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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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??Intravenous leiomyomatosis: A clinical analysis of 7 cases LI Xuan??XIN Shi-jie. Department of Vascular Surgery??the First Hospital of China Medical University??Shenyang 110001??China
Corresponding author??XIN Shi-jie??E-mail??sjxin@mail.cmu.edu.cn
Abstract Objective To investigate the diagnosis and treatment of intravenous leiomyomatosis (IVL). Methods The clinical data of 7 cases of IVL admitted between September 2004 and September 2015 in the First Hospital of China Medical University were analyzed retrospectively. Results Five cases of the 7 cases underwent surgical treatment, 2 cases underwent conservative treatment. All the 5 cases had pathological diagnosis of IVL. Five cases involved the uterus vein??iliac vein??vena ovarica and inferior vena cava; 4 cases involved right atrium; 1 case involved right cardiac ventrium and pulmonary artery. IVL of 5 cases originated from uterous tumor. Seven cases were followed. One case died of respiratory and circulatory failure in postoperative 2 months. Two cases of non operation died in postoperative 3 and 4 years respectively. One case of low grade endometrial stromal sarcoma recurred in postoperative 1 year. Conclusion IVL is a kind of rare and fatal diseases that should be paid more attention to the diagnosis and treatment in order to avoid misdiagnosing. A detailed operation program should be made before the operation.     

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目的 探讨乳腺导管内乳头状瘤(intraductal papillomas，IP)癌变的临床表现、生物学行为、诊断、治疗及预后。方法 对1980年1月至2001年12月间7例IP癌变病人临床资料进行回顾性分析。结果 7例IP癌变占同期113例IP的5．19％，术前均未能确诊，5例术中冰冻考虑IP癌变。结论 IP有癌变潜能，其癌变者术前确诊困难，术中冰冻对诊断治疗意义重大，应重视术后随访。     

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??Laparoscopic repair for giant hiatal hernia??A clinical analysis of 75 patients SUN Xiang-yu, QIN Ming-fang, ZHAO Hong-zhi, et al. Department of Mini-invasive Surgery, Tianjin Nankai Hospital, Tianjin 300100, China
Corresponding author: SUN Xiang-yu, E-mail: xiangyusun79@126.com
Abstract Objective To investigate the safety and effectiveness of laparoscopic repair for giant hiatal hernia. Methods The clinical data of 75 patients with giant hiatal hernia performed laparoscopic repair between January 2006 and August 2012 in Tianjin Nankai Hospital were analyzed retrospectively. The operation time, hospitalization time, intraoperative and postoperative complications, postoperative improvement of symptoms and upper gastrointestinal imaging were studied. Results All the patients were treated by laparoscopy successfully. Fifty-one patients were reinforced with meshes. Twenty-four patients were reinforced without mesh. Hiatal pillars in 40 patients were partly contracted and closed with meshes. Hiatal pillars in 35 patients were directly closed up to normal diameter by interrupted stitches. Among them, 11 patients were placed with meshes. Laparoscopic repair complicated with fundoplication was performed in 64 patients with average operation time of (97.2±2.1)min, average operative blood loss of (82.0±1.7)mL and average hospital stay of (5.0±1.2)d. No conversion and death occurred. Seventeen patients (22.7%) had short-term or long-term complications. Seventy-five patients were followed up for 3 months to 62 months with average of (31.0±2.1)months. Main symptoms of 66 patients (88%) were disappeared. Nine patients ??12%??had recurrence of symptoms. Four patients??5.3%??were found recurrence by barium swallow. Conclusion Laparoscopic repair for giant hiatal hernia is safe and reliable. Mesh repair can reduce the recurrence rate but accompanied with risk of complication.     

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??Effect of fecal microbiota transplantation on uerative colitis: A study of 9 patients WEI Yao, GONG Jian-feng, ZHU Wei-ming, et al. Institute of General Surgery, Jinling Hospital, Medical School of Nanjing University, Nanjing 210002, China
Corresponding author: LI Ning, E-mail:liningrigs@vip.sina.com
Abstract Objective To investigate the therapeutic effect of fecal microbiota transplantation on ulcerative colitis. Methods The clinical data of 9 patients with ucerative colitis??UC) accepted fecal microbiota transplantation following standard transplant path between September 2013 and February 2014 in Jinling Hospital, Medical School of Nanjing University were analyzed retrospectively. Patients’ Mayo score, CRP and ESR before and after transplantation was recorded respectively and the patients’ stool samples before and after 4 weeks of transplantation for fecal calprotectin detection were collected. Changes of disease activity and level of fecal calprotectin before and after treatment were compared. Results All patients were accepted the treatment successfully. One patient suffered from low fever but the rest of the patients had no adverse reactions such as abdominal distention, diarrhea and fever. Mayo score and fecal calprotectin levels all declined significantly [(5.89±1.96)&??1.56±1.01????(542.30±519.44)μg/g& (122.89±110.80) μg/g , P<0.05] and there was a correlation between Mayo score and fecal calprotectin levels, which could reflect disease activity well. CRP and ESR didn’t change significantly before and after transplantation. Conclusion Fecal flora transplantation is a safe and feasible method to treat mild and moderate UC and fecal calprotectin level is a sensitive marker for the diseases.     

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目的 总结10年来肠梗阻的诊治经验。方法 回顾性分析了10年间收治的599例肠梗阻资料。结果 病因明确540例（90.2%)，其中机械性肠梗阻529例（98.0%)；原因不明59例（9.8%）。非手术治疗381例（63.6%)，手术治疗218例（36.4%)，术后并发症7例（4.5%)。死亡27例。结论 10年间肠梗阻以粘连性肠梗阻、肿瘤性肠梗阻最常见。粘连性肠梗阻中84.2%为手术后所致，青年、无手术史的肠梗阻主要为结核性粘连所致。肿瘤性肠梗阻临床表现有一定特点。对手术后早期粘连性肠梗阻应以非手术治疗为主。     

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目的 探讨大肠癌病人同时合并息肉的诊断，处理。方法 对1995年1月至2000年12月132例大肠癌合并大肠息肉病人的临床资料进行回顾性分析。结果 大肠癌合并息肉者发生率高达18%。息肉术前确诊率低（20%），在切除大肠癌同时一期处理大肠息肉者101例（77%），术后二期处理息肉者26例（18%），85例获得随访，其中一期处理息肉者65例中术后息肉复发5例，恶变1例（1.5%)，二期处理息肉者20例中，12例息肉明显增大，其中恶变4例（20%），两者差异有显著意义。结论 息肉在大肠癌中漏诊率高，并有明显的恶变倾向。因此。应尽可能术前明确诊断，力争在根治大肠癌的同时处理息肉。术中仔细探查与纤结镜结合，可明确息肉诊断提高切除率，术后应加强随访，及时发现和处理复发息肉。     

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??Iatrogenic bile duct injuries: a clinical analysis of 64 cases ZHOU Yong, LIU Jin-gang. Department of General Surgery, Shengjing Hospital of China Medical University, Shenyang 110004, China
Corresponding author: LIU Jin-gang, E-mail: liujg@sj-hospital.org
Abstract Objective To analyze and summarize the experiences of diagnosis and treatment for iatrogenic bile duct injury (IBDI). Methods The clinical data of 64 cases of IBDI admitted between January 2005 and December 2009 in Shengjing Hospital of China Medical University were analyzed retrospectively. Results Of all 64 cases, there were 41 cases occurred in opened bile ductal surgeries; 16 cases happened in laparoscopic cholecystectomies; 7 cases come up with other surgeries. Four cases injured with leakage of bile gently were drainage by ENBD. Five cases were found in the operation and undergone a T-tube drainage in the injured site. Other 55 cases were treated by Roux-en-Y anastomosis of bile duct and jejunum. One case died; 2 cases went through operation once again due to the stricture of the anastomotic stoma; 1 case experienced re-operation due to the defluvium of the stent tube. Sixty-three cases recovered smoothly and were followed-up over 12 months. Conclusion On condition that gentle IBDI is found in the operation, it should take simple suturing and repairing into consideration modestly, but for a positive T-tube drainage. In case of complete truncation of the bile duct occurs in the operation, or the injury is found several days after the surgery or reconstruction surgery fails, Roux-en-Y anastomosis of bile duct and jejunum may be the first choice, which could lead a satisfactory curative effect, while the annular anastomat should be applied cautiously.     

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??Clinical analysis of lumbar hernia tension-free repair through retroperitoneal space: A report 7 cases LIN Rong-gui, HUANG He-guang, CHEN Yan-chang, et al. Department of General Surgery, Union Hospital, Fujian Medical University, Fuzhou 350001, China
Corresponding author: HUANG He-guang, E-mail??koomp@sina.com
Abstract Objective To evaluate the clinical experience of lumbar hernia tension-free repair with a Kugel patch through retroperitoneal space. Methods The clinical data of 7 cases of lumbar hernia tension-free repair with a Kugel patch through retroperitoneal space performed from December, 2008 to December, 2015 in Department of General Surgery, Union Hospital, Fujian Medical University were analyzed retrospectively. Follow-up was performed through outpatient service or telephone interview till June, 2016. Postoperative complications were summarized and the clinical effectiveness of the procedure was analyzed. Results Seven cases underwent lumbar hernia repair smoothly under general anesthesia, 5 cases with a 11 cm×14 cm Kugel patch and 2 cases with a 14 cm×17 cm one. Transfixing stitches were adapted in order to ensure the positioning of the mesh. The mean operative time was 65.2 min. Mean blood loss was 45.5 mL. A closed drainage tube was routinely placed in front of the patch with a mean removal time of 3.6 days. Early ambulation was encouraged with no limit to anesthesia. A semi-liquid diet was then restored 6 hours after the operation and pressure dressing was routinely adapted till 3 months after the operation. The mean length of postoperative hospitalization was 2.8 days. All patients were followed up for 6 to 78 months (average 32.7 months). A previous mesh was removed in a recurrent lumbar hernia before repair. An ipsilateral inguinal indirect hernia was repaired with Kugel procedure, and an ipsilateral lumbar cyst with the hernia was resected during the operation. No postoperative complication occurred, including seroma, hematoma, recurrence, incisional infection, chronic pain, and foreign body sensation. Conclusion Lumbar hernia tension-free repair with a Kugel patch through retroperitoneal space, adapting transfixing stitches for fixation, is a safe and useful technique, which is associated with effective repair, few postoperative complications, rapid recovery and good clinical results.     

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目的探讨高血压病人腹部外科手术前有否控制血压的必要性。方法回顾分析531例行腹部外科手术的高血压病人围手术期病情变化。结果一、二级高血压术前控制血压与否对围手术期病情无显著影响(P>0.05),三级及收缩期高血压术前未控制组围手术期并发症显著高于术前控制组(P<0.05)。结论一、二级高血压术前抗高血压治疗与否不增加手术危险性;三级及收缩期高血压术前应控制血压低于180/110mmHg(24.0/14.7kPa),且宜平稳1～2周,待病情稳定后施行择期手术。     

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目的 分析十二指肠外瘘发生的原因，探讨其诊断及治疗方法，方法 分析1987年1月至2000年5月共22例十二指肠外瘘发生的原因，诊断，临床表现，所有病例均行禁食，胃肠减压，维持水，电解质平衡，抗感染，通畅引流等一般治疗，同时部分病例行全胃肠外营养（TPN）及应用生长抑素等非手术治疗。结果 20例（90.9%)为手术后并发症，2例为外伤所致，确诊时间为手术后2-14天。11例（50%）瘘口自然关闭，8例手术治疗，均获治愈，3例死亡。结论 手术是导致十二指肠外瘘的主要原因，经过正规的非手术治疗效果不佳时可以考虑早期手术，配合全胃肠外营养及生长抑素类药物。     

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??Therapeutic effect of laparoscopic repair for inguinal hernias in female patients: An analysis of 225 patients WANG Ji??WANG Wen-rui??LI Jian-wen??et al. Department of General Surgery??Rui Jin Hospital??Shanghai Jiao Tong University School of Medicine; Shanghai Clinical Minimally Invasive Surgery Center??Shanghai 200025??China
Corresponding author: LI Jian-wen??E-mail??ljw5@yeah.net??ZHENG Min-hua??E-mail??zmhtiger@yeah.net
Abstract Objective To explore the clinical characteristics of laparoscopy in the treatment of inguinal hernia in female patients. Methods The clinical data of 246 hernias in 225 female patients performed laparoscopy between January 2001 and December 2013 in Rui Jin Hospital??Shanghai Jiao Tong University School of Medicine were analyzed retrospectively. All the procedures included 170 TAPPs for 183 hernias and 55 TEPs for the remaining 63 ones. According to the maintenance of round ligaments??the data were classified into preservation group ??104 hernias in 95 patients?? and transection group ??142 hernias in 131 patients??. The intraoperative and postoperative data between two groups were compared. Results (1) In preservation group??19 round ligaments were completely parietalized and 5 were dissected by openning and re-suturing the peritoneum around the round ligament. The meshes were placed in front of the ligament. For the remaining 80 hernias??the meshes were placed behind the ligament by keyhole technique. A total of 90 TAPPs (86.5%) and 14 TEPs (13.5%) were performed in the preservation group??and the numbers are 93 (65.5%) and 49 (34.5%) in the transection group (P=0.002). The average ages in preservation and transection groups was??41.2±1.7??and ??62.3±1.2??years old (P<0.000) respectively. The time of operation in preservation group is??31.3±1.3??minutes??compared to??25.0±1.0??minutes in transection group (P<0.000). (2) No conversion to laparotomy occurred. The postoperative hospitalization is??1.5±0.2??days. All patients returned to normal activity within 2 weeks. No recurrence but 10 patients with seroma (4.5%) and 2 urinary retention (1.0%) were noted in the follow-ups. Conclusion The surgeon should thoroughly evaluate multiple factors??including age??time of operation??recurrence and etc.??before transecting the round ligament. Both peritoneum dissection and re-suture technique and inner ring keyhole technique are available for the preservation.     

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??Laparoscopic hiatal hernia repair: a clinical analysis of 143 cases ZHAO Hong-zhi, QIN Ming-fang, WANG Qing, et al. Center of Tianjin Minimally Invasive Surgery, Nankai Hospital, Tianjin 300100, China
Corresponding author : ZHAO Hong-zhi, E-mail??tjzhhzh@sina.com
Abstract Objective To explore the feasibility and clinical value of laparoscopic surgery in treating patients with hiatal hernia. Methods From June 2001 to February 2010, 143 cases of hiatal hernia were enrolled to undertake laparoscopic hiatal hernia repair at Nankai Hospital of Tianjin City. Laparoscopic fundoplication was performed concomitantly in some cases if appropriate. Paraoperative clinical parameters were recorded and analyzed. All cases were followed up routinely. Clinical outcomes were collected and analyzed. Results All 143 cases of laparoscopic operations were accomplished successfully. No conversions were needed. Mean operation time was 86 minutes (range: 55-210 minutes). Mean intraoperative blood lose was 76 mL (range: 40-150 mL). Mean postoperative hospital stay was 4.6 days (range: 3-21 days). Clinical symptoms were relieved in all cases. No mortality and severe complications were noted. Mean follow up period was 3.8 years (range: 3 months to 9 years). Rate of satisfaction for operation was 91.67%. Mild dysphagia occurred in 8 cases. Reflux recurrence occurred in 5 cases, in whom 4 cases were controlled by antacid medicine and 1 case need open surgical revision. Conclusion Laparoscopic hiatal hernia repair has the advantages of minimal trauma, fast recovery, safe and high reliability.     

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??Acute recurrent pancreatitis??an analysis of 76 cases DING Guo-qian*,QIN Ming-fang, WANG Qing ,et al. *Graduate School of Tianjin Medical University, Tianjin 300070, China
Corresponding author ??QIN Ming-fang, E-mail:qins88@sina.com
Abstract Objective To explore the clinical features and the causes of acute recurrent pancreatitis (ARP) and the value of endoscopy in treatment of recurrent cholangitis-originated ARP??Methods The clinical data of 76 cases of ARP admitted between December 2004 and January 2010 at Nankai Hospital of Tianjin City were analyzed retrospectively. Results The mean recurrence rate of 76 cases of ARP was at 1.8 times. The time is 1-42 months after the first attack with the average of 5.9 months. Sixty-six cases ??86.8%?? recurred within 1 year. The main etiological factor of ARP was cholangitis-originated pancreatitis ??50 cases??. Fifty-two cases ??88.1%??were treated with endoscopy successfully and followed up 6 to 72 months without recurrence. Conclusion Finding the causes, removing incentives and targeted therapy in time are very important to avoid the ARP. Cholangitis-originated pancreatitis is the leading cause of ARP recurrence, and endoscopic treatment in time can reduce the recurrence of ARP??     

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乳腺纤维囊性增生病 (以下简称乳腺病 )迄今临床尚无满意治疗方法。我们采用乳腺神经及部分血管离断术治疗乳腺病获得了较满意的效果。报告如下。1　临床资料本组 30例病人 ,年龄 2 8～ 48岁 ,平均 36 4岁。病史 3～ 8年 ,平均 3 6年。临床症状均有明显的周期性或持续性乳房疼痛。约 2 /3与月经有关 ,另 1 /3与月经周期关系不明显 ,其中 2 7例曾行药物 (主要为中医中药 )治疗 ,效果欠佳。 4例有纤维瘤切除病史。体检所有病人双乳均可触及大小不等、多发的痛性结节 ,6例结节形成团块。 1 4例合并乳房轻度肥大 ,3例伴有浆液性乳头溢液。本…     

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目的 探讨原发骶前肿瘤的诊断和手术治疗方法。方法 分析1983-1999年治疗的23例原发骶前肿瘤病人的临床资料。结合文献进行讨论。结果 23例中先天性肿瘤为最常见类型。肛门指诊结合B超和CT检查对于术前评估非常重要。手术路径以经骶尾入路和经会阴入路最为常见。结论 如无手术禁忌证，所有原发骶前肿瘤均应予手术切除，应根据肿瘤的具体情况选择恰当的手术路径，术中应避免神经血管损伤，并尽可能完整切除肿瘤。     

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目的　总结原发性胆囊鳞癌、腺鳞癌的诊治经验。方法　回顾性分析了浙江大学医学院附属第二医院 1994～ 2 0 0 3年收治的少见胆囊癌 9例 (鳞癌 1例 ,腺鳞癌 8例 )。结果　行根治性手术 4例 ,姑息性手术 5例。9例中有 8例得到随访 ,均在术后半年内死亡 ,术后中位生存期 5 1d。结论　胆囊鳞癌腺鳞癌恶性程度较高 ,但淋巴结转移相对较晚。对于合适病例应尽可能行根治性胆囊切除 ,必要时行扩大根治性切除 ,术后放疗可能是一个较好的治疗方式。