Objective To evaluate the clinical value of laparoscopy in the diagnosis and surgical treatment of small intestinal tumors. Methods After the establishment of pneumoperitoneum with umbilicus puncture, a laparoscope was inserted.Two 5-mm trocars were placed through lateral right and left rectus abdominis to explore the location of the small intestine tumors.A 3 -4 cm incision was made along the abdominal midline or lower abdomen median.With the use of incision protector,benign tumors were given local excision of small intestine,or malignant tumors were given radical resection.End to end or side to side anastomosis of bowel was carried out,and then the mesenteric hole was closed and the puncture hole sutured. Results All the patients were diagnosed and treated by laparoscopic procedure successfully, including 23 cases of laparoscopic-assisted partial intestinal resections and 1 case of right hemicolectomy.The mean operative time was(70.3 ±21.7)min,the mean blood loss was(18.5 ±3.1)ml,the mean length of incision was(3.5 ±1.1)cm, and the mean time for passage of flatus was(2.5 ±0.5)d.Postoperative pathological examinations showed benign tumors in 8 cases,most of which were leiomyoma(5 cases), and malignant tumors in 16 cases, most of which were stromal tumors(6 cases).The postoperative hospital stay was(6.5 ±2.5)d.Follow-ups were conducted for 0.5-4.5 years(mean, 2.6 years)in 19 cases,including 6 cases of benign tumor and 13 cases of malignant tumor.No recurrent tumor was found except one fatal case of advanced intestinal carcinoma. Conclusion Laparoscopic exploration can diagnose small intestinal tumors accurately, and laparoscopic-assisted surgical treatment is safe.

Objective To summarize the microvascular decompression(MVD)surgery of vertebrobasilar blood vessel for primary trigeminal neuralgia patients. Methods Clinical data of 28 primary trigeminal neuralgia patients caused by vertebrobasilar blood vessel from October 2008 to June 2016 in our hospital were retrospectively analyzed.There were 25 patients receving MVD and 3 patients receiving MVD and trigeminal sensory-root partial rhizotomy. Results The neuralgia in all the 28 patients immediately disappeared after surgery.Facial hypesthesia on the operation side occurred in 3 patients receiving MVD and trigeminal sensory-root partial rhizotomy.During follow-ups for 3 -24 months(mean, 18.6 months), none of the trigeminal neuralgia relapsed. Conclusions For primary trigeminal neuralgia patients caused by vertebrobasilar blood vessel, adequate nerve decompression and restoration of normal nerve anatomy are the guarantee for the efficacy of MVD surgery.For vessels with tensions and can not be passaged by one-time,multi-point decompression can complete the surgery.

Objective To observe the efficiency and safety of dexmedetomidine and tramadol to prevent postoperative shivering after liposuction. Methods A total of 80 patients undergoing liposuction were randomly divided into 4 groups with 20 cases in each group:dexmedetomidine 0.4 μg/kg(D1 group),dexmedetomidine 0.6 μg/kg(D2 group),tramadol 1 mg/kg(T group),and saline control group(N group).These patients received an intravenous injection of dexmedetomidine, tramadol, or saline at the time of surgical suture.The respiratory recovery time,awakening time, extubation time, orientation recovery time, the case of shivering and adverse reactions after surgery were recorded. Results The respiratory recovery time,awakening time, and extubation time in the group D2 were longer than those in the other 3 groups[respiratory recovery time:(5.5 ±1.3)min vs.(6.2 ±1.2)min vs.(5.1 ± 1.8)min vs.(5.0 ±0.9)min,F=3.330,P=0.024;awakening time:(10.2 ±1.3)min vs.(11.5 ±1.5)min vs.(9.7 ±2.7) min vs.(9.5 ±1.8)min,F=4.429,P=0.006;extubation time:(12.9 ±1.5)min vs.(14.2 ±1.6)min vs.(12.8 ±2.4)min vs.(12.7 ±1.9)min,F=2.845,P=0.043].Postoperative shivering incidence in the group N was higher than those in the other 3 groups(3 cases vs.2 cases vs.3 cases vs.9 cases,χ2=9.188,P=0.027).The incidence of nausea and vomiting in the group T was higher than those in the other 3 groups(2 cases vs.1 case vs.8 cases vs.4 cases,χ2=9.436,P=0.024).The incidence of tachycardia in the group D2 was higher than those in the other 3 groups(3 cases vs.7 cases vs.1 case vs.1 case,χ2=9.412, P=0.024). Conclusion Dexmedetomidine 0.4 μg/kg by intravenous injection can treat postoperative shivering after liposuction effectively and reduce the adverse reactions.

Objective To investigate the feasibility and safety of reoperation of laparoscopic common bile duct exploration in the management of choledocholithiasis in patients with biliary surgical history. Methods Thirty-one patients with choledocholithiasis and biliary surgical history were performed by reoperation of laparoscopic common bile duct exploration between January 2012 and January 2014 in our hospital.The adhesion was disconnected under the laparoscopy, and then the common bile duct was opened to introduce an endoscope for stone removal.A T-tube was placed for drainage. Results The operations were successfully completed in all the 31 cases, without conversion to open surgery.The vital signs of those patients were smooth during the operation.The operation time was 65-125 min, with a mean of (118 ±21) min.The volume of blood loss was 10-75 ml during operations, with a mean of (39 ±19) ml.The patients could take food normally 24-48 h after operation, with a mean of (27 ±13) h.The drainage tubes were pulled out 48 -72 hours after operation.No severe complications, such as residual stones, bleeding, gastrointestinal leakage, or pancreatitis happened during hospitalization, except for 1 case of biliary leakage and 1 case of incision infection.The patients stayed in hospital for 6-9 days after operation, with a mean of (7.0 ±1.5) days.No biliary stricture or recurrence was found during a 3-24 months of follow-up (mean, 15.6 months) in 31 cases. Conclusion Reoperation of laparoscopic common bile duct exploration by experienced laparoscopic specialists for choledocholithiasis in patients with biliary surgical history is relatively safe and effective.

Objective To investigate the learning curve of minimally invasive direct coronary artery bypass ( MIDCAB) via left anterior small thoracotomy. Methods We retrospectively reviewed results of a consecutive series of 80 patients underwent MIDCAB via left anterior small thoracotomy performed by a single surgeon.The patients were divided into 4 groups ( group A, B, C, D, n=20 in each group) according to the sequence of the operation.The left internal mammary artery ( LIMA) harvesting time, anastomosis time, total operative time, the drainage volume of the first day postoperation, mechanical ventilation time, hospital stays postoperation, in-hospital morbidity and mortality were compared.The learning curve was assessed by means of regression analysis with logarithmic curve fitting. Results The basic clinical characters were similar in all groups before the operation.The operations were accomplished successfully in all the 80 cases.No intraoperative conversion to sternotomy, death, or perioperative myocardial infarction happened.The LIMA-harvesting time in the group B, C, and D was significantly shorter than that in the group A [(53.7 ±19.2) min, (50.2 ±17.7) min, and (43.2 ±10.3) min vs.(77.0 ±30.0) min, P =0.001, 0.000, and 0.000].There was no difference between group B and C, B and D, C and D in the LIMA-harvesting time (P>0.05).The total operative time in the group B, C, and D was significantly shorter than in the group A [ (128.7 ±21.7) min, (129.0 ±33.3) min, and (112.2 ±14.5) min vs. (165.2 ±41.8) min, all P=0.000], without difference between the group B and C, B and D, C and D (P>0.05).The learning curve models were obtained: LIMA-harvesting time ( min) =113.77 -16.869 × ln ( operation number); total operative time (min)=220.281 -25.276 ×ln (operation number). Conclusion MIDCAB via left anterior small thoracotomy is safe and effective, with a learning curve of approximately 20 cases.

Objective To investigate the application of intubation laryngeal mask in laparoscopic anesthesia for elderly patients with hypertension. Methods A total of 80 patients ( ASA Ⅱ -Ⅲ) over 70 years old undergoing laparoscopic gastrointestinal and gallbladder surgery from March 2014 to February 2015 were selected.They were randomly divided into the intubating laryngeal mask group ( ILMA group) or endotracheal tube group ( ET group) , with 40 patients in each group.After the intubation, the two groups were anesthetized with remifentanil by target-controlled infusion ( TCI ) and sevoflurane inhalation.The ILMA group was inserted matching laryngeal mask to control respiratory ventilation and deepened to the proper depth of anesthesia.An endotracheal tube were inserted through the mask 5 min later, and then the breath was controlled via transtracheal catheter to maintain anesthesia.The ET group was inserted tracheal intubation after induction, and then the breath was controlled until extubation after the recovery of the tracheal extubation after surgery.The heart rate (HR), blood pressure (SBP and DBP) and bispectral index (BIS) were recorded at time points of before induction (T0), laryngeal mask or endotracheal tube insertion (T1), after endotracheal tube insertion (T2), skin incision (T3), beginning tissue dissection or entry of laparoscope (T4), resection of organs or tissues (T5), and tracheal extubation ( T6 ) , respectively.In addition, the recovery time, the recovery of spontaneous breathing, complications during the recovery time, such as restlessness, nausea and vomiting, were observed and compared. Results There were significant differences in HR, SBP, DBP, BIS between the two groups and among different time points (P=0.000).At time points of before operation ( T0 -T2 ) and anesthesia maintaining stage ( T3 -T6 ) , the HR, SBP, DBP and BIS were stable in both groups.At the time points of after endotracheal intubation ( T2 ) and extubation ( T6 ) , the ET group had significantly increased HR, SBP, and DBP, which were higher than the ILMA group (P<0.05).At the time point of T6, the BIS values were significantly increased in the ET group than the ILMA group (P<0.05).On postoperative recovery quality, the time from anesthesia to spontaneous breathing recovery and from end of surgery to call to open eyes was significantly longer in the ET group than the LIMA group [(130.1 ±26.1) min vs. (96.4 ±24.5) min, t=5.94, P=0.000;(16.1 ±2.7) min vs.(5.5 ±2.2) min, t=19.07, P=0.000]. Conclusion For elderly patients with hypertension undergoing laparoscopic surgery, use of intubation laryngeal mask for anesthesia is more stable and has less adverse cardiovascular reactions, with good outcomes of anesthesia recovery.

Objective To investigate the clinical features of hidden horizontal tears of the posterior horn of the medial meniscus and clinical efficacy of arthroscopic partical meniscectomy. Methods A total of 14 cases of hidden horizontal tears of posterior horn of the medial meniscus from May 2011 to May 2013 were enrolled.The knee arthroscopy was carried out through anteromedial and anterolateral approaches.The lesion of tears was exposed after the inner edge of posterior horn of the meniscus was bitten away.The bottom of the posterior horn of meniscus was found instable during the operation, which was then removed to conduct a partial meniscectomy.Afterwards the arthroscopic meniscus plasty of the posterior horn was performed. Results Arthroscopic photographs showed normal appearance in 6 cases and tears underside meniscus in 8 cases, all of which were confirmed to be horizontal medial meniscus posterior horn tear during operation.The mean time of operation was 32 min (range, 26-40 min), and the mean hospitalization time was 6 days ( range, 3-8 d) .There was no complications, such as infections or stiffnesses.All the patients were followed up for 2 -3 years.Subjective symptoms improved significantly after arthroscopic partial meniscectomy.According to the Lysholm knee scoring scale, the scores were (71.1 ±6.6) points preoperatively and (92.0 ±3.4) points postoperatively, with significant difference (t=10.530, P=0.000). Conclusion Diagnosis of hidden horizontal tears of the medial meniscus posterior horn is often difficult, because most patients have osteoarthritic knees.Careful physical examination and MRI are critical for making a correct diagnosis.Arthroscopic partial meniscectomy can help patients obtain better results.

Objective To discuss the selection of different operation methods for cesarean scar pregnancy ( CSP ) . Methods A retrospective analysis was made on clinical data of 71 CSP patients treated in our hospital from January 2010 to January 2015.All the patients were accurately diagnosed by transvaginal color ultrasound examinations.Hysteroscopic evacuation was performed in 45 endogenous CSP patients, while in 26 exogenous CSP patients, 15 of them were treated by hysteroscopy and the other 11 patients were given laparoscopic operation. Results For the 45 endogenous patients, the success rate of hysteroscopic therapy was 92%( 41/45 ) .For the 26 exogenous patients, the success rate was 80% ( 12/15 ) for hysteroscopic and 82% ( 9/11 ) for laparoscopic therapy. Conclusions Preoperative categorizing of CSP is important for choosing different surgery methods. Hysteroscopic evacuation is the first choice for endogenous CSP.For exogenous patients, both hysteroscopic evacuation and laparotomy can be chosen.Therefore, the two minimally invasive procedures have limits, and transvaginal and laparotomy resection of lesion is still necessary sometimes.

[Summary] A total of 108 cases of endoscopic thyroidectomy via thoracic approach were conducted in our department between January 2012 and January 2015.The comfortable nursing was applied during the operation.The patients’ body position was adjusted properly according to requirements of the operation at different periods of pre-operation, intra-operation and post operation.No complications due to nursing mistakes or improper position occurred in the 108 patients. Follow-up checkups on the second postoperative day found 2 patients with vomiting.According to the Wong-Banker Faces Pain Scale to evaluate the head and back pain, there were 46 cases of 0 point, 51 cases of 1 point, 11 cases of 2 points.We got the conclusion that the application of comfortable nursing for proper position of patient not only reflects the nursing principle of Patients First, but also improves the entire quality of nursing services.

[Summary] Benign esophageal strictures can arise from various causes and mainly induce dysphagia .Commonly , the majority of benign esophageal strictures can achieve long-term relief through about three dilation sessions .However, some refractory benign esophageal strictures require other treatments , such as endoscopic stent placement and intralesional drug injection , but these treatments just attain short-time satisfactory results with a disappointingly low rate of long-term improvement.Recently, biodegradable stents and drug-eluting stents are developing and have obtained the positive effects .In this paper , we performed a review about the treatment of benign esophageal strictures .