ObjectiveTo selected the safe dosage of intrathecal injection of sufentanil for preemptive analgesia in lower limb orthopaedic surgery.MethodsSelected 96 patients who ASA classification Ⅰ - Ⅱ grades undergoing elective lower limb orthopaedic surgery with subarachnoid epidural block down,they were divided into six groups by random number table and double blind method,each group of 16 cases.Group Ⅰ,Ⅱ,Ⅲ,Ⅳ,Ⅴ,Ⅵ received 0.05,0.10,0.15,0.20,0.25,0 μ g/kg of intrathecal sufentanil and 2.5 ml of 0.5％ levobupivacaine.Observed and recorded the duration of block level of pain to T10,visual analog score (VAS)postoperative at 2,4,6,8,12,24,48 h,and side effects.ResultsThe duration of block level of pain to T10 of group Ⅰ,Ⅱ,Ⅲ,Ⅳ,Ⅴ,Ⅵ was (245.6 ± 34.2),(259.3 ± 36.7),(268.9 ± 37.8),(286.6 ± 38.8),(287.7 ± 39.1 ),(228.6 ± 31.4) min.There was no significant difference between group Ⅳ and group Ⅴ (P ＞ 0.05 ),the differences of other groups were statistically significant (P ＜ 0.05 ).Compared with group Ⅴ,VAS of group Ⅲ and group Ⅳ at 6,8,12,24,48 h after operation was not statistically significant (P ＞ 0.05),and they were lower than the other three groups(P ＜ 0.05 ).There were no respiratory depression occurred after operation in group Ⅰ,Ⅱ,Ⅲ,Ⅳ,Ⅵ,4 cases occurred in group Ⅴ.ConclusionThe best of effective dose of intrathecal injection of sufentanil for preemptive analgesia in lower limb orthopaedic surgery is 0.20 μ g/kg.

Objective To observe the efficacy of 3-dimensional image recombinant guidance in treatment of portal hypertension.Methods A total of 73 cases of portal hypertension were randomized into study and control groups: In study group(n=37),3DCT or MRA imaging display of whole portal venous system was used as guide in selecting portoazygos vein disconnection(P-AVD) operation;in control group(n=36),the classic P-AVD operation was performed.The postoperative complication rate and the degree of amelioration of esophageal varices were cbserved.Results Compared with the control group,the short term rebleeding rate in observation group(0.00%,0/37) was lower than that in control group(11.11%,4/36),improvement rate of esophageal varices in observation group(100%,37/37) was higher than that in control group(86.11%,31/36),and the aggregate rate of portal hypertensive gastric disease and esophageal varices in observation group(0.00%,0/36)was lower than that in control group(13.9%,5/36).There was a statistical difference between the two groups(all P

Objective To study the feasibility and clinical effect of trans umbilical single incision laparoscopic right hemicolectomy for right hemicolon carcinoma.Methods The clinical data of 35 patients with right hemicolon carcinoma were retrospectively analyzed,the 15 cases were received the trans umbilical single incision laparoscopic right hemicolectomy (single incision group) and 20 cases were received laparotomy right hemicolectomy (laparotomy group).The clinical indexes were compared between the 2 groups.Results The length of incision,intraoperative bleeding volume,passage of gas by anus time,feeding time,hospitalized time in single incision group were significantly better than those in laparotomy group [(5.5 ± 0.6) cm vs.(17.6 ± 2.2) cm,(84.0 ± 31.1) ml vs.(155.5 ± 43.1) ml,(2.00 ± 0.76) d vs.(3.75 ± 0.63) d,(5.3 ± 0.6) d vs.(6.5 ± 0.6) d,(9.3 ± 1.4) d vs.(13.5 ± 1.5) d],the operation time in single incision group was significantly longer than that in laparotomy group [(238.4 ± 19.3) min vs.(165.3 ± 25.8) min],there were statistical differences (P ＜ 0.05).There was no statistical difference in number of incision lymph node between the 2 groups (P ＞ 0.05).Postoperative complication in single incision group occurred in 2 cases,postoperative complication in laparotomy group occurred in 3 cases,there was no statistical difference (P ＞0.05).The follow-up time was 1-55 months,the median follow-up time was 28 months,local recurrence and distant metastasis were found in 2 cases in single incision group,and 4 cases was found in laparotomy group,there was no statistical difference (P ＞ 0.05).Conclusions Single incision laparoscopic right hemicolectomy for right hemicolon carcinoma is safe and feasible,which has the advantages of minimal trauma,aesthetic outlook,less bleeding,quick recovery and short hospitalization time,etc.It can be developed in the hospital which has some basis of laparoscopic surgery.

OBJECTIVETo explore the effect of arterial infusion with methylene blue during total mesorectal excision (TME) for better preservation of pelvic autonomic nerve on urination function and sexual function in male patients with rectal cancer.

METHODSA total of 68 male rectal cancer patients from Zhejiang Xiaoxing People's Hospital and 44 male rectal cancer patients from Guangdong Zhongshan Chenxinghai Hospital between June 2013 and June 2015 were prospectively enrolled. Patients were randomly divided into the trial group receiving arterial infusion with 8 ml of 1% methylene blue and the control group without artery infusion, with 56 cases in each group. All the patients underwent TME. Intra-operational lymph node removal and postoperative urination and sexual function (erection and ejaculation) were compared between two groups.

RESULTSThe baseline data of the two groups were not significantly different (all P>0.05). As compared to the control group, the trial group had shorter operation time [(3.28±0.63) hours vs. (4.01±0.94) hours, P<0.01], less blood loss[(92.5±36.4) ml vs. (174.1±61.4) ml, P<0.01], and more lymph nodes harvested per patient (15.8±7.6 vs. 11.9±4.3, P<0.01). One year after operation, classI(, II(, III(, IIII( of urination was observed in 33 cases (58.9%), 15 cases (26.8%), 6 cases (10.7%), 2 cases (3.6%) in the trial group, while 24 (42.9%), 15 (26.8%), 12 (21.4%), 5 (8.9%) in the control group, which indicated that trial group was superior to control group(P<0.05). ClassI(, II(, III( of erection was observed in 36 cases (64.3%), 18 cases (32.1%), 2 cases(3.6%) in the trial group, while 25(44.6%), 23(41.1%), 8(14.3%) in the control group, which indicated that trial group was superior to the control group (P<0.05). ClassI(, II(, III( of ejaculation was found in 36 cases (62.5%), 18 cases (32.1%), 3 cases (5.4%) in the trial group, while 24 (42.9%), 22 (39.3%), 10(17.9%) in the control group, which also indicated that trial group was superior to the control group(P<0.05).

CONCLUSIONSIn the treatment of male rectal cancer patients, TME combined with arterial infusion with methylene blue can facilitate the distinction of operation scope, which is beneficial to reduce damages to the pelvic nerve, leading to the protection of urinary function and sexual function. In addition, this procedure can result in shorter operation time, less operational blood loss and more lymph nodes harvested.

Digestive System Surgical Procedures ; Humans ; Infusions, Intra-Arterial ; Lymph Node Excision ; Male ; Methylene Blue ; administration & dosage ; Postoperative Period ; Rectal Neoplasms ; surgery ; Rectum ; surgery ; Urination

Objective    To evaluate the efficacy of tubless therapy for pulmonary bulla resection under the concept of fast track surgery. Methods    We retrospectively analyzed the clinical data of 45 patients (29 males and 16 females at an average age of 26.1 years) with pulmonary bullae in our hospital between January 2015 and December 2017. These patients were divided into two groups. Among them, 25 patients were treated with preoperative gastric tubes and catheters, tracheal intubation anesthesia and postoperative drainage tubes (a tube group). And 20 patients were treated with no preoperative gastric tube or catheter, sublaryngeal anesthesia and no postoperative drainage tube (a tubless group). Results    There was a statistical difference in postoperative pain index (2.60±1.14 vs. 5.16±1.24, P<0.001) and larynx complication (P=0.00) between the two groups. Shorter period of epidural analgesic tubes (1.40±0.50 d vs. 2.84±0.75 d, P<0.001), shorter operation and anesthesia time (15.00±2.59 min vs. 18.56±2.10 min, P<0.001; 95.30±4.38 min vs. 105.50±4.59 min, P<0.001), shorter hospital stay (9.45±1.66 d vs. 12.80±1.87 d, P<0.001), and less expense (20 245.96±1 113.02 yuan vs. 22 147.06±1 735.01 yuan, P<0.001) in the tubless group were found compared with the tube group. But there was no statistical difference in incidence of complication of lung (P=0.43) between the two groups. Conclusion    Tubless therapy in the treatment of pulmonary bulla resection can accelerate the postoperative recovery with shorter hospital stay and less expense, and is an advantageous treatment.

Objective    To investigate the clinical value of multidisclplinary team (MDT) in the application of non-small cell lung cancer (NSCLC). Methods    We retrospectively analyzed the postoperative clinical data of 80 patients with NSCLC in the First Hospital of Lanzhou University between January 2014 and May 2018. There were 56 males, 24 females at age of 59±10 years. Forty five patients were performed lobectomy with conventional model, 35 patients were also performed lobectomy after MDT discussion. The clinical effect of the two groups was compared. Results    Compared to conventional model, MDT can shorten operation time, intraoperative blood loss, postoperative chest drainage, catheterization time, complications, length of stay and hospital costs. But there was no significant difference in intraoperative transthoracotomy proportion, delayed wound healing and postoperative pulmonary leakage between the two groups. Conclusion    The efficacy of MDT in the surgical treatment of NSCLC is satisfactory. The MDT is valuable during operation, which reduces surgical trauma and accelerate patients’ recovery, and deserves the clinical promotion.

Objective To discuss the safety, feasibility and advantages of tubeless trans-subxiphoid thoracoscopic surgery in anterior mediastinal tumor resection. Methods A total of 32 patients suffering anterior mediastinal tumor were enrolled, including 17 patients (8 males and 9 females) with average age of 31.8±8.4 years who had been performed tubeless trans-subxipohoid tharcoscopic surgery and 15 patients (8 males and 7 females) with average age of 31.1±9.2 years who had been performed traditional trans-subxipohoid tharcoscopic surgery. The differences of surgical duration, the lowest intraoperative arterial oxygen saturation (SaO2), postoperative awaking time, postoperative pain visual analogue score (VAS), postoperative pulmonary recruitment time, duration of postoperative hospital stay and hospitalization cost were analyzed. Results Postoperative awaking time (18.5±1.8 min vs. 28.9±4.2 min, P=0.000), postoperative VAS (1.6±0.6 vs. 3.5±7.4, P=0.000), duration of postoperative hospital stay (2.5±7.2 d vs. 4.3±1.1 d, P=0.000) and hospitalization cost (3.2±1.1 ten thousand RMB vs. 4.9±1.1 10 ten thousand RMB, P=0.000) in the tubeless group were better than those in the control group. There was no significant difference in surgical duration (51.7±6.5 min vs. 55.1±8.5 min), the lowest intraoperative SaO2 (98.5%±0.9% vs. 98.1%±0.8%), postoperative pulmonary recruitment time (33.9±12.2 d vs. 38.4±15.2 d, P>0.05) between the two groups. Conclusion Tubeless trans-subxiphoid thoracoscopic surgery is safe, feasible and advanced in anterior mediastinal tumor resection.