Table of Content

20 February 2014, Volume 14 Issue 01

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论文

Review and prospect of spinal surgery

2014, 14(01):  1-2.  DOI: 10.3969/j.issn.1009-976X.2014.01.001

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Give prominence to the multiple image modality superiorities and realize accurate joint displacement

2014, 14(01):  3-4.  DOI: 10.3969/j.issn.1009-976X.2014.01.002

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Application of bipolar radiofrequency device Habib 4X for total laparoscopic hepatectomy

2014, 14(01):  5-7.  DOI: 10.3969/j.issn.1009-976X.2014.01.003

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RNA interference targeting ABCG2 reverses chemotherapy resistance in mamosphere cell of breast cancer

Yang Xing,.Hu Qian,.Ding-Lin Xiaoxiao, Jiang Junxia,.Lin Xiao,.Yao Herui

2014, 14(01):  8-12.  DOI: 10.3969/j.issn.1009-976X.2014.01.004

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【Abstract】 Objective To investigate the effect of RNA interference targeting ABCG2 gene on reverse chemotherapy resistance of mamosphere cell of breast cancer..Methods ABCG2-siRNA sequence was designed and inserted into lentiviral vector and virus was packaged,.then a stable ABCG2-silenced MCF-7 mamosphere cell lines was established. The expression level of ABCG2 was detected by Western blot..The proliferation was measured by MTT assay in MCF-7 mamosphere cells after RNA interference..Flow cytometry was performed to assess the cell cycle and apoptotic rate. Results Western Blot showed that ABCG2 was highly expressed in the mamosphere cells,.and the expression decreased concurrently after RNAi silenced ABCG2. MTT showed that inhibition rate of MCF-7 adherent cells was higher than that of MCF-7 mamosphere cells of in the presence of 5-Fu, and the inhibition rate increased as the concentration of 5-FU increased in ABCG2-silenced mamosphere cells. Flow cytometry also showed that most mamosphere cells were in G0/G1 phase, and the number of mamosphere cells in G0/G1 phase and apoptosis were elevated with increasing concentration of 5-Fu or ABCG2 gene blockage. Conclusion ABCG2 protein highly expressed in breast cancer mamosphere cells. The inhibition of ABCG2 gene expression could significantly increase the cell inhibition rate and the apoptosis rate in mamosphere cell, and reverse its resistance to 5-Fu.

The study about the mechanism of IL-8 promotes EMT through activation of AKT signal pathway in renal cell carcinoma

Lu Fuding, Xu Kewei, Bi Liangkuan, Liu Cheng, Xuan Xujun, Lin Tianxing

2014, 14(01):  13-16.  DOI: 10.3969/j.issn.1009-976X.2014.01.005

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【Abstract】 Objective To study the expression of IL-8 in renal cancer and the role of IL-8 in promoting epithelial to mesenchymal transition (EMT) of renal epithelial cells. Methods ELISA was used to detect the expression of IL-8 both in renal cell carcinoma and the para-carcinoma tissue, and the morphological changes of renal carcinoma cell lines (786-0) were observed before and after IL-8 treatment. Cell invasion assay was used to evaluate the impact of IL-8 on renal cell carcinoma' invasion, and western-blot was used to detect the expression levels of E-cadherin and N-cadherin as well as the phosphorylated AKT in 786-0 cells. Results The expression of IL-8 in 20 cases of renal carcinoma was elevated when compared with the para-carcinoma tissue. After treated with IL-8, 786-0 renal carcinoma cells changed their morphology and lost their cells polarity, the expression of E-cadherin on cell surface was decreased, while the N-cadherin expression became higher. In addition, IL-8 treatment enhanced significantly 786-0 cell penetration and promoted AKT phosphorylation, while EMT caused by IL-8 stimulation was blocked by inhibiting AKT phosphorylation. Conclusion IL-8 has an ability to induce EMT of renal cell carcinoma cell lines 786-0 through activation of AKT signaling and promote the invasion of renal carcinoma cells, which may be an important mechanism for RCC metastasis.

The relationship between the phenotypes of macrophages in omental/peritoneal milky spots and the clinical stages of colorectal carcinomas

Zhang Tong, Tang Xingkui, Liang Weixiong, Cai Yuzhi, Li Lin, He Jialin

2014, 14(01):  17-21.  DOI: 10.3969/j.issn.1009-976X.2014.01.006

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【Abstract】 Objective To investigate the relationship between the phenotypes of macrophages in omental/peritoneal milky spots and the clinical stages of colorectal carcinomas. Methods Omental and peritoneal specimens of colorectal carcinomas with different stages (60 cases) and normal person (10 cases)were collected in the central hospital of Panyu district from January 2011 to December 2012. After the macrophages had been isolated and purified,the phenotypes of macrophages in omental/peritoneal milky spots were identified and determined by immunofluorescence staining and Flow Cytometry (FCM). And the secretion of IL-10 and IL-12 in different time points were detected by Enzyme linked immunosorbent assay (ELISA). Results The number of M1 type macrophages in control and T1-3 group was larger than that in T4 group (P all<0.01). The number of M2 type macrophages in T4 group was larger than that in control and T1-3 group (P all<0.01). The number of M1 type macrophages was negative correlated with T stages of colorectal carcinomas (P<0.01). But the number of M2 type macrophages was positive correlated with T stages of colorectal carcinomas (P<0.01). There was significant differences in the secretion of IL-10 and IL-12 in different time points among three groups: the IL-10 in control and T1-3 group were lower than T4 group (P all<0.05); the IL-12 in T4 group were lower than control and T1-3 group (P all<0.05). The secretion of IL-12 in macrophages in omental/peritoneal milky spots was negative correlated with T stages of colorectal carcinomas (P<0.01). On the contrary, the secretion of IL-10 was positive correlated with T stages (P<0.01). There was a close correlation between the phenotypes of macrophages in milky spots in the omentum/peritoneum and clinical staging in patients of colorectal carcinomas, especially serosa tumor invasion and tumor lymphnode metastasis (P<0.05). Conclusion The phenotypes of macrophages in milky spots in the omentum/peritoneum is influenced by serosa tumor invasion and tumor lymphnode metastasis; Milky spots mainly express M1 type macrophages in patient with colorectal carcinomas in stage T1-3, it can capture and kill tumor cell; Milky spots mainly express M2 type macrophages in the T4 stages, and promote role for the growth of tumor.

Clinical significance of Kocher maneuver anatomic in surgical procedure of laparoscopic pancreatoduodenectomy

Zhou Xiaobo

2014, 14(01):  21-25.  DOI: 10.3969/j.issn.1009-976X.2014.01.007

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【Abstract】 Objective To explore the anatomic characteristics of the related blood vessels and fascia in laparoscopic pancreatoduodenectomy (LPD) and to provide the anatomical basis for laparoscopic anatomical location and operating approach. Methods Specimens were provided by Southern Medical University Department of anatomy..The blood vessels distribution and the fascial spaces,.the communication and the relationship to adjacent were observed and described. Results The space before and behind the body of the pancreas and its extension are two major surgical planes. The fusion fascia and fascia space behinal the pancreas were the natural plane of laparoscopic surgical operation. Any deviation whould result injury of nearby blood vessels and organs..LPD along the surgical plane, especially the using of Kocher incision approach,.could fully embody the operation principle of no damage and a radical cure in cancer. The important blood vessels supplying pancreas duodenum were located in the fascia and pancreas parenchyma,.which should be paid more attention to protect the blood vessels near by pancreas duodenal and maintain the integrity of fascia in LPD. Conclusion Understanding of related LPD anatomy characteristics of blood vessels and fascia can provide morphologic basis for laparoscopic surgery in the design and specification of LPD, so as to improve the safety of laparoscopic operation and completeness of radical cure.

The expression of HBx in hepatocellular carcinoma and its relationship with disease-free survival of HCC patients

Hong Qingqi, He Chuanchao, Xu Junyao, Hu Bin, Wang Jie

2014, 14(01):  26-29.  DOI: 10.3969/j.issn.1009-976X.2014.01.008

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【Abstract】 Objective To detect the expression of HBx in HCC and analyze its relationship with disease-free survival (DFS) in HBV-related HCC. To evaluate the detection performance of HBx antigen in human serum. Methods Immunohistochemical staining was utilized to detect the expression of HBx in 35 HBV-related HCC tissues, and results were analyzed with clinical data. Enzyme-linked immunosorbent assay (ELISA) was applied to detect the HBx antigen in human serum. Results HBx positive ratios were 20/35 (57.14%) in HCCs, with 15/24 (62.50%) of HBsAg positive and 5/11 (45.45%) of HBsAg negative cases respectively. The poorly differentiated ratio of HBx positive (9/20, 45.00%) was significantly higher than that of HBx negative (2/15, 13.33%) cases (P<0.01). Disease free survival (DFS) of HBx positive and negative group was estimated by Kaplan-Meier method and compared by log-rank test. The results showed poor DFS in HBx positive group (P=0.03). ELISA could efficiently detect HBx antigen in human serum with 48/77(62.34%) positive. Conclusions The expression of HBx is correlated with tumor pathological grading and poor DFS of HCC patients. ELISA can efficiently detect HBx antigen in human serum.

Comparative therapeutic effects of Combined and selective devascularization procedures in the surgical treatment of portal hypertension

Sun Hao, Liu Jikui, Yin Yaoxin, Long Guanghui, Lin Zewei, Tian Peikai

2014, 14(01):  30-32.  DOI: 10.3969/j.issn.1009-976X.2014.01.009

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【Abstract】 Objectives To evaluate the therapeutic effects of combined devascularization procedure. Methods Forty-six patients with portal hypertension and upper gastrointestinal bleeding were included in this study and the clinical data were analyzed respectively. Of 46 cases, 28 underwent the surgical procedure of selective devascularization.(selective group)..and 18 received selective devascularization combined with modified Sugiura procedure (combined group). Results There were no significant difference between the two groups in intraoperative blood loss,operation time,hospitalization days, free portal pressure (FPP) changes, and postoperative rebleeding (P>0.05). Postoperative esophageal varices disappearance rate for combined group was 94.4% (17/18) and selective group was 64.3% (18/28), with statistical difference (P<0.05). Conclusion In the present study, postoperative esophageal varices disappearance rate in patients with combined devascularization was higher. Although the rate of postoperative rebleeding was almost the same with selective devascularization,combined devascularization may be a better choice for the patients with good general condition.

Curative effect of transcatheter arterial chemoembolization combined with ¹²⁵I implantation in the treatment of Middle-advanced hepatic carcinoma

Ou Zhangsong, Zhang Qizhou, Hu Qian, Ding-Lin Xiaoxiao, Yao Herui

2014, 14(01):  33-36.  DOI: 10.3969/j.issn.1009-976X.2014.01.010

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【Abstract】 Objective To discuss the therapeutic effect of transcatheter hepatic arterial chemoemb-olization(TACE) combined with 125I radioactive particles implantation for the treatment of middle-advanced hepatic carcinoma. Methods Eighty-nine cases of hepatic carcinoma were collected from May 2011 to May 2012 and retrospectively analyzed. Of 89 cases, 45 patients were underwent TACE alone (group A), 44 were treated with TACE combined with 125I radioactive particles implantation (group B) under the computer-assisted three-dimensional treatment planning system (TPS). Efficacy evaluation was performed in two months, four months after operation by CT scan. The survival status was recorded in the fourth and ninth months after treatment. Efficacy evaluation and survival status were compared between two groups by chi-square test (P<0.05). Results The OR (CR+PR) were 24.44% (11/45), 17.78% (8/45) in group A, and 54.55% (24/44), 47.73% (21/44) in group B respectively at two months and four months after operation. There were significant differences between two groups (P<0.05). The survival rate at six, nine months in group A (62.22%, 42.22%) were significantly lower than those in group B (90.91%,72.73%),P<0.05. Conclusion TACE combined with 125I radioactive particles implantation is an effective method for the treatment of middle-advanced hepatic carcinoma, which would also improved survival rate.

Effect on the preservation of left colic artery in sigmoid colon cancer radical resection

Lv Yizhong, Zhu Jingtao, Tan Minghua, Jiang Xinquan

2014, 14(01):  37-40.  DOI: 10.3969/j.issn.1009-976X.2014.01.011

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【Abstract】 Objective To explore the effect and safety of preservation of the left colic artery (LCA) for the treatment of sigmoid colon cancer. Methods A total of 75 cases with sigmoid colon cancer were included in the study and the clinical data were analyzed retrospectively. Of 75 cases, 32 underwent radical dissection with LCA preservation (LCA preservation group), the ones who underwent traditional surgery with cutting the root of inferior mesenteric artery were controls. The surgical effect, clinical pathological parameters and postoperative complications were compared between two groups. Results There were no differences in surgical time and blood loss between LCA preservation group and traditional group. The proximal bowel cut end (11.5cm vs 16.7cm) and distal bowel cut end (5.8 cm vs 8.7 cm) were both shorter in the LCA preservation group. We found no difference in the amount of postoperative harvested lymph nodes. The main group of harvested lymph nodes (2.3 vs 2.1) and positive lymph nodes (0.2 vs 0.3) were similar between two groups. We also found that the incidences of overall complications were similar between LCA preservation group and traditional group. Conclusion The application of LCA preservation for the treatment of sigmoid colon cancer was available, safe and effective and ensured radical dissection of lymph nodes along the root of inferior mesenteric artery, with no risk in improving surgical risk.

Comparative study on transumbilical single port laparoscopic cholecystectomy and traditional laparoscopic cholecystectomy

Chen Xiaowu, Wang Weidong, Chen Jianping, Wu Zhiqiang, Feng Jianping, Liu Qingbo

2014, 14(01):  41-43.  DOI: 10.3969/j.issn.1009-976X.2014.01.012

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【Abstract】〓Objective〓To investigate the advantages and disadvantages of the transumbilical single port laparoscopic cholecystectomy (LC) and conventional LC. Methods〓Eighty patients received transumbilical single port LC (TUSPLC group, n=40) and traditional LC (TLC group, n=40) from June 2010 to June 2013 were included in the study. The clinical data were retrospectively analyzed. The operative time, intraoperative blood loss, postoperative intestinal function recovery time, the cases of postoperative using analgesic postoperative hospital stay and complications were compared between two groups. Results〓All operations in 80 cases were successful. No postoperative complications occurred. Compared with TLC group, the TUSPLC group took longer operative time [(50.3±24.9) min vs. (35.1±17.6) min, P<0.05], but the patients who needed analgesic after operation were less (5% vs. 27.5%, P<0.05), and the postoperative hospital stay was shorter [(3.9±0.7)d vs. (6.2±0.9)d,P<0.05]. For the intraoperative blood loss and postoperative intestinal function recovery time, there were no significant differences between the two groups (P>0.05). Conclusion〓Transumbilical single port LC is a safe, feasible and more minimally invasive surgery as compared with the traditional operation, and it has advantages of less postoperative pain, faster recovery and no obvious abdominal scars.

Analysis of clinical features of metachronous primary colorectal carcinomas in 19 cases

Lin Hang,.Deng Wujian,.Xie Fuhua,.Chen De

2014, 14(01):  44-46.  DOI: 10.3969/j.issn.1009-976X.2014.01.013

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【Abstract】 Objective〓To investigate the clinical features of metachronous primary colorectal carcinomas. Methods〓From 2000 to 2012,19 cases of the clinical features and outcomes of metachronous colorectal carcinoma were retrospectively analyzed. Results〓In the 1304 cases of radical operation of colorectal carcinoma, the metachronous primary colorectal carcinoma were found in 19 cases during 2000 to 2012. The incidence rate of metachronous primary colorectal carcinoma was 1.4%. The metachronous cancer was confirmed in 15 to 135 months after operation of primary colorectal cancer (mean 77 months and 74.2±29.5 months on average). 68.4% of the metachronous carcinomas were found in 5 years after first operation. Compared with the initial carcinomas, the metachronous carcinomas showed smaller mass in size and more located in the ascending colon. 78.6% of the patients had deficiency of mismatching modification gene protein expression. The 5-years survival rate was 94.7%. All patients were without lymphatic metastasis and blood metastasis. Conclusion〓Metachronous primary colon carcinomas is low in incidence rate, but it has a higher mismatching maodification gene and with better prognosis.

Experiences of the retroperitoneal laparoscopic anatomical adrenalectomy for adenal tumors

Li Song,.Li Zhengming, Li Gang, Shi Guoqiang, Huang Wensheng, Deng Xingjun

2014, 14(01):  47-49.  DOI: 10.3969/j.issn.1009-976X.2014.01.0014

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【Abstract】〓Objective〓To investigate the operative method and the clinical effect for treating adrenal tumors by retroperitoneal laparoscopic anatomical adrenalectomy. Methods〓Clinical data of 38 patients with adrenal tumors during 2010 to 2013 were retrospectively analyzed. Anatomical adrenalectomy were performed according to the established surgical procedure..The clinical data,.imaging and operation video were analyzed. Results〓The operations were completed successfully in all cases and intraoperative blood loss was less. Operation time was 42?鄄110 min (average 66±20.1 min). The hospital stay ranged from 3 days to 10 days with 6.6 days on average. A Follow?鄄up for 6 months to 2 years was performed and no postoperative complication and recurrent ease were found. Conclusion〓The retroperitoneal laparoscopic anatomical adrenalectomy procedure is clear in the anatomical layers, and it is easy to control and the curative effect is reliable.

The occurrence and its influencing factors of mental disorder caused by craniocerebral trauma

Xie Xiansheng, Liu Shengchu, Xie Ninghua

2014, 14(01):  49-52.  DOI: 10.3969/j.issn.1009-976X.2014.01.0015

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【Abstract】〓Objective〓To investigate the occurrence and its influencing factors of mental disorder caused by craniocerebral trauma in order to provide reference basis for prevention and cure. Methods〓One hundred and seventeen craniocerebral trauma patients who were treated in the neurosurgery department of our hospital from August 2011 to August 2013 were selected as the research objects. Their clinical data were investigated by self-made questionnaire made by the author after consulting a large number of references to find out the occurrence and influencing factors of mental disorder caused by craniocerebral trauma by SPSS19.0 statistical package. Results〓The occurrence of mental disorder caused by craniocerebral trauma was 38.46%(45/117), the most common type was mania. Multivariable logistic regression analysis showed that the frontal lobe damage (β=4.14. P<0.001), intracranial infection (β=5.81, P<0.001), hypoxemia (β=6.40, P<0.001) and ventricular compression (β=7.17, P<0.001) were influencing factors for mental disorders caused by craniocerebral trauma. Conclusion〓The occurr-ence of mental disorder caused by craniocerebral trauma is high..In clinical medical process, strengthening patrol and supervision,.discover the patients' mental symptoms for high-risk groups,.corresponding treatment and nursing intervention should be given according to the type of mental disorder patients,.it would contribute to recovery of disease and improves the prognosis of patients.

Clinical analysis of x-tube operation system for the treatment of lumbar disc herniation

Fu Chaohua, Chen Zhongxian, Liang Shengen, Fan Quan, Xue Zhonglin, Xie Qinghua

2014, 14(01):  53-55.  DOI: 10.3969/j.issn.1009-976X.2014.01.016

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【Abstract】〓Objective〓To investigate the curative effect on the decompressive laminectomy and discectomy using x-tube operation system for the treatment of lumbar disc herniation. Method〓From Jan 2010 to Jun 2012, the clinical data of 36 patients with lumbar disc herniation were analyzed respectively. All cases.(including L4/5 in 20 cases,L5/S1 in 16 cases)underwent the surgical procedure of decompressive laminectomy and discectomy using x-tube operation system..The clinical effects were evaluated according to Nakai scale. The operative time, intraoperative blood loss, complications, pre- and post-operative VAS score and ODI score were observed. Result〓All patients were followed-up for an average of 18 months (range from 12 to30)..The patients were excellent results in 22, good in 12, fair in 2 according to Nakai scale. The operative time was 50 min (30-110 min), intraoperative blood loss were 43 ml(10-150 ml). The pre- and post-operative VAS score were 8.1±1.5 and 2.7±1.2. The average ODI score was decreased from 75.5±18.2% of pre-operation to 18.3±7.5% of post-operation..ODI score in 6 months and one year were lower than that in preoperation. Cutaneous necrosis occurred in one case and disruption of wound happened in one case. Conclusion〓The surgical procedure of decompressive laminectomy and discectomy using x-tube operation system for the treatment of lumbar disc herniation could achieve satisfactory clinical results based on strict operation indication and a definitive study curve.

Treatment of acute osteochondral fracture of patella with absorbable screws

Li Hongjian, Wang Ge

2014, 14(01):  56-59.  DOI: 10.3969/j.issn.1009-976X.2014.01.0017

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【Abstract】〓Objective〓To investigate the effect of using absorbable screws in treating acute osteochondral fracture of patella. Methods〓From June 2004 to December 2009,14 patients with acute knee injury, aged from 13-21 years (3 males and 11 females, 8 left knees, 6 right knees). Eight cases were confirmed as acute osteochondral fracture of patella by CT imaging, and six cases by MRI. All cases revealed patella subluxation,osteochondral fracture in the rearward medial part and medial retinaculum injuries of patella,.as well as cartilage contusion of condylus lateralis femoris in intraoperative finding. Osteochondral fractures of patella were treated with open reduction and fixation with absorbable screws. Knee joints exercise with contraction of quadriceps muscle began in 24 hours after operation. The patients received external fixation for 3 weeks. Weight bearing walking began in 2-3 months after CT or X-ray showed bone healing. Results〓Twelve patients were followed with 4-9 years, an average of 6.5 years. According to HSS evaluation, 11 cases were excellent, one case was good. Conclusion〓Early surgical procedure, excellent reduction and fixation with absorbable screws, early active exercise were necessary for the treatment of osteochondral fracture of patellas.

Clinical effect of modified single open-door laminoplasty using titanium miniplate fixation in treatment of cervical myelopathy

Chen Jiayu, Liu Zhanliang, Li Xiaobin

2014, 14(01):  60-62.  DOI: 10.3969/j.issn.1009-976X.2014.01.018

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【Abstract】〓Objective〓To evaluate the clinical effect of single open-door cervical expansive laminoplasty (ELP) in treatment of cervical spondylosis. Methods〓From January 2008 to February 2012, a total of 46 patients with multi-segment cervical spondylotic myelopathy (MCSM) were implemented open-door cervical expansive laminoplasty with titanium miniplate fixation. The preoperative and postoperative JOA scores, cervical C5 segmental sagittal diameter in preoperation and 6 months after operation were evaluated,and the expansion rate of spinal canal was measured [(postoperative sagittal diameter-preoperative sagittal diameter)/(preoperative sagittal diameter)×100%]. Results〓The mean follow-up was 18 months (6 to 24 months). The average pre-OP JOA score was 8.2 and post-OP JOA score was 14.8. The mean sagittal diameter of C5 spinal canal was 8.6±1.1mm before operation and 16.1±0.9mm at 6 months after operation,with the expansion rate of 74.3±14.4%. CT scan showed bony fusion at hinge side at 6 months after operation. There was no case of screw loosening and reclosed door. Conclusion〓Modified single open-door cervical expansive laminoplasty with titanium miniplate fixation would obtain satisfactory clinical effect, it is able to reduce the probability of reclosed door.

Comparison of clinical efficacy between multifidus muscle gap and posterior midline approach in one-stage debridement and internal fixation for treating thoracolumbar spinal tuberculosis

Guo Shixiang, Xiong Bo, Liu Xiaolan, Huang Dali

2014, 14(01):  63-68.  DOI: 10.3969/j.issn.1009-976X.2014.01.019

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【Abstract】〓Objective〓To evaluate the clinical effect on surgical procedures of trans multifidus muscle gap and posterior midline approach in the treatment of thoracolumbar tuberculosis. Methods〓From March 2008 to March 2010,30 patients were diagnosed as spinal tuberculosis and treated with one-stage posterior surgery and anti-TB treatment, including 14 cases of the trans multifidus muscle gap approach (multifidus muscle gap group), 16 cases of conventional midline approach (traditional group). Short-segment pedicle screw fixation and posterior debridement,correction of kyphosis were used. The operative time, blood loss, postoperative drainage, hospital stay time, VAS score, ODI score, Cobb angle and interbody fusion were compared between two groups. Results〓Blood loss in trans multifidus muscle gap group and traditional group were in 230±70 mL and 550 ± 96 mL respectively(P<0.01). Postoperative drainage in two groups were in 185±56 mL and 479±118 mL respectively(P<0.01). Two groups of patients in the preoperative erythrocyte sedimentation rate were in 55-75 mm/h, and in the postoperative follow-up for 3~9 months,the ESR reached to normal level(<20 mm/h). Preoperative measurement of Cobb angle between multifidus musle gap group and the traditional group were 19.9±5.6° and 17.6±5.4° respectively, postoperative Cobb angle were 8.9±5.4° and 9.6±5.7°(P<0.01). Cobb angle correction showed no significant difference between two groups(P>0.05). In trans multifidus musle gap group,VAS scores and ODI score were better than that in traditional group in 6 weeks after operation,but no difference was observed in 24-36 months. And the incidence of complications in both groups, correction of kyphosis angle, fusion rate, recovery of neurological function showed no statistically significance. Conclusion〓Trans multifidus muscle gap approach has good clinical efficacy and gets rapid postoperative recovery.

Management of 355 patients with abdominal injuries in severe trauma

Han Qing, Zhuang Lizhao, Deng Xuesong, Deng Haoyuan, Fan Zibing, Ni Yong, Wang C

2014, 14(01):  68-72.  DOI: 10.3969/j.issn.1009-976X.2014.01.020

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【Abstract】〓Objective〓To discuss the diagnosis and treatment of abdominal injury in severe trauma. Methods〓The data of 355 cases of abdominal injuries with severe trauma in our hospital from Sept. 1999 to Sept. 2012 were analyzed. Results〓319 patients underwent immediate abdominal operations.103 patients received over two operations on different anatomic regions under a single anesthesia. Mean length of stay in the intensive care unit was 28.6±10.8 days. 237 cases had a good recovery, 78 cases were disability and 40 cases died. Conclusion〓Diagnostic peritoneocentesis and Ultrasound are rapid and accurate modalities for the diagnosis of intraabdominal injury. CT is sensitive for the evaluation of abdominal injury in hemodynamically stable patients. The operation sequence should be depended on the importance and the injury severity of the involved organ. The operations on different anatomic regions should be done as far as possible under a single anesthesia. Damage control surgery would effectively reduced mortality rate.

One case report of pathological complete remission of rectal cancer after neoadjuvant chemotherapy and review of literature

Lv Zejian, Zhang Yuchao, Liu Yeqing, Liu Gaojie, Chen Shuang

2014, 14(01):  73-75.  DOI: 10.3969/j.issn.1009-976X.2014.01.021

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【Abstract】 Objective〓To explore the clinical efficacy of neoadjuvant chemotherapy for patients with colorectal cancer. Methods〓The diagnosis and treatment course of one case with advanced rectal cancer undergoing neoadjuvant chemotherapy in the Gastroenterology Department, Sun Yat-sen Memorial Hospital of Sun Yat-sen University was reported,and related literature were reviewed. Results〓After three cycles of neoadjuvant chemotherapy,the postoperative pathological result after surgery suggested pathological complete remission (pCR). Conclusion〓Neoadjuvant chemotherapy is effective for the treatment of patients with advanced colorectal cancer, and it is suitable for patients with advanced colorectal cancer before operation.

Effect of preoperative percutaneous transhepatic cholangic drainage in perioperative treatment of obstructive jaundice

Miao Minchao,Liu Zanwei,Shi Shange

2014, 14(01):  76-79.  DOI: 10.3969/j.issn.1009-976X.2014.01.022

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【Abstract】〓Objective〓To summarize the experience in treatment of the obstructive jaundice by preoperative percutaneous puncture of liver bile duct drainage. Methods〓Eight-six patients with obstructive jaundice were included and divided into two groups according to the operation procedure, 44 cases were given preoperative percutaneous transhepatic cholangial drainage(observation group) and then,.underwent internal or external drainage or radical operation,.42 cases were served as control group without preoperative percutaneous transhepatic cholangial drainage..Intraoperative blood loss, operative time,..hospital stay and complications were compared between two groups. The preoperative and postoperative liver function tests,such as total bilirubin(TB),.serum alanine aminotransferase (ALT), aspartate aminotransferase (AST) were evaluated and compared in two groups. Results〓The operation time,.blood loss,.length of hospital stay and complication rates between observation group were lower than that in control group (P<0.05). The levels of TB, ALT, AST in 14 days after operation reduced in two groups, but were significantly decreased in observation group,.as compared to control group (P<0.05). Conclusion〓For patients with obstructive jaundice, preoperative percutaneous transhepatic cholangial drainage would shorten the length of hospital stay,.reduce complications occurrence,.and improve liver function.

Effect of propofol on inhibiting the stress action for the perioperative patients with colorectal carcinoma: an immunological view from the CD4+CD25+ regulatory T cells

Wu Qisheng, Lin Shiqing, Yang Kaihua

2014, 14(01):  79-82.  DOI: 10.3969/j.issn.1009-976X.2014.01.023

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【Abstract】〓Objective〓To explore the effect of propofol on inhibiting the stress action for the perioperative patients with colorectal carcinoma,basing on the immunological view from the CD4+CD25+ regulatory T cells (Treg). Methods〓Fifty perioperative patients with colorectal carcinoma were randomly divided into the observation and control group(n=25 for both). Target-controlled infusion (TCI) with propofol and remifentanil was given for the observation group,while the intravenous inhalation anesthesia with fentanil and isoflurane was given for the control group. The vital sign together the stress indexes were recorded at the three time points: before anesthesia induction (T1), 10 min after colon excision (T2) and after the whole operation (T3). The flow cytometry (FCM) was applied to test the levels of the Tregs, together with their intracellular cytokines including IL-10 and TGF-β1. Results〓1) Vital sign:the heart rate (HR) and mean arterial pressure (MAP) in the observation group were significantly lower than those in the control group at T2 and T3 (P<0.05). Stress indexes: the level of C-reaction protein (CRP), blood glucose (Glu) and interleukin 6 (IL-6) in the observation group were also significantly lower than those in the control group at T2 and T3 (P<0.05). 3) Immunological indexes: the levels of Tregs, IL-10 and TGF-β1 in the observation group were significantly higher than those in the control group at T2 and T3 (P<0.05). 4) Correlation analysis showed that anyone of Tregs, IL-10 and TGF-β1 negatively correlated with anyone of HR, MAP, CRP, Glu and IL-6(all |r|>0.65 and all P<0.05). Conclusion〓There is a relationship between Tregs and stress action for the perioperative patients with colorectal carcinoma. Propofol could regulate the activity of Tregs and its effect was better than fentanil.

Clinical and pathological characteristics of mammography negative breast ductal carcinoma in situ

Lian Zhenqiang, Zhang Anqin, Han Xiaorong, Zhang Yan, Gao Hongyi, Wang Qi

2014, 14(01):  83-85.  DOI: 10.3969/j.issn.1009-976X.2014.01.024

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【Abstract】 Objective〓To investigate the clinical and diagnostic characteristics of mammography (MG) negative breast ductal carcinoma in situ (DCIS) with or without microinvasion. Methods〓From January 2012 to August 2013, clinicpathological data from 32 cases of MG negative DCIS or DCIS-MI were retrospectively analyzed. Results〓Of all MG negative cases, 71.9% (23/32) presented as nipple discharge, 15.6% (5/32) presented as mass, 12.5% (4/32) presented as benign look-like calcifications. High density breast, low nuclear grade, PR positive and HER2 (-) or (+) were significantly higher in MG negative cases than those in MG positive cases (P<0.05). As complementary diagnostic methods for MG negative cases,sensitivity of ultrasound and MRI were 18.7% (6/32) and 87.5% (28/32) respectively. For the cases with nipple discharge, sensitivity of fiberoptic ductoscopy was 52.2% (12/23). Conclusions〓The clinicopathological prognostic index of MG negative DCIS or DCIS-MI is relatively better. MRI and fiberoptic ductoscopy are both beneficial complementary examination for diagnosis of DCIS and DCIS-MI.

Analysis of curative effects on severe mixed hemorrhoids by TST treatment in primary hospital

Shen Ronghua,Xu Aibin

2014, 14(01):  86-89.  DOI: 10.3969/j.issn.1009-976X.2014.01.025

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【Abstract】〓Objective〓To discuss the clinical effect and value of severe mixed hemorrhoids by Tissue-selecting Therapy stapler (TST) in primary hospital. Methods〓The clinical data of 102 severe mixed hemorrhoids patients from January 2011 to June 2012 were retrospectively analyzed. Among 102 cases,.48 cases underwent TST procedure (TST group) and 54 received the traditional Milligan-Morgan hemorrhoidectomy (M-M group). The clinical efficacy of two groups were observed and compared..Results〓The patients in TST groups had less intraoperative blood loss and shorter hospitaliza-tion time when compared with M-M group (P<0.01). TST was also superior to M-M in postoperative pain, wound edema, dysuria and the recurrence rate. Operation time between two groups had no statistical significance(P>0.05). Conclusion〓TST is a safe, effective, minimally invasive operation method in the treatment of severe mixed hemorrhoids, it is suitable for primary hospital.

Application of laparoscope combined cholangiofiberscope in the treatment of extrahepatic biliary calculi

Lin Guihai, Lin Jiayu, Luo Yuqing

2014, 14(01):  89-91.  DOI: 10.3969/j.issn.1009-976X.2014.01.026

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【Abstract】〓Objective〓To summarize the experience in treating extrahepalic biliary calculi with laparoscopic combined cholangiofiberscope..Methods From August 2010 to October 2012, the clinical data of 27 cases with extrahepalic biliary calculi undergoing laparoscope combined cholangiofiberscopy were analyzed retrospectively. Results〓The laparoscopic cholecystectomy and choledochotomy with exploration and choledocholithotomy by the cholangiofiberscope were performed in all cases..Among them,.primary suture of common bile duct was in 12 cases and indwelling T tube drainage was in 15 cases..The operations were completed smoothly in all cases. No one case was transferred to open abdominal surgery..The average operative time was 85 minutes..The average postoperative hospitalization time was 7.4 days..In the 12 cases of primary suture of common bile duct,.one case occurred mild biliary leakage and that case was cured by prolonging drainage time for 10 days. In the 15 cases of indwelling T tube drainage, the postoperative residual stones were found by T bube cholangiography in 2 cases. These residual stones were removed via T tube sinus with cholangiofiberscope 8 weeks after operation..No postoperative hemobilia, incisional infection and obvious abdominal infection were found..Conclusion〓Laparoscope combined cholangiofiberscope is a safe and effective method for the treatment of extrahepalic biliary calculi.

Clinical analysis of surgical treatment for traumatic colon rupture at one-stage repair in 20 cases

Mo Jiawei, Yang Yong, Huang Chenbin, Chen Zhimei

2014, 14(01):  92-94.  DOI: 10.3969/j.issn.1009-976X.2014.01.027

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【Abstract】〓Objective〓To investigate the feasibility of surgical procedure in one-stage closure for traumatic colon rupture and summarize the experience. Method〓Twenty patients with raumatic colon rupture were included in the study from January 2001 to January 2013. Among 20 cases,18 cases whose damage ranged on colon less than 1/2 by intestinal circumference were received conventional debridement and one-stage repair for ruptures. The other two patients with large range of injury underwent one-stage closure due to slight peritoneal contamination. Results〓All patients were recovery from surgical treatment, no death case occurred. One case was confirmed postoperative fistula with localized peritonitis, and cured one month and half after drainage. Two cases had infection of incisional wound and healed by one month of dressing change. Conclusion〓By the strict indications selection, correct preoperative treatment for patients with colon injury, it is feasibility for traumatic colon rupture to perform one-stage repair.

Diagnostic value of color doppler ultrasound in intramuscular lipoma

Zhang Huazhen

2014, 14(01):  94-96.  DOI: 10.3969/j.issn.1009-976X.2014.01.028

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【Abstract】〓Objective〓To summarize the ultrasonographic features of intramuscular lipoma. Methods〓The ultrasonographic findings in 18 patients with intramuscular lipoma were retrospectively analyzed. Results〓of 18 cases, the masses located in the lower extremity in 5 cases, upper extremity in 3 cases, neck in 3 cases, shoulder and neck in 2 cases, and lumbus in 5 cases. Lesions were round in 1 case, oval in 12 cases and irregular in 5 cases..Masses were well-defined in 5 cases, partial well-defined in 7 cases and ill-defined in 6 cases. Overall lesion echogenicity was hyperechoic to muscle in 11 cases, hypoechoic to muscle in 3 cases,isoechoic to muscle in 1 cases and mix-echoic to muscle in 3 cases. Color Doppler Flow Imaging (CDFI) showed blood flow signal around the masses in 8 cases and 4 were venous blood flow signal. Conclusion〓Intramuscular lipomas have some distinctive ultrasonographic features. Color Doppler ultrasound and could correctly show the location and deepness of the masses, which is useful for the diagnosis of intramuscular lipoma.

Experience in the treatment of severe mixed hemorrhoids

Huang Bao, Zhang Xiuna

2014, 14(01):  97-99.  DOI: 10.3969/j.issn.1009-976X.2014.01.029

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【Abstract】〓Objective〓To discuss the clinical effects on PPH plus hemorrhoids resection for treating severe mixed hemorrhoids. Methods〓The 18 caeses with III-IV degree severe mixed hemorrhoids undergoing PPH plus hemorrhoidal resection were analyzed retrospectively. Results〓Sixteen cases underwent PPH plus hemorrhoid resection. Because of large and hard hemorroids, 2 cases underwent simple hemorrhoidal resection..The postoperative hemorrhoids were retracted well in all cases, and no hemorrhoidal prolapse was found during defecation...Fifteen cases occurred transient hemafecia after operation..No postoperative fecal incontinence and anal stenosis were found in this group. Conclusion〓PPH plus hemorrhoid resection would improve curative effects on severe mixed hemorrhoids and reduce postoperative hemorrhoids recurrence.

Experience in the laparoscopic total mesorectal excision for treating low rectal cancer

2014, 14(01):  99-102.  DOI: 10.3969/j.issn.1009-976X.2014.01.030

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【Abstract】〓Objective〓To summarize the experience in laparoscopic total mesorectal excision (LTME) for the treatment of low rectal cancer. Methods〓From March 2007 to June 2012, 100 cases with low rectal cancer were analyzed retrospectively..These patients were randomly divided into laparoscopic group and laparotomy group..Among them, 50 cases underwent LTME,.and 50 cases underwent laparotomy total mesorectal excision..The intraoperative blood loss,.operation time, postoperative passing flatus time, postoperative hospitalization time, dissected number of lymph nodes total hospitalization cost and follow-up results were compared between two groups..Results〓In the intraoperative blood loss,.operation time,.postoperative passing flatus time,.postoperative hospitalization time,.the laparoscopic group was less than that laparotomy group (P<0.05). In the dissected number of lymph nodes,.the total hospitalization cost and the distance from tumor's low margin to distal rectum excising end,.there were no difference between two groups..In the postoperative complications and postoperative recurrence the laparoscopic group was lower than that laparotomy group (P<0.05). Conclusion〓Compared with the laparoscopic total mesorectal excision group and open total mesorectal excision group for the treatment of low rectal cancer, the long-term curative effects are similar between two groups..But,.the former group is better than that the latter group in the reducing injury and promoting postoperative recovery of patients.

Experience of excision of mammary minute mass by using dynamic B-type ultrasonic guiding

Chen Weirong, Wang Hong, Li Peiqiu

2014, 14(01):  103-105.  DOI: 10.3969/j.issn.1009-976X.2014.01.031

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【Abstract】〓Objective〓To investigate the application experience of excision of mammary minute mass with the dynamic guiding of B-type ultrasound in surgery. Methods〓100 cases of female patients with nonpalpable mammary minute lesions were divided into two groups by operative method, intraoperative B-type ultrasound guided group (n=56) and control group (n=44). In the intraoperative B-type ultrasound guided group, the mammary masses were removed by intraoperative dynamic B-type ultrasonic guiding. In the control group,.mammary masses resection was performed through preoperative B-type ultrasound localization. Results〓All mammary masses in the intraoperative B-type ultrasound guided group were excised accurately,.the average operation time was 18 min..Of 42 cases in the control group,.two cases were not removed the mammary minute lesions due to misresection and the average operation time was 27 min. Conclusion〓The excision of mammary minute mass with the dynamic guiding of B-type ultrasound is accurate, fast, nice appearance and economic, and can be used for early period diagnosis and treatment of mammary minute mass.