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It is still at the initial stage for basic-level military doctors to participate in the standardized residency training. While, their professional backgrounds and training objectives are significantly different from those civilian residents, it is necessary to explore the standardized training methods in line with the military career demands for those basic-level military doctors. Based on the actual needs of grass-roots troops and military medicine, this study makes significant progress in the integration of standardized residency training and field surgery training methods, making the basic-level military doctors achieve the goal of field surgery training in the course of clinical practice of residents. Not only the surgical capability of basic-level military doctors, but also the medical support capability in grass-roots troops has been improved. This article summarizes the application methods and experience of field surgery teaching in the standardized residency training of military medical residents at the grass-roots level.
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Objective To evaluate the safety and efficacy of microwave tissue coagulation assisted laparoscopic hepatectomy for the treatment of hepatic tumors.Methods 29 patients underwent laparoscopic hepatectomy using microwave liver tissue coagulation from December 2011 to June 2014 in the General Air Force Hospital.All patients underwent intraoperative ultrasound guided microwave coagulation assisted laparoscopic local hepatectomy.Intraoperative blood loss,operation time,postoperative hospital stay and complications were observed.Results All the operations were successfully performed without conversion to open surgery.There were 18 cases of hepatocellular carcinoma (HCC),2 cases of intrahepatic cholangiocarcinoma,2 cases of hepatic metastases from the rectal carcinoma,5 cases of hepatic hemangioma,1 case of hepatic focal nodular hyperplasia and 1 case of hepatic cystadenoma.Drainage tubes were placed in 3 patients and removed 5-7 d after the operation.The operation time was 150 (125-210) miu,the median amount of intraoperative bleeding was 120 (30-250) ml,the postoperative hospital stay was 7 (5-10) d.All patients recovered well after the operation and no complications such as intraabdominal bleeding and bile leakage were observed.The cutting edges of liver cancer of these 22 cases were negative.The postoperative follow-up time of these 22 cases were 3-36 months and no tumor recurrence and metastasis were observed.Conclusions Laparoscopic liver resection using intraoperative ultrasound guided microwave hepatic tissue coagulation can effectively control the bleeding,improve the safety of laparoscopic liver resection,which makes it a safe and effective minimally invasive technique.
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Objective To investigate the significance of cortactin in primary liver cancer. Methods Fiftythree paraffin embedded primary liver cancer specimens were collected at General Hospital of Air Force of PLA from January 2002 to May 2008. The expression of cortactin was detected by immunohistochemistry, and the relationship between cortactin expression and clinicopathologic parameters was analyzed. All data were analyzed via Wilcoxon rank sum test and Spearman rank correlation analysis. Results There was a significant difference in cortactin expression among tumor capsule integrity, TNM staging, portal vein tumor thrombus and extrahepatic metastasis (u =2. 19, 3. 584, 2. 796, P ＜ 0.05 ). There was a positive correlation between tumor invasion and cortactin expression ( r = 0. 5794, P ＜ 0.05 ). Conclusions Overexpression of cortactin may be one of the factors enhancing the invasion of primary liver cancer. The level of cortactin expression can be used in evaluating the invasive potential of primary liver cancer.
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Objective To investigate the expression and the early diagnostic significance of heat shock protein 70 in acute allograft rejection of liver-transplamed rats. Methods The model of rat orthotopic liver transplantation was made by using a modified "two-cuff technique". The rats were randomly divided into 3 groups. For each group, donors and receptors all included 15 rats respectively. The control group: Wistar to Wistar liver transplantation; The untreated group: SD to Wistar liver transplantation, not receiving any immunosuppressant after liver transplantation; The treatment group: SD to Wistar liver transplantation, receiving intramuscular injection of tacrolimus (FKS06, 2mg kg-1. day-1) after operation. Five rats were executed randomly in every group on the post-transplantation day 3, 5 and 7 and the graft samples were obtained for optical microscopic observation. The expression of HSPT0 in grafts was detected by using immunohistochemical method and RT-PCR. The correlation between acute rejection following liver transplantation and the expression of HSP70 in grafted liver was studied. Results There was no acute rejection examined in the control group. The untreated group showed typical allograft rejection and the rejection activity index (RIA) went up gradually after the operation (P<0.01). The treatment group showed no rejection or borderline allograft rejection. The level of HSP70 was increased transiently after operation, then reduced in the control group (P<0.05). The level of HSP70 in the untreated group was higher than in the control groupand gradually increased with the prolongation of time after transplantation (P<0.01). A significant correlation was found between HSP70 and pathological score in the untreated group (P<0.01). The treatment group showed low levels of HSP70 of all the time. Conclusions The expression of HSP70 in grafts is closely related to the occurrence and development of the acute rejection and can be useful for early diagnosis of acute allograft rejection following liver transplantation.
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Objective: To explore the parameters used for the clinical evaluation of post-trau- matic hepatic function crashing down to the ground. Methods: By establishing the animal model of liver impact injury in simulation of parachuter,blood were sampled before injuries and 15 min, 30 min,45 min,1 h, 3 h, 6 h ,9 h after injuries. Cytokines including TNF?、IL-2 and liver function parameters including ALT,AST,LD-L,GGT,ALP were measured and analyzed statistically. Results: TNF? increased after 15 min- utes, and IL-2 increased after 30 minutes(P0.05). These two pa- rameters were significantly increased all the time after injuries(P
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Objective To develop a rapid donor liver harvesting method in orthotopic liver transplantation in rats,and to study the stability and the success rate of the model.Methods A total of 200 healthy adult male SD rats were randomly divided into two groups: the experimental group(rapid donor liver harvesting transplant group),and the control group(conventional liver transplant group).The operation time,cold(ischemic) time and warm ischemic time of the donor liver, recipient post-transplation liver function and the success rate of the operation between the 2 grous were cpmpared.Results In the control group,the(operation) time of donor harvesting was(33.8?4.2) min,warm ischemic time and cold ischemic time of donor liver was(3.5?1.2) min and(62.0?4.2) min,with a 80% rate of success.The new method reduced the time for donor surgery to(13.1?2.2)min,and reduced the warm ischemic time and cold(ischemic) time of donor liver to 0 min and(38.0?3.1)min respectively,and with a 94% rate of success(all P
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Objective:To investigate the surgical indication and effect of surgical treatment for giant cavernous hemangioma of the liver(LHG).Methods:The clinical data,including selection of operations,management for severe operative bleeding and postoperative supplementary treatment,of 15 patients with giant LHG treated by surgical measures from 2003 in our hospital were summarized and assessed.Results:Nine cases accepted decollement of LHG,and the recovery courses were all right,6 cases accepted embolization of hepatic artery,in which 2 cases accepted operation afterward.Conclusions:Decollement or embolization of hepatic artery were effective in the treatment of giant cavernous hemangioma.
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Objective: To investigate the cinlical features and therapeutic methods of unex-pected gallbladder carcinoma. Methods: A retrospective analysis was performed in 19 cases of unexpected gallbladder carcinoma treated in our hospital from April 2002 to April 2008. Results: Ten cases in early stage were perfomed gallbaldder resection and local lymph node removal, and the average survival time was 18.7 months; 4 cases were perfomed extend radical resection, and the average survival time was 12.3 months; 5 cases were performed palliative resection, and the survival time was less than 6 months. Conclusions: Frozen section examination during opera-tion is key to diagnose unexpected gallbladder carcinoma. Radical resection is the first option once the diagnosis is confirmed, and the method can be decided according to Nevin classification and B ultrosound scaning during opreation.