Objective To study the method and effect of exposure the recurrent laryngeal nerve(RLN) in preventing the damage of RLN in thyroid surgery. Methods One thousand and ten sides total and(or) subtotal thyroidectomies were operated on 574 cases with RLN exposure in our hospital in recent 9 years. Results The RLN injury rate was 0.3% in this series.Of them, permanent RLN injury occurred in 2 cases and temporary injury in 1. Conclusions The exposure of RLN can greatly decrease the nerve injure in thyroid surgery, especially in total lobectomy. The dissection of RLN must followed the principle of RLN exposure . RLN should be dissected around the inferior thyroid artery first, if the RLN is difficult to be found,then dissecting around the thyroid cartilage, or finding the cervical vagus inside of carotid sheath to find RLN should be done.

Fifty four patients with chronic sinusitis (without nasal polyps) were randomly divided into two groups. Thirty patients in experimental group were treated with dirithromycin and 24 patients in control group were treated with clarithromycin. The doses was both 250 mg q. d. and the duration of treatment was 3to 6 months. The VAS scores of subjective symptoms (nasal obstruction, purulent nasal discharge,headache, smell worse ) and Lund-Mackay scores of objective signs (sinus CT ) in both groups were improved significantly compared with the baseline(P ＜0.05), and there were no statistical significances between two groups ( P ＞ 0. 05 ). The curative effect was positively correlated with the duration of treatment.The total effective rates were 73% and 67% and adverse reaction rates 7% and 21% in two groups,respectively (P ＞ 0. 05 ); but the adverse reactions in control group were more serious than those in experimental group. During the six-month follow-up, no recurrence and aggravation were observed. The results suggest that low-dose dirithromycin may be more suitable for long-term treatment of chronic sinusitis.

Objective To analyze the results of surgical treatment on chronic pancreatitis(CP),and investigate how to choose the appropriate surgical procedure.Methods The clinical data of 54 patients with chronic pancreatitis who underwent surgery at the First Affiliated Hospital of Harbin Medical University from January 2007 to December 2011 were retrospectively analyzed.Results All the 54 patients underwent surgery,including 8 decompression and drainage procedure (Partington procedure) ; 13 resections (7 cases of pancreaticoduodenectomy,1 case of distal pancreatectomy,4 cases of distal pancreatectomy combined with splenectomy and 1 case of pancreaticoduodenectomy combined with distal pancreatectomy,respectively); 12hybrids (7 cases of Beger procedure and 5 cases of Frey procedure,respectively) and 21 other procedures (15 cases of pancreatic pseudocyst jejunostomy,4 cases of exploratory laparotomy combined with pancreatic tissue biopsy,2 cases of gastrojejunostomy combined with choledochojejunostomy,respectively).There were 4 cases of post-operative pathologic evidence of cancer.Twelve patients had postoperative complications and were cured with non-operative management.Forty-four patients (81.5％) were followed for 2 to 67 months,36 out of 42(85.7％) patients who suffered from abdominal pain had a persistent remission,there were one case of new on-set diabetes and no steatorrhea was reported.Conclusions For CP patients with surgical indications,the choice of procedure should be individualized for the purpose of preserving the endocrine and exocrine functions of pancreas,and taking effectiveness as well as safety into consideration.

Objective To observe the efficacy, safety and feasibility of the four kinds of anticoagulation method in hemodialysis patients with high risk of hemorrhage. Methods 128 patients with high risk of hemorrhage who had undergone hemodialysis were randomly divided into four groups. In group A, 68patients were resorted with 30% regional sodium citrate anticoagulation(RCA). In group B, 60 patients were treated with local heparin anticoagulation. In group C, 64 patients were treated with low molecular weight heparin (LMWH). In group D, 66 patients received no heparinization hemodialysis. The changes of bleeding, clotting function, adverse effect and nursing strategies were studied. Results All patients of group A completed regular hemodialysis with satisfactory indices, 6 cases with bleeding and primary bleeding aggravated in group B, 8 cases with bleeding and primary bleeding aggravated in group C, 8 cases occurred grade three coagulation and finished dialysis in group D. 3 cases in group A and 2 cases in group B occurred adverse reaction, but no adverse reaction was seen in group C and D. Conclusions RCA is safe,effective and can be easily handled in regular hemodialysis. It is an ideal dialysate for hemodialysis in patients with high risk of hemorrhage.

Objective To study the methods and benefits of exposure of recurrent laryngeal nerve(RLN) in thyroid surgery Methods In this study, 2148 patients admitted in our hospital from July 1993 to July 2003 were divided randomly into two groups: RLN exposure group (936 cases) and RLN non exposure group (1212 cases) RLN was dissected around the inferior thyroid artery, thyroid cartilage, and cervical vagus Results Two cases (0 21%) suffered from RLN injury in exposure group and 5 cases (0 41%) suffered from RLN injury in non exposure group ( P

Objective To investigate the effect of xenotransplantation of microencapsulated rabbit parathyroid tissue in different sites in rats for the treatment of hypoparathyroidism. Methods The parathyroid glands from Wistar rats were removed to make them aparathyroid. Ultimately, sixteen rats were included because their serum calcium values were continuously below 1.6 mmol/L. We also encapsulated the cultured rabbit parathyroid tissue with alginate-BaCl2 microcapsule. According to the transplantation sites, rats were randomly divided into two groups: renal adipose microcapsule group and peritoneal microcapsule group, eight in each group. Encapsulated rabbit parathyroid tissues were then transplanted accordingly to different microcapsule groups. The calcium serum contents were examined on 5,15,25,35,45,55 and 65 d respectively after transplantation and the grafts were observed through electron microscope on the 65 d in particular. Results The calcium contents after transplantation in renal adipose microcapsule group restored to normal and the observation outcomes of grafts showed that they survived well. The calcium contents of posttransplantation in peritoneal group also restored to normal with an exception that it dropped to a level lower than 1.6 mmol/L on the 65 d. Electron microscope also showed that there were necrotic tissues in the center and only a few cells survived on the edge of the grafts. Within peritoneal microcapsule group, the values were significantly lower than others taken at different phases. Conclusion Microencapsulated rabbit parathyroid tissue that was xenotransplanted into rats can survive and function without administration of immunodepressant. There are significant differences of calcium contents at varying phases between two transplantation sites, which demonstrate that renal adipose may be an optimal site for microcapsule xenotransplantation.

Objective To detect the reactive samples of enzyme-linked immunosorbent assay (ELISA1) by chemiluminescence microparticle immunoassay (CMIA),and to analyze the application value of CMIA in HCV infection validation of blood donors.Methods Nucleic acid 3-item combined testing (NAT),another ELISA2,HCV antibody supplementary test(Western Blot test,WB) and CMIA test supplemented in blood samples of 102 ELISA1 anti-HCV reactive blood donors were retrospectively analysed.Results Among 102 blood donors of anti-HCV positive,32 cases (31.37%,32/102) were HCV RNA reactive samples,50 cases (49.02%,50/102) were ELISA2/WB reactive simultaneously.With CMIA NAT results as the reference standard,CMIA was poorly correlated with HCV RNA (Spearman correlation coefficient rs=0.395,P<0.01),and the consistency between them was weak by Kappa test (Kappa=0.270,P<0.01).With ELISA2/WB detection results as the reference standard,CMIA was highly correlated with the results(Spearman correlation coefficient rs=0.713,P<0.01),and which showed high consistency by Kappa test (Kappa=0.674,P<0.01).Conclusion CMIA as a detection method of protein label after HCV infection has great value in the HCV infection confirmation in low-risk population.

Objective To investigate the effects and value of enhance recovery after surgery (ERAS) application in patients with hepatocellular carcinoma underwent liver resection.Methods One hundred and seventy-two patients with hepatocellular carcinoma underwent liver resection in the first affiliated hospital of Harbin medical university from June 2013 to June 2015,ERAS group (92 cases) and control group (80 cases) were retrospectively studied.Laboratory indicators (ALT,AST,TBIL,ALB,PA,lymphocyte count),postoperative complications,postoperative hospitalization days and total hospitalization expenses were compared between two groups.Results For postoperative liver functional indicators (ALT,AST,TBIL),ERAS group Day 1 and Day 7 were respectively (216.3±141.7) U/Land (70.1 ±29.4) U/L,(184.0±155.8) U/Land (39.1 ±17.5) U/L,(22.4± 8.7) μmol/L and (20.0 ± 7.5) μmol/L,control group were respectively (304.5 ± 226.2) U/L and (83.9 ± 48.5) U/L,(294.1 273.0) U/L and (49.2 ±33.8) U/L,(26.9 ±15.6) μmol/L and (24.6 ± 10.8) μmol/L,the difference between two groups was statistically significant (F =9.33,9.84,9.26,P ＜ 0.05).For postoperative nutritional indicators (ALB,PA),ERAS group Day 7 were respectively (35.3 ± 4.4) g/Land (136.3 ±34.1) mg/L,control group were respectively (33.6 ±4.2) g/L and (108.0 ± 32.5) mg/L,the difference was statistically significant (F =4.97,4.54,P ＜ 0.05).For postoperative immune indicators (lymphocyte count),ERAS group Day 1 and Day 7 were respectively (0.9 ±0.3) × 109/L and (1.5 ± O.5) × 109/L,control group were respectively (0.7 ± 0.3) × 109/L and (1.3 ± 0.5) × 109/L,the difference was statistically significant (F =7.37,P ＜ 0.05).For postoperative complications (hemorrhage,bile fistula,hepatic dysfunction,infection) were no statistically significant differences (P ＞ 0.05),however,ascites had statistically significant difference (x2 =7.609,P ＜ 0.05).Off bed time,postoperative exhaust time,postoperative hospitalization time and total hospitalization expense of ERAS group were respectively (1.7 ± 0.5) days,(2.3 ± 0.6) days,(9.8 ± 2.3) days,(4.6 ± O.9) × 104 RMB,control group were respectively (3.0 ± 0.7) days,(3.4 ± 0.8) days,(17.6 ± 5.8) days,(6.3 ± 2.1) × 104 RMB,the difference was statistically significant (t =13.032,10.937,11.371,7.118,P ＜ 0.05).Conclusions Application of ERAS in patients with HCC underwent liver resection is safe and effective.ERAS effectively reduce stress reaction of patients,promote the recovery of liver function,improve the postoperative immune and nutrition status,shorter postoperative hospitalization time,and reduce the total cost of hospitalization.

Objective To study the delayed gastric emptying for patients underwent pylorus-preserving pancreaticoduodenectomy and standard Whipple procedure.Methods Clinical data of 401 consecutive patients who underwent standard Whipple procedure/pylorus-preserving pancreaticoduodenectomy between January 2012 and July 2016 in the First Affiliated Hospital of Harbin Medical University were retrospectively collected and analyzed.Using the independent-samples t test,x2 test or Fisher's exact test,Mann-Whitney test and other statistical methods to compare the postoperative complications between pylorus-preserving pancreaticoduodenectomy and standard Whipple procedure group.Results Compare with standard Whipple procedure group,delayed gastric emptying after pylorus-preserving pancreaticoduodenectomy occurred in 8 of 35 patients (22.9％),obviously higher than it after standard Whipple procedure occurred in 40 of 366 patients (10.9％) (P =0.038).Other postoperative complications were not significantly different (P ≥ 0.05).Each level of delayed gastric emptying after pyloruspreserving pancreaticoduodenectomy and standard Whipple procedure were not significantly different (P ≥ 0.05),but the average recovery time of delayed gastric emptying after pylorus-preserving pancreaticoduodenectomy (12.13 ± 3.09) d was obviously shorter than it after standard Whipple procedure (17.28 ± 9.63) d (P =0.009).Conclusions Pylorus-preserving pancreaticoduodenectomy increases the risk of delayed gastric emptying,but it does not increase severity delayed gastric emnptying by each level.The recovery time of delayed gastric after pyloruspreserving pancreaticoduodenectomy is shorter.