Table of Content

20 February 2017, Volume 17 Issue 01

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The application and evaluation of robot?assisted surgery for portal hypertension

HE Chuanchao，XIAO Zhiyu，ZHANG Jianlong，MAO Kai，WANG Jie

2017, 17(01):  1-4.  DOI: 10.3969/j.issn.1009?976X.2017.01.001

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【Abstract】 Esophagogastric devascularization with or without splenectomy is the main choice of surgical treatment for portal hypertension. In recent years, as the concept of minimal invasive surgery and the surgical technology developing，laparoscopic splenectomy plus esophagogastric devascularization， an original and promising surgical procedure creating by academics of our country, is gradually accepted by academics at home and abroad. However，this procedure is limited by the situation of splenomegalia and poor coagulation status. Moreover, the visual field and operating space during laparoscopy is not satisfying. Hence splenectomy plus esophagogastric devascularization using laparoscope is still a high?risk and high?challenge procedure. Da vinci surgery system can effectively make up for the disadvantage of laparoscopy in visual field and operating space, which make minimal invasive surgery for portal hyperten?sion safer and more practicable. Here，we summarize two cases of portal hypertension treating with Da vinci surgery system，and provide our initial experiences.

MiR?223 inhibitor promotes the M2 polarization of macrophage

YANG Limei, YAO Heri, LIU Yujie

2017, 17(01):  5-10.  DOI: 10.3969/j.issn.1009?976X.2017.01.002

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【Abstract】 Objective To investigate the expression and roles of miR?223 in regulating M2 polarization of macrophage. Methods The expression of miR?223 was detected by using qPCR. The phenotype of miR?223 adjusted macrophage was assayed by flow cytometry and Elisa. The ability of MDA?MB?231 cell migration was evaluated by transwell and wound?healing assay. Results MiR?223 was highly expressed in monocytes than in breast cancer cells. The expression of miR?223 was downregulated during monocytes differentiation stimulated by Lipopolysaccharides （LPS），IL?4 or cocultured with MDA?MB?231 cells. And the extent of miR?223 decrease in IL?4 and coculture group was greater than that in LPS treated group. Knockdown of miR?223 level increasesd the expression of M2 type macrophage markers CCL18，IL?10 and CD206，as well as the motility of cocultured MDA?MB?231 cells. Conclusion MiR?223 could serve as a potential target to improve tumor microenvironment and prevent breast tumor metastasis.

Analysis of influencing factors to non?sentinel lymph nodes in breast cancer patients with 1 or 2 positive sentinel lymph nodes

CAO Tengfei, TANG Tian, XU Qingya, JIANG Haihan, JIA Haixia, ZHANG Lehong

2017, 17(01):  11-14.  DOI: 10.3969/j.issn.1009?976X.2017.01.03

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【Abstract】 Objective To evaluate the correlation between non?sentinel lymph nodes（nSLN） metastasis and clinic?pathologic features in primary breast cancer patients with 1 or 2 sentinel lymph nodes（SLN） metastasis. Methods Retrospectively analyzed clinical and pathological data of 118 primary breast cancer patients with 1 or 2 positive sentinel lymph nodes and axillary lymph nodes dissection in The 2nd Affiliated Hospital of Guangzhou Medical University. Chi-square test and Logistic regression were used for univariate and multivariate analysis separately. Results 45.8%（54/118）of all patients with positive non?sentinel lymph nodes metastasis. Univariate analysis revealed nSLN metastasis was associated with tumor size, intravascular tumor thrombus and ratio of SLN metastasis（all P values less than 0.05）. Multivariate analysis showed that tumor size , intravascular tumor thrombus and ratio of SLN metastasis were independent influencing factors of nSLN metastasis（OR=3.159, 2.425, 2.258, all P values less than 0.05）. Conclusion In 1 or 2 positive SLN breast cancer patients with tumor size≥2 cm, intravascular tumor thrombus or ration of SLN metastasis≥2/3 are prone to have metastasis in nSLN.

The elevated preoperative neutrophil lymphocyte ratio predicts poor survival outcome in breast cancer patients

ZHU Jingtao，ZENG Zhiqiang，WEI Jintao，LV Yizhong，TANG Luxia.

2017, 17(01):  15-19.  DOI: 10.3969/j.issn.1009?976X.2017.01.004

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【Abstract】 Objective The neutrophil lymphocyte ratio（NLR）was used as a easy parameter of systemic inflammation and immune status. The purpose was to investigate the clinical importance of preoperative NLR in patients with breast cancer. Methods We performed a retrospective analysis of 213 eligible patients diagnosed with primary breast cancer following radical surgery at Chancheng District Central Hospital of Foshan City. Clinicopathological parameters and survival status were investigated. The optimal cut?off value for NLR was obtained by receiver operating characteristics（ROC）analysis. Overall survival（OS）and disease?free survival（DFS）were assessed using the Kaplan?Meier method. Univariate and multivariate Cox regression model was performed to evaluate clinical parameters for their prognostic relevance. Results The optimal cut?off value was determined as 2.2 for NLR. Significant distribution differences were observed between the two groups in terms of histological grade,T stage,TNM stage. Patients in the elevated group（NLR≥2.2）showed significantly lower OS（5?year OS：59.6% vs 78.9%, P=0.001）and DFS（5?year DFS：56.7% vs 78.0%，P=0.002）. In addition，histological grade，T stage， NLR status and T stage,NLR status were independent prognostic factors for OS and DFS in our study respectively. Conclusion Our study suggested that preoperative NLR indicated poorer OS and DFS in patients with breast cancer following radical surgery. Further studies were required before it can be used for individual risk assessment.

Effect of transcutaneous acupoint electrical stimulation on the dynorphin expression of skin incision in breast cancer patients

CHEN Yansheng, YANG Xue, ZHAO Jing, LI Guocai

2017, 17(01):  20-23.  DOI: 10.3969/j.issn.1009?976X.2017.01.005

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【Abstract】 Objective To observe the effect of transcutaneous electrical acupoint stimulation (TEAS) on the dynorphin expression of skin incision in breast cancer patients. Methods Eighty?three female patients with breast cancer scheduled to perform surgery were randomly assigned to sufentanil group (group 1, n=28), sufentanil plus TEAS with sparse waves group (group 2, n=25), sufentanil plus TEAS with encryption waves group (Group 3, n=30). Under monitoring of Narcotrend index (Ni), regulation of propofol target controlled infusion injection concentration. All the three groups were given sufentanil 0.3~0.4 μg/kg, cisatracurium 2~3 mg/kg. At the beginning and end of operation, the edge of skin incision tissue (0.5 cm × 1 cm) was taken for detection of dynorphin expression using immunohistochemically. Results All the dynorphin expression at the end of operation were significantly higher than that of the beginning (P<0.01), but no difference among the three groups (P>0.05). Conclusion Surgical stimulation increases the dynorphin expression of skin incision in breast cancer patients. TEAS has no effect on it.

Risk of local recurrence of benign and borderline phyllodes tumors of breast

LI Xiaoping, YU Qihe，LI Shangren，HUANG Hui

2017, 17(01):  24-26.  DOI: 10.3969/j.issn.1009?976X.2017.01.006

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【Abstract】 Objective To determine the recurrence rate of benign and borderline phyllodes tumors （PTs） of the breast and the association between the resection margins and risk of recurrence. Methods Patients with benign or borderline PTs from Jan. 2008 to Dec. 2015 were analyzed retrospectively. Clinical data of age, tumor size, surgical treatment, margin size, and local recurrence were collected. Results A total of 118 cases were identified，including benign tumor in 81 cases， borderline in 37 cases. The mean age was 48.3，the mean tumor size was 4.6 cm and the mean follow?up time was 3.5 years. Eighteen cases were identified local recurrences with a recurrence rate of 15.3%. The number of recurrences was too low，and the information of the resection margin was too sparse to estimate an adequate margin size for excision of nonmalignant PTs. Conclusion The recurrence rate of borderline PTs was considerably higher than benign PTs. The results do not justify wide excision margins of non?malignant phyllodes tumors of the breast.

Expression of RNA?binding protein 24 and its association with prognosis in breast cancer

ZENG Jiayi*，LIUZhihua*，FEI Chen，SU Shicheng

2017, 17(01):  27-33.  DOI: 10.3969/j.issn.1009?976X.2017.01.007

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【Abstract】 Objective To explore the expression of RNA?binding protein 24 and its prognostic significance in breast cancer. Methods Twenty?four pairs of breast cancer tissues and paraneoplastic breast tissues were collected. The mRNA and protein of RBM24 in these tissue samples were detected by reverse transcription?polymerase chain reaction （RT?PCR）and western blotting. Meanwhile，we examined the clinical significance of RBM24 in breast carcinoma using TCGA data. Results The mRNA and protein of RBM24 was significantly higher in the paraneoplastic breast tissues than in the breast cancer tissues（P<0.001）. Kaplan?Meier univariate survival analysis suggested that high RBM24 expression was associated with poor overall survival（P<0.05）. Conclusion RBM24 was downregulated in breast cancer，which was associated with poor prognosis. Therefore, RBM24 may serve as a prognostic biomarker for breast cancer.

Application of three?dimensional laparoscopic complete mesocolic excision for right hemi?colon cancer

ZENG Bing, CAI Canfeng，XIN Haiyang，CHEN Xiang，CHEN Guoxing，ZENG Jun，TANG

2017, 17(01):  30-33.  DOI: 10.3969/j.issn.1009?976X.2017.01.008

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【Abstract】 Objective To investigate the clinical value of three?dimensional（3D）laparoscopic complete mesocolic excision for right hemi?colon cancer. Methods The clinical and pathological data of 41 patients with advanced distal gastric cancer，who received treatment in our hospital of from January 2014 to September 2016，were analyzed retrospectively. Among these cases, 18 patients received 3D laparoscopic CME and 23 patients for 2D laparoscopic CME. The clinical effect was compared between the patients undergoing 3D laparoscopic CME and 2D laparoscopic CME. Results No significant difference was found in the average operation time and lymph node dissected（3D，217.8±35.9 vs 2D，223.2±40.0） min，（25.0±4.9 vs 24.0±5.7）between the two groups. The intraoperative blood loss in 3D group were less than that in the 2D group（96.8±24.2 ml vs 124.2±43.7 ml），and the surgical operation quality in 3D group were better than that in the 2D group（P<0.05）. No significant differences were found in the anal exsufflation time，hospital stay，hospitalization cost，and postoperative complications between the two groups（P>0.05）. The hospital stay was 13.5±2.3 d in 3D group and 12.9±2.3 d in 2D group. The hospitalization cost were 5.2± 0.7 and 5.4±0.9 thousand Yuan in the two groups respectively. There was two patient with postoperative complications in 3D group，and four patients with postoperative complications in 2D group. Conclusions 3D laparoscopic complete mesocolic excision for right hemi?colon cancer is feasible and safe.

The application of enhanced recovery after surgery in the laparoscopic surgery for gastric and duodenal perforation

CHEN Liuxiang，TENG Fanwu，ZHAN Xiaofeng

2017, 17(01):  34-38.  DOI: 10.3969/j.issn.1009?976X.2017.01.009

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【Abstract】 Objective The aim of this study was to assess the feasibility and safety of laparoscopic surgery for gastric and duodenal perforation within enhanced recovery after surgery （ERAS） programs. Methods In this retrospective analysis conducted between January 2014 and May 2016，88 consecutive patients diagnosed with gastric and duodenal perforation following laparoscopic surgery were allocated to either ERAS group（N=42）or conventional pathway group（N=46）. The complication，postoperative gastrointestinal function, hospital stay, cost and compliance were evaluated between two groups. Results There were no significant distribution differences of demographics and surgical time between two groups（P>0.05）. Moreover，the incidences of postoperative complication rate were similar between ERAS group and conventional group （9.5% vs 10.9%, P=0.835）. Gastrointestinal recovery parameters such as time to the first flatus（1.8 d vs 2.0 d，P=0.011）and time to the first defecation（2.2 d vs 2.5 d, P=0.018）occurred earlier in ERAS group. The post hospital stay（days）in ERAS and the conventional group were 6.9 d and 7.8 d（P=0.003） respectively. Moreover, the cost （yuan） in the ERAS group was reduced compared to the conventional group （8661.4 vs 9325.7, P=0.044）. In additional, cases in the ERAS group had a shorter stay of gastric tube, abdominal drainage tube and urethral catheter （P<0.05）. Conclusion This study appeared to the feasibility and safety of ERAS protocol in patients with gastric and duodenal perforation undergoing laparoscopic surgery and was associated with a great improvement in postoperative recovery，shorter duration of hospital stay and less cost.

Intraperitoneal hyperthermic perfusion chemotherapy combined with systemic chemotherapy in the treatment of advanced colorectal cancer- the clinical analysis

ZHANG Rixiong，WU ZUguang，LI En， LIU Hongtao， CHEN Kai， ZHANG Zhuoxin， ZENG Haijing， LI Zhiwang

2017, 17(01):  39-42.  DOI: 10.3969/j.issn.1009?976X.2017.01.010

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【Abstract】 Objective To investigate the clinical efficacy and adverse reaction by implement of abdominal hot perfusion chemotherapy on advanced colorectal cancer after laparoscopic radical resection. Methods Seven- eight cases of advanced colorectal cancer patients were recruited and assigned to two groups，39 cases in each group. The patients in combined chemotherapy group underwent laparoscopic radical colorectal cancer resection combined with intraperitoneal hyperthermic chemotherapy（IPHC）for 3 times after surgery，then received the conventional systemic chemotherapy（XELOX），and those in single chemotherapy group were performed systemic chemotherapy alone in 4 weeks after laparoscopic radical colorectal cancer resection. The clinical efficacy and safety were evaluated in patients of two groups. KPS score，adverse reaction，survival rate were recorded and analyzed. Results The KPS score increased at a rate of 53.85% in combined chemotherapy group，and 25.64% in single chemotherapy group. The difference between two groups had statistical significance（P<0.05）. There was no difference between two groups in incidence of the adverse reaction. The 1-year，3-year and 5-year survival rates were respectively 92.31%，64.10% and 46.15%. The 3-year and 5-year survival rates were rising when compared with single chemotherapy group（all P values less than 0.05）. Conclusion For advanced colorectal cancer patients, IPHC supplementation based on systemic chemotherapy generally provides improvement in survival after laparoscopic radical resection，and had less adverse reactions during chemotherapy.

Single?port laparoscopic surgery in the treatment for patent processus vaginalis

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

2017, 17(01):  43-45.  DOI: 10.3969/j.issn.1009?976X.2017.01.011

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【Abstract】 Objective To discuss the clinical value of trans?umbilical single port laparoscopic surgery in the treatment for indirect inguinal hernia and hydrocele in children. Methods Thirty?two cases of children with indirect inguinal hernia and hydrocele of our hospital between Jan. 2010 and June 2015 were enrolled in this study. They were all treated by high ligation of patent processus vaginalis under laparoscope with knitting needle. To analyze the operation time, blood loss, postoperative complications and recurrence rate for all the children. Results All surgery was successful without any serious complications. Operation time was 6.5 to 22.5 min，mean time was 13.2 min. Bleeding volume during the operation was 0.5 to 5 mL，mean volume was 1.2 mL. 25 patients were followed?up 6 to 36 months，mean visit time was 21.6 months. There were no complications and recurrence in this study. Conclusion Laparoscopic high sac ligation for pediatric indirect inguinal hernia and hydrocele by trans?umbilical single?port methods is safe，effective，convenient，micro?invasive，which is worth of being generalized in primary hospitals.

Clinical application of laparoscopic reduction and plug?mesh tension?free hernia repair in treat?ment of adult incarcerated inguinal hernia

REN Baojun，CHEN Xiaowu，ZHU Dajian，JU Yongle, FENG Jiali, LU Guangsheng, GENG Yan, OUYANG Manzhao

2017, 17(01):  46-49.  DOI: 10.3969/j.issn.1009?976X.2017.01.012

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【Abstract】 Objective To investigate the feasibility and clinical value of laparoscopic reduction and plug?mesh tension?free hernia repair in treatment of adult incarcerated inguinal hernia. Methods The clinical data of 46 patients with adult incarcerated inguinal hernia, who underwent laparoscopic reduction and plug?mesh tension?free hernia repair between June 2012 and June 2016，were analyzed retrospectively. Results Spontaneous reduction was occurred during the procedure of general anaesthesia in 11 patients and incarcerated small bowels were detected during laparoscopic examination. Strangulated small bowels were found in one patient who underwent enterectomy. The incarcerated tissues were reduced laparoscopically in the other 35 patients and strangulated omentum was found in two patients. The blood white cell count of peritoneal effusion ranged from 1.32×109/L to 78.81×109/L，（mean，25.34±11.03 ×109/L），while the count of extrasac effusion were from 0.18×109/L to 2.31×109/L，（mean，0.42±0.28 ×109/L）. The pus cells were not found in effusion of hernia sac. An incident finding of contralateral occult indirect hernia was also noted during laparoscopic exploration in 5 cases who underwent ligation of hernia ring，and fatty liver in seven cases，hepatic cyst in 14 cases，diverticulum of jejunum in one case，respectively. All patients underwent plug ? mesh tension ? free hernia repair successfully. The operation time ranged from 75 minutes to 110 minutes with a mean of 87.4 minutes. The hospital stay was 5 to 7 days with a mean of 6.7 days. The function of the bowel recovered in 15~36 hours with a mean of 20.4 hours. The postoperative seroma was found in 5 patients，transient paresthesia in 3 patients，and fat liquefaction of incisions in 1 patient who was cured by strengthening the wound disinfection. There were no complications in other patients. The follow?up periods arranged from 4 months to 36 months（mean， 22.8 months）. All of the patients had no recurrent hernias. Conclusion The procedure of laparoscopic reduction and plug?mesh tension?free hernia repair in treatment of adult incarcerated inguinal hernia has the advantage of complete exploration，timely reduction，spontaneous repair，safety and feasibility.

Analysis of risk factors associated with ureteral stricture in patients with cervical cancer after radiotherapy

CHEN Ting，YANG Jin，YU Xiaoli，BAI Shoumin

2017, 17(01):  50-55.  DOI: 10.3969/j.issn.1009?976X.2017.01.013

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【Abstract】 Objective To investigate the risk factors associated with ureteral stricture（US）in patients after radiotherapy. Methods Retrospectively analyzed the clinical characteristics of 332 patients with cervical cancer, including age, induction chemotherapy, concurrent chemotherapy, adjuvant chemotherapy，clinical stage，pathology，differentiation，brachytherapy（BT），BT dose，external beam radiation therapy dose （EBRT），total dose, surgery, diabetes or hypertension. Multivariate Logistic regression analysis was performed to analyze the independent risk factors of US. Kaplan?Meier analysis was used to analyze the overall survival rate. Results Totally 33 in 332 patients developed US（9.9%）， and 40 in 664 ureteral developed US （6.02%）. Multivariate analysis confirmed that surgery and total dose were independent risk factors of US. Kaplan?Meier analysis showed that patients with Ⅰ/Ⅱ stage and double?J?catheter had significant high overall survival rate. Conclusion Surgery and total dose were independent risk factors of US in patients with cervical cancer after radiotherapy.

Role of stone bacterial culture in percutaneous nephrolithotomy

LIU Kelong，CHEN Haifeng，LIU Shuhuai，MAI Changwen，HUANG Kunming，YU Yaling

2017, 17(01):  55-58.  DOI: 10.3969/j.issn.1009?976X.2017.01.014

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【Abstract】 Objective To investigate the correlation between preoperative urine and intraoperative stone culture in percutaneous nephrolithotomy （PCNL），and the role of intraoperative stone culture in systemic inflammatory response syndrome（SIRS）. Methods From July 2014 to July 2016，preoperative urine culture and intraoperative stone culture were obtained in 40 patients undergoing in PCNL. The postoperative SIRS events，antibiotics sensitivity and any changes in treatment. Results Of 40 cases， there were 13 cases（32.5%）with preoperative urine culture positive results and 27（67.5%）sterile，26 （65%）with intraoperative stone culture positive results and 14（35%）sterile. The positive rates of stone culture were higher than that of preoperative urine culture（P<0.05）. Sterile both preoperative and stone culture were found in 10 （25%） patients. Sterile stone culture and urine culture positive results were found in 4 （10%） patients. Sterile urine culture and stone culture positive results were found in 17 （42.5%）patients. urine culture and stone culture positive results were found in 9（22.5%）patients. In these cases，there was different types of bacteria. Otherwise SIRS happened in 10 patients. Conclusion Intraoperative stone culture can be more accurate to reflect the bacterial infection than preoperative urine culture.

Clinical analysis of penile fracture：A 19 cases report

LI Sihua，LIN Yueyue

2017, 17(01):  58-60.  DOI: 10.3969/j.issn.1009?976X.2017.01.015

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【Abstract】 Objective To analyze the clinical characteristics and generalize the experience of treatment in penile fracture. Methods A retrospective analysis of clinical data were performed in 19 cases of penile fracture in our hospital from October 2003 to June 2016，and the recent relevant literature was reviewed. The etiology of penile fracture in 19 cases included hardcore mistakes in 17 cases and brutal sexual intercourse in 2 cases. Except one case of conservative treatment，others were treated with emergency penile hematoma and albuginea repair. Results The patients were followed up from 6 to 12 months after operation. One patient believed that his hardness decreased when compared with the previous erecerection，and the rest did not show penile deformity，erectile pain，erectile dysfunction and other complications. Conclusion The history and physical examination is an important basis for diagnosis of penile fracture，and early surgery is the advisable treatment of penile fracture.

Laparoscopic cholecystectomy combined with endoscopic sphincterotomy for management of choledocholithiasis：an experience report

LIN Guihai，ZHONG Dongjia，CHEN Haixin，YUAN Yangchun， LIN Jiayu

2017, 17(01):  61-63.  DOI: 10.3969/j.issn.1009?976X.2017.01.016

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【Abstract】 Objective To summarize up the experience in management of choledocholithiasis by laparoscopic cholecystectomy combined with endoscopic sphincterotomy. Methods A retrospective data of medical records for 20 patients with common bile duct stones undergoing laparoscopic cholecystectomy combined with endoscopic sphincterotomy between Jun 2014 and Aug 2016 was undertaken and served as treatment group（EST + LC）. Another 25 patients in the same term who underwent open surgical cholecys? tectomy and T-tube drainage（OC+OCHTD）was selected as control group. The operative outcomes，proce? dure- related complications were compared between two groups. Results The patients in two group were followed up for 2 to 6 months. In EST+LC group，18 cases completed smoothly，and two cases transferred to open operation due to difficult intubation. The complications occurred in three cases，two cases of acute pancreatitis and one case of duodenal papilla bleeding. In OC+OCHTD group，five cases complicated with incision infection（2 cases），bile leakage（one case），and pulmonary infection（2 cases）. All patients in two groups got recovery by conservation treatment. Conclusion Our outcomes showed that at least in the short term，endoscopic sphincterotomy combined with laparoscopic cholecystectomy was a safe，effective and feasible method for the treatment of cholecystolithiasis and choledocholithiasis.

Effect of Kangfuxin Solution on treating air?leakage in patients with secondary spontaneous pneu mothorax

ZHANG Caiming, SONG Xiaoning, HUANG Wenhua

2017, 17(01):  64-67.  DOI: 10.3969/j.issn.1009?976X.2017.01.017

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【Abstract】 Objective To evaluate the therapeutic value and safety of Kangfuxin Solution in treatment of chronic obstructive pulmonary disease （COPD） patients with refractory pneumothorax. Methods Fifty COPD patients with refractory pneumothorax were included in the study which began from January 2014 to June 2016. All subjects were divided into treatment group and control group, 25 patients in each group. Thoracal closed drainage was performed in every patient. After lung recruitment maneuver, 100 ml kangfuxin solution （treatment group）, 100 ml sapylin 5KE plus 0.9% Nacl （control grou） were injected into thoracic cavity in each group respectively. And the clinical effects and side reactions were record and analyzed. Results The air leaks time in treatment group was 6.88±3.47 d, while 8.60±5.63 d lower in control group. There was no difference between two groups. Hydrothorax protein of treatment group was obviously higher than that of control group（P<0.05）. The follow?up ranged from 6 to 12 months. Two cases recurred in control group. Conclusion Kangfuxin solution injection of thoracic cavity showed an effective outcome to COPD patients with refractory pneumothorax. At least the efficacy of Kangfuxin solution injection was not worse than of sapylin.

Comparative study of the left internal mammary artery bypass graft between off?pump video?assisted coronary artery bypass graft and median thoracotomy operation in pig model

LIU Shenghua，CHEN Haisheng

2017, 17(01):  68-71.  DOI: 10.3969/j.issn.1009?976X.2017.01.018

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【Abstract】 Objective To establish a pig model for simulating the left internal mammary artery bypass graft in video?assisted off?pump coronary artery bypass graft and compared with median thoracotomy operation. Methods Sixteen pigs were randomly divided into two groups, VACAB Group （n=8）and MTCAB Group（n=8）. The former was performed video?assisted coronary artery bypass graft with left internal mammary artery-left anterior descending（LIMA-LAD）. The animals in MTCAB Group were subjected to median thoracotomy for coronary artery bypass graft with LIMA-LAD. Operation time, harvest time of left internal mammary artery（LIMA）and LIMA- LAD anastomosis time were compared between the two groups. And the levels of creatinine kinase （CK），creatinine kinase isoenzyme （CK- MB），and troponin I（cTnl）in different time points were recorded and compared between two groups. Results The operation time，the harvest time of LIMA and LIMA- LAD anastomosis time of VACAB group were longer than that of group MTCAB, and the differences were statistically significant. There was no significant difference in LIMA bridge flow between the two groups. The differences of CK, CK- MB and cTnI between the two groups were not statistically significant. Conclusion Video-assisted coronary bypass was a practical and effective method of minimally invasive direct coronary bypass graft. VACAB training by using the animal model is helpful to clinical practice

Application of gastric tube in combined thoracoscopic-laparoscopic esophagectomy for treatment of esophageal carcinoma

RAO Xinhui，LIANG Jinsong，ZHANG Zizheng，CHEN Gang

2017, 17(01):  72-76.  DOI: 10.3969/j.issn.1009?976X.2017.01.019

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【Abstract】 Objective To compare the results of combined thoracoscopic- laparoscopic and open esophagectomy performed for esophageal squamous cell carcinoma. Methods 160 patients with thoracic esophageal carcinoma from January 2011 and December 2015 in our hospital for treatment of radical resection of thoracic esophageal carcinoma combined with laparoscopy were divided into two groups，respectively，using the tubular gastric reflux surgery and traditional gastric closure treatment. Records of two patients completed surgery, compared two groups of patients with lymph node dissection number, operation time, blood loss, chest tube indwelling time, postoperative drainage, perioperative complications, and follow- up records of complications, comparison of two operative methods for total efficacy. Results Two kinds of operation in the thoracic lymph node dissection, intraoperative blood loss volume，the number of the chest tube drainage time and postoperative drainage had no significant difference（P>0.05）；gastric tube interposition surgery time, abdominal lymph node dissection significantly more than the number of total gastric closure （P<0.05）. The incidence rate of complications of tubular stomach replacement of esophagus was significantly lower than that of whole gastric suture （P<0.05）. The time of hospitalization， postoperative feeding time， recurrence and metastasis rate，two- year survival rate and quality of life （QOL）were significantly higher than that of whole gastric suture （P<0.05）. There was no significant difference in survival rate between the two groups（P>0.05）. Conclusion The treatment of esophageal cancer with esophageal tube can effectively reduce postoperative complications， improve the quality of life and survival rate of patients with esophageal cancer，and is safe and reliable.

The systemic inflammatory response to trauma in primary hyperthyroidism patients after endo? scopic bilateral subtotal thyroidectomy

LAI Yongqiang，LIANG Weixin，ZHU Mingzhang，HUANG Yongliang, LI Zhihong, SU Xiumei

2017, 17(01):  77-80.  DOI: 10.3969/j.issn.1009?976X.2017.01.020

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【Abstract】 Objective To evaluate the response to trauma in primary hyperthyroidism patients who underwent endoscopic thyroidectomy via breast approach. Methods Fifty?three patients with prima?ry hyperthyroidism patients，admitted from Oct 2015 to Oct 2016 and underwent bilateral subtotal thy?roidectomy，were assigned endoscopic thyroidectomy via breast approach group（ET，n=18），and con?ventional open thyroidectomy group （COT，n=35）. The responses to trauma were measured, including Hs?CRP，TNF?α and IL?6 in peripheral blood at 2 hours pre?operation and 24 hours post?operation. The systemic inflammatory response syndrome（SIRS）was assessed in two groups. Results The postopera?tive values of Hs?CRP，TNF?α and IL?6 were higher than preoperative values in ET group, as same as in COT group. However，the changes（△Hs?CRP，△TNF?α and △IL?6）before and after operation in two groups were no significant difference（P>0.05）. And the morbidity of post?operation SIRS was approxi?mate within the two different surgery ways （P>0.05）. Conclusion Both the endoscopic thyroidectomy and conventional open thyroidectomy caused patients trauma?associated inflammatory response. But there was no significant difference of the trauma effect between ET group and COT group. It is optional surgery for appropriate patients.

A controlled study of different anatomical landmarks on recurrent laryngeal nerve

LIU Zhenyu, WU Dan, OU Jinlin, ZENG Haifeng

2017, 17(01):  80-83.  DOI: 10.3969/j.issn.1009?976X.2017.01.021

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【Abstract】 Objective To summarize the experience of routine exposure of recurrent laryngeal nerve (RLN) by different anatomical landmarks. Methods 400 patients with thyroid surgery were includ?lage (group C), and tracheoesophageal groove (group D). Time of RNL exposure, RNL injury (temporary or permanent) were recorded in each group and analyzed. Results Among the groups, the shortest anatomi?cal time of RNL was in group C, the longest in group B, and the amount of bleeding had no significant dif?ferences in 4 groups. Ultrasonic scalpel helped to reduce operative hemorrhage and shorten operation time. Conclusions The way of recurrent laryngeal nerve exposure in thyroid surgery should be based on the surgeon′s preference and performed individualized anatomical way.

Risk factors and causes analysis of cervical spinal reoperation

LI Suiou，LIU Shaoyu，WANG Le， ZHONG Rui，WEI Fuxin，CUI Shangbin

2017, 17(01):  84-88.  DOI: 10.3969/j.issn.1009?976X.2017.01.022

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【Abstract】 Objective To investigate the risk factors and causes of cervical reoperation. Methods From May 2005 to May 2015 in the First Affiliated Hospital of Sun Yat?sen University, 1043 cases received cervical surgeries，among which 56 cases received reoperation. We recorded the patients′ gender, age, hospitalization days, surgery segment, surgery approach, with internal fixation or not, surgical blood loss，surgery duration，pre?operative diagnosis，WBC levels and the neutrophil percentage before the first operation. The statistical analysis was carried out with software SPSS. Results Using logistic regression analysis，we found that the hospitalization days，WBC levels before the first operation and surgical blood loss were the important risk factors of cervical reoperation. Spinal cord recompression, tumor recurrence and nonhealing wounds were the major causes of cervical reoperation. Conclusion For patients with associated risk factors, they should be informed about the high risk of cervical reoperation, the doctors may also need to regulate tumor radiation and chemotherapy, observe the postoperative wounds more frequently，review indicators of infection timely and limit the postoperative cervical activity by wearing a neck circumference，so as to reduce the incidence of cervical reoperation.

Analysis of the effect of soft tissue stretch for the treatment of flexion contracture deformity of fingers

KANG Guofeng, WANG Guangyao, LI Jingkuang, PENG Jianfei, JIA Xianlei, ZHANG Guangming

2017, 17(01):  89-92.  DOI: 10.3969/j.issn.1009?976X.2017.01.023

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【Abstract】 Objective To analyze the clinical effect of different surgical methods for the treat?ment of flexion contracture deformity of fingers. Methods Retrospective clinical data of 30 patients of traumatic flexion contracture deformity of the fingers were analyzed. The patients were treated with conventional flap or skin grafting （control group, 23 fingers） and miniature external fixation stenting （observation group，25 fingers）. The treating time in each of two procedures, bleeding loss，postopera?tive pain score, hospital stay, cost, finger function score, complication and recurrence were re?corded and analyzed in two groups. Results The micro?external fixation combined with soft tissue dis?traction plasty revealed superiority to traditional approach in terms of operation time, postoperative pain score，hospitalization time，postoperative complications，postoperative finger function scores. There was no significant difference in total treatment time, total cost and recurrence. Conclusion For flexion con?tracture deformity of the fingers, the micro?orthopedic external fixation showed better clinical effects in our clinical record document.

The efficacy of elastic intramedullary nailing fixation for the treatment of children′ s femoral shaft fracture

WANG Zhengfei，SHENG Xiaowen，XUE Feng

2017, 17(01):  93-98.  DOI: 10.3969/j.issn.1009?976X.2017.01.024

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【Abstract】 Objective To investigate the efficacy of elastic intramedullary nailing fixation for the treatment of children′ s femoral shaft fracture and to review published literature. Methods Between August 2003 and June 2014，35 patients（28 males and 7 females）with a mean age of 9.2 years（range from 5 to 13 years）were treated with the plate fixation in our institute. The hospital stay, operative time， surgical incision，intraoperative blood loss, full weight bearing time, time of fracture healing and complications were evaluated and reviewed by literaturce. Results The mean surgical time was 65 min （range from 45 to 95 min）. The mean blood loss was 70 mL. The mean period of hospital stay was 8 days （range from 6 to 14 days）. All fractures recovered with the mean time of fracture healing of 7.5 weeks （range from 6 to 9 weeks）after mean 14 months（range from 6 to 20 months）follow up. No nonunion, delayed union, infection, refracture occurred during fllow?up. Two patients experienced pain due to the irritation of nail end and relieved after removal of nail. Three cases presented with shortening of wound legs and 12 cases experienced overgrowth, within 1.5 centimeter leg length discrepancy at one?year?followup. Spontaneous recovery was observed in all cases during period of follow?up. Excellent rate was 89% according to the score system of Flynnetal. Conclusion Elastic intramedullary nail fixation is a minimal invasive and effective method to treat the children′s femoral shaft fractures.

Association of vertebral height restoration in osteoporotic vertebral compression fractures with clinical results

YANG Jiasheng，HE Chunjun，LAI Yiyi，PAN Sheng，HUANG Ziji，GAN Yi

2017, 17(01):  99-103.  DOI: 10.3969/j.issn.1009?976X.2017.01.025

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【Abstract】 Objective To assess the results of PVP, PKP and conservative therapy for the treatment of osteoporotic vertebral compression fractures with the pain degree and vertebral body height recovery. Methods A retrieval data for osteoporotic compression fractures was analyzed. Forty?five patients were included in the study and were assigned to three groups，percutaneous vertebroplasty（PVP） group，percutaneous kyphoplastygroup（PKP）group and conservative therapy，15 cases in each group. Clinical effects and Visual analogue scales（VAS），Oswsetry Disability Indexs（ODI）were recorded，and evaluated by follow?up. Results Restoration of vertebral height of anterior?wedge fracture was remark? able. Postoperative analgesic effect in PVP and PKP group was better than that of conservation treatment group, but there were not significant differences in the long?term pain relief effect between three groups. There were correlation between pain score with compression degree of anterior?wedge of vertebral body. There were four cases of bone cement leakage in PVP group during operation，and two cases in PKP group. In conservation group, pulmonary infection and bed?sore occurred in each two cases during. Conclusion Anterior wedge compression fractures in vertebrae was associated with moderate pain degree. PVP and PKP were superior to conservative treatment in short and medium term after operation.

The effects of dexmedetomidine on the spectrum of EEG and agitiation during emergence period in the patients with LC surgery

ZHANG Bohong，PENG Shuling，YE Xijiu，WANG Zhi，CAO Lin， YANG Tao, PENG Jun, YANG Yongzhi, ZHOU Mao, HE Mingliang, GU Beibei, SUN Runlu, LAN Qiusheng

2017, 17(01):  104-109.  DOI: 10.3969/j.issn.1009?976X.2017.01.026

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Methods This study was performed by two kinds of classification methods. Firstly, 60 patients were assigned to dexmedetomidine group （group D, n=30） and contral group （group C, n=30）. The patients in the group D received dex with a dose of 0.5 μ g/kg after the regular introduction of general anesthesia, while those in group C were treated with equal amount of 0.9% NaCl. EEG spectrum was collected by the Narcotrend monitor during the period before patients receiving general anesthesia till 30 minutes after removal of the endotracheal tube（including the EEG of preoperative waking state ：T Base and the period from washing out to extubation：T0）. The outcomes of RASS at the moment of T1（the right time when patients were removed of the endtracheal tube），T2（10 min after T1），T3（20 min after T1），T4 （30 min after T1）. Sedation score and the EEG spectrum were compared between two groups. Secondly，according to the RASS sedation score of awakening period, all patients were grouped into two groups： Awakening period calm state group（AC；in T1，T1，T3，T4 moment RASS score all negative）and Emergence Agitation group （EA；in T1，T1，T3，T4 moment at least one RASS score positive）. By comparing the EEG in T0 moment between group AC and group EA，observe whether the change of EEG before extubation can predict emergence agitation. Results 1）The comparation of the Intraoperative vital signs of group D and group C ：Comparison of the the mean arterial pressure MAP （mmHg）；Heart rate HR （times/min）；end?tidal CO2 tension EtCO2 ；Pulse oxygen saturation SpO2 （% ）between two groups is not statistically significant difference （P>0.05）. 2） The comparation of the status of the RASS results during awakening period of group D and group C ：there was significant difference of two groups .The negative value of RASS of group D is bigger than group C at the four moment which contains T1（the moment that patients removed of the endotracheal tube），T2（10 minutes after T1），T3（20 minutes after T1），T4（30 minutes after T1）respectivily（P<0.05）. The incidence of postoperative agitation of group C is higher than group D （P>0.05）. 3） The comparation of the EEG spectrum collected by Narcotrend monitor of group D and group C ：The total Power value of EEG in patients of group D collected by Narcotrend monitor is less than that in group C at the moment of T0 and T1 ；the percentence of Delta wave in group D is larger（P<0.05）at the moment of T1；while the other EEG data have no significance difference （P>0.05）. 4） The power and the percent of β wave in the EEG during the T0 period of EA group is bigger than that of AC group, the percent of δ wave is less than that of AC group， which can be used to predict the occurrence of emergence agitation. Conclusion DEX can provide a better postoperative sedation in patients suffering LC surgery with general anesthesia. DEX can decrease the power value of EEG spectrum and increase the percent of δ wave，which maybe the electrophysiological mechanism of the inhibitory effect on emergence agitation of DEX. The EEG changes including increasing the percent of β wave and decreasing the percent of δ wave before extubation can predict the occurrence of emergence agitation.

The correlation between narcotrend index and observeration sedation scale in patients under epidural?spinal anesthesia sedated with dexmedetomidine and propofol

HUANG Wei, ZHOU Mao，SUN Zhenzhong, ZHAN Changchun

2017, 17(01):  110-112.  DOI: 10.3969/j.issn.1009?976X.2017.01.027

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【Abstract】 Objective To compare the correlation between narcotrend index（NTI）and OAA/ S in patients undergoing surgery under epidural?spinal anesthesia sedated with dexmedetomidine and propofol. Methods Sixty patients who were going to receive elective lower abdominal surgery or lower extremity surgery under epidural?spinal anesthesia, ASA Ⅰ ～Ⅱ, were divided into two groups, respectively group dexmedetomidine （group D, n=30）and group propofol（group P, n=30）. After the EA anesthesia level became stable and the anesthesia effect ensured, drugs were administered using computer?controlled infusions targeting an plasma concentration of 0.6, 1.2, 2.4 ng · mL- 1 for dexmedetomidine or effect?site concentration 1、2、4 μg · ml- 1 for propofol. The relationship between NTI and OAA/S score was obtained 20 min after changing each drug concentration. Results NTI at OAA/S scores of 5，4，3，2，1 during propofol sedation were 96（89-97），83（86-82），66（63-71），57（50-61）， 46（40-50），respectively. NTI at OAA/S scores of 5，4，3，2，1 during dexmedetomidine sedation were 94 （78-98），79（83-75），45（45-52），38（34-41），24（20-30），respectively. Conclusion The combination of both NTI and OAA/S score could different to the clinicion evaluating the patient′s response to sedation than would either tool alone，especially when dexmedetomidine is used.

The imaging diagnosis of metastases in pelvic lymph nodes in patients with bladder cancer

SHI Siya，ZHU Wangshu，LI Yong

2017, 17(01):  113-118.  DOI: 10.3969/j.issn.1009?976X.2017.01.028

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【Abstract】 Bladder cancer is the most common tumor in urinary system in our country, and easy to recurrence and fast widespread of metastasis. Relative to negative lymph nodes, positive lymph nodes tend to recurrent and metastasize more often and once it happens it′ s much more likely to be fatal. It is significantly instructive for the choice of the treatment strategies that predicts positive or negative lymph nodes precisely. At the moment, the gold standard diagnosis of lymph nodes metastases is pathological re?sult after the surgery. Before the surgery, it′s mainly dependent on imaging with unsatisfactory accuracy. This passage would focus on the diagnostic methods of imaging in metastases in pelvic lymph nodes.

Progress in the correlation between enteral nutrition and main complications after pancreaticodu?odenectomy

LIAO Yingyang，ZHONG Jianhong，LI Lequn，PENG Ningfu

2017, 17(01):  119-127.  DOI: 10.3969/j.issn.1009?976X.2017.01.029

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【Abstract】 Pancreaticoduodenectomy （PD） contributes to 30%- 50% of morbidity, mainly including postoperative pancreatic fistula （POPF），postpancreatectomy hemorrhage （PPH），infectious complication and delayed gastric emptying（DGE）. Patients who have undergone pancreaticoduodenectomy often present perioperative malnutrition that is worse in the early postoperative days，and affects the number of postoperative complications. Few studies focus on the relation between enteral nutrition（EN）and post? operative complications. Our aim was to perform a review，including only randomized controlled trial （RCT）or well?designed studies，of evidence regarding the correlation between EN and main complications after pancreatico duodenectomy.

Research progress of circular RNA

XIAO shixi, WANG Tao

2017, 17(01):  122-127.  DOI: 10.3969/j.issn.1009?976X.2017.01.030

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【Abstract】 Circular RNA （circ RNA），is a special kind of newly confirmed noncoding RNA（ncRNA），is mainly composed of exons and（or）introns. In recent years，the study found that in some diseases（such as cancer，atherosclerosis，diabetes，neurological diseases）in the process of the development of circRNA plays an important role in regulation, this not only makes us have a better understanding of circular RNA，and in diagnosis，treatment and prevention of certain diseases also provides a new research direction for us.

Research progress of vacuum sealing drainage technique

ZHANG Qiang，LIU Jun

2017, 17(01):  128-131.  DOI: 10.3969/j.issn.1009?976X.2017.01.031

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【Abstract】 Vacuum sealing drainage technique since the fifties of the last century is proposed. Through continuous improvement in the late 1980s began in the clinic for the treatment of chronic com?plex wound VSD through soft tissue mechanical and biological effects and can stimulate angiogenesis, im?prove blood circulation，promote the continued growth of the cells and granulation tissue, accelerate wound healing significantly. It has been widely used in the treatment of limb trauma, skin and soft tissue defect，osteofascial compartment syndrome and play an important role. Although Vacuum sealing drain?age technology is widely used in the field of surgery, there are few studies on its mechanism. This article will summarize the related mechanism and clinical application of Vacuum sealing drainage technology, and provide the basis for the clinical application of Vacuum sealing drainage technology.

Effect of preoperative inspiratory muscle training on postoperative respiratory function in lung cancer patients

LIU Liqiong

2017, 17(01):  132.  DOI: 10.3969/j.issn.1009?976X.2017.01.032

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【Abstract】 Objective To observe the effect of respiratory function training on postoperative respiratory function and sputum excretion in lung cancer patients with pulmonary lobectomy. Methods Eighty lung cancer patients received pulmonary lobectomy in our hospital from May 2015 to November 2016 were selected as research object，in which 40 cases received routine nursing from May 2015 to February 2016（control group），and received health education，oxygen uptake，aerosol inhalation before and after surgery. Another 40 cases were assigned to observation group and accepted preoperative inspiratory muscle training on the basis of routine nursing from March 2016 to November 2016. The respiratory function pre?and post?operation for 7 d （maximal voluntary ventilation（MVV），forced vital capacity（FVC），forced expiratory volume in one second（FEV1），PaO2，PaCO2），sputum excretion amount，postoperative hospital stays，incidence of complications of two groups were recorded and compared between two groups. Results After surgery，the MVV%，FVC%，FEV1%，PaO2 levels of two groups were lower than before surgery，and PaCO2 level was higher than before surgery（P < 0.05）；After surgery，the MVV%、FVC%、FEV1%、PaO2 levels of control group were lower than those of research group（P < 0.05）. After surgery，there was no statistical difference in the PaO2 level compared between two groups （P > 0.05）. After surgery, the sputum excretion amount of control group was lower than that of research group, and postoperative hospital stays were higher than that of control group（P < 0.05）；After surgery，the total incidence of complications of control group was higher than that of research group（P < 0.05）. Conclusion Preoperative inspiratory muscle training can decrease the postoperative complications for lung cancer patients, which can improve respiratory function, promotion sputum excretion, shorten postoperative hospital stays，reduce risks of complications，and promote patients′ recovery.