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Status and Controversy on SkinSparing Mastectomy for Breast Cancer

【Abstract】ObjectiveTo review the status and controversy on skinsparing mastectomy (SSM) for breast cancer. MethodsThe pertinent literatures about SSM published recently to comprehend its relevant techniques and improvements in comparison with nonskinsparing mastectomy (NSSM) were analyzed and also the safety of SSM by analyzing the relationships between SSM and ductal carcinoma in situ, restrict nippleareola complex reservation, and postmastectomy radiotherapy were discussed. ResultsSkinsparing mastectomy combined with immediate breast reconstruction is a safe operative modality for T1/T2 tumor without skin adhesion, multicentric tumors, and ductal carcinoma in situ. What is more, it does not defer adjuvant therapy. However, it may be prudent to reserve the nippleareola complex only for peripherally located T1/T2 tumors and some other less serious invasion degree. Since the effect of SSM and immediate breast reconstruction on postmastectomy radiotherapy is confusing, there are still controversies on whether the patients who have already been operated should take radiotherapy. ConclusionSSM is a safe operative modality for selected patients with breast cancer, and delayed reconstruction may be a good choice for patients who would take postmastectomy radiotherapy.

Analysis of Risk Factors of Functional Delayed Gastric Emptying after Pylorus-Preserving Pancreatoduodenectomy

Objective To investigate the risk factors and preventions of functional delayed gastric emptying (FDGE) after pylorus-preserving pancreatoduodenectomy (PPPD). Methods The clinical data of 41 patients after undergoing PPPD between 2003 and 2009 in this hospital were analyzed retrospectively.Results In all 41 cases, postoperative complications developed in 13 patients (31.7%), in which 7 patients developed FDGE (17.1%). The complications excluding FDGE (P=0.010) and diabetes (P=0.024) had remarkable relations with the FDGE in the univariate analysis; Compared with the non-FDGE patients, the albumin was declined obviously (P=0.020) while the serum direct bilirubin increased significantly (P=0.036) in the FDGE patients, while the development of FDGE had relation only with the albumin (P=0.039) and the complication of diabete (P=0.047) by the binary logistic regression analysis. Conclusion In the patients undergoing PPPD, preoperative control of the blood glucose, preoperative correction of hypoproteinemia and hyperbilirubinemia, and centralizing PPPD in high-volume have possibly positive significance for the prevention of FDGE.

Clinical review and analysis of laparoscopic duodenum-preserving pancreatic head resection for 12 cases

ObjectiveTo evaluate and synthesize the available experiences related to laparoscopic duodenum-preserving pancreatic head resection (LDPPHR) in the management of benign pancreatic head lesions. MethodsA retrospective review of the clinical data was conducted for 12 patients who underwent LDPPHR at the Department of Hepatobiliary and Pancreatic Surgery, Second Affiliated Hospital of Kunming Medical University (between January 2020 and December 2024). ResultsAll 12 patients successfully underwent LDPPHR. The surgical duration ranged from 138 to 479 min, with a mean of 336 min. Intraoperative blood loss varied between 40 and 700 mL, averaging 270 mL. The hospital stay varied from 11 to 51 d, with a mean duration of 21.5 d. Notably, none of the 12 patients required blood transfusions during the procedure. Of the 12 patients, 6 were diagnosed with a pancreatic fistula postoperatively, including 5 cases classified as grade A pancreatic fistula, and 1 cases of grade B pancreatic leakage. There were 2 cases of bile leakage and 1 case of gastric emptying disorder. No deaths occurred during the perioperative period. Postoperative pathological examination revealed: chronic pancreatitis witch main pancreatic duct stones in 8 cases, intraductal papillary mucinous neoplasms with low-grade epithelial intraepithelial neoplasia in 3 cases, serous cystadenoma in 1 case. Postoperative follow-up was conducted for 10 patients, with follow-up durations ranging from 6 to 24 months. No recurrence was observed during the follow-up period, and no long-term complications such as diabetes, gastric emptying dysfunction, etc. were reported. ConclusionsLDPPHR offers several benefits, including minimal invasiveness, faster recovery, and enhanced postoperative quality of life for patients. It is safe and feasible for the treatment of benign lesions in the head of the pancreas.

Efficacy and long-term retention rate comparision of ketogenic diet (KD) for children with intractable epilepsy in outpatient department and inpatient department

ObjectiveTo compare the efficacy and compliance of children children with refractory epilepsy receiving ketogenic diet (KD) in outpatient department with children receiving KD treatment in inpatient department. MethodsA retrospective study of 44 children with intractable epilepsy receiving the modified classical ketogenic diets in outpatient department from June 2014 to December 2015, who were followed-up during the third, sixth and twelfth month. Records of epileptic seizures and adverse reactions were used to evaluate the efficacy and retention rate of inpatient department KD treatment in children with refractory epilepsy, and compared with 104 children receiving KD treatment in inpatient department at the same period. ResultsThirty-four of the forty-four children comleted observation after 12-month follow-up, 15 cases had been seizure freedom, 22 cases had more than 50% reduction in seizure frequency, 12 patients had less than 50% reduction in seizure frequency.The total effective rate of the KD therapy in outpatient department was 64.7%, and the retention rate was 71%. 18 of of the 104 children with KD treatment in inpatient department at the same period comleted observation after 12-month follow-up, 3 cases had been seizure freedom, 5 cases had more than 50% reduction in seizure frequency, 13 cases had less than 50% reduction in seizure frequency.The total effective rate of the KD therapy in inpatient department was 27.8%, and the retention rate was 17.3%. ConclusionThe KD therapy in outpatient department is effective to children with intractable epilepsy, and there is a highly efficacy and compliance of children receiving KD in outpatient department comparing with children receiving KD in inpatient department. Therefore, it's optional to children with refractory epilepsy who can't received KD by inpatient department because of insufficient number of beds.

Pancreatoduodenectomy with Retained Duodenal Papilla

目的　介绍保留十二指肠乳头的胰十二指肠切除术。 方法　对2例重型十二指肠合并胰腺损伤患者行保留十二指肠乳头的胰十二指肠切除术。结果　无手术死亡,术后无胰瘘等严重并发症,均痊愈出院。结论　对胆总管完整、十二指肠乳头尚存的重型胰十二指肠损伤患者，急诊手术行保留十二指肠乳头的胰十二指肠切除是值得考虑和应用的安全手术方法。

三维CT重建联合吲哚菁绿显影技术应用于腹腔镜保留十二指肠胰头切除术2例报道

目的探讨三维CT重建联合吲哚菁绿显影技术应用于腹腔镜保留十二指肠胰头切除术（laparoscopic duodenum-preserving pancreatic head resection，LDPPHR）相关经验。方法回顾性分析青海大学附属医院2022年5月至2022年8月期间在三维CT重建联合吲哚菁绿荧光导航下行LDPPHR 2例患者的临床资料。结果2例患者均顺利完成LDPPHR，病例1和病例2的年龄分别为53和55岁，均为女性，手术时间分别为445 min和425 min，术中出血量分别为200 mL和250 mL，均使用了负压冲洗引流管。病例2术后发生胰腺生化漏，经治疗后均恢复正常。2例均未发生严重并发症。病例1和病例2术后住院时间分别为12 d和25 d，术后病理学检查结果提示病例1为胰腺浆液性囊腺瘤、病例2为胰腺真性上皮性囊肿。病例1和病例2术后随访时间分别为13个月和10个月，随访期间内均未出现胰腺内、外分泌功能障碍。结论三维CT重建联合吲哚菁绿应用于LDPPHR是一种安全、有效的手术方式，能有效辨别术中胆管解剖结构，并能发现术中微小胆管损伤，避免术后胆汁漏的发生。

Research progress of sodium-glucose cotransporter-2 inhibitors in heart failure with preserved ejection fraction

Sodium-glucose cotransporter (SGLT) -2 inhibitors is a new type of oral sugar-lowering drug. Instead of relying on insulin, it lowers blood sugar by inhibiting the reabsorption of near-curvy tube glucose, which is drained from the urine. SGLT-2 inhibitors not only have a sugar-lowering effect, but also benefit significantly in cardiovascular disease, and this drug has the advantages of permeable diuretic, reducing capacity load, and improving ventricular remodeling. SGLT-2 inhibitors can improve the diastolic function of patients with heart failure with preserved ejection fraction (HFpEF) and reduce the risk of adverse cardiovascular events. SGLT-2 inhibitors can benefit patients with HFpEF. Therefore, this article will discuss the progress of SGLT-2 inhibitors in HFpEF.

Progress in Valve-sparing Aortic Root Replacement

Abstract： Replacement of the aortic valve and aortic root has been the standard surgical strategy for patients with aortic root aneurysm for many years. Along with the increasing knowledge about the aortic root anatomy and physiology, and complications after aortic valve replacement, the technique of valve-sparing aortic root replacement has developed greatly. We focus on the etiology and classification aortic valve insufficiency, the valve-sparing techniques and clinical outcomes of valve-sparing aortic root replacement in this review.

慢性复发性胰腺炎伴胰管结石行保留十二指肠、胆总管、Oddi’s括约肌的胰头整块全切除术（王氏手术）1例报道

Surgical resection of space occupying with extensive calcification of pancreatic head

ObjectiveTo estimate the prognosis of duodenum-preserving resection of pancreatic head (DPRPH) in the treatment of space occupying with extensive calcification of pancreatic head, and to summarize the key points of surgery.MethodsThe clinical data of a middle-aged woman with rare space occupying with extensive calcification of pancreatic head who underwent surgery in Department of Pancreatic Surgery of West China Hospital in May. 2016 was collected and analyzed.ResultsThe DPRPH operation was successfully completed, with the operative time was 207 min, the intraoperative blood loss was 130 mL, and the hospital stay was 12 d. Removing time of the gastric tube and off-bed activity were on the 3rd day after operation, and the volume of peritoneal drainage per day was decreasing from 30 mL to 10 mL until 7th day after operation. We made examination of serum amylase and fluid amylase for the patient every 2 days, and the examination indexes were within normal level. After removing the peritoneal drainage tube, the pain was obviously relieved on the 12th day after operation, then the patient made hospital discharge. There was no observable pancreatic fistula, duodenal fistula, biliary fistula, delay gastric emptying, peritoneal effusion, pleural effusion, abdominal infection, and abdominal bleeding, neither nor any special discomfort. During the follow-up period of 18 months, we got a good prognosis without any symptom of relapse or discomfort according to the result of CT scans and other examinations.ConclusionDPRPH can make a satisfied prognosis in the treatment of rare space occupying with extensive calcification of pancreatic head.