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29 August 2008, Volume 28 Issue 08 Previous Issue    Next Issue
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Understand total mesorectal excision from the anatomic morphology of the mesorectum LIN Mou-bin,YIN Lu,CHEN Wei-guo,et al. 2008, 28(08): 629-632.  Abstract ( )   PDF (594KB) ( )   Objective:To clarify the basis of total mesorectal excision by studying the morphology of the mesorectum. Methods:Twenty-four pelvises (12 male,12 female) harvested from embalmed cadavers were studied by dissectiodn. Results:There were two different fascial envelopes around the perirectal fat:a posterolateral envelope made up of the visceral pelvic fascia and an anterior membrane made up of the Denonovilliers fascia.Denonvilliers’ fascia couldn’t be regarded as anterior part of mesorectum. Conclusion:The improved prognosis achieved by total mesorectal excision lies in the excision of rectal compartment en bloc.

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Percutaneous radiofrequency ablation and surgical resection for small hepatocellular carcinoma:a comparative study PENG Zhen-wei,XU Li,CHEN Min-shan,et al. 2008, 28(08): 633-636.  Abstract ( )   PDF (554KB) ( )   Objective:To compare the effectiveness of percutaneous radiofrequency ablation (PRFA) and surgical resection as an initial treatment for patients with small hepatocellular carcinoma (HCC). Methods:Between November 1999 and June 2004,434 patients with a solitary HCC (diameter less than 5cm) and wellpreserved liver function (Childpugh class A ) received PRFA or surgical resection (SR) in Sun Yatsen University Cancer Center.Among them,183 patients received SR and 251 patients received PRFA. Results:The overall 1year,3year and 5year survival rates for SR group were 91.18%,70.18%,55.51% respectively,and for PRFA group were 91.92%,7441%,58.22% respectively.In patients with tumor diameter ≤3cm,the overall 1year,3-year and 5-year survival rates for SR group were 9587%,7369%,6245% respectively,and for PRFA group were 95.46%,80.15%,72.79% respectively.In patients with tumor diameter from 3.0m to 5.0cm, the overall 1year,3-year and 5-year survival rates for SR group were 88.07％,67.63％,51.18％ respectively,and for PRFA group were 80.16%,60.63％,32.34％ respectively.Survival of patients treated with PRFA were dependent on tumor size and serum bilirubin. Conclusion:PRFA is as effective as surgical resection in the group of solitary and small HCC.PRFA can be used instead of surgical resection in proper situations.

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Ultrasoundguided minimally invasive targeting ArgonHelium cryoablation in the treatment of hepatic carcinoma CHEN Huan-wei,CUI Wei-zhen,ZHANG Hai-xiong,et al. 2008, 28(08): 637-640,.  Abstract ( )   PDF (630KB) ( )   Objective:To explore the effectivity and safety of minimally invasive targeting ArgonHelium cryoablation in the treatment of hepatic carcinoma. Methods:Ultrasoundguided ArgonHelium targeting cryoablation using the CryoHit system with 1.47mm fine probe was performed percutaneously in 26 cases of primary hepatic carcinoma,15 cases of recurrent hepatic carcinoma and 13 cases of metastatic carcinoma with a total of 105 foci between June 2006 and June 2007 in the First People’s Hospital of Foshan.Serum tumor markers were detected and tumor necrosis was evaluated by ultrasonography,CT scan or MRI every 3 to 6 months.Survival rate was analyzed with KaplanMeier method. Results:One-year cumulative survival rates of primary,recurrent and metastatic hepatic carcinoma were 81.82%,46.22% and 80.21% respectively.Tumor foci diminished in different degrees or even disappeared when performed ultrasonography,CT scan or MRI after the procedures.Tumor complete necrosis rate could reach 96.2% to the foci less than 3cm,and they were 90.6% to the foci between 3cm to 5cm in size and 28.6% to the foci larger than 5cm.No complications such as bleeding or bile leakage were found. Conclusion:Ultrasoundguided targeting treatment of hepatic carcinoma with ArgonHelium cryoablation using fineprobe CryoHit system is a new,safe and effective procedure coming after radiofrequency and microwave ablation,although its longterm curative effects needs longterm follow-up survey.

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Analysis of portal vein variations by 64slice spiral CT and clinical application GUO Cheng-wei,LIANG Wen,QUAN Xian-yue,et al. 2008, 28(08): 641-643.  Abstract ( )   PDF (468KB) ( )   Objective:To analyze variations of main trunk of portal vein (MTPV) in healthy persons by multislice spiral computed tomography portagraphy (MSCTP). Methods:Four hundreds and five subjects （including 200 normal volunteers）were performed by test bolus to demonstrate the optimization of MSCTP from December 2006 to June 2007 at the Affiliated Zhujiang Hospital of South Medical University.The maximum intensity prejection (MIP),volume rendering (VR) and multiplanar reformation (MPR) were employed for threedimensional reconstruction to analyze variations of MTPV (1～3 grades). Results:There were 12 types of MTPV (1～3 details) with the variation rate of 2074%. Conclusion:Due to high variation rate of portal vein among normal people,the 3-D reconstruction of multislice CT is constructive to local the focus and the decision of approaches for the surgical treatment in clinic.

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Prevention and management of nonanastomotic biliary stricture after liver transplantation MA Yi,HE Xiaoshun,ZHU Xiaofeng,et al. 2008, 28(08): 644-646.  Abstract ( )   PDF (451KB) ( )   Objective:To investigate the prevention and management of nonanastomotic biliary stricture (NABS) after orthotopic liver transplantation. Methods:The clinical data of 516 patients underwent orthotopic liver transplantation from January 2004 to December 2006 at the First Affiliated Hospital of Sun Yatsen University were analyzed retrospectively.The incidence and course of NABS after liver transplantation were summarized. Results:NABS occurred in 18 patients (3.5%).Among them,9 patients had biliary strictures at the site of hepatic bile duct bifurcation,and 6 patients had intrahepatic biliary strictures,and 3 patients had multiple extrahepatic and intrahepatic biliary strictures.Eighteen patients with NABS were managed with interventional therapy,endoscopic treatment,RouxenY anastomosis or retransplantation.The shortterm curative rate was 55.6% (10/18).The incidence of NABSrelated retransplantation was 38.9% (7/18),and the NABSrelated mortality was 22.2%(4/18). Conclusion:It is very complicated to manage NABS after liver transplantation.Therefore more attention should be paid to its prevention.The management of NABS mainly includes interventional therapy and surgery,among which interventional therapy is a important treatment.To the patients who failed interventional therapy and surgery, retransplantaiton is indicated.

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Severe bone marrow suppression after liver transplantation:a report of 6 cases HUAI Ming-sheng,ZHU Zhi-jun,ZHENG Hong，et al. 2008, 28(08): 647-649.  Abstract ( )   PDF (386KB) ( )   Objective:To summarize the clinical characters of severe bone marrow suppression after liver transplantation and find effective measures to prevent severe bone marrow suppression occurring. Methods:The clinical data of 6 cases of severe bone marrow suppression after liver transplantation occurred between 2002 and 2006 in Tianjin First Central Hospital were analyzed retrospectively. Results:All patients received standard immunosuppressive protocols for liver transplantation,including a combination of tacrolimus,mycophenolate mofetil (MMF) and steroid.Ganciclovir was used for prophylaxis cytomegalovirus in each case.Severe bone marrow suppression (white blood cell count<10×109/L ) occurred from 19 to 78 days after transplantation.Clinical manifestations included fever,nausea,skin rash,infection even to sepsis.Liver functions of case 1 to 5 were almost normal until to dead.All patients were dead of severe sepsis and multiple system organ failure. Conclusion:Severe bone marrow suppression after liver transplantation maybe relates to immune reaction,drug toxicity,severe infection or other reasons.The incidence and accurate pathogenesis are unclear.Once severe bone marrow suppression occurred,the prognosis is very poor.It’s important to take effective measures to prevent severe bone marrow suppression occurring.

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Surgical treatment for colorectal cancer in the elderly patients over 75 years old:an analysis of 266 cases CAI Hong,ZHU Hui-yan,WANG Ya-nong,et al. 2008, 28(08): 650-652.  Abstract ( )   PDF (454KB) ( )   Objective:To analyze the clinical and pathological characteristics,surgical complications and prognosis of colorectal cancer (CRC) in the elderly patients,and discuss the surgical treatment for them. Methods:The clinical and pathological data of 266 CRC patients over 75 years old accepted surgical treatment between January 1985 and December 2003 in Cancer Hospital of Fudan University were analyzed retrospectively. Results:Among 266 patients,the age of 151 males and 115 females ranged from 75 to 91 years old.The rectum and sigmoid colon were the most popular sites in the elderly patients (69.2%),but still there were 22.2% of patients with tumors located in the right site of colon.Ninetyfour patients (35.3%) had complicated diseases before operation,such as cardiovascular disease and diabetes mellitus.Two hundreds and fifteen patients (80.8%) accepted radical excision while 35 patients (13.2%) accepted palliative resection.Thirty patients (11.3%) had postoperative complications,such as intestinal obstruction,haemorrhage,infection and so on. Among them,3 patients (1.1%) died several days after operation.The overall 5year survival rate was 51.3%. Conclusion:Though the elderly CRC patients have more complicated diseases before operation and more postoperative complications,the operative mortality is still lower if much more attentions are paid during operation.Also they have the 5year survival rate more than 50%.So the surgical treatment shouldn’t be ignored in the elderly CRC patients.

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Application of multislice spiral computed tomography to the locational diagnosis of anal fistula ZUO Zhi-gui,SONG Hua-yu,XU Chang,et al. 2008, 28(08): 653-656.  Abstract ( )   PDF (663KB) ( )   Objective:To evaluate the effectiveness and applied value of multislice spiral computed tomography (MSCT) plain and enhanced scan combined with fistulography to the locational diagnosis of anal fistula. Methods:Preoperatively MSCT examination was performed in 32 patients with clinically suspected anal fistulas between July 2004 and May 2006 and results were compared with microsurgical and followup findings.Multiplanar reconstruction (MPR) and volume rendering (VR) were adopted to reconstruct 3D images in all cases.Images of MSCT were reviewed by professional radiologist. Results:On MSCT examination,4 patients had no fistula.Five patients had simple fistulas.Twenty-three patients had complex fistulas.All patients were confirmed by operation.At the same time 8 cases were misdiagnosed in surgery’s professional examination.Six patients had lowlocated fistulas.Twentytwo patients had highlocated fistulas.All patients were confirmed by operation,but on surgery’s professional examination 8 cases with highlocated fistulas were misdiagnosed as lowlocated fistulas.Three cases of extrasphincteric fistulas were misdiagnosed as suprasphincteric fistulas.For detection of the presence of internal openings,secondary tracts,abscesses,MSCT had a accuracy of 62.1％,89.3％,100.0%.The 3D shape and track of fistula could be well demonstrated by VR，while MPR including curved planar reconstruction (CPR) could well show the site of anal fistula and its relationship with the sphincter complex and the levator ani muscle. Conclusion:MSCT combined with fistulography is a very effective and reliable method for the locational diagnosis of anal fistula.

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Endovascular treatment of chronic iliac artery occlusions for TASCC and D patients:an analysis of 14 cases YE Meng,LIANG Wei,ZHANG Hao,et al. 2008, 28(08): 657-659.  Abstract ( )   PDF (454KB) ( )   Objective:To evaluate the safety,technical success rate,and shortterm patency of endovascular treatment for iliac artery occlusions based on the patient’s Transatlantic Intersociety Consensus (TASC) stratification. Methods:From April 2005 to December 2006,14 patients with iliac artery occlusions (TASC-C,D) were performed endovascular therapy at the Affiliated Ren Ji Hospital of Shanghai Jiao Tong University. Among them,2 patients underwent surgical outflow reconstruction combined with endovascular therapy. Results:There was no perioperative death.The technical success rate was 93.7%.All patients were followed-up for 2-20 months with satisfactory results and no recurrence was occurred. Conclusion:TASC-C,D iliac lesions can be safely treated via endovascular means with high technical success rate,low incidence rate of perioperative complications and definite shortterm patency.The long-term patency should be studied further.

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Clinical application of infusion catheterdirected thrombolysis for actue lower limb ischemia:a report of 8 cases LIU Xiao-ping,GUO Wei,YIN Tai,et al. 2008, 28(08): 660-662.  Abstract ( )   PDF (470KB) ( )   Objective:To evaluate the feasibility and clinical outcome of the infusion catheterdirected thrombolysis for actue lower extremity ischemia. Methods:The clinical data of 8 cases of actue lower extremity ischemia treated with the urokinase infusion catheterdirected thrombolysis from August 2004 to April 2006 at the General Hospital of PLA were analyzed retrospectively.The infusion catheterdirected thrombolysis included accelerated thrombolysis with 250 000 to 500 000 IU of urokinase and the following infusion thrombolysis with 500 000 to 1 million U of urokinase.Adjunct angioplasty or stents implantation were pefromed after the infusion catheterdirected thrombolysis. Results:Eight limbs were saved. Initial success was 88% (7/8) in the eight cases,one distal artery thrombus during the infusion thrombolysis necessitated belowknee operative thromboembolectomy.The followup period ranges from 4 to 20 months,the cumulative patency was 75%(6/8). Conclusion:In patients with severe acute ischemia,transcatheter revascularization is a viable treatment option when strategies for reperfusion establish both inflow and microcirculatory outflow.