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Table of Content

    20 October 2015, Volume 15 Issue 05
    论文
    Application of ALPPS in massive hepatocellular carcinoma with hepatitis B cirrhosis
    Huang Pinbo, Hu Zhigang, Xu Qiaodong, Yan Yongcong, Wang Jie
    2015, 15(05):  527-532.  DOI: j.issn.1009-976X.2015.05.001
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    【Abstract】〓Objective〓To explore the applications of ALPPS in massive hepatocellular carcinoma with hepatitis B cirrhosis. Methods〓There was a retrospectively study using clinical data of 25 patients with hepatocellular carcinoma who accepted ALPPS from the Department of Hepatobiliary Surgery, Sun Yat-Sen Memorial Hospital of Sun Yat-Sen University. According to Ishak scoring system of the postoperative pathology,the patients were divided into two groups including mild-to-moderate liver cirrhosis and severe liver cirrhosis,which were then analyzed its relationship with postoperative liver volume compensation,interval time between surgeries and prognosis..Meanwhile the relationship between tumor emboli of portal vein and ALPPS was also analyzed. One supplement data of a patient taking comprehensive treatment after one stage of operation of ALPPS was attached here. Results〓In 25 patients, 21 patients (84%) completed the second stage of ALPPS, the survival rate was 88% within 6 months and 76% of them stay alive until now. Compared group of mild-to-moderate liver cirrhosis with group of severe liver cirrhosis, preoperative residual liver volume and postoperative residual liver volume was 296 ml (194 to 401 ml) VS 541 ml (337 to 862 ml) and 359 ml (249 to 417 ml) VS 519 ml (178 to 709 ml) respectively. Average operation interval time were 11 days (7-15 days) and 23.57 days(12-64 days). Three patients of Child class B accepted ALPPS and two of them succeed. 12 patients with tumor emboli in right branch of portal vein (level II) accepted ALPPS and 11 of them obtained ideal result. One of them failed to complete the second stage of the operation, but got a good prognosis after comprehensive treatment. Conclusion〓ALPPS has certain application value in patients with mild-to-moderate cirrhosis but requires further consideration in patients with severe cirrhosis and patients with tumor emboli in branches of portal vein (level I-II) may try to accept ALPPS. Patients of massive hepatocellular carcinoma along with moderate-to-severe cirrhosis and tumor emboli in branches of portal vein who cannot receive one stage resection or other effective therapies can consider accepting the first stage of ALPPS,.if the result meets the standard of the residual liver compensation, patients can continue the second stage of ALPPS. Otherwise, comprehensive treatment may lead to better prognosis and higher quality of life.
    An experimental study of miR-200b-mediated regulation of Bmi1 gene in liver cancer
    Wu Wenrui, Sun Hong, Yu Xianhuan, Zhang Rui, Shi Xiangde, Zhu Mansheng, Xu Leibo
    2015, 15(05):  533-537.  DOI: j.issn.1009-976X.2015.05.002
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    【Abstract】〓Objective〓To investigate the regulating effect of miR-200b on Bmi1 gene in liver cancer, and analysis the binding sites. Methods〓First, bioinformatics software was used to predict the putative miR-200b binding sites on the human Bmi1 3'-UTR. Next, Bmi1-3'-UTR-wild type and Bmi1-3'-UTR-mutant type reporter vectors were generated and luciferase reporter assays were performed to determine the binding sites. Last, real time PCR and Western blot analysis were used to validate the regulating effect of miR-200b on Bmi1 gene in human liver cancer cell line HepG2. Results〓The results obtained by bioinformatics software showed that human Bmi1 3′-UTR had three putative miR-200b binding sites. Dual luciferase reporter gene analysis showed that the luciferase activity of Bmi1-3'-UTR-wild type group was significantly reduced whereas the Bmi1-3′-UTR-mutant type group was unchanged after miR-200b-3p mimic transfection. Real time PCR and Western blot analysis confirmed that over-expression of miR-200b can significantly repress the expression of Bmi1. Conclusion〓miR-200b can regulate the expression of Bmi1 by base pairing to the 3'-UTR of Bmi1 mRNA in human liver cancer.

    HMGB1 mediated autophagy protects the hepatocyte injury in sepsis
    Sun Jian, Xu Kang, Peng Yaorong, Zhu Yue, Tang Qibin, Lin Haoming, Wang Jie
    2015, 15(05):  538-541.  DOI: j.issn.1009-976X.2015.05.003
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    【Abstract】 Objective To study the mechanism of high migration rate group protein B1(HMGB1) migration mediated autophagy protects the liver cells injury in sepsis. Methods〓Seventy-two male Lewis rats were randomly divided into endotoxin group (n=18), autophagy induction group (n=18), autophagy inhibition group (n=18) and control group (n=18). The rats in endotoxin group was given intraperitoneal injection of endotoxin (LPS, 25 mg/kg) to induce endotoxemia. Rats in autophagy induction group and inhibition group received intraperitoneal administration of rapamycin or ward penicillin pre stimulation respectively, and followed establishment of endotoxemia one hour later. Rats in blank group were treated with intraperitoneal injection of Ringer's solution(1 ml). The changes of HMGB1 and autophagy in liver tissue, liver function and cytokines were observed on the time points of 6 h, 24 h, 48 h after operation. Results〓In the endotoxin group, the autophagy of hepatocytes, the HMGB-1 in hepatocytes cytoplasm,the liver enzymes in serum and IL-1β levels increased significantly (P<0.01). However, the level of HMGB1, liver enzymes and IL-1β in the rats of autophagy induction group significantly decreased (P<0.01) compared with the endotoxin group. Conclusion〓In the sepsis, HMGB1 migration mediated autophagy regulates in IL-1β to reduce liver cell injury and promote the recovery of liver function.
    Application of precise hemi-hepatectomy in the treatment of primary liver cancer
    He Kun, Hu Zemin, Yu Yuanlong, Ruan Jiahou, Zhou Zaiping, Huang Ruiqin
    2015, 15(05):  542-545.  DOI: j.issn.1009-976X.2015.05.004
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    【Abstract】〓Objective〓To investigate the effect of precise hemi-hepatectomy in the treatment of primary liver cancer. Methods〓Clinical data of 30 patients who received precise hemi-hepatectomy in Department of Hepatobiliary Surgery,the Zhongshan People?蒺s Hospital from January 2013 to June 2014 were analyzed retrospectively..Intraoperative blood loss,.operative time,.and postoperative hospital stay and postoperative complications were recorded and analyzed. Results〓All the operations were successful. The median volume of intraoperative blood loss was 350 (50-800) ml, operative time was (252±98).min,.the postoperative hospital stay was 9.2±0.9 days..No death occurred during the perioperative period..No liver cross section bleeding,.peritoneal infection,.liver failure occurred in patients after operation..Four cases of pleural effusion postoperatively were cured by thoracentesis or conservative treatment..One case suffered from bile leakage and was cured by peritoneal drainage and symptomatic treatment..One case suffered from pulmonary infection and was cured by anti-infection treatment. The incidence of complications was 20% (6/30). Two patients with portal venous tumor emboli suffered from intrahepatic recurrence in 6 months after surgery. Conclusion〓Precise hemi-hepatectomy has the advantages of simple requirement of equipment, clear anatomy, less intraoperative bleeding, low incidence of postoperative complications, which has a important clinical application value in the surgical treatment of liver cancer.
    The preliminary study on the value of Gd-EOB-DTPA-enhanced MR imaging for distribution of segmental liver function
    Liu Jue, Mahendru Gurung, Zhu Wangshu, Li Yong
    2015, 15(05):  546-549.  DOI: j.issn.1009-976X.2015.05.005
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    【Abstract】〓Objective〓To explore the distribution characteristics of liver function in anatomy. Methods〓Forty-seven patients who underwent EOB-CE-MRI scans were analyzed. They were classified into three groups according to Child-Pugh classification (CPS): normal liver function (NLF) group (n=19), CPS A group (n=15), CPS B group (n=13). Liver-liver Rate of Enhancement (LLRE) method was adopted. Statistical analysis were performed by relevant software. A paired t-test was used to compare the differences between the central and peripheral zones, the right and left lobes, the right anterior and right posterior segments, and the S2 and S3 segments in three groups. Afterwards,the signal of pre-contrast and post-contrast in hepatobiliary phase were compared respectively in three groups. The P<0.05 indicated a significant difference. Results〓The LLRE between the central and peripheral zones was significantly difference (P<0.001) for patients. There were no statistical differences between left and right lobe as well as the S2 and S3 segments (P>0.05)..The mean value of the average signal had no difference in pre-contrast and had significant difference after contrast among different groups (P<0.05). Conclusion〓The liver function in the center of the liver was higher than peripheral zones. The difference between left and the right lobes as well as the S2 and S3 segments were not apparent. The relative enhancement ratio was significantly different among different groups.
    Analysis of decreasing the complications after pancreaticoduodenectomy
    Ding Huimin,.Zha Wenzhang, Sun Dalin, Ni Weixing, Zhou Yong, Qin Chenglin
    2015, 15(05):  550-553.  DOI: j.issn.1009-976X.2015.05.006
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    【Abstract】〓Objective〓To analyze postoperative complications of pancretoduod-enectomy (PD). Methods〓A retrospective review of 154 consecutive patients who underwent PD with pancreaticojejuno-stomy in recent 10 years was divided into the recent group of 105 cases and the long term group of 49 cases. Results〓The surgery-related complications was 18.1% in the recent group while was 32.7% in the long term group. The leak rate in the recent group was 4.8% and in the long term group 16.3%. The mean operation time in the recent group was 213.34±66.98 min and in the long term group 250.34±67.26 min. The mean hospital length of stay after PD was longer in the long term group (22.76±9.73)d as compared to the recent group.(18.45±7.11 d, P<0.05)..However there were no significant differences in bile fistula occurrence,.gastrointestinal and intraa-bdominal hemorrhage,gastroparalysis and infection, mortality and reoperation rate, operation time and intaoperative blood loss between the two groups..Conclusion〓Leakage of pancreatic is the key factor for the postoperative complications of PD, standard treatment, professional operation can effectively reduce the postoperative complications of PD.
    The experience in diagnose and treatment of pancreatic trauma with a report of 33 cases
    Li Jia, Song Yue, Zhang Caiyun, Wen Zhiqiang, Zhou Huancheng
    2015, 15(05):  554-556.  DOI: j.issn.1009-976X.2015.05.007
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    【Abstract】 Objective〓To summarize the experice of the diagnosis and treatment of pancreatic trauma. Methods〓The clinical data of 33 patients with pancreatic trauma treated in our hospital from 1997 to 2013 were collected for retrospective analysis. Results〓Among 33 cases, 26 cases were cured (79%) and 7 dead (21%). Twenty-one cases were treated with surgical operation, in whom the postoperative complications included nine cases of fistula of duodenum,one enteric fistula,two intra-abdominal hemorrhage,.one multiple organ failure and one gastrointestinal bleeding. Two cases were dead during the operation because of hemorrhage caused by abdominal open wound with inferior vena cava injury..Five case were dead postoperatively,.two with sepsis,.two with intra-abdominal hemorrhage and one with multiple organ failure. Of patients with grade I~II of pancreatic trauma, one case was dead and the patients with grade Ⅲ~Ⅴ,.6 case were dead. Conclusion〓It is crucial to early diagnosis and proper treatment for pancreatic trauma with high complications and high mortality, especially injured main pancreatic duct.
    Effect of the modified three-cavity drainage T-tube following the bile duct exploration (with 33 cases reported)
    Zhang Fan, Ye Xiaoyong, Lv Huizeng
    2015, 15(05):  557-560.  DOI: j.issn.1009-976X.2015.05.008
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    【Abstract】〓Objective〓To investigate the effect of a modified three-cavity drainage T-tube on clinical application following bile duct exploration. Methods〓Thirty-three patients with intra-and extra-hepatic bile duct stones underwent open surgical treatment through common duct exploration and removal of biliary stones. Biliary flushing and T-tube imaging were done by using a modified three-cavity T-tube after operation. Results〓All the postoperative courses were uneventful, no bile leakage, cholangitis occurred in the patients. Of 33 cases, Biliary bleeding were controlled completely in 6 cases by postoperative T-tube flushing for 1-3 days. The retained calculus were discovered in 4 cases by T-tube imaging in 5-7 days after operation, and cured using choledochoscopes to remove all the retained calculus. The average length of hospital stay was 7.5 days after surgery. All cases were followed up for 4-42 months. B-ultrasonography, abdominal CT and magnetic resonance cholangiopancreatography found no Bile duct stones recurrent or common bile duct stricture. Conclusion〓The application of the modified T-tube showed good clinical effect in patients underdone common duct exploration.
    Pharmaceutical care for a patient with severe acute pancreatitis by clinical pharmacists
    Liang Dan, Liang Lijun, Lv Yongfeng, Ren Jianying
    2015, 15(05):  560-562.  DOI: j.issn.1009-976X.2015.05.009
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    【Abstract】〓Pharmaceutical care was performed for a patient with severe acute pancreatitis by clinical pharmacists, participating in the patient's diagnosis and treatment. Pharmacist gave the suggestions, which were concerned with adjusting esomeprazole sodium frequency(once a day), solvent (normal saline), keeping the dose of esomeprazole through CRRT and prolonging meropenem drip time to 3 hours. Pharmacist suggested doctors pay attention to ADR (adverse drug reactions),tigecycline-relevant pancreatitis, gastric retention of EN, and also got the fact of octreotide influence on blood sugar.
    Application of conventional laparoscopic instruments in transumbilical single port laparoscopic cholecystectomy
    Yuan Yangchun, Zheng Zhaoming, Luo Yuqing, Chen Qiukai, Zhong Dongjia
    2015, 15(05):  563-565.  DOI: j.issn.1009-976X.2015.05.010
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    【Abstract】〓Objective〓To investrgate the clinical application value of conventional laparoscopic instruments in transumbilical single port laparoscopic cholecystectomy (TSPLC). Methods〓A retrospective clinical data was analyzed in 192 patients who underwent transumbilical single port laparoscopic cholecystectomy by conventional laparoscopic instruments from 2013 December to 2015 June. Results 181 patients (94.3%) were successfully completed the transumbilical single port laparoscopic cholecystectomy, and 11 cases (5.7%) were converted to the 2-hole method cholecystectomy. All cases had no organ perforation, biliary duct injury, vascular injury, bile leakage. Conclusion〓In our experience, conventional laparoscopic instruments seemed to be safe and reliable by using TSPLC, The method of suspension gallbladder serosa made the operation more simple,.which expanded the operation indications due to smaller trauma, faster recovery, less postoperative pain, hidden incision and cosmetic effect.
    Carbon nanoparticles improve the therapeutic efficacy of chemotherapy drug in metastatic lymph nodes of breast cancer
    Zhou Yi, Li Junda, Lin Qimou, Wang Xing, Li Yong, Guan Jianhua, Chen Chunmei
    2015, 15(05):  566-570.  DOI: j.issn.1009-976X.2015.05.011
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    【Abstract】〓Objective〓To observe the therapeutic efficacy of carbon nanoparticle loaded with 5-fluorouracil in treatment of breast cancer model with metastasized axillary lymph nodes. To probe into the efficacy of carbon nanoparticles using in chemotherapy of breast cancer as a drug carrier. Methods〓Thirty female New Zealand white rabbits were randomly and equally divided into three groups, text group, Ⅳ(intravenous) group, HI group, with 10 in each. VX2 tumor mass suspensions (1 ml) was injected into the mammary gland (Hypodermic) of each animal..Treatment was given while axillary lymph node enlarged and reached 5 mm in the maximum diameter..Animals in test group and HI group received a subcutaneous injection of 5-FU-carbon nanoparticle suspension and 5-FU solution, respectively, adjacent to the implanted tumor. The IV group received an auricular intravenous injection of 5-FU solution..The dose of 5-FU in each group was 25 mg/kg..Animals were killed after the treatment was given 5 days. Growth rate of tumor and lymph node was measured. Necrosis degree and apoptotic index of tumor and lymph node after treatment were observed and measured. Results〓The growth rate of test group was lower than the other groups,.while necrosis degree and apoptotic index were higher than the other groups. There was statistical significance difference between these three groups (P<0.05). Conclusion〓Carbon nanoparticle could improve the treatment efficacy of chemotherapy drug in axillary metastatic lymph node of breast cancer.
    Effectiveness and consistency of Ki67,.PR and P53 in subtype classification of luminal breast cancer
    Gu Ran, Hu Yue, Yang Yaping, Liu Fengtao, Jia Haixia, Su Fengxi
    2015, 15(05):  571-574.  DOI: j.issn.1009-976X.2015.05.012
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    【Abstract】 Objective〓The objective of this study were to determine the DFS(disease free survival) prognostic significance of subgrouping Luminal breast tumors into low- and high-risk luminal categories by using Ki67, PR, or P53 status and analyze whether the various methods can identify the same patients as being in the poor prognostic group. Methods〓Patients with early invasive breast cancer who were treated between March 2006 and December 2013,.were selected by searching breast tumor registries at Sun Yat-sen Memorial Hospital. Patient characteristics were collected. The primary outcome measured was DFS which was estimated using Kaplan-Meier test and a log-rank test was used to compare survival curves. Cox regression analysis was used to balance the risk factors for prognosis between groups. Kappa statistics were calculated among the three biomarkers. Results〓A total of 1107 patients with invasive breast cancer were eligible for inclusion in the study. Ki67, PR and P53 in the subclassification of Luminal tumors was all found to be of prognostic significance or independent prognostic significance on univariate analysis and multivariate analysis. They identified the different patients as being in the poor prognostic group. Conclusion〓In order to optimize patient management, better combination of these biomarkers need further explored.
    Clinical outcomes of early enteral nutrition on severe traumatic brain injury patients with stress hyperglycaemia in acute stage
    Zeng Fan, Cheng Yanzi, Zhao Ling
    2015, 15(05):  575-578.  DOI: j.issn.1009-976X.2015.05.013
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    【Abstract】〓Objective〓To investigate the role of early enteral nutrition in severe head injury patients with stress hyperglycemia. Methods〓Sixty cases of severe head injury complicated with stress hyperglycemia were recruited and a retrospective analysis from these patients was performed. According to the given enteral nutrition time,.the patients were divided into early enteral nutrition group (beginning from 8 hours after admission, n=30) and delayed enteral nutrition group (beginning from 48 hours after admission,.n=30)..Quality in evaluating diabetes control, hypoglycemia, and complications were observed and analyzed. Results〓Compared with delayed enteral nutrition group, the patients in early nutrition group displayed more reasonable average blood glucose after seven days of enteral nutrition, shorter the duration of insulin use and lower the occurrence of hypoglycemia (P<0.05). Meanwhile, the incidence of pulmonary infection was also lower in early enteral nutrition group than in delayed enteral nutrition group (P<0.05). There were no statistical significance in gastrointestinal hemorrhage, ventilation time and 28-day mortality. Conclusion〓The present findings indicate the early enteral nutrition can effectively improve the stress hyperglycemia and the hospital infection after severe head injury, but not bring beneficial effects on prognosis.
    The clinical effect of femoral neck fracture treated with cannulated screw fixation and total hip replacement
    Wu Bowen, Zhang Xiping, Wang Biao, Liu Shanfeng, Wang Yongzhong, Yang Xinyou
    2015, 15(05):  579-582.  DOI: j.issn.1009-976X.2015.05.014
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    【Abstract】〓Objective〓To investigate the clinical outcome of femoral neck fracture treated with cannulated screw fixation and total hip replacement. Methods〓109 patients with fresh femoral neck fractures were divided into group A (total hip replacement, n=59), and group B (cannulated screws fixation, n=50). The operation time, blood loss, intraoperative fluoroscopy frequency, duration of hospitalization, bedridden time, complications and Harris hip joint functional score were recorded and compared between two groups. Results〓All patients got followed-up for 17-36 months. The patients in group B had smaller incision, less trauma, shorter operation time, less intraoperative blood loss than those in group A(P<0.05). The patients in group A had lower intraoperative fluoroscopy frequency, shorter duration of hospitalization, shorter bedridden time, lower post-operation complications (P<0.05). Cases of group A had higher Harris hip joint functional score than that in group B (P<0.05). Conclusion〓Total hip replacement has less complications and good prognosis, but has more trauma. The surgical approach is chosen on the basis of practical situation.
    Clinical application of CT Guided and C arm X-ray guided percutaneous vertebrolplasty for treatment of thoracolumbar compression fractures in elderly patients
    Li Xing, Deng Siran, Luo Yuqiao, Luo Bofeng, Luo Jieduo, Xuan Tianxun
    2015, 15(05):  583-586.  DOI: 10.3969/j.issn.1009-976X.2015.05.015
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    【Abstract】〓Objective〓To observe the effect of CT guided and the C arm X-ray guided percutaneous vertebrolplasty(PVP) in the treatment of senile osteoporotic with thoracolumbar compression fractures. Methods〓A retrospective data of thoracolumbar vertebral compression fractures in the elderly was analyzed in our hospital from June 2008 to October 2013. Twenty-eight cases with 34 vertebral body were received surgical treatment by CT guided PVP(11 cases and 13 compression vertebral body) and the C arm X-ray guided PVP (17 cases and 21 compressed vertebral bodies). The success rate of puncture,.preoperative and postoperative pain according to the WHO standards were recorded and analyzed. The clinical efficacy was evaluated by CT,DR check. Results〓The pain got eased in all post-operative patients according to criterion of WHO. The surgical time of CT guided PVP was from 35 to 60 minutes, with high success rate of puncture. Vertebral bone cement leakage occurred in one case. C arm X-ray guided surgery time ranged from 45 to 130 minutes. Vertebral side clearance leakage of bone cement, and intervertebral leakage occurred in one case respectively, without nerve compression symptoms and signs. Conclusion〓Both CT guided PVP and the C arm X-ray guided PVP can obtain effective pain relief for senile osteoporotic thoracolumbar compression fractures. CT guided surgery shows more accurate, safe and effective puncture.
    Analysis of the relationship between hope and curative effect of spinal fusion in patients with chronic low back pain
    Hu Xumin, Cai Zhaopeng, Zheng Guiqiong, Shen Huiyong
    2015, 15(05):  587-590.  DOI: doi:10.3969/j.issn.1009-976X.2015.05.016
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    【Abstract】〓Objective〓To discuss how the extent of chronic low back pain act on the hope of recovery after spinal fusion, and what is the relationship between hope and the practical curative effect. Methods〓By retrospective cohort study, the researchers collected VAS score of each patients from before to after operation, and use the means of multilinear correlation analysis, Pearson correlation analysis and chi-square test, to analyze the relationships among those three factors. Results The period and extent of pain correlated with the hope for recovery negatively by the correlation coefficient of -0.02 and -0.36 respectively. The hope of recovery correlated with the one-year actual post-operational state positively with correlation coefficient 0.28. Patients with poor recovery took more pills to labor pains. Conclusion〓Patients with severe pain or long period of pain intended to lose their good hope for recovery. Low level of good hope reduce the therapeutic effect. Thus appropriated mental intervention is needed.
    Clinical experience with laparoscopic transabdominal preperitoneal hernioplasty in treatment of inguinal hernia
    Zhou jun, Zhang Zongtao, Zheng Jianzhong, Abudusimu·Aisha, Chen Gaofei, Lu Xiaol
    2015, 15(05):  590-592.  DOI: doi:10.3969/j.issn.1009-976X.2015.05.017
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    【Abstract】 Objective〓To summarize the 64 patients with inguinal hernia were performed the laparoscopic transabdominal preperitoneal (TAPP) approach, and explore its application skills and value. Methods〓To collect and analysis 64 patients performed transabdominal preperitoneal(TAPP) with inguinal hernia between April 2010 and April 2015. Results〓The operation were successfully completed, and the time of operation were 85±10.6 min (68-108 min), average bleeding volume were 35.25 ml, hospital stay after operation were (5.6±0.8)d (3-9 d). Three cases of scrotal edema, one case of seroma,three cases of acute urinary retention occurred after operation with 10.94% of complication rate,and all were cured. A mild pain occurred in post-operative patients,without incision swell, wound extravasating and none of patients received analgesics. Cases were followed up for 2-60 months with an average of 19 months and 92.19% of follow-up rate. Five cases failed to be followed up. No recurrence was found. Conclusion〓TAPP is a reliable efficient technique with shorter hospitalization and less complication to repair adult hernia or direct hernia or femoral hernia, especially to the hernia recurrence and incarcerated hernia with intestinal obstruction.
    Prognostic implications of the lymph node count in rectal cancer after neoadjuvant treatment
    Li Mingqiang, Luo Yi
    2015, 15(05):  593-598.  DOI: 10.3969/j.issn.1009-976X.2015.05.018
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    【Abstract】〓Objective〓To investigate the effect of neoadjuvant chemoradiotherapy on the number of lymph node retrieval and removal in rectal cancer surgery. Methods〓Data for patients who underwent neoadjuvant chemoradiotherapy followed by surgery for resectable rectal cancer from 2007 to 2013 were reviewed. The primary outcomes measured were the number of lymph nodes retrieved, their status, and patient survival. Results〓Of all retrievable cases, 300 patients underwent neoadjuvant chemoradiotherapy followed by surgery, and 140 patients had surgery alone. Neoadjuvant chemoradi-otherapy decreased both the number of lymph nodes retrieved [7(1-33) versus 12.5(0-44) respectively; P<0.001] and the number of positive lymph nodes [0(0-11) versus 0(0-16); P=0.001]. After neoadjuvant chemoradiotherapy, the number of retrieved lymph nodes was inversely correlated with tumor regression, and with the interval between treatment and surgery. The 5-year overall and disease-free survival rates were 86.5 and 79.1 percent respectively. After neoadjuvant therapy, lymph node status was found to be an independent predictor of survival, whereas the number of retrieved lymph nodes did not represent a prognostic factor for either overall or disease-free survival. Conclusion〓Low lymph node count after neoadjuvant chemoradiotherapy for rectal cancer does not signify an inadequate resection or understaging, but represents an increased sensitivity to the treatment.
    Study of using nano-carbon in near-total or total thyroidectomy:.with 80 cases report
    Du Guoneng, Xiao Yugen, Tan Yihong, Wang Kun
    2015, 15(05):  598-600.  DOI: doi:10.3969/j.issn.1009-976X.2015.05.019
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    【Abstract】〓Objective〓To study using nano-carbon in near-total or total thyroidectomy to protect the parathyroid glands..Methods〓Eighty patients of large goiter,.multinodular goiter and thyroid cancer were performed near-total or total thyroidectomy using nano-carbon to identify parathyroid glands..Results〓Parathyroid gland was not found in 78 species pathologically..Two cases were confirmed malignant tumor because of tumor invasion..All patients were examied and showed normal parathyroid hormone level in half an hour, 6 hours and 24 hours after surgery. Conclusion〓The use of nano-carbon in near-total or total thyroidectomy can avoid or reduce the injury of parathyroid glands.
    The application of laparoscopic exploration combined with TEP for incarcerated inguinal hernia
    Huang Yongping, Liu Zhongmin, Gao Feng, Zhong Yujie, Huang Haiqiu
    2015, 15(05):  601-603.  DOI: doi:10.3969/j.issn.1009-976X.2015.05.020
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    【Abstract】 Objective〓To investigate the feasibility and safety for patients with incarcerated inguinal hernia who treated by laparoscopic exploration combined with laparoscopic total extraperitoneal (TEP). Methods〓Twenty-three patients with incarcerated inguinal hernia were treated in our hospital from March 2010 to November 2014. Of them, 21 cases were performed by manipulative reduction and failed. Principle of management of laparoscopic exploration combined with TEP was performed when bowel was in good condition, and those found bowel necrosis were transferred open operation. Results Nineteon cases were performed TEP and no complications occurred after operation. Two cases were treated by open inguinal herniorrhaphy due to bowel necrosis. Conclusion〓Laparoscopic exploration combined with TEP is safe and feasible for management of acute incarcerated inguinal hernia under definite evaluation of intestinal ischemia and intestinal necrosis.
    Application of ultrasonic scalpel in thyroid surgery
    Lu Xiaoyu, Xie Rongming, Hou Xianqiong, Liao Kangxiong, Wei Wenbo
    2015, 15(05):  604-606.  DOI: doi:10.3969/j.issn.1009-976X.2015.05.021
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    【Abstract】〓Objective〓To investigate the clinical value of applying ultrasonic scalpel in the open thyroid surgery. Methods〓Based on the data collection of 120 cases of patients,we designed for use of ultrasonic scalpel in thyroid surgery 68 cases into the treatment group,and conventional thyroidectomy 52 cases as control group, both groups were performed by the same group surgeons. The factors of age, gender, disease constitution, resection specimen size, the length of incision, operative time,bleeding volume,postoperative drainage,surgical complications,postoperative pain, hospitalization time and cost were compared between the two groups,afterwards,it is evaluated the clinical application value of ultrasonic scalpel in the open thyroidectomy. Results〓All the procedures were completed successfully. In treatment group, the average length of incision was 4.54±1.61 cm, mean operation time was 61.27±10.44 min, average blood loss was 20.22±5.79 ml, the mean postoperative drainage was 39.26±11.00 ml, respectively, which had a statistical significance difference compared to the control group. Conclusion〓Use of ultrasonic scalpel in the open thyroid surgery can shorten the incision, decrease the operation time, bleeding and postoperative lead flux, which have a higher clinical application value.
    The effect of peritoneal lavage combined with laparoscopic appendectomy in the treatment of acute appendicitis accompanied with purulent peritonitis
    Xie Huihua, Du Hanpeng
    2015, 15(05):  607-610.  DOI: doi:10.3969/j.issn.1009-976X.2015.05.022
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    【Abstract】〓Objective〓To evaluate the effect of peritoneal lavage on laparoscopic appendectomy in patients with purulent peritonitis. Methods〓130 cases of acute appendicitis with purulent peritonitis from 2010 to 2014 were selected and divided into two groups based on surgical approaches..The patients in the observation group(n=64) were treated with peritoneal lavage during laparoscopic appendectomy and those in the control group were performed laparoscopic appendectomy alone(n=66)..The postoperative anal exhaust time, hospital stay, hospitalization expense, operative time, leucocyte count in 24 and 72 hours after operation, the complications were compared between the two groups. Results All the operation was successfully performed..Compared with the control group,.the observation group showed shorter postoperative anal exhaust time and hospital stay,.less hospitalization expense,.lower leucocyte count after operation 24 and 72 hours.(27.29±4.29 h vs 36.75±5.93 h,.4.83±1.18 d vs 6.34±1.34 d,7090±807 yuan vs 8880±1304 yuan,9.20±1.20×109/L vs 12.78±1.20×109/L,5.51±1.15×109/L vs 8.94±0.92×109/L),.and there was statistical difference. Meanwhile, the complications in the observation group were significantly less than in the control group..However,.peritoneal lavage spent longer operative time(51.29±6.32 min vs 41.16±2.95 min,.P<0.05). Conclusion〓The effect of peritoneal lavage during laparoscopic appendectomy is safe and effective in the treatment of acute appendicitis with purulent peritonitis..Although long time of operation,.it possesses advantages of short time of hospitalization period,.less hospitalization expense and complications.
    Efficacy of holmium laser combined with cold knife endoscopic incision for male posterior-urethral strictures
    Xu Hanxin, Wu Zhaochun, Huang Hai
    2015, 15(05):  610-613.  DOI: doi:10.3969/j.issn.1009-976X.2015.05.023
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    【Abstract】〓Objective〓To compare the clinical efficacy and safety between cold knife endoscopic incision and combined holmium laser with cold knife incision for posterior-urethral stricture. Methods Twenty-six cases of posterior-urethral stricture were assigned cold knife endoscopic incision only, while another 27 cases of posterior-urethral stricture patients were taken combined therapy with holmium laser incision and cold knife endoscopic incision. The average follow-up was 20 months (range 12-30 months). The post-operative clinical data and therapeutic results were compared and analyzed. Results〓All cases from both groups were treated successfully with no serious bleeding and severe complication. The maximal urinary flow rate in both group was improved after operation. The postoperative hospital stay and the mean operative time had no significant difference in two group (P>0.05). The recurrent stricture rate and reoperation rate of combined therapy group were lower than that of cold knife group (P<0.05). Conclusion〓Combined therapy of holmium laser endoscopic incision and cold knife incision for posterior-urethral stricture could be a safer and more effective minimally invasive therapeutic modality for posterior-urethral stricture, as compared with the simple cold knife endoscopic incision.
    Diagnosis and treatment experience of pheochromocytoma in pregnancy.(A report of 3 cases)
    Jin Xiaoyan, Zhang Meng, Wang Jiwen
    2015, 15(05):  614-616.  DOI: doi:10.3969/j.issn.1009-976X.2015.05.024
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    【Abstract】〓Objective〓To discuss the diagnosis and treatment experience of pheochromocytoma in pregnancy. Methods〓Three cases of pheochromocytoma in pregnancy were retrospectively analyzed. Results〓The age in the cases was 35,.28,.30 years old,.respective..All presented hypertension during pregnancy. The level of catecholamine or its metabolites of plasma or urinary in patients were higher than normal reference values..B ultrasound and MRI found adrenal tumor in the three patients. One case was found clinical silent adrenal tumor before pregnancy,.and presented hormonal activity after pregnancy..Another case presented pneumonedema when cesarean section..These two patients accepted laparoscopic surgery of adrenal laparoscopic pheochromocytoma. The histopathological findings proved pheochromocytoma..The third case underwent no surgical treatment..Conclusion〓Pheochromocytoma in pregnant patient is one of the most threatening medical conditions for mother and fetus. Early awareness and recognition is very important, the treatment of clinical silent adrenal pheochromocytoma in reproductive women should be more active.
    Clinical study on internal or external diversion for the treatment of ureteral calculus complicated with urosepsis
    Li Fajiang,Huang Hongxing,Zheng Yiqun,Huang Hai,Hu Ming,Li Wei, Shi Yingjiang
    2015, 15(05):  617-620.  DOI: doi:10.3969/j.issn.1009-976X.2015.05.025
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    【Abstract】〓Objective〓To investigate the therapeutic effect of by ureteral stent insertion (internal diversion) or percutaneous nephrostomy (external diversion) in the patients suffered from ureteral calculus complicated with urosepsis. Methods〓From Jan 2011 to Dec 2013,.a total of 63 patients suffered from ureteral calculus complicated with urosepsis were randomized into two groups. In internal diversion group, 31 patients underwent double J ureteral stenting, while in external group,.32 patients underwent percutaneous nephrostomy tube insertion. The double J stent was inserted retrograde by using cystoscope or ureteroscope,.while the percutaneous nephrostomy was done under ultrasound guidance. Results〓The overall success rate of diversion in internal diversion group and external diversion group is 96.8% and 90.6% respectively (P=0.3170). The time of controlling sepsis after the diversion were (4.6±1.9) d and (3.5±1.7) d (P=0.0184). After URL, six patients in the internal diversion group suffered from recurrent urosepsis, and no recurrence of urosepsis in external diversion group (P=0.0287). One patient progressed to septic shock among those 6 patients in the internal diversion group. Conclusion〓Both internal and external diversion appear effective in the patients suffered from ureteral calculus complicated with urosepsis,.but external diversion exists a better approach of temporary urinary diversion than internal diversion for management of ureteral calculus complicated with urosepsis.
    The retrograde holmium laser enucleation of prostate and cystotomy in the treatment of benign prostatic hyperplasia combined with vesical calculus
    Chen Jinyang, Li Shuren, Zheng Ming
    2015, 15(05):  621-623.  DOI: doi:10.3969/j.issn.1009-976X.2015.05.026
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    【Abstract】 Objective To evaluate the therapeutic efficacy of holmium laser enucleation of prostate combined with cystotomy in the treatment of benign prostatic hyperplasia combined with cystic calculus. Methods〓Between May 2010 and June 2014, 63 patients of benign prostatic hyperplasia combined with cystic calculus treated with retrograde holmium laser enucleation of prostate and cystotomy were retrospectively reviewed..The enucleated glands were pushed into the bladder retrogradely and were taken out by cystotomy together with the cystic calculus. Results〓All the operations were successfully finished. The operation time of Holmium laser enucleation was 65±25.2 (range from 30 to 110) minutes, The operation time of cyctotomy was 13±8.7 (range from 10 to 25) minutes. No blood transfusion was needed, none of the 63 patients showed intraoperative and postoperative transurethral resection syndrome, bladder perforation, residual stones, urethral stricture or other complicat-ions. Catheters were removed in 1 to 3 days after the operation. IPSS (international prostate symptom scores) decreased from 25.4±2.3 to 8.5±2.1. Qmax increased from 7.8±3.4 to 14.2±2.6. Conclusion The retrograde holmium laser enucleation of prostate and cystotomy in the treatment of benign prostatic hyperplasia combined with cystic calculus is safe and effective.
    Surgical management of cerebro spinal rhinorrhea by using MR combined with high resolution CT
    2015, 15(05):  624-625.  DOI: doi:10.3969/j.issn.1009-976X.2015.05.027
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    A giant ganglioneuroma of the posterior mediastinumassociated with rib deformity
    2015, 15(05):  626-627.  DOI: doi:10.3969/j.issn.1009-976X.2015.05.028
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    An painful mass in abdominal wall as first complaint in one cases of periappendiceal abscess with intestinal fistula
    2015, 15(05):  627-628.  DOI: doi:10.3969/j.issn.1009-976X.2015.05.029
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    Clinical consideration for diagnosis and surgery of spontaneous nipple discharge
    Yang Zejuan, Li Guokang, Yuan Shaoqian, Huang Qiongdiao
    2015, 15(05):  629-631.  DOI: doi:10.3969/j.issn.1009-976X.2015.05.030
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    【Abstract】〓Nipple discharge is often caused by breast benign or malignant tumor, mammary duct inflammation and mammary duct expansion. The patients with sigle hole, continuous, spontaneous nipple discharge should be examined by simple and noninvasive breast ultrasound and X-ray which can discover the breast mass and calcification,.by mammary gland fiber duct endoscopy which can clear discharge causes and location. In order to prevent the intraductal tumor to cancer, the nipple discharge caused by intraductal tumor should be taken to surgery. To avoid missed diagnosis, the patients with both nipple discharge and breast lumps or calcification should be coufirmed the number of lesions before surgery. And all the lesions should be removed surgically.
    The research progress of focus problems in the combined modality therapy of gastric cancer
    Huang Yongliang, Chu Zhonghua
    2015, 15(05):  632-636.  DOI: doi:10.3969/j.issn.1009-976X.2015.05.031
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    【Abstract】〓Gastric cancer is one of the most common malignancies worldwide..Surgery with lymphadenectomy is the best treatment option for resectable gastric cancer..But multi-disciplinary treatment is the best mode in comprehensive treatment of gastric cancer..This review is to introduce the progress in lymph node excision, minimally invasive treatment, chemotherapy and molecular targeted therapy.
    Nursing care in treating palmar hyperhidrosis by thoracoscopic sympathectomy under local anesthesia
    Cai Huiqing, Xie Liang
    2015, 15(05):  636-638.  DOI: doi:10.3969/j.issn.1009-976X.2015.05.032
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    Nursing care in percutaneous nephrolithotripsy in semisupine position to prevent position-associated complications
    Liu Wenmei, Liang Min, Luo Min, Li Juan, Chen Xiaoqing
    2015, 15(05):  639-641.  DOI: doi:10.3969/j.issn.1009-976X.2015.05.033
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    Perioperative nursing of surgical correction using autogenous septal cartilage and MEDPOR prosthesis in patients with cleft lip and palate
    Wu Biying,Wen Zuozhen, Zhang Liping, Ma Xin
    2015, 15(05):  641-642.  DOI: doi:10.3969/j.issn.1009-976X.2015.05.034
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    Effect of ultrasonic knife or electric knife on mixed hemorrhoid surgery: comparative observation and care
    Chen Ling, Lu Min, He Caiqun, Feng Jing, Xu Jinhuan, Ye Chunyuan
    2015, 15(05):  643-644.  DOI: doi:10.3969/j.issn.1009-976X.2015.05.035
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    Nursing experience of continuous abdominal cavity flushing and low negative pressure aspiration by a self-made double-sheath tube in the treatment of bile leakage
    Cao Chunhong, Zhong Jinyi, Zhou Haiyan
    2015, 15(05):  645-646.  DOI: doi:10.3969/j.issn.1009-976X.2015.05.036
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