AIM To analyze the clinicopathologic risk factors in hepatocellular carcinoma recurrence after surgery. METHODS Significance test (χ 2 and Student t test) of the single and multiple factors, and Wilcoxon Cox ...AIM To analyze the clinicopathologic risk factors in hepatocellular carcinoma recurrence after surgery. METHODS Significance test (χ 2 and Student t test) of the single and multiple factors, and Wilcoxon Cox tropic examination were used, a retrospective clinicopathologic analysis was made in 156 cases of hepatocellular carcinoma after hepatectomy. RESULTS Of the 156 cases, 68 4%, 57 3%, 46 7%, 31 5% and 28 6% had 1, 2, 3, 4 and 5 postoperative tumor free years respectively with a total recurrence rate of 53 2% (83/156). In the 83 recurrent cases, 65 were of intrahepatic sabclinical type, with a re resection rate of 78 3% (65/83). The relevant factors involved in recurrence were: males, tumor number and size, capsule infiltration, portal veins involvement, etc. Those factors obviously influenced the prognosis of the patients with postoperative hepatocellular carcinoma ( P <0 05). 63 1% tumor nodes (41/65) of recurrent liver cancinomas were located at the ipsilateral segment of the primary ones. CONCLUSION Males, tumor number and size, capsule infiltration and portal veins involvement are the factors for postoperative hepatocellular carcinoma recurrence after surgery. The recurrence is mainly unicentral. Right front lobe is the liver segment with a high recurrence rate.展开更多
AIM:To investigate the role of neoadjuvant chemoradiotherapy in prognosis and surgery for esophageal carcinoma by a meta-analysis.METHODS:PubMed and manual searches were done to identify all published randomized contr...AIM:To investigate the role of neoadjuvant chemoradiotherapy in prognosis and surgery for esophageal carcinoma by a meta-analysis.METHODS:PubMed and manual searches were done to identify all published randomized controlled trials(RCTs) that compared neoadjuvant chemoradiotherapy plus surgery(CRTS) with surgery alone(S) for esophageal cancer.According to the test of heterogeneity,a fi xed-effect model or a random effect model was used and the odds ratio(OR) was the principal measure of effects.RESULTS:Fourteen RCTs that included 1737 patients were selected with quality assessment ranging from A to C(Cochrane Reviewers' Handbook 4.2.2).OR(95% CI,P value),expressed as CRTS vs S(values>1 favor CRTS arm),was 1.19(0.94-1.48,P=0.28) for 1-year survival,1.33(1.07-1.65,P=0.69) for 2-year survival,1.76(1.42-2.19,P=0.11) for 3-year survival,1.41(1.06-1.87,P=0.11) for 4-year survival,1.64(1.28-2.12,P=0.40) for 5-year survival,0.82(0.39-1.73,P<0.0001) for rate of resection,1.53(1.33-2.84,P=0.007) for rate of complete resection,1.78(1.14-2.78,P=0.79) for operative mortality,1.12(0.89-2.48,P=0.503) for all treatment mortality,1.33(0.94-1.88,P=0.04) for the rate of adverse treatment,1.38(1.23-1.63,P=0.0002) for local-regional cancer recurrence,1.28(0.85-1.58,P=0.60) for distant cancer recurrence,and 1.27(0.86-1.65,P=0.19) for all cancer recurrence.A complete pathological response to chemoradiotherapy occurred in 10%-45.5% of patients.The 5-year survival benefi t was most pronounced when chemotherapy and radiotherapy were given concurrently(OR:1.45,95% CI:1.26-1.79,P=0.015) instead of sequentially(OR:0.85,95% CI:0.64-1.35,P=0.26).CONCLUSION:Compared with surgery alone,neoadjuvant chemoradiotherapy can improve the long-term survival and reduce local-regional cancer recurrence.Concurrent administration of neoadjuvant chemoradiotherapy was superior to sequential chemoradiotherapy.展开更多
INTRODUCTIONLiver surgery,was started in the late 1950s in Chinaand has developed rapidly in the past 40 years.The study on the diagnosis and treatment of primaryliver cancer in China underwent four stages:①Inthe 195...INTRODUCTIONLiver surgery,was started in the late 1950s in Chinaand has developed rapidly in the past 40 years.The study on the diagnosis and treatment of primaryliver cancer in China underwent four stages:①Inthe 1950s,the anatomical study of the liver lay asolid foundation for liver resection.①In展开更多
AIMS We report 15 cases of abdominal-surgical multiple organ failure(MOF)treated successfully by a new combined therapy four high doses in volume and one support“FHDOS”short period high doses in large volume anJsoda...AIMS We report 15 cases of abdominal-surgical multiple organ failure(MOF)treated successfully by a new combined therapy four high doses in volume and one support“FHDOS”short period high doses in large volume anJsodaminum;short period high doses in large volume dexamethasonum;high doses in large volume of dis- infectant antibiotics;high doses in large volume of abdominal cav- ity washing liquor and support of nutrition metabolism.The mortal- ity rate and cost of MOF were decreased.It is simple,practical and effective. METHODS The study group consisted of 15 patients(10 wom- en,5 men;average age,42.7)who were hospitalized in our hospital.All patients were given“FHDOS”:short period high in large volume Anisodaminum:intravenous injection 40 mg once; another 40rag may be added 30 minutes later according to condition.The total amount may reach 120-240 mg a day,or,in- travenous injection 40 mg every 15 minutes until condition being under control.Short period high doses in large volume Dexamethasonum:intravenous injection 100-200 mg once;this remedy may be continued for 1-3 days;the amount also may de- crease according to condition.High doses in large volume of dis- infectant Antibiotics:select and use antibiotics according to clini- cal condition,inference of Gram's stain;it is necessary to re- peatedly culture bacteria in many parts,and then,to make ad- justment according to culture result and drug-resistance,and to prevent carefully the dual infections from occurring.High doses in large volume of abdominal cavity washing liquor:generally adopt- ing physiological saline 6000o8000ml in washing abdominal cavity. “One support”means full support of nutrition metabolism. RESULTS All the patients in this group survive well after the rescue without any complication. CONCLUSIONS MOF should be prevented,if possible,by stopping or controlling the injury,removing as much necrotic tis- sue as possible,improving blood flow and oxygen consumption, supporting metabolism,and preventing infection or treating it ear- ly and adequately.“FHDOS”is a combined therapy and plays a key role in treating MOF.展开更多
Objective:The purpose of our study was to investigate the feasibility and short-term therapeutic effects of laparoscopic staging operation in women with endometrial carcinoma.Methods:We analyzed 86 patients with endom...Objective:The purpose of our study was to investigate the feasibility and short-term therapeutic effects of laparoscopic staging operation in women with endometrial carcinoma.Methods:We analyzed 86 patients with endometrial carcinoma in PLA general hospital between 2006 and 2009 retrospectively.Thirty-nine patients were performed laparoscopic modified radical hysterectomy plus systemic retroperitoneal lymphadenectomy.Forty-seven patients received traditional abdominal radical hysterectomy plus systemic retroperitoneal lymphadenectomy.We compared the operation time,blood loss,number of lymph nodes retrieved,time for restoration of gastrointestinal function,postoperative complications and morbidity,the incidence of wound infection,the length of hospital stay,and hospital charges.Results:There was no significant deviation between the two groups in age,clinical stage,and pathology.We found that there was no significant deviation between the two groups in the number of lymph nodes retrieved,postoperative complications,the rate of wound infection or hospital charge(P > 0.05).The laparoscopic group had an advantage in blood loss,time for restoration of gastrointestinal function,time for postoperative hospital stay(P < 0.05).Conclusion:Laparoscopic surgery,as a primary surgical intervention,seems to be a safe and feasible option especially in patients with early endometrial cancer.展开更多
AIMS To report the first experience in China in the treatment of malignant biliary obstruction with expand- able metal stent which allows the insertion of an endo- prosthesis as large as one cm in diameter. METHODS Be...AIMS To report the first experience in China in the treatment of malignant biliary obstruction with expand- able metal stent which allows the insertion of an endo- prosthesis as large as one cm in diameter. METHODS Between April 1994 and May 1996,we implanted expandable metal stents in 57 patients with incurable malignant biliary obstruction,among whom 54 underwent endoscopic procedure and the other 3 re- ceived percutaneous transhepatic placement. RESULTS Insertion of the stent following guidewire positioning was successful in 95% of the patients. Two patients developed cholangitis after stent insertion and were successfully treated with conservative treatment. The jaundice was eliminated completely in 21 cases and markedly decreased in 23 cases within 2 weeks af- ter placement of the stent. Nine patients,however, had late cholangitis due to stent failure after a median interval of 14 days. Twenty-three cases underwent na- sobiliary transient drainage and 3 underwent plastic stent transient drainage prior to metal stent insertion. Transient drainage was believed to have the advan- tages of drainage pre-assessment and infection controlling. CONCLUSIONS Our results show that expandable metal stent is suitable for the irresectable malignant choledochal stenosis. It can eliminate the jaundice and improve the patient's life quality. To get the highest benefit,however,the indication should be strictly selected. And to get long-term patency,the proximal and distal end of the stent proceeding the tumor should be no shorter than 2cm. In the case of hilar cancer, Bismuth classification is greatly helpful for the choice of drainage site.展开更多
AIM To summarize the experience in the clinical treatment of the biliary ductal strictures complicating localized left hepatolithiasis in recent two decades.
AIM To evaluate the curative effect of pylorus and pyloric vagus-preserving gastrectomy (PPVPG) on peptic ulcer.METHODS Treating 132 cases of GU and DU with PPVPG, and comparative studies made with 24 cases treated wi...AIM To evaluate the curative effect of pylorus and pyloric vagus-preserving gastrectomy (PPVPG) on peptic ulcer.METHODS Treating 132 cases of GU and DU with PPVPG, and comparative studies made with 24 cases treated with Billroth Ⅰ (BⅠ) and 20 cases with Billroth Ⅱ (BⅡ); advantages and shortcomings evaluated.RESULTS Not a single death after PPVPG. No recurrence of the disorder in the subsequent follow-up for an average of 6.5 years. Curative effect (visik Ⅰ & Ⅱ) 97.7%. Acidity reduction similar to that found in BⅠ and BⅡ, but 97.7% of the BⅠ and all BⅡ cases having more than second degree intestinal fluid reflux, in contrast to 7.1% in PPVPG cases. Dumping syndrome occurred in the BⅠ and BⅡ cases, none in PPVPG cases. With regard to gastric emptying, food digestion, absorption, body weight and life quality, PPVPG proved to be superior to Billroth procedure.CONCLUSION PPVPG has the advantages of conventional Billroth gastrectomy in reducing acid, removing ulcer focus, and at the same time preserves the pylorus and pyloric vagus for maintaining the normal gastric physiological function. Dumping syndrome, intestinal fluid reflux and other complications of conventional gastrectomy may be avoided.展开更多
AIM To evaluate the curative effect of stage Ⅱ surgical resection of hepatocellular carcinoma after TAE. METHODS Thirty eight patients with unresectable hepatocellular carcinoma were treated by transcatheter arte...AIM To evaluate the curative effect of stage Ⅱ surgical resection of hepatocellular carcinoma after TAE. METHODS Thirty eight patients with unresectable hepatocellular carcinoma were treated by transcatheter arterial embolization (TAE). When the sizes of tumors were markedly reduced after TAE, stage Ⅱ surgical resections were performed. RESULTS Before TAE, the diameters of tumors were 12 84cm±4 87cm ( ±s ), but reduced to 5 12cm±1 82cm ( ±s ) after TAE ( P <0 001). Pathologic examination of the resected specimens revealed obvious necrosis in most cases. After surgery, 26 patients were alive, with the longest survival of 96 months, twelve died and 10 had tumor recurrence. CONCLUSION Patients in moderate and advanced stages of hepatocellular carcinoma after TAE should be treated surgically, but the indication must be controlled strictly.展开更多
AIMS Using a new approach of regional adjuvant chemotherapy to prevent cancer cells hepatic metasta- sis after radical surgery of large bowel cancer. METHODS A model of liver with metastasis of hu- man colonic cancer ...AIMS Using a new approach of regional adjuvant chemotherapy to prevent cancer cells hepatic metasta- sis after radical surgery of large bowel cancer. METHODS A model of liver with metastasis of hu- man colonic cancer (HCC) cells in nude mice was used to observe the effect in prevention of metastasis of HCC cells inoculated via spleen applied with early postoper- ative intraperitoneal (IP) chemotherapy using large dose of 5-FU. RESULTS The incidence of metastasis to liver was decreased by 40%,the mean number of metastatic liv- er nodules in each animal was reduced by 50.89% and the mean survival times of each animal was prolonged by 48.21% by using 5-FU 40 mg/NS 40 ml/kg IP for two consecutive days as compared with the controls. CONCLUSIONS IP is a new and more effective re- gional adjuvant chemotheraputic approach in the pre- vention of liver metastasis HCC cells after radical surgery of large bowel cancer.展开更多
The purpose of the present article is to present an unusual case of internal herniation. In this case small bowl obstruction was due to congenital right trans-mesocolic hernia which had the right ureter at the neck of...The purpose of the present article is to present an unusual case of internal herniation. In this case small bowl obstruction was due to congenital right trans-mesocolic hernia which had the right ureter at the neck of the sac forming a constriction band. This requires careful widening of neck of hernia, so as to avoid iatrogenic trauma to ureter. This unusual presentation needs dissemination as this type of internal hernia is extremely rare.展开更多
Introduction: Intraoperative nerve monitoring is used in otolaryngology to assist in identification of nerves at risk. It is hoped that this will lead to lower rates of nerve injury. The objective of this study was to...Introduction: Intraoperative nerve monitoring is used in otolaryngology to assist in identification of nerves at risk. It is hoped that this will lead to lower rates of nerve injury. The objective of this study was to quantify the use of monitoring technology in current clinical practice. Method: An electronic survey was distributed to 376 registered fellows of the Australian Society of Head and Neck Surgery. Results: One-hundred and twenty-five responses were obtained. The majority of respondents report using monitoring at least some of the time during thyroid, parotid, and mastoid surgery (80%, 87%, and 73% respectively). Predictors of use include experience with intraoperative monitoring during training, and high caseloads in parotid surgery. Practice setting did not predict use. Conclusion: Despite equivocal evidence that intraoperative nerve monitoring is associated with a reduction in nerve injuries, this study demonstrates that the technology is widely used amongst otolaryngologists.展开更多
INTRODUCTIONAlthough the long-term postoperative survival rateof gastric cancer(GC) patients has been improvedsignificantly since the local dissection of lymph nodewas widely used in China,yet the low curativeresectio...INTRODUCTIONAlthough the long-term postoperative survival rateof gastric cancer(GC) patients has been improvedsignificantly since the local dissection of lymph nodewas widely used in China,yet the low curativeresection rate and the high recurrence rate fromperitoneal and hepatic metastases hinder it fromfurther improvement.To alter the currentunsatisfactory status of GC treatment,a展开更多
INTRODUCTIONCarcinoembryonic antigen ( CEA) , originally described by Gold and Freedman [1] in 1965, is now an acknowledged member of immunoglobulin superfamily[2],with a role as an intracellular adhesion molecule[3]....INTRODUCTIONCarcinoembryonic antigen ( CEA) , originally described by Gold and Freedman [1] in 1965, is now an acknowledged member of immunoglobulin superfamily[2],with a role as an intracellular adhesion molecule[3].Carbohydrate antigen 19-9(CA19-9), obtained with a monoclonal antibody produced by immunizing a monoclonal antibody produced by immunizing a mouse with a colonic cancer cell line in 1979[4],is a ligand for E-selectin that plays an important role in the addhesion of cancer cells to endothelial cells [5,6].展开更多
INTRODUCTIONCurrently the major treatment choices for shortbowel syndrome are parenteral nutrition and smallbowel transplantation.Both therapies involvegreat fiscal challenge and recurring complications.Recent years h...INTRODUCTIONCurrently the major treatment choices for shortbowel syndrome are parenteral nutrition and smallbowel transplantation.Both therapies involvegreat fiscal challenge and recurring complications.Recent years have witnessed the promisingexperimental results of pharmacologicalrehabilitation of remnant small bowel.展开更多
Colorectal cancer (CRC) is the 3<sup>rd</sup> most common cancer in the United States with more than 10000 new cases diagnosed annually. Approximately 20% of patients with CRC will have distant metastasis ...Colorectal cancer (CRC) is the 3<sup>rd</sup> most common cancer in the United States with more than 10000 new cases diagnosed annually. Approximately 20% of patients with CRC will have distant metastasis at time of diagnosis, making them poor candidates for primary surgical resection. Similarly, 8%-25% of patients with CRC will present with bowel obstruction and will require palliative therapy. Emergent surgical decompression has a high mortality and morbidity, and often leads to a colostomy which impairs the patient’s quality of life. In the last decade, there has been an increasing use of colonic stents for palliative therapy to relieve malignant colonic obstruction. Colonic stents have been shown to be effective and safe to treat obstruction from CRC, and are now the therapy of choice in this scenario. In the setting of an acute bowel obstruction in patients with potentially resectable colon cancer, stents may be used to delay surgery and thus allow for decompression, adequate bowel preparation, and optimization of the patient’s condition for curative surgical intervention. An overall complication rate (major and minor) of up to 25% has been associated with the procedure. Long term failure of stents may result from stent migration and tumor ingrowth. In the majority of cases, repeat stenting or surgical intervention can successfully overcome these adverse effects.展开更多
Recently, there has been a change in the strategy of how synchronous colorectal hepatic metastases are attributed to the development of more valuable protocols of chemotherapy and radiotherapy for neoadjuvant treatmen...Recently, there has been a change in the strategy of how synchronous colorectal hepatic metastases are attributed to the development of more valuable protocols of chemotherapy and radiotherapy for neoadjuvant treatment of colorectal neoplasms and their hepatic metastases. There is a consensus that patients with synchronous colorectal hepatic metastases have lower survival than those with metachronous colorectal hepatic metastases. Currently, controversy remains concerning the best approach is sequence in a patient with colorectal cancer and synchronous hepatic metastases resection. To obtain a better patient selection, the authors have suggested the initial realization of systemic chemotherapy in the circumstance of patients with colorectal tumor stage Ⅳ, since these patients have a systemic disease. The rationale behind this liver-first strategy is initially the control of synchronous hepatic metastases of colorectal carcinoma, which can optimize a potentially curative hepatic resection and longstanding survival. The liver-first strategy procedure is indicated for patients with colorectal hepatic metastases who require downstaging therapy to make a curative liver resection possible. Thus, the liver-first strategy is considered an option in cases of rectal carcinoma in the early stage and with limited or advanced synchronous colorectal hepatic metastases or in case of patients with asymptomatic colorectal carcinoma, but with extensive liver metastases. Patients undergoing systemic chemotherapy and with progression of neoplastic disease should not undergo hepatic resection, because it does not change the prognosis and may even make it worse. To date, there have been no randomized controlled trials on surgical approach of colorectal synchronous hepatic metastases, despite the relatively high number of available manuscripts on this subject. All of these published studies are observational, usually retrospective, and often non-comparative. The patient selection criteria for the liver-first strategy should be individualized, and the approach of these patients should be performed by a multidisciplinary team so its benefits will be fully realized.展开更多
BACKGROUND: Hilar cholangiocarcinoma has a low radi-cal resection rate and a poor long-term survival rate. In re-cent years, its prognosis has been improved with advance-ment of preoperative diagnostic techniques and ...BACKGROUND: Hilar cholangiocarcinoma has a low radi-cal resection rate and a poor long-term survival rate. In re-cent years, its prognosis has been improved with advance-ment of preoperative diagnostic techniques and surgicaltechniques. The aim of this study was to evaluate the prog-nostic factors of hilar cholangiocarcinoma and the relationsof surgical procedure to the prognosis of the carcinoma.METHODS: A retrospective cohort study was done in 198patients with hilar cholangiocarcinoma (117 men and 81women, aged from 27 to 81 years) , who had been admit-ted to this hospital from December 1997 to December 2002.Their symptoms were jaundice (94.5%), pruritus (56.6%)and abdominal pain (33.8%). Bismuth-Corlette classifica-tion showed type in 14 patients, type in 19, type in12, type in 15, type in 112, and unclassifiable typein 26. 144 patients underwent laparotomy and others re-ceived bile drainage endoscopically (including endoscopicretrograde biliary drainage (ERBD) or endoscopic metalbiliary endoprosthesis (EMBE) in 21 patients, endoscopicnose-biliary drainage (ENBD) in 31 or percutaneous trans-hepatic cholangiodrainage in 2. 120 patients (83.3%) re-ceived tumor resection including radical resection in 59 pa-tients (41.0%). Twenty-three patients underwent paunchedbiliary exploration and drainage.RESULTS: Cox' s regression model analysis showed thatoccupation, preoperative total serum bilirubin level, opera-tive procedure and postoperative adjuvant radiation weresignificantly related to postoperative survival rate in con-trast to gender, age, choledocholithiasis, hepatitis, preope-rative serum CA19-9 level, Bismuth-Corlette type, his-topathologic grading and postoperative chemotherapy. Thesurvival of patients in groups of biliary drainage, palliativeresection and radical resection differed statistically and pro-longed in a descending order. No statistical difference wasfound between ERBD or EMBE group and palliative resec-tion group. So was between ERBD or EMBE group andbiliary drainage group, or between ENBD group and biliarydrainage group. The survival differed statistically betweenERBD or EMBE group and ENBD group.CONCLUSIONS: Operative procedure is the most impor-tant prognostic factor affecting the operative results of hilarcholangiocarcinoma. Radical resection is still the primarymeasure for a cure and long-term survival of the patients.For patients with irresectable hilar cholangiocarcinoma, noevidence has shown that the prognosis after treatment ofERBD or EMBE is poorer than that after laparotomy.展开更多
文摘AIM To analyze the clinicopathologic risk factors in hepatocellular carcinoma recurrence after surgery. METHODS Significance test (χ 2 and Student t test) of the single and multiple factors, and Wilcoxon Cox tropic examination were used, a retrospective clinicopathologic analysis was made in 156 cases of hepatocellular carcinoma after hepatectomy. RESULTS Of the 156 cases, 68 4%, 57 3%, 46 7%, 31 5% and 28 6% had 1, 2, 3, 4 and 5 postoperative tumor free years respectively with a total recurrence rate of 53 2% (83/156). In the 83 recurrent cases, 65 were of intrahepatic sabclinical type, with a re resection rate of 78 3% (65/83). The relevant factors involved in recurrence were: males, tumor number and size, capsule infiltration, portal veins involvement, etc. Those factors obviously influenced the prognosis of the patients with postoperative hepatocellular carcinoma ( P <0 05). 63 1% tumor nodes (41/65) of recurrent liver cancinomas were located at the ipsilateral segment of the primary ones. CONCLUSION Males, tumor number and size, capsule infiltration and portal veins involvement are the factors for postoperative hepatocellular carcinoma recurrence after surgery. The recurrence is mainly unicentral. Right front lobe is the liver segment with a high recurrence rate.
文摘AIM:To investigate the role of neoadjuvant chemoradiotherapy in prognosis and surgery for esophageal carcinoma by a meta-analysis.METHODS:PubMed and manual searches were done to identify all published randomized controlled trials(RCTs) that compared neoadjuvant chemoradiotherapy plus surgery(CRTS) with surgery alone(S) for esophageal cancer.According to the test of heterogeneity,a fi xed-effect model or a random effect model was used and the odds ratio(OR) was the principal measure of effects.RESULTS:Fourteen RCTs that included 1737 patients were selected with quality assessment ranging from A to C(Cochrane Reviewers' Handbook 4.2.2).OR(95% CI,P value),expressed as CRTS vs S(values>1 favor CRTS arm),was 1.19(0.94-1.48,P=0.28) for 1-year survival,1.33(1.07-1.65,P=0.69) for 2-year survival,1.76(1.42-2.19,P=0.11) for 3-year survival,1.41(1.06-1.87,P=0.11) for 4-year survival,1.64(1.28-2.12,P=0.40) for 5-year survival,0.82(0.39-1.73,P<0.0001) for rate of resection,1.53(1.33-2.84,P=0.007) for rate of complete resection,1.78(1.14-2.78,P=0.79) for operative mortality,1.12(0.89-2.48,P=0.503) for all treatment mortality,1.33(0.94-1.88,P=0.04) for the rate of adverse treatment,1.38(1.23-1.63,P=0.0002) for local-regional cancer recurrence,1.28(0.85-1.58,P=0.60) for distant cancer recurrence,and 1.27(0.86-1.65,P=0.19) for all cancer recurrence.A complete pathological response to chemoradiotherapy occurred in 10%-45.5% of patients.The 5-year survival benefi t was most pronounced when chemotherapy and radiotherapy were given concurrently(OR:1.45,95% CI:1.26-1.79,P=0.015) instead of sequentially(OR:0.85,95% CI:0.64-1.35,P=0.26).CONCLUSION:Compared with surgery alone,neoadjuvant chemoradiotherapy can improve the long-term survival and reduce local-regional cancer recurrence.Concurrent administration of neoadjuvant chemoradiotherapy was superior to sequential chemoradiotherapy.
文摘INTRODUCTIONLiver surgery,was started in the late 1950s in Chinaand has developed rapidly in the past 40 years.The study on the diagnosis and treatment of primaryliver cancer in China underwent four stages:①Inthe 1950s,the anatomical study of the liver lay asolid foundation for liver resection.①In
文摘AIMS We report 15 cases of abdominal-surgical multiple organ failure(MOF)treated successfully by a new combined therapy four high doses in volume and one support“FHDOS”short period high doses in large volume anJsodaminum;short period high doses in large volume dexamethasonum;high doses in large volume of dis- infectant antibiotics;high doses in large volume of abdominal cav- ity washing liquor and support of nutrition metabolism.The mortal- ity rate and cost of MOF were decreased.It is simple,practical and effective. METHODS The study group consisted of 15 patients(10 wom- en,5 men;average age,42.7)who were hospitalized in our hospital.All patients were given“FHDOS”:short period high in large volume Anisodaminum:intravenous injection 40 mg once; another 40rag may be added 30 minutes later according to condition.The total amount may reach 120-240 mg a day,or,in- travenous injection 40 mg every 15 minutes until condition being under control.Short period high doses in large volume Dexamethasonum:intravenous injection 100-200 mg once;this remedy may be continued for 1-3 days;the amount also may de- crease according to condition.High doses in large volume of dis- infectant Antibiotics:select and use antibiotics according to clini- cal condition,inference of Gram's stain;it is necessary to re- peatedly culture bacteria in many parts,and then,to make ad- justment according to culture result and drug-resistance,and to prevent carefully the dual infections from occurring.High doses in large volume of abdominal cavity washing liquor:generally adopt- ing physiological saline 6000o8000ml in washing abdominal cavity. “One support”means full support of nutrition metabolism. RESULTS All the patients in this group survive well after the rescue without any complication. CONCLUSIONS MOF should be prevented,if possible,by stopping or controlling the injury,removing as much necrotic tis- sue as possible,improving blood flow and oxygen consumption, supporting metabolism,and preventing infection or treating it ear- ly and adequately.“FHDOS”is a combined therapy and plays a key role in treating MOF.
文摘Objective:The purpose of our study was to investigate the feasibility and short-term therapeutic effects of laparoscopic staging operation in women with endometrial carcinoma.Methods:We analyzed 86 patients with endometrial carcinoma in PLA general hospital between 2006 and 2009 retrospectively.Thirty-nine patients were performed laparoscopic modified radical hysterectomy plus systemic retroperitoneal lymphadenectomy.Forty-seven patients received traditional abdominal radical hysterectomy plus systemic retroperitoneal lymphadenectomy.We compared the operation time,blood loss,number of lymph nodes retrieved,time for restoration of gastrointestinal function,postoperative complications and morbidity,the incidence of wound infection,the length of hospital stay,and hospital charges.Results:There was no significant deviation between the two groups in age,clinical stage,and pathology.We found that there was no significant deviation between the two groups in the number of lymph nodes retrieved,postoperative complications,the rate of wound infection or hospital charge(P > 0.05).The laparoscopic group had an advantage in blood loss,time for restoration of gastrointestinal function,time for postoperative hospital stay(P < 0.05).Conclusion:Laparoscopic surgery,as a primary surgical intervention,seems to be a safe and feasible option especially in patients with early endometrial cancer.
文摘AIMS To report the first experience in China in the treatment of malignant biliary obstruction with expand- able metal stent which allows the insertion of an endo- prosthesis as large as one cm in diameter. METHODS Between April 1994 and May 1996,we implanted expandable metal stents in 57 patients with incurable malignant biliary obstruction,among whom 54 underwent endoscopic procedure and the other 3 re- ceived percutaneous transhepatic placement. RESULTS Insertion of the stent following guidewire positioning was successful in 95% of the patients. Two patients developed cholangitis after stent insertion and were successfully treated with conservative treatment. The jaundice was eliminated completely in 21 cases and markedly decreased in 23 cases within 2 weeks af- ter placement of the stent. Nine patients,however, had late cholangitis due to stent failure after a median interval of 14 days. Twenty-three cases underwent na- sobiliary transient drainage and 3 underwent plastic stent transient drainage prior to metal stent insertion. Transient drainage was believed to have the advan- tages of drainage pre-assessment and infection controlling. CONCLUSIONS Our results show that expandable metal stent is suitable for the irresectable malignant choledochal stenosis. It can eliminate the jaundice and improve the patient's life quality. To get the highest benefit,however,the indication should be strictly selected. And to get long-term patency,the proximal and distal end of the stent proceeding the tumor should be no shorter than 2cm. In the case of hilar cancer, Bismuth classification is greatly helpful for the choice of drainage site.
文摘AIM To summarize the experience in the clinical treatment of the biliary ductal strictures complicating localized left hepatolithiasis in recent two decades.
文摘AIM To evaluate the curative effect of pylorus and pyloric vagus-preserving gastrectomy (PPVPG) on peptic ulcer.METHODS Treating 132 cases of GU and DU with PPVPG, and comparative studies made with 24 cases treated with Billroth Ⅰ (BⅠ) and 20 cases with Billroth Ⅱ (BⅡ); advantages and shortcomings evaluated.RESULTS Not a single death after PPVPG. No recurrence of the disorder in the subsequent follow-up for an average of 6.5 years. Curative effect (visik Ⅰ & Ⅱ) 97.7%. Acidity reduction similar to that found in BⅠ and BⅡ, but 97.7% of the BⅠ and all BⅡ cases having more than second degree intestinal fluid reflux, in contrast to 7.1% in PPVPG cases. Dumping syndrome occurred in the BⅠ and BⅡ cases, none in PPVPG cases. With regard to gastric emptying, food digestion, absorption, body weight and life quality, PPVPG proved to be superior to Billroth procedure.CONCLUSION PPVPG has the advantages of conventional Billroth gastrectomy in reducing acid, removing ulcer focus, and at the same time preserves the pylorus and pyloric vagus for maintaining the normal gastric physiological function. Dumping syndrome, intestinal fluid reflux and other complications of conventional gastrectomy may be avoided.
文摘AIM To evaluate the curative effect of stage Ⅱ surgical resection of hepatocellular carcinoma after TAE. METHODS Thirty eight patients with unresectable hepatocellular carcinoma were treated by transcatheter arterial embolization (TAE). When the sizes of tumors were markedly reduced after TAE, stage Ⅱ surgical resections were performed. RESULTS Before TAE, the diameters of tumors were 12 84cm±4 87cm ( ±s ), but reduced to 5 12cm±1 82cm ( ±s ) after TAE ( P <0 001). Pathologic examination of the resected specimens revealed obvious necrosis in most cases. After surgery, 26 patients were alive, with the longest survival of 96 months, twelve died and 10 had tumor recurrence. CONCLUSION Patients in moderate and advanced stages of hepatocellular carcinoma after TAE should be treated surgically, but the indication must be controlled strictly.
基金Supported by the National Science Foundation of China,No.39270650
文摘AIMS Using a new approach of regional adjuvant chemotherapy to prevent cancer cells hepatic metasta- sis after radical surgery of large bowel cancer. METHODS A model of liver with metastasis of hu- man colonic cancer (HCC) cells in nude mice was used to observe the effect in prevention of metastasis of HCC cells inoculated via spleen applied with early postoper- ative intraperitoneal (IP) chemotherapy using large dose of 5-FU. RESULTS The incidence of metastasis to liver was decreased by 40%,the mean number of metastatic liv- er nodules in each animal was reduced by 50.89% and the mean survival times of each animal was prolonged by 48.21% by using 5-FU 40 mg/NS 40 ml/kg IP for two consecutive days as compared with the controls. CONCLUSIONS IP is a new and more effective re- gional adjuvant chemotheraputic approach in the pre- vention of liver metastasis HCC cells after radical surgery of large bowel cancer.
文摘The purpose of the present article is to present an unusual case of internal herniation. In this case small bowl obstruction was due to congenital right trans-mesocolic hernia which had the right ureter at the neck of the sac forming a constriction band. This requires careful widening of neck of hernia, so as to avoid iatrogenic trauma to ureter. This unusual presentation needs dissemination as this type of internal hernia is extremely rare.
文摘Introduction: Intraoperative nerve monitoring is used in otolaryngology to assist in identification of nerves at risk. It is hoped that this will lead to lower rates of nerve injury. The objective of this study was to quantify the use of monitoring technology in current clinical practice. Method: An electronic survey was distributed to 376 registered fellows of the Australian Society of Head and Neck Surgery. Results: One-hundred and twenty-five responses were obtained. The majority of respondents report using monitoring at least some of the time during thyroid, parotid, and mastoid surgery (80%, 87%, and 73% respectively). Predictors of use include experience with intraoperative monitoring during training, and high caseloads in parotid surgery. Practice setting did not predict use. Conclusion: Despite equivocal evidence that intraoperative nerve monitoring is associated with a reduction in nerve injuries, this study demonstrates that the technology is widely used amongst otolaryngologists.
文摘INTRODUCTIONAlthough the long-term postoperative survival rateof gastric cancer(GC) patients has been improvedsignificantly since the local dissection of lymph nodewas widely used in China,yet the low curativeresection rate and the high recurrence rate fromperitoneal and hepatic metastases hinder it fromfurther improvement.To alter the currentunsatisfactory status of GC treatment,a
基金This study was supported by the research grant from Administration of Key Disciplines for"Project 211"of Sun Yat-Sen University of Medical Sciences,Grant No.98097.
文摘INTRODUCTIONCarcinoembryonic antigen ( CEA) , originally described by Gold and Freedman [1] in 1965, is now an acknowledged member of immunoglobulin superfamily[2],with a role as an intracellular adhesion molecule[3].Carbohydrate antigen 19-9(CA19-9), obtained with a monoclonal antibody produced by immunizing a monoclonal antibody produced by immunizing a mouse with a colonic cancer cell line in 1979[4],is a ligand for E-selectin that plays an important role in the addhesion of cancer cells to endothelial cells [5,6].
基金the Medical and Health Research Foundation of PLA,No.98Q015
文摘INTRODUCTIONCurrently the major treatment choices for shortbowel syndrome are parenteral nutrition and smallbowel transplantation.Both therapies involvegreat fiscal challenge and recurring complications.Recent years have witnessed the promisingexperimental results of pharmacologicalrehabilitation of remnant small bowel.
基金Supported by(Entirely)Thomas Jefferson University HospitalUniversity of Utah through existing intramural funds and salary support
文摘Colorectal cancer (CRC) is the 3<sup>rd</sup> most common cancer in the United States with more than 10000 new cases diagnosed annually. Approximately 20% of patients with CRC will have distant metastasis at time of diagnosis, making them poor candidates for primary surgical resection. Similarly, 8%-25% of patients with CRC will present with bowel obstruction and will require palliative therapy. Emergent surgical decompression has a high mortality and morbidity, and often leads to a colostomy which impairs the patient’s quality of life. In the last decade, there has been an increasing use of colonic stents for palliative therapy to relieve malignant colonic obstruction. Colonic stents have been shown to be effective and safe to treat obstruction from CRC, and are now the therapy of choice in this scenario. In the setting of an acute bowel obstruction in patients with potentially resectable colon cancer, stents may be used to delay surgery and thus allow for decompression, adequate bowel preparation, and optimization of the patient’s condition for curative surgical intervention. An overall complication rate (major and minor) of up to 25% has been associated with the procedure. Long term failure of stents may result from stent migration and tumor ingrowth. In the majority of cases, repeat stenting or surgical intervention can successfully overcome these adverse effects.
文摘Recently, there has been a change in the strategy of how synchronous colorectal hepatic metastases are attributed to the development of more valuable protocols of chemotherapy and radiotherapy for neoadjuvant treatment of colorectal neoplasms and their hepatic metastases. There is a consensus that patients with synchronous colorectal hepatic metastases have lower survival than those with metachronous colorectal hepatic metastases. Currently, controversy remains concerning the best approach is sequence in a patient with colorectal cancer and synchronous hepatic metastases resection. To obtain a better patient selection, the authors have suggested the initial realization of systemic chemotherapy in the circumstance of patients with colorectal tumor stage Ⅳ, since these patients have a systemic disease. The rationale behind this liver-first strategy is initially the control of synchronous hepatic metastases of colorectal carcinoma, which can optimize a potentially curative hepatic resection and longstanding survival. The liver-first strategy procedure is indicated for patients with colorectal hepatic metastases who require downstaging therapy to make a curative liver resection possible. Thus, the liver-first strategy is considered an option in cases of rectal carcinoma in the early stage and with limited or advanced synchronous colorectal hepatic metastases or in case of patients with asymptomatic colorectal carcinoma, but with extensive liver metastases. Patients undergoing systemic chemotherapy and with progression of neoplastic disease should not undergo hepatic resection, because it does not change the prognosis and may even make it worse. To date, there have been no randomized controlled trials on surgical approach of colorectal synchronous hepatic metastases, despite the relatively high number of available manuscripts on this subject. All of these published studies are observational, usually retrospective, and often non-comparative. The patient selection criteria for the liver-first strategy should be individualized, and the approach of these patients should be performed by a multidisciplinary team so its benefits will be fully realized.
文摘BACKGROUND: Hilar cholangiocarcinoma has a low radi-cal resection rate and a poor long-term survival rate. In re-cent years, its prognosis has been improved with advance-ment of preoperative diagnostic techniques and surgicaltechniques. The aim of this study was to evaluate the prog-nostic factors of hilar cholangiocarcinoma and the relationsof surgical procedure to the prognosis of the carcinoma.METHODS: A retrospective cohort study was done in 198patients with hilar cholangiocarcinoma (117 men and 81women, aged from 27 to 81 years) , who had been admit-ted to this hospital from December 1997 to December 2002.Their symptoms were jaundice (94.5%), pruritus (56.6%)and abdominal pain (33.8%). Bismuth-Corlette classifica-tion showed type in 14 patients, type in 19, type in12, type in 15, type in 112, and unclassifiable typein 26. 144 patients underwent laparotomy and others re-ceived bile drainage endoscopically (including endoscopicretrograde biliary drainage (ERBD) or endoscopic metalbiliary endoprosthesis (EMBE) in 21 patients, endoscopicnose-biliary drainage (ENBD) in 31 or percutaneous trans-hepatic cholangiodrainage in 2. 120 patients (83.3%) re-ceived tumor resection including radical resection in 59 pa-tients (41.0%). Twenty-three patients underwent paunchedbiliary exploration and drainage.RESULTS: Cox' s regression model analysis showed thatoccupation, preoperative total serum bilirubin level, opera-tive procedure and postoperative adjuvant radiation weresignificantly related to postoperative survival rate in con-trast to gender, age, choledocholithiasis, hepatitis, preope-rative serum CA19-9 level, Bismuth-Corlette type, his-topathologic grading and postoperative chemotherapy. Thesurvival of patients in groups of biliary drainage, palliativeresection and radical resection differed statistically and pro-longed in a descending order. No statistical difference wasfound between ERBD or EMBE group and palliative resec-tion group. So was between ERBD or EMBE group andbiliary drainage group, or between ENBD group and biliarydrainage group. The survival differed statistically betweenERBD or EMBE group and ENBD group.CONCLUSIONS: Operative procedure is the most impor-tant prognostic factor affecting the operative results of hilarcholangiocarcinoma. Radical resection is still the primarymeasure for a cure and long-term survival of the patients.For patients with irresectable hilar cholangiocarcinoma, noevidence has shown that the prognosis after treatment ofERBD or EMBE is poorer than that after laparotomy.
