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Standardized surgical treatment for Bismuth type Ⅲa hilar cholangiocarcinoma: a case report

ObjectiveTo summarize a patient diagnosed as Bismuth type Ⅲa hilar cholangiocarcinoma who unerwent the curative surgery combined with partial portal vein resection and reconstruction+hilar bile duct formation+Roux-en-Y choledochojejunostomy, meanwhile we reviewed the current status of surgical treatment of hilar cholangiocarcinoma at home and abroad.MethodsTo retrospectively summarized and analyzed the clinical data of one case of Bismuth type Ⅲa hilar cholangiocarcinoma. The preoperative total bilirubin of this patient was 346.8 μmol/L, and this patient underwent the curative surgery combined with partial portal vein resection and reconstruction+hilar bile duct formation+Roux-en-Y choledochojejunostomy after reducing jaundice by percutaneous transhepatic biliary drainage (PTBD). Then we retrieved domestic and foreign related literatures.ResultsOperative time of this patient was about 290 min and intraoperative bleeding was about 350 mL. No intraoperative blood transfusion occurred. The results of pathological examination showed middle-differentiatied adenocarcinoma of hilar bile duct with negative tumor margins and no regional lymph node metastasis (0/14). The postoperative recovery was uneventful with hospital stay time of 9 days and without any complication. The patient had been followed-up in the outpatient department for 3 years,and was generally in good condition. The evidence of recurrence or metastasis wasn’t found.ConclusionsPre-operative biliary drainage can improve the safety of operation and reduce the incidence of postoperative complications, extend liver resection for the patient with Bismuth type Ⅲa hilar cholangiocarcinoma, which can improve R0 resection rate and extend postoperative survival.

垂直不稳定骨盆骨折的治疗

先天性束带综合征的治疗一例

下颈椎骨折合并齿状突骨折的手术治疗

目的 总结手术治疗下颈椎骨折合并齿状突骨折的临床疗效和方法。 方法 2001 年3 月－ 2008年6 月，在颅骨牵引基础上，采用颈前路减压病椎次全切除、自体髂骨植入、前路钛板内固定、齿状突骨折闭合复位空心加压螺钉内固定，治疗6 例下颈椎骨折合并齿状突骨折男性患者。年龄20 ～ 52 岁，平均34 岁。受伤至就诊时间6 h ～ 5 d。损伤节段：C4 1 例，C5 3 例，C6 2 例。下颈椎骨折根据ALLEN 分类，屈曲压缩型4 级2 例，纵向压缩型3 级4 例。齿状突骨折Anderson Ⅱ型2 例，浅Ⅲ型4 例。入院时脊髓损伤采用Frankel 分级：A 级2 例，B 级2 例，C 级2 例。 结果 术后患者切口均Ⅰ期愈合。6 例均获随访，随访时间6 ～ 72 个月，平均44 个月。齿状突骨折3 ～ 6 个月愈合，平均4.3 个月。1 例Frankel A 级患者术后6 个月死于肺感染，1 例Frankel A 级患者术后神经症状无改善，余4 例均有不同程度恢复。 结论 下颈椎骨折合并齿状突骨折临床少见，采用同一切口手术治疗不增加创伤，利于神经功能恢复，便于护理。

Diagnosis and Treatmsnt of TypeⅠ Choledochal Cysts in Adults

目的探讨成人Ⅰ型胆总管囊肿的诊断和治疗。方法回顾性分析1997年1月至2004年7月期间收治的8例成人Ⅰ型胆总管囊肿的临床资料。结果5例行胆总管囊肿全切除、RouxenY肝管空肠吻合术； 2例行囊肿部分切除、RouxenY囊肿空肠吻合术； 1例行囊肿部分切除、 RouxenY肝管空肠吻合术，术中常规行胆道镜检查，无一例手术死亡。8例患者术后平均随访2．8年(1~7年)，未发现胆道恶性肿瘤。1例行囊肿部分切除的患者，在术后出现3次右上腹绞痛，1次急性胆管炎表现，均经支持、对症、抗感染等治疗后好转。 结论 成人Ⅰ型胆总管囊肿的诊断主要依靠B超、逆行胰胆管造影(ERCP)或磁共振胆胰管造影（MRCP）检查，囊肿全切除、RouxenY肝管空肠吻合是安全、有效的手术方式，其疗效比较满意； 囊肿部分切除、RouxenY囊肿空肠吻合术虽疗效不及完整囊肿切除令人满意，但对于在技术上难以作到囊肿完全切除者，部分囊肿切除是明智的选择，建议术中常规胆道镜检查。

Surgical Chance of Operation in Decompressive Craniectomy in Malignant Middle Cerebral Artery Syndrome

Objective　To discuss the optimal time for operation in patients with malignant middle cerebral artery (MCA) syndrome. Method　The relation between effectiveness and operating time was analyzed in 47 patients to compare the effects of early and delayed operation by SPSS10.0. Results　Among 27 patients undergoing early operation, 18 were cured or restored, 4 seriously disabled and 5 died. While among 20 patients undergoing delayed operation, only 9 were cured or restored, 4 seriously disabled and 7 died. The prognosis of delayed operation group was worse than that of early operation group. Conclusions　Selecting the optimal time to operate may decrease the mortality and morbidity of MCA syndrome.

Application of Carbamide Proxide in Treatment for Severe Acute Pancreatitis

目的　观察内给氧治疗重症急性胰腺炎的临床效果。方法　对2005年2月至2009年3月期间收治的55例重症急性胰腺炎患者采用非手术治疗，在给予奥曲肽或施他宁、抗生素及基础性支持治疗的基础上，按入院时间先后分为2组，试验组(n=28)给予注射用内给氧治疗1周，对照组(n=27)未用内给氧。结果　试验组动脉血氧分压在应用内给氧治疗前为(53.8±8.1) mm Hg，治疗后为(87.9±9.5) mm Hg； 血氧饱和度治疗前为（81.1±7.4）%，治疗后为（93.2±6.7）%； 治愈病例中血淀粉酶降至正常的时间，试验组平均为(29.4±7.2) h，对照组平均为(162.1±46.8) h； 死于急性呼吸窘迫综合征者试验组为0（0/28），对照组为14.8%（4/27）; 上述指标差异均有统计学意义（P＜0.05）。结论　内给氧配合基础性治疗对重症急性胰腺炎有较好疗效，实用性较强。

小切口皮片回植术治疗腋臭

【摘要】　目的　总结彻底根治腋臭的同时保留皮肤完整性，术后不留明显瘢痕的手术方法。　方法　2004年7月-2010年7月对89例腋臭患者进行小切口剪除皮片回植术治疗，超过腋毛外1 cm的梭形范围内作肿胀麻醉，仅在下缘作一1 cm切口，用直尖剪盲视下将皮瓣修剪成全厚皮片，打包后弹性绷带加压包扎。　结果　除早期1例一侧出现部分皮肤坏死、1例一侧皮肤出现皱褶，余全部成活，无患者复发。仅在切口处有一小瘢痕及打包线处点状瘢痕。　结论　腋臭小切口剪除皮片回植术，汗腺清除彻底，外观漂亮。

手术治疗慢性胰腺炎胰管多发结石17例体会

目的探讨手术治疗慢性胰腺炎胰管多发结石的效果。 方法回顾性分析我院2000年1月至2013年12月14年间经手术治疗的17例慢性胰腺炎胰管多发结石患者的临床资料。 结果17例慢性胰腺炎胰管多发结石患者中有3例胰头肿块合并胰头部胰管结石，5例胰体胰管结石，8例胰尾胰管结石，1例全胰管结石。结石数量4～31枚，平均14枚；结石直径0.5～2.5 cm，平均直径0.9 cm。2例行胰十二指肠切除术，10例行胰管空肠Roux-en-Y吻合术，5例行胰尾切除术（其中4例同时行脾切除术）。均顺利完成手术，无手术死亡及胰漏发生。术后出现胸腔积液2例，切口裂开1例。获随访13例，随访时间1～7年，复查CT，1例胰体胰管结石复发。术前腹痛15例术后8例疼痛完全消失，6例疼痛部分缓解，1例术后因未戒酒、慢性胰腺炎未控制、顽固性疼痛需止痛药物治疗。术前血糖升高10例，其中8例术后血糖恢复正常，2例仍需胰岛素控制。术前脂肪泻6例，其中有4例痊愈，2例仍服胰酶制剂。 结论从本组有限的病例数据初步得出，外科手术治疗慢性胰腺炎胰管多发结石有效、可行。

Relation between marital status of patients with colorectal cancer and surgical treatment parameters: a real-world study based on DACCA

ObjectiveTo analyze the relation between the marital status of patients with colorectal cancer and surgical treatment options decision-making and outcomes in the current version of the Database from Colorectal Cancer (DACCA). MethodsThe version of DACCA selected for this analysis was updated on August 31, 2022. The patients were enrolled according to the established screening criteria and then assigned to 3 groups: the unmarried, married, and divorced or widowed groups. The differences in the surgical modality decisions, surgical quality, and surgical complications among these 3 groups were analyzed. ResultsA total of 7 634 data that met the screened criteria were enrolled. It was found that the difference in the composition of the willingness to conserve anus among patients with different marital status was statistically significant (χ2=28.635, P<0.001), reflecting that the willingness to conserve anus was “strong” among unmarried and married patients, and the overall willingness to conserve anus was relatively more positive among unmarried patients, while the willingness to conserve anus was “rational” among widowed or divorced patients. No statistical differences were found in the surgical modality decisions (rectal surgery: χ2=0.493, P=0.782; colon surgery: χ2=0.213, P=0.899), including the presence of prophylactic stoma for the patient with radical resection (χ2=5.156, P=0.076）, surgical quality (H=3.452, P=0.178）, presence of surgical in-hospital complications (χ2=1.663, P=0.435), and the presence of short-term surgical complications (χ2=1.695, P=0.428). ConclusionsAnalysis of the data in DACCA reveals that there is difference in willingness to preserve anus among colorectal cancer patients with different marital status. Married and unmarried patients have stronger anal preservation intention, suggesting that clinical care and family support should be strengthened during clinical diagnosis and treatment.