Objective To explore the effect of multi-disciplinary treatment of the Graves’ disease (GD) with huge-size thyroid during perioperative period. Methods Retrospectively analyzed the clinical data of 8 GD patients with huge-size thyroid who got treatment in Pekin Union Medical College Hospital during Jan. 2006 to Dec. 2016. All patients underwent comprehensive preparation before operation and underwent total thyroidectomy. To explore the changes of thyroid function and culture after anti-thyroid drug (ATD)/iodine preparation/arterial embolization before operation, and to summarize situation of the bleeding loss intraoperation, neck-drainage, thyroid function, and relapses after operation. Results All cases got a satisfactory operation result after standard ATD, iodine preparation (Lugol’s solution 10–15 drops for 3–4 weeks, combined with ATDs for 2–3 weeks ), and main arterial embolization of thyroid in 24 h preoperation. They got shorter operative time (2.5–4.5 h), less bleeding intraoperation (4 cases≤100 mL), less neck-drainage, and almost normal retention time. No severe or permanent complications, for example thyroid storm, abnormal voice, and hypoparathyroid occurred. They were followed as outpatients for 18–133 months, and were found a perfect long-term effect without complication and relapse. Conclusions Perioperative period management is very important to those GD patients with huge-sized thyroid, and multi-disciplinary treatment can decrease theintraoperation bleeding, as well as occurrence of thyroid storm effectively. In addition, operated subtly during surgery can protect the recurrent laryngeal nerve and parathyroid effectively.
Objective To explore the clinicopathologic features and treatment of desmoplastic small round cell tumor (DSRCT). Methods By summarizing the diagnosis and treatment of a DSRCT patient with liver metastasis, who was admitted to Department of Liver Surgery in West China Hospital in October 2017, and exploring its clinicopathologic features and treatment by reviewing literatures. Results This patient was generally in good condition, after the multi-disciplinary discussion between the imaging physician, the oncologist, and the liver surgeon, it was considered that there were indications of operation, and after communicating with the patient’ families, actively chose surgical treatment. The performance was successful, and this patient was treated with adjuvant chemotherapy postoperatively. The operative time for this patient was 5 hours, and blood loss was 600 mL. There was no complication occurred, such as bleeding, bile leakage, and intestinal fistula, and discharged on 8 days after surgery. This patient was followed up for 10 months, without tumor recurrence and metastasis occurred. The results of literatures showed that, DSRCT was more common in young male population, the mean age was 12–27 years old, the longest median survival time was 39.2 months, and 3-year survival rate was 20.8%–71%. Those patients who received surgery, had longer median survival time. Conclusions DSRCT is a rare aggressive soft tissue sarcoma, which is usually diagnosed with multiple organ metastases. The treatment is mainly multi-mode treatment based on surgical resection combined with radiotherapy and chemotherapy, but the overall prognosis is poor.
ObjectiveTo investigate clinical features and treatment of pancreatic metastasis from cardiac carcinoma.MethodsThe clinicopathological data of a patient with pancreatic metastasis from cardiac carcinoma in the General Hospital of Western Theater Command were retrospectively analyzed. The results of multi-disciplinary treatment (MDT) of this case were summarized.ResultsThe imaging findings of abdomen CT of this patient were that the solid occupying position of the head of pancreas was considered as a new organism. After discussing by the MDT and exclusing operative contraindications, the radical resection of cardiac cancer with pancreaticoduodenectomy and enlarged intraperitoneal lymph node dissection was performed under the general anesthesia. The operation was smooth and the bleeding was about 600 mL. The patient recovered well after the operation and had no serious complications. The patient was discharged on day 10 after the operation. The results of postoperative pathological diagnosis were the cardiac carcinoma with pancreatic head implantation metastasis (stage Ⅱ A, T3M0N0); obstructive jaundice, liver damage, extrahepatic and extrahepatic biliary dilatation. The patient received the intravenous infusion of the oxaliplatin pluse tigualone for 4 courses. The patient was generally in a good condition and had survived 5 months free tumor. The CA19-9 level was 45.6 U/mL (it was 449.60 U/mL before the operation).ConclusionsPancreatic metastasis from cardiac carcinoma is rare and need to be distinguished from primary pancreatic cancer. Survival time is short and prognosis is poor. Clinical symptoms are improved and survival time is prolonged after operation with postoperative chemotherapy.
ObjectiveTo summarize the effect of the multi-disciplinary treatment (MDT) for a patient with giant pancreatic cystic lymphangioma.MethodsThe clinical data of a patient with pancreatic lymphangioma admitted to the Affiliated Hospital of North Sichuan Medical College in March 2020 was retrospectively analyzed, then reviewed the literatures, and summarized the preoperative diagnosis, treatment, and management of perioperative period and long-term period after surgery of this rare disease.ResultsAfter admission, the patient was diagnosed as pancreatic tumor by various imaging and laboratory examinations. The nature was unknown. After discussion by MDT, it was decided to undergo a total pancreatectomy (TP). After the operation, drugs and diet were given to regulate blood glucose. The patient’s tumor disappeared after the operation, and no tumor recurrence was found in the three months after discharge.ConclusionsPancreatic lymphangioma is rare and lacks a clear diagnosis and treatment plan. The MDT mode can bring a clearer diagnosis and more effective treatment for it.
ObjectiveTo summarize the research status and new directions of surgical treatment of hepatic alveolar echinococcosis (HAE) in clinic, and to provide reference for further research in improving the rate of radical surgery.MethodThe recent literatures on the studies of HAE were reviewed.ResultsAlthough the biological behavior of HAE was similar to that of malignant tumor, the clinical symptoms appeared late as the intrahepatic lesions often grow slowly. At present, the treatment of this disease was mainly surgical operation, among which radical resection was the first choice. Drug therapy was also of great value in controlling disease progression and recurrence. In recent years, with the progress of surgical technology, the surgical method had gradually developed to the direction of multi-mode combination, especially for those cases that had not been able to perform conventional radical surgery before.ConclusionThe treatment concept of clinical multi-mode combination can benefit more patients, even achieve clinical radical resection, and improve the rate of radical resection.
Portal hypertension caused by viral post hepatic liver cirrhosis has brought a heavy burden to medical treatment in China. In addition to liver transplantation, the treatments include drugs, endoscopy, intervention and surgery, but the effect is not satisfactory. At present, the consensus and guideline for portal hypertension often focuse on a single treatment, and there is an urgent need for reasonable, standardized and individualized treatment to minimize the risk of upper gastrointestinal bleeding and improve the long-term survival of patients, which should also be the ultimate goal of multi-disciplinary treatment (MDT) mode of portal hypertension. The MDT diagnosis and treatment method of portal hypertension needs to be obtained in combination with the general situation of patients (including liver function level, upper gastrointestinal bleeding risk, hypersplenism, etc.) and local medical advantages. For patients with acute upper gastrointestinal bleeding, the treatment with less trauma and good hemostatic effect should be selected as far as possible. Patients with previous bleeding history or bleeding cessation should improve the relevant evaluation as soon as possible and submit it to MDT for discussion and selection of the next appropriate treatment. Drugs and endoscopy can be used for high-risk groups of upper gastrointestinal bleeding. Whether surgical preventive treatment can benefit patients or not needs further large sample research support. Minimally invasive surgery is the development direction of surgical treatment. Combination of internal and external treatment may give full play to their respective advantages, reducing the risk of bleeding and improving long-term survival.
Objective To study the effect of multi-disciplinary treatment (MDT) on the surgical efficacy and satisfaction of patients undergoing total knee arthroplasty (TKA) for the first time. Methods The clinical data of patients who underwent unilateral TKA for single-compartment osteoarthritis of the knee in the General Hospital of Ningxia Medical University between January and September 2022 were retrospectively collected and analyzed. According to whether MDT was performed on patients during the perioperative period, they were divided into MDT group and traditional group. Perioperative nutrition-related indicators, perioperative complications, total hospitalization time, Visual Analogue Scale (VAS), and Hospital for Special Surgery Knee Score (HSS) before and after surgery were detected and recorded. Results A total of 95 patients were included. Among them, there were 42 cases in the MDT group and 53 cases in the traditional group. The postoperative complications and total hospital stay of patients in the MDT group were lower than those in the traditional group, and their satisfaction scores were higher than those in the traditional group (P<0.05). The perioperative serum total protein (TP), hemoglobin (Hb), serum albumin (ALB) levels, VAS score, and HSS score of both groups of patients changed over time. The intra group comparison results showed that compared with preoperative, the levels of TP, Hb, and ALB in both groups decreased on the 1st and 3rd postoperative days (P<0.05). On the 3rd day after surgery, the levels of TP, Hb, ALB in the MDT group and Hb, ALB in the traditional group were lower than on the 1st day after surgery (P<0.05). There was no statistically significant difference in TP levels between the traditional group on the 3rd day after surgery and the 1st day after surgery (P>0.05). The results of intra group comparison at different time points showed that there were statistically significant differences in VAS score and HSS score between the two groups (P<0.05). Conclusion The application of MDT in elderly patients undergoing unilateral TKA for the first time can shorten the total hospitalization time, reduce the incidence of perioperative complications, and improve the surgical efficacy and patient satisfaction.