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Objective:To explore the protective effect of nerve plane-oriented laparoscopic total mesorectal excision (NPO+ LTME) for postoperative urinary and sexual function in patients with rectal cancer.Methods:Retrospective analysis was performed on rectal cancer patients who received surgical treatment at Renmin Hospital of Wuhan University from Jan 2016 to Dec 2018, including 114 patients in the NPO+ LTME group and 92 patients in the laparoscopic TME combined with pelvic autonomic nerve preservation (LTME+ PANP) group. Surgical and tumor-related indicators were recorded and compared between the two groups, and postoperative urination and sexual function were followed up.Results:There was no significant difference in baseline indicators between the two groups ( P>0.05). The operative time of the two groups was (150±7) min and (154±7) min, respectively ( t=3.585, P<0.05). Intraoperative bleeding was (9±3) ml and (15±6) ml ( t=7.654, P<0.05), respectively.Three months after surgery, the rate of urinary dysfunction in the NPO+ LTME group was lower than that in the LTME+ PANP group ( Z=2.549, P<0.05), but there was no difference between the two groups 6 and 12 months after surgery ( Z=0.814, P>0.05 and Z=1.275, P>0.05). At 3, 6 and 12 months after surgery, the erectile function in NPO+ LTME group was better than that in LTME+ PANP group ( Z=4.917, P<0.05; Z=4.947, P<0.05 and Z=4.081, P<0.05); The rate of ejaculation dysfunction was also lower than that of the LTME+ PANP group ( Z=4.464, P<0.05; Z=4.948, P<0.05 and Z=4.434, P<0.05); In addition, postoperative female sexual function was superior to LTME+ PANP group ( Z=2.532, P<0.05; Z=2.364, P<0.05; Z=2.076, P<0.05). Conclusion:NPO+ LTME has good surgical safety and also has certain advantages for patient sexual function and early urinary function protection.
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Objective@#Using previous total mesorectal excision with pelvic autonomic nerve preservation (PANP+TME) and simple total mesorectal excision (TME) without emphasis on retained nerves as control, we explore the advantages of nerve plane-oriented laparoscopic total mesorectal excision (NPO+LTME) on urinary and sexual function.@*Methods@#A retrospective cohort study was carried out. Case inclusion criteria: (1) male patients with pathologically confirmed middle and low rectal adenocarcinoma (4 to 11 cm from the anus); (2) stage T1-2tumor; (3) normal sexual life before operation. Exclusion criteria: (1) no pathological diagnosis before surgery; (2) local recurrence or distant metastasis; (3) preoperative neoadjuvant chemoradiotherapy; (4) opensurgery and laparoscopic surgery conversionto open; (5) no follow-up data. According to the above criteria, clinical data of 173 male patients with low and middle rectal adenocarcinoma who underwent radical operation for laparoscopic rectal cancer from July 2003 to July 2018 at the Department of Gastrointestinal Surgery, Wuhan University People′s Hospital were collected. According to different surgical methods, patients were divided into TME group (58 cases), PANP+TME group (63 cases) and NPO+LTME group (52 cases). There were no significant differences in the baseline data including age, body mass index and pathological examination between the 3 groups (all P>0.05). The nerve plane referred to the nerve, the adipose tissue, the extremely finecapillaries around the nerve with overlying fine membranous tissue. NPO+LTME referred to the process of laparoscopic TME guided by the nerve plane, performing in the loose connective tissue between the nerve plane and the rectal properfascia, in order to ensure the integrity of the nerve plane, and maximally protect the patient's urinary and reproductive functions. The operation time, intraoperative blood loss, urinary catheter removal time, urinary function grading, postoperative first erection time, and erectile function and ejaculation function were observed and compared among the 3 groups at 3- and 6-month after operation.@*Results@#In the NPO+LTME group, the PANP+TME group and the TME group, the operation time was (181.9±24.5) minutes, (176.7±29.2) minutes and (137.7±16.2) minutes, respectively (F=54.868, P<0.001); the intraoperative blood lost was (6.0±1.4) ml, (6.5±1.8) ml and (12.8±4.6) ml, respectively (F=95.016, P<0.001); the time to postoperative removal of the catheter was (2.4±1.1) days, (3.7 ±1.7) days and (6.5±2.4) days, respectively (F=79.409, P<0.001); the first postoperative erection time was (1.6±0.6) days, (8.9±2.7) days and (15.9±6.8) days (F=177.677, P<0.001), respectively, whose differences were all statistically significant (all P<0.01). In comparison of urinary function grading, the proportion of grade I (normal function, no urinary dysfunction) in the NPO+LTME, the ANP+TME group and the TME group was 84.1% (53/63), 39.7% (23/58) and 19.2% (10/52), respectively, and the difference was statistically significant (H=52.915, P<0.001). At postoperative 3- and 6-month, proportion of patients with grade I erectile function (normal erectile function) was 77.8% (49/63) and 85.7% (54/63), 44.8% (26/58) and 53.4% (31/58), 28.8% (15/52) and 48.1% (25/52) in the NPO+LTME group, the PANP+TME group, and the TME group, respectively. The differences were statistically significant (H=91.709, P<0.001; H=79.692, P<0.001). The proportion of patients with grade I ejaculation function (with ejaculation, no abnormalities in routine semen examination before and after surgery) at 3- and 6-month after surgery in the NPO+LTME group, the PANP+TME group and the TME group was 82.5% (52/63) and 87.3% (55/63), 53.4% (31/58) and 60.3% (35/58), 28.8% (15/52) and 46.1% (24/52), respectively. The differences were statistically significant as well (H=86.543, P<0.001; H=78.667, P<0.001). Patients in the NPO+LTME group had no grade III erections and ejaculation disorders.@*Conclusion@#The surgical procedure of NPO+LTME can promote the recovery of postoperative neurological function and preserve urination and sexual function better.
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Objective To study the feasibility of mouse nerve growth factor for injection in treatment of incision pain after inguinal hernia repair. Methods Eighty unilateral inguinal hernia patients who had underwent inguinal hernia repair were divided into 2 groups according to the sequential order with 40 cases each. The patients of odd number were divided into control group, and the patients of dual number were divided into treatment group. All patients were performed Lichtenstein tension free repair operation, and were given the basic treatment of inguinal hernia. At the 3rd d after operation, the patients in control group were given 2 ml water for injection through intramuscular injection, and the patients in treatment group were given 20 μg mouse nerve growth factor for injection through intramuscular injection. One course of treatment was 14 d. At 3 d, 15 d, 30 d, 3 months and 6 months after operation, the pain degree, the pain range, and the effect of pain on behavior was observed and evaluated according to visual analogue score (VAS), the innervation range of the inguinal region, and behavioral rating scale-6 (BRS-6) respectively. Results There were no statistical differences in VAS, pain range score and BRS-6 score 3 d after operation between 2 groups (P>0.05). The VAS, pain range score and BRS-6 score 15 and 30 d after operation in treatment group were significantly lower than those in control group, 15 d after operation:(1.64 ± 0.92) scores vs. (2.28 ± 1.06) scores, (1.23 ± 0.43) scores vs. (1.61 ± 0.56) scores and (1.02 ± 0.56) scores vs. (1.57 ± 0.73) scores, and 30 d after operation:(0. 98 ± 0.56) scores vs. (1.61 ± 1.04) scores, (0.87 ± 0.43) scores vs. (1.16 ± 0.56) scores and (0.86 ± 0.32) scores vs. (1.16 ± 0.73) scores, there were statistical differences (P0.05). Conclusions Injecting mouse nerve growth factor for injection is effective for pain treatment after inguinal hernia repair.
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Objective To research the effect and mechanism of phosphatidylinositol 3‐kinase(PI3K)/serine threonine protein kinase(AKT) and mitogen extracellular signal‐regulated kinase(MEK)/extracellular signal‐regulated kinase(ERK) signaling path‐way in tumor vascular endothelial cell migration .Methods The different concentrations of PI3K/AKT signaling pathway inhibitor LY294002 (2 .50 ,7 .50 ,15 .00 μmol/L) and the MEK/ERK signaling pathway inhibitor PD98059 (2 .50 ,7 .50 ,15 .00 μmol/L) were used to treat the tumor‐derived endothelial cells respectively .The DMEM‐F12 culture medium was added into 0 .10% DMSO culture medium as the control .The cell scratch test ,cell directional migration test and Transwell test were adopted to detect the effects of different signaling pathway inhibitors on the tumor vascular endothelial cells level ,horizontal ,vertical and directional mi‐gration .Results 0 .10% DMSO had no significant effect on endothelial cell migration and the role of endothelial cells′migration a‐bility after its action had no obvious difference compared with the single DMEM‐F12 medium action ,indicating that small doses of DMSO as the solvent of LY294002 ,PD98059 did not affect the tumor vascular endothelial cell migration function ;after treatment by signaling pathway inhibitor LY294002 and PD98059 ,the endothelial cell migration ability was suppressed and increased with the in‐hibitor concentration increase ;compared with the PD98059 group ,the migration distance in the LY294002 group was smaller and the number of migrating cells was less ,the differences had statistical significance (P<0 .05) .Conclusion The inhibition of PI3K/AKT and MEK/ERK signaling pathway can inhibit the level of tumor vascular endothelial cells ,vertical and directional migration , and which is positively correlated with the concentration of inhibitor ;the effect of PI3K/AKT signal pathway on the migration of endothelial cells is more significant than that of the MEK/ERK signal pathway .
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Objective To investigate the clinical values of preoperative through-the-scope(TST) stent implementation by analyzing its effectiveness and reliability in patients with acute colonic obstruction caused by proximal colonic cancer.Methods From June 2008 to June 2014,36 patients with proximal colonic cancer accompanied by acute obstruction were analyzed.Obstructive sites consisted of ileocecal junction(n =4),ascending colon(n =20),and transverse colon near the hepatic flexure(n =12).A-chievement ratio of the colonic tumor resection,the incidence rate of complications,operation time,and hospitalization were evaluated.Results TTS was successfully placed in all patients.All patients showed relief of obstructive symptoms within 1 ~2 days.Surgical resection was performed after 5 ~7 days.A total of 34 patients got a radical colonic tumor resection,while the other two patients had liver and pelvic metas-tasis.All patients were welly recovered without complications of anastomotic leakage,intraperitoneal infec-tion and bleeding.Conclusion For patients with acute colonic obstruction caused by proximal colonic cancer,preoperative through-the-scope(TST)stent implementation is a cost-effective and safe method.It reduces trauma and pain,and enhances life quality for patients,which is worthy of being spread.
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Objective To evaluate the preoperative diagnosis and treatment of internal abdominal hernia.Methods The clinical data from 38 patients with internal abdominal hernia,admitted to our hospital during the period from Jan.2001 to Dec.2011 were retrospectively analyzed.Results There were 50％ (19/38) patients of internal abdominal hernia caused by adhesion.Positive rate of CT detection was 65％ (13/20) and the correct percent of preoperative diagnosis was 73.7％ (28/38).Average time from admission to surgery was 18 h (3-78 h).There were 44.7％ (17/38) patients with intestinal necrosis and the average length of intestinal removal was 53 cm (15-170 cm).The rate of serious complication was 5.3％(2/38).Conclusions Atypical hernia was the main cause of internal abdominal hernia,and it is hard to diagnose early for the poorly positive rate of equipment inspection.Early diagnosis and treatment is possible when we correctly understood of the clinical features of internal abdominal hernia,then we can reduce the occurrence of serious complications.
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Objective To investigate the causes,diagnosis and treatment of small intestine bleeding.Methods Sixty-eight cases of small intestine bleeding from January 2000 to June 2010 were retrospectively analyzed.Among all cases,4 underwent routine hemostatic treatment under colonoscopy,40treated with open surgery and 24 patients with laparoscopic therapy.Among them,57 cases underwent part resection for some small intestine,completely laparoscopic resection of diverticula was performed in 7patients.Results Neoplasms was the leading cause of small intestine bleeding,accounting for 48.5％ (33/68)in these patients,followed by small intestine diverticulum accounted for 29.4％ ( 20/68 ),intestinal infective diseases accounted for 14.7％ ( 10/68 ) and vascular disease accounted for 7.4％ ( 5/68 ).Conclusion The clinical manifestations of small intestinal bleeding showed no specific signs.Neoplasm,intestine diverticulum and intestinal infective diseases are the most common causes of small intestinal bleeding.Small intestinal bleeding can be diagnosed in intraoperative colonoscopy.Surgery is the most effective treatment for small intestinal bleeding.
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Objective To explore protective effects of curcumin on lung injury in the early hepatic ischemia/reperfsion (reperfusion for 1 and 3 hour) inrats. Methods Wistarratswererandom]y divided into the fo]]owinggroups: GroupA (shamoperation), group B (control group) and group C (cureumin applied). Contents of superoxide dismutase (SOD), catalase (CAT), malondialdehyde (MDA), myeloperoxidase (MPO) in lung tissues were determined to evaluate the protective effect of eurcumin on lung injury in the injury of isehemia/ reperfusion. Results Curcumin relieved edema of diaphragmatic wall and exudation of blood cell and white cell in pulmonary alveoli. Curcumin increased the contents of SOD, CAT and decreased contents of MDA, MPO in lung tissue. Conclusion By repressing the generation of oxygen free radical and infiltration of polymorphonuclear leukocyte in lung tissue, curcumin can relieve lung injury in the early hepatic ischemia/repeffusion.
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Objective To study the application of ultracision harmonic scalpel in laparoscopic radical gastrectomy.Methods Ten patients with gastric cancer were given laparoscopic-assisted radical gastrectomy by using ultracision harmonic scalpel.Results All operations were successfully performed with ultracision harmonic scalpel,and none of which converted into open surgery.The operation time was 300-492 min,mean(385?64) min.The blood loss was 100-500 ml,mean(401?70) ml.The number of harvested lymph nodes was 21-43,mean 31?6.The time for gastrointestinal function recovery was 3-6 d,mean(4.2?1.0) d.The time of patients' taking out-of-bed activity was 3-7 d,mean(4.5?1.3) d.The time of taking liquid food was 4-6 d,mean(5.0?0.9) d.No case had relapse or metastasis after 4-20 months(mean 12.6 months) of follow-up.Conclusions Laparoscopic radical gastrectomy by using ultracision harmonic scalpel is safe and feasible.Ultracision harmonic scalpel has the advantage of minimal invasion,less bleeding and shorter operation time,which is a very important equipment and useful for laparoscopic gastrointestinal surgery.
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Objective To study the significance of ?-catenin expression in human gastric carcinomas, colorectal carcinomas and human hepatic carcinomas.Methods S-P immunohistochemical method was used to detect ?-catenin expression in 80 cases of human carcinomas of alimentary system and corresponding tumor-adjacent normal tissues by ?-catenin polyclonal antibody. The results were analyzed using densitometrically semiquantitated .Results ?-catenin were normally expressed in all tumor-adjacent normal tissues of digestive system. ?-catenin expression was reduced or negative in human carcinomas of alimentary system (P
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Objective To investigate the methods of diagnosis and treatment of acute lower gastrointestinal massive bleeding. Methods Retrospective analysis was made on diagnozing and treating of 21 patients with acute lower gastrointestinal massive bleeding Results Within a total of 21 cases,bleeding was controlled by conservative treatment in 6 cases(28.6%),supermesenteric angiography showe positive findings in 92.8% and the interventional therapy was applied successfully in 84.6%. no recurrence was observed after Ⅰ month to 4 year follow up. Conclusions Patients with acute lower gastrointestinal massive bleeding should be treated firstly by conservatie method,uncontrollable bleeding should be evaluated by selective supermesenteric angiography;after the bleeding artery was recongnized by angiography,the intervention embolotherapy should be taken;the patients whose angiography are negative and bleeding cannot be controlled should be operatded