Objective:A novel bile duct end-to-end anastomosis and percutaneous transhepatic cholangial drainage (PTCD) were designed to treat iatrogenic bile duct injuries, and the clinical efficacy and technical advantage of this combined treatment were analyzed.Methods:Clinical data from 11 patients with iatrogenic bile duct injuries treated between February 2012 to July 2021 was retrospectively analyzed. There were 4 females and 7 males, with age of (47.5±15.3) years old. The types of bile duct injuries were: Bismuth type 1 ( n=7), Bismuth type Ⅱ ( n=1), Bismuth type Ⅲ type ( n=1), combined Bismuth type 1 and type 2 ( n=1), and Bismuth type Ⅳ ( n=1). Repair operations were performed at the time of the initial surgical procedures in 8 patients. The remaining 3 patients had their repair done 2 days, 9 days and 5 months, respectively, after the initial operations. All patients underwent successful bile duct end-to-end anastomosis and PTCD without use of T-tubes. Results:All biliary injuries were successfully repaired with no operative mortalities. Two patients who underwent end-to-end anastomosis of common hepatic duct developed anastomotic bile leakage. The amount of bile leakage was small and bile leakage resolved with conservative treatment in 1 patients 3 days after surgery, and was treated successfully by percutaneous peritoneal drainage for 2 weeks in the other patient. There were no other complications, including stricture formation or cholangitis which developed in other patients. All patients’ liver functions recovered well. The percutaneous biliary drainage tube was removed 6 months after operation in 1 patient. The remaining patients had their drainage tubes removed 3 months after operation. On follow-up, all patients had no history suggestive of cholangitis, jaundice and other symptoms. The liver functions were normal on laboratory examinations. No stricture or dilatation of intrahepatic bile ducts were detected on imaging examinations. The cure rate was 100% (11/11).Conclusion:Surgical repair of biliary tract injuries should aim to preserve sphincter of Oddi function and maintain normal physiological pathway of bile excretion. PTCD helped smooth recovery of an end-to-end anastomosis, lowered severity of physical disability of patients and minimized occurrence of medical disputes.

Objective To investigate the clinical characteristics,diagnosis and treatment of primary abdominal cocoon.Methods The clinical data of 16 cases of primary abdominal cocoon were reviewed and analyzed.Results Only in 2 cases in which correct preoperative diagnosis was estabished by CT scan.The other 14 cases were diagnosed during operation.Parts or all small intestines were covered with a layer of milky white dense fibrous thin membrane,formed mass-likely adhesion,and fibrous film attached to the mesenteric roots.Extensive adhesion existed in between intestines.The operation included lysis of peritoneal adhesion plus fibrous membrane excision in 14 cases,lysis of peritoneal adhesion plus fibrous membrane excision and segmental enterectomy in 2 cases,and in 2 cases appendectomy was done.There was no anastomotic leakage or other major complications except for wound infection in 1 case.All the patients were followed up from 3 months to 7 years with a median follow-up time of 3.6 years,and no recurrent cases were found.Conclusions Surgery is the main method for the treatment of abdominal cocoon with evident clinical symptoms,and the prognosis is largely fair.

Objective To investigate early diagnosis and treatment of Paget disease of breast. Methods The clinicopathological data of 26 cases of breast Paget disease in the First Affiliated Hospital of Wenzhou Medical University from January 1995 to June 2018 was analyzed. Results The main clinical manifestation of 26 patients was eczema like papillae in 19 cases (73.1%), and associated with nipple discharge in 9 cases (34.6% ) and breast mass in 6 cases (23.1% ). The diagnosis of this disease was based on curettage cytology in 4 cases (15.4% ), biopsy in 8 cases (30.8% ), and needle aspiration cytology or post resection pathological examination in 14 cases (53.8% ). Paget disease consisted of simple papillary Paget disease in 3 cases (11.5%), ductal carcinoma in 18 cases (69.2%) and invasive ductal carcinoma in 5 cases (19.2%). Pathological TNM staging was 0 stage in 19 cases (73.1%), stageⅠin 3 cases (11.5%), stageⅡin 2 cases (7.7%), stageⅢin 2 cases (7.7%) and no stage inⅣcase. In this group, 2 cases underwent radical mastectomy, 18 cases underwent modified radical mastectomy, 4 cases underwent simple mastectomy, and 2 cases underwent mastectomy combined with low axillary lymph node dissection and intraoperative rapid frozen examination. Fourteen patients received adjuvant chemotherapy with CEF(cyclophosphamide + pharmorubicin + tegafur)/EC (pharmorubicin + cyclophosphamide) + T(docetaxel) or TP(docetaxel + cis- platinum)regiment after operation, 2 cases were treated with trastuzumab targeted therapy and 5 cases with adjuvant radiotherapy. Twenty-five of 26 patients were followed up for 8-108 months except one patient lost in follow-up. The 5-year survival rate was 96.0% (24/25), and the 10-year survival rate was 52.0% (13/25). Conclusions The diagnosis of Paget disease of the breast depends on cytology or pathology, and multidisciplinary treatment based on surgery is judged of by tumor stage and coincident other types of breast cancer and axillary lymph node involvement.

Objective To investigate the clinicopathological features of abdominal lymphangioma and its diagnosis and treatment.Methods The clinical data of 37 patients with abdominal lymphangioma were analyzed retrospectively.Results The clinical presentations were slight abdominal distention and discomfort in 6 cases (16％),abdominal pain or lumbago in 13 cases (35％),found by health screening in 14 cases (38％) and abdominal mass in 4 cases (11％).Tumor located in retroperitoneal space in 20 cases,small bowel in 7 cases,colon mesentery in 4 cases,small mesentery in 2 cases,duodenum in 2 cases,stomach in one case and pancreas in one case.The surgical procedures were complete resection in 31 cases and incomplete resection in 6 cases.Except 3 cases lost to fol]ow-up,no recurrence was found during the postoperative follow-up period.Conclusions It is difficult to diagnose abdominal lymphangioma before operation,and complete resection of tumor is the first choice.

Objective To investigate the clinical characteristics,surgical treatment and outcome for patients with duodenal stromal tumor.Methods Data of 40 patients with stromal tumor of duodenum were reviewed retrospectively.Results All patients received resection including local resection in 14 cases,segmental resection of the duodenum in 17 cases,and pancreaticoduodenectomy in 9 cases.38 cases were followed-up,and two were lost.The median follow-up was 59 months (range 3-240 mos).The 1,3,and 5-year overall survival rates were 92％,76％ and 68％,respectively.No recurrence was found in very-low-risk tumor (n =1) and low-risk turmors (n =4).The 1,3,and 5-year overall survival rates for intermediate-risk tumors were 95％,80％ and 70％,respectively;and those were 69 ％,31％,and 0 for high-risk tumors,respectively.14 of 33 cases (42％) suffered from recurrence after radical resection for intermediate or high-risk tumors.33 postoperative cases received treatment with Imatinib (Glivec) for more than one year,and one case developed recurrence at 2.5 years after operation.4 patients with synchronous liver metastasis received palliative resection and Imatinib,and two survived more than 1 year.Conclusion Surgery is the first choice for duodenal stromal tumor,and Imatinib should be administered for high-risk disease after surgery.

Objective To study the diagnosis and surgical treatment of primary sarcoma of liver in order to obtain a better understanding of this disease and to improve its clinical treatment.Methods The clinical data on the clinicopathological features,surgical treatments and prognosis of 17 patients with primary liver sarcoma who were treated from January 2001 to May 2016 were retrospectively analyzed.Results Of 17 patients with primary sarcoma of liver,elevation of preoperative serum AFP was detected in one patient (5.9％),HBsAg positivity in 3 patients (17.6％),elevation of CEA in 2 patients (11.8％) and abnormal liver function in 3 patients (17.6％).The main clinical symptoms included epigastric pain in 9 patients,epigastric distention in 7 patients,loss of appetite in 5 patients (including in one patient after resection of gastric carcinoma).Twelve of these 17 patients underwent resection (resection rate 64.7％).Five patients underwent laparotomy and biopsy.Among patients who were treated with surgical resection,10 patients had R0 resection and 2 patients had R1 resection.Postoperatively,5 of these patients underwent adjuvant selective hepatic arterial infusion chemotherapy (mitomycin + fluorouracil + epirubicin),and 4 patients were treated with adjuvant systemic chemotherapy (vincristin,cisplatin,cyclophosphamide and Doxorubicin).The postoperative 1,3 and 5-year overall survival rates for all the patients were 58.8％ (10/17),29.4％ (5/17) and 11.7％ (2/17),respectively.In patients with liver resection,the survival rates were 83.3％ (10/12),41.6％ (5/12) and 16.7％ (2/12),and for R0 resection,100.0％ (10/10),50.0％ (5/10) and 20.0％ (2/10),respectively.Condusions The diagnosis of primary sarcoma of liver was difficult before operation.High survival rate could be achieved by radical resection and adjuvant chemotherapy.

Objective To observe the regulatory effect of acupotomy lysis on SP level in spinal cord and tissues above spinal cord of rats with knee osteoarthritis.Methods 60 healthy SD rats were randomly divided into normal control group,model group,electro-acupuncture(EA)group,and acupotomy lysis(AL)group.Mix 4%papain solution with 0.3 mol/L cysteine solution in the ratio of 1∶1.After pausing for 0.5h,inject the mixture,20 μl each time,into the left knee joint cavities of rats in model,AL,and EA groups on the day of 1,4,7.After 4 weeks AL group was treated with acupotomy lysis and EA group with electro-acupuncture.Three weeks after treatment,take samples of spinal cord,midbrain,pituitary gland,thalamus,and hypothalamus from the swellings of rats'waists.Measure the content of SP therein separately.Results Compared with normal control group,there was a significant rise in the content of SP in spinal cord and the tissues above spinal cord of model group rats (P＜0.05,P＜0.01),and there was a significant rise in spinal cord,pituitary gland,thalamus and hypothalamus of EA group rats (P＜0.05,P＜0.01);in AL group,there was a significant rise in spinal cord,pituitary gland,thalamus,and there was no statistically difference in hypothalamus and midbrain.Compared with normal control group,there was a significant rise in spinal cord (P＜0.05)and a significant decrease in the SP contents in hypothalamus(P＜0.05,P＜0.01)in EA group.There was no statistically difference between EA group and AL group except in hypothalamus(P＜0.05).Conclusion Acupotomy lysis has positive functions in regulating SP content in centrum of rats with knee osteoarthritis,which helps easing pain.

Objective To evaluate the clinical effects of endobronchial ultrasound - transbronchial needle aspiration (EBUS-TBNA) in the evaluation of staging of lung cancer.Methods Between July 2008 to March 2010,the first 128 patients selected by CT or PET/CT scanning with lung cancer in whom metastatic carcinoma in the hilar and/or mediastinal lymph nodes underwent EBUS-TBNA and were clinically followed up.There were 102 males and 26 femals with the age of 37 - 85 years,average 60.1 years.Review the performance in check and the result of biopsy.Results From 128 patients of mean age 60.1 years ( range 37 - 85 ),189 lymph nodes were punctured.The mean diameter of the nodes was 12.3 mm and the range was 6-16 mm.There were no procedural complications.Accuracy,sensitivity,and specificity for EBUS-TBNA were 98.53％,98.50％,and 100％,respectively.Conclusion EBUS-TBNA allows real-time visualization of mediastinal and hilar lymph nodes,allowing sampling safely and efficiently.It has great potential for diagnosis of staging of lung cancer.

Objective To investigate the diagnosis and therapy of the sclerosing hemangioma of the lung.Mothods The case history of 15 patients were analyzed retrospectively and summarized the diagnosis and therapy of the Sclerosing hemangioma of the lung.Results There were 2 males and 13 females(1:6.5).No patients were diagnosed this disease before operation for there were no specific imageology features.The tumor cell indicated pantomorphia and there were 3 cases were misdiagnosed during the operation frozen section pathology.The optimization therapy methods was to resect the tumor with the VATS.The prognosis of this disease was well and there were no cases recurrence in these 15 patients.Conclusion The sclerosing hemangioma of the lung was the benign tumor and there were no specific imageology features.The misdiagnosis was frequently before operation.To resect the tumor with the VATS was the optimal therapy method.

Objective To report the experience of lung transplantation with size reduced graft lung.Methods Four cases receiving lung transplantation with size reduced graft lung were analyzed retrospectively.In case 1,left lung transplantation combined with contra-hteral lung volume mduction.In case 2,right lung transplantation Wag individually performed with partially msecfion of upper lobe of graft lung.In case 3.bilateral sequential lung transplantation wag performed using graft lung with partially resection of bilateral upper lobes.In the remained ease,bilateral sequential lung tansplantation was performed using graft lung with resection of right lower lobe.Results All the size reduced graft lungs had good functions during the peri-operation period.Case 1 and case 2 still survived without obvious complication.Case 3 experienced temporary air leak on the 5th day postoperation and cured by water seal drainage but died of abrupt bronchorrhea due to aspergillus infection on the 32th day postoperation.The last cage experienced smoothly recovery excepted fatal virus pneumonia 2 months postopemtion.Conclusion Size reduced graft lungs can be successfully used for transplantation.