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World Journal of Gastroenterology 2005年第48期11卷 7694-7696页

作者： sheng-Der Hsu hurng-sheng wu Chien-Long Kuo Yueh-Tsung Lee Division of General Surgery Division of General Surgery Department of SurgeryShow-Chwan Memorial HospitalChanghuaTaiwanChina Department of Pathology

Minimally invasive surgery has revolutionized the treatment of gastrointestinal tumors. Submucosal tumors of the stomach can be resected using laparoscopic techniques. We report here a case of ectopic pancreas tissue in the gastric wall that was removed using robotic-assisted laparoscopic resection. The patient was a 15-year-old female who presented with abdominal discomfort and tarry stools. Laboratory analysis showed iron deficiency anemia. Preoperative endoscopy revealed a submucosal lesion in the posterior wall of the gastric high body. Intraoperative upper endoscopy clearly located the lesion. A robotic-assisted laparoscopic wedge resection of the putative gastric submucosal tumor was performed. The pathology results showed an ectopic pancreas. The patient had an uneventful recovery and we believe that this is a valid treatment option for this benign condition.

关键词： Robotic surgery Ectopic pancreas

Primary retroperitoneal mucinous cystadenoma:Report of a case and review of the literature

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World Journal of Gastroenterology 2008年第37期14卷 5769-5772页

作者： sheng-Lei Yan Ho Lin Chien-Long Kuo hurng-sheng wu Ming-Ho Huang Yueh-Tsung Lee Division of Gastroenterology Departmentof Internal Medicine Chang Bing Show Chwan MemorialHospital Changhua County 505 Taiwan China Department of Life Sciences NationalChun~ Hsing University. Taichung City 402. Taiwan. China Department of Pathology Show ChwanMemorial Hospital Changhua City 500 Taiwan China Division of GeneralSurgery Department of Surgery Show Chwan MemorialHospital Changhua City500 Taiwan China Division of General Surgery Departmentof Surgery Chang Bing Show Chwan Memorial HospitalChanghua County 505 Taiwan China

Primary retroperitoneal mucinous cystadenomas (RMCs) are very rare and their biological behavior and histogenesis remain speculative. An accurate preoperative diagnosis of these tumors is difficult because no effective diagnostic measures have been established. We describe a 29-year-old woman with abdominal pain and a palpable mass. Computed tomography (CT) of the abdomen revealed a retroperi-toneal cystic mass which was resected successfully at laparotomy. Histopathological examination of the resected mass confirmed the diagnosis of RMC. There was no evidence of disease 2 years after surgery.

关键词： Retroperitoneal Mucinous cystadenoma Cystic mass Clinical features

Squamous cell carcinoma arising from longstanding colocutaneous fistula: A case report

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World Journal of Gastroenterology 2005年第33期11卷 5251-5253页

作者： Yueh-Tsung Lee sheng-Der Hsu Chien-Long Kuo Dev-Aur Chou Mao-sheng Lin Min-Ho Huang hurng-sheng wu Division of General Surgery Department of Surgery Show-Chwan Memorial Hospital Changhua Taiwan China Department of Pathology Show-Chwan Memorial Hospital Changhua Taiwan China Division of General Surgery Department of SurgeryTri-Service General Hospital Taipei Taiwan China Division of Urology Department of Surgery Show-Chwan Memorial Hospital Changhua Talwan China

A 60-year-old female patient suffered unhealed wounds over left flank for around 30 years after surgical removal of left renal stones. Fecal material spilled from the two small openings of the scar, bothered her all day long. During the course of the 30 years, she suffered from intermittent fever, diarrhea and wound pain and presented with malnourished condition. After serial examinations, tumor associated with iatrogenic colo-cutaneous fistula was impressed and she received en bloc resection. Pathology revealed squamous cell carcinoma arising from the fistula with colon and spleen invasion. To the best of our knowledge,no such case has been reported, as yet.

关键词： Squamous cell carcinoma Colo-cutaneous fistula

Endoscopic Management of Leaks Following Laparoscopic Sleeve Gastrectomy: The Experience of IRCAD Taiwan

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Surgical Science 2020年第11期11卷 347-353页

作者： Chien-Hua Lin Jing-Jim Ou Yueh-Tsung Lee hurng-sheng wu sheng-Lei Yan Department of Surgery IRCAD Taiwan Chinese Taipei Department of Surgery Tri-Service General Hospital Chinese Taipei Division of Gastroenterology Department of Internal Medicine Chang-Bing Show Chwan Memorial Hospital Chinese Taipei

Background: To present the experience of management of leaks following laparoscopic sleeve gastrectomy for morbid obesity in Show-Chwan memorial Hospital. Patients and Methods: Laparoscopic sleeve gastrectomy is considered one of the surgical options for morbid obesity. It is effective, with an average loss of 50% of excessive weight after 2 years of follow-up. The first laparoscopic sleeve gastrectomy was performed in January 2010 at Show-Chwan Memorial Hospital. Between January 2010 and October 2016, 300 patients underwent laparoscopic sleeve gastrectomy for morbid obesity. There were 218 women and 82 men with a mean age of 35.4 years. Preoperative mean body weight was 90.7 kg and mean body mass index (BMI) was 37.3 kg/m2. Results: Mean operative time was 85 minutes. Mean hospital stay was 3.5 days. There were no deaths. There were 5 complications (1.67%): leakage of gastroesophageal junction. One patient was conservative treatment. Two patients were successfully treated by self-expandable metallic stents and the other two patients were treated with esophageal stent also, but failed and further treated with fibrin (Histoacryl) injection to the leak site to try to seal the fistula. In six months follow-up, mean BMI decreased from 37.3 to 29.2 kg/m2, and mean excess weight loss reached 42.8%. Conclusions: Laparoscopic sleeve gastrectomy is a beneficial operation in terms of excessive weight loss, with acceptably complications. The leaks were located in gastroesophageal junction mostly, and could be resolved with esophageal stent. For the patients failed in esophageal stents, we try Histoacryl injection to improve it.

关键词： Bariatric Surgery Leaks Stent Histoacryl

Laparoscopic Sleeve Gastrectomy following Pylorus-Preserving Pancreaticoduodenectomy

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Surgical Science 2023年第5期14卷 355-359页

作者： Chien-Hua Lin Jing-Jim Ou Yueh-Tsung Lee hurng-sheng wu Department of Surgery Chang Bing Show Chwan Memorial Hospital Taiwan IRCAD Taiwan

Background: A 35-year-old married female (68 kg, 150 cm, BMI: 30.2) with pancreatic divisum complicated chronic pancreatitis and underwent pylorus-preserving pancreaticoduodenectomy in 2010. After that, her condition was well. However, body weight gained progressively to 76 kg (BMI: 33.7) and hypertension developed. During these two years, tried exercise and medication control for hypertension, but in vain. She received a laparoscopic sleeve gastrectomy in October 2013. The post-operative course was uneventful. Methods: We applied three ports for laparoscopic operation, including two 12 mm and one 5 mm trocars. The liver was not needed to be elevated due to adhesion. The operative time was 75 minutes. Results: The patient’s body weight was 10 kg reduced in the first two months and reduced to 59 kg 6 months later. Conclusions: We report a case that received laparoscopic sleeve gastrectomy following pylorus-preserving pancreaticoduodenectomy due to pancreatic divisum. This case encourages us to extend the indication of laparoscopic sleeve gastrectomy.

关键词： Sleeve Gastrectomy Morbid Obesity Obesity Pancreatectomy

Helicobacter pylori infection in relation to E-cadherin gene promoter polymorphism and hypermethylation in sporadic gastric carcinomas

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World Journal of Gastroenterology 2005年第33期11卷 5174-5179页

作者： Yao-Chi Liu Chen-Yang Shen hurng-sheng wu De-Chuan Chan Cheng-Jueng Chen Jyh-Cherng Yu Cheng-Ping Yu Horng-Jyh Harn Rong-Yaun Shyu Yu-Lueng Shih Chung-Bao Hsieh Huan-Mieng Hsu Division of General Surgery Department of Surgery Tri-Service General HospitalNational Defense Medical Center Taipei Taiwan China Division of Gastroenterology Department of Internal Medicine Tri-Service General HospitalNational Defense Medical Center Taipei Taiwan China Department of Pathology Tri-Service GeneralHospital National Defense Medical Center Taipei Taiwan China Department of Pathology Buddhist Tzu-Chi General Hospital Hualien Taiwan China Department of Surgery Show Chwan Memorial Hospital Changhua Taiwan China Institute of Biomedical Sciences Academia Sinica Taipei Taiwan China

AIM: To study Helicobacter pylori (H pylori) infection in relation to E-cadherin (E-cad) promoter polymorphism and hypermethylation in ***: Specimens were taken from representative cancerous lesions and adjacent non-cancerous epithelia of 67 resected GCs. Hpyloriwas detected by real-time PCR of the cagA gene from non-neoplastic epithelium.E-cad promoter polymorphism and hypermethylation were determined by restriction fragment length polymorphism analysis and methylation-specific PCR, respectively. Expression of E-cad protein was determined by ***: Hpyloriwas found in 57% of patients with GC.H pylori infection was more frequently found in tumors with the -160C/C genotype than those with the -160C/A and -160A/A genotypes (74% vs47%, P = 0.02). Hpylori infection was associated with E-cad methylation in nonneoplastic epithelium; however, no significant difference in H pylori was observed between methylated and unmethylated cancerous ***: Patients with the -160C/C genotype might require Hpyloriinfection to promote the inactivation of CDH1, suggesting that Hpylori infection might affect GC in an initial stage because polymorphism is germ *** of hypermethylation of CDH1 promoter in GC is complex, and Hpyloriinfection might affect it in an initial stage.

关键词： H pylort E-cadherirr -160 C→A polymorphism Hypermethylation Gastric carcinoma

An Easy Way to Close the Trocar Hole in Obese Patients

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Surgical Science 2015年第10期6卷 459-463页

作者： Chien-Hua Lin hurng-sheng wu Jing-Jim Ou Yueh-Tsung Lee IRCAD Taiwan Department of Surgery Chang-Bing Show Chwan Memorial Hospital Taiwan Department of Surgery Tri-Service General Hospital Taiwan

Background: Ten-millimeter ports are often used in laparoscopic surgery. It could be difficult to close the ports sites, especially in obese patients. We described a new method to close ten-millimeter port-site wounds, effective and easily to perform. Methods: Forty cases of laparoscopic bariatric surgery were performed from April 2010 to September 2011 at IRCAD Taiwan. Among them, 30 patients received trocar hole closed with SURGICEL® Original Hemostat and the other 10 patients received trocar hole closed with autologous fat. The results were recorded. Results: In group of SURGICEL® Original Hemostat, includes 21 female and 9 male, age range from 18 to 54 with average 39.5 years. Average BMI is 42.4 (range from 32.6 to 55). The operations include 27 cases of laparoscopic sleeve gastrectomy, 2 cases of laparoscopic gastric bypass, and 1 case of laparoscopic mini-bypass. Group of autologous fat includes 3 female and 7 male, age range from 20 to 49 with average 38.6 years. Average BMI is 39 (range from 32.8 to 64.5). The operations include 9 cases of laparoscopic sleeve gastrectomy, and 1 case of laparoscopic mini-bypass. No complications of trocar wound including infection, hematoma, and hernia were found for a mean follow-up of 6 months. Conclusions: For obese patients, closure of port sites can be difficult. We described a method of closing 10-mm port-sites wounds, which are easy, effective, and not required any special instruments.

关键词： Bariatric Surgery Autologous Fat Troca Port Site Hernia

Continuously Injection with Diluted Heparin Solution via Catheter for Implantation of Totally Implantable Access Ports (TIAP)

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Surgical Science 2012年第7期3卷 371-372页

作者： Chien-Hua Lin Jing-Jim Ou Yueh-Tsung Lee hurng-sheng wu Department of Surgery Chang-Bing Show Chwan Memorial Hospital Changhua Chinese Taipei

Background: Totally implantable access ports (TIAP) could be done in two methods: puncture of subclavian vein and cephalic vein cutdown. Cephalic vein cutdown method has fewer complications but has higher failure rates. We present a method to decrease the failure rates. Methods: We use the continuously injection with diluted heparin solution via catheter while introducing the TIAP catheter into the cephalic vein. Results: From January 2005 to January 2009, 20 patients were performed. This method was successfully applied in 11 patients with no complications. The other 9 patients was unsuccessfully and further underwent guidewire assisted. Conclusions: Continuously injection with diluted heparin solution via catheter while inserting TIAP catheter into the cephalic vein is safe and simple. It could be used for difficulties of insertion of TIAP and increased the successful rates of cephalic vein cut-down method.

关键词： Totally Implantable Access Ports (TIAP) Arrhythmia Port-A

The Causes of Conversion from Laparoscopy to Laparotomy in Patients with Laparoscopic Repair of Perforated Peptic Ulcer

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Surgical Science 2015年第2期6卷 75-79页

作者： Chien-Hua Lin Der-Ao Chou Yueh-Tsung Lee hurng-sheng wu Department of Surgery Chang-Bing Show Chwan Memorial Hospital Changhua Chinese Taipei IRCAD Changhua Chinese Taipei

Purpose: Perforated peptic ulcer is an emergency condition. Laparoscopic ulcer repair is a feasible and safe procedure. The aim of this study was to research the efficacy of laparoscopic repair of peptic ulcer and to discuss the causes of conversion from laparoscopy to laparotomy. Methods: We collected 34 patients with perforated peptic ulcer underwent laparoscopic surgery from October 2003 to October 2008. Thirty four patients with perforated peptic ulcer underwent laparoscopic intervention and 6 cases were converted to laparotomy. The demographics, laboratory data, perioperative data, morbidity and mortality were compared. Results: In demographics of two groups, there were no significant differences in sex, age, location, and mean duration of symptoms of acute abdominal pain. However, there were significant differences in median size of perforation, mean duration of history of peptic ulcer related pain, and the experiences of surgeon. There were no significant differences in the laboratory data and perioperative data of two groups. In morbidity?and mortality of two groups, there were no significant differences in leakage, wound infection, intra-abdominal abscess, ileus, urinary tract infection, pneumonia, and mortality, but there was significant difference in overall morbidity in two groups. Conclusions: Laparoscopic repair of perforated peptic ulcer is safe and could be used in routine clinical practice. However, patients with larger perforations (>10 mm), longer duration of history peptic ulcer related pain (>2 years), and learning curve of surgeon could be associated with conversion rate. It is associated with higher morbidity in patients with conversion from laparoscopy to laparotomy.

关键词： Laparoscopy Perforated Peptic Ulcer Repair Conversion Rate

Mechanisms inactivating the gene for E-cadherin in sporadic gastric carcinomas

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World Journal of Gastroenterology 2006年第14期12卷 2168-2173页

作者： Yao-Chi Liu Chen-Yang Shen hurng-sheng wu Tsai-Yuan Hsieh De-Chuan Chan Cheng-Jueng Chen Jyh-Cherng Yu Cheng-Ping Yu Horng-Jyh Harn Peng-Jen Chen Chung-Bao Hsieh Teng-Wei Chen Huan-Mieng Hsu Division of General Surgery Department of Surgery Tri-Service General Hospital National Defense Medical Center Taipei Taiwan China Division of Gastroenterology Department of Internal Medicine Tri-Service General Hospital National Defense Medical Center Taipei Taiwan China Department of Pathology Tri-Scrvice General Hospital National Defense Medical Center Taipei Taiwan China Department of Pathology Buddhist Tzu-Chi General Hospital Hualien Taiwan China Department of Surgery Show Chwan Memorial Hospital Changhua Taiwan China Institute of Biomedical Sciences Academia Sinica Taipei Taiwan China

AIM： To study the role of CDH1/E-cadherin （E-cad） gene alteration profiles including mutation, loss of heterozygosity （LOH）, promoter polymorphism and hypermethylation in mechanisms of CDH1 inactivation in gastric carcinoma （GC）. METHODS： Specimens were collected surgically from 70 patients with GC. Allelotyping PCR and detection of LOH, denaturing high pressure liquid chromatography and DNA sequencing, restriction fragment length polymorphism analysis, methylation specific PCR, and immunohistochemical staining were used. RESULTS： Promoter polymorphism was not a major mechanism of E-cad inactivation. Only one truncating mutation was found in a diffuse type tumor （3%）. Both LOH and promoter hypermethylation were major mechanisms of E-cad inactivation, but interestingly, there was a negative association between the fraction of allelic loss （LOH） in tumors and hypermethylation of CDH1. Therefore LOH and hypermethylation were two different tumorigenic pathways involved in GC. CONCLUSION： Given the findings that somatic mutation was extremely low and the relationship between LOH and hypermethylation was inverse, any two combinations of these three factors cannot fulfill the classical two-hit hypothesis of CDH1 inactivation. Thus, other mechanisms operating at the transcriptional level or at the post-translational level might be required to induce E-cadherin inactivation.

关键词： Gastric carcinoma E-cadherin gene alteration profiles Inactivation of E-cadherin