ABSTRACT
Surgical pathology is an important ele ment of surgery,as well as the foundation and prop of surgi cal practice.The technical surgeons,who are void of basis knowledge of pathology,may improve their own techniques,but could not enhance the ability of clinical judgement.To eliminate these surgeons' ignorance is better than to improve their surgical techniques.
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For clinical surgeons,physical diagnosis is the stepping stone or open sesame in clinical practice such as inquiry of medical history,physical examination,medical investigation,and disease comprehension.It is the starting point and complementation of clinical diagnosis in surgical practice.It helps and leads young practitioners to acquire basic,true,and useful scientific information and evidence of clinical diagnosis in each patient.It is the essential technique and procedure,which is applicable for lifelong time in young or elder surgeons.
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Perioperative Management is not a new issue in clinical practice,but a nonnegligible core issue related to the safety of surgical patients.In recent years,it has been neglected by surgeons.We must pay great attention and vigilance to perioperative management for the quality and safety of surgical practice.A master surgeon is from the patients' bedside-Mutual Encouragement !
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During the past half century,the great development and progress has been achieved in basic research and clinical management of biliary surgery in our country.The clinical treatment and relative complications of bile duct obstructive disease based on the central of hilar cholangiocarcinoma caused by hepatolithiasis has been explored and recognized.The systemic and supporting clinical strategy and joint treatment principle has been made,which resulted in qualified clinical outcome and formed hepatobiliary surgerythe bile duct surgery with Chinese characteristics.This series of studies had been honored as The National Science and Technology Progress Award in 2000. Bile duct tree is a closed tract full of alkaline liquid secreted by liver and pancreas to ensure the effective digestions.Previous studies had been mainly focus on the biochemical changes of structure and disease.The basic and clinical research for biomechanics of bile duct (Fluid mechanics) is obviously delayed,which caused one-sidedness,blindness and randomness in clinical thinking and treatment strategy.This also indicates the urgency to carry out the exploration and research in this field.This paper introduced the biomechanics of bile duct functions,relative physiological and pathological factors and proposed numbers of important points in the angle of clinical understanding and treatment.
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Comprehensive treatment is an important treatment for unresectable or recurrent multiple tumors under the background of surgical and technical development.Medical treatments for patient should be applied individually and high selectively according to their own situation, and should also emphasize the key role of clinical specialized physicians. The situation what we worry about is that the imaging or interventional technicians have many problems to chose or conduct comprehensive treatment independently.Solution: Make the departments of surgery, inter medicine and relative medical technique unit as an entirety for cooperation, complementary and fine selection. In this mater, we will neither miss the chance of surgery nor effective comprehensive treatment. Overall, we should reinforce the management of patient and help them to release pain and prolong their survival.
ABSTRACT
Instead of the breakthrough progress and change of basic theory and principles of surgery, developments of minimally invasive and transplant techniques in recent two decades are all due to the technology reform. In clinical trail, effectiveness, safety and long-term outcome must be concerned; fine selection must also be applied according to operative surgery. In the mean time, we must emphasize technical training, access to technology and compliance with the rules. We should serve the majority of the patient based on traditional technology, avoid over-treatment and technical misapplying. We should be a doctor with good personality and high skill and keep in mind the patient-centered rule, instead of a doctor machine.
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Currently,as various liver cancer-related treatments in China become developed,doctors also become super-subspecialized.This results in the doctors having more specialized skills and knowledge but a narrower vision.There is a tendency for these super-subspecialists to think and to make decisions based on a narrow perspective.As a consequence,interdisciplinary collaboration is becoming difficult.This hinders further improvement of treatment of liver cancer which has reached a plateau for many years.The present paper proposes a systematic perspective in decisionmaking for treatment of liver cancer.There are seven aspects which include the basic nature of medical care,the history of development of treatment,liver anatomical and functional characteristics,multicentric tumour occurrence,pathology,tumor immunology and biology.We aim to broaden the doctors’ vision and optimize their clinical thinking process.
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Objective To determine the prognostic factors after radical resection (RR) for hepatocellular carcinoma (HCC).Methods Altogether 144 patients who had undergone RR for HCC from 1988 through 1995 were included for a univariate and a Cox multivariate analysis.Nineteen factors contributing to overall survival rate (SR) and disease-free SR were analysed.Results The 5-year SR and disease-free SR (N=144) were 47.3% and 23.9%,separately.Multivariate analysis revealed that classification of RR was the signficant factor to overall SR,and presence of vessel invasion was the signficant factor to disease-free SR.The 5-year SR and disease-free SR in the patholngically RR and clinically RR groups were 60.2%,29.0% and 14.0%,0%,respectively.The 5-year disease-free SR in the group without (or with) vessel invasion was 27.8% (or 0%).Conclusions The classification of RR is the determinative prngnostie factor.Pathologically RR is the first option for patients with in- dications.It is essential to improve adjuvant therapy to decrease postoperative recurrence and metastasis rates.
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ObjectiveTo analyze the causes of and principles for reoperation of congenital choledochal cyst (CCC).MethodsDuring the period of 1986 to 2000, 120 cases of CCC were admitted to our unit,53 of them underwent reoperation. There were 33/14/2/4 cases respectively in Todani Type of Ⅰ/Ⅳa/Ⅳb and Ⅴ. First operation included simple external drainage in 17 cases, choledochoduodenostomy in 8 cases, and choledochojejunostomy with Roux en Y loop in 22 cases etc.ResultsPostoperative complications after external or internal drainage were cholangitis and hepatolithiasis, and high incidence of biliary carcinoma 19% (10/53). The mode of reoperation was mainly cyst excision with Roux Y hepaticojejunostomy (46/53).Conclusions Inappropriate surgical management of CCC incurred much complications that necessitated a reoperation. Cyst excision with reconstruction of the biliary tree by a Roux Y anastomosis is recommended as the therapy of choice for reoperation for patient with CCC.
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Objective To evaluate the long-term effect of surgical procedures for congenital choledochal cyst (CCC).Methods From 1986 to 2000, 120 cases of CCC were admitted and 73 of them underwent the primary operations in General Hospital of PLA. Three types procedures were performed,type I: external drainage of CCC in 7 cases; type II:cystojejunal Roux-en-Y anastomosis in 5 cases; type III: cyst excision with cystojejunal Roux-en-Y anastomosis or cystoduodenostomy in 57cases,and other procedures in 4 cases.Results 68 cases were followed-up for 6 months to 5 years (median 2.7 years). Three cases undergoing type I operations accepted reoperations;two cases undergoing type II operations accepted reoperations due to severe complications as cholongitis and hepatolithiasis; 57 cases treated by type III operation with the good results 88.7% and none reoperation.Conclusions External drainage is only a first-aid management on emergency basis. Internal drainage should never be done,because the effect is temporary,and severe complications result in reoperations. Cyst excision with biliary tract reconstruction is recommended as the optimal treatment of CCC.
ABSTRACT
A total of 1,867 patients were admitted or readmitted to this department in the period from January 1976 to November 1982 and 1,081 of them underwent certain biliary surgery for the treatment of biliary lithiasis. The operations of 702 cases out of the 1,081 were performed on the biliary duct, either exlrahepatic or intrahepatic. In 333 cases out of the 702 who received extrahspatic biliary surgery, 20 cases were found to have postoperative residual biliary stones (6%); while in 369 cases out of the 702 who underwent intrahepatic biliary operations, 136 cases were found to have residual stones (36.85%). Altogether 156 cases out of the 702 operated cases suffered from postoperative residual biliary stones and the overall incidence was 22%.The predisposing, causes of the occurrence of residual stones were discussed-In order to prevent or reduce the occurrence of residual stones, the key, as suggested by the authors, is to perform every emergency or selected operation very carefully without leaving any hidden trouble.