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28 February 2008, Volume 28 Issue 02 Previous Issue    Next Issue
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Preoperative management of 306 advanced age patients combined cardiovascular disease with colorectal cancer YANG Ming,DU Peng,ZHOU Di,et al. 2008, 28(02): 117-120.  Abstract ( )   PDF (3142KB) ( )   Objective:To explore the preoperative management of 306 advanced age patients combined cardiovascular disease with colorectal cancer. Methods:The clinical data of 306 cases over 70 years old of colorectal cancer combined cardiovascular disease admitted between January 2004 to December 2006 were evaluated and classified with ACC/AHA 2001 Guidelines on Perioperative Cardiovascular Evaluation and Care for Noncardiac Surgery to 3 risk levels and the preoperative management was analyzed retrospectively. Results:20 cases in high level,70 cases in intermediate level and 216 cases in low level. Postoperative complications included:stage 3 hypertension (22cases),congestive heart failure(10 cases),angina pectoris(3 cases),acute myocardial infarction(1 case),cardiac arrhythmia(102 cases),wound dehiscence(3 cases),pneumonia(34 cases),anastomotic leakage(6 cases),stress ulcer(8 cases),4 cases died in postoperative period. Conclusion:The cardiovascular disease increase the risk of surgical procedures of advanced age patients with colorectal cancer,but complete assessment of the patient’s general health and intensive perioperative management of the cardiovascular diseases can increase the success rate of operation and decrease the operative mortality and incidence of complication.

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Clinical feature and differential diagnosis of solid pseudopapillary tumor of pancreas:analyses of 24 cases LIU Jun-gui,ZHOU Ning-xin,XIA Hong-tian,et al. 2008, 28(02): 121-123.  Abstract ( )   PDF (2201KB) ( )   Objective:To summarize the experience of diagnosis of solid pseudopapillary tumor of pancreas (SPT). Methods:Clinical manifestations, laboratory examination, imageology, pathology of 24 patients with SPT admitted in general hospital of the People’ Liberation Army from February 2000 to March 2007 were retrospectively analyzed. Results:23 of 24 patients were female and the mean age was 244 years. Clinical presentation included a palpable abdominal mass in 5 patients, abdominal pain in 7 cases,diarrhea in 1 patient, nausea and abdominal distention in 2 cases.9 patients were asymptomatic.Tumor markers in all patients were negative.Abdominal imaging showed solid and solid cystic masses in pancreas or abdominal cavity.13 cases located in the head of pancreas,4 in the body of pancreas,7 in the tail of pancreas.2 cases received preoperative ultrasonic guidance biopsy and 6 underwent freezing pathology around surgery,1 case and 3 cases were diagnosed as SPT respectively. Conclusion:The correct diagnosis of SPT depends on comprehensive analysis of clinical feature,image and histopathologic characteristic.

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Videoassisted thyroidectomy in treating thyroid diseases：a Metaanalysis WANG Zhong-heng,HE Xiao-dong,YANG Ke-hu,et al. 2008, 28(02): 124-127.  Abstract ( )   PDF (2950KB) ( )   Objective:To evaluate the availability and safety of videoassisted thyroidectomy (VAT) for treating thyroid diseases (benign thyroid nodular diseases and “low risk” thyroid cancer). Methods:The electronic databases such as MEDLINE,EMBASE,PubMed,Cochrane Library,CBM，CNKI were searched;we handsearched some relevant Chinese periodicals.The quality of included trials was evaluated by two estimators.Metaanalysis in the homogenous studies was made.RevMan 4.2.8 software was used for statistical analysis. Results:Four randomized controlled trials (164 patients) undergoing videoassisted versus conventional thyroidectomy (CT) were included.The results of metaanalysis indicated that statistically significant differences were observed between the two operative procedures in cosmetic result［WMD105，95%CI（0.47,1.62）］;postoperative pain ［WMD-8.20,95%CI(-11.60,-4.80)］；operative time［WMD18.96,95%CI(17.23,20.69)］.The only no statistical significance was observed in complication rate［RR190,95%CI(0.65,5.54)］. Conclusion:Cosmetic result and postoperative pain in VAT are superior to that in CT.Operative time is longer in VAT than in CT.No significant differences are found between the two procedures in complication rate.There is insufficient evidence to demonstrate that VAT is also feasible for malignant thyroid diseases.More high quality,multicenter largescale randomized controlled trials are required.

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Laparoscopic left liver resection:a report of 28 cases JIANG Wen-shu,LU Bang-yu,CAI Xiao-yong,et al. 2008, 28(02): 128-129.  Abstract ( )   PDF (1549KB) ( )   Objective:To evaluate the feasibility of laparoscopic left liver rescetion. Methods:Candidate for laparoscopic left liver rescetion were 28 cases including hepatic hemangioma 3 cases,15 cases of hepatolithiasis,10 cases of primary hepatic carcinoma.Electriccautery,ultracision were used for left liver transection.Operative procedures includeded anatomical left hepatectomy in 8 case,nonanatomical left hepatectomy 20 cases.1 cases were performed cholecystectomy synchronously. Results:Laparoscopic left liver rescetion was successfully performed in all 28 cases.The operative duration was （251.15±40.94）min;The quantity of blood lost during the operation was （422.20±146.01）mL.The postoperative recovery was smooth and good.No complications occurred.The duration for hospitalization after operation was （5.98±0.73） day. Conclusion:Laparoscopic left liver rescetion is a prospective and minimally invasive technique which can be carried out safely and effectivel.

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Prognosis evaluation of patients underwent liver transplantation with two Acute Physiology and Chronic Health Evaluation Ⅱ models:a comparative study SHU Ming,PENG Cheng-hong,SHEN Bai-yong,et al. 2008, 28(02): 130-132.  Abstract ( )   PDF (2262KB) ( )   Objective:To study the accuracy of prognosis evaluation of patients underwent liver transplantation with two acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) models retrospectively. Methods:The clinical data of 74 cases of liver transplantation performed between March 2004 and August 2005 in Ruijin Hospital of Medical School of Shanghai Jiaotong University was analyzed retrospectively.All the cases were divided into survival group (69 cases) and died group (5 cases).The gender,age,etiology,preoperative childPugh classification and operative pattern were compared between two groups.APACHE Ⅱ score,risk of death,predicted hospital mortality calculated by original and modified APACHE Ⅱ models were compared also.The calibration and discrimination of two models were tested with HosmerLemeshow goodness-of-it and receiver operating characteristic curve statistic analysis respectively. Results:There was not magnificent difference in gender,age,etiology,preoperative childPugh classification and operative pattern.But score and risk of death had a significant difference between two groups.Original model overestimated hospital mortality.The calibration and discrimination of modified model were better than those of the original model. Conclusion:Original model overestimates the mortality.The modified model can provide an closely accurate prognosis evaluation of patients performed liver transplantation.

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Risk factors of local recurrence after curative resection in patients with middle and lower rectal carcinoma WU Ze-yu,YAO Yuan,WAN Jin,et al. 2008, 28(02): 133-135.  Abstract ( )   PDF (2042KB) ( )   Objective:The risk factors of local recurrence after curative resection were evaluated in patients with middle and lower rectal carcinoma. Methods:Cancer specimens from 56 patients with middle and lower rectal carcinoma who received total mesorectal excision at the Department of General Surgery of Guangdong Provincial People’s Hospital were studied.The relationship between mesorectal metastasis/circumferential resection margin status and local recurrence was identified.The relationship between local recurrence and clinicopathologic characteristics of middle and lower rectal carcinoma was also evaluated. Results:Local recurrence after curative resection occurred in 12.5%(7/56) of patients with middle and lower rectal carcinoma.Local recurrence was associated with family history (P=0.047),high CEA level (P=0.026),cancerous perforation (P=0.004),tumor differentiation (P=0.009) and vessel cancerous emboli (P=0.001). Twelve patients (21.4%) had positive circumferential resection margin.Local recurrence rate of patients with positive circumferential resection margin was 333%(4/12),whereas it was 68%(3/44) in those with negative circumferential resection margin (P=0.014).Thirty-six (64.3%) patients was detected mesorectal metastasis.Local recurrence rate of patients with mesorectal metastasis was 16.7% (6/36),whereas it was 5.0%(1/20) in those without mesorectal metastasis.The difference between these two groups was not statistically significant (P=0.206). Conclusion:The results demonstrate that family history, high CEA level, cancerous perforation, tumor differentiation, vessel cancerous emboli and circumferential resection margin status are significant risk factors of local recurrence after curative resection in patients with middle and lower rectal carcinoma.

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Prevention and management of postoperative complications after anterior resection of rectal cancer in 915 patients DONG Xin-shu，XU Hai-tao,WANG Ping,et al. 2008, 28(02): 136-138.  Abstract ( )   PDF (473KB) ( )   Objective:To approach the prevention and the management to the complications of 915 patients with rectal cancer after Anterior Resection (A.R.) from May 1975 to 2005. Methods:The clinic data of 915 patients with rectal cancer who underwent anterior resection (AR) was analyzed. Results:After AR,28 of 915 patients (3.06%) suffered from stoma leak and 24 patients（85%,24/28）with stoma leak were cured by expectant treatment.Sex,stapler,serious anemia and serious hypoproteinemia were significantly correlated with stoma leak.6 of 915 patients (0.66%) suffered from stoma hemorrhoea and 5 patients (5/6) with stoma hemorrhoea were cured by operation.38 of 915 patients (4.15%) suffered from stoma stenosis and all relieved after enlarging anus. Conclusion:Stoma leak,stoma hemorrhoea and stoma stenosis were three serious complications of AR.in rectal cancer,so we must think high of them.

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Comparison of the effects of surgical versus nonsurgical treatment for deep vein thrombosis of lower extremities CHEN Yi-kuan,ZHU Shi-qin,LUO Wen-jun,et al. 2008, 28(02): 139-141.  Abstract ( )   PDF (2454KB) ( )   Objective:To compare the effects of surgical versus nonsurgical treatment for deep vein thrombosis (DVT) of lower extremities. Methods:One hundred and twentyseven proximal or proximal and distal combined DVT patients were divided into surgical treatment group (67 patients) and nonsurgical treatment group (60 patients).The circumference of lower limb involving DVT in all patients were 2cm more than that of the other limb.The courses were from 8 hours to 90 days.The patients in the surgical group received thrombectomy,balloon venoplasty,and stent placement after placement of inferior vena cava filters.Two groups received anticoagulation and thrombolysis via limbs involving DVT.Color Doppler sonography and the edema fadeaway were used to evaluate the treatment effects. Results:The effect of surgical treatment was superior to nonsurgical treatment.The effects of acute and subacute patients in surgical group had no statistical difference,but that of acute and subacute versus chronic patients had statistical difference.The effects of acute patients in two groups had no statistical difference,but surgical treatment was superior to nonsurgical treatment for subacute patients. Conclusions:Non-surgical treatment may be proper for acute DVT of lower extremities.Surgical treatment is superior to nonsurgical treatment for subacute proximal or proximal and distal combined DVT patients who received nonregularizing treatment in acute stage.