2019年 · 第57卷第03期

A 31-year-old female was admitted to the hospital on 6 May 2018 due to "33 weeks of menopause, progressive aggravation of abdominal pain with vomiting for more than 1 d". The patient was married, pregnant 2 and gave birth 1. After eating greasy food 3 days before seeing the doctor, she had sudden upper abdominal pain, accompanied by nausea and vomiting, and the vomit was the stomach content. The white blood cell count was 24.3×10 in the emergency department of the local hospital⁹/L, the blood amylase concentration was 802 U/L, and the results of abdominal CT showed acute pancreatitis. After giving symptomatic treatment such as anti-inflammatory and rehydration, vomiting improved slightly. Because he still had abdominal discomfort, he was transferred to the Department of Obstetrics and Gynecology of our hospital for treatment. He claimed that the first fetus had a history of pancreatitis at about 33 weeks of pregnancy, and it improved after conservative treatment. Physical examination: body temperature 36.5 ℃, pulse 122 beats/min, breathing 20 beats/min, blood pressure 126/78 mmHg (1 mmHg =0.133 kPa), flat and soft abdomen, tenderness in the whole abdomen, no rebound pain, no mass, no subcostal reach of liver and spleen, negative Murphy sign, negative mobile voiced sound, and normal intestinal sound. No obvious uterine contractions were detected, and the fetal heart rate was 150 beats/min. Improve auxiliary examination: serum amylase 437 U/L; Blood ketone bodies (+ + +); urinary amylase concentration>1 300 U/L; procalcitonin (PCT) (ELECSYS B.R.A.H.M.S PCT Kit of Roche, Switzerland) 0.92 μ g/L, CRP 146.06 mg/L, erythrocyte sedimentation rate 87 mm/1 h; White blood cell count 29.93×10⁹/L, neutrophil percentage 95.7%; ALT 17 U/L, AST 30 U/L, direct bilirubin 11.3 μ mol/L, total bilirubin 21.3 μ mol/L, creatinine 38 μ mol/L, urea nitrogen 1.7 mmol/L; Free fatty acids were 3.17 mmol/L, triglycerides 15.24 mmol/L, and total cholesterol 20.69 mmol/L. Results of abdominal enhanced CT: acute hemorrhagic necrotizing pancreatitis with obvious peripancreatic exudation and fatty liver. Ultrasonographic images showed a depth of 18 mm of peritoneal effusion in the left and right lower abdomen, with obvious abdominal flatulence. PCT continued to decrease to 0.49 μ g/L from day 1 to day 3 of admission, CRP continued to rise to 176.45 mg/L on day 3, upper abdominal pain was aggravated, accompanied by nausea and vomiting, heart rate 136 beats/min, heart rate could not decrease after volume expansion and fluid replenishment, 30 breaths/min, blood pressure 106/56 mmHg, tenderness and rebound pain in upper abdomen, ultrasound images showed increased peritoneal effusion, suggesting that the patient's acute severe pancreatitis was aggravated and endangered the life of mother and child.

A 52-year-old male was admitted to the hospital on February 21, 2017 due to "upper abdominal distension and pain for 1 week, aggravated with fever for 3 days". The patient developed upper abdominal pain without obvious trigger 1 week ago, which was persistent distension and pain, and the pain radiated to the lower back and shoulders, accompanied by nausea and vomiting. The vomit was stomach content, and no special treatment was given. Three days ago, the above symptoms were aggravated with fever, and the body temperature was as high as 38℃. He went to a local hospital for treatment. Abdominal ultrasound examination showed acute pancreatitis. After treatment with fluid rehydration, acid inhibition and enzyme inhibition, his condition did not improve, so it was recommended to be transferred to a hospital for treatment. The patient underwent "laparoscopic pancreatic biopsy" in our hospital 8 months ago due to pancreatic space occupation. The postoperative pathological examination results showed pancreatic inflammatory mass and chronic pancreatitis. The patient had a history of drinking alcohol for 30 years and consumed alcohol almost daily. During the course of the disease, the patient had poor appetite, poor spirit, little urination, no defecation, and a recent weight loss of about 5 kg. Physical examination: flat abdomen, tension of abdominal muscles on the right side of the abdomen, tenderness in the whole abdomen, focusing on the right side of the abdomen, accompanied by rebound pain on the right side of the abdomen, no abnormal mass palpable, and weak intestinal sounds. On February 22, enhanced CT scan of abdomen showed chronic pancreatitis and mass in the tail of pancreas; Circular mixed density shadow in the running area of the descending duodenum, the possibility of pseudocyst combined with hemorrhage should be considered first; Localized peritonitis of right abdomen, secondary obstruction of transverse colon; Multiple calcifications in the head and neck of the pancreas. On February 25th, abdominal ultrasound showed: perihepatic effusion (4.3 cm deep) and localized effusion parapancreatic head (13.6 cm ×5.8 cm ×6.4 cm); Upright abdominal X-ray showed: intestinal gas accumulation, right diaphragm elevation; Gastroscopy showed a huge bulge at the junction of duodenal bulb and descending part. Partial laboratory findings at admission: white blood cell count 9.9×10⁹/L, neutrophil percentage 76.9%, red blood cell count 4.36×10¹²/L, hemoglobin 124 g/L, procalcitonin 49.2 μ g/L, potassium 2.71 mmol/L, sodium 127 mmol/L, creatinine 245 μ mol/L, total bilirubin 35.5 μ mol/L, albumin 31.3 g/L, AST 567.9 U/L, ALT 61.78 U/L, serum amylase 132 U/L and urinary amylase 189 U/L were detected by the ELECSYS B. R. A. H. M. S procalcitonin kit of Roche, Switzerland. Preliminary diagnosis of admission: acute onset of chronic pancreatitis; Pseudocyst of pancreas; localized peritonitis; Incomplete intestinal obstruction; Acute renal insufficiency; Right abdominal abscess; Severe fatty liver; hypokalemia; hyponatremia; Hypoalbuminemia.

A 20-year-old female was admitted to the hospital on April 6, 2016 due to "dysphagia, rash for more than 40 days, memory and advanced mental retardation for 1 month, and intermittent convulsions for 6 days". The patient developed dysphagia and scattered red rash on the chest and back more than 40 days ago; One month ago, there was a significant loss of memory, mainly recent memory, accompanied by intermittent disorientation, mental excitement and dance-like movements. Local hospital examination found hemoglobin 94 g/L, K⁺2.8 mmol/L, with huge mass occupation in the middle and upper abdomen. The patient was transferred to our hospital, during which he experienced intermittent seizures with daily fever, with a maximum body temperature of 38 ℃. Physical examination: red rash scattered on the chest and back, soft abdomen, large mass accessible in the left upper abdomen, with a maximum diameter of about 15 cm, tough texture and poor mobility. Laboratory tests: hemoglobin 63 g/L, alpha-fetoprotein 2 333 μ g/L, CA125 81.5 U/ml, gastrin 232.9 ng/L, adrenocorticotropic hormone (ACTH) 82.0 ng/L, cortisol>750 μ g/L. After multidisciplinary consultation, it was considered that the neurological symptoms were consistent with the limbic lobe encephalitis caused by paraneoplastic syndrome, and human blood gamma globulin was treated symptomatically, supplemented by sedation, intracranial pressure reduction and electrolyte disorder correction.

A 52-year-old female was admitted to the emergency department on 21 May 2017 due to "1 d of mobility impairment of both hands with both lower limbs after thyroid surgery". One month ago, a movable nodule was found in the patient's neck, and he went to the local hospital. After relevant examinations (no cervical spine related examinations), thyroid cancer was not ruled out. After entering the local hospital, the medical history was asked. There were no symptoms such as neck discomfort, numbness and weakness in the limbs, and feeling of stepping on cotton. Physical examination of the cervical spine and nervous system showed that the curvature of the cervical spine became straightened, the sequence and mobility of the cervical spine were normal, there was no tenderness or percussion pain in the neck, no paresthesia plane was found, no obvious abnormalities in the sensation and movement of the limbs were found, and the tendon reflex of the limbs was normal, without pathological reflex. Subtotal thyroidectomy was performed after perfect preoperative preparation. The patient took the supine position and successfully completed the tracheal intubation with laryngoscope under intravenous anesthesia. After the anesthesia was completed, the cervical dorsal extension position was taken to fully expose the surgical field. The operation time is about 80 min. The patient was awakened by the anesthesiologist after operation. The patient complained that both lower limbs were accompanied by mobility impairment of both hands, and both upper limbs felt acupuncture and numbness. Initially, the patient was not conscious, but 30 minutes later, the patient was conscious. There was no obvious movement of both lower limbs and hands, and the symptoms did not improve significantly. No obvious abnormalities were found after cervical X-ray examination and cervical CT in the local hospital. After that, the patient was transferred to the general ward for detailed observation. After 2 days, the patient's symptoms did not improve significantly, and the emergency department was transferred to our hospital for further treatment. Admission physical examination: the physiological curvature of the cervical spine is slightly straight, the sequence is as usual, the anterior transverse incision of the neck, dressing, negative pressure drainage, no obvious tenderness or percussion pain in the neck, the sensory plane is at the level of sternal angle, both forearms and hands feel acupuncture and numbness, the muscle tension of the limbs is not high, the muscle strength of bilateral deltoid muscles and biceps muscles is grade 4, the muscle strength of bilateral triceps muscles is grade 3+, the grip strength of both hands is grade 0, the muscle strength of each muscle of both lower limbs is grade 0, the reflex of bilateral biceps muscles is normal, the reflex of bilateral triceps muscles is not extracted, the reflex of bilateral knee tendon and the reflex of Achilles tendon is not extracted, the bilateral Hoffman sign is negative, the bilateral Babinsky sign is positive, and no obvious abnormalities are found in the remaining physical examinations. Japan Orthopedic Association scores 3 points (17 points method). Cervical spine MRI showed C_4~7The intervertebral disc is herniated backward, with C_5~6The level of the intervertebral disc was noted, the ligamentum flavum was not hypertrophic, and the C_4~7Strip-shaped T1WI low-signal T2WI high-signal spinal cord edema shadows can be seen in the cervical cord at the horizontal level of the posterior vertebral body (Figure 1）。 C_5~6Spinal canal stenosis at the level of the intervertebral disc, hypertrophy of the ligamentum flavum (Figure 2）。 CT of cervical spine showed that the curvature of cervical spine became straightened, local retraction, and bone hyperplasia was seen at the edges of vertebral bodies, with C₆Mainly vertebral body; C_4~7Intervertebral disc herniation with corresponding spinal stenosis, with C_5~7For the sake of (Figure 3）。 Combined with relevant examinations and physical examination, he was diagnosed as cervical spinal cord injury, quadriplegia, cervical spinal stenosis, and thyroid surgery, and was admitted to our hospital for emergency surgery.

In 2006, China's first "Operating Guidelines for Laparoscopic Radical Colorectal Cancer Surgery" was published, which played an important role in the standardization and promotion of laparoscopic radical colorectal cancer surgery. In 2006, NCCN Clinical Practice Guidelines for Colon Cancer began to recommend laparoscopic technique for radical colon cancer surgery, which established the status of laparoscopy in colon cancer surgery. With the results of COREN, COLOR Ⅱ, and ACOSOGZ6051 studies, the corresponding high-level evidence-based medical evidence has been provided^[1,2,3]In 2016, the NCCN Clinical Practice Guidelines for Rectal Cancer recommended that laparoscopic rectal cancer surgery should be applied to clinical practice on the premise of following certain principles. So far, there is sufficient basis for performing laparoscopic surgery on colorectal cancer patients who meet the surgical indications. In terms of specific surgical procedures, following the principle of total mesorectal excision (TME) for middle and low rectal cancer, the local recurrence rate can be reduced and the 5-year survival rate can be improved^[4]。 With the concept of complete mesocolic excision (CME) introduced in 2009, the scope and quality control of surgical resection of colon cancer have also met stricter and more meticulous standards^[5,6]。 The principles of TME and CME provide a more solid theoretical basis and practical standard for the standardized popularization and promotion of laparoscopic colorectal cancer surgery. It can be seen that after 12 years, both the laparoscopic technique itself and the concept of colorectal cancer surgery have changed greatly.

The patient was a 74-year-old male who was admitted to the hospital after physical examination showed that the right liver occupied space for 10 d. Preoperative CT angiography of the liver revealed space-occupying lesions in 8 segments of the liver, considering malignant tumor (Figure 1）。 The preoperative liver function was Child-Pugh grade A, and the 15-min retention rate of indocyanine green was 8.5%. Three-dimensional reconstruction of the portal vein system by preoperative imaging and surgical planning (Figure 2）； Laparoscopic fluorescence imaging-guided right anterior lobectomy of the liver was proposed.

In recent decades, although the incidence of colorectal cancer has been decreasing in the overall population, it has been increasing in the young population^[1]。 Therefore, the new guidelines of the American Cancer Society recommend that the starting age of colorectal cancer screening be lowered by 5 years to 45 years. Since 1994, colorectal cancer rates have increased by 51 percent among adults under 50, and this increase in risk is more prominent among the youngest adults in particular, the association said. Since the mid-1980s, the incidence of colon cancer in adults aged 20 to 39 years has increased by 1.0% to 2.4% annually. Similarly, the incidence of rectal cancer has shown a similar or even more pronounced upward trend, with the incidence of rectal cancer increasing by 3.2% annually in young people aged 20 to 29 years between 1974 and 2013.

The author of the paper "Analysis of Surgical Treatment Results of 237 Cases of Tricuspid Valve Displacement Deformity" published in Volume 56, Issue 6, 2018 of our journal should be "Tsinghua University Clinical Medicine_{", is hereby corrected}。