Hypospadias repair is highly challenging especially for those severe or cripple variants.Correction via single stage or staged repair is controvercial whereas the controversies are with different content with advancement of hypospadiology.Here the authors introduce the contemporary concepts of staged repair for hypospadias.

Objective To explose the experimental basis of microchemoembolism therapy on colon carcinoma. Methods 12 dogs were randomly divided into two groups. Performing inferior mesenteric arterial and portal vein catheterization. Simple contrast medium and the contrast medium mixed with CH 44 (?10～20?m) for the angiograms were analysed under DSA. The concentration of 5 Fu in the protal vein were measured with Liquid Chromatography and in recorded diagramatic curve. The half life times of 5 Fu after simple arterial infusion chemotherapy or after microchemoembolism therapy were calculated and analyzed with t test(in Microsoft Excel 97). 5 minutes and 3 hours after the microchemoembolism therapy, embolized colonic segment were taken and observed under optic and transmission electron microscopy. Two weeks later, autopsy was performed. Results The opacificotion time of simple contrast medium after injection was 6.25?1.50 seconds. The arteries looked smooth. The vessels oppeared to show spasm and tortuous after perfusion of the same amount of contrast medium mixed with CH 44 particles associated with narrowing of te bronches the opacification time was 930?192 seconds, which was conspicuously dramatically different from the simple contrast medium. In the simple contrast medium group, the initial concentration of 5 Fu in the portal vein was rather high, then it attenuated rapidly. The mean half life time was 12.36?5.25 min. In the microchemoembolism therapy group, the initial concentration of 5 Fu was relatively lower. After injection, it increased for a little while and then decreased slowly. The mean half life time was 47.37?14.02 min, which was conspicuously different from that of the simple contrast medium group( P

Objective To study and analyze the cause, prevention and treatment for complications in patients with serious hypospadias repaired by one-stage urethroplasty. Methods From 1987 to 2002,275 patients with serious hypospadias were repaired by one-stage urethroplasty, there were 35 cases had complications. The classifications were penoscrotal 148 cases, scrotal 95 cases and perineal 32 cases. The lengths of new urethras were from 3.0 to 8.4 cm, the mean was (4.1?0.7) cm. Thirty-two cases were received endocrinotherapy before urethroplasty. Results The rate of complications was 12.7% for 1～3 years following survey. There were urethral fistulas 24 cases (8.7%),urethral strictures 6 (2.2%), diverticulums 3 (1.1%), chordees 2 (0.7%).The rate of urethral fistulas was the first and urethral stricture was the second, they were higher than those of other complications (P

Objective To observe clinical efficacy and explore clinical value of a modified procedure of double-stapling technique for mid-low rectal cancer.Methods Clinical data of patients undergoing laparoscopic anterior resection at the Department of General Surgery,the First Affiliated Hospital of Soochow University from February 2011 to February 2015 was analyzed retrospectively.According to the different ways in doing double-stapling technique,we divided patients into modified group (51 cases) and conventional group (74 cases).Parameters were compared between the two groups as general considerations,oncologic outcomes.Data were analyzed by SPSS 17.0 software packet,using t and x2 inspection.Results The difference of the general data of two groups was not statistically significant (P ＞ 0.05).Operation time in the modified group was longer than that of the conventional group [(169 ± 23) vs.(150 ±42)min,t =-3.150,P ＜0.05],but it had shorter drainage tube indwelling days [(7.9 ±2.9)d vs.(10.8±11.6)d,t=1.999,P＜0.05] and length of hospital stay after surgery [(10.0±3.6)d vs.(13.3 ± 13.7) d,t =1.025,P ＜ 0.05].The incidence of anastomotic leakage (2.0％ vs.18.9％,x2 =4.402,P ＜ 0.05) and tenesmus(3.9％ vs.17.6％,x2 =4.110,P ＜ 0.05) in the modified group was less than that of the conventional group.The difference in those areas was not statistically significant (P ＞ 0.05),such as intraopretive blood loss,per-anal exhaust time,consumption of liquid diet time,anastomotic bleeding,intestinal obstruction,reoperation for neostomy and infections.Conclusions Compared with traditional laparoscopic anterior resection,End-Corner anastomosis has the benefits of less postoperative anastomotic leakage and fewer low anterior resection syndrome.

Background and purpose:Anastomotic leakage and low anterior resection syndrome(LARS) are both common complications in dual-anastomosis for patients with low rectal cancer. The aim of this study was to observe and explore the signiifcance and role of vertical cutting of the closed distal rectum in dual-anastomosis for patients with low rectal cancer.Methods:A total number of 120 patients with mid-low rectal cancer who admitted to and completed laparoscopic rectal cancer resection in the Department of General Surgery, the First Afifliated Hospital of Soochow University from Feb. 2010 to Jun. 2014 were pair-matched into Groups A and B based on their gender,age, tumor size, the distance of lower edge to the dentate line and tumor staging, etc. For the 55 patients in Group A (observation group), the rectum distal end was closed vertically instead of horizontally while disposing “the ifrst intestinal anastomosis”, intestine-intestine anastomosis was conducted in an “end-corner” approach when dealing with “the second intestinal anastomosis”, upper corner (“dog ear”) of the closed line in the distal end of the rectum was removed, the lower corner (“dog ear”) of the closed line in the distal end of the rectum was removed using vascular occlusion clamp method, and the T-shaped interchanges (“dangerous triangle”) of stapled sutures formed after anastomosis were strengthened with absorbable suture. For the 65 patients in Group B (control group), laparoscopic dual anastomosis was conducted using conventional method, and the two “dog-ears” and “dangerous triangles” were kept without any treatment. The clinical outcomes of the two groups of patients were analyzed retrospectively. Results:In group A, It was convenient to complete the operation when the “dog ears” and “dangerous triangle” on the vertical line after cutting the closed distal rectum vertically by “end-corner” anastomosis. The axis of intestine formed a certain angle making the closed distal rectum into “ampulla” sample without “dog ears”. the “dangerous triangle” were strengthened with absorbable suture. In group B, The distal and proximal intestine located on the same axis after intestine-intestine anastomosis leaving two “dog ears” and a “dangerous triangle”. The general clinical data of patients in the two groups were comparable and not signiifcantly different (P>0.05). The two groups of patients showed no signiifcant differences in blood loss, postoperative drainage, postoperative anastomotic bleeding, anal exhaust time, and length of hospital stay (P>0.05). However, the operation time as well as the numbers of anastomotic ifstula occurrence, defecation, tenesmus and post-operation re-ostomy differed significantly (P<0.05).Conclusion:Vertical cutting of the closed distal rectum with dual anastomosis made the “new” intestine closer to the physiological bending and morphology of the rectum, meanwhile, it simpliifed the approach of removing “dog ear” and strengthening “dangerous triangle”, ifnally it signiifcantly reduced the incidence of post-surgical complications.

Objective To evaluate dynamic graciloplasty (DGP) for canine in situ anal reconstruction. Methods Seventeen dogs were randomly divided into experimental group and control group. In control group, on the stage 1, the gracilis muscle were dissected in situ, manometry performed intraoperatively; In experimental group, the gracilis muscle were dissected in situ and stimulated chronically starting 7 days postoperatively. On stage 2, abdominoperineal resection of anus and graciloplasty for anal reconstruction were performed in two groups. After 2 weeks recovery, manometry and muscular fatigue-resistant curve (MFRC) were observed while myostimulator is switched off and on. The muscle of neosphincter was biopsied. Results After chronic low frequency electrical stimulation (CLFS), the percentage of type Ⅰ fibers in the stimulation group was higher than the control group (P0.05), but functioning neosphincter pressure is different significantly (P

98%. In the pDOR-myb infected HSCs, c-myb expression levels, the cell proliferation, and ? 1-Ⅰ collagen mRNA expression were repressed significantly. CONCLUSIONS: c-myb plays a key role in the activation and proliferation of HSC. c-myb antisense RNA can inhibit cell proliferation and ? 1-Ⅰ collagen mRNA expression in the infected HSC. These data suggest that inhibition of c-myb gene expression would be a potential way for the treatment of liver fibrosis.

【Objective】To construct the c-myb antisense RNA recombinant retroviral vector and its packaging cell line.【Methods】The segment of c-myb gene was cloned into pUC19 with TA cloning method after amplication by RT-PCR,and then was subcloned into retroviral vector pDOR.The recombinant retroviral vector named pDOR-myb was transfected into retroviral package cell line PA317 after selection with G418.【Results】Sequencing data indicated that the c-myb gene was exactly identical to the sequence in the GenBank.The segment of c-myb gene was inserted directionally into pDOR.Resistant colonies were obtained and the titers of pDOR-myb were 5.2×104～9.5×104 CFU/mL.【Conclusion】The recombinant retroviral vector containing c-myb gene is successfully constructed and its packaging cell line PA317/pDOR-myb was established.

OBJECTIVETo explore a new procedure of laparoscopic dual anastomosis for mid-low rectal cancer to reduce postoperative complications.

METHODSClinical data of 56 patients with mid-low rectal cancer undergoing laparoscopic rectal cancer resection(modified double-stapling technique, MDST, modification group) in the Department of General Surgery, the First Affiliated Hospital of Soochow University from February 2010 to June 2014 were compared with the data of 64 patients with mid-low rectal cancer (conventional double-stapling technique, DST, convention group) in the same period based on gender, age, tumor size, the distance from lower edge to the dentate line and tumor staging, etc. Patients in the modification group received operation as follows: (1) the rectum distal end was closed vertically instead of horizontally. (2) the anastomosis was conducted in an "end-corner" approach. (3) upper corner of the closed line in the distal end of rectum was removed. (4) the lower corner of closed line in the distal end of rectum was removed using vascular occlusion clamp method. (5) two T-shaped interchanges ("dangerous triangle") of stapled sutures formed after anastomosis were strengthened with absorbable suture. Patients in the convention group received laparoscopic dual anastomosis using conventional method: two corners and "dangerous triangles" were kept without any treatment. The clinical outcomes of two groups were analyzed retrospectively.

RESULTSThe intraoperational blood loss, postoperative drainage volume, postoperative anastomotic stoma bleeding, bowel function return and hospital stay were not significantly different between the two groups (all P>0.05). As compared to the convention group, the modification group had longer operation time [(211 ± 91) min vs. (174 ± 57) min, P<0.05], lower incidence of postoperative anastomotic leakage [1.8%(1/56) vs. 12.5% (8/64), P=0.030], lower tenesmus rate [3.6% (2/56) vs. 14.1% (9/64), P<0.05], less postoperative stoma re-creation [0 vs. 9.4% (6/64), P<0.05].

CONCLUSIONModified laparoscopic dual anastomosis for mid-low rectal cancer can significantly reduce the incidence of post-surgical complications such as anastomotic leakage.

Anastomosis, Surgical ; Anastomotic Leak ; Humans ; Laparoscopy ; Neoplasm Staging ; Operative Time ; Postoperative Complications ; Rectal Neoplasms ; surgery ; Retrospective Studies

Objective To study the feasibility and effect of scarless endoscopic thyroidectomy(SET) and minimally invasive video-assisted surgery of the thyroid(MIVA) endoscopic technique. Methods SET: Incisions were made on the anterior part of the breast and mareolata,blunt dissection of the subcataneous planes of the neck and chest were administered .MIVA: Incisions were made 3cm above the thymus notch and the operation was video assisted in the thyroid adenoma extripation and subtotal thyroidectomy. The thyroid nodules were extirpated or subtotal thyroidectomy was performed. Results All 10 cases of the SET and 12 cases of the MIVA were successful performed and without complications. Conclusions For thyroid surgery,SET is a good cosmetic operation,MIVA is a minimal trauma and effective operation.