Table of Content

20 December 2018, Volume 18 Issue 06

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Consideration in the diagnosis and treatment of hepatic cancer based on evidence-based guidelines and precision medicine

CHEN Zheng, WANG Jie

2018, 18(06):  615-617.  DOI: 10.3969/j.issn.1009?976X.2018.06.001

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Clinical features and diagnosis and treatment of acute hepatic failure

LIU Yanyan, LI Li

2018, 18(06):  618-623.  DOI: 10.3969/j.issn.1009?976X.2018.06.002

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Clinical application of argon helium cryoablation and radiofrequency ablation in the treatment of liver cancer

PAN Jingsheng，OU Bing，WANG Haohu，LIN Yejie，YANG Xiaowei

2018, 18(06):  624-626.  DOI: 10.3969/j.issn.1009?976X.2018.06.003

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Objective To investigate the clinical value of cryoablation and cold tip radiofrequency ablation（RFA）in the treatment of malignant liver tumors. Methods Ultrasound guided cryoablation with argon?helium knife was performed in 38 patients with 42 lesions，and ultrasound?guided RFA was performed in 40 patients with 44 lesions.Before and after treatment ，contrast enhanced ultrasound ， enhanced CT or enhanced MRI examination were used to confirm the diagnosis and evaluate the curative effect. Results 32 lesions were completely ablated after one?time cryoablation，10 lesions were completely ablated after another?time cryoablation，33 lesions were completely ablated after one?time RFA，and 11 lesions were completely ablated after another?time RFA. The total ablation rate was 76.2%（cryoablation） and 75%（RFA）respectively，and the difference was not statistically significant. Conclusion Argonhelium cryoablation and cold?circulating RFA can effectively inactivate liver cancer in situ ，which is one of the effective non?surgical methods for the treatment of malignant liver tumors.

Expression and clinical significance of PPARγ coactivator 1α in gastric cancer

ZHENG Senyou，TAN Jianan，CHEN Zhitao，HUANG Jing，ZHOU Shengning，YANG Bin，HAN Fanghai

2018, 18(06):  627-631.  DOI: 10.3969/j.issn.1009?976X.2018.06.004

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Objective To investigate the expression of PPARγ coactivator 1α（PGC1α）in gastric cancer and its clinical significance. Methods Ninety?nine cases of gastric cancer with the availability of clinical information and follow?up data were selected to detect PGC1α expression by immunohistochemistry，and the correlations of PGC1α expression with gastric cancer clinicopathological status as well as survival were analyzed. Results The PGC1α expression of gastric cancer was closely associated with tumor invasion，lymph node metastases，pathological TNM stage，histological type and Borrmann type（P<0.05），while recurrence，metastasis，tumor size，sex and gender was not（P>0.05）. Cox proportional hazard model applied for multivariate survival analysis revealed that PGC1α expression was an independent prognostic factor for both OS and RFS（P=0.009 and P=0.024，respectively），which is paralleled with pTNM stage，recurrence. Conclusion High PGC1α expression was identified as a protective prognostic factor for both OS and RFS in gastric cancer.

The clinical research of transoral endoscopic vestibular approach thyroidectomy and open thyroidectomy for thyroid disease

HUI Shuan，ZHANG Li

2018, 18(06):  632-635.  DOI: 10.3969/j.issn.1009?976X.2018.06.005

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Objective To compare the clinical efficacy between endoscopic thyroidectomy via vestibular approach and open thyroidectomy. Methods The clinical data of 68 cases of thyroidectomy from March 2016 to June 2017 were retrospectively analyzed in the First People′s Hospital of Xianyang. The patients were assigned to transoral thyroidectomy group（observation group，32 cases）and open thyroidectomy group （Control group，36 cases）. The operative time，intraoperative blood loss，postoperative drainage，hospital stay，parathyroid hormone level and aesthetic satisfaction were compared between the two groups. Results There was no significant difference between the two groups in the amount of blood loss，length of hospital stay，postoperative drainage，and parathyroid hormone levels. The operative time was and the aesthetic satisfaction were statistical significance（P=0.035，P=0.015，respectively）. Conclusion Endoscopic thyroidectomy via transoral approach is safe and reliable，which does not increase the surgical risk. It is more in line with the cosmetic requirements of young woman and has a quick recovery after operation.

Clinical experience of using endobiliary stent for primary suture after laparoscopic common bile duct exploration

PAN Desheng，YU Jiexiong，ZUO Chaohai

2018, 18(06):  636-639.  DOI: 10.3969/j.issn.1009?976X.2018.06.006

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Objective To investigate the feasibility of using endobiliary stent for primary suture after laparoscopic common bile duct exploration. Methods A total of 96 patients had laparoscopic common bile duct exploration between January 2016 and January 2018，47（49%），in whom underwent primary suture （primary suture group） and others （51%） received endobiliary stent implantation （endobiliary stent group）. Operative parameters and outcomes in the two groups were compared. Results The patients of two groups were cured to discharge from hospital. No mortality nor stones residue were found in two groups. First feeding time，drainage tube removal time，and postoperative stay were all significantly shorter in the endobiliary stent group as compared to that in the primary suture group （P<0.05）. Otherwise ， surgical time，intraoperative blood loss，bile leakage，and postoperative bleeding between the two groups had no significant difference （P>0.05）. Four patients suffered from bile leakage and recovered by short period drainage，and two patients with postoperative bleeding were cured after blood transfusion. The stent was removed by gastroscopy 2-3 weeks postoperatively ，while in some cases the stent was excreted spontaneously. The follow?up lasted for 1-6 months，and no stone recurrence or bile duct stenosis were found. Conclusion Using endobiliary stent for primary suture after laparoscopic common bile duct exploration is an effective and feasible method for common bile duct stone. It has better recovery and does not increase the incidence of biliary complications.

Efficacy and feasibility of laparoscopic minimally invasive surgery for 5~8 cm gastrointestinal stromal tumor

FU Xiangwei，XU Liang，WANG Shijian，RUI Xuancheng，JI Anlong，ZENG Xiangyong

2018, 18(06):  640-643.  DOI: 10.3969/j.issn.1009?976X.2018.06.007

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Objective To explore the efficacy and feasibility of laparoscopic minimally invasive surgery in the treatment of 5~8 cm gastrointestinal stromal tumor（GIST）. Methods The clinical data of each 48 patients with GIST of 5~8 cm diameter who underwent laparoscopic surgery（observation group） and laparotomy（control group）were retrospectively analyzed. The operation indexes（including operative time ，intraoperative blood loss ，incision length） and postoperative recovery （including postoperative exhaust time，postoperative feeding time，postoperative hospital stay）were compared between the two groups. And the complications within three months after operation ，recurrence，metastasis and death at one year after operation，and physical status ［Eastern Cooperative Oncology Group Score （ECOG）］ were also compared between the two groups. Results The operative time ，intraoperative blood loss ， incision length ， postoperative exhaust time ， postoperative feeding time and postoperative hospital stay in observation group were significantly lower than those in control group （P<0.05）. There was no significant difference in the occurrence of complications between the two groups within three months after operation （P>0.05）. At one year after operation ，there were no significant differences in recurrence ， metastasis ，and death status and physical status （ECOG score） between the two groups （P>0.05）. Conclusion Laparoscopic surgery and laparotomy have significant short?term efficacy and safety in the treatment of GIST with a diameter of 5~8 cm，and laparoscopic surgery has a good minimally invasive advantage and is more beneficial in promoting postoperative recovery.

Does patient age affect the PPV of ACR BI?RADS ultrasound categories 3 to 5 in the diagnostic setting？

HU Yue，YANG Yaping，GU Ran，SHEN Shiyu，LIU Fengtao，WANG Hongli，MEI Jingsi，JIANG Xiaofang，SU Fengxi*

2018, 18(06):  644-647.  DOI: 10.3969/j.issn.1009?976X.2018.06.008

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Objective To calculate the positive predictive value（PPV）of the Ultrasound section of the American College of Radiology Breast Imaging Reporting and Data System（ACR BI?RADS US）Atlas Categories 3 to 5 in different age groups and to determine whether patient age influences the PPV of each category in the diagnosis of breast lesions. Methods Using our database from June 2014 to June 2016， we identified 4428 ACR BI?RADS US categories 3 and 5 lesions with a known pathological diagnosis in 4428 women. The patients were classified into three age groups（<35，35~50，and >50 years）. The agerelated PPVs of each category in the three age groups were calculated based on the pathological diagnoses and compared using the chi squared test. Results PPV gradually increased with increasing age in patients with category 3 and 4 lesions. PPVs in the oldest group with categories 3 to 4B lesions were close to or exceeded the reference values. Conclusion PPV and age were significantly associated in patients with category 3 and 4 lesions according to the newest edition of ACR BI?RADS US in the diagnostic setting. Closer attention should be given to older patients when assigning a final assessment category.

Type III Mirizzi syndrome：A case report and literature review

QIAN Yibin，CHEN Minqiang，LI Wentao，ZHAO Jiasheng，LIU Xiaoguang，CHEN Nianping

2018, 18(06):  648-651.  DOI: 10.3969/j.issn.1009?976X.2018.06.009

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Mirizzi syndrome（MS）is a rare complication of cholelithiasis，whose pathological changes are severe and complicated. The clinical diagnosis and treatment of one case diagnosed with MS in the Affiliated Hospital of GuangDong Medical University in July 2018 was reported in this study. Through reviewing related literatures，this paper aims to summary the clinical features，pathological types and the latest diagnosis and treatment methods of MS.

Treatment of elder patient with early stage breast cancer：an experience of one case and literature review

WANG Yongnan，YAN Shanshan

2018, 18(06):  652-655.  DOI: 10.3969/j.issn.1009?976X.2018.05.010

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The article is to summarize the clinical data of an older patient with early stage breast cancer in our department. To analyze the effects of by anesthesia，surgery，adjuvant radiotherapy，adjuvant chemotherapy and endocrine therapy on the influence of older patients with early stage breast cancer in a multidisciplinary treatment team，and finally develop a treatment plan. He successfully received breastconserving surgery under local anesthesia by Lidocaine and healed 10 days after surgery. Postoperative pathology：left breast infiltrating papillary carcinoma，about 4 cm in diameter，negative for sentinel lymph nodes，ER（95%+），PR（95%+），HER?2（0），Ki?67（20%+）. No adjuvant radiotherapy or systemic systemic adjuvant therapy was performed after surgery. A multidisciplinary treatment teams assess the benefits and risks of treatment before treatment，and can develop clear，safe and reliable treatment options for older patient with early stage breast cancer.

Application of goal directed fluid therapy in cytoreductive surgery combined hyperthermic intraperitoneal chemotherapy

XIE Changle，ZHOU Jiawen，LUO Yuhao

2018, 18(06):  656-660.  DOI: 10.3969/j.issn.1009?976X.2018.06.011

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Objective To investigate the effect of goal?directed fluid therapy（GDFT）in cytoreductive surgery（CRS）combined hyperthermic intraperitoneal chemotherapy（HIPEC）. Methods This was a prospective approach. Eighty?six peritoneal metastases patients receiving CRS combined HIPEC were assigned to the control group and GDFT group （43 cases each group）. In the perioperative period ， patients in the control group received classical fluid therapy and patients in GDFT group received GDFT. Patients′ general information，hemodynamic index during surgery，lactic acid at the end of surgery， length of hospitalization，urine volume，intraoperative volume replacement，intraoperative bleeding volume ， usage of furosemide and dopamine，postoperative complications，intensive care unit（ICU）readmission and perioperative mortality were recorded. Results There were no significant differences in patients′ general information between two groups （P>0.05）. Crystalloid volume replacement and total volume replacement were significantly lower and colloid volume replacement was significantly higher in the experimental group than that in the control group （P<0.05）. Mean arterial pressure 30 min after surgery was significantly lower in the experimental group than that in the control group（P<0.05）. The ratio of usage of furosemide and dopamine，lactic acid at the end of surgery，length of hospitalization，ratio of postoperative abdominal，cardiac，respiratory and hepatic complication and ICU readmission were significantly lower in the experimental group than that in the control group （P<0.05）. Conclusion GDFT could decrease intraoperative volume replacement，postoperative complications and length of hospitalization.

Analysis of the effect of perioperative antibiotic application time in patients undergoing laparoscopic appendectomy on the incidence of complication

PENG Weiqian，LI Ruiping，GONG Shiwen

2018, 18(06):  661-664.  DOI: 10.3969/j.issn.1009?976X.2018.06.012

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Objective To analyze the effect of perioperative duration of antibiotic use on the incidence of complications in patients undergoing laparoscopic appendectomy. Methods 836 patients with laparoscopic appendectomy from July 2012 to June 2017 in our hospital were analyzed retrospectively， and the patients were divided into 3 groups according to different duration of antibiotics：186 patients as group A treated with antibiotics for less than 2 days after postoperation，404 as group B treated with antibiotics for 2-4 days，and 246 as group C treated with antibiotics for more than 4 days. The wound infection and incidence of diarrhea by using antibiotic were compared between the 3 groups. Results The proportions of patients with surgical incision achieving grade A healing were 77.96% ，76.24% and 80.89%，respectively，and the difference among group A，group B and group C was not significant（P> 0.05）. The infection rate of wound incision in the three groups was 2.69%，1.98% and 2.44%. There was no significant difference in the infection rate between the three groups （P>0.05）. However，antibiotic userelated diarrhea increases with prolonged use of antibiotics. Conclusion Perioperative duration of antibiotic use in patients undergoing laparoscopic appendectomy has no significant effect on the incidence of wound infection，but prolonged use increases the incidence of antibiotic?associated diarrhea in patients.

The clinical value of neck dissection of level Ⅶ lymph node for differentiated thyroid carcinoma

FENG Jianping，TANG Shibin，LIANG Zhiqiang，YE Jian

2018, 18(06):  665-667.  DOI: 10.3969/j.issn.1009?976X.2018.06.013

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Objective To explore the clinical value of level Ⅶ Neck dissection to differentiated thyroid carcinoma. Methods A total of 156 patients in Shunde Hospital from June 2015 to May 2017 were included in the study，in which 78 cases underwent thyroidectomy and level Ⅵ + level Ⅶ neck lymph nodes dissection（study group），and another 78 cases underwent thyroidectomy and level Ⅵ neck dissection（control group）alone. The number of lymph nodes，operation time，blood loss and postoperative complications were collected and analyzed in two groups. Results Central compartment lymph node metastasis was found in 52.56% of study group ，and in 51.28% of control group ，with no significant difference（χ2=3.34，P=0.345）. In study group，14.10% of level Ⅶ lymph nodes was found invasive， which was lower than other parts of central compartment lymph node district（52.56%，41/78）. Averagely， 7.7±1.2 lymph nodes were found in study group，whereas 5.2±1.1 lymph nodes in control group，which was significant difference（t=0.38 ，P=0.036）. In all cases of this group ，there was no difference in the average hospitalization stay ， operation time ， blood loss ， postoperative blood loss （P>0.05）. Conclusion DTC has high metastasis rate in the level Ⅶ. So it is necessary to clean lymph nodes in the level Ⅶ，which provide more accurate for postoperative efficacy of differentiated thyroid carcinoma.

Application of improved rapid enhanced recovery after surgery in laparoscopic cholecystectomy

ZHOU Chuanghuan，ZHOU Chenjie，YUAN Chunhui，CHEN Jingming，LONG Dingchao

2018, 18(06):  668-674.  DOI: 10.3969/j.issn.1009?976X.2018.06.014

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Objective To explore the feasibility of the improved on traditional rapid enhanced recovery after surgery（ERAS），for providing more perfect model of clinical treatment in laparoscopic cholecystectomy（LC）. Mothed The patients required cholecystectomy from Feb 2017 to jun 2016 were divided into either improved?ERAS group and traditional?ERAS group，with 71 cases in each group. The preoperative tensity，operation time，intraoperative bleeding，micturition and flatus time，time to get out off bed，time to intake general diet，level of incision pain，days of in?hospital，and hospitalization coast were compared. Results Compared with traditional?ERAS group ，postoperative complication rate of improved?ERAS group was low. The improved ERAS group had shorter micturition time（7.18 ± 1.30 vs. 6.63 ± 1.62h）， shorter flatus time（17.48±0.61 vs. 15.45±0.75 h），shorter time to get out off bed（12.75±1.05 vs. 12.27±1.71 h），shorter time to general diet（30.41±5.84 vs. 26.80±4.91 h），lower coast（12794.1±2737.3 vs 11092.8±2368.9 yuan），shorter days of in?hospital（7.3±3.2 vs. 5.9±2.5days），and patients′ subjective feeling were superior to traditional?ERAS group（P<0.001）. Conclusion Laparoscopic cholecystectomy is applied to traditional ERAS after improvement and optimization could shorten the length of in?hospital and reduce the pain of patients during perioperation.It will provide new methods and ideas for ERAS.

Preoperative CT guided localization and intraoperative dyestuff clip marking in video assisted thoracoscopic pulmonary nodule excision

YE Jun，YANG Jie，GU Weiquan，YANGSengli，WANG Fei；XIAO Ye，ZHANG Xiaowen，LUO Lingjun， ZHAO Ning，WU Lingling，CHEN Diyao

2018, 18(06):  671-674.  DOI: 10.3969/j.issn.1009?976X.2018.06.015

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Objective To investigate the value of preoperative CT?guided localization and intraoperative dyestuff?clip marking in VATS pulmonary nodule excision. Methods A total of 89 patients from August 2015 to May 2018 were registered，who received treatment in the department of thoracic surgery of The First People′s Hospital of Foshan. There were 98 pulmonary nodules used CT guiding localization before operation ，and used the methylene blueclip marking the pleural surface of pulmonary nodules during the operation. Then we performed the vedio assist thoracoscopic wedge resection. Results Of the 98 nodules ，85 cases（87%）were were successfully localized. The other 13 cases failed to locate because of their proximity to the mediastinal surface. All the 85 cases received vedio?assist thoracoscopic wedge resection successfully. There were no severe complications occurred during the operation，and no one transfered to open thoracotomy. All patients were histologically confirmed during the operation. Conclusion VATS by CT?guided localization before operation and dyestuff?clip marking intraoperatively is a viable safe procedure that meets oncological criteria for lung nodules surgery. In our experience， VATS is currently to be considered ideally indicated for pulmonary nodule surgery.

Single?incision video?assisted thoracoscopic exploration and surgical management for multiple rib fractures

WU Yongyong, HE Xueming, HE Zhongliang, CHEN Guoxing, LIU Zhijun, XIN Shunxin, WANG Yanning

2018, 18(06):  675-678.  DOI: 10.3969/j.issn.1009?976X.2018.06.016

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Objective To explore the clinical efficacy of thoracoscopic combined with small incision in the treatment of severe multiple rib fractures. Methods From August 2015 to February 2018 ，A retrospective analysis of 32 patients with severe chest blunt trauma admitted to our department. All patients underwent thoracoscopic exploration within one week after injury and assisted with one or more A small incision of about 10cm ，using a nickeltitanium memory alloy rib embracing fixator to fix the ribs，remodeling the structure and stability of the chest wall，and recording data related to surgery. Results All 32 patients underwent successful operation. The average number of rib fixation was 5.6（4?11）. The average operation time was 126 min（86-180 min）. The average intraoperative blood loss was 130 mL（100-250 mL）. The average extubation time after operation was performed 3 d（2-5 d）， average postoperative hospital stay：10.5 d（6?18d），follow?up was followed up for a total of 6 months ， 2 patients with chronic chest pain，no death and other serious complications. Conclusion Thoracoscopy?assisted small incision is safe and effective in the treatment of severe multiple rib fractures. It can make internal fixation surgery more minimally invasive and promote rapid recovery.

Application of coordinate precise positioning and small incision for rib fracture internal fixation

GUAN Junming，YUAN Yi，NIE Guangjie，ZHANG Huihuan

2018, 18(06):  679-683.  DOI: 10.3969/j.issn.1009?976X.2018.06.017

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Objective The purpose of this study was to explore the advantages of coordinate precise positioning small incision rib fracture internal fixation and traditional rib fracture internal fixation in clinical practice. Methods Forty patients with rib fracture were randomly divided into coordinate group and control group from March 2015 to December 2017. Eighteen patients in coordinate group and 22 patients in control group were enrolled in the study. postoperative complications，time of hospitalization and pain scores of 5 days after operation，the operation time，the length of incision，the amount of blood loss，the length of drainage tubewere compared between the two groups. Results The VAS scores of the two groups within 5 days after operation ，The scores were gradually reduced ，using the oneway general linear regression analysis of variance，F=34.689，P=0.000，there were statistical differences. There was no significant difference in the complications between the two groups （χ2=0.058，P=0.598）. There was no significant difference in the blood loss between the coordinate group and the control group（58±36 mL， 83+ 48 mL，t=1.83，P=0.058）. The operation time of the two groups was 53± 11 min in the coordinate group，and 87±24 min in the control group（t=5.51，P=0.010）. The incision sizes of the two groups were7.5±1.4 cm ，11.9±2.3 cm ，t=7.02 ，P=0.002 ，respectively. There was a statistical difference in theindwelling time of the wound drainage tube，t=6.32，P=0.003. There was no statistical difference in the VAS scores of the two groups before operation in terms of pain sensation. Conclusion The application of internal fixation with precise coordinate positioning for rib fracture through small incision has the advantages of less pain，faster recovery and better surgical effect than general internal fixation.

The correlation between thermal response latency and sciatic nerve myelin associated protein in streptozotocin?induced mouse with diabetes

CHEN Yuying,LI Li,LIU Yanyan,CHEN Binghao,SONG Weidong,WANG Chuan,YAN Li,YANG Chuan

2018, 18(06):  684-687.  DOI: 10.3969/j.issn.1009?976X.2018.06.018

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Objective To observe correlation between thermal response latency and sciatic nerve myelin associated protein in streptozotocin?induced mouse with diabetes. Methods Sixteen 6?week?old male SPF grade C57BL/6J mice were randomly divided into two groups with 8 mice each. STZ 200mg/kg in STZ group was injected intraperitoneally once to establish the mouse model with diabetes. The same volume of buffer was injected in CON group. Mice were placed on a hot plate apparatus to value the thermal response latency. Real time RT qPCR and western blot were used to detect the expression of MAG，P0 in the sciatic nerve of mice. The correlation between the thermal response latency and MAG、 P0 was analyzed. Results Compared with CON group，the FBG level of STZ group was significantly increased（P<0.0001），which showed that the STZ induced diabetes model was successfully established. Compared with CON group，the thermal response latency of STZ group was longer（P<0.05）. The mRNA and protein expression levels of MAG、P0 were all significantly decreased in group A than those in group B（P<0.0001）. Conclusion The sciatic nerve myelin associated proteins are attenuated in the STZ?induced mouse model with diabetes. The results suggest that peripheral hyperglycemia may cause thermalgesia，which might relative to the decrease of myelin associated protein. But the specific mechanism re? mains to be explored.

Effects of norepinephrine on prevention of hypotension during cesarean section under combined spinal-epidural anesthesia for mothers and infants

HOU Jie，YANG Fang，LIU Zhiheng

2018, 18(06):  688-692.  DOI: 10.3969/j.issn.1009?976X.2018.06.019

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Objective To observe the effects of norepinephrine on preventing hypotension during cesarean section under combined spinal?epidural anesthesia（CSEA）for mothers and infants. Methods This was a prospective study. Sixty patients undergoing cesarean section under CSEA were block divided into three groups，Group A，Group B and Group C，20 cases in each group. Twenty minutes before initiation of combined spinal and epidural anaesthesia ， patients were randomized to receive norepinephrine 0.05 μg·kg?1·min?1 in group A，norepinephrine 0.1 μg·kg?1·min?1 in group B，and saline 0.1 μg·kg?1· min?1 in group C，respectively. All the groups of patients were injected with 0.5% ropivacaine 3 mL at the L3 4 space for spinal anesthesia. Mean arterial pressure（MAP）and heart rate（HR）in the three groups of patients were observed and recorded at the following eight time points：before anesthesia（T1），spinal injection of the anesthetic （T2），5 min after spinal anesthesia （T3），10 min after spinal anesthesia （T4），20 min after spinal anesthesia（T5），postoperation（T6），postoperative 8 h（T7）and postoperative 24 h（T8）. The neonatal Apgar score，blood gas analysis，maternal adverse reactions in the three groups were observed. Results There was no statistical difference in MAP and HR among the three groups at T1， and no statistical difference in MAP and HR between group A and group B at each time point（P>0.05）. Compared with T1，MAP in group C at T3，T4 and T5 decreased significantly，HR in group C at T4 decreased significantly（P<0.05）. At T3，T4 and T5，MAP in group C was significantly decreased than that in group A and group B（P<0.05）. The levels of PaO2，PaCO2 and PH in umbilical cord blood of the three groups were not statistically different（P>0.05）. The incidences of nausea，vomiting and headache in group A and group B were significantly lower than those in group C（P<0.05）. The Apgar scores at 1 min and 5 min after born in the three groups were not significantly different（P>0.05）. Conclusion The outcomes showed preanesthesia 0.05 μg/kg·min norepinephrine was effective in preventing hypotension in cesarean section under combined spinal epidural anesthesia，and has little impact on mothers and infants，thus was safe.

Analgesic effect of morphine added to bupivacaine in transversus abdominis plane block for total abdominal hysterectomy

LI Xuelun，LIANG Nianhong，CHEN Jinming，FENG Chaoqun

2018, 18(06):  693-697.  DOI: 10.3969/j.issn.1009?976X.2018.06.020

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Objective To investigate the analgesic effect of morphine added to bupivacaine in transversus abdominis plane block（TAPB）for total abdominal hysterectomy. Methods This is a prospective study where 94 patients prepared to received total abdominal hysterectomy were assigned to the control group and the observation group（n=47）. After general anesthesia patients received TAPB about 15 min before surgery. TAPB anaesthetics in the control group were 0.5% bupivacaine hydrochloride 20 ml plus normal saline 20 ml，and those in the observation group were 0.5% bupivacaine hydrochloride 20 ml plus morphine 10 mg and normal saline 20 mL. TAPB anaesthetics 20 ml were respectively injected in bilateral sides. Results Visual analog pain scale at rest and during movement at 2，4，8，12，18 and 24 h postoperatively was significantly lower in the observation group than that in the control group （P< 0.05）. Moreover，ratio of using morphine intravenous patientcontrolled analgesia（IV PCA）and morphine IV?PCA consumption at 24 h were significantly less in the observation group than that in the control group（P<0.05）. Time for first request of analgesia was significantly longer in the observation group than that in the control group（P<0.05）. Ratio of postoperative nausea and vomiting was significantly lower in the observation group than that in the control group（P<0.05）. Conclusion Morphine added to bupivacaine TAPB could significantly decrease visual analog pain scale，morphine consumption and ratio of adverse effect and prolong the time for first request of analgesia at 24 h postoperatively for total abdominal hysterectomy patients，which is worth popularizing clinically.

The application of target controlled infusion with propofol by Marsh model versus Schnider model during hysteroscopic surgery

LI Li，ZENG Jianfeng，LU Fuding，CHEN Meixian

2018, 18(06):  698-701.  DOI: 10.3969/j.issn.1009?976X.2018.06.021

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Objective To evaluate the applicability of target controlled infusion（TCI）with propofol by Marsh model and Schnider model during hysteroscopic surgery. Methods Sixty unpremedicated gynecologic patients，aged 20-60 yr，with body mass index of 18-30，American Society of Anesthesiologists physical status I or II undergoing hysteroscopic surgery in SunYat?sen Memorial Hospital from January of 2017 to June of 2018 were divided into M and S groups（n=30 each）. Propofol was administered by TCI， with respectively March model and Schnider model in two groups，and the depth of anesthesia was monitored by Narcotrend. The applicability of two models was evaluated by ASA status ，age，BMI，operative time， propofol dosage per unit time ，number of body movement ，TCI parameter adjustment ，hypotension， sinus bradycardia，assistant breathing during the operation. The Narcotrend index date in the time of basic state（T0），loss of consciousness（T1），expansion of cervical（T2），end of anesthesia（T3）were collected and analyzed.Also recovery time of consciousness，number of nausea and vomiting，chill were recorded. Results There was no significant difference in the ASA status，age，BMI，operative time between group M and group S（P > 0.05）. The propofol dosage per unit time in group M were less than group S（P <0.001），number of body movement in group M was more than group S（P < 0.05），TCI parameter adjustment in group M was more than group S too（P < 0.01），but hypotension，sinus bradycardia，assistant breathing during the operation have no significant difference between the two groups. There was no significant difference in NTI between group M and group S in T0（P>0.05），NTI were higher in group M than group S in T1 and T2（P<0.01），but no significant difference in T3 between the two groups（P>0.05）. There was no significant difference in the recovery time of consciousness，number of nausea and vomiting，chill between group M and group S（P>0.05）. Conclusion Schnider model was better than Marsh model in propofol TCI during hysteroscopic surgery.

Applied analysis of absorbable line in repair of gastroduodenal ulcer perforation

YUAN Fengkun，WU Jian，WAN Kang，ZHOU Quan

2018, 18(06):  702-704.  DOI: 10.3969/j.issn.1009?976X.2018.06.022

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Objective To investigate the safety and effectiveness of absorbable line in repair of gastroduodenal ulcer perforation. Methods Eighty patients undergoing acute perforation of gastroduodenal ulcer from February 2014 to February 2017 were divided into two groups，including 40 cases in control group and 40 cases in observation group. The control group repaired the ulcer perforation with silk sutures， and the observation group repaired the ulcer perforation with absorbable line. There were no statistically significant difference between the two groups in terms of preoperative general data，time of perforations， site of perforations，operation time and hospitalization time（P>0.05）. The ulcer healing was observed and analyzed in the two groups after 1 month，3 months and 12 months. Results In the observation group，the healing of ulcer was significantly different from that in the control group under gastroscope（P<0.05）. Conclusion It is safe and feasible to perform repair of gastroduodenal ulcer perforation by using absorbable line，which could promote ulcer healing.

Treatment of ureteral calculi by ureteroscopic holmium laser：Experience of 428 cases

LIN Feihe，XIE Chunfa，GAO Hailiang，CAI Daoguang，CAI Boji

2018, 18(06):  705-707.  DOI: 10.3969/j.issn.1009?976X.2018.06.023

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Objective To Summarize the clinical experience and operation experience of ureteroscopic holmium laser in treatment of ureteral calculi in primary hospital. Methods The clinical data of 428 cases of ureteral calculi were retrospective analyzed. All patients underwent holmium laser procedure of ureteral lithotripsy from Aug 2016 to Aug 2018 in a primary hospital. Results Lithotripsy was performed successfully in all patients. Of 428，395 underwent one?stage lithotripsy with a success rate of 92.29% ；the stones were moved up to the kidney（6.31%）in 27 cases，and then extracorporeal shock wave lithotripsy（ESWL）was performed the double J tube was placed；3（0.7%）were changed to open surgery. No complications such as major bleeding ，ureteral tears ，severe infections occurred in all patients during and after operation. Conclusion Ureteroscopic holmium laser treatment of ureteral calculi in the primary hospital can achieve the advantages of safe ，minimally invasive ，rapid recovery ，and effective curative effect，but the primary hospital should have the ability to deal with serious complications.

Investigation and analysis of doctors′ health status in surgical departments of a Three-A Grade hospital

WANG Jiwen，QIU Yuru，HUANG Songyin

2018, 18(06):  708-710.  DOI: 10.3969/j.issn.1009?976X.2018.06.024

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Objective To explore the health status and management measures of doctors in surgical departments of a Three-A Grade hospital in Guangzhou. Methods A retrospective analysis was focused on the routine physical examination results of all the doctors in our hospital in 2018. According to the nature of their work，they were divided into operation group and non-operation group. Abnormalities in some indicators，such as blood sugar，lipids，uric acid，etc.，were statistically analyzed between the two groups. Results The incidence of abnormal blood glucose，lipids and uric acid（9.8%，38.7% and 23.3%） was significantly lower than that of the national residents. The incidence of abnormal blood glucose，blood lipids，uric acid and liver function in the operation group was higher than that in the nonoperation group，and the blood lipids increased significantly（P<0.05）. The abnormal rate of CHOL，TG and LDL-C increase was higher than that of the non operation group，and LDL-C had significant difference（P<0.05）. Conclusion The abnormal rate of metabolic diseases for the doctors of operating departments is higher than that in non-operating departments. It is necessary to strengthen the health care of， especially in the management and health education of blood lipids.

Advances in diagnosis and treatment of chronic pancreatitis

HUANG Yipei，XU Leibo

2018, 18(06):  711-715.  DOI: 10.3969/j.issn.1009?976X.2018.06.025

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Chronic pancreatitis，as a chronic disease of digestive system，is commonly emerged and diagnosed. However ， its pathogenesis remains unclear. The patients usually experience annoying symptoms such as recurrent abdominal pain ，indigestion ，fatty diarrhea，hyperglycemia，and so on. Patients with chronic pancreatitis tend to relapse easily and can′ t be treated with satisfaction. Various kinds of imaging examinations，together with the measurement of pancreatic secretory function，can help the diagnosis of chronic pancreatitis. However ，for patients with early chronic pancreatitis ，it is still difficult to detect and diagnose. Therapeutic strategies mainly focus on the relief of clinical symptoms and avoiding deterioration. In the meantime ，we are expected to improvethe pancreatic secretory function and prevent the relative complications. Furthermore，individualized multidisciplinary comprehensive treatmentis highlighted. Our present review gives a brief illustration on the disease characteristics and the developing views in the diagnosis and treatment of chronic pancreatitis in recent years。

Progress in the diagnosis and surgical indications of infective endocarditis

LIANG Jiakang，CHENG Keluo，CHEN Lin

2018, 18(06):  716-720.  DOI: 10.3969/j.issn.1009?976X.2018.06.026

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Infective endocarditis is a serious，life threatening cardiovascular diseases. Early diagnosis and early surgical treatment are the key to treating infective endocarditis. Appropriate early surgery can avoid death and severe complications，but the best time for surgery remains unclear. The benefits of early surgery should be weighed against its risks by Multidisciplinary collaborations for the clinical worker ，to ensure the opportunity of early surgery for patients. Currently，the main indications for early surgery in patients with IE are heart failure，uncontrolled infection and prevention of embolism. Here we discuss the diagnosis of infective endocarditis，antibiotic treatment and surgical indications.

Acute intestinal perforation caused by accidental swallowing of toothpicks: Two cases report

HUANG Zijian，HUO Jingshan，WU Minhan

2018, 18(06):  721-722.  DOI: 10.3969/j.issn.1009?976X.2018.06.027

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Effect of massotherapyon postoperative pain in total knee arthroplasty patients

CAI Xiaoshan，LIN Zhaoli，LI Xiangping，SU Guang

2018, 18(06):  723-726.  DOI: 10.3969/j.issn.1009?976X.2018.06.028

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Objective To explore the effect of massotherapy on postoperative pain in total knee arthroplasty（TKA）patients. Methods This was a prospective study. 142 patients received unilateral TKA were assigned to the control group and the observation group（n=71）. Postoperatively，patients in the control group received routine nursing，and patients in the observation group received massotherapy besides routine nursing. Results Patients′ pain score at postoperative 6 ，12 ，18 and 24 h in the observation group was significantly lower than that in the control group（P<0.05）；patients′ anxiety rate at postoperative 6 ，12 and 24 h was significantly lower than that in the control group （P<0.05）； patients′ morphine consumption at postoperative 6，12 and 24 h was significantly less than that in the control group（P<0.05）；patients′ postoperative satisfaction was higher than that in the control group（P<0.05）. Conclusion Massotherapy could significantly decrease TKA patients′ postoperative pain，anxiety and analgesic consumption，and increase patients′ postoperative satisfaction，which is worth popularizing clinically.

Effect of FTS concept nursing intervention on postoperative rehabilitation exercise compliance and VAS scores in patients with calcaneus fractures

YUAN Yuan，WU Di

2018, 18(06):  727-729.  DOI: 10.3969/j.issn.1009?976X.2018.06.029

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Objective To explore the effect of concept of fast tract surgery（FTS）in nursing intervention of patients with calcaneus fractures. Methods Sixtyseven patients with calcaneus fractures in our hospital were enrolled. Of them，33 patients（control group）in April 2016 to June 2017 were treated as outpatient treatment and nursing in the same period，while 34 patients from May 2017 to January 2018 were used as observation group who received nursing intervention based on the FTS concept. The rehabilitation exercise compliance，the pain sensation（VAS grade）at different time points（1 d，2 d，3 d after surgery）and the satisfaction were compared between the two groups. Results First，the total compliance rate of rehabilitation exercise in the observation group was 91.18%（31/34），which was higher than control group（69.70%（23/33），P<0.05）. Second，the VAS grade of the observation group were lower than control group at 1 day，2 days，and 3 days after operation（P<0.05）. Third，the nursing satisfaction of the observation group was 94.12%（32/34），which was higher than control group（72.73%（24/33）（P<0.05）. Conclusion The nursing intervention based on the FTS concept can improve the compliance of postoperative rehabilitation exercise and reduce postoperative pain，thus improving the satisfaction of nursing.

The evaluation of three intravenous drug injections for the assessment of liver function

ZHAO Juan，XIONG Rui

2018, 18(06):  730-732.  DOI: 10.3969/j.issn.1009?976X.2018.06.030

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Department of Hepatic Surgery，Guangzhou First People′s Hospital，Guangzhou 510180，China Objective To evaluate the three different intravenous injections for the determination of liver function. Methods We selected 100 patients with internal jugular vein catheter to assess liver function by indocyanine green （ICG） injection. Each patient received all three different kinds of intravenous drug injection method respectively for testing. Then we compared three methods of determination on K and R15 values to check if they have significant difference statistically. Method one：liquid medicine was pushed by injection with the cubital vein indwelling needle followed with the pipe saline washing immediately ；Method 2 ：the volume of liquid medicine was increased by 0.4 mL with cubital vein indwelling needle without pipe saline washing. Method three：medicine injection was through the jugular vein pipe without pipe saline washing. Results The K and R15 values showed no significant difference statistically among three methods. The peak of blood concentration of Method 3 occurred earlier ，but not affect the final test results. Conclusion The three intravenous injection methods for the determination of liver function can successfully complete the administration process，and their results were close to the data，but the central venous catheter was better.