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28 July 2006, Volume 26 Issue 08 Previous Issue    Next Issue
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Breast conservative therapy for early breast cancer:a retrospective cohort study. Fan Jiang,Wang Lei,Wu Jiong,et al. 2006, 26(08): 1-622.  Abstract ( )   PDF (427KB) ( )   Objective:o compare the effects of breast conservative therapy (BCT) with modified radical mastectomy (MRM) in women with early stage breast cancer. Methods: matched retrospective cohort study using data on patients derived from a prospectively collected breast cancer database was conducted.The database included patients who received MRM or BCT from 1995 to 2002 in Cancer Hospital of Fudan University.The match was conducted according with four variables:age at diagnosis,axillary lymph node status,sexual hormone receptor status and the dimension of tumor.The match ratio was 1∶2.Controls were patients who received MRM (n=254).Cases were patients who received BCT (n=127).Median followup for the controls and cases were 58 months and 49 months respectively.The differences of incidence of locoregional recurrence,disease free survival and overall survival at 5 years were compared.There were no significant differences in incidence of locoregional recurrence,DFS and OS at 5 years between the two groups of patients. Results:he incidence of locoregional recurrence was 1.4% in MRM group and 339% in BCT group (P=0.5).The OS in MRM and BCT patient were 97.7% and 96.73% (P=0.66).The DFS in MRM and BCT patients were 91.57% and 8604% (P=0.37). Conclusion:For appropriate breast cancer patients,classic lumpectomy plus axillary lymph node dissection and postoperative radiotherapy lead to excellent local control and good survival rate.The BCT can result in the same effects as MRM in breast cancer patients with better cosmetic appearances.

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Preoperative assistant radiotherapy for resectable rectal cancer:a metaanalysis of randomized controlled trial. Li Shizheng，Shan Jixian,Ma Zhenhai,et al. 2006, 26(08): 1-615.  Abstract ( )   PDF (510KB) ( )   Objective:To study the clinical value of preoperative radiotherapy for resectable rectal cancer. Methods:The literatures about preoperative assistant radiotherapy for resectable rectal cancer from 1994 to 2006 were searched in PubMed,CNKI and VIP,and limited to publication types “randomized controled trial”.Evidence was evaluated with mataanalysis. Results:Evidence from the current randomized trials showed that preoperative assistant radiotherapy for resectable rectal cancer could increases 12year survival ratio (12year survival odd ratio was equal to 1.2612.95% confidence interval was between 1.0539 and 1.5091),and file drawer analysis was 4.Local recurrence rates of different stages of Dukes also were decreased by preoperative assistant radiotherapy.(ORA was equal to 2.556495%CI was between 1.3448 and 4.8595.ORB was equal to 3.680795%CI was between 2.2859 and 5.9266.ORC was equal to 2.3667.95%CI was between 1.6030 and 3.4944.).The file drawer analyses were 4,20,12,respectievly. Conclusion:Assistant radiotherapy for rectal cancer before curative resection can increase 12year survival rate and decrease local recurrence rate.

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Role of CT and MRI in the diagnosis of rectal stromal tumors. Peng Weijun,Jiang Zhaoxia,Shi Yingqiang,et al. 2006, 26(08): 1-617.  Abstract ( )   PDF (2468KB) ( )   Objective:To investigate the role of CT and MRI in the diagnosis of rectal stromal tumors. Methods:Appearances of CT and MRI in 12 cases of rectal stromal tumors diagnosed by pathology between 2000 and 2006 were analyzed retrospectively, and compared with appearances of operative and pathologic specinmens. Results:The mean diameter of tumors was 7.5cm (3~18cm).All rectal stromal tumors were found in the lower twothirds of the rectum.Among them,16.67%（2/12）were submucosal;41.67%（5/12）were intramural;41.67%（5/12）were subserous.Pathological classification was as following: Among them,50.0%(6/12) were highrisk;33.3%(4/12) were intermediatedrisk;16.7% (2/12) were lowrisk;no case was very lowrisk.CT and MRI features of rectal stromal tumors were typically round or lobular,wellcircumscribed,exophytic,hypervascular,heterogeneous masses with cystic necrosis.They displaced adjacent structures occasionally,but never developed local lymphadenopathy. Conclusion:Appearances of CT and MRI of rectal stromal tumors are specific,which correspond well with histopathologic findings.MRI is better than CT for detecting internal components and assessing infiltration.Preoperative CT and MRI scanning have important significances for choosing management methods.

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Malignant gastrointestinal stromal tumors:a clinical analysis of 34 cases. Cai Xiujun,Zhang Yuhua,Yu Hong,et al. 2006, 26(08): 1-562.  Abstract ( )   PDF (2497KB) ( )   Objective:To study the clinical manifestation and pathologic characteristics of gastrointestinal stromal tumors(GIST). Methods:Thirtyfour cases of clinical and pathological data of malignant GIST (MGIST) admitted between 2002 and 2004 were analyzed retrospectively. Results:The common clinical manifestations were abdominal pain and digestive tract bleeding.The most common tumor locations were small intestine and stomach.The mean tumor size was 102cm.All cases were malignant in pathological diagnosis after operation.Twelve cases recurred after operation and 4 cases died. Conclusion:Tumor size,location,mitosis and immunohistochemical data are important indexes to define whether it is benign or malignant.Patients with MGST or potential MGST must be performed combined therapy including operation.

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Resection of hepatic caudate lobe tumors:a summary of 76 cases. Zhou Weiping，Li Aijun,Fu Siyuan，et al. 2006, 26(08): 1-601.  Abstract ( )   PDF (450KB) ( )   Objective:To analyze operative techniques and results of hepatic caudate 1obe tumors． Methods:Seventysix cases of hepatic caudate lobe tumors were resected between April 1994 and August 2004 in Eastern Hepatobiliary Surgery Hospital of Second Military Medical University.Short hepatic veins were divided and sutured.Liver was fully freed of posthepatic inferior vena cava.Hepatic caudate 1obe was resected alone or in combination with other segment. Results:Seventysix cases underwent caudate 1obe tumor resection．The number of the short hepatic veins transected and tied was 2-7(mean 5.2)．An intermittent Pringle’s manoeuver was used in 57 cases with a median occlusion time of 24.7 (range 10-45) minutes.The median blood loss was 655 (range 100-2400) mL．There were no major complications such as massive bleeding and hepatic failure．Intraoperative total vascular occlusion was used in only 5 cases． Conclusion:The use of third porta hepatic dissection for resection of the caudate 1obe tumors can reduce the risk of massive bleeding during the operation.Selecting the appropriate approaches to resect tumors can improve the rate of resection of caudate lobe tumors and reduce the postoperative complications．

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Diagnosis and treatment of rectal stromal tumors. Su Xiangqian,Cui Ming,Leng Jiahua,et al. 2006, 26(08): 1-622.  Abstract ( )   PDF (1500KB) ( )   Objective:To analyze the features of clinical diagnosis and treatment of rectal stromal tumors. Methods:Clinical and pathological data and treatment of 8 cases of rectal stromal tumors admitted between October 1998 and February 2006 in Peking University School of Oncology were analyzed retrospectively. Results:Presentations and symptoms of rectal stromal tumors varied depending on the tumor size.The most common clinical presentations were increased frequency of defecation,urinary retention,bloody stool and anal pain.Lesions located at low rectum and the size was usually larger.Rectal stromal tumors were diagnosed by pathology in all cases.Immunohistochemical results showed that CD117(+) in 7 cases and CD34(+) in 8 cases.Two cases accepted imatinib mesylate (Glivec) before operation.Symptoms of patients alleviated significantly.Size of tumors decreased significantly. Seven of the 8 cases underwent surgical resection.Among them,5 cases were treated by abdominoperineal resection and 2 cases were resected transanally. Conclusion:Size of rectal stromal tumors is usually larger when the symptoms appear.Diagnosis of the disease depends on pathological result.Abdominoperineal resection is a reasonable choice for low rectal stromal tumors with large lesions.Neoadjuvant therapy of imatinib mesylate before operation may be benefit for complete surgical resection.

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Diagnosis and treatment of acute mesenteric ischaemia. Zhang Fuxian,Zhang Changming,Hu Lu,et at. 2006, 26(08): 1-601.  Abstract ( )   PDF (320KB) ( )   Objective:To study diagnosis and treatment of acute mesenteric ischaemia. Methods:Clinical data of 35 cases of acute mesenteric ischaemia admitted between 1988 and 2005 in Beijing Shijitan Hospital were analyzed retrospectively.Arterial occlusion was found in 30 cases and vein thrombosis in 5 cases.Acute abdominal pain was the important clinical presentation (94%).There were changed of enzymes in serum in 51% of cases. Results:All lesions were identified by operations.Thrombolysis by percutaneous catheter in superior mesenteric artery was performed in 4 cases.Simple thrombectomy by fogarty catheter was performed in 15 cases.Nonviable bowel resection was performed in 16 cases.The mortality was 23% in total of cases and 50% in cases with bowel gangrene. Reperfusion injury occurred in a few cases after operations. Conclusion:It is beneficial for early diagnosis of acute mesenteric ischemia by examination of enzymes in serum.Reperfusion injury is another important feature of exacerbating intestinal damage.

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Stromal tumors in stomach and small intestine:an analysis of prognostic factors. Wu Aiwen,Ji Jiafu,Wang Peilin,et al. 2006, 26(08): 1-622.  Abstract ( )   PDF (2248KB) ( )   Objective:To analyze the prognostic factors of stromal tumors in stomach and small intestine. Methods:The clinical data of 105 cases of GIST admitted between January 1995 and January 2005 in Peking University School of Oncology were analyzed retrospectively. Results:Patients with small intestinal stromal tumors were more frequently with disseminated diseases.They were less likely to receive curative resection. Conclusion:Multivariate analysis showed that tumor locations and late at diagnosis are independent prognostic factors for stromal tumors in stomach and small intestine.

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Laparoscopic distal pancreatectomy with preservation of spleen for distal pancreatic tumor: a report of 5 cases. Bao Shiyun,Yu xiaofang,Zheng Jinfeng,et al. 2006, 26(08): 1-601.  Abstract ( )   PDF (453KB) ( )   Objective:To evaluate the feasibility of the laparoscopic distal pancreatectomy with preservation of the spleen for distal pancreatic tumor. Methods:Five cases of pancreatic tail tumor were performed by hand-assisted laparoscopic (two cases) and total laparoscopic (three cases) distal pancreatectomy with preservation of the spleen between November 2001 and February 2006 in Jinan University 2nd Clinical Medicine College. Results:The operations were completed successfully.Among them,3 cases were in total laparoscopy and 2 cases were in handassisted laparoscopy;operative bleeding was 50150mL;operative time was 90~180 minutes.All cases resumed liquid oralintake and motility at the second day postoperatively.Slight pancreatic leakage occurred in one case.Pancreatic pseudocyst occurred in one case.All cases were recovered from illness. Conclusion:Laparoscopic distal pancreatectomy with preservation of the spleen is minimal invasive,safe and feasible for isolated benign pancreatic tail tumors.

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Application of artificial synthetic material in the repairing of umbilical hernia in adults：a report of 52 cases. Na Dongming,Chen Jie,Shen Yingmo 2006, 26(08): 1-622.  Abstract ( )   PDF (291KB) ( )   Objective:To evaluate the application of artificial synthetic material mesh in the repairing of umbilical hernia in adults. Methods:Fiftytwo cases of adult patients with umbilical hernia admitted between January 2001 and June 2005 in the Treatment Center for Hernia and Abdominal Wall Diseases of Beijing Chaoyang Hospital of Capital University of Medical Science were analyzed retrospectively in terms of methods,characteristics and effects of synthetic material mesh in the repairing of umbilical hernia in adults. Results:All cases were cured.The average stay in hospital was 10 days (6 days after operation).The postoperative complications included:wound infection (1 case),wound skin necrosis (1 case),hypodermal seroma (1 case).No recurrence was followed up during 2-54 months. Conclusion:Repairing umbilical hernia in adults with artificial synthetic material mesh is a kind of safe,effective operation.It should be performed correctly and on casetocase basis.