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Total mesorectal excision (TME) has become the basic principle of surgical treat-ment for middle and low rectal cancer. Some of patients with ultra-low rectal cancer require under-going intersphincteric resection (ISR). Due to the limitation of the narrow pelvis, TME and ISR put forward higher requirements for the precise separation of the anatomical level and the protection of neurological function during the operation. At present, evaluation of the difficulty of surgery for middle and low rectal cancer is mainly based on the subjective judgment of chief surgeon, and there is no unified and objective scoring system or prediction model that can classify the difficulty of surgery for middle and low rectal cancer before surgery. The authors review relevant literatures and summarize the existing studies related to pelvic measurement for predicting the difficulty of surgery for middle and low rectal cancer, in order to provide significant guidance for the selection of surgical approach for patients with middle and low rectal cancer.
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Purpose@#Increasing evidence has shown an association of surgical technique, particularly anastomotic configuration, with postoperative recurrence of CD. This pilot study aimed to evaluate short-term outcomes of isoperistaltic side-to-side anastomosis (ISSA) employed on Crohn disease (CD) patients. @*Methods@#Data were retrieved from a prospectively maintained database. Postoperatively, all patients were followed up with close endoscopic (ileocolonoscopy) surveillance. @*Results@#From January 2017 to May 2021, 30 patients diagnosed with CD who underwent ISSA were compared with 45 CD patients who underwent antiperistaltic side-to-side anastomosis (ASSA). The 2 groups were comparable in baseline demographics and clinical characteristics. No significant differences were observed between groups regarding postoperative safety issues, including anastomotic leak, abdominal/pelvic abscess, length of hospital stay, readmission rate within 30 days, etc. At postoperative 24th month, reduced endoscopic recurrence was observed in the ISSA group compared with that in the ASSA group (18 of 24, 75.0%, vs. 36 of 38, 94.7%; P = 0.024). Regarding surgical recurrence, there was 0% in the ISSA group vs. 4.4% (2 of 45) in the ASSA group (P = 0.510). @*Conclusion@#In this study, we aimed to explore the influence of ISSA on postoperative recurrence in CD patients, and the preliminary results show that ISSA was technically safe and feasible, and appears to be effective in reducing postoperative recurrence in CD patients. However, our conclusion was underpowered due to small sample size and inadequate followup. We proposed ISSA be considered as another alternative option in the toolbox of inflammatory bowel disease surgeons when performing anastomosis on CD patients.
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Objective@#To investigate the sexual function, urinary function and quality of life in patients of ulcerative colitis(UC) and familial adenomatous polyposis(FAP) after total proctocolectomy and ileal pouch anal anastomosis (IPAA).@*Methods@#The clinical data of patients with UC and FAP undergoing IPAA at Zhongnan Hospital of Wuhan University from Jan 2006 to Sep 2018 were reviewed , postoperative sexual function, urinary function, and long-term quality of life were assessed.@*Results@#There were 45 patients with median age of 35 years , median follow-up time of 31 months. 18 were UC, 27 were FAP, 5 did 1-stage surgery, 37 did 2-stage surgery, 3 for 3-stage surgery, 13 underwent open surgery, and 32 underwent laparoscopic surgery. 7 patients suffered sexual dysfunction after IPAA, and there was no statistical difference between male and female (P=0.992), UC and FAP (P=0.153), 1-stage , 2-stage , and 3-stage surgery (P=0.363) , with statistically significant difference between the open group and the laparoscopic group (P=0.025). 6 patients complicated with urinary dysfunction after IPAA , and there was no statistical difference between male and female (P=0.562), UC and FAP (P=0.325), 1-stage, 2-stage, and 3-stage surgery (P=0.286) , with statistically significant difference between the open group and the laparoscopic group (P=0.007). The Cleveland Global Quality of Life (CGQL) score after IPAA was 0.696±0.085. There were no statistical difference on CGQL scores in males and females (P=0.635), UC and FAP (P=0.664), 1-stage, 2-stage, and 3-stage (P>0.05), open group and laparoscopic group (P=0.205), postoperative long-term QOL was significantly associated only with age at the time of surgery (P=0.001).@*Conclusions@#Compared with open surgery, laparoscopic TPC-IPAA patients had better postoperative sexual function and urination function.
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Objective To investigate the sexual function,urinary function and quality of life in patients of ulcerative cohtis(UC) and familial adenomatous polyposis(FAP) after total proctocolectomy and ileal pouch anal anastomosis (IPAA).Methods The clinical data of patients with UC and FAP undergoing IPAA at Zhongnan Hospital of Wuhan University from Jan 2006 to Sep 2018 were reviewed,postoperative sexual function,urinary function,and long-term quality of life were assessed.Results There were 45 patients with median age of 35 years,median follow-up time of 31 months.18 were UC,27 were FAP,5 did 1-stage surgery,37 did 2-stage surgery,3 for 3-stage surgery,13 underwent open surgery,and 32 underwent laparoscopic surgery.7 patients suffered sexual dysfunction after IPAA,and there was no statistical difference between male and female (P =0.992),UC and FAP (P =0.153),1-stage,2-stage,and 3-stage surgery (P =0.363),with statistically significant difference between the open group and the laparoscopic group (P =0.025).6 patients complicated with urinary dysfunction after IPAA,and there was no statistical difference between male and female (P =0.562),UC and FAP (P =0.325),1-stage,2-stage,and 3-stage surgery (P =0.286),with statistically significant difference between the open group and the laparoscopic group (P =0.007).The Cleveland Global Quality of Life (CGQL) score after IPAA was 0.696 ± 0.085.There were no statistical difference on CGQL scores in males and females (P =0.635),UC and FAP (P =0.664),1-stage,2-stage,and 3-stage (P ＞ 0.05),open group and laparoscopic group (P =0.205),postoperative long-term QOL was significantly associated only with age at the time of surgery (P =0.001).Conclusions Compared with open surgery,laparoscopic TPC-IPAA patiems had better postoperative sexual function and urination function.
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Objective To observe the clinical effect of thrombus removal of external hemorrhoid combined with procedure for prolapse and hemorrhoids(PPH) in the treatment of circumferential mixed hemorrhoid with incarceration.Methods A total of 118 cases of circumferential mixed hemorrhoid with incarceration were divided into two groups:experimental group of 60 cases was treated by thrombus removal combined with PPH;control group of 58 cases was treated by Milligan-Morgan.We observed the differences of postoperative visual analogue scale (VAS)score,edema,bleeding,residual skin tag,wound healing time,anal stenosis,fecal incontinence,anorectal manometry and satisfaction in the two groups.Results There was significant difference between the experimental group and the control group in postoperative edema,bleeding and residual skin tag(χ2=6.63,4.19,6.64,P0.05).Postoperative VAS score,wound healing time,satisfaction,anal resting and anal maximal squeeze pressure between the two groups were all statistically different(P<0.01).Conclusion The operation of thrombus removal of external hemorrhoid combined with PPH can effectively reduce the postoperative complications and promote recovery.
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<p><b>OBJECTIVE</b>To evaluate the safety and efficacy of the perineal rectosigmoidectomy (Altemeier procedure) in the treatment of full thickness rectal prolapse.</p><p><b>METHODS</b>Clinical and follow-up data of 52 patients with full thickness rectal prolapse undergoing Altemeier procedure in 9 hospitals from September 2010 to July 2016 were analyzed retrospectively. Of which 38 cases were from Zhongnan Hospital of Wuhan University, 1 case from Suizhou Central Hospital of Hubei province, 1 case from Jingzhou Second People's Hospital of Hubei province, 3 cases from Wuxue First People's Hospital of Hubei province, 1 case from Jingmen First People's Hospital of Hubei province, 1 case from Tuanfeng County Hospital of Hubei province, 4 cases from Jingzhou Central Hospital of Hubei province, 2 from PLA Rocket Army General Hospital, 1 case from the Affiliated Hospital of Xuzhou Medical University in Jiangsu province. Altemeier operation steps: The line shaped teeth, the prolapsed rectum is first exposed to the anus. In the dentate line proximal 1-3 cm with ultrasonic knife or Ligasure ring outer rectal incision, using electric knife to mark pre resection line in rectal mucosa. Open down in front of the pelvic peritoneum. Incision of the outer intestine and the reduction of the internal rectum and part of sigmoid colon. To free and remove excess pelvic retroperitoneal, pelvic peritoneum and be at the top of the colon or rectum anterior pelvic reconstruction suture. The rear of the levator ani muscle forming rectum. Pull gently to the anus and rectum and sigmoid, in the absence of tension, 2-3 cm outside the anus was selected as the proximal inner bowel pre resection line, along the line of pre transection of proximal bowel resection, again the broken end of intestine full-thickness end-to-end anastomosis. Postoperative complication and recurrence were summarized. Gastrointestinal quality of life index (GIQLI), Wexner constipation score and Wexner fecal incontinence score were used to evaluate the efficacy.</p><p><b>RESULTS</b>All the 52 patients were beyond moderate full thickness rectal prolapse. Thirty-one were male and 21 were female with age ranging from 22 to 83 (average 53) years. The length of prolapsed rectum was 6 to 20 (average 9) cm and course of disease was 0.5 to 46(average 19.5) years. No perioperative death. Five patients (9.6%) had postoperative complications, including 2 anastomotic bleeding, 1 wall portion dehiscence of anastomosis, 1 anastomotic stenosis, and 1 malnutrition. Recurrence rate was 9.6%(5/52) within the long-term follow-up of 5 to 71 (median 40) years. Compared with the preoperative results, Wexner constipation score and Wexner fecal incontinence score decreased obviously (2.1±1.4 vs. 4.6±3.4, 4.8±4.1 vs. 6.8±4.1), and GIQLI significantly increased from 99.6±8.0 to 103.0±9.1 (all P<0.05) at 6-month after operation. Above 3 scores were sustained and continuously improved at 12-, 24-, and 36-month during the follow-up (all P<0.05).</p><p><b>CONCLUSION</b>Altemeier procedure possesses good efficacy with low morbidity of complication and recurrence in the treatment of full thickness rectal prolapse.</p>
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Objective To observe and evaluate the clinical curative efficacy of perineal stapled prolapse resection in the treatment of complete rectal prolapse.Methods 15 patients of complete rectal prolapse were all treated by perineal stapled prolapse resection,The anal function of the patients were evaluated according to the Wexner incontinence score standard.Results All patients were successfully completed the operation.Postoperative complications:postoperative bleeding in 2 cases,anastomotic stenosis in 2 cases.These symptoms were relieved after symptomatic treatment.The anal sphincter function was improved in all patients after operation.There were no obvious incontinence.The preoperative Wexner incontinence score was 13.5±1.8,andpostoperative Wexner incontinence score was 4.2±1.5,there were significant statistical difference between them(P<0.05).The mean follow-up were 18 months(2-30 months).There was no recurrence during the follow-up period.Conclusion Perineal stapled prolapse resection as a new type of operation had small trauma,simple operation,less complications and short-term curative effect of good characteristics.They can effectively improve the symptoms of anal incontinence in patients with complete rectal prolapse.
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<p><b>OBJECTIVE</b>To explore the efficacy of partial resection of puborectalis combined with mutilation of internal anal sphincter(IAS) in the treatment of puborectalis syndrome with high anal pressure.</p><p><b>METHODS</b>Twenty-five cases of puborectalis syndrome with high anal resting pressure in the preoperative examination received the operation of partial resection of puborectalis combined with mutilation of IAS in Zhongnan Hospital of Wuhan University between January 2013 and May 2015. The position of puborectalis was confirmed by touching with the exposure under the transfixion device, and a transverse incision was made by electrotome between 3 and 5 o'clock direction of puborectalis, then partial puborectalis was lifted by vessel clamp at 5 o'clock direction, and about 0.5 cm of muscular tissue was resected. Between 8 to 10 o'clock direction of anal tube, about 1 cm length of transverse incision was made by electrotome, then partial IAS was lifted by vessel clamp and cut off. Preoperative and postoperative 3-month anorectal manometry and defecography were carried out. Wexner constipation score and Cleveland Clinic incontinence score were implemented before surgery and 3, 6, 12 months after operation. This study was registered in the Chinese Clinical Trial Registry (registration number: ChiCTR-ORB-16007695).</p><p><b>RESULTS</b>Of the 25 cases, 18 were male and 7 were female, the average age was 55 years old and the average course of disease was 9 years. Compared with pre-operation, the postoperative 3-month anal resting pressure and maximal squeeze pressure were significantly decreased [(53.56±9.05) mmHg vs. (92.44±7.06) mmHg, (142.80±20.35) mmHg vs. (210.88±20.56) mmHg, respectively, both P=0.000]; anorectal angulation at resting state and forced defecation state increased significantly [(102.32±4.96)degree vs. (95.88±4.01)degree, (117.88±5.95)degree vs. (89.52±3.25)degree, respectively, both P=0.000]. Wexner constipation score of postoperative 3-month, 6-month, 12-month (8.28±3.91, 7.40±3.64 and 8.04±4.74) was significantly lower than the preoperative score (16.00±3.69, all P<0.05), while the score was not significantly different among 3 time points after operation (P>0.05). Cleveland Clinic incontinence score was 0 at postoperative 6 and 12 months, and revealed 20 cases were effective among all the surgical patients(80%).</p><p><b>CONCLUSION</b>Partial resection of puborectalis combined with mutilation of internal anal sphincter can effectively reduce anal pressure and improve symptoms of outlet obstruction, which is an effective method in the treatment of puborectalis syndrome with high anal pressure.</p>
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Female , Humans , Male , Middle Aged , Anal Canal , General Surgery , Constipation , General Surgery , Defecation , Defecography , Digestive System Surgical Procedures , Methods , Gastrointestinal Diseases , General Surgery , Manometry , Muscle Hypertonia , General Surgery , Pelvic Floor , General Surgery , Pressure , Treatment OutcomeABSTRACT
Objective To observe the Lactulose Oral Solution's influence in PPH postoperative complications and patients′ satisfactory rate for constipation and to find more intervention measures for reducing the complications. Methods A hundred and twenty cases of hemorrhoids with constipation were randomly divided into the two groups: the experimental group, the control group in 60 cases in each group. All patients’ postoperative bleeding, anal edema, stool impaction and satisfaction were observed and compared within 30 days. Results In the control group, the postoperative bleeding’ cases were of 23, anal edema’s were of 20 and stool impaction‘s were of 8. The incidence was 38.3%, 33.3% and 13.3% severally. The satisfactory patients were of 49 and the degree of satisfaction was of 81.7%. In the experimental group, the postoperative bleeding’ cases were of 12, anal edema’s were of 8 and stool impaction's was of 1. The incidence was 20%, 13.3% and 1.7% respectively. The cases who were satisfactory were of 58 and the degree of satisfaction was 96.7%. The postoperative bleeding , anal edema , stool impaction and satisfaction were different statistically in the two groups above (P < 0.05). Conclusion It can reduce PPH postoperative complications and increase patients′satisfaction by using Lactulose Oral Solution in patients with constipation and it will have a certain clinical value if these patients take this oral solution routinely.
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<p><b>OBJECTIVE</b>To evaluate the clinical outcomes of ileal D-pouch anal anastomosis in the treatment of ulcerative colitis (UC) and familial adenomatous polyposis (FAP).</p><p><b>METHODS</b>Clinical and follow-up data of 6 UC patients and 5 FAP patients undergoing proctocolectomy and D-ileum pouch anal anastomosis between October 2014 and March 2015 were retrospectively analyzed. End-to-side anastomosis was firstly performed in ileal cutting end and ileum, then side-to-side anastomosis was operated in closing amphi-loop to construct the D-ileum pouch.</p><p><b>RESULTS</b>The mean age of the patients was 42 years (range 18 to 61 years), 5 patients were female. The duration of surgery was (225±23) min, the operation time to D-ileum pouch was (18±4) min, the volume of D-ileum pouch was (175±15) ml, the blood loss was (110±30) ml. There was no procedure-related death, however rectum perforation occurred in 1 male UC patient during operation. The postoperative hospital stay was 8 to 11 days (mean 8.5 days). The follow-up period was 2 to 7 months (median 3 months). One female FAP patient suffered from anal anastomosis vagina fistula 21 days after operation. No pouch-related fistula, anastomosis or input loop stricture fecal incontinence, and severe pouchitis were recorded. The defecation frequency was 4 to 6 times per day (UC) and 3 to 5 times per day (FAP) 6 months after operation. No night-time fecal leakage was complained in those patients. Wexner incontinence score was 3±2 and GQLI was 114±11 one month after operation. Clinical outcome in the first month was excellent in 10 patients and good in 1 patient.</p><p><b>CONCLUSIONS</b>After total colorectal resection for UC and FAP patients, application of D-ileum pouch can clear ileal stump of pouch and avoid the pouch-associated complications effectively.</p>
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Adolescent , Adult , Female , Humans , Male , Middle Aged , Young Adult , Adenomatous Polyposis Coli , Anastomosis, Surgical , Colitis, Ulcerative , Colonic Pouches , Fecal Incontinence , Ileum , Pouchitis , Proctocolectomy, Restorative , Rectal Fistula , Retrospective Studies , VaginaABSTRACT
<p><b>OBJECTIVE</b>To demonstrate the feasibility of extralevator abdominoperineal excision (ELAPE) for locally advanced low cancer in China.</p><p><b>METHODS</b>A prospective multicenter clinical trial was carried out by 7 general hospitals across China from August 2008 to October 2011. A total of 102 patients underwent ELAPE for primary locally advanced low rectal cancer. There were 60 male and 42 female patients. The patients' characteristics, complications and prognosis were recorded.</p><p><b>RESULTS</b>All patients underwent the ELAPE procedure successfully. The median operating time was 180 minutes (range 110-495 minutes) and median intraoperative blood loss was 200 ml (range 50-1000 ml). The rates of sexual dysfunction, perineal complications, urinary retention, and chronic perineal pain were 40.5%, 23.5%, 18.6% and 13.7%, respectively. Chronic perineal pain was associated with coccygectomy (12 months postoperatively, t = 8.06, P < 0.01), and the pain might gradually ease over time. Reconstruction of pelvic floor with biologic mesh was associated with lower rate of perineal dehiscence (χ(2) = 13.502, P = 0.006) and overall perineal wound complications (χ(2) = 5.836, P = 0.016) compared with primary closure. A positive circumferential margin (CRM) was demonstrated in 6 (5.9%) patients, and intraoperative perforations occurred in 4 (3.9%) patients. All CRM involvement and intraoperative perforation located at anteriorly and anterolaterally. The local recurrence was 4.9% at a median follow-up of 35 months (range, 18-58 months).</p><p><b>CONCLUSIONS</b>ELAPE performed in the prone position for low rectal cancer leads to a reduction in CRM involvement, intraoperative perforations, and local recurrence, but it might result in a little high rate of perineal wound related complications. Reconstruction of pelvic floor with biologic mesh might lower the rate of perineal wound complications.</p>
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Adult , Aged , Female , Humans , Male , Middle Aged , Digestive System Surgical Procedures , Methods , Perineum , General Surgery , Postoperative Complications , Prognosis , Prospective Studies , Rectal Neoplasms , General Surgery , Treatment OutcomeABSTRACT
Twenty two patients with outlet obstructive constipation (OOC) underwent pelvic fourcontrast defecography preoperatively and postoperatively. Functional outcome and the findings on defecography were analyzed. The inconsistent signs between preoperative and postoperative defecography findings were shown in all patients. Some new abnormal findings, including 5 cases with pelvic floor hernia, 4 with cystocele, 4 with vagina prolapse, 3 with uterine prolapse,2 with rectal prolapsed and 1 with spastic pelvic floor syndrome were present in 5 patients with ineffective surgical treatment and 9 patients with effective surgical treatment. Reduced abnormal signs were showed in the 9 effective patients, but other new abnormalities appeared. The abnormal signs were reduced or disappeared in 8 obviously effective patients and there were no new abnormalities present in those patients. Results indicate that pelvic four-contrast defecography can provide valuable information for patients with OOC postoperatively.
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Objective To study the inhibitory effects of hydroxyapatite nanoparticles on liver VX2 tumor in rabbits after intratumoral injection. Methods 40 rabbits with implantation of liver VX2 tumors were randomly divided into 4 groups and intratumorally injected with different preparations.Group A: (control group), 1 ml nomal saline containing 0.2% CMC-Na; Group B: ( 5-Fu group),20 mg/ml 5-Fu 1 ml; Group C: (Nano HAP), 20 mg/ml Nano HAP 1 ml; Group D: (5-Fu+Nano HAP), 20 mg/ml 5-Fu 1 ml and 20 mg/ml Nano HAP 1 ml. Ultrasonography was performed to measure liver tumor volume 7, 14, 21 d after treatment. Survival durations of the animals were recorded. Tumor tissues and liver tissues close to tumor were obtained and examined histologically.Results The average tumor volumes 7, 14 and 21 d after treatment were (4.93 ±0.76)cm3,(15. 67±2.75)cm3 and (52. 36±10. 57)cm3 in group A, (4. 16±0. 33)cm3 , (10. 26± 1.60)cm3 and (18. 89±4.65)cm3 in group B, (1.43±0.13)cm3 , (3.69±0.77)cm3 and (9.51±2.09)cm3 in group C, (2. 80±0.46)cm3 , (3. 77±0. 91)cm3 and (8. 46±0.95)cm3 in group D respectively. The average tumor volumes of groups B, C and D were significantly smaller than that of group A in the same time phases after treatment. The life span of group C was longer than that of other three groups, and there was no statistically significant difference between group B and group D, although the two groups were significantly longer than group A. Blood flow was not detected by color Doppler or power Doppler in group C and group D. Pathological examination showed that there was obvious intratumoral necrosis in group C and D. Tumor in group B exhibited thoroughgoing necrosis. Conclusion Hydroxyapatite nanoparticles intratumoral injection is safe and feasible for treatment of liver tumor. Hydroxyapatite nanoparticles can exert a significant inhibitory effect on liver VX2 tumor growth in rabbits without liver toxicity.
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Objective To investigate the relationship between hypoxia inducible factor-1?、angiopoietin2 and vascular endothelial growth factor and angiogenesis in hepatocellular carcinoma(HCC).Methods The(expression) of hypoxia inducible factor-1?、angiopoietin2 and vascular endothelial growth factor mRNA was(detected) in 52 HCC surgical specimens.And microvessel density(MVD) in tissue specimens of patients with coexpression of the parameters was examined.Results Of the 52 surgical specimens,36 cases had over(expression) of HIF-?、angiopoietin and VEGF protein,and coexpression of HIF-? and angiopoietin and VEGF mRNA in 38 of 52 cases.The expression of HIF-?、angiopoietin was related with the expression of VEGF(r_1= 0.783,P
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Objective To explore the changes of urinary Trypsinogen Activation Peptide (TAP) levels in patients with acute pancreatitis (AP).Methods We observed the association between urinary TAP concentration and severity of acute pancreatitis with competitive enzyme-linked immunosorbent assay(ELISA). Urine samples were collected for TAP concentration at admission,24,48,and 72 h from 57 patients with AP who presented within 48 h of the onset of symptoms and from 11 control patients. Results The median urinary TAP at admission for severe acute pancreatitis(SAP) (98 nmol/L) was signficantly higher than the median for both mild pancreatitis (22 nmol/L,P0.05).The peak median urinary TAP in severe eroup was seen at admission.In the following days,TAP concentrations decreased graduallg.Conclusion Breakthrough activation of trypsinogen in pancreatic interstitial and blood may be the key event in the development of SAP.
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ObjectiveTo study the early diagnosis and prevention of fungal infection in severe acute pancreatitis(SAP). Method 1.SAP patients from July 1998 to June 2002 were prospectively randomized into 3 groups: garlicin prevention group, fluconazole (low dosage) prevention group and control group, the incidence of fungal infection in SAP was compared between the groups. For fungal infection patients, the fungal clearance and mortality rate were observed. 2.Clinical data of SAP patients with fungal infection and with simple bacterial infection was compared by multivariate logistic regression, and clinical characters and risk factors of fungal infection were evaluated. Results 1.There were lower incidences of fungal infection in garlicin group (16% vs. 30%,P
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Objective To determine the prevention and therapy of fungal infection in patients with severe acute pancreatitis (SAP). Methods Seventy patients with SAP admitted from July,1998 to June,2002 were randomly divided into 3 groups: garlicin prevention group, fluconazole (low dosage) prevention group and control group.The incidence of fungal infection, the fungal clearance and mortality after the treatment were compared. Results The incidence of fungal infection in garlicin group and fluconazole group was lower than that in control group. (16%∶30%,P
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Objective To investigate the diagnosis and treatment of malignant fibrous histiocytoma (MFH) in abdominal cavity. Methods The clinical manifestations, imaging examination, pathology, methodology, effect of treatment and prognosis of 28 MFH patients were retrospectively analyzed. Results Tumors were in the retroperitoneal space in 17 cases, within abdominal cavity in 6, in mesentery in 3 cases, and in the abdominal wall in 2 cases. The clinical symptoms were body weight loss, abdominal pain and mass. B ultrasonography and CT scanning showed mass in the abdomen. 24 cases were with multiplefoci,4 cases were with a single mass. Seventeen cases underwent complete tumor resection,11 cases with partial resection, 16 cases received postoperative chemotherapy and 14 cases with postoperative radiotherapy. The overall survival rate of 1-, 3- and 5- year was 76.9%,26.9% and 3.9%,respectively. Conclusion MFH is most often located in retroperitoneal space, surgical resection was the treatment of choice. The prognosis in patients with MFH might be improved by complete resection combined with chemotherapy or/ and radiotherapy.
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Objective To study the clinical characteristic and correlation factors of fungal infection in severe acute pancreatitis(SAP). Methods Clinical data of SAP patients with fungal infection (fungus infection group-F1 group) and with bacterial infection (bacteria infection group, B1 group) in January,1994-December,2001 were retrospective analysed and compared. Results There were 40 cases in F1 group, 84 cases in B1 group. There were no significant difference in age, sexual, causes, APACHE II score between the two groups, Hospitalization in F1 was significantly longer than that in B1 group (57.7d∶42.7d, P= 0.044 ).Diabetes-mellitus, SAP grade II, multi-operation, intestinal and/or bile duct fistulas were related to fungal infection in SAP; mortality in F1 group was significantly higher than that in B1 group (P= 0.02 ). Conclusions Diabetes-mellitus, SAP grade II, multi-operation, intestine and/or bile duct fistulas are the risk factors of patients with severe acute pancreatitis developing fungal infection; fungus infection can increase the mortalily of SAP patients.Extra-pancreas fungal infection is commonly seen in digestive tract, respiratory tract and urinary system. unknown consciousness change and massive bleeding may indicate that the patient is complicated with fungal infection.
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Objective To investigate the value of TAP in the early prediction of severe acute pancreatitis (SAP) and to compare it with acute physiology and chronic health evalutionⅡ (APACHEⅡ).Methods We observed the association between TAP concentration and the severity of acute pancreatitis with competitive enzyme-linked immunosorbent assay(ELISA). Urine samples were collected for the measurement of TAP concentration at admission, 24,48,and 72*!h after from 41 patients with acute pancreatitis (AP) (12 severe cases, and 29 mild) who presented within 48*!h of the onset of symptoms and from 11 control patients, while APACHEⅡ scores were recorded at 48*!h after admission. Results The TAP at admission of SAP (95*!nmol/L) was signficantly higher than that of mild (20*!nmol/L; P