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21 April 2006, Volume 26 Issue 05 Previous Issue    Next Issue
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Clinic characteristics and impact factors of acute renal failure complicating severe actue pancreatitis. Tong Zhihui，Yu Wenkui，LiWeiqin,et al． 2006, 26(05): 1-368.  Abstract ( )   PDF (450KB) ( )   Objective:To analyse the clinic characteristics of acute renal failure (ARF) complicating severe actue pancreatitis(SAP),and study the methods of prevention and therapy of it. Methods:503 patients with SAP who were in hospital between Jan.1997 and Apr.2005 and 54 of whom were complicated with ARF were retrospectively analyzed to conclude the morbility and mortality from ARF complicating SAP,then analyze the impact factors of them respectively by linear regression (stepwise regression) methods. Results:In SAP patients,the morbility of ARF was 10.7%.The distinct impact factors of it were the patients'age,the duration of SIRS,severity grade(APACHE Ⅱscore,CT score),ARDS,MODS,ACS,infection and local complications and so on.18 of 54 patients with ARF were dead and the motality was 333%.Complicating ARDS and MODS simultaneously was the important reason of increasing motality，but whether complicating the infection around pancreas was not. Conclusion:ARF is the severe complication of SAP,early liquid resuscitation，function protection of vital organs and positive eduction are the important measures to prevent SAP from complicating ARF and improve the prognosis.

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Clinical analysis of mucinous noncystic carcinoma of the pancreas. Xu Xuefeng,Lou Wenhui,Wang Dansong,et al. 2006, 26(05): 1-365.  Abstract ( )   PDF (457KB) ( )   Objective:To investigate the histological features,biological features,clinical treatment and prognosis of pancreatic mucinous noncystic carcinoma. Methods:A retrospective review of 9 patients with pancreatic mucinous noncystic carcinoma treated in our hospital during a 5year period was apopted and We discuss the clinical feature,imaging changes,histopathologic feature,therapeutic process. Results:Pancreatic mucinous noncystic carcinoma was found in 7 men and 2 women with a mean age of 63.1±8.7 years.Tumor located in the head of pancreas in 8 patients,body and tail in 1.Of the 9 patients,8received pancreaticoduodenectomy and 1 distal pancreatectomy.Histologically,all tumors were 4.3×4.3×4.4cm in size,8 invaded duodenum,4 invaded superior mesenteric vein(SMV). Neural invasion was present in 3 cases.Lymphatic invasion was noted in 2 cases.The tumor is characterized by lakes of stromal mucin containing scant malignant epithelial cells.Followup showed that 5 cases died of tumor recurrence and liver metastasis from 5 months to 23 months after the operation. Conclusion:Pancreatic mucinous noncystic carcinoma ought to be recognized as a distinct tumor in the pancreas.The biological features of pancreatic mucinous noncystic carcinoma should to be studied further.

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The cause and treatment of definitive operation followed by anastomotic block in terminal ileum enterocutaneous fistula cases. Liu Lei,Zhao Yunzhao,Ren Jianan,et al. 2006, 26(05): 1-365.  Abstract ( )   PDF (461KB) ( )   Objective:To explore the reasons of anastomotic obstruction after definitive operation (elective right hemicolectomy) for entrocutaneous fistula of the terminal ileum,and to study the possibility and the effect of enteral nutrition after catheters decompression of the obstruction placed retrogradely under X ray guidance. Methods:Forty nine cases of entrocutaneous fistula of the terminal ileum received definitive operation between February of 2003 and March of 2005.Among which 12 cases developed intestinal obstruction at the anastomotic sites, the time of colonic diversion before the operation were between 37 and 68 days.Catheters were placed interventionally from anus upward to 15cm proximal to the anastomosis under the guidance of X ray.Negative decompression was applied to the catheter until the resolution of symptoms and signs of obstruction,when enteral nutrition was instituted and parenteral nutrition and intravenous hydration were withdrawn.The catheters were removed when intestines could pass stool and gas normally and the anastomosis were proven patent endoscopically. Results:Twelve patients received the catheter placement,all these procedures were successful,the average duration of the procedure was 9 to 17min (11.4±4.8min),symptoms and signs of obstruction resolved after 9 to 22 hours (14.9±3.6h).All patients weaned parenteral nutrition or intravenous hydration whthin 4 days after the catheter placement.The catheters were maintained for 12 to 23 days (16.4±4.2 day).There were no complications,no catheter blockage,no catheter defecated from the rectum. Enteral nutrition was proceeded uneventfully.Follow up studies by barium contrast enema and colonoscopy proved no stenosis of the anastomosis. Conclusion:The reason for the obstruction at the anastomosis after definitive right hemicolectomy for enterocutaneous fistula of the terminal ileum was prolonged diversion preoperatively.Combined modalities of interventional therapy and enteral nutrition is a safe,effective,nontraumatic,simple and economic therapy.

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Comparison of laparoscopy assisted vs open radical distal gastrectomy for gastric cancer. Wang Ziqiang,Yu Peiwu,Cai Zhimin,et al. 2006, 26(05): 1-378.  Abstract ( )   PDF (767KB) ( )   Objective:To investigate the feasibility,safety and cancer clearance of laparoscopic distal gastrectomy with D2 lymphadenectomy. Methods:We compared the safety,recovery,complications,oncological clearance and shortterm outcomes of two groups of patients with gastric cancer who underwent either radical laparoscopy assisted or open distal gastrectomy from march 2004 to May 2005 (including 44 and 58 cases in each group). Results:Except for 1 case of conversion to open surgery,the other 43 patients underwent laparoscopyassisted distal gastrectomy successfully,accompanied by D1+α lymphadenectomy in 6 cases,D1+β in 2 cases and D2/D2+ in 35 cases,with a mean number of total retrieved lymph nodes of 30.11±16.97.The mean operation time for laparoscopic distal gastrectomy was significantly longer than that for open surgery（282.84±32.81 vs 223.75±23.25min）.The mean blood loss,length of incision,times of analgetic injection,first flatus time and time to ground activity in laparoscopic group was 139.30±82.67mL,5.61±0.81cm,1.02±1.03,4.10±0.75d,3.24±077d respectively,which was significantly lesser or shorter than those in open group.The complication rate was comparable in two groups.No significant difference between two groups was observed for cancer clearance,in terms of number of lymph nodes removed and length of proximal and distal margin to the tumor. Conclusion:In spite of being time comsuming as compared with open surgery,laparoscopyassisted radical gastrectomy with D2 lymphadenectomy is a safe,feasible procedure,which achieves the same cancer clearance as open surgery and leads to quick postoperative recovery.

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Colonic anastomosis performed by the nickeltitanium temperaturedependent memoryshape device. JiangZhiwei,Lining,LiJieshou,et al. 2006, 26(05): 1-363.  Abstract ( )   PDF (294KB) ( )   Objective:This study was designed to evaluate compression anastomosis clip (CAC) for colonic anastomosis. Methods:Thirty patients with colonic cancer were assigned randomly to undergo an anastomosis either with the CAC or a stapler.The following parameters will be recorded: anastomotic complication;first postoperation flatus and bowel movement;extrusion of clip device. Results:Neither group had anastomotic complications such as leakage or obstruction.The clip is expelled with the stool within 8-14 days.Two group had the similar results in recovery of bowel function. Conclusions:Our study demonstrates that this CAC is safe and simple to use for colonic anastomosis.

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Liver transplantation for recurrence of primary liver carcinoma after resection (a report of 4 cases). Shu Ming,Peng Chenghong,Shen Baiyong,et al. 2006, 26(05): 1-374.  Abstract ( )   PDF (407KB) ( )   Objective:Summary the experience of 4 cases liver transplantation for recurrence of primary liver carcinoma after resection. Methods:From August 2002 to November 2004,4 patients have underwent liver transplantation because of recurrence of liver carcinoma after resection (one case complicated acute hepatic function failure) in Rui Jin hospital affiliated of the Shang Hai Jiao Tong University. Results:Up to now,the disease free survival of 3 patients was 17,12,27 months respectively.1 patient has died of multiple organ failure on 3th day after liver transplantation. Conclusion:Liver transplantation was the effective treatment for the recurrence after resection of small liver carcinoma and which was coincidence with Milano criteria yet;after liver transplantation,few patients with portal vein tumor thrombi has good prognosis also;but it should be especially prudent for the patients with acute liver function failure after resection of primary liver carcinoma.

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Multivariate analysis of prognosis in patients with hilar cholangiocarinoma. Xiao Mei,Zhou Ningxin,Huang Zhiqiang,et al. 2006, 26(05): 1-363.  Abstract ( )   PDF (403KB) ( )   Objective:To analyze prognostic factors of patients with hilar cholangiocarcinoma. Methods:Multivariate Cox model was used to analyze prognostic factors. Results:We have established mathematic function to evaluate postoperative survival risk state of hilar cholangiocarcinoma.The Cox proportional hazard model identified resection the carcinoma，operation pattern，histologic differentiation，preoperative serum bilirubin level，types of metastase as significant prognostic factors.The 1,2,3-year survival rate was 63.8%、29.1%、24.9%and 36.0%,0,0 in resection group and in drainage one,respectively.There has a statistical difference between them. Conclusion:The best survival rate was achieved after resection the carcinoma in patients with HCC.Lymph nodal and perineural involvement resection plays an important role for long term survival. Appropriately perioperative care can improve survival rate.

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Efficacy of intramuscular HBIg in preventing hepatitis B virus reinfection after liver transplantation. Lu Minqiang,Cai Changjie,Zhao Hui,et al. 2006, 26(05): 1-374.  Abstract ( )   PDF (408KB) ( )   Objective:To evaluate the efficacy of combination of intramuscular HBIg and nucleoside analogs of HBV reinfection. Methods:130 patients underwent liver transplantation and according with the study criterion in our center with HBV related endstage liver disease during Sep 2003 and Dec 2004 were prospectively studied.All patients received the combination of intramuscular HBIg and oral nucleoside analogs as prophylaxis for HBV reinfection.During the followup period HBV markers were tested in due time.The result was compared with domestic and alien studies. Results:HBsAg disappeared and HBsAb was detectable in 128 of total 130 patients.The median followup was 12.2 months.8 patients (6.3%) developed HBV reinfection.The reinfection in control group was 3.1% (P>0.05). Conclusion:Combination of intramuscular HBIg and nucleoside analogs as prophylaxis of HBV reinfection is effective.

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The treatments of hostile proximal landing zone of abdominal aortic aneurysm in endovascular aneurysm repair. Yang Daihua,Guo Wei,Liu Xiaoping,et al. 2006, 26(05): 1-365.  Abstract ( )   PDF (610KB) ( )   Objective:To probe the treatments of hostile proximal landing zone of abdominal aortic aneurysm(AAA) in endovascular aneurysm repair(EVAR). Methods:41 AAA cases which include excess short proximal neck,severe angulation,severe calcification,mural thrombosis,irregular neck shape were treated by the following methods and techniques:anchoring the proximal bare stent above the renal arteries,covering a part of lowest renal artery and then angioplasty and stent of the renal artery,placing the joint of connecting segment of stentgraft in the site of angulation,selecting a reasonable stentgraft to fit the angulation,using great diametric bare stent and proximal cuff in stentgraft,et al. Results:Primary proximal type I endoleak incidence rate was 17.1％（7/41）at the end of EVAR in 41 cases.4 of 7 primary proximal type I endoleaks cases sealed during followup and the other 3 cases translated to durative type I endoleak. 4 secondary type I endoleak were detected during followup.Advanced stage proximal type I endoleak rate was 17.1％（7/41）in these 41 cases.No conversion to open operation,renal infarction,rupture and other complications. Conclusion:Hostile proximal landing zone of AAA can be treated satisfactorily by some special technique which make it suit for EVAR.With the development of technique and device,the indications of EVAR for AAA will be wided.