2017年 · 第55卷第09期

Tang Zhaoyou

Professor Huang Ting has been away from us for a full 10 years, but his memory has not been diluted by the river of time, but has become clearer, so that he can always feel his presence at work and in academics. He seems to be right by our side, as always paying attention to the progress of the students (Figure 1)。

Radical surgery in patients with large or multiple tumors of the liver often requires the removal of a large area of liver tissue. If the remaining liver volume is too small, it limits the implementation of radical surgery. Two-step hepatectomy with liver dissection and portal vein ligation (associating liver partition and portal vein ligation for staged hepatectomy, ALPPS) It can promote the rapid growth of the remaining liver volume, and make some patients who can't undergo surgical resection get the opportunity of radical surgery. However, the incidence and mortality of complications such as biliary fistula and infection after ALPPS were higher^[1,2,3]And the first operation of ALPPS violated the principle of "tumor-free technology" and increased the risk of intraoperative cancer cell spread^[4,5]。 Since December 2014, our department has designed the first operation to only selectively dissect the blood vessels into the liver for patients with giant or multiple tumors of the right liver with insufficient remaining liver volume, and the second operation to perform anterior approach to right hemihepatic or right hepatic trilobectomy, and achieved good results. The report is as follows.

Pancreaticojejunostomy stenosis is one of the long-term complications after pancreaticoduodenectomy. Although the incidence rate is low, it is easy to cause recurrent attacks of acute pancreatitis, and it is difficult to manage clinically^[1]。 With the development of endoscopic retrograde cholangio-pancreatography (ERCP) technology and related supporting devices, the restricted areas of conventional ERCP based on normal digestive tract anatomy have been broken one by one. The center began to try the diagnosis and treatment of ERCP after gastrointestinal tract surgery in 1998. After nearly 20 years of experience accumulation and summary, it gradually formed its own characteristics and expertise in the diagnosis and treatment of ERCP after gastrointestinal tract surgery. Since 2009, our center has treated more than 300 patients with Billroth I, Billroth II (may include Braun's anastomosis), total gastrectomy with Roux-en-Y anastomosis, post-pancreaticoduodenectomy, bilioenterostomy and various combined gastrointestinal anastomosis reconstruction. We completed the endoscopic treatment of 3 cases of pancreaticojejunal anastomotic stenosis after duodenectomy with single balloon enteroscopy-assisted ERCP, which is reported below.

The patient was a 51-year-old female. Because of the soreness of the right hip for half a year, I had a right ovarian cyst resection and an appendectomy in a foreign hospital. 11 years ago, I had a sub-extensive total hysterectomy for cervical cancer. The postoperative pathological examination showed that cervical squamous cell carcinoma involved glands. Physical examination: About 8 cm long incision scar can be seen under the umbilicus of the abdomen, mild tenderness and percussion pain behind the sacrum, radiating to the right hip and the back of the thigh, normal lumbar spine activity, normal skin sensation and muscle strength of both lower limbs, normal reflex of bilateral calcaneal tendon, and no pathological signs were drawn out. Preoperative CT and MRI revealed that S_2～5Irregular soft tissue masses can be seen in the horizontal sacral canal, and the sacral bone destruction with enlargement of the right sacral foramen. The mass grows forward and backward along the right sacral foramen, which is closely related to the anterior iliac vessels, and the posterior paravertebral muscles are involved (Figure 1), and no metastasis was seen at other sites. After admission, a surgical biopsy was performed and a primary solitary fibrous tumor of the sacrum was diagnosed.

A 59-year-old male was admitted to the hospital in March 2015 due to "aortic dissection for 10 years and recurrent pain in the prethoracic area for 1 month". In 2005, the patient had sudden severe pain in the chest and back without obvious trigger, and aortic dissection was found in an external hospital. After conservative treatment with drugs, the symptoms gradually disappeared (the specific situation is unknown). No regular follow-up was performed after discharge, and there were no obvious discomfort symptoms during this period. One month ago, the patient experienced severe pain in the anterior chest area again, and came to our hospital for CT angiography (CTA). It showed that there was a ruptured dissecting aneurysm at the junction of thoracic and abdominal aorta, with a maximum diameter of 72 mm, a large amount of pleural effusion on the left side, and the celiac trunk artery started from the tumor body, and the initial part was stenotic. The dissection rupture was 10 mm from the opening of the superior mesenteric artery and 15 mm from the opening of both renal arteries; Complete thrombosis of the dissected false lumen of the proximal thoracic aorta and the distal abdominal aorta, and calcification of the abdominal aortic wall (Figure 1)。 With a history of hypertension for more than 10 years, blood pressure control can be achieved; There was a history of smoking for more than 20 years (20 cigarettes/d) and a history of intermittent small amount of alcohol consumption. The hemoglobin concentration was 78 g/L in routine preoperative blood tests.

The first academic symposium of the Professional Committee of Parathyroid and Bone Metabolic Diseases of the Chinese Society of Research Hospitals was successfully held in Beijing from May 20 to 21, 2017. The conference was chaired by Professor Liao Quan, Department of Basic Surgery, Peking Union Medical College Hospital, chairman of the special committee. Academician Zhao Yupei, vice chairman of China Association for Science and Technology, academician of Chinese Academy of Sciences and president of Peking Union Medical College Hospital, delivered a speech. Academician Ning Guang, academician of Chinese Academy of Engineering and vice president of Ruijin Hospital affiliated to Shanghai Jiaotong University School of Medicine, sent a congratulatory letter to the conference. More than 200 representatives from all over the country gathered together to fully discuss difficult and hot issues such as primary hyperparathyroidism, hypoparathyroidism, bone metabolism disorder of renal insufficiency, etc., and review and summarize the clinical and basic research on parathyroid and bone metabolism diseases in China in recent years.

Rectal bleeding and changes in bowel habits in patients under the age of 50, coupled with abnormalities in hematological parameters, strongly predict colorectal cancer and inflammatory bowel disease, according to the results of a study¹。 Investigators inBritish Journal of General PracticeAccording to the journal, this finding can help general practitioners prioritize patients with atypical colonoscopy diagnosis.

Recently, researchers inJAMA Internal MedicineIt is recommended in the journal that the use of gastric acid inhibitors in patients with C. difficile infection should be discontinued1.

Trustees in England and Wales employ an examination method that helps hospital ward staff quickly assess patient vision in order to avoid falling while patients travel and stay in hospital. The method uses a series of questions and visual aids to help a doctor, nurse or therapist check a patient's vision by the hospital bed. The results may suggest the severity of the vision problem.

An American woman died of septic shock after being infected with carbapenem-resistant Enterobacteriaceae (CRE). This bacterium is resistant to all available antimicrobial drugs in the United States. The superbug has been found to be Klebsiella pneumoniae, which is resistant to 26 antibiotics, including all tested aminoglycoside antibiotics and polymyxin antibiotics, and moderately resistant to tigecycline.