Objective To evaluate the value of video-assisted thoracic surgery(VATS)for penetrating thoracoabdominal injuries.Methods Under general anaesthesia and double-lumen tracheal intubation,VATS was carried out to examine patients with chest injuries.Those who had mild injuries received VATS combined with mini-incision surgery.Electrocoagulation or suturing was employed to control intraoperative bleeding,and then blood clots were removed.Injured diaphragm muscles were repaired,and organs with hemorrhage or ruptures were sutured or resected.The seriously injured cases underwent open surgery and intra-abdominal exploration instead.Results A total of 18 patients received the operations.Among them,15 patients underwent VATS combined with mini-incision surgery(repair of the diaphragm was performed on 15,controlling intercostal arterial bleeding on 8,repair of the lung on 2,wedge resection of the lung on 2,and coagulated hemothorax removal on 2),the other 3 were converted to open surgery for repairing the diaphragm(3),heart(1),or esophagus(1),or lobectomy(2).Abdominal surgery via the thorax were performed on 13 cases,including repair of the liver in 1,lienectomy in 1,gastrorrhaphy in 1,repair of diaphragmatic hernia in 3,and intra-abdominal exploration in 7.Five patients received open surgery(pancreatic neoplasty in 1,repair of the liver in 1,lienectomy in 1,gastrorrhaphy in 2,and repair of the caul and mesenterium in 3).One patient who had multi-organ penetrating injuries died of hemorrhagic shock,circulatory failure,and DIC after open thoracic and abdominal surgeries.The mean operation time in this series was(125?44)minutes(ranged from 45 to 220),and the mean blood loss was(1089?582)ml(500 to 10 000 ml).Twenty-four hours after the operation,the mean volume of chest drainage was(234?75)ml(100 to 350 ml)in the first 24 hours after the operation.The chest drainage tube was withdrawn 2.5(2 to 5)days postoperation.The patients expelled gas in 1 to 4 days(mean,2 days).Totally,12 patients were followed up for 3 to 12 months(mean,6 months),during which none of them had trauma-related complications.Conclusion VATS combined with mini-incision surgery is safe and effective for patients with thoracoabdominal injuries,if the cases were carefully selected.

Objective To evaluate the outcomes of thoracoscopy-assisted mini-incision procedure in patients with lung cancer.Methods From January 2003 to June 2003,66 patients with non-small cell lung cancer were treated in our hospital by lobectomy combined with mediastinal lymph node resection using thoracoscopy-assisted mini-incision(36 patients,VATS Group)or traditional surgery(30 patients,traditional group).The clinical and follow-up data of the two groups were compared after the operation.Results No significant difference was found in the operation time between the VATS and traditional groups(114.6?47.4)min vs(123.3?43.9)min,t=-0.768,P=0.449],while the postoperative hospital stay of the VATS group was significantly shorter than that in the traditional group (9.2?1.4)d vs(10.5?1.7)d,t=-3.408,P=0.001].Log-rank test showed that the survival curve in the two groups was comparable(?2=0.270,P=0.605).Cox regression model indicated that the pathological characteristics(risk ratio:3.912,P=0.000),TNM stage(risk ratio:3.737,P=0.000),and lymph node metastasis(risk ratio:15.495,P=0.000)were independent,unfavorable prognostic factors for the disease;whereas,no relation was detected between the thoracotomy incision and prognosis(P=0.414).Conclusions Thoracoscopy-assisted mini-incision procedure is a safe and reliable approach for patients with lung cancer with satisfying outcomes.

Objective To compare clinical effects of mini-incision pulmonary lobectomy with or without thoracoscopic assistance. Methods A total of 64 patients, in order of precedence of the operation, were divided into two groups according to a random numbers table. The Group A was given thoracoscopy-assisted mini-incision pulmonary lobectomy while the Group B underwent simple mini-incision lobectomy. Results The length of incision was significantly shorter in the Group A (5.3?0.6 cm) than in the Group B (8.9?0.5 cm) (t=-24.360,P=0.000); the intraoperative blood loss in the Group A (279.7?74.0 ml) was significantly less than that in the Group B (331.7?42.5 ml) (t=-3.330,P=0.002); the drainage volume at the first postoperative day was remarkably less in the Group A (162.5?47.4 ml) than in the Group B (202.0?49.2 ml) (t=-3.220,P=0.002). Complications were noted in 5 patients in the Group A and 11 patients in the Group B (?~2=4.099,P=0.043). The Group A presented a significantly shorter postoperative hospital stay (8.0?2.2 d) than the Group B (9.7?1.9 d) (t=-3.280,P=0.002). There was no statistically significant difference in the operating time between the two groups (t=-1.130,P=0.262). A follow-up observation was carried out in 57 patients for 6~12 months. Local recurrence was observed in 1 patient with stage Ⅲa lung squamous carcinoma at 6 months after operation in the Group A, whereas in the Group B, distant metastasis with local recurrence was found in 2 patients with stage Ⅲa small-cell lung carcinoma and in 1 patient with lung adenocarcinoma at 7~8 months after surgery. All the 4 patients died within 1 year. Three patients ended with other diseases unassociated with the surgery. No local recurrence or distant metastasis was found in the remaining 50 patients. Conclusions As compared with simple mini-incision pulmonary lobectomy, thoracoscopy-assisted mini-incision procedure provides less surgical invasion, fewer complications, and quicker postoperative recovery.

Objective To research the feasibility and superiority of video-assisted thoracoscopic surgery(VATS) in the diagnosis and treatment of thoracic traumas.Methods Video-assisted thoracoscopic surgery was used in 40 patients with thoracic traumas,including thoracic exploration,repair of pulmonary laceration,and evacuation of clotted hemothorax.[WTHZ]Results All the 40 patients were cured,including simple VATS in 31 patients,thoracoscopy-assisted mini-incision surgery in 8 patients,and conversion to open surgery in 1 patient.The time of operation was 79.9?33.1 min.The amount of blood clots and noncondensing blood cleared was 567.5?177.8 ml.The closed thoracic drainage tube was removed at 24~48 h postoperatively,with a drainage volume of 220?45.6 ml.The length of hospital stay was 4~13 d(mean,8.7 d).The sutured wound healed by first intention in all the patients.No postoperative complications were observed.Follow-up reviews in 35 patients for 6~12 months(mean,8.6?2.6 months) revealed uneventful recovery and no trauma-related complications.Conclusions As compared with conventional open surgery,VATS has shown advantages of exact diagnosis,timely management,little invasion,and quick recovery for patients with thoracic traumas.

OBJECTIVETo investigate the changes in the levels of monocarboxylate transporter-2 in spinal cord horn in a rat model of chronic inflammatory pain.

METHODSMale SD rats weighting 180 - 220 g were randomly divided into two groups(n = 48): normal saline group (NS group), complete Freund's adjuvant group (CFA group). Rats were given injections of CFA 100 µl in left hind paw in group CFA, and an equal volume of saline was given injection in group NS. Mechanical withdraw threshold(MWT) and thermal withdraw latency(TWL) were measured at before injection(T0 and 3 h, 1 d, 3 d, 7 d, 14 d, and 21 d after injection(T1-7). Four rats were chosen from each group at T0-7 and sacrificed, and L4-5 segments of the spinal cord horn were removed for measurement of the expression of monocarboxylate transporter-2 by Western blot analysis.

RESULTSIn CFA group, mechanical hyperalgesia and allodynia appeared on the 3 h after CFA injection, then until the day 14. The expression of monocarboxylate transporter-2 in the spinal dorsal horn of rats in CFA group was significantly higher than that in normal control group at T1-6(P <0.05). The protein level of monocarboxylate transporter-2 was apparently correlated with MWT and TWL(P <0.01 and P <0.05) in CFA group.

CONCLUSIONThe level of monocarboxylate transporter-2 in spinal dorsal horn is significantly increased in a rat model of chronic inflammatory pain and the change may involve in the formation and maintenance of central sensitization in spinal cord of chronic inflammatory uain.

Animals ; Disease Models, Animal ; Freund's Adjuvant ; Hyperalgesia ; chemically induced ; Inflammation ; chemically induced ; metabolism ; Male ; Monocarboxylic Acid Transporters ; metabolism ; Pain ; chemically induced ; metabolism ; Rats ; Rats, Sprague-Dawley ; Spinal Cord ; metabolism ; physiopathology

Objective To explore the effectiveness and safety of endoscopic papillary balloon dilation( EPBD ) for the removal of common bile duct stones. Methods Three hundred and twenty consecutive patients with common bile duct stones on endoscopic retrograde cholangiopancreatography (ERCP) who met all eligibility criteria were randomly assigned endoscopic sphincterotomy (EST) or EPBD.Complications were classified by an expert panel unaware of treatment allocation and outcome. Results After a single ERCP, all stones were removed from 112 patients ( 70% ) assigned EST and 104 ( 65% )assigned EPBD. Mechanical lithotripsy was used to fragment stones in 36 (22. 5% ) EPBD procedures and 32 ( 20. 0% ) EST procedures. Early complications occurred in 5.6% EST patients and 8.1% EPBD patients. No patient died. Gallstone disease recurrence, which is a long-term complication, is 7. 5% ( 12/160) in EST patients and 2.5% (4/160) in EPBD patients, P ＜0. 05. Conclusions The success rate of EPBD was similar to that of EST. We found no evidence of previously suggested higher risk of pancreatitis with EPBD, and suggest that EPBD is preferred in patients who are not suitable for EST, such as those with high risk of bleeding. This procedure is a valuable alternative to EST in patients with bile duct stones.

OBJECTIVE: To observe the effects of Ginkgolides inhalation on eosinophils infiltration in airway of asthmatic guinea pig model. METHODS: Guinea pigs were divided into seven groups(n=8 in each group): model group, ginkgolides inhalation low, medium and high dosage groups(5, 10, 20mg?kg-1, respectively), ginkgolides ip group (at a dosage of 20 mg?kg-1), Dexamethasone ip group (at a dosage of 10 mg?kg-1), normal control group. The eosinophils (EOS) in bronchoalveolar lavage fluid (BALF) and trachea were counted. RESULTS: As compared with normal control group, the number of EOS in BALF was significantly increased in model group, but that in BALF and trachea of the Ginkgolides inhalation group was significantly reduced(P

Anal Canal ; surgery ; Child ; Child, Preschool ; Colon, Sigmoid ; surgery ; Digestive System Surgical Procedures ; methods ; Female ; Hirschsprung Disease ; surgery ; Humans ; Infant ; Laparoscopy ; Male ; Rectum ; surgery ; Treatment Outcome

Objective To explore the management of benign prostatic hyperplasia(BPH)by photoselective vaporization of prostate(PVP)and curative effect in the near future. Methods Clinical data of 60 BPH patients underwent PVP were retrospctively aralyzed.The changes of IPSS and QOL and the max urine flow rate and residual urine volume(RUV)perioperatively were compared through observations of the operation time and complication. Results The therapeutic efficacy was favourable.No transurethral resection of prostate(TURP)syndrome and uroclepsia happens.IPSS(t=2.471,P <0.05)and QOL(t=2.392,P <0.05)and the max urine flow rate(t=2.287,P ＜0.05)and residual urine volume(t=2.513,P＜0.05)obviously improved(P ＜0.05). Conclusion PVP had many advantages such as operated simply and no serious complications.It was a good operation method to treat BPH.

Objective To investigate the change of monocyte autophagy in patients after trauma.Methods ①According to Injury Severity Score(ISS) or Abbreviated Injury Scale(AIS),we divided our 51 subjected trauma patients into 3 groups,the minor injury group(n=21),the moderate trauma group(n=19) and the severe trauma group(n=11).Another 14 healthy volunteers served as control.We collected the peripheral blood in 24 h,3,5 and 10 d after trauma,then harvested the monocytes by density gradient centrifugation with adherence separation.Then we observed the autophagy phenomenon by using laser confocal microscopy and transmission electron microscopy;② After the isolated monocytes were dyed with MDC and lysed,they were detected and quantified for fluorescent intensity by fluorospectrophotometer(excitation wavelength 380 nm and emission wavelength 525 nm);③Blood sugar level of all patients were measured in 24 h,3 and 5 d respectively after trauma,and the correlation between autophagy and blood sugar was analyzed.Results Compared with control group,more autophagy in monocytes was observed and quantified in trauma patients than in health volunteers(P