Apatinib has anti-tumor effects and induces autophagy in colon cancer cells.

OBJECTIVES: Apatinib recently has been used to treat patients with gastric cancer, but the function of apatinib in colon cancer remains unclear. This study was conducted to investigate the impacts of apatinib on the biological function and its potential mechanism of colon cancer cells in vitro. MATERIALS AND METHODS: The effect of apatinib in colon cancer cells were detected by assessing cell viability, migration and invasion capabilities. Apoptosis cells and the cell cycle distribution of colon cancer cells were analyzed by flow cytometry. The potential mechanism was investigated via autophagy related proteins and pathways in vitro. RESULTS: The proliferation, migration and invasion of colon cancer cells were inhibited when they were treated with different concentration of apatinib (20, 40 µM). When HCT116 and SW480 cells were treated with apatinib at the concentration of 20 µM, the apoptosis percentage were 3.7% and 5.8% respectively. As the drug concentration increased to 40µΜ, the the apoptosis percentage increased to 11.9% and 13.5%. Meanwhile, cell cycle was also altered. Furthermore, apatinib inhibited the expression of AKT-mTOR signaling pathway and increased the expression of LC3-II. CONCLUSION: Apatinib can significantly inhibit the malignant phenotype of colon cancer cells, and it was involved in regulation of autophagy.

Dynamic change of circulating monocyte subsets in the mouse model of quartz-induced pneumosilicosis and its implication / 医学研究生学报

Objective Pneumosilicosis is characterized by pulmonary fibrosis and cannot be effectively treated at present. This study was to explore the changes of monocyte subsets in the mouse model of silicon dioxide-induced experimental pneumosilicosis and the correlation of the changes with lung inflammatory injury and pulmonary fibrosis. Methods A total of 100 male C57BL/6J mice weighing 18-22 g were equally randomized into a normal saline (NS) group and a silicon dioxide (quartz) group.The model of experimental pneumosilicosis was established by oropharyngeal aspiration of quartz suspension.At 1, 3, 7, 14, and 28 days after treat-ment, the mice were sacrificed and the proportions of different circulating monocyte subpopulations determined by flow cytometry.Dif-ferent types of inflammatory cells in the bronchoalveolar lavage fluid ( BALF) were routinely counted.The inflammation score and col-lagen volume fraction ( CVF) of the lung tissue were obtained by HE and picrosirius red staining. Results At 7 days after quartz treatment, silicotic nodules were observed in the lung tissue.Compared with the NS controls, the model mice showed significantly in-creased inflammation score and CVF at 7 days (0.920 ±0.049 vs 1.400 ±0.089, P0.05).Compared with the NS controls, the quartz-treated mice showed markedly increased proportion of Ly6Chimonocytes at all time points, which peaked at 7 days (58.750 ±2.386 vs 78.300 ±2.517, P<0.01), with a positive corre-lation with the inflammation score (P<0.01) and CVF of the lung tissue (P<0.01) at 7 and 28 day. Conclusion The propor-tions of circulating Ly6Chi and Ly6Clo monocytes changed dynamically in the murine model of quartz-induced experimental pneumosilico-sis.The increased proportion of the Ly6Chi monocyte subpopulation might be closely related with lung inflammatory injury and pulmona-ry fibrosis in pneumosilicosis.

Effect of P2X7 R gene silencing by RNA interference on proliferation and phagocytosis of murine macrophage cell line RAW264.7 / 中国病理生理杂志

AIM: To establish a cell line of stable silencing of P2X7 receptor (P2X7R) expression through short hairpin RNA ( shRNA)-mediated interference in murine RAW264.7 macrophages, and to investigate the proliferation and apoptosis in the cell line.METHODS:Stable silencing of P2X7 R gene in the RAW264.7 cells was achieved by re-combinant shRNA plasmid targeting murine P2X7 R gene via liposome mediated transfection, followed by G418 selection. The efficacy of plasmid transfection and P2X7 R silencing in G418 resistant cells was verified by immunofluorescent micros-copy and real-time PCR, respectively.The proliferative activity was analyzed by CCK-8 assay and EdU cell proliferation as-say.The cell cycle distribution and apoptosis were evaluated by flow cytometry.RESULTS:The expression of P2X7 R at mRNA and protein levels was down-regulated by 80% in shP2X7 R group compared with negative control ( NC) plasmid transfection.In addition, P2X7 R-silencing cells exhibited higher proliferative activity compared with NC and wild-type RAW264.7 cells (P<0.05).Compared with NC cells, P2X7R silencing resulted in an increase in the phagocytosis of the cells ( P<0.05) .CONCLUSION:A cell line RAW264.7 of stable silencing of P2X7 R expression was successfully es-tablished.P2X7 R gene silencing stimulates the proliferation, and changes phagocytic function in murine RAW264.7 macro-phages.

Adenovirus-mediated siRNA targeting Mcl-1 gene increases radiosensitivity of pancreatic carcinoma cells in vitro and in vivo.

BACKGROUND: Myeloid cell leukemia-1 (Mcl-1), an anti-apoptotic member of the B cell lymphoma/leukemia-2 (Bcl-2) family, has been shown to be involved in apoptosis and the cell cycle. Mcl-1 is overexpressed in many malignancies, including pancreatic cancer. The aim of this study was to investigate the effect of siRNA targeted against Mcl-1 on the radiosensitivity of human pancreatic carcinoma cells. METHODS: In 3 pancreatic cancer cell lines, the expression of Mcl-1 mRNA was determined by RT-PCR assay, and the dose-dependent cytotoxicity of radiation was also assessed. Furthermore, the effects of adenovirus-mediated siRNA targeted against Mcl-1 on radiosensitivity of PANC-1 cells both in vitro and in vivo were evaluated. RESULTS: Pancreatic cancer cells showed various levels of Mcl-1 mRNA that were correlated with the radiosensitivity of tumor cells. AdU6/shMcl-1 significantly downregulated the expression of Mcl-1 gene in PANC-1 cells, the most radioresistant cell line. Furthermore, Mcl-1 downregulation could significantly enhance radiosensitivity of PANC-1 cells in vitro and in vivo. The mechanism might be correlated with apoptosis enhancement by activating celluar caspase-3. CONCLUSION: Mcl-1 might be a therapeutic target for radiosensitization of pancreatic carcinoma cells. Adenovirus-mediated siRNA targeting of Mcl-1 could enhance the radiosensitivity of pancreatic cancer cells both in vitro and in vivo, and thus might be a potential strategy for ameliorating cancer.

Laparoscopic vs conventional appendectomy for appendicitis / 中华普通外科杂志

Objective To compare laparoscopic appendectomy to conventional operation for the treatment of appendicitis.Methods In this study 1558 patients diagnosed as appendicitis were divided into group A(laparoscopic appendectomy)and group B(conventional operation)according to the random numbers.In group A,779 patients were treated with laparoscopic appendectomy.In group B,779 patients were treated with conventional open appendectomy.The inhospital data and that of followed-up were compared.Statistical analysis was carried out using SPSS11.5 for Windows.Comparisons between categorical variables and continuous variables were analyzed using the X~2 test and t test.Results The operation was successfully performed in all 1558 patients.The operating time in group A and B were(30±2.2)min versus(30±1.6)min(t=0.00,P>0.05),the blood loss were(15±2.9)ml versus(29±5.2)ml(t=65.62,P<0.05),the bed off activity time were(26±3.1)h versus(51±2.1)h(t=69.95,P<0.05),the bowels'move time were(29±1.6)h versus(52±4.6)h(t=10.92,P<0.05),the hospital stay were(3±0.9)d versus(7±1.2)d(t=74.42,P<0.05),the inhospital cost was (6591±41)yuan versus(4860±32)yuan(t=-12.19,P<0.05),the incision infection rate was 0 and 2.8%(X~2=25.40,P<0.05).Postoperative analgesics were needed in 3.8% and 31.4% (X~2=30.63,P<0.05).All the patients were followed-up from 4.5 years to 9.8 years(average 6.8 years).The development of incision hernia in group A and B was 0 versus 0.64% (X~2=5.01,P<0.05).Conclusions Laparoscopic appendectomy is a therapy of choice for patients with acute appendicitis with advantages of minimal invasion,early recovery,few complications and short hospital stay.

Laparoscopic subtotal thyroidectomy for Graves'disease / 中华普通外科杂志

Objective To study the safety and efficacy of laparoseopic subtotal thyroidectomy for primary hyperthyroidism.Methods From January 2003 to January 2007,seventy-five patients with primary hyperthyroisism underwent subtotal thyroidectomy,among which thirty patients by laparoscopic procedure and forty-five patients by open surgery.The clinical data were retrospectively analyzed.Results All the surgery were Successful.No patient in the endoscopic group was converted to open surgery.The mean operative times of endoscopic group and open surgery group were(110.5±12.3)min vs(98.8±15.5)min(t=3.46,P<0.05),the mean blood loss were(45.5±11.5)ml vs(65.8±12.6)ml(t=7.07,P<0.05),the inhospital fee were(11128.5±358.8)RMB yuan vs(6500.9±231.9)RMB yuan(t=67.92,P<0.05),the amount of drainage were(125.9±10.7)ml vs(46.5±9.4)ml(t=33.90,P<0.05),the days of drainage were(2.98±0.5)d vs(1.75±0.3)d(t=13.31,P<0.05),tlle use of analgeties was in 20.0%(6/30)vs 42.2%(19/45)(χ~2=4.00,P<0.05),the rate of temporary hoarseness wag 6.6%(2/30)vs 8.8%(4/45)(χ~2=0.12,P>0.05).There were 1 hypothyroidism and 1 recurrent hyperthyroidism in endoscopic group while 1 hypothyroidism and 2 recurrent hyperthyroidism in open surgery group after a 47.8 month's follow-up. Conclusions Endoscopic subtotal thyroideetomy for hyperthyroidism patients is safe,effective and presents a significant cosmetic advantage.

Laparoscopic thyroidectomy in the treatment of 12 patients with well-differentiated thyroid carcinoma / 中华内分泌外科杂志

Objective To evaluate the feasibility and efficacy of laparoscopic thyroidectomy in the treatment of thyroid carcinoma. Methods 12 patients with thyriod carcinoma treated with laparoscopic thyroidectomy from January 2003 to January 2006 in our hospital were analyzed retrospectively. Results All operations were successful and there were no surgical deaths. The postoperative complications included 2 cases of hoarseness, 1 extremity numbness and 1 temporary hypoparathyroidism. The number of dissected lymph nodes was from 0 to 13 with a mean of 7.6 nodes in each patient. Of the 12 patients, there was one patient with bilateral lymph nodes metastasis, 5 patients unilateral positive lymph nodes and 6 patients no lymph nodes involvement. The pathologic result of all 12 cases was papillary thyroid carcinoma. After 30 to 62 months' follow-up (average 50.4 months), all patient were still survive and no local recurrence or distance metastasis happened. Conclusion Laparoscopic thyroidectomy in the treatment of early papillary thyroid carcinoma is safe and feasible.

Comprehensive laparoscopic management for metastatic hepatoma / 中华普通外科杂志

Objective To study the efficacy of laparoscopic hepatectomy combined with Iodine-125 and radiofrequency ablation(RFA)in the treatment of metastatic hepatic carcinoma.Methods There were 124 patients diagnosed as hepatic metastasis detected by CT or MR scan, and were divided into two treatment groups. Group A(combined group of 41 cases)with laparoscopic excision,RFA and iodine-125 treatment and group B(control group of 83 cases)with transhepatic artery chemoembolization(TACE)and systematic chemotherapy.Results Nine new hepatic metastatic foci were found by laparoscopic ulstrasound during the operation in group A,and in this group,18 hepatic metastatic lesions located on the surface in 13 patients were removed,then RAF applied to the hepatic metastases,and iodine-125 planted in place,altogether 59 foci near to the porta hepatis or large vessels were treated by laparoscopic RFA and iodine-125 implantation.All patients were followed-up from 26 to 45 months(average 35.4 months).The total relief rate was 90.2% and 30.1 % in group A and B respectively(x~2=39.68,P＜0.05＝.The median survival time was 19 and 11 months in group A and B respectively(t=-9.74,P＜0.05＝.The survival rate at 1-,2-and 3-years was 80.5%,48.8%,24.4% and 54.2%,28.9%,9.6% in group A and B respectively (x~2=8.11,4.73,4.81,P＜0.05＝.Conclusions Laparoscopic excision,Iodine-125 implantation and radiofrequency ablation in the treatment of metastatic liver carcinoma is safe、effective,and this approach prolongs the patient's survival time.

Mesh free laparoscopic inguinal hernia repair / 中华普通外科杂志

Objective To study the efficiency of iaparoscopic inguinal hernia repair without the use of a mesh. Methods We used laparoscopic hernia repair without the use of a mesh in 92 cases of inguinal hernia. Results were compared with that of total extraperitoneal laparoscopic inguinal hernioplasty(TEP) in 91 cases from January 2001 to March 2004. Results The laparoscopic procedures were successfully performed in all the patients. In mesh-free and TEP group respectively the operating time was (21±4) min vs. (70±16) min (t=28. 01, P<0.05), hospital stay was (3.5±1.0) d vs. (4.8±1.2) d (t=7.96, P<0.05), average time off-bed was (1.0±0.5) d vs. (1.8±0.7) d (t=8.90, P<0.05), duration of pain was (1.0±0.5) d vs. (2.5±0.7) d (t=16.69, P<0.05), the expense was (4500±500) RMB yuan vs. (8000±820) RM B yuan(t=34.89, P<0.05), subcutaneous hematoma rate was 0% vs. 8.7% (χ~2=6.48, P<0.05). The 48 hour C-reaction protein level after the operation was (3.9±0.3) mg/dl and (8.8±0.5) mg/dl (t=80.48, P<0.05). All the difference was statistically significant between the two groups. All patients were followed up for 56.9±6.2 months. The recurrence rate was 0 and 2.1% (χ~2=0.51,P>0.05) respectively. Conclusions Mesh-free laparoseopie inguinal hernia repair is safe, cost-effective, as well as of much lower hernia recurrence.

125Ⅰ prevents local cancer recurrence after hepatectomy / 中华普通外科杂志

Objective To investigate the therapeutic effectiveness of residue liver embedding of iodine-125 on recurrence after hepatectomy in hepatocellular carcinoma patients. Methods In this study, 85 cases with resectable hepatocellular carcinoma were collected and divided into two groups randomly: intrahepatic embedding of iodine-125 group and control group. The serum values of T lymphocyte phenotypes (CD3 + CD4 + ,CD8 +), NK cells,TB IL, ALT, AST, AFP and MMP-9 were measured in all patients 1 day before and 7, 30 days after the operation respectively; B ultrasonic and CT were used to detect for intrahepatic dissemination and recurrence of HCC after hepateetomy. All patients were followed-up from 16 to 55 months (average 35.4 months). Results Surgery were successful in all cases. There were no difference in T lymphocyte phenotypes, NK cells, TBIL, ALT and AST between the two groups (P＞0.05). The serum values of AFP and MMP-9 were much lower in the intrahepatic embedding of iodine-125 group than the control group(P<0.05). In iodine-125 embedding group, the 0.5-, 1-year recurrent rates were 2.3%、6.9%, respectively, compared with 14.2% and 26.1%, respectively, in control group (all P<0.05). Conclusions Intrahepatic embedding of iodine-125 in HCC patients after hepatectomy decreases values of AFP, MMP-9 and local cancer recurrence rate in HCC patients after hepatectomy.

Capacity of colonizing to the liver after allografting of mesenchymal stem cells in rats / 中国组织工程研究

BACKGROUND: Meseuchymal stem cells (MSCs) have extremely strong self-duplication ability and multidirectional ifferentiation potential. When bone marrow stromal cells (BMSC) are isolated and cultured in vitro, implanted in vivo, the distribution and colonization are still unclear, which is concerned with whether BMSC can be usedas target cells in clinic.OBJECTIVE: To explore the capacity of colonizing to the liver after allografting of green fluorescent protein (GFP) labeled MSCs of rats by different approaches.DESIGN: Factorial design.SETTING: Department of General Surgery, Second People's Hospital of Guangdong Province, Postdoctoral Workstation of Sun Yat-Sen University;Department of General Surgery, Zhujiang Hospital, Southern Medical University; Department of Organ Transplantation, Third Hospital Affiliated to Sun Yat-Sen University.MATERIALS: The experiment was performed at the Staff Room of Pharmacology, Basic Department, First Military Medical University of Chinese PLA from January 2003 to December 2004. A total of 36 clean adult SD rats were selected and randomly assigned into 5 groups: CCL4 plus portal vein transplantation group (n=6), portal vein transplantation control group (n=6), CCL4 plus caudal vein transplantation group (n=6), caudal vein transplantation control group (n=6) and mixed group (n=12).METHODS: ① MSCs were obtained from rat marrow and labeled with GFP. After amplifying in vitro, MSCs suspension was implanted with thin needle, with the volume of 0.5 mL/100 g. ②CCL4 plus portal vein transplantation group: In 3 days before MSCs transplantation, the rats were administrated with 20 g/L CCL4 2.5 mL/kg by gastric perfusion every day. The dose was double at the first time. Labeled MSCs were implanted from portal vein. Portal vein transplantation control group: Before transplantation the MSCs were bred commonly, and the labeled MSCs were implanted from portal vein. CCL4 plus caudal vein transplantation group: In 3 days before MSCs transplantation, the rats were administrated with 20 g/L CCL42.5 mL/kg by gastric perfusion every day. The dose was double at the first time. Labeled MSCs were implanted from caudal vein. Caudal vein transplantation control group: Before transplantation the MSCs were bred commonly, and the labeled MSCs were implanted from caudal vein. Mixed group: On the basis of the former 4 groups, 2 rats were implanted with non-labeled MSCs; Another 2 rats fed with CCL4 for 3 days and normal feed were established, without MSCs transplantation. ③At days 3 and 7 after transplantation expression of transplanted MSCs in liver of rats of each group were examined with fluorescent quantitative PCR.MAIN OUTCOME MEASURES: ①Results of MSCs isolation, purification, in vitro amplification and phenotype identification, ②result of GFP-labeled MSCs, ③observation of growth of rats following allografting of MSCs, and ④result of quantitative identification of GFP positive DNA amount in hepatic tissues of each group.RESULTS: Totally 36 experimental SD rats were involved in the result analysis. ①Percoll gradient separating medium was applied to isolate bone marrow of rats. The obtained cells were transferred and amplified,and then mostly showed coincident shuttle shape. Cells did not express CD34 and CD45, but CD29, CD44 and CD90 of MSCs, which were noncommitted stem cells in non-differentiating status that were different from hemopoietic stem cells in bone marrow. ②The green fluorescent cells appeared 24 hours after MSCs transfection. From hour 48 to 72 the number of positive cells significantly increased, with strong intensity.The transfection efficiency was 20%-30% under high-power field, and most of the cells were with green fluorescence. But green fluorescent cells did not appear in the MSCs cells as control. ③After allografting of labeled or non-labeled MSCs of rats with different approaches, at day 1 the rats were listless with bad food appetite, less mobilization; At day 2mostly of them had normal diet and mood, but there was no significant difference in rats of each group. ④The rats in each group with the exception of mixed group had green fluorescent protein positive cells in liver at days 3 and 7. The number of green fluorescent protein positive DNA was higher in liver tissues in the CCL4 plus portal vein transplantation group and CCL4 plus caudal vein transplantation group than in the portal vein transplantation control group and caudal vein transplantation control group (P＜0.05).CONCLUSION: Duration and amount of stem cells colonizing in liver may be associated with liver injury, while not related to the implantation approach. In normal animals with uninjured liver the stem cells can colonize in liver, and the amount is associated with transplantation approach and post-transplantation duration.

Laparoscopic pull through proctectomy for rectal cancer / 中国微创外科杂志

Objective To study the efficacy of laparoscopic pull through proctectomy for the treatment of rectal cancer. Methods There were 60 patients colonoscopically diagnosed as having rectal cancer (3~12 cm from the anal margin). Laparoscopic pull through proctectomy was performed. The distal tumor-free margin was about 2 cm. Results All the operations were performed successfully, without conversions to open surgery. The operating time was 89~179 min (120?25 min), the blood loss was 48~147 ml (75?26 ml), the length of hospital stay was 5~12 d (8.3?1.5 d), and the hospitalization expenditure was 8 680~15 800 yuan (9 900?750 yuan). Follow-up observations in the 60 patients for 12~25 months (mean, 22.3 months) showed no intraabdominal hemorrhage, anal stenosis, or intestinal leakage. Fecal incontinence was not seen at 2 postoperative month. One patient was found local recurrence after 12 months and underwent a second laparoscopic resection. Conclusions Laparoscopic pull through proctectomy for rectal cancer is safe, effective, and minimally invasive.

Iodine-125 seed implantational radiotherapy combined with transcatheter arterial chemoembolization for hepatocellular carcinoma / 中华放射肿瘤学杂志

90 Gy . Tumor irradiation dose, the umber of tumor and liver cirrhosis were identified by Cox-regression analysis as independent predictors for survival. Two patients experienced CTC grade 1 acute hepatic toxicity and three patients experienced grade 3 acute hepatic toxicity. Two patients developed RILD. Nine patients experienced RTOG grade 1 acute gastrointestinal complication and one patient experienced acute gastrointestinal bleeding. Five patients experienced RTOG grade 1 leucopenia and five patients experienced grade 2 leucopenia. Conclusion Iodine-125 seed local radiotherapy combined with TACE is safe and effective for HCC. It is worth of further dose escalation study.

Application of median umbilical fold in laparoscopic repair of pediatric indirect inguinal hernia: Report of 105 cases / 中国微创外科杂志

Objective To study the effect and value of the application of the median umbilical fold in laparoscopic treatment for indirect inguinal hernia in children.Methods A total of 105 cases of pediatric indirect inguinal hernia(including 32 cases of incarcerated hernia, 25 cases of bilateral hernia,and 6 cases of recurrent hernia after open surgery) was treated with laparoscopic high ligation of the hernia sac and repair with the median umbilical fold from January 2004 to August 2005.The operation was performed through two or three trocars.Under laparoscopic visualization,the internal ring was identified for a purse-string suture.Then the median umbilical fold was sutured on the internal ring to repair the defect.Results The operation was successfully performed under laparoscope in all the 105 cases.The operative time was 10~25 min(mean,15 min) for unilateral hernia and 20~35 min(mean,25 min) for bilateral hernia.The intraoperative blood loss was hardly seen.The length of hospital stay was 2~3 days.The postoperative recovery was uneventful,without intestinal adhesion,infection,or hematoma of the scrotum.Follow-up observations in the 105 cases for 5~24 months(mean,18 months) found no recurrence.Conclusions Laparoscopic high ligation of the hernia sac and repair with the median umbilical fold is safe and effect for pediatric indirect inguinal hernia,with advantages of mini-invasion,simple performance,short operation time,low complication rate,and quick recovery.

Endoscopic surgery for thyroid diseases:Report of 98 cases / 中国微创外科杂志

Objective To investigate the clinical value of two kinds of endoscopic thyroidectomy for thyroid diseases.Methods Endoscopic thyroidectomy via breast approach or axillary approach was performed in 98 cases from December 2003 to August 2005.The subcutaneous space beneath the breast area and the subplatysmal space in the neck were bluntly dissected through a 5-mm incision.The CO_2 was insufflated at the pressure of 8~10 mm Hg to create an operative space.Three trocars were inserted.The dissection of the thyroid parenchyma and vessels was performed endoscopically by using an ultrasonically activated scalpel.The recurrent laryngeal nerve,the superior laryngeal nerve,and the parathyroid glands were preserved carefully.There were 1 case of lobectomy on one side and partial thyroidectomy on the other side,18 cases of unilateral lobectomy,12 cases of bilateral subtotal thyroidectomy,46 cases of unilateral subtotal lobectomy,and 21 cases of resection of thyroid mass. Results The operation was successfully completed in all the 98 cases,without conversions to open surgery.No complications were noted.The operative time was 69.1?29.0 min,the estimated blood loss was 37.9?10.6 ml,and the postoperative hospital stay was 3.5?0.7 days.The drainage tube was removed at 24~36 hours after operation.Two cases of thyroid cancer were followed for 24 months without recurrence.The remaining 96 cases were followed for 6~28 months(mean,16 months) without recurrence.Conclusions Endoscopic thyroidectomy via breast or axillary approach is feasible and safe,giving patients satisfactory cosmetic results.

Laparoscopic splenectomy with amputation of secondary structures of the spleen pedicel / 中国微创外科杂志

Objective To evaluate the value and clinical efficacy of amputation of secondary structures of the spleen pedicel for laparoscopic splenectomy(LS).Methods Twenty-one cases of idiopathic thrombocytopenic purpura(ITP) and 1 case of splenic cyst were given a 4-port laparoscopic splenectomy.After the spleen was mobilized,a non-traumatic forceps was used to clip the pedicel at the site 3~5 cm from the hilus of spleen for the control of hemorrhage.The serosa on the spleen pedicel was opened by using a harmonic scalpel.Then secondary structures of the splenic arteries and veins,one by one,were disconnected from without upward,double ligated with the Hem-o-lok clips,and severed with the harmonic scalpel.The spleen was placed into an extraction bag,broken into small pieces,and removed from the extraction incision.Results The laparoscopic splenectomy was successfully completed in all the 22 cases.The operative time was 75~180 min(mean,117 min),and the estimated intraoperative blood loss was 20~280 ml(mean,87 ml).All the patients got out of bed and began to take food at 1~2 days after operation. The length of postoperative hospitalization was 5~11 d(mean,5.6 d).There were 1 case of incisional subcutaneous hematoma and 1 case of subcutaneous emphysema.Follow-up for 1.5～52 months(mean,19.3 months) in the 22 cases revealed no surgery-related complications.Conclusions The amputation of secondary structures of the spleen pedicel is a relatively safe and effective measure for completing laparoscopic splenectomy.

A comparative study between laparoscopic and open appendectomy for acute appendicitis in children / 中国微创外科杂志

Objective To compare effects between laparoscopic appendectomy(LA) and open appendectomy(OA) for acute appendicitis in children.Methods A total of 95 children with acute appendicitis from July 2000 to July 2005 were given either LA(LA Group,n=50) or OA(OA Group,n=45).The surgical outcomes and curative effects were compared between the two groups.Results The operation was successfully completed in both of the groups.No bleeding,intestinal fistula,or stump appendicitis was seen.There was no difference in the operation time between the LA Group(38.8?17.4 min) and the OA Group(41.9?15.8 min)(t=-0.905,P=0.368).The time to first defecation was significantly shorter in the LA Group(26.4?7.2 h) than in the OA Group(39.7?8.8 h)(t=-8.094,P=0.000).Appendiceal perforation was found in 29 children in the LA Group and 26 children in the OA Group,without significant difference(?~2=1.633,P=0.983),but the incidence of wound infection was significantly higher in the OA Group(11 children) than in the LA Group(2 children)(?~2=8.381,P=0.004).A drainage placement was required in 3 children in the LA Group and 9 children in the OA Group,with significant difference(?~2=4.206,P=0.040).The LA Group had significantly shorter time to normal temperature(55.4?16.2 h) than the OA Group(77.8?30.6 h)(t=-4.522,P=0.000),shorter hospital stay(5.4?1.3 d) than the OA Group(13.4?6.5 d)(t=-8.520,P=0.000),but higher hospitalization costs(6 117.9?836.5 yuan) than the OA Group(4 528.6?527.1 yuan)(t=10.937,P=0.000).Conclusions Laparoscopic appendectomy is superior to open surgery for acute appendicitis in children because of its advantages of minimal invasion,little pain,early recovery,good cosmetic appearance,low complication rate,and short hospital stay.

Two-port endoscopic resection of benign mammary tumors: A report of 22 cases / 中国微创外科杂志

Objective To investigate the clinical feas ib ility of endoscopic resection of benign mammary tumors. Methods A total of 22 cases were detected as benign mammary tumors by molybdenum targe t X-ray examinations from March 2002 to August 2003, including 15 cases of fibro ma and 7 cases of cystoid adenoma. The tumor was 2~4 cm in diameter (mean, 2.8 c m). A two-port transaxillary endoscopic resection using the electrotome and harm onic scalpel was carried out. Results The resection was comple ted endoscopically in all the 22 cases. The operation time was 28~68 min (mean, 42 min). A drainage tube was maintained for 1 day. Except for 1 case of subcutan eous effusion, no skin necrosis and other complications happened. The patients r ecovered uneventfully and stayed in hospital for 2~4 d (mean, 3 d) postoperative ly. There were no scars on the breast. Conclusions Transaxilla ry endoscopic resection of benign mammary tumors is safe and feasible and gives good cosmetic results.

Laparoscopy for patients with an acute abdomen / 中国微创外科杂志

Objective To evaluate the efficacy and priority of laparoscopy in the diagnosis and treatment of acute peritonitis. Methods Clinical data of 133 cases of acute peritonitis diagnosed and treated under laparoscope between April 2001 and October 2004 were retrospectively reviewed. Results Of the 133 cases, there were 60 cases of gastroduodenal perforation, 15 cases of acute cholecystitis, 8 cases of gallbladder perforation, 2 cases of sigmoid colon perforation, 35 cases of acute perforated appendicitis, 3 cases of jejunal diverticulum perforation, 1 case of foramen of Winslow hernia, 4 cases of acute pancreatitis, and 5 cases of primary peritonitis. The diagnostic accuracy was 100%. All the patients were treated laparoscopically without complications. Conclusions Laparoscopy gives a high diagnostic accuracy for acute peritonitis. The rationale for the use of it lies in the possibility of avoiding time- consuming preoperative B-ultrasonography or CT scans and performing minimally invasive surgical interventions directly.

Totally Extraperitoneal Technique for Complex Inguinal Hernia Repair:Report of 42 Cases / 中国微创外科杂志

Objective To evaluate the clinic efficacy of laparoscopic totally extraperitoneal technique in complex inguinal hernia repair. Methods Totally 42 patients with complex inguinal hernia were repaired by laparoscopic totally extraperitoneal technique in our hospital during July 2004 to June 2008. Among the cases,18 patients had bilateral indirect inguinal hernia,8 had unilateral indirect and direct inguinal hernia,5 suffered from indirect inguinal hernia at one side and direct inguinal hernia in the other side,4 patients showed bilateral direct inguinal,3 showed bilateral indirect inguinal hernia and unilateral direct inguinal hernia,2 had bilateral direct inguinal hernia and unilateral indirect inguinal hernia,1 patient showed indirect inguinal hernia complicated with femoral hernia at the same side,and 1 patient had indirect and direct inguinal hernia at the both sides.During the operation,a 10-mm incision was made at 15 mm below the umbilicus reaching the Hunter's line,to place the laparoscope and separate the extraperitoneal space.Afterwards,two 5-mm trocars were inserted and then extraperitoneal pneumorperitoneum was established involving the retropublic space extending up to the anterior superior spine,so that to return the complex hernias.A polypropylene patch was then used to cover the pubic foramen and Hesselbach triangle. Results TEP was successfully completed in all of the 42 patients with a mean operation time of 85-165 min (mean,107.3 min) and estimated intraoperative blood loss of 10-20 ml. Scrotum aerocele was detected in all of the cases during the operation. The patients received normal diet in 2 days postoperation. They were discharged from our hospital in 7 to 9 days (mean,7.6 days). Follow-up was achieved for 3 to 32 months (mean,15.3 months) in all of the patients,during the period,2 patients showed recurrent direct inguinal hernia,and 5 had mild paraesthesia in the lower abdominal wall. Conclusions TEP is safe and effective for complex inguinal hernia.