Analysis of surgical complications after laparoscopic duodenum-preserving pancreatic head resection for noncancerous lesions / 中华普通外科杂志

Objective:To analyze the common complications of laparoscopic duodenum- preserving pancreatic head resection(LDPPHR).Methods:The clinical data of 32 patients undergoing LDPPHR from Jun 2018 to Jun 2021 in Cangzhou Central Hospital were analyzed retrospectively.Results:LDPPHR was successfully performed in all 32 patients without conversion to open surgery. The incidence of postoperative complications was 21.9% (7/32), 3 cases suffering from sever complications (1 case of long-term postoperative pancreatic fistula, 1 case of obstructive jaundice caused by duodenal papilla stenosis, 1 case of postoperative abdominal bleeding) were cured by laparotomy; 4 cases of minor complications were simple pancreatic fistula, which were cured by prolonging dranage.Conclusions:LDPPHR is technically feasible for isolated noncancerous lesions within pancreatic head and uncinate process,the complications were manageable.Its suggested benefits remain to be established by long term follow-up.

The clinical analysis of Menetrier disease / 中华普通外科杂志

Objective To investigate the clinical features of Menetrier disease and the related treatment progresses.Methods The clinical data of 7 patients with Menetrier disease who were admitted to Cangzhou Central Hospital from Jan 1997 to Mar 2018 were retrospectively analyzed.Results There were 3 males and 4 females.The main clinical manifestations were abdominal pain (n =5),loss of appetite (n =4),nausea and vomiting (n =2),weight loss (n =4),edema (n =3),hypoalbuminemia (n =6) and anemia (n =6).All patients had typical imaging findings.Two of the patients underwent non-surgical treatmen with temporary symptom reliefs.Finally,6 patients received surgical treatment including Subtotal gastrectomy in 1 patient,total gastrectomy in 5 patients.All the 6 cases underwent surgery successfully with no serious complications.5 cases were followed-up data until April 2018.All were in good condition,Hemoglobin and albumin levels were within the normal range.Conclusion According to the clinical manifestations and the related auxiliary examinations,this disease is easy to diagnose.Surgical treatment is the only way to cure Menetrier disease.

A case matched study on laparoscopic versus open radical resection for Bismuth-type Ⅲb hilar cholangiocarcinoma / 中华普通外科杂志

Objective To explore the safety and feasibility of laparoscopic radical resection of Bismuth-type Ⅲb hilar cholangiocarcinoma.Methods The clinical data of 109 patients with Bismuth-type Ⅲ b hilar cholangiocarcinoma in the Department of General Surgery of Cangzhou Central Hospital from Jan 2015 to Feb 2018 were retrospectively analyzed.Among those 17 patients undergoing total laparoscopic surgery were compared with 17 open cases.Results There were significant differences between the laparoscopic group and the control group in operation time [(420.8 ± 136.5) min vs (292.3 ± 65.6) min],total length of incision [(8.2 ± 4.7) cm vs (20.4 ± 5.8) cm],incidence of postoperative complications [29.4％ (5/17) vs 52.9％ (9/17)],postoperative feeding time,postoperative ICU stay and postoperative hospital stay (P ＜ 0.05).There were no significant difference in the amount of bleeding[(325.2 ± 98.7)ml vs(367.4 ±72.9)ml],pathological results,number of lymph node dissection,R0 resection rate and tumor recurrence rate (P ＞ 0.05).Conclusion Total laparoscopic radical resection of Bismuth-type Ⅲ b hilar cholangiocarcinoma is safe,feasible,and has the advantages of minimal invasion and rapid recovery.

Short-term result of laparoscopic pancreaticoduodenectomy / 中华普通外科杂志

Objective To compare the short-term efficacy of laparoscopic pancreaticoduodenectomy (LPD) with open pancreatoduodenectomy (OPD).Methods The clinical data of 122 LPD patients and 167 OPD patients at our department from 2015 to 2017 were analyzed retrospectively.Results There was no significant difference in demographic,ASA classification,preoperative liver function between the two groups (P ＞0.05).The operative time was (405 ± 109) min vs.(312 ±57) min,liquid diet intake time postoperatively was (5.4 ± 2.6) d vs.(7.9 ± 3.3) d,postoperative hospital stay was (10.4 ± 6.1) d vs.(14.5 ± 8.6) d,with all the difference statistically significant (P ＜ 0.05).Intraoperative blood loss was (290 ± 102) ml vs.(322 ± 75) ml,the number of lymph node dissection in malignant tumor cases was (14.7 ± 5.6) vs.(13.9 ± 7.3),R0 resection rate in malignant tumor cases was 97.9％ (96/98)vs.96.6％ (143/148),the incidence of postoperative complications was 39.3％ (48/122) vs.35.3％(59/167) (all P ＞0.05).All patients were followed up with a median time m group LPD and group OPD was 9 months and 11 months respectively,and the tumor free survival rate was 93.4％ (114/122) and 90.4％ (151/167) at 6 months (P ＞ 0.05).Conclusion LPD has the same safety and radical effect as the traditional OPD surgery,while of less trauma and quicker postoperative recovery.

Preparation and biological identification of monoclonal and functional antibody against human specific polypeptide FXYD6 / 重庆医学

Objective To study and prepare the monoclonal antibody library against human FXYD6 functional region,to screen the hybridoma cell lines secreting the monoclonal antibodies against intracellular or extracellular region of human FXYD6,and to identify the biological function of monoclonal antibody against extracellular domain.Methods FXYD6 functional region recombinant protein which did not contain the transmembrane region was prokaryotically expressed,purified,and FXYD6 recombinant protein was used to immunize BALB/c mice.Then splenocytes after immunization were fused with myeloma cells SP2/0.After several rounds of screening and cloning,the hybridomas which secreted the antibodies against the extracellular domain or the intracellular domain of human FXYD6 were established.The antibody specificity and subtype were identified with indirect ELISA,western blot and immunohistochemistry.The monoclonal antibodies against the extracellular domain which recognized the native conformation were screened with flow cytometry.The antibody against extracellular region was prepared with the ascites revulsion method and purified.The affinity constants were measured with indirect ELISA.The function of extracellular monoclonal antibody was detected by HepG2 cell line with high expression of FXYD6.Results The hybridoma cell library which secreted the monoclonal antibody against extracellular domain or the intracellular domain of human FXYD6 was successfully obtained,and extracellular region monoclonal antibodies with the functional blocking were prepared.Conclusion The prepared anti-human FXYD6 extracellular monoclonal antibodies could inhibit HepG2 cell proliferation.

Laparoscopic resection of primary extraperitoneal pelvic benign tumors / 中华普通外科杂志

Objective To investigate the surgical methods and techniques of total laparoscopic resection of primary extraperitoneal pelvic benign neoplasms.Methods The clinical data of 32 patients undergoing laparoscopic resection for primary extraperitoneal pelvic benign neoplasms in Cangzhou Central Hospital from March 2011 to June 2016 were retrospectively analyzed.Results All cases were successfully operated under total laparoscopic resection.The operation time was 95-240 min,with an average of(152 ± 37) min,the amount of blood loss was 30-100 ml,the average was (56 ± 14) ml.Postoperative pathological examination confirmed mature teratoma in 14 cases,lipoma in 6 cases,epidermoid cyst in 7 cases,dermoid cyst in 5 cases.Patients were discharged from hospital 5 to 8 days after surgery,with an average of (6.5 ± 0.7) days.All patients were followed up for 2 to 36 months with no tumor recurrence.Conclusion Laparoscopic surgery is a safe and effective method for primary extraperitoneal pelvic benign neoplasms.

Endovascular treatment for long segment occlusion of femoral-popliteal artery by using retrograde puncture path / 介入放射学杂志

Objective To assess the value of endovascular management in treating long segment occlusion of femoral-popliteal artery by using retrograde puncture path.Methods The clinical data of a total of 46 patients with long segment occlusion of femoral-popliteal artery,who were admitted to authors' hospital during the period from June 2009 to January 2017 to receive endovascular treatment,were retrospectively analyzed.The patients included 27 males and 19 females,with a mean age of (69±8) years old.Grade Ⅲ of Rutherford classification was seen in 32 patients,grade ⅣV in 8 patients,and grade V in 6 patients.On CT angiography,the mean length of occluded lesion was (17±5) cm.Results In 46 patients of this series,the technical success rate was 100％.The average time used for making the small skin incision and puncturing the artery was (5.2±2.3) min.A 4-F artery sheath was employed in 7 patients,endovascular management with no use of artery sheath was carried out in 39 patients.The guide wire smoothly passed through the occluded segment of femoral-popliteal artery and entered the proximal true lumen in 41 patients.Subintimal arterial flossing with antegrade-retregrade intervention (SAFARI) technique was adopted to establish guide wire working track in 5 patients.On the third postoperative day,the ankle brachial index (ABI) was (0.71±0.12),which was significantly different from preoperative (0.33±0.11),and the difference was statistically significant (t=12.483,P＜0.001).The overall incidence of operation-related complications was 23.9％ (11/46),the incidence of distal arterial puncture-related complications was 4.3％ (2/46).No death occurred in perioperative period.Forty-three patients (93.5％) were followed up for 3-24 months.CTA reexamination performed at 3,6 and 12 months after treatment showed that the primary patency rate of the stent were 91.3％ (4/46),78.3％ (10/46) and 58.7％(19/46) respectively,and the one-year limb salvage rate was 95.7％ (44/46).Conclusion For the treatment of long segment occlusion of femoral-popliteal artery,endovascular management by using retrograde puncture path is technically simple and clinically safe and effective,this technique has certain clinical application value.

The application of purse string suture and the end-to-side invagination pancreaticojejunostomy in pancreaticoduodenectomy / 中华胰腺病杂志

Objective To investigate the application of purse string suture and the end-to-side invagination pancreaticojejunostomy in pancreaticoduodenectomy (PD).Methods Clinical data of 175 cases who were admitted in Cangzhou Central Hospital and underwent pancreaticoduodenectomy because of malignant tumor from December 2012 to December 2016 were retrospectively analyzed.According to the texture of pancreas in the operation,the patients were divided into 2 groups.Purse string suture and the end-to-side invagination pancreaticojejunostomy was performed in study group.Duct-to-mucosa pancreaticojejunostomy was conducted in control group.The operation time,the time of pancreaticojejunostomy,the amount of intraoperative bleeding,the incidence of postoperative pancreatic fistula,postoperative recovery time of gastrointestinal function,the average length of hospital stay and the like were comparative analyzed between the two groups.Results There was no significant difference on gender,age,primary diagnosis,preoperative total serum bilirubin,alanine aminotransferase and serum albumin levels between the two groups.The pancreatic texture of the study group was softer than that of the control group,the pancreatic duct diameter in the study group was significantly smaller than that in the control group [(2.0 ± 0.9) mm vs (3.4 ± 1.3) mm],the time of pancreaticojejunostomy in the study group was significantly shorter than that in the control group [(13 ± 4) min vs (17-± 7) min],the incidence of postoperative pancreatic fistula in the study group was significantly lower than that in the control group(5.88％ vs 15.56％),and the differences were statistically significant (all P ＜0.05).There was no significant difference on mean operative time,mean blood loss,postoperative gastrointestinal recovery time and average hospital stay between the two groups.1 cases with postoperative abdominal bleeding occurred in the study group,and the bleeding was successfully stopped by secondary surgery.Conclusions Purse string suture and the end-to-side invagination pancreaticojejunostomy was simple,safe and effective,which had a advantage of reducing the time of pancreaticojejunostomy and the incidence of postoperative pancreatic fistula.

Analysis of prognostic factors for patients treated by radical resection of liver metastases from colorectal cancer / 临床肝胆病杂志

ObjectiveTo explore the prognostic factors for patients treated by radical resection of the liver metastases from colorectal cancer and to analyze the significance of these factors. MethodsThe clinical and pathological data concerning 182 patients with liver metastases from colorectal cancer, who were admitted to our hospital from January 2003 to March 2008, were retrospectively analyzed, and the relationship between clinicopathological factors and treatment outcome was analyzed. The survival rate was calculated by the Kaplan-Meier method; univariate prognostic analysis was performed using the log-rank test; multivariate prognostic analysis was performed using the Cox proportional hazards model. ResultsFollow-up visits were carried out in all patients, with a follow-up period ranging from 9 to 60 months. The 1-, 3-, and 5-year survival rates were 82.96%, 59.73%, and 40.11%, respectively. Univariate analysis revealed that the number, size, and distribution of metastatic tumors, preoperative serum carcino-embryonic antigen (CEA) concentration, complications, and postoperative auxiliary therapy were prognostic factors for patients treated by radical resection of the liver metastases from colorectal cancer (χ2=4598、4653、5327、4768、5502、4546, all P＜0.05). Multivariate analysis confirmed that the number of liver metastases, preoperative serum CEA concentration, and postoperative complications were regarded as independent predictors of survival (Wald = 5.155, 5.905, and 8.343, P＜0.05). ConclusionThe number of liver metastases, preoperative serum CEA concentration, and postoperative complications are independent predictors of survival. Expanding indications for surgical resection and active postoperative auxiliary therapy are crucial to increase the survival rate after radical resection of liver metastases from colorectal carcinoma.

On syntactic equivalence in medical English translation / 中华医学教育探索杂志

Starting from the syntactic features of Medical English , namely extensive use of nominalization structure, passive voice and complex sentences, the present research attempts to carry out an in-depth study of Medical English translation on the sentence level guided by Nida 's Functional Equivalence Theory . It attempts to combine the translation theory with the translation practice of Medical English, with a view to improving students' translation proficiency and promoting Medical English teaching.

Protective effect of GYY4137 on rat myocardial cells infected by Coxsackie virus B3 / 中华实用儿科临床杂志

Objective To study the protective effect of GYY4137 on rat myocardial cells infected by Coxsackie virus B3 (CVB3) and its signal transduction mechanism.Methods Cardiomyocytes were treated with different concentrations of GYY4137(10,50,100 μmol/L) for 24 hours before addition of 100 TCID50 CVB3 for 2 hours before serum-free conditions.After treatment,the cell viability was ascertained with Cell Counting Kit-8 (CCK-8) assay.At the same time,the levels of tumor necrosis factor-α (TNF-α),interleukin-1β (IL-1β),interleukin-6 (IL-6) in the supernatants were analyzed by enzyme-linked immunosorbent assay (ELISA).Western blot was used to study the expression of nuclear factor kappa-B (NF-κB) protein and the inhibitory subunit of (IκBα) in myocardial cells.Results After exposure of cardiomyocytes to GYY4137 with different concentration (10,50,100 μmol/L)for 24 hours cell viability had no change.The NF-κB expression and the levels of TNF-α,IL-1β,IL-6 [(175.80 ± 5.05) ng/L,(25.80 ± 1.97) ng/L,(65.33 ± 3.51) ng/L] in the GYY4137-treated CVB3 infection group were significantly reduced when compared with untreated CVB3 infection group (P ＜ 0.01),respectively.Compared with the normal group,the GYY4137 concentration-dependently restrained the CVB3-mediated IκBα degradation(P ＜ 0.01).Conclusions GYY4137 exerts anti-inflammatory effects in CVB3-infected cardiomyocytes.This anti-inflammatory mechanism may be associated with suppression of the activation of the NF-κB.

A prospective multicenter clinical trial of extralevator abdominoperineal excision for locally advanced low rectal cancer / 中华外科杂志

<p><b>OBJECTIVE</b>To demonstrate the feasibility of extralevator abdominoperineal excision (ELAPE) for locally advanced low cancer in China.</p><p><b>METHODS</b>A prospective multicenter clinical trial was carried out by 7 general hospitals across China from August 2008 to October 2011. A total of 102 patients underwent ELAPE for primary locally advanced low rectal cancer. There were 60 male and 42 female patients. The patients' characteristics, complications and prognosis were recorded.</p><p><b>RESULTS</b>All patients underwent the ELAPE procedure successfully. The median operating time was 180 minutes (range 110-495 minutes) and median intraoperative blood loss was 200 ml (range 50-1000 ml). The rates of sexual dysfunction, perineal complications, urinary retention, and chronic perineal pain were 40.5%, 23.5%, 18.6% and 13.7%, respectively. Chronic perineal pain was associated with coccygectomy (12 months postoperatively, t = 8.06, P < 0.01), and the pain might gradually ease over time. Reconstruction of pelvic floor with biologic mesh was associated with lower rate of perineal dehiscence (χ(2) = 13.502, P = 0.006) and overall perineal wound complications (χ(2) = 5.836, P = 0.016) compared with primary closure. A positive circumferential margin (CRM) was demonstrated in 6 (5.9%) patients, and intraoperative perforations occurred in 4 (3.9%) patients. All CRM involvement and intraoperative perforation located at anteriorly and anterolaterally. The local recurrence was 4.9% at a median follow-up of 35 months (range, 18-58 months).</p><p><b>CONCLUSIONS</b>ELAPE performed in the prone position for low rectal cancer leads to a reduction in CRM involvement, intraoperative perforations, and local recurrence, but it might result in a little high rate of perineal wound related complications. Reconstruction of pelvic floor with biologic mesh might lower the rate of perineal wound complications.</p>

Early anticoagulation therapy after splenectomy plus devascularization in the prevention of thrombosis / 中华普通外科杂志

Objective To explore the effect of early anticoagulation therapy on the blood coagulation in patients undergoing splenectomy plus devascularization.Methods Clinical data of 106 patients in Cangzhou Central Hospital from June 2000 to December 2012 were reviewed.Beginning 24 h after surgery,low molecular dextran 500 ml + ligustrazine 160 mg,once a day for 1 week,and after 48 h low molecular heparin calcium at 4 250 U to 4 500 U was given every 12 h for 7 to 14 d.Blood coagulation was tested on day 3,5,7,10 and 14,ultrasound 1-2 times a week was taken for detection of portal venous thrombosis.Results The incidence of portal thrombosis was 7.5％ (8/106).APTT prolonged during 7-14 d.Prothrombin time (PT),thrombin time (TT) and fibrinogen (FIB) decreased,but all the changes were not statistically significant when compared with the normal values(P ＞0.05).Anticoagulant treatment did not cause bleeding complications in this series.Conclusions Postoperative application of low molecular heparin calcium anticoagulant therapy is effective in the prevention of portal thrombosis and safe in terms of coagulation when started early in patients undergoing splenectomy.

Establishment of a digital model of juxtahepatic vena cava / 中华消化外科杂志

Objective To investigate the feasibility of establishing a digital model of juxtahepatic vena cava.Methods The clinical data of 120 participants (without liver diseases) who were admitted to the Cangzhou Central Hospital from January 2013 to May 2013 were collected.The results of computed tomography were analyzed.The diameters of juxtahepatic vena cava on different levels (P1 plane:inferior vena cava at the entrance to the right atrium,P2 plane:the upper margin of the roots of hepatic veins,P4 plane:lower boundary of liver,P5 plane:confluence of renal veins and inferior vena cava),and the circumference of the inferior vena cava and the lengths between these levels were recorded.A digital model of juxtahepatic vena cava was established by these data on the premise that the juxtahepatic vena cava was engorged.All data were analyzed using the analysis of variance,paired sample t test and independent samples t test,and correlation and regression were used in analysis of relations between there data.Results Data of the P1 plane and P2 plane were both missed in 3 cases,and the data of the P4 plane was missed in 8 cases.The theoretical diameter of hepatic vena cava at the P1,P2 and P4 planes were (28.1 ± 4.0) mm,(28.7 ± 3.5) mm and (23.5 ± 2.7) mm,respectively.The median diameter of hepatic vena cava at the P5 plane was 24.3 mm.The juxtahepatic vena cava was a 3 dimensional structure of cylinder with a slightly protruding middle part.There were significant differences in P1D-P2D,P2D-P4D,P1D-P4D (F =77.5,P ＜ 0.05).There were significant differences between P2D-P4D and P1D-P4D (t =14.893,11.210,P ＜ 0.05).The median length of hepatic vena cava between P1 and P2 planes was 7.5 mm.The lengths of hepatic vena cava between P1 and P4 planes,P2 and P4 planes were (85.2 ± 11.0)mm and (78.2 ±9.8)mm,respectively.The median length of hepatic vena cava between the P4 and P5 planes was 10.0 mm.P1D-P2D,P2D-P4D,P2D-P5D and P4D-P5D were positively correlated (r =0.862,0.308,0.186,0.788,P ＜ 0.05),while P1D-P4D and P2D-P5D did not correlated (r =0.180,0.118,P ＞0.05).P2D was correlated with the body weight,and P5 D was correlated with the age (r =0.200,0.130,P ＜ 0.05).The P1 D,P2D,P4D and P5 D of the inferior vena cava were (28.5 ± 3.7) mm,(29.0 ± 3.4) mm,(23.9 ± 2.8) mm and (24.3 ± 2.6) mm in males,and (27.8 ±4.2) mm,(28.5 ± 3.6) mm,(23.1 ± 2.5) mm and 24.0 mm in females.There were no significant difference in P1D,P2D,P4D and P5D between males and females (t =0.911,0.809,1.588,1.902,P ＞ 0.05).The length between P1 and P2 planes was negatively correlated with P1D and P2D (r =-0.245,-0.160,P ＜ 0.05),while the length between P4 and P5 planes was positively correlated with P1D (r =0.149,P ＜ 0.05).The length between P2 and P4 planes was positively correlated with P2D (r =0.195,P ＜ 0.05).The length between P1 and P2 planes did not correlated with the age,height and body weight (r =-0.092,-0.047,-0.033,P ＞ 0.05).The lengths between P2 and P4 planes,P1 and P4 planes were negatively correlated with the age (r =-0.343,-0.371,P ＜ 0.05),but positively correlated with the body weight (r =0.271,0.208,P ＜ 0.05).The length between P4 and P5 planes was positively correlated with the height and body weight (r =0.154,0.255,P ＜ 0.05).There were no significant difference in the lengths between P1 and P2 planes,P1 and P4 planes,P2 and P4 planes,P4 and P5 planes between males and females (t =-1.046,-1.274,-0.908,1.375,P ＞ O.05).The length between P2 and P4 planes was similar to the length of retrohepatic vena cava.The length between P2 and P4 planes(mm) =71.23-0.293 × age (years) +0.32 × body weight (kilogram).Conclusion The establishment of digital model of juxtahepatic vena cava based on the computed tomography imaging data is feasible,which provides basis for clinical investigation.

Prevention of portal venous system thrombosis after splenectomy and devasculation / 中华肝胆外科杂志

Objective To investigate the causes and prevention measures for patients with portal hypertension hypersplenism undergone splenectomy plus pericardial devascularization and post-operative portal vein thrombosis (portal vein thrombogenesis,PVT).Methods 178 cases of splenectomy plus devascularization from July 2013 to May 1994 in Cangzhou Central Hospital of Hebei Province,including 102 cases of early postoperative application of low molecular heparin anticoagulant for the prevention group,76 cases without anticoagulant medicine as control group.33 cases with PVT found by B ultrasound or CT scan,were treated with urokinase body intravenous thrombolysis,hepatic artery catheterization thrombolysis,intestinal resection of + Fogarty catheter embolectomy vein stump treatment respectively.Results The total incidence of thrombosis was 18.5％ (33/178),prevention group was 8.8％ (9/102),including 7 cases in grade Ⅰ,Ⅲ,Ⅳ thrombus,in 1 cases,no intestine necrosis.The control group thrombosis rate was 31.6％ (24/76),including 7 cases in grade Ⅰ,Ⅲ,Ⅳ,thrombosis in 17 cases,5 cases of intestine necrosis,two groups of thrombosis rate were significantly differences (x2 =14.932,P =0.000).Thrombus disappeared completely in 7 cases,the thrombus grading decreased in 2 cases in the preventive group after thrombolysis,and thrombus disappeared completely in 6 cases,11 cases of thrombosis degraded in the control group after treatment of thrombolysis,1 case cured by TIPS with thrombolysis and thrombectomy,1 case died of sudden digestive tract bleeding,Among 5 cases of intestinal necrosis,4 cases died and 1 case undergone abdominal exploration being found with intestine & colon necrosis.Conclusions There are a variety of factors causing PVT after splenectomy and devascularization.Early anticoagulation can significantly reduce the incidence of PVT,early discovery and treatment can prevent severe outcome.

Nano-hydroxyapatite/chitosan/alginate for repairing mandibular defects / 中国组织工程研究

BACKGROUND:Studies have confirmed that the nano-hydroxyapatite/chitosan/alginate composite materials have a certain flexibility and strength and possess a bioactivity similar to human bone. OBJECTIVE:To explore the effect of the nano-hydroxyapatite/chitosan/alginate composite materials on the repair of rabbit mandible defects. METHODS:Bilateral mandibular defect models of 10 mm × 5 mm × 5 mm were made in 18 healthy New Zealand white rabbits. Then, the rabbits were divided into two groups:experimental group was implanted with nano-hydroxyapatite/chitosan/alginate composite material, and control group was implanted with hydroxyapatite/chitosan composite. At 4, 8 and 12 weeks after implantation, cone-beam CT was applied to observe implant degradation, cal us growth and bone connection in the defect area;new bone formation was observed by hematoxylin-eosin staining. RESULTS AND CONCLUSION:The gray values of the bone density in the experimental group and control group gradual y increased with time, and there were remarkably significant differences between the two groups at different time points (P<0.01). At the same time point, the experimental group was superior to the control group in gross observation, cone-beam CT observation, gray value of CT and histological observation (P<0.05). At 4-8 weeks after implantation, the implant materials in the two groups were gradual y degraded with a blurred junction between the defect and bone tissue, and a smal amount of new bone formed tightly integrated to the recipient bone tissue, in which the experimental group was more significant. And during 8 to 12 weeks, the degradation of implanted materials in the two groups was basical y complete, and the implant began to merge with the recipient bone tissue, with further generation of new bone tissue and gradual repair of bone defect area, in which, the experimental group was more obvious. Results show that the nano-hydroxyapatite/chitosan/alginate can repair bone defects effectively, and promote the new bone formation.

Early anticoagulation after splenectomy in the prevention of portal vein thrombosis in cirrhotics / 中华普通外科杂志

ObjectiveTo evaluate the effect of early anticoagulation therapy in the prevention of portal venous system thrombosis (PVT) in portal hypertensive patients undergoing splenectomy plus portaazygous devascularization. MethodsAt our hospital from August 1994 to July 2011,157 patients underwent splenectomy plus devascularization. Among them 89 cases (beginning 2000 )receiving intravenous low molecular dextran 500 ml daily for 7 days starting immediately postoperatively,and after 48 h subcutaneously low molecular weight heparin calcium 4250 U every 12 hours for 7 - 14 d were in group A.Before 2000,the 68 cases receiving no postoperative anticoagulation therapy were in the control group (B).After 3 - 12 months follow-up,PVT was evaluated and compared between the two groups. ResultsIn group A thrombosis incidence was 8％ (7/89),of which class Ⅰ, Ⅱ thrombosis accounted for 71％(5/7),class Ⅲ and up thrombosis accounted for 29％ (2/7),there was no bowel necrosis case; In group B thrombosis incidence was 29％ (20/68),class Ⅰ,Ⅱ thrombosis accounted for 20％ (4/20),class Ⅲand above thrombosis accounted for 80％ (16/20),3 cases suffered from intestinal necrosis,the difference was statistically significant (P ＜ 0.01 ). ConclusionsMultifactors lead to postoperative PVT formation,early postoperative,anticoagulation therapy is safe,and effective in the prevention of postoperative PVT.

Efficacy of different surgical treatment of 104 patients with hilar cholangiocarcinoma and survival analysis / 中国综合临床

Objective To study the efficacy of surgical treatment in hilar cholangiocarcinoma patients. Methods One hundred and four cases underwent surgical treatment of hilar cholangiocarcinoma were retrospective enrolled in the study from 1998 to 2008, including 45 cases of radical resection, 38 cases of palliative resection, vitro bridge drainage in 21 cases, 93 cases of postoperative patients. Ninty-three patients were followed up for 5 - 67 months, the different procedures of the treatment was summerized. Results Oneyear survival rate of radical resection and palliative resection was 80. 0% ( 32/40 ) and 86. 8% ( 33/38 ),respectively. No significant difference between the two groups (P ＞0. 01 ) were found; 2-year survival rate was 67. 5% (27/40) and 39. 5% ( 15/38), with significant difference between the two groups (P ＜0. 01 ) ;3-year survival rates were 37.5% ( 15/40 ) and 13.2% ( 5/38 ), with significant difference between the two groups (P＜0. 05). Palliative resection had higher 1-year survival rate than in vitro bridge drainage(P ＜ 0.01).Conclusion Surgical treatment of hilar cholangiocarcinoma is the most effective way to prolong the survival time of radical resection, radical surgery had better efficacy than palliative surgery, and palliative surgery is superior to external drainage. In patients of severe jaundice combined with biliary drainage infection, preoperative bridge drainage would improve the safety.