The traditional teaching modes and approaches of medicine are facing with unexpected challenges and opportunities.In order to train high-quality medical students,we now need to reconsider and reform the traditional teaching modes and approaches of medicine. This essay will provide some suggestions of teaching reform in clinic medicine.

Objective:To review the feasibility and efficacy of partial lumbar sympathectomy for Buerger's disease with video-assisted laparoscopic lumbar sympathectomy (VALLS).Methods:From July 2002 to Octomber 2003,7 patients with Buerger's disease were treated in our hospita1 with VALLS.3 cases underwent bilateral resection,3 cases left side resection,1 case right side resection,1 case common femoral-superficial femora1 artery bypass,1 case right greater saphenous vein arterialization,and 2 cases toes amputation.Results:All the 7 cases were confirmed by pathological examination(one was reported as one lymph node).The skin temperature of lower limb immediately rose significantly after operation.Serious complications were not found in all the patients.Only one case developed aerodermectasia,but recovered completely after three days of symptomatic therapy.Follow-up survey of 2-18 months(with mean of 8.7 months)showed the effect was satisfactory with the manifestations of normal limb temperature,improved blood supply,remission and resolution of the pain.Conclusion:Because of its small incision,little wound,excellent view of the retroperitoneal space and accurate anatomical location,VALLS is relatively simpler than classical operation and its effect is satisfactory.

Objective: To explore the Prevention and Cure of the Complications of video - assisted Laparoscopic Lumbar Sympathectomy (VALLS). Methods; 13 cases of Buerger' s disease treated with VALLS were retrospectively reviewed. Results; Serious complications were not found in all the patients. Only two cases developed aerodermectasia. Conclusions: VALLS is the ideal minimally invasive surgery for Buerger's disease. Only then grasps the laparoscopic operation skill and anatomy of retroperitoneal space, protects the neighbor important structures, can the complication fall to the lowest.

Objective To study systematically regional anatomy of lumbar sympathetic trunk to provide anatomic information for endoscopic lumbar sympathectomy (VALLS). Method The anatomy of the lumbar sympathetic trunk and its relationship with neighboring structures were studied in 128 sides of adult cadavers, and it was substantiate in 13 cases of endoscopic lumbar sympathectomy. Results (1) The location, shape and number of the sympathetic ganglia were quite variable. The number varied from 1 to 6 on one side. (2) It was found that the lumbar sympathetic trunk split into 2-3 branches at the distal portion. (3) Lumbar arteries were all located under the lumbar sympathetic trunk and the lumbar veins situated superior to the trunk in 68.42%±4.35% of instance. (4) Genitofemoral nerve was found to pierce the psoas muscle at the level of 2nd to 4th vertebra or its intervertebral discs. It was only 0.81±0.48 cm away from the medial rim of the psoas muscle. (5) Distance between ureter- iliac vessel junction and the lateral edge of the psoas muscle was 3.36±0.59 cm on the left side, and 3.41±0.59 cm on the right side. (6) A report of the experience of our 13 VALLS was presented. Conclusions Because of great variation and complicated anatomic relation between lumbar sympathetic trunk with its neighboring structures, familiarity to the anatomy of the retroperitoneal space is cracial for a successful minimal invasive laparoscopic lumbar sympathectomy.

Surgical science is one of the chief courses in medical college.The teaching quality of clinical practice has a great influence on the trainees whether they can become qualified doctors as quickly as they can.This paper discusses mainly how to develop the students' scientific clinical thinking ability,enhance basic operating skills and deal with the relationship between doctors and patients.

With the development of the society,general surgery teaching has faced higher demands.This paper mainly discusses how to increase comprehensive quality,medical ethics and manipulation capability of the surgeons.

Objective To compare enteral nutrition (EN) and parenteral nutrition (PN) in the treatment of severe acute pancreatitis (SAP), in order to elucidate the feasibility and advantage of EN. Method 65 patients were randomly divided into PN and EN groups. The nutritional status and the immunologic index were determined on the 1st, 7th and 14th day after giving the nutritional support, and the incidence of the complications, infection rate, mortality rate, hospital stay days and hospital expenditure were compared. Results After giving the nutritional support, the serum contents of albumin and transferrin were increased obviously, and blood glucose and blood diastase were lowered significantly in both PN and EN groups (P

Objective To compare the video-assisted laparoscopic lumbar gangliosympathectomy with open lumbar gangliosympathectomy on their advantages and disadvantages. Method From June 2002 to May 2006, a total of 21 adults with Buerger's disease underwent the video-assisted laparoscopic lumbar gangliosympathectomy. The operation time, intraoperative blood loss, hospitalization time, postoperative effects and postoperative complications were analyzed. The data of the 21 cases were compared with those from other 27 cases with Buerger's disease who had undergone open lumbar gangliosympathectomy in the same period. Results The operation time was longer in the laparoscopic group (174?14.84min) than that in the open group (132?32.81min, P

Objective To research regional anatomy of lumbar sympathetic trunk and provide anatomic information for video-assisted laparoscopic lumbar sympathectomy(VALLS).Methods Lumbar sympathetic trunk and its neighboring anatomic relation in 128 sides of adult cadavers and 21 clinic VALLS were retrospectively reviewed.Results ① The location,shape and number of the sympathetic ganglia were quite variable.There was 1 to 6 in number unilaterally.② Lumbar sympathetic trunks of 12 sides in 128 sides were found dividing into 2-3 branches at the distal part.③ Lumbar arteries were all located under the lumbar sympathetic trunk and the lumbar veins consisting 68.42% situated superficially to the trunk.④ Genitofemoral nerve pierced the psoas muscle at the level of 2nd to 4th vertebrate or its intervertebral disc.It was only(0.81?0.48)cm away from the medial rim of the psoas muscle.⑤ Distance between ureter-iliac vessel junction and the lateral rim of the psoas muscle was(3.36?0.59)cm at left side and(3.41?0.59)cm at right side.The operation time was 2-3.5 hours and the intraoperative blood loss was 50-80 ml.There were no severe complications and the effects were satisfying.Conclusion Because of great variants and complex neighboring anatomic relation of lumbar sympathic nerve,the critical factor of successful microinvasive VALLS is to grasp the laparoscopic operation skill and anatomy of retroperitoneal space(especially the regional anatomy of lumbar sympathetic trunk)and carefully operating.

Objective To investigate somatostatin receptor subtype 2 (SSTR2) mRNA expression and its correlation with proliferating cell nuclear antigen (PCNA) in human colorectal cancer. Methods A total of 60 colorectal cancer samples were analyzed. The SSTR2 mRNA expression was examined by in situ hybridization (ISH) using multiphase oligoprobes. The PCNA were detected by immunohistochemical staining. A computerized image analysis system was utilized to estimate the relative contents of SSTR2 mRNA. Results The positive rate of expression of SSTR2 mRNA and relative contents in early and well-differentiated colorectal cancer were higher than those in advanced and poorly differentiated lesion. A negative correlation between SSTR2 mRNA expression and PCNA was found in colorectal cancer. Conclusion In the samples of colorectal cancer, the expression of SSTR2 mRNA is correlated with the degree of differentiation and clinical stage, and it plays an important role in reflecting the degree of malignancy and prognosis.