Pub Date : 2020-01-20DOI: 10.3760/CMA.J.ISSN.1673-9752.2020.01.006
Yinmo Yang
Currently the treatment strategy of pancreatic cancer has shifted from the mode "surgery first" to multidisciplinary team. More and more evidences have revealed that neoadjuvant therapy will help to increase the R0 resection rate, reduce the recurrence rate, and improve the prognosis of the patients with borderline resectable pancreatic cancer. Furthermore, neoadjuvant therapy is also recommended for resectable pancreatic cancer patients with high risk factors of tumor recurrence. In this article, the current controversy and research progress of neoadjuvant therapy for pancreatic cancer are reviewed and commented in order to deepen the understanding of the hot topic in clinial surgeons. Key words: Pancreatic neoplasms; Resectablity; Neoadjuvant therapy; Multidisciplinary team; Efficacy
{"title":"Evaluation of neoadjuvant therapy for pancreatic cancer: is it the best choice?","authors":"Yinmo Yang","doi":"10.3760/CMA.J.ISSN.1673-9752.2020.01.006","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1673-9752.2020.01.006","url":null,"abstract":"Currently the treatment strategy of pancreatic cancer has shifted from the mode \"surgery first\" to multidisciplinary team. More and more evidences have revealed that neoadjuvant therapy will help to increase the R0 resection rate, reduce the recurrence rate, and improve the prognosis of the patients with borderline resectable pancreatic cancer. Furthermore, neoadjuvant therapy is also recommended for resectable pancreatic cancer patients with high risk factors of tumor recurrence. In this article, the current controversy and research progress of neoadjuvant therapy for pancreatic cancer are reviewed and commented in order to deepen the understanding of the hot topic in clinial surgeons. \u0000 \u0000 \u0000Key words: \u0000Pancreatic neoplasms; Resectablity; Neoadjuvant therapy; Multidisciplinary team; Efficacy","PeriodicalId":36400,"journal":{"name":"中华消化外科杂志","volume":"19 1","pages":"41-45"},"PeriodicalIF":0.0,"publicationDate":"2020-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48236793","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-01-20DOI: 10.3760/CMA.J.ISSN.1673-9752.2020.01.004
Y. Miao
In recent years, enhance recovery after surgery (ERAS) has attracted many attentions in the surgical field. ERAS is a new model of perioperative management, in which more attention is paid to patients′ perception to the medical treatment. This new medical model is different from the past one which is completely led by medical practitioners, thus full of humanistic concerns and rationality. With the premise of medical safety guaranteed, a series of measures, especially evidence-based medical interventions, are implemented to optimize the perioperative management and promote the recovery of patients in ERAS. A certain level of economic and social benefit will be gained with this process. The development history of ERAS was systemically reviewed in current editorial to help the readers to get a better understanding of the origin and evolving process of ERAS. It tracked back to the 1960s when "two reductions and one guarantee" and "removal of two tubes and one prohibition" were proposed as a revolutional perioperative management mode by the surgical community in our country. The goals pursued and measures implemented by our surgical predecessors back in those days were astonishingly similar to those in today′s ERAS practice. They actually enlightened the initiation of ERAS in China. While ERAS is widely implemented nowadays, this new medical model should be objectively evaluated. A patient-centered medical system should be built, and ERAS should be promoted from an academic perspective, through which the ultimate goal of "surgery without danger and pain" could be finally achieved. Key words: Treatment outcome; Enhanced recovery after surgery; Fast track surgery; Perioperative management
{"title":"Historical inspiration and practical thinking of enhanced recovery after surgery","authors":"Y. Miao","doi":"10.3760/CMA.J.ISSN.1673-9752.2020.01.004","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1673-9752.2020.01.004","url":null,"abstract":"In recent years, enhance recovery after surgery (ERAS) has attracted many attentions in the surgical field. ERAS is a new model of perioperative management, in which more attention is paid to patients′ perception to the medical treatment. This new medical model is different from the past one which is completely led by medical practitioners, thus full of humanistic concerns and rationality. With the premise of medical safety guaranteed, a series of measures, especially evidence-based medical interventions, are implemented to optimize the perioperative management and promote the recovery of patients in ERAS. A certain level of economic and social benefit will be gained with this process. The development history of ERAS was systemically reviewed in current editorial to help the readers to get a better understanding of the origin and evolving process of ERAS. It tracked back to the 1960s when \"two reductions and one guarantee\" and \"removal of two tubes and one prohibition\" were proposed as a revolutional perioperative management mode by the surgical community in our country. The goals pursued and measures implemented by our surgical predecessors back in those days were astonishingly similar to those in today′s ERAS practice. They actually enlightened the initiation of ERAS in China. While ERAS is widely implemented nowadays, this new medical model should be objectively evaluated. A patient-centered medical system should be built, and ERAS should be promoted from an academic perspective, through which the ultimate goal of \"surgery without danger and pain\" could be finally achieved. \u0000 \u0000 \u0000Key words: \u0000Treatment outcome; Enhanced recovery after surgery; Fast track surgery; Perioperative management","PeriodicalId":36400,"journal":{"name":"中华消化外科杂志","volume":"19 1","pages":"32-35"},"PeriodicalIF":0.0,"publicationDate":"2020-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43166591","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-01-20DOI: 10.3760/CMA.J.ISSN.1673-9752.2020.01.005
M. Zheng, Junjun Ma
The oncological minimally invasive surgery, represented by laparoscopic surgery, has been developed in the past three decades. Despite the techniques and procedures have been improved, the oncological outcomes of radical surgery by minimally invasive approach in several cancer types are still controversial according to the results of recent clinical researches. Whatever the truth is, the key point of tumor radical surgery is the quality control of minimally invasive surgery. Grasping the surgical indications strictly and providing the most suitable treatment modality for cancer patients will be helpful to ensure quality control and minimize risks. In addition, with standardizing minimally invasive surgical procedures by constructing a systematic training system, the quality of minimally invasive tumor surgery can be guaranteed perioperatively. For novel minimally invasive surgical techniques, rigorous and prudent attitude is particularly proposed for the quality control. In the context of highly developed minimally invasive surgery, not only "maintaining speed" , but also better "guaranteeing quality" can minimally invasive surgery bring real benefits to more cancer patients. Key words: Neoplasms; Minimally invasive surgery; Quality control; Laparoscopy
{"title":"Enlightenment and reflection of clinical research results on oncological minimally invasive surgery: how to improve the quality control of minimally invasive surgery","authors":"M. Zheng, Junjun Ma","doi":"10.3760/CMA.J.ISSN.1673-9752.2020.01.005","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1673-9752.2020.01.005","url":null,"abstract":"The oncological minimally invasive surgery, represented by laparoscopic surgery, has been developed in the past three decades. Despite the techniques and procedures have been improved, the oncological outcomes of radical surgery by minimally invasive approach in several cancer types are still controversial according to the results of recent clinical researches. Whatever the truth is, the key point of tumor radical surgery is the quality control of minimally invasive surgery. Grasping the surgical indications strictly and providing the most suitable treatment modality for cancer patients will be helpful to ensure quality control and minimize risks. In addition, with standardizing minimally invasive surgical procedures by constructing a systematic training system, the quality of minimally invasive tumor surgery can be guaranteed perioperatively. For novel minimally invasive surgical techniques, rigorous and prudent attitude is particularly proposed for the quality control. In the context of highly developed minimally invasive surgery, not only \"maintaining speed\" , but also better \"guaranteeing quality\" can minimally invasive surgery bring real benefits to more cancer patients. \u0000 \u0000 \u0000Key words: \u0000Neoplasms; Minimally invasive surgery; Quality control; Laparoscopy","PeriodicalId":36400,"journal":{"name":"中华消化外科杂志","volume":"19 1","pages":"36-40"},"PeriodicalIF":0.0,"publicationDate":"2020-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42754835","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-01-20DOI: 10.3760/CMA.J.ISSN.1673-9752.2020.01.012
Lei Wang, Ziguo Lin, Tian Yang, J. Lou, Shu-guo Zheng, X. Bi, Jianming Wang, W. Guo, Fuyu Li, Jian Wang, Ya-min Zheng, Jingdong Li, S. Cheng, Yongyi Zeng, Jingfeng Liu
Objective To investigate the clinical value of lymph node dissection (LND) in the radical resection of intrahepatic cholangiocarcinoma (ICC). Methods The propensity score matching and retrospective cohort study was conducted. The clinicopathological data of 448 patients with ICC who were admitted to 12 medical centers from December 2011 to December 2017 were collected, including 279 in the Eastern Hepatobiliary Surgery Hospital of Navy Medical University, 32 in the Mengchao Hepatobiliary Hospital of Fujian Medical University, 21 in the First Hospital Affiliated to Army Medical University, 20 in the Cancer Hospital Chinese Academy of Medical Science and Peking Union Medical College, 19 in the West China Hospital of Sichuan University, 18 in the Second Hospital Affiliated to Zhejiang University School of Medicine, 18 in the Renji Hospital Affiliated to Shanghai Jiaotong University School of Medicine, 16 in the Beijing Friendship Hospital Affiliated to Capital Medical University, 10 in the Xuanwu Hospital Affiliated to Capital Medical University, 7 in the Tongji Hospital Affiliated to Tongji Medical College of Huazhong University of Science and Technology, 5 in the Beijing Tiantan Hospital Affiliated to Capital Medical University, and 3 in the Affiliated Hospital of North Sichuan Medical College. There were 281 males and 167 females, aged from 22 to 80 years, with a median age of 57 years. Of the 448 patients, 143 with routinely intraoperative LND were divided into LND group and 305 without routinely intraoperative LND were divided into control group, respectively. Observation indicators: (1) the propensity score matching conditions and comparison of general data between the two groups after matching; (2) intraoperative and postoperative situations; (3) follow-up; (4) survival analysis. Patients were followed up by outpatient examination, telephone interview and email to detect survival of patients and tumor recurrence up to October 31, 2018 or death. Follow-up was conducted once every 3 months within postoperative 1-2 years, once every 6 months within postoperative 2-5 years, and once a year after 5 years. The propensity score matching was realized using the nearest neighbor method with 1∶1 ratio. Measurement data with normal distribution were represented as Mean±SD, and comparison between groups was analyzed using the t test. Measurement data with skewed distribution were represented as M (range), and comparison between groups was analyzed using the Mann-Whitney U test. Count data were described as absolute numbers, and comparison between groups was analyzed using the chi-square test or Fisher exact probability. Kaplan-Meier method was used to calculate survival rates and draw survival curve, and Log-rank test was used to perform survival analysis. Univariate analysis and multivaraiate analysis were conducted using the Log-rank test and COX regression model, respectively. Results (1) The propensity score matching conditions and compar
{"title":"A multicenter retrospective study on clinical value of lymph node dissection in the radical resection of intrahepatic cholangiocarcinoma","authors":"Lei Wang, Ziguo Lin, Tian Yang, J. Lou, Shu-guo Zheng, X. Bi, Jianming Wang, W. Guo, Fuyu Li, Jian Wang, Ya-min Zheng, Jingdong Li, S. Cheng, Yongyi Zeng, Jingfeng Liu","doi":"10.3760/CMA.J.ISSN.1673-9752.2020.01.012","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1673-9752.2020.01.012","url":null,"abstract":"Objective \u0000To investigate the clinical value of lymph node dissection (LND) in the radical resection of intrahepatic cholangiocarcinoma (ICC). \u0000 \u0000 \u0000Methods \u0000The propensity score matching and retrospective cohort study was conducted. The clinicopathological data of 448 patients with ICC who were admitted to 12 medical centers from December 2011 to December 2017 were collected, including 279 in the Eastern Hepatobiliary Surgery Hospital of Navy Medical University, 32 in the Mengchao Hepatobiliary Hospital of Fujian Medical University, 21 in the First Hospital Affiliated to Army Medical University, 20 in the Cancer Hospital Chinese Academy of Medical Science and Peking Union Medical College, 19 in the West China Hospital of Sichuan University, 18 in the Second Hospital Affiliated to Zhejiang University School of Medicine, 18 in the Renji Hospital Affiliated to Shanghai Jiaotong University School of Medicine, 16 in the Beijing Friendship Hospital Affiliated to Capital Medical University, 10 in the Xuanwu Hospital Affiliated to Capital Medical University, 7 in the Tongji Hospital Affiliated to Tongji Medical College of Huazhong University of Science and Technology, 5 in the Beijing Tiantan Hospital Affiliated to Capital Medical University, and 3 in the Affiliated Hospital of North Sichuan Medical College. There were 281 males and 167 females, aged from 22 to 80 years, with a median age of 57 years. Of the 448 patients, 143 with routinely intraoperative LND were divided into LND group and 305 without routinely intraoperative LND were divided into control group, respectively. Observation indicators: (1) the propensity score matching conditions and comparison of general data between the two groups after matching; (2) intraoperative and postoperative situations; (3) follow-up; (4) survival analysis. Patients were followed up by outpatient examination, telephone interview and email to detect survival of patients and tumor recurrence up to October 31, 2018 or death. Follow-up was conducted once every 3 months within postoperative 1-2 years, once every 6 months within postoperative 2-5 years, and once a year after 5 years. The propensity score matching was realized using the nearest neighbor method with 1∶1 ratio. Measurement data with normal distribution were represented as Mean±SD, and comparison between groups was analyzed using the t test. Measurement data with skewed distribution were represented as M (range), and comparison between groups was analyzed using the Mann-Whitney U test. Count data were described as absolute numbers, and comparison between groups was analyzed using the chi-square test or Fisher exact probability. Kaplan-Meier method was used to calculate survival rates and draw survival curve, and Log-rank test was used to perform survival analysis. Univariate analysis and multivaraiate analysis were conducted using the Log-rank test and COX regression model, respectively. \u0000 \u0000 \u0000Results \u0000(1) The propensity score matching conditions and compar","PeriodicalId":36400,"journal":{"name":"中华消化外科杂志","volume":"19 1","pages":"72-80"},"PeriodicalIF":0.0,"publicationDate":"2020-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41612594","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-01-20DOI: 10.3760/CMA.J.ISSN.1673-9752.2020.01.014
F. Cheng, Jianfei Zhu, Yi Liu, Yuting Hu, Jingping Zhang, W. Lou, X. Qin, Chunfu Zhu
Objective To investigate the influencing factors for poor jaundice resolution after radical pancreaticoduodenectomy in patients with malignant obstructive jaundice. Methods The retrospective case-control study was conducted. The clinicopathological data of 121 patients with malignant obstructive jaundice who were admitted to the Affiliated Changzhou No.2 People′s Hospital of Nanjing Medical University between March 2013 and June 2018 were collected. There were 70 males and 51 females, aged (69±9)years, with a range from 39 to 85 years. Of 121 patients, 112 underwent open radical pancreaticoduodenectomy, and 9 underwent totally laparoscopic radical pancreaticoduodenectomy. Observation indicators: (1) situations of jaundice resolution after pancreaticoduodenectomy; (2) influencing factors for poor jaundice resolution after pancreaticoduodenectomy. Measurement data with normal distribution were represented as Mean±SD. Measurement data with skewed distribution were represented as M (range). Count data were described as absolute numbers. Univariate analysis was performed using the chi-square test, t test, Fisher exact probability or Mann-Whitney U test. Multivariate analysis was performed by the Logistic regression model using P<0.10 as an inclusion criteria in the univariate analysis . Results (1) Situations of jaundice resolution after pancreaticoduodenectomy: of 121 patients, 97 had good jaundice resolution after pancreaticoduodenectomy, and 24 had poor jaundice resolution after pancreaticoduodenectomy. (2) Influencing factors for poor jaundice resolution after pancreaticoduodenectomy: results of univariate analysis showd that preoperative level of serum total bilirubin, comorbidity with diabetes mellitus were influencing factors for poor jaundice resolution after pancreaticoduodenectomy (t=-2.073, χ2=10.201, P<0.05). Postoperative pancreatic fistula was also an influencing factor for poor jaundice resolution after pancreaticoduodenectomy (P<0.05). Results of multivariate analysis showed that comorbidity with diabetes mellitus and postoperative pancreatic fistula were independent risk factors for poor jaundice resolution after pancreaticoduodenectomy (odds ratio=0.258, 0.129, 95% confidence interval: 0.087-0.769, 0.023-0.726, P<0.05). Conclusions Preoperative level of serum total bilirubin, diabetes mellitus, and postoperative pancreatic fistula are influencing factors for poor jaundice resolution after pancreaticoduodenectomy. Comorbidity with diabetes mellitus and postoperative pancreatic fistula are independent risk factors for poor jaundice resolution after pancreaticoduodenectomy. Key words: Bile duct diseases; Malignant obstructive jaundice; Pancreaticoduodenectomy; Poor jaundice resolution; Diabetes mellitus; Pancreatic fistula
{"title":"Influencing factors for poor jaundice resolution after radical pancreaticoduodenectomy in patients with malignant obstructive jaundice","authors":"F. Cheng, Jianfei Zhu, Yi Liu, Yuting Hu, Jingping Zhang, W. Lou, X. Qin, Chunfu Zhu","doi":"10.3760/CMA.J.ISSN.1673-9752.2020.01.014","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1673-9752.2020.01.014","url":null,"abstract":"Objective \u0000To investigate the influencing factors for poor jaundice resolution after radical pancreaticoduodenectomy in patients with malignant obstructive jaundice. \u0000 \u0000 \u0000Methods \u0000The retrospective case-control study was conducted. The clinicopathological data of 121 patients with malignant obstructive jaundice who were admitted to the Affiliated Changzhou No.2 People′s Hospital of Nanjing Medical University between March 2013 and June 2018 were collected. There were 70 males and 51 females, aged (69±9)years, with a range from 39 to 85 years. Of 121 patients, 112 underwent open radical pancreaticoduodenectomy, and 9 underwent totally laparoscopic radical pancreaticoduodenectomy. Observation indicators: (1) situations of jaundice resolution after pancreaticoduodenectomy; (2) influencing factors for poor jaundice resolution after pancreaticoduodenectomy. Measurement data with normal distribution were represented as Mean±SD. Measurement data with skewed distribution were represented as M (range). Count data were described as absolute numbers. Univariate analysis was performed using the chi-square test, t test, Fisher exact probability or Mann-Whitney U test. Multivariate analysis was performed by the Logistic regression model using P<0.10 as an inclusion criteria in the univariate analysis . \u0000 \u0000 \u0000Results \u0000(1) Situations of jaundice resolution after pancreaticoduodenectomy: of 121 patients, 97 had good jaundice resolution after pancreaticoduodenectomy, and 24 had poor jaundice resolution after pancreaticoduodenectomy. (2) Influencing factors for poor jaundice resolution after pancreaticoduodenectomy: results of univariate analysis showd that preoperative level of serum total bilirubin, comorbidity with diabetes mellitus were influencing factors for poor jaundice resolution after pancreaticoduodenectomy (t=-2.073, χ2=10.201, P<0.05). Postoperative pancreatic fistula was also an influencing factor for poor jaundice resolution after pancreaticoduodenectomy (P<0.05). Results of multivariate analysis showed that comorbidity with diabetes mellitus and postoperative pancreatic fistula were independent risk factors for poor jaundice resolution after pancreaticoduodenectomy (odds ratio=0.258, 0.129, 95% confidence interval: 0.087-0.769, 0.023-0.726, P<0.05). \u0000 \u0000 \u0000Conclusions \u0000Preoperative level of serum total bilirubin, diabetes mellitus, and postoperative pancreatic fistula are influencing factors for poor jaundice resolution after pancreaticoduodenectomy. Comorbidity with diabetes mellitus and postoperative pancreatic fistula are independent risk factors for poor jaundice resolution after pancreaticoduodenectomy. \u0000 \u0000 \u0000Key words: \u0000Bile duct diseases; Malignant obstructive jaundice; Pancreaticoduodenectomy; Poor jaundice resolution; Diabetes mellitus; Pancreatic fistula","PeriodicalId":36400,"journal":{"name":"中华消化外科杂志","volume":"19 1","pages":"87-92"},"PeriodicalIF":0.0,"publicationDate":"2020-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47280563","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Objective To investigate the effects of treatment of hernia sac stump in laparoscopic transabdominal preperitoneal inguinal hernia repair (TAPP) on postoperative seroma. Methods The prospective study was conducted. The clinical data of 128 male patients with primary indirect inguinal hernia who were admitted to Fujian Medical University Union Hospital from October 2017 to March 2019 were selected. Patients were divided into two groups by random number method. Patients in experimental group had hernia sac stump sutured and fixed at the lower margin of rectus abdominis after transection of hernia sac in TAPP, and patients in control group had hernia sac stump free in the abdominal cavity after dissection and transection of hernia sac in TAPP. Observation indicators: (1) surgical situations; (2) follow-up. Follow-up using outpatient examination and telephone interview was conducted to detect the incidence of postoperative seroma, incision infection, chronic pain, and hernia recurrence up to June 2019. Measurement data with normal distribution were represented as Mean±SD, and comparison between groups was done using the t test. Measurement data with skewed distribution were represented as M (range), and comparison between groups was done using the Mann-Whitney U test. Count data were described as absolute numbers and percentages, and comparison between groups was analyzed using the chi-square test. Results A total of 128 male patients were screened for eligibility, including 60 patients in the experimental group and 68 patients in the control group. The 128 patients were aged from 47 to 74 years, with an average age of 61 years. (1) Surgical situations: operation time and hospital expenses were (102±34)minutes and (12 813±2 390)yuan for the experimental group, and (97±30)minutes and (12 125±2 205)yuan for the control group, respectively, showing no significant difference between the two groups (t=0.907, 1.685, P>0.05). (2) Follow-up: all the 128 patients received follow-up. There were 8 cases of seroma in both the experimental group and the control group, with no significant difference between the two groups (χ2=0.072, P>0.05). The extraction volume of patients with seroma was 20 mL (range, 4-31 mL) in the experimental group, and 43 mL (range, 23-98 mL) in the control group, showing a significant difference between the two groups (Z=-2.013, P<0.05). There was no incision infection, chronic pain or hernia recurrence in 3 months after operation in patients with seroma of either experimental group or control group. Conclusions During TAPP, suture and fixation of the hernia sac stump to the lower edge of rectus abdominis and free hernia sac stump in the abdominal cavity after dissection and transection of hernia sac can effectively repair indirect inguinal hernia. The former method can reduce the extraction volume of seroma after operation. Key words: Hernia; Indirect inguinal hernia; Transabdominal preperitoneal inguinal hernia
{"title":"A prospective study on effects of treatment of hernia sac stump in laparoscopic transabdominal preperitoneal inguinal hernia repair on postoperative seroma","authors":"Ming-guang Wang, Heguang Huang, Xian-chao Lin, Congfei Wang, Haizong Fang","doi":"10.3760/CMA.J.ISSN.1673-9752.2020.01.013","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1673-9752.2020.01.013","url":null,"abstract":"Objective \u0000To investigate the effects of treatment of hernia sac stump in laparoscopic transabdominal preperitoneal inguinal hernia repair (TAPP) on postoperative seroma. \u0000 \u0000 \u0000Methods \u0000The prospective study was conducted. The clinical data of 128 male patients with primary indirect inguinal hernia who were admitted to Fujian Medical University Union Hospital from October 2017 to March 2019 were selected. Patients were divided into two groups by random number method. Patients in experimental group had hernia sac stump sutured and fixed at the lower margin of rectus abdominis after transection of hernia sac in TAPP, and patients in control group had hernia sac stump free in the abdominal cavity after dissection and transection of hernia sac in TAPP. Observation indicators: (1) surgical situations; (2) follow-up. Follow-up using outpatient examination and telephone interview was conducted to detect the incidence of postoperative seroma, incision infection, chronic pain, and hernia recurrence up to June 2019. Measurement data with normal distribution were represented as Mean±SD, and comparison between groups was done using the t test. Measurement data with skewed distribution were represented as M (range), and comparison between groups was done using the Mann-Whitney U test. Count data were described as absolute numbers and percentages, and comparison between groups was analyzed using the chi-square test. \u0000 \u0000 \u0000Results \u0000A total of 128 male patients were screened for eligibility, including 60 patients in the experimental group and 68 patients in the control group. The 128 patients were aged from 47 to 74 years, with an average age of 61 years. (1) Surgical situations: operation time and hospital expenses were (102±34)minutes and (12 813±2 390)yuan for the experimental group, and (97±30)minutes and (12 125±2 205)yuan for the control group, respectively, showing no significant difference between the two groups (t=0.907, 1.685, P>0.05). (2) Follow-up: all the 128 patients received follow-up. There were 8 cases of seroma in both the experimental group and the control group, with no significant difference between the two groups (χ2=0.072, P>0.05). The extraction volume of patients with seroma was 20 mL (range, 4-31 mL) in the experimental group, and 43 mL (range, 23-98 mL) in the control group, showing a significant difference between the two groups (Z=-2.013, P<0.05). There was no incision infection, chronic pain or hernia recurrence in 3 months after operation in patients with seroma of either experimental group or control group. \u0000 \u0000 \u0000Conclusions \u0000During TAPP, suture and fixation of the hernia sac stump to the lower edge of rectus abdominis and free hernia sac stump in the abdominal cavity after dissection and transection of hernia sac can effectively repair indirect inguinal hernia. The former method can reduce the extraction volume of seroma after operation. \u0000 \u0000 \u0000Key words: \u0000Hernia; Indirect inguinal hernia; Transabdominal preperitoneal inguinal hernia ","PeriodicalId":36400,"journal":{"name":"中华消化外科杂志","volume":"19 1","pages":"81-86"},"PeriodicalIF":0.0,"publicationDate":"2020-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42439945","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-01-20DOI: 10.3760/CMA.J.ISSN.1673-9752.2020.01.018
Chao Wang, K. Ning, Huanhuan Hu, C. Yuan
Pancreatic cancer is an aggressive malignant tumor with poor prognosis. On the one hand, it has a narrow therapeutic window due to the lack of specific markers and obvious clinical symptoms. Once diagnosed, it has often developed to an advanced stage. On the other hand, located in a vital region of the body, pancreatic operation is difficult and the postoperative recurrence rate is high. Therefore, surgical treatment is only sui-table for a small number of early patients. Pancreatic cancer has a tumor microenvironment with the characteristic of dense stroma, hypoxia, paucity of blood vessels and highly immunosuppression. It is often insensitive to traditional radiation and chemotherapy. Therefore, strategies targeting on tumor microenvironment have a potential prospect. This article reviews the research progress in tumor microenvironment of pancreatic cancer, in order to provide the references in the further research and treatment of pancreatic cancer. Key words: Pancreatic neoplasms; Tumor microenvironment; Pancreatic stellate cell; Immunosuppression; Stromal barrier
{"title":"Research progress in tumor microenvironment of pancreatic cancer","authors":"Chao Wang, K. Ning, Huanhuan Hu, C. Yuan","doi":"10.3760/CMA.J.ISSN.1673-9752.2020.01.018","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1673-9752.2020.01.018","url":null,"abstract":"Pancreatic cancer is an aggressive malignant tumor with poor prognosis. On the one hand, it has a narrow therapeutic window due to the lack of specific markers and obvious clinical symptoms. Once diagnosed, it has often developed to an advanced stage. On the other hand, located in a vital region of the body, pancreatic operation is difficult and the postoperative recurrence rate is high. Therefore, surgical treatment is only sui-table for a small number of early patients. Pancreatic cancer has a tumor microenvironment with the characteristic of dense stroma, hypoxia, paucity of blood vessels and highly immunosuppression. It is often insensitive to traditional radiation and chemotherapy. Therefore, strategies targeting on tumor microenvironment have a potential prospect. This article reviews the research progress in tumor microenvironment of pancreatic cancer, in order to provide the references in the further research and treatment of pancreatic cancer. \u0000 \u0000 \u0000Key words: \u0000Pancreatic neoplasms; Tumor microenvironment; Pancreatic stellate cell; Immunosuppression; Stromal barrier","PeriodicalId":36400,"journal":{"name":"中华消化外科杂志","volume":"27 8","pages":"109-112"},"PeriodicalIF":0.0,"publicationDate":"2020-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41278520","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-01-20DOI: 10.3760/CMA.J.ISSN.1673-9752.2020.01.016
Yan Xiao, Lei Zhou, Wei-Chang Cheng, Shengtao Huang, Yaling Liu, Guo-guang Li, Jianhui Yang, Xiaojie Pan, Xiangying Wang
Objective To investigate the application value of real-time virtual sonography(RVS)in the diagnosis and treatment of complicated hepatolithiasis. Methods The retrospective and descriptive study was conducted. The clinical data of 10 patients with complicated hepatolithiasis who were admitted to Hunan Provincial People′s Hospital between October 2017 and March 2018 were collected. There were 3 males and 7 females, aged from 40 to 69 years, with an average age of 57 years. Patients received abdominal color Doppler ultrasound examination, magnetic resonance cholangiopancreatography, and upper abdominal spiral computed tomography (CT) thinly scanning + enhanced examination. Data of CT examination were imported into RVS. RVS was used to locate hepatolithiasis, relationship between stones and vessels, anatomy of bile ducts and vessels in hepatic hilus. Surgical methods included RVS-guided hilar cholangiotomy, biliary stricturoplasty, bilateral hepatojejunostomy, hepatic segmentectomy (lobectomy), and hepatolithotomy. Observation indicators: (1) surgical and postoperative situations; (2) typical case analysis; (3) follow-up. Follow-up using outpatient examination was performed to detect residual stones up to June 2019. Measurement data with skewed distribution were represented as M(range). Count data were described as absolute numbers. Results (1) Surgical and postoperative situations: 10 patients underwent RVS-guided surgeries successfully for complicated hepatolithiasis, with successful match in RVS (difference between CT images and ultrosound images <2 mm). No residual stone was identified by choledochoscope during operation. The operation time and volume of intraoperative blood loss were 285 minutes (range, 210-360 minutes) and 200 mL (range, 100-600 mL), respectively. No blood transfusion was needed during the operations. The duration of hospital stay was 20.5 days (range, 14.0-29.0 days). There was no perioperative death. One patient had postoperative biliary leakage and abdominal infection, and was cured after conservative treatment. (2) Typical case analysis: the tenth patient, female, 60 years old, was diagnosed with complicated hepatolithiasis, and was prepared to undergo hepatolithotomy+ quadrate lobectomy and hilar cholangioplasty+ bilateral hepatojejunostomy. Preoperative CT images and intraoperative color Doppler ultrasound images of the patient were fused and matched on the sagittal section of the portal vein and the cross section of the right branch of portal vein, and stones and important vessels were marked on the images. After accurate positioning, a curette was used to remove the stones. Removal of biliary stones through hepatic parenchyma and peripheral dilated bile ducts was conducted at the site where stones obviously existed. After the stones were removed, the intrahepatic bile duct and hilar bile duct merged. The left end of the bile duct split was confirmed by real-time ultrasound. After location of portal vein was
{"title":"Application value of real-time virtual sonography in diagnosis and treatment of complicated hepatolithiasis","authors":"Yan Xiao, Lei Zhou, Wei-Chang Cheng, Shengtao Huang, Yaling Liu, Guo-guang Li, Jianhui Yang, Xiaojie Pan, Xiangying Wang","doi":"10.3760/CMA.J.ISSN.1673-9752.2020.01.016","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1673-9752.2020.01.016","url":null,"abstract":"Objective \u0000To investigate the application value of real-time virtual sonography(RVS)in the diagnosis and treatment of complicated hepatolithiasis. \u0000 \u0000 \u0000Methods \u0000The retrospective and descriptive study was conducted. The clinical data of 10 patients with complicated hepatolithiasis who were admitted to Hunan Provincial People′s Hospital between October 2017 and March 2018 were collected. There were 3 males and 7 females, aged from 40 to 69 years, with an average age of 57 years. Patients received abdominal color Doppler ultrasound examination, magnetic resonance cholangiopancreatography, and upper abdominal spiral computed tomography (CT) thinly scanning + enhanced examination. Data of CT examination were imported into RVS. RVS was used to locate hepatolithiasis, relationship between stones and vessels, anatomy of bile ducts and vessels in hepatic hilus. Surgical methods included RVS-guided hilar cholangiotomy, biliary stricturoplasty, bilateral hepatojejunostomy, hepatic segmentectomy (lobectomy), and hepatolithotomy. Observation indicators: (1) surgical and postoperative situations; (2) typical case analysis; (3) follow-up. Follow-up using outpatient examination was performed to detect residual stones up to June 2019. Measurement data with skewed distribution were represented as M(range). Count data were described as absolute numbers. \u0000 \u0000 \u0000Results \u0000(1) Surgical and postoperative situations: 10 patients underwent RVS-guided surgeries successfully for complicated hepatolithiasis, with successful match in RVS (difference between CT images and ultrosound images <2 mm). No residual stone was identified by choledochoscope during operation. The operation time and volume of intraoperative blood loss were 285 minutes (range, 210-360 minutes) and 200 mL (range, 100-600 mL), respectively. No blood transfusion was needed during the operations. The duration of hospital stay was 20.5 days (range, 14.0-29.0 days). There was no perioperative death. One patient had postoperative biliary leakage and abdominal infection, and was cured after conservative treatment. (2) Typical case analysis: the tenth patient, female, 60 years old, was diagnosed with complicated hepatolithiasis, and was prepared to undergo hepatolithotomy+ quadrate lobectomy and hilar cholangioplasty+ bilateral hepatojejunostomy. Preoperative CT images and intraoperative color Doppler ultrasound images of the patient were fused and matched on the sagittal section of the portal vein and the cross section of the right branch of portal vein, and stones and important vessels were marked on the images. After accurate positioning, a curette was used to remove the stones. Removal of biliary stones through hepatic parenchyma and peripheral dilated bile ducts was conducted at the site where stones obviously existed. After the stones were removed, the intrahepatic bile duct and hilar bile duct merged. The left end of the bile duct split was confirmed by real-time ultrasound. After location of portal vein was","PeriodicalId":36400,"journal":{"name":"中华消化外科杂志","volume":"19 1","pages":"99-105"},"PeriodicalIF":0.0,"publicationDate":"2020-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46291618","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-01-20DOI: 10.3760/CMA.J.ISSN.1673-9752.2020.01.003
Jia Fan
Hepatocellular carcinoma (HCC), a highly prevalent malignancy and one of the leading cause of cancer death in China, remains a major public health problem in the next decades. Owing to the tremendous achievements in early diagnosis, precision liver surgery, molecular targeted therapy and immunotherapy, we have witnessed significant improvements in the long-time survival of HCC patients, if properly treated. However, HCC is a highly heterogeneous disease. Even for patients within the same clinical stage, their clinical outcome and treatment efficacy vary significantly. Great efforts to improve the molecular classification of HCC patients are needed to foster precision medicine, paving the way for novel therapeutic strategies. Advances in multi-omics, single-cell analysis, molecular imaging and artificial intelligence will lead to better understanding of the molecular classification and refine precision treatment in HCC, ultimately excluding this neoplasm from the risk list of our Healthy China. Key words: Hepatic neoplasms; Molecular classification; Diagnosis; Treatment
{"title":"Research advances in molecular classification for precision diagnosis and treatment of hepatocellular carcinoma","authors":"Jia Fan","doi":"10.3760/CMA.J.ISSN.1673-9752.2020.01.003","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1673-9752.2020.01.003","url":null,"abstract":"Hepatocellular carcinoma (HCC), a highly prevalent malignancy and one of the leading cause of cancer death in China, remains a major public health problem in the next decades. Owing to the tremendous achievements in early diagnosis, precision liver surgery, molecular targeted therapy and immunotherapy, we have witnessed significant improvements in the long-time survival of HCC patients, if properly treated. However, HCC is a highly heterogeneous disease. Even for patients within the same clinical stage, their clinical outcome and treatment efficacy vary significantly. Great efforts to improve the molecular classification of HCC patients are needed to foster precision medicine, paving the way for novel therapeutic strategies. Advances in multi-omics, single-cell analysis, molecular imaging and artificial intelligence will lead to better understanding of the molecular classification and refine precision treatment in HCC, ultimately excluding this neoplasm from the risk list of our Healthy China. \u0000 \u0000 \u0000Key words: \u0000Hepatic neoplasms; Molecular classification; Diagnosis; Treatment","PeriodicalId":36400,"journal":{"name":"中华消化外科杂志","volume":"19 1","pages":"28-31"},"PeriodicalIF":0.0,"publicationDate":"2020-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42035859","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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