2015年 · 第30卷第11期

In the surgical treatment of liver cancer, the relationship between risk and benefit is relative. Surgeons don't have liver tumors that can't be cut, but whether the body can tolerate them. The key is how to cut it and whether it makes sense. What kind of treatment is the most suitable for patients, and what kind of treatment can make patients obtain long-term satisfactory survival, all of which need us to evaluate the patient's condition and economic status comprehensively, and obtain the maximum benefit with the smallest risk. Of course, different treatment methods have different risks and benefits. In the current special medical environment, we mainly discuss the risks and benefits of surgical treatment of liver cancer.

In this study, the expression of five multidrug resistance gene-related proteins: DNA topoisomerase Ⅱ (Topo Ⅱ), P-glycoprotein (P-gp), lung resistance-related protein (LRP), multidrug resistance-associated protein (MRP) and glutathione S-transferase-π (GST-π) in adenocarcinoma of gastroesophageal junction (AGEJ) was detected, so as to find reliable predictors of chemosensitivity and provide an important basis for the individualized treatment of AGEJ.

Rectal cancer is one of the most common digestive tract malignancies^[1]Surgical resection is still the main treatment for rectal cancer, but ureteral injury often occurs in rectal cancer surgery. The clinical data of 11 cases of ureteral injury in 9 patients undergoing rectal cancer surgery in our hospital from January 2009 to March 2014 were retrospectively analyzed, the causes of injury were analyzed, and preventive measures were put forward, which are reported as follows.

Studies have shown that Stathmin protein is closely related to the development of many human tumors^[1]。 Pokemon protein has the common structural characteristics of POK protein family members, inhibits the apoptosis of tumor cells, and is regarded as the "master switch" of tumor development and development^[2]。 In this study, the expression of Stathmin and Pokemon protein in small intestinal stromal tumor tissues was examined, and the correlation between Stathmin and Pokemon protein and the risk grade and survival rate of small intestinal stromal tumor was investigated.

Appendicectomy is an effective treatment for appendicitis. laparoscopic appendectomy (LA) has the advantages of less trauma and fast recovery^[1]But it is not the gold standard surgical method for all appendicitis^[2]。 Jiaxing area is a high incidence area of schistosomiasis. In this study, 40 patients with appendicitis with schistosomiasis cirrhosis were performed laparoscopic and open appendectomy (open appendectomy OA) respectively, and the application value of laparoscopic appendectomy in patients with schistosomiasis cirrhosis was preliminarily understood by comparative study.

Severe pancreatic rupture is often combined with other organ injuries. At the same time, due to the leakage and corrosion of pancreatic juice, the injury becomes complicated, and complications such as pancreatic fistula are easy to form after operation, which makes it difficult to treat^[1]。 From February 2005 to February 2014, our hospital used modified pancreatogastric anastomosis to treat 12 cases of severe pancreatic neck rupture, and the curative effect was satisfactory. The report is as follows.

percutaneous laser ablation (PLA) is a minimally invasive therapeutic technique developed gradually in recent years. It has been used by foreign scholars to treat benign thyroid nodules, thyroid autonomic functional adenomas and recurrent thyroid malignant tumors, and the clinical results are satisfactory^[1]。 The purpose of this paper is to investigate the feasibility of PLA in the treatment of recurrent nodular goiter (RNG).

Bile duct injury is a serious complication of laparoscopic cholecystectomy. The incidence rate of bile duct injury in laparoscopic cholecystectomy in China is 0.19%^[1]Among them, bile duct transverse injury and/or severe bile duct defect injury are the most serious, and if improperly treated, it will lead to serious consequences. We received 5 cases of bile duct injury after laparoscopic cholecystectomy, which are now reported below.

The patient was a 65-year-old female. The main reason was upper abdominal discomfort. After eating, I felt obvious upper abdominal fullness, and the symptoms worsened recently. B-ultrasound in the local county hospital 2 days before admission showed splenomegaly and multiple hyperechoic nodules in the spleen. Blood routine: WBC 21.37×10⁹/L, RBC 5.78×10¹²/L, PLT 432×10⁹/L, liver, kidney function, electrolyte indexes were normal. CT showed: splenomegaly, uneven and wavy edges, low-density shadows in the spleen, but lymphoma was not excluded. Both bone marrow punctures were dry draw and blood smears: middle and late granulocytes, megakaryocytes, nucleated red blood cells and platelet accumulation distribution were seen. Clinical diagnosis: spleen occupying space, splenomegaly. The patient underwent splenectomy after completing relevant examinations. During the operation, adhesion between the upper pole of the spleen and the diaphragm was found. The size of the spleen was 26 cm ×17 cm ×9 cm. There were no enlarged lymph nodes around the spleen, free splenic pedicle and residual perisplenic ligament. The spleen was completely removed and sent for pathological examination. The size of the spleen submitted for examination was 25 cm ×18 cm ×7 cm. The volume of the spleen was obviously increased, the surface was swollen and smooth, and the capsule was intact. Book-shaped incision, the spleen section is dark red, the red pulp is congested and swollen, the section can see bleeding, nodular, the spleen tissue at the bleeding site is slightly spongy, the size is 3 cm ×2 cm, the white pulp is atrophic and brittle.

The patient was a 27-year-old female. I was admitted to hospital for 1 d with upper abdominal pain, which was persistent tingling without release. No nausea, vomiting, no fever, yellowness, no diarrhea and tenesea. No frequent urination, urgency and painful urination. Physical examination: abdominal breathing was weakened, upper abdominal tenderness, mainly in the left upper abdomen, accompanied by rebound pain and mild muscle tension. Murrphy sign negative. The liver and gallbladder are not palpable under the costs, but the spleen is palpable under the costs. Percussion pain was obvious in the spleen area. Blood routine: WBC: 14.28×10⁹/L, RBC: 3.76×10¹²/L, HGB: 87 g/L. Coagulation routine : PT-sec: 11.5 s, PT-INR: 0.84, PT: 111.00%, FIB: 4.59 g/L, TT: 14.7 s. There was no abnormality in urine routine and no abnormality in liver function. There were no abnormalities in ECG and chest radiographs. Tumor markers : CEA: 0.71 ng/ml, CA-199 153.35 U/ml. Abdominal CT showed: the spleen was enlarged, about 11.6 cm ×6.1 cm in size, the CT value was 40 HU, and the intestinal canal, left kidney and pancreas in the abdominal cavity were compressed, displaced and deformed. After the enhanced scan, there was no obvious enhancement in the arterial phase, delayed phase and spleen parenchyma, and the CT value was about 42 HU; The splenic artery was not developed behind the splenic hilum, the splenic artery was not obviously thickened or dilated, the splenic vein was not filled with contrast medium, the splenic vein was spiral in shape, and a small amount of fluid accumulation was seen around the spleen (Figure 1)。 Diagnosis: Splenomegaly, no enhancement of the splenic parenchyma, occlusion of the splenic artery behind the splenic hilum, and torsion of the splenic vein. In the emergency department, exploratory laparotomy and splenectomy were performed under general anesthesia. During the operation, the spleen was wrapped by the omentum and adhered to the surrounding tissues. After the adhesion was separated, the spleen was obviously enlarged, about 12 cm ×8 cm ×4 cm, dark red, the capsule was obviously thickened, the splenic parenchyma was hard in texture, the capsule was separated from the splenic parenchyma, and there was a small amount of dark red bloody fluid around the spleen. The splenic arteries and veins were tortuous and thickened at the splenic hilum, and thrombi were filled inside (Figure 2), no torsion was seen. The patient recovered smoothly after surgery. Postoperative pathology: The spleen was 18 cm ×10 cm ×4 cm, the section was solid and dark red, with coagulation in splenic arteries and veins, and thrombi in blood vessels. The patient was cured and discharged 10 days after operation. After 7 months of follow-up, the patient was in good condition without discomfort. The platelets had dropped to normal, and there was no abdominal pain again.

Aortic dissection is a state in which the intima of the aortic wall is ruptured, and the arterial blood flow enters the aortic wall to divide it into true lumen and false lumen. The clinical manifestation is dangerous and the mortality rate is high^[1,2]。 Stanford type B aortic dissection mainly involves the descending aorta, and its treatment modalities include conservative medical, surgical and endovascular repair^[3]。 In the early stage, conservative treatment was the main treatment, and surgical operation was taken when related complications occurred, but the surgical trauma was large and the mortality rate was high. With the rise of endovascular treatment techniques, thoracic endovascular aortic repair (TEVAR) has been gradually applied to the treatment of aortic dissection. The technique has little injury, high success rate, and has the functions of sealing dissection, preventing aortic rupture and reducing complications^[4]。

A large amount of mucoid substance accumulates in the extrahepatic biliary tract, causing obstruction and dilation of the biliary tract, which in turn leads to obstructive jaundice and/or cholangitis, known as mucobilia, 1987 by Hadjis^[1]Introduce this concept first. The primary disease is mostly tumors with endocrine mucus in the bile duct, and tumors with mucus secretion function in the liver or pancreas can also be seen invading the bile duct. The clinical manifestations are mainly jaundice and abdominal pain. Because it is rare in clinical practice, it is mainly reported by cases worldwide, so there is no unified diagnosis and treatment guideline at present. Combined with domestic and foreign literatures, the etiology, clinical manifestations, diagnosis and treatment of mucocholedosis are summarized as follows.

At present, the surgical technique and perioperative management of liver transplantation are quite mature, but the long-term survival rate of liver transplantation recipients still needs to be improved. According to the China Liver Transplant Registry (CLTR) database, the 10-year survival rate after liver transplantation is less than 60%^[1]。 Studies have shown that among the recipients who die 1 year after liver transplantation, 63% of the death causes are not directly related to the function of the transplanted liver, but are related to cardiovascular disease, kidney disease, infection and new tumors^[2]。 It can be seen that these complications greatly affect the long-term survival of the recipient. Metabolic disease is a common complication after liver transplantation, with obesity, diabetes, hypertension and hyperlipidemia as the typical characteristics. If three of them are met, metabolic syndrome can be diagnosed. Metabolic diseases are closely related to complications such as immunosuppressants, cardiovascular diseases, kidney diseases and infections, and are one of the main causes of long-term death in liver transplant recipients. The purpose of this consensus is to provide recommendations for the prevention and treatment of postoperative metabolic diseases in Chinese liver transplant recipients, with a view to improving the long-term survival of recipients.