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World Journal of Gastroenterology 2005年第12期11卷 1779-1784页

作者： Yi-Yin Jan chun-nan yeh Ta-Sen yeh Tse-Ching Chen Department of Surgery Department of Pathology

AIM: To analyze the prognostic factors influencing the overall survival of peripheral cholangiocarcinoma (PCC)patients undergoing surgical treatment during 25 years at a single ***: This study retrospectively reviewed prospectively collecting data about 373 patients with histologically proven PCC who underwent surgical treatment between 1977 and ***: Three hundred and seventy-three PCC patients (159 men and 214 women) underwent surgical treatment from 1977 to 2001. Among them, 187 PCC patients underwent hepatectomy and 135 had curative resection (curative resectability rate: 36.2%). The follow-up duration ranged from 1.05 to 167.6 mo (mean/median = 14.1/7.2 mo).Overall cumulative survival rates at 1, 3, and 5 years were 32.5%, 9.2%, and 4.1%, respectively. Univariate log-rank analysis identified the following as adverse influences on overall survival: presence of symptoms, absence of mucobilia, elevated CEA and CA 19-9 levels, non-papillary tumor type, receiving non-hepatectomy, advanced tumor staging, lack of post-operative chemotherapy, and radiotherapy. Meanwhile, multivariate Cox's proportional hazard analysis demonstrated that absence of mucobilia,non-papillary tumor type, advanced tumor staging, nonhepatectomy, and lack of post-operative chemotherapy were the five independent prognostic factors that adversely affected overall ***: Favorable overall survival of PCC patients undergoing surgical treatment depends on early tumor stage, presence of mucobilia, papillary tumor type, hepatic resection, and post-operative chemotherapy.

关键词：手术治疗肝切除手术化学治疗外周性胆管癌

Hepatic resection for hepatocellular carcinoma in end-stage renal disease patients: Two decades of experience at Chang Gung Memorial Hospital

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World Journal of Gastroenterology 2005年第14期11卷 2067-2071页

作者： chun-nan yeh Wei-Chen Lee Miin-Fu Chen Department of General Surgery Chang Gung Memorial Hospital Chang Gung UniversityTaoyuanTaiwanChina

AIM: Hepatocellular carcinoma (HCC) is a common disease in Taiwan. The prevalence of viral hepatitis infection and the subsequent development of HCC are well known to be higher in patients with end-stage renal disease (ESRD) requiring hemodialysis (HD) or peritoneal dialysis (PD) than among the general population. However, information on hepatic resection for ESRD-HCC patients is limited. METHODS: The clinical features of 26 ESRD-HCC patients who underwent hepatic resection from 1982 to 2001 were retrospectively reviewed. Meanwhile, the clinicopathological features and the outcome of 1 198 HCC patients without ESRD undergoing hepatic resection were used for comparison. RESULTS: Of 1 224 surgically resected HCC patients, 26 (4.2%) were ESRD-HCC. Univariate analysis revealed more associated disease, more physical signs of anemia and postoperative complications, lower hemoglobin, platelet, α-fetoprotein, elevated blood urea nitrogen (BUN) and creatinine levels, smaller tumors, lower HBsAg positivity, higher HCV positivity, and longer hospital stays in the ESRDHCC group compared with the HCC group. Furthermore, multivariate stepwise logistic regression analysis revealed that elevated BUN and creatinine levels were the only two independently significant factors in the patients in the ESRD-HCC group. Overall and disease-free survival rates were similar between the ESRD-HCC and HCC ***: Elevated BUN and creatinine were the only two main independent factors differentiating ESRD-HCC from HCC patients. ESRD should not be a contraindication of hepatic resection in HCC patients; however, careful operative techniques and perioperative care are crucial to achieving lower morbidity and mortality. Comparable overall survival and disease-free survival can be achieved in selected ESRD-HCC patients undergoing hepatic resection when compared with conventional HCC patients.

关键词：肝切除手术肝细胞癌肾脏疾病疾病终末期

Advanced gastrointestinal stromal tumor patients with complete response after treatment with imatinib mesylate

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World Journal of Gastroenterology 2006年第13期12卷 2060-2064页

作者： Kun-chun Chiang Tsung-Wen Chen chun-nan yeh Hsiang-Lin Lee Department of Surgery and Nuclear Medicine Chang Gung Memorial Hospital Chang Gung UniversityTaoyuanTaiwanChina

瞄准：大多数胃肠的基质肿瘤(大意) 快车组成地激活工具包激酶或导出血小板的生长因素受体高山的变异的 isoforms 哈(PDGFRA ) ，它是为 imatinib mesylate (Glivec ) 的潜在的治疗学的目标。部分反应发生在与 Glivec 对待的几乎三分之... 详细信息

瞄准：大多数胃肠的基质肿瘤(大意) 快车组成地激活工具包激酶或导出血小板的生长因素受体高山的变异的 isoforms 哈(PDGFRA ) ，它是为 imatinib mesylate (Glivec ) 的潜在的治疗学的目标。部分反应发生在与 Glivec 对待的几乎三分之二个大意病人。然而，在 Glivec 治疗以后的完全的反应(CR ) 偶发地被报导。这里，我们在 Glivec 治疗以后与 CR 说明了先进大意病人。方法：在 2001 年 1 月和 2005 年 6 月之间， 42 个先进大意病人与 Glivec 被对待。病人们被管理在 100-mg 囊的 Glivec 的 400 mg，每天与食物口头上地拿。到 Glivec 的肿瘤的反应此后在一个月，三个月，和每三个月以后被评估或每当医药需要被显示时。病人的每个肿瘤为工具包或 PDGFRA 的变化被调查。结果：与 Glivec 对待的 42 个先进大意病人的中部的后续时间是 16.9 个月(范围， 1.0-47.0 月) 。总的来说，有的 3 个病人完成反应 CR (7.1%) ， 26 部分反应(67.8%) ， 5 静止疾病(11.9%) ，和 3 进步疾病(11.9%) 。为三个病人的 Glivec 管理的中部的持续时间是 36 个月(范围， 23-36 月) 。在 Glivec 治疗以后的 CR 的中部的时间是 20 个月(范围， 9-26 月) 。11 上的 c 工具包前的删除和插入变化和 9 上的 c 工具包前的插入变化分别地在二种情况和一个案例中被发现。结论：完全的反应(CR ) 能在与 Glivec 对待的选择先进大意病人被完成。在 Glivec 治疗以后的 CR 的中部的时间是 20 个月。11 上的工具包前的删除和插入变化和 9 上的工具包前的插入变化在这些选择盒子中贡献基因特征。

关键词：胃肠基质肿瘤甲磺酸盐治疗病理机制

Treatment of patients with advanced gastrointestinal stromal tumor of small bowel: Implications of imatinib mesylate

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World Journal of Gastroenterology 2006年第23期12卷 3760-3765页

作者： chun-nan yeh Tsung-Wen Chen Ting-Jung Wu Swei Hsueh Yi-Yin Jan Department of Surgery Chang Gung Memorial HospitalChang Gung University5 Fu-Hsing StreetKwei-ShanTaoyuanTaiwanChina Department of Pathology Chang Gung Memorial HospitalChang Gung University5 Fu-Hsing StreetKwei-ShanTaoyuanTaiwan China

瞄准：检验 imatinib 的影响耐心的幸存和反应和它的安全上的 mesylate (Glivec ) ，和反应的关联与工具包基因变化地位评价。方法：74 中的 33 个(44.6%) 在药品切除术以后并且不开发了复发的胃肠的基质肿瘤(大意) 病人与 Glivec 对待... 详细信息

瞄准：检验 imatinib 的影响耐心的幸存和反应和它的安全上的 mesylate (Glivec ) ，和反应的关联与工具包基因变化地位评价。方法：74 中的 33 个(44.6%) 在药品切除术以后并且不开发了复发的胃肠的基质肿瘤(大意) 病人与 Glivec 对待的小肠是被分类组 A 病人。与 Glivec 对待的 22 个先进的小肠大意病人作为组 B 病人被分类。Clinicopathological 特征，复发以后、全面的幸存率被比较。在组 B 病人的每个肿瘤为工具包或导出血小板的生长因素高山的变化被调查哈(PDGFRA ) 。变化类型与临床的结果被相关。在组 B 病人的 Glivec 的反肿瘤效果和安全也被估计。结果：与 Glivec 对待的先进的小肠大意病人比没与 Glivec 对待的那些有 substatntially 更长的复发以后的幸存和更高全面的幸存率。15 个病人的一个总数有部分回答(PR )(67.8%) 。c 工具包的激活的变化在 19 个测试病人中的 16 个被发现，没有 PDGFRA 异种被识别。在有在 11 个工具包变化上怀有前的大意的 13 个病人，部分反应率(PR ) 是 69.3% ，而有在 9 工具包变化上包含前的肿瘤的三个病人中的二个有 66.7% 的全面反应率(ORR )( 不重要) 。结论：Glivec 显著地与先进大意延长亚洲病人的复发以后、全面的幸存。Glivec 导致持续客观回答在多于有先进的小肠大意的亚洲病人的一半。11 上的工具包前的激活的变化在绝大多数大意是可检测的。在 11 个变化上处于为其大意在 9 上有工具包前的病人和前的 PR 率没有差别。

关键词：胃肠基质肿瘤小肠肿瘤甲磺酸盐病理机制

Primary squamous cell carcinoma of the liver:A successful surgically treated case

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World Journal of Gastroenterology 2006年第33期12卷 5419-5421页

作者： Hsiang-Lin Lee Yu-Yin Liu chun-nan yeh Kun-chun Chiang Tse-Ching Chen Yi-Yin Jan Department of Surgery Chang Gung Memorial Hospital Chang Gung University Taiwan China Department of Pathology Chang Gung Memorial Hospital Chang Gung University Taiwan China

Primary squamous cell carcinoma (SCC) of the liveris rare. Totally nine such cases have been reportedin the literature. Primary SCC of the liver has beenreported to be associated with hepatic teratoma,hepatic cyst, or hepatolithiasis. Complete remission ofpoorly differentiated SCC of the liver could be achievedby systemic chemotherapy followed by surgery orremarkably respond to hepatic arterial injection of lowdose chemotherapeutic drugs. Here we report the fi rstcase of primary SCC of the liver presenting as a solidtumor and receiving successful hepatic resection with9-mo disease free survival.

关键词：原发性鳞状细胞癌肝癌手术治疗临床

Clinicopathological study of solid and pseudopapillary tumor of pancreas: Emphasis on magnetic resonance imaging findings

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World Journal of Gastroenterology 2007年第12期13卷 1811-1815页

作者： Chi-Chang Yu Jeng-Hwei Tseng chun-nan yeh Tsann-Long Hwang Yi-Yin Jan Department of Surgery Chang Oung Memorial Hospital Chang Gung University Kwei-shan Taoyuan Taiwan China Department of Radiology Chang Gung Memorial Hospital Chang Gung University Kwei-shan Taoyuan Taiwan China

AIM: To report the clinicopathological features and magnetic resonance imaging (MRI) findings of solid and pseudopapillary tumor (SPT) of ***: From 1981 to 2005, 26 surgically treated cases of SPT were retrospectively reviewed. MRI findings of the latest 11 consecutive SPT cases were ***: There were 25 women and one man having SPT (median age: 23 year) with a median tumor size of 7.5 cm. Among them, nine patients developed solid pseudopapillary carcinoma. During the median follow-up period of 66 mo, the 5-year survival rate of the 26 SPT patients was 96.2%. Three MRI features were proposed including Type 1 image, displaying SPT with completely solid part. All SPT patients with type 1 image were detected incidentally. Type 2 image displays of SPT with solid mass hemorrhage and type 3 image with massive hemorrhage. All the eight SPT patients with type 2 and 3 images suffered abdominal pain due to hemorrhage from ***: SPT had a favorable survival rate irrespective of surgical procedures, malignancy, and MRI findings, however, MRI could reliably correlate with its clinicopathological features.

关键词：胰腺肿瘤实体瘤假性乳头状瘤临床病理研究 MRI 磁共振成像

Timing of mortality in severe acute pancreatitis:Experience from 643 patients

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World Journal of Gastroenterology 2007年第13期13卷 1966-1969页

作者： Chih-Yuan Fu chun-nan yeh Jun-Te Hsu Yi-Yin Jan Tsann- Long Hwang Department of General Surgery Chang Gung Memorial Hospital Chang Gung University 5 Fu-shin Street Kweishan Taoyuan Taiwan China

AIM: To determine the timing of mortality after onset of severe acute pancreatitis (SAP) and the course of the disease in a large series of patients. METHODS: From July 1996 to June 2005, all patients diagnosed with acute pancreatitis at Chang Gung Memorial Hospital, Taipei, Taiwan were retrospectively studied. Three thousand two hundred and fifty episodes of acute pancreatitis were recorded in 2248 patients (1431 males and 817 females; median age, 55.6 years; range, 18-97 years). Mortality was divided into two groups: early death (≤ 14 d after admission), and late death (> 14 d after admission). The clinical features of patients in these two groups were compared. RESULTS: Although the overall mortality rate of acute pancreatitis was 3.8% (123/3250), mortality rate of SAP was as high as 16.3% (105/643). Of those 105 SAP mortalities, 44 (41.9%) deaths occurred within the first 14 d after admission and 61 (58.1%) occurred after14 d. Incidence of early death did not significantly differ from that of late death. The co-morbidities did not contribute to the timing of death. Early deaths mainly resulted from multiple organ failure. Late deaths were mainly caused by secondary complication of infected necrosis. Intra- abdominal bleeding significantly caused higher mortality in late death. CONCLUSION: Approximately half (42%) of SAP deaths occur within 14 d and most were due to multiple organ failure. The late deaths of SAP were mostly due to infected necrosis.

关键词：重症急性胰腺炎死亡率患者死亡时间临床统计

The Optimization Design of the Nozzle Section for theWater Jet Propulsion System Applied in Jet Skis

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Computer Modeling in Engineering & Sciences 2024年第3期138卷 2277-2304页

作者： Cheng-yeh Li Jui-Hsiang Kao Department of Systems Engineering and Naval Architecture Taiwan Ocean UniversityKeelungTaiwanChina

The performance of a water jet propulsion system is related to the inlet duct,rotor,stator,and ***,the flow inlet design must fit the bottom line of the hull,and the design of the inlet duct is often limited by stern *** entire section,from the rotor to the nozzle through the stator,must be designed based on system integration in that the individual performance of these three components will influence each ***,the section from the rotor to the nozzle significantly impacts the performance of a water jet propulsion *** study focused on nozzle design and established referable analysis results to facilitate subsequent integrated studies on the design parameters regarding nozzle *** existing studies concentrate on discussions on rotor design and the tip leakage flow of rotors or have replaced the existing complex computational domain with a simple flow ***,research has yet to implement an integrated,optimal design of the section from the rotor to the *** the above,our program conducted preliminary research on this system integration design issue,discussed the optimal nozzle for this section in-depth,and proposed design suggestions based on the *** program used an existing model as the design *** study referred to the actual trial data as the design conditions for the proposed *** prior references’simple flow field form,this study added a jet ski geometry and free surface to the computational *** the linear hull shape was considered,the inflow in the inlet duct would be closer to the actual *** on the numerical calculation result,this study recommends that the optimal nozzle outlet area should be 37%of the inlet area and that the nozzle contour should be ***,for the pump head,static pressure had a more significant impact than dynamic pressure.

关键词： Water jet propulsion system rotor nozzle outlet area nozzle contour

Intractable bleeding from solitary mandibular metastasis of hepatocellular carcinoma

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World Journal of Gastroenterology 2007年第33期13卷 4526-4528页

作者： Shiang-Fu Huang Ren-Chin Wu Joseph Tung-Chieh Chang Sheng-Chieh Chan chun-Ta Liao I-How Chen chun-nan yeh Department of Otolaryngology Chang Oung Memorial Hospital Chang Oung University Linkou Taiwan China Department of Anatomic Pathology Chang Gung Memorial Hospital Chang Gung University Linkou Taiwan China Department of Radiation Oncology Chang Gung Memorial Hospital Chang Gung University Linkou Taiwan China Department of Nuclear Medicine Chang Gung Memorial Hospital Chang Gung University Linkou Taiwan China Department of General Surgery Chang Gung Memorial Hospital Chang Gung University Linkou Taiwan China

Hepatocellular carcinoma (HCC) metastasizes to themandible is infrequently seen. Solitary bony metastasis tothe mandible is rarer. The intractable bleeding caused byrupture of the metastatic HCC is challenging to *** present a case of a 74-year-old woman with HCCunder control without progression for 3 years. Left facialswelling and episodes of bleeding developed recently andbiopsy revealed a metastatic HCC. Computer tomographyshowed a large tumor in parapharyngeal space withevident mandibular ramus destruction. Bleeding occurredfrom the metastatic tumor but could not be controlledby electrocauterization, Surgicel?, tissue glue, andbone wax and angiographic embolization. Palliativeradiotherapy (2400 cGy in 6 fractions) was tried andthe intractable bleeding was successfully stopped afterthe radiotherapy. Because of the hypervascular andosteolytic nature of the solitary mandibular metastaticlesion, the bleeding was troublesome. Radiotherapyprovided successful control of intractable bleeding fromthe metastatic tumor.

关键词：肝癌症状下颌骨放射治疗

Correct diagnosis and successful treatment for pericardial effusion due to toothpick injury: A case report and literature review

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World Journal of Gastroenterology 2007年第31期13卷 4278-4281页

作者： Yu-Yin Liu chun-nan yeh Hsiang-Lin Lee Yi-Yin Jan Jeng-Hwei Tseng Ji-Tseng Fang Department of Surgery Chang Gung Memorial Hospital ChangGung University Taiwan China Department of Radiology Chang GungMemorial Hospital Chang Gung University Taiwan China Department of Internal Medicine Chang GungMemorial Hospital Chang Gung University Taiwan China

We reported a 55-year-old man who suffered from chest pain and dyspnea on exertion for two weeks associated with night sweating, general malaise, poor appetite, and body weight loss. Physical examination revealed friction rub with distant heart sound, bilateral clear breathing sound, no abdomen tenderness, and normal bowel sound. Subsequent chest X-ray revealed cardiomegaly and cardiac echo showed massive pericardial and pleural effusion with normal left ventricular function. Constrictive pericarditis was diagnosed based on clinical information. Tuberculosis (TB), malignancy, autoimmune disease, infection, hypothyroidism, and idiopathic could be the causes but excluded by further study. High-resolution lung CT scan after reconstruction revealed a moderate amount pericardial effusion with possible superimposed infection. Thickness of pericardium and left lobe liver abscess were found. A straight tubular structure about 6 cm in length transverses the lateral segment of liver to pericardial space and unknown foreign body was suspected. Laparotomy was performed, 6.5 cm toothpick was found through the liver into pericardium. Post-operative course was uneventful and he discharged one week later. The patient could not remember swallowing the toothpick before. He had no chest pain and dyspnea on exertion during a 6-mo follow-up period.

关键词：心包疾病牙签心脏损伤剖腹术