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24 June 2008, Volume 28 Issue 07 Previous Issue    Next Issue
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Risk factors of delayed breast cellulitis after breast conserving surgery in breast cancer:an analysis of 14 cases YE Jing-ming,DUAN Xue-ning,ZHANG Lan-bo,et al. 2008, 28(07): 544-546.  Abstract ( )   PDF (452KB) ( )   Objective:To analyze the risk factors of delayed breast cellulitis (DBC) after breast conserving surgery in breast cancer. Methods:The clinical data of 152 patients received breast conserving surgery during January 2001 to December 2006 in Breast Disease Center of Peking University First Hospital were analyzed retrospectively.All the patients were identified by the accepted criteria: diffuse breast erythema,edema,tenderness,and warmth occurring >3 months after definitive surgery and >3 weeks after radiotherapy.Forteen patients were diagnosed DBC. Results:The incidence of DBC in the group was 9.2% (14/152). The median time to onset of DBC was 6.2 months after breast conserving surgery.Primary tumor T stage, upper outer quadrant tumor,>15 axillary lymph nodes removed and the breast hematoma/seroma after surgery,were significantly associated with DBC.Age,diabetes,neoadjuvant chemotherapy, positive axillary lymph nodes metastasis were not the factors associated with DBC. Conclusion:Lymphatic drainage damaged by surgery procedures and radiotherapy maybe the most important factors contributed to the onset of DBC.

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Breastconserving assisted by mastoscopy and entirely mastoscopic axillary lymph node dissection for breast cancer:a feasibility study with breast cancer LIN hua,LUO Cheng-yu,ZHANG Jian,et al. 2008, 28(07): 547-549.  Abstract ( )   PDF (482KB) ( )   Objective:To study the standardized skill and feasibility of breastconserving assisted by mastoscopy and entirely mastoscopic axillary lymph node dissection. Methods:The clinical results and operation experiences between 276 cases of breastconserving surgery combined with mastoscopic axillary lymph node dissection and 142 cases of modified radical operation in the treatment of breast cancer were analyzed and compared.All the cases were admitted between August 2001 and August 2007 in Beijing Fuxing Hospital,Capital University of Medical Sciences. Results:In 276 cases of breastconserving surgery combined with mastoscopic lymph nodes dissection,the operation time was shortened from 2h originally to 40 min.The shortterm complications were appeared only in 2 cases.In 142 cases of modified radical operation of breast cancer,the shortterm complication were appeared in 27 cases. Conclusion:Using the mastoscopy in the breastconserving surgery combined with traditional axillary lymph node dissection can shorten the operation time and simplify the operation procedure.The method makes patients attain a physiological and psychological minimal invasiveness.Besides assuring the quality of axillary lymph node dissection,the method can reduce the occurrence of surgical complication and improve the patients’ life quality.Mastoscopic axillary lymph node dissection can replace the routine surgery and can be carried out in the conditional hospital.

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Small cell neuroendocrine carcinoma of the breast:a clinical and pathological analysis of 3 cases CUI Ming,ZHANG Ji,LENG Jia-hua,et al. 2008, 28(07): 550-552.  Abstract ( )   PDF (450KB) ( )   Objective:To analyze the features of clinical diagnosis and treatment of small cell neuroendocrine carcinoma of the breast. Methods:Three cases of breast small cell neuroendocrine carcinoma were admitted between January 2001 and June 2006 in Peking University School of Oncology.Their clinical and pathological data,treatment and prognosis were analyzed retrospectively. Results:All the three lesions were palpable and were found by the patients themselves. Mammography showed no calcification in any of the three lesions.Breastconserving surgery was performed in 2 patients,and modified radical mastectomy in 1 patient. All the patients were diagnosed small cell neuroendocrine carcinoma pathologically. Immunohistochemical results showed Syn（++） and CgA（++） in 2 patients and NSE (+) in 1 patient.Expression of ER,PR and Her2 were negative in all patients.Followup ranged from 9 to 74 months.One patient with no lymph node metastasis was still alive without relapse and metastasis 74 months after the treatment.Multiple metastasis were revealed in 2 patients with lymph node metastasis within 12 months after diagnosis.One died within 15 months after excision.The other had survived for 9 months after excision. Conclusion:Small cell neuroendocrine carcinoma is rare neoplasms of the breast.No calcification and negative expression of ER,PR and Her2 might be the characteristics of the disease.Diagnosis of the disease should depend on pathological results.Significant differences of prognosis and curative effect of treatments suggest that the disease may have subtypes.

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Reconstruction of hepatic artery and management of its early thrombosis in liver transplantation:experiences from a single team of Eastern Hepatobiliary Surgery Hospital YANG Ning,YANG Guang-shun,LU Jun-hua,et al. 2008, 28(07): 553-555.  Abstract ( )   PDF (434KB) ( )   Objective:To explore the surgical techniques of hepatic arterial reconstruction in liver transplantation and the therapeutic selection of its early thrombosis. Methods:The clinical data of hepatic arterial reconstruction based on 159 cases of cadveric donor liver transplantation and 3 cases of livingrelated liver transplantation perfomred from April 2003 to March 2006 in the Eastern Hepatobiliary Surgery Hospital of Second Military Medical University were analyzed retrospectively.Anastomosis time was compared between two groups with different vascular calibers. Early hepatic arterial thrombosis (HAT) was treated by means of interventional thrombolysis. Results:Anastomosis for hepatic artery with less than 3mm in diameter （n＝42,average time 33.6±21.3 min ） exhausted significantly more time in comparison with those with more than 3mm in diameter（n＝120,average time 19.4±7.4min）.For 3 cases of livingrelated liver transplantation,anastomosis time was 89min,120min and 34min,respectively.Two cases (1.2%) were complicated with early HAT.One case was successfully treated by thrombolysis,but the other had to establish urgently a conduit between aorta and the graft following an attempting thrombolysis. Conclusion:It exists more difficulties in the reconstruction of hepatic artery with small caliber.It implicates that microsurgery should be applied for pediatric livingrelated liver transplantation.But adequate surgical techniques could diminish the incidence of postoperative HAT.Effective therapeutic procedure needs to be carefully chosen for individual early HAT.

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Perivascular epithelioid cell tumor of the liver:a report of one case and review of the literature HAN Wei,JIANG Wei,LI Jian-he,et al. 2008, 28(07): 556-558.  Abstract ( )   PDF (479KB) ( )   Objective:o report a case of perivascular epithelioid cell tumor (PEComa) of the liver,and improve the understanding of the tumor. Methods:he clinical,imaging and pathological features of one case of liver perivascular epithelioid cell tumor admitted in October 2007 in Beijing Friendship Hospital Affiliated to Capital University of Medical Scienc was analyzed retrospectively and related literatures were reviewed. Results:he PEComa of liver didn't have any symptoms and characterized imaging features,and was difficult to make correct diagnosis before operation.Histologically,the resected tumor was composed of epithelioid cells,without vascular or lipomatous component,and was characterized by HMB45 positive on immunohistochemistry.Among present literatures,less than 10 cases of PEComa of the liver were reported. Conclusion:EComa is a very rare tumor of the liver which arises from mesenchymal tissues.The diagnosis of PEComa mainly depends on the pathological features.In respect of uncertain biologic potential of PEComa,long term follow up is indicated.

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Digestive tract reconstruction performed with the nickeltitanium temperaturedependent memoryshape device after total gastrectomy LI Xin-iang，YE Jian-in，SHI Zheng，et al. 2008, 28(07): 559-560.  Abstract ( )   PDF (296KB) ( )   Objective:o evaluate the safety and efficacy of compression anastomosis clip (CAC) for small bowel anastomosis. Methods:rom January 2006 to March 2007,30 gastric cancer patients performed total gastrectomy in the Department of Surgical Oncology of First Hospital Affiliated to Fujian Medical University were randomly divided into two groups and received sidetoside Roux-en-Y small bowel anastomosis with CAC or stapler.The following parameters were recorded,small bowel anastomotic complication,first postoperation flatus and bowel movement,extrusion of clip device. Results:Neither group had small bowel anastomotic complications such as leakage or obstruction.The clip was expelled with stool within 7-14 days．Two groups had the similar results in recovery of bowel function． Conclusion:CAC is safe and simple for small bowel anastomosis.

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Clinical value of intraoperative enteroscopy for diagnosis and treatment of intestinal vascular malformation XI Shi-fu,SHI Xiao-lei,ZHANG Li-hua. 2008, 28(07): 561-563.  Abstract ( )   PDF (460KB) ( )   Objective:To evaluate the diagnostic and therapeutic value of intraoperative enteroscopy in patients with intestinal vascular malformation. Methods:The clinical data of 17 cases of intestinal vascular malformation admitted from January 2003 to January 2005 in Affiliated Drum Tower Hospital of Medical School of Nanjing University were analyzed retrospectively. Results:All cases received preoperative gastroscopy examination to exclude any gastricduodenal bleeding, as well as colonoscopy examination to exclude lower digestive tract (colon and rectum) bleeding.The capsule endoscopy examinations were also carried out with the diagnosis of intestinal vascular malformation (10/17) and obscure gastrointestinal bleeding (7/17).All the cases had the indication of exploratory laparotomy.The operations and the intraoperative enteroscopy were carried out.All the postoperative specimen were proved to be intestinal vascular malformation by pathological examination.All the cases were followed up for 2-4 years with an average of 33 months and no rehaemorrhagia occurred. Conclusion:Intraoperative enteroscopy could afford accurate qualitative and localized diagnosis,so the intraoperative enteroscopy has an extremely important value in the diagnosis and treatment of intestinal vascular malformation,and could serve as a main means in the future.

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Diagnosis and treatment of lumbar hernia:a report of 9 cases WU Jian-guo,FANG Guo-en,LUO Tian-hang. 2008, 28(07): 564-566.  Abstract ( )   PDF (472KB) ( )   Objective:To study the pathogeny,clinical manifestlation,diagnosis and treatment of lumbar hernia. Methods:The clinical data of 9 cases of lumber hernia admitted from January 1997 to January 2007 in the Department of General Surgery Affiliated Changhai Hospital of the Second Military Medical University were analyzed retrospectively. Results:Among 9 cases,1 case was caused by nature. Two cases were caused by traumatic factors and 6 cases were caused by other factors.The clinical manifestation of lumbar hernia included lumbar bump in 9 cases,lumbar pain in 5 cases,nausea and vomiting in 2 cases,gut incarcerated with bowel obstruction in 1 case. The typical sign was a painful flank bulging in the superior or inferior triangle.Seven cases had hernia in superior lumbar triangle;one of them had hernia in both inferior lumbar triangle and superior lumbar triangle.Hernioplasty included by using contiguity tissue and synthetic patch were performed in 8 of all the cases. Conclusion:The diagnosis could be made according to clinical symptoms and signs.Doppler ultrasound examination,CT and MRI scanning are helpful for diagnosing lumbar hernia.Excision of the sac and repairing with surrounding tissue or by prosthetic material may show satisfactory results．

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Clinical significance and anatomical character of the non-recurrent laryngeal nerve in thyroid surgery GAO Ming,WEI Song-feng,LI Yi-gong,et al. 2008, 28(07): 567-568.  Abstract ( )   PDF (298KB) ( )   Objective:To explore the experience of anatomizing the nonrecurrent laryngeal nerve and how to discern and prevent the injury of this nerve in thyroid surgery. Methods:The clinical data of 3637 cases of thyroid tumor admitted from January 2004 to December 2006 in the Department of Thyroid &Neck Tumor of Tianjin Medical University Cancer Hospital were analyzed retrospectively in exposing the recurrent laryngeal nerve. Results:Among all the cases,2875 cases were performed recurrent laryngeal nerve exposure.Nonrecurrent laryngeal nerve in the rightlateral neck was found in 7 cases and the incidence was 0.24%. Conclusion:The clinical incidence of nonrecurrent laryngeal nerve is low, but it should be paid more attention by surgeons.The nonrecurrent laryngeal nerves are always found in the rightlateral neck.

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Surgical treatment on Marfan syndrome accompanied with descending aortic aneurysms: an analysis of 16 cases ZHAO Yang,WANG Yu-qi,FU Wei-guo. 2008, 28(07): 569-570.  Abstract ( )   PDF (306KB) ( )   Objective:To summarize the surgical experiences in Marfan syndrome accompanied with descending aortic aneurysms. Methods:The clinical data of 16 cases of Marfan syndrome accompanied with descending aortic aneurysms admitted between 1998 and 2005 in Shanghai Chest Hospital Affiliated to Shanghai Jiao Tong University were analyzed retrospectively. Results:All the 16 cases had history of Marfan syndrome and 2 of them had an additional experience of Bentall operation.All the 16 cases underwent operations,including traditional operation in 12,fenestration in 2 and endovascular treatment in 2.Two cases died postoperatively and 1 of them died on the 10th day after the endovascular therapy.Thirteen cases were followed up for 4 months to 7 years,of which,1 died of rupture of the thoracic aortic dissection suddenly,and 2 were excellent.Six of 10 cases with hypertension preoperatively showed normal blood pressure,and the other 4 were controlled by medicine. Conclusion:The aorta wall structures of the aneurysms accompanied with Marfan syndrome are more fragile than the normal patients and though a Bentall operation advanced.There is even likely recurrence of dissections and aneurysms.It could be treated with traditional operation primarily and the indication for the endovascular technique should be further discussed

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Surgical management of carotid body tumor: an analysis of 10 cases HAN Sheng-bin，JIN Hui,CAI Hong-bo. 2008, 28(07): 571-572.  Abstract ( )   PDF (323KB) ( )   Objective:To outline several experiences and skills in the clinical treatment of the carotid body tumor,especially in the operation process and peripheral operation stage and help clinicians to treat the carotid body tumor more efficiently,safely and scientifically. Methods:The clinical data of 10 cases of carotid body tumor admitted between Febuary 1998 and June 2006 in the Department of Vascular Surgery of First Affiliated Hospital of Kunming Medical Institute were analyzed retrospectively. The cases were performed tumor stripping or stripping combined artificial blood vessel reconstruction. Results:All cases recovered perfectly after one week’s postoperative observation and nursing. Conclusion:The carotid body tumor is an encapsulated,firm round mass at the bifurcation of the common carotid artery,but with a complex anatomy.There are high risks during operation and postoperative stage.It should treat carefully and safely during the operation and perioperative peroid to avoid the postoperative complications.