ObjectiveTo investigate the adequate surgical procedures for well-differentiated thyroid cancer (WDTC) located in the isthmus.MethodsNineteen patients with WDTC located in the isthmus were identified with WDTC and managed by surgery in Department of General Surgery in Xuanwu Hospital of Capital University from Jun. 2013 to May. 2018.ResultsAmong the nineteen cases, fifteen patients had a solitary malignant nodule confined to the isthmus, four patients had malignant nodules located separately in the isthmus and unilateral lobe. One patient received extended isthmusectomy as well as relaryngeal and pretracheal lymphectomy; six patients received isthmusectomy with unilateral lobectomy and central compartment lymph node dissection of unilateral lobe; four patients received isthmusectomy with unilateral lobectomy and subtotal thyroidectomy on the other lobe as well as central compartment lymph node dissection of unilateral lobe; seven patients received total thyroidectomy or isthmusectomy with unilateral lobectomy and nearly total thyroidectomy on the other lobe, as well as central compartment lymph node dissection of both sides; one patient received total thyroidectomy and central compartment lymph node dissection of both sides, as well as lateral thyroid lymph node dissection of both sides. The median operative time was 126 minutes (67–313 minutes), the median intraoperative blood loss was 30 mL (10–85 mL), and the median hospital stay was 6 days (4–11 days). Hypocalcemia occurred in 12 patients. There were no complications of recurrent laryngeal nerve palsy or laryngeal nerve palsy occurred. All the nineteen patients were well followed. During the follow up period (14–69 months with median of 26 months), there were no complications of permanent hypoparathyroidism occurred, as well as the 5-year disease-specific survival rate and survival rate were both 100%.ConclusionsFor patients with well-differentiated thyroid cancer located in the isthmus with different diameters and sentinel node status, individualized surgical procedures should be adopted.
目的 探讨十二指肠损伤后预防肠瘘的合理手术方式。方法 对我院2005年3月至2009年10月期间收治的28例十二指肠损伤患者的临床资料进行回顾性分析。结果 28例均行手术治疗，其中1例因多器官功能衰竭于术后第2天死亡，3例十二指肠瘘均经保守治疗后痊愈。27例患者术后随访2～6个月（平均3.5个月），2例发生不全性肠梗阻，1例发生盆腔脓肿，均经非手术治疗后痊愈。结论十二指肠损伤后选择合理的手术方式是预防术后发生十二指肠瘘的关键因素。
目的 结合腹腔镜手术的特点，设计出部分顺逆结合法腹腔镜胆囊切除术(LC)，总结该法的应用体会。方法 介绍部分顺逆结合法LC的方法。在1 250例LC中有255例采用部分顺逆结合法切除胆囊，其中慢性胆囊炎146例，急性、亚急性胆囊炎65例，慢性萎缩性胆囊炎44例。结果 所有患者均获痊愈。术中发现胆囊三角区细小副肝管4例，胆汁渗漏3例，均予妥善处理，无严重并发症发生。结论 该法吸取了开腹顺逆结合法胆囊切除术的优点，又符合腹腔镜手术的特点，适用于胆囊三角解剖结构不清者的手术。该法对发现解剖变异及避免胆管损伤有一定的作用。
ObjectiveTo discuss the pattern of lymph node metastasis for Siewert type Ⅱ adenocarcinoma of the esophagogastric junction and its appropriate surgical approach. MethodsWe retrospectively analyzed the clinical data of 162 patients with Siewert type Ⅱ adenocarcinoma of the esophagogastric junction who underwent curative resection in West China Hospital of Sichuan University from January 2007 through February 2010. The patients were divided into three groups based on their surgical approach, including 96 patients in a left thoracic group, 20 patients in an Ivor-Lewis group and 46 patients in an abdominal group. ResultsThere were 120 patients with lymph node metastasis. The lymph node metastatic rate was 74.1%. Simple thoracic lymph node metastasis was observed only in 2 patients (1.7%), 98 patients (81.7%) with simple abdominal lymph node metastasis, and 20 patients (16.6%) with both capacity lymph node metastasis. The thoracic approaches had an advantage in dissection lower mediastinal lymph node over the abdominal approach, while for the abdominal lymph node the result was reversed. There are 11 groups of lymph node with a more than 10% metastatic rate. ConclusionsThe abdominal lymph nodes are the dominating metastatic area of Siewert type Ⅱ AEG, but some important groups of lower mediastinal lymph node should be removed. In terms of curative resection of tumor, the Ivor-Lewis operated by a thoracic surgeon who is more familiar with the abdominal lymph node may be a reasonable choice.
目的:探讨盲部憩室炎的诊断和手术方式的选择。方法:回顾性分析18例盲部憩室炎的临床资料,包块临床表现、腹部体征、辅助检查、手术方式及随访结果。结果:18例均有右下腹疼痛及右下腹压痛。术前诊断困难,仅通过钡灌肠结肠造影和结肠镜确诊各1例,误诊为急性阑尾炎12例、阑尾周围脓肿1例、回盲部肿瘤3例。憩室单发3例,多发性15例,其中2个憩室9例,3个憩室6例。单纯憩室切除9例,回盲部切除2例;右半结肠切除7例。全组患者均获治愈,无严重并发症发生。结论:盲肠憩室炎的临床特征与急性阑尾炎相似,极易误诊为急性阑尾炎等。术中应注意探查,避免遗漏病变。根据憩室具体情况决定手术方式。
Objective To review the latest progress in classification system of thoracolumbar fractures and its surgical treatment with posterior approaches. Methods Recent l iterature about classification system of thoracolumbar fractures and its surgical treatment was reviewed. Results For the treatment of thoracolumbar fracture, the surgeon first should decide whether the surgical treatment was necessary. Recently, a new classification system had been developed to help the surgeon make the right decision. The surgical methods included short segment internal fixation and long segment internalfixation with or without fusion, and minimally invasive internal fixation. Conclusion The progress in the surgical treatmentof thoracolumbar fracture will help spinal surgeon decide the necessary surgery beneficial for the patients. The most appropriate and effective surgical method with the minimum damage should be used to treat the fracture. The advantages of non-fusion surgical treatment still need a further study.