Clinical study of the first stage suture after laparoscopic common bile duct exploration / 中国医师进修杂志

Objective To research the clinical application value of laparoscopic bile duct exploration and the first stage suture for choledocholithiasis. Methods The clinical data of 86 patients with choledocholithiasis were analyzed retrospectively from January 2015 to January 2017 in Affiliated Suzhou Hospital of Nanjing Medical University. According to the different methods of laparoscopic bile duct exploration, they were divided into one stage suture group (observation group, 46 cases) and T tube drainage group (control group, 40 cases). Results The recovery time of gastrointestinal function, hospitalization time and hospitalization expenses in observation group were significantly better than those in control group: (22.71 ± 10.92) h vs. (35.63 ± 11.12) h, (8.4 ± 2.6) d vs. (13.5 ± 2.3) d and (12.1 ± 3.2) thousand yuan vs. (13.5 ± 4.2) thousand yuan, and there were statistical differences (P＜0.05). Conclusions Compared with T tube drainage, the first stage suture after laparoscopic common bile duct exploration has shorter hospitalization time, lower treatment cost and faster recovery. It is a safe and feasible operation method, and is worthy of popularization and application.

Long-term results of intersphincteric resection for ultra-low rectal cancer / 国际外科学杂志

Objective To evaluate the long-term therapeutic results of intersphincteric resection (ISR) in the treatment of ultra-low rectal cancer.Methods Sixty cases of ultra-low rectal cancer with the inferior border of the tumor within 5 cm to the edge of anus underwent intersphincteric resection (ISR),and the clinical data were analyzed retrospectively.There were 39 males,21 females and their average age was 55 years old (range from 30 to 77 years old).The inferior border of the tumor were from 28 to 50 mm to the edge of anus,averaging 42 mm.Results Sixty patients underwent intersphincteric resection successfully with 3 cases developing anastomotic leakage and 2 cases anastomotic stenosis postoperatively.After a median follow-up period of 49 months (range from 18 to 90 months),local and distant recurrence were observed in 6 and 4 patients respectively.Five-year overall survival rate and disease-free survival rate were 88.3％ and 83.3％ respectively.The mean stool frequency were (3.8 ± 1.3) times in each day based on data from 53 patients,and the stool control function of 73.6％ of all patients was preserved satisfactorily according to Kirwan classification.Conclusions This study indicated that intersphincteric resection might be a candidate technique in the treatment of early stage ultra-low rectal cancer restricted within rectal wall and could achieve satisfactory long-term results in both oncologic and functional respects.

Study of anal function after ileal pouch anal anastomosis with modified double-stapled mucosectomy / 国际外科学杂志

Objective To evaluate the long-term functional outcome after ileal pouch anal anastomosis with modified double-stapled technique.Methods From January 2002 to March 2011,forty-five patients underwent ileal pouch anal anastomosis with modified double-stapled technique.The clinical data of these patients were reviewed.The postoperative anal function was assessed by Kirwan classification and Oresland pouch-specific function score.Results During the median follow-up of 65 months,2 patients with malignant adenomatous polyps died,2 patients were diagnosed dysplasia by biopsy,4 patients developed mild to moderate anastomotic narrowing,1 patient developed persistent anastomotic stricture needing surgical intervention,16 patients developed at least 1 episode of pouchitis.There was no incontinence in these patients,and the median functional Oresland score was 6,3 and 2 after 1 year,2.5 years and 5 years respectively.Conclusion The functional results of ileal pouch anal anastomosis with modified double-stapled technique are promising,with no incontinence in our patients.

Anatomical basis for pelvic autonomic nerve preservation in total mesorectal excision of adult male / 国际外科学杂志

Objective To study the pelvic fascia related to pelvic autonomic nerve and detect the anatomical localization of pelvic autonomic nerve by marker in adult male.Methods Twelve pelvises of adult male harvested from cadavers were studied by dissection.Results Hypogastric nerve was embedded in the posterior leaf of the visceral pelvic fascia.Pelvic plexus was situated between vesicohypogastric fascia and visceral fascia.Pelvic nerve branch of seminal vesicle and prostate was located at the anterolateral part of Denonvilliers fascia.Sacral promontory,ureter,junction of Denonvilliers fascia,visceral fascia and seminal vesicle could be regarded as anatomical markers for pelvic autonomic nerve.Conclusion The anatomical characteristics of pelvic autonomic nerve can be used for protecting and isolating pelvic autonomic nerve in total mesorectal excision of adult male.

Local resection for early rectal tumours: comparative study of transanal endoscopic microsurgery versus conventional transanal excision / 国际外科学杂志

Objective To compare the application,safety and theraputic effect of local resection of early rectal tumours by transanal endoscopic microsurgery(TEM) and the conventional transanal excision(TAE).Methods The data of seventy-six patients who were treated by conventional transanal excision from January 2003 to July 2006 and fifty-three patients who were treated by transanal endoscopic microsurgery from September 2006 to February 2010 in Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine were reviewed.Results Age,sex,tumour size,blood loss,postoperative hospital stay were similar in the two groups(P＞0.05).The median distance from the anal verge was significantly higher in the TEM group ( TEM/TAE =7.0/5.0 cm,P ＜ 0.01 ).The operation time was significantly longer in the TEM group (TEM/TAE =70.00/30.00 min,P ＜ 0.01 ).There was no operation-related mortality in both groups (P ＞ 0.05 ).Two patients in the TEM group developed postoperative haemorrhage,and one patient developed pulmonary infection and retention of urine respectively.There were two secondary haemorrhage cases in the TAE group.On median follow-up of 30 months,there was 7.8％ recurrence rate in the TEM group,compared with 23.2％ the in TAE group.Conclusions Transanal endoscopic microsurgery is a safe and effective mininally invasive surgical technique for the treatment of early rectal neoplasm.It has broader indication,and better theraputic effect than the conventional transanal excision.

Surgical management of aortic diseases / 中国普通外科杂志

Objective To explore the surgical management of aortic diseases. Methods The clinical data of 45 cases of aortic diseases were analysed retrospectively. Results There were 37 males and 8 females.The age ranged from 21 85 years with a mean age of 64.7 years, Among these cases, 11 were thoracic aortic dissection, 2 were ruptured descending aortic local dissection and formed an aneurysm;above and below the renal artery abdominal aortic aneurysms( AAAs) were 3 and 23 respectively; complicated with rupture of the AAA in 2, and with aortojejumal fistula in 1;the other 3 cases were traumatic aortal rupture. Among the 45 cases, 18 underwent endoluminal treatment, 25 underwent AAA resection and artificial vessel implantment, and 3 underwent repair of the ruptured aorta. The operative mortality was 6.67% ( 3/45 ). 36 patients were followed up for 2 months to 4 years, all the 36 patients still alive well. Conclusions In the management of appropriate aortic diseases, endoluminal technique is much simple,safe, less trauma, and less complications, it can also short the hospital stay of the patient . However, with improvement of the surgical skills,the surgical operation is still very important and effective, especially for the cases who can not be treated via endovascular technique.

Therapeutic effect of kansui root on patients with severe acute pancreatitis / 中国普通外科杂志

Objective To investigate the therapeutic effect of kansui root on patients with severe acute pancreatitis(SAP). Methods Clinical data of 54 cases of severe acute pancreatitis treated with kansui root(kansui root group) were analyzed and compared with 54 cases of severe acute pancreatitis treated without kansui root (control group).Results The releivng time of abdominal pain was significantly shorter than that in control group( P