Objective To explore the advantage of transection the cervical muscles at sternal end and flip fixed in therapeutic bilateral huge thyroid surgery. Methods The transection of the cervical muscles at sternal end and flip fixed in 53 cases was observation group， 44 cases of the neck white line incision thyroid surgery completed for the control group. The completion of the surgery by the same group of physicians. The operative time， operation field of exposing effect， amount of bleeding in operation， postoperative complications， and postoperative drainage volume were compared between two groups. Results There was no statistically differences of sex， age， disease composition， and tumor size between two groups （P＞0.05）. Operative time， amount of bleeding， and postoperative drainage volume in observation group were shorter （less） than that in control group （P＜0.01）. The postoperative complication rate in observation group was lower than that in control group（P=0.04）. Surgical field exposure in observation group was better than that in control group （P＜0.01）. Conclusions The huge bilateral thyroid surgery with the sternal end approach is feasible and simple. The operation field exposure is better than the white line neck incision， complications after operation is less. It is worthy of clinical application.
ObjectiveTo explore the safety-related factors for total thyroidectomy in differentiated thyroid carcinoma. MethodsThe clinical data of 72 patients with differentiated thyroid carcinoma treated by total thyroidectomy from January 2002 to January 2010 were retrospectively analyzed, the laryngeal recurrent nerve injury and hypoparathyroidism were observed. ResultsThe incidences of hypoparathyroidism and laryngeal recurrent nerve injury were 15.28% （11/72) and 4.17%（3/72）, respectively. The hypoparathyroidism was significantly related to the thyroid reoperation, the lymph nodes metastases of central compartment, or the extraglandular invasion of the primary tumor (Plt;0.05), but not to the dissection of neck lymph nodes (Pgt;0.05). The laryngeal recurrent nerve injury was not relative to those factors (Pgt;0.05). ConclusionThe safetyrelated factors of total thyroidectomy in differentiated thyroid carcinoma include thyroid reoperation, the lymph node metastasis of central compartment, and the extraglandular invasion of the primary tumor.
Objective To explore the value of dual-channel anastomosis of residual stomach and jejunum in radical resection of the upper gastric cancer. Methods Forty patients with upper gastric cancer had undergone proximal gastrectomy and dualchannel digestive tract reconstruction, including esophagus-jejunum side to side anastomosis, residual stomachjejunum anastomosis, and jejunum-jejunum anastomosis. Results The cutting margin away from tumor in all the cases was more than 5 cm and no carcinoma residual. The number of lymph nodes dissection was 21±6, reaching the requirement of D2 radical surgery. There was no case appearing complications such as anastomotic leakage, obstruction or bleeding. Barium meal examination after operation showed that most of barium was directly into the jejunum, the remaining went through the duodenum into the jejunum without gastroesophageal reflux. Followed up 6-30 months with average 18 months, there were no visible reflux esophagitis in all the cases, and only 1 case appeared minor dumping syndrome. The hemoglobin increased and the quality of life was satisfactory after operation. Conclusions In regard to dual-channel anastomosis of residual stomach and jejunum, resection range is reasonable, dissection scope accords with the protocol and residual stomach has a certain pouch effect. The anastomosis has a favorable prevention from reflux esophagitis and dumping syndrome and retains the duodenum pathway, so that improves the quality of patients’ life and is a relatively ideal digestive tract reconstruction.
ObjectiveTo investigate the clinical value of veress needle with thread for laparoscopic high ligation of hernia sac in children. MethodsThe clinical data of 56 cases of pediatric inguinal hernia using laparoscopic high ligation of hernia sac with veress needle from May 2013 to May 2014 were analyzed retrospectively. ResultsAll patients were successfully carried out operation by laparoscopic high ligation of hernia sac.Forty-one cases underwent unilateral surgery, and operative time was 6-18 min (mean 9.6 min); 15 cases underwent bilateral surgery, and operative time was 10-32 min (mean 14.3 min).Nine cases of contralateral recessive hernia were found and ligated during operation.There was no complications, such as scrotal edema, scrotal gas or incision infection after operation, and all patients were discharged in l-2 days after operation.No recurrence or testicular dysplasia was found during 3 to 15 months (mean 10.8 months) follow-up. ConclusionsThere are many advantages in laparoscopic high ligation of hernia sac with veress needle, such as less damage, hidden incision, faster recovery, shorter hospital stay, simple operation, and better efficacy.We can find contralateral recessive hernia during operation and avoid second surgery with high clinical value, therefore it is worthy of clinical application.
Objective To explore the feasibility of clinical application of hepatic artery （HA） or proper hepatic artery （PHA） anastomosing with superior mesenteric artery （SMA） and internal iliac vein （IIV） anastomosing with superior mesenteric vein （SMV） or portal vein （PV） in the extended pancreaticoduodenectomy combined with vascular resection．Methods The HA，PHA，SMA， SMV， PV， and IIV were dissected on 20 adult corpses， and the length， thickness，and lumen diameter of blood vessels were measured and compared with the results of multislice spiral CT scan，magnetic resonance angiography，or color Doppler in 25 patients with pancreatic head carcinoma．The extended pancreaticoduodenectomy was carried out on 5 patients of pancreatic head carcinoma with vascular invasion according to the mathcing results，and the reconstructions of HA or PHA with SMA and IIV with SMV or PV were performed．Results According to autopsy，HA-PHA was （5.50±1.50） cm in length，（0.20±0.01） mm in thickness，（5.02±1.32） mm in lumen diameter；and SMA was （4.00±1.00） cm in length，（0.21±0.01） mm in thickness，（6.05±1.06） mm in lumen diameter．The lumen diameter of left IIV，right IIV，and PV or SMV was （11.06±0.16） mm，（11.10±0.13） mm，and （11.56±0.20） mm，respectively．The thickness of left IIV，right IIV，and PV or SMV was （0.10±0.01） mm，（0.10±0.02） mm，and （0.10±0.02） mm，respectively．The multislice spiral CT scan，magnetic resonance angiography，color Doppler，and selective arteriography in vivo showed that the thickness and lumen diameter of HA-PHA and SMA were wider （0.1 mm and 0.3 mm） than those of the autopsy results，and there were no statistic significances （P＞0.05），but the length of HA-PHA was longer （1－2 cm） than that of SMA，and there was statistic significance （P＜0.05）. The survival of 5 patients with extended pancreaticoduodenectomy combined with PHA or SMA and IIV-PV/SMV resection and reconstruction was longer than that of palliative surgery patients or giving-up patients at the same period，and no long-term complications occurred．Conclusions The vascular invasion of pancreatic head carcinoma is not an absolute contraindication of radical pancreaticoduodenectomy．The survival of 5 patients with vascular invasion of pancreatic head carcinoma in this group is prolonged by extended pancreaticoduodenectomy combined with vascular resection and reconstruction as compared with palliative surgery group at the same period．HA，PHA，and IIV are the best autologous vascular alternative materials without more complications． Being familiar with regional anatomy will guide the surgeons in extended pancreaticoduodenectomy.
ObjectiveTo explore the expressions of survivin, p53, and Ki67 in recurrence or metastasis breast cancer tissue, and explore their correlations and clinical significance. MethodsEighty-six patients with the chest wall local recurrence, axillary or supraclavicular lymph node metastases get treated in this hospital between January 2005 and January 2010 were excised and the expressions of survivin, p53, and Ki67 were detected by immunohistochemistry test, then compared them between the recurrence and metastasis breast cancer tissues and the primary breast cancer tissues. ResultsThe positive expression rate of survivin, p53, and Ki67 in the recurrence and metastasis breast cancer tissues were significantly higher than those in the primary breast cancer tissues, survivin: 90.70% (78/86) versus 61.63% (53/86), χ2=20.014 895, Plt;0.001; p53: 68.60% (59/86) versus 52.33% (45/86), χ2=4.766 968, Plt;0.05; Ki67: 62.79% (54/86) versus 46.51% (40/86), χ2=4.597 927，Plt;0.05. The positive expression rates of survivin in the recurrence and metastasis patients with p53, Ki67 negative expression were significantly higher than those of the primary breast cancer tissue (70.37% versus 24.39%, χ2=14.071 113, Plt;0.05; 75.00% versus 39.13%, χ2=6.540 373, Plt;0.05). The correlation coefficient of survivin with p53 and Ki67 positive expressions in the recurrence and metastasis breast cancer tissue and the primary breast cancer tissue were 0.876 214, 0.773 643 and 0.725 164, 0.698 112, respectively, Plt;0.05. ConclusionThe positive expression rates of survivin, p53, and Ki67 which increase in recurrence and metastasis breast cancer tissue indicate bad prognosis.
ObjectiveTo study the expressions of cyclooxygenase-2(COX-2) and Ki-67 in the invasive ductal carcinoma (IDC) of breast and to analyze its clinical significance. MethodsImmunohistochemical SP method was performed to detect the expressions of COX-2 and Ki-67 in 82 cases of IDC of breast and corresponding tumor-adjacent normal breast tissues, and the relationship of these expressions to clinicopathologic characteristics was analyzed. Results①The positive rates of COX-2 and Ki-67 protein expressions in the IDC of breast tissues were significantly higher than those in the corresponding tumor-adjacent normal breast tissue [COX-2:71.95%(59/82) versus 8.54%(7/82), χ2=68.56, P < 0.001;Ki-67:64.63%(53/82) versus 13.42%(11/82), χ2=45.20, P < 0.001].②The positive rates of COX-2 and Ki-67 protein expressions were positively correlated with TNM staging (COX-2:rs=0.349, P < 0.05;Ki-67:rs=0.305, P < 0.05), lymph node metastasis (COX-2:rs=0.336, P < 0.05;Ki-67:rs=0.419, P < 0.01), vascular invasion (COX-2:rs=0.235, P < 0.05;Ki-67:rs=0.461, P < 0.01), and histological grade (COX-2:rs=0.434, P < 0.01;Ki-67:rs=0.378, P < 0.05).The positive rate of Ki-67 protein expression was positively correlated with tumor diameter (rs=0.365, P < 0.01), but the positive rate of COX-2 protein expression wasn't correlated with it (rs=0.135, P > 0.05).The positive rates of COX-2 and Ki-67 protein expressions weren't correlated with menstrual status (COX-2:rs=0.172, P > 0.05;Ki-67:rs=0.163, P > 0.05).③The positive rate of COX expression was positively correlated with the positive rate of ki-67 expression (rs=0.475, P < 0.01). ConclusionsThere are high-expressions of COX-2 and Ki-67 in IDC of breast.COX-2 and Ki-67 are significantly correlated with the clinicopathologic characteristics in IDC of breast.Combined detection of COX-2 and Ki-67 might calculate the biological behaviors of IDC of breast.COX-2 might be a target of molecular targeted therapy to breast cancer.
ObjectiveTo investigate the correlation between the expressions of matrix metalloproteinase-3 (MMP-3) and vascular endothelial growth factor (VEGF) in the three negative breast cancer (TNBC) and analyze their clinicopathologic significances. MethodsOne hundred and twelve patients confirmed TNBC from January 2008 to January 2013 in this hospital were collected. The cases of luminal type with the similar pathological type and pathological staging were chosen as control. The expressions of MMP-3 and VEGF were detected by immunohistochemistry. Results①The positive expression rates of MMP-3 and VEGF in the TNBC tissues were significantly higher than those in the luminal tissues[MMP-3:90.18%(101/112) versus 49.11%(55/112), P < 0.05;VEGF:84.82%(95/112) versus 48.21%(54/112), P < 0.05]. 2 The positive expressions of MMP-3 and VEGF in the TNBC tissues were correlated with age, menopausal status, tumor size, axillary lymph node metastasis, and TNM stage(P < 0.05).③The expression of MMP-3 was positively correlated with VEGF in the TNBC tissues(rs=0.711, P < 0.01).④The results of follow-up showed that the recurrence and metastasis rate within 3 years was 73.21%, the survival rate within 5 years was 36.61% in the patients with TNBC. ConclusionsThere is a close relation between MMP-3 and VEGF in TNBC, the expressions of MMP-3 and VEGF may serve as important biomarkers for evaluating invasion and metastasis in TNBC. There is a higher metastasis rate within 3 years and a lower survival rate within 5 years in TNBC. According to intervening the expressions of MMP-3 and VEGF, and inhibiting cancer cells matrix degradation and vascular formation, then cancer cells metastasis could be blocked, it may be important to reduce the 3-year recurrence rate and improve 5-year survival rate.
ObjectiveTo explore the clinical significance of hepatectomy combined with vascular reconstruction in hilar cholangiocarcinoma with vascular invasion. MethodsThe clinical data of 62 cases of hilar cholangiocarcinoma with vascular invasion in Suqian People's Hospital of Nanjing Drum-Tower Hospital Group from January 2006 to January 2014 were analyzed retrospectively. All cases were divided into two groups according to assessment of surgical trauma tolerance, nutritional status, and family's wishes. Thirty-three cases underwent hilar cholangiocarcinoma radical operation and hepatic artery combined with portal vein resection and reconstruction (combined resection group), while 29 cases of hilar cholangiocarcinoma underwent palliative surgery for treating jaundice in synchronization (palliative operation group). ResultsThe median survivals in combined resection group and palliative operation group was 26.3 and 9.6 months, respectively. The survival rates of 1-year, 2-year, and 3-year between combined resection group and palliative operation group were 84.85% vs. 26.32%, 66.67% vs. 15.79%, and 42.42% vs. 0, respectively, there were significant differences between both groups in survival time and survival rate (t=4.470, P=0.000; χ2=28.338, 20.348, and 15.891, P=0.000). Among of 33 cases in combined resection group, postoperative complications occurred in 9 cases, the rate of complications was 27.27% and the mortality rate in perioperative period was 3.03%; while postoperative complications in palliative operation group occurred in 5 cases, the rate of complications was 17.24%, no case died in the perioperative period. There were no significant difference between both groups in the rate of postoperative complications and the mortality rate in perioperative period (χ2=0.888, P=0.346; χ2=0.893, P=0.345). ConclusionsHepatectomy combined with vascular resection and reconstruction can significantly improve the radical resection (R0) rate of HCCA, and greatly increase the 1-year, 2-year, and 3-year survival rates of patients. Furthermore, complications can be controlled, and the mortality rate in perioperative period does not increase.