Objective To evaluate the role of transanal ileus tube decompression in the management of malignant obstruction of left-sided colon. Methods With the help of colonoscopy and radiography, 11 cases of left-sided malignant colonic obstruction were treated with transanal ileus tube insertion into the proximal obstruction site for the decompression of the dilated bowel. Curative effects were evaluated according to patient’s symptom relief, bowel sounds, abdominal circumference, intra-abdominal pressure, and plain abdominal radiography. Results Symptoms of acute intestinal obstruction were relieved in all the 11 cases after ileus tube decompression for 3~5 days. Laparoscopic or open primary colectomy was performed in 7 patients with resectable tumor. Postoperative follow-up observations for 1~18 months (median, 11 months) showed no complications like anastomotic leakage. Conclusions Transanal ileus tube decompression in the management of malignant obstruction of left-sided colon is safe and effective.

Objective To investigate the safety and feasibility of laparoscopic total/subtotal proctocolectomy. Methods Laparoscopic total/subtotal proctocolectomy was performed in 8 cases from March 2003 to November 2005, including 1 case of multiple colorectal tumors, 3 cases of ulcerative colitis, 2 cases of familial adenomatous polyposis, and 2 cases of slow transit constipation. The operation included ileal pouch-anal canal anastomosis in 3 cases, ileal pouch-rectum anastomosis in 3 cases, and cecum-rectum anastomsis in 2 cases. A prophylactic ileostomy was conducted in 5 cases. Results The operation was laparoscopically conducted in all the 8 cases, without conversions to open surgery. No fatal case was encountered. The operative time was 5.5~7.5 h (median, 6 h). The intraoperative blood loss was 150~400 ml (median, 200 ml). There was no intra- or post-operative blood transfusion. The patients began to take diet at 48 h postoperatively. Follow-up observations in 8 cases for 4~31 months (median, 25 months) showed 1 case of intraabdominal infection and 1 case of anastomsis stenosis. Conclusions Laparoscopic total/subtotal proctocolectomy is safe and feasible.

Objective To evaluate the safety of laparoscopic resection for giant abdominal benign mass.Methods Six cases of giant abdominal benign mass(8～25 in diameter)underwent laparoscopic exploration and resection under general anesthesia from July 2005 to March 2006.Results The laparoscopic resection was accomplished in all the 6 cases.The operation time was 75～220 min(mean,135 min),the intraoperative hemorrhage volume was 20～100 ml(mean,55 ml),the duration for abdominal drainage was 1～3 d(mean,2 d),and the postoperative hospital stay,2～7 d(mean,4.3 d).There was no complications such as intestinal injury,postoperative bleeding,or abdominal infection.Follow-up visits for 1～9 months(mean,6.5 months)found no recurrence.Conclusions Laparoscopic resection of giant abdominal benign mass is a feasible and safe minimally invasive technique.

Objective To study the safety of laparoscopic total mesorectal excision for middle and lower rectal cancer.Methods A retrospective comparison was made between 52 cases of open total mesorectal excision from December 2002 to December 2005(Open Group) and 49 cases of laparoscopic mesorectal excision from January 2003 to June 2006(Laparoscopic Group).Results There was no difference in baseline parameters between the two groups.As compared with the Open Group,the Laparoscopic Group presented less blood loss [for anterior resection: 160?106 ml(n=37) vs 298?186 ml(n=36),t=-3.908,P=0.000;for abdominoperineal resection: 180?153 ml(n=10) vs 356?170 ml(n=14),t=-2.604,P=0.016].The recovery time of bowel functions was shorter in the Laparoscopic Group than in the Open Group(2.4?1.8 d vs 3.6?1.5 d;t=-3.648,P=0.000).The overall complication rate in the Laparoscopic Group(14.3%,7/49) was lower than that in the Open Group(44.2%,23/52)(?2=10.834,P=0.001).No significant difference was seen between the two groups in the number of lymph node resected(12.7?6.5 vs 13.6?7.0;t=-0.668,P=0.505),with negative margins in both groups.Follow-up observations were carried out in 45 cases in the Laparoscopic Group(91.8%) for 2～42 months and in 47 cases in the Open Group(90.4%) for 6～42 months,respectively.The local recurrence rate was respectively 4.4% in the Laparoscopic Group(2/45) and 4.3% in the Open Group(2/47). Conclusions Laparoscopic total mesorectal excision for middle and lower rectal cancer is safe and feasible.

0.05).Conclusions Laparoscopic resection of colorectal carcinoma is feasible and safe for elderly patients.The method can reduce the rate of postoperative complications.

Objective To study the feasibility of laparoscopic radical gastrectomy.Methods From August 2006 to May 2007,31 patients with gastric cancer received laparoscopic radical gastrectomy(radical distal gastrectomy in 26 cases and radical total gastrectomy in 5).Results Among the cases,1 was converted to an open surgery,2 were treated completely by laparoscopic radical gastrectomy;and in the other 28 cases,the radical gastrectomy was performed under the assistance of laparoscopy.Lymph node dissection of D1+? was performed on 2 patients and D2/D2+ was adopted in the other 29.One case was done in combination with partial liver dissection.The median operative time was 5 h(range 4.5-7 h).The median blood loss was 150 ml(range,100-600 ml).One patient received blood transfusion during the operation.Intraoperative spleen injury occurred in one case.The median number of harvested lymph nodes was 20(range,14-33).No patient died after the surgery.The median time for gastrointestinal function recovery was 4 d(range 3-6 d).One patient developed gastroparalysis after the operation and was cured by conservative therapy.One of the patients had bleeding of the jejunal pouch after total gastrectomy.And one showed subluxation of the articulatio cricothyroideus.No anastomotic leakage and lung infection occurred after the surgery.And no recurrence or metastasis was found during a 2-to 8-month follow-up(median,5).Conclusion Laparoscopic radical gastrectomy is feasible and safe.

Objective To analyze perioperative process, oncologic state and prognosis of patients with rectal carcinoma treated by lapascopic abdominoperineal resection. Methods 9 cases of rectal carcinoma treated by lapascopic abdominoperineal resection were reviewed retrospectively from December 1993 to February 1996. Results The median age was 50y(30y～67y), median follow-up time 80 months(40m～90m) and median operative time 6h (4 5h～7 5h). 9 cases were operated on by standard radical operation, including abdominal procedures under laparoscope in 8 cases and under the help of mini-incision in 1 case.Complications occurred in 4 cases, including subcutaneous emphysema and urine detention, iliac vein injury, deep vein thrombosis and part mucous necrosis, and perineal wound infection in 1 case respectively. The median number of lymph nodes in the specimen was 13(4～25). 6 patients survived and 3 ones died with the survival rate at 5-year being 77.8%. Conclusions Lapascopic abdominoperineal resection in the treatment of rectal carcinoma is feasible, and it can meet the tumor resection requirements of open radical operation.

Objective To compare effects of laparoscopic versus open anterior resection of rectal carcinoma on immune functions.Methods A total of 38 patients were given either laparoscopic(18 patients) or open(20 patients) anterior resection of rectal carcinoma from April 2004 to June 2005 in this department.The percentages of T-lymphocytes(CD_3,CD_4,and CD_8) and natural killer cells were calculated by using the flowcytometry.The levels of immunoglobins(IgG,IgA,and IgM) and complements(C_3 and C_4) were detected by using the immunonephelometry.Results In levels of T-lymphocytes,immunoglobins,and complements,there were no statistically significant differences between open and laparoscopic groups 24 and 96 hours after operation.In levels of natural killer cells,no differences were observed in laparoscopic group before and after operation(24 and 96 postoperative hours) while a significant decrease were found in open group after operation.Conclusions As compared with open surgery,laparoscopic anterior resection of rectal carcinoma has less influence on natural killer cells.

Cerebrospinal Fluid Rhinorrhea ; surgery ; Craniotomy ; methods ; Endoscopy ; Frontal Sinus ; surgery ; Humans ; Male ; Nose ; surgery ; Reconstructive Surgical Procedures ; methods ; Young Adult

AIM: To quantitatively investigate transforming growth factor-β(TGF-β) and its receptors in normal bulbar conjunctival tissues and pterygium tissues. METHODS: Thirty cases of pterygium patients were randomly selected to undergo surgical resection of pterygium lesion, and the normal margin of bulbar con-junctival tissues were collected as control. Gene expres-sion was detected quantitatively by the method of quantitative real-time PCR (QRT-PCR) analysis. RESULTS: The expression level of TGF-β1 and TGF-β2 was 4.26×10-7±1.45×10-7 and 1.08×10-10±0.68×10-10 in normal bulbar conjunctival tissues, while 10.67×10-7±7.47×10-7 and 8.23×10-11±6.63×10-11 in pterygium tissues. The expression level of TGF-βRⅠand TGF-βRⅡwas 0.003015±0.0036 and 5.33×10-5±5.05×10-5in normal bulbar conjunctival tissues, while 0.000379±0.000281 and 1.002×10-5±9.04×10-6 in pterygium tissues. The expression level of TGF-β1 and TGF-β2 in pterygium was elevated (P<0.01). TGF-β1 expression level in pterygium increase 2.9±2.8 times than in normal conjunctiva. TGF-β2 expression level in pterygium increase 7.5±1.4 times than in normal conjunctiva. The expression level of TGF-βRⅠin pterygium was significantly lower (P<0.05). The expression level of TGF-βRII in pterygium was significantly lower (P<0.01). CONCLUSION: QRT-PCR is an effective method to quantitatively detect gene expression in eye. The upregulation of TGF-β1 and TGF-β2 and downregulation of their receptors expression may play an important role in the pathogenesis of pterygium, which is noteworthy further investigation in diagnosis and treatment of pterygium.real-time PCR; gene expression