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??Clinical research on regional intra-arterial infusion for the treatment of severe acute pancreatitis ZHOU Meng-tao*, ZHANG Qi-yu, WANG Chun-you, et al. *Department of Hepatobiliary & Pancreatic Surgery, the First Affiliated Hospital, Wenzhou Medical College, Wenzhou 325000, China Corresponding author: ZHANG Qi-yu, E-mail: qiyuz@126.com Abstract Objective To study the the rapeutic effect of regional arterial infusion??RAI??on severe acute pancreatitis (SAP) on early stage. Methods Forty-five cases of SAP were treated with RAI on early stage between August 1999 and June 2007 at the First Affiliated Hospital of Wenzhou Medical College. Then the state of illness, drugs infused, combined surgery and therapeutic effect were analyzed. Results ??The fatality rate was 4.4%. ??The incidence rate of complication was 35.6%(16/45).??The average length of hospital stay of total cases was 29.4 days; thereinto, the average length of hospital stay of the 33 cases with only RAI, 12 cases with RAI combined surgery was 23.1 days and 39.0 days, respectively. ??The average medical cost of total cases was 60.1 thousand yuan RMB; thereinto, the average medical cost of 33 cases with only RAI, 12 cases with RAI combined surgery was 44.3 thousand yuan RMB and 103.4 thousand yuan RMB, respectively. ??The incidence rate of secondary infection of total cases was 28.9%. Conclusion RAI can bring down the fatality rate, reduce the incidence rate of complications, shorten hospital stays, reduce medical cost. It is a synergistic non-operation therapeutic method of SAP.     

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??Report for 25 cases of the upper arm central venous port implantation in breast cancer patients LIU Qian, ZHAO Xuan, WANG Ying-xin, et al. Breast Disease Center, Peking University First Hospital, Beijing 100034, China
Corresponding author: LIU Ying-hua,E-mail: liuyinhua7520@163.com
Abstract Objective To discuss the standard procedure and potential advantages in upper arm central venous ??CV?? port implantation. Methods Retrospectively analyze the results of upper arm CV port implantations performed in Peking University First Hospital Breast Disease Center to confirm the clinical utility and advantages of upper arm CV port implantation compared to internal vein CV port implantation. Results 97 CV port implantations were performed in Peking University First Hospital Breast Disease Center from January to October 2017. Procedural success and complication rates between internal vein ??n=72?? and upper arm ??n=25?? groups were compared. There is no significant difference in surgery time ??t=0.342??P=0.733??and short-time complication??P=1.000?? between the upper arm and internal vein groups. Conclusion Upper arm CV port implantation can provide safety and comfort benefits to clinicians and patients if performed following implantation procedures strictly.     

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??Clinical research of effects of nutrition support containing differential fatty acids ingredient on improving protein catabolism of liver transplantation patients ZHOU Xü, LIU Jun, YANG Feng-hui, et al. Center of Organ Transplantation, Provincial Hospital Affiliated to Shandong University, Jinan 250021,China
Corresponding author: LIU Jun, E-mail:zhouxu2008@sina.com
Abstract Objective To compare the difference of effects between enteral nutrition and parenteral nutrition formula containing either MCT/LCT or LCT only on protein metabolism of liver transplantation(LTP) patients and determine the mechanism of MCT/LCT improving nutritional status of LTP patients. Methods A random controlled clinical trail containing 86 cases of liver transplantation was conducted and all the cases were divided into 4 groups. The several parameters were observed before liver transplantation 1day and after liver transplantation 1, 4, 7 and 10 days, such as serum concentrations of transferrin and prealbumin. Results The results showed that the patients of F, N group had an increased blood concentration of transferrin, prealbumin than those of the patients of K, C group( P<0.05 or P<0.01). The above two parameters were markedly higher in group F than in group N as same as group K vs group C(P<0.05 or P<0.01). Excretion of nitrogen and 3-methylhistidine in urine was also markedly reduced in patients fed with nutrients containing MCT/LCT compared with LCT(P<0.05 or P<0.01) . Nitrogen balance was better in group F than that in N and K group. Conclusion An enteral compound diet containing MCT/LCT can reduce decomposition of the body proteins, enhance the level of serum albumin, and improve the status of protein metabolism of patients after liver transplantation more effectively.     

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??Fecal microbiota transplantation for treatment of slow transit constipation: A clinical study of 20 patients TIAN Hong-liang??DING Chao??GONG Jian-feng??et al. Department of General Surgery??Jinling Hospital??Medical School of Nanjing University??Nanjing 210002?? China
Corresponding author??LI Ning??E-mail: liningrigsnju@163.com
Abstract Objective To examine the safety and efficacy of fecal microbiota transplantation (FMT) for slow transit constipation (STC). Methods Twenty patients with STC were enrolled in the prospective open-label study. All the patients were performed FMT. Autonomous defecation frequency??Wexner constipation scale, bowel movement and related adverse reaction per week around FMT were evaluated at each study visit. All the patients were followed up for 8 weeks. Results Compared with pre-FMT treatment??the patient’s stool frequency increased significantly ??(1.5 ± 1.3) times/week vs. (4.5±1.5) times/week?? after eight weeks of treatment. Meanwhile??Wexner constipation scores demonstrated a significant reduction ??(15.7 ± 3.5) vs. (7.5 ± 1.6)?? and GIQLI score increased remarkably??(84.6 ± 12.5) vs. (116.6 ± 11.5)??, which has significant difference statistically (P<0.05). There were 12 patients obtained clinical improvement and seven patients obtained clinical remission till to 8 weeks. FMT efficacy was stable and no serious adverse event occurred during the whole follow-up. Conclusion FMT is safe and effective for treating slow transit constipation and the short-term treatment effect is good.     

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??A comparative study of omentum wrapping in pancreaticojejunostomy for reducing postoperative pancreatic fistula XU Jie-ru*??CHEN Chao??SHEN Ning-jia??et al. *Medical College of Soochow University??Suzhou 215000??China
Corresponding author: ZHANG Yong-jie, E-mail: yjoy005@sina.com
Abstract Objective To investigate the efficacy of the omentum wrapping technique in pancreaticojejunostomy on decreasing the incidence of pancreatic fistula after pancreaticoduodenectomy. Methods The clinical data of 225 patients underwent pancreaticoduodenectomy and pancreaticojejunostomy in single operation group from January 2009 to October 2015 in No.2 Department of Biliary Tract Surgery, Eastern Hepatobiliary Surgery Hospital Affiliated to the Second Military Medical University were analyzed retrospectively. Patients were divided into two groups??including group with omentum wrapping technique (n=125) and control group without it (n=100). After propensity score matching??the rates of pancreatic fistula were compared between the two groups??including group with omentum wrapping technique (n=64) and control group without it (n=64). Results All operations were completed successfully. The overall complication rate of all 225 patients was 62.7%??141/225??. The reoperation rate was 2.7%??6/225??. The mortality is 2.7%??6/225??. The incidence of pancreatic fistula was 46.7%??105/225????including 61 cases of Class A??37 cases of Class B??and 7 cases of Class C. The incidence of bleeding was 11%??25/225??. The incidence of DGE was 24.9%??56/225??. The incidence of abdominal infection was 20.9%??47/225??. Except the incidence of pancreatic fistula??there was no statistical difference between the two groups in the incidence of bleeding??DGE and abdominal infection??P>0.05??. In the omentum wrapping group, no reoperation case occurred??and there were only 2 death cases. In the control group??there were 4 reoperation cases and 4 death cases. There was no significant difference between the two groups in those data??P=0.119, 0.680??. In the PSM model??soft pancreas??pancreatic duct diameter and omentum wrapping were related to the postoperative pancreatic fistula in single factor analysis. In the multiple factors analysis??pancreatic duct diameter <3 mm and no omentum wrapping were independent risk factors for pancreatic fistula. Conclusion The omentum wrapping technique can decrease the rate of pancreatic fistula and it is worth applying in pancreaticojejunostomy.     

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??Surgical and endovascular treatment of thromboangiitisobliterans LIU Bing, HUANG Ren-ping. Department of Vascular Surgery, the First Affiliated Hospital of Harbin Medical University, Harbin 150001, China
Corresponding author: HUANG Ren-ping, E-mail: cup521@163.com
Abstract Objective To investigate the outcomes of surgical and endovascular treatment for thromboangiitisobliterans. Methods The clinical data of 202 patients with thromboangiitisobliterans underwent surgical and endovascular treatment in the First Affiliated Hospital of Harbin Medical University from April 2006 to April 2015 were analyzed retrospectively. According to the outcomes of ankle brachial index (ABI) and the Rutherford classification value (R-value), the effectiveness of different operation methods were evaluated. Results The Rutherford classification value evaluation??One month after operation, R-value decreasedin all 4 groups??P<0.05??. Six months after operation, R-value decreased in lumbar sympathectomy group, sequential endarterectomy group and sequential endarterectomy combined with lumbar sympathectomy group??P<0.05??. Twelve months after operation, R-value decreased in sequential endarterectomy group and sequential endarterectomy combined with lumbar sympathectomy group??P<0.05??.ABI evaluation??One week after operation,ABI increased in all 4 groups ??P<0.05??. Six months after operation, ABI increased in sequential endarterectomy combined with lumbar sympathectomy group??P<0.05??. Twelve months after operation, ABI increased in sequential endarterectomy group and sequential endarterectomy combined with lumbar sympathectomy group??P<0.05??. Conclusion Percutaneous transluminal angioplasty (PTA) and lumbar sympathectomy can bring benefit to the patient with TAO in the short term. Sequential endarterectomy combined with or without lumbar sympathectomy are proved to be effective as a surgical method for TAO.     

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??Intra-operative puncture and identification for lymph nodes and parathyroid glands: A clinical study of 28 patients LI Yong-ping*??YANG Li??LI Nan-lin??et al. *Department of Thyroid-Breast-Vascular Surgery??Xijing Hospital??the Fourth Military Medical University??Xi'an 710032??China
Corresponding author??LING Rui??E-mail: lingruiaoxue@126.com
Abstract Objective To explore the feasibility of intra-operative puncture and real-time identification of lymph nodes and parathyroid glands. Methods A total of 28 thyroid cancer patients hospitalized into Xijing Hospital??the Fourth Military Medical University between January 2014 and July 2014 were included into the study and proceeded with radical surgery. When intra-operative frozen pathological detection proceeded??the intra-operative puncture and real-time identification was started at the same time. Finally, the diagnostic efficiency such as sensitivity and specificity of two methods was evaluated. Results A total of 40 suspicious nodes were distinguished in 28 patients??including 29 suspicious parathyroid glands??9 suspicious lymph nodes and 2 other suspicious nodes. Intra-operative identification rate of parathyroid glands was 27.5% (11/40)??while that of lymph nodes was 37.5% (15/40). Bases on the gold standard of frozen pathological results??the accuracy rate of lymph node and parathyroid glands detection was 100% and 93.1%??respectively. Meanwhile??the sensitivity and specificity of intra-operative parathyroid distinction was 100% and 97.0%. Conclusion The intra-operative rapid detection plays a significant role in distinguishing lymph nodes??which may enhance the protection and in-situ retention of parathyroid glands.     

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??Left and right sides plastic duct and choledochojejunostomy of hilar cholangiocarcinoma: A study of 11 cases LI Ke-hao??WU Lin-quan??YIN Xiang-bao??et al. Department of Hepatobiliary Surgery??the Second Affiliated Hospital of Nanchang University??Nanchang 330006, China
Corresponding author??WU Lin-quan??E-mail??Wulqnc@163.com
Abstract Objective To investigate safety and practicality of left and right sides dults anaplasty respectively with duct jejunum anastomosis after radical resection of Bismuth ?? hilar cholangiocarcinoma. Methods The clinical data and follow-up of 11 cases of Bismuth II hilar cholangiocarcinoma under double bile ducts jejunum anastomosis admitted between January 2010 and January 2015 in Department of Hepatobiliary Surgery of the Second Affiliated Hospital of Nanchang University were analyzed retrospectively. Results The average operation time was about 5 hours; the intraoperative bleeding was 400 mL averagely; all the cases began to eat in postoperative 3 to 6 days; the hospitalization days was about 11 to 20 days. There was no hospital death. There were 3 cases of postoperative bile leakage??2 cases of abdominal infection??3 cases of pleural effusion. The symptoms had been alleviated by anti-infection treatment and drainage. There was no case of anastomotic bleeding. The follow-up period was 3 to 60 months. Ten cases were followed up with outpatient services and letters. The total follow-up rate was 90.9%. Review methods were T angiography??CT??MRI examination. There were 1 case of anastomotic stricture considered recurrence of cholangiocarcinoma, 1 case of accidental biliary tract infection symptoms which can be improved by antibiotic therapy. All the 10 cases were with a median survival of 29 months and overall survival rate of 70.0% (7/10). Conclusion Type II hilar cholangiocarcinoma after resection of the tumor with large number and distance of left and right sides bile ducts should plastic alone and concide with jejunum respectively.     

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目的 观察连续性高流量血液滤过(HVHF)治疗严重感染伴有多器官功能障碍综合征(MODS)的临床疗效及安全性.方法 2005-2007年中国医科大学附属第一医院收治的20例确诊为产重感染伴有MODS的病人,平均APPACHEⅡ评分为23.8±8.3,平均SOFA评分为10.6±4.0,在常规治疗的基础上应用HVHF治疗至少3d,血流速度250mL/min,超滤量4L/h,置换液以前稀释方式输入,普通肝素抗凝,每24h更换滤器1次.比较治疗前后病人生命体征、血清尿素氮、肌酐、胆红素、动脉血乳酸、血小板、氧合指数及APPACHEⅡ评分和SOFA评分的变化,并监测治疗过程中的并发症.结果 20例病人在HVHF治疗后生命体征迅速稳定,体温、心率、呼吸频率降低,平均动脉压上升,血清尿素氮、肌酐水平下降,动脉血乳酸降低,血小板计数升高,氧合指数改善,APPACHEⅡ评分及SOFA评分降低,与治疗前相比差异具有统计学意义(P＜0.05),血清胆红素水平在治疗后来见明显改善.治疗过程中病人未见严重的离子及酸碱紊乱及其他并发症的发生.结论 连续性HVHF治疗能够降低严重感染伴有MODs病人的全身炎性反应,改善器官功能水平,未见严重并发症的发生,安全有效.     

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??Effect of empowerment intervention on ulcerative colitis patients’ anal function and quality of life after ileal pouch-anal anastomosis GAO Sen-yang??ZHANG Ying-ying??LI Kai-yu??et al. Department of General Surgery, Tianjin Medical University General Hospital??Tianjin 300052??China
Corresponding author??LIU Gang??E-mail??landmark1503@sina.com
Abstract Objective To investigate the effect of empowerment intervention on ulcerative colitis (UC) patients’ anal function and quality of life after ileal pouch-anal anastomosis (IPAA??and provide gist for clinical intervention. Methods Sixty patients with UC who underwent IPAA between January 2010 and September 2014 in Department of General Surgery, Tianjin Medical University General Hospital were invited as the intervention group and the control group randomly??which received empowerment intervention and traditional health education respectively. Six months after intervention?? the patients’ anal function and stool form by the 24 hours and night defecation??Kirwan grade??Bristol stool form scale were evaluated. Before and after the intervention of 6 months??serum total protein (TP), prealbumin (PA), albumin (ALB) and transferrin (TRF) were usd to assess patients’ nutritional status, assess the patients’ quality of life by the Inflammation Bowel Disease Questionare (IBDQ). Results Six months after empowerment intervention??24 hours and night defecations of intervention group were better than those of control group ??24h:??4.3±1.5??vs. (5.9±2.4); night:??1.6±0.7??vs. (2.3±1.3)??all P<0.05??. The number of patients in intervention group were 21 in grade ??(Kirwan classification)??7 in grade??2 in grade ??and the control group were 14 in grade ??12 in grade ??4 in grade ??χ2=3.380??P>0.05??. The number of patients in intervention group were 20 in type four (Bristol stool form scale)??6 in type five??4 in type six ??and the control group were 11 in type four??17 in type five??2 in type six ??χ2=8.540??P<0.05??. In intervention group??ALB levels were elevated ???47.4±5.8??g/L vs. ??43.3±6.5??g/L??P<0.05????. The IBDQ scores of intervention group are higher than those of control group (P<0.05). Conclusion Empowerment intervention may improve the anal function and stool form of UC patients after IPAA and enhance the quality of their life.     

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??Expression of molecular markers predict breast cancer to neoadjuvant anthracycline chemotherapy value CHEN Yi-zuo*, CHEN Can-ming, FEI Fei, et al. *Department of Breast Surgery, Fudan University Shanghai Cancer Center,Shanghai 200032, China
Corresponding author: WU Jiong, E-mail??wujiong1122@vip.sina.com
Abstract Objective To investigate the predictive value of biological markers for responsiveness to anthracyline-based regimen in neoadjuvant systemic therapy for local advanced breast caner. Methods Postoperative paraffin-embedded tumor samples from 420 breast cancer patients admitted between January 2000 and December 2010 in Department of Breast Surgery of Fudan University Shanghai Cancer Center were examined for expression of ER, PR, Her-2/neu and other 15 markers by immunohistochemistry, to analyze the predictive value of the biological markers for response to neoadjuvant chemotherapy. Results Negative p53, cathepsin-D and loss of GSTπwere significantly predictive for an effective response to anthracycline-based neoadjuvant chemotherapy. In multivariate logistic regression analysis, the GSTπand p53 status were found with independent predictive value. Conclusion Loss of GSTπand p53 independently predict the response to anthracycline-based regimen.     

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??Case-control study on clinical features and long term effect of inflammatory abdominal aortic aneurysm in comparison with atherosclerotic abdominal aortic aneurysm WANG Shao-ye, ZHANG Jian, YIN Ming-di, et al. Department of Vascular Surgery, the First Hospital, China Medical University, Shenyang 110001, China
Corresponding author: ZHANG Jian, E-mail: jianzhang_cmu@yahoo.com.cn
Abstract Objective To analyze clinical features and long term effect of inflammatory abdominal aortic aneurysm (iAAA). Methods Between 1988 and 2008, 412 cases of AAA in the First Hospital of China Medical University were performed elective surgical operations. Eleven (2.7%) of them were diagnosed as iAAA. The former group was matched in a case control fashion to a group of 33 patients with aAAA with similar characteristics of age, gender and preoperative risk factors. All available clinical, pathologic and postoperative variables were reviewed retrospectively, and the two groups were compared. Results In comparison with aAAA, patients with iAAA were more symptomatic significantly (100% vs. 42.4%, P=0.001) and had larger aneurysm size on admission ??(7.4±0.7)cm vs. (6.3±0.9) cm??P=0.006??, and preoperative erythrocyte sedimentation rate was found to be elevated significantly ??(44.5±9.1)mm/h vs. (11.4±5.4)mm/h??P<0.05??. Surgical morbidity and mortality rates did not differ between two groups. The operation time of patients with iAAA was longer than patients with aAAA significantly ??(308±36)min vs. (224±46)min, P<0.05??, and cross-clamp time was similar in both groups??(41.5±6.2) min vs. (41.8±6.2)min, P= 0.92??. A five-year survival rate analysis showed no significant difference between two groups (P=0.711) . Conclusion Despite the more symptomatic, larger size and long operation time of iAAA, iAAA can be treated with low morbidity and mortality similar as aAAA now. Long term effect of iAAA is of no difference from aAAA.     

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??Comparative study of clinical efficacy of precision biliary surgical technique and traditional surgery for gallbladder carcinoma LI Mao-lan, ZHU Yi-di, WU Xiang-song, et al. Department of General Surgery, Xin Hua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200092, China
Corresponding author??LIU Ying-Bin??E-mail??laoniulyb@163.com
Abstract Objective Discuss the value and clinical applications of precise biliary surgery theory and technology in gallbladder tumor resection.Methods The clinical data of 97 patients with gallbladder cancer who received radical cholecystectomy in XingHua Hospital, Shanghai Jiao Tong University School of Medicine from January 2000 to June 2015 were retrospectively analyzed??All the patients were divided into 2 groups??38 patients who were admitted from January 1986 to December 2006 were in the traditional surgery group??and 59 patients who were admitted from January 2011 to June 2015 were in the precision surgery group??The perioperative condition and prognosis of the patients in the 2 groups were compared??Results There were no significant differences in the clinicopathological characteristics, such as gender, age, histological grade, the TNM stage, median volume of intraoperative blood loss and duration of postoperative hospital stay between the two groups. The ratios of extended radical operation were 35.5??(21/59)in the precision surgery group, and 15.6%(6/38)in the traditional surgery group??with significant difference between the 2 groups(χ2=4.513??P<0.05)??Patients in the precision surgery group had significantly higher R0 resection rate (66.1% vs. 18.4??, P??0.05) and median dissected lymph node number (26.0±12.1 vs. 17.0±9.1, P??0.05).The median survival time was 19.2 months in patients in the precision surgery group??and the 1- and 3- year survival rates of patients were 62.7%??28.8% respectively. The median survival time was 9.9 months in patients in the traditional surgery group??and the 1- and 3- year survival rates of patients were 42.1%??7.89% respectively. There was a significant difference between the 2 groups. The differences of the median volume of intraoperative blood loss??complication rates??duration of postoperative hospital stay between the 2 groups were notstatistically significant. Conclusion Application of the concept and techniques of precision biliary surgery significantly increase the radical resection rate and improve the therapeutic outcomes.     

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??Comparative study of clinical curative effect on reduced incision laparoscopic surgery and multi-incision laparoscopic surgery in rectal cancer ZHANG Qing-tong*, LIU Ya-li, ZHANG Xu, et al. *Department of Colorectal Surgery??Cancer Hospital of China Medical University, Liaoning Cancer Hospital & Institute??Shenyang 110042, China
Corresponding author??SONG Chun??E-mail??songchun1@hotmail.com
Abstract Objective To investigate the short-term and long-term clinical curative effects on redued incision laparoscopic surgery and multi-incision laparoscopic surgery in rectal cancer. Methods A retrospective study of 124 cases of rectal cancer admitted from June 2010 to June 2012 in Liaoning Cancer Hospital was conducted??in which were excluded the cases with high years old and dysfunction of the heart and lung or the other important viscera??and with the distance less than 6 cm from the inferior tumor margin to the anal edge and the rectal cancer of the ??and ??stages. A total of 62 cases proceeded the reduced incision laparoscopic surgery ??reduced incision group?? and 62 cases undergone the multi-incision laparoscopic surgery??multi-incision group??simultaneously. Results Two groups had no statistically significant difference in operative time, intraoperative bleeding, the number of lymph node harvest, the incidence of anastomotic leakage and anus reserved, completeness of specimen, distance to proximal margin,ditance to distal margin, positive rate of circumferencial resection margin (CRM) and distal resection margin (DRM), local recurrence rate, 3-year disease free survival rate, 3-year overall survival rate, etc.( all P??0.05).But the total length of incision??postoperative pain score of the first and the second day??anal exhausting time?? independently walking for the first time between two groups had statistically significant diferences( all P??0.05). Conclusion Reduced incision laparoscopic rectal cancer surgery can decrease the total length of incision, lower postoperative pain degree??shorten anal exhausting time??and improve cosmetic effect. And the kind of approach does not prolong operative time significantly??and the quality of tumor resection??and 3-year disease free survival rate?? 3-year overall survival rate are not inferior to multi-incision laparoscopic surgery.     

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??Exploration of the value of magnetic resonance imaging in early prediction of tumor response to neoadjuvant chemotherapy in breast cancer XIN Ling*, LIU Wen-qing, XU Ling, et al. *Peking University First Hospital, Beijing 100034, China
Corresponding author: XU Ling, E-mail: xuling_en@126.com
Abstract Objective To explore the value of functional parameters changes in the early prediction of tumor response to neoadjuvant chemotherapy. Methods A total of 151 cases of breast cancer received neoadjuvant chemotherapy and subsequent surgery at Peking University First Hospital from January 2010 to December 2014 were studied retrospectively. Breast MRI examinations were underwent to define the clinical response to the treatment. The enrolled cases were divided into good response (GR) group and minor response (MR) group, and the relationship of MRI parameters changes(ΔD%??ΔADC%??ΔSmax% and ΔTIC) and therapy response was analyzed. A clinical response prediction model logit P based on combined functional parameters was established, and AUCs for therapeutic effect prediction were compared to evaluate prediction efficacy. Result Functional parameters changes (ΔADC%??ΔSmax%??
ΔTIC) after 2 cycles of neoadjuvant chemotherapy were significantly different between 2 groups??P<0.001??.The AUCs for response prediction of ΔD%??ΔADC%??ΔSmax% and ΔTIC were 0.600,0.820,0.807 and 0.786.The AUC for pathological prediction of logit P based on functional parameters was 0.898??95%CI 0.844 —0.953??. Conclusion There is predictive value of functional parameters changes (ΔADC%??ΔSmax% ??ΔTIC) after 2 cycles of neoadjuvant therapy for pathologic response.     

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??Clinical research of BD detaining needle for subcutaneous liquid accumulation drainage after breast cancer radical operation NIE Jian-yun, JIANG Ni, LI Bi-xiu, et al. Department of Breast Cancer,the 3rd Affiliated Hospital of Kunming College, Kunming 650118, China Corresponding author: NIE Jian-yun, E-mail:njyvip@sina.com Abstract Objective To study the effect of BD detaining needle for subcutaneous liquid accumulation drainage after breast cancer radical operation. Methods Ninety cases of breast cancer suffering from subcutaneous liquid accumulation after operation between January 2005 and December 2008 at the 3rd Affiliated Hospital of Kunming College were divided into 3 groups.The total volume and days of drainage,time cost of practice,pain and infection of the wound,the direct medical cost,satisfaction of patient were recorded and analyzed. Results The research group showed superiority in the time cost of practice,pain and infection of the wound, direct medical cost and high rate of satisfaction. Compared with control group B, the total volume and days of drainage also decreased.Conclusion BD detaining needle for subcutaneous liquid accumulation drainage is a good choice in decreasing the rate of complication after operation. It can also save time and money.     

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目的 了解肝功能不良病人术后早期进行肠内营养的疗效及安全性。方法 将２５例肝胆管手术后肝功能不良病人随机分成两组,分别于术后第３天进行肠内和肠外营养,共１０天,观察营养状况、肝功能、电解质、空腹血糖及胃肠道功能的变化。结果 （地）两两 的营养状况及肝功能均明显改善,与术前相比差异有极显著性意义,组间差异无显著性意义。（２）两种营养方法均能纠正由于手术所致的同轻度异常,而血糖无明显影响。（３）肠内营     

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??Analysis of prognostic predictors affecting hepatectomy combined with postoperative adjuvant TACE in patients with hepatocellular carcinoma??A double-centered propensity-score matching study QU Kai*??GU Jing-xian??CUI Rui-xia??et al. *Department of Hepatobiliary Surgery??the First Affiliated Hospital of Xi'an Jiaotong University??Xi'an 710061??China
Corresponding author??LIU Chang??E-mail??eyrechang@126.com??FAN Hai-ning??E-mail??1486713174@qq.com
Abstract Objective To confirm the clinical effectiveness of postoperative adjuvant transcatheter arterial chemoembolization??TACE?? in HCC patients after liver resection??and further identify the patients who could benefit most from postoperative adjuvant TACE. Methods The clinical data of 593 consecutive patients were retrospectively collected from the First Affiliated Hospital of Xi’an Jiaotong University from January 2005 to December 2016 and the Affiliated Hospital of Qinghai University between January 2011 and June 2017. Propensity score matching (PSM) was used between hepatectomy patients with and without receiving postoperative adjuvant TACE and finally a total of 348 patients were matched. Kaplan-Meier analysis was performed to compare overall survival (OS) and recurrence-free survival (RFS) between the two groups??univariate COX regression and stratified survival analysis were performed to screen and identify survival predictors for postoperative adjuvant TACE patients. Results The Log-rank tests showed both OS and RFS of the patients in postoperative adjuvant TACE group were significantly longer than those in the control group (P<0.05). The identified prognostic predictors by Cox regression and stratified survival analysis included hepatitis B infection??spleen diameter??preoperative serum alpha-fetoprotein (AFP)??TNM stage??tumor size??tumor number. Conclusion Postoperative adjuvant TACE could improve prognosis markedly in HCC patients??particularly in late-stage ones with hepatitis B??portal hypertension??or higher level of preoperative AFP.     

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??Chimney technique for aortic diseases involving supra-aortic branches in a single center SHU Chang, WANG Tun. Department of Vascular Surgery, the Second Xiangya Hospital, Central South University, Changsha 410011, China
Corresponding author: SHU Chang, E-mail??changshu01@yahoo.com
Abstract Objective To evaluate the mid- and long-term efficiency of thoracic endovascular aortic repair (TEVAR) with chimney technique for aortic arch disease involving the supra-aortic branches. Methods The clinical data of 57 cases of aortic arch diseases performed TEVAR with chimney technique from September 2009 to December 2013 in Department of Vascular Surgery, the Second Xiangya Hospital, Central South University were analyzed retrospectively. There were 2 cases (3.5%) of aortic arch aneurysm, 1 case (1.8%) of type I endoleak after TEVAR for thoracic aortic aneurysm, 1 case (1.8%) of type I endoleak after TEVAR for type B aortic dissection (TBAD), 53 cases (92.9%) of TBAD. One case was complicated with Marfan syndrome. Results All of the stent grafts were deployed as planned. Five cases had type II endoleak during TEVAR. One case received re-TEVAR and another chimney stent grafts deployment because of ischemia of branch arteries caused by migration of chimney stent grafts during anesthesia resuscitation. All patients followed up for 2 to 51 months. One case of TBAD received re-TEVAR for distal re-entry. One case died of cerebral hemorrhage 3 months later. No TEVAR related complications happened, such as stent graft migration, occlusion, fracture or type I endoleak during follow-up. Conclusion Chimney technique can be used with TEVAR to treat aortic arch disease invaded supra-aortic branches, which is reliable and stable. Reconstructed supra-aortic branches with covered stent is useful for prevention of post-TEVAR complications