Objective To estimate the clinical curative effect of replacement of inverttype artificial total scapula and shoulder joint prosthesis and reserving arm with rehabilitation of function in the treatment of malignant tumor in shoulder. Methods From February 2001 and November 2004, five youth patients with primary malignant shoulder tumors were treated operatively by resection of neoplasmsthoroughly, replacement of inverttype artificial total shoulder blade and joint prosthesis, the functional reconstruction. Of them, there were 4 males and 1 female, aging from 19 to 26 years with an average of 23.6 years. Two cases were diagnosed as having osteosarcoma, one as having chondrosarcoma, and 2 as having Ewing sarcoma. After operation, the upper limbs was immobilized for 3 weeks. The rehabilitation training including passive exercise and initiative exercise. Results The average operative time was 425 min (380 to 530 min), and the blood loss ranged from 1 250 ml to1 900 ml(1 540 ml on average). The follow-up ranged from 7 to52 onths,with an average of 24.6 months. Postoperative complication included 1 case of pneumothorax, one case of shoulder incision skin part necrosis and 1 case of clavicle stump raising and pierce skin with shallow infection. No complication of postoperative incision deeply infection, nerve damage and prosthesis exposure or dislocation occurred. According to the scoring system of JOA(Japan orthopaedics association), the average score was 65 (60 to 72). The flexion and extension function of elbow joint recovered to normal. Conclusion The replacement of inverttype artificial total scapula and shoulder joint prosthesis is an efficacious method for the treatment of malignant tumor in shoulder. There are advantages of numerous adaption, wide range of motion and goodstability. It can not only reserve arm but also rehabilitate function.
【Abstract】 Objective To di scus s the resect ion of tumors of pelvic ring and i t s recons truct ion ofdefects. Meth ods From January 1999 to December 2006, 48 patients with tumors in pelvic ring were treated and defects were reconstructed. There were 32 males and 16 females, aged 14-72 years(mean 45.1 years), including 12 cases of benign tumor and 36 cases of mal ignant tumor. Fourteen cases had lesions in region Ⅰ , 11 cases in region Ⅱ , 12 cases in region Ⅲ , 3 cases in region Ⅳ and 8 cases had two or more regions. The selection of surgical method: benign tumor in wing of il ium or in sacro-il iac articulation was curettaged , mal ignant tumors were resected radically or boardly . Benign or mal ignant tumor in pubis, ischium or pubic symphysis was resected radically , defects were reconstructed with plastic plate or not. For tumor affecting aceta bulum , resection of tumor and replacement of the peri- pelvic prothetic or artificial hip joint replacement were performed to reconstructthe function of hip joint. Results Twelve patients with benign tumors were followed up 12-72 months and could walk well, only 1 case relapsed locally. Thirty-six patients with mal ignant tumor were followed up 6 - 72 months, the survival time was 6-12 months in 2 cases (5.6%), 12-24 months in 2 cases(5.6%), 24-36 mongths in 6 cases (16.7%), 36-72 months in 14 cases (38.8%), and more than 72 months in 12 cases (33.3%); 28 patients (77.8%) could walk normally, 6 (16.7%) could walk with the help of walking stick , 2(5.5%) needed wheel chair to move. Compl ications occurred in 6 cases( including 2 venous thrombus,1 anoxic encephalopathy, 2 wound delayed heal ing, and 1 dislocation after total hip joint replacement); the patients’ condition took a turn for the better. Conclusion Operation is a favorable way for the treatment of pelvic tumor. Selecting convenient operation methods to resect tumors or reconstruction defects according the position of the tumor will do good favor to good results,increase the survival time and improve qual ity of l ife.
Objective To discuss the resection extent of primary surgery for papillary thyroid carcinoma （PTC） based on the analysis of the remaining thyroid gland residue and lymph nodes metastasis. Methods The clinical data of 163 patients with PTC received reoperation from January 2009 to September 2011 in our hospital were analyzed retrospectively. Results There were 24 males and 139 females in these patients. The age was 10-75 years old with （38.22±14.57） years old. Among 131 patients received residual thyroid thyroidectomy，88 patients were below 45 years old，and the cancer residual rate was 60.23% （53/88）；the others were over 45 years old，and the cancer residual rate was 76.74% （33/43），which was no significant difference （P?=?0.062）.The lymph nodes metastasis rate was 77.14% （81/105） in the patients below 45 years old and 81.13%?（43/53） in the patients over 45 years old among 158 patients received cervical lymph nodes dissection，which was no significant difference （P?=?0.958）.The cancer residual rate was 74.36%?（58/78），53.66%?（22/41），50.00%?（6/12），and 0 （0/32） in the patients with the tissue less than one lobe resection，lateral lobe （isthmus） resection，lateral lobe plus opposite side subtotal resection，total or subtotal resection，respectively. The total cancer residual rate was 65.65% （86/131） and the bilateral cancer residual rate was 52.76%?（86/163） after reoperation.79.75%?（130/163） of the patients didn’t received lymph nodes dissection in the primary surgery. The lymph nodes metastasis rate was 71.21%?（94/132） and 80.58% （83/103） in the reoperation patients received central region lymph nodes dissection and cervical lateral lymph nodes dissection, respectively. Conclusions Multifocus is an obvious character of PTC. Patients over 45 years old have more opportunities of tumor residual than that of the youngers （below 45 years old），but the result was no statistic value. For the most patients with PTC，a smaller resection extent suggests a larger risk for cancer residual，and total thyroidectomy or subtotal thyroidectomy leads to the least possibility for the risk. Cervical lymph node is a major type for its metastasis. Proper lymph nodes dissection is an essential way to reduce recurrence and reoperation. The Revised American Thyroid Association Management Guidelines for Patients with Thyroid Nodules and Differentiated Thyroid Cancer （2009） could be a best choice for therapy of PTC. And it is proposed to take central region lymph nodes dissection during primary surgery.
Objective To investigate the feasibility and indication of synchronous resection of colonic carcinoma and its hepatic metastasis. Methods Radical sigmoidectomy and right hemi-hepatectomy plus left lateral segment resection were performed at the same time in a 71-year-old patient with sigmoid carcinoma and multiple hepatic metastasis. Results The operation lasted for 5 hours and 10 minutes with 300ml blood lost during the procedure. The patient recovered smoothly and was discharged 2 weeks after operation. Follow-up showed no reoccurrence up to the day of this presentation(4 months).Conclusion The operation could be performed safely by experienced surgeon in good-equipment hospital.
Objective To improve the curative resection rate of hilar cholangiocarcinoma (H-CC).Methods Lileratures about surgical treatment of H-CC were collected and reviewed. Results The crucial points are as follow: ①Early diagnosis; ②Recognition of the invasion to liver; ③Rational resection of the tumor with associated vessels; ④Reduction of postoperative complications. Conclusion Improved longterm resection effects on H-CC is possible.
OBJECTIVE To investigate the reconstructional method of posterior wall of vagina after the resection of rectum carcinoma. METHODS From August 1991 to March 1996, 10 patients with rectum carcinoma were adopted in this study, among them, there were 4 cases belong to B stage of Dukas, and 6 cases belong to C stage of Dukes. In operation, rectum carcinoma and posterior wall of vagina were resected, and concurrent reconstruction was finished by using pedicled muscular flap of uterus. RESULTS The effect of operation were satisfactory except one case who was failed because of insufficient blood supply of the flap. Followed-up for 3-6 months, the posterior wall of vagina healed in 7 cases, the width of vagina was 2-3 fingers and the depth was 5-6 cm. CONCLUSION Reconstruction of the posterior wall of vagina with pedicled muscular flap of uterus was available in clinic. For its simplicity and feasibility, it’s suitable for the resection of rectum carcinoma in which the posterior wall of vagina was infiltrated.
ObjectiveTo exclusively compare the short-and long-term outcomes of hepatic resection (HR) patients with multifocal tumors meeting the Milan criteria between locating in same and different sections. MethodsA total of 219 consecutive HR patients with multifocal tumors meeting the Milan criteria were divided into group SS (n=97, same section) and group DS (n=122, different sections) according to their anatomical location (Couinaud's segmentation). ResultsThe 1-, 3-, and 5-year overall survival (OS) and recurrence-free survival (RFS) rates were significantly higher in the group SS than those in the group DS (P < 0.05). The subgroup analysis showed that patients with 2 tumors and those undergoing en bloc resection were associated with better OS and RFS (P < 0.05). ConclusionsFor HCC patients with multifocal tumors meeting the Milan criteria, those with tumors locating in same hepatic section may have better longterm survival and lower HCC recurrence rates than those locating in different sections after HR.
Objective To investigate the impact of laparoscopic versus. open hepatic resection for liver cancer on clinical rehabilitation and humoral immune function in patients organism. Methods Forty-four patients of laparoscopic and open left-lateral sectionectomy from January 2010 to June 2012 were selected， including 22 patients of laparoscopy group and 22 patients of conventional laparotomy group. The levels of IgG， IgA， IgM， C3， C4， C reactive protein （CRP）， IL-2， IL-6， and TNF-α in peripheral blood of patients on the last day before operation， first day and 5th day after operation were determinated by using ELISA assay. At the same time， the operative time， intraoperative bleeding， hospitalization time， and complications after operation between two groups were compared. Results The postoperative analgesic using time， first time eating， and hospitalization time in laparoscopic group were （1.9±0.8） days， （2.2±0.5） days， and （6.3±1.3） days， respectively， they were shorter than that in conventional laparotomy group （P＜0.05）. The operative time， intraoperative bleeding， complication rate， and mortality in two groups were not significant differences（P＞0.05） . Compared with before operation， the levels of C3， C4， IgA， IgG， IgM， and IL-2 on the first day after oper-ation in two groups were obviusly reduced， the levels of CRP， IL-6， and TNF-α on the first day after operation in two groups were significantly increased. The levels of C3， C4， lgA， IgG， lgM， and IL-2 on the first day after operation in conventional laparotomy group were significantly decreased than that in laparoscopic group （P＜0.05）. On the 5th day after operation， the levels of C3， C4， lgA， IgG， lgM， and IL-2 of laparoscopy group increased， the levels of CRP， IL-6，and TNF-α were reduced，that were no difference compared with before operation. Compared with before operation，the levels of C3， C4， lgA， IgG， lgM， and IL-2 of conventional laparotomy group were still at a low level state， and the levels of CRP， IL-6， and TNF-α were still at a high level state on the 5th day after operation. Conclusions Laparoscopic resection of liver cancer after operation， the patients’ recovery are quickly， and the impact on humoral immune function of laparoscopic radical resection for liver cancer patients is significantly less than that conventional laparotomy.
Objective To explore the clinical significance on protection of parathyroid and recurrent laryngeal nerve （RLN） by meticulous capsular dissection and exposure of RLN in thyroid lobectomy. Methods Clinical data of 452 patients who underwent thyroid lobectomy by meticulous capsular dissection and exposure of RLN in our hospital from Jan. 2010 to Dec. 2012 were retrospectively analyzed. Results All of the 452 cases underwent thyroid lebectomy successfully without death， and the operative time was 45-110min （average 60 min）， the blood loss was 5-100mL （average 20mL）. The pathological results showed that there were thyroid adenoma in 193 cases， nodular goiter in 175 cases， Hashimoto thyroiditis in 38 cases， thyroid cancer in 46 cases. After operation， 4 cases suffered RLN injury， 1 of the 4 cases recovered after removal of drainage tube， and other 3 cases recovered during 0.5 to 3.0 months. In addition， 2 cases suffered laryngeal nerve injury whose symptoms disappearred within 1 week， 5 cases suffered parathyroid founctional damage without permanent hypocalcemia whose symptom had kept 1-5 days after treatment. Three cases were reoperated because of bleeding， including branch of anterior venous bleeding in 1 case， thyroid side arterial tube bleeding in 1 case， and thyroid stump bleeding in 1 case. Twenty one cases suffered hypothyroidism in 1 month after operation， and no recurrence happened during the followed up period. Conclusions Meticulous capsular dissection can effectively protect function of parathyroid and reduce the injury probability of RLN. Exposure of RLN is safe and feasible， which plays an important role in avoiding serious RLN injury.
The influence on the wrist stability following ulnar head resection (Darrach s procedure)was studied. A series of X-ray films and arthrography of the wrist joint were taken before and after ulnar head re- section. The results showed that after ulnar head resection the radial deviation increased 3 degree(Plt;0.01). and the ulnar deviation 11.92 degree (Plt;0.001). The position of the lunate remained unchanged. Arthrography of the wrist joint demonstrated that 11 specimens had injury of the triangular fibrocartilage.The stability of the wrist joint would no doubt be certainly affected following the ulnar head resction.