Objective　To evaluate the effect of abdominal drains on difficult cholecystectomy.Method　894 cases of difficult cholecystectomy from Jan. 1988 to Jun. 1999 were retrospectively analysed.Results　The incidences of complication, reoperation and death in drain group were 6.81%,1.16% and 0.33%，respectively while those in non-drain group were 33.56%,9.59% and 4.11% respectively.There was significant difference between the two groups.Conclusion　Abdominal drains should be laid routinely in difficult cholecystectomy.

Objective　To explore the cause, diagnosis and treatment of retroperitoneal fibrosis.Methods　5 cases of retroperitoneal fibrosis were respectively treated by moving ureter into abdomen cavity, encapsulating with pediculate omenta and ilel ureter.Results　Following-up of 5 cases for 1 to 3 years, all cases had normal renal functions and hydronephrosis were much decreased.Conclusions　Intravenous urogenous(IVU),retrograde pyelography(RGP) and computed tomography (CT) are important methods to diagnose the disease. And the treatment method chosen depends on the range, location of ureterostenosis, and whether the ureter is open or not.

Objective To evaluate the causes,prevention and treatment of mesh infection after abdominal wall hernia mesh repair.Methods The clinical data of 14 mesh infections admitted from De-cember 1997 to December 2013 were analyzed retrospectively.There were one case of inguinal hernia with Lichtenstein repair,eleven cases of inguinal hernia with preperitoneal repair,one case of incisional hernia with Bard Composix Mesh and 1 case of parastomal hernia with mesh repair above the abdominal muscle. Based on prothetic materials and infection status,the infection meshes were removed in 4 cases and open dressing change were operated in 10 cases.Results All patients were healed and discharged without peri-operative death.There was no hemorrhage and bladder injury during the procedures.The time of dressing change ranged from 3 weeks to 6 months,with a median of 4 weeks.All patients were followed up for 8 to 64 months.One patient had a recurrence of abdominal incisional hernia.Conclusion There are many fac-tors related to mesh infection after mesh repair and preventing mesh infection is the most important.Once the infection occurs,the management should be individualized.Antibiotic treatment and surgical drainage can be effective in most polypropylene mesh(PPM)infection However,infected expanded polytetrafluoro-ethylene(ePTFE)mesh should be removed completely.

Objective To analyze the reasons and notes of failed laparoscopic surgery for patients with inguinal hernia.Methods The clinical data of 17 cases of failed laparoscopic inguinal hernia opera-tion from August 2003 to January 2013 in our hospital were reviewed retrospectively.Results The reasons of reoperation included 9 cases of recurrence,1 case of patch infection,1 case of intestinal fistula,1 case of intestinal wall hernia,2 cases of suture reaction,1 case of bladder injury,1 case of ruptured umbilical inci-sion,1 case of scrotal hematoma and 1 cases of iliac vascular injury.Six patients received repeated laparo-scopic surgery and the other patients were treated with open surgery.All patients were successfully treated and discharged after 2-15 days.Conclusion When the laparoscopic technique is applied for inguinal her-nia,indications of laparoscopic surgery should be strictly controlled and operation standard should be fol-lowed.For patients with special condition,difficult laparoscopic operation should be timely converted to laparotomy.Close attention needs to be paid to the occurrence of postoperative complications and they need timely treatment.

Objective To compare the safety and efficiency of endoscopic total extraperitoneal patchplasty(TEP)and modified Kugel hernioplasty for inguinal hernia.Methods The clinical data of 284 cases(312 surgeries)of preperitoneal inguinal hernia repair,including 134 cases(152 surgeries)of TEP and 150 cases (160 surgeries)of modified Kugel hernioplasty,were retrospectively evaluated from June 2009 to June 2011.Mean operative time,postoperative hospital stay,postoperative complications and recur-rence were compared between groups.Results There were no significant differences in mean operative time [(48.75 ±12.14)min vs(51.46 ±24.76)min,P=0.248],postoperative hospital stay [(5.23 ± 1.85)d vs(5.84 ±1.52),P=0.126],postoperative complications [5 cases(3.3%)vs 8 cases(5.0%), P=0.598]and recurrence [1 case(0.7%)vs 2 cases(1.3%),P=1.00]between TEP and modified Kugel hernioplasty,espectively.Conclusion TEP and modified Kugel hernioplasty are both methods for preperitoneal hernia repair and they can completely repair the defect of myopectineal orifice.They are safe and effective,which is worthy of being spread in clinical practice.

Objective To explore the values and relationship among the contents of thrombus precursor protein(TpP)and plasma D-dimer(D-D),complications after mechanical heart valve replace-ment and their correlation with international normalized ratio(INR)in anticoagulation therapy and monito-ring.Methods A total of 150 patients with mechanical heart valve replacement were enrolled.TpP,D-D, INR,other indicators and complications were compared to draw conclusions.Results There were signifi-cant differences in TpP among the groups(P<0.0083).Significant differences in D-D among the postop-erative group(100.96 ±61.56),thrombosis group(17.78 ±5.94)and control group(5.97 ±1.58)were observed(P<0.0083).Significant differences in INR among the postoperative group(1.65 ±0.34),hem-orrhage group(2.22 ±0.65)and control group(1.11 ±0.10)were observed(P<0.0083),but the effec-tiveness of INR monitoring for determining the state of thrombosis was limited to a certain extent.Conclu-sion TpP and D-D examination can facilitate monitoring after mechanical heart valve replacement,and it has a certain guiding significance for determining anticoagulation therapy and monitoring of complications after mechanical heart valve replacement.

Objective To explore the effects of anatomical and nonanatomical hepatectomy on the prognosis of patients with hepatocellular carcinoma(HCC).Methods A total of 62 HCC patients were enrolled,including 33 cases of anatomical hepatectomy(Group AH)and 29 cases of nonanatomical hepa-tectomy(Group IH).The operation situation and hematocrystallin(HB)loss were record.Fasting venous blood of HCC patients were extracted for detection of circulating AFP mRNA expression.The recurrence, mortality and complication rate were recorded at the same time.Results The operative time of Group AH was significantly higher than that of Group IH,while the bleeding volume and HB loss were lower(P<0.05).There were no significant differences in AFP mRNA expression and recurrence rate.The short-term mortality rate of Group AH was lower than Group IH(P<0.05 ),but their long-term mortality rates were similar(P>0.05 ).There was no significant difference in complication rate between groups.Patients of Group AH got more hepatosis due to liver cirrhosis or fibrosis,while patients of Group IH got more bleeding or infection due to the central tumor.Conclusion Anatomical hepatectomy has advantages in protecting artery and improving prognosis for HCC patients,but it has surgical risks for patients with serious patholog-ical damage in hepatic lobes,and nonanatomical hepatectomy may be considered.

Objective To evaluate the effects and security of single or combined sufentanil application on sedation and analgesia for mechanically ventilated patients in intensive care unit(ICU).Method A total of 160 ICU patients with mechanical ventilation were randomly allocated into four groups:sufentanil group,sufentanil plus midazolam group,sufentanil plus dexmedetomidine group and fentanyl group.Facial pain scale(FPS),Ramsay score and vital signs were employed to assess the effects of different therapies on organ functions and adverse reactions.Result After the treatment,FPS in all groups were significantly decreased and maintained around 3 points.Ramsay scores were significantly increased(P <0.001)and the score in group given sufentanil combined with midazolam or dexmedetomidine at the time points of30 min,1 h,6 h were even higher.Compared with the preoperative data,indicators of lung function(PaCO2and blood lactic acid),liver function(AST)and renal function(Cr)were decreased in all groups(P <0.05).Respiratory rate in the fentanyl group was significantly higher than the others.Total consumption ofsufentanil in group with combined sufentanil application was significantly lower.No significant differencesin adverse reactions were noticed among the groups(P >0.05).Conclusion For mechanically ventilatedpatients,sufentanil has efficient sedative and analgesic effects with less physiological interference and severe adverse reactions.Combined application is beneficial in decreasing total sufentanil consumption andinhibition to respiratory system,which is worthy of being spread.

Objective To research the effects of parenteral nutrition(PN)with high branchedchain amino acid(BCAA)content for critically ill patients in general ICU.Methods A total of60 patientsfrom the general ICU were randomly divided into the control group(30 cases)and treatment group(30 cases).The control group was given PN with balanced amino acids,while the treatment group received PNwith high content of BCAA.Therapeutic outcomes and the blood parameters were measured betweengroups.Results Total protein (TP),albumin (ALB),prealbumin (PA),arm muscle circumference(AMC)and arm circumference(MAC)of the treatment group increased significantly(P <0.05).In thecontrol group,the change of TP,ALB and PA after 7 days was statistically significant(P <0.05).Compared to the control group,the improvement of parameters in the treatment group was more obvious.Conclusion For patients in general ICU,parenteral nutrition with high BCAA content is able to provide effective nutritional support without relative sideeffects.