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Gastrointestinal stromal tumors of the duodenum: a clinical analysis of 39 cases

Yuji LI ; Jianping ZHOU ; Xin LI ; Fanmin KONG ; Yulin TIAN ; Ming DONG

Chinese Journal of General Surgery.2013;28(9):654-657. doi:10.3760/cma.j.issn.1007-631X.2013.09.002

Objective To investigate the clinical characteristics and surgical treatment of gastrointestinal stromal tumors (GIST) of the duodenum.Methods The clinical data of 39 patients with duodenal GISTs from 1992 to 2010 were analysed retrospectively.Results The most common symptoms of duodenal GISTs were alimentary tract hemorrhage,occuring in 18 cases of the 39 cases (46％).Clinical diagnosis established by CT in 22 cases (69％).Duodenoscopy performed in 18 cases established the definite diagnosis of GIST in 15 (83％).Duodenal GISTs were most commonly located in the descending portion of the duodenum in 27/39 cases (69％).All 39 cases received surgical treatment,with R0 resection in 34 cases,including partial resection of the duodenum in 47％ (16/34),pancreaticodenectomy in 35％(12/34),segmental resection of the duodenum in 3 cases,subtotal gastrectomy in 3 cases; One died perioperatively and postoperative complications developed in 9 cases,which were cured by conservative therapy.The 1,3,5 year survival rate was 90％,72％,41％ for those receiving R0 resection.Conclusions The abdominal CT scan with contrast and duodenoscopy are helpful to establish the diagnosis of duodenal GISTs.Surgical procedures depend on the size and site of the lesion for R0 resection.To decrease postoperative recurrence and prolong survival adjuvant therapy with Imatinib is necessary.

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The emergency treatment of iliac artery rupture in the process of iliac artery angioplasty

Zhiwei WANG ; Jiaxiang WANG ; Sheng GUAN ; Xiuxian MA ; Zhen LI

Chinese Journal of General Surgery.2013;28(9):658-660. doi:10.3760/cma.j.issn.1007-631X.2013.09.003

Objective To evaluate covered stent placement in the treatment of iliac artery rupture in the process of iliac artery angioplasty.Methods Clinical data of 9 patients' iliac artery rupture in the process of iliac artery angioplasty were retrospectively reviewed.Results Covered stent was successfully placed in all cases.The patency of involved iliac artery was identified in 8 cases by angiography and there was no contrast extravasation.Type Ⅰ endoleak occurred in one patient in the proximal end of the stent graft and iliac artery graft replacement was done by open surgery immediately.Postoperatively clinical symptoms were relieved in all these 9 patients.One case lost to follow up.8 patients were followed up for 14 to 45 months,average (22 ±9) months.Stenosis on the distal end of the covered stent (external iliac artery)was found in one patient who underwent external iliac artery balloon-expandable stent angioplasty.One patient with artificial vessel placement was symptoms free with patency of the involved artery as reviewed by ultrasonography on 18 month followed up.Conclusions When iliac artery rupture in the process of iliac artery angioplasty should develop,the first choice is immediately covered stent placement therapy,while open surgery remains as the last resort.

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Debridement hepatectomy with selective hepatopetal blood occlusion in the treatment of severe hepatic trauma

Kunlun LUO ; Zheng FANG ; Feng YU ; Hong LIU ; Zhiqiang TIAN

Chinese Journal of General Surgery.2013;28(9):661-664. doi:10.3760/cma.j.issn.1007-631X.2013.09.004

Objective To evaluate the effect of debridement hepatectomy with selective hepatopetal blood occlusion in the treatment of severe hepatic trauma.Methods The clinical data of 55 patients with severe hepatic trauma treated by debridement hepatectomy with selective hepatopetal blood occlusion were retrospectively analyzed.20,20 and 15 patients were with grade Ⅲ,Ⅳ and Ⅴ hepatic trauma respectively,combined with major peripheral hepatic vascular injury in 14 cases and with other trauma in 35 cases.Additional procedures including liver suture repair in 7 cases,perihepatic gauze packing in 3 cases,inferior vena cava repair in 5 cases,hepatic vein repair in 4 cases,hepatic vein ligation in 3 cases and hepatic artery ligation in 2 cases were performed.Other operations such as craniotomy debridement in 3 cases,cholecystectomy in 6 cases,T tube drainage of common bile duct in 4 cases,splenectomy in 5 cases,pancreatic tail resection in 2 cases,left kidney resection in 1 case,thoracic cavity closed drainage in 9 cases,partial small bowel resection or repair in 4 cases and stomach repair in 1 case were performed as needed.Results The operations were successful in 47 patients.Postoperative complications were observed in 19 cases (34.5％) including coagulation disorders in 1 case,postoperative abdominal bleeding in 2 cases,intestinal obstruction in 1 case,liver and renal dysfunction in 4 cases,abdominal infection in 3 cases,incision infection in 2 cases,pulmonary infection in 4 cases,pleural effuion in 10 cases.Death occurred in 8 patients (14.5％),the cause of death were hemorrhagic shock in 3 cases,combined with severe craniocerebral injury in 2 cases,septic shock in one case,and multiple organ failure in 2 cases.Conclusions Debridement hepatectomy with slective hepatopetal blood occlusion is an effective treatment for severe hepatic trauma.

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Prognosis of radical resection of liver metastases from colorectal cancer

Qingguo LI ; Guangfa ZHAO ; Daorong WANG ; Ping CHEN ; Jinggui CHEN ; Jie CHEN

Chinese Journal of General Surgery.2013;28(9):665-668. doi:10.3760/cma.j.issn.1007-631X.2013.09.005

Objective To analyze the clinicopathological factors impacting on the prognosis of colorectal cancer liver metastases and to investigate how to improve patients' survival.Methods The clinical data of 103 patients who received radical resection for liver metastases from colorectal cancer from January 2005 to December 2011 were enrolled.The survival curve was drawn by Kaplan-Meier method,and the survival rates were analyzed by Log-rank test.Factors influencing survival were analyzed by Cox regression model.Results All patients were followed up from 10 to 60 months,The 1-,3-,5-year's survival rates were 90％,49％,39％,respectively.Univariate analysis revealed that number and size of liver metastases,distribution of liver metastases,serum CEA concentration,complications,postoperative chemotherapy were related to prognosis (x2 =24.732,9.461,9.568,25.948,25.370,5.701,P ＜ 0.05).Multivariate analysis identified number of liver metastases,serum CEA concentration,complications were as significant predictors of survival (Wald =7.974,12.051,11.547,P ＜ 0.05).Conclusions Number of liver metastases,serum CEA concentration,complication are important prognostic factors for liver metastases from colorectal cancer.Appropriate expansion of surgical indication,early diagnosis with intensive follow-up is crucial to increase the survival rate after hepatectomy for liver metastasis of coloractal carcinoma.

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A compared study on Gd+-EOB-DTPA and Gd+-DTPA-enhanced MRI in detection of hepatocellular carcinoma

Ying DING ; Caizhong CHEN ; Shengxiang RAO ; Mengsu ZENG

Chinese Journal of General Surgery.2013;28(9):682-685. doi:10.3760/cma.j.issn.1007-631X.2013.09.010

Objective To evaluate the difference of image quality and lesion detection between Gd+-EOB-DTPA with Gd+-DTPA-enhanced MRI in cases of hepatocellular carcinoma (HCC).Methods A total of 21 HCC patients underwent both Gd+-EOB-DTPA and Gd+-DTPA-enhanced MRI examination,comparing the difference between the two agents using the value of lesion display quality index,sensitivity,specificity,positive and negative predictive value,diagnosis accuracy and CNR.Results There were 25 lesions on the 21 HCC patients with 9 lesions ＜ 1.0 cm.24 lesions showed hypointensity and 1 lesion showed isointensity on hepatobiliary phase with Gd+-EOB-DTPA-enhanced MRI.15 lesions showed hypointensity,5 lesions showed isointensity and 5 lesions showed hyperintensity on portal venous phase with Gd+-DTPA-enhanced MRI.The value of lesion (in particular for the lesion ＜ 1.0 cm)display quality index,sensitivity,specificity,positive and negative predictive value,diagnosis accuracy on Gd+-EOB-DTPA-enhanced MRI and Gd+-DTPA-enhanced MRI were 17scors,89％,89％,89％,89％ and 12 scors,33％,33％,33％,67％ respectively.CNR on hepatobiliary phase with Gd+-EOB-DTPA-enhanced MRI was 639.35.CNR on arterial phase and portal venous phase with Gd+-DTPA-enhanced MRI were 225.25 and 93.25 respectively.The data showed that Gd+-EOB-DTPA-enhanced MRI was better than that of Gd+-DTPA-enhanced MRI.Conclusions Gd+-EOB-DTPA-enhanced MRI displays lesions (especially for lesions ＜ 1.0 cm) better compared with Gd+-DTPA-enhanced MRI increasing the diagnostic accuracy of small HCC.

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Clinicopathological characteristics and prognosis of patients of serum alpha-fetoprotein-producing gastric cancer

Peng ZHOU ; Hui QU ; Guorui SUN ; Qingsi HE ; Yang XU ; Jingwei PENG

Chinese Journal of General Surgery.2013;28(10):740-743. doi:10.3760/cma.j.issn.1007-631X.2013.10.005

Objective To investigate the clinicopathological characteristics and prognosis of serumb alpha-fetoprotein(AFP)-producing gastric cancer.Methods A total of 1396 cases of gastric cancer in our hospital from 2002 to 2007 were retrospectively reviewed.The relationship between serum AFP with clinicopathological factors,survival rate,prognosis and liver metastasis were analyzed.Results There were 90 AFP-producing gastric cancer patients accounting for 6.45％ of all the gastric cancer cases during the time period.In those patients there was bigger tumor size,more T3 and T4 invasion (82.2％ vs.69.2％),higher incidence of lymph node metastasis (80.0％ vs.60.2％)and liver metastasis(6.67％ vs.1.68％),and later clinical stage than that in the AFP-negative group.The 1,3,5 year-overall survival (OS) rate in AFP-positive group were 52.2％,31.1％,20％ while those in AFP-negative group were 82.5％,59.9％,48.8％.The 1,3,5 year-disease free survival(DFS) rate in AFP-positive group were 47.8％,24.4％,15.6％ while those in AFP-negative group were 77.5％,54.8％,44.3％.The AFP-positive group had a shorter median time period than the AFP-negative group when liver metastasis happened (5 months vs.11 months).Conclusions Serum AFP-producing gastric cancer was higher malignancy,it was deeper in invasion and later in clinical stage,more patients with lymph nodes and liver metastasis,low survival rate and poorer prognosis.

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Preoperative diabetes mellitus and postoperative morbidity of pancreatoduodenectomy for pancreatic adenocarcinoma

Siming ZHENG ; Caide LU ; Xinhua ZHOU ; Hong LI ; Feng QIU ; Hua YE ; Jianlei ZHANG

Chinese Journal of General Surgery.2013;28(9):649-653. doi:10.3760/cma.j.issn.1007-631X.2013.09.001

Objective To investigate the influence of preoperative diabetes mellitus (DM) on postoperative morbidity of pancreatoduodenectomy for pancreatic ductal adenocarcinoma.Methods The clinical data of 302 pancreatic ductal adenocarcinoma patients who underwent pancreatoduodenectomy from January 1,2005 to August 31,2012 were retrospectively analyzed.Results 113 patients (37.4％)had preoperative DM among the total 302 patients.The percentage of the major complication including pancreatic fistulas,delayed gastric emptying,infections,acute kidney injury and mortality accounted for 19.9％,12.9％,25.9％,36.0％,3.2％ and 3.5％ respectively.In the DM group,firm pancreatic texture was more common than that in non-DM group (x2 =15.175,P ＜ 0.01).While pancreatic fistula in the DM group developed less frequently(x2 =7.811,P =0.005) than that in non-DM group.Delayed gastric emptying,infections,acute kidney injury,hemorrhage,pulmonary,cardiovascular and neurologic complications,as well as length of stay in hospital and mortality were in similar frequency in the two groups (P ＞ 0.05).Binary Logistic regression analysis showed DM(OR =0.358,P =0.035) and firm pancreatic texture(OR =0.395,P =0.032) were protective factors against pancreatic fistula while preoperative jaundice(OR =3.819,P =0.010) and intraoperative blood transfusion (OR =1.268,P =0.001) were predisposing factors for pancreatic fistula.Conclusions With good control of perioperative glucose level,DM does not increase operation risk in pancreatoduodenectomy for pancreatic ductal adenocarcinoma.

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Diagnosis and treatment of mucin-producing intrahepatic biliary tumors

Maolin YAN ; Yaodong WANG ; Shaoming WEI ; Yifeng TIAN ; Zhide LAI ; Funan QIU ; Songqiang ZHOU

Chinese Journal of General Surgery.2013;28(9):669-671. doi:10.3760/cma.j.issn.1007-631X.2013.09.006

Objective To investigate the diagnosis and treatment of mucin-producing intrahepatic biliary tumor (MPIBT).Methods We retrospectively analyzed the clinical,radiologic,surgical and pathologic findings of 16 MPIBT cases from January 2004 to December 2011.Results There were six men and ten women,age ranged from 44 to 69 years (mean 60 years).Clinical presentation included jaundice with abdominal dull pain in 5 patients,acute cholangitis in 4 patients,painless jaundice in 2 patients,upper abdominal dull pain in 3 patients,no obvious symptoms in 1 patient,body weight loss more than 5 kg within 3 months in 5 patients.The most characteristic appearance of MPIBT on magnetic resonance cholangiopancreatography were asymmetry of intrahepatic bile duct dilatation and the dilatation in both extraand intrahepatic bile duct distal to the hepatic mass and not sudden interruption in extrahepatic bile duct.The primary tumor located in the left hepatic bile duct in 15 cases,in the right hepatic bile duct in one.13 MPIBT cases received hemihepatectomy and extrahepatic bile duct resection and Roux-en-Y anastomosis was done in 8 cases,3 received palliative biliary drainage.Pathologically 13 was papillary adenocarcinoma and 3 was papillary adenoma.The 1-,2-,3-year survival rates for the 16 MPIBT patients were 81％,66％,56％,respectively.Conclusions MPIBT had no specific clinical manifestations,MRCP might be an effective means for the diagnositic strategy and assessment of tumor extension before surgery,radical resection was the first choice of treatment,palliative biliary drainage could prolong the survival time.

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Clinical anatomy for external branch of the superior laryngeal nerve during thyroid surgery by intraoperative neuromonitoring

Hanqing ZOU ; Chungen XING ; Xun ZHU ; Tao JIN ; Hong XIE ; Jianfang CAO ; Suwei TAO

Chinese Journal of General Surgery.2013;28(9):676-678. doi:10.3760/cma.j.issn.1007-631X.2013.09.008

Objective To evaluate the mechanism of external branch of the superior laryngeal nerve (EBSLN) injury during thyroid surgery as showed by intraoperative neuromonitoring.Methods 70 patients with 109 nerves at risk were enrolled in this study from March 2011 to October 2011.A positive signal is determined by observing contractions of the cricothyroid muscle.The relationship between EBSLN and the upper pole of the thyroid or the inferior constrictor muscle was studied.Results 108 nerves (99.1％) were located successfully,42 of which were visualized (38.9％).55 nerves (50.9％) crossed the superior thyroid artery more than 1 cm apart,while the other 53 nerves (49.1％) went less than 1 cm including 24 nerves(more than 0.5 cm,less than 1 cm) and 29 nerves (less than 0.5 cm) or coursed below the superior pole of the thyroid.The rate of the latter type was significantly elevated in patients with the top to botton diameter of the gland more than 5 cm.One patient suffered from impairing in the production of high tones postoperatively.Conclusions Intraoperative neuromonitoring is useful and helpful in providing instructive information for operations by locating EBSLN.

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Budd-Chiari syndrome in youth: clinical features and interventional therapy

Lei WANG ; Maoheng ZU ; Fei TENG ; Qianjin HUA ; Xiaoyu WANG

Chinese Journal of General Surgery.2013;28(9):686-689. doi:10.3760/cma.j.issn.1007-631X.2013.09.011

Objective To present the clinical features and to evaluate interventional therapy for Budd-Chiari syndrome in Chinese youth.Methods From January 1990 to April 2012,227 cases who hospitalized at the age ＜ 29 underwent color Doppler ultrasound scan and digital subtraction angiography (DSA).87 cases were with occlusive inferior vena cava (IVC type),105 cases with occlusive hepatic veins (HV type) and 35 cases with occlusive inferior vena cava and hepatic veins (MIX type).The occlusive veins were opened by percutaneous transluminal angioplasty (PTA),endovascular stent placement,intravenous catheter thrombolysis or combination.Postoperative anticoagulation was given to all patients.Results The symptoms and signs of portal hypertension disappeared or were alleviated in successful cases.Technical success was achieved in 210 patients.The success rate was 100％ in IVC type,85.7％ in HV type and 94.3％ in MIX type.IVC pressure decreased from (26.52 ± 8.16) cm H2O to (14.28 ±4.08) cmH2O(P ＜ 0.05) and HV pressure dropped from(35.70 ± 13.26) cm H2O to(18.36 ±8.16) cm H2O (P ＜0.05).Restenosis or occlusion was found in 21.4％ (45/210) patients after a follow-up of 1 month to 15 years.The rate was 13.8％ (12/87) in IVC type,31.1％ (28/90) in HV type and 15.2％ (5/33) in MIX type.These patients were managed by interventional procedures.Technical successwas achieved in 44 cases with restenosis.Conclusions Hepatic vein occlusion was the most common type of BCS in Chinese youth.The symptoms and signs of portal hypertension were the initial clinical manifestations.Postoperative recurrence rate in HV type was higher than that in the other two types.

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