Objective To evaluate the effects and cosmetic results of total removal of the glands for male gynecomastia . Methods A total of 13 male patients with gynaecomastia were operated by using the method of keyhole-style total removal of the glands from March 2012 to March 2013.The fat lysate was injected into the subcutaneous area of the breast enlargement .Then an incision about 1.0 cm in length was made by the side of areola , through which a vacuum aspiration was carried out to suck the fat tissues.Also, the hypertrophical breast tissues were excised gradually .Finally, the incision was closed with medical biological adhesive or absorbable suture . Results The time of unilateral operation was 40-100 min ( average , 70 min) .The amount of blood loss was 20-50 ml (average, 30 ml).Subcutaneous effusion occurred in 2 cases (accompanying local hematoma in 1 case), which was cured by repeated aspiration for 3 days.The postoperative hospitalization was 2-5 days (mean, 2.8 days).All the patients were cured with incision healed by first intention and no obvious scars left .There was no necrosis on the nipple or areola .The breast curve was flat and natural .A total of 8 cases were followed up for 3 months, with satisfactory appearance .Three patients felt numbness of nipples and areola of breast after surgery and the symptom disappeared 3 months later . Conclusion Keyhole-style total removal of the glands for the male ynaecomastia has advantages of easy operation ,safety,and good cosmetic results .

Objective To investigate the diagnostic value of hysteroscopy combined with B -ultrasonography for uterine incision diverticulum after secondary cesarean section . Methods From May 2012 to May 2013, hysteroscopy check was performed in 38 cases with a history of two times of caesarean sections . The hysteroscopic results and ultrasound images were analyzed retrospectively . Results Incision diverticulum was diagnosed in 34 cases by using diagnostic hysteroscopy combined with B-ultrasonography, with a diagnosis rate of 89.5%(34/38).There were 18 cases of mild diverticulum (47.4%), 16 cases of severe diverticulum (42.1%), and 4 cases of good healing (10.5%).Of the 16 cases of severe diverticulum , the distance from top to serosal surface was 1.6-6.0 mm, and the width was 3-17 mm.Preoperative transvaginal ultrasonography ( TVS) showed only 10 cases of uterine incision diverticulum in patients with severe diverticulum , providing a diagnosis rate of 26.3% (10/38).Compared TVS with hysteroscopy combined with B-ultrasonography , there was a significant difference (χ2 =31.091, P=0.000) in the diagnosis rate for uterine incision diverticulum . Conclusion Hysteroscopy combined with B-ultrasonography has a high diagnosis rate for the diagnosis of uterine incision diverticulum in patients with two times of cesarean sections , being worthy of clinical application as a minimally invasive examination method after cesarean sections .

Objective To investigate the feasibility and safety of three-dimensional video-assisted thyroidectomy (3D VAT). Methods During January to April of 2014, 10 cases with unilateral or bilateral thyroid benign diseases , thyroid cancer, or parathyroid lesions were enrolled .The 3D VAT was carried out by using a 10-mm 3D stereoscopic endoscope .Local excision or lobectomy was performed via a 2-4 cm curve skin incision one finger above the sternal notch .In two patients , lobotomy combined with systematic lymphadenectomy was performed when papillary thyroid microcarcinoma was identified during operation . Results All the procedures were accomplished successfully under 3D video-assisted system, without intra-operative abnormal blood loss or conversion to conventional thyroidectomy .The operative time was 30-90 min (61.8 ±22.4 min);the intra-operative blood loss was 1.3-93.0 g (median, 5.2 g).All the patients were followed up for 1-4 months.Neither intra-nor post-operative complications about recurrent laryngeal nerve , superior laryngeal nerve , or parathyroid were observed . Conclusions Preliminary impression emerging from this study seems to suggest that 3D VAT is safe and effective.Compared with 2D surgery, a good perception of depth and easy recognition of anatomic structures are noticeable .

Objective To investigate the causes and prevention of bile duct injury during laparoscopic cholecystectomy (LC). Methods Clinical data of 16 cases of bile duct injury during LC between January 2004 and November 2013 (9 cases from Songqiao Central Hospital and 7 cases from Northern Jiangsu People ’ s Hospital ) were analyzed retrospectively .The bile duct injury was found intraoperatively in 10 cases, 4 of which were given common bile duct repaired with T tube drainage , 1 of which was given common bile duct anastomosisd with T tube drainage , 1 of which was given Roux-en-Y anastomosis , and 4 of which were given suturing of leakage at the gallbladder bed .The bile duct injury was found postoperatively in 6 cases, 3 of which were given peritoneal drainage , 2 of which were given reoperation of bile duct repaire with T tube drainage , and 1 of which underwent percutaneous gallbladder drainage guided by B ultrasonography . Results The hospitalization stay was 12-23 days, with an average of 16.3 days.All the patients were cured after treatment .Among the 16 cases of bile duct injury , the T tube was removed 3 months later in 6 cases of common bile duct repaired with T tube drainage , and the T tube removed 6 months later in 1 case of common bile duct anastomosis with T tube drainage.No complications or dysfunctions occurred in postoperative follow-up ranging from 3 months to 8 years. Conclusions We should pay more attention to causes of bile duct injury in laparoscopic cholecystectomy , especially indications for emergency cases .The relationship among the common hepatic duct , common bile duct , and cystic duct should be carefully identified .A timely conversion to open surgery is needed if necessary .

Objective To assess the application and effects of meticulous capsular dissection technique in the prevention of recurrent laryngeal nerve and parathyroid injuries in thyroid operations . Methods A retrospective analysis of clinical data of 195 cases which received meticulous capsular dissection technique in thyroid operations from June 2007 to June 2012 was carried out .All the cases were supermicro-dissected in the loose clearance between real and false thyroid capsules , leaving the blood vessel dissected close to the real thyroid capsule . Results The operation was successfully performed in all the 195 patients, with recurrent laryngeal nerve clearly exposed in the operation in 9 patients.There were 4 cases of transient recurrent laryngeal nerve paralysis (2.1%) and 1 case of permanent paralysis (0.5%).No permanent recurrent laryngeal nerve and superior laryngeal nerve injuries and permanent hypoparathyroidism happened in the remaining cases . Conclusion The use of meticulous capsular dissection technique not only can effectively avoid the superior laryngeal nerve and recurrent laryngeal nerve injuries , but also can preserve in situ parathyroid glands and their nutrient vessels .

Objective To explore the curative effects of microsurgical clearance for supratentorial hypertensive intracerebral hemorrhage. Methods A retrospective analysis of clinical data of 30 cases of supratentorial hypertensive intracerebral hemorrhage in our hospital from January 2010 to January 2013 was carried out. According to the head CT images, the position of incision was determined. Under orotracheal intubation general anesthesia, a bone flap craniotomy was performed. A cortex fistula 2-3 cm in length was made. Then by using an automatic retraction device, the hematoma was revealed from the shallower to the deeper, and microscopic clearance of hematoma was completed. Results All the 30 cases of operation were successful. Re-examination of head CT scans on the first postoperative day showed hematoma was completely removed in 14 cases, was 90%cleared in 11 cases, and 80%in 5 cases. Four patients died within 4 weeks after operation (13.3%):2 patients died of cerebral hernia caused by brainstem function failure, 1 patient died of lung infection, and 1 patient died of multiple organ failure. The postoperative survival rate was 86.7%.The ADL grade assessment 3 months after operation showed gradeⅠin 7 cases, grade Ⅱin 9 cases, grade Ⅲin 6 cases, grade Ⅳ in 3 cases, and grade Ⅴin 1 case. Conclusion Microscopic hematoma clearance and open haemostatic intervention has advantages of little brain tissue damage, good haemostatic results, and satisfactory efficacy.

Objective To evaluate the key points of anesthetic management for retroperitoneoscopic nephrectomy combined with inferior vena cava ( IVC ) tumor thrombectomy. Methods Perioperative clinical data of 3 patients undergoing retroperitoneoscopic nephrectomy combined with IVC tumor thrombectomy from December 2010 to June 2014 were retrospectively analyzed.There were 2 cases of level Ⅰthrombus and 1 case of level Ⅱthrombus.All the patients were given general anesthesia with intubation.Brief inferior vena cava occlusion was performed in the patient with level Ⅱ thrombus. Results The operation was completed smoothly in all the cases without conversions to open surgery. The operating time was 244, 333, and 289 min, respectively. The total IVC control time for level Ⅱ thrombus was 10 min.No intraoperative pulmonary embolism and other severe anesthetic complications occurred. One patient with level ⅠIVC thrombus was extubated and sent back to surgical ward after surgery, and the remaining 2 patients underwent intensive care monitoring overnight and were extubated and discharged to surgical ward on the next day. Conclusions Retroperitoneoscopic nephrectomy and IVC thrombectomy is a brand-new, difficult but feasible procedure. Anesthesiologist should have a full recognition of surgical procedures and make perfect anesthetic plan to ensure close collaboration. Furthermore, circulatory swing during IVC clamping and perioperative severe complications such as pulmonary embolization and massive hemorrhage cannot be neglected.

Objective To review systemically the effectiveness and safety of mesh versus traditional colporrhaphy for pelvic organ prolapse . Methods The literature were retrieved from the PubMed ( 1980 -2013 ) , Cochrane ( 1995 -2013 ) , Google Scholar (1980-2013), CNKI (1980-2013), and SinoMed (1980-2013).The randomized controlled trials (RCT) were collected and compared, and the data were analyzed by using the RevMan 5.0 software. Results There were totally 10 randomized controlled trials collected .Meta-analysis showed that:the operation time was significantly longer in the mesh group than that in the colporrhaphy group [WMD:16.57 min, 95%CI:14.06-19.08 min, P<0.00001]; the intraoperative blood loss was significantly more in the mesh group than that in the colporrhaphy group [ WMD: 24.98 ml, 95%CI:7.13 -42.84 ml, P=0.006]; the mesh group was superior to colporrhaphy group in the increase of objective cure rate [OR:4.16, 95%CI:3.10-5.58,P<0.00001] and subjective cure rate [OR:2.13, 95%CI:1.55-2.91, P<0.00001]; as compared with all various relating operations , the incidence rate of dyspareunia was statistically significant (P=0.04), whereas there were no statistical differences in postoperative recurrence of urinary incontinence and re-operation (P=0.13, P=0.06). Conclusion Apllication of mesh for pelvic organ prolapse can improve the objective and subjective cure rates .Mesh may be usefully applied to the treatment of pelvic organ prolapse , and further high-quality prospective studies are needed .

Objective To explore the safety and feasibility of conservative laparoscopic salpingotomy and embryo removal . Methods A total of 24 patients with tubal interstitial pregnancy underwent laparoscopic salpingotomy and embryo removal between January 2012 and January 2014.A longitudinal incision was made on the bulge lesions under laparoscope .The gestational sac and affiliated organizations were removed and the incision was continuously sutured with absorption threads .Results The operation was completed in all the 24 patients.The operation time was ( 33.5 ±6.2 ) min, and the blood loss was ( 40.6 ±9.4 ) ml.No postoperative persistent salpingocyesis occurred .The postoperative serum β-hCG recovery time was (14.2 ±4.6) d.Postoperative hysterosalpingography showed unobstructed fallopian tube in 13 patients, connected but not patent in 4 patients, and blocked in 5 patients. Conclusion Laparoscopic salpingotomy and embryo removal is safe and effective , with the patency of fallopian tube partly retained.

Objective To explore the effect of microsurgery for refractory temporal lobe epilepsy . Methods A retrospective analysis was made in 102 patients with refractory temporal lobe epilepsy from January 2005 to December 2011.The patients received comprehensive preoperative localization , intraoperative frontotemporal pterional incision , and microsurgical resection of epileptogenic focus .The efficacy was evaluated according to the Engel standards .Indications such as self-care ability, learning ability, and working ability were used to evaluate the quality of life , which were recorded and compared before and after operation . Results Follow-up was accomplished in all the 102 cases for a duration of 1 year and 9 months to 7 years.There were no mortality and serious complications .The effects evaluations at 1 year after operation showed complete disappearance of symptoms ( levelⅠ) in 61 cases (59.8%), almost disappearance (level Ⅱ) in 17 cases (16.7%), symptoms improvement more than 75% (level Ⅲ) in 13 cases (12.7%),and ineffective (level Ⅳ) in 11 cases (10.8%), bearing an effective rate of 89.2% (91/102) and a good-and-excellent rate of 76.5%(78/102).At one year and nine months postoperatively , 6 patients could not take care of themselves , 32 patients obtained partial self-care, and 64 patients had complete self-care,as compared with which there were 21 patients, 67 patients, and 14 patients preoperatively, respectively, having significant differences before and after surgery (Z =-7.001, P =0.000). Statistical significances were obtained before and after operation in 67 cases of children and adolescents with learning ability ( Z=-3.747, P =0.000) and in 35 adult cases with working ability ( Z =-2.564, P =0.010). Conclusions Microsurgical treatment is an effective method for refractory temporal lobe epilepsy .Patients ’ quality of life can get significant improvement after surgery.