ABSTRACT
Objective To decrease tumor local recurrence after abdominoperineal resection (APR)for low rectal cancer using cylindrical abdominoperineal resection. Methods From February 2009 to February 2010 cylindrical APR was performed in 15 patients of advanced ultralow rectal cancer at the Department of General Surgery, Qilu Hospital of Shandong University, according to the standard protocol as described by Holm. The procedure involves careful mobilization of the mesorectum as far down as the origins of the levator muscle. Ater stoma formation, the abdomen is closed, the patient is rotated into the prone position, and an extended perineal dissection is performed. This includes the sphincter complex and the inferior surface of the levators to a point laterally where they originate on the pelvic sidewall. This point should be just inferior to the level where the abdominal procedure was terminated. The coccyx is often removed in continuity with the main specimen to improve direct visualization of the dissection.Results The cylindrical technique removed more tissue in the distal rectum. There was no bowel perforation, perineal wounds were primary healing. One patient developed perineal seroma. One patient developed peritoneocele hernia of pelvic floor. Conclusions Cylindrical APR performed in the prone position for low rectal cancer removes more tissue around the tumor that leads to a reduction in intraoperative perforations, which should reduce local disease recurrence.
ABSTRACT
Objective To evaluate the significance of hemihepatic vascular occlusion with extrahepatic control of major hepatic veins for hepatectomy in cirrhotic carcinoma. Methods A retrospective comparative study for hepatectomy in patients with hepatocellular carcinoma(HCC) using Pringle maneuver (groupA,n=44),hemihepatic vascular occlusion(group B,n=76) and hemihepatic vascular occlusion plus extrahepatic control of major hepatic veins(group C,n=85)were made from March 2006 to September 2008.The amount of intraoperative bleeding,time of operation,postoperative liver function,liver function recovering and complications were compared.Results There was significant difference in the amount of intraoperative blood loss between the three groups(543.7 ml、415.8 ml、324.5 ml,respectively,F=98.96,P<0.001).There was no difference in the time of operation.The level of serum alanine transaminase(ALT) and that of serum bilirubin on the 3rd and 6th day postoperatively in group B,and C was significantly lower than that in group A.Conclusions Hemihepatic vascular occlusion with control of major hepatic veins results in selective liver isolation from the systemic circulation,which is more effective than Pringle maneuver for controlling intraoperative bleeding without interruption of hemodynamic stability in liver cancer patients.
ABSTRACT
Objective To investigate the diagnosis and treatment of patients with benign tumor of duodenum(BTD). Methods Clinico-pathological data of 24 patients with BTD treated by surgery in our department in recent 21 years were analyzed retrospectively. Among the 24 cases, 18 cases underwent local resection, 4 segmental duodenectomy, 1 subtotal gastrectomy and 1 pylorus-preserving pancreatoduodenectomy. Results Abdominal pain, digestive tract hemorrhage and duodenal obstruction were the common clinical manifestations of BTD. The correct diagnostic rates of air barium double contrast radiography and duodenoscopy were 82.4% and 93.3% respectively. The result of surgical treatment was satisfactory, except 1 patient who died of acute myocardial infarction 6 days after the operation. Of the 24 patients, the pathological examination showed as follows 8 had a villous adenoma, 6 gastrointestinal stromal tumor, 5 Brunner′s gland adenoma, 2 leiomyoma, 2 multiple adenomas in familial adenomatous polyposis, 1 hemangioma. Conclusions Air barium double contrast radiography and duodenoscopy are mainsteps for the diagnosis of BTD. The best treatment is surgical resection.
ABSTRACT
Objective:To introduce the method of cylindrical abdominoperineal resection(APR)for low rectal cancer.Methods:Cylindrical APR was performed for 6 patients with advanced ultralow rectal cancer according to standard protocol in Stockholm from February to May in 2009.The procedure involved careful mobilization of the mesorectum as low as the origins of the levator muscle.After stoma formation,the abdomen was closed,the patient was rotated into the prone position,and an extended perineal dissection was performed.This included the sphinctercomplex and followed the inferior surface of the levators to a point laterally where they originated on the pelvic sidewall.This point should be just inferior to the level where the abdominal procedure was terminated.Results:The cylindrical technique removed more tissue in the distal rectum.There was no bowel perforation,perineal wounds were uneventfully.One patient developed perineal seroma.One patient developed peritoneocele hernia of pelvic floor.Conclusion:Cylin-drical APR performed in the prone position for low rectal cancer removes more tissue around the tumor that leads to a reduction in CRM involvement and intraoperative perforations,which should reduce local disease recurrence.
ABSTRACT
Objective: To investigate the expressions of Slit2 and its receptor Robo1 in human gastric carcinomas. Methods: The expression of Slit2 protein, Robo1 protein and CD34-labeled microvessel density(MVD) were measured by immunohistochemical staining (SP) in 54 cases of gastric carcinomas and 28 cases of Para-cancer tissues. Results:The positive rates of Slit2 ,Robo1 were 63.0% and 77.8% and the expression of Slit2 , Robo1 and MVD in cancerous tissues were higher than those in para-cancer tissues2(?2=26.586,P
ABSTRACT
Objective : The patients with inguinal hernia were treated with plug mesh hernia repair. Methods:The hernia sacs were isolated and dissected back to the internal ring. The unoperated sacs were allowed to drop back through the internal ring into the abdominal cavity. A cone-shaped mesh hernia plug is inserted tapered end through ring and placed into position just beneath the crura. All our repairs were reinforced a second piece of flat was placed from the pubic tubercle, overlying the direct space. Results : Com-paired with conventional suture surgical techniques, a plug repair uses less disscection and ensures tenssion free hernioplusty. Conclusion : We believe that the two factors are the most important reseasons for greater patients confort, rapit rehabilitation, decreased recurrence and lessened overall complication rates with the mesh hernia plug techniques.