ObjectiveTo systematically evaluate the therapeutic effect of gastroesophageal devascularization( GD),portasystemic shunt( PSS),devascularization plus portasystemic shunt ( GD + PSS) for the treatment of 4250 cirrhotic portal hypertension cases reported in Chinese literature. MethodsThe literatures about the effect of gastroesophageal devascularization,portasystemic shunt,devascularization plus portasystemic shunt on portal hypertension were collected from Wanfang databases, China National Knowledge Infrastructure(CNKI) from 1980 to 2011.RevMan 4.2 and SPSS 13.0 were used for data analysis. ResultsIn this study 17 reports were enrolled into the meta-analysis.The results of the mta-analysis showed that long term survival rate in the group of GD plus PSS was higher than that in group of GD [OR=1.73,95％CI (1.23,2.44),P ＜0.01].That in group of PSS was similar with the group of GD [ OR =0.87,95 ％ CI (0.63,1.20),P =0.40 ].That of group GD plus PSS was similar with the group of PSS [ OR =1.73,95％ CI (0.95,3.13),P =0.07 ].For recurrent variceal bleeding rate,that in group of PSS was lower than that in the group of GD[ OR =0.46,95％ CI (0.35,0.61 ),P ＜0.01 ].That in the group of GD plus PSS was lower than that in the group of GD [ OR =0.25,95％ CI (0.18,0.35),P ＜ 0.01 ].The group of GD plus PSS was similar to that of group of PSS [ OR =0.72,95％ CI ( 0.40,1.29 ),P =0.27 ].Encephalopathy rate was higher in the group of PSS than the group of GD [ OR =3.57,95％ CI (2.43,5.23 ),P ＜0.01 ].That in group of GD plus PSS was lower than that in the group of PSS[ OR =0.37,95％ CI (0.20,0.69),P ＜0.01 ],while that in GD plus PSS was similar to the group of GD[ OR =1.58,95％ CI (1.02,2.43),P =0.04 ].ConclusionsThe only significant factor influencing the long term result in Chinese patients with portal hypertension is preoperative liver function.The three types of operation have different benefits and disadvantages.

Objective To summarize clinical experience on the diagnosis and management of pancreatic regional portal hypertension. Methods The clinical manifestations,diagnostic methods and therapeutic modalities of 40 cases of pancreatic regional portal hypertension were analyzed retrospectively.Results Male:female =26: 14.The average age was (40 ± 10)yrs.Among these patients,16 patients (40％) were accompanied by upper gastrointestinal bleeding and 20 patients (50％) by hypersplenism.There were 16 patients (40％) suffering from benign lesions and 6 patients (15％) from malignancy at pancreatic body and tail respectively,and 8 patients(20％ ) from severe necrotic pancreatitis accompanying pseudocyst and 10 patients (25％) from chronic pancreatitis. The average splenic venous pressure was (28.4±4.2) cm H2O(P ＜0.01 ).The average diameter and speed of splenic vein bloodflow by Doppler examination was ( 1.3 ± 0.2 ) cm ( P ＜ 0.01 ) and ( 9.3 ± 0.5 ) cm/s ( P ＜ 0.05 ).The follow-up rate was 100％.Splenectomy was effective for controlling gastrointestinal bleeding. Conclusions It is not difficult to diagnose pancreatic regional portal hypertension based on findings of US,CT and endoscopic examination,together with its clinical features. Therapy should be aimed at both regional portal hypertension and underlying diseases.

ObjectiveTo evaluate the therapeutic effect of gastroesophageal devasculariztion on cirrhotic portal hypertensive bleeding.MethodsClinical data of 85 cirrhotic patients with portal hypertentsive bleeding undergoing gastroesophageal devascularization were retrospectively analyzed. Results The following-up rate was 78％. The 1-yr,3-yr and 5-yr survival rate was 95％, 88％and 82％respectively.There was significant difference in survival time after devascularization between patients of Child-Pugh A and Child-Pugh B.For the whole group the 1-yr,3-yr and 5-yr recurrent bleeding rate was 6％,16％ and 28％ and postoperative hepatic encephalopathy was 7％.ALT,AST and ALB recovered to pre-operative level on post-operative day 7.ConclusionsGastroesophageal devascularization was an effective therapy in treating portal hypertensive variceal bleeding.Liver function remains a significant factor influencing long term survival.

After surgical removal of a primary tumor the minimal residual cancer cells (MRCC) and metastases derived thereof are the actual targets for all theraputic approaches. Due to the great sensitivity and PCR-based detection systems, the molecular characterization of MRCC can provide information about their metastatic potential, availability of drug targets, drug sensitivity and development of therapy resistance, which will close the analytical gap between primary disease and the detection of metastases by conventional methods such as imaging procedures, and this will help therapy selection, monitoring of the treatment effects and predicting of the prognosis. Patients will benefit from a individualized therapy in the end.

Objective To observe the effect of intranasal dexmedetomidine on preventing myoclonus induced by etomidate.Methods One hundred patients who ASA classification Ⅰ-Ⅱ grades were divided into two groups by random digits table method with 50 cases each.Before anesthesia induction with dexmedetomidine 1 μ g/kg (dexmedetomidine group) or equivalent 0.9％ sodium chloride (control group) intranasal,30 min after two groups were injected etomidate 0.3 mg/kg.Mean artery pressure(MAP),heart rate (HR),oxygen saturation with pulse oximetry (SpO2) and respiratary rate were recorded before intranasal instillation of dexmedetomidine (T0),at l5 min (T1) and 30 min (T2) after intranasal dexmedetomidine,myoclonus was observed and graded.Results The MAP,HR at T2 was lower than that at T0 in dexmedetomidine group [(75.9 ± 8.1) mm Hg (1 mm Hg =0.133 kPa) vs.(81.4 ± 10.4) mm Hg,(80.9 ± 7.6) times/min vs.(85.9 ± 9.1) times/min],there was significant difference (P ＜ 0.05),but all within the normal range; other within the group at each time point had no statistical significance between two groups (P ＞ 0.05).The incidence of myoclonus was significantly reduced in dexmedetomidine group compared with that in control group [42％(21/50) vs.70％(35/50)],there was significant difference (P ＜ 0.01).Conclusion Intranasal instillation of dexmedetomidine can safely prevent myoclonus induced by etomidate.

OBJECTIVE:To investigate the clinical efficacy and safety of rh-endostatin combined with cantharidin sodium vita-min B6 in the treatment of advanced non-small cell lung cancer (NSCLC). METHODS:180 patients diagnosed as advanced NSCLC were divided into group A,group B and group C ,with 60 cases in each group according to random number table meth-od. 3 groups were all given gemcitabine+cisplatin(GP)chemotherapy plan;Group B additionally received Rh-endostatin injection 7.5 mg/m2 intravenously for 3 h,d1-14;group C was additionally given Cantharidin sodium vitamin B6 injection 40 ml intrave-nously,qd,d1-14,on the basis of group B. every 21 days for a cycle,evaluation of therapeutic effect after 2 cycles. The clinical benefit rate,quality improvement rate of life,time to progression (TTP) and the occurrence of ADR were observed in 3 groups. RESULTS:The clinical benefit rate of groups A,B and C were 40.0%,58.3%,71.6% respectively,the quality improvement rate of life in 3 groups were 28.3%,41.7%,56.7% respectively,the differences were statistically significant among those groups(P<0.05). The median TTP of groups A,B and C were 126,190 and 195 days,TTP of groups B and C were significantly longer than that of group A,with statistical significance (P<0.05);there was no significant difference between group B and group C(P>0.05). The rates of leukopenia,thrombocytopenia,nausea and vomiting in group C were significantly lower than those of group A and B,with statistical significance(P<0.05);there was no statistical significance between group A and B(P>0.05). CONCLU-SIONS:Rh-endostatin combined with cantharidin sodium vitamin B6 can significantly improve the effectiveness of chemotherapy in patients with advanced NSCLC on the basis of the GP chemotherapy,while reduce the toxicity of chemotherapy drugs,improve the quality of life and prolong the survival time.

Objective To study the application of Supreme laryngeal mask airway (SLMA) with new type to the general anesthesia of lateral position. Methods Sixty patients with ASA Ⅰ - Ⅱ who planned to receive selective poster laparoscopic surgery were divided into SLMA group and general tracheal tuber (GTT) group with 30 cases of each by random digits table. After fast intravenous induction SLMA and GTT were intubated respectively to obtain artificial airway in each group. The time of intubation, efficiency of success,heart rate(HR), invasive blood pressure(IVBP),airway pressure,side effects were observed and recorded. Results The intubation time in SLMA group [(15.1 ±4.0) s] was shorter than that in GTT group [(30.5 ±: 16.2) s] (t' =-5.05,P ＜0.05); there was no significant difference in efficiency of success between two groups [96.7%(29/30) vs. 76.7%(23/30),P＞ 0.05]. There was no significant difference in HR and IVBP during the time of intubation and extubation in SLMA group(P＞ 0.05), but not in GTT group(P＜0.05). There was no significant difference in the change of the airway pressure between two groups during the ventilation. There were no complications in two groups. Conclusions The time of SLMA intubation in the general anesthesia with lateral position is short. The effect of intubation and extubation to HR and blood pressure is light. The SLMA intubation is another way to set up safely artificial airway.

Objective To explore feasibility and therapeutic effect of posterior decompression by vertebral body resection, interbody bone fusion and transpedicular screw internal fixation in treatment of severe rotational throracolumar fracture and dislocation. Methods From October 2007 to July 2008, nine patients with severe rotational throracolumar fracture and dislocation classified as AO C types under-went decompression by vertebral boby resection, intervertebral bone fusion and transpedicular screw inter-nal fixation via a posterior midline small incision. There were eight males and one female, at age range from 23 to 54 years. All patients involved levels at T_(11)-L_2. According to AO classification, there were three patients with type C1 bursting fractures with rotational dislocation, five with distraction fracture com-bined with rotational dislocation and one with rotational distraction shear fracture/dislocation. The preop-erative Frankel Grading was Grade A in three patients, Grade B in one, Grade C in four and Grade D in one. Postoperative neurological status, the correction and loss of dislocation and the location and union of bone graft were reviewed. Results All patients received successful operation, with operation time of 3.5-5.8 hours (mean 4.4 hours), blood loss of 1 200-3 500 ml (mean 1 800 ml). The follow- up period in nine patients was 3-12 months (mean seven months). Postoperative X-ray photographs showed that the dislocation in all patients was reduced, the spine curvature was recovered to normal and the intervertebral bone graft was well fixed. Three patients at Frankel Grade A had no improvement, one at Grade B was improved to Grade C. Of four patients at Grade C, three patients were improved to Grade D. The follow-up showed bony fusion in all patients, with no loosening, dislocation or breakage of the internal fixation or implants. Conclusions For severe rotational throracolumar fracture and dislocation, decompression, reduction, fusion and fixation are rather difficult, while sufficient posterior decompression by vertebral body resection, rigid interbody bone fusion and transpadicular screw internal fixation can be an effective alternative measure.

Objective To compare the clinical curative effect of pedicle screw reduction and fix-ation via or not the injured vertebra in treatment of thoracolumbar fractures. Methods A retrospective study was performed on 27 patients with single thoracolumbar fractures admitted from March 2006 to Feb-ruary 2008. There were 12 patients treated with pedicle screw fixation (Group A) and 15 with traditional two-level fixation (Group B). Group A involved 11 males and 5 females, aged average 43 years (25-56 years); Group B included 10 males and 5 females, aged from 23 to 61 years (mean 42 years). All pa-tients had fresh fractures with intact pedicles on either unilateral or bilateral sides. With body position re-duction under anesthesia, the patients in Group B were treated with posterior routine distraction and lordo-sis restoration, while those in Group A were treated with the methods used in Group B as well as pedicle screw reduction and fixation. The kyphosis (Cobb angle) and recovery of injured vertebral height were observed. Results The mean follow-up period was 9 months (6-22 months). After operation, the op-timal Cobb angle and anterior column restoration were achieved through the ventral reduction from the in-jured vertebral body. The degree in anterior movement of injured vertebrae pre- and post-operatively was (0.089±0.036)° in Group A and (0.023±0.048)° in Group B, with statistical difference (P < 0.01). Cobb angle was (9.88±7.69)° in Group A and (5.19±3.24)° in Group B (P < 0.05). Changes of distance between the anterior- upper edge of the cephalad vertebrae to the anterior - lower edge of the caudal vertebral body was (39.3±5.2) % in Group A and (20.6±6.5)% in Group B (P < 0.05). Over distraction of the contiguous discs was also avoided efficiently. Conclusions Selective pedicle screw fixation into the injured vertebrae can help correct the kyphosis and maintain the reduction and en-hance the stiffness of the posterior short-segment instrumentation in single thoracolumbar fractures.

Objective To evaluate the feasibility and safety of percutaneous posterior pedicle screw fixation in treatment of traumatic thoracolumbar fracture without neurologie deficits. Methods From January 2007 through December 2007, there were 15 patients with traumatic fracture of the thoracic or lumbar spine without neurologie deficits treated within 10 days after injury. There were 10 males and 5 females at age range of 31-65 years (average 45.6 years). The fracture was located at T11 in 1, T12 in 4,L1 in 7, L2 in 2 and L3 in 1. Preoperative anteroposterior and lateral radiographs of the fractured spine as well as CT and MRI were done to evaluate injury severity of the vertebral body, spinal canal and diseolig-amentary structures. According to Magerl classification criteria, there were 10 patients with type A3 frac-ture, 3 with type A2 fracture and 2 with type A1 fracture, which were treated with pereutaneous posterior pediele screw fixation. Operative time and intraoperative blood loss were recorded to observe clinical re-suits. Results The average operation time was 82 minutes (65-110 minutes), with a mean intraopera-five blood loss of 35 ml (20-50 ml ). There were no conversions to open surgery, new neurological deficits or other surgery-related complications. All patients were followed up for 3-11 months (average 7.6 months), which showed that Cobb angle was corrected from preoperative (15.7±6.3)° to postoperative (3.5±1.2)°. Postoperative CT showed sound reduction of posterior bone displacement in all patients compared to preoperative CT results. Conclusions Percutaneous posterior pedicle screw fixation is fea-sible and safe surgical procedure with fine short-term outcome in treating traumatic thoracolumbar fracture without neurologic deficits. This technique offers serveral potential advantages over open approaches inclu-ding less tissue trauma and blood loss as well as quicker recovery.