Objective To evaluate the clinic efficacy of laparoscopic totally extraperitoneal technique in complex inguinal hernia repair. Methods Totally 42 patients with complex inguinal hernia were repaired by laparoscopic totally extraperitoneal technique in our hospital during July 2004 to June 2008. Among the cases,18 patients had bilateral indirect inguinal hernia,8 had unilateral indirect and direct inguinal hernia,5 suffered from indirect inguinal hernia at one side and direct inguinal hernia in the other side,4 patients showed bilateral direct inguinal,3 showed bilateral indirect inguinal hernia and unilateral direct inguinal hernia,2 had bilateral direct inguinal hernia and unilateral indirect inguinal hernia,1 patient showed indirect inguinal hernia complicated with femoral hernia at the same side,and 1 patient had indirect and direct inguinal hernia at the both sides.During the operation,a 10-mm incision was made at 15 mm below the umbilicus reaching the Hunter's line,to place the laparoscope and separate the extraperitoneal space.Afterwards,two 5-mm trocars were inserted and then extraperitoneal pneumorperitoneum was established involving the retropublic space extending up to the anterior superior spine,so that to return the complex hernias.A polypropylene patch was then used to cover the pubic foramen and Hesselbach triangle. Results TEP was successfully completed in all of the 42 patients with a mean operation time of 85-165 min (mean,107.3 min) and estimated intraoperative blood loss of 10-20 ml. Scrotum aerocele was detected in all of the cases during the operation. The patients received normal diet in 2 days postoperation. They were discharged from our hospital in 7 to 9 days (mean,7.6 days). Follow-up was achieved for 3 to 32 months (mean,15.3 months) in all of the patients,during the period,2 patients showed recurrent direct inguinal hernia,and 5 had mild paraesthesia in the lower abdominal wall. Conclusions TEP is safe and effective for complex inguinal hernia.

Objective To explore the feasibility of mastoscopic resection of benign mammary gland tumors. Methods A total of 68 cases were diagnosed as having benign mammary gland tumors(42 cases of fibroma and 26 cases of cystic adenoma) by using molybdenum target X-ray examinations.The tumor was located at lower outer quadrant in 26 cases,upper inner quadrant in 16 cases,lower inner quadrant in 14 cases,and upper outer quadrant in 12 cases,respectively.The operation was conducted via a transaxillary approach.A specially-designed flap dissector was utilized to establish a tunnel underneath the breast skin,where the air was inflated to build a surgical space.Then the tumor was resected by using an electrotome or harmonic scalpel. Frozen-section examination was routinely carried out during operation. Results The operation was successfully completed in all the 68 cases,without intraoperative complications.The operation time was 28~45 min(mean,35 min).The drainage tube was indwelled for 1~2 d.Subcutaneous effusion occurred in 1 case.Postoperative recovery was uneventful without skin necrosis or other complications.The length of postoperative hospital stay was 2~5 d(3.0?1.5 d).Follow-up checkups in the 68 cases for 3~36 months(mean,12 months) revealed good cosmetic outcomes. Conclusions Transaxillary mastoscopic resection of benign mammary gland tumors is safe and feasible,with good cosmetic results.

Objective To compare effects between laparoscopic appendectomy(LA) and open appendectomy(OA) for acute appendicitis in children.Methods A total of 95 children with acute appendicitis from July 2000 to July 2005 were given either LA(LA Group,n=50) or OA(OA Group,n=45).The surgical outcomes and curative effects were compared between the two groups.Results The operation was successfully completed in both of the groups.No bleeding,intestinal fistula,or stump appendicitis was seen.There was no difference in the operation time between the LA Group(38.8?17.4 min) and the OA Group(41.9?15.8 min)(t=-0.905,P=0.368).The time to first defecation was significantly shorter in the LA Group(26.4?7.2 h) than in the OA Group(39.7?8.8 h)(t=-8.094,P=0.000).Appendiceal perforation was found in 29 children in the LA Group and 26 children in the OA Group,without significant difference(?~2=1.633,P=0.983),but the incidence of wound infection was significantly higher in the OA Group(11 children) than in the LA Group(2 children)(?~2=8.381,P=0.004).A drainage placement was required in 3 children in the LA Group and 9 children in the OA Group,with significant difference(?~2=4.206,P=0.040).The LA Group had significantly shorter time to normal temperature(55.4?16.2 h) than the OA Group(77.8?30.6 h)(t=-4.522,P=0.000),shorter hospital stay(5.4?1.3 d) than the OA Group(13.4?6.5 d)(t=-8.520,P=0.000),but higher hospitalization costs(6 117.9?836.5 yuan) than the OA Group(4 528.6?527.1 yuan)(t=10.937,P=0.000).Conclusions Laparoscopic appendectomy is superior to open surgery for acute appendicitis in children because of its advantages of minimal invasion,little pain,early recovery,good cosmetic appearance,low complication rate,and short hospital stay.

Objective To evaluate the value and clinical efficacy of amputation of secondary structures of the spleen pedicel for laparoscopic splenectomy(LS).Methods Twenty-one cases of idiopathic thrombocytopenic purpura(ITP) and 1 case of splenic cyst were given a 4-port laparoscopic splenectomy.After the spleen was mobilized,a non-traumatic forceps was used to clip the pedicel at the site 3~5 cm from the hilus of spleen for the control of hemorrhage.The serosa on the spleen pedicel was opened by using a harmonic scalpel.Then secondary structures of the splenic arteries and veins,one by one,were disconnected from without upward,double ligated with the Hem-o-lok clips,and severed with the harmonic scalpel.The spleen was placed into an extraction bag,broken into small pieces,and removed from the extraction incision.Results The laparoscopic splenectomy was successfully completed in all the 22 cases.The operative time was 75~180 min(mean,117 min),and the estimated intraoperative blood loss was 20~280 ml(mean,87 ml).All the patients got out of bed and began to take food at 1~2 days after operation. The length of postoperative hospitalization was 5~11 d(mean,5.6 d).There were 1 case of incisional subcutaneous hematoma and 1 case of subcutaneous emphysema.Follow-up for 1.5～52 months(mean,19.3 months) in the 22 cases revealed no surgery-related complications.Conclusions The amputation of secondary structures of the spleen pedicel is a relatively safe and effective measure for completing laparoscopic splenectomy.

Objective To investigate the clinical value of two kinds of endoscopic thyroidectomy for thyroid diseases.Methods Endoscopic thyroidectomy via breast approach or axillary approach was performed in 98 cases from December 2003 to August 2005.The subcutaneous space beneath the breast area and the subplatysmal space in the neck were bluntly dissected through a 5-mm incision.The CO_2 was insufflated at the pressure of 8~10 mm Hg to create an operative space.Three trocars were inserted.The dissection of the thyroid parenchyma and vessels was performed endoscopically by using an ultrasonically activated scalpel.The recurrent laryngeal nerve,the superior laryngeal nerve,and the parathyroid glands were preserved carefully.There were 1 case of lobectomy on one side and partial thyroidectomy on the other side,18 cases of unilateral lobectomy,12 cases of bilateral subtotal thyroidectomy,46 cases of unilateral subtotal lobectomy,and 21 cases of resection of thyroid mass. Results The operation was successfully completed in all the 98 cases,without conversions to open surgery.No complications were noted.The operative time was 69.1?29.0 min,the estimated blood loss was 37.9?10.6 ml,and the postoperative hospital stay was 3.5?0.7 days.The drainage tube was removed at 24~36 hours after operation.Two cases of thyroid cancer were followed for 24 months without recurrence.The remaining 96 cases were followed for 6~28 months(mean,16 months) without recurrence.Conclusions Endoscopic thyroidectomy via breast or axillary approach is feasible and safe,giving patients satisfactory cosmetic results.

Objective To study the effect and value of the application of the median umbilical fold in laparoscopic treatment for indirect inguinal hernia in children.Methods A total of 105 cases of pediatric indirect inguinal hernia(including 32 cases of incarcerated hernia, 25 cases of bilateral hernia,and 6 cases of recurrent hernia after open surgery) was treated with laparoscopic high ligation of the hernia sac and repair with the median umbilical fold from January 2004 to August 2005.The operation was performed through two or three trocars.Under laparoscopic visualization,the internal ring was identified for a purse-string suture.Then the median umbilical fold was sutured on the internal ring to repair the defect.Results The operation was successfully performed under laparoscope in all the 105 cases.The operative time was 10~25 min(mean,15 min) for unilateral hernia and 20~35 min(mean,25 min) for bilateral hernia.The intraoperative blood loss was hardly seen.The length of hospital stay was 2~3 days.The postoperative recovery was uneventful,without intestinal adhesion,infection,or hematoma of the scrotum.Follow-up observations in the 105 cases for 5~24 months(mean,18 months) found no recurrence.Conclusions Laparoscopic high ligation of the hernia sac and repair with the median umbilical fold is safe and effect for pediatric indirect inguinal hernia,with advantages of mini-invasion,simple performance,short operation time,low complication rate,and quick recovery.

Objective To study the efficacy of laparoscopic pull through proctectomy for the treatment of rectal cancer. Methods There were 60 patients colonoscopically diagnosed as having rectal cancer (3~12 cm from the anal margin). Laparoscopic pull through proctectomy was performed. The distal tumor-free margin was about 2 cm. Results All the operations were performed successfully, without conversions to open surgery. The operating time was 89~179 min (120?25 min), the blood loss was 48~147 ml (75?26 ml), the length of hospital stay was 5~12 d (8.3?1.5 d), and the hospitalization expenditure was 8 680~15 800 yuan (9 900?750 yuan). Follow-up observations in the 60 patients for 12~25 months (mean, 22.3 months) showed no intraabdominal hemorrhage, anal stenosis, or intestinal leakage. Fecal incontinence was not seen at 2 postoperative month. One patient was found local recurrence after 12 months and underwent a second laparoscopic resection. Conclusions Laparoscopic pull through proctectomy for rectal cancer is safe, effective, and minimally invasive.

Objective To explore the efficacy of laparoscopic hepatectomy in combination with radiofrequency ablation and Iodine-125 brachytherapy in the treatment of hepatic carcinoma.Methods The study included 26 cases of hepatic carcinoma(left-sided,12 cases;right-sided,11 cases,both-sided,3 cases).There were 34 tumor lesions,with a maximum diameter of 2.8～13.0 cm.All the patients underwent laparoscopic hepatectomy in combination with radiofrequency ablation and Iodine-125 brachytherapy.Results The combination operation was successfully completed in all the cases,without conversions to open surgery.During the operation,2 new tumor lesions were founded by laparoscopic ulstrasound.Among the 36 lesions,only harmonic scalpel vaporization and Iodine-125 seeds implantation was performed in 8 cases of posterior right lobe lesions,and laparoscopic hepatectomy in combination with radiofrequency ablation and Iodine-125 seeds implantation was conducted in 28 cases of margin lesions.Follow-up checkups for 12～25 months(mean,22.3 months)showed a 1-year survival rate of 92.3%(24/26).Local tumor recurrence was seen in 3 out of 36 lesions.No severe complications occurred.Conclusions Combination of laparoscopic hepatectomy,radiofrequency ablation,and Iodine-125 brachytherapy for treating hepatic carcinoma is safe and minimally invasive,with a rapid recovery and a high survival rate.

Objective To study the feasibility of laparoscopic high ligation and median umbilical fold onlay for the treatment of adult inguinal hernia.Methods Laparoscopic high ligation and median umbilical fold onlay was performed in 35 cases of adult inguinal hernia(including 5 cases of incarcerated hernia,12 cases of bilateral hernia,and 8 cases of recurrent hernia)from Janaury 2003 to August 2005.Surgical outcomes ad follow-up records were compared with those from another 30 cases of inguinal hernia treated by conventional surgery.Results The laparoscopic operation was successfully performed in all the 35 cases.As compared with conventional surgery,laparoscopic operation presented a shorter operation time(20.8?8.8 min vs 53.5?12.6 min;t=-12.262,P=0.000)and postoperative hospital stay(5.5?1.8 d vs 8.5?1.9 d;t=-6.529,P=0.000).Edema of scrotum was not found in laparoscopic cases but occurred in 11 out of 30 conventional cases(36.7%;?2=15.448,P=0.000).Follow-up examinations for 18.6?8.9 months found 2 cases of recurrence after conventional surgery and no recurrence after laparoscopic operation(?2=0.691,P=0.406).Conclusions Laparoscopic high ligation and median umbilical fold onlay is safe and feasible in the treatment of adult inguinal hernia.

Objectives To study the changes of gastrointestinal hormones in chronic constipation. Methods 17 outpatient chronic constipation patients, and 10 normal persons were respectively chosen as observation group and control group. Fasting blood samples were taken in all patients. The serum levels of somatostatin (SS) and substance P (SP) were tested using RIA method.Results The serum level of SS and SP in observation group were (120.57?27.84)pg/ml and (7.68?2.5)pg/ml respectively, significantly higher than that in control group (P