Objective To further investigate the possible mechanism of the correction of scol iosis with Staple by quantifying the effect of Staple on growth rate of vertebral growth plates in goat scol iosis. Methods Experimental scol iosis was created in 10 juvenile female goats by using unilateral pedicle screws asymmetric tethering. After 8-10 weeks, goats were divided randomly into Staple treated group (n=5) and control group (n=5). All tethers were removed in both groups and Staplegroup underwent anterior vertebral stapl ing with 4-5 shape memory alloy Staples along the convexity of the maximal curvature after posterior tether being removed. All goats were observed for an additional 8-13 weeks, the Cobb angle were measured to observe the correction of scol iosis. The fluorochromes Oxytetracycl ine and Calcein were administered respectively 18 and 3 days before death to label the ossifying front under the growth plates. Superior intervertebral disc of apical vertebra and two adjacent growth plates were completely harvested in all goats. All specimens were embedded with polymethyl methacrylate and sl iced undecalcified. The growth rates of the vertebral growth plates were calculated by measuring the distance between the two fluorescent l ines with fluorescence microscope. Results Nine (5 in Staple treated group and 4 in control group) of 10 tethered goats had progressive scol iotic curves of significant magnitude after 8-10 weeks of tethering. In Staple treated group, the Cobb angles were (34.8 ± 12.4)° at the instant after treatment , and (15.6 ± 11.7)° 8-13 weeks after treatment; showing statistically significant difference (P lt; 0.05). In the control group, the Cobb angles were (49.3 ± 18.0)° at the instant after treatment, and(49.0 ± 17.6)° 8-13 weeks after treatment; showing no statistically significant difference (P gt; 0.05). In Staple treated group, the growth rate of growth plate in the concavity (3.27 ± 0.96) μm/d was higher than that in convexity (1.84 ± 0.52) μm/d (P lt; 0.05), while the growth rate of the concavity did not differ significantly from that of the convexity in control group (P gt; 0.05). Conclusion Staple can significantly alter the growth rates of two sides of vertebrae in scol iosis with the growth rate of concavity exceeding the one of convexity, which results in correction of deformity.
Objective To evaluate the effect of mechanical suture in surgery of esophageal carcinoma,Methods Five hundred and sixty-eight cases of esophagogastrostomy and esophagojejunostomy for esophageal and cardiac carcinoma were collected in our hospital between January, 1988 and December, 2002. They were devided into two groups according to the methods of anastomoses, the group by stapler and the group with hand. The incidence of postoperative complications in the two groups was compared. Results The time of esophagogastrostomy, the total operating time, and postoperative fasting time of group by stapler were shorter than those of group with hand （Plt;0. 01）, and there was no statistically difference in the median hospitalized time after operation for two groups. The anastomotic leakage, anastomotic stricture, anastomotic bleeding , incidence of postoperative complications in respiration and circulation and mortality rate of group by stapler were lowed than those of group with hand （2.1%, 1.4%,0%,2.8% and 0.7% vs.6.8%,4.3%,1.4%,16.5% and 2.9%）. There was no statistical difference in the postoperative gastro-esophageal reflux for two groups （P 〉 0.05 ）. Conclusion The median time of esophagogastrostomy and the median operating time by stapler are decreased and the incidence of postoperative complications is decreased.
Objective To summarize the clinical effect and the key part of operation of procedure for prolapse and hemorrhoids （PPH） in treatment for severe mixed hemorrhoids or circular hemorrhoids. Method The data of 183 patients with severe mixed hemorrhoids or circular hemorrhoids underwent PPH in this hospital from August 2006 to November 2012 were analyzed retrospectively. Results The operation time was （28.5±3.1） min. The operations were successfully completed at one-stage in all the patients. The average hospital stay was 5.2 d. No postoperative bleeding， fecal incontinence， and infection happened. No recurrence and complications such as postoperative rebleeding，anal stenosis， fecal incontinence， etc were found during 1 month to 3 years of follow-up with an average 26 months. Conclusions PPH as a minimally invasive operation， every detail of it should be well performed in order to improve the clinical treatment effect and reduce complications of the patients with severe mixed hemorrhoids or circular hemorrhoids.
Objective Both stapled transanal rectal resection (STARR) and vaginal bridge repair are new operative techniques for treatment of rectocele transanal and transvaginal, respectively. In this study we observe the clinical outcomes for STARR as compared with vaginal bridge repair procedure. Methods The clinical data of 31 patients with obstructive defecation syndrome from January 2007 to May 2009 were retrospectively analyzed. The patients were divided into 2 groups according to different operative approach: STARR group (n=18) and bridge repair suture group (n=13). The clinical outcomes observed were operative time, blood loss, length of stay, cost of hospitalization, complication and the improvement of obstructed defecation syndrome. Results There was no difference in the age and severity in the patients of two groups. Evaluation of the clinical outcomes showed 16 (88.9%) patients in the STARR group and 6 (46.2%) in the bridge repair suture group reported improvement in symptoms (P=0.017). STARR had a shorter operative time (24.6 min vs. 33.2 min， Plt;0.01), less estimated blood loss (3.9 ml vs. 16.2 ml， Plt;0.01), more costly (10 743 yuan vs. 3 543 yuan, Plt;0.01) and a higher anal incontinenc rate but reversible. The length of stay was similar (average 6 d). Conclusion The stapled transanal rectal resection procedure is more superior to the vaginal bridge repair suture for improvement of obstructed defecation syndrome from rectocele, however, it has a higher cost and some patient with reversible slight anal incontinence after surgery.
Objective To study the effect of laparoscopic total mesorectal excision and per anum rectal pull-type of anastomosis on male patients with low rectal cancer. Methods The successful experiences of anus saving operation on 23 male patients with low rectal cancer were summarized. Results A laparoscopic total mesorectal excision technique was used, with the full separation of the rectum at the bottom. After pulling out the distal rectum together with the cancer from the anus, the transection of the proximal tumor was performed. The end-to-end anastomosis of rectum and descending colon was performed by tubular stapler. Anus was reserved successfully in the 23 cases. There was no left-tumor stump after surgery detected by postoperative pathological examinations, no anastomotic leakage, and no operative death. Conclusions To the relatively narrow male pelvis, laparoscopic total mesorectal excision and per anum rectal pull-through resection and anastomosis is safe and reliable for anus saving in low rectal cancer. It can simplify the operation, and raise the success rate of sphincter preserving in surgery of low rectal cancer.
Objective To evaluate the safety and ascendancy of small caliber stapler application for anterior resection in ultra-low rectal cancer with anal sphincter preservation. Methods A retrospective analysis of the data of 60 cases of ultra-low rectal cancer treated by anterior resection with anal sphincter preservation by double stapling technique according to TME principle between June 2006 and June 2009 were undertaken. The 60 patients were divided into two groups, each group included 30 cases. One group adopted 33 mm stapler and another group adopted 29 mm stapler, and then the profiles of medi-operation, post-operation, and prognosis were assessed. Results Time of simple anastomose in operation was (9.0±3.3) min in 33 mm stapler group and (6.0±2.6) min in 29 mm stapler group, and there was significant difference between them (P=0.022 5). There were 6 cases needed to be restored because of lesion during operation or dys-anastomosis in 33 mm stapler group, while 2 cases in 29 mm stapler group, there was significant difference between them (P=0.030 1). No significant differences were observed between the two groups in terms of the time for operation, leakage, bleeding, stenosis, anastomotic recurrence, and fecal incontinence after operation or length of stay. Conclusion The application of 29 mm stapler not only can shorten time for anastomose and step down the degree of difficulty, but also dosen’t increase stenostomia and other complications.
Objective To evaluate the clinical efficacy of fistula repair by stapler technique in patients with cervical tracheoesophageal fistula. Methods Retrospective analysis of 8 patients with cervical tracheoesophageal fistula who accepted operative treatment in the Department of Thoracic Surgery, Lanzhou University Second Hospital from October 2014 to October 2016 was conducted. There were 5 males and 3 females at a mean age of 46.4±13.9 years ranging from 23 to 67 years. The fistula was induced by tracheal intubation in 4 patients, by esophageal foreign bodies in 2, by tracheal stent in 1 and by esophageal diverticulum in 1. The fistula was closed by stapler technique. The surgical effects were evaluated through Karnofsky performance score (KPS), image assessment, patient satisfaction score and assessment of improvement in feeding-induced bucking. Results The operations were performed successfully with time of 117.5±6.6 min and intraoperative blood loss of 60.0±7.0 ml. After the operations, the patients did not suffer incision bleeding and infection, hoarseness, dyspnea, drinking-induced bucking, fistula relapse, tracheoesophageal stenosis or any other complications, and no death occurred during the perioperative period. The chest X-ray test was performed 1 week later showed that the pulmonary infection disappeared, and only 1 patient suffered from esophageal stenosis 1 year later. The postoperative KPS score was 90.0±7.0 points, which significantly improved in contrast to preoperation (P<0.01). Postoperative pulmonary infection area reduced significantly (P<0.05), tracheoesophageal fistula disappeared, postoperative patients satisfaction rate was 90%, and assessment of feeding-induced bucking was excellent. Conclusion Using stapler technique to repair cervical tracheoesophageal fistula is safe, easy and useful, with less operation time and postoperative complications.