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Objective:To explore the practice of comprehensive teaching based on multiple evaluation in general surgery practice teaching.Methods:A total of 83 students were selected from the General Surgery Department, The Second Affiliated Hospital of Harbin Medical University. Among them, 40 interns used traditional teaching (control group) and 43 interns used comprehensive teaching based on multiple evaluation (experimental group). After the teaching, the assessment results of the theoretical knowledge and skill operation of the two groups of interns were evaluated, and the instructor evaluated the comprehensive ability of the interns, and evaluated the teaching satisfaction and teaching feedback results. SPSS 24.0 was used for t-test and Chi-square test. Results:After the teaching, the examination scores of interns' theoretical knowledge and skill operation in the experimental group [(94.24±2.28) points and (92.33±2.58) points] were higher than those in the control group [(90.56±2.37) points and (88.75±2.41) points]. The scores of independent learning ability, independent thinking ability, logical thinking ability, group cooperation ability, and humanistic care ability of interns in the two groups after teaching were significantly higher than those before teaching, and the scores of each ability in the experimental group were higher than those in the control group ( P<0.05). The total satisfaction rate of interns in the experimental group [95.35% (41/43)] was higher than that in the control group [75.00% (30/40)], and the difference was statistically significant ( P<0.05). The experimental group in improving the participation and learning efficiency of interns in teaching activities [97.67% (42/43), 90.70% (39/43)] was significantly higher than the control group [75.00% (30/40), 70.00% (28/40)] ( P<0.05). Conclusion:The application of comprehensive teaching based on multiple evaluation in general surgery practice teaching can help improve the interns' theoretical knowledge and skill operation performance, improve their comprehensive ability and teaching satisfaction, and improve their learning enthusiasm and efficiency, which deserves promotion and application.
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Circulating tumor cells(CTCs)are a special type of biomarker that can be used as a diagnostic tool to predict the prognosis of multiple tumors.At present,although circulating tumor cells have not been full clinically application,studies on circulating tumor cells have shown high clinical efficacy,especially in the fields of breast cancer,lung cancer,prostate cancer and colorectal canc-er.This article reviews the research progress of circulating tumor cells in metastatic cancer and non-metastatic cancer,analyzes the clinical efficacy and practicability of circulating tumor cells.
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Colon cancer is a common malignant tumor. Early diagnosis and treatment is one of the most important clinical challenges. Since MicroRNA is discovered to closely relate to cancer, it has been suggested to be used in the diagnosis and treatment of cancer. This review focuses on recent advances in the diagnosis and treatment of MicroRNA in colon cancer and the role of MicroRNA in Wnt signaling pathways and epidermal growth factor receptor (EGFR) signaling pathways.
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Objective To summarize surgical experience for the treatment of substernal goiter.Methods 102 cases of substernal goiter underwent surgical resection,in 74 by low collar incision,12 cases by larger low collar incision and pillowing the shoulder pad about 20 degrees for neck hyperextension,8 cases by unilateral or bilateral infrahyoid muscles transection,8 cases by low collar and up-mid-sternal incision plus horizontal sawing in 2 and 3 ribs.Results Resection was performed successfully in all cases.Hoarseness occurred in 7 cases,4 cases recovered after one month,3 cases did not improve because of tumor invasion of laryngeal recurrent nerve.Postoperative transient hypocalcemia in 9 cases recovered after 2 to 3 months.102 patients were followed up for 1 to 3 years without recurrence.Conclusions Substernal goiter can be resected successfully through a transcervical approach or mid-sternal incision.CT scanning and chest X radiograph are decisive for the surgical approach.
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Objective To explore the diagnosis and treatment of cystic dilatation of the cystic duct in adults.Method Clinical data of 25 cases of the cystic dilatation of cystic duct in adults in 3 hospitals in Songhuajiang river drainage area from 1991 to 2012 confirmed by surgery were analyzed retrospectively.Results The 25 cases were with manifestations of chronic cholecystitis,and 14 patients with right upper quadrant recurrent biliary colic and nausea,vomiting and other gastrointestinal symptoms,9 patients with yellowish discoloration of sclera and skin,and fever.Ultrasonography was done in 25 cases,ERCP in 16 cases and MRCP in 9 cases,displaying liquid dark area of diameter from 1.6 cm × 1.6 cm to 2.5 cm ×2.5 cm in the gallbladder tube suspective of calculi,and characteristic dumbbell shape image.Preoperative diagnosis was cystic duct cyst with stones or gallstones which was confirmed by surgery.Gallbladder and cyst resection was performed in all 25 cases,and bile duct jejunum Roux-en-Y anastomosis was done in 2 of these cases because of introgenic bile duct injury.Conclusions Cysts of the cystic duct is the special type (Ⅵ type) of choledochocele,and its prognosis is good after surgical treatment.
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Objective To explore the etiology,diagnosis and treatment of omohyoid muscle syndrome(OMS).Method Clinical data of 34 OMS cases was analyzed retrospectively from 1980 to 2008.In the autopsy of 19 bodies we studied omohyoid muscle,especially the intermediate tendons,sheaths of tendon and projection of omohyoid muscles.Result The symptom of omohyoid muscle syndrome lies in a mass that can be seen on the neek while swallowing,and the patient feels discomfort and dysphagia.The mass disappears immediately after swallowing and cann't be found by palpation.Congenital fascia weakness,intermediate tendon sheath relaxation,atrophy,degeneration and contracture of omohuoid muscle causes OMS.OMS was diagnosed on clinical manifestation.All 34 patients were treated surgically including cutting off the cross part of omohyoid muscle and sternocleidomastoid muscle,separating adhesion of muscle and fascia.Postoperatively symptoms disappeared in all these 34 patients.Conclusions Omohyoid muscle syndrome is a disease that can be easily diagnosed basing on characteristic clinical symptom and sign,the prognosis is good if treated properly by an operation.
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ObjectiveTo summarize our experience on the diagnosis and surgical treatment of hepatocellular adenoma (HCA).MethodsClinical data of 47 HCA cases managed from 1989 to 2009 were analyzed retrospectively. ResultsAll were single lesions.Preoperative correct diagnosis was established in only 7 cases ( 14.9％ ).Tentative malignant space-occupying lesions was diagnosed in other 40 cases (85.1％),including hepatocellular carcinoma in 11 cases,liver hemangioma in 10 cases,liver focal nodular hyperplasia in 14 cases and miscellaneous in the remaining 5 cases.Local resection,segmental hepatectomy,hepatic lobectomy and hemiheptectomy were performed according to the size and location of the lesions.To prevent recurrence or malignant transformation,not less than 1.0 cm safe margin was allowed in all cases.Final diagnosis was made by fast frozen pathology or postoperative pathology.Postoperatively 45 cases were followed up to 6 years without recurrence.ConclusionsPreoperative misdiagnosis of HCA is common.Surgical resection is the only effective treatment,and the prognosis of HCA is favorable.
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Objective To summarize the diagnosis and surgical treatment of hepatic focal nodular hyperplasia (FNH). Methods The clinical data of 63 patients with FNH proved by pathology were analyzed retrospectively. Results The disease mainly affected young to middle aged, 50 cases (79. 4% )were of 31-50 years old. Male and female ratio was 2.94: 1. Fifty-six patients (89%) were asymptomatic, 3 cases were HBsAg positive (4.8%). Liver function was basically normal (92. 1%),5 cases (7.9%) were with elevated level of total bilirubin and rGT. AFP, CEA and CA19-9 was all negative. FNH occured as a single node in 95.2% cases, ranging from 1.5 cm to 17 cm in diameter ( average 4. 5 cm). Of these patients, 25 lesions were present in the left lobe, 29 in the right lobe, 6 in the mid lobe, and 3 in the caudate lobe. A big central artery was found in 2 cases (3. 2% ) as found by color Doppler ultrasound. CT scan showed transient immediate enhancement in 96. 8% (61/63) of patients, with central scar in 6 cases. MRI demonstrated early vigorous enhancement in 93. 7% (59/63) of patients, with central scar in 5 cases. All patients underwent surgical resection; including local resection in 34 cases;segmentectomy or hepatectomy in 13 cases; hemihepatectomy in 13 cases. There was no postoperative mortality and major complications. Conclusions FNH is a kind of hepatic benign disease and characteristic of high preoperative misdiagnosis rate (25. 4% ).
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Objective To summarize the etiology,pathological mechanism, and the experience of diagnosis and treatment of bronchobiliary fistula (BBF). Methods Clinical data of 29 BBF patients admitted and operated on from 1976 to 2009 were analyzed retrospectively. Results Clinical menifestation included abdominal pain, chill and high fever,jaundice, hepatomegaly, chest distress, cough, hemoptysis,bilious cough, moist rale in the lower right lung or decreased or disapeared breath sound. Abdominal radiograph, chest X-ray, BUS, CT, PTC, MRCP and ERCP are helpful for localizing diagnosis. All the 29patients were surgically treated. 19 patients were treated by choledochotomy to extract common bile duct stones, T-tube drainage, liver abscess drainage, fistula excision and diaphragmatic repair. Three patients were treated by cholecystectomy, choledocholithotomy, and T-tube drainage. One patient underwent cholecystectomy, choledocholithotomy, and Roux-en-Y hepatojejunostomy. Three patients received liver abscess drainage, choledochotomy, T-tube drainage. 2 patients did subphrenic abscess drainage,choledochotomy, T-tube drainage. One patient complicating Oddi sphincter stenosis received liver abscess drainage, diaphragmatic repair, and Roux-en-Y hepatojejunostomy. 26 patients were cured. 3 patients died.Conclusions The etiology of BBF is obstruction related bilious tract infection leading to liver abcess and lung abscess. In the process of surgical treatment, relief of bilious tract obstruction, clearance of focal lesion and effective drainage of biliary tract are the mainstay of management.
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Objective To improve the diagnosis and treatment of sliding hernia of adult urinary bladder. Methods Clinical data of 32 cases of adult sliding hernia of the bladder from 1984 to 2009 were analyzed retrospectively. Discomfort was complained in all the 32 patients along with palpable mass. Twentynine cases suffered from urgency of micturition, ascheturesis and dysuria, 15 cases had interruption of urination. The mass was saddle-shaped in 29 cases, when the bladder was filling. In all the 32 cases of hernia block were in a sense of fluctuations and flat on percussion. In 26 cases the bladder appeared a dumbbell-shaped image on cystography. By B-ultrasonic examination an opaque dark area of fluid was detected in 29 cases when there was retention of urine. Results Preoperatively 29 cases were diagnosed of bladder sliding hernia, 3 cases with misdiagnosis ( misdiagnosis rate of 9.4% ). 32 cases were cured by surgical treatment. The prolapsed portion of the bladder including stones in 2 cases were resected. 32 cases were followed up from 1 to 5 years without recurrence. Conclusions Once the sliding hernia of the bladder is diagnosed, patient should receive surgery. Intraoperatively the key of preventing inadvertent cut or missed diagnosis is familiar with pathological anatomy and careful exploration.
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Objective To summarize the diagnosis and surgical treatment of the cavernous transformation of portal vein (CTPV). Methods Clinical data of 63 patients with adult CTPV trea-ted in our hospital from 1976 to 2006 were retrospectively analyzed. Results The diagnosis of CT-PV was comfirmed according to (1) The main symptoms were repeated haematemesis, hemafecia, hy-persplenotrophy, hypersplenia and normal hepatic function. (2) B uhrasonography or ultrasonic Doppler manifested that portal vein thinning or obstruction or embolism, honeycomb appearance con-duit can be seen around. Portal vein frequency spectrum can be seen in the honeycomb appearance con-duit. (3) CT and MR scan materials were exhibited that the main portal vein and its branches lost the normal shape and had the shaggy edge. (4) percutaneous splenoportography or selective arteriography of superior mesenteric artery showed that occlusion of the main branch of portal vein at the porta hepa-tis was revealed, and a masslike network of tortuose veins around the porta hepatis and many small ir-regular veins radiating from the network to the liver were demonst rated. Splenectomy and devaseu-larization was performed in 23, spleneetomy and splenorenal shunt in 32, portal systemic shunt plus porta-azygous devascularization in 8. Portal hypertension was treated first in CTPV with disease of biliary tract. No death happened. The rascult of haemogram recovered in a short period of time.Conclusion Once the patients are diagnosed to suffer from adult CTPV, they should receive explora-tory laparotomy. It is important to choose the most effective treating method for the disease.
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Objective To summarize diagnosis and surgical treatment of insulinoma. Methods Clinical data of 64 patients with insulinoma from 1980 to 2006 were analyzed retrospectively. Results All patients had Whipple's triad. Accurate preoperative localization rate of B ultrasonography, CT and enhanced CT, MRI, DSA was 46.9% (30/64), 58.2 %(23/39) and 91.7%(11/12), respectively. Localization rate of intraoperative ultrasonography (IOUS) was 92% (23/25). The tumors were single in 58 cases, and multiple in 6 cases. In the location of single tumor, 19 of them were in the head, 17 in the body, and 22 in the tail;while for multiple tumors, 2 tumors were both located in the body in 4 patient, and 2 tumors were separately located in the body and tail respectively in 2 patients. Treatment Local enucleation was performed in 39 cases, resection of pancreatic body and tail in 13 cases, resection of pancreatic body and tail plus splenectomy in 6 cases, resection of pancreatic tail in 8 cases, resection of pancreatic tail plus splenectomy in 4 cases, laparoscopic resection of insulinoma in 1 case, piecewise resection of pancreas from left to right (blind resection) in 2 cases, pancreaticoduodenectomy in 1 case. The tumor was benign in 62 cases, and malignant in 2 cases. Pancreatic fistula developed after operation in 3 cases, acute pancreatitis in 4 cases, and in these cases, they healed after non-operative treatment. All patients had no symptoms of hypoglycemia after operation. At follow-up visit in 62 cases, 2 case of benign tumor recurred 4 years after operation, and was cured by resection of the pancreas body with tumor, 2 malignant tumors cases, recurred and died of hepatic metastasis in 3 years and 4 years after operation. Conclusions Whipple's triad and IRI/G>0.3 are the bases for qualitative diagnosis of insulinoma. Meticulously palpating the gland combined with IOUS during operation is the most effective method for accurate tumor localization. Resection of insulinoma is the best mode of surgical treatment of insulinoma.
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Objective:To summarize diagnosis and surgical treatment of syndrome of splenic flexure of colon(SSFC) .Methods:The clinical data of SSFC in 81 patients between Jan,1987 and Dec,2008 were analysed retrospectively.Results:The main clinical manifestations were repeated abdominal pain,abdominal distension,constipation and chronic incomplete colon obstruction.X-ray barium enema showed that splenic flexure of colon was 7 cm higher than hepatic flexure of colon.The angle of splenic flexure of colon was less than 45 ?.Two patients underwent release of splenic flexure of colon and 3 patients accepted side-to-side anastomosis of splenic flexure of colon which were suitable to old,weak and emergent patients.The effects of these methods were well shorthy after operation,but not in long term(6 months to 2 years) .As to the rest 76 patients,thorough operation were done:subtotal resection of proximal segment colon(14 patients) ,subtotal resection of colon(20 patients) and total resection of colon(42 patients) .Conclusion:The diagnosis of SSFC is depended on clinical manifestations and barium enema.Thorough surgical treatment is the best method including proximal part resection,subtotal resection and total resection of colon.
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Objective:To summarize diagnosis and treatment of hashimoto's disease(HD) complicated with thyroid adenomas(TA) in 107 patients.Methods:Clinical data of 107 patients of HD complicated with TA were analysed retrospectively.Results:Complete serum immunologic examinations,B ultrasonography and fine needle aspiration biopsy were helpful for the diagnosis of HD with TA.Thirty-eight patients(35.5%) were diagnosed before operation.Misdiagnosis rate was 64.5%(69/107).Intraoperative frozen section diagnosis rate was 81.3%(87/107).Partial,large and total resection of thyroid gland can be selected according to frozen section and local disease focus.Afteroperation,87patients(81.3%)hada goodrecovery.Threepatients with total thyroid gland resection need thyroxin tablet.Thyroid hypofunction did not happented in 104 patients.Conclusions:HD with TA should be treated surgically.Intraoperation frozen section is helpful for selecting operationmethods.
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Objective:To summarize experience of diagnosis and surgical treatment of tuberculosis in ileocecal junction.Methods:Clinical data of 74 cases of tuberculosis in ileocecal junction were analysed retrospectively.Results:Clinical manifestations consisted of chronic abdominal pain(87.8%),right lower abdominal mass(95.9%),low fever、emaciation and anemia(36.5%),alternation of constipation and diarrhea(39.2%).Diagnosis rate of barium enema was 63.8%,colonoscopy and biopsy was 100%.Diagnosis rate before operation was 68.9%(51/74).In 74 cases,53 cases performed right hemicolectomy,15 cases performed anastomosis of end of ileum and transverse colon,6 cases performed building fistula of end of ileum.Conclusion:Tuberculosis in ileocecal junction should be diagnosed early and be identified with cancer of ileoceum.Good prognosis depend on positive surgical treatment and systematic medicine treatment.