To investigate the risk factors of disease-free survival rate after modified radical mastectomy in patients with T1-2N1M0 stage breast cancer.

Retrospective analysis were performed in 208 patients with T1-2N1M0 breast cancer underwent modified radical mastectomy from January 2011 to November 2014. The endpoint of follow-up was November 2019 and 5-years survival, of patients metastasis and recurrence of tumors were analyzed, Statistical analysis were performed by using SPSS 22.0 software. Count data were expressed as % and were analyzed by using χ² test. The univariate and Cox multivariate regression models were used to analyze the risk factors of prognosis. A P value<0.05 was considered as statistically significant difference.

In this study, 208 patients were followed up. Among them, 28 cases had metastatic or recurrence, 180 cases had no metastasis and recurrence, with the 5-year disease-free survival rate of 86.5%. The results of single factor analysis showed that the risk factors of prognosis of patients with T1-2N1M0 breast cancer undergoing modified radical mastectomy included age of <45, Histological grade III, postoperative radiotherapy and Ki-67≥30%, with statistically significant difference (P<0.05).

Age of <45y, histological grade III, postoperative radiotherapy and Ki-67≥30% are independent risk factors for recurrence and metastasis after modified radical mastectomy in patients with T1-2N1M0 stage breast cancer, which might increase the prognosis risk.

To analyze the clinical outcome of reoperation after parathyroidectomy for the recurrence of the secondary hyperparathyroidism in 16 patients.

The clinical data of 16 patients with recurrent secondary hyperparathyroidism after parathyroidectomy, who underwent reoperation from May 2017 to October 2019, were analyzed retrospectively. Statistical analysis were performed by using SPSS 22.0 software. Measurement data, such as Parathyroid volume, laboratory parameters, and quality of WHOQOL-BREF were expressed as (±s), and were examined by using paired sample t test. Surgical success rate, symptom improvement and postoperative complications were analyzed by using χ² test A P value <0.05 was considered as statistically significant difference.

15 of 16 patients (93.75%) received successful surgery. Compared with the preoperative period, patients' complains of skin pruritus, bone pain, fracture or bone deformity, muscle weakness with atrophy and ectopic calcification was much lower at 6 months after operation. Blood calcium (Ca) and phosphorus (P) levels are low, WHOQOL-BREF scores are high in all dimensions, with significant difference (P<0.05). There were no complications of hand and foot twitching, bleeding in the operation area, dyspnea and bone hunger syndrome in 16 patients. Hypocalcemia occurred in 5 cases, while short-term eating cough occurred in 1 case.

For the recurrence of secondary hyperparathyroidism after parathyroidectomy, the success rate of reoperation is pretty good with low complications, which could promote the improvement and disappearance of clinical symptoms, including reducing the serum iPTH level, avoiding the residual parathyroid glands, with improved life quality.

To investigate the curative effect of self-expandable metal stents (SEMS) in the preoperative management of acute obstructive colorectal cancer.

A retrospective analysis was performed in 55 patients with obstructive colorectal cancer who underwent surgery from 2014 to 2019, including 25 cases in the SEMS group received peroperative implantation of SEMS and underwent selective surgery 1 week later, while 30 cases in ES group received emergency surgery. Statistical analysis were performed by using SPSS24.0 software. Intraoperative and postoperative indexes were expressed as (±s), and were examined by using independent t test. Count data such as postoperative complications and radical resection rate of tumor were tested by using χ² test. A P value of <0.05 was considered as statistically significant difference.

In terms of radical resection of the primary tumor, there were 22 patients (73.3%) in the ES group which were significantly lower than 25 patients (100%) in the SEMS group. In terms of harvested lymph nodes, there were (9.6±5.5) in the ES group which was significantly lower than (18.7±7.7) in the SEMS group. In terms of incidence of colostomy in primary surgery, there was 26 cases (86.7%) in the ES group and 11 cases (44.0%) in the SEMS group. The Colostomy closure rate was 38.4% in the ES group and 90.9% in the SEMS group. The permanent colostomy rate was 53.3% (16/30 cases) in the ES group and 4.0% in the SEMS group (1/25 cases). There were 4 cases (13.3%) of surgical incision infection in the ES group, while 0 cases (0.0%) in the SEMS group, with significant difference (P<0.05).

It is a safe and effective treatment to use SEMS as peroperative management of acute obstructive colorectal cancer.

To investigate the clinical outcome of external intestinal plication (Noble) for the surgical management of abdominal cocoon.

We retrospectively analyzed the clinical data of 5 patients with abdominal cocoon who received intestinal plication surgery from 2013. We summarized the clinical characteristics, surgical management and clinical outcome of these patients.

Among 5 patients, including 3 males and 2 females with an average age of 59.8 years, 3 patients had previous abdominal surgical history. The average operation time of external intestinal plication was 367 minutes, with average intraoperative blood loss of 760 ml. Three patients received partial resection of small bowel with an average length of 21.3cm. All patients restored liquid diet about 14.8 days after surgery, and were discharged 22 days after operation. None of them was readmitted due to recurrent bowel obstruction during follow-up period of 45.2 months.

External intestinal plication (Noble) is safe and effective for the treatment of abdominal cocoon.

To analyze the application effect of hepatectomy combined with hepatic artery reconstruction in treatment of 10 cases of hilar cholangiocarcinoma (HCCA).

The clinical data of 10 patients with Hilar Cholangiocarcinoma who underwent hepatectomy combined with hepatic artery reconstruction from January 2016 to February 2017 were analyzed retrospectively.

Among the 10 patients, 4 cases underwent left hemihepatectomy combined with caudate lobectomy (type ⅢB), 3 casesunderwent right hemihepatectomy combined with caudate lobectomy (type Ⅲa), and 2 casesunderwent caudate lobectomy (type Ⅱ), 1 case underwent right anterior lobe and caudate lobe resection (type Ⅳ); There were 6 cases of right hepatic artery resection and reconstruction, 4 case of proper hepatic artery resection and reconstruction; The R0 resection rate was 80.0%, no death cases during the perioperative period was found, 1 case of postoperative biliary fistula, 1 cases of gastrointestinal bleeding, 1 cases of hepatic artery thrombosis secondary to biliary tract infection were found, all of which improved after conservative treatment; All patients were given postoperative follow-up for 9~24 months, 3 patients died of tumor recurrence, hepatic artery thrombosis and hepatic abscess, and the 24-month survival rate was 70.0% (7/10).

Hepatectomy combined with hepatic artery reconstruction in treatment of HCCA can increase R0 resection rate, improve liver function, which have less perioperative complications and high postoperative survival rate.

To investigate the safety and feasibility and clinical outcome of laparoscopic complete mesocolic excision (CME) for left colon cancer at splenic flexure based on membrane anatomy.

From Jan 2016 to Jun 2019, 33 patients with left colon cancer at splenic flexure were enrolled in the present study, who underwent laparoscopic CME, and their clinical data were analyzed retrospectively. All of 33 patients received preoperative colonoscope and the lesions were labeled by using nano carbon and/or titanium clip, eventually they were all diagnosed by biopsy and pathological examination. The lesions were confirmed to be located at splenic flexure by preoperative examinations of abdominal enhanced CT and/or standing abdominal X-ray. There were 5 cases of stage Ⅰ, 19 cases of stage Ⅱ and 9 cases of stage Ⅲ in preoperative TNM staging evaluation. Based on the theories of membrane anatomy and CME, the operations were carried out by using a combined cephalic-middle-lateral approach. The roots of left colon artery, left branch of middle colon artery and inferior mesenteric vein were ligated and cut off respectively, then the 223 and 253 lymph nodes were dissected. Measurement data such as general data of patients, operation parameters and postoperative rehabilitation data were expressed as (±s). The incidence of postoperative complications were expressed as %. Statistical analysis were performed by using SPSS 20.0 software.

All of 33 patients receive successful laparoscopic left colectomy without conversion, with the operation time of (160.0±25.4)min and intraoperative blood loss of (70.6±46.4)ml. The number of harvested lymph nodes were (19.3±3.2) and the length of specimens were (23.0±2.8) cm. Rapid recovery of patients were observed with the first exhaust time of(4.5±1.2) d, the oral feeding time of (5.5±1.3) d and postoperative hospital stay of(7.8±1.1) d. There were 4 cases of stage Ⅰ, 21 cases of stage Ⅱ and 8 cases of stage Ⅲ in postoperative TNM staging evaluation. There were 2 cases of inflammatory ileus after operation, who recovered after conservative treatment. No postoperative abdominal bleeding and anastomotic complications occurred. All the patients survived without tumor recurrence and metastasis during the followed-up of 8~49 months (median follow-up time of 26 months).

Based on the theories of membrane anatomy, for colon cancer at splenic flexure, the cephalic-middle-lateral approach makes it possible to clearly visualize the pancreas and origin of the transverse mesocolon, leading to safe splenic flexure mobilization and complete mesocolic excision. It appears to be safe and feasible and could be a promising method for selected patients with left colon cancer.

To evaluate the feasibility and safety of transanal endoscopic resection of rectal stromal tumor.

39 cases of rectal stromal tumor treated with transanal endoscopic microsurgery (TEM) in our department from January 2013 to December 2018 were retrospectively analyzed. There were 24 male and 15 female, the average age was (57.3±13.1) years old. All the 39 patients were managed by the unified surgical team during operation and perioperative period, and were followed up for 8~68 months.

All the rectal stromal tumor in 39 patients were successfully excised by TEM without blood transfusion or laparotomy. The average intraoperative blood loss was (10.4±3.7) ml, and the average operative time was (50.3±9.8) min. No serious complications occurred. The average size of the tumor after resection was (3.3±1.4) cm, and the postoperative pathology confirmed, and the average length of stay was (7.9±2.3) d. During the follow-up period, 1 patient with recurrence and 3 patients with metastasis were found. The TEM was preformed once again in the patient with recurrence and was stable until now. 2 patients with liver metastases was found, 1 patient with bone metastases was occurred, and 2 patients died.

TEM is safe and feasible for the treatment of rectal stromal tumor.

To investigate the efficacy and safety of two types of laparoscopic metabolic surgery in treating super obesity.

Form March 2011 to November 2017, clinical data of 30 patients with super obesity were analyzed retrospectively. There were 9 cases underwent laparoscopic sleeve gastrectomy (LSG group) and 21 cases received laparoscopic Roux-en-Y gastric bypass (LRYGB group). Statistical analysis were performed by using SPSS 21.0 software package. Measurement data such as perioperative indicators, postoperative clinical indicators and Percentage of extra weight loss (%EWL) were expressed as (±s) and examined by using independent t-test. Count data such as short- and long-term complication rate and efficacy were compared by using χ² test. A P value of <0.05 was considered as statistically significant difference.

30 patients underwent laparoscopic surgery successfully without conversion to open surgery. The% EWL of the two groups increased significantly within 6 months after operation, and then increased slowly. LSG group was less than LRYGB group (P<0.01), suggesting that the short-term weight loss effect of LRYGB group was better than LSG group. One patient in LSG group had bleeding at the cutting edge of stomach 2 days after operation, and underwent reoperation. One patient in LRYGB group had alopecia and osteoporosis 6 months after operation. There was no significant difference in the early and long-term complications between the two groups (P>0.05).

Both LSG and LRYGB for the treatment of super obesity are safe and effective during short term follow-up period.

To analyze the clinical diagnosis and treatment of two cases of retroperitoneal neurilemmoma with severe compression of inferior vena cava and right renal vein.

Preoperative diagnosis by 3D reconstruction and other imaging examinations were made. Then surgical treatment, postoperative pathological diagnosis and follow-up were preformed in 2 patients.

The tumours were resected completely in 2 cases without peripheral blood vessels and viscera injury. The postoperative pathology was retroperitoneal neurilemmoma. No recurrence was found at follow-up.

Retroperitoneal schwannoma is rare and difficult to diagnose before operation. The large benign tumors adjoining complex blood vessels can still be resected completely, and there is good prognosis and low recurrence rate.

To explore the pathogenesis and surgical diagnosis and treatment of adult intussusception.

From January 2005 to January 2018, clinical data of 150 patients with adult intussusception were analyzed retrospectively, including 139 cases received surgical treatment and 4 cases underwent conservative treatment, while 7 cases refused any treatment.

A total of 150 patients included 36 cases of small intestine type, 87 cases of small intestine colon type (ileocecal type), 27 cases of colon colon type. The main causes of intussusception were malignant tumor of 51 cases (36.7%), benign tumor and polyp of 50 cases (36.0%), inflammatory adhesion of 23 cases (16.5%), diverticulum of 6 cases (4.3%). There were 2 cases of heterotopic pancreas (1.4%) and 7 cases of idiopathic intussusception (5.0%). In order to make a definite diagnosis, 150 patients had two or even three examinations: 138 cases received abdominal CT, 26 cases underwent enteroscopy, 22 cases underwent abdominal ultrasound, and 3 cases underwent barium enema (early stage). The correct diagnostic rates of CT, enteroscopy, ultrasonography and barium enema were 97.8%, 90.9%, 92.3% and 100%, respectively.

Adult intussusception has definite etiology, mainly benign and malignant tumors. Abdominal CT is the first choice for adult intussusception. A clear diagnosis before operation is conducive to the implementation of accurate surgery, and the choice of operation mode should be determined according to the location and type of intussusception and the nature of the primary disease.

To explore the prevention and treatment of metabolic surgery complications in super-obese patients.

The clinical data of super-obese patients treated with metabolic surgery from March 2011 to November 2017 were collected. The incidence of surgical complications was retrospectively analyzed.

There were 35 cases of super-obese patients treated with metabolic surgery, of whom 2 cases(5.71%) had postoperative complications. Hemorrhage at the gastric margin was found in one patient and reoperation was performed. Trocar hernia was found in one patient and the hernioplasty was performed.

Metabolic surgery for super obesity is controlled by macroscopic and microscopic aspects, and the incidence of its surgical complications is acceptable.

To study the effect of interventional therapy in patients with hilar cholangiocarcinoma complicated with obstructive jaundice and to explore the factors influencing the clinical prognosis.

The data of 66 cases of hilar cholangiocarcinoma complicated with obstructive jaundice from January 2014 to June 2017 were retrospectively analyzed to observe the clinical prognosis of interventional therapy. Data were analyzed using spss19.0 statistical software. Liver function index was showed as ±s, compared with t test; Univariate and multivariate analyses were performed by non-conditional Logistic regression. P<0.05 was statistically significant.

The survival rate at 12 months after interventional therapy was 80.3%, and of which the symptoms of obstructive jaundice disappeared. Liver function indexes (TBIL, ALT, IBIL, GOT) were significantly lower after treatment (all P<0.05). Tumor stage (OR=3.034, P=0.014), degree of obstruction (OR=1.143, P=0.014), child-pugh grade of liver function (OR=3.493, P=0.014), frequency of interventional therapy (OR=1.562, P=0.014) and subsequent chemotherapy (OR=3.146, P=0.014) were independent risk factors for survival of interventional therapy (all P<0.05).

Interventional therapy can significantly improve the liver function of patients with hilar cholangiocarcinoma complicated with obstructive jaundice, and reduce the symptoms of obstructive jaundice.

To explore the surgical technique and clinical effect of primary closure of bile duct incision in laparoscopic common bile duct exploration simultaneous with two endoscopy (laparoscopy+ choledochoscopy) or three endoscopy (laparoscopy+ choledochoscopy+ duodenoscopy) for treatment of gallbladder stones combined bile duct secondary stones.

Clinical data of 2410 patients who met the inclusion criteria from June 1992 to June 2018 were retrospectively analyzed.

The operation is successful in 2226 (92.4%) out of 2410 patients, 16 cases (0.7%) were shifted to open common bile duct exploration. Bile leakage occurred in 101 cases (4.2%). Residual stones were found in 26 cases (1.1%). Other complications were found in 41 cases (1.7%). Total rate of postoperative complication was 7.0% (169/2410).

From preliminary results of limited cases in our hospital, if patients are suitable, simultaneously use with two endoscopy or three endoscopy for treatment of gallbladder stones combined with bile duct stones is safe and effective.

To evaluate the feasibility and clinical value of laparoscopic pancreaticoduodenectomy in the treatment of pancreatic head cancer.

From January 2017 to August 2018, clinical data of 19 patients with pancreatic head cancer were retrospectively analyzed, including 11 male cases and 8 female cases, with average age of (54.3±14.2) years ranging from 23 to 79 years. There were 15 cases of pancreatic ductal adenocarcinoma, 2 cases of pancreatic mucinous adenocarcinoma and 2 cases of papillary carcinoma. The localization two-dimensional CT imaging were performed, and the three-dimensional visualization technique were used to reconstruct the two-dimensional CT images. The preoperative evaluation was carried out. The clinical classification and resectability of the patients were evaluated by three-dimensional visualization and the results were compared after surgery.

All of 19 cases were proved to be pancreatic head carcinoma by surgical exploration. In 19 patients with 3D visual reconstruction, the resectability was assessed as 4 cases of type I, 7 cases of type Ⅱ, 1 case of type Ⅲ, 3 cases of type Ⅳ and 4 cases of type Ⅴ, pancreatic tumor resection were performed in 8 cases, with 2 cases of vascular anatomic variation. 11 cases of suspected lymph nodes. The anatomical relationship of the three-dimensional reconstruction tumor was approximately consistent with surgical exploration.

Three-dimensional visualization is helpful to evaluate the resectability of pancreatic tumor patients before operation, to determine tumor size, anatomic variation, enlarged lymph nodes, and so on. It is worth popularizing in clinic.

To explore the surgical technique and clinical effect of laparoscopic T tube+ double biliary catheter bundling and supporting drainage (LCTBS) of transabdominal consequent propulsive guidance technology for the treatment of extrahepatic bile duct stones with obstruction and stenosis of papillory during the course of therapeutic laparoscopy.

Clinical data of 45 patients who met the inclusion criteria between April 2001 and June 2018 were retrospectively analyzed.

It was in 45 cases removed the gallbladder and exploration of common bile duct by laparoscopy. Step by step dilatable catheter expanded duodenal papilla and indwelling T tube and double biliary catheter drainage was in 86.7% (39/45); step by step dilatable catheter combining balloon catheter expanded duodenal papilla and indwelling T tube and double biliary catheter drainage was in 4.4% (2/45); with duodenoscopic papillary sphincterotomy and indwelling T tube and double biliary catheter drainage due to residual stenosis of duodenal papilla was used in 6.7% (3/45); with indwelling T shape tube drainage due to place the double biliary catheter drainage result in failure was used in 2.2% (1/45). Residual stone was not occurred. Bile leakage was cured in one case (2.2%). There were no failed cases through the T tube fistula pull T tube and double biliary catheter support drainage. No cases had perforation of intestine and bile duct, bleeding, acute pancreatitis. No death. Total postoperative complication formation rate was in 2.2%(1/45).

From preliminary results of limited cases in our hospital, if patients are suitable, LCTBS for treatment of the extrahepatic bile duct stones with obstruction and stenosis of papillory is safe and effective.