[Summary] The article reported 107 cases of bile duct residual stones treated by plasma shock wave lithotripsy with inverse flush under fiber choledochoscope via T-tube fistula.Of the 107 patients, stones were completely removed in 98 patients, and residual stones remained in 9.Intraoperative biliary hemorrhage occurred in 5 cases, which were stopped after spraying the norepinephrine . There were 4 cases of arhythmia , 13 cases of subcostal or upper abdominal pain , and 11 cases of abdominal distention and diarrhea , all of which were cured by symptomatic treatment .Postoperative biliary infection occurred in 7 cases, which were cured by anti-infection and biliary drainage.Except for 1 patient of lost of follow-up, 106 patients were followed for 6 months.Ultrasound and CT examinations showed free of calculus in 101 cases, and intrahepatic bile duct residual stones in 5 cases.We deem that plasma shock wave lithotripsy combined with reverse flushing under fiber choledochoscope is a minimally invasive , safe, and effective treatment for difficult biliary residual stones .

[Summary] The paper reported 9 cases of external type cesarean scar pregnancy treated with transvaginal local lesion resection between January 2013 and March 2014 in this hospital .The surgical exposure was established by using vaginal tractors .The cervical front lip was pulled below outwards by using cervical clamp to expose the front vaginal fornix .Hemostatic water was injected into the cervix vaginal clearance (epinephrine 0.5 mg +NS 500 ml).The vaginal mucosa was opened at bladder cervix groove level for entering the bladder cervix clearance .The bladder was seperated upwards and to the side with fingers to expose uterine isthmus lesions . After cutting the thin muscle , the embryos and part of necrotic tissues were extracted for pathological examination .The incision scar around tissues were trimed and a drainage tube was placed in the uterine .A myometrium full-thickness continuous suture was performed with 1-0 absorbable sutures ( paying attention to avoid endometrial tissues ) , and the vaginal wall was continuously sutured with 1-0 absorbable thread .The drainage tube was removed 5 days after operation .The operations were successfully accomplished in all the 9 cases.The average operation time was 65 min (40-90 min), and the average blood lose was 60 ml (40-80 ml).Cervical tube adhesion occurred in 1 case, and no complications were observed in the remaining cases .The average hospitalization time was 7.5 days (5-10 days).The postoperative time of menstruous restoration was 28-40 days.We deem that transvaginal resection of cesarean scar pregnancy lesion is simple and deserves clinical popularization .

Objective To introduce the surgical outcome of a combined laparoscopy and minilaparotomy hysterectomy (LMH) approach for the management of very large fibroid uteri. Methods From May 2011 to December 2013, 10 women underwent a combined laparoscopy and laparotomy hysterectomy for very large fibroid uteri ( larger than 1000 grams) .Among them, 6 cases combined with salpingo-oophorectomy. The patient characteristics, surgical data and clinical outcome are presented retrospectively.Briefly, this combined laparoscopy and minilaparotomy approach is to use the laparoscopy to perform a prior assessment of the ovaries, tubes, adhesions, sizes and positions of fibroids.A minilaparotomy wound of less than 6 cm is performed.Under the laparoscopic lighting and vision, coagulation of ovarian or uterine vessels can be performed via the minilaparotomy wound.Similarly round ligaments, tubes or ovarian infundibulo-pelvic ligaments can also be coagulated and divided using conventional open surgical instruments and technique.For very large fibroid uteri, tissue reduction by myomectomy is often necessary prior to a standard open hysterectomy for small sized uterus or to perform a subtotal hysterectomy to separate the large fibroid uterus from the cervix, the large uterus can be removed via the minilaparotomy wound with morcellation techniques as described previously in the literature. Results All hysterectomies were successfully completed without any intraoperative or postoperative complication.The mean operation time is 2 hours.All patients recovered well after operation and had an early discharge from hospital (1.5 -3 d). Conclusions This combined laparoscopy and minilaparotomy approach for hysterectomy can replace open abdominal hysterectomy for very large fibroid uterus more than 1000 g.It is a safe and feasible alternative to laparoscopic hysterectomy as a minimally invasive surgery.

Objective To explore the feasibility of a novel technique of anvil placement in combined use of laparoscopic and thoracoscopic Ivor Lewis esophagectomy. Methods From June 2011 to October 2012, we performed a novel technique of minimally invasive Ivor Lewis esophagogastrectomy in 20 patients with midthoracic esophageal cancer.The anvil was placed to connection with the esophageal stump under thoracoscopic vision, and an apical pleural stomach esophagus anastomosis was performed by using normal stapling. Results The mean operation time lasted for 200 minutes (150-300 minutes) with a mean blood loss of 180 ml (150-250 ml) without blood transfusion.The mean number of lymph nodes resected was 18 (12-44).No additional incision was required. There were no complications at post-operation and no anastomic leakage.The patient’s hospital stay lasted a mean of 10 days (8-12 days) .Follow-up reviews were conducted for 6 months and no recurrence was found in all the 20 patients. Conclusion Laparoscopic and thoracoscopic Ivor Lewis esophagectomy with novel technique of anvil placement for the treatment of esophageal carcinoma ensures the feasibility and safety.

Objective To explore the application of ultrasonography combined with hysteroscopy for the diagnosis of dated uterine false passage. Methods From May 2012 to May 2013, a total of 3437 cases were examined in the center by ultrasonic monitoring combined with hysteroscopic examinations.Dated uterine false passage was found in 4 cases.Under the guidance of ultrasonography, the hysteroscope was introduced into the uterine cavity.The ultrasonic probe was put at the site above the pubic symphysis for comprehensive examinations, with uterine distention fluid as reference. Results There were 2 cases of uterine anteversion and 2 cases of retroversion.There were 1 case of intracervical mouth stenosis, 1 case of intracervical mouth adhesion, and no intracervical mouth stricture or adhesion in 2 cases.The uterine false passage was located in the anterior wall in 2 cases and located in the back wall in 2 cases.The distance to serosal surface was about 3 mm at the thinnest place.The uterine false passage was 3-4 cm in depth. Conclusion Ultrasound monitoring combined with hysteroscopic examination can determine the part of the uterine endometrium line, improve the accuracy of diagnosis and treatment of intrauterine lesions.

[Summary] Postoperative cognitive dysfunction ( POCD) is a common central nervous system complication after anesthesia and surgery.The mechanisms of POCD are not clear yet.The article reviewed several potential mechanisms that have been reported. Further researches are needed to identify the pathophysiologic progress of POCD, which have great clinical and economic values.

Objective To assess patient ’ s fallopian tube function after laparoscopic salpingotomy for tubal ectopic pregnancy.Methods We observed the degree of pelvic adhesion and previous tubal patency by laparoscopic secondary exploration. The fallopian tube function were evaluated in 24 cases ( 26 fallopian tubes ) which had experienced laparoscopic salpingotomy. Results There were 4 cases of severe adhesions (16.7%), 4 cases of moderate adhesions (16.7%), 5 cases of mild adhesions (20.8%), and 11 cases of minor adhesions (45.8%).The status of fallopian tubes:tubal rapture and tissue absence were seen in 11 oviducts (42.3%), intact but obviously shortened oviduct with distal hydrops was seen in 11 oviducts (42.3%), and normal oviduct was recorded in 4 oviducts (15.4%).The methylene blue flow test was performed in the 26 tubes, showing 23 (88.5%) occluded and 3(11.5%) patent. Conclusions The fallopian tubes have incomplete shapes after laparoscopic tubal fenestration for ectopic pregnancy in most patients.We confirm that laparoscopic salpingotomy can not preserve the fertility effectively.

Objective To compare effects between laparoscopic operation and laparotomy in the treatment of acute colonic perforation, and to explore the safety of laparoscopic surgery. Methods A retrospective analysis was conducted on clinical data of 42 cases of acute colonic perforation treated in our hospital from January 2008 to December 2014, including 22 cases of laparoscopic surgery and 20 cases of traditional open surgery.The surgical treatment effects were compared between the two groups. Results As compared with the open group, the laparoscopic group had shorter operation time [(160.5 ±25.4) min vs.(210.3 ±45.6) min, t=-4.426, P=0.000], less amount of blood loss [(112 ±21) ml vs.(220 ±53) ml, t=-8.834, P=0.000], earlier enterostomy exhaust time [(4.2 ±1.2) d vs.(7.3 ±3.4) d, t=-4.016, P=0.000], less pulmonary infections [9.1% (2/22) vs.40.0%(8/20),χ2 =3.945, P=0.047], shorter total hospitalization time [(10.3 ±2.6) d vs.(15.6 ±2.4) d, t=-6.839, P=0.000], and lower costs of hospitalization [(2.26 ±0.45) ×104 yuan vs.(3.16 ±0.38) ×104 yuan, t=-6.966, P=0.000]. There was no significant difference in the perioperative mortality and wound infection rate between the two groups (P >0.05). Conclusion Laparoscopic surgery for acute colonic perforation has advantages of little surgical trauma, less bleeding, quick postoperative intestinal function recovery, low pulmonary infection rate, short hospitalization time, and low hospitalization costs, being an effective, safe, and feasible method worthy of clinical promotion.

Objective To compare clinical outcomes of percutaneous endoscopic lumber discectomy ( PELD ) versus minimally invasive transforaminal lumbar interbody fusion ( Mis-TLIF ) under the Quadrant system in the treatment of lumbar disc herniation. Methods From January 2010 to December 2013, 60 patients with lumbar disc herniation and failed to conservative treatment were enrolled in this study.According to the random number table, the patients were divided into two groups, with 30 patients in each group.There were no significant differences in age, gender, segment of disease, clinical diagnosis, and imaging results between the two groups (P >0.05).The surgery of PELD under the TESSYS endoscopic system or Mis-TLIF under the Quadrant system was performed by a same surgical team.Follow-up was conducted for 12-24 months (mean, 16.2 months).The operation time, blood loss, hospital stay, visual analogue scores (VAS) for back and leg pain, Oswestry disability index (ODI), Japanese Orthopaedic Association ( JOA ) scores, MacNab criteria, and complications were compared between the two groups. Results As compared with the Mis-TLIF group, the PELD group had significantly shorter operation time [(72.0 ±18.7) min vs. (137.0 ±48.3) min, t=-6.857, P=0.000], less intraoperative blood loss [(28.0 ±14.7) ml vs.(314.0 ±13.6) ml, t=-11.831, P=0.000], and shorter hospitalization stay [(4.0 ±1.0) d vs.(10.0 ±3.0) d, t=-9.298, P=0.000].The scores of VAS of back and leg pain at 2 weeks and 3 months postoperation in the PELD group was lower than the Mis-TLIF group (P<0.05). The scores of ODI and JOA at 3 and 12 months postoperation in the PELD group were superior to the Mis-TLIF group (P<0.05).No significant difference was recorded in the MacNab criteria at 12 months postoperation between the two groups (P>0.05).There wasno significant difference in complication rate between the two groups. Conclusions Both PELD and Mis-TLIF are safe and effective for lumbar disc herniation.PELD has smaller incision, shorter operation time, and less blood loss as compared with Mis-TLIF.

Objective To evaluate the effects of laparoscopic filling with pedicled greater retina for hepatic cysts. Methods Clinical data were reviewed on 36 patients with hepatic cysts undergoing laparoscopic filling with pedicled greater retina from January 2010 to May 2014.The diameters of cysts ranged from 10 to 26 cm, with a diameter smaller than 20 cm in 29 patients and bigger than 20 cm in 7 patients.Laparoscopic fenestration of hepatic cysts was performed to destroy cyst cells with iodine and absolute alcohol. Pedicled greater retina was used for filling the cavity of cysts. Results The procedures were completed smoothly.The operative time was 45-115 min, with an average of (80.4 ±13.1) min.No abdominal cavity infection happened.Primary healing of abdominal incision was achieved in all the patients.The postoperative hospital stay was 5-10 d, with an average of (6.4 ±1.2) d.All the 36 patients were followed up for 6-12 months with a mean of (9.3 ±1.5) months.None of the patients showed recurrence under liver B-ultrasonography or CT scanning. Conclusion Laparoscopic filling with pedicled greater retina for hepatic cysts has advantages of minimal invasion, quick postoperative recovery, short hospital stay, and good results.