Objective To study the prevention and treatment of pneumoperitoneum-related complications after laparoscopic cholecystectomy (LC). Methods A retrospective analysis was made on clinical data of 1 100 cases of LC from October 1993 to January 2003. The cases were divided into two groups: 980 cases admitted before September 2001 received a 14 mmHg carbon dioxide pneumoperitoneum (Group A), and 120 cases after September 2001 received a 10 mmHg pneumoperitoneum (Group B). Results Carbonemia happened in 2 cases in the Group A but in no cases in the Group B. The incidence of postoperative shoulder pain was significantly lower in the Group B (19 2%, 23/120) than in the Group A (43 9%, 430/980) ( ? 2 =26 951, P =0 000). The incidence of postoperative nausea and vomiting (PONV) was significantly lower in the Group B (25 8%, 31/120) than in the Group A (61 2%, 600/980) ( ? 2 =54 750, P =0 000). Conclusions Carbonemia, shoulder pain and PONV can be reduced by regulating the ventilation and decreasing the pneumoperitoneum pressure.

Objective To study the relationship between Helicobacter pylori (Hp) DNA positive detection in bile of gallbladder and intragastric Hp's colony and its plausible mechanism.Methods Sixty patients of gallbladder innocence diseases were recruited in the case group and 30 health populations were recruited in the control group.13CPDB was used to detect the infection of Hp.The cytotoxin associated gene antigen (cagA) in gall and gall-stone were detected through PCR.The empty function was tested through B ultrasound.Results The infection rate of Hp in all cases is 50.0% (30/60) and 7 of 30 bile (23.3%) ,1 of 30 gallstones (3.3%) were positive for Hp cag-A by PCR analysis in positive Hp infection group,with none of the 30 bile were positive in negative group( x2 = 5.822 ,P ＜ 0.05 ).The contraction rate of gallbladder of Hp positive group ( 56.8 ± 17.1 ) %was lower than negetive group' s ( 69.4 ± 13.1 ) % and the control group' s (63.3 ± 17.1 ) % ( F = 5.633,P ＜0.05).Conclusions Hp DNA is present in bile of gallbladder,and is related with Hp infection in stomach.Impairment of the gallbladder empty function may be related with Hp infection.

Objective Summing up and analyzing outcome and influencing factors following thymectomy in patients with ocular myasthenia gravis tries to provide clinical evidence for an option of the treatment modalities.Methods From May 2007 to November 2014,thymectomy was performed in 129 patients with ocular myasthenia gravis consisting of 110 patients by Video-assisted thoracoscopic surgery(VATS) and 19 by partial sternotomy.Follow-up information was obtained by outpatient visit and telephone contact.The outcome evaluation after thymectomy was classified into full remission,partial remission,unchanged and deteriorated.Statistical analysis was done using x2 test and Cox regression model.Results There was no perioperative death.Seven(5.4％) postoperative complications occurred and cured after treatment.Follow-up was complete in 123 patients(95.3％) and the mean duration of follow-up was 49(range 21-99) months.Surgical outcome revealed full remission in 40 patients,partial remission in 68,unchanged in 9 and deteriorated in 6 patients.Response(full remission and partial remission) rate was 87.8％ and no benefit(unchanged and deteriorated) rate was 12.2％.Four of 6 patients in deteriorated condition progressed into generalized myasthenia gravis(3.3％).The significant difference was noted in 24 months or less of preoperative clinical duration (P =0.004) and thymic hyperplasia (P =0.001) in postoperative pathology among the full remission,partial remission and no benefit group.On the other hand,there was no statistical difference in sex,age,symptoms,comorbidities,preoperative taking acetylcholinase inhibitor,corticosteroid,surgical approach,and associated thymona among the three groups.Multivariate Cox regression analysis also demonstrated that a preoperative duration of symptoms 24 months or less and postoperative histology being thymic hyperplasia favourably influenced the outcome.Conclusion The role of thymectomy in patients with ocular myasthenia gravis can relieve symptoms effectively and avert or decrease the potential development of generalized symptoms.Thymectomy,which has a low postoperative mortality and morbidity,may be a first-line option of the therapeutic armamentarium to treat ocular myasthenia gravis.Thymectomy via VATS has clinical advantages of minimal trauma,less pain,fast recovery,and the comparable clinical results over via the traditional sternotomy.Therefore,this procedure deserves to be advocated for ocular myasthenia gravis.

Objective To determine if the carbon dioxide (CO 2) pressure used in laparoscopic cholecystectomy (LC) has any effect on the occurrence of postoperative shoulder pain. Methods One hundred and twenty consecutive patients undergoing LC were prospectively divided into three groups(40 patients in each group): Patients in group A underwent LC with 10 mm Hg of CO 2, those in group B with 12 mm Hg of CO 2, and in group C with 14 mm Hg of CO 2. PaO 2?PaCO 2?pH before and after LC were recorded. Shoulder pain was recorded on a visual analogue pain scale 1,3,6,12,24,48,72,96 h after operation. Results The intraoperative CO 2 consumption was significantly higher in group C (F=11.38,P