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Diagnosis and treatment of Nevin Stage V gallbladder cancer

Weiqi LU ; Bingsheng WANG ; Houbao LIU ; Saixong TONG ; Liqing YAO

Chinese Journal of Practical Surgery.2001;21(2):107-108.

ObjectiveTo summarize the experience of diagnosis and different surgical management for Nevin Stage V gallbladder cancer. Methods The present study was an retrospective analysis of 74 patients who were operated in our hospital and suffered from Nevin Stage V gallbladder cancer proved histopathologically. ResultsThe diagnostic accuracy of color Doppla ultrasound was 75.0%(21/28), abdominal enhanced CT, 82.1%(32/39).23 patients with Nevin Stage V disease received radical or extended radical cholecystectomy, the mean survival time was 1 year and 3 months;11 patients with Nevin Stage V disease without a complete resection had a mean survival of 6 months; 38 patients with Nevin Stage V diesase had a mean survival of 2 months after palliative bypass procedure or biopsy. ConclusionA exploratory operation by laparoscope is useful in the diagnosis of advanced gallbladder cancer. According to local situation of gallbladder cancer and general body state, different management are employed in treatment so that the effect may be improved.

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Treatment of the cases with the papilla of Vater located in the diverticula by opening of diverticula adding Oddis sphincteroplasty.

Lixin SUN ; Zhi XU ; Nengwei ZHANG ; Xiaosi ZHOU

Chinese Journal of Practical Surgery.2001;21(2):105-106.

Objective To introduce a surgical technique for the cases with the papilla of Vater located in the diverticula. Methods When diverticula was opened, there was a cuff shape edge left in the bottom, which reduced tensility of oversew, and the probability of postoperative leakage was reduced. Fistula Oddi sphincteroplasty was adopted oversewwing when it was splitted,and the length of each time was not more than 3mm,and the total length was not more than 2cm. ResultsNone of 11 cases died in postoperation, 3 of them occured biliary fistula,duodenal fistula,and pancreatic fistula, the rate of fistula was 27.27%. They were all followed-up, and the result was satisfactory.ConclusionAlthough the operation technique is ifficult,and there are many complications,it is a good technique.

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Causes and treatment of bile leakage(a report of 22 cases).

Xiaopeng CHEN ; Shuyou PENG

Chinese Journal of Practical Surgery.2001;21(2):102-104.

Objective To investigate the cause,prevention and treatment of bile leakage. MethodsThe clinical data of 22 cases with bile leakage treated from Jan.1993 to Dec.1998 were reviewed retrospectively. Results Of the 19 cases treated with nonoperative therapy,1 patient died,3 patients were transferred to be operated later, and the other 15 cases were cured. The cure rate of nonoperation was 79%(15/19). 3 patients were cured with emergent operation at the beginning of bile leakage. Of the 3 cases who were transferred to be operated later,2 cases were finally cured by operation while the other 1 patient was not cured.The total cure rate was 91%(20/22). ConclusionBile leakage often oocurs in cholecystectomy procedure and after removal of a T tube, which is mainly related to inflammation, adhesion, abnormality of anatomy and incorrect manipulation. In order to prevent it,surgeons should pay more attention to the 3 links of prirnary procedure, including preoperative preparation,operative management and postoperative treatment. Different treatments are optional according to the degree of leakage and the condition of patients.

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Surgical treatment of large bowel obstruction caused by eolorectal carcinoma(a report of 52 cases).

Shuo YIN ; Zhongyu WANG ; Lianquan SHI ; Rongyu ZHAO

Chinese Journal of Practical Surgery.2001;21(2):100-101.

ObjectiveTo study the surgical treatment of large bowel obstruction caused by colorectal carcinoma.MethodsRetrospective analysis of the experience of surgical treatment for the large bowel obstruction caused by colorectal carcinoma in 52 patients from 1995 to 1999 was performed. ResultsIn the 52 patients, the right hemnicolectomy was performed in 9 patients; left hemicolectomy with proximal colon fistulization was performed in 37patients;transvercolectomy was performed in 4 patients; sigmoid fistulization was performed in 2 patients for their rectum carcinoma couldn't be resected. The postoperative complication rate was 15.3%(8/52),and perioperative mortality rate was 3.8%(2/52). Conclusion More attention should be paid to large bowel obstruction caused by colorectal carcinoma. Selecting rational colectomy and appropriate perioperative management is important for reducing both complication and mortality rate.

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Analysis of etiology of 72 cases with incision hernia of abdominal wall.

Jingsheng PENG ; Yongdong CHEN

Chinese Journal of Practical Surgery.2001;21(2):91-92.

ObjectiveTo explore the etiology of incision hernia of abdominal wall. Methods 72 cases with incision hernia were analyzed retrospectively in types of incision, technique of suture, materials, infection of incision, increase of intraabdominal pressure, age, nutrition and time of occurrence. ResultsLongitudinal incision, bad technique of suture,infection of incision, increase of intraabdominal pressure, aged, hypoalbuminemia and diabetes mellitus easily induced incision of hernia. ConclusionTransverse incision should be adopted if operation and safety are not affected. Prevent and treat infection or rupture of incision by strict aseptic manipulation, hemostasis and right use of antibiotics. Prevent increase of intraabdominal pressure in every aspect. Pay atention to nutrition supply of the elderly and promote healing of incision. Postoperative half year is high incidence stage of incision hernia and all inducing factors should be avoided.

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Laparoscopic hernioplasty in 50 cases.

Cunchuan WANG ; Jufeng QIAO ; Qian LI ; Weichen LIANG ; Jun CHEN ; Yihao XU

Chinese Journal of Practical Surgery.2001;21(2):88-90.

ObjectiveTo study the method,indications, advantage and shortcoming of laparoscopic repair of inguinal hernia. MethodsFrom Jun. 1995 to Jun. 2000,50 patients with inguinal hernia were treated with laparoscopy. There were 34 indirect inguinal hernia, 9 direct inguinal hernia and 7 concealed hernia. The transabdominal preperitoneal laparoscopic mesh repair of hernia(TAPP) was performed in 34 patients. Closure of the internal orifice of hernia was performed in 7 patients. Totally extraperitoneal repair was performed in 9 patients. ResultsAll cases were operated successfully. The mean operation time was 59.3(15～180) mins. The average length of postoperative stay was 5.4(3～7)days. There were no death record and no conversion operation. There was one early failure owing to the use of too small a piece of mesh. There has been no long-term recurrence. ConclusionThe results indicate that mesh repair of hernias is a satisfactory technique with a low recurrence rate and a low major complication rate.

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Tension-free mesh-plug repair in inguinal strangulated hernia

Kai YIN ; Chengzhu ZHENG ; Jianwei BI ; Jide HU

Chinese Journal of Practical Surgery.2001;21(2):86-87.

Objective To evaluate the clinical effect of tension-free mesh-plug repair in inguinal strangulated hernia. MethodsUsing the mesh-plug materials (Perfix-Plug) of Bard surgical product company, we performed operation on 19 patients suffering from strangulated indirect inguinal hernia. In these cases,14 patients were older than 60,17 patients had other severe diseases,and 5 cases had small intestine necrosis. ResultsThere was no postoperative mortality. The only complication was scrotal haematoma which occurred in one patient. All the patients retrieved motility two days after operation except those who had intestinal necrosis and underwent intestinal anastomosis. The length of hospital stay was 2 to 4 days or 6 to 7 days respectively in patients without or with intestinal necrosis. The follow-up period ranged from 3 to 16 months, and no recurrence was observed. ConclusionTension-free mesh-plug repair has the advantages of safety, minimal invasion and rapid recovery. Meanwhile, this method can be applied to those with intestinal necrosis with satisfactory results.

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The application of polypropylene mesh & plug in hernia repair.

Lei HUA ; Feng HAN

Chinese Journal of Practical Surgery.2001;21(2):84-85.

Objective To approach the advantages and summarize the experience of mesh & plug tension-free hernia repair. MethodsThe mesh & plug tension-free hernia repair was administered in 102 patients of groin hernia with the BardR Mesh & PerfixR plug offered by Bard Company in U. S. A. The operation time,postoperative pain,patient's ability recovery, complications and recurrence rate were followed up. ResultsThe average operation time was 31.5minutes. The patients could move 4～6 hours after operation. Postoperative pain lasted about 2～3 days. One had retention of urine and two had wound subcutaneous hydrops. No wound infection. Nine had feeling of foreign matter in the groin region. Only one had recurrence in 89 patients who were followed-up. ConclusionBardR Mesh & PerfixR Plug has good tissue-compatibility,no rejection,and capability of anti-infection. It is an ideal material for hernia repair. The mesh & plug tension-free hernia repair is easy to be administered, with minor lesion, quicker recovery and lower recurrence. And the operation indication can be widened. It is a most advanced method in treating groin hernia.

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The application of tension-free hernioplasty in elderly inguinal hernia.

Hui XIAO ; Shan GUAN ; Zhigang CUI

Chinese Journal of Practical Surgery.2001;21(2):82-83.

ObjectiveTo summarize the recent therapeutic effects of mesh-plug tension-free hernioplasty in elderly inguinal hernia. MethodsAll cases were performed with mesh-plug case-hardened products, which are manufactured by American Bard Company. ResultsAll the operative procedures were performed smoothly. Postoperative complications were:6 cases of urinary retention,4 scrotal hydroceles,2 persistent wound pain,2 local lightly projections with foreign body sensation,2 hypoincisional haematoma. 1～24 months of follow-up were taken,2 recent recurrences were reported. ConclusionMesh-plug tension-free hernioplasty is a perfect surgical operation. Its main characteristics are:simple performance, less trauma, tension-free, time-saving, good recent therapeutic effect, and fewer recent recurrence. It is especially suitable to the elderly patients and/or Patients with other diseases.

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Observe the shape of plug mesh and patch by B ultrasound after plug-mesh hernia repair.

Yangqing LI ; Songzhang MA ; Suning SHI

Chinese Journal of Practical Surgery.2001;21(2):80-81.

ObjectiveInvestigate the shape of plug mesh and patch after plug-mesh hernia repair and discuss the necessity of improving the operative procedures. MethodsUse B ultrasound to investigate the shape of plug-mesh and patch after mesh plug hernia repair and review the patients medical record,evaluate how operative procedures affect the shape of patch and the results. ResultsIn 4 of the 16 cases,the distant end of patches overlapped the pubic margin,in the remaining 12cases the distant end of patches didn't reach the pubic margin. When changing the cut-in direction of B ultrasound probe,a wide and dense shadow was discovered in 8 cases whose patches didn't reach the pubic margin. Between the pubic margin and dense shadow there was a space showing low dense shadow. These photocopies showed that the patches had folded up or crimped. In 11 of 12 cases,the patches didn't fix on pubic margin or cut shorter during operation. Conclusion It is suggested to fix the distant end of patch on the aponeurosis tissue of pubic in the procedure of mesh plug hernia repair,and combine the plug-mesh repair with Lichtenstein repair.

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