Objective To observe the length of duration of free gas presence in abdomen after laparoscopic cholecystectomy (LC). Methods A Series of chest X-ray examinations following LC in 69 patients in this hospital from April 2002 to December 2002 were taken to review the condition of subphrenic free gas. Results Gas was detected on (1.8?1.1) days following LC and was completely absorbed within 6 days after LC. The logarithm of the length of duration of pneumoperitoneum had a parallel relationship with the subphrenic residual gas volume within 24 postoperative hours ( r =0.616, P =0.000), bore a negative relationship with the pneumoperitoneum time ( r =-0.228, P =0.014), and was not correlated with age, body weight, height, operation time and consumption of CO 2. Conclusions Clearing intraabdominal CO 2 gas away so far as possible can shorten the length of duration of gas presence in abdomen.

Objective To study the prevention and treatment of pneumoperitoneum-related complications after laparoscopic cholecystectomy (LC). Methods A retrospective analysis was made on clinical data of 1 100 cases of LC from October 1993 to January 2003. The cases were divided into two groups: 980 cases admitted before September 2001 received a 14 mmHg carbon dioxide pneumoperitoneum (Group A), and 120 cases after September 2001 received a 10 mmHg pneumoperitoneum (Group B). Results Carbonemia happened in 2 cases in the Group A but in no cases in the Group B. The incidence of postoperative shoulder pain was significantly lower in the Group B (19 2%, 23/120) than in the Group A (43 9%, 430/980) ( ? 2 =26 951, P =0 000). The incidence of postoperative nausea and vomiting (PONV) was significantly lower in the Group B (25 8%, 31/120) than in the Group A (61 2%, 600/980) ( ? 2 =54 750, P =0 000). Conclusions Carbonemia, shoulder pain and PONV can be reduced by regulating the ventilation and decreasing the pneumoperitoneum pressure.

Objective To study the relationship between the Helicobacter pylori (Hp) infection and the formation of gallstones. Methods In this controlled study, the Hp infection rate was detected in both 35 cases of simple gallbladder stones (Experimental Group) and 25 cases of polypoid lesions of the gallbladder (Control Group). The Hp cytotoxin associated gene antigen (cag-A) in bile and gallstones of the both groups was amplified by PCR technique. Results The Hp infection rate was 51.4% (18/35) in the Experimental Group and 48.0% (12/25) in the Control Group, without significant differences (?~2=0.069,P=0.793). In the Experimental Group, cag-A positive results were noted in bile samples in 7 cases (20.0%, 7/35) and in gallstone samples in 1 case (2.9%, 1/35), whereas in the Control Group there were no positive results observed. The Hp cag-A positive rate was significantly different between the two groups (?~2=5.822,P=0.016). The presence of Hp cag-A in bile was correlated with the Hp infection of the stomach (x~2=3.886,P=0.049). Conclusions That the DNA of the Hp can be found in bile and gallstones of patients with cholelithiasis indicates a correlation between Hp infection of the gallbladder and the formation of gallstones.

Objective To discuss the effect of abnormal biliary dynamics on the formation of cholelithiasis.Methods A total of 35 cases of gallstone(Gallstone Group),25 cases of gallbladder polypoid lesions(Polypus Group),and 30 normal cases(Control Group) were included in this study.The fasting gallbladder volume was measured with B-ultrasonography,the serum concentration of vasoactive intestinal poly-peptide(VIP) was determined with radioimmunoassay,and the expression of cholecystokinin-A(CCK-A) receptor in the gallbladder mucous membrane was detected with reverse transcriptase polymerase chain reactions(rt-PCR). Results ①The fasting gallbladder volume was significantly greater in the Gallstone Group than in the other two groups(F=3.45,P=0.039).②The gallbladder contraction rate was significantly lower in the Gallstone Group than in the other two groups(F=5.747,P=0.005).③The postprandial increases of VIP of the three groups were not of statistical significance(F=0.768,P=0.47).④Compared with the Polypus Group,the expression of CCK-A receptor in the Gallstone Group was significantly decreased(t?=4.390,P=0.022).Conclusions ① The increase of the fasting gallbladder volume in the Gallstone Group is associated with the formation of gallstones.②In the Gallstone Group,depressed gallbladder contraction results in the formation of gallstones.③The decreased expression of CCK-A receptor leads to depressed gallbladder contraction,which facilitates the formation of gallstones.④Serum VIP is not related to the formation of gallstones.

0.05). The stepwise regression analysis showed that the logarithm of the duration of residual gas had a parallel relationship with the gas volume under the hemi-diaphragm 24 hours after operation(r=0.616,P=0.006),a negative correlation with the duration of pneumoperitoneum (r=-0.228,P=0.014), and no correlation with patients’ age,body weight,height,operation time and gas volume consumed. Postoperatively, 26 patients reported postoperative shoulder pain. The shoulder pain VAS scores were significantly increased with the increasing of CO_2 pressure in the three groups (F=9.635, P=0.000). The shoulder pain VAS scores had a parallel relationship with the gas volume under the right hemi-diaphragm 24 hours after operation (r=0.333, P=0.005) and the duration of residual gas (r=0.296, P=0.014). Conclusions The CO_2 should be removed as thoroughly as possible at the end of operation to reduce the absorption of residual gas. The different CO_2 pressures of pneumoperitoneum have little effects on the volume of residual CO_2 24 hours after operation and the duration of residual gas. The shoulder pain following LC, will be aggravated with the increasing of pneumoperitoneum pressure. The over-stretching of the diaphragmatic fibers due to insufflation is the main cause of shoulder pain.

In the present study,50 patients were treated by mesh & plug hernia repair with Bard R Mesh & FerFix R Plug. Operation time ranged from 24 min to 71 min with mean time being 43.2min.There was no need for analgestic.Hospitalization time ranged from 3d to 7d with mean time being 4.5d.The patients were followed up for 6w to 20 months.No recurrence occurred.

Objective To investigate the possibility of urethroplasty with a free graft of colic mucosa for the treatment of complex anterior urethral stricture of long length. Methods Six dogs underwent a procedure in which the urethral mucosa was totally removed and replaced with a free graft of colic mucosa. All the dogs were sacrificed 12 weeks after the procedure for histological examination of urethra.Besides, a patient with complex anterior urethral stricture was treated by urethroplasty with the use of a colic mucosal graft.Retrograde urethrography,urethroscopy and uroflowmetry were carried out 3 months after operation. Results Histological examination revealed that all the grafted colic mucosa have survived in the urethra of the experimental dogs and some of the glandular epithe lium has been transformed into urethelium. Clinically,the patient voided well after removal of the urethral stent.Neither necrosis of the neourethral mucosa nor stenosis at the anastomosis sites has been observed on urethroscopy. Retrograde urethrogram demonstrated a wide urethral caliber with no significant graft sacculation. Uroflowmetry examination showed the maximum flow rate was 30 ml/s. Conclusions Colic mucosa graft urethroplasty is an effective one stage procedure for the treatment of complex anterior urethral stricture. The technique is useful for urethral reconstruction when local or preputial skin and buccal or bladder mucosa are not available.

Objective To evaluate bulbourethral sling procedure in the treatment of post prostatectomy incontinence. Methods 5 patients with post prostatectomy incontinence underwent the bulbourethral sling procedure.Preoperatively 1 patient was completely incontinent and 4 patients required a mean of 3.5 pads per day.The mean duration of incontinence was 4.5 years. A sling tension of a mean of 500 g was used to correct incontinence. Results 4 patients have been completely dry,whereas postoperative difficulty in voiding occurred in the other patient and was corrected by subsequent transurethral bladder neck revision resulting in free passage of urine and continence. Conclusions The bulbourethral sling procedure is an effective means in the treatment of post prostatectomy incontinence.

Objective To evaluate the selection of different procedures for the treatment of complex anterior urethral stricture and the key to successful operation. Methods 78 patients with complex anterior urethral strictures underwent different procedures of urethroplasty.Of them various mucosa urethral reconstruction were adopted in 40 cases,one-stage pedicle flaps urethroplasty in 26 and two-stage urethroplasty of Johanson procedure in 12. Results The patients were followed up for 6 to 36 months (mean 16.5 months).67 patients voided well and complications developed in 11. Of the 11 cases urethrocutaneous fistula occurred in 1,meatal stenosis in 2 and penile chordee in 1 for mucosal urethroplasty;urethrocutaneous fistula occurred in 2 and 1 of them was accompanied by hair bearing neourethra,urethral re-stricture in 3 for pedicle flaps urethroplasty;penile chordee developed in 2 and 1 of them was accompanied by hair bearing neourethra for two-stage urethroplasty of Johanson procedure. Conclusions Selection of different procedures for treatment of complex anterior urethral strictures depends on stricture length,location and severity.Penile pedicle flap urethroplasty is an effective method for those with urethral stricture 10 cm,especially in those whose bladder mucosa is not available.

100 g).The catheters were removed 1 to 5 days after operation,with transient retention occurring in 5 patients and transient frequency and urgency of urination in 5.At one-month follow-up,the mean IPSS decreased to 11, and mean Qmax increased to 17.8 ml/s. Conclusions The results demonstrate that PVP is safe,efficacious and minimally invasive for patients with obstructive BPH,especially for those of advanced age or at high risk.