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03 January 2008, Volume 28 Issue 01 Previous Issue    Next Issue
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Time distribution of the mortality hazard for breast cancer patients undergoing surgery YIN Wenjin, ZHOU Liheng, LU Jinsong,et al. 2008, 28(01): 41-43.  Abstract ( 1337 )   PDF (485KB) ( 562 )   Objective:To investigate the rule of mortality risk for breast cancer patients undergoing surgery in China. Methods:We performed a retrospective study of 2214 female unilateral breast cancer patients with complete data undergoing surgery in our hospital in order to conduct survival and mortality risk analysis. Results:Both univariate and multivariate survival analysis indicated that tumor size, axillary nodal status and progesterone receptor (PR) were prognostic factors for overall survival (P<0.05).Annual mortality hazard curve for entire population showed doublepeaked pattern.The analysis according to tumor size and axillary nodal status proved that the doublepeaked pattern was almost completely generated by patients with larger tumors and by N+ patients.While hormone receptor did not change the bimodal pattern of mortality risk,the results showed that it was a timedependent variable. Conclusion:According to the time distribution of mortality hazard, we could formulate novel strategies for postoperative treatment and follow-up, which provides the possibility to improve the therapeutic effect and reduce the mortality hazard.

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Treatment and character of the patients who received liver retransplantation during perioperation CAI Chang-jie,YI Shu-hong,LI Min-ru,et al. 2008, 28(01): 44-46.  Abstract ( 1079 )   PDF (2544KB) ( 565 )   Objective:To conclude the perioperative clinical character and management experience of liver retransplantation (ReTx). Methods:The clinical data of 34 patients undergone liver retransplantation at the liver transplantation center of the Third Affiliated Hospital of Sun Yet-sen University from January 2004 to December 2006 were retrospectively analyzed. The retransplantation indications included biliary complications (18 cases)，recurrence of HCC (6 cases),hepatitis recurrence (6 cases) and hepatic artery complication (4 cases).34 patients received modified piggyback liver transplantation. Results:No patient died during operation.9 patients (26.5%) died in hospital, which was significant higher than that of the first transplantation (6.9%,46/671)(P<0.05).Infection accounted for 55.6%(5/9).There was significant difference of the preoperative infectious rate between retransplantation and primary transplantation group,which was 32.4%(11/34) and 10.88%(72/671) respectively (P<0.05).There was no significant difference of the postoperative infectious rate between retransplantation and primary transplantation group,which was 61.8%(21/34) and 46.3%(311/671) respectively (P>0.05). Conclusion:Infection is the main cause of death in liver retransplantation.Effective perioperative antiinfection treatment and reasonable individual immunosuppression regime refer to liver retransplantation may increase the success rate of liver retransplantion.

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Comparative clinical research between the Uncut Roux-en-Y choledochojejunostomy and the Roux-en-Y choledochojejunostomy QIAO Li-zhu，ZHANG Xue-wen，JIANG Tao，et al. 2008, 28(01): 47-49.  Abstract ( 1214 )   PDF (2169KB) ( 588 )   Objective:To investigate the shortterm therapeutic effects of the Uncut Roux-en-Y choledochojejunostomy. Methods:To analyze a total of 41 cases of Uncut Roux-en-Y choledochojejunostomy and compare with 48 cases underwent RouxenY choledochojejunostomy from April 2005 to December 2006. Results:The anastomotic time of the Uncut Roux-en-Y choledochojejunostomy is shorter (P<0.05).The period of recovery of bowel sound and flatus are earlier in the patients with Uncut Roux-en-Y choledochojejunostomy than that with Roux-en-Y choledochojejunostomy (P<0.05).The serum level of total bilirubin decreases in both Uncut RouxenY choledochojejunostomy group and Roux-en-Y choledochojejunostomy group with no statistical differences. Conclusion:The shortterm therapeutic effects of the Uncut Roux-en-Y choledochojejunostomy is better than Roux-en-Y choledochojejunostomy,but the further therapeutic effect need more study.

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Segmental pancreatic resection to treat benign pancreatic tumors WU Wen-ming,ZHAO Yu-pei,LIAO Quan,et al. 2008, 28(01): 50-53.  Abstract ( 1310 )   PDF (2538KB) ( 572 )   Objective:To review the experience on the segmental pancreatectomy to treat pancreatic tumors. Methods:Data from 28 patients of pancreatic tumors in PUMCH were retrospectively and statistically analyzed. Results:All the 28 patients were performed segmental pancreatectomy and the symptoms vanished after the operations.Exocrine and endocrine function of pancreas were preserved well.Pancreatic fistula is the commonest complication with morbidity of 14.2%.The longtime follow-up outcomes were satisfied. Conclusion:Segmental pancreatectomy is a safe,effective,and less invasive treatment to pancreatic tumors,better for the benign tumors.It preserves pancreatic parenchyma and function,leads to a better long time outcome.

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Relationship between the pancreatic fistulae and the bacterial culture of abdominal draining fluid after pancreatic operations HU Ya,ZHAO Yu-pei,LIAO Quan,et al. 2008, 28(01): 53-55.  Abstract ( 1237 )   PDF (2645KB) ( 631 )   Objective:The aim of this study was to determine the bacterial spectrum of abdominal infection after pancreatic resections and the relationships between pancreatic fistulae and abdominal infections. Methods:Intraperitoneal drainage fluid was collected through sampling tubes and bacteriological examinations were performed.The clinical characters of patients and the duration of intraperitoneal drainage were recorded. Results:For 60 patients, positive cultures of drainage fluid were 2.7%（1/37）、 27.27%（15/55）、 45.76%（27/59）、 70.27%（26/37） and 87.5%（14/16）in POD0,POD1,POD3,POD7 and POD14.Sixty-seven stems of bacteria were identified.The most dominant bacteria were MRSCoN 16.4％（11/67），E. faecalis 14.9％（10/67） and MRSA11.9％（8/67）.Abdominal infections were found in 17 cases during 10 days after operations, and 22 patients suffered from pancreatic fistulae with intraperitoneal drainage more than 14 days.χ2 statistics and Binary Logistic Regression shows that intraperitoneal infections during 10 days after operations was potential risk factors for pancreatic fistulae, while positive culture of drainage fluid in P1D and P3D were not related with pancreatic fistulae. Conclusion:The incidence of positive culture of drainage fluids increased with the duration of postoperative abdominal drainage.Pancreatic fistulae were not related with abdominal drainage fluid cultures,but with clinical abdominal infections.

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Value of technique of spleen subpedicle severance for splenectomy in portal hypertension patients KONG Ying,LIU Ying-Bin,WANG Xu-an,et al. 2008, 28(01): 56-58.  Abstract ( 1254 )   PDF (2345KB) ( 693 )   Objective:Evaluate the value of technique of spleen subpedicle severance for splenectomy in portal hypertension patients. Methods:Compare stay time,operation time,blood loss volume,incidence rate of complication between spleen subpedicle group and control group in portal hypertension patients with splenectomy and Pericardiac devascularization.and analysis the relationship between complication and spleen size. Results:The incidence rate of spleen fever,pancreas leakage and stay time are higher in control group than in test group.The operation time and blood loss volume are no significantly different in two groups.Spleen size in patients with spleen fever or pancreas leakage is thicker than in patients without spleen fever or pancreas leakage. Conclusion:The technique of spleen subpedicle severance can decrease incidence rate of spleen fever,pancreas leakage and shorten stay time in portal hypertension patients with splenectomy and Pericardiac devascularization.It is a value operation technique especially for patients with large spleen.

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Fast track rehabilitation in rectal cancer patients undergoing anterior resection JIANG Zhi-wei,LI Jie-shou,WANG Zhi-ming,et al. 2008, 28(01): 59-61.  Abstract ( 1283 )   PDF (2435KB) ( 531 )   Objective:This study was designed to compare fast track surgery with conventional perioperative management in rectal cancer patients undergoing anterior resection. Methods:42 rectal cancer patients undergoing anterior resection were recruited for this comparative study.20 patients received perioperative fast track rehabilitation;meanwhile other 22 received conventional perioperative care.Outcomes were assessed by length of postoperative hospital stay,medical cost,nutritional status,gut function,and postoperative complication. Results:Fast track rehabilitation group was associated with a significantly shorter postoperative hospital stay,less medical cost,earlier first passage of flatus,less loss of body weight in the postoperative period compared with conventional care group,and there were no differences in morbidity or mortality between two groups. Conclusion:Fast track rehabilitation was feasible and effective in rectal cancer patients undergoing anterior resection.

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Randomized clinical trial comparing subtotal colectomy and combined use of subtotalcolectomy and modified Duhamel procedure for severe functional constipation JIANG Jun,LI Ning,ZHU Wei-ming,et al. 2008, 28(01): 62-64.  Abstract ( 1034 )   PDF (2610KB) ( 652 )   Objective:Severe functional constipation (SFC) was a challenging medical problem that might warrant surgery.This study compared stool frequency,postoperative complications and qualityoflife（QOL）outcomes of subtotal colectomy and combined use of subtotal colectomy and modified Duhamel procedure for SFC. Methods:Between June 2004 and July 2006,31 patients were randomized to receive subtotal colectomy (n=10) or combined surgery (n=21).The selection criteria were normal colonoscopy,abnormal colon transit time (CTT) and abnormal dynamic proctography (DPG).The functional outcomes after surgery were assessed by stool frequency and QOL outcomes over one year period. Results:The preoperative clinical manifestations of the two groups were similar.Functional outcomes with score costive gastrointestinal symptoms［(73.6±8.2)%vs(60.3±805)%］,GIQOL index score (107.6±8.2vs92.1±9.6),recurrent constipation rate(9.5% vs 60.0%) for combined use of subtotal colectomy and modified Duhamel procedure were significantly better than that for subtotal colectomy.No statistically significant difference was observed between the two groups for time for recovery of the bowel function,average length of postoperative hospitalization,and the early postoperative complications. Conclusion:Combined use of subtotal colectomy and modified Duhamel procedure for SFC was better GIQOL outcomes.