Objective　To summrize the experience of the diagnosis and treatment of fibroadenoma in adolescence.Methods　48 cases of fibroadenoma were reviewed retrospectively.The average age was 14.5,16 patients of them underwent tumor resection only,24 cases had an excision to remove the tumor and suitable gland tissue around it,8 cases had a breast regional resection plus mammoplasty.Results　The complication such as wound hemorrhage,hypodemic hydrocele,nipple necrosis and wound infection were not occurred after operation,6 cases were recurred after six months.The recurrence rate was 12.5%(6 cases).Conclusions　Age of the disorder attack is a main bases of diagnosis of the adolescent fibroademoma.Their breast's apparent shape and its function should be maintained as far as.And the tumor recurrence should be controlled as in time as possible.

Objective To summrize the experience of the diagnosis and treatment of fibroadenoma in adolescence.Methods 48 cases of fibroadenoma were reviewed retrospectively.The average age was 14.5,16 patients of them underwent tumor resection only,24 cases had an excision to remove the tumor and suitable gland tissue around it,8 cases had a breast regional resection plus mammoplasty.Results The complication such as wound hemorrhage,hypodemic hydrocele,nipple necrosis and wound infection were not occurred after operation,6 cases were recurred after six months.The recurrence rate was 12.5%(6 cases).Conclusions Age of the disorder attack is a main bases of diagnosis of the adolescent fibroademoma.Their breast's apparent shape and its function should be maintained as far as.And the tumor recurrence should be controlled as in time as possible.

Objective To evaluate the rationale of pancreatoduodenectomy for the treatment of chronic local pancreatitis in the head of pancreas.Methods Eleven patients underwent pancreatoduodenectomy for chronic local pancreatitis in the head of pancreas with 7 cases treated by Whipple′s operation and 4 by pylorus preserving pancreatoduodenectomy.Results Postoperative stress ulcer and wound infection occurred and were cured subsequently in one each.Postoperative follow up showed good quality of life in all the 11 patients.Conclusions Pancreatoduodenectomy is an effective cure for patients suffering from chronic local pancreatitis of the head of the pancreas refractory for conservative therapy.

Objective: To explore the diagnosis and surgical treatment for cholelithiasis of cau- dal lobe of liver. Methods: The data of 98 patients with cholelithiasis of caudal lobe were reviewed. Results: 42 cases (43% ) got preoperative diagnosis. No cases died during operation.7cases had residual stones,the rate of which was 7.1% . The stones recurred in 10 cases and the rate was 12.3% . Conclusion: Understanding the disease, the preoperative image examination combining with introperative exploration are important to decrease the misdiagnosis and increase the rate of diagnosis. The surgical treatment should follow the principle of individualized therapy.

Objective To study the effect of pelvic autonomic nerve preservation(PANP)on urination and sexual function in total mesorectal excision(TME). Methods Two hundred and forty cases of male rectal cancer patients,divided into the PANP who accept the pelvic autonomic nerve preservation in TME,and the control group of 120 patients who do not.The urination and sexual function were observed and compared.3-year-survival rate,local recurrence rates of the two groups were recorded. Results The urinary disorder rates,erective disorder rates and ejaculation disorder rates of PANP group were 30.8%,28.3%and 34.2%,while values of control group were 55.0%、60.0%and 62.5%.The difference between them had statistical significance(P<0.05).The 3-year-survival rate and local recurrence rate of PANP group were 9.4%and 75.0%.The 3-year-survival rate and local recurrence rate of control group were 9.0%and 65.0%.There was no significant difference between them(P>0.05). Conclusion The PANP technique in TME could improve the urinary and sexual function of male patients without affect the prognosis.

OBJECTIVETo summarize the treatment status of gastric gastrointestinal stromal tumor (GIST) in Shandong province,by analyzing the clinicopathological features and prognostic factors.

METHODSClinicopathological and follow-up data of 1 165 patients with gastric GIST between January 2000 and December 2013 from 23 tertiary referral hospitals in Shandong Province were collected to establish a database. The risk stratification of all cases was performed according to the National Institutes of Health(NIH) criteria proposed in 2008. Kaplan-Meier method was used to calculate the survival rate. Log-rank test and Cox regression model were used for univariate and multivariate prognostic analyses.

RESULTSAmong 1 165 cases of gastric GIST, 557 were male and 608 were female. The median age of onset was 60 (range 15-89) years. Primary tumors were located in the gastric fundus and cardia in 623 cases(53.5%), gastric body in 346 cases(29.7%), gastric antrum in 196 cases(16.8%). All the cases underwent resection of tumors, including endoscopic resection (n=106), local resection (n=589), subtotal gastrectomy(n=399), and total gastrectomy(n=72). Based on the NIH risk stratification, there were 256 cases (22.0%) at very low risk, 435 (37.3%) at low risk, 251 cases (21.5%) at intermediate risk, and 223 cases (19.1%) at high risk. A total of 1 116 cases(95.8%) were followed up and the median follow-up period was 40 (range, 1-60) months. During the period, 337 patients relapsed and the median time to recurrence was 34 (range 1-60) months. The 1-, 3-, and 5-year survival rates were 98.6%, 86.1% and 73.4%, respectively. The 5-year survival rates of patients at very low, low, intermediate, and high risk were 93.1%, 85.8%, 63.0% and 42.3% respectively, with a statistically significant difference (P=0.000). Multivariate analysis showed that primary tumor site (RR=0.580, 95%CI:0.402-0.835), tumor size (RR=0.450, 95%CI:0.266-0.760), intraoperative tumor rupture(RR=0.557, 95%CI:0.336-0.924), risk classification (RR=0.309, 95%CI:0.164-0.580) and the use of imatinib after surgery (RR=1.993, 95%CI:1.350-2.922) were independent prognostic factors.

CONCLUSIONSThe choice of surgical procedure for gastric GIST patients should be based on tumor size. All the routine procedures including endoscopic resection, local excision, subtotal gastrectomy and total gastrectomy can obtain satisfactory curative outcomes. NIH classification has a high value for the prediction of prognosis. Primary tumor site, tumor size, intraoperative tumor rupture, risk stratification and postoperative use of imatinib are independent prognostic factors in gastric GIST patients.