目的 总结胰腺瘘管空肠Roux-en-Y吻合术治疗胰管离断综合征的治疗效果。方法 回顾性分析2002年3月至2010年7月期间我院行胰腺瘘管空肠Roux-en-Y吻合术治疗的5例胰管离断综合征患者的临床资料，分析其治疗效果及手术并发症。结果 5例患者均为急性出血坏死性胰腺炎手术治疗后，经MRCP确诊为胰管离断综合征，手术方式为瘘管空肠Roux-en-Y吻合术，中位手术时间为178min（120～360min），中位术中失血量为300ml（150～600ml），术后中位进食时间为5d（3～8d）。随访中位时间为390d（120～712d），5例患者恢复顺利。2例患者切口感染，经切口换药治愈；1例患者出现短暂的胰肠吻合口漏，经保守治疗治愈。结论 从本组有限的病例资料看，胰腺瘘管空肠Roux-en-Y吻合术是胰管离断综合征较安全的治疗方式。
Objective To summarize the experiences in diagnosis and treatment for iatrogenic injury of cholodocho-pancreatico-duodenal junction （CPDJ）. Method The clinical data of 9 patients with CPDJ injury were analyzed retro-spectively. Results Double lumen tube drainage was emplaced in all the operations. Nutrition support and inhibitor ofpancreatic secretion were applied in all the patients. ①CPDJ injuries were observed intraoperatively for 6 out of 9 patientswith CPDJ injury. Two patients with simple perforation of posterior wall of common bile duct inferior segment and 2patients with simple duodenal perforation who were treated by perforation repair， common bile duct T tube drainage， andperitoneal drainage. Two cases of bile duct or duodenal injury with pancreatic injury were treated by choledochojejunostomyand BillrothⅡgastrojejunostomy. These 6 patients with CPDJ injury were cured and none of case was death. ②Injuries of CPDJ were observed postoperatively for 3 out of 9 patients with CPDJ injury. Total bile diversion or total bile diversion with duodenal diverticulum were performed in 2 cases of bile duct or duodenal injury with pancreatic injury， respectively. The one with total bile diversion only was died of abdominal infection， duodenal fistula， wound dehiscence， abdominal and upper gastrointestinal tract bleeding， and multiple organ failure；the one with total bile diversion with duodenal diverticulum and the one with sequent PTCD and choledochojejunostomy for biliary obstruction caused by operation ofgigantic duodenal interstitialoma were cured. Conclusions CPDJ injury usually occurs in biliary duct exploration， endoscopic sphincterectomy or duodenal operation. It is easily misdiagnosed and serious consequences may happen from this. Timely and correct treatment should be taken according to the specific injury observed during or after the operation.
Objective To summarize the research progress of transanal total mesorectal excision (TaTME) for rectal cancer. Methods The literatures about current status, limitations, and prospects of TaTME in China and abroad were collected to make an reviewe. Results TaTME is conformed to the principle of total mesorectal excision (TME), by using the ‘bottom-up’ approach and assisting in the laparoscopic technique platform, to ensure an adequate oncological distal margin, and it could improve the quality of the mesorectum specimens, reduce the circumferential margin involvement rate, afford more precise autonomic nerve preservation rate, and increase sphincter preservation rate. But it is also facing new complications, oncological and functional outcomes problems. Conclusions Although the experience with TaTME remains limited, the safety, feasibility, and short-term outcomes are acceptable. Nevertheless, there is a need for multicenter, large sample size, and long-term follow-up clinical studies focusing on the long-term outcomes to further improve the oncological safety of TaTME, before widespread application can be recommended.
ObjectiveTo investigate the effect and prognosis of emergency hepatectomy and second stage hepatectomy after transcatheter arterial chemoembolization (TACE) in spontaneous rupture and bleeding of resectable primary liver cancer.MethodsA total of 42 patients with spontaneous rupture and bleeding of resectable primary liver cancer in this hospital from January 2010 to January 2016 were retrospectively reviewed. Among them 24 cases had accepted the emergency hepatectomy in 24 h–48 h after admission (emergency hepatectomy group, n=24), 18 cases had accepted the second stage hepatectomy in 1 week–2 weeks after the TACE (second stage hepatectomy group, n=18), the intraoperative blood loss and intraoperative blood transfusion volume, perioperative mortality, postoperative incidence of hepatic insufficiency, recurrence rate and abdominal metastasis rate within 1 year after the operation, 1- and 3-year survival rates were compared between the emergency hepatectomy group and the second stage hepatectomy group.ResultsThere was no significant difference in the preoperative general data between these two groups (P>0.050). The intraoperative blood loss and transfusion volume of the emergency hepatectomy group were significantly more than those of the second stage hepatectomy group (P=0.028, P=0.017). There were no significant differences in the perioperative mortality (P=0.489), incidence of hepatic insufficiency (P=1.000), 1- and 3-year survival rates (P=0.650, P=0.463) and 1-year recurrence rate (P=0.601) between these two groups. No intraperitoneal implantation metastasis was found in these two groups.ConclusionBoth emergency hepatectomy and second stage hepatectomy after TACE are safe and effective in treatment of spontaneous rupture and bleeding of resectable primary liver cancer, appropriate treatment should be selected according to the specific conditions of patients.
ObjectiveTo observe the impact of antiviral therapy on prognosis in patients after curative resection for hepatitis B virus (HBV)-related hepatocellular carcinoma (HCC). MethodsThe data of 50 patients who had undergone liver resection for HBV-related HCC in our department from August 2008 to June 2012 were retrospectively analyzed. The patients were divided into two groups:21 patients who had not antiviral therapy (untreated group) and 29 patients who received antiviral therapy using nucleotide analogues (antiviral therapy group). ResultsAfter radical resection of HCC, the disease-free survival rate of 1-year, 3-year, and 5-year were 72.4%, 58.6%, and 31.0% in antiviral therapy group and 61.9%, 38.1%, and 14.3% in untreated group, respectively. The overall survival rate of 1-year, 3-year, and 5-year were 86.2%, 68.9%, and 55.2% in antiviral therapy group and 71.4%, 47.6%, and 28.6% in untreated group, respectively. The cumulative disease-free survival rate and overall survival rate of antiviral therapy group were significantly higher than those in the untreated group (P < 0.05). Univariate analysis revealed that the number of tumor, antiviral therapy, and TNM staging were risk factor for tumor-free survival rate, The tumor size, the number of tumor, antiviral therapy, and TNM staging were risk factor for overall survival rate. Multivariate analysis revealed that the number of tumor and TNM staging were independent risk factor for tumor-free survival rate (OR:2.95, 95% CI:1.502-6.114, P < 0.05; OR:4.12, 95% CI:1.972-8.960, P < 0.05), the antiviral therapy and TNM staging were independent risk factor for overall survival rate (OR:3.86, 95% CI:1.745-7.028, P < 0.05; OR:5.17, 95% CI:2.356-11.479, P < 0.05). ConclusionUsing nucleotide analogs antiviral therapy may improve the prognosis after resection of patients with HBV-related HCC.
Objective To investigate the mechanism of bone morphogenetic protein-4 (BMP4) in promoting the recovery of small intestinal mucosal barrier function during the recovery period of small intestine ischemia-reperfusion (I/R) injury. Methods Twenty-eight C57BL/6J male mice aged 6–8 weeks were randomly selected and assigned to small intestine I/R group (n=24) and sham operation (SO) group (n=4) by random number table method. Small intestine I/R injury models of 24 mice were established, then 4 mice were randomly selected at 6, 12, 24 and 48 h after I/R established modeling and killed to observe the morphological changes of small intestinal mucosa and detect the expression of BMP4 mRNA in the jejunal epithelial cells, the other 8 mice were allocated for the experimental observation at the recovery period of small intestine I/R injury (24 h after I/R was selected as the observation time point of recovery period of small intestine I/R injury according to the pre-experimental results). Twelve mice were randomly divided into I/R-24 h-BMP4 group (recombinant human BMP4 protein was injected intraperitoneally), I/R-24 h-NS (normal saline) group (NS was injected intraperitoneally), and I/R-24 h-blank group (did nothing), 4 mice in each group. Then the small intestinal transmembrane electrical impedance (TER) was measured by Ussing chamber. The expressions of BMP4 protein and tight junction proteins (occludin and ZO-1), Notch signaling pathway proteins (Notch1 and Jagged1), and Smad6 protein were detected by Western blot. Results At 24 h after I/R injury, the injuries of villous epithelium, edema, and a small part of villi were alleviated. The BMP4 mRNA expressions at 6, 12, 24 and 48 h after I/R injury in the small intestinal epithelial cells were increased as compared with the SO group. Compared with the I/R-24 h-NS group and the I/R-24 h-blank group, the TER was increased, and the expression levels of occludin, ZO-1, p-Smad6, Notch1, Jagged1 were increased in the I/R-24 h-BMP4 group. Conclusion From the preliminary results of this study, during recovery period of small intestine I/R injury, the expression of BMP4 in small intestinal epithelial cells is increased, permeability of jejunal mucosal barrier is increased, which might promote the recovery of small intestinal mucosal barrier function by activating the Notch signaling pathway (Notch1 and Jagged1), Smad classic signaling pathway, and promoting the increase of tight junction protein expression (occludin and ZO-1).
目的 探讨成人先天性胆总管囊肿的诊治方法和手术技巧。方法 对2001年5月至2011年5月期间我院手术治疗的成人先天性胆总管囊肿38例的临床资料进行回顾性分析。结果 全部病例均行B超和磁共振（MRCP）检查确诊，均行手术治疗。其中7例行急诊囊肿外引流术。行择期手术者中24例行囊肿切除、胆肠吻合术，其中3例合并肝叶切除术； 行内引流术4例； 仅行胆囊切除术3例。囊肿剥除采用点状钳夹、电凝及推剥囊肿黏膜外纤维血管束的办法，不出血，无副损伤。无手术死亡病例，术后恢复顺利。38例患者中术后获随访28例（73.68％），失访10例； 随访时间 3～120个月，平均74个月。24例行囊肿切除者症状消失20例，偶感上腹痛、抗炎治疗后症状可缓解1例，3例失访；11例行内或外引流术者术后近期均有不同程度的胆管炎症状，其中6例于术后2～10 年再手术，另5例失放，6例再手术者中2例术中发现癌变，分别于再手术后2个月和10个月死亡，余4例临床症状消失；3例仅行胆囊切除术者，2例失访，1例仍有反复发作的畏寒、发热及右上腹痛。结论 B超和MRCP检查有助于明确诊断； 囊肿全切除、肝管空肠Roux-en-Y 吻合术应作为胆总管囊肿的首选术式，囊肿外引流术仅在合并严重感染、全身情况差的患者采用； 手术技巧的改进可为手术提供安全保障。
目的 分析肝脏良性肿瘤的临床诊断、治疗及治疗效果。方法 对川北医学院附属医院2008年2月至2011年2月期间收治并经术后病理学检查证实为肝脏良性肿瘤的156例患者的临床资料进行回顾性分析。结果 156例患者中肝血管瘤119例，肝细胞腺瘤13例，肝内胆管囊腺瘤3例，肝局灶结节性增生9例，肝淋巴管瘤4例，肝血管平滑肌脂肪瘤3例，肝炎性假瘤5例。3例肝局灶结节性增生患者行保守治疗，随访1年，其肿瘤大小和肝功能均无明显变化； 余153例患者行手术治疗，全部切除了病灶，病灶切除率为100％，术后随访6～48个月，平均24个月，均无死亡及复发。结论 肝脏良性肿瘤的症状不典型，缺乏特异性表现，易误诊，应完善超声、CT及MRI检查，并结合病史进行综合分析。对于具有临床症状、肿瘤体积较大（肿瘤直径＞5cm）的肝脏良性肿瘤患者，应积极行手术治疗，术后密切随访。
ObjectiveTo summarize the experience in the treatment of anastomotic leakage after laparoscopic D2 radical gastrectomy.MethodThe clinicopathologic data of 11 patients with anastomotic leakage after the laparoscopic D2 radical gastrectomy in the Nanchong Central Hospital from May 2016 to January 2018 were analyzed retrospectively.ResultsAmong the 11 patients with anastomotic leakage, 3 were grade Ⅱ leakages and 8 were grade Ⅲa leakages. There were no symptoms in the 3 cases of anastomotic leakage, which were confirmed only by the gastrointestinal radiography and were healed after 7 d of conservative treatment. Among the 8 patients with the clinical symptoms, 5 cases were treated by the endoscopic drainage and negative pressure suction for 60–90 d, 3 cases were treated by the endoscopic covered stent, 2 cases were cured after 30–60 d, and 1 case died of massive bleeding after 45 d.ConclusionsDue to differences of location, time, limitation, and size of anastomotic leakage after laparoscopic D2 radical gastrectomy, individualized treatment should be performed according to specific situation of patients in local treatment. Endoluminal covered stent has certain clinical application value.