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Objective To explore the clinical effect of laparoscopic high ligation of hernial sac for inguinal hernia in children.Methods Retrospective comparative analysis was taken,50 children with inguinal hernia were selected as the research subjects.According to the different treatment methods,they were divided into two groups,25 cases in the control group received the traditional high ligation of the hernia sac,25 cases in the observation group received laparoscopic high ligation of hernial sac.The amount of bleeding,operation time and hospitalization time,postoperative pain lasting time,complications,disease complex condition were compared between the two groups.Results The amount of bleeding,operative time,hospitalization time,postoperative pain in the control group were (6.78 ± 2.15) mL,(34.58 ± 4.50) min,(7.46 ± 0.40) d,(2.25 ± 0.50) d,respectively,which in the observation group were (2.45 ± 1.20) mL,(19.33 ± 5.45) min,(3.35 ± 0.30) d,(0.92 ± 0.23) d,respectively,there were statistically significant differences between the two groups (t =8.79,10.79,41.10,12.08,allP ＜ 0.05).The incidence rate of complications,recurrence rate in the control group were 44.0％,36.0％,respectively,which were higher than 16.0％,4.0％ in the observation group,the differences between the two groups were statistically significant (x2 =4.67,8.00,all P ＜ 0.05).Conclusion Laparoscopic high ligation of hernial sac in the treatment of inguinal hernia in children not only can effectively reduce the amount of bleeding,shorten operation time,but also can reduce the postoperative pain of patients,reduce hospitalization time,reduce the incidence of complications and recurrence rate,and it is worthy of clinical application.
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Objective:To observe the incidence and risk factors of anastomotic leakage after laparoscopic assisted Dixon.Methods:120 patients accepted laparoscopic Dixon operation in our hospital from March 2013 to March 2015 were selected as the observation object.By using the method of retrospective study,the postoperative incidence the anastomotic fistula were counted,and analyzed the risk factors for anastomotic fistula.Results:Among the 120 patients with postoperative anastomosis fistula,21 patients occurred anastomotic leakage,the anastomosis fistula incidence rate was 17.5％.Univariate analysis showed that the anastomosis fistula incidence rate of patients with more than or equal to 65 years of age,body mass index ＞ 23 kg/m2,diabetes mellitus,albumin is more than or equal to 35 g/L,preoperative radiotherapy,chemotherapy and anastomosis from the anal ＜ 7 cm were higher,the difference was statistically significant (P＜0.05).Logistic regression analysis showed that more than or equal to 65 years of age,diabetes mellitus,albumin is more than or equal to 35 g/L,anastomosis from the anal ＜7 cm were risk factors of anastomosis fistula in rectal cancer patients with Dixon operation (OR=4.356,5.238,3.562,4.415,P＜0.05).Conclusion:The factors of patients with laparoscopic Dixon operation after anastomosis fistula are age,diabetes,serum albumin levels and anastomotic distance from the anus.
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Objective To investigate the clinical efficacy of the laparoscopic Roux-en-Y gastric bypass (LRYGB) and metformin in the treatment of obese patients with type 2 diabetes mellitus,and influencing factors of remission rate of diabetes.Methods The case-control study was conducted.The clinical data of 172 obese patients with type 2 diabetes mellitus who were admitted to the First People's Hospital of Shangqiu (43 patients) and the First Affiliated Hospital of Sun Yat-sen University (129 patients) from June 2010 to June 2015 were collected.Of 172 patients,82 undergoing LRYGB were allocated into the group A and 90 taking oral metformin were allocated into the group B.Observation indicators:(1) follow-up situations;(2) comparison of metabolic indices after treatment between the 2 groups;(3) influencing factors analysis of remission rate of diabetes in patients undergoing LRYGB;(4) influencing factors analysis of remission rate of diabetes in patients taking oral metformin.Follow-up using outpatient examination and telephone interview was performed to detect occurrence of treatment-related complications up to January 2017,and metabolic indices were measured regularly.Measurement data with normal distribution were represented as ±s and comparison between groups was analyzed using the independent-sample t test.Repeated measurement data were analyzed by the repeated measures ANOVA.Comparisons of count data were evaluated by the chi-square test.The univariate analysis and multivariate analysis were respectively done using the chi-square test and Logistic regression model.Results (1) Follow-up situations:172 patients were followed up after treatment for 19-43 months,with a median time of 28 months.During the follow-up,5 patients complicated with mild diarrhea and 1 complicated with iron deficiency anemia at 1 year postoperatively were improved by symptomatic treatment in the group A,and there was no treatment-related complications in the group B.(2) Comparison of metabolic indices after treatment between 2 groups:body mass,BMI,2-hour postprandial blood glucose (2HPBG),2-hour postprandial serum C-peptide,glycosylated hemoglobin (GHb),fasting insulin,2-hour postprandial insulin (2HPI),low-density lipoprotein (LDL) and cases with hypertension in the group A were (89±6) kg,(31.5±2.0) kg/m2,(19.4±3.9) mmol/L,(3.52± 0.32) μg/L,15.7％ ±5.3％,(8.0± 1.4) uIU/L,(20.6± 2.5) uIU/L,(3.7 ± 1.3) mmol/L,24 before LRYGB and(77±16)kg,(24.2±2.9)kg/m2,(10.6±2.6) mmol/L,(7.19± 2.23) μg/L,5.3％±4.5％,(9.2± 4.3)uIU/L,(28.3±2.9)uIU/L,(2.2±2.1)mmol/L,9 after LRYGB,respectively,with statistically significant differences between preoperative and postoperative indicators (F=2.112,3.026,1.253,2.107,1.257,3.473,1.223,2.584,x2 =8.540,P ＜ 0.05).Fasting blood glucose,2HPBG,fasting serum C-peptide,2-hour postprandial serum C-peptide,GHb,fasting insulin and 2HPI in the group B were (11.3±2.5)mmol/L,(18.5± 4.4) mmol/L,(1.54±0.33) μg/L,(3.57±0.91) μg/L,17.5％ ±8.0％,(8.2± 1.3) uIU/L,(21.2±2.6) uIU/L before taking oral metformin and (6.6 ± 1.1) mmol/L,(10.2 ± 2.8) mmol/L,(3.52 ± 1.34) μg/L,(7.68 ± 1.94) μg/L,5.4％ ±2.1％,(9.6± 3.9) uIU/L,(30.3± 3.1) uIU/L after taking oral metformin,respectively,with statistically significant differences between before and after taking oral metformin (F=1.245,3.224,3.127,2.064,3.672,2.074,1.137,P＜0.05).Remission rate of diabetes and excess weight loss (EWL) in patients after treatment were 14.6％,80％ ± 15％ in the group A and 11.1％,60％ ± 10％ in the group B,respectively.There were statistically significant differences in body mass,BMI and EWL after treatment between the 2 groups (t=1.973,2.326,2.347,P＜0.05),and no statistically significant difference in remission rate of diabetes between the 2 groups (x2 =0.477,P＞0.05).(3) Influencing factors analysis of remission rate of diabetes in patients undergoing LRYGB:the results of univariate analysis showed that BMI,diabetes duration and LDL were factors affecting remission rate of diabetes in patients undergoing LRYGB,with statistically significant differences (x2=11.267,9.519,5.567,P＜0.05).The results of multivariate analysis showed that diabetes duration ＜ 10 years was an independent factor affecting good remission rate of diabetes in patients undergoing LRYGB,with statistically significant differences [OR=2.202,95％ confidence interval (CI):1.418-3.420,P＜0.05].(4) Influencing factors analysis of remission rate of diabetes in patients taking oral metformin:the results of univariate analysis showed that diabetes duration,GHb and LDL were factors affecting remission rate of diabetes in patients taking oral metformin,with statistically significant differences (x2 =6.306,7.758,4.652,P＜0.05).The results of multivariate analysis showed that GHb ＜ 15.0％ was an independent factor affecting good remission rate of diabetes in patients taking oral metformin,with statistically significant differences (OR=3.167,95％CI:1.586-6.325,P＜0.05).Conclusions LRYGB and oral metformin in the treatment of obese patients with type 2 diabetes mellitus are safe and effective,showing an equivalent remission rate of diabetes,and LRYGB had an advantage of weight loss.Diabetes duration ＜ 10 years and GHb ＜ 15.0％ are respectively independent factors affecting good remission rate of diabetes in patients undergoing LRYGB and taking oral metformin.
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Objective To explore the clinical efficacy of continuous intravenous pump of Shengmai injection for treatment of patients with acute coronary syndrome(ACS)combined with cardiogenic shock. Methods In the period from January 2005 to March 2011,33 hospitalized patients with ACS complicated by cardiogenic shock were selected in the treatment group,and in the same period,32 in-patients with ACS were enrolled in the control group, According to traditional Chinese medicine(TCM)syndrome type,the treatment group was subdivided into Yin xutype(Yin deficiency,15 cases),Qi xu type(Qi deficiency,11 cases),Xue yu type(blood stasis,7 cases). Conventional western medicine treatment was given to the two groups,besides,Shengmai injection in 30-60 mL intravenous drip,once a day was applied in the control group,while in the treatment group,Shengmai injection in 10-100 mL/h trace pump continuous intravenous infusion was given,after the blood pressure returned to normal,the infusion was changed to 5 mL/h trace pump continuous intravenous injection for consecutive 5-7 days. After treatment, the changes of clinical efficacy,blood pressure,heart rate ,improvement of clinical symptoms were observed in two groups,and the changes of mean arterial pressure(MAP)in cases with different syndromes in treatment group were also investigated. Results The rates of the significant therapeutic effect and total effect in the treatment group were obviously higher than those in the control group〔significant effect:69.7%(23 cases)vs. 46.9%(15 cases);the total efficacy:90.9%(30 cases)vs. 62.5%(20 cases),both P0.05). After 48 hours of treatment in the two groups,the clinical symptoms were all improved〔chest pain:2 cases(6.1%)vs. 10 cases(31.3%),sweating:3 cases(9.1%)vs. 13 cases(40.6%),shortness of breath:4 cases(12.1%)vs. 12 cases(37.5%),all P0.05〕. In treatment group,the increase of MAP in patients withYin xutype(mm Hg,1 mm Hg=0.133 kPa)was higher than that in patients with Qi xu type and Xue xu type(105.00±8.53 vs. 91.00±9.53,89.00±3.53,both P<0.05). Conclusion Continuous intravenous injection of Shengmai injection has significant therapeutic effect for treatment of patients with ACS combined with cardiogenic shock.
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Objective To investigate the expression of STAT3 and its clinicopathological characteristics in colorectal carcinomas. Methods The expression and location of STAT3 and VEGF protein were deterimined using MaxVisionTM immunohistochemistry and immunohistochemiscal S-P method in 50 colorectal carcinomas and 30 nor-real colorectal tissues. Results Positive expression rates of STAT3 protein in colorectal cancer tissues and normal colorectal mucosa tissues were 82.0% and 33.3%. The expression of STAT3 protein was related to differentiation, TNM stage and lymph node metastasis in colorectal carcinomas (P<0.05 ). VEGF in the expression of lower tumor differentiation and highter TNM stage was significantly higher than that in higher turner differentitation and lower TNM stage (P < 0.01 ). VEGF in the groups of serosa invasion and lymph node metastasis was higher than that in no serosa invasion and lymph node metastasis ( P < 0.05 ). Conclusions STAT3 protein expression is associated with the development of colorectal carcinoma, and its overexpression is an independent adverse prognosticator in colorectal cancer. STAT3 and VEGF protein may play an important role in colorectal tumorigenesis and disease progression.