慢性胰腺炎是一种胰腺的进展性和不可逆性炎症病变，最终将导致胰腺结构破坏和内、外分泌功能的丧失。病程通常呈反复发作性，表现为复发性腹痛或慢性无痛综合征。急性胰腺炎、慢性胰腺炎和胰腺癌这三种疾病之间存在着较复杂的关系。急性胰腺炎的发作通常先于慢性胰腺炎几年时间，而胰腺癌往往是在慢性胰腺炎明确诊断后20年左右发生，关于他们在发病上是否存在着一定的序贯性或是有其他短暂的联系，目前仍有争论。一些资料完整的临床病例随访分析提示，长期患慢性胰腺炎的患者发展为胰腺癌的危险性明显高于普通人群。
Objective To analyze clinical features of reoperation patients with differentiated thyroid cancer, and to explore reason, surgical pattern and therapeutic effectiveness of reoperation. Method The clinical data of 80 patients with differentiated thyroid cancer underwent reoperation from January 2012 to June 2016 in Peking Union Medical College Hospital were analyzed retrospectively. Results ① Eighty (5.37%) patients with differentiated thyroid cancer underwent reoperation were identified from a total of 1 491 patients with thyroid cancer in our treatment team. Twenty-seven cases were males, 53 cases were females. The male to female ratio was 1∶1.96. The age was (44±13) years with a range from 14 to 66 years. The median time between reoperation and the first operation was 16.8 months with a range from 8 days to 17 years. ② Thirteen cases underwent reoperation because of uncertain frozen sections, and the reoperation style was residual lobectomy and selective lymph node dissection. Sixty-seven cases underwent reoperation because of local recurrence or metastasis, 15 of them accepted residual lobectomy and selective lymph node dissection while the other 52 accepted selective lymph node dissection. ③ The rate of residual in thyroid cancer confirmed by postoperative pathology was 18.8% (15/80). The rate of cervical lymph node metastasis was 63.8% (51/80). The temporary laryngeal recurrent nerve injury occured in 6 cases, the temporary hypocalcemia occured in 9 cases, and the lymphorrhagia occured in 2 cases. ④ The hospitalization time was (6.50±0.97) d with a range from 3 to10 d, the time of drainage tube remove was (2.41 ±0.95) d with a range from 2 to 7 d. Seventy-three cases were followed up from 3 to 58 months with (32±18) months, 4 of them underwent operation once again because of local recurrence, no distant metastasis or death happened. ⑤ The proportion of male patients in reoperation patients was significantly higher than that of the first operation patients (P<0.05). The proportion of patients aged <45 years, the average hospitalization time, the average time of drainage tube remove, and the postoperative complications rate had no significant differences between the patients with the first operation and the patients with reoperation (P>0.05). Conclusions For reoperation patients, proportion of male patients is higher. Reoperation is proper treatment for patients with residual lobe or local recurrence or metastasis for differentiated thyroid cancer. Serious complications could be avoided by suitable surgical pattern and careful dissection during operation. Residual lobectomy and selective lymph node dissection are suggested for reoperation.
ObjectiveTo sum up the diagnosis and treatment of adult ileal duplication with clinical cases from Peking Union Medical College Hospital (PUMCH). MethodsSix cases of adult ileal duplication admitted in our hospital from February 1996 to December 2010 were analyzed. Different assistant investigations were supposed to different patients due to the chief complaints including gastroscope, colonoscopy, abdominal CT scan, arteriography, 99Tcm radionuclide imaging, and double-balloon intestinal endoscope. None was made a definite diagnosis before operation with only one uncertain case. All cases received operation and pathological examination. Results All cases admitted were male. The chief complaints included intestinal bleeding, abdominalgia, intestinal obstruction, and abdominal mass. Five out of six patients received gastroscope, colonoscopy, and abdominal CT scan while three received mesenteric arteriography, but none was found any suggestion for ileal duplication. Even 99Tcm radionuclide imaging pointed out only two with abnormal abdominal bleeding. Three received doubleballoon intestinal endoscope, paying attention that only one discovered with ileal duplication. In a concluding, none was made a definite diagnosis before operation with only one uncertain case. All the cases received operation. The duplications of ileum in the length of 6-25 cm were found at the site of 11-100 cm proximal to ileocecum during the operation. Pathological report confirmed the clinical diagnosis of all cases with adult ileal duplications． Two cases were found with ectopic gastric mucosa, another two with diverticulum, and one with ectopic pancreas， in addition the remaining with inflammatory fibrous pseudotumor. Prognosis were good for all after operation. ConclusionsIleal duplications are rarely seen in adults, gender prefer male． Without specific clinical symptoms and inspections, definite diagnosis before operation is hard to make. But maybe doubleballoon intestinal endoscope and 99Tcm radionuclide imaging can give out positive result. Surgeons should be aware of this condition when performing abdominal exploration. Once discovered, resection is necessary.
ObjectiveTo investigate the long-term efficacy of laparoscopic cholecystectomy (LC) for gallbladder cancer.MethodThe clinical data of 52 patients with gallbladder cancer only underwent LC from January 1998 to December 2018 in the Peking Union Medical College Hospital were analyzed retrospectively.ResultsFifty-two patients met the inclusion criteria were included, including 23 males and 29 females. The age was (67±12) years. Fifty-two patients were treated with LC because of gallbladder occupying or gallstone. Twenty-three patients were diagnosed as incidental gallbladder cancer after the surgery, while 29 patients were diagnosed as the gallbladder cancer before or during the operation. Eleven patients with T1a lesions received the close follow-up, the other 41 patients refused the radical operation due to the advanced age, severe underlying diseases or their own preferences. Five cases of postoperative complications were observed. All patients were followed-up for (40.2±33.8) months, 21 patients survived and 31 died. The dead patients had an older age, longer hospital stays, and later T stage (P<0.050) as compared with the living patients. The patients with T1a lesions had significantly longer survival time than those with T1b and above (113.5 months versus 39.6 months, P<0.001).ConclusionsLC is a radical operation in T1a lesions. At the same time, it can meet the requirements of postoperative life quality for some special patients due to its safety and low postoperative complication rate.
ObjectiveTo investigate the effect of combined or non-combined liver resection for T2a gallbladder cancer. MethodsAccording to the established inclusion and exclusion criteria, the patients with T2a gallbladder cancer admitted to Peking Union Medical College Hospital from January 2016 to December 2021 were retrospectively collected, then were assigned into combined with liver resection group and non-combined with liver resection group. The general characteristics, perioperative information, and prognosis of the two groups were compared. ResultsA total of 58 patients were enrolled in this study, including 23 males and 35 females; aged (64.8±11.1) years. There were 43 cases in the combined with liver resection group and 15 cases in the non-combined with liver resection group. There were no statistic differences in the demographic data, lifestyle, onset symptoms, preoperative combined diseases, and preoperative tumor markers between the two groups (P>0.05). Compared with the combined with liver resection group, the proportion of patients received bile duct resection was higher (P=0.013) and the operation time was shorter (P=0.045) in the non-combined with liver resection group. There were no statistic differences in the other perioperative informations between the two groups (P>0.05). A total of 12 patients had postoperative complications, including 3 cases of grade Ⅰ, 8 cases of grade Ⅱ, and 1 case of grade Ⅲa by Clavien-Dindo classification. All patients improved after treatment and were discharged smoothly. No patient was readmitted within 30 d after discharge. All 58 patients were followed up with a median follow up time of 29 months. During the follow-up period, there were 47 cases (81.0%) of tumor-free survival, 2 cases (3.4%) of survival with tumor, and 9 cases (15.5%) of death. There were no statistic differences in the overall survival and disease-free survival between the two groups by log-rank test (χ2=3.418, P=0.064; χ2=1.543, P=0.214). ConclusionFromthe results of this study, for T2a gallbladder cancer, liver resection would not result in increased complications or longer hospital stay, but don’t obviously improve prognosis.