Objective:To explore the clinical characteristics, treatment and prognosis of splenic marginal zone lymphoma.Methods:The clinical data of 51 patients with splenic marginal zone lymphoma who underwent surgical treatment at Department of Hepatobiliary in Peking University People's Hosipital from Dec 2009 to Oct 2022 were retrospectively analyzed.Results:The patients 's average age was 60.5±11.8 years old, and the ratio of male to female rate was about 1:1. As of the last follow-up date of Feb 28, 2023, 8 patients died of the primary lymphoma and 14 patients suffered from disease progression. The 5-year progression free survival rate was 68%, and the overall survival rate was 79%. Univariate analysis showed that age ≥65 years old, decreased preoperative albumin, increased bilirubin level, and increased lactate dehydrogenase bode ill for overall survival time, but none of them were independent risk factors; Age ≥65 years old and diffuse large B cell transformation were independent risk factors.Conclusions:Surgery combined with comprehensive treatment which contained rituximab is currently the main treatment method. Splenectomy remains an important treatment and diagnostic method for patients with obvious symptoms or persistent unrelieved blood count abnormalities and unexplained splenomegaly. Advanced age, elevated bilirubin and lactate dehydrogenase, decreased albumin, and diffuse large B cell transformation, it may indicate poor prognosis.

Objective:To evaluate the clinical efficacy of acupuncture combined with extracorporeal shock wave therapy in the treatment of piriformis syndrome.Methods:Eighty patients with piriformis syndrome who received treatment in Huaihe Energy Occupational Disease Prevention Hospital Rehabilitation Medicine Center from February 2021 to December 2022 were included in this study. They were divided into a treatment group ( n = 40) and a control group ( n = 40) according to different treatment methods using a retrospective cohort study design. The treatment group was treated with acupuncture combined with extracorporeal shock wave therapy, once every 7 days for 3 consecutive weeks. The control group was treated with extracorporeal shock wave therapy alone once every 7 days for 3 consecutive weeks.Pre- and post-treatment visual analogue scale scores and clinical efficacy were compared between the two groups. Results:There was no significant difference in baseline data between the two groups (all P > 0.05). After treatment, the visual analogue scale score decreased in each group. After adjusting for covariates, there was no significant difference in visual analogue scale score between the two groups ( F = 112.38, P < 0.001). After adjusting the pre-treatment visual analogue scale score, the post-treatment visual analogue scale score in the treatment group was lower than that in the control group [1.417 (95% CI: 1.151-1.683)]. The total response rate in the treatment group was 97.5% (39/40), which was significantly higher than 82.5% (33/40) in the control group ( Z = -2.03, P = 0.042). Conclusion:Acupuncture combined with extracorporeal shock wave therapy is highly effective on piriformis syndrome.

Objective:To investigate the application value of domestic robotic surgical system in radical resection of hilar cholangiocarcinoma (hCCA).Methods:The retrospective and descriptive study was constructed. The clinicopathological data of a 66-year-old male patient with hCCA who was admitted to the Second Hospital of Shandong University in November 2022 were collected. Radical resection of hCCA was performed using the Toumai? laparoscopic surgical robot system. Observation indicators: (1) intraoperative conditions; (2) postoperative conditions; (3) follow-up. Count data were represented as absolute numbers and (or) percentages.Results:(1) Intraoperative conditions. The patient underwent radical resection of hCCA successfully using robotic surgical system, including tumor resection, lymph node dissection, and gastrointestinal reconstruc-tion. The operation time and volume of intraoperative blood loss were 400 minutes and 100 mL, respectively, and no intraoperative blood transfusion was required. (2) Postoperative conditions. The patient began ambulation on postoperative day 1 and began taking liquid food on postoperative day 4. Liver function examination and abdominal computed tomograph (CT) on postoperative day 5 showed a decrease in serum bilirubin, no biliary or intestinal leakage, and no edema or necrosis at the anastomotic site. The abdominal pre-anastomotic and post-anastomotic drainage tubes were removed on the 7th and 9th day after the surgery respectively, and the patient was discharged on the 10th day after surgery. Results of postoperative pathological examination showed moderately to poorly differentiated adenocarcinoma of the bile duct. Immunostaining was positive for CK7 and CK19. The Ki-67 proliferation index was 35%. The proximal and distal resection margin of bile duct were negative. The tumor diameter was 30 mm. Perineural invasion was positive. The surgical specimen margin was negative. Two lymph nodes were identified containing tumor cells positive for malignancy. No tumor cell metastasis was detected in the No.8, No.12 or gastric lesser curvature lymph nodes submitted for pathological examination. (3) Follow-up. The patient was followed up at postoperative 1-, 3-, 5-month after discharge. During follow-up period, results of liver function examination and abdominal CT showed liver function restore to normal levels, no complication such as biliary fistula, intestinal fistula, gastroparesis or tumor metastasis.Conclusion:The Domestic Toumai ? laparoscopic surgical robot system can be applied to radical resection of hCCA.

Objective:To compare the differences of short and long-term outcomes between laparoscopic surgery and open surgery treatment of intrahepatic cholangiocarcinoma patients.Methods:A retrospective cohort study was conducted to collect the clinical data of 118 patients with intrahepatic cholangiocarcinoma who underwent surgery in Qilu Hospital of Shandong University from January 2015 to June 2020. They were divided into laparoscopy group and open group according to the operation methods. The perioperative data, such as intraoperative surgical conditions, hospital costs, postoperative complications, postoperative blood biochemical tests, and the follow-up data of the two groups were compared.Results:In the laparoscopic group, there were 40 patients, 18 males and 22 females, aged (61.5±9.1) years. There were 78 patients in the open group, 48 males and 30 females, aged (61.2±8.3) years. The tumor size of the laparoscopic group was (4.4±1.8) cm, which was smaller than that of the open group (6.0±3.3) cm, and the differences were statistically significant ( P<0.05). In the laparoscopic group, 4 cases (10%) were converted to open surgery. The intraoperative blood loss, intraoperative blood transfusion proportion, 3 or more liver segments resection proportion and hospital costs of laparoscopic group were lower than those of open group [200.0(100.0, 261.8) ml vs. 300.0(100.0, 400.0) ml, 5.0%(2/40) vs. 26.9%(21/78), 37.5%(15/40) vs. 66.7%(52/78), (6.2±2.0) wan yuan vs. (7.2±2.3) wan yuan], the differences were statistically significant (all P<0.05). There were no significant differences in the incidence of postoperative complications between the two groups ( P>0.05). On the first post-operative day, ALT serum level and the third post-operative day TBil serum level in the laparoscopic group were lower than those in the open group [188.5(130.5, 274.0) U/L vs. 320.0(144.0, 427.0) U/L, 26.4(18.3, 26.4) μmol/L vs. 31.6(18.8, 37.5) μmol/l], the differences were statistically significant ( P<0.05). There were no significant differences in 1-year and 2-year overall survival rate and disease-free survival rate between the two groups ( P>0.05). Conclusion:Compared with open surgery, laparoscopic surgery in the treatment of intrahepatic cholangiocarcinoma has better short-term outcomes, and can achieve similar results in medium- or long-term outcomes.

Objective To evaluate the clinical application and effect of computerized digital sur -gical assisted design and manufacture for reconstruction of mandibular defect with vascularied iliac crest flap graft .Methods CT was used to scan the craniofacial and maxillofacial region of mandibular ameloblastoma patient ,and then the 3D model of the maxillofacial skeleton was reconstructed using the computerized digital surgical aid design to simulate the focal resection and the mandibular defect reconstruction with the iliac crest flap .Surgical guides were prepared by 3D printing to assist focal re-section and bone reshaping .Postoperatively ,clinical and CT examinations were performed to observe the restoration of the patient's facial appearance and occlusal relationship ,as well as wound healing and graft survival .Results Postoperative review results showed that the bone graft survived well ,and the anastomosed bone was formed .The wound in the surgery area healed .No recurrence of the tumor was found after clinical and CT examination .The maxillofacial appearance was well restored ,and the re-sidual occlusal relationship recovered well .Conclusions The use of computerized digital surgical aided design combined with 3D printing technology can effectively simplify the mandibular segmental defect repair and reconstruction and optimize the postoperative repair effect .

Objective To explore the role of computer-aided design and manufacturing technology (CAD/CAM technology) in the repair of mandibular defects using the fibular osteomyocutaneous free flap.Methods Eight patients with a portion of mandible defect due to various reasons were subjected to preoperative CT scan,obtaining CT data of the mandible and the fibular bone to be transplanted.The original and the reconstructed skull model,as well as the mandible and fibula osteotomy guide plates,was printed using CAD/CAM technology.The titanium plates were preformed using the reconstructed skull model,and the operation was performed with the help of guide plates and a preformed titanium plate.The patients were followed up for 6 to 24 months to evaluate the operation effect.Results Two in 8 cases had flap necrosis caused by immune rejection of the implant,and one case had flap necrosis due to poor postoperative blood glucose control.The other 5 patients healed at the primary site and the fibular myocutaneous flap survived well.There were no serious complications in the donor and recepient site.The patients' satisfaction was high.Conclusions The reconstruction of mandible with the aid of CAD/CAM technique has the advantages of accelerating the operation process,shortening the operation time,improving the accuracy of mandibular amputation and fibular shaping,promotlng postoperative function and morphology recovery.

OBJECTIVETo investigate the effect of vascularized composite flap with iliac crest and nternal oblique muscle of abdomen for half mandibular reconstruction.

METHODSFrom July 2009 to Sept. 2013, 14 cases with half mandibular defect after tumor resection were treated with composite flap of iliac crest and internal oblique muscle of abdomen pedicled by deep circumflex iliac vessels. During operation, one group performed tumor resection and got the recipient area vessels ready for anastomosis. The other group performed harvesting of composite flap. Then the flap was trimmed and fixed to construct the defect with vessel anastomosis.

RESULTSAll the 14 composite flaps survived with local infection only in 1 case. The size of harvested iliac crest ranged from 6 cm x 3 cm to 9 cm x 3 cm. The size of harvested internal oblique muscle of abdomen ranged from 5 cm x 4 cm to 7 cm x 5 cm. The patients were followed up for 6 months to 26 months (mean, 13 months) with satisfactory results and no complication. Mandibular panoramic radiographs showed new bone formation and good union.

CONCLUSIONSVascularized composite flap with iliac crest and internal oblique muscle of abdomen has the advantages of abundant bone volume, as well as soft tissue reconstruction in one stage. The reconstructed mandible can attain normal function and appearance.

Abdominal Muscles ; transplantation ; Abdominal Wall ; Humans ; Ilium ; transplantation ; Mandibular Reconstruction ; methods ; Reconstructive Surgical Procedures ; methods ; Surgical Flaps ; blood supply ; transplantation

Objective To explore the expressions and significance of Yes-associated protein (YAP) and large tumor suppressor gene 1 ( LATS1 ) in renal clear cell carcinoma (RCCC).Methods There are 30 cases of RCCC,15 males and 15 females.The median age was 63 (36 - 77) years.There were 17 cases of stage Ⅰ - Ⅱ,13 cases of stage Ⅲ - Ⅳ.There were 8 cases well differentiated,13 cases moderately differentiated and 9 cases low differentiated.The expressions of YAP,LATS1 mRNA and proteins in 30 cases of RCCC and normal renal tissues were tested by RT-PCR and immunohistochemistry,and were analyzed with clinical data.ResultsThe expression level of YAP mRNA in RCCC was higher than that in normal renal tissues (0.569 ± 0.066 vs 0.515 ±0.068,P =0.003 ),and the level of LATS1 mRNA in RCCC was lower than that in normal renal tissues (0.454 ± 0.115 vs 0.514 ± 0.093,P =0.029 ).Thepositive rate of YAP proteins in RCCC was obviously higher than that in normal renal tissues (63.3％ vs 33.3％,P =0.020),and the positive rate of LATS1 proteins in RCCC was lower than that in normal renal tissues (46.7％ vs 76.7％,P =0.017).The positive rate of YAP proteins was 33.3％ in well differentiated tissues,61.5％ in moderately differentiated tissues and 88.9％ in low differentiated tissues ( P =0.018),and the positive rate of LATS1 proteins was 75.0％ in well differentiated tissues,53.8％ in moderately differentiated tissues and 11.1％ in low differentiated tissues (P =0.024).The positive rate of YAP proteins was 47.1％ in stage Ⅰ - Ⅱ and 84.6％ in stage Ⅲ - Ⅳ ( P =0.034 ),and the positive rate of LATS1 proteins was 64.7％ in stage Ⅰ - Ⅱ,23.1％ in stage Ⅲ - Ⅳ ( P =0.024 ).ConclusionYAP and LATS1 play important roles in the development of renal clear carcinoma,and may become new targets in the treatment of RCCC.

Objective To explore the operation of C-type osteotomy for reduction of prominent zygomatic complex. Methods Based on the severity and characteristics of prominent zygomaitc complex, Ctype osteotomy was designed for the malar complex reduction by using oral and minor pre-auricular approaches under general anaesthesia. Two paralleled osteotomic lines of C-type were marked from zygomatic alveola to the conjunction of lateral orbital margin and zygomatic arch through the inferio-lateral edge of orbit. The extension of zygomatic arch reduction was determined the width of two osteotomic lines. The bone which marked lines was removed by reciprocating saw and osteotome. The zygomatic arch root was osteotomiced by pre-auricular approaches. Then, the zygomatic complex could move freely towards superior-medial position. Finally, the zygoma was fixed with titanium mini-plates. Results 12 patients with prominent zygomatic complex had been successfully operated by C-type osteotomy from July 2006 to April 2009. Of them, six cases were symmetrical and six cases were unsymmetrical. Postoperative follow-up for 4-24 months, infection was not occurred, and the scar of pre-auricular incision was not obvious. All the patients obtained positive results. Conclusion C-type osteotomy for correction of prominent zygomtic complex through intra-oral and minor pre-auricular approach is an effective surgical method and gives superior results. It preserves the intactness of maxillary sinus, prevents facial slack, and is especially effective for patients with prominent zygomatic arch.

To detect into the relationship between tibrosls an liver damage of liver and serum levels C-IV, HA and CG in patients with hepatic diseases． Methods:l63 cases of patients with hepatic disease cases and 60 cases of normal persons were studied, the three substances in serum of them were determined with RIA method． Results:The serum levels of above 3 substances were all high in l63 patients than that in normal persons． Statistics of these data shows that the increasing of them is parallel direct to the degree of liver fibrosis． Conclus ion: It has important clinical significance to determine serum C-IV, HA and CG dynamically in patient s with hepatic diseases