腹腔镜根治性切除治疗肝门部胆管癌15例分析

目的 探讨腹腔镜根治性切除治疗肝门部胆管癌的可行性及安全性。方法 回顾性分析2013年5月至2018年5月在川北医学院附属医院行根治性手术治疗并经病理学检查证实的15例肝门部胆管癌病人的临床资料，分析术中及术后情况，并随访观察。结果 15例肝门部胆管癌病人中13例行完全腹腔镜手术，2例病人中转开放手术。手术时间为（404.3±62.8）min，术中出血（502.0±133.8）mL，术后住院时间为（9.6±2.7）d，术后首次排气时间为（3.2±0.8）d。术后淋巴结检出数目为（9.5±2.6）枚，1例发现N2淋巴结转移。术后发生胆漏1例，大量腹腔积液1例，切口脂肪液化1例，均经保守治疗后好转出院。所有病人均获得随访，截至2018年5月，随访时间为6～60个月，死亡4例。结论 通过术前充分评估及术中探查制定相应手术策略，并且在严格掌握手术适应证的前提下，由具备丰富腹腔镜手术经验的医生主持操作，腹腔镜技术应用于肝门部胆管癌病人相对安全、可行。     

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??Value of molecular testing technique in diagnosis and management of thyroid nodule LIU Xiao-li??LI Fang??SUN Hui. Department of Thyroid and Parathyroid Surgery??China-Japan Union Hospital??Jilin University & Jilin Provincial Key Laboratory of Surgical Translational Medicine??Changchun 130033??China
Corresponding author??SUN Hui??E-mail??sunhui1229@163.com
Abstract Thyroid cancer is one of the few cancer disease has been epidemic with rising incidence worldwide. The main diagnostic methods are ultrasound and ultrasound-guided fine needle aspiration (FNA). The coincidence rate of ultrasound and pathology diagnosis ranges from 60% to 90%. There are significant difference between different doctors and hospitals. The current guidelines recommend FNA as the gold standard to evaluate nodules. However??there are 20%—25% cytologically indeterminate thyroid nodules??which likely cannot be discriminated due to technical limitations of FNA. With the significant progress of the pathogenesis of thyroid cancer based upon molecular biology aspects and rapid development of molecular testing techniques??the diagnosis??prognosis and treatment have gotten remarkable improvement. The development of the technologies is expected to make up for the deficiency of FNA??tailor the preoperative risk stratification??optimize the initial treatment options??and then balance oncologic concerns with quality of life considerations.     

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??Surgical outcomes after laparoscopic-assisted radial total gastrectomy for Siewert type ?? and type ??adenocarcinoma of the esophagogastric junction CHEN Qi-yue??LÜ Chen-bin??ZHENG Zhao-hui, et al. Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou 350001, China
Corresponding author: HUANG Chang-ming, E-mail??hcmlr2002@163.com
Abstract Objective To investigate the oncologic efficacy of laparoscopic-assisted radial total gastrectomy ??LATG?? for Siewert type ?? and ?? adenocarcinoma of the esophagogastric junction (AEG). Methods The clinicopathalogical data of 418 patients with Siewert type ?? and ?? AEG who had undergone radical total gastrectomy between December 2008 and June 2013 in Fujian Medical University Union Hospital were analyzed retrospectively. The short and long term outcomes were compared between the LATG (n=342) and opened radial total gastrectomy ??OTG?? (n=76) groups. Results The clinicopathological characteristics between the two groups had no statistical difference. LATG compared with OTG was associated with shorter operative time??less blood loss??shorter time to the resumption of a semi-fluid diet and shorter hospital stay. However, postoperative complication rates between the two groups had no significant difference. The 3-year overall survival rate in the LATG group was significantly higher than that in the OTG group (71.1% versus 61.1%??P=0.033). In stratified analysis according to Siewert classification??the LATG group demonstrated significantly higher 3-year overall survival rate (79.5%versus 69.1%??P=0.010) for Siewert type ?? AEG compared with the OTG group??however??in the Siewert type ?? AEG subgroup??the 3-year overall survival rates were similar (P=0.315). COX proportional hazards regression model indicated that the surgical approach and TNM stage were independent prognostic factors affecting the whole group??P<0.05??. Conclusion LATG is a safe and feasible procedure with better short-term outcomes for Siewert type ?? and ?? AEG. For Siewert type ?? AEG particularly??LATG may yield better long-term survival.     

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??Re-operation for papillary thyroid carcinoma after radiofrequency ablation therapy: A clinical analysis of 5 cases DONG Wen-wu??ZHANG Hao??ZHANG Ping??et al. Department of Thyroid Surgery??the First Affiliated Hospital of China Medical University??Shenyang 110001??China
Corresponding author??ZHANG Hao??E-mail??haozhang@mail.cmu.edu.cn
Abstract Objective To investigate the treatment of papillary thyroid carcinoma (PTC) after radiofrequency ablation (RFA). Methods The clinical data of 5 cases of PTC after RFA from November 2014 to January 2015 in the Department of Thyroid Surgery??the First Affiliated Hospital of China Medical University were studied retrospectively. Results There were 3 cases of single lesion and 2 cases of multiple lesions in bilateral lobes. The mean tumor size was 1.76 cm (range 0.4??3.0 cm). Two cases received unilateral thyroid lobectomy plus isthmusectomy with ipsilateral central lymph node dissection (CLND). One case received total thyroidectomy with unilateral CLND. One case received total thyroidectomy with bilateral CLND and 1 case received total thyroidectomy with bilateral CLND and unilateral modified lateral lymph node dissection. All cases were diagnosed as PTC by routine histopathology. There were 4 cases of central lymph node metastasis in which 1 case of lateral lymph node metastasis. There was no complications??but temporary hypoparathyroidism in 1 case. Conclusion The indications for RFA should be grasped strictly. Early operations for PTC after RFA should be performed by an experienced surgeon??given that local tissue adhesion was obvious.     

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??Learning curve of laparscopic resection in rectal cancer for experienced surgeon ZHU Xiao-ming??LOU Zheng??GONG Hai-feng??et al. Department of Colorectal Surgery??Changhai Hospital??the Second Military Medical University??Shanghai 200433??China
Corresponding author??ZHANG Wei??E-mail: weizhang2000cn@163.com
Abstract Objective To investigate how experienced surgeons in open surgery can quickly learn laparscopic resection for rectal cancer. Methods The clinical data of 120 cases of laparscopic resection for rectal cancer performed by the same team of surgeons from August 2009 to April 2015 in Changhai Hospital of the Second Military Medical University were analyzed retrospectively. The cases were divided into three groups (40 cases in each group) by operative sequence. The time span was 36, 19, 11 months respectively. The operating time??blood loss??the rate of conversion to open operation??number of lymph nodes??the integrityof mesorectum??postoperative aerofluxus time??postoperative hospital stay and the rate of postoperative complications were compared among the 3 groups. Results The operating time in group A was ??162.9±36.7??min??which as much higher than that in group B ??147.0±36.8??min and group C (132.7±31.9)min (P<0.05). However??there was no significant difference between group B and C (P>0.05). Intraoperative blood loss??the rate of conversion to open operation and postoperative hospital stay in group A had no significant difference compared with those in group B and C (P??0.05). Also??there was no significant difference in the integrity of mesorectum??number of lymph nodes??postoperative aerofluxus time and the rate of postoperative complications among 3 gourps ??P>0.05??. Conclusion From the learning curve??surgeons with rich experience in open surgery can learn laparscopic skills for rectal cancer after performing 40 cases.     

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??Relationship between central lymph node ratio and the lateral lymph node metastasis in papillary thyroid microcarcinoma GUO Kai, GUAN Qing, LI Duan-shu, et al. Department of Head and Neck Surgery, Fudan University Shanghai Cancer Center; Department of Oncology, Fudan University Shanghai Medical College, Shanghai 200032, China
Corresponding author: WANG Zhuo-ying, E-mail:zhuoyingwang@hotmail.com
Guo Kai and Guan Qing contributed equally to this work
Abstract Objective To explore the relationship between cLNR (Central Lymph Node Ratio) and the LLNM (Lateral Lymph Node Metastasis) in papillary thyroid microcarcinoma. Methods This study retrospectively examined 859 patients with PTMC (Papillary Thyroid Microcarcinoma) in our hospital from Jan 2006 to Dec 2014.We analyzed the relationship between cLNR and LLNM/recurrence. Results In the patients with suspected positive lateral cervical lymph node metastasis (cN1b+), we detected significant association between cLNR stratification, positive lymph node numbers and LLNM. Otherwise, there’s no significant difference between cLNR and recurrence in the patients with cN1b- disease, but lateral cervical recurrence obviously increased when positive number of central lymph node more than 3. Conclusion There existed certain correlation between cLNR, metastatic numbers and LLNM.     

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??Comparation between blood vessel suture instrument and traditional surgical suture in EVAR surgery for abdominal aortic aneurysm: An analysis of 130 cases ZHANG Zheng, CHEN Zhong, TANG Xiao-bin, et al. Beijing Anzhen Hospital ??Capital Medical University, Beijing 100029, China
Corresponding author??CHEN Zhong, E-mail??chenzhong8658@vip.sina.com
Abstract Objective To investigate the application of the Perclose Proglide vascular closure devices in the endovascular abdominal aortic aneurysm repairing operation and its significance. Methods The clinical data of 130 cases of endovascular abdominal aortic aneurysm repairing operation performed between March 2013 and February 2015 in Department of Vascular Surgery??Beijing Anzhen Hospital of Capital Medical University were analyzed retrospectively. Among them, 69 cases were treated with Perclose Proglide vascular closure devices to suture the puncture site of the femoral arteries and 61 cases were treated with the traditional surgical suture to close the puncture site of the femoral arteries. The relationship between the two groups and various clinicopathological factors of patients with abdominal aortic aneurysm were analyzed by Chi-square using statistical software SPSS17.0. The clinicopathological factors include operation successful rate??operation time??intraoperative blood loss??hospital stay??cost of operation??wound healing??lower limb ischemia and so on. Results Analysis using chi-square showed that Perclose Proglide vascular closure devices group was obviously better than the other group in operative time, intraoperative blood loss and hospital stay (P<0.05). Conclusion Comparing with the traditional surgical suture method??Perclose Proglide vascular closure devices are safe and effective. The patients have less injury and can recover more quickly??The Perclose Proglide vascular closure devices are worthy of clinical popularization??     

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??MT01 is a single-stranded oligodeoxynucleotide??ODN??which is designed based on human mitochondrial DNA sequences. It has immune activity of selective negative regulator. Several studies have shown that MT01 has a significant effect in suppressing excessive immune reaction caused by pathogens infection??and it also inhibits the absorption of alveolar bone and promotes osteoblast cell activation. Inflammation and bone resorption are the nature of periodontal diseases. Here we review the latest research progress of MT01 and its related research in periodontitis.