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24 November 2005, Volume 25 Issue 11 Previous Issue    Next Issue
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Nutritional management and rehabilitative therapy of short bowel syndrome. Wu Guohao,Wu Zhaohan,Wu Zhaoguang 2005, 25(11): 1-693.  Abstract ( 1101 )   PDF (667KB) ( 548 )   Abstract Objective To assess the effects of nutritional management and rehabilitative therapy on the survival and general conditions of patients with short bowel syndrome.Methods A retrospective analysis was made on 64 patients with short bowel syndrome.26 patients received exogenous growth hormone,supplemental glutamine.Results 58 patients are survival and 6 patients dead.The survival time was 6.6±9.4 years (range,3 month to 19 years).36 patients were weaned from TPN,the length depend on TPN was 8.6±14.2 months.13 patients received PN and EN supplemented occasionally to maintain normal nutritional status.9 patients were maintained home TPN.Of the 26 patients treated with growth hormone and glutamine,34.6% (n=9) were weaned completely from PN,30.8% (n=8) experienced a reduced in the number of day/week (from 6.5±1 to 4.2±1 days per week) and the volume of PN (from 13.6±5.2 L to 8.2±3.3 L,per week) that they required,346% (n=9) had no change in their need for PN. Conclusion Most patients with short bowel syndrome could be weaned from TPN and had good quality life.Rehabilitative therapy could promote the adaptation of remained intestinal in short bowel patients.

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Neoadjuvant radiotherapy for low rectal cancer. Wu Bin,Qiu Huizhong,Xiao Yi,et al. 2005, 25(11): 1-646.  Abstract ( 1177 )   PDF (311KB) ( 516 )   Objective To assess the effectiveness of neoadjuvant radiotherapy followed by surgery in locally advanced low rectal cancer. Methods The clinical data of 39 locally advanced low rectal cancer patients were analyzed retrospectively.All patients received 50 Gy for 5 weeks in 25 fractions.After an interval of 2-6 weeks,all patients were submitted to surgery under the rule of TME technique. Results All patients underwent surgery:14 abdominoperineal resection,13 anterior resection,8 Parks operation and 4 Hartmann operation.In pathological finding,3(7.7%) patients showed complete regression (CR),the overall response rate (CR plus PR) was 64.1%(25/39).The percentage of sphinctersaving surgery in the response group was higher (64% in response group vs 35.7% in no response group,P<0.01). Conclusion In patients with locally advanced low rectal cancer,neoadjuvant radiotherapy provides shrinkage of tumor mass,downstaging and increases the percentage of sphinctersaving surgery.

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Surgical experience in huge primary retroperitoneal tumor. Wang Xiaoping，Shi Kaiwang，Cao Hongyong. 2005, 25(11): 1-693.  Abstract ( 1165 )   PDF (317KB) ( 503 )   Abstract Objective To summarize the surgical experience in huge primary retroperitoneal tumor and improve tumor resection rate. Methods Eighteen cases with huge primary retroperitoneal tumor between 1998 and 2002 were analyzed. Results fourteen of all cases received total resection,1 partial resection,3 exploratory laparotomy and biopsy.Ten cases of malignant tumor were total resected.Among these,8 cases were underwent combined organ resection.4 cases of benign tumor were all resected totally,including 1 combined organ resection. No case died during perioperation.All cases received 3 years’ followup.14 alive and 4 died.Tumor recurred in 14 cases. Conclusion Precise preoperative evaluation,right approach of operation and excellently surgical technique are the keys to improve tumor resection rate.

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Management of enteric fistula complicated with short bowel syndrome:an analysis of 32 cases. Ren Jian’an,Tao Qingsong,Wang Xinbo,et al. 2005, 25(11): 1-646.  Abstract ( 1300 )   PDF (470KB) ( 484 )   Objective To investigate the specific rule and feature of diagnosis and therapy of enteric fistula complicated with short bowel syndrome (SBS). Methods The causes,locations,surgery therapy and intestinal rehabilitation therapy of enteric fistula were analyzed in collected enteric fistula patients with small bowel length less then 100cm since 1995. Results Twenty patients were treated successfully.Six patients died and six patients gave up treatment among 32 enteric patients complicated and treated in this decade. The mean length of residual small bowel was (5803±2830) cm.Enteral nutrition (EN) were restored in 28 patients.Nine patients with average residual small bowel length (528±315) cm did not received intestinal rehabilitation therapy and EN was restored in (1296±898) days.Nineteen patients with average residual small bowel length (641±192) cm received intestinal rehabilitation therapy and EN was restored in (618±540) days. Conclusion The main cause of enteric fistula was small intestine volvulus and fistula site located mainly at intestinal anastomosis.The main reason of enteric fistula is that necrotic margin can not be decided clearly.Early use of somatostatin can reduce gastrointestinal fluid and alleviate the symptoms of diarrhea.Subsequent use of somatotropin can promote the spontaneous close of enteric fistula and the adaption of intestinal epithelium both in function and structure.

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Effect of CO2 insufflation pressure on the adhesion potential of colon cancer cells and its relationship with expression of adhesion molecules. Zheng Minhua,Ma Junjun,Feng Bo,et al. 2005, 25(11): 1-693.  Abstract ( 1238 )   PDF (475KB) ( 536 )   Objective To investigate the influence of CO2insufflation and its pressure on adhesion potential of the colon cancer cells based on expression of adhesion molecules.Methods With an artificial pneumoperitoneum model in vitro,SW1116 human colon carcinoma cells were exposed to CO2insufflation in 5 different pressure groups:6mmHg,9mmHg,12mmHg,15mmHg and control group,respectively for 1 hour.Expression of E-cadherin,ICAM1,CD44 and E-selectin were measured at 0,12,24,48 and 72 hours after CO2insufflation by using flowcytometry.The adhesion capacity of SW1116 cells before and after exposed to CO2insufflation was detected by cell adhesion assay in vitro. Results The expression of Ecadherin,ICAM1, CD44 and E-selectin in SW1116 cells were changed significantly following exposure to CO2 insufflation of different pressure groups (P<0.05).When 0 h after exposure,with CO2insufflation pressure ascending,the expression of the Ecadherin,CD44 and ICAM1 decreased (P<0.05).The adhesive cells also decreased gradually with the pressure ascending in adhesion assay (P<0.05). Conclusion The expression of adhesion molecules can be affected temporarily and bidirectionally by continuous CO2 insufflation.Higher pressure of CO2insufflation could inhibit the adhesion potential in vitro,which is associated with inhibited expression of adhesion molecules.

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Laparoscopic choledocholithotomy for thin choledochus. Chen Anping,Zhao Cong,Chen Dafu,et al. 2005, 25(11): 1-646.  Abstract ( 1223 )   PDF (321KB) ( 524 )   Abstract Objective To summarize the experience of Laparoscopic choledocholithotomy for thin choledochus. Methods From October 1993 to March 2005,there were 87 cases undergoing the operation.Main methods included choledochotomy, choledochoscopic exploration,ureteral catheter through cystic duct remnant for drainage of bile duct,Ttube drainage,and the primary closure of duct incision. Results The operation was successful in 87 cases.None of them were shifted to open common bile duct exploration.No one had residual stones.Bile leakage was cured by drainage in 5 cases.Two patients had bile duct stenosis of primary closure of duct incision. No one died postoperatively. Conclusion If patients are suitable,laparoscopic choledocholithotomy is safe and effective in the hands of skilled endoscopiests.

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The analysis of the efficacy of portalazygous disconnection with splenectomy for treating hepatocirrhosis with portal hypertension and hypersplenism. Chen Weifeng,Wang Qian,Liang Lijian,et al. 2005, 25(11): 1-685.  Abstract ( 1282 )   PDF (618KB) ( 623 )   Abstract Objective To summarize and analyze the efficacy of portalazygous disconnection with splenectomy for treating hepatocirrhosis with portal hypertension and hypersplenism.Methods A retrospective analysis was made on the results of 74 patients with hepatocirrhosis,portal hypertension and hypersplenism who were treated with disconnection from Jan,2000 to June,2004 in the first affiliated hospital of Sun Yatsen University.ResultsThe rate of complications was 513%.One patient died of systemic infection and respiration failure.The others recovered nicer after treatment.Conclusion The effect of portalazygous disconnection with splenectomy for treating hepatocirrhosis with portal hypertension and hypersplenism appears to be effective.To improve the operated result,the following should be emphasized:the selection of the operative opportunity and indications,thorough porta azygous disconnection and the performance of the operation in according to the corrective technique,prevention of surgical complications.

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Diagnosis and treatment of cystic neoplasms of the pancreas:a report of 26 cases. Wang Dansong*，Jin Dayong，Lou Wenhui，et al. 2005, 25(11): 1-683.  Abstract ( 1273 )   PDF (475KB) ( 531 )   Abstract Objective To investigate the diagnosis and treatment of cystic neoplasms of the pancreas. Methods Retrospective analysis was made on the clinical data of 26 cases of cystic neoplasms of the pancreas from June 2000 to June 2005. Results Cystic neoplasms of the pancreas occur predominately in women.Presenting symptoms are often vague and nonspecific.Ultrasonography and computed tomography (CT) displayed a cystic tumor in 88% and 92% of all patients,respectively,but the accurate differentiation may be difficult. Of the 26 cases,pancreaticoduodenectomy and distal pancreatectomy were performed in 11 respectively,middle segment pancreatectomy in 1,enucleation in 3.Postoperative pancreatic fistula was the leading complication.All the patients were followed up.One case of mucinous cystadenocacinoma died of recurrence and metastasis 11 months after operation.The others are still alive now with no evidence of recurrence.Conclusion Ultrasonography and CT scan are helpful in the diagnosis of pancreatic cystic neoplasms.Surgical resection is indicated for the symptomatic serous cytadenomas,and for the mucinous cystic neoplasms and intraductal papillary mucinous tumors because of their malignant tendency or difficult differentiation preoperatively between cystadenomas and cystadenocarcinomas,while asymptomatic patients with serous cytadenoma could be followed with serial imaging and managed nonoperatively.Surgical modality varies with the type (and even subtype) of cystic neoplasms of the pancreas.When the neoplasm is completely resected,the pancreatic cystadenoma is curative,and the outcome of the pancreatic cystadenocarcinoma is also satisfactory.

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Diagnosis and treatment of gastrointestinal stromal tumor:an analysis of 46 cases. Bi Jianwei,Jing Wei,Wei Guo,et al. 2005, 25(11): 1-653.  Abstract ( 1233 )   PDF (321KB) ( 565 )   Abstract Objective To explore the diagnosis and treatment of gastrointestinal stromal tumor (GIST). Methods fortysix patients with gastrointestinal stromal tumor in Changhai Hospital from 1998 to 2004 were retrospectively analyzed. Results All patients received operation.Of them,benign GIST was in 13 cases,potential malignant GIST in 10,and malignant GIST in 23.All patients were followedup from 6 to 72 months.7 of them had local recurrence and metastasis and 10 case died. Conclusion The diagnosis of GIST is difficult because of the lack of clinical feature.Final diagnosis should be based on pathology.The main choice of treatment is operation.Reoperation can prolong the life of the patient in recurrent and metastatic cases.

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Experience of diagnosing and treatment for 33 cases of abdominal aortic aneurysm. Luo Canhua,Pan Aizhen,Tan Yucan,et al. 2005, 25(11): 1-653.  Abstract ( 1412 )   PDF (306KB) ( 467 )   Abstract Objective To discuss experience on diagnosis and operative management in patient with abdominal aortic aneurysm (AAA). Methods Thirtythree patients with AAA received surgery in our hospital from June 1996 to December 2004.One of them belonged to type IV thoracoabdominal aortic aneurysm.All of them were treated with anerysmectomy and prosthetic grafting. Results Among the seven patients whose anerysms ruptured before operation,two died during operation.There was no operative mortality in rest of cases. Conclusion Correct preoperative diagnosis and proper operative opportunity are the key of success.Aortic angiography using sixteendetector row computed tomography is a safe,rapid,and noninvasive method in the diagnoses of AAA.As long as there are indications for surgery,active treatment should be given. Improving traditionally surgical skill was beneficial to safer surgery.

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Influence of surgeonrelated factors on postoperative sexual function in patients with rectal cancer. Wang Jianping,Cai Guanfu,Huang Meijin,et al. 2005, 25(11): 1-685.  Abstract ( 1306 )   PDF (292KB) ( 500 )   Abstract Objective To investigate the influence of surgeonrelated factors on postoperative sexual function in patients with rectal cancer. Methods Clinical and followup data of 105 male patients with rectal cancer treated surgically from October 1997 to July 2004 were retrospectively analyzed.The patients were randomly divided into 5 groups and the operation was implemented by 5 surgeons,respectively.Rates of postoperative sexual dysfunction were compared among different surgical groups. Results The total rate of postoperative sexual dysfunction was 352%.The rates in different groups were 15.4%,35.7%,57.9%,52.6% and 154%,respectively.Significant differences were found in different groups (χ 2=13.5, P=0.009). ConclusionSurgeon related factors could influence postoperative sexual function in patients with rectal cancer and more understanding on nerve preserving resection would be helpful to decrease the rates of postoperative sexual dysfunction.