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22 June 2007, Volume 27 Issue 06 Previous Issue    Next Issue
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Clinical analysis of 86 transanal local resection for lower rectal tumors YIN Lu,CHEN Chunqiu,ZHAO Ren,et al. 2007, 27(06): 1-437.  Abstract ( )   PDF (436KB) ( )   Objective:To evaluate the outcome and the prognosis of transanal local excision in the treatment of patients with benign and malignant lower rectal tumors. Methods:From January 2003 to July 2006,86 patients (49 man,37 women) with benign (n=55) and malignant (n=31) rectal tumors underwent transanal local excision.Data were analyzed retrospectively and 69 patients obtained followup. Results:Among 86 patients,there were 26 cases of adenocarcinomas（30.2%）,39 cases of adenoma （45.3%）,3 cases of carcinoid （3.5%）,1 case of GIST （1.2%）,and 17 cases of others （19.8%）.All tumors located 1 to 12cm from the dentate line.The tumor size was less than 3cm in 68 patients (79.1%),and more than 3cm in 18 patients (21.9%).During the followup of 69 patients,tumor recurrence was observed in 6 of 57 patients with the tumor size ＜3cm,in 5 of 12 patients with ≥3cm,and the difference was significance (P＜0.01).Among the assessable patients of adenocarcinoma,there were 19 cases in T1 and 7 cases in T2.The tumor recurrence was observed in 2 of 16 patients for T1 and in 4 of 7 patients for T2 (P＜0.05). Conclusion:Transanal local excision for low rectal tumor is appealing for its less morbidity and excellent functional results.It may be used in the curative management of benign rectal tumors and selected early malignant neoplasm with small tumor size.It is also a treatment option for patients who would be unable to tolerate radical surgery.

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Transabdominal coloanal anastomosis for low rectal cancer located between 4 and 6cm away from the anal verge PAN YiSheng,WAN YuanLian,LIU YuCun,et al. 2007, 27(06): 1-437.  Abstract ( )   PDF (297KB) ( )   Objective:To investigate the effect of transabdominal coloanal anastomosis on the treatment of low rectal cancer located between 4 and 6cm away from the anal verge. Methods:From November 2001 to December 2005,36 patients with low rectal cancer between 4 and 6cm away from the anal verge underwent partial internal anal sphincter resection and transabdominal coloanal anastomosis with double stapling technique. Results:The coloanal anastomosis was about 2.5cm above the anal verge.The median followup was 23 months. Distant metastasis occurred in 4 patients and no local recurrence was confirmed.Total 3year survival rate was 100% and tumorfree 3year survival rate was 84.6%.According to Williams’s classification of continence,among 28 patients after 1 year surgery,23 patients were in GradeⅠ(Perfect),2 patients in Grade Ⅱ (Incontinent of flatus),3 patients in Grade Ⅲ (Occasional minor soiling). Conclusion:Transabdominal coloanal anastomosis is an optimal sphinctersaving procedure for low rectal cancer located between 4 and 6cm away from the anal verge.Partial internal anal sphincter resection does not compromise the longterm anal function.

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Surgical treatment of familial adenomatous polyposis with stapled technique CAO Zhixin,XU Xiangshang,YANG Chuanyong. 2007, 27(06): 1-437.  Abstract ( )   PDF (316KB) ( )   Objective:To evaluate the surgical management of familial adenomatous polyposis with stapled technique. Methods:Twenty-one patients with familial adenomatous polyposis underwent surgical treatment with stapled technique in Tongji Hospital,Tongji Medical College of Huazhong University of Science and Technology from January 2000 to December 2005 were reviewed retrospectively. Results:Twentyone patients with familial adenomatous polyposis were performed restorative proctocolectomy,ileal Jpouch anal anastomosis and protective ileostomy with stapled technique.There was no mortality,no severe complications such as anal anastomotic fistula,pelvic infection,and anastomotic stenosis and so on.In the followup,1 case with ileal pouch adherence was treated endoscopically;polyps in ileal pouch were found in 2 patients and excised endoscopically.All patients had ideal continence function,the defecation frequency per 24 hours were 2 to 5 times. Conclusion:Restorative proctocolectomy,ileal Jpouch anal anastomosis and protective ileostomy with stapled technique may be considered the preferred surgical treatment for patients with familial adenomatous polyposis.It is a safe,simple,save time and little complication procedure.After operation,all patients should be followed up in order to found and treat recurrent polyps.

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Investigate the skillful elements in laparoscopic parastomal herniorraphy with meshes YAO Qiyuan,CHEN Hao,DING Rui,et al. 2007, 27(06): 1-437.  Abstract ( )   PDF (460KB) ( )   Objective:To summarize the effectiveness of laparoscopic parastomal herniorrhaphy with meshes. Methods:A laparoscopic mesh repair was performed for 16 patients with parasromal hernias from September 2004 to November 2006 in Hua Shan Hospital,Shanghai Medical College of Fu Dan University. Results:Laparoscopic parastomal herniorrhaphy with meshes was successfully performed for 14 patients,Two cases were converted to an open procedure because of extensive adhesion (n=1) and intestine damaged (n=1).The average operating time was 116 min (range,45-180 min).The mean hernia defect was 5.4 cm (range,4-6cm) and postoperative hospital stay averaged 5.4 days(range,3-8 days).Twelve patients complained the temporary pain in operative area and 7 patients were occurred in seroma. One patient felt dyspnea, which ameliorate by the assistant of VPAP.There was no wound infection or early recurrence in the cases.The local appearance was better in patients with small hernia sac or who accept herniaraphy earlier than in those with larger hernia sacs or who accept operation later. Conclusion:Laparoscopic parastomal herinorrhaphy with meshes is a security, feasibility and effective method.

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Wirelocalization and open biopsy of nonpalpable breast lesion guided by ultrasound XU Shuguang，ZHU Jingzhi,YIN Zhiqiang,et al. 2007, 27(06): 1-437.  Abstract ( )   PDF (474KB) ( )   Objective:To evaluate the clinical value of wirelocalization biopsy guided by ultrasound for management of nonpalpable breast lesion （NPBL）. Methods:Prior to NPBL resection treatment and biopsy diagnosis,wirelocalization guided by ultrasound was performed. Results:Forty-two lesions of 41 cases were accurately excised and all of them obtained the pathologic diagnosis.12% of them were malignant. Conclusion:It is worth careful consideration of NPBL management.Wire-localization biopsy guided by ultrasound is simple,accurate,and practical method.

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Repeat hepatic resection for recurrent colon liver metastases ZHANG Haizeng,DONG Shuxiao,ZHOU Zhixiang,et al. 2007, 27(06): 1-437.  Abstract ( )   PDF (289KB) ( )   Objective:To investigate the safety and the value of repeat hepatic resection for recurrent colorectal liver metastases(RCLM). Methods:Retrospectively analysed 4 RCLM patients received repeat hepatic resection who admitted in Cancer Hospital,Chinese Academy of Medical Science,Peking Union Medical College between October 1997 and August 2006. Results:There were no postoperative deaths and complication following both the first hepatetomy and the repeat hepatectomy.The median survival of the 4 RCLM,measured from the time of first hepatectomy and the repeat hepatectomy,was 57 months and 25.5 months respectively. Conclusion:Repeat hepatectomy is safe and feasible to RCLM, and can provide longterm survival in selected patients.

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Reoperation of bile duct stricture after common bile duct exploration and Ttube drainage operation with clinical analysis 23 cases SU Maosheng,ZHOU Ningxin，LIU Jungui,et al. 2007, 27(06): 1-437.  Abstract ( )   PDF (289KB) ( )   Objective:To investigate the characteristic, causes and treatment of bile duct stricture after conventional open common bile duct (CBD) exploration,Ttube drainage operation. Methods:The clinical data of 23 cases of bile duct stricture after conventional open CBD exploration,T-tube drainage operation in General Hospital of PLA from 1990 to 2005 were analyzed, and the previous operation,current diagnosis and treatment outcome of those cases were summarized and analyzed. Results:Diagnosis of 23 cases of bile duct stricture for the first time was cholecystolithiasis. There were 1 to 3 times of operative history.Stricture level:There were 7 cases of Bismuth levelⅠ(30.4%),8 cases of Bismuth levelⅡ(34.8%),and 4 cases of Bismuth level Ⅲ and Ⅳ(17.4%),respectively.Operative mode：There were 11 cases (47.8%) of repair operation and cholangiointestinal anastomosis operation respectively as well as one case (4.3%)of interventional therapy. Among 13 cases of followup,the effects of repair operation and cholangiointestinal anastomosis operation were both excellent;there was one case of interventional therapy dead with liver function failure because of longterm bile tract obstruction. Conclusion:Hilar bile duct is the site where is very easy to be injured. So the severe complication derived from inappropriate, conventional, classical and open common bile duct (CBD)exploration,Ttube drainage operation should not be neglected.

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Study on the relations between the level of perioperative blood CRP and the adverse events short terms after arterial bypass ZHOU Zhaoxiong,ZHANG Jiwei,ZHANG Hao,et al. 2007, 27(06): 1-437.  Abstract ( )   PDF (462KB) ( )   Objective:To explore the relations between the level of perioperative inflammation reactivity and adverse events short terms after arterial bypasses.Discussing the value of CRP on predicting the outcome of lower limb ischemia. Methods:One handred and fifty-two patients were enrolled for lower limb arterial bypasses.Grouping patients into high and low inflammation reactivity according to the standard of 8mg/L preoperation and the means of crp level three days after opertions.The adverse events were surveyed and analysed during 6 month follow up in all enrolled patients. Results:The preoperative mean of crp was 5.03±7.27mg/L,19 and 133 patients were assigned to the high and low inflammation reactive group respectively.Adverse events occurred in 8 (42.1%)patients of high group,in 28(21.1%) of low inflammation reactivity group,P=0.043.The postoperative mean of crp was 10.82±9.31mg/L.Sixty-three and 89 patients were assigned to the high and low inflammation reactive group respectively.Adverse events occurred in 15(23.8%) patients of high group,in 21(23.6%) patients of low inflammation reactive group.No significant difference exist. Conclusion:The data suggest that preoperative high levels of CRP are positive related with adverse events short terms after operation and it also supports the hypothesis that high inflammation reactivity predict the advancing conditions of systemic atherosclerosis.Antiinflammatory interventions may help in maintenance of the illness.Otherwise, the prognosis is poor.