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Objective@#To investigate the clinical value of gallbladder-preserving cholelithotomy by natural orifice transumbilical endoscopic surgery on patients with cholecystolithiasis.@*Methods@#A retrospective study was performed on data of 15 patients with cholecystolithiasis, who underwent gallbladder-preserving cholelithotomy by natural orifice transumbilical endoscopic surgery from April 2018 to July 2018. The operative data, including situation of operation, operative time, intraoperative hemorrhage, and postoperative complications were recorded.@*Results@#The procedure was performed successfully in all patients with a mean operative time of 108±12 min (ranged from 92-129 min). The intraoperative hemorrhage was 10-30 mL. Eight patients suffered from slight right upper abdominal pain, and 7 patients felt slight pain in umbilical a week after surgery. No fever, incision infection, umbilical hemia, peritonitis, and ascites were reported. The clear-liquid diet was recommended for one day after operation, and postoperative activity was allowed since the second day after operation. All patients were discharged on the fourth or fifth day, and all recovered to their normal life at one week after discharge. Follow-up showed that the scar was small and hidden in umbilical without visible incision after one month. Ultrasonic examination results showed that gallbladder contractile function worked perfectly in four patients and no gallbladder stone was found after three months.@*Conclusion@#Gallbladder-preserving cholelithotomy by natural orifice transumbilical endoscopic surgery is a safe and effective option for patients with cholecystolithiasis, provides excellent cosmetic outcomes, and can be appropriately carried out under the strict control of surgical indications.
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Objective To investigate the clinical value of gallbladder-preserving cholelithotomy by natural orifice transumbilical endoscopic surgery on patients with cholecystolithiasis. Methods A retrospective study was performed on data of 15 patients with cholecystolithiasis,who underwent gallbladder-preserving cholelithotomy by natural orifice transumbilical endoscopic surgery from April 2018 to July 2018. The operative data,including situation of operation,operative time,intraoperative hemorrhage,and postoperative complications were recorded. Results The procedure was performed successfully in all patients with a mean operative time of 108±12 min (ranged from 92-129 min). The intraoperative hemorrhage was 10-30 mL. Eight patients suffered from slight right upper abdominal pain,and 7 patients felt slight pain in umbilical a week after surgery. No fever,incision infection,umbilical hemia,peritonitis,and ascites were reported. The clear-liquid diet was recommended for one day after operation,and postoperative activity was allowed since the second day after operation. All patients were discharged on the fourth or fifth day,and all recovered to their normal life at one week after discharge. Follow-up showed that the scar was small and hidden in umbilical without visible incision after one month. Ultrasonic examination results showed that gallbladder contractile function worked perfectly in four patients and no gallbladder stone was found after three months. Conclusion Gallbladder-preserving cholelithotomy by natural orifice transumbilical endoscopic surgery is a safe and effective option for patients with cholecystolithiasis,provides excellent cosmetic outcomes,and can be appropriately carried out under the strict control of surgical indications.
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Objective To discuss effects of different injection methods of nanocarbon tracer on gastrectomy for patients with gastric cancer. Methods Patients, who underwent D2 gastrectomy in Fuzhou General Hospital from January 2014 to December 2015, were randomly divided into group A and group B. The patients in group A were injected with nanocarbon into gastric submucosa of peripheral area of tumor under gastroscope 24 hours before operation. The patients in group B were injected with normal saline firstly, and then injected with nanocarbon. The operations were performed by 5 high qualification physicians and 3 low qualification physicians. The detection of lymph nodes and black stain nodes,detection time,and lymph node metastatic rate were compared between the two groups.Results A total of 248 patients were enrolled in this study,and each group had 124 cases. There was no statistical difference on basic characteristics between the two groups(P>0.05). A total of 2 975 and 3 855 lymph nodes were detected in group A and group B, respectively. The mean number of detected lymph nodes in group A was significantly lower than that of group B(23.9±7.9 VS 31.1±3.6, P=0.00). The rate of black stain nodes in group A was significantly lower than that of group B[71.3%(2 121/2 975)VS 78.1%(3 011/3 855), P= 0.00].There were no statistical differences on lymph node detection time(24.3±5.7 min VS 23.5±6.2 min), tiny lymph node detection rate(33.1% VS 34.9%),and lymph node metastatic rate(27.3% VS 25.8%)between the two groups(P>0.05).In subgroup of low qualification physicians, the number of lymph nodes(16.9± 4.0 VS 30.1±3.7)and the rate of black stain nodes(61.3% VS 77.2%)in group A were significantly lower than those of group B(P<0.05). The corresponding indicators(31.1±3.3 VS 31.5±3.5,76.8% VS 79.0%) had no statistical differences in the subgroup of high qualification physicians(P>0.05). Conclusion For low qualification physicians, injection of normal saline then of nanocarbon into gastric submucosa under gastroscope could improve lymph node and black stain nodes detection rate for patients with gastric cancer on gastrectomy.
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Objective To compare the efficacy and safety between local injection of triamcinolone and oral methylprednisolone in preventing esophageal stricture formation after endoscopic submucosal dissection (ESD) in patients with early esophageal cancer.Methods From January 2014 to January 2016,67 patients with early esophageal cancer were enrolled,all of them received ESD and were divided into triamcinolone injection group (22 cases),oral methylprednisolone group (22 cases) and control group (23 cases).Patients of triamcinolone group received injection of triamcinolone at injured mucosal under endoscope immediately after ESD.Patients of oral methylprednisolone group took methylprednisolone 30 mg per day since the third day after ESD,and then dosage reduced 5 mg every other week until drug withdrawal.Patients of control group only received ESD.After operation,gastroendoscopy examination was repeated to evaluate the extent of esophageal stricture.Patients with esophageal stricture were treated with an additional endoscopic balloon dilatation (EBD).The rate of esophageal stricture and the frequency of EBD treatment of the three groups were compared.Chi-square test,Wilcoxon rank sum test and Kruskal-Wallis rank sum test were used for statistical analysis.Results The rates of esophageal stricture of triamcinolone injection group,oral methylprednisolone group and control group were 18.2％ (4/22),13.6％0 (3/22) and 73.9％ (17/23),respectively,and the difference was statistically significant (x2 =22.20,P＜0.01).There was no significant difference in the rates of esophageal stricture between triamcinolone injection group and oral methylprednisolone group (x2 =0.17,P=0.50),but the rate of esophageal stricture in triamcinolone injection group was lower than control group,and the difference was statistically significant (x2 =14.03,P＜0.01);the rate of esophageal stricture in oral rnethylprednisolone group was lower than control group,and the difference was also statistically significant (x2 =16.55,P＜0.01).The median frequency of EBD treatment of triamcinolone injection group,oral methylprednisolone group and control group were 2.1 (range 0 to 4.0),1.6 (range 0 to 3.0) and 6.0 (range 0 to 13.0) times,respectively,and the difference was statistically significant (H =17.80,P ＜ 0.01).There was nosignificant difference in the frequency of EBD treatment between triamcinolone injection group and oralmethylprednisolone group (Z=1.21,P=0.23);but the frequency of EBD treatment in triamcinolone injection group was less than control group,and the difference was statistically significant (Z=4.96,P＜ 0.01);the frequency of EBD treatment in oral methylprednisolone group was less than control group,and the difference was also statistically significant (Z=4.32,P＜0.01).There was no severe adverse effect in the three groups.Conclusions Local injections of triamcinolone and oral methylprednisolone both reduced the rate of esophageal stricture after ESD,and decreased frequency of EBD treatment in patients with esophageal stricture.The two regimens showed equal efficacy and good safety.
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Bismuth quadruple therapy is recommended as a first-line therapeutic regimen for Helicobacter pylori (Hp) infection in China.However, the renal toxicity induced by bismuth resulted in limitation of its clinical use.Aims: To assess the efficacy and safety of hybrid therapy for initial eradication of Hp infection.Methods: One hundred and fifty-two patients proved to be positive for Hp infection and treatment-na(i)ve at the Fuzhou General Hospital of Nanjing Military Command of Chinese PLA from Jan.2014 to Dec.2015 were enrolled and randomized to receive either hybrid therapy (esomeprazole and amoxicillin for 7 days, followed by esomeprazole, amoxicillin, clarithromycin and metronidazole for 7 days) or bismuth quadruple therapy (esomeprazole, amoxicillin, clarithromycin and colloidal bismuth pectin for 14 days).Hp eradication was assessed by 14C/13C-urea breath test at a minimum of 4 weeks after the end of treatment.Results: No significant differences were found in general status between the two groups at baseline (P>0.05).A total of 149 patients completed the therapy.In hybrid therapy group the eradication rate was 97.4% (75/77) by ITT analysis and 98.7% (75/76) by PP analysis;while in bismuth quadruple therapy group the eradication rates by ITT and PP analyses were 89.3% (67/75) and 91.8% (67/73), respectively.Hybrid therapy was superior to bismuth quadruple therapy (P all <0.05).Although the incidence of adverse events was higher in hybrid therapy group than in bismuth quadruple therapy group (29.9% vs.16.0%, P<0.05), none of the patients discontinued the therapy because of severe adverse events.Conclusions: Hybrid therapy showed better efficacy than bismuth quadruple therapy for treatment of Hp infection, and the adverse events were well tolerated.Hybrid therapy might be used as first-line treatment for Hp infection.
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Objective To investigate the preventive effect of somatostatin and nitroglycerin on post-ERCP pancreatitis (PEP) and hyperamylasemia.Methods A total of 184 patients who underwent endoscopic retrograde cholangiopancreatograph (ERCP) were enrolled,and randomly divided into three groups to receive somatostatin or nitroglycerin or normal saline according to random number table.Incidence of PEP and hyperamylasemia were observed and compared among the three groups.Results Nine patients stopped the medication and dropped out of the study after occurence of adverse reactions from receiving nitroglycerin injections.The incidence rates of hyperamylasemia were 38.7％ (24/62),51.8％ (28/54) and 37.3％ (22/59) in somatostatin,nitroglycerin and control group respectively,with no significant differences among the three groups (P ＞ 0.05).The incidence rates of PEP were 6.4％ (4/62),9.3 ％ (5/54) and 23.7％ (14/59) in somatostatin,nitroglycerin and control group,respectively.The incidence rates of PEP in somatostatin and nitroglycerin group were both significantly lower than that in control group (somatostatin group vs control group:x2 =7.13,P =0.01 ; nitroglycerin group vs control group:x2 =4.22,P =0.03).There was no significant difference between somatostatin group and nitroglycerin group (x2 =0.32,P =0.41).Conclusion Somatostatin and nitroglycerin injections after ERCP show similar efficacy on preventing PEP,but the former is safer.Both have little effects on the prophylaxis of hyperamylaemia.
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Objective To investigate the safety,efficacy of CO2 insufflations during ERCP.Methods One hundred and forty eligible patients who underwent ERCP in Fuzhou General Hospital of Nanjing Military Command from January to December 2012 were randomized according to random digits in a double blind manner to receive either CO2 insufflations or air insufflations (65 vs 75).The patient's experience of abdominal pain and distension at 1 h,2 h,6 h and 24 h post-ERCP were evaluated by visual analogue scale (VAS).The heart rates,blood pressure,SpO2,PaCO2 were recorded before,during,after ERCP,and 24 h after the examination.Plain abdominal radiographic images were collected to show abdominal distention before and after ERCP,waist circumference,operative time,recovery time,intraoperative and post-ERCP complications were also determined.Results Post-ERCP the VAS of abdominal pain at 3 h was (4.08 ± 1.36) in CO2 group,which was significantly lower than that in air group [(4.59 ± 1.66),P ＜ 0.01].The VAS of abdominal distension at 1 h,3 h,6 h after ERCP were(1.78 ± 1.90),(0.72 ± 1.15),(0.12 ±0.45),which were significantly lower than those in air group [(3.53 ± 2.71),(2.51 ± 2.04),(0.84 ± 1.24),P ＜ 0.05] ; the intraoperative SpO2 was (93.29 ± 1.40)％,which was significantly lower than that in air group [(93.52 ± 1.06) ％,P ＜ 0.01].The waist circumference at 1 h after ERCP increased by (2.48 ± 1.33)cm,which was significantly lower than that in air group [(3.56 ± 2.13) cm,P =0.00).Recovery time was (11.2 ± 2.5) rain in CO2 group,which was significantly longer than that in air group [(9.7 ± 1.7) min,P =0.00].And the difference between the two groups was statistically significant.The plain abdominal radiographic images showed the degree of bowel distension was severer in air group than that in CO2 group (P =0.04).Conclusions CO2 insufflations are safe and efficacy during ERCP.CO2 can better alleviate abdominal pain and distension than air.
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Objective To evaluate effects of minimal invasive plating for treatment of mid-distal humeral shaft fractures.Methods From May 2004 to December 2007, 20 patients with isolated unilat-eral mid-distal third humeral shaft fractures were surgically treated with close reduction and internal fixation using a 4.5 mm dynamic compression plate which was anteriorly inserted through 2 small incisions on the anterior aspects of proximal and distal parts of the arm, away from the fracture site.The postoperative function of the radial nerve and the musculocutaneous nerve, the postoperative alignment of the main fragments on the anteroposterior radiographs, the bone healing time and muscle strength of biceps muscles were measured and recorded, Results Four patients complained of numbness at the area innervated by the lateral ante-braehial cutaneous nerve in the affected forearm after the surgery.No signs of iatrogenic radial nerve palsies occurred after the surgery.A completely normal alignment was achieved in 7 patients, but varus of 11° was found in 2 cases and varus of 2°, 3°, 4°, 5°, 6°, 7° and 10° in one each.Valgus deformity was noticed in 4 cases, and valgus of 3°, 4°, 6° and 7° in one each.The mean follow-up of 10.4 months for 19 patients re-vealed bony union of all the fractures.The average bone healing time was 13.4 weeks.At the latest follow-up, the biceps muscle strength of all the patients was 5 degrees.Hardwires were removed in 5 patients without any complications.Conclusions Minimally invasive anterior plating is a safe alternative osteosynthesis for mid-distal third humeral shaft fractures.However, this technique may interfere with the function of the lateral antebrachial cutaneous nerve.
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From January 2006 to December 2007,44 cases of humeral shaft fractures were admitted to Department of Orthopaedics,Sixth People's Hospital of Shanghai Jiao Tong University,including 29 males and 15 females,with an average age of 40.7 years old(ranging 19-89 years).Of them,13 cases of fracture involved upper segment,24 involved middle segment and 7 lower segment.All fractures were close fractures.According to AO/ASIF classification,there were 5 cases of type A1,11 of A2,6 of A3,6 of B1,12 of B2,and 4 of B3.All patients were treated by expendable intramedullary nailing system.Time of operation,hospitalization and healing,blood loss,intra-or postoperative complications and range of shoulder and elbow motion were recorded and analyzed statistically.X-ray was shot to observe the union of fractures.The expendable intramedullary nailing was successfully performed in all patients for 86 minutes(ranging 30-150 minutes).The blood loss ranged from 30 to 200 mL with a mean of 70 mL.Except primary injury-caused radial paralysis,no iatrogenic radial paralysis occurred.All 44 patients were follow-up with an average of 18 months.Of them,41 patients had fracture union,and 3 nonunion.The average healing time was 15.8 weeks.There were 15 patients complained of pain in the shoulder joint,which did not affect daily life.According to UCLA shoulder scoring system,an excellent result was found in 18 patients,good in 23 patients,and fair in 3 patients with an excellent/good rate of 93.2%.All the patients had the excellent results according to Mayo elbow performance score system.No infection,iatrogenic fracture,limb shortening,nail breakage,fat embolism syndrome or peripheral nerve injury was found.The expandable nail offers the advantages of little blood loss,reduced operation time and exposure to radiation.However,nail antegrade insertion may lead to shoulder pain,and it should be paid more attention for cases of rotational instability in inferior segment of the humerus.