In order to observe the morphological feature and blood supply of the pedicled trapezius myocutaneous flap, dissection was carried out on 114 sides of 54 cadavers. It was demostrated that trapezius muscle had multiple sources for its blood supply, including (1) dorsal scapular artery; (2)transvers cervical artery; (3) occipital artery and (4)spinal perforating artery. The dorsal scapular artery may originate from the same stem with the transvers cervical artery (68.4%), or originate seperatly (31.6%). Thirteen patients had radical resection for malignant tumour of head and neck, and were combined with pedicled trapezius myocutaneous flap, in which 6 with upper trapezius myocutaneous flap and 7 with lower trapezius myocutaneous flap. The results were fairly good. the advantages and disadvantages of the lower and upper trapezius myocutaneous flaps as well as the pectorlis major myocutaneous flap were discussed.
Objective To explore the impact of the severity of low anterior resection syndrome (LARS) on the quality of life in patients with rectal cancer. Methods Literatures published from January 2012 to August 2020 in the Cochrane Library, PubMed, Embase, CNKI, WanFang and other databases were searched according to the search terms. Study screened, data extracted, and quality evaluated were conducted by three reviewers independently, and the RevMan 5.4 software was used for meta-analysis. Results Seven studies, involving 1 616 patients were included. Meta-analysis results showed that the functional scores (including overall health status, physiological functioning, role functioning, emotional functioning, cognitive functioning, and social functioning) of patients with major LARS were lower than those of patients with no/minor LARS (P<0.001). Except for appetite loss, the symptom score (including fatigue, nausea and vomiting, pain), shortness of breath, insomnia, constipation, diarrhea, and financial difficulties of patients with major LARS were higher than those of patients with no/minor LARS (P<0.01). Conclusion Major LARS has a greater impact on the quality of life of patients after surgery than no/minor LARS.
Objective To summarize the application and progress of common autologous organ transplantation (AOT) techniques. Method A literature review and summary of previous and recent studies on common AOT was performed, including autologous liver transplantation, autologous kidney transplantation and intestinal autotransplantation techniques. Results AOT solved the issues of bleeding that cannot be controlled by in vivo resection of lesions, difficulties in vascular reconstruction, and the inability to radically resect lesions, and extended the indications for treatment of partially diseased conditions. Conclusions The AOT technique has an ameliorating effect on the tight donor situation in China, providing more potential donors. And the application of the AOT technique effectively avoids the usage of postoperative immunosuppressive drugs and the progression of lesions due to waiting for allogeneic organ transplantation. However, the clinical benefit in malignant tumors remains to be further investigated.
ObjectiveTo explore the effectiveness of the usage of artificial bone of tricalcium phophate in sellar floor reconstruction after transsphenoidal microsurgery for pituitary adeoma. MethodsBetween January and December 2014, 85 patients with pituitary adema underwent transsphenoidal microsurgery, and the clinical data were retrospectively analyzed. "Sandiwich" was used for sellar floor reconstruction in 46 cases (control group), and "sandiwich" combined with the artificial bone of tricalcium phophate in 39 cases (trial group). There was no significant difference in gender, age, disease duration, size of tumor, invasiveness, and the degree of damage to the sellar floor between 2 groups (P>0.05). ResultsTotal removal and subtotal removal of tumors were achieved in 39 cases and 7 cases of the control group, and in 33 cases and 6 cases of the trial group, showing no significant difference between 2 groups (Z=-1.303, P=0.193). Cerebrospinal leakage occurred in 8 cases of the control group and in 10 cases of the trial group during operation, showing no significant difference (Z=-1.748, P=0.080). The case number of cerebrospinal leakage in the control group (4 cases) was significantly more than that in the trial group (0) after operation (P=0.020). The time of gauze removal in the trial group (3 days) was significant shorter than that in the control group[(4.3±1.6) days] (t=2.236, P=0.033). The patients were followed up 3-14 months in the control group and 5-13 months in the trial group. No cerebrospinal leakage occurred during follow-up. ConclusionSellar floor reconstruction with artificial bone of tricalcium phophate is safe, and it can reduce cerebrospinal leakage and shorten the time of gauze removal.
The effect of proximal subtotal or total gastrectomy by choosing abdominal median incision plus left 7-9 ribs resection in 32 cases of upper gastric cancer had been studied. There was 1 case of residual tumor cells at the esophageal margin, 1 case of hydrothorax and hydrops of costal bed, no costal chondritis, pneumothorax and fistula formation. We consider that it is better to choose abdominal median incision plus left ribs resection in patients with upper gastric cancer in which subphrenic esophageal invasion is under 2cm of length and the function of heart or lung is severely damaged.
From 1972 to 1990,121 cases of bone tumor were treated by segmental resection of tumor and followed by artifical joint re- placement. All of the prostheses were designed and manufactured by our hospital. One hundred and two cases were followed up for an average of 7.4 years and the curative rate with the affected limbs preserved was 85.28%. The indication, the advantages and disadvantages, the material and the type of artifical joints, and the assessment of functional reconstruction following operation were discussed.
We reviewed the clinical studies on drug therapy for gallbladder cancer and expounded on the current situation of conversion therapy for gallbladder cancer. Gallbladder cancer was usually diagnosed late, with high malignancy, low surgical resection rate, and poor prognosis. With the development of conversion therapy, systemic therapy combined with radical resection had effectively improved the surgical resection rate and prognosis of gallbladder cancer patients. At present, most of the published conversion therapies for gallbladder cancer were mainly retrospective researches, lacking large multicenter prospective research, and the treatment plan was still based on chemotherapy, lacking the research of targeted therapy in combination with immunotherapy. It is expected that more high-quality clinical trials can be made first-line recommendations for the conversion therapy of gallbladder cancer.
ObjectiveTo identify the risk factors of postoperative recurrence and survival for patients with hepatocellular carcinoma within Milan criteria following liver resection. MethodsData of 267 patients with hepatocellular carcinoma within Milan criteria who received liver resection between 2007 and 2013 in our hospital were retrospectively analyzed. ResultsAmong the 267 patients, 123 patients suffered from recurrence and 51 patients died. The mean time to recurrence were (16.9±14.5) months (2.7-75.1 months), whereas the mean time to death were (27.5±16.4) months (6.1-75.4 months). The recurrence-free survival rates in 1-, 3-, and 5-year after operation was 76.8%, 56.3%, and 47.6%, respectively; whereas the overall survival rates in 1-, 3-, and 5-year after operation was 96.6%, 82.5%, and 74.5%, respectively. Multivariate analyses suggested the tumor differentiation, microvascular invasion, and multiple tumors were independent risk factors for postoperative recurrence; whereas the tumor differentiation, positive preoperative HBV-DNA load, and preoperative neutrophil-to-lymphocyte ratio adversely influenced the postoperative survival. ConclusionsFor patients with hepatocellular carcinoma within Milan criteria after liver resection, the tumor differentiation, microvascular invasion, and multiple tumors contribute to postoperative recurrence; whereas the tumor differentiation, positive preoperative HBV-DNA load, and preoperative neutrophil-to-lymphocyte ratio adversely influence the postoperative survival.
ObjectiveTo explore the security and feasibility of simultaneous laparoscopic surgery for synchronous colorectal cancer liver metastasis (SCRLM). MethodThe data of 36 patients underwent simultaneous surgery for SCRLM in the Division of Gastrointestinal Surgery, Department of General Surgery, West China Hospital of Sichuan University from March 2015 to December 2021 were retrospectively collected, and the perioperative outcomes, postoperative morbidity and survival were analyzed. ResultsThe surgical procedure of all 36 enrolled patients were accomplished. The operation time was (328.9±85.8) min. The intraoperative blood loss was 100 (50, 150) mL and 4 cases (11.1%) needed intraoperative transfusion. The time to first flatus was (2.9±0.8) d and the time to liquid diet was (3.2±1.0) d. The average postoperative VAS score was 1.9±0.3. The postoperative length of stay was (6.8±4.3) d, 5 (13.9%) cases developed postoperative complications, which were cured by conservative treatment. No severe complications and death occurred within 30 days after surgery. After a median follow-up of 24.7 months, 15 cases (41.7%) experienced recurrence or metastasis and 1 case (2.8%) died. The 1-, 2- and 3-year disease-free survival rates were 89.8%, 55.0%, 29.2%, respectively. The 1-, 2- and 3-year overall survival rates were 100.0%, 100.0%, 87.5%, respectively. There was no significant differences in disease-free survival rates (χ2=1.675, P=0.196) and OS (χ2=0.600, P=0.439) between patients with (n=26) or without (n=10) neoadjuvant. ConclusionsSimultaneous laparoscopic surgery seems to be a secure and feasible strategy for patients with SCRLM, with considerable survival benefits and short-term outcomes including small incision, little bleeding, quick recovery and low complication rate. More high-quality clinical studies are desirable in the future to further confirm the efficacy and safety of this operation.
Objective To explore the influencing factors for pulmonary infection after radical resection of colon cancer. Methods A cohort study included 56 patients who underwent radical resection of colon cancer in People’s Hospital of Daye City from Oct. 2014 to Oct. 2016 were followed-up prospectively, to observe the occurrence of pulmonary infection, and collectting the related factors for pulmonary infection in addition. Results The clinical data of 53 patients were finalized and the clinical data of these patients were complete. Among them, 13 patients suffered from pulmonary infection after radical resection of colon cancer, and 40 patients had no obvious exacerbation and no complicated pulmonary infection. Results of logistic regression showed that, value of forced expiratory volume in1 second/forced vital capacity (OR=1.174, P=0.033), operative time (OR=1.638, P=0.012), levels of postoperative copeptin (OR=1.328, P=0.032), and procalcitonin (OR=1.465, P=0.042) were risk factors for pulmonary infection after radical resection of colon cancer. Receiver operating characteristic curve (ROC) showed that, operative time was 6.207-hour, postoperative copeptin level was 10.420 pmol/L, and the postoperative procalcitonin level was 3.676 ng/mL, which had the best predictive effect on predicting pulmonary infection after radical resection of colon cancer. Conclusions Value of forced expiratory volume in 1 second/forced vital capacity, operative time, levels of copeptin and procalcitonin after operation are the independent influencing factors for pulmonary infection after radical resection of colon cancer, and it has best prognostic outcome when the operative time is 6.207-hour, postoperative copeptin level is 10.420 pmol/L, and the postoperative procalcitonin level is 3.676 ng/mL.