Lingnan Modern Clinics In Surgery

2012, 12(01): 13-15.

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Objective To study clinical feasibility and value of retroperitoneal splenic autotransplantation in severe trauma of the spleen. Methods A prospective case-control study, the retroperitoneal splenic autotransplantation, the omentum of splenic autotransplantation were performed in 32 and 34 cases respectively．The spleen-preserving operations were observation of postoperative general condition, after 1 day to 12 months of blood routine, blood IgA, IgM, IgG, C3, Tuftsin level changes. Results Retroperitoneal splenic autotransplantation group operation time is shorter than that in omentum of splenic autotransplantation group ( P< 0.05 ). 1 cases of postoperative adhesive obstruction in the omentum of splenic transplantation group,other general condition, after 1 day to 12 months of blood IgA, IgM, IgG, C3, Tuftsin levels showed no significant difference ( P> 0.05 ) in two groups. Conclusion Retroperitoneal splenic autotransplantation to retain part of spleen immune function, and the operation is relatively simple.It’s a deserved popularized method.

Experimental Study on the Growth of HepG2 cell line by Methylyprednisolone in Vitro

2012, 12(01): 16-19.

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【Abstrct】:Objective To investigate the efficacy and the possible mechanism of HepG2 cell line induced by methylyprednisolone (MP) in vitro.Methods The proliferation of HepG2 cells treated with MP was determined by MTT assay. Flow cytometry was used to detect cell cycle and apoptosis induced by MP. HepG2 cells were randomly divided into 6 groups: the control group, the MP group I (MP 10u/l), group II (MP20ug/l), group III (MP50ug/l), group IV (MP500ug/l), group V (MP5000ug/l). The expression of VEGF mRNA of HepG2 cells was detected by fluorescent quantitation ploymerase chain reaction (FQ-PCR). The VEGF concentration of supernate of HepG2 cells was measured by ELISA. Results MP enhanced the proliferation of HepG2 cells at the concentration of 50-5000ug/l in vitro. The expression of VEGF mRNA was promoted significantly by MP at the concentration of 500-5000ug/l. The expression of VEGF mRNA in the control group, the MP group I , group II, group III, group IV, group V was (4.761±0.624)、(4.679±0.875)、（5.554±0.541）、（5.710±1.22）、（7.293±0.409）、(8.231±0.216）(P＜0.01). The supernate concentration of VEGF was promoted significantly by MP at the concentration of 500-5000ug/l (P＜0.01).Conclusion High dose of methylyprednisolone can enhance the growth of hepatocellular carcinoma cell lines HepG2 in vitro and up-regulate the transcription and translation of VEGF mRNA.

Consideration for One-stage Resection of Acute Colon Obstruction caused by Left Colon Cancer in 16 cases

2012, 12(01): 30-31.

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[Abstract] Objective To explore the safety and clinical application of one-stage resection and anastomosis for acute colon obstruction caused by left colon cancer. Methods To summarize the clinical data of 16 cases of acute colon obstruction caused by left colon cancer in our department from July 2008 to May 2011. All received one-stage resection and anastomosis.Combined therapy were carried out by antibiotics andtotal parenteral alimentation after operation. Result 16 cases received one-stage resection and anastomosis.15 cases received complete resection,and one received palliative resection. All cases were recovery,one occurred abdominal wound infection,no stoma fistula and intraperitoneal abscess.Conclusion One-stage left hemicolectomy is safe and feasible method for acute obstruction due to left hemicolon cancer,as only as if only strict grip operation indication ,combine good intestinal tract irrigation and combined therapy,which deserve clinical application.

Nutrition support is helpful for patients during perioperative period

2012, 12(01): 32-34.

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【Abstract】 Objective In order to investigate the effect of enteral nutrition support on blood glucose levels and nutritional status of perioperative patient with diabetes. Methods Thirty-eight perioperative patients with diabetes were divided randomly into two groups of 19. All the patients were fed according to the nutrition treatment principle for diabetes. After operations, the patients in control group were given liquid, semi-liquid and normal diets gradually based on their gastrointestinal tract tolerance, while the patients in experimental group were given full nutrients diet special for diabetes containing 4% dietary fiber. The calories intake of each group patients were kept at 84~105kj/kg?d. Results Before operation, the fasting blood glucose level of control group was similar to that of experimental group (7.2±1.6 mmol/L vs 7.3±1.3 mmol/L), respectively. However, the blood glucose level of experimental group (7.6±1.1mmol/L) was significantly lower than that of the control group (8.8±1.8mmol/L) on the eighth day post-operation。The serum prealbumin levels and total numbers of blood lymphocytes were statistically higher in experimental group patients than those in control group. Significantly lower infection incidence occurred in experimental group than in control group. No patient suffered metabolism dysfunction such as low blood glucose and ketoacidosis。Conclusion Proper nutrition treatment for perioperative patient with diabetes is helpful to control blood glucose levels, improve nutritional status, promote wound heal and prevent implications.

Clinical analysis of tension-free hernioplasty for adult's inguinal hernia through individualize treatment：A report of 546 cases

2012, 12(01): 37-38.

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Abstract ：Objective To analysis the clinical value of tension-free hernioplasty for adult sufferer inguinal hernia through individualize treatment. Methods Clinical data of 546 cases with inguinal hernia treated by tension-free hernioplasty through individualize treatment from June 2004 to February 2011 were analyzed retrospectively. Results All patients were successfully cured. 5 cases have recurred after operation, the postoperative recurrence rate was 0.92％; 27 cases have occurred scrotal swelling after operation; 26 cases have occurred chronic pain after operation, the chronic pain rate was 4.76％; Postoperative recovery time were 4.3±0.5 hours; and hospital stay time were 4.1±0.7 days. Conclusion The application of tension-free hernioplasty for adult's inguinal hernia through individualize treatment is worth to be popularized for it fast to recovery，low recurrence rate, less postoperative complicationsless, short hospital stay time and low cost.

Clinical observation of procedure for prolapse and hemorrhoids in 46 cases with severe hemorrhoids

2012, 12(01): 39-40.

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【Abstract】 Objective To study the clinical effects of procedure for prolapse and haemorrhoids (PPH) in the treatment of severe haemorrhoids. Methods 46 cases with severe haemorrhoids operated by procedure for prolapase and hemorrhoids was analyzed retrospecttively and their clinical effect was evaluated. Results All the cases anastomosed successfully. The average operation and hospitalization time was 20 minutes and 3.8 days. No anal incontinence, anal stricture, perianal infection and recurrence occurred after the mean follow-up time of 13.4 months. Conclusions PPH is an effective, safe and minimally invasive treatment for severe haemorrhoids, it has advantages of less bleeding, less pain, shorter hospitalization time, low recurrence rate, deserve the clinical expansion.

Application of insulation membrane for anti-adhesion in laparoscopy thyroid surgery to prophylaxis adhesion of juqular skin flap.

2012, 12(01): 45-46.

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Abstract Objective To evaluate the feasibility and validity of insulation membrane for anti-adhesion in laparoscopy thyroid surgery to prophylaxis adhesion of juqular skin flap after operation,supply a new way to prophylaxis adhesion of juqular skin flap.Methods Stochastic select 40 patients who were accepted thyroid surgery in laparoscopy.Insulation membrane for anti-adhesion were placed between juqular skin flap and musculature in cure group.and observed effect termly.At one time the patients in contradinstinctive group were not placed insulation membrane for anti-adhesion,and processd statistical analysis to contrast effect.Results All patients incision cicatrization were Ⅰ expectation,no one patient was appear ill reaction such as fluidify,fever,rejection,and so on,effct of anti-adhesion and plersing to the eye are better.Conclusion Using Bai Fei Mi insulation membrane for anti-adhesion in laparoscopy thyroid surgery is safety and efficiency to prophylaxis adhesion of juqular skin flap.The advantage of pleasing to the eye in laparoscopy thyroid surgery have more assured,and it can be a new way to prophylaxis adhesion of juqular skin flap.

A preliminary report of the treatment of lumbar disc herniation with x-tube operation system .

2012, 12(01): 49-50.

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The analysis of complication in 141 cases with ventriculoperitoneal shunt

2012, 12(01): 51-53.

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Objective To explore the complication of the ventriculoperitoneal shunt.Methods From December 2000 to March 2011,141 cases with ventriculoperitoneal shunt were analyzed retrospectively.Results The incidence of complication was 9.93%, 5 cases shunt obstruction (3.55%), 3 cases postoperative infection (2.13％), 3 cases intracranial hypotension syndrome (2.13%), 2 cases gastrointestinal symptom (1.42%), 1 case prolapse through the Anus (0.71%), 1 case intracranial hematoma (0.71%). Conclusion With strict aseptic technique, improve the surgical technic, choose the suitable shunt equipment are the keys to reduce the occurrence of complication of ventriculoperitoneal shunt patients.

The clinical observation of dexmedetomidine for prevention of cardiovascular response to tracheal intubation and extubation during general anesthesia

2012, 12(01): 56-59.

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【Abstract】 Objective To observe the effects of dexmedetomidine to prevent cardiovascular response induced by tracheal intubation and extubation during general anesthesia. Methods A total of 30 patients (ASAⅠ～Ⅱ) undergoing selective abdominal operation under general anesthesia were randomly divided into two groups: control group (group C, n=15) and dexmedetomidine group (group D, n=15). The patients in group D received dexmedetomidine 1ug/kg intravenous injection over 15 min while those in group C received equal volume of normal saline before anesthesia induction. Anesthesia was induced with propofol 1.5mg/kg, fentanyl 3μg/kg and cisatracurium 0.2mg/kg in both groups. Mean arterial blood pressure (MAP), heart rate (HR) and the rate-pressure product (RPP) were recorded at these moment: ① before infusion (baseline value), 5min, 10min and 15 min after infusion; ② 1min before intubation, the moment of intubation, 1min, 3min and 5 min after intubation; ③ 5min before extubation, the moment of extubation, and 3min, 5min and 10 min after extubation. The incidences of RPP more than 12000 were caculated during intubation and extubation. Results At 10, 15 min after infusion and 1 min before intubation, HR significantly decreased in group D, compared with the baseline value (P＜0.05). At the moment of intubation, 1 min after intubation, and the moment of extubation, MAP and HR significantly decreased in group D, compared with group C (P＜0.05). At each time point from 15 min after infusion to after extubation, RPP significantly decreased in group D, compared with group C (P＜0.05). The incidences of RPP more than 12000 in group D were significantly less than that in group C during intubation and extubation (P＜0.05). There were no significant differences in the recovery time, extubation time and Ramsay conscious-sedation score between the two groups (P＞0.05). Conclusion Dexmedetomidine can effectively reduce cardiovascular responses to tracheal intubation and extubation during general anesthesia, and have hemodynamic-stabilizing effects while not prolonging the recovery time from anesthesia.

Effects of dezocine on the reaction at periextubation period in elderly undergoing thoracoscopy

2012, 12(01): 60-62.

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Objective: To compare the effects of dezocine and sufentanil on the reaction at periextubation period in elderly undergoing thoracoscopi procedures. Method Sixty elderly patients scheduled for thoracoscopic lobectomy were randomized into group D1, D2 or SF. At 15 min before the end of procedure, intravenous dezocine 0.1mg/kg, 0.15mg/kg or sufentanil 0.1μg/kg were given in group D1, D2 or SF, respectively. Around the extubation period, blood pressure, heart rate, eyes open time, extubation time, orientation recovery time were observed. After extubation, pain, restlessness, analgesia supplement, side effects and blood gas analyses were recorded. Results: At the time of extubation, there was no any significant difference in hemodynamics, pain score and restlessness score between the three groups (p>0.05). SpO2 of group D1 was significantly higher than that of group SF after extubation(p<0.05). There was no any significant difference in PaO2 and PaCO2 between the three groups (p>0.05). Conclusion: Dezocine can reduce the adverse reactions similar to sufentanil in elderly patients undergoing thoracoscopic procedures during the extubation period.

Clinical experience of traumatic diaphragmatic hernia: A analysis of 28 cases.

2012, 12(01): 71-73.

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[Abstract] Objective：To analyze the diagnosis and treatment of traumatic diaphragmatic hernia, summed up the experience of early diagnosis and misdiagnosis causes of treatment. Methods： Retrospective analysis of hospital 2002.01 - 2011.10 treated 28 patients with traumatic diaphragmatic hernia clinical data. Results： The 20 patients after thoracic surgery, the abdominal repair in 8 cases. 1 died. Conclusion：(1) The left side of traumatic diaphragmatic hernia is the high incidence than the right. (2) To improve multi-disciplinary physician mechanism of traumatic diaphragmatic hernia awareness, not to the specific signs of diaphragmatic hernia does not appear to negate the diagnosis of traumatic diaphragmatic hernia and dynamic laboratory examinations can reduce misdiagnosis. (3) Once diagnosed as early as possible surgical treatment, surgery should be based on the condition the flexibility to choose the path, mode of operation should be simple and effective. (4) Simple traumatic diaphragmatic hernia not the cause of death in patients.

A case of myxofibrosarcoma on the left foream

2012, 12(01): 75-76.

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