ObjectiveTo understand the application of vacuum assisted rotary cutting technique in benign and malignant breast diseases.MethodThe related literatures about the application of vacuum assisted rotary cutting technique in the breast benign and malignant diseases were reviewed.ResultsThe technique of vacuum assisted rotary cutting had been applied to the treatment of intraductal and phyllodes tumors. The non-lactation mastitis lesions could all be removed by this technique, and as a minimally invasive treatment for gynecomastia. It could guided by the color Doppler ultrasound, mammography and MRI, which could obtain enough tissue specimens for the screening and biopsy of early breast cancer. The indication of vacuum assisted rotary cutting technique should be further discussed in the breast conserving treatment of breast cancer.ConclusionsVacuum assisted rotary cutting technique has been widely used in treatment of various benign diseases of the breast and diagnosis and treatment of breast cancer. The best indication for operation should be determined based on clinical manifestations and auxiliary examination results.
Abstract： Objective To investigate the effect of singledirection lobectomy plus systematic lymphnode dissection for primary nonsmall cell lung cancer (NSCLC) in the early stage by videoassisted thoracic surgery (VATS). Methods We retrospectively analyzed the clinical data of 89 patients who received VATS lobectomy plus systematic lymphnode dissection for earlystage primary NSCLC in the Second People’s Hospital of Chengdu between June 2006 and December 2009. Based on the operative approach, the patients were divided into two groups: VATSminithoracotomy group and singledirection lobectomy VATS group. In the former group, there were 46 patients, including 36 males and 10 females, with an age of 58.76±14.78 years. For patients in this group, minithoracotomy was carried out assisted by VATS. In the latter group, there were 43 patients, including 37 males and 6 females, with an age of 61.34±12.56 years, and singledirection lobectomy VATS was performed for patients in this group. Moreover, 42 patients undergoing routine posterior lateral open thoracotomy were chosen to form the control group (thoracotomy group, included 37 males and 5 females with an age of 56.30±15.59 years). The clinical features, such as operative time, operative blood loss, the number of systematic dissected lymph nodes, postoperative drainage quantity, postoperative complications and visual analogue scale (VAS) of chest pain were retrospectively analyzed to evaluate the early outcomes. Results No operative death occurred in all three groups. There were significant differences among the three groups in the postoperative drainage time (P=0.024), postoperative drainage quantity (P=0.019), operative blood loss (P=0.009), early outofbed activity time (P=0.031), and the incidence of cardiopulmonary complications (P=0.048). Compared with the VATSminithoracotomy group, the singledirection lobectomy VATS group was significantly lower or shorter (Plt;0.05) in postoperative drainage quantity (208.33±50.39 ml vs. 245.98±45.32 ml), operative blood loss (78.79±24.23 ml vs. 112.63±64.32 ml), and the early outofbed activity time (2.31±0.27 d vs. 3.56±0.31 d). The rate of using Dolantin in the control group was significantly higher than the other two groups (P=0.046, 0.007). The change of VAS score among the three groups after operation was also statistically significant (F=5.796, P=0.002). A total of 109 patients (37 in the VATSminithoracotomy group, 37 in the singledirection lobectomy VATS group, and 35 in the control group) were followed up after operation with a period of 2 to 48 months. Twentytwo patients were lost in the followup. There were 10, 9, and 8 deaths during the followup in the three groups respectively, and the median survival time was 40 months, 37 months, and 37 months respectively. There was no significant difference among the three groups in survival time (P=0.848). Conclusion VATS, especially VATS assisted single direction lobectomy and systematic lymphnode dissection for primary NSCLC in the early stage has the same surgical efficacy as the traditional open thoracotomy, and is minimally invasive, which contributes to a quick recovery. Consequently, it is a reliable approach for lung cancer in the early stage.
ObjectiveTo summarize clinicopathologic and immunophenotypic features of hepatic epithelioid angiomyolipoma (HEAML) and to explore its diagnostic and differential diagnostic methods.MethodThe clinical and imaging manifestations, pathological morphology and immunohistochemical features of 5 patients with HEAML from August 2011 to December 2017 in this hospital were retrospectively analyzed.ResultsThere were 2 males and 3 females in the 5 patients with HEAML, aged 38–64 years with an average age of 50 years. There were 2 cases of the left lobe tumors and 3 cases of the right lobe tumors. Three cases were diagnosed as the hepatocellular carcinoma and the other two cases were diagnosed as the hepatic hamartoma and (or) hemangioma by the preoperative imaging examination. The diameter of tumors ranged from 1.5 cm to 7.0 cm, with an average of 3.6 cm. Microscopically, the tumors were composed of more epithelioid smooth muscle cells, parenchyma vessels and a small amount of fat. The immunohistochemical results showed that the melan-A, HMB45, and SMA were positive, while the HepPar-1, AE1/AE3, EMA, CD117, Dog-1, CD10, CgA, Syn, and Desmin were negative. The Ki-67 proliferation index was 2%–10%. The patients were all alive without the tumor recurrence after following up for 2–76 months with an average of 31.4 months.ConclusionsHEAML is a rare primary mesenchymal tumor of liver, which should be misdiagnosed for other benign or malignant tumors for influencing clinical treatment. Diagnosis and differential diagnosis can be made by histopathology and immunohistochemical staining.
【摘要】 目的 探討腔鏡技術通過不同切口方式取出聚丙烯酰胺水凝膠（polyacrylamide hydrogel，PAHG）注射隆乳劑手術的臨床效果，以取得最大隆乳劑清除率。 方法 2008年1月－2011年3月雙側乳房PAHG注射隆乳術后并發癥患者35例，將腔鏡技術分別應用于經乳房外側切口和經乳暈切口PAHG注射隆乳劑取出手術。經乳房外側切口治療21例，于乳房外側緣隱匿部位分別選做長約0.5～1.0 cm的切口1～3個，穿刺吸刮PAHG后在腔鏡結合彩色多普勒超聲徹底清除PAHG；經乳暈切口14例，沿乳暈下緣做2～3 cm弧形切口，吸刮PAHG后，以長頭拉鉤挑起囊腔，在內鏡輔助下通過刮除或吸刮交替清除殘留PAHG，彩色多普勒超聲掃查確認未見PAHG回聲團塊。總結比較兩種切口中應用腔鏡技術的臨床經驗。 結果 所有患者均順利完成手術，達到最大限度取出隆乳劑的目的。無中轉改變手術方式，無術后出血、感染、引流不暢、隆乳劑殘留等并發癥；患者均對切口感到滿意。經乳暈切口組中6例取出隆乳劑后同期置入硅膠囊假體，該組有1例出現乳頭乳暈的感覺敏感度降低。 結論 腔鏡輔助下經乳腺外側切口和經乳暈切口都能夠安全、有效并最大限度地取出PAHG注射隆乳劑，具有美容、微創和可以同期切除病變組織的優勢，經乳暈切口手術方便同期硅膠囊假體的置入。腔鏡技術值得在PAHG注射隆乳劑取出術中進一步推廣應用。【Abstract】 Objective To explore the clinical outcome of endoscopic techniques in the removal of injected breast-augmentation polyacrylamide hydrogel (PAHG) through different incision methods in order to achieve a maximal PAHG removal rate. Methods From January 2008 to March 2011, 35 patients with postoperative complications after bilateral breasts PAHG injection were diagnosed and treated in our hospital. Endoscopic techniques were applied to remove PAHG through the lateral incision of breast or the mammary areolar incision. Twenty-one patients were treated with lateral incision in which 1-3 incisions with a length of 0.5-1.0 cm were selected at hidden lateral sites of breasts, and PAHG was removed by vacuum sucking followed by endoscopic technique with Doppler color ultrasound to achieve a complete removal. Fourteen patients were treated with mammary areolar incision where an arc-shaped 2-3 cm incision was made under the lower margin of mammary areola. After vacuum sucking of PAHG, long head hook was used to lift the cyst and endoscopic technique was used along or alternate with sucking to remove the remaining PAHG. Doppler color ultrasound scanned to confirm the absence of PAHG mass. The clinical experiences of these two endoscopic techniques were compared and summarized. Results All patients successfully underwent the surgery and achieved a goal of maximal removal of PAHG. None of the patients had to switch surgery approach, and no such complications as post-surgery bleeding, infection, obstructed drainage or PAHG remaining occurred. Patients were all satisfied with the appearance of incisions. Six patients were given silicone prosthesis implantation after removing PANG through the areola incision, among whom one patient showed a decreasing sensitivity in mammary nipple and areola. Conclusions Both endoscopic techniques through the lateral incision of breast and the mammary areolar incision are safe, and can achieve maximal removal of PAHG. They both have the advantages of beautifying, minimal invasiveness and simultaneous removal of pathologic tissues. The mammary areolar incision facilitates implantation of silicone prosthesis simultaneously. The endoscopic techniques are worthy to be further applied into removal of PAHG
【摘要】 目的 探討乳腺癌保乳切除加經乳腔鏡清掃腋窩淋巴結的可行性和手術難點。 方法 將2007年2月－2011年2月行乳腺癌保乳切除手術的27例患者，分成乳腔鏡腋窩清掃組（乳腔鏡組）11例和常規腋窩清掃組（常規組）16例，比較兩組患者手術時間、術中出血量、術中清掃淋巴結數、術后引流時間及引流量等。 結果 手術時間:乳腔鏡組（186.36±11.20） min，常規組（158.13±25.29） min，兩組差異有統計學意義（P=0.002）；術中出血量:乳腔鏡組（61.82±51.54） mL，常規組（103.75±42.56） mL，兩組差異有統計學意義（P=0.030）；兩組術中清掃淋巴結個數、術后引流時間、引流量比較，差異均無統計學意義（Pgt;0.05）；隨訪1個月~4年，無一例發生腫瘤局部復發或戳孔轉移。 結論 乳腺保乳切除加經乳腔鏡清掃腋窩淋巴結可以安全應用于早期乳癌的保乳治療，操作者需學習一定的手術技巧。【Abstract】 Objective To investigate the feasibility and surgical difficulty of breast-conserving resection and endoscopy-assisted axillary lymph node dissection for breast cancer patients. Methods Twenty-seven patients treated by breast-conserving surgery from February 2007 to February 2011 in our hospital were divided into endoscopy-assisted axillary lymph node dissection group (the EALND group, n=11) and conventional axillary lymph node dissection group (the CALND group, n=16). Then, we compared the operation time, intra-operative bleeding volume, number of lymph nodes dissected, postoperative drainage time and amount between the two groups. Results The operation time was significantly longer in the EALND group than that in the CALND group [(186.36±11.20) vs. (158.13±25.29) minutes, P=0.002]. The intra-operative bleeding volume of the EALND group was significantly less than that of the CALND group [(61.82±51.54) vs. (103.75±42.56) mL, P=0.030]. There were no significant differences between the two groups in the number of lymph nodes dissected, postoperative drainage time and amount. Follow-up was done for one month to four years, during which no local recurrence or trocar displacing occurred. Conclusion The breast-conserving resection and endoscopy-assisted axillary lymph node dissection can be safely used in early breast cancer patients, and surgical skills should be mastered in the study.
Objective To investigate the effect of topical appl ication of insul in on the burn wound heal ing in aging diabetes mell itus (DM) rats and to explore its mechanism. Methods Seventy-five SPF Wistar rats (female and/or male), aged 12-24 months and weighing 300-350 g, were selected and randomly divided into group A (burn control group, n=25), group B(DM burn control group, n=25), and group C (DM insul in treatment group, n=25). The rats in group B and group C were fedwith high-fat, high-protein, and high-sugar forage for 1 month and received intraperitoneal injection of streptozotocin (STZ)to establ ish experimental model of aging DM. The rats were fed with high-fat, high-protein, and high-sugar forage for another 8 weeks. Then, the deep second-degree burn model was establ ished in the rats of group B and group C. The wounds in group A and B underwent local subcutaneous injection of 2 mL isotonic sal ine and group C received local subcutaneous injection of 0.1 U insul in. The rate of wound heal ing was calculated 7, 14, and 21 days after burn injury. At 1, 3, 7, 14, and 21 days after burn injury, HE staining observation, immunohistochemistry staining for CD34, detection of sugar and hydroxyprol ine (HOP) content in wound tissue, and microvessel density (MVD) calculation were performed. Results At 7, 14, and 21 days after burn injury, the wound heal ing rates of group A and group C was significantly higher than that of group B (P lt; 0.05), and there was no significant difference between group A and group C (P gt; 0.05). Histology observation at 21 days after burn injury: in group A, certain degree of epithel ization was evident in the wound epithel ium; in group B, large quantity of necrotic tissue was evident; in group C, complete epithl ization occurred in the wound epithel ium with better epithel ial cell differentiation and more neonatal collagen. For the sugar content in the wound tissue, group A was significantly lower than group B or group C at 1, 3, 7, 14, and 21 days (P lt; 0.05) and group C was significantly lower than group B at 7, 14, and 21 days (P lt; 0.05). For the HOP content in the wound tissue and the MVD count, group A or group C was significantly higher than group B (P lt; 0.05) and there was no significant difference between group A and group C (P gt; 0.05). CD34 expression: in group A, it was (+) at 7 days, (++) at 14 days, and (+++) at 21 days; in group B, it was (+) at 14 and 21 days; in group C, it was (++) at 7 days and (+++) at 14 and 21 days. Conclusion Topical appl ication of insul in can promote the synthesis of wound collagen, accelerate the woundangiogenesis, and speed up the wound heal ing in aging DM rats.
Colorectal polyps are important early markers of colorectal cancer, and their early detection is crucial for cancer prevention. Although existing polyp segmentation models have achieved certain results, they still face challenges such as diverse polyp morphology, blurred boundaries, and insufficient feature extraction. To address these issues, this study proposes a parallel coordinate fusion network (PCFNet), aiming to improve the accuracy and robustness of polyp segmentation. PCFNet integrates parallel convolutional modules and a coordinate attention mechanism, enabling the preservation of global feature information while precisely capturing detailed features, thereby effectively segmenting polyps with complex boundaries. Experimental results on Kvasir-SEG and CVC-ClinicDB demonstrate the outstanding performance of PCFNet across multiple metrics. Specifically, on the Kvasir-SEG dataset, PCFNet achieved an F1-score of 0.897 4 and a mean intersection over union (mIoU) of 0.835 8; on the CVC-ClinicDB dataset, it attained an F1-score of 0.939 8 and an mIoU of 0.892 3. Compared with other methods, PCFNet shows significant improvements across all performance metrics, particularly in multi-scale feature fusion and spatial information capture, demonstrating its innovativeness. The proposed method provides a more reliable AI-assisted diagnostic tool for early colorectal cancer screening.
Objective To compare the effectiveness of poly ether ether ketone (PEEK) localization marker combined with mixed reality technology versus color doppler ultrasound guidance for the vessel localization of anterolateral thigh perforator flap. Methods A retrospective analysis was conducted on 40 patients with tissue defects after oral cancer resection who underwent repair using the anterolateral thigh perforator flap between January 2022 and June 2023. According to the different intraoperative positioning methods of the anterolateral thigh perforator flap, they were randomly divided into PEEK group [using PEEK localization marker combined with mixed reality technology based on CT angiography (CTA) data] and color ultrasound group (using color ultrasound guidance), with 20 cases in each group. There was no significant difference in gender, age, etiology, and disease duration between the two groups (P>0.05). The number of perforator vessels identified in the two groups of regions of interest was recorded, and compared them with the intraoperative actually detected number to calculate the success identifying rate of perforator vessels; the distance between the perforating point and the actual puncture point was measured, the operation time of the two groups of flaps was recorded. ResultsIn the PEEK group, 32 perforator vessels were identified, 34 were detected by intraoperative exploration, and the success identifying rate was 94.1% (32/34); in the color ultrasound group, 29 perforator vessels were identified, 33 were detected by intraoperative exploration, and the success identifying rate was 87.8% (29/33); there was a significant difference in the success identifying rate between the two groups (P<0.05). The distance between the perforating point and the actual puncture point and the operation time in PEEK group were significantly shorter than those in color ultrasound group (P<0.05). Patients in both groups were followed up 6-30 months, with a median of 17 months; there was no significant difference in follow-up time between the two groups (P>0.05). In the PEEK group, there was 1 case of flap necrosis at the distal edge and delayed healing after trimming and dressing change. In the color ultrasound group, there was 1 case of flap necrosis at 7 days after operation and pectoralis major myocutaneous flap was selected for repair after removal of the necrotic flap. In the rest, the flap survived and the incision healed by first intention. Donor site infection occurred in 1 case in PEEK group and healed after anti-inflammatory treatment. The maxillofacial appearance of the two groups was good, the flap was not obviously bloated, and the patients were satisfied with the repair effect. Conclusion Compared with the traditional color ultrasound guidance, the PEEK localization marker combined with mixed reality technology based on CTA data in vessel localization of anterolateral thigh perforator flap has higher success identifying rate and positioning accuracy, and the flap production time is shorter, which has high clinical application value.
目的 探討腹腔鏡胃微創游離術在食管癌Ivor-Lewis術式的應用價值。 方法 回顧性分析2009年4月－2011年1月行Ivor-Lewis術式食管癌患者25例，其中男15例，女10例，年齡50～72歲，平均63歲，食管中段癌14例，食管下段癌11例，腹部操作均采用經臍部、右腋前線平膽囊底水平、左腋前線平左側肋緣及前述兩操作孔與臍部連線中點做操作孔置入腹腔鏡器械，超聲刀游離胃并清掃腹腔淋巴結。 結果 25例手術均取得成功,無中轉開腹。腹腔鏡操作時間30~80 min;出血約2~20 mL，無術中輸血；行胃左動脈、肝總動脈、腹腔干動脈、胃大、小彎及賁門旁淋巴結完全清掃,術后患者2～4 d肛門排氣,術后5～7 d恢復進食，術后住院9～12 d ；25例患者隨訪1～2年，進食及生活質量良好，無復發轉移及死亡者。 結論 食管癌Ivor-Lewis術式中采用腹腔鏡胃微創游離術是安全可行的，可充分游離胃、腹腔淋巴結清掃徹底同時具有減少手術創傷、出血少、疼痛輕、術后并發癥少、住院時間減少等優點，值得推廣。
Tumor chemotherapy is a treatment method that employs chemotherapeutic drugs to eradicate cancer cells. These drugs are cytotoxic, meaning they can affect both tumor cells and normal cells. In recent years, there has been a gradual increase in chemotherapy-induced liver injury. Chemotherapy-induced parenchymal liver injury often manifests as diffuse lesions, although focal lesions can occasionally be observed. There is a diversity in the pathogenesis and pathological changes of chemotherapy-induced focal liver disease. Radiologically, there is often challenging in differentiating chemotherapy-induced focal liver disease from hepatic metastases. Therefore, early and accurate diagnosis of this condition poses a certain challenge in clinical practice. This article presents the radiological findings of a case of chemotherapy-induced focal liver disease induced by chemotherapy for gastric cancer, and summarizes the radiological features and differential diagnostic points of chemotherapy-induced focal liver disease, aiming to enhance the understanding of this type of lesion among radiologists and clinicians and reduce related missed diagnoses and misdiagnoses.