RESUMEN
<p><b>OBJECTIVE</b>To report a case of the implantation of thyroid hyperplastic or neoplastic tissue after endoscopic thyroidectomy and discuss this complication in aspects of prevalence, pathogenesis, protection, and therapies.</p><p><b>METHODS</b>A systematic search of literature from the PubMed database was conducted for identifying eligible studies on implantation of thyroid hyperplastic or neoplastic cells after endoscopic thyroid surgery.</p><p><b>RESULTS</b>Overall, 5 reported cases on patients suffering from endoscopic thyroid surgery with implantation of thyroid hyperplastic or neoplastic cells were included in the systematic review.</p><p><b>CONCLUSIONS</b>Unskilled surgeons, rough intraoperative surgical treatment, scarification or rupture of tumor, contamination of instruments, chimney effect, aerosolization of tumor cells may be associated with the implantation after endoscopic thyroidectomy. To minimize the risk of such complication, we should be more meticulous and strict the endoscopic surgery indications.</p>
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Adulto , Femenino , Humanos , Adulto Joven , Endoscopía , Hiperplasia , Patología , Neoplasias de la Tiroides , Patología , Cirugía GeneralRESUMEN
<p><b>OBJECTIVE</b>To retrospectively evaluate the diagnosis and treatment of Mirizzi syndrome (MS).</p><p><b>METHODS</b>Patients who received elective or emergency cholecystectomies in our center during 23 years were retrospectively evaluated. The data reviewed included demography, clinical presentations, diagnostic methods, surgical procedures, postoperative complications, and follow-up.</p><p><b>RESULTS</b>There were 27 patients diagnosed with MS among 8697 cholecystectomies performed during that period. The preoperative diagnostic modalities included ultrasonography, computed tomography, magnetic resonance cholangiopancreatography, and endoscopic retrograde cholangiopancreatography. The incidence of MS Type I (12/27, 44.4%) had the dominance in the four types, the incidence of MS Type II and III were 33.3% (9/27) and 22.2% (6/27), and there were no MS Type IV patients. Laparoscopic cholecystectomy was performed in 15 (55.6%) patients, but only 3 (11.1%) patients with MS Type I had a successful surgery, and the other 12 were converted to open cholecystectomy. The remaining 12 patients directly underwent open cholecystectomy. The surgical procedures except laparoscopic cholecystectomy included simply open cholecystectomy (including laparoscopic cholecystectomy converted to open cholecystectomy) (6/27, 22.2%), open cholecystectomy, T-tube placement with choledochotomy (9/27, 33.3%), open cholecystectomy, closure of the fistula with gallbladder cuff, T-tube placement (3/27, 11.1%), and open cholecystectomy with excision of the external bile ducts, and Roux-en-Y hepatico-jejunostomy (6/27, 22.2%). Of them, 88.9% (24/27) patients recovered uneventfully and were discharged in good condition without any operation related mortality.</p><p><b>CONCLUSIONS</b>Endoscopic retrograde cholangiopancreatography is a good method with diagnostic and therapeutic purposes. Total or partial cholecystectomy is generally adequate for MS Type I. For MS Type II-IV, paritial cholecystectomy, choledochoplasty, or if impossible, Roux-en-Y hepatico-jejunostomy may be performed. Laparoscopic cholecystectomy may be successful in selected preoperatively diagnosed MS Type I patients, and open cholecystectomy is the standard therapeutic method.</p>
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Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Colecistectomía Laparoscópica , Síndrome de Mirizzi , Diagnóstico , Patología , Cirugía General , Estudios RetrospectivosRESUMEN
<p><b>OBJECTIVE</b>To summarize the clinical features and outcomes of unsupected gallbladder carcinoma ( UGC) detected during or after laparoscopic cholecystectomy.</p><p><b>METHODS</b>Medical records of 8005 patients, who underwent laparoscopic cholecystectomy in Peking Union Medical College Hospital between June 1993 and June 2011, were reviewed. Patients that pathologically diagnosed as UGC were retrospectively studied in terms of clinical features, preoperative and postoperative diagnosis, surviving period, and complications.</p><p><b>RESULTS</b>In the 8005 patients who received laparoscopic cholecystectomy, 36 (0.45%) were diagnosed as UGC during (25 patients) or after (11 patients) laparoscopic cholecystectomy. The gallbladder cancer was staged as T1 in 16 patients, T2 in 11 patients, and T3 in 9 patients. The 1-, 3-, and 5-year survival rates of all the patients were 88.9% (32/36), 63.9% (23/36), and 58.3% (21/36). The 5-year survival rates in T1 stage, T2 stage, and T3 stage patients were 100%, 75.0%, and 0.0%, respectively.</p><p><b>CONCLUSIONS</b>The survival rate of UGC is associated with tumor stage, not with operation approaches. Laparoscopic cholecystectomy is appropriate for T1 patients.</p>
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Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad , Colecistectomía Laparoscópica , Neoplasias de la Vesícula Biliar , Diagnóstico , Patología , Cirugía General , Estudios RetrospectivosRESUMEN
OBJECTIVE: To evaluate the treatment of recurrent acute cholangitis with hepatolithiasis. METHODS: We retrospectively analyzed the clinical data of patients with recurrent acute cholangitis who were treated in Peking Union Medical College Hospitals emergency department from January 1998 to December 2008. RESULTS: Totally 408 patients underwent surgery, of which 167 patients received emergency operations and 241 underwent selective operations after medication and interventional treatment. The incidence of complications was 6.4% among those who received emergency operations and 3.2% among selective operations. The 30-day mortality rate of selective operations was zero. CONCLUSION: Along with the progress of percutaneous cholangiographic drainage and endoscopic retrograde cholangiopancreatography, selective operations have been increasingly applied for acute cholangitis with notably low complications and postoperative death.
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Colangitis/cirugía , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Colangitis/etiología , Colelitiasis/complicaciones , Colelitiasis/cirugía , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Resultado del Tratamiento , Adulto JovenRESUMEN
<p><b>OBJECTIVE</b>To summarize the clinical features and surgical methods for colorectal cavernous hemangioma in China.</p><p><b>METHODS</b>Data of 4 cases in Peking Union Medical College Hospital and 54 cases with colorectal cavernous hemangioma from 1979 to 2006 reported in Chinese literatures were analyzed retrospectively, including clinic manifestations and surgery treatment.</p><p><b>RESULTS</b>The incidence of male to female was 1.0:1.0, and 43.1% of the patients had their first onset of recurrent rectal bleeding in early childhood. Colonoscopy, rectal CT scan and MRI were the accurate methods for the diagnosis (100%). 91.4% of the patients had diffuse infiltrative lesions and 8.6% of the patients had localized lesions. 82.8% of the patients underwent surgical treatment while 3.5% of the patient did not received treatment.</p><p><b>CONCLUSIONS</b>Colonoscopy is the first choice for the diagnosis of colorectal cavernous hemangioma. Local resection should be performed for the localized cavernous hemangioma. Sigmoid colon and rectum resection with coloanal anastomosis is suitable for the diffuse and infiltrative colorectal cavernous hemangioma.</p>