ObjectiveIn order to enhance the curative resectability rate of pancreatic carcinoma. MethodsSixteen consecutive patients received an extended resection, which is referred to systemic dissection of regional lymph nodes and combined resection of the diseased PV/SMV based on traditional Whipple operation or the distal pancreatectomy. ResultsMean operation time was 8.5 hours. Mean intraoperative blood infusion was 1250mL. The procedure was considered curative in 11 (68.8 % ) and palliative in the other five. Postoperative complications occurred in 7 (43.8% ). Perioperative death occurred in one patient(6.25% ). Median length of hospital stay was 35 days. In nine patients undergoing curative resection,two cases survived for 1/2～1 year, six patients survived for 1～2 year and another patient has survived for more than 32 months without evidence of recurrence. ConclusionExtended resection for pancreatic cancer is technically feasible and two- third of pancreatic carcinoma invading PV/SMV alone can be expected to obtain curative resecetion.

ObjectiveTo evaluate the effect of the comprehensive surgical management of primary venous reflux disease in lower extremity. MethodsComprehensive surgical management was performed on 108 patients( 126 limbs) with primary venous reflux disease between February, 1996 and Sept, 2000. All limbs were performed with superficial venous operation. External valvuloplasty of femoral vein valve was given to 83 cases(97 limbs) simultaneously, and to 22 cases (26 limbs) with concomitant subfascial endoscopic perforator surgery(SEPS). 3 cases (3 limbs) were operated with concomitant SEPS only. ResultsVenous claudication,swelling, and aching disappeared in 80.2% of limbs( 101/126) and apparent improvement in 19.8 % of limbs(25/126). All varicose veins were gone. Ulcer healing pre sented in 80 % of the limbs(8/10) with ulcers and ulcer decreasing in 20% of the limbs(2/10) in 3～6 months after superficial and deep venous operations. Ulcer healing presented in 23 cases(26 limbs) with ulcers and ulcer decreasing in remaining 2 limbs in 14 to 32 days after additional SEPS besides superficial and or deep venous operations. Deep venous valve sufficiency was demonstrated in 89.7% (113/126) of the limbs by Color Duplex. ConclusionIn the patients with severe primary venous reflux disease,comprehensive surgical management with concomitant superficial, deep and perforating veins might greatly improve the clinical effect.

Objective　In order to explore the prevalence of hypophosphatemia in postoperative patients of general surgery,as well as the time and dosage of phosphate replacement and its effects.Methods　To serum phosphate levels of 45 patients with phosphate replacement begun on the second postoperative day and 45 without replacement were monitored at the preoperative day,and the first,third,fifth and seventh postoperative day.Results　The incidence of hypophosphatemia was 91.1%(41/45) in cases without phosphate replacement.While it was 57.8%(26/45) in those with replacement.The serum phosphate concentrations in cases with phosphate replacement were higher than those without replacement on the third(P<0.001),fifth(P<0.05) and seventh(P<0.01) postoperative day.The Apache Ⅱ scores in cases with phosphate replacement decreased on the third postoperative days compared with those on the first day(P<0.001).Conclusion　The postoperative replacement of phosplates can avert the occurrence of hypophosphatemia and improve the Apache Ⅱ score.

Objective　This study was To investigate the incidence rate of Cockett syndrome and relationship between Cockett syndrome and varicose veins and deep venous incompetence of the left lower extremities.Methods　73 patients(100 legs) with varicose veins of the lower extremities were investigated by descending deep venography and iliography preoperatively.Results　There were 35(47.9%) cases with abnormalities of the left common iliac vein (ALCIV)in all the cases.There were 31 cases with this conditions in the patients with varicose veins of the left or both lower extremity.While in the patients with varicose veins of the only right lower extremity,there were only 4 cases with ALCIV.In contrast,there was a significant difference between groups(χ2=9.8641,P=0.0017).In the patients with ALCIV,14 cases with Ⅲ or Ⅳ grade of deep venous incomptence were found, and only 6 cases with deep venous incompetence in the patients without ALCIV.There was a significant difference(χ2=5.3688,P=0.0205).Conclusion　Cockett's syndrome frequently occurs in varicose veins of the left lower extremity.There is a relationship between them.Cockett's syndrome might be one of the causes for the deep venous incompetence of the left leg.

Objective　To discuss the technique,advantages and follow-up results of subfascial endoscopic perforator surgery.Methods　Subfascial Endoscopic Perforator Surgery was performed for 23 patients wth chronic venous insufficiency.Over two years postoperative follow-up was done.Results　21 in 23 cases with ulcers healed.Only one case had wound infection.Conclusion　Subfascial Endoscopic Perforator Surgery is a safe and effective procedure in treating venous insufficiency.

Objective　To evaluate adbomen surgery in patients who are found to have poorly controlled or untreated hypertension before operation.Methods　From January 1997 to December 1998,the perioperative clinical data of 531 patients with hypertension and undergoing abdomen surgery in our hospital were retrospectively analyzed.Results　The incidences of perioperative hypertensive events were not significantly different,between controlled and uncontrolled patients with grade one and grade two (P>0.05).In grade three and systolic hypertension,certain perioperative complications in patients with poorly controlled hypertension were higher than in those with well-controlled hypertension(P<0.05).Conclusion　The patients with grade on e and grade two hypertension are not at increased operative risk.In Patients with grade three and systolic hypertension,perioperative complications are increased and elective surgery should be postponed until their blood pressure is brought under 180/110 mmHg over 1 to 2 weeks.

Objective To study how to reduce the incidence rate of skin flap necrosis after the eradicative resection of breast cancer. Methods 45 patients with breast cancer underwent eradicative operation with new methods to prevent the necrosis of skin flap,and they were studied and compared with 1210 cases treated by traditional ways. Results With the new methods adopted, the necrosis rate of skin flap following eradicative operation of breast cancer was reduced from 45%(original)to 2%(present).Statistic analysis showed that there was outstanding difference between them. Conclusion In the eradicative operation of breast cancer,the key to prevent the necrosis rate of skin flap is:prevention of subaxillary lymphatic fistula, two tubular drainage set individually in subcostalis and subaxillaris, appropriate force of chest bandaging, proper thickness of skin flap and perfect suture without tension.

Objective The purpose of this study was to determine the indication,methods,safety and efficacy of hepatic resection for metastatic carcinoma of the liver. Methods Sixty-nine consecutive hepatic resections in 67 patients with secondary carcinoma of the liver were reviewed. Results One case died and operative mortality rate was 1.5 %.Median follow-up was 5 years, ranging from 1 to 7 years. The 1、3、5-year survival rates for all patients were 28.36%、 19.40% 、and 11.94% respectively. The survival rate of over 5-years in the hepatic resection for metastatic colorectal carcinoma was 21.43%. Conclusions Surgical resection of metastatic disease to liver is not only safe but also curative. We recommend that for any patient with metastatic carcinoma of the liver, an anatomic distribution of tumors to preserve hepatic function after resection and fitness to withstand the procedure should be considered for resection.

Objective To understand the effect of the resect margin(RM)to hepatectomy for primary hepatocellularcarcinoma(PHC).Methods In 544 cases,72 cases were small PHC(≤3cm),473 cases were large PHC(＞3cm). Four groups were classified according to the distance of RM The 5-year recurrence rate and survival rate after hepatic resection in each group were analyzed. Results RM with residue cancer or cancer embolus had a high 5-year recurrencre rate and lower survival rate in both small and large PHC. Small PHC with RM≥1.0cm and large PHC with RM≥2.0cm had higher 5-year survival rate and lower recurrence rate. Conclusion We recommend RM≥1.0cm for smallPHC and RM≥2.0cm for large PHC.

Objective To investigate the causes,diagnosis and treatment of postoperative acute cholecystitis. Methods Clinical data of 9 cases with postoperaive acute cholecystitis were analyzed retrospectively. Results7 cases was confirmed by ultrasonography, 1 case was confirmed by CT, and 1 case died of gallbladder perforation, no operative mortality in emergency cholecystectomy. Conclusion The prevalent etiology is biliary stasis. Early diagnosis and treatment is the key point to decrease the death rate.