2017年 · 第32卷第04期

The 5-year survival rate of pancreatic cancer patients is only 4% ~6%, most patients are advanced at the time of diagnosis, and less than 20% of patients can be surgically resected^[1]。 Recently, nanoknife ablation, a novel technique based on the principle of irreversible electroporation (IRE), has been gradually applied to the clinical treatment of tumors. We summarized the clinical data of 12 patients with pancreatic cancer who underwent nanoknife ablation in our department from November 2015 to March 2016, aiming to preliminarily explore the advantages and clinical application value of nanoknife ablation, and provide reference for follow-up research.

Traditionally, the recurrence rate of anal fistula surgery can reach about 10%^[1]。 In 2007, a ligation of intersphincteric fistula tract (LIFT) appeared, which can effectively protect the anal sphincter function and avoid the risk of fecal incontinence. We have improved the surgical operation on the basis of the LIFT procedure, which is reported below.

This study retrospectively analyzed advanced adenocarcinoma of esophagogastric junction (AEG) undergoing radical abdominal resection + D₂hyperthermic intraperitoneal perfusion chemotherapy (hyperthermic intraperitoneal perfusion chemotherapy) was given to 61 of 107 patients undergoing lymph node dissection in order to understand the safety of paclitaxel HIPEC.

endovascular repair of abdominal aortic aneurysm (EVAR) has been widely used in the treatment of abdominal aortic aneurysm (AAA) Treatment, but only 20% to 50% of the total number of AAAs that meet the anatomical criteria of EVAR^[1]。 The complexity of vascular anatomy seriously restricts the popularization of endovascular therapy, especially for AAA with short neck and twisted neck, which is the difficulty of EVAR, and the choice of endovascular therapy has not yet reached a wide consensus. From July 2011 to December 2015, the First Affiliated Hospital of Anhui Medical University treated 15 cases of complex tumor neck AAA, all of whom completed modified EVAR by endovascular technique and received good results, which are reported as follows.

Gallbladder stones are one of the most common diseases in biliary tract surgery. At present, the main treatment is cholecystectomy, but due to various symptoms after cholecystectomy^[1]Relevant scholars have proposed gallbladder-preserving stone removal^[2,3]Because the gallbladder is an important digestive organ in the human body, it has important functions such as storage of bile, regulation of the pressure of bile duct, concentration of bile, secretion and immunity^[4]In order to compare the efficacy of choledochoscopic choledocholithotomy and hysteroscopic choledocholithotomy, we retrospectively analyzed 52 cases of hysteroscopic choledocholithotomy and 73 cases of choledochoscopic choledocholithotomy from 2010 to 2015. The report is as follows.

sclerosing angiomatold nodular transformation (SANT) of the spleen is a rare benign lesion of the spleen newly confirmed in recent years. At present, there are not many reports in the literature, and the clinical understanding is still insufficient. We retrospectively analyzed the CT and MRI findings of 7 cases of SANT confirmed by operation and pathology to explore the diagnostic value of CT and MRI in this disease.

Anal fistula plug is a minimally invasive operation to realize the transition from incision surgery to filling repair, and a protective operation to realize the function and appearance of anus, which reflects the new concept and mode of treating anal fistula. The purpose of this study was to evaluate the clinical efficacy of anal fistula suppository in the treatment of anal fistula healing rate, postoperative pain, healing time, anal function, etc.

In this study, the distribution of TAZ gene I240F polymorphism in colorectal cancer tissues and the expression of TAZ protein in colorectal cancer tissues with different genotypes were examined to explore its clinical significance.

endovascular aneurysm repair (EVAR) is gradually becoming the main method for treating aortic aneurysm and other diseases^[1]。 EVAR requires validation of aortic aneurysm morphology and branch artery openings using intra-arterial contrast media. However, patients with abdominal aortic aneurysms with renal dysfunction or hypersensitivity to contrast agents are at high risk of acute kidney injury after endovascular intervention^[2]。 In order to avoid renal complications, a total of 4 patients with abdominal aortic aneurysm (AAA) underwent EVAR without contrast agent from May 2014 to August 2016, and achieved good results.

A 40-year-old male was admitted to the hospital for "dull pain and discomfort in the right upper abdomen for more than half a month". Physical examination: soft abdomen, not reaching the liver and spleen under the costs, no palpable mass, mild percussion pain in the liver area, negative mobile voiced sound, and normal intestinal sound. Laboratory tests: tumor markers serum CA50>500 U/ml (normal value 0-25 U/ml), CA19-9>1 200 U/ml (normal value 0-37 U/ml), AFP 2.74 μ g/L (normal value 0-13.4 μ g/L), CA72-4 4.93 μ g/ml (normal value 0-6.5 μ g/ml). Chest X-ray showed localized bulge of the right diaphragmatic surface. MRI showed: a huge cystic mass in the right upper abdominal cavity, with clear boundaries, internal stratification signs, and slightly high signal diffusion. CT examination revealed: huge cystic low-density shadow on the lateral side of the liver, with a few nodular and calcified shadows at the edge (Figure 1)。 Laparoscopic exploration was performed. There was no effusion in the peritoneal cavity, no abnormalities in the gastrointestinal and omentum. There was a cystic space at the top of the diaphragm of the right lobe of the liver that compressed the liver, and there was no adhesion to the liver tissue. Considering that the cyst was located in the thoracic cavity, thoracotomy was decided. The seventh costal bed incision on the lateral side of the right chest was taken to open the chest, and a small amount of pleural effusion was seen in the chest cavity. The diaphragm formed a cystic bulge without adhesion to the right lung. A large amount of turbid fluid flowed out after part of the diaphragm was incised. Diaphragm cyst was diagnosed during the operation. After suction of fluid, ulcer-like changes were observed in the inner wall of the diaphragmatic cyst, and calcification was also observed. The pleural side of the diaphragm was completely removed, and the ventral membrane of the diaphragm was explored to be intact and obstructed from the abdominal cavity. A closed thoracic drainage tube was placed during the operation. Postoperative pathological examination showed that chronic cell infiltration such as lymphocytes in diaphragm and fibrous tissue, and vasodilatation and congestion. Diagnosis of cyst with chronic inflammatory cell infiltration in cyst wall (Figure 2)。 The serum CA50 and CA19-9 were 973 U/ml and 3635 U/ml after 10 days postoperative reexamination; The serum CA50 and CA199 were 157 U/ml and 317 U/ml after 1 month postoperative reexamination; The serum CA50 was 10 U/ml and CA19-9 was 12 U/ml after 3 months postoperative reexamination.

A 42-year-old male was found to have a mass under the skin around the anus 4 months ago, about the size of a soybean, semi-elliptical, with clear boundaries, no tenderness, no obvious movement when pushing, and distension, pain and discomfort when defecating. In the past 4 months, the mass has increased, about the size of a walnut, occasionally tender, discomfort when lying down, mild tenderness on the local skin, and no fever. Physical examination: A mass of about 3 cm ×4 cm size can be palpable at 9 points around the anus 3 cm away from the anus, which is soft and mildly tender. There is no redness in the surrounding skin and the skin temperature is slightly higher. Mass resection was performed. During the operation, the mass was located subcutaneously around the anus, 3 cm ×4 cm in size, semi-elliptical in shape, and the boundary with the surrounding tissues was clear. It was completely resected and sent for pathological examination. General observations: grayish-brown irregular tissue, about 5 cm ×3 cm ×1 cm in size, pale yellow grayish-brown cut surface, medium texture. What was seen under light microscope: the subcutaneous tissue structure was destroyed, showing chronic suppurative inflammation and inflammatory granulation-like changes, and actinomycetes were visible. The bacterial mass was blue-dyed and cotton-shaped, and the hyphae around the bacterial mass were arranged in a linear shape, surrounded by neutrophils, and some neutrophils were adsorbed on the hyphae (Figure 1)。

The patient was a 67-year-old male. He was seen for "bilateral popliteal pulsatile mass for 3 months". Physical examination: Pulsatile mass was palpable in bilateral popliteal fossa, bilateral dorsal pedis artery was palpable, and there was no murmur in auscultation of bilateral popliteal fossa. Enhanced CT examination showed bilateral popliteal aneurysm with mural thrombosis in the tumor cavity, and the diagnosis was: bilateral popliteal aneurysm (FIG. 1A)。 The patient received the treatment of "popliteal aneurysm absent + artificial blood vessel bypass", and the patient recovered well after operation. Enhanced CT review was performed 2 months after operation, which confirmed thrombosis in popliteal aneurysm and patency of artificial blood vessels (FIG. 1B)。 After 4 months follow-up, the patient had no ischemic manifestations in both lower limbs and recovered well.

The patient was a 62-year-old female. After undergoing left nephrectomy for 12 years due to left kidney stone, an upper abdominal mass was found for 6 months and was admitted on 9 February 2016. Physique found a pulsatile mass in the upper abdomen, systolic blow-like murmur and palpable tremor. computed tomography angiography (CTA) revealed neoplasmic dilatation of the inferior vena cava with a transverse diameter of about 9 cm (FIG. 1A), left renal arteriovenous stump fistula, fistula about 0.9 cm (FIG. 1B)。 The renal artery was dilated with an internal diameter of approximately 1.2 cm. Vascular ultrasonography showed significant dilatation of the inferior vena cava. Echocardiography showed normal cardiac function and left ventricular ejection fraction of 67%. Procedure: Retrograde puncture and placement of 6F short sheath. A 5 F Cobra catheter was placed above the renal artery for aortomography, diagnosis was confirmed and left renal artery stump diameter was measured, and the appropriate diameter occluder was selected accordingly [ASD occluder with waist diameter 12 mm, large disc diameter 26 mm, and small disc diameter 22 mm (MicroPort Scientific Corporation, Shanghai)]. Selectively enter the left renal artery with a 0.035 inch super-hard guide wire, make the soft tip of the super-hard guide wire enter the left renal vein through the fistula, switch the 9F guide catheter, and lead the front end of the guide catheter to the stump end of the left renal artery. The ASD occluder is pushed to the distal left renal artery through the guide catheter to complete the release of the occluder (Figure 1C)。 The guide catheter was retracted into the aortic lumen, and the occluder was confirmed by pigtail catheterography to be stabilized in the middle and distal left renal artery, but blood flow was rapid. Seven 12-16 cm coils (Boston Science, USA) were inserted into the ASD and into the proximal left renal artery, and reangiography confirmed that the inferior vena cava was significantly delayed (Figure 1D)。 The operation was successful, the tremor disappeared immediately after the operation, and the hospital was discharged after 3 days. Postoperative subcutaneous injection of low molecular weight heparin injection 4 100 IU/time, once/d for 5 consecutive days; Later, it was changed to oral clopidogrel tablets 75 mg/dose, once/d, for 3 consecutive months. Two months after surgery, the patient complained that the mass was significantly reduced without tremor. After 3 months of operation, CT revealed that the inferior vena cava was significantly reduced, and the transverse diameter of the largest part was only 5.6 cm (Figure 1E)。

Acute mesenteric arterial ischemia is an acute vascular occlusion of the superior mesenteric artery caused by arterial embolism or primary thrombosis, resulting in large-scale intestinal ischemia or even necrosis. The onset is sudden, the condition is dangerous, and the mortality rate is over 70%^[1]。 Early diagnosis and early treatment of the disease are closely related to the prognosis of patients. Once diagnosed, it is necessary to intervene as soon as possible to restore arterial blood supply as soon as possible. At present, there are three main treatment modes for vascular recanalization, namely open surgery, endovascular surgery and hybrid surgery. The importance of revascularization surgery as the most fundamental treatment for acute mesenteric arterial ischemia is self-evident. However, after the mesenteric artery undergoes ischemia, recovery and recanalization, how to preserve more ischemic intestines, avoid intestinal necrosis, and reduce the incidence of short bowel syndrome is also a difficult point in clinical practice. We will focus on these problems, combined with the latest progress in the current domestic and foreign literature and the treatment experience and experience of our unit to elaborate.

Aortic aneurysm is a localized or diffuse dilatation of the aortic vessel when the diameter exceeds 1.5 times the normal arterial diameter^[1]。 According to the site of onset, aortic aneurysms are divided into thoracic aortic aneurysm, thoracic abdominal aortic aneurysm and abdominal aortic aneurysm^[2]。 Among them, abdominal aortic aneurysms are more common than thoracic aortic aneurysms. Demographic surveys show that the prevalence of abdominal aortic aneurysms in people over 65 years old is about 2.5%^[3]The incidence of thoracic aortic aneurysm is about (4.5~5.9) /100 000^[4]。 Abdominal aortic aneurysm cannot be eliminated by conservative therapy, and the mortality rate of abdominal aortic aneurysm is 50% at 2 years^[5]Once ruptured, the mortality rate is as high as 80% ~90%^[6,7]Epidemiological surveys in western countries show that aortic aneurysm is the 13th leading cause of death among residents^[8]In the United States alone, aortic aneurysms cause between 15,000 and 30,000 deaths per year^[9]。 On the one hand, the vast majority of patients with aortic aneurysm lack obvious clinical symptoms, and aortic aneurysm is just an unexpected finding during routine imaging examination or diagnosis of other diseases^[8]； On the other hand, because imaging tests are expensive or invasive, they are not suitable for mass screening of asymptomatic people. This seriously hinders the rapid screening, early diagnosis and condition evaluation of patients with aortic aneurysms by doctors. Searching for serological biomarkers suitable for rapid screening, early diagnosis and disease assessment of aortic aneurysm is one of the hot spots in aortic aneurysm research. At present, the more mature biomarkers are D-dimer, C-reactive protein, interleukin-6 (IL-6), microribonucleic acid (miRNA), thrombin-antithrombin Ⅲ complex (TAT), homocysteine (Hcy), etc. The research hotspots and progress of biomarkers of aortic aneurysm will be reviewed in this paper.

As a highly malignant digestive system tumor, about 90% of pancreatic cancer is ductal adenocarcinoma originating from glandular duct epithelium, and its diagnosis and treatment are difficult. Because of the difficulty of early diagnosis, most of them are locally progressive or advanced when the diagnosis is clear, and the chance of radical resection is lost. The overall 5-year survival rate<8%, which is one of the worst prognostic malignancies. In the United States, although pancreatic cancer ranks about 10th in the incidence of common tumors, its mortality rate is as high as fourth. The high mortality rate of pancreatic cancer is caused by difficulty in early diagnosis, lack of effective clinical treatment, and unclear mechanism of development of pancreatic cancer^[1,2]。 The reveal of the mechanism of tumorigenesis and development is expected to become the key to change the poor prognosis.