The clinical value of early postoperative enteral nutrition in patients with cholangiocarcinoma / 中国医师杂志

Objective To compare the clinical value of early enteral nutrition and parenteral nutrition therapy in postoperative patients of cholangiocarcinoma.Methods 56 cases of cholangiocarcinoma patients were randomly divided into early enteral nutrition group (EPN group) and parenteral nutrition group (PN group).All patients received nutritional support on the basis of metabolic support.Leukocyte count and neutrophil percentage decrease rate,total bilirubin decrease rate and hepatase (valley-C conversion) were counted at 3 and 7 days after operation.The decrease rate of aminase and glutamic oxaloacetic transaminase,recovery time of intestinal function (anal exhaust and defecation),incidence rate of surgical site infection (abdominal cavity and wound),hospitalization time after operation,incidence rate of bile leakage and hospitalization cost were compared between the two groups.Results The recovery time of intestinal function [(51.2 ±4.4) h],the decrease rate of leukocyte count (0.438 7 ±0.191 5) and neutrophil ratio (0.179 5 ± 0.046 1),the decrease rate of bilirubin (0.502 5 ± 0.153 5),alanine aminotransferase (ALT) (0.688 1 ±0.113 3),aspartate aminotransferase (AST) (0.617 0 ± 0.178 8) and hospitalization expenses [(87 852.37 ±9 127.04)yuan] in EPN group were better than those in PN group [(72.0 ± 12.9)h,0.090 5 ±0.120 3,0.083 4 ±0.036 8,0.201 5 ±0.077 8,0.251 6 ±0.419 0,0.230 9 ± 0.437,(109 036.69 ± 7 949.71) yuan,P ＜ 0.05].However,the incidence of abdominal distension (42.31％) was higher than that of PN group (13.33％,P ＜ 0.05).The incidence of bile leakage (7.69％) was not significantly different from that of PN group (13.33％,P ＞0.05).Conclusions Early enteral nutrition has obvious advantages in postoperative recovery of patients with cholangiocarcinoma.

The clinical effect of Cold-Knife Conization in patients with early cervical cancer and its influence in the pregnancy outcome / 中国医师杂志

Objective To study the clinical effect of Cold-Knife Conization (CKC) in patients with early cervical cancer and its influence in the pregnancy outcome.Methods 40 early cervical cancer patients of adopting the CKC from January 2010 to September 2012 in our Department were selected as observation group.40 early cervical cancer patients without history of cervical conization were selected as control group.All patients were followed up for 8 to 36 months.Tumor recurrence,pregnancy and maternity history and pregnancy outcomes were recorded and compared between groups.Results In the observation group,32 cases were pregnant (the success rate of pregnancy was 80.0％),of which 4 cases were aborted and the delivery rate was 87.5％.In the control group,39 cases were pregnant(the success rate of pregnancy was 97.5％),no abortion was found,and the delivery rate was 100.0％.The pregnancy rate and delivery rate in the observation group were lower than those in the control group (P ＜ 0.05).There was no significant difference in delivery mode between the two groups (P ＞ 0.05).The observation group had 8 cases (28.6％) premature delivery,9 cases (32.1％) neonatal asphyxia,6 cases (21.4％) premature rupture of membranes,and the average weight of neonates was (2 842.17 ±48.99)g.The control group had 3 cases (7.7％) premature delivery,1 case (2.6％) neonatal asphyxia,2 cases (5.1％) premature rupture of membranes,and the average weight of neonates was (3 243.81 ±51.02)g.The perinatal premature birth rate,neonatal asphyxia rate and premature rupture rate of membranes in the observation group were higher than those in the control group,and the average weight of newborns was lower than that in the control group,with statistically significant difference (P ＜ 0.05).During the follow-up period,the recurrence rate of the observation group was lower than that ofthe control group [2.5％ (1/40) vs 17.5％ (7/40)],with statistical significant significance (P ＜ 0.05).Conclusions Although cold knife conization can reduce the recurrence rate of early cervical cancer patients,the fertility and pregnancy outcomes of patients after operation is greatly affected.Careful selection should be made in clinical treatment according to the actual situation.

A study on the safety of pneumoperitoneum performed under intravenous anesthesia during robotic rectectomy / 中国医师杂志

Objective The purpose of this study was to assess the safety of carbon dioxide pneumoperitoneum on patients during robotic rectectomy.Methods 50 patients [American Society of Anesthesiologists (ASA) physical status Ⅱ,18 and 65 years of age] underwent rectal cancer surgery were selected in our study.According to whether or not robotic assisted surgery was performed,they were divided into a robotic surgery group (group RS) and a laparoscopic surgery group (group LS) by surgical approach,25 patients in each group.All participants were given the same anesthesia protocol.Arterial blood samples 1 ml was obtained from the left radial artery for blood gas analysis to measure the partial pressure of arterial carbon dioxide (PaCO2) and and calculate the arterial-to-end-tidal carbon dioxide pressure difference (Pa-ETCO2) just 10 min after endotracheal intubation (T0),at 30 min(T1),1 h(T2),2 h(T3) after pneumoperitoneum and 30 minutes after release (T4).Meanwhile,the airway peak pressure was monitored.Blood samples (4 ml) extracted at T0,T3 and T4 were centrifuged and measured the serum levels of interleukin (IL)-6 and IL-10 by enzyme linked immunosorbent assay (ELISA).The time to resuscitation,extubation time,intraoperative medication and perioperative adverse events were all recorded.Results Compared with group LS,PaCO2 in the RS group was increased significantly at T1,T2 and T3 after pneumoperitonum and the IL-6 was lower at T4 (P ＜ 0.05).There were no statistically significant differences in Pa-ETCO2,airway peak pressure,IL-10,time to resuscitation,extubation time and the incidence of adverse events between the two groups (P ＞ 0.05).Conclusions It is safe for normal adult patients performed by intravenous anesthesia during robotic-assisted rectal surgery and the inflammatory response is small,which is beneficial to the patient's postoperative recovery.

The clinical application value of TACE combined with SPVE in the treatment of two stage hepatectomy / 中国医师杂志

Objective To investigate the clinical application value of liver transarterial chemoembolization (TACE) combined with selective portal vein embolization (SPVE) in the treatment of two stage hepatectomy.Methods From January 2010 to December 2013,120 patients with liver tumors who were not suitable for one stage hepatectomy admitted to our department were enrolled in this study.Among them,60 (control group) received TACE therapy and 60 (observation group) accepted TACE combined with SPVE treatment.The liver function,liver volume change,the second stage resection,survival rate,complication and adverse reaction were compared between the two groups after treatment,and the application value of the therapy was analyzed.Results All the patients were successfully completed the treatment.The aspartate aminotransferase (AST),alanine aminotransferase (ALT),and total bilirubin (TB) of the two groups were all recovered to the pre-treatment level on the 7th day after treatment,and there was no statistical difference between the two groups (P ＞ 0.05).Except for the 6th months,the survival rates of the observation group in 12th months,18 months and 24 months were all higher than those in the control group.The liver volume of the control group and the observation group increased to varying degrees,and the tumor volume showed varying degrees of atrophy.The residual liver volume (RLV) of the observation group was (527.29 ±58.69) cm3,which was increased and higher than the control group before the treatment (P ＜ 0.05).The implementation rate of the second stage operation was also higher than that of the control group (P ＜ 0.05).There were no serious complications in the two groups,and there was no significant difference between the two groups about adverse reactions (P ＞ 0.05).Conclusions The treatment of TACE combined with SPVE can effectively control tumor growth,increase RLV,so as to improve the resection rate and survival rate of patients with primary hepatectomy who can not undergo primary resection.

Study on the correlation between oxidative stress and pain after laparoscopic myomectomy / 中国医师杂志

Objective To investigate the correlation between oxidative stress and pain after laparoscopie myomectomy.Methods 84 patients with uterine myoma who were treated in Changsha Hospital of traditional Chinese Medicine from March 2014 to March 2017 were enrolled in the study.The patients were divided into the control group (n =42) and the observation group (n =42) according to the random number table method.The patients in the control group were treated with conventional laparotomy hysteromyoma expetion,and the patients in the observation group were treated by laparoscopic myomectomy.The levels of oxidative stress indexes [reactive oxygen species (ROS),malondialdehyde (MDA),advanced oxidation protein products (AOPP)] and pain indexes [interleukin-6 (IL-6),substance P (SP),prostaglandin E2 (PGE2) and visual analogue scale (VAS) score] were compared between two groups before operation,1 d after operation and 3 d after operation.Pearson correlation analysis was used to analyze the correlation between oxidative stress and pain.Results The levels of plasma ROS,MDA and AOPP in the two groups 1 d after operation and 3 d after operation were higher than those before operation (all P ＜ 0.05),the levels of plasma ROS,MDA and AOPP in observation group 1d after operation and 3 d after operation were significantly lower than in the control group (all P ＜ 0.05).The levels of serum IL-6,SP,PGE2 and VAS score in the two groups 1 d after operation and 3 d after operation were all higher than those before operation (all P ＜ 0.05),the levels of serum IL-6,SP,PGE2 and VAS score in observation group after 1 d and 3 d after operation were all lower than those in control group (all P ＜ 0.05).The results of Pearson correlation analysis showed that ROS,MDA and AOPP was positively correlated with PGE2 (P ＜ 0.05).Conclusions Laparoscopic myomectomy can effectively reduce the oxidative stress response to postoperative hysteromyoma and relieve postoperative pain,and oxidative stress is positively correlated with PGE2 after operation.

Endoscopic nasopharyngectomy for recurrent nasopharyngeal carcinoma: a review of 31 patients and analysis of the prognostic factors / 中国医师杂志

Objective To evaluate the efficacy of endoscopic nasopharyngectomy in the management of recurrent nasopharyngeal cancers (NPC) and to identify the prognostic factors.Methods Between september 2010 and october 2016,31 patients who received endoscopic nasopharyngectomy in our hospital for recurrent NPC were retrospectively reviewed.The clinical and pathological features of the patients,such as sex,age,T stage,pathological type,recurrence location,operation time,bleeding volume,perioperative complications,postoperative recurrence time,location and survival were recorded and analyzed,and the prognosis was observed.Results All patients underwent endoscopic resection of nasopharyngeal carcinoma locally,and no 1 cases received external nasal route surgery.All patients underwent successful endoscopic nasopharyngectomy.No patient was transferred to open approach.The mean operative time was (108.55 ± 34.36)min.The average blood loss was (23.05 ± 16.11)rnl.No serious postoperative complications occurred,no surgical deaths,and 1 cases had positive edge.Postoperative follow-up time was 3-82 months.During follow-up,29 cases survired,including that 9 patients survived with disease,1 patient concurrent oropharyngeal carcinoma,1 patient lost and 1 patient died.There were 6 cases of local recurrence,1 cases of liver metastasis and 2 cases of cervical lymph node metastasis after operation,2 patients with recurrent postoperative received endoscopic nasopharyngectomy and no recurrence of postoperative follow-up.One-year overall survival rate,disease-free survival rate and no local recurrence survival rate were 96.67％,80.00％ and 86.67％ respectively.Five-year disease-free survival rate was 61.80％.The progression free survival time was 2-82 (31.87 ± 23.26) months.Multivariate analysis showed that sex,age,first diagnosed T stage,and tumor necrosis were not the independent prognostic factor for survival in recurrent nasopharyngeal carcinoma patients.Conclusions Endoscopic nasopharyngectomy is a safe and effective procedure for the treatment of recurrent nasopharyngeal carcinoma.

Effects of intravenous anesthesia with sufentanil combined with propofol on hemodynamics and oxygen metabolism in patients with esophageal cancer under high altitude / 中国医师杂志

Objective To investigate the effect of intravenous anesthesia with sufentanil combined with propofol on hemodynamics and oxygen metabolism in patients with esophageal cancer under high altitude.Methods 60 patients with esophageal cancer radical surgery was selected from March 2015 to March 2017 in our hospital and were divided into two groups according to the random number table,30 patients in each group.Patients in the control group were given with fentanyl and propofol intravenous anesthesia,and patients in the observation group were given sufentanil combined with propofol anesthesia.The occurrence of restlessness during the recovery of anesthesia in the two groups were observed,the spontaneous breathing recovery time,extubation time and postoperative Mini-mental State Examination (MMSE) score were recorded,and the indexes of hemodynamics and oxygen metabolism were measured at the time of before induction of anesthesia (T0),tracheal intubation (T1),skin incision (T2),thoracotomy (T3),free esophagus (T4),esophageal catheter removal time (T5).Results The spontaneous respiration recovery time and extubation time of the observation group were significantly shorter than those of the control group (P ＜ 0.05).The degree of restlessness in the observation group was weaker than that in the control group (P ＜ 0.05).Mean arterial pressure (MAP) in the control group at T2-T4 were significantly higher than those in T0 (P ＜ 0.05),but MAP and heart rate (HR) in the observation group at T1-T5 were significantly lower than those of T0 (P ＜ 0.05).Compared with T0 group,oxygen saturation (SpO2),oxygen saturation of mixed venose blood (SvO2) and oxygen delivery (DO2) at T1-T5 were significantly decreased (P ＜ 0.05),oxygen consumption (VO2) at T2-T4 was significantly increased (P ＜ 0.05),especially in the control group (P ＜ 0.05).The MMSE scores of the two groups were significantly lower than those before the operation (P ＜ 0.05),and the scores in observation group was significantly higher than the control group (P ＜ 0.05).Conclusions The intravenous anesthesia with sufentanil combined with propofol is more helpful in maintaining hemodynamic stability and oxygen metabolism balance than intravenous anesthesia with fentanyl combined with propofol and has little effect on postoperative anesthesia recovery and cognitive function.

The clinical value of comprehensive surgical staging in malignant ovariangerm cell tumors / 中国医师杂志

Malignant ovariangerm cell tumors (MOGCTs) is second only to epithelial tumor which often occur in young women and young women,with high malignancy and high mortality.Effective treatment is particularly important in clinical practice.The prognosis is improved for valid chemotherapy scheme foun ded in recent years.Surgery still play a crucial role in the therapy of MOGCTs no matter for the primary operation or re-operation.Since the 70s,the comprehensive surgical staging (CSS) has improved the prognosis in patients with malignant ovarian cell tumors.Retroperitoneal lymphadenectomy is an integral part of the complete staging in MOGCT.The paper discusses various aspects of the clinical value of comprehensive surgical staging in MOGCTs.

The Progress of repair and regeneration of tissue and organ in oncology plastic surgery / 中国医师杂志

With the development of modern medical technology,accurate resection of tumor and timely repair and repair of defective tissues and organs are important concerns in the field of tumor research.The precise excision of tumor,refers to the preoperative assessment of systemic and local detection based on detailed to personalized surgical planning,the use of precise operation in operation,ensure as much as possible while minimizing surgical trauma to patients after removal of the lesions,creating the optimal conditions of recovery for trauma patients.Repair and regeneration of defective tissues and organs refers to the deletion or damage of tissues and organs,and gradually resume its anatomical structure and function process under the action of a variety of cells,extracellular mechanisms and related regulatory factors.Then from the tumor resection,tumor resection and accurate regeneration after three point repair technology to change rapidly in the tissue of tumor plastic organ regeneration in tissue of origin.

Analysis of the effect of different pressure CO2 pneumoperitoneum on patients with laparoscopic gastrectomy / 中国医师杂志

Objective To compare the effect of different pressure CO2 pneumoperitoneum on hemodynamics and arterial blood gas in patients with laparoscopic gastrectomy.Methods 130 cases of patients with advanced or locally advanced distal gastric cancer in our hospital from June,2014 to December,2016 were selected and divided into three groups according to the random number table.The pressures of CO2 pneumoperitoneum were set at 6-8,9-11 and 12-14 mmHg in low pressure group,middle pressure group and high pressure group.The changes of heart rate (HR),mean arterial pressure (MAP),pH,partial pressure of oxygen (PaO2) and partial pressure of carbon dioxide (PaCO2) in three groups were measured before pneumoperitoneum (T1),60 minutes after pneumoperitoneum (T2),120 minutes after pneumoperitoneum (T3) and 60 minutes after discharge (T4).The complications of the three groups,such as abnormal intraoperative rhythm,hypercapnia,subcutaneous emphysema and air embolism were compared.Results Compared with T1,the HR and MAP of the three groups increased at T2,T3 and T4 points (P ＜0.05);The levels of HR,MAP and PaCO2 in T2,T3 and T4 points were higher in the middle pressure group and the high pressure group than that in the low pressure group at the same time point (P ＜ 0.05);There was no significant difference in pH value and PaO2 among the three groups (P ＞ 0.05);The incidence of central arrhythmia in the high pressure group was higher than that in the low pressure group and the middle pressure group (P ＜ 0.05).Conclusions The pressure of 6-8 mmHg CO2 pneumoperitoneum is conducive to maintain the hemodynamic stability of patients with laparoscopic gastrectomy and less impact on the PaCO2.

Observation on the changes of body metabolism and gastrointestinal function of patients with laparoscopic radical resection of colorectal cancer during the perioperative period / 中国医师杂志

Objective To observe the change situation of body metabolism and gastrointestinal function of patients with laparoscopic radical resection of colorectal cancer during the perioperative period.Methods 56 patients with colorectal cancer who were treated with radical resection in our hospital from May 2015 to July 2016 were selected as the research subjects.56 surgical patients were divided into control group (conventional open surgery group,28 cases) and observation group (laparoscopic surgery group,28 cases) by the random number table.The indexes of protein metabolism,lipid metabolism indexes and gastrointestinal function of surgical patients in two groups during the perioperative period were detected and compared.Results The protein metabolism indexes,lipid metabolism indexes and gastrointestinal function indexes of surgical patients in two groups before the surgery had no statistical significance (all P ＞ 0.05),while the protein metabolism indexes,lipid metabolism indexes and gastrointestinal function indexes of surgical patients in two groups after the surgery all had significant differences,and they were all better than those of control group (all P ＜ 0.05).Conclusions The body metabolism and gastrointestinal function indexes fluctuations of patients with laparoscopic radical resection of colorectal cancer during the perioperative period are smaller than those of open surgery,so the laparoscopic radical resection is more suitable to the patients with colorectal cancer.

Clinical value of intraoperative interorganizational targeted injection chemotherapy for Dixon operation of advanced rectal cancer / 中国医师杂志

Objective To explore the clinical value of intraoperative interorganizational targeted injection chemotherapy (IITIC) in Dixon operation of advanced rectal cancer (ARC).Methods From June 2013 to December 2013,53 patients who suffered from ARC and were treated by operation in our hospital were divided into group A and group B randomly.29 patients in group A were carried out Dixon operation and IITIC,while 24 patients in group B were carried out Dixon operation only.Serum levels of tumor necrosis factoroα (TNF-ot),carcinoembryonic antigen (CEA) and carbohydrate antigen 242 (CA242) were measured and compared for all the patients in perioperative period.Also,Serum levels of white blood cell (WBC),platelet (PLT),alanine aminotransferase (ALT),aspartate aminotransferase (AST) and creatinine (Cr) were measured and compared for all the patients in perioperative period.Postoperative anastomotic fistula,intra-abdominal hemorrhage,intra-abdominal abscess and death were observed and compared between group A and group B.Postoperative follow-up and survival analysis were carried out for patients in both groups.Results The serum levels of TNF-α,CEA and CA242 at each time point were significantly different both in group A and group B (P ＜ 0.05).Furthermore,The serum levels of TNF-α and CA242 were statistically different between group A and group B (P ＜ 0.05),while there was no statistically significant difference in the serum levels of CEA (P ＞ 0.05).The serum levels of WBC,ALT,AST and Cr were not statistically significant difference between group A and group B (P ＞ 0.05),while the serum levels of PLT were statistically significant difference (P ＜ 0.05).All of the 53 patients were not encountered anastomotic fistula,intra-abdominal hemorrhage,intra-abdominal abscess and death.According to survival analysis,the postoperative1-,2-and 3-year cumulative survival rates of the patients in group A were 93.1％,85.9％ and 71.1％,respectively,while those of the patients in group B were 91.5％,78.4％ and 61.0％,respectively.The median survival times of the Patients in group A and group B were 40.0 months and 39.0 months,respectively,the difference was not statistical significant (P ＞ 0.05).Conclusions It is safe and feasible to carry out IITIC in Dixon operation for ARC.IITIC can increase the treatment effect to operation of ARC,which also can improve patients' prognosis.

Study on the complications of radical vaginal hysterectomy for locally bulky cervical cancer patients / 中国医师杂志

Objective To analyze the complications of radical vaginal hysterectomy in patients with locally bulky cervical cancer.Methods All 258 patients of early cervical cancer (stage Ⅰ A2-Ⅱ A) selected in our hospital during the period of June 2011 to June 2016 undergoing radical vaginal hysterectomy and laparoscopic pelvic lymph node dissection were analyzed.All cases were divided into observation (locally bulky) and control (conventional) groups.Comparison analysis was performed for complications of the two groups and the influence of neoadjuvant chemotherapy on the complications of local bulky patients.Results The incidence of complications in the observation group was 26 cases (27.9％),higher than that in the control group of 28 cases (17.0％),the difference was statistically significant (P ＜ 0.05).The incidence of bladder injury (5 cases vs 2 cases) in observation group was significantly higher than that in control group (P ＜ 0.05).For patients with locally bulky early cervical cancer,the incidence rate of complications of the neoadjuvant chemotherapy group (15.8％) was significantly lower than the simple operation group (36.4％) (P ＜ 0.05).The incidence rate of ureteral injury in neoadjuvant chemotherapy group (0 cases vs 6 cases) was significantly lower than that in simple operation group (P ＜ 0.05).Conclusions Early cervical cancer patients with locally bulky (stage Ⅰ B2/ 1Ⅱ A2) had higher incidence of complications of radical vaginal hysterectomy,and neoadjuvant chemotherapy can reduce the incidence of surgical complications.

Preoperative spleen-liver volume ratio predicts the risk of liver cancer recurrence after hepatectomy / 中国医师杂志

Objective To explore the value of preoperative spleen-liver volume ratio (SLVR) for predicting recurrence of primary liver cancer after hepatectomy.Methods Clinical data of 86 cases of hepatocellular carcinoma undergoing hepatectomy were analyzed retrospectively from January 2009 to December 2014.According to the preoperative SLVR,these patients were divided into two groups:SLVR ＜ 0.8 group (low SLVR group) and SLVR≥0.8 group (high SLVR group).Patients were followed-up until June 2015.Cox ratio risk pattern analysis was used for the recurrent correlative factors.Results The 1-,3-,and 5-year survival rates were 95.5％,88.6％,and 81.8％ in the low SLVR group,and 73.8％,47.6％,and 40.5％ in the high SLVR group,respectively.The difference were statistically significant between two groups (P ＜0.05).Cox regression analysis revealed that SLVR≥0.8,AFP-L3％ ≥10％,the maximum diameter of the tumor ＞ 5 cm,and hepatic or portal vein tumor thrombus were independent predictors of poor disease-free survival after hepatectomy for hepatocellular carcinomas (P ＜ 0.05).Conclusions Preoperative SLVR≥0.8 is an independent adverse predictor of poor disease-free survival.

Correlation between cytoreduction outcome and staging of ovarian cancer with preoperative blood cell count / 中国医师杂志

Objective To investigate the relationship between cytoreduction outcome and staging of ovarian cancer with preoperative blood cell count.Methods The data of 148 ovarian cancer patients from January 2007 to June 2012 were analyzed retrospectively.Clinicopathological and blood cell count data were collected,and benign ovarian tumor group (n =96) as controls.Results Compared to the control group,there were significant differences in the number of white blood cells,neutrophils,lymphocytes,monocytes,platelets,neutrophil to lymphocyte ratio,and platelets to lymphocyte ratio in patients with ovarian cancer (P ＜ 0.05).The same results were also observed in advanced groups and early groups.While between optimal cytoreduction and suboptimal cytoreduction,there were significant differences in platelets,monocytes,neutrophil to lymphocyte ratio,and platelets to lymphocyte ratio (P ＜ 0.05).Conclusions The cytoreduction outcome and pathological staging of ovarian cancer are closely related to the preoperative blood cell count.Blood cell count is important for the identification of benign and malignant ovarian tumors,cytoreduction outcome and the prediction of pathological staging,and may be of significance to the monitoring and prognosis of the disease.

Effect of ultrasound-guided serratus plane block on efficacy of postoperative analgesia in patients undergoing radical mastectomy / 中国医师杂志

Objective To investigate the effect of ultrasound-guided serratus plane (SP) block on efficacy of postoperative analgesia in patients undergoing radical mastectomy.Methods From February 2012 to October 2016,sixty American Society of Anesthesiologists (ASA) physical status Ⅰ or Ⅱ patients scheduled for radical mastectomy under general anesthesia were randomly divided into two groups (n =30 each):SP block group (observation group) and control group.After induction of anesthesia,ultrasoundguided homolateral SP block was performed,and 0.375％ ropivacaine 20 ml was injected in observation group,while the equal volume of normal saline was used instead in control group.The patients received patient-controlled intravenous analgesia (PCIA) with sufentanil after operation in the two groups.The scores of prince henry pain scale (PHPS) were evaluated at 2,4,8,12 and 24 hours (T1,T2,T3,T4,T5) after operation.The consumption of sufentanil,propofol and remifentanil were recorded,meantime the times of successfully delivered doses (D1) and attempts (D2) within 24 h after operation were added up,calculating D1/D2.The adverse effects were also recorded.Results The scores of PHPS at T1 [(1.4 ± 0.6) scores vs (3.1 ±0.7) scores],T2 [(1.5 ±0.7) scores vs (2.9 ±0.9) scores],T3 [(1.7 ±0.6) scores vs (2.8±0.8) scores],and the consumption of sufentanil [(53.4 ± 16.8) μg vs (87.8 ±24.6) μg],remifentanil [(288.7 ±42.2) μg vs (376.5 ±61.7) μg] were significantly lower in observation group than in control group,while D1/D2 (0.89 ±0.13 vs 0.57 ±0.19) was higher (P ＜0.05).The incidence of adverse reactions was significantly lower in the observation group (0 vs 23.3 ％) (P ＜ 0.05).Conclusions Ultrasound-guided SP block reduces the consumption of perioperative opioids and enhances the efficacy of postoperative analgesia in patients undergoing radical mastectomy.

Three-dimensional versus two-dimensional imaging systems in thoracoscopic lobectomy for lung cancer in different year / 中国医师杂志

Objective To compare the clinical application of three-dimensional (3D) and two-di-mensional (2D) imaging systems in thoracoscopic lobectomy for non-small cell lung cancer ( NSCLC). Methods In 2014 and 2016, the patients with NSCLC undergoing thoracoscopic lobectomy with 2D or 3D imaging systems were performed by a single experienced surgeon. The baseline characteristics and perioper-ative data of the patients were collected and analyzed. Results In 2014, 19 patients underwent 3D thora-coscopic lobectomy and the other 23 patients underwent 2D thoracoscopic lobectomy. Compared to 2D thora-coscopic lobectomy group, 3D thoracoscopic lobectomy group had a significantly shorter operative time [(147.0 ±23.9)min vs (179.1 ±54.4)min,P=0.016], a smaller volume of intraoperative blood loss [(142. 1 ± 69. 3)ml vs (203. 0 ± 90. 4)ml,P=0. 018]. In 2016, 36 patients underwent 3D thoracoscopic lobectomy and the other 32 patients underwent 2D thoracoscopic lobectomy. No significant differences were found between two groups in terms of preoperative indicators. Conclusions To some extent, 3D thoracos-copy reduces the operation difficulty, shortens the operative time and reduces intraoperative blood loss. However, with the accumulation of surgical experience, 2D can effectively compensate for the disadvantages of thoracoscope.

Clinical application of the da vinci robotic system for lung cancer / 中国医师杂志

For early-stage lung cancer,the treatment is given priority to surgery.As a new approach of minimally invasive surgery,three-dimensional and high definition view,and better dexterity robotic platform and tremor filtering system are the main advantages of da vinci robot compared to video-assisted thoracic surgery.In recent years,the technique of robot surgery has become more and more mature and has already been used in the treatment for lung cancer.However,its safety and postoperative outcomes should be evaluated in detailed.As a consequence,the comparison of robotic,video-assisted thoracic surgery and thoracotomy surgery for lung cancer has become a hot spot in recent clinical research.

Short-term outcomes of robot-assisted esophagectomy / 中国医师杂志

Objective To investigate our early results of robot-assisted esophagectomy (RAE) and present our learning curve experience with the largest study from one-single institution of China.Methods Between November 2015 and April 2017,a series of consecutive patients undergoing RAE at Shanghai Chest Hospital were reviewed.The patients'demographics,operative and postoperative outcomes were demonstrated.Results A total of 154 patients underwent RAE during the study.All patients received Mckeown esophagectomy and extensive thoraco-abdominal two-field lymph node dissection.Of these,122 were male and 32 were female.The mean total operative duration was 179-445 (271.0 ±61.5) min and the operative duration of the thoracic phase was 51-142 (96.7 ± 27.0)min.The mean estimated blood loss was 100 -1 000 (230.4 ±74.4)ml.The pathological results showed that 150 had squamous cell carcinoma,2 had adenocarcinoma,and 2 had small cell carcinoma.The R0 resection was 92.2％.The mean number of lymph node dissection was 11-64 (20.4 ± 8.5) and the lymph node sampling rate along left and right recurrent laryngeal nerve (RLN) were 92.2％ and 88.3％.The morbidity was present in 64 of 154 patients (41.6％).The major complications rate was anastomotic leak (12.3％),and vocal cord paralysis (16.9％).Intensive care unit (ICU) hospital stay time was 0-27 (2.7 ± 3.6) d,the median length of hospital stay was 7-81 (15.8 ± 11.6)days.There was no 90-day mortality.Conclusions RAE is a safe and feasible alternative for treatment of esophageal cancer.RAE can improve the efficacy of lymph node dissection,especially for the lymphadenectomy along recurrent laryngeal nerve.

The preliminary study on the effects of preoperative depression condition in patients with breast cancer on the efficacy of intravenous analgesia with dezocine and the serum level of 5 hydroxytryptamine / 中国医师杂志

Objective To explore preliminarily the effects of preoperative depression condition in patients with breast cancer on the efficacy of intravenous analgesia with dezocine and the serum level of 5 hydroxytryptamine.Methods Sixty patients with breast cancer were assessed with Hamilton depression scale (HAMD).The total patients were divided into three groups according to HAMD scores,including normal group (26 cases),suspicious group (22 cases),and depression group (12 cases).The postoperative analgesia was facilitated with patients intravenous control analgesia with dezocine and the postoperative pain was assessed by visual analogue scale (VAS) at 2 hours,12 hours,and 24 hours.Yhe serum concentration of 5 hydroxytryptamine was measured by enzyme-linked immunosorbent assays before anesthesia,2 hours after surgery beginning,and 24 hours after surgery.Results The postoperative VAS at 12 hours and 24 hours in suspicious group and in depression group were higher than those in normal group (P ＜ 0.05).There was no statistical difference between depression and suspicious groups (P ＞ 0.05).The serum concentrations of 5 hydroxytryptamine in three groups increased obviously at 2 hours after surgery beginning (P＜0.05),and then decreased at 24 hours postoperation.The serum concentrations of 5 hydroxytryptamine in suspicious group and depression group at three measurement point were significantly lower than those in normal group (P ＜0.05).The serum concentrations of 5 hydroxytryptamine in depression group at three measurement point were significantly lower than those in suspicious group (P ＜ 0.05).Conclusions Under this preliminary study condition,the preoperative severity of the depression in patients with breast cancer may affect the analgesia effect of patients intravenous control analgesia with dezocine and maybe have some relationships with serum levels of 5 hydroxytryptamine.