�ȳ��ǺϿ���Ĥ���������ٴ���Ч�о�

??A comparative study of omentum wrapping in pancreaticojejunostomy for reducing postoperative pancreatic fistula XU Jie-ru*??CHEN Chao??SHEN Ning-jia??et al. *Medical College of Soochow University??Suzhou 215000??China
Corresponding author: ZHANG Yong-jie, E-mail: yjoy005@sina.com
Abstract Objective To investigate the efficacy of the omentum wrapping technique in pancreaticojejunostomy on decreasing the incidence of pancreatic fistula after pancreaticoduodenectomy. Methods The clinical data of 225 patients underwent pancreaticoduodenectomy and pancreaticojejunostomy in single operation group from January 2009 to October 2015 in No.2 Department of Biliary Tract Surgery, Eastern Hepatobiliary Surgery Hospital Affiliated to the Second Military Medical University were analyzed retrospectively. Patients were divided into two groups??including group with omentum wrapping technique (n=125) and control group without it (n=100). After propensity score matching??the rates of pancreatic fistula were compared between the two groups??including group with omentum wrapping technique (n=64) and control group without it (n=64). Results All operations were completed successfully. The overall complication rate of all 225 patients was 62.7%??141/225??. The reoperation rate was 2.7%??6/225??. The mortality is 2.7%??6/225??. The incidence of pancreatic fistula was 46.7%??105/225????including 61 cases of Class A??37 cases of Class B??and 7 cases of Class C. The incidence of bleeding was 11%??25/225??. The incidence of DGE was 24.9%??56/225??. The incidence of abdominal infection was 20.9%??47/225??. Except the incidence of pancreatic fistula??there was no statistical difference between the two groups in the incidence of bleeding??DGE and abdominal infection??P>0.05??. In the omentum wrapping group, no reoperation case occurred??and there were only 2 death cases. In the control group??there were 4 reoperation cases and 4 death cases. There was no significant difference between the two groups in those data??P=0.119, 0.680??. In the PSM model??soft pancreas??pancreatic duct diameter and omentum wrapping were related to the postoperative pancreatic fistula in single factor analysis. In the multiple factors analysis??pancreatic duct diameter <3 mm and no omentum wrapping were independent risk factors for pancreatic fistula. Conclusion The omentum wrapping technique can decrease the rate of pancreatic fistula and it is worth applying in pancreaticojejunostomy.     

Ѫ˨�����������������ǻ��������Ч�о�

??Surgical and endovascular treatment of thromboangiitisobliterans LIU Bing, HUANG Ren-ping. Department of Vascular Surgery, the First Affiliated Hospital of Harbin Medical University, Harbin 150001, China
Corresponding author: HUANG Ren-ping, E-mail: cup521@163.com
Abstract Objective To investigate the outcomes of surgical and endovascular treatment for thromboangiitisobliterans. Methods The clinical data of 202 patients with thromboangiitisobliterans underwent surgical and endovascular treatment in the First Affiliated Hospital of Harbin Medical University from April 2006 to April 2015 were analyzed retrospectively. According to the outcomes of ankle brachial index (ABI) and the Rutherford classification value (R-value), the effectiveness of different operation methods were evaluated. Results The Rutherford classification value evaluation??One month after operation, R-value decreasedin all 4 groups??P<0.05??. Six months after operation, R-value decreased in lumbar sympathectomy group, sequential endarterectomy group and sequential endarterectomy combined with lumbar sympathectomy group??P<0.05??. Twelve months after operation, R-value decreased in sequential endarterectomy group and sequential endarterectomy combined with lumbar sympathectomy group??P<0.05??.ABI evaluation??One week after operation,ABI increased in all 4 groups ??P<0.05??. Six months after operation, ABI increased in sequential endarterectomy combined with lumbar sympathectomy group??P<0.05??. Twelve months after operation, ABI increased in sequential endarterectomy group and sequential endarterectomy combined with lumbar sympathectomy group??P<0.05??. Conclusion Percutaneous transluminal angioplasty (PTA) and lumbar sympathectomy can bring benefit to the patient with TAO in the short term. Sequential endarterectomy combined with or without lumbar sympathectomy are proved to be effective as a surgical method for TAO.     

�����Ը�����ѪҺ�˹��������ظ�Ⱦ������ٹ����ϰ��ۺ�����Ч����ȫ���о�

目的 观察连续性高流量血液滤过(HVHF)治疗严重感染伴有多器官功能障碍综合征(MODS)的临床疗效及安全性.方法 2005-2007年中国医科大学附属第一医院收治的20例确诊为产重感染伴有MODS的病人,平均APPACHEⅡ评分为23.8±8.3,平均SOFA评分为10.6±4.0,在常规治疗的基础上应用HVHF治疗至少3d,血流速度250mL/min,超滤量4L/h,置换液以前稀释方式输入,普通肝素抗凝,每24h更换滤器1次.比较治疗前后病人生命体征、血清尿素氮、肌酐、胆红素、动脉血乳酸、血小板、氧合指数及APPACHEⅡ评分和SOFA评分的变化,并监测治疗过程中的并发症.结果 20例病人在HVHF治疗后生命体征迅速稳定,体温、心率、呼吸频率降低,平均动脉压上升,血清尿素氮、肌酐水平下降,动脉血乳酸降低,血小板计数升高,氧合指数改善,APPACHEⅡ评分及SOFA评分降低,与治疗前相比差异具有统计学意义(P＜0.05),血清胆红素水平在治疗后来见明显改善.治疗过程中病人未见严重的离子及酸碱紊乱及其他并发症的发生.结论 连续性HVHF治疗能够降低严重感染伴有MODs病人的全身炎性反应,改善器官功能水平,未见严重并发症的发生,安全有效.     

���ܸ�Ԥ�������Խ᳦��������ЧӰ���о�

??Effect of empowerment intervention on ulcerative colitis patients’ anal function and quality of life after ileal pouch-anal anastomosis GAO Sen-yang??ZHANG Ying-ying??LI Kai-yu??et al. Department of General Surgery, Tianjin Medical University General Hospital??Tianjin 300052??China
Corresponding author??LIU Gang??E-mail??landmark1503@sina.com
Abstract Objective To investigate the effect of empowerment intervention on ulcerative colitis (UC) patients’ anal function and quality of life after ileal pouch-anal anastomosis (IPAA??and provide gist for clinical intervention. Methods Sixty patients with UC who underwent IPAA between January 2010 and September 2014 in Department of General Surgery, Tianjin Medical University General Hospital were invited as the intervention group and the control group randomly??which received empowerment intervention and traditional health education respectively. Six months after intervention?? the patients’ anal function and stool form by the 24 hours and night defecation??Kirwan grade??Bristol stool form scale were evaluated. Before and after the intervention of 6 months??serum total protein (TP), prealbumin (PA), albumin (ALB) and transferrin (TRF) were usd to assess patients’ nutritional status, assess the patients’ quality of life by the Inflammation Bowel Disease Questionare (IBDQ). Results Six months after empowerment intervention??24 hours and night defecations of intervention group were better than those of control group ??24h:??4.3±1.5??vs. (5.9±2.4); night:??1.6±0.7??vs. (2.3±1.3)??all P<0.05??. The number of patients in intervention group were 21 in grade ??(Kirwan classification)??7 in grade??2 in grade ??and the control group were 14 in grade ??12 in grade ??4 in grade ??χ2=3.380??P>0.05??. The number of patients in intervention group were 20 in type four (Bristol stool form scale)??6 in type five??4 in type six ??and the control group were 11 in type four??17 in type five??2 in type six ??χ2=8.540??P<0.05??. In intervention group??ALB levels were elevated ???47.4±5.8??g/L vs. ??43.3±6.5??g/L??P<0.05????. The IBDQ scores of intervention group are higher than those of control group (P<0.05). Conclusion Empowerment intervention may improve the anal function and stool form of UC patients after IPAA and enhance the quality of their life.     

���ӱ������Ԥ�����ٰ��컷���¸���������Ч��ֵ�о�

??Expression of molecular markers predict breast cancer to neoadjuvant anthracycline chemotherapy value CHEN Yi-zuo*, CHEN Can-ming, FEI Fei, et al. *Department of Breast Surgery, Fudan University Shanghai Cancer Center,Shanghai 200032, China
Corresponding author: WU Jiong, E-mail??wujiong1122@vip.sina.com
Abstract Objective To investigate the predictive value of biological markers for responsiveness to anthracyline-based regimen in neoadjuvant systemic therapy for local advanced breast caner. Methods Postoperative paraffin-embedded tumor samples from 420 breast cancer patients admitted between January 2000 and December 2010 in Department of Breast Surgery of Fudan University Shanghai Cancer Center were examined for expression of ER, PR, Her-2/neu and other 15 markers by immunohistochemistry, to analyze the predictive value of the biological markers for response to neoadjuvant chemotherapy. Results Negative p53, cathepsin-D and loss of GSTπwere significantly predictive for an effective response to anthracycline-based neoadjuvant chemotherapy. In multivariate logistic regression analysis, the GSTπand p53 status were found with independent predictive value. Conclusion Loss of GSTπand p53 independently predict the response to anthracycline-based regimen.     

���Ը����������붯��Ӳ���Ը����������ٴ��ص㼰Զ����Ч�����о�

??Case-control study on clinical features and long term effect of inflammatory abdominal aortic aneurysm in comparison with atherosclerotic abdominal aortic aneurysm WANG Shao-ye, ZHANG Jian, YIN Ming-di, et al. Department of Vascular Surgery, the First Hospital, China Medical University, Shenyang 110001, China
Corresponding author: ZHANG Jian, E-mail: jianzhang_cmu@yahoo.com.cn
Abstract Objective To analyze clinical features and long term effect of inflammatory abdominal aortic aneurysm (iAAA). Methods Between 1988 and 2008, 412 cases of AAA in the First Hospital of China Medical University were performed elective surgical operations. Eleven (2.7%) of them were diagnosed as iAAA. The former group was matched in a case control fashion to a group of 33 patients with aAAA with similar characteristics of age, gender and preoperative risk factors. All available clinical, pathologic and postoperative variables were reviewed retrospectively, and the two groups were compared. Results In comparison with aAAA, patients with iAAA were more symptomatic significantly (100% vs. 42.4%, P=0.001) and had larger aneurysm size on admission ??(7.4±0.7)cm vs. (6.3±0.9) cm??P=0.006??, and preoperative erythrocyte sedimentation rate was found to be elevated significantly ??(44.5±9.1)mm/h vs. (11.4±5.4)mm/h??P<0.05??. Surgical morbidity and mortality rates did not differ between two groups. The operation time of patients with iAAA was longer than patients with aAAA significantly ??(308±36)min vs. (224±46)min, P<0.05??, and cross-clamp time was similar in both groups??(41.5±6.2) min vs. (41.8±6.2)min, P= 0.92??. A five-year survival rate analysis showed no significant difference between two groups (P=0.711) . Conclusion Despite the more symptomatic, larger size and long operation time of iAAA, iAAA can be treated with low morbidity and mortality similar as aAAA now. Long term effect of iAAA is of no difference from aAAA.     

��׼������Ƽ����봫ͳ�������Ƶ��Ұ��ٴ���Ч�Ա��о�

??Comparative study of clinical efficacy of precision biliary surgical technique and traditional surgery for gallbladder carcinoma LI Mao-lan, ZHU Yi-di, WU Xiang-song, et al. Department of General Surgery, Xin Hua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200092, China
Corresponding author??LIU Ying-Bin??E-mail??laoniulyb@163.com
Abstract Objective Discuss the value and clinical applications of precise biliary surgery theory and technology in gallbladder tumor resection.Methods The clinical data of 97 patients with gallbladder cancer who received radical cholecystectomy in XingHua Hospital, Shanghai Jiao Tong University School of Medicine from January 2000 to June 2015 were retrospectively analyzed??All the patients were divided into 2 groups??38 patients who were admitted from January 1986 to December 2006 were in the traditional surgery group??and 59 patients who were admitted from January 2011 to June 2015 were in the precision surgery group??The perioperative condition and prognosis of the patients in the 2 groups were compared??Results There were no significant differences in the clinicopathological characteristics, such as gender, age, histological grade, the TNM stage, median volume of intraoperative blood loss and duration of postoperative hospital stay between the two groups. The ratios of extended radical operation were 35.5??(21/59)in the precision surgery group, and 15.6%(6/38)in the traditional surgery group??with significant difference between the 2 groups(χ2=4.513??P<0.05)??Patients in the precision surgery group had significantly higher R0 resection rate (66.1% vs. 18.4??, P??0.05) and median dissected lymph node number (26.0±12.1 vs. 17.0±9.1, P??0.05).The median survival time was 19.2 months in patients in the precision surgery group??and the 1- and 3- year survival rates of patients were 62.7%??28.8% respectively. The median survival time was 9.9 months in patients in the traditional surgery group??and the 1- and 3- year survival rates of patients were 42.1%??7.89% respectively. There was a significant difference between the 2 groups. The differences of the median volume of intraoperative blood loss??complication rates??duration of postoperative hospital stay between the 2 groups were notstatistically significant. Conclusion Application of the concept and techniques of precision biliary surgery significantly increase the radical resection rate and improve the therapeutic outcomes.     

Ī��ɳ�ǶԼ�����֢��������Ч���ٴ��о�

??Clinical efficacy and safety of moxifloxacin for acute cholangitis of severe type--A prospective multi-centric study YIN Da-long*, LU Zhao-yang, LIU Lian-xin, et al. *The First Affiliated Hospital,Haerbin Medical University ,Haerbin 150001,China Corresponding author: LIU Lian-xin,E-mail:liulianxin@medmail.com.cn Abstract Objective To investigate the clinical efficacy and safety of moxifloxacin for acute cholangitis of severe type(ACST). Methods In this prospective, single-blind, multi-centric study a total of 50 consecutive patients from January 2008 to June 2008 with ACST were included the current clinical trial. The efficacy and safety of moxifloxacin 400 mg by intravenous infusion once daily were evaluated to treat ACST accompanying surgery or endoscopy. The clinical and bacteriologic response at different intervals after administration were observed, as well as body temperature, leucocytes, alanine aminotransferase, total bilirubin, alkaline phosphate andγ-glutamyltransferase. Results The temperature and leucocytes of 42 in 49 patients were markedly decreased at 3 days after treatment compared to those at admission . There were significant decrease (P<0.01) in alanine aminotransferase, total bilirubin, alkaline phosphate and γ-glutamyltransferase at 3 days comparable with those at admission, respectively. Clinical success rates at test-of-cure were 85.7% (42 of 49) for moxifloxacin. Pathogens were isolated from bile or blood cultures in all patients. Thirty out of 49 patients had positive bile and/or blood cultures, including 11(36.7%) patients with mixed infection with several species. The predominant strains were E.coli (22/49), Klebsiella species (8/49) and Enterococcus species (5/49). Bacterial eradication rates were 83.3%(35/42) for moxifloxacin at 7 days after administration.Conclusion E.coli, Klebsiella species and Enterococcus species were the most common bacteria isolated from bile or blood from patients with ACST and a mixed infection with several species was observed. Moxifloxacin evidently showed high clinical and bacteriological efficacies and safety in the hospitalized patients with ACST.     

�������׸�ǻ����������ֱ�����ٴ���Ч�Ա��о�

??Comparative study of clinical curative effect on reduced incision laparoscopic surgery and multi-incision laparoscopic surgery in rectal cancer ZHANG Qing-tong*, LIU Ya-li, ZHANG Xu, et al. *Department of Colorectal Surgery??Cancer Hospital of China Medical University, Liaoning Cancer Hospital & Institute??Shenyang 110042, China
Corresponding author??SONG Chun??E-mail??songchun1@hotmail.com
Abstract Objective To investigate the short-term and long-term clinical curative effects on redued incision laparoscopic surgery and multi-incision laparoscopic surgery in rectal cancer. Methods A retrospective study of 124 cases of rectal cancer admitted from June 2010 to June 2012 in Liaoning Cancer Hospital was conducted??in which were excluded the cases with high years old and dysfunction of the heart and lung or the other important viscera??and with the distance less than 6 cm from the inferior tumor margin to the anal edge and the rectal cancer of the ??and ??stages. A total of 62 cases proceeded the reduced incision laparoscopic surgery ??reduced incision group?? and 62 cases undergone the multi-incision laparoscopic surgery??multi-incision group??simultaneously. Results Two groups had no statistically significant difference in operative time, intraoperative bleeding, the number of lymph node harvest, the incidence of anastomotic leakage and anus reserved, completeness of specimen, distance to proximal margin,ditance to distal margin, positive rate of circumferencial resection margin (CRM) and distal resection margin (DRM), local recurrence rate, 3-year disease free survival rate, 3-year overall survival rate, etc.( all P??0.05).But the total length of incision??postoperative pain score of the first and the second day??anal exhausting time?? independently walking for the first time between two groups had statistically significant diferences( all P??0.05). Conclusion Reduced incision laparoscopic rectal cancer surgery can decrease the total length of incision, lower postoperative pain degree??shorten anal exhausting time??and improve cosmetic effect. And the kind of approach does not prolong operative time significantly??and the quality of tumor resection??and 3-year disease free survival rate?? 3-year overall survival rate are not inferior to multi-incision laparoscopic surgery.     

�Ź����ܲ��������ٰ��¸���������Ч����Ԥ���ֵ�о�

??Exploration of the value of magnetic resonance imaging in early prediction of tumor response to neoadjuvant chemotherapy in breast cancer XIN Ling*, LIU Wen-qing, XU Ling, et al. *Peking University First Hospital, Beijing 100034, China
Corresponding author: XU Ling, E-mail: xuling_en@126.com
Abstract Objective To explore the value of functional parameters changes in the early prediction of tumor response to neoadjuvant chemotherapy. Methods A total of 151 cases of breast cancer received neoadjuvant chemotherapy and subsequent surgery at Peking University First Hospital from January 2010 to December 2014 were studied retrospectively. Breast MRI examinations were underwent to define the clinical response to the treatment. The enrolled cases were divided into good response (GR) group and minor response (MR) group, and the relationship of MRI parameters changes(ΔD%??ΔADC%??ΔSmax% and ΔTIC) and therapy response was analyzed. A clinical response prediction model logit P based on combined functional parameters was established, and AUCs for therapeutic effect prediction were compared to evaluate prediction efficacy. Result Functional parameters changes (ΔADC%??ΔSmax%??
ΔTIC) after 2 cycles of neoadjuvant chemotherapy were significantly different between 2 groups??P<0.001??.The AUCs for response prediction of ΔD%??ΔADC%??ΔSmax% and ΔTIC were 0.600,0.820,0.807 and 0.786.The AUC for pathological prediction of logit P based on functional parameters was 0.898??95%CI 0.844 —0.953??. Conclusion There is predictive value of functional parameters changes (ΔADC%??ΔSmax% ??ΔTIC) after 2 cycles of neoadjuvant therapy for pathologic response.     

���ٰ���������BD����������Ƥ�»�Һ��Ч�о�

??Clinical research of BD detaining needle for subcutaneous liquid accumulation drainage after breast cancer radical operation NIE Jian-yun, JIANG Ni, LI Bi-xiu, et al. Department of Breast Cancer,the 3rd Affiliated Hospital of Kunming College, Kunming 650118, China Corresponding author: NIE Jian-yun, E-mail:njyvip@sina.com Abstract Objective To study the effect of BD detaining needle for subcutaneous liquid accumulation drainage after breast cancer radical operation. Methods Ninety cases of breast cancer suffering from subcutaneous liquid accumulation after operation between January 2005 and December 2008 at the 3rd Affiliated Hospital of Kunming College were divided into 3 groups.The total volume and days of drainage,time cost of practice,pain and infection of the wound,the direct medical cost,satisfaction of patient were recorded and analyzed. Results The research group showed superiority in the time cost of practice,pain and infection of the wound, direct medical cost and high rate of satisfaction. Compared with control group B, the total volume and days of drainage also decreased.Conclusion BD detaining needle for subcutaneous liquid accumulation drainage is a good choice in decreasing the rate of complication after operation. It can also save time and money.     

�ι��ܲ����������������ڳ�����Ӫ����Ч����ȫ���о�

目的 了解肝功能不良病人术后早期进行肠内营养的疗效及安全性。方法 将２５例肝胆管手术后肝功能不良病人随机分成两组,分别于术后第３天进行肠内和肠外营养,共１０天,观察营养状况、肝功能、电解质、空腹血糖及胃肠道功能的变化。结果 （地）两两 的营养状况及肝功能均明显改善,与术前相比差异有极显著性意义,组间差异无显著性意义。（２）两种营养方法均能纠正由于手术所致的同轻度异常,而血糖无明显影响。（３）肠内营     

����������ƥ����г��������Ͼ���������˨���ٴ���Ч�о�

??Analysis of prognostic predictors affecting hepatectomy combined with postoperative adjuvant TACE in patients with hepatocellular carcinoma??A double-centered propensity-score matching study QU Kai*??GU Jing-xian??CUI Rui-xia??et al. *Department of Hepatobiliary Surgery??the First Affiliated Hospital of Xi'an Jiaotong University??Xi'an 710061??China
Corresponding author??LIU Chang??E-mail??eyrechang@126.com??FAN Hai-ning??E-mail??1486713174@qq.com
Abstract Objective To confirm the clinical effectiveness of postoperative adjuvant transcatheter arterial chemoembolization??TACE?? in HCC patients after liver resection??and further identify the patients who could benefit most from postoperative adjuvant TACE. Methods The clinical data of 593 consecutive patients were retrospectively collected from the First Affiliated Hospital of Xi’an Jiaotong University from January 2005 to December 2016 and the Affiliated Hospital of Qinghai University between January 2011 and June 2017. Propensity score matching (PSM) was used between hepatectomy patients with and without receiving postoperative adjuvant TACE and finally a total of 348 patients were matched. Kaplan-Meier analysis was performed to compare overall survival (OS) and recurrence-free survival (RFS) between the two groups??univariate COX regression and stratified survival analysis were performed to screen and identify survival predictors for postoperative adjuvant TACE patients. Results The Log-rank tests showed both OS and RFS of the patients in postoperative adjuvant TACE group were significantly longer than those in the control group (P<0.05). The identified prognostic predictors by Cox regression and stratified survival analysis included hepatitis B infection??spleen diameter??preoperative serum alpha-fetoprotein (AFP)??TNM stage??tumor size??tumor number. Conclusion Postoperative adjuvant TACE could improve prognosis markedly in HCC patients??particularly in late-stage ones with hepatitis B??portal hypertension??or higher level of preoperative AFP.     

�����ɹ��п���·���ƾ޴���������֯����15���ٴ���Ч�о�

??Abdominoinguinal incision in the resection of large soft tissue tumor at the area of iliac fossa??A report of 15 patients QIU Hui??Wu Jian-hui??LI Cheng-peng??et al. Sarcoma Center??Peking University Cancer Hospital & Institute??Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education)??Beijing 100142??China
Corresponding author??HAO Chun-yi??E-mail??haochunyi@vip.sina.com
Abstract Objective To explore the safety and feasibility of abdominoinguinal incision in large tumors at the area of the iliac fossa. Methods A total of 15 cases of large tumor at the area of the iliac fossa were performed operation through the abdominoinguinal incision from August 2015 to February 2018 in Sarcoma Center of Peking University Cancer Hospital.The clinical data were analyzed retrospectively. Results Complete resection were successfully performed in all patients??13 R0 resection????combined with 13 colectomy??9 nephrectomy??4 total/partial cystectomy??4 adnexectomy/orchiectomy and 10 partial resection and reconstruction of external iliac vessels. The operation time and blood loss was 360 to 720 min and 500 to 8000 mL respectively. One wound infection??6.7%??was observed??and no patient died in hospital. Conclusion The abdominoinguinal incision has a good exposure for the removal of large tumors at the area of iliac fossa.The tumors could be resected integratedly and safely.     

“�̴�”���������ۼ�������֧����������Զ����Ч�о�

??Chimney technique for aortic diseases involving supra-aortic branches in a single center SHU Chang, WANG Tun. Department of Vascular Surgery, the Second Xiangya Hospital, Central South University, Changsha 410011, China
Corresponding author: SHU Chang, E-mail??changshu01@yahoo.com
Abstract Objective To evaluate the mid- and long-term efficiency of thoracic endovascular aortic repair (TEVAR) with chimney technique for aortic arch disease involving the supra-aortic branches. Methods The clinical data of 57 cases of aortic arch diseases performed TEVAR with chimney technique from September 2009 to December 2013 in Department of Vascular Surgery, the Second Xiangya Hospital, Central South University were analyzed retrospectively. There were 2 cases (3.5%) of aortic arch aneurysm, 1 case (1.8%) of type I endoleak after TEVAR for thoracic aortic aneurysm, 1 case (1.8%) of type I endoleak after TEVAR for type B aortic dissection (TBAD), 53 cases (92.9%) of TBAD. One case was complicated with Marfan syndrome. Results All of the stent grafts were deployed as planned. Five cases had type II endoleak during TEVAR. One case received re-TEVAR and another chimney stent grafts deployment because of ischemia of branch arteries caused by migration of chimney stent grafts during anesthesia resuscitation. All patients followed up for 2 to 51 months. One case of TBAD received re-TEVAR for distal re-entry. One case died of cerebral hemorrhage 3 months later. No TEVAR related complications happened, such as stent graft migration, occlusion, fracture or type I endoleak during follow-up. Conclusion Chimney technique can be used with TEVAR to treat aortic arch disease invaded supra-aortic branches, which is reliable and stable. Reconstructed supra-aortic branches with covered stent is useful for prevention of post-TEVAR complications     

����Ƥ��ȫ�̳�����ѹ�����и��������пڷ����Ч�о�

??Treatment studies of subcutaneous continuous negative pressure drainage during the whole course of incision suture in the abdominal operation HUANG Xing-hua,HU Huan-zhang, JIANG Yi. Department of Hepatobiliary Surgery??Fuzhou General Hospital of Nanjing Military Command of PLA, Fuzhou 350025,China
Corresponding author: JIANG Yi,E-mail:jiangyi8183@163.com
Abstract Objective To discuss the clinical efficacies of subcutaneous continuous negative pressure drainage during the whole course of incision suture in the abdominal operation. Methods The clinical data of 136 patients performed hepatobiliary-pancreatic operation between July 2014 and March 2015 in Department of Hepatobiliary Surgery, Fuzhou General Hospital of Nanjing Military Command of PLA were analyzed retrospectively. All the patients were divided into Group A and Group B according to the incision suture methods. Group A (n=72) underwent hepatobiliary-pancreatic operation by the whole subcutaneous continuous negative pressure drainage and Group B (n=64) by early extrusion drainage. Suturing time of abdominal wall, situation of incision healing, numbers of postoperative incision liquefaction and postoperative incision split, time of incision healing, patients’ satisfaction and other indexes were analyzed. Results Suturing time of abdominal wall, incision healing time and patients’ satisfaction in Group A and B were 23(14-30)min, 9(7-15)d,10??5-10??vs. 29(18-42) min,12??8-17??d, 8??4-10?? , respectively, and the statistical differences were significant??all P??0.001??. Numbers of postoperative incision liquefaction and rates of A-grade healing of Group A and B were 3 cases, 94.44% vs. 12 cases, 81.25%, respectively and there were significantly statistical differences??all P??0.05??. Postoperative incision split occurred in Group A and B occurred in zero and one patients, respectively without statistical difference??P??0.05??. Conclusion Skin intradermal suture combined with subcutaneous continuous negative pressure drainage during the whole course of incision suture in the abdominal operation without suturing subcutaneous fat layer plus, can not only shorten operation time, promote incision healing, but also got cosmetic effect, which meets the needs of patients and is worthy of wide application.     

�������븹ǻ���Ұ�᳦�г���������Ч�����о�

??Contrast study of short-term effect between the da Vinci surgical robot and laparoscopic technology in right hemicolectomy for colon carcinoma LIU Dong-ning??XIONG Ling-qiang??ZOU Zhen??et al. No.5 Department of General Surgery??the First Affiliated Hospital of Nanchang University??Nanchang 330006??China
Corresponding author??LI Tai-yuan??E-mail??jylitaiyuan@sina.com
Abstract Objective To compare the short-term surgical outcomes of robot-assisted right hemicolectomy (RA group) with laparoscopic-assisted right hemicolectomy (LA group) for colon carcinoma in order to evaluate the safety and feasibility of robotic surgery system. Methods The clinical data of 30 cases in RA group and 30 cases in LA group both admitted from December 2014 to May 2016 in Department of General Surgery, the First Affiliated Hospital of Nanchang University were analyzed retrospectively. Perioperative situation was compared between the two groups. Results The estimated blood loss was significantly lower in the RA group than that in the LA group ???87.3±26.1??mL vs. ??132.2±31.6??mL??P<0.05??. The operating time in the RA group was significantly longer than that in the LA group???152.3±12.4??min vs.??125.7±29.0??min??P=0.012??. Compared with the LA group??the times to first flatus passage were significantly shorter in the RA group???61.5±9.4??h vs. ??69.7±10.5??h??P=0.042??. The 24 hour pain scores in the RA group were significantly less than those in the LA group. Overall hospital costs in the RA group were significantly higher than that in the LA group????52235.7±528.2 vs. ??41263.5±436.1??P=0.006??. Compared with the LA group??the RA group had larger number of lymph node dissection??15.6±4.5 vs. 12.5±2.9??P=0.036??. Conclusion Compared with laparoscopic-assisted right hemicolectomy??robotic surgery has less harm to the patients??with better resection of primary tumor??and more thorough dissection of lymph nodes. Thus??it is feasible and safe for colon carcinoma.     

ȫ��ǻ����Բ���Ǻ�����ֱ���и�պ�����ʳ�ܿճ��Ǻ���Ч�����о�

??Various types of intracorporealesophagojejunostomy after laparoscopic total gastrectomy for gastric cancer??A national multi-center retrospective study FENG Xing-yu*,WANG Wei, ZANG Lu, et al. *Department of General Surgery, Guangdong General Hospital, Guangdong Academy of Medical Science, Guangzhou 510080, China
Corresponding author?? LI Yong, E-mail??yuan821007@126.com
Abstract Objective To compare the security and short-term effect of the digestive reconstruction during the totally laparoscopic total gastrectomy for gastric cancer between the circular anastomosis and linear anastomosis. Methods The clinical data of 224 gastric cancer patients with digestive reconstruction underwent totally laparoscopic total gastrectomy between January 2011 and June 2016 in 17 domestic hospitals were analyzed retrospectively.According to the difference of digestive reconstruction??all the patients can be divided into the circularanastomosis with 90 patients and the linear anastomosis with 134 cases.Results The operative time in digestive reconstruction with linear anastomosis was shorter (47.4 min vs. 52.3 min, P??0.015). There was no difference between the two groups on the intraoperative blood loss??near cutting margin??cost of the reconstruction??postoperative exhaust time??fluid diet??soft diet and the duration of postoperative hospital stay.Both groups had no death case during the perioperative period and there was no significant statistical difference of the postoperative complication rate(11.1% vs.11.9%, P??0.849). Conclusion The circular anastomosis and linear anastomosis are both safe and feasible for the digestive reconstruction under the totally laparoscopic total gastrectomy for gastric cancer.Besides??the linear anastomosis has the advatage of the less reconstruction time.     

ע����AȺ������������ٰ�Ч���о�

目的评价应用注射用A群链球菌在乳腺癌治疗中的价值。方法 2011年1~12月上海交通大学医学院附属新华医院普外科建立乳腺癌的动物模型,局部应用注射用A群链球菌后观察瘤重和肿瘤直径以及相关免疫指标的变化;30例乳腺癌病人术中应用注射用A群链球菌,观察病人术后引流量、创口及血液中免疫指标的变化。结果在乳腺癌模型中,注射用A群链球菌对乳腺癌瘤体的肿瘤抑制率为32.48%,白介素-6(IL-6)、白介素-12(IL-12)和转化生长因子-β(TGF-β)的表达量较未应用者明显升高。临床病人应用注射用A群链球菌后,术后5d引流量降低20%~30%,创口恢复良好,免疫相关指标CD4/CD8比值由2.23变为1.74,免疫系统恢复正常,自然杀伤细胞(NK)的数量较未使用注射用A群链球菌的病人无明显变化,所有病人均未出现明显的不良反应。结论注射用A群链球菌在乳腺癌治疗中有较好疗效,可以增强宿主的抗肿瘤免疫功能。     

����������������븹ǻ����Զ��θ��������������Ч�����о�

??Contrast study of short-term effect between the Da Vinci surgical robot and laparoscopic technology in patients after distal gastric cancer surgery ZHAO Kun??PAN Hua-feng??WANG Gang??et al. Department of General Surgery, Nanjing General Hospital of Nanjing Military Command, Nanjing 210002, China
Corresponding author:JIANG Zhi-wei,E-mail:surgery34@163.com
Abstract Objective To make a contrast between the Da Vinci surgical robot ( referred to as "robots") and laparoscopic technology in patients’ postoperative recovery after distal gastric cancer surgery. Methods Thirty robotic distal gastric cancer patients as robotic group and 30 laparoscopic gastric cancer patients as compared group both admitted from January 2012 to May 2012 in Nanjing General Hospital of Nanjing Military Command were analyzed. Perioperative situation was compared between the two groups. Results The robotic group was better than the laparoscopic group in intraoperative bleeding, the surgical incision length, postoperative incision pain and the first feeding time (P < 0.05). There was no statistical significance in lymph node dissection and postoperative complications. Conclusion Robot distal gastric cancer surgery is worthy of popularization and application for its less invasive surgery and quicker postoperative recover than laparoscopic surgery.