Application of hairpin shaped incision combined with cover-lifting flap in plastic surgery of huge fat pad on nape and back / 中国修复重建外科杂志

OBJECTIVE@#To explore the effectiveness of hairpin shaped incision combined with cover-lifting flap in plastic surgery of huge fat pad on nape and back.@*METHODS@#Between March 2019 and March 2023, 10 patients with huge fat pad on the nape and back were treated. There was 1 male and 9 females with an average age of 52 years (range, 39-57 years). All patients had soft tissue bulge on the nape and back. Preoperative MRI showed the subcutaneous fat thickening. The length of the longitudinal axis of the fat pad ranged from 10.0 to 25.0 cm (mean, 14.1 cm), the length of the transverse axis ranged from 6.0 to 15.0 cm (mean, 10.8 cm); the thickness of the fat pad ranged from 2.5 to 5.1 cm (mean, 3.9 cm). Under general anesthesia, the patient was placed in a prone position and a hairpin shaped incision was made. The flap was lifted to remove the fat pad according to the marked area. The dressing was changed every 2 days after operation.@*RESULTS@#The operation time was 35-110 minutes (mean, 72 minutes). The intraoperative blood loss was 35-80 mL (mean, 49.5 mL). The drainage tube was removed at 2-5 days after operation (mean, 3.4 days). All incisions healed by first intention without incision dehiscence, infection, subcutaneous bruising, hematoma, or other related complications. All patients were followed up 2-24 months (mean, 12 months). All patients had a good shape of the nape and back and no noticeable scar on the incision. According to the Vancouver Scar Scale evaluation criteria, the incision scar score was 3-5 (mean, 3.7) at 2 months after operation. Patients had good neck movement with no recurrence.@*CONCLUSION@#For the huge fat pad on the nape and back, the plastic surgery using hairpin shaped incision and cover-lifting flap has the advantages of fully exposing the fat pad, concealed incision, simple operation, and natural shape of the nape and back after operation.

Robot-assisted transperitoneal and retroperitoneal adrenalectomy for huge adrenal tumors in 45 cases / 现代泌尿外科杂志

【Objective】 To compare the outcomes of robot-assisted laparoscopic transperitoneal and retroperitoneal operation for huge (>6 cm) adrenal tumors. 【Methods】 The clinical data of 45 patients with huge adrenal tumors who underwent robotic surgery during Jan.2017 and Dec.2021 were retrospectively analyzed, including 28 cases via the transperitoneal approach and 17 cases via the retroperitoneal approach. 【Results】 No patients were converted to open operations. There were no significant differences in postoperative drainage time (2.24±0.44 vs. 2.36±0.49) d, operation time (130.88±5.96 vs. 136.61±8.39) min, blood loss (189.41±13.91 vs. 192.5±12.36) mL and postoperative hospital stay (7.06±0.56 vs. 7.46±0.69) d between the retroperitoneal and transperitoneal approaches. Retroperitoneal approach was better than transperitoneal approach in early postoperative feeding [(38.82±6.75 vs. 74.14±6.57) h, P<0.01] . 【Conclusion】 Robotic surgery is safe and effective in the treatment of large adrenal tumors. The choice of surgical approach should be based on patients’ condition, tumor volume and location.

Effectiveness of lobulated pedicled rectus abdominis myocutaneous flap for repairing huge chest wall defect / 中国修复重建外科杂志

OBJECTIVE@#To explore the effectiveness of lobulated pedicled rectus abdominis myocutaneous flap to repair huge chest wall defect.@*METHODS@#Between June 2021 and June 2022, 14 patients with huge chest wall defects were treated with radical resection of the lesion and lobulated pedicled rectus abdominis myocutaneous flap transplantation for reconstruction of chest wall defects. The patients included 5 males and 9 females with an average age of 44.2 years (range, 32-57 years). The size of skin and soft tissue defect ranged from 20 cm×16 cm to 22 cm×22 cm. The bilateral pedicled rectus abdominis myocutaneous flaps in size of 26 cm×8 cm to 35 cm×14 cm were prepaired and cut into two skin paddles with basically equal area according to the actual defect size of the chest wall. After the lobulated pedicled rectus abdominis myocutaneous flap was transferred to the defect, there were two reshaping methods. The first method was that the skin paddle at the lower position and opposite side was unchanged, and the skin paddle at the effected side was rotated by 90° (7 cases). The second method was that the two skin paddles were rotated 90° respectively (7 cases). The donor site was sutured directly.@*RESULTS@#All 14 flaps survived successfully and the wound healed by first intention. The incisions at donor site healed by first intention. All patients were followed up 6-12 months (mean, 8.7 months). The appearance and texture of the flaps were satisfactory. Only linear scar was left at the donor site, and the appearance and activity of the abdominal wall were not affected. No local recurrence was found in all tumor patients, and distant metastasis occurred in 2 breast cancer patients (1 liver metastasis and 1 lung metastasis).@*CONCLUSION@#The lobulated pedicled rectus abdominis myocutaneous flap in repair of huge chest wall defect can ensure the safety of blood supply of the flap to the greatest extent, ensure the effective and full use of the flap tissue, and reduce postoperative complications.

FLASH Binds p53 and Enhances its Transcriptional Activity / 中国生物化学与分子生物学报

As an important transcription factor, the tumor suppressor protein p53 is involved in multiple biological processes such as cell cycle regulation, cell division, cell senescence and DNA repair The functional roles of p53 under various physiological conditions are inseparable from the assistance of many cofactors, which can regulate the protein modification, cellular sub-localization, and protein stability of p53 Therefore, the identification of p53-binding protein(s) has important biological significance for further understanding the signal transduction network of p53 in vivo. In the present study, a novel p53-binding protein, FADD-like interleukin-1β-converting enzyme associated huge protein (FLASH) was identified through a yeast two-hybrid screen The protein-protein interaction and the structural basis of the interaction between FLASH and p53 was also confirmed by co-immunoprecipitation analysis These studies have shown that p53 can simultaneously interact with both FLASH-N1 (aa 1 ~ 200) and FLASH-C1 (aa 1 534 ~ 1 780) In addition, both of FLASH-N and FLASH-C can interact with the same region of p53 (aa 293 ~ 393) Transcription analysis has revealed that the full length of FLASH and FLASH-M (aa 921 ~ 1533) can enhance the transcription activity of p53 In summary, FLASH can bind to p53 and enhance its transcriptional activity

Aneurisma gigante de la arteria esplénica: reporte de un caso / Giant splenic artery aneurysm: case report

Resumen Objetivo: Reportar el caso de un aneurisma gigante de la arteria esplénica de 9,5 cm de diámetro, en una mujer de 75 años de edad, que consultó por síndrome vertiginoso, con hallazgo incidental al examen físico de masa abdominal pulsátil, confirmado mediante angiotomografía de abdomen y pelvis. Materiales y Método: Registro clínico de una paciente sometida a reparación quirúrgica abierta de una aneurisma gigante de la arteria esplénica. Resultados: Mediante laparotomía, abordaje anterior, se efectúa la ligadura del aneurisma con resección parcial del saco aneurismático más esplenectomía, evolucionando sin complicación a 12 meses de seguimiento. Discusión: Se define como aneurisma de la arteria esplénica a toda dilatación mayor a 1 cm de diámetro, presenta indicación quirúrgica cuando mide más de 2 cm y se denomina gigante a partir de los 5 cm. Conclusión: Los aneurismas de la arteria esplénica son una condición infrecuente, habitualmente asintomática, pero potencialmente mortal especialmente en embarazadas; en la literatura solo existen 78 casos reportados de aneurismas gigantes de la arteria esplénica, se recomienda la resolución quirúrgica expedita.

Aim: To report the case of a giant splenic artery aneurysm of 9.5 cm diameter, in a 75 years old woman, who consulted for vertiginous syndrome, with incidental finding to the physical examination of pulsatile abdominal mass, confirmed by angiotomography of abdomen and pelvis. Materials and Method: Clinical record of a patient undergoing open surgical repair of a giant splenic aneurysm. Results: By laparotomy, anterior approach, the ligation of the aneurysm is performed with partial resection of the aneurysm sac plus splenectomy, evolving without complication at 12 months of follow-up. Discussion: The splenic artery aneurysm, is defined at any dilatation greater than 1 cm in diameter, it is surgically indicated when they measure more than 2 cm and called giant from 5 cm. Conclusion: Splenic artery aneurysm is a uncommon condition, usually asymptomatic, but potentially fatal especially in pregnant women, in the literature there are only 78 reported cases of giant splenic artery aneurysms, expedited surgical resolution is recommended.

Laparoendoscopic Single Site Surgery for the Treatment of Huge Ovarian Cysts Using an Angiocatheter Needle

PURPOSE: The aim of this study was to evaluate the feasibility and safety of laparoendoscopic single site (LESS) surgery using an angiocatheter needle in patients with huge ovarian cysts (diameter ≥15 cm). MATERIALS AND METHODS: Thirty-one patients with huge ovarian cysts underwent LESS surgery using an angiocatheter needle between March 2011 and August 2016. An intra-umbilical vertical incision (1.5–2.0 cm) was made in the midline. After the cyst wall was punctured using an angiocatheter needle, the fluid contents were aspirated with a connected vacuum aspirator. After placing a Glove port in the umbilical incision, LESS surgery was performed using a rigid 0-degree, 5-mm laparoscope and conventional, rigid, straight laparoscopic instruments. Knife-in-bag morcellation was instituted for specimen collection. RESULTS: The median maximal diameter of ovarian cysts was 18 cm (range, 15–30 cm), the median operation time was 150 minutes (range, 80–520 minutes), and the median volume of blood loss was 100 mL (range, 20–800 mL). Three patients (9.7%) were diagnosed with malignant ovarian cancer using intraoperative frozen examination, and 1 patient was converted to laparotomy due to advanced disease. Thirty patients underwent LESS, and there was no need for an additional laparoscopic port. CONCLUSION: LESS surgery using an angiocatheter needle, with leaving only a small postoperative scar, was deemed feasible for the management of huge ovarian cysts.

Rare huge serous cystadenoma of broad ligament: A case report and literature review / 吉林大学学报(医学版)

Objective: To analyze the clinical data and surgical treatment procedures of a patient vyith rare huge serous cystadenoma of broad ligament, to clarify its diagnostic and treatment characteristics, and to explore the present situation and advantages of laparoscope in the operation of broad ligament tumor. Methods: The patient vyas admitted to hospital due to abdominal distension for 2 years and aggravated ulness for 2 months. The diagnosis result vyas pelvic and abdominal mass arising from ovarian according to the preoperative color Doppler ultrasound and physical examination. Based on the laparotomy and intraoperative rapid pathological results, the patient was diagnosed as huge serous cystadenoma of broad ligament. The location of ureter and uteri artery and vein were carefully identified during the operation and they were ligated for hemostasis at the basal part of tumor. The operation was successful Results: The ultrasonography image of the huge serous cystadenoma of broad ligament was very similar to that of large ovarian tumor. The misdiagnosis rate of ultrasound was high, and CT and MRI were important for the identification of large broad ligament tumor; the accuracy rate of preoperative diagnosis could be improved by CT and MRI Carefully blunt separation close to the tumor surface during the operation could avoid the ureteral injury. The patient recovered well and discharged from hospital. Conclusion: The symptoms of huge serous cystadenoma of broad ligament patient are lack of specificity. The accuracy rate of preoperative diagnosis should be improved in combination with the medical history and imageological findings of the patient The operation plan should be chosen reasonably and the operation should be carefully performed to avoid the occurrence of secondary injuries.

Successful airway management with combined use of McGrath® MAC video laryngoscope and fiberoptic bronchoscope in a severe obese patient with huge goiter: a case report / 대한마취과학회지

Huge goitor can lead to tracheal compression and hence difficulty in intubation. This is compounded by severe obesity. Failed tracheal intubation in difficult intubation is a serious event that may lead to increased patient morbidity and mortality. Current intubation rescue techniques and combination of different rescue techniques may increase the success rate of difficult intubation. In a 47-year-old female patient, with severe obesity and a huge goiter, our attempts at intubation using direct laryngoscope, video laryngoscope, and awake fiberoptic bronchoscope had failed. We succeeded by applying video laryngoscope to improve visualization of the airway and fiberoptic bronchoscope as a stylet for endotracheal tube.

Analysis of two cases of huge adrenal tumor / 基础医学与临床

Objective To investigate the clinicopathological characteristics, diagnosis and treatment of huge adrenal tumor.Methods Retrospectively analysed the clinical data of the 2 patients with huge adrenal tumor more than 10 cm in diameter, who were admitted in our hospital from September 2013 to January 2015.Clinical manifestations, treatment and prognosis were evaluated.Results Two patients were both suspected of adrenocortical carcinomas.Case 1 was a 28-year-old female.Laparoscopic surgery was performed at first but was conversed to open palliative adrenalectomy due to tumor rupture and bleeding.The postoperative pathology was adrenocortical carcinoma.The patient died of gastrointestinal bleeding caused by tumor metastasis 10 months later.Case 2 was a 39-year-old female, who underwent laparoscopic adrenolectomy with tumor excision completely.The postoperative pathology showed neoplasm of malignant potential, and no tumor recurred in 15 months follow-up.ConclusionsOpen surgery should be the priority if the diameter of adrenal tumor is more than 10 cm and diagnosis as suspicious of malignancy.Huge adrenocortical carcinoma is related to poor therapeutic response,and multimodality therapy may improve the prognosis.

Application value of the preoperative multi-slice spiral computed tomography for the repair of huge abdominal incisional hernia / 中华消化外科杂志

Objective To explore the application value of the preoperative multi-slice spiral computed tomography (MSCT) for the repair of huge abdominal incisional hernia.Methods The retrospective crosssectional study was conducted.The clinical data of 61 patients with huge abdominal incisional hernia who were admitted to the Xinjiang Uygur Autonomous Region People's Hospital from January 2012 to February 2016 were collected.All patients underwent preoperative MSCT and three-dimensional reconstruction to measure the percentage of volumes of the hernia sac and abdominal cavity and then selected the individualized surgical methods according to the percentage,and length of small intestine resected was calculated in patients undergoing initiative volume reduction combined with onlay repair.Observation indicators:(1) pre-and post-operative situations:percentage of volumes of the hernia sac and abdominal cavity,duration of preoperative hospital stay,surgical procedure,length of small intestine resected in patients undergoing initiative volume reduction combined with onlay repair,operation time and volume of intraoperative blood loss;(2) postoperative recovery situation:intraabdominal pressure at postoperative 48 hours,recovery time of postoperative gastrointestinal function,removal time of postoperative abdominal drainage-tube,postoperative complications and duration of postoperative hospital stay;(3) follow-up.Follow-up using outpatient examination and telephone interview was performed to detect the postoperative hernia recurrence and long-term complications up to March 2017.Measurement data with normal distribution were represented as (x)±s and measurement data with skewed distribution were described as M (range).Results (1) Pre-and post-operative situations:percentage of volumes of the hernia sac and abdominal cavity in 61 patients was 19％ ± 4％,and duration of preoperative hospital stay was (7 ± 5) days.All the 61 patients underwent successful operation,including 48 receiving onlay repair and 13 receiving initiative volume reduction combined with onlay repair,without conversion to other surgery.Length of small intestine resected in 13 patients undergoing initiative volume reduction combined with onlay repair was (48±8)cm.Operation time and volume of intraoperative blood loss in 61 patients were (2.6 ± 0.8) hours and (82± 50) mL.(2) Postoperative recovery situation:intra-abdominal pressure at postoperative 48 hours,recovery time of postoperative gastrointestinal function and removal time of postoperative abdominal drainage-tube in 61 patients were (9.6 ± 2.9) mmHg (1 mmHg=0.133kPa),(2.1 ± 0.9) days and (3.5 ± 1.1) days,respectively.Twelve patients had postoperative complications,and grade Ⅰ intra-abdominal hypertension,grade Ⅱ intra-abdominal hypertension,incisional effusion,incisional infection,incisional sinus,mesh infection and urinary retention were respectively detected in 4,2,4,2,1,1,1 in patients undergoing the onlay repair and 2,1,1,0,0,0,0 in patients undergoing initiative volume reduction combined with onlay repair.Some patients had 2 or more of complications.There was no occurrence of abdominal compartment syndrome and perioperative death.Patients with complications were cured or improved by symptomatic treatment.Duration of postoperative hospital stay in 61 patients was (8±4)days.(3) Follow-up:all the patients were followed up for 6-36 months,with a median time of 19 months.During follow-up,2 patients with recurrence of huge abdominal incisional hernia received tentative follow-up,and were suggested to treat risk factors of recurrence firstly and then undergo reoperations.Other patients didn't have long-term complications.Conclusion MSCT can provide the accurate data of percentage of volumes of the hernia sac and abdominal cavity before repair of huge abdominal incisional hernia,it also has the important clinical value of choosing the individualized surgical method,preserving the maximum out of normal organs in initiative volume reduction combined with onlay repair and increasing surgical outcomes.

Application value of three-dimensional visualization technology in the resectability assessment and surgical planning for huge hepatic carcinoma / 中华消化外科杂志

Objective To investigate the application value of three-dimensional (3D) visualization technology in the resectability assessment and surgical planning for huge hepatic carcinoma.Methods The retrospective cross-sectional study was conducted.The clinical data of 48 patients with huge hepatic carcinoma who were admitted to the Zhujiang Hospital of Southern Medical University between January 2012 and June 2015 were collected.The preoperative image of computed tomography (CT) was converted to 3D reconstruction,visual observations and simulated surgery for assessing the tumor resectability through MI-3DVS,and corresponding treatments were performed according to the results of assessment.Observation indicators:(1) 3D reconstruction situations;(2) tumor resectability assessment through simulated surgery:tumor diameter,tumor volume,preoperative standard liver volume (SLV),tumor-free liver volume after simulated resection,future liver remnant (FLR) after simulated resection,hepatic resection rate (HRR);(3) surgical and postoperative situations:surgical procedures,resection extent,operation time,volume of intraoperative blood loss,complications,duration of postoperative hospital stay;(4) typical case analysis;(5) follow-up.Follow-up using outpatient examination and telephone interview was performed to detect the survival of patients and tumor recurrence or metastasis up to June 2016.Measurement data with normal distribution were represented as(-x) ± s.Results (1) Three-D reconstruction situations:48 patients with huge hepatic carcinoma received successful 3D reconstruction and visual observations.Portal vein branches and hepatic vein branches reached level 4 through 3D reconstruction,and spacial position relationship between tumor and intrahepatic vascular backbones or branches can be clearly observed,as well as location and degree of vascular compression and invasion.(2) Tumor resectability assessment through simulated surgery:of 48 patients receiving simulated hepatectomy,26 underwent hepatectomy and 22 didn't undergo hepatectomy based on the assessment of resectability.Tumor diameter,tumor volume,preoperative SLV,tumor-free liver volume after simulated resection,FLR after simulated resection and HRR through assessment of 3D reconstruction and simulated surgery were (12.3-± 2.0) cm,(838 ± 284) mL,(1 884 ± 391) mL,(494 ± 140) mL,(551 ± 184) mL,46％ ± 12％ in 26 patients with resectable tumor and (14.0 ± 2.0) cm,(1 877 ± 1 240) mL,(2 945 ± 1 194) mL,(666 ± 206) mL,(402 ± 86) mL,62％ ± 9％ in 22 patients with unresectable tumor,respectively.(3) Surgical and postoperative situations:26 patients with resectable tumor underwent hepatectomy,without occurrence of death.Of 26 patients,21 underwent anatomic hepatectomy,including 12 undergoing right hemihepatectomy,3 undergoing left hemihepatectomy,2 undergoing right lobectomy of the liver,2 undergoing right posterior lobectomy of the liver,1 undergoing left lobectomy of the liver and 1 undergoing resection of hepatic segment Ⅴ + Ⅵ.And 5 underwent non-anatomic hepatectomy,including 2 with reduced right hemihepatectomy,1 with resection of hepatic segment Ⅱ + Ⅲ and partial segment Ⅳ,1 with resection of hepatic segment Ⅵ + Ⅶ and partial segment Ⅴ and 1 with resection of hepatic segment Ⅴ + Ⅵ and partial segment Ⅶ.Operation time and volume of intraoperative blood loss in 26 patients were respectively (6.4 ± 1.3) hours and (712 ±633)mL.Three patients with postoperative pleural effusion and 1 with postoperative bile leakage were cured by symptomatic treatment,without the occurrence of hepatic dysfunction.Duration of postoperative hospital stay was (19 ± 8) days.Of 22 patients with unresectable tumor,14 underwent transcatheter hepatic arterial chemoembolization (TACE),4 underwent portal vein ligation,1 underwent portal vein embolization and 3 abandoned treatment.(4) Typical case analysis:results of 3D reconstruction through MI-3DVS showed that patients underwent portal vein right anterior branch-preserving expanded right posterior lobectomy of the liver,with a smooth recovery.Patients were followed up for 14.0 months,with a good survival and without tumor recurrence and metastasis.(5) Follow-up:40 of 48 patients were followed up for 6.0-33.0 months with a median time of 13.0 months,including 26 with surgery and 14 without surgery.During the follow-up,the median survival time of patients with and without surgery was 20.0 months and 10.5 months,respectively.Twelve patients with surgery had tumor recurrence and metastasis.Conclusion Three-dimensional visualization technology is safe and feasible in the resectability assessment and surgical planning for huge hepatic carcinoma,and it will benefit to reduce risk of surgery.

The value of three-dimensional medical imaging guided ultrasound in the treatment of huge hepatic hemangioma / 中华医学超声杂志（电子版）

Objective To evaluate the clinical application value of three-dimensional medical image guided ultrasound in the chemotherapy of huge hepatic hemangioma.Methods Seventy-six cases were enrolled in a randomized control study.All cases were randomly divided into two groups (group A and group B).In group A,all cases underwent treatment based on the traditional two-dimensional medical images.Under the assistance of three-dimensional medical image information,preoperative treatment planning was performed in group B.After puncture treatment,therapeutic efficacy was evaluated by color ultrasound during follow-up.Results For treating huge hepatic hemangioma (tumor diameter ≥ 10.0 cm),the insertion number and pingyangmycin dosage in the group B were less than those in the group A [(6.2± 0.5)times vs (9.3±0.6) times,t=24.467,P=0.035;(99.2±8.0) mg vs (148.8±9.6) mg,t=34.613,P=0.029].The success rate of first treatment in the group B was higher than that in group A [73.6％(28/38) vs 100％(38/38),x2=131.91,P=0.032].Conclusion For huge hepatic hemangioma,the three-dimensional medical image information can be applied to reduce the insertion number and anesthetics dosage,improving the success rate of first treatment and therapeutic effect.

Stormy Course of a Huge Submitral Aneurysm Causing Low Cardiac Output State

Submitral aneurysm is a rare structural abnormality of congenital or acquired aetiology. Most reported cases are from Africa. Unless promptly treated surgically this condition is invariably fatal. We report a case of a young Indian male who presented with dyspnea of recent onset, diagnosed to have a massive submitral aneurysm causing low cardiac output and compression of cardiac structures.

Mioma cervical gigante en adolescente / Giant cervical myoma in an adolescent

Se reporta el caso de una paciente de 13 años con presencia de una masa perineal que protruía a través del introito, cuya patología correspondió a un leiomioma cervical polipoideo gigante. Se realizó miomectomía vaginal con buena evolución. El objetivo de esta comunicación es presentar un caso clínico de baja frecuencia.

We report the case of a patient of 13 years old, who presented with a bulky perineal mass expelled from the introitus. It was a huge prolapsed cervical leyomioma. We performed a vaginal myomectomy with a good outcome. The aim of this report was to present a clinical case of low occurrence.

Surgical management of huge pelvic tumor: a report of 56 cases / 中华消化外科杂志

Objective To investigate the surgical management of huge pelvic tumor.Methods The clinical data of 56 patients with huge pelvic tumor who were admitted to the Cancer Hospital of Henan Province from February 2005 to January 2012 were retrospectively analyzed.Tumor resectability was assessed via enhanced computed tomography or three-dimensional reconstruction,and the tumors were freed and resected by combination of muliiple surgical approaches.All the patients were followed up via telephone or re-examination at the out-patient department to learn the recurrence and metastasis of tumor.The survival rate was calculated using the life table.Results Fifty patients received preoperative computed tomography examination,and the imaging data of 6 patients were three-dimensionally reconstructed.Preoperative evaluation showed that 49 patients needed combined multivisceral resection,5 needed tumor resection,and the tumors of 2 patients were unresectable.Fourteen patients were diagnosed preoperatively,and 8 patients were diagnosed by intraoperative rapid frozen section examination,and the rest 34 patients were diagnosed by postoperative pathological examination.The surgical approaches including anterior median sacral approach combined with transperineal coccyx anterior approach (21 patients),anterior median sacral approach (11 patients),obturator approach (8 patients),retropubic approach (8 patients) and obturator approach combined with transperineal approach of coccyx (8 patients).Tumor and rectum resection was carried out on 18 patients,tumor and partial bladder resection on 12 patients,tumor,uterus and ovariectomization on 12 patients,tumor,part of the small intestine and colorectal resection on 10 patients,tumor and total pelvic exenteration on 4 patients.In all the 56 patients,53 achieved R0 resection,2 cases reached naked eye clean,1 case had residual tumor.The mean operation time was 100 minutes.Fifty patients recovered uneventfully.Six patients had postoperative complications,including 3 patients with intestinal obstruction (2 patients were cured by conservative treatment,and 1 patient was cured by surgery),2 patients with pelvic infection and 1 patient with colostomy hernia,and they were cured by drainage and nutritional support.One patient died of postoperative myocardial infarction.The results of postoperative pathologic study showed that 25 patients were with adenocarcinoma,16 with sarcoma and 15 with gastrointestinal stromal tumor.Forty-seven patients were followup to December 2012,and the 5-year survival rate was 26.7％ for patients with adenocarcinoma,18.9％ for patients with sarcoma,and 52.6％ for patients with gastrointestinal stromal tumor.Conclusion Preoperative assessment of resectability of huge pelvic tumor can reduce unnecessary laparotomy and improve the safety of operation.

Prognostic factors of survival in patients with huge hepatocellular carcinoma after hepatectomy / 中华肝胆外科杂志

Objective To analyze the prognostic factors of survival in patients with huge hepatocel lular carcinoma (HCC) who underwent hepatectomy with a view to improve treatment efficacy.Methods A retrospective study was conducted on 124 patients with huge hepatocellular carcinoma who underwent hepatectomy for HCC from January 2004 to December 2010 in our hospital.Univariate and multivariate analyses were performed using statistical software (SPSS 19.0 for Windows) to identify independent prognostic factors.Results The cumulative 1-,3-and 5-year survival rates of the 124 patients were 65.1％,35.8％ and 25.1％ respectively.The mean survival and the median survival were 34.7 and 26.0 months respectively.In the 65 patients who underwent curative resection,the 1-,3-and 5-year disease-free survival rates were 40.2％,19.3％ and 7.1％ respectively.The mean disease-free survival and the median disease-free survival were 18.6 and 9.0 months respectively.Univariate analysis showed HBsAg,tumor capsule,liver cirrhosis,vascular invasion,tumor rupture,intrahepatic metastasis,curative resection and BCLC staging significantly affected postoperative survival(P ＜ 0.05).The Cox multivariate analysis indicated HBsAg,liver cirrhosis,curative resection and intrahepatic metastasis were independent prognostic factor (P ＜ 0.05).Conclusions Intrahepatic metastasis,liver cirrhosis and HBsAg were prognostic factors influencing survival outcome of huge HCC in patients after hepatectomy.Improving curative resection rate of huge HCC significantly extended survival for these patients.

A Case of the Huge Ethmoid Osteoma Involving the Skull Base and Orbit

Osteoma is a slow-growing benign tumor that consists of mature or cancellous bone. It most commonly occurs in the frontoethmoidal area of the paranasal sinus and is usually asymptomatic. Surgical excision is necessary for osteoma, which causes symptoms such as headache, nasal obstruction, facial asymmetry, and visual disturbance. Surgical approaches should also be considered depending on the size and location of the osteoma, in order to reduce intracranial and orbital complications. We recently treated a huge frontoethmoid osteoma involving the skull base and orbit, which was removed via endoscopic sinus surgery and a combined extracranial approach. Herein, we report this case with a review of the relevant literature.

The surgical approach in huge scrotal lymphedema.

Giant Scrotal Lymphoedema is a rare disease. Such Scrotal elephantiasis presents multiple problems both to the patient as well as the treating clinician obstruction, aplasia, or hypoplasia of the lymphatic vessels. The most common cause worldwide is lymphatic Filariasis. A case where the resected scrotal tissue weighed 30kg which is one of the largest so far mentioned in literatures. The lymphedema was progressive over 15 year’s duration and the testes were not palpable with the penis deeply buried. There is no effective medical treatment for filariasis. There are different surgical methods for scrotal filariasis in the literature. In this case, the patient was treated by Modified Charles procedure. Once fibrosis sets in resectional therapy will be needed in most cases. Successful reduction scrotoplasty with acceptable cosmetic results can be obtained in giant scrotal lymphedemas weighing as large as 30kg as in this case.

Interventional heated chemotherapy for moderate and advanced huge primary hepatocellular carcinoma / 局解手术学杂志

Objective To explore the effects of the therapeutic effects of interventional heated chemotherapy( IHC) for moderate and advanced huge primary hepatocellular carcinoma and compare with transcatheter arterial chemoembolization( TACE) . Methods The 68 pa-tients with moderate and advanced huge primary hepatocellular carcinoma accepted the treatment of IHC were considered as the observation group,and 32 patients managed TACE were regarded as the control group. The therapeutic effects,living quality,secondary surgery rates,The reduced level of serum AFP,survival rate,and toxic side effects of 2 groups were contrasted. Results The effective rate of observation group was obviously higher than that of control group (79. 4% vs 56. 3%,P <0. 05),and secondary surgery rates was increased(70. 6% vs 43. 8%,P<0. 01). The ratio of increased Karnofsky score was more than 20 in observation group,which was obviously higher than that of control group(35. 3% vs 12. 5%,P<0. 01). T The reduced level of serum AFP was more than 50% in observation group,which was higher than that of control group (52. 9% vs 25. 0%,P<0. 01). The survival rate of 12,18,24 months after treatment in control group was in-creased than that in control group individually (P<0. 01). Conclusion IHC is effective for huge primary hepatocellular carcinoma and in-creases the secondary surgery rates,which is one of the safe and effective methods for huge primary hepatocellular carcinoma.

Surgical resection of huge non-hepatic tumors in the right upper quadrant of abdomen / 中华肝胆外科杂志

Objective To study the pathology and treatment of huge nonhepatic tumors in the right upper quadrant of abdomen.Methods The clinical data of 9 patients with huge nonhepatic tumor in the right upper quadrant of abdomen treated surgically at our hospital from May 2004 to December 2009 were retrospectively analyzed.Results Preoperative imaging failed to define the tumors as nonhepatic in original in 7 patients and operation failed to recognize the origin of the tumors in 2 patients.All the tumors were successfully resected,with combined hemigastectomy in 1 patient,partial resection of the lateral wall of the infrahepatic vena cava in 2,complete resection of adipose capsule of the right kidney in 2,pancreatoduodenectomy plus transverse colectomy in 1,and transection of pancreatic duct of the body and tail of the pancreas and pancreaticojejunostomy in 1.The median operation time was 390 min (318-660 min).The median intraoperative blood loss was 2560 ml (400-6000 ml).The median intraoperative blood transfusion was 2450 ml (0 -5250 ml).The average diameter of the resected tumor was 14.5 cm (11-30 cm),and the average tumor weight was 2465 g (960-5100 g).Postoperative pathological diagnoses showed that 8 patients had malignant tumors and 1 had a potentially malignant and undifferentiated tumor (solid pseudopapillary tumor of pancreas).Perioperative pancreatic anastomotic leak occurred in 1 patient,and there were no severe postoperative complications and operative death in this series.Tumor recurrence was detected 5 months following operation in 1 patient.The 1,2-,3-year survival rates were 100％,56％,33％,respectively.One patient survived for more than 5 years.Conclusions Huge non-hepatic tumors in the right upper quadrant of abdomen could easily be misdiagnosed as hepatic neoplasms.The surgical resection rate was high.The prognosis for patients who received resectional treatment was satisfactory.