Objective To evaluate the safety and feasibility of LC in patients with acute cholecystitis. Methods The authors retrospectively analyzed 145 cases of acute cholecystitis treated by LC from 1992～2000. Results All cases were successfully treated by LC, durations of operations being 30 to 130min with a mean 68min. Postoperative complications were found in 5 cases: Two patients underwent cystic artery bleeding, which was stopped successfully via laparoscope; the other three patients had bile leakage, bleeding of the greater omentum and subhepatic abscess, respectively, the first two cases being dealt with by open operations and the later by anti-inflammatory therapy. The success rate of LC was 96 6% (140 of 145). Conclusions LC may be applied successfully to the patients with acute cholecystitis within the first three days of incidence, after the gallbladder wall is proved ≤ 5mm by B-ultrasonography.

Objective:To investigate the causes, characteristics and treatment of maxillofacial trauma in children. Methods: A retrospective analysis of 470 consecutive maxillofacial records of the patients not older than 14 years was conducted. Data regarding age, gender, cause, anatomic site and treatment were reviewed. Results:Most of the patients were mals(335 cases, 71.3% ), with a male and female ratio of approximately 2. 5;1 of the injuries, 28. 5% were due to accidental falls, 17.0% traffic accidents and 10.0% sharp implementt cutting. Injuries of soft tissue often occurred on gingiva, cheek, lip and chin. Mandibuir fratures were the most common (55.1% ) of all bone fractures. Conservative therapy, such as closed reduction surgery, maxillomandibular fixation, was usually performed. Conclusion: ①Boys are more tendent to be victims of maxillofacial trauma than girls. ②Falls are the first cause of child victims. ③Gingiva, chin, lip, check and mandible are the most commonly injuried sites.

Objective: To investigate the method of using tubular demineralized tubular bone matrix scaffold composited with marrow stromal osteoblasts to fabricate tissue-engineered bone in vivo. Methods: Marrow stromal cells were harvested from illiac bone of 5 New Zealand rabbits respectively. After being cultured and multiplied in vitro, marrow stromal cells were induced to differentiate to osteoblasts with dexamethasone. The induced cells were harvested and mixed with 1.5% alginate sodium solution to generate a cell suspension. The suspension was dropped into tubular demineralized bone (1～1.5 cm in length, 0.2～0.5 cm in diameter) and then gelled with 2.5% CaCl 2. The demineralized tubular bone matrix/osteoblasts composites were placed in the dorsum of the rabbit subcutaneously as autogenous cells transplantation. Samples were investigated 6 and 12 weeks after implantation with histological and roentgenographic examination. Results: Osteoid tissue and new bone were observed in 4 weeks. In 8 weeks, more new bone formation, cells lied in the lacunae and arranged in order were found.Conclusion: Demineralized tubular bone matrix can be used as scaffold for the marrow stromal osteoblasts and alginate which was employed as three dimension carrier for cell growing and producing extral cell matrix.

ObjectiveTo evaluate the hemostatic effect of human thrombin in surgery.Methods A prospective, randomized, controlled and multicenter study was designed to evaluate the hemostatic effect of human thrombin on abdominal operation incision (96 cases) and liver wound (40 cases). Human thrombin was insufflated topically in study group, with 0 9% NS as control. Results The average hemostatic time of abdominal incision in study group was (104?70) s, hemorrhagic volume per square unit was (0 4?0 3)g/cm 2, in liver wound the average hemostatic time was (106?78) s, the hemorrhagic volume per square unit was (1 0?0 7) g/cm 2, the difference was all statistically significant ( P

Objective Several surgical procedures are available for treatment the prominent mandibular angle. But in some patients, only one procedure is not likely to obtain satisfactory results. This study was to evaluate the effect of curved osteotomy combined with sagittal splitting osteotomy of the mandibular angle by an intraoral approach for treatment the broad lower face. Methods 21 patients with broad lower face were treated with mandibular angle osteotomy plus mandibular angle splitting osteotomy under general aesthesia by intraoral approach. Changes of the distance between the mandibular angles were observed during follow up phase. Questionnaires were used to assess the patents level of satisfaction after operation. Results All the wounds healed without complications of bleeding and infection. After 7 months to 12 months follow up, the distance between the mandibular angles was effectively reduced, the deformity of broad lower face were improved markedly, the curve of the mandibular angle was smooth and the shape was natural. Conclusion This method is worthy to be applied widely because of the good result with effective reduction of the width of the lower face, smooth and gentle outline of the face.

Objective To summary the experience of laparoscopic cystectomy ileal conduit (Bricker) and orthotopic ileal neo‐bladder (Hautmann) and compare the short‐term efficacy of the two types of urinary diversion for invasive bladder cancer . Methods Retorspective analysis of the patients in our hospital who accepted laparoscopic radical cystectomy from 2010 to 2014 was performed ,74 of them accepted ileal conduit ,and 30 of them accepted orthotopic ileal neobladder .The general clinical data ,postop‐erative recovery ,postoperative complications and Oncology feature were analyzed and compared between the two groups .Results There was no demonstrable difference was found in operation time ,blood loss ,intraoperative blood transfusion rate ,the number of removed lymph node ,average hospital stay ,specimens positive margin rate and postoperative pathology results between the two groups (P>0 .05) .But there were significant difference in postoperative intestinal function recovery time[(4 .2 ± 1 .4)d ,(5 .3 ± 2 .2)d] ,(P=0 .002) ,and the complication rates 31 .9% (23 cases)vs .53 .3% (16 case) ,P=0 .043 .After 6 months ,the daytime and nighttime urinary control were 76 .9% ,57 .7% ,after 12 months ,the daytime and nighttime urinary control increased to 90 .9% , 81 .8% .2 cases(7 .7% ) were diagnosed with recurrence or metastasis during follow‐up in Hautmann group ,while 9 cases(14 .1% ) were diagnosed with recurrence or metastasis in Bricker group .Conclusion Two kinds of surgical procedures both have the similar therapeutic effect ,but the postoperative quality of life is better for Hautmann orthotopic neobladder patients .

Objective To evaluate the surgical treatment for renal cell carcinoma with inferior vena cava tumor thrombus and the clinical significance of multidisciplinary treatment. Methods Two cases of renal cell carcinoma with inferior vena cava thrombus diagnosed by Doppler ultrasonography and CT were included in this retrospective analysis. The tumor thrombus was in level Ⅱ in one case and in level Ⅳ in the other. Coagulation test and complete blood count were done again before surgery. Human albumin, fibrinogen, prothrombin complex, plasma, platelet, UW and irrigating solution were prepared before the operation.Under general anesthesia, surgery was performed using abdomen inverted Y shaped incision. Right radical nephrectomy was finished by the urological surgeon; the vena cava was completely dissected from the renal vein level to the secondary porta of the liver by the hepatobiliary surgeon, the vena cava and the surrounding branch vein were blocked in the upper and lower vena cava tumor thrombus; tumor thrombus was removed completely by the vascular surgeon. In one case (patient with level Ⅳ thrombus ) where the tumour thrombus invaded the wall of the vena cava, the thrombus was found to be extending to the cavo-atrial junction but not into the right atrium. The left femoral venous-right atrial bypass was established, the cardiopulmonary bypass lasted for 241 mia, and the aorta was blocked for 18 min. Salvage autotransfusion was used during surgery, and the hepatic vein of the secondary liver porta was anastomosed to artificial vascular graft.The data for surgical indication, operation time, operative blood loss and postoperative hospital stay were analyzed. Results Right radical nephrectomy and inferior vena cava thrombectomy were performed successfully, and the two patients were discharged on the 15th and 27th day after surgery, respectively. The two patients were followed up for 1 and 16 months after surgery, respectively, and both survived without local recurrence and distant metastasis. Conclusion Radical nephrectomy and inferior vena cava thrombectomy is the preferred method for patients without metastasis, and multidisciplinary cooperation could shorten the operation time, reduce the tumor recurrence and increase the survival rate of patients.

OBJECTIVETo study the effect of osteogenic inducer (dexamethasone, beta-sodium glycerophosphate and Vitamin C) carried by gelatin sponge on healing and remodeling of tooth extraction sockets.

METHODSFifty rabbits were selected. After extracting the first premolars of bilateral maxillary, the right side tooth extraction sockets were filled with gelatin sponge containing osteogenic inducer as experimental side, tooth extraction sockets on left side were filled with gelatin sponge as control. Every ten rabbits were executed at the end of 1, 2, 4, 8, 12 weeks after tooth extraction. Bone density was measured through digital X-ray images. The specimens were examined by histology. The absorption height of alveolar bone at 12 weeks was measured.

RESULTSX-ray measurement showed that the bone density of experimental side was higher than that of control side at 2, 4, 8, 12 weeks, the difference had statistical significance (P<0.01). The histology examination showed that new bone formation in tooth extraction sockets of experimental side was earlier than that in control side. The absorptional height of alveolar bone had significant difference between experimental side and control side (P<0.01), of which experimental side was less.

CONCLUSIONFilling the osteogenic inducer in tooth extraction sockets can promote the healing and new bone formation and prevent from alveolar bone absorption.

Objectives To screen the high-risk population of stroke in China using color Doppler flow imaging (CDFI)and to establish a stroke risk prediction model in Chinese population in order to prevent and treat stroke early. Methods Forty-one base hospitals and 715 286 people in the project areas of the first 6 provinces of China conducted routine physical examinations and investigated the related risk factors for cardiocerebrovascular diseases from July 2011 to April 2012 using a cross-sectional study,among them 61 860 patients underwent carotid CDFI screening,and 49 386 of them were high-risk population (exposed to≥3 risk factors). The bilateral common carotid interma-media thickness (IMT),the number of plaques and the degree of carotid stenosis were screened and documented. And whether carotid IMT thickening or not,with or without carotid plaques,and degree of carotid artery stenotic rate 0-49% and≥50% were performed by multivariate logistic regression analysis with the risk factors for stroke,respectively. Results (1)Logistic regression analysis showed that hypertension,atrial fibrillation,smoking,and lack of physical exercise were the independent risk factors for carotid IMT thickening (hypertension:OR,1. 17;95%CI 1. 12-1. 22;atrial fibrillation:OR,1. 15;95%CI 1. 09-1. 21;smoking:OR,1. 13;95%CI 1. 08-1. 17;and lack of physical exercise:OR,1. 12;95%CI 1.08-1. 16). (2)Hypertension,atrial fibrillation, smoking,and diabetes were the independent risk factors for carotid plaque and carotid artery stenosis rate≥50%(carotid plaque,hypertension:OR,1. 55;95%CI 1. 47-1. 62;atrial fibrillation:OR,1. 13;95%CI 1.06-1. 21;smoking:OR,1. 16;95%CI 1. 11-1. 22;and diabetes:OR,1. 30;95%CI 1. 24-1. 37). Carotid stenosis rate≥50%,hypertension:OR,1. 78;95%CI 1.55-2. 03;atrial fibrillation:OR,1. 59;95%CI 1. 39-1. 81;smoking:OR,1. 33;95%CI 1. 20-1. 48;and diabetes:OR,1. 30;95%CI 1. 17-1. 45. Simple obesity did not increase the incidences of carotid atherosclerotic plaque and carotid artery stenosis ≥50%(OR,0. 78, 0.83;95%CI 0. 75-0. 82 ,0. 75-0. 92,respectively). Conclusions Neck vascular ultrasound can be used as a valuable means for screening high-risk population and detecting risk factors of stroke. It has an important clinical significance for the early diagnosis and treatment of carotid atherosclerosis disease.

Objective To analyze the main causes for unplanned re-operation of pheochromocytoma (PCC) and explore the countermeasures on reducing the re-operation rate.Methods The clinical data of 6 patients with pheochromocytoma who underwent an unplanned re-operation were analyzed retrospectively between September 2011 and December 2016 in our hospital.There were 4 males and 2 females with a mean age of 46 years,ranged from 24 to 60 years.Only 1 patient had paroxysmal hypertension and headache,and the other 5 patients had no symptoms or atypical symptoms.Tumors of 3 cases were located in adrenal,and 3 were extra-adrenal PCCs.The average size of tumors was 5.25cm,ranged from 3 to 10 cm.Among the 6 cases,2 cases were diagnosed as PCC preoperatively and underwent adequate preparationwith stable hemodynamics during the first operation,who encountered post-operative bleeding soon after the surgery.Four cases were misdiagnosed,with poor preoperative preparation and operation was aborted.One case was misdiagnosed as bladder carcinoma and underwent transurethral resection.Results All 6 re-operations were performed by urologists.The main causes for unplanned re-operation were as follows:perioperative hemodynamic unstability (50％,3/6),post-operative bleeding (33.3％,2/6),uncertainty of surgical outcome (16.7％,1/6).Conclusions A precise diagnosis and an adequate preoperative preparation are the key to prevent a second-look surgery.An appropriate surgical approach and a complete surgical hemostasis could help lowering the re-operation rate.