ABSTRACT
Objective:To summarize the experience and the clinical data of patients with primary hyperparathyroidism undergoing endoscopic parathyroidectomy.Methods:A total of 24 patients who underwent endoscopic parathyroidectomy for primary hyperparathyroidism in Peking Union Medical College Hospital during Feb. 2021 to May. 2022 were concluded in this study (20 cases of parathyroidectomy via axillary approach and 4 cases of parathyroidectomy via thoracic and breast approach) . The operation time, postoperative drainage, length of stay, level of parathyroid hormone and serum calcium of those patients were collected. Postoperative complications and recurrence of hyperparathyroidism were also observed.Results:The postoperative levels of serum parathyroid hormone and serum calcium were significantly reduced (over 50%) compared with preoperative level ( P<0.05) . The average operation time was (96±22) min (64-157 min) . The mean postoperative drainage volume was (47±16) ml on day 1, (46±11) ml on day 2, and (30±9) ml on day 3, respectively. The average length of postoperative hospital stay was (2.8±1.1) days (2-6 days) . In one case of parathyroidectomy via axillary approach, the operation was converted to open surgery because of the low position of lesion. Other cases completed endoscopic surgery and obtained satisfactory cosmetic results. There were no postoperative complications such as bleeding, permanent hoarseness, coughing while drinking water, or surgical site infection. The mean follow-up time was (7.4±4.2) months (1-16 months) . There was no obvious discomfort and no recurrence during follow-up. Conclusion:Endoscopic parathyroidectomy is safe and effective in the treatment of primary hyperparathyroidism, which can be used as a surgical option for patients with cosmetic requirements.
ABSTRACT
The comprehensive and multiple disciplinary team therapeutic strategies of pancreatic cancer have been accepted as a consensus. Immune checkpoint inhibitors have made great breakthroughs in the treatment of various solid tumors. However, immune checkpoint inhibitors failed to elicit efficacy in patients with pancreatic cancer and how to overcome the immunosuppressive tumor microenvironment may be the crucial event. Combination regimens of immune checkpoint inhibitors with chemotherapy, radiotherapy, and molecular targeted therapy have been underway, but the sample size of the clinical trial was still limited. Considering the current research status and progress of pancreatic cancer, this article further discusses the practical problems of immune checkpoint inhibitors and makes objective evaluation of its value.
ABSTRACT
The comprehensive and multiple disciplinary team therapeutic strategies of pancreatic cancer have been accepted as a consensus. Immune checkpoint inhibitors have made great breakthroughs in the treat-ment of various solid tumors. However, immune checkpoint inhibitors failed to elicit efficacy in patients with pan-creatic cancer and how to overcome the immunosuppressive tumor microenvironment may be the crucial event. Combination regimens of immune checkpoint inhibitors with chemotherapy, radiotherapy, and molecular targeted therapy have been underway, but the sample size of the clinical trial was still limited. Considering the current re-search status and progress of pancreatic cancer, this article further discusses the practical problems of immune checkpoint inhibitors and makes objective evaluation of its value.
ABSTRACT
Hepatolithiasis is a common disease of abdominal surgery,although its incidence appears to decline,China is still a high incidence area with millions of patients with hepatolithiasis.Because of the complex pathogenesis,progressive development and frequent recurrence,it is seriously affecting physical and mental health of patients and quality of life,as well as difficult to define the diagnosis and select treatment methods for hepatolithiasis.The Guideline of the Diagnosis and Treatments of Hepatolithiasis and the Expert Consensus of the Laparoscopic Treatments of Hepatolithiasis (2013 edition) proposed a concise and practical classification system of the hepatolithiasis and summarized the principles of surgical treatments,which includedresecting the lesions,cleaning the stones,correcting the stricture,recovering the drainage and preventing the recurrence .Meanwhile,the application of laparoscopic technique in the treatments of bepatolithiasis was proposed,which played an important role to promote the standard diagnosis and treatments of hepatolithiasis in China.Recent years,more and more evidences from evidence-based medicine further proved the importance of the anatomical hepatectomy in the treatments of hepatolithiasis.With the soaring development of laparoscopic surgery,the combination of laparoscopic hepatectomy with the assistance of other endoscopies are applied more and more frequently.The concept of precise surgery also brings new vitality to the standard diagnosis and treatments of the hepatolithiasis.