【Abstract】ObjectiveTo review the status and controversy on skinsparing mastectomy (SSM) for breast cancer. MethodsThe pertinent literatures about SSM published recently to comprehend its relevant techniques and improvements in comparison with nonskinsparing mastectomy (NSSM) were analyzed and also the safety of SSM by analyzing the relationships between SSM and ductal carcinoma in situ, restrict nippleareola complex reservation, and postmastectomy radiotherapy were discussed. ResultsSkinsparing mastectomy combined with immediate breast reconstruction is a safe operative modality for T1/T2 tumor without skin adhesion, multicentric tumors, and ductal carcinoma in situ. What is more, it does not defer adjuvant therapy. However, it may be prudent to reserve the nippleareola complex only for peripherally located T1/T2 tumors and some other less serious invasion degree. Since the effect of SSM and immediate breast reconstruction on postmastectomy radiotherapy is confusing, there are still controversies on whether the patients who have already been operated should take radiotherapy. ConclusionSSM is a safe operative modality for selected patients with breast cancer, and delayed reconstruction may be a good choice for patients who would take postmastectomy radiotherapy.
Objective To investigate efficacy and safety of laparoscopic lymphadenectomy combined with pelvic autonomic nerve preservation in patients with rectal cancer. Methods Seventy-three patients underwent D3 radical resection of rectal cancer with pelvic autonomic nerve preservation from March 2015 to October 2016 in the People’s Hospital of Pengzhou City were collected, then were divided into a laparoscopic surgery group (38 cases) and an open surgery group (35 cases) according to the choice of operation. The intraoperative and postoperative indexes were compared between these two groups, and the urination and sexual functions at preoperation and on month 1 after operation for male patient with rectal cancer were evaluated. Results ① The age, gender, tumor diameter, TNM stage, and tumor location had no significant differences between these two groups (P>0.05). ② Compared with the open surgery group, the intraoperative blood loss was less (P<0.05), but the operation time was longer (P<0.05) in the laparoscopic surgery group. The number of lymph node dissection had no significant difference between these two groups (P>0.05). ③ The anal exhaust time and hospitalization stay in the laparoscopic surgery group were significantly shorter than those in the open surgery group (P<0.05), and the incidences of postoperative infection, intestinal adhesion, and intestinal obstruction were significantly lower in the laparoscopic surgery group as compared with the open surgery group (P<0.05). ④ The IPSS score of urination function and the IIEF-5 score of sexual function on month 1 after operation had no significant differences between these two groups (P>0.05), but compared with the preoperative points, the IPSS score was significantly increased, the IIEF-5 score was significantly decreased in the same group (P<0.05). Conclusion The preliminary results of limited cases in this study show that laparoscopic lymphadenectomy combined with pelvic autonomic nerve preservation in patients with rectal cancer is safe and effective, it has some advantages of mild invasion, lower complication rate, and fast covery.
Objective To investigate the risk factors and preventions of functional delayed gastric emptying (FDGE) after pylorus-preserving pancreatoduodenectomy (PPPD). Methods The clinical data of 41 patients after undergoing PPPD between 2003 and 2009 in this hospital were analyzed retrospectively.Results In all 41 cases, postoperative complications developed in 13 patients (31.7%), in which 7 patients developed FDGE (17.1%). The complications excluding FDGE (P=0.010) and diabetes (P=0.024) had remarkable relations with the FDGE in the univariate analysis; Compared with the non-FDGE patients, the albumin was declined obviously (P=0.020) while the serum direct bilirubin increased significantly (P=0.036) in the FDGE patients, while the development of FDGE had relation only with the albumin (P=0.039) and the complication of diabete (P=0.047) by the binary logistic regression analysis. Conclusion In the patients undergoing PPPD, preoperative control of the blood glucose, preoperative correction of hypoproteinemia and hyperbilirubinemia, and centralizing PPPD in high-volume have possibly positive significance for the prevention of FDGE.
【Abstract】 Objective To explore the flexibil ity and rel iabil ity of cementless total knee arthroplasty (TKA) without patellareplacement through a retrospective study of the mid-term therapeutic effect of the treatment of the patients. Methods FromJune 1997 to March 2000, a consecutive series of 152 (152 knees) cementless TKA performed in Hessing-Stiftung was studied. Among them, there were 63 males and 89 females, with 70 left knees and 82 right knees. Their ages ranged from 51 years to 72 years, with an average of 59 years. There were 146 cases of osteoarthritis and 6 cases of traumatic arthritis. The course of the disease lasted for 1.0 years to 3.5 years. The EFK prostheses of German Plus company were used in all the cases. The HSS score before the operation was 41.5 ± 12.3, and the average range of motion was 55º (ranging from 30º to 90º). Results Five patients underwent anterior knee pain, and the pain was released after the appropriate treatment. No deep infection happened in all cases. A total of 145 patients (145 knees) were followed up for 5 years to 8 years. The HSS score was 87.5 ± 8.2 at the end of the follow-up, showing significant difference (P lt; 0.05). The average range of motion was 95º (ranging from 90º to 110º). Partial radiolucencies occurred at the tibia side in 18knees 3 to 6 months after the operation. Among them, the width was less than 2 mm in 15 knees without symptom, and more than 2 mm in 3 knees. There were 2 of the 3 knees which were revised at the tibia side because of the aseptic loosing, while 1 patient had only mild pain in the knee during the follow-up, with no sign of loosing. Conclusion The mid-term effect of cementless TKA is satisfactory. The ingrowth of femur and tibial bones is rel iable. The early stage migration of the component is the main reason of loosing. Satisfying outcomes can also be achieved without patella replacement during TKA.
目的 探讨保留幽门的胰十二指肠切除术的手术疗效和手术并发症的发生率。方法 回顾性总结解放军第401医院肝胆外科自2004年4月至2010年6月期间所行的37例保留幽门的胰十二指肠切除术的手术体会，术后并发症发生情况，以及术后生存率。结果 本组患者总并发症发生率为18.9% （7/37），其中胃排空障碍1例， 胰瘘3例，肺部感染2例，切口感染1例。无胆瘘、十二指肠空肠吻合口漏、消化道应激性出血等并发症发生。37例患者全部获随访，随访时间为6～54个月，平均31.4个月。1年生存率为75.7% （28/37），2年生存率为56.3% （18/32），3年生存率为34.6% （9/26）。结论 保留幽门的胰十二指肠切除术不影响胰头癌、壶腹周围癌根治的彻底性，手术并发症低，术后恢复快，是一种安全有效的手术方式。
ObjectiveTo observe the effect of preserving tibial residual fibers on the expressions of ligament remodeling related genes in rabbit anterior cruciate ligament (ACL) reconstruction model. MethodsSixty healthy adult New Zealand white rabbits were randomly divided into 4 groups:normal control group (group A, n=6) , sham-operation group (group B, n=18) , non tibial remnant preserved group (group C, n=18) , and tibial remnant preserved group (group D, n=18) . At 2, 6, and 12 weeks after operation, the ligament tissue was harvested to detect the mRNA expressions of collagen type 1A1(COL1A1) , collagen type 3A1(COL3A1) , transforming growth factor β1(TGF-β1), vascular endothelial growth factor (VEGF), growth-associated protein 43(GAP-43) , and neurotrophin 3(NT-3) by real-time fluorescent quantitative PCR. ResultsAt each time point, there was no significant difference in the mRNA expressions of COL1A1, COL3A1, VEGF, and NT-3 between group A and group B (P>0.05) . In group D, the mRNA expressions of COL1A1, COL3A1, TGF-β1, and GAP-43 significantly increased when compared with those of group C at 6 weeks after operation (P＜0.05) ; an increased level of VEGF mRNA was also detected in the group D at 12 weeks after operation (P＜0.05) ; and an increased level of NT-3 mRNA was also observed in group D at 2 and 12 weeks after operation (P＜0.05) . ConclusionThere is a time-dependent manner of angiogenesis-promoting, repair-related, and nerve-related gene expressions after ACL reconstruction with preserving tibial residual fibers during the process of ligamentization. Furthermore, the remnant preservation in ACL reconstruction can promote the expressions of related genes in some time points.
ObjectiveTo evaluate and synthesize the available experiences related to laparoscopic duodenum-preserving pancreatic head resection (LDPPHR) in the management of benign pancreatic head lesions. MethodsA retrospective review of the clinical data was conducted for 12 patients who underwent LDPPHR at the Department of Hepatobiliary and Pancreatic Surgery, Second Affiliated Hospital of Kunming Medical University (between January 2020 and December 2024). ResultsAll 12 patients successfully underwent LDPPHR. The surgical duration ranged from 138 to 479 min, with a mean of 336 min. Intraoperative blood loss varied between 40 and 700 mL, averaging 270 mL. The hospital stay varied from 11 to 51 d, with a mean duration of 21.5 d. Notably, none of the 12 patients required blood transfusions during the procedure. Of the 12 patients, 6 were diagnosed with a pancreatic fistula postoperatively, including 5 cases classified as grade A pancreatic fistula, and 1 cases of grade B pancreatic leakage. There were 2 cases of bile leakage and 1 case of gastric emptying disorder. No deaths occurred during the perioperative period. Postoperative pathological examination revealed: chronic pancreatitis witch main pancreatic duct stones in 8 cases, intraductal papillary mucinous neoplasms with low-grade epithelial intraepithelial neoplasia in 3 cases, serous cystadenoma in 1 case. Postoperative follow-up was conducted for 10 patients, with follow-up durations ranging from 6 to 24 months. No recurrence was observed during the follow-up period, and no long-term complications such as diabetes, gastric emptying dysfunction, etc. were reported. ConclusionsLDPPHR offers several benefits, including minimal invasiveness, faster recovery, and enhanced postoperative quality of life for patients. It is safe and feasible for the treatment of benign lesions in the head of the pancreas.
ObjectiveTo compare the efficacy and compliance of children children with refractory epilepsy receiving ketogenic diet (KD) in outpatient department with children receiving KD treatment in inpatient department. MethodsA retrospective study of 44 children with intractable epilepsy receiving the modified classical ketogenic diets in outpatient department from June 2014 to December 2015, who were followed-up during the third, sixth and twelfth month. Records of epileptic seizures and adverse reactions were used to evaluate the efficacy and retention rate of inpatient department KD treatment in children with refractory epilepsy, and compared with 104 children receiving KD treatment in inpatient department at the same period. ResultsThirty-four of the forty-four children comleted observation after 12-month follow-up, 15 cases had been seizure freedom, 22 cases had more than 50% reduction in seizure frequency, 12 patients had less than 50% reduction in seizure frequency.The total effective rate of the KD therapy in outpatient department was 64.7%, and the retention rate was 71%. 18 of of the 104 children with KD treatment in inpatient department at the same period comleted observation after 12-month follow-up, 3 cases had been seizure freedom, 5 cases had more than 50% reduction in seizure frequency, 13 cases had less than 50% reduction in seizure frequency.The total effective rate of the KD therapy in inpatient department was 27.8%, and the retention rate was 17.3%. ConclusionThe KD therapy in outpatient department is effective to children with intractable epilepsy, and there is a highly efficacy and compliance of children receiving KD in outpatient department comparing with children receiving KD in inpatient department. Therefore, it's optional to children with refractory epilepsy who can't received KD by inpatient department because of insufficient number of beds.