Objective To study the indication and the feasibility of laparoscopic cholecystectomy (LC) combined with laparoscopic appendectomy (LA). Methods Following routine LC under general anasthesia,a dissecting forceps was introduced from the 10 mm trocar on the right McBurney point.The appendix was excised outside the abdomen,or removed by using an electrotome after the mesoappendix and the appendix root were dipped. Results The operation time was 29～76 min (mean, 48 min) and the length of hospital stay was 2～7 days(mean,3 days).Complications occurred in 3 cases: 1 case of transection of the common bile duct, 1 case of appendicular artery bleeding, and 1 case of right lower abdominal pain with unknown causes. Conclusions LC combined with LA is feasible and applicable to cholecystic benign diseases accompanying simple or suppurative appendicitis.

Objective To investigate the value of laparoscopy combined with choledochoscopy in treatment of cholecystolithiasis complicated with choledocholithiasis.Methods Clinical data of 168 patients with cholecystolithiasis and choledocholithiasis treated in our haspital from June 2005 to June 2009 were analysed.Ninety patients were randomly selected and treated by laparoscopic cholecystectomy combined with choledocholithotomy and T-tube drainage (group A),the other 78 patients,as control group,underwent routine cholecystectomy and choledocholithotomy plus T-tube drainage by laparotomy (group B).Results The hospital stay and the mean time to passage of flatus in group A was much shorter than that in group B (P0.05).Conclusions Laparoscopic cholecystectomy combined with choledocholithotomy and T-tube drainage for cholecystolithiasis and choledocholithiasis is a microtrauma management with advantages of quick recovery and shorter hospital stay,that makes it superior to the open operation.

Objective·To compare the efficacy of video-assisted thoracic surgery (VATS) and conventional lung volume reduction surgery for the treatment of patients with severe chronic obstructive pulmonary disease with a meta-analysis.Methods·Randomized controlled trials (RCT) and non-randomized control studies of VATS (the VATS group) and conventional lung volume reduction surgery (the thoracotomy group) for treating patients with severe chronic obstructive pulmonary disease were collected from databases,including Web of Science,EMbase,PubMed,the Cochrane Library,CNKI,CBM disc,WanFang Data,and VIP.The latest literature was published in November 2016.The assessment included the quality of literature and RevMan5.3 software was used to perform the meta-analysis.Results·Of 779 retrieved articles,12 studies involving 966 patients were included according to the inclusion criteria.The results of meta-analysis showed that the operation time of bilateral LVRS was longer in the VATS group than in the thoracotomy group,but the difference in the operation time of single LVRS between the two groups was not statistically significant.The difference in the duration of chest tube drainage for bilateral LVRS between the two groups was not statistically significant,while the duration of chest tube drainage for single LVRS was significantly shorter in the VATS group than in the thoracotomy group.The amount of intraoperative blood loss postoperative drainage was significantly smaller in the VATS group than in the thoraeotomy group.Postoperative pulmonary function and blood gas analysis showed that the 6 min walking distance was longer in the VATS group than in the thoracotomy group.The differences in FEV1 and PaO2 between the two groups were not statistically significant,as well as the difference in postoperative complications between the two groups.Conclusion·Comparing to conventional lung volume reduction surgery,Video-Assisted thoracic lung volume reduction surgery is a better choice.However,randomized control trials with higher quality and larger scale are required for verification this conclusion due to limitations of the quality and samples of these studies.

Objective To explore the methods for early diagnosis and treatment of blunt pancreatic injury.Methods The clinical data of 32 patients with blunt pancreatic injury treated in our hospital from Janurery 2004 to Janurery 2009 were retrospectively analyzed.Results The conformity diagnosis rate of CT was 79.3%.Four cases received nonoperative treatment including 3 cases of grade I and 1 of grade II injury.A total of 28 cases with blunt pancreatic injury underwent operation: 5 grade I and 7 grade II cases underwent debridement and drainage;among the patients with grade Ⅲ injury,4 underwent distal pancreatectomy in combination with splenectomy,and 2 pancreatectomy with spleen preservation;amongst the 5 patients with grade Ⅳ injury,4 underwent Roux-en-Y pancreaticojejunostomy and 1 underwent distal pancreatectomy in combination with splenectomy;of the 5 patients with grade Ⅴ injury,1 case was operated on using duodenorrhaphy and diverticulization,2 underwent the Whipple′s procedare and 2 had damage control surgery.Three patients died of multiple organ failure,and complications occurred in 19(76.0%).Pancreatic fistula and pancreatic pseudocysts were the main complications.Conclusions In the absence of major pancreatic ductal injury,and the clinical conditions were stable,pancreatic injuries can be treated with nonoperative management.Operative treatment is suitable for severe blunt pancreatic injury.Appropriate operation,based on patient condition and the classification of pancrecatic trauma,is the key to increase the cure rate and decrease mortality rate.

Objective:To discuss treatment of complete response cases after neoadjuvant radiotherapy in rectal cancer. Methods:This retrospective study analyzed clinical data of 84 rectal cancer cases with pre-operative neoadjuvant chemoradiotherapy in our hospital from January 2010 to Augnst 2014. Results:After neoadjuvant chemoradiotherapy, 33 patients presented clinically complete response at a rate of 39.3%. After post-operative pathologic examination, among clinically complete response cases, six cases exhibited patho-logically complete responses at a rate of 18.2%. No recurrence or disease progression occurred within 12-36 months of post-operative follow up. Conclusion:Neoadjuvant chemoradiotherapy can significantly lower tumor stage and promote clinically complete remission of some patients. However, for clinically complete remission cases, further radical surgery should be provided.

Objective To evaluate the diagnosis, treatment and prognosis of primary duodenal carcinoma. Methods The clinical data of 41 cases with primary duodenal carcinoma admired during 2000-2007 were analyzed retrospectively. Results Clinical manifestation was not specific, including abdominal pain, abdominal distention, jaundice, bowel obstruction or bleeding. The correct diagnosis rate of endoscopy, duodenography, ultrasound and CT was 86%, 90%, 20% and 33% respectively. 23 cases underwent pancreaticoduodenectomy, 6 cases received segmental duodenectomy, 9 cases received bypass operation and 3 cases underwent biopsy. Overall postoperative 5-year survival rate was 18%. Univariate analysis revealed that the operation types, tumor histology, depth of tumor invatian, lymphatic invasion correlated with prognosis. Multivariate analysis showed that only the operative types, depth of tumor invasion and lymphatic invasion were independent prognostic factors. Conclusions Duodenography and endoscopy are major methods for diagnosis of primary duodenal carcinoma. Pancreaticoduodenectomy is the choice of therapy for primary duodenal carcinoma.

OBJECTIVETo explore the feasibility and safety of scarless laparoscopic radical resection of rectal cancer.

METHODSClinical data of 26 patients who underwent scarless laparoscopic radical resection of rectal cancer from January 2011 to June 2013 were retrospectively analyzed. Lymph node dissection and transection of proximal and distal colon were performed in the conventional manner of total mesorectal excision (TME). The distal rectum 2 cm away from the tumor was closed with a linear stapler, and was pulled out through the anus. The specimen was extracted through the Alexis. The rectal opening was reclosed with a linear stapler. End-to-end colorectal anastomosis was performed using the double-stapling technique.

RESULTSThe operation time was (126±35) min. The intraoperative blood loss was (33±61) ml. The number of harvested lymph nodes was 17.0±5.6. The time to first bowel movement was (2.7±1.3) d. The postoperative hospital stay was (7.9±2.6) d. Only one case developed anastomotic hemorrhage.

CONCLUSIONScarless laparoscopic radical resection of rectal cancer is feasible.

Adult ; Aged ; Anastomosis, Surgical ; methods ; Female ; Humans ; Laparoscopy ; methods ; Lymph Node Excision ; Male ; Middle Aged ; Rectal Neoplasms ; surgery ; Retrospective Studies

Objective To investigate the effect and mechanism of miR-885-3p on the radiosensitivity of colorectal cancer cell HT-29. Methods The expression of miR-885-3p in HT-29 cells irradiated with different doses (0, 2, 4, 6, 8 Gy) of X-rays was detected by qPCR. The effect of miR-885-3p in modulating cell radiosensitivity was assessed in HT-29 cells with miR-885-3p overexpression. Bioinformatics prediction and dual luciferase reporter gene assay were employed to identify the direct target gene of miR-885-3p. Relationship between miR-885-3p and target gene tyrosine kinase 1 (AKT1) was investigated via regulation of miR-885-3p expression. The effect of AKT1 on radiosensitivity in HT-29 cells was evaluated through knockdown AKT1. The effect of AKT1 on miR-885-3p-induced radiosensitivity was detected by co-transferring miR-885-3p and AKT1 gene into HT-29 cells. Results miR-885-3p expression was up-regulated in radiation-induced HT-29 cells (F=46. 64, P<0. 05). Over-expression of miR-885-3p and knockdown of AKT1 enhanced cell radiosensitization by inhibiting survival and promoting apoptosis (t=12. 33, 12. 95, P <0. 05) with SER of 1. 602 and 1. 946, respectively. Inhibition of miR-885-3p promoted radioresistance by increasing cell survival and inhibiting apoptosis (t=11. 94, P<0. 05) with a SER of 0. 839. AKT1 is a target gene downstream of miR-885-3p, overexpression of AKT1 reversed the effect of miR-885-3p on cell radiosensitivity with a SER of 0. 680. Conclusions miR-885-3p can enhance the radiosensitivity of colorectal cancer HT-29 cells by directly targeting AKT1, which provides a target for improving the radiosensitivity of clinical colorectal cancer.

Objective To explore the feasibility and safety of scarless laparoscopic radical resection of rectal cancer. Methods Clinical data of 26 patients who underwent scarless laparoscopic radical resection of rectal cancer from January 2011 to June 2013 were retrospectively analyzed. Lymph node dissection and transection of proximal and distal colon were performed in the conventional manner of total mesorectal excision(TME). The distal rectum 2 cm away from the tumor was closed with a linear stapler, and was pulled out through the anus. The specimen was extracted through the Alexis. The rectal opening was reclosed with a linear stapler. End-to-end colorectal anastomosis was performed using the double-stapling technique. Results The operation time was (126 ±35) min. The intraoperative blood loss was (33 ±61) ml. The number of harvested lymph nodes was 17.0 ±5.6. The time to first bowel movement was (2.7±1.3) d. The postoperative hospital stay was (7.9±2.6) d. Only one case developed anastomotic hemorrhage. Conclusion Scarless laparoscopic radical resection of rectal cancer is feasible.

ABSTRACT:Objective To study the application effect of clinical nursing pathway in swal-lowing disorder patients with acute cerebral infarction.Methods A total of 60 swallowing disorder patients with acute cerebral infarction hospitalized in our department the patients were divided into control group with 30 cases and the observation group with 30 cases according to admission time. The control group was given the routine nursing while the observation group was given clinical nurs-ing pathway on the basis of control group,including swallowing function assessment,health educa-tion,psychological nursing,feeding training,basic training and rehabilitation training,diet test, discharge guidance,and one-week telephone follow-up service.On the 15th day after admission, questionnaire and kubota drinking water test was used to evaluate the extent of the mastery of swal-lowing disorder knowledge and improvement of swallowing disorder,and the complications occur-rence (aspiration pneumonia and malnutrition)was recorded.Results The awareness of swallow-ing disorder knowledge in the observation group was higher than that in the control group,the dif-ference was statistically significant(P <0.05).The improvement of total efficacy rate in the obser-vation group was higher than that in the control group,the difference was statistically significant(P<0.05).The occurrence rate of aspiration pneumonia and malnutrition in the observation group was lower than that in the control group,the difference was statistically significant (P <0.05). Conclusion Clinical nursing pathway can effectively increase the level of swallowing disorder knowledge in patients and their families ,improve the degree of swallowing disorder ,reduce the
incidence of complications of swallowing disorder,so it is worthy of widely promotion in clinic.