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目的探讨肝小静脉闭塞病(HVOD)的临床特点和诊治经验。方法回顾性分析2003年6月至2004年6月诊治8例HVOD的临床资料特点及经验。结果8例均有肝大和顽固性腹水,全部经肝静脉造影和肝脏组织活检确立诊断。其中急性和亚急性5例,慢性3例。5例行门体分流术,好转3例,无效1例,手术死亡1例;3例采用支持治疗,2例好转,1例死亡。结论肝静脉造影和肝脏组织活检可以确诊HOVD,急性或亚急性病人宜采用非手术治疗,一旦出现食管静脉曲张等门静脉高压症状时,可行门体分流和(或)断流手术。     

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我院自 1991年 1月至 2 0 0 1年 1月共收治甲状腺疾病病人 487例 ,其中 38例为甲状腺微小癌 ,占 7 8%。现将诊治情况分析如下。1　临床资料本组 38例 ,男 2例 ,女 36例。年龄最小 18岁 ,最大 5 8岁 ,平均 42岁。病程 13～ 90个月 ,平均 30个月。单侧 34例 ,双侧 4例。 18例发现甲状腺内有直径 0 7～ 1 0cm的包块 ,在彩超引导下细针穿刺 2 3个结节 ,细胞学检查 15例病人中 19个结节查到癌细胞 ,12例伴有甲状腺功能亢进。34例为单侧 ,4例为双侧。 1处病灶 35例 ,2处病灶以上 3例。乳头状癌 2 8例 ,滤泡状癌 4例 ,未分化癌 5例 ,髓样癌 1例。…     

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??Da Vinci robotic surgical treatment of papillary thyroid carcinoma: A clinical analysis of 150 cases WANG Meng??ZHENG Lu-ming??YU Fang??et al. Department of Thyroid and Breast Surgery??the General Hospital of Jinan Military Command of PLA??Jinan 250031??China
Corresponding author??HE Qing-qing??E-mail:heqingqing@yeah.net
Abstract Objective To explore the technical safety of the operation??the oncology security and the feasibility of clinical application of Da Vinci robotic papillary thyroid microcarcinoma surgery. Methods The clinical and pathological datas of 150 cases of PTMC performed da vinci robotic thyroidectomy in the General Hospital of Jinan Military Command of PLA from February 2014 to January 2016 were analyzed retrospectively. The 150 cases underwent total robotic thyroidectomy (or lobectomy and isthmusectomy) and central neck dissection (CND). Result All the cases of robotic thyroidectomy were completed successfully??and no conversion to open operation. A total of 61 cases (40.7%), 8 cases??5.3%??and 3 cases ??2.0%?? had level ??, ?? and ?? lymph nodes metastasis, respectively. The total volume of drainage was??0.2±0.1??L . The time of drainage was ??5.5±1.4??days. Transient recurrent laryngeal nerve injury occurred in 3 cases. Transient hypoparathyroidism occurred in 19 cases. Intraoperative subcutaneous tunnel bleeding occurred in 1 case. All the cases had no permanent recurrent laryngeal nerve injury and hypoparathyroidism. All the cases were followed up for 1 to 24 months with the median follow-up time of 11 months. no tumor recurrence. The cosmetic results were satisfactory. The case of subcutaneous tunnel bleeding had no metastasis and recurrence. Conclusion Da Vinci robotic thyroid surgery is safe??feasible??and with good cosmetic results??suitable for PTMC cases who pay attention to the neck cosmetic effect.     

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??Comparative study of internal intestinal splinting with long nasointestinal tube vs traditional ileus surgery LIU Zhi-gang, SHANG Dong, BI Wei, et al. Third Department of General Surgery, the First Affiliated Hospital of Dalian Medical University, Dalian 116011, China
Corresponding author: SHANG Dong, E-mail: shangdong@medmail.com.cn
Abstract Objective To evaluate the application value of internal intestinal splinting with long nasointestinal tube in management acute small bowel obstruction. Methods The clinical data of 129 cases of mechanical small bowel obstruction performed operation and followed up between April 2005 and December 2010 in the Third Department of General Surgery, the First Affiliated Hospital of Dalian Medical University were analyzed retrospectively. There were 41 cases in treatment group (internal intestinal splinting with long nasointestinal tube) and 88 cases in control group (traditional ileus surgery). Results There was no significant difference in the postoperative exhaust time or defecation time, the rate of postoperative complications and the postoperative mortality between the two groups (P>0.05). The postoperative recurrence rate of 5-years was 5.0% (2/40) in the treatment group, which was obviously less than the 18.8% (16/85) in the control group (P<0.05). And the recurrence time in the treatment group was (42.5±7.8) months, which was obviously less than (20.3±11.8) months in the control group (P<0.05). Conclusion The treatment of internal intestinal splinting with long nasointestinal tube has a good control effect on recurrence of acute small bowel obstruction.     

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目的 探讨严重腹腔感染合并全身炎症反应病人血小板变化及其意义。方法 对693例腹腔感染病人进行回顾性分析，观察病情严重程度(APACHEⅡ、Ⅲ)、全身炎性反应综合征(SIRS)、血容量因素、病程、营养状况、年龄、性别、体重、体温、并发症等因素对血小板的影响。并根据入院时有无SIRS把病人分为两组即SIRS组(n＝318)和非SIRS组(n=375)观察血小板计数和血小板减少发生率的变化。同时分析血小板计数与病死率和APACHEⅡ评分的关系。结果 经过多因素逐步直线回归分析表明，血容量、SIRS、病情严重程度、病程及营养等因素是对血小板有显著影响的图责，SIRS是影响血小板计数的独立相关因素。SIRS组的血小板计数减少的发生率以及平均血小板计数和非SIRS组差异有显著性(P＜0．05和P＜0．01)。血小板计数与APACHEⅡ评分和APACHEⅡ死亡风险存在显著的直线相关关系(r＝0．18，P＜0．01)。死亡组和存活组的血小板计数有显著差异，且随着血小板计数的减少病死率明显升高。结论 SIRS是影响血小板计数的重要因素 ，血小板计数是腹腔感染病人预后和病情严重程度的重要指标。     

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目的 分析甲状腺微小癌的临床特征和预后，并探讨其手术切除范围。方法 回顾分析1970年1月至1997年12月手术治疗的92例甲状腺微小癌的临床资料。结果 男女之比为1：6．08，55例（59．78％）是在甲状腺良性病变术中或术后发现，82例（89．13％）为单发癌结节。平均随访8．5的，4例死于局部复发和远处转移。结论 甲状腺微小癌女性发病率高，且以单发癌结节为主，多数因甲状腺良性病变在术中或术后发现，甲状腺微小癌预后较好。     

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??Clinical pathway effective for gastric cancer on perioperatiove management HU Xiang. Department of General Surgery, the First Affiliated Hospital of Dalian Medical University, Dalian 116011, China
Abstract For the need of efficiency management, the managerial method of clinical pathway has been developed in the 1980s.The clinical pathway in gastric cancer, standardized gastric cancer treatment based on guideline for the treatment of gastric cancer??, together with standardized surgery of gastric cancer, standardize management of preoperation and postoperation of gastric cancer and make it visible. It will lay strong foundation in safety of medical treatment, high efficiency and quality and provide technical warranty.     

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??Objective:Present the experience on a variety of hepatectomy by occluding the branches of hepatic artery(HA) and portal vein(PV) to the liver lobe,segment or subsegments in hilar H fissure for 335 patients from 1978 to 2006. Methods:According to the size and location of liver tumor,major hepatectomy (65 cases),resection of separated hepatic subsegments (15cases,HS),resection of adjacent HS (209 cases),and resection of single HS(46 cases) were used to treat these patients. Results:??1??Operative mortality rate was 3.0%(10/335,8 for liver failure and 2 for bleeding)??2??Long??term survival:8 HCC patients survived for 10-19 years.11,5,4 years survival for 1 patient respectively in hilar cholangiocarcinoma.1/2-3years survival for intrahepatic cholangiocarcinoma.1/2-1 year survival for carcinoma of gallbladder.All patients of benign liver diseases were cured. Conclusion:??1??Separated multiple hepatic subsegmentectomy is an effective procedure in one operation to cure the compacted stones in 2-6 subsegmental hepatic ducts both in right and left lobes.??2??This procedure is reasonable,effective and low cost for hepatectomy.??3??Current treatment of B hepatitis is essential for preventing metastasis or recurrence after resection of HCC associated with B hepatitis based on the experience of long??term survivals.     

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??Radioactive iodine-131 therapy of papillary thyroid microcarcinoma LIN Yan-song??YANG Xue. Department of Nuclear Medicine??Peking Union Medical College Hospital??Beijing 100730, China
Corresponding author??LIN Yan-song??E-mail??linys@pumch.cn
Abstract Radioactive iodine-131??131I?? therapy is an effective modality of adjuvant therapy after total thyroidectomy or near-total thyroidectomy for thyroid microcarcinoma??TMC??. Most lesions are confined to the thyroid without other risk factors. However??a minority of lesions present aggressive characteristics such as extrathyroidal extension??cervical lymph node involvement and distant metastasis. Therefore??the decision-making recommendations for papillary thyroid carcinoma??PTC?? with tumor diameter larger than 1 cm are not appropriate to be applied directly to TMC. In addition??because of the lack of large-scale??prospective??multicenter clinical research evidence??131I therapy even the extent of surgery for TMC is still controversial. TMC especially PTMC patients with coexistent or multiple invasive features (such as multifocility, pathological subtype such as tall cell or solid subtype and moleculer characteristics such as BRAF mutation) should be particularly paid attention during the risk reassessment before 131I therapy. Both pathological characteristics and postoperative dynamic risk stratification should be considered during risk assessment before 131I therapy. Throglobulin (Tg) especially preablative stimulated Tg is a pivotal marker for predicting disease-free status, disease persistence and distant metastasis. It would never be too cautious to emphasize that 131I therapy decision-making should be made in terms of different risk through considerable assessment.     

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目的：总结小肝癌手术切除经验,探讨影响疗效因素和进一步提高疗效的途径。方法：比较小肝癌和大肝癌临床病理资料,用Cox模型作影预后多因素分析。结果：小肝癌（n=1000)与大肝癌（n=1366)统计比较表明,小肝癌组手术切除率高（93．6％）,手术死亡率低（1．5％）,癌细胞分化程度好（Edmondson分级III－IV,14．9％）,肿瘤单结了者多（82．6％）,肿瘤包膜完整者多（73．3％）,门静脉有癌栓者少（4．9％）,生存率高（5年为62．7％,10年为46．3％）,小肝癌作有限肝切除（n=949）与肝叶切除（n=51)生存率无显著差异（P＞0．05）,小肝癌切除后复发,转移再切除者84例,结论：手术切除是小肝部首选治疗方法,对合并肝硬化病人作有限肝切除替代肝叶切除是提高切除率和死亡率,对术后亚临床复发和单结肺转移作再切除是进一步提高疗效的重要途径。     

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??Efficacy of Lichtenstein inguinal hernia repair using porcine small intestinal submucosa mesh DAI Wei-gang, ZUO Ji-dong, TAN Jin-fu, et al. Department of Gastrointestinal Surgery, Hernia and Abdominal Wall Surgery, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, China
Corresponding author: TAN Min, E-mail: tantommy@163.com
Abstract Objective To evaluate the safety and efficacy of Lichtenstein hernioplasty using porcine small intestinal submucosa mesh (SIS). Methods The clinical data of 87 patients with inguinal hernia who underwent Lichtenstein hernia repair with SIS mesh from March 1, 2012 to October 31, 2015 in the First Affiliated Hospital of Sun Yat-sen University were analyzed retrospectively. The postoperative complications of the patients were analyzed and the long-term effects were observed. Results The mean operation time was (55.7±6.9) minutes (range 45 to 70 minutes). The postoperative pain score of VAS in 24 hours was 0 points in 9 patients (10.3%), 1 to 3 scores in 71 patients (81.6%), 4 to 6 scores in 7 patients (8.0%), respectively. Postoperative serum swelling was found in 2 patients (2.3%). 4.6% (4/87) of patients showed fat liquefaction or infection in the wound, and all the patients did not remove the patches,who were cured after changing dressings and using antibiotics. Slight swelling of the scrotum occurred in 3 patients (3.9%). A total of 70 patients were followed up for a long term of 36 (range 22.5 to 66.0) months. The follow-up rate was 80.5%. Seventeen patients (24.3%) felt mild pain during exercise and no obvious resting pain. Ten patients (14.3%) had groin discomfort during exercise, and there was no discomfort at rest. Ten patients (14.3%) had inguinal numbness or sensory differences lasting for 6 to 12 months. Three patients (4.3%) felt mild foreign sensation in the groin area and lasted for 6 to 12 months. One patient (1.4%) relapsed.The testicular complications and sexual function in 59 patients had been followed up. There were no testicular atrophy, no ejaculatory dysfunction or pain, and the sexual function did not decrease compared with the preoperative condition. Conclusion SIS mesh used in Lichtenstein repair is safe and effective. It may be superior to synthetic patch in chronic pain, and long-term effect needs the further observation.     

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??Central lymph node dissection for non-incidental papillary thyroid microcarcinoma: 10 years’ experience WANG Zhuo-ying?? SUN Tuan-qi?? WU Yi?? et al. Department of Head and Neck Surgery, Fudan University Shanghai Cancer Center (FUSCC);Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China
Corresponding author: GUAN Qing, E-mail: monique.gq@hotmail.com
Abstract Objective To assess the role of central lymph node dissection (CLND) in papillary thyroid microcarcinoma (PTMC). Methods This study included 1048 consecutive PTMC patients who underwent CLND from 2000 to 2009. The data of the incidence of central compartment metastasis, the diagnostic accuracy through ultrasound and intraoperative inspection, the follow-up and the incidence of complication were collected and analyzed. Results The incidence of central compartment metastasis was 38.5%. The status of central compartment metastasis was correlated with major clinicopathologic parameters such as sex, age, multifocal lesions, and the tumor size. The sensitivities, specificities and diagnostic accuracies were 32.2%, 77.1%, 59.8% for the combination of ultrasound and intraoperative inspection, respectively. With a median follow-up of 46.5 months, the metastasis rate was 1.9% (20). Conclusion Considering there was a relatively high rate of central lymph node metastasis, also the sensitivity of preoperative US or intraoperative inspection was not good enough to determine the surgical extent, we suggest that CLND needed to be done even in the low-risk PTMC patients.     

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??Endoscopic retrograde cholangiopancreatography after digestive tract reconstruction and the value of balloon-enteroscopy assistance WANG Xue-feng, WU Wen-guang. Department of General Surgery, Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 200092, China
Corresponding auhor: WANG Xue-feng, E-mail: wxxfd@live.cn
Abstract Endoscopic retrograde cholangiopancreatography (ERCP) after digestive tract reconstruction is relatively difficult and challenging. Different types of post-GI tract surgery ERCP have their own characteristics, and also have different difficulties in ERCP process. Post-GI tract surgery ERCP can be divided into post-gastrectomy ERCP and post-pancreatobiliary surgery ERCP, and different diagnosis and treatment strategies can be adopted for different types. Single balloon enteroscope (SBE)-assisted ERCP post-pancreatobiliary surgery based on the multidisciplinary cooperation should be the first-line standard method for the diagnosis and treatment.     

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??Predictive factors of rVIb metastasis and the correlation between rVIa and rVIb metastasis in papillary thyroid microcarcinoma LIU Wen, CHENG Ruo-chuan, SU Yan-jun, et al. Department of Thyroid Surgery, the First Affiliated Hospital of Kunming Medical University, Kunming 650032, China
Corresponding author??CHENG Ruo-chuan, E-mail??cruochuan@foxmail.com
Abstract Objective To investigate the predictive factors of lymph node metastasis of deep surface ??r??b?? of the right recurrent laryngeal nerve ??rRLN?? in papillary thyroid microcarcinoma ??PTMC??patients?? and the correlation between rRLN superficial surface ??r??a?? and r??b lymph node metastasis in the patients. Methods Based on metastasis in r??b?? 772 PTMC patients admitted in the First Affiliated Hospital of Kunming Medical Universityfrom July 2013 to June 2016 were divided into two groups. χ2 test and multivariate logistic regression were used to analyze the risk factors of r??b metastasis. Results The r??b metastasis rate was 7.1% ??55/772??. Univariate analysis showed that the factors that correlated with r??b metastasis were gender?? age?? tumor size?? tumor location?? extrathyroid invasion??metastasis of left central area + r??a?? lateral lymph node metastasis ??LLNM???? combined with nodular goiter?? the right tumor location?? r??a lymph node metastasis?? and metastasis number and ratio. Multivariate analysis showed that male?? extrathyroid extension?? r??a metastasis?? LLNM and right tumor region were independent predictive factors of r??b. Conclusion Clinical and pathological factors have certain predictive value for ??a metastasis of PTMC. The risk of lymph node metastasis in r??b was increased by 8.4 times and by 10.9 times when the metastatic lymph node ≥2 and metastasis ratio of r??a was ??60% respectively. Patients with high risk in r??b should be chosen for more complete r??b including central lymph node dissection.     

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1996年 10月至 1999年 12月采用自制自动牵开器、深部打结器及 2ｍｍ光导束等器械行小切口胆囊切除 78例 ,效果满意。报道如下。1　资料与方法1 1　一般资料本组 78例 ,男 37例 ,女 41例。年龄 2 4～ 77岁。体重49～ 88ｋｇ。其中胆囊结石 71例 ,胆囊息肉 7例。术中使用自制自动牵开器、深部打结器等器械 ,35 0Ｗ高亮度卤钨灯 ,外径为 2ｍｍ光导束小切口内照明 ,3ｍｍ金属管烟雾吸排。1 2　术前准备术前在Ｂ超指导下明确胆囊底部在体表的投影 ,以确定切口的位置。用一直径为 10ｃｍ的圆枕垫置于腰部与胆囊相对的位置 ,臀部以上抬高 15～ 2 0…     

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??Application of localization needles under mammographic, ultrasound or fiberoptic ductoscopy guidance for the nonpalpable breast lesions YUAN Zhu, QU Xiang, WANG Yu,et al. General Surgical Department, Beijing Friendship Hospital, Capital Medical University,Beijing 100050, China
Corresponding author??ZHANG Zhong-tao, E-mail: zhangzht@medmail.com.cn
Abstract Objective To evaluate the usefulness of localization needles under mammographic, ultrasound or fiberoptic ductoscopy guidance for nonpalpable breast lesions. Methods Eighty-three patients undergoing needle localization and biopsy of a nonpalpable breast lesions under mammographic??ultrasound or fiberoptic ductoscopy guidance from June 2013 to December 2014 in Beijing Friendship Hospital were included in the study. The preoperative imaging assessment, application of localization needles, surgical operation and pathological examination were recorded and analyzed retrospectively. Results A total of 83 localization and biopsies were carried out, of which 27 were performed under mammographic guidance, 32 under ultrasound guidance and 24 under fiberoptic ductoscopy guidance. Twenty-seven cases of breast microcalcifications were localized under mam¬mographic guidance and surgically removed, of which 8 cases pathologically diagnosed as malignant.Thirty-two cases of nonpalpable breast lesions were localized under ultrasound guidance and 30 pathologically diagnosed, of 4 cases pathologically diagnosed as malignant.Twenty-four cases of intraductal occupying lesions were localized under ductoscopy guidance and surgically removed, of 5 cases pathologically diagnosed as malignant. Conclusion It is a safe and effective procedure of localization needles under mammographic, ultrasound or fiberoptic ductoscopy guidance for nonpalpable breast lesions. With the help of this procedure, more malignant lesions are localized and surgically removed, and which is more helpful for the diagnosis of breast cancer.