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10 September 2008, Volume 28 Issue 09 Previous Issue    Next Issue
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Clinical research of different surgical approaches for lymphadenectomy in radical esophagectomy CUI Ji,CAI Shi-rong,HUANG Yi-hua,et al. 2008, 28(09): 746-749.  Abstract ( )   PDF (557KB) ( )   Objective:To compare 2 surgical approaches for radical esophagectomy and discuss which is a better operative pathway of lymphadenectomy. Methods:Clinical data of 96 patients of thoracic incision and 117 of left abdominothoracic incision with squamous cell carcinoma of the lower esophagus, who underwent radical esophagectomy from Jan 2000 to Jan 2005 in the first affiliated hospital of Sun Yetsan Universtiy,were analyzed retrospectively. Compared was made on number of lymph node resected, regional lymph node metastasis ratio,perioperative mortality,operation time,bleeding volume,surgical complication rate,postoperative hospital stay,median survival period between the 2 groups. Results:There was significant difference in superior mediastinum,and lymph node of the 1st,2nd group abdomen between 2 groups (P<0.05),but there were no significant difference between 2 groups (P>0.05) in the perioperative mortality,operation time,bleeding volume,surgical complication rate,postoperative hospital days,survival rate. Conclusion:Left thoracic incision is more effective on lymphadenectomy of superior mediastinum,Whereas abdominothoracic incision shows more effective on lymphadenectomy of abdominal region.

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Transformed dermatofibrosarcoma protuberans:clinical analysis of 34 cases CAI Hong,SHI Ying-qiang,WANG Ya-nong,et al. 2008, 28(09): 750-752.  Abstract ( )   PDF (2452KB) ( )   Objective:Try to analyze the clinical and pathological characteristics in patients with transformed dermatofibrosarcoma protuberans (DFSP) and discuss the standard surgical treatment and combined treatments for them. Methods:Medical charts of 34 patients with histologically confirmed transformed DFSP treated between January 1985 and December 2006 in Cancer Hospital of Fudan University were submitted to a retrospective study. Results:Among the 34 cases,32 had high grade fibrosarcomatous change (DFSP-FS) and 2 had malignant fibrous histiocytoma change (DFSPMFH).Compared with classical DFSPs,these transformed DFSPs had significantly higher recurrence rate after wide excision (P<0.0001),and the sizes of the recurrent tumors were larger (P=0.009),the durations of recurrence were shorter (P=0.012).Also they had higher metastatic rate (P<0.0001) and worse survival rates (P<0.0001). Conclusion:Transformed DFSPs are more aggressive tumors which need more active treatments.In order to reduce the local recurrence rate and decrease the degeneration into more malignancy caused by multiple local recurrences of the tumor,adequate initial resection and standard wide excision are more important for patients with transformed DFSPs.Combined treatments including adjuvant radiotherapy may be an optimal therapeutic strategy.

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Diagnosis and surgical management of pancreatic trauma:a report of 15 cases ZHANG Si-yao,LIU Bing-yang,DONG Ming,et al. 2008, 28(09): 753-756.  Abstract ( )   PDF (639KB) ( )   Objective:To discuss the experience of diagnosis and surgical treatment of pancreatic trauma. Methods:The clinical data of 15 patients with pancreatic trauma treated surgically from April 2002 to February 2007 in the First Hospital of China Medical University were analyzed.According to American Association for the Surgery of TraumaOrgan Injury Scale (AAST-OIS)，2 cases were in gradeⅠ,7 in grade Ⅱ,3 in grade Ⅲ,2 in grade Ⅳ,and 1 in grade Ⅴ.Five patients received nonsurgery treatments.Ten patients underwent surgeries including débridement and hemostasis of hematoma in pancreatic head and intraperitoneal drainage with multiple tubes in 1 case,suturing and repairing rapture in pancreatic neck also drainage around in 4 cases,ligature of pancreatic duct and suture repair of the pancreatic head with resection of the distal pancreas in 3 cases,and ligature of pancreatic duct and suture repair of the pancreatic head with Roux-en-Y distal pancreaticojejunostomy in 2 cases. Results:Twelve patients fully recovered.Of them,1 developed the pancreatitis and 2 suffered from the pancreatic leakage.These 3 cases recovered with conservative treatment including using pancreas enzyme inhibitor.For remaining 3 cases，2 improved and 1 died of multiple trauma. Conclusion:Early diagnosis and the carefully surgical exploration were the key for treating pancreatic trauma.According to the grade of the pancreatic trauma,reasonable choice of surgical manner might increase cure rate and reduce the postoperative complications.

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Study on application of three-dimensional reconstruction and visual simulation surgery to pancreas based on the data of 64row helical CT scanning FANG Chi-hua,LIU Yu-bin,HUANG Yan-peng,et al. 2008, 28(09): 757-760.  Abstract ( )   PDF (628KB) ( )   Objective:To study application of threedimensional reconstruction and visual simulation surgery on pancreas based on the data of 64-row helical computed tomograph (CT) scanning. Methods:To collect the data of pancreatopaphy on 64-row helical CT scanning,the automatic extraction and segment were carried on to the CT sequence images based on the algorithm of auto adapted region growing.The images which had been segmented were proceeded the 3D reconstruction by medical image proceeding system which was designed by us.Then reconstructed objectives were imported into FreeForm Modeling System in the form of STL format to embellish and smooth.Using the GHOST SDK software of FreeForm Modeling System Various instruments were developed.Investigate the visual simulation surgery of pancreas with PHANTOM software. Results:It is rapid and effective that the image sequence segmentation of pancreas is applied by the algorithm of auto adapted region growing.The 3D reconstruction result of pancreas by medical image processing software show clearly and has vivid appearance.The visual simulation surgery of pancreas is high simulated,vivid,exact and give the feeling of ‘strength’ and make people feel operating a real surgery on an operation table. Conclusion:3D reconstruction and simulation surgery based on helical CT scanning has important application value on the operation planning selection,risk assessment and clinical training.

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Prospective randomized study of abdominal drains in gastric cancer surgery JIANG Zhi-wei,LI Jie-shou,WANG Zhi-ming,et al. 2008, 28(09): 761-762.  Abstract ( )   PDF (298KB) ( )   Objective:The aim of this study was to compare the safety and effectiveness of routine drainage and no-drainage regimes after selective gastric cancer surgery. Methods:All patients received selective D2 gastric cancer resection, and were randomized divided into two groups: group I (no-drains,P=51),group Ⅱ (with drains,n=49).The incidence of anastomotic leak and complications specific to the drain as well as other complications were compared in 2 groups. Results:The mean length of postoperative stay was (9.6±2.4) d in group I and (10.4±2.4)d in group Ⅱ (P>0.05),and postoperative days for oral intake were (5.1±1.6)d in group Ⅰ and (5.6±2.3) d in group Ⅱ (P>0.05).No significant difference was noted in the incidence of postoperative complication between the no-drain group and the drain group (9.8% vs 12.2%,P>0.05). Conclusion:Routine abdominal drainage after gastric cancer surgery to prevent anastomotic and other complications is unnecessary.

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Recurrent constipation and incontinence after surgery for slowtransit constipation FENG Yong,CONG Jin-chun,CHEN Chun-sheng,et al. 2008, 28(09): 763-765.  Abstract ( )   PDF (434KB) ( )   Objective〓〖WTBZ〗To evaluated the recurrent constipation and incontinence for different anal pressure with different operating technique for slow-transit constipation(STC). 〖WTHZ〗Methods〓〖WTBZ〗106 patients with STC received surgery as ileorectal anastomosis(IRA),ileosigmoidal anastomosis (ISA) or cecorectal anastomosis(CSA) from 1996 to 2006 in Shengjing Hospital of China Medical University.The patients were divided into STCONLY group and STC-rectal evacuatory disorder (STCRED) group according to whether involve the rectum,and subsequently the latter were divided into low pressure group，high pressure group and normal pressure group on the basis of vectorial manometry. 〖WTHZ〗Results〓〖WTBZ〗The recurrent constipation and incontinence of STCONLY group was lower than that of STCRED group (P<005),for the latter,with the gradually raising anal pressure the rate of recurrent constipation increased (P<005),however the rate of incontinence decreased (P<005).About the three different techniques, incontinence happened least after the CSA (P<005),but there were more risk of constipation recurrence (P<005). 〖WTHZ〗Conclusion〓〖WTBZ〗For the surgery of STC,the technique of CSA has the merit for preventing the incontinence after operation,but the risk of constipation recurrence is high on the other hand.Compared with the STC-ONLY,the STCRED had high risk for recurrent constipation and incontinence,this result was concerned with anal pressure.