Objective To investigate the applied value of combined flap that was anastomosed a set of blood vessels. Methods This team includs 26 cases, all cases were injured in traffic accident. The wound parts were knee, calf or ankle. All skin defaults was combined with osseous exposure, chronic inflammation and the wound area was huge. So all cases were terminal repair. After drastically debriding,the wound was repaired through transplanting combined flap that was anastomosed a set of blood vessels. The 6 types flaps were selected. It demonstrates signs of adequate circulation. Its longest was 70 cm, its largest was 42 cm x 42 cm. Results All flaps were alive, the wounds were closed up, the fractures were healed up, the feet or calves were reserved. All above was condition for function reservation. Conclusion THe applying of combined flap that anastomosed a set of blood vessels could substitutes the built-up flaps that was anastomosed a group of blood vessels. The procedure have spent smaller time, and have higher successful ratio. So it would be prone to applying and popularizing in clinical.

Gallbladder carcinoma (GC) is the most common malignant tumor in bile duct system.Xanthogranulomatous cholecystitis (XGC) is a benign inflammatory gallbladder disease.It is often misdiagnosed between them.This paper,through reviewing the literature and summarizing our own clinical experience,will give a better understanding on the two diseases,which was summarized as follows:inflammation is important both in the pathogenesis of GC and XGC,and we can make the correct diagnosis and choose an appropriate treatment by analy zing the feature of disease history,image data and rapid intraoperative pathological diagnosis.Radical resection remains the first choice in the treatment of GC,but the extent of resection is controversial.Normally,cholecystectomy is sufficient for curing XGC,but different surgeries are needed according to the specific disease conditions.

Objective To discuss the clinical feasibility and safety of modified invaginated pencreaticojejunostomy approach (Jiang's anastomosis) which was developed by the team of biliary surgery department from Shanghai Eastern Hepatobiliary Surgery Hospital.Methods Clinical data of 289 patients receiving modified invaginated pencreaticojejunostomy approach in pancreaticoduodenectomy were retrospectively studied.Wilcoxon signed-rank test,Chi-square and logistic regression tests were comprehensively used to evaluate the postoperative complications and the association with POPF.Results One hundred and sixtythree of 289 patients (54.6％) experienced postoperative complications after pancreaticoduodenectomy procedure.There were 45 onsets of severe complications,accounted for 17.6％ (45/255).Perioperative mortality was 3.1％ (9/289).The most common complications included celiac effusion and infection (26.6％),delayed gastric emptying (17.6％),gastroenterological tract fistula (12.4％),gastroenterological tract hemorrhage (9.7％).Additionally,the incidence of POPF was 9.3％,which all conformed as biochemical fistula (6.9％) and grade-B fistula (2.4％).Conclusions As a risk factor,POPF may play crucial role in celiac hemorrhage and infection associated with pancreaticoduodenectomy.Modified invaginated pencreaticojejunostomy approach (Jiang's anastomosis) with easy manipulation,wide indication,safe and effective performance,could be recommended to reduce POPF incidence.

Objective:To investigate the effect of Lamins B2 (LMNB2) on the migration of human retroperitoneal liposarcoma (RPLS) cells SW872.Methods:Immunohistochemistry was used to analyze the the differential expression levels of LMNB2 in 33 RPLS tissue samples . The correlation between LMNB2 expression and clinical prognosis and clinicopathological features was analyzed. siRNA was used to lower the expression level of LMNB2 in tumor cells, and the effect of LMNB2 on the scratch healing ability and migration ability of SW872 cells was examined by using wound-healing assay and transwell migration assay. The expression levels of p-AKT and AKT in each group cells were detected by Western blot.Results:Patients with high LMNB2 expression had a lower recurrence-free survival and overall survival compared to those with low LMNB2 expression, and were more likely to experience recurrence, ( χ2=4.872, P=0.027; χ2=4.180, P=0.041; χ2=7.127, P=0.008). The migration ability of cells was significantly reduced following the silencing of LMNB2 expression ( t=11.240, P<0.01; t=7.445, P<0.01). The expression level of p-AKT in the silencing group was significantly lower than that in the control group, while there was no significant difference in the expression level of AKT between the two groups ( t=9.784, P<0.01). Conclusion:LMNB2 may promote the migration of human retroperitoneal liposarcoma cells SW872 by regulating AKT signaling pathway.

Objective To retrospectively study the clinical value and the advantages in " planned hepatectomy" for the "central type" intrahepatic and extrahepatic choledochal cysts.Methods The clinical data of 7 patients with the "central type" of intrahepatic and extrahepatic choledochal cysts which were treated with "planned hepatectomy" from January 2014 through April 2017 at the Department of Biliary Tract Surgery of the Eastern Hepatobiliary Surgery Hospital,Second Military Medical University were retrospectively analyzed.Results All the patients completed radical resection of the intrahepatic and extrahepatic choledochal cysts in accordance with the " planned hepatectomy".The operations included 6 patients who were treated with percutaneous transhepatic cholangial drainage (PTCD) and 5 patients with portal vein embolization (PVE) prior to the surgical excision.Combined right liver resection was performed in 6 patients,and combined left liver resection in one patient.All the 7 patients had a history of chronic cholangitis.Liver volume tests demonstrated that the hemiliver volume to be removed (the embolized hemiliver) significantly decreased after PVE,whereas the hemilivers to be persevered were remarkably enlarged.No complication associated with PTCD and PVE occurred.The mean postoperative hospitalization was 12 days.Liver function tests suggested all the patients recovered well.No postoperative complication of bleeding,infection or liver function failure was observed,except in one patient who experienced pleural and abdominal effusion.Conclusions Combined subtotal hepatectomy may increase the risk of complications associated with the "central type" intrahepatic and extrahepatic choledochal cysts.The surgical strategy in planned hepatectomy can be used effectively to treat the "central type" of intrahepatic and extrahepatic choledochal cysts,with improved surgical safety,decrease in incidences of postoperative liver function failure and residual choledochal cysts.

Objective To evaluate the clinical efficacy and safety of preoperative endovascular embolization of Solid Hemangioblastomas.Methods The data bases including Wan Fang,CNKI(China National Knowledge Infrastructure),VIP Database,PubMed、Medline、Springer were searched for the related studies.Two independent surgeons assessed trails for eligibility and quality,and all data marching the standards were abstracted for Meta-analysis by RevMan 5.3.Results 8 randomized controlled trails(RCT)were included.Selected analysis of embolized and non-embolized groups of Solid Hemangioblastomas were observed for variables of clinical efficacy in surgery time,number of blood loss and transfusions,complete resection,there were statistical difference.(P＜0.000 01,WMD=-1.18,95％CI[-1.16,-0.71];P＜0.000 01,WMD=-464.17,95％CI[-492.17,-437.24];P＜0.000 01,WMD=-238.81,95％CI[-282.84,-194.77];P＜0.006,RR=1.17,95％CI[1.05,1.31]).Conclusion The preoperative endovascular embolization is beneficial for Hemangioblastomas because it can shorten the time of surgery,diminish the necessity of intra-operative blood loss and transfusion,it also raises the ratio of complete resection of Solid Hemangioblastomas.

Since the outbreak of Corona Virus Disease 2019 occurred in December 2019, the reduction of population mobility has curbed the spread of the epidemic to some extent but also prolonged the waiting time for the treatment of patients with gastric cancer. Based on fully understanding the different staging characteristics of gastric cancer, clinical departments should develop reasonable out-of-hospital management strategies. On one hand, reasonable communication channels should be established to allow patients to receive adequate guidance out of the hospital. On the other hand, shared decisions with patients should be made to adjust treatment strategies, and education on viral prevention should be implemented to minimize the impact of the epidemic on tumor treatment.

OBJECTIVETo investigate the interval time to canceration, clinicopathological characteristics and prognostic factors of carcinoma in remnant stomach (CRS) in patients with primary benign diseases or primary malignant tumors.

METHODSBased on the criteria of the definition of CRS proposed by Japanese Gastric Cancer Association in 2017, a retrospective analysis was conducted on clinicopathological characteristics of patients diagnosed with CRS at Peking University Cancer Hospital from March 1992 to March 2017. Between patients with primary benign diseases (CBS-B group) and primary malignant tumors (CBS-M group), continuous variables were compared using the Student's t-test or the Mann-Whitney U test; categorical variables were compared using the chi-square test or Fisher's exact test. Spearmen-Rho was used to examine correlation. Survival was estimated and compared using Kaplan-Meier methods. Cox proportional hazards regression was applied to identify independent prognostic factors. Area under ROC curve(AUC) was used to evaluate and compare prediction accuracy.

RESULTSA total of 89 patients were included in the study with a male: female ratio of 5.4 to 1.0. The male: female ratio in CRS-B (n=46) and CRS-M (n=43) group was 14.3 to 1.0 and 2.9 to 1.0 respectively with significant difference (χ=6.091, P=0.019). The interval time to canceration in CRS-B and CRS-M group was 342(36-576) months and 47(12-360) months respectively with significant difference (t=8.887, P=0.000). The interval time to canceration was correlated with the first operative procedure in CRS-B group (r=0.398, P=0.006), while interval time to canceration was correlated with the age at the first operation in CRS-M group (r=0.337, P=0.027). After differentiating the pathological findings of the first operative sample and the second operative sample, 27 patients presented recurrence and 15 patients had new cancer, and the corresponding interval time to canceration was 46(12-132) months and 60(12-360) months respectively with significant difference (t=5.652, P=0.023). In CRS-B group, location of stump carcinoma in gastric intestinal anastomosis, gastric anastomosis, and non-anastomosis area was found in 60.9%(28/46), 23.9%(11/46) and 15.2%(7/46) respectively, and the corresponding percentage in CRS-M group was 39.5%(17/43), 16.3%(7/43) and 44.2%(19/43) respectively without significant difference (χ=4.726, P=0.096). Among 77 patients with radical gastrectomy, the overall surgical complication rate was 20.8%(16/77), including 8 cases of infection and 7 cases of respiratory system diseases. The 3-year survival rate was 78.4% and 62.6% in CRS-B and CRS-M group respectively with significant difference (χ=3.969, P=0.046), indicating better prognosis of CRS-B patients. The AUC for the lymph nodes ratio and N staging was 0.725 and 0.639 respectively. Multivariate analysis showed the pathological T staging was an independent risk factor of prognosis (HR=1.192, 95%CI:1.032-1.376, P=0.017).

CONCLUSIONSMen have more CRS than women. The interval time to canceration is correlated to the first operative procedure for CRS-B patients, while it is correlated to the age at the first operation for CRS-M patients. The major location of CRS is in the gastrointestinal anastomosis for CRS-B patients and in non-anastomosis area for CRS-M patients. Main postoperative complications include respiratory and infectious complications. Pathological T staging is an independent prognostic risk factor for CRS patients.

Cancer Care Facilities ; Factor Analysis, Statistical ; Female ; Gastrectomy ; Gastric Stump ; pathology ; surgery ; Humans ; Lymphatic Metastasis ; Male ; Neoplasm Recurrence, Local ; Neoplasm Staging ; Prognosis ; Proportional Hazards Models ; Retrospective Studies ; Stomach Neoplasms ; surgery ; Survival Rate ; Universities

Objective: To study the use of MRCP digital quantitative diagnosis in the differential diagnosis of choledochal cyst type Ic. Methods: The clinical data of 41 patients with choledochal cyst type Ic, 47 patients with distal choledochal obstruction and 43 patients with simple gallbladder stones or polyps who were treated at the Eastern Hepatobiliary Surgery Hospital, PLA Naval Medical University from January 2010 to June 2016 were retrospectively analyzed. The diameters of the common bile duct, the left and the right hepatic ducts were measured and compared. Results: The maximum diameter of the left hepatic duct (LHD), right hepatic duct (RHD) and common bile duct (CBD) were significantly different (all P<0.05) in patients with choledochal cyst type Ic compared to patients with distal choledochal obstruction. The CBD/LHD ratio and CBD/RHD ratio were significantly larger (P<0.05). For patients with choledochal cyst type Ic, when compared with patients with simple gallbladder stones or polyps, the maximum diameter of CBD was significantly larger (P<0.05), but the maximum diameters of LHD and RHD were not significantly different (both P>0.05), while the ratios of CBD/LHD and CBD/RHD were significantly larger (P<0.05). For patients with choledochal cyst type Ic, when compared with patients with simple gallbladder stones or polyps, the maximum diameter of CBD was significantly larger (P<0.05), the maximum diameter of LHD and RHD was also significantly larger (P<0.05), while the ratios of CBD/LHD and CBD/RHD were not significantly different (P>0.05). The proportion of pancreaticobiliary maljunction (PBM) in patients with type Ic choledochal cyst was significantly higher than patients with distal choledochal obstruction and simple gallstone or polyp (P<0.05). Conclusions For patients with choledochal cyst type Ic, their CBD shows obvious dilation, while there is no obvious dilation in LHD and RHD. It is helpful to conduct differential diagnosis of choledochal cyst type Ic by the use of MRCP to observe the presence of PBM and to quantitatively compare the CBD/LHD and CBD/RHD ratios.