Surgical treatment and prognosis of cancer of hepatic flexure of colon invading the duodenum in 65 patients / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To discuss surgical treatment of right colon carcinoma of hepatic flexure invading the duodenum.</p><p><b>METHODS</b>Sixty-five patients with right colon carcinoma of hepatic flexure invading the duodenum, treated in our department from 1987 to 2007, were included in this study. Their clinicopathological data were retrospectively reviewed and analyzed. All the cases were divided into three types (local invasion, regional invasion, and cancer with internal fistula) according to duodenal defect, including local invasion (< 2.0 cm), wide invasion (> 2.0 cm) and the presence of internal fistula.</p><p><b>RESULTS</b>25 patients with local invasion underwent en bloc resection of the duodenal wall. Pedicled ileal flap was used to cover the large duodenal defect measuring 2.0 - 3.0 cm in 5 patients. Dudenojejunostomy was used to reconstruct the large defect measuring more than 5 cm in 3 patients. Conservative resection of right-sided colon was performed in 18 patients with wide invasion. 4 patients underwent pancreaticoduodenectomy combined with right hemicolectomy for colon cancer involving the pancreatic head. 10 underwent duodenal diverticularization. One patient with anastomotic leakage healed within 3 weeks. Other patients were cured without postoperative complications. The total 3-year and 5-year survival rates after surgery were 53.8% and 9.2%, respectively.</p><p><b>CONCLUSION</b>The surgical procedure to be performed is usually decided according to the cancer location, extent, and duodenal defect and invasion, which are important for prolonging life time, improving of quality of life and prognosis in these patients.</p>

Diagnosis and surgical treatment of carcinoid tumors of the appendix in 64 patients / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To summarize the experience in the diagnosis and surgical treatment of carcinoid tumors of the appendix.</p><p><b>METHODS</b>From 1972 to 2006, 64 patients with carcinoid tumors of the appendix received surgical treatment in our hospitals. The clinical data of those patients were retrospectively analyzed.</p><p><b>RESULTS</b>Of the 64 cases, only 6 cases (9.4%) were correctly diagnosed preoperatively, while 58 (90.6%) not confirmed, with a misdiagnosis rate of 90.6%. All patients underwent surgical treatment, including appendectomy in 54, ileocecectomy in 4, right hemicolectomy in 2 and right hemicolectomy with regional lymph node dissection in 4 cases. The operation modes were determined according to the doctor's judgments based on the age of the patients, the nature, size, location, infiltration depth and lymph node metastasis of the tumors. Of the 64 patients, 58 were followed up with a longest follow-up period of 13 years, while 6 lost follow-up. Fifty-seven of those were still surviving, only one died of liver metastasis at 13 years after operation.</p><p><b>CONCLUSION</b>Carcinoid tumor of the appendix is rare with a high rate of misdiagnosis before operation. Surgical resection is the only effective treatment for this disease and proper operation mode is the key to achieve good survival.</p>

Study on inhibition of acute rejection in rat limb allografts by inducible costimulator pathway blockade / 中国地方病学杂志

Objective To observe the effect of inducible costimulator(ICOS) costimulation pathway blockade in rat limb allografts acute rejection by RNA interference. Methods Twenty-seven cases of modified hind llmb allotransplantation were performed from Wistar to SD rats. The rats were divided into 3 gronps(each n=9): the rejection group not given a special disposal; the control group, consisting of SD rats that received injection of pSilencer 4.1 and Sofast complex by vein post transplantation; and the interference group that received injection of pSilencer 4.1-ICOSshRNA and Sofast complex. On the eighth day posttransplantation, 3 rats were killed to study the pathological changes in each group. The expressions of ICOS gene in vivo were detected by flow cytometry and RT-PCR. The mixed lymphocyte reaction (MLR) was performed and eytokines in blood were measured by ELISA. The rest rats were used to record limb survival time. Results The mean survival time in rats of the rejection and the control groups were(11.34±1.21) and (11.14±1.32) days respectively. In the interference group, the mean survival time of limb allografts was (16.85±1.73) days(P<0.05). The rats in the rejection and the control groups experienced moderate to serious acute rejections with skin epidermal necrosis, a large quantity of lymphocyte infdtration, muscle cell necrosis and interstitial edema, while the pathological changes in rats of the interference group were mild. The splenocyte ICOS mRNA expression level in the interference group(18.75%) was significantly lower than that of the rejection group(100%) and the control group(98.51%). ICOS cell surface expression level as judged by the fluorescence intensity was 45.59±12.87 in the interference group, 103.72±21.76 in the rejection group, and 93.47±29.55 in the control group(F=6.89, P<0.05). In stimulation assays, a one-way mixed lymphocyte reaction stimulation index(SI), with spleen cells from Wistar and Lewis rats, respectively, the rejection group (5.26±0.42,5.18±0.29) and the control group (5.37±0.27,4.93±0.44) had significantly greater reactions than the interference group(2.37±0.35, 4.87±0.36), respectivily(F=7.29, P<0.05; F=6.19, P0.05). In the IFN-γ and IL-4 expression assays, reactions of the interference group (230.17±38.47,160.32±59.13) were lower than those of the rejection group(490.73±51.48,230.67±45.21) and the control group(480.15±43.96, 240.53± 47.36), (F=7.23,6.75, all P<0.01). Conclusions In vivo transfection of pSilencer 4.1-ICOS shRNA interference plasmid can effectively block T-cell co-stimulation pathway, suppress acute rejection, and prolong limb allografts survival.

Clinical analysis of primary small intestinal neoplasms in 305 cases / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To summarive the experience in diagnosis and treatment of primary small intestinal neoplasm.</p><p><b>METHODS</b>The data of 305 patients with pathologically confirmed primary small intestinal tumor collected from 6 hospitals around the Songhua River during the past 33 years were analyzed retrospectively.</p><p><b>RESULTS</b>There were 42 benign and 263 malignant tumors in this series with a ratio of 1: 6.26. The 263 malignant tumors in this series consisted of 135 adenocarcinomas, 57 malignant stromal tumors, 37 malignant lymphomas, 20 carcinoids, and etc. Chronic occult bleeding, gradual of body weight loss and mild abdominal pain (three obscurities) were the common clinical features and alerting massage of intestinal tumor. Correct preoperative diagnostic rate was only 57.0% (174/305) due to difficulty in early diagnosis, which was 67.2% (92/137) in the duodenal tumors, and 51.9% (82/168) in the jejunoileal tumors. All of the 42 benign tumors were resected completely. For the 263 patients with malignant tumors, radical dissection was performed in 153, palliative resection in 34, and gut by-pass or biopsy in 76. The median survival of the patients who underwent radical resection of their malignant tumors was 92 months, which was significantly higher than that of the other groups.</p><p><b>CONCLUSION</b>Early diagnosis of primary small intestinal tumors is difficult and with a preoperative misdiagnosis rate of 43.0%. Total intestinal barium swallowing, endoscopy and superior mesenteric arteriography are three critical examinations for diagnosis and location. Early surgical resection is crucial in improving the prognosis. The primary small intestinal tumor should be resected as early as possible if no distant metastasis is detected.</p>

Clinical analysis of gastrointestinal stromal tumor: a report of 29 patients / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To investigate the clinical manifestations, diagnosis and treatment of gastrointestinal stromal tumor (GIST).</p><p><b>METHODS</b>Clinicopathological data of 29 cases with GIST from 2003 to 2005 were retrospectively analyzed.</p><p><b>RESULTS</b>The most common clinical manifestations were abdominal pain, distention or discomfort in 16 cases (55.2%), abdominal mass in 9 (31.0%), melena and hematemesis in 5 cases (17.2%). The tumor was located in the stomach in 16 cases, the small intestine in 9, the colorectum in 2, the esophagus in one, and the duodenum in one case. All the cases underwent operation, included total gastrectomy in one case, subtotal gastrectomy in 8, partial gastrectomy in 4, local excision of the tumor in 5 cases, partial small intestine resection in 9 and right colectomy in 2 cases. The resection rate was 100% and no complication and death occurred. The positive rates of CD117(+) and CD34(+) were 93.1% and 51.7% respectively. After follow up from one to 2 years after operation, 2 cases died of tumor recurrence and metastasis, the others survived.</p><p><b>CONCLUSIONS</b>Immunohistochemical examinations of CD117 and CD34 are important diagnostic markers. Surgery is the main method of final diagnosis and treatment.</p>

Clinical analysis of gastroparesis syndrome after nongastrectomy abdominal operation: a report of 22 cases / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To investigate the causes, diagnosis and treatment of gastroparesis syndrome after nongastrectomy abdominal operation.</p><p><b>METHODS</b>The clinical data of 22 cases with gastroparesis syndrome after nongastrectomy abdominal operation from 1972 to 2004 were retrospectively analyzed.</p><p><b>RESULTS</b>Gastroparesis syndrome after nongastrectomy abdominal operation often occurred during 4-6 days postoperatively when the patients began to take in food, characterized by upper abdominal distension, nausea, vomiting, strong splashing bowel sound, weak bowel sound and large quantity of gastric drainage ranging from 1000 to 3000 ml every day. Barium meal was valuable not only in the diagnosis but also effective for promoting gas motility. It revealed a non-peristaltic, flabby and static stomach, and retention of contrast medium in the stomach even 5-6 hours later. All the patients recovered through non-operative therapy for 5-25 days including continuous gastrointestinal decompression, TPN and gastro-intestinal dynamic medicine.</p><p><b>CONCLUSIONS</b>The causes of gastroparesis syndrome after nongastrectomy abdominal operation are multifactorial, most of such patients can be cured by non-operative therapy.</p>

Expressions and clinical implications of kruppel-like factor 6 and APC in human colorectal carcinoma / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To investigate the expressions and clinical implications of kruppel-like factor 6(KLF-6) and APC in human colorectal carcinoma.</p><p><b>METHODS</b>The expressions of KLF-6 and APC in tumor and normal tissues from 32 patients with colorectal carcinoma were investigated by RT-PCR and immunohistochemical technique.</p><p><b>RESULTS</b>The expression rates of KLF-6 and APC mRNA were 37.5% and 34.3% in tumor tissue, 96.9% and 93.8% respectively in normal tissues (both P< 0.05). The expression rates of KLF-6 and APC protein were 28.1% and 25.0% in colorectal carcinomas, 81.3% and 84.43% respectively in normal tissues (both P< 0.05). There was a significant correlation between the expressions of KLF-6 and APC in colorectal carcinomas (P < 0.05). The expressions of KLF-6 and APC were significantly correlated with tumor differentiation, depth of infiltration, lymph node metastasis and clinical stage (P< 0.05).</p><p><b>CONCLUSION</b>Down-regulations of KLF-6 and APC might play an important role in the carcinogenesis, development, metastasis of human colorectal carcinoma.</p>

Diagnosis and treatment of paraduodenal hernia: a report of 16 cases / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To summarize the experience of diagnosis and treatment for paraduodenal hernia (PDH).</p><p><b>METHODS</b>The clinical data of 16 cases with PDH surgically treated from 1962 to 2003 were analyzed retrospectively.</p><p><b>RESULTS</b>The average age of the patients was 36 years old. There were 13 cases with left PDH (Landzerts hernia) and 3 cases with right PDH (Waldeyer's hernia). Ten patients usually had no symptoms, while acute abdominal pain occurred after full food in 3 case and after vigorous movement in 13 cases respectively. X-ray revealed complete or incomplete intestinal obstruction in 12 cases, while ultrasonography and CT revealed dilated cystic jejunal loop between the pancreas and the stomach in 6 cases. Fourteen cases (87.5%) were misdiagnosed before operation. The hospital stay ranged from 10 to 13 days. All patients were followed up from 2 to 4 years without recurrence.</p><p><b>CONCLUSION</b>With high misdiagnostic rate, it is the key to perform exploratory operation for suspicious PDH.</p>

Analysis of clinical manifestations and surgical treatment of Crohn disease: a report of 82 cases / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To elucidate the clinical types of Crohn disease and evaluate its surgical treatment.</p><p><b>METHODS</b>Clinical data of 82 cases with Crohn disease were retrospectively analyzed from June 1972 to June 2003.</p><p><b>RESULTS</b>Among 82 cases with Crohn disease,38 cases were diagnosed before operation,and 44 cases(53.7% ) were misdiagnosed. Main clinical manifestations included abdominal pain(96.3% ),diarrhea(89.0% ) and abdominal mass(28.0% ),other clinical manifestations included fistulation,intestinal hemorrhage and extra- intestinal manifestations such as ulcerative stomatitis,mycotic stomatitis. Patients received different surgical procedures as following: partial enterectomy in 57 cases,hemicolectomy and colostomy in 4 patients,partial ileectomy and ileostomy in 2,ileocolic bypass procedure in 3 patients,partial enterectomy and colectomy and anastomosis in 3 patients because of internal fistula,repair of ileal perforation in 2,lysis of adhesion in 6,drainage of intraperitoneal abscess and ostomy in 3,radical operation in 2 due to colon cancerization. Seventy- three cases(89.0% ) were cured by operation,postoperative complications occurred in 9 patients and 2 cases died.</p><p><b>CONCLUSION</b>It is the key point to achieve successful operation that the corresponding operative modes respectively for varied types of Crohn disease should be adopted.</p>

Intractable constipation caused by adult dolichocolon / 中国普通外科杂志

Objective To summarize the diagnosis and surgical treatment for intractable constipation caused by adult dolichocolon.Methods Clinical data of 82 adult dolichocolon cases suffering from intractable constipation were analyzed retrospectively.Results Of the 82 patients,intractable constipation were found in 66 patients(80%),abdominalgia,abdominal distension in 28 patients(34%) and constipation alternatively with diarrhea in 16 patients(19%).Diagnosis was established in 74 patients by barium enema while 8 during the emergency operation.Dolichocolon was divided into 3 types as type Ⅰ in 35 cases,type Ⅱ in 19 and type Ⅲ in 28,in which there were 18 cases of total dolichocolon syndrome. Surgery performed including sigmoidectomy(32 patients),right hemicolectomy(3 patients),right hemicolon and transvers colon resection(4 patients),left side of transvers colon and splenic flexure colon resection(4 patients),descending colon and sigmoid colon resection(15 patients),transvers,descending and sigmoid colon resection(6 patients),pancolectomy with anastomosis of terminal ileum and upper rectum (18 patients).There were no severe postoperative complications such as anastomotic leakage and the recovery was uneventful in all 82 patients.The curative effect was graded as well and up in all 72 cases followed up from 3 months to 4 years,with a follow-up rate of 88%(72/82).Conclusion A history of intractable constipation and barium enema are the mainstay for the diagnosis of dolichocolon,and operation is the effective treatment for intractable constipation caused by adult dolichocolon.