2016年 · 第31卷第10期

For colorectal cancer surgery, it is a consensus that laparoscopy has the advantages of less trauma and fast recovery. However, previous studies have excluded transverse colon cancer^[1,2]Therefore, a large amount of clinical data is still needed to demonstrate whether radical resection of transverse colon cancer is suitable for laparoscopy. The purpose of this paper is to compare the feasibility and safety of traditional laparotomy and laparoscopic radical resection of transverse colon cancer.

Metastasis and recurrence are difficult points in the treatment of primary hepatocellular carcinoma (HCC). HCC cells are mainly transferred through the portal vein system, which eventually leads to postoperative recurrence of HCC^[1]。 At present, systemic chemotherapy and regional chemotherapy are commonly used for postoperative chemotherapy of HCC. Wherein regional chemotherapy includes hepatic artery administration and portal vein administration^[2,3]。 We retrospectively analyzed 161 patients diagnosed with HCC with radical resection and TNM stage Ⅰ/Ⅱ with complete follow-up data in our department to explore the safety of portal vein chemotherapy (PVC) after HCC operation and its impact on postoperative prognosis of HCC.

Stage Ⅱ/Ⅲ rectal cancer has high risk of recurrence and poor prognosis. The preoperative treatment is mainly based on the evaluation of magnetic resonance imaging (MRI)^[1]。 Because of the low sensitivity to assess the stage, there is a possibility of overuse of radiotherapy and chemotherapy. In recent years, it has been found that circumferential resection margin (CRM) is more effective in predicting patient prognosis^[2]。 In this study, patients with negative CRM were selected by preoperative MRI and divided into direct surgery group and preoperative chemoradiotherapy + surgery group. The postoperative results of the two groups were compared to clarify and avoid the overuse of neoadjuvant chemoradiotherapy.

In this study, proteomics methods were used to study the proteomic differences of gastric stromal tumors, to find the related tumor proteins, and to explore the clinical significance of the differential proteins.

epithelioid inflammatory myofibroblastic sarcoma (EIMS) is a spindle cell mesenchymal tumor that is very rare and is currently considered to be associated with anaplastic lymphoma kinase (anaplastic lymphoma kinase,ALK) Exception related^[1]。 ForALKFor positive tumors, the application of specific small molecule inhibitor crizotinib to prevent ALK kinase activity is expected to achieve good efficacy, thus changing the course of patients' disease. There is one case of EIMS successfully treated with crizotinib, which is reported below.

As an important part of gastric cancer treatment, whether it is preoperative neoadjuvant chemotherapy^[1]Both postoperative chemotherapy and chemotherapy play an important role in the treatment of gastric cancer. At present, many studies have confirmed that Tegio is effective in the treatment of patients with advanced gastric cancer^[2]。 This study investigated the effect of continuous therapy and the occurrence of adverse reactions in patients with radical gastrectomy who were intolerable during routine postoperative systemic intravenous chemotherapy, and compared them with those of patients with whole course of intravenous chemotherapy to explore the therapeutic effect and feasibility.

Continuous expansion of pseudoaneurysms of lower limbs can cause complications such as compression of adjacent tissues, tumor rupture and massive hemorrhage, and distal arterial embolism caused by wall thrombus detachment. In severe cases, it can cause ischemic necrosis of limbs and even life-threatening. Lower extremity pseudoaneurysms are mostly caused by trauma and iatrogenic injury, and spontaneous lower extremity pseudoaneurysms are rarer. A retrospective analysis of 11 cases of spontaneous pseudoaneurysm of lower limbs diagnosed and treated in the First Affiliated Hospital of Sun Yat-sen University from July 2014 to May 2015 is presented.

From August 2007 to March 2015, the Department of Head and Neck Cancer Surgery of Guizhou Cancer Hospital completed a total of 2,245 thyroid surgeries, and 12 cases were reoperated due to bleeding and tracheal fistula. The clinical data of these 12 patients are retrospectively analyzed and reported as follows.

regulatory T cell (Treg) is closely related to the immune status of patients after liver transplantation. Immune regulation through cytokines is also one of the mechanisms of action of Treg. At the same time, T helper cells (Th) class 1 and Th2 cytokines also affect the immune status of patients after liver transplantation. We examined the expression of Treg and related cytokines in peripheral blood of patients with long-term survival after liver transplantation, and investigated the effects of different immune status on Treg/Th1/Th2 after liver transplantation.

The 51-year-old male was admitted to the hospital on November 12, 2015 due to "gastric mass found in physical examination for more than half a year". Physical examination: No abnormalities were found. Endoscopic ultrasound showed that a huge mucosal bulge was seen in the small curvature of the gastric antrum with a smooth surface (Figure 1)。 Laparoscopically assisted distal partial gastrectomy (Bi I type) was performed. During the operation, the mass was located in the small curvature of gastric antrum, with clear boundary, no invasion of serosa, and no swelling of perigastric lymph nodes. Postoperative pathological report: The proliferation of spindle cells was observed in the muscle wall and serous surface of the gastric wall at the lesion, the nucleus of tumor cells was oval, the nucleoli were obvious, and the nuclear division was not easy to see (Figure 2)。 Immunohistochemical staining results: Dog (-), CK (-), ALK (-), CD117 (-), CD34 (-), SMA (+), Ki-67 (+1%), β-catenin positive (Figure 3)。 Pathological diagnosis: gastric fibromatosis. No adjuvant treatment was performed after surgery. After 6 months of follow-up, no recurrence was observed, and the patient was in good condition.

A 72-year-old male was admitted to hospital in November 2011 because of "intraperitoneal effusion" found in physical examination. Physical examination: soft, swollen abdomen, mobile voiced sound (+). Serum CEA, AFP, CA-125, CA-199 and CA-50 were all normal. Abdominal CT examination revealed: abdominal and pelvic effusion and unclear mesenteric structure. Laparoscopic exploration revealed a large amount of grass-green clear ascites in the abdominal cavity, with a volume of about 3 500 ml, containing a large number of small follicles. There were many follicular nodules on the parietal peritoneum and the surface of the organs, and the greater omentum was contractured into a mass. Biopsy of parietal peritoneal nodules and omental nodules showed that a large amount of mucus in fibrous adipose tissue was infiltrated by inflammatory cells, and small expanded glands were seen in the mucus, without obvious proliferation of glands, and obvious local tissue extrusion. Ascites sediment was negative for acid-resistant staining. In February 2016, the patient was readmitted due to vomiting and diarrhea. After rehydration treatment in the local hospital, he developed full abdominal distension and pain with dyspnea. Physical examination: The abdomen is highly swollen and has high tension. Abdominal CT examination showed: abdominal and pelvic effusion. Serum CEA 123.6 ng/ml, CA-125 47.32 U/ml, CA-199 558.4 U/ml, CA-724 148.10 U/ml. The abdominal cavity was punctured with the No. 7 needle without fluid leading out, and only a trace amount of light yellow mucous-like thick fluid was seen when the No. 9 needle was used instead. Laparoscopic exploration revealed a large amount of gelatinous thick fluid in the abdominal cavity, about 2 700 ml. After the mucus was sucked out, the surface of the organ was obviously congested, and the surface spots were focal bleeding spots (Figure 1), multiple nodules on the surface of the parietal peritoneum, and the contracture of the omentum is cake-shaped. Pathological examination of the nodule revealed: peritoneal pseudomyxoma (Figure 2)。

The patient, a 77-year-old male, visited our hospital on September 10, 2015 because of "abdominal mass found during physical examination for 2 days". Physical examination: No positive signs in the abdomen. Laboratory tests: Serum CEA was 2.21 ng/ml and AFP was 44.65 ng/ml. CT plain scan showed that a mass between the spleen and the fundus of the stomach compressed the surrounding intestine, suspected to invade the lower pole of the spleen and part of the descending colon (Figure 1)。 No abnormalities were found on colonoscopy and the patient refused to have a gastroscopy. Exploratory laparotomy was performed: A cystic-solid mass was found between the stomach and spleen during the operation, which was tough in texture, without intact capsule, and the surface was not smooth. The size was about 10 cm ×7 cm ×6 cm, and it was infiltrated with the great curvature of the stomach and the spleen (Figure 2)。 Subtotal gastrectomy and splenectomy were performed. Postoperative pathological report: Moderate to poorly differentiated adenocarcinoma of the stomach with germ cell tumor components, full-thickness infiltration of the stomach wall and involvement of the omentum and splenic envelope (Figure 3)。 Immunohistochemistry: P53 (85% +), HER-2 (-), CK20 (focal +), AFP (-), CD30 (focal +), CD117 (focal +), HCG (-). Diagnosis: Tumor with multiple heterologous differentiation, gastric germ cell tumor. The patients underwent bilateral testicular color ultrasound examination after operation, and no abnormalities were found. After 6 months follow-up, no adverse events occurred.

The patient was a 34-year-old male. He was admitted to the emergency department on May 12, 2014 due to tarmaceous melena for 7 days and dark red bloody stool for 3 days. The patient underwent an emergency exploratory laparotomy 2 years ago for a knife stab wound in the abdomen, and underwent intraoperative colonoplasty. Physical examination on admission: Surgical scar was seen in the left side of the abdomen, and under the xiphoid process of the middle abdomen and blowing-like murmur was heard, but no abnormalities were found. Admission examination: hemoglobin 84 g/L; Stool occult blood + + +; Abdominal B-ultrasound showed that the portal vein was widened. Gastroscopy showed: esophageal and gastric varices (severe), portal hypertensive gastropathy, but no obvious erosion or bleeding focus was found. Colonoscopy showed no obvious abnormalities. Abdominal CTA + CTV examination showed that the portal vein, superior mesenteric vein and splenic vein were thickened and enhanced simultaneously with the arteries, and the soft tissue density shadow between the superior mesenteric vein and the superior mesenteric artery was enhanced simultaneously with the vessels, which was suggested to be the formation of superior mesenteric arteriovenous fistula (FIG. 1A)。 In the early morning of May 31st, the patient suddenly vomited blood, with a volume of about 1 250 ml, which was dark red bloody liquid with blood clots; Immediately administer an infusion of allogeneic type A RHD positive leukocyte-deactivated suspended erythrocytes for 3 U. Considering the rupture and bleeding of esophageal and gastric varices, ligation of esophageal varices and ligation of gastric varices and bleeding were performed under emergency endoscopy. Postoperatively, 2 U of leukosuspended red blood cells, 10 U of cryoprecipitate and 300 ml of fresh frozen plasma were continuously infused. Endovascular isolation of superior mesenteric arteriovenous fistula was performed every other day under general anesthesia. One covered stent (6 mm ×100 mm, FLUENCY stent, Bard Company, USA) was used during the operation. Postoperative angiography showed that the covered stent was well expanded, the distal branches of superior mesenteric artery were well developed, there was type II endoleak, and the portal vein was not developed. Mesenteric CTA 9 d after operation showed that the capsular pocket shadow between superior mesenteric artery and superior mesenteric vein was still communicated after superior mesenteric artery isolation; Considering the displacement of the covered stent, the arteriovenous fistula still exists (FIG. 1B)。 On June 10, he was transferred to Zhongshan Hospital affiliated to Fudan University, and underwent endovascular isolation of superior mesenteric arteriovenous fistula under brachial plexus plus local anesthesia. Two stents (8 mm ×50 mm, 10 mm ×50 mm, Viabahn stent, GORE Company) were used during the operation. Postoperative angiography showed that the stents were well expanded (Figure 1C)。 The patient recovered and was discharged after surgery. One week later, the mesenteric CTA revealed that there was no communication between the superior mesenteric artery and the superior mesenteric vein after the isolation of the superior mesenteric artery and the stent placement in the mesenteric artery.Figure 1D)。

A 51-year-old male suffered from severe postprandial abdominal pain for half a year. He denied having a history of surgery and long-term medication. After falling from a 4 m high forklift 1 year ago, he started to experience abdominal distension, which progressively aggravated and lost 40 kg of weight. Colonoscopy, gastroscopy, abdominal CT, color ultrasound and other examinations were performed many times, but the cause was not clear. Physical examination: The whole abdomen was soft, slightly flexible, without tenderness and rebound pain, liver and spleen were not large, and intestinal sounds were 5 times/min. CT examination showed that part of the small intestine was obviously dilated, and the local intestinal tube in the left lower abdomen was gathered and the wall was thick (Figure 1)。 Intraoperative exploration showed the absence of omentum, most of the intestinal tube was wrapped by a white cocoon-like membrane, the lateral small intestine and most of the colon showed membranous adhesions, some small intestines dilated and effused, and a small amount of pale yellow clear peritoneal effusion (Figure 2)。 The capsule with a size of about 18 cm ×16 cm was completely peeled from the surface of small intestine and right colon by blunt-sharp combination method to repair the damaged area of small intestine serosa and mesenteric membrane. After exact hemostasis and peritoneal irrigation, an intestinal obstruction catheter is inserted nasally, the end of the catheter is passed through the ileocecal valve to the cecum, 20 ml of water is injected into the anterior water sac, the guide wire is withdrawn, and the small intestine is arranged (Figure 3)。 Intraoperative diagnosis: abdominal cocoon, incomplete intestinal obstruction. Pathological report: fibrous tissue hyperplasia with hyaline degeneration, local infarction. Chronic inflammatory cell infiltration, local giant cell reaction and old hemorrhage (Figure 4)。 The patient exhausted and defecated on the 4th day after surgery, started enteral nutrition on the 5th day, and transitioned to semi-liquid food on the 9th day without abdominal distension and abdominal pain. On the 17th day, the whole abdominal CT was re-examined. There was no encapsulated fluid or gas accumulation in the abdominal cavity, and no intestinal wall edema was observed, so the intestinal obstruction catheter was removed. After half a year's follow-up, the patient recovered well without discomfort and gained 35 kg.

A 61-year-old woman found a small mass in her right hip 15 years ago, and the posterior mass gradually increased to the size of a football, accompanied by poor stool, which seriously affected the daily life of the patient. Physical examination: Subcutaneous soft tissue mass of right buttock, tough in texture, acceptable movement, normal movement and sensation of lower limbs, no edema. Triple examination: the right pelvic cavity can be palpable with unclear boundary, and the vagina and the right side of the lower rectum are compressed. Color ultrasound examination showed a slightly hypoechoic mass subcutaneously on the right buttock; Needle aspiration cytology of buttock revealed lipoma; MR examination showed that a huge short T1 long T2 signal mass was seen in the right buttock and pelvic cavity with clear boundary, uterus and bladder were compressed, and no swollen lymph nodes were seen in the pelvic cavity (Figure 1)； Ultrasonic colonoscopy showed that the rectal lumen was narrowed, and the external pressure of hypoechoic mass outside the intestinal wall was visible; The results of urinary tract X-ray imaging showed that the right lower ureter and bladder were compressed and displaced. Preliminary diagnosis: huge lipoma invading the pelvic cavity in the right buttock. Laparoscopic assisted resection of right pelvic floor mass + pelvic floor reconstruction was performed. During the operation, the tumor was located on the right pelvic floor, penetrated the pelvic floor fascia along the right pelvic wall and adhered to the pelvic internal organs. The size was about 18 cm ×12 cm ×10 cm, and the boundary was unclear. The perineal structure, rectum, uterus and bladder were deformed under pressure and displaced to the left. The adhesion between the tumor and the surrounding organs was separated, the right pelvic floor fascia was opened, and the tumor was separated from the surrounding tissues along the tumor envelope. After separation to the deep part, an auxiliary incision of about 7 cm in the middle of the lower abdomen was taken, and the tumor was further separated subcutaneously to the right buttock. In view of the huge size of the tumor, no hip incision was performed to facilitate postoperative recovery, and the tumor was removed in blocks through the abdominal incision. Avoid damage to perianal sphincter, ureter, uterine appendages, mesorectum, femur, gluteus maximus, piriformis, etc. during separation, and stop bleeding carefully. After tumor resection, the right pelvic floor defect was large and could not be pulled together and sutured, so the composite patch was used to repair the pelvic floor defect. The composite patch was placed in the defect treatment, the smooth surface was in contact with the pelvic contents, the patch was fixed on the pelvic wall tissue around the defect with silk thread, and the repair ring was checked to be complete. After the tumor was removed, it was grey-red fat-like tissue (Figure 2)。 Postoperative pathological report: Gray-red adipose tissue, total volume 28 cm ×19 cm ×4 cm, gray-yellow section, soft texture, some areas seem to have capsule. Lipoma-like changes were observed under light microscope (Figure 3)。 After 6 months follow-up, there was no abnormal movement and sensation in the buttocks and lower limbs, and the appearance of the buttocks was normal.

delayed gastric emptying (DGE) is a gastric dysfunction syndrome with gastric emptying disorder as the main symptom, and is not accompanied by organic lesions of the stomach or mechanical obstruction of the outflow tract. The main clinical manifestations are postprandial epigastric pain, fullness, nausea, vomiting, and decreased appetite, which are common after gastrointestinal surgery and one of the common complications after pancreaticoduodenectomy. It is reported abroad that the incidence rate is about 19% ~57%^[1]However, because the definition of DGE is not uniform, the report on the incidence of DGE is actually inaccurate. If the definition of DGE proposed by the International Committee of Pancreatic Surgery in 2007 is followed^[2]The incidence rate is likely to be higher than previously reported. Although postoperative DEG does not endanger patients' lives, it often leads to the increase of hospital stay time and cost, which seriously affects the postoperative quality of life of patients. In this paper, the progress in the mechanism, diagnosis and treatment of DEG after pancreaticoduodenectomy will be reviewed.