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??Ultrasound-guided wire-localized surgical biopsies for nonpalpable breast lesions LI Yan-ping*, GAO Hong, WANG Hui-yu, et al. *Department of Breast Disease, Beijing Shijitan Hospital, Beijing 100038??China Corresponding author: LI Yan-ping, E-mail: liyanping112@yahoo.com.cn Abstract Objective To investigate the value and feasibility of wire-location surgical biopsies by ultrasound for non-palpable breast lesions. Methods Between March 2007 and December 2008, 57 women with 60 non-palpable breast lesions underwent surgery at Beijing Shijitan Hospital. Wire localization guided by ultrasound was performed before operation. Results All lesions founded by ultrasound were accurately localized and excised. Forteen (24.6%) cases were malignant and 16(28%) were ductal or lobular atypical hyperplasia by pathologic diagnosis. Conclusion Careful consideration should be taken for the cases of non-palpable breast lesions. Ultrasound-guided wire localization of breast lesions is useful in assisting surgical biopsy and worth extensive generalization.     

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??Value and rational option of hepatectomy in the treatment of hepatic benign space-occupying lesions CAI Xiu-jun, LIANG Yue-long. Department of General Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou 310016, China
Corresponding author: CAI Xiu-jun, E-mail: cxjzu@hotmail.com
Abstract With the fast development of medical diagnostic modalities in China?? more and more patients with hepatic benign space-occupying lesions (HBSOL) have been found. The importance of the diseases has never been so emphasized before. In the past two decades?? hepatectomy has developed quickly??meanwhile the utilization of laparoscopic hepatectomy has become a great complement to the traditional liver surgery by increasing safety and decreasing damage. Howeve??there are still controversies in the area of laparoscopic treatment for HBSOL??such as the operation indication and optimal surgical strategies.     

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腹会阴联合切除术(APE)和全直肠系膜切除(TME)明显改善了直肠癌病人的预后。然而,与直肠癌前切除手术(AR)相比,低位直肠癌的环周切缘(CRM)阳性率和术中穿孔(IOP)的发生率仍然很高,这是导致复局部发率高的重要因素。提肛肌外腹会阴联合切除术(ELAPE)可明显降低CRM阳性率和IOP发生率,增加局部根治性。在欧洲,ELAPE被认为是治疗低位直肠癌的外科新理念。ELAPE手术要求在会阴区沿提肛肌外侧平面操作,腹部手术遵循TME原则。明确解剖标志和操作原则可缩短外科医生的学习曲线。     

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??Excision of Intraductal Lesions under the guidance of mammography image locating technology ZHOU Dan, ZHANG Guo-qiang, PANG Da, et al. Department of Breast Surgery, Tumor Hospital Affiliated to Harbin Medical University, Harbin 150081, China Corresponding author: ZHANG Guo-qiang, E-mail:6-Fu@163.com Abstract Objective To evaluate the value of mammography image location technology for the diagnosis and microinvasive treatment of intraductal lesions Methods A total of 105 patients with nipple discharge without breast lumps were examined by mammary ductography, localized by the guidance of mammography image location eye-measurement method.After the location of the tumor was identified, and a proper incision was made to resecte the tumor Results The lesions were resected completely in all the 105 patients. Three of them had malignant lesion and received extended resection. After the operation, no obvious change was observed in the appearance of the breast Conclusion Resection of intraductal lesions under the guidance of mammography image location is less traumatic with good cosmetic outcomes. It characterized easy to learn??economics??especially enhance the diagnostic and treatment of intraduactal lesions effectively.     

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??Role and status of open surgery in the development of vascular surgery XIN Shi-jie, LIN Ruo-ran. Department of Vascular Surgery,the First Hospital of China Medical University??Shenyang 110001??China
Corresponding author: XIN Shi-jie??E-mail??xinshijie1963@aliyun.com
Abstract The morbidity of vascular disease is increasing daily?? while endovascular repair??EVR?? technique is becoming riper than before. It leads to most of the patients choose EVR instead of open surgical repair??OSR???? which can also obtain satisfactory therapeutic effects. In addition?? the phenomenon of the vascular surgeon neglect and forgot OSR should draw everyone’s attention. Overall?? OSR technique is essential grounding of each vascular surgeon.     

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??The values and status of hepatectomy in the treatment of hepatolithiasis YIN Xiao-yu. Department of Pancreato-biliary Surgery??the First Affiliated Hospital of Sun Yat-Sen University??Guangzhou 510080??China
Abstract Hepatolithiasis is referred to the intra-hepatic bile duct stones which occurs proximal to the confluence of right and left hepatic ducts. It can involve in one or more segments or lobe of the liver??and even the whole liver??and is commonly associated with biliary stricture??confluence anomalies and even biliary dilatation. It is one kind of difficultly-treated benign disease??especially for the complicated hepatolithiasis. Provided choledochotomy with extraction of stones has been used in the treatment of hepatolithiasis??its alone frequently fails to completely remove all stones??and is associated with high incidence of stone recurrence. Anatomical hepatectomy is helpful to remove all stones completely??simultaneously remove the diseased bile ducts and the hepatic parenchyma??and has the advantages of low incidences of residual stones and stones recurrence. Hence??hepatectomy represents as a curative approach and should be actively adopted for the indicated patients with hepatolithiasis.     

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目的探讨脾脏占位性病变的临床诊断特点和治疗体会。方法对北京大学人民医院1992～2003年收治的36例脾脏占位性病变的临床资料进行回顾性分析。结果脾脏占位性病变的诊断主要依靠影像学检查。36例脾脏占位性病变中良性25例，恶性11例。35例行手术治疗，其中单纯脾脏切除27例，脾切除加胰尾切除3例，脾切除加原发灶切除3例，脾部分切除术2例。结论影像学检查是诊断脾脏占位性病变的主要手段。脾脏占位性病变以良性为主，手术切除是有效的治疗方法。     

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??Laparoscopic intersphincteric resection versus open intersphincteric resection in sphincter-preserving surgery of ultralow rectal carcinom??A Meta-analysis LI Chang-rong??LI Wei-feng??LI Hong-lang. Department of Gastrointestinal Surgery??the Second Affiliated Hospital of Nanchang University??Nanchang330006??China
Corresponding author??LI Hong-lang??E-mail??lihonglang6802@163.com
Abstract Objective To compare the clinical safety and efficacy of laparoscopic intersphincteric resection versus open intersphincteric resection in sphincter-preserving surgery of ultralow rectal carcinom. Methods Studies comparing laparoscopic intersphincteric resection with open intersphincteric resection in sphincter-preserving surgery of ultralow rectal carcinoma were retreived from PubMed??Medline??Ovid??China National Knowledge Infrastructure (CNKI) and Wanfang databases by 2014. The methodological quality of the selected studies was assessed to determine studies suitable for inclusion. Meta-analysis was performed by fixed or random effects model. Results Ten observational studies with a total of 939 patients (501 patients in laparoscopic surgery groups and 438 patients in open surgery groups) were identified. Compared with open surgery group??laparoscopic surgical operation time extended??WMD=36.28??95%CI 4.30—68.26??P<0.05????intraoperative bleeding reduced (WMD=-95.84??95%CI -123.64—-68.03??P??0.01)??time of bowel function recovering??WMD=-1.05??95%CI -1.70—-0.41??P<0.01????normal dieting (WMD=-0.95??95%CI -1.34—-0.55??P<0.01) and hospital staying (WMD=-2.43??95%CI -3.95—-0.92??P<0.01) shortened respectively. Incidence of overall postoperative complication??OR=0.60??95%CI 0.44—0.84??P<0.01????positiving circumferential resection margin (OR=2.49??95%CI 1.12—5.54??P<0.05) and wound infection??OR=0.20??95%CI 0.07—0.60??P<0.01?? reduced respectively. No statistically significant difference was found on the local recurrence rate??distant metastasis??anastomotic leakage??postoperative intestinal obstruction between the two groups (P>0.05). Conclusion Laparoscopic-assisted intersphincteric resection is a technically feasible and safe alternative to open surgery with better short-term and long-term postoperative outcomes for ultralow rectal carcinoma.     

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??Localizing and qualitative diagnosis of papillary microcarcinoma of thyroid by ultrasound ZHAO Jing-zhu??GAO Ming??ZHANG Sheng??et al. Department of Thyroid & Neck Tumors??Tianjin Medical University Cancer Institute & Hospital??Key Laboratory of Cancer Prevention and Therapy,Tianjin 300060??China
Corresponding author??GAO Ming??E-mail??tijgaom@163.com
Abstract Objective To appreciate the value of ultrasonography in the diagnosis of papillary microcarcinoma of the thyroid. Methods Data of 92 cases of papillary microcarcinoma of the thyroid was analyzed for ultrasound characteristics and diagnosis. Results The nodules were graded by TI??RADS. Papillary microcarcinoma of the thyroid can be diagnosed according to features detected by ultrasound??including hypo-echo tubercle??microcalcification??irregular and indefinite border??with an accuracy rate of 89.1%.Two-dimensiona and high-frequency sonography is helpful to localizing and qualitative diagnosis of papillary microcarcinoma. Conclusion Ultrasonography has a very important effectiveness for localizing and qualitative diagnosis of papillary microcarcinoma??which provid the valuable diagnostic evidence to the individual therapy.     

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溃疡病的发病率在高峰时期曾高达人群的 1 0 % ,但近30年来不断下降 ,尤以十二指肠溃疡 (ＤＵ)最为明显 ,致使与胃溃疡 (ＧＵ)之比由原来 1 0∶1降至 <2∶1。有人将发病率陡降归功于Ｈ2 受体拮抗剂高疗效的结果 ,但流行病学调查表明早在此类药物问世的十几年前 ,ＤＵ的发病率已开始下降。近年应用的Ｈ2 受体拮抗剂及质子泵抑制剂治疗ＤＵ的疗效甚佳 ,但停药后 1年复发率却高达 5 0 %～ 80 % ,需要再治或长期半量维持。而且 5 %～ 1 0 %的病例无论何种药物均不能使溃疡愈合 ,成为难治性溃疡 (ｒｅｆｒａｃｔｏｒｙｕｌｃｅｒ)。因此目前ＤＵ…     

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??The prophylactic and management strategy for the biliary injury after hepatectomy SHEN Feng, YAN Zhen-lin. Eastern Hepatobiliary Surgery Hospital, the Second Military Medical University, Shanghai 200438, China
Corresponding author: SHEN Feng, E-mail:shenfengdfgd@yahoo.com.cn
Abstract Biliary injury is a major complication in the process of hepatectomy. The clinical manifestation of biliary injury is quite different from that from cholecystectomy. The main presentations of biliary injury after hepatectomy are bile leakage, obstructive jaundice and biliary bleeding. The biliary injury is strongly associated with the type of the hepatectomy procedure, especially when the resection of the liver is associated with the segment 4. When the lesion is located in segment 4, careful preoperative preparations is a must, asking for the careful interpretation of the imaging data. Preoperative ultrasonography is recommended for its convenience of usage and will be helpful for the selection of the cutting surface of the hepatic lesion. Bile leakage is the most commonly seen after hepatectomy, and the drainage is the first choice for patients in case of bile collection in the abdominal cavity or even abscess formation. Biliary decompression is recommended when the bile leakage is suspected or documented. Surgery is indicated for some patients when the bile drainage is cut from the intestinal passage or the mechanic obstruction is overt.     

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??Laparoscopic radical gastrectomy for gastric stump carcinoma: a report of 14 cases QIAN Feng, YU Pei-wu,SUN Gang, et al. Department of General Surgery, Center of Minimal Invasive Gastrointestinal Surgery, Southwest Hospital, the Third Military Medical University, Chongqing 400038, China Corresponding author: YU Pei-wu, E-mail: yupeiwu01@sina.com Abstract Objective To investigate the techniques and results of laparoscopic radical gastrectomy for gastric stump carcinoma (GSC). Methods The clinical data of 14 cases of GSC admitted between July 2006 and July 2009 at the Southwest Hospital of the Third Military Medical University were analyzed retrospectively.Laparoscopic total gastrectomy were applied successfully in all the cases. The way, method ,difficulty and main points of the operation were analyzed. Moreover, its clinical results were evaluated. Results Eleven cases were completed successfully with laparoscopic radical gastrectomy, 2 cases with laparoscopic palliative gastrectomy and 1 case transfered to open surgery. Average operative time was (210±25)mins. Average blood loss was (110±40)mL and average number of lymph nodes dissected was 17.5±5.0. Gastric tube was not detained routinely after the opetation. Average postoperative time to passing flatula was??2.5±1.0??d. The start of oral liquids was??2.5±1.0??d. The patients began to get out of bed at (3.0±0.5)d. Infection of incision occurred in 1 case postoperatively. The time to follow up was 6 to 36 months. Three patients were dead, 1 case with hepatic metastasis, 1 case with peritoneal metastasis and 1 case with dermatitis glandularis erythematosa. The other 11 cases were still in survival. Conclusion It is feasible for laparoscopic gastrectomy in the treatment for GSC. Compared with open surgery, laparoscopic radical gastrectomy for GSC is assioated with less invasivion and faster recovery. Furthermore, it has received better short-term results.     

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目的 总结380例小肝癌（≤5cm）手术切除的效果。方法 1964－1999年共切除小肝癌380例。289例为不规则肝切除术,91例为简化肝切除术。结果 380例小肝癌术后5年生存率为57．3％,＜3cm为59．4％,3－5cm为51．4％,不规则肝切除术为52．3％,简化肝切除术为62．5％,再次肝切除术为24．7％。术后3年复发率为39．2％。结论 对左叶或表浅和肝边缘的小肝癌作为规则肝切除术;以中央型、有包膜、深在小肝癌作简化肝切除术、手术切除效果满意。