Archive

14 August 2007, Volume 27 Issue 08 Previous Issue    Next Issue
---
论著


For Selected:

Download Citations EndNote Ris BibTeX

Toggle Thumbnails

论著

Select

Analysis of the causes of reoperation after liver transplantation WANG Xiao-ming,PENG Cheng-hong,SHEN Bai-yong,et al. 2007, 27(08): 1-615.  Abstract ( )   PDF (303KB) ( )   Objective:To study the causes of reoperation after liver transplantation (LT). Methods:Two hundreds and twentyfive patients were performed LT from June 2002 to June 2006 in Rui Jin Hospital Affiliated to Medical college of Shanghai Jiao Tong University.Among them,27 patients were performed reoperation after LT.The clinical data of the 27 patients were analyzed retrospectively. Results:Thirtytwo times of reoperation were performed in the 27 patients and the incidence of reoperation was 142％.The causes of reoperation included as following： intraabdominal bleeding in 17 cases (53.1％),biliary complications in 9 cases (11 times,34.3％),hepatic artery thrombosis in 2 cases (6.3％),upper gastrointestinal bleeding in 1 case and thorax bleeding in 1 case.Among 27 patients,7 patients died after reoperation with the mortality of 25.9%. Conclusions:The causes of reoperation after LT are various.Intraabdominal bleeding and biliary complications are the major factors.Recognizing the causes of reoperation after LT is very important to decrease the mortality after LT.

Select

Clinical application of albumin administration in patients following liver surgery MAO Yi-lei,SANG Xin-ting,YANG Zhi-ying,et al. 2007, 27(08): 1-615.  Abstract ( )   PDF (426KB) ( )   Objective:To summarize and discuss the result and effectiveness of postoperative administration of albumin in patients with different liver diseases performed various hepatectomy. Methods:The clinical data of 132 patients performed hepatectomy between June 2005 and March 2007 in Peking Union Medical College Hospital were analyzed.All the patients were divided into three groups according to the types of the surgery and function of the liver:hepatic hemangioma group,liver cancer group1,and liver cancer group 2.The supplementation of albumin and its influence on postoperative liver function and recovery were analyzed. Results:The administration of albumin had no significant effect on postoperative serum albumin levels (3.17±0.40 vs 3.15±0.23,P=0.37) and other liver functions in the hepatic hemangioma group with normal liver function;The application of albumin had also no effect on postoperative serum albumin levels (3.17±0.40 vs 3.15±0.23,P=0.37) in the cancer group with Child A liver function,following 2-3 hepatic segments excision;Whereas to those who had hypoalbuminemia preoperatively and /or underdone lobectomy or up,supplementation of albumin routinely postoperation had an effect of maintain lower incidence of complications. Conclusion:The indication of postoperative use of albumin can be restrictive in the patients with normal liver function and performed smallmedium liver resection.However,administration of albumin is suggested in the patients with preoperative significant hypoalbuminemia and/or performed major hepatectomy.It may decrease the incidence of complications and improve the prognosis of the surgery.

Select

Restrictive and liberal transfusion strategy in patients after orthotopic liver transplantation:a randomized and controlled clinical trial WU Jian-feng*,GUAN Xiang-dong,HE Xiao-shun,et al. 2007, 27(08): 1-639.  Abstract ( )   PDF (277KB) ( )   Objective:To determine whether a restrictive strategy of redcell transfusion and a liberal strategy produced equivalent results in patients after orthotopic liver transplantation (OLT). Methods:Two hundred and twentysix patients after OLT who had hemoglobin concentrations of less than 9.0 g per deciliter after admission to the intensive care unit and randomly assigned 112 patients to a restrictive strategy of transfusion,in which red cells were transfused if the hemoglobin concentration dropped below 7.0 g per deciliter and hemoglobin concentrations were maintained at 7.0 to 9.0 g per deciliter,and 114 patients to a liberal strategy,in which transfusions were given when the hemoglobin concentration fell below 10.0 g per deciliter and hemoglobin concentrations were maintained at 10.0 to 12.0 g per deciliter.Thirty days’ mortaligy,hospital stay in ICU,duration of mechanical ventilation and transfusion volume between two groups were compared. Results:Hospital stay in ICU (2.5d vs 2.3d),30day mortality (2.7％vs 3.5％) and postoperative liver function were similar in the two groups (P＞0.05).There was no significant difference between two groups in duration of ventilation and complications incidence in 30 days. Conclusion:Restrictive strategy of redcell transfusion is an effective and safe strategy for transplantation recipients without active hemorrhage.

Select

Clinical characteristics and diagnosis of gastrojejunocolic fistula：a report of 12 cases DING Yin-lu,ZHOU Yong，GAO Zhuang-lei，et al. 2007, 27(08): 1-615.  Abstract ( )   PDF (308KB) ( )   Objective:To investigate the clinical characteristics and diagnosis of gastrojejunocolic fistula (GJF). Methods:The clinical data of 12 cases of GJF admitted between August 1970 and January 2006 were analyzed retrospectively. Results:All of the 12 cases had case history of duodenal ulcer (DU) and gastronesteostomy. he main symptoms of GJF were diarrhoea（100%）,faecal vomtiting/belching（83.3%） and weight loss（66.7%）.The diagnostic rate of barium meal,gastroscopy,colonoscopy and barium enema was 33.3%（3/9），44.4%（4/9），85.7%（6/7），100%（11/11）respectively.Eleven cases were performed 1stage operation.One case were performed 2stage operation.Two cases died postoperatively. Conclusions:Attention should be paid to those underwent gastronesteostomy for DU when diarrhoea,faecal vomtiting/belching and weight loss appeared.Colonoscopy and barium enema are two methods with higher diagnostic rate.

Select

Diagnostic laparoscopy in ascites of unknown origin ZHOU Donglei,ZHENG Chengzhu,HU Xuguang,et al. 2007, 27(08): 1-639.  Abstract ( )   PDF (452KB) ( )   Objective:To investigate the diagnostic value and surgical technique of laparoscopic exploration in patients with ascites of unknown origin. Methods:Laparoscopic exploration under general anesthesia was performed in 72 patients with ascites of unknown origin between September 1999 to October 2006 in the Department of General Surgery of Changhai Hospital of Second Military Medical University.All the suspected tissues were taken for pathologic examination. Results:Sixty-eight patients were positive by laparoscopy (94.5%).Among them,the major cause was tuberculous peritonitis (44/72,61.1%);metastatic adenocarcinoma ranked the second (12/72,16.7%);the third was peritoneal mesothelioma (5/72,7.0%);the forth was extraovarian peritomeal serous papillocarcinoma (4/72,5.5%);the rest three cases were lymphoma,schistosomiasis and colon carcinoma respectively.The origin of the other 4 cases remained unknown (5.5%).Due to preoperative preparation and careful operation,no complication was found in the series. Conclusions:Laparoscopic exploration is safe and effective for the determination of origin of ascites.Laparoscopy and histopathological examination can reveal the causes for ascites.Special preoperative preparation and operational technique is required in performing diagnostic laparoscopy.

Select

Immediate breast reconstruction with partial latissimus dorsi muscular flap after subcutaneous mastectomy FENG Rui,CAO Xu-chen,SUN Qiang,et al. 2007, 27(08): 1-615.  Abstract ( )   PDF (310KB) ( )   Objective:To explore a new method of immediate breast reconstruction (IBR) after subcutaneous mastectomy. Methods:The clinical data of 12 cases of breast cancer performed IBR with a strip of latissimus dorsi muscle and an implant after subcutaneous mastectomy between January 2006 and January 2007 in Peking Union Medical Hospital and Tianjin Tumor Hospital were analyzed.A introduce was made on the methods of IBR.The indication of the procedure was evaluated. Results:Subcutaneous seroma occurred in 2 cases,and they healed after 1 weekly pump treatment.All patients received chemotherapy after operation routinely.They all satisfied with their new breasts.The longest followup was 1 year,doctors and patients were all satisfied with the cosmetic outcome of IBR. Conclusions:IBR technique is safe,simple,and effective.It can shorten operation time.The indication of IBR is that patients are evaluated not to be adapted to breast save therapy,or not to expect an aesthetic outcome after a breast save therapy,and tumor site is 2cm from the NAC and no more than 3 cm.

Select

Exploring the relationship of micrometastasis in portal vein blood of colorectal carcinoma with its prognosis LI Taiyuan,ZHANG Haitao,DUANMU Jinzhong. 2007, 27(08): 1-639.  Abstract ( )   PDF (431KB) ( )   Objective:To evaluate the effects of micrometastasis in portal vein blood on the oneyear,twoyear,and threeyear postoperative survival rates of patients with colorectal carcinoma. Methods:Cytokeratin 20 (CK20) mRNA in portal vein blood of 46 cases of colorectal carcinoma performed operation between May 2002 and September 2003 was detected by using RTPCR technique.All the cases were followed up over 3 years. Results:The positive rate of CK20 mRNA in portal vein blood of 46 cases was 54.3%.The one-year,twoyear,and threeyear postoperative survival rates were 86.5%,70.2% and 63.1% respectively.The oneyear,twoyear,and threeyear postoperative survival rates of positive cases were 74.5%,46.5% and 41.9% respectively.And those of negative cases were 95.2%,85.7% and 85.7% respectively.The survival rates of the cases with positive expression of CK20mRNA were lower than those with negative expression,χ2=11.69，P<0.01. Conclusions:Detecting micrometastasis in portal vein blood is help to evaluate the prognosis of colorectal carcinoma, and supply information for monitoring and further treatment.

Select

Strategy for the emergency management of acute obstruction result from left colon cancer PIAO Da-xun,ZHU An-long,JIANG Hong-chi,et al. 2007, 27(08): 1-615.  Abstract ( )   PDF (302KB) ( )   Objective:To investigate the strategy for the emergency management of acute obstruction result from left colorectal cancer. Methods:The clinical data of 36 cases of acute obstruction result from left colorectal cancer admitted between 2000 and 2006 in the First Affiliated Hospital of Harbin Medical University were analyzed retrospectively. Results:Onestage resection and primary anastomsis was performed in 27 cases.Palliative colostomy was perfomed in 4 cases.Decompression and decontamination by transanal ileus tube and then primary anastomosis were performed in other 5 cases.Wound infection occurred in 2 cases as a surgical complication and no anastomotic leakage appeared.There was no surgical death in the cases. Conclusion:For the emergency management of acute obstruction result from left colorectal cancer,onestage resection and primary anastomosis are feasible and safety in selected cases.Decompression and decontamination by transanal ileus tube is an effective complement for onestage resection and primary anastomosis.

Select

Endoscopic submucosal dissection for large flat colonic polyp:an analysis of 18 cases ZHOU Ping-hong,YAO Li-qing,XU Mei-dong,et al. 2007, 27(08): 1-639.  Abstract ( )   PDF (584KB) ( )   Objective:To assess the clinical efficacy and safety of endoscopic submucosal dissection（ESD）for large flat colonic polyp. Methods:Between August 2006 and March 2007,18 patients with large flat colonic polyp were managed by ESD with the needle knife after chromoscopy,magnification and endoscopic ultrasonography examination as following:(1) injecting sodium chloride fluid into the submucosa to elevate the lesion from the muscle layer;(2) precutting the surrounding mucosa of the lesion;(3) dissecting the connective tissue of the submucosa beneath the lesion. Results:Of 18 large flat colonic polyps,11 located in rectum,3 in sigmoid colon,1 in descending colon,1 in hepatic flexture of colon,1 in ascending colon and 1 in caecum.Polyps ranged from 2.0 to 5.2 cm and a mean resected size was 3.1cm.Confirmed pathologically,all 18 polyps were successfully resected with ESD and en bloc resection rate was 100% (18/18).The mean ESD procedure time was 75 min (ranged from 55 to 115 min).None of patients had massive hemorrhage during ESD which couldn’t be controlled under colonoscope and had delayed bleeding after ESD.One patient had subcutaneous emphysema due to deep tearing of the muscle layer,and recovered after several days’conservative treatment.Perforation occurred in 1 case during the dissection of the lesions,which was typically closed with metallic endoclip without surgical treatment.The perforation rate of ESD was 11.1%(2/18).Twelve cases were followed up after ESD，with confirmed healing of the artificial ulcer with no residue or recurrence. Conclusions:ESD is an efficacious and safe endoscopic surgical procedure to treat large flat colonic polyp,which makes it possible to resect en bloc polyp and provide pathological information about the whole polyp.

Select

Anorectal malignant melanoma:an analysis of 26 cases ZHONG Jian,ZHOU Jiannong,SHANG Junqing,et al. 2007, 27(08): 1-622.  Abstract ( )   PDF (436KB) ( )   Objective:To summarize experiences on clinical features,diagnosis and treatment of anorectal malignant melanoma (AMM). Methods:The clinicopathologic data of 26 patients with AMM admitted from 1977 to 2005 in Jiangsu Provincial Cancer Hospital were analyzed retrospectively. Results:The most common complaints of AMM patients were hematochezia (88.5%),anus pain or discomfort (53.8%),anus mass (26.9%) and so on.The distances from the tumor to anal verge of all the patients were no more than 5cm.The misdiagnosis rate was 846%.The rate of definite pathologic diagnosis before surgery was 44%.The positive rates of immunohistochemical staining results of HMB45,S100 and Vimentin were 85.7%（6/7）,100%（7/7）,833%（5/6）,respectively.The overall 1,3,5year survival were 12,4,3 cases,respectively. Conclusions:AMM is a rare disease with poor prognosis.And it tends to be misdiagnosed.Hematochezia is the most common symptom.Digital rectal examination is very important to the diagnosis of AMM.Immunohistochemical staining is helpful to pathologic diagnosis of AMM.