[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 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 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 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.

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 explore the diagnosis and treatment of tumor associated gastrocolic fistula (GCF).Methods The records of the 4 patients with GCF between August 2008 to February 2014 were retrospectively analyzed.Three female and one male patients,those whose average age were 61 years,have been pathologically diagnosed postoperatively as gastrocolic fistula caused by malignant diseases.The main clinical symptoms were diarrhea (3 cases),fecal vomitus (3 cases),weight loss (4 cases),and abdominal pain (4 cases).Positive diagnostic tests for GCF included gastroscope (3 cases),colonoscope (1 case),barium enema (1 case),upper gastrointestinal contrast (2 cases).Results En-bloc resection of the involved gastrocolic region have been performed for all,2 patients underwent radical gastrectomy and colon resection and 2 patients were taken on palliative procedure.Pathology indicated adenocarcinoma all,Immunohistochemical detection for CK20,CDX-2 were applied for identifying the originations of tumors.Delayed gastric emptying and DIC occurred in one patient who died in 3 months after the operation,anastomotic leakages were found in 2 cases.The survival patients were all discharged and taken capecitabine combined with Oxaliplatin for chemotherapy.Conclusions Endaoscopy and gastrointestinal imaging are main evidences for diagnosis of GCF.En-bloc resection of the involved gastrocolic region were recommended,enterostomy was safer than entero-anastomosis in one stage procedure.The originations of tumors may be identifying according to the pathological characteristic and CDX-2,CK20 staining.Adjuvant chemotherapy should be applied.

Objective To investigate the effectiveness of electromyography-triggered stimulation on the hand function post stroke.Methods 40 stroke patients were divided into electromyography-triggered stimulation group and neuromuscular electric stimulation group.They were assessed with Fugl-Meyer Assessment (FMA), active range of motion of wrist extension (WE-AROM) and modified Barthel index (MBI) before and 6 weeks after treatment. Results The scores of all the assessments improved in both groups after treatment (P<0.001),and improved more in the electromyography-triggered stimulation group than in the neuromuscular electric stimulation group (P<0.05).Conclusion Compared with neuromuscular electrical stimulation, electromyography-triggered stimulation may further improve the hand function post stroke

Objective To explore the possibility of anterior open reduction and internal fixation to treat the lower cervical irreducible dislocation. Methods 15 cases of lower cervical irreducible dislocation were treated by the anterior open reduction and internal fixation, 11 cases were male and 4 cases were female, 10 cases were unilateral facet locked and 5 eases were bilateral facet locked which were confirmed by the MRI and CT scan. All the cases were failed to the skull traction before operation and received anterior open reduction and plate fixation, and interver-tebral fusion. All the cases were followed up, the recovery of neurological function and the fusion rate were evaluated. Results 15 cases were completely reduction and none of them got a worse neurological function. Conclusion The treatment effect of anterior open reduction and fixation for the lower cervical irreducible dislocation were good.

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.