2017年 · 第55卷第08期

At present, all kinds of complex operations in general thoracic surgery, including lobectomy with angioplasty, can be performed under thoracoscope. Compared with conventional multi-port thoracoscope, single-port thoracoscope technique is less invasive, but it is more difficult to operate and requires higher instruments. The vascular occlusion forceps used in conventional thoracoscopy need to occupy one operating hole^[1,2]When using single-port thoracoscopic technique, the vascular occlusion forceps can affect the operating space of the lens and other devices. We used a self-modified thoracic built-in vascular occlusion device to perform lobar sleeve resection with angioplasty under single-port thoracoscopy. After blocking the blood vessels, the occlusion device was placed in the chest cavity, which did not occupy the operation space at the single hole, and the blocking effect was reliable. The experience is reported below.

A 56-year-old male was admitted to the hospital on October 20, 2016 due to "intermittent abdominal pain for 8 years and recurrence of abdominal pain for 4 months without obvious trigger". The patient experienced intermittent epigastric pain for the first time 8 years ago. The pain was tear-like and persistent, and radiated to the left shoulder and back, accompanied by nausea, vomiting and excessive sweating. He went to a local hospital, and his blood and urine amylase were elevated, and he was diagnosed as "acute pancreatitis". He was given fasting water, enzyme inhibition, nutritional support and other treatments, and the patient's symptoms were relieved. Five years ago, he was diagnosed as "biliary pancreatitis" in a local hospital and underwent laparoscopic cholecystectomy. Since then, the above symptoms still repeat, with an average of about one time/year. Four months ago, the patient had recurrent abdominal pain without obvious trigger, the degree and nature of which were the same as before, and was transferred to our hospital for further diagnosis and treatment. The patient had a previous history of diabetes mellitus for 6 years. Physical examination: epigastric tenderness, no rebound pain, muscle tension. Auxiliary examination: blood amylase 1 200 U/L, urinary amylase 12 000 U/L, fasting blood glucose 10.0 mmol/L, normal blood lipid and calcium, normal liver and kidney function, normal carcinoembryonic antigen and CA19-9, neuron-specific enolase (NSE) and IgG subclasses were not special. Pancreatic enhanced CT examination showed pancreatic swelling, peripancreatic exudation, segmental dilatation of the pancreatic duct, and a blood-rich lesion in the neck of the pancreas, approximately 1.2 cm ×1.7 cm in size (FIG. 1A)。 Magnetic resonance cholangiopancreatography: the common bile duct was slightly dilated, with a maximum diameter of about 1.0 cm, no bile duct stones were observed, and the distal end of the pancreatic duct was dilated (FIG. 1B)。 Abdominal CT angiography: A mass with abundant blood supply was seen in the neck of the pancreas, which was closely related to the splenic artery (Figure 1C)。 Because of the nature of pancreatic neck lesion to be determined, fine needle aspiration biopsy guided by ultrasound endoscopy was performed. Endoscopic ultrasound: An irregular hypoechoic occupier size of 1.5 cm ×2.0 cm was seen in the neck of the pancreas, and the pancreatic duct of the body and tail of the pancreas was dilated at the distal end of the lesion, and the fat space around the pancreas was blurred. Fine needle aspiration biopsy smear: massive lymphocyte infiltration, no abnormal cells. Preliminary diagnosis: acute pancreatitis; Solid pancreatic mass occupation (nature to be determined); Type 2 diabetes. Therefore, communicate with patients and their families to treat acute pancreatitis first, and then consider surgery after their condition improves.

A 50-year-old female was admitted to our hospital on May 4, 2016 due to "recurrent middle and upper abdominal pain for more than 10 days 2 months after undergoing laparoscopic pancreatoduodenectomy (LPD)". The patient received LPD due to pancreatic head mass in our hospital on March 8, 2016, and was discharged from the hospital with good recovery after operation; On April 25th, there was no obvious trigger for recurrent distension and pain in the middle and upper abdomen, which could be relieved by changing body position, accompanied by nausea, vomiting and low fever, with a maximum of 38℃, and no jaundice. On May 4th, the patient's abdominal pain worsened and he was admitted to our hospital again. Physical examination on admission: No yellowing staining on the skin and sclera of the whole body, no abnormalities in the heart and lungs, flat abdomen, no palpable mass in the whole abdomen, obvious tenderness in the middle and upper abdomen, lifting pain in the left low back, negative mobile voicing, and normal intestinal sounds. Laboratory examination: gastroscopy revealed anastomotic stomatitis, residual gastritis. White blood cell count 9.82×10⁹g/L, red blood cell count 3.96×10⁹g/L, hemoglobin 120 g/L, platelet count 240×10⁹g/L; Alanine aminotransferase 20.4 U/L, aspartate aminotransferase 21.8 U/L, albumin 39 g/L, total bilirubin 12.4 μ mol/L, direct bilirubin 3.9 μ mol/L; Blood amylase was 731.5 U/L and blood lipase was 599.9 U/L. Abdominal CT examination showed changes after pancreatoduodenectomy, residual pancreas was enlarged compared with before, and duct shadows were visible in the pancreatic duct (FIG. 1A), suggesting edematous pancreatitis; Abdominal standing X-ray showed no free gas and intestinal obstruction, which was roughly normal. The initial diagnosis was that the pancreatic duct support tube completely fell into the pancreatic duct, resulting in pancreatitis.

Today, with the rapid development of science and technology in the 21st century, surgeons are keen on the professional pleasure brought by various new technologies. It seems a little inappropriate for us to talk about returning to the anatomy room now. As a surgeon who has been practicing medicine for more than 30 years, I spent my best youth under the shadowless lamp in the operating room. I love my profession and I am catching up with new technologies that are changing with each passing day, but I also see that our surgeons are chasing new technologies while ignoring the basic surgical basics. When I ask young physicians (including some middle-aged surgeons), "What is the rectum? What is the anal canal? What is the perianal? What is the pelvic autonomic nerve? What is the anorectal ring? What is the anal margin?" I find many surgeons looking blank. They can complete a "radical surgery" for rectal cancer in 30 minutes, but they can't tell the most basic anatomical concepts. They don't know whether the patient should continue to have adjuvant chemotherapy after surgery, and they don't even know the clinical and pathological stage of this patient. Such a surgeon really worries me. Today, I want to talk about the importance of human anatomy in surgical practice from the perspective of a colorectal surgeon.

JAMA Intern MedThe results of a series of published studies show that conflicts of interest among clinicians, patient advocacy groups and professional groups need to be further transparent.

We support Lineberry, etc.^[1]Proposed consensus recommendations to improve the credibility and transparency of adverse event reporting from vendor-sponsored studies in published papers. Similarly, we support similar methods for developing criteria and consensus for reporting patient benefit and harm clinical outcomes in surgical trials, including early surgical studies. Review articles published in recent years summarize the heterogeneity of reported results in many surgical fields^[2,3,4,5,6]Including evaluation of innovative surgical procedures^[7]。 This heterogeneity limits evidence integration and increases the risk of bias in clinical outcome reporting. For early clinical studies, reporting biased clinical outcomes is likely to result in overoptimism and underreporting of adverse reactions to new interventions.

Ann SurgA published meta-analysis shows that up to 3/4 of surgical patients receiving antithrombotic intervention is "unnecessary"^[1]。

Comrade Kong Fanhu, one of the pioneers of plastic surgery in China, an editorial member of the sixth, seventh, eighth and ninth editorial boards of Chinese Journal of Surgery, and a professor and chief physician of plastic surgery in Peking University Third Hospital, died on June 12, 2017 at the age of 92 due to illness.