【Abstract】ObjectiveTo summarize the study on the feasibility of celiac axis ligation. Methods Literatures about celiac axis ligation were reviewed retrospectively. ResultsCeliac axis branches included common hepatic artery， splenic artery， left gastric artery which had many variation and collateral flow between celiac and mesenteric vessels by gastroduodenal artery and pancreaticoduodenal artery. Celiac axis could be possibly ligated without obvious complications in patients who had celiac axis injuries, celiac artery aneurysms, upper gastrointestinal haemorrhage, excision of carcinoma around the celiac axis and portal hypertension. However, gallbladder necrosis or perforation, focal infarction of the liver even higher mortality had also been reported. ConclusionCeliac axis ligation should not be performed routinely, but it is surgically possible and may be a life saving approach in certain circumstances.
OBJECTIVE To introduce a method to repair the vagina following pelvic exenteration for carcinoma of rectum in which the posterior wall of the vagina and cervix of the uterus were often involved. METHODS From 1990 to 1997 segment of the vascularized ileum was used to repair the vagina in 5 cases, and in 2 of which the whole vagina was repaired while in the other 3 cases only the posterior wall of the vagina was repaired. RESULTS All of the patients had successful results after operation repair. CONCLUSION Vascularized graft was an ideal material for the repair of vagina defect following pelvic exenteration for carcinoma of rectum, because this material was easily accessible, and its vascular pedicle was long enough for its transferring to the perineal region and the ileum had good blood supply which made healing easy. The vagina following repair had a thick posterior wall, good elasticity and very little scar tissue surrounded.
Objective To explore the clinical therapeutic value of pancreatoduodenectomy in patients with carcinoma of ampulla of Vater (AVC). Methods The clinical data of 195 patients with AVC between March 1995 and March 2009 in this hospital were analyzed retrospectively. All the patients were divided into non-surgery group (n＝51), palliative surgery group (n＝96), and resection group (n＝48) according to the treatment methods. Results The 1-year, 3-year, and 5-year survival rates in the resection group were higher than those in the non-surgery group and the palliative surgery group (Plt;0.01). However, the incidence of complications in the resection group was higher than that in the nonsurgery group or the palliative surgery group (Plt;0.05). The radical resection rates, 1-year, 3-year, and 5-year survival rates of carcinomas of head of pancreas were significantly lower than those of carcinomas of the terminal of common bile duct or carcinomas of duodenal papilla (Plt;0.05, Plt;0.01). There was no significant difference of the perioperative mortality, complications rate, 1-year, 3-year, or 5-year survival rate between preoperative drainage jaundice group and preoperative nondrainage jaundice group (Pgt;0.05). The perioperative mortality in the resection group above the age of 70 years old was higher than that of less than or equal to 70 years old （Plt;0.05）. Compared with the non-surgery group or palliative surgery group, there were significant increasement of the incidence of serious or deadly perioperative complications in the resection group (Plt;0.05). Conclusions Surgical resection remains one of the most important measures of the treatment of AVC, in particular, the radical pancreatoduodenectomy is the only effect way for AVC, thus significantly prolonging the patient’s postoperative survivals and significantly improving the qualities of life.
Objective To evaluate the effect of laparoscopy-assisted surgery for lymph node dissection in patients with carcinoma of gastric cardia. Methods The clinical data of patients with carcinoma of gastric cardia who underwent either laparoscopy-assisted or open gastrectomy between January 2004 and September 2009 in the Department of General Surgery, the Nanchong Central Hospital were analyzed retrospectively. The number of lymph node dissection was compared. Results Thirty-nine patients underwent laparoscopy-assisted gastrectomy (laparoscopy group) and 63 patients underwent open gastrectomy (open group). There was no significant difference in preoperative complications, type of pathology or pTNM stage between two groups (Pgt;0.05). The number of lymph node dissection was 16.44±6.25 in the laparoscopy group， of which the number of first station lymph node was 10.56±3.78 (metastasis rate was 74.4%), the second station was 3.82±1.82 (metastasis rate was 46.2%), the third station was 2.00±1.36 (metastasis rate was 5.1%); in the open group, the numbers of corresponding lymph node were 16.38±5.83, 10.94±3.91 (metastasis rate was 71.4%), 3.71±1.55 (metastasis rate was 42.9%), and 1.75±1.06 (metastasis rate was 3.2%), respectively. There was no significant difference between two groups (Pgt;0.05). Conclusion The effectiveness of lymph node dissection is satisfactory by laparoscopy-assisted surgery for patients with carcinoma of gastric cardia, but prospective efficacy is still being followed up.
Objective To investigate the role of KiSS-1 gene in the metastatic process of carcinoma of gallbladder and the clinicopathologic significance of KiSS-1 gene expression in carcinoma of gallbladder. Methods Pathological specimens from 59 gallbladder carcinoma tissues (13 hepatic invasion and 13 lymphatic invasion tissues were included), matched with 7 para-tumor and 6 normal gallbladder tissues, were examined for the expression of KiSS-1 gene by tissue microarray technique and immunohistochemistry (EnVision). Results The positive rate of KiSS-1 expression was down-regulated (P＜0.05) in tumor tissues, as compared with normal and para-tumor tissues. In carcinoma of gallbladder, the expression of KiSS-1 had no relationship with the gender, age, tumor size, histological grade or differentiation, and metastasis of lymph node, while was associated with the depth of infiltration, invasion of liver and the clinical stages (Nevin). In Ⅰ+Ⅱ, Ⅲ+Ⅳ and Ⅴ stage, the positive rates of KiSS-1 were 92.3%, 57.1% and 27.8% respectively, with an undeniably clear lowering tendency (P=0.002). Conclusion Down-regulating expression of KiSS-1 is closely associated with the processes of genesis, invasion and metastasis in carcinoma of gallbladder, and may participate in regulating these processes.
ObjectiveTo investigate the proportion of peripheral blood CD4+CD25+ regulatory T cells (Tregs) in patients with pancreatic head carcinoma, the dynamic changes of these cells before and after pancreatoduodenectomy were also analyzed. MethodsThe proportions of peripheral blood CD4+CD25+ Tregs in patients with pancreatic head carcinoma and normal individuals were examined by using flow cytometric analysis. The CD4+/CD8+ ratio was also studied before and after operation. ResultsThe patients with pancreatic head carcinoma showed higher ratio of CD4+CD25+ and CD4+CD25high Tregs compared with normal control before operation (Plt;0.05). However, the percentage of these T cells reduced significantly after pancreatoduodenectomy, which was most obviously on the 3rd day after operation (Plt;0.01, Plt;0.05). After operation, CA199 level began to decrease, which was obvious on the fourteen day after operation. This tendency of CD4+CD25high Tregs changes was similar to that of CA199. The patients showed an decreased ratios of CD4+/CD8+ compared with normal controls, which further declined after operation, and reached the lowest point on the seventh day after operation (Plt;0.05). ConclusionsPancreatoduodenectomy may be helpful for the recovery of antitumor immunity. The perioperative period of patients with pancreatic head carcinoma may be a beneficial windowphase for immune intervention and Tregs may be served as target cells.
Objective To determine the safety and efficacy of surgical biliary bypass on the elderly patients with unresectable pancreatic head cancer. Methods The clinical data of 55 cases with unresectable pancreatic head cancer treated with palliation methods from July 2002 to June 2009 in our hospital were retrospectively analyzed. The patients were divided into three groups according to different age and therapeutic program: Nineteen patients, 65 years of age or older, were managed with surgical biliary bypass (group A), 19 patients under 65 years of age were treated by surgical biliary bypass (group B) and 17 patients with the age of 65 years or older received percutaneous transhepatic biliary drainage (group C). Then the therapeutic results were compared.Results With respect to the postoperative level of serum bilirubin, the incidence of early complications, postoperative hospitalization and mean survival time, no statistically significant difference was found between group A and B (Pgt;0.05). There was one case of recurrent jaundice and one case of gastric output obstruction in group B, while no one suffered postoperative complication in group A, and the difference was statistically significant (Plt;0.01). Compared with group A, the postoperative level of serum bilirubin, the number of patient readmitted, the rate of recurrent jaundice and gastric output obstruction were higher in group C (Plt;0.05 or Plt;0.01). The mean postoperative hospitalization and overall survival time were significantly shorter in group C than group A (Plt;0.05 or Plt;0.01, respectively). Conclusion Surgical palliation does not increase the morbidity rate, but it does improve the quality of life in elderly patients with unresectable pancreatic head cancer.
Objective To introduce the current study on 18F-fluorodexyglucose positron emission tomography (18F-FDG PET) scanning in diagnosis and treatment of carcinoma of large intestine. Methods The literatures about 18F-FDG PET scanning in diagnosis and treatment of carcinoma of large intestine in recent years were reviewed. Results 18F-FDG PET scanning is superior to CT and MRI in identificating carcinoma of large intestine recurrence, metastasis in the early stage after operation and staging carcinoma of large intestine. Conclusion 18F-FDG PET scanning may be one of the accessory examinations in carcinoma of large intestine and may be helpful for the choice of treatment.
Sixteen cases unresectable carcinoma of the head of the pancreas complicated with jaundice were treated by one stage cholecysto-jejunal and gastro-jejunal loop double anastomosis, the same result of jaundice drainage and prevention of bile reflux were obtained when compared with simple cholecysto-jejunal loop anastomosis, on the other hand, the obstructive symptoms resulting from postoperative cancerous comppression of duodenum and pylorus were avoided as well. The operation is simple with less physiologic disturbance and the patient can lead better postoperative live.
ObjectiveTo compare the advantages and drawbacks of harmonic scalpel (HS) versus conventional electro-scalpel (ES) in the surgery for carcinoma of uterine cervix.
MethodsA total of 126 patients with stage Ⅰ uterine cervix carcinoma who underwent surgery between January 2011 and November 2015 were randomly and averagely divided into HS group and ES group with 63 patients in each. The operation time, intra-operative bleeding volume, the number of lymph nodes detected and operation cost were compared between the two groups of patients.
ResultsAll the patients underwent surgery successfully. There were significant differences between the HS and ES groups in terms of operation time[(202.06±11.67) minutes vs.(223.48±18.01) minutes, P<0.001], intra-operative bleeding[(373.97±27.95) mL vs.(458.16±33.18) mL, P<0.001], operation cost[(4 171.43±276.46) yuan vs.(3 101.54±258.59) yuan, P<0.001]. There was no significant difference between the two groups in terms of the number of lymph nodes detected (10.38±2.43 vs.9.76±2.61, P=0.172).
ConclusionThe use of harmonic scalpel can reduce operation time and intra-operative bleeding volume effectively, but it cannot increase the number of lymph nodes detected. Moreover, it significantly increases the operation cost and economic burden for the patients.
