Objective To investigate the method and effect of laparoscopic splenectomy(LS) using the Endo-Cutter and the LapDisc.Methods Laparoscopic splenectomy(LS) using the Endo-Cutter and the LapDisc was performed in 12 patients,including 7 patients with hematopathy and 5 patients with benign tumors.The laparoscopic procedure was performed with the surgeon's left hand through the LapDisc.With the left hand providing safe retraction,a harmonic scalpel was used to incise the splenorenal ligament and the splenogastric ligament.After the spleen was mobilized,a vascular stapler(Endo-Cutter) was used to divide the splenic hilum.The spleen was delivered out of the abdominal cavity through the hand-assisted incision.Results All the LS were successfully completed and no conversion to open surgery was needed.The operating time was 35~120 min(mean,80 min),the blood loss during operation was 40~200 ml(mean,127 ml),and the hospital stay,3~6 d(mean,4.5 d).Follow-up in the 12 patients for 6 months found no complications. Conclusions Laparoscopic splenectomy using the Endo-Cutter and the LapDisc is safe and effective.

Objective To improve the effect of reoperation for postoperative upper gastrointestinal rebleeding due to portal hypertension.[WT5”HZ] Method [WT5”BZ] The operative procedure and effect of reoperation in 29 patients in our hospital within the last 7 years were evaluated and reviewed. [WT5”HZ] Results [WT5”BZ] There was no mortality and short term rebleeding; 8 patients had postoperative complications(8/29) including postoperative gastric bleeding in 4. 23 patients received barium meal examination and gastroscopy on follow up of an average of 35 months. 5 of 23 patients were found to have newly developed esophageal varices. Among them, 3 patients with moderate severe varices had had simple pericardial devascularization; 1 patient with slight varices had before had pericardial devascularization plus esophagus transection and reanastomosis. Only one out of 4 receiving mesocaval shunt developed moderate varices. None of the 7 patients receiving lower part esophagus resection plus proximal gastrectomy developed recurrent esophageal varices.[WT5”HZ] Conclusion [WT5”BZ] The result of simple pericardial devascularization was unsatisfactory. Lower part esophagus resection plus proximal gastrectomy had good short and long term result for the treatment of upper gastrointestinal rebleeding due to portal hypertension.

Objective To investigate the characteristics of thyroid surgical emergency related disease and prognosis,provide the basis to improve treatment.Methods Retrospective analysis of 24 cases of thyroid surgical emergency patients in Peking Union Medical College Hospital,Chinese Academy of Medical between 2004 and 2014who was performed,and the Fisher analytic method was used.Results According to the condition of diseases,conservative treatment for 1 case,surgical treatment for 23 cases,interventional therapy for 2 cases were performed.The overall preoperative diagnosis rate was 45.8％.The overall perioperative death were 5 cases (20.8％),total death were 7 cases(29.2％).8 cases preoperative diagnosed or highly suspected thyroid lymphoma patients were received oral or intravenous corticosteroid treatment,with the use of corticosteroids perioperative survival rate increased from 50％ to 100％.Conclusions (1) Thyroid surgical emergency with different causes should quickly make a clinical diagnosis based.on the patient's history and examination,select rational treatments.(2) Thyroid lymphoma patients that preoperative highly suspected or diagnosed,immediate received glucocorticoid treatment can reduce airway obstruction and decrease mortality,should be promoted.

Purpose:To assess the effect of surgery combined with intraoperative radiotherapy (IORT) in the treatment of rectal carcinoma.Methods:97 patients with rectal carcinoma underwent IORT with 10～30Gy by 9～16MeV elect ro n beam to the tumor bed and local lymphatic regions. Another 122 patients treate d by surgery alone served as control.Results:Surgery combined w ith IORT did not improve the 5-year survival rate and local recurrence rate in the stage Dukes A patients. IORT have increased the 3-year and the 5-year surv ival rates in the stage Dukes B patients to 19.9%?27.2%, decreased their local recurrence rates to 19%?20.2%(P

Objective To clarify if estrogen increases gastric mucosal injury in portal hypertensive rats and its role in the pathogenesis of portal hypertensive gastropathy. Methods Forty SD rats were divided into 4 groups:P + E, P, S + E and S groups. P + E and P groups received portal vein ligation and the S + E and S groups underwent sham operation. P + E and S + E groups were given estrogen intramascularly. All rats were maintained on their indiuidual treatment for 14 days. One hour before the sacrifice rats were orally lavaged with 2 ml 99% ethanol. Gastric mucosal blood flow, degree of gastric mucosal injury and mucosal NO production were determined. Results The P + E group had the highest gastric blood flow of (103?14) U compared with the other 3 groups (P

AIM: To observe effect of ? radioactive [103Pd] stent on the proliferation and apoptosis of smooth muscle cells, the mechanism of radioactive stent preventing in-stent restenosis was explored. METHODS: Fifty male New Zealand rabbits were randomized into stent group and [103Pd] stent group. Control group was set up. The materials were harvested on 3, 7, 14, 28, 56 days after operation and the following investigation were carried out, including pathomorphology, immunohistochemistry, apoptosis (TUNEL) and in situ hybridization studies.RESULTS: ① The severity of the stenosis in [103Pd] stent group was less severe than that in stent group. It was most obvious on 56 th day (P

Objective To investigate the treatment for papillary thyroid carcinoma (PTC) located in the isthmus.Methods 90 patients with PTC located in the isthmus receiving surgery from May 2007 to Dec.2013 were enrolled.Patients' age,muhifocality,capsular invasion,central compartment lymph node metastasis were analyzed and compared with the results of 82 patients who had PTC within the thyroid lobe.Results In patients with PTC located in the isthmus,those with multi foci were older((49.4 ± 9.9)years,P =0.004).Patients with capsular invasion had larger tumor((1.02 ± 0.43) cm,P =0.001).Compared with PTC within the lobe,PTC located in isthmus were more likely to be multifocal (27.8％ vs 14.6％,P =0.036)and capsular invasive(42.2％ vs.19.5％,P =0.001).Central compartment lymph nodes metastasis rate was higher in patients with PTC located in isthmus but no statistical difference was found(53.3％ vs 48.8％,P =0.551).Conclusions PTC located in the isthmus tends to be more aggressive at early stage.Central compartment lymph node metastasis occursearly and can be on both sides.Most patients should receive total thyroidectomy and central compartment lymph node dissection of both sides,but there's no need to dissect lymph node beneath the recurrent laryngeal nerve on the contralateral central compartment.

Objective To summarize our experiences in the diagnosis and prognosis of different subtypes of primary thyroid lymphoma (PTL). Methods The clinical data of 27 PTL patients who were treated in our hospital from January 1998 to December 2014 were retrospectively analyzed. The pathological types of these patients included B cell lymphoma unclassifiable (BCLU) (n=5),mucosa-associated lymphiod tissue lymphoma (MALT) (n=9),diffuse large B cell lymphoma (DLBCL) (n=12),and T cell lymphoma (n=1). Results Of all these 27 cases,the most common clinical symptom was painless swelling of the neck (n=21,77.8%). Of 7 patients who had received preoperative fine needle biopsy,lymphoma was suspected in 2 cases (28.6%). Among these 7 cases,the positive rate of suspicious lymphoma was 66.7% in 3 DLBCL patients,0 in 3 MALT patients,and 0 in 1 BCLU paitent. Also,25 patients underwent intraoperative frozen pathological examination,which revealed lymphoma or suspicious lymphoma in 16 cases (64.0%); in these patients,the positive rate was 66.7% for BCLU,77.8% for MALT,58.3% for DLBCL,and 0 for T-cell lymphomas. The overall survival was (89.3±12.4) months,and the overall 5-year survival rate was 61.6%. The estimated survival in symptomatic group was 31.6 months,which was significantly shorter than that in asymptomatic group (97.9 months) (P=0.032). Other factors including age,sex,tumor size,tumor stage,international prognostic index,tracheal compression,lactate dehydrogenase,residual tumor,and pathological type showed no significant effect on survival(all P>0.05). Conclusions DLBCL has the highest fine needle biopsy positive rate,MALT has the highest frozen pathological positive rate,and intraoperative frozen pathology has more malignant results than the preoperative fine needle biopsy in the diagnosis. The accompanying lymphoma symptoms may be an adverse prognostic factor.

Objective: To study effects of Naomaitong on injury of cerebro-microvessel basement membrane in different periods and gene expression of gelatinase system after cerebral ischemia/reperfusion(I/R) in rats.Methods: Focal cerebral ischemia/reperfusion model was established by MCAO method of the intraluminal filament technique.Rats were divided into sham-operated group,model group,Naomaitong group and Nimodipine group at random,the later three groups with ischemia 3h and I/R 6h,12h,24h,3d,6d.Ransmission electron microscope and hybridization in situ method were used to observe the structure of micrangium and gene expression of gelatinase and its inhibitor.Results: Under electron microscope,the pathodamage in medico-group seemed lighter.According to the gene expression of gelatinase system,Naomaitong could step down the mRNA expression of MMP-2(I/R 6h-6d)and MMP-9(I/R 12h,I/R 3d).And increase the mRNA expression of TIMP-1(I/R 6h-3d).Conclusion: The protection of Naomaitong on cerebro-microvessel basement membrane after cerebral I/R in rats are related to the gene expression regulation of gelatinase system.

Objective: Lymph node metastasis (LNM) often occurs in cN0 papillary thyroid microcarcinoma (PTMC). The risk factors for lymph node metastasis, especially for high-volume metastasis, were investigated in this study. Methods: The medical records of 1,268 consecutive PTMC patients admitted in the Peking Union Medical College Hospital from 2013 to 2014 were reviewed. Their clinical and pathological features were collected. Univariate and multivariate analyses were performed to identify the risk factors for LNM/highvolume LNM. Results: Of the 1,268 patients, 416 patients (32.8％) and 43 (3.4％) had LNM and high-volume LNM, respectively. According to the univariate analysis results for the risk factors of LNM, male (42.22％ vs. 30.26％, P<0.01), <40 years (<40 years, 48.39％; 40-59 years, 27.62％; ≥60 years 22.45％, P<0.03), multifocality (41.00％ vs. 29.03％, P<0.01), without chronic thyroiditis (36.44％ vs. 20.62％,P<0.01), tumor size >0.5 cm (35.77％ vs. 23.05％, P<0.01) were associated with LNM. Meanwhile, according to the multivariate analysis results, male, multifocality, and tumor size >0.5 cm are independent risk factors for LNM (OR=1.516, 1.743, and 1.788, respectively, all P<0.05). The protective factors for LNM are 40-59 years, ≥60 years, and chronic thyroiditis (OR 0.388, 0.301, and 0.472, respectively,all P<0.05). In the univariate analysis of risk factors for high-volume LNM, the results indicated that being male (6.30％ vs. 2.61％, P= 0.005), <40 years (<40 years, 7.62％; 40-59 years, 2.05％; ≥60 years 0, P<0.001), and tumor size >0.5 cm (4.01％ vs. 1.36％, P=0.027) are associated with high-volume LNM. In multivariate analysis, the results suggest that being male is an independent risk factor for LNM (OR=2.383, P=0.002), whereas age of 40-59 years is a protective factor for LNM (OR=0.270, P<0.001). Conclusion: Lymph node metastasis often ocucrs in cN0 PTMC, whereas high-volume LNM is rare. Being male and <40 years old are risk factors for both LNM and highvolume LNM.