Long-term outcomes of choledochoduodenostomy for hepatolithiasis / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Oddi sphincter plays an important role in preventing reflux cholangitis. There exists the controversy on application of choledochoduodenostomy in hepatolithiasis management. The present study aimed at evaluating long-term outcomes of choledochoduodenostomy for the treatment of hepatolithiasis.</p><p><b>METHODS</b>Forty-six consecutive cases of hepatolithiasis who underwent choledochoduodenostomy were analyzed retrospectively. The pre- and postoperative rates of recurrent cholangitis and acute cholangitis severe type were compared. Paired chi-square test was applied.</p><p><b>RESULTS</b>The mean follow-up time was 17.3 years ranging from 1.6 to 40 years with a follow-up rate of 97.8% (45/46). High rates of remnant stones (39.1%, 18/46), recurrent stones (31.1%, 14/45), uncorrected strictures (85%, 17/20), and mortality (24.4%, 11/45) were observed in this group. Regurgitation of food debris and duodenal content into the biliary tract through the anastomosis was observed. The rate of recurrent cholangitis was equal to the preoperative period (93.3%, 42/45). The rate of acute cholangitis severe type after choledochoduodenostomy (46.7%, 21/45) increased significantly (P<0.01) when compared to the preoperative period (20.0%, 9/45).</p><p><b>CONCLUSIONS</b>Choledochoduodenostomy did not entirely achieve the goal of clearance of stones, correction of strictures, and removing of hepatobiliary lesions by itself. Choledochoduodenostomy without cholangioplasty resulted in an increase of severe reflux cholangitis due to the loss of the anti-reflux function of the sphincter of Oddi. Therefore, choledochoduodenostomy is not an ideal approach to reduce cholangitis in hepatolithiasis and is not the best choice in the management of hepatolithiasis.</p>

Surface detection of thyroid cancer by Fourier transform infrared spectroscopy / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To explore a novel non-invasive method in detection of thyroid cancer by Fourier transform infrared (FTIR) spectroscopy.</p><p><b>METHODS</b>Surface FTIR spectra of 15 cases of thyroid cancer and 51 cases of normal subjects were collected. 22 variables of 11 bands including peak positions and relative intensities were measured and all data were statistically analyzed.</p><p><b>RESULTS</b>In the cancer group: (1) the peak position of 1743 cm(-1) was shifted toward higher wave number (P < 0.05), and that of 1250 cm(-1) to the lower (P < 0.05), when compared to those of normal ones. (2) The relative intensity ratios of I(1546)/I(1460), I(1250)/I(1460), I(1120)/I(1460), I(1080)/I(1460) were significantly increased (P < 0.05). (3) The presence rate of band of 1340 cm(-1) was significantly decreased (P < 0.05).</p><p><b>CONCLUSION</b>FTIR surface spectra may become a novel powerful non-invasive approach of detecting thyroid cancer in regular routine check-up.</p>

Clinical effects of subcutaneous tunnel hepatocholangioplasty on the treatment of hepatolithiasis / 中华外科杂志

<p><b>OBJECTIVE</b>To evaluate the therapeutic effect of subcutaneous tunnel hepaticoplasty on the treatment of hepatolithiasis.</p><p><b>METHODS</b>The early complications and clinical effects of 99 hepatolithiasis cases who underwent subcutaneous tunnel hepaticoplasty from January 1993 to August 2006 were analyzed retrospectively. The stones of 28 (28.3%) patients were in the left lobe, 24.2% (24/99) in the right, and 47.5% (47/99) in bilateral lobe. Sixty-six patients (66.7%) had both stones and biliary strictures. During the procedure, a portion of the liver habouring stone was resected if necessary. The hepatic duct and strictures were opened, the stones were removed, and the porta hepatis was repaired by one end of a segment of jejunum. The other end of the jejunum was set subcutaneously. The gall bladders of 27 patients (27.3%) were used as subcutaneous tunnel instead.</p><p><b>RESULTS</b>Ninety-five out of ninety-nine cases were followed up with an average of 4.2 years (1 month to 13.5 years). The rates of residual stone, recurrent stone and cholangitis were 23.2% (23/99), 20.0% (19/95) and 14.7% (14/95) respectively. Postoperatively, 34 cases who had residual or recurrent stones were underwent lithotomy by choledochoscope through the subcutaneous blind loop and the achievement ratio was 91.2% (31/34).</p><p><b>CONCLUSIONS</b>Subcutaneous tunnel hepatocholangioplasty decreases the relapsing cholangitis effectively, and makes an easy way to take out residual or recurrent stones.</p>

Prognostic analysis of T1 and T2 stage gallbladder cancer with invasion within the gallbladder wall / 中华外科杂志

<p><b>OBJECTIVE</b>To explore the impact of different treatment procedure on the prognosis of T1 and T2 stage gallbladder cancer with the invasion within the gallbladder wall.</p><p><b>METHODS</b>A retrospective analysis was conducted on 45 patients with pathologic stage T1 and T2 gallbladder cancer who had undergone surgical resection from 1990 and 2005.</p><p><b>RESULTS</b>Depth of invasion (T), radical cholecystectomy and postoperative adjuvant chemotherapy were independent prognostic factors on Cox multivariate analysis. The 5-year survival rates of patients with T1a, T1b and T2 stage gallbladder cancer who underwent simple cholecystectomy without postoperative adjuvant chemotherapy were 100%, 67% and 0, respectively. The survival rate in T2 was significantly lower than those in T1a and T1b. Without postoperative adjuvant chemotherapy, the 5-year survival rates of patients with T2 stage gallbladder cancer who underwent simple cholecystectomy and radical cholecystectomy were 0 and 63%, respectively. There was significant difference between the survival time of T2 patients who had undergone simple cholecystectomy with and without postoperative adjuvant chemotherapy.</p><p><b>CONCLUSIONS</b>The prognosis of patients with T1 stage gallbladder cancer is much better than that of T2 stage. The 5-year survival rates of patients with T1a and T1b stage gallbladder cancer who received simple cholecystectomy are relatively good. Radical cholecystectomy and postoperative adjuvant chemotherapy can improve the prognosis of patients with T2 gallbladder cancer.</p>

FTIR spectroscopic characterization of freshly removed breast cancer tissues / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To identify the FTIR spectroscopic characterization of breast cancer and explore the possibility of application of FTIR in differentiation of malignant and benign breast lesions.</p><p><b>METHODS</b>FTIR spectra of surgically removed fresh breast tissues were measured by spectrometer equipped with mid-infrared fiber optics and an ATR probe. Peaks in the spectra were measured and relative intensity ratios were calculated and analyzed if there are significant differences between the spectra of malignant and benign breast lesions.</p><p><b>RESULTS</b>There were significant differences (P < 0.05) between the spectra of malignant breast cancers and benign breast tissues in the relative intensity ratios of different peaks (I1640/ I1550 and I1160/I1120 for protein structures; I1640/I1460 and I1550/I1460 for relative content of protein and lipid; I1460/I1400 for lipid structures; I1310/I1240 for nucleic acid).</p><p><b>CONCLUSION</b>FTIR spectroscopy could be a useful tool in clinical diagnosis of breast cancer.</p>

The retrospective analysis of HBV and HCV infection in cholangiocarcinoma / 中华外科杂志

<p><b>OBJECTIVE</b>In order to study the diagnosis and treatment of HBV and HCV infection.</p><p><b>METHODS</b>We retrospectively analysed clinical data of 680 patients with cholangiocarcinoma from 1995 to 2001 and stated by SPSS software.</p><p><b>RESULTS</b>(1) The fastigium of cholangiocarcinoma was 60 - 65 years old. The incidence of cholangiocarcinoma was higher in aged males and the sex ratio (male:female) was 1.36:1. (2) The proximal cholangiocarcinoma was most (41.6%) and distant cholangiocarcinoma was secondly (28.7%). (3) Most patients of cholangiocarcinoma were late. The resection rate was low and the rate of radical operation was 21.6% (147/680). (4) The incidence of proximal cholangiocarcinoma was higher in the positive Serologic marks for HBV and HCV and course of diseases was short. Moreover, the pathology of. positive Serologic marks for HBV and HCV trended to low-differentiation and invasion, metastasis and the resection rate was lower.</p><p><b>CONCLUSIONS</b>Cholangiocarcinoma is common in the aged males. The infection of HB(C)V and hilar cholangiocarcinoma are correlated and incline to the proximal bile duct. The hilar cholangiocarcinoma infected HB(C)V may have higher malignant degree in biological characteristics and more badly prognosis.</p>