2017年 · 第32卷第01期

In recent years, on the premise of ensuring the radical cure of rectal cancer, preserving anal function and improving the postoperative quality of life of patients have become important goals in the treatment of low rectal cancer. For that distance between the lower edge of the tumor and the dentate line<For ultra-low rectal cancer within 2 cm or 5 cm from the anal margin, traditional combined abdominoperineal resection makes patients undergo permanent stoma, while intersphincteric rectal resection (ISR) preserves the anus for some patients and improves the quality of life.

The study found that the expression of miR-145 was significantly down-regulated in various malignant tumors^[1,2]。 In this study, the expression of miR-145 in gastric cancer tissues and peripheral blood of gastric cancer patients was detected by fluorescence quantitative polymerase chain reaction technique, and its clinical significance was analyzed.

With the continuous research on gastric bypass, this procedure has an important effect on the treatment of type 2 diabetes mellitus (T2DM) and its complications^[1]。 Recent studies have shown that high plasma homocysteine (Hcy) levels in adults are closely related to the development of macrovascular disease^[2,3]。 The purpose of this study was to investigate the changes of plasma Hcy, folic acid and VitB12 in patients with T2DM after gastric bypass, and to provide theoretical basis for gastric bypass in the treatment of T2DM and its associated lower extremity vascular lesions.

Digestive duplication malformation can occur in any part of the gastrointestinal tract, and it is a rare congenital disease of the digestive tract. It is more common in ileum and ileocecal region, followed by jejunum, esophagus, colon, stomach, duodenum, etc. Duodenal duplication malformation is a kind of duplication malformation of digestive tract, which refers to congenital developmental malformation of duodenum caused by abnormal development of digestive tract embryo. The incidence rate is low, accounting for about 5% of duplication malformation of digestive tract, and it is relatively rare in clinical practice. Because of the lack of specific symptoms and signs in the early clinical stage, it is easy to be misdiagnosed and missed. The diagnosis and treatment experience of a patient with duodenal duplication malformation is reported as follows.

The amount of bleeding during surgical resection of liver tumors was significantly correlated with the incidence of postoperative complications and mortality^[1,2]。 Bipolar radiofrequency has been gradually applied in hepatectomy. Studies have shown that bipolar radiofrequency-assisted hepatectomy can significantly reduce intraoperative hemorrhage and transfusion rate^[3]。 We applied bipolar radiofrequency-assisted hepatectomy to achieve satisfactory results, which are reported below.

There are many types of benign space-occupying liver lesions. Except for hepatic hemangioma, hepatic cyst and hepatic abscess, the incidence of other types of benign space-occupying liver lesions is low, and most of them lack specific symptoms, signs and imaging manifestations, so it is difficult to diagnose before operation. We retrospectively analyzed the diagnosis and treatment data of 21 patients with benign space-occupying liver lesions, so as to improve the diagnosis and treatment effect of benign space-occupying liver lesions.

Pancreatic abscess is one of the common complications in the late stage of severe acute pancreatitis. The main treatment methods include active anti-infection, abscess surgery and drainage, etc. However, the treatment effect is not good and the mortality rate is high. From January 2013 to September 2015, 8 patients with severe acute pancreatitis complicated with pancreatic abscess formation were treated in our department. After abscess puncture and catheter drainage, sensitive antibiotics were injected into the abscess cavity according to the results of pus antibacterial drug sensitivity test. The symptoms and signs of 8 patients improved quickly, their body temperature and blood image returned to normal, the abscess disappeared, and they were cured and discharged. The summary report is as follows.

native arterio-venous fistula (AVF) is the lifeline of hemodialysis patients, and choosing appropriate anastomosis method during fistulostomy is crucial for maintaining the long-term patency rate of AVF. At present, the most commonly used surgical methods in AVF are end-to-end anastomosis and end-to-side anastomosis^[1]。 However, it is still inconclusive which of the two anastomosis methods is superior or inferior, and which is more conducive to maintaining long-term patency of vascular access. From January 2008 to June 2012, 127 patients were treated with two types of AVF in Ningxia Hui Autonomous Region People's Hospital, which are reported as follows.

In the past five years, the research reports of minimal invasive pancreaticoduodenectomy (MIPD) in large cases have been increasing. In some large medical centers, minimal invasive PD has become a mature and even routine surgical method. At present, the requirements for MIPD have evolved from early completion of surgery to reducing the difficulty of surgery, improving the quality of surgery and pursuing short-term and long-term efficacy. More than 50 cases of MIPD have been completed in our center, of which 8 cases were revealed by reverse S pathway + posterior approach to superior mesenteric artery, and the results were satisfactory. The results are reported below.

A 64-year-old female was admitted to the hospital because of "abdominal wall mass found for more than 1 month". B-ultrasound examination in the local hospital showed nodular hypoechoic, uneven internal echoes, liquid dark area in the center, and clear boundary. The patient felt that the mass became larger, and there was pain when changing the position. Reexamination of B-ultrasound showed: a mixed mass of fluid and solid, and the abscess was first considered. CT examination showed: solid subcutaneous mass of abdominal wall (Figure 1)。 Physical examination: A hard mass about 4 cm in diameter can be palpable in the upper abdomen, with tenderness and no rebound pain. Abdominal wall mass resection was performed. The mass was located near the middle under the xiphoid process of the left upper abdominal wall, about 4 cm ×4 cm in size, hard in texture and clear in border. The mass was separated along the normal space of about 0.5 cm around the mass, and the adhesion between the base of the mass and the left rectus abdominis sheath was obvious. Therefore, the anterior rectus abdominis sheath with a range of about 2 cm ×2 cm was removed together with the mass, and the mass was completely removed (Figure 2)。 The bleeding of the surgical wound was completely stopped, and the surgical field was washed with normal saline. The anterior sheath of rectus abdominis and the abdominal white line were sutured with Puttis suture, and a drainage skin slip was placed. Rapid intraoperative freezing pathology report: highly malignant tumor. Postoperative pathological examination showed diffuse large B-cell lymphoma (non-GCB type) (Figure 3)。 Immunohistochemical staining results: CD10 (-), Bcl-6 (+), MUM-1 (+), Ki-67 (about 90% +) (Figure 4)。

The patient was a 21-year-old female. Complained of stool shape and habit change for 1 month, relieving stool 2 to 3 times a day, containing mucus. Five years after removal of a previous rectal adenoma. Physical examination: the abdomen is flat, the abdomen is soft, and the liver and spleen are not reached. The digital rectal examination showed that a 2.0 cm ×1.5 cm mass could be palpable 5 cm from the anal margin, with medium hard texture and smooth surface, and no blood in the finger cuff. Endoscopic examination showed that a submucosal mass was seen on the anterior rectal wall 5 cm away from the anal margin, with smooth surface mucosa, and congestion and erosion of the proximal rectal mucosa (12~15 cm away from the anal margin), suggesting the possibility of rectal stromal tumor (Figure 1)。 CT scan showed hypertrophy of the intestinal wall of the rectum. Transacrorectal mass resection under general anesthesia resulted in smooth recovery and good stool control function. Intraoperatively, the tumor was located on the anterior wall of the rectum, about 2.0 cm ×1.5 cm ×0.4 cm in size, cystic, and contained light brown turbid fluid. Postoperative histopathological examination: Under light microscope, glands and mucous cysts of different sizes were seen in the deep mucosal muscle layer. The structure of the glands was basically the same as that of normal rectum. The inner wall of the cyst was lined with a single layer of flat or cubic or even columnar epithelial cells. The cyst cavity was filled with mucus, and part of the cyst wall was covered with epithelium and disappeared, forming a mucus pool. Pathological diagnosis: deep cystic colitis of the rectum (Figure 2)。

Case 1 female, 36 years old, was seen for "recurrent abdominal pain with nausea, vomiting, anemia, hypoalbuminemia for 30 years". Physical examination: anemia appearance, mild tenderness in the lower abdomen, no rebound pain. CT examination showed that the ileal wall of the pelvic cavity was slightly thickened in multiple segments with obvious enhancement, and local inflammatory changes were shown. Colonoscopy showed chronic active inflammation of the terminal ileum with lymphoid tissue hyperplasia and inflammatory granulation tissue hyperplasia and villous atrophy. Enteroscopy revealed multiple strictures of the terminal ileum. Case 2 female, 31 years old, was admitted for "recurrent abdominal pain with blood in stool for 3 years and lower limb edema for 1 year". Physical examination: anemia appearance, lower abdominal tenderness, no rebound pain, lower limb edema. Abdominal CT examination showed that the middle and lower abdominal small intestine and ileocecal intestinal wall were segmentally thickened and strengthened obviously, combined with incomplete intestinal obstruction. Enteroscopy showed an annular ulcer approximately 1 m from the ileocecal valve and a longitudinal ulcer approximately 30 cm proximally. Both cases had been diagnosed with Crohn's disease, and were treated with hormones and immunosuppressants. The symptoms were repeated, and then they underwent surgery to remove part of the small intestine. In case 2, abdominal pain recurred in the third year after operation. Abdominal CT examination showed multisegmental ileal stenosis with dilatation, and then surgery was performed. During the course of the disease, the erythrocyte sedimentation rate and high-sensitivity C-reactive protein were normal, and the serum tumor indexes were not abnormal. The antinuclear antibody profile and vasculitis series were negative, T-SPOT was negative, and cytomegalovirus antibody IgM was negative. Surgical resection of gross specimens: multiple fibrous stenosis can be seen in the resected intestinal segment, and the stenotic intestinal wall is annularly thickened, which cannot accommodate the passage of one finger; Multiple linear and annular ulcers can be seen in the intestinal mucosa, and multiple cystic protuberances can be seen in the surrounding mucosa (Figure 1)。 Postoperative pathological report: Case 1: Chronic inflammation of small intestinal mucosa, focal activity, erosion formation in some intestinal segments, obvious inflammatory granulation tissue proliferation, thickening of mucosal muscles below the erosion area, and a large number of chronic inflammatory cells accumulated in both mucosal muscles and submucosa, which is consistent with the diagnosis of cryptogenic multifocal ulcerative stenotic enteritis; Example 2: A large number of chronic inflammatory cells infiltrated in the mucosa and submucosa, accompanied by granulation tissue hyperplasia and ulcer formation, consistent with the diagnosis of cryptogenic multifocal ulcerative stenotic enteritis (Figure 2)。 Both patients recovered well after surgery, and no recurrence of abdominal pain, anemia and melena occurred at postoperative follow-up.

The patient was a 32-year-old male. He was admitted to hospital on 23 July 2015 due to "sudden upper abdominal pain with palpitations for 1 month". Suffered from hypertension for 3 years without regular treatment; One month ago, I had sudden upper abdominal pain after exercise, radiating to my low back, accompanied by palpitations and headache, and my blood pressure was 232/119 mmHg (1 mmHg =0.133 kPa). I went to Beijing Anzhen Hospital and was diagnosed as "acute non-ST segment elevation myocardial infarction and grade 2 hypertension". Abdominal CT showed that the left retroperitoneal capsule was solid occupying space, and the nature was unknown. Transfer to our hospital. Abdominal MRI showed that there was a round mass above the left retroperitoneal splenic vein and the left proximal renal vein, about 3.5 cm ×3.6 cm in size, and the boundary with the left adrenal gland was not clear. No abnormalities were observed in both kidneys and right adrenal gland. No enlarged lymph nodes were observed in the abdominal cavity (Figure 1)。 Preoperative blood aldosterone was normal in upright and recumbent position, with angiotensin 79 pg/ml in recumbent position (normal value 25-60 pg/ml) and 243 pg/ml in upright position (normal value 50-120 pg/ml). Preoperative diagnosis: ectopic pheochromocytoma. Preoperatively, doxazosin extended-release tablets 4 mg, 4 times/d; Betaloc 12.5 mg, 4 times/d; Blood pressure was controlled around 120/80 mmHg, heart rate<80 times/min, and volume expansion treatment for 1 week. On August 4, 2015, laparoscopic surgical resection was performed under general anesthesia. During the operation, the lower margin of the pancreas and the left anterior renal fascia were completely free, and the horizontal part of the duodenum, the left renal vein, the superior mesenteric artery and the inferior mesenteric vein, and the left margin of the right abdominal aorta were sequentially exposed. The vessels in the basal area were dissected along the tumor surface with ultrasonic scalpel, and the basal vessels were ligated with Hem-o-lock (Figure 2)。 The procedure went smoothly, the operation time was 160 min, and the bleeding was 50 ml. Intraoperative peak systolic blood pressure was 160 mmHg and peak diastolic blood pressure was 100 mmHg. He was discharged 7 days after surgery. Postoperative pathology: retroperitoneal pheochromocytoma, size 3.3 cm ×3.0 cm ×2.0 cm. Immunohistochemistry: synaptophysin (Syn) (+), S-100 protein (S-100) (+), epithelial membrane antigen (EMA) (-) (Figure 3)。 One week after surgery, aldosterone was normal, angiotensin (recumbent position) was 59.57 pg/ml, oral antihypertensive drugs were stopped, and there was no tumor recurrence after 1 year follow-up.

colorectal cancer (CRC) is one of the most common malignant tumors. Its incidence ranks third in the world, and its tumor-related mortality ranks fourth in the world^[1]。 Although the diagnosis and treatment level of CRC is constantly improving, due to its occult early symptoms, 20% of patients are metastatic colorectal cancer (mCRC) at the time of diagnosis, and the treatment is mainly traditional radiotherapy and chemotherapy. In the chemotherapy study of mCRC, the biggest breakthrough was a phase III clinical trial reported in 1994. The median overall survival (OS) of CRC patients treated with fluorouracil combined with calcium leucovorin was 12 months. Thereafter, fluorouracil calcium leucovorin combined with irinotecan or oxaliplatin prolonged the median OS from 12 months to 20 months in patients with CRC. In recent years, with the deepening of research on cell signal transduction pathways, targeted drugs acting on pathway-related molecules have gradually become a new direction of drug therapy for mCRC. The progress of targeted therapy for CRC is summarized as follows.

With the continuous improvement of surgical equipment and accumulation of surgical technical experience, thoracic endovascular aortic repair (TEVAR) has become one of the main methods for the treatment of aortic diseases due to its characteristics of less trauma, short hospital stay, quick recovery and low postoperative mortality^[1]。 retrograde type A aortic dissection (RTAD) has attracted the attention of vascular surgeons as a complication with low incidence and high mortality after TEVAR^[2,3]。 So far, many studies have been carried out at home and abroad on the risk factors of RTAD after TEVAR. This article reviews the risk factors and management of RTAD after TEVAR by reviewing the previous literature.