The theme of this article lies in how to preserve the anus or restore the anal function in the treatment of middle or lower rectal cancer in order to avoid abdominal artificial anus,on the basis of not violating the principles of radical resection.From August 1995 to October 2004,86 cases of rectal cancer were operated with radical resection,48 of which preserved anus.Based on close observation of the patients,postoperative anal function seems the best in those with Dixon's anterior approach.if transplantation of the gracilis muscle is successful,satisfactory function restoration is always possible.Many scholars ever reformed Dixon's resection with lots of operative procedures,such as Bacon's resection.Because stapler can join rectal and anal together at any location,Bacon's resection is seldom adopted in clinical practice.The indications for anus preserving operation are as follows:①early or middle stage disease with localized lesion not invading beyond the muscle layer of the bowel;②no metastatic regional lymph adenopathy and;③adenocarcinoma at high or moderate degree of differentiation.It is suggested that different types of operative procedures are adopted according to the location of the lesion.

Objective To investigate the effect of combined general anesthesia with localanesthetic infiltration on heart rate variability and hemodynamics in laparoscopic cholecystectomy.Methods By simple randomization 70 patients undergoing laparoscopic cholecystectomy were assignedto two groups,68 patients completed the study(34 in each group).Group GA was given generalanesthesia.Group GL was given general anesthesia combined with local anesthetic.Iow-frectuency(LF),high-frequency(HF),LF/HF,Lfnu(LF/TP×100%),Hfnu(HF/TP×100%)and totalpower(TP),were recorded at the time points of baseline(T_0),skin incision(T_1),skin closure(T_2)and 1 h(T_3),3 h(T_4)after surgery.MAP and HR were recorded at the points of baseline,skinincision,skin closure and 1,3 h after surgery.Results Compared with the baseline,there was anincrease in MAP and HR at T_1,T_3,T_4(P<0.05)in group GA. Heart rate variability changesshowed that in group GA Lfnu,LF/HF increased significantly at T_1-T_4(P<0.05)and in group GLLF/HF increased significantly at T_1,T_2(P<0.05),and TP in group GA and group GL decreasedsignificantly at T_1,T_2(P<0.05).Conclusion Our results support that combined general anesthesiawith local anesthetic infiltration has lass influence on hemodynamics and automomic nerve,and can bean useful analgesic adjuvanct for patients undergoing laparoscopic cholecystectomy.

Objective To study the effects of propofol on the expressions of tumor necrosis factor(TNF)-α, interleukin-10 (IL-10) and nuclear factor-κB(NF-κB) in rat cerebrum undergoing ischemia and reperfusion. Methods Thirty rats were randomly divided into five groups with 6 rats each. The rats in group S accepted sharm operation as the controls, in group IR focal cerebral ischemia Concentrations of TNF-α and IL-10 in the cerebrum were measured by enzyme-linked immunosorbance assay(ELISA). An isotope([32P]-ATP) technique was applied for detecting nuclear factor-κB(NF-κB) in rat cerebral cortex. Electrophoretic mobility shift assay (EMSA) was performed in nuclear extracts from cerebral tissues. Results Compared with group S,TNF-α of group IR increased [(2.57±0.19) pg/g vs. (1.60±0.15) pg/g](P<0.05),so did the IL-10 [(11.59±1.32) pg/g vs. (7.97±1.96) pg/g](P<0.05). Compaered with group IR,TNF-α of group PP decreased [(1.88±0.26) pg/g vs. (2. 57±0. 9) pg/g](P<0.05) ,so did the IL-10 [(8.35±1.00) pg/g vs. (11.59±1.32) pg/g](P< 0.05),with decreased activity of NF-κB. There was no significant difference in the levels of TNF-α, IL-10 and NF-κB between group IR and group PA. The changes of IL-10 and NF-κB activity were parallel to that of TNF-α. Conclusion Pre-treatment with propofol can prevent the elevation of inflammatory factors in the cerebrum undergoing ischemia and reperfusion, which was not when used after cerebral ischemia. The effect of propofol on reduction of TNF-α production in ischemic cerebrum may be through inhibiting transduction pathway of NF-κB.

ObjectiveTo compare and evaluate the effectiveness of Airtraq laryngoscope combined with a Bougie and Airtraq laryngoscope alone for tracheal intubation in simulated difficult airway.Methods Four anesthetists and 4 clinical physicians of standardized training were enrolled in the study.The participants intubated the trachea of the ALS simulator manikin in 5 tongue edema scenarios simulating modified Cormack-Lehane grade 1,2a,2b,3,and 4 views and 1 cervical immobilization scenario.Results No significant difference in the rate of successful intubation was detected between two techniques(P＞ 0.05 ).In Cormack-Lehane grade 1,2a views,the duration of successful intubation in Airtraq laryngoscope alone [ ( 14.3 ± 1.3),( 17.1 ± 2.9) s] was shorter than that in Airtraq laryngoscope combined with a Bougie [ (26.6 ± 3.8),(36.4 ± 3.6) s ] with significant difference (P ＜ 0.01 ).Cormack-Lehane grade 2b,3,4 views,the duration of successful intubation in Airtraq laryngoscope alone[ (74.5 ± 6.5 ),(116.3 ± 9.8),(53.0 ± 6.1 )s] was longer than that in Airtraq laryngoscope combined with a Bougie [ (35.4 ± 4.3 ),(52.3 ± 5.0),(40.4 ± 3.8 ) s ] with significant difference (P ＜ 0.05).ConclusionAirtraq laryngoscope combined with a Bougie can be quickly intubated in simulated difficult airway compared with Airtraq laryngoscope alone.

Objective To evaluate the influence of dexmedetomidine（Dex） on sedation and requirement of propofol during anesthesia induction. Methods Thirty patients（ASA Ⅰ or Ⅱ） undergoing selective operation were randomly divided into 2 groups：Dexmedetomidine group （group D,n=15） or control group （group C,n=15）. Patients in the group D received 1 μg/kg dex diluted to 10ml over 10 min by pumped infusion and patients in the group C was simply recieved normol saline at the same way.Twenty minutes after administrating the drug,patients in both groups were pumped propofol at the speed of 0.4 mg·kg-1·min-1. When holding up jaw without movement,patients received 1 μg/kg fentanyl and 0.6 mg/kg rocuronium,and endotracheal intubated 1.5 minutes later. RE,SE,Ramsay sedation scale of the patients were recorded before（T0） and after 5,10,20 minutes（T1-T3） of drug adminstration.The minimum dose and total dose of propofol during induction were recorded.Results Compared with group C and T0,RE and SE in group D decreased obviously at T1-T3 （P0.01）,while Ramsay sedation scale rised significantly （P0.01）. Compared with group C,the minimum dose and the total dose of propofol decreased obviously in group D during induction （P0.01）.Conclusion Dexmedetomidine causes sadetive without respiratory depression,and has the propofol sparing effect during anesthesia induction.

Objective To study curative efficacy of radix notoginseng saponin dispersible tablets combined with rivaroxaban in treatment of tibial fracture after operation and its effects on joint function and the leves of inflammatory factors .Methods 90 patients of tibial fracture who received therapy from March 2014 to March 2016 in our hospital were selected.According to random number table,all elective surgery,those patients were divided into the observation group (n=45) and the control group (n=45),the control group was treated with radix notoginseng saponin dispersible tablets,while the observation group was treated combined with rivaroxaban.After two weeks of treatment, the hemorheology, inflammatory factors, joint function were compared between two groups.Results The patient swelling time and bed time in the observation group were shorter than the control group (P<0.05);after treatment,the levels of red cell volume, whole blood viscosity,fibrinogen in the observation group were lower than the control group (P<0.05);the levels of tumor necrosis factor TNF-α, IL-1,IL-6 in the observation group were lower than the control group (P<0.05);after treatment three months and six months,the Baird-Jackson scores in the observation group were higher than the control group (P <0.05).Conclusion Radix notoginseng saponin dispersible tablets combined with rivaroxaban is well for tibial fracture after operation,which can improve hemorheology,reduce the level of inflammatory factors,promote joint functional recovery.

Objective To evaluate the role of heme oxygenase-1 ( HO- 1 ) in inflanmatory responses in septic rats.Methods Seventy-two male Wistar rats,aged 10-14 weeks,weighing 250-300 g,were used in this study.The animals were anesthetized with intraperitoneal 2％ pentobarbital sodium 50 mg/kg.Sepsis was induced by cecal ligation and puncture (CLP).The animals were randomly divided into 4 groups ( n =18 each):control group (C group),CLP group,HO-1 inducer cobalt protoporphyrin Ⅸ (CoPPⅨ) group (Co group) and HO-1 inhibitor zinc protoporphyrin Ⅸ (ZnPPⅨ) group (Zn group).Six rats in each group were randomly chosen at 6,12 and 24 h after operation to collect blood samples,and then the animals were sacrificed to obtain lung tissues at 24 h after operation.The serum levels of TNF-α,IL-6 and high mobility group box 1 (HMGB1) were determined by ELISA.The expression of HMGB1 mRNA in lung tissues was detected by RT-PCR.Another 40 Wistar rats with the same conditions were grouped according to the method mentioned above and the survival curve was drawn.Results Compared with group C,the serum levels of TNF-α,IL-6 and HMGB1 were significantly increased,the expression of HMGB1 mRNA in lung tissues was up-regulated,and the survival rate was significantly decreased in CLP,Co and Zn groups ( P ＜0.05).Compared with group CLP,the serum levels of TNF-α,IL-6 and HMGB1 were significantly decreased,the expression of HMGB1 mRNA in lung tissues was down-regulated,and the survival rate was significantly increased in group Co ( P ＜ 0.05),while no significant change was found in the parameters mentioned above in group Zn ( P ＞ 0.05).Conclusion Inducing the expression of HO-1 is helpful in reducing inflammatory responses in septic rats.

The present study was to examine the effect of stellate ganglion block (SGB) on bilateral regional cerebral oxygen saturation (rSO2) and postoperative cognitive function. Eighty patients undergoing selective coronary artery bypass graft with cardiopulmonary bypass (CPB) were randomly and equally divided into two groups. The patients in group S were given right SGB with ropivacaine, while the patients in group C were injected with normal saline. We compared the bilateral rSO2 after SGB. Minimum Mental State Examination (MMSE), Visual Verbal Learning Test (VVLT), and Digital Span Test (DST) were applied to observe the effect on cognitive function. We found that the incidence of postoperative cognitive dysfunction (POCD) 7 days after surgery in group S was lower than that in group C. The level of blocked side rSO₂ of S group were significantly higher before CPB time of rewarming than that before SGB (P < 0.05), much higher than corresponding non-blocked side rSO₂ before CPB (P < 0.05), and much higher than rSO₂ level in group C before CPB and after CPB (P < 0.05). The non-blocked side rSO₂ in group S before anesthesia were much lower than basic levels and those in group C (P < 0.05). It could be concluded from the above results that there was significant increase in the blocked-side rSO₂ compared to the non-blocked side and there was significant decrease in the incidence of POCD compared to the control group after SGB.
Autonomic Nerve Block ; adverse effects ; Cardiopulmonary Bypass ; adverse effects ; Cerebrum ; physiology ; Cognition ; Cognition Disorders ; Coronary Artery Bypass ; adverse effects ; Humans ; Incidence ; Oxygen ; physiology ; Oxygen Consumption ; Postoperative Complications ; Stellate Ganglion

Objective To research the 50% effective anesthetic volume ( EAV50) of 0.5% ropivacaine in nerve stimulator-guided vertical infraclavicular brachial plexus block. Methods Thirty patients scheduled for forearm or hand surgery were blocked using 0. 5% ropivacaine in nerve stimulator-guided vertical infraclavicular brachial plexus block. The EAV50, which is the anesthetic volume corresponding to 50% success and 50% failure was determined by up-and-down sequential test. The starting dose of 0. 5% ropivacaine was 0. 55ml/kg. Block failure resulted in a dose increase 110% , and block success in a reduction 110%. The sensory and motor blockade were accessed at 5- min intervals (up to 60 min). Results In nerve stimulator-guided vertical infraclavicular brachial plexus block, EAV50 for 0.5% ropivacaine was 0.417ml/kg. In up-and-down sequential test, there were significantly different in the block success rates of lateral, medial and posterior cord ( P <0.01). Conclusion In nerve stimulator-guided vertical infraclavicular brachial plexus block, enough anesthetic volume must be given to increase block success rates of all the cords of brachial plexus, and EAV50 for 0. 5% ropivacaine was 0.417ml/kg.

Objective Toinvestigate the effects of carbon dioxide pneumoperitoneum on cardiovascular system by making use of arterial pressure waveform analysis( FloTrac/Vigileo system) to observe the change of heart function of patients undergoing laparoscopy cholecystotomy. Methods Forty patients scheduled for elective laparoscopy cholecystotomy were divided into two groups with 20 cases each by random sampling.Ventilatory capacity was fixed (tidal volume was 10 ml/kg, frequency was 12 times/min) in group A and adjusted to keep arterial carbon dioxide tension (PaCO2) and end expiration carbon dioxide tension(PETCO2)in normal range in group B. The parameters, such as mean arterial pressure (MAP), cardiac output(CO),stroke volume (SV), stroke volume variability (SVV), heart rate(HR), pulse oxygen saturation (SpO2),PETCO2, PaCO2 were recorded and analyzed. Results In group A:HR,MAP,CI,SVV,PaCO2 and PETCO2 were increased at 10,30 min after pneumoperitoneum (P ＜0.05 or ＜0.01),there was no significant difference in SVV between the end of pneumoperitoneum and 5 min after intubation [(8 ±2)% vs. (9 ±3 )%](P＞ 0.05 ) ,but HR, MAP, CI,SVI,PaCO2 and PETCO2 increased significantly (P＜ 0.05 or ＜ 0.01 ). In group B: HR, MAP, CI, SVI, PaCO2 and PETCO2 at 10,30 min after pneumoperitoneum were no changes (P ＞0.05 ), SVV was higher than that at 5 min after intubation (P ＜ 0.01 ), there was no significant difference in SVV between the end of pneumoperitoneum and 5 ain after intubation [(9 ± 2)% vs. ( 10 ± 2)%] (P ＞0.05 ). HR, CI, SVI, PaCO2, PETCO2 at 30 min after pneumoperitoneum and the end of pneumoperitoneun were significantly higher in group A than those in group B (P ＜ 0.05 or ＜ 0.01 ). Conclusions During carbon dioxide pneumoperitoneum, hypercapnia can increase MAP, HR, CO,SV significantly, and intra abdominal pressure can decrease preload by hindering the reflow of inferior vena cava and abdominal viscera veins. Arterial pressure waveform analysis can promptly reflect the effects of carbon dioxide pneumoperitoneum on cardiovascular system and be in favour of adjusting the respiration parameters and managing transfusion in laparoscopic surgery.