Comparison and analysis of skiing injuries at ski resorts in Chongli, China and Japan / 中华创伤杂志(英文版)

PURPOSE@#The rapid development of winter sports requires investigation on injuries in Chongli district, Zhangjiakou city, one of the ski sites of the 2022 Winter Olympics. Careful evaluation is required to observe which injuries are caused under what circumstances, and then we can make corresponding preventive measures and recommendations based on the results.@*METHODS@#In this retrospective study, the data of injury cases at ski resorts in China (Chongli district) and Japan were analyzed to provide a reference for the ongoing injury prevention at ski resorts. We collected data on injuries at Wanlong and Fulong ski resorts in Chongli district during the 2017-2018 and 2018-2019 ski seasons. We referred to the skiing injury report issued in February 2020 of a nationwide ski safety statistical service - Japan Ski Safety Association. The causes of injury and specific injured body parts were analyzed based on the data of Chinese and Japanese ski resorts. Statistical significance has been calculated using the Chi-square test.@*RESULTS@#During the 2019-2020 ski season in Japanese ski resorts, the number of reported injuries per 10,000 skiers was 0.93, of which 457 (17.3%) were over 50 years old, accounting for a large proportion of injuries, meanwhile in Chongli ski resort, the injury rate of skiers aged 50 and over was 7.1%. The knee joint (23.7% at Wanlong ski resort and 28.4% in Japanese ski resorts) was the most injured body part among Chongli and Japanese skiers. Among snowboarders, shoulder joint injury (17.7% in Japanese ski resorts) was the most common, and injury on hands and fingers (16.3% in Wanlong ski resorts) was the most common. Head injury rates are similar in Chongli, China and Japanese ski resorts (8.2% and 8.7%, respectively).@*CONCLUSION@#Our analysis demonstrated that injury data recorded among young skiers was higher in Chinese ski resorts (Chongli district) than that in Japanese ski resorts, and elderly skiers made up a larger proportion of skiing injuries in Japanese resorts. Thus, according to our research, the protection of knee joints, shoulder joints, and hands and fingers should be taken seriously. It should pay attention to the teaching of ski poles (for finger protection), and use protective devices such as knee pads, helmets, etc.

Analysis of factors influencing postoperative gastrointestinal function recovery in patients undergoing hyperthermic intraperitoneal chemotherapy / 上海交通大学学报（医学版）

Objective · To investigate the effect of hyperthermic intraperitoneal chemotherapy on postoperative gastrointestinal function recovery in patients with gastrointestinal cancer. Methods · Sixty-two cases of gastrointestinal cancer patients were enrolled who accepted cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in Department of General Surgery, Shanghai Public Health Clinical Center, Fudan University, from July 2014 to June 2017. The gastrointestinal function of patients were evaluated according to the I-FEED scoring system. The patients were divided into normal recovery group (I-FEED score＜6, n=38) and delayed recovery group (I-FEED score ≥ 6, n=24). Univariate and multivariate Logistic analyses were performed on characteristic factors that may affect the recovery of postoperative gastrointestinal function including gender, age, presence of diabetes, preoperative albumin, and so on. Results · There were significantly differences in the preoperative serum albumin level (P=0.040), intraoperative bleeding (P=0.044), the time of extraction of the peritoneal cavity drainage tube (P=0.026), the time of urethral tube extraction (P=0.021) and the time of hospitalization (P=0.017) in the two groups of patients with normal or delayed gastrointestinal function recovery. Multivariate Logistic regression results suggested that preoperative serum albumin level may be beneficial for the recovery of postoperative gastrointestinal function (OR=0.84, 95％ CI 0.17-4.27, P=0.041).Conclusion · The preoperative serum albumin level can be used as an independent predictor of postoperative gastrointestinal functional recovery in patients with gastrointestinal cancer after cytoreductive surgery combined with hyperthermic intraperitoneal chemotherapy.

An analysis of long-term survival after laparoscopic radical resection for rectal cancer / 中华普通外科杂志

Objective To evaluate the efficacy of laparoscopic radical resection for rectal cancer by collecting and analyzing long-term outcomes of patients and to investigate prognostic factors of overall survival and disease free survival.Methods The clinicopathological data of 235 patients who underwent laparoscopic radical resection for rectal cancer from Jan 2007 to Dec 2010 were retrospectively analyzed.COX proportional hazards regression model was used to determine the risk factors for overall survival and disease free survival.Results A total of 235 patients were included in this analysis.Local recurrence rate were 8.1％ at 3 years and 9.8％ at 5 years.Overall and disease free survival were 85.2％ and 75.1％ at 3 years,77.1％ and 69.6％ at 5 years,respectively.Factors found to significantly and independently predict a poor overall and disease free survival were laparoscopic Hartmann,postoperative complications,stage Ⅲ tumor and ulcerative type tumor.Neural invasion was also an adverse prognostic factor of overall survival.Conclusions Laparoscopic Hartmann,postoperative complications,stage Ⅲ tumor and ulcerative type tumor were independently associated with overall and disease free survival.In addition to this,neural invasion was also an adverse prognostic factor of overall survival.

Clinical efficacy of the laparoscope-assisted transanal total mesorectal excision for middle-low rectal cancer / 中华消化外科杂志

Objective To explore the clinical efficacy of laparoscope-assisted transanal total mesorectal excision (La-TaTME) for middle-low rectal cancer.Methods The retrospective cross-sectional study was conducted.The clinical data of 16 patients with middle-low rectal cancer who underwent La-TaTME in the Peking University Third Hospital from August 2015 to August 2016 were collected.Sequential surgery of La-TaTME was applied to patients in the same team,with laparoscopic surgery first and then transanal surgery.Observation indicators:(1) operation and postoperative recovery situations:conversion to open surgery,anastomosis method,operation time,volume of intraoperative blood loss,intraoperative complications,time for out-of-bed activity,time for liquid diet intake,postoperative complications and duration of postoperative hospital stay.(2) postoperative pathological situations:length of surgical specimen,tumor diameter,distance from tumor to resected distant intestinal canal,complete degree of mesorectum,circumferential resection margin,pathological T stage,pathological N stage,number of lymph node detected and tumor cell differentiation.(3) follow-up.Patients in stage Ⅲ-ⅣV of TNM stage of RC underwent postoperative adjuvant chemotherapy.Follow-up using outpatient examination was performed once every 3 months postoperatively to detect the patients' survival and tumor recurrence up to December 2016.Measurement data were represented as M (range).Results (1) Operation and postoperative recovery situations:all the 16 patients underwent successful La-TaTME without conversion to open surgery,including 10 with colorectal anastomosis,3 with colon-canalis analis anastomosis and 3 with permanent colostomy.Operation time and volume of intraoperative blood loss were 290 minutes (range,215-420 minutes) and 50 mL (range,30-100 mL),respectively.One patient had intraoperative complication,showing broken ends ischemia of sigmoid colon after dragging out resected rectum from the anus,following free splenic flexure of colon,about 5 cm ischemic sigmoid colon were resected,and descending colon-rectum anastomosis was performed.Time for out-of-bed activity and time for liquid diet intake were 1 days (range,1-3 days) and 2 days (range,1-9 days),respectively.Among 3 patients with postoperative complications (Ⅱ stage of ClavienDindo),2 with incomplete intestinal obstruction were improved by gastrointestinal decompression and total parenteral nutrition,and 1 with presacral infection was improved by drainage and antibiotic therapy.Duration of postoperative hospital stay was 7 days (range,5-21 days).(2) Postoperative pathological situations:length of surgecal specimen,tumor diameter and distance from tumor to resected distant intestinal canal were respectively 18.0 cm (range,12.0-24.0 cm),3.5 cm (range,0.5-6.8 cm) and 2.5 cm (range,1.0-5.0 cm).Evaluation of mesorectum of surgical specimen:14 patients had complete mesorectum of surgical specimen and 2 had nearly complete mesorectum.There was no residual tumor at circumferential resection margin,proximal and distal ends.Pathological T stage of 16 patients:T0 (pathological complete response after neoadjuvant therapy),T1,T2 and T3 stages were found in 1,1,4 and 10 patients,respectively.Pathological N stage:12,2 and 2 patients were detected in N0,N1 and N2 stages,respectively.Number of lymph node detected was 16 (range,6-32).Tumor cell differentiation:no tumor cell (pathological complete response after neoadjuvant therapy),high-,moderateand low-differentiated tumors were respectively detected in 1,2,7 and 6 patients.(3) Follow-up.All the patients were followed up for 12 months (range,4-16 months).There were no local tumor recurrence or distant metastasis and death.Conclusion La-TaTME may be a new,safe and effective resection for middle-low rectal cancer.

Outcomes evaluation of laparoscopic radical coloproctectomy and hepatectomy for resectable colorectal cancer with liver metastases / 中华外科杂志

<p><b>OBJECTIVE</b>To explore the feasibility and safety of laparoscopic radical coloproctectomy and hepatectomy for resectalble colorectal cancer with liver metastases (CRCLM), and evaluate the survival outcomes of short-middle term for these patients.</p><p><b>METHODS</b>Totally 36 cases of CRCLM which were evaluated to undergo laparoscopic coloproctectomy and hepatectomy preoperatively, were enrolled from January 2009 to January 2014, including 28 synchronous and 8 metachronous CLM respectively. Laparoscopic colorectal resection and hepatectomies were performed in 35 cases, including 24 male and 11 female patients, with a mean age of (64 ± 12) years and a median age of 67 years (ranging from 35 to 80 years). Management strategies were made by a board of multi-disciplinary team. Intra-operative ultrasonography was used to detect the metastases in all cases. Overall survival and disease free survival were calculated by Kaplan-Meier curve.</p><p><b>RESULTS</b>Radical total colectomy, right hemicolectomy, left hemicolectomy, sigmoidectomy, and proctectomy and were performed in 1 case of familial adenomatous polyposis with transverse colon cancer, 5 cases of cecal or asending colon cancer, 1 case of descending colon cancer, 14 cases of sigmoid colon cancer, and 14 cases of rectal cancer respectively. Metastasectomy only, anatomic hepatectomy only, and metastasectomy plus anatomic hepatectomy were done in 21, 10 and 4 cases respectively. Totally 35 colorectal tumors and 62 liver lesions were removed. The mean blood loss of colorectal and liver surgery were (80 ± 32) and (212 ± 153) ml, the median blood loss was 70 ml and 150 ml respectively. Colorectal and hepatic specific complications were not observed in all cases except a case of biliary leakage following right hemihepatectomy. Relapses were observed in 15 cases during a mean follow-up of (26 ± 16) months (median follow-up of 22 months). Four cases died of late-stage cachexia. The 1- and 3-year cumulative overall survival rates were 92.9% and 79.4% respectively. The 1- and 3-year cumulative disease free survival rates were 61.1% and 49.4% respectively.</p><p><b>CONCLUSIONS</b>Laparoscopic coloproctectomy and hepatectomy for resectable CRCLM in carefully selected cases is safe and feasible, which makes simultaneous surgery possible. The oncologic outcome of short-middle term is acceptable, and long-term survival is expected.</p>

A clinical study on multi-disciplinary team and surgery for resectable colorectal cancer with liver metastases / 中华外科杂志

<p><b>OBJECTIVES</b>To analyze the survival outcomes of the surgery for colorectal cancer with liver metastases (CRCLM), and study the mode of multi-disciplinary team (MDT) for CRCLM.</p><p><b>METHODS</b>The retrospective analysis was conducted for 38 patients with CRCLM received MDT management and surgical treatment from January 2009 to August 2011. The peri-operative and survival outcomes of MDT and surgery were evaluated.</p><p><b>RESULTS</b>All the cases met the present criteria of resetability for CRCLM, but only 4 cases (10.5%) met the previous one. Coloproctectomy and hepatectomy were performed in all cases, with 39 colorectal neoplasms and 155 liver lesions removed. One case died of postoperative septic shock. Colorectal and hepatic specific complications were absent in the others patients except one case of biliary leak which was treated with conservative management. Neoadjuvant chemotherapy was arranged in 13 cases. Adjuvant chemotherapy was administered for every patient. After a mean follow-up of (22 ± 10) months according to the finding time of liver metastases, recurrence and metastases were observed in 16 cases and 6 cases died of late-stage cachexia. The 1-, 2- and 3-overall survival rate were 94.4%, 85.3% and 75.8% respectively, and the 1-, 2- and 3-disease-free survival rate were 70.1%, 54.2% and 54.2% respectively.</p><p><b>CONCLUSIONS</b>MDT mode for resectable CRCLM is recommendable. Surgical resection of CRCLM is feasible and safe, which seems to achieve favourable short-middle oncologic outcomes. And long-term survival is expected.</p>

The improvement of mixed human serum-induced anaphylactic reaction death model in guinea pigs / 法医学杂志

OBJECTIVE@#To increase the death rate of fatal anaphylaxis in guinea pigs and the detectahie level of the tryptase of mast cell in hlood serum.@*METHODS@#Seventy-four guinea pigs were randomly divided into five groups: original model group, original model control group, improved model group, improved model control group, improved model with non-anaphylaxis group. Using mixed human serum as the allergen, the way of injection, sensitization and induction were improved. ELISA was used to detect the serum mast cell tryptase and total IgE in guinea pigs of each group.@*RESULTS@#The death rate of fatal anaphylaxis in original model group was 54.2% with the different degree of hemopericardium. The severe pericardial tamponade appeared in 9 guinea pigs in original model group and original model control group. The death rate of fatal anaphylaxis in improved model group was 75% without pericardial tamponade. The concentration of the serum total IgE showed no statistically difference hetween original model group and original model control group (P > 0.05), hut the serum mast cell tryptase level was higher in the original model group than that in the original model control group (P > 0.05). The concentration of the serum total IgE and the serum mast cell tryptase level were significantly higher in improved model group than that in the improved model control group (P < 0.05).@*CONCLUSION@#The death rate of the improved model significantly increases, which can provide effective animal model for the study of serum total IgE and mast cell tryptase.

Minimally invasive surgery for resectable colorectal cancer with liver metastases: a prospective study / 中华肝胆外科杂志

Objective To prospective study the use of minimally invasive surgery (MIS) for colorectal cancer with liver metastases (CRCLM) and to analyze the safety and survival outcomes.Methods 31 patients with resectable CRCLM were enrolled into this study from January 2009 to August 2011.Synchronous or metachronous liver metastases were diagnosed in 26 and 5 patients,respectively.The treatment strategy was discussed and decided by a multi disciplinary team which consisted of experienced colorectal surgeons,hepatic surgeons,medical oncologists,radiologists,and pathologists.Treatment included the use of neoadjuvant chemotherapy,one or two-staged surgery,and suitability to use laparoscopic surg(e)ry.Results Coloproctectomy and partial hepatectomy were carried out in all these patients,and every patient received at least one laparoscopic procedure.The operations in cluded: laparoscopic coloproctectomy plus hepatectomy (n=10),laparoscopic coloproctectomy only (n 18) and laparoscopic partial hepatcctomy only (n=3).One-staged coloproctectomy and hepatectomy were performed in 19 patients who presented with synchronous CRCLM.Colorectal and hepatic specific complications,such as anastomotic leak,liver failure,biliary leak,abdominal infection and abdominal bleeding,were not detected in these pati(e)nts.Neoadjuvant chemotherapy was used in 12 patients.Adjuvant chemotherapy was given to every patient.At a mean follow-up of 23.3 months from the diagnosis of liver metastases,the overall survival and disease-free survival were 87.1％ and 71.0％,respectively.Conclusions MIS for resectable CRCLM in carefully selected patients was safe and feasible.A one staged laparoscopic coloproctectomy and partial hepatectomy was possible.The short-middle oncologic outcomes were acceptable,but the long-term survival was still not clear.

Long naso-intestinal tube decompression versus octreotide in the treatment of early post-operative inflammatory ileus / 中华外科杂志

<p><b>OBJECTIVE</b>To evaluate and compare the effect of naso-intestinal tube decompression and octreotide in conservative management of early post-operative inflammatory ileus (EPII).</p><p><b>METHODS</b>From March 2005 to January 2009, forty-five patients diagnosed with EPII, who failed to improve with conventional conservative management including nasogastric tube decompression, were enrolled in this study. All patients were prospectively nonrandomized into naso-intestinal tube group (n = 23) or Octreotide group (n = 22). The outcomes were compared between nasogastric tube, naso-intestinal tube and Octreotide groups.</p><p><b>RESULTS</b>All the forty-five patients with EPII refractory to conservative management with nasogastric decompression were treated successfully with the naso-intestinal tube decompression or octreotide in 3-12 days. Compared with the Octreotide group, the first passage of flatus was earlier [(4.7 +/- 1.9) d vs (6.7 +/- 1.6) d] and abdominal circumference recovered faster [(90.4 +/- 2.0)% vs (95.1 +/- 1.3)%] in the naso-intestinal tube group (P < 0.05). But the volume of cumulative and daily gastrointestinal decompression were more in naso-intestinal tube group than those in Octreotide group [(4037 +/- 1155) ml vs (3316 +/- 1038) ml; (890 +/- 181) ml vs (492 +/- 83) ml; P < 0.05].</p><p><b>CONCLUSIONS</b>Patients with EPII could be safely and effectively managed by naso-intestinal tube decompression or octreotide. It is possible for those patients to avoid second laparotomy. Naso-intestinal tube decompression and octreotide are associated with faster recovery and less fluid loss respectively.</p>

ACPGBI scoring predicting mortality of patients with colorectal cancer / 中华普通外科杂志

Objective To evaluate a score system(Association of Coloproctology of Great Britain and Ireland ACPGBI)in prediction of postoperative mortality from colorectal cancer patients in a Chinese hospital. Methods We analyzed retrospectively 904 patients with histologically confirmed colorectal cancer who had colorectal surgery from 1992 to 2005.There were 525 colonic cancer patients and 379 rectal cancer patients.We divided patients into several groups according to operative urgency(elective or emergency);surgeons(colorectal specialists or other surgeons);cancer location(colon or rectal).According to ACPGBI score we got the prediction.This prediction was compared with the actual mortality;Chi-square test,receiver operator characteristic curve(ROC),Hosmer-Lemeshow goodness-of-fit test were used.Results Observed overall mortality within 30 days after surgery was 1.0%(9/904),and the predicted mortality was 8.3%(75/904).In all the subgroups the predicted momdity wag higher than observed mortality.We found that the actual mortality was higher in an individual subgroup in which the predicted mortality was higher. Conclusions For colorectal cancer patients undergoing a surgery the predicted mortality of ACPGBI score system was higher than the actual mortality in a Chinese hospital.

Laparoscopically assisted neovaginaplasty using peritoneum as vaginal mucous substitute / 中华整形外科杂志

<p><b>OBJECTIVE</b>To practice a more atraumatic, physiological and aesthetically valued approach of construction for neovagina.</p><p><b>METHODS</b>Laparoscopically using peritoneum as neovagina lining.</p><p><b>RESULTS</b>From March 2005 to September 2006, this technique was adopted to treat 10 patients whose diagnosis was congenital absence of vagina. The ages of the patients were from 19 to 32. The operation lasted average 2.34 hours. And hospitalization was about 20.5 days. Follow-up ranged from 3 - 12 months. No complication occurred. All of the patients was satisfied with their sexual life.</p><p><b>CONCLUSIONS</b>Laparoscopically assisted neovaginaplasty, in which peritoneum was substituted for vaginal mucous membrane, was a kind of ideal approach of vaginal creation.</p>

Laparoscopy and colonoscopy for left-sided colonic carcinoma with acute bowel obstruction / 中华普通外科杂志

Objective To evaluate the effect of via-anal preoperative depression with assistance of colonoscopy and primary stage laparoscopic cancer resection and anastomosis for the treatment of malignant obstruction of left-sided colon. Methods Eleven cases of malignant left-sided colonic obstruction were treated from December 2004 to August 2007 by this modality.With the help of colonoseopy and the guiding of radiography,ileus tube was inserted into the proximal bowel of the obstructive site via anus.We used the tubes to decompress the dilated bowel.Patient's symptom,bowel sounds,abdominal girth,intra-abdominal pressure,plain abdominal radiograph were observed.After the relief of bowel obstruction,elective laparoseopic colorectal resection and anastomosis was accomplished in one stage with routine preoperative preparation.Results After 5～14 days of depression by ileus tube,the relief of bowel obstruction was achieved in all these patients hence emergency operation wag avoided.Elective first-staged laparoseopic resection and anastomosis was performed in all 11 cases.The complications such as anastomotic leakage and incisional/abdominal cavity infection were not observed.After an average 15.2-month fouow up,local recurrence rate,incisional or port implantation rate,and tunlor-free survival rate were 9%,0 and 91% respectively. Conclusions First-staged laparoscopic resection and anastomosis assisted by preoperative colonoscopic depression in malignant left-sided colonic obstruction is a safe and effective procedure.

In-hospital morbidity and mortality for patients of colorectal cancer evaluated by three different POSSUM models / 中华普通外科杂志

objective To compare three risk prediction system,the physiological and operative severity score for the enumeration of mortality and morbidity(POSSUM),the Portsmouth POSSUM (P-POSSUM)and the colorectal POSSUM(Cr-POSSUM)for the accuracy in predicting operative mortality of patients of colorectal cancer in a single Chinese referral hospital setting. Methods Data of 903 patients,who undergone surgery for colon and rectal cancers from 1992 to 2005 at Peking University Third Hospital,were enrolled in the study.POSSUM,P-POSSUM and Cr-POSSUM was used respectively to predict the mortality rate.ROC curve was applied to judge the differentiation ability of each score.Model goodness-or-fit was tested by the Hosmer-Lemeshow statistic and subgroup analysis was performed by the ratio of observed to expected deaths(O∶E ratio). Results The actual inhospital mortality in our series was 1.0%(9/903).The oredicted mortality rate by POSSUM,P-POSSUM and Cr-POSSUM were 5.6%,2.8% and 4.8%respectively.These predicted mortality rate were significantly higher than actual mortality of our patients.The O∶E ratio was 0.18,0.35 and 0.2 respectively. Conclusion The predicted mortality rate of POSSUM,P-POSSUM and Cr-POSSUM were significantly higher than actual observed mortality rate in a single Chinese referral hospital for patients of colorectal cancer.

Effects of laparoscopic anterior resection of rectal carcinoma on immune functions / 中国微创外科杂志

Objective To compare effects of laparoscopic versus open anterior resection of rectal carcinoma on immune functions.Methods A total of 38 patients were given either laparoscopic(18 patients) or open(20 patients) anterior resection of rectal carcinoma from April 2004 to June 2005 in this department.The percentages of T-lymphocytes(CD_3,CD_4,and CD_8) and natural killer cells were calculated by using the flowcytometry.The levels of immunoglobins(IgG,IgA,and IgM) and complements(C_3 and C_4) were detected by using the immunonephelometry.Results In levels of T-lymphocytes,immunoglobins,and complements,there were no statistically significant differences between open and laparoscopic groups 24 and 96 hours after operation.In levels of natural killer cells,no differences were observed in laparoscopic group before and after operation(24 and 96 postoperative hours) while a significant decrease were found in open group after operation.Conclusions As compared with open surgery,laparoscopic anterior resection of rectal carcinoma has less influence on natural killer cells.

Laparoscopic Radical Gastrectomy: Report of 31 Cases / 中国微创外科杂志

Objective To study the feasibility of laparoscopic radical gastrectomy.Methods From August 2006 to May 2007,31 patients with gastric cancer received laparoscopic radical gastrectomy(radical distal gastrectomy in 26 cases and radical total gastrectomy in 5).Results Among the cases,1 was converted to an open surgery,2 were treated completely by laparoscopic radical gastrectomy;and in the other 28 cases,the radical gastrectomy was performed under the assistance of laparoscopy.Lymph node dissection of D1+? was performed on 2 patients and D2/D2+ was adopted in the other 29.One case was done in combination with partial liver dissection.The median operative time was 5 h(range 4.5-7 h).The median blood loss was 150 ml(range,100-600 ml).One patient received blood transfusion during the operation.Intraoperative spleen injury occurred in one case.The median number of harvested lymph nodes was 20(range,14-33).No patient died after the surgery.The median time for gastrointestinal function recovery was 4 d(range 3-6 d).One patient developed gastroparalysis after the operation and was cured by conservative therapy.One of the patients had bleeding of the jejunal pouch after total gastrectomy.And one showed subluxation of the articulatio cricothyroideus.No anastomotic leakage and lung infection occurred after the surgery.And no recurrence or metastasis was found during a 2-to 8-month follow-up(median,5).Conclusion Laparoscopic radical gastrectomy is feasible and safe.

Laparoscopic Resection for Colorectal Carcinoma in Elderly Patients / 中国微创外科杂志

0.05).Conclusions Laparoscopic resection of colorectal carcinoma is feasible and safe for elderly patients.The method can reduce the rate of postoperative complications.

A clinical application of laparoscopic total/subtotal proctocolectomy / 中国微创外科杂志

Objective To investigate the safety and feasibility of laparoscopic total/subtotal proctocolectomy. Methods Laparoscopic total/subtotal proctocolectomy was performed in 8 cases from March 2003 to November 2005, including 1 case of multiple colorectal tumors, 3 cases of ulcerative colitis, 2 cases of familial adenomatous polyposis, and 2 cases of slow transit constipation. The operation included ileal pouch-anal canal anastomosis in 3 cases, ileal pouch-rectum anastomosis in 3 cases, and cecum-rectum anastomsis in 2 cases. A prophylactic ileostomy was conducted in 5 cases. Results The operation was laparoscopically conducted in all the 8 cases, without conversions to open surgery. No fatal case was encountered. The operative time was 5.5~7.5 h (median, 6 h). The intraoperative blood loss was 150~400 ml (median, 200 ml). There was no intra- or post-operative blood transfusion. The patients began to take diet at 48 h postoperatively. Follow-up observations in 8 cases for 4~31 months (median, 25 months) showed 1 case of intraabdominal infection and 1 case of anastomsis stenosis. Conclusions Laparoscopic total/subtotal proctocolectomy is safe and feasible.

Management of left-sided acute malignant colonic obstruction by transanal ileus tube decompression / 中国微创外科杂志

Objective To evaluate the role of transanal ileus tube decompression in the management of malignant obstruction of left-sided colon. Methods With the help of colonoscopy and radiography, 11 cases of left-sided malignant colonic obstruction were treated with transanal ileus tube insertion into the proximal obstruction site for the decompression of the dilated bowel. Curative effects were evaluated according to patient’s symptom relief, bowel sounds, abdominal circumference, intra-abdominal pressure, and plain abdominal radiography. Results Symptoms of acute intestinal obstruction were relieved in all the 11 cases after ileus tube decompression for 3~5 days. Laparoscopic or open primary colectomy was performed in 7 patients with resectable tumor. Postoperative follow-up observations for 1~18 months (median, 11 months) showed no complications like anastomotic leakage. Conclusions Transanal ileus tube decompression in the management of malignant obstruction of left-sided colon is safe and effective.

Liver transplantation for advanced primary hepatocellular carcinoma / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To investigate the value of liver transplantation for late hepatocellular carcinoma.</p><p><b>METHODS</b>Thirty-six patients were treated by liver transplantation from August 2000 to February 2002, of which 15 patients had had advanced hepatocellular carcinoma and thirteen of these 15 patients were evaluated for results.</p><p><b>RESULTS</b>The 1-year survival rate was 86% (6/7). Only one patient died of recurrence within 6 months. The tumor-free survival was 5 to 19 months. Till February 2002, two patients have survived for 10 months and 19 months with recurrence.</p><p><b>CONCLUSION</b>In our country, if the patients can afford liver transplantation, advanced hepatocellular carcinoma without extrahepatic metastasis is still indicated for liver transplantation, since some patients may survive relatively long.</p>

Hilar plate and hepatic vein in cirrhosis: Anatomy and clinical application / 中国微创外科杂志

Objective To study the application of the selective regional anemia hepatectomy. Methods The hepatic veins and hilar plates of 5 liver samples of posthepatitic cirrhosis were measured. Results Out of the 5 samples, the average width and depth of the left branch of hilar plate were 1.78cm and 0.82cm, of the left medial branch were 1.04cm and 1.02cm, of the left lateral superior branch were 0.96cm and 0.74cm, of the left lateral inferior branch were 1.02cm and 0.76cm, of the right branch were 2.02 cm and 1.28cm, of the right posterior branch were 1.20cm and 1.10cm, and of the right anterior branch, 1.22cm and 1.16cm. The average width and depth of the left hepatic vein were 0.82cm and 0.74cm, of the right hepatic vein were 1.16cm and 1.04cm, and of the middle hepatic vein, 0.92cm and 1.18cm. The regional anemia hepatectomy was performed successfully in 2 cases. Conclusions Selective occlusion of the blood flow in and out the hepatic segment or lobe may contribute to a safe and reliable hepatectomy.