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25 March 2018, Volume 23 Issue 02 Previous Issue    Next Issue

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Rapid identification of parathyroid by fluorescence microsphere immunochromatography YAN Zewen, WANG Peisong, ZOU Xian, TONG Hailei, LU Qiyu, HAN Hui, YANG Shuai, MENG Wei, CHEN Guang 2018, 23 (02):  120-124.  DOI: 10.16139/j.1007-9610.2018.02.008 Abstract ( 560 )   PDF (630KB) ( 110 )   Objective To explore the feasibility of rapid identification of parathyroid with fluorescence microsphere immunochromatography during thyroid and parathyroid surgery. Methods Clinical data of 36 patients who underwent thyroid and parathyroid surgery by same surgical group in Department of Thyroid Surgery First Hospital of Jilin University from July 2017 to October were collected. The parathyroid and non-parathyroid tissue such as thyroid, fat tissue and lymph node which were resected were punctured by same operator using 1 mL needle. The T1 (test value) and C (control value) were measured by fluorescence microsphere immunochromatography. T1/C were compared between different tissues and T1/C of the punctured tissue compared with the pathological diagnosis. Results A total of 51 sets of data were obtained. T1/C of parathyroid was (3.653± 3.177) and T1/C of non-parathyroid tissue was (0.056± 0.027) with statistically significant diffe-rence(P< 0.01). T1/C of parathyroid was significantly higher from that of non-parathyroid tissue including thyroid, lymph node and fat tissue (P< 0.05). There was no significant difference between T1/C of parathyroid and parathyroid adenomas (P> 0.05). The results of immunofluorescence test to identify parathyroid had sensitivity (true positive rate) 95.7% (22/23), specificity (true negative rate) 100% (28/28), false positive rate (misdiagnosis rate) 0 (0/28), false negative rate (omission diagnostic rate) 4.4% (1/23) and accuracy 98.0% (50/51). Conclusions Fluorescence microsphere immunochromatography can be used to identify parathyroid in real-time mode during surgery with high sensitivity and specificity, which is a convenient procedure and valuable to be recommended. References | Related Articles | Metrics

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Clinical analysis of primary hyperparathyroidism: a report of 138 cases LI Fuxin, JIANG Ruoyu, LI Dongyang, CHEN Zuoyu, WEI Mingze, ZHANG Bai, HE Xianghui 2018, 23 (02):  125-129.  DOI: 10.16139/j.1007-9610.2018.02.009 Abstract ( 458 )   PDF (532KB) ( 112 )   Objective To summarize the experience in the diagnosis and treatment of primary hyperparathyroidism (PHPT). Methods The clinical data of 138 patients with PHPT who underwent parathyroidectomy in our hospital from January 2015 to November 2017 were analyzed retrospectively. Results The patients including 30 males and 108 females were all treated with surgical treatment. Five cases had parathyroid crisis and 1 case underwent emergent surgery. A total of 150 parathyroid glands were resected. Postoperative pathology confirmed that 123 (82.0%) lesions were parathyroid adenoma, 9 (6.0%) lesions parathyroid hyperplasia, 4 (2.7%) lesions parathyroid carcinoma, 10 (6.6%) lesions parathyroid cysts and 4(2.7%) lesions parathyroid atypical adenoma. Parathyroid hormone decreased to normal and the blood calcium decreased in all cases after parathyroidectomy. The symptoms of hypocalcemia were found in 48 cases whose blood calcium restored to normal after supplementation of active vitamin D and calcium gluconate. There were no recurrent laryngeal nerve injury and other complications. Conclusions Blood calcium and parathyroid hormone can be used in the diagnosis of PHPT in early stage. Parathyroidectomy is an effective treatment for PHPT. Preoperation precise localization is helpful for the exploration of pathological lesion. Management with hydration diuresis and bisphosphonates and early parathyroidectomy have good effect on parathyroid crisis. References | Related Articles | Metrics

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Surgical treatment of primary hyperparathyroidism using da Vinci Si surgical system HE Qingqing, ZHOU Peng, ZHUANG Dayong, ZHU Jian, FAN Ziyi, ZHENG Luming, YUE Tao, WANG Meng, WANG Dan, LI Xiaolei 2018, 23 (02):  130-134.  DOI: 10.16139/j.1007-9610.2018.02.010 Abstract ( 452 )   PDF (841KB) ( 175 )   Objective To evaluate the safety and effectiveness of surgical treatment of the patients with primary hyperparathyroidism using da Vinci Si surgical system. Methods A retrospective analysis was performed on the clinical data of 12 patients with primary hyperparathyroidism in our department who received robotic-assisted parathyroidectomy using da Vinci Si surgical system from November 2014 to December 2017. Preoperative diagnosis with precise localization of parathyroid had been done. Blood parathyroid hormone, calcium and phosphate levels were detected before and after operation. Postoperative complications such as bleeding, hoarseness and cough of drinking water were analyzed and the patients were followed up from 2 to 24 months. Results All twelve cases had successful robotic parathyroidectomy assisted with the da Vinci Si surgical system. There were no severe operative complications and no conversions to open surgery. The operation time was(58± 17.37)(38~89) min and intraoperative blood loss was(25± 4.75)(20~35) mL. Transient hypocalcemia occurred in 7 cases postoperatively and cured with calcium and vitamin D. The postoperative cosmetic result was excellent. The patients had no postoperative recurrence during the period of follow-up except 1 patient with parathyroid hyperplasia. Conclusions It showed that the surgical treatment of primary hyperparathyroidism assisted with da Vinci Si surgical system was safe and effective when the surgical indication was fully established, especially suitable for the patients with cosmetic requirements. References | Related Articles | Metrics

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Anlaysis of safety of splenectomy in adult hemophagocytic lymphohistiocytosis JIANG Chongyi, LIANG Yun, CAI Zhiwei, WANG Wei 2018, 23 (02):  135-139.  DOI: 10.16139/j.1007-9610.2018.02.011 Abstract ( 286 )   PDF (536KB) ( 122 )   Objective To evaluate the safety and feasibility of splenectomy in adult hemophagocytic lymphohistiocytosis (HLH) of unknown origin. Methods The clinical data of 29 adults with HLH of unknown origin treated with splenectomy in our center from January 2013 to January 2017 were reviewed retrospectively. The patients with HLH were diagnosed with pathological examination of spleen postoperatively. Results All cases had repeated high fever, 27 cases (93.1%) with cytopenia involving at least two or three lineages, 23 cases(79.3%) with abnormal liver function and 24 cases (82.8%) with dysfunction of blood coagulation. American Society of Anesthesiologists (ASA) scores were above grade Ⅲ in all patients before operation. The maximum diameter of spleen was (22.8± 6.3) cm. The operative time was(112.3± 27.7) min and the estimated blood loss (281.8± 399.5) mL. The postoperative pancreatic leak occurred in 8 cases (27.6%) according to ISGPF definition, including 5 cases (17.2%) of grade A and 3 cases(10.3%) of grade B. Three cases (10.3%) had pulmonary infection. One case (3.5%) required relaparotomy due to postoperative abdominal bleeding. There was no peri-operative mortality in this study. After splenectomy, a clear lymphoma diagnosis could be determined in 27 patients (93.1%) and the cause of HLH in other 2 patients was still unclear. Conclusions Splenectomy is a valid and safe diagnostic approach for adult HLH of unknown origin even though the patients with HLH were in severe condition with multiple organ dysfunction of some patients. The pathological diagnosis for resected spleen provided a clue for the further treatment. References | Related Articles | Metrics

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Diagnosis and treatment of patients with focal nodular hyperplasia GUAN Ruoyu, MA Di, YANG Kui, GONG Xiao-yong, CHEN Yongjun 2018, 23 (02):  140-144.  DOI: 10.16139/j.1007-9610.2018.02.012 Abstract ( 702 )   PDF (619KB) ( 318 )   Objective To review the experience of diagnosis and treatment of focal nodular hyperplasia (FNH) in our department for the management of FNH represents a challenge. Methods Twenty-two cases with FNH from October 2010 to January 2017 were studied retrospectively. All patients were diagnosed as FNH by postoperative pathological assessment. Results Twelve male cases and 10 female cases with FNH were recruited with sex ratio 1.2∶ 1.0 and mean age (32.50± 8.38)(18-50) years. Three cases manifested clinical symptoms with 3 cases of abdominal pain and one case of high CA-724 level. The others had no any symptoms. Seventeen cases were diagnosed as FNH by imaging. All cases received surgical therapy with operating time (142.72± 54.81) (50-300) min, operative blood loss (397.27± 466.95) (50-1 700) mL and hospital stay(7.90± 2.86) (4-15) days, There was no both severe morbidity and mortality peri-operatively and no recurrent case was found during the period of follow-up from 11 to 75 months. Conclusions FNH is a rare benign proliferative lesion of liver with rare clinical symptoms and characterized by central scar. Combination of several imaging modalities would be valuable to the diagnosis. For the patients with symptomatic FNH, combined with hepatitis and cirrhosis or difficult to distinguished from hepatic cancer or hepatic adenoma, surgical resection should be considered and the prognosis is better. References | Related Articles | Metrics

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A retrospective controlled clinical study on laparoscopic versus open complete mesocolic excision for right colon cancer YU Minhao, QI Yang, QIN Shaolan, MU Yifei, LUO Yang, QIU Yier, CUI Ran, ZHONG Ming 2018, 23 (02):  145-149.  DOI: 10.16139/j.1007-9610.2018.02.013 Abstract ( 392 )   PDF (939KB) ( 153 )   Objective To compare the efficacy of laparoscopic complete mesocolic excision (CME) for right colon cancer with open CME. Methods The clinical data of the patients with right colon cancer in our department from January 2010 to December 2014 was retrospectively analyzed. There were 102 patients with laparoscopic CME as laparoscopic group and 116 patients with open CME as open group. Peri-operative outcomes and survival were compared between two groups. Results The baseline information was not significantly different between two groups (P> 0.05). Compared with open group, the patients in laparoscopic group had longer operating time [(155.20± 4.17) min vs (140.10± 4.00) min, P=0.009 6], but less bleeding [(102.60± 7.37) mL vs(145.90± 12.23) mL, P=0.003 7], more retrieved lymph nodes [(12.17± 0.39) vs(10.78± 0.42), P=0.016 8], faster recovery course including shorter time to liquid diet [(2.91± 0.47) day vs (3.62± 0.41) day, P=0.034] and shorter postoperative hospital stay [(10.59± 0.57) day vs (14.13± 0.52) day, P=0.041]. No significant difference was observed in the postoperative complications between two groups. The period of follow-up had no significant difference between two groups [(38.83± 1.73) month vs (30.74± 1.60) month, P> 0.05]. Three-year survival rate of the patients in laparoscopic group was significantly higher than that in open group (89.81% vs 82.22%, P=0.048 2). Conclusions Laparoscopic CME provides the patients of right colon cancer with faster recovery and better overall survival. References | Related Articles | Metrics

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Laser ablation of perforator in lower limb venous ulcer MAO Jieqi, GAN Shujie, LI Yang, DAI Xueming 2018, 23 (02):  150-154.  DOI: 10.16139/j.1007-9610.2018.02.014 Abstract ( 448 )   PDF (684KB) ( 88 )   Objective To evaluate the safety and efficacy of laser ablation in the treatment of perforating veins from lower limb venous ulcer. Methods A total of 28 cases with chronic venous ulcer admitted between January 2014 to December 2015 were concluded in this study. Localization and mark of the perforating veins were done with CTV. High ligation was performed in all cases with great or small saphenous vein. Then half of them underwent the procedure of laser ablation to perforating venous in 14 cases as laser group. The other 14 cases were treated by ligation of perforating veins after high ligation of great or small saphenous veins as control group. Compression with local therapy of ulcer postoperatively and 2 year of follow-up were given for all the cases. Results There was no difference of general information in 2 groups. The ulcer area and history of venous ulcer were similar in both groups before operation. The decrease in ulcer area of postoperative first week in laser group was much more than that in control group (P< 0.05). However the decrease in ulcer area was similar in postoperative 1 month and 2 month between 2 groups. Six cases（42.9%） in control group and one in laser group had wound complication(P< 0.01). Complete healing of ulcer within 2 months was obtained in 12(85.7%) cases both group. The recurrence rate within 1 year was similar between 2 groups(P> 0.05) and no recurrence was present between 1 to 2 year in 2 groups. Conclusions Laser ablation of perforating vein can effectively promote the healing of ulcer after high ligation of great or small saphenous vein. References | Related Articles | Metrics

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Damage control surgery for patients with acute abdomen and abdominal trauma：a report of 120 cases HAN Yi, HUANG Liang, SHI Ting, LIU Yuanbin, XU Zhenye, SUI Liang, YU Ping, XIA Yi, GEN Zhichao, MAO Enqiang, WANG Xiaoyan 2018, 23 (02):  155-157.  DOI: 10.16139/j.1007-9610.2018.02.015 Abstract ( 375 )   PDF (350KB) ( 139 )   Objective To evaluate the results of damage control surgery in the treatment of abdominal trauma and secon-dary peritonitis. Methods The data of 120 patients with abdominal trauma or acute abdomen undergoing damage control surgery from January 2008 to February 2013 were reviewed. Results For the patients with peptic ulcer perforation and secon-dary peritonitis, surgical repair was performed in 97 cases and duodenostomy in 5 cases. Operative time was (65± 12) min and blood loss was (50± 21) mL. There was no perioperative mortality, digestive tract leakage and abdominal infection. Pulmonary infection was found in 8 cases and wound infection in 4 cases. Duodenostomy was done for 6 cases with duodenal trauma. Surgical haemostasis and debridement and drainage were given for 5 cases with pancreatic trauma. Suture haemostasis combined with filling omentum majus was performed for 7 cases with liver traumatic rupture. Operative time was (100± 28) min and blood loss was (250± 65) mL. Eight cases were treated at ICU postoperatively for rehabilitation. One case with severe pancreatic trauma died 3 days after operation. Perioperative complications included pulmonary infection in 4 cases, renal dysfunction in 2 cases. Pancreatic leak and biliary leak and hepatic abscess were each 1 case. Conclusions The perioperative morbidity and mortality of the patients could be lower when damage control surgery was used. It is an effective approach for the patients with abdominal trauma and acute abdomen. References | Related Articles | Metrics

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Risk factors analysis of skeletal-related events in breast cancer patients with bone metastases: a systematic review and retrospective analysis of 104 cases HU Guangfu, YANG Weige, YANG Ziang, WANG Hong, ZHU Wei, QIU Xiaochun, ZHANG Hongwei, YI Haiying 2018, 23 (02):  158-165.  DOI: 10.16139/j.1007-9610.2018.02.016 Abstract ( 430 )   PDF (654KB) ( 50 )   Objective To explore the risk factors of skeletal-related event(SRE) in breast cancer patients with bone metastases in order to provide clinical base for early prevention of SRE. Methods A systematic literature search from PubMed, Web of Science, CNKI, VIP and Wanfang Data was conducted for the study on risk factors of SRE in breast cancer patients with bone metastases published in Chinese or English between January 1 2000 and October 31 2017. Then relevant information and conclusion were extracted. A total of 104 breast cancer patients with bone metastases from April 2004 to December 2016 in Zhongshan Hospital Fudan University and Shanghai Huangpu District Central Hospital were followed up for SRE. The risk factors of SRE were analyzed. Results Six literatures met the inclusion criteria and were included, which provided univariable and/or multivariable analysis of the risk factors of SRE including patient age, ER/PR/HER2, histological/nuclear grade, clinical stage of disease, duration of bone metastases, number of bone metastases sites and type of surgery. Most studies supported later clinical stage, longer duration of bone metastases and more sites of bone metastases were risk factors of SRE although the conclusions of 6 literatures were different slightly. During median follow-up of 60 months, 58 of 104 cases occurred SRE. Both primary distant metastasis (P=0.017) and multiple bone metastases sites (P=0.008) were independent risk factors of SRE by univariable and multivariable analysis. Similar results were gotten in retrospective study and systematic review. Conclusions It was shown by systematic review and retrospective analysis with 104 cases that later clinical stages, longer duration of bone metastases and more bone metastases sites were probably the risk factors of SRE. Nevertheless, age, molecular classification of breast cancer, histological/nuclear grade or surgery type etc. were not necessarily related to SRE. References | Related Articles | Metrics