Volume 16,Issue 12,2007 Table of Contents

1 Laparoscopy-assisted radical proximal gastrectomy for gastric cancer: a report of 22 cases

DU Xiao-hui , LI Rong , CHEN Lin , GUO Qiang , ZHANG Xiao-jie , CHEN Liang

2007, 16(12):1-113. DOI: 10.7659/j.issn.1005-6947.2007.12.001

[Abstract](878) [HTML](0) [PDF 916.54 K](751)

Abstract:
Abstract:Objective:To explore the clinical efficacy of laparoscopy-assisted radical D2 proximal gastrectomy.
Methods :The clinical data of 22 cases of laparoscopy-assisted D2 radical proximal gastrectomy were analysed retrospectively.
Results:Laparoscopy-assisted radical proximal gastrectomy was carried out in all of the 22 cases. There was no conversion to open surgery in this series. The mean operation time was 188（162～270） min. The mean operative blood loss was 182（100～260）mL. The number of lymph nodes dissected was 18.6（10～32）. The average time for gastrointestinal function recovery was 78（48～140）h. Postoperative anastomotic leakage occurred in one patient who had tumor invasion of distal esophagus, and it healed after 4 weeks of conservative treatment. There were no postoperative deaths in this series. All the 22 cases were followed up for 1～37 months (mean 9.2 months) and revealed no recurrence or metastasis.
Conclusions:Laparoscopy-assisted radical D2 proximal gastrectomy for early and advanced gastric cancer is feasible, safe, and minimally invasive.

2 Hand-assisted gasless laparoscopic surgery of colorectal carcinoma

WU Wei , PENG Jie , RUAN Jing-de， OU Di-peng , XIA Zheng , ZENG Zhi-jun

2007, 16(12):2-114. DOI: 10.7659/j.issn.1005-6947.2007.12.002

[Abstract](808) [HTML](0) [PDF 838.47 K](715)

Abstract:
Abstract:Objective:To explore the feasibility of hand-assisted gasless laparoscopic surgery of colorectal carcinoma.
Methods :The clinical data of 25 cases of colorectal carcinoma treated with hand-assisted gasless laparoscopic radical surgery were analyzed retrospectively.
Results:All the operations were successfully completed without serious complications such as anastomotic fistula, and none died from operation. The mean time of operation was (171.5+15.6) min. An average of (14.1士1.4) mesenteric lymph nodes were removed at operation. The length of resected specimen in cases of colon carcinoma was (23.8士2.3) cm, and for rectal carcinoma was (19.4士1.5) cm. There were 3 cases of wound infection after operation.
Conclusions:Hand-assisted gasless laparoscopic surgery for colorectal carcinoma is safe, feasible and effective, and meets the requirements of radical resection of colorectal carcinoma.

3 Laparoscopic splenectomy for idiopathic thrombocytopenic purpura: a report of 21 cases

LIU Zhen , WANG Yi , CHEN Ping , WANG Guang-yi

2007, 16(12):3-114. DOI: 10.7659/j.issn.1005-6947.2007.12.003

[Abstract](1003) [HTML](0) [PDF 837.51 K](770)

Abstract:
Abstract:Objective:To evaluate the therapeutic efficacy of laparoscopic splenectomy (LS) for patients with idiopathic thrombocytopenic purpura (ITP) and to investigate the change of parameters of platelets.
Methods :Twenty-one patients with ITP after LS were studied, including the following paramenters: the operation time, intraoperative blood loss and postoperative complications, and compared perioperative platelet count(PC), packed platelet volume(PPV), mean platelet volume(MPV), and platelet distribution width (PDW) with the postoperative results.
Results:The mean operation time was 1.5 h. Intraoperative mean blood loss was 60 mL, postoperative hospitalization time was 5 d and with no case of delayed healing of incision. Accessory spleen was found in 19 % of patients . The incidence of complication was 4.8 %, and with no deaths. Platelet count and packed platelet volume increased with fluctuation, but mean platelet volume and platelet distribution width decreased with fluctuation. The parameters were in multipoint dynamic equilibrium with fluctuation and coordinated restoration. All patients were followed-up. No case had recurrence at 1.5~5.5 y, and platelet-associated antibody was in normal range. Bone marrow examination was normal.
Conclusions:The treatment of ITP with LS is safe and effective. The selection of therapeutic plan should depend on the changes of platelet parameters.

4 Combined use of duodenoscopy and laparoscopy for treatment of calculus of extrahepatic bile duct

HUO Xin-he

2007, 16(12):4-114. DOI: 10.7659/j.issn.1005-6947.2007.12.004

[Abstract](702) [HTML](0) [PDF 840.63 K](777)

Abstract:
Abstract:Objective:To discuss the clinical effect of combined use of duodenoscopy and laparoscopy for treatment of cholecystolithiasis complicated by choledocholithiasis.
Methods :The clinical data of 106 cases of cholecystolithiasis with cholelcoholithiasis in our department during 7 years were analyzed.Endoscopic sphincteromy (EST) and endoscopic nasobiliary drainage (ENBD), followed by laparoscopic cholecystectomy(LC) was employed.
Results:In 101 cases(95.3 %) stones were removed by EST successfully. Complicated with postoperative pancreatitis in 11cases(10.4 %), bleeding in 1 case (0.9 %), and acute cholangitis in 2 cases (1.9 %). All of the patients recovered and discharged. Eighty-five cases were followed up for average 3.1 years. Of them, 5 cases had choledocholithiasis recurrence, 1 had papillary re-stenosis, 2 had bile duct carcinoma, and 2 died of other caused.
Conclusions:Combined use of EST and LC for treatment of calculus of extrahepatic bile duct is a safe and effective mini-intrusive operation.

5 Clinical experience in repair of huge incisional hernia with mesh by laparoscopic technique

TIAN Wen , MA Bing， DU Xiao-hui , XIA Shao-you , XIAO Xi-ping , LI Rong , CHEN Lin

2007, 16(12):5-115. DOI: 10.7659/j.issn.1005-6947.2007.12.005

[Abstract](982) [HTML](0) [PDF 983.82 K](821)

Abstract:
Abstract:Objective:To investigate the technique and outcome of laparoscopic repair of huge ventral incisional hernia using mesh.
Methods :The clinical data of 25 patients with huge incisional hernia（abdominal wall defects 12 to 25 cm in length size and 9 to 18 cm in horizontal size, defect area of 108～451 cm2） were analyzed.
Results:Twenty-one patients(84 %) underwent hernia repair successfully, 4 cases (16 %) were converted to open operation because of extensive adhesions intraperitoneally. The operative time was 78～186 (average 95) min. Postoperative hospital stay was 5 ～8 (average 6.5) days. Eight patients (32 %) had prolonged pain over three months, and nine patients (36 %) had seroma. No death, intestinal fistula ,or infection occurred postoperatively.No recurrence occurred in any of the cases within 6 to 25 months(average eleven months) follow-up.
Conclusions:The laparoscopic repair of huge incisional hernia using mesh is a new, safe and effective operation.If extensive dense adhesions interfere with dissection ,the procedure should be converted to open operation.

6 Clinical application of laparoscopic appendectomy

YI Shi-jian , LI Lan-lan , SUN Chang-li , WANG Xing-qun , LIU Zhao-yun

2007, 16(12):6-115. DOI: 10.7659/j.issn.1005-6947.2007.12.006

[Abstract](868) [HTML](0) [PDF 836.21 K](1018)

Abstract:
Abstract:Objective:To compare the merits and drawbacks of laparoscopic appendectomy (LA) and open appendectomy (OA).
Methods :One hundred and six cases of LA and 154 cases of OA were performed during March 2006 to March 2007. The clinical data of LA and OA cases were analyzed and compared.
Results:There was no difference between the two methods in mean operative time（P>0.05）, but LA patients had less postoperative pain,less time to ambulation after operation, less time to food intake after operation, less average length of hospital stay,less rate of incision infection and less intestinal adhesion than OA did（all P<0.05）.
Conclusions:LA has significant advantages in treating appendicitis than OA, and it should be widely used.

7 Adventitia applied slow-releasing triptolide inhibits intima hyperplasia in vein graft

WU Guo , SHI De

2007, 16(12):7-115. DOI: 10.7659/j.issn.1005-6947.2007.12.007

[Abstract](672) [HTML](0) [PDF 1.15 M](940)

Abstract:
Abstract:Objective:To investigate the inhibitory effect of appling slow-releasing triptolide on adventitia on the intima hyperplasia of autologous vein graft.
Methods :In 24 male New Zealand rabbits, external jugular vein to common carotid artery models were established, and then were divided into 3 equal groups at random: blank-control group, receiving no management on adventitia of the vein graft; F-127 control group, receiving local application of 0.5 mL of 20 % F-127 on adventitia of the vein graft; experiment group, receiving local application of 0.5 mL of 20 % F-127 containing triptolide 300μg. Vein graft specimens were harvested at 2 weeks after the operation. Histomorphologic methods were used to detect the degree of intima hyperplasia of the specimens. The expression of bcl-2 and Fas of the specimens was detected by immunohistochemistry. The apoptosis vascular smooth muscle cells (VSMC) were detected by TUNEL.
Results:Two weeks after vein grafting, compared to blank-control group and F-127 control group, intima hyperplasia of experiment group ［intima thickness （29.9±7.6）μm, I/M 0.56±0.08］ was markedly inhibited (P<0.05). Expression of bcl-2［(18.2±8.4)%］ was reduced significantly, however, expression of Fas(21.4±8.9）% increased markedly, and the apoptotic cells ［(28.4±7.6)%］ also increased markedly (P<0.05).
Conclusions:Applied slow-releasing triptolide by F-127 pluronic on the vein graft adventitia can effectively inhibit intima hyperplasia of vein graft by a mechanism of enhancement of VSMC apoptosis.

8 Research on the expression difference of hot shock protein 70 before and after laparoscopic cholecystectomy for acute cholecystitis patients

ZHU Shi-bin , ZHANG Ge-wen

2007, 16(12):8-116. DOI: 10.7659/j.issn.1005-6947.2007.12.008

[Abstract](982) [HTML](0) [PDF 891.43 K](886)

Abstract:
Abstract:Objective:To compare the expression difference of heat shock protein 70 (HSP70) in blood of acute cholecystitis (AC) patients before and after laparoscopic cholecystectomy, and to explore the relationship between HSP70 and AC at molecular and proteinic level.
Methods :Subjects in the study included 85 in-hospital AC patients who received laparoscopic cholectectomy. Blood before and after laproscopic operation were obtained. Ezyme linked immunosorbent assay (ELISA) was used to determine the quantity of HSP70. Four subjects were randomly selected and the total RNA and protein in blood were extracted. RT-PCR and Western-blotting were applied to determine the expression of HSP70. The data on the figure was analysed with the software Quantity one of Bio-rad Company.
Results:The expression level of HSP70 of acute cholecystitis patients before laparoscopic cholecystectomy (181.42±13.58) was significantly higher than that of those patients after laparoscopic cholecystectomy (63.74±9.03) (P<0.05). The results of RT-PCR and Western-blotting showed that the HSP70 expression level of acute cholecystitis patients decreasd notably after laparoscopic operation.
Conclusions:HSP70 is related closely with acute cholecystitis and it′s expression level increases when stimulated by acute inflammation. The expression level of HSP70 rapidly declines when the inflammatory focus is eliminated by laparoscopic operation.

9 The influence of RhoC on the expression of angiogenic factors in HCC cells

ZHENG Yan-song , LU Xin-sheng

2007, 16(12):9-116. DOI: 10.7659/j.issn.1005-6947.2007.12.009

[Abstract](833) [HTML](0) [PDF 943.74 K](888)

Abstract:
Abstract:Objective:To study the influence of pcDNA3.1-RhoC on the expression of endogenous angiogenic factors in HCC cells.
Methods :The reconstructed plasmid pcDNA3.1-RhoC was transfected into HepG2 cells, and expression of VEGF and bFGF was detected with the RT-PCR and immunohistochemical stain. HepG2 cells transfected with pcDNA3.1-RhoC or pcDNA3.1 were implanted into nude mice to observe the tumor occurrence rate.
Results:HepG2 cells transfected with pcDNA3.1/RhoC showed higher expression of RhoC . The expression of RhoC enhanced the expression of VEGF and bFGF(P＜0.01).The tumor occurrence rate in nude mice implanted with HepG2 cells transfected with pcDNA3.1-RhoC(20 %) was higher than those implanted with HepG2 cells transfected with pcDNA3.1 (0 %).
Conclusions:The expression of RhoC efficiently enhances the expression of VEGF and bFGF;RhoC can promote the expression of angiogenic factors in HCC cell, and it may be one of the mechanisms of RhoC for enhancement of invasion and metastasis of HCC.

10 Quercetin regulates bax gene expression and induces apoptosis in hepatocellular carcinoma HepG2 cells

MA Xing-biao , ZHANG Ji-hong，LIANG Li-jian， HUANG Jie-fu

2007, 16(12):10-117. DOI: 10.7659/j.issn.1005-6947.2007.12.010

[Abstract](1212) [HTML](0) [PDF 953.36 K](1014)

Abstract:
Abstract:Objective:To explore the role of 1, 4, 5-trisphosphate inositol ( IP3) and bax gene expression in apoptosis of HepG2 cells induced by Quercetin.
Methods :HepG2 cells were cultured for 72h as control. HepG2 cells were treated with different concentrations including 20,40.60,80μmol/L Quercetin for 72h, and treated with 60μmol/ L Quercetin for 12h, 24h, 48h and 72h. IP3, bax mRNA, bax protein and apoptosis rate were assayed by IP3-［3H］ Birtrak assay,RT-PCR, Western blotting and flow cytometry, respectively.
Results:In HepG2 cells incubated with each of the concentrations of Quercetin for 72 h，IP3continent was lower than that of control(P<0.01)，bax mRNA expression and bax protein expression was higher than that of control，and the apoptosis rate was higher than that of control; in HepG2 cells incubated with Quercetin for 6 h, 12 h, 24 h, 48 h, 72 h, IP3content was lower than that of control(P<0.01);bax mRNA and bax protein expression in groups incubated with 60 μmol/L Quercetin for 12h was higher than that of control， and the apoptosis rate in groups incubated with 60μmol/ L Quercetin for 24h, 48h and 72h was significantly higher than that in control (P<0.01).
Conclusions:Quercetin induces apoptosis of HepG2 cells by reducing IP3production and up-regulating bax gene expression.

11 Management of colorectal injuries: a report of 125 cases

GAO Jin-mou，ZHAO Shan-hong , LIN Xi , ZENG Jian-bo , HE Ping , WEI Gong-bin

2007, 16(12):11-117. DOI: 10.7659/j.issn.1005-6947.2007.12.011

[Abstract](600) [HTML](0) [PDF 840.21 K](954)

Abstract:
Abstract:Objective:To evaluate operative and perioperative treatment for colorectal injuries.
Methods :The clinical data of 125 patients with colorectal injuries treated over a period of 19 years were retrospectively studied.
Results:In 69 patients with perforated colon or intraperitoneal segment of the rectum, 56(81.16 %) were managed with primary repair or anastomosis, 11 cases received a colostomy, and 2 cases had "Damage control surgery". In the 18 patients with perforated extraperitoneal segment of the rectum, 14 underwent diverting colostomy of the proximal end of sigmoid with presacral drainage; 4 cases, whose wound was small and contamination was mild, received primary repair without colostomy; and the other 38 cases without full-thickness lesions of the colon and rectum were treated by simple suture. The overall mortality rate was 6.40 %(8/125); 7 patients died of hemorrhagic shock during the operation（n=6） or after the operation(n=1), and the another one died from septic complication of the thoracic cavity. The complications related with operation for colorectal trauma included local infection in 6 and intestinal obstruction in one; all of them were cured.
Conclusions:In most of the patients with injury of colon or intraperitoneal segment of rectum, primary repair or anastomosis can be carried out safely. Rational use of perioperative antibiotics, especially Metronidazole, is a necessity. Staged operation is used for injuries of extraperitoneal segment of rectum; a completely diverting proximal sigmoid colostomy should be performed, because a loop style colostomy can not interrupt contamination of the distal rectum.

12 Treatment of liver trauma: a report of 160 cases

MOU Hong-chao , ZHOU Hui , SUN Mao , DONG Li-jun

2007, 16(12):12-117. DOI: 10.7659/j.issn.1005-6947.2007.12.012

[Abstract](622) [HTML](0) [PDF 850.67 K](929)

Abstract:
Abstract:Objective:To explore the diagnosis and treatment of liver trauma.
Methods :A retrospectively analysis of clinical data of 160 cases of liver trauma, including 96 cases of blunt trauma and 64 cases of open trauma, was made.
Results:Among the 160 cases, one case with stage IV trauma and severe thoracic injury died 30min after admission. Among the other 159 cases, 45cases (9 cases of stage Ⅰ, 31 cases of stage Ⅱ and 5cases of cases Ⅲ) received nonoperative treatment, and 114cases (7 cases of stage Ⅱ, 67 cases of stage Ⅲ and 50 cases of stage Ⅳ) received operative therapy. In non-operative treatment group, the cure rate was 100 %(45/45). In operation treatment group the cure rate was 98.2 %(112/114), the mortality rate was 1.8 %(2/114), 1 case died of hemorrhage after operation and 1 case died of ARDS. Five patients with postoperative complications were cured, including hepatic abscess in 2 cases, biliary fistula in 2 cases, and hemorrhage after operation in 1 case.
Conclusions:B-ultrasound is the method of choice for diagnosis of liver trauma, and CT can be used if conditions permit. Cases of lives truma of stages Ⅰ and Ⅱ and some cases of stage Ⅲ that have stable hemodynamics, can receive nonoperative treatment under close observation. Some cases of stage Ⅱ, most cases of stage Ⅲ and all cases of stages Ⅳ to Ⅵ injury should preferably undergo surgical treatment.

13 Treatment of blunt liver injury: a report of 109 cases

Yang Chang-an , ZHONG De-wu , CHEN Zhi-kang

2007, 16(12):13-118. DOI: 10.7659/j.issn.1005-6947.2007.12.013

[Abstract](666) [HTML](0) [PDF 904.35 K](915)

Abstract:
Abstract:Objective:To explore the feasibility and indications of non-operative management for blunt liver injury.
Methods :The clinical data of 109 patients with blunt liver injury treated in recent 5 years were reviewed retrospectively.
Results:Among 109 cases, 35 were treated with nonoperation and 33（94.3 %） were cured; there were 3 cases(9.1 %) with complications among the 33 cases who were cured. The mean amount of blood transfusion, hospitalization days and expenses were （2.5±0.8）U，（13.2±1.3）d and （5 250±335） yuan, respectively. Seventy-four cases were treated with operation and 68（91.2 %）were cured, there were 14 cases (20.6 %) with complications among the 68 cases who were cured. The mean amount of blood transfusion,number of hospitalization days and expenses were (8.4±1.1)U，(15.4±0.9)d and (13 550±805) yuan,respectively.The mean amount of blood transfusion and hospitalization expenses of nonoperative group were lower than those of operative group (P＜0.05).
Conclusions:With earlier diagnosis, more intensive monitoring of blood dynamics, strict control of the indications of nonoperative treatment and close monitoring of changes of the liver injury, the nonoperative therapy for blunt hepatic trauma of stages Ⅰto Ⅲ is safe and feasible.

14 Diagnosis and treatment of closed abdominal injuries in infants

LIAO Bin， ZHOU Ping

2007, 16(12):14-118. DOI: 10.7659/j.issn.1005-6947.2007.12.014

[Abstract](916) [HTML](0) [PDF 837.25 K](889)

Abstract:
Abstract:Objective:To explore the diagnosis and treatment of closed abdominal injuries in infants.
Methods : A retrospectively analysis of the clinical data of 84 infants with closed abdominal injury was made.
Results:Among the 84 cases, 60 cases had closed parenchymal visceral injury (32 cases of liver and 28 cases of spleen), 10 cases had small intestine perforation, and 14 cases had soft tissue contusion of abdominal wall. Non-operative treatment was used in 27 cases of liver injury and 22 cases of splenic injury, operative treatment in 5 cases of liver injury and 6 cases of splenic injury, and operative treatment for the 10 cases of other types of injury. All the 84 infant patients were cured.
Conclusions:In diagnosis and treatment of closed abdominal injuries in infants, abdominal centesis, type-B ultrasound and CT should be rationally chosen and applied in order to quickly determine location and extent of visceral injury; indications for operation should be under strict control. Non-operative treatment of parenchymal visceral injury of infants is proved to be safe and with a high cure rate.

15 Biological feedback treatment of pelvic floor functional constipation

HUANG Zhong-cheng , LIU Qi , LUO Wei-zhen , SU Ji , TANG Jia-xin , WANG Ai-min , LIU Qing-an

2007, 16(12):15-118. DOI: 10.7659/j.issn.1005-6947.2007.12.015

[Abstract](882) [HTML](0) [PDF 851.07 K](957)

Abstract:
Abstract:Objective:To study the effect of biological feedback treatment of pelvic floor functional constipation.
Methods :A analysis of the clinical data of 46 cases of biological feedback treatment of pelvic floor functional constipation was made.
Results:Among 44 cases who completed the biological feedback treatment, anorectic manometer detection results of 35 cases indicated that the rectum sensitivity threshold and the maximum tolerance capacity and recto-anal inhibitory reflex decreased, compared with those before treatment. Paradoxical contraction of pelvic floor disappeared and normal bowel movement was regained; in cases the symptoms were improved, including times of bowel movement, functional constipation and anorectic distention. The effective rate of biofeedback treatment was 93.2 %. Only 3 cases were ineffective and 2 cases stopped treatment.
Conclusions:The short-term effect of biological feedback treatment for pelvic floor functional comstipation is satisfactory, and has advantages of non-traumatic, low cost and no need for hospital admission.

16 Effect of intra-and post-operative high concentration oxygen supplement on abdominal clean-contaminated wound infection

WANG Xing-xiang , LU Wen-zuo , WU Sheng-ying , WANG Yi-sheng , DING Yu-zhu , ZHANG Pu , WANG Yong，GUO Jie , CHENG Ye , LI Xiong-nian , YU Xiao-cun , WANG Ya-ying

2007, 16(12):16-119. DOI: 10.7659/j.issn.1005-6947.2007.12.016

[Abstract](699) [HTML](0) [PDF 843.79 K](887)

Abstract:
Abstract:Objective:To explore the effect of intra-and post-operative administration of supplemental high concentration oxygen on abdominal clean-contaminated surgical wound infection.
Methods :From January 2001 to June 2005, 425 patients undergoing abdominal clean-contaminated operation were randomly divided into receive FiO2 60 % (n=213, study group) or FiO2 28 % (n=212, control group) inspired oxygen during the operation and two hours postoperatively. The partial pressure of oxygen in arterial blood and the peripheral arterial oxygen saturation was were measured two hours after operation. During 15 postoperative days, the wounds that drained pus were considered infected.
Results:The results showed that the partial pressure of oxygen in arterial blood was significantly higher in the study group than in the control group （P＜0.001）, and the peripheral arterial oxygen saturation was normal in both groups. Seven(3.29 %) patients in study group had surgical wound infection, as compared with 18(8.49 %) patients in control group (P＜0.05).
Conclusions:The results indicate that perioperative high concentration oxygen supplement can reduce the incidence of infection abdominal clean-contaminated surgical wound.

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Volume 16,Issue 12,2007 Table of Contents

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