Objective To study the dissection technique of total mesoreetal excision(TME).Method One hundred and twelve eases of rectal cancer underwent TME from January 2000 to August 2008 were retrospectively analyzed.Results All the procedures were conducted sueeessfully,average blood loss was(45±32)ml during the dissection of rectal mesentery,the hypogastrie nerves were preserved in 96 eases,urinary retention occurred in 6 eases and recovered 1 month later.Anastomotie leakage occurred in 1 ease and healed after transverse colostomy.Wound infection in 6 eases and healed by dress changing.There was no ureter injury.There were 14 eases of death,6 eases of recurrence and 15 eases of distal metastasis according to(3.7±1.1)years follow-up in 112 eases.The survival rate of 1,3,5 years was 92.0%(103/112),84.8%(95/112),66.1%(74/112)respectively.Conclusion Anatomical dissection adequate exposure and hemostasis are critical factors for TME.

Objective To investigate the comparative analysis between single-port access laparoscopic Miles surgery with jackknife position and laparoscopic Miles surgery with lithotomy position for low rectal cancer.Methods Retrospectively analyzed 36 patients with low rectal cancer (TNM stage:Ⅱ-Ⅲ) undergoing laparoscopic abdominoperineal excision.Patients were divided into two groups.Lithotomy position group:laparoscopic Miles surgery with lithotomy position.Jackknife position group:single-port access laparoscopic Miles surgery with jackknife position.The operation time,blood loss,postoperative recovery,postoperative complication,postoperative recurrence and survival rate were observed.Results Blood loss of perineal position in jackknife position group was less than that in lithotomy position group [(31.5 ± 22.4) ml vs.(53.5 ± 25.6) ml] (P =0.01),and removal of drainage tube in jackknife position group was earlier than that in lithotomy position group [(6.7 ± 1.9) d vs.(9.8 ± 1.7) d] (P ＜ 0.01).However,the operation time,blood loss in abdomen,blood loss,postoperative out-of-bed activity time,recovery of gastrointestinal function time,dermal sutures out time,postoperative hospital stay,complication,postoperative recurrence in 2 years and survival rate between two groups had no significant difference (P ＞0.05).Conclusions Single-port access laparoscopic Miles surgery is safe and feasible with better surgical outcome and cosmetic benefits.Furthermore,the blood loss and postoperative exudation at perineal region is less than that in traditional lithotomy position.

Objegtive To study the feasibility and clinical effects of enteral nutrition by needle catheter jejunostomy(NCJ)tube in the postoperative adjuvant chemotherapy for patients of staged gastric cancer.Methods Eighty-two patients with staged gastric cancer underwent radical gastrectomy and going to receive chemotherapy were randomly divided into group A(41 cases)and group B(41 cases).All of the patients had been NCJ.Group A received enteral nutrition through the tube during chemotherapy,and group B had been given general diet.A series of parameters were measured post-chemotherapy.And the gastrointestinal complications were carefully observed.Results In post-chemotherapy,the level of hemoglobin,albumin,prealbumin,interleukin-2,natural killer cell activities and CD3+,CDd4+,CD4/CD8 in group A[(106.9±12.0)g/L,(26.2±1.4)g/L,(202.9±32.2)mg/L,(11.9±2.1)μg/L,(21.3±5.2)%,(62.9±3.3)%,(26.1±4.7)%,1.1±0.2]were significantly higher than those in group B(P＜0.05 or＜0.01).The incidences of vomiting in group A(4.9%,2/41)was significantly lower than that in group B (26.8%,11/41)(P＜0.05).The average intake in group A[(1312±114)ml]was significantly more than that in group B[(76.5±186)ml](P＜0.05).No severe enteral nutrition related complications occurred in group A.Conclusions It is safe and feasible to enteral nutrition supported by NCJ tube in chemotherapy for patients of staged gastric cancer.It can improve the nutrition status and immune function in the given patients.

Objective To identify applied value of multifunctional peritoneal biopsy needle(MPBN)in the diagnosis of tuberculous peritonitis(TP).Methods Peritoneal biopsy was performed with MPBN in 19 cases of 27 patients with TP between January 2001 and September 2005,which was compared with the clinical presentation,laboratory analysis and laparoscopy.Results Five patients were diagnosed as TP according the clinical presentation and laboratory analysis.In 19 patients with TP,73.68% was accurately diagnosed as with MPBN.All of the 3 patients were accurately diagnosed as TP with laparoscopy.Conclusion Peritoneal biopsy with MPBN is useful in diagnosis of tuberculous peritonitis,especially when there is no laparoscope.

OBJECTIVE:To study the chemical constituents of Sedum lineare. METHODS:Silica gel column chromatogra-phy,TLC and crystallization were adopted to isolate the chemical constituents of S. lineare. And chemical structures were analyzed and identified based on physicochemical properties and spectral data of compounds. RESULTS:A total of 6 sterols and 2 triterpe-noids were isolated from petroleum ether fraction of S. lineare,which were identified as stigmaster-5-ene-3β-ol-7-one(1),stigmas-ter-5-ene-3β,7α-diol(2),daucosterol(3),daucosterol palmitate(4),β-sitosterol(5),stigmaster-7-ene-3β-ol(6),δ-amyrin(7),andδ-amyrone(8)respectively. CONCLUSIONS:Compounds 3,4 and 7 are isolated from S. lineare for the first time,and compound 4 is isolated from genus S.lineare for the first time. The study has laid certain foundation for the quality evaluation of S. lineare.

Objective To study the distribution characteristics of intraperitoneal free gas and the location value of the site of gastrointestinal perforation using multi-slice CT (MSCT).Methods 60 cases of gastrointestinal perforation were retrospectively collected.The distribution of the intraperitoneal free gas in CT image was analyzed and observed.The digestive tract were divided to the upper digestive tract and the lower digestive tract by Treitz ligament.The distribution of the intraperitoneal free gas was analyzed using χ2 test.The distribution of the intraperitoneal free gas between each different perforational site was analyzed.Results 38 cases of the site of gastrointestinal perforation located in upper gastrointestinal tract and 22 cases located in lower gastrointestinal tract,there was statistically significant difference between the upper digestive tract and the lower digestive tract about the distribution of the intraperitoneal free gas(χ2=22.33,P<0.001).In the cases of upper gastrointestinal tract perforation,13 cases of the site located in stomach and 25 cases located in doudenum,there was no statistically significant difference between stomach and duodenum(χ2=1.97,P>0.05).In the cases of lower gastrointestinal tract perforation,11 cases of the site located in bowel and 11 cases located in colon,there was statistically significant difference between bowel and colon(χ2=8.98,P<0.05).Conclusion The MSCT distribution of the intraperitoneal free gas has important value in localization diagnosis of gastrointestinal perforation.

Objective To compare the efficacy and complications of Chinese Shang Ring circumcision with conventional circumcisiom Methods Clinical data of 479 cases of Chinese Shang Ring circumcision and 354 cases of conventional circumcision with complete follow-up were analyzed.Comparisons were made between the two groups on operation time,pain score,blood loss,postoperative complications,postoperative satisfaction with penile appearance,wound healing time and treatment costs. Results There was no statistical difference in age and foreskin status between the two groups (P＞0.05).For the Shang Ring group,the operation time was(5±1)rain,blood loss was (0.98±1.14)ml,pain score during operation was 0.25±0.54,24-hour pain score after operation was 1.63±0.87,the postoperative complication rate was 6.89% (33/479),wound healing time was (20±5)d,the satisfaction rate of appearance was 99.79% (478/479),and treatment cost was (871±52) yuan.For the conventional group,the operation time was (27±5) min,blood loss was (8.30±3.60)ml,pain score during operation was 3.29±1.57,24-hour pain score after operation was 5.56±1.42,the postoperative complication rate was 13.28%(47/354),wound healing time was (13±2)d,satisfaction rate of appearance was 92.37% (327/354),and treatment cost was (554±46) yuan.Compared with the conventional group,the Shang Ring group had a shorter operation time,less blood loss,less pain score,higher appearance satisfaction rate and a lower complication rate (P＜0.05).But wound healing time was longer and treatment cost was higher in the Shang Ring group (P＜0.05). Conclusions Chinese Shang Ring circumcision is simpler and an improved approach over conventional circumeision with shorter operative time,less blood loss,less pain,relatively lower complication rate and higher satisfaction and acceptability.

Objective To determine the effect of nanochemotherapy drug on Survivin and p53 ex-pressed by human biliary traet carcinoma cell line QBC939.Methods Culturing the human biliary tract carcinoma cell line QBC939 in vitro and it was divided into five groups including saline,nanochemotherapy drug,nanopartiele withoul nanochemotherapy drug,5-FU and gemcitabine.Using the methods of MTT and flow cytometry to observe the growth of QBC939 which was dealt with different drugs.In addition,RT-PCR and Western blot were used to delect the expression of mRNA and protein by Survivin or p53.Results The expression of mRNA and protein by Survivin decreased in the following set:saline,nanoparlicle withoul nanochemotherapy drug,5-FU,gemcitabine and nanochemotherapy drug,respeclively.However,the ex-pression of mRNA and protein by p53 were in reverse order.The inhibiting action to QBC939 was obvious in nanochenmtherapy drng and the apoplotic rate was higher than others except for gemcitabine(P＜0.05). Conclusion Nanochemotherapy drug has significant effect on treatment cholangiocarcinoma in vilro,which may attribute to the down regulation of Survivin and up regulation of p53.

Objective: To explore MSCT features of hepatic metastases of nonhypervascular pancreatic neuroendocrine tumor(PNET) and pancreatic ductal adenocarcinoma (PDAC), and its value for differential diagnosis. Methods: A total of 21 patients with nonhypervascular PNET and 56 patients with PDAC associated with hepatic metastases were analyzed retrospectively. The CT features of hepatic metastases including tumor number, distribution, size, fusion of lesions, abnormal hepatic perfusion and the CT enhancement degree were observed and analyzed. Results: There was no significant difference of the tumor number, distribution and lesion fusion of hepatic metastases between nonhypervascular PNET and PDAC (all P>0.05). There was significant difference of the maximum diameter of hepatic metastases between nonhypervascular PNET and PDAC (P=0.03). The incidence of abnormal hepatic perfusion of PDAC was higher than that of nonhypervascular PNET (67.86% vs 28.57%,P<0.01). In arterial phase, portal phase and equilibrium phase, the enhancement index of hepatic metastases of nonhypervascular PNET were all higher than that of PDAC(P<0.01). Logistic regression analysis showed that only the enhancement index in arterial phase was an independent factor for differentiating hepatic metastases between nonhypervascular PNET and PDAC, with AUC of 0.97. Conclusion: The imaging features of hepatic metastases on MSCT is helpful for differentiating diagnosis of nonhypervascular PNET and PDAC.

Objective To study whether the organs besides digestive system of musca domestica Ⅲ instar larvae have the capability of produceing musca β-glucosidase.Methods Tissues of malpighian tubules,trachea,epiploon and body wall of musca domestica Ⅲ instar lar-vae were dissected under anatomic microscope,and the expression of β-glucosidase gene in these dissected tissues were detected by reverse transcription PCR.And the tissue localization of β-glucosidase mRNA was further identified by in situ hybridization.Moreover,anti-cellulase was used to determinate the tissue distribution with immunohistochemical staining.The relative mRNA expression levels of musca domesticaβ-glucosidase gene in these organs were tested by real-time quantitative PCR.Results The reverse transcription PCR showed that the ampli-fication products of β-glucosidase gene were observed in tissues of malpighian tubules,trachea and body wall.β-glucosidase mRNA was shown in the epithelium cells of malpighian tubules,trachea and body wall by in situ hybridization,and it was almost the same in the results of im-munohistochemical staining.The real-time quantitative PCR showed that the relative expression quantity of β-glucosidase gene in malpighian tubules and body wall were higher than that in foregut,while it was lower in itrachea than that in foregut.And it was of statistical difference in gene expression level of β-glucosidase among these organs (P <0.05).Conclusion Malpighian tubules,trachea and body wall of musca domestica Ⅲ instar larvae have the function of secreting β-glucosidase.Combining with the characteristics of secreting β-glucosidase in most organs of digestive system,it may provide a new biological method for the prevention and treatment of human diseases transmitted by musca domestica with the use of taget gene β-glucosidase.