0.05),but significant difference in procalcitonin((2.12?1.57) vs(1.60?0.58)ng/ml,P

Objective To study the therapeutic effect of e ndoscopic injection on Forrest graded peptic ulcer bleeding and evaluate its sig nificance.Methods From July 2001 to August 2002, eighty-one patients wi th haematemesis and/or hematochezia diagnosed as peptic ulcer by immediate endos copy were divided into two groups based on Forrest grading, 41 were treated with injection therapy (injection group); other 40 with conservative therapy only (c ontrol group).Results The haemostatic rates in injection therapy group and co ntrol group were 95 1% and 80 0% respectively with prominent statistical diffe rence (P

ObjectiveTo assess the value of intraoperative cholangiography(IOC) for detecting bile duct injury during laparoscopic cholecystectomy.Methods31 cases of bile duct injuries were reviewed regarding the site of injury,mechanism,time of diagnosis,and the place of IOC was evaluated.ResultsBile duct injuries resulted from misidentification in 19 cases.In 12 of these 19 cases,the diagnosis was made by IOC.Primary laparoscopic repair or open repair and T-tube drainage solved the problem without postoperative complications.However,in 3 of the above 19 cases the result of IOC was misinterpreted and in 4 of the above 19 cases IOC was not performed.Two of the 7 patients had aberrant bile duct injuries, in all of them the diagnoses were delayed.There were two cases in which bile duct injury developed after an IOC.ConclusionsCorrect interpretation of IOC enables detecting bile duct injury caused by intraoperatively misidentification and consequent morbidity.

Objective To evaluate the effects of Laparoscopic cholecystectomy (LC) combined with intraoperative cholanggiography (IOC)and intraoperative endoscopic sphincterotomy (IOEST) for the treatment of cholecystocholedocolithiasis. Methods 106 cases with cholecystocholedocolithiasis diagnosed and treated by LC combined with IOC and IOEST were reviewed retrospectively. Results 60 40%(64/106)patients diagnosed cholelithiasis pre-LC were found choledocholithisis; LC combined with IOC and IOEST was successfully performed on 99 of 106 cases(93 40%),and their CBD stones were completely cleared in 98 of 99 cases(99 00%). Six cases(6 1%) were complicated with mild acute pancreatitis, 1 case(0 01%) with duodenal perforation,1 case(0 01%) with bile leakage, and 2 cases(0 02%) with stomach stasis. Conclusions LC combined with IOC and IOEST was a safe ,effective approach to diagnosis and minimally invasive treatment of cholecystocholedocholithiasis.

Objective　To discuss the technique,advantages and follow-up results of subfascial endoscopic perforator surgery.Methods　Subfascial Endoscopic Perforator Surgery was performed for 23 patients wth chronic venous insufficiency.Over two years postoperative follow-up was done.Results　21 in 23 cases with ulcers healed.Only one case had wound infection.Conclusion　Subfascial Endoscopic Perforator Surgery is a safe and effective procedure in treating venous insufficiency.

Objective To identify the spectrum of pathogenic microorganisms of urinary tract infection and the drug resistance in a hospital setting. Methods The pathogenic microorganisms isolated from 3117 mid-stream urine samples of patients admitted in Hangzhou First People's Hospital from 2005 to 2007 and their drug resistance results were retrospectively analyzed. Results Bacteria were the most prevalent microorganisms in the urinary tract infection, and followed by fungus, mycoplasma and chlamydia. Escherichia eoli accounted for the largest proportion of gram-negative bacteria, in which the ESBLs positive strains accounted for 51.2%, and their drug resistance rate was much higher than that of ESBLs negative strains. Main gram-positive coccobacteria was all sensitive to vancomycin, and relatively sensitive to nitrofurantnin and ampicillin. Conclusions Escherichia coli continue to prevail upon the spectrum of pathogenic microorganism of the urinary tract infection, and the fungus, mycoplasma and chlamydia infections are rising. Antibacterial agents should be used under the guidance of drug sensitivity test, and the combined use should be avoidd.

[Objective]To establish digitized visible model of the wrist joint.[Method]Coronal sect ional images of a series of 0.2 man-thick cryosecfions of wrist joint specimens were obtained.After registration and segmentation,the three-dimensional computerized reconstruction of the carpal bone and arch-ligament and its adjacent structures were performed on PC.[Result]For reconstructed Successfully 3D the structures model of wrist joint its adjacent 28 structures.This model can be displayed with single structure and its adjacent structures for wrist joint and can be displayed with several structures in different color and hyalinize.And it can be displayed from any direct ion.Moreover all structures can be measured through angle or line from any direction.[Conclusion]Three-dimensional reconstruction model of the wrist joint demonstrate the relation of anatomy between the carpal bone and ligament by poly-point of view and is meaningful for operations of the wrist joints.

Objective To explore the feasibility and indications of T tube free laparoscopic common bile duct exploration (LCBDE). Methods The therapeutic results of LCBDE in 175 cases were reviewed retrospectively regarding the cure rate, complications, and postoperative hospital stay. Results LCBDE was performed successfully in 169 cases. Laparoscopic stone removal was failed in 6 out of the 175 cases. Two were converted to open exploration, the remaining 4 cases received intraoperative EST, the procedure failed in one case and it was converted to open surgery. T tube free LCBDE was performed successfully in 104 cases, in 36 out of the 104 cases laparoscopic transcystic common bile duct exploration was successful, the mean operation time was 140 minutes and the mean hospital stay after operation was 2 days; in other 68 cases laparoscopic choledochotomy with primary duct closure was performed, the mean operation time was 135 minutes and the mean hospital stay after operation was 3 days. T tubes were placed in 65 cases, the mean operation time for those patients was 150 minutes and the mean hospital stay after operation was 4 days, the mean T tube drainage time was 38 days. Retained stone was found in one out of the 65 cases, and was removed by EST. Bile leakage after removal of T tube developed in one case, and was cured by conservative therapy. No mortality nor complications such as bleeding or bile leakage occurred in remaining cases, asymptomatic hyperamylasia was found in 4 cases postoperatively. No stone recurrence or duct stricture were found at a mean follow-up of 13 months. Conclusions T tube free LCBDE as an alternative to the treatment of CBD stones is safe and feasible, with shorter hospitalization and avoiding the potential complications related to the T tube placement.

Objective To evaluate multiple instrument guide (MIG) in the use of laparoscopic choledochotomy (LCD). Methods The common bile duct (CBD) exploration time,surgical outcome,complications and damage of choledochoscope with or without MIG were compared retrospectively. Results MIG assisted LCD was performed successfully in all 25 cases,no complication such as bleeding,bile leakage or retained stones happened. CBD exploration time were 30 minutes,the mean number of removed stones was 6,no damage of choledochoscope was encountered. In 38 cases receiving traditional LCD,an average 5 pieces of stone were removed,the duct exploration time was 60 minutes. Two cases were complicated with hyperamylasia,stones were retained in one case. Choledochoscope was damaged in 6 times. Conclusions MIG facilitates LCD procedure,shortens operative time,and protects choledochoscope.

Objective To evaluate the curative effect and superiority of minimally invasive transanal surgery in the treatment of cancerate rectal adenoma and early rectal cancer by using CUSA.Method Local resection was clone in 15 patients with cancerate rectal adenoma or early rectal cancer,the tumours were excised intactly by 5 mm CUSA(submucosal or superficial muscularis),the incisions were closed by continuous suture in the lumen.Results All of the tumours were excised intactly,the incisal edges and funduses were all negative.The operation time was 30～180 min,average:60 min,the amount of bleeding during operation was 0～30 ml,average:10 ml.Complications:temporary fecal incontinence in 2 cases,acute urinary retention in 1 case.Pathology after operation:villous adenoma accompanied by high grade intra epithelial neoplasia in 8 cases,mixed adenoma in 2 cases,intra-mucosal carcinoma in 5 cases.15cases were followed up 4～48 months,averge 18 months,no tumour recur in original place.Conclusion Minimally invasive transanal surgery by CUSA is a safe and effective operation in the treatment of cancerate rectal adenoma and early rectal cancer.It can keep the anus and improve the quality of life.