Humans ; Laparoscopy

Since its first application for radical gastrectomy, laparoscopic surgical technique has been used for almost 20 years. Howev-er, given the complexity of the anatomic plane and vessels of stomach and the particular operation of laparoscopic instruments, lapa-roscopic lymph node dissection is still a difficult technique that requires experience. An appropriate approach is the key point to the success of laparoscopic lymph node dissection. On the basis of lymphatic drainage routes and anatomy of perigastric lymphatic sys-tem, different approaches are selected to dissect periodic gastric lymph nodes safely and radically. Surgery is performed according to the patient's position, surgeons' stance, and sequence of lymphadenectomy for laparoscopic gastrectomy and lymph node areas, such as suprapancreatic, cardial, and splenic hilar areas. In this article, we introduce different surgical approaches of laparoscopic radical gastrectomy with extended lymphadenectomy to provide information for surgeons who want to perform this surgery.

Splenic hilar lymph node must be dissected in D2 dissection for advanced upper gastric cancer.With the advances of surgical technology and updated treatment concept,spleen-preserving splenic hilar lymph node dissection has been widely accepted and gradually carried out by surgeons.However,laparoscopic spleen-preserving splenic hilar lymph node dissection has become a technical difficulty of laparoscopic surgery for gastric cancer due to complex anatomy of splenic hilar vessels and exposed difficulty in splenic hilar region,especially in obese patients.Surgeons not only have skillful laparoscopic techniques but also know anatomic characteristics of splenic hilar vascular well,and reasonable surgical approach and programmed surgical procedures can guarantee successful laparoscopic spleen-preserving splenic hilar lymph node dissection.Meanwhile,with the development of laparoscopic spleen-preserving splenic hilar lymph node dissection,there is also some disputes about lymph node dissection.

The reconstruction with harmstring tendons is the commonly therapic method for the anterior cruciate ligament (ACL) injury. The graft-implant fixation is important for the initial biomechanics stability and the graft-tunnel healing. The methods of fixation are variable, which can be classified by direct fixation and indirect fixation or by in-tunnel fixation and non-in-tunnel fixation. The interface screw, endobutton, cross pin and tendon knot are most commonly used in clinic. No fixation method is superior to all others, for every method has advantages and disadvantages respectively.

Objective To investigate individual variations of the femoral isometric poiIit of anterrior cruciate ligament(ACL). Methods The femoral isometric points(i)were determined by measuring the knee joint lateral projections in 100 adults.The distances from the femoral isometric point i to the posterior border of intercondylar notch were measured and compared among 4 age groups(20 to 30 y,30 to 40 y,40 to 50 y and>50 y)by 2 × 2 factor analysis and Student-Newman-Keuls (SNK-q)Analysis to determine the effects of age and gender on the measurements. Results The average distance was(10.6±1.55)mm,ranging from 15.05 am to 7.50 mm.The 2×2 factor analysis showed the differences were signifcant between age groups(F=2.843,P=0.042)and between sexes(F=4.245,P=0.042).but the age and sex factors were not interacted (F=0.456,P=0.7 14). The SNK-q Analysis revealed the differences were significant between the 20 to 30 y group and the 40 to 50 y group as well as the>50 y group(P<0.05),but not significant between the 30 to 40 y group and the 20 to 30 y group(P>0.05).No signifieant difference was observed between any two of the 30 to 40 y group,40 to 50 y group and>50 y group(P>0.05). Conclusion Since the ACL femoral isometric points vary from person to person,it is valuable to check them twice radiologically before and during the operation.

Objective To evaluate the risk of chondral injury during anterior cruciate ligament (ACL) reconstruction using a double cross-pin femoral fixation device via the anteromedial portal in Chinese cadavers. Methods Nine specimens of the knee (6 left ones and 3 right ones) were taken from 5 male and 4 female conservative cadavers of Chinese adult. The average age of the cadavers were 34.8 (26 to 45)years old. Femoral tunnel drilling and cross-pin guide insertion were performed using the Rigidfix Cross Pin device through the anteromedial portal. The ACL reconstructions were simulated at 3 entrance points of the cross-pin (0°, 45° and 90° relative to the horizontal plane) . The risks of chondral injury were statistically analyzed when the cross-pin entrance point was at the 3 different positions relative to the femoral chondral surface. Results The incidence of chondral injury was 100% when the Rigidfix cross-pin guide was at 90° relative to the horizontal plane. When the Rigidfix cross-pin guide was at 45° and 0° the incidences of chondral injury were 66. 7% and 22. 2% respectively. Conclusion Since there is always a risk of chondral injury when the Rigidfix cross-pin device is used to reconstruct ACL via the anteromedial portal, the anteromedial portal is not recommended for the ACL reconstruction using Rigidfix femoral fixation.

[Objective]To study the feasibility and short-term effects of the arthroscopic reconstruction of ACL with LARS artificial ligaments and quadruple hamstring tendon autograft usirg anatomical isometric technique.[Method]Arthroscopic ACL reconstruction was carried out in 20 patients with ACL injuries by using the LARS artificial ligaments and quadruple hamstring tendon autograft.Bone tunnels of the femur and the tibia were prepared with ACL anatomical isometric technique.20 patients were divided into LARS artificial ligaments group(11 patients) and quadruple hamstring tendon group(9 patients).The artificial tendon group was inserted into the tunnels and fixed with two interface screws after being tightened.Quadruple hamstring tendon group was fixed with endobutton plate.[Result]The operation time were 30～80 min(mean,56 min) in LARS artificial ligaments group and 80~120 min(mean,100 min) in quadruple hamstring tendon group.No postoperative complications such as synovitis and ligament rupture and movement restriction occurred iF two groups.A follow-up check up was made in the 20 patients for 6～12 months(mean,9 months).The Lysholm scores improved from a preoperative score of 22～65(36.72～15.54) to 80～98(90.45～4.68) at follow-up(t=10.535,P

[Objective]To investigate the feasibility and short-term effects of arthroscopic suture fixation with cannulated screw and washer for bony avulsion of the posterior cruciate ligament.[Method]Arthroscopic suture fixation with cannulated screw and washer was carried out in 30 patients with bony avulsion of the posterior cruciate ligament.The posterior cruciate ligament and avulsion bone fragment were held together with two Ethibond 5 polyester threads,which were first wrapped around the posterior cruciate ligament from the anterior to the posterior,and then tied behind the posterior cruciate ligament and over the bone fragment.The threads were pulled out through tibia tunnels,tighted and fixed on cannulated screw and washer under the tibia tunnels 2 cm.[Result]The operation time were 60-90 min.A follow-up was made in 10 patients for 6-12 months.All fractures were united without displacement at 6 weeks after operation.No postoperative complications occurred.The Lysholm scores were 83-95(89.6?4.03).[Conclusion]Arthroscopic suture fixation with cannulated screw and washer for bony avulsion of the posterior cruciate ligament technique is simple to perform and gives a satisfactory short-term results.

By the needle-warming moxibustion, 43 cases of diabetic vesical pathological changes,together with 43 cases in the control group, were treated for 30 days, to observe the times of urination,volume of urine and residual urine inside the bladder before and after treatment every day. It has been indicated in observation that needle-warming acupuncture therapy can decrease the time of urination every day, elevate the urine volume each time and decrease the residual urine in the bladder, with a significant difference (P＞0.05) in comparison with before the treatment.

Objective To observe the effects of indole-3-carbinol on neointimal hyperplasia and restenosis of rat artery after balloon injury and the possible mechanisms.Methods Balloon dilation was used to establish the neointimal injury model of left carotid artery in rats.Twenty Sprague-Dawley rats were randomly divided into single balloon dilation group(control group)and balloon dilation followed by indole-3-carbinol therapy group(therapeutic group).After balloon dilation,indole-3-carbinol(12.5,25,50 mg/d)was applied to the rats for 7 days respectively.The rats were killed two weeks after balloon dilation and the injured vascular specimens were harvested for pathologic examination and immunohistochemical staining.Results ①The neointimal thickness,neointimal area in the therapeutic groups were significantly less than that of the control group(P