acuity lost 1 to 3 lines. Conclusions. Corneal epithelial ingrowth with flap melt is a severe complication after LASIK. However, with proper treatment, vision can be salvaged in most cases.

Gender differences in the efficacy of cardiovascular rehabilitation in patients after cardiac surgery procedures

Cardiac rehabilitation （CR） programs are well known to improve patients＇ functional status after cardiac surgery and are recommended by current guideline. In fact, they pro- mote not only structured physical exercises but also a complete secondary prevention determining an overall reduction in recurrent cardiac events and an improvement in functional, psychosocial status and survival.

Long-term outcome and efficacy of endoscopic hemorrhoid ligation for symptomatic internal hemorrhoids

AIM:To assess the long-term outcome of endoscopic hemorrhoid ligation (EHL) for the treatment of symptomatic internal hemorrhoids.METHODS:A total of 759 consecutive patients (415 males and 344 females) were enrolled.Clinical presentations were rectal bleeding (593 patients) and mucosal prolapse (166 patients).All patients received EHL at outpatient clinics.Hemorrhoid severity was classified by Goligher's grading.The mean follow-up period was 55.4 mo (range,45-92 mo).RESULTS:The number of band ligations averaged 2.35 in the first session for bleeding and 2.69 for prolapsed patients.Bleeding was controlled in 587 (98.0%) patients,while prolapse was reduced in 137 (82.5%) patients.After treatment,93 patients experienced anal pain and 48 patients had mild bleeding.Patient subjective satisfaction was 93.6%.Repeat treatment or surgery was performed if symptoms were not relieved in the first session.In the bleeding group,the recurrence rate was 3.7% (22 patients) at 1 year,and 6.6%and 13.0% at 2 and 5 years.In the prolapsed group,the recurrence rate was 3.0%,9.6% and 16.9% at 1,2 and 5 years,respectively.CONCLUSION:EHL is an easy and well-tolerated procedure for the treatment of symptomatic internal hemorrhoids,with good long-term results.

Efficacy and safety of transnasal butorphanol for pain relief after anal surgery

AIM:To compare the analgesic properties and efficacy of transnasal butorphanol with intramuscular meperidine after anal surgery.METHODS: Sixty patients who underwent fistulectomy were enrolled in the study from January 2006 to December 2007. They were randomly divided into transnasal butorphanol (n=30) or intramuscular meperidine (n=30) treatment groups. Assessment of postoperative pain was made using a visual analogue scale (VAS). The VAS score was recorded 6 h after the completion of surgery, before receiving the first dose of analgesic, 60 min after analgesia and the next morning. Any adverse clinical effects such as somnolence, dizziness, nausea or vomiting were recorded. Satisfaction with narcotic efficacy, desire to use the particular analgesic in the future and any complaints were recorded by patients using questionnaires before being discharged.RESULTS: Forty-two men and eighteen women were included in the study. There were no significant differences in VAS scores between the groups within 24 h. Length of hospital stay and the incidence of adverse effects between the groups were similar. In addition, most patients were satisfied with butorphanol nasal spray and wished to receive this analgesic in the future, if needed.CONCLUSION: Butorphanol nasal spray is effective for the relief of pain after fistulectomy. However, it offered patients more convenient usage and would be suitable for outpatients.

Efficacy of Surgical Therapy for Carotid Body Tumors

Objective To evaluate the efficacy of surgical therapy for carotid body tumors. Methods A retrospective analysis was conducted, covering the diagnosis, surgical procedure, postoperative complications, and prognosis of 120 cases of carotid body tumors in Peking Union Medical College Hospital from 1949 to May, 2011. Results Surgical excision was successfully performed in 111 cases with 117 tumors. In all those cases, 50 underwent simple tumor resection, 42 underwent resection of tumors and ligation of the external carotid arteries, 7 underwent co-resection of tumors and common carotid arteries, internal carotid arteries, as well as external arteries without vascular reconstruction, and the other 12 cases experienced tumor resection and vascular reconstruction as internal carotid arteries were involved. After operation, 3 cases developed cerebral infarction, 30 cases showed cranial nerve palsy, including 15 cases of hypoglossal nerve damage, 10 cases of vagus paralysis, and 5 cases of Horner's syndrome. Conclusion It is essential to make a proper surgical strategy, which can reduce postoperative com- plications.

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.

ANALYSIS OF EFFECT AND COMPLICATION ON SURGICAL TREATMENT OF CAROTID BODY TUMORS IN 46 CASES

Objective.To describe the effects of surgical treatment a nd complications in46patients with carotid body tumor.Method.Retrospe ctive study on surgical treatment and complications was carried out in46case s of CBT which were surgically treated with different kind of procedures.Resul t.All procedures performed successfully except that the CBT was not excised in 4cases.No operative mortality was observed.There were2postoperative hemiple gia,4hypoglossal nerve impairment ,2glossopharyngeal nerve impairment ,1va gus nerve impairment ,and1accessory nerve impairment.One patient presented p ostoperative cranial nerve impairment in glossopharyngeal,vagus and hypoglossa l nerves.Two patients developed local recurrence during the long-term follow-up.Conclusion.Complete surgical excision was possible in each patient if th e diagnosis had been cor-rectly made through selective preoperative angiography ,vessel ultrasound Doppler and other examinations.Reasonable surgical procedur e and Matas training were necessary to the successful surgical treatment and t hus decrease the complicative incidence rate of carotid chemodectomas.

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

A comparative study of the therapeutic effect in two protocols: video-assisted thoracic surgery combined with laparoscopy versus right open transthoracic esophagectomy for esophageal cancer management

Objective: The aim was to evaluate the best intra-thoracoscopic surgery technique between video-assisted thoracic surgery (VATS) combined with laparoscopy and right open transthoracic esophagectomy, in patients with esophageal cancer. Methods: From November 2006 to May 2008, 221 patients with esophageal cancer were enrolled in this study, prospective randomized in two groups. 111 patients were performed the VATS technique (Experimental group), whereas in the other 110 patients esophagectomy was adopted by thoracotomy (Control group). Results: The time consuming of Experimental group was 272.3 min in average with a standard deviation(std) of 57.9, and it was 218.7 min in average with std of 91.0 in the control group (P=0.000). The operative blood loss was 219.7±194.4 mL in the Experimental group, compared with 590.0±324.4 mL in the control group, with significant difference (P=0.000). Postoperative hospital stay of Experimental group was 9.6±1.7d, and it was 11.4±2.3d in the control group (P=0.000). There was no-delayed union of incision in the Experimental group, but 6.36% in the control group (P=0.007). The disorder of gastric emptying occurred 0.9% in the Experimental group, whereas 6.4% in the Control group. There was no significant difference in survival curves and rates (P=0.555). Conclusion: There were several advantages of VATS technique, such as reduced hemorrhage, better recovery, few complications, and great number of lymph node dissection, although there was no significant difference in long-term survival rate. Thus the VATS combined with laparoscopy technique was worthy of generalization in esophageal surgery with good prospects.

Comparison of the Outcomes of Monopolar and Bipolar Radiofrequency Ablation in Surgical Treatment of Atrial Fibrillation

Objective To compare the therapeutic effects and safety of monopolar and bipolar radiofrequency(RF) ablation used during cardiac surgery to treat atrial fibrillation.Methods We retrospectively studied a total of 81 patients with chronic atrial fibrillation who underwent open cardiac surgery with concomitant RF ablation between January 2007 and March 2011.Fifty-eight patients received bipolar RF ablation and 23 received monopolar RF ablation,respectively.The sinus rhythm restoration rate,the procedural duration,the frequency of severe perioperative complications,and mortality were compared between the two groups.Results The sinus rhythm restoration rate did not differ significantly between the two groups after follow-up of 15.1 ± 12.6 months(P=0.199).The frequencies of severe perioperative complications and mortality were also similar in the two groups.The total procedural time using bipolar RF ablation was significantly shorter than that using monopolar ablation(19.7±4.6 minutes vs.28.1±8.5 minutes,P< 0.001).Conclusions Both monopolar and bipolar RF ablation are safe and effective in treating chronic atrial fibrillation patients during open cardiac surgery,but bipolar RF ablation is more convenient in practice.

Long-term efficacy of infliximab maintenance therapy for perianal Crohn’s disease

AIM:To assess the long-term efficacy of seton drainage with infliximab maintenance therapy in treatment of stricture for perianal Crohn’s disease(CD). METHODS:Sixty-two patients with perianal CD who required surgical treatment with or without infliximab between September 2000 and April 2010 were identified from our clinic’s database.The activities of the perianal lesions were evaluated using the modified perianal CD activity index(mPDAI)score.The primary endpoint was a clinical response at 12-15 wk after surgery as a shortterm efficacy.Secondary endpoints were recurrence as reflected in the mPDAI score,defined as increased points in every major element.The clinical responses were classified as completely healed(mPDAI=0),partially improved(mPDAI score decreased more than 4 points),and failure or recurrence(mPDAI score increased or decreased less than 3 points). RESULTS:There were 43 males and 19 females,of whom 26 were consecutively treated with infliximab after surgery as maintenance therapy.Complete healing was not seen.Failure was seen in 10/36(27.8%) patients without infliximab and 4/26(15.4%)patients with infliximab(P=0.25).Partial improvement was seen in 26/36(72.2%)patients without infliximab and 22/26(88.5%)patients with infliximab(P=0.25). Short-term improvement was achieved in 48/62(77.4%) patients.Although the mPDAI score improved significantly with surgery regardless of infliximab,it decreased more from baseline in patients with infliximab(50.0%) than in those without infliximab(28.6%),(P=0.003). In the long-term,recurrence rates were low regardless of infliximab in patients without anorectal stricture.In patients with anorectal stricture,cumulative recurrence incidences increased gradually and exceeded 40%at 5 years regardless of infliximab.No efficacy of infliximab treatment was found(P=0.97).Although the cumulative rate of ostomy creation was also low in patients without stricture and high in patients with stricture,no protective efficacy was found with infliximab treatment(P =0.6 without stricture,P=0.22 with stricture). CONCLUSION:Infliximab treatment was demonstrated to have short-term efficacy for perianal lesions.Longterm benefit with infliximab was not proven,at least in patients with anorectal stricture.

Therapeutic effectiveness of pediatric renal transplantation in 63 cases

Objective： To explore the characteristic of operation, intra-operation treatment and the application of immunosuppressant in pediatric renal transplantation in order to improve therapeutic effectiveness. Methods： From March 1986 to October 2006, the clinical data of 63 children who underwent renal transplantation in our hospital were retrospectively analyzed. Results： The 1-, 3-, 5-, 10-year graft survival rates were 98.4%, 90.5%, 88.9% and 68.3%, respectively. And the corresponding patient survival rates were 100%, 95.2%, 92.1%, 71.4%. The body weight increased 4 to 12 kg and the body height grew up 2 to 6 cm during the first year post-transplantation. The main complications in the first year post-transplantation were hypertension （26/63, 41.3%）, crinosity （14/63, 22.2%）, drug-induced hepatic injury（11/63, 17.5%）, gingival hyperplasia （10/63, 15.8%）, pulmonary infection（9/63, 14.3%）, bone marrow suppression（5/63, 7.9%）, herpes （4/63, 6.3%） and diabetes （3/63, 4.8%）. Conclusion： Renal transplantation is a preferred method for the treatment of children in end-stage renal disease （ESRD）. Good tissue matching, proper operative time and pattern, peri-operactive care were essential to success, as well as appropriate immuno-suppressant strategy and good compliance.

Efficacy of endoscopic therapy for gastrointestinal bleeding from Dieulafoy’s lesion

AIM： To investigate the endoscopic hemostasis for gastrointestinal bleeding due to Dieulafoy＇s lesion. METHODS： One hundred and seven patients with gastrointestinal bleeding due to Dieulafoy＇s lesion were treated with three endoscopic hemostasis methods： aethoxysklerol injection （46 cases）, endoscopic hemoclip hemostasis （31 cases）, and a combination of hemoclip hemostasis with aethoxysklerol injection （30 cases）. RESULTS： The rates of successful hemostasis using the three methods were 71.7% （33/46）, 77.4% （24/31） and 96.7% （29/30）, respectively, with significant differences between the methods （P 〈 0.05）. Among those who had unsuccessful treatment with aethoxysklerol injection, 13 were treated with hemoclip hemostasis and 4 underwent surgical operation; 9 cases were successful in the injection therapy. Among the cases with unsuccessful treatment with hemoclip hemostasis,7 were treated with injection of aethoxysklerol and 3 cases underwent surgical operation; 4 cases were successful in the treatment with hemoclip hemostasis. Only 1 case had unsuccessful treatment with a combined therapy of hemoclip hemostasis and aeth- oxysklerol injection, and surgery was then performed. No serious complications of perforation occurred in the patients whose bleeding was treated with the endoscopic hemostasis, and no releeding was found during a 1-year follow-up. CONCLUSION： The combined therapy of hemoclip hemostasis with aethoxysklerol injection is the most effective method for gastrointestinal bleeding due to Dieulafoy＇s lesion.

COMPARISON THE EFFICIENCY OF DIFFERENT SURGICAL PROCEDURES FOR URINARY STRESS INCONTINENCE

Objective.To analyse the efficiency of two operations for treatment of unirary stress incontinence (USI). Methods. The clinical data of 95 USI cases or accompany USI treated by surgical procedures (Kelly operation 63 cases, Colposuspension 32 cases) was analysed retrospectively in our department. Results.The cure rates during three months after operation were 92.9% in Colposuspension group and 68.9% in Kelly operation group (P<0.05), and decreased to 73.7% and 57.5% one year after operation in Colposuspension group and Kelly operation group respectively (P>0.05). Abnormal senses rates of sexual intercouse was 3.7% in Cloposuspension and 7.3% in Kelly operation group. The length of retaining Folly catheter after Colposuspension was more than Kelly operation. [WT5”BX]Conclusion.[WT5”BZ]The cure rate during three months after Colposuspension is better than Kelly operation. But the cure rates during one year after surgery are the same in two groups.

SURGICAL TREATMENT OF SPONDYLOLISTHESIS WITH SOCON INSTRUMENTATION

To observe the clinical outcomes of using a new instrumentation SOCON system in the treatment of degenerative spondylolisthesis. Methods. Retrospective clinical and roentgenograph review of 21 patients who suffered from degenerative spondylolisthesis with spinal stenosis treated by decompression, posterolateral intertransverse arthrodesis, and with transpedicle instrumentation of SOCON system. Results.Nineteen of 21 patients were completely recovery from their preoperative symptoms, 17 of 18 cases with grade one slippage reduced to normal spine alignment, 2 cases of grade two slippage fully reduced, and one case of grade two spondylolisthesis got 70% reduction. Post operative satisfactory rate was 90.5%. Pain relief was 90.5%. Neither infection nor neurologic complication occurred in this series. Conclusion. Our short time followup and limited cases showed satisfactory preliminary result of surgical treatment of spondylolisthesis with SOCON instrumentation.