【主题活动】普外专业顶级英文期刊最新跟踪学习交流专贴

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杂志全名及年卷期：J Gastrointest Surg. 2007 Jun;11(6):778-82
文题：Laparoscopic Medial-to-lateral Colon Dissection: How and Why..
作者：Pigazzi A, Hellan M, Ewing DR, Paz BI, Ballantyne GH.
英文摘要：
Laparoscopic colectomy is a difficult procedure with a long learning curve. We describe in this study our technique for right- and left-sided laparoscopic medial-to-lateral colectomy. The medial approach involves division of the vascular pedicle first, followed by mobilization of the mesentery toward the abdominal wall, and finally freeing of the colon along the white line of Toldt. This approach allows immediate identification of the plane between the mesocolon and the retroperitoneum and renders the dissection fast and safe. Our series of 50 consecutive laparoscopic colectomies supports this concept. We believe that surgeons familiar with this technique will have an important tool in their armamentarium to circumvent some of the challenges of laparoscopic colectomy.
PMID: 17562120

中文翻译：
题目：腹腔镜下从中央－外围结肠解剖：怎么做和为什么？
摘要：腹腔镜下结肠切除术是一个困难的操作步骤，需要长时间的学习。本篇文章中我们介绍右边和左边的腹腔镜下中央－外围结肠切除技术。中央的径路包括首先分离切断血管蒂，接着使肠系膜移向腹壁，最后沿着Toldt白线游离结肠。这个径路可以即时确认结肠系膜和腹膜后腔之间的层面，使得分离又快又安全。我们的50例腹腔镜下结肠切除术支持这个观念。我们相信，外科医生掌握了这项技术后，其必将一种重要的工具去面对腹腔镜结肠切除术所带来的挑战。
点评：我所在的医院正在逐渐的开展腹腔镜下结肠切除术，对于这项技术，其实在国外，甚至在台湾也是一项比较成熟的技术，国内也有好些医院已经很顺利的开展起来。虽然在治疗预后上还有争议，其确实是一门值得掌握的技术。

附一个台湾医生的介绍（有简单示意图）：
http://www.a-bin.net.tw/surgery.htm

2007-06-18 18:01

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• 浙一咋了？？爆炸了？？？

flymusic130

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杂志全名及年卷期：J Gastrointest Surg. 2007 Jun;11(6):783-90.
文题：Assessment of pancreatic neoplasms: review of biopsy techniques.
作者：Goldin SB, Bradner MW, Zervos EE, Rosemurgy AS.
英文摘要：
Pancreatic cancer is the 4th leading cause of cancer death annually. Recent technological advances in imaging have led to non-uniformity in the evaluation of pancreatic neoplasms. The following article describes the history behind various biopsy techniques and the rationale for obtaining a biopsy of a pancreatic neoplasm and discusses the benefits and disadvantages of the various pancreatic biopsy techniques, including fine needle aspiration biopsy, Tru-cut needle biopsy, endoscopic brushings/cytology, and endoscopic ultrasound guided biopsies. A treatment algorithm for pancreatic neoplasms is then presented.
PMID: 17562121
中文翻译：
题目：胰腺新生物的判断：活检技术综述
摘要：
胰腺癌是每年因癌症死亡的第四大原因。最近的影像技术的进展在胰腺的新生物的诊断中带来了不一致的结果。接下来的文章在介绍了多种活检技术的历史和获得胰腺新生物的活检组织的原理，以及讨论了不同活检技术的好处和不足，这些技术包括：细针穿刺活检，Tru-cut针吸活检，内镜刷洗/细胞学检查，和内镜超声引导下活检。然后介绍了胰腺新生物的治疗策略。
点评：关于胰腺新生物的活检，虽然在课堂上，讨论中常常谈到，但是在我说接触的方面，其实真正使用的仅有ERCP下活检。然后就是开腹的手术活检。不知道大家所在的医院情况如何。

2007-06-18 18:03

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• 八十年前协和医院大查房漫画曝光，折射出当代医疗界乱像

flymusic130

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杂志全名及年卷期：J Gastrointest Surg. 2007 Jun;11(6):714-718
文题：Hyperbilirubinemia in Appendicitis: A New Predictor of Perforation
作者：Estrada JJ, Petrosyan M, Barnhart J, Tao M, Sohn H, Towfigh S, Mason RJ.
英文摘要：
This study examines the relationship between hyperbilirubinemia and appendicitis. It was hypothesized that an association exists between the presence of appendiceal perforation and hyperbilirubinemia. Patients with liver function tests on admission and pathologically confirmed appendicitis were included in the study. Age, duration of symptoms, temperature, white blood cell counts, systemic inflammatory response score, and bilirubin levels were independent variables in a logistic regression analysis assessing factors predicting the presence or absence of appendiceal gangrene/perforation. Elevated total bilirubin levels (>1 mg/dl) were found in 59 (38%) of 157 patients. Patients with gangrene/perforation were significantly (p = 0.004) more likely to have hyperbilirubinemia than those with acute suppurative appendicitis. No statistical differences were observed for any of the other variables. On logistic regression the only significant relationship between the presence or absence of appendiceal gangrene and perforation was the presence of hyperbilirubinemia (p = 0.031, 95% confidence interval 1.11-7.6). The odds of appendiceal perforation are three times higher (odds ratio 2.96) for patients with hyperbilirubinemia compared to those with normal bilirubin levels. Hyperbilirubinemia is frequently associated with appendicitis. Elevated bilirubin levels have a predictive potential for the diagnosis of appendiceal perforation.
PMID: 17436050
中文翻译：
题目：阑尾炎患者的高胆红素血症：穿孔的一个新预报标志。
摘要：本研究检测了高胆红素血症与阑尾炎间的关联。我们假定在阑尾穿孔与高胆红素血症之间存在某种关联。本研究的对象是入院时做了肝功能检查和病理证实为阑尾炎的患者。年龄，症状的持续时间，体温，白细胞计数，系统炎症应答评分，和胆红素水平在逻辑回归分析中作为独立变量，该分析用来评价上述因子是否预测阑尾坏疽/穿孔存在与否。157名患者中，59名（38％）患者发现总胆红素水平升高（>1mg/dl）。与急性化脓性阑尾炎患者比，坏疽/穿孔患者更有值得注意的高胆红素血症（P<0.004）。其他变量没有观察到任何有统计学意义差别。在逻辑回归分析中，在存在或不存在坏疽/穿孔的患者间唯一值得注意的关联就是高胆红素血症的存在（P=0.31，95％可信区间：1.11-7.6）。与胆红素正常的患者相比较，存在高胆红素血症的患者的阑尾穿孔机率是前者的3倍（优势比：2.96）。阑尾炎经常伴随出现高胆红素血症。升高的胆红素水平可以作为一个预测阑尾穿孔的潜在性预测因素。
点评：阑尾炎见得多了，其实倒是没有真的从这个方面去总结过，在以后的诊治中倒是可以观察验证一下文章所得的结论。

2007-06-18 18:36

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• 首套【肺石医生】表情上架啦，一起斗图吧！

Cantoness

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杂志全名及年卷期：Arch Surg. 2007;142:431-437.
文题：Kentucky Hepatoma Epidemiologic Variant or Same Problem in a Different Region?
作者：Robert C. G. Martin II, MD; Jennifer Loehle, BS; Charles R. Scoggins, MD; Kelly M. McMasters, MD, PhD
英文摘要：Background Hepatitis and cirrhosis are common etiologic factors in hepatocellular carcinoma (HCC) in the United States. However, noncirrhotic, nonfibrotic HCC has been recognized more frequently in Kentucky. The aim of this study was to evaluate the epidemiologic features of this variant of HCC. Hypothesis Kentucky hepatoma, defined as a noncirrhotic, nonfibrotic, hepatitis-negative HCC, occurs in an older population with more favorable preoperative factors when compared with other patients with HCC. Design A prospective review of our 1002 hepatopancreaticobiliary patients, the Kentucky Cancer Registry, and the Surveillance, Epidemiology, and End Results database. Setting An academic referral center. Patients All patients with HCC treated from January 1, 1999, through September 30, 2005, were reviewed for clinicopathologic factors, recurrence, and outcome. Results In a review of the region's 703 patients with HCC, we have seen a 4-fold increase in age-specific HCC diagnosis, with the most rapid increase seen in the 60- to 69-year-old age group. In our institution's 103 patients with HCC, 62 (60.2%) were without hepatitis or cirrhosis. These noncirrhotic, hepatitis-free patients were found to be significantly older (70 vs 55 years; P = .001), to be more often female (40.3% vs 24.4%; P = .01), to have a larger tumor size (6.5 vs 3.9 cm; P = .004), to have fewer liver lesions (1 vs 3; P = .22), and to more frequently undergo surgical therapy (75.6% vs 53.8%; P = .01) than the patients with cirrhosis or hepatitis (n = 41). Conclusions A larger percentage of the patients with HCC seen in our region are significantly different from those in other reports throughout the United States in preoperative clinical and pathologic presentation. The reason for this change is as yet unknown, but the incidence continues to rise annually.

中文翻译：
题目：肯塔基肝癌――流行病学变化还是不同领域中的同一个问题？
摘要：背景：在美国，肝炎以及肝硬化是肝细胞性肝癌的共同病因。但是，在肯塔基州非硬化性、非纤维化的肝细胞性肝癌越来越常见。该研究的目的是评估这种肝细胞性肝癌变化的流行病学特点。前提：肯塔基肝癌定义为一种非硬化性、非纤维化、肝炎阴性的肝细胞性肝癌；与其它肝癌相比，这种肝癌多发生在老年人群而且拥有更有利的术前因素。设计：预期回顾1002个肝胰胆管病的患者、肯塔基癌注册、以及流行病学检测和最终结果数据设定：一个学校的参考中心病人：回顾从1999年1月1日到2005年9月30日之间持续治疗的所有肝癌患者，以了解他们的临床病理因素，复发情况以及结果。结果：在对该区域的703位肝癌患者的一个回顾中，我们发现年龄特异的肝癌诊断的四个增加锋值，其中在60到69岁年龄组诊断肝癌的病例数增加最快。在我们的系统中，103位肝癌患者其中62位是没有肝炎或者肝硬化的（比例为60.2％）。与有肝炎以及肝硬化的肝癌患者相比（n = 41）这些非硬化、非肝炎的肝癌患者的年龄明显更老（70岁比55岁，P值为0.001），女性患者更多见（40.3%比24.4%，P值为0.01），肿瘤更大（6.5厘米比3.9厘米，P值为0.004），肝坏死更少见（1比3，P值为0.22），更经常可以手术切除(75.6%比53.8%; P值为0.01)。结论：在我们区域所见的肝癌患者有很大部分在术前临床以及病理上都和全美国的其它报告的描述有显著的不同。这种变化的原因目前还不清楚，但是这种病例每年都在上升。

点评：不光是在美国，在我国，肝癌大部分都有肝炎和肝硬化，这篇文章报导这样一种病理类型的肝癌，很值得我们今后在临床上多留意。
___________________________
已经翻译过了，发帖前请先搜索！_by zwqql

2007-06-18 20:09

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zwqql 编辑于 2007-06-18 20:22

• “轮椅小仙女”疑因无障碍通道坡度过大摔伤去世：曾爬上世界屋脊，却倒在人行道

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