超声引导下头皮神经阻滞联合静脉麻醉在小儿颅缝早闭手术中的应用研究

目的 分析小儿颅缝早闭手术中使用超声引导下头皮神经阻滞麻醉联合静脉麻醉与传统静吸复合插管全麻的效果及影响。方法 选取2017年7月—2021年7月河南省儿童医院收治的60例小儿颅缝早闭手术患儿为数据提供对象,分组时的方法主要为数字随机表法,随机分成常规组和研究组,以30例为组间对象,均进行颅缝早闭手术,在手术时麻醉方式上分别选择常规静-吸复合麻醉、超声引导下头皮神经阻滞麻醉联合静脉麻醉,分析麻醉效果。结果 血流动力学指标:两组在T0插管前、T1插管后、T2切皮后、T3手术结束时的血流动力学指标对比无统计学意义(P>0.05),但是两组血流动力学指标均有所下降,血流动力学指标相对平稳;麻醉相关指标:研究组在瑞芬太尼使用剂量、拔管时间上均优于常规组,P<0.05,但是两组在丙泊酚使用剂量上对比无统计学意义(P>0.05);疼痛程度:研究组在术后4小时、8小时的VAS分数更低,但是在术后24小时及48小时的VAS分数上两组对比无统计学意义(P>0.05);不良反应:两组不良反应对比无统计学意义(P>0.05)。结论 对小儿颅缝早闭手术患儿在手术时选择超声引导下头皮神经阻滞联合静脉麻醉方式进行麻醉后的效果显著,对儿童来说该麻醉方式安全性较强,且可确保血流动力学指标稳定,缩短患儿苏醒时间,值得推广。

眶爆裂骨性折98例临床分析

目的探讨眶爆裂性骨折的诊断方法和治疗效果。方法对两年间收治的98例（98只）眼眶爆裂性骨折的临床特点与治疗效果进行总结分析。结果复视患者全部恢复，眶下神经分布区域感觉迟钝者部分恢复。结论早诊断，需要手术治疗时早进行，对预防复视减少并发症都有较好疗效。

胆囊切除术胆道损伤防治8例报告

目的分析医源性胆道损伤原因及预防,早期处理,以提高治疗水平。方法自2003年1月—2011年4月,共收治胆囊切除手术致胆管损伤8例,其中5例均为术中发现,及时处理;2例术后2～3d发现,1例术后20d发现,均作了相应的早期手术处理。结果 8例经早期手术处理,效果满意。结论胆囊切除手术致胆管损伤,应早诊断并采用相应的手术方法处理,可取得满意的效果。

股及腘动脉损伤20例的治疗体会

目的:探讨股及腘动脉损伤早期诊断标准、处理方法及临床疗效。方法:股及腘动脉损伤20倒,其中开放伤15例,闭合伤5例,骨折7例,静脉损伤5例,神经损伤4例。结果:1例截肢,19例功能恢复良好。结论:股及腘动脉损伤后早期诊断和尽早手术探查修复,可避免引起严重后果。

外伤性脾损伤临床分析

目的总结外伤性脾损伤诊断与治疗的临床经验。方法回顾性分析1993年1月至2006年1月88例外伤性脾损伤的临床资料。结果52例行脾切除术。31例行保脾手术,5例行非手术治疗。治愈82例,死亡6例。结论脾损伤应以临床为主早诊断,及早手术;根据脾损伤情况、患者的全身状况等决定手术以及手术方式。

Minilaparotomy to rectal cancer has higher overall survival rate and earlier short-term recovery

AIM： To report our experience using mini-laparotomy for the resection of rectal cancer using the total meso- rectal excision （TME） technique, METHODS： Consecutive patients with rectal cancer who underwent anal-colorectal surgery at the authors＇ hospital between March 2001 and June 2009 were included, In total, 1415 patients were included in the study, The cases were divided into two surgical proce- dure groups （traditional open laparotomy or mini-lap- arotomy）, The mini-laparotomy group was defined as having an incision length ≤ 12 cm. Every patient un- derwent the TME technique with a standard operation performed by the same clinical team. The multimodal preoperative evaluation system and postoperative fast track were used. To assess the short-term outcomes, data on the postoperative complications and recovery functions of these cases were collected and analysed. The study included a plan for patient follow-up, to ob- tain the long-term outcomes related to 5-year survival and local recurrence. RESULTS： The mini-laparotomy group had 410 pati- ents, and 1015 cases underwent traditional laparoto- my. There were no differences in baseline characteris- tics between the two surgical procedure groups. The overall 5-year survival rate was not different between the rnini-laparotorny and traditional laparotorny groups （80.6% vs 79.4%, P = 0.333）, nor was the 5-year local recurrence （1.4% vs 1.5%, P = 0.544）. However, 1-year mortality was decreased in the rnini-laparotorny group compared with the traditional laparotorny group （0% vs 4.2%, P 〈 0.0001）. Overall 1-year survival rates were 100% for Stage Ⅰ, 98.4% for Stage Ⅱ, 97.1% for Stage Ⅲ, and 86.6% for Stage Ⅳ. Local recurrence did not differ between the surgical groups at 1 or 5 years. Local recurrence at 1 year was 0.5% （2 cases） for mini-laparotorny and 0.5% （5 cases） for traditional laparotorny （P = 0.670）. Local recurrence at 5 years was 1.5% （6 cases） for mini-laparotorny and 1.4% （14 cases） for traditional laparotorny （P = 0.544）. Days to first ambulation （3.2 ± 0.8 d vs 3.9 ± 2.3 d, P = 0.000） and passing of gas （3.5 ± 1.1 d vs 4.3 ± 1.8 d, P = 0.000）, length of hospital stay （6.4 ± 1.5 d vs 9.7 ± 2.2 d, P = 0.000）, anastomotic leakage （0.5% vs 4.8%, P = 0.000）, and intestinal obstruction （2.2% vs 7.3%, P = 0.000） were decreased in the rrnini-laparotorny group compared with the traditional laparotorny group. The results for other postoperative recovery function indi- cators, such as days to oral feeding and defecation, were similar, as were the results for immediate post- operative complications, including the physiologic and operative severity score for the enumeration of mortal- ity and morbidity score. CONCLUSION： Mini-laparotomy, as conducted in a sin- gle-centre series with experienced TME surgeons, is a safe and effective new approach for minimally invasive rectal cancer surgery. Further evaluation is required to evaluate the use of this approach in a larger patient sample and by other surgical teams.

Risk factors for lymph node metastasis and evaluation of reasonable surgery for early gastric cancer

AIM: To give the evidence for rationalizing surgical therapy for early gastric cancer with different lymph node status. METHODS: A series of 322 early gastric cancer patients who underwent gastrectomy with more than 15 lymph nodes retrieved were reviewed in this study. The rate of lymph node metastasis was calculated. Univariate and multivariate analyses were performed to evaluate the independent factors for predicting lymph node metastasis. RESULTS: No metastasis was detected in No.5, 6 lymph nodes (LN) during proximal gastric cancer total gastrectomy, and in No.10, 11p, 11d during for combined resection of spleen and splenic artery and in No.15 LN during combined resection of transverse colon mesentery. No.11p, 12a, 14v LN were proved negative for metastasis. The global metastastic rate was 14.6% for LN, 5.9% for mucosa, and 22.4% for submucosa carcinoma, respectively. The metastasis in group Ⅱ?was almost limited in No.7, 8a LN. Multivariate analysis identified that the depth of invasion, histological type and lymphatic invasion were independent risk factors for LN metastasis. No metastasis from distal cancer (≤ 1.0 cm in diameter) was detected in group Ⅱ?LN. The metastasis rate increased significantly when the diameter exceeded 3.0 cm. All tumors (≤ 1.0 cm in diameter) with LN metastasis and mucosa invasion showed a depressed macroscopic type, and all protruded carcinomas were > 3.0 cm in diameter. CONCLUSION: Segmental/subtotal gastrectomy plus D1/D1 + No.7 should be performed for carcinoma (≤ 1.0 cm in diameter, protruded type and mucosa invasion).Subtotal gastrectomy plus D2 or D1 + No.7, 8a, 9 is the most rational operation, whereas No.11p, 12a, 14v lymphadenectomy should not be recommended routinely for poorly differentiated and depressed type of submucosa carcinoma (> 3.0 cm in diameter). Total gastrectomy should not be performed in proximal, so does combined resection or D2+/D3 lymphadenectomy.

Lack of CD44 variant 6 expression in rectal cancer invasive front associates with early recurrence

AIM: To investigate the prognostic value of CD44 variant 6 (CD44v6), a membranous adhesion molecule, in rectal cancer. METHODS: Altogether, 210 rectal cancer samples from 214 patients treated with short-course radiotherapy (RT, n = 90), long-course (chemo) RT (n = 53) or surgery alone (n = 71) were studied with immunohistochemistry for CD44v6. The extent and intensity of membranous and cytoplasmic CD44v6 staining, and the intratumoral membranous staining pattern, were analyzed.RESULTS: Membranous CD44v6 expression was seen in 84% and cytoplasmic expression in 81% of the cases. In 59% of the tumors with membranous CD44v6 expression, the staining pattern in the invasive front was determined as "front-positive" and in 41% as "front-negative". The latter pattern was associated with narrower circumferential margin (P = 0.01), infiltrative growth pattern (P < 0.001), and shorter disease-free survival in univariate survival analysis (P = 0.022) when compared to the "front-positive" tumors. CONCLUSION: The lack of membranous CD44v6 in the rectal cancer invasive front could be used as a method to identify patients at increased risk for recurrent disease.

Sister Mary Joseph's nodule as a first sign of pancreatic cancer

Sister Mary Joseph's nodule(SMJN) refers to a metastatic tumor of the umbilicus.It is a rare entity which arises from a malignancy in the intra-abdominal cavity.We herein describe a patient who presented with SMJN as his first sign of pancreatic cancer.It is an even more unusual case of SMJN.We therefore,suggest that pancreatic cancer should be included in the differential diagnosis when an umbilical mass is found.With the progress made in surgical procedures and other modalities,an early diagnosis will dramatically improve the prognosis of the patients.

Endoscopic approach to malignant strictures at the hepatic hilum

Hilar tumors have proven to be a challenge to treat and manage because of their poor sensitivity to conventional therapies and our inability to prevent or to detect early tumor formation. Endoscopic stent drainage has been proposed as an alternative to biliary-enteric bypass surgery and percutaneous drainage to palliate malignant biliary obstruction. Prosthetic palliation of patients with malignant hilar stenoses poses particular difficulties, especially in advanced lesions （type Ⅱ lesions or higher）. The risk of cholangitis after contrast injection into the biliary tree in cases where incomplete drainage is achieved is well known. The success rate of plastic stent insertion is around 80% in patients with proximal tumors. Relief of symptoms can be achieved in nearly all patients successfully stented.

Pancreatic ductal adenocarcinoma screening:New perspectives

Pancreatic ductal adenocarcinoma accounts for more than 90% of all pancreatic cancers and its incidence has increased significantly worldwide.Patients with pancreatic ductal adenocarcinoma have a poor outcome and more than 95% of the people affected die from the disease within 12 mo after diagnosis.Surgery is the first-line treatment in the case of resectable neoplasm,but only 20% of patients are candidates for this approach.One of the reasons there are few candidates for surgery is that,during the early phases of the disease,the symptoms are poor or non-specific.Early diagnosis is of crucial importance to improve patient outcome;therefore,we are looking for a good screening test.The screening test must identify the disease in an early stage in order to be effective;having said this,a need exists to introduce the concept of "early" ductal adenocarcinoma.It has been reported that at least five additional years after the occurrence of the initiating mutation are required for the acquisition of metastatic ability of pancreatic adenocarcinoma and patients die an average of two years thereafter.We have reviewed the most recent literature in order to evaluate the present and future perspectives of screening programs of this deadly disease.

Does testosterone prevent early postoperative complications after gastrointestinal surgery?

AIM:To investigate the role of sex hormones in the early postoperative complications of gastrointestinal diseases. METHODS:A total of 65 patients who underwent operations for gastric and colorectal diseases(mainly malignant diseases)were included in the study. Peripheral venous blood samples were collected at different times for analysis of estradiol,testosterone and progesterone.The only study endpoint was analysis of postoperative complications. RESULTS:Patients of both sexes were uniform but postoperative complication rate was significantly higher in female patients(P=0.027).There was no significant association of estradiol and progesterone with postoperative complications.Testosterone levels in complicated patients were significantly lower than in uncomplicated patients(P<0.05).Area under the receiver operating characteristic curve showed that a lower value of testosterone was a predictor for higher complication rate(P<0.05),and a lower value oftestosterone at later times after surgery was a better predictor of complications. CONCLUSION:Patients with low testosterone level were prone to higher postoperative complications,which was evident in both sexes.However,further studies are necessary to support this result.

Endoscopic submucosal dissection for early gastric cancer:Quo vadis?

The diagnosis of early gastric cancer(EGC) is of great interest because its endoscopic and surgical treatment presents the best chance for a cure.With technical development,endoscopic submucosal dissection(ESD) has been widely performed for the curative treatment of EGC in Korea.Multinational studies of ESD for EGC will be the next missions that overcome these limitations and global guidelines will be processed for ESD for EGC.

Regional lymphadenectomy strongly recommended in T1b gallbladder cancer

This article discusses the adequate treatment of early gallbladder cancer （Tla, Tlb） and is based on published studies extending over nearly 3 decades. Ran- domized studies and meta analyses comparing different surgical treatments do not exist. The literature shows that in up to 20% of patients lymph node metastasis are found in Tlb gallbladder cancer. Due to high malignancy with early angiolymphatic spread and resistance to chemotherapy and radiation on the one hand, and the relative low operative risk of extended cholecystectomy （cholecystectomy and regional lymphadenectomy） on the other hand, we believe that this procedure is mandatory in early gallbladder cancer.

Transarterial embolization chemotherapy at early stage after hepatectomy of 45 patients with large hepatocellular carcinoma

Objective: To investigate the effect of transarterial embolization (TAE) at early stage postoperatively to prevent rumor recurrence after hepatectomy in patients with large hepatocellular carcinoma (HCC). Methods: Forty-five volunteer patients with large HCC received TAE 2 to 4 weeks after the hepatectomy. Another 48 patients with large HCC without postoperative TAE treatment served as control. Results: No severe complications associated with TAE or hepatectomy occurred, and follow-up visit of all patients revealed that 1-year recurrence rate for patients with PAL was markedly lower than those without (43.24%vs 70.73%, P＜0.05＝. Conclusion: The treatment with TAE at early stage after hepatectomy is safe and feasible for the patients with liver function Child-Pugh score not higher than 8, and it may help reduce the postoperative recurrence of hepatocellular carcinoma.

Carcinoma of the papilla of Vater following treatment of pancreaticobiliary maljunction

Pancreaticobiliary maljunction(PBM)is frequently associated with biliary cancer due to reflux of pancreatic enzymes into the choledochus,and even after surgery to correct the PBM such patients still have a risk of residual bile duct cancer.Here,we report the case of a 59-year-old female with carcinoma of the papilla of Vater which developed 2.5 years after choledochoduodenostomy for PBM.During the postoperative follow-up period,computed tomography obtained 2 years after the first operation demonstrated a tumor in the distal end of the choledochus,although she did not have jaundice and laboratory tests showed no abnormalities caused by the previous operation.As a result,carcinoma of the papilla of Vater was diagnosed at an early stage,followed by surgical cure.For early detection of periampullary cancer in patients undergoing surgery for PBM,careful long-term follow-up is needed.

Jejunoileal bypass:A surgery of the past and a review of its complications

Jejunoileal bypass(JIB),popular in the 1960s and 1970s,had remarkable success in achieving weight loss by creating a surgical short bowel syndrome.Our patient had an unusual case of liver disease and provided no history of prior bariatric surgery.Later,it was recognized that he had a JIB in the 1970s,which was also responsible for the gamut of his illnesses.Patients with JIB are often not recognized,as they died of complications,or underwent reversal of their surgery or a liver-kidney transplant.Early identification with prompt reversal,and the recognition and treatment of the life-threatening consequences play a critical role in the management of such patients.

Synchronous Multiple Primary Gastric Carcinomas： A Case Report

IntroductionCarcinomas of the stomach are the most common malignant tumors in China. Due to the recent developments in diagnostic techniques and instrumentation, the early detection of gastric carcinoma （GC） has increased. Yet synchronous multiple primary gastric carcinomas, de- fined as 2 or more primary gastric carcinomas occurring in 1 patient simultaneously, are not frequently seen. The etiology of synchronous tumors is still unclear, and their coexistence can be problematic for surgeons, oncologists and pathologists in regards to diagnosis, treat- ment, and follow-up. Research has focused mainly on such issues as the frequency of occurrence of primary multiple carcinomas, identi- fication of high-risk groups, early diagnosis, treatment methods, and prognostic factors. The purpose of this article is to present a rare case of synchronous tumors and to review the literature addressing the surgical treatment for patients with multiple cancers.

Complete remission of leiomyosarcoma with lung and brain metastasis by chemoradiotherapy after surgery

Nowadays, leiomyosarcoma is stil dif icult to early diagnosis, has no standard treatment to fol ow, and the thera-peutic value of surgery, chemotherapy and radiotherapy haven’t been evaluated ef ectively. Here was a case, which was misdiagnosed as uterine myoma, and was found already to occur lung metastasis after surgery. Complete remission （CR） was achieved after four cycles of albupax-containing chemotherapy. But six months later brain metastases was found. Then the patient received semustine, local radiotherapy and surgery, once again, achieved CR.

主动脉夹层动脉瘤的治疗体会

目的:回顾35例主动脉夹层动脉瘤病例资料,总结外科治疗经验。方法:35例中,DeBakeyⅠ型19例,Ⅱ型6例,Ⅲ型10例。25例手术治疗,8例行Bentall术,5例行升主动脉置换,同时主动脉瓣成形3例,2例行胸主动脉置换,10例置入支撑型人工血管。10例拒绝手术。结果:手术死亡2例,非手术10例中,6例死亡,4例转慢性化趋稳定出院。结论:对主动脉夹层动脉瘤应积极手术,Ⅰ、Ⅱ型可急诊手术,Ⅲ型可置入支撑型人工血管。早诊断、急诊手术是抢救成功的关键。