Objective To observe whether the motor nerve babysitter could improve the delayed nerve anastomosisand promote the functional recovery. Methods Sixteen SD rats weighing 200-250 g were randomly divided into 2 groups.In group A, the left musculocutaneous nerve was transected to make the model of biceps brachii denervation and anastomosed to its proximal end 6 weeks later; In group B, the musculocutaneous nerve was transected and the distal end was coapted to the purely motor medial pectoral nerve immediately (nerve babysitter) and the musculocutaneous nerve was separated from the medial pectoral nerve, and reanastomosed to its proximal end 6 weeks later. In the animal model, the left l imbs served as experimental sides, the right l imbs as control sides. After 6 and 12 weeks of the second surgery, behavioral test (grooming test) was performed and the degree of the biceps brachii atrophy was observed, the latent period and the ampl itude of the maximun action potentials of the biceps brachii were detected, the wet muscle weight, muscle fiber cross-section area and the activity of Na+-K+-ATPase of the biceps brachii were measured. Results After 4 weeks of the second surgery, grooming behavior was found in group B, while few grooming behavior was seen in group A till 6 weeks after the secondary surgery. After 6 weeks of the second surgery, the recovery rate of the latent period and the ampl itude, the wet muscle weight, muscle fiber cross-section area and the enzymatic activity of Na+-K+-ATPase of the biceps brachii in group A was 187.25% ± 1.97%, 46.25% ± 4.63%, 55.14% ± 1.99%, 49.97% ± 1.71%, and 65.81% ± 2.24%, respectively, which was significantly different from that in group B (155.96% ± 3.02%, 51.21% ± 2.13%, 74.18% ± 1.82%, 55.05% ± 1.64% and 71.08% ± 1.53%, respectively, P lt; 0.05). After 12 weeks of the second surgery, the recovery rate of the latent period and ampl itude, the wet muscle weight, muscle fiber cross-section area andthe enzymatic activity of Na+-K+- ATPase of the biceps brachii in group A was 145.36% ± 3.27%, 51.84% ± 5.02%, 77.92% ± 1.73%, 61.04% ± 2.68% and 71.94% ± 1.65%, respectively, which was significantly different from that in group B (129.83% ± 8.36%, 75.22% ± 2.78%, 84.51% ± 1.34%, 78.75% ± 3.69% and 84.86% ± 1.81%, respectively, P lt; 0.05). Conclusion Motor nerve babysitting could reduce muscular damage after denervation, improve the effect of delayed nerve repair and promote the functional recovery of musculocutaneous nerve.
Objective To evaluate the impact of transcatheter arterial chemoembolization（TACE） on survival and tumor recurrence in patients with primary liver cancer， provide reference of clinical diagnosis and treatment for the primary liver cancer patients. Methods Two hundred and twenty-two cases of primary liver cancer were divided into TACE group （n=110） and control group （n=110）， TACE was performed after operation in the TACE group， convention treatment was performed after operation in the control group. The survival and tumor recurrence rates were compared between the TACE group and control group. Results The 1-， 2-， and 3-year survival rates were 83.64%， 56.36%，and 42.73% in the TACE group， respectively， which were 65.45%， 40.91%， and 21.82% in the control group，respectively. The differences were statistically significant （P＜0.05）. The 1-， 2-， and 3-year tumor recurrence rates were 20.91%， 54.55%， and 67.27% in the TACE group， respectively， which were 38.18%， 57.27%， and 70.91% in the control group， respectively. The 1-year tumor recurrence rate in the TACE group was significantly lower than that in the control group （P＜0.05）， but the differences of the 2- and 3-year recurrence rates were not statistically significant（P＞0.05）. Conclusions TACE treatment for primary liver cancer patients can increase long-term survival， but can’tdecrease long-term recurrence.
ObjectiveTo study the efficacy and safety of early laparoscopic cholecystectomy with percutaneous transhepatic gallbladder drainage (PTGBD) in the treatment of elderly patients with high risk moderate acute cholecystitis.MethodsThe clinical data of 218 elderly patients with high risk moderate acute cholecystitis admitted to Department of Hepatobiliary Surgery in Dazhou Central Hospital from January 2015 to October 2019 were retrospectively analyzed, including 112 cases in the PTGBD combined with early LC sequential treatment group (sequential treatment group) and 106 cases in the emergency LC group. In the sequential treatment group, PTGBD was performed first, and LC was performed 3–5 days later. The emergency LC group was treated with anti infection, antispasmodic, analgesia, and basic disease control immediately after admission, and LC was performed within 24 hours. The operation time, intraoperative blood loss, conversion to laparotomy rate, postoperative catheter retention time, postoperative anal exhaust time, postoperative hospitalization time, hospitalization cost, incidence of incision infection, and incidence of complications above Dindo-Clavien level 2 were compared between the two groups to evaluate their clinical efficacy and safety.ResultsAll patients in the sequential treatment group were successfully treated with PTGBD, and the symptoms were significantly relieved within 72 hours. There were significant differences in the operation time, intraoperative blood loss, conversion to laparotomy rate, postoperative tube retention time, postoperative anal exhaust time, postoperative hospitalization time, incidence of incision infection, and the incidence of complications above Dindo-Clavien level 2 between the two groups (P<0.05), which were all better in the sequential treatment group, but the hospitalization cost of the sequential treatment group was higher than that of the emergency LC group (P<0.05). There were no cases of secondary operation and death in the 2 groups. After symptomatic treatment, the symptoms of all patients were relieved, without severe complications such as biliary injury and obstructive jaundice. All the 218 patients were followed up for 4–61 months, with an average of 35 months. During follow-up period, 7 patients in the sequential treatment group had postoperative complications, and complications were occurred in 13 patients in the emergency LC group.ConclusionPTGBD is the first choice for elderly high risk moderate acute cholecystitis patients with poor systemic condition and high risk of emergency surgery, but it has the disadvantage of relatively high medical cost.
ObjectiveTo investigate the efficacy and safety of percutaneous transhepatic gallbladder drainage (PTGBD) combined with early laparoscopic cholecystectomy (LC) in the treatment of elderly patients with high-risk acute cholecystitis.MethodsThe clinical data of 128 elderly patients with high-risk acute cholecystitis admitted to Department of Hepatobiliary Surgery in Dazhou Central Hospital from January 2015 to January 2019 were retrospectively analyzed. Among them, 62 patients underwent PTGBD combined with early LC treatment (PTGBD+early LC group), 66 patients underwent PTGBD combined with delayed LC treatment (PTGBD+delayed LC group). Comparison was performed on the operative time, intraoperative blood loss, conversion to laparotomy rate, postoperative indwelling time, postoperative hospitalization time, total hospitalization time, and complication.ResultsPTGBD was successfully performed in all patients, and the symptoms were relieved within 72 hours. There was no significant difference in operative time, intraoperative blood loss, conversion to laparotomy rate, postoperative indwelling time, postoperative hospitalization time, and total complication rate between the two groups (P>0.05), but the total hospitalization time of the PTGBD+early LC group was shorter than that of the PTGBD+delayed LC group (P<0.001). There was no second operation and death in both two groups. The 128 patients were followed-up for 2–50 months with a average of 19 months. Results of follow-up after operation showed that the patients did not complain of obvious abdominal pain, abdominal distension, chills, fever, jaundice, and other discomforts.ConclusionsFor elderly patients with high-risk acute cholecystitis, early LC is a safe and effective treatment for patients with good overall condition after PTGBD. It can not only shorten the total hospitalization time, but also significantly shorten the time of tube-taking and improve the quality of life of patients. It has important clinical application value.