Objective It is controversial to the surgical treatment of the DeBakey I aortic dissection.The purpose of the study was to summarize the clinical experience on total arch replacement combined with implantation of stented elephant trunk into the descending aorta for DeBakey I aortic dissection.Methods From June 2005 to March 2008,41 consecutive patients with acute(in 31)or chronic(in 10)DeBakey I aortic dissection underwent total arch replacement combined with implantation of stented elephant trunk into the descending aorta.The mean age was 57(27～76)years.Thirty-two patients were male.The procedure was performed under deep hypothermic circulatory arrest and selected cerebral perfusion.The stented elephant trunk was implanted through the aortic arch under deep hypothermic circulatory arrest.The stented elephant trunk was an 8～10 cm long self-expandable graft.Concomitant procedures included Bentall operation and total arch replacement in 24,Wheat operation and total arch replacement in 6,ascending aorta and total arch replacement in 11.Computed tomography was performed in every patient before discharge to evaluate the postoperative outcomes of the procedure.Results Cardiopulmonary bypass time was(168±32)min.The cross clamp time was(109±24)min and selective cerebral perfusion and the lowerbody circulatory arrest time wsa(31±11)min.The in-hospital mortality was 4.9%(2/41).One patient died of hemorrhagic shock and another died of multi-organ failure postoperatively.Fourteen cases suffered complications and 12 cases were cured.One case died of the cerebral hemorrhage after 4 months due to inappropriate anticoagulation during follow up.Conclusion Ascending aorta and total aortic arch replacement combined with implantation of stented trunk into descending aorta is a safe,effective and feasible way in closing the residual false lumen of the descending aorta with a low morbidity and mortality.This procedure might contribute to a better long-term outcomes of DeBakey I aortic dissection.

OBJECTIVE: To study the effectiveness of preserving laryngeal function for senile hypopharyngeal cancer patientsolder than 65. METHOD: The clinical data of 58 surgery cases of senile hypopharyngeal cancer patients more than 65 years old were colleted and analyzed. Thirty-one cases preserved the laryngeal function, while the rest did not. Perfect preoperative preparation was done before surgery. Surgical resection specimens were sent to frozen-section examination. When the negative incisal margin was confirmed, the defect was repaired by the appilication of local stitching, ribbon muscle flap, major myocutaneous flaps, split thickness skin and replacement of esophagus by stomach. Radical radiotherapy was used after surgery. Survival rate was calculated by the Kaplan-Meier method. Chi-square test was used to compare complications of the two groups. RESULT: The 3 years and 5 years survival rate for all cases were 48.3% (28/58) and 27.6% (16/58), respectively. For patients with laryngeal function preservation, the 3 years and 5 years survival rate were 51.6% (16/31), 29.0% (9/31), respectively. For cases without laryngeal function preservation, the 3 years survival rate and 5 years survival rate were 44.4% (12/ 27), 25.9% (7/27), respectively. The result showed no obvious difference in survival rate between two groups (P > 0.05). Surgery complication rate were 45.2% (14/31) and 40.7% (11/27), without obvious differences between the two groups (P > 0.05). CONCLUSION It is feasible for senile hypopharyngeal cancer patients to choose suitable operation based on their physical conditions and the tumor extension. The key issues include well perioperative treatment management, correct indications grasp, and intraoperative repair skills improvement.
Aged ; Humans ; Hypopharyngeal Neoplasms ; surgery ; Larynx ; Survival Rate

OBJECTIVE: To systematically evaluate the efficacy and safety of harmonic scalpel in neck dissection. METHOD: Available literatures of PubMed, EMBASE, Cochrane Library, Google Scholar, CBM, CNKI, WangFang and VIP published before June 2014 were searched. Inclusion criteria and quality assessment were performed. All data were analyzed by using RevMan 5.2 software. RESULT: Fourteen studies including 632 cases were enrolled. Among them, 319 cases were in harmonic scalpel group and 313 cases in conventional resection group. Compared with conventional resection group, the harmonic scalpel group showed shorter surgery time(weighted mean difference [95% confidence intetval]: -28.01 [-36.83, -19.19], Z = 6.22, P < 0.01)and less intra-operative blood loss (weighted mean difference [95% confidence intetval]: -46.68 [-57.25, -36.12], Z = 8.66, P < 0.01). The number of cervical lymph nodes dissected and the incidence of postoperative chylous leakage were similar in both groups. CONCLUSION Using the harmonic scalpel in neck dissection was as efficient and safe as that of the conventional technique with the advantage of shorter time of surgery and less intraoperative blood loss.
Blood Loss, Surgical ; Humans ; Lymph Nodes ; Neck ; surgery ; Neck Dissection ; instrumentation ; Postoperative Period ; Surgical Instruments

Objective To investigate use of magnetic resonance diffusion tensor imaging (MR-DTI) for quantitatively evaluating the efficacy of Mailuoning Injection on non-compressive lumbar radiculitis.Methods Nine Bama mini pigs were selected and divided into group A,B and C,3 cases in each group.The non-compressive lumbar radiculitis model was established under CT-guiding.The corresponding therapeutic drugs (group A:10 mL Mailuoning;group B:10 mL normal saline;group C:10 mL diminishing inflammation fluid) were given by epidural injection on 14 d after constructing model.MR-DTI was performed before model construction,14 d after model construction and before treatment.One experimental pig in each group was taken on 3,7,14 d after treatment,performed MR-DTI and killed for taking the nerve root sample to conduct the immunohistochemical detection.The fractional anisotropy (FA) values of nerve root in MR-DTI imaging were measured.The FA values and immunohistochemical detection results were statistically analyzed.Results MR-DTI:the FA values after model construction in each group was decreased (P<0.05);the FA values on 14 d after treatment in the group A was increased,which showed statistically significant difference compared with before treatment (P<0.05);the FA values after 3,7 d treatment in the group A had no obvious increase,the difference between the group A and B was not statistically significant (P>0.05),but the FA values increase in the group C was earlier and more rapid than other two groups (P<0.05);the FA values after 14 d treatment in the group A was risen again,the FA values of bilateral nerve roots had no statistical difference between the group A with the group B and C (P>0.05),while the FA values had statistical difference between the group B and C (P<0.05).The immunohistochemical results:TNF-α integral absorbency value(IA value) on 7 d after treatment in the group A began to decline;the TNF-α IA value on 14 d after treatment in the group A and C was significantly decreased compared to group B,the difference was statistically significant (P<0.05).Conclusion Mailuoning Injection has a certain effect on non-compressive lumbar radiculitis,which can be evaluated by using DTI.

Objective To investigate the safe and effective method for laryngeal microsurgery in difficult la‐ryngeal exposure cases .Methods We selected 62 patients’ clinical data who had received laryngeal microsurgery with difficult laryngeal exposure and could not exposure by normal self -retaining laryngoscope between July 2012 and June 2015 .There were 42 cases of vocal cord polyp ,9 cases of the vocal cyst ,5 cases of the vocal amyloidosis , 4 cases of severe atypical hyperplasia of vocal cords and 2 cases of vocal cord high differentiated squamous carcino‐ma .We completed all kinds of laryngeal microsurgery to expose the glottis by adjusting the postures of patients ,in‐creasing the anesthesia depth ,using self -retaining laryngoscope with endoscopy which can be adjusted and pressing the throat .Results In 62 patients ,58 patients were successfully operated with adjustable self -retaining laryngo‐scope with endoscopy ,the success rate was 93 .55% .And 25 cases was exposed the glottis completely by increasing the anesthesia depth ,however ,when we increased the anesthesia depth ,there were 10 cases needed to combined with pressing the throat to expose .Five patients had retropharyngeal injure with different levels .One case with small jaw deformity of the vocal cord polyp surgery was not successful ,the success of electronic endoscopic under surface anesthesia surgery .The other one case with teeth unkempt and porcelain teeth and two cases of intraoperative frozen tip vocal cord cancer completed the operation of the open throat under the non trachea incision .Conclusion Most of difficult exposed laryngeal can be safely and effectively exposed through using the adjustable self -retaining laryngo‐scope with endoscopy while normal self -retaining laryngoscope can not .When necessary ,we can put 30°endoscope into the side channel of self -retaining laryngoscope to complete all kinds of laryngeal microsurgery .

OBJECTIVE: To explore the clinical characteristics and genetic basis of a child with Kartagener syndrome (KTS). METHODS: Trio-whole exome sequencing was carried out for the child and his parents, and candidate variants were verified by Sanger sequencing. Changes in protein structure due to missense variants were simulated and analyzed, and the Human Splicing Finder 3.0 (HSF 3.0) online platform was used to predict the effect of the variant of the non-coding region. RESULTS: The child had featured bronchiectasis, sinusitis and visceral inversion. Genetic testing revealed that he has harbored compound heterozygous variants of the DNAH5 gene, namely c.5174T>C and c.7610-3T>G. Sanger sequencing confirmed the existence of the variants. The variants were not found in the dbSNP, 1000 Genomes, ExAC, ClinVar and HGMD databases. Protein structural analysis suggested that the c.5174T>C (p.Leu1725Pro) variant may affect the stability of local structure and its biological activity. The results of HSF 3.0 analysis suggested that the c.7610-3T>G variant has probably destroyed a splicing receptor to affect the transcription process. CONCLUSION The compound heterozygous variants of the DNAH5 gene probably underlay the pathogenesis in the child. Above finding may facilitate the understanding of the clinical characteristics and genetic basis of KTS, and further expand the spectrum of DNAH5 gene variants.
Male ; Humans ; Child ; Mutation ; Kartagener Syndrome/genetics* ; Genetic Testing ; Mutation, Missense ; Exome Sequencing ; Axonemal Dyneins/genetics*

Objective: To discuss the effect of psychological nursing based on relaxation training for the psychological state in patients with impatced third molar removal surgery. Methods: A total of one hundred patients with impacted third molar removal surgery were selected from June 2015 to June 2017 in People's Liberation Army No. 105 hospital. According to the nursing method, all patients were divided into psychological intervention group and the control group, 50 cases in each group, the control group was given routine nursing intervention and the psychological intervention group was given psychological nursing intervention based on relaxation training. Results: The after intervention Corah's modified dental anxiety scale (6.3±1.2), Stouthard dental fear scale (62.9±6.5) scores and heart rate [(76.4±5.2) bpm], systolic blood pressure [(102.5±6.3) mmHg], diastolic blood pressure [(75.3±3.1) mmHg] levels of psychological group were significantly lower than those of the control group. The once removal success rate, intraoperative relaxation sense rate of psychological group were significantly higher than those of the control group, the teeth extraction time of psychological group was significantly lower than that of the control group, the difference was statistically significant (P=0.013, P=0.003). Conclusions Psychological nursing intervention based on relaxation training can effectively improve the mental state and stress state of patients with impacted third molar removal surgery, which is beneficial to the process of the surgery.

Objective:To share our exprience with the surgical management of pituitary macroadenoma and giant adenoma excision technique through the endoscopic transsphenoidal approach. Method:A retrospective analysis data of 27 patients with pituitary macroadenoma and giant adenoma surgery methods, postoperative complications and follow-up results. Result:All patients have no postoperative complications happened such as: nasal bleeding, intracranial hemorrhage, cerebrospinal fluid leak, blood sugar increased. Tumors invaded cavernous sinus in 5 cases, surrounded internal carotid artery in 2 cases, compressed optic chiasma in 7 cases and encroached optic nerve in 1 case. Postoperative vision decline occurred in 2 cases: 1 case recovered to the preoperative level after being taken out nasal stuffing and with conservative treatment, 1 case (preoperative visual acuity 0.1) restored light perception after conservative treatment. Postoperative diabetes insipidus occurred in 4 cases, and recovered in next week with corresponding therapy. Conclusion:Endoscopic endonasal transsphenoidal surgery is a safe and effective surgical technique.

Objective: To investigate the clinical efficacy of preoperative-, postoperative-radiotherapy and surgery for preserving laryngeal function in patient over 70 years of age with medial wall pyriform sinus cancer. Methods: Clinical data of 48 patients over 70 years of age with medial wall pyriform sinus cancer who received surgical treatment from January 2001 to December 2010 were retrospectively analyzed. Among them, 21 cases were given preoperative radiotherapy and surgery (R+ S). The radiation therapy dose was 45 Gy. And 14 cases′ larynx is preserved. In addition, 27 cases were given postoperative radiotherapy and surgery (S+ R). The radiation therapy dose was 65 Gy. And 10 cases had preserved laryngeal function. Survival rates were analyzed by the Kaplan-Meier method. Chi-square test was used to compare complications between two groups. Results: The larynx preservation rate in R+ S group [66.7% (14/21)] was significantly higher than that in S+ R group [37.0% (10/27), P<0.05]. The complication rate and decannulation rate in R+ S group were 42.9% (9/21) and 64.3% (9/14), respectively, showing no difference compared with those in S+ R group [37.0% (10/27) and 50.0% (5/10), respectively] (all P>0.05). The complication rates of patients with and without larynx preservation were 41.7% (10/24) and 37.5% (9/24), respectively, showing no difference between two groups (P>0.05). The overall 3-years and 5-years survival rates for all patients were 54.2% (26/48) and 35.4% (17/48), respectively. There was no significant difference in survival rates between R+ S [38.1% (8/21)] group and S+ R group [33.3% (9/27), P>0.05)]. In the R+ S group, the survival rates in patients with and without larynx preservation were 40.0% (4/10) and 29.4% (5/17), respectively, showing no significant difference between two groups (P>0.05). Conclusions It is secure and effective to choose the operation with laryngeal preservation for patient over 70 years of age with medial wall pyriform sinus cancer based on their physical conditions and the tumor extension. The preoperative- and postoperative-radiotherapy have the similar effect. Preoperative radiotherapy and surgery increases the laryngeal preservation rate.