Objective To improve the recognition of intrahepatic biliary cystadenoma.Methods The clinical manifestations,radiologic features,diagnosis and surgical treatment of 18 patients with intrahepatic biliary cystadenomaadmitted in our hospital during the recent 8 years were retrospectively analyzed.Results Four cases were discovered by general medical examination,while the other 14 patients had varying symptoms that included right upper abdominal discomfort or pain in 11 cases,abdominal mass in 3 cases,and jaundice accompaniedby fever in 2 cases.B ultrasound and CT scan showed intrahepatic cystic occupying lesions consistingof multilocular or single cyst,and usually with papillary structures in the cyst wall.All of 18 cases received surgical resection.The patholgic dingnosis was intrahepatic biliary cystadenoma in all the 18 cases,and 6 of them showed malignant change.The average survival time of maligmant patients was 35(27-58)months.Conclusions Preoperative diagnosis of intrahepatic biliary cystadenoma is difficult.Intrahepatic biliarycystadenoma is easy to develop into cystadenocarcinoma.Early surgical resection is necessary,and can effectively prevent recurrence or malignant transformation.

ObjectiveTo evaluate nipple-areola complex sparing modified radical mastectomy for breast cancer.MethodsClinical data of 159 breast cancer cases undergoing NAC sparing modified radical mastectomy from Jan 1998 to Dec 2009 were retrospectively analyzed.ResultsNAC sparing modified radical mastectomy was successfully carried out in 141 out of the 159 cases ( 88.68％ ).In 14 cases (8. 81％ ) the original operative protocol was changed to modified radical mastectomy or radical mastectomy during the operations because NAC ischemia in 4 (2. 52％ )cases, NAC occult involvement or dysplasia in 5 cases (3. 14％ ), Ⅲ level lymph node metastasis was found in 3 cases (1.89％). Postoperative complete nipple necrosis occurred in 4 (2. 52％ ) cases. Other significant postoperative complications included nipple necrosis in 20 cases ( 12. 58％ ), skin flap necrosis and infection in 11 cases ( 6.92％ ), subcutaneous hydrops in 10 cases (6. 29％ ). All patients got follow-up ranging from 15 to 96 months,median follow-up was 51 months. Local region recurrences were observed in 5 cases (3. 14％ ), distant metastasis in 2 cases ( 1.26％ ). There was no recurrence in the region of NAC.ConclusionsNipple-areola complex sparing modified radical mastectomy is oncologically safe by strict preoperative selection criteria and strict operative procedure.

Objective To investigate the effect of acute physiology and chronic health evaluationⅡ ( APACHEⅡ) scoring system on evaluating the severity and prognosis in severe acute pancreatitis(SAP). Methods The APACHEⅡ scores were analyzed in 52 patients with SAP. Results The mean APACHEⅡ score of SAP was 16.60?9.07(8～40), and there were significant differences between the scores not only in Grade SAPⅠand Grade SAPⅡ(?

OBJECTIVETo analyze the risk factors of liver metastasis in patients after radical resection of pancreatic cancer.

METHODSOne hundred and twenty-four patients with non-metastatic, resectable pancreatic cancer treated in our department between 2006 and 2012 were included in this study. All of these patients underwent resection of the primary tumor combined with extensive lymph node dissection. The development of postoperative liver metastases was carefully followed up, and the clinicopathological factors and molecular characteristics were evaluated by univariate analysis and multivariate logistic regression using SPSS 16.0 software.

RESULTSForty-eight cases of liver metastases were found among the 124 cases of pancreatic cancer after radical surgery (38.7%). The rate of liver metastasis of pancreatic cancer after radical surgery in the age groups < 40, 40-60, and > 60 were 68.8%, 33.3% and 35.1%, respectively. The rate of liver metastasis in the body mass index (BMI) group < 20 kg/m2, 20-25 kg/m2, and > 25 kg/m2 were 21.6%, 44.1% and 52.6%, and the rate of liver metastasis in the time between the onset and diagnosis groups ≥ 3 months and < 3 months were 59.4% and 31.5%, respectively. The rate of liver metastasis in patients with preoperative fatty liver was 14.3% and it was 43.7% in patients without preoperative fatty liver. The rate of liver metastasis in patients of histological high, medium and low grade was 10.0%, 35.4% and 49.0%, respectively. The rate of liver metastasis in patients with venous tumor thrombus was 68.8% and it was 34.3% in patients without venous tumor embolus. The rate of liver metastasis in patients with postoperative chemotherapy was 31.2% and it was 51.1% in patients without postoperative chemotherapy. All those differences had statistical significance (P < 0.05). Univariate analysis revealed that age, body mass index (BMI), time between the onset and diagnosis, preoperative fatty liver, histological grading, tumor invasion depth, venous tumor embolus, and postoperative chemotherapy were significantly related to postoperative liver metastasis. Multivariate analysis revealed five statistically independent risk factors for postoperative liver metastasis: BMI, time between onset and diagnosis, preoperative fatty liver, histological grading, and venous tumor embolus.

CONCLUSIONSOur data suggest that patient's BMI, time between onset and diagnosis, histological grade, and venous tumor embolus are significantly correlated with postoperative liver metastases in patients with pancreatic cancer. Pancreatic cancer patients with preoperative fatty liver have less postoperative liver metastasis.

Adult ; Aged ; Body Mass Index ; Humans ; Liver Neoplasms ; secondary ; Lymph Node Excision ; Middle Aged ; Pancreatic Neoplasms ; pathology ; surgery ; Regression Analysis ; Risk Factors

Objective To analyse tratment strategies and to evaluate the relation between different therapies and survival rate of patients of with asynchronous liver metastases after pancreatic cancer surgery (PCLM).Methods From January 2006 to January 2012,48 patients with PCLM were included in this study,and their medical records were retrospectively analyzed.Results Among the 48 patients,27 cases of liver metastases were found within six months after surgery,and the survival rate for 1,3 and 5 years was 22.2％,3.7％ and 0％,respectively,with the median survival of 6 months,and 21 cases of liver metastases were found after six months,and the survival rate for 1,3 and 5 years was 85.7％,30.6％ and 9.2％,with the median survival of 15 months,and the difference between the two groups was statistically significant (P ＜ 0.01).After pancreatic cancer surgery and adjuvant gemcitabine chemotherapy,the probability of liver metastases was 33.3％ (8/24) within six months,the median disease-free survival time was 8 months and the disease-free survival rate for 1,3 and 5 years was 20.8％,4.3％ and 0％.For patients without adjuvant gemcitabine chemotherapy,the probability of liver metastases was 79.2％ (19/24),the median disease-free survival time was 3 months and the disease-free survival rate for 1,3 and 5 years was 4.2％,0％ and 0％,and the difference between the two groups was statistically significant (P ＜ 0.01).The overall survival for patients undergoing resection of liver metastases combined with gemcitabine treatment was better than the other groups (P ＜ 0.01).And the overall survival for patients undergoing transhepatic arterial embolization (TACE) combined with gemcitabine treatment was better than TACE group,gemcitabine group or the observation group (P ＜0.05).There were no difference in overall survival between TACE group,gemcitabine group and observation group.Conclusions Pancreatic cancer patients who develop liver metastasis within six months after surgery have poor prognosis,but postoperative chemotherapy can delay the development of liver metastasis.For patients with resectable lesion,resection of asynchronous liver metastasis is the treatment of choice,and TACE combined with gemcitabine has better efficacy than that of single treatment.

ObjectiveTo summarizeand the law of lymph node metastases from adenocareinoma of esophagogastric junction ( AEG),analyses the extent of lymphadenectomy for AEG.Methods198 cases of AEG had been retrospectively analyzed from 2006.6.6 to 2010.12.31,and kept detailed record of the operation type、Siewert's type、TNM stage and group of metastatic lymph nodes.ResultsThe thoraco-abdominal two field lymph node dissection had been performed for 198 AEG,the total number of lymph nodes had been dissected was 3069,the average number was 15.50,the number of metastases lymph nodes was 859.In the 198 AEG,132 cases with lymph node positive,The metastatic rate and incidence was 66.67％ and 27.99％,respectively.The manner of the metastasis about 130 cases was station by station and 2 cases was skipping over station,accout for 98.48％ and 1.52％ of all nodes-positive cases,1 case skiped to left gastric and celiac axis and another case skiped to tracheal bifurcation.The location of positive lymph nodes about Siewert Ⅰ and Ⅱ were recorded:tracheal bifurcation(6.25％,3.33％ ) 、lower posterior mediastinum and paraoesophageai(25.00％,14.67％ ),right paracardiac (47.92％,52.00％ ),left paracardiac (31.25％,36.67％ ) 、lesser curvatura(43.75％,43.33％ ),greater curvatura( 27.08％,22.00％ ) 、left gastric and celiac axis( 27.08％,30.00％ ).The lymph nodes metastastic rate of stage T1 + T2 and T3 + T4 were 40.43％,74.83％,respectively,the difference were significantly.The lymph nodes metastastic rate of different tumor length were analyzed,≤ 3cm group were 40.74％,3 ～5cm group were 70.71％ and ≥5cm group were 88.89％,the difference were significantly;but there were no significant difference related to different differentiation grades and different Siewert types.The mediastinal lymph node metastase rates between Siewert Ⅰ (27.08％) and Siewert Ⅱ (14.67％) were significant difference,but the difference were not found in pericardiac lymph nodes.ConclusionSiewert Ⅰ 、Ⅱ AEG trend to metastasized to middle and low mediastinal and pericardiac,the modified left thansthoracic route and two field lymph node dissection maybe suitable to the lymphadenectomy for AEG.

Objective To explore the rule of central region lymph nodes metastasis in differentiated thyroid carcinoma (DTC) and the significance of central region lymph nodes neck dissection in surgical operation for DTC.Methods The clinical and pathological data of 122 lymph nodes in 109 patients (31 female and 78 male) with DTC undergoing neck lymph nodes ( central region lymph nodes included) dissection from Jan.2003 to Jun.2007 in our hospital were analyzed retrospectively.According to preoperative physical examination and imaging analysis,patients were divided into clinical cervical lymph nodes metastasis ( cN + ) group and clinical no cervical lymph nodes metastasis (cNO) group and compared respectively with their pathological data after surgery.Resuits Of the 122 lymph nodes,lymph node metastasis rate was significantly higher in region Ⅵ than in region Ⅱ,Ⅲ and Ⅳ.The difference had statistical significance (P ＜0.01 ).65.6％ (80/122) metastasis was in the central region.81.2％ (56/69) patients in cN + group and 45.3％ (24/53) patients in cN0 group had central region lymph nodes metastasis.Conclusions Central region lymph nodes metastasis is common for patients with DTC.Routine neck dissection in central region should be done in DTC operation.

Objective To investigate the exposure and protection of recurrent laryngeal nerve (RLN) in the reoperation for thyroid diseases.Methods Clinical data of 214 cases undergoing thyroid reoperation were retrospectively analyzed.The patients with a short interval between the 2 thyroid operations or with external-infiltrated thyroid cancer were approached at the lateral strap muscles and the leading edge of the sternocleidomastoid.RLNs were exposed in the lateral region of superior mediastinum tracheoesophageal groove or at the point where RLN enters to throat.RLNs of patients with lymph node metastasis were exposed beside the enlarged lymph nodes.The patients with a long interval between the 2 thyroid operations and with benign tumor or tumor without external infiltration were exposed their thyroids at the anterior midline and then RLNs were exposed at the posterior lateral of the middle thyroid veins or at the inferior thyroid artery.Results Among the 214 cases,344 RLNs were anatomically exposed including 188 right and 156 left.84 cases had single exposure and 130 cases had bilateral exposure.44 RLNs were exposed at the point where RLN enters to throat,104 RLNs at the posterior lateral of the middle thyroid veins,40 RLNs at the inferior thyroid artery,124 RLNs at the lateral region of superior mediastinum tracheoesophageal groove,and 32 RLNs beside the enlarged lymph nodes.For the 2 cases suffering hoarse voice the day after they underwent thyroid operation in other hospital,suture ligation at the the entrance point was found when they received the reoperation in our hospital.Three of the total 344 RLNs (0.87％ ) had RLN branch injury in the entire group.Conclusion It is possible to reduce RLN injury during the reoperation for thyroid disease if surgeons are familiar with the dissection of RLN under normal or pathological condition,avoid adhesive or scar tissues,and select the appropriate anatomic approach.

Objective To investigate the level and clinical significance of nerve growth factor ( NGF) , transforming growth factor ( TGF )-β1 , estradiol ( E2 ) and testosterone ( T ) in serum and ex-pressed prostatic secretion (EPS) of patients with category Ⅲprostatitis. Methods From August 2011 to January 2012, 64 patients with (chronic prostatitis/chronic pelvic pain syndrome , CP/CPPS) and 20 health people were enrolled in this study.In CP/CPPS group, the age of patients ranged from 18 to 56 years, mean (36.6±9.3) years.The history of CP/CPPS ranged from 3 months to 6 years, mean 2 years.All patients were asked to complete NIH-CPSI questionnaires with CP/CPPS, including group ⅢA 35 cases and groupⅢB 29 cases.The age of healthy controls ranged from 25 to 41 years.The average healthy control age was (33.1±3.9) years.EPS and serum samples from CP/CPPS and control group were collected and frozen . NGF, TGF-β1 , E2 and T level in EPS and serum were measured by ELISA and radioimmunoassay and com -pared in each group. Results The mean E2, E2/T, TGF-β1 level in serum of patients with CP/CPPS were (175.7±82.4) pmol/L, (7.9±6.7), (2 216.2±581.6) ng/L, which were higher than that in healthy controls, (131.7±49.4) pmol/L, (4.6±2.4), (1 599.8±469.5) ng/L.The mean T level in CP/CPPS pa-tients′serum was (24.7±8.9) nmol/L, which was lower than that in controls (29.2±7.0) nmol/L.The E2/T (34.5±29.8), TGF-β1(6 859.3±5 229.4 ng/L), NGF (467.0±164.3 ng/L) levels in EPS of CP/CPPS patients were higher than that in controls (16.5±13.8), (1 774.1±1 304.3) ng/L, (310.8±106.6) ng/L. The TGF-β1 level in EPS of CP/CPPS patients showed the positive correlation ship with urination symptom score (6.1±2.4) (r=0.641, P<0.05).The NGF level in EPS of CP/CPPS patients also showed the positive correlation ship with pain score (7.6±2.6) (r=0.497, P<0.05).E2/T,TGF-β1 levels in serum and E2/T, TGF-β1,NGF levels in EPS of group ⅢA were (7.1±4.6), (2131.5±412.0)ng/L and (31.5±22.3), (7 667.1±5 652.4)ng/L, (440.6±134.3)ng/L, which were significantly higher than those in healthy con-trol (P<0.05).E2/T, TGF-β1 levels in serum and E2/T, TGF-β1, NGF levels in EPS of group ⅢB were (8.9±8.5), (2 340.5±728.2) ng/L and (38.2±37.1), (5 884.4±4 574.3) ng/L, (498.9±192.1) ng/L, which were also higher than those in healthy control ( P<0.05) . Conclusions Hormonal imbalance in es-tradiol and testosterone with TGF-β1 , NGF higher levels in EPS is closely related with pathogenesis and clin-ical symptom of category III chronic nonbacterial prostatitis .

Objective To explore the correlation between the levels of estradiol E2 and testosterone T in serum and expressed prostatic secretion(EPS) with the erectile function in the patients with type Ⅲ prostatitis(CP/CPPS) .Methods The E2 and T lev‐els in serum and EPS from 64 cases of CP/CPPS ,including 35 cases of type Ⅲ A and 29 cases of Ⅲ B ,and 20 individuals of physical examination were detected by using the radioimmunoassay .All cases were evaluated by the scores of NIH‐CPSI and the Internation‐al Index of Erectile Function 5(IIEF‐5) .64 patients were grouped according to the IIEF‐5 scores ,the erectile dysfunction(ED) group(32 cases) and the non‐ED group(32 cases) .Results The mean E2/T levels in serum and EPS of the Ⅲ A group and the Ⅲ B group were higher than those in the control group ,the difference had statistical significance(P<0 .05) .20 cases(57 .14% ) of ED were found in the Ⅲ A group ,which were more than 12 cases(41 .38% ) of ED in the Ⅲ B group ,but there was no statistically signifi‐cant difference (>0 .05 .There was a positive correlation between the IIEF‐5 score and the T level in serum and EPS in the CP/CPPS group(r=0 .218 ,r=0 .231 ,P<0 .05) .There was a negative correlation between the IIEF‐5 score and the E2/T level in ser‐um and EPS(r= -0 .189 ,r= -0 .652 ,P<0 .05) ,which had no correlation with the NIH‐CPSI score(P>0 .05) .The serum T level in the ED group was (6 .32 ± 1 .86)ng/mL ,which was lower than(7 .89 ± 2 .92)ng/mL in the non‐ED group and (8 .41 ± 2 .02)ng/mL in the control group ;the .E2/T level in EPS in the ED group was (55 .02 ± 29 .26) ,which was higher than (14 .06 ± 9 .36) in the non‐ED group and (16 .45 ± 13 .76) in the control group ,the differences among them were statistically significant (P<0 .05) .Con‐clusion The imbalance degree of hormone estradiol and testosterone in serum and EPS is related with erectile function in the pa‐tients with CP/CPPS .