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  • JOURNAL OF CLINICAL SURGERY

    主管单位:湖北省卫生和计划生育委员会
    主办单位:中华医学会湖北分会
    地  址:武汉市武昌区东湖路165号
    邮  编: 430071
    电  话:027-87893476
    电子邮件:whlcwk@126.com
    国际标准刊号:ISSN 1005-6483
    国内统一刊号:CN 42-1334/R
    邮发代号:38-184

Current Issue
20 November 2021, Volume 29 Issue 11
Influence of clinical application of newly developed drugs on surgical decision making of hepatocellular carcinoma
LIANG Binyong, HUANG Zhiyong, CHEN Xiaoping
JOURNAL OF CLINICAL SURGERY. 2021, 29 (11):  1001-1003.  DOI: 10.3969/j.issn.1005-6483.2021.11.001
Abstract ( 1 )   PDF (988KB) ( 5 )   PDF(mobile) (988KB) ( 0 )  
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Clinical features and diagnostic criteria of hepatobiliary duct cell carcinoma
LIN Ximeng, CHEN Minshan
JOURNAL OF CLINICAL SURGERY. 2021, 29 (11):  1004-1007.  DOI: 10.3969/j.issn.1005-6483.2021.11.002
Abstract ( 17 )   PDF (931KB) ( 7 )   PDF(mobile) (931KB) ( 0 )  
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The road to radical cure in advanced hepatocellular carcinoma——conversion therapy
HUANG Cheng, SUN Huichuan
JOURNAL OF CLINICAL SURGERY. 2021, 29 (11):  1008-1011.  DOI: 10.3969/j.issn.1005-6483.2021.11.003
Abstract ( 11 )   PDF (921KB) ( 3 )   PDF(mobile) (921KB) ( 0 )  
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Conversion therapy for hepatocellular carcinoma: strategies and current status
WANG Guanyu
JOURNAL OF CLINICAL SURGERY. 2021, 29 (11):  1012-1014.  DOI: 10.3969/j.issn.1005-6483.2021.11.004
Abstract ( 8 )   PDF (921KB) ( 0 )   PDF(mobile) (921KB) ( 0 )  
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Evaluation and research progress of residual liver volume after hepatectomy
WANG Xiaofei, LI Debao, XIA Feng
JOURNAL OF CLINICAL SURGERY. 2021, 29 (11):  1015-1018.  DOI: 10.3969/j.issn.1005-6483.2021.11.005
Abstract ( 8 )   PDF (936KB) ( 1 )   PDF(mobile) (936KB) ( 0 )  
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Laparoscopic anatomic segmental resection of liver
CHEN Jiye, SU Ming, HAN Jun, et al
JOURNAL OF CLINICAL SURGERY. 2021, 29 (11):  1018-1021.  DOI: 10.3969/j.issn.1005-6483.2021.11.006
Abstract ( 5 )   PDF (1781KB) ( 0 )   PDF(mobile) (1781KB) ( 0 )  
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Perioperative adjuvant therapy for hepatocellular carcinoma
LIU Zhicheng, GUO Bin, ZHOU Yi, et al
JOURNAL OF CLINICAL SURGERY. 2021, 29 (11):  1022-1024.  DOI: 10.3969/j.issn.1005-6483.2021.11.007
Abstract ( 7 )   PDF (919KB) ( 0 )   PDF(mobile) (919KB) ( 0 )  
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Pathogenic characteristics and drug resistance of vancomycin resistant enterococci after liver transplantation
REN Zhangyong, LV Shaocheng, CAO Di, et al.
JOURNAL OF CLINICAL SURGERY. 2021, 29 (11):  1025-1028.  DOI: 10.3969/j.issn.1005-6483.2021.11.008
Abstract ( 7 )   PDF (875KB) ( 1 )   PDF(mobile) (875KB) ( 0 )  
Objective In order to investigate the etiology and drug resistance of vancomycin resistant enterococci after liver transplantation.
Methods We retrospectively analyzed the clinical data of 524 consecutive patients who underwent liver transplantation in Beijing Chaoyang Hospital in January 2015-2019 in December.Incidence rate and etiology of vancomycin resistant enterococci infection after operation were analyzed.Distribution and drug resistance.
Results 109 of the 524 patients underwent abdominal infection after operation,the incidence rate was 20.80%(109/524).Enterococcus infection was 46 cases,all enterococcus faecium,enterococcal infection rate was 8.78%(46/524),enterococcal infection accounted for 42.2%(46/109) of the patients with abdominal infection,accounting for 64.79%(46/71) of gram positive cocci infection,15 cases of vancomycin resistant hair coloring and 15 vancomycin resistance rate of 32.61%(15/46),and drug sensitivity test showed 
vancomycin resistant enterococcus was completely resistant to penicillin, ampicillin, ciprofloxacin, levofloxacin and erythromycin antibiotics;it was also widely resistant to tetracycline, streptomycin, gentamicin and other antibiotics;and the drug resistance rates were 71.43%(15/21),85.71%(18/21),71.43%(15/21),38.10%(8/21) to teicoplanin,and resistant strains to linezolid,the drug resistance rate was 9.52%(2/21).Tecycline is the most sensitive and no resistant bacteria have been detected.
Conclusion Vancomycin resistant Enterococcus is one of the common pathogens in liver transplantation patients.Conventional prophylactic antibiotics are ineffective in the treatment of vancomycin resistant enterococci,and tigecycline and linezolid can be the first choice for the treatment.
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Establishment of risk prediction model of biliary fistula after laparoscopic hepatectomy in patients with primary liver cancer
FANG Xiaosan, WANG Xiaoming, HAN Ting, et al.
JOURNAL OF CLINICAL SURGERY. 2021, 29 (11):  1030-1033.  DOI: 10.3969/j.issn.1005-6483.2021.11.010
Abstract ( 3 )   PDF (683KB) ( 0 )   PDF(mobile) (683KB) ( 0 )  
Objective To establish a risk prediction model of biliary fistula in patients with primary liver cancer(PHC) after laparoscopic hepatectomy(LH).
Methods 100 patients with PHC admitted to the hospital from January 2016 to January 2021 were prospectively selected as the research subjects,the baseline data were collected,treated with LH,the occurrence of postoperative biliary fistula of patients was recorded,they were divided into a biliary fistula group and a non biliary fistula group,baseline data and operation related variables were compared between the two groups,regression analysis test was used to examine the risk factors of biliary fistula after LH,the risk prediction model of biliary fistula was established,Hosmer-Lemeshow goodness of fit test was used,and the ROC curve was drawn,the predictive efficiency of risk prediction model of biliary fistula on biliary fistula after LH was evaluated.
Results Among the 100 patients with PHC after LH,11 cases developed biliary fistula,and 89 cases did not;after preliminary comparison of baseline data and operation related variables between biliary fistula group and non biliary fistula group,through single Logistic regression analysis,the results showed that lesion diameter,high alanine aminotransferase(ALT),aspartate aminotransferase(AST),combined with preoperative cholangitis and intraoperative blood loss were the risk factors of postoperative biliary fistula after LH(OR>1,P<0.05);the high volume of remaining liver was the protective factor of biliary fistula after LH(OR<1,P<0.05);ROC curve was drawn and  showed that AUC of biliary fistula risk prediction model used to predict the risk of biliary fistula after LH were >0.80,which had certain predictive value;on the basis of the original study population,the bootstrap method was used to resample 100 times,the internal validation population was obtained,the established risk prediction scoring system was used to assess the risk of patients in the internal validation population,the results showed that Hosmer-Lemeshow goodness of fit test P was >0.05,fitting had no significant difference,fitting with satisfaction.
Conclusion There are many risk factors for biliary fistula in PHC patients after LH,according to multiple risk factors,the risk prediction model is established,which has certain efficiency in predicting the risk of postoperative biliary fistula.
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Effect of pre-stored autotransfusion on inflammatory response and immune function in patients undergoing liver cancer surgery
LI Zhuwei, YIN Dongliang, LI Xiaolan, et al.
JOURNAL OF CLINICAL SURGERY. 2021, 29 (11):  1034-1037.  DOI: 10.3969/j.issn.1005-6483.2021.11.011
Abstract ( 3 )   PDF (648KB) ( 0 )   PDF(mobile) (648KB) ( 0 )  
Objective To explore the effect of pre-stored autotransfusion on patients undergoing liver cancer surgery,as well as the effect on inflammation and immune function.
Methods From June 2019 to February 2021,60 cases of liver cancer patients planned to undergo open partial liver resection in our hospital were selected,according to the different blood transfusion methods,they were divided into 30 cases in the control group using allogeneic blood transfusion and 30 cases in the observation group using pre-stored autotransfusion.Record the operation status of the two groups.The serum inflammatory response and immune function indexes of the two groups were tested before operation and 1,5 days after operation.
Results There was no significant difference between the two groups in operation and anesthesia time,urine volume,intraoperative blood loss(P>0.05).The levels of IL-2,CD3+,CD4+,CD4+/CD8+,NK,IgG,IgA,IgM in the control group 1,5 days after operation and in the observation group 1 day after operation were lower than those before operation,and the IL-10,CRP,TNF-α,CD8+ levels were higher than before operation,and the IL-2,CD3+,CD4+,CD4+/CD8+,NK,IgG,IgA,IgM levels in the observation group were higher than those in the control group at the same time period,the levels of IL-10,CRP,TNF-α and CD8+ were lower than those in the control group in the same time period(P<0.05).The incidence of complications of blood transfusion in the observation group (0) was lower than in the control group (13.34%,P<0.05).
Conclusion Pre-stored autotransfusion has little effect on the inflammation and immune function of patients undergoing liver cancer surgery,and has good safety.
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The application of laparoscopic cholecystectomy following the A-B-D approach in acute suppurative and gangrenous cholecystitis
JIANG Kangyi, GAO Fengwei, LEI Zehua, et al.
JOURNAL OF CLINICAL SURGERY. 2021, 29 (11):  1038-1040.  DOI: 10.3969/j.issn.1005-6483.2021.11.012
Abstract ( 5 )   PDF (644KB) ( 0 )   PDF(mobile) (644KB) ( 0 )  
Objective To investigate the clinical value of laparoscopic cholecystectomy following A-B-D approach applied in the operation of acute suppurative or gangrenous cholecystitis.
Methods We seeked out the Patients diagnosed as acute suppurative or gangrenous cholecystitis and treated by laparoscopic cholecystectomy following the A-B-D approach in People's Hospital of Leshan from Sep.2019 to Dec.2020,and we analyzed clinical data of the patients retrospectively to investigate the safety and efficacy of the A-B-D approach LC procedure.
Results The A-B-D approach LC procedure was completed successfully in 44 cases,only 1 case was converted to laparotomy.The mean operation time was(100.3±38.6) min and postoperative hospitalization  time was(4.3±2.2) d.No serious complications such as biliary tract injury and postoperative bleeding occurred in all cases.
Conclusions The laparoscopic cholecystectomy following the A-B-D approach is a optimized surgical procedure and our clinical practice preliminarily confirmed the safety and efficacy of the procedure.
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Construction and application of the best evidence-based practice program for nasogastric tube insertion
LI Yan, SU Lan, FENG Li.
JOURNAL OF CLINICAL SURGERY. 2021, 29 (11):  1040-1043.  DOI: 10.3969/j.issn.1005-6483.2021.11.013
Abstract ( 1 )   PDF (788KB) ( 0 )   PDF(mobile) (788KB) ( 0 )  
Objective To explore the clinical practice of best evidence-based practice program for nasogastric tube insertion and evaluate its application.
Methods By referencing to Australia JBI model for evidence-based healthcare, we retrieved and summarized the best evidence for preoperative insertion of nasogastric tube, judged the position of nasogastric tube and alleviated the discomfort caused by the nasogastric tube insertion.Then we formed inspection indicators, maded baseline inspections before application of the best evidence on 29 medical staffs and 50 patients who met the inclusion criteria in department of hepatobiliary surgery, took transformative measures to boost application of the best evidence, and made post-application inspections to evlaute the effect.
Results After the application of the best evidence, the routine operation process of gastric tube insertion was improved; the awareness rate of audit indicators in medical staffs, audit indicators implementation rate, and the correct rate of gastric tube implantation were significantly improved (P<0.05 for all).
Conclusion The summarization and application of the best evidence for preoperative nasogastric tube insertion can improve medical staffs' operation level of nasogastric tube insertion,standardize the operation behaviors,reduce the patients' discomfort caused by the nasogastric tube insertion and improve their satisfaction.
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A retrospective study of segmentectomy and wedge resection in the treatment of peripheral lung cancer with a diameter of ≤2cm
WANG Xianguo, LIU Jun.
JOURNAL OF CLINICAL SURGERY. 2021, 29 (11):  1044-1046.  DOI: 10.3969/j.issn.1005-6483.2021.11.014
Abstract ( 2 )   PDF (843KB) ( 0 )   PDF(mobile) (843KB) ( 0 )  
Objective To compare the therapeutic effects of segmentectomy and lung wedge resection for lung cancer with a diameter ≤ 2cm and CT shows that ground glass nodules ≥ 50%.
Methods From January 2020 to July 2021,38 patients with lung adenocarcinoma who underwent segmental resection or pulmonary wedge resection at Zhongnan Hospital of Wuhan University were enrolled.Among them:16 cases in the segmental resection group(segmental resection group);22 cases in the wedge resection group(wedge resection group),compared the clinical data of the two groups of patients.
Results There was no perioperative death in both groups.Operation time [(131.6±40.2)min vs.(20.3±10.2) min],intraoperative blood loss [(67.2±49.1) ml vs.(9.9±5.1) ml],drainage tube extubation time[(3.5±1.5)d vs.(1.5±0.5)d] and hospitalization time [(4.5±3.5)d vs.(2.5±1.5)d] in the segmental resection group and the wedge resection group were statistically significant(P<0.05).All these aspects,resection the wedge resection group was significantly better than the segment resection group.
Conclusion Pulmonary wedge resection is beneficial to the rapid recovery of patients with peripheral(1/3 of outside the lung parenchyma) and pulmonary adenocarcinoma with diameter ≤2cm.
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Retrospective analysis of clinicopathological features of invasive ductal carcinoma with ductal carcinoma in situ
ZHENG Yuan, CHEN Bo.
JOURNAL OF CLINICAL SURGERY. 2021, 29 (11):  1047-1049.  DOI: 10.3969/j.issn.1005-6483.2021.11.015
Abstract ( 1 )   PDF (638KB) ( 0 )   PDF(mobile) (638KB) ( 0 )  
Objective Analyze the clinicopathological features of invasive ductal carcinoma  with ductal carcinoma in situ(IDC+DCIS) and  invasive ductal carcinoma(IDC).
Methods 335 breast cancer patients treated in the Department of Thyroid and Breast Surgery,Maternal and Child Hospital of Hubei Province from 2016 to 2020 were adopted,including 123 patients in the IDC+DCI group and 212 patients in the IDC group.SPSS 23.0 software was used for statistical analysis to compare the tumor size,lymph node stage,and the expression of ER,PR,HER-2,Ki-67%,CK5/6 and other molecular indicators between the two groups.
Results The expression of HER-2 in the IDC+DCIS group was higher than that in the IDC group(40.7% vs 25%,P=0.003),while the positive rate of CK5/6 was significantly lower than that in the IDC group(10.4% vs 42.6%,P=0.00).In addition,the IDC group had a higher rate of triple negative breast cancer(23.3% vs 9.8%,P=0.02).
Conclusion Compared with invasive carcinoma,invasive ductal carcinoma with carcinoma in situ shows different immunohistochemical phenotype.Whether this difference in phenotype indicates that the two cancers infiltrate through different pathways is worthy of further research.
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Laparoscopic assisted radical resection of splenic flexure carcinoma
MA Bing, DU Xiaohui, Huang Xiaotian, et al.
JOURNAL OF CLINICAL SURGERY. 2021, 29 (11):  1050-1053.  DOI: 10.3969/j.issn.1005-6483.2021.11.016
Abstract ( 1 )   PDF (1056KB) ( 0 )   PDF(mobile) (1056KB) ( 0 )  
Objective To summarize the methods and key points of laparoscopic assisted colon splenic flexure free.
Methods 21 cases of colon cancer with splenic flexure or proximal splenic flexure were treated by laparoscopy.The gastrocolic ligament was cut off under the gastroepiploic vascular arch,and the root of transverse mesocolon was cut off at the lower edge of pancreas.The corresponding vessels were ligated and the lymph nodes of No253 and No223 were removed.Through the small incision in the left upper abdomen,the resection was performed outside the abdominal cavity,and the end-to-end anastomosis was performed.
Results 20 patient were successfully performed under laparoscopy.One patient was converted to laparotomy when part of the gastric wall was resected because the tumor invaded the greater curvature of the stomach.The average time of laparoscopy was(65.4 ± 6.1)min.The average number of lymph nodes was(20.6 ± 3.1).The average blood loss was(30.7 ± 6.2)ml.The average length of auxiliary incision was(8.5 ± 1.5)cm.,and the postoperative hospital stay was(6.8 ± 0.9)d.No other incision or puncture site complications,intestinal fistula and abdominal infection occurred.
Conclusion Standardized laparoscopic is a safe and effective treatment for the colon splenic flexure dissociation The prospective study of D3 dissection can achieve safe results. 
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The role of Skp2/p27 axis in the occurrence and development of colorectal cancer
WANG Haijuan, ZHENG Yabin, ZHANG Jing.
JOURNAL OF CLINICAL SURGERY. 2021, 29 (11):  1054-1058.  DOI: 10.3969/j.issn.1005-6483.2021.11.017
Abstract ( 4 )   PDF (828KB) ( 0 )   PDF(mobile) (828KB) ( 0 )  
Objective To investigate the molecular mechanism of Skp2/p27 axis involved in the occurrence and development of colorectal cancer(CRC) and to study its effect on the proliferation,migration and invasion of CRC cell line LS513 and tumorigenicity of nude mice.
Methods The expression of Skp2 and p27 in CRC tissues,paracancerous tissues,human normal colon epithelial cells CCD841CoN,different CRC cell lines LS513,SW480,HT29 and SW620 were detected by real-time fluorescence quantitative polymerase chain reaction(qRT-PCR).LS513 cells with a growth density of 50%-60% were transfected with siRNA NC or siRNA Skp2,respectively,and divided into siRNA NC group and siRNA Skp2 group respectively,in addition,LS513 cells without transfection(LS513 group) were taken.After 24 hours of transfection or culture,the cell proliferation was detected by CCK-8 method;Transwell chamber method was used to detect cell migration and invasion;the tumorigenicity of the cells in vivo was detected by nude mice tumorigenicity test;the protein expression levels of Skp2,p27,p21,p57 and CKS1 were detected by Western Blot.
Results Skp2 mRNA and protein expression levels in CRC tissues and LS513,SW480,HT29 and SW620 cancer cells were significantly higher than those in adjacent tissues and CCD841CoN cells,the expression levels of p27 mRNA and protein were significantly lower(P<0.05),Compared with those in LS513 group and siRNA NC group,the protein expression levels of Skp2 and CKS1,cell proliferation,migration,invasion and tumorigenicity in vivo were significantly lower in siRNA Skp2 group(P<0.05),and the protein expression levels of p27,p21 and p57 were significantly higher(P<0.05).
Conclusion Skp2/p27 axis is involved in the occurrence and development of CRC.Interference with Skp2 can increase the expression of tumor suppressor proteins such as p27 in CRC cells,decrease the expression of CKS1 protein,and inhibit the growth,migration and invasion of CRC cells.
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Anatomical reconstruction for acute compression fractures of the humeral articular surface after shoulder dislocation
WANG Zhe, PENG Fei, LI Jianping, et al.
JOURNAL OF CLINICAL SURGERY. 2021, 29 (11):  1059-1062.  DOI: 10.3969/j.issn.1005-6483.2021.11.018
Abstract ( 5 )   PDF (1084KB) ( 0 )   PDF(mobile) (1084KB) ( 0 )  
Objective To summarize the operation techniques and experience of anatomical reconstruction for acute of the humeral head compression fractures.

Method From October 2017 to December 2019,5 cases of humeral head compression fracture caused by dislocation of glenohumeral joint(7 side).The shoulders were exposed via deltopectoral approach.The fractures were elevated and allograft bone were filled under the osteochondral,then underpinned with screws.With regular follow-up visits,shoulder function was assessed by Constant-Murley scores.
Results The follow-up period ranged from 13 to 36 months[average(20.4±8.9)months].Postoperatively,the sphericity of the humeral head was restored without internal fixation failure.No evidence of collapse,osteonecrosis,or osteoarthritis progression was seen at latest follow-up.Functional results were excellent.Constant score was 82 to 98 at the last review.

Conclusion Anatomical reconstruction is a safe and reliable technique to restore humeral head sphericity in patients with glenohumeral joint dislocations with serious acute humeral head defect.
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Evaluation of the effect of local application of tranexamic acid in ERAS measures of posterior lumbar fusion
GU Yanchao, LI Ying, HU Shengli, et al.
JOURNAL OF CLINICAL SURGERY. 2021, 29 (11):  1064-1067.  DOI: 10.3969/j.issn.1005-6483.2021.11.020
Abstract ( 7 )   PDF (648KB) ( 0 )   PDF(mobile) (648KB) ( 0 )  
Objective To evaluate the safety and effectiveness of intraoperative local application of aminocycline when performing ERAS(enhanced recovery after surgery) measures during the perioperative period of lumbar posterior fusion.
Method A total of 102 patients who underwent 2-level spinal fusion surgery in our hospital from January 2019 to January 2020 were selected and randomly divided into 2 groups,namely the intraoperative local application of tranexamic acid(experimental group) and intraoperative local The normal saline group(control group).There were 51 cases in each group.In the experimental group,1.5g of tranexamic acid(Lidafei) for injection was dissolved in 100ml of normal saline before the operation was sutured,the wound was soaked for 5 minutes,and the liquid was sucked out before suture.In the control group,the wound was soaked in 100ml of physiological saline for 5 minutes before suturing,and then sutured after sucking out the saline.Record the four coagulation items and D-dimer values of the two groups of patients before operation and the wound drainage,coagulation four items and D-dimer values of the patients on the first day,the second day,and the third day after the operation.
Results No thrombotic disease occurred in the two groups of patients after surgery.The drainage volume of the experimental group was(60±20)ml on the first postoperative day,(20±10)ml on the second postoperative day,and the wound drainage volume on the third day after surgery was(15±5)ml;in the control group,the drainage on the first day after surgery was(160±80)ml,the drainage on the second day after surgery was(100±30)ml,and the drainage on the third day after surgery was(45±5)ml.The difference between the two groups was Obviously,it is statistically significant(P<0.05).There was no significant difference between the two groups in the four coagulation values of patients on the first day,the second day and the third day after the operation,and it was not statistically significant(P>0.05).The value of D-dimer in the experimental group before operation(0.82±0.16)mg/L,the first day after operation(1.82±0.21)mg/L,the second day(1.85±0.41)mg/L,the third day after operation D-dimer(1.22±0.43)mg/L;preoperative D-dimer value of the control group was (0.88±0.12)mg/L,postoperative day 1(2.67±1.32)mg/L,postoperative day 2(3.11±2.60)mg/L,postoperative day 3(2.21±1.06)mg/L. The comparison between the two experimental groups was significantly lower than the control group,the difference was statistically significant(P<0.05).
Conclusion The topical application of tranexamic acid immersion to the wound during spinal fusion surgery can effectively reduce postoperative wound bleeding without increasing related complications.It is safe and effective.It reflects the scientific concept of ERAS and can be used as an important part of the ERAS concept in spinal surgery.Worth promoting.
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Effect of flexible ureteroscopic lithotripsy and miniaturized percutaneous nephrolithotomy on lower-calyx calculi and the level of procalcitonin,C reactive protein and IL-6 levels in patients with lower-calyx calculi of elderly patients
HUANG Zhiqiang, LI Hu, MA Nan, et al.
JOURNAL OF CLINICAL SURGERY. 2021, 29 (11):  1068-1070.  DOI: 10.3969/j.issn.1005-6483.2021.11.021
Abstract ( 8 )   PDF (641KB) ( 0 )   PDF(mobile) (641KB) ( 0 )  
Objective To study the effect of flexible ureteroscopic lithotripsy(FURSL)and miniaturized percutaneous nephrolithotomy(MPCNL)on lower-calyx calculi in elderly patients and their effects on PCT,CRP and IL-6 levels in patients with lower-calyx calculi.
Methods A total of 102 patients who underwent FURSL(n=50) or MPCNL(n=52) for subrenal calyx calculus stones from January 2018 to December 2020 were retrospectively analyzed.the Intraoperative and postoperative data including stone-free rate and complications were compared,the levels of serum PCT,CRP and IL-6 were detected before and 24 h after operation.
Results The one-time stone removal rate and operation time of FURSL group[70.00%,(46.83±4.09)min] were lower than those of MPCNL group[88.46%,(35.47±6.33)min](P<0.05).Compared with MPCNL group,the incidence of delayed bleeding and the decrease of hemoglobin in FURSL group[0,(2.72±0.65)g/L] were better than MPCNL Group[13.46%,(3.18±0.74)g/L] with significant difference(P<0.05).The serum levels of PCT,CRP and IL-6 were (0.11±0.04)ng/ ml,(10.50±2.64)mg/L,(12.12±3.23)pg/ml and (0.07±0.02)ng/ml,(12.38±1.91)mg/L,(11.32±3.23)pg/ml at 24h and 72h after MPCNL,respectively,and those in FURSL group were (0.09±0.03)ng/ml,(9.46±2.53)mg/L,(10.01±2.74)pg/ml and (0.06±0.01)ng/ml,(11.22 ±1.74)mg/L,(9.28±2.53)pg/ml,respectively.MPCNL group was higher than FURSL group(all P<0.05).
Conclusion FURSL and MPCNL are both effective and safe for treating subrenal calyx caculus with a diameter of 2~3cm.MPCNL shows more higher stone free rate.However,FURSL is associated with less reauma,less bleeding and mild inflammatory reaction.
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Narrow band imaging combined with green laser in the treatment of non-muscle invasive bladder tumor
ZHAO Yubo, LIU Cuilong, WANG Xiyou, et al.
JOURNAL OF CLINICAL SURGERY. 2021, 29 (11):  1071-1074.  DOI: 10.3969/j.issn.1005-6483.2021.11.022
Abstract ( 7 )   PDF (654KB) ( 0 )   PDF(mobile) (654KB) ( 0 )  
Objective To investigate the safety and clinical efficacy of narrow band imaging(NBI) combined with green laser in the treatment of non-muscle invasive bladder tumor(NMIBC).
Methods The data of 63 patients with NMIBC who were diagnosed in our hospital from March 2015 to May 2018 and underwent green laser surgery and were followed up for 2 years were retrospectively analyzed.According operation method they were divided into 2 groups:NBI group(33 cases) received NBI combined with green laser surgery and WLI group(30 cases) received green laser surgery under WLI(white light imaging).The number of pathological changes found in the operation,the number of pathological specimens obtained,pathological results,postoperative indwelling catheter time,postoperative hospital stay,intraoperative and postoperative complications,postoperative recurrence rate within 2 years were compared between the two groups.
Results The number of lesions per capita and the total number of pathological specimens obtained in NBI group were more than those in WLI group(2.4±1.4/person,95 cases vs 1.3±0.5/person,61 cases,P<0.01).Low grade urothelial carcinoma was the main pathological result.The operation time of WLI group was shorter than that of NBI group[(29.4±17.9)min vs (49.1±21.8)min,P<0.01].There was no significant difference in indwelling catheter time and postoperative hospital stay between two groups(P>0.05).The incidence of complications in group NBI was higher than that in group WLI(18.2% vs 16.7%,P<0.01),and the main complication was bladder spasm.The 2-year recurrence rate of group NBI was significantly lower than group WLI(3.0% vs 10.0%,P<0.01),and the recurrence case in group NBI was not in situ recurrence after 1 year.
Conclusion NBI combined with green laser in the treatment of NMIBC is safe and effective.It can reduce the recurrence rate,and simple to operate.It is worthy of further clinical research and promotion.
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Expression of CDC20 and miR-34a-5p in bladder urothelial carcinoma and its correlation with clinicopathology
Ge Xinguo, Yuan Xiaobin.
JOURNAL OF CLINICAL SURGERY. 2021, 29 (11):  1075-1078.  DOI: 10.3969/j.issn.1005-6483.2021.11.023
Abstract ( 6 )   PDF (822KB) ( 0 )   PDF(mobile) (822KB) ( 0 )  
Objective To investigate the expression of cell division cycle protein 20(CDC20) and microRNA-34a-5p(miR-34a-5p) in bladder urothelial carcinoma(BUC) and their correlation with clinicopathology.
Methods 80 patients with BUC in our hospital were selected. All of them received surgical treatment, the cancer tissue (BUC group) and the corresponding adjacent tissue (control group, 2.5 cm away from the cancer edge) were taken during the operation.The relationship between expression levels of CDC20 and miR-34a-5p and clinicopathological features were analyzed.Analyze the risk factors affecting the prognosis of patients with BUC.
Results The expression level of CDC20 mRNA in BUC group was higher than that in control group,and the expression level of miR-34a-5p in BUC group was lower than that in control group(P<0.05).The positive rate of CDC20 in BUC group was higher than that in adjacent normal tissue(P<0.05).The expression of CDC20 and miR-34a-5p in patients with BUC was closely related to histological grade,lymph node metastasis,tissue invasion and recurrence.The 3-year cumulative survival rate of patients with positive expression of CDC20 was lower than that of patients with negative expression of CDC20;the 3-year cumulative survival rate of patients with high expression of miR-34a-5p was higher than that of patients with low expression of miR-34a-5p.Multivariate COX analysis showed that high CDC20 level and low miR-34a-5p level were risk factors for poor prognosis of BUC(P<0.05).
Conclusion The expression of CDC20 is high and the expression of miR-34a-5p is low in BUC,they are closely related to histological grade,lymph node metastasis,tissue invasion,recurrence and poor prognosis,and may be used as potential diagnostic markers.
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Effect of urethral length and vascular nerve preservation on urinary control function and quality of sexual life in patients with T1 stage prostate cancer undergoing radical prostatectomy
WANG Xiaobo, LUO Hua, LIAO Gaoyuan, et al.
JOURNAL OF CLINICAL SURGERY. 2021, 29 (11):  1079-1082.  DOI: 10.3969/j.issn.1005-6483.2021.11.024
Abstract ( 7 )   PDF (647KB) ( 0 )   PDF(mobile) (647KB) ( 0 )  
Objective To investigate the value of preserving urethral length and nerve vessels in radical resection of T1 prostate cancer.
Methods Patients with stage T1 prostate cancer admitted to our hospital were divided into two groups:group A(53 cases) and group B(57 cases)Routine laparoscopic surgery was performed in group A,while vascular and nerve bundles were preserved in group B,and urethral length was preserved to the maximum extent.Perioperative indexes,urodynamic indexes,urinary control ability and BMSFI scores were compared between the two groups.
Results The amount of bleeding and postoperative time of getting out of bed in group B[(156.52±12.56)ml and (42.82±6.21)h] were shorter than that in group A[(184.93±10.04)ml and (49.19±7.84)h](P<0.05).The postoperative bladder compliance,maximum urethral pressure,maximum urinary flow,maximum detrusor pressure and urinary control ability of group B[(32.31±3.02)cmH2O、(40.09±2.46)cm H2O、(11.65±1.58)ml/s、(17.26±1.85)cm H2O] were all superior to group A[(27.93±2.35)cm H2O、(37.29±2.24)cm H2O、(9.29±0.64)ml/s、(13.16±1.10)cm H2O](P<0.05).In group B, the proportion of grade 0 was 52.63% six months after operation, which was higher than that one month after operation(29.82%) and group A(39.62%)(P<0.05).Intra-group comparison after operation in group B,Sexual desire, erectile function, ejaculation function, problem assessment, overall satisfaction rating[(3.26±0.42),(8.79±1.01),(5.43±0.76),(8.79±0.94),(1.89±0.23)] were significantly lower than before surgery[(3.86±0.73),(9.51±2.01),(6.23±0.85),(9.29±1.41),(2.28±0.29)].However, the inter-group comparison was significantly higher than that of group A after surgery[(3.08±0.47),(8.43±0.74),(5.07±0.59),(8.34±0.45),(1.74±0.21)],the difference was statistically significant(P<0.05).
Conclusion Preserving the length of vascular nerve bundle and urethra during surgery can reduce intraoperative blood loss, get out of bed as soon as possible after surgery, and improve postoperative urinary control ability and sexual function.
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Effects of different doses of dexmedetomidine on agitation and oxidative stress reaction after abdominal surgery in children
ZHANG Xifeng, CHEN Lingling, AN Hongqiang, et al.
JOURNAL OF CLINICAL SURGERY. 2021, 29 (11):  1083-1085.  DOI: 10.3969/j.issn.1005-6483.2021.11.025
Abstract ( 5 )   PDF (636KB) ( 0 )   PDF(mobile) (636KB) ( 0 )  
Objective To analyze the effects of different doses of dexmedetomidine on postoperative agitation and oxidative stress in children undergoing abdominal surgery.
Methods Totally 175 children undergoing abdominal surgery under general anesthesia in our hospital from January 2019 to September 2020 were randomly divided into 5 groups,with 35 cases in each group,by random number table method.Dexmedetomidine(0.4 μg/kg,0.6 μg/kg,0.8 μg/kg and 1.0 μg/kg)was used in the first four groups during anesthesia induction.The levels of adrenaline,glucagon,blood glucose and cortisol;and the postoperative analgesia and sedation scores were evaluated.
Results Restlessness score in group A to D was significantly lower than that in group E(P<0.05);postoperative sedation and analgesia in group B,C and D were significantly better than those in group A and E(P<0.05).
Conclusion The optimal dose of dexmedetomidine in pediatric abdominal surgery is 0.8 μg/kg.
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Advances in immune microenvironment and immunotherapy of hepatocellular carcinoma
LI Jiang, HUANG Zhiyong.
JOURNAL OF CLINICAL SURGERY. 2021, 29 (11):  1089-1091.  DOI: 10.3969/j.issn.1005-6483.2021.11.027
Abstract ( 1 )   PDF (648KB) ( 0 )   PDF(mobile) (648KB) ( 0 )  
Hepatocellular carcinoma(HCC) is one of the most common malignancies and a variety of factors can contribute to the occurrence and development of HCC.Among them,changes in the immune microenvironment may play an important role in recurrence and metastasis,immune escape and immune resistance of HCC.In recent years,immunotherapy represented by immune checkpoint inhibitors,adoptive cell therapy and tumor vaccine has brought new hope to patients with HCC.This review is focused on the research progress on the impacts of different immune cells of tumor microenvironment on the occurrence and development of HCC and the efficacy of different immunotherapies,as well as the outlook of immunotherapy trend.
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Advances in the throughout assessment and management of surgical resection for liver cancer and cirrhotic completed with portal hypertension
GUO Zhangyou, HONG Yuan.
JOURNAL OF CLINICAL SURGERY. 2021, 29 (11):  1092-1095.  DOI: 10.3969/j.issn.1005-6483.2021.11.028
Abstract ( 8 )   PDF (658KB) ( 2 )   PDF(mobile) (658KB) ( 0 )  
The incidence of liver cirrhosis is increasing,and portal hypertension(PH) caused by liver cirrhosis is widespread in China.Patients with cirrhosis and PH require liver resection due to primary or metastatic carcinomas.However,the incidence of perioperative complications,intraoperative management,and postoperative outcomes of expanded hepatectomy in patients with cirrhosis and PH remain a challenge.Barcelona Clinical Liver Cancer Staging recommends limiting surgical resection in liver cancer patients with cirrhotic to the early stages of cirrhosis presenting with PH.However,with the increase in the means and the gradual comprehensiveness of preoperative liver function evaluation,the standardization of perioperative liver disease management,the development of postoperative intensive care and liver resection techniques,it has become possible to perform extended liver resection in patients with cirrhosis and PH.Therefore,we conducted a review on the preoperative risk assessment,perioperative morbidity and mortality,and postoperative management of patients with liver cancer and cirrhotic completed with PH who underwent extended hepatectomy.
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The value and significance of molecular markers in the diagnosis of differentiated thyroid carcinoma
HUANG Bin, WU Yaohua.
JOURNAL OF CLINICAL SURGERY. 2021, 29 (11):  1096-1098.  DOI: 10.3969/j.issn.1005-6483.2021.11.029
Abstract ( 7 )   PDF (652KB) ( 1 )   PDF(mobile) (652KB) ( 0 )  
At present,the most direct method for preoperative diagnosis of thyroid cancer is ultrasound-guided fine needle biopsy,but it cannot achieve high accuracy.There are many molecular markers in the thyroid,such as BRAF gene,RAS gene,thyroglobulin,thyroid antibody,etc.This article reviewed some studies and found that some common gene mutations or changes in the level of circulating markers are related to the judgment of benign and malignant thyroid nodules,the aggressiveness of thyroid cancer,and even the prognosis,recurrence,or metastasis of thyroid cancer after surgery.We will analyze some common molecular markers in differentiated thyroid cancer,including genetic markers and circulating markers,analyze their value and significance in the diagnosis of disease,and discuss whether these molecular markers can provide different diagnostic methods for patients with thyroid nodule.
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