Objective To evaluate the feasibility and safety of cap-assisted endoscopic nylon loop ligation (C-ENLL) as a new and simple method on gastric fundus submucosal tumors. Methods 74 cases with small gastric fundus submucosal tumors ≤2.00 cm in diameter were reviewed between January 2015 and June 2016. All cases were treated by C-ENLL. The clinical efficacy was analyzed. Results All the 74 patients underwent endoscopic ultrasonography before operation, 70 cases originated from the muscularis propria, 3 cases originated from the muscularis mucosae, 1 case originated from the submucosa. The average diameter of the lesions ranged 0.50 ～ 1.80 cm. C-ENLL achieved an en bloc resection rate of 100.0％, with a mean total procedure time of 26 min. Two patients developed delayed perforation, were treated with nylon rope and metal clip purse suture wound. All of whom were managed successfully. There was no delayed bleeding after operation. Pathological examination showed that 66.2％ (49/74) of the tumors were gastrointestinal stromal tumors. No tumor recurrence was observed during the follow-up. Conclusion The C-ENLL may be a feasible and safe method for the treatment of small gastric fundus submucosal tumors.

Objective To analyze the clinical, endoscopic and pathological data of patients with chronic diarrhea, and explore the possible risk factors of microscopic colitis (MC). Methods A prospective analysis of the clinical data of patients with complaints of watery diarrhea from June 2016 to April 2017 was conducted. All patients received colonoscopy examination with multi-point intestinal mucosal biopsy, histopathological and HE Masson staining. The history and pathology were analyzed. Results In 102 cases of watery diarrhea, MC was diagnosed in 3 cases (3/102, 2.94％), of which there were 3 cases of collagenous colitis (CC) in all these cases, all of them were female, aged 24～36 years old, and no lymphocytic colitis (LC) in all these cases. Mucous membrane of normal or mild hyperemia and edema showed only; histopathology showed epithelial cell injury, intraepithelial lymphocytosis, inflammatory cell infiltration in lamina propria, subepithelial collagen thickening. Recent hypoglycemic agents, PPIs, gluten and other factors may be closely related to the incidence of MC. Conclusion MC is an important cause of chronic diarrhea, the clinical symptoms and endoscopic manifestations are nonspecific, chronic diarrhea patients should undergo colonoscopy under multi-point biopsy, the incidence may be related to the use of certain drugs (such as hypoglycemic agents, PPIs) and some foods (gluten).

Objective To compare the effectiveness of arthroscopy assisted percutaneous internal fixation and open reduction of traditional surgery for tibial plateau fractures. Methods Between January 2012 and January 2015, 178 patients with tibial plateau fractures were treated with arthroscopy assisted percutaneous internal fixation (arthroscopy group, n = 99), and control group (n = 79) with traditional surgery for the treatment of tibial plateau fractures. The operation time, fracture healing time, intraoperative and postoperative blood loss and complications were compared between the two groups. Knee function score and the range of motion were measured according to American Hospital for Special Surgery (HSS) score standard. Results Compared with control group, the amount of blood loss in arthroscopic group was less than that in control group (P < 0.05), and there was no significant difference in the operation time compared with control group. After 18～24 months follow-up, the HSS score of the arthroscopic group was higher, the wound healing time was shorter and the complication occurred less, the difference was statistically significant (P < 0.05). Conclusion The two treatment methods can achieve good clinical results, but after arthroscopic microscopic examination of the tibial plateau fractures with benefits such as: less blood loss, not increased the operation time, shorter healing time and less complications, higher HSS score while reduced the suffering of patients and improved the efficacy.

Objective To investigate the effect of 1.94 μm thulium laser enucleation of benign prostatic hyperplasia (BPH) with volume >80 ml by morcellator. Methods From September 2014 to June 2016, there were 95 BPH patients with prostate volume over 80 ml treated by thulium laser were divided into two groups according to the surgical procedure: 45 cases in group A, prostate tissue were washed out of bladder after vapoenucleation by 1.94 μm thulium laser; 50 cases in group B, the enucleated prostate tissue were extracted by morcellator. The operation time, the decreasing level of hemoglobin on the first day after surgery, the hospitalization time, the gland tissue weight, catheterization duration, short-term incidence of complications, and the IPSS, PVP, Qmax, QOL in 3 months after surgeon of the two groups were observed and recorded. Results There was significant difference in operation time and gland tissue weight between the two groups. The group B have significantly short operation time compared with group A (P < 0.05), and obtained gland tissue remarkably exceed the group A (P < 0.05). No significant difference was found in hemoglobin level, hospitalization time, catheterization duration, and short-term complication between the two groups (P > 0.05). The IPSS, PVR, Qmax and QOL of 3 month, after operation were significantly improved but without any significant difference between the two groups (P < 0.05). Conclusion Vaporization cutting tissue or morcellating tissue after 1.94 μm thulium laser enucleation has high safety, good curative effect and low complication, while extraction prostate tissue by morcellator can shorten the operation time and get more tissues.

Objective To discuss the pain degree of the three different incisions (subxiphoid, navel, right abdomen) and the relationship between incisions local infiltration and nausea-vomiting after Laparoscopic Cholecystectomy (LC). Methods 100 patients (ASA I) scheduled for elective surgery were randomly divided into 5 groups (n = 20): Subxiphoid Group (Group A), Navel Group (Group B), Right Abdomen Group (Group C), All Incisions Group (Group D) and Control Group (Group E). Before the incisions were sutured, patients in Group A, Group B and Group C received incisions local infiltration of Ropivacaine (0.5％, 3 ml) in subxiphoid, navel and right abdomen. Patients in Group D received incisions local infiltration of Ropivacaine (0.5％, 3 ml) in all the three incisions. Patients in Group E received saline with the same volume (3 ml) in all the three incisions. The Visual Analogue Scale (VAS) pain scores were recorded when the patients left the operating room, 2 hours, 4 hours, 8 hours, 16 hours and 24 hours after the operation. The circumstances of nausea-vomiting were also recorded. Results Demographic parameters were similar among groups. The VAS pain scores declined with time gone by. The VAS pain scores:Group A< Group D < Group C < Group B < Group E (F = 7.16, P = 0.000). Comparison between groups: The VAS pain scores in Group A and Group D were significantly less than these in Group C and Group B. The VAS pain scores in Group C and Group B were significantly less than these in Group E. There is a difference among all the groups about the percentages of nausea-vomiting. The percentages of Group B were significantly less than these in the other 4 Groups (χ2 = 10.39, P = 0.034). Conclusions The pain of the subxiphoid incision was the most severe pain in the patients receiving LC. Compared with the other two incisions local infiltration, subxiphoid incision local infiltration proved to be the most effective treatment in reducing the VAS pain scores in patient receiving LC. Navel incision local infiltration proved to be the most effective treatment in reducing the percentages of nausea-vomiting after LC.

Objective To analyze the clinical efficacy of arthroscopic assisted surgery for tibial plateau fractures and discuss the characteristics of the treatment. Methods 60 patients were randomly divided into observation group and control group, 30 cases in each. The observation group was treated by limited reduction and internal fixation with knee arthroscopy, while the control group was treated with traditional open reduction and internal fixation. Among them, there were 18 cases of rupture of the free edge of the meniscus, including 11 cases of avulsion fracture of the tibial ligament of the anterior cruciate ligament and 9 cases of the rupture of the medial collateral ligament. At the end of the operation, the operation time and incision length of the two groups were observed and the two groups were followed up for 1 year after operation. The curative effect was evaluated according to the HSS functional standard of knee joint. Results After treatment, the operation time in observation group was (81.6 ± 21.7) min, which was significantly lower than that in control group (109.7 ± 31.6) min; the cut length of the observation group is shorter than the control group, two sets of contrasting differences, P < 0.05, statistically significant. Observe the incidence of postoperative complications of the group is 3.3％ in the control group incidence of complications after surgery for 20.0％, two sets of contrasting differences, P < 0.05; in terms of clinical, Observer Group of patients has a high rate of 96.7％, much better than the control group patients with 60.0％, two sets of contrasting differences, statistically significant, P < 0.05. Conclusion Arthroscopic assisted surgical treatment of tibial plateau fractures, to maximize patient cure rates, reduce the probability of complications and have a less traumatic, intuitive, reliable fixed reset features, and clinically to promote.

Objective To investigate the early diagnostic value of bronchoalveolar lavage for pulmonary aspergillosis in non-immunocompromised patients. The GM absorbances of recycled bronchoalveolar lavage fluid in different orders were compared, in order to estabilsh a uniform of broncholaveolar lavage in GM test. Methods We mainly focused on the patients (84 cases) confirmed as pulmonary infection by HRCT chest imageological examination from January 2016 to February 2017. They underwent the bronchoalveolar lavage before empirical or pathogenic antifungal therapy. Meanwhile, the lavage was collected in order of the first and the second tube. Then, BALF-GM test was performed. The GM absorbance (A) and I value of bronchoalveolar lavage fluid were detected by ELISA method. The GM test result of the first tube of bronchoalveolar lavage fluid was included into GM1 group and the GM test result of the second tube of bronchoalveolar lavage fluid was included into GM2 group. According to the standards, the patients were divided into case group (proven 2 cases, probable 7 cases, possible 13 cases) and non-IPA group (62 cases). The GM test diagnostic efficiency of bronchoalveolar lavage fluid collected in different orders were statistically analyzed between the case group and control group. Results The GM-I values showed significant difference between GM1 and GM2 groups (Z = -3.98, P = 0.000). the average rank I value of BALF-GM1 (1.78 ± 1.71) was significantly higher than the BALF-GM2. According to the ROC curve, the optimal cut-off of BALF-GM1 was 0.6, the sensitivity was 86.36％, the specificity was 93.55％, the positive predictive value was 82.61％ and the negative predictive value was 95.08％. The area under the curve of BALF- GM1 (0.941) was significantly higher than that of BALF-GM2 (0.798), indicating that the diagnostic efficiency of BALF-GM1 was higher. Conclusion The operation sequence of collecting bronchoalveolar lavage could affect the I value of BALF-GM test. The diagnostic efficiency of BALF-GM test result of the first tube of bronchoalveolar lavage fluid was higher and had the higher application value in the diagnosis of pulmonary aspergillosis.

Objective To evaluate the long-term efficacy of total laparoscopic radical gastrectomy combined with delta-shaped anastomosis in treatment of distal gastric cancer. Methods The clinical data of 128 patients with distal gastric cancer who underwent laparoscopic radical gastrectomy from January 2014 to April 2016 were retrospectively reviewed. According to the different surgical methods, patients were divided into TLDG plus DA treatment group (DA group, 72 cases) and LADG plus TA treatment group (TA group, 56 cases). The operation time, intraoperative blood loss, disconnection time, postoperative exhaust time, lymph node dissection, hospitalization time and postoperative complications were recorded. Patients were followed up monthly by call, to April 2017. Results The blood loss [(55.6 ± 12.5) vs (85.6 ± 15.8) ml] and postoperative exhaust time [(2.5 ± 1.0) vs (4.5 ± 1.5) d] were significantly lower in the DA group than that in TA group (P < 0.05). There was no significant difference between the two groups in the operation time, the removal time, the number of lymph node dissection and the hospitalization time (P > 0.05). The incidence of anastomotic stenosis (0.00％ vs 7.14％), anastomotic fistula (0.00％ vs 8.93％) and anastomotic bleeding (0.00％ vs 7.14％) in DA group was significantly lower than that in TA group (P < 0.05). All the patients were followed up for 16 to 62 months in DA group. 16 patients died of tumor recurrence or metastasis, and the cumulative survival rate was 77.78％. TA group were all effective follow-up, the follow-up time of 15 to 61 months, 14 patients died of tumor recurrence or metastasis, the cumulative survival rate of 75.00％. There was no significant difference in cumulative survival rate between DA group and TA group (P > 0.05). Conclusion In the treatment of distal gastric cancer, there is a certain advantage in the effect of laparoscopic radical gastrectomy plus delta-shaped anastomosis in the treatment of distal gastric cancer over tubular anastomosis.

Objective To evaluate the role of endoscopic retrograde cholangiopancreatography (ERCP) in treatment for biliary complications of hepatic hydatid disease. Methods From October 2010 to October 2016 , 27 patients who were admitted for hepatic hydatid disease underwent therapeutic ERCP pre- or post-operation, then we retrospectively analyzed the clinical manifestations, laboratory tests, imaging examinations, ERCP methods and therapeutic effects in perioperative period of ERCP. Results All the 27 patients who underwent ERCP pre-or post-operations because of biliary complications of hepatic hydatid disease obtained good treatment effect. There were some reasons for ERCP, 12 cases for acute suppurative cholangitis and obstructive jaundice caused by intrabiliary rupture and 7 for severe jaundice compress by large hepatic hydatid cyst, whereas 6 cases for biliary fistula and 2 for biliary stricture after operation. 6 indexes including white blood cell count (WBC), aspertate aminotransferase (AST), alanine aminotransferase (ALT), total bilirubin (TBIL), alkaline phosphatase (ALP), gamma-glutamyl transferase (GGT) were significantly different between 24 hours pre- and 48 hours post- ERCP (P < 0.05), all the patients were improved after operation. Conclusion ERCP which is performed at pre- or post- operation may be an effective treatment for biliary complications of hepatic hydatid disease such as acute suppurative cholangitis, biliary fistula and stricture.

Objective To observe the clinical application of all seeing needle system system in diagnosis and treatment of patients with hematospermia. Methods From May 2015 to September 2016, 22 patients with hemospermia were treated with seminal vesiculoscopy and seminal vesicle lithotripsy by using a all seeing needle system instead of traditional seminal vesicle. Results All the patients were successfully found the seminal vesicle gland and successfully entered the seminal vesicle gland, 16 cases had chronic inflammation of the seminal vesicle, dilute iodine rinse, 6 cases of seminal vesicle, holmium laser lithotripsy, stone basket to remove. The average operation time was (15.7 ± 6.2) min. The catheterization was performed the next day after operation. The average hospital stay was 2 d. After follow-up for 3 to 6 months, 20 patients had disappeared (90.9％). No complication was found Disease and long-term complications. Conclusion The all seeing needle system can replace the traditional seminal vesicle for the operation of seminal vesicle. The puncture system is short, directional and maneuverable. It has advantages of short operation time, simple operation, easy to master and no complications.