Satisfactory Short-term Outcome Research Articles

A case report of gastric antral vascular ectasia treated by endoscopic band ligation combined with lauromacrogol injection.

Gastric antral vascular ectasia (GAVE) is a rare acquired lesion characterized by vascular dilation in the gastric antrum, frequently results in occult or overt gastrointestinal bleeding. Endoscopic intervention remains the cornerstone of therapy. Argon plasma coagulation was previously considered a first treatment option. But recently, endoscopic band ligation (EBL) has emerged as an alternative, increasingly favored for its safety and efficacy. Nonetheless, a consensus on the most effective treatment approach has yet to be established. A 74-year-old female was hospitalized for persistent chest tightness and dyspnea for 1 year. Physical examination showed an anemic appearance with normal blood pressure. Upon admission to the hospital, the blood routine examination revealed severe anemia and the fecal occult blood test was persistently positive. The endoscopic observations and histological evidence led to a diagnosis of GAVE for the patient. Considering the poor response to prior pharmacotherapy, endoscopic intervention was selected for this hospitalization. The initial EBL alone did not yield particularly satisfactory results. Combining EBL with lauromacrogol injection as a subsequent treatment resulted in encouraging outcomes. At the 6-week follow-up, the patient exhibited a negative fecal occult blood test, normalization of hemoglobin level, and endoscopic images demonstrated near complete resolution of vascular ectasias. The combination of EBL with lauromacrogol injection has shown a satisfactory short-term outcome, providing a new option for the endoscopic management of GAVE. However, its long-term efficacy still requires further observation.

Role of ablative therapy for squamous cell neoplasia of esophagus

: Esophageal squamous cell neoplasia (ESCN) is the histologic precursor to esophageal squamous cell carcinoma (ESCC), which causes a large burden of disease across the world. Over the past years, on account of the rapid development of endoscopic techniques with highly effectiveness and less invasiveness, the management of ESCN had changed from radical esophagectomy towards endoscopic therapeutics, including endoscopic resection (ER) and ablation techniques. Compared with ER, ablative techniques offer more convenient and safe modality, showing a reasonable efficacy and promising results in eradicating ESCN. Two most widely used ablative therapies for ESCN are radiofrequency ablation and cryoablation. Radiofrequency ablation ablates tissue through heat, while cryoablation coagulates tissue through cold. Recent data show that radiofrequency ablation is highly effective and durable in the removal of early ESCN, and demonstrates a lower rate of stenosis in treating large and extensive ESCN. Meanwhile, cryoablation also demonstrates relatively satisfactory short-term outcome in eradicating ESCN. However, there is still a risk of recurrence and residual lesions for both RFA and cryoablation when treating ESCN. Considering that complete tissue destruction of ablation does not allow histological assessment, staging the neoplasia and deciding which patient may be an ablation candidate before treatment is of great importance, and endoscopic surveillance with Lugol’s chromoendoscopy is also necessary to detect any recurrence and metachronous lesions. Moreover, a combination approach of ER with ablation therapies has promising results in selected patients, and may provide minimally invasive and effective treatment. This review mainly focuses on the role of ablative therapy in practice for squamous cell neoplasia of esophagus.

182. LAPAROSCOPIC-ASSISTED SINGLE-PORT MEDIASTINOSCOPIC ESOPHAGECTOMY CAN PROVIDE A SAFE AND EFFECTIVE SURGICAL OPTION FOR PATIENTS WITH SPECIFIC ESOPHAGEAL CANCERS

Abstract The majority of traditional minimally invasive esophagectomies are transthoracic esophagectomies. However, transthoracic esophagectomy is often difficult to perform in some patients with pulmonary insufficiency, severe pleural adhesions, chest deformities, and poor tolerance for single-lung ventilation. For this reason, we propose laparoscopic-assisted single-port mediastinoscopic esophagectomy as a potential surgical treatment for patients who are unsuitable for transthoracic esophagectomy. The goal of this study was to report the effectiveness and safety of its treatment. This study retrospectively collected clinical data from hard-to-reach transthoracic patients who underwent laparoscopic-assisted single-port mediastinoscopic esophagectomy at our center from October 2016 to August 2021 to report their perioperative treatment outcomes. Data for continuous variables are expressed as mean ± standard deviation, and categorical variables are expressed as n [%]. All data were analyzed using SPSS 25.0 software. A total of 8 cases were included and all completed the surgery successfully. The average operating time was 266.14 min, the average intraoperative bleeding was 114.29 mL, the average number of lymph nodes obtained was 13.29, the average number of recurrent laryngeal nerve (RLN) lymph nodes was 3.14, the rate of RLN lymph nodes obtained was 75%, the average postoperative hospital stay was 22.29 days. Postoperative complications included type I vocal cord paralysis [37.5%], anastomotic leak [25%], pneumonia [12.5%], pleural effusion [25%], and type I Chyle Leak [12.5%], with no perioperative deaths. There was one recurrence and no death within 1 year postoperatively. The results of this study suggest that laparoscopic-assisted single-port mediastinoscopic esophagectomy can provide a safe and effective treatment option for patients with esophageal cancer who have difficulty undergoing transthoracic esophagectomy and can achieve a more satisfactory short-term survival outcome.

The Efficacy and Outcome of a Two-Staged Operation for Irreducible Knee Dislocation: A Prospective Short-Term Follow-Up.

Background: Irreducible knee dislocation (IKD) is a very rare but serious type of knee dislocation; it can lead to soft tissue necrosis due to incarceration of the medial structures and faces great difficulty in the postoperative rehabilitation, too. IKD needs careful pre-operative planning. There is no universal agreement about the appropriate surgical strategy for IKD. The purpose of this study was to investigate the clinical efficacy, safety, and outcome of the two-staged operation in treatment of IKD. Methods: IKD patients were included from June 1, 2016 to May 31, 2020. In the stage-1 surgery, acute reduction and extra-articular structure repair were performed. Following an intermediate rehabilitation, delayed cruciate ligament reconstructions were performed in stage-2. Physical examination, CT, MRI, and X-ray were performed during the pre-operative period. Knee function, joint stability, ligament laxity, knee range of motion (ROM), and alignment were accessed at follow-ups. The minimum and maximum follow-up times were 0.5 years and 1 year, respectively. Results: In total, 17 IKD patients were included. There were three subjects (17.65%) missing at the 1 year follow-up and the average follow-up was 11.18 ± 2.53 months. After stage-1, normal alignment and superior valgus/varus stability were restored in most subjects; however, a notable anterior–posterior instability still existed in most patients. The intermediate rehabilitation processed smoothly (6.94 ± 1.20 weeks), and all patients achieved knee ROM of 0–120° finally. At 0.5 years and 1 year follow-up after stage-2, all subjects had achieved normal knee stability, ROM, and satisfying joint function. No infection or DVT was observed. Conclusions: The two-staged operation for IKD has superior efficacy on knee stability and function, and it can facilitate the rehabilitation and achieve satisfactory short-term outcome.

The Progressive Loss Risk Scale for Hair Restoration Surgery.

Limited information exists on the long-term risks to individuals undergoing procedures in hair restoration surgery. The short-term risks are well known and similar to other procedures in dermatologic surgery. The long-term risks of hair restoration surgery are seldom discussed between the physician and patient. The author sought to describe a classification system that can be used as a communication tool between physicians and patients to define the long-term risk involved with hair restoration surgery. The Progressive Loss (PL) Scale is an attempt at assessing the cosmesis because of future hair loss following a hair transplant procedure. The PL Risk Scale has designated 5 levels, 1 to 5, with each ascending level representing a higher level of risk. The PL Risk Scale can be assigned to an individual at the time of the assessment for hair restoration surgery. Each patient can be assigned a risk level based on how future hair loss may affect the overall cosmetic result of their hair transplant. This risk is dependent on age, and specific for the area to be transplanted. The younger the age of the patient, the higher the risk. The larger the area to be transplanted, the higher the risk. It is not a static scale, because it will be affected by age, donor area, location of transplantation, and other mitigating factors. Pattern baldness in men and women is progressive and unrelenting. The dichotomy of hair restoration surgery is that a satisfactory short-term outcome can evolve to disappointing results because of progressive hair loss. The PL Risk Scale can be assigned to every individual undergoing a hair restoration procedure. This scale assignment will convey to the patient their lifetime risk associated with any given surgical hair restoration procedure for that age and the specific area to be restored.

A New Generation of Osteochondral Autograft Transfer System for the Treatment of Osteochondritis Dissecans of the Femoral Condyle: Clinical Experience in 18 Dogs.

The aim of this study was to describe the clinical application and outcome of osteochondral autograft transfer using the COR system (COR; DePuy Synthes, Warsaw, Indiana, United States) for the treatment of osteochondritis dissecans (OCD) of the femoral condyle in dogs. Medical records of dogs that were treated for OCD of the femoral condyle using the COR system between February 2013 and March 2020 were retrospectively reviewed. The results of pre- and postoperative clinical and radiographic examinations were evaluated. Twenty stifles (18 dogs; 15 lateral and 5 medial femoral condyles) met the inclusion criteria. A single graft transfer was done in six stifle joints and mosaicplasty in 14 (2 grafts in 9/14 stifles; 3 grafts in 5/14 stifles). Proper anatomic reconstruction was confirmed intraoperatively and radiographically in all dogs. There were no major and three minor postoperative complications. At 3 months, 15 of 20 stifles (14 of 18 dogs) had no lameness or radiographic signs of inflammation. At 6 months, 12 of 13 dogs had no lameness or discomfort, and four of 13 stifles had radiographic evidence of moderate osteoarthritis. Treatment of OCD of the femoral condyle using the COR system is feasible in dogs, with low complications and provides a satisfactory short-term outcome.

Effectiveness of pigtail catheter crushing combined with AngioJet mechanical aspiration for treatment of acute left iliofemoral vein thrombosis

We investigated the efficacy of combined pigtail catheter crushing and AngioJet mechanical aspiration of thrombi in the treatment of acute iliofemoral deep venous thrombosis (DVT). Eighty-two patients with acute iliofemoral DVT were retrospectively divided into a pigtail catheter+AngioJet group (group A, 42 cases) and an AngioJet-only group (group B, 40 cases). The difference in the circumference of the healthy limbs before and after treatment, immediate thrombus clearance rate in the lower limbs, recannalization percentage of venous lumen, and duration of postoperative hematuria were compared to evaluate the safety and effectiveness of the combination method. The technical success rate was 100%, no serious bleeding complications occurred, lower extremity symptoms were effectively alleviated, and post-treatment recannalization percentage of venous lumen were similarly high in both groups. Group A fared significantly better than group B in immediate thrombus clearance (P<0.05), intraoperative aspiration time (199.38±68.55 vs. 295.30±76.02s), postoperative CDT urokinase dosage (2.10±0.94 vs. 3.07±0.94 million units), and duration of postoperative hematuria (13.23±2.96 vs. 16.75±3.11h) (all P<0.001). At 6 months, the recannalization percentage of venous lumen of group A and group B was 89.71±16.02% and 88.64±16.68%, respectively. The combination of pigtail catheter crushing and AngioJet mechanical aspiration of thrombi for acute left iliofemoral vein thrombosis is safe, easy, and effective, with a satisfactory short-term outcome.

COVID-19 in a child with down syndrome and extensive pulmonary tuberculosis: a case report

Abstract Introduction: although pediatric patients have comparatively fewer cases of COVID-19, children with Down Syndrome exhibit comorbidities such as immunodeficiency, diabetes and, in this perspective, are considered a population at risk for severe COVID-19. In addition, the literature also points to an unfavorable perspective on co-infection with Mycobacterium tuberculosis, considered an important comorbidity and a predictor of a worse clinical outcome. Description: female child, nine years old, with Down Syndrome, congenital heart disease and prematurity, with significant weight loss and intermittent fever for six months. A week ago, she had an intensification of fever, productive cough and mild respiratory distress. RT-PCR for SARS-CoV-2 detectable in nasopharynx swab, chest X-ray with diffuse alveolar infiltrate, chest CT with consolidations, excavation, solid micronodules in a sprouting tree pattern mainly in the right upper and lower lobes. Molecular rapid test for Mycobacterium tuberculosis detectable in gastric lavage. After specific treatment, the patient progressed well and was discharged from the hospital after 72 hours without fever and improvement in her breathing pattern. Discussion: despite the extensive pulmonary involvement, the patient did not require invasive ventilatory support and presented a satisfactory short-term outcome. Therefore, the relevance of the association of Tuberculosis and COVID-19 and other comorbidities in the pediatric age group still remains uncertain.

Treatment of type IV Pipkin fracture in patients with a high BMI via hip arthroscopy-assisted surgery: a case report.

Pipkin type IV femoral head (FH) fracture–dislocations are usually treated via open surgery. There are many surgical approaches for the treatment of this difficult fracture depending on the fracture pattern. Obesity presents another challenging problem in surgical treatment and sometimes leads to a poorer outcome. We discuss herein a patient of a high body mass index (BMI) with a Pipkin type IV FH fracture who underwent open reduction internal fixation (ORIF) of anacetabular fracture with reconstruction plates and hip arthroscopy-assisted fixation of the FH fracture with two Herbert screws via the posterior approach. The intra-articular osteochondral loose bodies were excised by hip arthroscopy simultaneously. The joint congruency and screw positions were checked during surgery by arthroscopy. After 6 months, clinical and computed tomography (CT) follow-ups showed excellent results. The patient of a high BMI recovered immediately and had a satisfactory short-term outcome after hip arthroscopy-assisted surgery. We concluded that hip arthroscopy-assisted surgery is a viable option for the treatment of Pipkin type IV FH fracture–dislocations.

Satisfactory short-term outcome of total laparoscopic loop ileostomy reversal in obese patients: a comparative study with open techniques.

Reversal of loop ileostomy after colorectal surgery in obese patients can be challenging and total laparoscopic (TLAP) approach may be beneficial. This study aims to compare short-term outcomes of TLAP and open approaches in obese patients undergoing loop ileostomy reversal after laparoscopic-assisted colorectal surgery. A retrospective review was performed for consecutive patients who underwent laparoscopic-assisted colorectal surgery previously and underwent loop ileostomy reversal between January 2017 and April 2020. TLAP and open cases performed in obese patients were identified and compared for the following outcomes: baseline characteristics, operative outcomes, postoperative recovery, and postoperative complications. TLAP or open-loop ileostomy reversal was performed on 30 and 34 patients, respectively. TLAP approach was associated with a similar operation time and blood loss compared with an open approach (P > 0.05). The median length of incision for stoma removal was significantly shorter in the TLAP group than in the open group (6.5cm vs. 8.5cm; P < 0.05), and a lower incidence of incisional infection was also noted in the TLAP group (6.7% vs. 26.5%; P < 0.05). The groups were comparable as regards the time to ground activities and length of hospitalization (P > 0.05), but the time to first flatus was decreased (2.0 vs. 3.0days; P < 0.05). This retrospective study demonstrated that TLAP loop ileostomy reversal may have a satisfactory short-term outcome for obese patients after laparoscopic-assisted colorectal surgery, with a shorter incisional length and a lower incidence of incisional infection as well as an earlier time to first flatus.

AN ISOLATED PALMAR SCAPHOID DISLOCATION WITH UNDISPLACED FRACTURE: A CASE REPORT AND REVIEW OF LITERATURE

Isolated carpal scaphoid dislocation is an extremely uncommon injury. Various methods have been used to treat the scaphoid dislocations, which involves open reduction and K-wire fixation with or without ligament repair or just closed reduction and cast application. The rarity of this injury has led to the proposal of vague and sometimes conflicting treatment strategies. In this article, we report a case of isolated palmar dislocation of scaphoid with an undisplaced fracture. Even though isolated dislocations of scaphoid have been reported before, this particular injury pattern of isolated dislocation with a fracture through the waist of scaphoid has not been reported before to the best of our knowledge. This case was managed by closed reduction, percutaneous Herbert screw fixation, and cast immobilization for 6 weeks, which produced a satisfactory short-term outcome.

Analysis of Presentations and Outcomes of Care of Children with Disorders of Sexual Development in a Nigerian Hospital.

To describe the presentation, diagnosis, management, and short-term outcome of children with disorders of sexual development (DSD) in the context of multidisciplinary team care. Prospective descriptive study. University Teaching Hospital. All children who presented with genital ambiguity. Records of all patients diagnosed and managed for DSD between January 2011 and December 2016 were reviewed. The care pathway included clinical, laboratory, internal genitalia evaluation, and panel (including parents) meeting. Fifteen children presented with DSD at a median age of 20months. Only 5/15 (33.3%) presented in the neonatal period. Ten of fifteen patients (66.7%) presented with genital ambiguity. Ovotesticular DSD was the most common diagnosis (9/15; 60%). Seven of the patients were genetically female (46, XX), 1 was genetically male (46, XY) and 1 without genetic diagnosis. Six patients were assigned male gender and they underwent male genitoplasty. Five of them had excision of Müllerian structures with gonadectomy. Three of fifteen patients (20%) were diagnosed as 46, XX DSD, at a median age of 7years. All of them were due to congenital adrenal hyperplasia and underwent female genitoplasty. Two patients were diagnosed as XY, DSD. They were both raised as female at presentation and were reassigned male sex. Both had urethroplasty done. Four patients had postoperative urethrocutaneous fistula and 1 had partial wound dehiscence. The median follow-up period was 21months (interquartile range, 2-26months). The frequency of ovotesticular DSD is high in our setting. The decision of sex assignment was finally made at a median age of 7.5months in most of our patients with satisfactory short-term surgical outcome.

Satisfactory Short-Term Results of Navigation-Assisted Gap-Balancing Total Knee Arthroplasty Using Ultracongruent Insert

The use of highly conforming ultracongruent (UC) polyethylene insert is bone-preserving and became a relatively common alternative to the conventional posterior stabilized total knee arthroplasty (TKA) design. The purpose of this study was to analyze the short-term clinical and radiologic results of UC insert TKA using the navigation-assisted gap-balancing technique. Two hundred thirty-three knees were operated with a mean follow-up period of 8.1 years (minimum of 5 years). Radiologic and clinical outcomes were assessed before operation and at latest follow-up using the Knee Society Score and Western Ontario and McMaster Universities Osteoarthritis Index score. For statistical analysis, paired sample t-test and analysis of variance were used. Significance was considered as P < .05. According to the preoperative deformities (valgus, mild varus, and moderate varus), there were 23 cases (9.9%) of valgus deformity, 180 cases (77.3%) of mild varus deformity, and 30 cases (12.9%) of moderate varus deformity. Overall, the results at mean 8.1 years revealed an improvement in mean Knee Society Score (54 ± 12 to 92 ± 3) and mean Western Ontario and McMaster Universities Osteoarthritis Index scores (62 ± 14 to 17 ± 3). Overall, 220 of 233 cases (94.4%) were in neutral alignment (between-3° and+3°) at latest follow-up. There were no migrating or shifting prosthesis that should be considered as possible failure. There was 0% component revision rate. Navigation-assisted gap-balancing technique using UC insert TKA had satisfactory short-term outcome. Strict gap-balancing technique using the offset-type-force-controlled-spreader-system aided in the satisfactory results.

Clinical effects of mini-locking plate with vertical or parallel technology for treatment of Dubberley type B capitellar fractures

Objective To investigate the clinical effects of mini-locking plate with vertical or parallel technology in the treatment of Dubberley type B capitellar fractures. Methods A case series study was done on clinical data of 17 cases of Dubberley type B capitellar fractures treated through operation with vertical or parallel mini-locking plate. There were 12 males and 5 females, with age range of 23-77 years (mean 56.4 years). The fractures were classified according to the Dubberley system, including type ⅠB in 2 cases, ⅡB in 6 and type ⅢB in 9. The operations were conducted through the Kocher approach at posterior-lateral rear elbow joint and the fractured bone was fixed firstly with Kirschner wire and mini screws after resetting and then with vertical or parallel mini locking plate. The surgery time and bleeding volume during the surgery were recorded. The position of fracture, healing, avascular necrosis of capitellum, heterotopic ossification, and traumatic arthritis were evaluated. At the final follow-up, the Mayo elbow performance score (MEPS) was used to evaluate the function of elbow, and flexion and extension of the elbow, swing of the forearm and inner stability of the elbow joint were evaluated. Results The surgery time was 50-90 minutes (mean 60 minutes). The bleeding volume during surgery was 40-120 ml (mean 60 ml). All patients were followed up for 12-24 months (mean 12.1 months). Anatomical reduction was seen in 12 cases and almost anatomical reduction in 5. None had vessel or nerve wound, and the wound was healed at phase Ⅰ within 10-12 days after operation. The clinical fracture healing time was 8-12 weeks (mean 11.4 weeks). At the final follow-up, the fractures were well healed without complications like fracture reduction loss, ischemic necrosis of the humerus, traumatic arthritis or heterotopic ossification of the elbow joint. MEPS in all cases was 60-100 points (mean 87.6 points). MEPS assessment result was excellent in 13 cases, good in 3 and fair in 1, with the excellent rate of 94%. At the final follow-up, the average activity of the elbow was 6 ° (0°-10°) for extension and 118° (90°-130°) for flexion, the average forearm pronation was 70° (60°-90°), the average forearm supination was 82°(70°-90°), and the inner stress test showed no instability. Conclusion Vertical or parallel mini-locking plate in the treatment of Dubberley type B capitellar fractures is associated with few complications, early functional exercise after operation, and satisfactory short-term outcome. Key words: Humeral fractures; Fracture fixation, internal; Mini-locking plate

Application of early total care in treatment of unstable pelvic fractures

Objective To evaluate the clinical effect of early total care (ETC) for treatment of unstable pelvic fractures. Methods This retrospective case series study included eighteen patients with unstable pelvic fractures treated surgically from May 2013 to May 2015. There were 11 male and 7 female patients, aged (45.1±13.1)years. Eleven patients were injured due to road traffic accidents and 7 due to fall from height. Tile B type pelvic fractures were seen in 8 patients and Tile C type in 10 patients. All patients were treated with ETC method and received open reduction and internal fixation within 24 to 48 hours after the primary treatment. Data were collected, such as operation time, intraoperative blood loss, hospital length of stay and perioperative complications. Majeed score and EuroQol 5 dimension (EQ-5D) were used for evaluation of clinical outcome and quality of life respectively. Excellent and good rate of operation was assessed using the Matta clinical evaluation standard. Results Three patients died and fifteen patients survived. Operation time was (120.1±22.2)minutes, amount of intraoperative blood loss was (355.9±56.4)ml, and hospitalization was (8.5±1.6)days. Incidence of perioperative complications was 56%, including 3 patients with acute respiratory distress syndrome, 1 pneumonia, 2 acute lung injury, 1 incisional wound infection, 2 multiple organ failure and 1 diffuse intravascular coagulation. All patients were followed up for (15.1±2.4)months (range, 12-21 months). Majeed score was decreased from preoperative (93.7±6.1)points to final follow-up of (74.1±9.2)points, and the EQ-5D index was decreased from preoperative 0.96±0.04 to final follow-up of 0.74±0.19 (both P<0.05). Excellent and good rate of operation was 80%. Conclusions ECT provides satisfactory short-term outcome for treatment of unstable pelvic fractures, but the incidence of complications is high. Doctors should choose reasonable treatment plan according to the surgical indications. Key words: Pelvis; Fracture fixation, internal; Postoperative complications

Initial experience of single-port video-assisted thoracoscopic surgery sleeve lobectomy and systematic mediastinal lymphadenectomy for non-small-cell lung cancer.

In this study, we evaluate the feasibility and safety of single-port video-assisted thoracoscopic surgery (VATS) sleeve lobectomy (SL) and systematic mediastinal lymphadenectomy and summarize our surgical experience. From October 2014 to December 2015, eight cases of single-port VATS SL [seven male patients and one female patient, median age 56.0 (range, 38-63) years] were performed by a single group of surgeons in Fujian Medical University Fujian Union Hospital. The median tumor size was 2.7 cm. Types of resection included four right upper, one right lower, and three left upper sleeve lobectomies. Systematic mediastinal lymphadenectomy was performed in all patients. A modified anastomosis technique developed by the author (Chen's technique) was applied for bronchial anastomosis. Postoperative outcome and short-term follow-up data were recorded and analyzed. All eight operations were completed uneventfully with no conversion to thoracotomy or reoperation required. No perioperative death was observed. Major results (medians or percentages) were as follows: operative duration, 234.5 [185-345] min; bronchial anastomosis duration, 38.0 [30-43] min; blood loss, 65.0 [50-200] mL; number of lymph node dissected, 22.5 [18-37]. The postoperative complication rate was 37.5% (three of eight cases, including two pulmonary infections and one atrial fibrillation). All patients recovered and were discharged uneventfully with symptomatic therapy. Pathology showed squamous cell carcinoma in seven patients and adenocarcinoma in one patient; two patients were in TNM stage IB, three in stage IIA, one in stage IIB, and two in stage IIIA. The mean follow-up was 7.5 [2-15] months. There were no tumor recurrences or bronchial anastomotic complications. Single-port VATS SL and mediastinal lymphadenectomy are safe and feasible. Improvements in operating procedures can help facilitate single-port VATS. The application of Chen's technique in bronchial anastomosis is easy and reliable and shows a satisfactory short-term clinical outcome.

Associating liver partition and portal vein ligation for staged hepatectomy in the treatment of hepatocellular carcinoma with cirrhosis

Objective To investigate the safety and clinical effect of associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) in the treatment of hepatocellular carcinoma (HCC) with cirrhosis. Methods The retrospective cohort study was adopted. The clinical data of 5 patients with primary HCC with cirrhosis who underwent ALPPS at the First Bethune Hospital of Jilin University between October 2014 and August 2015 were collected. The surgical plan was determined according to preoperative liver function and liver functional reserve. The patients underwent portal vein (PV) ligation and liver partition in the first staged surgery. The second staged surgery was performed when growing future live remnant (FLR) came up to the standard of safe section by rescan of computed tomography (CT) at 10, 14, 18 days after the first staged surgery, and hemi-hepatectomy and hepatic segmentectomy were applied to patients. (1) The intraoperative situations were observed, including the severity of liver cirrhosis, first staged surgery time, volume of intraoperative blood loss and FLR in the first staged surgery, interval time of surgery, growth rate of liver volume, ratio of FLR and standard liver volume (SLV), time and volume of intraoperative blood loss in the second staged surgery. (2) Pre- and post-operative biochemical indicators in the first and second staged surgeries were detected, including total bilirubin (TBil) and alanine phosphatase (ALT). (3) Postoperative situations were observed, including occurrence of complications, results of pathological examination and duration of hospital stay. (4) The follow-up using telephone reservation and outpatient examination was performed to detect tumors recurrence and metastasis and survival of patients by imaging examination and tumor marker test up to November 2015. Count data were represented as mean (range). Results (1) Intraoperative situations: of 5 patients, there were 1 patient with F3 of liver cirrhosis and 4 with F4 of liver cirrhosis. One patient was complicated with lots of peritoneal effusion, followed by acute renal failure, and didn't receive the second staged surgery. Four patients underwent successful ALPPS. The first staged surgery of 5 patients: average operation time, volume of intraoperative blood loss, FLR, interval time of surgery, growth rate of liver volume, ratio of FLR and SLV were 282 minutes (range, 240-320 minutes), 500 mL (range, 300-700 mL), 457 cm3 (range, 338-697 cm3), 15 days (range, 14-18 days), 58% (range, 46%-67%) and 42% (range, 32%-44%), respectively. Average operation time and volume of intraoperative blood loss in second staged surgery were 220 minutes (range, 200-260 minutes) and 412 mL (range, 300-600 mL). (2) Pre- and post-operative biochemical indicators: levels of TBil and ALT of 5 patients from pre-operation to postoperative day 12 in the first staged surgery were from 4.9-30.4 μmol/L to 9.8-56.1 μmol/L and from 12.9-156.1 U/L to 46.3-207.3 U/L, respectively. Levels of TBil and ALT of 4 patients from pre-operation to postoperative day 10 in the second staged surgery were from 10.1-21.2μmol/L to 6.9-38.0 μmol/L and from 30.8-55.5 U/L to 19.8-72.8 U/L, respectively. (3) Postoperative situations: there were no perioperative death and postoperative complications of liver failure and intraperitoneal infection. One patient complicated with bile leakage was cured by non-operative treatment for 30 days.Results of pathological examination: 5 patients were confirmed asⅡ-Ⅲ stage HCC, and 4 tumors had vascular tumor thrombi and negative resection margin with tumor size of 8-13 cm. Duration of hospital stay of 5 patients was 36 days (range, 28-48 days). (4) Results of follow-up: 4 patients undergoing successful ALPPS were followed up for 4-12 months. One patient was emerged with a new lesion of 2 cm in left half liver at postoperative month 7, level of AFP of which was 512 μg/L before the first staged surgery reduced to normal level at postoperative month 2, and then the patient received transcatheter arterial chemoembolization (TACE) and radio frequency ablation (RFA) treatments without tumor recurrence up to postoperative month 12. No tumor recurrence and new lesions in liver were detected in other 3 patients by abdominal enhanced scan of CT, with a normal level of AFP. Conclusion ALPPS is safe and feasible for HCC with cirrhosis, with a satisfactory short-term outcome. Key words: Liver neoplasms; Cirrhosis; Associating liver partition and portal vein ligation for staged hepatectomy; Future liver remnant; Liver regeneration

Clinical effect of totally laparoscopic radical resection for gallbladder cancer

Objective To investigate the safety and feasibility of totally laparoscopic radical resection of gallbladder cancer. Methods The retrospective cross-sectional descriptive study was adopted. The clinical data of 30 patients who underwent laparoscopic radical resection of gallbladder cancer at the Sun Yat-sen Memorial Hospital of Sun Yat-sen University from January 2013 to August 2015 were collected. The patients received synchronous hepatic segmental or extrahepatic bile duct resection according to the conditions of patients, and choledochojejunostomy was applied to patients undergoing extrahepatic bile duct resection. The patients accepted postoperative adjuvant chemotherapy according to the results of postoperative pathological examination. Observation indicators included (1) operation situations, including surgical procedures, operation time, volume of intraoperative blood loss and number of lymph node dissected, (2) postoperative situations, including time for out-off-bed activity, time for diet intake, time of drainage tube removal, occurrence of complications and duration of hospital stay, (3) results of postoperative pathological examination, including tumor stage and surgical margin, (4) postoperative adjuvant treatment, (5) follow-up situation including the survival of patients, tumor recurrence and metastasis. The follow-up using outpatient examination and telephone interview was performed to detect the survival of patients and tumor recurrence and metastasis up to December 2015. Count data were represented as average (range). Results All the 30 patients underwent successful laparoscopic radical resection of gallbladder cancer combined with hepatic S4b and S5 resection+ lymph node dissection at N1 region. Six patients with obstructive jaundice caused by tumor invaded to extrahepatic bile duct underwent combined laparoscopic extrahepatic bile duct resection+ Roux-en-Y hepaticojejunostomy, without perioperative death.The average operation time, average volume of intraoperative blood loss and average number of intraoperative lymph node dissected were 238 minutes (range, 178-430 minutes), 250 mL (range, 200-600 mL) and 7 (range, 4-15), respectively. (2) The patients got out-off-bed activity and normal diet intake at postoperative day 2, with a average time of drainage tube removal of 3 days (range, 0-25 days) and an average duration of hospital stay of 5 days (range, 3-28 days). Two patients with complications were cured by symptomatic treatment. (3) Results of postoperative pathological examination showed that all the patients received R0 resection, and pathological stage showed that 12 patients were detected inⅠB stage, 10 inⅡstage, 7 in ⅢA stage and 1 in ⅢB stage. (4) One patient in ⅢB stage (pT3N1M0 stage ) received gemcitabine+ cisplatin chemotherapy and other patients didn't receive the adjuvant treatment. (5) All the patients were followed up for a median time of 16 months (range, 4-32 months), without tumor recurrence and metastasis at Trocar puncture site. There were 25 patients with tumor-free survival and 5 patiens died of tumor recurrence. Conclusion Laparoscopic radical resection of gallbladder cancer is technically safe and feasible, with a satisfactory short-term outcome. Key words: Gallbladder neoplasms; Radical resection; Laparoscopy

Clinical effect of laparoscopic I-stage resection for colorectal liver metastasis

Objective To investigate the safety, feasibility and clinical effect of laparoscopic Ⅰ-stage resection of colorectal liver metastasis (CRLM). Methods The retrospective cohort study was adopted. The clinicopathological data of 11 patients who underwent laparoscopic Ⅰ-stage resection of CRLM at the Affiliated Tumor Hospital of Zhengzhou University from February 2012 to October 2015 were collected. The primary lesions were confirmed by preoperative colonoscopy, abdominal CT and pathological biopsy, and liver metastases were diagnosed by abdominal enhanced CT or MRI. Patients selected preoperative individualized adjuvant therapy according to their conditions, and then underwent laparoscopic Ⅰ-stage resection of CRLM. After operation, patients received adjuvant chemotherapy of FOLFOX6 (oxaliplatin+ calcium folinate+ fluorouracil) or FOLFRIRI (irinotecan+ calcium folinate+ fluorouracil) regimens. The pre-, intra- and post-operative indexes were recorded, including (1) location and diameter of tumor and preoperative treatment; (2) surgical method, volume of intraoperative blood loss, operation time, resection margin and number of lymph node dissected; (3) complications, result of pathological examination, time of gastrointestinal function recovery, time for diet intake, duration of hospital stay, adjuvant therapy and recurrence of tumor. Patients were followed up by outpatient examination and telephone interview. The regular reexaminations of tumor marker, ultrasound and abdominal CT were applied to patients for detecting the recurrence of tumor till November 2015. Measurement data with normal distribution and with skewed distribution were presented as ±s and M(range), respectively. Results (1)Preoperative indexes: ascending colon cancer was detected in 2 patients, descending colon cancer in 1 patient, sigmoid cancer in 2 patients and rectal cancer in 6 patients. There were 6 solitary liver metastases with tumor diameter of 2.0-5.0 cm and 5 multiple liver metastases with average tumor number of 2.4 and tumor diameter of 1.0-4.0 cm. Four patients underwent preoperative neoadjuvant chemotherapy and 1 with rectal cancer underwent neoadjuvant radiotherapy. (2) Intra-operative status: all the 11 patients received successful laparoscopic Ⅰ-stage resection of CRLM. Laparoscopic liver irregular wedge resection was performed in 7 patients, regular hepatic lobes resection in 4 patients, left hemicolec-tomy in 2 patients, right hemicolectomy in 2 patients, Miles operation in 4 patients and Dixon operation in 3 patients. The operation time and volume of intraoperative blood loss were (245±61)minutes and (400±277)mL, without the occurrence of uncontrollable bleeding. The distal and proximal resection margins of colorectal cancer specimens (R0 resection) and circumferential resection margin of rectal cancer were negative. The median number of lymph node dissected, positive lymph node, negative resection margin of liver tumor (R0 resection)and positive laparoscopic resection margin (R1 resection) were 16 (range, 11-27), 0 (range, 0-7), 10 and 1, respectively. (3) Postoperative status: 2 patients had postoperative complications including 1 with intra peritoneal effusion and 1 with intraperitoneal infection, without occurrence of bile leakage, abdominal bleeding, anastomotic leakage, subphrenic abscess and hepatic failure. The time of postoperative gastrointestinal function recovery, time for diet intake and duration of hospital stay were (3.0±0.6)days, (3.0±0.9)days and (11.0±4.0)days, respectively. All the 11 patients underwent adjuvant chemotherapy of FOLFOX6 regimen, and 1 of 11 patients changed FOLFOX6 regimen into FOLFRIRI regimen due to recurrence of liver metastases. All the patients were followed up for a median time of 17 months (range, 2-44 months). During the follow-up, 1 patient died of pulmonary, brain and abdominal metastases and 10 patients had survival without recurrence of tumor except 1 with recurrence of liver metastasis. Conclusion Laparoscopic Ⅰ-stage resection of CRLM is safe and feasible for eligible patients, with a satisfactory short-term outcome. Key words: Colorectal neoplasms; Liver metastases; Laparoscopy

Treatment of posterior and anterior ankle impingement syndrome with combined anterior, tarsal sinus and posterolateral approaches under arthroscopy

Objective To discuss the methods and effects of arthroscopic treatment of posterior and anterior ankle impingement syndrome through anterior approach, tarsal sinus approach plus posterolateral approach. Methods The study enrolled 12 patients with posterior and anterior ankle impingement syndrome treated from January 2012 to March 2014. There were 8 males and 4 females, aged17-65 years (mean, 45 years). Left ankle injury was noted in 9 patients and right ankle injury in 3 patients. Eight patients had a history of obvious ankle injury (5 acute and 3 chronic sprains). Arthroscopic surgery was performed to manage the posterior and anterior ankle impingement syndrome through the combined anterior, tarsal sinus and posterolateral approaches, and prone position and posteromedial incision were not used during operation. Postoperative outcome was evaluated using the American Orthopedic Foot and Ankle Society (AOFAS) score. Results Operation time was 45-80 min (mean, 62 min). Arthroscopy confirmed anterior bone impingement in all patients. Three patients suffered from posterior bony impingement of the talus, while nine patients os trigonum injury. Duration of follow-up was 10-18 months (mean, 14 months). AOFAS score was (91.4±6.5)points after operation, significantly higher (34.4±12.6)points before operation (t=14.607, P<0.01). All patients had normal ankle range of motion after operation. There were no complications such as neurovascular injury. All the surgical incisions achieved primary healing. Conclusion The procedure avoids body position shift and posteromedial incision during operation, and attains a good vision to the anterior and posterior portions and satisfactory short-term outcome. Key words: Ankle injuries; Arthroscopy; Impingement