Analysis of stylized operation step in the neck endoscopic thyroidectomy for 51 cases of papillary thyroid microcarcinoma / 中国医师进修杂志

Objective:To summarize experience and effect of the stylized operation step in the neck endoscopic thyroidectomy for papillary thyroid microcarcinoma (PTMC).Methods:The clinical data of 51 patients who underwent transthoracic breast approach scarless neck endoscopic thyroidectomy (SET) from January 2018 to September 2019 in Tungwah Hospital Affiliated to Sun Yat-sen University were retrospectively analyzed. The operative procedure used stylized operation steps: establishment of operating space, three-step method thyroidectomy, central lymph node dissection (CLND), close operating space.Results:Among 51 patients, 25 cases underwent unilateral thyroidectomy plus isthmic resection, 26 cases underwent total/near-total thyroidectomy, and 16 cases underwent preventive CLND. The recurrent laryngeal nerve (RLN) was exposed in all 51 cases, the external branches of the superior laryngeal nerve (EBSLN) was exposed in 35 cases, no procedure was converted into open neck incision thyroidectomy. Forty-two cases were followed up, 2 cases had postoperative hoarseness and unilateral recurrent laryngeal nerve paralysis, which were recovered 55 and 75 d after operation respectively. There was no bucking, voice blunt or permanent low calcium. One patient had abnormal sensation of neck skin after operation, and recovered gradually 3 months after operation.Conclusions:The stylized operation step in the SET can increase safety of surgery.

Clinical characteristics and antimicrobial resistance profile of nosocomial bloodstream infections caused by Klebsiella pneumoniae in surgical patients / 中国感染与化疗杂志

Objective To retrospectively review the clinical characteristics and antimicrobial resistance profile of nosocomial bloodstream infections caused by Klebsiella pneumoniae in surgical patients for better use of antimicrobial agents.Methods The clinical data of the surgical patients who were diagnosed with K.pneumoniae-associated bloodstream infections in Tung Wah Hospital from January 2013 to June 2015 were reviewed and analyzed retrospectively.The diagnosis of bloodstream infections was based on national diagnostic criteria.The pathogens were routinely isolated and identified.Antimicrobial susceptibility testing was carried out by using Kirby-Bauer method.The data were analyzed by WHONET 5.6 software.Results A total of 78 surgical patients were identified with nosocomial bloodstream infections due to K.pneumoniae during this period,including primary bloodstream infections (12.8％,10/78) and secondary bloodstream infections (87.2％,68/78).These infections were mainly associated with surgical and invasive procedures.Nearly 40％ of the K.pneumoniae isolates were resistant to ceftriaxone,cefuroxime and piperacillin.ESBLs were produced in 43.6％ (34/78) of the K.pneumoniae isolates.The ESBLs-producing strains showed significantly higher resistance rates to various antibiotics than non-ESBLs-producing strains.Piperacillin-tazobactam,amikacin,imipenem,and meropenem still have good antibacterial activity against these K.pneumoniae isolates.However,imipenem-resistant strains are emerging.Conclusions Most of the bloodstream infections caused by K.pneumoniae were secondary to infections in other body sites in surgical patients.Hospital infection control measures should be strengthened.Meanwhile,the clinicians should take full advantages of microbiological laboratory to profile the pathogens and their susceptibility patterns,which is crucial for rational use of antibiotics.

The clinical application of endoscopic thyroidectomy through two-areola axillary approach / 中华内分泌外科杂志

ObjectiveTo discuss the more aesthetic and minimally invasive surgical approach of endoscopic thyroidectomy.Methods50 cases of endoscopic thyroidectomy via breast areola-axillary approach were retrospectively analyzed.Among these cases,12 received unilateral partial lobectomy,30 received unilateral total lobectomy and 8 received bilateral partial lobectomy.Results Endoscopic thyroidectomy was completed in all the patients.The intraoperative blood loss was ( 12.77 ± 20.12 ) ml.The operation time was (67.00 ± 21.28 )min.The postoperative hospital stay was (3.77 ± 0.50)days.Hoarseness occurred in 2 cases.All the 50 cases were followed up from 1 to 6 months and no other complication occurred.ConclusionEndoscopic thyroidectomy via breast areola-axillary approach is more aesthetic and minimally invasive; however,the operator needs an adaptive process for a better surgical view angle.

One hole method of laparoscopic surgery in emergency treatment of the incarcerated inguinal hernia in children / 国际外科学杂志

ObjectiveTo evaluate the application value of the emergency laparoscopic surgery in incarcerated inguinal hernia of children. MethodsManual reduction of incarcerated hernia was laparoscopic- assisted after anesthesia, high-ligation of hernia sac was done by one hole method of laparoscopic treatment.ResultsAll of 22 cases of pediatric incarcerated hernia were done, no complications occurred. Eighteen patients were followed up for 3 - 15 months, 9.3 months on average, without serious complications. ConclusionsThe emergency laparoscopic surgery in children of incarcerated inguinal hernia is safe and feasible,with smaller trauma, quicker recovery and smaller health risk.

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.

Treatment of primary retroperitoneal malignarnt tumor / 国际外科学杂志

Objective To investigate diagnosis and surgical treatment of primary retroperitoneal malignarnt tumor.Methods Retrospectively analyzed the clinical data with primary retroperitoneal tumor.Results Twenty-eight eases with benign tumor and 47 cases with malignant tumor underwent total resection,only 17cases with malignant tumor underwent local resection.Conclusion The diagnosis B-ultrasonography,CT and MR of primary retroperitoneal tumor is very important for preparative of preoperation and to estimate of involved organ.Involved organ resection and repeated operation for recurred tumor improve cure rate.

Diagnosis and treatment of gastrointestinal stromal tumors: a report of 32 cases / 中国普通外科杂志

Objective To explore the diagnosis and treatment of gastrointestinal stromal tumors(GISTs).Methods Clinical and pathological data of the 32 GISTs cases treated over the recent 5 years in our hospital were reviewed retrospectively.Results Stomach was the most frequent site for GISTs.Abdominal pain was the most common symptom.Before operation,81.3%(26/32) of the cases were misdiagnosed.All of the cases underwent surgical resection.10 recurrent GIST patients received a second resection,and 8 patients(underwant) three or more resections.Follow-up was made from six months to 5 years,and 8 patients died.Conclusions The diagnosis of GISTs is difficult and mainly depends on histopathology and(immunohistochemistry).Surgical resection is the principal treatment of GISTs.Reoperation is effective for the treatment of recurrent cases.