Table of Content

20 February 2020, Volume 20 Issue 01

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Analysis of risk factors for duodenal stump fistula after laparoscopic radical gastrectomy

ZHANG Kang, GU Li-hu, MO Yu-xuan, XU Hong-liu, CHEN Ping

2020, 20(01):  1-7.  DOI: 10.3969/j.issn.1009-976X.2020.01.001

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［Abstract］ Objective The purpose of this study was to investigate the incidence, risk factors and management of DSL after laparoscopic radical gastrectomy for gastric cancer （GC）. Methods Relevant data were collected from Patient databases to retrospectively analyze the data of GC patients who underwent Billroth II （B-II） and Roux-en-Y （R-Y） reconstruction after laparoscopic gastrectomy at our institutions （HwaMei Hospital, University of Chinese Academy of Sciences）. The risk factors of DSL were analyzed by univariate and multivariate analysis regression. Results Finally, 421 patients were eligible for our analysis （174 patients with R-Y and 247 patients with B-II）. A total of 11 patients with DSL （1.43%） were observed. preoperative C-reactive protein （CRP）, and reinforcement of duodenal stump were the independent risk factors for DSL. The diagnosis time of DSL was 2~9 days, with a median of 3.5 days. Three patients received conservative treatment, three patients received puncture treatment. All patients recovered after treatment without death. Conclusion The risk factors of DSL were elevated preoperative CRP, and unreinforced duodenal stump. Non-surgical treatments were the preferred treatment for DSL.

The application of pelvic floor peritoneal reconstruction combined with transanal drainage in prevention of anastomotic leakage after laparoscopic rectal cancer anterior resection

LUO Jia-yao, FANG Si-fu, LAI Jian-qin, ZHANG Di, HUANG Hua-ping, CHEN Cheng, YE Wei-heng, GONG Jin

2020, 20(01):  8-11.  DOI: 10.3969/j.issn.1009-976X.2020.01.002

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［Abstract］ Objective To investigate the feasibility and effectiveness of pelvic floor peritoneal reconstruction combined with anal canal drainage in the prevention of anastomotic leakage after laparoscopic low rectal cancer anterior resection. Methods A total of 137 patients who underwent laparoscopic low rectal anterior resection in the first affiliated hospital of Jinan University from Jan 2013 to Dec 2017 was retrospective analyzed. After radical resection of the tumor, the pelvic floor was reconstructed with suture retraction. Next, the anastomosis was placed by suture line and the peritoneal drainage tube, and the anal canal was placed through the anus. Results The total 137 cases were successful in the laparoscopic rectal cancer anterior resection and there were no perioperative deaths. Nine patients had anastomotic leakage after operation, and the incidence rate was 6.57%. 8 patients were cured though full drainage. One patient was recovered from pelvic infection and septic shock again after ileal endostomy. Conclusion The pelvic floor peritoneal reconstruction combined with anal canal drainage in laparoscopic anterior resection of middle and low rectal cancer can effectively prevent postoperative anastomotic leakage, and it is effective and feasible in clinical application.

Percutaneous transhepatic gallbladder drainage combined with elective laparoscopic cholecystectomy in elderly patients with moderate acute cholecystitis

ZHONG Qi-huan, CHEN Bo-yi, DENG Guo-rong, YU Yong, LI Rong, LI Sheng-cai

2020, 20(01):  12-15.  DOI: 10.3969/j.issn.1009-976X.2020.01.003

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［Abstract］ Objective To investigate the value of percutaneous transhepatic gallbladder drainage （PTGD） combined with elective laparoscopic cholecystectomy （LC） in elderly patients with moderate acute cholecystitis （AC）. Methods A total of 95 elderly patients with moderate AC were divided into PTGBD+LC group （35 cases） and LC group （60 cases） according to the patient??s condition, willingness and economic situation. The LC group was treated with emergency LC. The PTGBD+LC group was treated with PTGD combined with selective LC. The perioperative evaluation index of LC, cellular immune function, humoral immune function and complications in the two groups were compared. Results Compared with the LC group, the composition ratio of conversion to open surgery in the PTGBD+LC group was significantly lower, the blood loss in LC was significantly less, the operation time, drainage time after LC and hospitalization time after LC were significantly shorter （P<0.05 or 0.01）. The values of IgA, IgG, IgM, CD3+, CD4+ and CD4+/CD8+ of the PTGBD+LC group were significantly higher than those of the LC group （P<0.05）. The total incidence of complications of the PTGBD+LC group was significantly lower than that of the LC group （P<0.05）. Conclusion PTGD combined with selective LC can significantly reduce the difficulty and risk of LC, improve the effect of LC, accelerate the recovery of elderly patients with moderate AC, reduce incidence of complications.

Comparative study of ERCP and PTCD in palliative treatment of malignant obstructive jaundice

ZHANG Long, LIU Ji-kui, YIN Yao-xin, LI Gui-xian, Gan Zhe, LIU Xiao-ping

2020, 20(01):  16-20.  DOI: 10.3969/j.issn.1009-976X.2020.01.004

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［Abstract］ Objective The aim of paper is to investigate the effects of endoscopic retrograde cholangiopancreatography （ERCP） and percutaneous transhepatic cholangio-drainage （PTCD） in palliative treatment of malignant obstructive jaundice （MOJ）. According to the research results, provide reference materials for the future selection of MOJ treatment plan to improve the quality of life of patients. Methods All patients with ERCP or PTCD palliative treatment of MOJ were enrolled in the Department of Hepatobiliary and Pancreatic Surgery of our hospital from January 2017 to December 2018. According to different treatment methods, they were divided into two groups, namely ERCP group and PTCD group. Results There were no significant differences in age, gender, disease diagnosis, obstruction site, combined underlying disease, preoperative indexes, surgical success rate, postoperative complication rate, and total hospitalization expenses （P>0.05）. Changes in the indexes of the two groups： The ALT and TB indexes of the two groups were decreased in different degrees, and the difference was statistically significant （P<0.05）. The TB index decreased significantly in the ERCP group, and the difference was statistically significant （P<0.05）. Postoperative hospital stay in both groups： The average postoperative hospital stay in the ERCP group was 7.25 days, and the mean postoperative hospital stay in the PTCD group was 17.73 days. The difference was statistically significant （P<0.05）. Conclusion Both ERCP and PTCD are effective methods for palliative treatment of MOJ, which can effectively alleviate liver damage caused by obstructive jaundice, but ERCP is more significant in reducing yellowing effect. ERCP significantly reduced the number of postoperative hospital stays, but there were no significant differences between the two groups in terms of success rate, postoperative complication rate, and total hospitalization costs.

Hepatic epithelioid hemangioendothelioma： a case report and review of literature

LAI Bing-jia, LI Ji-xin, ZHONG Jing-lian

2020, 20(01):  21-24.  DOI: 10.3969/j.issn.1009-976X.2020.01.005

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［Abstract］ Objective To investigate the clinicopathological features, imaging features and treatment of hepatic epithelioid hemangioendothelioma. Methods A case of hepatic epithelioid hemangioendothelioma confirmed by pathology in our hospital was analyzed in terms of clinical manifestations, imaging features and histopathological features. Literature review was conducted to explore the clinical, imaging, pathological features and the treatment of this rare tumor. Results The clinical manifestations of hepatic epithelioid hemangioendothelioma were poor, and the imaging features were that the tumor was low density. There were “capsular retraction sign” and “lollipop sign” in other literature. The enhancement characteristics varied with the size of the tumors. The pathological features were that the tumor was composed of epithelioid cells, which were arranged in strips, nests or adenoids. Immunohistochemical CD31 and CD34 were positive. Liver tumors resection and liver transplantation were the treatment methods. Conclusion The clinical manifestations and imaging features of hepatic epithelioid hemangioendothelioma were poor. Pathological histochemistry was the method to make a definitive diagnosis. Surgical treatment is the main method of treatment. HEHE should be paid attention to in clinical diagnosis and treatment.

Clinical Application of Self-made Modified Specimen Bag in Laparoscopic Cholecystectomy

CHEN Hai-jun, SUN Zi-cheng, LIU Yan, ZHANG Ti

2020, 20(01):  25-28.  DOI: 10.3969/j.issn.1009-976X.2020.01.006

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［Abstract］ Objective To explore the advantages and feasibility of Self-made Modified Specimen Bag in laparoscopic cholecystectomy （LC）. Methods Fifty-eight patients undergoing LC in general surgery from January 2018 to December 2018 were selected as the research objects, and randomly divided into the umbilical cholecyst extraction group （30 cases in the improved group） and the xiphoid cyst extraction group （28 cases in the conventional group）. Basic data （Gender, Age, Body mass index, ASA score） and surgical indications of the two groups were recorded. The patients in the two groups were compared in terms of the conversion rate of laparotomy, incidence of complications, average operation time, intraoperative cost and total cost, postoperative pain duration and pain degree score（NRS）, and postoperative hospitalization time. Results Basic data no statistical difference in both groups, all cases with no transfer laparotomy and severe complications occurred, two groups of patients with an average operation time, total cost of hospitalization and postoperative hospital stay were no statistical difference （P>0.05）, but the length of hospital stay in the improved group was lower, postoperative pain relief time improved group was obviously shortened, the degree of pain scores significantly decreased （P<0.05）. Conclusion The self-made modified specimen removal bag can be used to conveniently remove the gallbladder through the umbilical incision, reduce the damage caused by stabbing the subcoastal incision, avoid suture, shorten the postoperative hospitalization time and cost of treatment, significantly shorter incision pain and pain intensity, and prevent calculus or bile from falling into the abdominal cavity or polluting the wound, fully conforms to the concept of enhanced recovery after surgery.

Pathogenic status and drug sensitivity analysis of bile culture in patients with acute cholangitis

LIU Guo-hua, LIU Jia-xing, TAN Xiao-yu, DI Dong, ZHONG Guo-hui, YANG Jun-xing

2020, 20(01):  29-33.  DOI: 10.3969/j.issn.1009-976X.2020.01.007

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［Abstract］ Objective To profile the types of bacteria in bile culture and study their antibiotic sensitivity pattern in patients of acute cholangitis, and to provide guidance for reasonable clinical use of antibiotics. Methods A retrospective analysis was conducted on 314 patients with acute cholangitis from January 2015 to January 2018 satisfied the inclusion criteria. And the pathogen distribution and drug resistance were analyzed. Results The overall positive rate of 314 patients with acute cholangitis was 82.80%. Totally, 358 strains of pathogens were detected, gram-positive bacteria were 230 strains, gram-native bacteria were 122 strains, fungi were 6 strains. The most common pathogens were e. coli （129 strains, 36.03%）, enterococcus faecalis（59 strains, 16.48%）, pseudomonas aeruginosa （27 strains, 7.54%）, klebsiella pneumonia （24 strains, 6.70%）, and enterococcus faecalis （17 strains, 4.75%）. When the pathogenic bacteria in bile culture were gram-negative bacteria, the relatively sensitive drugs were carbapenems （drug resistance rate respectively were Ertapenem 0% imipenem 8.41% meropenem 22.22%） and aminoglycosides （drug resistance rate respectively were amikacin 1.35% gentamicin 20.00% tobramycin 10.19%）. While the pathogenic bacteria in bile culture were gram-positive bacteria, the drug resistance is relatively light, which are lower than 10% among minocycline, moxifloxacin, ampicillin and ceftriaxone. However, the drug resistance of antibiotics such as clindamycin and erythromycin are higher than 40%. Conclusion In the present paper, the types of bacteria in bile culture among patients with acute cholangitis were mainly gram-native bacteria. And the relatively sensitive drugs are hydrogenase-enes and enterococcus faecalis. It is necessary to strengthen the management and monitoring of the application of antibiotics in clinical practice.

Clinical analysis of hepatic perivascular epithelioid cell neoplasm： A report of two cases

LIU Kang-Shou， CAO Ming-Rong

2020, 20(01):  34-37.  DOI: 10.3969/j.issn.1009-976X.2020.01.008

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［Abstract］ Objective To investigate the clinical features of hepatic perivascular epithelioid cell carcinoma （PEComa） and the experiments in the diagnosis and treatment to hepatic PEComa. Methods The clinical data of two patients with hepatic PEComa at The First Affiliated Hospital of Jinan University from August 2018 to November 2019 were collected. The clinical manifestations， imaging features， diagnostic and therapeutic strategies， pathologic features， prognosis were analyzed. Results The two patients with hepatic PEComa were female， with no specific clinical symptoms and signs. The tumor indicators such as AFP， CEA and ca-199 were negative， and the imaging diagnosis was liver cancer. Two patients received a surgical resection and no recurrence or metastasis was observed. Conclusion Hepatic PEcoma is a rare mesenchymal tumor， which is mainly benign and difficult to diagnose before surgery. Histological and immunochemical examination are the main methods of diagnosis. The main treatment measures are surgical resection and long-term close follow-up.

Role of Bim on the proliferation and apoptosis of breast cancer cells induced by prodigiosin

YE Hui-rong， WU Li-hua， ZHANG Yu-juan， GAO Xue-zhong， WANG Xi-yue， CAO Yin

2020, 20(01):  38-43.  DOI: 10.3969/j.issn.1009-976X.2020.01.009

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［Abstract］ Objective To investigate the effects and mechanism of prodigiosin in regulation of breast cancer cells. Methods MTT and flow cytometry were used to detect the proliferation and apoptosis of human breast cancer MCF-7 cells. Bim was detected by RT-PCR and Western blot. siRNA was used to investigate the role and mechanism of prodigiosin on the apoptosis of MCF-7 cells induced by prodigiosin. Results Prodigiosin inhibited the proliferation of MCF-7 cells and induced the apoptosis of MCF-7 cells in a dose and time dependent manner. Prodigiosin arrested MCF-7 cells at G1 phase， with reduced proliferation index and decreased cells in S phase. Prodigiosin induced the expression of Bim in MCF-7 cells in a concentration and time dependent manner. Suppression of Bim can partially abolish the apoptosis induction of MCF-7 cells by prodigiosin. Conclusion Prodigiosin can inhibit the proliferation of MCF-7 cells， and induce MCF-7 cells apoptosis through the regulation of Bim.

Comparison of breast conserving operation and modified radical operation in the treatment of early breast cancer

LI Liu-dan

2020, 20(01):  44-54.  DOI: 10.3969/j.issn.1009-976X.2020.01.010

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［Abstract］ Objective To compare the advantages of breast conserving operation and modified radical operation. Methods This is a prospective research method. The early breast cancer patients who were treated in our hospital from October 2016 to December 2018 were selected as research objects. The patients were divided into two groups： breast conserving operation group （n=36） and modified radical operation group （n=36）. The relevant indexes， postoperative complications， quality of life were observed and analyzed. Results There was no significant difference in baseline characteristics between the two groups （P<0.05）. Compared with the modified radical mastectomy group， the operation time， bleeding volume， drainage volume， hospitalization time and breast aesthetics of the breast conserving group were significantly better. There was no difference in functional recovery score between the two groups （P>0.05）， however， there were significant differences in the incidence of fatigue， vomiting， pain， insomnia， financial difficulties， breast symptoms and hair loss between the two groups. There were significant differences between the two groups in terms of economic conditions， fear of recurrence， image influence and fertility desire （P>0.05）， but the fear of recurrence in breast conserving group was higher than that in radical group （P<0.05）. Conclusion Breast conserving surgery has advantages in the choice of surgery for early breast cancer， which is in line with previous research reports.

Bioinformatics Analysis of Potential Susceptible Genes Involved in Aortic Valve Calcification

ZHANG Ding-wen， LIU Lin-ru， LV Lei， WU Zong-lv， LI Hao-tian， TANG Pan-li， YI Bin， YANG Song-ran， HUA Ping

2020, 20(01):  48-54.  DOI: 10.3969/j.issn.1009-976X.2020.01.011

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［Abstract］ Objective Based on bioinformatic method， to investigate the potentially susceptible genes involved in aortic valve calcification. Methods Differential expression analysis aimed to screened out genes with significant differences in gene expression. Functional analysis purposefully screened genes enriched in osteogenesis and calcium metabolism， and identified these genes may lead to aortic valve calcification in these biological processes. PPI interaction network analysis further interprets the regulatory relationships within these genes. Results Total of 133 differentially expressed genes， including 51 up-regulated genes and 82 down-regulated genes were identified. GO and KEGG enrichment analysis screened the biological processes of osteoblast differentiation， skeletal system development， and ossification. Combining the results of functional analysis and PPI interaction network， SPP1 and COL5A2 were finally identified as key genes. Conclusion In this study， bioinformatics analysis was used to identify potential susceptible genes that SPP1 and COL5A2 may be aortic valve calcification.

Comparison of skin grafting combined with VSD and traditional packing technique in repairing chronic wounds

WU Ri-zhao， HUO Jing-shan， LIU Ming-huai， WU Min-han， LIU Hai-yan， HAN Xin-feng

2020, 20(01):  55-58.  DOI: 10.3969/j.issn.1009-976X.2020.01.012

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［Abstract］ Objective To observe and compare the clinical efficacy of vacuum sealing drainage （VSD） combined with traditional packing technique in repairing chronic wounds. Methods From November 2015 to October 2018， 64 patients with chronic wounds were treated with skin grafting combined with VSD （VSD group） and traditional packing technology （control group） in Foshan Jianxiang Hospital and Foshan Traditional Chinese Medicine Hospital. The survival quality， healing time， healing rate and adverse reactions of the two groups were compared. Results The average healing time of wounds in the experimental group was 9.8 days， which was significantly shorter than that in the control group （14.1 days on average） （P<0.05）； the survival rate of skin grafts in the experimental group was 93.94% better than that （71.0%） in the control group （P<0.05）； and the healing rate during hospitalization was 97.0% better than that （77.4%） in the control group （P<0.05）. Conclusion Compared with skin grafting combined with traditional packaging technology， skin grafting combined with VSD can reduce wound healing time and improve skin grafting survival and healing quality.

The clinical effectiveness of enlarged laparoscopic total extraperitoneal hernia repair in 9 patients with umbilical hernia

RAO Zhu-feng， ZHAO Li-ye， ZAHNG Jin-jie， XU Yu-yuan

2020, 20(01):  59-61.  DOI: 10.3969/j.issn.1009-976X.2020.01.013

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［Abstract］ Objective To investigate the clinical effect of enlarged laparoscopic total extraperitoneal hernia repair （Enlarged TEP） in 9 patients with umbilical hernia. Methods From October 2016 to June 2019， 9 cases with umbilical hernia treated with Enlarged TEP were selected as the study subjects. The clinical effects of Enlarged TEP in the treatment of umbilical hernia were retrospectively analyzed. Results The operation was successful in 9 patients. There were no recurrence cases and no complications during follow-up. All of the patients recovered well. Conclusion Enlarged TEP has more advantages in the treatment of umbilical hernia and midline abdominal wall hernia， which is worthy of clinical application.

Quantitative analysis of spine multifidus muscle in MRI technique in lumbar disc herniation

DAI Kai-feng， HUANG Yong-chu， CAI Ya-li， WANG Lin， LIN Qian-sen

2020, 20(01):  62-66.  DOI: 10.3969/j.issn.1009-976X.2020.01.014

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［Abstract］ Objective To investigate the composition of lumbar spine muscles in patients with lumbar disc herniation and neurological compression. Magnetic resonance imaging was performed by magnetic resonance imaging （MRI） qualitative and quantitative methods. Methods A total of 50 eligible patients were included. The signal intensity of the multifidus muscles on MRI was retrospectively measured by two radiologists， and the fat content of patients with unilateral articular lumbar disc herniation was visually graded using a 5-point grading system. The temporal and contralateral performance was compared and the relationship between fat content and the severity of nerve compression and duration of symptoms was assessed. Results In terms of quantitative measurements and qualitative scores， the signal intensity of the multi-cracked muscle on the affected side was significantly higher than that of the contralateral muscle. In the affected multi-cleft muscles， the degree of nerve compression was significantly correlated with duration of symptoms and fat content （P<0.05）. Conclusion Compared with the contralateral side， lumbar disc herniation has a higher content of ipsilateral multifidus muscle fat. Visual grading of muscle components for fat infiltration seems to be as useful as quantitative measurements.

The analysis of bostrom pocedure for treatment of chronic ankle instability

ZOU Yun-xuan， ZHU Yong-zhan， SHEN Guo-dong， ZHANG Hong-ning， LI Xue， YIN Hang

2020, 20(01):  67-71.  DOI: 10.3969/j.issn.1009-976X.2020.01.015

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［Abstract］ Objective To analyze the effects of modified Brostrom procedure for treatment of chronic ankle instability. Methods Eighty-two patients in our department from August 2013 to August 2015 were selected. The patients underwent the modified Brostrom procedure for treating chronic ankle instability. The examination results of ankle， scores of AOFAS， scores of VAS， complications were recorded and analyzed. Results Postoperative ankle physical examination， such as talar tilt angle， talus forward shift， ankle plantar flexion， dorsiflexion， valgus， varus， showed that the clinical indicators after modified surgery were significantly better than those before surgery， and the differences between the two had statistical significance （all P values were less than 0.001）. In the patients with Davis-Weber type A， B， C， the postoperative pain， abnormal gait， ankle support and autonomic function， ankle flexion and extension， maximum walking distance， ankle stability， ankle joint function and AOFAS score were improved significantly compared with those before operation （all P values were less than 0.001）. And talar tilt angle， talus forward shift， ankle plantar flexion， dorsiflexion， valgus， varus were got improvement in these patients with Davis-Weber type A， B， C （all P values were less than 0.001）. After two years of follow-up， the results of ankle joint examination were better maintained than that after operation， and there was no significant difference between the results of various examinations and that after operation （P>0.05）. There were no significant postoperative complications such as nerve injury， infection and necrosis of the skin margin in the two-year follow-up of the patients （P>0.05）. No skin necrosis happened in all patients. Conclusion Brostrom procedure could improve examination results and function of ankle， reduce VAS scores and AOFAS scores， enhance clinical effect.

Clinical efficacy of digital orthopaedic technique and navigation template assisted atlantoaxial personalized pedicle screw placement

FU Chao-hua， JIANG Xiong-jian， LAO Yong-bing， FU Zhao-zong， LIANG Sheng-gen， FENG Zhi-qiang， LIU Yi-tao， CHEN Zhong-xian

2020, 20(01):  72-76.  DOI: 10.3969/j.issn.1009-976X.2020.01.016

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［Abstract］ Objective To investigate the clinical efficacy and safety of digital orthopaedics and navigation template assisted atlantoaxial personalized pedicle screw. Methods From Jan 2015 to Jul 2018， 12 cases of atlantoaxial dislocation and instability， including 7 males and 5 females， aged 38 to 67 years， with an average of 49.7 years， were analyzed retrospectively. All patients had occipital and neck pain， limited neck movement or sensory and motor dysfunction of extremities. The preoperative VAS score was 3 to 7， with an average of 4.3， and the preoperative JOA score was 5 to14， with an average of 8.4. All patients were examined by thin slice CT （slice thickness 1 mm）. The obtained CT data are imported into the 3D reconstruction software Mimics software in DICOM format， and the original model of atlantoaxial vertebrae is obtained， the STL format file is generated， and the navigation template， 3D printer printing model and navigation template were made in Med CAD module. The pedicle screw was inserted according to the navigation template during the operation. The （VAS） score and JOA score were recorded preoperatively， at 3rd days postoperative， 1st month postoperative， 3rd month postoperative and the final follow-up. The operation time， bleeding volume and postoperative drainage were recorded. CT scan of upper cervical vertebrae was performed after operation， and the accuracy of pedical screw placement was analyzed according to the method proposed by Kawaguchi. Results Twelve patients successfully completed the operation， the operation time was about 120 min~180 min， the average intraoperative blood loss was （148±35） min， the average blood loss was about 100 to 300 ml， and the average drainage volume ranged from 120 to 260 ml， with an average of （160±60） ml. There were no complications such as vertebral artery injury， spinal cord and nerve injury， cerebrospinal fluid leakage and so on. All patients were followed up with an average of （24.5±9.8） months. There was no significant difference in VAS score at 3rd days postoperative （P>0.05）. There was significant difference in VAS score at 1st month postoperative， 3rd month postoperative and the final follow-up （P<0.05）. There was no significant difference in JOA score at 3rd days postoperative （P>0.05）， There was significant difference in JOA score at 1st month postoperative， 3rd month postoperative and the final follow-up （P<0.05）. The results of repeated measurements of ANOVA showed that 12 patients had statistically significant differences between VAS and JOA scores at different time points （P<0.001）. Conclusion Preoperative digital orthopaedic navigation template assisted atlantoaxial pedicle screw placement is a safe， effective and reliable method for clinical application of atlantoaxial pedicle screw placement.

Analysis on the difference of urinary tract stone composition between indigenous residents and foreign residents in Shunde area

LU Guo-han， MENG Zhong-long， YAO Ru-he， LI Jian-hui

2020, 20(01):  77-80.  DOI: 10.3969/j.issn.1009-976X.2020.01.017

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［Abstract］ Objective To analyze the difference of urinary calculi composition between indigenous residents and foreign residents in Shunde area. Methods From January 2017 to January 2019， 300 patients with urinary calculi were divided into indigenous residents group （150 cases） and foreign residents group （150 cases） according to the source of residents. The components of urinary calculi were analyzed and compared by infrared spectrum stone detector. Results The proportion of calcium stones and pure uric acid stones in indigenous residents group was higher than that in foreign residents group， and the proportion of infectious stones was lower than that in foreign residents group （P<0.05）. There was no difference in the proportion of other stones. The proportion of calcium oxalate monohydrate in the indigenous resident group was significantly higher than that in the indigenous resident group （P<0.05）， and the proportion of calcium oxalate dihydrate， calcium oxalate monohydrate + calcium oxalate dihydrate was similar to that in the indigenous resident group （P>0.05）， and there was no significant difference between the two groups （P>0.05）. The proportion of ammonium urate， anhydrous uric acid sodium urate monhydrate and uric acid dihydrate in the indigenous residents group was similar to that in the foreign residents group， there was no significant difference between the two groups （P>0.05）. Conclusion There were great differences in the composition of urinary calculi among ingigenous residents and foreigns in Shunde area.

The treatment for upper urinary stones complicated with urosepsis

YANG Yun-jie， XU Xun， LIU Qi， FENG Quan-yao

2020, 20(01):  81-83.  DOI: 10.3969/j.issn.1009-976X.2020.01.018

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［Abstract］ Objective To investigate the treatment of upper urinary stones complicated with urosepsis. Methods We retrospectively analyzed the clinical data of 43 patients with upper urinary stones complicated with urosepsis in our hospital between July 2014 and May 2018. All 43 patients received active anti-infection treatment. The first stage interventions included retrograde ureteroscope intubation or percutaneous nephrostomy placement for removal of obstruction. After the infection was controlled， a second stage operation of ureteroscopic or percutaneous nephroscopic lithotripsy was performed. Results Among first stage retrograde ureteral stenting， there were 23 cases of unilateral stones and 6 cases of bilateral stones stenting succeed. B-ultrasound guided percutaneous nephrostomy was carried out in cases of unfit for retrograde ureteral stenting and failed stenting. After the infection was controlled and stable general situations were obtained， a second stage treatment with minimal invasive surgery was performed. The lithotripsy rate was 95.35% （41/43）. Two patients underwent extracorporeal shock wave lithotripsy after surgery. After a mean follow-up of 3 months， the stone clearance rate was 97.67% （42/43）， and the renal functions were preserved or improved in all the cases. No serious complications in all 43 patients. Conclusion Retrograde ureteroscope intubation or percutaneous nephrostomy combined with minimally invasive surgery is a safe and effective method for treating patients with upper urinary stones complicated with urosepsis， and worthy of being widely applied in clinic。

Studies on the role of progesterone in the regulation of immune inflammation and the improvement of prognosis in traumatic brain injury

CHEN Xiao-chen， REN Xue-jiao， Gao Wei-wei， YUE Shu-yuan

2020, 20(01):  84-92.  DOI: 10.3969/j.issn.1009-976X.2020.01.019

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［Abstract］ Objective To explore whether progesterone regulates inflammatory and improves neurological outcomes in traumatic brain injury. Methods The mice were randomly assigned into three groups： sham-operated group， PROG-treated group and traumatic control group. The TBI model was done by the controlled contusion instrument. Progesterone treatment （16 mg/kg） was initiated intraperitoneally after injury with PROG-treated group， and the control group was injected with normal saline with the same dose. Neurological function was evaluated by the Modified Neurological Severity Score （mNSS）。 Dry-wet weight method was conducted in order to determine the water content in the brain tissue. The Western Blot was underwent to assess inflammatory cytokines like IL-10， IL-1β， TNF-α， NF-κB. The number of inflammatory cells （MPO， CD3， GFAP and Iba-1） cells were detected by immunocytochemistry. Quantitive determination of Treg cells in spleen was done by flow cytometry. Results Our study found that： the mNSS score of PROG-treated group are significantly lower than control group after TBI third， fifth， seventh day （P<0.05）. The water content in the brain tissue of PROG-treated group are obviously lower than control group after TBI fist， third， fifth， seventh day （P<0.05）. Compared to the sham-operated group， inflammatory cytokines， like IL-10， IL-1β， TNF-α， NF-κB， and inflammatory cells （MPO， CD3， GFAP and Iba-1） in the PROG-treated group and the control group was discovered more （P<0.05）. Compared to the control group ， inflammatory cytokines inflammatory cells in the PROG-treated group was very fewer （P<0.05）， and the Treg cells in spleen was significant increased. The PROG-treated group and the sham operation group has no difference in the number of MPO and CD3 after TBI three days， but all lower than the control group. Conclusion Progesterone treatment can improve the neurological outcome after TBI， and its mechanism may be related to the regulation of progesterone on immune inflammation after brain injury.

The clinical efficacy of laparoscope surgery in the treatment of giant uterine myoma

XU Yan

2020, 20(01):  89-92.  DOI: 10.3969/j.issn.1009-976X.2020.01.020

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［Abstract］ Objective To analyze the clinical efficacy of laparoscope surgery in the treatment of giant uterine myoma. Methods Sixty patients with giant uterine myoma and 60 with uterine myoma was less than 8 cm in our hospital from June 2014 to June 2017 were selected. The surgical index， postoperative complications， condition of resuming， and follow up results of the two groups were compared. Results There were significant differences in bleeding volume， operative time， postoperative analgesia ratio， first exhaust time， first out of bed time， hospital stay between the observation group and the control group， P<0.05； There was no significant difference in the incidence of complications and the follow up results between the observation group and the control group， P>0.05. Conclusion Laparoscope surgery has distinct advantage in the treatment of giant uterine myoma， which is worth to be spread for patients with fertility requirements.

Logistic Analysis of Influencing Factors of Glottic Exposure Difficulty in Support Laryngoscope

CHENG Jing-wei， YE Yuan-hang， WU Wei-jun， ZENG Yan-ling

2020, 20(01):  93-97.  DOI: 10.3969/j.issn.1009-976X.2020.01.021

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［Abstract］ Objective To explore the influencing factors of glottic exposure difficulty in support laryngoscope. Methods 210 patients who underwent laryngeal surgery under support laryngoscope from November 2016 to November 2018 were selected as subjects， and were divided into non-glottic exposure difficulty group （113 cases） and glottic exposure difficulty group （97 cases）. The data of sex， age， body mass index （BMI）， neck circumference， improved Mallampati classification， mandibular thyroid cartilage angle （TMA）， mouth opening， neck flexion and extension， tongue-chin distance （HMD）， chest-chin distance （SMD）， nail-chin distance （TMD）， vertical nail-chin distance （VTMD）， horizontal nail-chin distance （HTMD） of patients were collected before operation， Logistic regression was used to analyze the influencing factors of glottic exposure difficulty. Results In univariate analysis， gender （c2=0.485， P>0.05）， modified Mallampati classification （c2=2.751， P>0.05）， age （t=1.723， P>0.05）， BMI （t=1.508， P>0.05）and SMD （t=1.926， P>0.05） were not associated with intraoperative glottic exposure difficulty （P>0.05）， cervical circumference （t=4.172， P<0.001）， TMA （t=8.444， P<0.001）， mouth opening （t=2.635， P=0.009）， neck flexion and extension （t=4.261， P<0.001）， HMD （t=2.471， P=0.014）， TMD （t=8.488， P<0.001）， VTMD （t=4.683， P<0.001） and HTMD （t=2.724， P=0.007） were all associated with intraoperative difficulty in glottic exposure （P<0.05）. Logistic multivariate analysis showed that TMA （OR=6.393， 95%CI=2.158-18.941， P<0.001）， neck flexion and extension （OR=4.243， 95%CI=1.754-10.266， P<0.001）， and TMD （OR=4.533， 95%CI=1.349-15.234， P=0.002） were risk factors for intraoperative glottic exposure difficulty （P<0.05）. ROC curve was used to study the diagnostic value of three independent risk indicators （TMA， neck flexion and extension， and TMD），the AUC of TMA， neck flexion and extension and TMD were all >0.7， TMA≤117°， TMD≤6.5cm and neck flexion and extension ≤100.5° were predicted as glottis exposure difficulty， the predicted sensitivity was 88.5%， 87.6% and 66.4%， and the specificity was 57.7%， 55.7% and 71.1%， respectively. Conclusion Preoperative measurement of TMA， neck flexion and extension， and TMD by support laryngoscope can predict the degree of intraoperative exposure of glottic region to a certain extent， so as to formulate the best surgical plan and improve the quality of surgery.

Endovascular treatment of acute stroke due to atherosclerotic stenosis-related large vessel occlusion

CHENG Lei， LI Xu-dong， WANG Shi-bo， FAN Yi-mu

2020, 20(01):  98-101.  DOI: 10.3969/j.issn.1009-976X.2020.01.022

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［Abstract］ Acute ischaemic stroke due to large vessel occlusion leads to grave neurological morbidity and mortality. The publication of five positive randomised controlled trials of emergency thrombectomy for acute ischaemic stroke in 2015 provided strong evidence to support endovascular reperfusion therapy. Endovascular treatment （EVT） has become a standard treatment for acute ischemic stroke due to large vessel occlusion （LVO） in the anterior circulation. There have been only a few studies about EVT for ICAS-related LVO， and these studies revealed that mechanical thrombectomy with a stent retriever or contact aspiration was less effective and more time consuming in ICAS-related LVO than in embolic LVO. In this report， we review the results of mechanical thrombectomy using stent retriever or contact aspiration and rescue treatments after failure of mechanical thrombectomy for ICAS-related LVO. Finally， we propose the EVT strategy appropriate for ICAS-related LVO based on a literature review and our experience.

Systematic review of antibiotic-loaded hip bone cement spacer

YANG Shuai， ZHANG Guang-ming

2020, 20(01):  102-107.  DOI: 10.3969/j.issn.1009-976X.2020.01.023

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［Abstract］ Infection can be a devastating complication of surgically inserted prosthetic implants and intramedullary rods， plates and pins. Although appropriate perioperative antibiotics， a considerable number of patients developed postoperative prosthetic-joint infections （PJI）. PJI results in excessive antibiotic use， implant removal， reoperation， and potential amputation. Currently， PJI is often difficult to predict， diagnose， and treats. This article explores the approach to infected implants. Two-stage exchange arthroplasty is a reasonable option for the treatment of PJI. In this paper， the progress on the hip spacer prosthesis is reviewed.

Epidemiological characteristics and risk factors of infection after liver transplantation

ZHONG Si-quan， CHEN Wei-qiang

2020, 20(01):  108-112.  DOI: 10.3969/j.issn.1009-976X.2020.01.024

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［Abstract］ At present， liver transplantation （LT） has become the recommended treatment for patients with end-stage liver disease and advanced liver cancer. Its 5-year survival rate is close to 60%-80%， but infection is still the main reason affecting the survival rate of patients after liver transplantation. This article will review the etiological characteristics and risk factors of infection after liver transplantation in order to increase the awareness of post-operative infection.

Diagnosis and treatment of familial adenomatous polyposis with multifocal thyroid cancer as a parenteral manifestation

LI Peng, LIU Jun, WANG Dong-lai, HAN Bin, WEI Wei

2020, 20(01):  113-115.  DOI: 10.3969/j.issn.1009?976X.2020.01.025

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Application of modified Mini-CEX scale in the formative evaluation of standardized training surgeons in breast surgery department

CHEN Xin-xin， XIA Ting， CAO Teng-fei， JIA Hai-xia， HU Xiao-wu

2020, 20(01):  116-119.  DOI: 10.3969/j.issn.1009-976X.2020.01.026

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［Abstract］ Objective To explore the effectiveness and feasibility of modified Mini-CEX scale as a tool for formative assessment of training surgeons in breast surgery Department. Methods A total of 51 surgeons who receiving regularized training in the 2nd Affiliated Hospital of Guangzhou Medical University during 2017-2019 were included in this study. A modified Mini-CEX scale was used for formative assessment and the scores were compared to find out the differences in the 3 evaluations. Results The average scores of all the surgeons of the 3 evaluation were 53.03±2.22， 65.83±2.63，72.11±2.76 respectively，and the difference between above were found statistically significant （P<0.01）. Either the total scores or the scores of each item of the scale of the three assessments were found improved significantly， among which the improvement of medical consultation ability was the most significant （P<0.01）. Conclusion Our modified Mini-CEX scale is effective as a formative assessment tool for the residents of breast surgery Department，and is worth promoting during the teaching and clinical practice.

Application of health education based on WeChat platform and micro class indicators in rehabilitation exercise of patients with lower limb fractures

ZHANG Yan， ZHANG Feng-xia， DUAN Mu-li

2020, 20(01):  120-123.  DOI: 10.3969/j.issn.1009-976X.2020.01.027

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［Abstract］ Objective To study the application effect of health education based on WeChat platform and micro class indicators in rehabilitation exercise of patients with lower limb fractures. Methods 60 patients with lower limb fractures diagnosed and treated in the hospital between January 2017 and January 2019 were divided into observation group and control group by the random number table method， with 30 cases in each group. They were given health education based on WeChat platform combined with micro class intervention， and routine Nursing intervention， respectively. After 3 months of intervention， the balance ability， motor function of lower limbs， negative emotions and cognition degree of rehabilitation knowledge were compared between the two groups before and after the intervention， and the patients?? activities of daily living were evaluated after the intervention. Results There was no significant difference in the Berg Balance Scale （BBS） score， lower limb Fungl-Meyer motor function scale （FMA） score， negative emotions or cognition degree of rehabilitation knowledge score between the two groups before the intervention （P>0.05）. After intervention， the BBS score， FMA score， and cognition degree of rehabilitation knowledge of the observation group were significantly higher than those of the control group， while the score of negative emotion was significantly lower than the control group （P<0.05）. The activities of daily living scores of the observation group were significantly higher than those of the control group after 1 month and 3 months of intervention （P<0.05）. Conclusion The application of health education based on WeChat platform and micro class indicators in the rehabilitation exercise of patients with lower limb fractures can obviously improve patients of intervention control group， while the score of negative emotion was significantly lower recovery of lower limb function and activities of daily living.

Application of self-made spiral opening pocket in postoperative caring of patients with ileostomy

YU Hong-yan， MA Ning， HU Jing-zhi， YUAN Lei， ZHOU Tai-cheng

2020, 20(01):  124-127.  DOI: 10.3969/j.issn.1009-976X.2020.01.028

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［Abstract］ Objective To investigate the clinical effect of self-made spiral opening pocket in postoperative caring of patients with ileostomy. Methods 300 patients with Ileostomy were enrolled into this study. The learning time， dumping time， cost， the pollution rate of pocket opening or hands， subjective evaluation and practicability were recorded between three kinds of pockets with different opening. Results The spiral opening pocket was superior to the other two types in the patients?? learning time， dumping time， cost， pocket opening or hands pollution rate， subjective evaluation and practicability， and the differences were statistically significant （P<0.05）. Conclusion Spiral opening pocket is easy to use， with high practicability， low cost and less nursing time as well as improving the quality of life of patients with ileostomy， and deserve to be used in ileostomy patients.

Effect of psychological intervention program for breast cancer patients receiving chemotherapy at a high risk of depression

LIANG Xue-fang， LU Xiao， TAN Yan-fang， ZHANG Cui-yan

2020, 20(01):  128.  DOI: 10.3969/j.issn.1009-976X.2020.01.029

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［Abstract］ Objective To explore the effect of psychological intervention for breast cancer patients receiving chemotherapy at a high risk of depression. Methods 166 breast cancer patients prepared to receive chemotherapy were assigned to the control group （n=83） and the experimental group （n=83）. Patients in the control group received regular treatment and nursing postoperatively， and patients in the experimental group received psychological intervention besides that. Profile of mood states （POMS） scores and European Organization for Research and Treatment of Cancer Quality of Life questionnaire-Core Questionnaire version 3.0 （EORTC QLQ-C30） scores were recorded. Results After psychological intervention POMS tension， depression， anger， vigour， fatigue and confusion scores were significantly lower in the experimental group than those in the control group （P<0.05）. After psychological intervention EORTC QLQ-C30 global health status， physical function， role function， emotional function， cognitive function and social function scores were significantly higher in the experimental group than those in the control group （P<0.05）， and fatigue， nausea and vomiting， pain， dyspnoea， insomnia， appetite loss， constipation， diarrhea and financial difficulties scores were significantly lower in the experimental group than those in the control group （P<0.05）. Conclusion Nurse-led psychological intervention could improve physical and mental health of breast cancer patients receiving chemotherapy at a high risk of depression and relieve patients?? side effects of chemotherapy， which is worth popularizing clinically.