Correction of tibial multiplanar deformities using single Taylor external fixator combined with biplanar osteotomy / 中国修复重建外科杂志

OBJECTIVE@#To investigate the effectiveness of single Taylor external fixator combined with biplanar osteotomy on correction of tibial multiplanar deformities.@*METHODS@#Between October 2016 and December 2021, 11 patients with tibial multiplanar deformities (20 sides) were treated with single Taylor external fixator and biplanar osteotomy. Of them, 4 were male and 7 were female; the average age ranged from 13 to 33 years (mean, 21.9 years). Diagnosis included rickets severe genu varum deformity (7 cases, 14 sides), rickets severe genu valgum deformity (2 cases, 4 sides), multiple osteochondromatosis calf deformity (1 case, 1 side), neurofibromatosis medial lower leg anterior arch deformity with short of leg (1 case, 1 side). After fibular osteotomy and tibial multiplanar osteotomy, a Taylor external fixator was installed. After operation, the deformities were corrected successively and fixed completely. The osteotomy healed, then the external fixator was removed. Before operation and at 12 months after operation, the full-length X-ray films were taken. The leg-length discrepancy, medial proximal tibial angle (MPTA), lateral distal tibial angle (LDTA), posterior proximal tibial angle (PPTA), anterior distal tibial angle (ADTA), and tibial rotation angle were measured. The degree of lower limb deformity was scored with reference to a customized tibial mechanical axis scoring table.@*RESULTS@#Osteotomy was successfully completed without neurovascular injury and other complications. The external fixator was adjusted for 28-46 days, with an average of 37 days, and the external fixator was worn for 136-292 days, with an average of 169 days. Mild needle infection during the fixation period occurred in 3 sides, refracture at the distal tibial osteotomy in 1 side after removing the external fixator, and nonunion of the distal fibular osteotomy in 1 side. All patients were followed up 369-397 days (mean, 375 days). At 12 months after operation, the lower limb discrepancy decreased, but there was no significant difference ( P>0.05). MPTA, LDTA, PPTA, ADTA, and tibial rotation angle improved, and the differences in LDTA, ADTA, and tibial rotation angle were significant ( P<0.05). The score of lower limb deformity was significantly higher than that before operation ( P<0.05), and the results were excellent in 9 sides, good in 8 sides, fair in 3 sides, with the excellent and good rate of 85%.@*CONCLUSION@#Single Taylor external fixator combined with biplanar osteotomy is effective in the correction of tibial multiplanar deformities.

Conjoint fascial sheath suspension in treatment of severe blepharoptosis caused by inadequate suspension system tension / 中华医学美学美容杂志

Objective:To evaluate the safety and efficacy of conjoint fascial sheath (CFS) suspension surgery for severe blepharoptosis caused by low-tension suspension system.Methods:A total of 62 cases with severe blepharoptosis caused by low-tension suspension system received CFS suspension correction surgery from September 2014 to September 2017 were collected and followed up with a range of 12-36 months. The MRD-1, curve of upper eyelid, appearance and complications were recorded and underwent statistical analysis to evaluate the effect based on functionality, aesthetics and complication.Results:The postoperative MRD-1 was + 1 mm ~+ 4 mm compared with preoperative -3 mm ~+ 1 mm. The difference in the mean change was statistically different ( t=5.893, P<0.05). The satisfactory rate was 92.1% (82 cases), 7.9% (7 cases) were improved, and no case was invalid. There were no cases of recrudescence. Conclusions:Severe blepharoptosis can be caused by the inadequate tension of the upper eyelid suspension system. Laxity and abnormality of fixed structures may be major cause of decreasing levator aponeurotic tone. CFS suspension prevents further damage to the previous fixed structures, so it should be the first choice for such cases.

Long-term efficacy of bioprosthetic anal fistula plug in the treatment of transsphincteric anal fistula / 中华胃肠外科杂志

Objective@#To evaluate the long-term healing rate of transsphincteric anal fistula treated with anal fistula plug procedure and the risk factors affecting the healing of anal fistula.@*Methods@#A retrospective case-control study was conducted to analyze the clinical data of 207 patients with transsphincteric anal fistulas who received anal fistula plug procedure at the Department of General Surgery, Beijing Chaoyang Hospital of Capital Medical University from August 2008 to September 2012. Inclusion criteria: (1) consistent with the diagnosis of transsphincteric anal fistula: the anal fistula passed through the internal and external sphincter; (2) complete data; (3) initial treatment with anal fistula plug procedure. Exclusion criteria: (1) acute rectal or perianal infection or poorly controlled focal infection; (2) recent incision and drainage of perianal abscess or spontaneous rupture of abscess; (3) patients with malignant tumor; (4) patients with Crohn′s disease or ulcerative colitis; (5) patients with heart, liver, brain, lung or renal insufficiency; (6) cachexia due to various chronic wasting diseases; (7) patients could not tolerate surgery. Patients were followed up for anal fistula healing. The cumulative healing rate of patients with transsphincteric anal fistula was plotted using the Kaplan-Meier method, and the factors affecting anal fistula healing were explored by univariate and multivariate logistic regression analysis.@*Results@#There were 186 males and 21 females with age of 15 to 69 (mean 38) years. The duration of anal fistula was 3-60 (mean 15) months. Three patients had a history of previous episodes of perianal abscess and underwent incision and drainage of perianal abscess (all more than 3 months). During follow-up ending on October 31, 2018, 72 patients (34.8%) were lost to follow-up. Among 135 patients who were successfully followed up, the average follow-up period was 96 (75-124) months. Seventy-five patients had anal fistula healing, with healing rate of 55.6%. Kaplan-Meier survival curve showed that the healing time of anal fistula was prolonged and finally stabilized at 55.6%. In the patients who failed initial treatment with anal fistula plug packing, there were 6 cases whose anal fistula healed spontaneously without other treatment. Among them, 3 cases healed spontaneously 2 years and 3 cases 3 years after operation without recurrence. From 2008 to 2012, the annual healing rates of anal fistula plug treatment were 3/6, 61.5% (24/39), 42.1% (24/57), 12/15 and 12/18, respectively. Multivariate logistic regression analysis showed that the duration of anal fistula≥6 months (OR=3.187, 95% CI: 1.361-7.466, P=0.008) was an independent risk factor for anal fistula healing after treatment with anal fistula plug.@*Conclusion@#The long-term efficacy of anal fistula plug procedure in the treatment of transsphincteric anal fistula is positive, and this procedure should be implemented as soon as possible.

Comparison between KeyPort access and traditional transanal endoscopic microsurgery in the treatment of rectal tumors / 中华普通外科杂志

Objective:To compare the efficacy and safety of KeyPort access and traditional transanal endoscopic microsurgery(TEM) in the treatment of rectal tumors.Methods:In this study, 36 cases of rectal tumors were treated by KeyPort TEM access and 52 cases by traditional TEM. Tumor type, size, distance from anal edge, operation time, intraoperative blood loss, postoperative hospitalization time, specimen quality and complications were compared between the two groups.Results:There were no significant differences in tumor type, size, operation time, intraoperative blood loss, postoperative hospitalization time, complications, recurrence and metastasis rate between the two groups. The distance between lower cutting edge to the anus in KeyPort access group was significantly greater than that of traditional TEM group[(6.7±1.9) vs. (5.1±1.8) cm , t=3.901, P<0.001]. All the surgeries in the KeyPort access group were completed. While two cases of in traditional TEM group were coverted to other surgical approaches. All patients in the KeyPort group had normal anal function in the early postoperative period, while 2 patients in the traditional TEM group suffered anal function impairment. Conclusion:TEM by KeyPort access is safer and more effective then traditional TEM, as well as more generous indications.

The changes of peripheral blood T lymphocyte subsets predict the effect of neoadjuvant chemoradiotherapy in rectal cancer / 中华普通外科杂志

Objective:To explore the effect of peripheral blood T lymphocyte subsets on locally advanced rectal cancer after neoadjuvant chemoradiotherapy.Methods:108 patients were included at the Department of General Surgery of Beijing Chaoyang Hospital from Jun 2016 to Jun 2017. Peripheral blood was collected within one week before neoadjuvant therapy and one week before rectal surgery. Flow cytometry was applied to detect the CD3 + 、CD4 + 、CD8 + 、CD45RA + 、CD45RO + expression. Receiver operating characteristic (ROC) curve analysis was performed to determine the best cut-off value of the ratio of lymphocytes. A logistic regression model was obtained in multivariate analysis. Results:The values of CD3 + , CD4 + and CD8 + T lymphocytes in peripheral blood of the patients decreased compared with that before neoadjuvant treatment (all P<0.05). There was no significant decrease in the proportion of CD4 + , CD8 + , CD45RA + T and CD45RO + lymphocytes in patients′ peripheral blood (all P>0.05). The CD45RO in peripheral blood decreases during neoadjuvant therapy for locally advanced rectal cancer, and it is associated with better tumor regression( P<0.05). The best cut-off value for the ratio changes of CD45RO was 1.07. The ratio changes of CD45RO were the only significant factor for tumor regression in multivariate analysis ( P=0.005, OR=26.867, 95% CI: 1.530-471.635). Conclusion:The percentage of peripheral blood CD45RO may predict the sensitivity of neoadjuvant therapy in rectal cancer patients.

Application of KeyPort access to transanal endoscopic mircrosurgery / 中华胃肠外科杂志

Objective@#To explore the effectiveness of KeyPort access in transanal endoscopic mircrosurgery (TEM).@*Methods@#A descriptive case series study was performed. Clinicopathological data of 20 patients undergoing KeyPort access TEM in Beijing Chaoyang Hospital of Capital Medical University from December 2016 to April 2018 were collected and analyzed retrospectively. Procedure of KeyPort access TEM: general anesthesia or combined spinal epidural anesthesia (CSEA); lithotomy or prone jack-knife position; anal dilation; placement of the KeyPortaccess; connection of TEM pneumoperitoneum device, light source and imaging equipment; placement of 5 mm dedicated endoscope; insufflation of CO2 with pressure of 1.6-2.0 kPa (12-15 mmHg); after rinsing the intestinal lumen, circular resection marginlabeled by the needle-shaped electrocautery;electric coagulation or ultrasonic knife used to perform a full-thickness resection with a 0.5 cm-1 cm margin along the marking line. Indications of KeyPort access TEM: (1) benign large sessile polyps which were difficult to resect under colonoscopy; (2) submucosal lesions with diameter <2 cm; (3) Tis and T1 stage rectal carcinoma without lymph node metastasis; (4) palliative resection of T2 stage rectal carcinoma without lymph node metastasis. Contraindications: (1) accompanying serious diseases without the tolerance of anesthesia and operation; (2) distance from lesion to anal verge >20 cm.@*Results@#There were 10 males and 10 females with age of (63±15) years old and BMI of (24.5±3.3) kg/m2. The diameter of the lesions was (2.0±1.3) cm, and the distance from lesion to anal verge was (6.2±2.2) cm. One patient had 3 lesions at different positions in rectum with diameters of 0.5 cm, 0.5 cm, and 1 cm, respectively. All operations were accomplished through the KeyPort access TEM and no case was transferred to other methods. The duration of surgery was 75 (30-220) minutes; intraoperative blood loss was 10 (0-30) ml. Two patients with rectal anterior wall lesions underwent full-thickness resection of the intestine wall reaching the peritoneal reflex with penetration into the peritonealcavity, and received suture closure immediately. For the patient with 3 rectal lesions, the 1.0 cm lesion received a full-thickness resection and the other 2 lesions received submucosal resection. No postoperative complication occurred. Postoperative pathology showed that there were 1 case of chronic inflammatory lesion, 4 cases of benign tumor, 3 cases of carcinoma in situ, 4 cases of neuroendocrine tumor, 6 cases of pT1 rectal cancer, 2 cases of pT2 rectal cancer (both invading the superficial muscle layer). The median hospital stay was 6 (3-7) days. The postoperative follow-up was (7.2±3.8) months. No postoperative complication or recurrence was observed.@*Conclusion@#TEM with KeyPort access is safe, rapid and effective in the treatment of rectal tumors.

The clinical analysis of conjoint fascial sheath suspension on the treatment of severe blepharoptosis after levator muscle resection / 中华整形外科杂志

Objective@#To evaluate the safety and efficacy of Conjoint Fascial Sheath (CFS) suspension in the treatment of severe blepharoptosis, after levator muscle resection.@*Methods@#In total of 336 patients with severe blepharoptosis after levator muscle resection, received CFS suspension from December 2010 to December 2016 in Beijing Lomeye Cosmetic Surgery Clinic. They were followed up for 12—60 months.The margin reflex distance, curve of upper eyelid, appearance and complications were recorded preoperatively and postoperatively. The outcome was evaluated based on function, aesthetics and complication.@*Result@#Functional satisfaction assessment: In the 495 eyes of 336 patients, 426 eyes (86.1%) were completely corrected, 65 eyes (9.1%) were improved, while 4 eyes (0.8%) had no improvement. One patients had conjunctival edema, recovered after conservative treatment. There was no serious complication.@*Conclusions@#CFS suspension is an effective method for severe blepharoptosis after levator muscle resection, with advantages of repeatability and feasibility, less trauma and predictable outcome.

Preliminary report on prospective, multicenter, open research of selective surgery after expandable stent combined with neoadjuvant chemotherapy in the treatment of obstructive left hemicolon cancer / 中华胃肠外科杂志

OBJECTIVE@#To evaluate the safety and feasibility of neoadjuvant chemotherapy prior elective surgery following self-expanding metallic stents (SEMS) for complete obstructive left hemicolon cancer.@*METHODS@#This prospective, multicenter, open-labelled trial was approved by the Ethics Committee of Beijing Chaoyang Hospital, Capital Medical University(2016-ke-161-1) and registered in Clinicaltrials.gov (NCT02972541).@*INCLUSION CRITERIA@#(1)age between 18 and 75 years old;(2) adenocarcinoma confirmed by pathology;(3) left hemicolon cancer confirmed by clinical manifestations and imaging examinations with the distance to anal verge > 15 cm; (4) resectable cancer evaluated by imaging examination without distant metastasis; (5) Eastern Cooperative Oncology Group (ECOG) score ≤ 1 or Karnofsky Performance Scale (KPS) > 70, indicating tolerance of neoadjuvant chemotherapy and operation; (6) absence of chemotherapy or radiotherapy within past six months; (7) bone marrow system and hepatorenal function: hemoglobin ≥ 90 g/L, neutrophil ≥ 1.5×10/L, platelet ≥ 80×10/L, total bilirubin ≤ 1.5×ULN(upper limits of normal), serum transaminase ≤ 2.5×ULN, serum creatinine ≤ 1.0×ULN, endogenous creatinine clearance rate > 50 ml/min; (8) sign for informed consent.@*EXCLUSION CRITERIA@#(1) multiple primary colorectal cancer; (2) rejection of operation;(3) presenting peritonitis or bowel perforation before SEMS; (4) unqualified conditions proved by inspector from registration data. According to inclusion criteria, 62 consecutive patients receiving neoadjuvant chemotherapy prior to elective surgery following SEMS for complete obstructive left hemicolon cancer from Beijing Chaoyang Hospital of Capital Medical University (n=31), Qilu Hospital of Shandong University (n=14), the Third Xiangya Hospital of Central South University (n=13), Zhongnan Hospital of Wuhan University (n=2), the Fourth Hospital of Hebei Medical University (n=2) between December 2015 and December 2017 were prospectively enrolled in this study. Patients were divided into neoadjuvant chemotherapy group and elective surgery group according to the investigator's clinical experience and patient's preference. Patients in the elective surgery group received surgery within one to two weeks after SEMS placement without neoadjuvant chemotherapy. Those in the neoadjuvant chemotherapy group received 2 cycles of CapeOX or 3 cycles of mFOLFOX6 neoadjuvant chemotherapy within one to two weeks after SEMS placement, and then underwent surgery within 3 weeks after finishing neoadjuvant chemotherapy. Data between groups were compared using Student t-test, chi-square analysis or Fisher exact test analysis, including basic clinical informations, operational conditions and postoperative complications. The adverse reactions during the neoadjuvant chemotherapy were recorded. Surgical difficulty was assessed using visual analog scales ranging from 1 to 10, where 1 represented the lowest and 10 the highest degree of surgical difficulty, as judged by the surgeon.@*RESULTS@#The study included 38 males and 24 females with mean age of (64.8±8.8) years. The clinical baseline data between 2 groups were not significantly different (all P>0.05) except the average time interval between SEMS and surgery was significantly longer in neoadjuvant chemotherapy group [(61.6±13.5) days vs. (10.4±5.2) days, t=16.679, P0.05).@*CONCLUSION@#Neoadjuvant chemotherapy prior elective surgery following SEMS is a relatively safe and feasible approach in the treatment for obstructive left hemicolon cancer, and is associated with less stoma, more laparoscopic surgery, shorter operative time, less blood loss, lower surgical difficulty, and faster postoperative recovery as compared with conventional elective surgery.

Application of modified purse-string closure in the wound following loop stoma reversal / 中华胃肠外科杂志

OBJECTIVE@#To compare the safety and feasibility between modified circumferential purse-string closure and conventional primary linear closure of the wound following loop stoma reversal.@*METHODS@#Clinical data of 88 consecutive patients who underwent loop colostomy or loop ileostomy closures at our hospital from July 2011 to June 2013 were retrospectively analyzed. Among them, 43 cases underwent modified purse-string technique (modified purse-string group), 45 cases underwent direct suture (direct suture group). The operation method of modified purse-string suture was as follows: (1) the circumferential subcutaneous adipose tissue was sutured with the absorbable suture, avoiding tightening at knotting and retaining a 1 cm pore;(2)absorbable suture was used to perform purse-string suture of the dermis, retaining a 0.5 cm central pore when knotting; (3) a rubber drain was placed through the pore. The clinical parameters, surgical results and postoperative complication of two groups were recorded and compared.@*RESULTS@#There were 56 males and 32 females with age of (65.0±11.5) years old. Seventy-nine cases were malignant tumors, 6 were benign tumors and 3 were traumatic. There was no significant difference in the baseline data between two groups (all P>0.05). Compared with the direct suture group, the modified purse-string group had significantly lower wound infection rate [7.0%(3/43) vs. 24.4%(11/45), χ²=5.015, P=0.025]; significantly shorter postoperative hospital stay (mean 7.1 days vs. 8.6 days, t=-2.656, P=0.010); significantly lower total hospitalization costs (mean 25 668.4 yuan vs. 27 718.1 yuan, t=-2.488, P=0.015); however, the wound healing time of the modified purse-string group was significantly longer (mean 22.0 days vs. 13.0 days, t=5.701, P<0.001). The average healing time of the wounds in the direct suture group was 29.8 days, which was significantly longer than that of the first-stage healing cases (7.5 days, t=-15.446,P<0.001). The average wound healing time of the infected cases in the modified purse-string suture group was 22.0 days, compared with 22.1 days in the first-stage healing cases, the difference was not statistically significant(t=0.077,P=0.943).@*CONCLUSIONS@#Modified purse-string closure after loop stoma reversal is an appropriate technique with lower stoma site infection rate, shorter postoperative hospital stay and lower hospitalization cost than conventional primary closure, although wounds may take longer to heal in this approach.

The clinical analysis of conjoint fascial sheath suspension on the treatment of pediatric congenital moderate-severe ptosis / 中华整形外科杂志

Objective@#To investigate the functional and cosmetic outcomes of conjoint fascial sheath(CFS) suspension surgery in pediatric congenital ptosis.@*Methods@#Forty-four moderate to severe ptosis patients(58 eyes) underwent CFS suspension surgery from December 2013 ot December 2014. With 12 to 36 months follow-up, the levator function, margin reflx distance, curve of upper eyelid, appearance and complications were recorded and analyzed, to evaluate the effect based on functionality, aesthetics and complication.@*Results@#①Functional assessment: in the 58 eyes of 44 cases, the satisfactory rate was 91.4%(53 eyes), 2 eyes(3.45%)were under—corrected, 3 eyes(5.17%) were over corrected. The mean preoperatively LF was 2.5 mm, which was increased postoperatively to 6.1 mm at the final visit.The average marginal reflex distance (MRD) was 0.1 mm preoperatively. After at least one year, average MRD was 3.8 mm (P<0.05). ②Cosmetic satisfaction assessment: According to satisfaction surveys, the rate of excellence and good was 88.64%, 6.81% fair, and 4.54% poor. ③Complications: the most common complication was reoperation, which was performed in 2 eyelids (3.45 %) because of incomplete correction and 3 eyes(5.17%) over corrected. Only one case of cornea exposure which recovered after conservative treatment.@*Conclusions@#CFS suspension was an effective treatment for moderate-severe congenital ptosis, showing good long term result.

Study on expression profile of long non-coding RNA in colorectal carcinoma / 肿瘤研究与临床

Objective To analyze the differentially expressed long non-cording RNA (lncRNA) in human colon carcinoma tissue and paracancerous normal colon tissue. Methods Total RNA from the colon carcinoma tissues and paracancerous normal colon tissues of 6 patients from July to August 2015 in Beijing Chao-Yang Hospital, Capital Medical University were prepared respectively. The mRNA of total RNA was amplified, labeled and purified. Hybridization was performed with the profile chip, and the data were normalized and analyzed. Results Compared with normal tissues, 1 339 lncRNAs expressed differentially (P < 0.05), 53 lncRNAs were significantly differential (fold change > 2) in colon carcinoma tissues, in which 41 lncRNAs were up-regulation and 12 lncRNAs were down-regulation.Three lncRNAs had more than 3 times changes. Conclusion Obvious changes of lncRNA expression profile are observed in the pathogenesis of colon carcinoma,suggesting that lncRNA may be related to the progress of colon carcinoma.

Therapeutic evaluation and surgical strategy after neoadjuvant chemoradiotherapy for rectal cancer / 中华胃肠外科杂志

Neoadjuvant chemoradiotherapy for rectal cancer could significantly reduce the tumor stage, improve the radical resection and increase the overall survival rate of the patients. Recently researches reported that patients who acquired complete response after neoadjuvant chemoradiotherapy might accept "wait and see" strategy or local excision and could earn promising long-term outcomes as those accepted radical surgery. The diagnostic criteria and efficacy of tumor response for chemoradiotherapy are insufficient and controversial. Moreover, clinical practice showed that chemoradiotherapy-related surgical complications, including anastomotic leakage, incision complications and colon stricture, remarkably increased, so the benefits and risks of patients should be reconsidered further in choosing the surgical strategies after neoadjuvant chemoradiotherapy.

Abdominal cocoon: A roport of 5 cases / 中华普通外科杂志

Objective To explore the clinical characteristics and treatment of abdominal cocoon.Methods Clinical data of 5 cases with abdominal cocoon in our hospital from October 2015 to February 2017 were analyzed.Results 5 patients with abdominal cocoon were recruited,including 3 males and 2 females.Of the 5 patients,one with gastric cancer,1 with colon cancer,2 with rectal cancer and 1 with cryptorchidism.All the patients have no symptoms of intestinal obstruction.Laparotomy revealed that all or part of small intestine had been wrapped in a layer of tough fibrous membrane.Excision of primary lesion without lysis of adhesions were done.No symptoms of intestinal obstruction and intestinal fistula occurred after operation.Conclusions The preoperative diagnosis of abdominal cocoon is difficult.It is often inadvertently found in the operation,asymptomatic patients,do not need treatment.

Application value of biological mesh in the pelvic floor reconstruction of extralevator abdominoperineal excision for advanced low rectal cancer / 中华消化外科杂志

Objective To investigate the application value of biological mesh in the pelvic floor reconstruction of extralevator abdominoperineal excision (ELAPE) for advanced low rectal cancer (RC).Methods The retrospective cohort study was conducted.The clinicopathological data of 228 patients with advanced low RC who underwent ELAPE in the Beijing Chaoyang Hospital of Capital Medical University between August 2008 and December 2016 were collected.Of 228 patients,174 using biological mesh closure and 54 using primary closure were respectively allocated into the biological mesh group and primary closure group.Observation indicators:(1)intra-and post-operative situations;(2) postoperative complications (including short-term and long-term complications);(3) follow-up and survival situations.Follow-up using outpatient examination and telephone interview was performed to detect postoperative long-term complications,tumor recurrence or metastasis and overall survival up to December,2017.Measurement data with normal distribution were represented as（ x） ±s,and comparison between groups was analyzed using the independent-sample t test.Measurement data with skewed distribution were described as M (range),and comparison between groups was analyzed using the nonparametric test.Comparisons of count data were evaluated by the chi-square test or Fisher exact probability.Results (1)Intra-and post-operative situations:all the patients underwent successful ELAPE.The perineal operation time,time of indwelling perineal drainage-tube and hospital expenses were respectively (60 ± 50)minutes,(11.6 ± 2.4) days,(57 781± 11 337) yuan in the biological mesh group and (50±21) minutes,(8.9± 1.7) days,(53 714± 13 395)yuan in the primary closure group,with statistically significant differences between groups (t =3.327,7.691,-2.203,P＜0.05).The total operation time and duration of postoperative hospital stay were respectively (242±53) minutes,(13.0±5.0) days in the biological mesh group and (228±51) minutes,(12.0±5.0) days in the primary closure group,with no statistically significant difference between groups (t =1.701,1.309,P＞0.05).(2) Postoperative complications:26 and 19 patients in the biological mesh group and primary closure group had respectively perineal wound complications (1 patient combined with multiple complications),showing a statistically significant difference between groups (x2 =10.660,P＜0.05).The perineal wound infection,perineal hernia and disruption of perineal wound were respectively detected in 20,6,1 patients in the biological mesh group and 12,7,3 patients in the primary closure group,showing statistically significant differences between groups (x2 =3.931,5.282,P＜0.05).(3) Follow-up and survival situations:174 patients in the biological mesh group were followed up for 64 months (range,13-112 months),and 54 patients in the primary closure group were followed up for 51 months (range,23-76 months).The local recurrence rate,distal metastasis rate and overall survival rate were respectively 5.17％ (9/174),20.11％ (35/174),77.59％ (135/174) in the biological mesh group and 7.41％(4/54),24.07％(13/54),79.63％(43/54) in the primary closure group,with no statistically significant difference between groups (x2 =0.080,0.389,0.101,P＞0.05).Conclusions The biological mesh in the pelvic floor reconstruction of ELAPE for advanced low RC is safe and feasible.Compared with primary closure,biological mesh closure will extend perineal operation time and time of indwelling perineal drainage-tube,and increase hospital expenses,but doesn't affect total operation time and duration of postoperative hospital stay,meanwhile,it can also reduce the overall perineal wound complications,especially in perineal wound infection,perineal hernia and disruption of perineal wound.

Domestic external fixator application in the treatment of limb deformities: 7 289 cases application report / 中华外科杂志

Objective@#To discuss the clinical application and effects of domestic external fixator in the treatment of patients with malformations of limbs.@*Methods@#A total of 7 289 patients with malformation of limbs who had been operated in Qin Sihe orthopedic surgery team from January 1989 to June 2016 were retrospective analyzed. The patients were treated with domestic external fixator, including 4 033 males and 3 256 females, aging from 2 to 82 years with a mean age of 23.4 years. There were 2 732 patients using Ilizarov external fixator, 4 713 patients using hybrid external fixator, 57 patients using monobrachial external fixator, 232 patients using Ilizarov external fixator and hybrid external fixator. The Ilizarov, hybrid and monobrachial external fixator were used in 67, 65 and 0 patients on the upper limbs and in 2 665, 4 616 and 57 patients on the lower limbs. There were 3 028 patients operated on the left limbs, 3 260 patients operated on the right limbs and 1 001 patients operated on the bilateral limbs. The top three types of diseases were sequelae of poliomyelitis, cerebral palsy and post-traumatic stress disorder peromely. Deformity types inclued talipes equinovarus, knee flexion deformity, cavus foot and so on.@*Results@#All the patients were followed up for a period of 2.5 months to 22.4 years, with an average follow-up time of 5.4 years. All of the external fixators were used for single once, and there was no substitute for external fixator quality problem. All the patients were completed surgery goal until removing external fixation except 1 patient gave up treatment and 1 removed the fixator because of metal allergy. The common complications included wire or pin infection and joint movement limitation and so on.@*Conclusions@#The domestic external fixator developed and produced based on the characteristics of Chinese limb deformity disability. The domestic external fixator can be used to treat kinds of limb deformities with the advantages of practical, economical, adjustable, universal and portable. The domestic external fixator could meet the clinical demand for fixation of the osteotomy end of the limbs, the correction of the deformity, the repair of the defects and the limb lengthening.

Surgical repair of bad eye state caused by double eyelids line scars / 中华整形外科杂志

Objective@#In order to explore the method to correct double eyelids line scars and to present its therapeutic schedule, curative effects, pathogenesis and precautions.@*Methods@#Surgical incisions were designed based on preoperative communication, original scars location and skin elasticity. Scar contracture and synechia was relaxed thoroughly. The pretarsal orbicularis oculi muscle of the lower incision margin was fixed to the pretarsal fascia on the new designer location of double eyelid line to firm shape. Complete pretarsal layer tissue were joined layer by layer with interrupted suture. Finally, the skin was sutured closely by locking stitch technique.@*Results@#From November 2014 to September 2016, 583 eyes with unsatisfied double eyelid scars were treated. Patients were followed up for 3 months to 1 year with sustained aesthetic. There is no visible man-made crease in 549 eyes under eye-closed state. Less than 1 mm wide scars with smooth surface were showed on 19 eyelids. Mild depressed or more than 1 mm wide scars still remained in 15 eyes with improved appearance.@*Conclusions@#Unsatisfied appearance caused by double eyelids line scars must be paid highly attention in clinical setting. The appearance can be effectively improved by proper surgical procedures and appropriate suture and fixation.

Laparoscopy combined with transperineal extralevator abdominoperineal excision for locally advanced low rectal cancer / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To evaluate the laparoscopy combined with transperineal extralevator abdominoperineal excision (TP-ELAPE) for locally advanced low rectal caner.</p><p><b>METHODS</b>Clinical data of 12 patients with locally advanced low rectal cancer undergoing laparoscopy combined with TP-ELAPE in our department from May 2013 to March 2015 were retrospectively analyzed. There were 8 male and 4 female patients with median aged of 63 (46 to 72) years. The median distance from tumor lower margin to anal verge was 3.5(2.0 to 4.0) cm. A self-made transanal suit for minimally invasive operation was used to make a sealed lacuna outside the sphincter, thus laparoscope can be applied to perform transperineal operation.</p><p><b>RESULTS</b>All the patients underwent operations successfully without conversion to open abdominal operation. The median operating time was 206 (180 to 280) minutes with perineal operating time 95(80 to 120) minutes. The median intraoperative blood loss was 120(50 to 200) ml. The median postoperative hospital stay was 12(9 to 18 ) days. Postoperative pathology revealed that all circumferential margins (CRM) were negative. The area of sample horizontal section was (2 824±463) mm(2), and of outer muscularis propria was(2 190±476) mm(2). Postoperative complications included chronic sacrococcygeal region pain in 2 cases, urinary retention in 3 cases, perineal wound infection in 1 case. No perineal seroma, perineal hernia, wound dehiscence and sinus tract formation were observed. Among 8 patients with preoperative normal sexual function, sexual dysfunction occurred in 2 patients. There was no local recurrence and metastasis during a median follow-up of 21(12 to 34) months.</p><p><b>CONCLUSION</b>Laparoscopy combined with TP-ELAPE has the potential to simplify the operation procedure for low rectal cancer, can ensure the radical treatment and safety of operation, and may be carried out in experienced centers.</p>

Effect of perioperative Ambroxol combined with Ipratropium on lung cancer patients aged 70 years and over undergoing thoracoscopic surgery / 中华老年医学杂志

Objective To evaluate the effect of perioperative administration of Ambroxol combined with Ipratropium on elderly lung cancer patients undergoing thoracoscopic surgery.Methods 82 lung cancer patients aged ≥70 years who were scheduled for thoracoscopic lung resection were randomly assigned into 2 groups:the observation group(n=42) and the control group(n=40).Patients in the observation group were treated with 90 mg Ambroxol(mucosolvan) by intravenous drip and Ipratropium(atrovent) by atomizing inhalation,while patients in the control group were treated with an equal volume of 0.9％ sodium chloride solution.Pulmonary function and changes of arterial blood gases at admission,before surgery and 5 days after surgery,incidences of postoperative atelectasis and pulmonary infection,the rate of return to the intensive care unit(ICU),and the length of postoperative hospital stay were compared between the 2 groups.Results Compared with the control group,the percent predicted forced expiratory volume in 1 second (FEV1％),the ratio of forced expiratory volume in 1 second to forced vital capacity(FEV1/FVC％),the percent predicted maximum ventilation volume per minute (MVV％),and the arterial oxygen pressure (PaO2) were increased in the observation group before surgery [(87.0±8.2)％ vs.(80.6±7.6) ％,(90.4±6.4)％ vs.(81.4±7.0)％,(87.1±5.6)％ vs.(74.6±6.9) ％,(86.6±6.2) mmHg vs.(81.7±6.9)mmHg,t=2.477,2.588,2.937,3.405,respectively,allP＜0.05].TheFEV1％,FEV1/FVC％,MVV％ and PaO2 were higher in the observation group than in the control group 5 days after treatment [(76.4±9.2) ％ vs.(67.3±10.2) ％,(74.7±9.1) ％ vs.(63.0±11.2) ％,(69.5±9.2)％ vs.(60.1±9.2) ％,(79.5±11.5) mmHg vs.(70.1±11.8) mmHg,t 2.583,2.987,2.778,2.666,respectively,all P＜0.05].The incidences of postoperative atelectasis,pulmonary infection and the length of postoperative hospital stay were lower or less in the observation group than in the controlgroup[7.1％ vs.25.0％,11.90％ vs.32.50％,(8.5±1.8) days vs.(12.1±2.6) days,x2=4.897,5.072,2.351,respectively,all P＜0.05].No significant difference in the rate of return to ICU was found between the two groups(P＞0.05).Conclusions The combination of perioperative Ambroxol and Ipratropium can effectively improve lung function by improving ventilation and gas exchange function,reduce postoperative pulmonary complications and shorten the length of postoperative hospital stay in lung cancer patients aged 70 years and over.

Left transthoracic small incisions in combination with tubular gastrectomy for radical esophageal cancer surgery in elderly patients / 中华老年医学杂志

Objective To investigate the application of left transthoracic small incisions in combination with tubular gastrectomy for radical esophageal cancer surgery in elderly patients.Methods Clinical data of 83 patients with carcinoma in the middle or lower third of the esophagus aged ≥ 70 years who had undergone radical surgery at our hospital from January 2012 to September 2014 were collected.Patients were divided into two groups:the tubular gastrectomy group (n=38) which had undergone radical surgery through left transthoracic small incisions in combination with tubular gastrectomy and the stomach group (n =45) which had been treated with esophagectomy through conventional left posterolateral incisions and esophageal reconstruction with the remnant stomach.Clinical outcomes were compared between the two groups.Results Compared with the stomach group,operative blood loss [(204.3±75.4) ml vs.(258.4±80.2) ml,t=2.720,P＜0.05],chest drainage on the first and second postoperative day [(201.7±82.6) ml vs.(320.5±78.1) ml,(150.8±83.0) ml vs.(244.6 ± 81.2) ml,t =3.221 and 3.189,respectively,each P＜0.05],pain scores on the third postoperative day [(3.73 ± 1.02) vs.(0.24 ± 1.15),t =2.858,P ＜ 0.05],incidence of arrhythmia (13.2％ vs.33.3％,x2 =4.585,P＜0.05),pulmonary complications (18.4％ vs.46.7％,x2=7.353,P＜0.05) and incidences of gastroesophageal reflux and gastric emptying disorders (23.7％ vs.55.6％,0.0％ vs 11.1％,x2 =8.654 and 4.493,both P＜0.05) were less or lower in the tubular gastrectomy group.The two groups had no significant difference in operation time,length of hospital stay,anastomotic leakage,anastomotic stenosis or 1-year survival rate (each P ＞0.05).Conclusions Radical surgery with small incisions through the left chest combined with tubular gastrectomy shows highly favorable clinical outcomes in elderly patients with middle or lower esophageal cancer,and can significantly reduce surgical trauma,decrease postoperative complications,improve the quality of life,and help patients recover after surgery.

Clinical safety and efficacy of shortened period of clopidogrel treatment after BuMA stent ;implantation in elderly coronary heart disease patients over 75 years old / 中国介入心脏病学杂志

Objective To evaluate the clinical efficacy and safety of domestic BuMA biodegradable drug eluting coronary stent in elderly coronary heart disease patients over 75 years old with shortened duration of clopidogrel treatment. Methods 100 elderly patients who received coronary angiography and PCI were included, and they were randomly divided into the observation group ( n=50, received oral clopidogrel for 9 months) and the control group (n=50, received oral clopidogrel for 12 months). The occurance of angina pectoris, AMI, bleeding events and the results of control angiography were compared between the two groups after 12 months of follow-up. Results All the 100 patients were followed up in 12 months after discharge. 4 patients ( 8. 0%) in the observation group and 3 patients ( 6. 0%) in the control group had recurrent angina. Control coronary angiography 12 months later showed no restenosis in the stents. There was no significant difference between the two groups in the recurrence of angina pectoris and coronary stent restenonsis. No acute myocardial infarction,cliniacl bleeding events and late stent thrombosis occurred in the two groups. Conclusions The application of the domestic BuMA biodegradable drug eluting stent for the treatment of coronary heart disease patients over 75 years old is safe and effective with shortened duration of clopidogel treatment.