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04 July 2006, Volume 26 Issue 07 Previous Issue    Next Issue
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Surgical treatment of toxic multinodular goiter:a report of 33 cases. Liu Xiao’an,Wang Shui,Wang Fengliang,et al. 2006, 26(07): 1-505.  Abstract ( )   PDF (308KB) ( )   Objective:To summarize the experience of the surgical treatment of toxic multinodular goiter(TMNG). Methods:Clinical data of 33 patients hospitalized with TMNG from 1999 to 2005 were reviewed. Results:All patients were given with preoperative medical management,21 cases with antithyroidal drugs and iodide solution,5 cases with betablockers and iodide solution,7 cases with iodide solution only.All patients were treated surgically with subtotal thyroidectomy except one case for coexistent thyroid cancer.No patients developed thyroid crisis,permanent recurrent laryngeal nerve palsy and hypoparathyroidism postoperatively. Conclusion:Surgical treatment is safe and effective for TMNG,and preoperative medical treatment and appropriate option of surgical procedure were required.

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Hyperthyroidism:a retrospective analysis of 5 365 cases Xu Zheli,Wang Keren,Song Changlong,et al. 2006, 26(07): 1-508.  Abstract ( )   PDF (455KB) ( )   Objective:To discuss the evolution of hyperthyroidism under different iodine circumstances,and give a summary of transition,such as etiologic factor and methods of diagnosis and treatment. Methods:Clinical data of 5 365 cases of thyroidism admitted from 1960 to 2005 were analyzed retrospectively. Results:A decreasing trend of Graves’ Diseases was from 88.5% in 1960s to 36.5% in recent 5 years,while an increasing trend of secondary hyperthyroidism was from 11.2% in 1960s to 63.5% in recent 5 years.Cases of hyperthroidism initiated by thyroiditis and iodine appeared more regularly than that first appeared 25 years ago. Conclusion:The etiologic factor of hyperthyroidism changes from Graves’disease to secondary hyperthroidism and iodineinduced hyperthroidism.The transition of diagnosis is from clinical manifestation,basal metablic rate and absorption rate of iodine to color displaying Doppler ultrasonic tomograph and functional test of thyroid.Simple medicine treatment of hyperthyroidism is replaced by combination of drug and surgery,and the latter has taken half of all.

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Hypocalcemia after thyroid surgery:a clinical analysis of 386 cases. Wang Wei,Sun Hui,Fu Yantao,et al. 2006, 26(07): 1-482.  Abstract ( )   PDF (436KB) ( )   Objective:To investigate the rule,etiology and treatment of hypocalcemia after thyroid surgery. Methods:The change of serum calcium was analyzed in 2 357 patients who received thyroid operation between January 2001 and January 2006. Results:Three hundred and eightysix cases developed hypocalcemia after operation.Of them,13 cases were in subtotal thyroid lobectomy,14 cases in total thyroidectomy,304 cases in unilateral lobectomy with contralateral subtotal lobectomy,53 cases in unilateral subtotal lobectomy with contralateral subtotal lobectomy,and 2 cases in unilateral lobectomy with contralateral partial thyroid lobectomy.Furthermore,Hypocalcemia included 222 cases (222/1886) in professional surgeons and 164 cases (64/471) in nonprofessional surgeons. Conclusion:Hypocalcemia often occurs in total thyroidectomy and unilateral lobectomy or subtotal lobectomy,with contralateral subtotal lobectomy.The patient who has accepted unilateral subtotal lobectomy with contralateral subtotal lobectomy should be observed the level of serum calcium in three days at least after thyroid surgery.It is necessary to treat hypocalcemia.Hypocalcemia after thyroidectomy is related with experience of surgeons.

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Laparoscopic cholesystectomy using in the patients associated with cirrhosis. Liu Yi,Qin Mingfang. 2006, 26(07): 1-508.  Abstract ( )   PDF (478KB) ( )   Objective:To investigate the significance of laparoscopic cholesystectomy (LC) in the cirrhosis patients with gall bladder disease. Methods:From January 2000 to December 2004,118 cases with cholecystolithiasis associated with liver cirrhosis received LC.Their clinical data were analyzed retrospectively. Results:Eightyfive cases receipted LC successfully;28 cases were undertook subtotal cholecystectomy,and 5 cases did conversion.No severe complications developed.The postoperative hospital stay was (7.5±2.4)d. Conclusion:LC is safe and effective for the treatment of patients associated with liver cirrhosis.It is very important to avoid hemorrhage of cholecyst bed.In order to minimize the complication rate，the conversion indication should be broadened.

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Clinicopathological features and treatment of primary malignant liver mesenchymoma. Zhang Haizeng,Dong Shuxiao,Shao Yongfu. 2006, 26(07): 1-482.  Abstract ( )   PDF (454KB) ( )   Objective:To investigate the clinicopathological features and reasonable diagnostic and therapeutic strategy of primary malignant liver mesenchymal tumor (PMLM). Methods:Seventeen cases of PMLM admitted between 1961 and 2003 were analyzed retrospectively.All of them had complete clinical data and were confirmed by pathology.The recent literatures were reviewed. Results:Ten cases received hepatectomy;5 cases received only biopsy;2 cases were not performed operation. Conclusion:The clinical and imaging manifestations of PMLM are not specific.The diagnosis mainly depends on pathology.Active surgery should be performed.When surgery is impossible,chemotherapy and radiotherapy can be used. Liver lymphoma should receive comprehensive therapy.

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Surgical treatment for congenital cholangiectasis in adults. Kong Fanmin，Sun Yanbin,Li Yuji,et al. 2006, 26(07): 1-508.  Abstract ( )   PDF (324KB) ( )   Objective:To summarize the experience of surgical treatment for congenital cholangiectasis in adults. Methods:Sixty-eight excised cases with adult congenital cholangiectasis admitted between January 1985 and December 2004 in the Department of General Surgery of the First Affiliated Hospital of China Medical University were reviewed.Flanigan Ⅰ type were in 59 cases,Flanigan Ⅱ in 3,and Flanigan IV in 6.All cases underwent cystectomy. Results:Six cases occurred bile leak;3 cases occurred pancreas leak;2 cases complicated with acute pancreatitis,and 2 cases died.Following up continued for 1 to 20 years in 56 cases,the rate of following up was 823%.Five cases appeared light cholangitis;2 cases occurred stricture of anastomotic stoma,and remnant 49 cases were recovered. Conclusion:Cyst excision with Roux-en-Y hepaticojejunostomy remains the major choice for this disease.Large mouth anastomosis should be taken in proximate of cyst after resection in order to prevent stricture of stoma.It should clean the tunica intima of cyst,not injury debouch of pancreas,and ensure unobstructed pancreatic fluid flowing.

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Missed diagnosis of pancreatic cancer during laparoscopic cholecystectomy:a clinical analysis of 7 cases. Zhang Tong，Zheng Cheng，Sun Jian，et al. 2006, 26(07): 1-482.  Abstract ( )   PDF (470KB) ( )   Objective:To investigate the causes of the missed diagnosis of pancreatic cancer，the indication of exploring pancreas during laparoscopic cholecystectomy，the early diagnosis after operation and selection of retreatment methods. Methods:Clinical data of 7 patients who were missed diagnosis of pancreatic cancer during LC from January 1996 to October 2004 in the Third Affiliated Hospital of Sun Yatsen University were retrospectively analyzed and followed up. Results:The time for revisit after operation was 3 days to 5 months，and the mean time was 61.3 days.The survival time after reoperation was 3 to 17 months and mean survival time was 8.6 months. ConclusionThe main measures to decrease missed diagnosis for pancreatic cancer during LC are to complete preoperative checkups to think highly of early diagnosis among highrisk group and to identify the indication of exploring pancreas during the operation.

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Total or subtotal gastrectomy for gastric carcinoma by transabdominal and intramediastinal pathway:a report of 47 cases. Lou Chaoyang,Cai Xiaotang,Zhang Shaoyan，et al. 2006, 26(07): 1-508.  Abstract ( )   PDF (323KB) ( )   Objective:To explore the ideal procedure of total or subtotal gastrectomy and digestive reconstruction in gastric carcinoma. Methods:From 1997 to 2005,fortyseven cases of upper gastric carcinoma and cardial carcinoma received total or subtotal gastrectomy by transabdominal and intramediastinal pathway while digestive reconstruction with colon.The skills,the complications and symptoms of alimentary tract of operation were observed. Results:There was one case anastomotic leakage and no other complications occurred in other 46 cases.The operation was showed as fewer traumas,less complication,and rapid recuperation compared with thoracolaparotomy. Conclusion:Total or subtotal gastrectomy by transabdominal and intramediastinal pathway while digestive reconstruction with colon is safe,practical and satisfied. Survival quality of patients is improved with nutrition after operation.

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Efficacy and safety profile of ClinOleic 20% in surgical patients requiring parenteral nutrition. Wu Guohao,Cao Weixin Cai Duan,et al. 2006, 26(07): 1-532.  Abstract ( )   PDF (454KB) ( )   Objective:To confirm the safety and nutritional efficacy of ClinOleic 20% through a pragmatic study allowing its use as an alternative to Intralipid 20%. Methods:The study was performed as a multicenter,randomized,doubleblinded,prospective,noninferiority trial.Two hundred and five patients undergoing moderate abdominal surgery were randomly assigned to receive ClinOleic 20% and Intralipid 20% as part of their TPN regimen over 5 days.Daily parenteral intakes of energy nitrogen and lipid were equal in two groups.The nutrition regimen was given as an allinone mixture,delivered continuously over 20 hours per day for 5 consecutive days. Results:Efficacy analysis showed that ClinOleic can be considered as efficient as Intralipid in providing energy to maintain albumin plasma concentrations.No serious adverse event was reported in the two groups.For hematology,renal,hepatic safety criteria and vital signs,no significant difference was observed between groups.No significant difference was observed concerning Cholesterol.For triglycerides, a statistically significant difference was observed between ClinOleic and Intralipid groups but the difference was not medically relevant and the means remained within the normal range. Conclusion:ClinOleic is a new safe and efficient lipid emulsion for parenteral nutrition.

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Unresectable gastric cancer treated with 125I radioactive seeds implantion simply:a report of 9 cases. Wang Juan,Sui Aixia,Jia Yitao,et al. 2006, 26(07): 1-498.  Abstract ( )   PDF (395KB) ( )   Objective:To discuss the clinical method and the effect of advanced gastric cancer following iodine125(125I) brachytherapy. Methods:From March 2004 to October 2005，125I radioactive seeds were applied to treat unresectable advanced gastric cancer.CT was chosen as target reference.Applying brachytherapy planning system decided iodine125 seeds’ distribution,activity and quantity.The matched peripheral dose（MPD）was 110～130Gy.Adopting intraoperative small incision or percutnaeous puncturation,iodine125 seeds were implanted with uniplane or biplane according to scheme.Postoperative hemogram,CT,KPS,pain relieving period and survival period were observed. Results:Patients’ appetite and KPS were improved.The pain relieving cases was 7 patients.0-1 degree acute radiotherapeutic sideeffects happened without other symptoms like abdominal pain,vomitus cruentus,intestinal obstruction etc. Conclusion:Applying 125I implantation to treat advanced gastric cancer with reasonable seeds distribution can improve clinic symptoms and their quality of life significantly.The radioactive damage is mild.The method can be used as an important supplementary treatment for unresectable advanced gastric cancer.