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??Objective:To investigate the security and the operative experiences of laparoscopic ventral incisional herniorrhaphy. Methods:The laparoscopic mesh repair was performed for 79 patients with abdominal ventral incisional hernias from March 2004 to May 2006 in Hua Shan Affiliated Hospital of Fu Dan University. Results:Laparoscopic incisional herniorrhaphy with meshes was successfully performed in 98.7% (78/79) of patients.One case (1.3%) was converted to an open procedure because of extensive adhesion intraperitoneally. The mean operating time was 88 minutes and postoperative hospital stay averaged 4.6 days.Eighteen (22.8%) patients were found to have more than one hernial defect intraoperatively.Postoperative complications included severe pain in operative area temporary (n=58,73.4%),prolonged pain in suture site (n=6,7.6%),seroma (n=14,17.7%),intestinal fistula (n=1,1.3%) and recurrence (n=1,1.3%). Conclusion:Laparoscopic ventral incisional herniorrhaphy with meshes can be performed in most of incisional hernias after complete dissection of adhesions,through the laparoscopy it may find others defects.But the postoperative pain is severe in repair area.If extensive dense adhesion will interfere with the manipulation and lysis,the patients should be converted to open operation.     

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??Surgical and endovascular treatment of thromboangiitisobliterans LIU Bing, HUANG Ren-ping. Department of Vascular Surgery, the First Affiliated Hospital of Harbin Medical University, Harbin 150001, China
Corresponding author: HUANG Ren-ping, E-mail: cup521@163.com
Abstract Objective To investigate the outcomes of surgical and endovascular treatment for thromboangiitisobliterans. Methods The clinical data of 202 patients with thromboangiitisobliterans underwent surgical and endovascular treatment in the First Affiliated Hospital of Harbin Medical University from April 2006 to April 2015 were analyzed retrospectively. According to the outcomes of ankle brachial index (ABI) and the Rutherford classification value (R-value), the effectiveness of different operation methods were evaluated. Results The Rutherford classification value evaluation??One month after operation, R-value decreasedin all 4 groups??P<0.05??. Six months after operation, R-value decreased in lumbar sympathectomy group, sequential endarterectomy group and sequential endarterectomy combined with lumbar sympathectomy group??P<0.05??. Twelve months after operation, R-value decreased in sequential endarterectomy group and sequential endarterectomy combined with lumbar sympathectomy group??P<0.05??.ABI evaluation??One week after operation,ABI increased in all 4 groups ??P<0.05??. Six months after operation, ABI increased in sequential endarterectomy combined with lumbar sympathectomy group??P<0.05??. Twelve months after operation, ABI increased in sequential endarterectomy group and sequential endarterectomy combined with lumbar sympathectomy group??P<0.05??. Conclusion Percutaneous transluminal angioplasty (PTA) and lumbar sympathectomy can bring benefit to the patient with TAO in the short term. Sequential endarterectomy combined with or without lumbar sympathectomy are proved to be effective as a surgical method for TAO.     

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??Clinical application of ultrasound-guided core needle biopsy for breast lesions LI Jin-ping*, LI Juan , WU Li-gang,et al.*Chongqing Medical University, Chongqing 400016, China
Corresponding author ??LIU Qi-lun, E-mail??liuql6311@hotmail.com
Abstract Objective To evaluate the clinical value of ultrasound-guided core needle biopsy (US-CNB) as a preoperative diagnostic modality for breast lesions. Methods Data were collected prospectively from August 2007 to May 2009 for 115 ultrasound-guided core needle biopsy that were followed by excisional breast procedure (EP) within 1 week at our hospital. The histopathological diagnosis on ultrasound-guided core needle biopsy was then compared with the findings of the excisional biopsy. Results Out of the total 115 cases, US-CNB showed 81 as invasive ductal carcinoma, three invasive lobular carcinoma, two ductal carcinoma in situ??two atypical ductal hyperplasia and 26 benign disease. The principle histology identified at CNB was confirmed at EP for 93.9% of the lesions, generating a kappa value of 0.891(P??0.01). The sensitivity for malignancy with CNB was 95.6% and the specificity was 100%. The false negative rate was 4.39% and the false positive rate was 0. Overall, our results indicate moderate agreement between the principal histology identified at USB relative to that identified at EP. Conclusions Ultrasound-guided core breast biopsy is a satisfactory procedure for the histopathological diagnosis of breast lesions. Any unsatisfactory, suspicious or atypical change on US-CNB should be followed by an open biopsy.     

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??Establishment and value of three-dimensional visualization diagnosis platform in the treatment of hepatolithiasis FANG Chi-hua, FANG Zhao-shan, CAI Wei, et al. The First Department of Hapatobiliary Surgery, Zhujiang Hospital, Southern Medical University, Guangzhou510282,China
Corresponding author:FANG Chi-hua,E-mail: fangch_dr@126.com
Abstract Objective To study the establishment and value of three-dimensional visualization diagnosis platform in the treatment of hepatolithiasis. Methods The clinical data of 112 consecutive patients with hepatolithiasis between January 2008 and April 2015 in the First Department of Hepatobiliary Surgery, Zhujiang Hospital, Southern Medical University were analyzed. (1) In order to acquire submillimeter CT data, each patient underwent the spiral CT epigastric enhancement scanning. Medical image three-dimensional visualization system (MI-3DVS) was used to establish three-dimensional visualization image model. (2) The three-dimensional visualization analysis covered the vascular classification, the classification of clinical diagnosis, liver segments, virtual hepatectomy and liver volume calculation with three-dimensional visualization technology. (3) Preoperative evaluation and surgical planning were performed to select a reasonable plan. (4) The 3D printing of liver might be performed when necessary, which help to perform the precise surgery. (5) Therapeutic effect was evaluated. Results All the patients had a real reconstruction of three-dimensional visualization image model based on CT images. The position and distribution of calculus, location and degree of biliary stricture, vascular anatomic relationships were shown in the three-dimensional visualization image model clearly. The category of hepatic artery, hepatic vein and portal vein were made. The three-dimensional visualization diagnostic classification of hepatolithiasis and liver segments was also performed. The relationships between lesions and vasculature were shown in the 3D printing model of liver. The three-dimensional visualization preoperative evaluation and 3D printing model were in tune with actual operation. The stone residue rate, incidence rate of complications and calculus recurrence rate was less than 3.0%, 5.6% and 2.4% respectively. Conclusion The establishment of three-dimensional visualization diagnosis platform for hepatolithiasis could help to improve the clearance of calculus and decrease postoperative complications. It could provide safe, precise, minimally invasive and efficient therapeutic measures for hepatolithiasis and has a good clinical prospect.     

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??A comparative study of omentum wrapping in pancreaticojejunostomy for reducing postoperative pancreatic fistula XU Jie-ru*??CHEN Chao??SHEN Ning-jia??et al. *Medical College of Soochow University??Suzhou 215000??China
Corresponding author: ZHANG Yong-jie, E-mail: yjoy005@sina.com
Abstract Objective To investigate the efficacy of the omentum wrapping technique in pancreaticojejunostomy on decreasing the incidence of pancreatic fistula after pancreaticoduodenectomy. Methods The clinical data of 225 patients underwent pancreaticoduodenectomy and pancreaticojejunostomy in single operation group from January 2009 to October 2015 in No.2 Department of Biliary Tract Surgery, Eastern Hepatobiliary Surgery Hospital Affiliated to the Second Military Medical University were analyzed retrospectively. Patients were divided into two groups??including group with omentum wrapping technique (n=125) and control group without it (n=100). After propensity score matching??the rates of pancreatic fistula were compared between the two groups??including group with omentum wrapping technique (n=64) and control group without it (n=64). Results All operations were completed successfully. The overall complication rate of all 225 patients was 62.7%??141/225??. The reoperation rate was 2.7%??6/225??. The mortality is 2.7%??6/225??. The incidence of pancreatic fistula was 46.7%??105/225????including 61 cases of Class A??37 cases of Class B??and 7 cases of Class C. The incidence of bleeding was 11%??25/225??. The incidence of DGE was 24.9%??56/225??. The incidence of abdominal infection was 20.9%??47/225??. Except the incidence of pancreatic fistula??there was no statistical difference between the two groups in the incidence of bleeding??DGE and abdominal infection??P>0.05??. In the omentum wrapping group, no reoperation case occurred??and there were only 2 death cases. In the control group??there were 4 reoperation cases and 4 death cases. There was no significant difference between the two groups in those data??P=0.119, 0.680??. In the PSM model??soft pancreas??pancreatic duct diameter and omentum wrapping were related to the postoperative pancreatic fistula in single factor analysis. In the multiple factors analysis??pancreatic duct diameter <3 mm and no omentum wrapping were independent risk factors for pancreatic fistula. Conclusion The omentum wrapping technique can decrease the rate of pancreatic fistula and it is worth applying in pancreaticojejunostomy.     

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??Surgical anatomy of superior mesenteric vessels and its distributaries XIAO Yi??LU Jun-yang??XU Lai. Department of General Surgery??Peking Union Medical College Hospital??Peking Union Medical College??Chinese Academy of Medical Sciences??Beijing 100730??China
Corresponding author: XIAO Yi??E-mail: xiaoy@pumch.cn
Abstract Objective To study the surgical anatomy of superior mesenteric vessels and its distributaries in the pancreaticoduodenal area. Methods The prospective observational trial included 27 patients performed laparoscopic complete mesocolic excision (CME) procedure in order to study the anatomical artery-vein relationships of the ileocolic vessels??right colic vessels??middle colic vessels??and the configurationally relationship of the distributaries to Henle’s trunk. Results Ileocolic vessels were found in each patient. The probability of right colic artery and vein were 33.3% and 11.1% respectively. The middle colic artery and vein were found at a rate of 88.9% and 92.6% respectively. The length of middle colic artery was 1.9??0 to 7.2??cm. The probability of Henle’s trunk was 92.6%??with the length of 0.8 ??0.2 to 2.4??cm. There were 2 to 5 branches drained into Henle’s trunk. Conclusion Laparoscopic CME procedure should start at dissecting ileocolic vessles??because of its constant location. Getting familiar with the complicated anatomic configuration of pancreaticoduodenal area would be helpful to precisional surgery.     

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目的 探讨大肠癌区淋巴结微转移的检测和临床意义。方法 采用逆转录聚合酶链反应（ＲＴＰＣＲ）技术,扩增角蛋白１９（Ｋ１９）,１２例病人大肠癌肿瘤组织和９５个区域淋巴结进行检测。结果 １２例病人大肠癌组织均有Ｋ１９ｍＲＮＡ表达,良性病人的２１个淋巴结均无表达。大肠癌区域淋巴结１１个经病理检查有转移,其Ｋ１９ｍＲＮＡ表达阳性。８４个病理检查未发现转移的淋巴结中有８个Ｋ１９ｍＲＮＡ表达阳性。结论 Ｋ１９ｍ     

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??Application of 3-D visualization technique in the preoperative evaluation of 20 patients with iatrogenic biliary stricture YAN Jia-yan*, LI Tai-xi, HE Min,et al. *Department of Pancreaticobiliary Surgery, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China
Corresponding author: WANG Jian, E-mail??dr_wangjian@126.com
Abstract Objective To explore the value of 3-D visualization technique in preoperative evaluation and operation procedures selection in the repairing of iatrogenic biliary strictures. Methods The clinical data of 20 patients with biliary stricture due to iatrogenic injury who were underwent surgical treatment from January 2014 to March 2018 in Department of Pancreaticobiliary Surgery??Renji Hospital, Shanghai Jiao Tong University School of Medicine were analyzed retrospectively. 3-D visualization processing and evaluation were done by 3-D visualization workstations based on abdominal enhanced CT data of all the patients. Variations of hepatic vasculatures??location of biliary strictures??liver atrophy??porta hepatis rotation??hepatolithiasis and depth of porta hepatis were evaluated by enhanced CT and 3-D visualization technique respectively. The consistence between preoperative operation plan made by 3-D visualization and actual operation procedures were compared. Patients were followed up of biliary stricture??liver function and quality of life in the long-term. Results The Bismuth classification of biliary stenosis evaluated by 3-D visualization technique was completely consistent with intraoperative evaluation??while enhanced CT mistaked 2 cases of Bismuth I for Bismuth ?? and one case of Bismuth ?? for Bismuth ??. Several variations of hepatic artery and portal vein were ignored by enhanced CT??but detected by 3-D visualization technique.The range of depth of portal hepatic and length of transverse part of left hepatic duct were(-10.1~+21.1)mm and??15.2±4.6??mm respectively. Preoperative operation plan made by 3-D visualization and actual operation procedures were identical. Vascular injury and massive hemorrhage did not occur intraoperatively. Conclusion The accuracy of preoperative evaluation can be improved by using3-D visualization technology??which is conducive to the formation of reasonable surgical path, plan and improvement of surgical safety.     

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??Relationship between preoperative combined subclinical hypothyroidism and prognosis of papillary thyroid carcinoma LI Xiao-ke??ZHANG Qin??QIU Nian-cun??et al. Department of General Surgery??Chang Zheng Hospital Affiliated to Second Military Medical University??Shanghai 200003??China.
Corresponding author??QIU Ming??E-mail??qium127@sina.com
Abstract Objective To assess the difference between preoperative subclinical hypothyroidism and euthyroidism on prognosis and clinicopathological features of papillary thyroid carcinoma (PTC). Methods A total of 656 patients underwent surgery for PTC between January 2005 and December 2007 in Chang Zheng Hospital Affiliated to Second Military Medical University was enrolled in the study. All the clinical pathological factors between 70 patients with preoperative subclinical hypothyroidism and 514 patients with euthyroidism before the operation were compared. The difference factors were analyzed by multivariate logistic regression analysis. Results No significant difference was observed in tumour size??extrathyroidal extension and multifocality between subclinical hypothyroidism and euthyroid patients. But metastatic rate of lymph nodes in patients with subclinical hypothyroidism was less than that in euthyroid patients??8.6% vs. 21.8%??P=0.068??. Conclusion Subclinical hypothyroidism with elevated TSH is not an independent predictor of tumour aggressiveness and poor prognosis in PTC.     

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??How to establish a high quality clinical surgical research LIU Lian-xin.Department of General Surgery, the First Affiliated Hospital of Harbin Medical University??Harbin150001,China Abstract Although the development of general surgery today is rapid, there are still many obstacles yet to be studied and solved. We should design ethics of clinical research to be retrospective on the basis of the past and the prospective practical work, also taking in account the scenarios of latest advancement from home and abroad, guided by the experience of others and experts. Clinical studies besides being deserving should be practical, scientific, feasible, and innovative. In addition, clinical studies should be using different research methods and statistical analysis techniques in the light of different research objectives to finally reveal the mechanisms of different diseases and assiduously tackle them.     

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目的　了解甲状腺滤泡状癌细胞中导入内皮抑素 (Endostatin ,ES)基因对体内外生长的影响 ,并探讨其作用机制。方法　用逆转录病毒载体将ES基因导入FTC133 细胞中 ,采用RT PCR和ELISA检测导入基因在肿瘤细胞的表达。观察肿瘤在裸鼠模型中的生长状况。用抗CD31抗体对肿瘤切片进行免疫组织化学染色检测微血管 ,计算微血管密度 (microvesseldensity ,MVD)。检测血清中ES和VEGF浓度。 结果　顺利将ES基因导入到FTC13 3 中得到稳定表达ES的肿瘤细胞系FTC133 rvEndo。后者在体外增值速度与母系相似。而在裸鼠模型中 ,其肿瘤生长速度明显慢于母系。种植 33天后 ,FTC133 组肿瘤大小为 ( 30 0 2± 44 1)mm3,FTC13 3 rvEndo组为 ( 5 5 7± 15 2 )mm3,两组间差异有显著性 (P =0 0 0 0 2 )。免疫组化染色表明FTC133 rvEndo肿瘤中血管内皮细胞数明显减少 ,MVD为 34 86± 10 6 8;而对照组为 6 4 71± 17 0 5 ,差异有显著性 (P =0 0 0 2 0 )。带瘤鼠血清人VEGF浓度FTC133 rvEndo组为 ( 8 99± 0 6 5 )ng/L ,明显低于对照组 ( 2 9 34± 5 5 5 )ng/L( P =0 0 0 98)。结论　利用逆转录病毒载体可将ES基因转入甲状腺滤泡状癌细胞系中 ,该基因的导入通过抑制血管生成使肿瘤体内生长速度减慢。其机制可能与抑制肿瘤细胞     

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目的前瞻性地观察肝移植术后早期应用重组生长激素(rhGH)的有效性和安全性。方法将2003年1～10月在中山大学器官移植研究所肝移植中心接受原位肝移植的30例良性终末期肝移植病人随机分为观察组和对照组两组,观察组于术后第1天开始连续7d每天1次皮下注射重组人生长激素10U,其它治疗与对照组相同。术前及术后1、4、8、14天测定生化、免疫和营养等指标,并观察两组的感染率和排斥率。结果观察组术后第4、8、14天血清测定生长激素(GH)、胰岛素样生长因子-1(IGF1)水平较对照组显著升高(P<0.05);而术后4、8天谷丙转氨酶(ALT)、血清尿素氮(BUN)和转铁蛋白较对照组显著降低(P<0.05)。观察组感染率较对照组降低,但两组差异无显著性,同时两组血清IgG,IgM,IgA,IL2水平CD4/CD8值及急性排斥反应发生率差异均无显著性(P>0.05)。结论rhGH能促进肝移植术后肝细胞损伤的修复与GH-IGF-1轴的恢复,能适当降低术后感染率且未增加急性排斥反应发生率。     

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??Clinical comparative study of laparoscopy versus open surgery in the treatment of portal hypertension YAO Ying-min, ZHENG Xin, WU Zhen-hua,et al. Department of Hepatobiliary Surgery,the First Hospital, School of Medicine,
Xi’an Jiaotong University, Xi’an 710061, China
Corresponding author:LIU Qing-guang, E-mail:liuqingguang@vip.sina.com
Abstract Objective To evaluate the advantage of total laparoscopic splenectomy and pericardial devascularization compared to traditional open operation and investigate its feasibility, superiority and operation skill. Methods The preoperation data of 7 patiens who had received total laparoscopic splenectomy and pericardial devascularization in the First Affiliated Hospital of Medical College of Xi’an Jiaotong University from February 2007 to July 2008 were retrospectively analyzed. And according to the result, open operation control group was selected. Simulating the random controlled trial (RCT), the perioperative data between both groups were retrospectively analyzed. Results The intraoperaive blood loss and length of postoperative hospitalization were both obviously less in the laparoscope group. However, the operative time , postoperative complication and cost of hospitalization were similar in both groups. Conclusions Total laparoscopic splenectomy and pericardial devascularization can be applicated safely in the treatment of portal hypertension.Compared to the traditional open operation, there are several advantages such as minimal invasion, faster recovery, beautiful outlook and so on. But it must be cautious to control the indication and select the performers.     

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??Microalbuminuria as predictor of outcome after major abdominal surgery ZHU Guo-chao, LI Rong??QUAN Zhuo-yong??et al.Department of Surgery , the Affiliated Hospital of Jianghan University, Wuhan 430015,China
Corresponding author : LI Rong??E-mail: rongman@163.com
Abstract Objective To evaluate microalbuminuria as predictor of outcome after major abdominal surgery. Methods Microalbuminuria (ACR) was measured in 48 hours post-operation and arterial lactate, PaO2/FiO2 ratio at ICU admission. Receiver-operator curves (ROC) were constructed to compare ACR, physiological and operative severity score for the enumeration of mortality and morbidity (POSSUM) score, LAC and PaO2/FiO2 ratio to predict outcome. Results A total of 13 postoperative complications were recorded in 118 patients (11%). ACR at ICU admission and 6, 12, 18, 24 and 48 hours at ICU was significantly higher in patients with postoperative complications than in those without complications ??P≤0.001??. ACR at 24 and 48 hours were positively correlated with POSSUM ??r=0.374, P??0.001??r=0.390, P??0.001????LAC??r=0.381, P<0.001??r=0.296, P=0.001??and LAC ??r=0.381, P<0.001??r=0.296, P=0.001??and inversely correlated with mean PaO2/FiO2??r=-0.27, P=0.003??r=-0.251, P=0.006). The area of ROC of ACR at ICU 24, 48 hour and POSSUM to morbidity was statistically higher than 0.5 (0.857 vs 0.946 vs 0.89). Using a cutoff for ACR at ICU 24 hour of 5.0g/mol. The sensitivity for complication was 86.7%, with specificity of 33.3% and the positive predictive value of death was 16.9%, with negative predictive value of 94.1%. Conclusion ACR is a valuable predictor of in-hospital outcome after major abdominal surgery.     

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??Paying attention to clinical study of surgical treatment for main vascular diseases in abdomen WANG Shen-ming. The First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, China Abstract The recent development and situation of the treatment for main vascular diseases in abdomen had been reviewed through vein and artery system in the article. It is showed that surgical therapy is an important method for the abdominal vascular diseases and the clinical study must be focused.     

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??Application of negative pressure ball drainage on the perianal abscess in deep parapharyngeal space : a study of curative effect PAN You-zhen, ZHEN Jin-xia, ZHENG Zhen-lin. Department of Proctology Surgery, Gongli Hospital of Pudong New Area, Shanghai 200135, China. Corresponding author: ZHEN Jin-xia, E-mail: zhenjinxia8@163.com Abstract Objective To study the clinical effect of the negative pressure ball drainage in the application of postoperative perianal abscess in deep parapharyngeal space. Methods The 60 patients with perianal abscess in deep parapharyngeal space admitted between January 2007 and August 2008 at Gongli Hospital of Pudong New Area of Shanghai City were randomly divided into negative pressure ball group (treatment group n=30) and vaseline gauze group (control group n=30). Occurrence of pain, postoperative analgesic, postoperative drainage and wound healing time were compared respectively. Follow-up was performed in 3 months, 6 months and 12 months after the operation in order to observe the occurrence of secondary anal fistula. Results Occurrence of pain, postoperative analgesic, postoperative drainage and wound healing time of treatment group was lower than those of the control group (P <0.01). Incidence of secondary anal fistula of treatment group was lower than that of the control group (P <0.01). Conclusion Negative pressure ball is very suitable for postoperative drainage of perianal abscess in deep parapharyngeal space.     

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??Diagnosis and treatment of central venous stenosis in haemodialysis patients SHI Ya-xue*, ZHANG Hao, LIANG Wei, et al. *Department of Vascular Surgery, Affiliated Ren Ji Hospital of Shanghai Jiao Tong University, Shanghai 200001??China
Corresponding author: ZHANG Ji-wei, E-mail??zhangjiwei001@sina.com
Abstract Objective To investigate the diagnosis and treatment experience of central venous stenosis (CVS) in haemodialysis patients. Methods The clinical data of 13 haemodialysis cases of central vein stenosis admitted from July 2006 to July 2008 at Affiliated Ren Ji Hospital of Shanghai Jiao Tong University were analyzed retrospectively. Results Among all the cases, 61.54% of them had a history of catheterization with arm swelling and venous hypertension. One case was bilateral disease and others were unilateral including 2 cases of subclavian vein occlusion, 2 cases of branchiocephalic vein occlusion, 3 cases of branchiocephalic stenosis and 5 cases of subclavian vein stenosis. Management methods included PTA, subclavian vein-contralateral subclavian vein bypass and ligation of the access. All the cases were syptom-free. Conclusion Central venous stenosis in haemodialysis cases is accompanied with severe clinical symptoms and affected the use and the life of vascular access. Venography is the first choice for the diagnosis and the current management of CVS is far from being effective for the long term.     

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医学影像学是临床医学科学中发展较快的学科之一。在原有X线造影检查基础上，计算机体层成像(CT)、磁共振成像(MRI)、超声等断面成像技术应用于腹部之后，使腹部疾病的诊断发生了质的变化。近年来，随着影像技术的迅速发展，如多排螺旋CT、高场强MRI、肝脏功能成像、组织(器官)特异性对比剂、彩超、各种介入技术在临床上的应用，使影像技术在腹部疾病中所发挥的作用已经超越了单纯的定位与定性诊断，并在选择治疗方案、制定详细手术计划、疗效评估以及微创治疗等方面，正在发挥着越来越大的作用。因此，作为普外科医生应重视影像技术的临床应用研究，熟知各种影像技术的特点，掌握其适应证，更加充分地利用影像技术为普外科临床服务。