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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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??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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??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 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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??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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大肠癌发病率有逐年代上升趋势 ,在我国城市已成为第三位常见恶性肿瘤。早期诊断是提高治愈率的关键 ,手术治疗仍是最有效的方法。但术后复发、转移仍是亟待解决的棘手问题。重视这一领域的问题具有十分重要的现实意义。1　大肠癌复发、转移的种类与频率　　大肠癌血行转移率最高 ,主要为肝、肺转移 ,约占 4 0 %～ 5 0 % ,与胃癌的腹膜转移相似。进行期直肠癌局部复发占首位 ,包括吻合口复发、手术野淋巴结转移与癌细胞种植 ,共约 4 0 % ,结肠癌则不足 30 %。腹膜转移在结肠癌约占 2 0 % ,在直肠癌则极为罕见。2　大肠癌复发、转移的解剖、…     

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??Breast magnetic resonance imaging with abbreviated protocol in detection and diagnosis of breast cancer WU Jing*??GUO Jia-jia??WANG Shu??et al. *Department of Radiology??Peking University People’s Hospital, Beijing 100044, China
Corresponding author: WANG Yi, E-mail: wangyi@pkuph.edu.cn
Abstract Objective To investigate the feasibility of breast magnetic resonance imaging (BMRI) with an abbreviated protocol (BMRI-AP) in detection and diagnosis of breast carcinoma. Methods A total of 214 patients with single lesion suspected by digital mammograms or ultrasounds admitted from May 2010 to December 2014 in Peking University People’s Hospital were performed BMRI. All patients underwent BMRI-AP and full diagnostic protocol BMRI (BMRI-FDP). Two radiologists detected and diagnosed breast carcinomas based on criteria of Breast Imaging Reporting and Data System (BI-RADS) . Sensitivity??specificity??positive predictive value (PPV) and negative predictive value (NPV) of BMRI-AP and BMRI-FDP were analyzed and compared. Results Both BMRI-AP and BMRI-FDP could detect 119 breast carcinomas that were confirmed by pathological analyses. The imaging acquisition and interpretation time of BMRI-AP and BMRI-FDP were 5min, 45s and 25min, 1200s, respectively. The ability of BMRI-AP and BMRI-FDP in determination of breast carcinoma were shown as sensitivity of 97.5% and 95.8%??specificity of 73.7% and 82.1%, PPV of 82.1% and 87.0%, and NPV of 95.9% and 94.0%, respectively. But there was no statistical significance (P=0.72, P=0.22, P=0.32, P=0.72). Conclusion BMRI-AP with shorter acquisition time and interpretation time has similar sensitivity and specificity in detection and diagnosis of breast cancer compared with BMRI-FDP. BMRI-AP is demonstrated as one of efficient imaging tool in screening breast carcinoma.     

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??Study of relation between lymph nodes metastatic ratio and prognosis of colorectal cancer JIANG Ke-wei, LIU Yan, YE Ying-jiang, et al. Department of Gastrointestinal Surgery, Peking University People’s Hospital, Beijing 100044, China
Corresponding author: WANG Shan, E-mail: shwang60@sina.com
Abstract Objective To study the relation between lymph nodes metastatic ratio??LNR??and disease-free survival (DFS) as well as overall survival (OS) in stage III colorectal cancer. Methods One hundred and twenty-four patients with stage III colorectal cancer performed radical resection between January 2000 and April 2004 in the Department of Gastrointestinal Surgery, Peking University People’s Hospital were analyzed. Patients were assigned to 3 groups based on LNR: LNR??0.167, 0.167≤LNR??0.562 and LNR≥0.562. The relation between overall and disease-free survival at 5 years and 10 variables including age, sex, tumor location, size, grade, histology, T stage, number of positive LNs, and LNR, was analyzed by multivariate analysis. Survival curves were constructed using the Kaplan-Meier method. Results Both LNR and the number of positive LNs were significant prognostic factors for 5ys-DFS and OS in patients with stage III colorectal cancer. LNR was an independent prognostic factor for 5ys-OS. LNR remained an independent prognostic factor in patients with not more than 12 lymph nodes examined. Conclusion LNR is an important prognostic factor in patients with stage III colorectal cancer, which should be used in future staging systems or stratification schemes for colorectal caner with metastatic LNs, especially for not more than 12 lymph nodes examined.     

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??Affact of perineural invasion on the prognosis of patients with rectum cancer FAN Ping, TIAN Jing-zhong, LI Guang-yun, et al. Department of General Surgery, Bozhou People’s Hospital, Bozhou236800, China Corresponding author: FAN Ping, E-mail: dengfang1992@sina.com Abstract Objective To analyze the effect of perineural invasion on evaluating the prognosis of patients with rectal cancer. Methods The clinical data of 213 patients with rectum cancer performed total mesorectal excision (TME) from 2000 to 2007 at Bozhou People’s Hospital were analyzed retrospectively. Paraffin sections of surgical specimens from all the patients who underwent TME were stained with laminin. The effect of PNI on overall survival (OS) in patients with rectum cancer and the association between PNI and other clinical and pathological parameters were analyzed. Results PNI was positive in 62 of all the 213 patients (29.11%). The size of tumors, T stage and clinical stage were related to PNI significantly. The OS of the PNI-positive patients [??23.04±9.95??months] was shorter than that of the PNI-negative patients [??52.10±14.61??months] in the univariate analysis significantly (P<0.01). And at multivariate Cox proportional hazards model of OS analysis, the positivity of PNI appeared to be an independent prognostic factor to OS , which was also influenced by tumor size, lymph node metastasis and clinical stage (P<0.01). Conclusion The incidence of PNI plays an important role in evaluation of the tumor classification, stage and the prognosis of rectum cancer and it could serve as an independent predictor of prognosis of rectum cancer.     

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??Study of clinical strategy of transanal endoscopic microsurgery in patients with colon or rectal tumor YIN Lu?? LIN Mou-bin, HUA Zhi-li, et al.Department of Surgery??RuiJin Hospital??Medical school of shanghai Jiaotong University, Shanghai200025, China. Corresponding author: YIN Lu??Email:yindalu@yahoo.com.cn Abstract Objective To evaluate the feasibility of transanal endoscopic microsurgery and discuss the possible difficulties during the operation. Methods The data of 36 patients undergoing transanal endoscopic microsurgery during the period September 2006 to June 2008 in Ruijin hospital were reviewed. Results Transanal endoscopic microsurgery was successfully performed in all the patients. There was no procedure converted to laparotomy. The average operative time was 71(20~200) min. The histologic diagnosis indicated 1 inflammatory mass, 22 adenomas, 5 carcinoids, 8 carcinomas. The average hospital stay after transanal endoscopic microsurgery was 4.7(3~9) days. There was no operation-related mortality. Complications included rectal bleeding (n=1),flatus incontinence (n=1). There was one local recurrence which was found in the 5 month. Conclusion Transanal endoscopic microsurgery is an effective, safe and minimally invasive surgical technique leading to a short hospital stay and less complications. Therefore, transanal endoscopic microsurgery can achieve similar or better consequence than traditional surgery.     

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??Comparison of different combined modality therapy after surgical treatment of large primary liver cancer with portal vein tumor thrombus WU Yu??ZHANG Zhi-wei??GAO Dan??et al. Hepatic Surgery Center??Tongji Hospital??Tongji Medical College??Huazhong University of Science and Technology??Wuhan 430030??China
Corresponding author??ZHANG Zhi-wei??E-mail??zwzhang@tjh.tjmu.edu.cn
Abstract Objective To study the value of surgical treatment for large primary liver cancer with portal vein tumor thrombus (PVTT) involving the main or first-order branches. Methods The clinical data of 87 large primary liver cancer patients with PVTT involving the main or first-order branches underwent hepatectomy and thrombectomy from January 2003 to December 2010 in Tongji Hospital??Tongji Medical College??Huazhong University of Science and Technology were analyzed retrospectively. The 87 patients were divided into 3 groups: group A only have hepatectomy and thrombectomy??group B have portal vein infusion chemotherapy after hepatectomy and thrombectomy??group C have transcatheter hepatic arterial chemoembolization after hepatectomy and thrombectomy. Results The 1-??2- and 3-year overall survival rates were 31.8%??12.7% and 6.4% for group A??44.7%??23.2% and 11.6% for group B and 49.0%??27.2% and 11.7% for group C??respectively. The overall survivals were significantly better in group B and group C than group A (P=0.049??P=0.033 respectively). There was no statistical significant difference in group B and group C (P=0.751). Conclusion Surgical intervention with postoperative transcatheter hepatic arterial chemoembolization or portal vein infusion chemotherapy is more effective than surgical intervention alone in treatment for large primary liver cancer with PVTT involving the main or first-order branches. However??it still needs to be carefully chosen if PVTT extends to the main trunk.     

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??Study of surgical stress on the aged abdominal major operation patients ZHANG Juan-juan?? GAO Tao??XI Feng-chan, et al. Research Institude of General Surgery??Nanjing General Hospital of Nanjing Military Command??PLA??Nanjing 210002??China
Corresponding??YU Wen-kui??E-mail??yudrnj@163.com
Abstact Objective To investigate the difference of surgical stress on the aged and non-aged abdominal major operation patients. Methods From February to April in 2013??a prospective study was performed of abdominal operation patients with gastrointestinal neoplasms in research institude of general surgery, including 36 aged patients (≥65 years old) and 37 non-aged patients (??65 years old). We observed differences of postoperative vital sign??white blood cell count??neutrophil proportion??C-reactive protein??plasma cortisol and ACTH in two groups??and analyzed these dates. Results Compared with the non-aged group??plasma cortisol of the first day after operation in aged group was much higher??P=0.049. C-reactive protein of the first day and the second day after operation in aged group was much lower??P(D1)=0.046??P(D2)=0.008. There were no differences of white blood cell count??neutrophil proportion and ACTH in two groups. Conclusion Compared with the non-aged patients??the stress hormone plasma cortisol of the aged abdominal major operation patients was much higher after operation??but the inflammatory reaction was not higher??and even lower.     

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??Comparison of self-expandable metallic stent placement for acute colorectal obstruction caused by extracolonic malignancy and colorectal cancer ZHOU Jia-min, ZHONG Yun-shi, XU Mei-dong, et al. Endoscopy Center, Zhongshan Hospital, Fudan University; Endoscopy Clinics Institute of Fudan University; Technology Engineering Research Center of Shanghai Endoscopy Clinics, Shanghai200032, China
Corresponding author??YAO Li-qing, ZHONG Yun-shi, E-mail??13564623481@126.com
Abstract Objective To evaluate the safety??efficacy and prognosis of self-expendable metallic stent (SEMS??placement in patients with acute colorectal obstruction (ACO) caused by extracolonic malignancies (ECM). Methods One hundred and nine cases of ACO admitted between November 2006 and April 2012 in Zhongshan Hospital of Fudan University were analyzed. The cases caused by metastatic or recurrent colorectal cancer (CRC) (n = 96) were compared with the cases caused by ECM (n = 13) in success rate??complications and survival time. Results ECM group included 8 cases of gastric cancer??61.5%????3 cases of gynecologic cancer??23.1%????1 case of bladder cancer ??7.7%??and 1 case of pelvic inflammatory fibroblastic tumor ??7.7%??. The technical success rate was 100% in both ECM group and CRC group. The clinical remission rate was not significantly different between the two groups (77.0% vs. 83.3%??P = 0.696). The stent patency time was also similar between the two groups (117.0 ± 148.8 vs. 188.2 ± 203.6??P =0.230). Stent related complications in ECM group included 2 cases of reobstruction and 1 case of migration. Symptom was not relieved in 1 case performed SEMS placement. There were not significantly difference in 30-day mortality??1-year survival rate and overall survival rate between two groups (P= 1.000??P= 0.140??P= 0.282). Conclusion The safety and effectiveness of SEMS placement in patients with ACO caused by ECM are comparable to that in patients with ACO caused by metastatic or recurrent CRC. It may be an appropriate option for treating malignant ACO.     

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??Clinical intervention study of low molecular heparin (LMH) and coagulopathy in critical post-surgical patients with infection WAN Lin-jun, HUANG Qing-qing, YUE Jin-xi, et al. Department of Surgical Intensive Care Unit, the Second Affiliated Hospital of Kunming Medical College, Kunming650101, China Corresponding author: WAN Lin-jun, E-mail: wanlj2003@yahoo.com.cn Abstract Objective To observe the index of blood coagulation, intervention treatment and safety of low molecular heparin (LMH) in critical post-surgical patients with infection. Methods The clinical data of 200 critical post-surgical patients with infection in the Department of SICU of Second Affiliated Hospital of Kunming Medical College between October 2006 and August 2009 as study group and 100 non-infection patients as comparative group in synchronization. The study group was randomly divided into infection group that 100 patients were treated regularly of ICU, and LMH treatment group that 100 patients were taken 40mg LMH by a subcutaneous injection twice per day on regular treatment in post-surgical 8 hours. All patients of study group and comparative group were observed regularly by ICU. PT, APTT, TT, FIB and side effect of Heparin such as hemorrhage in 7 days were observed. The patients accorded with the transfer criteria of ICU were gotten out from ICU during observation time. Results ??1??PT and APTT in all patients with infection compared with non-infection were time-lapse in post-surgical 1 to 7 days (P??0.01), and TT was time-lapse a little bit but located in normal range in post-surgical 6 to 7 days. FIB in all groups were similar in the first day (P??0.05). However, FIB in all of infection patients increased compared with that of comparative group in 2 to 7 days (P??0.01). (2) PT in LMH treatment group was shorter than infection group’s in post-surgical 4 to 7 days. APTT was time-lapse compared with that of infection group in post-surgical 5 to 7 days. TT did not change. FIB in LMH treatment group decreased compared with that of comparative infection group (P??0.01). (3) The proportion of getting out from ICU in LMH treatment group was higher than that of regular treatment group as observation was over (P??0.01). The time in ICU was not different (P??0.05). (4) Injection sites of three patients in LMH treatment group presented ecchymosis. Conclusion Critical post-surgical patients with infection usually accompany by phenomenon of coagulation activation and fibrinolytic inhibition. Early treatment by LMH in post-surgical patients with infection might improve coagulation activation and fibrinolytic inhibition, increase effect of combined therapy and have good safety.     

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目的　评价可分解吻合环 (BAR)在肠道吻合手术中的应用。方法　前瞻性对照研究将 2 0 0 1年 11月至 2 0 0 4年 2月收治的 131例行肠吻合术的病例分为两组 ,吻合环组 (BAR组 ) 6 7例 ,手工缝合组 6 4例。术后分别记录肠道功能恢复时间 ,与吻合口有关的并发症发生等。 92例结、直肠癌中 89例 (BAR组 4 5例 ,手工缝合组4 4例 )术后随访时观察吻合口炎症发生情况。另外 ,BAR组记录BAR排出时间。两组病例一般资料分布均衡。结果　BAR组死亡 1例 ,但与手术无关。BAR组未发生术后吻合口瘘 ,手工缝合组发生 2例 (3 12 % ) ;BAR组未发生吻合口出血和梗阻 ,手工缝合组发生 2例 (3 12 % ) ,两组间差异无显著性 (P >0 0 5 )。术后肠道功能恢复时间 :BAR组 (2 7 2± 5 6 )h ,手工缝合组 (4 9 6± 8 7)h ,两组间差异有显著性 (P <0 0 1)。BAR组发生吻合口炎症 1例 (2 2 2 % ) ,手工缝合组 11例 (2 5 0 0 % ) ,两组间差异有显著性 (P <0 0 1)。术后吻合环排出时间为(12 4± 6 9)d。结论　BAR是一种安全有效 ,可标准化的肠道吻合方法 ,特别是对急诊的高危病例     

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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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??Clinical research of two kinds of open operation in herniorrhaphy with artificial synthetic material for parastomal hernias SHEN Ying-mo, CHEN Jie. Center of Hernia and Abdominal Wall Surgery, Beijing Chaoyang Hospital, Capital University of Medical Science, Beijing 100020, China Abstract Objective To evaluate the effect of two kinds of open operation in herniorrhaphy with artificial synthetic material for parastomal hernias by the application with the method of IPOM or Onlay respectively. Methods The clinical data of 48 patients with parastomal hernia admitted from January 2002 to July 2007 at Beijing Chaoyang Hospital of Capital University of Medical Science were analyzed retrospectively. Twenty-five patients received Bard CK parastomal patch repair (IPOM group). Twenty-three patients received Bard Marlex mesh repair (Onlay group). Data collected included operation time, days of postoperative stay, the cases of postoperative complications. The data were analyzed by statistical method. Results No significant difference was found between the two groups in the operation time and the days of postoperative stay. During the follow up period of 6??72 months, there was no recurrence but there were 2 cases of wound infection, 2 cases of subcutaneous seroma and 3 cases of postoperative chronic pain or foreign body sensation in the IPOM group. There were 5 cases of recurrence, 4 cases of wound infection, 6 cases of subcutaneous seroma and 9 cases of postoperative chronic pain or foreign body sensation in the Onlay group. The incidence of recurrence and postoperative chronic pain or foreign body sensation in the IPOM group were lower than those in the Onlay group significantly (P<0.05). Conclusion The two kinds of open operation in herniorrhaphy with artificial synthetic material for parastomal hernias are safe and effective surgical procedures. The method of IPOM can diminish the incidence of recurrence and postoperative chronic pain or foreign body sensation, and diminish the incidence of postoperative wound infection and subcutaneous seroma.     

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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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??Research on the treatment of chronic pain after tension-free repair of inguinal hernia MENG Ling-qin??YANG Fu-quan. Department of General Surgery??Shengjing Hospital of China Medical University??Shenyang 110004??China
Corresponding author??YANG Fu-quan??E-mail??Yangfq@sj-hospital.org
Abstract Objective To explore the prevention and treatment of chronic pain after tension-free repair of inguinal hernia. Methods The clinical data of 802 patients with inguinal hernia underwent the tension-free hernioplasty from October 2010 to October 2013 in Shengjing Hospital of China Medical University were analyzed retrospectively. Results Twenty-one patients had chronic pain after operation including 20 patients in open operation and 1 patient in laparoscopic operation. Incidence rate of chronic pain after laparoscopic operation is lower than open operation (P??0.05). Mild, moderate and severe pain occurred in 12, 8 and 1 patient respectively. The patient who had severe pain was relieved after reoperation and others who had mild or moderate pain were improved or recovered by medical treatment. Conclusion Careful and proper operation by special doctor of hernia surgery can reduce the incidence rate of chronic pain??and operation is the last method for the patients who have intractable pain.     

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??Clinical research of the method of lymph node anatomy after axillary dissection in breast cancer ZHANG Qin-qin, WANG Ning-xia. Department of Breast Surgery, the First Affiliated Hospital of Jinan University, Guangzhou 510630, China
Corresponding author: WANG Ning-xia, E-mail??13316268808@163.com
Abstract Objective To explore the effect of pretreating the axillary lymphatic tissue by liposuction before the anatomy in breast cancer patients. Methods A total of 82 cases of stage ?? breast cancer were performed modified radical mastectomy between March 2011 and October 2013 in the First Affiliated Hospital of Jinan University. The axillary lymphatic tissue was soaked in liposuction by 15—20 minutes after the modified radical mastectomy (experimental group). The number of lymph node, the minimum diameter and the time of anatomy in experimental group were compared with those in control group (traditional anatomy method). Results The mean number of lymph node in experimental group was higher than that in control group (23.10 vs. 18.38, P =0.000). The mean minimum diameter in experimental group was less than that in control group (0.16cm vs. 0.25 cm, P =0.000). The median time of the duration of anatomy in experimental group was shorter than that in control group (19.95 min vs. 24.02 min, P =0.000). The difference in the number of lymph node between the two groups was more significant in the obese patients than in the non-obese patients (7.00 vs. 3.52). There was no significant difference in the pathological section between two groups. Conclusion The method of pretreating the axillary lymphatic tissue by liposuction in breast cancer can increase the number of detection, make the anatomy easily and shorten the time of anatomy, which is particularly recommended for obese patients.