改良睑黄色瘤切除手术的观察

目的 观察改良睑黄色瘤切除术的应用效果。方法 选择病灶〈10mm以下的瘤体为手术观察对象，共22例（38眼）。按超皮损病灶边界1mm设计切口缘，梭形切除病灶，深达真皮层，在显微镜下清除皮下组织及切缘脂肪组织，松解切口边缘皮肤，连续皮内缝合切口。另外，酌情行上睑松弛矫治术。结果 失访2例（2眼），随访20例（36眼）6—12个月，未见黄色瘤复发，切口平整，痕迹隐约。结论 采用改良睑黄色瘤切除术更会增强眼睑形态美感。     

经尿道前列腺电切气化术治疗前列腺增生568例报告

目的 :进一步探讨前列腺增生 (BPH)的有效手术新方法。方法 :采用经尿道前列腺电切术和气化术治疗BPH患者 5 6 8例。结果 :疗效满意 ,术后 3～ 6个月随访 ,国际前列腺症状评分 (IPSS) 8.5± 1.5分 ;最大尿流率 (Q max) 2 0 .5± 4 .5ml s,剩余尿量 2 9.1± 14 .2ml,未出现严重并发症。结论 :将电切和气化相结合行经尿道前列腺切除术是一种安全性高、并发症少、疗效确切的新手术方法 ,具有操作易掌握、出血少、速度快、安全可靠等优点。     

Self-expandable metallic stents in the treatment of post-esophagogastrostomy/post-esophagoenterostomy fistula

Esophageus or gaster resection in patients with malignant disease is still a treatment of choice. It is obvious that each surgical procedure in these patients carries some possibility of complications. Esophageo-gastric or esophageo-jejuno anastomosis has a 4-27% frequency of fistula occurrence. All these result in 65% mortality in cases of poorer prognosis. The aim of this paper is not to present all types of complications but to objectively analyse the usefulness of the covered stent placement in the treatment of anastomotic fistulas. We present six patients who were treated for postoperative fistula of esophageo-gastric anastomosis (1 case) or esophageo-jejuno anastomosis (5 cases). All patients were treated with stapler suture for digestive tract reconstruction after malignancy removal during the primary surgical procedure. Signs and symptoms of suture leak between 5-8 days post-surgery were observed. Conservative therapy was not effective. Thus a new method of treatment was employed - covered stent placement. The procedure was performed under X-ray control. In all treated patients there was change for the better and quick reduction of secretion from the fistulas was observed. All patients were discharged from the department after several days and all had survived at 30 days follow-up. Covered esophageal stent placement seems to be a safe and promising method of treatment for patients with anastomotic fistula which significantly reduces mortality and improves quality of live. Our experiences confirms that of other investigators.     

Laparoscopic Local Resection Based on Sentinel Node Evaluation for Early Gastric Cancer: A Preliminary Report

We previously reported that lymphatic mapping using isosulfan blue can be used to identify sentinel nodes (SNs). This study was undertaken to evaluate the feasibility of using the SN technique in treating early gastric cancer and to explore its usefulness for minimal invasive surgery. Twenty-three patients with early gastric cancer who underwent SN biopsy were retrospectively evaluated. Based on SN evaluation, individualized surgery was performed in five patients with T1N0M0 gastric cancer. When pathological examination of frozen sections revealed metastasis in SNs, we performed a standard D2 gastrectomy. Laparoscopic local resection was applied when the SN biopsy was negative. Our results showed that the success rate with SN biopsy in early gastric cancer was 100%, as were the accuracy, sensitivity, and specificity. All five patients with early gastric cancer had SNs negative for metastases both by frozen section and by postoperative pathology. Thus, all these patients underwent laparoscopic local resection without extended lymphadenectomy. We conclude that SN biopsy is a useful tool to individualize the operative procedure, and laparoscopic local resection can be safely performed using SN guidance in selected patients with early gastric cancer.     

Quality of life after total mesorectal excision for rectal cancer

BACKGROUND: After total mesorectal excision for rectal cancer, many surgeons try to avoid an abdominoperineal resection (APR) by performing a transanally double stapled low colo-rectal anastomosis (LRA), frequently without a pouch. This policy is mainly based on the assumption that the quality of life after such LRA is higher than after APR. It has been suggested that a better functional outcome and therefore a higher quality of life might be achieved by a colo-anal J-pouch anastomosis (CPA). The aim of this study was to assess quality of life among disease-free survivors after APR, LRA and CPA. METHODS: The charts of 301 consecutive patients who had undergone surgery for cancer in the middle or lower third of the rectum were analysed. Two hundred four patients were eligible for inclusion. The quality of life among these patients was assessed using one generic (EQ-5D) and two disease-specific questionnaires (EORTC QLQ-C30 and EORTC QLQ-CR38). RESULTS: The response rate was 82%. The median follow-up was 31 months. Overall, quality of life was good but CPA patients had better quality of life scores than APR and LRA patients. This difference was not only due to the better functional outcome but also to the lower incidence of disturbed micturition and sexual problems in the CPA group. CONCLUSION: The quality of life after colo-anal J-pouch anastomosis is better than after abdominoperineal resection (APR) and low colo-rectal anastomosis (LRA). The quality of life after APR is similar to that after LRA.     

Calcium absorption following small bowel resection in man. Evidence for an adaptive response

Seventeen patients who had undergone extensive small bowel resection were studied for calcium absorption (FACa) and plasma vitamin D metabolites. FACa was measured by a double radio-tracer technique and expressed as percentage of total oral dose. FACa was decreased compared with controls (34%, range: 3-46 v 65%, range: 57-73, P less than 0.01). A positive correlation (r = 0.49, P = 0.05) was found between FACa and the remaining length of small bowel (SBL). As wide variations in both SBL and duration after surgery were observed among the seventeen investigated patients, we were led to individualize less heterogeneous subgroups of patients. Better correlations were found when the patients were divided into two subgroups according to whether the time interval between the resection and the investigation was shorter (r = 0.75, n = 11, P less than 0.02) or longer (r = 0.89, n = 6, P = 0.05) than 2 years. In thirteen patients who had a SBL shorter than 100 cm, a positive correlation was observed between FACa and the time interval after surgery (months): r = 0.65, P less than 0.05. Plasma 1,25 (OH)2D was markedly reduced in the whole group (31 pmol l-1, range: 8-108) compared with controls (103 pmol-1, range: 59-134, P less than 0.01). The present study shows that in extensively small bowel resected patients, calcium absorption is reduced, the alteration being dependent both on the length of the remnant small bowel and on the time after surgery.(ABSTRACT TRUNCATED AT 250 WORDS)     

Surgical approach after failed enteryx injection for GERD.

OBJECTIVE: We report on 3 patients who underwent laparoscopic antireflux procedures for persistent symptoms of GERD after biopolymer injection. METHODS: Experienced laparoscopic surgeons completed all 3 procedures laparoscopically. In 2 patients, there was an extramural extravasation of the polymer outside and adherent to the esophageal wall. In these patients, a partial posterior fundoplication was used. The third patient, who had the polymer material deposits removed preoperatively by endoscopic mucosal resection, underwent a Nissen fundoplication. RESULTS: Postoperative recovery was uneventful in all cases. At follow-up of 6 to 12 months, all patients were symptom free, off medical therapy, and experiencing no dysphagia. CONCLUSION: Surgical therapy for patients after failed biopolymer injection is safe and effective. The choice of surgery may depend on whether the polymer mass can be removed preoperatively.     

急性梗阻的左半结肠癌Ⅰ期切除吻合体会

目的探讨左半结肠癌急性梗阻Ⅰ期切除吻合的Ⅰ临床应用价值。方法对1988年1月至2006年12月24侧实施左半结肠癌急性梗阻Ⅰ期切除吻合手术患者的资料进行回顾性总结。结果24例均未发生吻合口漏，仅3例发生切口感染，经局部换药处理Ⅱ期愈合。结论积极的术前准备、术中彻底的肠减压能为左半结肠癌急性梗阻Ⅰ期切除吻合提供安全保证.     

Treatment strategy for synchronous metastases of colorectal cancer: is hepatic resection after an observation interval appropriate?

Background In cases of synchronous colorectal hepatic metastases, the primary colorectal cancer strongly influences on the metastases. Our treatment policy has been to conduct hepatic resection for the metastases at an interval of 3 months after colorectal resection. We examined the appropriateness of interval hepatic resection for synchronous hepatic metastasis. Materials and methods The subjects were 164 patients who underwent resection of hepatic metastasis of colorectal cancer (synchronous, 70 patients; metachronous, 94 patients). Background factors for hepatic metastasis and postoperative results were compared for synchronous and metachronous cases. Results The cumulative survival rate for 164 patients at 3, 5, and 10 years postoperatively was 71.9%, 51.8%, and 36.6%, and the post-resection recurrence rate in remnant livers was 26.8%. Interval resection for synchronous hepatic metastases was conducted in 49 cases after a mean interval of 131 days. No difference was seen in postoperative outcome between synchronous and metachronous cases. Conclusion The outcome was similarly favorable in cases of synchronous hepatic metastasis and in cases of metachronous metastasis. Delaying resection allows accurate understanding of the number and location of hepatic metastases, and is beneficial in determining candidates for surgery and in selecting surgical procedure.