OBJECTIVE: To compare the therapeutic effect of postoperative radiotherapy with surgery alone in advanced supraglottic laryngeal squamous cell carcinoma (LSCC). METHOD: According to the treatment methods, 59 patients with advanced supraglottic LSCC were divided into surgery plus radiotherapy group (S+R group) (33 cases) and surgical group (S group) (26 cases). In S+R group, total laryngectomy was performed on 27 patients and partial laryngectomy on 6 patients, 27 of whom underwent lateral neck dissections; while in S group, total laryngectomy was performed on 23 patients and partial laryngectomy on 3 patients, 24 of whom underwent lateral neck dissections. RESULT: The 3-year overall survival rate of S+R and S group were 62.6% and 62.6% respectively, and the 5-year overall survival rate of S+R and S group were 43.8% and 40.5% respectively. But there was no statistically significant difference of survival rate between two groups by Log-rank test (P > 0.05). In S+R group, recurrence happened in 5 cases and the recurrent rate was 15.1%; in S group, recurrence happened in 10 patients and the recurrent rate was 38.5%, statistically significant difference was found between the two recurrent rates (P < 0.05). CONCLUSION Surgery combined with postoperative radiotherapy could not improve the 3-year-or 5-year overall survival rate, but could significantly reduced tumor recurrence rate.
Adult ; Aged ; Carcinoma, Squamous Cell ; pathology ; radiotherapy ; surgery ; Combined Modality Therapy ; Female ; Glottis ; pathology ; Head and Neck Neoplasms ; pathology ; radiotherapy ; surgery ; Humans ; Laryngeal Neoplasms ; pathology ; radiotherapy ; surgery ; Laryngectomy ; Male ; Middle Aged ; Neck Dissection ; Squamous Cell Carcinoma of Head and Neck ; Survival Rate ; Treatment Outcome

OBJECTIVE: This study was to evaluate the patterns of central lymph nodes metastasis, by analyzing the results of surgery in clinical NO (cNO) papillary thyroid carcinoma (PTC). METHOD: We retrospectively studied the effect of surgical treatment among 123 cN0 PTC patients. All the patients underwent central lymph node dissection; 47 patients underwent ipsilateral neck dissection and 9 patients underwent bilateral neck dissection. RE- SULT: Seventy-eight cases (63.4%)were found positive central lymph node, which included 34 cases (27.6%) bilateral positive central lymph node. Central lymph node metastases correlated with age < 45 years, extrathyroidal extension, surrounding tissue invasion and tumor size grade (P < 0.05), were the independent risk factors of central lymph node metastasis. CONCLUSION Age < 45 years, extrathyroidal extension and surrounding tissue invasion were the independent risk factors of central lymph node metastasis. For cNo patients with PTC, primary excision as well as central neck dissection was recommended; according to the results of intraoperative frozen and situation, further process were made.
Adult ; Carcinoma ; pathology ; Carcinoma, Papillary ; Humans ; Lymphatic Metastasis ; Neck Dissection ; Retrospective Studies ; Risk Factors ; Thyroid Cancer, Papillary ; Thyroid Neoplasms ; pathology

Background Implantable contact lens (ICL) surgery is a primary intraocular refractive corrective surgery for high myopia.However,whether there will be enough distance between ICL and anterior face of lens to avoid the occurrence of anterior capsular cataract in non-accommodated and the largest physiological accommodated state after ICL implantation is worthy of investigation.Objective The purpose of this study was to investigate the alteration of lens vault after ICL implantation and explore the relationship between accommodation and change of lens vault.Methods A observational study was carried out.Sixty-six eyes of 33 patients with high myopia who received ICL implantation were enrolled in Affiliated First Hospital of Guiyang Medical College from May to November,2012.Best corrected visual acuity (BCVA),uncorrected visual acuity (UCVA),refractive diopter were regularly examined using synthetical optometry,and crystalline lens rise (CLR) and lens vault in non-accommodative or accommodative condition were observed by the anterior segment OCT (Visante OCT) and ultrasound biomicoscopy (UBM) before operation and 1 day,1 week,l month and 3 months after operation.Data were analyzed with SPSS version 16.0.Repeated measurement one-way analysis of variance was used to compare the differences of vision and refractive diopter among various time points.The relationship between accommodation and CLR was assessed using Pearson linear correlation.The alteration of CLR with accommodation change was analyzed by linear regression equation.Lens vault was measured and compared between non-accommodation and maximal physical accommodation status by paired t test.Results The postoperative UCVA was improved in comparison with preoperative BCVA,and the postoperative diopter was significantly lower than that of preoperation,with significant differences among various time points (F =16.904,P =0.000 ; F =1.498,P =0.000),and the diopter was stable after operation.A positive correlation was found between the alteration of CLR and accommodation under the physical accommodative stimulation in high myopic eyes (R2 =0.49,P =0.00).Under physiological accommodation,CLR elevated 20 μm for per 1.0 D accommodation.In addition,the difference of lens vault values within postoperative 3 months was statistically significant (F=16.025,P=0.000).The lens vault values lowed with the enlargement of accommodation in 48.5％ eyes,and the lens vault values increased with the enlargement of accommodation in 50.0％ eyes.However,1.5％ of the lens vault were in a stable state under the maximal physiological accommodated condition 3 months after operation.Lens vault were greater than zero in 97.0％ eyes (64/66),and only 3.0％ eyes (2/66) were zero under the maximalphysiological accommodated condition.Significant differences were seen in the lens vault between nonaccommodated and the maximal physiological accommodated state 1 day or 1 week after operation (t =4.755,P =0.000 ;t =3.327,P =0.001) ; but there was no statistical significance in 1 month or 3 months after operation (t =1.544,P=0.127,t=0.621,P=0.537).Conclusions During physiological accommodation,the alteration of CLR with accommodation in high myopic eyes.The location of ICL in the eyes is unstable within 3 months after operation.Majority of operative eyes remain enough vault in the maximal physiological accommodated state,but minority of operative eyes occur contact of ICL with the anterior surface of lens.Whether this contact causes anterior capsular cataract still needs to study.

Objective To evaluate the impact of early enteral nutrition (EEN) compared with parenteral nutrition (PN) on patients after hepatectomy. Methods Seventy-eight patients undergoing liver resection were randomized prospectively into two groups: EEN group receiving early enteral nutrition (n=35) and PN group receiving parenteral nutrition (n=43). The patients in both groups received isocaloric and isonitrogenous nutritional formulas 24 h after operation and the formulas were stopped on postoperative day 7. The general conditions, liver function tests, clinical complications,and clinical nutritional variables at three time points that included preoperative phase, postoperative day 1 (POD 1) and postoperative day 8 (POD 8) were observed. Results No significant differences were found in length of hospital stay, liver function and clinical nutritional variables between the 2 groups. In the EEN group, the serum prealbumin level almost returned to the preoperative level on POD 8. The nutritional complication rate of the EEN group was increased significantly but it was milder than that of the PN group. The time of gut function recovery in the EEN group was shorter than that of the PN group. The costs of nutritional drugs showed a significant decrease in the EEN group.Conclusion Early enteral nutrition is safe, rational and effective in patients who have undergone hepatectomy. Early enteral nutrition is better than parenteral nutrition in promoting liver function recovery, liver protein synthesis, postoperative recovery of gut function and decreasing costs of nutritional drugs.

OBJECTIVETo compare the early clinical effects of Activ C cervical disc replacement (ACDR) and anterior cervical discectomy and fusion (ACDF) in treating single-level cervical spondylosis.

METHODSThe clinical data of 76 patients with single-level cervical spondylosis underwent surgery from July 2009 to September 2012 were retrospectively analyzed. Among them, 28 patients were treated with ACDR (ACDR group), including 18 males and 10 females, aged from 32 to 62 years old with an average of (45.2±6.2) years; and 48 patients were treated with ACDF (ACDF group), including 28 males and 20 females, aged from 33 to 60 years old with an average of (45.8±6.4) years. Visual analogue scale (VAS), Japanese Orthopedics Association (JOA) score, Short Form-36 (SF-36), imaging data were used to assess the clinical effects after operation.

RESULTSA total of 76 patients were followed up from 6 to 24 months with an average of 13.2 months. VAS of neck pain and brachialgia were improved in all patients after operation (P<0.05), there was no significant difference between two group (P>0.05). Somato-score and psycho-score of SF-36 of two groups were obviously increased (P<0.05), ACDR group was better than that of ACDF group (P<0.05). In ACDR group, there was no significant difference in the range of motion of surgical segments and adjacent segments between preoperative and postoperative (P>0.05); heterotopic ossification around the edge of vertebral body occurred in 1 case on the 6th month after operation, no fusion was found on the 1st year after operation. In ACDF group, the adjacent vertebral disease occurred in 1 case and the patient underwent the reoperation.

CONCLUSIONActiv C cervical disc replacement can reduce the degeneration of adjacent segments and its early outcomes for the treatment of single-level cervical spondylosis are satisfactory, but the long-term effects still need study.

Adult ; Cervical Vertebrae ; surgery ; Diskectomy ; methods ; Female ; Humans ; Male ; Middle Aged ; Spinal Fusion ; methods ; Spondylosis ; surgery ; Total Disc Replacement ; methods

Objective:To summarize the clinical characteristics and surgical treatment experience of pregnant women with acute Stanford type A aortic dissection.Methods:From January 2005 to December 2018, a total of 12 patients with acute Stanford type A aortic dissection were treated in Zhongshan Hospital affiliated to Fudan University. Two patients died of sudden aortic dissection rupture during emergency CTA examination. The other 10 patients underwent surgical treatment, the age was 22-40 years[mean(30.7±5.8) years], the pregnancy was 15-39 weeks[mean(28.8±6.5) weeks], two cases in the second trimester of pregnancy, seven cases in the third trimester of pregnancy and one case in puerperium. Among them, seven cases were Marfan syndrome, one case was bicuspid aortic valve malformation, two cases were complicated with pregnancy hypertension.Results:One case died during perioperative period and died of rupture of abdominal aortic dissection in twelfth day after operation. One fetus was diagnosed as stillborn before operation. Before December 2013, six patients underwent surgeries, the mean cardiopulmonary bypass time was(96.8±16.5)min, aortic occlusion time was(70.8±19.3)min, intensive care unit time was(3.4±2.3) days, ventilator-assisted mechanical ventilation time was(21.6±15.6)h. After January 2014, four patients underwent surgeries, the mean cardiopulmonary bypass time was(202.3±6.4)min, the aortic cross-blocking time was(137.5±10.3)min, circulatory arrest time was(27.3±8.8)min, intensive care unit time was(12.0±5.7) days, and the ventilator-assisted mechanical ventilation time was(40.3±24.4)h. The postoperative complications included tracheotomy in two cases, hemodialysis in one case, poor wound healing in one case. One patient who had been treated with Bentall was followed up to sixth year and died of progressive rupture of descending arch dissection. One patient was followed up to seventh year after Bentall surgery, redo Bentall and Sun’s procedure were performed because of artificial valve infection, and was discharged uneventful. No adverse cardiovascular events occurred in other patients.Conclusion:Surgical treatment should be actively considered in pregnancy complicated with acute Stanford type A aortic dissection. Multi-disciplinary team cooperation can effectively improve the safety and effect of operation.

The strategy of root reconstruction for Stanford type A aortic dissection (AAD) includes resection of the intimal tear site, correction of concomitant aortic valve dysfunction and amendment of coronary lesion. Supracommissural tube graft replacement is a well-adopted and convenient procedure for most patients, although its application is limited when distinct sinus expansion and severe intimal damage is present. Composite valve conduit replacement (Bentall procedure) is suitable for patients with overt sinus damage. However, a fraction of patients with functional aortic valve will be unnecessarily put into risks for prosthetic complications. Valve-sparing aortic root replacement (VSRR), which includes aortic root remodeling (Yacoub procedure) and reimplantation (David procedure) techniques, has the advantage of retaining autologous aortic valve while guaranteeing resection of damaged vessel segments.The Yacoub procedure is relatively convenient but harbors long-term risk for annulus expansion, while the David procedure demonstrates long-term benefit but may be too demanding to be operated in emergent scenario as AAD. The last decade has witnessed worldwide endeavors to investigate the treatment strategy for aortic root, especially the VSRR approach. The preliminary results are encouraging and demonstrating improvements for both mid- and long-term outcomes of AAD, which enables standardized and personalized surgical management for these patients.

Objective To explore the technique of breast reconstruction after mastectomy. Methods 30 cases of patients with breast cancer who were not suitable for breast conservative surgery were sum-marized. Among them, immediate breast reconstruction with prosthetic implants after mastectomy was used in 16 patients, transverse rectus abdominis musculocutaneous flap (TRAM flap) in 10 patients, and latissimus dorsi musculocutaneous flap in 4 patients. There were 27 patients who underwent immediate breast reconstruction, while 3 patients underwent delayed breast construction. Results The appearance was good in 16 cases of breast reconstruction with prosthetic implants and no complications were found. Two out of the ten patients who had the transevarse rectus abdominis musculocutaneous flap (TRAM flap) breast reconstruction had partly necrosis of skin flap, and one lateral ventral syndrome. The appear-ance of the 7 cases after the TRAM flap breast reconstruction evaluated well, 2 cases moderate, and one case less satisfactory. The appearance of 4 patients who had breast reconstruction with latissimus dorsi musculocutaneous flap evaluated well. Conclusion Breast reconstruction is an important part of combined therapy for the breast cancer, especially for the patients who have strong desire to conserve breast, while incompetence for breast conserving surgery. In such a case breast reconstruction is a good choice. Imme-diate breast reconstruction is better than delayed breast construction. The appropriate method of breast reconstruction depends on each individual patient. Patients with locally advanced breast carcinoma can se-lectively choose immediate breast reconstruction.

10.3969/j.issn.2095-4344.2013.26.023

Objective To analysis of risk factors for left atrial thrombosis in patients with rheumatic mitral stenosis.Methods From January 2001 to December 2008, 2277 patients with rheumatic mitral stenosis underwent operations in our hospital. There were 737 males and 1540 female, the age ranged from 19 to 84 years [average (50.9 ±10.2) years]. Left atrial thrombosis group (554 cases) and no thrombosis group (1723 cases) were divided, retrospectively collected data were analyzed with univariate and multivariate Logistic regression. Results 12 bvariables, including age, mitral valve orifice area, left atrial diameter, left ventricular diastole diameter, CRP, gender , degree of mitral stenosis, or regurgitation, degree of bicuspid regurgitation, degree of pulmonary hypertension, atrial fibrillation and heart function had statistic difference between two groups. With multivariate Logistic regression for these 12 factors, age, mitral valve orifice area, left atrial diameter, degree of mitral regurgitation and atrial fibrillation were found to be the affecting factors for left atrial thrombosis in patients with rheumatic mitral stenosis. Conclusion For patients with rheumatic mitral stenosis, age, mitral valve orifice area, left atrial diameter and atrial fibrillation are the risk factors for left atrial thrombosis. Mitral regurgitation is a protective factor for left atrial thrombosis.