Clinicopathological features of intraabdominal bronchogenic cyst: an analysis of 8 cases / 中华全科医师杂志

Objective:To analyze the clinicopathological features of intraabdominal bronchogenic cyst.Methods:The clinical data of 8 patients with intraabdominal bronchogenic cyst admitted in 3 Grade-A tertiary hospitals in Yunnan province between 2014 and 2023 were retrospectively analyzed. The clinical and pathological features, diagnosis, treatment and prognosis of intraabdominal bronchogenic cyst were reviewed.Results:There were 1 male and 7 females with an mean age of 45±12 years (21-65 years). Two patients presented with abdominal pain and 5 asymptomatic patients were found during physical examination. The cysts were located in retroperitoneum in 4 cases, located between the pancreas tail, spleen and the posterior wall of the stomach in 2 cases, located in the posterior wall of the stomach in 1 case, and located close to left adrenal gland in 1 case. Two patients had elevated tumor markers, while tumor markers in the remaining 6 cases were normal. Seven cases underwent laparoscopic complete cyst resection and 1 case had open surgical resection. The wall of most cysts were lined with respiratory epithelium and composed of goblet cells or pseudostratified ciliated columnar epithelium. The wall of cysts was composed of fibrous connective tissue or smooth muscle bundles, and the cavity contained serous mucous glands. Two cases showed cartilage tissue and one showed the infiltration of large number of inflammatory cells. The mean follow-up time was 31±32 months (range 5-107 months), and no recurrence or metastasis was found during the follow-up.Conclusions:Abdominal bronchogenic cyst is often found in adulthood, and most cases are symptomatic and found during physical examination. The diagnosis mainly depends on pathological examination, and tumor markers are not specific for its diagnosis. Surgery is the best way for treatment.

[Surgical treatment of presacral recurrent rectal cancer].

Presacral recurrent rectal cancer (PRRC) which involves the presacral fascia or/and sacral bone is one of the classification of locally recurrent rectal cancer. Presacral fascia or/and sacral bone involvement and posterior fixation make treatment difficult. In recent years, there are many researches on the diagnosis, surgical treatment and surgical methods of PRRC. The major therapeutic principle of PRRC is to perform radical resection with combined therapy under the evaluation of the multidisciplinary team (MDT). Among the surgical methods, abdominal resection or abdominoperineal resection, sacrectomy and abdominosacral resection are the common surgical methods for the treatment of PRRC. Recent articles revealed that limited sacrectomy could also result in good efficacy, provided strict indications for this procedure. With the development of minimally invasive technology, the application of laparoscopic technology in PRRC has been increasingly emphasized. In summary, the surgical principle of PRRC has shifted from solely pursuring radical resection to obtaining good efficacy as well as reduced morbidity with individualized management. In this article, the research progress of surgical methods of presacral recurrent rectal cancer in recent years are reviewed in order to provide reference to clinical diagnosis and treatment.

[The shift of the treatment strategy of gastrointestinal stromal tumor from the surgical perspective].

As tumors originated from mesenchymal tissue, gastrointestinal stromal tumors (GIST) has its own typical history. For the idea of treatment for GIST at different historical periods, the role and value of surgery for the treatment of GIST keep changing. Laparoscopy and endoscopy will have the role they deserved. With the understanding of pathogenesis of GIST, targeted chemotherapy will be more and more accurate and individualized. How to improve the overall therapeutic effect of GIST, especially for the patients with the high risk and drug-resistance, is the dilemma and challenges for the surgeons.

Enlightenment and reflection of splenic hilar lymph node dissection for advanced proximal gastric cancer / 中华消化外科杂志

Splenic hilar lymph node (LN) is the difficulty and focus of perigastric LN dissection during radical gastrectomy for advanced proximal gastric cancer (APGC).Although the new edition of Japanese Gastric Cancer Treatment Guidelines excluded the splenic hilar LN from the D2 lymphadenectomy in patients with APGC,there are still few high-level evidences.Meanwhile,the guideline recommends that splenectomy is still necessary for patients with APGC involving the greater curvature.With the support of increasing evidences,the spleenpreserving splenic hilar LN dissection has been recognized by more and more scholars.Additionally,the technique of laparoscopy provides a new method for splenic hilar LN dissection.Our center proposed a new technique named Huang's three-step maneuver for laparoscopic spleen-preserving splenic hilar lymphadenectomy,which not only reduces the difficulty of operation,but also makes the technique easier to popularize and with a significance of minimally invasive effect.During the clinical practice,the dissection of LNs behind the splenic portal vessels is also one of the controversies.Therefore,the difficult technique of splenic hilar LN dissection not only requires us to make a technical exploration,but also requires us to explore precise indications,in order to avoid unnecessary operation in patients who do not require dissection of the No.10 LNs and to avoid missing the opportunity for radical surgery in high-risk patients because of the difficult techniques.

Enlightenment and reflection of splenic hilar lymph node dissection for advanced proximal gastric cancer / 中华消化外科杂志

Splenic hilar lymph node (LN) is the difficulty and focus of perigastric LN dissection during radical gastrectomy for advanced proximal gastric cancer (APGC). Although the new edition of Japanese Gastric Cancer Treatment Guidelines excluded the splenic hilar LN from the D2 lymphadenectomy in patients with APGC, there are still few high-level evidences. Meanwhile, the guideline recommends that splenectomy is still necessary for patients with APGC involving the greater curvature. With the support of increasing evidences, the spleen-preserving splenic hilar LN dissection has been recognized by more and more scholars. Additionally, the technique of laparoscopy provides a new method for splenic hilar LN dissection. Our center proposed a new technique named Huang′s three-step maneuver for laparoscopic spleen-preserving splenic hilar lymphadenectomy, which not only reduces the difficulty of operation, but also makes the technique easier to popularize and with a significance of minimally invasive effect. During the clinical practice, the dissection of LNs behind the splenic portal vessels is also one of the controversies. Therefore, the difficult technique of splenic hilar LN dissection not only requires us to make a technical exploration, but also requires us to explore precise indications, in order to avoid unnecessary operation in patients who do not require dissection of the No.10 LNs and to avoid missing the opportunity for radical surgery in high-risk patients because of the difficult techniques.

The shift of the treatment strategy of gastrointestinal stromal tumor from the surgical perspective / 中华外科杂志

As tumors originated from mesenchymal tissue, gastrointestinal stromal tumors (GIST) has its own typical history. For the idea of treatment for GIST at different historical periods, the role and value of surgery for the treatment of GIST keep changing. Laparoscopy and endoscopy will have the role they deserved. With the understanding of pathogenesis of GIST, targeted chemotherapy will be more and more accurate and individualized. How to improve the overall therapeutic effect of GIST, especially for the patients with the high risk and drug-resistance, is the dilemma and challenges for the surgeons.

[Clinical outcomes of buttress plating in treating posterior Pilon fractures through modified posteromedial approach].

OBJECTIVE: To explore clinical outcomes of buttress plating in treating posterior Pilon fracture by amodified posteromedial approach. METHODS: From July 2014 to January 2015, 10 patients with posterior Pilon fracture were respectively analyzed, including 7 females and 3 males, aged from 31 to 54 years old. One patient were type , 3 patients were type IIand 6 patients were type III according to classification of Pilon fracture by YU Guang-rong. All patients were treated by buttress plating through amodified posteromedial approach. Postoperative complications, fracture healing and reduction were observed, AOFAS score were used to evaluate function recovery at 1 year after operation. RESULTS: All patients were followed up for 12 to 18 months with an average of(14.1±3.2) months. All incisions were primarily healed at stage I without wound complication, neurovascular injuries or musculus flexor contracture. According to Burwell-Charnley imaging scoring, 8 patients got anatomical reduction and 2 patients got moderate reduction. All fracture got healing from 12 to 16 weeks with an average of(13.2±1.8) weeks. According to AOFAS score at 1 year after operation, 8 got excellent results and 2 moderate. All patients returned to work at about(4.7±1.4) months (ranged from 3 to 6 months) after operation. CONCLUSIONS: Buttress plating using a modified posteromedial approach in treating posterior Pilon fractures is an effective method, has less complications, and could recovery early weight-bearing functional exercise.

[Application of total en bloc spondylectomy in spinal tumors].

Total en bloc spondylectomy is a surgical technique cutting off tumors of spine and its satellite. Previous studies have shown that this technique could reduce postoperative recurrence rate of spinal tumor, but surgical indications are not unified. Wide application of spinal tumor surgical staging and life expectancy system make it more clear for surgery. However, it is difficult to carry out extensive operation for the characteristics of more bleeding, great difficulty and high risk. As for continuous improvement of TES technology, application of endoscopy and appearance of 3D printing artificial vertebral body could push the operation becoming mature.

[Meta plate and cannulated screw fixation for treatment of type Letenneur III lateral Hoffa fracture through posterolateral approach].

OBJECTIVE: To explore clinical effect of meta plate with cannulated screw fixation in treating Letenneur III lateral Hoffa fracture through posterolateral approach. METHODS: From June 2012 to June 2016, 12 patients with Letenneur III lateral Hoffa fracture were treated with meta plate and cannulated screw fixation through posterolateral approach, including 8 males and 4 females;aged from 22 to 66 years with an average of 42 years old;and 5 cases on left side, 7 cases on right side. Preoperative and postoperative X-ray and CT were taken before and after operation to assess location of fracture and fracture healing. Letenneur scoring standard was used to evaluate clinical effects. All patients were treated with meta plate combined with cannulated screws. RESULTS: All incisions healed at stage I. The fractures were healed from 11 to 32 weeks with an average of 17.2 weeks. No internal fixation loosening, displacement and necrosis of femoral condyle and deep vein thrombosis of lower extremity occurred. All patients were followed up from 8 to 24 months with an average of 12.8 months. At the latest follow-up, 7 cases got excellent results, 4 good and 1 moderate according to Letenneur scoring standard. CONCLUSIONS: Posterlateral approach is easy to expose, meta plate fixation with cannulated screws has advantages of strong internal fixation, high fracture healing rate, early knee joint function exercise and good recovery of joint function.

[Treatment progress on giant cell tumors of bone].

Giant cell tumors(GCT) of bone is benign bone tumors with aggressive and osteolytic activity. As traditional treatment of GCT, removal of bone graft is disease with high local recurrence rate, and could reduce local recurrence by auxiliary means. Different surgical methods such as prosthesis replacement, wide resection and En-bloc resection could be selected for different parts of giant cell tumor of bone, based on the lesion location, size, extent of invasion, recurrence rate. For patients with special region of GCT of bone with removed incompletely and high surgical risk expected, arterial embolism could be performed. The application of bisphosphonates and denosumab are mainly used in treating recurrent, refractory, special parts, metastatic giant cell tumor of bone will bring new hope of treatment for giant cell tumor of bone, due to lower the recurrence rate. Chemotherapy is mainly used in the treatment of metastasis and malignant bone tumor. Radiotherapy for recurrent or unresectable bone giant cell tumor can control tumor progression, but there is the possibility of malignancy. While long-term follow-up studies and long-term results of applications of bisphosphonates and denosumab are lacking, new methods and development of new drugs are still be needed to treat patients with giant cell tumor of bone and also bring about more hope.

Clinical outcomes of buttress plating in treating posterior Pilon fractures through modified posteromedial approach / 中国骨伤

<p><b>OBJECTIVE</b>To explore clinical outcomes of buttress plating in treating posterior Pilon fracture by amodified posteromedial approach.</p><p><b>METHODS</b>From July 2014 to January 2015, 10 patients with posterior Pilon fracture were respectively analyzed, including 7 females and 3 males, aged from 31 to 54 years old. One patient were type , 3 patients were type IIand 6 patients were type III according to classification of Pilon fracture by YU Guang-rong. All patients were treated by buttress plating through amodified posteromedial approach. Postoperative complications, fracture healing and reduction were observed, AOFAS score were used to evaluate function recovery at 1 year after operation.</p><p><b>RESULTS</b>All patients were followed up for 12 to 18 months with an average of(14.1±3.2) months. All incisions were primarily healed at stage I without wound complication, neurovascular injuries or musculus flexor contracture. According to Burwell-Charnley imaging scoring, 8 patients got anatomical reduction and 2 patients got moderate reduction. All fracture got healing from 12 to 16 weeks with an average of(13.2±1.8) weeks. According to AOFAS score at 1 year after operation, 8 got excellent results and 2 moderate. All patients returned to work at about(4.7±1.4) months (ranged from 3 to 6 months) after operation.</p><p><b>CONCLUSIONS</b>Buttress plating using a modified posteromedial approach in treating posterior Pilon fractures is an effective method, has less complications, and could recovery early weight-bearing functional exercise.</p>

Application of total en bloc spondylectomy in spinal tumors / 中国骨伤

Total en bloc spondylectomy is a surgical technique cutting off tumors of spine and its satellite. Previous studies have shown that this technique could reduce postoperative recurrence rate of spinal tumor, but surgical indications are not unified. Wide application of spinal tumor surgical staging and life expectancy system make it more clear for surgery. However, it is difficult to carry out extensive operation for the characteristics of more bleeding, great difficulty and high risk. As for continuous improvement of TES technology, application of endoscopy and appearance of 3D printing artificial vertebral body could push the operation becoming mature.

Meta plate and cannulated screw fixation for treatment of type Letenneur III lateral Hoffa fracture through posterolateral approach / 中国骨伤

<p><b>OBJECTIVE</b>To explore clinical effect of meta plate with cannulated screw fixation in treating Letenneur III lateral Hoffa fracture through posterolateral approach.</p><p><b>METHODS</b>From June 2012 to June 2016, 12 patients with Letenneur III lateral Hoffa fracture were treated with meta plate and cannulated screw fixation through posterolateral approach, including 8 males and 4 females;aged from 22 to 66 years with an average of 42 years old;and 5 cases on left side, 7 cases on right side. Preoperative and postoperative X-ray and CT were taken before and after operation to assess location of fracture and fracture healing. Letenneur scoring standard was used to evaluate clinical effects. All patients were treated with meta plate combined with cannulated screws.</p><p><b>RESULTS</b>All incisions healed at stage I. The fractures were healed from 11 to 32 weeks with an average of 17.2 weeks. No internal fixation loosening, displacement and necrosis of femoral condyle and deep vein thrombosis of lower extremity occurred. All patients were followed up from 8 to 24 months with an average of 12.8 months. At the latest follow-up, 7 cases got excellent results, 4 good and 1 moderate according to Letenneur scoring standard.</p><p><b>CONCLUSIONS</b>Posterlateral approach is easy to expose, meta plate fixation with cannulated screws has advantages of strong internal fixation, high fracture healing rate, early knee joint function exercise and good recovery of joint function.</p>

Treatment progress on giant cell tumors of bone / 中国骨伤

Giant cell tumors(GCT) of bone is benign bone tumors with aggressive and osteolytic activity. As traditional treatment of GCT, removal of bone graft is disease with high local recurrence rate, and could reduce local recurrence by auxiliary means. Different surgical methods such as prosthesis replacement, wide resection and En-bloc resection could be selected for different parts of giant cell tumor of bone, based on the lesion location, size, extent of invasion, recurrence rate. For patients with special region of GCT of bone with removed incompletely and high surgical risk expected, arterial embolism could be performed. The application of bisphosphonates and denosumab are mainly used in treating recurrent, refractory, special parts, metastatic giant cell tumor of bone will bring new hope of treatment for giant cell tumor of bone, due to lower the recurrence rate. Chemotherapy is mainly used in the treatment of metastasis and malignant bone tumor. Radiotherapy for recurrent or unresectable bone giant cell tumor can control tumor progression, but there is the possibility of malignancy. While long-term follow-up studies and long-term results of applications of bisphosphonates and denosumab are lacking, new methods and development of new drugs are still be needed to treat patients with giant cell tumor of bone and also bring about more hope.

[Current knowledge in the treatment of anterolateral ligament injury of knees].

Although the function of the anterolateral stabilizing structures of the knee in the anterior cruciate ligament (ACL) injuries has been recognized since many years, most of orthopedic surgeons do not take the anterolateral structure into consideration when performing an ACL reconstruction. Anatomic ACL reconstruction will improve knee stability, but a small subset of patients may experience some residual anteroposterior and rotational instability. For this reason, some researchers have paid attention to the anterolateral aspects of the knee, especially the anterolateral ligament. We don't know the best time to perform ACL and ALL reconstruction. And we lack the evidence to prove which technique is the best one. So we look forward to more random controlled trial.