ABSTRACT
Objective:To investigate the recent and long-term efficacy and safety of pancreaticoduodenectomy for pancreatic head carcinoma and periampullary carcinoma.Methods:82 cases of pancreatic cancer combined with periampullary carcinoma patients admit ted in our hospital from August 2009 to June 2013 were selected and randomly divided into the control group and the observation group With 41 patients in each group.The control group received palliative surgical treatment,while the observation group underwent pancreatoduodenectomy.The operation time,hospitalization time,intraoperative bleeding volume and the incidence of complications,1,2,3-year survival rate and the recurrence rate at 1 year after operation and tumor eradication rate were compared between twp groups.Results:The amount of bleeding,operation time of observation group were significantly higher than those of the control group(P＜0.01),no signif icant difference was found in the hospitalization time between the two groups(P＞0.05);the incidence of complications in the observation group (41.46％) was significantly higher than the control group (22.96％)(P=0.03);the 2-year and 3-year survival rate of observation group were significantly higher than those of the control group (P＜0.05),the recurrence rate at 1 year after operation of observation group was significantly lower than that of the control group (P=0.04),the tumor eradication rate was significantly higher in the observation group than that of the control group (P=0.04).Conclusion:Though pancreaticoduodenectomy could prolong the operation time,increase the risk of bleeding and complications for pancreatic head carcinoma and periampullary carcinoma,but it could effectively reduce the possibility of recurrence after operation,significantly improve the long-term survival rate.
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Objective To retrospectively evaluate the necessity to dissect the recurrent laryngeal nerve in operation of thyroid gland.Methods From Jan 2004 to Jan 2009,there were 512 patients in our hospital who underwent operation of thyroid gland,and they were divided into two groups aecording to whether or not the recurrent laryngeal nerve was dissected during the operation.The rate of injury of recurrent laryngeal nerve between the two groups was compared.Results Among the 189 cases in dissection of recurrent laryngeal nerve group,3 cases(1.59%) had hoarseness after operation,and in the 323 cases without dissection of the recurrent laryngeal nerve group,5 cases(1.55%) had hoarseness after operation,but the difference was not significant(1.59% vs.1.55%).However,in the high risk cases between the two groups,the difference was significant(1.02% vs.3.95%).Conclusions Whether oe not to dissect the recurrent laryngeal nerve should be decided by the specific circumstances.For most benign lesions,one should,if possible,not expose the recurrent laryngeal nerve;but for large thyroid neoplasms,second or multiple operations and thyroid cancer,exposure of recurrent laryngeal nerve is necessary.
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Objective To discuss the clinical effect of combined use of duodenoscopy and laparoscopy for treatment of cholecystolithiasis complicated by choledocholithiasis.Methods The clinical data of 106 cases of cholecystolithiasis with cholelcoholithiasis in our department during 7 years were analyzed.Endoscopic sphincteromy (EST) and endoscopic nasobiliary drainage (ENBD), followed by laparoscopic cholecystectomy(LC) was employed. Results In 101 cases(95.3 %) stones were removed by EST successfully. Complicated with postoperative pancreatitis in 11cases(10.4 %), bleeding in 1 case (0.9 %), and acute cholangitis in 2 cases (1.9 %). All of the patients recovered and discharged. Eighty-five cases were followed up for average 3.1 years. Of them, 5 cases had choledocholithiasis recurrence, 1 had papillary re-stenosis, 2 had bile duct carcinoma, and 2 died of other caused.Conclusions Combined use of EST and LC for treatment of calculus of extrahepatic bile duct is a safe and effective mini-intrusive operation.