Due to the special anatomical location,complex functions,and significant impact on patients’appearance and psychology,the treatment of oral and maxillofacial tumors has always been a key and difficult issue in the fi...Due to the special anatomical location,complex functions,and significant impact on patients’appearance and psychology,the treatment of oral and maxillofacial tumors has always been a key and difficult issue in the field of head and neck surgery.With the rapid development of surgical technology,microsurgical reconstruction technology,perioperative management,and multidisciplinary treatment models,surgical treatment has occupied a core position in the comprehensive treatment system of oral and maxillofacial tumors.Based on this,this paper conducts research on the clinical outcomes of surgical treatment for patients with oral and maxillofacial tumors,expounds the optimization strategies of surgical treatment,and analyzes the clinical effects of the optimized surgical treatment,aiming to provide a reference for the clinical treatment of oral and maxillofacial tumors.展开更多
Colorectal cancer(CRC)is the third most prevalent malignancy worldwide and the second leading cause of cancer-related mortality.Its global incidence increases annually,with most patients diagnosed at advanced stages.D...Colorectal cancer(CRC)is the third most prevalent malignancy worldwide and the second leading cause of cancer-related mortality.Its global incidence increases annually,with most patients diagnosed at advanced stages.Despite substantial advancements in chemotherapy,radiotherapy,immune therapy,and targeted therapy,surgical treatment remains the mainstay for CRC management.Particularly,surgery is most effective for managing early-stage and locally advanced cancers.CRC surgery has evolved from conventional subtractive surgery to modern minimally invasive and precision-based techniques.Additionally,CRC treatment strategies have expanded from a single surgical therapy to a multimodal integrated system encompassing endoscopic therapy,perioperative therapy,molecular targeted therapy,and immunotherapy.This review elucidates the evolution of CRC surgical treatment,describing its transition from early palliative surgery to radical surgery,and,finally,to functional surgery,minimally invasive surgical techniques,and personalized treatment.It reflects the transformation in CRC treatment from simplistic to complex,from generalized to precise,and from singular to comprehensive techniques,providing a holistic perspective on advancements in CRC surgical treatment.展开更多
To improve the treatment effect of obstructive hypertrophic cardiomyopathy,this article focuses on the treatment of obstructive hypertrophic cardiomyopathy and conducts a comprehensive analysis of the disease.It highl...To improve the treatment effect of obstructive hypertrophic cardiomyopathy,this article focuses on the treatment of obstructive hypertrophic cardiomyopathy and conducts a comprehensive analysis of the disease.It highlights the limitations of traditional treatment methods and elaborates on interventional and surgical treatments.Additionally,this article compares the indications,risks,treatment effects,and costs of the two different treatment methods,providing a reference for doctors and patients in selecting clinical treatment plans.展开更多
BACKGROUND Data from the World Health Organization’s International Agency for Research on Cancer reported that China had the highest prevalence of cancer and cancer deaths in 2022.Liver and pancreatic cancers account...BACKGROUND Data from the World Health Organization’s International Agency for Research on Cancer reported that China had the highest prevalence of cancer and cancer deaths in 2022.Liver and pancreatic cancers accounted for the highest number of new cases.Real-world data(RWD)is now widely preferred to traditional clinical trials in various fields of medicine and healthcare,as the traditional research approach often involves highly selected populations and interventions and controls that are strictly regulated.Additionally,research results from the RWD match global reality better than those from traditional clinical trials.AIM To analyze the cost disparity between surgical treatments for liver and pancreatic cancer under various factors.METHODS This study analyzed RWD 1137 cases within the HB1 group(patients who underwent pancreatectomy,hepatectomy,and/or shunt surgery)in 2023.It distinguished different expenditure categories,including medical,nursing,technical,management,drug,and consumable costs.Additionally,it assessed the contribution of each expenditure category to total hospital costs and performed cross-group comparisons using the non-parametric Kruskal–Wallis test.This study used the Steel–Dwass test for post-hoc multiple comparisons and the Spearman correlation coefficient to examine the relationships between variables.RESULTS The study found that in HB11 and HB13,the total hospitalization costs were significantly higher for pancreaticoduodenectomy than for pancreatectomy and hepatectomy.Although no significant difference was observed in the length of hospital stay between patients who underwent pancreaticoduodenectomy and pancreatectomy,both were significantly longer than those who underwent liver resection.In HB15,no significant difference was observed in the total cost of hospitalization between pancreaticoduodenectomy and pancreatectomy;however,both were significantly higher than those in hepatectomy.Additionally,the length of hospital stay was significantly longer for patients who underwent pancreaticoduodenectomy than for those who underwent pancreatectomy or liver resection.CONCLUSION China Healthcare Security Diagnosis Related Groups payment system positively impacts liver and pancreatic cancer surgeries by improving medical quality and controlling costs.Further research could refine this grouping system and ensure continuous effectiveness and sustainability.展开更多
Hepatocellular carcinoma(HCC) is the most common primary liver malignancy. The treatment of HCC is complex and complicated by the severity of associated chronic liver disease, the stage of HCC, and the clinical condit...Hepatocellular carcinoma(HCC) is the most common primary liver malignancy. The treatment of HCC is complex and complicated by the severity of associated chronic liver disease, the stage of HCC, and the clinical condition of the patient. Liver resection(LR) is one of the most efficient treatments for patients with HCC, with an expected 5-year survival of 38%-61% depending on the stage of the disease. Improved liver function assessment, increased understanding of segmental liver anatomy from advanced imaging studies, and surgical technical progress are important factors that have led to reduced mortality in patients with HCC. The indication for LR may be expanded due to emerging evidences from laparoscopic hepatectomies and combined treatments with newly developed chemotherapies. Liver transplantation(LT) is considered as an ideal treatment for removal of existing tumors and the injured/preneoplastic underlying liver tissue with impaired liver function and the risk of multicentric carcinogenesis that results from chronically injured liver. However, LT is restricted to patients with minimal risk of tumor recurrence under immunosuppression. The expansion of criteria for LT in HCC patients is still under trial and discussion. Limited availability of grafts, as well as the risk and the cost of transplantation have led to considerable interest in expansion of the donor pool, living donor-related transplantation, and combined treatment involving LR and LT. This highlight presents evidence concerning recent studies evaluating LR and LT in HCC patients. In addition, alternative therapies for the treatment of early stage tumors and the management of patients on transplant waiting lists are discussed.展开更多
AIM:To describe clinical findings and complications from cases of traumatic lens subluxation/dislocation in patients with secondary glaucoma,and discuss the multiple treating methods of operation combined with primary...AIM:To describe clinical findings and complications from cases of traumatic lens subluxation/dislocation in patients with secondary glaucoma,and discuss the multiple treating methods of operation combined with primary intraocular lens(IOL)implantation.METHODS:Non-comparativeretrospectiveobservational case series.Participants:30 cases(30 eyes)of lens subluxation/dislocation in patients with secondary glaucoma were investigated which accepted the surgical treatment by author in the Ophthalmology of Xi’an No.4Hospital from 2007 to 2011.According to the different situations of lens subluxation/dislocation,various surgical procedures were performed such as crystalline lens phacoemulsification,crystalline lens phacoemulsification combined anterior vitrectomy,intracapsular cataract extraction combined anterior vitrectomy,lensectomy combined anterior vitrectomy though peripheral transparent cornea incision,pars plana lensectomy combined pars plana vitrectomy,and intravitreal cavity crystalline lens phacofragmentation combined pars plana vitrectomy.And whether to implement trabeculectomy depended on the different situations of secondary glaucoma.The posterior chamber intraocular lenses(PC-IOLs)were implanted in the capsular-bag or trassclerally sutured in the sulus decided by whether the capsular were present.Main outcome measures:visual acuity,intraocular pressure,the situation of intraocular lens and complications after the operations.RESULTS:The follow-up time was 11-36mo(21.4±7.13).Postoperative visual acuity of all eyes were improved;28 cases maintained IOP below 21 mm Hg;2cases had slightly IOL subluxation,4 cases had slightlytilted lens optical area;1 case had postoperative choroidal detachment;4 cases had postoperative corneal edema more than 1wk,but eventually recovered transparent;2 cases had mild postoperative vitreous hemorrhage,and absorbed 4wk later.There was no postoperative retinal detachment,IOL dislocation,and endophthalmitis.CONCLUSION:To take early treatment of traumatic lens subluxation/dislocation in patients with secondary glaucoma by individual surgical plan based on the different eye conditions would be safe and effective,which can effectively control the intraocular pressure and restore some vision.展开更多
Rectal cancer accounts for one third of all colorectal cancers.The age adjusted death rates from colorectal cancer have declined over recent decades due to a combination of colorectal cancer screening,improved diagnos...Rectal cancer accounts for one third of all colorectal cancers.The age adjusted death rates from colorectal cancer have declined over recent decades due to a combination of colorectal cancer screening,improved diagnostic tests,improved standardized surgical technique,improved medical support,neoadjuvant chemotherapies and radiation treatment or combinations of these.Because of complex treatment algorithms,use of multidisciplinary teams in the management of rectal cancer patients has also been popularized.Medical gastroenterologists performing colonoscopies are frequently the first health care provider to raise the suspicion of a rectal cancer.Although the diagnosis depends on histological confirmation,the endoscopic presentation is almost diagnostic in many cases.In order to meet the patient's immediate needs for information,it is important that the endoscopist has knowledge about the investigations and treatment options that will be required for their patient.The aim of this paper is to describe the modern preoperative investigations and operative procedures commonly offered to rectal cancer patients taking into account perspectives of three colorectal surgeons,practicing in the USA,Europe and Asia.展开更多
AIM: To analyze the prognostic factors influencing the overall survival of peripheral cholangiocarcinoma (PCC) patients undergoing surgical treatment during 25 years at a single institution. METHODS: This study retros...AIM: To analyze the prognostic factors influencing the overall survival of peripheral cholangiocarcinoma (PCC) patients undergoing surgical treatment during 25 years at a single institution. METHODS: This study retrospectively reviewed prospectively collecting data about 373 patients with historically proven PCC who underwent surgical treatment between 1977 and 2001. RESULTS: Three hundred and seventy-three PCC patients (159 men and 214 women) underwent surgical treatment from 1977 to 2001. Among them, 187 PCC patients underwent hepatectomy and 135 had curative resection (curative resectability rate: 36.2%). The follow-up duration ranged from 1.05 to 167.6 mo (mean/median = 14.1/7.2 mo). Overall cumulative survival rates at 1, 3, and 5 years were 32.5%, 9.2%, and 4.1%, respectively. Univariate log-rank analysis identified the following as adverse influences on overall survival: presence of symptoms, absence of mucobilia, elevated CEA and CA 19-9 levels, non-papillary tumor type, receiving non-hepatectomy, advanced tumor staging, lack of post-operative chemotherapy, and radiotherapy. Meanwhile, multivariate Cox's proportional hazard analysis demonstrated that absence of mucobilia, non-papillary tumor type, advanced tumor staging, non-hepatectomy, and lack of post-operative chemotherapy were the five independent prognostic factors that adversely affected overall survival. CONCLUSION: Favorable overall survival of PCC patients undergoing surgical treatment depends on early tumor stage, presence of mucobilia, papillary tumor type, hepatic resection, and post-operative chemotherapy.展开更多
Surgery is the most important and effective method for the treatment of gastric cancer.Since the first gastrectomy in the early 19th century,surgical treatment of gastric cancer has undergone more than 100 years of de...Surgery is the most important and effective method for the treatment of gastric cancer.Since the first gastrectomy in the early 19th century,surgical treatment of gastric cancer has undergone more than 100 years of development.With the increasing understanding of gastric cancer and the promotion of a series of clinical trials,the concept of gastric cancer surgery has evolved from the initial"bigger is better"to today’s"standardized surgery"and is developing towards individualized surgery focusing on accurate resection and quality of life.This trend has had a tremendous impact on the development of surgical treatments,such as minimally invasive surgeries,functionpreserving surgeries,and the optimal extent of lymph node dissection.Understanding the development and current status of gastric cancer surgery and exploring the remaining academic controversies are goals that every gastric surgeon should constantly pursue.However,how should gastric cancer surgery develop in the future?What opportunities and challenges will we encounter?In this review,we elaborate on the development and current status of gastric cancer surgery based on a series of clinical studies and discuss the controversy in the development of gastric cancer surgery.展开更多
AIM:To evaluate the efficacy and safety of traditional Chinese surgical treatment for anal fistulae with secondary tracks and abscess.METHODS:Sixty patients with intersphincteric or transsphincteric anal fistulas with...AIM:To evaluate the efficacy and safety of traditional Chinese surgical treatment for anal fistulae with secondary tracks and abscess.METHODS:Sixty patients with intersphincteric or transsphincteric anal fistulas with secondary tracks and abscess were randomly divided into study group [suture dragging combined with pad compression(SDPC)] and control group [fistulotomy(FSLT)].In the SDPC group,the internal opening was excised and incisions at external openings were made for drainage.Silk sutures were put through every two incisions and knotted in loose state.The suture dragging process started from the first day after surgery and the pad compression process started when all sutures were removed as wound tissue became fresh and without discharge.In the FSLT group,the internal opening and all tracts were laid open and cleaned by normal saline postoperatively till all wounds healed.The time of healing,postoperative pain score(visual analogue scale),recurrence rate,patient satisfaction,incontinence evaluation and anorectal manometry before and after the treatment were examined.RESULTS:There were no significant differences between the two groups regarding age,gender and fistulae type.The time of healing was significantly shorter(24.33 d in SDPC vs 31.57 d in FSLT,P < 0.01) and the patient satisfaction score at 1 mo postoperative followup was significantly higher in the SDPC group(4.07 in SDPC vs 3.37 in FSLT,P < 0.05).The mean maximal postoperative pain scores were 5.83 ± 2.5 in SDPC vs 6.37 ± 2.33 in FSLT and the recurrence rates were 3.33 in SDPC vs 0 in FSLT.None of the patients in the two groups experienced liquid and solid fecal incontinence and lifestyle alteration postoperatively.The Wexner score after treatment of intersphincter fistulae were 0.17 ± 0.41 in SDPC vs 0.40 ± 0.89 in FSLT and transsphincter fistulae were 0.13 ± 0.45 in SDPC vs 0.56 ± 1.35 in FSLT.The maximal squeeze pressure and resting pressure declined after treatment in both groups.The maximal anal squeeze pressures after treatment were reduced(23.17 ± 3.73 Kpa in SDPC vs 22.74 ± 4.47 Kpa in FSLT) and so did the resting pressures(12.36 ± 2.15 Kpa in SDPC vs 11.71 ± 1.87 Kpa in FSLT),but there were neither significant differences between the two groups and nor significant differences before or after treatment.CONCLUSION:Traditional Chinese surgical treatment SDPC for anal fistulae with secondary tracks and abscess is safe,effective and less invasive.展开更多
BACKGROUND: Xanthogranulomatous cholecystitis (XGC) is a rare presentation of chronic cholecystitis, characterized by xanthogranuloma, severe fibrosis and foam cells, and can be a cause of difficulty in cholecystectom...BACKGROUND: Xanthogranulomatous cholecystitis (XGC) is a rare presentation of chronic cholecystitis, characterized by xanthogranuloma, severe fibrosis and foam cells, and can be a cause of difficulty in cholecystectomy. Patients with XGC are frequently misdiagnosed intraoperatively as having carcinoma of the gallbladder and are treated with extensive excision. This study aimed at providing proper surgical treatment for patients with XGC. METHODS: The clinical data of 33 patients with XGC definitely diagnosed by pathological examination over a period of 10 years were analyzed retrospectively (mean age of onset, 60 years; male/female ratio, 1.5: 1). RESULTS: Preoperatively, the 33 patients were examined by abdominal B-ultrasonography while 20 of them were further examined by computed tomography (CT). Intraoperatively, XGC associated with cholecystolithiasis was found in 97.0% of the patients, thickening of the gallbladder wall in 90.9%, xanthogranulomatous tissue invading into other tissues in 87.9%, XGC associated with choledocholithiasis in 15.2%, and Mirizzi syndrome in 9.1%. In addition, a gallbladder fistula was observed in 4 patients. Open cholecystectomy was performed on 15 patients, partial cholecystectomy on 7, cholecystectomy and partial liver wedge resection on 5, and gallbladder cancer radical correction on 6. The intraoperative misdiagnosis rate was 24.2%. Frozen-section examination was carried out in 9 patients. Postoperative complications were observed in 5 patients. CONCLUSIONS: XGC is difficult to diagnose either preoperatively or intraoperatively and definite diagnosis depends exclusively on pathological examination. Firm adhesions of the gallbladder to neighboring organs and tissues are common and lead to difficulty in surgical treatments. The mode of operation depends on specific conditions in varying cases, and since frozen-section examination plays an important role in determining the nature of the lesions, intraoperative frozen-section examination should be carried out to differentiate XGC from carcinoma of the gallbladder.展开更多
Familial adenomatous polyposis (FAP) is an autosomal dominant inherited syndrome characterized by multiple adenomatous polyps (predisposing to colorectal cancer development) and numerous extracolonic manifestations. T...Familial adenomatous polyposis (FAP) is an autosomal dominant inherited syndrome characterized by multiple adenomatous polyps (predisposing to colorectal cancer development) and numerous extracolonic manifestations. The underlying genetic burden generates variable clinical features that may influence operative management. As a precancerous hereditary condition, the rationale of performing a prophylactic surgery is a mainstay of FAP management. The purpose of the present paper is to bring up many controversial aspects regarding surgical treatment for FAP, and to discuss the results and perspectives of the operative choices and approaches. Preferably, the decision-making process should not be limited to the conventional confrontation of pros and cons of ileorectal anastomosis or restorative proctocolectomy. A wide discussion with the patient may evaluate issues such as age, genotype, family history, sphincter function, the presence or risk of desmoid disease, potential complications of each procedure and chances of postoperative surveillance. Therefore, the definition of the best moment and the choice of appropriate procedure constitute an individual decision that must take into consideration patient’s preferences and full information about the complex nature of the disease. All these facts reinforce the idea that FAP patients should be managed by experienced surgeons working in specialized centers to achieve the best immediate and long-term results.展开更多
BACKGROUND: The recurrence rates of choledocholithiasis depend on the type of the disease. This study was undertaken to examine recurrent lithiasis after surgical treatment of elderly patients with choledocholithiasis...BACKGROUND: The recurrence rates of choledocholithiasis depend on the type of the disease. This study was undertaken to examine recurrent lithiasis after surgical treatment of elderly patients with choledocholithiasis, especially with primary common bile duct stones, and thereby to determine the best treatment modality for choledocholithiasis in the elderly. METHODS: The recurrence rates of choledocholithiasis were calculated from the records of 193 outpatients who had been treated from January 1993 to January 2005 and monitored for periods ranging from I to 12 years (mean 6.7 years). The patients were divided into 3 groups: 81 who had undergone choledocholithotomy and T-tube drainage, 41 who had had choledochoduodenostomy. and 71 patients who had received choledochojejunostomy. RESULTS: Since the 41 choledochoduodenostomy cases had only one recurrence of choledocholithiasis, the recurrence rate was analyzed for the remaining 152 cases, which were divided into two groups: group A with recurrent lithiasis (13 cases), and group B without recurrence (139 cases). The recurrence was found in 7 patients after choledocholithotomy and T-tube drainage (7/81, 8.6%), and in 6 patients after choledochojejunostomy (6/71, 8.5%). The recurrence rates for these procedures were higher than for choledochoduodenostomy (1/41, 2.4%, P<0.05). Moreover, stones recurred in 4 of the 11 patients with primary bile duct stones who underwent choledocholithotomy an T-tube drainage (4/11, 36.4%), and in 5 of the 34 patients who had choledochojejunostomy (5/34, 14.7%). The recurrence rates for these procedures were higher than for choledochoduodenostomy (1/39, 2.6%, P<0.05). The diameter of the common bile duct was more dilated in group A (14.6 +/- 3.9 mm) than in group B (10.8 +/- 4.5 turn, P<0.05). Primary bile duct stones were found in 9 cases of group A (69.2%), and in 36 cases of group B (25.9%, P<0.01). CONCLUSION: Choledochoduodenostomy should be recommended for elderly patients with primary bile duct stones to prevent postoperative recurrent lithiasis.展开更多
Extensive lesions involving the posterior quadrant of the cerebral hemisphere （temporal, parietal, and occipital lobes） induce intractable epilepsy. These patients are potential candidates for surgical treatmenttu. ...Extensive lesions involving the posterior quadrant of the cerebral hemisphere （temporal, parietal, and occipital lobes） induce intractable epilepsy. These patients are potential candidates for surgical treatmenttu. Maintenance of isolated nerve tissue activity after surgery plays a crucial role in the neuroprotective effects of neurosurgery treatment. Disconnection surgery of the posterior quadrant is used to completely isolate nerve fibers, while blood supply at the isolated lobes is maintained. Subsequently, cavities caused by cystic or necrotic nerve tissues should be reduced as much as possible,展开更多
BACKGROUND: Hepatic hilar cholangiocarcinoma can be diagnosed early with the progress in diagnostic imaging, and thus the rate of resection of the tumor has increased markedly. To assess the effectiveness of resection...BACKGROUND: Hepatic hilar cholangiocarcinoma can be diagnosed early with the progress in diagnostic imaging, and thus the rate of resection of the tumor has increased markedly. To assess the effectiveness of resection, we reviewed 185 cases of hepatic hilar cholangiocarcinoma diagnosed and treated at our hospital. METHODS: The clinical data of 185 patients with hepatic hilar cholangiocarcinoma who had been treated surgically from 1972 to 2006 were retrospectively analyzed. RESULTS: The records of the 185 patients were divided into first stage (1972-1986) or second stage (1987-2006) according to the incidence of the tumor and its resection rate. Primary symptoms included upper abdominal discomfort or pain, anorexia, tiredness, weight loss and progressive jaundice. Ultrasonography, computed tomography (CT), magnetic resonance imaging (MRI), and magnetic resonance cholangiopancreatography (MRCP) were first line methods for atraumatic diagnosis. If the patients displayed intrahepatic bile duct dilatation or were diagnosed as suffering from extrahepatic obstructive jaundice, percutaneous transhepatic cholangiography (PTC), MRCP or endoscopic retrograde cholangiopancreatography (ERCP) should be used. In this series, 87 patients underwent resection of the tumor (47.0%). Of the 87 patients, 43 received radical resection and 44 palliative resection. Fifteen patients underwent resection in the first stage and 72 in the second stage. A total of 74 patients were followed up after the resection. The median survival time of the radical resection group was 37 months and that of the palliative resection group was 17 months (P<0.001). The other 62 patients receiving no resection died within 1.5 years. CONCLUSIONS: Once patients are diagnosed with hepatic hilar cholangiocarcinoma, they should undergo exploratory laparotomy. Resection is the most effective method for the treatment of hepatic hilar cholangiocarcinoma.展开更多
Objective： To investigate the clinical characteristics, diagnosis and surgical treatment of intravenous leiomyomatosis （IVL）, and outline the differences between Chinese and overseas cases. Methods： Clinical data ...Objective： To investigate the clinical characteristics, diagnosis and surgical treatment of intravenous leiomyomatosis （IVL）, and outline the differences between Chinese and overseas cases. Methods： Clinical data of two IVL cases, treated in our hospital, were analyzed retrospectively and the related literature was also reviewed. The data of preoperative diagnostic rate, surgical procedures, and postoperative recurrence between patients in China and other countries were compared. Results： The first stage operation was performed successfully in 2 patients. However, they refused subsequent therapies, including a second stage operation to excise the remnants Of the tumor, uterus, bilateral oviducts and ovaries, and anti-estrogen therapy. Both suffered from IVL recurrence, one at 6-month and the other at 9-month, and died at 16-month and 12-month respectively after the first stage surgery. Worldwide reports of 110 IVL cases were reviewed, which included 28 cases in China and 82 cases in other countries. In the majority of the Chinese patients, tumors only extended into the fight atrium rather than the right ventricle （RA 22 cases vs RV 4 cases）. However, among the overseas patients, the rate of extension into the right atrium was similar to that of extension into the right ventricle （RA 41 cases vs RV 38 cases）. The rate of hysterectomies was not significantly different between Chinese and overseas patients （ 67.86% vs 55.9%, P=0.278）. The rate of correct preoperative diagnosis in the Chinese patients was significantly lower than that in the overseas patients （32.14% vs 80%, P=0.000002.）, as well asthe rate of complete excision of the tumor （22.7@0 vs 75.5%, P=0.000001）. The proportion of patients who undergoing a single-stage or a two-stage operation was similar in Chinese and overseas patients. The recurrence rate was significantly higher in the Chinese patients than in the overseas patients （36.8% vs 9.1%, P=0.0055）, and the patients with tumor recurrence were partial tumor excision patients. Conclusion： The possibility of IVL should be considered if echocardiography in female patients demonstrates a tumor in the right heart and a mass in the inferior vena cava （IVC）. Further imaging should be performed to confirm the diagnosis. The correct diagnosis and accurate preoperative delineation of tumor extension are essential for an optimal surgical outcome. The key point in IVL treatment is the complete excision of tumors （single-stage or two-stage surgical procedure）.展开更多
BACKGROUND Patients with gastrointestinal tumors often suffer from poor nutritional status during treatment.Surgery is the main treatment for these patients,but the long postoperative recovery period is often accompan...BACKGROUND Patients with gastrointestinal tumors often suffer from poor nutritional status during treatment.Surgery is the main treatment for these patients,but the long postoperative recovery period is often accompanied by digestive and absorption dysfunction,leading to further deterioration of the nutritional status.Early enteral nutrition support is hypothesized to be helpful in improving this situation,but the exact effects have yet to be studied in depth.AIM To observe the effect of early enteral nutritional support on postoperative recovery in patients with surgically treated gastrointestinal tract tumors,with the expectation that by improving the nutritional status of patients,the recovery process would be accelerated and the incidence of complications would be reduced,thus improving the quality of life.METHODS A retrospective analysis of 121 patients with gastrointestinal tract tumors treated in our hospital from January 2020 to January 2023 was performed.Fifty-three of these patients received complete parenteral nutrition support as the control group for this study.The other 68 patients received early enteral nutritional support as the observation group of this study.The clinical indicators comparing the two groups included time to fever,time to recovery of postoperative bowel function,time to postoperative exhaustion,and length of hospital stay.The changes in immune function and nutritional indexes in the two groups were compared.Furthermore,we utilized the SF-36 scale to compare the changes in the quality of life between the two groups of patients.Finally,the occurrence of postoperative complications between the two patient groups was also compared.RESULTS The postoperative fever time,postoperative bowel function recovery time,postoperative exhaustion time,and hospitalization time were all higher in the control group than in the observation group(P<0.05).The levels of CD3+,CD4+,immunoglobulin(Ig)A,IgM,and IgG in the observation group were significantly higher than those in the control group at 1 d and 7 d postoperatively,while CD8+was lower than in the control group(P<0.05).Total protein,albumin,prealbumin,and transferrin levels were significantly higher in the observation group than in the control group at 7 d postoperatively(P<0.05).The SF-36 scores of patients in the observation group were significantly higher than those in the control group(P<0.0001).The overall incidence of adverse reactions after the intervention was significantly lower in the control group than in the observation group(P=0.021).CONCLUSION We found that patients with gastrointestinal tumors are nutritionally vulnerable,and early enteral nutrition support programs can improve the nutritional status of patients and speed up postoperative recovery.This program can not only improve the immune function of the patient and protect the intestinal function,but it can also help to improve the quality of life of the patient.However,this program will increase the incidence of complications in patients.Caution should be taken when adopting early enteral nutrition support measures for patients with gastric cancer.The patient's condition and physical condition should be comprehensively evaluated and closely monitored to prevent possible complications.展开更多
The clinical value of transvaginal ultrasound in clinical surgical treatment of cesarean scar pregnancy（CSP） was evaluated. The clinical data of 104 patients with CSP admitted at Tongji Hospital from 2013 to 2016 we...The clinical value of transvaginal ultrasound in clinical surgical treatment of cesarean scar pregnancy（CSP） was evaluated. The clinical data of 104 patients with CSP admitted at Tongji Hospital from 2013 to 2016 were collected and analyzed retrospectively, including the patients＇ age, gestational age, the size of gestational sac or uneven mass, the uterine scar thickness, β human chorionic gonadotropin（h CG） levels and so on. Of these 104 cases, 30 cases were subjected to laparotomy, 29 cases to laparoscopy, 27 cases to hysteroscopy, 16 cases to ultrasound-guided uterine curettage, and 2 cases to conservative treatment. The transvaginal ultrasound showed that uterine scar thickness and gestational sac or uneven mass size had significant difference（P〈0.05） among different surgical methods by comparatively analyzing the patients＇ data. It was suggested that transvaginal ultrasound may provide the valuable reference for choosing clinical surgical procedures for CSP.展开更多
We read the article titled,“Long-term follow-up of liver alveolar echinococcosis using echinococcosis multilocularis ultrasound classification,”by Schuhbaur J with great interest.However,we found some worthwhile iss...We read the article titled,“Long-term follow-up of liver alveolar echinococcosis using echinococcosis multilocularis ultrasound classification,”by Schuhbaur J with great interest.However,we found some worthwhile issues that we believe should be discussed with the authors,and have provided our comments in this letter.It would be valuable if the authors could provide further information about the clinical stages,follow-up time,and clinical outcomes of the patients.展开更多
BACKGROUND Spontaneous cerebrospinal fluid(CSF)leaks associated with cervical spondylosis are rare.To our knowledge,only a few cases have been reported in which treatment is challenging and varies from case to case.He...BACKGROUND Spontaneous cerebrospinal fluid(CSF)leaks associated with cervical spondylosis are rare.To our knowledge,only a few cases have been reported in which treatment is challenging and varies from case to case.Here,we review the literature and describe the surgical treatment of a 70-year-old woman who presented with a CSF leak due to a cervical spine spur.CASE SUMMARY A 70-year-old female patient who was treated for a cerebral infarction,presented with complains of weakness in the right lower extremity and a feeling of stepping on cotton.The patient underwent regular neck massage and presented with neck and right shoulder pain radiating to the right upper extremity one-month ago.Magnetic resonance imaging showed a strip of leaking cerebrospinal fluid posterior to the C1-4 vertebrae,and computed tomography showed a“sickleshaped”disc prolapse with calcification in C4/5.We chose to perform an anterior cervical discectomy.When the prolapsed C4/5 disc was scraped,clear fluid leakage was observed,and exploration revealed a 1 mm diameter rupture in the anterior aspect of the dura mater,which was compressed continuously with cotton patties,with no significant cerebrospinal fluid leakage after 1 h.CONCLUSION Three months after surgery,the patient was asymptomatic and follow-up imaging demonstrated complete resolution.展开更多
文摘Due to the special anatomical location,complex functions,and significant impact on patients’appearance and psychology,the treatment of oral and maxillofacial tumors has always been a key and difficult issue in the field of head and neck surgery.With the rapid development of surgical technology,microsurgical reconstruction technology,perioperative management,and multidisciplinary treatment models,surgical treatment has occupied a core position in the comprehensive treatment system of oral and maxillofacial tumors.Based on this,this paper conducts research on the clinical outcomes of surgical treatment for patients with oral and maxillofacial tumors,expounds the optimization strategies of surgical treatment,and analyzes the clinical effects of the optimized surgical treatment,aiming to provide a reference for the clinical treatment of oral and maxillofacial tumors.
基金Supported by Postgraduate Practice Innovation Program of Jiangsu Province,No.KYCX23_3621.
文摘Colorectal cancer(CRC)is the third most prevalent malignancy worldwide and the second leading cause of cancer-related mortality.Its global incidence increases annually,with most patients diagnosed at advanced stages.Despite substantial advancements in chemotherapy,radiotherapy,immune therapy,and targeted therapy,surgical treatment remains the mainstay for CRC management.Particularly,surgery is most effective for managing early-stage and locally advanced cancers.CRC surgery has evolved from conventional subtractive surgery to modern minimally invasive and precision-based techniques.Additionally,CRC treatment strategies have expanded from a single surgical therapy to a multimodal integrated system encompassing endoscopic therapy,perioperative therapy,molecular targeted therapy,and immunotherapy.This review elucidates the evolution of CRC surgical treatment,describing its transition from early palliative surgery to radical surgery,and,finally,to functional surgery,minimally invasive surgical techniques,and personalized treatment.It reflects the transformation in CRC treatment from simplistic to complex,from generalized to precise,and from singular to comprehensive techniques,providing a holistic perspective on advancements in CRC surgical treatment.
文摘To improve the treatment effect of obstructive hypertrophic cardiomyopathy,this article focuses on the treatment of obstructive hypertrophic cardiomyopathy and conducts a comprehensive analysis of the disease.It highlights the limitations of traditional treatment methods and elaborates on interventional and surgical treatments.Additionally,this article compares the indications,risks,treatment effects,and costs of the two different treatment methods,providing a reference for doctors and patients in selecting clinical treatment plans.
基金Research Center for Capital Health Management and Policy,No.2024JD09.
文摘BACKGROUND Data from the World Health Organization’s International Agency for Research on Cancer reported that China had the highest prevalence of cancer and cancer deaths in 2022.Liver and pancreatic cancers accounted for the highest number of new cases.Real-world data(RWD)is now widely preferred to traditional clinical trials in various fields of medicine and healthcare,as the traditional research approach often involves highly selected populations and interventions and controls that are strictly regulated.Additionally,research results from the RWD match global reality better than those from traditional clinical trials.AIM To analyze the cost disparity between surgical treatments for liver and pancreatic cancer under various factors.METHODS This study analyzed RWD 1137 cases within the HB1 group(patients who underwent pancreatectomy,hepatectomy,and/or shunt surgery)in 2023.It distinguished different expenditure categories,including medical,nursing,technical,management,drug,and consumable costs.Additionally,it assessed the contribution of each expenditure category to total hospital costs and performed cross-group comparisons using the non-parametric Kruskal–Wallis test.This study used the Steel–Dwass test for post-hoc multiple comparisons and the Spearman correlation coefficient to examine the relationships between variables.RESULTS The study found that in HB11 and HB13,the total hospitalization costs were significantly higher for pancreaticoduodenectomy than for pancreatectomy and hepatectomy.Although no significant difference was observed in the length of hospital stay between patients who underwent pancreaticoduodenectomy and pancreatectomy,both were significantly longer than those who underwent liver resection.In HB15,no significant difference was observed in the total cost of hospitalization between pancreaticoduodenectomy and pancreatectomy;however,both were significantly higher than those in hepatectomy.Additionally,the length of hospital stay was significantly longer for patients who underwent pancreaticoduodenectomy than for those who underwent pancreatectomy or liver resection.CONCLUSION China Healthcare Security Diagnosis Related Groups payment system positively impacts liver and pancreatic cancer surgeries by improving medical quality and controlling costs.Further research could refine this grouping system and ensure continuous effectiveness and sustainability.
文摘Hepatocellular carcinoma(HCC) is the most common primary liver malignancy. The treatment of HCC is complex and complicated by the severity of associated chronic liver disease, the stage of HCC, and the clinical condition of the patient. Liver resection(LR) is one of the most efficient treatments for patients with HCC, with an expected 5-year survival of 38%-61% depending on the stage of the disease. Improved liver function assessment, increased understanding of segmental liver anatomy from advanced imaging studies, and surgical technical progress are important factors that have led to reduced mortality in patients with HCC. The indication for LR may be expanded due to emerging evidences from laparoscopic hepatectomies and combined treatments with newly developed chemotherapies. Liver transplantation(LT) is considered as an ideal treatment for removal of existing tumors and the injured/preneoplastic underlying liver tissue with impaired liver function and the risk of multicentric carcinogenesis that results from chronically injured liver. However, LT is restricted to patients with minimal risk of tumor recurrence under immunosuppression. The expansion of criteria for LT in HCC patients is still under trial and discussion. Limited availability of grafts, as well as the risk and the cost of transplantation have led to considerable interest in expansion of the donor pool, living donor-related transplantation, and combined treatment involving LR and LT. This highlight presents evidence concerning recent studies evaluating LR and LT in HCC patients. In addition, alternative therapies for the treatment of early stage tumors and the management of patients on transplant waiting lists are discussed.
文摘AIM:To describe clinical findings and complications from cases of traumatic lens subluxation/dislocation in patients with secondary glaucoma,and discuss the multiple treating methods of operation combined with primary intraocular lens(IOL)implantation.METHODS:Non-comparativeretrospectiveobservational case series.Participants:30 cases(30 eyes)of lens subluxation/dislocation in patients with secondary glaucoma were investigated which accepted the surgical treatment by author in the Ophthalmology of Xi’an No.4Hospital from 2007 to 2011.According to the different situations of lens subluxation/dislocation,various surgical procedures were performed such as crystalline lens phacoemulsification,crystalline lens phacoemulsification combined anterior vitrectomy,intracapsular cataract extraction combined anterior vitrectomy,lensectomy combined anterior vitrectomy though peripheral transparent cornea incision,pars plana lensectomy combined pars plana vitrectomy,and intravitreal cavity crystalline lens phacofragmentation combined pars plana vitrectomy.And whether to implement trabeculectomy depended on the different situations of secondary glaucoma.The posterior chamber intraocular lenses(PC-IOLs)were implanted in the capsular-bag or trassclerally sutured in the sulus decided by whether the capsular were present.Main outcome measures:visual acuity,intraocular pressure,the situation of intraocular lens and complications after the operations.RESULTS:The follow-up time was 11-36mo(21.4±7.13).Postoperative visual acuity of all eyes were improved;28 cases maintained IOP below 21 mm Hg;2cases had slightly IOL subluxation,4 cases had slightlytilted lens optical area;1 case had postoperative choroidal detachment;4 cases had postoperative corneal edema more than 1wk,but eventually recovered transparent;2 cases had mild postoperative vitreous hemorrhage,and absorbed 4wk later.There was no postoperative retinal detachment,IOL dislocation,and endophthalmitis.CONCLUSION:To take early treatment of traumatic lens subluxation/dislocation in patients with secondary glaucoma by individual surgical plan based on the different eye conditions would be safe and effective,which can effectively control the intraocular pressure and restore some vision.
文摘Rectal cancer accounts for one third of all colorectal cancers.The age adjusted death rates from colorectal cancer have declined over recent decades due to a combination of colorectal cancer screening,improved diagnostic tests,improved standardized surgical technique,improved medical support,neoadjuvant chemotherapies and radiation treatment or combinations of these.Because of complex treatment algorithms,use of multidisciplinary teams in the management of rectal cancer patients has also been popularized.Medical gastroenterologists performing colonoscopies are frequently the first health care provider to raise the suspicion of a rectal cancer.Although the diagnosis depends on histological confirmation,the endoscopic presentation is almost diagnostic in many cases.In order to meet the patient's immediate needs for information,it is important that the endoscopist has knowledge about the investigations and treatment options that will be required for their patient.The aim of this paper is to describe the modern preoperative investigations and operative procedures commonly offered to rectal cancer patients taking into account perspectives of three colorectal surgeons,practicing in the USA,Europe and Asia.
文摘AIM: To analyze the prognostic factors influencing the overall survival of peripheral cholangiocarcinoma (PCC) patients undergoing surgical treatment during 25 years at a single institution. METHODS: This study retrospectively reviewed prospectively collecting data about 373 patients with historically proven PCC who underwent surgical treatment between 1977 and 2001. RESULTS: Three hundred and seventy-three PCC patients (159 men and 214 women) underwent surgical treatment from 1977 to 2001. Among them, 187 PCC patients underwent hepatectomy and 135 had curative resection (curative resectability rate: 36.2%). The follow-up duration ranged from 1.05 to 167.6 mo (mean/median = 14.1/7.2 mo). Overall cumulative survival rates at 1, 3, and 5 years were 32.5%, 9.2%, and 4.1%, respectively. Univariate log-rank analysis identified the following as adverse influences on overall survival: presence of symptoms, absence of mucobilia, elevated CEA and CA 19-9 levels, non-papillary tumor type, receiving non-hepatectomy, advanced tumor staging, lack of post-operative chemotherapy, and radiotherapy. Meanwhile, multivariate Cox's proportional hazard analysis demonstrated that absence of mucobilia, non-papillary tumor type, advanced tumor staging, non-hepatectomy, and lack of post-operative chemotherapy were the five independent prognostic factors that adversely affected overall survival. CONCLUSION: Favorable overall survival of PCC patients undergoing surgical treatment depends on early tumor stage, presence of mucobilia, papillary tumor type, hepatic resection, and post-operative chemotherapy.
文摘Surgery is the most important and effective method for the treatment of gastric cancer.Since the first gastrectomy in the early 19th century,surgical treatment of gastric cancer has undergone more than 100 years of development.With the increasing understanding of gastric cancer and the promotion of a series of clinical trials,the concept of gastric cancer surgery has evolved from the initial"bigger is better"to today’s"standardized surgery"and is developing towards individualized surgery focusing on accurate resection and quality of life.This trend has had a tremendous impact on the development of surgical treatments,such as minimally invasive surgeries,functionpreserving surgeries,and the optimal extent of lymph node dissection.Understanding the development and current status of gastric cancer surgery and exploring the remaining academic controversies are goals that every gastric surgeon should constantly pursue.However,how should gastric cancer surgery develop in the future?What opportunities and challenges will we encounter?In this review,we elaborate on the development and current status of gastric cancer surgery based on a series of clinical studies and discuss the controversy in the development of gastric cancer surgery.
基金Supported by Grants from Chinese Ministry of Education,No. 210077 and No.20093107110005Shanghai Municipal Education Commission,No.10ZZ77Shanghai Science and Technology Commission,No.10QA1406600
文摘AIM:To evaluate the efficacy and safety of traditional Chinese surgical treatment for anal fistulae with secondary tracks and abscess.METHODS:Sixty patients with intersphincteric or transsphincteric anal fistulas with secondary tracks and abscess were randomly divided into study group [suture dragging combined with pad compression(SDPC)] and control group [fistulotomy(FSLT)].In the SDPC group,the internal opening was excised and incisions at external openings were made for drainage.Silk sutures were put through every two incisions and knotted in loose state.The suture dragging process started from the first day after surgery and the pad compression process started when all sutures were removed as wound tissue became fresh and without discharge.In the FSLT group,the internal opening and all tracts were laid open and cleaned by normal saline postoperatively till all wounds healed.The time of healing,postoperative pain score(visual analogue scale),recurrence rate,patient satisfaction,incontinence evaluation and anorectal manometry before and after the treatment were examined.RESULTS:There were no significant differences between the two groups regarding age,gender and fistulae type.The time of healing was significantly shorter(24.33 d in SDPC vs 31.57 d in FSLT,P < 0.01) and the patient satisfaction score at 1 mo postoperative followup was significantly higher in the SDPC group(4.07 in SDPC vs 3.37 in FSLT,P < 0.05).The mean maximal postoperative pain scores were 5.83 ± 2.5 in SDPC vs 6.37 ± 2.33 in FSLT and the recurrence rates were 3.33 in SDPC vs 0 in FSLT.None of the patients in the two groups experienced liquid and solid fecal incontinence and lifestyle alteration postoperatively.The Wexner score after treatment of intersphincter fistulae were 0.17 ± 0.41 in SDPC vs 0.40 ± 0.89 in FSLT and transsphincter fistulae were 0.13 ± 0.45 in SDPC vs 0.56 ± 1.35 in FSLT.The maximal squeeze pressure and resting pressure declined after treatment in both groups.The maximal anal squeeze pressures after treatment were reduced(23.17 ± 3.73 Kpa in SDPC vs 22.74 ± 4.47 Kpa in FSLT) and so did the resting pressures(12.36 ± 2.15 Kpa in SDPC vs 11.71 ± 1.87 Kpa in FSLT),but there were neither significant differences between the two groups and nor significant differences before or after treatment.CONCLUSION:Traditional Chinese surgical treatment SDPC for anal fistulae with secondary tracks and abscess is safe,effective and less invasive.
文摘BACKGROUND: Xanthogranulomatous cholecystitis (XGC) is a rare presentation of chronic cholecystitis, characterized by xanthogranuloma, severe fibrosis and foam cells, and can be a cause of difficulty in cholecystectomy. Patients with XGC are frequently misdiagnosed intraoperatively as having carcinoma of the gallbladder and are treated with extensive excision. This study aimed at providing proper surgical treatment for patients with XGC. METHODS: The clinical data of 33 patients with XGC definitely diagnosed by pathological examination over a period of 10 years were analyzed retrospectively (mean age of onset, 60 years; male/female ratio, 1.5: 1). RESULTS: Preoperatively, the 33 patients were examined by abdominal B-ultrasonography while 20 of them were further examined by computed tomography (CT). Intraoperatively, XGC associated with cholecystolithiasis was found in 97.0% of the patients, thickening of the gallbladder wall in 90.9%, xanthogranulomatous tissue invading into other tissues in 87.9%, XGC associated with choledocholithiasis in 15.2%, and Mirizzi syndrome in 9.1%. In addition, a gallbladder fistula was observed in 4 patients. Open cholecystectomy was performed on 15 patients, partial cholecystectomy on 7, cholecystectomy and partial liver wedge resection on 5, and gallbladder cancer radical correction on 6. The intraoperative misdiagnosis rate was 24.2%. Frozen-section examination was carried out in 9 patients. Postoperative complications were observed in 5 patients. CONCLUSIONS: XGC is difficult to diagnose either preoperatively or intraoperatively and definite diagnosis depends exclusively on pathological examination. Firm adhesions of the gallbladder to neighboring organs and tissues are common and lead to difficulty in surgical treatments. The mode of operation depends on specific conditions in varying cases, and since frozen-section examination plays an important role in determining the nature of the lesions, intraoperative frozen-section examination should be carried out to differentiate XGC from carcinoma of the gallbladder.
文摘Familial adenomatous polyposis (FAP) is an autosomal dominant inherited syndrome characterized by multiple adenomatous polyps (predisposing to colorectal cancer development) and numerous extracolonic manifestations. The underlying genetic burden generates variable clinical features that may influence operative management. As a precancerous hereditary condition, the rationale of performing a prophylactic surgery is a mainstay of FAP management. The purpose of the present paper is to bring up many controversial aspects regarding surgical treatment for FAP, and to discuss the results and perspectives of the operative choices and approaches. Preferably, the decision-making process should not be limited to the conventional confrontation of pros and cons of ileorectal anastomosis or restorative proctocolectomy. A wide discussion with the patient may evaluate issues such as age, genotype, family history, sphincter function, the presence or risk of desmoid disease, potential complications of each procedure and chances of postoperative surveillance. Therefore, the definition of the best moment and the choice of appropriate procedure constitute an individual decision that must take into consideration patient’s preferences and full information about the complex nature of the disease. All these facts reinforce the idea that FAP patients should be managed by experienced surgeons working in specialized centers to achieve the best immediate and long-term results.
文摘BACKGROUND: The recurrence rates of choledocholithiasis depend on the type of the disease. This study was undertaken to examine recurrent lithiasis after surgical treatment of elderly patients with choledocholithiasis, especially with primary common bile duct stones, and thereby to determine the best treatment modality for choledocholithiasis in the elderly. METHODS: The recurrence rates of choledocholithiasis were calculated from the records of 193 outpatients who had been treated from January 1993 to January 2005 and monitored for periods ranging from I to 12 years (mean 6.7 years). The patients were divided into 3 groups: 81 who had undergone choledocholithotomy and T-tube drainage, 41 who had had choledochoduodenostomy. and 71 patients who had received choledochojejunostomy. RESULTS: Since the 41 choledochoduodenostomy cases had only one recurrence of choledocholithiasis, the recurrence rate was analyzed for the remaining 152 cases, which were divided into two groups: group A with recurrent lithiasis (13 cases), and group B without recurrence (139 cases). The recurrence was found in 7 patients after choledocholithotomy and T-tube drainage (7/81, 8.6%), and in 6 patients after choledochojejunostomy (6/71, 8.5%). The recurrence rates for these procedures were higher than for choledochoduodenostomy (1/41, 2.4%, P<0.05). Moreover, stones recurred in 4 of the 11 patients with primary bile duct stones who underwent choledocholithotomy an T-tube drainage (4/11, 36.4%), and in 5 of the 34 patients who had choledochojejunostomy (5/34, 14.7%). The recurrence rates for these procedures were higher than for choledochoduodenostomy (1/39, 2.6%, P<0.05). The diameter of the common bile duct was more dilated in group A (14.6 +/- 3.9 mm) than in group B (10.8 +/- 4.5 turn, P<0.05). Primary bile duct stones were found in 9 cases of group A (69.2%), and in 36 cases of group B (25.9%, P<0.01). CONCLUSION: Choledochoduodenostomy should be recommended for elderly patients with primary bile duct stones to prevent postoperative recurrent lithiasis.
基金The Science Fund of Health Bureau of Tianjin,No.2013KZ046
文摘Extensive lesions involving the posterior quadrant of the cerebral hemisphere （temporal, parietal, and occipital lobes） induce intractable epilepsy. These patients are potential candidates for surgical treatmenttu. Maintenance of isolated nerve tissue activity after surgery plays a crucial role in the neuroprotective effects of neurosurgery treatment. Disconnection surgery of the posterior quadrant is used to completely isolate nerve fibers, while blood supply at the isolated lobes is maintained. Subsequently, cavities caused by cystic or necrotic nerve tissues should be reduced as much as possible,
文摘BACKGROUND: Hepatic hilar cholangiocarcinoma can be diagnosed early with the progress in diagnostic imaging, and thus the rate of resection of the tumor has increased markedly. To assess the effectiveness of resection, we reviewed 185 cases of hepatic hilar cholangiocarcinoma diagnosed and treated at our hospital. METHODS: The clinical data of 185 patients with hepatic hilar cholangiocarcinoma who had been treated surgically from 1972 to 2006 were retrospectively analyzed. RESULTS: The records of the 185 patients were divided into first stage (1972-1986) or second stage (1987-2006) according to the incidence of the tumor and its resection rate. Primary symptoms included upper abdominal discomfort or pain, anorexia, tiredness, weight loss and progressive jaundice. Ultrasonography, computed tomography (CT), magnetic resonance imaging (MRI), and magnetic resonance cholangiopancreatography (MRCP) were first line methods for atraumatic diagnosis. If the patients displayed intrahepatic bile duct dilatation or were diagnosed as suffering from extrahepatic obstructive jaundice, percutaneous transhepatic cholangiography (PTC), MRCP or endoscopic retrograde cholangiopancreatography (ERCP) should be used. In this series, 87 patients underwent resection of the tumor (47.0%). Of the 87 patients, 43 received radical resection and 44 palliative resection. Fifteen patients underwent resection in the first stage and 72 in the second stage. A total of 74 patients were followed up after the resection. The median survival time of the radical resection group was 37 months and that of the palliative resection group was 17 months (P<0.001). The other 62 patients receiving no resection died within 1.5 years. CONCLUSIONS: Once patients are diagnosed with hepatic hilar cholangiocarcinoma, they should undergo exploratory laparotomy. Resection is the most effective method for the treatment of hepatic hilar cholangiocarcinoma.
基金supported by a grant:the"QingLan"projectthe Department of Education of Jiangsu province,No.(JX10210540 /DG216G15020)
文摘Objective： To investigate the clinical characteristics, diagnosis and surgical treatment of intravenous leiomyomatosis （IVL）, and outline the differences between Chinese and overseas cases. Methods： Clinical data of two IVL cases, treated in our hospital, were analyzed retrospectively and the related literature was also reviewed. The data of preoperative diagnostic rate, surgical procedures, and postoperative recurrence between patients in China and other countries were compared. Results： The first stage operation was performed successfully in 2 patients. However, they refused subsequent therapies, including a second stage operation to excise the remnants Of the tumor, uterus, bilateral oviducts and ovaries, and anti-estrogen therapy. Both suffered from IVL recurrence, one at 6-month and the other at 9-month, and died at 16-month and 12-month respectively after the first stage surgery. Worldwide reports of 110 IVL cases were reviewed, which included 28 cases in China and 82 cases in other countries. In the majority of the Chinese patients, tumors only extended into the fight atrium rather than the right ventricle （RA 22 cases vs RV 4 cases）. However, among the overseas patients, the rate of extension into the right atrium was similar to that of extension into the right ventricle （RA 41 cases vs RV 38 cases）. The rate of hysterectomies was not significantly different between Chinese and overseas patients （ 67.86% vs 55.9%, P=0.278）. The rate of correct preoperative diagnosis in the Chinese patients was significantly lower than that in the overseas patients （32.14% vs 80%, P=0.000002.）, as well asthe rate of complete excision of the tumor （22.7@0 vs 75.5%, P=0.000001）. The proportion of patients who undergoing a single-stage or a two-stage operation was similar in Chinese and overseas patients. The recurrence rate was significantly higher in the Chinese patients than in the overseas patients （36.8% vs 9.1%, P=0.0055）, and the patients with tumor recurrence were partial tumor excision patients. Conclusion： The possibility of IVL should be considered if echocardiography in female patients demonstrates a tumor in the right heart and a mass in the inferior vena cava （IVC）. Further imaging should be performed to confirm the diagnosis. The correct diagnosis and accurate preoperative delineation of tumor extension are essential for an optimal surgical outcome. The key point in IVL treatment is the complete excision of tumors （single-stage or two-stage surgical procedure）.
基金the Xiangshan County Science and Technology Bureau,Project Name Regional Quality Control on the Impact and Value of Endoscopic Screening for Intestinal Adenomas,No.2022C6018.
文摘BACKGROUND Patients with gastrointestinal tumors often suffer from poor nutritional status during treatment.Surgery is the main treatment for these patients,but the long postoperative recovery period is often accompanied by digestive and absorption dysfunction,leading to further deterioration of the nutritional status.Early enteral nutrition support is hypothesized to be helpful in improving this situation,but the exact effects have yet to be studied in depth.AIM To observe the effect of early enteral nutritional support on postoperative recovery in patients with surgically treated gastrointestinal tract tumors,with the expectation that by improving the nutritional status of patients,the recovery process would be accelerated and the incidence of complications would be reduced,thus improving the quality of life.METHODS A retrospective analysis of 121 patients with gastrointestinal tract tumors treated in our hospital from January 2020 to January 2023 was performed.Fifty-three of these patients received complete parenteral nutrition support as the control group for this study.The other 68 patients received early enteral nutritional support as the observation group of this study.The clinical indicators comparing the two groups included time to fever,time to recovery of postoperative bowel function,time to postoperative exhaustion,and length of hospital stay.The changes in immune function and nutritional indexes in the two groups were compared.Furthermore,we utilized the SF-36 scale to compare the changes in the quality of life between the two groups of patients.Finally,the occurrence of postoperative complications between the two patient groups was also compared.RESULTS The postoperative fever time,postoperative bowel function recovery time,postoperative exhaustion time,and hospitalization time were all higher in the control group than in the observation group(P<0.05).The levels of CD3+,CD4+,immunoglobulin(Ig)A,IgM,and IgG in the observation group were significantly higher than those in the control group at 1 d and 7 d postoperatively,while CD8+was lower than in the control group(P<0.05).Total protein,albumin,prealbumin,and transferrin levels were significantly higher in the observation group than in the control group at 7 d postoperatively(P<0.05).The SF-36 scores of patients in the observation group were significantly higher than those in the control group(P<0.0001).The overall incidence of adverse reactions after the intervention was significantly lower in the control group than in the observation group(P=0.021).CONCLUSION We found that patients with gastrointestinal tumors are nutritionally vulnerable,and early enteral nutrition support programs can improve the nutritional status of patients and speed up postoperative recovery.This program can not only improve the immune function of the patient and protect the intestinal function,but it can also help to improve the quality of life of the patient.However,this program will increase the incidence of complications in patients.Caution should be taken when adopting early enteral nutrition support measures for patients with gastric cancer.The patient's condition and physical condition should be comprehensively evaluated and closely monitored to prevent possible complications.
基金supported by Central University Independent Innovation Fund of China(No.2015ZHYX009)
文摘The clinical value of transvaginal ultrasound in clinical surgical treatment of cesarean scar pregnancy（CSP） was evaluated. The clinical data of 104 patients with CSP admitted at Tongji Hospital from 2013 to 2016 were collected and analyzed retrospectively, including the patients＇ age, gestational age, the size of gestational sac or uneven mass, the uterine scar thickness, β human chorionic gonadotropin（h CG） levels and so on. Of these 104 cases, 30 cases were subjected to laparotomy, 29 cases to laparoscopy, 27 cases to hysteroscopy, 16 cases to ultrasound-guided uterine curettage, and 2 cases to conservative treatment. The transvaginal ultrasound showed that uterine scar thickness and gestational sac or uneven mass size had significant difference（P〈0.05） among different surgical methods by comparatively analyzing the patients＇ data. It was suggested that transvaginal ultrasound may provide the valuable reference for choosing clinical surgical procedures for CSP.
文摘We read the article titled,“Long-term follow-up of liver alveolar echinococcosis using echinococcosis multilocularis ultrasound classification,”by Schuhbaur J with great interest.However,we found some worthwhile issues that we believe should be discussed with the authors,and have provided our comments in this letter.It would be valuable if the authors could provide further information about the clinical stages,follow-up time,and clinical outcomes of the patients.
文摘BACKGROUND Spontaneous cerebrospinal fluid(CSF)leaks associated with cervical spondylosis are rare.To our knowledge,only a few cases have been reported in which treatment is challenging and varies from case to case.Here,we review the literature and describe the surgical treatment of a 70-year-old woman who presented with a CSF leak due to a cervical spine spur.CASE SUMMARY A 70-year-old female patient who was treated for a cerebral infarction,presented with complains of weakness in the right lower extremity and a feeling of stepping on cotton.The patient underwent regular neck massage and presented with neck and right shoulder pain radiating to the right upper extremity one-month ago.Magnetic resonance imaging showed a strip of leaking cerebrospinal fluid posterior to the C1-4 vertebrae,and computed tomography showed a“sickleshaped”disc prolapse with calcification in C4/5.We chose to perform an anterior cervical discectomy.When the prolapsed C4/5 disc was scraped,clear fluid leakage was observed,and exploration revealed a 1 mm diameter rupture in the anterior aspect of the dura mater,which was compressed continuously with cotton patties,with no significant cerebrospinal fluid leakage after 1 h.CONCLUSION Three months after surgery,the patient was asymptomatic and follow-up imaging demonstrated complete resolution.
