Objective To investigate the effect of the modified and controllable sigmoid colostomy in ostomy operation.Methods Sixty patients were divided into two groups.The control group (30 cases) received extraperitoneal sigrnoid colostomy while the experimental group (30 cases) received modified and controllable sigmoid colostomy.Postoperative complications caused by sigmoid colostomy,artificial anal function,psychological disorder,life quality,and the level of tumor marker between two groups were compared.Results In experimental group,4 patients (13.33％,4/30) at postoperative 6 months and 1 patient (3.33％,1/30) at postoperative 12 months suffered from complications caused by sigmoid colostomy.The incidence rate of complications caused by sigmoid colostomy was higher in control group[30.00％(9/30) and 10.00％(3/30)],but there was no significant difference (P ＞ 0.05).In experimental group,the defecate controllable and times were increased,18 patients (60.00％,18/30) could freedom control defecation,14patients (46.67％,14/30) defecation times ≤3 at postoperative 12 months.But there were 11 patients (36.67％,11/30) and 8 patients (26.67％,8/30) in control group,there was significant difference (P ＜0.05).The rate of human communication disorders,self abasement,anxiety and disappointment in experimental group at postoperative 12 months were significantly lower than those in control group (P ＜ 0.05).The rate of pessimism,loneliness and fear between two groups had no significant difference (P ＞ 0.05).In the evaluation of QLQ-C30 scale,aside from recognition function and financial straits had no significant difference(P ＞ 0.05),others scores in experimental group were significantly better than those in control group (P ＜ 0.05 or ＜ 0.01).In the evaluation of QLQ-C38 scale,the scores in experimental group at postoperative 12 months were significantly better than those in control group (P ＜ 0.01 or ＜ 0.05).At postoperative 12 months,the level of carcinoembryonic antigen,cancer antigen 125 and cancer antigen 199 in experimental group were significantly lower than those in control group (P ＜ 0.05).Conclusion The modified and controllable sigrnoid colostomy has the advantages,less complications,controllable,simple,safe and it is worthy of application more widely in clinical practice.

Objective:To investigate the diagnostic value of MRI and CT for the liver space-occupying lesions.Methods:The clinical data of 70 cases of patients with liver space-occupying lesions in our hospital from June 2012 to May 2016 were divided into two groups and retrospectively analyzed.35 cases underwent contrast enhanced ct scans (CT group),and others underwent dynamic contrast-enhanced MR imaging(MRI group).The pathological diagnosis,number of lesions and lesions diameter were ompared between two groups.Results:No significant difference was found in the pathological diagnosis,number of lesions(71 vs 70) and lesions diameter(2.25 ± 2.01 cm vs 2.19± 1.98 cm) between two groups(P＞0.05).As the gold standard by pathological diagnosis results,correct diagnostic rate of MRIgroup were 85.71％,which was 77.14％ CT group and lower than that of the MRI group,but no significant difference was found between two groups (P＞0.05).The incidence of adverse reactions in CT group was significantly higher than that of the MRI group (P＞0.05).Conelusion:Both CT and MRI enhancement scanning have higher diagnostic value for the liver space-occupying lesions,but MRI enhancement scanning has higher safety and tolerability.

Objective To investigate the effectiveness and safety of low-intensity warfarin anticoagulation in over 80-year-old patients with nonvascular atrial fibrillation (NVAF). Methods The 180 NVAF patients aged over 80 years were randomly assigned into 2 groups: 90 patients in lowintensity warfarin anticoagulation group (target value of INR 1.6-2.0), the other 90 patients in standard-intensity warfarin anticoagulation group (target value of INR 2. 0-3.0). All patients were followed up in outpatient-department for one year. Main outcome measures included the incidence rates of bleeding and thromboembolic events, and secondary outcome measures included the warfarin dosage and times of INR＞3.0. Results The incidence rate of thromboembolic events was 4.4% (4/90) in low-intensity group and 3.3% (3/90) in standard-intensity group with no statistically significant difference between these two groups (P＞0. 05). However, the incidence rate of hemorrhage was significantly lower in low-intensity group than in standard-intensity group [5.6% (5/90) vs. 16.7%(15/90), P＜0. 05]. Meanwhile the warfarin dosage was significantly lower in low-intensity group than in standard-intensity group [(1. 55±0. 63) mg vs. (2.31±0.57) mg, P＜0.05]. The times of INR＞3.0 were less in low-intensity group than in standard-intensity group (P＜0. 05). Conclusions Therapy with low-intensity warfarin anticoagulation in NVAF patients aged over 80 years may be equally effective as, but safer than that with standard-intensity warfarin.

Objective To observe the survival rate of free flaps and incidence of vascular crisis following the perforator flap transfer in end-to-side microvascular anastomosis compared with the traditional method and investigate the scientificity and practicability of this scheme.Methods From February, 2012 to October, 2013, 152 cases of free flaps (including superficial illiac circumflex perforator flap, lateral arm flap, peroneal perforator flap, and anterolateral thigh flap) were performed.The end-to-side anastomosis were performed in 72 cases while end-to-end anastomosis in 80 cases;All patients were followed up for 6-24 months.The occurrence of vascular crisis in all cases were observed and recorded.The results of the two groups were conducted statistical analyzed.Results The average anastomosis time for end-to-side anastomosis (21.3 ± 3.8 min) was significantly higher than the end-to-end anastomosis (14.4 ± 3.2 min) (P ＜ 0.05).The incidence of anastomotic vasospasm after end-to-side anastomosis (5.6％) was significantly lower than traditional method (16.3％) (P ＜ 0.05).There was no significant difference in the survival rate of the free flaps between the end-to-side anastomosis group (97.2％) and the traditional group postoperatively (96.3％) (P ＞ 0.05).Conclusion Although anastomosis times were increased in the end-to-side group, this technique showed lower spasm rate and similar flap survival rate.Therefore, this technique is a reliable and technically feasible method and should be considered first as a choice when facing vessel discrepancy and for preserving the recipient artery and vein system.

Objective To investigate the clinical effect of free posterior interosseous artery perforator flap combined with muscle fascia for repairing soft tissue and extensor tendon defect of hand.Methods Fifteen cases of hand skin soft tissue and extensor tendon defect admitted to Ningbo No.6 Hospital from December 2017 to December 2020 were repaired with free posterior interosseous artery perforator flap combined with extensor carpi ulnaris muscle fascia transplantation,and curative effect was observed.Results All flaps survived and patients were followed up for 6-24 months.The texture and thickness of the flap were satisfactory,and the recovery of the finger extension and flexion function were good.The excellent and good rate of hand tendon repair was 66.7%.In three cases with nerve anastomosis,the skin flap sensation recovered to S3.Conclusion The free posterior interosseous artery perforator flap combined with muscle fascia has a good clinical effect in repairing hand skin soft tissue and tendon defect.

Objective:To analyse clinical outcomes and risk factors of vascular crisis on patients received oral and maxillofacial defect repairations with free tissue flap.Methods:From January, 2013 to July, 2018, 1 049 patients with soft tissue defect of oral and maxillofacial were reconstructed with free tissue flap, in which 64 cases occurred vascular crisis. Among the cases, 28 defect were reconstructed with radial forearm free flap (RFFF), 19 with anterolateral thigh flap (ALTF), and 17 with fibula flap. All patients underwent surgical exploration. The clinical data and surgical outcomes were collected. The univariate analysis and multivariate regression analysis were performed by using SPSS version 22.0 software. The result was supposed to statistically significant when P<0.05. Results:Among 64 patients occurred vascular crisis, 44 flaps were rescued successfully by surgical procedures (68.8%). Univariate analysis revealed that the salvage rate was related to the smoking history, type of tissue flap, time of vascular crisis occurrence, cause of vascular crisis and the time interval between crisis occurrence and surgical exploration ( P<0.05). Multivariate regression analysis revealed that only type of tissue flap, the time of vascular crisis occurrence and the interval time were the independent significant factors for salvage rate ( P<0.05). Conclusion:The salvage rate became higher when the vascular crisis occurred earlier, and the interval time was shorter. The type of tissue flap could affect the outcome of surgical exploration. The success rate decreased with an order of RFFF, ALTF to fibula flaps. The primary principle in the management of vascular crisis was early identification and early surgical exploration.

Anticonvulsants/therapeutic use*