Table of Content

20 June 2016, Volume 16 Issue 03

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Analysis on the distribution characteristics of central memory T cells and effector memory T cells subsets in peripheral blood of patients with hepatocellular carcinoma

WANG Lidong, YUAN Xiaodong, LUO Biwei, XIE Yong, TIAN Peikai, OU Xi, LIN Zewei, LIU Xiaoping, LIU Jikui, CHEN Xinchun, ZHANG Mingxia

2016, 16(03):  249-253.  DOI: 10.3969/j.issn.1009-976X.2016.03.001

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【Abstract】 Objective〓The study aims to illustrate the expression characteristics of CD45RO/CD62L/CCR7 memory T lymphocytes and understand the distributions of CD45RO+CD62L+CCR7+ central memory T cells (TCM) and CD45RO+CD62L-CCR7- effector memory T cells (TEM) in peripheral blood of hepatocellular carcinoma (HCC) patients. Methods Thirty HCC patients hospitalized during August 2011 to August 2013 were, as the HCC group, enrolled in the study. The control groups consisted of 28 healthy persons, as the normal control group, and 28 chronic hepatitis B (CHB) patients, as the CHB control group. Polychromatic flow cytometry (PFC) was used to test CD3, CD4, CD8, CD45RO, CD62L and CCR7 of memory T lymphocyte in the peripheral blood mononuclear cells (PBMC). Results〓In the HCC group, the proportions of CD4+T lymphocytes and CD8+T lymphocytes in PBMC were significantly higher than the CHB control group (P<0.001,P=0.019),and there was no difference between the HCC group and that in normal control group (P=0.206, P=0.347). In the proportions of CD4+TEM in CD4+T memory lymphocytes in PBMC, the HCC group were significantly higher than both of the CHB control group and the normal control group (P=0.001, P=0.018). As for the proportions of CD4+TCM in CD4+T memory lymphocytes of peripheral blood, the HCC group were significantly lower than both of the CHB control group and the normal control group. In the three groups, the proportions of CD4+TEM in CD4+T memory lymphocytes were all higher than that of CD4+TCM (all P values were less than 0.001). In the population of CD8+T memory lymphocytes, the differences in the proportions of CD8+TEM and CD8+TCM during the HCC group and the other two control groups were insignificant (P=0.768,P=0.211,P=0.140,P=0.458, respectively). In the three groups, the proportions of CD8+TEM in CD8+T memory lymphocytes were significantly higher than that of CD8+TCM (all P values were less than 0.001). Conclusion〓In the HCC group, the CHB control group and the normal control group, the proportions of CD4+TEM in CD4+T memory lymphocytes were significantly higher than that of CD4+TCM, while the proportions of CD8+TEM in CD8+T memory lymphocytes were significantly higher than that of CD8+TCM. In the population of CD4+TEM memory lymphocytes, the HCC group were significantly higher than both the normal control group and the CHB control group. In the population of CD4+TCM memory lymphocytes, the HCC group are significantly lower than both the normal control group and the CHB control group, but the proportions of CD8+TEM and CD8+TCM have no difference during the three groups.

Construction of a lentiviral vector harboring HBEGF gene under the control of Alb promoter

JIA Junshuang, CHEN Bangzhu, LIN Xia, LIU Yu, XIAO Dong, LIN Xiaolin

2016, 16(03):  254-257.  DOI: 10.3969/j.issn.1009-976X.2016.03.002

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【Abstract】〓Objective〓To generate lentiviral vector carrying HBEGF gene under the control of liver-specific albumin (Alb) promoter. Methods〓Firstly, the fragment of Alb-enhancer/promoter was amplified from pAlb-Cre-GH/BS, and subsequently subcloned into the Not I site in the polylinker of pTRECK6-GFP by In-Fusion cloning to generate pAlb-TRECK6..Secondly,.the fragment of Alb-TRECK6 was amplified from pAlb-TRECK6,.and then inserted into pCD823A-1 at the Xba I/BamH I sites by In-Fusion cloning, designated pLV-ATTG, as verified by restriction enzyme digestion and sequencing. According to the standard protocol from Invitrogen,.lentiviruses were produced and then infected BEL-7402 cells,.followed by copGFP assay under inverted fluorescence microscope, and detecting the expression of HBEGF transgene by qRT-PCR. Results〓the data from enzyme digestion and DNA sequencing demonstrated that pLV-ATTG was successfully constructed..Cells infected with LV-ATTG displayed the green fluorescence under inverted fluorescence microscope, and the increased expression of HBEGF detected by qRT-PCR. Conclusion〓The lentiviral vector harboring HBEGF gene under the control of liver-specific Alb promoter was successfully constructed,.which will lay a solid foundation for further research.

Bmi-1 induces the malignant transformation of pancreatic ductal epithelial cells in vitro

DENG Hui, YIN Xiang, CHEN Haojun

2016, 16(03):  258-261.  DOI: 10.3969/j.issn.1009-976X.2016.03.003

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【Abstract】 Objective To investigate the effect of Bmi-1 gene overexpression on the proliferation of human pancreatic ductal epithelial cell line hTERT-HPNE. Methods〓The plasmid containing Bmi-1 gene and control was transducted into hTERT-HPNE cells by retroviral transfect. The expression of Bmi-1 mRNA and protein levels were detected by quantitative real-time PCR (qRT-PCR) analysis and Western blot analysis, respectively. The effect of Bmi-1 gene overexpression on the proliferation, migration, invasion and colony formation by MTS assay, Transwell assay and soft agar assay. Results The results of qRT-PCR analysis and Western blot analysis demonstrated that stable transfected cell lines successfully established..The expression of Bmi-1 promoted cell growth and proliferation, enhanced clone formation capability, and increased migration and invasion abilities. Conclusion〓Our findings demonstrated that ectopic expression of Bmi-1 lead to malignant transformation of pancreatic ductal epithelial cells.

Effect of combined argon-helium cryoablation and GM-CSF treatment on cytokine secretion of splenic DCs and CTLs cytotoxic activity in glioma-bearing mice

XU Hongchao, TAO Jingli, LIN Chunnan, WANG Qifu, WANG Huiqing, ZHANG Shizhong

2016, 16(03):  262-265.  DOI: 10.3969/j.issn.1009-976X.2016.03.004

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【Abstract】 Objective〓To explore the effect of combined argon-helium cryoablation and GM-CSF treatment on cytokine secretion of splenic DCs and CTLs cytotoxic activity in glioma-bearing mice...Methods〓Glioma-bearing mice models were established and divided into four groups of no-treatment,.GM-CSF injection,.cryoablation treatment,.and GM-CSF and cryoablation combined treatment. After seven days' treatment, the mice spleens were obtained, then the DCs were purified and cultured in vitro. The secretions of IL-10, IL-12p70 and IFN-γ were detected by ELISA. And the CD8+ CTLs were separated and cultured with GL261 cells in vitro..Then the cytotoxic activity of CD8+ CTLs were detected by LDH test. Results〓Combined treatment with cryoablation and GM-CSF could not only significantly decrease the secretions of IL-10, but also increase the secretions of IL-12 and IFN-γ..Furthermore,.combined treatment could signifcantly increase the cytotoxic activity of CD8+ CTLs..Conclusion〓Argon-helium cryoablation combined with GM-CSF treatment can further effectively activate T cells and enhance specific anti-tumor immunity through the stimulation of DCs and secretion of Th1 type cytokines.

Neoadjuvant chemotherapy for resectable locally advanced colon carcinoma:a prospective case controlled trial

ZHUANG Yezhong, LIN Jiarui, HUANG Miansheng, WANG Weifeng, XU Muming

2016, 16(03):  266-269.  DOI: 10.3969/j.issn.1009-976X.2016.03.005

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【Abstract】〓Objective〓To investigate the feasibility, safety, and efficacy of neo-adjuvant chemotherapy of XELOX (oxaliplatin and capecitabine) for the resectable locally advanced colon carcinoma. Methods〓From Jan. 2010 to Dec. 2014, 100 patients with resectable locally advanced colon carcinoma (T3/T4 or N+) were randomized into either perioperative chemotherapy and surgery (study group, n=50) or surgery followed by postoperative chemotherapy (control group, n=50). Perioperative chemotherapy consisted of two-four preoperative cycles of intravenous Oxaliplatin(130 mg/m2) on day 1, and oral capecitabine (1000 mg/m2) for two weeks (day 1 to day 14) every 21 days and four to six postoperative cycles of the same regimen. Results〓All the patients completed neo-adjuvant chemotherapy and no severe grade 3-4 toxicity happened. All the tumours were resected with no significant differences in postoperative morbidity between the study group and the control group. These two groups were comparable in clinical T stage and N stage, and when compared with control, neo-adjuvant chemotherapy resulted insignificant involvement in N stage (P<0.01) and TNM (P<0.01) and less positive node (P<0.01). With a median follow-up of four years, median survival was 46 months in the neo-adjuvant chemotherapy group compared with 26 months in the control group. 5-year DFS were 44.9% and 33.6% (P=0.041) and 5-year OS were 51.0% and 41.6% (P=0.33). Conclusion〓Neo-adjuvant chemotherapy with Oxaliplatin and Capecitabine improve survival without additional serious adverse events in the treatment of patients with resectable locally advanced colon carcinoma.

Safety and effectiveness analysis of hyperthermic intraperitoneal perfusion chemotherapy combined with venous chemotherapy for advanced colorectal cancer

ZHOU Jun, HAN Yuan, SUN Guohui, SONG Mu

2016, 16(03):  270-274.  DOI: 10.3969/j.issn.1009-976X.2016.03.006

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【Abstract】 Objective To evaluate the clinic effects of hyperthermic intraperitoneal perfusion chemotherapy (HIPEC) combined with venous chemotherapy for the treatment of advanced colorectal cancer. Methods〓Sixty-five cases of advanced colorectal cancer were divided into HIPEC group (n=30)and control group(n=35)..After radical resection,HIPEC were combined the FOLFOX6 chemotherapy plan in experiment group. Whereas the control group were received FOLFOX6 chemotherapy plan only. The clinical effect and prognosis were compared. Results〓The KPS scale increasing rate were 53.33% in HIPEC group and 40.00% in control group respectively..The variation between the two groups achieved statistical significance(P<0.05)..Two adverse reactions are reversible,.and became better after discontinuation..The incidence rate of hypoproteinemia were 20.0% at the third day after operation..There were no severe complications occurred in two groups..And there were no significant increase about the incidence rate of overall postoperative complications..The local recurrence and liver metastasis rate of HIPEC group were significantly lower than the control group,the difference was statistically significant (χ2=18.056, χ2=10.187, all P values were less than 0.05). The 1-, 3-, and 5-year survival rates in treatment group were 97.3%, 71.8%, 50.9% and 96.7%, 60.3%, 39.2% in control group respectively. The 1-year survival rate achieved no statistical significance (P>0.05), but the 3- and 5-year survival rates achieved statistical significance between the two groups(all P values were less than 0.05). Conclusion〓When combined with venous chemotherapy, (HIPEC was safe, reliable.It can improve the quality of life and raise the 3- and 5-year survival rate of the advanced colorectal cancer patients significantly. It was effective adjuvant treatment to colorectal cancer.

Preliminary study on the clinical applications of detection of biliary residual stones with digital tomosynthesis applied cholangiography

ANG Qiqing, HOU Dongsheng, YE Jingsong. ZHANG Chengpeng, WEI Jialiang, SHE Zhanpeng

2016, 16(03):  274-278.  DOI: 10.3969/j.issn.1009-976X.2016.03.007

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【Abstract】〓Objective〓To investigate the clinical effect of digital tomosynthesis on diagnosis of bile duct residual stone. Methods〓Thirty-one patients with hepatolithiasis were performed surgical treatment and stayed the biliary drainage tube after operation. All of patients received both abdomen digital radiography and digital radiography examination. The scores of DR and DTS imagines were analyzed the bile duct resident stones under the standard of choledochoscopy exploration. Results〓The sensitivity,.specificity,.accuracy of bile duct resident stones analyzed with DR imagines were 72%,.33.3%, 64.52%, respectively, while for DTS imagines were 88%, 66.7%, 86.67%. The score of DR imagines was 3.03±0.87,while that of DTS imagines was 4.03±0.79,.and there was statistical difference between two groups (P<0.01). Conclusion〓The clinical efficacy of DTS was better than that of DR, as showed higher sensitivity, specificity, accuracy of bile duct resident stones.

Clinical significance of cystic duct access during laparoscopic cholecystectomy plus laparoscopic common bile duct exploration with primary suture: a summary of 347 cases

U Banglv, CHEN Yongbing, ZHANG Weiyi, NIE Hongfeng, YANG Ronghua, SHEN Xiaoqing, YU Conghui

2016, 16(03):  279-281.  DOI: 10.3969/j.issn.1009-976X.2016.03.008

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【Abstract】〓Objective〓To explore the value through the cystic duct access to the prevention of bile duct injury and stricture of bile duct during laparoscopic cholecystectomy (LC) plus laparoscopic common bile duct exploration with primary suture. Methods〓The clinical data of 347 cases of LC plus laparoscopic common bile duct exploration with primary suture through cystic duct access performed from January 2009 to April 2014 in General Hospital of Beijing Command were analyzed. Results〓Based on the cystic duct access and dissection transition zone of cystic duct and common bile duct, the cholecystic ampulla, cystic duct, the bile common duct and the arteria cystica were to reveal. All the cases were operated with LC plus laparoscopic common bile duct exploration successfully without injury of blood vessel and bile duct. No stricture of bile duct were founded during 8-24 months of follow up. Conclusion〓The transition zone of cystic duct and common bile duct is the key landmark. Through the cystic duct and common bile duct transitional zone for exploration of common bile duct in primary suture is a safe, feasible, and it can effectively prevent the bile duct injury and stricture of bile duct.

Laparoscopic suture rectopexy:a simple and effective procedure for complete rectal prolapse

YU Si, DENG Jianzhong, JI Yiong, LIN Yiban

2016, 16(03):  282-286.  DOI: 10.3969/j.issn.1009-976X.2016.03.009

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【Abstract】〓Objective〓To investigate the clinical effect of laparoscopic suture rectopexy for the treatment of complete rectal prolapse in adults. Methods〓A total of 52 patients with complete rectal prolapse from January 2010 to January 2014 were included in this study, in which 36 cases (Group A) underwent surgical treatment by using laparoscopic suture rectopexy procedure, 16 (Group B) in the same period underwent laparoscopic mesh rectopexy. The clinical efficacy was observed in all patients and compared between two groups. Results〓The average operation time was 110±13 min in Group A and 120±9 min in Group B, in which there was significant difference (P<0.05). There was no significant difference between two groups about the average intraoperative bleeding (30±10 ml vs 34±9 ml), the average postoperative anal exhaust time (35±8 h vs 39±9 h), the average postoperative hospitalization time (5.1±1.3 d vs 5.8±1.2 d)(all,P>0.05). The average treatment cost was RMB 16227±845 yuan in Group A and RMB 19143±1163 yuan in Group B, and there was significant difference between two groups(P<0.05). There were no early complications found in both groups. The median follow-up time was 26 months. There was no significant difference between the two groups about the rectal prolapse recurrence rate, Wexner constipation score and gastrointestinal quality of life index (GIQLI) of one month or one year after operation(P>0.05). Conclusion〓Laparoscopic suture rectopexy for complete rectal prolapse had such advantages as minor surgical trauma, quicker recovery, shorter hospitalization time, lower cost, and showed satisfactory results in short and long term follow-up.

A modified single-port laparoscopic technique for the repair of indirect inguinal hernia in children

JIANG Huayu, LI Binggen, MO Yuxuan, NIE Xiangyang, GONG Duhui, PENG Yonghui, XIE Zhihua

2016, 16(03):  286-288.  DOI: 10.3969/j.issn.1009-976X.2016.03.010

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【Abstract】〓Objective〓To introduce a modified method of laparoscopic treatment for indirect inguinal hernia in children,.evaluate its safety and efficacy. Methods〓During Feb..2006 and Oct. 2010,.77 children with indirect inguinal hernia were treated by laparoscopic surgery..All patients underwent high ligation surgery with a modified one port laparoscopic technique:.mainly performed by extracorporeal suturing with an ordinary taper needle.(1/2 Arc 11×34)..The clinical data were retrospectively analyze. Results〓All surgeries were successful without serious complications..During operation,.contralateral occult indirect inguinal hernia were found and subsequently repaired in 22 cases(31.4%)..The mean of operative time was 13 mins (7-19 min) in 48 cases of unilateral hernia and 21 min.(14-31 min) in 29 cases of bilateral hernia. The mean of postoperative hospital stay was 48 h.(26-52 h). Thirty-five patients were followed-up from 6 to 36 months,.and mean followed-up time was 22.6 months. There were no complications and recurrence in this study. Conclusion〓The modified single-port laparoscopic technique for the repair of indirect inguinal hernia in children is a safe and reliable procedure,.with minor invasion and satisfied outcome. It is easy.to be learned and performed.

Case-controlled study to compare single-incision laparoscopic procedure versus standard 3-port laparoscopic procedure in obese patients with acute appendicitis

CAO Jinpeng,JI Yong, PENG Xiang, DENG Jianzhong, ZHOU Yonghui, CHENG Longqin

2016, 16(03):  289-292.  DOI: 10.3969/j.issn.1009-976X.2016.03.011

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【Abstract】〓Objective〓To investigate the safety and feasibility of single-incision laparoscopic appendectomy (SILA) in obese patients with acute appendicitis. Methods〓Eighty adult obese patients with acute appendicitis from March 2014 to September 2015 were randomized into the experimental group and the control group. Patients in the experimental group were assigned to undergo single-incision laparoscopic appendectomy,Patients in the control group were assigned to undergo standard 3-port laparoscopic appendectomy(SLA). The terms of demography,American Society of Anesthesiologists (ASA) classification,appendicitis type,details of operations,post-operative recovery, and postoperative complications were recorded and analyzed. Results〓There were no significant differences between the two groups for age, gender, ASA score, body mass index (BMI) (P>0.05). There were no significant differences among the groups in terms of average operative time, blood loss, time to liquid diet, time to hospital stay(P>0.05). There were no significant differences between the two groups for postoperative pain scores [2.8 (1-5) vs 3.3 (2-6),P>0.05]. Significant differences were observed for cosmesis satisfaction scores between the two groups [9.58 (9-10) vs 8.60 (8-9),P<0.05]. There were also no significant differences in the conversion rate between the experimental group and the control group (2.5% vs 0%, P>0.05). Conclusion〓SILA in obese patients with acute appendicitis is safe and feasible, and is better in cosmesis satisfaction scores than SLA.

Laparoscopic reduction of pediatric intussusception with two trocars

ZHANG Qingfeng, YAO Gan

2016, 16(03):  293-296.  DOI: 10.3969/j.issn.1009-976X.2016.03.012

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【Abstract】〓Objective〓To investigate the feasibility and surgical experience of laparoscopic reduction of pediatric intussusception with two trocars. Methods〓During June 2009 and June 2014, 32 cases of pediatric intussusception with either failing air enema reduction or recurrence of intussusception, underwent laparoscopic reduction of intussusception with two trocars. Of 32 cases, the patients who were successfully reduced by laparoscopic procedure were assigned to A group and those converted to open reduction served as B group. The clinical data were retrospectively analyzed and compared between two groups, including the age, onset time, type of intussusception, length of intussusception bowel, combined lesions. Results〓Twenty-four cases of intussusception were successfully reduced by laparoscopic reduction with two trocars (24/32, 75%), including 2 cases of Meckel’s diverticulum from 3 recurrent cases. Eight cases converted to open reduction by extending the umbilical incision, including 4 cases of ankylenteron caused by intestinal perforation or necrosis, 1 case of incarcerated ileum polypus, and 3 cases of long intussusception bowel. The patients of B group had longer intussusception bowel and higher rate of combined lesions than that of A group, and there were statistical differences between two groups. There were no significant difference between two groups in age and onset time and complications. Conclusion〓Laparoscopic reduction of intussusception with two trocars can be performed first for stable patients either failing air enema reduction or recurrence of intussusception. The length of intussusception bowel and combined lesions may be influence the success rate of laparoscopic reduction.

Strategy and experience of exposing and protecting recurrent laryngeal nerve in laparoscopic thyroidectomy

CAO Jiezhi, MAI Weijin, SU Gangling

2016, 16(03):  297-300.  DOI: 10.3969/j.issn.1009-976X.2016.03.013

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【Abstract】〓Objective〓To summarize the experience for protecting recurrent laryngeal nerve in laparoscopic thyroidectomy. Methods〓Ninety?鄄three patients under went laparoscopic thyroidectomy in July 2011 to June 2015 and their clinical data were retrospectively analyzed..Basing on different diagnosis, patients were treated with different surgical procedures, including partial thyroidectomy, subtotal thyroidectomy, thyroid gland and isthmic resection or lymph node dissection. During operation, recurrent laryngeal nerve was exposed through tracheoesophageal groove route, and thyroid artery area route and inferior corner of thyroid cartilage route. Results〓Recurrent laryngeal nerves were successfully exposed in all cases, including 32 nerves of left side, 37 nerves of right side, 48 nerves in both sides. Among of them, 57 cases were exposed through tracheoesophageal groove route(account for 48.71%),48 were through thyroid artery area route(account for 41.03%),and 12 were through inferior corner of thyroid cartilage route (account for 10.26%). Temporary paralysia of recurrent layngeal occurred in three cases, and no permanent nerve injury was found. Conclusion〓As long as knowing well correct anatomic approach and skills,following the principle of initiative exposing and strict protection, exposing recurrent laryngeal nerve in laparoscopic thyroidectomy should be feasible and safe.

Clinical experience of elective laparoscopic surgery for treating non-strangulated adhesive intestinal obstruction (a report of 26 cases)

WU Guitang, HE Xiaowen, ZHANG Ruijiang, LI Junxian, LI Guangquan, GUO Liang, LI Meirong

2016, 16(03):  301-303.  DOI: 10.3969/j.issn.1009-976X.2016.03.014

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【Abstract】 Objective〓To investigate the clinical application and efficacy of elective laparoscopic surgery in treatment of non-strangulated postoperative adhesive intestinal obstruction..Methods〓The clinical dates from 26 cases of non-strangulated adhesive intestinal obstruction were analyzed..All patients underwent surgery of laparoscopic enterolysis after the symptoms were relieved by conservative treatment..The effect and clinical experience were reported..Results〓All surgical operations were completed smoothly..The patients discharged home in postoperative 7-15 days (9.76 ± 2.42 days), and were followed for 12-60 months.(34.04 ± 12.05months).without recurrence of intestinal symptoms. Conclusinon〓It is an effective treatment method of elective laparoscopic surgery treatment of non-strangulated postoperative intestinal obstruction.

Analysis and experience of pancreaticoduodenectomy nutritional support: one case report

LIN Jieru, CHANG Huili

2016, 16(03):  304-307.  DOI: 10.3969/j.issn.1009-976X.2016.03.015

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【Abstract】 Objective〓To analyze the individualized program of nutritional support during perioperative period on a patient with pancreatic cancer. Methods〓A 48-year-old male with pancreatic cancer was performed a surgical procedure of pancreaticoduodenectomy..The clinical pharmacist participated in setting the reasonable nutrition support program, from total parenteral nutrition in initial stage to enteral nutrition and tube feeding enteral nutrition,.supplemented by semi-liquid diet finally for further treatment of the disease. Results〓With the involvement of clinical pharmacists,.surgeon developed and adjusted the patient’s nutrition support program and improved the nutritional status of the patient..The patient was enterally fed successfully and supplemented semi-liquid diet,.a critical transitional stage from TPN to TEN..The enteral nutrition was delivered early through a trans-anastomotic feeding tube. Conclusion〓By a reasonable nutritional management protocol for peri-operative patient of pancreaticoduodenectomy, the clinical pharmacist optimize the nutritional support program to ensure the good outcome.

The evaluation of single-port laparoscopic hernia sac high ligation for pediatric inguinal hernia

CHEN Quanbin

2016, 16(03):  308-310.  DOI: 10.3969/j.issn.1009-976X.2016.03.016

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【摘要】〓目的〓探讨单孔腹腔镜下疝囊高位结扎术治疗小儿腹股沟斜疝的疗效。方法〓选取2014年1月至2015年1月期间潮安区人民医院普外科住院部小儿腹股沟斜疝200例,全部研究对象均根据患儿家属的治疗意愿分组,观察组采用患儿单孔腹腔镜下疝囊高位结扎术治疗,对照组患儿采用常规开放性手术治疗。结果〓与对照组比较,观察组患儿手术时间、住院时间明显缩短,切口直径明显小于对照组(P<0.05)。观察组患儿家属对切口满意率明显高于对照组(P<0.05)。观察组患儿术后镇痛药物应用率,复发率明显低于对照组(P<0.05)。观察组患儿术后并发症发生率明显低于对照组,两组患儿比较差异具有统计学意义。结论〓单孔腹腔镜下疝囊高位结扎术治疗小儿腹股沟斜疝的疗效显著,有助于显著缩短术后恢复时间,降低术后并发症与复发风险。

Endoscope-assisted resection of breast tumor through anterior axillary incision approach

LIU Yuankun, HU Zengqing

2016, 16(03):  311-313.  DOI: 10.3969/j.issn.1009-976X.2016.03.017

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【Abstract】 Objective〓To explore the surgical effect of endoscope-assisted benign breast tumor removal by the anterior axillary incision. Methods〓Between January 2015 and January 2016 in our hospital, 35 cases of patients with mammary gland fibroma underwent surgery by a endoscope-assisted and one-incision breast tumor resection (observation group). Another 35 cases were recruited as controls and underwent surgery by areola incision (control group). Clinical effect was compared between two groups in operation time, intraoperative blood loss, hospital stay and postoperative complications. Results〓Two groups of patients were successfully completed, there were no postoperative complications such as skin ecchymosis and subcutaneous effusion. Observation group had advantage over control group in the operation time, intraoperative blood loss, length of incision and incision to the focal distance, length of hospital stay. Conclusion〓Endoscope-assisted anterior axillary incision for benign breast surgery has better clinical efficacy than traditional breast surgery procedure.

Comparison of analgesia effect between oxycodone+propofol and sufentanil+propofol in patients undergoing esophageal gastric varices ligation operation

LIU Yuming, YAO Zhixiong, YE Xiaoyin, WU Bingbing

2016, 16(03):  314-316.  DOI: 10.3969/j.issn.1009-976X.2016.03.018

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【Abstract】〓Objective〓To investigate the efficacy and safety of oxycodone hydrochloride injection combined with propofol or sufentanil in patients underwent esophageal gastric varices (EGV) ligation operation. Methods〓Forty-eight patients with EGV were divided into two groups (n=24 each), oxycodone hydrochloride injection group (group A) and sufentanil injection group (group B). Patients in group A were administrated in vein with 0.1 mg/kg of oxycodone, induced with propofol 2 mg/kg and maintained with 4-7 mg-1·kg-1·h-1 propofol. Patients in group B were administrated in vein with 1 μg/kg of sufentanil, induced with 2 mg/kg of propofol and maintained with 4-7 mg-1·kg-1·h-1 of propofol. MAP, HR, RR, SPO2, BLS were continuously monitored. Cough, respiratory depression, total dosage of propofol and postoperative 30 min pain score were recorded. Results〓There were no significant differences in MAP, HR, RR, SPO2 and BLS between two groups (all P values were more than 0.05). The rates of adverse effects such as cough, body movement, respiratory depression, total dosage of propofol and postoperative 30 min pain score in group A were significantly lower than that of group B (P<0.05). Conclusion〓In the present study, xycodone hydrochloride injection was a safer and more effective treatment in patient underwent EGV ligation operation.

Collapse prediction for patients with femoral head necrosis via ROC analysis

KONG Xiangquan, HUANG Meijun, LI Quanmeng, LIANG Zhijian, TANG Yangwei

2016, 16(03):  317-320.  DOI: 10.3969/j.issn.1009-976X.2016.03.019

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【Abstract】〓Objective〓Toinvestigate the angle of femoral head necrosis (FHN)/necrosisarea ratio in the prediction of patients with traumatic ischemic necrosis of femoral head in the sensitivity of the collapse of the femoral head and specific degrees. Methods〓Thirty-sevenhips of 31 patients with hip FHN were collected for long-term follow-up, measuring the necrosis area and angle (coronal plane of MRI), using the receiver-operating characteristic curve (ROC) method to evaluate the sensitivity of the patients with femoral head collapse and specific degrees. Results〓Of 37 hips, a total of 11 hips showed collapse of the femoral head (29.7%). Compared with control group (without collapse), the necrosis angle and the necrosis area weresignificant increased (P=0.001,P=0.001), and the angle/area ratio was also significantly greater than that of control group (P<0.001). The area under the curve (AUC) of necrosis angle was 0.772, with 95% confidence interval (CI) was(0.613, 0.932).The area of the corresponding AUC was 0.724, 95% CI (0.516, 0.516), and the corresponding AUC/Angle area was 0.785, 95% CI (0.627, 0.627).Angle, area and Angle/area ratio and femoral head collapse existed significant correlation (P=0.008, 0.019, 0.005, respectively). When the angle/area value was 1.895 (108°/57%), the ratio to predict the sensitivity of the collapse of the femoral head were 97.5% and 98.4%, higher than the corresponding angle of 96.3% and 87.4 and above the area corresponding to 76.4% and 92.5%. Conclusion〓In our study, the necrosis angle was 108° or femoral head necrosis area coverd an area of 57%, it should be highly on guard that femoral head occurred in collapse.Angle/area ratio in the prediction of the sensitivity of the collapse of the femoral head and or specific degrees were superior to angle area of single index.

Comparison between the unipedicular and bipedicular kyphoplasty in treatment of osteoporotic vertebral compression fracture

LIN Qisheng, WANG Yimin, HE Qiongfang, ZHANG Hongbo, LI Zhongchan, LUO Futan, HUANG Xingzhong

2016, 16(03):  320-323.  DOI: 10.3969/j.issn.1009-976X.2016.03.020

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【Abstract】 Objective To observe and compare the efficacy of unipedicular and bipedicular percutaneous kyphoplasty for treating osteoporotic vertebral compressive fractures. Methods A total 32 patients with osteoporotic vertebral compression fractures in single segment vertebral body were included in the study. Of them,16 cases underwent unipedicular percutaneous kyphoplasty (unipedicular group) and another 16 were received bipedicular percutaneous kyphoplasty bipedicular group)..The complication, Kyphosis Cobb's angle, pain relief index score (VAS score), ADL score and operation duration were compare between two groups. Results There was no significant difference in occurrence of complication, pain relief and correction of spinal Kyphosis Cobb's angle in 6 month after operation between two groups. The operation duration of unipedicular kyphoplasty group was short than that of bipedicular kyphoplasty group (P>0.05). After operation in 6 months, Cobb's angle in unipedicular group was 4.8°±0.5° and less than that in bipedicular group (t=-14.840, P<0.001). VAS score in unipedicular group was 2.2±0.3 and less than that in bipedicular group (2.4±0.3)(t=-1.886, P=0.069). Kyphosis Cobb’s angle, pain relief index score (VAS score), ADL score in two groups were getting better than that before operation. Conclusion〓The effect of pain relief, Kyphosis Cobb's angle correctic and occurrence of complication between unipedicular with bipedicular kyphoplasty are similar, but the unipedicular kyphoplasty has the advantage of less operation time and simpler procedure.

Treatment of double-segment lumbar spondylolisthesis with transforaminal lumbar interbody fusion

HANG Aiming, LI Qing, ZHANG Fei, LIANG Daochen, ZHAO Chengyi, MEI Zhi

2016, 16(03):  324-326.  DOI: 10.3969/j.issn.1009-976X.2016.03.021

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【Abstract】〓Objective〓To probe the surgical effect of double-segment lumbar spondylolisthesis with transforaminal lumbar interbody fusion(TLIF). Methods〓Eleven cases of lumbar spondylolisthesis were treated with decompression of nerve root and dura, reduction of spinal, reconstruction of vertebral canal, pedicle screw fixation and fusion by TLIF. The Lenke grading system was used to assess the spinal fussion. The Henderson grading system was used to assess the clinical effect. Results The reduction of the spondylolisthesis was satisfied in all cases based on a follow-up of 1-2 years. The spinal fusion: A grade in one cases, B grade in one case. The clinical effect showed excellent in 9 cases, good in one case, poor in one case. Conclusion〓The application of TIIF in the treatment of patients with double-segment lumbar spondylolisthesis can provide successful interbody fusion and clinical results.

Significance of PSA density for detecting prostate cancer in Paients with a PSA between 2.5-10.0 ng/ml and 10.1-20.0 ng/ml:a multicenter study

WEI Xinghua, Lin Yurong, YANG Wenjun, XIE Keji, TANG Ping

2016, 16(03):  327-330.  DOI: 10.3969/j.issn.1009-976X.2016.03.022

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【Abstract】〓Objective〓To investigate the significance of prostate-specific antigen density (PSAD) for detecting prostate cancer in patients with a PSA between 2.5-10.0 ng/ml and 10.1-20.0 ng/ml. Methods〓461 men with a PSA between 2.5-20.0 ng/ml, underwent prostatic biopsy at two centers in Guangzhou, were retrospectively studied, and were divided into two groups (PSA 2.5-10.0 ng/ml vs. PSA10.1-20.0 ng/ml). Receiver operating characteristic (ROC) curve was used to evaluate the efficacy of PSA and PSAD for the diagnosis. Results〓In men with a PSA of 2.5-10.0 or 10.1-20.0 ng/ml, the areas under the ROC curve (AUCs) were higher for PSAD than for PSA. The optimal PSAD cut-off for predicting prostate cancer in men with a PSA of 2.5-10.0 ng/ml was 0.15 ng/ml/ml, with a sensitivity of 64.4% and specificity of 64.6%. The optimal cut-off for PSAD in men with a PSA of 10.1-20.0 ng/ml was 0.33 ng·ml-1·ml-1,with a sensitivity of 60.3% and specificity of 82.7%. Conclusion〓PSAD is illuminated a predictor of prostate cancer in patients with PSA between 2.5-10.0 ng/ml and 10.1-20.0 ng/ml.

The recovery of pelvic pressure in short time after operation in children with hydronephrosis

DENG Gaoyan, SUN Junjie, MO Jiacong, DENG Zhijian, WANG Fenghua

2016, 16(03):  331-334.  DOI: 10.3969/j.issn.1009-976X.2016.03.023

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【Abstract】〓Objective〓To investigate the renal pelvic pressure trends after pyeloplasty for children with congenital hydronephrosis. Methods〓Thirty patients who underwent Anderson–Hynes pyeloplasty for ureteropelvic junction obstruction were included in a retrospective analysis. Nephrostomy tubes were placed when the operations were performed. After surgeries, renal pelvic pressure, bladder pressure and urine volume of the hydronephrotic kidneys were measured every day,and lasted for 14 days. Results〓Renal pelvic pressure decreased to the same level of bladder pressure 1 day after operation, while increases temporary 1 week later, and then decreased to a steady level. Urine volume of hydronephrotic kidneys also increased temporary 1 week after operation. Conclusion〓Anastomosis functional obstruction exited within one week after operation. Nephrostomy tube or ureteral tent should be placed for more than 1 week was imperative after operation. They should be removed in 3 weeks.

Holmium laser internal urethrotomy with balloon dilation under ureteroscope for urethral stricture

LIU Hongjun, KANG Yongsheng, TANG Yunfeng, LI Huaqiang, XIAN Xiaohui, LIN Dejin, XIE Bin, ZHOU Shaohua, LIANG Yu

2016, 16(03):  334-337.  DOI: 10.3969/j.issn.1009-976X.2016.03.024

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【Abstract】〓Objective〓To study the efficacy of optical internal urethrotomy with Holmium laser and balloon dilation in the treatment of urethral stricture. Methods〓From June 2013 to December 2014,.a total of 36 patients with symptomatic urethral stricture were evaluated with clinical history, physical examination,.uroflowmetry,.and retrograde urethrogram preoperatively..All patients were treated with optical internal urethrotomy followed by balloon dilation at the urethrotomy site..An indwelling 16-18Fr silicone catheter was left in place for a period of 7-21 days..All patients were followed up for 6-12 months postoperatively with symptoms, uroflowmetry, and retrograde urethrogram and micturating urethrogram every 3 months if indicated. Results〓The overall success rate after first OIU(optical internal urethorotomy) (30 out of 36 patients) was 83.4%. Urethral restenosis occurred in 6 cases. Conclusion〓Optical internal urethorotomy by Holmium laser with balloon dilation is a safe and effective minimally invasive therapeutic modality for urethral strictures.

Comparison study of preoperative antibiotic use on minimally invasive percutaneous nephrolithotomy for treatment of staghorn stone

ENG Peng, JIANG Chonghe, CHEN Shaojuan, PAN Chuzao, ZENG Jianwen, MO Jianfeng, ZENG Shaohua

2016, 16(03):  337-340.  DOI: 10.3969/j.issn.1009-976X.2016.03.025

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【Abstract】〓Objective〓To investigate the effectivity and strategy of preoperative antibiotic use in treatment of staghorn calculi by percutaneous nephrolithotomy (PCNL). Methods〓Ninety-six patents who suffered from kidney staghorn calculi with no urinary tract infection were selected PCNL procedure. The patients were divided into two groups, Group A(n=49), preventive antibiotics administrated 1 hour before the operation, Group B (n=47), received cephalosporin treatment for 3 days before the operation. The incidence of bacteriuria and fever after the operation were compared. Results〓The surgical procedure of PCNL was completed in allpatients. The incidence of bacteriuria was 18.4%, fever 26.5% in group A, while the incidence of bacteriuria was 4.3%, postoperative fever 10.6% in group B. The incidence of bacteriuria and fever after the operation were lower in patients treated with cephalosporin 3 days before the operation than the patients with preventive treatment (P<0.05). Conclusion〓The management of preoperative antibiotics treatment for 3 days in the patient with kidney staghorn calculi but no clinical and laboratory infection evidence efficiently reduced the incidence of postoperative bacteriuria and fever after PCNL.

A comparison between endoscopic incision and incision plus balloon dilation for ureteral stenosis

LI Jintang

2016, 16(03):  341-343.  DOI: 10.3969/j.issn.1009-976X.2016.03.026

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【Abstract】〓Objective〓To compare the clinical effect of endoscopic incision and incision plus balloon dilation in the treatment of ureteral stenosis. Methods〓The clinical data of 66 patients with ureteral stenosis admitted in our hospital from January 2008 to December 2015 were retrospectively analyzed. Thirty patients were enrolled in the control group treated by endoscopic holmium laser incision before December 2011, and 36 patients were assigned to the observation group treated by holmium laser incision combined with balloon dilation after January 2012. The clinical efficacy and complications were evaluated between two groups. Results〓The clinical efficacy of the observation group was significantly better than that of the control group (effective rate: 73.3% vs 91.7%, P<0.05). There were no complications such as ureteral perforation and renal colic between two groups. Conclusion〓For ureteral stenosis, endoscopic holmium laser incision combined with balloon dilation has an advantages of good clinical effect, small damage and rapid recovery.

The effect of cremaster-sparing hernia repair on spermatogenesis function in a rat model

WANG Zhenlong, CHEN Ming, LI Chencai, CHEN Boyi,LUO Xiaofeng

2016, 16(03):  344-347.  DOI: 10.3969/j.issn.1009-976X.2016.03.027

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【Abstract】 Objective〓To investigate the protective role of spermatogenesis by cremaster-sparing tension-free hernia repair in a rat model. Methods〓Twenty-four adult SD rats were randomized into 4 group, control group, sham group, operation group (OP1 and OP2, again). Op1 performed surgery by cremaster-sparing tension-free hernia repair, and cremaster was cut during operation in Op2 group. The animals were sacrificed in 90 days after experimental animal model establishment. The testiculartissue was taken for H.E staining and the assessment of quantity changes of spermatogeniccells in each group. The pathological changes of the testis in each group were observed. Results〓The testis of rats group OP2showed degenerative changes. The germinal epithelium disorder, the number of germinal cells were decreased, and the number of haploid cells and diploid cells were significantly decreased, as compared with group OP1 and group sham group (all P values were less than< 0.05). Conclusion〓Cremaster could be protective role on the spermatogenic function in rats underwent tension-free hernia repair. It is maybe an important step for hernia repair to protect the continuity and integrity of cremaster.

Extracapsular dissection of parotidectomy in parotid benign tumor

HUANG Chen, ZHANG Xuwen, CHEN Lei, FAN Yingchun, CHEN Yang, LIU Jing

2016, 16(03):  347-350.  DOI: 10.3969/j.issn.1009-976X.2016.03.028

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【Abstract】 Objective〓To evaluate and compare the clinical results of extracapsular dissection and superficial parotidectomy. Methods〓151 patients who underwent excision of the parotid benign tumor between 2000 and 2010 were reviewed. Of them, 91 patients underwent extracapsular dissection and 60 patients received superficial parotidectomy. All patients were followed up for 4 to 14 years. Results〓Surgical complications (facial paralysis, Frey’s syndrome and salivary fistula) were lower in extracapsular dissection than in superficial parotidectomy, but the recurrence rate was not significantly different between two surgical modalities. Conclusion〓Extracapsular dissection could retain more parotid gland tissue,had less complications and can be the first choice for the treatment of parotid benign tumor.

Neuroprotective effect of ketone metabolism on brain during times of traumatic brain injury

WANG Huanyu, LIU Baolong, WANG Hong

2016, 16(03):  351-354.  DOI: 10.3969/j.issn.1009-976X.2016.03.029

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【Abstract】〓Traumatic brain injury could resulted in hypoxia-ischemia of brain tissue. It would lead to a series of pathophysiological changes,.including secondary inflammation,.cephalophyma, encephaledema, increased intracranial pressure..Secondary brain injury is the primary cause of deterioration of diseases and death or disability of patients..The post traumatic glucose metabolic disturbance can worsen the metabolic condition of neuron. Ketone diet is a diet therapy with high fat, low carbohydrates and protein. The energy source of body comes from lipometabolism instead of carbohydrates. The ketogenic diet had been applied in clinical antiepileptic therapy. The late research demonstrates that ketogenic diet post-traumatically could affect the neuron apoptosis. It could also alleviate the brain edema to protect the neuron. In this paper, we would review the neuroprotective effect of ketone metabolism on brain post traumatic brain injury.

Evidence-based management of anticoagulant therapy for general surgical patients

LUO Bin, XU Jia

2016, 16(03):  354-356.  DOI: 10.3969/j.issn.1009-976X.2016.03.030

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【Abstract】〓Whether the general surgical patients should receive postoperative routine anticoagulation therapy is still more controversial, although it is suggested and discussed in many literatures because there is a risk of postoperative thromboembolism. But less general surgeon accept into the actual clinical practice until there is evidence of prompt infarction. Then this article will review the evidence-based management of anticoagulant therapy and discuss the anticoagulation-related management problems.

The assessment of postoperative fatigue syndrome

CHEN Hongyan, PANG Fengsun, QIN You

2016, 16(03):  357-360.  DOI: 10.3969/j.issn.1009-976X.2016.03.031

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【Abstract】〓Postoperative fatigue syndrome (POFS) is a common complication after surgery. To date, postoperative fatigue syndrome lacks a universally accepted assessment technique, which is one of the biggest obstacle in POFS study. This review focuses on the progression of these tools towards an as yet unreached ideal that would provide accepted assessment of postoperative fatigue over time. Different levels of fatigue were noted in clinical laboratory values,.at the same time a battery of psychological questionnaires contain the helper function of diagnosis. In short, postoperative fatigue is multidimensional and also no definite examination is available. The combination of multiple methods is necessary for a comprehensive assessment.

The research progress of transforming growth factor-β in the action of tuberculous pleural fibrosis

JIANG Youding, GAO Jianqi

2016, 16(03):  360-363.  DOI: 10.3969/j.issn.1009-976X.2016.03.032

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【Abstract】 Pleural fibrosis is an important pathological change in tuberculous pleurisy progression. At present, most researches focus on the treatment of anti-tuberculosis drugs and pleural fiber-board stripped surgery, howerer the study of the mechanism of tuberculous pleural fibrosis is relatively little. In fact, pleural fibrosis has a more guiding significance for the prognosis of the disease. Studies have found that transforming growth factor beta(TGF-β) had been closely related with the tuberculous pleural fibrosis. This article reviews the role of TGF-β in the tuberculous pleural fibrosis, so as to further improve the theoretical understanding of tuberculous pleural fibrosis.

Giant gastric stromal tumor: one case report

WANG Yiping, WANG Haidong

2016, 16(03):  364-365.  DOI: 10.3969/j.issn.1009-976X.2016.03.033

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Investigation and analysis on summer scientific research program in medical undergraduates

LIU Yanling, WU Chen, ZHENG Dahui, WU Dide, Liu Yanjing, YANG Dongzi, ZHAO Xiaomiao

2016, 16(03):  366-369.  DOI: 10.3969/j.issn.1009-976X.2016.03.034

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【Abstracrt】 Objective To investigate the current status and impact factors of medical undergraduates on summer scientific program. Methods〓A combination of the on-line questionnaire and on-site questionnaire was adopted among those who have took part in the summer scientific program. Results〓As for the school officials, they need to pay more attention to develop kinds of activities to foster abilities in the preparation of the program. And for tutors, they should fulfill their responsibilities in the scientific guidance work. Conclusion〓In the view of medical undergraduates, both the school officials and tutor do indeed need to improve in the summer scientific research program of medical undergraduates.

The application of thinking-mode teaching procedure in surgery clinical practice teaching

ZHAO Guangfeng, ZHU Yifan

2016, 16(03):  370-372.  DOI: 10.3969/j.issn.1009-976X.2016.03.035

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【Abstract】 Objective To explore the effect of thinking method on improving surgery clinical thinking. Methods〓Ninety-eight interns were randomized into thinking-mode teaching procedure based teaching group (thinking mode group) and conventional teaching group (control group). Corresponding steps were performed according to different ways of ward-round in each group. Teaching efficiency was evaluated by comprehensive test and medical record writing. Results〓Compared to conventional teaching group, the students in thinking method group behaved much better in comprehensive test, collecting medical history and writing medical record, and the students of thinking-mode group were more satisfied with the teaching method than those of control group. Conclusion〓Thinking-mode based teaching is better in improving surgery clinical thinking when compared with conventional teaching and this method worth further investigation and popularization.

Influence of comprehensive nursing intervention on psychological status of patients undergoing bowel preparation prior to colonoscopy

TU Lujuan

2016, 16(03):  373-375.  DOI: 10.3969/j.issn.1009-976X.2016.03.036

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Operation of muscle injection at less-than 90 degree of puncture may raise the adverse reactions to diphtheria-pertussis-tetanus vaccine

YANG Suhua, XU Xiaoli

2016, 16(03):  375.  DOI: 10.3969/j.issn.1009-976X.2016.03.037

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【Abstract】〓Objective〓To investigate the adverse reactions of diphtheria-pertussis-tetanus vaccine by muscle injection at less-than 90 degree of puncture. Methods〓This is a prospective study in which 933 with age feom 18 months to 24 months were divided in two groups, observation group (n=466) and control group (n=467). The vaccinee in observation group were treated by muscle injection at a vertical puncture way, while those in control group by muscle injection at less-than 90 degree of puncture way. The adverse reactions were recorded and analyzed. Results〓The adverse reactions occurred in 23 cases (23/466, 4.94%) in observation including fever in 11, and local red and swelling hard nodes induced by muscular injection in 12 cases. In control group, there were 44 cases of adverse reactions (44/467, 9.42%), fever in 24, and local red and swelling hard nodes induced by muscular injection in 20 cases. The difference between two groups had statistical significance(P=0.008). The FLACC scores in observation group were lower those in control group (P<0.05). Conclusion〓Carrying out the standard operating instructions of DPT vaccine is propitious to reduce the adverse reactions.