Table of Content

20 June 2019, Volume 19 Issue 03

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Comparison of short?term efficacy and cost between open hepatectomy and laparoscopic hepatectomy in the treatment of liver diseases

DAI Kangfu1，2， HUANG Zhifeng2， ZHANG Yanqiang3， ZHANG Shijie1，2， ZHANG Long2， OU Xi2， LIN Zewei2， YIN Yaoxin2， LIU Jikui2， LIU Xiaoping1，2

2019, 19(03):  251-255.  DOI: 10.3969/j.issn.1009?976X.2019.03.001

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［Abstract］ Objective This study compares the short?term efficacy and hospitalization costs between open hepatectomy （OH） and laparoscopic hepatectomy （LH）， so as to provide a reference for surgeons in the choice of surgical methods. Methods The data of 98 patients received LH and OH in Shenzhen Hospital of Peking University from January 01， 2012 to October 30， 2018 were collected， including 38 cases in LH group and 60 cases in OH group. The data of the two groups were compared in operation time， intraoperative bleeding， hepatic hilar occlusion， postoperative time to get out of bed， postoperative time to resume eating， postoperative time to use painkillers， postoperative discharge time， whether complications occurred. The changes of liver function and the difference of cost， To evaluate the difference in short?term efficacy and cost between OH and LH. Results Compared with OH group， LH group had less operation time， intraoperative bleeding， hilar obstruction rate， getting out of bed time， resuming eating time， postoperative discharge time. There was no significant difference in the changes of liver function and the time of analgesic use （P>0.05）. The average cost of LH group was lower than OH group on the first day after operation （P<0.05）， however， there was no statistical significance （P>0.05）. Conclusion Under the condition of strict implementation of indications， LH has advantages over OH in short?term effect after operation， and does not increase the cost. Surgeons need to consider comprehensively and choose the appropriate operative method.

Endoscopic biliary stent implantation in patients with malignant hilar biliary obstruction

ZHANG Geng， SU Shuying， FEI Lin， WANG Zhonghui

2019, 19(03):  256-259.  DOI: 10.3969/j.issn.1009?976X.2019.03.002

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［Abstract］ Objective The aim of this study is to discuss the efficacy of biliary stent implantation under endoscopy in malignant biliary hilar obstruction and its influencing factors. Methods We evaluated the success rate， effective drainage rate， the incidence of complications， 30 d mortality rate， duration of unobstructed stent and survival time for 168 cases who underwent biliary stent implantation under endoscopy from Aug. 2008 to Apr. 2014， who were retrospectively analyzed. Results In 168 cases， 148 were successfully implanted with plastic or metal stents through endoscopic retrograde cholangiopancreatography （ERCP）， among them， 13 were performed under a reunion operation which combines percutaneous transhepatic cholangio （PTC） and ERCP， and the success rate was 88.1%|another 20 cases failed in both and were converted to PTCD external drainage|the effective drainage rate was 91.9%， the incidence of early complications was 23.0%， the total effective time of stents was 59 days， and median survival time was 248 days. Conclusion These pilot results indicate that different treatment protocols should be chosen according to individualized principle|and clinical doctors should pay attention to effective operation and the reduction of complications.

The clinical and prognostic value of BORIS expression in gastric cancer

CAI Yuzhi1， LIAO Haihua1， HAN Jing2， GAO Jian1， LIU Dingyi1， ZHANG Tong1

2019, 19(03):  260-263.  DOI: 10.3969/j.issn.1009?976X.2019.03.003

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［Abstract］ Objective Brother of regulator of imprinted sites （BORIS） was a DNA-binding protein that was normally expressed in the testes and associated with some kinds of tumor malignancy. The aims of the present study was aimed to investigate BORIS expression in gastric cancer （GC） and found out the prognostic value of this proteins. Methods Using immunohistochemical staining， BORIS expression was studied to assess potential correlation between BORIS expression in GC following radical surgery with clinicalpathological parameters and overall survival in this study. Survival analysis was performed and compared using Kaplan?Meier curves， Life?table， log?rank test， and Cox regression analysis. Results BORIS expression was significantly higher in GC tissues than in normal adjacent tissues. In 63.1% （41 of 65 cases） BORIS was observed in stomach tumors. BORIS expression was associated with tumor invasion， lymph node metastasis and advanced TNM stage. Furthermore， those patients with BORIS positive had worse survival outcome compared with the ones with BORIS negative （5?year survival rate： 22.0% vs 49.8%， P=0.009）. Univariate Cox regression analysis revealed that BORIS expression was a prognostic parameter in out study. Conclusion BORIS was a promising indicators for predicting clinicopathological features and prognosis in GC cases.

Risk factors and surgical timing of necrotizing enterocolitis in neonates

CUI Guanhua， LIAN Taofeng， FAN Liang， DU Youyin， ZHOU Hongjie， CHEN Fengshun， LI Huiting

2019, 19(03):  264-267.  DOI: 10.3969/j.issn.1009?976X.2019.03.004

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［Abstract］ Objective To analyze the risk factors affecting necrotizing enterocolitis （NEC） in neonates and to explore the surgical treatment timing. Methods A retrospective analysis was performed on 70 cases of NEC children patients and 140 non?NEC neonates in our hospital from January 2013 to December 2018， and univariate analysis and multivariate logistic regression analysis were performed on factors that might affect NEC occurrence， and the treatment methods and results were counted among NECchildren patients. Results There were significant differences between NEC group and non?NEC group in terms of hypertensive disorder complicating pregnancy， prenatal glucocorticoids， premature rupture of membranes， neonatal Apgar score， neonatal weight， combined pulmonary infection， combined sepsis and feeding patterns （P<0.05）. Neonatal Apgar score <7 points， neonatal weight <2.5 kg， combined pulmonary infection and combined sepsis were risk factors for NEC in neonates （P<0.05）， and breastfeeding was a protective factor for NEC in neonates （P<0.05）. Conclusion Influencing factors for NEC in neonates include neonatal Apgar scores， neonatal weight， combined pulmonary infection， combined sepsis and breastfeeding. Children patients with Bell stage Ⅰ and stage Ⅱare given conservative treatment， and children patients with stage Ⅲ stage are treated with surgery as soon as possible， and the surgical timing is suitable within 1 week after the occurrence of NEC

Effect of iodine?125 seed on expression of nuclear factor kappa b in gastric cancer

CHU Yan， ZHANG Wanfu， LI Xiaogang， JIN Wendi， WAN Hongwei， NIU Zhao， FANG Xingyi， LIU Peiyu， LI Bo

2019, 19(03):  268-271.  DOI: 10.3969/j.issn.1009?976X.2019.03.005

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［Abstract］ Objective To investigate the mechanism of Iodine?125 seed refraining the growth of tumors cell by hindering the expression of NF?kB stomach carcinoma cells. Methods The animal models with the stomach carcinoma cells （SGC?7901） were established by subcutaneously injecting the tumor cells into nude mice. When the tumors were fully established， the animals were randomly assigned to groups. There was no significant difference in average tumor size between groups. The mice of experiment group were intravenously administered Iodine?125 seed （0.6 MBq， n=30） and mice intravenously administered 0 MBq of Iodine?125 seed were used as blank control grpup （n=30）. The controls were nothing for implantation （n=30）. The size of tumors was measured every two days and their volumes then were calculated. Anatomy analysis were done separately after 28 days of the implantation of the Iodine?125 seeds|the mRNA and proteinum expressions of NF?kB were measured by the ways of RT?PCR and immunohistochemistry. Results After Iodine?125 seeds were transplanted into the tumors of the experimental animals， tumors grew more slowly， and the tumor inhibitory rate was 38% （control group） and 43% （experimental group）. After the 28 days， the mRNA and protein express level of NF?kB in tumors were significantly decreased in experimental groups. There was significant difference between the three groups （P<0.01）. Conclusions It is one of important molecular biology mechanisms to restrain stomach carcinoma with iodine?125 seeds to decreass the expression of NF?kB in tumor cells.

Clinical application research of laparoscopic transabdominal preperitoneal hernioplasty in primary hospitals

HUANG Jintuan， CHEN Weili， YANG Heyan

2019, 19(03):  272-275.  DOI: 10.3969/j.issn.1009?976X.2019.03.006

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［Abstract］ Objective To analyze the effect and provide experience of different patches in TAPP operation. Methods From March 2015 to March 2017， 180 patients with inguinal hernia were selected as study objects and divided into control group and observation group， 90 cases each. The control group was treated with classical TAPP procedure with 3D patch， nail gun fixation and intermittent suture of peritoneum， while the observation group was treated with modified TAPP with domestic flat patch， glue fixation and continuous suture of peritoneum. The success rate of surgery and the recurrence rate within one year were compared between the two groups of patients. The intraoperative indexes were compared： operation time， intraoperative blood loss， ambulation time， hospitalization time， and hospitalization fee. VAS was used to evaluate postoperative pain. Observe and record the complications. Results There was no significant difference between the two groups in the success rate of surgery and the recurrence rate of the two groups within one year （P>0.05）. There was no significant difference in blood loss between the two groups （P>0.05）. There was no significant difference in VAS score， time of ambulation and hospital stay between the two groups （P>0.05）. The operation time of the observation group was significantly shorter than that of the control group （P<0.05）. The cost of hospitalization was significantly lower than that of the control group （P<0.05）|There was no significant difference in the total incidence of complications between the two groups （P>0.05）. Conclusion The modified TAPP procedure has similar clinical effects as the traditional TAPP procedure， but the operation time is shorter and the operation is easier， which promotes the patient′s postoperative recovery. At the same time， the modified TAPP procedure has lower surgical cost.

A comparative analysis of the efficacy of open preperitoneal hernia repair and open Lichtenstein method

CHEN Qiukai， WU Haifeng， ZHENG Xuqing， XIE Tian， YUAN Yangchun

2019, 19(03):  276-284.  DOI: 10.3969/j.issn.1009?976X.2019.03.007

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［Abstract］ Objective To evaluate the clinical efficacy of open preperitoneal hernia repair with UHS and Lichtenstein repair for inguinal hernia. Methods 213 inguinal hernia patients from January 2013 to December 2018 were included in the study. Inclusion criteria were complete clinical and follow-up data. The patients underwent open preperitoneal hernia repair with UHS were assigned to UHS group （101 cases） and those received Lichtenstein method were served as Lichtenstein group （112 cases）. The curative effects of the two surgical methods were evaluated on the clinical data of both groups such as operation time， average hospitalization time， treatment cost， postoperative pain and recurrence rate. Results There were no significant differences in the operation time and average hospitalization time between the two groups （P>0.05）. There were no significant differences in complications such as hematoma， scrotal edema. The patients of UHS group had less discomfort， chronic pain and ischemic orchitis than that of Lichtenstein group （P<0.05）. No recurrence was found in UHS group and 5 cases in Lichtenstein group at a follow-up of one year. Conclusion In the present study， the open preperitoneal hernia repair （UHS） was superior to Lichtenstein operation with less chronic pain， discomfort and testicular ischemia.

Totally laparoscopic right colectomy for colon cancer in elderly patients： a prospective study

CAO Jinpeng， JI Yong， YANG Ping， YU Si， LI Zhicheng， ZHANG Jian， LUO Tedong.

2019, 19(03):  280-284.  DOI: 10.3969/j.issn.1009?976X.2019.03.008

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［Abstract］ Objective To investigate the safety， feasibility of totally laparoscopic right colectomy （TLRC） in elderly patients with colon cancer. Methods Eighty elderly patients with right?sided colon cancer from February 2017 to November 2018 were randomized into the observation group and the control group. Patients in the observation group were assigned to undergo totally laparoscopic right colectomy （TLRC）， Patients in the control group were assigned to undergo laparoscopic?assisted right colectomy （LARC）. The terms of demography， American Society of Anesthesiologists （ASA） classification， preoperative stage distribution（TNM）， details of operations， post?operative recovery， and postoperative complications were recorded and analyzed. Results No significant differences were found among preoperative clinical data （P>0.05）. There were no significant differences among the groups in terms of average operative time， blood loss， lymph node harvest，specimen length， time to hospital stay （P>0.05）. There were significant differences in the length of mini?laparotomy between the observation group and the control group （4.2±0.8 vs 5.9±0.7 cm， P<0.00）.Timing of first flatus （2.5±1.4 vs 3.2±1.3 d， P<0.05） and time to liquid diet （2.6±1.4 vs 3.2±1.4 d， P<0.05） were statistically lower in observation group. There were no significant differences between the two groups for post?operative complications （12.5% vs 15.0%， P>0.05）. Conclusion TLRC in elderly patients with colon cancer is safe and feasible， and is better in post?operative recovery.

Transoral endoscopic radical thyroidectomy via vestibular route： A report of 36 cases

HAN Bin， WANG Donglai， LI Peng， ZHU Lizhang， WEI Wei

2019, 19(03):  285-288.  DOI: 10.3969/j.issn.1009?976X.2019.03.009

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［Abstract］ Objective To investigate the feasibility and safety of endoscopic thyroidectomy via oral vestibular approach for thyroid cancer. Methods The clinical data of endoscopic thyroidectomy via oral vestibular approach were analyzed retrospective， including basic information of patients， operation procedures， operation time， bleeding volume， complications， hospital stay， and pathological results. Results From November 2016 to November 2018， 36 patients underwent endoscopic thyroidectomy via oral vestibular approach， including 27 females and 9 males， with a median age of 27 years （22-32 years）. All patients were successfully treated withradical thyroidectomy via oral vestibular approach （thyroidectomy and isthmus+lymphadenectomy of central region of affected side）， with an average operation time of 150 min （120-180 min）. The average amount of bleeding during operation was 35 ml （20-75 ml）， and no complications were found，such as wound infection， bleeding， hoarseness， drinking cough， hand?foot twitching after operation. One case was punctured the submental skin during operation. All cases had different degrees of swelling of the lips and chin after operation， and disappeared after 7 days. Pathological results showed that 36 cases were papillary thyroid cancer. The average number of lymph nodes was 5.5 （3-11）|there were no scars on the body surface and oral vestibule 3 months after operation， and the patients were satisfied with the cosmetic effect. Conclusion Endoscopic thyroidectomy via oral vestibular approach is safe and feasible in selecting suitable cases. It has advantages in cosmetic effect and thorough lymph node dissection in central region.

Comparison of clinical application of Mammotome Biopsy system and wire localization in nonpalpable breast lesions

ZHEN Lefeng， CHEN Xiaoming， HUANG Tao， WANG Jinzhong， WEN Dahui

2019, 19(03):  289-292.  DOI: 10.3969/j.issn.1009?976X.2019.03.00

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［Abstract］ Objective To evaluate the accuracy and safety of the Clinical application of Mammotome Biopsy system and wire localization in nonpalpable breast lesions （NPBL）. Methods Eighty?four patients with NPBL were randomized into Mammotome Biopsy system group （MMT） and wire localization group （WL） and the diagnosis results， time， bleeding， specimen size， cost and complication were compared between two groups. Results Biopsy was successful in both groups. Compared with WL group， MMT group had shorter operation time， less blood loss and smaller specimen volume， and the difference was statistically significant （P<0.05）. In terms of hospital cost and complication rate， MMT group was significantly higher than WL group （P<0.05）. The diagnostic accordance rate of MMT was 97.6% （41/42）. Compared with WL group （42/42）， there was no significant difference （P>0.05）. In MMT group the positive rate of the incisional margin was higher than WL group. Conclusion For biopsy of NPBL， the Mammotome Biopsy system and the wire localization biopsy have high diagnostic accuracy. In MMT group， it takes less time to perform， has fewer mammary tissue specimen to be removed， has a smaller incision and better cosmetic effect， but it is more expensive and has a higher incidence of complications than the WL group. The positive rate of the incisional margin was higher after the Mammotome Biopsy system. For the diagnosis and treatment of high?risk patients， the choice of wire localization biopsy is more appropriate.

Effect of overexpression of FOXO1 on invasion and migration of osteosarcoma cells and its mechanism

WANG Xiong1， WANG Wenji1， XIE Ruimin2， LI Xiang2， WANG Yongping1

2019, 19(03):  293-302.  DOI: 10.3969/j.issn.1009?976X.2019.03.011

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［Abstract］ Objective To investigate the effect of FOXO1 on invasion and migration of osteosarcoma cells. Methods Real?time quantitative PCR （qRT?PCR） was used to detect the mRNA expression level of FOXO1 in human osteoblast hFOB 1.19 and human osteosarcoma cells U2OS and MNNG/HOS. The FOXO1 overexpressed cell model was established by the recombinant plasmid of pcDNA3.1?FOXO1， and the empty plasmid （pcDNA3.1?vector） was used as a control. The transfection efficiency was verified by the method of qRT?PCR and Western blot.The proliferation ability （absorbance value） of osteosarcoma cells was detected by Cell Counting Kit?8 （CCK?8） test after the successful overexpression of FOXO1 gene. The invasion and migration ability of osteosarcoma cells was detected in Transwell experiment in vitro， and the matrix metalloproteinase 9 was detected by qRT?PCR and western blot methods. Results The expression level of FOXO1 mRNA in MNNG/HOS and U2OS of human osteosarcoma cells was significantly lower than that of human osteoblast hFOB 1.19 （P<0.05）， and the expression level of FOXO1 in osteosarcoma cell U2OS was much lower. After transfection of recombinant plasmid pcDNA3.1?FOXO1， the expression level of FOXO1 in osteosarcoma cell U2OS increased significantly. Compared with the control group （pcDNA3.1?vector）， the proliferation of U2OS?FOXO1 overexpressed cells decreased （P<0.05）， and the ability of invasion and migration and migration decreased， and the expression level of MMP9 was significantly lower than that of the control group （P<0.05）. Conclusion The expression level of FOXO1 in osteosarcoma cells is significantly lower than that in normal osteoblasts. Overexpression of FOXO1 may inhibit the invasion and migration of osteosarcoma cells by downregulating MMP9.

Anatomical locking plate internal fixation in high tibial osteotomy for the treatment of knee osteoarthritis

YAN Song1， WANG Zhanwei2， CHEN Keming3， XIE Gang1， ZHU Xiaoqi2， DONG Wei1

2019, 19(03):  303-306.  DOI: 10.3969/j.issn.1009?976X.2019.03.013

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［Abstract］ Objective To compare the efficacy of anatomical locking plate and conventional plate fixation in high tibial osteotomy for the treatment of knee osteoarthritis. Methods The clinical data of 34 patients with knee osteoarthritis admitted to Shenzhen Bao′an People′s Hospital from January 2013 to December 2018 were retrospectively analyzed. According to the fixation methods， the patients were divided into anatomical locking plate group and conventional plate group. The operation time， intraoperative bleeding volume， fracture healing time， Lysholm score of knee joint function at 3 months， 6 months and 1 year after operation， and the incidence of complications were compared between the two groups. Results There was no significant difference in bleeding volume between two groups （P>0.05）|the fracture healing time of the anatomical locking plate group was lower than that of the conventional plate group （P=0.000）|the operation time was longer inanatomical locking plate groupthan that of conventional plate group （P=0.002）. Lysholm score was higher in the anatomical locking plate group in three months，6 months and one year after operation （P<0.05）. The incidence of complications was 5.0% in the anatomical locking plate group and 35.7% in the conventional plate group. There was significant difference between the two groups （P=0.021）. Conclusion Anatomical locking platewith high tibial osteotomy could achieve satisfactory results in the treatment of knee osteoarthritis.

Effect of different internal fixation on posteromedial fracture of tibial plateau

ZHENG Peizhong， ZHANG Weiqiong， PANG Feifeng

2019, 19(03):  307-310.  DOI: 10.3969/j.issn.1009?976X.2019.03.014

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［Abstract］ Objective To discuss the effect of two internal fixation on posteromedial fracture of tibial plateau （PMF?TP）. Methods Eighty patients with PMF?TP were selected from March 2014 to March 2017 in our Hospital. According to different surgical approaches， the patients were divided into two groups， posteromedial approach group （40 cases） and parapatellar anteromedial approach group （40 cases）. The former was treated with routine posteriormedial approach of knee joint， the later was treated with improved parapatellar anteromedial approach. The operation， complications， fracture reduction and knee joint function of the two groups were compared. Results The intraoperative blood loss， operation， hospitalization， weight bearing exercise， fracture healing time and incidence of complications of parapatellar anteromedial approach were significantly lower than those of the posteriormedial approach， and the difference was statistically significant （P<0.05）. The fracture reduction and knee joint function excellent rate 6 months after operation of posteriormedial approach group were significantly higher than those of the parapatellar anteromedial approach， and the difference was statistically significant （P<0.05）. Conclusion The modified medial parapatellar approach is simpler and safer than the conventional posteromedial approach.

MRI features and misdiagnosis analysis of intracranial extracerebral cavernous malformations

HUANG Yu1， PAN Heng2， YANG Zehong2， SHI Guangzi2

2019, 19(03):  311-316.  DOI: 10.3969/j.issn.1009?976X.2019.03.015

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［Abstract］ Objective To summarize the MRI features and reasons of misdiagnosis of intracranial extracerebral cavernous malformations （ECMs） for improving the diagnostic level. Methods The MRI manifestations of 9 patients diagnosed ECMs with surgically and pathologically were retrospectively analyzed. The lesion and signal characteristics were observed， and misdiagnosis was analyzed by combining pathological characteristics. Results MRI examination of 9 patients had multiple lesions in 2 cases， namely， internal auditory canal combined with intracerebral cavernous hemangioma， single lesion in 7 cases， with the location at cavernous sinus in 3 cases， at middle cranial fossa， posterior horn of lateral ventricle， the fourth ventricle and confluence of sinuses separately each had one. Peripheral tissue edema in 1 case and no edema in 8 cases. Non?uniform signal were found in 5 patients， uniform signal was found in 4 patients， presenting as iso?signal on T1WI， high?signal on T2WI and FLAIR， and heterogeneous enhancement， the intensity of which was similar to vascular enhancement. Presenting iso?signal on susceptibility weighted imaging（SWI） in 3 cases， and heterogeneous signal in 4 cases. Presenting mild high?signal on diffusion weighted image（DWI） in 3 case and heterogeneous iso?signal in 1 case， presenting slightly high?signal on appearance diffusion coefficient（ADC） in 4 cases. The choline（Cho） peak and N?Acetyl?L?aspartic（NAA） peak recorded at baseline level in 3 patients were scanned magnetic resonance spectrum（MRS）， one of which was found Lactate（Lac） peak. One patient presented low blood flow of brain in perfusion weighted imaging（PWI）. Conclusion ECMs are cerebral vascular malformations，which are characterized by high?signal on T2WI and FLAIR，finding “iron ring sign”， with low perfusion and rare peripheral tissue edema. Making use of new technology such as SWI， MRS， PWI， can increase the diagnostic accuracy of ECMs， as well as providing comprehensive and accurate information for clinical therapy.

The value of eustachian tube CT reconstruction in patients with hyperbaric oxygen therapy

HAN Yuanyuan1， HU Huijun2， FANG Weijun1

2019, 19(03):  317-320.  DOI: 10.3969/j.issn.1009?976X.2019.03.016

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［Abstract］ Objective To explore the value of eustachian tube CT reconstruction in patients with hyperbaric oxygen therapy. Methods Eighty patients （total 160 ears） were recruited. Among 160 ears， 112 ears which showed eustachian tube dysfunction in eustachian tube pressure test were grouped into eustachian tube dysfunction group （ETD） and the other 48 ears into normal eustachian tube function group （NETF）. All participants underwent CT scanning both in resting state and after performing Valsalva maneuver. 3D CT reformations were done and structural parameters were measured. Analyze the incidence of middle ear barotrauma in patients treated with hyperbaric oxygen. Results Significant difference were found between the ETD and NETF groups for cartilaginous portion length after Valsalva maneuver （F=3.57，P=0.017）. However， there was no statistically significant difference between the angle of bony portion and cartilaginous portion，the total length of cartilage between the two groups，the open length of the static lower cartilages. The total incidence of middle ear barotrauma was 7.2%. Conclusion 3D CT reformation is a valuable tool for revealing eustachian tube structure and assessing its function. The incidence of middle ear barotrauma can be greatly reduced by timely targeted etiological treatment for patients with eustachian tube dysfunction.

The effect of fenestration of the lamina terminalis on chronic hydrocephalus caused by aneurysmal subarachnoid hemorrhage

YANG Yumin， LIU Zhiyi， LONG Xiaodong， LI Aiguo， LI Feng， QIN Xinghu

2019, 19(03):  321-328.  DOI: 10.3969/j.issn.1009?976X.2019.03.017

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［Abstract］ Objective To analyze the effect of fenestration of the lamina terminalis （FLT） in the treatment of chronic hydrocephalus caused by aneurysmal subarachnoid hemorrhage （aSAH）. Methods A total of 165 patients with aneurysm were included in the study. The patients underwent elective craniotomy and aneurysm clipping in Neurosurgery Dept. of our hospital from January 2015 to December 2017. According to whether or not FLT was performed during surgery， the patients were divided into FLT group （n=72） and non-FLT group （n=93）. FLT group was composed of included gradeⅠ（9 cases）， gradeⅡ （12 cases）， grade Ⅲ （31 cases）， and grade IV （20 cases） in terms of the Fisher classification. non-FLT group includedⅠgrade （n=13）， Ⅱgrade （n=21）， Ⅲgrade （n=40）， Ⅳgrade （n=19）. All patients were followed up for 6 months. The incidence of chronic hydrocephalus between the two groups were compared. Results In the patients with FisherⅠand Ⅱ grade， incidence of chronic hydrocephalus were no statistically significant differences between FLT group and non-FLT group （χ2=0.770， P=0.380）. In the patients with Fisher Ⅲ grade， incidence of chronic hydrocephalus were statistically higher in non-FLT group than in FLT group （χ2=4.329， P=0.037）. In the patients with Fisher Ⅳ grade， incidence of chronic hydrocephalus were statistically higher in non-FLT than in FLT group （χ2=3.955， P=0.047）. Conclusion In aSAH patients with Fisher Ⅲ and Ⅳ grade， FLT can reduce the incidence of chronic hydrocephalus.

Clinical value of newtype compression bandage in postoperative application of breast cancer

CHEN Yong1， HUANG Yao1， WEI Yanghui1， LIANG Lijian2

2019, 19(03):  325-328.  DOI: 10.3969/j.issn.1009?976X.2019.03.018

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［Abstract］ Objective To analyze the clinical advantages of applying new type compression bandages after breast cancer surgery and to explore its clinical application value. Methods A total of 200 patients with breast cancer between October 2016 and October 2018 were enrolled. Among them， 100 new type compression bandages and 100 cases of normal control bandages were used to compare the rate of skin flap necrosis and subcutaneous fluid accumulation. Incision healing， mean extubation time， daily drainage， average hospital stay， postoperative comfort. Results The new type compression bandage for postoperative patients with breast cancer can reduce skin flap necrosis and subcutaneous effusion， and promote wound healing （χ2=8.00， 12.37， 6.82， both P<0.01）， reduce drainage， shorten extubation time and average Hospitalization days （t=17.59， 26.52， 30.25， 9.97， both P<0.01）， the patient′s postoperative comfort improved（χ2=18.52，8.72，8.79， both P<0.01）， the difference was statistically significant. Conclusion The new type compression bandage is superior to the control group （common elastic bandage） in patients with breast cancer after surgery， and can achieve satisfactory clinical results.

Effect of intraoperative warming infusion on temperature and coagulation function in patients undergoing robot?assisted laparoscopic radical surgery for bladder cancer

LUO Jianwei1， HUANG Haiming1， HUANG Lijuan2， WEI Fuwang1

2019, 19(03):  329-332.  DOI: 10.3969/j.issn.1009?976X.2019.03.019

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［Abstract］ Objective To investigate the effect of intraoperative warming infusion on temperature and coagulation function in patients undergoing robot?assisted laparoscopic radical surgery for bladder cancer. Methods A total of sixty patients undergoing robot?assisted laparoscopic radical surgery for bladder cancer， aged 18~65 years， ASA between Ⅰ and Ⅲ， were randomly divided into control group and warming infusion group， 30 cases in each group. Patients in control group underwent routine temperature preservation measures （room temperatures set above 24°C， patients covered with the quilts， the peritoneal rinse pre?heated before irrigation， and resuscitation of temperature after surgery）|based on the same measures as those in control group， patients in warming infusion group performed continuously warming infusion during anesthesia and surgery， setting the temperature at 41℃. The perioperative core body temperature （temperature of nasopharynx） and changes of coagulation parameters such as PT， APTT， TT， Fib， and PLT were recorded. Results Body temperatures of patients in control group decreased progressively to 35°C at the conclusion of surgery， with significantly different from those of warming infusion group at the points except the baseline value and 1 h after surgery（P<0.05）. However， patients in warming infusion group maintained their temperature within a normal range. The prolongation time of APTT in control group was greater than that of warming infusion group（P<0.05）， and the shortening time of TT was greater than that of warming infusion group（P<0.05）. There was no significant difference between the two groups with respect to PT， Fib and PLT. Conclusion During the robot?assisted laparoscopic radical surgery for bladder cancer， continuously warming infusion can maintain the patient′s temperature within a normal range and avoid the coagulation disorder induced by hypothermia， which is worthy of popularization in clinic.

A clinical study of abiraterone combined with prednisone for treating elderly metastatic castration?resistant prostate cancer

HU Lijuan， DAI Qishan， HU Jianbo

2019, 19(03):  333-336.  DOI: 10.3969/j.issn.1009?976X.2019.03.020

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［Abstract］ Objective To observe the clinical efficacy and safety of abiraterone combined with prednisone for treating elderly metastatic castration?resistant prostate cancer （mCRPC）. Methods Thirty?six elderly patients with mCRPC in our hospital from January 2017 to January 2019 were enrolled in the study. These patients received abiraterone （1，000 mg once daily） plus prednisone （5 mg twice daily）. The PSA response rate and side effects of the drugs were recorded. Results The median follow?up time was 15.8 months. 23 patients had a PSA overall relief. According to the baseline， PSA baseline value can be divided into different levels： PSA ≤ 100 ng/mL， >100 ng/mL， the PSA response rates were 64.7%， 63.2%. The Gleason scores were divided into <8， =8， >8， with the PSA remission rate of 42.8%， 63.6%， 90.9%. The numbers of osseous metastasis in the mCRPC patients were divided into ≤10， >10， the response rates were 54.5%， 60%. There were 8 cases with PSA Flare in 23 cases of PSA relief， and 10 cases in total 36 patients. There were 7 cases with remission in 10 cases. IN the no PSA Flare phenomenon cases， 15 cases had PSA response. The main adverse effect （AE） were abnormal liver function， hypokalemia， edema and hypertension. There was no AE leading to discontinuation of drug therapy. Conclusion The abiraterone plus prednisone treatment is an effective and safe option to elderly mCRPC patients. In addition to Gleason scores， patients with different baseline values have not correlated therapeutic effect. The PSA Flare has a more positive response of the tumor to the drug.

The expression of deubiquitinase 3 in prostate cancer and its effect on biological phenotypes of prostate cancer cells

YOU Hongke， WEN Bo， YIN Yonghua

2019, 19(03):  337-340.  DOI: 10.3969/j.issn.1009?976X.2019.03.021

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［Abstract］ Objective To explore the expression of Deubiquitinase 3 （DUB3） in different human prostate cancer cell lines and the effect on cell proliferation， migration and epithelial?mesenchymal transition in prostate cancer. Methods Western Blot and quantitative RT?PCR were performed to detect the protein and mRNA expression of DUB3 in prostate cancer cell lines and normal prostate epithelial cell line. Then， PC?3 cells were transiently transfected with siRNA for DUB3 silencing， and MTS and Transwell were performed to measure the cell proliferation and migration. Finally， we used Western Blot to investigate the relationship between DUB3 and Snail1. Results The results of Western Blot and qRT?PCR showed that both the protein and mRNA levels of DUB3 were obviously higher in prostate cancer cell lines than in normal prostate epithelial cell line （P<0.05）|After DUB3 was inhibited by siRNA， the cell proliferation and cell migration of PC?3 were both obviously decreased （P<0.05）. Furthermore，the expression of Snail1 in prostate cancer cells was also downregulated. Conclusion DUB3 is overexpressed in prostate cancer and promotes cells proliferation and migration. Importantly， DUB3 may facilitate EMT in prostate cancer by deubiquitination of Snail1. USP3 is expected to be a candidate target for prostate cancer treatment.

Comparative study of non?tubular micro?channel percutaneous nephrolithotomy and ureteroscopic lithotripsy in the treatment of upper urinary calculi

ZHENG Xianbin， HONG Yingqia， ZHAN Zhensheng

2019, 19(03):  341-349.  DOI: 10.3969/j.issn.1009?976X.2019.03.022

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［Abstract］ Objective To explore and compare the efficacy of tubeless percutaneous nephrolithotomy （PCNL） and ureteroscopic lithotripsy （URL） in the treatment of upper urinary calculi. Methods From February 2017 to March 2019， 60 cases of upper urinary tract calculi in our hospital were divided into PCNL group and URL group according to different surgical schemes， 30 cases each. The operation related indexes （operation time， phase I stone clearance rate， hemoglobin reduction， indwelling time of urinary catheter and hospitalization time）， postoperative pain degree， use rate of analgesics and incidence of postoperative complications were compared between the two groups. Results There was no significant difference in operation time， hemoglobin reduction， indwelling time of urinary catheter and hospitalization time between the two groups （P>0.05）|the stone clearance rate of stage I in PCNL group was higher than that in URL group （P<0.05）|the pain score and the use rate of analgesics in PCNL group were no significant difference compared with that in URL group （P>0.05）|there was no significant difference in the incidence of postoperative complications between the two groups （P>0.05）. Conclusion Compared with URL， PCNL without cannulated microchannel has a higher clearance rate of upper urinary tract calculi in stage I. It can effectively reduce the degree of pain and the use of analgesics， reduce the occurrence of complications， shorten the indwelling time of urinary catheter， and promote the recovery of patients. It is worthy of clinical promotion and application.

Effectiveness of antiseptic barrier cap in reducing central line?associated bloodstream infections： A systematic review and meta?analysis

PAN Lifen， TAN Shufang,QIU Yihong， ZHAO Haixuan

2019, 19(03):  344-349.  DOI: 10.3969/j.issn.1009?976X.2019.03.023

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［Abstract］ Objective To systematically evaluate the effects of antiseptic barrier cap use and manual disinfection on the incidence of CLABSIs. Methods The studies included were retrieved from Embase， Medline Ovid， Web?of?science， EBSCO， Cochrane Library， PubMed， CBM， CNKI， WANGFANG and VIP database until March 2， 2018. Two reviewers independently assessed the studies and extracted data. The primary outcome， reduction in CLABSIs per 1000 catheter?days， expressed as an incidence rate ratio （IRR）， was analyzed by RevMan 5.3. Results A total of 302 articles were identified as potentially relevant and after exclusion of duplicates， 176 articles were screened based on title and abstract|20 articles were read full text. Eventually， 11 studies were included in the systematic review， and nine of these 11 in the random effects meta? analysis. The pooled IRR showed that use of the antiseptic barrier cap was effective in reducing CLABSIs （IRR=0.60， 95%CI=0.52-0.70， P<0.0001）. Conclusion Use of an antiseptic barrier cap is associated with a lower incidence CLABSIs and is an intervention worth adding to central?line maintenance bundles.

Catheter?directed thrombolysis for DVT in left lower limb： a momocenter experiment

CAO Jianqiang， TAN Yucan， XING Yue， LUO Canhua

2019, 19(03):  350-353.  DOI: 10.3969/j.issn.1009?976X.2019.03.024

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［Abstract］ Objective To investigate the feasibility and efficacy of catheter?directed thrombolysis （CDT） in treatment for deep venous thrombosis （DVT） of lower limbs. Methods The clinical data of 38 patients with acute DVT from June 2010 to January 2014 in the First Peoples′ Hospital of Foshan were analyzed retrospectively. All patients were treated with CDT. Then， thrombolysis and intermittent compression therpy were performed again. Limb circumference difference between preoperative and postoperative， complications of thrombolysis and post?thrombotic syndrome （PTS） were compared between before and after treatment. Result All patients undergo thrombolysis were cured or improved. The circumference difference 10 cm below patella between bilateral limbs was reduced from （3.74±0.94）cm to （1.85±0.76）cm. The circumference difference 10 cm above patella between bilateral limbs was reduced from （7.31±0.91） cm to （4.35±1.28） cm. The duratioins of follow?ups for （18±9.3） months and the follow up rate was 100%. The PTS was diagnosed in 10 patients followed. Conclusion Using two catheter?directed thrombolysis combined with intermittent compression therapy has a definite curative effect on DVT of low extremities and the incidence of PTS was low.

Relationship between serum levels of C1q/TNF?related protein 3 and cardiovascular adverse events after interventional therapy in patients with coronary heart disease

LV Shaoxiang1， GAO Chao1， WU Haihua1， TU Junrong2， HUO Minqing1

2019, 19(03):  354-357.  DOI: 10.3969/j.issn.1009?976X.2019.03.025

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［Abstract］ Objective To investigate the relationship between C1q/TNF?related protein 3 （CTRP3） levels and cardiovascular adverse events after percutaneous coronary intervention（PCI） in patients with coronary heart disease. Methods 107 patients with coronary heart disease after PCI admitted to the department of cardiology from June 2016 to June 2017 were selected， regularly indwelling all patients with blood samples before treatment. According to the occurrence of adverse events within half a year after surgery， 42 patients with adverse events were selected as the observation group， and 65 patients without adverse events were selected as the control group， blood samples from the two groups of patients after half a year the operation were collected. The changes of inflammatory factors such as C1q/TNF?related protein 3 （CTRP3）， C?reactive protein （CRP）， interleukin?10 （IL?10） and tumor necrosis factor?α （TNF?α） were compared between the two groups before and after half a year treatment. Results The levels of CTRP3 and IL?10 in the observation group were significantly lower than those in the control group， the levels of TNF?α and CRP in the observation group were significantly higher than those in the control group （P<0.05） before treatment， but the levels of IL?6 in the two groups were not significantly different （P>0.05）. The levels of serum CTRP3 and IL?10 in the observation group after half a year treatment were lower than those in the control group， and CRP was higher than that in the control group （P<0.05）， there was no significant difference in TNF?α and IL?6 levels between the two groups （P>0.05）， and the levels of TNF?α， CRP， and IL?6 are higher than before intervention in both two group. Correlation analysis result showed that there is a positive correlation between CTRP3 and IL?10 levels （r=0.615， P<0.001）， and a negative correlation with CRP levels （r=-0.737， P>0.001）. Conclusion There may be a negative correlation between CTRP3 and cardiovascular adverse events after interventional therapy in patients with coronary heart disease. The lower the level of CTRP3， the higher the incidence of cardiovascular adverse events. Therefore， it is of great clinical significance to regularly detect CTRP3 levels in patients undergoing coronary stent implantation.

Effects of transversus abdominis plane block with mepivacaine on hyperalgesia induced by remifentanil

ZHOU Lisheng， LIAO Zhaoxia， LI Yujuan

2019, 19(03):  358-360.  DOI: 10.3969/j.issn.1009?976X.2019.03.026

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［Abstract］ Objective To investigate the effects of transversus abdominis plane block with mepivacaine on hyperalgesia，which was induced by remifentanil. Methods A total of 50 patients undergoing selective abdominal hysterectomy were randomly divided into mepivacaine group or control group. In mepivacaine group， 1.5% mepivacaine 20 mL was used for transversus abdominis plane block under ultrasound guidance on each side after anesthesia induction， whereas no transversus abdominis plane block was performed in control group. The anesthesia was maintained with sevoflurane at 0.8?1.1MAC and remifentanil at 0.05~0.3 μg/kg·min， which was adjusted depending on the hemodynamic changes and Bispectral index （BIS）. The total intraoperative consumption of remifentanil， the degrees of postoperative pain using visual analogue score （VAS score） at 1 h（VAS 1）， 3 h（VAS2）， 6 h（VAS3）， 12 h（VAS4）， and 24 h （VAS 5） after surgery， as well as the frequency of analgesics supplement and related complications were observed and compared. Results The intraoperative consumption of remifentanil in mepivacaine group was significantly lower than that in control group （P<0.05）， as well as the VAS score at each time point （P<0.05）. And the frequency of postoperative analgesics supplementation was also less than that in control group （P<0.05）. Conclusion Pretreatment of transversus abdominis plane block with mepivacaine can significantly reduce the consumption of intraoperative remifentanil， resulting in relieving hyperalgesia caused by remifentanil.

Feasibility of total intravenous anesthesia without muscle relaxants in spinal surgery with combined electroneurophilogy monitoring

WU Qiang1，2， LIN Jing3， ZHAO Min4， JI Fengtao2， MIAO Liping2， FU Yanni2， CAO Minghui2

2019, 19(03):  361-364.  DOI: 10.3969/j.issn.1009?976X.2019.03.027

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［Abstract］ Objective To compare the effects of total intravenous anesthesia with or without muscle relaxants on combined electroneurophilogy monitoring of the spinal cord during the spinal surgery， and to explore a safe and effective anesthesia protocol for electroneurophilogy monitoring. Methods Forty patients undergoing selective spinal surgery who underwent combined electroneurophilogy monitoring were enrolled and divided into A and B groups. All patients were anesthetized by propofol， remifentanil and dexmedetomidine. Patients in group A were treated with small doses of atracurium to maintain muscle relaxation during the surgery， while patients in group B were treated without muscle relaxants. Combined electroneurophilogy monitoring， somatosensory evoked potentials （SEP） and motor evoked potentials （MEP）， were used to monitor the spinal cord function. The amplitudes and latencies of SEP and MEP were recorded at different time points during the operation， and the occurrence of severe body motility and spontaneous breathing during transcranial electrical stimulation was also recorded. The recovery time and quality of anesthesia after operation were compared between the two groups. Results There was no significant difference in the amplitude and latency of SEP between the two groups at different time points. The latencies of MEP were similar （P>0.05）， while the amplitudes of MEP had significant difference between two groups （P<0.05）. No spontaneous breathing and severe body motility was detected during the surgery. The recovery time in group B is significantly shorter than that in group A （P<0.01）. Conclusion Our protocol of total intravenous anesthesia （propofol， remifentanil and dexmedetomidine） without muscle relaxants can be safely and effectively applied in spinal surgery with combined electroneurophilogy monitoring， and has obvious advantages in signal quality and postoperative recovery.

Evaluation of simple pulmonary function measurement in elderly patients with painless enteroscopicmultiple polypectomy

WANG Genbao1， ZHANG Meng2， PENG Xueqiang1， ZHU Xiaobing1， OUYANG Fubin1， ZHEN Shaokang3， WU Lun1

2019, 19(03):  365-368.  DOI: 10.3969/j.issn.1009?976X.2019.03.028

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［Abstract］ Objective To explore the value of simple lung function test in elderly patients undergoing painless enteroscopic multiple polypectomy. Methods According to preoperative pulmonary function test results， one hundred and eighty elderly patients were selected and divided into normal pulmonary function （A group， n=108）， mild?moderate abnormal pulmonary function （B group， n=47） and severe abnormal pulmonary function （C group， n=25）. The heart rate （HR）， respiratory rate （RR）， mean arterial pressure （MAP）， blood oxygen saturation （SpO2） were compared with different time point， pre?dose （T1）， colonoscopy （T2）， treatment start 10 min （T3）， retrospective （T4）， leaving the operating room （T5）. The operating time， recovery time， and residence time of the postoperative recovery room （PACU） were recorded. Intraoperative ephedrine， atropine and propofol dosage and adverse reactions， including respiratory depression and hypotension， were recorded. Results Compared T2 with T1 time point， MAP， MAP， and SpO2 decreased in group A and group B|however， in group C， all indexes， including MAP， SpO2， HR and RR， decreased in group C （P<0.05）. Compared with group A and group B， the recovery time and the residence time of PACU was longer in group C （P<0.01）. Compared with group A and B， the incidence of adverse reactions and the use of vasoactive drugs in group C was higher， and the use of atropine and ephedrine increased （P<0.01）. Conclusion Patients with pulmonary insufficiency have an increased adverse reaction to polypectomy under painless colonoscopy. Simple lung function tests are important for the assessment of elderly painless intestinal polypectomy.

Exploration and practice and of standardized training for resident in cardiovascular surgery

MA Ruiyan， XIAO Yingbin

2019, 19(03):  369-375.  DOI: 10.3969/j.issn.1009?976X.2019.03.029

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［Abstract］ The aim of this article is to provide a reference for further standardizing the standardized training of cardiovascular residents and improving the quality of regulations. Based on the general requirements of resident physicians， combined with the strong professionalism of cardiovascular surgery， the author has high requirements for the practical ability of disciplined physicians. Through the implementation of the system， the optimization of teachers， the emphasis on “three basics” training， and the improvement of teaching methods， Strengthening the training of humanistic medical skills， etc.， and exploring an optimized standardized training strategy for residents in practice. Through the improvement and implementation of the above methods， the positive form of teaching teachers was mobilized， and a good teaching effect was achieved， which was welcomed by the doctors. The development of targeted regulation measures from multiple levels can significantly improve the quality of standardized training for residents in cardiovascular surgery.

Nursing care of enhanced recovery after surgery protocol in patients with closed calcaneal fracture

ZOU Dan， LIN Jiali， YANG Na， XIE Qingmei， ZHANG Chengjuan

2019, 19(03):  372-375.  DOI: 10.3969/j.issn.1009?976X.2019.03.030

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［Abstract］ Objective To explore the effect of enhanced recovery after surgery protocol in nursing patients with closed calcaneal fracture. Methods Thirty patients with closed calcaneal fractures from July 2017 to December 2018 were enrolled for implementing ERAS protocol as an observation group， and 27 patients with closed calcaneal fractures from March 2015 to December 2016 as control group without ERAS management. Of 57 cases of calcaneal fracture， Sanders classification was 12 cases of type Ⅱ， 27 cases of type Ⅲ and 18 cases of type Ⅳ. The clinical data were analyzed and compared between two groups in terms of pain score， tolerance time of rehabilitation training， time of wound swelling subsidence， hospitalization days， hospitalization expenses and patient satisfaction. Results The pain score of the observation group was significantly lower than that of the control group （P<0.01）|the rehabilitation training time of the observation group was better than that of the control group （P<0.01）|the swelling subsidence time and hospitalization days of the observation group was significantly shorter than that of the control group （P<0.05）|the nursing satisfaction of the observation group was higher than that of the control group （P<0.05）. Conclusion ERAS rapid rehabilitation surgery concept in the treatment of closed calcaneal fracture patients can reduce hospitalization days， improve patient satisfaction with nursing treatment.

Application of WeChat platform in teaching management of operating room interns

DENG Jun， SANG Ying， PENG Yulan

2019, 19(03):  376-383.  DOI: 10.3969/j.issn.1009?976X.2019.03.031

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［Abstract］ Objective To explore the application effect of WeChat platform in the teaching management of operating room interns. Methods From September 2017 to September 2018， 104 operating room interns in our hospital were selected as research subjects. According to different teaching management methods， they were divided into innovation group and control group， 52 cases each. The control group was given a routine teaching management method. On this basis， the innovation group gave a teaching management method based on the WeChat platform. Statistical comparisons were made between the two groups of interns， scores of critical thinking ability and satisfaction with teaching management. Results There was no significant difference between the two groups in the basic theoretical results （P>0.05）. The classroom participation， technical operation and total scores of the innovation group were higher than the control group （P<0.05）. The innovation group looked for the truth， systemic ability and analytical ability. The self-confidence， cognitive level， curiosity score and total score of critical thinking were higher than those of the control group （P<0.05）|the satisfaction of the innovative group interns to teaching management was 98.08% （51/52） compared with the control group （84.62%）. 44/52） high （P<0.05）. Conclusion WeChat platform is applied to the teaching management of operating room interns， which can effectively improve the performance of interns and strengthen the critical thinking ability， and its satisfaction with teaching management is high.

Effect of continuous nursing after high?grade glioma operation on discharged patients and family nurses

CHEN Yuanping， GUO Yan， FU Yanli， ZHANG Jihui

2019, 19(03):  379-383.  DOI: 10.3969/j.issn.1009?976X.2019.03.032

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［Abstract］ Objective To investigate and analyze the effect of continuous nursing on patients and related nurses after high?grade glioma （HGG） surgery. Methods Between April 2016 to February 2018， 41 eligible HGG patients received a continuous nursing for 2 months after discharged.Assessment was by open discussion and a semi?structured questionnaire， together with the Quality of Life Assessment with Modified FACT O Scale. Objects of investigation were patients themselves and family caregiversand 45 family caregivers were also asked to complete a satisfaction questionnaire. Results Fourty?one patients and 45 family caregivers completed the survey. For general nursing advice， clinical nursing knowledge， management of adverse reactions and side effects， the most helpful ones were 82.9%， 87.8%， 58.4%， 61.0% （patients）， and 84.4%， 86.7%， 73.4%， 53.3% （family caregivers）. Continuous nursing was mainly reflected in the improvement of patients′ emotions. There is a significant difference in scores before and after intervention （P<0.05）. There were no significant differences in the scores of patients′ physiological status， social/family health and functional health before and after intervention （P>0.05）. In survey of patients′ satisfaction with continuing nursing， from 1 point “very poor” to 10 points “very excellent” series ranking， the number of people with 8 points was the largest. Psychological survey results of family caregivers were mainly reflected in anxiety/depression. Other factors were the increase of financial burden and the limitation of spiritual life. Conclusion Continuous nursing can improve their quality of life fordischarged patients with HGG.