Objective To investigate the experience of laparoscopic surgery for pedicle torsion of ovarian cyst with pregnancy. Methods A retrospective analysis was made on 26 cases of pregnancy complicated with pedicle torsion of ovarian cyst receiving emergency laparoscopic surgery from January 2009 to December 2016 in our hospital. After the establishment of pneumoperitoneum, laparoscopic cyst dissection or accessory resection of the affected side was performed according to intraoperative conditions. Patients with early pregnancy were given progesterone 20-40 mg intramuscular injection, once a day for 3 days. Patients with late pregnancy were given intravenous drip of magnesium sulfate, 5 g daily for 3 days. The pregnancy outcome was recorded by readmission records, outpatient visits, or telephone follow-ups. Results Laparoscopic surgery was performed in all the 26 patients. During operation, 11 patients with ovarian necrosis underwent affected side resection, and the remaining 15 patients underwent enucleation of the affected ovary. The operation time was 20-60 min (average, 47. 8 min). The intraoperative bleeding was 10-400 ml (average, 88. 8 ml). The hospitalization time was 2-16 d (average, 5. 8 d). There were 21 cases of postoperative tocolytic therapy (80. 8%). All the 26 patients had no symptoms of miscarriage or premature delivery. They continued to term delivery, including 13 cases of spontaneous labor and 13 cases of caesarean section. The newborns were healthy, with 1-and 5-min Apgar scores of 8-10 points. Conclusions It is safe to treat the pregnancy complicated with pedicle torsion of ovarian cyst by laparoscopic surgery. Surgery is difficult for large cysts and late pregnancy.

Objective To explore the influence of no drainage on pelvic lymphocyst following laparoscopic radical hysterectomy and pelvic lymphadenectomy . Methods A total of 105 patients with cervical cancer undergoing laparoscopic radical hysterectomy and pelvic lymphadenectomy in this hospital from January 2012 to February 2016 were divided into either non-drainage group (50 cases) or drainage group (55 cases) according to whether the pelvic drainage tube was placed after surgery .Comparative analyses on the incidence of postoperative complications such as pelvic lymphocyst were made between the two groups . Results No significant difference in lymphocyst rate was found between the two groups [27.3%(15/55) vs.24.0%(12/50), χ2 =0.147, P=0.702].The incidence of pelvic infection was lower in the non-drainage group (2.0%, 1/50) than that in the drainage group (14.5%, 8/55), but the difference was not statistically significant (χ2 =3.781, P=0.052).Other postoperative complications including urinary retention , urinary fistula, and deep venous thrombosis of lower limb had no statistical differences between the two groups (P>0.05). Conclusions Drainage after radical hysterectomy and pelvic lymphadenectomy for cervical cancer does not make a difference to the incidence of lymphocyst .Non-drainaging doesn ’ t increase the risk of infection .

[Summary] Malignant obstructive jaundice is the bile obstruction caused by the invasion of cholangiocarcinoma , pancreatic cancer or ampulla cancer .Due to lack of effective treatment , the prognosis is poor .In recent years , with the rapid development of medical technology and imaging technology , dual interventional treatment technology , such as percutaneous transhepatic cholangial drainage ( PTCD) or biliary stenting combined with radioactive seed implantation , ablation catheter lumen combined with biliary stent implantation , is applied in the treatment of malignant obstructive jaundice .This article is the summary of the clinical application of PTCD combined with radioactive seed implantation , biliary stent combined with radioactive seed implantation and intraluminal catheter radiofrequency ablation combined with biliary stent implantation technique .

Objective To investigate the clinical efficacy of the self-retaining laryngeal microsurgical operation in the treatment of Reinke ’ s edema of vocal cords . Methods There were 24 cases of Reinke ’ s edema who were treated with self-retaining laryngoscope mucosal stripping surgery of vocal cords from January 2004 to December 2009 ( traditional group ) , while another group of 32 cases of Reinke ’ s edema were treated with self-retaining laryngoscopic microsurgery lateral submucosal incision micro-flap operation of vocal cords from January 2010 to December 2015 ( laryngeal microsurgery group ) .The two groups were executed with electronic laryngoscopy and subjective voice evaluation GRBAS ( The Speech and Language Institute of Japanese in 1979, G: Grade, R:Roughness, B:Breathness, A:Asthenia, S:Strain) in pre-operation and post-operation (1 week, 3 weeks, 8 weeks).The wound healing time of vocal cords , hoarseness improved time and voice improvement were retrospectively compared between the two groups . Results The patients in laryngeal microsurgery group had earlier voice hoarse improvement and more rapid mucosal epithelial of vocal cords recovery time in post-operation as compared with the patients in the traditional group [voice improving time, (7.3 ±1.9) d vs. (11.3 ±2.7) d, t=-6.481, P=0.000;mucosal epithelial of vocal cords recovery time , (12.2 ±3.1) d vs.(20.1 ±3.4) d, t=-9.062, P=0.000].The results of pre-operative voice evaluation with GRBAS showed no significant differences between the two groups, but the results of post-operative evaluation of each session (1 week, 3 weeks, 8 weeks) showed that the main data were statistically different.The GRBAS score of laryngeal microsurgery group was lower than that of traditional group in post -operation, especially after 8 weeks (8 weeks after post-operation, G:1.0 ±0.8 vs.1.6 ±0.2, t=-3.584, P=0.000; R:1.0 ±0.9 vs. 1.5 ±0.4, t=-2.536, P=0.014;B:1.0 ±0.6 vs.1.4 ±0.5, t=-2.647, P=0.011).In laryngeal microsurgery group, 24 cases were cured , 5 cases were effective and 3 cases were invalid , contrasting in the traditional group with 11 cases of cured , 7 cases of effective and 6 cases of invalid respectively, with a significant difference (Z=-2.239, P=0.025).No significant difference in effective rate between the two groups [90.6%(29/32) vs.75.0%(18/24),χ2 =1.459, P=0.227]. Conclusion The clinical efficacy of self-retaining laryngoscope microsurgery in the treatment of Reinke ’ s edema of vocal cords is faster and better comparing traditional operation , with a more significant pronunciation quality improvement .

Objective To explore the effects of compound lidocaine cream applied to postoperative wound and nasal packing on postoperative sinus pain after endoscopic sinus surgery . Methods From April 2015 to June 2016, 100 cases of endoscopic sinus surgery were carried out in our hospital under general anesthesia .The patients were randomly divided into two groups , with 50 cases in each group .The group A was given compound lidocaine cream 4 g on the nasal surgery wound and medical inflation sponge for intranasal packing;the group B was given saline 4 g on the nasal surgery wound and medical inflation sponge for intranasal packing . The heart rate (HR), systolic blood pressure (SBP) and diastolic blood pressure (DBP) were measured at the time of extubation (T0), 1 h after extubation (T1), 4 h after extubation (T2), 10 h after extubation (T3), and 12 h after extubation (T4), respectively.The visual analogue scale (VAS) of pain after extubation was recorded . Results The HR, SBP and DBP at T0, T1, T2 and T3 in the group A were significantly lower than those in the group B (P<0.05).The HR and SBP were not significantly different at T4 between the two groups (P>0.05), while the DBP was significantly lower in the group A than that in the group B (t=-2.562, P=0.012).The VAS scores were significantly lower in the group A than those in the group B at T 0, T1, T2 and T3 (P=0.000).No statistical difference was seen in VAS scores at T4 between the two groups (t=-1.199, P=0.233). Conclusions Application of compound lidocaine cream on nasal endoscopic wound and intranasal packing can effectively relieve the pain after endoscopic sinus surgery .The method has good analgesic effects and is worthy of popularization and application .

Objective To explore the efficacy of internal fixation in the treatment of intra-articular calcaneum fractures via the sinus tarsi approach . Methods A retrospective study was made on 55 feet with intra-articular calcaneum fractures in 51 patients treated with open reduction and intemal fixation via sinus tarsi approach from January 2010 to June 2015.According to the Sanders classification, there were 15 feet of type Ⅱfractures and 40 feet of type Ⅲfractures. Results All the patients were followed up for a mean period of 15.7 months (range, 6-33 months).The fractures were completely healed .According to the Maryland Foot Scores , the operative effect was excellent in 43 feet, good in 7 feet, fair in 4 feet, and poor in 1 foot.The excellent and good rate was 90.9%(50/55).The postoperative width of the calcaneum , B?hler angle, and Gissane angle were significantly improved than before operation (P=0.000). Conclusion Open reduction and internal fixation via sinus tarsi approach is a simple and effective method for minimally invasive treatment of Sanders type Ⅱand Ⅲintra-articular calcaneum fractures .

Objective To investigate the clinical effect of minimally invasive surgery via basisylvian fissure approach in the treatment of severe hypertensive cerebral hemorrhage in basal ganglia. Methods The Study Group included 28 patients who received a minimally invasive surgery via basisylvian fissure approach, while the Control Group had 26 patients who underwent a traditional hematoma removal. Comparisons were made between the two groups on short-term (1 month) and long-term (6 months) effects. Results The rates of excellent or good short-term outcomes and mortalities were 53.6% (15/28) and 17.9% (5/28) in the Study Group, and 46.2% (12/26) and 15.4% (4/26) in the Control Group, respectively, without significant differences between the two groups (?2=0.297, P=0.586; ?2=0.000, P=1.000). However, the activity of daily life (ADL) grade I~Ⅲ accounted for 63.2% (12/19) of long-term survivors in the Study Group, which was superior to the Control Group (23.6%, 4/17) (z=-2.189, P=0.029). Conclusions Minimally invasive surgery for severe hypertensive cerebral hemorrhage in basal ganglia provides better life quality of survivors after operation than traditional hematoma removal.

Objective To investigate outcomes of transanal endoscopic microsurgery(TEM) for the treatment of rectal villous adenoma and early-stage rectal carcinoma.Methods A series of 31 patients with rectal tumors underwent TEM from November 1995 to December 2003.The operation was performed under general anesthesia.The patients were placed in a dependent position dictated by the location of the tumor.A special rectoscope was inserted into the anus with CO_2 insufflation to keep the rectum open.Under the stereoscope and laparoscopic-type instruments,the tumor was completely resected(submucosal or full-thickness excision) using a needle diathermy or a 5-mm ultrasonic dissector.The operative wound was closed with intra-lumen continuous sutures.Results The rectal tumor was completely removed with negative resection margins in all the 31 patients.The operating time was 45~220 min(mean,95 min) and the intraoperative blood loss was 0~180 ml(mean,40 ml).Complications included temporary flatus incontinence in 2 patients,acute retention of urine in 1 patient,exacerbation of chronic obstructive airway disease in 1,and secondary hemorrhage following Aspirin taking in 1.The postoperative pathological stages were pT_0 in 16 patients,pT_(is) in 2 patients,pT_1 in 7,pT_2 in 3,and pT_3 in 3.Follow-up checkups in the 31 patients for 2~92 months(mean,23 months) revealed no local recurrence.Conclusions TEM is a safe and effective minimally invasive surgical technique for the treatment of rectal villous adenoma and early rectal carcinoma.

Objective To investigate the accuracy of observing common bile duct ( CBD ) residual stones by saline injection through endoscopic nasobiliary drainage ( ENBD ) under the guidance of ultrasound after endoscopic retrograde cholangiopancreatography (ERCP), endoscopic sphincterotomy (EST) and endoscopic stone extraction . Methods From October 2014 to August 2015, 58 patients with CBD stones received ENBD after endoscopic stone extraction .Ultrasound examination was performed on the 1-5 postoperative days .After routine examination by a professional ultrasound doctor , a total of 50-200 ml saline was injected through ENBD slowly at a rate of 100 ml/min.Ultrasonic results, including changes of bile duct diameter and detection rate of CBD residual stones , were compared before and after the injection . Results All the 58 patients were given ENBD cholangiography after endoscopic stone extraction .Among them, CBD residual stones were detected positive in 3 patients and negative in 55 patients by ENBD cholangiography .Among the 55 patients, CBD residual stones were detected in 1 patient by routine ultrasound which was confirmed after injection .Among the other 54 patients who were not detected stones by routine ultrasound , failure of injection occurred in 1 patient due to the damage of ENBD , and 2 patients showed bad tolerance of abdominal pain after injection of 20 ml saline and 3 patients were detected CBD residual stones after injection .While the other 48 patients were negative with CBD residual stones.For the 3 patients who were detected residual stones by cholangiography , routine ultrasound showed negative results but stones were detected after injection .Stone removal was achieved in 5 patients.The Youden index for CBD residual stones by saline injection through ENBD under ultrasound was 0.98, which was higher than cholangiography (0.4) and routine ultrasound (0.2).Among the 57 patients who underwent injection , obvious dilation of the diameter and length of the CBD was observed after injection in 56 patients (P<0.05). Conclusions For patients with ENBD, observing CBD residual stones by saline injection through ENBD under ultrasound has advantages of non-invasion, non-radiation, inexpensive cost , repeatedly checking and dynamic observation .It has a very important reference value in diagnosing CBD stones and proposes a new examination .

Objective To compare the efficacy and safety between rigid combined with flexible ureteroscopic lithotripsy and minimally invasive percutaneous nephrolithotomy ( MPCNL ) for impacted upper ureteral calculi . Methods We retrospectively analyzed 102 cases of impacted upper ureteral calculi treated in our hospital between June 2010 and April 2015.The patients were divided into two groups according to treatment methods: 54 cases underwent rigid combined with flexible ureteroscopic lithotripsy ( Combined group ) and 48 cases received MPCNL ( MPCNL group ) .The operation time , blood loss during operation , clearance rate of the stone, incidence of postoperative complications , and hospitalization time were statistically analyzed . Results All the patients tolerated operations without severe complications .The mean operation time of the Combined group was (87.9 ±21.6) min, which was significantly longer than that of the MPCNL group [(61.5 ±16.7) min, t=-6.795, P=0.000].The intraoperative blood loss in the MPCNL group was (52.8 ±9.6) ml, which was higher than that of the Combined group [(12.5 ±2.6) ml, t=29.644, P=0.000].The mean postoperative hospitalization time in the MPCNL group was (6.1 ±1.3) d, which was longer than that in the Combined group [(2.8 ±0.7) d, t=16.162, P=0.000].There was no significant difference in the incidence of postoperative complications between the two groups (χ2 =0.330, P=0.566).The stone clearance rates after one month postoperation were 95.7％(45/47) and 94.4％(51/54) in the MPCNL group and Combined group , but there was no signification difference between the two groups (χ2 =0.000, P=1.000). Conclusions Both rigid combined with flexible ureteroscopic lithotripsy and MPCNL are effective and safe for impacted upper ureteral calculi .Rigid combined with flexible ureteroscopic lithotripsy is a kind of natural orifice transluminal endoscopic surgery , which has no direct damage to the renal parenchyma with less bleeding and trauma , and shorter hospitalization time.