Congenital diaphragmatic hernia(CDH) is characterized by a spectrum developmental defects in the diaphragm caused by embryogenesis disorders,and lead to incomplete fusion of elements which results in rise of the diaphragm.With the promotion of antenatal diagnosis,postoperation rehabilitation and neonatal intensive care unite,the mortality of CDH has been remarkably decreased.Nevertheless,the condition is uncommon enough that it has proven to be difficult to conduct prospective studies,leading to the lack of evidence of evidence-based medicine to explore the pathological mechanism and therapies.With the rise of endoscopic technique,the laparoscopy and thoracoscopy are also gradually carried out for the surgical management of CDH.Now,the minimally invasive surgery for CDH was reviewed.

Objective To explore the efficacy of endoscopic therapy for common bile duct stones in the elderly. Methods From July 2003 to June 2006,421 elderly patients with common bile duct stones were treated in the Danyang People's Hospital(112 cases) and the Second Affiliated Hospital of Nanjing Medical University(309 cases).The clinical data of the patients were retrospectively analyzed Results ERCP was completed in all the 421 patients,of which 27 was converted to a pre-cut sphincterotomy because of difficulties in the deep cannulation of the bile duct.The diagnosis of common duct stones was confirmed during the operation in all the cases,and 46 of them were found complicated with cholecystolithiasis.Of the patients,266 patients had one stone,107 had two,and 48 had three or more.The calculi were removed using basket directly in 283 patients,balloon catheter in 122,lithotrity in 10,and plastic stent placement without calculus removal in 6.The stones were removed completed at the first operation in 392 cases,and the other 23 cases received a second operation after endoscopic nasobiliary drainage.Errhysis occurred in 20 patients during the pre-cut sphincterotomy,and was healed by locally sprinkling or injecting noradrenaline(1:10 000),or electric coagulation.Six patients had hemorrhage from the incision on the duodenal papilla 48 hours after the operation,and were cured by using submucous injection of noradrenaline(1:10 000,4 cases) or titanium clipper(2 cases).34 patients had a transient increase of serum amylase without abdominal pain;10 patients developed mild pancreatitis and then was cured by fasting,inhibiting pancreatic secretion and pancreatic enzyme activities,anti-inflammation therapy,and rehydration;4 patients developed cholangitis,and was cured by anti-inflammation therapy.All the patients were discharged without complications.342 of the patients were followed up for 6-12 months,4(1.2%) of them had recurrence of stones and was treated with endoscopy,3(0.9%) had cholangitis and received anti-inflammation therapy.In the 6 patients with plastic stent,the stones were dissolved in 2 of them in half a year.Conclusions Endoscopic therapy is safe and efficient for common bile duct stones in the elderly and is associated with a low rate of complications.

Objective To study the curative effect of internal thoracic arterial chemoembolization in the treatment of advanced lung cancer.Methods Internal thoracic artery was confirmed to be the main supplied artery by digital substraction angiography(DSA) in 8 cases with lung cancer. The internal thoracic artery was embolized by stainless steel coil below the supplied segment in order to avoid the normal vascular territory occlusion.Then iodized oil combined with Cis-Diaminedichloroplatinum(DDP) and mitomycin(MMC) were injected into the supplied segment slowly until blood flow stopped,at last,the gelfoam sponge sheet was inserted into this supplied segment to decrease the wash of iodized oil by blood flow.Results Clinical symptoms were improved obviously in all cases after therapy.CT scans showed that iodized oil accumulated in the tumor better four weeks after the chemoembolization. Conclusion For these cases with advanced lung cancer which the blood supply mainly by internal thoracic artery,it is necessary to perform chemoembolization.

Objective To evaluate intraoperative cholangiopancreatography in understanding pathologic changes of congenital choledochal cyst(CCC) with anomalous junction of pancreaticobiliary duct(APBD) and for rational operative procedure. Methods Eighty-two CCC cases were examined by intraoperative cholangiopancreatography(ICP). The morphologies of the biliary tract and types of APBD were recorded. Results Of the 82 CCC cases there were 35 cases of Todani Ia,9 cases of Ib,28 cases of Ic and 10 cases of Ⅳ.APBD was diagnosed in 73 cases and classified according to Komi classification. Of them,37 cases were classified as type I of APBD (bile duct drains into pancreatic duct),30 cases as type II (pancreatic duct drains into bile duct) and 6 cases as type III (complicated APBD with patent accessory pancreatic duct). Of the 44 cases with choledochal cystic dilatations,33 cases were of type I. Of the 29 biliary fusiform dilatations,21 were of type II. Of 21 patients with pancreatitis,17 were of type II (? 2=33.14,P

Objective To compare the surgical and functional outcomes of single-site (transumbilical two-port) intracorporeal purse-suturing (IP) and single-port extracorporeal knotting (EK) for laparoscopic pediatric inguinal hernia (PIH) repair.Methods Between June 2008 and December 2014,358 PIH children underwent lapamscopic inguinal herniorrhaphy,including 126 treated by single-site intracorporeal purse string stitching using a needle-holder (IP group),and 232 by single-port extracorporeal knotting using an inner two-hook needle with preperitoneal hydrodissection (EK group).Results In all patients laparoscopic procedures were completed successfully without conversion.The operating time in IP group was significantly longer than that in EK group [unilateral:(20.4 ± 2.1) min vs.(9.4 ± 1.3) min,t=-5.23,P＜0.01;bilateral:(31.3 ±2.9) min vs.(15.2±1.7) min,t=-4.22,P＜0.01)].The hospital stay were similar between the two groups [(2.35 ±0.25) d vs.(2.38 ±0.18) d,t =-0.062,P ＞ 0.05].Five cases had intraoperative hematoma in the IP group while none in the EK group.One each suffered from recurrence in IP group and EK group.Three postoperative hydroceles were seen in IP group and one in EK group.Subcutaneous knot granulomas were seen in two in EK group.Conclusions Both IP and EK laparoscopic procedures are safe and feasible.With the assistance of preperitoneal hydrodissection technique,single-port laparoscopic EK herniorraphy is superior to single-site IP repair in easy performance and shorter operation time.

Objective To study the anatomy of splenic hilum blood vessels in order to thread ligature(endoligature)instead of using stapler during the process of laparoscopic splenectomy and to evaluate the prelimnary clinical results.Methods 41 children patients underwent laparoscopic splenectomy with this technique(endoligature)for various hematologic and autoimmune disorders,including 25 cases of hereditary spherocytosis,13 idiopathic thrombocytopenia purpura,and 3 hypersplenic granulocytopenia.The anatomy of splenic pedicle,the adjacent relation between splenic vessel and pancreas were detected by color Doppler ultrasonography preoperatively.The above-mentioned parameters were compared with that found intraoperatively.Results The relationships of splenic vessel and pancreas was of type Ⅰ in 24 cases and type Ⅱ in 17.In 31 cases,the major splenic blood vessels were ramified into branches 2 cm away from the hilum and in 10 it was within 2 cm as detected by preoperative ultrasonography.These characters were largerly identified by laparoscopic laparotomy,and in all the 41 cases laparoscopic splenectomy was successfully accomplished using this endoligature instead of vasculature stapler.There was no serious complication.The mean operating time was(114 ±31)min,the estimated blood loss was(51 ±23)ml.Conclusions Ultrasonography could identify the anatomic type of splenic vessel,and its relation with the pancreas.Endoligature in the management of splenic pedicles during laparoscopic splenectomy is safe and reliable.

Objective:To mining differential expression genes (DEGs) and establish a regulatory network of dysregulated microRNAs (miRNAs) and messenger RNAs (mRNAs) in biliary atresia (BA) spectrum via bioinforma-tics analysis, and to explore the pathogenesis of BA.Methods:GSE46960 dataset was download from gene expression omnibus (GEO). DEGs between normal liver tissues and BA tissues were analyzed using the GEO2R analysis tool.The functional and pathway enrichment analyses of DEGs were performed utilizing the Database for Annotation, Visualization and Integrated Discovery (DAVID6.8). A protein-protein interaction (PPI) network was constructed using the PPI database (STRING11.0) and Cytoscape_v3.7.1 software, and thus key genes were analyzed.BA-related miRNAs were obtained using the human miRNA disease database (HMDD_V3.0) and target mRNAs were predicted by the miRNA target prediction database (miRDB). The intersection between the predicted target mRNAs and DEGs from the GSE46960 dataset was selected.The regulatory network of miRNA-mRNA was constructed using Cytoscape software.Results:A total of 565 DEGs, including 352 up-regulated ones and 213 down-regulated ones were identified.Among them, up-regulated DEGs were enriched in extracellular matrix(ECM)-receptor interaction, focal adhesion kinase (FAK), Amoebiasis, and the phosphoinositide 3 kinase/protein kinase B(PI3K/Akt) pathway.Down-regulated DEGs were enriched in metabolic signaling, biosynthesis of antibiotics and steroid biosynthesis pathway.From the PPI network, 10 key genes were screened out.A complex miRNA-mRNA regulatory network was constructed based on screened DEGs.Conclusions:Identified DEGs and miRNA-mRNA regulatory network constructed in this study may help clarify the molecular mechanisms of BA.This study provides a new direction to explore promising molecular targets for the diagnosis and treatment of BA.