Table of Content

20 October 2018, Volume 18 Issue 05

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Predictive significance of preoperative colorectal inflammation for local progression of colorectal cancer

LI Senmao，CHEN Yongle，LIAO Yi，HE Zhen，KE Jia，WU Xianrui，LAN Ping

2018, 18(05):  487-498.  DOI: 10.3969/j.issn.1009-976X.2018.05.001

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［Abstract］ Objective The aim is to identify the influence of non?specific colorectal inflammation on colorectal cancer and its clinical significance. Methods This study was a retrospective cohort study by reviewing colorectal cancer patients from the Sixth Affiliated Hospital of Sun Yat?sen University from 2007 to 2010. All patients with preoperative colonoscopy data or surgical pathology confirmed enteritis were included in the study ；divided into inflammation group（enteric endoscopy and surgical pathology enteritis）and control group；comparison of tumor stage, lymph node metastasis, cancer nodule metastasis Other surgical pathological data and survival prognosis indicators；follow?up of overall survival and tumor recurrence, followed up for 3 years. Results A retrospective study of 907 patients included 346 patients. Among them, 70 cases were in the inflammation group, including 39 cases of distant enteritis（20.2%）, and 16 cases of tumor?in situ enteritis. 22.9%）, 15 cases（21.4%）with surgical pathology and 276（78.8%） in the control group. In the inflammatory group, the tumor incidence rate was 74.3%（P<0.001）, lymph node metastasis rate was 62.3%（P<0.001）, and cancer nodule metastasis rate was 40.2%（P=0.001）. Logistic regression analysis showed that surgical pathology enteritis was an independent risk prognostic factor for advanced tumors（P=0.016）, lymph node metastasis（P=0.017）, and cancer nodule metastasis（P=0.017）. Prostate distant enteritis was independent risk prognostic factors for advanced tumor （P= 0.003）and lymph node metastasis（P=0.017）. Conclusion There is a clear correlation between non?specific inflammation of the colorectal before surgery and the staging of the tumor. Such cases can be used to study the relationship between colorectal inflammation and malignant tumors.

Pain control of intraoperative periarticular multimodal injection in total knee arthroplasty for patients of osteoarthritis

LI Deng，SU Baohua，XU Jie，CAI Zhiqing，MA Ruofan

2018, 18(05):  499-503.  DOI: 10.3969/j.issn.1009-976X.2018.05.002

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［Abstract］ Objective This study aims to explore the effectiveness of pain control of intraoperative periarticular multimodal injection in total knee arthroplasty for patients of osteoarthritis. Methods Sixty patients of knee osteoarthritis undergoing unilateral primary total knee arthroplasty were divided into injection group and control group. The patients were observed and followed at 48 hours, 1 week, one month, three months, and six months postoperatively. The Visual Analogue Scale（VAS）, Range of motion （ROM）、American Knee Society Score （KSS）, patient satisfaction, side effects and wound complications were recorded and statistically analyzed. Results There was a lower VAS in the injection group 48hours and one week after TKA（P<0.05）. A larger range of motion, a higher KSS and satisfaction rate were observed 48hours and one week postoperatively（P<0.05）. None of the indexes above were found statistically significant at one month, three months or six months postoperatively. No wound complication occurred. Conclusion Periarticular multimodal injection is effective in pain control after TKA in the early period, and it brings early function recovery, better inpatient experience, higher satisfaction rate, and faster rehabilitation eventually.

The optimal concentration of prostaglandin E1 against apoptosis of rat bone marrow mesenchymal stem cells

LIU Congyong，ZHANG Lu，SU Feng，DENG Baoping，ZENG Kuan，YANG Yanqi

2018, 18(05):  504-508.  DOI: 10.3969/j.issn.1009-976X.2018.05.003

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［Abstract］ Objective To explore the optimal concentration of prostaglandin E1 against apoptosis of rat bone marrow mesenchymal stem cells in vitro. Methods Bone marrow mesenchymal stem cells were extracted from SD rats, rat bone marrow mesenchymal stem cells （P3?P5） were cultured in hypoxia/ serum?deprivation（H/SD）model, in vitro, and Prostaglandin E1 take different concentrations（0 μg/L, 1 μg/L, 10 μg/L, 20 μg/L, 30 μg/L, 40 μg/L, 50 μg/L, 100 μg/L ）, and set 48 h, 72 h two groups, then measure the apoptosis rate of bone marrow mesenchymal stem cells in each group by flow cytometry and analyze the data by statistical methods. Results The apoptosis rate of bone marrow mesenchymal stem cells could be reduced by Prostaglandin E1 at concentrations of 1, 10, 20, 30, 40, 50 and 100 μg/L, the lowest apoptosis rate was at 20 μg/L；Rat bone marrow mesenchymal stem cells have the lowest apoptosis rate at 48 hours. Conclusion The optimal concentration of prostaglandin E1 against apoptosis of rat bone marrow mesenchymal stem cells was 20 μg/L, and its anti?apoptotic effect peaked at 48 h in vitro.

The diagnosis value of ultrasonography guided core needle biopsy for axillary lymph nodes of primary breast cancer

MEI Jingsi，HU Yue，GU Ran，LIU Fengtao，WANG Hongli，JIANG Xiaofang，SHEN Shiyu，GONG Chang

2018, 18(05):  509-513.  DOI: 10.3969/j.issn.1009-976X.2018.05.004

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［Abstract］ Objective To evaluate the diagnosis value of ultrasonography guided core needle biopsy （US?CNB）for detecting axillary lymph node metastasis of primary breast cancer. Methods We retrospectively reviewed 134 breast cancer patients who underwent US, US?CNB and axillary lymph node surgery in our department from Jan. 2016 to Jul. 2017. The diagnostic performance of US?CNB for detecting axillary lymph node metastasis was calculated on the basis of final pathologic reports of axillary lymph node surgery. Analysis the correlation of US?CNB results with stage N and stage T. Results The sensitivity, specificity, positive predictive value （PPV）, negative predictive value （NPV）and accuracy of US?CNB were 91.8%（90/98）, 58.3%（21/26）, 85.7%（90/105）, 72.4%（21/29）and 82.8%（111/134）, respectively, Youden′s index was 50.1%, AUC was 0.751, Kappa=0.535. Excluding 14 patients who underwent adjuvant chemotherapy, the specificity, PPVand accuracy of US?CNB in the remaining 120 patients were95.5%（21/22）, 98.9%（90/91） and 92.5%（111/120）, respectively, Youden′ s index was 87.3%, AUC was 0.936, Kappa=0.777. The sensitivity of US?CNB in stage N1?N3 were 86.8%（46/53）, 96.2%（25/26）and 100%（19/19）, respectively. The sensitivity of US?CNB in stage T1?T4 were 84.2% （16/19）, 91.1%（51/56）, 100%（18/18）and 100%（5/5）, respectively. Conclusion US?CNB is useful in the preoperative diagnosis for axillary lymph node metastasis of primary breast cancer. Patients with US?CNB detected axillary lymph node metastases may had a higher tumor burden.

The manifestations of computed tomography and magnetic resonance imaging on autoimmune pancreatitis

CUI Liping，ZENG Weike，YE Yufeng，ZHU Wangshu，GAO Ming，CHU Zhonghua

2018, 18(05):  514-517.  DOI: 10.3969/j.issn.1009-976X.2018.05.005

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［Abstract］ Objective To investigate the imaging features of CT and MRI of autoimmune pancreatitis （AIP）and improve the preoperative diagnosis of the diseases. Methods CT and MRI imaging data of 45 patients with AIP proved by effective clinical hormone therapy and surgery were retrospectively reviewed. Changes in pancreas and surrounding tissues, pancreatic duct and bile duct were analyzed. CT and MRI imaging features of AIP were summarized. Results Among the 45 patients with AIP, 32 were males, 13 were females. 37 patients were appeared pancreas diffusely enlargement, 8 patients with segmental enlargement, and the density of pancreatic lesions in all 27 patients was reduced during CT examination. In the 16 cases of MRI, signal changes were observed in pancreatic lesions, showing low signal on T1WI and slightly high signal on T2WI. Delayed enhancement was observed in all 45 patients. Pancreatic duct stenosis appeared in 10 cases of CT and 7 cases of MRI, and common bile duct stenosis appeared in 2 cases of CT and 1 case of MRI. In 14 cases, “pseudo capsule sign”was found in CT and MRI. Conclusion CT and MRI of AIP have certain characteristics. Combined with laboratory examination, the diagnosis of AIP is helpful.

Cohort study 2 years after trans?abdominal pre?peritoneal and totally extra?peritoneal inguinal hernia operation

TANG Fuxin，ZHOU Taicheng，JIANG Zhipeng，LI Yingru，MA Ning，GAN Wenchang，HOU Zehui， YU Zhuomin，LIU Wei，CHEN Shuang

2018, 18(05):  518-523.  DOI: 10.3969/j.issn.1009-976X.2018.05.006

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［Abstract］ Objective To investigate clinical efficiency of laparoscopic transabdominal preperitoneal repair （TAPP） and laparoscopic totally extraperitoneal （TEP） in the treatment of inguinal hernia. Methods A total of 138 patients with inguinal hernia performed laparoscopic herniorrhaphy in the Sixth Affliated Hospital of Sun Yat?sen University between January, 2015 and January, 2016 were enrolled into the study, 70 patients treated with TAPP were group A, and 68 cases repaired by TEP were group Baseline data, operative time, blood loss, hospitalization cost, postoperative complications and so on of the two groups were compared. Results The mean cost was 9229.0±72.8 yuan for TAPP group and 8928.4±127.5 yuan for TEP group（t=5.243, P=0.042）, the difference was statistically significant. There were no significant difference in operative time, blood loss, postoperative length of stay and recovery time between TAPP and TEP（t=7.015, 1.742, 1.161, 0.091, P=0.057, 0.084, 0.248, 0.927）. The differences of the complications, inguinal seroma, uroschesis, postoperative pain, scrotal emphysema, intestinal obstruction, were not statistically significant（χ2=0.104, 0.229, 0.079, 0.771, 0.145, P=0.747, 0.633, 0.779, 0.380, 0.703）. There were no showed accidental injury of major vessels or abdominal organs between two groups. After the followup of 2 years, no recurrence and mesh infection were found. Conclusion Both TAPP and TEP for the treatment of inguinal hernia are safe and effective, compared with TAPP, TEP could shorten reduce hospitalization cost. TAPP should be the first choice for beginners or general surgeons. TAPP can lay a foundation for TEP, which is suitable for specialists in hernia surgery.

Comparison between three different procedures of Gilbert，Lichtenstein and Rutkow and in the treatment of inguinal hernia

CHEN Wenfeng，ZHENG Xiyue，HUANG Peng

2018, 18(05):  524-527.  DOI: 10.3969/j.issn.1009-976X.2018.05.007

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［Abstract］ Objective To compare the outcomes of three different tension- free repair approaches known as Lichtenstein, Rutkow and Gilbert. Methods 168 patients with type III inguinal hernia were assigned to three groups, Lichtenstein group（n=65）, Rutkow group（n=53）and Gilbert group（n=50）. The comparisons across groups were carried out in terms of operation length, postoperative pain, femoral vein flow velocity, complications, recurrence, length of hospital stay, and cost. Results No difference was found among the groups regarding age, gender, postoperative pain, and late complications （all P values >0.05）. There was a statistical difference in operation length in three groups（P<0.05）. The preoperative values of mean femoral venous flow velocity in the Lichtenstein, Rutkow, and Gilbert groups were 14.08±4.27 cm/s, 12.99±3.91 cm/s, and 14.32±3.25 cm/s, respectively（P=0.173）, While postoperative values were 13.01±2.32 cm/s, 12.02±2.07 cm/s, and 13.87±4.57 cm/s, respectively（P=0.016）. However, no difference was determined between the groups regarding the decrease rates. Among early complications, hematoma was observed in three （4.6%） patient of Lichtenstein group, five （9.4%） patients of Rutkow group, and 5（10%）patients of Gilbert group（P=0.033）. Cost for Lichtenstein, Rutkow, and Gilbert groups was RMB 12887±595, 13573±647, and 14201±875, respectively（P<0.001）. Conclusion The three kinds of surgery have their own characteristics, Gilbert′s operation had better effects, however, the operation is slightly more complicated；Lichtenstein′s operation is simpler, it is feasible whenthe operation performed under local anesthesia.

An experience of retroperitoneal laparoscopic dilatation and drainage of pancreatic bed combine with minimal access retroperitoneal pancreatic necrosectomy in the treatment of type Ⅱ，Ⅲ of severe acute pancreatitis

CHEN Jiyi，HE Yong，LIU Shiyong，TIAN Qiaolin

2018, 18(05):  528-532.  DOI: 10.3969/j.issn.1009-976X.2018.05.008

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［Abstract］ Objective To report an experience of retroperitoneal laparoscopic dilatation and drainage of pancreatic bed combine with retroperitoneal pancreatic necrosectomy in the treatment of severe acute pancreatitis and sum up the experiences. Methods The clinical data of 4 cases of severe acute pancreatitis in our hospital from 2015- 2017 were analyzed retrospectively. Two cases treated with retroperitoneal laparoscopic pancreatic lavage drainge, and 2 cases with retroperitoneal laparoscopic pancreatic lavage drainge and pancreatic necrotic tissue clearance（MARPN）. Results One patient discontinued surgery due to a loss of pneumoperitoneum after intraoperative peritoneal rupture. The remaining 3 patients were successfully completed the operation. One patient had postoperative pancreatic fistula, and a pseudocyst around the pancreas was formed and resolved spontaneously through conservative treatment. Conclusion It is worthy of further study that retroperitoneal laparoscopic dilatation and drainage of pancreatic bed in the early stage of SAP, whether to plus with MARPN decided by the actual situation.

An analysis of hepatic cholangitis cases of clonochis sinensis infected with misdiagnosed as cholangiocarcinoma

LIN Jie，WANG Weidong，LIU Qingbo，MA Jing

2018, 18(05):  533-536.  DOI: 10.3969/j.issn.1009-976X.2018.05.009

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［Abstract］ Objective To introduce the diagnosis and treatment of 3 cases of hepatic cholangitis with clonorchis sinensis infected and summarize the clinical experience. Methods The clinical characteristic of clonorchiasis sinensis misdiagnosed as cholangiocarcinoma were retrospectively analyzed. Results Sexuality of 3 hepatic clonorchis infected patients all were male, age ranged from 50 y to 65 y, and with a story of eating rawfish. The case 1 suffered from upper abdominal pain for 4 days, case 2 had upper abdominal pain for 1 month, and case 3 with upper abdominal pain for 6 months. All the patients were misdiagnosed as cholangiocarcinoma before operation. All the three patients underwent surgical treatments included cholecystectomy, choledochotomy with exploration and cholangoscopy, and T tube drainage. In three patients, a large number of clonorchiasis worms were observed during operation, and one of them developed suppurative cholangitis. The patients was cured with no obvious complications. Conclusion For patients with hepatic cholangitis who highly suspected cholangiocarcinoma, it is a more appropriate decision for next surgical plan after deworming treatment, repeated imaging studies or multiple endoscopy combinations.

The application of ascending to descending aorta bypass technique for patient with aortic coarctation

LIN Weibin，YANG Song，WANG Cuiping，YAO Jianping，CHEN Guangxian，LIANG Mengya，WU Zhongkai

2018, 18(05):  537-539.  DOI: 10.3969/j.issn.1009-976X.2018.05.010

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［Abstract］ Objective To explore the practical application of ascending?to?descending aortic bypass for complex aortic coarctation. Methods Five patients with complex aortic coarctation underwent ascending?to?descending aortic bypass via median sternotomy. Among them, the bypass graft was positioned on the right side along the right atrial free wall in one patient and along the left side anterior to the pulmonary artery in three patients. Results None of the 5 patients died. The pressure gradient between upper and lower extremity was lower than 20 mmHg in all patients postoperatively. Postoperative complications included cough and visual field defect. Conclusion Satisfied result can be achieved in complex aortic coarctation treated with ascending?to?descending aortic bypass through median sternotomy. However, further study about surgical details should be performed.

Effects of different concentrations of inhaled sevoflurane combined with remifentanil on postoperative delirium in elderly patients undergoing hip replacement

LU Wenmin，LIN Zonghang，HUANG Xuefang，LI Xuemei，ZHANG Bin，FU Baojun，ZHANG Xueying，LI Heng

2018, 18(05):  540-543.  DOI: 10.3969/j.issn.1009-976X.2018.05.011

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［Abstract］ Objective To observe the effect of inhaling different concentrations of sevoflurane on postoperative delirium in elderly patients undergoing hip replacement surgery. Methods In this respective research, 100 elderly patients, aged 65 to 75 years and more than 6 years of education, were performed the hip arthroplasty in our hospital. The grouped patients were assigned to two groups, low concentration group（group L）and high concentration group（group H）, with 50 patients in each group. The concentration of sevoflurane inhalation in the L group was 1.5%, and the sevoflurane inhalation concentration in the H group was 3%. Chinese revised version of delirium assessment scale（CAM?CR） was used to assess the incidence of delirium in the preoperative day 1, postoperative day 1, postoperative day 2, and postoperative day 3. Peripheral venous blood was taken before anesthesia induction（T0）, 1 h postoperatively（T1）, 6 h postoperatively（T2）, 1 day postoperatively（T3）extraction of peripheral venous blood for detecting the concentration of S100β protein. Results The total incidence of postoperative delirium（POD）in 3 days after operation in group H was significantly higher than that in group L （P<0.05）. The S100β protein level of T1 and T2 in group H was significantly higher than that in L group（P<0.05）, and the time of recovery was obviously prolonged（P<0.05）. Conclusions The 3% concentration of sevoflurane inhaled combined with remifentanil could lead to an increase in the incidence of POD in the elderly patients undergoing hip replacement. 1.5% sevoflurane inhalation combined with remifentanil has higher safety.

Clinical analysis of cervical artificial disc replacement for cervical spondylotic myelopathy

ZHANG Daijie，FANG Qingmin，WANG Dawei，ZHANG Tianqi

2018, 18(05):  544-548.  DOI: 10.3969/j.issn.1009-976X.2018.05.012

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【Abstract】 Objective To explore the clinical efficacy of cervical artificial disc replacement （CADR）and nterior cervical decompression and fusion（ACDF）in the treatment of single?segment cervical spondylotic myelopathy（CSM）. Methods From January 2015 to January 2018, 40 patients with single?segment CSM were enrolled, 19 of whom were treated with ACDF（ACDF group）and 21 with CADR （CADR group）. The patients in two groups were observed and followed before the surgery and 3 months, one year, 3 years after surgery. The JOA score, NDI score and the improvement rate of JOA score was recorded. The changes of MRI and X?ray images were examined. The effect of cervical decompression and fusion and the implant were observed and recorded. Results The clinical symptoms of the two groups were significantly relieved, and the neurological function was significantly improved. The JOA score and NDI score were statistically different between the two groups（P<0.05）. There was no significant difference in JOA scores between the ACDF group and the CADR group（P>0.05）, and the NDI scores in the CADR group were superior to the ACDF group（P<0.05）. The ACDF group had excellent JOA scores. The rate was 84%, and the CADR group was 90%. There was no statistically significant difference（P>0.05）. In the imaging findings, the success rate of fusion in the ACDF group was 94.7% at the last follow?up, and mild heterotopic ossification occurred in 2 patients in the CADR group, but the artificial intervertebral joint mobility was not significantly restricted. No serious postoperative complications occurred in either group. Conclusion Compared with the classic anterior fusion method, cervical artificial disc replacement can not only obtain the same excellent decompression effect, but also use the bionic prosthesis to maintain the original intervertebral activity, effectively avoiding the degeneration caused by peripheral bone joint compensation function increase because of fusion and a satisfactory short?term effect is obtained.

Effect of implant removal on physical function in femoral neck fracture patients after internal fixation

LAN Xianqi，MAI Huiqiang，HE Zhiyong

2018, 18(05):  549-552.  DOI: 10.3969/j.issn.1009-976X.2018.05.013

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［Abstract］ Objective To explore the effect of implant removal on physical function in femoral neck fracture patients after internal fixation. Methods Clinical data of 108 femoral neck fracture patients after internal fixation were collected, and patients were divided into the removal group（n=45）and the control group（n=63）. General clinical data, 12?Item Short Form Survey（SF?12）scores and The Western Ontario and McMaster Universities Osteoarthritis Index（WOMAC）scores of two groups before fracture and before and 2 years after implant removal were compared. Results Compared to the control group, patients were younger, and the incidence of displaced fracture, implant loosening, and walking alone was higher in the removal group（P<0.05）. Before implant removal, activity sub?score and total score in SF?12 and pain sub?score, stiffness sub?score, function sub?score and total score in WOMAC were significantly lower in the removal group than that in the control group （P<0.05）. After implant removal, there were no significant differences between two groups in activity sub?score, mentality subscore and total score in SF?12 and pain sub?score, stiffness sub?score, function sub?score and total score in WOMAC（P>0.05）. Moreover, activity sub?score in SF12 and pain sub?score, function sub?score and total score in WOMAC were significantly lower in the control group after implant removal than that before implant removal（P<0.05）. Activity sub?score and total score in SF?12 and pain sub?score, stiffness sub?score, function sub?score and total score in WOMAC were significantly higher after implant removal in the removal group than that before implant removal（P<0.05）. Conclusion Implant removal could improve physical function in femoral neck fracture patients after internal fixation with continuous pain and activity limitation in operative site, and removal of internal fixation is necessary for above patients.

Effect of individualized telephone follow?up on postoperative rehabilitation and physical and mental health in total knee arthroplasty patients

LU Xiaohua，HUANG Jiabao，HU Dan

2018, 18(05):  553-557.  DOI: 10.3969/j.issn.1009-976X.2018.05.014

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［Abstract］ Objective To explore the effect of individualized telephone follow?up on postoperative rehabilitation and physical and mental health in total knee arthroplasty（TKA）patients. Methods 156 patients received TKA were assigned to the control group and the observation group（n=78）. Patients in the control group received subsequent visit in the outpatient clinic at 1 and 3 months after discharge. Patients in the observation group received individualized telephone follow?up besides subsequent visit in the outpatient clinic. Patients′ Western Ontario & McMaster Universities osteoarthritis index（WOMAC） scores, the MOS item short from health survey（SF?36）scores, general self?efficacy scale（GSES）scores and times of unscheduled visits were recorded at 1 and 3 months after discharge. Results WOMAC scores were significantly lower in the observation group than that in the control group at 1 and 3 months after discharge（P<0.05）. SF?36 and GSES scores in the observation group were significantly higher than that in the control group（P<0.05）. Unscheduled visits in the observation group were significantly less than that in the control group（P<0.05）. Conclusion Individualized telephone follow?up could improve postoperative rehabilitation and physical and mental health in TKA patients, decrease their unscheduled visits, which is worth popularizing clinically.

Application of multimodal analgesia in Da Vinci robot-assisted radical cystectomy and orthotopic ileal neobladder

LIU Jiayi，HONG Yu，WANG Zhi

2018, 18(05):  558-561.  DOI: 10.3969/j.issn.1009-976X.2018.05.015

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［Abstract］ Objective To explore the application value of multimodal analgesia in robot?assisted radical cystectomy and orthotopic ileal neobladder. Methods Sixty patients undergoing elective robot?assisted radical cystectomy and orthotopic ileal neobladder were divided into 2 groups（n=30）, multimodal analgesic group（group M）and control group（group C）. The analgesic strategy of group M were treated as follow：（1）Paracoxib sodium was used intravenously；（2）transverse abdominal plane block was performed；（3）no opioid patient controlled intravenous analgesia. The patients in group C were treated with conventional patient?controlled intravenous analgesia. The postoperative pain score, incidence of analgesia?related adverse reactions and postoperative rehabilitation of the two groups were collected and analyzed. Results The postoperative pain scores of 2 h, 6 h, 12 h, 24 h and 48 h in group M were significantly lower than those in C group. The incidence of nausea, vomiting, drowsiness, pruritus, hypotension, supplemental analgesics and additional antiemetic drugs in group M were lower than those in group Postoperative ambulation time, exhaust time, defecation time and hospitalization time in group M were significantly earlier than those in group C. Conclusion Multimodal analgesia can effectively alleviate postoperative pain of patients with radical cystectomy combined with orthotopic ileum and promote early bed removal by Da Vinci robot, which can help patients recover after operation and shorten the time of hospitalization.

Comparison of efficacy of spinal anaesthesia and sub?fascial local anaesthetic inguinal field block for open inguinal hernia repair in a primary hospital

LIU Guohua，LU Weijian，LIAO Bo，CHENG Fengbao，LI Kaifeng

2018, 18(05):  562-565.  DOI: 10.3969/j.issn.1009-976X.2018.05.016

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［Abstract］ Objetive To investigate the most suitable anaesthesia method for the tension?free herniorrhaphy in the primary hospitals under the limited condition by comparative study of the effect of local anesthesia and epidural anesthesia in tension?free repair of inguinal hernia. Methods A total of 102 unilateral inguinal hernia cases from July 2016 to January 2017 were collected and divided into the local anaesthesia group and epidural anaesthesia group. All patients in two groups were operated with high ligation of hernia sac and flat mesh repair of inguinal hernia. The operation time and postoperative wound pain time, postoperative adverse reactions and complications were compared between the two groups. The postoperative patients′ satisfaction with the anesthetic effect was recorded. After the discharge, the patients were reviewed once a week in the first month. Telephone follow?up was performed once a month for two years. Results There was no significant difference of subcutaneous hematoma, wound infection, scrotal swelling, inguinal nerve and abdominal organ injury and the duration of postoperative pain between two groups（P>0.05）. It was found that hospital stay and the occurrence of complication of Nausea/ vomiting, Headache/dizzy, and uroschesis in local anaesthesia group were significantly lessor lower than those in epidural anaesthesia group（P<0.05）. Two patients had chronic pain in each group during the 2?year follow?up, and were improved by NSAIDs. There were no statistically significant differences in VAS scores between the two groups at 1 month, 6 months, 12 months, and 24 months（Table 3）. The patients in the epidural group were more satisfied anesthesia than those in the local anesthesia group. Conclusion It is feasible to perform tension?free repair of open inguinal hernia under local anesthesia in primary hospitals, and it does not increase the incidence of chronic pain.

Nerve growth factor，tyrosine kinase A and p75 neurotrophin receptor expression in the human herniated intervertebral disc and effect of NGF on clinical symptoms

WANG Gang，XUAN Tianhang，LUO Rongsen，CAO Zhenglin，GUAN Honggang.

2018, 18(05):  566-570.  DOI: 10.3969/j.issn.1009-976X.2018.05.017

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［Abstract］ Objective To investigate the expression of nerve growth factor（NGF）and its receptor, tyrosine kinase A（TrkA）and p75 neurotrophin receptor（p75NTR）in discs from patients with lumbar disc herniation（LDH）and the effect of NGF on clinical symptoms. Methods Patients（n=62）with a singlelevel lumbar disc herniation treated by surgery were included, disc samples were obtained from patients during surgery. The expression of NGF, TrkA and P75NTR was detected by immunohistochemistry method. Protein levels were quantified using an enzyme?linked immunosorbent assay（ELISA）for NGF. Levels of NGF in the discs were compared between low?grade and high?grade degenerated discs. Multiple linear regression analysis was used to assess the factors affected to NGF level. Patient′s symptoms were assessed using a visual analog scale（VAS）and the Oswestry disability index（ODI）；the influence of NGF levels on preand postoperative symptoms was examined. Results Immunopositive staining for NGF, TrkA and P75NTR was identified in the chondrocyte?like cells of the disc tissue. No significant differences in levels of NGF were found between low?grade and high?grade degenerated discs. The results of multiple linear regress analysis showed the cellular immunopositivity of NGF and TrkA are significantly related to NGF levels. Pre?operative symptoms were not related to NGF levels. Post?operative lower extremity pain and low back pain（LBP）were greater in patients with high levels of NGF. Conclusion This study demonstrates that NGF and its receptor, TrkA and P75 were expressed by disc cells and NGF is actually being produced by the chondrocyte?like cells of the disc tissue. Our results showed that pre?operative disc protein levels of NGF affected postoperative LBP and lower extremity pain, suggesting there is some degree of impact of NGF on generation of LBP and lower extremity pain.

Misdiagnosis of primary thyroid lymphoma：report of one case and literature review

CHEN Zhiwei，CAO Mingrong

2018, 18(05):  571-574.  DOI: 10.3969/j.issn.1009-976X.2018.05.018

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［Abstract］ Primary thyroid lymphoma （PTL）is uncommon and stems from the pathological thyroid lymphoid tissue. Its pathogenesis is unclear and may be related to the autoimmune effects of Hashimoto′s thyroiditis.This article describes the diagnosis and treatment of a 74?year?old woman with primary thyroid lymphoma（diffuse large B?cell lymphoma）, and reviews the clinical and pathological features and treatment of PTL.

Effects of desflurane and sevoflurane anesthesia on levels of blood glucose and lactic acid in brain tumor patients

LI Li，ZENG Jianfeng，LUO Jianwei，LU Fuding

2018, 18(05):  575-578.  DOI: 10.3969/j.issn.1009-976X.2018.05.019

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［Abstract］ Objective To investigate the effects of desflurane and sevoflurane on blood glucose and lactic acid in patients with brain tumor. Methods Sixty four patients with brain tumor, aged 21-62 yr, American Society of Anesthesiologists status Ⅰ-Ⅱ, with body mass index of 20-25, scheduled for brain tumor resection surgery, were assigned into desflurane group（Group Des, n=30）and sevoflurane group （Group Sevo, n=34）using a random number table, the two groups were anesthetized with desflurane and sevoflurane respectively. 1 mL artery blood sample were taken to detect the levels of blood glucose and lactic acid at each time of before operation（T0）, one hour after operation（T1）, two hours after operation（T2）, end of operation（T3）. Results The level of blood glucose in both group were significant increased（P<0.01）, but there were no statistical difference between the two groups（P>0.05）. There were no significant increase on the level of lactic acid in both group（P>0.05）, also, no statistical difference between the two groups （P>0.05）. Conclusion Both desflurane and sevoflurane anesthesia increase blood glucose levels in patients with brain tumors.

The clinical feasibility of transurethral plasmakinetic enucleation of prostate in treatment of large benign prostatic hyperplasia

SU Bin，FANG Jianning，WU Miaofeng，QIU Zhiyong，LAN Yansi，

2018, 18(05):  579-581.  DOI: 10.3969/j.issn.1009-976X.2018.05.020

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［Abstract］ Objective To investigate the curative effect of transurethral plasmakinetic enucleation for treatment of large benign prostatic hyperplasia. Methods Forty?five cases of huge benign prostatic hyperplasia patients from March 2016 to March 2017 were assigned to two groups, PKRP group（treated with plasmakinetie resection of the prostate, n=22）and PKEP group（treated with plasma kinetic enucleation of the prostate, n=23）. The related clinical indicators were recorded and compared between two groups. Results There was no significant difference between the two groups in operation time （t=1.132, P>0.05）. The PKEP group had more prostate tissue resection than PKRP group（t=3.462, P< 0.01）, and the intraoperative blood loss was reduced（t=5.395, P<0.01）, and no perforation occurred in the PKEP group. After 3 months of follow?up, the IPS and QOL of the two groups decreased significantly, and the residual urine decreased significantly. The IPSS and QOL of PKEP group were significantly lower than of PKRP group, and the difference was statistically significant（t=2.093, P<0.05；t=2.761, P<0.01）. There was no significant difference in PVR and hospitalization time between the two groups（P>0.05）. Conclusion Compared with PKRP, PKEP can excise more effective benign prostatic hyperplasia, has less intraoperative bleeding, and is a safer surgical approach.

Risk factors for renal calculi associated with primary hypertension and the relationship with stone composition

CUI Xuejiang，FENG Quanyao，HU Ming，HUANG Yiheng，YANG Yunjie，ZHAO Zhenhua.

2018, 18(05):  582-585.  DOI: 10.3969/j.issn.1009-976X.2018.05.021

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［Abstract］ Objective To observe the risk factors of renal calculi in patients with primary hypertension and analyze the correlation between primary hypertension and stone compositions. Methods 685 cases of renal calculi patients treated in our hospital from August 2015 to December 2017 were grouped with（group A）or without（group B）primary hypertension. Sex, age, BMI and blood biochemical indexes were counted, screening the related risk factors. The lithiasis composition of stone specimens was analyzed by infrared spectroscopy. The statistical analysis was carried out by SPSS software such as t test, Chi square test and Pearson correlation analysis. Results 372（54.3%）patients （group A）with primary hypertension had higher BMI, blood uric acid, fasting blood glucose, triglyceride, blood urea nitrogen and blood creatinine and lower blood albumin level, when compared with 313（45.7%）without hypertension （P<0.05）. The stone composition in group A included calcium oxalate （32.97%） and uric acid（23.78%）, and calcium carbonate stone, calcium phosphate stone, magnesium phosphate stone were significantly reduced than that in group B. There were positive correlations between different grades of hypertension and renal stone components（χ2=27.57, P=0.016；r=0.100）and between uric acid stones and hypertension grade（r=0.270, P<0.05）. Conclusion Hypertension, hyperuricacid, hyperglycemia, hypertriglyceridemia, hypoproteinemia, elevated blood urea nitrogen and creatinine are risk factors for kidney stones. There is a certain correlation between the classification of hypertension and the composition of urinary calculus.

Rectal gastrointestinal stromal tumor with intraperitoneal neurofibromatosis type 1: one case report

LI Zuoan, ZHANG Xiaoyan, ZHANG Jianmin, QIAN Changchun, CHA Wenzhang

2018, 18(05):  586-588.  DOI: 10.3969/j.issn.1009-976X.2018.05.022

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Multidisciplinary treatment of recurrent hepatocellular carcinoma after liver transplantation

GUAN Zhifen，CHEN Weiqiang

2018, 18(05):  589-592.  DOI: 10.3969/j.issn.1009-976X.2018.05.023

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［Abstract］ Liver transplantation is currently the most effective treatment for primary liver cancer. Despite strict selection criteria, recurrence often occurs after surgery, which affects the long?term survival of patients. The incidence of recurrence after liver transplantation is reported to be estimated to be 6%50% and occurs more frequently in the first two years after transplantation. This article reviews the multidisciplinary treatment strategies for recurrence after liver transplantation.

Early diagnosis and accurate treatment of hepatocellular carcinoma

carcinoma ZHAO Bingbing，LI Zitao，HU Weidong，XUE Jing，LI Mingyi

2018, 18(05):  593-598.  DOI: 10.3969/j.issn.1009-976X.2018.05.024

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［Abstract］ Hepatoma ranks the sixth in the incidence of cancer and the second in the global tumor?related mortality. Patients with hepatoma have an extremely low survival rate due to difficult early diagnosis, rapid disease progression and lack of targeted drugs. Early detection of hepatocellular carcinoma （HCC）is greatly limited due to the wide variety of risk factors（including genetic susceptibility, morphological diversity and microenvironment）. Therefore, based on the heterogeneity of individual patients with hepatoma, precision medicine provides a new perspective for individualized diagnosis and targeted treatment of cancer, and even enables us to carry out pre?clinical screening of tumors in high?risk groups. This paper reviews the advances in the early diagnosis, molecular classification, signal disorders and individualized treatment of hepatoma.

The effect of preoperative nursing intervention on the recovery of giant incision hernia

YU Hongyan，LIU Ya′nan，ZHOU Taicheng

2018, 18(05):  599-601.  DOI: 10.3969/j.issn.1009-976X.2018.05.025

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［Abstract］ Objective To explore the systematic nursing intervention of patients with huge incisional hernia in the abdominal wall, and to summarize the experience. Methods A total of 16 patients underwent massive incisional hernia repair in our hospital from October 2015 to October 2016, and their clinical data were retrospectively analyzed for comprehensive systemic nursing intervention. The nursing entry included preoperative health education, respiratory function intervention, abdominal wall compliance intervention, skin and intestinal preparation；preoperative, postoperative, postoperative time, postoperative heart rate, blood oxygen saturation, intra?abdominal pressure changes. Results The preoperative preparation time of the 15 patients who underwent surgery was 19.09±4.06 days, the operation time was 161±39 min, the postoperative hospital stay was 11.2±3.7 days, and the follow?up period was 2- 12 months. There was no recurrence. Conclusion Comprehensive and systematic preoperative intervention can achieve the trust and cooperation of patients, get better completion of preoperative preparation, and reduce postoperative complications.

Analysis of the causes and nursing strategies for refractory vomiting in the patients undergoing pancreaticoduodenectomy

YIN Xiaomin

2018, 18(05):  602-605.  DOI: 10.3969/j.issn.1009-976X.2018.05.026

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［Abstract］ Objevtive To investigate the causes and nursing strategies of refractory vomiting after pancreaticoduodenectomy（PD）. Methods Eighty?two patients who underwent pancreaticoduodenectomy in our hospital from August 2013 to March 2017 were enrolled. Among them, 32 patients with postoperative refractory vomiting were used as observation group, and the other 50 without refractory vomiting served as a control group. ANOVA and Logistic regression were used to analyze the risk factors affecting the occurrence of refractory vomiting after PD operation. Then the specific nursing strategies were proposed and the nursing effect was analyzed by CIVIQ life scale. Results By univariate analysis, age（≥60 years）, preoperative total bilirubin（≥170 μmol/L）, preoperative albumin（≥35 g/L）preoperative fasting blood glucose（≥7.0 mmol/L）, intraoperative blood loss（≥250 mL）and postoperative complications were influenting factors of refractory vomiting after pancreaticoduodenectomy（all P values<0.05）. Risk factors affecting refractory vomiting after pancreaticoduodenectomy included preoperative albumin, preoperative fasting blood glucose, and postoperative complications（all P values<0.05）. The CIVIQ scores of the patients with refractory vomiting after pancreaticoduodenectomy were 70.20±11.21 and 89.38±15.45, respectively（P<0.05）. Conclusion The risk factors for refractory vomiting after pancreaticoduodenectomy include preoperative albumin, preoperative fasting blood glucose, and postoperative complications. The patients should be given the necessary care interventions to improve the quality of life of patients and improve the prognosis of patients.

Nursing experience for patients with deep venous thrombosis of lower extremities

WU Wenjie，SHI Ruifen，LIANG Qiling，FU Lifen

2018, 18(05):  606-608.  DOI: 10.3969/j.issn.1009-976X.2018.05.027

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［Abstract］ Objective To summarize the nursing experience of 482 patients with deep venous thrombosis（DVT）in our hospital in the past five years and explore the effect of Well′s score and the reasonable nursing measures of DVT. Method The clinical data of 482 patients with DVT in our hospital in the past 5 years were collected. The first 4 years were treated with routine nursing methods. After 2017, the new nursing options was implemented to predicted risk of DVTby using the Wells scale after admission, and the actual coincidence rate of patients′ DVT was calculated.A series of communication and daily key examination carried out for confirmed DVT patients, and highlighted specialist care and necessary rescue preparation. The incidence of DVT between 2017 and the first 4 years was compared and explore new nursing experience from it.Results After the implementation of standardized prevention and treatment of venous thrombus embolism（VTE）and the implementation of standardized nursing measures, a total of 3 pulmonary embolism（PE）cases occurred in 121 DVT patients in 2017. The incidence of DVT concurrent PE was 2.48% which displayed a dramatic decline.Compared with previous years, PE concurrent rate decreased significantly. The difference was statistically significant（P<0.05）. Conclusion The Wells scoring system can accurately predict DVT patients. Sufficient communication with patients diagnosed with DVT, perfect DVT specialist nursing and necessary rescue preparation help to reduce the incidence and mortality of concurrent PE.

Influencing factors and current status of ICU nurses′ knowledge for ventilatorassociated pneumonia

ZHANG Cuimei，FENG Huijuan，OU Nvzhi

2018, 18(05):  609-611.  DOI: 10.3969/j.issn.1009-976X.2018.05.028

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［Abstract］ Objective The study aimed to investigate the present situation of nurses′ knowledge for preventing ventilator?associated pneumonia in ICU, to explore the related factors that affect nurses′ knowledge for Preventing VAP in Intensive Care Unit, to provide a reference and evidence for nursing education, training to prevent VAP. Methods By convenience sampling, a total of subjects were selected and surveyed with a self?designed questionnaire, which contain demographic data and knowledge in preventing VAP. Results The score of knowledge in preventing VAP was 6.58±1.66. As multiple stepwise regression analysis showed that education level, title and ICU working years were entered regression equation of preventing VAP in ICU. Conclusions ICU nurses were lack of knowledge concerning VAP prevention. It was suggested that the knowledge for preventing VAP be trained and learned.