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??Contrast study of short-term effect between the da Vinci surgical robot and laparoscopic technology in right hemicolectomy for colon carcinoma LIU Dong-ning??XIONG Ling-qiang??ZOU Zhen??et al. No.5 Department of General Surgery??the First Affiliated Hospital of Nanchang University??Nanchang 330006??China
Corresponding author??LI Tai-yuan??E-mail??jylitaiyuan@sina.com
Abstract Objective To compare the short-term surgical outcomes of robot-assisted right hemicolectomy (RA group) with laparoscopic-assisted right hemicolectomy (LA group) for colon carcinoma in order to evaluate the safety and feasibility of robotic surgery system. Methods The clinical data of 30 cases in RA group and 30 cases in LA group both admitted from December 2014 to May 2016 in Department of General Surgery, the First Affiliated Hospital of Nanchang University were analyzed retrospectively. Perioperative situation was compared between the two groups. Results The estimated blood loss was significantly lower in the RA group than that in the LA group ???87.3±26.1??mL vs. ??132.2±31.6??mL??P<0.05??. The operating time in the RA group was significantly longer than that in the LA group???152.3±12.4??min vs.??125.7±29.0??min??P=0.012??. Compared with the LA group??the times to first flatus passage were significantly shorter in the RA group???61.5±9.4??h vs. ??69.7±10.5??h??P=0.042??. The 24 hour pain scores in the RA group were significantly less than those in the LA group. Overall hospital costs in the RA group were significantly higher than that in the LA group????52235.7±528.2 vs. ??41263.5±436.1??P=0.006??. Compared with the LA group??the RA group had larger number of lymph node dissection??15.6±4.5 vs. 12.5±2.9??P=0.036??. Conclusion Compared with laparoscopic-assisted right hemicolectomy??robotic surgery has less harm to the patients??with better resection of primary tumor??and more thorough dissection of lymph nodes. Thus??it is feasible and safe for colon carcinoma.     

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??Comparative study of clinical efficacy of precision biliary surgical technique and traditional surgery for gallbladder carcinoma LI Mao-lan, ZHU Yi-di, WU Xiang-song, et al. Department of General Surgery, Xin Hua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200092, China
Corresponding author??LIU Ying-Bin??E-mail??laoniulyb@163.com
Abstract Objective Discuss the value and clinical applications of precise biliary surgery theory and technology in gallbladder tumor resection.Methods The clinical data of 97 patients with gallbladder cancer who received radical cholecystectomy in XingHua Hospital, Shanghai Jiao Tong University School of Medicine from January 2000 to June 2015 were retrospectively analyzed??All the patients were divided into 2 groups??38 patients who were admitted from January 1986 to December 2006 were in the traditional surgery group??and 59 patients who were admitted from January 2011 to June 2015 were in the precision surgery group??The perioperative condition and prognosis of the patients in the 2 groups were compared??Results There were no significant differences in the clinicopathological characteristics, such as gender, age, histological grade, the TNM stage, median volume of intraoperative blood loss and duration of postoperative hospital stay between the two groups. The ratios of extended radical operation were 35.5??(21/59)in the precision surgery group, and 15.6%(6/38)in the traditional surgery group??with significant difference between the 2 groups(χ2=4.513??P<0.05)??Patients in the precision surgery group had significantly higher R0 resection rate (66.1% vs. 18.4??, P??0.05) and median dissected lymph node number (26.0±12.1 vs. 17.0±9.1, P??0.05).The median survival time was 19.2 months in patients in the precision surgery group??and the 1- and 3- year survival rates of patients were 62.7%??28.8% respectively. The median survival time was 9.9 months in patients in the traditional surgery group??and the 1- and 3- year survival rates of patients were 42.1%??7.89% respectively. There was a significant difference between the 2 groups. The differences of the median volume of intraoperative blood loss??complication rates??duration of postoperative hospital stay between the 2 groups were notstatistically significant. Conclusion Application of the concept and techniques of precision biliary surgery significantly increase the radical resection rate and improve the therapeutic outcomes.     

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??Comparative study of clinical curative effect on reduced incision laparoscopic surgery and multi-incision laparoscopic surgery in rectal cancer ZHANG Qing-tong*, LIU Ya-li, ZHANG Xu, et al. *Department of Colorectal Surgery??Cancer Hospital of China Medical University, Liaoning Cancer Hospital & Institute??Shenyang 110042, China
Corresponding author??SONG Chun??E-mail??songchun1@hotmail.com
Abstract Objective To investigate the short-term and long-term clinical curative effects on redued incision laparoscopic surgery and multi-incision laparoscopic surgery in rectal cancer. Methods A retrospective study of 124 cases of rectal cancer admitted from June 2010 to June 2012 in Liaoning Cancer Hospital was conducted??in which were excluded the cases with high years old and dysfunction of the heart and lung or the other important viscera??and with the distance less than 6 cm from the inferior tumor margin to the anal edge and the rectal cancer of the ??and ??stages. A total of 62 cases proceeded the reduced incision laparoscopic surgery ??reduced incision group?? and 62 cases undergone the multi-incision laparoscopic surgery??multi-incision group??simultaneously. Results Two groups had no statistically significant difference in operative time, intraoperative bleeding, the number of lymph node harvest, the incidence of anastomotic leakage and anus reserved, completeness of specimen, distance to proximal margin,ditance to distal margin, positive rate of circumferencial resection margin (CRM) and distal resection margin (DRM), local recurrence rate, 3-year disease free survival rate, 3-year overall survival rate, etc.( all P??0.05).But the total length of incision??postoperative pain score of the first and the second day??anal exhausting time?? independently walking for the first time between two groups had statistically significant diferences( all P??0.05). Conclusion Reduced incision laparoscopic rectal cancer surgery can decrease the total length of incision, lower postoperative pain degree??shorten anal exhausting time??and improve cosmetic effect. And the kind of approach does not prolong operative time significantly??and the quality of tumor resection??and 3-year disease free survival rate?? 3-year overall survival rate are not inferior to multi-incision laparoscopic surgery.     

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??Associating partial pancreatectomy and extended extrahepatic bile duct resection VS. pancreatoduodenectomy for the middle cholangiocarcinoma involving the pancreas bile duct: clinical analysis of 41 cases YIN Lei* ,FANG Zheng,YUAN Bo, et al. *No.2 Department of Biliary Surgery, Eastern Hepatobiliary Surgery Hospital, the Second Military Medical University, Shanghai 200438, China
Corresponding author:ZHANG Yong-jie, E-mail??510531179@qq.com
YIN Lei,FANG Zheng are the first authors who contributed equally to the article
Abstract Objective To compare the effect of associating partial pancreatectomy and extended extrahepatic bile duct resection with pancreaticoduodenectomy in the treatment of the middle cholangiocarcinoma involving the pancreas bile duct (MCIPB). Methods The clinical features, surgical methods and follow-up results of 41 patients with MCIPB were retrospectively analyzed from January 2010 to December 2015 in Eastern Hepatobiliary Surgery Hospital.Clinical factors that may affect the prognosis of the MCIPB were included in Kaplan-Meier analysis. Results Operations were performed in all 41 patients of MCIPB, including 23 patients of associating partial pancreatectomy and extended extrahepatic bile duct resection (APPER) and 18 patients of pancreaticoduodenectomy (PD), in which 5 were performed with pylorus-preserving pancreaticoduodenectomy (PPPD).The median survival time of the patients in the APPER group was 15 months, and the survival rate in 1, 3 and 5 years was 69.6%, 34.8% and 0% respectively.The median survival time in PD group was 21.5 months, and the survival rate in 1, 3 and 5 years was 55.5%, 33.3% and 22.2%, respectively.There was no statistically significant difference between the two groups (P=0.59).Multivariate analysis suggests that R1 resection was the only risk factor for survival. Conclusion APPER can obtain a certain clinical curative effect for part of MCIPB, but pancreatic-biliary surgeons should select suitable cases carefully.It is the key for APPER to ensure the negative margin.     

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??Middle hepatic vein-guidedhepatectomy for treatment of hepatocellular carcinoma: A preliminary clinical study JI Gu-wei??WANG Ke??LI Chang-xian??et al. Liver Transplantation Center??the First Affiliated Hospital of Nanjing Medical University??Nanjing 210029??China
Corresponding author??LI Xiang-cheng??E-mail??drxcli@njmu.edu.cn
Abstract Objective To explore the clinical efficacy of middle hepatic vein (MHV)-oriented hepatectomy for treatment of hepatocellular carcinoma (HCC). Methods A retrospective analysis of the clinical and follow-up data of 91 patients??who received radical treatment by hemihepatectomy at Liver Transplantation Center??the First Affiliated Hospital of Nanjing Medical University between June 2006 and June 2015 was conducted. Surgical approaches were divided into MHV-oriented group and conventional group according to full exposure of the MHV on the dissection plane. Early recurrence was defined as tumor recurrence within the first year after surgery. One-to-one propensity score matching (PSM) analysis of the two groups was performed to investigate the clinical efficacy of different surgical approaches. Results Among the 91 patients??left and right hemihepatectomy was performed in 30 and 61 patients. Mean tumor size was 9.9 cm (1.5 to 20.0 cm). Median survival time was 48 months (2 to 127 months). The 1-??3- and 5-year overall survival (OS) rates were 80.1%??58.0%??and 41.8%??respectively. Corresponding disease-free survival (DFS) rates were 57.7%??37.4%??and 30.3%. There was no statistic difference between MHV-oriented group and conventional group in terms of OS and DFS; However??early recurrence rate in conventional group was significantly higher than that in MHV-oriented group. The result was further confirmed by PSM. Multivariate analysis of all patients showed that macrovascular invasion and satellite focus were independent prognostic factors for OS??macrovascular invasion was the independent prognostic factor for DFS??and surgical approach was an independent risk factor for early recurrence after surgery. Conclusion MHV-oriented hepatectomy is associated with decreased early recurrence after radical resection of HCC??However??tumor biology remains the main determinant of overall prognosis.     

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??Laparoscopic radical resection of rectal cancer with and without preservation of the left colonic artery??A comparative study LUO Yang, QIN Jun, CHEN Jian-jun, et al??Department of Gastrointestinal Surgery, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200127, China
Corresponding author??ZHONG Ming, E-mail: drzhongming1966@163.com
Abstract Objective To evaluate the clinical significance and value of preserving left colic artery ??LCA?? when treating the inferior mesenteric artery ??IMA?? in laparoscopic resection for rectal cancer. Methods The clinical data of 523 cases of rectal cancer performed laparoscopic resection of rectal cancer in Renji Hospital, Shanghai Jiaotong University School of Medicine from January 2015 to December 2016 were analyzed retrospectively. All the cases include 203 cases with preservation of LCA ??low ligation group?? and 320 cases without preservation of LCA ??high ligation group??. The clinical conditions during operation and after operation were compared between two groups. Results The difference was not significant statistically in age?? sex?? tumor size?? depth of tumor invasion?? histopathologic type??tumor differentiation?? blood loss and urinary retention rate between two groups??P??0.05??. The postoperative exhaust time, anastomotic leakage rate and defecation frequency 3 months after operation in low ligation group were lower than those in high ligation group??P??0.05??. What’s more?? the number of lymph node and operative time in low ligation group was more in high ligation group??P??0.05??. Conclusion Preservation of left colic artery in laparoscopic resection of rectal cancer can achieve radical clearance of lymph nodes?? increase the number of lymph node detection?? reduce the incidence of anastomotic leakage rate and postoperative exhaust time?? which is worth clinical promotion.     

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??Analysis of prognostic predictors affecting hepatectomy combined with postoperative adjuvant TACE in patients with hepatocellular carcinoma??A double-centered propensity-score matching study QU Kai*??GU Jing-xian??CUI Rui-xia??et al. *Department of Hepatobiliary Surgery??the First Affiliated Hospital of Xi'an Jiaotong University??Xi'an 710061??China
Corresponding author??LIU Chang??E-mail??eyrechang@126.com??FAN Hai-ning??E-mail??1486713174@qq.com
Abstract Objective To confirm the clinical effectiveness of postoperative adjuvant transcatheter arterial chemoembolization??TACE?? in HCC patients after liver resection??and further identify the patients who could benefit most from postoperative adjuvant TACE. Methods The clinical data of 593 consecutive patients were retrospectively collected from the First Affiliated Hospital of Xi’an Jiaotong University from January 2005 to December 2016 and the Affiliated Hospital of Qinghai University between January 2011 and June 2017. Propensity score matching (PSM) was used between hepatectomy patients with and without receiving postoperative adjuvant TACE and finally a total of 348 patients were matched. Kaplan-Meier analysis was performed to compare overall survival (OS) and recurrence-free survival (RFS) between the two groups??univariate COX regression and stratified survival analysis were performed to screen and identify survival predictors for postoperative adjuvant TACE patients. Results The Log-rank tests showed both OS and RFS of the patients in postoperative adjuvant TACE group were significantly longer than those in the control group (P<0.05). The identified prognostic predictors by Cox regression and stratified survival analysis included hepatitis B infection??spleen diameter??preoperative serum alpha-fetoprotein (AFP)??TNM stage??tumor size??tumor number. Conclusion Postoperative adjuvant TACE could improve prognosis markedly in HCC patients??particularly in late-stage ones with hepatitis B??portal hypertension??or higher level of preoperative AFP.     

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??Applied anatomy of the blood supply of the uncinate process in laparoscopic pancreatoduodenectomy WANG Wei*??JIANG Chong-yi??CHEN Yin-tao??et al. *Department of General Surgery??Pancreato-Biliary Clinical Center??Minimally Invasive Surgery Center??Huadong Hospital??Fudan University??Shanghai 200040??China
Corresponding author??WANG Wei??E-mail??hdwangwei@fudan.edu.cn
Abstract Objective To investigate the origin and distribution of arteries in the uncinate process, and provide precious anatomy structure of the blood supply of the uncinate process for laparoscopic pancreatoduodenectomy (LPD). Methods Twelve cases of cadaver specimen fixed with formaldehyde and 1 cases of fresh casting mold specimen of pancreatic vessels allied with pancreatic duct were studied for the blood supply of the uncinate process of pancreas in Department of Anatomy, Shanghai Medical College of Fudan University. The distribution of dorsal pancreatic artery (DPA) of 12 cases of LPD performed between January 2014 and December 2014 in Pancreato-Biliary Clinical Center??Huadong Hospital??Fudan University were also observed in operations. Results ??1??The right branch of DPA distributes to the uncinate process. (2) From ventral aspect, the right branch of the DPA was divided into two smaller branches at four o’clock. And those two branches anastomosed with each other at eight o’clock??which formed a closed arterial loop in the uncinate process. The arterial loop communicated with the common hepatic artery and the pancreaticoduodenal arterial arcade by hub-and-spoke arterial anastomosis. (3) In 12 cases of LPD??4 cases (66.7%) of DPA originated from the splenic artery and 2 cases (33.3%) from superior mesenteric artery. Conclusion The uncinate process is supplied by the pancreaticoduodenal arterial arcade and the right branch of DPA, and they communicate with each other by hub-and-spoke arterial anastomosis in the uncinate process. In order to decrease the risk of bleeding in LPD procedure??the surgeons should pay attention to the right branch of DPA and the anastomosed branches from the uncinate process arterial circle.     

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??Comparative clinical study of the effects of gastric bypass with different types of anastomosis on type 2 diabetes mellitus WANG Lie, ZHANG Zai-zhong, HUANG Sheng, et al. Research Institute of General Surgery, Fuzhou General Hospital of Nanjing Military Command, Fuzhou 350025, China
Corresponding author: WANG Yu, E-mail:fzptwk@163.com
Abstract Objective To assess the effects of gastric bypass with different types of anastomosis on type 2 diabetes mellitus (T2DM). Methods From June 2006 to February 2009, 61 patients with gastric lesions combined with type 2 diabetes mellitus performed gastrectomy were prospectively assigned into Billroth ?? group (n=11), Billroth ?? group (n=26) and Roux-en-Y group (n=24) in Fuzhou General Hospital of Nanjing Military Command. The pre- and postoperative clinical parameters associated with glycometabolism and body mass index were measured during a 6-month follow-up period. Results Fasting blood glucose and glycated hemoglobin levels were significantly decreased after surgery in both Billroth ?? and Roux-en-Y groups (P<0.01 or P<0.05). At 3 and 6 months, patients in both Billroth?? and Roux-en-Y groups had significantly increased fasting C-peptide and significant improved oral glucose tolerance test (P<0.01 or P<0.05). The changes of those parameters above in Roux-en-Y group were greater than those in Billroth ?? group(P<0.01 or P<0.05). However, the effects were not shown in Billroth ?? group through the entire follow-up period. T2DM control rate in Roux-en-Y group was higher than that in Billroth ?? and Billroth ?? group (P<0.01 or P<0.05). Conclusion As compared with Billroth ?? and Billroth ?? reconstruction after gastrectomy, Roux-en-Y gastric bypass seems to be more effective on T2DM control. The therapeutic effect of gastric bypass is independent on loss of body weight. Roux-en-Y gastric bypass may be as a potential management option for T2DM.     

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??Efficacy and prognostic factors of repeat hepatic resection for recurrent hepatocellular carcinoma??A report of 175 cases XU Yun*??SHEN Qiang??WANG Neng??et al. *Department of Minimally Invasive Therapy??Hepatobiliary Surgery Hospital??the Second Military Medical University??Shanghai 200438??China
Corresponding author??QIAN Guo-jun??E-mail??qgjs@sina.com
Abstract Objective To investigate the safety, efficacy and prognostic factors for the survival in the patients with recurrent hepatocellular carcinoma (HCC) treated with repeat hepatic resection (RHR). Methods The clinical data of 175 cases of recurrent HCC following resection treated with RHR from January 2007 to December 2011 in Hepatobiliary Surgery Hospital of the Second Military Medical University were analyzed retrospectively. Complication rate, overall survival rates, disease-free survival rates were calculated and prognostic risk factors were analyzed. Results The severe complication rate after RHR was 7.4%. The 1-,3-,5-year overall survival rates and disease-free survival rates were 92%,71%,51% and 75%,43%,36%, respectively. Elderly patient??>65 years old??, primary HCC at Barcelona Clinic Liver Cancer (BCLC) stage B, microvascular invasion, larger size and incomplete capsule were risk factors for overall survival. Conclusion Indications of RHR should be managed strictly. For patients who satisfy the indications, RHR is safe and effective. For elderly patients??>65 years old??, primary HCC at BCLC stage B, microvascular invasion, larger size and incomplete capsule, closer follow-up and auxiliary treatment following RHR should be considered to improve relatively poor prognosis of the category.     

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目的探讨虚拟肝脏手术规划对中央型肝癌切除术的指导价值。方法应用虚拟肝脏手术规划系统软件Liv1.0对福建医科大学附属第一医院2007年6月至2012年6月49例病人进行虚拟中央型肝癌切除手术规划,将虚拟手术规划结果与手术中所见进行对比。结果 49例病人虚拟肝脏手术规划所测预切除肝脏体积为(543±225)mL,实际切除肝脏体积为(573±212)mL,平均误差(29±66)mL,两者间高度正相关(相关系数r=0.983,P<0.01)。结论针对中央型肝癌切除术,应用虚拟肝脏手术规划进行手术模拟,有利于评估肿瘤的可切除性并指导手术切除方式的选择。     

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??Clinical comparison of short-term treatment outcomes between two-port and conventional laparoscopic anterior resection for rectal cancer ZHANG Hong, LING Yun-zhi, CONG Jin-chun,et al.Department of Colorectal Surgery, Shengjing Hospital, China Medical University, Shenyang 110004, China
Corresponding author: ZHANG Hong, E-mail: haojiubujian1203@sina.cn
Abstract Objective To explore and analyze the safety and feasiblity of two-port laparoscopic anterior resection for rectal cancer. Methods The clinical data of 38 patients underwent two-port laparoscopic surgery and 40 patients underwent conventional laparoscopic surgery for treatment of rectal cancer in Shengjing Hospital, China Medical University between June 2012 and December 2014 were analyzed retrospectively. The blood loss, duration of procedure, intraoperative complication, conversion to open surgery, length of abdominal incision, distal resection margin, rates of circumferential resection margin involvement, number of lumph nodes havested, postoperative TNM stage, reoperation, duration before first flatus, postoperative complication, postoperative pain score, systemic stress responses and length of postoperative hospital stay of the two groups were analyzed. Results No significant difference was observed in blood loss, operative time, conversion rate, distal resection margin, rates of circumferential resection margin involvement, number of lumph nodes havested, postoperative TNM stage, duration before first flatus, intraoperative and postoperative complication, and length of postoperative hospital stay between the two groups??P>0.05??. Two-port group had shorter length of abdominal incisions ???5.1±0.5??cm vs.??8.4±0.9??cm, P<0.05??. Postoperative pain scores were lower in the two-port group at 24h ???4.1±1.3??vs.??5.0±1.6??, P<0.05??, 48h ???2.8±1.1??vs. (4.0±1.4), P<0.05?? and 72h ???1.9±1.1?? vs.??2.7±1.2??, P<0.05?? . The level of C-reactive protein ??13.2(1.3??111.7)mg/L vs. 22.2(6.9??135.0)mg/L, P<0.05??,interleukin-6??(20.8±9.4??ng/L vs.??26.6±13.6??ng/L, or 20.5(6.1??45.5) mg/L vs. 30.8(6.3??60.2)mg/L, P<0.05??, and cortisol???619.4±185.4??nmol/L vs.??754.6±164.1??nmol/L,or 499.7(300.8??935.7) nmol/L vs. 777.2(533.7??1008.5)nmol/L, P<0.05?? in the two-port group were lower than those in conventional laparoscopic surgery group at 1 day postoperatively. The level of C-reactive protein???30.1±27.4??mg/L vs.??64.1±49.1??mg/L,or 20.8(1.4??110.1) vs. 68.7(9.7??176.6)mg/L, P<0.05?? and cortisol??566.7(438.6??1005.2)nmol/L vs.666.2(100.5??1099.8)nmol/L,P<0.05?? in the two-port group was lower than that in conventional laparoscopic surgery group at 2 day postoperatively. The level of C-reactive protein??12.5(1.5??111.1)mg/L vs. 23.4(9.7??167.8)mg/L, P<0.05?? was lower than that in conventional laparoscopic surgery group at 3 day postoperatively. Conclusion Two-port laparoscopic anterior resection for rectal cancer is safe and feasible. It is not worse than conventional laparoscopic surgery in terms of short-term perioperative and oncological outcomes and has the benefits of less postoperative pain and less systemic stress response.     

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目的介绍一种全胃切除术改良双贮袋Roux-en-Y吻合消化道重建方式,并与传统袢式吻合和Roux-en-Y吻合的中短期效果进行对比研究。方法 2008年5月至2010年3月河南省肿瘤医院普外科将106例因胃癌行根治性全胃切除术病人,随机分为3组分别接受改良双贮袋Roux-en-Y吻合、袢式吻合和Roux-en-Y吻合3种空肠代胃手术方式。比较3组病人的手术时间、术后并发症、住院总费用和住院时间。并于术后1、6、12个月分别进行胃癌病人生活质量调查问卷(QLQ-STO22)评分。结果改良双贮袋Roux-en-Y吻合在手术时间、术后并发症、住院总费用、住院时间等方面与其他两组比较差异无统计学意义。但生活质量评估(吞咽困难、疼痛、呃逆和饮食受限)明显优于其他两组。结论改良双贮袋Roux-en-Y吻合具有安全、术后生活质量高等优点。     

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??Clinical research of the “modified four-step” technique applied in laparoscopic splenectomy and pericardial devascularization HONG De-fei??CHENG Jian??ZHANG Yu-hua??et al. Department of Hepatobiliary Pancreatic and Micro-invasive Surgery??Zhejiang Provincial People’s Hospital??Hangzhou 310014??China
Corresponding author: HONG De-fei, E-mail: hongdefi@163.com
Abstract Objective To summarize effect and experience of the "modified four-step" technique applied in laparoscopic splenectomy and pericardial devascularization (LSPD). Methods The clinical data of 105 cases of LSPD conducted by the " modified four-step" technique between June 2012 and June 2015 in Department of Hepatobiliary Pancreatic and Micro-invasive Surgery??Zhejiang Provincial People’s Hospital were analyzed retrospectively. Results All cases were operated successfully. Among them, 2 cases (1.9%) were converted to open surgery and the rest 103 cases were conducted successfully under complete laparoscopy. Operative time was (175.6 ± 49.8) min and blood loss was (310.9 ± 240.9) mL. Postoperative complication included 1 case of abdominal bleeding??1 case of pancreatic leakage??2 cases of abdominal infection??2 cases of splenic vein thrombosis??3 cases of hepatic dysfunction. One case of liver dysfunction with hepatic encephalopathy gave up treatment and automatically discharged. Other cases were cured by conservative treatment. Postoperative hospital stay (8.7 ± 3.6)d. Two cases ocurred recurrece of GI bleeding after following 12—48 months. Conclusion The "modified four-step" technique in LSPD has high laparoscopic success rate??low rate of postoperative complications and the low rate of GI bleeding recurrence. It’s worthy of clinical promotion and application.     

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??Comparison of short-term outcome of 3D and 2D laparoscopy-assisted radical gastrectomy ZHANG Ke-cheng??WANG Xin-xin??WEI Bo??et al. Department of General Surgery??Chinese PLA General Hospital??Beijing 100853??China
Corresponding author: CHEN Lin??E-mail??chenlinbj@vip.sina.com
Abstract Objective To compare the clinical efficacy of 3D and 2D laparoscopy-assisted radical gastrectomy. Methods The clinical data of 156 patients who underwent 3D (70 patients) or 2D (86 patients) laparoscopy-assisted radical gastrectomy by the same operation group at Chinese PLA General Hospital between November 2015 and November 2016 were analyzed retrospectively. Intraoperative and postoperative variables were compared between the two groups. Results Compared with 2D group, 3D group had significantly shorter operation time [??202.4±89.7??min versus ??232.9±95.8??min??P=0.044] and less blood loss [(138.9±42.0)mL versus (152.8±41.0)mL??P=0.039]. There was no significant difference regarding lymph node retrieval, number of positive lymph nodes, day of the first flatus, postoperative hospital stay, medical cost, complication rates and complication severity between the two groups??all P>0.05??. Conclusion Compared with 2D laparoscopy-assisted radical gastrectomy??3D laparoscopy-assisted radical gastrectomy could achieve similar short-term outcome with potential efficacy improvement while shorten the operative time and reduce blood loss.     

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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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??Clinical significance of changes in CT signs after imatinib treatment for unresectable or metastatic gastrointestinal stromal tumors LIN Zhen-meng,WEI Sheng-hong,YE Zai-sheng, et al. Department of Gastrointestinal Tumor Surgery,Fujian Medical University Cancer Hospital, Fuzhou 350014,China
Corresponding author:CHEN Lu-chuan,E-mail:317871454@qq.com
Abstract Objective To study CT image changes after imatinib mesylate treatment in patients with metastatic/unresectable gastrointestinal stromal tumor(GIST). Methods Forty-three patients suffering metastatic/unresectable GIST were treated with imatinib in Fujian Medical University Cancer Hospital between September 2008 and November 2016. All patients were assessed by contrast-enhanced CT after oral imatinib treatment for three months. Progression free survival(PFS) and overall survival??OS??were recorded. The tumor size and density ??Hounsfield unit(HU)?? on CT were measured on axial images. Clinical effects were evaluated according to Choi. The patients were separated into two groups: good responder group??complete response(CR)+partial response??PR???? and poor responder group??stable disease (SD)+progression of disease(PD). The clinicopathologic features (age??gender??location of tumor,tumor size,calcifications, seroperitoneum, cystic necrosis,gene mutation??were compared between two groups after 3 months treatment. The differences of PFS and OS between PR evaluated by the length change and HU change were employed by Kaplan-Meier test. The accuracies of predicting two-year progress between length change rates and HU change rates were appraised by the receiver operating characteristic curve??ROC??. Results In the 43 patients, no patient got CR, 27??62.8%??got PR, 13??30.2%??got SD, and 3 (7.0%) got PD. The value in good responder group was significantly correlated with the gene mutation, and had nothing to dowith the age, gender, location of tumor, tumor size, calcifications, seroperitoneum and cystic necrosis. All the patients were followed up successfully, and median of follow-up time , PFS and OS were 65.5(15-96), 15.8 and 43.3 months, respectively. There was not statistical significance of PFS and OS between PR according to the length change rates and PR according to HU change rates??P=0.996,0.771??. The accuracies of predicting two-year progress by length change rate and HU change rates with area under ROC curve were 0.853 and 0.868 respectively. Conclusion The targeted therapy of metastatic/unresectable GIST is related to the type of gene mutation. The length change rates and HU change rates which possess moderate prediction accuracy, can be used in evaluation of GIST treated by imatinib.     

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??None routine nasogastric decompression tube and early oral feeding in abdominal surgery WANG Jian-zhong*??JIANG Zhi-wei??BAO Yang,et al. *No.2 Department of General Surgery, the First Affiliated Hospital of Gannan Medical University, Ganzhou 341000, China Corresponding author: JIANG Zhi-wei, E-mail: surgery34@163.com Abstract Objective To investigate the security and feasibility with none routine nasogastric decompression tube and early oral feeding in abdominal fast track surgery. Methods 62 patients who accepted gastrointestinal operation were inserted nasogastric decompression tube as control group(A group), meanwhile other 58 with none routine nasogastric decompression tube and early oral feeding according fast track surgery rules as the experiment group(B group). We compared their time to flatus and the ratio of postoperative complications including throat ache, nausea, atelectasis, wound infection, pneumonia, anastomotic leak. Results To compared A group the time to flatus was advanced in B group(P??0.05). While the ratio of throat ache and nausea in A group increased significantly(P??0.01). And other postoperative complications were no difference between two groups. There were few patients need to reinsertion of nasogastric decompression tube because of atelectasis in two groups but no significantly difference(P??0.05). Conclusion None routine nasogastric decompression tube and early oral feeding in abdominal fast track surgery was safe and feasibility.     

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??Effects of histological grading of liver cirrhosis on long-term outcomes of hepatectomy for small hepatocellular carcinoma LIANG Bin-yong, DONG Ke-shuai, ZHANG Er-lei, et al. Hepatic Surgery Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
Corresponding author: HUANG Zhi-yong, E-mail??zyhuang@medmail.com.cn
Abstract Objective To investigate the effect of histological severity of liver cirrhosis on the prognosis of hepatectomy for patients with small hepatocellular carcinoma (HCC) and liver cirrhosis. Methods A total of 500 patients with small HCC and liver cirrhosis underwent radical hepatectomy in Tongji Hospital of Huazhong University of Science and Technology from Aug 2001 to December 2015 were analyzed. The patients were divided into mild, moderate and severe cirrhosis group according to the Laennec histological sub-classification of liver cirrhosis. The recurrence-free survival rates and overall survival rates of each group were compared, and the prognostic factors were analyzed. Results The 5-year recurrence-free survival and overall survival rates were 52.4%, 26.4%, 10.3%and 76.8%, 50.8%, 38.3%, respectively, in mild, moderate and severe cirrhosis group. With the increasing severity of liver cirrhosis, the recurrence-free survival rates and overall survival rates were decreased significantly. The difference was statistically significant (P<0.05). Multivariate analysis showed that the severity of cirrhosis, portal hypertension, tumor size, microvascular invasion, and tumor differentiation were the independent risk factors for postoperative recurrence and long-term survival in patients with small HCC and liver cirrhosis. Conclusion The severity of cirrhosis is one of the independent risk factors for postoperative recurrence and long-term survival in patients with small HCC and liver cirrhosis. The severity of cirrhosis may play an important role in patient selection and prognosis for the patients with small HCC and liver cirrhosis.