Objective To investigate the clinical effect of retroperitoneal laparoscopic dismembered pyeloplasty on ureteropelvic junction obstruction (UPJO). Methods From November 2010 to September 2015, a total of 28 cases (21 males and 7 females) with ureteropelvic junction obstruction (UPJO) underwent retroperitoneal laparoscopic dismembered pyeloplasty. All the 28 patients had a previous history of different degrees of lumbar pain, which was confirmed as typical UPJO by imaging examination. Operation method: following complete renal pelvis and upper ureter isolation, the renal pelvis was clipped into a trumpet-shaped mouth, 1/3 of the upper renal pelvis was temporarily kept without section. In the inferior margin of renal pelvis, longitudinal cut procedure was operated in the ureter and across the stenotic segment in about 1–2 cm; and then, anastomosis of the ureter and the renal pelvis at the lowest was performed, to maintain the continuity of the renal pelvis and ureter. Subsequently, the stenosed segment of ureter and the dilatant renal pelvis were removed, the posterior ureteropelvic anastomosis was made with an interrupted suture, and antegrade stenting of double J tube was further performed, followed by a continuous suture of the anterior wall. Results The procedure was successfully accomplished in all patients whithout conversion to open surgery. The operating time was 90-240 minutes with the median time of 160 minutes. The estimated blood loss was 20-70 mL with the median of 50 mL. No severe surgical complication occurred in perioperative period. The 3-24 -month follow up showed that symptoms of lumbar pain were relieved or disappeared in all the incorporated patients. Postoperative radiographic examination showed no stomal stenosis at the ureteropelvic junction, and the hydronephrosis was alleviated. Conclusions Retroperitoneal laparoscopic dismembered pyeloplasty for UPJO is an effective, safe, and minimally invasive surgical technique. The key to the success of the operation is to the accurate renal pelvis clipping, tension- and torsion-free anastomosis of the lowest position of the renal pelvis and the ureter, and the reconstruction of a new funnel-shaped ureteropelvic junction.
Objective To know the basic research and the clinical application of cartilage-derived retinoic acid-sensitive protein (CD-RAP) in orthopedic and in other clinical fields. Methods The literature related to CD-RAP in basic research and clinical application were extensively reviewed. Results CD-RAP, as a protein, which is cartilage-specific,could be a marker of the joint diseases. It also can be used to monitor metastsais of melanoma. Conclusion CD-RAP test provides a new way to study repair of cartilage and metastsais of melanoma.
ObjectiveTo explore the clinical efficacy and safety of ligation of intersphincteric fistula tract in the treatment of high simple anal fistula.MethodsA prospective collection of 72 patients diagnosed with high simple anal fistula, who admitted to the department of the author’s hospital between March 2015 and December 2017 was performed, and then the patients were divided into two groups according to the random number table method combined with the patients’ wishes: the ligation of intersphincteric fistula tract group (experimental group, 32 cases) and the low incision and high hanging group (control group, 40 cases). Comparison of indexes on the operative effect and physiological function of the sphincter in six months after operation was performed.ResultsCompared with the control group, the patients in the experimental group had short postoperative pain duration, short postoperative wound healing time, high cure rate, low recurrence rate, low initial sensory threshold, high anal resting pressure, and long anal high pressure band length, with statistically significant differences (P<0.05). However, there was no statistically significant difference between the two groups in the operation time, anal maximal contractive pressure, and rectal resting pressure (P>0.05). The results suggested that the physiological function of anus in the experimental group recovered well.ConclusionThe ligation of intersphincteric fistula tract is a safe and reliable method in the treatment of high simple anal fistula, which can be widely used in the clinic.
Objective To investigate the way and process of degradation behavior of acellular porcine aortic valve in vitro. Methods Acellular porcine aortic valve（n=90）were randomly divided into 3 groups （collagenase group, elastase group, control group）, 30 piece in each group . Behavior of acellular porcine aortic valve was degradated with 0.05mg/ml collagenase Ⅰ, 0. 05mg/ml elastase, phosphate buffered solution in collagenase group, elastase group and control group. The histomorphology, weight loss, value of protein and hydroxyproline were observed at 3,6,9, 12, 15 and 30d after degradation. Results The behavior of acellular porcine aortic valve of collagenase group and elastase group became poorer, looser and broken gradually in degradation. The weight loss of valve, the value of protein and hydroxyproline in vehiculum became greater gradually in collagenase group and elastase group（P〈0. 01）. Furthermore the effect of collagenase Ⅰ was b than elastase in degradation. Conclusion The effect of collagenase Ⅰ and elastase can degradate the acellular porcine aortic valve in vitro. Collagenase Ⅰ is b than elastase in degradation.
Abstract: Objective To evaluate the biological characteristics of decellularized bovine jugular vein valved conduit treated with dyemediated photo oxidation. Methods From July 2009 to July 2010, this study was carried out in Xijing Hospital affiliated to the Fourth Military Medical University. Forty bovine jugular vein valved conduits were obtained from Qinchuan scalpers aged between 2 to 6 years with the weight ranged from 200 to 400 kg. Then, the 40 conduits were divided into four groups by random digital table with 10 in each group. The conduits were treated with glutaraldehyde in the glutaraldehyde group (GA group), were decellularized in the decellularized group (DC group), were decellularized and treated with dyemediated photo oxidation in the decellularized and dyemediated photo oxidation treated group (DP group) , and were not dealt with in the control group (CO group). Thickness, appearance, histology, water content, shrinkage temperature, breaking strength, and soluble protein level of the conduit wall and valve were detected and compared among the four groups. Results Thickness and water content of the conduit wall and valve in the DP group were similar to those in the CO group (Pgt;0.05), while thickness of both wall and valve in the DP group was less than those in the GA group (wall: 0.8±0.1 mm vs. 1.1±0.1 mm; valve: 02±0.1 mm vs. 0.3±0.1 mm, Plt;0.05), and water content of the conduit wall and valve in the DP group was more than those in the GA group (wall: 86.1%±2.2% vs. 70.4%±2.8%; valve: 87.1%±2.5% vs. 72.1%±3.1%, Plt;0.05). The breaking strength and shrinkage temperature of the DP group were similar to those of the GA group (Pgt;0.05), while the shrinkage temperature (wall: 84.7±1.4 ℃ vs. 70.4±0.3 ℃; valve: 85.7±1.5 ℃ vs. 70.7±0.6 ℃, Plt;0.05) and the breaking strength (wall: 10.4±1.1 N vs. 6.8±1.0 N; valve: 8.0±0.9 N vs. 3.2±0.6 N, Plt;0.05) of the DP group were higher than those in the CO group. Conclusion Decellularized bovine jugular vein valved conduits treated with dyemediated photo oxidation have nice biological characteristics.Key words: Dyemediated photo oxidation; Decellularized; Bovine jugular vein valved conduit; Biological characteristics
ObjectiveTo explore the effect of body mass index (BMI) on the outcomes of laparoscopic surgery for esophageal hiatal hernia.MethodsWe divided the patients who underwent hiatal hernioraphy and fundoplication surgery in our hospital between July 2013 and June 2018 into two groups according to the BMI: a group A, BMI ≥24 kg/m2, 77 patients, 41 males, 36 females, with an average age of 42 years; a group B: BMI<24 kg/m2, 63 patients, 38 males, 25 females, with an average age of 67 years, and the age, gender, type of hiatal hernia, score of subjective feeling of symptoms, level of reflux esophagitis were analyzed with the propensity score matching method. Fifty one patients were successfully matched in each group, and the curative effect of surgery was compared between the two groups.ResultsThere was no statistical difference in the type of surgery, intraoperative complications, postoperative complications, and hospital stay between the two groups (P>0.05). The operative time of the group A was significantly longer than that of the group B (P=0.023). There was no statistical difference between the two groups in postoperative recurrence (P=0.741).ConclusionThe operative time in overweight patients is significantly longer than that in the non-overweight patients, but it has no effect on the surgical outcomes and complications.
Abstract: Objective To evaluate the results of surgical treatment of tetralogy of Fallot in adults． Methods From July 2002 to August 2009，75 adult patients with tetralogy of Fallot received surgical treatment in Xijing Hospital, ForthMilitary Medical University．There were 35 males and 40 females, with age at l7 to 37 years (23.30±3.50 years), and eoperativehemoglobin at 143 to 231 g/L(172.00±31.00 g/L)．All these patients were diagnosed by.echocardiograph before operation. All the patients were received tetralogy of Fallot of corrective operation in the hypothermia cardiopulmonary bypass. A total of 46 patients had a transannular right ventricular outflow tract patch，and 29 patients had a non ansannular patch． Results Operation time was 157 to 276 min(221.32±41.34 min), cardiopulmonary bypass time was 68 to 163 min(91.71±28.35 min) and aorta intercepted time was 37 to 96 min（55.47±23.61 min）. There were 6 operative deaths with an operative mortality at 8.00％. The causes of death were low output syndrome(n=3)，acute renal failure(n=2)， and multiple organ failure(n=1)．Nine patients needed reoperation for postoperative bleeding(12.00％)．We followed up 69 patients from 3 to 56 months (26.31±7.40 months). There were 2 patients with trivial residual shunt. The cardiac function status were New York Heart Association(NYHA) Ⅰ to Ⅱ in the 69 patients．No late death occured． Conclusion The effectiveness of surgical treatment for adults with tetralogy of Fallot is satisfactory．
ObjectiveTo explore the utility and advantage of same-day surgery mode of Mammotome minimally invasive operation (MMT) in ambulatory surgery center, and summarize the key points of clinical management.MethodsFemale patients who underwent MMT in West China Hospital of Sichuan University between June and December 2019 were included. According to the operation mode, the patients were divided into same-day surgery group and routine group (routine day operation). The perioperative data were analyzed.ResultsA total of 1 297 female patients were included. Among them, 571 cases were in the same-day surgery group and 726 cases were in the routine group. There was no significant difference in baseline data, intra-operative bleeding volume, operation time, or complication rate between the two groups (P>0.05). There were significant differences in the number of masses (χ2=13.384, P<0.001), pathological type (χ2=11.990, P=0.007) and operation method (χ2=89.185, P<0.001). The length of hospital stay in the same-day surgery group was significantly shorter than that in the routine group (Z=–29.746, P<0.001); the cost of biopsy (Z=–8.549, P<0.001), the cost of surgical instruments (Z=–9.564, P<0.001), and the total cost of hospitalization (Z=–10.378, P<0.001) in the same-day surgery group were less than those in the routine group. In addition, the result of generalized estimating equation showed that the postoperative pain scores of patients in the same-day surgery group were lower than those in the routine group (P<0.001).ConclusionsThe same-day surgery mode of MMT is safe and feasible with high time economic benefits, which is worthy promoting in ambulatory surgery center. Cautions should addressed with patients’ safe and high-quality health education.
Abstract： Objective To evaluate the early and late results of mitral valve replacement with home made C-L pugesturt tilting disc and analyse the factors which impact on the therapeutic effect，so as to elevate the operative effect. Methods A retrospective study was made on the result of clinical data and longterm followup of 259 patients who had undergone the Chinesemade C-L pugesturt tilting disc mechanical valve replacement from October 1991 to November 2006. Results The data showed that there were 12 patients died in the duration of hospital stay.The hospital mortality was 4.63% (12/259).There were no mechanical valverelated complication in the earlier postoperative period.The mortality fell to 2.59% since 1996.Among the 235 patients,12 patients were lost during the followup,the rate of followup was 95.1%(235/247).The time for followup was 9.77±3.09 years. There were 26 late deaths.During the follow-up,death associated with the deterioration of valve structure were not observed. The 5 years, 10 years and l5 years survival rates were 86.80%±2.30%, 78.20%±3.33% and 55.23%±4.34% respectively; the thromboembolic event free rates for 5 years, 10 years and l5 years were 95.95%±0.74%, 92.52%±4.11% and 80.52%±4.11% respectively; the anticoagulant related bleeding free rates for 5 years, 10 years and l5 years were 94.64%±1.75%, 89.55%±3.28% and 79.39%±4.43% respectively.There were 141 patients(67.46%) in New York Heart Association(NYHA) classⅠ, 56 patients(26.79%) in class Ⅱ, 10 patients(4.78%) in class Ⅲ and 2 patients(0.95%) in class Ⅳ. Conclusion The results of follow-up for 15 years suggest that the Chinesemade C-L pugesturt tilting disc medical mechanical valve is a reliable and safe choice for mitral valve replacement.
Objective To compare the biological and biomechanical characteristics of decellularized bovine jugular venous tissue-engineered valved conduit scaffolds with that of fresh bovine jugular veins. Methods Fortyeight fresh bovine jugular veins were divided into control group and experimental group with random number table method, 24 veins in each group. There were fresh bovine jugular veins in control group, decellularized bovine jugular veins in experimental group. The veins of experimental group were treated with sodium deoxyeholate plus Triton-X-100 to decellularize the cells in valves and vessel walls. The thickness, water absorption rate, water maintenance rate, destroying strength, stretch rate of valves and vessel walls in two groups were detected. Results The endothelial cell and fibroblast of valves and vessel walls in experimental group were completely decellularized, no cell fragments were retained within the matrix scaffold; collagen fiber and elastin fiber had been preserved with intact structure and wavily arrayed; deoxyribonucleic acid content of valves and vessel walls in experimental group were decreased by 97.58%, 97.25% compared with that of control group. The thickness, water absorption rate and water maintenance rate of valves and vessel walls in experimental group were lightly increased than those of control group, but there were no significant differences between them （P 〉 0. 05）. There were no significant differences in destroying strength and stretch rate of valves and vessel walls between two groups （P〉0. 05）. Conclusion Decellularized bovine jugular vein scaffold has stable biological and biomechanical characteristics and it may be ideal natural fibrous matrix for developing the tissue-engineered valved conduit by host recellularization.