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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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??Value of ultrasound-guided fine-needle aspiration in diagnosis and differential diagnosis of thyroid nodule DONG Yi-jie??ZHAN Wei-wei. Department of Ultrasound??Rui Jin Hospital??Shanghai Jiao Tong University School of Medicine??Shanghai200025??China
Corresponding author??ZHAN Wei-wei??E-mail??shanghairuijin@126.com
Abstract Fine-needle aspiration (FNA) is one of most important procedures in diagnosing thyroid nodules because of its convenience??safety??minimal invasion and fast. The American Thyroid Associations recommends FNA as the most accurate and cost-effective method for evaluating thyroid nodules. It is considered to be gold standard of initial diagnosis in thyroid nodules. Ultrasound-guided FNA utilizes real-time US to localize the needle tip in the target nodule correctly??which improves the accuracy of biopsy and reduces the rate of false-negative.     

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??Value of radiotherapy for colorectal liver metastases SHEN Li-jun??ZHANG Zhen. Department of Radiation Oncology, Cancer Hospital, Fudan University; Department of Oncology, Shanghai Medical College, Fudan University,Shanghai 200032, China
Corresponding author: ZHANG Zhen, E-mail: zhenzhang6@
gmail.com
Abstract With the development of radiation technology, radiation becomes more precise and it also can increase radiation dose to the target. Radiation as a local therapy plays a significant role in colorectal liver metastases??especially in rectal cancer with synchronous liver metastases. But the value of the new technologies including stereotactic body radiation therapy (SBRT), Yttrium-90 and proton in the management of colorectal liver metastases still needs to be verified.     

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??Value of 3-D visualization technique in the diagnosis and treatment of iatrogenic bile duct injury WANG Jian. Department of Pancreaticobiliary Surgery, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai 200127, China
Abstract Repairing of iatrogenic biliary stricture is a challenge in the field of biliary surgery due to the complexity and variability of the hilar anatomy??the diversity of injury forms and types and the difficulty of repair technique. Comprehensive preoperative assessment??especially imaging evaluation??is a prerequisite for successful repairing. 3-D visualization technology can be used to evaluate the confluence and spatial conformation of hepatic portal vasculature intuitively??stereoscopically and comprehensively.It can also be used to quantitatively assess the position of bile duct stenosis??hepatic portal depth and hepatic portal rotation angel??and measure the volume of each segment of liver to determine whether there is hepatic atrophy.By rotation??superposition and removal of intrahepatic vascular structure??surgeons can formulate reasonable surgical paths??forecast the operation risk??plan operation scheme to improve the operation safety and efficacy??avoid secondary injury caused by blind surgical exploration.     

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??Value of precise pathological detection in diagnosis and treatment of infectious disease XU Ying-chun??YANG Qi-wen. Department of Laboratory Medicine, Peking Union Medical College Hospital??Beijing 100730??China
Corresponding author??XU Ying-chun??E-mail??xycpumch@139.com
Abstract With the variation of pathogen distribution and increase of resistance rates, traditional empirical diagnosis and treatment has been greatly challenged, which also increase the requirements for etiological diagnosis and individualized treatment. Precise etiological diagnosis and treatment require correct specimen collection and transportation procedure, advanced laboratory technology and accurate report interpretation.     

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保乳手术能否将肿瘤切除干净,避免或尽可能减少术后复发是保乳手术成功的关键.怎样才能做到既根治肿瘤,保证乳腺功能和外形的完整,又能避免或减少术后肿瘤复发是医学工作者多年来探寻和努力的目标.     

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??Endoscopic ultrasound in the diagnosis of pancreatic neuroendocrine tumors SHU Hui-jun, YANG Ai-ming.Department of Gastroenterology??Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100730??China
Corresponding author: YANG Ai-ming,E-mail:yangaiming@medmail.com.cn
Abstract Pancreatic neuroendocrine tumors (PNETs) are rare tumors with malignant potential. Endoscopic ultrasound (EUS) has been shown to be of great importance in the preoperative localization and diagnosis of PNETs and may likely be superior to other imaging techniques in the assessment of small tumors. The usefulness of EUS as a primary exploration after US or CT has been posited for tumor diagnosis and localization before surgery.     

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外科病人由于手术创伤等因素,术后常存在水电解质及酸碱平衡紊乱,同时机体释放大量炎性介质,引起全身血管内皮细胞损伤,最终可能导致全身炎性反应综合征及毛细血管渗漏综合征,严重者甚至导致低血容量休克。大量动物实验及临床研究显示,高渗盐水利用其高渗性特点及在炎症方面的作用,在液体复苏的治疗过程中可改善病人的上述问题。但高渗盐水使用的最佳剂量、配伍问题以及如何减少其副反应仍有待进一步研究。     

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??Application of serum biomarkers in diagnosis and treatment of gastroenteropancreatic neuroendocrine neoplasm CHEN Jie??YANG Qiu-chen. Department of Gastroenterology??the First Affiliated Hospital of Sun Yat-sen University??Guangzhou 510080??China
Corresponding author: CHEN Jie, E-mail: chen0jie@hotmail.com
Abstract Gastroenteropancreatic neuroendocrine neoplasm (GEP-NENs) is a heterogeneous group of tumour arising from neuroendocrine cells in the digestive system. Since regular tumor markers used in neoplasms of the digestive system are scarcely beyond normal range in GEP-NENs??together with the silent clinical manifestation at the early stage of the disease??50% of GEP-NENs patients present with advanced disease when diagnosed. Therefore??it is critical to find effective circulating biomarkers for the diagnosis of GEP-NENs??as well as to assess treatment efficacy and monitor progression. Among practical serum biomarker for GEP-NENs diagnosis and treatment??hormones secreted by functional GEP-NENs are served as specific serum markers. The non-specific "universal" biomarker chromogranin A is the most important serum marker at present??which is of great value in diagnosis and treatment of GEP-NENs.     

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??Hyperthermic intraperitoneal chemotherapy in the treatment of peritoneal carcinomatosis of gastric cancer WU Xiao-jiang, JIA Yong-ning, JI Jia-fu. Department of Gastrointestinal Surgery, Peking University School of Oncology, Beijing Cancer Hospital & Institute; Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Beijing 100142, China
Corresponding author: JI Jia-fu, E-mail??jiafuji@hotmail.com
Abstract The peritoneal carcinomatosis is the main cause of death for gastric cancer. Once diagnosed, the prognosis is poor extremely. While simple peritoneal carcinomatosis has been considered as localized disease gradually, and more aggressive methods could be adopted including hyperthermic intraperitoneal chemotherapy (HIPEC) and peritoneal resection. Combination of surgery and HIPEC could significantly decrease the recurrence rate, and the combination of CRS and HIPEC could also enhance the therapeutic effect of gastric cancer patients with obvious peritoneal dissemination. Careful selection of the potential beneficiary is the key for better survival. But up to now a standard protocol is demanded highly, and more prospective clinical trials are needed to provide enough evidence for the protocol conformation.     

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3D技术及其仿真手术过程在显示肝胆管狭窄、胆道及血管变异、肝内外病灶等方面较普通影像学检查更直观、更全面,因而对复发性肝胆管结石更具诊断价值。同时,3D技术在手术切口及手术路径设计、胆道系统结石复发机制判断、规则性肝(叶)段切除手术规划、胆-肠吻合术的合理选用以及手术流程优化等方面,对复发性肝胆管结石的合理选择手术方式发挥重要作用。     

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目的探讨螺旋CT判断胰头癌可切除性的方法和标准。方法上海华东医院2002年1月至2003年9月使用螺旋CT对18例胰头癌病人进行术前薄层多期扫描，将胰周血管受侵犯程度分为4级，结合周围组织脏器的受累情况判断胰头癌的可切除性，并与手术结果相对照。结果18例胰头癌病人，术前9例判断可切除，实际8例得到了根治性切除。准确率达87．5％，不可切除的判断准确率达90％。结论利用血管受侵犯程度分级，螺旋CT可以较准确的判断胰头癌的可切除性，具有重要的临床意义。     

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??Clinical value of serum CA19-9 in the diagnosis of suspected pancreatic cancer by imaging methods WANG Wei-lin*, WU Ze-hui, ZHU Feng, et al. Department of Hepatobiliary and Pancreatic Surgery, First Affiliated Hospital of Medical School of Zhejiang University, Hangzhou310003, China
Corresponding author: ZHENG Shu-sen, E-mail:shusenzheng@zju.edu.cn
Abstract Objective To explore the clinical value of the combination of serum tumor marker CA19-9 and imaging methods (computed tomography and magnetic resonance imaging) in the diagnosis of pancreatic cancer. Methods The clinical data of 267 patients with suspected pancreatic cancer by imaging methods admitted from January 2010 to February 2012 in Department of Hepatobiliary and Pancreatic Surgery, First Affiliated Hospital of Medical School of Zhejiang University were analyzed retrospectively. Results In all 267 patients, 225 (83.0%) and 42 (17.0%) patients were diagnosed as pancreatic cancer and non-pancreatic cancer respectively. In the pancreatic cancer group, serum CA19-9 was elevated in 173 (76.9%) patients. Eighty-five patients with suspected pancreatic cancer by imaging methods had normal CA19-9 value. Among them, 52 (61.2%) patients were finally diagnosed as pancreatic cancer on pathology, and 33 (38.8%) patients as non-pancreatic cancer. One hundred and eighty-two patients with suspected pancreatic cancer by imaging methods had elevated CA19-9 value. Among them, 173 patients were finally diagnosed as pancreatic cancer on pathology and 9 patients as non-pancreatic cancer. Conclusion Serum tumor marker CA19-9 may provide valuable clues for the diagnosis of pancreatic cancer which is suspected by imaging methods. As to CA19-9 negative patients, in whom pancreatic cancer is suspected by imaging methods, much more attention should be paid to the possibility of false positive results of imaging methods. Pancreas puncture before surgery is recommended to confirm the diagnosis and exclude the possibility of chronic pancreatitis, pancreatic neuroendocrine tumors and solid-pseudopapillary tumor, etc. As to patients with elevated CA19-9 and imaging methods suspected pancreatic cancer, operation is recommended.     

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2000年 3月至 2003年 3月,我们 (烟台毓璜顶医院 )研究了 325例血清糖类抗原 (CA19 9 ) >200U/mL的临床病例资料,重点研究了其中 101例接受手术治疗胰腺癌病人的资料,发现CA19 9数值大小与肿瘤部位、大小有一定关系 [1]。现报道如下。1　资料与方法1. 1　临床资料　本组 101例中男性 63例,女性 28例。年龄平均 54 ( 38 ~85 )岁。按CA19 9数值大小分类, 200 ~500U/mL42例, >500 ~1000U/mL31例, >1000U/mL28例。101例均接受手术治疗。56例手术探查发现无法根治切除,而行短路手术或直接关腹, 45例行传统胰十二指肠切除术。45例中大部…     

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目的探讨影像学检查和CA199、CEA的测定对肝外胆管癌(extrahepaticcholangiocarcinoma,EHCC)的诊断价值。方法回顾性分析1995～2003年107例肝外胆管癌US、CT、MRCP、ERCP、PTC诊断结果。其中51例进行了CA199、CEA的测定,并与42例胆道良性病变进行对照研究。结果US、CT、ERCP肿块显示率分别为708%、602%、690%;US、CT、MRCP、ERCP、PTC定位诊断准确率分别为729%、759%、100%、714%、769%。EHCC组与胆道良性病变组相比较,血清CA199、CEA和胆汁CA199值明显升高(P<001,P<005和P<001)。血清CA199、CEA和胆汁CA199的敏感性分别为863%、255%、409%,其特异性分别为875%、952%、788%。结论MRCP对EHCC诊断优于US、CT、ERCP及PTC,血清CA199的测定是EHCC术前可靠的定性诊断手段。     

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目的分析重症加强治疗病房呼吸机相关性肺炎(VAP)的病原菌分布特点及变迁。方法对中国医科大学附属第一医院重症加强治疗病房(ICU)2003年1月至2006年12月间VAP病人的痰培养病原菌及药敏结果进行回顾性分析。结果4年中ICU中VAP发生率为19.1%。铜绿假单胞菌为最常见菌,洋葱伯克霍尔德菌、鲍曼不动杆菌、嗜麦芽窄食单胞菌4年中均排在前6位。金黄色葡萄球菌在2003-2005年间逐年增加,2006年有所下降;脑膜败血黄杆菌在2005、2006年分离率明显下降;近两年肺炎克雷伯杆菌的分离率增加。2004年铜绿假单胞菌对多种抗生素耐药率高(均在75%以上)。4年中对亚胺培南的耐药率均超过40%。鲍曼不动杆菌对亚胺培南和左氧氟沙星耐药率较低,嗜麦芽窄食单胞菌对复方磺胺甲恶唑、环丙沙星和左氧氟沙星耐药率较低。分离出的金黄色葡萄球菌中,耐甲氧西林金黄色葡萄球菌(MRSA)所占比例高。结论铜绿假单胞菌、洋葱伯克霍尔德菌、鲍曼不动杆菌、嗜麦芽窄食单胞菌等非发酵菌仍为VAP主要致病菌。4年中VAP致病菌的分布特点和耐药性发生了改变。     

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??Endoscopic submucosal dissection in the trearment of lower rectal tumor YAO Li-qing, ZHONG Yun-shi. Endoscopic Center, Zhongshan Hospital of Fudan University, Shanghai 200032,China Corresponding author: ZHONG Yun-shi, E-mail:zhongamy2002@126.com Abstract There were disputations of local resection of rectal cancer, in this article we reviewed the development, intradiction, methods of endoscopic resection and the value in the treatment of lower rectal tumor??especially focused on endoscopic submucosa dissection, including instrument, methods, postoperative treatment and effect.     

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??Assesment of laparoscopic surgery for mid-low rectal cancer LI Guo-xin.Department of General Surgery,Nanfang Hospital,Southern Medical University,Guangzhou 510515,China Abstract The technical safty and feasibility of laparoscopic procedure for mid-low rectal cancer were confirmed by increasing clinical studies .The short-term advantages of fast postoperative recovery,less pain and short hospital stay for laparoscopic rectal cancer surgery were shown in a growing body of literatures. Laparoscopic surgery for mid-low rectal cancer could strictly adhere to the oncological principle to guarantee the oncologic safty . Laparoscopic approach might be superior to the open surgery in terms of anal sphincter saving and impact on bladder and sexual function,and could be safe and feasible in total mesorectal excision with preoperative chemoradiation therapy.In conclusion,the data from the recent trials have shown promising clinical benefits of short-term advantages as well as long-term oncologic equivalence for laparoscopic surgery for mid-low rectal cancer.However,adequately powered,multiple center trials are justified and necessary to assess the role of laparoscopy in mid-low rectal cancer surgery.     

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??Assesment of laparoscopic surgery for mid-low rectal cancer with sphincter preservation YING Min-gang??YANG Chun-kang. Department of Abdominal Surgery??Fujian Provincial Tumor Hospital??Fuzhou 350014??China
Corresponding author??YING Min-gang??E-mail??yingmg@163.com
Abstract The application and feasibility of laparoscopic procedure for mid-low rectal cancer were confirmed by increasing clinical studies.The advantages of sphincter preservation for laparoscopic rectal cancer surgery were shown in a growing body of literatures.Laparoscopic surgery for mid-low rectal cancer could strictly adhere to the oncological principle and sphincter-preservating requirement to guarantee the oncologic safty.Laparoscopic multiplication might be superior to the open surgery in terms of anal sphincter saving and nerves protecting??and could retain Defecation control ability??bladder and sexual function.In conclusion??the data from the recent trials have shown promising clinical benefits of short-term advantages as well as long-term oncologic equivalence for laparoscopic surgery for mid-low rectal cancer in sphincter preservation resection.However??adequately powered??multiple center trials are justified and necessary to assess the role of laparoscopy in mid-low rectal cancer sphincter-preservating surgery.