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??Influence of enhanced recovery after surgery for radical resection of gastric cancer on immune function??a Meta-analysis WANG Xiang-an, YU Li-ming, FAN Ji-chang, et al. Department of Gastrointestinal Surgery, the Second Affiliated Hospital, Nanchang University, Nanchang 330006, China
Corresponding author??YANG Gang, E-mail??ygrealtom@sohu.com
Abstract Objective To evaluate the influence of enhanced recovery after surgery (ERAS) for radical resection of gastric cancer on immune function. Methods The major domestic and foreign databases were searched to collect the literatures of randomized controlled trial (RCT) about the the comparison of ERAS and conventional perioperative care in radical resection of gastric cancer published by December, 2014 in both Chinese and English. After screening for inclusion, quality assessment and data extraction, Meta-analysis was conducted by the Review Manager 5.2 software. Results Sixteen studies involving 1101 patients were selected finally, with 563 patients in ERAS group and 538 patients in control group. Results of Meta-analysis showed that the levels of IL-6 on postoperative day (POD) 1, 3 and TNF- α on POD3 and CRP on POD1, 3, 7 in ERAS group were lower than those in control group significantly (all P<0.05) . Those on the rest of the days showed no significant difference (all P>0.05). The levels of IgA on POD1, 3, 7 and IgG on POD3, 6, 7 in ERAS group were higher than those in control group significantly (all P<0.05). But, the levels of IgM on POD1, 3, 7 showed no significant difference between the two groups (all P>0.05) . Conclusion ERAS for radical resection of gastric cancer can decrease the inflammatory responses and preserve immune function of bodys compared with conventional perioperative care.     

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??Correlation between lymph node metastasis of colorectal carcinoma and vascular pattern of inferior mesenteric artery by CTA LIU Huan-ran, HU Xiang, ZHANG Jian, et al. No. 1 Department of General Surgery, the First Affiliated Hospital of Dalian Medical University, Dalian 116011, China
Corresponding author: HU Xiang, E-mail??lhrlhr9050@sina.com
Abstract Objective To study vascular pattern of inferior mesenteric artery (IMA) by CT angiography (CTA) for colorectal operation. Methods Seventy-seven patients with colorectal carcinoma underwent preoperative IMA CTA from January 2011 to April 2013 in the First Affiliated Hospital of Dalian Medical University were selected randomly. IMA and its branches were reconstructed by VR-r AV technique and divided into different categories. Results All the patients’ IMA branched off the abdominal aorta. Four types of branching were confirmed. Type A, where the three arteries branched off from the same point; Type B, where SA branched off from LCA; and Type C, where SA branched off from SRA; Type D, where SA branched off from LCA and SRA respectively. There was no statistical relation between typing and age, gender, invasive depth of tumor, lymph node metastasis, distance from tumor to anus. But lymph node metastasis had significant associated with the distance from tumor to anus (P=0.002). Conclusion Aberrance of IMA is various, metastasis of 242 group lymph nodes was associated with aberrance of SA. Performing preoperative IMA-CTA is helpful to preserve LCA and reduce inadequate lymph node dissection.     

儿童先天代谢异常伴发的肥厚型心肌病

儿童先天代谢异常是导致肥厚型心肌病（HCM）的重要病因, 掌握每种疾病的特征性表现有助于正确的诊断及鉴别诊断。多数先天代谢异常伴发HCM属于常染色体隐性遗传,少数为常染色体显性遗传X连锁遗传方式,部分线粒体病呈母系遗传。常规心电图、超声心动图等心脏检查即可以为部分疾病的基础病因找到诊断线索。随着酶替代疗法等新的治疗方法的不断进步,加强心脏评估,恰当地针对原发病治疗,多学科协同合作将为越来越多的患者生存提供可能。     

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??Application of single layer pancreaticojejunostomy with external drainage of the pancreatic duct in patients with soft pancreas during pancreaticoduodenectomy??A report of 64 cases YANG Feng??JIN Chen??LI Ji??et al. Department of Pancreatic Surgery??Huashan Hospital??Pancreatic Disease Institute??Shanghai Medical College of Fudan University??Shanghai 200040, China
Corresponding author??FU De-liang??E-mail??surgeonfu@163.com
Abstract Objective To investigate the application value of single layer pancreaticojejunostomy with external drainage of the pancreatic duct in patients with soft pancreas during pancreaticoduodenectomy. Methods The clinical data of 64 patients with soft pancreas who received single layer pancreaticojejunostomy with external drainage of the pancreatic duct during pancreaticoduodenectomy between February 2011 and November 2012 in Department of Pancreatic Surgery??Huashan Hospital??Shanghai Medical College of Fudan University were analyzed retrospectively. Intraoperative condition and postoperative therapeutic effect were observed. Results The operation time of the 64 patients was 6.2??4.0-9.5??h??with intraoperative blood loss of 400??50-2900??mL??anastomosis time of 15.6??11-25??min??and postoperative hospital stay of 14.2 (8-43) d. A total of 35 cases (54.7%) had postoperative complications??including 30 cases of pancreatic fistula ??46.9%??composed of 23 cases of grade A and 7 cases of grade B. There were 3 cases ??4.7%??of delayed gastric emptying??4 cases ??6.3%??of intra-abdominal abscess??1 case ??1.6%??of intra-abdominal hemorrhage and 3 cases ??4.7%?? of incision infection. All the complications were cured after corresponding treatment and none had reoperation or perioperative death. The Clavien-Dindo classification of surgical complications: level ?? in 3 cases??4.7%????level ?? in 27 cases ??42.2%????and level ??a in 5 cases ??7.8%??. Conclusion Single layer pancreaticojejunostomy with external drainage of the pancreatic duct during pancreaticoduodenectomy can obviously reduce clinically significant pancreatic fistula??B/C grade????is especially appropriate for those with soft pancreas. It is worthy of further clinical promotion.     

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??Methylmalonic aciduria is severe metabolic disorders with potential life-threatening acute complications. Early recognition of metabolic decompensation and appropriate management are critical to ensure good outcome. Plasma total homocysteine should be determined as soon as possible for the differential diagnosis of isolated MMA or combined MMA. The cornerstone of acute management is provision of enough calories and volume of body fluid. Protein restriction is necessary for the patients with isolated MMA. Cobalamin??folate and L-carnitine supplementation are important to correct the metabolic disorders. Underlying triggers should be paid attention to. Long-term management can prolong the life time and improve the quality of life. The individualized nutritional therapy and medical management are keys.     

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??Clinical application and prospect of single-port laparoscopic assisted transanal total mesorectal excision KANG Liang, CHEN Wen-hao, CAI Yong-hua, et al, Department of Colorectal Surgery, the Sixth Affiliated Hospital, Sun Yat-Sen Universiry, Guangzhou 510282, China
Corresponding author: WANG Jian-ping. E-mail: wangjpgz@126.com
Abstract Transanal total mesorectal excision (TaTME) has become one of the hottest spots in the field of colorectal surgery. Due to technical bottleneck, currently the majority of TaTME cases are performed in a hybrid approach--assisted by laparoscopic assistance. However, given the fact that pure single-port laparoscopic rectal cancer surgery is difficult to accomplish and the fact that TaTME assisted by multi-ports laparoscopic surgery has no more mini-invasive advantages, the combination of TaTME and single-port laparoscopic surgery which placed trocar in the planned ileostomy site is assumed to achieve the maximal balance of mini-invasiveness, operative difficulty and resection quality.     

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??Endovascular treatment for shunt stenosis or occlusion after restricted portosystemic shunt??An analysis of 24 cases WANG Zhi-wei??MA Xiu-xian??WANG Jia-xiang, et al. Department of Vascular and Endovascular Surgery??the First Affiliated Hospital of Zhengzhou University??Zhengzhou 450052, China
Corresponding author??WANG Jia-xiang, E-mail??wangzhiwei126@126.com
Abstract Objective To explore the cause of artificial vessel stenosis or occlusion after restricted portosystemic shunt (mesocaval shunt was short for superior mesenteric vein-inferior vena cava shunt; spleen shunt was short for splenic vein-inferior vena cava shunt), and analysis the feasibility and efficacy of percutaneous endovascular therapy. Methods The clinical data of 24 cases of artificial vessel stenosis or occlusion after restricted portosystemic shunt for portal hypertension from March 2009 to March 2012 in Department of Endovascular Surgery, the First Affiliated Hospital of Zhengzhou University were analyzed retrospectively (19 cases of mesocaval shunt, 15 cases of spleen shunt). Results In the 24 cases of artificial vessels stenosis or occlusion treated by restricted portosystemic shunt for portal hypertension, 7 cases who got acute thrombosis within a week after the surgery were treated by catheter directed thrombolysis; 9 cases who got shunts stenosis for anastomotic stenosis of artificial vessel-superior mesenteric vein from 1 to 8 years after surgery were cured by balloon dilatation or stent angioplasty. The shunts artificial vascular occlusion occurred in 8 cases from 1 to 4 years after surgery, 6 of whom succeed to be patent by balloon dilatation or stent angioplasty, and 2 cases were failed for the guide wire can’t go through the anastomotic site of artificial vessel-superior mesenteric vein. And 13 cases were associated with embolism of esophagogastric varices for postoperative standard anticoagulation. Conclusion Endovascular therapy by percutaneous puncture through "femoral vein-inferior vena cava-artificial vessel-portal vein” (including catheter directed thrombolysis, balloon dilatation, stent placement ,etc) are little trauma, highly successful and have a remarkable effect in the treatment of shunt stenosis or occlusion after restricted portosystemic shunt in portal hypertension.     

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??One layer continuous suture with edge sealing in gastrointestinal anastomosis: Experience of 419 cases WEI Ji-shu??WU Peng-fei??YIN Jie??et al. Pancreas Center??the First Affiliated Hospital of Nanjing Medical University??Nanjing 210029??China
Corresponding author: MIAO Yi, E-mail: miaoyi@njmu.edu.cn
Abstract Objective To observe the effect ofone layer continuous suture with edge sealingin gastrointestinal anastomosis. Methods Clinical data of 419 open pylorus preserving pancreaticoduodenectomy cases that using one layer continuous suture with edge sealing for duodenojejunostomy in the Pancreas Center of the First Affiliated Hospital of Nanjing Medical University from 01/01/2014 to 31/12/2016 were retrospectively analyzed. Time of duodenojejunostomy was recorded in forty randomly selected cases. Results mortality 7 cases (1.7%). 9 cases(2.1%) undergoing radiology interventional therapy for postoperative hemorrhage, 6 cases(1.4%) reoperation for invalid of interventional therapy. Average time of anastomosis was 4.9??4.5??5.8??min. In this series??there was no postoperative duodeno-jejunum anastomostic complications??namelyhemorrhage??fistula and stenosis. No mortality occurreddue to duodeno-jejunal anastomosisrelatedcomplications. Conclusion One layercontinuoussuture withedge sealing is a simple and safe methodforgastrointestinal anastomosis.