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02 March 2006, Volume 26 Issue 03 Previous Issue    Next Issue
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The feasibility and efficacy of percutaneous radiofrequency ablation in the treatment of pulmonary neoplasm. Yin Weiqiang,He Jianxing,Xu Xin,et al. 2006, 26(03): 1-165.  Abstract ( )   PDF (2332KB) ( )   Objective:To explore the feasibility and efficacy of percutaneous radiofrequency ablation through the guidance of computed tomography (CT) in the treatment of pulmonary neoplasm. Methods:Using CT to localize the tumor and determine the optimal approach,WE7568 ablation needle was inserted into the target lesion.Radiofrequency was applied via the electrode for 10 or 15 min at 75~95℃. Results:Total 78 cases were received 80 times of radiofrequency ablations through the guidance of CT.Reduced size of the pulmonary neoplasm and reduced chest CT number by 30~37 were founded in most cases（77.4％）.After the therapy,chest pain was alleviated in most cases.There was no severe complication and no case death. Conclusion:Percutaneous radiofrequency ablation through the guidance of CT is one of feasible and effective treatment in unoperateble or late stage solid lung cancer.

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Reasons and countermeasure of complications after procedure for prolapse and haemorrhoids. Yao Liqing,Zhong Yunshi,Xu Jianmin，et al. 2006, 26(03): 1-169.  Abstract ( )   PDF (454KB) ( )   Objective:To assess the reasons and countermeasure of the complications after procedure for prolapse and haemorrhoids (PPH). Methods:Five hundreds and four cases of Ⅲand Ⅳdegree haemorrhoids were treated with PPH from July 2000 to October 2004.The reasons and countermeasure of the complications were analyzed. Results:Of the 504 patients,the mean operation time was 9 min.In the next day after procedures,pain rate was 20.5% and the bleeding rate was 5.7%.10.9％ (55/504) of patients had rebleeding 7w (5-12w) after procedures.Only 3 patients were found stricture in the rectum 1，3 and 9 months after the procedure.In 455 followedup patients (455/498,914%),there were only 2 severe patients had twice of procedure and no recurrence in other patients. Conclusion:PPH is effective,safe,minimal invasive method and is the ideal choice to treat severe haemorrhoids.

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Bile duct reoperation:an analysis of 235 cases. Lai Jiaming,Liang Lijian,Peng Baogang,et al. 2006, 26(03): 1-180.  Abstract ( )   PDF (436KB) ( )   Objective:To summarize the practical experience in bile duct reoperation and to discuss its characteristics,causes,and corresponding treatment. Methods:The clinical data of 235 cases of bile duct reoperation in the fist Affiliated Hospital of Sun YetSen University from July 1996 to June 2005 was investigated. Results:The main cause of reoperation was remain or recrudesce of gallstones in hepatic bile ducts which occurred in 82.2% of the reviewed cases.The secondary causes were bile ducts strictures after RouxenY hepaticojejunostomy,dilatation or cyst of bile ducts,bile ducts strictures,and bile ducts tumor.Main surgical treatments of bile duct reoperation included lobar resection (66%) with RouxenY hepaticojejunostomy and Ttube drainage.The complication rate of reoperation was 25%. Conclusion:Bile duct reoperation is mainly caused by the bile duct diseases and iatrogenic factors.Therefore,to reduce reoperation in bile ducts requires sufficient preoperation preparation, careful exploration during operation,and appropriate choice of surgical methods and appropriate postoperation treatment as assist.

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The therapeutic effect analysis of highlevel resection of hepatic ducts in hilar cholangiocarcinoma. Zheng Guangqi. 2006, 26(03): 1-162.  Abstract ( )   PDF (300KB) ( )   Objective:To evaluate the therapeutic effect of high level resection of hepatic duct in treatment of advanced hilar cholangiocarcinoma (HC). Methods:A total of 13 cases of advanced HC in the Montreal Hospital of Chengdu from 1995 to 2004 were divided into two groups.Group A:8 cases of HC with intrahepatic and extrahepatic duct invasion.Of them,7 cases invaded to second or three grade intrahepatic duct.Group B:5 cases of large left intrahepatic cholangiocarcinoma with right hepatic duct (RHD,2 cases) or second grade of RHD (3 cases) invasion.Skeletonization resection,central hepatectomy,and reconstruction of a new hilar bile duct (HBD) from 3-9 branches of intrahepatic bile duct by RouxenY cholangiojejumostomy were performed for the patients in group A.Left hepatic lobectomy;resection of HBD,reconstruction of RHD,and Y type cholangiojejunostomy were performed for the patients in group B. Results:One patient died postoperatively from hepatic failure.One case survived for ten years,2 for four years,and 2 for two years with a ratio of 417% in those survival longer than two years. Conclusion:Skeletonization resection, central hepatectomy, and HBD resection at a high level could improve the therapeutic effect of advanced HC.

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The effect of low central venous pressure on blood loss and renal function during liver resection. Lin Chengxin*,Guo Ya,Liu Jingchen,et al. 2006, 26(03): 1-180.  Abstract ( )   PDF (409KB) ( )   Objective:To investigate the effect of low central venous pressure on blood loss and renal function during liver resection. Methods:Seventyfour patients(ASA Ⅰ~Ⅱ),undergoing selective liver resection under general anesthesia in our hospital from August 2003 to November 2004,were randomly divided into two groups:low central venous pressure group (LCVP group,n=37) and control group (C group,n=37).Central venous pressure (CVP) was maintained at 0 to 5 cmH2O (1cmH2O=0.098kPa) during liver parenchyma dissection in LCVP group,and it was maintained at 6 to 12 cmH2O in C group.Total blood loss and blood transfusion during operation were collected in two groups.The volume of blood loss was compared in different segments of liver resection in two groups.The volume of blood loss during liver resection with and without portal trial occlusion was compared in two groups.The renal function before and after operation was compared in two groups. Results:The blood loss during operation was significantly less in the LCVP group than that in the C group ［(427±317)mL v.s (800±709)mL，P＜0.05］.The volumes of blood loss in different segments of liver resection in the LCVP group were less than those in the corresponding C group. The mean blood loss with portal trial occlusion in the LCVP group was significantly less than that in the C group ［(413±297)mL,n=29 v.s (774±522)mL,n=24,P＜0.05］.The renal function before and after operation was no significant difference between the two groups. Conclusion:Low central venous pressure can reduce the blood loss during liver resection and has not influence on renal function.

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Expression of nuclear factorkappa B and the relationship with angiogenesis in cholangiocarcinoma. Cai Xiujun,Shen Bo,Yu Hong,et al. 2006, 26(03): 1-162.  Abstract ( )   PDF (259KB) ( )   Objective:To explore the expression of nuclear factor kappa B (NF-kB) and the relationship with angiogenesis in cholangiocarcinoma. Methods:Microvessel density (MVD),expression of VEGF and NFkB were investigated in 50 cases of cholangiocarcinoma,27 cases of paratumor,and 9 cases of normal bile duct specimens by immunohistochemistry. Results:Positive expressive rate of NFkB in cholangiocarcinoma (48/50) and paratumor (27/27) was significantly higher than that of normal bile duct tissue (4/9）(P<0.05).In NFkB strong positive expression group,MVD was significantly higher than that in NF-kB weak positive group or in NFkB negative group（F=12.662，P<0.01）.Expression of NFkB was positive relative with MVD (rs=0.542,P<0.01) and VEGF (rs=0.660,P<0.01). Conclusion:NF-kB is upregulated in cholangiocarcinoma and is positive relative with angiogenesis.NF-kB might promote angiogenesis through upregulating VEGF expression in cholangiocarcinoma.

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The effects of combination of EVL and Hassab’s procedure on portoazygous collateral shunt in patients with portal hypertension. Liu Bo,Deng Meihai,Lin Nan,et al. 2006, 26(03): 1-180.  Abstract ( )   PDF (438KB) ( )   Objective:To explore the efficacy and prognosis of combination of EVL and Hassab’s procedure treatment on portoazygous collateral shunt in patients with portal hypertension. Methods:Fourtythree patients with esophageal varication were received a combination of EVL and Hassab’s procedure treatment for variceal eradication.The esophagus vascular structures were examined with endoscopy and miniature ultrasonic probe.The change of vascular structure was evaluated,and recurrence and rebleeding of esophageal varices were also investigated. Results:After treatment,the esophageal varication was obliterated,and the collateral veins were diminished in size or obliterated,and the azygos blood flow (ABF) decreased 43%.During a shortterm followup,the recurrence and rebleeding rate of esophageal varices were 25％ and 0. Conclusion:The combination of EVL and Hassab’s procedure can effectively shut off the portoazygous shunt,prevent esophageal varices bleeding.It’s a simply and less cost procedure.

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Effect of early enteral nutritional support on liver and renal function in postoperative patients with malignant obstructive jaundice. Li Jiang,Liu Bin,Zheng Nan. 2006, 26(03): 1-169.  Abstract ( )   PDF (405KB) ( )   Objective：To investigate the effect of EEN and TPN on liver and renal function in postoperative patients with malignant obstructive jaundice. Methods：Thirtyseven patients with malignant obstructive jaundice admitted beween January 2003and May 2004 were randomized to receive postoperative TPN (n=20) or EEN (n=17). Their liver and renal functions were measured before operation and postoperative day 5 and 7,respectively. Results：Liver function in EEN group recovered more quickly than those in TPN group after operation.The levels of TB and γ-GT were significantly lower on the 7th day after operation compared to those in TPN group.Renal function in EEN group came down faster than those in TPN group.The levels of TRF,NAG and α1mG were significantly lower on the 7th day after operation compared to those in TPN group. Conclusion：EEN may present better protective towards liver and renal function compared to TPN in the patients with malignant obstructive jaundice after operation.

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Diagnosis and treatment of pancreatic islet cell tumor:a report of 35 cases. Xu Shaoming,Gong Weihua,Tian Hua,et al. 2006, 26(03): 1-162.  Abstract ( )   PDF (445KB) ( )   Objective：To discuss the diagnosis and treatment of pancreatic islet cell tumor and review its incidence in China based on the recent literatures. Methods：Thirtyfive patients with pancreatic islet cell tumor from 1953 to 2003 admitted in the 2nd Affilinted Hospital of Zhejiang University School of Medicine were analyzed retrospectively.The diagnosis and treatment of pancreatic islet cell tumor were also discussed based on the recent native literatures. Results：Thirtythree patients with pancreatic islet cell tumor received operation,which were confirmed by pathology. Among 33 patients,there were 24 cases classified as insulinoma (72.7%,24/33),7 cases of nonfunctional pancreatic islet cell tumor (21.2%, 7/33),1 case of glucagonoma and 1 case of gastrinoma.There were 2 785 cases of pancreatic islet cell tumor reported in literature during same period. Conclusion：Insulinoma and nonfunctional pancreatic islet cell tumor are the mostly dominant in pancreatic islet cell tumor.It should be performed simply tumor remove or partial pancreas resection for benign pancreatic islet cell tumor.Extended radical resection combined with other comprehensive treatment is benefited for malignant pancreatic islet cell tumor.It has a better prognosis than other abdominal organ tumors.

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Evaluation of transcystic common bile duct exploration with choledochoscope：a report of 87 cases. Zhao Haiying*,Liu Jingang,Zhang Yupeng,et al. 2006, 26(03): 1-169.  Abstract ( )   PDF (305KB) ( )   Objective：To evaluate the clinical application of transcystic common bile duct exploration with choledochoscope for choledocholithiasis. Methods：Between September 1997 and December 2004,82 cases of open transcystic common bile duct exploration with choledochoscope and 5 cases of laparoscopic transcystic common bile duct exploration with choledochoscope were performed.The data were analyzed retrospectively. Results：The clearance rate of stones of common bile duct was 100% and 3 cases got incision fat liquefaction.The mean postoperative hospital stay was 72 days. Conclusion：In both of open and laparoscopic operation,it should choose transcystic common bile duct exploration with choledochoscope first without contraindications.

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The clinical analysis of hepatic function change after primary hepatic carcinoma operation. Guo Xinggang*，Xu Haitao，Dong Xinshu，et al. 2006, 26(03): 1-177.  Abstract ( )   PDF (269KB) ( )   Objective:To investigate the change of hepatic function in the patients with primary hepatic carcinoma after operation. Methods:Hepatic function of 142 patients with primary hepatic carcinoma admitted between 1990 and 2005 was analyzed retrospectively.The patients were divided into two groups:102 patients with Child A in group A and 40 with Child B in group B.The change of hepatic function in two groups after operation was compared. Results:The alanine aminotransferase (ALT)，aspartate aminotransferase (AST), and serum bilirubin (SB) were found increasing 3 days after operation and then decreasing.The amplitude of increasing and the tendency of decreasing were significantly different between two groups.The hepatic function turned to normal in the group with child A grade. Conclusion:Before and after operation,the Child degree is direct correlative with the change of mainly hepatic function.

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Pheochromocytoma in Children:a report of 8 cases. Fan Xinrong*,Li Hanzhong,Song Zonglu,et al. 2006, 26(03): 1-169.  Abstract ( )   PDF (457KB) ( )   Objective:To investigate the clinical features,diagnosis,and treatment of pheochromocytoma in children. Methods:Eight cases of children pheochromocytoma in Peking Union Medical College Hospital from 1984 to 2004 were analyzed retrospectively.Definitive diagnosis and localization of the tumor were made preoperatively by clinical manifestations,24hour urinary catecholamine,131I-MIBG,B-ultrasound and CT scan.Preoperative management with αadrenergic receptor blocker was performed. Results:Tumor resection was performed in all 8 patients and the diagnosis was confirmed by pathological results,in which 5 were benign and 3 were malignant. Conclusion:Pheochromocytoma is rare in children,and the development is fast.Early diagnosis and surgical excision is the only way to cure the disease.

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Evaluation of the preventive operation for portal hypertension. Huang Yuan,Lin Jinling, Lan Liugen,et al. 2006, 26(03): 1-177.  Abstract ( )   PDF (296KB) ( )   Objective:To evaluate the situation of combined operation in preventive operation for portal hypertension (PHT). Methods:The therapeutic results of 84 PHT patients for posthepatitic cirrhosis in the First Afiliated Hospital of Guangxi Medical University from March 1997 to March 2004 were analyzed. Results:The free portal pressure (FPP) decreased（12.21±4.73）cmH2O (1cmH2O=0.098 kPa)after combined operation, which decreased （7.16±8.35）cmH2O after devascularization for portal hypertension (PHT).Portal venous flow (PVF) slightly increased after devascularization,but decreased after combined operation (P<0.05).Compared with devascularization,esophageal varices distinctly relieved after combined operation (P<0.05).Both the bleeding rate and the mortality rate were 625% for the group who receipted combined operation, which were better than the group of devascularization or the group of nonoperation (P<0.05). Conclusion:Combined operation for the PHT patients with good liver function is attributed to the improvement of the life quality.

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The reason and the prevention of recurrent laryngeal nerve injury during operation on benign thyroid neoplasm. Kong Fanmin,Wang Chunsheng,Li Hangyu,et al. 2006, 26(03): 1-169.  Abstract ( )   PDF (295KB) ( )   Objective:To investigate the reason and the preventive measures of recurrent laryngeal nerve injury during operation in patients with benign thyroid neoplasm. Methods:The clinic data of 2 266 cases of benign thyroid neoplasm admitted between Jannary 2000 and July 2004 were analyzed retrospectrvely.The relationships between different neoplasm location and different operation measure in injury of recurrent laryngeal nerve were studied. Results:Injury incidence of recurrent laryngeal nerve in the cases with neoplasm located on the background of thyroid was 8.62％（81／940）,which was significantly higher than that in the cases with neoplasm on other sites (0.15%,2/1303).In the cases with nodular goiter and thyroid adenoma on the dorsum of thyroid,injury incidence of recurrent laryngeal nerve were 1.56 %(1/64) and 0 (0/33),respectively,for exposed cases and 8.53% (59/692) and 13.91% (21/151),respectively,for nonexposed.In the cases with benign thyroid neoplasm on the other sites of thyroid,injury incidence of recurrent laryngeal nerve was not significantly different between exposed and nonexposed cases. Conclusion:The location of neoplasm is one of reasons of injury of recurrent laryngeal nerve.Exposing the recurrent laryngeal nerve is necessary in the cases with nodular goiter or thyroid adenoma on the dorsum of thyroid.

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The study of the endoscopic thyroidectomy by breast approach for benign thyroid tumor. Jin Xiaojian,Lu Bangyu,Cai Xiaoyong,et al. 2006, 26(03): 1-162.  Abstract ( )   PDF (437KB) ( )   Objective:To explore the feasibility and advantage of endoscopic thyroidectomy by breast approach in patients with benign thyroid tumor. Methods:Total 101 patients were underwent endoscopic thyroidectomy in First Affiliated Hospital of Guangxi Medical University from August 2002 to May 2005,including 40 cases of adenoma and 61 cases of nodular goiter. Results:One hundred cases were successfully completed endoscopically.There was one case to convert to conventional thyroidectomy because of bleeding.Twentyseven patients underwent bilateral near total lobectomy (A group),64 patients underwent unilateral near total lobectomy (B group),and 10 patients underwent adenoma enucleation (C group).The operating time was (147.67±46.59)min，(117.37±51.84)min，(80.83±14.7)min in group A,B and C,respectively.It was significantly longer in group A than that of in group B and group C(q=2.058,P<0.05;q=4.463,P<0.5).The analgesic requirements was much more in group A (3333%)than that in group B (9.8%) and group C(10%)(χ2=8.59,P=0.1).There were no difference in blood loss,volume of drainage,time of stay and postoperation stay,and the time of taken to return to normal activity in all three groups.Postoperative complications occurred in four cases.There were two case (superior or recurrent laryngeal nerve paralysis) Occurred group A.One occurred in group B（hypocalcemia）and one occurred in group C (bleeding). Conclusion：The results of this study confirm that endoscopic thyroidectomy is a technically feasible and safe procedure.It can successfully treat bilateral thyroid diseases and is a good select for patients of benign thyroid tumor.

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The effect of anusretained operation in different anastomotic location on bowel control in elderly patients with low rectal cancer. Lu Bing，Fu Chuangang，Liu Lianjie，et al. 2006, 26(03): 1-176.  Abstract ( )   PDF (429KB) ( )   Objective:To evaluate the bowel control of the anusretained operation in different anastomotic location in elderly patients with low rectal cancer. Methods:Thirthnine cases of the elderly patients（≥75 years）with low rectal cancer who receipted surgery between 2000 and 2003 were divided into various groups according to different anastomotic location.The bowel control and satisfaction of patients were investigated. Results:The time of recovering normal bowel frequency was (9.8±2.9) months.36.1% of the patients experienced some problems with continence.There were no difference on bowel function between lower anastomosis group and lowest anastomosis group.The patients with colonic Jpouchanal anastomosis displayed significantly better function in terms of defecation per 24h postoperatively,and bowel movement and anorectal manometric findings（P<0.05）. Conclusion:For the elderly patients with rectal cancer of the anusretained operation,there are no differences on bowel function between lower anastomosis group and lowest anastomosis group.However,Colonic Jpouchanal anastomosis after the anusretained operation can significantly improve the bowel function.

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The methods of surgical therapy in patients with injury of subclavian artery and traumatic pseudoaneurysm. Wan Shengyun*，Song Haiping，Yu Changjun,et al. 2006, 26(03): 1-180.  Abstract ( )   PDF (310KB) ( )   Objective:To investigate the methods of surgical therapy in patients with injury of subclavian artery and traumatic pseudoaneurysm. Methods:Two patients with injury of subclavian artery and six patients with the traumatic pseudoaneurysm were underwent surgical therapy.According to the location,severity and extension of the trauma,the incision was via supraclavicular,infraclavicular,median sternum or a left thoracic “open book” etc.The operation adopted artery litigation with reconstruction,vessel wall repair,endtoend anastomosis or Dacron graft interposed.Two cases were underwent assisted extracorporeal circulation and balloon catheter controlling hemorrhage. Results:The operation was successful in six cases.One patient developed stegnosis in subclavian artery and venous,another patient who had legated the artery developed arterial occlusion accompany with injury of brachiplex.The average loss of blood was 800 mL. Conclusion:Operation of subclavian artery injury and pseudoaneurysm is very complicated and the overall assessment of trauma before operation is very important.The selection of incision and the method of operation are the key factors in reducing the complication of operation.