Objective To evaluate the therapeutic effect of abdominal multiple visceral organ transplantation for hepatic cirrhosis combined with diabetes by using donation after cardiac death (DCD).Methods Two patients suffering from hepatitis B-related liver cirrhosis,hepatocellular carcinoma combined with insulin dependent type 2 diabetes mellitus were given multiple visceral organ transplantation from May to June 2012.The transplanted organs including the liver,pancreas and duodenum were obtained from two donors after cardiac death which accorded with C-Ⅲ criteria.The donor internal and external iliac arteries were anastomosed to celiac axis and superior mesenteric artery and then the donor arteria iliaca communis was anastomosed to recipient abdominal aorta.The portal vein reconstruction was performed by end-to-side anastomosis between the donor and recipient portal vein.The pancreatic juice drainage was achieved by side to side anastomosis between donor duodenum and recipient jejunum.The pancreases of recipients were retained.Results The alanine aminotransferase,aspartate aminotransferase and total bilirubin of two patients were recovered to normal level at 2nd week after operation.The blood glucose and serum amylase returned to normal levels at 7th d and 4th d respectively.The fasting serum C-peptide and insulin were also at normal level at 2nd week.One patient with local intestinal anastomotic fistula was given percutaneous puncture drainage for four weeks and recovered.One patient recovered smoothly one month after transplantation without surgical complications.Conclusion Abdominal multiple visceral organ transplantation is an effective treatment for hepatic cirrhosis combined with diabetes by using DCD donor.

Objective To compare the feasibility and efficacy between dexmedetomidine and midazolam in herniorrhaphy surgery for older patients. Methods Sixty American Society of Anesthesiology (ASA) gradeⅠ~Ⅱpatients, treated by herniorrhaphy surgery under local anesthesia,were randomly divided into dexmedetomidine group (n=30) and midazolam group (n=30) .Patients in dexmedetomidine group were given dexmedetomidine at a loading dose of 1μg/kg for 10 min,then they were injected continuously by 0.4μg/(kg·h),whereas midazolam group were given midazolam at a loading dose of 0.06 mg/kg, then 0.04 mg/(kg·h) injected continuously.The mean blood pressure (MAP) and heart rate (HR) were recorded before infusion (T0),incision of skin (T1),15min (T2) and 30 min (T3) after administration and when sutured skin (T4), adverse reaction were also assessed. Results The difference of sedation level was not significant between the two groups (P>0.05) .Compared with T0 , the decrease of HR was significantly more in dexmedetomidine group from T1 to T4 (P<0.05) . Compared with midazolam group , the decrease of HR was significantly more in dexmedetomidine group from T1 to T4 (P<0.05) . Compared with dexmedetomidine group, the rate of respiratory depression and restlessness were more in midazolam group, but bradycardia was lower (P<0.05) .Conclusions Dexmedetomidine is a comparable alternative to midazolam for sedation in herniorrhaphy surgery under local anesthesia. It is associated with better respiration and lower restlessness but with a high incidence of bradycardia.

Objective To investigate the pancreaticoenterostomy technique using end to end anastomosis of remianing pancreas and jejunum with jejunum mucus preserved. Methods 28 cases underwent pancreatectomy were observed and analyzed from May 2005 to August 2009. There were 26 cases underwent duodenopancreatectomy and 2 cases underwent the pancreatectomy of pancreas body and tail. All cases used the end to end pancreaticoenterostomy, remnant pancreas was directly anastomosed with jejunum without destroy of jejunal mucosa. During the operation, 2.0 cm～2.5 cm long remnant of pancreas was pulled into jejunum without mucosa destroyed. Then, the cut end of the jejunum was fixed on the pancreatic remnant correspondingly by interrupted suture. Finally, a 7-silk suture was used to bind the jejunum and the pancreatic remnant together 1 cm away from the cut surface of the pancreatic remnant. Results 1 case underwent operated again due to bleeding of the pancreatic remnant. 28 patients recovered and discharged from hospital without having the complication of pancreatic fistula. Conclusions Because of the complicated suturation methods, the conventional pancreaticoenterostomy consumes more time. But it still has rather high incidence of pancreatic fistula.The new pancreaticoenterostomy which we used can shorten the operating time and integrity and binding stomas. It is effective to lower the incidence of pancreatic fistula.

Objective To observe the clinical effect of dexmedetomidine for preventing agitation during extubation period in the patients undergoing percutaneous nephrostolithotomy.Methods Sixty ASA Ⅰ-Ⅱ patients with elective percutaneous nephrostolithotomy under general anesthesia were selected and randomly assigned to the dexmedetomidine (DEM) and normal saline group (NS),30 cases in each group.The DEM group was given dexmedetomidine 0.5 μg/kg by intravenous pumping at 30 min before the end of the operation,while the NS group was given the equal volume of normal saline by intravenous pumping for 10 min.MAP and HR were recorded before anesthesia induction(T0),at the end of skin suturing(T1),at the moment of extubation(T2),at 5 min (T3) and 10 min(T4)after extubation.The eye opening time and extubation time,and incidence of agitation were observed in the two groups.Results MAP and HR at T2,T3 and T4 in the DEM group were lower than those in the NS group(P＜0.05).MAP and HR at T2,T3,T4 in the NS group were higher than those before anesthesia induction(P＜0.05).The total incidence rate of agitation during extubation period in the DEM group was also significantly lower that that in the NS group(P＜0.01).No statistically significant differences were found between the two groups in the recovery time and extubation time(P＞0.05).Conclusion Intravenous pumping of dexmedetomidine 0.5 μg/kg at 30 min before the end of percutaneous nephrostolithotomy can effectively reduce the occurrence of agitation during extubation period.