Table of Content

20 August 2016, Volume 16 Issue 04

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Clinical effect of interventional therapy for the treatment of acute hemorrhage after upper digestive tract reconstruction

CHEN Dong, SUN Hongliang, JIANG Xiongying, LUO Jianghong, CHEN Yaoting, NI Jiayan, WANG Weidong, ZHOU Jingxing, XU Linfeng

2016, 16(04):  377-379.  DOI: 10.3969/j.issn.1009-976X.2016.04.001

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【Abstract】 Objective〓To explore the clinical effect of interventional therapy for acute hemorrhage after upper digestive tract reconstruction. Methods〓The clinical data of 22 patients with acute hemorrhage after upper digestive tract reconstruction, who accepted intervention therapy between Jan 2013 and Dec 2015, was analyzed retrospectively. The bleeding lesions included gastroduodenal artery(11 cases), inferior pancreaticoduodenal artery (5 cases), dorsal pancreatic artery (3 cases), hepatic general artery (2 cases), right gastric artery (one case). Results〓All of 22 patients stopped bleeding after interventional therapy of the responsible artery with the success rate of hemostasis being 100%. No complications and no recurring hemorrhage occurred in the follow-up 5 to 24 months. Conclusion Interventional therapy is quite effective for acute hemorrhage after upper digestive tract reconstruction and has the advantages of safety, small trauma, effectiveness, and good prognosis.

Diagnosis and treatment of pancreatic fistula and delayed hemorrhage after pancreatoduode-nectomy

WU Jianwu, QIN Ancheng, QIAO Zhiming, HUANG Bo, JIANG Xinwei

2016, 16(04):  380-382.  DOI: 10.3969/j.issn.1009-976X.2016.04.002

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【Abstract】 Objective〓To review the experience for the diagnosis and treatment of pancreatic fistula complicated with delayed intra-abdominal bleeding after pancreaticoduodenectomy. Methods〓We summarized the experience for the diagnosis and treatment of pancreatic fistula complicated with delayed intra-abdominal bleeding in 3 cases who subjected to pancreaticoduodenectomy. Results Among the three patients who developed pancreatic fistula accompanied with delayed intra-abdominal bleeding after pancreaticoduodenectomy,.one patient was cured with interventional therapy,.one patient was complicated with abdominal infection after interventional therapy and had debridement of abdominal cavity with pancreatectomy,.and the other one was discharged with surgical suture and ligation for rebleeding after two failed endovascular embolization treatment. Conclusion〓Intervention combined with surgical treatment is an important way for pancreatic fistula complicated with delayed intra-abdominal bleeding after pancreaticoduodenectomy.

Investigation in the integrated combination of ultrasound elastography and conventional ultrasonography for differentiating benign and malignant hepatic tumors

ZHOU Xinchuan, HAO Shaoyun, OU Bing, ZHI Hui, LUO Baoming

2016, 16(04):  383-386.  DOI: 10.3969/j.issn.1009-976X.2016.04.003

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【Abstract】 Objective〓To investigate the method of combination of ultrasound elastography and conventional ultrasonography for differentiating benign and malignant hepatic tumors. Methods Comprehensive creteria consisting of diameter, echogenicity, elastic score and strain of hepatic tumors was established for distinguishing benign and malignant hepatic tumors. Results Comprehensive creteria for diagnosis bear a sensitivity of 87.9%, a specificity of 97.8% and an accuracy of 93.9%, higher than that of other valuables (P<0.05). Conclusion It may be probable to differentiate benign and malignant tumors more accurately and objectively by the integrated combination of ultrasound elastography and conventional ultrasonography.

Short-term outcomes and prognosis of laparoscopic versus open resection for colorectal cancer in elderly patients

LIU Feng, YANG Weijin, TIAN Ye, SUN Zheng

2016, 16(04):  386-390.  DOI: 10.3969/j.issn.1009-976X.2016.04.004

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【Abstract】〓Objective〓To explore short-term outcomes and prognosis of laparoscopic versus open resection for colorectal cancer in elderly patients. Methods〓The clinicopathological and follow-up data of elderly patients with colorectal cancer in the No.1 People's Hospital of Guangzhou from Jun..2003 to Dec..2013 were analyzed retrospectively,.and operative and oncological outcomes were compared respectively between two groups. Results〓A total of 104 patients were included in the study. Sixty-three patients underwent laparoscopic surgery,.whereas 41 underwent open surgery..There were no statistically significant differences of baseline data and follow up period between laparoscopic surgery and open surgery group..Compared with the open surgery group,.the laparoscopic surgery group showed significantly less blood loss,.postoperative activity time,.earlier resumption of an oral diet..No significant differences were observed in overall mortality, cancer-related mortality and recurrence rate. As survival analysis showed,.there were no significant differences in cumulative overall survival, cancer-related survival and recurrence-free rates. Conclusion Laparoscopic surgery in elderly colorectal cancer patients is superior to open surgery in terms of short-term outcomes and not inferior to open surgery in terms of overall survival.

Expressions and its role of miR-20b in breast cancer

TANG Wei, YE Xigang, PAN Lingxiao, GAO Jin, CHEN Lun, Zhang Xiaoshen, ZHENG Wenbo

2016, 16(04):  391-396.  DOI: 10.3969/j.issn.1009-976X.2016.04.005

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【Abstract】〓Objective〓To investigate the expressions of miR-20b in breast cancer and its role in breast cancer cells in vitro. Methods〓Total RNA from 134 breast cancer tissues were isolated for miR-20b quantitative analysis by real-time RT-PCR. The associations between miR-20b expression levels and clinicopathological features were analyzed. Breast cancer cells were transfected with miR-20b inhibitors,then CCK-8 and flow cytometry methods were used to detect the proliferation and apoptosis of the cells. Results〓The expression of miR-20b was up-regulated in breast cancer tissues compared with those in adjacent tissues (P<0.001). There was a significant correlation between miR-20b expression and tumor stage,distal metastasis and Ki67 expression (P<0.05). High miR-20b expression was positively correlated with shorter DFS and OS (P<0.05). The down-expression of miR-20b resulted in decrease in the rate of cell proliferation and increase in cell apoptosis. Conclusion〓Higher miR-20b is associated with poor prognosis of breast cancer and may serve as independent prognostic markers for breast cancer cells.

Meta-analysis of the correlation between XRCC1 Arg194Trp polymorphism and genetic susceptibility of colorectal cancer

HUANG Shengxin, ZHOU Jun, LI Yingru, PENG Qiquan, XIE E, WANG Xiaozhong

2016, 16(04):  396-401.  DOI: 10.3969/j.issn.1009-976X.2016.04.006

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【Abstract】 Objective〓To explore the relationship between the polymorphism of X-ray cross complementing group 1 (XRCC1) Arg194Trp and genetic susceptibility of colorectal cancer (CRC). Methods〓All eligible case-control studies on the relationship between the polymorphism of the XRCC1 Arg194Trp and CRC in Chinese population were searched in both English and Chinese databases. Odds ratio (OR) with 95% confidence interval (CI) was used to assess the strength of this association. All analyses were conducted in Stata 12.0. Results〓A total of 11 case-control studies with 2710 cases and 3567 controls on XRCC1 Arg194Trp were included the Meta-analysis, and significant increased risks were found in additive models [(T vs C): OR (95%CI)=1.18 (1.01-1.39), P=0.036], homozygote comparison [(TT vs CC): OR (95%CI) =1.39 (1.02-1.90), P=0.038], Dominant models [(CT/TT vs CC): OR (95%CI) =2.24 (1.78-2.82), P<0.001], and recessive models [(TT vs CT/CC): OR (95%CI)=1.23 (1.02-1.49), P=0.030]. No publication bias was found in all genetic model. Conclusion〓In Chinese population, individuals carrying mutation allele T or homozygous mutation TT may have an increased risk of developing CRC, furthermore, individuals with the CT/TT genotype significantly increased the risk of suffering from CRC.

Continuous regional intra-artery perfusion in the treatment of severe lipid-induced acute pancreatitis

ZHENG Yu, LI Zhiwei, JIN Shu, LI Qiong, WANG Yuanxi, LUO Mingjian, KE Shaobiao, ZHANG Qing

2016, 16(04):  402-406.  DOI: 10.3969/j.issn.1009-976X.2016.04.007

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【Abstract】〓Objective〓To investigate the effect of continuous regional artery perfusion (CRAI) on treating acute severe lipid-induced pancreatitis. Methods〓Forty-three patients with severe lipid-induced pancreatitis patients admitted to our hospital from January 2013 to May 2016 were assigned to two groups, CRAI group (n=23) and control group (n=20). The patients of CRAI group received conventional treatment combined with conventional treatment and controls were performed the conventional treatment protocol alone. The levels of white blood cell count, amylase, blood sugar, blood calcium were collected in two groups and compared between two groups. The abdominal pain relief time, serum amylase recovery time, the hospitalization stay and expenses, peripancreatic infection incidence of pancreatic pseudocyst were compared between two groups. Results〓In CRAI group, the levels of serum amylase, urinary amylase, blood glucose on the sixth day, the first ten days of recovery were faster back to normal than that in conventional group, so did the blood calcium recovery time. Abdominal pain relief time, hospitalization stay, incidence of infection, pancreatic pseudocyst, pancreatic drainage in CRAI group were decreased than in normal group. Two cases were dead in control group and there were no death in CRAI group. Conclusion〓In the present study, CRAI was demonstrated a good efficacy in the treatment of severe acute pancreatitis, selected as an alternative treatment plan in combination with treatment protocol.

The treatment of acute biliary pancreatitis and the opportunity of operation,an experience report

WANG Desheng, FENG Ping

2016, 16(04):  410-412.  DOI: 10.3969/j.issn.1009-976X.2016.04.009

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【Abstract】〓Objective〓To investigate the treatment of acute biliary pancreatitis and the opportunity of operation. Methods〓The clinical data of 198 ABP patients admitted to the department of general surgery, the First People's Hospital of Zhaoqing city from June 2012 to June 2015 were reviewed. Results〓A total of 198 cases were included in the study and subjected to surgery. Of them, Eight patients recovered after conservative treatment; 138 cases of mild ABP cases were performed surgery for bile duct stones at the first admission; Twenty-eight cases of severe ABP patients received expectant treatment for 3-4 weeks before surgical procedure at the first admission; Twenty-two cases of severe obstructive ABP were treated by emergent endoscopic intervention for biliary drainage due to failed expectant treatment and surgical procedure at two admissions in 1-3 months; Two cases of obstructive cholangitis complicated with acute severe cholangitis were subjected to surgery and one cured, another was dead of severe abdominal and pulmonary infection. The patients were treated with open surgery, endoscopic intervention or laparoscopic operation according to the condition of the patients. Conclusion Based on the AP classification, biliary obstruction, and severity of pancreatitis cholangitis, to decided the surgical the timing and approach.

Case management of breast cancer promote the completion for chemotherapy--an investigation

WANG Hong

2016, 16(04):  413-415.  DOI: 10.3969/j.issn.1009-976X.2016.04.010

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【Abstract】〓Objective〓To evaluate the effect of case management model of breast cancer on improving the completion rate of chemotherapy in h breast cancer. Methods〓Ninety-five breast cancer patients were received routine medical treatment and nursing care in the treatment as the control group in our hospital from August 2011 to July 2013. Ninety-six breast cancer patients were performed a case management model and conventional medical treatment and care as experimental group from August 2013 to July 2015. According to NCCN guide, patients in the two groups underwent postoperative chemotherapy treatment. The completion rate of chemotherapy in the two groups were analyzed. Results Eighty-three cases in control group completed chemotherapy, another 12 patients did not complete chemotherapy. Ninety-four cases in experimental group completed chemotherapy, two patients did not finish chemotherapy protocol. The difference between the two groups was statistically significant (P<0.05), reflecting the case management model group was better than the control group. Conclusion〓The application of case management model can effectively improve the completion rate of chemotherapy in patients with breast cancer.

The retrospective analysis of clinicopathological characteristics and prognosis on 85 young breast cancer

PENG Yonghui, HAN Zheng, XIE Zhihua, GONG Duhui, NIE Xiangyang

2016, 16(04):  416-419.  DOI: 10.3969/j.issn.1009-976X.2016.04.011

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【Abstract】〓Objective〓To investigate clinicopathological characteristics of young breast cancer and its effect on clinical prognosis. Methods〓In this study, 85 cases of young breast cancer (≤35 years) in our hospital were treated as the youth group, 98 cases (>35 years) in the same period were recruited as the older group. The data, including clinicopathological characteristics, estrogen receptor (ER) and progesterone receptor (PR), Her-2 expression, P53 expression aspect, axillary lymph node metastasis and postoperative 5-year disease-free survival,were analyzed. Results〓There was no significant difference on pathological type, histological grade and clinical stage between the young and the older group (all P values >0.05). There was a significant difference on terms of estrogen receptor (ER), progesterone receptor (PR), Her-2 expression and axillary lymph node metastasis (all P values<0.05), except for P53 expression (P>0.05). The differences of postoperative 5-year disease-free survival in the two groups was statistically significant. Conclusion〓Young breast cancer has characteristics of more aggressive,earlier lymph node metastasis and lower postoperative 5-year disease-free survival compared to the older group, indicating that the early detection and standardized treatment is the best way to improve the prognosis.

Preliminary clinical analysis of bone marrow metastasis

LUO Xingxi, LI Junxun, ZENG Yujie, LAI Wenxing, XU Heyang, HUANG Yongliang, WU Heng

2016, 16(04):  420-423.  DOI: 10.3969/j.issn.1009-976X.2016.04.012

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【Abstract】 Objective〓To investigate the clinical characteristics of bone marrow metastasis. Methods〓The complete information of 156 cases with bone marrow metastasis was collected from the First Affiliated Hospital of Sun Yat-sen Memorial Hospital and the First Affiliated Hospital and the Third Affiliated Hospital of Sun Yat-sen Hospital from 2002 to 2014. Results〓The average age of the 156 cases was 61 year old. The most common symptoms were anemia (121 cases,77.6%) and bone pain (98 cases,62.8%). Biochemical examination showed raised levels of serum alkaline phosphate (97 cases,62.2%) and lactate dehydrogenase (72 cases,46.2%). 108 cases showed hyperplasia of bone marrow, and 22 cases presented reduced proliferation. Most cases could survive less than one year. A total of 119(76.3%) cases with metastasis tumors were found premary sites. Conclusion〓In the present group of patients with bone marrow metastasis, most usually appeared anemia and bone pain, alkaline phosphate and lactate dehydrogenase were often increased. Patients always had poor prognosis and needed to be diagnosis early.

Comparative evaluation of Narcotrend index in preschool children during laparoscopic surgery

MENG Ligang, MA Xinggang, ZHOU Nawu, ZHENG Limin

2016, 16(04):  423-427.  DOI: 10.3969/j.issn.1009-976X.2016.04.013

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【Abstract】〓Objective〓To explore the sensitivity of the Narcotrend index, Bispectral index and Entropy index in the preschool children during subjected to laparoscopic surgery. Methods〓120 cases of children undergoing elective laparoscopic surgery were chosen and were assigned to 4 groups, Narcotrend index group (N group, n=30), Bispectral index (B group, n=30), Entropy index (E group, n=30) and control group (D group, n=30). After standard intravenous anesthesia induction, the endotracheal tube was inserted for mechanical ventilation,and then inhaled sevoflurane and infused remifentanil to maintain anesthesia. The MAP, SpO2, HR, NTI, BIS, entropy index were recorded in each observation stage between entrance in and out operation room. The operation time, time from stopping infusion drugs to breathe spontaneously were recorded. The dosage of sevoflurane and remifentanil was calculated. Results〓In N group, N value was increased in T3 T4 and T9 moment than in T2 moment (all P values<0.05). Compare with other groups, the recovery time of spontaneous breathing of NTI group was shortened (all P values<0.05), and the dosage of sevoflurane and remifentanil of NTI group was reduced (all P values<0.05). Conclusion〓In preschool children for laparoscopic surgery, Narcotrend index hand the advantage to both bispectral index and entropy index in monitoring anesthesia depth sensitivity, as well as the smaller dosage of anesthetic drugs, shorten the time of awakening, smaller PRST fluctuations.

Clinical diagnosis and treatment experience of large goiter

WANG Bozhi, LI Tingjian, WENG Shaotao, CHEN Zhaocheng, LU Xuqiang

2016, 16(04):  428-431.  DOI: 10.3969/j.issn.1009-976X.2016.04.014

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【Abstract】〓Objective〓To review the experience of perioperative management for large goiter disease. Methods〓Sixty-seven cases with large goiter from January 2011 to 2014 June were analyzed retrospectively. All patients were performed surgical treatment under general anesthesia. Results〓All operation were completed smoothly and the patients got recovery..Temporary functional disorder of nervus laryngeus superior appeared in 3 cases,and hypocalcemia appeared in 5 cases..The complications were getting good in 3 months after operation..The pathological results of 34 cases showed Graves' disease, 23 cases nodular goiter with fibrosis and calcification, 3 cases toxic nodular goiter; 3 cases nodular goiter with chronic thyroiditis, 2 sases thyroid follicular carcinoma, 2 cases thyroid adenoma..Conclusion〓The key factors for the operation are associated with sufficient preoperative preparation, good surgical exposure and fine operation.

Clinical observation of nasal endoscopic-assistant thyroidectomy with small-incision in neck for patients with benign tumor of the thyroid

SHI Chengming, CHEN Xinglin, WANG Guanbo, LI Zhi

2016, 16(04):  432-435.  DOI: 10.3969/j.issn.1009-976X.2016.04.015

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【Abstract】 Objective To summarize up the experience and clinical effect of the nasal endoscopic-assistant thyroidectomy with minimal incision in neck and to compare with the conventional open thyroidectomy. Methods〓Sixty-two patients with benign thyroid tumor (less than 4 cm) underwent thyroid surgery by using nasal endoscopic-assistant minimally invasive anterior cervical approaches with small incision (endoscopic group, n=33) and conventional thyroidectomy (conventional open group,n=29). The clinical data were analyzed respectively. Results〓Operations were performed successfully in all cases without severe complications..Compared with the conventional group,.endoscopic group was taken longer operation time but less blood loss,shorter scar and less post-surgery pain. Conclusion〓Nasal endoscopic-assistant thyroidectomy with minimal incision has advantages of superior cosmetic results, less bleeding and less post-surgery pain.

Analysis of the therapeutic effect of lauromacrogol for infant oral and maxillofacial hemangioma

LIN Zhili, LIANG Jianping, HUANG Lei, BAI Zhibao

2016, 16(04):  436-438.  DOI: 10.3969/j.issn.1009-976X.2016.04.016

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【Abstract】〓Objective〓To investigate the effect of lauromacrogol for oral and maxillofacial hemangioma. Methods〓Ninety patients with oral and maxillofacial hemangioma were assigned to four groups including sodium morrhuate,bleomycin,lauromacrogol group. The clinical effects and adverse reactions were observed in three groups. Results〓In sodium morrhuate group, 10 cases were cured, 15 cases were markedly effective, 3 case effective, 2 cases lost. In bleomycin group, 11 cases were cured, 10 cases were markedly effective, 6 cases effective, 3 cases lost. In lauromacrogol group 18 cases were cured, 7 cases were markedly effective, 3 cases effective, 2 cases lost. There were statistical differences between effective treatment and adverse reactions such as abdominal discomfort and low fever. Conclusion〓In the treatment of oral and maxillofacial hemangioma, lauromacrogol is characterized by explicit therapeutic effects, few side effects and less adverse reactions, so it deserves to be popularized and applied in clinical practice.

CT manifestations of gastrointestinal neuroendocrine neoplasm

WU Zhe, CAI Jiuming, CHU Zhonghua, ZHANG Jianlong, ZENG Yujie, SUN Jian, GAO Ming

2016, 16(04):  439-442.  DOI: 10.3969/j.issn.1009-976X.2016.04.017

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【Abstract】 Objective To investigate the CT findings of gastrointestinal neuroendocrine neoplasm and improve the preoperative diagnosis of the disease. Methods〓Thirty-four patients with pathologically diagnosed with gastrointestinal neuroendocrine neoplasm were retrieved from hospital records between Jan. 2013 and Dec. 2015. For these cases, CT findings, the manifestations, and CT feature based on different histopathological classifications were studied. Results〓Twenty-two of 34 gastric neuroendocrine tumors were men, and 12 cases were women. Eighteen cases occur in the stomach, 2 cases in duodenum, 14 cases in colorectum. For WHO Grade, 6 cases were G1 grade (including 1 case in the stomach, 1 case in duodenum, 4 cases in colorectum), 7 cases were for G2 grade (2 cases in the stomach, 1 case in duodenum, 4 cases in colorectum), 21 cases were for G3 grade (15 cases in the stomach,6 cases in colorectum). Conclusion〓CT appearances of gastrointestinal neuroendocrine neoplasm showed characteristics in different clinical and histologic classification, while the diagnostic and tumor stage of the disease was important.

Clinical efficacy of endoscopic extraperitoneal reset combined with TEP on treating irreducible inguinal hernia

CHEN Xin, WANG Zhitao, ZENG Shangming, LU Yi

2016, 16(04):  443-446.  DOI: 10.3969/j.issn.1009-976X.2016.04.018

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【Abstract】 Objective〓To summarize up endoscopic extraperitoneal reset combined with TEP treating for inguinal irreducible hernia. Methods〓From March 2012 to November 2015,48 patients with irreducible inguinal hernia were performed modified laparoscopic totally extraperitoneal hernia repair in our hospital (observation group). And the other 50 cases of irreducible inguinal hernia in same period were performed with open mesh plug hernia repair (control group). The clinical effect of both groups were analyzed in two groups. Results〓Operation time of control group was shorter than that of observation group, and. blood loss, ambulation time, hospital stay, duration of pain in the observation group were significantly lower than those in the control group, and the differences were statistically significant. The postoperative complications was 6.25% in the observation group, and 22.00% in the control group (P<0.05). Conclusion〓The clinical application of extraperitoneal reset endoscopic combined with TEP for treating inguinal irreducible hernia is feasible, which has the advantage to open operation. And our results in the study is in line with literature reports.

Comparison of efficacy in abdominal incisional hernia repair by laparoscopic surgery versus open mesh repair

WANG Yang, LIU Jianping, SU Zheng, ZHANG Ketao

2016, 16(04):  447-450.  DOI: 10.3969/j.issn.1009-976X.2016.04.019

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【Abstract】 Objectives〓To investigate the effect of laparoscopic surgery and open surgery on abdominal wall incisional hernia repair. Methods〓The clinical data of 120 patients who underwent abdominal wall incisional hernia repair operations from January 2010 to October 2015 was analyzed retrospectively. The patients were assigned to laparoscopic group (30 cases) and open surgery group (28 cases). Operation time, postoperative hospitalization, bleeding volumes, complications and recurrence were compared and analyzed. Results〓The operation time, postoperative hospitalization, bleeding volumes and complication in laparoscopic group were significantly lower than that in open surgery group (P<0.05). Conclusion〓Outcomes in our study showed laparoscopic incision hernia repair was safe and reliable with less damage, shorter hospitalization, fast postoperative recovery, shorter operation time and less complications.

Comparative evaluation of different surgical procedures in high-risk patients with benign prostatic hyperplasia

HUANG Jiantuan, HUANG Jianmou, OU Yongyue, LIN Yaobin

2016, 16(04):  450-453.  DOI: 10.3969/j.issn.1009-976X.2016.04.020

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【Abstract】〓Objective〓To summarize up the experience of transurethral enucleation of the prostate (TUEP) and compare the clinical effect between transurethral resection (TURP) and TUEP in the treatment of high-risk patients with benign prostatic hyperplasia. Methods〓The data of 80 cases with high-risk patients with benign prostatic hyperplasia from February 2012 to February 2015 were analyzed retrospective, in which 40 cases were performed TUEP (TUEP group) and 40 cases received TURP (TURP group). Results〓The operative time, intraoperative blood loss, postoperative indwelling catheter time of patients in of TUEP group were decreased than those of TURP group (55.4±6.8 min vs 72.5±7.2 min, 195.4±17.3 ml vs 253.7±26.8 ml, 5.2±1.4 d vs 7.3±2.1 d, all P values were less than 0.05), and excised weight were greater than TURP group (69.4±4.2 g vs 55.4±3.7 g, all P values were less than 0.05). Post-operative IPSS, Qmax, PV in TUEP group were significantly improved than those in TURP group 5.4±1.2 vs 8.9±2.0, 22.7±2.3 ml/s vs 17.9±1.8 ml/s, 10.3±2.1 ml vs 16.7±2.3 ml, all P values were less than 0.05). Urinary incontinence, secondary bleeding in TUEP group were lower than that in TURP group (5.0% vs. 17.5%, 2.5% vs 15.0%, all P values were less than 0.05). Conclusion〓Compared with conventional TURP, TUEP was illuminated the better clinical effect. And it conforms to the literature report.

The clinical observation of the Zuckerkandl tubercle and its significance in detecting the recurrent laryngeal nerve

WU Luyang, TANG Shibin, YE Jian

2016, 16(04):  454-457.  DOI: 10.3969/j.issn.1009-976X.2016.04.021

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【Abstract】 Objective To investigate Zuckerkandl tubercle and its anatomical relationship with the recurrent laryngeal nerve (RLN). Methods〓102 consecutive thyroid surgeries were included in the prospective study. The presence of the ZT, its size, and relationship to the RLN were recorded. Results〓A total of 124 thyroid lobes were included in the study. ZT was identified in 62.9% of all thyroid lobes. The median size was 9.5 mm (range 3-40 mm). There is no difference in the probability that ZT was identified on the right (68.2%, 45/66) or the left side (56.7%, 33/58, P>0.05). When ZT was present, the RLN was found deep to the ZT in 97.4% of cases. Conclusion〓In our study, ZT was present in the majority of thyroid lobes. And ZT may be a real constant landmark pointing to the RLN. In order to find and protect RLN during thyroid surgery, a careful, bloodless, and meticulous dissection should be carried out around the Zuckerkandl tubercle.

The distribution of bacteria infected by urinary tract in adolescent patients and the analysis of drug resistance ability

WU Bin

2016, 16(04):  457-459.  DOI: 10.3969/j.issn.1009-976X.2016.04.022

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【Abstract】 Objective〓To investigate the bacterial distribution and drug resistance of urinary tract infection in adolescent patients. Methods〓From July 2014 to July 2015, 44 patients (aged between 18 and 20) with urinary tract infections were assigned as research subjects. Urine specimen were collected in the middle of urination for urine culture. A total of 1382 isolated bacterial colonies were found. The kinds of pathogens responsible for urinary tract infection,bacterial distribution,antimicrobial susceptibility and resistant strains were analyzed. Results〓The causative organisms included gram-positive bacteria 20.12%, 3.04% fungi, Gram-negative bacteria 76.85%. Most of the bacteria were E.faecium and E.faecalis in the detected gram-positive bacteria (76.91%), E.coli and Pseudomonas aeruginosa in the detected gram-negative bacteria(73.54%),Candida parapsilosis and Candida albicans in the detected fungi. Staphylococcus aureus was the highest resistant to Ciprofloxacin, and E.faecium was to ofloxacin, E.faecalis was to clindamycin,E.coli was to ceftriaxone,pseudomonas aeruginosa was to aztreonam,klebsiella pneumoniae was to Ceftriaxone,citrobacter was to Ciprofloxacin. Conclusion〓As for the young bacterial urinary tract infection patients,Gram-negative bacteria was the main drug-resistant pathogens, especially Escherichia coli.

The influence of total extraperitoneal herniorrhaphy on testicular blood flow and serum testosterone

LIN Qimou, LI Yong, ZHOU Yi

2016, 16(04):  460-464.  DOI: 10.3969/j.issn.1009-976X.2016.04.023

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【Abstract】〓Objective〓To investigate the totally extraperitoneal laparoscopic tension-free inguinal hernia repair (TEP) and its influence on testicular hemodynamics. Methods〓Sixty-six cases with unilateral inguinal hernia were enrolled in a prospective internally controlled cohort study, and were performed totally laparoscopic extraperitoneal tension-free inguinal hernia repair (TEP). Pre- and post-operative blood flow parameters of bilateral testicular arteries, including peak systolic velocity (PSV), end diastolic velocity (EDV), testicular volume and plasma testosterone level were studied and compared. Results〓In pre-operation of 48 hours, there were no statistical differences in PSV, EDV and testicular volume between the both side (all P values >0.05). In post-operation of 48 hours and two weeks after operation,PSV、EDV and testicular volume of the affected side were significantly lower than that of the other side (all P values <0.05). PSV, EDV and testicular volume were not significantly different in one month after operation. There were no statistically significant differences in plasma testosterone level in pre-operation of 48 hours, post-operation of 48 hours, 2 weeks after operation and one month after operation. Conclusion〓Testicular hypotension occurred in two weeks after TEP procedure on the affected side, and improved in 1 month later. Plasma testosterone level were not influenced.

Experience of transurethral plasma prostatic enucleation in treatment of elderly patients with benign prostatic hyperplasia

WU Zhiqiang, HAN Jinli, LAN Biwen, LING Yun

2016, 16(04):  465-467.  DOI: 10.3969/j.issn.1009-976X.2016.04.024

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【Abstract】〓Objective〓To review the experience of transurethral plasma prostatic enucleation on the time index, complications and life quality for elderly patients with benign prostatic hyperplasia. Methods〓The clinical data of 96 elderly patients with benign prostatic hyperplasia who had been admitted to our hospital between January 2015 and January 2016 were selected for retrospective analysis. The patients were divided into two groups according to the different treatment given. Forty-two subjected to transurethral electron resection were assigned as the control group and the other 54 treated with transurethral plasma prostatic enucleation as the observation group. The relevant time index, complications and life quality of patients in the two groups were compared. Results〓Surgical blood loss, operation duration, time for postoperative bladder irrigation and catheter indwelling time in the observation group were less than in the control group (all P values less than 0.05). The maximum urinary flow rate in observation group was not significantly different (P>0.05) when compared to control groups. Incidence of complications in the observation group was 7.41%, lower than the 23.81% in the control group (P<0.05). The total health scores were improved in both groups, with the improvement in the observation group more significant than the control group (P<0.05). Conclusion〓Transurethral plasma prostatic enucleation is better surgical approach for treatment of elderly patients with benign prostatic hyperplasia.

A one-year clinical observation of tumor palliative resection combined with vertebroplasty for the treatment of metastases in the thoracolumbar spine

YANG Lei, GU Hongsheng, ZHANG Rui, ZHOU Wenyu

2016, 16(04):  468-471.  DOI: 10.3969/j.issn.1009-976X.2016.04.025

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【Abstract】〓Objective〓To assess the surgical treatment and effectiveness for the metastases in thoracolumbar spine which have caused spinal cord compression. Methods〓From 2013 to 2015, there were 19 patients in our hospital with spinal bone metastases and the emergence of neurological dysfunction had accepted the treatments including tumor palliative resection and pedicle screw system fixation combined with bone cement filling vertebral intensive treatment to observe the postoperative quality of life (including pain, sleep, appetite) and the improvement of neurological recovery. Results All surgical procedures were succesfully done,and the spine was stable. The postoperative pain, appetite, sleep was significantly improved (compared with the preoperative P<0.01), and 63% of patients with neurological function was restored at least Frankel 1 level and above. Conclusion Tumor palliative resection combined with vertebroplasty is relatively simple, safe and can effectively improve the life quality of the patients suffered spinal metastases.

Application of a kind of modified vacuum sealing drainage in treatment of severe wounds in limbs

LUO Jie, LU Daowang, CHEN Shunxing, YOU Qin

2016, 16(04):  472-475.  DOI: 10.3969/j.issn.1009-976X.2016.04.026

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【Abstract】〓Objective〓To probe the clinical effect of a kind of modified vacuum sealing drainage in treatment of severe wound in limbs. Methods〓From January, 2013 to September, 2015, 102 cases diagnosed with severe wounds in limbs were enrolled. Based on the treatment, all cases were randomly divided into three groups: conventional treatment, conventional vacuum sealing drainage and modified vacuum sealing drainage. The cases in three groups were 33, 35 and 34, respectively and the number of wound care,.the expenditure of hospitalization,.the length of wound closure and hospital stay were recorded in three groups, as well as the recurrent rate of wound infection. Results〓Compare to conventional treatment group, all of the number of wound care, the expenditure of hospitalization, the recurrent rate of wound infection, the length of wound closure and hospital stay were lower in other two groups. However, the length of wound closure and hospital stay are lower in modified vacuum sealing drainage group than in common vacuum sealing drainage group. Conclusions〓The modified vacuum sealing drainage are better than other two groups. Modified vacuum sealing drainage is an ideal method for severe wounds in limbs.

Effects of edaravone pretreatment on inflammatory cytokines and early stage postoperative cognitive dysfunction in elderly patients undergoing orthopedic surgery

GUO Qiang, ZHANG Yiwen, LV Wenhui

2016, 16(04):  475-479.  DOI: 10.3969/j.issn.1009-976X.2016.04.027

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【Abstract】〓Objective〓To evaluate the effect of edaravone on inflammatory cytokines and early stage postoperative cognitive dysfunction in elderly patients undergoing orthopedic surgery. Methods Sixty patients (ASA I-Ⅲ) aged 65 and over, undergoing hip joint surgery under general anesthesia, were assigned to groups (n=30, each group), control group (group C) and edaravone group (group E). Group E was treated with 30 mg of edaravone plus 100 ml saline for administration of intravenous drip. Group C was use 100 ml normal saline alone. The venous blood samples were drawn after induction of anesthesia (T1), at the end of surgery (T2), 24 hours after surgery (T3). The levels of IL-6, IL-10, TNF-α and S100-β were measured. The cognitive function in all patients at 1 day before surgery and 1 day,7 days after surgery was assessed by using Mini- Mental State(MMSE) test. POCD was defined as the difference between preoperative and postoperative mean MMSE score decline ≥2 points. Results〓Compared with T1, the levels of IL-6, IL-10, TNF-α and S100-β at T2 and T3 were significantly increased (all P values <0.05). The levels of IL-6, TNF-α at T3 in group C, were significantly increased than that in group E (all P values <0.05). Compared with group C, The levels of S100-β in group E at T2 and T3 were significantly decreased (P<0.05, vs group C). Compared with 1 day before surgery, the MMSE score were significantly declined at 1 day after surgery (P<0.05). Compared with group C, the MMSE score were significantly increased in group E at 1 day after surgery (P<0.05). The occurrence rate of POCD in group E were lower than that of group C at 1 day after surgery (P<0.05). Conclusion〓To a certain extent, edaravone could impair inflammatory reaction and reduce the incidence of POCD in elderly patients undergoing orthopedic surgery.

Application of local anesthesia combined CT three-dimensional reconstruction in the second phase of PCNL

LIN Yangyan, QIU Chunming, YANG Yong, SUN Canbiao, ZOU Feng, LI Hulin

2016, 16(04):  480-483.  DOI: 10.3969/j.issn.1009-976X.2016.04.028

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【Abstract】〓Objective〓To explore the clinical value and safety of local anesthesia combined CT 3D reconstruction in the second phase of percutaneous nephrolithotomy. Methods〓Between January 2012 and November 2015, 64 cases of patients with residual stone after PCNL were selected, and analyzed by CT 3D reconstruction, and second phase of PCNL was performed under local anesthesia. The stone clearance rate, security and pain degree were assessed. Results〓Of 64 cases undergoing PCNL, the residual renal stones were removed completely in 60 cases (93.8%), and 4 cases failed and the size of residual stones were less than 4.0 mm. Post-operative pain score included 54 cases in 0 to 3 points (84.4%), 7 cases in 4 to 6 points of (10.9%), and 3 cases in 7 to 9 points(4.7%). No one was transferred to general anesthesia for operation due to unbearable pain or needed open surgery. No serious complications occurred in all patients. The hemoglobin level, renal function and serum electrolytes had not changed obviously. Conclusion〓Management of local anesthesia combined CT three dimensional reconstruction was safe to treating remove residual calculi in the second phase of PCNL.

Dynamic monitoring of bone metabolism, platelet activity and oxidative stress in adolescent patients with fracture

CAI Silin, CHEN Yucheng

2016, 16(04):  483-486.  DOI: 10.3969/j.issn.1009-976X.2016.04.029

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【Abstract】 Objective To investigate the bone metabolism, platelet activation and oxidative stress responses of young patients with bone fracture, and to study its clinical significance. Methods From August 2012 to October 2014, 78 cases of young patients with fracture in our hospital were recorded as the observation group. And then 78 young people for health examination at the same period were recruited as the control group. Serum bone metabolism, platelets activity,oxidative stress, blood lipids of patients were observed in two groups and compared between two groups. Results Serum levels of bone metabolism (OPG, HCT, IGF- II and ALP), Platelet activity (PAC-1, GMP-140, CD61 and CD63) of the observation group at 7 days showed an upward trend, and the overall level was higher than that of the control group. And platelet activating levels returned to normal levels at the 14th days, but the level of bone metabolism continued to rise. In addition, the levels of oxidative stress index (SOD, TAC, CAT and MDA), blood lipid (TC, TG, and HDL-C) of the observation group at 7 days showed a decreasing trend, and the levels were lower than those of the control group. And all returned to normal level at the 14th days. Conclusion〓Fractures in the young patients result in substantial changes in serum levels of bone metabolism, platelet activities and oxidative stress index, which is helpful for deeper study for traumatic fractures.

Effect of oral sulodexide combined with melilotus extract tablet on deep venous thrombosis-related post-thrombotic syndrome

TANG Guang’en, LI Zhiping, HUANG Kai, ZHENG Jiafu, LI Ye

2016, 16(04):  487-489.  DOI: 10.3969/j.issn.1009-976X.2016.04.030

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【Abstract】〓Objective〓To explore the effect of oral sulodexide combined with melilotus extract tablet on post-thrombotic syndrome (PTS). Methods〓Thirty-four cases with PTS were included in the study from March 2015 to December 2015, in which 18 cases were treated with oral sulodexide combined with melilotus extract tablet (observation group) and 16 were taken melilotus extract tablet alone. The clinical effect was evaluated by the Villalta’s score. Results〓The therapeutic effect of subjective symptoms in the suffering limbs, such as symptomatic pain and paresthesia (heaviness, numbness, itching and discomfort) in the observation group had a great improvement as compared with the control group (symptomatic pain: 14/77.78% vs 6/37.5%, P=0.016; paresthesia: 14/77.78% vs 7/43.75%, P=0.040). The objective indicators, including skin irritation and redness, tenderness of gastrocnemius muscle also showed obvious improvement (4/25%, 15/83.33% vs P=0.01). Conclusion Oral sulodexide combined with melilotus extract tablet can facilitate post-thrombotic syndrome to achieve better clinical effect.

Application of percutaneous continuous circumsuture for superficial varicose veins in treatment of great saphenous vein varicosity in the community hospital

WU Zhongli, LIANG Faliang, HUANG Liruo

2016, 16(04):  490-492.  DOI: 10.3969/j.issn.1009-976X.2016.04.031

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【Abstract】 Objective〓To summarize up experience and clinical efficacy of percutaneous continuous circumsuture (PCCS) for treatment of great saphenous vein varicosity in the community hospital. Methods〓A retrospective analysis was conducted on the clinical data of 86 cases of varicosis of great saphenous vein from June 2009 to June 2013. The patients were assigned to tradition group (n=43) and PCCS group (n=43). Patients in tradition group were performed by traditional high ligation and exfoliation procedure. The clinical data of the two groups were compared. Results Superficial varicose veins of lower extremities disappeared in both groups after treatment. There were statistical differences between two groups in operation duration, incision number, blood loss complications and postoperative hospital stay time(all P values were less than 0.05). There was no statistical difference in days of postoperative pain, forced foot and deep veins thrombosis between two groups. Varicose vein recurrence happened on one patient in PCCS group after the average of 34-month-follow up, and no patient got varicose vein recurrence in tradition group during the average of 38-month-follow up. Conclusion〓In the present study, PCCS was demonstrated easy operation, better efficacy,.minimal invasiveness and cosmetic effect for treatment of great saphenousvein varicosity.

The clinical effect of compression stockings on thrombophilia patients with ectopic pregnancy for the prevention on deep venous thrombosis after laparoscopic surgery

LI Zhiping, TANG Guang’en, HUANG Kai, LI Ye, ZHENG Jiafu

2016, 16(04):  493-496.  DOI: 10.3969/j.issn.1009-976X.2016.04.032

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【Abstract】〓Objective〓To explore the clinical effect of compression stockings on thrombophilia patients with ectopic pregnancy for the prevention on the lower extremities deep venous thrombosis after laparoscopic surgery. Methods A total of 132 cases with ectopic pregnancy were subjected to laparoscopic surgery from January 2014 to December 2015. Of them,38 patients were involved in this research,.and was divided into two groups,.the observation group which the compression stockings were on application and the control group which would be not.The incidence of postoperative lower limb deep vein thrombosis and pulmonary embolism,.and postoperative levels in D2 polymers,were respectively compared between the two groups. Results〓The incidence of extremity deep venous thrombosis in the observation group could be lower than that in the control group, which showed the great significance (5.6% VS 35%, P=0.045). However, the incidence of postoperative pulmonary and the levels of D2 polymers had no significant difference in two groups. Conclusion〓Although there is relative insufficiency in the design and sample size in this study, the early postoperative application of compression stockings on the prevention and treatment of lower extremity deep venous thrombosis in thrombophilia patients with ectopic pregnancy after laparoscopic surgery,.would be effective,.and relatively safe.

Effect of pretreatment with hydromorphone on the development of remifentanil-induced hyperalgesia

ZHOU Liangjun, WANG Shouping

2016, 16(04):  496-499.  DOI: 10.3969/j.issn.1009-976X.2016.04.033

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【Abstract】〓Objective〓To investigate the effect of pretreatment with hydromorphone on the development of remifentanil-induced hyperalgesia. Methods〓Sixty patients with ASA I or II were assigned to 3 groups for undergoing spinal operation. All the patients received desflurane inhalation anesthesia and continuous remifentanil infusion during operation. Remifentanil was given by continuous infusion at the rate of 0.2 μg·kg-1·min-1 in all groups. In control group (group C), 0.9% normal saline was administered intravenously 30 min before the end of operation. Fentanyl at a dose of 2 μg/kg was administered intravenously 30 min before the end of operation in group fentanyl (group F). Hydromorphone at a dose of 0.04 mg/kg was administered intravenously 30 min before the end of operation in group hydromorphone (group M). Pain and agitation score and the change of blood sugar were recorded after operation. Results〓Compared with Group C, agitation score at the time of extubation, pain score after extubation and the level of blood sugar were significantly decreased in Group F or M (P<0.05). Compared with Group F, pain score after extubation and the level of blood sugar were significantly decreased in Group M(P<0.05). Conclusion Pretreatment with hydromorphone can alleviate remifentanil-induced hyperalgesia, and the analgesic effect is better than that of equivalent dose of fentanyl.

Analysis of related factors of postoperative cognitive dysfunction after general anesthesia

LIU Weihua, JIANG Jingjing, DU Liangqin, LI Heng

2016, 16(04):  500-502.  DOI: 10.3969/j.issn.1009-976X.2016.04.034

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【Abstract】 Objective〓To observe the related factors of postoperative cognitive dysfunction in patients with non-cardiac surgery after general anesthesia. Method〓267 non-cardiac surgery patients under general anesthesia were included in this study. The patients with POCD were assigned to PD group and those without POCD were served as NPD group. Perioperative information of the patients were recorded. Logistic regression was used in the statistical analysis to the occurrence of postoperative cognitive disorder before and after operation. Results〓Postoperative cognitive disorder was related to age, ASA grade, smoking history, amount of bleeding, premedication, length of operation time, blood transfusion, dosage of remifentanil, dosage of isoflurane, the hypotension of intraoperative period, the hypertension of postoperative period, high VAS scores. Conclusion〓The patients age, length of operation time, the hypotension of intraoperative and the VAS score are the risk factors of postoperative cognitive disorder.

The effect of different decubitus and significance of nursing care on patients with pleural effusion

HUANG Lixia

2016, 16(04):  506-508.  DOI: 10.3969/j.issn.1009-976X.2016.04.036

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【Abstract】〓Objective〓To investigate the postural care on patients with unilateral pleural effusion of blood oxygen saturation and complications. Methods〓Sixty-four patients with unilateral pleural effusion were recruited and assigned to two groups according to fluid volume, small amount of fluid group (A group, n=34) and massive fluid group (B group, n=30). In the quiet situation, patients were taken contralateral supine and ipsilateral supine for 5 minutes in a state without oxygen and suffering. Chest distress, symptoms of chest pain, coughing, dyspnea were observed and recorded. Then the affected side, contralateral position was held in 15 min, respectively. Heart rate at different postures, breathing, blood oxygen saturation, and complications were recorded with EDAN multi-parameter monitor. Results〓There were statistical differences in respiration rate, heart rate, oxygen saturation and complications (chest distress, chest pain, cough and dyspnea) when taking healthy lateral decubitus. When taking the affected side decubitus, the heart rate, oxygen saturation value, chest distress, chest pain, cough were significantly different (P<0.05), while the dyspnea and respiratory rate were not statistically different. Conclusion〓The patients with medium or low level of pleural effusion were advised to take Andral's decubitus, while those who with high level were advised to take affected side decubitus. When decubitus change causes oxygen saturation decline, analyze and turn to proper decubitus.

The application of Shuxuening injection in preventing central venous catheter obstruction

ZENG Jieyi, WANG Min, ZHONG Shufen

2016, 16(04):  509-510.  DOI: 10.3969/j.issn.1009-976X.2016.04.037

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【Abstract】 Objective To investigate the effect of Shuxuening injection on prevention of plugging of central venous catheter. Methods〓The patients were from Intensive Care Unit through July 2013 and June 2015 and a total of 134 cases of indwelling central venous catheter were included for a prospective study. Of them, 65 cases were treated with Shuxuening injection 20 ml daily through intravenous infusion for two weeks (observation group), 69 cases (control group) received routine care. The incidence of central venous plugging was compared between the two groups. Results〓The incidence of central venous catheter plugging in the observation group was significantly lower than that of control group(P<0.05). Conclusion〓Shuxuening injection minimized central venous catheter plugging.

Clinical advantage of endoscopy-assistant laparoscopic procedure in treatment for concomitant gallstone and common bile duct stone

WANG Daodu, HE Yongyue, WAN Deyan

2016, 16(04):  503-505.  DOI: 10.3969/j.issn.1009-976X.2016.04.035

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【Abstract】 Objective To explore the advantages of the combination of three kinds of endoscopies in treatment of gallbladder stone combined with common bile duct stones. Methods〓Eighty-eight cases of patients with gallstone combined with common bile duct stones were selected from the Second People's Hospital of Shanwei from February 2010 to October 2015..The patients were assigned to two groups, EST+LAP group and control group. The patients in EST+LAP group (n=44) were subjected to laparoscopic procedure for treating concomitant gallstone and common bile duct stone by using combining endoscopic sphincterotomy and choledochoscope..The controls were performed common laparoscopic cholecystectomy and exploration of the common bile duct..The clinical effects were compared between two groups. Results〓There were no statistical differences in the rates of transfer to open operation, residual stone and postoperative complications between two groups. The operative time, blood loss, postoperative hospitalization time in EST+LAP group were lower than those in the control group (all P values less than 0.05). Conclusion〓EST-assistant laparoscopic procedure for treating gallbladder stone combined with common bile duct stones has obvious advantages to traditional surgical method.