Objective Allograft Vasculopathy(AV), which limits the function and long-term survival of transplanted organs, it is the most urgent problem need to be solved in the field of organ transplantation.Traditional vascular anastomosis requires excellent microsurgical techniques, it is difficult to carry out.To explore a simple and feasible AV model can provide ideas for clinical research.Methods We make vessel cannulas by using vein detained needles, pulling the thoracic aorta of donor rat in vessel cannula, both ends turned over and fixed,and then transplant it in recipient rat abdominal aorta.1, 4 and 8 weeks after transplantation, we take out of the transplanted arteries, HE stain, to observe the histomorphology and measurement the vascular intimal thickness.Results 38 of the 40 recipient rats healthy survival to the detection time points, the legs and tail can move freely, defecating and urinating normally.It is found that transplanted arteries concentric circles thickening, its histomorphology just like the AV by using HE staining.Conclutions The method of rats artery transplantation is simple and feasible, significantly shorten the time of abdominal aortic blocking, reduce surgical trauma, can improve the success rate and the reproducibility of operation.

Objective It is controversial to the surgical treatment of the DeBakey I aortic dissection.The purpose of the study was to summarize the clinical experience on total arch replacement combined with implantation of stented elephant trunk into the descending aorta for DeBakey I aortic dissection.Methods From June 2005 to March 2008,41 consecutive patients with acute(in 31)or chronic(in 10)DeBakey I aortic dissection underwent total arch replacement combined with implantation of stented elephant trunk into the descending aorta.The mean age was 57(27～76)years.Thirty-two patients were male.The procedure was performed under deep hypothermic circulatory arrest and selected cerebral perfusion.The stented elephant trunk was implanted through the aortic arch under deep hypothermic circulatory arrest.The stented elephant trunk was an 8～10 cm long self-expandable graft.Concomitant procedures included Bentall operation and total arch replacement in 24,Wheat operation and total arch replacement in 6,ascending aorta and total arch replacement in 11.Computed tomography was performed in every patient before discharge to evaluate the postoperative outcomes of the procedure.Results Cardiopulmonary bypass time was(168±32)min.The cross clamp time was(109±24)min and selective cerebral perfusion and the lowerbody circulatory arrest time wsa(31±11)min.The in-hospital mortality was 4.9%(2/41).One patient died of hemorrhagic shock and another died of multi-organ failure postoperatively.Fourteen cases suffered complications and 12 cases were cured.One case died of the cerebral hemorrhage after 4 months due to inappropriate anticoagulation during follow up.Conclusion Ascending aorta and total aortic arch replacement combined with implantation of stented trunk into descending aorta is a safe,effective and feasible way in closing the residual false lumen of the descending aorta with a low morbidity and mortality.This procedure might contribute to a better long-term outcomes of DeBakey I aortic dissection.

OBJECTIVE: To study the effectiveness of preserving laryngeal function for senile hypopharyngeal cancer patientsolder than 65. METHOD: The clinical data of 58 surgery cases of senile hypopharyngeal cancer patients more than 65 years old were colleted and analyzed. Thirty-one cases preserved the laryngeal function, while the rest did not. Perfect preoperative preparation was done before surgery. Surgical resection specimens were sent to frozen-section examination. When the negative incisal margin was confirmed, the defect was repaired by the appilication of local stitching, ribbon muscle flap, major myocutaneous flaps, split thickness skin and replacement of esophagus by stomach. Radical radiotherapy was used after surgery. Survival rate was calculated by the Kaplan-Meier method. Chi-square test was used to compare complications of the two groups. RESULT: The 3 years and 5 years survival rate for all cases were 48.3% (28/58) and 27.6% (16/58), respectively. For patients with laryngeal function preservation, the 3 years and 5 years survival rate were 51.6% (16/31), 29.0% (9/31), respectively. For cases without laryngeal function preservation, the 3 years survival rate and 5 years survival rate were 44.4% (12/ 27), 25.9% (7/27), respectively. The result showed no obvious difference in survival rate between two groups (P > 0.05). Surgery complication rate were 45.2% (14/31) and 40.7% (11/27), without obvious differences between the two groups (P > 0.05). CONCLUSION It is feasible for senile hypopharyngeal cancer patients to choose suitable operation based on their physical conditions and the tumor extension. The key issues include well perioperative treatment management, correct indications grasp, and intraoperative repair skills improvement.
Aged ; Humans ; Hypopharyngeal Neoplasms ; surgery ; Larynx ; Survival Rate

Objective To investigate the safe and effective method for laryngeal microsurgery in difficult la‐ryngeal exposure cases .Methods We selected 62 patients’ clinical data who had received laryngeal microsurgery with difficult laryngeal exposure and could not exposure by normal self -retaining laryngoscope between July 2012 and June 2015 .There were 42 cases of vocal cord polyp ,9 cases of the vocal cyst ,5 cases of the vocal amyloidosis , 4 cases of severe atypical hyperplasia of vocal cords and 2 cases of vocal cord high differentiated squamous carcino‐ma .We completed all kinds of laryngeal microsurgery to expose the glottis by adjusting the postures of patients ,in‐creasing the anesthesia depth ,using self -retaining laryngoscope with endoscopy which can be adjusted and pressing the throat .Results In 62 patients ,58 patients were successfully operated with adjustable self -retaining laryngo‐scope with endoscopy ,the success rate was 93 .55% .And 25 cases was exposed the glottis completely by increasing the anesthesia depth ,however ,when we increased the anesthesia depth ,there were 10 cases needed to combined with pressing the throat to expose .Five patients had retropharyngeal injure with different levels .One case with small jaw deformity of the vocal cord polyp surgery was not successful ,the success of electronic endoscopic under surface anesthesia surgery .The other one case with teeth unkempt and porcelain teeth and two cases of intraoperative frozen tip vocal cord cancer completed the operation of the open throat under the non trachea incision .Conclusion Most of difficult exposed laryngeal can be safely and effectively exposed through using the adjustable self -retaining laryngo‐scope with endoscopy while normal self -retaining laryngoscope can not .When necessary ,we can put 30°endoscope into the side channel of self -retaining laryngoscope to complete all kinds of laryngeal microsurgery .

OBJECTIVE: To systematically evaluate the efficacy and safety of harmonic scalpel in neck dissection. METHOD: Available literatures of PubMed, EMBASE, Cochrane Library, Google Scholar, CBM, CNKI, WangFang and VIP published before June 2014 were searched. Inclusion criteria and quality assessment were performed. All data were analyzed by using RevMan 5.2 software. RESULT: Fourteen studies including 632 cases were enrolled. Among them, 319 cases were in harmonic scalpel group and 313 cases in conventional resection group. Compared with conventional resection group, the harmonic scalpel group showed shorter surgery time(weighted mean difference [95% confidence intetval]: -28.01 [-36.83, -19.19], Z = 6.22, P < 0.01)and less intra-operative blood loss (weighted mean difference [95% confidence intetval]: -46.68 [-57.25, -36.12], Z = 8.66, P < 0.01). The number of cervical lymph nodes dissected and the incidence of postoperative chylous leakage were similar in both groups. CONCLUSION Using the harmonic scalpel in neck dissection was as efficient and safe as that of the conventional technique with the advantage of shorter time of surgery and less intraoperative blood loss.
Blood Loss, Surgical ; Humans ; Lymph Nodes ; Neck ; surgery ; Neck Dissection ; instrumentation ; Postoperative Period ; Surgical Instruments

OBJECTIVE: To discuss imaging characteristics of CT, MRI of tumors involving skull base in the parapharyngeal space,maximatily limit and improve the diagnosis rate of tumors involving skull base in the parapharyngeal space. METHOD: Thirty-one patients with tumors involving skull base in the parapharyngeal space treated in our department were collected and reviewed. All the patients have pathological diagnosis and were examined by CT and/or MRI. To explore shape of tumor, its relation with surrounding structures, CT shows density size and the MRI signal directly through retrospective analysis of imaging characteristics of CT, MRI. RESULT: In all the 31 cases, 19 tumors were schwannoma, 8 tumors were mixed tumor of salivary gland, 2 tumors were carotid body tumor. 2 tumors were nasopharyngeal carcinoma involving skull base. Schwannomas and salivary gland mixed tumor can be expressed as round or oval with periphery smooth, and had intact capsule. The tumors had necrosis, sac variable area. Pleomorphic adenoma are all derived from deep parotid. Schwannoma had clear boundary with deep parotid. The effect of cavum nasopharyngeal and cavum oropharyngeal is relevant to tumor sizes and locations. Imaging characteristics of CT, MRI for carotid body tumor show soft tissue mass with attenuation similar to that of muscle. CT enhancement scan show intense enhancement. MRI show imaging of flowing empty vein. Imaging characteristics of MRI for nasopharyngeal carcinoma involving skull base in the parapharyngeal space show oval mass with low density signal, T1WI enhancement scan show necrosis, sac variable area. CONCLUSION CT and MRI could provide the position, size, boundary of the tumor and its relationship with cervical blood vessels well, which were important to operation schemes. CT and MRI before operation are valuable to the treatment of PPS tumors.
Adult ; Female ; Humans ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Pharyngeal Neoplasms ; diagnostic imaging ; pathology ; Retrospective Studies ; Skull Base Neoplasms ; diagnostic imaging ; pathology ; Tomography, X-Ray Computed

Gastric cancer with hemorrhage and cerebral infarction is a serious complica-tion with poor prognosis in clinic. Although the incidence rate is extremely low, the fatality and disability rates are very high. In addition, the opposition in treatment between the two complica-tions increases the difficulty of clinical diagnosis and treatment. The authors report the diagnosis and treatment of a gastric cancer patient with hemorrhage and new cerebral infarction, in order to to provide reference for related treatments.

Objective: To discuss the effect of psychological nursing based on relaxation training for the psychological state in patients with impatced third molar removal surgery. Methods: A total of one hundred patients with impacted third molar removal surgery were selected from June 2015 to June 2017 in People's Liberation Army No. 105 hospital. According to the nursing method, all patients were divided into psychological intervention group and the control group, 50 cases in each group, the control group was given routine nursing intervention and the psychological intervention group was given psychological nursing intervention based on relaxation training. Results: The after intervention Corah's modified dental anxiety scale (6.3±1.2), Stouthard dental fear scale (62.9±6.5) scores and heart rate [(76.4±5.2) bpm], systolic blood pressure [(102.5±6.3) mmHg], diastolic blood pressure [(75.3±3.1) mmHg] levels of psychological group were significantly lower than those of the control group. The once removal success rate, intraoperative relaxation sense rate of psychological group were significantly higher than those of the control group, the teeth extraction time of psychological group was significantly lower than that of the control group, the difference was statistically significant (P=0.013, P=0.003). Conclusions Psychological nursing intervention based on relaxation training can effectively improve the mental state and stress state of patients with impacted third molar removal surgery, which is beneficial to the process of the surgery.

Objective:To share our exprience with the surgical management of pituitary macroadenoma and giant adenoma excision technique through the endoscopic transsphenoidal approach. Method:A retrospective analysis data of 27 patients with pituitary macroadenoma and giant adenoma surgery methods, postoperative complications and follow-up results. Result:All patients have no postoperative complications happened such as: nasal bleeding, intracranial hemorrhage, cerebrospinal fluid leak, blood sugar increased. Tumors invaded cavernous sinus in 5 cases, surrounded internal carotid artery in 2 cases, compressed optic chiasma in 7 cases and encroached optic nerve in 1 case. Postoperative vision decline occurred in 2 cases: 1 case recovered to the preoperative level after being taken out nasal stuffing and with conservative treatment, 1 case (preoperative visual acuity 0.1) restored light perception after conservative treatment. Postoperative diabetes insipidus occurred in 4 cases, and recovered in next week with corresponding therapy. Conclusion:Endoscopic endonasal transsphenoidal surgery is a safe and effective surgical technique.

Objective: To investigate the clinical efficacy of preoperative-, postoperative-radiotherapy and surgery for preserving laryngeal function in patient over 70 years of age with medial wall pyriform sinus cancer. Methods: Clinical data of 48 patients over 70 years of age with medial wall pyriform sinus cancer who received surgical treatment from January 2001 to December 2010 were retrospectively analyzed. Among them, 21 cases were given preoperative radiotherapy and surgery (R+ S). The radiation therapy dose was 45 Gy. And 14 cases′ larynx is preserved. In addition, 27 cases were given postoperative radiotherapy and surgery (S+ R). The radiation therapy dose was 65 Gy. And 10 cases had preserved laryngeal function. Survival rates were analyzed by the Kaplan-Meier method. Chi-square test was used to compare complications between two groups. Results: The larynx preservation rate in R+ S group [66.7% (14/21)] was significantly higher than that in S+ R group [37.0% (10/27), P<0.05]. The complication rate and decannulation rate in R+ S group were 42.9% (9/21) and 64.3% (9/14), respectively, showing no difference compared with those in S+ R group [37.0% (10/27) and 50.0% (5/10), respectively] (all P>0.05). The complication rates of patients with and without larynx preservation were 41.7% (10/24) and 37.5% (9/24), respectively, showing no difference between two groups (P>0.05). The overall 3-years and 5-years survival rates for all patients were 54.2% (26/48) and 35.4% (17/48), respectively. There was no significant difference in survival rates between R+ S [38.1% (8/21)] group and S+ R group [33.3% (9/27), P>0.05)]. In the R+ S group, the survival rates in patients with and without larynx preservation were 40.0% (4/10) and 29.4% (5/17), respectively, showing no significant difference between two groups (P>0.05). Conclusions It is secure and effective to choose the operation with laryngeal preservation for patient over 70 years of age with medial wall pyriform sinus cancer based on their physical conditions and the tumor extension. The preoperative- and postoperative-radiotherapy have the similar effect. Preoperative radiotherapy and surgery increases the laryngeal preservation rate.