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27 June 2007, Volume 27 Issue 07 Previous Issue    Next Issue
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Reason for negative result in intraoperative fine needle aspiration cytology for preoperative diagnosis as pancreatic cancer ZHANG Jian-wei,WANG Cheng-feng,ZHAO Ping,et al. 2007, 27(07): 1-513.  Abstract ( )   PDF (445KB) ( )   Objective:To investigate the meaning of negative result in intraoperative fine needle aspiration cytology (FNAC) of pancreas spaceoccupy lesion and the pattern to increase the accuracy. Methods:The clinical data of 33 patients with negative FNAC findings diagnosed as pancreatic cancer preoperatively between December 1995 and June 2006 were analyzed retrospectively.The clinical data included the clinical character,image feature,laboratory examination result and clinical followup. Results:All the patients were followed up for 3 months to 8 yeas.Among them,30 cases were diagnosed as chronic pancreatitis (CP) because the lesions unchanged with true negative label.Three cases were found tumor extend and multimetastases with false negative label. Conclusion:Chronic pancreatitis (CP) is main reason for the negative result.Tumor volume,growth pattern and technique of operator affect the result of FNAC.Acknowledging the clinical character of CP,reversal aspiration at malignant suspect lesion,improving aspiration technique will reduce false negative cases.

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Stapled anastomoses in ultralow anterior dissection of rectal cancer: an analysis of 342 cases LIU Chao,XU Lin,LIU Baoshan,et al. 2007, 27(07): 1-530.  Abstract ( )   PDF (2445KB) ( )   Objective:To investigate the technique，indication and efficiency of stapled anastomoses in the ultralow anterior dissection of rectal cancer. Methods:The clinical data of 342 cases of rectal cancer performed ultralow anterior dissection were reviewed.The average distance from anal verge to tumor margin was 2 cm in 134 cases of Dukes A stage,3 cm in 136 cases of Dukes B stage,and 4 cm in 72cases of Dukes C stage,respectively. Results:Among 342 cases,anastomotic leakage happened in 11 cases (3.2%).Anastomotic stenosis took place in 73 cases (21.3%).The average defecation was (4.3±5.2) times per day during hospital stay,and it relieved in 2 months (2.5±3.1) times per day),and normalized in 3 months after surgery.The local recurrence rate was 11.8% (40/342) in 5 years.The 5year survival rate was 68.8% (235/342). Conclusion:For ensuring the oncological excision and efficiency of anastomosis,the application of stapled anastomoses in the ultralow anterior dissection of rectal cancer can preserve the anal sphincter function.

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Surgical treatment of femoral artery infected false aneurysms：an analysis of 61 cases LI Xiao-xi,LI Song-qi,HU Zuo-jun,et al. 2007, 27(07): 1-516.  Abstract ( )   PDF (471KB) ( )   Objective:To evaluate the outcome of the excision of the aneurysm with femoral artery ligation and local debridement, without any revascularization in surgical management of posttraumatic femoral artery infected false aneurysms (pfa-IFA). Methods:The clinical data of 61 cases of pfaIFA admitted between January 2001 and December 2006 were analyzed retrospectively.Clamping of the external iliac artery was achieved retroperitoneally through an oblique suprainguinal incision.Distal superficial femoral artery was controlled through middle of thigh incision.All the cases were performed the excision of the false aneurysm with ligation of vessels and local debridement. Results:There was no hemorrhage,amputation or mortality in the cases.The duration of followup ranged from 3 to 48 months (mean 32 months).Two cases had mild claudication. Conclusion:Ligation of artery and wide debridement without immediate revascularization is an easy,effective and safe management for pfaIFA.

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Surgical management of carotid artery injury:a report of 16 cases SUN Zhanfeng，JIANG Weiliang,SUN Qingfeng,et al. 2007, 27(07): 1-505.  Abstract ( )   PDF (472KB) ( )   Objective:To explore the early diagnosis and surgical management method of carotid artery injury. Methods:The clinical data of 16 cases of carotid artery injury treated from October 2003 to December 2006 in the Department of Vascular Surgery of Second Affiliated Hospital of Harbin Medical University were analyzed.Among them,external carotid artery injury, common carotid artery injury,internal carotid artery，carotid pseudoaneurysm artery,thrombosis in carotid artery and iatrogenic carotid artery injury was in 4,3,1,3,1and 4 case respectively. Results:Ligation of external carotid artery,repairing of common carotid artery,auto great saphenous vein transplantation,endovascular stentgrafts inplantation,anticoagulation and thrombolysis was performed in 4,2,7,2 and 1 case respectively.Among 16 patients,there were death,hemiplegiaaphasia,Horner syndrome and hoarse voicehydroposia bucking in 1,1,5 and 4 cases respectively. The rest was recovery. Conclusion:Early diagnosis, effective haemostasis and reconstruction of carotid artery are the keys to reduce the mortality and decrease the morbidity of neurological deficit.

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Retransplantation for liver transplanter with poor graft function:a report of 22 cases FU Bin-sheng,CAI Chang-jie,YI Shu-hong,et al. 2007, 27(07): 1-516.  Abstract ( )   PDF (2355KB) ( )   Objective:To sum up the clinical experience of liver retransplantation (ReTx) for patients with poor graft function. Methods:The clinical data of 22 patients performed liver retransplantation at the Organ Transplant Institute of Sun Yat-sen University from January 2004 to June 2006 were analyzed retrospectively.The indications included biliary complications (12 patients),recurrence of HCC (4 patients),hepatic artery thrombosis (HAT) (2 patients),hepatic artery stricture (2 patients) and hepatitis B recurrence (2 patients).The rate of retransplantation was 3.62%.All the patients received piggyback liver transplantation with cadaveric allografts. Results:No perioperative mortality occurred.Eight patients were cured with the survival time being 21 months,14 months,12 months,12 months,8 months,3 months,1 month,1 month.Other 14 patients survived from 2 weeks to 28 months.The perioperation mortality rate of patients performed retransplantation between 8 and 30 days after their initial transplantation was the highest (66.7%).Ten patients were died of sepsisrelated (60%) within 1 year. Conclusion:Liver retransplantation is the only effective treatment for liver transplanter with poor graft function after liver transplantation.Proper indication and optimum operation time,surgical procedure,reasonable individual immunosupppression regime and effective perioperative antiinfection treatment contribute to the increase of the survival rate of the patients performed liver retransplantion.

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Iatrogenic bile duct injury:prevention and management DUAN Jian-ping，LIAO Xuan-ming，MEI Jian-min，et al. 2007, 27(07): 1-505.  Abstract ( )   PDF (476KB) ( )   Objective:To investigate the causes,prevention and management of iatrogenic bile duct injury. Methods:The clinical data of 31 patients with iatrogenic bile duct treated from January 1990 to December 2005 were analyzed retrospectively. Results:The main causes for iatrogenic bile duct injury were open cholecystectomy,common bile duct exploration and laparoscopic cholecystectomy, which accounted for 87.1% (27/31).Forty-one bile duct reconstruction operations were performed in 31 patients.Among 31 patients,29 patients were followed up for 3 months to 7 years and the rate of satisfactory outcome was 82.8%. Conclusion:Iatrogenic bile duct injury often occurs during cholecystectomy.Good knowledge of the anatomy and the possible variations of the bile ducts, strictly controlling of operative indications and recognition of bile cyst,common hepatic duct and common bile duct are the keys to prevent iatrogenic bile duct injury.Management according to the time and types of bile duct injury,early finding and timely correct management are very important to the prognosis.Roux-en-Y biliaryenteric anastomosis is the commonest and the most effective method for the bile duct reconstruction.

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Totally laparoscopic extraperitoneal herniorrhaphy: a report of 142 cases CAI Xiao-yong，LU Bang-yu，LU Wen-qi，et al. 2007, 27(07): 1-523.  Abstract ( )   PDF (322KB) ( )   Objective:To study the successful experience, operation skills, the safety, the feasibility and practicality of totally laparoscopic extraperitoneal herniorrhaphy (TEP). Methods:Between October 2002 and May 2006,142 patients were performed 169 totally laparoscopic extraperitoneal hernia repairs for inguinal hernia,including 40 direct inguinal hernia and 129 indirect inguinal hernia operations.Among 142 patients,115 patients had unilateral hernia and 27 patients had bilateral hernias,including 29 recurrent hernia. Results:Among 169 TEP,3 cases were converted from TEP to transabdominal preperitoneal hernia repair（TAPP）. The operations were lasted for 30 to 182 minutes.The mean operating duration was 69 minutes for unilateral hernia and 106 minutes for bilateral hernia.The patients stayed in hospital for 5 to 12 days.The mean inpatient hospital stay was 7 days.The patients didn’t need analgesics.The mostly complications were scrotum hematomas or seromas,which appeared in 18 cases (10.65%).Inguinal pain appeared in 4 cases.One case had bladder injury.All the patients were followed up for 3-44 months.There was only 1 case of recurrence and it occurred in the initial part of the series. Conclusion:The procedure of TEP is safe,with faster postoperative recover, less pain and lower recurrence rate.TEP should be the main laparoscopic procedure for inguinal hernia repair.

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Surgical treatment for xanthogranulomatous cholecystitis: an analysis of 74 cases ZHANG Tao,WANG Ming-liang,ZANG-Lu,et al. 2007, 27(07): 1-505.  Abstract ( )   PDF (302KB) ( )   Objective:To discuss the surgical treatment of xanthogranulomatous cholecystitis. Methods:The clinical data of 74 cases of xanthogranulomatous cholecystitis admitted between May 1996 and February 2006 were analyzed retrospectively.Laparoscopic and laparotomy group were compared with respect to operating time and postoperative hospital stay. Results:Among 74 cases,47 cases were performed laparoscopic surgery and 27 cases were performed laparotomy. The mean operative time of laparoscopic and laparotomy group was 113.9 mins and 69.4 mins respectively.It showed statistically significant difference between two groups (P<0.01).The postoperative hospital stay of laparotomy and laparoscopic group was 183 d and 866 d respectively (P<0.01).The converting rate of laparoscopic group was 10.6%. Conclusion:Surgical treatment is the most effective and feasible option for xanthogranulomatous cholecysitits.Because of the outstanding advantage in operating time and postoperative hospital stay,laparoscopic surgery could be the first choice in treating xanthogranulomatous cholecystitis.

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Clinical application of Kugel patch and modified Kugel patch in inguinal hernia CHEN Yan-chang,HUANG He-guang，LU Feng-chun,et al. 2007, 27(07): 1-533.  Abstract ( )   PDF (312KB) ( )   Objective:To evaluate clinical application of Kugel patch and modified Kugel patch in treating inguinal hernia. Methods:The clinical data of 193 patients with 203 inguinal hernia performed open preperitoneal inguinal hernia repairs between November 2004 and May 2006 in the Department of General Surgery of Affiliated Union Hospital of Fujian Medical University were analyzed.Kugel hernia patch and modified Kugel hernia patch were used in the operations. Results:The average operating time was 25-90 mins ［(41.6±15.2) mins］.Local hematoma appeared in 1 case.Postoperative pain was minimal.No wound infection appeared.There was 1 case of early recurrence. Conclusion:It suggested that Kugel hernia patch and modified Kugel hernia patch have many advantages respectively. They are feasible for all types of inguinal hernia reparation with less complication and short postoperative recovery.