����Ҷ�г�������������������

??Preoperative assessment and surgical technique of mesohepatectomy YANG Jia-mei??LU Jiong-jiong. Eastern Hepatobiliary Surgery Hospital, the Second Military Medical University, Shanghai 200438, China
Corresponding author: YANG Jia-mei??E-mail: jiameiyang@ssmu.edu.cn
Abstract Objective To investigate the surgical technique and safety of mesohepatectomy. Methods The clinical data of 62 cases of mesohepatectomy performed between January 2006 and March 2010 at Eastern Hepatobiliary Surgery Hospital, the Second Military Medical University were analyzed retrospectively. Results The postoperative complication rate was 11.3%(7/62). There were bile leakage in 4 cases, pleural effusion in 1 case and adult respiratory distress syndrome in 1 case. Above complications cases were cured. One case (1.61%) died of pulmonary embolism. Conclusion The preoperative assessment could mainly depand on the resectability and preoperative liver function. The control of operative blood loss, management of the cut surfaces and secure the inflow and outflou of the remained liver could be the important methods of mesohepatectomy.     

Ӱ���ϸ���ΰ��г�������������������

目的 探讨影响肝细胞肝癌手术切除长期生存的预后相关因素。方法 1964～1993年中山大学肿瘤防治中心经手术切除的522例肝细胞肝癌病人，随访至2003年1月，对随访结果进行回顾性分析，计算生存率并作单因素及多因素分析。结果 术后3、5、10和15年累积生存率分别为49．1％、33．8％、16．7％和13．7％；生存5年以上182例，生存10年以上56例，生存15年以上16例。单因素分析结果表明，预后影响因素为性别、术前肝功能Child-Pugh分级、GGT水平、术中肝硬化程度、肿瘤大小、肿瘤数目、有无癌栓、有无卫星结节和是否根治性切除；多因素分析得出影响术后长期生存的预后因素为术前肝功能Child-Pugh分级、GGT水平、术中肝硬化程度、肿瘤大小、有无癌栓和是否根治性切除。结论 肝癌切除术后病人长期生存与否取决于肝病背景、肿瘤情况和治疗因素。术前肝功能Child-PughA级、GGT正常、无或伴轻度肝硬化、肿瘤≤5cm、无癌栓以及行根治性切除的肝癌病人可能获得长期生存。     

ԭ���Ըΰ����г����󲢷�֢���س̶�Ӱ�����ط�������84�����棩

??Risk factors of complications severity after hepatectomy for primary liver cancer: A report of 84 patients SUN Peng??WU Li-qun??WANG Zu-sen??et al. Department of Hepatobiliary Surgery, the Affiliated Hospital of Qingdao University??Qingdao 266003??China
Corresponding author??WU Li-qun??E-mail??wulq5810@126.com
Abstract Objective To explore the risk factors of complications’ severity after hepatectomy for primary liver cancer. Methods The clinical data of 84 patients with comlications who underwent hepatectomy for primary liver cancer from January 2011 to December 2012 in Department of Hepatobiliary Surgery, the Affiliated Hospital of Qingdao University were analyzed retrospectively. The patients who had postoperative complications were divided into two groups according to the severity of complications: the mild group and heavy group??respectively. The predictors of severe complications were studied by univariate and multivariate analysis. Results 84 patients??94 times of complications??included 59 patients in mild group and 25 patients in heavy group. There was no death related to complications by the univariate analysis??Child-Pugh B grade??bleeding≥500 mL and intraoperative blood transfusion were related to severe complications (P<0.05). By the multivariate analysis of the heavy group??Child-Pugh B grade was an independent risk factor??OR=5.139??95%CI 1.103-23.944??P=0.033??. Conclusion The patients of primary liver cancer with Child-Pugh B grade were more likely to suffered from severe postoperative complications.     

�������������������

胰腺囊性肿瘤大部分为良性,部分为恶性或有恶变及转移潜能。术前肿瘤类型及良恶性的判断是决定治疗方案的关键因素,关于囊性肿瘤的手术时机和手术方法,国内外一直存有争论,尤其对于分支胰管型的导管内乳头状黏液腺瘤的处理争议最大。由于此类肿瘤少见,目前国际上仍无关于胰腺囊性肿瘤的基于循证医学的指南。对于浆液性囊腺瘤,因绝大部分为良性,极少数为低度恶性,应严格把握手术指征;对于黏液性囊腺瘤、主胰管型导管内乳头状黏液腺瘤、实性假乳头状瘤虽可为良性,但有恶性潜能或已恶变,应尽早手术切除;分支胰管型的导管内乳头状黏液腺瘤因对其恶变潜能及恶变的临界点不确定,手术及时机争论颇多。因胰腺囊性肿瘤谱从良性、不典型增生、原位癌至恶性分布不等,手术方式亦从较小的囊腺瘤剥除至胰十二指肠切除术不等。     

�������������������

??Surgical therapy of carotid body tumor LV Wei-ming*,LIU Rui-lei,Li Jie,et al. *Department of Vascular Surgery , the First Affiliated Hospital , Sun Yat-sen University, Guangzhou 510080 , China Corresponding author:WANG Shen-ming, E-mail:lijie3218@sina.com Abstract Objective To summarize our treatment experience of carotid body tumor. Methods Retrospectively analyze the clinical data of 59 cases(62 sides) of carotid body tumor from Jan 1980 to Dec 2006,including their preoperative preparations,operative procedures,and complications. Evaluate the value of preoperative superselective arteriography plus emboliazation before surgery. Results The intraoperative blood loss and cranial nerve injury significantly decreased in the embolism group( P < 0.01; P < 0.05).11 interal carotid artety reconstructions were carried out, internal shunts were used in 6 cases and 2 cases of them suffered cerbral infarctions(33.3%);27 injuries of cranial nerve occered in 21 pationts(33.87%),but only one permanent injury in them. Pathology reslts: 3 were malignant,others were benign;with 63 months follow-up ,no recurrence or metastasis occurred.Conclusion Preoperative superselective arteriography plus embolization may facilitate the surgical removal of CBT.Operation should be done within 48h.Internal shunts should not be used as a routine method. Histomorphology can not efficiently predict its biological behavior,so we should found a potent follow-up system.     

�������������������

自 195 1年ＤｕＢｏｓｔ[1 ] 首次成功施行腹主动脉瘤切除术以来 ,由于手术技巧的不断改进和更为妥善的术前术后处理 ,目前在世界范围内择期腹主动脉瘤围手术期病死率已被控制在 5 % [2 ] 以内。我院 1998年报道的 2 6 1例肾动脉下腹主动脉瘤的围手术期病死率为 3 8% [3] 。虽然腹主动脉瘤的手术死亡率自 2 0世纪 70年代后已降至很低 ,但这并不意味所有的腹主动脉瘤病人都需立即行手术治疗。只有当瘤体破裂的风险大于手术风险时 ,手术才是正确的选择。1　传统手术治疗1.1　手术指征对腹主动脉瘤手术指征的掌握涉及瘤体破裂风险、手术风险和…     

ֱ��ȫϵĤ�г�����ǰ���г�ƽ��

??Anterior plane of rectal mobilization in total mosorectal excision LIN Mou-bin*, YIN Lu, CHEN Wei-guo, et al. *Department of Surgery, Ruijin Hospital, Medical School of Shanghai Jiaotong University , Shanghai 200025,China. Corresponding author: Yin Lu, E-mail:yindalu@yahoo.com.cn Abstract Objective To clarify the appropriate anterior plane in total mesorectal excision. Methods 24 pelvises harvested from embalmed cadavers were studied by dissection in Shanghai Jiaotong University School of Medicine. Results The appearance of Denonvilliers’ fascia varies considerably. Denonvilliers’ fascia was more closely applied to the seminal vesicles than the rectum. Denonvilliers’ fascia ends at the pelvic plexus, and in some cases, the communicating branches of bilateral pelvic plexuses run in front of Denonvilliers’ fascia. Conclusion In circumstances in which the anterior circumferential margin is not threatened, the appropriate anterior plane is behind Denonvilliers’ fascia for reliable preservation of autonomic nerves.     

���ϳ�ϵĤ�Ͼ����г�����ʮ��ֱ���г����������ٹ�ͻ����

目的 探讨累及肠系膜上静脉（SMV）的胰腺钩突部癌手术切除时,联合SMV、门静脉（PV）切除的手术方法、操作要点,以提高切除率。方法 总结1990年1月至2000年6月手术切除累及SMV的胰腺钩突部癌8例,合并PV、SMV切除、重建的经验。其中5例切除静脉干长度为2．0－4．2cm,直接对端吻合,3例行受浸润血管侧壁切除修补术。结果 1例术后3天肝功能衰竭死亡;1例未行脾静脉与SVM吻合者,术后出现乳糜样腹水,经治疗40天痊愈,术后存活20个月;5例术后生存13－29个月;1例术后已3个月,无癌肿复发。结论 胰腺钩突部癌的门静脉浸润不是根治手术禁忌证;联合PV、SMV切除可提高根治手术切除率。     

��ֱ������ת�Ƶ��������ƾ��ߣ�ͬ���г����Ƿ����г�

当结直肠癌确诊并发现伴有同时性肝转移时,原发灶和转移灶手术时机的选择尚存争议。学术界传统观点是首先切除结直肠癌原发灶,然后再分期切除肝转移灶,但是近年来原发灶和转移灶同期切除的理念得到迅速发展,在一些特殊病例,甚至还会选择先切除肝转移灶,再切除原发灶的"逆向策略"。因此,当前结直肠癌伴同时性肝转移的外科治疗仍缺乏统一的规范,尚需高级别循证医学证据来支持。对于每例结直肠癌肝转移病人,需经过多学科查房讨论,制定个体化的综合治疗方案。     

��״�ٴ�ȫ�г���������˫��ȫ/��ȫ�г�����̽��

??Total or near-total bilateral thyroidectomy after subtotal bilateral thyroidectomy YANG Wei-ping, SHAO Tang-lei,CHEN Wei-gou, et al.Department of General Surgery, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200025, China. Corresponding author:SHAO Tang-lei,E-mail:shaotl_03@hotmail.com Abstract Objective To evaluate the safety of total or near-total bilateral thyroidectomy after subtotal bilateral thyroidectomy. Methods Thirty-four cases of subtotal bilateral thyroidectomy because of benign thyroid disease were performed total or near-total bilateral thyroidectomy because of the recurrence of nodules between June 1995 and June 2008 at Ruijin Hospital of Shanghai Jiaotong University School of Medicine. The clinical data of all the cases were analyzed. Results Partial fibers of right recurrent laryngeal nerves were cut at their entrance to the larynges in 2 cases.But the mobility of the vocal cord return to normal and the hoarseness were disappeared 6 months after operation. Hypocalcaemia was occurred in 6 cases.The hypocalcaemia disappeared by calcium supplementing through oral or/and intravenously in 5 of 6 cases 2 weeks after operation. But the righr superior parathyroid was cut inadvertently in one thyroid papillary cancer case, and the case underwent parathyroid autotransplantation. Hypocalcaemia was alleviated gradually 1 year after operation in the case. The levels of calcaemia and PTH were still under the normal until 14 months after operation. Conclusion If choosing the right way to expose the remnant gland and being familiar with the anatomical position of bilateral recurrent laryngeal nerves and parathyroids, it is safety to perform total or near-total bilateral thyroidectomy after subtotal bilateral thyroidectomy.     

�Ǻ������г��ͳ������г���������¶Ⱦ��ıȽ�

目的　比较吻合器痔切除术和常规痔切除术后肛门温度觉的差异。方法　利用自制的肛门温度觉测量仪测量经肛门镜下吻合器痔切除术 (PPH)和常规痔切除手术前后肛门可感觉的最小温度变化值 (minimumde tectabletemperaturechange ,MDTC)的变化。术前、术后肛门镜检查痔核大小及出血情况。切除标本病理检查。结果　PPH手术后 10例病人痔核明显缩小 ,出血停止。病理检查标本中未见有肌肉组织及痔组织。肛管的MDTC值均较术前降低 ,肛管下部和中部MDTC值下降明显 (P <0 0 5 ) ,肛管上部最显著 (P <0 0 1)。常规痔切除手术后 10例病人的MDTC值均较术前增高 ,肛管上部、中部和下部MDTC值均升高明显。痔核消失 ,出血停止。病理检查标本中无肌肉组织 ,但有痔组织。结论　PPH手术可保护肛垫 ,使痔病人术后肛门感觉改善 ,控便功能加强。     

�������������������Σ�����ط�������303�������������棩

??Related risk factors of pancreatic fistula after pancreatic surgery: A report of 303 cases LIU Bao-chuan??GE Chun-lin. Department of Pancreatic Surgery, the First Affiliated Hospital of China Medical University??Shenyang 110001??China
Corresponding author??GE Chun-lin??E-mail??gechunlin@139.com
Abstract Objective To investigate the risk factors of pancreatic fistula in patients after pancreatic operation. Methods The clinical data of 303 cases of pancreatic operation performed from February 2012 to January 2015 in the First Hospital of China Medical University were analyzed retrospectively, included 50 postoperative pancreatic Fistula cases. The potential risk factors of pancreatic fistula were analyzed by univariate and multivariate Logistic regression analysis. Results The univariate analysis showed that the risk factors of pancreatic fistula included sex, pathological type, dilatation of pancreatic duct, operation time, intraoperative blood loss, preoperative Hb, preoperative and postoperative serum TBIL??P<0.05??. The multivariate nonconditional Logistic regression analysis showed that the risk factors of pancreatic fistula included gender??OR??12.001??95%CI 3.049—47.230??P=0.00??, duodenal cancer and vater cancer in pathological diagnosis??OR??1.605??95%CI=1.108—2.324??P=0.00??, dilatation of pancreatic duct??OR??1.177??95%CI 0.188—0.468??P=0.00??, time of surgery??OR=1.641??95%CI 1.173—2.339??P=0.00??,intraoperative blood loss??OR=1.096??95%CI 1.094—1.099??P=0.00??,preoperative hemoglobin??OR=0.888??95%CI 0.823—0.921??P=0.00??, preoperative serum total bilirubin??OR=1.359??95%CI 1.335—1.381??P=0.00??, postoperative serum total bilirubin??OR=1.030??95%CI 1.064—1.004??P=0.00??. Conclusion Male??high serum total bilirubin before and after surgery, duodenal cancer and vater cancer in pathological diagnosis are independent risk factors of the incidence of pancreatic fistula??and dilatation of the main pancreatic duct can reduce the risk of pancreatic fistula.     

����������Ҷ����г����ؽ���ʮ��ָ���г���2������

??Analysis of the effectiveness of ultrasound-guided thermal ablation in initial treatment of primary thyroid tumor: A report of two cases and retrospective analysis of the previous literature MA Ben*??WANG Yu??JI Qing-hai??et al. *Department of Head and Neck Surgery??Fudan University Shanghai Cancer Center??Shanghai 200032??China
Corresponding author??WANG Yu??E-mail??neck130@hotmail.com
Abstract Objectives To investigate the effectiveness of ultrasound-guided thermal ablation in treatment of primary thyroid cancer. Methods We retrospectively analyzed two cases with suspicious thyroid cancer by ultrasound-guided fine needle aspiration biopsy who accepted surgery after undergoing thermal ablation at Fudan University Shanghai Cancer Center in October and November 2015??and performed a pooled analysis on the two cases and the other similar cases selected from the previous studies. Results The primary tumors of the two cases after treatment of thermal ablation were confirmed to be remnant by surgery??and respectively PTC and MTC by histological pathology. Conclusion Our findings suggest that there is not enough evidence for the effectiveness of the thermal ablation procedure in treatment of primary thyroid cancer.