Objective To present the initial experience and results of the laparoscopic radical cystectomy (LRC) with orthotopic ileal neobladder. Methods Fifteen patients (14 men and 1 women) with invasive bladder carcinoma underwent LRC with orthotopic ileal neobladder.The mean age was 59.5 years(range,39 to 71 years).The LRC with orthotopic ileal neobladder consists of 3 major steps,namely laparoscopic cystectomy,extracorporeal formation of ileal pouch and laparoscopic urethra-pouch anastomosis.With 5 trocars,the surgeon conducted the procedure through the 2 ports on the left side,and the assistants did so on the right side and hold the laparoscope.The bilateral pelvic lymphadenectomy were performed first.The ureters were dissected just outside the bladder.The radical cystoprostatectomy was performed for the male patients.The total bladder, uterus and appendage were removed for the female patient.A 4 to 5 cm median incision in lower abdomen was made to remove the surgical specimens and construct the ileal pouch.A 50 cm ileal loop was taken from the abdominal cavity,isolated,detubularized and reconfigured into “M” shaped pouch with running suture.The anti-refluxing ureter implantation was performed by inserting the 1 cm of ureter into the pouch and suturing them.For the first 4 cases,the urethra-neobaldder anastomosis was completed through the abdominal incision;while for the other 11 cases,the anastomosis was done under the laparoscope. Results The mean duration of surgery was 5 to 10 h with a mean of 6.5 h;the blood loss was 200 to 1000 ml with a mean of 387 ml.During a follow-up of 1 to 11 months,all patients were alive and asymptomatic with normal upper tracts and had no evidence of local recurrence or metastasis.4 to 6 weeks after surgery,all the patients with orthotopic ileal bladder had complete daytime continence,and nocturnal continence was achieved with 2 to 3 times voiding at night. Conclusions This procedure combines the advantages of minimally invasive laparoscopy with the speediness of open surgery.The laparoscopic cystoprostactomy has a magnified clear vision,which makes meticulous manipulation possible,and reduces bleeding,sphincter injury and nerve bundle injury.Shorter time of intestine exposure during the procedure is good for recovery of intestinal function and for reducing postoperative intestinal adhesion.External construction of ileal pouch shortens operation time remarkably.Ileal segment has long and mobile mesentery,thereby can be easily taken out through a small abdomen incision and anastomosed with urethra stump without tension,so it is more suitable for construction of a pouch.

Objective To evaluate the outcomes of M-shaped orthotopic ileal neobladder. Methods A total of 42 male patients with malignant bladder tumors underwent M-shaped orthotopic ileal neobladder after extraperitoneal total cystoprostatectomy.A segment of 45 to 50cm ileal loop was isolated,detubularized,and reconfigured in “M”- shape to form a pouch.Bilateral ureters were reimplanted by means of inserting the 1 cm distal segment into the pouch.The bottom of pouch was opened and anastomosed with the urethra. Results The 42 patients were followed up for 12 to 96 months with a mean of 44 months.38 cases(90.5%) were well continent during daytime,and 36 cases(85.7%) were continent at night.The volume of the pouch was (361?48)ml at 12 months postoperatively. Urodynamic examination showed that the peak voiding pressure was (86.8?21.4)cm H 2O(1 cm H 2O=0.098 kPa).The maximum flow rate (Q max ) was(18.4?6.1)ml/s.No remarkable ureter reflux and obstruction were found.No patient was detected to develop recurrent urethral carcinoma. Conclusions Extraperitoneal cystectomy can prevent the abdomen from tumor contamination and protect the operative field from intestine interference.The ureter-inserting reimplantation technique is a simple anti-reflux anastomosis with lower rate of ureteral stenosis.Isolating the neobladder and ureters from the peritoneal cavity can reduce the postoperative complications of adhesive ileus,internal hernia,and urine leakage to peritoneal cavity.The neobladder is similar to original bladder in position,volume,shape,and anti-reflux of ureter connection.

Radiation proctitis is one of the complications after radiotherapy for pelvic malignancies.Surgery is not necessary for the most of radiation proctitis.However, surgery is unavoidable when rectal obstruction, uncontrollable bleeding, and fistula occur. This article reviews the progress in surgical treatment of radiation proctitis.

Objective To compare the therapeutic effect of laparoscopic radical cystectomy with orthotopic ileal neobladder (LRC-INB) vs open radical cystectomy (ORC-INB). Methods A total of 81 patients were evaluated including 33 undergoing LRC-INB (group A) and 48,ORC-INB (group B) from June 1994 to September 2004 at our institution.The parameters for analysis included operative time,surgical method,blood loss,therapeutic effect,complications and hospital stay.Statistics included t-test and chi-square analysis (P

Objective To understand the effect of circumcision in reducing high-risk human papilloma virus (HPV) infection in male adults. Methods One hundred and twenty-eight married adults with phimosis who underwent circumcision enrolled in the case group and high-risk HPV of urethral discharge specimens were detected before and 2 years after operation. A total of 128 cases of phimosis without circumcision were recruited in the control group. High-risk HPV infection rates were compared between the two groups. Results The highrisk HPV infection rates in the two groups were comparable at baseline. In the circumcision group, high-risk HPV infection rate was 27. 3% preoperative and it significantly decreased to 12.5% two years after operation( x2 =8. 839 ,P =0. 005). In the control group,high risk HPV infection rate was 28. 1% at baseline and it was 25.0%two years later, with no significant difference (x2 =0.320,P = 0.671).Conclusion Circumcision can significantly reduce high-risk HPV infection. Promoting circumcision actively in our country may have an important role in preventing high-risk HPV infection.

Objective To evaluate the effect of extracorporeal membranous oxygenation (ECMO) on the small bowel preservation in a porcine model of controlled donors after cardiac death (CDCD).Method The domestic crossbred donor pigs were anesthetized and ventilated with 100％ oxyger.An intravenous cannula was placed through iliac arteries and jugular vein,and connected to ECMO system.The ECMO was performed to infuse abdominal organs when cardiac death was declared.Pathology,electron microscope,energy metabolism and cell apoptosis level of intestinal mucosa were evaluated before operation,in cardiac death and at the end of extracorporeal support,respectively.Result The normothermic extracorporeal support could quickly restore graft blood supply and oxygenation.One-h extracorporeal support could improve the energy status in intestine of donation after cardiac death (DCD).The histologic damage and apoptosis of 1-h extracorporeal support had no significant difference with those before operation and in cardiac death (P＞0.05).With the extension of extracorporeal support,the intestinal mucosa damage degree was gradually increased,and the content of adenosine triphosphate in intestinal mucosa reduced gradually.Conclusion The normothermic extracorporeal support for 1 h in DCD is beneficial for improving the viability of small bowel.However,the integrity of intestinal mucosa is destroyed gradually as extracorporeal supporting time over,which may be initiated by the activation of intestinal epithelial apoptosis.

Objective To investigat the changes of hemodynamics and arterial blood gas during the establishment of ECMO model and provide an ideal platform for the study of the mechanism of DCD protection using ECMO, a porcine model of controlled donors of cardiac death (CDCD) with extracorporeal support was established in the paper. Methods Eight domestic crossbred pigs were anes-thetized, atracurium (1mg/kg) and heparin (150~200 U/kg) was administered and the ventilator was discontinued while the animal was under deep anesthesia to kill the animal.Meanwhile, blood was drained from the left jugular vein catheter into the ECMO circuit and re-turned into the left femoral artery to establish the porcine model of CDCD with extracorporeal support . The average blood press and arterial blood gas were ministered at normal, cardiac arrest and ECMO supporting 1 h, 3 h and 5 h. Results The model of CDCD with extra-corporeal support was established successfully.Two animals restored the beating of the heart and the high doses of potassium chloride were given untill cardiac arrest during extracorporeal support.Blood gases throughout the apneic time showed a severe hypoxemia and acidosis, pH and PaO2 reduced to 7.09 ±0.24 and 5.3 ±0.93mmHg respective-ly, which can be improved during extracorporeal support.MAP and PaO2 were maintained over 300mmHg and 65mmHg respectively. Conclusion A new porcine model of controlled donors of cardiacdeath with extracorporeal support has been successfully established and showed to be feasible for related pathophysiological research work.

Objective To develop a novel suspension concentrate of niclosamide (SCN) and evaluate its characteristics and molluscicidal effect against Oncomelania snails. Methods Niclosamide was milled by a sand granule mill and mixed with different amounts of wetting agent, dispersant agent, thickener, and water etc., to develop suspension concentrates, and its dispersion, suspensibility and stability were evaluated. According to the results of evaluation the best recipe and quality indexes for producing SCN were selected. The molluscicidal effects against Oncomelania snails were tested under lab condition and in field. Results The novel SCN contained 25% niclosamide (w/w), 1.5%-2.0% wetting agent (RS 3), 4% dispersant (FS 2), 0.10% thickener, a litte of other agent and water. The quality indexes which the SCN reached were as following: the content of niclosamide was more than 25%(w/w); the suspensibal rate was more than 90%; the pH was from 4 to 7; the size of more than 98% granules of niclosamide was smaller than 44?m; the thickener was smaller than 600 mpa.s. The SCN was very stable when it was stored in high or in low temperature. Under lab condition the LC 50 concentrations of SCN by the immersion method for 24, 48 and 72 hours were 0.0474 mg/L, 0.0412 mg/L and 0.0412 mg/L respectively while the LC 50 concentrations of 50% wettable powder of niclosamide (WPN) were 0.0947 mg/L, 0.0583 mg/L and 0.0442 mg/L. In the field death rates of the snails sprayed with 2.0 g/(L?m 2 ) of 25% SCN after 3, 7 and 15 days were 95.77%, 99.07%, 97.09% while the death rates of the snails sprayed with 2.0 g/(L?m 2 )of 50% WPN were 97.37%, 95.17% and 97.41%. Conclusion SCN had stable quality and high molluscicidal effect against Oncomelania snails, and it was suitable to be used in the field. The molluscicidal effect using 2.0 g/(L? m 2 ) of 25% SCN was similar with that using 2.0 g/(L?m 2) of 50% WPN.

Objective:To study the a feasibility of modified pharyngoplasty in the treatment of velopharyngeal insufficiency.Methods:30 cases of velopharyngeal insufficiency were treated with a modified pharyngoplasty followed by speech training.The effects of the treatment were evaluated by blowing test (BT),chinese articulation inteligibility test (CIT) and hypernasality observation(HO).Results:Before and after treatment BT was 1～26 and 8～40,CIT(%) 20～60 and 47～82,HO(cases) 30 and 3,respectively.Conclusions:The modified pharyngoplastic surgery is feasible in the treatment of velophayngeal insufficiency.

Objective To evaluate the clinical effect and safety of retroperitoneal laparoscopic partial nephrectomy in treatment of patients with T1b renal carcinoma.Methods Fourteen patients (11 males and 3 females) with T1b renal carcinoma were retrospectively performed.The age of patients was (54.5 ± 9.2)years old,with 8 cases on the left side and 6 cases on the right side.Tumor diameter was (5.1±1.3) cm.All the patients received retroperitoneal laparoscopic partial nephrectomy.Results None of the 14 cases was converted to open surgery.The operation time was (112.0 ± 24.7) min,the intraoperative blood loss was (64.6 ± 15.9) ml,the warm ischemia time was (26.5 ± 9.3) min.The 14 patients were not blood transfusion in intraoperative and postoperative.Postoperative negative pressure drainage placement time was (3.1 ± 1.5)d,lying in bed time was 72 h.Serum creatinine increase was found in 1 case postoperative 12 h,others were no severe complications.Postoperative pathology:the incisal margin of 14 cases were all negative,clear cell carcinoma was in 13 cases,the pathology stage was T1bNoM0;angiomyolipoma of kidney was in 1 case.All the patients were follow-up 3-16 (21.4 ± 9.6) months,all the patients had normal renal function and had no tumor recurrence or metastasis.Conclusion Retroperitoneal laparoscopic partial nephrectomy is safe and reliable for treatment of patients with T1b renal carcinoma.