The purpose of this study was to investigate the function of stereo visual acuity in patients after phacoemulsifications and intraocular lens implantation. Mensuration of stereopsis with laser holographic stereovision test chart was done in 80 cases who had undergone phacoemulsifications and intraocular lens implantation. In this group, 43 patients were male, 37 were female .Ages of the patients were 52 to 81 years. Single eye operation was done in 18 cases, while both eye operation in 62 cases. The corrected vision was all over 0 4 in both eyes.In the 80 cases 67 (83 7%) had near stereopsis and 13 cases (16 3%)did not have; 71 cases (88 8%) had distance stereopsis and 9 cases (11 2%)did not have. Function of stereopsis weakens gradually following aging and is closely related with vision. The function of sterovision would recover to varying degrees after phacoemulsifications and intraocular lens implantation. Recovery of distance stereopsis was better than that of near stereopsis.The results of this study show that the status of stereopsis is an important index to evaluate the curative effect in patients after phacoemulsifications and intraocular lens implantation.

Objective To determine the median effective concentration(EC50) of remifentanil by TCI inhibiting the cardiovascular response to the placement of operating laryngoscope performed under propofol anesthesia administered by TCI.Methods Twenty ASA Ⅰ orⅡ patients,aged 20-51 yr,weighing 52-83 kg,undergoing extirpation of vocal cord polyps under general anesthesia with remifentanil-pmpofol administered by TCI.were enrolled in the study.The target plasma concentration (Cp) of propofol was set at 4μg/ml.Operating laryngoscope was placed at 3 min after tracheal intubation.HR and MAP were continuously monitored.When HR or MAP increased by 15%,the candiovascular response was defined as positive.The EC50 was determined by up-and-down technique.The initial Cp of remifentanil was set at 5 ng/ml and was increased/decreased by 20%in the next patient if the cardiovascular response was positive or negative.Results No chest wall stiffness and intraoperative awareness occurred in all the patients.The EC50 of remifentanil TCI inhibiting the cardiovascular response to the placement of operating laryngoscope was 3.50ng/ml with confidence interval(CI) between 3.47-3.60 ng/ml.Conclusion Thee EC50 of remifentanil TCI inhibiting cardiovascular response to the placement of operating laryngoscope is 3.50ng/ml with CI between 3.47-3.60ng/ml.

Quality is the key not only to the competence of the hospital,but also to the "two benefits".It is the essence of the development of the hospital.Aiming at improving the management of the hospital's quality,combining with some experience before,the article discusses on the aspects as follows: change ideal and intensify consciousness,reform system and improve institution,stick to the project and put emphasis on the implement.

Objective To investigate the clinicopathologic features and prognostic analysis of intrahepatic mucinous cholangiocarcinoma (IMCC) and intrahepatic cholangiocarcinoma (ICC).Methods The retrospective cohort study was adopted.The clinicopathological data of 20 patients with IMCC and 51 patients with ICC who were admitted to the Fujian Provincial Hospital from March 2003 to March 2014 were collected.The observation indicators included (1) clinicopathologic features:gender,age,clinical symptoms (fever,jaundice,abdominal pain and peritoneal effusion),preoperative laboratory examination [alanine transaminase (ALT),aspartate transaminase (AST),direct bilirubin (DBil),carcinoembryonic antigen (CEA),CA19-9 and alphafetoprotein (AFP)],operation methods (radical resection,palliative resection) and pathological features (tumor location,lymph node metastasis,vascular invasion and pathological stage).(2) The follow-up of outpatient examination and telephone interview was performed to detect the survival of patients up to March 2015.Measurement data with normal distribution were represented as x-± s and comparison between groups was analyzed using t test.Count data were analyzed using the chi-square test.The survival curve was drawn by Kaplan-Meier method,and the survival rate was analyzed using the Log-rank test.Result The numbers of patients with fever,jaundice,elevated level of AST and DBil,lymph node metastasis,vascular invasion and numbers of patients with stage 0,Ⅰ,Ⅱ,Ⅲ,Ⅳ were 13,11,10,11,3,1 and4,6,2,6,2 with IMCC,12,10,9,2,22,36 and 0,14,5,3,29 with ICC,respectively,showing statistically significant differences in the above indicators (x2=10.830,8.639,7.672,25.059,8.036,24.765,26.601,P ＜ 0.05).All the patients were followed up for a median time of 14 months (range,1-118 months).The survival time and 1-,3-,5-year survival rates were (55 ± 8)months,94.4％,44.0％,16.7％ in 20 patients with IMCC and (30 ±6) months,36.5％,12.5％,4.0％ in 51 patients with ICC,respectively,showing a statistically significant difference (x2 =8.126,P ＜ 0.05).Conclusion The patients with MICC are more easily complicated with fever,jaundice and liver dysfunction,while they have less lymph node metastasis and vascular invasion,earlier pathological stage and better prognosis compared with patients with ICC.

Objective To investigate the diagnosis and treatment of mucin-producing intrahepatic biliary tumor (MPIBT).Methods We retrospectively analyzed the clinical,radiologic,surgical and pathologic findings of 16 MPIBT cases from January 2004 to December 2011.Results There were six men and ten women,age ranged from 44 to 69 years (mean 60 years).Clinical presentation included jaundice with abdominal dull pain in 5 patients,acute cholangitis in 4 patients,painless jaundice in 2 patients,upper abdominal dull pain in 3 patients,no obvious symptoms in 1 patient,body weight loss more than 5 kg within 3 months in 5 patients.The most characteristic appearance of MPIBT on magnetic resonance cholangiopancreatography were asymmetry of intrahepatic bile duct dilatation and the dilatation in both extraand intrahepatic bile duct distal to the hepatic mass and not sudden interruption in extrahepatic bile duct.The primary tumor located in the left hepatic bile duct in 15 cases,in the right hepatic bile duct in one.13 MPIBT cases received hemihepatectomy and extrahepatic bile duct resection and Roux-en-Y anastomosis was done in 8 cases,3 received palliative biliary drainage.Pathologically 13 was papillary adenocarcinoma and 3 was papillary adenoma.The 1-,2-,3-year survival rates for the 16 MPIBT patients were 81％,66％,56％,respectively.Conclusions MPIBT had no specific clinical manifestations,MRCP might be an effective means for the diagnositic strategy and assessment of tumor extension before surgery,radical resection was the first choice of treatment,palliative biliary drainage could prolong the survival time.

OBJECTIVETo summarize the experiences of applying three-dimensional (3D) technique in scarless endoscopic thyroidectomy (SET) via anterior chest approach.

METHODSMedical records of patients who undenvent SET using 3D technique from December 2013 to May 2014 were retrospectively reviewed. A total of 32 patients who had a preoperative ultrasound-guided fine-needle aspiration cytology diagnosis of unilateral papillary thyroid carcinoma and underwent lobectomy associated with central lymph node dissection were included in this study. All patients were female with a mean age of (37 ± 10) years at diagnosis. In addition, 45 female patients who underwent traditional endoscopic thyroidectomy at the same period were randomly selected as control.

RESULTSAll surgical procedures were successfully finished. The mean surgical time in 3D group was (91. 7 ± 11. 4) minutes, and mean hospitalization time was (3. 2 ± 0. 5) days. Contemporary hoarseness was observed in one patient, and no bleeding, infection, hypocalcemia and other postsurgical complications were observed. Compared to the traditional endoscopic surgery group, 3 D group had significantly shorter surgical time of lobectomy ((23. 2 ± 5. 1) minutes vs. (28. 0 ± 5. 0) minutes, t = 4. 156, P = 0. 000). Negative results were seen in the time taking of creating surgical space ((14. 6 ± 3. 3) minutes vs. (15. 6 ± 2. 5) minutes), central lymph node dissection ((25. 1 ± 5. 4) minutes vs. (24. 4 ± 6. 3) minutes) and total surgical time ((91.7 ± 11. 4) minutes vs. (96. 1 ± 13. 0) minutes).

CONCLUSIONApplication of 3D technique in endoscopic surgery can offer 3D vision of the surgical field, thus significantly shorten lobectomy time and more easily to achieve fine dissection and functional protection of recurrent laryngeal nerves, parathyroids and other vital anatomic structures.

Adult ; Biopsy, Fine-Needle ; Carcinoma ; diagnosis ; surgery ; Carcinoma, Papillary ; Endoscopy ; methods ; Female ; Humans ; Middle Aged ; Minimally Invasive Surgical Procedures ; methods ; Operative Time ; Retrospective Studies ; Thyroid Neoplasms ; diagnosis ; surgery ; Thyroidectomy ; methods

OBJECTIVETo summarize the therapeutic experience in removing huge craniofacial hemangioma in 135 cases and reveal the rules of repairing the damaged tissues or organs caused by the extirpation.

METHODSThe procedure was to remove the focal lesion correctly, control hemorrhage, keep the stable blood volume, repair and rebuild the damaged tissues or organs reasonably.

RESULTSThe focal lesion was removed rather completely without accidental injuries or deaths. The damaged tissues or organs were repaired and rebuilt quite satisfactorily.

CONCLUSIONHuge craniofacial hemangioma of any type should be operated on as early as possible with sufficient preoperative preparations.

Adult ; Facial Neoplasms ; surgery ; Female ; Hemangioma ; surgery ; Humans ; Male

The self—formulated modified“Blood—activating andQi—benefitting Decoction of Fructus Cirri Sarco-dactylis”with heavy dose of Radix Angelica Sinensiswas applied for the treatment of 50 cases of apoplexycomplicated with pseudo—Bulbar paralysis.The totaleffective rate of dysathria was 98% with a 58% abovemarked effect rate,while the total effective rate for-choking and coughing was 98%,with a 94% abovemarkedly effective rate.

Objective To investigate the clinical efficacy of pericardial devascularization (PCDV) combined with splenectomy and partial gsstric fundus resection (PGFR) in the treatment of portal hypertension-induced severe gastric varices complicated with gastrorenal shunt (GRS).Methods The retrospective cross-sectional study was conducted.The clinicopathological data of 18 patients with portal hypertension-induced severe gastric varices complicated with GRS who were admitted to the Fujian Provincial Hospital from January 2010 to December 2015 were collected.According to the stage of technical development,open surgery or laparoscopic surgery was selected based on patients' and their family's wishes.Observation indicators:(1) surgical and postoperative recovery situations;(2) postoperative pathological examination;(3) follow-up and survival.The follow-up using outpatient examination and telephone interview was performed once every 3 months within 1 year postoperatively and once every 6 months after 1 year to detect long-term complications and survival up to June 2017.The reexaminations of gastroscopy,enhanced scan of X-ray computed tomography (CT) on the epigastric region or magnetic resonance imaging (MRI) were done at 1 month postoperatively for detecting resection of fundus ventriculi varicosity.Measurement data with normal distribution were represented as (x)±s.Measurement data with skewed distribution were described as M (range).The survival rate was calculated by the Kaplan-Meier method.Results (1) Surgical and postoperative recovery situations:18 patients underwent successful PCDV combined with splenectomy and PGFR,including 12 with open surgery and 6 with laparoscopic surgery (1 with conversion to open surgery due to intraoperatively uncontrollable bleeding).There was no perioperative death.The operation time,volume of intraoperative blood loss,recovery time of gastrointestinal function,time of postoperative drainagetube removal and duration of hospital stay were (192± 20) minutes,(280± 30) mL,(33 ±6) hours,8 days (range,5-9 days),8 days (range,5-12 days) in 12 patients with open surgery and (208±40)minutes,(210±10)mL,(28±5)hours,7 days (range,5-26 days),7 days (range,5-10 days) in 6 patients with laparoscopic surgery,respectively.One patient with laparoscopic surgery had intraoperative condensed erythrocyte infusion with 2 U.Seven,1,0 patients with open surgery and 4,1,1 patients with laparoscopic surgery were respectively complicated with pleural effusion,delayed gastric emptying and pancreatic leakage in level A,and they were cured by conservative treatment.(2) Postoperative pathological examination:results of postoperative pathological examination in 18 patients showed that a large number of varicose veins in the mucous and seresal layers of gastric fundus and moderate or severe hepatic cinr hosis.(3) Follow-up and survival:18 patients were followed up for 8-78 months with a median time of 39 months.The gastroscopy and enhanced scan of X-ray CT at 1 month postoperatively showed that no varicose veins in the gastric fundus.During the follow-up,there was no recurrence of gastric varices with GRS and esophageal stenosis.Of 4 patients with portal vein thrombosis,1 died of portal hypertensive gastropathy-induced upper gastrointestinal bleeding due to stop taking warfarin,and other 3 patients had portal vein patency by warfarin therapy.One patient was complicated with liver cancer at 32 months postoperatively and received radiofrequency ablation therapy.Two patients died,including 1 dying of hepatic failure at 35 months postoperatively and 1 dying of advanced liver cancer at 54 months postoperatively.The 1-,3-and 5-year overall survival rates of 18 patients were respectively 93.8％,84.4％ and 70.3％.Conclusion The PCDV combined with splenectomy and PGFR is safe and effective in the treatment of portal hypertension-induced severe gastric varices with GRS,with a dissemination value for appropriate patients.

Objective: To summarize the preliminary experience with transoral endoscopic thyroidectomy via vestibular approach (TOETVA). Methods: A total of 150 consecutive patients with thyroid disease underwent TOETVA from November 2014 to February 2017 at Department of Thyroid Surgery, the Second Affiliated Hospital of Zhejiang University School of Medicine. The patients were comprised of 138 females and 12 males. The mean age of the patients was (31.7±7.6) years (ranging from 15 to 51 years). There were 108 patients of differential thyroid carcinoma (T1 or T2 ≤3 cm, cN0 or cN1a, M0) and 42 patients of benign thyroid disease (solid nodule ≤6 cm). The criteria analyzed were clinicopathologic characteristics, types of operation, operation time, complications and results of follow-up. Results: Two cases were converted into open surgery due to an incredible unexpected tumor size and tracheal invasion, respectively. One hundred and three patients with papillary carcinoma underwent transoral central neck dissection (CND), with the mean operation time of (146±34) minutes for hemithyroidectomy with CND, and (187±36) minutes for total or near total thyroidectomy with CND. The mean number of lymph node yields was 8.2±4.7, and the lymph node metastasis rate was 41.7% (43/103). Regarding postoperative complications, transient hoarseness occurred in 3 patients, and permanent recurrent laryngeal nerve occurred in 2 patients. One patient had local infection or transient mental nerve palsy. Transient hypocalcemia occurred in 31.8% of 22 patients who underwent total, near-total, or subtotalthyroidectomy, and no permanent hypocalcemia was registered. Mean hospital stay after operation was (3.5±0.6) days (ranging from 2 to 5 days). Mean follow-up period was (11.5±7.8) months (ranging from 1 to 28 months), no recurrence or metastasis occurred. Conclusions TOETVA is feasible and safe for strictly selective patients. It brings perfect cosmetic effect. Long-term follow-up and further study is needed to assess its curative effect.