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??Surgical and endovascular treatment of thromboangiitisobliterans LIU Bing, HUANG Ren-ping. Department of Vascular Surgery, the First Affiliated Hospital of Harbin Medical University, Harbin 150001, China
Corresponding author: HUANG Ren-ping, E-mail: cup521@163.com
Abstract Objective To investigate the outcomes of surgical and endovascular treatment for thromboangiitisobliterans. Methods The clinical data of 202 patients with thromboangiitisobliterans underwent surgical and endovascular treatment in the First Affiliated Hospital of Harbin Medical University from April 2006 to April 2015 were analyzed retrospectively. According to the outcomes of ankle brachial index (ABI) and the Rutherford classification value (R-value), the effectiveness of different operation methods were evaluated. Results The Rutherford classification value evaluation??One month after operation, R-value decreasedin all 4 groups??P<0.05??. Six months after operation, R-value decreased in lumbar sympathectomy group, sequential endarterectomy group and sequential endarterectomy combined with lumbar sympathectomy group??P<0.05??. Twelve months after operation, R-value decreased in sequential endarterectomy group and sequential endarterectomy combined with lumbar sympathectomy group??P<0.05??.ABI evaluation??One week after operation,ABI increased in all 4 groups ??P<0.05??. Six months after operation, ABI increased in sequential endarterectomy combined with lumbar sympathectomy group??P<0.05??. Twelve months after operation, ABI increased in sequential endarterectomy group and sequential endarterectomy combined with lumbar sympathectomy group??P<0.05??. Conclusion Percutaneous transluminal angioplasty (PTA) and lumbar sympathectomy can bring benefit to the patient with TAO in the short term. Sequential endarterectomy combined with or without lumbar sympathectomy are proved to be effective as a surgical method for TAO.     

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??iagnosis and treatment of local recurrent mid-lower rectal cancer WANG Zhen-jun. Department of General Surgery, Beijing Chaoyang Hospital,Capital Medical University, Beijing 100020,China Abstract Local recurrence of mid-lower rectal cancer persistently constitutes a challenging clinical problem. Recurrent lesion often located in anastomosis, perineum, osteal pelvis and adjacent organs in the pelvis. Clinical manifestation of local recurrent rectal cancer (LRRC) patients include blood stool, perineal pain, pelvic and presacral lump, et al. Regular postoperative physical examination, CT, MRI as well as tumor markers are important methods for diagnosis of LRRC. The treatment choice include excision as the main part of multimodality treatment or palliative radiochemotherapy on comprehensive analysis of type of recurrence, cancer biological features and involvement extent of recurrent cancer.     

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198 5年 5月至 1998年 12月我科对 5 6例直肠癌病人施行Dixon手术 ,取得了良好的效果。现报道如下。1　资料与方法本组 5 6例 ,男 3 8例 ,女 18例。年龄 2 2 72岁。肿瘤下缘距肛缘的距离 68cm 3 6例 ,910cm 2 0例 ,平均 8cm。Dukes分期为A期 8例 ,B期 3 8例 ,C期 10例。病理诊断高、中分化腺癌 3 7例 ,粘液腺癌 8例 ,低分化腺癌 9例 ,未分化癌 2例。所有病例探查肿瘤位于盆底腹膜返折水平或以下 ,无远处转移病灶 ,按直肠癌根治原则行全直肠系膜切除(TME) ,直视下在骶前间隙进行锐性分离 ,保持包裹直肠系膜的盆筋膜脏层的完整无损 ,以防…     

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中低位直肠癌最主要的治疗手段目前仍然是手术根治性切除,但近10余年间治疗策略发生了很大的变化。以往,术前诊断的重点是定性诊断,强调的是手术的根治性或能否保肛。当前,直肠癌术前分期诊断受到重视,针对不同分期选择治疗方式及术式,使病人最大限度的收益。对于不伴有不良预后因素的T1N0M0期早期直肠癌可以慎重选择局部切除术;对于局部中晚期直肠癌[T3~4期和(或)伴有区域性淋巴结转移]推荐术前放化疗然后再行手术;而对于伴有肝、肺等远处转移的直肠癌病人,根据情况决定原发病灶是否需要切除。     

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??Selective lateral pelvic lymph node dissection for mid-low rectal cancer WEI Ming-tian??WANG Zi-qiang. Department of Gastrointestinal Surgery??West China Hospital??Chengdu 610041??China
Corresponding author??WANG Zi-qiang??E-mail??wangzqzyh@163.com
Abstract Lateral pelvic lymph node metastasis is not uncommon in patients with advanced mid-low rectal cancer??and is also the cause of lateral recurrence. The latter has been indicated to be the most common kind of local recurrences in Asian reports. Presence of enlarged lateral lymph nodes at presentation is an independent risk factor for lateral pelvic recurrence after chemoradiotherapy (CRT) and total mesorectal excision. Controversy exists between Asian and western countries with respect to the use of CRT and lateral lymph node dissection (LLND) in the management of mid-low advanced rectal cancer. Primary reports indicated that thecombination of CRT and LLND was likely to be superior to either of the two strategies and provided more favourable local control and survival. So far??there is no consensus on the criteria to diagnose lateral lymph node metastases (LLNM) and the indication for selective LLND. More multicenter prospective cohort studies are warrant to address the issues, before we can provide better health care to the patients to improve their survival??as well as to avoid unnecessary LLND??which has been associated with more surgical complications and poorer quality of life.     

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与结肠癌相比,直肠癌尤其是中低位直肠癌在解剖和治疗学上有许多不同之处。首先大多数中低位直肠癌病人面临着是进行传统的经腹会阴联合切除,还是进行保留括约肌的保肛手术的问题。其次,虽然近年来随着手术技术的不断改进,尤其是在全直肠系膜切除(TME)技术得到推广以后,病人的保肛率、长期生存率得到明显的提高,但是术后局部复发仍然是直肠癌手术失败的重要原因之一,尤其是直肠癌侵犯深达全层以上、淋巴结有转移或周边切缘肿瘤阳性的病人,盆腔或局部复发的机会仍然比较高,即使采用TME技术,仍然可达5%～40%。另外,由于直肠位于狭小的盆腔…     

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??Pathology of the mid-lower rectal carcinoma ZHU Xiong-zeng. Department of Patholgy, Cancer Hospital, Fudan University, Shanghai 200032, China Abstract The rectum is the most common site of the large bowel carcinoma. In rectal carcinoma, about 70% cases are located in the mid-lower rectum. Also some issues have been mantioned at histopathological diagnosis, including (1) the concept of the intraepithelial neoplasia (I N) and the relationship with surgical treatment, especially introducing the Vinna classification of gastronitesinal epithelial neoplasia and clinical management. (2) the prognostic paremeters determined by histopathology, such as resected margins, extent of extracolorectal invasion, reginal nodal metastases, vascular and perineural invasion, and (3) genetics of the large bowel cancers, mainly about hereditary nonpolyposis colorectal cancer(HNPCC) and familial adenomatous polyposis(FAP).     

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Ｍｉｌｅｓ手术是治疗直肠癌的经典术式 ,但所造成的腹壁永久性人工肛门给病人带来痛苦和生活不便 ,生存质量下降 ,病人难以接受。近几十年来关于直肠癌的病理和免疫等各方面的研究进展以及手术操作的熟练 ,尤其是端端吻合 (ＥＥＡ)吻合器的应用 ,使一部分直肠中低位的癌肿应用前切除术 (Ｄｉｘｏｎｓ手术 )既免受人工肛门之苦 ,又能获得较满意的疗效。本文对 1 992～ 1 997年我们医院收治的 2 8例距肛缘 6～ 8ｃｍ的中低位直肠癌应用改进的ＥＥＡ吻合器吻合方法行低位前切除术进行研究分析并就相关的问题进行探讨。1　临床资料1 1　一般…     

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??Establishment and value of three-dimensional visualization diagnosis platform in the treatment of hepatolithiasis FANG Chi-hua, FANG Zhao-shan, CAI Wei, et al. The First Department of Hapatobiliary Surgery, Zhujiang Hospital, Southern Medical University, Guangzhou510282,China
Corresponding author:FANG Chi-hua,E-mail: fangch_dr@126.com
Abstract Objective To study the establishment and value of three-dimensional visualization diagnosis platform in the treatment of hepatolithiasis. Methods The clinical data of 112 consecutive patients with hepatolithiasis between January 2008 and April 2015 in the First Department of Hepatobiliary Surgery, Zhujiang Hospital, Southern Medical University were analyzed. (1) In order to acquire submillimeter CT data, each patient underwent the spiral CT epigastric enhancement scanning. Medical image three-dimensional visualization system (MI-3DVS) was used to establish three-dimensional visualization image model. (2) The three-dimensional visualization analysis covered the vascular classification, the classification of clinical diagnosis, liver segments, virtual hepatectomy and liver volume calculation with three-dimensional visualization technology. (3) Preoperative evaluation and surgical planning were performed to select a reasonable plan. (4) The 3D printing of liver might be performed when necessary, which help to perform the precise surgery. (5) Therapeutic effect was evaluated. Results All the patients had a real reconstruction of three-dimensional visualization image model based on CT images. The position and distribution of calculus, location and degree of biliary stricture, vascular anatomic relationships were shown in the three-dimensional visualization image model clearly. The category of hepatic artery, hepatic vein and portal vein were made. The three-dimensional visualization diagnostic classification of hepatolithiasis and liver segments was also performed. The relationships between lesions and vasculature were shown in the 3D printing model of liver. The three-dimensional visualization preoperative evaluation and 3D printing model were in tune with actual operation. The stone residue rate, incidence rate of complications and calculus recurrence rate was less than 3.0%, 5.6% and 2.4% respectively. Conclusion The establishment of three-dimensional visualization diagnosis platform for hepatolithiasis could help to improve the clearance of calculus and decrease postoperative complications. It could provide safe, precise, minimally invasive and efficient therapeutic measures for hepatolithiasis and has a good clinical prospect.     

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??Standard of pathological evaluation for mid-low rectal cancer YAO Hong-wei*??LI Wen-di??TIAN Mao-lin??et al. *Department of General Surgery??Peking University Third Hospital??Beijing100191, China
Corresponding author: SHI Xue-ying??E-mail??zhsh6812@aliyun.com??LIU Yin-hua??E-mail??liuyinhua@medmail.com.cn
Abstract Pathological examination plays a core role in the multi-disciplinary diagnosis and treatment of rectal cancer. It can evaluate the effect of neoadjuvant therapy and operation??can assist postoperative adjuvant therapy??and can even predict cancer recurrence and risk degree of patient's prognosis. Anatomy and TNM staging are the basis of pathological assessment of mid-low rectal cancer. Standardized evaluation of routine pathology includes resection range??tumor site??tumor size??gross type??distance between tumor and bowel margin??grade of cancer??depth of invasion (T staging)??number of lymph nodes evaluated and number positive (N staging)??status of proximal and distal margin??circumferential resection margin??response of neoadjuvant therapy??lymphovascular invasion??perineural invasion??and tumor deposition. Molecular pathological diagnosis plays more and more prominent role in the choice of drug and prognosis assessment.     

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??A comparative study of omentum wrapping in pancreaticojejunostomy for reducing postoperative pancreatic fistula XU Jie-ru*??CHEN Chao??SHEN Ning-jia??et al. *Medical College of Soochow University??Suzhou 215000??China
Corresponding author: ZHANG Yong-jie, E-mail: yjoy005@sina.com
Abstract Objective To investigate the efficacy of the omentum wrapping technique in pancreaticojejunostomy on decreasing the incidence of pancreatic fistula after pancreaticoduodenectomy. Methods The clinical data of 225 patients underwent pancreaticoduodenectomy and pancreaticojejunostomy in single operation group from January 2009 to October 2015 in No.2 Department of Biliary Tract Surgery, Eastern Hepatobiliary Surgery Hospital Affiliated to the Second Military Medical University were analyzed retrospectively. Patients were divided into two groups??including group with omentum wrapping technique (n=125) and control group without it (n=100). After propensity score matching??the rates of pancreatic fistula were compared between the two groups??including group with omentum wrapping technique (n=64) and control group without it (n=64). Results All operations were completed successfully. The overall complication rate of all 225 patients was 62.7%??141/225??. The reoperation rate was 2.7%??6/225??. The mortality is 2.7%??6/225??. The incidence of pancreatic fistula was 46.7%??105/225????including 61 cases of Class A??37 cases of Class B??and 7 cases of Class C. The incidence of bleeding was 11%??25/225??. The incidence of DGE was 24.9%??56/225??. The incidence of abdominal infection was 20.9%??47/225??. Except the incidence of pancreatic fistula??there was no statistical difference between the two groups in the incidence of bleeding??DGE and abdominal infection??P>0.05??. In the omentum wrapping group, no reoperation case occurred??and there were only 2 death cases. In the control group??there were 4 reoperation cases and 4 death cases. There was no significant difference between the two groups in those data??P=0.119, 0.680??. In the PSM model??soft pancreas??pancreatic duct diameter and omentum wrapping were related to the postoperative pancreatic fistula in single factor analysis. In the multiple factors analysis??pancreatic duct diameter <3 mm and no omentum wrapping were independent risk factors for pancreatic fistula. Conclusion The omentum wrapping technique can decrease the rate of pancreatic fistula and it is worth applying in pancreaticojejunostomy.     

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??Diagnosis and treatment of medium low rectal cancer in the status quo and outlook WANG Jian-ping. Department of Gastrointestinal Surgery, the Sixth Affiliated (Gastrointestinal and Anal Hospital) of Sun Yat-sen University, Guangzhou 510655, China Abstract Middle-low rectal cancer is a common disease with high morbidity. It is of vital importance for early detection and early treatment, which results in high survival rate. In addition, it is becoming routine to provide prognostic and predictive factors for treatment selection and prognosis when diagnosing. The progress in image methods has made reliable information for pre-treatment diagnosis and staging, which helps to make treatment strategy. Multi-disciplinary treatment and individual treatment are two major principles when treating middle-low rectal cancer. More and more studies are carried on to find the best combination of operation, radiation and chemotherapy. The aims of treatment are to improve survival rate as well as to maintain the function of anus and pelvic automatic nerve. Quality of life is the crucial focus during the whole process of treating patients with middle-low rectal cancer.     

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尽管外科手术一直都是治疗直肠癌的主要手段,但单纯的手术疗法效果不尽人意。近年来,术前放、化疗在中低位直肠癌治疗中的作用已经在越来越多的临床实践中得到验证。新辅助疗法的引入,在降低肿瘤局部复发率、提高保肛率、延长病人的生存时间等方面均取得了明显进步。1术前放化疗方案术前化疗还没有统一方案,目前多数临床研究是以5-氟脲嘧啶(5-FU)为基础联合化疗方案。有研究表明,联合用药可以提高完全缓解率。联合应用较多的有甲酰四氢叶酸(LV)。近年,不少新药应用于直肠癌治疗,取得了良好的效果,如卡培他滨、雷替曲塞、奥沙利铂和伊立替…     

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??Combined multimodality in the treatment of distal rectal cancer ZHANG Zhen. Department of Radiation Oncology, Cancer Hospital, Fudan University, Shanghai 200032,China Abstract German trial has showed the benefit of neoadjuvant chemoradiation compared with adjuvant chemoradiation in the management of rectal cancer and it has been the preference standard of care of stage II and III rectal cancer. Tumor location is known to be an important prognostic factor in results of treatment. Consensus are not reached in the treatment of distal rectal cancer, especially in the radiation style, short course vs long course; radiation alone or chemoradiation and patient selection. There is no universal model for the neoadjuvant chemoradition of distal rectal cancer. Multidisciplary approach and fully consideration should be taken.     

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??Usage of mechanical stapler in digestive tract reconstruction of laparoscopic total gastrectomy MIAO Ru-lin??LI Zi-yu??WANG Yin-kui??et al. Gastrointestinal Cancer Center, Peking University Cancer Hospital &Institute; Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Beijing 100142, China
Corresponding author??LI Zi-yu?? E-mail??ligregory@outlook.com
Abstract Objective To evaluate the safety and effectiveness of mechanical staplers in laparoscopic total gastrectomy. Methods The clinical data of gastric adenocarcinoma patients who received laparoscopic-assisted or totally laparoscopic total gastrectomy in Gastrointestinal Cancer Center Ward I of Peking University Cancer Hospital from March 2012 to April 2016 was collected retrospectively. The clinical pathologic characteristics??operative features and postoperative recovery features were compared between patients with linear stapler (LS) and the ones with circular stapler (CS). Logistic regression was used to identify the risk factors of postoperative complications. Results A total of 72 patients were enrolled in the study with 47 patients in the CS group and 25 patients in the LS group. The difference of age??gender??BMI??tumor size??Lauren classification??differentiation grade??and pathologic stage between the two groups were not significant statistically??P??0.05??. The proportion of patients who received preoperative therapy were lower in the LS group (4.0% vs.27.7%??P=0.026). The difference of surgical time and intraoperative blood loss of OS group and LS group were not significant statistically (median surgical time??247min vs. 258min??median intraoperative blood loss??100mL vs. 50mL). There was no statistical difference in the extent of curative??retrieved lymph node number??and proximal margin distance between the two groups. On postoperative recovery??the first liquid diet time was shorter in the LS group (3.5d vs. 5.0d??P=0.030)??but the postoperative hospital stay??first flatus time??first semi-liquid diet time and first abdominal drainage tube removing time were same statistically between the two groups. The rates of postoperative complications were 25.5% and 32.0% in CS group and LS group (P =0.560)??and no risk factor was identified in regression model. Conclusion For laparoscopic total gastrectomy??mechanical staplers are safe. The surgical time??intraoperative blood loss and postoperative risk of linear stapler are comparable to those of circular stapler??and gastrointestinal function recovery may be faster in linear stapler group.     

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自 1990年 11月至 1995年 5月 ,我们对行肝癌根治性切除术的 85例病人 ,于术中同时行肝动脉门静脉双埋泵(ＩＤＤＳ) ,用以术后化疗与栓塞 ,取得了良好的疗效。现对照同期未行埋泵术的 2 9例肝癌手术病人 ,报告如下。1　临床资料治疗组 85例 ,男 76例 ,女 9例。年龄平均 49岁 ( 2 4～73岁 )。全部病例均为肝细胞癌。单发肿瘤 75例 ,肿瘤位于肝脏某一段或有数段同时累及。多发肿瘤 ( 2处病灶 ) 10例 ,肿瘤分别位于左右肝或不相邻的两个肝段。肿瘤大小1 8～ 2 7ｃｍ不等。对照组 2 9例 ,男 2 5例 ,女 4例。年龄平均 45岁 ( 2 2～ 6 9岁 )。肿瘤…