Our clinical experiences in reconstruction of the defects from excision of benign tumors with expanded skin flap were reported. Since 1987 we have applied this method 23 cases with satisfactory results. When we decided to use this technique, the expander was placed in a pocket adjacent to a benign tumor planned to be excised. Once the skin flap was expanded fully, the tissue expanders were removed. After excision of the benign tumor, the defect was than be covered with the expanded skin flap. The problems related to treatment were discussed in detail.
ObjectiveThyroid nodules are an exceptionally common thyroid disorder. Past studies suggested a possible link between thyroid diseases and breast neoplasms. However, few studies have delved into the causal relationship between thyroid nodules and breast neoplasms. This study conducted a Mendelian randomization (MR) analysis to further investigate the causal relationship between them. MethodsThis study was conducted using data sourced from genome-wide association study (GWAS) summary datasets. The study focused on thyroid nodules, benign breast tumors, and malignant breast cancers as the research objects, and relevant single nucleotide polymorphisms (SNPs) were selected as instrumental variables (IVs). The inverse-variance weighted (IVW) was primarily used to assess the causal relationship between thyroid nodules and breast neoplasms. Cochran’s Q test was employed to detect heterogeneity, while MR-Egger intercept and MR-PRESSO were used to test for pleiotropy. Sensitivity analysis was conducted using the leave-one-out method. ResultsThere was a significant causal relationship between thyroid nodules and malignant neoplasm of breast (OR=0.88, 95%CI 0.83 to 0.95, P<0.01), with no evidence of reverse causality between them (OR=1.01, 95%CI 0.99 to 1.03, P=0.16). No causal relationship was found between thyroid nodules and benign neoplasm of breast, as indicated by both forward MR analysis (OR=0.97, 95%CI 0.89 to 1.06, P=0.51) and reverse MR analysis (OR=0.97, 95%CI 0.92 to 1.04, P=0.40). Sensitivity analyses suggested that the study findings were accurate and reliable. ConclusionThe present study identifies thyroid nodules as a potential protective factor for malignant neoplasm of breast.
目的探讨经胸锁乳突肌前缘入路行甲状腺良性肿瘤切除术的体会。方法2002年10月至2010年10月期间我院对128例甲状腺良性肿瘤患者行经胸锁乳突肌前缘入路甲状腺手术，手术切口采取皮内缝合。结果所有患者均顺利完成手术。手术时间45~130 min（平均65 min），术中出血10~100 ml（平均40 ml）； 引流管均在术后第2天拔除，引流量15~30 ml（平均20 ml）； 手术切口长3~7 cm（平均5 cm），均一期愈合； 住院时间3~6 d（平均4.5 d）。术后无出血，无神经、甲状旁腺损伤及其他并发症。术后随访0.5~8年（平均5.5年），12例患者（9%）复发，复发时间为术后1~3年（平均1.5年）; 8例患者结节lt;1 cm，给予临床观察; 其余4例患者经相同入路经二次手术治愈，随访无复发，未发现甲状腺癌。结论经胸锁乳突肌前缘入路行甲状腺良性肿瘤切除术不损伤或横断舌骨下肌群，术中出血少，无颈部肌肉瘢痕粘连影响外观之虑。
ObjectiveTo compare efficacy of laparoscopic or open hepatectomy in benign liver tumors patients with different difficult operations. MethodsAccording to the inclusion and exclusion criteria, the patients with benign liver tumors who underwent hepatectomy in the Affiliated Hospital of Xuzhou Medical University from September 2014 to March 2021 were collected. The enrolled patients were assigned into low, medium, and high difficulties by the Hasegawa liver resection surgical difficulty score model, then the patients were matched by propensity score matching. The liver function and inflammatory indexes, intraoperative bleeding, operative time, total hospital stay, postoperative complications, and hospitalization expenses of patients with benign liver tumors after laparoscopic (laparoscope group) or open (open group) hepatectomy were compared. ResultsA total of 209 patients who met the inclusion and exclusion criteria were enrolled in this study. According to the Hasegawa criteria, there were 59, 89, and 61 patients with low, medium, and high difficulties respectively. After 1∶1 propensity score matching, 18, 34, and 14 patients in the laparoscope group and open group were matched respectively. There were no statistic differences in the baseline data between the laparoscope group and open group (P>0.05). ① For the patients with low and medium difficulties, compared with the open group, the different values of alanine aminotransferase, aspartate aminotransferase, white blood cell count, and neutrophil percentage were lower (P<0.05), the intraoperative bleeding and total hospital stay were less or shorter (P<0.05), and the albumin were higher (P<0.05) in the laparoscope group. There were no statistic differences in these indexes among the patients with high difficulty (P>0.05). ② Compared with the open group, the operative time of the laparoscope group was shorter in the patients with low difficulty (P<0.05) and longer in the patients with high difficulty (P<0.05), and there was no statistic difference in patients with medium difficulty (P>0.05). ③ The postoperative complications had no statistic differences between the two groups for the patients with low and high difficulties (P>0.05), while which in the laparoscope group were lower than in the open group for the patients with medium difficulty (P<0.05). ④ The hospitalization expenses of the laparoscope group was higher than the open group for the patients with high difficulty (P<0.05), while which had no statistic differences between the two groups for the patients with low and medium difficulties (P>0.05). ⑤ The total hospital stay of the laparoscope group was shorter than the open group (P<0.05) no matter which difficult operation.ConclusionsAccording to results of this study, laparoscopic hepatectomy has more obvious advantages as compared with open hepatectomy for patients with low or medium difficulty, which could greatly shorten hospital stay and accelerate rehabilitation of patients. Even for patients with high difficulty, laparoscopic hepatectomy still shows an advantage of shortening hospital stay.
ObjectiveTo investigate the role of local pancreatectomy for benign and low-grade malignant pancreatic tumors.MethodThe clinical data of 45 patients with benign and low-grade malignant pancreatic tumors who underwent local pancreatectomy from January 2014 to June 2019 in Union Hospital Affiliated to Tongji Medical College of Huazhong University of Science and Technology were analyzed.ResultsForty-five patients underwent the local enucleation or resection with negative margin. The pathological results showed that there were 17 cases of solid pseudopapilloma, 5 cases of mucinous cystadenoma, 4 cases of serous cystadenoma, 10 cases of islet cell tumor, 5 cases of nonfunctional neuroendocrine tumor, 4 cases of congenital cyst. There were 6 cases of head of pancreas, 26 cases of body of pancreas, 8 cases of tail of pancreas, 5 cases of uncinate process. The tumor was 1.2 to 9.0 cm in diameter with an average of 3.2 cm. Among them, the diameter was more than 5.0 cm in 9 cases. The incidence of pancreatic fistula after operation was 57.8%, 65.4% was grade A fistula, 34.6% was grade B fistula, and no grade C fistula occurred. The incidence of abdominal infection was 13.3%, incidence of abdominal hemorrhage was 6.7%. There was no secondary diabetes mellitus and pancreatic endo- and exocrine dysfunction, and no death case.ConclusionsPancreatic enucleation for benign and low-grade malignant pancreatic tumors after strict preoperative evaluation can effectively preserve the pancreatic endocrine function of patients. Although the incidence of pancreatic fistula is high, it is mostly biochemical fistula, and the incidence of serious complications is low.
From 1976 to 1991, 34 cases of benign tumors of femoral neck were received in our department and 29 cases were treated surgically with either free bone graft (18 cases) or vascularized bone graft (11 cases). Fibrous dysplasia of bone and bone cyst had a high incidence in this group (75%)and most of the patients were over 30 years old. Because the femoral neck had its own anatomical characteristics and was biomechanically important and in order to accelerate. The graft healing and prevent the occurrence of pathological fracture, the choice of operations should depend on the extent of the lesion, the thickness of the cortical bone of the affected past,and the presence or absence of complications.
Objective To study the clinical significance of central pancreatectomy in treatment of benign tumor of neck and body of pancreas. Methods The clinical data of 29 patients with benign tumor of pancreas were reviewed retrospectively in our hospital during the past 5 years. Results There was no perioperative death. Mean of operative time was （165±45） min （125-270min）， mean of blood loss was （173±88） mL （50-450mL）. The pathological diagnosis of all the patients were benign. Pancreatic fistula occurred in 10 patients. One patient with bleeding after operation was treated with another two operations. Twenty-one patients were followed-up with the time ranged from 3 months to 4 years （average 16 months）. There were no complications related to diabetes. Conclusion Central pancreatectomy is reasonable for patients with benign tumor of pancreas， it could well preserve the endocrine and exocrine function of pancreas， and improve the quality of life of patients.
Duodenum-preserving pancreatic head resection (DPPHR) is a surgical approach indicated for benign or low-grade malignant tumors of the pancreatic head, pancreatic duct stones in the pancreatic head, chronic pancreatitis, and related pathologies. Compared to traditional pancreaticoduodenectomy (PD), its core principle lies in preserving the integrity of the stomach, duodenum, and biliary tract, thereby reducing postoperative digestive dysfunction and metabolic complications to improve patients’ quality of life. With the continuous advancement of laparoscopic techniques, laparoscopic duodenum-preserving pancreatic head resection (LDPPHR) has emerged as a significant refinement of conventional PD, achieving an optimal integration of minimally invasive laparoscopy and organ function preservation. This article synthesizes recent Chinese and English literature to provide a systematic review of surgical indications, technical nuances, complication management, and clinical outcomes of LDPPHR.
ObjectiveTo investigate the correlation between abnormal thyroid function and benign or malignant breast tumors. MethodsThe contents of free iodine three original acid (FT3), three iodine original acid (T3), thyroxine (T4), free thyroxine (FT4), thyroid-stimulating hormone (TSH), anti-thyroglobulin antibodies (Anti-TG), and antithyroid peroxidase antibody (Anti-TPO) were detected by chemiluminescence method in 563 patients with benign breast neoplasms, 87 patients with breast cancer, and 123 health examination population. ResultsT3 and T4 levels in patients with breast cancer were lower than those of normal control group and benign tumor group (P < 0.05). However, there were no significant difference in the levels of FT3, FT4, and TSH between the 3 groups (P > 0.05). The positive rates of Anti-TPO and Anti-TG were higher than those of benign group and normal group (P < 0.001). T3 and T4 levels in patients with breast cancer were not related to the expression of ER and PR, in Her-2 negative expression and lymph node metastasis were relatively low (P < 0.05). ConclusionThe decrease of contents of T3 and T4, and the positive expressions of Anti-TPO and Anti-TG may provide a basis for predicting the incidence of breast cancer.