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??Eeffective analysis of conversion therapy for advanced gastric cancer: A report of 13 cases GAN Qiang-jun??ZHANG Qi??LI Hao-jie??et al. Department of General Surgery??Zhongshan Hospital??Fudan University??Shanghai 200032??China
Corresponding author??LIU Feng-lin??E-mail??liu.fenglin@zs-hospital.sh.cn
Abstract Objective To analyze the efficacy and safety of conversion therapy for advanced gastric cancer. Methods The clinical data of 13 cases of advanced gastric cancer underwent gastrectomy with D2 lymph node dissection after conversion therapy between January 2014 and July 2017 at Zhongshan Hospital??Fudan University were analyzed retrospectively. Results After conversion therapy??9 cases received PR??4 cases were SD. In all 13 cases??the number of lymph nodes resected was (47.5±11.7) ; the surgical time was (180.9+38.2) min; the intraoperative blood loss was (203.9 + 92.3) mL; and no blood transfusion was performed during operation. The time of gastric tube indwelling was (52.0 + 30.8) h; the time of drainage tube placement was (170.2+47.0) h; the time to first liquid intake was (122.0+24.3) h; the time to first semifluid intake was (154.9+32.1) h; the postoperative hospital stay was (8.7+2.0) d. There were three cases of post-operative complications; one was intra-abdominal abscess and the rest two were pulmonary inflammation. According to Clavien Dindo classification for post-operative complications??only one was grade ??a and the rest got grade ??. There were no unplaned reoperation and death during hospitalization.The median PFS (progression-free survival) was 16.3 months; the median OS (overall survival) was 18.8 months. Conclusion Although conversion therapy increases the risk of postoperative complications slightly??some patients with advanced gastric cancer do get significant survival benefit; conversion therapy can be one of the important treatment methods for advanced gastric cancer.     

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??Laparoscopic versus open surgery for complete mesocolic excision with colon cancer: A Meta-analysis WANG Wen-tao, FENG Yong.
Department of Colorectal Cancer Surgery, Shengjing Hospital, China Medical University, Shenyang 110004,China
Corresponding author: FENG Yong, E-mail: fengy@sj-hospital.org
Abstract Objective To systemically assess the feasibility and safety of laparoscopic complete mesocolic excision(CME) for colon cancer. Method A search of Cochrane library, Pubmed, OVID, Springer Linker, Science Direct, EBSCO, CNKI, VIP and Wanfang database was undertaken and studies published in the last six years were identified. We included controlled clinical trials that compared laparoscopic CME and open CME for colon cancer in our Meta-analysis. Studies selection and Meta-analysis were performed using Review-Manager 5.3 software according to the Cochrane Handbook. Results A total of 2179 patients undergoing colon cancer surgery ( laparoscoPic CME group n= 1128, open CME group n= 1051) were examined. Meta-analysis showed that: (1) The amount of bleeding during operation in the laparoscopic CME group was smaller than open CME group??WMD=-54.44,95%CI??-105.38~-3.49??P=0.04??.There was no significant differences in the amount of operation time??WMD=28.78,95%CI??-4.66~62.21??P=0.09??between laparoscopic CME group and open CME group; (2) The significant differences lie in the time of first flatus??WMD= -17.19, 95%CI: -29.71~ -4.67, P=0.007?? and the postoperative complication??OR=0.57,95%CI??0.43~0.75??P<0.0001??, in which the datas of the laparoscopic CME group was smaller than that of the open CME group. No significant difference was found in the mortality(P=0.21) between two kinds of operative methods; (3) There was no significant difference in the length of large bowel resection ??WMD=-2.83,95%CI??-5.88~0.22??P=0.07??. Meanwhile, compared with the open CME group, the number of lymph node of the laparoscopic CME group was less??WMD=-1.70??95%CI??-1.88~-1.53??P<0.00001??, while the number of positive lymph node was more??WMD= 0.6, 95%CI: 0.51~ 0.68, P<0.00001??; (4) In the long-term effects, there were no significant differences in the local recurrence rate, distant Metastasis rate, 5-years survival rate and disease free survive(DFS)(P= 0.43, P=0.29, P=0.44, P=0.52 resPectively). Conclusion laparoscopic CME is safe and effective in the treatment of colon cancer.     

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目的探讨影响结直肠癌肝转移手术治疗的预后因素。方法回顾性分析中国医学科学院肿瘤医院腹部外科2000年1月至2011年1月资料完整并行手术治疗的123例结直肠癌肝转移病人的临床资料。结果全组病人1,3,5年存活率分别为87.2%,35.6%及21.1%。单因素分析显示肿瘤大小、术前癌胚抗原(CEA)水平、是否R0切除是影响预后的因素(P<0.05)。COX多因素分析显示是否R0切除是影响预后的独立危险因素。结论手术切除是结直肠癌肝转移病人获得长期生存的最佳手段,综合治疗是病人达到R0切除、改善远期疗效的关键。     

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??Application of modified end-to-side invagination pancreaticojejunostomy in pancreatoduodenectomy: an analysis of 21 cases ZHANG Bao-hua??YANG Jue??LI Nan??et al. Eastern Hepatobiliary Surgery Hospital, the Second Military Medical University, Shanghai 200438, China Corresponding author: ZHANG Bao-hua, E-mail: zhbh_1@tom.com Abstract Objective To investigate the improvement of pancreaticojejunostomy technique in pancreatoduodenectomy (PD), in order to decrease incidence of pancreatic leakage. Methods The clinical data of 21 cases of PD admitted between March 2006 to March 2008 at the Second Military Medical University was analyzed retrospectively. Intersection mattress suture was used for pancreaticojejunostomy that suture full-thickness of pancreas and seromuscular layer of jejunum at first layer. Results No pancreatic leakage occurred in the cases. Two cases of postoperative bleeding of gastrointestinal anastomosis occurred. No postoperative death occurred. Conclusion Intersection mattress suture is a safe and feasible method. The method is effective to decrease incidence of pancreatic leakage and it is valuable to be generalized and applied.     

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??Conventional stripping combined with transilluminated powered phlebectomy for lower extremity varicose vein??An analysis of 3170 cases QIAN Song-yi?? LIU Peng??YE Zhi-dong??et al. Department of Cardiac and Vascular Surgery??China-Japan Friendship Hospital??Beijing100029??China
Corresponding author??LIU Peng??E-mail??liupeng5417@163.com
Abstract Objective To summarize operation key points and medium and long-term follow-up results of conventional stripping combined with transilluminated powered phlebectomy for lower extremity varicose vein. Methods The clinical data of 3170 cases (4675 limbs) treated by conventional stripping with transilluminated powered phlebectomy??TIPP??from February 1, 2005 to July 31, 2013 were analyzed retrospectively??The patients were followed up to observe postoperative recovery condition??postoperative complications and postoperative recurrence rate. Results Great saphenous vein trunks was stripped away by conventional stripping technique in all patients and all superficial varicose vein labeled before operation were resected with TIPP. Perforating veins and varicose veins mass in the calf and thigh were divided and ligated respectively according to the labels marked before operation. Surgical time was??62±14??min in unilateral lower extremity and ??97±22??min in bilateral lower extremities. The average hospitalization days was??5.1±1.6??d. Two patients died in perioperative period and perioperative mortality was 0.06%. Total 2747 patients ??3890 lower extremities?? were followed up in 6 to 98 months??and the median follow up time was 47.5 months. The follow-up rate was 86.7% in all patients. Total 2697 patients (3548 lower extremities) had accepted the operation more than 1 year??2265 patients (2877 lower extremities) in which were followed up. There were 133 patients ??4.9%?? recurred ??above C2??. Conclusion Conventional stripping with transilluminated powered phlebectomy for varicose vein of lower limb has the advantages of little trauma??easily operating??definite effect??less complication. The follow-up results suggest that the operation is a surgical procedure with rapid recovery and low recurrence rate.     

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进展期胃癌行CT检查,尤其是多层螺旋CT检查可以了解胃癌的腔内外侵犯范围、淋巴结转移和远处器官转移等情况,对胃癌的术前分期有较大的帮助,已成为当前术前检查的常用方法。本文通过正常胃和进展期胃癌的CT表现进行对比阐述,以提高临床医师对胃癌CT征象的认识。1胃的正常CT表现1.1胃壁的厚度正常胃壁的厚度与胃的充盈程度有关,胃腔充盈良好时,胃壁厚约2～5mm,胃腔充盈不良时,胃壁厚度可达10mm。贲门和胃窦部较胃体部的胃壁稍厚,判断胃壁是否增厚必须结合胃腔的充盈情况和部位(图1)。在胃的多期扫描中,因各期的扫描时间不同,胃腔的充盈在…     

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??Laparoscopic ventral hernia repair with defect closure: An analysis of clinical outcomes in 105 patients Saifuding·Aibibula??Aikebaier·Aili , Azatijiang·Ainiwaer, et al??Department of Minimally Invasive Surgery??Hernia and Abdominal Wall Surgery??People's Hospital of Xinjiang Uyghur Autonomous Region??Urumuqi 830001??China
Corresponding author: Kelimu·Abudureyimu, E-mail: klm6075@ 163 .com
Abstract Objective To investigate the clinical outcomes of laparoscopic ventral hernia repair with defect closure??Methods The clinical data of 105 patients who underwent laparoscopic ventral hernia repair with defect closure in the People's Hospital of Xinjiang Uygur Autonomous Region from June 2010 to December 2015 were analyzed retrospectively. Results Of all the 105 patients??there was no patient converted to open operation. The mean operation time was (102.6±41.9) minutes??The out-of-bed activity time after operatiom was (1.3±0.5) days??and the postoperative flatus time was (1.5±0.6) days. Fifteen patients required for analgetic within 3 days after operation (14.3%) . The length of postoperative hospital stay was (4.2±1.5) days??There was only 1 patient occurred intra-operative bowel injury (1.1%) . Other compilications included 1 incomplete ileus (1.1%) and 2 wound infection (1.9%) . A total of 92 patients were followed up for 4 to 69 months??and just 1 patient??1.1%??recurred. No complications of seroma formation, mesh bulging, mesh infection and chronic pain was found??Conclusion Laparoscopic ventral hernia repair with defect closure is safe and feasible, has fewer complications and lower recurrence rate.     

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目的探讨断流与肠腔分流联合手术的血流动力学变化及其临床效果。方法对1980～1995年采用联合手术治疗的100例门静脉高压症进行回顾性分析。结果分流术后自由门静脉压力(FPP)下降1.92kPa,能够降低门静脉压力,防止出血;联合手术后FPP平均为(2.46±0.30)kPa,仍可保持高水平的向肝血流灌注,减少脑病发生。全组效果满意,无手术死亡。89例随访5～15年无复发出血,脑病5％,总病死率15％。其中肝功能ChildC级13例死于肝终末期病变,如肝衰、肝癌及肝肾综合征,5年生存率94.5％,10年生存率68.5％。结论联合手术具有断流术和外周型合理口径分流的特色,是断流和分流术两者优缺点互补,是目前我国治疗门静脉高压症的理想术式。     

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胆汁或者含有胆汁的液体持续通过非正常途径流出称为“胆瘘”。绝大多数的胆瘘都是无意造成的 ,多发生在胆道或者胆道邻近部位和脏器的外科手术 ,可能因为胆道解剖的异常、手术并发症 ,或者可能由于手术错误而造成。手术损伤造成胆瘘是可以防止的 ,但一旦发生则可能造成更严重的并发症 ,也存在一定的死亡率。1　胆瘘的病因1 1　手术原因1 1 1　人工造瘘　作为有计划地治疗胆道梗阻的方法 ,由于是作为治疗措施 ,不一定是永久性的。永久性的人工造瘘目前已经很少应用。常常因为胆道远端的恶性病变或者胆管结石造成的胆道梗阻而行此手术。当胆…     

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胰瘘是急慢性胰腺炎、腹部外科手术后特别是胰腺手术和外伤后严重的并发症之一 ,也是对腹部外科与消化科医生的挑战[1] 。作者以胰瘘 (ｐａｎｃｒｅａｔｉｃｆｉｓｔｕｌａ)和胰腺假性囊肿 (ｐａｎｃｒｅａｔｉｃｐｓｅｕｄｏｃｙｓｔ)作主题词对美国国立医学图书馆 (ＮＬＭ )的Ｍｅｄｌｉｎｅ文献库进行检索 ,收集到了 3119条有关胰瘘的文章摘要 ,并对近 5年来发表的重要文章进行了复习。现结合临床治疗胰瘘的实践 ,将有关观点综述如下。1　胰瘘的定义与常见原因　　据克氏外科学中Ｙｅｏ和Ｃａｍｅｒｏｎ[2 ] 的定义 :各种原因致胰管破裂 …     

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目的探讨女性股疝病人行腹腔镜经腹腹膜前修补术(TAPP)并对子宫圆韧带进行重建的疗效。方法回顾性分析2011年4月至2013年10月哈尔滨医科大学附属第四医院收治的8例女性股疝病人的临床资料,均行腹腔镜TAPP,并行子宫圆韧带重建。结果 8例病人术后均顺利出院,住院时间为3~9(5.2±1.7)d,手术时间28~51(37.9±4.8)min,术后下地活动时间为4~6 h。术后病人疼痛较轻微,子宫圆韧带重建对女性生理功能影响较小,术后无切口感染、腹股沟区血清肿等并发症。随访6~36个月,8例子宫圆韧带重建病人无性生活不适感,所有病人均无慢性疼痛及股疝复发。结论腹腔镜TAPP治疗女性股疝疗效确切,同期行子宫圆韧带重建对女性生理功能影响较小。     

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??Microwave ablation in the treatment of intrahepatic recurrence of hepatocellular carcinoma after liver transplantation: An analysis of 13 cases WU Pan-pan*??LU Wen??SUN Ai-xue??et al. *Graduate School of Soochow University??Suzhou 215123, China
Corresponding author??QIAN Guo-jun??E-mail??qgjs@sina.com
Abstract Objective To explore the effect and safety of percutaneous microwave coagulation therapy (PMCT) in the treatment of intrahepatic recurrence of hepatocellular carcinoma after liver transplantation. Methods The clinical data of 13 cases of liver cancer after liver transplantation performed PMCT from August 2005 to October 2013 in Eastern Hepaticbiliary Surgery Hospital of the Second Military Medical University were analyzed retrospectively. The complete ablation rate of the lesion??intrahepatic recurrence rate??6 months??1.0 year??1.5 years??2.0 year survival rate and incidence of complications were analyzed comprehensively to evaluate the safety and effect of PMCT. Results All the cases were followed up for 3-26 months. Postoperative local complete ablation rate was 92.3 %. Intrahepatic recurrence rate was 53.8%. Six months??1.0 year??1.5 years??2.0 years survival rates was 92.3 %??53.8 %??38.5 %??30.8 %. The average survival time was 12.8??3.5-25.6??months. Adverse reactions included fever in 1 case (7.7%)??nausea and vomiting in 1 case (7.7%)??right upper quadrant pain in 2 cases (15.5%) and no other complication occurred. Conclusion PMCT is a safe and effective treatment for intrahepatic recurrence of hepatocellular carcinoma after liver transplantation. The patient is well tolerated because of a mild adverse reaction and no other complication.     

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??Outcomes evaluation of endoscopic submucosal dissection for relative indication group of early esophageal squamous cell carcinoma in aged patients: An analysis of 69 cases LI Bing??QI Zhi-peng??ZHOU Ping-hong??et al. Endoscopy Center and Endoscopy Research Institute??Zhongshan Hospital??Fudan University??Shanghai 200032??China
Corresponding author??ZHONG Yun-shi??E-mail??zhong.yunshi@zs-hospital.sh.cn
Abstract Objective To evaluate the safety??efficacy and long-term outcomes of endoscopic submucosal dissection (ESD) for relative indication group of early esophageal squamous cell carcinoma in aged patients. Methods The clinical data of early esophageal squamous cell carcinoma treated by ESD from January 2008 to December 2013 in the Endoscopy Center of Zhongshan Hospital, Fudan University were analyzed retrospectively. A total of 69 cases of elderly patients were with the relative indications from the part of endoscopic treatment of Guidelines for Diagnosis and Treatment of Carcinoma of the Esophagus April 2012 edited by the Japan Esophageal Society and no additional treatment were picked out. The incidence of complications and long-term outcomes were observed and analyzed. Results 62 (89.9%) cases were infiltrated to muscularis muscular (M3)??7 (10.1%) cases were infiltrated into submucosal within 200 μm (SM1); 6 (8.7%) cases were lymphatic infiltration. There were 1 (1.4%) case with postoperative bleeding who underwent endoscopic hemostatic procedures after the ESD??2 (2.9%) cases with perforation who underwent the endoscopic suturing closure and 22 (31.8%) cases with esophageal stricture after operation. The recurrence rate was 11.6% (8/69) and the median recurrence time was 24 months. Liver and lymph node metastasis were existed in 1 case. As a result??the 5-year disease-free survival rate was 86.2%. The 5-year overall survival rate was 90.0% in the case of 4 patients (5.8%) died??and the median survival time was 56 months. Conclusion ESD could achieve comparatively ideal long-term outcomes in the treatment of early esophageal squamous cell carcinoma of aged patients without additional treatment, which has high safety and effectiveness.     

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??Percutaneous microwave ablation for very-early stage hepatocellular carcinoma XU Yun*??SHEN Qiang??WANG Neng??et al. *Graduate School of Soochow University??Suzhou 215006??China
Corresponding author??QIAN Guo-jun??E-mail??qgjs@sina.com
Abstract Objective To investigate the effects and prognostic factors for the survival in the patients with very-early stage hepatocellular carcinoma (HCC) treated with percutaneous microwave ablation. Methods From January 2007 to January 2012??102 cases of very-early stage HCC were treated by percutaneous microwave ablation. Complete ablation rate??overall survival rate??disease-free survival rate were observed and analyzed. Results The complete ablation rate was 96.1%. The 1-??3-??and 5-year overall survival ratet and corresponding disease-free survival rate was 94.1%, 84.3%, 72.5% and 90.2%, 73.5%, 59.2% respectively. Conclusion Percutaneous microwave ablation is a safe and efficient therapy for very-early stage HCC.     

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??Curative effect of laparoscope and component separation technique in the treatment of parastomal hernia: An analysis of 16 cases LIU Chang??SUN Xu-yang??JI Yan-chao??et al. Department of General Surgery??the Fourth Affiliated Hospital of Harbin Medical University??Harbin 150001??China
Corresponding author??LIU Chang??E-mail??changliu72@163.com
Abstract Objective To study the effectiveness of using laparoscope and component separation technique (CST) to cure parastomal hernia. Methods The clinical data of 16 cases of parastomal hernia performed laparoscopy and CST from January 2012 to January 2015 in the Fourth Affiliated Hospital of Harbin Medical University were analyzed retrospectively. Results The operation time ranged from 70 to 250 minutes with a mean of ??152.9±60.8??min. The postoperative seroma occurred in 2 cases. One case had incisional infection. Two cases had abdominal pain and most of the pain could be alleviated in 3-4 weeks. They were followed up for 6-15 months. A total of 16 cases were performed laparoscopy and CST to cure parastomal hernia restored abdominal wall appearance effectively, normal breathing and coordination of movement in other parts of the body??to achieve the effect of abdominal wall function reconstruction. All the cases had no chronic pain and recurrence. Conclusion Laparoscope and CST have the advantages of minor injury??light interference??quicker recovery, which can not only restore the continuity of the abdominal wall structure and achieve the functional reconstruction of abdominal wall??but also reduce recurrence of hernia.     

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??Reconstructive surgery for deep vein reflux for left iliac vein stenosis complicated with severe deep venous insufficiency: An analysis of 73 cases MA Jie*??MA Tao. *Department of Vascular Surgery, No. 210 Hospital of Chinese People's Liberation Army, Dalian116012, China
Corresponding author??MA Jie??E-mail??majie541019@sina.com
Abstract Objective To report the clinical outcomes and mid-term results of deep vein valve reconstruction combined with superficial vein surgery in treating deep venous insufficiency (DVI) complicated with left iliac vein stenosis (LIVS). Methods From January 2007 to June 2014??73 cases of DVI complicated with LIVS (male 14??female 59??mean age 49.7) were diagnosed via ascending venography. Deep venous valve reconstruction surgery were performed. Pre-and postoperative Doppler ultrasound??dynamic venography were conducted. Hemodynamic??thrombosisstatus and venous clinical severity score (VCSS) were recorded and compared. Results Among 73 cases, venography results showed 60 cases (82.1%) had stenosis rate between 50.6??to 58.7??and 13 cases (17.9%) had stenosis rate between 60.1?? to 65.6??. All the cases had Kistner Class III-IV venous reflux. Postoperative popliteal vein reflux quantity [??165.61±10.25??mL ] was significant lower than preoperative popliteal vein reflux quantity [??812.63±57.42??mL] (t=12.17??P<0.001). VCSS reduced from preoperative ??7.98±1.35?? to postoperative ??1.47±0.68?? (t=54.62??P<0.001). All the cases were followed-up for 58 months. No postoperative thrombosis was observed. Limb pain and swelling were relieved??ulcers were healed in 96.2% of the cases??ulcer recurrent rate was 3.8%. Conclusion The deep vein valve reconstruction surgery at the popliteal vein??combined with great saphenous vein??small saphenous vein and perforator vein surgery in treating DVI complicated with LIVS (>50%??65%) is safe and effective??providing satisfactory long-term results.     

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??Effective of laparoscopic treatment of hepatic hemangioma JIN Xiao-jian, LU Bang-yu, CAI Xiao-yong, et al. Department of Minimally Invasive Surgery??the First Affiliated Hospital??Guangxi Medical University??Nanning 530021??China
Corresponding author: LU Bang-yu, E-mail: jj541@sohu.com
Abstract Objective To evaluate the feasibility and effective of laparoscopic treatment of hepatic hemangioma??Methods The clinical data of 43 cases of laparoscopic treatment of hepatic hemangioma from November 2003 to October 2009 in the Department of Minimally Invasive Surgery??the First Affiliated Hospital of Guangxi Medical University were analyzed retrospectively??The portal blood stream was blocked by the home-made laparoscope portal blood blocker or semi-block. Electronic knife and ultrasound knife were used in hemangioma enucleation, hepatic left lateral lobectomy and partial excision. Results Laparoscopic treatment of hepatic hemangioma was performed in 41 cases successfully??Conversion laparotomy was performed in two out of 43 (4.6%) cases for uncontrolled bleeding. There was no mortality. The tumor diameter was (6.24±2.87)cm. The operating time was (125.27±74.76) min. The time of block was (11.27±14.11) min. The intraoperative blood loss was (285.5±425.04)mL. The volum of intraoperative blood transfusion was (1.22±2.57)u. The volume of postoperative drainage was (169.61±224.43)mL. The time taken to return to normal activity after operation was (2.20±0.99) days. The length of stay after operation was (8.5±3.6) days. The total length of stay was (17.5±7.4) days. The total outlay was (11441.6±9668.7) Yuan RMB. The postoperative complications were occurred in 2 (4.8%) cases, which were 1 case of bile leakage and 1 case of subhepatic abscess. The 2 cases were recovered after expectant treatment. Conclusion Laparoscopic treatment of hepatic hemangioma is safe and feasible if suitable patients were selected and hepatic portal blood block technique was mastered by surgeons.     

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急性胆囊炎伴胆囊管结石嵌顿因结石阻塞胆囊管造成胆囊腔内压力增高,胆囊血供受阻,易引起胆囊坏疽穿孔,胆囊三角常粘连较重,分离困难,使腹腔镜手术难度增加。2010年1月至2013年1月天津市南开医院采用胆囊横断法完成腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC)治疗217例急性梗阻性胆囊炎病人。现报告如下。1资料与方法1.1临床资料本组共217例急性胆囊炎、胆囊管结石嵌