Objective:To explore the result of segmental undercutting decompression in the Treatment of Lumbar Spinal Stenosis.Methods:A retrospective analysis of 213 cases of ineffective conservative treatment of degenerative lumbar spinal stenosis,who underwent the multi-segmental undercutting decompression surgery.Results:The patients post-operation following up ranged from 5 months to 6 years,the average follow-up were 3 years and 6 months,The outcome was excellent in 142 cases(66.7%),good in 59 cases(27.7%),fair in 11 cases(5.2%),poor in 2 cases(0.9%).94.4 percent have the excellent or good results.Conclusion:With control of surgical indications strictly,segmental undercuttingdecompression in the Treatment of Lumbar Spinal Stenosis is effective, and it can also preserve the stability and integrity of posterior structure of spine.

Objective To discuss the clinical effect of using autologous quadriceps tendon fixed by a patellar block as the graft to reconstruct posterior cruciate ligament (PCL ) under arthroscopy on a single-bundle way .Methods We treated 21 patients with damaged PCL using autologous quadriceps tendon fixed by a patellar block as the graft and absorbable interference screw fixation to reconstruct PCL under arthroscopy on a single-bundle way .Their functional recovery was evaluated by Lysholm scoring ,Tegner scoring and International Knee Documentation Committee (IKDC) criteria .Results All 21 patients got successful surgery on PCL reconstruction and multiple trauma ,no patients lost to follow-up .The subjective symptoms were improved after operation ,the post-operative Lysholm score and Tegner score were both significantly enhanced and showed statistical significance compared with the preoperative scores(P<0 .01) .Conclusion Using autologous quadriceps tendon fixed by a patellar block as the graft to reconstruct PCL on a single-bundle way leads to satisfactory short term clinical effects ,however ,the long term clinical effects remain to be eval-uated .

Objective To analyze the effect of sperm factor on recurrent pregnancy lass.Methods Accordingto WHO criteria,we routinely analyzed the sperm of 21 unexplained recurrent pregnancy loss patients as study group.and 20 proven fertility men as control group.Meanwhile,we evaluated sperm chromosome aneuploidy for chromosomes 18,X and Y using standard FISH procedure,and sperm DNA ingegrity using sperm chromatin structure assay(SCSA)procedure.Results The percentage of normal morphology sperm is(10.8±2.8)%,and DFI value is(21.7±6.7)%,and the percentage of sperm aneuploidy for sex chromosome and chromosome 18 is(0.80±0.14)%and(0.23 ±0.09)%respectivelyin study group.The differences between the two groups were statistically significant(P＜0.01).Conclusion Sperm morphology,DNA integrity and chromosome aneuploidy are the correlative factors to recurrent pregnancy loss.

A rarely reported postoperative complication following biliary surgery,and to discuss its possible mechanism.This article summarizes I reported HSB case that developed after laparoscopic cholecystectomy in our department and 9 other cases reported in literature.HSB occurred most frequently after simple cholecystectomy in addition to post operative bile duct exploration with cholecystectomy or endoscopic retrograde cholangiopancreatography.The main clinical presentation of HSB was paroxysmal colic in the upper abdomen early in the postoperative period,which could be induced after a meal.Imaging revealed subcapsular hepatic fluid collection,and successful treatment involved placement of a percutaneous drain in the biloma.The mechanism of HSB still needs to be clarified even though it is a rarely reported postoperative complication following biliary surgery.We hypothesize,after analyzing these 10 cases,that sphincter of Oddi dysfunction after biliary surgery and the subsequent persistence of high biliary system pressure may be the root cause of HSB formation.More awareness should be paid to the changes of the sphincter's motility after biliary surgery and its related complications (biliary colic,HSB etc.).

Objective To summarize the reasons of mis-diagnosis and mis-treatment of autoimmune pancreatitis (AIP). Methods Clinical data of 17 patients with AIP,who were admitted to the hospital from May 2005 to July 2010 and experienced mis-diagnosis and mis-treatment, were retrospectively analyzed. Results The main clinical manifestations included epigastric pain (13 cases),progressive obstructive jaundice (12 cases), fever (6 cases) and weight loss (9 cases). Fifteen patients had extrapancreatic organ involvemnet, including allergic rhinitis, swelling of lymphoglandulae submaxillares, swelling of submaxillary gland, allergic asthma, rheumatoid arthritis, Sjogren syndrome, diabetes mellitus, primary sclerosing cholangitis and autoimmune hepatitis. Of these 17 cases, 11 cases presented with high serum globulin, 14 cases with high serum IgG, 13 cases with high serum γ-globulin, 13 cases with positive anti-nuclear antibody and 2 cases with positive anti-insulin IgG antibody. The abdominal imaging demonstrated that 15 patients had diffuse enlargement of the pancreas with diffuse or segmental narrowing of main pancreatic duct, narrowing of the intrapancreatic common bile duct, dilation of the proximal biliary duct and gallbladder enlargement. Focal enlargement of the pancreas was found in 2 cases. Thirteen cases were misdiagnosed as pancreatic carcinoma. Among them, 4 cases underwent pancreaticoduodenectomy and 7 cases underwent choledochojejunostomy. Two cases were misdiagnosed as end stage of cancer that lost therapeutic chance. Another 4 cases were misdiagnosed as chronic pancreatitis. Steroid therapy was administered in all patients with satisfactory response. All patients were followed-up for 15 months (ranged from 6 months to 45 months), and recurrence was found in 4 cases. Satisfactory response was found in patients treated with steroid for the second time. No pancreatic cancer was found in these patients in the follow up period. Conclusion The main causes of mis-diagnosis and mis-treatment of AIP may be contributed by difficulty in differentiating AIP from pancreatic carcinoma based on clinical manifestations and inadequate knowledge of AIP as well as insufficient attention to AIP in China.

Objective To retrospectively evaluate the role of consolidative repeat radiofrequency ablation (CRRFA) based on safety margin (SM) analyses in local tumor control for alpha-fetoprotein (AFP) negative hepatocellular carcinoma (HCC) patients who had been shown to have radiological complete ablation (CA) with radiofrequency ablation (RFA). Methods From July 2002 to July 2009,152 AFP negative HCC patients who were shown to have radiological CA with RFA therapy were retrospectively analyzed. Among them, 110 patients had a SM of less than 1 cm and the other 42 patients had a SM of 1cm or more. Among 110 patients with SM less than 1 cm, fifty nine patients accepted CRRFA within 6 months after the first RFA and 51 did not. From these patients, a narrow SM-CRRFA group (n=41) and a narrow SM-single RFA group (n=37) were enrolled respectively. The wide SM-single RFA group (n= 30) was enrolled from the 42 patients with a SM of 1 cm or more.The LTP (local tumor progression)-free survival rate of the 3 groups were compared with a log-rank test. Results One-, two-, three-, four-, and five-year LTP-free survival rates respectively were 97. 1%, 90.9%, 69.6%, 47.2%, and 33. 0% in the narrow SM-CRRFA patients. 85.9%, 66. 5%,43.5%, 15.8%, and 0. 0%, in the narrow SM-single RFA patients, and were 92.7%, 83.7%,59.3%, 36. 9%, and 9.2% in the wide SM-single RFA patients. There were statistically significant differences (χ2 = 14. 789, P= 0. 001) between the groups. Conclusions An ablation zone with an SM of 1 cm or greater was the most important factor for local control of AFP negative HCC ranging from 3 to 5 cm in diameter. For these patients with a SM of less than 1 cm, CRRFA improved the overall local control outcomes.

Radiofrequency ablation (RFA) has been recognized as a curative therapeutic modality for hepatocellular carcinoma (HCC) for its increasing efficacy in the recent more than ten years. However, RFA has not been generally carried out in our country and the efficacy still waits for improvement. This paper presents a systemic discussion on the technical measures to promote the efficacy of RFA for HCC from the surgeon's perspective, aiming to provide technical standard and reference for the further popularization and application of RFA in China. The 13 measures include clarification of the tumor location and extent, following the indications and contraindications of RFA, scientific application of pretreatments, selection of the best approach of RFA and of the reasonble guiding method for percutaneous RFA, selection of suitable RFA probe, adequate analgesia, sufficient ablative margin to guarantee pathological complete ablation,optimization of ablaiton strategy, active prevention, diagnosis and treatment of complications, correct evaluation of complete ablation, standadized follow-up and selection of RFA to treat the local tumor progression and intrahepatic occurrence.

Objective To explore experimently the effect of tumor angiogenesis on rapid progression of residual tumor of liver cancer after radiofrequency ablation ( RFA). Methods A rabbit VX2 hepatoma model was established. Inoculated tumors were treated by using RFA at 55 ℃ , 70 ℃ and 85 ℃ respectively to establish the residual VX2 hepatoma model. Rabbits implanted with VX2 hepatoma but receiving no RFA treatment served as controls. The expression of vascular endothelial growth factor (VEGF)was determined in tumors to assess the relationship between VEGF and the focal tumor volume and distant metastasis. The expression of VEGF and microvessel density ( MVD) in tumor tissues was assessed by immunohistochemistry. The protein expression of VEGF was assessed by Western blot. The expression of VEGF mRNA was detected by RT-PCR. Results There were significant differences of the local tumor volume between the control group (9.91 ±0.98) cm3 and the other groups (respectively t = -17.43,-10.11, -8.79,all P<0. 05). Compared with the 70 ℃ group (17. 08 ±2. 28 ) cm3 and the 85 ℃ group (15.95 ±4.95) cm3, the focal tumor volume of 55 ℃ group was the largest (21.26 ±2.32) cm3,( respectively t = 4. 69,6. 78, all P<0. 05). Much more metastatic lesions of lung were observed in the RFA treated groups in comparison to the control group. Moreover, the lung metastasis in 55 ℃ group was the most serious among the three RFA treated groups (respectively t = -21.65, -30. 15, all P<0. 05 ).Immunohistochemical staining indicated that the expression of VEGF and MVD in the RFA treated groups was much higher than those in control group ( MVD respectively t = -13.01, -5. 46, -5. 63, all P<0. 05), ( VEGF respectively t = 8. 00,4. 92,4. 21, all P<0. 05 ). Furthermore, the expression of both VEGF protein and VEGF mRNA in 55 ℃ group was the highest among the three RFA treated groups.Conclusions The over-expression of VEGF accelerating the tumor angiogenesis may be one of the mechanisms inducing rapid progression of residual liver tumor after RFA.

ObjectiveTo summarize the occurrence of missed diagnosis of periampullary diverticulum (PAD) with pancreatobiliary diseases and analyze its underlying reasons.MethodsWe conducted a retrospective analysis of 194 patients with PAD complicated with pancreatobiliary diseases from January 2006 to December 2011 in our hospital ResultsAt the first onset of pancreatobiliary diseases,the diagnosis of PAD was made in 48 patients (correct diagnosis group) and missed in 146patients (missed diagnosis group),with a rate of missed diagnosis of 75.3％.At the second,third and fourth onsets of pancreatobiliary diseases in the missed diagnosis group patients,the rates of missed diagnosis were 37.7％,21.8％,and 0％ respectively.There were no significant differences between the correct diagnosis group and the missed diagnosis group with respect to sex,age or the kinds of pancreatobiliary diseases (P＞0.05).But there were significant differences in the two groups with respect to different medical groups,period of admission,the frequency of application of CT,magnetic resonance (MRI) and magnetic resonance cholangiopancreatography (MRCP),duodenal endoscopy/endoscopic retrograde cholangiopancreatography (ERCP) and upper gastrointestinal contrast radiography (P＜0.05).The accuracy rates of CT,MRI,MRCP,upper gastrointestinal contrast radiography and duodenal endoscopy/ERCP for the diagnosis of PAD were 30.0％,31.5％,36.3％,64.5％ and 100.0％ respectively.At the first,second,third and fourth onset of pancreatobiliary diseases,the application rates of duodenal endoscopy/ERCP were 18.0％,33.6％,70.9％ and 91.7％,respectively.Compared with the missed diagnosis group,recurrence rate of symptom were lower significantly in the diagnosis group 1,2,and 3 years post-treatmnet.ConclusionsThe missed diagnosis of PAD complicated with pancreatobiliary diseases is rather common,mainly due to insufficient understanding for PAD.As a result,for PAD patients with pancreatobiliary diseases,the correct diagnosis rates of CT,MRI,MRCP and upper gastrointestinal contrast are low and the use of duodenal endoscopy/ERCP is insufficient.

Objective To assess the safety and efficacy of radiofrequency ablation (RFA) for the treatment of large (≥5 cm in diameter) hepatic hemangiomas.Methods Clinical data of 50 patients with large hepatic hemangiomas (≥5 cm in diameter) treated with RFA between October 2007 and December 2012 were analyzed.Patients were divided into two groups (5-10 cm and ≥ 10 cm) according to tumor size.Results Thirty-two patients had 36 hemangiomas of 5-10 cm in diameter and 18 patients had 19 hemangiomas of ≥ 10 cm in diameter.Technical success,complications related to RFA,completed ablation,symptom relief,change in size of ablation zone and recurrence of the residual tumor were analyzed.The average diameters of the two groups were 7.1 ± 1.2 cm and 13.2-± 2.4 cm separately (t =-12.57,P ＜ 0.01) ; the technical achievement ratios of the two groups were both 100％ ; Seven of 32 patients with hemangiomas 5-10 cm and all the 18 patients with hemangiomas ≥ 10 cm had 13 and 61 complications related to RFA,the incidence of complications were 21.88％ and 100％ respectively (x2 =28.13,P ＜ 0.01); 94.55％ hemangiomas (52/55) acquired complete ablation,the complete ablation rates of 5-10 cm hemangiomas and ≥10 cm hemangiomas were 100％ (36/36) and 84.21％ (16/19) respectively (P =0.014).The mean diameters of ablation zone were respectively decreased to 5.3 ± 1.0 cm and 10.62±1.8 cm (t =-14.30,P ＜0.01).Conclusions RFA for hepatic hemangiomas 5-10 cm in diameter is safe and effective; while its complication for ablation of hemangiomas ≥ 10 cm is high.