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The prevention and management of massive bleeding during resection of retroperitoneal tumour

Chinese Journal of General Surgery.2000;0(11):-.

Objective To improve the safety and decrease the blood loss during resection of retroperitoneal tumour (RRT).[WT5”HZ]Method [WT5”BZ]We analysed retrospectively 54 patients whose blood loss were over 3?000?ml during RRT in our hospital from 1983 to 1998.The blood loss was over 5?000?ml each in 22 patients,and over 8?000?ml each in 7 patients, the maximum blood loss was 10?000?ml.[WT5”HZ]Result [WT5”BZ]Among the 54 patients whose blood loss were over 3?000?ml and up during RRT, 17 sank into shock and 2 of them died.[WT5”HZ]Conclusion [WT5”BZ]The preoperative evaluation and preparation are important to operative safety.We emphasize intraoperative management of massive bleeding during RRT.

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The diagnosis and treatment of 65 patients with abdominal aortic aneurysm

Zhiquan DUAN ; Yingwei LUO ; Qiang ZHANG

Chinese Journal of General Surgery.2000;0(11):-.

Objective To summarize our experience of the diagnosis and treatment in patients with abdominal aortic aneurysm(AAA).[WT5”HZ]Methods [WT5”BZ]From 1980 to 1999 sixty five AAA patients were hospitalized with 40 cases of general type, 18 cases of rupture type,4 cases of inflammatory type and 3 cases of infective type. In situ artificial graft transplantation was performed in 62 cases and nonanatomy pathway in 2 cases. The remaining one with inflammatory type was treated by interventionel therapy.[WT5”HZ]Results [WT5”BZ]57 cases were cured and were followed up from 1 to 12 years without complications.Death occurred in 7 cases.[WT5”HZ]Conclusions [WT5”BZ]The abdominal pulsate mass should draw much attention. Ultrasound is the selected examination and DSA, helix CT are accurate image appliance. It can elevate the curative ratio and decrease the mortality through rational operation based on the location, type and individual condition of AAA patients.

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The experimental and clinical studies on APA microencapsulated neonatal swine islet cells for xenotransplantation

Lehong ZHANG ; Yize HU ; De CHEN

Chinese Journal of General Surgery.2000;0(11):-.

Objective To evaluate the effect and result of xenotransplantation with alginic polylysine alginic(APA) microencapsulated neonatal swine islets for the treatment of IDDM patients.[WT5”HZ] Method [WT5”BZ] The neonatal pig islets were microencapsulated with APA technique and cultured in vitro. The secretion of insulin, glucose stimulated insulin release test and histological examination between the microencapsulated and unmicroencapsulated neonatal pig islets were compared. 3 patients with IDDM received a xenotransplantation of microencapsulated neonatal pig islets by laparoscopic procedure. The change in blood glucose level, C peptide and the dose of insulin used were observed before and after the xenotransplantation. [WT5”HZ]Results [WT5”BZ] No significant difference was found between microencapsulated and unmicroencapsulated neonatal pig islets in vitro in terms of biological activity of the islets. The levels of serum C peptide in two of the 3 recipients increased by 11 and 23 times respectively, the postoperative dose of insulin needed decreased by 63% in one, insulin independency was achieved in the other recipient.In these two cases,the microencapsulated islets have functioned effectively for up to 80 ds.[WT5”HZ] Conclusion [WT5”BZ] APA microencapsulated neonatal pig islets have good biological activity and survived while transplanted into IDDM recipients. Omentum minus cavity xenotransplantation of microencapsulated neonatal pig islets by laparoscopic technique is safe, capable of repeated transplantation.

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The clinical and pathological study of hepatocellular carcinoma invading on to bile duct:a report of 39 cases

Jinbo WANG ; Zhenping HE

Chinese Journal of General Surgery.2000;0(11):-.

Objective To evaluate the clinical and pathological features and treatment of primary hepatocellular carcinoma invading on to the bile duct.[WT5”HZ]Methods [WT5”BZ]39 cases of hepatocellular carcinoma of icteric type were collected in our hospital.[WT5”HZ]Results [WT5”BZ]The incidence was 6% in all hepatocellular carcinoma patients.Preoperative correct diagnosis was achieved in only 33% of the 39 cases.The positive diagnostic rate of B ultrasound and CT was 88% and 80%respectively,and 49% of cases suffered from intraportal thrombi concomitantly.[WT5”HZ]Conclusion [WT5”BZ]Preoperative correct diagnosis depends on image test,hepatectomy with biliary duct drainage is the mainstay for treatment.

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The diagnostic value of preoperative MRI for advanced gastric carcinoma

Kaixiong TAO ; Daoda CHEN ; Jianhua LU

Chinese Journal of General Surgery.2000;0(11):-.

Objective To evaluate the diagnostic value of preoperative MRI for advanced gastric cancer and metastasis. Methods MRI was preoperatively performed in 36 patients with advanced gastric carcinoma by the superconductive type of magnetic resonance imaging instrument through a single breath holding fast scan sequence, the results were correlated with the intraoperative and histopathologic findings.[WT5”HZ] Results[WT5”BZ] The correct rate of localization and qualitative determination in gastric carcinoma by MRI were both 100%. The displaying rate of metastatic lymph notes was 83%(25/30), and the correct diagnostic rate was 73%(35/48) for metastasis or invasion to adjacent abdominal organs.[WT5”HZ] Conclusions[WT5”BZ] Gastric carcinoma shows characteristic MRI pictures, hence MRI examination has the advantage of diagnosing gastric cacinoma, its spreading, even metastasis of lymph nodes.

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The closed establishment of pneumoperitoneum for laparoscopic procedures in patients with a history of abdominal surgery

Mingchen BA ; Xunru CHEN ; Jisheng CHEN

Chinese Journal of General Surgery.2000;0(11):-.

Objective To investigate the feasibility and ways of closed establishment of pneumoperitoneum for laparoscopic procedures in patients with a history of abdominal surgery. [WT5”HZ]Methods[WT5”BZ] Between September 1991 and December 1998, 963 patients with a history of abdominal surgery received closed establishment of pneumoperitoneum. The difficulties with closed establishment were classified as false and real types. Veress needle penetrating into falciform ligament, mesentery, great omentum or retroperitoneal fat tissue caused false difficulty, while the difficulty due to Veress needle penetrating into abdominal viscera or because of extensive adhesion was known as real difficulty.[WT5”HZ] Results[WT5”BZ] 18 cases for false and real difficulty were transfered to open surgery.Two cases suffered visceral injuries for laparoscopic cholecystectomy, including jejunum and ileum injuries in one each case. The occurrence rate of visceral injuries accounted for 0 2% in this group.[WT5”HZ] Conclusion[WT5”BZ] This result demonstrates that closed establishment of pneumoperitoneum is safe and feasible in most patients with abdominal operative history. Abiding by the rule of closed establishment pneumoperitoneum and conversion to laparotomy in time in real difficulty is important to avoid visceral injuries.

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Surgical diagnosis and treatment of splenic space occupying disease

Xiaodong HE ; Weiming KANG ; Chaoji ZHENG

Chinese Journal of General Surgery.2000;0(11):-.

Objective [WT5”BZ]To improve recognition and differential diagnosis of splenic space occupying disease.[WT5”HZ]Method [WT5”BZ]40 cases admitted from 1983 to 1999 were analyzed retrospectively。[WT5”HZ]Result [WT5”BZ]Twenty six out of 40 cases were of benign splenic disease including one case of cyst, 3 cases of splenic abscesses, 7 cases of splenic tuberculosis, 5 cases of splenic “true” cyst, 4 cases of splenic angiolymphoma, 3 cases of splenic aneurysm, and one each of splenic lymphoangioma, epidermoid cyst and hamartoma. There were 14 cases of malignant tumor, amongwhich,there were two cases of non Hodgkin′s lymphoma and two of leiosarcoma,one angiosarcoma and metastatic splenic malignant tumor in 9 cases.[WT5”HZ]Conclusion [WT5”BZ]Therapeutics should be adopted according the nature of splenic diseases, based on clinical and image characteristics.

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Hereditary nonpolyposis colorectal cancer:a report of 21 cases from 7 families

Shilin WANG ; Yingqin DING ; Xueming WEI

Chinese Journal of General Surgery.2000;0(11):-.

Objective For better recognition of the hereditary nonpolyposis colorectal cancer (HNPCC) with reference to its clinical characteristics, diagnosis and treatment [WT5”HZ]Methods [WT5”BZ] A survey of 7 families of HNPCC patients was made [WT5”HZ] Results [WT5”BZ]Among the 7 families, 21 persons had colorectal cancer with age ranging from 26 to 79 years (average 46 years) The total of the colorectal cancer foci in 21 cases were 31,among which 16 were located proximal to,10 distal to the splenic flexure and 5 without definite record 61 5%(16/26) of the colorectal cancer foci were located proximal to the splenic flexure Six patients had multifocal colorectal cancer, which accounted for 28 6%(6/21) of all cases [WT5”HZ] Conclusions [WT5”BZ] HNPCC patients and their family members should be followed up regularly for early diagnosis and treatment of the disease and for better prognosis

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Autonomic-nerve-preserving extended radical operation for rectal cancer

Zhongchen LIU ; Xinshu DONG ; Pingguo LIU

Chinese Journal of General Surgery.2000;0(11):-.

Objective To evaluate autonomic nerve preserving extended operation (ANPEO) for rectal cancer in the protection of postoperative urinary and male sexual functions.[WT5”HZ]Methods [WT5”BZ] 80 Dukes B and C cases underwent ANPEO for rectal cancer, including 10 cases with unilateral ANPEO. Result was compared with that of 25 cases undergoing traditional extended radical operation. [WT5”HZ] Result [WT5”BZ] Among 70 cases with bilateral ANPEO and 10 cases with unilateral ANPEO normal postoperative erectile was maintained in 97 1% vs 70%, ejaculatory functions in 92 9% vs 50%, ability of sexual intercourse in 91% vs 40%, and orgasm in 88 5% vs 40% respectively. In 25 cases without ANPEO extended operation sexual functions were all lost. 3/80 cases with ANPEO suffered temporary urinary dysfunction, 23/25 cases without ANPEO suffered temporary urinary dysfunction and 7 with long term dysfunction [WT5”HZ]Conclusions [WT5”BZ] ANPEO is effective to reduce the postoperative urinary and sexual dysfunction while maintaining the radical cure for the cancer.

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Expression of cyclooxygenase 2 gene in human colorectal tumors

Suikuan GAO ; Zhanbing LIU ; Jianxun ZHAO

Chinese Journal of General Surgery.2000;0(11):-.

Objective To test the expression of cyclooxygenase 2 (COX 2) gene in colorectal adenomas, cancers in contrast to that of normal mucosa.[WT5”HZ] Methods [WT5”BZ] With reference to the expression of ? actin gene, the expression of COX 2 mRNA was examined in colorectal adenomas from 10 patients, cancerous tissues and adjacent noncancerous mucosa from 30 patients by reverse transcription polymerase chain reaction (RT PCR). Quantitation of relative band densities was performed using densitometry scanning techniques.[WT5”HZ] Result [WT5”BZ] Strong expression of COX 2 mRNA was detected in ninety percent of cancers with range of 0 02～0 85 (median 0 5). The difference of expression of COX 2 mRNA between cancers and normal mucosa or adenomas was significant (rank sum test, P

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