Laparoscopic hepatectomy: the choice in the era of minimally invasive surgery / 临床肝胆病杂志

Since Reich completed the first laparoscopic hepatectomy (LH) in 1991,LH has been developed rapidly with the continuous improvement of surgeons' technique and the technological changes in devices and related processes.This article elaborates on the safety and efficacy of LH,the value of 3D visualization,3D printing technology,and 3D laparoscopic technology in guiding precise hepatectomy,control of hemorrhage during LH,and safety and efficacy of robotic hepatectomy.

The clinical impact of artery-first approach combined with vascular resection and reconstruction in the treatment of pancreatic head carcinoma / 中华肿瘤杂志

Objective@#To evaluate the application of artery first, combined vascular resection and reconstruction in the treatment of pancreatic head carcinoma.@*Methods@#The clinical data of 13 patients with pancreatic head cancer were retrospectively analyzed from February 2014 to March 2016 in the Affiliated Hospital of Xiamen University. Preoperative computed tomography of high resolution layer or magnetic resonance imaging examination demonstrated pancreatic head carcinoma, as well as close adhesion, stenosis, compression or displacement of superior mesenteric vein or portal vein wall. In the operation, the artery first approach was used and the whole arterial blood supply in the head of the pancreas was fully exposed and interdicted. Finally, en block resection and vascular resection and reconstruction was adopted.@*Results@#12 of 13 patients had pancreatoduodenectomy synchronously with vascular resection and reconstruction; the other patient had these two surgery sequentially. Four patients received blood vessel wedge resection, five had segmental resection combined with end to end suture, and four had segmental resection combined with artificial vascular graft reconstruction. Operation time was (327.2±65.5) minutes, and the amount of blood loss was (472.6±226.4) millilitres. One patient suffered from delayed gastric emptying, and two patients had pancreatic fistula. All patients recovered from postoperative complications by conservative treatment. No patients developed biliary fistula, gastrointestinal fistula, abdominal infection, pulmonary infection, diarrhea, hypoglycemia or other complications, and none died in perioperative period. Postoperative pathological findings confirmed the diagnosis of pancreatic ductal adenocarcinoma. Mean tumor diameter was (4.2±1.5)cm, and (3.8±1.5) metastasis were found in (13.6±2.5) resected lymph nodes. In 11 cases, the tumor cells were found in the outer membrane of blood vessels, 2 cases were found to have tumor invasion in the inner membrane, and all the resection margins were negative. All patients were followed up, and 2 patients died of liver metastasis 11 months and 18 months after operation, respectively. One patient survived with local recurrence of tumor 13 months after surgery. Other patients had no tumor recurrence and metastasis.@*Conclusions@#The artery first approch combined vascular resection and reconstruction is safe effective and feasible in the treatment of pancreatic head carcinoma. It can improve the ablation rate of pancreatoduodenectomy.

Application of three dimensional visualization combined with portal vein arterialization technologies in pancreaticoduodenectomy / 中华消化外科杂志

Objective To explore the application value of three-dimensional (3D) visualization combined with portal vein (PV) arterialization technologies in pancreaticoduodenectomy.Methods The retrospective descriptive study was adopted.The clinical data of 1 patient with duodenal cancer who was admitted to the Chenggong Hospital of Xiamen University in August 2015 were collected.The preoperative plain scan images in the upper abdomen and enhanced scan images in the arterial and PV phases using 320-slice spiral CT were converted to the 3D images by 3D visualization technology.The 3D data were used for detecting tumor invading pancreatic head and organizational structure surrounding hepatic hilus,and making a preliminary surgical plan.Open exploration found that tumor involved pancreatic head and didn't invade superior mesenteric artery and vein,and then pancreaticoduodenectomy was applied to the patient during operation.Intraoperative proper hepatic artery-PV end-to-side anastomosis was used for increasing R0 resection rate.Operation time,volume of intraoperative blood loss,result of postoperative pathological examination,liver function and complication and vascular patency at postoperative week 1 and vascular patency at postoperative month 1 were observed.The patient underwent color Doppler ultrasound and digital subtraction angiography (DSA) at postoperative month 1 in order to detect blood vessels,and was followed up by outpatient examination for observing tumor till November 2015.Results There was a clear and solid 3D reconstruction model between anatomical position of tumor and blood vessels,and preoperative assessment was consistent with intraoperative finding.Operation time and volume of intraoperative blood loss were 6.5 hours and about 1 500 mL.The patient was confirmed as intestinal diffuse large B-cell lymphoma by postoperative pathological examination.The patient had normal liver function at postoperative week 1 and discharged from hospital at postoperative week 2,without abdominal secondary hemorrhage,infection,pancreatic fistula,intestinal fistula and other severe complications.PV blood flowing was normal by color Doppler ultrasonography at postoperative week 1 and month 1.DSA examination showed that there was no proper hepatic artery images and visible compensatory liver artery at postoperative month 1.During follow-up,no tumor recurrence was detected.Conclusion 3D reconstruction model can provide an accurate preoperative assessment,and PV arterialization technology for unreserved hepatic artery has a certain degree of clinical value in pancreaticoduodenectomy.

Diagnosis and treatment of spontaneous isolated superior mesenteric artery dissection / 中华消化外科杂志

With the development of imaging technology,the reports of spontaneous isolated superior mesenteric artery dissection become more frequently,but there is no consensus on the therapeutic plans which consist of conservative therapy,endovascular treatment and surgical treatment.Therefore,the related questions of the spontaneous isolated superior mesenteric artery dissection will be discussed in order to improve the diagnosis and treatment of vascular diseases of digestive tract with a review of literatures.

Application of three-dimensional visualization system in the treatment of hilar cholangiocarcinoma / 中华消化外科杂志

Objective To investigate the value of three-dimensional visualization system in the treatment of hilar cholangiocarcinoma.Methods The clinical data of 10 patients with hilar cholangiocarcinoma who were admitted to Chenggong Hospital of Xiamen University from January 2012 to September 2012 were retrospectively analyzed.The two-dimensional computed tomography images were converted to three-dimensional images with the three-dimensional visualization system,and then the volume of liver and tumor size,volume of liver to be resected,remnant liver volume were measured.Surgical procedure was planned based on the three-dimensional images,and the difference between the actual and planned surgical procedures was analyzed.The correlation between actual liver resection volume and predicted liver resection volume was analyzed by calculating the Pearson correlation coefficient.Results The mean liver volume,tumor size,predicted liver resection volume and remnant liver volume of the 10 patients detected by the three-dimensional visualization system were (1496 ± 162) ml,(67 ± 18) ml,(335 ± 241)ml and (1140 ± 197)ml,respectively.The average error rate of predicted liver resection volume was 6.4％.Surgical plan was made in accordance with the principle of curative hepatectomy,including 4 cases of left semihepatectomy,2 cases of right semihepatectomy,3 cases of partial liver resection and 1 case of palliative liver resection.The coincidence rate between the planned and actual surgical procedures was 9/10.R0 resection was performed on 7 patients,R1 resection on 1 patient and palliative resection on 2 patients.One patient received restrictive portal vein arterialization.Preoperative evaluation of the anatomy of blood vessels,bile ducts and tumors based on three-dimensional images was confirmed with operative findings.The accuracy of tumor typing by the three-dimensional visualization system was 8/10.The actual liver resection volume was (325 ± 258) ml,which was positively correlated with the predicted liver resection volume (r =0.902,P ＜ 0.05).Conclusion The three-dimensional visualization system is helpful in the treatment of hilar cholangiocarcinoma.

Clinical features of hepatocellular carcinoma during pregnancy / 中华肝胆外科杂志

Objective To explore the clinical features of hepatocellular carcinoma (HCC) during pregnancy. Methods Clinical data of 4 patients with HCC in pregnancy were retrospectively analyzed.Results All 4 patients were positive for hepatitis B surface antigen. A marked increase in maternal serum a-fetoprotein (AFP) was found in 3 patients (310.1-5630.0 ng/ml ). Three patients were diagnosed at their advanced stages and died of disease in the 4th, 6th and 7th months, respectively. One patient diagnosed as having early HCC underwent curative surgery and has been without recurrence for 26 months. Conclusion The overall survival of patients with HCC in pregnancy is grim because most patients are diagnosed in the advanced stage. Surveillance with AFP and ultrasonography should be recommended for pregnant woman for the detection of early HCC, especially in hepatitis B virus carriers from high endemic areas, to improve patient survival.

The feasibility of pancreatoduodenectomy with vascular reconstruction to treat pancreatic and duodenal tumor / 中国癌症杂志

Background and purpose:Radical surgery remains the main treatment for the patients with pancreatic and duodenal cancer,but resectability rate is low when clinically diagnosed,portal vein/superior mesenteric vein or inferior caval vein invaded by tumors are a few of the main reasons.How to increase resectability of pancreatic cancer and duodenal cancer still is very challenging to the clinician.This study was done to explore the feasibility of the new surgical approach for the treatment of pancreatic and duodenal cancer with portal vein/superior mesenteric vein or inferior caval vein invasion.Methods:5 patients received pancreatoduodenectomy with vascular reconstruction between February 2002 and June 2005.Three patients with pancreatic head cancer underwent pancreatoduodenectomy combined with portal vein/SMV resection and vascular reconstruction and two patients with duodenal cancer underwent pancreatoduodenectomy combined with inferior caval vein resection and vascular reconstruction.Results:There was no surgery related death.The serious complications such as artificial blood vessel infections or obstructions were not experienced.After surgery,one patient died 10 months later,one patient died 24 months later,two patients survived for over 3 years and one patient over 4 years.Conclusions:Pancreatoduodenectomy with vascular reconstruction for patients with carcinoma of the pancreatic head or duodenum invading portal vein/superior mesenteric vein or inferior caval vein has been proved to be a safe treatment,it could improve the resectability of the tumor and prolong survival.

Early and late outcomes in patients with severe extracranial internal carotid stenosis undergoing carotid endarterectomy / 中华医学杂志(英文版)

<p><b>OBJECTIVE</b>To determine the perioperative and late outcomes for carotid endarterectomy (CEA) in treatment of patients with high-grade stenotic lesions of the extracranial internal carotid artery.</p><p><b>METHODS</b>Twenty patients underwent 21 CEAs at the Zhongshan Hospital between May 1993 and June 2000. They were 19 men and 1 woman, with a mean age of 64 +/- 9 years. Seven patients were performed for stroke, 11 for transient ischaemic attacks (TIAs) and 2 for asymptomatic disease. Duplex scan was the primary tool of evaluation prior to surgery. Perioperative digital subtraction angiography and magnetic resonance angiography were done for 19 and 18 patients, respectively. The percentage of stenosis was calculated using NASCET criteria. Of the 21 lesions operated, 19 had a stenosis of 70% or greater, 2 had ulcerative lesions with a stenosis ranging from 60% to 69%. All CEAs were performed under cervical block anaesthesia with selective intraoperative shunting and patch angioplasty. The patients were followed up regularly with duplex scan surveillance.</p><p><b>RESULTS</b>There was no mortality or stroke during 30 days postoperatively. A TIA occurred in one patient and cranial nerve injury in 2 patients perioperatively. All patients were followed up for a mean interval of 31 +/- 20 months (range: 1 - 63 months). The 2-year survival rate and risk of stroke were 92.3% and 0%, respectively, and the 5-year survival rate and risk of stroke were 79.1% and 12.5%, respectively. Two asymptomatic recurrent stenoses ranging from 50% to 60% were detected on follow-up duplex scan.</p><p><b>CONCLUSIONS</b>For the patients in this study, CEA is associated with an acceptable perioperative outcome as well as a satisfactory long-term beneficial effect in stroke prevention.</p>

Surgical treatment of Takayasu arteritis accompanied with aneurysms / 中国普通外科杂志

Objective To discuss the diagnosis and surgical treatment of Takayasu arteritis accompanied with aneurysms. Methods The clinical features and the effect of operation types in 14 patients were reviewed.Results All the 14 patients had history of Takayasu arteritis and had steroid therapy before the formation of aneurysms.Among the 14 patients,aortic aneurysms were found in 13(including 9 thoracoabdominal aneurysms),carotid aneurysm with subclavian aneurysm in 1 and multiple aneurysms in 5.All the 14 patients underwent operations ,including replacement of aorta in 11 cases,bypass of aorta in 3 cases,reconstruction of visceral vessels in 8, renal autotransplatation in 1 and replacement of carotid in 1.1case had heart failure and cured ;1 died postoperatively. Eight cases were followed up for 4 months - 18 years,of which, 1 died of heart failure,2 were excellent, 3 of 5 cases with hypertension preoperatively showed normal blood pressure,and the other 2 were controlled by medicines.Conclusions Operation should be performed as early as possible if the aneurysm is found in patients with Takayasu arteritis.The stenosis of renal artery should be resolved during the operation.

Correlation between HLA gene and Takayasu arteritis in the Chinese / 中国普通外科杂志

Objective To determine the correlation between HLA gene and Takayasu arteritis(TA) in the Chinese. Methods Forty four TA patients and 135 healthy controls were examined for HLA DQA 1 and HLA DQB 1 locus alleles by PCR/SSOP typing and mass genetics techniques. Results The frequency of DQA 1 0301 allele(14.8%) in TA patients was significantly decreased compared with the controls( 30.7% )(P0.05). Conclusions In Chinese, people with HLAⅡ DQB 1 0601 gene may be susceptible to TA, while people with HLAⅡ DQA 1 0301 gene may be resistant to TA.

Resection of retroperitoneal tumors with reconstruction of major blood vessels in 12 patients / 中国癌症杂志

Background and purpose:In all treatments of retroperitoneal tumors,surgical operation is still the only effective method which might cure the tumors.However,the patients were always in advanced stages when they were clinically diagnosed.The inferior cava of the patients always have been invaded by tumors,which is considered to be a relative surgical contraindication.This study was to explore the surgical method in treatment of retroperitoneal tumors with major blood vessels invasion,and in order to raise the resection rate and survival rate. Methods :Retrospective analysis of twelve cases which implicate major vessels and have parallel artificial vascular reconstruction during operations of retroperitoneal tumor from January 2003 to June 2007. Results :Twelve cases of retroperitoneal tumor and implicated major vessels were integrally resected,corresponding important vascular reconstructions were done,no short-term postoperative deaths. Conclusions :Retroperitoneal tumor involving abdominal important vessels is not a contraindication of radical surgical.Integrated resection of retroperitoneal tumor and implicated major vessels and corresponding important vascular reconstruction are safe,and can improve the resection rate and reduce the relapse rate,extend the survival time.

Treatment strategy for patients with abdominal aortic aneurysm and concomitant digestive system surgical diseases : report of 6 cases / 中国普通外科杂志

ObjectiveTo evaluate the treatment strategy for patients with abdominal aortic aneurysm (AAA) and concomitant digestive system diseases (DSD) necessitating a surgery.Method From Mar. 1999 to Oct. 2001, clinical result of 6 cases suffering from concomitant AAA and DSD was reviewed. The AAA ranged from 4 8 to 11?cm in diameter. Cholecystectomy (for acute cholecystitis) and sigmoidectomy (for colonic cancer) were performed synchronously with AAA repair in 2 cases and 1 case respectively. Right semicolonectomy, radical subtotal gastectomy and esophagogastrectomy (all for carcinoma) were performed heterochronously with AAA endovascular exclusive grafting in one each patient, ResultGastric paresis developed postoperatively and recovered spontaneously in one patient. Esophagogastroanastomosis leakage caused a death in 1 patient. With follow up of 6～42 months the remaining 5 patients were alive, with no graft infection, nor cancer recurrence. ConclusionThe concurrent presentation of AAA and digestive tract diseases necessitating surgical intervention could be successfully managed synchronously or heterochronously.Endovascular exclusive graft of AAA is an effective therapy in patiens suffering from concomitant AAA and DSD.

Effects of tumor necrosis factor-? on skeletal muscle ischemia reperfusion injury / 中国普通外科杂志

Objectives To investigate the effect of tumor necrosis factor ? on skeletal muscle ischemia reperfusion injury (SMIR). Methods Twenty four healthy male Sprague Dawley rats were divided into three groups. Group A underwent anesthesia and external jugular vein cannulation only. Group B underwent 4 hours of left hind limb ischemia followed by 4 hour reperfusion. Group C ischemia and reperfusion were treated with anti TNF ? monoclonal antibody (2?mg/kg). ResultsSMIR significantly increased the transcription of TNF ? mRNA in monocyte. The increased TNF ? raised significantly the level of MDA(9 9?1 8 vs. 5 5?0 4)?CK(122?24 vs. 49?11)?NO(270?98 vs. 128?46) in plasma and MPO(skeletal muscle 4 27?0 53 vs. 1 28?0 19, lung 2 61? 0 12 vs. 0 57?0 02) in tissues respectively( P

Endovascular stent grafts for the treatment of infrarenal abdominal aortic aneurysms / 中国普通外科杂志

Objective [WT5”BZ] To evaluate the preliminary clinical results of the endovascular grafts for the treatment of abdominal aortic aneurysms (AAA).[WT5”HZ]Methods [WT5”BZ] Fourteen patients with infrarenal abdominal aortic aneurysms underwent transluminal endovascular graft placement for the exclusion of AAA.[WT5”HZ]Results [WT5”BZ] Two patients received tubular and 12 patients received bifurcated endograft, the placement was successful in all cases. Aortography carried out immediatly after the procedure showed the AAA were completely excluded by endografts, and no endoleaks both on the proximal or distal connections. Myocardial infarction developing in a patient postoperatively was successfully treated by thrombolysis. Perioperative death occurred in 2 cases. Technical success at 30 days was 85 7%. 24 month follow up in 12 cases found migration of the graft in none and endoleaks in 2 cases.[WT5”HZ] Conclusion [WT5”BZ] Based on our initial results and a rather short follow up period of 24 months, the endovascular treatment of AAA with stent graft is safe and effective. Long term follow up is needed to evaluate the feasibity of this procedure.

Major vessels reconstruction after resection of retroperitoneal neoplasm / 中国普通外科杂志

Objective To summarize the experience in major vessels reconstruction after resection of retroperitoneal neoplasm invided major vessel. Methods Sixteen patients with retroperitoneal neoplarsm invading major vessels underwent resection of the tumor companying with the inviding major vessels, and the resected vessels were reconstructed.Of them, 13 artificial vessels were placed for the vascular reconstruction,and 3 underwent inferior vena cava partial resection and repair with or without PTFE patch;combined reconstruction of arteries and veins were performed on 6 patients,and combined resection and reconstruction of vessels and other invaded organs were performed on 3 patients. Results There was no operative mortality in this series. Fourteen patients were followed up for 3-71 months( averaged 30 months) .Five patients died,in which 3 patients died within 12 months, 1died at 64 months and 1died at 71 months after surgery,respectively.There were no obstruction of the reconstructed vessels during follow up. Conclusions Combined resection of retroperitoneal neoplasm with invided major vessel and vascular reconstruction is a safe, effective operation for retroperitoneal neoplasm companying with inviding major vessel.

Resection of retroperitoneal tumors with reconstruction of major blood vessels in fifty six patients / 中国普通外科杂志

Objective To study the surgical manipulation of major blood vessels invaded by retroperitoneal tumors in order to raise the resection rate. Method Clinical data were analyzed on 56 patients undergoing resection of retroperitoneal tumors along with reconstruction of major blood vessels in our hospitals from July 1994 to June 2002. Results There was no surgical mortality, and 51 patients were followed-up from 6 months to 8 years and 1 month (average of 4.8 years). Grafts were patent in 49 cases, thromboembolism developed in 2 cases. Forty-seven cases have survived more than 1 year, 38 cases more than 3 years, and 16 cases more than 5 years. Conclusion Combined resection of retroperitoneal neoplasm and reconstruction of major blood vessels is safe, effective and practical.

Combined pancreatoduodenectomy and vascular reconstruction in the treatment of pancreatic head malignant tumors / 中国普通外科杂志

Objective To evaluate surgical indications and method for regional pancreatoduodenectomy combined with blood vessel reconstruction. Methods Forty-four patients underwent pancreatoduodenectomy combined with superior mesenteric vein and portal vein(smv-pv) resection and reconstruction between April 1994 and March 2001.Among them superior mesenteric artery (SMA) and hepatic artery (HA) were reconstructed in 4 and 2 cases, respectively. Partial resection of the anterior wall of the inferior vena cava was performed in one case for tumor invasion. Results The overall mortality was 7.1%,with no complications. The resected endothelium or margins of the blood vessel and pancreas were microscopically tumor free in all cases. Histological specimen examinations demonstrated adenocarcinoma of pancreas head in 43 cases, neuroendocrine adenocarcinoma was diagnosed in one case. Patients were followed-up from 3～87 months with 2 cases lost after PV/SMV for pancreatoduodectomy. Six patients have survived more than 5 yearsand 21 cases more than 3 years. Conclusion Regional pancreatoduodenectomy combined with reconstructionof blood vessel could increase tumor resection rate in properly selected patients and could be performed safely without increased morbidity and mortality.

A Study on Laboratory Rearing of Anopheles dirus / 第三军医大学学报

Anopheles dims Peyton et Harrison, 1979 is an important malaria vector in Southeast Asia and China particularly in forested hilly zones. To establisha a laboratory mating colony for this mosquito is one of the subjects to be solved urgently in malaria research.This paper is to report our experience on breeding this mosquito. Ecological environment is created to simulate the natural conditions. The room-temperature of the insectary is 25?-28℃ and its relative humidity is around 80%.Mosquitoes are kept in cages with the si2e of 50 ? 50 ? 100cm. The larvae are fed with a mixture of de-fatted pig liver powder and yeast with a ratio of 1:3. The adults are fed with a mixture syrup containing 4% of orange juice, 10% of sucrose and other materials. The insectary is illuminated with a 3o w fluorescent light in the day time and a 15 w blue light in the night continuously to induce mating.The mating rate of the fourteenth generation reached 68% and the descendants bred can be used in research work now.

A Preliminary Observation on the Susceptibility of Anopheles dims to plasmodium yoelii / 第三军医大学学报

Anopheles dirus was fed with the mice of Kunming strain infected by plas-modium yoelii yoelii (By265 strain) for three or four days. Then the midgut and the salivary glands of the mosquitoes were examined. It was found that the infection rate of the malaria parasite of the midgut was 78.57% (44/56), but that of the salivary glands was only 4.88% (2/41) . After two passages of the malaria parasite through the mice and the mosquitoes, the infection rate of the salivery glands could be increased up to 13.96% (6/43).