Abstract:

Objective：To summarize the operative complications, fatality and the long-term outcome of pancreaticoduodenectomy (PD).
Methods：The clinical data of 328 consecutive patients undergoing PD between Janunary 2001 and Janunary 2011 were retrospectively analyzed, which included 281 cases of standard PD, 8  cases of pylorus-preserving PD and 39 cases of extended PD.
Results：The incidence of operative complications in the whole group was 34.1% (112/328), of which the five major complications were delayed gastric emptying (16.5%), pancreatic fistula (11.9%), hemorrhage (7.0%), intra-abdominal infection (5.2%) and pulmonary infection (4.9%). The reoperation rate was 6.1% and fatality rate was 3.0%. The 1-, 3- and 5-year survival rate of the patients with periampullary carcinoma (n=202) was 79.1%, 51.5% and 33.8%, respectively, and the median survival time was 38 months, of which the 1-, 3-, and 5-year survival rate of the lymph node negative cases (n=144) was 81.7%, 57.6% and 40.6%, respectively, with a median survival time of 47 months, and the 1-, 3-, and 5-year survival rate of the lymph node positive cases (n=58) was 72.1%, 36.4% and 16.8%, respectively, with a median survival time of 24 months. The long-term survival time of lymph node negative patients was significantly higher than that of lymph node positive patients (P=0.003). The 1-, 3-, 5-year survival rate of the patients with pancreatic head cancer (n=42) was 67.6%, 29.1% and 9.7%, respectively, and the median survival time was 16 months, but the 3-year survival rate of the lymph node positive cases (n=11) was 0. The 1-, 2-, 3-year survival rate of the patients with nonperiampullary primary tumors (n=16) was 71.4%, 39.6% and 19.8%, respectively, and the median survival time was 21 months.
Conclusions：The keys to reducing the postoperative complications and fatality of PD are strictly adhering to the indications for extended PD, improving the operative technique and strengthening the perioperative management. The lymph node status is the important factor of prognosis for periampullary and pancreatic head cancer. En bloc PD can be considered as a treatment option for nonperiampullary tumors such as locally advanced gastrointestinal cancers, because it may prolong the survival in some of these patients.

Abstract:

Objective：To explore the effect of a modified pancreaticojejunostomy on the incidence of pancreatic fistula after pancreatoduodenectomy.
Methods：The clinical data of 78 patients undergiong pancreaticojejunostomy were retrospectively analyzed. The anastomoses of pancreas and jejunum were performed by a modified pancreaticojejunostomy (modified group) or the conventional pancreaticojejunostomy (conventional group), respectively, and the incidences of pancreatic fistula and clinical outcomes of the two groups after surgery were observed.
Results：Of the 48 patients in the modified group, postoperative complications occurred in 5 cases (10.4%) that included 1 case of pancreatic fistula (2.1%). Of the 30 patients in the conventional group, postoperative complications occurred in 11 cases (36.7%) that included 5 cases of pancreatic fistula (16.7%), and 1 case died of abdominal infection and hemorrhage secondary to the pancreatic fistula. All the 77 cases recovered and were discharged from hospital.
Conclusions：The application of the modified pancreaticojejunostomy in pancreatoduodenectomy can reduce the incidence of pancreatic fistula, and it is an effective procedure for the prevention of the pancreatic fistula after pancreatoduodenectomy.

Abstract:

Objective：To evaluate the feasibility and safety of spleen-preserving distal pancreatectomy.
Methods：From February 2006 to Agust 2010, a total of 16 patients with benign or junctional tumor in the body and tail of pancreas underwent spleen-preserving distal pancreatectomy (SPDP) at our center. Of the patients, 15 cases underwent SPDP with conservation of splenic vessels and one case with dissection of splenic vessels.
Results： Postoperative complications included 9 cases of pancreatic fistula, one case of wound infection, 3 cases of abdominal bleeding (one case of bleeding due to pancreatic fistula), and 2 cases of pleural effussion. Of the 9 patients with pancreatic fistula, 8 of them healed within 3 to 7 weeks by nonsurgical treatment, while one case complicated with hemorrhage underwent digital subtraction angiography and splenic arterial embolization to stop bleeding, and recovered at the 17th week postoperatively. In another 2 cases of intraabdominal bleeding, one was controlled with nonsurgical treatment, the an other one underwent reoperation and ligation of a branch of the splenic vein that was bleeding. There was no mortality in this group.
Conclusions：SPDP can be used as first choice for patients with benign or junctional tumor of distal pancreas, and is a safe procedure with satisfactory results.

Abstract:

Objective：To investigate the timing of the surgical intervention  in the infection phase of severe acute pancreatitis (SAP).
Methods：The clinical data of 88 SAP patients admitted in Nankai hospital, who underwent surgical treatment in the infection phase, from January 2003 to January 2011 were retrospectively analyzed. According to the time span from the onset of SAP to receiving surgery, the patients were divided into group A (1 week to 2 weeks after onset), group B (3 to 4 weeks after onset) and group C (more than 5 weeks after onset).  The score of acute physiology and chronic health evaluation (APACHE-Ⅱ), C-reactive protein level, reoperation rate, fatality and postoperative complications, etc. were compared among the groups.
Results：The APACHE-Ⅱ score and blood C-reactive protein level of group B ［4.74±0.82, (84.81±4.65)U/L］ were significantly decreased compared with group A ［9.14±0.33, (103.40±4.40)U/L］ and group C ［8.69±0.30, (122.40±3.86)U/L］, respectively (both P＜0.01). The fatality, reoperation rate and postoperative complications of group B (6%, 27.66%, 23.40%) were significantly lower than those of the group A (12.03%, 90.32%, 51.61%) and group C (40%, 80%, 80%), respectively. (all P＜0.01).
Conclusions：The optimal timing of surgery for SAP in infection phase is 3 to 4 weeks after the onset of SAP. At that time, surgical intervention results in less postoperative complications, lower reoperation rate, and lower mortality.

Abstract:

Objective：To investigate a minimally invasive therapeutic procedure for peripancreatic abscess with the combined use of interventional ultrasound and choledochoscopy.
Methods：The clinical data of 52 patients diagnosed as peripancreatic abscess, who underwent B-ultrasound guided percutaneous puncture and catheterized drainage, and subsequent irrigation and debridement by choledochoscopy after dilatation of the drainage catheter sinus tract, were retrospectively analzyed.
Results：Of the 52 patients, 50 cases were cured by this procedure,  the curative rate was 96.2%, and the other 2 cases were converted to open drainage due to the inadequate catheter drainage. The average time for cure of the 50 cases was 73 days, of whom 1 case developed an enterocutaneous fistula and 2 cases were complicated by abdominal hemorrhage, but all the 3 cases were all cured by nonsurgical treatment. No residual peripancreatic necrosis was noted in any patient at the follow-up period of 3 months to >1 year.
Conclusions：The combined use of interventional ultrasound and choledochoscopy is a safe and effective procedure for treatment of peripancreatic abscess, so it can be widely used.

Abstract:

Objective：To preliminarily screen out the drug resistance-related genes downstream of signal transducer and activator of transcription 3 (STAT3) in human pancreatic cancer cell by small interfering RNA (siRNA) and gene chip technique, with the purpose of providing a basis for studying the mechanism of STAT3-associated drug resistance.
Methods：The differentially expressed genes between the human pancreatic SW1990 cells of wild-type STAT3 gene and STAT3 gene silenced by siRNA were compared after using gene chip technique to preliminarily screen out the drug resistance-related genes downstream of STAT3.
Results： Nine hundred and eighty-two (2.55%) differentially expressed genes were screened from the 47000 genes represented on the microarray according to the criterion of significant difference, of which, 592 genes were up-regulated by 2-fold and 390 genes were down-regulated by 2-fold, respectively. Among those, some drug resistance-related genes were identified that included significantly up-regulated genes of topoisomerase IIα (TOPOIIα) and TNF-related apoptosis-inducing ligand (TRAIL), and significantly down-regulated genes of cysteine-rich 61 (CYR61), RAS-related protein Rap-1A (RAP1A), BCL-2-associated athanogene 1 (BAG1) and cystic fibrosis transmembrane conductance regulator (CFTR).
Conclusions：The drug resistance of pancreatic cancer is a result of the interactions which involving multigenes and multipathways. The expression profile of six drug resistance-related genes changes after the STAT3 gene silencing with siRNA technique. Our results may provide new clues to further inspect the relation between STAT3 and drug resistance of pancreatic cancer, and also provide new insights into the treatment of pancreatic cancer.

Abstract:

Objective：To investigate the effects of 5-aza-2′-deoxycytidine (5-Aza-dC) and trichostatin A (TSA) on the methylation and expression of TFPI-2 gene in pancreatic cancer Panc-1 cells.
Methods：Panc-1 cells were treated with 5-Aza-dC alone, TSA alone and their combination. Methylation specific PCR (MSP), RT-PCR and Western Blot were used to determine the DNA methylation in promoter region, mRNA and protein expression of TFPI-2, respectively.
Results：After treatment with 5-Aza-dC alone or the combination of 5-Aza-dC and TSA, the hypermethylation of TFPI-2 gene in Panc-1 cells was reversed to an unmethylated pattern; the TFPI-2 mRNA and protein that did not express before treatment were reexpressed in Panc-1 cells; the TFPI-2 mRNA expression level was 0.821±0.050 and 0.887±0.042, and TFPI-2 protein expression level was 0.613±0.092 and 0.712±0.059, respectively. The effects of the two treatments (B5-Aza-dC alone and 5-Aza-dC plus TSA) were similar. However, no reversion of the hypermethylation status and no reexpression of TFPI-2 gene were noted in the Panc-1 cells treated with TSA alone.
Conclusions：The methylation of promoter region is a main cause of transcriptional inactivation of TFPI-2 gene in Panc-1 cells. Either 5-Aza-dC alone or 5-Aza-dC plus TSA can reverse the hypermethylation status of TFPI-2 gene and reexpress TFPI-2 in Panc-1 cells. However, TSA alone has no reverse effect on the inhibited TFPI-2 gene.

Abstract:

Objective：To investigate the protective effect of S-adenosylmethionine on liver injury secondary to severe acute pancreatitis (SAP) in rats and its mechanisms.
Methods：Forty-eight rats were equally randomized into sham-operated group, SAP model group and SAP model with two doses (100 mg/kg, 200 mg/kg) of SAM pretreatment groups. Eighteen hours after the models were established, the blood samples of each group were collected to meassure the serum levels of amylase (AMY), alanine transaminase (ALT) and aspartate aminotransferase (AST), and the liver tissues were also harvested to detect the TNF-α expression level by RT-PCR and Western blot methods, respectively.
Results：Comparison to the sham-operated group, the TNF-α mRNA expression in the liver as well as the serum levels of AMY, ALT and AST of other 3 groups all significantly increased to different extents (all P＜0.05). SAM pretreatment of both doses significantly inhibited the elevation of TNF-α expression in the livers, and decreased the serum levels of AMY, ALT and AST, comparing with the SAP rats (both P＜0.05). Moreover, these effects presented in a dose dependent manner (P＜0.05).
Conclusions：Supplemental exogenous SAM  has protective effect on liver injury secondary to SAP, and the mechanism may probably be related to its inhibitory effect on TNF-α expression in the liver.

Abstract:

Objective：To investigate the therapeutic effects of angiopoietin-1 for acute necrotizing pancreatitis (ANP) complicating pancreatic encephalopathy in mice.
Methods：Fifty-four Bal b/c mice were equally randomized into control group, acute necrotizing pancreatitis group and ANP with Ang-1 treatment group. Each group was further equally divided into 3 subgroups to collect the specimens at 9,18 and 24 h, respectively. The ANP model of mouse was induced by intraperitoneal injection of caerulein (50 μg/kg, once hourly, 7 times), the mice of control group were given the same volume of saline in the same administration regimen, and the mice of the Ang-1 treatment group received intraperitoneal injection of Ang-1 (100 μg/kg) after ANP induction. The mice of each group were sacrificed at each predefined time point. The serum levels of amylase (AMY), IL-6 and TNF-α were measured, the histopathological changes of pancreatic tissue were examined and graded with a scoring criterion. Meanwhile, the brain malondialdehyde (MDA) level, brain water content and leukocyte count of the cerebral microvasculature were also determined.
Results：Compared with the control group, the serum levels of AMY, IL-6 and TNF-α, the histopathological score of pancreatic tissue, brain MDA level and water content, and leukocyte count of the cerebral microvasculature of the other two groups at each time point were all significantly increased (all P＜0.05). Except for the brain MDA level (P＞0.05), all the parameters of the Ang-1 treatment group were significantly improved compared with ANP group (all P＜0.05).
Conclusions：Ang-1 has protective effect on ANP and ANP-induced brain injury as well.

Abstract:

Objective：To inhibit growth hormone receptor (GHR) gene expression in human colon cell line SW480 by small interfering RNA (siRNA) technique, and thereby to observe the effect of GHR gene silencing on proliferation of SW480 cells.
Methods：After the GHR gene specific siRNA design, the eukaryotic plasmid expression vector targeting human GHR (pcDNATM6.2-GW/EmGFP-siRNA-GHR) was constructed, which was then transfected into SW480 cells by electroporation. The transfected cells were cultured for 48 to 72 hours, and then the cell proliferative activity was assayed by tetrazolium bromide (MTT), GHR protein expression was detected by Western Blot, and GHR mRNA was determined by fluorescence real time quantitative reverse transcription-polymerase chain reaction, respectively.
Results：Compared with the control group, the proliferative speed, GHR protein and mRNA expression of SW480 cells were all significantly decreased after transfection (all P＜0.05).
Conclusions： The pcDNATM6.2-GW/EmGFP-GHR-siRNA constructed can effectively down-regulate GHR expression in SW480 cells, and thereby inhibit the proliferation of SW480 cells.

Abstract:

Objective：To screen out the aberrantly expressed miRNAs in the intestinal type gastric cancer.
Methods：The miRNA expression levels of 6 cases of intestinal type gastric cancer tissues and their adjacent non-tumour tissues were evaluated with miRCURYTM LNA microRNA array (v.14.0), and the average level  increased (or decreased) more than 2 folds and P value less than 0.01 were set as cutoff values. Part of the aberrantly expressed miRNAs revealed by microRNA array were selected and further analyzed in 29 cases of intestinal type gastric cancer tissues and their adjacent non-tumour tissues using quantitative real-time PCR (RT-qPCR), and the correlation between the two results was analyzed.
Results：As revealed by miRNA microarray analysis, 40 mRNA presented significant up-regulated expression, of which 24 genes had been found to be increased in gastric cancer tissue previuosly; 36 mRNA showed significant down-regulated expression, of which 19 mRNA had been reported to be abnormally decreased in gastric cancer previously. Six up-regulate miRNAs  and 5 down-regulated miRNAs in the microRNA array analysis were examined by RT-qPCR, and the results were consistent with the results of the microRNA array analysis. There was a significant positive correlation between the two methods (P<0.01).
Conclusions：Our study identifies a series of new miRNA aberrantly expressed in intestinal type gastric cancer and thereby provides a basis for further study.

Abstract:

Objective：To assess the clinical value of macrophage inhibitory cytokine-1 (MIC-1) as a serum tumor marker for diagnosis of pancreatic cancer.
Methods：Serum MIC-1 levels were measured by enzyme-linked immunosorbent assay (ELISA) in 35 patients with pancreatic cancer, 30 patients with benign pancreatic disease and 30 healthy control subjects. Meanwhile, the results of MIC-1 were compared with that of CA19-9.
Results：The serum MIC-1 level in patients with pancreatic carcer［(1 589.8±838.5) pg/mL］ was significantly higher than that in patients with benign pancreatic diseases ［(400.6±104.3) pg/mL］ or healthy subjects ［(386.1±145.5) pg/mL］ (both P<0.01), while MIC-1 levels exhibited no significant difference between the patients with benign pancreatic diseases and the healthy subjects (P>0.05). The sensitivity, specificity, positive predictive value, negative predictive value, and area under the curve (AUC) of receiver operating characteristic curve of MIC-1 measurement for diagnosis of pancreatic cancer were 85.7%, 93.3%, 93.8%, 84.9% and 0.973, respectively, which were all higher than those of the corresponding values of CA19-9 (74.3%, 90.0%, 89.6%, 75.0% and 0.862, respectively). The sensitivity and specificity of combined measurement of MIC-1 and CA19-9 was 91.4% and 83.3%, respectively. The positive rate of MIC-1 was significantly lower than that of CA19-9 in patients with benign pancreatic diseases (3.3% vs. 26.7%, P<0.05). The positive rate of CA19-9 in patients with benign pancreatic diseases complicated by jaundice was significantly higher than that patients without jaundice (55.6% vs. 14.3%, P<0.05), while whether complicated by jaundice or not, it had no influence on the positive rate of MIC-1 (P>0.05).
Conclusions：The comprehensive diagnostic ability of MIC-1 is better than CA19-9 for diagnosis of pancreatic cancer, and MIC-1 may potentially be a novel serum tumor marker of pancreatic cancer.

Abstract:

Objective：To investigate the changes of free fatty acid in type 2 diabetic (T2DM) patients after gastric bypass surgery.
Methods：The parameters including free fatty acid (FFA), homeostasis model assessment of insulin resistance (HOMA-IR), fasting plasma glucose (FPG), 2-hour postprandial plasma glucose (PPG), glycosylated hemoglobin (HbA1C), and body mass index (BMI) were measured in 20 patients with type 2 diabetes before, and 3 and 6 months after surgery, and 20 cases of healthy subjects were used as control.
Results：Of the T2DM patients, 15 cases achieved complete remission, 3 cases obtained partial remission, and 2 cases had no remission. The values of FFA, HOMA-IR, FPG, PPG, and HbA1C of the T2DM patients were significantly higher than those of the healthy subjects before operation. The values of FFA and HOMA-IR in the T2DM patients decreased progressively from 3 to 6 months after surgery and all were significantly lower than those before operation (both P＜0.01). FPG, PPG and HbA1C were all decreased significantly after surgery (all P＜0.01). The correlation coefficients of FFA and HOMA-IR in the T2DM patients before, and 3 and 6 months after surgery were 0.58 (P＜0.01), 0.46 (P＜0.05) and 0.48 (P＜0.05), respectively.
Conclusions：Gastric bypass surgery can reduce the serum FFA level of T2DM patients and thereby lessen their insulin resistance. It may be one of the mechanisms of the therapeutic effect of gastric bypass on T2DM patients.

Abstract:

Objective：To investigate the diagnostic methods of pancreatic capsule micrometastasis of gastric cancer.
Methods：The CK20 and CEA mRNA expressions in the pancreatic capsule of patients with gastric cancer were measured by RT-PCR method.
Results：Of the 67 patients, 22 cases (32.8%) had both CK20 and CEA mRNA positive expression (pancreatic capsule micrometastasis-positive) in the pancreatic capsule. The pancreatic capsule micrometastasis of gastric cancer was related to the depth of infiltration, location of the gastric cancer, histological type, clinical stage and lymph node metastasis (P＜0.05), but was irrelevant to the age and sex of the patients (P＞0.05).
Conclusions：The measurement of CK20 and CEA mRNA by RT-PCR is a sensitive method for diagnosis of pancreatic capsule micrometastasis of gastric cancer. The pancreatic capsule micrometastasis is positively correlated with the malignant degree of gastric cancer and it can be a guide for resection range of gastric cancer.

Abstract:

Objective：To investigate the optimal strategy of surgical treatment for primary retroperitoneal tumor (PRPT).
Methods：The clinical data of 78 patients with PRPT treated from January 1994 to May 2009 were retrospectively analyzed.
Results：Of the patients, 38 cases were malignant tumors (maximum diamater 3-25 cm and avarage 9.94 cm), and 40 cases were benign lesions (maximum diamater 7-42 cm and avarage 18.36 cm). Fifty-nine cases underwent complete resection, 15 casess underwent palliative resection, and 4 cases underwent surgical exploration and biopsy. Eighteen (30.51%) of the patients undergoing complete resection had combined resection en bloc with the adjacent organs that included colon, intestine, kidney, pancreas and spleen, respectively. Three cases underwent vascular reconstruction. There was no perioperative death. The 1-, 3- and 5-year survival rate of patients with malignant tumor undergoing complete resection was 88.04%, 73.68% and 42.1% respectively, while those undergoing palliative resection was 66.67%, 33.33% and 0, respectively. All the differences between them had statistical significance (all P＜0.01). Fifteen cases underwent reoperation due to recurrence.
Conclusions：Adequate preoperative preparation, proper operative approach and combined resection with the involved organs are the keys of surgical treatment of PRPT. Aggressive reoperation for recurrence may still improve the survival rate of PRPT patients.

Abstract:

Objective：To investigate the clinical significance of CK20 mRNA detection in peritoneal fluid of gastric cancer patients.
Methods：CK20 mRNA expressions in ascitic or peritoneal lavage fluid of 49 patients with gastric cancer were detected by real-time fluorescent quantitative reverse transcription polymerase chain reaction (FQ-RT-PCR), and 10 non-tumor patients undergoing surgery during the same period were used as control.  Further, the results were analyzed with their clinicopathological data and follow-up results.
Results：The positive rate of CK20 mRNA in ascitic and peritoneal lavage fluid was 50.00% and 35.90%, respectively, which showed no significant difference (P＞0.05). The overall positive rate of CK20 mRNA was 38.78% in gastric cancer group, while no positive expression was detected in control group. The positive rate of CK20 mRNA expression was significantly higher than the positive rate of peritoneal cytology examination (10.20%) (P＜0.05). The expression of CK20 mRNA was related to whether or not lymph node metastasis and the depth of tumor invasion (both P＜0.05), but was irrelevant to the degree of differentiation (P＞0.05). The average survival time of the patients with CK20 mRNA positive expression was significantly decreased compared with the negative ones (20.95 months vs. 33.24 months) (P＜0.01).
Conclusions：The detection of CK20 mRNA in ascites or peritoneal washings can diagnose the peritoneal micrometastasis in the early-stage, and is useful for estimating prognosis and guiding treatment.

Abstract:

Objective：To explore the digestive tract reconstruction procedure after total gastrectomy.
Methods：The clinical efficacies of two types of digestive tract reconstruction procedures, P-type jejunal pouch Roux-en-Y esophagojejunostomy (PRY, n=120) and modified “P” jejunal interposition pouch reconstruction (mPJIP, n=122), were compared. The operative time, surgical complications and change of postoperative nutrition indexes were observed.
Results：There was no statistical difference (P＞0.05) in operation time between PRY and mPJIP group, which was (3.8±0.2) h and (3.6±0.1) h, respectively. The surgical complications and death of PRY group ［13 cases (10.8%), 4 cases (3.3%)］ were significantly higher than and those of mPJIP group ［9 cases (7.4%), 3 cases (2.5%)］ (both P＜0.05). The postoperative nutrition indexes alteration such as body weight, total protein and prognostic nutritional index in mPJIP group were significantly better than those of PRY group (all P＜0.05).
Conclusions：The mPJIP reconstruction can improve patient′s quality of life and reduce the postopertative complications and mortality of total gastrectomy. mPJIP is an ideal procedure for digestive tract reconstruction after total gastrectomy and therefore is recommended for use in clinical practice.

Abstract:

Objective：To study the clinical features, diagnosis and treatment of  patients with nodular goiter concomitant thyroid cancer.
Methods：The clinical data of 142 cases with concomitant thyroid cancer in 1 859 cases of nodular goiter admitted from January 2008 to January 2011 were retrospectively analyzed.
Results：All the 142 patients underwent surgical treatment, of which, there were 112 cases of primary surgery and 30 cases of secondary surgery. The ratio of men to women was 1∶3.1, and the patients predominantly manifested as nodular goiter. Fifty-five cases (38.7%) were suspected of having concomitant thyroid cancer as suggested by preoperative ultrasound examination, of which 21 cases (18.7%) had nodular psammomatous calcification. Twelve cases had cervical lymph node enlargement. Ninety patients underwent high-resolution color Doppler ultrasound examination, of which 68 cases (75.6%) were suspected of having malignant lesion. Fine needle aspirations (FNA) were performed in 45 cases and the correct diagnostic rate was 48.9%. The pathological examinations of intraoperative fast frozen section were performed in 138 patients, with accuracy rate of 96.4%, 5 false negative cases and no false positive case. Of the patients with thyroid cancer, 83 cases were unifocal and 59 cases were multifocal, lesions less than 2.0 cm accounted for 75.3%, the main pathological type was papillary carcinoma (75.4%), and 64 cases showed lymph node metastasis. The surgical procedures comprised ipsilateral total lobectomy combined with isthmusectomy, ipsilateral total lobectomy combined with isthmusectomy plus contralateral subtotal lobectomy or total thyroidectomy, and ipsilateral or bilateral central compartment (level VI) lymph node dissection. The patients with enlarged cervical lymph nodes and suspected of having cervical lymph node metastasis before or during surgery underwent additional modified neck dissection. After surgery, all the 142 patients received replacement therapy with levothyroxine, 101 cases of whom were also given radioactive131I ablative therapy. Eight cases underwent reoperation due to relapse.One case died of pulmonary metastasis of the thyroid cancer during the postoperative follow-up period of 6 months to 3 years.
Conclusions：Papillary cancer is the most common type of the concomitant thyroid cancer in patients with nodular goiter and the lesion usually is less than 2.0 cm. Preoperative ultrasonography, FNA and pathological examination of intraoperative fast frozen section can increase the detection rate and effectively reduce the misdiagnosis of concomitant thyroid cancer in nodular goiter. Rigorous follow-up of those patients with nodular goiter can improve the early detection rate of concomitant thyroid cancer.

Abstract:

Objective：To investigate the techniques and effectiveness of endovascular repair for treating Stanford type B thoracic aortic dissection.
Methods：The clinical data of 78 patients with Stanford type B thoracic aortic dissection were retrospectively analyzed. All patients were evaluated before surgery by CT angiography (CTA) or magnetic resonance angiography (MRA). A vascular prosthesis (membrane-covered stent) was introduced via the femoral artery into the dissected thoracic aorta under digital subtraction angiography (DSA) guidance to exclude the proximal primary entry tear. DSA examination was carried out immediately after the stent placement procedure to confirm the exclusion of the dissection. Follow-up CTA was performed at 1, 3 and 6 months after surgery, and then every one year thereafter. The survival status, endoleak types, true and false lumen diameter of the residual dissection of the patients were recorded.
Results：Intraoperative angiography revealed 6 cases of type I endoleak following endovascular repair. Of these patients, the endoleak in 2 cases disappeared after cuff insertion, the proximal endoleak in 2 cases disappeared after the balloon expansion, and another 2 cases with small leak as evidenced by less contrast material in the false lumen received no treatment. A persistent endoleak was only found in 1 case, but no enlargement of the false lumen diameter 3 months later. Type II endoleak occurred in 2 cases who received no treatment due to small amount of blood leakage. Of the 2 cases, endoleak spontaneously closed in 1 case, and persisted without enlargement of the false lumen diameter 6 months later in the another one. Of the 78 patients, 15 cases underwent intentional occlusion of the left subclavian artery during surgery, of whom, 2 cases presented the steal syndrome of left upper limb accompanied by debilitating fatigue, 2 cases suffered cerebral infarction after 2 years, and 1 case, after 6 months, developed Stanford type A aortic dissection, that underwent ascending aorta replacement. No severe complications (such as, heart, lung and renal function failure or paraplegia) occurred in the rest of the patients.
Conclusions：Our brief follow-up study suggests that endovascular repair for Stanford type B thoracic aortic dissection is safe and effective treatment. Endoleak is the major complication after endovascular treatment.