Escalating strategies of surgical intervention for infected pancreatic necrosis / 中华消化外科杂志

The step-up approach is the most important modality in the treatment of infected pancreatic necrosis (IPN) and has been recommended by several national and international guidelines. Screening patients with low success rates of percutaneous drainage for timely treatment using the step-up approach and selecting appropriate escalation approach based on IPN staging are expected to improve the overall cure rate of IPN. The open debridement in the step-up approach should be carried out under reasonable indications and timing. When the patient's overall condition is poor and the condition of disease is complex, it is not necessary to adhere to a fixed treatment mode and choose a leapfrogging treatment strategy in a timely manner after thorough evaluation.When following the step-up approach in the treatment of IPN, endoscopic and surgical interventions are advocated in parallel, and escalating and leapfrogging strategies are promoted to establish an integrated, disease-centric, multidisciplinary treatment platform, with the aim of improving clinical prognosis. The authors review relevant literature and combine with team's treatment experience to explore the escalating strategies of surgical intervention for IPN, with a view to further improving the overall cure rate of IPN patients.

The treatment strategies for chronic pancreatitis: endoscopic treatment or surgical intervention / 中华消化外科杂志

Chronic pancreatitis (CP) is a chronic inflammatory and fibrotic disease of the pancreas caused by a variety of causes. The basic treatment principle of CP is to remove the etiology, control the symptoms, improve the pancreatic secretory function and prevent the complications. At present, more and more studies have been conducted on CP treatment strategies. The step-up approach and the surgery first approach are both effective strategies for CP treatment. In clinical practice, endoscopic intervention can be the preferred treatment for pancreatic pseudocyst, pancreatic duct stone, and biliary stenosis. Partington operation is the first choice for dilated main pancreatic duct patients without pancreatic head lesion. Patients with pancreatic head lesions should be intervened with the Beger or Frey operation. For patients without main pancreatic duct dilatation, pancreatectomy should be performed according to the specific lesion location. The total pancreatectomy is advisable for patients with total pancreatic inflammatory disease or multiple lesions of pancreas. Surgeons should follow the individualized and multidisciplinary treatment concepts and strategies in choosing surgical procedures, especially for the control of surgical indications, timing and methods. The authors comprehensively analyze the research progress at home and abroad, elaborate the endoscopic treatment and surgical intervention strategies of CP in order to further optimize the overall efficacy of CP.

Repeat hepatectomy for post-hepatectomy recurrent hepatocellular carcinoma / 中华肝胆外科杂志

Objective:To study the impact of repeat hepatectomy for patients with post-hepatectomy recurrent hepatocellular carcinoma (HCC).Methods:The data of patients who developed post-hepatecotmy recurrent HCC and underwent repeat hepatectomy at the General Surgery Department of Beijing Tongren Hospital from May 2013 to May 2016 (the Recurrence Group), were retrospectively compared with the data from patients who underwent initial hepatectomy for HCC during the same study period (the Primary Group). The general data, perioperative data, postoperative complications and survival of the two groups were compared.Results:The primary group included 179 patients, consisting of 133 males and 46 females, aged (57.3±11.7) years, with a range from 14.0 to 84.0 years. The recurrence group included 36 patients, consisting of 30 males and 6 females, aged (55.9±11.4) years, with a range from 40.0 to 77.0 years. There were no statistically significant differences between the two groups in gender, age, hepatitis virus infection status, preoperative alpha fetoprotein, Child-Pugh score and indocyanine green retention rate at 15 min ( P>0.05). However, there were statistically significant differences ( P<0.05) between the two groups in operative time [(244.2±84.3)min vs. (283.4±66.8)min], intraoperative blood loss[(428.5±151.6)ml vs. (756.2±187.4)ml], anatomic or nonanatomic hepatectomy, single tumor or multiple tumors, and maximum tumor diameter[(5.81±2.24)cm vs. (3.69±1.55)cm]. There were no statistically significant differences between the two groups in incidences of tumor capsular invasion, tumor thrombus and degrees of tumor differentiation ( P>0.05). There were no statistically significant differences in surgical complication rates ( P>0.05), and in 1-year and 3-year overall and disease free survival rates between the two groups ( P>0.05). Conclusions:Repeat hepatectomy for recurrent HCC after hepatectomy was safe and effective. Its long-term survival outcomes were similar to first hepatectomy for HCC.

Surgical intervention strategies for local complications of severe acute pancreatitis / 中华消化外科杂志

The second "death peak" in the late stage of severe acute pancreatitis (SAP), dominated by infectious pancreatic necrosis (IPN), is a challenge in clinical management. Surgeons play an important role in choosing the indication, timing, strategy and mode of the surgical intervention. Simultaneously, the early prediction and recognition, post-operative management and cooperation of IPN need to be strengthened. Nowadays, some new characteristics including minimal invasiveness, staging, multi-disciplinization, profe-ssionalization and diversi-fication emerge in the modern surgical intervention of IPN. Clinicians should establish a comprehensive treatment system centered on diseases. In addition, clinicians should also pay attention to non-infectious local complications of SAP to prevent the diseases. Based on clinical practice, the authors investigate the clinical practice of surgical intervention for local complications of SAP in order to further improve the overall cure rate of SAP patients in the later period.

Surgical intervention strategy for severe acute pancreatitis in minimally invasive era / 中华外科杂志

With the development of minimally invasive concept, the treatment mode of severe acute pancreatitis has changed greatly. The tendency of surgical intervention has changed from excessive intervention to inadequate intervention. The timing of intervention has changed from earlier to later, and the mode of intervention has changed from openness as the main way to minimally invasive as the guidance. The transformation of surgical intervention tendency conforms to both minimally invasive trend and the step-up approach, but there are still some shortcomings: inadequate surgical intervention, inappropriate timing and indications, and over dependence on minimally invasive surgery. Correctly grasping the indications of surgical intervention, accurately grasping the timing of surgical intervention, and reasonably choosing the mode of surgical intervention are the keys to solve the insufficiency of surgical intervention. Laying emphasis on multidisciplinary team and correctly recognizing the role and status of surgical intervention can effectively reduce the mortality of severe acute pancreatitis patients.

Perioperative treatment effects of colorectal cancer in elderly patients / 中华老年医学杂志

Objective To explore the clinical features and perioperative treatment effects of colorectal cancer in elderly patients.Methods Retrospective analysis of clinical data especially focusing on perioperative treatment from 104 elderly patients with coloreetal cancer were performed.Results A total of 99 patients (95.2%) were cured or improved at discharge.Perioperative pulmonary infection occurred in 13 cases (12.5%), of whom 6 cases (5.8%) suffered from respiratory failure.Lower extremity deep venous thrombosis occurred in 3 cases (2.9%), incision infection in 6 cases (5.8%), wound dehiscence in 2 cases (1.9%), intestinal fistula in 1 case (1.0%) and gastroparesis in 1 case (1.0%).About 5 cases (4.8%) died from multiple organ failure.Conclusions Old age is not a contraindication in surgical treatment for colorectal cancer.Paying attention to accurate and timely treatment in perioperative peroid can reduce postoperative complications and improve patients' quality of life.

Surgical treatment for chronic pancreatitis characterized by a pancreatic mass / 中华普通外科杂志

Objective To summarize the diagnostic and therapeutic experience on chronic pancreatitis characterized by a pancreatic mass. Methods The clinical data of 28 cases of chronic pancreatitis with mass undergoing surgical operations were retrospectively analyzed in our hospital from June1999 to June 2009. Results Among the 28 cases, 19 were diagnosed as carcinoma, 9 cases were diagnosed as chronic pancreatitis respectively before operation. Needle aspiration biopsy and/or postoperative pathology identified chronic pancreatitis in all cases. The symptom included abdominal pain (22 cases),jaundice (15 cases), and obstruction of duodenum (4 cases). Pancreaticoduodenectomy was performed in 17 cases, choledochojejunostomy performed in 3 cases, pancreatojejunostomy performed in 1 case.Duodenum-preserving resection was performed in 4 cases, and resection of body and tail of the pancreas were performed in 3 cases. There was no operative death. Postoperative complications included pancreatic leakage (2 cases), severe gastroplegia (2 cases) and stress peptic ulcer with massive bleeding ( 1 case). All patients got follow-up ranging from 6 months to 5 years. Recurrence of abdominal pain developed in 7 cases after 2 years. Canceration of pancreatic mass was found respectively in 8 months, 1 year after operation in one each cases. Conclusion Preoperative differential diagnosis of chronic pancreas and pancreatic tumor was difficult. Although needle aspiration biopsy is the effective method for diagnosis, there may be still a possibility of missed diagnosis/misdiagnosis.

Study on the Gene Mutation in a Pedigree with Dowling-Meara Type Epidermolysis Bullosa Simplex by PCR-Heteroduplex Analysis / 中华皮肤科杂志

Objective To study the gene mutation in a pedigree with Dowling-Meara type epidermolysis bullosa simplex (DM-EBS). Methods Using the immuno-histochemistory, electron microscopy, PCR-HA and DNA sequencing. Results The cytolysis was observed throughout the lower basal layer, tonofilaments were decreased; using PCR-HA, the K14 gene mutation was detected. By DNA sequencing, we found gene mutation in this pedigree: K14 1A domain: N123R. Conclusion There is K14 1A domain gene mutation in this DM-EBS pedigree.

The Detection of Keratin 5 Mutation in Patients with Weber-Cockayne Epidermolysis Bullosa Simplex / 中华皮肤科杂志

In order to study the relationship of keratin 5 gene and Weber-Cockayne epidermolysis bullosa simplex (WC-EBS), we use polymerase chain reaction (PCR) amplification combined with single strand conformation polymorphism (SSCP) methods and DNA sequenceing to detect the point mutation of keratin 5 in a family of WC-EBS. The results showed that there is a G→T substitution at the third base pair of codon 327, which caused methionine changed into isoleucine. This abnormality of keratin structure makes the normal assembly of tonofilaments impossible. Furthermore, the above change resulted in blister formation and epidermolysis clinically. This indicates that PCR-SSCP is useful for the gene and prenatal diagnosis of genodermatoses and also provides the basis of theroies for gene therapy.

Amplification of 160 000 Bullous Pemphigoid Antigen cDNA Fragment from Human Keratinocyte Library / 中华皮肤科杂志

Bullous pemphigoid antibodies can recognize two autoantigens-BPAG1 (220 000-240 000 ) and BPAG2 (160 000 -180 000). With two specific primers, we successfully amplified a 588bp cDNA fragment of 160 000 BP antigen from human keratinocyte cDNA library in this paper. The result confirmed that lip antigens were synthesized by keratinocyte at a molecular level. This cDNA fragment could not be amplified with epidermal DNA Templets. We suggest that BP antigen gene may be separated by some introns. We will prepare cDNA probes and recombinant antigens using PCR product in order to elicit autoimmunity mechanism of BP.