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??Long term follow-up and risk factors analysis of adhesive small bowel obstruction PING Xiao-chun, LI You-sheng, LI Ning, et al. Department of Surgery, Nanjing General Hospital of Nanjing Command, Nanjing University School of Medicine, Nanjing 210002, China
Corresponding author: LI You-sheng, E-mail:liys@medmail.com.cn
Abstract Objective To compare the long-term outcome of surgical or conservative treatment for patients with adhesive small bowel obstruction (ASBO). Methods The clinical data of 150 patients with ASBO admitted from January 2001 to June 2006 at Research Institute of General Surgery of PLA, Nanjing General Hospital of Nanjing Command were analyzed retrospectively and followed up. Results Among the 162 admissions in 150 patients, 119 admissions ??73.5%??were surgical treated and 43 admissions ??26.5%??were performed conservative treatment. The mean recovery time was ??64.5±2.1??months and the accumulative incidence of surgical recurrence in 5 years was (18±5) % in surgical group and those in conservative group were ??54.0±4.6??months and (32±8) % respectively. There was significant difference between two groups ??P??0.020??. No other independent risk factor of recurrence was found. Conclusion Surgical treatment serves as a better way in the prevention of later recurrences in patients with ASBO under certain conditions, although the strength of the conclusion may be limited due to the retrospective non-randomized nature of the study.     

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??Ultrasound diagnosis of thyroid microcarcinoma ZHAN Wei-wei. Department of Ultrasound Diagnosis and Treatment, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai200025, China
Abstract Ultrasonography (US) is increasingly being used by endocrinologists and surgeons in the diagnosis and management of patients with thyroid nodules. US may be used to help stratify the risk of malignancy in thyroid nodules and cervical lymph nodes. US plays an important role in the preoperative evaluation of thyroid microcarcinoma and cervical lymph nodes.     

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甲状腺微小癌(thyroid microcarcinoma，TMC)是指肿瘤直径≤1．0cm的甲状腺癌结节。根据尸解研究，人群中其病死率较高，约超过10％的非甲状腺癌死亡病人患有TMC，且无性别和年龄的差别。Bramley等总结了世界各地尸解报告，微小癌的发现率为1．5％～35．5％。然而，大多数微小癌病灶可能几乎没有临床意义，这些病灶可在病人身上无症状存留终生。     

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??Ultrasound characteristics of thyroid microcarcinoma PAN Fu-shun*??XIE Xiao-yan??LI Xiao-xi??et al. *Department of Ultrasound, the First Affiliated Hospital of Sun Yat-sun University, Guangzhou 510080,China
Corresponding author??XIE Xiao-yan??E-mail??xxy1992@live.cn
Abstract Objective To investigate the ultrasound characteristics of thyroid microcarcinoma. Methods The ultrasound imaging of thirty-four cases of thyroid microcarcinoma confirmed by surgery and pathology between January 2003 and January 2009 at the First Affiliated Hospital of Sun Yat-sun University was analyzed retrospectively. Results Thirty-two (94.1%) cases were detected as hypo-echo nodules. Twenty-eight (85.3%) cases were with irregular shape. Twenty-six (76.5%) cases were with irregular edges calcification. Blood flow was detected in 7 cases with CDFI and lymph node metastasis was found in 4 cases. Conclusion Hypo-echo nodules, regular shape, irregular edges and calcification are the ultrasound characteristic. Comprehending the characteristics may improve the pre-operation diagnosis efficacy.     

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??Thyrotropin suppression therapy in thyroid microcarcinoma??Current understanding and challenges GUAN Hai-xia. Department of Endocrinology and Metabolism??the First Affiliated Hospital of China Medical University??Shenyang 110001??China
Abstract Thyroid microcarcinoma (TMC) has become an increasingly greater proportion of differentiated thyroid cancer. Postoperative thyrotropin??TSH??suppression therapy remains rational and necessary for patients with TMC. Not all TMCs harbor low risk, thus the target of TSH suppression therapy should be set according to dynamic risk evaluation. Aggressive TSH suppression should not be recommended in low-risk TMC.     

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??Treatment of thyroid microcarcinoma DAI Wen-jie, ZHU Hua-qiang, JIANG Hong-chi. Department of General Surgery, the First Affiliated Hospital of Harbin Medical University, Harbin 150001, China
Corresponding author: DAI Wen-jie,, E-mail: wenjdai@yahoo.com.cn
Abstract Objective To study on the treatment of thyroid microcarcinoma. Methods Retrospective study was performed on the treatment of 141 cases of thyroid microcarcinoma admitted between January 2002 and January 2007 at the First Affiliated Hospital of Harbin Medical University. Different extent of thyroidectomy and lymphadenectomy were performed on different patients according to their diagnostic procedures. Therapeutic effect of different treatments and the factors associated with the presence of lymph node metastases were analyzed. Results One hundred and seventeen cases were diagnosed preoperatively or intraoperatively, and were treated with ipsilateral total lobectomy +isthmusectomy + contralateral subtotal lobectomy, or bilateral total / near-total / subtotal thyroidectomy. Four of them recurred (3.4%). Twenty-one cases were diagnosed as benign thyroid diseases preoperatively and intraoperatively, but incidentally detected as malignancy after the operation. They were firstly treated with ipsilateral subtotal lobectomy. Reoperation was not performed because all of them were single focal without capsular or vascular effraction. None of them recurred. Lymphadenectomy was performed in 27 cases with lymphadenectasis, and 3 of them recurred (11.1% ). Lymphadenectomy was not performed in another 114 cases without lymphadenectasis, and only 2 of them recurred (1.8%). Conclusion The surgical treatment of thyroid microcarcinoma should be individualized based on the patient and tumour. Lymph node metastases are common in thyroid microcarcinoma patients. The factors correlated with the presence of lymph node metastases were multifocal, capsular effraction, and tumor size (≥5mm). Lymphadenectomy is necessary for patients with lymphadenectasis, but is unnecessary for patients without lymphadenectasis.     

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??Central compartment lymph node dissection in thyroid microcarcinoma WANG Zhuo-ying. Department of Head and Neck Surgery??Fudan University Shanghai Cancer Center??Shanghai 200032??China
Abstract The incidence of thyroid microcarcinoma shows an upward trend in recent years. There are still some controversial in choice of central compartment lymph node dissection (CND) for those patients??especially the cN0 patients. The basis against prophylactic CND is no prognosis improvement after total thyroidectomy plus radioactive iodine ablation (RAI) with CND??but more complications. On the other hand, prophylactic CND may increase the local control rate due to high metastatic rates and avoid the complications related to secondary surgery. With the revised guidelines, prophylactic CND may play a more important role in thyroid microcarcinoma treatment. Regarding the two points of view??the optimal personalized choice of central compartment dissection should be base on the improvement of local control and lower operation related complications.     

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??Over-treatment and under-treatment of papillary thyroid microcarcinoma ZHU Jing-qiang??LEI Jian-yong. Thyroid and Parathyroid Surgery Center??West China Hospital of Sichuan University??Chengdu 610041??China
Corresponding author??ZHU Jing-qiang??E-mail??zjq-wkys@163.com
Abstract In recent years??the treatment for the papillary thyroid microcarcinom??PTMC??is controversial, which includes over-treatment and under-treatment in the clinical. The following protocols should be considered as “under-treatment”??ablation therapy is the first choice??against to the principle of “two at least”??for patients with proved contralateral lymph node metastasis only performed ipsilateral lobectomy and central lymph node dissection and lateral lymph node dissection??for patients with node in the contralateral lobe only performed ipsilateral lobectomy??cases should accept surgery therapy but failed??inappropriate TSH suppression therapy without evaluation and follow-up after surgery. The following protocols should be considered as “over-treatment”??PTMC with diameter less than 5 mm??without lymph node metastasis and no risk factors of capsular invasion??but accepting total thyroidectomy or unilateral/bilateral central lymph node dissection??cases have accepted lobectomy and the postoperative histological examination indicated the “accidental carcinoma”??but been advised to accept the central lymph node dissection without evidence of lymph node metastasis??PTMC patients with diameter less than 5 mm accepted surgery in the early or late pregnancy period??cases accepted over TSH suppression therapy and the follow-up less than 3 months. So the surgeon should have a correct understanding of PTMC with correct assessment??safety consideration of surgery??patients’ will and medical resources??and then make the reasonable diagnosis and treatment protocols.     

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??Consensus and controversy on surgical treatment of papillary thyroid microcarcinoma ZHANG Hao. Department of Thyroid Surgery??the First Hospital of China Medical University??Shenyang 110001??China
Abstract The therapeutic strategies and choice of operation of papillary thyroid microcarcinoma (PTMC) remain controversial. An active surveillance is not suitable for the actual condition and medical environment in China, which should not be excessively popularized, unless there is a gold standard to distinguish indolent and aggressive PTMC. Surgery is the first choice for PTMC that is diagnosed definitely. Guidelines at home and abroad are essentially the same for the extent of thyroidectomy. Thyroid lobectomy plus isthmectomy is chosen for low-risk patients and total/near total thyroidectomy should be performed for intermediate- to high-risk patients. It’s advocated that at least ipsilateral central-compartment neck dissection should be performed and prophylactic lateral neck compartmental lymph node dissection is not necessary for PTMC. It’s recommended that individualized therapy should be chosen by the comprehensive evaluation of the available risk factors and the considerations of the patients’ preference, the skills of the surgeon, and the balance of complications and the risk of disease.     

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目的 确定创伤性失血性休克（ＨＴＳ）病人死亡和并发症发生的高危因素。方法 分析在创伤ＩＣＵ和急诊部（ＥＤ）内ＨＴＳ病人,确定病死率、感染、器官功能障碍（ＯＤ）的发生率和与此有关的预测指标。结果 １４３例ＨＴＳ病人２８％在入院后２ｈ内死亡,１０％死于２－２４ｈ６％在２４ｈ后死亡;５６％生存。生存〉２４ｈ病人４７％发生感染和２４％发生ＯＤ;最初２４ｈ内复苏时增加晶体液输入,病死率升高。结论 创伤失血致     

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??Clinical features and risk factors of coagulation syndrome after endoscopic submucosal dissection SUN Di, QI Zhi-peng, ZHONG Yun-shi, et al. Endoscopy Center, Zhongshan Hospital, Fudan University; Shanghai Center of Engineering Technology, Diagnosis and Treatment in Endoscopy??Shanghai 200032,China
Corresponding author: ZHONG Yun-shi, E-mail??zhong.yunshi@zs-hospital.sh.cn
Abstract Objective To investigate the clinical features and risk factors of post-ESD electrocoagulation syndrome ??PEECS?? in patients with colorectal submucosal tumors (SMTs). Methods The medical records of 412 patients underwent ESD for colorectal SMTs at Endoscopy Center of Zhongshan Hospital??Fudan University between January 2008 and July 2014 were analyzed retrospectively.The correlation between PEECS and age??gender??tumor size??tumor location and tumor origin were analyzed. Results Among 412 patients??PEECS was developed in 28 patients ??6.8%??. Univariate analysis showed that tumor size??tumor location and tumor origin were related to PEECS. By multivariate analysis??tumor size ≥20mm??location in colon and origin from the muscularis propria were the risk factors for PEECS??P??0.05??. Conclusion Tumor size≥20mm??location in colon and origin from the muscularis propria are the risk factors for PEECS. Therefore??postoperative close observation and careful additional management are recommended for those patients.     

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??Incidence and risk factors analysis of venous thromboembolism of general surgery ZHANG Tai-ping, YANG Gang, FENG Meng-yu, et al. Department of General Surgery, Peking Union Medical College Hospital, Beijing 100730, China
Corresponding author: ZHAO Yu-pei, E-mail: zhao8028@263.net
Abstract Venous thromboembolism (VTE) is a common complication and one of the important causes of death in surgical patients. Risk factors of VTE mainly include the patient related factors (such as age, obesity, cancer and infection, etc.) and surgery related factors (such as operation duration, operation type and operation method, etc.). In recent years, though the incidence of VTE has decreased with the improvement of perioperative VTE administration guidelines, Clinicians should still be vigilant and know the risk factors clearly to identify and prevent early, avoiding the occurrence of pulmonary embolism and other serious adverse events.     

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目的分析影响腹主动脉瘤破裂病人手术治疗预后的危险因素。方法回顾性分析1999年8月至2010年12月重庆医科大学附属第一医院行手术治疗的40例腹主动脉瘤破裂病人资料。从病人年龄、性别、合并其他基础疾病、瘤体直径、输血量、手术时间以及术前低血压持续时间几方面进行研究,采用单因素分析和多因素分析了解影响腹主动脉瘤破裂病人手术治疗预后的危险因素。结果单因素分析:术前有低血压表现的病人(P=0.034)死亡风险为术前无低血压病人的3.2倍,低血压持续时间≥2h病人(P=0.008)为低血压持续时间<2h病人的2.6倍。术前合并冠心病(P=0.028)、慢性阻塞性肺疾病(P=0.012)及肾功能不全(P=0.028)的病人病死率显著升高。病人年龄≥70岁的(P=0.031)和瘤体直径≥5cm的病人(P=0.016)病死率显著升高。病人病死率与输血量(P=0.225)、性别(P=0.689)及手术时间(P=0.360)无明显关系。多因素分析:低血压持续时间(P=0.042)、术前合并冠心病(P=0.036)和年龄(P=0.040)三种因素差异有统计学意义,而术前合并慢性阻塞性肺疾病(P=0.102)、肾功能不全(P=0.057)和瘤体直径(P=0.225)在多因素分析中差异无统计学意义。结论低血压持续时间、合并冠心病和高龄是影响腹主动脉瘤破裂病人预后的危险因素。缩短低血压持续时间可以明显改善腹主动脉瘤破裂病人预后。     

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??An analysis of clinical characteristics and risk factors for non-puerperal mastitis LIU Lu, ZHOU Fei, YU Li-xiang, et al. Department of Breast Surgery, the Second Hospital of Shandong University, Jinan 250033,China
Corresponding author: YU Zhi-gang, E-mail:yzg@medmail.com.cn
Abstract Objective To investigate the clinical characteristics and risk factors for non-puerperal mastitis (NPM). Methods The clinical and pathological data of 120 resident patients between January 2011 and March 2015 in Department of Breast Surgery, the Second Hospital of Shandong University were collected and analyzed retrospectively, while 111 healthy controls were included in the non-matched case-control study. Epidemiological and clinicopathological features were recorded and etiologic factors were obtained by comparing case and control group information using univariate and multivariable analysis. Results The median age of patients was 33 (range from 20 to 62) years. The lesions often located in the upper outer quadrant(21.7%), upper inner quadrant(20.0%) and the subareolar area(30.8%) of the breast, and the most common clinical type was mass-type(45.8%). There were significant differences between two groups in the aspect of overweight/obesity, age at menarche, number of full-term pregnancies, early age at first full-term pregnancy, long duration of breastfeeding, history of breastfeeding and nipple retraction. Multivariable logistic analysis showed overweight/obesity (OR=1.25, 95%CI 1.08—1.44, P=0.002), number of full-term pregnancies (OR=5.02, 95%CI 1.06—23.86, P=0.042) and age at menarche (OR=1.97, 95%CI 1.45—2.68, P??0.001) as independent risk factors for NPM, age at first full-term pregnancy(OR=0.85, 95%CI 0.74—0.98, P=0.025) as a protective factor. Conclusion Overweight/obesity, times of bearing birth and age at menarche are associated with NPM. Late first full-term pregnancy can minimize the modifiable risks.     

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??Risk factors for bacterial infection in leucopenia patients with gastrointestinal fistula ZHOU Zheng*??REN Jian-an, LIU Hai-yan , et al. *Research Institute of General Surgery, Nanjing General Hospital of Nanjing Military Command?? Nanjing 210002??China
Corresponding author: REN Jian-an??E-mail??jan@medmail.com.cn
Abstract Objective To find risk factors for bacterial infection in leucopenia patients with gastrointestinal fistula. Methods The clinical data of 98 leucopenia patients with gastrointestinal fistula admitted between January 2007 and June 2008 at the General Surgical Institute of Jinling Hospital of Nanjing Univeristy were analyzed retrospectively. Cases consisted of 25 patients with bacterial infection positive and controls consisted of 73 patients with bacterial infection negative. Results The only independent determinant was central vein catheter, with in cases, 40% of patients had central vein catheter, whereas only 5.48% of patients in controls had central vein catheter. Other risk factors included hepatic dysfunction, mechanical ventilation and urinary catheter. The factors most strongly associated with mortality in controls were renal insufficiency and urinary catheter. Conclusion Central vein catheter is by far the most important predisposing factor to bacterial infection in leucopenia patients with gastrointestinal fistula. The data will help clinicians to give gastrointestinal fistula patients more supportive management and prevention strategies to treat bacterial infections.     

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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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??Focal points and controversies of the diagnosis and treatment for thyroid microcarcinoma WU Yi. Department of Head and Neck Surgery, Fudan University Shanghai Cancer Center; Thyroid Tumor Diagnosis and Treatment Research Center, Fudan University??Shanghai 200032??China
Abstract Thyroid microcarcinoma (TMC) is defined as a thyroid cancer measuring ≤1 cm in greatest diameter. Since more and more thyroid microcarcinomas have been detected frequently, it needs to explore the standard diagnosis and treatment of TMC. For the TMCs diagnosed definitively, standardized treatment of thyroid carcinoma should be adopted. Strict indications of non-operative-management should be grasped for TMC. Careful analysis of the history, strict operation indications and non-neoplasm touch technology are required when treating TMC by endoscopy. Furthermore, domestic surgeons should also learn the advanced experience from foreign colleagues in order to enhance the ability of diagnosing and treating TMC in China.     

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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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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。…