Objective:To discuss the relationship between defunctionign stoma in low anterior resection for rectal carcinoma and the incidence of anastomotic leakage.Methods:Totally 270 patients who received low anterior resection for rectal carcinoma(with the distance between anastomosis and anal edge being 6 cm or less)from Jan.2005 to Oct.2006 were included in the present study.Defunctioning stoma was performed in 113(41.9%)patients considered with high risk of anastomotic leakage.The clinicopathological data were used to construct database.SPSS 10.0 software was used to analyze the incidences of anastomosis leakage in patients with and without receiving defunctioning stoma.Results:There were 20(7.4%)leakages in the 270 cases.The symptoms included abdominal pain(37%),increase of pulse(53%),fever(47%),leukocytosis(53%),pelvic fluid properties change(68%),anal discharge of bloody fluid(26%)and others(10%).The average age of patients with leakage was 57.8 years.No death was caused by anastomotic leakage.Four(3.5%)leakages happened in defunctioning stoma group,and 16(10.2%)leakages happened in non-stoma group(P=0.04).Eighteen(75%)of the 24 patients with preoperative radiotherapy history received defunctioning stoma and none of them had leakage.Two of the 6 cases who had preoperative radiotherapy history receiving no defunctioning stoma had anastomotic leakages;the fisher exact probability test showed P=0.054.The leakage rate was 4.9%(7 cases)in 142 cases who had received protective measures during low anterior resection and the rate was 10.2%(13 cases)in the rest 128 cases who had not received any protective measures(P=0.10).Leakages subsided with conservative treatment in the 4 patients with stoma,but 8 patients without stoma had severe symptoms and required surgical intervention;one developed peritonitis.The average fasting periods were significantly different between the 2 groups(P

Objective To investigate the clinical characteristics and surgical management of adult presacral tumors.Methods The clinical data of 24 patients with adult presacral tumors from 2007 to 2012 were retrospectively analysed.All patients were diagnosed by digital rectal examination and imaging examination before operation.Seventeen patients with via sacrococcygeal approach,4 patients with via abdominal approach,and 3 patients with via combined abdominal and sacrococcygeal approach.Results The incision of 22 patients primary healing.There were 2 patients with postoperative incision infections,after dressing change cure.No patients died during perioperative period.Twenty patients were followed up for 3-17 months,1 patient with via abdominal approach recurrenced,and was healed after a second surgical resection.Conclusions Digital rectal examination and imaging examination are the main methods for diagnosis of adult presacral tumors.Most adult presacral tumors can be resected through sacrococcygeal route.

Objective To discuss the application values of image reconstructive technique in 16-slice helical CT scanning. Methods 32 cervical spinal cord lesion images which have processed in MPR, MIP and VR were reviewed to discover the best image reconstructive form. Results By grading, reconstruction score of MPR, MIP and VR was 4.75, 1.75 and 4.5, MPR and VR in top. Conclusion 16-slice CT scanning with MPR and VR image reconstructive of cervical spinal cord can be satisfied the clinical demands.

Objective To investigate the value of Doppler ultrasound in the eady diagnosis,monitoring and assessing of renal damage in neonatal asphyxia.Methods A total of 60 cases of neonates within 24 h were divided into severe asphyxia group (Apgar score 0-3),mild asphyxia group (Apgar score 4-7) and healthy control group (Apgar score 8-10) according to Apgar score at 1 min after born.Then the peak systolic velocity (PSV),end diastolic velocity (EDV) and resistance index (RI) of renal artery were obtained by Doppler ultrasound within 24 h,on day 3,day 7,and day 10.The level of serum cystain C (sCysC) was also recorded accordingly.Results Within 24 h,compared with healthy control group,the PSV and EDV in severe asphyxia group and mild asphyxia group decreased (all P＜0.05),while RI increased (all P＜0.05).The PSV in mild asphyxia group returned to normal in 3 days,EDV and RI returned to normal in 10 days,there were no statistically significant difference compared with healthy control group (all P＞0.05).The PSV,EDV and RI in severe asphyxia group were still significantly differences compared with healthy control group on day 10 (all P＜0.05).Within 24 h and on day 3,sCysC in the mild asphyxia group increased obviously compared with healthy control group (both P＜0.05).On day 7 and day 10,the differences of sCysC was not statistically significant between mild asphyxia group and healthy control group (both P＞0.05).Compared with healthy control group,the sCysC in severe asphyxia group increased significantly (all P＜0.05) on every time point.PSV and EDV were negatively correlated with sCysC,RI was positively correlated with sCysC.Conclusion Changes in renal function can be reflected soon by index of renal blood flow PSV,EDV and RI.

Objective:To study the effect of ischemic postconditioning(I-postC)on the lung injury following ischemia-reperfusion(I/R)of skeletal muscle in the hind limbs of rats.Methods:The rat model of hind limbs I/R injury was established by subrenal abdominal aorta cross-clamping for 4 hours.Forty-eight rats were divided into 3 groups:I/R group,IPC and I-postC group.Each group received 4 hours of ischemia and then 12 or 24 hours of reperfusion respectively.The tissue morphology,wet-to-dry weight(W/D)ratio,malondialdehyde(MDA)and myeloperoxidase(MPO) of lung tissue were compared.The expression of ICAM-1 mRNA in lung was also studied by RT-PCR or in situ hybridization.The protein product was detected by Western blot.Results:In IPC and I-postC groups,all parameters decreased significantly compared with I/R ischemia group(P

Objective To summarize our experience in treating abdominal aorta saddle embolism(ASE).Methods The clinical data of 21 cases of abdominal ASE were treated with Fogarty catheter and other(methods) during January 2000 to July 2006 were retrospectively assessed.Results After the blood flow was restored by operation,4 died in the postoperative early stage because of sudden cardiac asystole due to(hyperkalemia);in the late stage,6 died of multiple organ dysfunction syndrome socondary from acute renal(failure)(ARF).Eleven patients were cured.Of them,bilateral lower extremites were salvaged in 5 patients;and 6 patients received amputation.Ten patients were followed up,and the blood supply of the salvaged legs was good.Conclusions Early diagnosis and embotism removal are the key points to decrease the mortality and amputation rate of ASE.The intra-operative and post-operative prevention and management of(hyperkalemia) and ARF are important for reduction of mortality.

Objective To observe the pathological changes of tissues of the injured bile duct, and to provide theoretical basis for bile duct repair. Methods Dog models of obstructive biliary injury were established.Sixty dogs were equally divided into five groups according to the duration of biliary obstruction: biliary obstruction for 5 days (BDL5 group), 10 days (BDL10 group), 15 days (BDL15 group), 20 days (BDL20 group) and 30 days (BDL30 group). The morphological and pathological changes of bile duct and local tissues were observed, and biliary-enteric Roux-en-Y anastomosis was applied to repair the injured bile duct and postoperative complications were observed. All data were analyzed by LSD test, independent sample t test, one-way analysis of variance and chi-square test. Results Proximal bile duct rapidly expanded as the pressure increased in the early stage, and the bile duct expanded to ( 15.6 ± 1.8)mm in the BDL10 group. The expansion rate decreased in the later stage,and the bile duct expanded to (18.9 ± 1.9)mm in the B DL15 group. Acute inflammation was observed in injured local tissues. The acute inflammation was severe in the BDL5 group with white blood cell count of 54 ± 6, and the acute inflammation was relatively mild in the BDL15 group with white blood cell count of 42 ± 7. There was a significant difference between the BDL5 group and BDL15 group in the degree of acute inflammation (t =4. 688,P ＜ 0. 05). The content of the collagen was increased in the injured bile duct as time passed by. Bile duct repair was successfully performed on 57 dogs. Ten dogs ( three in the BDL5 group, four in the BDL10 group, one in the BDL15 group, one in the BDL20 group and one in the BDL30 group) died of bile leakage after the operation. The incidences of bile leakage was 30% (7/23) within 10 days and 9% (3/34) beyond 10 days, with a significant difference between the two groups (x2 =4.429, P＜0.05). Conclusion Ten days after obstructive biliary injury,an obvious reduction of bile duct expansion and edema of the bile duct is observed, the difficulty of the operation is reduced and the incidence of bile leakage is low, so 10 days after the incidence of obstructive biliary injury is the proper timing for the surgical repair.

Objective To summarize the clinical experience of three different treatments for gallbladder and common bile duct stones.Methods The clinical data of 180 cases of gallbladder stones combined with bile duct stones undergoing surgery from May 2010 to May 2013 were retrospectively analyzed.They were divided into three groups,A group of 60 patients underwent a period of endoscopic sphincterotomy (EST),under the second phase of laparoscopic cholecystectomy (LC);Group B 60 patients underwent laparoscopic cholecystectomy (LC) + laparoscopic common bile duct exploration surgery (LCBDE) + T tube drainage;Group C 60 patients underwent conventional open cholecystectomy (OC) + bile duct exploration (OCBDE) + T tube drainage.Results A group of 53 cases completed surgery successfully,5 cases of remaining 7 patients failured in the first phase surgery,2 cases of the 5 patients did LC + LCBDE,3 of the 5 patients underwent conventional surgery.Two patients underwent the conventional surgery in the second phase surgery.B group of 57 cases completed surgery successfully,three cases convert to open surgery.All of the group C completed the surgery successfully.Group A complication was the most in the three groups (P＜0.05);group B had the shortest time of hospitalization (P＜0.05),the complication rate was lower than that in group A (P＜0.05),the complication had no significant difference between A and B.(P and group B ＞ 0.05),group B had shortest operation time (P＜0.05);no statistically significant differences were found among three groups in fasting time.Conclusion Three treatment methods have advantages as well as disadvantages,a reasonable treatment should be selected according to the specific circumstances.

Objective To explore the value of combined detection with MMP-9 and uPA in the progno-sis of pancreatic carcinoma. Methods By immunohistochemistry PV methods,the expression of MMP-9 and uPA was respectively studied in 63 surgical specimens of primary pancreatic carcinoma and the survival time of patients with pancreatic carcinoma was analysed. Results The expressions of MMP-9 and uPA were positively related(r=0. 573,P=0. 000). The expression of MMP-9 and uPA significantly correlated with differentiation (r= -0. 271,P=0. 032;r= -0. 333,P=0. 008),TNM stages(r= -0. 449,P=0. 000;r= -0. 430,P=0. 000)and lymph node metastasis(r=0. 329,P=0. 009;r=0. 400,P=0. 001),separately. The expression of MMP-9 had also a significant correlation with tumer size(r= -0. 297,P=0. 018)and distant metastasis(r=0. 320,P=0. 011). Univariate analysis identified that tumor size(χ2 =8. 766,P=0. 012),differentiation(χ2 =29. 050,P=0. 000),clinical stage(χ2 =24. 940,P=0. 000),distant metastasis(χ2 =12. 846,P=0. 000), lymph node metastasis(χ2 =15. 457,P=0. 000),MMP-9(χ2 =32. 700,P=0. 000)and uPA(χ2 =41. 495,P=0. 000)were significantly associated with prognosis. Kaplan-Meier survival analysis showed that 1-year survival rate of patients with MMP-9 ( -),uPA ( -)were significantly longer than that of the patients with MMP-9( ﹢),uPA( ﹢),respectively(χ2 =32. 700,P=0. 000;χ2 =41. 495,P=0. 000);1-year survival rate of patients with MMP-9( -)/uPA( -)was significantly longer than the others( Log-rank test,χ2 = 54. 892, P=0. 000). COX regression revealed that differentiation(RR=2. 315,P=0. 004),clinical stage(RR=1. 694, P=0. 002),MMP-9(RR=0. 165,P=0. 000)and uPA(RR=0. 244,P=0. 007)was independent prognostic factors in pancreatic carcinoma. Conclusion They may have a synergistic function in the the process of growth and invasion in pancreatic cancer between MMP-9 and uPA,and the posssible mechanism is that uPA activate degradation of MMP-9,which is not favorable to prognosis. Combined analysis of MMP-9 and uPA may lead to a more reliable prognostic estimation,as the beneficial supplement of the differentiation,and clinical stage to judge the prognosis of pancreatic cancer.

Objective: To investigate the temperature control methods for long-distance transportation of red blood cell suspensions in military affairs or emergence.Methods: We loaded blood transport cars with red blood cell suspensions to full capacity and kept the temperature by combined cooling methods.Results: The temperature in the container was kept between 2-6.2℃ during the 72 h transportation,even when the refrigeration system of the car was out of work.Conclusion: The required temperature for long-distance transportation of red blood cell suspensions could be attained by combined cooling methods in case of insecurity of transportation time and the effect of single cooling method.