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??Value of early goal-directed therapy for treatment of surgical patients with severe sepsis DAI Hai-wen, ZHANG Zhao-cai, YAN Jing, et al. Department of Intensive Care Unit, Zhejiang Hospital, Hangzhou 310013, China Corresponding author: YAN Jing, E-mail: zjicu@vip.163.com Abstract Objective To investigate the effect of early goal-directed therapy (EGDT) on surgical patient with severe sepsis. Methods One hundred and seventy-seven surgical patients with severe sepsis admitted between August 2004 and June 2007 at 7 hospitals of Grade III Level A in Zhejiang Province were randomized to conventional treatment group (n=90) and EGDT group (n=87), the former was underwent fluid resuscitation goaled by central venous pressure (CVP), mean artery blood pressure (MBP) or systolic blood pressure (SBP) and urinary output, and the latter was guiding by CVP, MBP or SBP and UO plus central venous oxygen saturation (ScvO2)??The patients were achieved the goals by treating with fluid, transfusions and cardiac stimulants in a period of 6 hours after enrollment. The difference of 28-day survival (primary endpoint), the length of stay in ICU, mechanical ventilation time, antibiotics utilization time, complication of newly infection and clinical scores (secondary endpoints) between the 2 groups was compared. Results In comparison with conventional group, the 28-day survival of EGDT group was increased by 18% (79.3% vs 61.1%, P=0.023), the APACHE II score and MODS score were significantly improved after 6h of EGDT fluid resuscitation (APACHE II: 21.7±5.9 vs 15.4±4.3, P=0.008; MODS: 8.4±3.3 vs 5.1±2.9, P=0.017), there is no difference in other parameters for secondary endpoint (all P>0.05). Conclusion EGDT improved 28-day survival and clinical scores and had beneficial effects on outcomes in surgical patients with severe sepsis.     

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??Clinical value of parathyroid hormone-immune colloidal gold technique in intraoperative rapid identification of parathyroid gland ZHANG Jin-jun??XIA Wen-fei??SHEN Wen-zhuang, et al. Department of Breast and Thyroid Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
Corresponding author: LI Xing-rui??E-mail??lixingrui@tjh.tjmu.edu.cn
Abstract Objective To investigate clinical value of intraoperative rapid identification of parathyroid gland with parathyroid hormone -immune colloidal gold technique??PTH-ICGT??. Methods The data of 79 patients who received thyroid lobectomy in the Department of Breast and Thyroid Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology between January 2016 and May 2016 were collected. Parathyroid hormone (PTH) was detected in different tissues around parathyroid gland of these patients with PTH-ICGT, and the results were conducted comparative analysis. The data of 106 patients who received total thyroidectomy between June 2016 and December 2016 were collected, who were randomly divided into PTH-ICGT group and conventional visual group, the numbers of parathyroid gland recognition and the incidence of hypoparathyroidism were analyzed between the two groups. Results Among the 79 cases who received thyorid lobectomy, PTH in parathyroid gland tissue detected by PTH-ICGT method was ??955.3±16.1??ng/L which was highlyexpressed, while the results in skeletal muscle, thyroid tissue, adipose tissue, lymph node tissue respectively were ??14.5±1.5??ng/L, ??15.0±1.3??ng/L, ??15.3 ±1.2??ng/L, ??14.0±1.2??ng/L respectively, which were extremely low, the difference was statistically significant between PTH in parathyroid and the other tissues??t=23.62,33.42,39.34,30.77 respectively; all P<0.0001??.The results of PTH in different distance from parathyroid gland were??955.3±16.1?? ng/L (parathyroid gland / 0mm), ??14.6±1.5?? ng/L(1 mm),??16.7±1.6?? ng/L(2 mm),??15.1±1.4?? ng/L(3 mm),??13.0±1.1?? ng/L(5 mm), the difference was statistically significant between 0mm and the other different distances (t=23.62,30.68,33.42,31.50 respectively; all P<0.0001). The total matching percentage in the conventional visual group was 74.1%??and that in PTH-ICGT group was 98.6%??χ2=35.57;P<0.0001??. In the 106 patients who received total thyroidectomy, the rate of parathyroid gland detection was 92.4% in the conventional visual group??n=53??, and 96.2% in PTH-ICGT group??n=53??, the difference was not significant??χ2=0.7067??P=0.40??. The incidence of temporary hypoparathyroidism in the conventional visual group and PTH-ICGT group were 11.3% and 5.7% (χ2=1.093, P>0.05), and that of permanent parathyroid hypogonadism in the two groups was 3.8% and 0 respectively (Fisher test, P=0.495). Conclusion The recognition efficiency of PTH-ICGT in detecting parathyroid glands was high. PTH-ICGT method may improve the rate of clinical parathyroid gland recognition and reduce the incidence of hypoparathyroidism related to the operation, but large sample studies are still needed to be further verified.     

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目的探讨胆道镜在胰管结石手术治疗中的应用价值。方法回顾性分析2004年1月至2009年9月中国医科大学附属盛京医院在胰管切开取石联合胰管空肠Roux-en-Y吻合手术中应用胆道镜治疗9例胰管结石(胆道镜取石组),并与2003年1月至2009年9月仅行常规胰管切开取石联合胰管空肠Roux-en-Y吻合术治疗12例胰管结石(常规手术组)进行比较。结果胆道镜取石组术中出血量(233.3±55.9)mL,显著低于常规手术组[(583.0±135.4)mL,t=5.448,P=0.031]。术后残石率胆道镜取石组显著低于常规手术组(0 vs.41.7%,P=0.045)。术后疼痛缓解率胆道镜取石组(88.9%)高于常规手术组(50.0%),但差异无统计学意义(P=0.159)。结论在胰管结石手术中使用胆道镜取石技术能显著提高结石取净率和减少术中出血量,有可能提高术后疼痛缓解率。     

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??Effect of the biliary drainage reconstruction by jejunal foreside to hepatic parenchyma on the ?? ??type hilar cholangiocarcinoma DU Xi-chen, JIN Xing-lin. Department of Hepatobiliary, Yanbian University Hospital, Yanji 133000, China
Corresponding author??JIN Xing-lin?? E-mail:xljin@ybu.edu.cn
Abstract Objective To study the technique for anastomosis of jejunal forepart with hepatic parenchyma on the ????type hilar cholangiocarcinoma. Methods Twenty-three patients with advanced ??, ?? type hilar cholangiocellular carcinoma underwent radical resection with jejunum rearside to bile duct rearside between June 2004 and June 2009 at the Department of Hepatobiliary of Yanbian University Hospital. In the cavity of jejunum near anastomosis drainage tube was laid and fetched out. Then hepatic parenchyma to jejunal foreside was sewed up. Results Only one patient occurred anastomotic leakage. None of the patients developed anastomotic blooding and stenosis. The duration for accomplishing the anastomosis was 20 minutes averagely. Conclusion The techniqe of the biliary drainage reconstruction by jejunal foreside to hepatic parenchyma on the hilar cholangiocarcinoma can be safe and used routinely.     

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目的探讨应用回肠蕈状双腔造口预防腹腔镜直肠癌全直肠系膜切除(TME)术后吻合口漏的可行性。方法回顾性分析2006年4月至2010年3月辽宁省肿瘤医院大肠外科应用回肠蕈状双腔造口术预防腹腔镜TME术后吻合口漏的65例(造口组)及同期未行预防性造口的腹腔镜直肠癌TME手术85例(未造口组)病人临床资料。腹腔镜下完成低位或超低位吻合后,造口组于距回盲瓣30～40cm处回肠于右髂前上棘与脐连线外1/3处行双腔造口,回肠沿与纵轴垂直方向切开达1/2周,近端做蕈状乳头高于皮肤0.5cm,远端回肠平坦式缝合于皮肤。骶前放置双腔引流管。术后3～5个月闭瘘。未造口组仅骶前放置双腔引流管。结果造口组病人粪便转流彻底。无造口周围皮肤严重腐蚀与不耐受,无死亡病例,无吻合口漏。未造口组5例出现吻合口漏,3例4～8周后愈合,2例行手术造口治疗后治愈,无死亡病例。结论应用回肠蕈状双腔造口术预防腹腔镜直肠癌TME术后吻合口漏是可行的,造口护理方便,闭瘘创伤小,粪便转流彻底。     

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??Laparoscopic resection for gastric stromal tumor LI Zi-yu*, XING Zhao-dong, WANG Jing, et al. *Department of Gastrointestinal Surgery, Peking University Cancer Hospital & Institute, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education of China), Beijing 100142, China
Corresponding author: LI Zi-yu, E-mail: ligregory@outlook.com
Abstract Objective To evaluate the indication and safety of laparoscopic resection for gastric stromal tumor.??Methods The clinical data of 58 cases of GIST performed laparoscopic gastric resection (LR) and 99 cases performed open gastric resection (OR) from July 2007 to September 2014 at Peking University Cancer Hospital and Institute were compared retrospectively. Results Compared with the OR group, the LR group showed no significant difference in postoperative hospital stay [8.5 d vs. 8.9 d, P=0.684] and operation time [118 min vs. 110 min, P=0.272]. However, the bleeding volume in the LR group was less [37 mL vs. 66 mL, P=0.000], incision length was shorter [5.1 cm vs. 15.7 cm, P=0.000], and tumor size was smaller [3.9 cm vs. 5.5 cm??P=0.000]. No severe complications such as bleeding and leakage were found in both groups. Median follow up time in the LR group and the OR group was 29 months and 36 months respectively. During the period, no recurrence was detected in the LR group, while recurrence was found in two cases of high risk in the OR group. Conclusion Laparoscopic resection is safe, feasible and minimally invasive for the small gastric stromal tumor and can get the same therapeutic effect as OR.     

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??Clinical significance of calcification in Hashimoto's thyroiditis with thyroid cancer LONG Guan-bao, ZHANG Chun-xia, ZHENG Jian-wei, et al. Department of Biliary-pancreatic Surgery, Affiliated Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030,China
Correspondence author: SHEN Ming, E-mail:shen_ming75@yahoo.com.cn
Abstract Objective To investigate the clinical significance of calcification in Hashimoto's thyroiditis with thyroid cancer. Methods The clinical data of 184 cases of Hashimoto's thyroiditis asscciated with thyroid cancer treated between January 2001 and December 2011 in Department of Biliary-pancreatic Surgery, Affiliated Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology (excluding cases with a history of thyroid surgery) were analyzed retrospectively. Results Hashimoto's thyroiditis associated with thyroid cancer was in 43 cases??23.4%??43/184??, with calcification in 26 cases. Among 141 cases of Hashimoto's thyroiditis and Hashimoto's thyroiditis associated with benign thyroid diseases, 13 cases had calcifications. The ratio of calcification in Hashimoto's thyroiditis associated with thyroid cancerthe was higher than that in Hashimoto's thyroiditis associated with benign thyroid diseases (P<0.05). There were 22 cases of microcalcifications in 26 cases of malignant calcification while coarse calcifications were 3 cases. The specificity of microcalcifications ratio in Hashimoto's thyroiditis with thyroid cancer was 84.6%??22/26??.The diagnosis rate of Hashimoto's thyroiditis associated with thyroid cancer performed FNAC was 67.6%(25/37). Conclusion Microcalcification has the high specificity for the diagnosis of Hashimoto's thyroiditis associated with thyroid cancer. Prompted Hashimoto's thyroiditis patients with microcalcifications on ultrasonography should be positive surgical exploration combined with intraoperative rapid pathological examination, which can improve the rate of early diagnosis of Hashimoto's thyroiditis associated with thyroid cancer effectively.     

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目的 探讨连续性血液净化(CBP)治疗普通外科严重感染综合征的临床价值.方法 回顾性分析中山大学附属第一医院SICU在2006-01-01-2007-12-31期间52例接受CBP治疗的严重感染综合征(severe sepsis)病人资料.结果 CBP治疗时间(13.5±29.4)d,在CBP治疗期间分别采用低分子质量肝素抗凝11例(21.2%)、体外肝素抗凝13例(25.0%)、无抗凝19例(36.5%),未发生严重出血并发症.52例病人好转16例(30.8%),自动放弃治疗19例(36.5%),ICU内死亡17例(32.7%).抗凝方式、手术类型、感染部位等对CBP疗效影响差异无统计学意义.结论 CBP是外科严重感染综合征病人重要治疗措施之一,治疗过程中应采取个体化抗凝方案.     

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??Application of Cattell-Braasch maneuver in the surgical treatment of retroperitoneal tumors LI Cheng-peng??QIAN Hong-gang??LENG Jia-hua??et al. Key Laboratory of Carcinogenesis and Translational Research??Ministry of Education????Sarcoma Center??Peking University Cancer Hospital & Institute??Beijing100142??China
Corresponding author??HAO Chun-yi??E-mail??haochunyi@vip.sina.com
Abstract Objective To investigate the feasibilities and safeties of the application of Cattell-Braasch maneuver in the surgical treatment of retroperitoneal tumors. Methods The clinical data of 47 cases of retroperitoneal tumors which explored by Cattell-Braasch maneuver intraoperatively at Peking University Cancer Hospital between July 2007 and March 2015 were analyzed retrospectively. Results All tumors in 47 cases were resected completely. Operations lasted for 110 to 835 min (average??320min)??in which only 10 to 15 min were needed for Cattell-Braasch maneuver. The blood loss was 50 to 4500mL. The sizes of the resected tumor were 3.2 to 39.5cm. Neither abdominal organs nor vessels were accidentally injured by Cattell-Braasch maneuver in all cases. Conclusion Cattell-Braasch maneuver could provide satisfactory explosion of retroperitoneal spaces and improve security of en-bloc resection of retroperitoneal tumors.     

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目的探讨虚拟肝脏手术规划对中央型肝癌切除术的指导价值。方法应用虚拟肝脏手术规划系统软件Liv1.0对福建医科大学附属第一医院2007年6月至2012年6月49例病人进行虚拟中央型肝癌切除手术规划,将虚拟手术规划结果与手术中所见进行对比。结果 49例病人虚拟肝脏手术规划所测预切除肝脏体积为(543±225)mL,实际切除肝脏体积为(573±212)mL,平均误差(29±66)mL,两者间高度正相关(相关系数r=0.983,P<0.01)。结论针对中央型肝癌切除术,应用虚拟肝脏手术规划进行手术模拟,有利于评估肿瘤的可切除性并指导手术切除方式的选择。     

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??The application of ultrasound guided vacuum assisted excision system in the diagnosis and treatment of breast disease XU Xiao-zhou, ZHANG BO-lin, WANG Xiang. Cancer Hospital, Chinese Academy of Medical Science, Beijing 100021, China Corresponding author: WANG Xiang, E-mail: Xiangw@vip.sina.com Abstract Objective To investigate the clinical value of ultrasound guided vacuum assisted excision on the diagnosis and treatment of breast lesions. Methods Ultrasound guided vacuum assisted excision was performed on 469 lesions from 416 patients between Dec 2006 to May 2008. Its value on diagnosis and treatment of breast lesions was analyzed retrospectively. Results Among them, there were 6 cases of invasive ductal carcinoma and 3 case of intraductal carcinoma(four cases of T0 stage and five cases of T1 stage) and 460 cases of benign lesions. All patients with breast cancer received additional radical operation and no histological underestimation was found. 2 cases of local recurrence among the benign lesions were found six month later and received another excision with the pathological diagnosis of fibroadenoma. No remnant lesion was found at the re-examination six months later. Incidence rate of postoperative complications was 1.2%. Conclusion Breast lesions with the maximum diameter from 5 to 28 millimeters could be resected completely by ultrasound guided vacuum assisted excision system and obtained the pathologic diagnosis. With the help of this method, we can find breast cancer in early stage suspected by ultrasound. In addition, benign disease could also be treated with a minimum wound. This technique has the characteristics of accurate, safe and small wound.     

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??Preoperative evaluation of hepatic hilum cholangiocarcinoma resectability with enhanced MRI and MRCP ZHOU Qian-jing, ZHANG Tao, WU Wen, et al. Department of Radiology, No. 157 Hospital, General Hospital of Guangzhou Military Command of PLA, Guangzhou 510010, China
Corresponding author: ZHOU Qian-jing, E-mail: bl7515@126.com
Abstract Objective To study enhanced MRI and MRCP findings of hepatic hilum cholangiocarcinoma and their preoperative evaluation value. Methods Enhanced MRI and MRCP findings in 30 patients with hepatic hilum cholangiocarcinoma proved pathologically between June 2006 and October 2009 at General Hospital of Guangzhou Military Command of PLA were analyzed retrospectively. The preoperative evaluations and operative results were compared. Results All patients were found to have soft tissue mass at porta hepatis with delayed enhancement, and intrahepatic biliary duct dilation was seen. Enhanced MRI and MRCP imaging could find infiltrated bile duct and blood vessel objectively, and metastatic tumor also could be seen availably. The sensitivity, specificity and accuracy of preoperative evaluation in all patients with hepatic hilum cholangiocarcinoma were 81.8?? and 91.6?? and 86.9??. Conclusion Enhanced MRI and MRCP are valid methods in the preoperative evaluation of hepatic hilum cholangiocarcinoma.     

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??Total laparoscopic uncut Roux-en-Y anastomosis in the distant gastrectomy with D1+ or D2 dissection for gastric cancer YANG Li*, XU Ze-kuan, XU Hao, et al. *Division of Gastric Surgery, Department of General Surgery, the First Affiliated Hospital of Nanjing Medical University, Nanjing210029, China
Corresponding author: XU Ze-kuan, E-mail: xuzekuan@njmu.edu.cn
Abstract Objective To investigate the safety and feasibility of laparoscopic uncut Roux-en-Y anastomosis in the distant gastrectomy with D1+ or D2 dissection for gastric cancer. Methods The clinical data of 18 patients performed laparoscopic uncut Roux-en-Y anastomosis from September 2014 to January 2015 in the Division of Gastric Surgery, Department of General Surgery, the First Affiliated Hospital of Nanjing Medical University were analyzed retrospectively. Results All the patients were performed the operation successfully. The mean operation duration, anastomosis time, blood loss and the number of lymph nodes dissection during the surgery were (164.8±23.1) min, (31.4±7.1)min, (19.1±9.0)mL and 37.0±8.5 respectively. The time cost before gastrointestinal motility, liquid-diet intake, out-of-bed ambulation and the average hospitalization days after operation were (70.6±17.9) hours, (4.9±0.8) days, (46.2±17.3) hours and (10.2±3.0) days respectively. Two patients suffered from gastrointestinal bleeding and were cured conservatively. None of the other complications occurred, such as anastomotic fistula, anastomotic stenosis, RSS, infection of incision and so on. Conclusion The total laparoscopic uncut Roux-en-Y anastomosis is safe and feasible in the distant gastrectomy with D1+ or D2 dissection for gastric cancer, with advantages of less trauma, faster recovery and so on.     

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??Application of chimney technique in thoracic endovascular aneurysm repair of aortic arch lesion without good landing zone ZHANG Xi-wei, YANG Hong-yu, ZOU Jun-jie, et al. Department of Vascular Surgery, the First Affiliated Hospital of Nanjing Medical University, Nanjing 210019, China
Corresponding author: ZOU Jun-jie, E-mail: junjiezou1974@gmail.com
Abstract Objective To evaluate the feasibility of chimney technique in thoracic endovascular aneurysm repair (TEVAR) of aortic arch lesion without good landing zone. Methods The clinical data of 31 cases of aortic arch lesion without good landing zone treated by chimney technique in TEVAR from January 2011 to May 2012 in the First Affiliated Hospital of Nanjing Medical University were analyzed retrospectively. Results Thirty-two chimney stents were deployed in the 31 cases successfully. Endoleakage happened in only 1 case of double chimney stents during the follow-up period of 3 months. Conclusion Chimney technique expands the applicability of TEVAR to patients with challenging anatomy. It is a safe, effective and microinvasive method in the treatment of aortic lesions recently and the therapeutic effect of long term still need to be studied.     

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目的探讨Rouviere沟作为肝外胆管参照点在腹腔镜胆囊切除术中的作用。方法自2010年3月至2011年4月温州医学院附属第一医院腔镜外科连续实施腹腔镜胆囊切除术584例,术中记录Rouviere沟的出现率及分型,并采用以Rouviere沟为导向的胆囊三角区解剖方法。结果 584例中,开放型Rouviere沟346例,融合型Rouviere沟102例,共448例(76.7%)存在Rouviere沟。全组未发生胆管损伤及手术死亡,3例(0.5%)中转开腹,所有病例恢复良好。结论 Rouviere沟是重要的肝外胆管解剖标志,出现于大多数人中。以Rouviere沟为导向的胆囊三角区解剖方法可以预防腹腔镜胆囊切除术中胆管损伤,值得推广应用。     

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??Diagnosis in thyroid nodules with coexistent chronic autoimmune Hashimoto thyroiditis by shear wave elastography LIANG Jin-yu*??LIU Bao-xian??WANG Wei??et al. *Department of Medical Ultrasonics??Institute of Diagnostic and Interventional Ultrasound??the First Affiliated Hospital of Sun Yat-sen University??Guangzhou 510080,China
Corresponding author: WANG Wei??E-mail??wangw73@mail.sysu.edu.cn
Abstract Objective To assess the diagnostic performance of shear wave elastography (SWE) in the differentiation of thyroid nodules with coexistent Hashimoto thyroiditis??HT??. Methods From January 2013 to June 2014??conventional ultrasound (US) and SWE were performed on 297 suspicious thyroid nodules of 260 patients with histological confirmation. 73 patients with 83 nodules were included in the HT group. Results SWE value in the maglignant nodule was significant higher than that in the benign one and surrounding parenchyma (64.4±42.8??kPa vs??26.8±15.3??kPa vs??17.7±5.3??kPa, P<0.05). SWE value in HT group of malignant module was significantly higher than that of benign one and surrounding parenchyma. In the benign and malignant nodules??SWE value between HT and non-HT groups showed no significant differences (P>0.05). SWE value of surrounding parenchyma in HT group was higher than that in non-HT group and had positive correlation with TPO-Ab(r=0.307, P<0.05). Optimal value of SWE to diagnose malignancy was 39.1kPa with sensitivity, specificity and accuracy 68.9%,91.7% and 82.9%, respectively. Conclusions 39.0 kPa of SWE value showed good diagnostic performance in the differentiation of malignant and benign thyroid nodules with coexistent HT.     

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目的探讨腹腔镜镜头旋转与腹腔镜乙状结肠和直肠手术中损伤的关系,总结腹腔镜手术的基本操作原则。方法回顾性分析2006年9月至2014年3月哈尔滨医科大学附属第一医院普外科完成的504例腹腔镜乙状结肠和直肠手术资料。测量腹腔镜镜头旋转角度(<15°、15~30°和>30°),分析术中损伤发生率及镜头旋转角度的关系。结果无损伤组病人术中镜头旋转角度分布为:<15°437例,15~30°31例,无旋转角度>30°者;而损伤组则为:<15°4例,15~30°25例,>30°7例,两组差异有统计学意义(χ2=235.57,P<0.001)。按手术时间顺序对病人进行分组,每100例为1组(最后一组为104例),后4组病人(均采用重力线原则)术中镜头旋转角度分布差异均无统计学意义(P>0.05),且与第一组(前100例,未采用重力线原则)差异均有统计学意义(P<0.05)。结论镜头旋转角度过大易增加腹腔镜直肠手术术中损伤的风险;重力线原则可避免镜头旋转,降低手术风险,快速提高手术水平,建议作为腹腔镜手术的基本原则加以遵循。     

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??Application of single layer pancreaticojejunostomy with external drainage of the pancreatic duct in patients with soft pancreas during pancreaticoduodenectomy??A report of 64 cases YANG Feng??JIN Chen??LI Ji??et al. Department of Pancreatic Surgery??Huashan Hospital??Pancreatic Disease Institute??Shanghai Medical College of Fudan University??Shanghai 200040, China
Corresponding author??FU De-liang??E-mail??surgeonfu@163.com
Abstract Objective To investigate the application value of single layer pancreaticojejunostomy with external drainage of the pancreatic duct in patients with soft pancreas during pancreaticoduodenectomy. Methods The clinical data of 64 patients with soft pancreas who received single layer pancreaticojejunostomy with external drainage of the pancreatic duct during pancreaticoduodenectomy between February 2011 and November 2012 in Department of Pancreatic Surgery??Huashan Hospital??Shanghai Medical College of Fudan University were analyzed retrospectively. Intraoperative condition and postoperative therapeutic effect were observed. Results The operation time of the 64 patients was 6.2??4.0-9.5??h??with intraoperative blood loss of 400??50-2900??mL??anastomosis time of 15.6??11-25??min??and postoperative hospital stay of 14.2 (8-43) d. A total of 35 cases (54.7%) had postoperative complications??including 30 cases of pancreatic fistula ??46.9%??composed of 23 cases of grade A and 7 cases of grade B. There were 3 cases ??4.7%??of delayed gastric emptying??4 cases ??6.3%??of intra-abdominal abscess??1 case ??1.6%??of intra-abdominal hemorrhage and 3 cases ??4.7%?? of incision infection. All the complications were cured after corresponding treatment and none had reoperation or perioperative death. The Clavien-Dindo classification of surgical complications: level ?? in 3 cases??4.7%????level ?? in 27 cases ??42.2%????and level ??a in 5 cases ??7.8%??. Conclusion Single layer pancreaticojejunostomy with external drainage of the pancreatic duct during pancreaticoduodenectomy can obviously reduce clinically significant pancreatic fistula??B/C grade????is especially appropriate for those with soft pancreas. It is worthy of further clinical promotion.     

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??Clinical application and quality control of ultrasound-guided fine-needle aspiration cytology in evaluation of thyroid nodules ZHOU Le??ZHANG Guang??ZHANG Da-qi??et al. Department of Thyroid Surgery??China-Japan Union Hospital??Jilin University & Jilin Province Key Laboratory of Surgical Translational Medicine??Changchun 130033??China
Corresponding author??SUN Hui??E-mail??sunhui1229@163.com
Abstract Objective To investigate the strategy to improve ultrasound-guided fine-needle aspiration in diagnosis of thyroid nodules. Methods A retrospective analysis of thyroid nodules diagnosed by ultrasound-guided fine-needle aspiration between May 2012 and October 2014 in Department of Thyroid Surgery??China-Japan Union Hospital??Jilin University was analyzed comparatively and chronologically. Results A total of 7000 patients underwent puncture (7382 thyroid nodules) were enrolled. Based on the Bethesda reporting system??165 nodules were categorized as class ??(2.2%)??3202 as class ?? (43.4%)??621 as class ?? (8.4%)??zero as class ????734 as class ??and 2660 as class ??. A total of 2536 nodules were identified as control by post-operative histopathology??with sensitivity of 91.4%??specificity of 82.7% and false positive rate of 1.2%??respectively. When the nodules were sorted by every six months and chronologically analyzed??the sensitivity was 83%??78%??89.1%??93.1% and 96.3%??respectively??the specificity was 59%??100%??84.6%??91.7% and 97.2%??respectively. A total of 94 patients occurred local tiny hematoma during puncture??and no serious complications occurred. Conclusion Case screening??puncture drawn??interpretation of results and other aspects of quality control contribute to improve ultrasound-guided fine-needle aspiration in diagnosis of thyroid nodules.     

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??Clinical therapeutic effect of trans-anal ileus tube placement in acute obstruction result from left colorectal cancer LIU Qi , SU Ji, LUO Wei-zhen, et al. Department of General Surgery, the People’s Hospital of Hunan Province, Changsha 410005, China
Corresponding author: HUANG Zhong-cheng, E-mail: drliuqi@126. com
Abstract Objective To evaluate the clinical therapeutic effect of trans-anal ileus tube placement and drainage in acute obstruction result from left colorectal cancer. Method From Dec. 2007 to Jun. 2009, 29 patients of acute obstruction result from left colorectal cancer were admitted in the People’s Hospital of Hunan Province. 15 patients were received trans-anal ileus tube placement and drainage for 10 to 20 days before limited operation; and the other 14 patients were received emergency operation. The clinical effect, modus operandi, recovery effect, length of stay in hospital and the cost of hospitalization were observed in the two group patients. Result 15 patients were placed the trans-anal ileus tube successfully. Besides 1 patient’s tube prolapsed negligently after three days, the others rechecked the abdomen X-rays and founded the bowel obstructive signs disappeared before radical excision without abdominal stoma. The other 14 patients who received emergency operation needed further surgery treatment. Two group patients had no severer complications and the tube placement group had shorter length of total stay in hospital???25.90±2.46??d vs ??29.70±1.52??d??P<0.05??and the lower cost of hospitalization???27500.00±2163.5342????vs ??33200.00± 2512.4267??????P<0.05??. Conclusion Trans-anal ileus tube placement and drainage in acute obstruction result from left colorectal cancer could successfully avoid patients received surgical attack again. It was effective and safe and may be the first choice of clinical therapeutic.