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??The blocking effect research of complete block technique applied in radical gastrectomy for gastric antrum cancer WANG Jun??GUO Feng-hua??MAO Xiang??et al. Department of General Surgery??Huashan Hospital??Fudan University??Shanghai 200040??China
Corresponding author??WANG Zhi-ming??E-mail??wzhm824@126.com
Abstract Objective To study the effect of complete block technique for gastric antrum cancer on preventing intraoperative metastases of tumor cells. Methods Seventy-six cases of gastric antrum cancer admitted between July 2008 and September 2010 at Huashan Hospital of Fudan University were selected in the study. All the cases were randomly divided into two groups and performed radical gastrectomy with complete block technique (blocking group) and traditional radical gastrectomy (conventional group) respectively. Blood samples from the portal vein and peritoneal wash samples were obtained immediately after laparotomy and during surgical resection. RT-PCR was used to determine levels of carcinoembryonic antigen (CEA) and cytokeratin 20 (CK20). Carbon nanoparticles were injected into the subserosa of the blocked region before resection to determine lymph flow out of the region or not in blocking group. Results Before tumor resection??the positive rate of CEAmRNA and CK20 mRNA expression in portal vein blood was 10%??4/40??and 15%??6/40??in blocking group respectively and 8.3%??3/36??and 11.1% (4/36) in conventional group respectively. There was no significant difference between two groups (P>0.05). During tumor resection??the positive rate of CEA mRNA and CK20 mRNA expression in portal vein blood was 7.5%??3/10??and 15.0%??6/40??in blocking group respectively and 30.5% (11/36) and 36.0%??13/36??in conventional group respectively. There was significant difference between two groups (P<0.05). The difference was not statistically significant for peritoneal washes. Lymph nodes in the blocked area were fully black dyed while those out of the blocked region were normal. Conclusion Complete block technique can effectively prevent free tumor cells being shed into blood and lymph circulation caused by surgical mobilization to reduce intraoperative metastases.     

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目的 前瞻性比较研究乳房切除并腋淋巴结清扫术(MAD)与根治术(RM)对Ⅰ、Ⅱ期乳腺癌的远期疗效。方法将192例Ⅰ、Ⅱ乳腺癌随机分两组：MAD组96例或加卵巢去势术；RM组96例，或加卵巢去势术。MAD组腋淋巴结清除范围是腋下群淋巴结；RM组采用Halsted或仿根治Ⅱ式。卵巢去势是在乳房手术同时行双侧卵巢切除术。结果 MAD组和RM组10年生存率分别为80．4％和81．8％；无病生存率分别为76．7％和79．3％。局部复发率：MAD组和RM组分别为3．2％和2．3％。患侧上肢肿胀发生率：MAD组和RM组分别为3．2％和7．9％。绝经前去势组(36例)与未去势组(58例)10年生存率分别为79．4％和81．4％，无病生存率分别为74．7％和74．9％。结论 对Ⅰ、Ⅱ期乳腺癌采用MAD的疗效与RM相同，且能改善病人的生存质量。     

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??Clinical application of WIFi classification system on the wound healing of diabetic foot patients with lower limb ischemia after lower limbs re-vascularization WANG Tao, ZHAO Jun, MEI Jia-cai, et al. Department of Vascular Surgery, the Affiliated Sixth People’s Hospital, Shanghai Jiao Tong University, Shanghai 200233, China
Corresponding author: ZHAO Jun, E-mail: junnzhao@126.com
Abstract Objective To evaluate clinical significance of WIFi classification issued by American Society for Vascular Surgery in 2014 , predict the effectiveness of revascularization for diabetic foot patients with peripheral vascular disease.Methods The total of 109 diabetic foot patients with peripheral artery disease successfully conducted re-vascularization between January 2013 and January 2016 in Affiliated Sixth People’s Hospital, Shanghai Jiao Tong University were divided into two groups. Sixty-four patients whose wound healed successfully were set into observation group, while forty-five patients with non-healing wound as the controlled group. Clinical data, WIFi classification of those patients were analyzed retrospectively. The high risk factors of wound healing were analyzed by single factor, multiple factor and Logistic regression analysis. Results There was no significant difference in clinical data such as age, gender, ABI, HbA1c,TC, blood glucose,the course of diabetes and ratio of cardiovascular and cerebrovascular diseases between the two group??P>0.05??. Single factor regression analysis showed that there was significant difference between two groups in the W and I classification system??P<0.01??. Multiple factors regression analysis indicated that wound and ischemia grade were independent risk factors of wound healing time after re-vascularization. Logistic regression analysis displayed that serious I grade in the WIFi classification system was predictive independent risk factors of wound healing time after re-vascularization??P<0.01??. Conclusion Using WIFi classification system to evaluate the risk of wound healing after re-vascularization among diabetic foot patients with peripheral artery disease has a better prediction and evaluation value.     

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目的介绍一种全胃切除术改良双贮袋Roux-en-Y吻合消化道重建方式,并与传统袢式吻合和Roux-en-Y吻合的中短期效果进行对比研究。方法 2008年5月至2010年3月河南省肿瘤医院普外科将106例因胃癌行根治性全胃切除术病人,随机分为3组分别接受改良双贮袋Roux-en-Y吻合、袢式吻合和Roux-en-Y吻合3种空肠代胃手术方式。比较3组病人的手术时间、术后并发症、住院总费用和住院时间。并于术后1、6、12个月分别进行胃癌病人生活质量调查问卷(QLQ-STO22)评分。结果改良双贮袋Roux-en-Y吻合在手术时间、术后并发症、住院总费用、住院时间等方面与其他两组比较差异无统计学意义。但生活质量评估(吞咽困难、疼痛、呃逆和饮食受限)明显优于其他两组。结论改良双贮袋Roux-en-Y吻合具有安全、术后生活质量高等优点。     

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??Clinical research of the “modified four-step” technique applied in laparoscopic splenectomy and pericardial devascularization HONG De-fei??CHENG Jian??ZHANG Yu-hua??et al. Department of Hepatobiliary Pancreatic and Micro-invasive Surgery??Zhejiang Provincial People’s Hospital??Hangzhou 310014??China
Corresponding author: HONG De-fei, E-mail: hongdefi@163.com
Abstract Objective To summarize effect and experience of the "modified four-step" technique applied in laparoscopic splenectomy and pericardial devascularization (LSPD). Methods The clinical data of 105 cases of LSPD conducted by the " modified four-step" technique between June 2012 and June 2015 in Department of Hepatobiliary Pancreatic and Micro-invasive Surgery??Zhejiang Provincial People’s Hospital were analyzed retrospectively. Results All cases were operated successfully. Among them, 2 cases (1.9%) were converted to open surgery and the rest 103 cases were conducted successfully under complete laparoscopy. Operative time was (175.6 ± 49.8) min and blood loss was (310.9 ± 240.9) mL. Postoperative complication included 1 case of abdominal bleeding??1 case of pancreatic leakage??2 cases of abdominal infection??2 cases of splenic vein thrombosis??3 cases of hepatic dysfunction. One case of liver dysfunction with hepatic encephalopathy gave up treatment and automatically discharged. Other cases were cured by conservative treatment. Postoperative hospital stay (8.7 ± 3.6)d. Two cases ocurred recurrece of GI bleeding after following 12—48 months. Conclusion The "modified four-step" technique in LSPD has high laparoscopic success rate??low rate of postoperative complications and the low rate of GI bleeding recurrence. It’s worthy of clinical promotion and application.     

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??Efficacy and prognostic factors of repeat hepatic resection for recurrent hepatocellular carcinoma??A report of 175 cases XU Yun*??SHEN Qiang??WANG Neng??et al. *Department of Minimally Invasive Therapy??Hepatobiliary Surgery Hospital??the Second Military Medical University??Shanghai 200438??China
Corresponding author??QIAN Guo-jun??E-mail??qgjs@sina.com
Abstract Objective To investigate the safety, efficacy and prognostic factors for the survival in the patients with recurrent hepatocellular carcinoma (HCC) treated with repeat hepatic resection (RHR). Methods The clinical data of 175 cases of recurrent HCC following resection treated with RHR from January 2007 to December 2011 in Hepatobiliary Surgery Hospital of the Second Military Medical University were analyzed retrospectively. Complication rate, overall survival rates, disease-free survival rates were calculated and prognostic risk factors were analyzed. Results The severe complication rate after RHR was 7.4%. The 1-,3-,5-year overall survival rates and disease-free survival rates were 92%,71%,51% and 75%,43%,36%, respectively. Elderly patient??>65 years old??, primary HCC at Barcelona Clinic Liver Cancer (BCLC) stage B, microvascular invasion, larger size and incomplete capsule were risk factors for overall survival. Conclusion Indications of RHR should be managed strictly. For patients who satisfy the indications, RHR is safe and effective. For elderly patients??>65 years old??, primary HCC at BCLC stage B, microvascular invasion, larger size and incomplete capsule, closer follow-up and auxiliary treatment following RHR should be considered to improve relatively poor prognosis of the category.     

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??Abdominoinguinal incision in the resection of large soft tissue tumor at the area of iliac fossa??A report of 15 patients QIU Hui??Wu Jian-hui??LI Cheng-peng??et al. Sarcoma Center??Peking University Cancer Hospital & Institute??Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education)??Beijing 100142??China
Corresponding author??HAO Chun-yi??E-mail??haochunyi@vip.sina.com
Abstract Objective To explore the safety and feasibility of abdominoinguinal incision in large tumors at the area of the iliac fossa. Methods A total of 15 cases of large tumor at the area of the iliac fossa were performed operation through the abdominoinguinal incision from August 2015 to February 2018 in Sarcoma Center of Peking University Cancer Hospital.The clinical data were analyzed retrospectively. Results Complete resection were successfully performed in all patients??13 R0 resection????combined with 13 colectomy??9 nephrectomy??4 total/partial cystectomy??4 adnexectomy/orchiectomy and 10 partial resection and reconstruction of external iliac vessels. The operation time and blood loss was 360 to 720 min and 500 to 8000 mL respectively. One wound infection??6.7%??was observed??and no patient died in hospital. Conclusion The abdominoinguinal incision has a good exposure for the removal of large tumors at the area of iliac fossa.The tumors could be resected integratedly and safely.     

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目的 观察连续性高流量血液滤过(HVHF)治疗严重感染伴有多器官功能障碍综合征(MODS)的临床疗效及安全性.方法 2005-2007年中国医科大学附属第一医院收治的20例确诊为产重感染伴有MODS的病人,平均APPACHEⅡ评分为23.8±8.3,平均SOFA评分为10.6±4.0,在常规治疗的基础上应用HVHF治疗至少3d,血流速度250mL/min,超滤量4L/h,置换液以前稀释方式输入,普通肝素抗凝,每24h更换滤器1次.比较治疗前后病人生命体征、血清尿素氮、肌酐、胆红素、动脉血乳酸、血小板、氧合指数及APPACHEⅡ评分和SOFA评分的变化,并监测治疗过程中的并发症.结果 20例病人在HVHF治疗后生命体征迅速稳定,体温、心率、呼吸频率降低,平均动脉压上升,血清尿素氮、肌酐水平下降,动脉血乳酸降低,血小板计数升高,氧合指数改善,APPACHEⅡ评分及SOFA评分降低,与治疗前相比差异具有统计学意义(P＜0.05),血清胆红素水平在治疗后来见明显改善.治疗过程中病人未见严重的离子及酸碱紊乱及其他并发症的发生.结论 连续性HVHF治疗能够降低严重感染伴有MODs病人的全身炎性反应,改善器官功能水平,未见严重并发症的发生,安全有效.     

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目的了解胆道感染时胆汁中致病菌菌群及其对抗生素敏感性的变化,为临床选择用药提供参考和依据。方法将2002年1月至2003年12月培养阳性的264例胆汁标本323株病原菌及药敏结果进行统计分析。结果323株细菌中包含了52种细菌,其中革兰阴性杆菌占594%,革兰阳性球菌占406%。排列前6位的细菌依次为肠球菌220%,大肠埃希菌195%,克雷白菌属118%,葡萄球菌属108%,假单孢菌属87%,肠杆菌属84%。59例混合感染中,大肠埃希菌和铜绿假单孢菌各占12例和10例。细菌对青霉素类、头孢类、喹诺酮类、大环内酯类抗生素敏感性普遍下降,对亚胺培南、美罗培南、万古霉素、替考拉宁仍保持相当高的敏感率。阿米卡星对细菌敏感性也较高,尤其对铜绿假单孢菌有效率仍达687%。结论胆道感染致病菌菌群不断在改变,细菌数量和种类在增加,其对药物敏感性普遍下降;治疗胆道感染应动态监测菌群和药物敏感性的变化及合理应用抗生素。     

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目的研究蒽环类联合紫杉类方案对三阴型乳腺癌进行新辅助化疗的疗效,应用动态增强磁共振成像(MRI)及组织病理学进行疗效评价。方法选择2008年1月至2011年12月北京大学第一医院乳腺疾病中心初始实施蒽环类联合紫杉类新辅助化疗并完成手术的三阴型乳腺癌病人为研究对象。疗效评价包括动态增强MRI临床评价及组织病理学评价。定义MRI评价包括临床完全缓解、临床部分缓解为临床评价有效,计算临床有效率;定义病理分级G3~G5为病理评价有效,计算病理有效率。结果共诊治1190例新发乳腺癌,其中三阴型乳腺癌129例(占10.8%),41例符合入组标准,新辅助治疗临床评价有效率为65.85%(27/41),病理评价有效率为85.37%(35/41),其中病理完全缓解率(pCR)为36.59%(15/41),新辅助治疗MRI评价与病理评价符合率为77.1%。结论蒽环类联合紫衫类方案是治疗三阴型乳腺癌的有效方法。动态增强MRI能准确评价三阴型乳腺癌新辅助化疗疗效,并与病理评价相符合。     

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目的研究染料法腋窝反向淋巴作图(axillary reverse mapping,ARM)结合前哨淋巴结活检(sentinel lymph nodebiopsy,SLNB)在乳腺癌术中的应用。方法回顾性分析2011年6月至2013年6月蚌埠医学院第一附属医院肿瘤外三科收治的共363例乳腺癌病人资料,均行乳腺癌腋窝淋巴结清扫术(ALND),其中联合行ARM+SLNB者78例(ARM+SLNB组),单纯行ALND者285例(ALND组),比较两组术后疗效。结果 ALND组病人术后带管时间为(12.3±1.5)d,而ARM+SLNB组为(9.6±1.9)d,二者差异有统计学意义(t=11.74,P<0.05)。ARM+SLNB组术后第1~7天的引流量均较ALND组明显减少,差异有统计学意义(P<0.05)。随访12个月,两组均未发现Ⅲ级水肿,第12个月ALND组与ARM+SLNB组水肿发生率差异有统计学意义(P<0.05)。结论 ARM可保护患侧上肢淋巴通道,减少术后上肢水肿的发生。     

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目的探索乳腺癌非前哨淋巴结(NSLN)转移的危险因素,验证纪念斯隆凯特琳癌症中心(MSKCC)列线图的临床应用价值。方法回顾性分析山东省肿瘤医院2001年12月至2012年1月接受前哨淋巴结活检的1227例乳腺癌病人,评估前哨淋巴结(SLN)阳性病人NSLN转移的危险因素。登陆MSKCC网站计算病人NSLN转移风险,通过绘制趋势线和计算受试者工作特征曲线(ROC)下面积(AUC)评估预测准确性。结果肿瘤大小、SLN阳性数、组织学分级、脉管侵犯和多灶性与NSLN转移差异有统计学意义(P<0.05),其中肿瘤大小、SLN阳性数、组织学分级和脉管侵犯是NSLN转移的独立预测因素。趋势线显示预测值曲线和真实值曲线趋势基本相同,MSKCC列线图的AUC值为0.765,预测值<10%的病人(51/412,12.4%)NSLN阳性率为5.9%(3/51)。结论 MSKCC列线图可以较准确的预测NSLN转移风险,为病人是否行腋窝淋巴结清扫术(ALND)提供参考依据,预测值<10%的病人可以避免ALND。     

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??Associating partial pancreatectomy and extended extrahepatic bile duct resection VS. pancreatoduodenectomy for the middle cholangiocarcinoma involving the pancreas bile duct: clinical analysis of 41 cases YIN Lei* ,FANG Zheng,YUAN Bo, et al. *No.2 Department of Biliary Surgery, Eastern Hepatobiliary Surgery Hospital, the Second Military Medical University, Shanghai 200438, China
Corresponding author:ZHANG Yong-jie, E-mail??510531179@qq.com
YIN Lei,FANG Zheng are the first authors who contributed equally to the article
Abstract Objective To compare the effect of associating partial pancreatectomy and extended extrahepatic bile duct resection with pancreaticoduodenectomy in the treatment of the middle cholangiocarcinoma involving the pancreas bile duct (MCIPB). Methods The clinical features, surgical methods and follow-up results of 41 patients with MCIPB were retrospectively analyzed from January 2010 to December 2015 in Eastern Hepatobiliary Surgery Hospital.Clinical factors that may affect the prognosis of the MCIPB were included in Kaplan-Meier analysis. Results Operations were performed in all 41 patients of MCIPB, including 23 patients of associating partial pancreatectomy and extended extrahepatic bile duct resection (APPER) and 18 patients of pancreaticoduodenectomy (PD), in which 5 were performed with pylorus-preserving pancreaticoduodenectomy (PPPD).The median survival time of the patients in the APPER group was 15 months, and the survival rate in 1, 3 and 5 years was 69.6%, 34.8% and 0% respectively.The median survival time in PD group was 21.5 months, and the survival rate in 1, 3 and 5 years was 55.5%, 33.3% and 22.2%, respectively.There was no statistically significant difference between the two groups (P=0.59).Multivariate analysis suggests that R1 resection was the only risk factor for survival. Conclusion APPER can obtain a certain clinical curative effect for part of MCIPB, but pancreatic-biliary surgeons should select suitable cases carefully.It is the key for APPER to ensure the negative margin.     

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目的评价血清钠浓度对肠瘘合并腹腔感染病人死亡情况的预测价值。方法选择2012年1月至2013年1月南京军区南京总医院普通外科收治的162例肠瘘合并腹腔感染病人作为推导队列,根据28 d死亡情况将病人分为生存组(119例)和死亡组(43例)。监测病人入院当天及入院第3、7天的各项生化指标[血清钠浓度([Na+])、血清降钙素原(PCT)]。以[Na+]为例:[Na+]0、[Na+]3、[Na+]7分别为入院当天和入院后第3、7天的[Na+];Δ[Na+]3=[Na+]3-[Na+]0;Δ[Na+]7=[Na+]7-[Na+]0;Δ[Na+]7-3=[Na+]7-[Na+]3。其余指标以此类推。使用ROC曲线分析各指标对预后的影响。同时,选择2013年1-10月的116例相关病人作为验证队列,对各指标的预测价值进行验证。结果 ROC曲线分析表明,[Na+]7>147.5 mmol/L和Δ[Na+]7>5.2 mmol/L可准确地预测病人的死亡情况。[Na+]7:敏感度81.2%,特异度87.7%,AUC=0.872(P<0.001);Δ[Na+]7:敏感度81.3%,特异度83.6%,AUC=0.836(P<0.001)。联合多个指标预测的准确度最高:[Na+]7>147.5 mmol/L+Δ[Na+]7>5.2 mmol/L+ΔPCT7<5.3ng/m L(AUC=0.899,P<0.001)。结论动态监测血清钠浓度可预测肠瘘合并腹腔感染病人的28 d死亡情况,高钠血症和血钠波动幅度过大是敏感的预警指标,应该在危重症病人的临床监护中加以重视。     

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目的　探讨乳腺癌新辅助化疗中Ki- 6 7、bcl- 2和AI表达率与临床疗效的关系。方法　2 0 0 2年1月至2 0 0 3年6月对5 8例可手术女性乳腺癌病人采用CEF方案新辅助化疗3个周期。对资料完整的4 2例,检测化疗前后Ki -6 7、bcl- 2及肿瘤细胞凋亡指数(AI)的变化。结果　化疗有效率为6 2. 1%。Ki 6 7高表达乳腺癌有效率高(P <0 .0 5 )。疗效与bcl- 2表达及AI值无明显关系。结论　可手术乳腺癌采用CEF方案新辅助化疗,Ki- 6 7表达情况对预测化疗效果具有重要价值。     

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目的探讨D山梨醇清除率在评估肝储备功能中的作用。方法2000年1月至2001年12月对50例行断流手术的肝硬化合并门静脉高压症病人术前进行肝功能分级及D山梨醇肝清除率测定,分析D山梨醇肝清除率与肝功能分级及断流术后并发症发生率的关系。结果ChildPugh肝功能分级为A级的病人比B级病人D山梨醇肝清除率高,断流术后无并发症病人比有并发症病人D山梨醇肝清除率高,在肝功能B级组中随着D山梨醇肝清除率降低,术后并发症发生率增高。结论D山梨醇肝清除率能够反映病肝储备功能,联合应用D山梨醇肝清除率和肝功能分级可以更客观地评估病肝储备功能。     

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目的研究中国乳腺癌病人术后死亡风险时间分布规律。方法回顾性研究1992年1月至2003年12月复旦大学附属肿瘤医院手术治疗并且资料完整的原发性乳腺癌2214例临床资料,对其进行生存及死亡风险分析。结果单因素和多因素生存分析均提示肿瘤大小、腋下淋巴结转移状态和孕激素受体状态是影响总存活率的预后因素(P<0.05)。全组病人年死亡风险曲线呈现双峰型,死亡高峰分别位于术后第2年及术后第9.5～10年,且该死亡模式在肿瘤较大及淋巴结阳性的亚组中更为明显。激素受体状态虽不改变病人的双峰型复发模式,但却呈现出一定的时间依赖性。结论乳腺癌术后死亡风险时间分布呈现出一定的规律,针对性制定术后随访和辅助治疗的新策略,可能有助于改善乳腺癌的治疗效果。     

A群链球菌制剂联合化疗用于结肠癌根治术后的前瞻性随机对照研究

目的 研究A群链球菌制剂联合化疗对结肠癌根治术后局部复发、肝转移及生存率的影响.方法 将2004年1月至2005年12月间行根治手术的132例Ⅱ期和Ⅲ期结肠癌患者,根据计算机产生的随机数字表将患者随机分成试验组60例（A群链球菌制剂联合腹腔灌注及全身静脉化疗）和对照组72例（单纯化疗,给药方式和化疗方案同试验组）,比较两组患者的毒性反应、腹腔局部复发、肝转移率及生存率.结果 两组患者化疗期间不良反应的差异无统计学意义（P〉0.05）.试验组患者术后3年内有9例（15.0%）发生肝转移,11例（18.3%）出现局部复发,均低于对照组（30.6%和34.7%）,差异具有统计学意义（均P〈0.05）.两组术后3年生存率分别为73.3%和54.2%,差异有统计学意义（P〈0.05）.结论 A群链球菌制剂联合腹腔灌注及全身静脉化疗可降低结肠癌根治术后局部复发和肝转移发生率,并提高术后生存率.     

激活素A、TGF-β1在兔下颌骨牵引中的表达

目的 检测下颌骨牵引过程中激活素A(ACT A)及转化生长因子β1(TGF-β1)的表达情况，了解ACTA、TGFβ1在下颌牵引成骨中作用的异同点。方法 采用兔下颌骨牵引模型在牵张不同时期取牵引组织用免疫组化和RT-PCR检测ACTA、TGFβ1蛋白及mRNA在不同时期的表达。结果 牵引过程开始ACT A mRNA的表达量逐渐上升，固定10d及20d达峰值，ACT A蛋白主要分布在成骨细胞内。延迟期末TGFβ1表达量达峰值，其蛋白主要分布于间质及间质细胞。结论 在兔下颌骨牵引过程中ACT A与TGFβ1的作用有很大不同，二者联合可能促进新骨形成。