Objective To explore the clinical significance on protection of parathyroid and recurrent laryngeal nerve （RLN） by meticulous capsular dissection and exposure of RLN in thyroid lobectomy. Methods Clinical data of 452 patients who underwent thyroid lobectomy by meticulous capsular dissection and exposure of RLN in our hospital from Jan. 2010 to Dec. 2012 were retrospectively analyzed. Results All of the 452 cases underwent thyroid lebectomy successfully without death， and the operative time was 45-110min （average 60 min）， the blood loss was 5-100mL （average 20mL）. The pathological results showed that there were thyroid adenoma in 193 cases， nodular goiter in 175 cases， Hashimoto thyroiditis in 38 cases， thyroid cancer in 46 cases. After operation， 4 cases suffered RLN injury， 1 of the 4 cases recovered after removal of drainage tube， and other 3 cases recovered during 0.5 to 3.0 months. In addition， 2 cases suffered laryngeal nerve injury whose symptoms disappearred within 1 week， 5 cases suffered parathyroid founctional damage without permanent hypocalcemia whose symptom had kept 1-5 days after treatment. Three cases were reoperated because of bleeding， including branch of anterior venous bleeding in 1 case， thyroid side arterial tube bleeding in 1 case， and thyroid stump bleeding in 1 case. Twenty one cases suffered hypothyroidism in 1 month after operation， and no recurrence happened during the followed up period. Conclusions Meticulous capsular dissection can effectively protect function of parathyroid and reduce the injury probability of RLN. Exposure of RLN is safe and feasible， which plays an important role in avoiding serious RLN injury.
【Abstract】 Objective To di scus s the resect ion of tumors of pelvic ring and i t s recons truct ion ofdefects. Meth ods From January 1999 to December 2006, 48 patients with tumors in pelvic ring were treated and defects were reconstructed. There were 32 males and 16 females, aged 14-72 years(mean 45.1 years), including 12 cases of benign tumor and 36 cases of mal ignant tumor. Fourteen cases had lesions in region Ⅰ , 11 cases in region Ⅱ , 12 cases in region Ⅲ , 3 cases in region Ⅳ and 8 cases had two or more regions. The selection of surgical method: benign tumor in wing of il ium or in sacro-il iac articulation was curettaged , mal ignant tumors were resected radically or boardly . Benign or mal ignant tumor in pubis, ischium or pubic symphysis was resected radically , defects were reconstructed with plastic plate or not. For tumor affecting aceta bulum , resection of tumor and replacement of the peri- pelvic prothetic or artificial hip joint replacement were performed to reconstructthe function of hip joint. Results Twelve patients with benign tumors were followed up 12-72 months and could walk well, only 1 case relapsed locally. Thirty-six patients with mal ignant tumor were followed up 6 - 72 months, the survival time was 6-12 months in 2 cases (5.6%), 12-24 months in 2 cases(5.6%), 24-36 mongths in 6 cases (16.7%), 36-72 months in 14 cases (38.8%), and more than 72 months in 12 cases (33.3%); 28 patients (77.8%) could walk normally, 6 (16.7%) could walk with the help of walking stick , 2(5.5%) needed wheel chair to move. Compl ications occurred in 6 cases( including 2 venous thrombus,1 anoxic encephalopathy, 2 wound delayed heal ing, and 1 dislocation after total hip joint replacement); the patients’ condition took a turn for the better. Conclusion Operation is a favorable way for the treatment of pelvic tumor. Selecting convenient operation methods to resect tumors or reconstruction defects according the position of the tumor will do good favor to good results,increase the survival time and improve qual ity of l ife.
【Abstract】Objective To establish and assess the rat model of postoperative fatigue syndrome (POFS). Methods The rat model of POFS was developed by the partial resection of the liver. The behavioral changes prior and post to operation, the disorder of nutritive intake after operation, stress reaction (pathological changes of mucous membrane in small intestine) and the hepatic albumin gene expression were observed. Results Low body temperature, lower sensitivity and reactivity were found. The serum levels of the iron, total protein, albumin, globulin and so on as the indexes of nutrition obviously dropped. The injury of the mucous membrane resulted from the stress reaction after the resection of the liver. The gene expression of the albumin decreased in the model group.Conclusion The experimental rat model of POFS by partial resection of the liver can be used for the investigation of POFS.
OBJECTIVE To investigate the reconstructional method of posterior wall of vagina after the resection of rectum carcinoma. METHODS From August 1991 to March 1996, 10 patients with rectum carcinoma were adopted in this study, among them, there were 4 cases belong to B stage of Dukas, and 6 cases belong to C stage of Dukes. In operation, rectum carcinoma and posterior wall of vagina were resected, and concurrent reconstruction was finished by using pedicled muscular flap of uterus. RESULTS The effect of operation were satisfactory except one case who was failed because of insufficient blood supply of the flap. Followed-up for 3-6 months, the posterior wall of vagina healed in 7 cases, the width of vagina was 2-3 fingers and the depth was 5-6 cm. CONCLUSION Reconstruction of the posterior wall of vagina with pedicled muscular flap of uterus was available in clinic. For its simplicity and feasibility, it’s suitable for the resection of rectum carcinoma in which the posterior wall of vagina was infiltrated.
ObjectiveTo compare and evaluate the application of two types of chest drainage in patients who had undergone the lung lobe resection. MethodWe retrospective analyzed the clinical data of 240 patients who underwent left lobe resection. The patients were divided into a single conventional drainage group with single chest drainage tube (normal group) and a single conventional drainage tube combined with drainage of disposable surgical negative pressure drainage ball (NPBD) (combination group). There were 140 patients including 86 males and 54 females at mean age of 48.76± 4.92 years in the normal group. There were 100 patients including 58 males and 42 females at mean age of 48.37± 4.56 years in the combination group. We compared the outcomes between the two groups. ResultThe postoperative pathological results revealed there were 12 patients with tuberculosis (TB), 87 patients with squamous carcinoma, and 41 patients with adenocarcinoma in the normal group; 5 patients with TB, 66 patients with squamous carcinoma, and 29 patients with adenocarcinoma in the combination group. There were statistical differences in postoperative hospital stay (11.35± 2.78 d vs. 9.33± 2.46 d), chest drainage tube indwelling time (6.75± 2.10 d vs. 8.28± 2.10 d), total volume of chest drainage (1 176.07± 384.62 ml vs. 926.50± 22.35 ml) with P values less than 0.001 between the normal group and the combination group. No statistical difference was found between the two groups in complications (P>0.05). ConclusionSingle conventional drainage tube combined with drainage of disposable surgical negative pressure drainage ball (NPBD) has more advantages than single conventional chest drainage tube drainage, and is worth to be applied popularly in clinic.
Objective To investigate the impact of laparoscopic versus. open hepatic resection for liver cancer on clinical rehabilitation and humoral immune function in patients organism. Methods Forty-four patients of laparoscopic and open left-lateral sectionectomy from January 2010 to June 2012 were selected， including 22 patients of laparoscopy group and 22 patients of conventional laparotomy group. The levels of IgG， IgA， IgM， C3， C4， C reactive protein （CRP）， IL-2， IL-6， and TNF-α in peripheral blood of patients on the last day before operation， first day and 5th day after operation were determinated by using ELISA assay. At the same time， the operative time， intraoperative bleeding， hospitalization time， and complications after operation between two groups were compared. Results The postoperative analgesic using time， first time eating， and hospitalization time in laparoscopic group were （1.9±0.8） days， （2.2±0.5） days， and （6.3±1.3） days， respectively， they were shorter than that in conventional laparotomy group （P＜0.05）. The operative time， intraoperative bleeding， complication rate， and mortality in two groups were not significant differences（P＞0.05） . Compared with before operation， the levels of C3， C4， IgA， IgG， IgM， and IL-2 on the first day after oper-ation in two groups were obviusly reduced， the levels of CRP， IL-6， and TNF-α on the first day after operation in two groups were significantly increased. The levels of C3， C4， lgA， IgG， lgM， and IL-2 on the first day after operation in conventional laparotomy group were significantly decreased than that in laparoscopic group （P＜0.05）. On the 5th day after operation， the levels of C3， C4， lgA， IgG， lgM， and IL-2 of laparoscopy group increased， the levels of CRP， IL-6，and TNF-α were reduced，that were no difference compared with before operation. Compared with before operation，the levels of C3， C4， lgA， IgG， lgM， and IL-2 of conventional laparotomy group were still at a low level state， and the levels of CRP， IL-6， and TNF-α were still at a high level state on the 5th day after operation. Conclusions Laparoscopic resection of liver cancer after operation， the patients’ recovery are quickly， and the impact on humoral immune function of laparoscopic radical resection for liver cancer patients is significantly less than that conventional laparotomy.
Objective To investigate the feasibility and indication of synchronous resection of colonic carcinoma and its hepatic metastasis. Methods Radical sigmoidectomy and right hemi-hepatectomy plus left lateral segment resection were performed at the same time in a 71-year-old patient with sigmoid carcinoma and multiple hepatic metastasis. Results The operation lasted for 5 hours and 10 minutes with 300ml blood lost during the procedure. The patient recovered smoothly and was discharged 2 weeks after operation. Follow-up showed no reoccurrence up to the day of this presentation(4 months).Conclusion The operation could be performed safely by experienced surgeon in good-equipment hospital.
Seven hundred and eighty three cases of rectal carcinoma were treated in this hospital Jan. 1986 to Dec. 1994. There were 552 cases(70.5%)in which the tumor located in the middle and lower portion of the rectum. Of this group, 201 cases were treated with the operations of preservation of sphincter ani. The operations included transabdomino-sacral resection(5 cases), transpubic resection(5 cases), Dixon’s operation(67 cases), perineal pull through anastomosis(44 cases), Welch’s operation(68 cases), and local resection(12 cases). The 3-year survival rate was 90.9%. We consider that anal sphincter preservation is rational in the treatment of rectal cancer of middle and lower segment, As often os the radical resection and maintenauce of normal defecation is concerned, it is suitable for rectal carcinomas in Duke’s A and B1 stages. Combined treatment is necessary to prevent the recurrence and increase the survival rate.
ObjectiveTo investigate the systemic stress responses after laparoscopic resection in colorectal cancer patients.MethodsSixty patients were randomized into the laparoscopic resection group (30 cases) and open resection group (30 cases) from October 2001 to September 2002 in our hospital.Analgesic dosages, recovery time of intestinal peristalsis, postoperative temperatures, C reactive protein(CRP), IL6 and white blood cell (WBC) counts were recorded after operation. ResultsThe changes of postoperative temperatures and WBC counts showed no significant difference between two groups.But in the laparoscopic resection group, the recovery time of intestinal peristalsis, postoperative analgesic dosages, CRP and IL6 significantly decreased (P＜0.01,P＜0.05).ConclusionCompared with traditional open resection, laparoscopic resection of colorectal cancer can diminish the systemic stress responses and decrease the injury to patients.
ObjectiveTo summarize the experience of applying trans-upper-sternal approach in resection of cervicothoracic junction tumors. MethodsWe retrospectively analyzed the clinical data of 32 patients with cervicothoracic junction tumors received surgical resection through the trans-upper-sternal approach in our hospital from March 2012 through March 2015. There were 20 males and 12 females at age of 18 to 76(44.8±11.3) years. ResultsAll patients successfully underwent tumor resection through trans-upper-sternal approach. No patient required to convert to full sternotomy during the surgery. There was no early death, re-operation, or incision infection in the perioperation. Hornor syndrome occurred in 1 patient, hoarseness in 3 patients, and lymphatic leakage in 1 patient in the early postoperative time. Postoperative in-hospital time ranged from 3 to 7 days. No patient needed blood transfusion. Pathological examination showed that 17 patients had malignant tumor. Among them, 15 patients received postoperative radiotherapy or chemotherapy. Follow-up duration ranged from 6 to 42 months. All patients were alive, and no limbs disturbance occurred. ConclusionApplying trans-upper-sternal approach is safe, feasible and effective for the resection of cervicothoracic junction tumor with satisfactory outcome, less trauma, better cosmetolgy, and faster recovery.