ObjectiveTo study the feasibility,safety and effect of laparoscopic splenectomy and selective pericardial devascularization in the treatment of portal hypertension.MethodsThis study included 7 patients diagnosed as posthepatitie cirrhosis and portal hypertension with a history of up GI bleeding receiving laparoscopic splenectomy and selective pericardial devascularization.ResultsThe operation was successful in all 7 patients without conversion to laparotomy.There were no postoperative severe complications.The average operation time was 4.2 h,mean blood loss was 430 ml.All patients recovered well,and were followed-up for 0.5 ～ 2.0 years,and there was no rebleeding in this period.ConclusionsLaparoscopic selective pericardial devascularization is feasible,safe,minimally invasive.The short to mid term result was satisfactory.

Objective To evaluate effects of steep meridian clear corneal incisions on corneal anterior surface and total astigmatism in phacoemulsification surgery . Methods Clinical data of 56 cases of phacoemulsification surgery with steep meridian clear corneal incisions from August to December 2015 were analyzed in this retrospective study .Corneal anterior surface and total astigmatism were measured with the Pentacam 3D anterior segment measurement and analysis system at the time before surgery and 1 month and 3 months after surgery .The polar coordinate analysis was used to evaluate effects of steep meridian incisions on corneal astigmatism . Results All the operations were accomplished successfully with smooth recovery .The corneal anterior surface and total astigmatism reduced significantly after 1 month and 3 months in astigmatic polar value AKP ( +0) (P<0.05), but no significant difference was found in AKP(+45) (P>0.05).No significant differences were detected between both corneal anterior surface and total astigmatism in AKP(+0) or AKP(+45) between 1 month and 3 months after surgery. Conclusion Steep meridian incision performed on the preoperative steeper meridian of keratometric astigmatism may reduce corneal total astigmatism .

Objective To explore the elasticity of carotid artery in children with simple obese by echo tracking imaging technique.Methods Intima-media thickness (IMT), resistent index (RI), pulsatility index(PI ), the ratio of systolic phase and diastolic phase(S/D ) of common carotid artery (GCA) were detected differently in 50 simple obese children (obese group) and 50 normal children (control group) by CDFI.Internal systolic diameter (Ds), internal diastolic diameter (Dd),pressure-strain elastic moduhs(E ρ ), stiffness parameter ( β ), arterial compliance (AC), augmentation index (AI), pulse wave velocity ( PWV β ) were calcuhted automatically by means of echo tracking system.Results There was no significant difference in Ds,Dd,RI, PI,S/D and AI'between two groups (P >0.05).In obese group, IMT was significantly thicker,E ρ,β, PWV β were significantly higher,and AC was significantly lower thon those in control group (P < 0.05).Conclusions It has alteration of early atherosele in carotid artery of simple obese children.Echo tracking imaging technique is a quick, noninvasive, accurate and quantitative evaluating method for the elasticity of carotid artery.

Objective To assess the safety and effectiveness of laparoscopically total extraperitoneal (TEP) repair using two mesh cross and overlap without stapler technique and to discuss the cause of main complications. Methods In this study 243 cases of inguinal hernia were randomly divided into two groups. One group underwent two meshes cross and overlap no fixation TEP, the other underwent a single mesh stapling fixation TEP. The average postoperative follow-up was ( 28 ± 6 ) months. For comparing the effect of the two approaches, statistical analysis including the χ2 test and Student's t test was carried out where appropriate. A p value of less than 0. 05 was considered statistically significant. Results The recurrence rate for the mesh no fixation group ( 1.9% ) did not increase when compared to mesh fixation group( 2. 9% ) ( P ＞ 0. 05 ). The overall postoperative complication rate or individual complication rate was not significantly different between the two groups. Conclusions Laparoscopically total extraperitonealrepair(TEP) using two mesh cross and overlap no fixation technique is safe and reliable.

Objective To summarize the anterior trans-sternal approach endoscopic subtotal thyroidectomy. Methods Clinical data of 10 cases of endoscopic subtotal thyroidectomy were reviewed. Results All endoscopic operations in the 10 cases were successfully completed. The operation time was 140～360 min (mean, 164 min), and the postoperative hospital stay ranged 4～8 days (mean, 5 days). No injuries of nerve or parathyroid glands, or other complications occurred. Conclusions The anterior trans-sternal approach endoscopic thyroidectomy is characterized by its safety, reliability, short incision, and good cosmetic results.

Objective To investigate the laparoscopic anatomy of the spleen vessels and its clinical application. Methods The data of 47 cases of total laparoscopic splenectomy (TLS) were analyzed. Among the patients, 21 had cirrhotic portal hypertension, 19 had thalassemia, 2 idiopathic thrombocytopenic purpura, 2 hereditary spherocytosis, 1 angioma of the spleen, 1 splenic cyst, and 1 primary hypersplenism. The color of the spleen was observed after the splenic artery near the pancreatic tail was ligated. And then the splenic artery was categorized according to the color. Results Among the 47 cases, 34 (72.3%) were categorized as typeⅠ, 9 were type Ⅱ (19.1%), and 2 were type Ⅲ (4.3%). The arterial anatomy was unclear under a laparoscope in 2 cases (4.3%). The TLS was completed in 46 cases with a success rate of 97.9% (46/47). Among the cases, 14 received extensive esophagogastric devascularization simultaneously,and 3 patients who had thalassemia underwent cholecystecotomy after the TLS because of gallbladder stones. One case was converted to an open surgery because of extensive bleeding owning to coagulation disorder. The spleen artery was ligated in 43 cases, and the hilar vessels were resected by dissecting and ligating in 45 cases. The Operation time averaged at (110?35) min (range 50-240 min), and the mean intraoperative blood loss was (160?87) ml (range, 20-1500 ml). Conclusions In spite of the prominent type Ⅱ of the spleen vessels, the spleen artery can be dissected and ligated at the level of the superior edge of the pancreatic tail to stop the blood supply to the spleen. The hilar vessels can be resected by dissecting and ligating. The spleen artery ligation and hilar vessels resection by dissecting and ligating are effective in controlling intraoperative bleeding and avoiding pancreas injury.

Objective To evaluate the feasibility of laparoscopic left lateral hepatic lobectomy(Ⅱand Ⅲ segments)for the treatment of primary hepatic carcinoma(PHC).Methods From January 2002 to June 2007,23 patients with PHC were treated by laparoscopic left lateral hepatic lobectomy.During the operation,after the portal blood stream was blocked by portal clamps,left lateral lobectomy was performed by using electric or ultrasonic scalpel.Then,laparoscopic hepatic suture was carried out,and fibrin sealant was used to cover the surgical surface.Results Laparoscopic left lateral hepatic lobectomy was completed in all the 23 cases with a mean operation time of(131.7?33.9)min and mean blood loss of(297.9?124.0)ml.All the patients recovered well without postoperative complications and were discharged(5.5?1.3)days after the operation.Among the cases,20(20/23,87%)were followed up for 2-24 months(2-12 months for 9 cases,and 13-24 months for 11 cases),during which no patients died,3 patients had recurrent hepatic carcinoma.Conclusions Laparoscopic left lateral hepatic lobectomy is feasible for PHC.The method should be the first choice for left lateral PHC because it is safe and minimally invasive.

Objective To explore the feasibility and advantages of endoscopic thyroidectomy via breast areola approach.Methods Endoscopic thyroidectomy via breast areola approach was performed in 113 cases between August 2002 and May 2005.Preoperative diagnosis included 46 cases of adenoma,62 cases of nodular goiter,and 5 cases of Graves' disease.Results The operation was successfully completed endoscopically in 112 cases,and was converted to conventional thyroidectomy in 1 case because of bleeding.The tumor was 2.3?1.6 cm in diameter(range,0.8~7.0 cm).The operating time was 136.7?58.0 min(range,50~310 min),the intraoperative blood loss was 42.5?62.7 ml(range,10~200 ml),the postoperative drainage volume was 87.1?78.1 ml(range,15~310 ml),the time to resume normal activities was 2.2?0.9 d(range,1~4 d),and the length of postoperative hospital stay was 5.5?1.9 d(range,2~9 d).Out of the 113 cases,analgesic requirement was necessary in 18 cases (15.9%).Postoperative complications occurred in 6 cases,including 2 cases of recurrent laryngeal nerve injuries,1 case of superior laryngeal nerve injuries,1 case of hemorrhage,1 case of hypocalcemia,and 1 case of recurrence of Graves' disease.Pathological results showed 43 cases of thyroid adenoma,58 cases of nodular goiter,5 cases of Graves' disease,3 cases of thyroid cancer,and 4 cases of Hashimoto's thyroiditis.Conclusions Endoscopic thyroidectomy via breast areola approach is a technically feasible and safe procedure.It can be employed as the first choice for indicated patients.

Objective To investigate the laparoscopic techniques in the diagnosis and treatment of acute abdominal emergency. Methods The efficacy of laparoscopic checkups and treatment in 122 consecutive patients with surgical acute abdomen admitted from January 2001 to February 2003 were analyzed retrospectively. Results Diagnosis was clarified under laparoscope in all the patients.Operations were completed under laparoscope in 117 patients,while a conversion to open surgery was required in 5 patients because of the limitation of vision scope or dense adhesion leading to difficult exposure.Two patients expired. Conclusions Laparoscopy is valuable for the differential diagnosis of surgical acute abdomen.Laparoscopic treatment can be completed in the majority of the patients,but is not advisable in certain cases.

Objective To evaluate clinical application value of critical flicker frequency (CFF),psychometric hepatic encephalopathy score (PHES) and Stroop test in the diagnosis of covert hepatic encephalopathy (CHE).Methods A total of 110 patients with decompensated liver cirrhosis and 54 individuals without liver diseases were enrolled as control group.According to PHES＜-4 points as reference threshold for CHE,the threshold of CFF and time of Stroop test for CHE diagnosis was caculated.Positive results of at least two of PHES,CFF and Stroop tests was considered as the gold standard for CHE diagnosis,and then the value of these three methods in CHE diagnosis was evaluated.Student's t test and receiver operating characteristic curve (ROC) were used for statistical analysis.Results Among the 110 patients with liver cirrhosis,40 patients had no hepatic encephalopathy (HE0),52 patients had CHE,and 18 patients had grade 2 hepatic encephalopathy (HE2).The CFF value and total time of Stroop test of control group were (43.70±1.92) Hz and (201.17±20.65) s,respectively.The CFF value of HE0 group was (41.40 ± 1.85) Hz,which was higher than that of CHE group ((38.33 ± 2.32) Hz),and the difference was statistically significant (t=-7.116,P＜0.01).The total time of Stroop test of HE0 group was (197.91±26.68) s,which was shorter than that of CHE group ((253.24± 33.33) s),and the difference was statistically significant (t=8.936,P＜0.01).When PHES＜-4 points was considered as a reference threshold of CHE,the threshold of CFF for CHE diagnosis was 39 Hz,the sensitivity was 94.9％ and the specificity was 73.1％,the area under the curve (AUC) was 0.879.The threshold of the total time of Stroop test for CHE diagnosis was 233.80 s,the sensitivity was 83.3 ％ and the specificity was 71.1％,the AUC was 0.803.The completion time of the number connection test (NCT)-A,NCT-B and digit symbol test (DST),which were there of five subtests of PHES,of CHE group were (80.27±36.05) s,(124.18±55.96) s and (25.03±8.23) s,respectively,compared with those of HE0 patients ((56.68±18.82) s,(80.00±25.58) s and (34.68±8.75) s,respectively),the differences were statistically significant (t =3.691,4.108 and-4.780;all P＜0.01).Compared with the results of combined PHES and Stroop test in the diagnosis of HE0,CHE and HE2,the consistency rates of CFF＜39 Hz as threshold for diagnosis were 95.0％,61.5％ and 100.0％,respectively.Conclusions NCT-A,NCT-B and DST three subtests of PHES have higher efficiency in CHE diagnosis.CFF and Stroop test are also reliable screening methods for CHE,with advantage of objectivity and high specificity.