Objective: To summarize experiences in 136 cases of retroperitoneal laparoscopic surgery. Methods:From April 1997 to May 2002, retroperitoneal laparoscopic surgery were performed for 136 cases of adrenal dis-eases. There were 63 aldosterone- producing adenoma, 22 adrenalcortical adenoma, 39 nonfunctional adrenal tu-mor, 7 adrenal cyst and 5 phenochromocytoma. Results: Except for one case converts to open surgery, success hasbeen achieved in all cases without major complications. Intraoperative blood loss was 76 + 32ml without blood trans-fusion. Postoperative hospital stay was 6 + 3 days. There were statistical differences among these indices when com-paring to those of open surgery for 126 cases with adrenal diseases( P ＜ 0.05). But operative time was little longer inlaparoscopic group than in group of open surgery(P＜0.05) ,whereas it has been changed to similar in those recentcases. Conclusion:Retroperitoneal laparoscopic surgery was less traumatic to the patients, with less postoperative dis-comfort and quicker recovery and should be considered the first choice of therapy for adrenal disorders.

[Objective] To discuss the clinical significance of simple synovial tuberculosis treated and diagnosed by arthroscopy. [Methods] A review study of 8 patients with simple synovial tuberculosis from September 1998 to September 2004. The 8 cases with the main clinical manifestation of articular swelling were confirmed as simple synovial tuberculosis by arthroscopic examination and arthroscopic synovectomy in pathology. [Results] The 8 cases were definitely diagnosed by arthroscopy pathologically. The average follow-up period was two years and four months. For all of the 8 cases, the articular symptoms disappeared, articular function recovered well and the therapeutic effect was satisfactory. [Conclusion] Arthroscopic examination is an effective method to diagnose synovial tuberculosis at early stage. Synovectomy with arthroscopy can remove the pathological synovial membrane and is beneficial to the control of the local tubercular focus.

[Objective] To investigate the endoscope feature of gastric signet-ring carcinoma and evaluate the methods of diagnosis and treatment. [Methods] To retrospectively analysis 36 cases who were confirm diagnosed.Their clinical feature, endoscope feature, pathologic types and curative effect of therapy were analyzed. [Rusult]Most carcinoma site located at anterior or posterior wall at lesser curvature of mid-upper part of gastric body. Endoscope feature: mucosa plica were tumefactional, small node formated, erosion, it was easy to bleeding. Biopsy: Mojority carcinoma type was BorrmannⅡ and Ⅱb and Ⅱc type. More topical biopsy and deep biopsy were necessary for improving biopsy positive rate. [Conclusion] Endoscope and biopsy are effective methods for early diagnosis of gastric signet-ring carcinima.

Objective: To report our prelimilary experience of laparoscopic radical prostatectomy (LRP) for clinically localized prostatic cancer.Methods:23 cases with localized prostatic cancer underwent LRP in our institution from October 2000 to August 2003. The median age was 64.5 years old, the median PSA was 13 ng/ml and median Gleason score of biopsy specimens was < 7. The operations were performed according to Montsouris technique. Briefly, operations were carried out transperitonealty, combining posterior and anterior approachs to the prostate, transecting the bladder neck, lateral dissection of the prostate, urcthrovesical anastomosis, completing the operation.Results:No death and no conversion rate were observed in this series of 23 cases of LRP. No re-intervention was needed. The median operating time was 325 minutes (range 270 to 660 min) including the lymphadenectomy phase that was considered necessary in the case whose PSA value was 51ng/ml and pathological reading was negative to thoses lymph nodes; The median intraoperative blood loss was 430 ml(rang 200 to 1100 ml). Postoperative bladder catheterization time was 20 days. Surgical positive margin was found in I case of pathlogical stage of pT2b and Casodex 50 mg had been used on this case for 3 mon after the PSA value was < 0.2 ng/ml. Postoperation follow-up of 3 to 24 mo. showed no signs of complications such as urethral stricture or urine incontinence. The PSA concentrations was < 0.3 ng/ml in all cases.Conclusions: LRP provides a clear and magnified anatomical image to allow a more precise and safer dissection.

Objective:The aim of this study was to explore the epidemiological characteristics of large intestine carcinoma in North Zhejiang.Methods:A retrospective review of clinical records and endoscopic findings of 339 large intestine carcinoma patients (detected from 5320 endoscopic examinees) throught past 8 years was executed.Results:General detection rate was 6.37%.Annual detection rate fluctuated between 4.60% and 8.79%.The detection rate for male was slightly higher than that for female.The ratio of male to female was 1.15∶1.The 41～60 years interval was the susceptible age interval (48.37%);rectum and sigmoid colon were the most frequently sites involved (71.38%).Most (89.38%) of the carcinomas were adenomatous histopathologically.Conclusions:There were susceptible age interval and topological sites for large intestine carcinoma.Most of them were adenomatous.Annual detection rate in this region through the past 8 years showed neither rise nor decline year by year.

Objective:Combined laparoscopy and hysteroscopy in the diagnosis and therapy of the female infertity is and advanced means in the gynecologcial field.We analysed the causes and the treatments of the 71 infertile patients.Pelvic adhesions,endometrosis and salpingtis were the main causes of infertity in our 71 cases.Of 71 cases,29 cases were primary infertity,in whichc endometriosis,PCOS and anatomic uterine defect were the main causes,and 42 cases were secondary infertity,in which 35 cases (83%) had previous intrauterine operations.All the patients were treated for the causes.We concluded that combined laparoscopy and hysteroscopy can diagnose the causes of infertity and can observe the tubal patency by hysteroscopic tubal cathertetization and hydrotubation,which will direct the treatments and estimate the results of the therapy.Methods:Infertity;Combined Laparoscopy and Hysteroscopy.

[Objective] To explore the techniques of hand-assisted laparoscopic splenectomy plus portozygos disconnection procedure. [Methods] 18 patients with portal hypertension were operated by hand-assisted laparoscopic splenectomy plus portozygos disconnection. [Results] The operations were completed successfully. The mean operative time was 180(150～260) minutes, the mean blood loss estimated was 540(200～2 000) mL, the mean weight of spleen was 910 (500～2000) g and the mean length of hospital stay was 9.7 (8～18) days after operation. All patients had recovered rapidly and suffered less pain and only 5 patients needed analgesic. The mean recovery time of the bowel function was 52(24～74) hours. The hand incisions healed well, and only one occurred complications and another suffered death. [ Conclusions ] Hand-assisted laparoscopic splenectomy plus portozygos disconnection procedure is to be feasible and safe, and has the merits of minimally invasive surgery.

Objective To evaluated the security of endoscopic retrograde cholangiopancreatography (ERCP) among the patients aged over 80 years. Methods 80 patients who were accepted ERCP and aged over 80 years were analgzed, to learn the diseases of patients and evaluate what the impact of ERCP. To complete ERCP in the shortest time, we observed of vital signs, abdominal symptoms and nasal biliary drainage rigorouly after the opration , and to test blood routine, serum amylase, urine amylase and biochemical indicators, detect whether secondary or aggravate other organs damage within 1 week. Results There were 11 cases (13.75%) had secondary organs damage, the percentage of with over two diseases is 51.25%, 78 cases (96.25%) accepted the ERCP, the primary success rate of lithotomy in 55 cases of common bile duct stones is 74.55%, among them there were 3 cases accepted internal drainage by cutting the nasobiliary since they can not be conducted lithotomy once more. One patient of pancreatic carcinoma complicated with duodenal stenosis was treated in implantation of biliary metal stent after accepted the dilation of bile duct , and then the stent was implanted in the narrow duodenum. One patient was died of heart failure, renal failure and respiratory failure after one week; There were no other serious complications occurred, the total incidence rate of complication was 7.50%, the average operation time was (26.64 ± 8.31) min. Conclusions The patients over 80 years old are relatively safe for ERCP, the effect is obviously, and appropriate management of perioperative can reduce the incidence of complications.

Objective To evaluate the efficacy and safety of one-step dilation technique in minimally invasive percutaneous nephrolithotomy (MPCNL). Methods Clinical data of 2813 patients who underwent MPCNL by one-step dilation technique from February 2011 to March 2015 was retrospectively analyzed. Results 2813 patients were successfully underwent MPCNL by one-step dilation, including 2383 cases who were accessed by single tracts (84.71%) and 430 (15.29%) cases by multiple tracts. The mean operating time was (78.6 ± 41.1) min, the mean tract accessing time was (2.3 ± 0.8) min.The stone-free rate after one session operation was 78.59%. It improved to 91.50% one month after operation. During and after operation, 93 cases needed transfusion, 21 underwent selective renal artery embolization. Adjacent viscera damage: 9 cases with pleural lesions and 1 case with colon injury, 13 cases with urinary extravasation, perirenal hematoma in 15 cases, without liver and spleen injury. Septic shock in 2 cases, who was recovered after anti-infection treatment. Conclusion One-step dilation is safe and effective technique to establish tracts in MPCNL, which can reduce X-ray exposure and operation time, but does not increase the risk of bleeding.

Objective To explore the clinical effects on endoscopic treatment of chronic pancreatitis (CP) and the improvement of the symptoms of patients with abdominal pain, to provide basis for clinical treatment. Methods 81 patients with CP treated by endoscopic were selected from July 2011 to June 2013. Observe the efficacy, complications and bellyache. Results The operation of 81 patients were all successful, no death case. 1 week after the average pain was of (2.29 ± 0.14), lower than before the operation (7.13 ± 0.27), the difference was significant (P < 0.05). 1 week after, the operation, painless, mild pain and moderate pain were 46.91% (38/81), 35.80% (29/81) and 13.58% (11/81), were higher than those of preoperation (P < 0.05). The severe pain of after 1 week was 3.70% (3/81), lower than the preoperative 56.79% (46/81) (P < 0.05). 1 week after the operation, fatty diarrhea and malnutrition were 0.00% (0/81) and 7.41% (6/81), were lower than the preoperative 25.93%(21/81) and 37.04% (30/81), the difference was significant (P < 0.05). After 1 week, serum amylase concentration was (74.18 ± 2.75) u/L, was lower than the preoperative (182.45 ± 8.32) u/L, the difference was significant (P < 0.05). Conclusion Endoscopic treatment of chronic pancreatitis was fewer complications, reliable, and with the advantages of minimally invasive and repeated. It was effective in the treatment of patients with chronic pancreatitis and could effectively alleviate the pain.