��λ�����п����ڼ�״�ٰ������Ծ����ܰͽ���ɨ����ֵ�о�

??Clinical value of low-transverse arc collar incision with cervical plexus preservation for papillary thyroid carcinoma GUO Kai??WANG Zhuo-ying??LI Duan-shu??et al. Department of Head and Neck Surgery??Fudan University Shanghai Cancer Center??Department of Oncology??Fudan University Shanghai Medical College??Shanghai 200032??China
Corresponding author??WANG Zhuo-ying??E-mail??zhuoyingwang@hotmail.com
Abstract Objective To evaluate the thoroughness??safety and satisfaction with the appearance of low-transverse arc collar incision (low-collar incision for short) with cervical plexus preservation for papillary thyroid carcinoma (PTC). Methods The clinical data of 284 patients diagnosed with PTC in Department of Head and Neck Surgery??Fudan University Shanghai Cancer Center from Jan. 2013 to Dec. 2013 were analyzed retrospectively. All the patients were performed the operation of total thyroidectomy and central lymph node (level ??) and/or ipsilateral or bilateral neck (level ??~??) dissection. The metastatic rates and resected cervical lymph node numbers of patients with low-collar incision (group low-incision??279 patients) and conventional incision (group conventional-incision??36 patients) were calculated respectively and the patients’ postoperative life quality was estimated through scales and compared with complications. Results The operation time in group low-incision was shorter than that in group conventional-incision, which is with significant difference (P<0.05). There was no difference in total resected lymph node numbers between two types of incisions (P??0.05). But resected lymph node numbers of level ??b and ?? in group low-incision were lower than those in group conventional-incision. Postoperative life quality was improved in group low-incision (P<0.05). Correlation analysis showed the risk of level ??b metastasis increased when level ??a involved (r=0.197 and 0.067??P<0.001)??and the risk of level ??a and ?? metastasis increased when multi-levels involved (r=0.242 and 0.243??P<0.001). Conclusion Low-transverse arc collar incision with cervical plexus preservation for papillary thyroid carcinoma has the characteristics of thoroughness??safety and satisfaction with the appearance. However??conventional incision should be recommended for patients with ??a or multi-levels metastasis.     

���������пڸ�Ĥǰ3D-max��Ƭ�޲����ɹ�����Ч�о�����115�����棩

??Preperitoneal inguinal hernia repair via midline incision with 3D-max patch: A study of 115 cases WANG Tong-sheng??DING Lei??ZHAO Ai-min??et al. Department of General Surgery??Beijing Shijitan Hospital Affiliated of Capital Medical University??Beijing 100038??China
Corresponding author??GAO Hong??E-mail: gaohongdoctor@sina.com
Abstract Objective To explore the value of preperitoneal inguinal hernia repair via midline incision with 3D-max patch. Methods The clinical data of 115 cases of inguinal hernia underwent preperitoneal hernia repair via midline incision with 3D-Max patch from January 2012 to December 2014 in Department of General Surgery??Beijing Shijitan Hospital Affiliated of Capital Medical University were analyzed retrospectively. Among them??there were 89 cases of unilateral hernia??26 cases of bilateral hernia; 73 cases of indirect hernia??22 cases of direct hernia??20 cases of composite hernia??11 cases of recurrent hernia. Operative time??length of hospital stay??complications and recurrence rate were recorded. The postoperative follow-up ranged from 4 months to 2 years. Results The mean operative time was 51.2 min in the cases of unilateral hernia and 76.6 min in the cases of both sides. The length of hospital stay were 6.1 days. Seroma occurred in 5 cases; fat liquefaction and incision split occurred in 4 cases; they were cured by drainage and dressing respectively. No recurrence occurred during follow-up for 3 to 24 months. Conclusion Preperitoneal inguinal hernia repair via midline incision with 3D-max patch is suitable for complicated hernia and recurrent hernia??but difficult to use??has no obvious advantages for incipient inguinal hernia.     

Ӧ���ӽ������޲��޴����Ը����п����ٴ��о�����28�����棩

??Hybrid technique for the repair of large complicated incisional hernia??Report of 28 cases YANG Bin, JIANG Zhi-peng, LI Ying-ru, et al. Department of Gastrointestinal Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, China
Corresponding author??CHEN Shuang??E-mail??sysusc@126.com
Abstract Objective To evaluate the operational skills and efficacy of a combined laparoscopic and open technique (hybrid technique) for the repair of large complicated incisional hernia. Methods The clinical data of 28 cases of large complicated incisional hernia underwent hybrid repair technique from September 2008 to February 2011 in Sun Yat-sen Memorial Hospital of Sun Yat-sen University were analyzed retrospectively. Results All cases were operated on successfully and recovered uneventfully. The operating time was 76-162 (102±21)min. The length of incision was 4-8 (6.1±0.8)cm. The diameter of the hernia ring was 10-25 (15.5±3.2)cm and the size of hernia ring was 64-224(118.0±42.1)cm2. Missed hernia was detected in 7 cases (25%) intraoperatively and was repaired during the procedure. Postoperative complications included abdominal pain (n=8, 28.6%), abdominal distension (n=3, 10.7%), seroma (n=2, 7.1%) and hematoma (n=1, 3.6%). All of them were cured with conservative treatment. Postoperative hospital time was 3-13 (4.9±1.8) days. No patient developed wound infection, massive haemorrhage, intestinal injury or cardiorespiratory function failure. One recurrent case was observed during a mean (25.1±5.6) months follow-up period. Conclusion Hybrid technique for incisional hernia repair is a safe and effective procedure especially suitable for patients with large complicated hernias, which deserves to be popularized.     

����������ǻ���޸�����Ѫ�ܷ�����������п�����ٴ�Ӧ�öԱ��о�

??Comparation between blood vessel suture instrument and traditional surgical suture in EVAR surgery for abdominal aortic aneurysm: An analysis of 130 cases ZHANG Zheng, CHEN Zhong, TANG Xiao-bin, et al. Beijing Anzhen Hospital ??Capital Medical University, Beijing 100029, China
Corresponding author??CHEN Zhong, E-mail??chenzhong8658@vip.sina.com
Abstract Objective To investigate the application of the Perclose Proglide vascular closure devices in the endovascular abdominal aortic aneurysm repairing operation and its significance. Methods The clinical data of 130 cases of endovascular abdominal aortic aneurysm repairing operation performed between March 2013 and February 2015 in Department of Vascular Surgery??Beijing Anzhen Hospital of Capital Medical University were analyzed retrospectively. Among them, 69 cases were treated with Perclose Proglide vascular closure devices to suture the puncture site of the femoral arteries and 61 cases were treated with the traditional surgical suture to close the puncture site of the femoral arteries. The relationship between the two groups and various clinicopathological factors of patients with abdominal aortic aneurysm were analyzed by Chi-square using statistical software SPSS17.0. The clinicopathological factors include operation successful rate??operation time??intraoperative blood loss??hospital stay??cost of operation??wound healing??lower limb ischemia and so on. Results Analysis using chi-square showed that Perclose Proglide vascular closure devices group was obviously better than the other group in operative time, intraoperative blood loss and hospital stay (P<0.05). Conclusion Comparing with the traditional surgical suture method??Perclose Proglide vascular closure devices are safe and effective. The patients have less injury and can recover more quickly??The Perclose Proglide vascular closure devices are worthy of clinical popularization??     

���п��������������ҽʦ��ǻ��ֱ����������ѧϰ�����о�

??Learning curve of laparscopic resection in rectal cancer for experienced surgeon ZHU Xiao-ming??LOU Zheng??GONG Hai-feng??et al. Department of Colorectal Surgery??Changhai Hospital??the Second Military Medical University??Shanghai 200433??China
Corresponding author??ZHANG Wei??E-mail: weizhang2000cn@163.com
Abstract Objective To investigate how experienced surgeons in open surgery can quickly learn laparscopic resection for rectal cancer. Methods The clinical data of 120 cases of laparscopic resection for rectal cancer performed by the same team of surgeons from August 2009 to April 2015 in Changhai Hospital of the Second Military Medical University were analyzed retrospectively. The cases were divided into three groups (40 cases in each group) by operative sequence. The time span was 36, 19, 11 months respectively. The operating time??blood loss??the rate of conversion to open operation??number of lymph nodes??the integrityof mesorectum??postoperative aerofluxus time??postoperative hospital stay and the rate of postoperative complications were compared among the 3 groups. Results The operating time in group A was ??162.9±36.7??min??which as much higher than that in group B ??147.0±36.8??min and group C (132.7±31.9)min (P<0.05). However??there was no significant difference between group B and C (P>0.05). Intraoperative blood loss??the rate of conversion to open operation and postoperative hospital stay in group A had no significant difference compared with those in group B and C (P??0.05). Also??there was no significant difference in the integrity of mesorectum??number of lymph nodes??postoperative aerofluxus time and the rate of postoperative complications among 3 gourps ??P>0.05??. Conclusion From the learning curve??surgeons with rich experience in open surgery can learn laparscopic skills for rectal cancer after performing 40 cases.     

�����븹ǻ���¸����п����޲������󲢷�֢�ķּ���������ǰհ����������о�

??Classification and valuation of postoperative complications in a randomized trial of open versus laparoscopic ventral herniorrhaphy Kaafarani HMA*, Hur K, Campasano M, et al. * Department of Surgery, VA Boston Healthcare System (112), 1400 VFW Parkway, West Roxbury, MA 02132, USA
Corresponding author: Kaafarani HMA,E-mail: kitani@med.va.gov; kitani@va.gov
Abstract Objective Generic instruments used for the valuation of health states (e.g., EuroQol) often lack sensitivity to notable differences that are relevant to particular diseases or interventions. We developed a valuation methodology specifically for complications following ventral incisional herniorrhaphy (VIH). Methods Between 2004 and 2006, 146 patients were prospectively randomized to undergo laparoscopic (n = 73) or open (n = 73) VIH. The primary outcome of the trial was complications at 8 weeks. A three-step methodology was used to assign severity weights to complications. First, each complication was graded using the Clavien classification. Second, five reviewers were asked to independently and directly rate their perception of the severity of each class using a non-categorized visual analog scale. Zero represented an uncomplicated postoperative course, while 100 represented postoperative death. Third, the median, lowest, and highest values assigned to each class of complications were used to derive weighted complication scores for open and laparoscopic VIH. Results Open VIH had more complications than laparoscopic VIH (47.9 vs. 31.5%, respectively; P = 0.026). However, complications of laparoscopic VIH were more severe than those of open VIH. Non-parametric analysis revealed a statistically higher weighted complication score for open VIH (interquartile range: 0-20 for open vs. 0-10 for laparoscopic; P = 0.049). In the sensitivity analysis, similar results were obtained using the median, highest, and lowest weights. Conclusion We describe a new methodology for the valuation of complications following VIH that allows a direct outcome comparison of procedures with different complication profiles. Further testing of the validity, reliability, and generalizability of this method is warranted.     

��ǻ���ᡢֱ���������пڼ�����ת�Ƶ�ʵ���о�

目的　研究腹腔镜结直肠癌手术对肿瘤切口种植及脏器转移的影响。方法　选用人结肠癌细胞 (Lo Vo细胞 )悬液 (1× 10 7/L) ,OT针注入雌性Balb/C裸鼠盲肠浆膜下 (0 1mL) ,建立人结肠癌细胞裸鼠原位种植模型。 2周后 ,实验裸鼠随机分为 3组 :CO2 人工气腹术组 (31只 )、剖腹术组 (31只 )、和未行手术组 (30只 )。 10周后 ,3组裸鼠均脱颈法处死 ,探查肿瘤细胞原位种植及致瘤鼠肿瘤细胞切口种植及各脏器转移情况。结果　 (1) 3组裸鼠的致瘤率为 :CO2 人工气腹组 2 3/ 31例 ,开腹术组 2 2 / 31例 ,未手术组 2 1/ 30例 ,差异无显著意义。 (2 )CO2 人工气腹术组的 2 3只致瘤鼠中 ,有 2只发生切口种植 ,12只发生脏器转移 ;开腹术组的 2 2只致瘤鼠中 ,有 4只发生切口种植 ,13只发生脏器转移 ;未手术组 2 1只致瘤鼠中 ,有 10只发生脏器转移 ,致瘤裸鼠的切口种植及脏器转移率差异无显著意义。结论　CO2 人工气腹没有促进人结肠癌细胞裸鼠原位种植模型切口种植及脏器转移的发生 ,腹腔镜结直肠癌手术具有一定的安全性与可行性。     

���Ը����������붯��Ӳ���Ը����������ٴ��ص㼰Զ����Ч�����о�

??Case-control study on clinical features and long term effect of inflammatory abdominal aortic aneurysm in comparison with atherosclerotic abdominal aortic aneurysm WANG Shao-ye, ZHANG Jian, YIN Ming-di, et al. Department of Vascular Surgery, the First Hospital, China Medical University, Shenyang 110001, China
Corresponding author: ZHANG Jian, E-mail: jianzhang_cmu@yahoo.com.cn
Abstract Objective To analyze clinical features and long term effect of inflammatory abdominal aortic aneurysm (iAAA). Methods Between 1988 and 2008, 412 cases of AAA in the First Hospital of China Medical University were performed elective surgical operations. Eleven (2.7%) of them were diagnosed as iAAA. The former group was matched in a case control fashion to a group of 33 patients with aAAA with similar characteristics of age, gender and preoperative risk factors. All available clinical, pathologic and postoperative variables were reviewed retrospectively, and the two groups were compared. Results In comparison with aAAA, patients with iAAA were more symptomatic significantly (100% vs. 42.4%, P=0.001) and had larger aneurysm size on admission ??(7.4±0.7)cm vs. (6.3±0.9) cm??P=0.006??, and preoperative erythrocyte sedimentation rate was found to be elevated significantly ??(44.5±9.1)mm/h vs. (11.4±5.4)mm/h??P<0.05??. Surgical morbidity and mortality rates did not differ between two groups. The operation time of patients with iAAA was longer than patients with aAAA significantly ??(308±36)min vs. (224±46)min, P<0.05??, and cross-clamp time was similar in both groups??(41.5±6.2) min vs. (41.8±6.2)min, P= 0.92??. A five-year survival rate analysis showed no significant difference between two groups (P=0.711) . Conclusion Despite the more symptomatic, larger size and long operation time of iAAA, iAAA can be treated with low morbidity and mortality similar as aAAA now. Long term effect of iAAA is of no difference from aAAA.     

��ǻ��ʳ���ѿ����޲������Ͽ����������ٴ���Ч�о�����835�����棩

??Laparoscopic anti-reflux surgery for gastroesophageal reflux disease with hiatal hernia: A clinical analysis of 835 cases Kelimu.Abudureyimu??Alimujiang.Maisiyiti??Azhatijiang??et al. Department of Hernia and Abdominal Wall Surgery & Minimally Invasive Surgery??the People’s Hospital of Xinjiang Uyghur Autonomous Region??Urumqi 830001??China
Corresponding author??Kelimu.Abudureyimu??E-mail??klm6075@163.com
Abstract Objective To evaluate the efficacy and safety of laparoscopic hiatal hernioraphy and fundoplication for gastroesophageal reflux disease (GERD). Methods The clinical data of 835 cases of GERD and hiatal hernia admitted from September 2005 to May 2015 in the People’s Hospital of Xinjiang Uyghur Autonomous Region were analyzed retrospectively. All the cases were performed laparoscopic hiatal hernioraphy and fundoplication. Results Laparoscopic hiatal herniorrhaphy and fundoplication were successfully performed in all 835 cases without mortality or conversion. A total of 183 cases were performed combined operation??accounting for 21.9%. The duration of operation ranged from 40 to 90 min??and bleeding from 5 to 50 mL. No intraoperative or postoperative blood transfusion occurred. Liquid diet was performed in postoperative 24 to 48 h. All the cases were followed up for 3 months to 10 years (average 37.5 months). A total of 56 cases??6.7%?? had postoperative complications, including 28 cases of postoperative dysphagia??4 cases of recurrent hiatal hernia (gastric wrap herniated into the chest) , 18 cases of recurrence of symptoms and 6 cases of gas bloating syndrome. Conclusion Laparoscopic hiatal hernioraphy and fundoplication is safe and effective??an ideal choice for GERD patients with hiatal hernia due to advantages of less invasive??faster recovery and fewer complications. Also it can combine surgical treatment of other diseases.     

����Ƥ��ȫ�̳�����ѹ�����и��������пڷ����Ч�о�

??Treatment studies of subcutaneous continuous negative pressure drainage during the whole course of incision suture in the abdominal operation HUANG Xing-hua,HU Huan-zhang, JIANG Yi. Department of Hepatobiliary Surgery??Fuzhou General Hospital of Nanjing Military Command of PLA, Fuzhou 350025,China
Corresponding author: JIANG Yi,E-mail:jiangyi8183@163.com
Abstract Objective To discuss the clinical efficacies of subcutaneous continuous negative pressure drainage during the whole course of incision suture in the abdominal operation. Methods The clinical data of 136 patients performed hepatobiliary-pancreatic operation between July 2014 and March 2015 in Department of Hepatobiliary Surgery, Fuzhou General Hospital of Nanjing Military Command of PLA were analyzed retrospectively. All the patients were divided into Group A and Group B according to the incision suture methods. Group A (n=72) underwent hepatobiliary-pancreatic operation by the whole subcutaneous continuous negative pressure drainage and Group B (n=64) by early extrusion drainage. Suturing time of abdominal wall, situation of incision healing, numbers of postoperative incision liquefaction and postoperative incision split, time of incision healing, patients’ satisfaction and other indexes were analyzed. Results Suturing time of abdominal wall, incision healing time and patients’ satisfaction in Group A and B were 23(14-30)min, 9(7-15)d,10??5-10??vs. 29(18-42) min,12??8-17??d, 8??4-10?? , respectively, and the statistical differences were significant??all P??0.001??. Numbers of postoperative incision liquefaction and rates of A-grade healing of Group A and B were 3 cases, 94.44% vs. 12 cases, 81.25%, respectively and there were significantly statistical differences??all P??0.05??. Postoperative incision split occurred in Group A and B occurred in zero and one patients, respectively without statistical difference??P??0.05??. Conclusion Skin intradermal suture combined with subcutaneous continuous negative pressure drainage during the whole course of incision suture in the abdominal operation without suturing subcutaneous fat layer plus, can not only shorten operation time, promote incision healing, but also got cosmetic effect, which meets the needs of patients and is worthy of wide application.     

�¸������п���·��Ĥǰ���ɹ����޲����ٴ�Ӧ���о�

??Preperitoneal tension-free inguinal hernia repair via hypogastric midline incision LIU Chun-fu??GONG Jin-wei??XU Jun. Department of General Surgery??the Fourth Affiliated Hospital of Harbin Medical University??Harbin 150001??China
Corresponding author??XU Jun??E-mail??gongjinwei321@163.com
Abstract Objective To explore the value of preperitoneal tension-free inguinal hernia repair via hypogastric midline incision. Methods The clinical data of 120 cases of inguinal hernia underwent the tension-free hernia repair with 3D-Max patch from April 2010 to October 2012 in Department of General Surgery??the Fourth Affiliated Hospital of Harbin Medical University were analyzed retrospectively. Among them??there were 98 cases of unilateral hernia??22 cases of bilateral hernia, 85 cases of inguinal hernia??30 cases of direct hernia??5 cases of recurrent hernia. Operation time??degree of comfort??complications and recurrence rate were recorded. Results The operation time was 20 min to 60 min. The mean operative time was 30 min for the cases with unilateral hernia and 50 min for the cases with both sides. The mean time of ambulation was 6 h. The mean hospitalization days were 4 days. Incision effusion occurred in 2 cases. Neither scrotal hematoma nor scrotal effusion nor urinary retention occurred. No recurrence occurred during follow-up for 6 months to 2 years. Conclusion Preperitoneal tension-free inguinal hernia repair via hypogastric midline incision has many advantages with short learning curve??simple operation??high safety??low recurrence rate??quick recovery after operation??mild foreign body discomfort and low incidence of chronic pain after a hernia repair??which is suitable for bilateral hernia and recurrent hernia especially.     

������-�ش󼡸��ϼ��꼴���鷿�����о�

??Immediate breast reconstruction with partial latissimus dorsi and pectoralis major compound muscular flap ZHANG Bin*, FENG Rui, GE Jie, et al. Department of Breast Cancer, Cancer Hospital of Tianjin Medical University, Tianjin 300060, China. Corresponding author: CAO Xu-chen, E-mail: CXC@medmail.com.cn Abstract Objective To investigate immediate breast reconstruction following skin-sparing mastectomy in breast carcinoma patients by using thoracodorsal artery descending branche based partial latissimus dorsi and pectoralis major compound muscular flap with breast prothesis. Methods Breast reconstruction were performed in 16 patients with operation procedures described above, and the traits and indications of the procedure were analyzed. The patients were admitted between January 2006 and March 2009 at Cancer Hospital of Tianjin Medical University and Tianjin Central Hospital for Gynaecology and Obstetrics. Results Fifteen patients (16 breasts) underwent the breast reconstruction procedure following immediate mastectomy as described above. Three patients had experienced seroma, which was treated and cured by aspiration method. Forteen patients performed chemotherapy after being confirmed as invasive breast cancer by pathology and none of them had experienced relative complications. The median follow up time was 16 months (2??36 months), reconstructive breast demonstrated of good shape, soft texture, and without any capsular contracture. Conclusion Breast reconstruction with partial latissimus dorsi-pectoralis major compound muscular flap and breast prothesis is a simple and safe procedure, which reserved the functionof latissimus dorsi and pectoralis major and conserved the donor site. The procedures is suitable for the patients who were either inappropriate for or unable to comply with breast-conserving surgery and radiotherapy is not required in pre- and intra-operation evaluation.     

ȫ��ǻ����Բ���Ǻ�����ֱ���и�պ�����ʳ�ܿճ��Ǻ���Ч�����о�

??Various types of intracorporealesophagojejunostomy after laparoscopic total gastrectomy for gastric cancer??A national multi-center retrospective study FENG Xing-yu*,WANG Wei, ZANG Lu, et al. *Department of General Surgery, Guangdong General Hospital, Guangdong Academy of Medical Science, Guangzhou 510080, China
Corresponding author?? LI Yong, E-mail??yuan821007@126.com
Abstract Objective To compare the security and short-term effect of the digestive reconstruction during the totally laparoscopic total gastrectomy for gastric cancer between the circular anastomosis and linear anastomosis. Methods The clinical data of 224 gastric cancer patients with digestive reconstruction underwent totally laparoscopic total gastrectomy between January 2011 and June 2016 in 17 domestic hospitals were analyzed retrospectively.According to the difference of digestive reconstruction??all the patients can be divided into the circularanastomosis with 90 patients and the linear anastomosis with 134 cases.Results The operative time in digestive reconstruction with linear anastomosis was shorter (47.4 min vs. 52.3 min, P??0.015). There was no difference between the two groups on the intraoperative blood loss??near cutting margin??cost of the reconstruction??postoperative exhaust time??fluid diet??soft diet and the duration of postoperative hospital stay.Both groups had no death case during the perioperative period and there was no significant statistical difference of the postoperative complication rate(11.1% vs.11.9%, P??0.849). Conclusion The circular anastomosis and linear anastomosis are both safe and feasible for the digestive reconstruction under the totally laparoscopic total gastrectomy for gastric cancer.Besides??the linear anastomosis has the advatage of the less reconstruction time.     

���������¸��ಿ���г�����Χ�����ڴ����Ѫ����ֵ�����������Ӱ���о�

??Effect of perioperation care on serum arterial lactate value and lactate clearance rate in patients undergoing partial hepatectomy under fluid restriction YU Ling, SUN Hong-wei, JIN Huang-mo, et al. Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education); Department of Anesthesiology, Peking University Cancer Hospital & Institute??Beijing 100142, China
Corresponding author:TAN Hong-yu??E-mail??maggitan@163.com
Abstract Objective To investigate the related factors of serum arterial lactate concentration in hepatectomy patients with fluid restriction before resection of liver lesions. Methods Patients classified as ASA ??or ??who had been chosen for an open procedure were candidated for elective liver resections at our hospital between Jun 2017 and Dec 2017.Limited fluid was infused at rate 6 mL/(kg·h) before liver resection. The infusion speed was quickened after resection of liver lesion. Patients’ demographic data??portal triad clamping period were recorded. All serum arterial lactate concentration were measured by arterial blood gas analysis during perioperation. Results In 67 patients??the blood lactate value increased significantly at 10 minutes after the end of resection of the liver lesion ??T3??and T4 at end of leaving recovery room??T4??.There was significant positive correlation between the lactate value at T3 and T4 the duration of portal triad clamping ??P<0.001??. There was no significant correlation between the lactate value during perioperation and the number of ephedrine, the number of rapid fluid bolus, the amount of blood loss, the value of CVP during hepatectomy and liver cirrhosis. Conclusion Hepatic portal clamping increases the value of arterial blood lactate in patients with undergoing hepatectomy. The blood lactate clearance rate is positive while liquid infusion is accelerated after liver resection.     

�׽���11���������ڸ�ϸ������֯��Ｐ�����о�

??Expression and significance of interleukin-11(IL-11) and interleukin-11 receptor (IL-11R) in primary hepatic carcinoma SUN Chuan-zheng*, HUANG Fei-zhou, YANG Ming-shi, et al. *Department of General Surgery, Third Affiliated Hospital, Central South University, Changsha 410013, China
Corresponding author: HUANG Fei-zhou, E-mail: zheng-1016@hotmail.com
Abstract Objective To clarify the role of IL-11 and IL-11R in human hepatocellular carcinoma. Methods Thirty primary hepatic carcinoma (PHC) tissues, their pericarcinomatous liver tissues and their clinicopathological factors admitted between December 2006 and March 2007 in the Third Affiliated Hospital, Central South University were obtained in the current study. Expression levers of IL-11 and IL-11R proteins in samples of pericarcinomatous liver and tumor tissue were analyzed by Western blot. The IOD of IL-11, IL-11R and β-actin was analyzed quantitatively by analysis software. The expression level of IL-11 and IL-11R was denoted by the ratio of IOD, which was called value A. Results The expression of IL-11 and IL-11R was upregulated obviously in PHC tissue. The expression of IL-11 was significantly related to Edmondson’s grade, capsule invasion and tumor’s thrombus in portal vein and the expression of IL-11R was correlated with Edmondson’s grad, capsule invasion and tumor’s thrombus in portal vein. Conclusion The finding suggests that IL-11/IL-11R may play important role in the occurrence, differentiation, invasion and transfer of PHC.     

�������븹ǻ���Ұ�᳦�г���������Ч�����о�

??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.     

���г�����С��Ѫ�ܻ������Ƽ�ֵ���о�

目的 探讨术中肠镜对小肠血管畸形的诊治价值.方法 回顾性分析2003年1月至2005年1月南京大学医学院附属鼓楼医院收治并手术确诊的17例小肠血管畸形的临床资料.结果 17例病人均以反复黑便或血便等消化道出血为主要临床表现;术前均经胃镜检查排除胃十二指肠出血;结肠镜检查排除下消化道(结肠及直肠)出血;术前均行胶囊内镜检查,其中诊断小肠血管畸形10例(10/17),不能明确诊断或漏诊7例(7/17).17例病人均行剖腹探查,术中肠镜检查发现点状或片状黏膜血管扩张或出血点,分布于整个小肠,病变最多达18处,最少2处.行点状切除1例,点状+楔形切除7例,点状+肠段切除4例,楔形切除3例,肠段切除2例.手术切除标本行病理检查均证实为小肠血管畸形.17例病人随访2～4年,平均33个月,无一例发生再出血.结论 术中肠镜检查对小肠血管畸形具有重要价值,可对小肠血管畸形做出准确定性诊断,是诊治小肠血管畸形的主要手段.     

����������������븹ǻ����Զ��θ��������������Ч�����о�

??Contrast study of short-term effect between the Da Vinci surgical robot and laparoscopic technology in patients after distal gastric cancer surgery ZHAO Kun??PAN Hua-feng??WANG Gang??et al. Department of General Surgery, Nanjing General Hospital of Nanjing Military Command, Nanjing 210002, China
Corresponding author:JIANG Zhi-wei,E-mail:surgery34@163.com
Abstract Objective To make a contrast between the Da Vinci surgical robot ( referred to as "robots") and laparoscopic technology in patients’ postoperative recovery after distal gastric cancer surgery. Methods Thirty robotic distal gastric cancer patients as robotic group and 30 laparoscopic gastric cancer patients as compared group both admitted from January 2012 to May 2012 in Nanjing General Hospital of Nanjing Military Command were analyzed. Perioperative situation was compared between the two groups. Results The robotic group was better than the laparoscopic group in intraoperative bleeding, the surgical incision length, postoperative incision pain and the first feeding time (P < 0.05). There was no statistical significance in lymph node dissection and postoperative complications. Conclusion Robot distal gastric cancer surgery is worthy of popularization and application for its less invasive surgery and quicker postoperative recover than laparoscopic surgery.     

�ž��������Ʒ�Ԥ�����г�����ζ���˥�ߵ��о�

目的 探讨门静脉激素疗法对肝切除术后肝衰的预防价值。方法 对照组（ｎ＝６０）仅给予常规保肝治疗处理,研究组（ｎ＝３０）另于肝门阻断前后及术后第１～３日行地塞米松门静脉注射治疗。结果 对照组术后肝衰１４例（２３．３％）,因肝衰死亡６例（１０％）;研究组术后肝衰２例（６．７％）,无肝衰死亡。两组术后肝衰的差异存在显著性（Ｐ〈０．０５）。结论 门静脉激素疗法可以降低术后肝衰的发性率。