Objective To present a modified technique of total cystectomy and ileal neobladder. Methods Radical cystectomy and ileal neobladder were performed for 25 male patients. The dome, the upper part or the lateral walls and the base of the bladder were dissected antegradly. After cutting the ureters, the mobilization was then made retrogradly.For the construction of the reservior, the isolated 40 cm ileal segment was opened along its antimesenteric border and then arranged into a W shape. The wall of ileal pouch was created by side-to-side blanket suture of the incised ileum. The ureters were implanted at the two corners of W shape with antireflux nipple. Results 24 of 25 cases of ileal neobladder have been followed up for 2 to 84 months with a mean of 24 months.The operation took 150 to 310 minutes with a mean of 240 minutes. The intraoperative blood transfusion was 0 to 1200 ml.1 patient died of cancer metastasis. 23 patients have achieved excellent daytime continence,whereas only 14 had nighttime continence. The mean bladder capacity for the entire group was 310 ml. Renal functions of 2 patients were mildly abnormal.Hypokalemia occurred in 2.There was no metabolic acidosis.There were 3 cases of hydroureter or hydronephrosis on one side. 1 calculus of neobladder was discovered on BUS. On voiding cystography, no reflux has been noted in all.And no patient suffered from urethral recurrence. Conclusions The modified total cystectomy and ileal neobladder takes less time and is more feasible.

[Objective]To discuss the surgical treatment of huge tumor invovled sacrum.[Method]A review of records in 18 patients with tumors invovled sacrum was made.Age at surgery averaged 43 years(range:31~65),eleven patients were male,seven patients were female.In this series,malignant tumor was in 14 cases,according to Enneking classification,these cases were classified toⅠA~ⅠB subtypies,which concluded chordoma(8 cases),giant cell tumor(5 cases)and osteochondroma(1 case).Benign tumor was in 4 cases with neurogenic tumor(3 cases)and aneurysmal bone cyst(1 cases).[Result]Over all,no patients were dead in the operation,no other major complications were occurred,the blood loss during surgery was 1 000 ml to 5 000 ml.All incisional wound were primary healing except 4 cases,two of them gained secondary closure after gluteus maximus pushing flap.Eighteen patients gained follow-up visiting,the average time of follow-up was 30 months,only 2 cases were tumor recurrence.[Conclusion]Huge tumors invovled sacrum present a great challenge,because of many organs surrounding sacrum invovled and complexity in anatomic region,sacrectomy of sacral tumor always complic generous blood loss,disorder of urination and defecation,disorder of sexual function et al.Abdominosacral approach can lead to a safer and relative radical local control of tumor,it is benefit to protect blood vessel and nerves.

Objective To investigate the effect of stress level on blood coagulation and fracture healing in fracture patients.Methods The clinical data of 50 fracture patients (fracture group) and 50 healthy volunteers (control group) were analyzed retrospectively.The oxidative stress indexes [superoxide dismutase (SOD) and malondialdehyde (MDA)] and blood coagulation indexes [plasma fibrinogen (Fib),activated partial thromboplastin time (APTT),thronbin time (TT),and prothrombin time (PT)] were compared between the 2 groups.Correlation between stress level and coagulation indexes in the fracture patients was analyzed by Spearman correlation coefficient.The correlation between stress level and the progress of fracture healing in fracture patients was analyzed.Results There were no significant differences in APTT,TT,PT or other blood coagulation indexes between the 2 groups (P ＞ 0.05).The fracture group had a significantly lower SOD level but significantly higher MDA and Fib levels than the control group (P ＜ 0.05).Spearman analysis showed that the SOD level was negatively correlated to the Fib level (P ＜ 0.05) while the MDA level was positively correlated to the Fib level in the fracture group (P ＜ 0.05).The MDA level was negatively correlated to the process of fracture healing (P ＜ 0.05) while the SOD level was positively correlated to the process of fracture healing in the fracture group (P ＜ 0.05).Conclusions Traumatic fracture can cause stress reaction.It should be kept in mind that the severity of stress reaction is closely related to the Fib level and the process of fracture healing.

Objective To investigate the effect of ultrasound-guided serratus plane block onefficacy of postoperative analgesia in patients undergoing radical mastectomy. Methods From January 2013 to December 2016, sixty-eight ASA physical statusⅠorⅡ patients scheduled for radical mastectomy under general anesthesia were randomly divided into two groups (n = 34 each): SP block group (observation group) and control group. After induction of anesthesia, ultrasound-guided homolateral SP block was performed, and 0.375% ropivacaine 20 ml was injected in observation group, while the equal volume of normal saline was used instead in control group. The patients received patient-controlled intravenous analgesia (PCIA) with sufentanil after operation in two groups. The scores of prince henry pain scale (PHPS) were evaluated at the 2nd, 4th, 8th, 12th and 24th hour (T1, T2, T3, T4, T5) after operation. The consumption of sufentanil, propofol and remifentanil was recorded.Meantime, the times of successfully delivered doses (D1) and attempts (D2) within 24 h after operation were added up, and D1/D2 was calculated. The adverse effects were also recorded. Results The scores of PHPS at T1 [(1.4 ± 0.5) scores vs. (3.1 ± 0.6) scores], T2 [(1.5 ± 0.6) scores vs. (2.9 ± 0.8) scores], T3 [(1.7 ± 0.5) scores vs. (2.8 ± 0.7) scores], and the consumption of sufentanil [(53.4 ± 16.7)μg vs. (87.8 ± 24.5)μg], remifentanil[(288.7 ± 42.1)μg vs. (376.5 ± 61.6)μg] were significantly lower in observation group than those in control group, while D1/D2 (0.89 ± 0.12 vs. 0.57 ± 0.18) was higher (P<0.05). The incidence of adverse reactions was significantly lower in observation group: 0 vs. 20.6% (7/34), P<0.05. Conclusions Ultrasound-guided SP block reduces the perioperative opioids consumption and enhances the efficacy of postoperative analgesia in patients undergoing radical mastectomy.

Objective To observe the effect of Latexin treatment on the chemoresistance in gemcitabine-resistant pancreatic cancer cell line SW1990, and explore the potential mechanism.Methods Gemcitabine-resistant pancreatic cancer cell line SWl990/GZ was induced and established by increasing gemcitabine dosage intermittently.IC50 of gemcitabine in SW1990 cells and SWl990/GZ cells pre and post Latexin treatment at the dosage of 10, 20 and 40 ng/μl for 48 h was evaluated using CCK-8 assay.The mRNA and protein expression of Latexin gene in SW1990 and SW1990/GZ cells were evaluated using qRT-PCR and Western blot, and the expression of Shh and Gli1 in 40 ng/μl Latexin treated SW1990 and SW1990/GZ cells for 48 h.Results A gemcitabine-resistant pancreatic cancer cell line SWl990/GZ was obtained successfully, which can grow stably and passage in the media containing 150 μmol/L gemcitabine.The IC50 values of gemcitabine in SW1990 cells and SWl990/GZ cells were (3.8±0.4)μmol/L and(226.52±13.61)μmol/L, respectively, and the later was greatly higher than the former, which was statistically different (P=0.000).The drug resistance indexes (RI) was 59.6.After treated with different concentrations of Latexin(10,20,40 ng/μl), the IC50 of SW1990 cells was (3.0±0.4)μmol/L, (2.5±0.3)μmol/L and (1.8±0.3)μmol/L, respectively,and the IC50 of SW1990/GZ cells was(113.08±5.01)μmol/L,(70.26±2.31)μmol/L and (42.12±1.31)μmol/L, respectively.Compared with the untreated cells,the IC50 of gemcitabine in 20,40 ng/μl Latexin treated cells was obviously decreased, and the differences were statistically significant (P<0.05).Compared with the SW1990 cells,the expression of Latexin in SW1990/GZ cells was obviously decreased.RI were 37.7, 28.1 and 23.1,respectively.mRNA relative expression of Latexin in SW1990 and SW1990/GZ cells were 0.85±0.08 and 0.31±0.07, and protein relative expression were 0.49±0.09 and 0.13±0.05, and Latexin expression in SW1990/GZ was obviously lower than that in SW1990 cells and the difference was statistically significant (P<0.05).After being treated by 40 ng/μl Latexin, SHH mRNA in SW1990/GZ cells decreased from 0.89±0.09 (control cells) to 0.53±0.06, Gli1 mRNA decreased from 0.58±0.06 to 0.35±0.05, Shh protein decreased from 0.72±0.09 to 0.35±0.06,Gli1 protein level decreased from 0.78±0.08 to 0.28±0.03, and all the differences were statistically significant (P<0.05 or 0.01).Conclusions Latexin can significantly improve the chemosensitivity in gemcitabine-resistant pancreatic cancer cells, and the potential mechanism may be related to the inhibition of sonic hedgehog pathway activation.

ObjectiveTo study the efficacy of transcatheter arterial chemoembolization (TACE) combined with surgical resection in the treatment of ruptured hepatocellular carcinoma (HCC).MethodsThe clinical data of 26 patients who presented with ruptured HCC to our hospital from January 2008 to December 2011 were retrospectively studied. These patients received TACE (n=19),surgical resection (n=7),and surgical resection after TACE (n=8).ResultsShock in the 19 patients who received TACE was promptly corrected and the vital signs were stabilized.On subsequent CT,the tumors shrunk in size.Salvage liver resection was carried out in 8 patients 1 month after TACE.After treatment,AFP decreased or became normalized,thus the treatment results were good. A one-stage liver resection was carried out in 7 patients. One patient died after operation and peritoneal metastases occurred in 4 patients. Conclusions TACE stopped bleeding from ruptured HCC efficaciously,reduced the need for open exploration,and improved the rate of resection of HCC.TACE combined with surgical resection significantly lowered the rate of abdominal tumor metastases.

Objective To study the hemostnsis effects of compression cords oppressing after femoral artery puncture and encheiresis. Methods Self-made compression cords were used to stop bleeding of femoral artery puncture sites in 2164 patients underwent 3046 cases of arteriopuncture encheiresis. The total eases were divided into group A (1482 eases) and group B (1564 cases) according to different treatment of oppression and breaking duration which were 8-10 hours for group A and 5-6 hours for group B, the hemostasis effects, discomfortableness and related complications within two groups were evaluated. Results The proportion of patients who got good hemostasis effects were 99.2% in group A, 99.0% in group B. There was no difference in hemostasis effects between two groups (P> 0.05). While the rate of discomfortableness in group A (63.8%) was higher than that in group B(42.9%) (P<0.05). The related serious complications were 2 patients in group A, but no occurred in group B. Conclusion Self-made compression cords op- pressing and 5-6 hours breaking time course can achieve both finer hemostasis effect and lower frequency of complications after femoral artery puncture and encheiresis.

Objective To discuss the effect of different methods of dropping the high temperature of the tubercular meningitis patients. Methods 35 cases with tubercular meningitis with high fever were divided into research group(11 cases) and control group(24 cases) ,24 patients in control group were treated by traditional cooling method, 11 patients in research group were rteated by mild hypothermia therapy, The self signs, the intracranial pressure,Glasgow scores, complications and the death rates of patients were assessed and compared. Results The effective rates of the research and control cooling method were 81.8% and 41.7% respectively. The difference between the two groups was significant;After the intervention,compared with the control group, the self scale is superior in research group,and the intracranial pressure and the death rates of patients were lower,and patients'Glasgow scores were higher,but the complications between the two groups had no significant differences. Conclusion Mild hypothermia can effectively control patients'temperature,at the same time, which can improve the patients conscious state and reduce the mortality.

Objective To summarize our experience in the prevention and treatment of right accessory hepatic duct and right hepatic duct injury during laparoscopic cholecystectomy. Methods The clinical data of 21 cases with right accessory hepatic duct or right hepatic duct during laparoscopic cholecystectomy were reviewed retrospectively. Result According to anatomy identified by preoperative work-up and selective cholangiography during the operation, 18 cases had the right accessory hepatic duct,eleven of them were confirmed intraoperatively. The accessory hepatic ducts were conserved in 3 cases and clipped without biliary leaks postoperativly in 7 cases; One case had biliary leaks postoperatively with the duct sutured intraoperatively, and recovered well conservative therapy. Accessory hepatic ducts were accidentally injuried in 7 cases, two patients were transferred to open surgery; three cases were confirmed to be injuried and clipped by second laparoscopic exploration because of biliary leaks postoperatively. Three cases had a low confluence of the right and left hepatic duct with the gallbladder duct joining the right bile duct, the ducts were conserved in 2 cases and injuried in one. Postoperatively all these 21 cases were followed up for 2 years, without jaundice or liver dysfunction. Conclusions To prevent injury of right accessory hepatic duct and right hepatic duct. High vigilance and familiarity with the anatomic variants of the biliary tree and intraoperative cholangiography in selective cases are fundmental.

BACKGROUND:Clinical resection of thoracolumbar spinal tumor has a great impact on the spinal stability. Positive internal fixation is required clinicaly in order to maintain the spinal stability. The use of titanium mesh implantation can provide a firm internal fixation folowing resection of tumors. OBJECTIVE:To explore the spinal stability undergoing titanium mesh implantation with internal fixation folowing thoracolumbar tumor resection. METHODS:Twenty-four patients with thoracolumbar tumor admitted at the Central Hospital of Suining City from September 2013 to September 2014 were randomly selected and given tumor resection folowed by titanium mesh implantation with internal fixation. After treatment, patients were folowed up for 1-12 months to observe and analyze the neural functional recovery and spinal stability of the patients. RESULTS AND CONCLUSION:Al the 24 patients successfuly completed the operation treatment, and there was no case of death at the end of folow-up. During the folow-up, patient's clinical symptoms and neural function were significantly relieved, and Frankel classification was significantly improved after treatment. Regular X-ray examination showed that there was no change in the position of titanium mesh and anterior internal fixation system. There was also no titanium mesh colapse, internal fixation fracture and loosening, and the spinal stability was stil excelent. These findings indicate that patients were not changed, and did not appear because the amount of loose, good spinal stability. Resection of thoracolumbar tumors showed that the thoracolumbar spinal reconstruction with titanium mesh implantation combined with internal fixation folowing tumor resection can obtain good clinical effect and excelent biocompatiblity.