Objective To summarize the clinical and pathological characteristics of primary gallbladder carcinoma, analyze factors such as surgical procedures, tumor stages that associated with prognosis, and standardize the diagnosis and treatment strategy for primary gallbladder carcinoma.Methods From January 1986 to October 2009, 197 patients of primary gallbladder carcinoma were treated in Peking Union Medical College Hospital (PUMCH). A retrospective study was performed basing on clinical data of these patients, statistical analysis carried out using SPSS version 13.0, Kaplan-Meier estimate employed for the survival analysis and Log-rank test for the group comparisons. Results One hundred and ninety-seven patients were enrolled (73 male and 124 female) with the mean age of 64.4±1.1years. Abdominal pain (77.3%) , obstructive jaundice (33.6%) and fever (19.5%) were the main symptoms of primary gallbladder carcinoma, with accompanying cholecystolithiasis in 99 cases. B-mode ultrasonic examination and CT scan were important for preoperative diagnosis. Nevin stages and surgical modalities were independent prognosis factors. For stage Ⅰ and Ⅱ patients the survival terms were not different between those receiving radical cholecystectomy and simple cholecystectomy. However, for stage Ⅲ, Ⅳ and Ⅴ patients the survival terms were of statistically different between those in radical cholecystectomy group and simple cholecystectomy group. Conclusions For stage Ⅰ and Ⅱ patients, simple cholecystectomy is a good surgical procedure. For those at more advanced stages, radical cholecystectomy is the choice of therapy, while simple cholecystectomy also improves the prognosis compared with laparotomy only.

Objective To summarize the clinical and pathological characteristics of incidental gallbladder carcinoma,analyze the factors such as surgical procedures,tumor stages that associated with prognosis,and standardize the diagnosis and treatment strategy of incidental gallbladder carcinoma. Methods Between January 1991 and October 2009,27 incidental gallbladder carcinoma patients were treated in Peking Union Medical College Hospital (PUMCH).A retrospective study was performed based on the clinical data of these patients to evaluate the methods of diagnosis,curative treatment and prognosis. Results Twenty-seven patients were collected (8 male and 19 female) with the mean age of (68.3 ± 1.9)years.Abdominal pain,obstructive jaundice and fever were the main symptoms of incidental gallbladder carcinoma.All the 27 cases underwent open cholecystectomy based on preoperative tentative diagnosis of benign disease,and carcinoma of gallbladder was confirmed by postoperative pathology.In this group(9 lowdifferentiation,9 moderate-differentiation,4 high-differentiation and 5-carcinogenesis from adenoma).Two cases were on the stage of Nevin Ⅰ,5 on Nevin Ⅱ,8 on Nevin Ⅲ,5 on Nevin Ⅳ and 7 on Nevin Ⅴ.The survival terms were of statistic significance between the radical cholecystectomy groups and simple cholecystectomy groups(x2 =4.450,P=0.035); The prognosis of patients on stages Ⅰ、Ⅱ are better than those who are on stages Ⅲ、Ⅳ、Ⅴ (x2 = 6.825,P = 0.014). Conclusion The clinical manifestations of incidental gallbladder carcinoma are diverse,which usually lead to misdiagnosis.Frozen section examination during operation is key to diagnose incidental gallbladder carcinoma.Surgical operation is the first choice of therapy,offering much better prognosis than those received simple cholecystectomy.

Objective To investigate the diagnosis and treatment strategy of primary sclerosing cholangitis (PSC). Methods From January 1991 to August 2009, 31 patients with PSC were treated at the Peking Union Medical College Hospital. A retrospective study was performed based on the clinical data of these patients to evaluate the methods of diagnosis, curative treatment and prognosis. Results Obstructive jaundice, fever and abdominal pain were the main symptoms of PSC, which accounted for 90% (28/31) , 65% (20/31) and 52% (16/31) , respectively. Thirty patients presented with an elevation of alkaline phosphatase. The positive rate of autoantibody was 45% (14/31). The positive expression of serum tumor markers of 15 patients was elevated, and 13 of the 15 patients had an elevated expression of CA19-9 (84-5000 U/mL). The diagnostic accuracies of B-mode ultrasound, computed tomography, magnetic resonance cholangiopancreatography, and endoscopic retrograde cholangiopancreatography (ERCP) were 3/28, 2/24, 2/18, 18/25, respectively. Nineteen patients received drug therapy and only one patient had no obvious discomfort after the treatment. Twelve patients received surgical treat-ment and the prognosis of two patients who underwent liver transplantation was good. Eleven patients received endoscopic treatment, only one patient had no obvious discomfort and the condition of the remaining 10 patients was alleviated after treatment. Conclusions PSC is usually characterized by an elevated expression of CA19-9. ERCP has a high diagnostic accuracy. Conventional treatments can only relieve the symptoms, whereas liver transplantation has a favorable long-term efficacy.

Objective To apply the percutaneous endoscopic gastrostomy (PEG) for deglutition disorders of the elderly. Methods 32 elderlypatients with deglutition disorders accepted PEG were reviewed. They accepted post-operative enteral nutrition and were followed upmonthly with their weight, body mass index and mini-nutritional assessment (MNA). Results 2 cases presented skin infection of stoma, nomore complications happened. Their weight, body mass index and MNA improved significantly 3 months after treatment (P<0.05). ConclusionPEG is an effective treatment for the elderly deglutition disorders.

Upper limb dysfunction can severely threaten the quality of life of the patients with breast cancer after mastectomy. This paper reviewed the researches on its pathogenesis, diagnosis, treatment, prevention and so on in the last 10 years. Early rehabilitation is very important for upper limb dysfunction after mastectomy.

Objective To investigate the stapled trans-anal rectal resection (STARR) and Altemeir's resection for rectum prolapse in spinalcord injury (SCI) patients. Methods Anus bowel disease of 260 SCI patients were investigated, 21 cases with rectum prolapse who wereinvalid for nonoperative treatment chose Altemeir's resection or STARR depending on the degree of rectum prolapse. They were recorded ac- cording to International Spinal Cord Injury Bowel Function Based and Extension Set before and 12 months after operation. Results 85 SCIpatients were with rectum prolapse (32.7%), 21 patients complicated with constipation and mixed hemorrhoid, 19 with rectal mucous membraneprolapse (<7 cm), 4 with rectal internal mucous intussusception, 2 were completely rectum prolapse (≥7 cm). Rectum prolapse of Ⅰdegree was found in 13 cases, Ⅱ in 5 cases, and Ⅲ in 3 cases. Patients with Ⅰ or Ⅱ degrees rectum prolapse accepted STARR, those withⅢ degrees accepted Altemeir's resection. No serious complication was found. Self-report of intestinal dysfunction affecting the quality oflife during the 12 months after operation significantly decreased (P<0.01), so as the need of drawing out defecate with hands (P<0.01), theusage of liner, plug, or antidiarrheal (P<0.001). The symptom such as endless defecate feeling, abdominal distension, abdominal pain, abdominaldiscomfort were significantly alleviated (P<0.05). Conclusion STARR and Altemeir's resection are both safe and effective operationfor rectum prolapse in SCI patients.

Objective To explore the diagnosis, treatment and pathogenesis of solitary rectal ulcer syndrome (SRUS) in patients with spinal cord injury (SCI). Methods 260 patients with SCI accepted rectal diseases survey, anal examination and anus straight endoscopic. Those who had rectal ulcer also performed biopsy, and patients who had been diagnosed as SRUS were evaluated by the index of International bowel function basic SCI data set, then further accepted non-operative or surgical treatment, and regular reexamination with anal straight colonoscopy for clinical evaluation after discharge. Results and Conclusion Bowel dysfunction, constipation, and anal rectum prolapsed, improper uses of glycerine enema were important causes of SRUS after SCI. Non-operative therapy as well as strengthening defecate management could be an effective treatment for SRUS after SCI.

Liver metastasis is the one of the main prognostic factors of pancreatic neuroendocrine neoplasm (PNEN). With the development of multidisciplinary collaboration among surgical oncology, medical oncology, and intervention treatment, the treatment of PNEN with liver metastasis gradually tends to become diversification. Surgery is still the only way for curing the patients with pancreatic neuroendocrine tumor with liver metastasis when the histological types are G1 and G2. Medical oncology and intervention treatment could be selected for those having PNEN with diffuse liver metastasis or those cannot tolerate surgery. Liver transplantation only suits for a small number of selected patients. The present article explored the relationship between histological classifications and the treatment options of PNEN with liver metastasis, and discussed the specific treatments from perspectives of surgical treatment, medical treatment and intervention treatment.

Objective To explore the change of sexual life quality and its influencing factors of premenopausal breast cancer patients.Methods 94 premenopausal breast cancer patients were included. Changes in Sexual Functioning Questionnaire short-form (CSFQ-14) was used and part of its items was changed. Their sexual life was evaluated before and after treatment by using depth interview and anonymous methods. Results 94 cases received face-to-face communication and study. 88 (93.6%) questionnaires were received, in which 81 (92.1%) questionnaires were effective. Their sexual life quality and sexual satisfaction significantly decreased and there was significant difference in the CSFQ-14 score (P<0.001) before and after treatment. The ratio of bad, worse, and worst sexual life were 39.5%, 29.6%, and 14.8% respectively after treatment. 65.4% of the patients had no sexual activity. The reasons included medical related factors, fear of cancer metastasis and recurrence, physical discomfort, poorer body image, partner sexual attitudes changed, life stress, common psychological problems, traditional ideas and so on. Conclusion Sexual dysfunction was obvious and sexual life quality significantly decreased in premenopausal breast cancer patients after treatment. Patients' physical and mental damage, the change of body image and spouse's attitude are significant influencing factors. It is necessary to give sexual rehabilitation guidance to patients and their spouses.

Pancreatic pseudocyst is the most common pancreatic cystic disease in clinical practice.In the surgical treatment of pancreatic pseudocysts, most surgeons preferred laparoscopic surgery in recent years.The options and the timing of laparoscopic surgery for pancreatic pseudocysts in different situations are explored in the paper.Pancreatic pseudocysts during the observation period, the imaging examination to detect whether the cyst has disappeared or increased, such as cysts found to be enlarged or still can not dissipate after 6 months, the largest diameter greater than 6 cm, and clinical symptoms, surgical drainage should be considered treatment.Surgery based on the location of the cyst and surgical experience of surgical options.Pancreatic cyst often choose laparoscopic cyst-gastric anastomosis, far from the stomach cyst should choose laparoscopic cyst-jejunal anastomosis.Laparoscopic surgery for the treatment of pancreatic pseudocyst has a unique advantage, short operation time, less bleeding, less trauma, less postoperative complications, rapid recovery, is a safe and effective treatment options.