Objective To investigate the value of thyroid stimulating hormone (TSH) inhibition therapy in postoperative patients with differentiated thyroid carcinoma. Methods One hundred and six patients with differentiated thyroid carcinoma after total or near-total thyroidectomy were divided into two groups: TSH inhibition therapy group and thyroid hormone replacement therapy group. The non-recurrence and (or) non-metastasis rate in two groups was analyzed retrospectively by Wilcoxon statistical analysis. Results The non-recurrence and (or) non-metastasis rate of 3-， 5- and 10-year in TSH inhibition therapy group were 98.31%， 92.41% and 75.45% respectively， and were higher than those (93.57%， 84.18% and 52.06% respectively) in thyroid hormone replacement therapy group （P=0.046 5）. Conclusion TSH inhibition therapy after total or near-total thyroidectomy may be an essential treatment for differentiated thyroid carcinoma patients.
Objective To summarize the role of the relationship between liver cancer and cellular immunological function, and the role of immune therapy in clinical application. Methods To analyze the relationship between liver cancer and cellular immunological function, and the present research situation of immune therapy for liver cancer in clinical application retrospectively via review the related domestic and foreign literatures. Results The cellular immune dysfunction existed in all liver cancer patients. The state of body’s cellular immunological function is closely related with the arising and development of liver cancer, and the lowness of cellular immunological function is an important factor of hepatocellular carcinoma hard to cure or recurrence and metastasis. Immune therapy plays an important role in the treatment of liver cancer by adjusting the body’s cellular immunological function. Conclusions Liver cancer is closely related with the body’s cellular immunological function. Immune therapy is expected to offer a new way for the treatment of liver cancer, which can also be used as an important auxiliary treatment way.
Objective To study the effects of partial axillary lymph node dissection (PALD) on prognosis and upper limb function in patients with breast cancer. Methods Ninety-eight breast cancer patients with stage Ⅰ and Ⅱ were randomly divided into two groups and different surgical procedures following modified mastectomy were performed: partial axillary lymph node (level Ⅰ and Ⅱ) dissection (PALD) group (n=48) and total axillary lymph node (levelⅠ, Ⅱ and Ⅲ) dissection (TALD) group (n=50). The longterm positive relapse rate and upper limb function between 2 groups were compared. Results During the follow-up of 5 to 10 years (average 4.5 years), there were 2 cases (4.2%) of local recurrence on chest wall and one case (2.1%) of recurrence in axillary lymph node and one case (2.1%) of recurrence in supraclavicular lymph node in PALD group, and 2 cases (4.0%) of local recurrence on chest wall and no axillary lymph node recurrence and one case (2.0%) of recurrence in supraclavicular lymph node happened in TALD group. There was no statistical difference between PALD group and TALD group (Pgt;0.05). The incidence of upper limb edema and dysfunction was 4.2% (2/48) in PALD group and 16.0%(8/50) in TALD group (P＜0.01). There was no significant statistical difference of 5year and 10year survival rate between PALD group and TALD group (89.6% vs. 88.0%， 79.2% vs. 78.0%，Pgt;0.05). Conclusion PALD may reduce upper limb dysfunction after operation in patients with stage Ⅰ and Ⅱ breast cancer, and does not increase prognostic risk.
Objective To evaluate the outcome of liver transplantation in patients with recurrent liver cancer after resection. Methods Data of 23 patients underwent liver transplantation for recurrent liver cancer from April 2001 to March 2008 were retrospectively collected and analyzed. Results Previous history of liver resection had little negative effect in subsequent liver transplantation in technical aspect. Liver function recovered uneventfully after transplantation in all cases. Alpha fetoprotein (AFP) recovered to normal value in 13 of 17 cases with elevated AFP before transplantation within one month after operation. Five cases (21.74%) had postoperative complications. Nineteen cases (82.61%) were followed up, average follow-up duration were 610 days. There were 5 cases (26.32%) of cancer recurrence and 6 deaths during follow-up, survival rate was 68.42%. Conclusion Liver transplantation is a reasonable treatment for recurrent liver cancer after resection.
ObjectiveTo investigate the surgical skills and clinical effects of the laparoscopic transabdominal preperitoneal (TAPP) inguinal hernia repair in treatment of recurrent inguinal hernia with plug prefix mesh. MethodsThe clinical data such as operation time, intraoperative blood loss, postoperative hospital stay, and postoperative complications of 87 patients with recurrent inguinal hernia reoperated in laparoscopic TAPP after inguinal hernioplasty with plug prefix mesh (recurrent hernia group), in the Department of Gastroenterology and Hernia surgery of the First Affiliated Hospital of Kunming Medical University from January 2011 to December 2013, were retrospectively analyzed, which were compared with the 834 incipient inguinal hernia patients operated first by TAPP (incipient hernia group) at the same time. ResultsThe operations were completed successfully in all of the 921 patients without conversion to open surgery. The operation time and intraoperative blood loss in the recurrent hernia group were significantly more than those in the incipient hernia group (P=0.000, P=0.000), the postoperative hospital stay had no signifcant difference between two groups (P=0.057). No recurrences were observed in the recurrent hernia group and incipient hernia group for following-up of (31±4) months and (28±6) months, respectively. Compared with the incipient hernia group, the rates of postoperative pain on day 30 and seroma on day 1 and 3 were higher in the recurrent hernia group (P=0.001, P=0.040, P=0.003, respectively). There were no severe complications such as collateral damage, foreign body sensation, incision infection, intestinal obstruction and so on in the two groups. ConclusionsThe laparoscopic TAPP inguinal hernia repair is safe and effective for patients with recurrent inguinal hernia with plug prefix mesh. More skills are required to reduce the complications. The operation time and intraoperative blood loss in reoperated patients with recurrent inguinal hernia are more than those in patients with incipient inguinal hernia. The rates of seroma on day 1 and 3 are also higher.
ObjectiveTo investigate the effectiveness of epidermal growth factor receptor antagonist (AG-1478) on chronic proliferative cholangitis (CPC), so as to investigate new treatment approach for hepatolithiasis associated with CPC. MethodsForty-six SD rats were divided into 5 groups: CPC model group (n=10), only made models. AG-1478 treatment group (divided into 3 mg/kg， 6 mg/kg， and 12 mg/kg groups, n=10 per group), the common bile ducts in CPC animal model received an intralumenal administration of AG-1478 at the meantime of modeling, followed by intraperitoneal AG-1478 injection of 1.5 mg/(kg·d) for 7 days. Sham operation group (SO group, n=6). Subsequently, histopathological observation, immunohistochemistry, real time PCR， and Western blot were used to evaluate the mRNA expression and influence of AG-1478 on the hyperplasia （EGFR， ki-67， BrdU， collagen Ⅰ protein） and lithogenic potential (Mucin 5AC) of CPC. ResultsCompared with CPC model group, the expressions of EGFR, ki-67， and BrdU were obviously decreased in the AG-1478 treatment group. Also, the inhibition of hyperplasia of biliary epithelium and collagen fibers were confirmed by histopathological observation. Additionally, the expressions of Mucin 5AC mRNA and collagen Ⅰ protein remarkable decreased in the AG-1478 treatment group (Plt;0.05). Conclusions EGFR inhibitor (AG-1478) could shows inhibitory effectivenss on the CPC-mediated hyperplasia and lithogenic potential, and therefore holds promise as the new treatment approach for CPC.
Objective To summarize the experience in diagnosis and treatment of primary retroperitoneal tumor (PRT). Methods Clinical data of 69 patients with PRT from June 1998 to June 2008 were analyzed retrospectively. Results Bellyache, abdominal distention, and abdominal mass were common symptoms in the patients with PRT. Ultrasound, CT, and MRI examination were effective. The major histopathological classification was soft tissue tumor, germinoma, lymphatic hematopoietic system tumors, and other rare tumors. Complete resection of tumors was performed in 42 cases, combined organs resection in 10 cases, partial resection of tumors in 11 cases, and only biopsy in 6 cases. There were 10 cases of intraoperative vessel and organ injury, which were treated by repair or vessels suturing and combined organ resection. Postoperative complications occurred in 8 cases, which were cured by conservative treatment. One patient died of hemorrhage acute stress ulcer combined multiple organ failure. The survival rates of 1, 3, and 5 years in patients underwent complete resection of tumors were 71%, 64%, and 46%, respectively. Of 11 patients underwent partial resection of tumors, 8 cases died within one year, and 3 cases died within 3 years after operation. All malignant tumor patients treated by biopsy died within one year after operation.Conclusion Synthetically using imaging examination may diagnose definitely, and to resect tumors as much as possible will improve patients’ survival.
Objective To investigate the cl inical outcome of treating dorsal wrist gangl ion with an improved surgical strategy by excising the gangl ion completely along their stalk and repairing the dorsal carpal l igaments under brachial anesthesia. Methods From March 2005 to January 2007, 34 patients with dorsal wrist gangl ion were treated and studied retrospectively. There were 14 males and 20 females, aged 25-65 years (43 years on average). The left sides were involved in 22 cases and right sides in 12 cases. Thirteen cases of relapse received excision for 1 to 4 times under local anesthesia, with amean period of 17 months (14 days to 7 years) from excision to recurrence. Twenty-one patients were first attack cases with a mean period of 11 months (15 days to 8 years) from diagnosis to excision. The size of the gangl ion ranged from 1.5 cm × 1.2 cm to 4.5 cm × 4.0 cm. Now, each surgical process was performed under brachial anesthesia, and a pneumathode tourniquet was used. In 6 patients, the stalks of gangl ion did not invade the carpal l igaments, and gangl ion was removed completely without immobil ization after operation. In 28 patients, the stalks of gangl ion invaded the carpal l igaments, gangl ion was excised completely along its stalk to the dorsal carpal structure; the l igaments were sutured directly in 16 cases and were repaired with adjacent tissue such as the wall of sheathing canal of extensor tendon in 12 cases. The wrists were immobil ised for 3 weeks. Results Primary wound heal ing was achieved in all incisions. All patients were followed up for 26-36 months with an average of 31.5 months. Only 2 cases (5.9%) recurred. The range of motion of the wrist remained normal and the symptom of the dorsal wrist was rel ieved sl ightly. Patients’ satisfaction score ranged from 60 to 100, with an average of 83.8. Conclusion The gangl ion should be excised completely together with defect repair of dorsal carpal l igament under brachial anesthesia and the wrist immobil ised for 3 weeks, the recurrence rate will be reduced greatly.
【Abstract】ObjectiveTo evaluate the therapeutic benefits of three styles of hernioplasties such as the traditional hernioplasty, the mesh only hernioplasty and the plug amp; mesh hernioplasty. MethodsThe traditional hernioplasty in 534 cases(583 sides), the mesh only hernioplasty in 57 cases(60 sides) and the plug amp; mesh hernioplasty in 51 cases(54 sides) were performed. The comparing studies on the operative time, the postoperative complications, the recurrent rate and so on were analyzed. ResultsThe average operative time of the traditional styles group was (34.26±4.56) min, which was significantly shorter than the mesh only group 〔(40.35±6.24) min, P＜0.05〕 and the plug amp; mesh group 〔(49.12±8.69) min, P＜0.01〕 respectively. This significant difference between the mesh only group and the plug amp; mesh group was also identified (P＜0.05). Postoperative complications in the traditional styles group, the mesh only group and the plug amp; mesh group were 1.12%, 1.75% and zero,respectively (Pgt;0.05). Recurrent rate in the traditional styles group was 5.99%(32/534), which was significantly higher than that of the mesh only and the plug amp; mesh group (no recurrence). The average hospitalizing time in the traditional styles group, the mesh only group and the plug amp; mesh group was (7.11±3.06) days，（5.38±2.53） days and （6.19±3.61） days, respectively, in which there was no significant difference among groups. The activityrecovering time in the traditional styles group was (16.98±4.35) days, which was significantly longer than （7.26±2.46） days in the mesh only group and （8.02±3.35） days in the plug amp; mesh group. Conclusion The mesh only hernioplasty or the plug amp; mesh hernioplasty have a lower recurrent rate comparing with that in the traditional hernioplasty, which should be much more popularly applied in the treatment of inguinal hernia.
Objective To evaluate the urine cytology silver staining combined with ultrasonography（USG）in the detection of bladder transitional cell carcinoma （TCC） recurrence after transurethral resection of bladder tumor（TURBT）in terms of sensitivity and specificity. Methods Cystoscopy was used as “gold standard”. Urine cytology combined with USG or cystoscopy was measured separately and blindly. AgNORs protein stained by silver were used in cytology with Kappa of inter-observers 0.81. For the USG, the patients were scanned with trans-rectal probe with Kappa of inter-observers 0.76. The results of urine cytology combined with USG （Positive when urine cytology and/or USG positive. Negative when both urine cytology and USG negative） were compared with “gold standard”. Results The 148 consecutive superficial TCC patients with TURBT one year previously were included in this study. Fifty seven recurrenced cases were detected. Recurrence rate was 38.51%. The sensitivity and specificity of urine cytology silver stain were 89.47% （95% CI 0.82 to 0.98） and 87.91% （95% CI 0.81 to 0.95）. Area under ROC curve was 82.22%. The sensitivity and specificity of USG were 57.90% （95% CI 0.45 to 0.71 ） and 90. 11% （ 95% CI 0.84 to 0.96）. Area under ROC curve was 73.13% . The sensitivity was improved to 94. 74% （95% CI 0.89 to 1.00） when cytology combined with USG. But specificity decreased to 84. 62% （95% CI 0.77 to 0.92 ）. Area under ROC curve was improved to 98.28%. Conclusions Urine cytology silver stain combined with USG improves the high sensitivity for follow-up TCC patients after TURBT. The non-invasive protocol is suggested.