Objective To compare the clinical efficacy of three different concentrations of ropivacaine combined with morphine and granisetron on postoperative patient controlled analgesia by epidural anesthesia.Methods Ninety postoperative patients were randomly divided into three groups with 30 cases each.The patients in group Ⅰ received 0.25% ropivacaine,in group Ⅱ 0.20% ropivacaine,in group Ⅲ 0.125% ropivacaine.Each group combined with morphine(6?g/ml) and ciranisetron(0.03mg/ml).The patients controlled epidural analgesia(PCEA) continually infused of 2ml/h.Motor block(in limb) was assessed with Bromage scale.Results Visual analogue scales(VAS) were observed at 6,12,24 and 48h postoperatively.Pain score was higher in group Ⅲ than that in group Ⅰ and Ⅱ.Motor block by Bromage scale was higher in group Ⅰ than that in group Ⅱ and Ⅲ.Each group had no anesthetic complication.Conclusion PCEA by 0.20% ropivacaine combined with morphine and granisetron can provide a good postoperative analgesia and have no significant motor retarded.It is worth popularizing.

Objective To observe the effects of different anesthetic techniques on T-lymphocyte subsets in patients with cardia cancer. Methods Thirty-two patients undergoing elective radical operation for cardia cancer who had been average assigned into two groups by random digits table, group Ⅰ :general anesthesia;group Ⅱ :epidural anesthesia combined with general anesthesia (16 cases in each group).Peripheral blood T-lymphocyte subsets were measured before induction, after anesthesia, end of operation, 1d,3 d after operation. Results CD3,CD4,CD8 and CD4/CD8 all decreased in two groups after anesthesia,end of operation and 1 d after operation than before induction (P < 0.05). The index almost returned to the baseline values at 3 d after operation in group Ⅱ [ (60.75 ± 4.22 )%, (39.65 ± 3.64)%, (25.90 ± 1.17 )%,1.57 ±0.15](P >0.05),while in group Ⅰ still lower [(55.83 ±5.20)%, (35.15 ±5.65)%, (23.00 ±1.03 )%, 1.47 ± 0.35 ](P< 0.05 ). The two groups ontrast had significant deviation at 3 d after operation (P<0.05). Conclusion Epidural anesthesia combined with general anesthesia can reduce depression of Tlymphocyte subsets induced by surgical trauma and anesthesia.

Objective To determine the effects of different anesthetic techniques on T-lymphocyte subsets in patients with esophageal carcinoma. Methods Forty patients were randomly assigned into general anesthesia group (group Ⅰ),or combined generae anesthesia with epidural anesthesia group(group Ⅱ). Peripheral blood CD3, CD4,CD8 were measured before induction ( T1 ), after anesthesia ( T2 ), end of operation ( T3 ), 1d ( T4 ), 3d ( T5 ) after surgery. Resolts CD3,CD4,CD8,CD4/CD8 decreased at T2 in the two groups. In group Ⅱ ,CD3,CD4,CD8,CD4/CD8 ratio almost returned to the baseline values at T4 ,while group Ⅰ did not. Conclusion Epidural anesthesia combined with general anesthesia can reduce depression of T-lymphocyte subsets induced by surgical trauma and anesthesia, and is the anesthetic tecnique of choice for cancer patients undergoing major operation.

BACKGROUND: Although the sternohyoid muscular valves are traditionally used as reparative material for functional reconstruction after partial laryngectomy, the late-term results are not so satisfactory.OBJECTIVE: To investigate the efficacy of using external layer mucoperiosteum valve of thyroid cartilage to repair the wound surface and reconstruct vocal function.DESIGN: A self-controlled observational trial using the patients as subjects.SETTING: Department of otolaryngology of a municipal hospital.PARTICIPANTS: A total of 57 patients with laryngocarcinoma were selected from the Department of Otolaryngology, Shantou Second People' s Hospital, from June 1998 to May 2004. Among them, there were 56 men and 1 woman who were aged 37 to 78 years with the average age of 60. 38 years and whose disease duration was two months to one year with the average of five months.METHODS: In the 57 patients with laryngocarcinoma, their external layer mucoperiosteum valves of thyroid cartilages in the affected side were preserved and inverted into laryngeal cavities, which were used to cover the wound surface and rebuild the vocal fold.MAIN OUTCOME MEASURES: The final outcome indices: changes in the symtoms and function and Karnofsky scores before and after treatment. Risk indices: adverse events and side effects.RESULTS: The operations on the 57 patients were successful. The incidence of respiratory tract obstruction and hoarseness in the patients before operation was 38.9% and 98. 1%, but 1.9% and 96. 3% after treatment. Karnofsky score was 40 and 70 before and after treatment, respectively. No complications of pharyngeal stricture occurred in the near and long term.CONCLUSION: Vertical partial laryngectomy and laryngeal reconstruction with mucoperiosteum valve are easy to operate. The recovery of the wound surface is good, phonation efficacy is satisfacory, and respiratory function is not affected. The treatment has low incidence of complications and satisfactory long-term results.

Objective To explore the etiopathogenisis of Reinke's edema. Methods To detect 15 samples of Reinke's edema of vocal cord mucosal and 5 samples of common vocal cord mucosal with S-P immunohistochemical method. Then to observe the effect of immunity class under the light microscope. To detect the expression of the VEGF and the production of the blood capillary in the sample of Reinke's edema of vocal cord mucosal with immunohisto-chemical method. Results There are 12 effects of sex in the 15 samples of Reinke's edema of vocal cord mucosal. There are effects of feminine in the 5 samples of common. Conclusion The main etiopathogenisis of Reinke's edema is that blood vessel grew ad libitum, the permeability of blood vessel increase and oxygen lack partly.