Objective Two-incision video-assisted thoracic surger relieved post operative pain when compared with open thoractomy ,while it is rarely reported worldwide ,most thoracic surgeons think it is hard to finish the complicated operation and it is not safe .We compared the safety between open and two -incision VATS.Methods Bwteen Febrary 2009 to December 2011 ,a total of 334 cases with clinical early -staged lung cancer of open thoracotomy were performed ,66 cases were completely performed with 2-incision VATS,17 cases were transferred to open thoracotomy defined as two -incision VATS assisted thoracotomy .We compared and ana-lyzed open thoracotomy with two -incision VATS in operating time ,and pre,post and total period of hospitaliza-tion,postoperative chest tube removal time ,postoperative complications .Results Operating time in the left lower lobe of both traditional open thoracotomy and two -incision VATS was 162.5 ±6.5 and 185.8 ±12.8 minutes re-spectively(P=0.1228),there was no statistical significance for the remaining parts of the lobectomy ,the operat-ing time of open thoracotomy was shorter than two -incision VATS.The overall complication and perioperative mortality rate of open thoracotomy and two -incision VATS were 10.2% and 15.0%(P=0.238),and 2.0%and 0.0%(P=1.000)respectively,there was no statistical significance.Conclusion The lobectomy and lymph node dissections for 2-incision VATS in treating clinical stage I lung cancer is feasible and safe .

Objective To evaluate the clinical effect of Uniportal video -assisted thoracoscopic surgery and single utility port video-assisted thoracoscopic surgery for ⅠA stage non-small cell lung cancer .Methods A total of 81 patients with ⅠA stage non-small cell lung cancer was admitted to our hospital from January 2015 to November 2015 .The patients were divided into control group and observation group .51 patients of control group received single utility port video -assisted thoracoscopic surgery , while other 30 patients of observation group received Uniportal video -assisted thoracoscopic surgery .Results The incision length of observation group was(4.27 ±0.29) cm,operative time was (208.80 ±61.12) mins.The volume of blood intra -operation was (92.33 ±73.75)mL;the number of lymph nodes dissection was (15.62 ±5.12),post-operative drainage within 24 hours was(401.70 ±53.31)mL;drainage tube retention was (6.30 ±3.01)days;postoperative hospitalization time was(19.03 ±5.85)days.The incidence rate of postoperative complications was 13.33%.The incision length of control group was(3.86 ±0.23)cm.The operative time was(184.30 ±51.36)mins;The volume of blood intra-operation was(84.90 ±80.98)mL,the number of lymph nodes dissection was (15.84 ±5.66),post-operative drainage within 24 hours was(398.00 ±52.73)mL;drainage tube retention was(6.10 ±3.25)days;postoperative hospitalization time was(18.69 ±6.81) days;The incidence rate of postoperative complications was 25.49%, there were no significant difference between the two groups (P>0.05).VAS pain score of the observation group was(2.32 ±0.94)and it was(4.18 ±0.95)in control group,and observation group was significantly better than the control group(P<0.05).Conclusion Uniportal video -assisted thoracoscopic surgery has the benefit of less trauma and pain ,and it is worth using widely .

Objective The aim of this study is to evaluate whether video -assisted thoracoscopic surgi-cal( VATS) lobectomy is as effective as open thoracotomy lobectomy for complete dissection of the mediastinal lymph node(MLN).Methods Patients with clinical stage N0 lung cancer who underwent lobectomy between January 2008 and June 2013were retrospectively evaluated based on the LN station resected and lobectomy proce -dure used,and a resection ratio was calculated .Nodal stage and the proportion of patients ,from whom at least three MLNs and station 7were dissected and compared by lobectomy type .Results Of the 201 patients enrolled in the study,84 and 117 underwent VATS and open thoracotomy lobectomies ,respectively.The mean number of LNs dissected at station 3a was similar in the two groups (1.34 ±2.58 vs.1.52 ±1.78;P>0.05),but the re-section ratio differed(39%sv .63%;P <0.05).However,there were no differences at stations7 and 9R in terms of the number of LNs dissected or resection ratio for the right -sided approaches (P >0.05).There were no differences in the number of LNs dissected or resection ratio between the two groups for stations 4 L,5 L6, L,7 L, and9 L for the left-sided approaches .Only station 8L showed significant differences between the VATS and open thoracotomy groups in the number of LNs dissected (0.12 ±0.44 vs.0.46 ±0.71;P<0.05)and resection ratio (8%vs.36%;P<0.05).There were no differences in the number of LNs dissected or resection ratio between groups for station 7:82.1%of patients in each group had at least three MLNs and station 7 removed(P>0.05). The Kaplan-Meier 5-year survival was also similar between the two groups (log-rank test,P>0.05).Con-clusion VATS lobectomy is as effective as open thoracotomy lobectomy for the dissection of MLNs .Thus,VATS lobotomy resection will continue to be offered as the best choice for patients with clinical stage N0.

Objective To study the effect of dexmedetomidine(DEX)intrathecal administration on formation of chronic neuropathic pain induced by chronic constriction injury(CCI)in rats. Methods One hundred and twenty healthy adult male Sprague-Dawley(SD)rats were divided randomly into four groups(each n=30):sham group, model group,30μg/kg and 60μg/kg DEX intrathecal injection group(D30 group,D60 group). The CCI model was installed by left sciatic nerve ligaturing,sham surgery was done by exposing the sciatic nerve without ligation,and 30 μg/kg,60 μg/kg DEX(each,10 μl)and 10 μl normal saline were given intrathecally in D30,D60 and model groups respectively,all kinds of injection being once a day for 7 days. Hind paw mechanical contraction reflex threshold(MWT),heat-shrinkable reflex latency(TWL)and the score of motor dysfunction of hind extremity in rats were recorded on 1 day before ligation and 1,3,7 days after operation,and before ligation and 1,7,14 and 21 days after operation,the contents of tumor necrosis factor-α(TNF-α),interleukin(IL-1βand IL-6)in intumescentia lumbalis were measured by enzyme linked immunosorbent assay (ELISA). Results Compared with before operation,there were no significant differences in values of MWT,TWL,the motor function evaluation,TNF-α, IL-1β,and IL-6 at each time points(all P>0.05);however,with the prolongation of time,MWT and TWL were decreased,and the motor function evaluation,TNF-α,IL-1β,and IL-6 were increased in all the other groups. Compared with those of the sham group,MWT and TWL were declined,and the motor function evaluation,TNF-α, IL-1β,and IL-6 were elevated in model group. Compared with those of model group,30μg/kg and 60μg/kg DEX could significantly raise MWT(g)and TWL(s),obviously improve motor function and remarkably decrease the contents of TNF-α(pg/mg),IL-1β(pg/mg)and IL-6(pg/mg)in the spinal cord of CCI rats from 1 day after operation. And the changes in 60 μg/kg DEX group were more significant than those in 30 μg/kg DEX intrathecal injection group〔postoperative 1 day MWT:39.3±1.3 vs. 20.3±2.2,TWL:10.9±0.4 vs. 8.2±1.1,motor function score:2.00±0.00 vs. 2.00±0.75,TNF-α:33±7 vs. 125±18,IL-1β:108±12 vs. 203±34,IL-6:156±39 vs. 405±75,all P<0.05〕. Conclusions The DEX intrathecal administration has certain degree of dose-dependent therapeutic effect on hyperalgesia in CCI rat models. The mechanism is related to the amelioration of inflammatory reaction at the lumbar segment of spinal cord.

Objective To investigate the effects of chin lift on the patency of upper airway in normal conscious adults using magnetic resonance imaging (MRI).Methods Sixteen healthy volunteers aged 21-35 yr with a body mass index of 17-26 kg/m2 were enrolled in this study.The subjects lay on their back with their heads slightly extended.The lower jaw was first left in standard position.The mouth was slightly open (the distance between the upper and lower incisors was 0.5 cm).The chin was then lifted upward.The upper airway (from the base of slull to the level of vocal cord) was scaned by MRI along the median sagital plane.The length of soft palate,root of tongue and epiglottis and the area of pharyngeal cavity were measured.The position of the rim of epiglottis was examined.The mean percentage changes induced by chin lift were calculated.Results Compared with standard position,chin lift significantly prolonged the length of soft palate,root of tongue and epiglottis and increased the area of pharyngeal cavity.The percentage change in the position of the rim of epiglottis was largest after chin lift.Conclusion Chin lift significantly improve the patency of the upper airway in conscious adult by changing the position of the rim of epiglottis and increasing the area of pharyngeal cavity.

Objective To evaluate the multi-spiral CT(MSCT)imaging features and classification of renal pelvis carcinoma.Meth-ods 76 patients of renal pelvis carcinoma proved pathologically were analyzed retrospectively,and divided into different types ac-cording to the MSCT features.The MSCT differences for different types were analyzed.Results Most of the tumors showed iso-density or slight hyperdensity (95%)on un-enhanced images,and persistent mild-to-moderate enhancement (91%)in enhanced im-ages.All cases were divided into three types:pelvic mass type in 30 cases (39%),substance invasion type in 25 cases (33%),wall thickening type in 21 cases (28%).All cases were also divided into two types:substance invasion type(25 cases,33%)and renal pelvis type(5 1 cases,67%).The occurrence rate of local low enhancement,whole kidney low enhancement,hydronephrosis,lymph node metastasis and vein tumor thrombus were 80%,20%,48%,52%,1 6% in substance invasion type cases,and 4%,42%, 75%,4%,6% in the renal pelvis type cases,respectivily.Conclusion MSCT multiphase enhancement scanning shows important valuation in the diagnosis and classification of renal pelvis carcinoma.Obvious differences of CT features are showed for different types.The diagnosis accuracy may be improved by the knowledge of substance invasion type.

Objective:In order to prevent tracheostomal stenosis (TSS) instead of laryngectomy cannulas after total laryngectomy, Nickel\|Titanium shape memory alloys(NI\|SMA) stents in tracheostome were produced and applicated in clinic. Methods: The diameter of NI-SMA is 0.8mm, and Ni 50%, Ti 50%. The shape of the Ni\|SMA stent is the two\|threeth of circumference and its diameters are 18mm, 19.5mm, 21mm. The stents were implanted between the first and the second tracheal cartilage ring of the stump in twenty\|two patients with advanced laryngeal carcinoma or hypopharyngeal carcinoma or esophagul carcinoma in neck. All the patients were free of laryngectomy cannulas after operation. Results: Nieteen patients healed at one stage. Infections after operation were seen in three cases. Eight patients received radiotherapy after total laryngectomy. The NT\|SMA stent did not influence radiotherapy after operation. The TSS occured in six of the patients. A simple procedure named “doughnut” for widening stenosis was performed successfully with an electric cautery knife in all the patients with tracheostomal stenosis after operation. Conclusions: The results suggested that the NT\|SMA stents can prevent from traheostenosis instead of metal laryngectomy cannulas after total laryngectomy.

10.3969/j.issn.1000-3606.2013.06.010

BACKGROUND: Ankle fracture combined with deltoid ligament rupture and distal tibiofibular syndesmosis injury occurs occasionally. Its treatment with distal tibiofibular syndesmosis screw fixation or deltoid ligament repair remains controversial. The former appears with poor reduction, broken nails, secondary surgery and other problems.OBJECTIVE: To observe the clinical effectiveness of suture anchor repair for ankle fracture combined with deltoid ligament injury.METHODS: Twelve patients with ankle fracture combined with deltoid ligament injury were selected from the First Affiliated Hospital of Guangzhou University of Chinese Medicine between January 2013 and December 2015. All patients were treated with open reduction, internal fixation, and anchor repair, but without distal tibiofibular syndesmosis screw fixation. The curative efficacy and joint stability were observed.RESULTS AND CONCLUSION: (1) All patients were followed-up for more than 12 months. (2) The modified Baird-Jackson scoring system showed excellent in nine cases, good in two cases, average in one case, poor in none case, and the excellent and good rate was 92%. (3) At 1 year after internal fixation, the X-ray examination showed the malleolus gap and talus slope angle of the affect side were (3.47±0.12) mm and (0.45±0.18)°, and the malleolus gap and talus slope angle of the healthy side were (3.44±0.05) mm and (0.43±0.14)°, and there was no significant difference between two sides (P > 0.05). (4) These results indicate that the suture anchor can repair the anatomy and biomechanics of deltoid ligament with stable ankle joint, and secondary surgery is unnecessary.