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Table of Content

    25 March 2019, Volume 24 Issue 02 Previous Issue    Next Issue
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    Experts forum
    Postcholecystectomy jaundice
    2019, 24 (02):  105-107.  DOI: 10.16139/j.1007-9610.2019.02.004
    Abstract ( 793 )   PDF (367KB) ( 176 )  
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    Study on occult pancreaticobiliary reflux
    2019, 24 (02):  116-120.  DOI: 10.16139/j.1007-9610.2019.02.007
    Abstract ( 393 )   PDF (518KB) ( 226 )  
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    Original article
    Three-dimensional visualization in preoperative assessment of hilar cholangiocarcinoma
    WANG Jiwen, SHEN Sheng, NI Xiaojian, WANG Yueqi, LIU Han, LIU Houbao
    2019, 24 (02):  126-130.  DOI: 10.16139/j.1007-9610.2019.02.009
    Abstract ( 383 )   PDF (739KB) ( 125 )  
    Objective To evaluate the resectability of hilar cholangiocarcinoma using three-dimensional visualization technique. Methods A retrospective analysis was done using the clinical data of 15 patients with hilar cholangiocarcinoma who underwent radical dissection between June 2018 and January 2019 in Department of General Surgery Zhongshan Hospital. Epigastric computed tomography scan combined with three-dimensional visualization by 3D-Liver imaging analysis system was performed for assessment of anatomical variants, tumor classification, vascular invasion, respectability and preoperational planning. We compared preoperative assessment with operative finding, and analyzed operative time, blood loss and peri-operative complication. Results Based on three-dimensional visualization of Bismuth-Corlette classification, there were 3 cases in type Ⅱ, 10 cases in type Ⅲ, and 2 cases in type Ⅳ. Liver volume was evaluated (1 286.06± 321.56) mL, and left and right liver volume were (451.90± 173.98) mL and (834.14± 220.34) mL, respectively. The tumor volume was evaluated as (15.19± 12.91) mL. Twelve in 15 patients (80%) completed radical resection, which was consistent with preoperative evaluation. There were 5 cases with variant hepatic artery, 4 cases with variant hepatic vein and 1 case with variant portal vein, which was all correctly evaluated preoperatively. Eleven patients had liver resection. Operative time was (343± 111) minutes with blood loss (355± 189) mL. Conclusions Three-dimensional visualization had important role in preoperative assessment of hilar cholangiocarcinoma and allowing operation safety.
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    CT angiography in evaluating resectability of hilar cholangiocarcinoma
    LI Min, TAO Ying, SONG Lujun, NI Xiaoling, SUO Tao, LIU Han, SHI Hongcheng, LIU Houbao
    2019, 24 (02):  131-134.  DOI: 10.16139/j.1007-9610.2019.02.010
    Abstract ( 480 )   PDF (411KB) ( 93 )  
    Objective To investigate the clinical value of abdominal CT angiography (CTA) in evaluating resectability of hilar cholangiocarcinoma. Methods The clinical data of 86 patients with hilar cholangiocarcinoma diagnosed pathologically in Department of Surgery this hospital were reviewed from January 2013 to December 2018. All patients underwent CT scan and CTA preoperatively for assessing of surgical resectability of hilar cholangiocarcinoma. Results A total of 53 patients (61.63%) had radical resection (R0 resection) in 86 patients with hilar cholangiocarcinoma. Remaining 33 patients underwent palliative surgery because of vascular invasion, distant lymph node metastasis or extensive intra-abdominal metastasis. CTA provided higher accuracy in evaluating major vascular invasion near the hepatic hilum with sensitivity 78.79%, specificity 92.45% and accuracy 87.21%. In evaluating lymph node metastasis near the hepatic hilum, CTA provided sensitivity only 42.86%. CTA evaluated distant metastasis with same sensitivity 42.86%. Conclusions CTA has certain advantages in evaluating major vascular invasion near the hepatic hilum. However, the sensitivity of CTA is poor in evaluating hilar lymph node metastasis and distant metastasis.
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    Comprehensive treatment of deep neck space infection: a report of12cases
    YANG Chen, SUN Xiang, DING Jiazeng, DING Xiaoyi, ZHANG Hua, WANG Shili, CAI Changping
    2019, 24 (02):  135-140.  DOI: 10.16139/j.1007-9610.2019.02.011
    Abstract ( 517 )   PDF (963KB) ( 415 )  
    Objective To investigate the comprehensive treatment of deep neck space infection. Methods The clinical data of 12 patients with deep neck space infection were retrospectively analyzed in Department of Otolaryngo-logy, Ruijin Hospital from January 2005 to September 2018. Results Four cases had concurrent diabetes mellitus and pharyngalgia was the most common and first-episode symptom. All patients were diagnosed as deep neck space infection by neck CT scan. The parapharyngeal space was the most involved among deep neck spaces. Eight patients underwent abscess dissection including one case with dissection in one space and CT-guided percutaneous aspiration and drainage in another space. Three patients underwent tracheotomy simultaneously. Intravenous antibiotics was given all patients and nasogastric feeding in 5 patients. Hospital stay was (29.1± 7.3) days. Totally 11 patients were cured and 1 patient died. Conclusions It is indicated in this study that early and adequate use of broad-spectrum antibiotics, timely drainage, airway management and nutritional support are the key to treat deep neck space infection comprehensively.
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    Study on serum exosome proteins in metastatic breast cancer patients
    CAO Lichen, TIAN Baoxing, QU Feilin, ZHANG Qinghua, GUO Shanyu
    2019, 24 (02):  141-148.  DOI: 10.16139/j.1007-9610.2019.02.012
    Abstract ( 512 )   PDF (1021KB) ( 240 )  
    Objective To study differentially expressed protein in serum exosome of the patients with both metastatic and non-metastatic breast cancer. Methods Serum was collected from both 25 breast cancer patients with metastasis of lymph node or distant organ (M+ group) and 25 breast cancer patients without any metastasis (M- group). Serum exosomes were separated with EIQ3 analytic kit in 4 breast cancer patients in M+ group and 4 breast cancer patients in M- group.These serum exosomes were recognized by CD9 and CD63 as surface markers using western blotting, and the size of exosomes were meaured by nanosight tracking analysis（NTA）. Protein mass spectrometry and bioinformatics analysis were performed to identify the differentially expressed proteins in serum exosomes of breast cancer patients, which were also quantified by Western blot. Results The particle size by nanosight tracking analysis ranged from 20 to 200 nm and the expression of CD9 and CD63 were positive. Totally there were 301 proteins identified by mass spectrometry and among them 16 proteins differentially expressed from serum exosomes in M+ group and M- group. The expression of vitronectin(VN) and kallistatin (KAL) was up-regulated, while the expression of obscurin(OBSCN) was down-regulated in M+ group compared with those in M- group using Western blotting, which was consistent with the results of analysis by mass spectrometry. Conclusions The serum exosomes in breast cancer patients are present identified by particle size and markers. VN, KAL and OBSCN in exosomes could serve as potential candidate biomarkers for prediction of metastatic breast cancer.
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    Study on salivary tumor markers in diagnosis of pancreatic cancer
    ZHAO Zhifeng, XIE Rongli, SHEN Dongjie, ZHANG Jun, XU Zhiwei, CHENG Dongfeng, FEI Jian, DENG Xiaxing, SHEN Baiyong, PENG Chenghong
    2019, 24 (02):  149-154.  DOI: 10.16139/j.1007-9610.2019.02.013
    Abstract ( 411 )   PDF (604KB) ( 106 )  
    Objective To analyze salivary tumor markers in diagnosis and evaluation of pancreatic cancer. Methods Twenty-six patients with pancreatic cancer, 9 patients with benign pancreatic tumor and 16 healthy controls were involved. We compared the concentrations of salivary tumor markers including AFP, CEA, CA125, CA19-9, CA724 and CA242 in three groups to find the tumor marker to diagnose pancreatic cancer and the biomarker associated with the patients of local advanced pancreatic cancer. The tumor marker associated with survival of pancreatic cancer was also studied. Results Salivary AFP, CEA, CA125 and CA724 in the patients with pancreatic cancer were higher when compared those in patients with benign pancreatic tumor and in healthy controls. The difference of salivary tumor markers was present significantly between pancreatic cancer group and control group (P< 0.05). Salivary CEA and CA125 to diagnose pancreatic cancer had area under curve 0.91 and 0.94, respectively. Both tumor markers got same sensitivity 92.31% and same specificity 84.62%. Salivary CEA and CA125 were associated with the patients of survival less half year and with the patients of locally advanced pancreatic cancer significantly (P< 0.05). Conclusions The results showed that salivary tumor markers CEA and CA125 could be used in diagnosis of pancreatic cancer at some extent and further study is needed.
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    Effect of different flow of oxygen on postoperative oxygen saturation of patients in high altitude area
    XIE Xiaowei, LI Wujun, ZHAO Hai, WANG Tinghui
    2019, 24 (02):  155-158.  DOI: 10.16139/j.1007-9610.2019.02.014
    Abstract ( 758 )   PDF (475KB) ( 224 )  
    Objective To study the effect of oxygen therapy by different flow on pulse arterial oxygen saturation (SpO2) of postoperative patients of general anesthesia in high altitude area. Methods Eighty cases with operation under general endotracheal anesthesia were enrolled in the study between August 2017 and April 2018 in Ali district People's Hospital of Tibet. By random number table, the patients were divided into 4 groups according to oxygen flow after extubation including 2 L/min (group L1), 4 L/min (group L2), 6 L/min (group L3) and 8 L/min (group L4). SpO2 was recorded as baseline before operation without oxygen inhalation and 30 min, 1 h, 2 h, 4 h or 24 h later after oxygen inhalation with oral and nasal mask ventilation. Results There were 47 male and 33 female cases with age range 19-58 years and weight 48-72 kg. The level of American Association of Anesthesiologists was grade Ⅰ-Ⅱ preoperatively. All the SpO2 of cases was higher by oxygen therapy with oral and nasal mask after extubation of general anesthesia than before surgery (P< 0.05). SpO2 remained lower level at oxygen flow 2 L/min and was close to healthy people in low altitude areas at 4 L/min. However, SpO2 increased no longer when oxygen flow increased to 6 L/min or more. There was no significant difference in oxygen saturation between group L2 and group L3 and between group L2 and group L4 (P> 0.05) after 4 hours of intake oxygen. Therefore oxygen flow could be reduced to 4 L/min. When patients intaked oxygen for 24 h after surgery, SpO2 in group L1 was 94.86% which is close to 95% the SpO2 of healthy people. We recommended that oxygen flow could be reduced to 2 L/min 24 h later. Conclusions Early oxygen intake in patients with general anesthesia in high altitude areas need 6 L/min of oxygen flow or more. Thereafter, it can be reduced to 4 L/min and 2 L/min for avoiding the waste of high flow oxygen and the risk of oxygen poisoning.
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    Clinical study of robotic pancreatectomy with vascular reconstruction
    SUN Changjie, DENG Xiaxing, SHEN Bai-yong, PENG Chenghong
    2019, 24 (02):  159-162.  DOI: 10.16139/j.1007-9610.2019.02.015
    Abstract ( 437 )   PDF (355KB) ( 78 )  
    Objective To evaluate the safety and feasibility of robotic pancreatectomy with vascular reconstruction. Methods The data of 15 patients who underwent robotic pancreatectomy combined with vascular reconstruction were reviewed. There were 8 cases of pancreatoduodenectomy with portal vein (PV) and superior mesenteric vein reconstruction. One case had pancreatoduodenectomy with variant right hepatic artery reconstruction. Four cases had distal pancreatectomy including 2 case with PV reconstruction and 2 cases with common hepatic artery reconstruction. Two cases had total pancreatectomy with PV or SMV reconstruction. Results The operative time was (343+80)(210-540) min with blood loss (573+310)(200-1 100) mL. The postoperative hospital stay was (29.8+27.7)(14-122) d. Pancreatic fistula occurred in 2 cases (13.3%) without mortality. Conclusions Robotic pancreatectomy with vascular reconstruction could be safe and feasible, however, extensive experience with technical support should be needed.
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    Validation of CA19-9, CA125in predicting respectability of pancreatic ductal adenocarcinoma
    LI Fanlu, WU Zhichong, ZHAN Qian, SHEN Baiyong
    2019, 24 (02):  163-167.  DOI: 10.16139/j.1007-9610.2019.02.016
    Abstract ( 296 )   PDF (553KB) ( 188 )  
    Objective To investigate the effect of increase extent of serum CA19-9 and CA125 in predicting resectability of pancreatic ductal adenocarcinoma preoperatively. Methods From January 2009 to December 2015, the clinical data of 441 patients with pancreatic ductal adenocarcinoma who were diagnosed pathologically and were evaluated to be resectable by radiology in our hospital were retrospectively analyzed. Patients were divided into resectable group and non-resectable group according to R0 resection. Preoperative serologic tumor markers including CA 19-9 and CA 125 in 2 groups were analyzed. Results There was significant statistical difference in CA19-9 and CA125 between resectable group and non-resectable group (P< 0.001). After correction of CA19-9 in the patients with direct bilirubin higher than 34.2 μmol/L, significant statistical difference in CA19-9 between two groups was still present (P< 0.001). Logistics multiple regression analysis and ROC curve showed that CA19-9 (cut-off= 582.10 U /mL, and adjusted CA19-9 cut-off= 449.70 U/mL) and CA125 (cut-off= 41.45 U/mL) were selected as predicting markers in resectability of pancreatic ductal adenocarcinoma. Conclusions Preoperative increase extent of CA19-9 and CA125 could assist to predict resectability of pancreatic ductal adenocarcinoma. The patients will have no chance of R0 resection when tumor markers increase more than cut-off value.
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    Clinical research
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