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26 February 2007, Volume 27 Issue 03 Previous Issue    Next Issue
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Surgical treatment of Crohn’s disease:a report of 85 cases ZHOU Jun,WANG Jian-ping,WANG Jie,et al. 2007, 27(03): 1-238.  Abstract ( 1234 )   PDF (456KB) ( 556 )   Objective:To analyze the surgical treatment of Crohn’s disease (CD). Methods:The clinical data of 85 cases of Crohn’s disease admitted between 1980 and 2005 were analyzed retrospectively. Results:The number of inpatient with CD increased significantly in recent years.The rate of preoperation diagnosis was 23.53%.Ileus (25.88%),mass in the right abdomen (10.59%),cecum cancer (12.94%) and acute appendicitis (4.71%) were the most common causes of misdiagnosis before operation.The most surgical procedure was the right half colon resection（37.65%）.The second was partial enterectomy (21.18%).The prognosis of enteral and external fistula and perianal CD were satisfactory. Conclusion:Surgical treatment is an important means to treat CD.The timely diagnosis and reasonable medical management are helpful to decrease the chance of operation when the lesion is active.It can improve the prognosis significantly.The main surgical signs of CD include obstruction,abdomen mass,fistula,acute perforation,hemorrhage and perianal lesions,etc.The surgical patterns are related to the location of lesion and type of the complication.The research of surgical patterns and standardization is the clinical issue to be resolved urgently.

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Prophylaxis and treatment of postoperative early complication in ulcerative colitis LI Meng-bin,WANG Wei-zhong,ZHANG Hong-wei,et al. 2007, 27(03): 1-213.  Abstract ( 1463 )   PDF (420KB) ( 562 )   Objective:To summarize and analyze the cause and management experience of postoperative early complication in ulcerative colitis. Methods:The clinical data of 26 cases of ulcerative colitis underwent surgery operation between January 1995 and December 2005 was analyzed retrospectively.In the all,19 cases were admitted because of the complications, such as colonic hemorrhage,colon perforation,toxic megacolon,stoma fistula and so on.And 7 cases were because of the failure of medical treatment.Twelve cases underwent emergency operation,and 14 patients were selective operation. Total coloproctectomy were performed in 11 cases,and partial colectomy and colostomy were performed in 15 patients. Results:Postoperative complication occurred in 11 patients,and the total incidence rate was 423%.The incidence rate was high in cases performed emergency operation.The major complications were abdominal incisionrelated complications and stoma fistula.In the 4 cases of occurred stoma fistula,2 patients recovered by expectant treatment,and 2 patients underwent reoperation.Among all cases,2 cases died. Conclusion:Total coloproctectomy is effecive method to treatment ulcerative colitis, and the incidence rate of postoperative complication could be cut down by reasonable selection of operation juncture and method.Continual presacral irrigation,unobstructed draining and decompression of pouch are feasible and effective in treatment of stoma fistula.

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Influence of laparoscopic and open cholecystectomy on geriatric patients with type 2 diabetes mellitus WANG Feng,QI Yu-zhong,LIU Jia-ning，et al. 2007, 27(03): 1-191.  Abstract ( 1150 )   PDF (311KB) ( 527 )   Objective:To investigate the influence of laparoscopic and open cholecystectomy on geriatric patients with type 2 diabetes mellitus. Methods:Among the 69 geriatric patients with gallstones and type 2 diabetes mellitus admitted between August 2002 and June 2006,35 cases performed laparoscopic cholecystectomy served as experimental group,and 34 cases performed open cholecystectony served as control group.The glucose level,insulin level and insulin resistance were compared between two groups. Results:The postoperative glucose levels in experimental group was significantly lower than those in control group(P<0.01).There was no significant difference in postoperative insulin level between two groups (P>0.05).Postoperative insulin sensitivity in experimental group was significantly higher than that in control group(P<0.01). Conclusion:Laparoscopic cholecystectomy has less influence on the glucose level and insulin resistance in geriatric patients with type 2 diabetes mellitus compared with open cholecystectony,

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Prospective research of intraoperative cholangiography combined with laparoscopic ultrasonography for detection of occult choledocholithiasis LI Jianwen,ZHENG Minhua,LI Huaqing,et al. 2007, 27(03): 1-191.  Abstract ( 1235 )   PDF (2206KB) ( 565 )   Objective:To evaluate the clinical effect of intraoperative cholangiography (IOC) combined with laparoscopic ultrasonography (LUS) for detection of occult common bile duct stones (CBDS) at laparoscopic cholecystectomy. Methods:From December 2002 to August 2005,103 patients with intermediate and moderate levels of suspicion of CBDS underwent IOC and LUS simultaneously during LC were analyzed prospectively. Results:The successful rate of IOC and LUS were 91.3% and 100% respectively.The time required for LUS (8.5±1.9)min was significantly shorter than for IOC (13.8±3.7)min (P＜0.01).The sensitivities,specificities,accuracies,positive and negative predictive values,positive and negative likelihood ratios identifying occult CBDS were 75.0%,98.7%,92.2%,95.5%,91.4%,57.7 and 0.253 by IOC,and 82.1%,98.7%,94.2%,95.8%,93.7%,63.2 and 0.181 by IUS respectively.The McNemar test showed no significant difference between two methods (P=0.754) with a higher diagnosis concordance (KAPPA coefficient=0720).The sensitivity of IOC combined with LUS was 92.9%,which was clearly superior to that of IOC and LUS taken separately. Conclusion:LUS can be performed in case IOC has failed or is contraindicated.The combination of both methods maximizes intraoperative detection of CBDS and should be recommended.

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Liver transplantation for the recurrence after resection of liver cancer YANG Ning,YANG Guangshun,Shao Zhuo,et al. 2007, 27(03): 1-238.  Abstract ( 1231 )   PDF (543KB) ( 508 )   Objective:To study the indication and announcement of liver transplantation for the patients underwent recurrence after resection of liver cancer. Methods:The clinical data of 59 patients performed liver transplantation because of primary liver cancer between July 2003 and August 2005 was analyzed.Among them,12 patients (recurrent group) underwent recurrence after tumor resection,while the other 47 patients (control group) had not undergone surgical operation.Their hapatic functions before liver transplantation,treating state,exploration during the operation,the duration of the opertion and anhepatic phase,the volume of blood loss and the healing condition were compared between two groups. Results:The duration of the operation,the volume of blood loss and blood transfusion during operation in recurrent group were greater than those in control group significantly,but there was no significant difference in anhepatic phase and 1-year (75% vs. 86%,P＞0.05) and 2year survival rate (70.8% vs. 83.3%,P＞0.05) between two groups. Conclusion:Liver transplantation is an effective therapy for the patients underwent recurrence after radical resection of liver cancer.The key point to treat these patients is to utilize the indications for liver transplantation reasonably.

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Diagnosis of extrahepatic bile duct carcinoma: an analysis of 206 cases LIU Xiao-fang,ZHOU Xian-ting,XU Zheng，et al. 2007, 27(03): 1-191.  Abstract ( 1061 )   PDF (295KB) ( 518 )   Objective:To study the diagnosis program of extrahepatic bile duct carcinoma in order to improve the level of its diagnosis and treatment. Methods:The clinical data of 206 cases of extrahepatic bile duct carcinoma validated by operation admitted between June 1995 and October 2004 was analyzed retrospectively. Results:(1)Jaundice was usually the first symptom in extrahepatic bile duct carcinoma.Other symptom included abdominal hidden pain（49.5%）,atony（30.6%）,fleshless（27.2%）and inappetence (13.1%).(2)Among the lab examinations,the positive rate of AKP，γ-GT and CA19-9 were 100%（206/206）,937%（193/206） and 684%(140/206) respectively.(3)Among manifold imaging,the according rates were 100% in adopting B-US+CT +MRCP/PTC and B-US+CT+MRCP+ERCP groups.Two cases of early extrahepatic bile duct carcinoma were diagnosed by ERCP. Conclusion:To set up the diagnosis criterion of extrahepatic bile duct carcinoma is the key of improving its prognosis.

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Surgical treatment of hypothyroidism SUN Hui,FU Yantao,CHEN Wei,et al. 2007, 27(03): 1-238.  Abstract ( 1296 )   PDF (467KB) ( 582 )   Objective:To investigate the necessities and feasibility of surgical treatment of thyroid diseases complicated with hypothyroidism. Methods:The clinical data of 118 cases of hypothyroidism with surgery treatment performed between 2000 and 2005 were reviewed. Results:Among them,57.6% were Hashimoto thyroiditis (HT) and 39.8% were iatrogenic hypothyroidism.Two cases of HT were complicated with thyroid papillary cancer.One case of HT was complicated with B cell lymphoma.In HT cases,the group of nearly total thyroidectomy excelled the group of isthmusectomy or partial thyroidectomy in the curative effect and the quantity of TGAb and TMAb descended (P<0.05). Conclusion:Paying attention to the diagnosis of hypothyroidism and choosing prime treatment can avoid the occurrence of hypothyroidism.Nearly total thyroidectory is a better method when the medicine treatment was failed. It can find and treat HT complicated with thyroid cancer at the same time.

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Incidence of pancreatic leakage in pancreaticojejunostomy following pancreaticodudenectomy SHEN Jun,YANG Yong,TIAN Zhijie,et al. 2007, 27(03): 1-191.  Abstract ( 1042 )   PDF (456KB) ( 527 )   Objective:To evaluate the possible difference of pancreatic leakage relative to various methods of pancreaticojejunal reconstruction. Methods:The clinical data of 106 cases of pancreaticodudenectomy performed between January 2001 and December 2005 was analyzed retrospectively.Fiftytwo cases were performed pancreaticojejunal endtoend anastomosis.Thirty one cases were performed endtoside anastomosis and 23 cases were performed endtoside “mucosatomucosa” anastomosis.Five cases and 101 cases were performed external and internal transanastomotic drainage respectively.Ttube drainages were used in all cases. Results:The overall incidence of pancreatic fistula was 104%.The leakage rate following endtoend anastomois was 9.6%.The leakage rate of endtoside anastomois was 12.9%,and that of mucosatomucosa anastomois was 8.70%.Five cases of external drainage did not complicated with pancreatic leakage.The results showed that there were no significant difference of incidences of pancreatic fistula among the three methods of pancreaticojejunal reconstruction（P>0.05）. Conclusion:The same one method of pancreaticojejunal reconstruction is not suitable for all cases.Surgeon’s experience seems to be an important factor.To decrease of the incidence of pancreatic leakage needs to choose one method suitable for the corresponding cases.

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Endoscopic thyroidectomy by breast approach versus conventional open thyroidectomy：a prospective study JIN Xiao-jian,LU Bang-yu,CAI Xiao-yong,et al. 2007, 27(03): 1-238.  Abstract ( 1105 )   PDF (461KB) ( 707 )   Objective：To compare the clinical effect of endoscopic thyroidectomy by breast approach with conventional open thyroidectomy prospectively. Methods：The clinical data of 113 patients underwent endoscopic thyroidectomy (group endoscopy) and 104 patients underwent conventional open thyroidectomy (group open) performed between August 2002 and May 2005 was analyzed retrospectively. Results：There was no significantly difference in operative time,time of stay and postoperative stay between two groups. Blood loss was significantly less in group endoscopy than that in group open ［(42.5±62.8)mL vs (118.2±120.8)mL］(P<0.05),but the volume of drainage in group endoscopy was increaser than that in group open ［(84.9±76.1)mL vs （44.1±38.7）mL］（P<0.05）.Time taken to return to normal activity was （2.2±1.0）d in group endoscopy and (2.5±1.1)d in group open (P＞0.05).The analgesic requirements was more decreased in group endoscopy than that in group open,but its cost of hospitalization in group endoscopy was higher than that in group open.The most postoperative complication was hurn of superior or recurrent laryngeal nerve paralysis.Moreover there were more complications in hyperthyroid patients in group endoscopy than that in group open.Hemorrhage was the most postoperative complication in group open. Conclusion：If suitable cases are selected, endoscopic thyroidectomy for thyroid diseases is feasible and safe with excellent cosmetic benefits, less blood loss and less pain compared with conventional surgery.

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Catheter of popliteal vein thrombolysis combined with iliac vein intraluminal stenting in the treatment of iliofemoral deep venous thrombosis DONG Dian-ning,ZHANG Shi-yi,JIN Xing,et al. 2007, 27(03): 1-191.  Abstract ( 1154 )   PDF (497KB) ( 573 )   Objective:To discuss the clinical effect of catheterbased thrombolysis combined with intraluminal dilatating and stenting on iliofemoral venous thrombosis. Methods:The clinical data of 30 cases of iliofemoral venous thrombosis admitted between February 2004 and September 2006 in Shandong Provincial Hospital were analyzed retrospectively.All the cases were performed catheter of popliteal vein thrombolysis guided by Bultrasound combined with intraluminal dilatating and stenting in the iliofemoral vein.The clinical therapeutic effect and short followup outcome were analyzed. Results:Catheterbased thrombolysis through the ipsilateral popliteal vein was effective for all the cases.Balloon dilatation angioplasty combined with endovascular stenting was applied for 25 patients. Balloon dilatation angioplasty alone was applied for the other 5 patients.The followup time was 1～31 months and the patency rate of stent in iliac vein was 100%.The shortterm followup outcome was satisfactory. Conclusion:Catheter of popliteal vein thrombolysis combined with iliac vein intraluminal stenting is a effective therapeutic strategy for the iliofemoral venous thrombosis,but it is very expensive.The longterm followup is necessary.

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Persistent peritoneal lavage and drainage in the treatment of digestive tract fistula ZHANG Hong-wei,LI Hong-hao,WANG Jie. 2007, 27(03): 1-216.  Abstract ( 974 )   PDF (290KB) ( 540 )   Objective：To investigate the effectiveness of persistent peritoneal lavage and drainage in the treatment of fistula of digestive tract. Methods：Double tubes were inserted into the peritoneal cavity via percutaneous puncture guided by Btype ultrasound or from the abdominal incision in 12 cases of digestive tract fistula between October 2002 and March 2005. Persistent peritoneal lavage and drainage and nutrition support were performed. Results：All patients recovered after persistent peritoneal lavage and drainage.The average time of fistula healing was 36 days.Upper gastrointestinal bleeding occurred in one patient and another patient suffered from abdominal bleeding during persistent peritoneal lavage and drainage.No infection of abdomen or skin and septicemia happened. Conclusion：Persistent peritoneal lavage and drainage is a minimal invasive and effective method in the treatment of digestive tract fistula.

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Surgical treatment of Hashimoto is disease complicated with other concurrent thyropathy WU Wei,LI Xiao-rong,TANG Zhong-hua,et al. 2007, 27(03): 1-191.  Abstract ( 1248 )   PDF (313KB) ( 541 )   Objective：To sum up the experience on surgical treatment of Hashimoto’s disease complicated with other concurrent thyropathy. Methods：The clinical data were analyzed on 76 cases of Hashimoto’s disease(HD) surgically found to have other concurrent thyropathy out of 189 HD cases undergoing surgery. Results：Thyroid nodules were found in all 76 HD cases,among which 24 were with thyroid cancer,3 with malignant lymphoma,8 with thyroid adenoma,2 with hyperthyroidism,38 with nodular goiter,and 1 with nontypical hyperplasia of lymph tissue.Thyroidectomy of different extent was performed according to pathological results.Postoperatively all cases were given thyroxine.On follow up a patient with malignant lymphoma died,and three patient suffered hypothyroidism. Conclusion：HD cases complicated with thyroid nodules should be treated surgically.Intraoperative frozen section is a reliable diagnostic method and may guide the surgical modality.The normal thyroid tissue should be maintained as more as possible during operation in order to avoid the postoperative hypothyroidism.