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@#The traditional view is that breast reconstruction is not an option for day surgery center. As a result, few hospitals in the world conduct this operation in day surgery center. Endoscopic breast reconstruction with liposuction and robot-assisted breast reconstruction are minimally invasive surgeries for breast cancer patients, but they cannot be carried out in the day surgery center due to long operation time. The novel endoscopic-assisted immediate implant-based breast reconstruction after nipple sparing mastectomy through a single axillary incision for breast cancer patients has been successfully conducted in the day surgery center in our hospital due to short operation time and small trauma. Standardized management of the complete process from the patient selection to follow-up after discharge brings rapid recovery and few complications. At the same time, the development of endoscopic surgery makes the breast almost scarless and improves aesthetic results. Therefore, the mode of endoscopic-assisted reconstruction in the day surgery center of our hospital is expected to be popularized in the whole country.
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@#Objective To explore the surgical technique and preliminary results of endoscopic nipple-sparing mastectomy (E-NSM) and immediate pre-pectoral implant-based breast reconstruction (BR) with titanium-coated polypropylene mesh (TiLoop Bra) via single axillary incision for breast cancer patients. Methods The clinical data of 9 consecutive female patients who underwent E-NSM and immediate pre-pectoral implant-based BR with TiLoop Bra from March to May 2021 were retrospectively analyzed. The mean age of patients was 40.6 (22-60) years. The operation time, early complications were collected, and the patients' social and mental health, breast satisfaction and chest function before and after the operation were assessed with the BREAST-Q questionnaire. Results All the patients had unicentric tumor with a mean diameter of 2.4 (0.6-4.7) cm. The mean distance from the tumor to the nipple was 2.5 (2-4) cm. There were 2 patients with tumor stage 0 and 7 patients with stageⅠ. The mean operation time was 161.1 (125-201) min, the mean blood loss was 41.1 mL and the hospital stay time was 1.5 d. There were 5 patients in the day-care unit. All the patients were successfully followed up with a median follow-up time of 1 (1-2) month. One (11.1%) patient with depigmentation of the nipple-areola complex caused by mild ischemia. None of the patients had incision complications, subcutaneous emphysema, hematoma, infection, nipple-areola or skin flaps necrosis, implant loss. During the follow-up period, no local/regional recurrence or distant metastasis was found. Chest well-being was decreased in the first month after the surgery compared with preoperative status, and the difference was statistically significant (P=0.001). There was no statistical difference in the breast satisfaction or psychosocial function scores between pre- and post-operation (P>0.05). Conclusion E-NSM and immediate pre-pectoral implant-based BR with TiLoop Bra via single axillary incision has minimal trauma, rapid postoperative recovery, short operation time, few early complications and good early cosmetic effect, and the short-term result is satisfactory.
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Objective To evaluate the safety of laparoscopic complete mesocolic excision (CME) in radical resection for right colon cancer. Methods From January 2012 to June 2013, laparoscopic CME was performed in 40 patients with right colon cancer. Another group of 38 patients underwent traditional radical resection from January 2011 to December 2011.Surgical outcomes were compared between the two groups . Results The number of lymph nodes retrieved in the laparoscopic group ( 22.1 ±7.8 ) was significantly more than that in the traditional group (18.6 ±4.3, t =2.436, P =0.017).In patients with stage Ⅲ cancer, the laparoscopic group was associated with higher lymph node counts (23.0 ±6.0 vs.18.2 ±5.1, t=2.699, P=0.000), however, there were no significant differences in those with stage Ⅱ cancer between the two groups (t=0.758, P=0.454).There were no differences in operation time and intraoperative blood loss between the two groups (t=0.716, P=0.476;t=-1.547, P=0.126), but in the laparoscopic group the time to pelvic drainage tube removal , time to first flatus, time to liquid diet intake , duration of hospital stay, and postoperative complications were significantly better than those in the traditional group (t=-2.950, P=0.004;t=-5.767, P=0.000; t =-7.817, P =0.000; t =-6.065, P =0.000; χ2 =4.504, P =0.034). Conclusions CME technique in laparoscopic radical right hemicolectomy is feasible , safe, and effective.CME improves the surgical quality with keeping the integrity of mesocolon , more harvested lymph nodes , and not increasing surgical risks and postoperative complications .
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Objective To carry on statistical analysis of tradtional mongolian medicine syndrome in angina pectoris of coronary heart disease, find out the significative indices for syndrome diagnosis, and establish the diagnostic criteria of tradtional mongolian medicine syndrome in angina pectoris of coronary heart disease. Methods Cases of angina pectoris of coronary heart disease were selected according to modern medical diagnostic criteria. Clinical observations were carried on and clinical information was filled in the forms of the clinical cases. Each case was differentiated and made corresponding diagnosis of syndrome according to tradtional mongolian medicine. Clinical cases were grouped according to syndrome of tradtional mongolian medicine and decided the significative indices by statistical analysis. Results Four hundred and ten cases were differentiated which contain tradtional mongolian medicine information about angina pectoris of coronary heart disease, including 358 cases of Chu Si syndrome, 23 cases of Nian Xie syndrome, and 29 cases of Wei Sha syndrome. Through statistical analysis of the various syndromes and the objective indices, diagnostic criteria of tradtional mongolian medicine syndrome in angina pectoris of coronary heart disease was established. Conclusion Diagnostic criteria of tradtional mongolian medicine syndrome in angina pectoris of coronary heart disease was summarized by combination of disease and syndrome, and provides a theoretical basis for the resonable application of mongolian herb.
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Objective To discuss the management of bile duct injuries during laparoscopic cholecystectomy(LC).Methods From March 1992 to October 2006,totally 8876 cases of LC were performed in our hospital.Bile duct injury occurred in 16 of them,among which,the common bile duct was mistakenly cut in 4 cases,partly torn in 5,and wrongly clipped in 5,and electrical burn injury happened in 3.The patients received bile duct repair and T-tube drainage(6),bile duct anastomosis plus T-tube drainage(3),or Roux-en-Y bowel biliary anastomosis(5) after the accidents.In 2 patients,the titanium clips were removed.Results In one of the patients with the bile duct been cut,bile duct anastomosis was performed,and T-tube drainage was continued for 3 months;however,3 to 5 months after the T tube being removed,the patient had to underwent Roux-en-Y bowel biliary anastomosis because of biliary stenosis.No obstructive jaundice occurred in this patient after the Roux-en-Y.Two patients received a second t Roux-en-Y bowel biliary anastomosis owing to anastomotic stenosis.The second operation was carried out 9 or 10 month after the first surgery,and the patients were then followed up for 2 to 4 years.None of them developed cholangitis or calculi during the follow-up.One patient,who suffered a clipped bile duct,underwent Roux-en-Y bowel biliary anastomosis after the LC,but developed recurrent infection of the bile duct after the second operation.Among the 16 patients,12 were cured,10 of them were followed up for 3 to 4 years,during which no one showed biliary symptoms.Conclusions Bile duct injury is one of the major complications after LC.Early prevention and intervention are very important to avoid repeated operations.
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Objective To investigate the effects and advantages of laparoscopic hernioplasty for hernia.Methods From June 1995 to June 2005,222 patients with hernia were treated with laparoscopy.Transabdominal preperitoneal hernia repair(TAPP) were performed in 166 patients.Totally extraperitoneal hernia repair(TEP) were performed in 25 patients.Closure of the internal orifice of hernia was performed in 21 patients.Furthermore,incisional hernia in 2 patients, diaphragmatic hernia in 1 patient and mesenteric hernia in 1 patient were performed by laparoscopic hernioplasty and 6 patients with hernia of oesophagus finestra performed hernioplasty combined collapse gastric fundus with laparoscopy.In this series 45 patients associated with other abdominal disease were simultaneously treated with laparoscopy.Results All cases were operated successfully.The span of operation reduration was 42.5 min((10～180 min)).The average length of postoperative hospital stay were 4.6 days.There was one early failure owing to the use of too small a piece of mesh.Conclusion The results indicate that mesh repair of hernias is a satisfactory technique with a low recurrence rate and a low major complication rate.
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The extent to which sex influence CYP activity remains unclear in humans. Estrogen have widespread biologic actions especially estradiol , it can be used in ERT and Oral contraceptives. What is the effect of estrogen on drug metabolism and transport? If estrogen can regulate the genes of drug metabolism and transport,what is the mechanism.