【Abstract】ObjectiveTo facilitate a better understanding of the progress in the research, diagnosis and treatment of PeutzJeghers syndrome (PJS).MethodsAlmost all the papers related to PJS from various magazines published in English and Chinese in recent years were reviewed. Current progresses in PJS research and related diagnosis and treatment were discussed in this review.ResultsPJS is a rare inherited disease with autosomal dominant trait, which is characterized by the presence of hamartomatous gastrointestinal polyps and mucocutaneous pigmentation of the lips, buccal mucosa, and digits. This syndrome is commonly complicated with intestinal obstruction, bleeding, or intussusception,and patients with this disease are at high risk for the development of both GI and extraintestinal malignancies. STK11 on chromosome 19p13.3 are responsible for most cases of PJS. The polyps of PJS tend to have a high incidence of malignant change, and the recurrence of malignancy after treatment is also high. ConclusionThe STK11 has been identified as one of the main genes responsible for PJS and has close correlation with formation and development of tumors. Patients with PJS are at high risk for the development of both GI and extraintestinal malignancies.
【Abstract】ObjectiveTo explore the effect of surgical treatment of metastatic hepatic cancer. MethodsTwo hundred and eight patients with metastatic hepatic cancer received surgical treatment in our department during the past seven years, and their information were analyzed retrospectively in this paper. The ages of these patients ranged from 19 years to 82 years, and 133 of them were male, 75 of them were female. Two of them were complicated with hepatocirrhosis, and 5 with polycystic liver. The metastatic cancer originated from gastrointestinal tract in 121 cases (58.2%), and from other parts of the body in 87 cases (41.8%). One hundred and sixteen of the patients received resection treatment (resection group), and 92 of them received nonresecton treatment (nonresection group). The survival rates of the two groups were compared through Chi square test.ResultsThe 1, 3 and 5year survival rates for all patients were 56.3%,23.1% and 13.0%, respectively. The 1, 3 and 5year survival rates were 74.1%,39.7% and 23.3% in the resection group respectively and 33.7%， 2.2% and 0 in the nonresection group， respectively. Resection group had a higher survival rate than that of the nonresection group (P＜0.05). The main postoperative complications include pulmonary infection (6 cases), subphrenic infection (2 cases), incisional infection (4 cases).ConclusionSurgical resection is an effective treatment method for the patients with metastatic hepatic cancer. Resection should be conducted as long as they could withstand the surgery.
【摘要】 目的 總結腹腔鏡對小兒美克爾憩室的臨床診斷和應用價值。 方法 2005年4月-2009年12月，將41例行美克爾憩室切除術患兒隨機分為兩孔法腹腔鏡手術組和傳統手術組，就手術治療、術后并發癥、術后效果等臨床資料進行對比分析。 結果 腹腔鏡手術組患兒手術時間、術中出血量、下床活動時間、住院時間等均優于傳統手術組；術后并發癥發生例數均明顯少于傳統手術組。 結論 腹腔鏡對患兒美克爾憩室的診斷和治療具有明顯優越性，可作為小兒美克爾憩室治療的首選方式。【Abstract】 Objective To investigate the diagnostic and applicative value of laparoscopy for Meckel’s diverticulum in children. Methods The clinical data of 41 children with Meckel’s diverticulum who underwent resection between April 2005 to December 2009 were retrospectively analyzed. The patients were divided into tow-port laparoscopy-assisted resection group (group A,19 patients) and traditional resection group (group B, 22 patients). The intra-operative accidental injury, postoperative complications, postoperative general condition and prognosis were evaluated via randomized contrast analysis. Results The time of operation, amount of bleeding, recover intestinal peristalsis,out-of-bed activities time and the average days in hospital in group A were less than those in group B. The postoperative complications occurred in one and eight patients in group A and B respectively. Conclusion Laparoscopy had obvious superiority for the children’s Meckel’ s diverticulum in diagnosis and treatment,which should be the best choice.
摘要:目的：探討急性重癥胰腺炎（SAP）早期不同種類液體復蘇對其預后的影響。方法：應用隨機對照的方法,分別對2007年12月~2009年10月同期入院的48例SAP患者,隨機分成兩組,試驗組和對照組。試驗組第一周內液體復蘇采用晶體液和人工膠體（羥乙基淀粉）,對照組采用晶體液,其他治療方法不變。然后統計其第一周死亡率、ARDS、多器官功能障礙綜合征（MODS）發生率,對比兩組患者呼吸頻率、血氧飽和度和紅細胞壓積（HCT）差異,以及兩組患者腸功能恢復時間、住院時間以及并發癥發生率。結果：試驗組的液體復蘇較對照組顯著改善SAP的各項指標（P＜005）。血清乳酸水平（15±05）mmol/L,紅細胞壓積(HCT)為（324±69）%,ScvO2為（817±152）%,病死率83%,MODS發生率333%,〖HT5”H〗結論:〖HT5”SS〗 SAP早期聯合應用晶膠體進行液體復蘇可有效恢復循環血容量和防止體液潴留,顯著提高其治愈率。Abstract: Objective: To investigate the optimal strategy of fluid resuscitation in the early stage ofsevere acute pancreatitis.〖WT5”HZ〗Methods:〖WT5”BZ〗Fourfyeighs SAP patients who received treatment in our hospital from 12,2007 to 10,2009 were randomly divided into 2 groups (n=24) according to the different amounts of crystal and colloid inthe daily resuscitation,including crystal group,combined group(the ratio of crystal to colloid was 2 to 1).The levels of hematocrit(HCT),saturation of central vein oxygen ( ScvO2 ),serum lactic acid as well as the advent of negative fluid balance the amount of fluid contained in the third space,mortality rate and the incidence of multiple organ dysfunction syndrome(MODS) in different groups were compared.〖WT5”HZ〗Results:〖WT5”BZ〗 Compared with crystal group,all the parameters were significantly improved in combined group(P＜005).HCT in the group of patients was(324±69)%,ScvO2 was (817±152)%,lactic acid was(15±05)mmol/L,mortality rate was 83% and MODS incidence was 333%. Conclusion:In the early stage of SAP,fluid resuscitation by a combination of crystal and colloid could effectively restore blood volume, reduce the amount of fluid contained in the third space and significantly improve the prognosis of SAP.
ObjectiveTo summarize a patient diagnosed as Bismuth type Ⅲa hilar cholangiocarcinoma who unerwent the curative surgery combined with partial portal vein resection and reconstruction+hilar bile duct formation+Roux-en-Y choledochojejunostomy, meanwhile we reviewed the current status of surgical treatment of hilar cholangiocarcinoma at home and abroad.MethodsTo retrospectively summarized and analyzed the clinical data of one case of Bismuth type Ⅲa hilar cholangiocarcinoma. The preoperative total bilirubin of this patient was 346.8 μmol/L, and this patient underwent the curative surgery combined with partial portal vein resection and reconstruction+hilar bile duct formation+Roux-en-Y choledochojejunostomy after reducing jaundice by percutaneous transhepatic biliary drainage (PTBD). Then we retrieved domestic and foreign related literatures.ResultsOperative time of this patient was about 290 min and intraoperative bleeding was about 350 mL. No intraoperative blood transfusion occurred. The results of pathological examination showed middle-differentiatied adenocarcinoma of hilar bile duct with negative tumor margins and no regional lymph node metastasis (0/14). The postoperative recovery was uneventful with hospital stay time of 9 days and without any complication. The patient had been followed-up in the outpatient department for 3 years,and was generally in good condition. The evidence of recurrence or metastasis wasn’t found.ConclusionsPre-operative biliary drainage can improve the safety of operation and reduce the incidence of postoperative complications, extend liver resection for the patient with Bismuth type Ⅲa hilar cholangiocarcinoma, which can improve R0 resection rate and extend postoperative survival.