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??Analysis of risk factors for prognosis of postoperative hemorrhage after pancreaticoduodenectomy: a report of 60 cases ZHU Qi-cong??WU Peng-fei??LU Zi-peng??et al. Pancreas Center??the First Affiliated Hospital of Nanjing Medical University??Nanjing 210029??China
Corresponding authors??JIANG Kui-rong??E-mail??jiangkuirong@njmu.edu.cn??MIAO Yi??E-mail??miaoyi@njmu.edu.cn
Abstract Objective To analyze common risk factors and treatment strategy for prognosis of postoperative hemorrhage after pancreaticoduodenectomy. Methods The clinical data of 60 patients who underwent pancreaticoduodenectomy in the First Affiliated Hospital of Nanjing Medical University from January 1??2012 to December 31??2015 were analyzed retrospectively. The risk factors for prognosis of postoperative hemorrhage were analyzed. Results Among them, 8 patients died after surgery??others were alive. Early bleeding appeared in 10 patients and delayed hemorrhage occurred in 50 patients. Bleeding site included 23 gastrointestinal hemorrhage patients and 37 abdominal hemorrhage patients. Mild bleeding occurred in 37 patients and severe bleeding in 23 patients. Among them, 3 patients were grade A??40 patients grade B??17 patients grade C. Postoperative complications included postoperative pancreatic fistula in 28 patients??intra-abdominal infection in 5 patients and biliary fistula in 3 patients. Treatment strategies contained 41 patients with bleeding were treated conservatively, 9 patients received endoscopy or angioembolization while 10 patients underwent reoperation. Intra-abdominal infection and bleeding degree were important risk factors of clinical outcomes of hemorrhage after pancreaticoduodenectomy. ROC curve analysis showed that the 5th day of after surgery was a clear demarcation point of clinical prognosis. Conclusion Intra-abdominal infection, bleeding degree and grade are important risk factors of hemorrhage after pancreaticoduodenectomy. The 5th day after surgery may be a clear demarcation point of clinical prognosis, which has certain significance for the bleeding grade.     

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胰部分切除或全胰切除均可发生吻合口溃疡 (ａｎａｓｔｏ ｍｏｔｉｃｕｌｃｅｒａｔｉｏｎ) ,属胰腺切除的远期并发症 ,吻合口溃疡又称边缘溃疡 (ｍａｒｇｉｎａｌｕｌｃｅｒａｔｉｏｎ)。为了防止吻合口溃疡发生 ,传统的胰腺切除手术往往附加远端胃切除术或迷走神经切断术。但 5 0 %以下的胃切除不足以预防溃疡的发生。因此 ,文献常有胰十二指肠切除后并发边缘溃疡的报告。1　发病率复习近几十年文献 ,胰部分切除或全胰切除后吻合口溃疡的文献报道较少。其准确的发生率尚未明了 ,究其原因可能与此并发症并非十分常见有关。另外 ,相当部分病…     

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??A retrospective analysis of lung recurrence after curative resection for gastric cancer LIU Dan*, LU Ming, LI Jian, et al. *Department of Phase 1 Clinical Trial, Key Laboratory of Carcinogenesis and Translational Research??Ministry of Education/Beijing??,Beijing100142, China
Corresponding author??SHEN Lin??E-mail??linshenpku@163.com
Abstract Objective Systematical analysis for lung recurrence has not yet been established for gastric cancer after surgical resection.The aim of this study was to investigate the incidence of and related risk factors for lung recurrence after surgical resection of gastric cancer. Methods A cohort of 1054 gastric adenocarcinoma patients after curative resection without neo-adjuvant chemotherapy was enrolled.Clinicopathological characteristics were retrospective collected.The incidence and the risk factors of lung recurrence after surgical resection of gastric cancer were investigated by software SPSS. Results In a total of 1054 patients analyzed??lung recurrence was detected in 35 patients ??3.3%??.Lung recurrence was general observed in advanced gastric cancers.Most patients had multiple lung metastases.The median time for lung recurrence was 13.2 months ??interquartile range [IQR] 6.37??21.33?? from the surgery.The median survival was 18.83 months ??IQR 8.20??36.30?? from the lung recurrence.In univariate analysis??the lung recurrence rate was higher in the tumors with old age ????65y????location in the upper third or entire stomach.Patients with N0-1 and signet ring cell cancer showed potential less likelihood of experiencing lung recurrence.In multivariate analysis??age ????65y vs.?Q65y?? was the most predictable risk factor for lung recurrence ??odds ratio [OR] 2.102??95% confidence interval [CI] 1.046-4.226??.And tumor location ??upper third stomach??entire stomach vs.lower third stomach?? was also independently associated with lung recurrence.Conclusion The incidence of lung recurrence was low after curative resection in patients with gastric cancer.However??the prognosis of lung recurrence was relative better.Regular follow up with chest computerized tomography ??CT?? seems to be necessary in those patients with old age ????65y?? and tumors location in upper third and entire stomach??especially within the first 3 years after curative surgery.     

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??Analysis of the risk factors of hypoparathyroidism following total thyroidectomy ZHU Li-zhang, LI Peng, HAN Bin, et al. Department of Thyroid Surgery, Peking University Shenzhen Hospital, Shenzhen 518036, China
Corresponding author??WEI Wei, E-mail??rxwei1123@163.com
Abstract Objective To investigate the risk factors of transient hypoparathyroidism after total thyroidectomy and the clinical value of routine postoperative calcium supplementation. Methods The data of 237 patients performed total thyroidectomy in Peking University Shenzhen Hospital from January 2017 to October 2017 were analyzed retrospectively. All the patients were given calcium supplementation on the day of operation prophylactically. Meanwhile, PTH and Ca2+ were reexamined on the first day after operation. The clinical data of all the patients were collected and analyzed. Results (1) Among the patients, hypoparathyroidism was occurred in 139 cases (58.6%). Three cases (1.3%) were permanent hypoparathyroidism and 136 cases (57.3%) were transient hypoparathyroidism. (2) There was no significant difference in the incidence of transient hypoparathyroidism among different age, sex, and surgical pathway (P>0.05). (3) The scope of lymph node dissection, reoperation and whether the parathyroid glands were misdissection had statistical significance in the incidence of postoperative hypoparathyroidism (P<0.05). Conclusion (1) Wider lymphadenectomy, complicated surgery and incidental parathyroidectomy are the risk factors of transient hypoparathyroidism.(2) The detection of PTH on the first day after operation can predict postoperative hypoparathyroidism better than serum calcium. (3) Regular supplement of calcium and calctriol can avoid hypocalcemia effectively.     

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??Risk factors for anastomotic leakage after anterior resection for rectal cancer PAN Bo??ZHOU Jian-ping??DONG Ming. Department of Gastrointestinal Surgery??the First Hospital of China Medical University??Shenyang 110001??China
Corresponding author??DONG Ming??E-mail??dongming@cmu.edu.cn
Abstract Objective To explore the risk factors for anastomotic leakage after anterior resection for rectal cancer. Methods The clinical data of 262 patients who underwent anterior resection for rectal cancer in the Department of Gastrointestinal Surgery, the First Hospital to China Medical University from January 2014 to June 2018 were analyzed retrospectively. The association between the 31 variables and anastomotic leakage by univariate and multivariate logistic regression analyses were performed. Results Forty-one patients had anastomotic leakage which constituted 15.6% of total 262 patients who underwent anterior resection for rectal cancer. The results of univariate analyses revealed that??the number of distal rectal cut closure??P=0.040????anastomotic methods??P=0.030????perioperative blood transfusion??P<0.001????postoperative diarrhea??P<0.001?? were significantly associated with anastomotic leakage; Multivariate analyses found that: anastomotic methods??P=0.008????perioperative blood transfusion??P<0.001????postoperative diarrhea??P<0.001?? were significantly associated with anastomotic leakage independently. Conclusion In anterior resection of rectal cancer??reduce use frequency of anastomat stapler??avoid unnecessary perioperative blood transfusion??and pay attention to early postoperative diarrhea??it is helpful to reduce anastomotic leakage.     

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??Risk factors of pancreatic fistula after pancreaticoduodenectomy YANG Yin-mo. Department of Surgery??Beijing University First Hospital??Beijing 100034??China
Abstract Pancreaticoduodenectomy offers the only chance of curative resection for periampullary tumors??which is technically challenging and is accompanied by a substantial risk for postoperative complications. The most significant complication is pancreatic fistula which often causes infectious complications??hemorrhage??which makes it the leading risk factor for postoperative death. Risk factors for development of pancreatic fistula are now well known??and several technical modifications??which focus on the type of pancreatic anastomosis??duct stenting??somatostatin and analogues??have been suggested in prevention of pancreatic fistula. Although no one technique of pancreatic anastomosis has been shown to be superior in decreasing the rate of pancreatic fistula??meticulous attention to intraoperative details by surgeons is necessary to prevent pancreatic fistula.     

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??Risk factors analysis of bile duct injuries caused by laparoscopic cholecystectomy WANG Hong, LUO Jian-guan, LIANG Peng, et al. Department of Hepatobiliary Surgery, People’s Hospital of Liuyang City, Liuyang 410300, China
Corresponding author: WANG Hong, E-mail??wanghong810112@tom.com
Abstract Objective To analyze risk factors of bile duct injuries caused by laparoscopic cholecystectomy. Methods The clinical data of 4531 cases of laparoscopic cholecystectomy between October 1999 and December 2010 in People’s Hospital of Liuyang City were analyzed retrospectively. All influential factors were checked in chi square, and independent risk factors about bile duct injuries were analyzed simultaneously. Results Univariate analysis showed bile duct injuries were associated with gender, staging of inflammation, thickness of cholecyst wall by sonography, anatomy of Calot’s triangle and surgical experience (P??0.05). Anatomy of Calot’s triangle and surgical experience were independent risk factors of bile duct injuries, which was showed by multivariate unconditional Logistic regression analysis (P??0.05). Conclusion Anatomy of Calot’s triangle and surgical experience are independent risk factors of bile duct injuries.     

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??Analysis of risk factors leading complications after laparoscopic-assisted radical gastrectomy QIU Jiang-feng??GU Jia-yi??WANG Xiao-song??et al. Department of Gastrointestinal Surgery, Renji Hospital??Shanghai Jiaotong University School of Medicine??Shanghai 200127??China
Corresponding author??ZHAO Gang??E-mail??zhaogang74313@aliyun.com
Abstract Objective To explore the risk factors of the complications after laparoscopic-assisted radical gastrectomy. Methods The clinical data of 245 patients receiving laparoscopic-assisted radical gastrectomy in Department of GI Surgery??Renji Hospital??Shanghai Jiaotong University School of Medicine from January 2010 to December 2015 were analyzed retrospectively. The ROC curve was used to determine the critical value of the observed index, and the correlation between the factors and the incidence of complications was analyzed by χ2 test. Logistic regression was used for multivariate analysis. Results Of the 245 patients undergoing laparoscopic-assisted radical gastrectomy??33 patients??13.5%??had postoperative complications. Of the 17 indexes observed in the analysis??BMI≥25??χ2=12.620??P<0.01????with more than 1 comorbidities??χ2=4.272??P=0.039????serum albumin≤33 g/L??χ2=6.805??P<0.01????operation time> 230 min??χ2= 7.976??P<0.01????intraoperative blood loss> 200 mL??χ2=7.140??P<0.01????perioperative blood transfusion> 600 mL??χ2=22.686??P<0.01????tumor diameter>2 cm??χ2=9.812??P<0.01??and lack of operation experience??χ2=5.896??P=0.015??were associated with postoperative complications. Multivariate analysis showed that serum protein levels??≤33 g/L??, perioperative blood transfusion volume ??>600 mL??and tumor diameter ??>2 cm?? were independent risk factors for postoperative complications. Conclusion For the patients performed laparoscopic-assisted radical gastrectomy??surgeons should preoperatively assess the patients’ general conditions carefully and correct the hypoproteinemia??accuratly operate to reduce the amount of bleeding and blood transfusion??choose appropriate method of anastomosis and complete learning curve of the procedure as soon as possible to reduce the incidence of complications effectively.     

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目的 探讨胃大部切除术后残胃功能性排空障碍的病因、诊断及治疗。方法 对1990—2001年587例胃大部切除术病例资料进行回顾性分析。结果 587例中有26例出现胃功能性排空障碍，发生率为4．4％。所有病例经保守治疗后，7—28天内治愈。结论 术后胃肠道运动的改变及吻合口水肿可能是胃排空障碍的主要原因，而高龄、营养不良、水电解质失衡、腹腔感染则是诱因。胃肠道造影及胃镜检查是诊断本病的重要方法。采取非手术治疗一般均可治愈。     

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??Potential risk factors for postoperative pulmonary complications in gastric cancer patients ZHANG Wei-han??CHEN Xin-zu??YANG Kun??et al. Department of Gastrointestinal Surgery??Institute of Gastric Cancer??West China Hospital??Sichuan University??Chengdu 610041??China
Corresponding author??HU Jian-kun??E-mail??hujkwch@126.com
Abstract Objective To compare the clinicopathological characteristics between postoperative pulmonary complications (PPCs) patients and non-complication patients, to identify the potential risk factors for developing PPCs. Methods The clinical data of 719 gastric cancer patients who underwent gastrectomy in West China Hospital of Sichuan University from January 2012 to December 2015 were analyzed retrospectively. Patients received preoperative chemotherapy, diagnosed as remnant gastric cancer or had any other postoperative non-pulmonary complications were excluded. All the patients were divided into PPCs group (103 patients) and non-PPCs group (616 patients). Results Patients in the PPCs groups had significantly longer postoperative hospital stay than patients in the non-PPCs group [??13.5±7.0??d vs.??10.7±3.1??d??P<0.001]. Other data had no statistical difference between two groups??P>0.05??. The age of patients (P=0.018)??history of pulmonary disease (P<0.001)??preoperative pulmonary function test (FEV1/FVC) ??P=0.002????hemoglobin level (P=0.004)??intraoperative blood loss (P=0.042) and surgical duration (P=0.048) were risk factors identified by the univariate analysis. Finally, the logistic regression found out that??history of pulmonary disease (P<0.001)??preoperative pulmonary function test (P=0.032) and hemoglobin level (P=0.004) were the independent risk factors for the incidence of the PPCs. Conclusion The postoperative pulmonary complication is one of the common complications of the gastric cancer patients. Body Mass Index level (≥25)??history of pulmonary disease??preoperative pulmonary function test (FEV1/FVC<60) and hemoglobin level (<90 g/L) were the independent risk factors for the incidence of the PPCs.     

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目的探讨食管下段胃近端切除，回盲肠间置术治疗门静脉高压症术后再出血的疗效。方法1998～2004年广西医科大学附属第一医院采用食管下段胃近端切除．回盲肠间置术治疗断流术术后再出血5例。结果5例均获随访，最长6年，最短2年。随访期无食管静脉曲张，无复发出血。无术后近期死亡、并发症。结论食管下段胃近端切除、回盲肠间置术治疗门静脉高压症术后再出血止血确切，是一种比较理想的手术方法。     

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??Risk factors for early postoperative complication after ileal/ileocecal resection for chronic radiation enteritis with small bowel obstruction GONG Jian-feng, ZHU Wei-ming, YU Wen-kui, et al. Research Institute of General Surgery, Nanjing General Hospital of Nanjing Military Command PLA, Medical College of Nanjing University, Nanjing 210002, China
Corresponding author ??LI Ning, E-mail: liningrigs@yahoo.com.cn
Abstract Objective To identify the perioperative complication incidence and its risk factors in patients underwent ileal/ileocecal resection for chronic radiation enteritis (CRE) with small bowel obstruction. Methods Univariate and multivariate analysis of a retrospectively gathered database between June 2001 and December 2011 in Department of General Surgery, Nanjing General Hospital of Nanjing Military Command PLA were performed on a cohort of patients (n=158) underwent ileal/ileocecal resection for CRE obstruction at a single institution. Altogether, we analyzed 33 potential risk factors to identify significant influence on the postoperative outcome. Results Overall and major morbidity rates were 57.0% (90 patients) and 28.5% (45 patients), respectively. The mortality rate was 1.9% (3 patients). Univariate analysis determined that ASA score of not less than 3, anemia, low platelet level, long operation time, intraoperative transfusion, presence of radiation uropathy and proctitis and experience of surgeons were important risk factors for Grade ??-?? morbidity. Multivariate analysis found ASA score of not less than 3, anemia, intraoperative transfusion, low platelet level, radiation uropathy and surgeon’s experience as independent risk factors for Grade ??-?? morbidity. Conclusion The current study provides the first evidence of predictive risk factors for postoperative morbidity of ileal/ileocecal resection for CRE.     

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1990～ 1999年 1月我院发生 10例胆囊切除术中漏诊胃肠道肿瘤的病例 ,同时收治外院转来同类病人 6例。共16例。男 9例 ,女 7例。年龄 42～ 6 6岁 ,平均 6 2 2岁。表现上腹部或右上腹部疼痛不适 16例 ,恶心、呕吐 8例 ,纳差、消瘦 5例 ,贫血 6例 ,黑便 1例 ,腹泻 2例。胆囊切除术前Ｂ超检查提示 :胆囊结石、慢性胆囊炎11例 ,胆囊结石、慢性胆囊炎急性发作 2例 ,慢性胆囊炎 3例。本组术前均未行有关胃肠道肿瘤诊断检查。术后胃镜检查并活检证实胃癌 9例 ,结肠镜检查并活检证实结肠癌4例 ,钡灌肠检查显示升结肠占位病变 2例 ,低张上消化道钡餐…     

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??Prevention and treatment of reflux esophagitis after proximal gastrectomy SUO Jian??LI Wei. Department of Gastrointestinal Surgery??the First Hospital of Jilin University??Changchun 130021??China
Corresponding author??SUO Jian??E-mail??suojian0066@126.com
Abstract Proximal gastrectomy is one of operation methods to treat the benign and malignant tumors of the esophagogastric junction and gastric fundus which can reserve more function of the stomach and get a better quality of life after surgery. For the reason of the upper gastrectomy??breaking the anatomical structures and biological function and other reasons leading to reflux esophagitis are the main reasons for reducing postoperative quality of life. Many different types of reconstruction have been proposed. It is of important values to choose appropriate reconstruction methods to prevent reflux esophagitis. Surgery??intervention therapy and pharmacotherapy can be used to treat reflux esophagitis and to improve the quality of life of patients.     

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1　病历简介例 1.女 ,3 0岁。因胃溃疡行了胃大部切除、经结肠后Billroth Ⅱ式胃肠重建术。术后第 4天胃肠功能恢复 ,拔除胃管开始进流质食物 ,第 7天拆除切口皮肤缝线。术后第8天下午病人出现上腹疼痛 ,检查上腹部压痛、软。对症处理 ,并再禁饮食。第 9天出现呕吐 ,安放胃肠减压管 ,继续观察。第 10天下午腹痛加重 ,腹部X线透视见左上腹有液平面 ,当晚行二次手术。术中见部分空肠经胃空肠吻合口后间隙疝入 ,压迫空肠输入襻使之梗阻 ,十二指肠第 3段扩张呈囊袋状 ,且已发黑坏死并穿孔 ,十二指肠第 2段血运良好。诊断 :内疝、输入襻梗阻、十…     

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??Clinical efficacy and quality of life of pylorus-preserving gastrectomy for early gastric cancer: a Meta-analysis LIANG Ji-wang, SONG Yong-xi, SUN Jing-xu, et al. Department of Surgical Oncology and General Surgery, the First Hospital of China Medical University, Shenyang 110001, China.
Corresponding author: WANG Zhen-ning, E-mail??josieon826@yahoo.com.cn
Abstract Objective To assess the clinical efficacy and postoperative quality of life of pylorus-preserving gastrectomy(PPG) for early gastric cancer. Methods Literature search was performed in PubMed, Wiley Online Library, Chinese Biomedical Database(CBM), CNKI, VIP and Wanfang to identify clinical randomized controlled trails on PPG and conventional distal gastrectomy (CDG) for early gastric cancer published between January 1995 and November 2010.RevMan 5.0 software was used for statistical analysis. Results A total of 13 studies involving 1011 patients were included. Meta-analysis showed that compared with PPG group, early dumping syndrome, gastritis were more common in CDG group. Nutritional status and the average relative body weight in PPG group were better than those in CDG group significantly. However, there were no significant differences between the two groups in complications, gallstones and reflux esophagitis. Conclusion PPG is safe and effective for the treatment of patients with early gastric cancer, which may have a better postoperative quality of life. Due to the poor quality and small sample size of included trials, more well-designed randomized controlled trials should be performed.