Clinical study of local application of triamcinolone acetonide in promoting wound healing after granulomatous lobular mastitis operation / 中国医师进修杂志

Objective To investigate the effect of local application of triamcinolone acetonide in promoting wound healing and recurrence after granulomatous lobular mastitis (GLM) operation. Methods The clinical data of 55 GLM patients with the diameter > 5 cm were retrospectively analyzed, and all patients treated with incision drainage to breast abscess and removal of inflammatory lesions. Thirty - one patients were treated with routine dressing change after operation (control group), and 24 patients were treated with routine dressing change and triamcinolone acetonide injection after operation (experiment group). The wound dressing time, recovery rate and recurrence rate were compared between 2 groups, and hormone related adverse reaction of experiment group was observed. Results The wound dressing time in experiment group was significantly shorter than that in control group:(58 ± 19) d vs. (71 ±25) d, and there was statistical difference (P0.05. The patients of experiment group did not have the hormone related adverse reaction. Conclusions The local application of triamcinolone acetonide after GLM operation can accelerate the wound healing, and it may also contribute to higher recovery rate and lower recurrence rate.

Application of two different gastrectomy methods in proximal gastric cancer / 国际肿瘤学杂志

Objective To evaluate the impacts of the two different gastrectomy methods on the quality of life,complication and prognosis in proximal gastric cancer.Methods One hundred and two cases of proxi-mal gastric cancer in Tung Wah Hospital were collected for retrospective analysis.They were divided into proxi-mal gastrectomy/gastroesophagostomy (PG)group (n =50)and total gastrectomy/esophagojejunostomy (TG) group (n =52),according to the methods of gastrectomy and reconstruction.The postoperative complications, nutritional status and prognosis of the two groups were compared.Results The incidence of reflux esophagitis was obviously higher in PG group than that in TG group (38.0% vs 1 9.2%,χ2 =4.464,P =0.035).No sig-nificant differences were found between the two groups in the incidences of postoperative infection,bleeding and anastomotic leakage (χ2 =0.063,P =1 .000;χ2 =0.001 ,P =0.978;χ2 =0.31 1 ,P =0.577).There were no significant differences between PG and TG group in total plasma protein [(65.26 ±4.1 0)g/L vs (65.33 ± 3.75)g/L,t =-0.402,P =0.688],albumin [(39.76 ±2.1 7)g/L vs (39.59 ±2.04)g/L,t =1 .778,P =0.076],hemoglobin [(1 07.33 ±1 1 .1 0)g/L vs (1 08.09 ±1 1 .1 7)g/L,t =-1 .502,P =0.1 33]and weight loss [1 .00 ~8.00 kg vs 0.50 ~8.20 kg,t =-1 .622,P =0.1 05]in one year postoperatively.All cases were followed-up for 7 months to 1 0 years.No significant differences were found between PG and TG group in the incidences of anastomotic tumor recurrence (4.0% vs 5.8%,χ2 =0.1 71 ,P =0.679),metastasis (24.0% vs 28.8%,χ2 =0.308,P =0.579)and median survival time (53.6 months vs 49.8 months,χ2 =2.564,P =0.1 09).Conclusion Compared with PG group,the incidence of postoperative reflux esophagitis is effectively reduced,and the incidences of malnutrition,tumor recurrence and metastasis and death are not increased in TG group.Hence,TG should be a safe and effective surgery strategy.

Influences of three types of digestive tract reconstruction on quality of life after total gastrectomy / 中华临床营养杂志

Objective To compare the short-term quality of life after total gastrectomy in patients with gastric cancer with three recontructive methods of stamoch storage function. Methods Totally 62 cases underwent jejunal interposition afar total gastrectomy from March 2000 to December 2007. Patients were divided into three groups according to the procedures: functional jejunal interposition (FJI-type) group ( n = 23 ), modified jejunal interposition ( Ⅲ -type) group ( n = 20), and P-type jejunal interposition (P-type) group (n = 19). In each group,the patients' general conditions, the nutritional status at month 3 and 12, and gastrointestinal symptoms were evaluated. Results The durations of procedures were significantly different among three groups (P ＜0. 01 ). The intraoperative bleeding volume, postoperative complications, and food intake of each meal at month 3 were not significantly different ( P ＞ 0. 05 ). Compared with the data at month 3, the levels of hemoglobin and serum calcium at month 12 were significantly higher in all three groups (P ＜ 0. 01 ). Compared to the level at month 3, the level of serum albumin at month 12 significantly increased in FJI-type group (P ＜ 0. 05 ) but showed not significant difference in Ⅲ-type group and P-type group ( P ＞ 0. 05 ). The incidence of reflux esophagitis in three groups and the comparative parameters among the three groups at month 12 were not significantly different ( P ＞ 0. 05 ). Conclusions The jejunal interpositions after total gastrectomy will not increase the complexity and risk of the surgical procedure. In fact, they can reduce the reflux esophagitis and improve quality of life by keeping the storage function and restoring food passage through the duodenum. FJI-type is simpler than the other two types, and P-type is preferred for operations that need to open the pectoral cavity.

Clinical Study of Direct-covering Pancreaticojejunostomy with Remaining Jejunal Mucosa / 中国肿瘤临床

Objective:To investigate and summarize the procedures of direct-covedng pancreaticojejunostomy with remaining jejunal mucosa in pancreaticoduodenectomy and to analyze the incidence of pancreatic fistula and other postoperative complications.Methods:A total of 21 patients were treated with pancreaticoduodenectomy between May 2005 and June 2009.During the surgery,we dissected 3cm long remnant of the pancreas out of ambient tissues.Near the 2.0-3.0cm of the pancreatic remnant.we fixed partial posterior wall with the full-thickness jejunum without mucosa destroyed by interrupted suture,and then pushed the remnant into the jejunum and fixed the anterior wall.Finally,at the 1.0cm of the panceratic remnant,we binded the iejunum to surround the pancreas through 7-silk sutures.Results:One case was treated with secondary surgery due to bleeding of the pancreatic remnant.The other patients recovered smoothly without pancreatic fistula or other complications.Conclusion:Postoperative pancreatic fistula is related to the texture of pancreas,method of pancreaticojejunostomy,surgical skills and perioperative treatment.Compared with other types of pancreaticojejunostomy,direct-covering pancreaticojejunostomy with remaining jejunal mucosa is simpler.

The clinical study of jejunal mucus preserving plus end to end pancreaticoenterostomy / 中华内分泌外科杂志

Objective To investigate the pancreaticoenterostomy technique using end to end anastomosis of remianing pancreas and jejunum with jejunum mucus preserved. Methods 28 cases underwent pancreatectomy were observed and analyzed from May 2005 to August 2009. There were 26 cases underwent duodenopancreatectomy and 2 cases underwent the pancreatectomy of pancreas body and tail. All cases used the end to end pancreaticoenterostomy, remnant pancreas was directly anastomosed with jejunum without destroy of jejunal mucosa. During the operation, 2.0 cm～2.5 cm long remnant of pancreas was pulled into jejunum without mucosa destroyed. Then, the cut end of the jejunum was fixed on the pancreatic remnant correspondingly by interrupted suture. Finally, a 7-silk suture was used to bind the jejunum and the pancreatic remnant together 1 cm away from the cut surface of the pancreatic remnant. Results 1 case underwent operated again due to bleeding of the pancreatic remnant. 28 patients recovered and discharged from hospital without having the complication of pancreatic fistula. Conclusions Because of the complicated suturation methods, the conventional pancreaticoenterostomy consumes more time. But it still has rather high incidence of pancreatic fistula.The new pancreaticoenterostomy which we used can shorten the operating time and integrity and binding stomas. It is effective to lower the incidence of pancreatic fistula.

A comparative study on nerve exposing versus no exposing for avoiding recurrent laryngeal nerve injury in thyroidectomy / 中华内分泌外科杂志

Objective To compare the incidence of recurrent laryngeal nerve (RLN) injury in thyroidectomy with or without exposing RLN. Methods Records of 704 patients in our hospital undergoing thyroidectomy were retrospectively studied, among whom 472 patients underwent thyroidectomy with RLN being exposed and 232 underwent thyroidectomy without RLN being exposed. Results The incidence of RLN temporary damage and permanent damage in RLN exposed group was 1.49% (7/472) and 0, while it was 6. 03% (14/232)and 2. 16%(5/232) in the non-exposed group. There was statistic difference between the two groups in terms of permanent injury incidence and operation duration (P ＜ 0. 01). Conclusions Although the operation duration was prolonged in RLN exposure group, RLN exposure during operation is very helpful to prevent recurrent laryngeal nerve injury. Therefore, it's necessary to expose RLN during operation in sub-total thyroidectomy and total thyroidectomy.

Surgical management of the Graves' disease with severe thyroid gland enlargement / 中华内分泌外科杂志

Objective To study the perioperation management and surgical therapy of Graves' disease accompanied with severe thyroid gland enlargement. Methods 32 cases of Graves' disease with severe thyroid gland enlargement were included in our study and their symptom control, perioperation management, surgical therapy and postoperative complication treatment were analysed retrospectively. Results There was no surgical death among the 32 patients. The incidence of postoperative complications was 21.9%. And among them, 2 cases had respiratory tract obstruction, 2 cases temporary hypocalcemia and 3 cases mild hypothyroid. ConclusionFor Graves' disease, surgical therapy has a satisfactory effect but a higher incidence of complication.

The perioperative management of orthotopic liver transplantation in Chinese inbred miniature porcine / 中国普通外科杂志

Objective To summarise the perioperative features of orthotopic liver transplantations(OLTs) in miniature porcine,to establish mature、stable OLT models.Methods In order to observe hemodynamics and blood changes and improved perioperative management and summarise the perioperative characteristics,8 preliminary experiments(group A) and 18 experiments(group B) of OLTs were performed without veno-venous bypass(VVB) in Chinese inbred miniature porcine.Results The mean operation time was(179.6?14.3)min in our 18 OLTs,and the mean anhepatic phase time was(27.3?3.4)min.Dramatic hemodynamic and metabolic changes were identified during anhepatic phase.The oneweek survival rate was 88.9% in group B,but all the 8 pigs in group A died.The experiment group pigs urinated after 3～5hours and had normal diet after 3days.Conclusions Decreasing the operation time and stability of hemodynamics in anhepatic phase are the keys for success in OLTs without VVB.

Study on the PKC in signal transduction pathway in hepatocyte ischemic preconditioning / 中国普通外科杂志

Objective To investigate the mechanism of alternation of PKC activify in liver ischemia preconditioning(IP). Methods After establishment of rat liver IP model, PKC inhibitor and activator were utilized to analyze the phosphorylation of PKC and P44/42MAPKs and HSP expression, and cellular structure was also observed. All of the data were statistically analyzed. Results Compared with the control group without IP, the phosphorylation of PKC was significantly increased in IP treated models and PKC activated group(P