Objective To evaluate the role of transanal ileus tube decompression in the management of malignant obstruction of left-sided colon. Methods With the help of colonoscopy and radiography, 11 cases of left-sided malignant colonic obstruction were treated with transanal ileus tube insertion into the proximal obstruction site for the decompression of the dilated bowel. Curative effects were evaluated according to patient’s symptom relief, bowel sounds, abdominal circumference, intra-abdominal pressure, and plain abdominal radiography. Results Symptoms of acute intestinal obstruction were relieved in all the 11 cases after ileus tube decompression for 3~5 days. Laparoscopic or open primary colectomy was performed in 7 patients with resectable tumor. Postoperative follow-up observations for 1~18 months (median, 11 months) showed no complications like anastomotic leakage. Conclusions Transanal ileus tube decompression in the management of malignant obstruction of left-sided colon is safe and effective.

Objective To evaluate the safety of laparoscopic resection for giant abdominal benign mass.Methods Six cases of giant abdominal benign mass(8～25 in diameter)underwent laparoscopic exploration and resection under general anesthesia from July 2005 to March 2006.Results The laparoscopic resection was accomplished in all the 6 cases.The operation time was 75～220 min(mean,135 min),the intraoperative hemorrhage volume was 20～100 ml(mean,55 ml),the duration for abdominal drainage was 1～3 d(mean,2 d),and the postoperative hospital stay,2～7 d(mean,4.3 d).There was no complications such as intestinal injury,postoperative bleeding,or abdominal infection.Follow-up visits for 1～9 months(mean,6.5 months)found no recurrence.Conclusions Laparoscopic resection of giant abdominal benign mass is a feasible and safe minimally invasive technique.

OBJECTIVE To explore clinic effect of antibiotics intervention during perioperative period guided by rational usage of antibiotics.METHODS Selected all the discharged patients of Oct 2003 and Apr 2004 as group without intervention and that of Oct 2004,Apr and Oct 2005,and Apr and Oct 2006 as group with intervention,to analyze their antibiotics usage data.RESULTS After continuous intervention,antibiotics utilization ratio promoted,especially the antibiotics half an hour pre-operation utilization ratio of clean-contaminated incision and contaminated incision improved from 48.9% and 14.3% in pre-intervention group to 88.2% and 50.0% in post-intervention group,respectively,antibiotics cost to total drug fee ratio decreased from 30.51% to 24.06%.CONCLUSIONS Effective and feasible intervention can promote antibiotics prophylaxis utilization during perioperative period and decrease incision infection and medical expense.

Objective To evaluate the effect of via-anal preoperative depression with assistance of colonoscopy and primary stage laparoscopic cancer resection and anastomosis for the treatment of malignant obstruction of left-sided colon. Methods Eleven cases of malignant left-sided colonic obstruction were treated from December 2004 to August 2007 by this modality.With the help of colonoseopy and the guiding of radiography,ileus tube was inserted into the proximal bowel of the obstructive site via anus.We used the tubes to decompress the dilated bowel.Patient's symptom,bowel sounds,abdominal girth,intra-abdominal pressure,plain abdominal radiograph were observed.After the relief of bowel obstruction,elective laparoseopic colorectal resection and anastomosis was accomplished in one stage with routine preoperative preparation.Results After 5～14 days of depression by ileus tube,the relief of bowel obstruction was achieved in all these patients hence emergency operation wag avoided.Elective first-staged laparoseopic resection and anastomosis was performed in all 11 cases.The complications such as anastomotic leakage and incisional/abdominal cavity infection were not observed.After an average 15.2-month fouow up,local recurrence rate,incisional or port implantation rate,and tunlor-free survival rate were 9%,0 and 91% respectively. Conclusions First-staged laparoscopic resection and anastomosis assisted by preoperative colonoscopic depression in malignant left-sided colonic obstruction is a safe and effective procedure.

OBJECTIVETo evaluate and compare the effect of naso-intestinal tube decompression and octreotide in conservative management of early post-operative inflammatory ileus (EPII).

METHODSFrom March 2005 to January 2009, forty-five patients diagnosed with EPII, who failed to improve with conventional conservative management including nasogastric tube decompression, were enrolled in this study. All patients were prospectively nonrandomized into naso-intestinal tube group (n = 23) or Octreotide group (n = 22). The outcomes were compared between nasogastric tube, naso-intestinal tube and Octreotide groups.

RESULTSAll the forty-five patients with EPII refractory to conservative management with nasogastric decompression were treated successfully with the naso-intestinal tube decompression or octreotide in 3-12 days. Compared with the Octreotide group, the first passage of flatus was earlier [(4.7 +/- 1.9) d vs (6.7 +/- 1.6) d] and abdominal circumference recovered faster [(90.4 +/- 2.0)% vs (95.1 +/- 1.3)%] in the naso-intestinal tube group (P < 0.05). But the volume of cumulative and daily gastrointestinal decompression were more in naso-intestinal tube group than those in Octreotide group [(4037 +/- 1155) ml vs (3316 +/- 1038) ml; (890 +/- 181) ml vs (492 +/- 83) ml; P < 0.05].

CONCLUSIONSPatients with EPII could be safely and effectively managed by naso-intestinal tube decompression or octreotide. It is possible for those patients to avoid second laparotomy. Naso-intestinal tube decompression and octreotide are associated with faster recovery and less fluid loss respectively.

Abdomen ; surgery ; Adult ; Aged ; Aged, 80 and over ; Decompression ; methods ; Female ; Humans ; Intestinal Obstruction ; etiology ; therapy ; Intubation, Gastrointestinal ; Male ; Middle Aged ; Octreotide ; therapeutic use ; Postoperative Complications ; therapy ; Prospective Studies ; Treatment Outcome ; Young Adult

OBJECTIVETo evaluate the long-term clinical results and the factors that influences the outcomes of the revision open lumbar discectomy by fenestration.

METHODSFifty-one patients, who underwent the second open discectomy by fenestration from January 1 1988 to December 31 1994, were followed for an average of 146.8 months (range, 120 to 203 months). The long-term follow-up results were evaluated by using the MacNab classification and the Japanese Orthopaedic Association (JOA) scoring system through direct examinations and questionnaires. Radiography was also used in patients who agreed to visit the hospital, and findings were compared with those on preoperative radiographs.

RESULTSAt the final follow-up, with the MacNab classification an excellent and good outcome was achieved in 70.6% of the cases, 78.4% were satisfied with their results. The failure rate was 15.7% (8 patients). Excluding those 8 failed cases who needed another reoperation, the average improvement calculated by JOA scores was (64.6 +/- 18.2)%. The disc height of the operation site significantly decreased after surgery, nevertheless, this did not affect the long-term clinical outcome. Factors that were associated with a fair and bad outcome included smoking, isolated trauma or injury, fibrosis and the length of the remaining or recurrent primary postoperative symptoms history. Psychosociological signs were probably known as negative predictors of lumbar disc surgery outcome.

CONCLUSIONThe long-term outcome of the revision open lumbar discectomy by fenestration in this series was favorable. Because the revision operation is typically associated with a higher complexity, selection of suitable surgical candidates and determination of valid indications for operative treatment are very important. JOA scores have proved to be easy to perform for patients and clinicians and standardize subjective data.

Adult ; Aged ; Diskectomy ; methods ; Female ; Follow-Up Studies ; Humans ; Lumbar Vertebrae ; surgery ; Male ; Middle Aged ; Reoperation ; Retrospective Studies ; Treatment Outcome

OBJECTIVEWith the development of endoscopic therapy in children, endoscopic electrocoagulation polypectomy had gradually replaced surgery and became an important method to resect gastrointestinal polyps in children. Simple electrocoagulation polypectomy could often bring some complications of gastrointestinal bleeding and perforation because of incomplete electrocoagulation or mechanical incision, especially in gastrointestinal thick-pedunculated polyps which always have thick nutrient blood vessel. Hemoclips can successfully interdict arteriovenous blood because it can clamp tissue firmly without causing necrosis around the target area. Based on its good mechanical hemostasis, hemoclips are not only widely used in treating bleeding like from ulcer, tumor and variceal ligation but also used in removal of thick-pedunculated gastrointestinal polyps in adults. This paper describes the application of endoscopic electrocoagulation with metal hemoclips to remove thick-pedunculated intestinal polpys in children for the first time, sums up the experience and evaluates its efficacy and safety.

METHODSBetween October, 2001 and December, 2002, 5 cases with thick-pedunculated intestinal polpys were presented. The age of the patients ranged from 3 to 5 years. The clinical features were gastrointestinal bleeding or abdominal pain. The longest course of disease was 2 years. Enough preparations for alimentary tract were necessary for polypectomy. The procedures were performed under general anesthesia in order to avoid the risk of bleeding aspiration. Endoscopy was performed in the standard fashion. The apparatus included electronic colonic endoscope (XQ 200, Fuji Corp, Tokyo, Japan), snare (XQ200, Fuji Corp, Tokyo, Japan), impeller of the clip (HX-5QR-1) and hemoclip (MD850) which could be passed through the biopsy channel of endoscope. The clip was completely covered with a hood avoiding any injury to the mucous membrane. The pedicel with diameter of more than 1.0 cm underwent endoscopic electrocoagulation polypectomy with hemoclips. The clip contacted polyps in upright direction. One or more hemoclips were selected to clamp the proximal basement of the pedicel in terms of the pedicel diameter. Turning of the red colour of polyps to purple suggested that hemoclip interdicted arteriovenous blood effectively. The clip was then shut off and electrocoagulation polypectomy was followed. Six polyps were observed and removed.

RESULTSSix polyps including 2 transverse colon polyps and 4 descending colon polyps were resected. Pathological results showed that 3 were juvenile polyps and the other 3 adenomatous polyps. All the polyps were completely resected. The diameter of pedicel were 1.2 - 2.2 cm. The head and pedicel of the biggest polyp was about 5 cm x 5 cm and 2.2 cm, respectively, and five clips were used in order to remove it. No complications of bleeding and perforation were observed in these children. All hemoclips were expelled from intestines within one week. The symptoms of these patients disappeared.

CONCLUSIONMechanical hemostasis with hemoclips successfully interdicted arteriovenous blood of thick-pedunculated polyps. Hemoclips can successfully prevent the complications of bleeding and perforation. The clipping brings about a new method in endoscopic therapy. Endoscopic electrocoagulation polypectomy with hemoclips is a simple, safe and effective method to treat thick-pedunculated gastrointestinal polyps in children and it is a valuable tool in polypectomy for children.

Child ; Child, Preschool ; Endoscopy ; methods ; Humans ; Intestinal Polyps ; surgery ; Surgical Instruments ; Treatment Outcome

Leigh syndrome is a genetically heterogeneous disease caused by defects in enzymes involved in aerobic energy metabolism and the Krebs', cycle. Mitonchondrial complex I deficiency is a main cause of Leigh syndrome. In this study, a Chinese child with Leigh syndrome caused by 13513G>A mutation was reported. The proband was the first child of his parents. The previously healthy boy presented with generalized epilepsy at 12 years of age. When he visited Peking University First Hospital at 13 years of age, he had subacute loss of vision in two eyes and temporal defect of visual field in the left eye. He walked with a spastic gait. His blood lactate and pyruvate levels were elevated. Muscle biopsy showed mild lipid accumulation in muscle fiber. An electrocardiogram showed incomplete right bundle branch block. Brain magnetic resonance imaging showed bilateral, symmetrical lesions in the basal ganglia, supporting the diagnosis of Leigh syndrome. 13513G>A mutation was identified by gene analysis in the patient, which led to mitochondrial respiratory chain complex I deficiency. Multivitamins and L-carnitine were administered. At present, the patient is 16 years old and has progressive deterioration with significant muscle weakness and body weight loss. He is absent from school. He has no obvious retardation in intelligence. 13513G>A mutation was first identified by gene analysis in Chinese population with Leigh syndrome. This may be helpful in genetic counseling.
Adolescent ; DNA, Mitochondrial ; genetics ; Electron Transport Complex I ; deficiency ; Humans ; Leigh Disease ; genetics ; Male ; Mutation

Objective To prospective study the use of minimally invasive surgery (MIS) for colorectal cancer with liver metastases (CRCLM) and to analyze the safety and survival outcomes.Methods 31 patients with resectable CRCLM were enrolled into this study from January 2009 to August 2011.Synchronous or metachronous liver metastases were diagnosed in 26 and 5 patients,respectively.The treatment strategy was discussed and decided by a multi disciplinary team which consisted of experienced colorectal surgeons,hepatic surgeons,medical oncologists,radiologists,and pathologists.Treatment included the use of neoadjuvant chemotherapy,one or two-staged surgery,and suitability to use laparoscopic surg(e)ry.Results Coloproctectomy and partial hepatectomy were carried out in all these patients,and every patient received at least one laparoscopic procedure.The operations in cluded: laparoscopic coloproctectomy plus hepatectomy (n=10),laparoscopic coloproctectomy only (n 18) and laparoscopic partial hepatcctomy only (n=3).One-staged coloproctectomy and hepatectomy were performed in 19 patients who presented with synchronous CRCLM.Colorectal and hepatic specific complications,such as anastomotic leak,liver failure,biliary leak,abdominal infection and abdominal bleeding,were not detected in these pati(e)nts.Neoadjuvant chemotherapy was used in 12 patients.Adjuvant chemotherapy was given to every patient.At a mean follow-up of 23.3 months from the diagnosis of liver metastases,the overall survival and disease-free survival were 87.1％ and 71.0％,respectively.Conclusions MIS for resectable CRCLM in carefully selected patients was safe and feasible.A one staged laparoscopic coloproctectomy and partial hepatectomy was possible.The short-middle oncologic outcomes were acceptable,but the long-term survival was still not clear.

OBJECTIVESTo analyze the survival outcomes of the surgery for colorectal cancer with liver metastases (CRCLM), and study the mode of multi-disciplinary team (MDT) for CRCLM.

METHODSThe retrospective analysis was conducted for 38 patients with CRCLM received MDT management and surgical treatment from January 2009 to August 2011. The peri-operative and survival outcomes of MDT and surgery were evaluated.

RESULTSAll the cases met the present criteria of resetability for CRCLM, but only 4 cases (10.5%) met the previous one. Coloproctectomy and hepatectomy were performed in all cases, with 39 colorectal neoplasms and 155 liver lesions removed. One case died of postoperative septic shock. Colorectal and hepatic specific complications were absent in the others patients except one case of biliary leak which was treated with conservative management. Neoadjuvant chemotherapy was arranged in 13 cases. Adjuvant chemotherapy was administered for every patient. After a mean follow-up of (22 ± 10) months according to the finding time of liver metastases, recurrence and metastases were observed in 16 cases and 6 cases died of late-stage cachexia. The 1-, 2- and 3-overall survival rate were 94.4%, 85.3% and 75.8% respectively, and the 1-, 2- and 3-disease-free survival rate were 70.1%, 54.2% and 54.2% respectively.

CONCLUSIONSMDT mode for resectable CRCLM is recommendable. Surgical resection of CRCLM is feasible and safe, which seems to achieve favourable short-middle oncologic outcomes. And long-term survival is expected.

Adult ; Aged ; Chemotherapy, Adjuvant ; Colorectal Neoplasms ; mortality ; pathology ; surgery ; Female ; Follow-Up Studies ; Humans ; Liver Neoplasms ; mortality ; secondary ; Male ; Middle Aged ; Retrospective Studies ; Survival Rate ; Treatment Outcome