In-hospital mortality and influential factors of hip arthroplasty in older adult patients / 中国基层医药

Objective:To analyze the in-hospital mortality and influential factors of total hip arthroplasty (THR) in older adult patients.Methods:A total of 130 older adult patients subjected to THR in Department of Orthopedics, Huzhou Linghu People's Hospital between August 2019 and August 2021 were included in this study. In-hospital mortality was calculated. These patients were divided into death and survival groups according to whether they were dead or alive. Sex, age, smoking, drinking, disease type, complications, cardiovascular disease history, operation severity score, operative time, amount of intraoperative blood loss, postoperative osteoporosis treatment and postoperative rehabilitation training were compared between the two groups. The risk factors that influence in-hospital mortality were analyzed using logistic analysis method.Results:Among 130 patients, 9 patients died in Huzhou Linghu People's Hospital, with the mortality of 6.92%. Thus, there were 9 patients in the death group and 121 patients in the survival group. There were significant differences in age, smoking, complications, operation severity score and postoperative osteoporosis treatment between the two groups ( t = 1.70, χ2 = 5.48, χ2 = 4.09, t = 2.86, χ2 = 4.03, all P < 0.05). Multivariate logistic analysis showed that the age (≥ 85 years old), smoking (yes), complications (≥ 3), operation severity score (≥ 15 points) were the risk factors that influence in-hospital mortality. Postoperative osteoporosis treatment was the protective factor of THR. Conclusion:The in-hospital mortality of older adult patients after THR is high. Age ≥ 85 years old, smoking, complications ≥ 3, and operation severity score ≥ 15 are the risk factors of THR and may greatly affect the prognosis. More attention should be paid to older adult patients who have these risk factors.

Perimembranous ventricular septal defect performed minimally invasive transthoracic device closure of ventricular septal defect / 中华胸心血管外科杂志

Objective To analyze retrospectively the therapeutic effect and safety of minimally invasive transthoracic device closure of perimembranous ventricular septal defect (PVSD).Methods One hundred and twenty-nine patients with PVSD from January 2011 to December 2011 in our hospital were selected and a 3 to 5 cm incision was made in the inferior sternum,which performed minimally invasive transthoracic device closure of ventricular septal defect (VSD).Right ventricular free wall was punctured and guided by transthoracic echocardiography (TEE),and then the occluder was released after a delivery sheath passed through the VSD.Location of occluder,effect on heart valve,fastness and residual shunt were evaluated by TEE instantly during operation.All patients were followed up intimately after operation,echocardiogram and electrocardiogram were rechecked regularly.Results One hundred and fourteen cases were successfully occluded.Fifteen cases were performed VSD repair operation with cardiopulmonary bypass.The amounts of concentric occluder and eccentric occluder were 96 and 20,respectively.The patients performed minimally invasive transthoracic device closure of VSD had no severe complications after operation.Conclusion Although the short-term therapeutic effect of minimally invasive transthoracic device closure of PVSD is definitely and has favourable prospect of application,the long-term follow-up remains to be studied.

Efeito do extrato hidroalcoólico de Aroeira (Schinus terebinthifolius Raddi) na cicatrização de anastomoses colônicas. Estudo experimental em ratos / Schinus terebinthifolius Raddi and it's influence in the healing process of colonic anastomosis. Experimental study in rats

INTRODUÇÃO: A cicatrização é evento biológico complexo envolvendo inflamação, quimiotaxia, proliferação celular, diferenciação e remodelação. Na medicina popular brasileira, utiliza-se a Aroeira para tratar as mais diversas situações patológicas No Estado do Maranhão - Brasil, a Aroeira é extensivamente utilizada no tratamento de afecções do aparelho respiratório, digestivo e ginecológico. As anastomoses intestinais sempre foram motivo de preocupação para cirurgiões e constituem, até hoje assunto polêmico e repleto de controvérsias. Entre as causas de insucesso da anastomose intestinal destacam-se as fístulas e deiscências. OBJETIVO: Avaliar o efeito do extrato hidroalcoólico de Aroeira (Schinus terebinthifolius Raddi) no processo de cicatrização de anastomoses colônicas em ratos. MÉTODOS: Foram utilizados 40 ratos da linhagem Wistar divididos em dois grupos (grupo Aroeira e grupo controle), aleatoriamente, composto de 20 animais cada, de acordo com o tratamento recebido (extrato da Aroeira ou solução salina a 0,9%) após a anastomose, e subdividiu-se cada grupo em dois subgrupos (C3 e C7 e A3 e A7,) de acordo com o dia de eutanásia (ao 3º e 7º dias). As variáveis utilizadas para mensuração foram: análise macroscópica, microscópica e tensiométrica. As interações entre os grupos foram analisadas pelo teste não-paramétrico de Mann-Whitney. RESULTADOS: Quanto ao grau de adesão, não foi observado diferença significativa entre os grupos Aroeira e controle tanto no 3º quanto no 7º dia. Quando se comparam os subgrupos do ponto de vista microscópico no 3º dia, a diferença entre o grupo que recebeu o extrato da Aroeira e o grupo controle foi significativa nas variáveis congestão (p = 0,005), polimorfonucleares (p = 0,034), mononucleares (p = 0,023), proliferação fibroblástica (p = 0,023) e na fase de cicatrização (p = 0,001). Na análise do 7º dia, todas as variáveis da análise microscópica foram significativas o que levou a 100% dos ratos do grupo Aroeira apresentarem inflamação crônica contra 20% do grupo controle. Em relação ao teste de pressão de ruptura, não houve diferença estatisticamente significante entre os grupos controle e Aroeira. CONCLUSÃO: Observou-se efeito favorável da Aroeira, a nível microscópico, no processo de cicatrização de anastomoses de cólon.

INTRODUCTION: The healing is a complex biological event that involves inflammation, chemotaxis, cells proliferation, differentiation and remodelation. In Brazilian popular medicine, the "Aroeira" is used to treat different situations The anastomotic healing is always a preoccupation among surgeons. The fail in intestinal anastomosis leads to fistulas and dehiscences. PURPOSE: To evaluate the effect of the hidroalcoholic extract of Schinus terebinthifolius Raddi (brazilian peppertree) in the healing of colonic anastomosis. METHODS: Forty Wistar rats were randomly divided in two groups (Aroeira and control), each one with 20 animals, according to the treatment received after the anastomosis (Aroeira extract or saline solution 0,9%) and each group was divided in two subgroups (C3 and C7 and A3 and A7,) according to the euthanasia day (at 3rd and at 7th). The macroscopic, microscopic and bursting pressure measurements were performed. To evaluate the groups, the non-parametric test of Mann-Whitney was applied. RESULTS: In the macroscopic aspects, there was no significant difference between the Aroeira and the control group, both at the 3rd and the 7th days. When compared the subgroups of microscopic analysis at the 3rd day, the difference between the Aroeira and the control group was significant in the variables congestion (p = 0,005), polymorphonuclears (p = 0,034), mononuclears (p = 0,023), fibroblastic proliferation (p = 0,023) and at the healing stage (p = 0,001). At the 7th day analysis, the difference between the Aroeira and the control group was significant in all the variables of microscopic analysis. No significant differences were found in the bursting pressure.

Study on The Surgical Treatment of 89 Hepatolithiasis Patients / 医学研究杂志

Objective To explore the effective therapeutic methods for hepatolithiasis.Methods We retrospectively analyzed the clinical material of 89 hepatolithiasis patients who underwent surgical therapy.Among the 89 patients,53 patients were treated with T-tube drainage(including 3 patients with left hepatic lobe or quadrate lobe resection),and 36 patients were treated with bile duct-intestinal anastomosis(including 6 patients with left hepatic lobe or quadrate lobe resection).Results Recurrence rate of postoperative angiocholitis in the two groups was 50.0% and 22.2% respectively,and the reoperation rate was 28.0% and 8.3% respectively.Conclusion The key to prevent recurrent angiocholitis and reduce the reoperation rate is to relieve biliary tract stricture,remove the focus of infection and provide unobstructed bile duct drainage.

The Double Stapling Technique for Sphincter Preservation Operation in mediate-low Rectal Carcinoma / 医学研究杂志

Objective To evaluate the effect of double stapling technique for sphincter preservation operation in mediate-low rectal carcinoma.Methods The resection through double stapling technique for sphincter preservation approach was performed on 30 patients with mediate-low rectal carcinoma from January 2004 to November 2007.The distance between the anal verge and the lower margin of the tumor was 4～8cm(averaged 6.5 cm),including 22 patients in Dukes A stage,6 Dukes B and 2 Dukes C.Results Fecal continences were preserved successfully in all patients.2 cases had got anastomotic narrowing(6.6%) after operation.At a median follow-up of 46 months,two patients had local recurrences(6.6%).There was no urinary dysfunction in this series.Conclusion Double stapling technique for sphinceter preservation operation was feasible and safe,provide a original operative style for mediate-low rectal carcinoma.

Treatment of Trichiasis and Districhiasis with Ellman Dento-Surg 90FFP

PURPOSE: To evaluate the efficacy of the Ellman Dento-Surg 90FFP for the isolated trichiasis or distichiasis. METHODS: 61 eyelashes of 23 patients, who were diagnosed as trichiasis or distichiasis and had less than 5 aberrant cilia that were isolated, were treated with the Ellman Dento-Surg 90FFP. At 1 week, 1 month, 2 month and 6 month postoperatively, we examined the success rate and postoperative complication. RESULTS: Fifteen eyelashes of 9 patients were regrown after mean 1.3month follow-up period (75.4% success rate). Among 10 eyelashes of 6 patients, 2 eyelashes of 2 patients were regrown (80% success rate). Thirteen patients experienced mild burning sensation 1-2 days postoperatively. Eyelid notching was observed in 2 patients. CONCLUSIONS: High frequency radio wave electrosurgery with Ellman Dento-Surg 90FFP is a simple and secure procedure with high success rate and negligible complication, and can be effectively used to treat isolated trichiasis or distichiasis.

Computer tomograghy study on periodontal patients with anterior displaced teeth before and after combined orthodontic-periodontal treatment / 北京大学学报(医学版)

Objective:To evaluate evaluation of the changes of alveolar bone height in the periodontal patients with anterior teeth displacement before and after combined orthodontic periodontal treatment with circumferential fibrotomy. Methods: Totally 16 periodontal patients with anterior displaced teeth were analyzed after random clinical trialed as groups with and without circumferential fibrotomy of involving teeth followed by orthodontic intrusion. Evaluations of the changes of alveolar bone were given before and after treatment by means of periapical X ray film and CT scan of the involving teeth. Results: Orthodontic treatment with circumferential fibrotomy can increase the height of crest bone. Alveolar bone height was increased in the patients with circumferential fibrotomy followed by orthodontic intrusion of displaced anterior teeth. Alveolar bone height was increase by 1.2 mm on average in circumferential fibrotomy patient. In the patients with symmetric alveolar bone loss, 0.8 mm increase of alveolar bone height was observed following treatment. For the patients with asymmetric alveolar bone loss, 0.9 mm increase of alveolar bone height was detected in mild bone loss patients, but 1.4 mm and 2.2 mm increase of alveolar bone height were found in moderate and severe bone loss patients, respectively. For patients having the orthodontic treatment without circumferential fibrotomy, the alveolar bone height was increased by 0.1 mm only. Statistic significance was found between the circumferential fibrotomy group and non fibrotomy group. Conclusion: Combined orthodontic periodontal treatment with circumferential fibrotomy could correct the malpositioned teeth, and improve the periodontium conditions and gain the crest bone.

Surgical treatment of hilar cholangiocarcinoma(a report of 73 cases) / 中国普通外科杂志

Objective　To evaluate the diagnosis and surgical treatment of hilar cholangiocarcinoma(H-CC). Methods　Retrospective analysis was made on the clinical feature, surgical treatment and the effect on 73 patients with H-CC. Results　Diagnosis was made in all of the patients preoperatively and the correct diagnostic rate of BUS was 69.9%. In the treatment, radical resection was performed on 15 patients with good results in a short-term period. Of the 43 patients who underwent biliary tract internal drainage or exterrnal drainage, 37 patients had good results in a short-term period, while 6 died after operation. Laparotomy or hepatic artery cannulization with chemotherapy was performed on 15 patients and no change occurred in a short-term period after operation. In 15 cases subjected to radical resection, 11 cases were followed up. The 1,3-year survival rates was 90.9%, 20.0% respectively, but none of the patients survived for over 5 years. In patients undergoing other operations, none survived more than 9 months. Conclusions　It's still difficult to mak early diagnosis of H-CC, which mainly depends on imaging technics. The BUS should be choiced first. Radical resection rate is still low nowadays. The lobus quadratus resection is helpful to select the operation.

Clinical analysis on 4200 cases of minielectrocholecystectomy / 中国普通外科杂志

Objective　To study the effect of minielctrocholecystectomy(MEC) for gallbladder stone. Methods　The clinical data of 4,200 cases(1991-2000) undergoing MEC were analysed restrospectively; the results of different operotors for the MEC were compared. Results　All 4,200 cases were cured. Of them, 41 cases(0.98%) had serious complications, including intraoperative bleeding in 4 cases(0.09%), biliary tract injury in 18(0.43%); stress ulcer in 8(0.19%), and residual stones of biliary tract in 11(0.26%). Conclusions　MEC has the following advantages: less trauma, short operation time, fast postoperative recovery and lower expense. The different operotors on MEC have distinguish difference in the results. It is important to preven the complications of MEC.

Diagnosis and treatment of the extrahepatic bile ducts carcinoma / 中国普通外科杂志

Objective　To summarize the methods of diagnosis and operation of carcinoma of the extrahepatic bile ducts. Methods　The clinical data of 100 cases of carcinoma of the extrahepatic bile ducts which were treated in our hospital from 1972 to 1999 were retrospectively analysed. In this series, there were 68 cases of the cancer located in the upper portion of exlrahepatic duct(proximal cancer), 12 in midder portion(midder cancer), 18 in lower portion(distal cancer), and 2 in whole bile duct. Results　The initial symptom was upper abdominal discomfort or vague pain, abdominal distension, weakness, weight loss and progressive jaundice. BUS, CT and MRI were scatheless. If the intrahepatic bile duct dilatation or extrahepatic cholestatic jaundice were revealed, PTC(13 cases in this series) or ERCP(42 cases in this series) were to further determine the location of tumor. According to the position and type of the tumor, the different operations were selected. Twenty-five cases(36.8%) of the proximal cancer were resected, including 15 cases of type Ⅰ treated with localresection or “skeletonization” resection, 9 cases of type Ⅱ treated with resection of the tumor and caudate lobe, 1 case of type Ⅲb treated with resection of the tumor, caudate lobe and left hepatic trisegmentectomy. Nine cases(75%) of midder cancer were resected. After resected the proximal and midder cancer, bile duct reconstruction by Roux-en-Y hepaticojejunostomy was performed on all the cases. Fourteen cases(77.8%) of distal cancer were treated by pancreatoduodenectomy. The total resection rate in this series was 48%. Of the cancer resected cases, 35 were followed up, the five-year survival rate was 58%. 32 of the 52 cases without cancer resection were followed up, and all of them died one to one and half year after operation. Conclusions　BUS, CT and MRI are the first selective methods for early diagnosis of the carcinomas of extrahepatic bile duct. If needed, PTC or ERCP should be done because of these methods have more accurate diagnostic value. Surgical resection of the tumor is the only likelihood for effective treatment.

Selection of operation procedures for gallbladder carcinoma / 中国普通外科杂志

Objective　To investigate the operation treatment of gallbladder carcinoma(GBC). Methods The clinical data of 132 patients with GBC from 1980 to 1999 were analysed. Results　The mean age was 55 years and the occurrence sex ratio in female/male was 1.5∶1. Gallstone was found in 80% of the patients, and 87.1% of the GBC were adenocarcinoma. Before December 1990(forward group), simple cholecystectomy were performed on 11 cases, radical cholecystectomy on 9 cases, extended radical cholecystectomy on 5 cases, palliative extra- or intra- drainge on 15 cases, surgical biopsy on 30% cases. Hospital death occurred in 4 cases, the postoperative complications occurred in 20 cases including biliary fistula in 4 cases, pancreatic fistula in 2 cases. Since January 1991(latter group), radical simple cholecystectomy were performed on 2 cases, radical cholecystectomy on 16 cases, extended radical cholecystectomy on 24 cases; palliative extra- or intra- drainge in 9 cases, surgical biopsy on 8 cases. Hospital death occurred in 1 cases; postoperative complications in 12 cases, including biliary fistula in 1 cases, pancreatic fistula in 1 cases. Radical resection rate was 35.7% in forword group, 72.6% in latter group. Conclusions　Surgical tech-nique progress and application with Peng's Multifunctional Operative Dissector can improve the resection rate of GBC. Extended redical resection is an effective and active method to treat middle or late stage GBC.

Closed establishment of pneumoperitoneum in patients with peritoneal adhesion in laparoscopic cholecystectomy / 中国普通外科杂志

Objective　To investigate the way of closed establishment of pneumoperitoneum(CEPP) in patients with peritoneal cvity adhesion in laparoscopy cholecystectomy(LC). Methods　CEPP experiences of 1046 patients in 6600 cases LC in our hospital from September 1991 to September 1999 were retrospectively analysed. The difficulty in establishing pneumoperitoneum was divided into two kinds: real establishment pneumoperitoneal difficulty(REPPD) and false establishment pneumoperitoneal difficulty(FEPPD). REPPD was due to Veress needle penetrating into visceral or extensive adhesion in peritoneal cavity resulting in CO2 flowing into difficulty. FEPPD was due to Veress needle pentrating in the fat out of peritoneum, in round hepatic ligament or in greater omentum. The formal situation needed to open laparotomy as a change, and the latter situation could establish pneumoperitoneum successfully by regulating the Veress needle penetrating direction or depth in the second penetration. Results　Of the 1046 patients, 1028 cases had been establishedpneumoperitoneum successfully though CEPP; 6 cases of REPPD and 18 of FEPPD were required opening laparotomy as a change. The successful rate of CEPP was 98.3%. Conclusions　CEPP is a safe and feasible method in patients with peritoneal adhesion in LC. It is the main reason for CEPP failure regarding REPPED as FEPPD made by the deficiency in LC experience and loss confidence in laparoscopist.

Causes and management of reoperation after cholangioenterostomy / 中国普通外科杂志

Objective　To study the causes and management of the reoperation after cholangiointestiostomy(CIS). Methods　A retrospective analysis was made on the clinical data of 28 cases of reoperation after CIS from June 1995 to June 1999. Results　Among the 28 cases, 26 cases(92%) had CIS anastomotic stenosis. Of the 26 cases, 9 cases accompanied with left hepatobiliary duct stenosis, 3 cases with right hepatobiliary duct stenosis, 5 cases with left and right hepatobiliary ducts stenosis. 9 cases with biliary reflux comfirmed by barium meal radiography, all of the 9 cases were subjected to a choleduodenostomy. Of the 28 patients, 3 underwent reanastomose after excision the primary anstomosis, 8 operated with hilar bile duct reform and left lateral hepatolobectomy, 2 with left hepatic duct jejunostomy and hilar bile duct jejunostomy. 15 cases with intrahepatic bile duct jejunal Roux-en-Y anastomosis, after resolved the intrahepatic bile duct stenosis. Conclusions　The basic cause of reoperation after CIS is anastomotic stenosis, the other causes are as follows: the selected operation is unsuitable, the intrahepatic bile duct stenosis is not resolved, and the stonedoes not clean out completly. When reoperation is performed on these cases, the following principles must be abided by: romoving all the stones, resolving the stenosis, making a clear drainage; and performing hepatic lobectomy, anastomotic sustaining and drainage, and cholefibroscopic management must be done if needed.

Treatment of perforated congenital choledochal cyst / 中国普通外科杂志

Objective　To study the diagnosis and treatment of perforated congenital choledochal cyst(PTCC). Methods　The clinical data of 10 children with PTCC were retrospectively analysed.Results　6 males, 4 females, average age 4.5 years old. The cyst perforted time within 12 hours was in 4 cases, 12～72 hours in 3, and more than 72 hours in 3. Of these cases, 2 had infection and the others had no obvious discomfort before perforation. Of 7 cases undergoing cyst excision and biliary reconstruction, 5 cases were recovered without complications; 2 occurred anastomostic leakaged(1 case had infection before perforation and the other with perforcted time more than 72 hours). 3 cases subjected to external drainage at first, and cyst excision and biliary reconstruction were performed on three months later. Conclusions　If PTCC is treated earlier, cyst excision and biliary reconstruction can be performed as a primary operation.

Application of intraoperative cholagngiography in cholecystectomy for gallbladder stone / 中国普通外科杂志

Objective　To study the value of intraoperative cholangiography(IOCG) in cholecystectomy for gallbladder stone. Methods　The IOCG data of 694 cases in the Affiliated Hospital, Yanan University Medical School were retrospectively analysed. Results　Among 694 cases with IOCG, 65 had positve findings. Bile duct stone occurred in 44 patients, residnal stone in cyst duct in 7, bile duct injury in 2, and Mirizzi syndrom in 3. Among the 44 cases with bile duct stone, the age of 4.3% cases was 22～50 years old, 10.3% older than 50 years. The incidence of bile duct stone occurring after 50 years old increased with age. The accurate rate of IOCG was 98% in this series. Conclusions　IOCG can not only find residual stone, but also find bile duct abnormality and bile duct injury in time, if correct imagic technique is applied.

Combined endoscopic treatment for postoperative refractory residual gallstones / 中国普通外科杂志

Objective　To explore a new way of treating refractory residual gallstones by endoscopy. Methods　Choledochfiberscope(CHF) combined with air pressure ballistic lithoclast(APBL) under ureterscopy were used on 28 cases of large or impacted residual gallstones. Results　All refractory stones were crushed and extracted completely in 1-3 times, including sufficient once in 16, twice in 10 and thrice in 2. No severe complications were occurred in this series. Conclusions　This procedure is a safe, effective, simplicity, less complication and no heat injury methods. It is proved to be a new way of treating refractory residual gallstones, especially for large or impacted lithiasis. It is worthy for clinical application widely in the future.

Analysis of therapeutic strategy and effectiveness of therapy for severe gallstone pancreatitis / 中国普通外科杂志

Objective To investigate a rational treatment for severe gallstone pancreatitis(SGP) and evaluate therapeutic effect.Methods A retrospective study was made on the clinical data of 97 cases with SGP.(Results) Among 97 SGP patients,54 cases were in severe grade I, 43 cases were Grade II;77(79.4%) cases were cured and 20(20.6%)died.The morbidity rates of endoscopic therapy(EST),delayed surgery and early surgery were 24.1%,25.0% and 65.5% respecticely,while the mortality rates in the 3 groups were 10.3%,13.9% and 37.5% respectively.The morbidity and morality rates in the first 2 groups were significanty lower than the early surgery group(P

Severe acute pancreatitis complicated with postoperative duodenal fistula / 中国普通外科杂志

Objective To study the causes and methods of prevention and treatment of severe acute pancreatitis (SAP) complicated with postoperative duodenal fistula. Methods Twenty-two cases with severe acute (pancreatitis) complicated with postoperative duodenal fistula were retrospectively analyzed . Results Among 184 patients with severe acute pancreatitis undergoing operative treatment,duodenal fistula developed in 22 (patients),and in 15 of the 22 (patients), it occurred 2 weeks after operation.In 18 patients the duodenal fistula healed spontaneously with conservative therapy and 4 patients were cured by re-operation. Conclusions (Duodenal) fistula is related to early operation for SAP,peripancreatic infection,and improper placement of (drainage) tube at time of operation or (prolonged) (placement) of (drainage) tube.Most duodenal fistulas can be (spontaneously) cured by maintaining patent drainage around the fistula, actively controlling peripancreatic (infection), suppression of gastrointestinal secretion, and augmention of nutritional support.

Clinicopathological features of resectable carcinoma of the pancreatic head:a report of 102 cases / 中国普通外科杂志

Objective To explore the clinicopathelogical features of resectable carcinoma of the head of (pancreas).Methods A retrospcctive analysis was made on the clinicopathological data of 102 patients with cancer of the head of pancreas, who had received pancreatoduodenectomy from Nanfang Hospital in January 1990 to January 2003. Results The incidence rate of the peri-pancreatic tissue infiltration was 74.5%,the infiltration rate of retroperitonealfat was 27.5% and the incidence rate of peri-pancreatic lymph-node (metastasis) was 71.6%. Metastasis rate of 21.1% was seen in the abdominal aorta lymph nodes. (Conclusions) Surgically resectable carcinoma of the pancreatic head is not equivalent to early cancer. The surgical area of radical resection of cancer of the pancreatic head should at least include pancreatoduodenectomy and clearance of regional soft tissue and lymph nodes. It may be more reasonable if the abdominal aorta lymph nodes were assigned to the first station of lymph drainage of carcinoma of head of the pancreas.

Diagnosis and surgical treatment of carcinoma of duodenal papilla :a report of 48 cases / 中国普通外科杂志

Objective To study the results of diagnosis and treatment of duodenal papilla carcinoma. Methods The clinical data of 48 cases of duodenal papilla carcinoma admitted and treated in our hospital during a 7-year period were analyzed retrospectively. The main clinical symptoms included jaundice(43 cases), upper abdominal pain(23 cases), pruritus of skin(12 cases) and other symploms (7cases). The diagnosis accuracy rate of B ultrasound, CT, and ERCP examination were 39.6%, 50.0% and 93.3% respectively. Pancreaticoduodenectomy was performed in 39 cases. (of these, 1 case underwent pylorus-preserving procedure), 5 cases underwent cholecystojejunostomy and/or gastroenterostomy, and 3 were willfully discharged after diagnosis.Results Thirty-six patients were followed up.Survival beyond 1 year and beyond 2 years afer pancreaticoduodeneoctomy were 66.7% and 30.6% (respectively), and 2 cases among 8 cases of 7-year survivors are alive now. But the 3 discharged patients who refused operations lived less than 1 year; and only 1 patient among those who underwent cholecystojejunostomy and/or (gastroenterostomy) lived more than 1 year. Conclusions ERCP plus biopsy are the primary means of diagnosis, and radical resection is the main treatment modality for duodenal papilla carcinoma.