Randomized Trial of Immediate Postoperative Pain Following Single-incision Versus Traditional Laparoscopic Cholecystectomy / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>We undertook a randomized controlled trial to ascertain if single-incision laparoscopic cholecystectomy (SILC) was more beneficial for reducing postoperative pain than traditional laparoscopic cholecystectomy (TLC). Moreover, the influencing factors of SILC were analyzed.</p><p><b>METHODS</b>A total of 552 patients with symptomatic gallstones or polyps were allocated randomly to undergo SILC (n = 138) or TLC (n = 414). Data on postoperative pain score, operative time, complications, procedure conversion, and hospital costs were collected. After a 6-month follow-up, all data were analyzed using the intention-to-treat principle.</p><p><b>RESULTS</b>Among SILC group, 4 (2.9%) cases required conversion to TLC. Mean operative time of SILC was significantly longer than that of TLC (58.97 ± 21.56 vs. 43.38 ± 19.02 min, P < 0.001). The two groups showed no significant differences in analgesic dose, duration of hospital stay, or cost. Median pain scores were similar between the two groups 7 days after surgery, but SILC-treated patients had a significantly lower median pain score 6 h after surgery (10-point scale: 3 [2, 4] vs. 4 [3, 5], P = 0.009). Importantly, subgroup analyses of operative time for SILC showed that a longer operative time was associated with greater prevalence of pain score >5 (≥100 min: 5/7 patients vs. <40 min, 3/16 patients, P = 0.015).</p><p><b>CONCLUSIONS</b>The primary benefit of SILC appears to be slightly less pain immediately after surgery. Surgeon training seems to be important because the shorter operative time for SILC may elicit less pain immediately after surgery.</p>

A clinical comparison of two strategies for minimal invasive treatment of secondary common bile duct stone / 中华外科杂志

<p><b>OBJECTIVE</b>To compare the clinical efficiency of two strategy in the treatment of secondary common bile duct stones: laparoscopic cholecystectomy with transcytotic common bile duct exploration (LC + LTCBDE), or laparoscopic cholecystectomy after endoscopic sphincterotomy (EST + LC).</p><p><b>METHODS</b>According to the screening standard, 88 patients with secondary bile duct stones (43 cases in LC + LTCBDE group, 45 cases in EST + LC group) who were treated from June 2005 to November 2007 were analyzed retrospectively. The achievement ratio, complications, average hospital stay and cost between two groups were compared. And all patients were followed up.</p><p><b>RESULTS</b>There were no significant differences on achievement ratio and complications between two groups (P > 0.05). The LC + LTCBDE group has significantly shorter hospital stay and lower cost (P < 0.05). There were no recurrence in 1 year.</p><p><b>CONCLUSIONS</b>LTCBDE is a promising strategy which has more advantages in the minimal invasive treatment of secondary common bile duct stones.</p>

Clinical and pathological features of operable breast cancer in women over 65 years / 中华外科杂志

<p><b>OBJECTIVE</b>To study the clinical and pathological characteristics of operable breast cancer in women over 65 years.</p><p><b>METHODS</b>The data of 95 patients treated from February 2003 to February 2005 were collected, and the clinicopathological characteristics were retrospectively analyzed.</p><p><b>RESULTS</b>These 95 patients accounted for 26.1% of all female breast cancer patients registered in our hospital in the mean time. Local advanced breast cancer accounted for 74.5% of the patients. The median time from symptom presentation to treatment seeking was 1.2 years. Curative resection was performed in 96 breasts of 94 patients, 71 patients received chemotherapy and 67 received endocrine therapy. Sixty-four cases (67.3%) were confirmed invasive ductal carcinoma. Positive expression of estrogen or progesterone receptor was found in 65 cases (68.4%); overexpression of C-erbB-2 was found in 23.5% of the patients and low level expression of Ki-67 (<30%) was found in 54.1% of the cases, respectively. The 3-year overall survival rate and disease free survival rate was 87.4% and 71.4%, respectively.</p><p><b>CONCLUSIONS</b>Of the breast cancer in aged women, most are local advanced breast cancer. Breast cancer in the elderly women has distinctive clinicopathological characteristics. Less radical surgery combined with adjuvant chemotherapy and(or) endocrine therapy is feasible treatment.</p>

Effects of hepatotrophic factors on the liver after portacaval shunt in rats with portal hypertension / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Portacaval shunt (PCS) prevent hepatotrophic factors from flowing into the liver, but they enter directly the systemic circulation and worsen liver injury. This study was designed to investigate the effects of hepatotrophic factors through the portal vein on the liver in rats with portal hypertension after portacaval shunt.</p><p><b>METHODS</b>Intrahepatic portal hypertension (IHPH) was induced by intragastric administration of carbon tetrachloride, and end-to-side PCS was performed. Eight normal rats served as controls, and eight rats with IHPH served as IHPH model (IHPH group). Another 32 rats with IHPH-PCS were randomly subdivided into 4 groups: normal saline (NS) given to 8 rats, hepatocyte growth factor (HGF) 8, insulin (INS) 8, hepatocyte growth factor and insulin (HGF + INS) 8. Hepatotrophic factors were infused into the portal vein through an intravenous catheter. Portal venous pressure (PVP) was measured. The levels of serum alanine aminotransferase (ALT) and aspartate aminotransferase (AST) were tested biochemically and those of hyaluronic acid (HA) and laminin (LN) were measured by radioimmunoassay. Hepatic fibrosis was assessed histologically and the expression of collagens type I and III were detected immunohistochemically. Ultrastructural change of hepatocytes and the number of mitochondria were observed under an electron microscope. The data were compared between groups and subgroups by Student-Newman-Keuls procedure with SPSS10.0.</p><p><b>RESULTS</b>PVP was significantly higher in the IHPH rats than in the control rats (P < 0.05). The levels of serum ALT, AST, HA, and LN, hepatic fibrosis score, the amount of collagen deposition, collagens type I and III increased more significantly in the IHPH group than in the control rats (P < 0.05). The number of mitochondria decreased more significantly in the IHPH rats than in the control rats (P < 0.05). The levels of serum ALT, AST, HA and LN as well as hepatic fibrosis score, the amount of collagen deposition, and the amount of collagens type I and III in the HGF and HGF + INS rats were significantly lower than those in the NS rats (P < 0.05). The damage to hepatocyte ultrastructure was markedly alleviated and the number of mitochondria was increased more significantly in the HGF and HGF + INS rats than in the NS rats under an electron microscope.</p><p><b>CONCLUSIONS</b>Perfusion of exogenous hepatotrophic factors through the portal vein can alleviate liver injury, minimize the damage to the ultrastructure of hepatocyte, protect liver function, and lessen hepatic fibrosis in rats with portal hypertension after PCS.</p>

Effect of endothelin-1 and its antagonists on the expression of endothelin receptors mRNA in HSC-T6 cells / 中华外科杂志

<p><b>OBJECTIVE</b>To study the effect of endothelin-1 (ET-1) and its antagonists on the expression of endothelin and its receptors mRNA in HSC-T6 cells.</p><p><b>METHODS</b>Cultured HSC-T6 cells were randomly divided into 7 groups: Sham control group, ET-1 group (10 nmol/L ET-1), BQ-123 group [1 micromol/L BQ-123, a selective endothelin receptor A (ETRA) antagonist], BQ-788 group [1 micromol/L BQ-788, a selective endothelin receptor B (ETRB) antagonist], ET-1 + BQ123 group (10 nmol/L ET-1 + 1 micromol/L BQ-123), ET-1 + BQ-788 group (10 nmol/L ET-1 + 1 micromol/L BQ-788) and ET-1 + BQ-788 group (10 nmol/L ET-1 + 1 micromol/L BQ-123 + 1 micromol/L BQ-788). The expression of endothelin receptor mRNA of HSC-T6 cells was determined by reverse-transcription polymerase chain reaction (RT-PCR).</p><p><b>RESULTS</b>The expression of ETRA mRNA in ET-1 + BQ123 + BQ788 and ET-1 + BQ788 group was significantly lower than ET-1 group (0.329 +/- 0.044 and 0.292 +/- 0.023 vs. 0.440 +/- 0.030 P < 0.05). Compared with ET-1 group, the expression of ETRB mRNA in ET-1 + BQ788 group was down regulated obviously (0.499 +/- 0.136 vs. 0.153 +/- 0.071, P < 0.05). There was no significant difference in ET-1 + BQ123 group and ET-1 + BQ123 + BQ788 group when compared with ET-1 group (0.499 +/- 0.136 vs. 0.496 +/- 0.103 and 0.299 +/- 0.129, P > 0.05).</p><p><b>CONCLUSIONS</b>ET-1 has no obvious effect on the expression of ETRA mRNA in HSC-T6. ET-1 may up-regulate the expression of ETRB mRNA. Act on ETRA receptor, ET-1 can inhibit the expression of ETRB mRNA.</p>