Objective To investigate the value of laparoscopic operation in the diagnosis and treatment of closed abdominal injury.Methods Forty-seven cases of closed abdominal trauma were diagnosed and treated under laparoscope from December 2003 to July 2006.Under general anaesthesia or epidural anesthesia,an incision about 1 cm was made below the umbilicus.Then artificial pneumoperitoneum was established through an open tunnel or the veress needle(according to patient's condition).The camera was inserted through a trocar to clarify the diagnosis.If a confirmative diagnosis was not obtained,one or two additional trocars were inserted for further exploration. When the diagnosis was identified,another two or three trocars were inserted according to the location of lesions and corresponding treatment was performed based on pathogenetic condition.Results All the 47 cases were confirmatively diagnosed under laparoscope,including 15 cases of hepatorrhexis,13 cases of splenic rupture,9 cases of small intestinal rupture,3 cases of mesenteric injury,2 cases of pancreatic injury,2 cases of retroperitoneal hematoma,and 3 cases of intraabdominal multiple organ injury.Laparoscopic treatment was completed in 28 cases,a conversion to open surgery was needed in 17 cases,and conservative treatment was given in 2 cases of retroperitoneal hematoma.No surgical related death or complications happened.Conclusions Laparoscopy can be used in closed abdominal trauma to achieve a high diagnostic accuracy and to give a timely,effective,and proper treatment.

Objective To explore the cause and hemostasia for bleeding during endoscopic sphincterotomy (EST). Methods Clinical data of 90 patients undergoing EST and suffering from intraoperative bleeding in the Second Affiliated Hospital of Guangzhou Medical University between January 2013 and October 2016 were analyzed retrospectively. There were 48 males and 42 females with a mean age of (51±2) years. The informed consents of all patients were obtained and the local ethical committee approval was received. The bleeding part, bleeding cause and efficacy of different hemostasia in EST patients were obsesrved. Comparison of rates was conducted by Chi-square test. Results 72 cases were observed with definite bleeding points, including 51 cases' bleeding part was at the papilla 10-2 o'clock direction, 10 cases at 2-6 o'clock direction, and 11 cases 6-10 o'clock direction. 18 cases were observed with diffuse bleeding. The bleeding causes included inaccurate direction, excessively deep knife cut, excessively high knife bow,and excessively large incision. All patients were cured, including 40 cases of titanium clip hemostasis with a success rate 97%(39/40), 31 cases of electric coagulation hemostasis with a success rate 81%(25/31), 14 cases of thermal probe hemostasis with a success rate 71%(10/14), 10 cases of fibrin glue infusion with a success rate 7/10, 10 cases of 1:10 000 epinephrine sub-mucosal injection with a success rate 5/10, 6 cases of local compression with spherical sacculus, with a success rate 3/6, and 1 case receiving operative hemostatis. Endoscopic titanium clip hemostatis, electric coagulation hemostatis and thermal probe hemostatis had definite effects. The success rate of titanium clip hemostatis was obviously higher than electric coagulation hemostatis (χ2=11.813, P=0.008). Titanium clip hemostatis was particularly applicable to patients with exposed bleeding vessel, while electric coagulation and thermal probe hemostatis were applicable to patients with errhysis. Conclusion Duodenal papilla bleeding, as a common postoperative complication of EST, endoscopic titanium clip hemostatis, electric coagulation hemostatis and thermal probe hemostatis had relatively definite effects.

Objective:To study the complete genome characterization of Human Astrovirus (HAstV) in Shandong Province.Methods:Stool samples from acute flaccid paralysis (AFP) surveillance in Shandong Province from 2020 to 2022 were collected, and HAstV nucleic acid was examined by real-time quantitative PCR (qPCR). Next-generation sequencing (NGS) was conducted for the positive samples to obtain complete genome sequences and identify the genotype. Homology comparison and phylogenetic analysis were performed by using BioEdit and Mega software.Results:A total of 667 samples were examined by qPCR, of which 14 were HAstV-positive (2.1%), including HAstV-1 ( n=6), MLB1 ( n=6), MLB2 ( n=1), and VA2 ( n=1). The complete genome sequences were obtained from 11 samples. The six HAstV-1 sequences of this study had 98.2% to 99.9% nt similarities with each other and 87.6% to 98.6% with those from other regions. The four MLB1 sequences of this study had 99.1% to 99.9% nt similarities with each other and 92.2% to 99.4% with those from other regions. The VA2 sequence of this study had 96.0% to 96.3% nt similarities with those from other regions. Phylogenetic analysis based on ORF2 region showed that the local HAstV-1 sequences were most closely related to Japanese strains, and had distinct topology with phylogenies based on ORF1a and ORF1b regions. Conclusion:The complete genome sequences of 11 HAstV strains are obtained, and the VA2 complete genome is found.

ObjectiveTo investigate the clinical application value of early enteral nutrition after laparoscopic hepatectomy for hepatocellular carcinoma (HCC).MethodsA total of 49 patients with HCC undergoing laparoscopic hepatectomy in Sun Yat-sen Memorial Hospital of Sun Yat-sen University between November 2013 and June 2014 were included in this prospective study. These patients were divided into the enteral nutrition group and the parenteral nutrition group according to the random number table method. Twenty-five patients were divided into the enteral nutrition group, among them, 20 were males and 5 were females with the average age of (49±17) years old. Twenty-four patients were divided into the parenteral nutrition group, among them, 18 were males and 6 were females with the average age of (51±14) years old. The informed consents of all patients were obtained and the local ethical committee approval had been received. The patients in the enteral nutrition group were given Ensure nutrient solution orally 24 h after operation for 7 d and the patients in the parenteral nutrition group were given parenteral nutrition 24 h after operation for 7 d. The total human albumin supplemented volume, recover time of gastrointestinal function, length of hospital stay after operation and hospitalization expenses of the two groups were compared. The nutritional support associated complications were observed. The data of the two groups were compared usingt test or Wilcoxon rank-sum test.ResultsThe total human albumin supplemented volume after operation of the enteral nutrition group was (40±11) g, which was signiifcantly lower than (45±10) g of the parenteral nutrition group(t=-16.089,P<0.05). The recovery time of gastrointestinal function after operation of the enteral nutrition group was (25±8) h, which was signiifcantly shorter than (43±11) h of the parenteral nutrition group (t=-36.928,P<0.05). The length of hospital stay after hepatectomy of the enteral nutrition group was (8±2) d, which was signiifcantly lower than (10±3) d of parenteral nutrition group (t=-12.025,P<0.05). The total hospitalization expenses of the enteral nutrition group were RMB 45,000 (37,000-61,000) yuan, which were signiifcantly lower than RMB 49,000 (42,000-67,000) yuan of the parenteral nutrition group (Z=-18.495,P<0.05). Five patients in the enteral nutrition group and 8 patients in the parenteral nutrition group developed abdominal distention and diarrhea, which were alleviated by adjusting doses or infusion speed. ConclusionsEarly enteral nutrition after laparoscopic hepatectomy for HCC is beneifcial to the postoperative recovery of gastrointestinal function and may effectively reduce the ifnancial burden of patients. Moreover, its overall curative effect is better than that of parenteral nutrition.