Gasless laparoscopic surgery plus abdominal wall lifting for giant hiatal hernia-our single-center experience / 华中科技大学学报（医学）（英德文版）

Giant hiatal hernia (GHH) comprises 5% of hiatal hernia and is associated with significant complications. The traditional operative procedure, no matter transthoracic or transabdomen repair of giant hiatal hernia, is characteristic of more invasion and more complications. Although laparoscopic repair as a minimally invasive surgery is accepted, a part of patients can not tolerate pneumoperitoneum because of combination with cardiopulmonary diseases or severe posterior mediastinal and neck emphesema during operation. The aim of this article was to analyze our experience in gasless laparoscopic repair with abdominal wall lifting to treat the giant hiatal hernia. We performed a retrospective review of patients undergoing gasless laparoscopic repair of GHH with abdominal wall lifting from 2012 to 2015 at our institution. The GHH was defined as greater than one-third of the stomach in the chest. Gasless laparoscopic repair of GHH with abdominal wall lifting was attempted in 27 patients. Mean age was 67 years. The results showed that there were no conversions to open surgery and no intraoperative deaths. The mean duration of operation was 100 min (range: 90-130 min). One-side pleura was injured in 4 cases (14.8%). The mean postoperative length of stay was 4 days (range: 3-7 days). Median follow- up was 26 months (range: 6-38 months). Transient dysphagia for solid food occurred in three patients (11.1%), and this symptom disappeared within three months. There was one patient with recurrent hiatal hernia who was reoperated on. Two patients still complained of heartburn three months after surgery. Neither reoperation nor endoscopic treatment due to signs of postoperative esophageal stenosis was required in any patient. Totally, satisfactory outcome was reported in 88.9% patients. It was concluded that the gasless laparoscopic approach with abdominal wall lifting to the repair of GHH is feasible, safe, and effective for the patients who cannot tolerate the pneumoperitoneum.

The comparative analysis of video-assisted thoracoscopic versus transsternal thymectomy for myasthenia gravis / 中华外科杂志

<p><b>OBJECTIVE</b>To investigate different characteristics of the video-assisted thoracoscopic (VATS) versus transsternal thymectomy for myasthenia gravis (MG).</p><p><b>METHODS</b>The clinical data of 106 patients who underwent VATS thymectomy for MG between February 2002 and May 2007, and 108 patients who underwent transsternal thymectomy between March 1998 and August 2003 were analyzed retrospectively. In VATS group, there were 64 male and 42 female patients, and the mean age was 38-years-old. In the transsternal group, 68 patients were male and 40 were female, and the mean age was 36-years-old. Analysis of conditions related to the surgical procedure between two groups was made, such as length of surgery, operative bleeding, postoperative drainage, hospital stay, hospitalization expenses and complications. The mean time of follow-up was 38.5 months (ranging from 10 to 67 months). All patients were classified according to the MGFA clinical classification.</p><p><b>RESULTS</b>Intraoperative bleeding in VATS group was (34 +/- 5) ml, significantly less than (150 +/- 23) ml in the transsternal group. Postoperative drainage in VATS group was (42 +/- 18) ml, significantly less than (168 +/- 31) ml in the transsternal group. Complications and hospital stay in VATS group were also significantly lower than those in the transsternal group. There was no significantly different in the long-term outcome between two groups.</p><p><b>CONCLUSION</b>Although both thoracoscopic and transsternal approaches to thymectomy in patients with MG are effective after the long-term follow-up, VATS thymectomy has its specific advantages of minimal invasion, less complications, and rapid recovery.</p>

Intraoperative esophageal manometry employed in the course of Heller's cardia-myotomies / 中华外科杂志

<p><b>OBJECTIVE</b>To study the changes of lower esophageal sphincter (LES) high-pressure zone, and to determine the accurate length of myotomy on the esophageal and gastric sides.</p><p><b>METHODS</b>There were 15 patients undergoing the Heller's cardia-myotomies and Toupet fundoplications from May 2006 to December 2007. Among them, 9 patients were female and 6 was male. The age ranged from 28 to 61 years old, and the disease duration ranged from 6 months to 9 years. The intraoperative oesophageal manometry underwent in the surgical procedures to investigate the changes of the lower esophageal sphincter pressure and the length of myotomy.</p><p><b>RESULTS</b>There was no postoperative death. After (5.3 +/- 1.5) cm of esophageal side myotomy and (0.8 +/- 0.4) cm of gastric side myotomy, the mean LES pressure decreased from (33.6 +/- 13.3) mm Hg (1 mm Hg = 0.133 kPa) to (9.7 +/- 4.6) mm Hg and (4.8 +/- 3.1) mm Hg respectively (P < 0.05). The lower esophageal sphincter length ranged from 5 to 8 cm.</p><p><b>CONCLUSION</b>Intraoperative esophageal manometry helps determine the accurate myotomy length of myotomy on the esophageal and gastric sides of the gastroesophageal junction and provides valuable information for the Heller's myotomy.</p>

Outcome of Nissen fundoplication using intraoperative manometry / 中华外科杂志

<p><b>OBJECTIVE</b>Through reviewing the surgical experience in the treatment of sliding hiatus hernia, the effectiveness of Nissen fundoplication using intraoperative oesophageal manometry has been evaluated.</p><p><b>METHODS</b>There were 84 undergoing the transabdominal surgery who have been divided into three groups: 27 patients were in the Nissen group, 39 in the floppy Nissen group, 18 in the intraoperative-oesophageal-manometry group.</p><p><b>RESULTS</b>There is no postoperative death. Complications occurred in 5 patients within one month after operation: in the Nissen group, 2 patients suffered from severe dysphagia and 1 from regurgitation; In the floppy Nissen group, 2 patients had regurgitation; In the intraoperative-oesophageal-manometry group, there were no one suffering severe dysphagia or regurgitation. During the long-term follow-up, excellent functional results were also observed in the intraoperative-oesophageal-manometry group, whereas 2 patients suffered from severe dysphagia and 1 from nausea in the Nissen group and 1 patient recurred in the floppy Nissen group.</p><p><b>CONCLUSIONS</b>The Nissen fundoplication (NF) should be suitable to be done in patients with sliding hiatus hernia. But if there are possibilities to perform intraoperative oesophageal manometry during the operation of anti-reflux, side effects can be decreased to the least. Intraoperative manometry is useful in standardizing the tightness of the wrap in NF. And it will contribute to reducing or avoiding the happening of complications.</p>

Study on the relationship among the NF-?B activation,uPA expression and apoptosis induced by 5- Fu in HCT116 human carcinoma cell line / 肿瘤研究与临床

Objective To study the relationship among apoptosis,NF-KB activation and uPA expres- sion in human colon carcinoma cell line HCTll6 induced by 5-fluorouracil,and to observe the effect of in- hibiting activity of NF-KB by PDTC on apoptosis as well as expression of uPA.Methods Cell apoptosis was analysed by Annexin V-FITC.Fluctuation of NF-KB and uPA was detected by semi-quantitative immuno- histochemistry.Results 5-fluorouracil could induce apoptosis and activate NF-KB.PDTC could significantly increase the apoptosis and suppress the activation of NF-KB induced by 5-fluorouracil.There was a positive correlation between the changes of uPA and NF-KB.Conclusion 5-fluorouracil could induce apoptosis,ac- tivate NF-KB and up-regulate expression of uPA of HCT116 cells.The mechanism of enhanced apoptosis by PDTC may be related to suppressing activation of NF-?B and down-regulating expression of uPA.

Surgical treatment with sliding esophageal hiatal hernia / 中华外科杂志

<p><b>OBJECTIVE</b>To study the effect and method of surgical treatment in patients with sliding esophageal hiatal hernia.</p><p><b>METHODS</b>To divide into two groups: fifty-two patients with sliding esophageal hiatal hernia diagnosed with gastroscopy and X-ray barium meal examination accepted operation. Forty-seven cases were treated by Nissen's operation. Three cases were treated by Hill's operation. One case was treated by Boerema's operation. One case was treated by Rampal's operation. 24-hour esophageal pH and esophageal motility were also monitored before and after operation. Thirty healthy volunteer were performed control group and were monitored by 24-hour esophageal pH and esophageal motility.</p><p><b>RESULTS</b>The patients in operation group had lower esophageal sphincter relaxation and acid reflux before operation. They became significantly ameliorative after operation. Forty-seven cases (90%) had the satisfactory effect. Two cases (4%) recrudesced.</p><p><b>CONCLUSION</b>Comprehensive examination and perfect surgical choice may play an important role in the treatment of sliding esophageal hiatal hernia; The better method for sliding esophageal hiatal hernia is Nissen's operation.</p>