Objective To discuss the performance of multi-disciplinary team (MDT) of colorectal cancer treatment within West China Hospital in Sichuan University. Methods To compare the therapeutic effect between groups of MDT model and non-MDT model by retrospectively analyzing the data of patients who diagnosed colorectal cancer and accepted in-hospital therapy during December 2006 and May 2007. Results The in-hospital days of the MDT model group during the perioperative period and in the surgical ward were less than that of the non-MDT model group ( Plt; 0. 05) , but there was no significant difference between the two groups about the total hospitalization time. And the MDT model group had a higher rate of cancer resection ( P lt; 0. 05) . Although the incidence of anastomotic leakage and bleeding as early postoperative complications didn’t show any variations between the two groups , the non-MDT model groupencountered more early postoperative ileus ( Plt; 0. 05) . During the 5－ 10 months follow-up , there came out less cancer recurrence rate in the MDT model group than the other ( P lt; 0. 05) . And the morbidity of anastomotic stricture and ileus didn’t show any statistical difference between the two groups. Conclusion The combined-therapy st rategy ofcolorectal cancer has showed a priority to routine ways , not only the more reasonable time arrangement for therapy , but also the more satisfied surgical outcomes. However , the factors correlated to the efficacy of the MDT model are not clear ; the MDT model still needs to be improved that a morereasonable and effective perioperative MDT model may come t rue.
【Abstract】Objective To study the clinical application of laparoscopic operation. Methods The clinical findings from 13 840 cases of laparoscopic surgery in this hospital from 1992 to 2005 were reviewed retrospectively.Results Laparoscopic operation were performed successfully in 13 653（98.6%）,187 cases were transferred to open operation. Complications were occurred in 115 cases, including common bile duct injury in 3 cases. Combined treatment with laparoscope and endoscope were performed in 162 cases. Eleven thousand three hundred and fiftytwo patients had been succeeded in followup survey. Over 90.0 percent of patients recovered smoothly. Conclusion Laparoscopic operation may be applied in a more extensive scope. The major complications can be reduced by strict procedures of laparoscopic operation. The combined treatment of laparoscope and endoscope should be further studied and widely used.
Objective To investigate the feasibility and clinical value of combined treatment for lung cancer with cerebral metastasis. Methods From May 1999 to May 2005, twentyone patients diagnosed lung cancer with cerebral metastasis received treatment in our hospital. The management consists of cerebral lesion resection, chemotherapy, lung cancer resection and chemotherapy or radiotherapy. Then evaluate the short-term and long-term outcome. Results No severe complications occurred in hospital. The 1-, 2-, and 3-year survival rates were 75.0%(12/16), 37.5%(6/16), and 12.5%(2/16) respectively. Life quality was promoted significantly. Conclusion Although lung cancer with cerebral metastasis is classified as stage Ⅳ,the effect of combined treatment is favorable because of the special metastatic position. But the choice of the patient is important.
【Abstract】 Objective To summarize the effectiveness of surgical removal combined with adjuvant therapy onthe aural region keloid. Methods From January 2000 to December 2005, 42 patients (71 side ears) with keloid at the auralregion were treated. There were 8 males and 34 females, aged 16 to 50 years (mean 26.2 years). The course of diseaseranged from 6 months to 4 years. The causes of disease included earhole piercing (n=32), ear trauma(n=7), and postoperativehyperplasia(n=3); the sizes of keloids ranged from 0.3 cm × 0.3 cm× 0.2 cm to 6.0 cm × 4.0 cm × 1.0 cm with globular, dumb-bell,nodular shapes. According to the different sizes and the range of keloids, different operations to remove the keloids and repairthe defect tissue were chosen. Wounds were exposed to the electron beam at first 24 hours after operation, once a day at 2 Gyeach time for 10 days. An immediate local injection for the keloid with hormones anti-scar drugs, which was a mixture of Betamethasone(Diprospan) and 2% Lidocaine with a proportion of 1 ∶ 3, was given to the patients who had recurrence trend 3 times,every 3 weeks. Results After operation, all the wounds healed by first intention. And 37 cases(64 lateral ears) were followedup for 1 year, and all achieved cl inical cure. Five cases (7 lateral ears) had the trend of recurrence 3-6 months after operation andwere cured after the immediate local injection for the keloid with hormones anti-scar drugs. According to LIU Wenge’s curativecriterion, 37cases were cured and 5 cases responded to treatment. Conclusion Surgical removal combined with local radiationand hormones infiltrated individually as early as possible can effectively treat aural region keloids. And it is an optimal method.
Objective To summarize the clinical experience in the treatment of refractory decubitus ulcers.Methods From May 1998to March 2005, 22 patients with decubitus ulcers(29 decubitus ulcers) were admitted, whose age was 3692 years. The lesion size was 4 cm×2 cm to 18 cm×15 cm. The locations of decubitus ulcers were the sacrococcygeal region(18 cases), the tuber ischiadicum region (6 cases) and the trochanter major region(5 cases).Enteral nutrientwas given orally and the wound was treated with Wuhuangyihao 8-15 days. Three diabetic patients were injected with insulin. According to patient’s age, ulcer position, ulcer extent and ulcer degree, the flap type was determined. Three wounds were repaired by local flaps, the flap size was 6 cm×4 cm-12 cm×10 cm; 10 by fasciocutaneous flaps, 10 cm×7 cm-20 cm×17 cm; 9 by gluteus maximusmyocutaneous flaps, 13 cm×11 cm-17 cm×14 cm; and 6 by longhead of biceps femoris flaps,11 cm×6 cm-14 cm×7 cm. One was sutured directly. After operation, the patients were placed on airflow suspended bed 7-14 days.Results General nutritional status was improved, hemoglobin was greaterthan 100 g/L, albumen was greater than 30 g/L. Necrosis tissue was removed, granulation tissue turned into fresh, secretion reduced and no redness and swelling occurred in wound. All flaps survived and the wounds healed by first intention. After a followup of 6 months to 5 years, no patient had a recurrence, the color and texture of the flaps were good, the appearance was satisfactory.Conclusion Applying the technique of combined treatment can accelerate the healing of refractory decubitus ulcers and improves the success of operation.
ObjectiveTo summarize the treatment effects and success rate of spleen-preserving treatments for patients with splenic injury, and to explore the ideal spleen-preserving treatment for different types of splenic injury. MethodWe retrospectively analyzed the clinical data of 136 patients with splenic injury who underwent spleen-preserving treatment in the Department of Hepatobiliary Surgery between July 1998 and December 2010. And the treatment effects of different combined treatment methods were compared and studied. ResultsTwenty-seven patients were treated without surgery; 23 underwent vascular suture combined with fibrin glue treatment; 26 accepted splenic artery ligation, partial suture and fibrin glue treatment; 20 underwent ultrasonic scalpel partial splenectomy and wound spray fibrin glue treatment; 17 accepted splenic artery ligation and RF hemostatic cutter row spleen resection; and 23 accepted laparoscopic ultrasonic scalpel with partial splenectomy and wound spray fibrin glue treatment. Spleen-preserving succeeded in 131 cases (95.58%) and failed in 5 cases (4.42%) without any deaths. ConclusionsIn the treatment of splenic injury, the success rate of different methods of spleen-preserving is close. The success rate of combined use of several spleen-preserving methods together is higher. Under the principle of "Save lives first, and preserve spleen second", we should carry out individualized treatment plan for the patients based on patients' general condition, the extent and grade of splenic rupture, and medical equipment and technical conditions. For those medical units with good treatment conditions, combined spleen-preserving treatment can be performed.
ObjectiveTo observe the clinical efficacy of ulinastatin combined with low-dose arginine vasopressin in treating severe pulmonary contusion. MethodSixty patients with severe pulmonary contusion were enrolled in our hospital between April 2012 to June 2014 year. All the patients were randomly divided into three groups. They were respectively defined as a routine treatment group (group A, n=20), an ulinastatin treatment group (group B, n=20), and a combined treatment group (group C, n=20). The respiratory frequency (RR), oxygenation index, partial pressure of carbon dioxide (PaCO2), the change of chest X-ray and the change of serum interleukin-6 (IL-6), IL-8 levels were compared among three groups before and after therapy. ResultThe respiration frequency(RR) and the concentration of serum IL-6, IL-8 levels were decreased in the group C before and after treatment with statistical differences (P=0.000, 0.000, 0.000). PaO2/FiO2 and PaCO2 were significantly increased in the group C before and after treatment (P=0.000, 0.000). After treatment for 7 d, the respiration frequency (RR) and the concentration of serum IL-6, IL-8 of patients in the group B decreased significantly compared with those in the group A (P=0.000, 0.043, 0.000). While PaO2/FiO2, PaCO 2 and the score of chest X-ray increased significantly in the group B (P=0.010, 0.000, 0.000). Compared with those in the group B, RR and the concentration of serum IL-6, IL-8 of patients in the group C decreased significantly (P=0.000, 0.045, 0.000), while PaO2/FiO2, PaCO2 and the score of chest X-ray increased significantly (P=0.043, 0.010, 0.001). ConclusionUlinastatin combined with low-dose arginine vasopressin shows obvious effects in the patients with severe pulmonary contusion. And its therapeutical effects are better than that of the other two treatment options.
ObjectiveTo systematically review the efficacy and safety of hyperthermia in combination with radiation, chemotherapy or both for middle/advanced cervical cancer patients (LACC). MethodsThe databases such as PubMed, The Cochrane Library (Issue 6, 2013), CNKI, WanFang Data and VIP were searched from inception to July 1st, 2013 for randomized controlled trials (RCTs) that investigated hyperthermia in combination with radiation, chemotherapy or both for LACC for cervical cancer at middle/advanced stage. Two reviewers screened literature according to the inclusion and exclusion criteria, extracted data, and evaluated methodological quality of included studies. Meta-analysis was then performed using RevMan 5.2.6 software. ResultsSix RCTs were included. A descriptive analysis was conducted due to significant heterogeneities among the results of studies. Out of 6 studies, the results of 4 studies showed that hyperthermia increased complete remission rate; the results of 3 studies reported objective effectiveness; while only one study showed statistical significance. Overall survival was reported in all studies, while only one study showed that hyperthermia significantly improved overall survival. Only one study reported 3-year progression-free survival with statistical significance. Two studies reported disease-free survival but only one showed statistical significance. Only two studies reported adverse events, and the data in one study showed acute toxicities of Grade 2-3 were higher for hyperthermia with unclear long-term reaction. ConclusionCurrent evidence is insufficient to confirm the efficacy and safety of hyperthermia for cervical cancer, and large-scale well-designed RCTs are further needed to verify the efficacy and safety of hyperthermia in the combined treatment of cervical cancer.