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01 October 2007, Volume 27 Issue 11 Previous Issue    Next Issue
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MRI volumetry,T downstaging,N staging in evaluating therapeutic effects in advanced rectal carcinoma with preoperative chemoradiotherapy：a comparative study SUN Ying-shi,ZHANG Xiao-eng,TANG Lei,et al. 2007, 27(11): 1-856.  Abstract ( )   PDF (777KB) ( )   Objective:o observe tumor volume,volume reduction rate with postoperative histopathologic tumor downstaging,lymph node status in rectal cancer after preoperative chemoradiotherapy (CRT) and to investigate the usefulness of MRI volumetry for predicting response to neoadjuvant chemoradiotherapy. Methods:ortytwo patients with locally advanced rectal cancer admitted between December 2004 and October 2006 were performed preoperative CRT,followed by surgical resection.DWI volumetry was performed before and after CRT.Pre and post CRT tumor volume and percent of volume reduction,according to postoperative Tdownstaging, histopathologic lymph node staging in accordance with the AJCC TNM classification were compared. Results:ighteen patients demonstrated a tumor downstaging after chemoradiation therapy.Both pre and posttreatment MRI tumor volumes were significantly smaller in downstaged patients than in not downstaged patients (P＜0.01）,but the percentage of volume reduction rates was not significantly higher in downstaged patients (P＞0.05).According to N staging,the patients were divided into N0 group and N1-2 group.There was not significant difference in mean tumor volume before preoperative CRT between N0 group and N1-2 group (P＞0.05). Conclusion:The higher tumor volume reduction rate does not correlate with histopathologic downstaging,and initially smaller tumors are more likely to be downstaging tumor. So it might be unsafe to evaluate tumor response and to select the surgical method on the basis.The tumor volume before chemoradiotherapy does not correlate with histopathologic lymph node status,but the tumor volume after chemoradiotherapy and tumor volume reduction rate in patients with nodematastasis are significantly different with those in patients without nodematastasis.So the higher DWI volumetric tumor reduction rate is more inclined to have negative nodes in rectal cancer with preoperative chemoradiotherapy.

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Role and significance of right hepatic vein and hepatic pedicle exclusion in large liver tumor resection DAI Weidong,HU Jixiong,ZHONG Dewu，et al. 2007, 27(11): 1-923.  Abstract ( )   PDF (301KB) ( )   Objective:To explore the role of right hepatic vein and hepatic pedicle exclusion in large liver tumor operation. Methods:One hundred and thirtyeight patients with large hepatic carcinoma involving right hemiliver and segmentⅠ,Ⅳ,Ⅶ,Ⅷ underwent major hepatectomies,during which right hepatic vein and hepatic pedicle were isolated and taped to control blood flow between Febuary 2003 and August 2006.The blood loss volume,postoperative recovering situation of the liver function and the incidence of complication were observed.The time of hepatic vascular exclusion and the whole operate time were also recorded. Results:Extrahepatic isolation and control of right hepatic vein were performed in 135 patients.Hepatic pedicle exclusions were performed successfully in all cases.The time of hepatic vascular exclusion was about (18±6) minutes,and the whole operate time was about (180±45) minutes.The amount of blood loss was from 400 to 1 200 mL.Intraoperational blood transfusion was not performed in 56 patients.There was no operative mortality and liver function failure. Conclusion:Right hepatic vein and porta hepatis exclusion during hepatectomy is a safe method and effective to prevent massive bleeding and to reduce the incidence of liver function failure.

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Reasons and preventions for damage of recurrent laryngeal nerve in thyroid surgery SHI Lan,CHENG Bo,QU Xin-cai, et al. 2007, 27(11): 1-856.  Abstract ( )   PDF (431KB) ( )   Objective:To investigate the reasons and the preventive measures of recurrent laryngeal nerve (RLN) injury during operations in patients with thyroid neoplasm. Methods:The clinic data of 1 174 cases of thyroid neoplasm in a single unit (department of breast and thyroid surgery center,Union hospital,Tongji medical college,Huazhong university of science and technology) from June 2003 to August 2006 were surveyed retrospectively.The relationships of 41 cases postoperative RLN injury between type of operation,routine identification and unidentification of the RLN during the operation were analyzed. Results:Transient RLN injury in primary,second time and over two times operation were 2.1%,3.8%and 9.5% respectively.Permanent RLN injury in primary,second time and over two times operation were 10%,1.5% and 4.8% respectively.Routine identification and no identification RLN inducing transient RLN injury were 2.3% and 2.5% respectively,whereas permanent RLN injury were 02%and 2.3% respectively. Conclusion:Operations for thyroid cancer and reoperation for thyroid diseases demonstrate higher RLN injury rates significantly.Routine nerve exposure remain crucial to the minimization of permanent RLN injury.And the way always cause temporary RLN injury immediately postoperation which can complete recovery with expectant treatment as long as RLN was anatomically intact.Once RLN injury without certain cause was made,an operation should be performed as early as possible to recovering the function of RLN.

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Diagnosis and treatment of recurrent chronic venous insufficiency：an analysis of 60 cases SHI Ya-xue,JIAO Yuan-yong,ZHANG Ji-wei,et al. 2007, 27(11): 1-852.  Abstract ( )   PDF (469KB) ( )   Objective:To analyze the cause of the recurrent chronic venous insufficiency (CVI) and summarize the treatment experience. Methods:A total of 66 limbs in 60 patients with recurrent CVI admitted between August 1995 and November 2005 were examined through ascending venography and duplex sonography preoperatively to definitude the recurrent cause,then underwent operation to correct venous insufficiency. Results:Incompetent perforator vein,residual saphenous trunk or tributaries and deep venous insuffieciecy were the major causes,and found in 95.45%（63/66）,72.72%（48/66） and 43.94%（29/66） cases respectively.The diagnosis accurate rate on venous smoothness of ascending venography was 100%，while 87.5% and 79.16% agreement between ascending venography and duplex sonography on deep venous insuffieciecy and residual saphenous trunk or tributaries respectively.The false negative rate was significantly higher in ascending venography （28.31%） than duplex sonography （5.11%）.The value of clinical situation severity was lower after reoperation （1.9±1.3） than before （7.0±4.2）significantly，（P<0.01）. Conclusion:Imcompetent perforator vein and residual saphenous trunk or tributaries are the main causes of recurrence,so that reoperation should entirely correct the superficial,deep and perforator venous insufficiency.Duplex sonography has the irreplaceable advantage of diagnosing cause and localization of the lesion in recurrent cases,especially in the ones with the lesion in the saphenofemoral junction and perforator vein.

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Dynamic variation of ET1,TNFα in portal hypertensive patients with hemorrhage and its clinical significance LUO Hongwu,HUANG Feizhou,LIU Bo,et al. 2007, 27(11): 1-852.  Abstract ( )   PDF (376KB) ( )   Objective:To investigate variations of plasma ET-1,TNF-α and liver function and its clinical significance in portal hypertensive patients with esophageal variceal hemorrhage. Methods:A total of 66 patients with portal hypertension admitted between June 2001 and June 2004 in the Third Xiangya Hospital of CentraSouth University were divided into 2 groups.The patients in groupⅠ(32 cases) were performed general therapy and those in GroupⅡ(34 cases) were performed the general therapy and ulinastatin after hemorrhage.The plasma ET-1 and TNF-α concentration were measured on the 1st,2nd,4th,7th,10th and 14th day and liver function determined on the 1st,7th and 14th day after the hemorrhage.Other 20 patients without the hemorrhage were served as the control group. Results:On the 7th and 14th day after hemorrhage,the levels of TBIL,ALT and AST were elevated firstly and then decreased in groupsⅠ and Ⅱ.The decreased of TBIL,ALT and AST levels was significantly faster in groupⅡ than in groupⅠ(P<0.05) on the 14th day after hemorrhage.On the 1st day after the hemorrhage the ET-1,TNF-α concentration was markedly increased in groupⅠandⅡ compared with the control group (P<0.01).Then it was gradually decreased on the 10th day after hemorrhage.The ET1,TNFα concentration in groupⅡ was decreased more rapidly than that in groupⅠon the 2nd,4th and 7th day after hemorrhage(P<0.05).Meanwhile the decreased index of ET-1 and TNF-α concentration was negatively correlated to increased index of TBIL in the 2 groups(P<0.05). Conclusion:The increased plasma ET-1,TNF-α in portal hypertensive patients with hemorrhage may contribute to liver injure.Ulinastatin can protect liver function by inhibiting ALT,AST,TBIL and ET-1,TNF-α level.

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Clinical pathological characters of early gastric cancer with distant metastasis YANG Qiu-meng,ZHU Zheng-gang,Yutaka Yonemura. 2007, 27(11): 1-863.  Abstract ( )   PDF (386KB) ( )   Objective:To analyze clinical pathological characters of early gastric cancer with distant metastasis. Methods:The clinical data of 4 420 patients with early gastric cancer admitted between April 1973 and November 1998 in 8 hospitals of Chinese and Japanese university were analyzed retrospectively.Among them,22 patients had distant metastasis.The sex ratio,average age,maximum tumor diameter,infiltrating depth,differentiation type,and long term survival were compared between the distant metastasis (DM) group and nondistant metastasis (control) group. Results:There were very significant differences of sex ratio,maximum tumor diameter,infiltrating depth,and 5 year survival rate (DM group 34.7%,control group 91.3%) between DM group and control group (P<0.01).There were no significant differences of age and differentiation type between the two groups. Conclusion:Even early gastric cancer can have distant metastasis and poor prognosis.Female,tumor infiltrating submucosa and maximum diameter >4cm can be risk factors of early gastric cancer with distant metastasis.

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Operational mode for differentiated thyroid cancer and correlated complications LIU Chunping,LI Zhi,HUANG Tao. 2007, 27(11): 1-856.  Abstract ( )   PDF (290KB) ( )   Objective:To approach reasonable operational mode with differentiated thyroid cancer and precaution of correlated complications. Methods:The clinical data of 430 cases of differentiated thyroid cancer admitted between June 2003 and September 2006 at the Union Hospital of Huazhong University of Science and Technology were reviewed retrospectively.All the cases were performed bilateral thyroidectomy with or without cervical lymphonode excision. Results:There were no death with operation or in hospital. There were 5 cases (1.16％) of single lateral recurrent laryngeal nerve injury,2 cases (0.47％) of parathyroid gland partly injury,3 cases (0.69％) of superior laryngeal nerve injury,3 cases (0.69％) of bleeding and 1 case (0.23％) of esophago injury after operation. Conclusion:Total thyroidectomy is essential operational mode for differentiated thyroid cancer,and it is secure and feasible.

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Laparoscopic radical gastrectomy for early gastric cancer HU Wei-guo,ZHENG Min-Hua,MA Jun-jun,et al. 2007, 27(11): 1-890.  Abstract ( )   PDF (2432KB) ( )   Objective:To evaluate laparoscopyassisted radical gastrectomy for early gastric cancer. Methods:The clinical data of 31 patients with early gastric cancer underwent laparoscopyassisted radical gastrectomy from October 2004 to May 2007 were reviewed and analyzed with the surgical procedure,operative time,blood loss,time for passage of flatus,postoperative hospital stay,complications and pathology retrospectively. Results:All patients underwent laparoscopy-assisted- gastrectomy and lymph nodes dissection successfully without conversion to open surgery,including 28 distal gastrectomy,2 proximal gastrectomy and 1total gastrectomy.Sixteen patients,2 patients,and 13 patients were performed with D1＋α,D1＋β,and D2 lymph nodes dissection respectively.The mean operative time was 195 (90-280) min.The blood loss was 146 (40-800) mL.The time for passage of flatus was 1-8 (1－4)d and the postoperative hospital stay was 10-8 (7-20)d.Except one patient（3-2%）with anastomostic leakage,no operative complication occurred.The tumor to normal -resection-margin was 3.8（1-8）cm and 3.5（1.5-7.0）cm，and average number of dissected lymph node with gastrectomy was 9-6 (2-19).After 14 (2-32) months follow-up,there was no operative recurrence and metastasis. Conclusion:Laparoscopy-assisted radical gastrectomy is the safe,feasible，effective and less invasive surgery for early gastric cancer.

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Liver transplantation for hepatocellular carcinoma combined with portal vein thrombosis:an analysis of 12 cases ZHANG Tong,CAI Chang-jie,LU Min-qiang,et al. 2007, 27(11): 1-856.  Abstract ( )   PDF (443KB) ( )   Objective:To investigate the therapeutic effect,operation technique and perioperative management of liver transplantation for hepatocellular carcinoma combined with portal vein thrombosis（PVT）. Methods:The clinical and followup data of 12 patients with hepatocellular carcinoma combined with portal vein thrombosis underwent liver transplantation between October 2003 and June 2005 in the Third Affiliated Hospital of Sun Yatsen University were analyzed retrospectively. Results:All the patients were followed up from 8 days to 36 months with median time of 195 months after operation. Three patients died of pulmonary infection and multiple organ failure on the 12th,21th,30th postoperative day.During the followup period one patients died of tumor recurrence on the 15th months after operation.In present 8 patients survived:one patient with tumor recurrence survived for 36 months after operations.The remaining 7 patients survived without tumor recurrence for 13,14,24,24,25,28,30 months.The 1year accumulative survival rate of 12 patients was 75.0％.One patient had survived for 30 months with local PVT recurrence in 2 months. Conclusion:The prognosis of patients with hepatocellular carcinoma combined with portal vein thrombosis performed liver transplantation is good. Reasonable operation technique and correct postoperation treatment can avoid the recurrence of PVT.