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 explore the effects of modified radical surgery combined with chemo-therapy on postoperative complications and quality of life in breast cancer patients.Methods The clinical data of 175 patients with early breast cancer were retrospective analyzed.According to the different ways of surgical treatment,patients were divided into the control group(n =100)and the study group(n =75).In the study group,patients received modified radical mastectomy,and preoperative and postoperative chemo-therapy as adjuvant therapy.In the control group,patients received traditional standard radical surgery.The follow-up ranged from 1 to 3 years.Recurrence,mortality,postoperative complications,and quality of life were compared between the two groups.Results There were no significant differences in local recurrence (6.7% vs 6%)and axillary lymph node recurrence (2.7% vs 3%),distant metastasis (10.7% vs 11%),and 5-year survival rate(92% vs 91%)between the study group and control group(P >0.05).In the study group,the incidence of postoperative complications was significantly lower(6.7% vs 42%), while its score on quality of life significantly improved(P <0.05).Conclusion For early breast cancer, modified radical mastectomy combined with chemotherapy has similar effects as the standard radical mas-tectomy.It has obvious advantages in reducing complications and improving the quality of life,which is worthy of being spread clinically.

Objective To systematically evaluate the effectiveness and safety of axillary lymph node dissection for breast cancer patients with negative sentinel node biopsy.Methods Literatures in CNKI,PubMed,EMBASE and CBMwere searched from their establishment to December 1,2013.Accord-ing to the inclusion and exclusion criteria,trials of axillary lymph node dissection and sentinel node biopsy for breast cancer were strictly screened and extracted for quality assessment and result analysis.Meta-anal-ysis was conducted by using Revman 5.1 software.Results A total of 10 studies involving 7731 patients were eligible for the final analysis.Because of the large differences in research type,measurement indica-tor,follow-up period and statistical index,subgroup analysis was adopted.Meta-analysis was applied for homogeneous researches and the remaining studies were analyzed with qualitative descriptive analysis.The results showed no significant differences in disease-free survival,overall survival,local recurrence rate,and distant metastasis rate in different follow-up periods.Conclusion For breast cancer patients with single invasive lesion,axillary lymph node dissection is not necessary.More high-quality random control trials and long-term follow-up are required to confirm the conclusions of this systematic review.

Objective To observe the influence of intensive insulin therapy on inflammatory fac-tors and prognosis in severe multiple trauma patients.Methods A total of 53 cases of severe multiple trauma were randomly divided into the treatment group(n =27)and the control group(n =26).Besides basic treatment,patients in the treatment group received additional intensive insulin therapy by micro-pump.The level of blood glucose in the control group was controlled under 11.1 mmol/L.Levels of TNF-α,IL-1β,IL-6,and CRP were tested before and after treatment.Multiple organ dysfunction syndrome,noso-comial infection rate,and mortality rate were also observed.Results The levels of TNF-α,IL-1β,IL-6, and CRP in the treatment group were significantly lower than those of the control group(P <0.05 or P <0.01).The incidence of multiple organ dysfunction syndrome,nosocomial infection,and mortality rate in the treatment group was lower(P <0.05).Conclusion Intensive insulin therapy can effectively decrease the expressions of inflammatory factors in patients with severe multiple trauma,improve the prognosis,re-duce the incidence of nosocomial infection and mortality.

Objective To explore the method and effects of operative treatment of superior shoul-der suspensory complex(SSSC)injury.Methods A total of 18 patients with SSSC injury were enrolled. There were six cases of scapular neck fracture combined with comminuted clavicle fracture,five cases of scapular neck fracture combined with acromial fracture,and two cases of comminuted clavicle fracture com-bined with acromial and glenoid fracture.These patients were treated with open reduction and internal fixa-tion.Three patients had acromioclavicular joint dislocation combined with coracoclavicular ligament rupture and they were given hook plate fixation and ligament repair.One patient with scapular neck fracture com-bined with acromioclavicular joint dislocation,and one patient with comminuted clavicle fracture combined with coracoclavicular ligament rupture,were treated with the open reduction,internal fixation and the liga-ment repair.Results All patients were followed up for 3 to 14 months,with an average of 9 months.Ana-tomical reduction and healing were all achieved within 7 to 12 weeks,with an average of 8.6 weeks.Con-clusion Anatomical structure of SSSC is very complex and surgery is given priority to internal fixation, which restores the stability good therapeutic effect.

Objective To explore the best minimal invasive method in treating renal pelvic stones less than 1.5 cm.Methods A total of 90 patients with renal pelvic stone less than 1.5 cm were enrolled, including 47 cases of retrograde intrarenal surgery(RIRS)by rigid and flexible ureteroscopy with holmium laser lithotripsy,and 43 cases of percutaneous nephrolithotomy(PCNL)by holmium laser lithotripsy.Opera-tion time,stonefree rate(SFR),hospitalization,and complications were analyzed for comparison.Results The average sizes of stone in the RIRS group and PCNL group were 1.2 cm(range 1.0 ~1.5 cm)and 1.3 cm (1.0 ~1.5 cm),respectively.In the RIRS group,45(95.74%)patients out of 47 had complete clearance and 32 patients needed combination of flexible ureteroscopy to fragmentate the stones falling into the renal calices.The operation time was 44 min(range 27 ~70 min)with postoperative fever in 2 cases.The decrea-sing in hemoglobin and hematocrit was(0.18 ±0.06)g/L and 0.11%,respectively.No major complication was recorded.In PCNL group,the mean operation time was 70min(range 45 ~90 min)with a stone-free rate of 95.35%(41 /43).The decreasing in hemoglobin and hematocrit was(17.25 ±6.70)g/L and 5. 62%,respectively.The complications in PCNL group were postoperative fever in two cases and bleeding in two cases.Conclusion RIRS has the advantages of natural orifice endoscopic surgery in shortening opera-tion time,reducing blood transfusion requirements,and decreasing postoperative complications.For renal pelvic stone less than 1.5 cm,RIRS can be the primary choice.

Objective To evaluate the expression of p53 in triple negative breast cancer( TNBC) and its impact on the prognosis of TNBC systematically. Methods Documents published on PubMed, Medline,CNKI,CNKI,Wanfang data,and VIP data were screened for relative researches. Two reviewers filtered,extracted and assessed the literatures according to the inclusion criteria and exclusion criteria. The meta analysis was conducted by using RevMan5. 0 software. Result A total 13 trails were included,con-taining 11 Chinese documents and 2 English documents. The meta analysis showed that p53 is significantly expressed in TNBC[OR=2. 02,95%CI(1. 28,3. 19)]. TNBC patients with positive p53 expression had higher rates in lymph node metastasis[OR=2. 02,95%CI(1. 28,3. 19)],recurrence[OR=3. 39,95%CI(1.45,7. 90)],metastasis[OR =2. 65(1. 36,5. 18)],disease-free survival[OR =0. 29(0. 18, 0. 47)]and overall survival[OR=0. 29(0. 18,0. 47)]than patients with negative p53 expression. Con-clusion p53 is overexpressed in TNBC,which plays a certain role in guiding the clinical prognosis of TN-BC. It can be regarded as an independent factor to evaluate the prognosis of TNBC,and a therapeutic tar-get in further studies.

[ Abstract]Objective To investigate the effect of two-tage skin grafting with artificial dermis for perianal hidradenitis suppurativa. Methods A total of 20 cases diagnosed as perianal hidradenitis suppu-rativa in our hospital were selected from 2011 to 2013. In the first-stage operation,all diseased skin inclu-ding the superficial subcutaneous fatty tissue was excised,and normal deep subcutaneous fatty tissue was preserved. Then,artificial dermis was grafted to the preserved fatty tissue. After two weeks,split-hickness skin grafts were used for the skin defects as the second-tage operation. Graft success,recurrence and post-operative appearance were evaluated in these patients who were followed up for 9 to 28 months. Results Skin grafts of all 19 patients were successfully survived. The recurrence of hidradenitis suppurativa oc-curred in only one patient. This patient was treated with reoperation and the postoperative appearance was welly recovered. Conclusion Two-tage skin grafting with artificial dermis appears to be a good treatment option for perianal hidradenitis suppurativa.