Objective To study the safety and efficacy of transurethral resection of bladder tumor(TURBt)under block anesthesia of bilateral obturator nerves.Methods Seventy-seven patients were chronologically divided into two groups.Forty-six of patients with lateral,bilateral or multiple tumors in the bladder,which underwent transurethral resection of bladder tumor under epidural anesthesia from April 2003 to October 2004,were chosen as the Control Group.Thirty-one patients whom were administrated with epidural anesthesia plus bilateral block of the obturator nerve from October 2004 to July 2005 served as the Study Group.Incidences of bladder perforation and obturator nerve reflex were compared between the two groups.Results In the Control Group,obturator nerve reflex occurred in 25 patients(including intense reflex in 11 patients),giving an incidence of 54.3%(25/46),and bladder perforation resulted from the reflex was observed in 8 patients,with an incidence of 17.3%(8/46).In the Study Group,slight obturator nerve reflex happened in 3 patients(9.9%,3/31)and bladder perforation was found in 1 patient(3.2%,1/31).A significant higher rate of obturator nerve reflex was noted in the Control Group than in the Study Group(?2=15.970,P=0.000),but no statistical difference was seen in bladder perforation rate between the two groups(?2=2.359,P=0.125).Conclusions Bilateral block of the obturator nerve can improve the safety remarkably during transurethral resection of bladder tumor,especially when the tumor was located in the lateral bladder wall.

Objective To compare volar plating and nonoperative treatment for senile comminuted fractures of the distal radius. Methods From October 2012 to June 2015, 46 senile comminuted fractures of the distal radius ( AO types B and C ) were treated surgically or conservatively. Twenty old patients were managed by open reduction and fixation with a volar locked plate. They were 7 men and 13 women, with an average age of 67. 9 ± 10. 7 years, including 7 cases of AO type 23-B and 13 cases of AO type 23-C. Twenty-six patients were managed with closed reduction and plaster cast. They were 8 men and 18 women, with an average age of 66. 2 ± 11. 5 years, including 10 cases of AO type 23-B and 16 cases of AO type 23-C. The 2 groups were compared in terms of follow-up time, union time and wrist functional scores and complica-tions. Results There was no significant difference between the 2 groups in follow-up time ( P > 0. 05 ) . Fractures in the 2 groups all united about 11 weeks after surgery. According to Dienst scoring for reduction, the volar plating group had 13 excellent cases, 4 good ones, 2 fair ones and one poor case, with an excellent to good rate of 85. 0％ while the nonoperative group had 5 excellent cases, 10 good ones, 5 fair ones and 6 poor ones, with an excellent to good rate of 57. 7％. A significant difference was shown between the 2 groups ( P <0. 05 ) . At final follow-ups, the volar plating group had significantly lower Gartland & Werley wrist functional score ( 2. 16 ± 1. 82 ) and complication rate ( 30. 0％, 6/20 ) than the nonoperative group [ 6. 62 ± 3. 78 and 53. 8％( 14/26 ) , respectively ] ( P <0. 05 ) . Conclusion In treatment of senile comminuted fractures of the distal radius, volar locked plating may lead to better functional recovery and fewer complications than nonoper-ative management. However, one should take full account of the physical condition and preference of the patient when surgery is chosen.

Objective To evaluate the application of percutaneous transhepatic gallbladder drainage (PTGD) in the treatment of acute calculous cholecystitis in 3 kinds of special population including the elderly, cirrhosis or mid and late-stage pregnant women. Methods Clinical data of 292 patients with acute calculous cholecystitis among 3 kinds of special population who underwent PTGD in Baoji Central Hospital of Shaanxi between January 2009 and December 2015 were analyzed retrospectively. The informed consents of all patients were obtained and the local ethical committee approval was received. There were 105 males and 187 females, aged from 22-91 and with a median age of 47 years old. 176 cases were elderly patients, 77 were with cirrhosis and 39 were mid and late-stage pregnant women. Ultrasound-guided PTGD was performed in the patients to relieve gallbladder tension rapidly, and laparoscopic cholecystectomy (LC) was performed according to the patient's condition. Efficacy of cholecystitis control in elderly patients before and after PTGD as well as the efficacy of surgical treatment in patients with liver cirrhosis or mid and late-stage pregnant women were observed. Cholecystitis indexes before and after PTGD were compared using t test. Results Symptoms of elderly patients significantly improved 3 d after PTGD. The average WBC, C-reactive protein and procalcitonin were (9.8±0.5)×109/L, (22.0±1.3) μg/L and (0.15±0.02) μg/L, which were significantly lower than preoperative (12.5±0.4)×109/L, (35.0±2.8) μg/L and (0.25±0.03) μg/L, respectively (t=-18.725,-29.062, -21.287; P<0.05). Cholecystitis in 77 patients with liver cirrhosis were effectively controlled within 1 week after PTGD, including 66 received sequential LC and 1 converted to open cholecystectomy, with a length of operation (31±9) min, intraoperative blood loss (21±5) ml and postoperative length of hospital stay (4.3±0.6) d. Cholecystitis in 39 mid and late-stage pregnant women were effectively controlled 1 week after PTGD. These patients received elective LC during the period after PTGD to 1 month after delivery, including 1 converted to open cholecystectomy. Conclusions For patients with acute calculous cholecystitis in 3 kinds of special population including the elderly, those with cirrhosis or mid and late-stage pregnant women, PTGD can effectively control the cholecystitis with the advantages of simple operation, minimally invasive, safety and effectiveness, and sequential elective LC can reduce the risk of emergent surgery.