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Percutaneous intratumoral injection of lipiodol and chemotherapeutic agents emulsion for primary liver cancer

Yong CHEN ; Jianbo ZHAO ; Qingle ZENG ; Xiaofeng HE ; Wei LU ; Qiaohua ZHU ; Kewei ZHANG ; Dexiao HUANG ; Fan HE ; Junjie MAO ; Yanhao LI

Chinese Journal of General Surgery.2009;24(12):992-995. doi:10.3760/cma.j.issn.1007-631X.2009.12.012

Objective To evaluate percutaneous intratumoral injection of chemotherapeutic agents lipiodol emulsion (CALE) for the treatment of primary liver cancer. Methods This study included 57 patients of hepatocellular carcinoma (n=49) and intrahepatic cholangiocarcinoma (n=8).53 were male and 4 were female,with a mean age of 48.02 years(range,19～70 years).In all,ninety CALE injections were assigned to 90 target areas within the lesions.Before the procedures,transcathetcr arterial chemoembolization (n=55) or infusion (n=2) was carried out in these patients.By arteriography,low blood supply of target areas was showed or it was concluded that superselective catheterization of supply arteries of lesions could not accomplished.Percutaneous intratumoral CALE injection was carried out under fluoroscopy or CT guidance.Therapeutic effect,side effect and complications were assessed based on clinical manifestation,laboratory examination and fluoroscopy or CT one week after procedure.Follow-up was carried out after 1,3,6 months and 1 year,and once every six months thereafter.Local recurrences were treated according to patients'will.Results 90 sessions of percutaneous injection were successfully performed on 57 patients,with 100% technique success rate.The volume of CALE iniected per session ranged 3.0-7.0 ml(mean,6.0 ml) in target size less than 3 cm,12.0-20 ml(mean,15 ml)in target size of 3-5 cm and 24-40 ml in target larger than 5 cm.Serum AFP was positive in 43 patients and decreased to normal in 14 patients(28%).54 lesions(60%)were with well distribution of the lipiodol-chemotherapy mixture on CT 1 month after procedure.Follow-up ranged from 2 months to six years(mean,16 months).The median survival time was 400 d.The cumulative survival rates at 200 d,600d was 85%and 30%,respectively.Complications included fever (n=22,24.4%),nausea and vomit(n=11,12.2%),and pain at the puncture site (n=17,18.9%).Conclusions Percutaneous intratumor CALE injection is safe and effective for the treatment of primary liver cancer.

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Surgical treatment for huge hepatoblastoma in children

Jun JIA ; Liuming HUANG ; Hongwu ZHANG ; Quan WEN ; Gang LIU

Chinese Journal of General Surgery.2009;24(12):981-983. doi:10.3760/cma.j.issn.1007-631X.2009.12.009

Objective To discuss the surgical treatment for huge hepatoblastoma in children,and the technique of hepatectomy without blockade of the blood supply to the remained liver lobes.Methods We reviewed 12 cases of huge hepatoblastorna who had been operated from July 2001 to January 2009 in our hospital.The mean age of the children was 3.2 years(range,11 months to 12 years).The diameter of the tumor was from 10 to 23 cm.3～7 cycles of chemotherapy was routinely administrated before operation.When the tumor reduced to a certain size that radical resection could be performed safely,regular hepatectomy was conducted.Hepatoblastoma resection without blocking the blood supply to the remained liver lobes was performed in every patient.Results The operations were successfully accomplished in all the 12 children.5 cases received right trihepatectomy (segment Ⅳ,Ⅴ～Ⅷ),4 cases received right hemihepatectomy(segment Ⅴ～Ⅷ),and the other 3 cases received Ⅳ,Ⅶ,Ⅷ segmentectomy,right Ⅴ,Ⅵ segmentectomy,and left hemihepatectomy respectively.The intraoperative hemodynamic parameters were stable,and there was no perioperative mortality.Postoperative chemotherapy wag routinely administrated.The follow-up period varied from 2 to 92 months.11 children survived and were disease free,among those 6 children have survived for more than 5 years.One child had brain and lung metastasis 5 months post operation,and died 7 months post operation. Conclusion Preoperative chemotherapy administrated to children with huge hepatoblastoma can reduce the tumor size and render tumor reseetable.Hepatoblastoma resection without blocking the blood supply to the remained liver lobes is a safe and feasible surgical technique.

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Transsphincteric surgery for rectal tumors

Huizhong QIU ; Bin WU ; Guole LIN

Chinese Journal of General Surgery.2009;24(12):977-980. doi:10.3760/cma.j.issn.1007-631X.2009.12.008

Objective To evaluate transsphincteric operation (Mason operation) for rectal tumors.Methods Retrospective study was used to analyze the experience of Mason operation for 150 patients with mid and lower rectal tumors between Aug 1990 to Dee 2008. Results There were villous adenoma in 75 cases,early rectal cancer in 48 and advanced rectal cancer in 9,submucosal carcinoid nodule in 23.Of the 126 rectal tumor patients,120 underwent partial rectectomy,6 underwent segmental rectectomy.Seventeen out of the 21 rectovaginal fistula or rectourethral fistula cases underwent successful one-stage repair.Six patients(4%)developed wound infection.Five patients(3.3%)were complicated with recto-cutaneous fistula.Two patients(4.3%) suffered from local recurrence in 46 followed up early staged rectal carcinoma with a five-year survival rate of 84.5%(39/46).On discharge from hospital no patient suffered from incontinence.Conclusion Mason operation is satisfactory with good exposure and simple access to the rectum,which Was suitable for those lesions that could be locally resected on mid and lower rectum.

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The experience in laparoscopic thyroidectomy

Yiping LU ; Nengwei ZHANG ; Yao LU ; Changhai LI ; Kai LI ; Tongsheng WANG ; Chen LIU

Chinese Journal of General Surgery.2009;24(12):969-972. doi:10.3760/cma.j.issn.1007-631X.2009.12.005

Objective To discuss the operative difficulties and management in laparoscopic thyroidectomy.Method The clinical data of 169 cases undergoing laparoscopic thyroidectomy were retrospectively analyzed.Result Among 169 cases,only 2 cases were switched to open surgery.Among the other 167 cases local thyroidectomy for thyroid adenoma Was performed in 37 cases,one side subtotal thyroidectomy in 63 cases,two side subtotal thyroidectomy in 42 cases,laparoscopic subtotal thyroideetomy was done in 20 cases for Grave's disease,and radical thyroidectomy was undeRaken in 5 cases of thyroid carcinoma.Postoperatively fat colliquation occurred in 2 cases,pneumohypoderma,skin bruise and temporary vocal dullness or hoarsness in 1 each case.There was no postoperative recurrent laryngeal nerve injury,nor that of the parathyroid gland. Conclusions Laparoscopie thyroidectomy has its own intraoperative difficulties. Accurate operative skills and careful perioperative management can decrease the occurrence of complications.

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The evaluation on modified T-staging system for hilar cholangiocarcinonm

Ningfu PENG ; Lequn LI ; Minhao PENG ; Xiao QIN ; Xigang CHEN ; Kaiyin XIAO ; Tao PENG ; Zhong QIN ; Bin CHEN

Chinese Journal of General Surgery.2009;24(12):988-991. doi:10.3760/cma.j.issn.1007-631X.2009.12.011

Objective To evaluate the clinical significance of a modified T-staging system for hilar cholangiocarcinoma(HCC).Methods From 1999 through 2007,98 HCC patients were stratified by the Tstaging system.Statistical differences were evaluated for resectability,radical resectability,concomitant partial hepatectomy,partial portal vein resection,histological differentiation,lymph node characteristic and survival rate.Results There were 43 HCC patients graded at T1,37 at T2 and 18 at T3 respectively.The resectability rates were 65%,40% and 11%,and radical resection was achieved in 46%,21% and 0% respectively.Resectabilities decreased with increasing T stage(χ~2=15,P<0.01;χ~2=14,P<0.01,separately).In patients with T1 and T2 tumors who underwent resection,the concomitant partial hepatectomy accounted for 60% and 73%(χ~2=0.6,P>0.05),partial portal vein resection for 3% and 33%(χ~2=4,P<0.05),poor differentiated types for 71% and 40%(χ~2=4,P<0.05),and lymph node metastasis for 50% and 40%(χ~2=0.4,P>0.05),respectively.The 1-,3-and 5-year survival rates in patients with T1 lesions were 58%,30%and 18%,in 12 patients it was 43%,11%and 0.The 1-and 2-year survival rate in T3 patients was 12%and 0.Patients witll T1 or T2 stage tumors had a significantly longer survival than those with T3(P<0.05)(Log rank χ~2=14,Breslow χ~2=12,P<0.01;Log rank χ~2=6,Breslow χ~2=4,P<0.05,individually),and the difference in survival between T1 and T2 was not significant(Log rank χ~2=2,Breslow χ~2=1,P>0.05).Conclusions The T-staging system is appropriate for preoperative evaluation in HCC patients.However,its correlation with tumor histological differentiation and lymphatic characteristics needs to be elucidated.

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Relationship between expression of cydooxygenase-2, Bcl-2 and chemosensitivities in lymph node metastases of gastric carcinoma

Bibo TAN ; Lijun SUN ; Wei GENG ; Bingrong LU ; Jie HAN

Chinese Journal of General Surgery.2009;24(11):930-933. doi:10.3760/cma.j.issn.1007-631X.2009.11.024

Objective To investigate the relationship between expression of cyclooxygenase-2 (COX-2), Bcl-2 and chemosensitivities in lymph node metastases (LNMs) of gastric carcinoma. Methods The chemosenisitivities to 9 drugs were measured by MTT assay, and the expression of COX-2, Bcl-2 was determined immunohistochemically in 40 paired primary tumor (PT) and lymph node metastases(LNMs)of gastric carcinoma. Results The positive rate of COX-2 and Bcl-2 in PT were 52.5%, 45.0% respectively, and in LNMs, the positive rate were 72.5% and 60.0%. The expression of COX-2 was higher in LNMs than in PT(χ~2=4, P<0.05). There was no statistically difference in the expression of Bcl-2 between PT and LNMs(χ~2=3, P>0.05). There was positive correlation of COX-2, Bcl-2 between PT and LNMs(r=0.3403, 0.4560, beth P<0.05). There was positive correlation between COX-2 and Bcl-2 in PT and LNMs (r=0.6014, 0.5330, both P<0.01). In PT the inhibition rate for 5-FU, VCR and eADM in COX-2 high expression group were lower than those in low expression group (t=2.29, 2.18, 2.41, all P< 0.05). The inhibition rate to 5-FU, PTX and eADM was significantly lower for the Bcl-2 high expression group in PT (t=2.46, 2.23, 2.22, all P<0.05). In LNMs, there were lower inhibition rates for VCR and MTX in COX-2 strong expression group (t=2.17, 2.35, both P<0.05); the inhibition rates to 5-FU, VP-16, PTX and MTX were significantly lower for the Bcl-2 strong expression group in LNMs (t=2.32, 2.29, 2.50, 2.25, all P<0.05). Conclusions COX-2 and Bcl-2 are involved in MDR of gastric carcinoma. The LNMs of gastric carcinoma are heterogeneous with respect to expression of COX-2, Bcl-2 and response to chemosensitivities. Effective adjuvant chemotherapy in gastric carcinoma depends on targeting the metastatic component of the tumor.

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N-acetylcysteine decreases the severity of pancreatic injury in rats with acute necrotizing pancreatitis

Bin ZHU ; Jiabang SUN ; Kai LI ; Dongdong ZHANG

Chinese Journal of General Surgery.2009;24(11):904-907. doi:10.3760/cma.j.issn.1007-631X.2009.11.013

Objective To investigate the correlation between pancreatic nuclear factor-κB (NF-κB) activation, cell apoptosis and pancreatic injury. To determine effects of N-acetylcysteine (NAC) on pancreatic injury in rats with acute necrotizing pancreatitis (ANP). Methods Thirty-three Wistar rats were divided into five groups: normal group, normal saline (NS) group, ANP group, prophylactic and therapeutic groups with NAC randomly. ANP was produced by 3.5% sodium taurocholate retrograde injection. In the prophylactic group, rats received intravenous (i. v.) injection of NAC (300 mg/kg) 1 hour before taurocholate injection and in the therapeutic group, NAC i.v. injection was given 1 hour after sodium taurocholate injection. Animals were sacrificed at 12 hours after induction of pancreatitis. Activation of NF-KB in pancreatic tissues was determined by electrophoretic mobility shift assay(EMSA). Cell apoptosis was assessed by modified TUNEL method. The following parameters were also measured: plasma levels of amylase and lipase, pancreatic wet/dry weight ratio and histologic grading. Results Taurocholate pancreatitis is characteristic of necrosis, haemorrhage, and severe leukocyte infiltration in the pancreas. Plasma amylase and lipase levels, pancreatic wet/dry weight ratio increased in rats of ANP. NF-κB banding activity was higher after pancreatitis induction (6.03±0.41). When NAC was given 1 hour before induction of pancreatitis, the activation (3.28±0.42) of NF-κB was prevented with significantly decreased severity of pancreatitis as assessed by amylase, pancreatic wet/dry weight ratio. The number of apoptotic cells in pancreatic tissue sections was greater in rats treated with NAC than in rats not treated with NAC. There was a negative correlation between NF-κB banding activity and apoptosis of pancreatic cells (r=-0.96, P< 0.01) and there was a positive correlation between NF-κB activation and histopathological score (r=0.63, P<0.01). Histopathological score of pancreatic injury had negative correlation with apoptosis of pancreatic cells(r=-0.98, P<0.01). Conclusion Early blocked NF-κB activation with NAC increases cell apoptosis in pancreatic tissue and decreases edema of pancreas and severity of pancreatitis in rats with ANP.

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Prosthetic infection after tension-free hernioplasty in 12 cases

Xiaoqiang WANG ; Xiaojun LI

Chinese Journal of General Surgery.2009;24(11):882-884. doi:10.3760/cma.j.issn.1007-631X.2009.11.007

Objective To evaluate the prevention and treatment of prosthetic infections after tension free hernioplasty. Methods The clinical date of 12 prosthetic infections admitted from May 2005 to May 2008 were analyzed retrospectively. Patch was inserted under prefascial retromuscular site in 8 cases, between fascial edges in 2, Mesh plug and patch Lichentstein in one each. As for the material used there were flat knitted polypropylene in 7 cases, polytef in 1 case and composite prosthesis in 4 cases. Treatments were based on prothetic materials and levels infected. Infectious patchs were removed completely in 8 cases and partially removed in 2 cases, Open dress change with patchs left in situ in 2 cases. 3 cases in 10 cases of removed patchs were given immediate suturation with closed drainage. Results Infection was cured in all cases without mortality. There was no hemorrhage and injury of bladder during the procedures. No retention of urine, pain and other complications during postoperation. Change of dressing was made from 7 days to 6 months( median 2 weeks). Selected antibiotic was used from 3 to 7 days (average 4.5 days). All patients were followed up from 18 to 78 months (average 38.5 months) without hernia recurrence and infection. Conclusion It was most important to prevent infections after tension-free hernioplasty. Management should be individualized according to different type of patch used and the surgical procedure in hernia repair.

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Mesh free laparoscopic inguinal hernia repair

Kaiyun CHEN ; Guoan XIANG ; Hanning WANG ; Fanglian XIAO

Chinese Journal of General Surgery.2009;24(11):874-877. doi:10.3760/cma.j.issn.1007-631X.2009.11.005

Objective To study the efficiency of iaparoscopic inguinal hernia repair without the use of a mesh. Methods We used laparoscopic hernia repair without the use of a mesh in 92 cases of inguinal hernia. Results were compared with that of total extraperitoneal laparoscopic inguinal hernioplasty(TEP) in 91 cases from January 2001 to March 2004. Results The laparoscopic procedures were successfully performed in all the patients. In mesh-free and TEP group respectively the operating time was (21±4) min vs. (70±16) min (t=28. 01, P<0.05), hospital stay was (3.5±1.0) d vs. (4.8±1.2) d (t=7.96, P<0.05), average time off-bed was (1.0±0.5) d vs. (1.8±0.7) d (t=8.90, P<0.05), duration of pain was (1.0±0.5) d vs. (2.5±0.7) d (t=16.69, P<0.05), the expense was (4500±500) RMB yuan vs. (8000±820) RM B yuan(t=34.89, P<0.05), subcutaneous hematoma rate was 0% vs. 8.7% (χ~2=6.48, P<0.05). The 48 hour C-reaction protein level after the operation was (3.9±0.3) mg/dl and (8.8±0.5) mg/dl (t=80.48, P<0.05). All the difference was statistically significant between the two groups. All patients were followed up for 56.9±6.2 months. The recurrence rate was 0 and 2.1% (χ~2=0.51,P>0.05) respectively. Conclusions Mesh-free laparoseopie inguinal hernia repair is safe, cost-effective, as well as of much lower hernia recurrence.

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Endovenous laser therapy (EVLT) or endovenons microwave coagulation (EMC) in the treatment of varicose vein in the lower extremities

Shaoying LU ; Guangbing WEI ; Guangyu QI ; Lin YANG ; Zhi WANG ; Huiyong NIE

Chinese Journal of General Surgery.2009;24(11):922-925. doi:10.3760/cma.j.issn.1007-631X.2009.11.020

Objective To compare endovenous laser therapy (EVLT) with endovenous microwave coagulation (EMC) in the treatment of varicose vein in the lower extremities. Methods Sixty-five (male 30, female 35) patients with 70 lower extremities (35 legs in each treatment group) were pair matched according to age, gender and CEAP classification to receive endovenous laser therapy (EVLT) or endovenous microwave coagulation (EMC). The same surgeon performed all procedures. Patients were monitored on 72 hours, 4 weeks and 6 months after the procedure (by procedural site scored for bruising, skin burn, painful induration or trabes as well as a pain score), the cured extremities were examined via Duplex uhrasonography to evaluate the effects of the procedure. Results All these 65 patients (mean age, 47.52 years) completed treatment and were followed-up. The mean operation time of EMC group was less than that of EVLT (71±25 vs. 59±15, P=0.01). At 72 hour after the procedure, bruising scores and skin buring were significantly different (P<0.05): patients in the EMC group showed less bruising (17.14% vs. 54.29%) but more burn (48.57% vs. 20%) on the procedure site than the patients in the EVLT group. At 4 weeks and 6 months after the procedure, no significant differences were found between patient outcomes, physical conditions, and symptoms and or possible adverse events. In 20/28 patients the pigmentation faded away, Edema were relieved in all the 25 extremities. 4 patients with ankle ulcer were healed. No major complications were found. Conclusions Both EMC and EVLT were effective in treating lower extremities varicose veins, with no major complications.

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