The application of liver free technique in surgery of renal cell carcinoma with tumor thrombus / 中华泌尿外科杂志

Objective:To disiuss the application of liver free technique in renal cell carcinoma patients with Mayo Ⅱ-Ⅳ tumor thrombus.Methods:The clinical data of renal cell carcinoma patients with MayoⅡ-Ⅳ IVC tumor thrombus in our hospital from January 2014 to December 2019 were retrospectively analyzed. 25 patients underwent right part of liver or hepatic portal part dissection via open abdominal approach. There were 20 males and 5 females, aged 45-74 years (mean 61±6 years). All patients underwent urinary tract CTU or MRU examination, vena cava enhanced magnetic resonance angiography.There were left 8 cases, right 17 cases; the median length of tumor was 7 cm (3.6-12.1 cm). There were 1 case of Mayo grade Ⅱ tumor thrombus, 7 cases of Mayo grade Ⅲ tumor thrombus, and 17 cases of Mayo grade Ⅳ tumor thrombus. There were 7 cases of distant metastasis, including 6 cases of lung metastasis and 1 case of bone metastasis. After multi-disciplinary consultation (MDT), 19 patients underwent radical nephrectomy and 6 patients underwent tumor reducing nephrectomy. During the operation, the ligaments around the liver were completely dissociated and the space between the liver and kidney was opened. The bare area of the liver was fully dissociated, to expose the inferior vena cava. For Mayo grade Ⅳ tumor thrombus, 11 cases were treated with free diaphragmatic thrombus removal without thoracotomy, and 6 cases were treated with open chest cardiopulmonary bypass.Results:The median operation time was 444(258-694)min, the median intraoperative blood loss was 2 000(250-10 000)ml, and the median value of suspended red blood cell transfusion was 1 300(400-10 400)ml. The median postoperative hospital stay was 10(4-25)days.15 patients (60%) had postoperative complications, including 8 cases of liver injury, 5 cases of respiratory complications, 4 cases of kidney injury, 3 cases of anemia, 3 cases of infection and 1 case of thrombosis. Three patients died during perioperative period.Conclusions:The application of total liver free technique might obtain good exposure of surgical field, effectively control the hemorrhage of inferior vena cava, which is helpful for safe resection of tumor.

Laparoscopic total splenectomy vs partial splenectomy for splenic benign tumors / 中华普通外科杂志

Objective To evaluate laparoscopic partial splenectomy (LPS) for benign splenic tumors.Method Data of 55 patients undergoing laparoscopic partial splenectomy (20 cases) vs total splenectomy (LTS in 35 cases) at Peking University Third Hospital from August 2008 to July 2016 were collected and retrospectively analyzed.Results There was no difference in sex,BMI,preoperative H GB,preoperative PLT,operation time,operative blood loss and hospital stay between two groups.Age in LPS cases was younger than LTS group,while the tumor size was larger.On the 4th day postoperatively,PLT level was significnatly higher in LTP group.More patients in LTS group suffered from thrombocytosis.Conclusions Laprtoscopic partial splenectomy is a safe and effective procedure for the management of splenic benign tumors.

The effect of distal splenorenal shunt in treatment of portal hypertension / 中华普通外科杂志

Objective To evaluate the effect of distal splenorenal shunts (DSRS) in treatment of portal hypertension.Methods A retrospective analysis was made on 16 patients undergoing DSRS between 2009 and 2015 in a single institution.Perioperative free portal pressure (FPP),blood routine,liver function were collected and analyzed.Postoperative complications,long-term anastomotic status and the rate of re-bleeding were observed.Results Before and after DSRS,FPP were (43 ± 9) cmH2O and (31 ± 6) cmH2 O,a decrease of 29.1％ (t =7.326,P ＜ 0.01).Postoperative serum total bilirubin and peripheral blood leukocyte increased significantly (t =-3.462,t =-2.822,P ＜ 0.05).There was no significant difference in the changes of platelet and albumin before and after surgery.7 patients (7/16,43.8％) had one or more complications including 5 cases (31.3％) of portal vein thrombosis,massive ascites in 4 cases (25.0％),1 case (6.3％) of pulmonary infection and 1 case (6.3％) of wound infection.There was no inhospital mortality and all the 16 cases were followed up with no shunt anastomotic stenosis as showed by enhanced CT scan,meanwhile postoperative re-bleeding occurred in 1 case (6.3％) and 1 case (6.3％) died from liver failure.Conclusions Distal splenorenal shunts provides an effective method for the treatment of portal hypertension.

Surgical experience on Roux-en-Y pancreaticojejunostomy after local pancreatic head resection for benign tumors of the pancreatic head / 中华外科杂志

<p><b>OBJECTIVE</b>To explore the value of Roux-en-Y pancreaticojejunostomy after local pancreatic head resection in treating benign tumors of pancreatic head (BTPH).</p><p><b>METHODS</b>The clinical data of 12 patients diagnosed as BTPH and treated by Roux-en-Y pancreaticojejunostomy after local pancreatic head resection in Department of General Surgery, Peking University Third Hospital from November 2006 to October 2013 were retrospectively analyzed.Of the 12 cases, 5 patients were male, 7 patients were female, the age of patients ranged from 21 to 64 years(average 42.3 years). Diameter of tumors was 3.0-4.8 cm.Diameter of pancreatic wound after resection was 5.1-7.9 cm, and main pancreatic duct injury happened in 1 case.</p><p><b>RESULTS</b>Two cases of mucinous cystadenoma, 2 insulinoma, 3 solid pseudopapillary tumor and 4 nonfunctional pancreatic neuroendocrine tumors were confirmed histopathologically.No mortality and pancreatic leakage occurred during the perioperative period.All the 12 patients had no sign of recurrence.Experienced good life quality without occurrence of diabetes during the follow-up period of 24-108 months(more than 60 months in 4 cases).</p><p><b>CONCLUSIONS</b>Roux-en-Y pancreaticojejunostomy after local pancreatic head resection is a reasonable choice for benign tumors of the pancreatic head as long as the patient is properly selected.</p>

Data analysis of 36 cases with intraductal papillary mucinous neoplasm of the pancreas for their clinicopathological features, diagnosis, and treatment / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Intraductal papillary mucinous neoplasm (IPMN) is a rare pancreatic cystic neoplasm, accounting for 1% of all exocrine pancreatic neoplasms. This study aimed to summarize the clinicopathological and biological behaviors, as well as the experience in diagnosis and treatment of IPMN.</p><p><b>METHODS</b>Clinicopathological data were collected from 36 cases with IPMN who were treated in Department of General Surgery, Peking University Third Hospital from May 2001 to July 2011.</p><p><b>RESULTS</b>The 36 cases of IPMN patients included 27 males and 9 females (M:F = 3:1). The age of patients ranged from 52 to 78 years, with an average of 67.3 years. Regarding tumor location, 20 tumors were located in pancreatic head, 3 in pancreatic neck, 10 in pancreatic body and tail, and 3 in the whole pancreas. All the 36 cases underwent surgical treatment, with 13 cases of pancreaticoduodenectomy, 3 cases of middle pancreatectomy, 7 cases of tumor resection plus pancreaticojejunostomy, 3 cases of distal pancreatectomy, 7 cases of distal pancreatectomy plus spleen resection, and 3 cases of total pancreaticoduodenectomy. Of the 36 patients, 9 patients underwent the operations under laparoscopy. The 36 cases included main duct type (14 cases, 38.9%), branch duct type (10 cases, 27.7%), and mixed duct type (12 cases, 33.3%). Pathologically, of the 36 cases, there were 7 IPMN adenomas, 11 borderline IPMNs, 6 IPMN with carcinomas in situ, and 12 IPMNs with invasive carcinomas. All the 36 cases were followed up. During an average of 42 months follow-up period (26-129 months), no recurrence occurred.</p><p><b>CONCLUSIONS</b>IPMN, which primarily occurs in male, is a low-grade malignancy which may involve any part of the pancreas, with specific clinicopathological features. IPMN is a different malignancy type from pancreatic ductal carcinoma. Imaging and laboratory examination are helpful for the diagnosis and differential diagnosis. The prediction of invasive IPMN is still difficult. Surgical resection is recommended as the first choice of treatment. Aggressive and proper operation procedure produces better prognosis. Long-term follow-up is necessary for patients after operation. Laparoscopic distal pancreatectomy is a feasible and safe procedure for the indicated patients.</p>

A clinical study about applying different R1 criteria to evaluate pancreatic head ductal adenocarcinoma specimens / 中华外科杂志

<p><b>OBJECTIVE</b>To analyze the R1 rate of the pancreatic head carcinoma resection specimens which delt with a unified protocol by two different R1 criteria.</p><p><b>METHODS</b>Between November 2011 and October 2013, a unified pathological protocol was prospectively used to handle 70 consecutive pancreatioduodenectomy specimens for pancreatic ductal adenocarcinoma. Apart from the pancreatic transection margin, the bile duct and stomach/jejunum margins, different colors were used to stain the anterior surface, the superior mesenteric vein (SMV) groove margin, the superior mesenteric artery (SMA) margin, and the posterior surface. Axial slicing technique was used to dissect the pancreatioduodenectomy specimens.</p><p><b>RESULTS</b>Among the 70 patients, 3, 30 and 37 patients were classified as well, moderately and poorly differentiated respectively;7, 15 and 48 patients were classified as pT1, pT2 and pT3 respectively.Forty patients (57.1%) had metastases in regional lymph nodes (pN1) , and 16 patients (22.9%) had metastases in para-aortic nodes.Resection of the portal vein and/or the superior mesenteric vein was performed in 13 patients (18.6%) .When applying the UICC criteria, 26 cancer resections were classified R1 (37.1%) , 33 margins were turned out to be R1. The SMV groove margin and SMA margin were infiltrated in 13 specimens (13/33, 39.4%) respectively.When applying the Royal College of Pathologist's criteria, 39 cancer resections were classified R1 (55.7%) , 51 margins were turned out to be R1. The SMV groove margin and SMA margin were infiltrated in 18 (18/51, 35.3%) and 19 (19/51, 37.3%) specimen respectively.Until April 2014, the median follow-up was 18(range 6-42) months.</p><p><b>CONCLUSIONS</b>Applying the unified protocol for pancreatic head ductal adenocarcinoma specimens results in an significant R1 rate of the resection margins, and the R1 rate is related to the R1 criterion. The SMV groove margin and SMA margin are the two most frequent sites of R1.</p>

Analysis of risk factors affecting the prognosis of pancreatic neuroendocrine tumors / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Pancreatic neuroendocrine tumors (pNETs) are a type of tumors with the characteristics of easy metastasis and recurrence. Till date, the risk factors affecting the prognosis are still in the debate. In this study, several risk factors will be discussed combined with our cases and experience.</p><p><b>METHODS</b>Thirty-three patients diagnosed as pNETs were enrolled and the clinical features, blood tests, pathological features, surgical treatment, and follow-up data of these patients were collected and analyzed.</p><p><b>RESULTS</b>In this study, operation time of G3 cases was longer than G1/G2 cases (P = 0.017). The elevated level of tumor markers such as AFP, CEA, Ca125, and Ca19-9 may predict easier metastasis, earlier recurrence, and poor prognosis (P = 0.007). The presence of cancer embolus and nerve invasion increases along with the TNM stage (P = 0.037 and P = 0.040), and the incidence of positive surgical margin increased (P = 0.007). When the presence of nerve invasion occurs, the chance of cancer embolus and lymph node metastasis also increases (P = 0.016 and P = 0.026).</p><p><b>CONCLUSIONS</b>pNETs were tumors with the features of easy recurrence and metastasis and many risk factors could affect its prognosis such as the elevated levels of tumor markers and the presence of nerve invasion, except some recognized risk factors. If one or more of these factors existed, postoperative treatments may be needed to improve prognosis.</p>

Laparoscopic distal pancreatectomy / 中华普通外科杂志

Objective To study the safety and feasibility of laparoscopic distal pancreatectomy in different modalities.Methods From September 2005 to October 2012,57 patients with masses located at pancreatic body/tail were treated by laparoscopic distal pancreatectomy.According to the operation procedure,patients were divided into four groups:distal pancreatectomy with splenectomy; Spleenpreserving distal pancreatectomy with conservation of the splenic artery and vein; spleen-preserving distal pancreatectomy and without conservation of the splenic artery and vein and laparoscopic to open distal pancreatectomy.Data of each group for operation time,blood loss and complications were collected and statistically analyzed.Results In 57 patients,5 cases were converted to open distal pancreatectomy.52 cases underwent successful laparoscopic operation (including 1 cases of hand-assisted).22 cases of spleen preserving operation (39％),and 30 cases of splenectomy operation (61％).Among the 4 groups of patients operation time,intraoperative blood loss,postoperative length of stay were not significantly different (all P ＞ 0.05).There was no operative mortality.Two cases suffered from B level postoperative pancreatic leakage,there was no C level pancreatic leakage.Conclusions Laparoscopic distal pancreatectomy with or without splenectomy is safe for the treatment of body and tail tumors of the pancreas.

Thoracoscopic hepatectomy for hepatic carcinoma in 3 cases / 中华普通外科杂志

Objective To study the safety,feasibility and efficacy of thoracoscopic hepatectomy for liver carcinoma. Methods Thoracoscopic hepatectomy was performed in 3 cases with single liver neoplasm from 2007 to 2011,including hepatocellular carcinoma ( HCC ) in one case and metastatic liver cancer in 2 cases.By preoperative imaging the tumor was located accurately to simulate the port position in operation.Patients were placed in a left lateral decubitus position,and 3 ports were inserted into the chest wall surrounding the tumor. Through the use of intra-operative thoracoscopic uhrasonography (IOTU),the diaphragm just above the tumor was opened.IOTU was performed on the liver surface and the resection line was marked.Throughout the course of parenchymal transection,IOTU was performed repeatedly to guide the resection line,and ensure the complete removal of the tumor.After meticulous hemostasis of the resection surface,the diaphragm was closed. A thoracic drain was left. Results Thoracoscopic hepatectomy succeeded in all 3 cases,the median total operating time was 150 min (110 -210 min),and the medianblood loss was 297 ml (130 -600 ml). Patients recovered quickly and had no major post-operative complications.During 9 to 42 months' follow-up,one patients died of other cause,no relapse of the diseases was found. Conclusions Thoracoscopic hepatectomy is a safe and feasible operation in selected patients and has advantages in post-operative morbidity and in hospital time.

Donor specific tolerance for MHC mis-matched murine skin allograft induced by donor bone marrow transplantation with precondition of high dose immunosuppressants / 中华器官移植杂志

Objective To establish a non-irradiated precondition strategy for successful donor specific transplantation tolerance induced by bone marrow transplantation which may be introduced to clinical application by a murine model.Methods Male C57BL/6 and female BALB/c mice were used as skin transplant donors and recipients respectively. In all, 11 groups were studied: group 1, control mice with skin graft and without any other treatment; group 2, mice receiving only donor bone marrow transplantation (DBMT) before skin transplantation; groups 3～5, mice administrated by only high dose FK506, CsA or CTX respectively and then skin transplantation; groups 6～8, mice receiving DBMT preconditioned by high dose FK506, CsA or CTX respectively and followed by skin transplantation. Both skin and bone marrow donors were male C57BL/6 mice in above 8 groups. Mice in groups 9～11 were treated almost equally to groups 6～8 except that skin grafts were from the third party ICR donors to prove specificity of tolerance. Every group included 6 recipients. Survival time of skin graft was recorded. Macrochimerism were examined by PCR method.Results Neither standard dose DBMT nor high dose immnodepressants alone could prolong skin graft survival, and macrochimerism was not detected, either. But skin graft survival time was significantly prolonged and macrochimerism was also detected in mice of 6～8 groups. Survival time of skin graft from the third party mice was not prolonged. Conclusions Bone marrow transplantation preconditioned with high dose immunosuppressants and without irradiation can induce donor specific transplantation tolerance and prolong murine skin graft survival. It may work through the mechanism of establishment of macrochimerism.

Long-term results of preoperative regional intraarterial chemotherapy against colorectal cancer / 中华外科杂志

<p><b>OBJECTIVES</b>To summarize the clinical experience of preoperative intraarterial chemotherapy (PRAC) and evaluate the long-term results of multimodality against colorectal cancer.</p><p><b>METHODS</b>Seldinger procedure was used to intubate the tube to the artery branch which supplied blood to the tumor. The tumor was imaged to make sure the diagnosis and irrigate the chemotherapeutic drugs. Ten days after PRAC, the patients received radical operation and 6 chemotherapeutic courses with FCF regimen. Concurrent patients receiving surgical treatment yet no PRAC therapy were chosen as controls.</p><p><b>RESULTS</b>One-year survival rate was 93.05% in the PRAC group and 80.78% in the controls (P = 0.023). COX multivariate analysis was used to analyse the prognostic factors. Dukes'staging and the PRAC prescription or not were found to be independent prognostic factors of colorectal cancer patients. Patients in the PRAC group survived longer than those in the control group.</p><p><b>CONCLUSION</b>PRAC can improve the survival of colorectal cancer patients.</p>

A discussion on indications of endoscopic sphincterotomy / 中国微创外科杂志

Objective To investigate proper indications of endoscopic sphincterotomy (EST). Methods A retrospective review was made on 9 cases of EST with controversial indications from January 2005 to January 2006 in this hospital. There were 1 case of jaundice due to hepatitis and intrahepatic cholestasis, 1 case of intrahepatic and extrahepatic cholelithiasis, 1 case of common bile duct stones, 2 cases of bile duct obstruction due to malignant tumors at upper (1 case) or lower segment (1 case), 2 cases of papillary tumors, 1 case of choledochal cyst, and 1 case of gallstones accompanying common bile duct stones. Results Except for 1 case of jaundice due to hepatitis and intrahepatic cholestasis misdiagnoed as having obstructive jaundice, surgical indications presented in 8 cases. Of the 8 cases, 5 cases were given a surgical operation following EST, 1 case was inoperable because of worse general condition after EST, and a radical operation was given up in 2 cases of end-stage tumors. Conclusions Without complete relief of proximal bile duct obstruction, EST may worsen the patient’s condition instead of curing the biliary diseases. EST may be unnecessary for resectable tumors, especially in young patients.

Tolerance for murine skin allograft induced by bone marrow transplantation with the precondition of Tacrolimus (FK506): An experimental study / 中国微创外科杂志

Objective To investigate the feasibility and practicability of the precondition using high-dose of Tacrolimus (FK506) before the bone marrow transplantation (BMT) for macrochimerism specific tolerance. Methods One hundred male C57BL/6 mice and 60 female BALB/C mice were respectively used as donors and recipients of skin transplantation, and another 15 male ICR mice were used as the third germ line to detect the specificity of tolerance. Sixty recipient mice were divided randomly into 5 groups: blank control group, FK506 group, BMT group, experimental group (FK506+BMT) and third party donor control group, with 12 mice in each group. Before the skin transplantation, high-dose abdominal injection of FK506 (3 mg/kg?2 d) was performed in recipient mice. On the transplantation day a bonus of 2?10 7 bone marrow cells were injected through the tail vein. Then a short period of low-dose FK506 (0.5 mg/kg?7 d) was administrated for maintenance treatment. The survival time of skin grafts, reject reaction against the third party skin, and mixed lymphocyte culture (MLC) were observed. The polymerase chain reaction (PCR) was employed for the detection of macrochimerism. Results Routine dose of bone marrow cells infusion or short period of FK506 administration led to neither prolonged survival time of grafts nor the formation of macrochimerism. The skin graft survival time was significantly prolonged in the experimental group (24 0?1 5 d), as compared with the blank control group (9 6?1 1 d), the FK506 group (10 5?1 6 d), the BMT group (10 3?1 5 d), and the third party donor control group (9 8?1 1 d), respectively ( P

Laparoscopic Distal Pancreatectomy:Report of 26 Cases / 中国微创外科杂志

Objective To evaluate the safety and feasibility of laparoscopic distal pancreatectomy.Methods From September 2005 to June 2008,26 patients with masses located at pancreatic body/tail were treated in our hospital.Before the operation,25 of the cases were diagnosed with benign tumor and one was suspected as having malignant neoplasm.The median size of the tumors was 5 cm in diameter(range,1.2 to 10 cm).Results All of the operations were completed by laparoscopy.Distal pancreatectomy was performed on 15 patients with the spleen being preserved with(10 cases)or without(5)splenic vessels preservation;and laparoscopic distal splenopancreatectomy was carried out in 10 cases.In one patient who had received open distal splenopancreatectomy before admission,resection of the pancreatic body was made.The median operation time was 268.5 minutes in this series(range,129 to 400 minutes),and the median intraoperative blood loss was 100 ml(range,50 to 800 ml).The patients were discharged in 6 to 21 days postoperation(median,9 days).None of them developed pancreatic fistula or splenic infarction.Two of the patients developed encapsulated fluid and were cured by conservative treatments,one patient showed incisional infection.Follow-up was available in all the patients for 1 to 35 months(median,15.5 months).During the period,no recurrence was detected.Conclusions Laparoscopic distal pancreatectomy is feasible and safe for benign tumors located at the body or tail of the pancreas.