Objective To systematic evaluate the safety and efficacy of laparoscopic-assisted versus open radical gastrectomy for advanced gastric cancer. Methods We retrieved the comparative studies on laparoscopic-assisted and open radical gastrectomy for advanced gastric cancer from the databases of PubMed, Embase, Cochrane Library, China Knowledge Network, VIP and Wanfang published from June 2008 to June 2018.The qualities of studies were evaluated and the relevant clinical data analyzed.Meta-analysis was performed with RevMan 5.3 software.Results A total of 12 studies were included, including 7 English articles, 5 Chinese articles, 2 randomized controlled trials (RCTs) and 10 respective non-controlled trials (RNTs).With a total sample size of 4 199, laparoscopic (n=2 118) and open (n=2 081) groups were designated.As compared with open gastrectomy group, laparoscopic-assisted gastrectomy group achieved a longer operative duration (WMD=26.32, P=0.01) and a smaller volume of blood loss (WMD=-109.84, P=0.00); no significant differences existed in number of harvested lymph node dissection, proximal resection margin or distal resection margin (WMD=1.2, -0.20,-0.01; all P>0.5).The time to flatus and oral intake and duration of hospitalization stay were significantly shorter than those of open group (WMD=-0.57, -0.67, -3.14; all P<0.05); the incidence of postoperative complications was lower (OR=0.75, P=0.00); 1/5-year overall survival rate showed no significant inter-group difference (OR=1.17, 3.36, P>0.05).Sensitivity analysis revealed the stability of the above results.And funnel plot indicated no significant publication bias.Conclusion With faster postoperative recovery, laparoscopic-assisted radical gastrectomy is both safe and feasible.It is expected to achieve a comparable radical efficacy as conventional open surgery.

Objective Abdominal aortic aneurysm(AAA) can be divided into symptomatic abdominal aortic aneurysm(sAAA) and asymptomatic abdominal aortic aneurysm (aAAA) according to its manifestations, and the purpose of this study was to investigate the difference and correlation of morphological data of the two groups.Methods January 2013 to January 2019 were included in the study. They were divided into symptomatic group (27 cases) and non-symptomatic group (80 cases) according to whether there was associated back and/or abdominal pain. According to the relevant data of computer tomography angiography (CTA), the differences and correlations of the main morphological indicators (maximum diameter of tumor, neck angle, etc.) between the two groups were analyzed and compared.Results The maximum diameter of the tumor in the sAAA group was greater than that in the aAAA group, with a statistically significant difference [(5.40±1.58) cm vs. (4.73±1.02) cm, P=0.047], for neck length [(2.87±1.27) cm vs. (2.76±1.43) cm, P=0.711] and neck angle (48.06°±36.06° vs. 36.66°±21.65°, P=0.131), with no statistically significant difference between the two groups, and the proportion of eccentric aneurysms was relatively higher in the sAAA group, with a statistically significant difference (51.9% vs. 30.0%, P=0.04). There was a negative correlation between neck length and the maximum diameter of the tumor (r_s=-0.36, P<0.01), and a positive correlation between the angle of the neck and the maximum diameter of the tumor (r_s=0.258, P=0.007).Conclusion In this study, there were statistically significant differences in the maximum diameter of the tumor, neck length, and geometric variables of neck angle between sAAA and aAAA, and the proportion of eccentric aneurysms was relatively higher in sAAA, which provided support for the aggressive clinical management of sAAA. There is a negative correlation between the length of the neck and the maximum diameter of the tumor, while there is a positive correlation between the angle of the neck and the maximum diameter of the tumor. The morphological variables of abdominal aortic aneurysm are also related to each other and interact with each other. However, the maximum diameter of the tumor alone cannot be used to predict the risk of abdominal aortic aneurysm rupture. It should also be analyzed from the perspective of hemodynamics and pathophysiology, which will make the prediction and determination more scientific.

Rectal cancer is one of the common gastrointestinal malignancies in China. Surgery remains the most effective way to the treatment of rectal cancer. With the development of low and ultra-low sphincter-preserving surgery following neoadjuvant chemoradiotherapy, the incidence of surgical complications of rectal cancer maintains at a high level. Surgical complications not only affect the short-term surgical efficacy, increase the patient's disease burden and costs, and prolong the length of hospital stay, but also affect patients' long-term survival. Therefore, evaluating the risk factors for complications following rectal cancer surgery, taking prophylactic measures and choosing effective management will help to reduce the incidence of serious complications, decrease the impact of complications and improve the outcomes of surgical treatment for rectal cancer. This article will summarize the causes as well as the treatment strategies of common complications following surgery for patients with rectal cancer.

Objective To analyze the clinical characteristics of small intestinal stoma closure operation and reduce the complications. Methods The clinical data of 131 patients who received small intestinal stoma closure operation were reviewed retrospectively. According to the presence or absence of previous serious abdominal infection, abdominal chemotherapy, the history of more than three times of abdominal surgery and other risk factors, patients were divided into low risk (n=96) and high risk (n=35) groups. All the patients underwent preoperative imaging examinations, including chest and abdomen enhanced CT, ECG, colonoscopy, gastrointestinal imaging, echocardiography, etc. Patients all received routine laboratory tests, including tumor markers and other blood tests. Patients were given appropriate supportive therapy after admission. According to preoperative evaluation, the incisions were designed through the stoma or the middle of the abdomen. All patients underwent postoperative nutritional support, albumin supplement, wound dressing, peritoneal washing and other treatments. High-risk group and low-risk group received small intestinal stoma closure operation 6 months and within 2 to 6 months after the last operation respectively. Results In low-risk group, there were 51 males and 45 females with average age of 56.4±13.8 years. In high-risk group, there were 20 males and 15 females. The small intestinal stoma in the low-risk group was caused by preventive intestinal colostomy after elective surgery for colorectal tumor. In high-risk group, the reasons included preventive intestinal stoma in 20 patients, anastomosis fistula in 4 cases and intestinal perforation or traumatic enterorrhexis in 11 cases. In high-risk group, there were 2 cases who merged in preoperative abdominal radiotherapy, 9 cases in preoperative intraperitoneal perfusion chemotherapy, 6 patients with the history of more than 3 times previous abdominal surgery, and 18 cases with severe abdominal cavity infection. In low-risk group, 88 cases were qualified in 6 min walk test and 8 cases were unqualified. In high-risk group, 30 cases were qualified and 5 cases were unqualified. Preoperative serum albumin was greater than 30 g/L in all patients of low-risk group, and 29 cases in high-risk group. There were 6 cases less than 30 g/L in high-risk group. The hospital stay in low-risk group was 8.08±0.98 days, and 12.34±7.55 days in high-risk group. Complications of abdominal cavity infection, infection of incision, incision hernia, and intestinal fistula in high-risk groups were significantly more than those in low-risk group. The mortality was significantly higher in the high-risk group. Complications of positive patients in 6 min walk test significantly increased compared with those of negative patients. Conclusions Difficult small intestinal stoma closure operation is a high risk of surgery and it has the characteristics of long operation time, more bleeding, inevitable bowel injury or bowel resection. It has higher incidence of postoperative intestinal fistula, abdominal cavity infection, infection of incision, and incision hernia. The recovery is slow, and the expenses are high.

Severe acute pancreatitis is an acute abdomen with acute onset of symptoms and severe complications including multiple organ failure and with poor prognosis in some patients. By now, surgical debridement still plays an important role in the treatment. The aim of this article was to summarize the progress in surgical intervention of sever acute pancreatitis and the management of its complications in combination with retrospective studies on recent data in the treatment of patients with severe acute pancreatitis in Ruijin Hospital.

Liver resection remains the first-line treatment of hepatocellular carcinoma (HCC). In addition to the factors associated with tumor invasiveness, liver function and general performance, the type of liver resection, the width of surgical margins and intraoperative blood loss might affect the patient's long-term survival after surgery. With an intention of achieving an R0 resection, resection types and surgical margin should be carefully selected based on the tumor burden, tumor location and liver functional reserve. On the premise of ensuring a sufficient functional liver remnant, an anatomical or a wide margin resection may benefit for patients with poorly differentiated tumor, or with local or microvascular invasion. The accurate preoperative assessment and the operation using low central venous pressure and proper blood flow control technique to reduce intraoperative blood loss may provide more chance to achieve optimal surgical safety and long-term survival.

Objective To investigate the incidence of intestinal obstruction one month after surgical procedure, and the influencing factors.Methods The clinical data of 227 cases diagnosed with colon cancer who received colorectal surgery from Oct. 2014 to Oct. 2016 In PLA General Hospital were collected, and all patients were followed up for 1 month after operation.The incidence of intestinal obstruction was statistically analyzed. The influencing factors were analyzed by chi-square test and multi-factor unconditioned Logistic regression analysis.Results Nineteen cases out of 227 patients with colorectal cancer suffered from intestinal obstruction with an incidence rate of 8.37%. Of 19 cases of intestinal obstruction, including 11 cases of inflammatory intestinal obstruction, 4 cases of mechanical intestinal obstruction and 4 cases of paralytic intestinal obstruction.Chi-square test showed that the patients with preoperative intestinal obstruction and higher T staging showed higher incidence of intestinal obstruction. The incidence rate of intestinal obstruction in the patients receiving laparoscope was significantly lower than that in the patients receiving traditional open operation(P<0.05). Multi-factor unconditioned Logistic regression analysis showed that age (OR=0.158, 95% CI:0.114-1.215), preoperative intestinal obstruction (OR=1.114, 95% CI: 0.482-1.664) and T staging (OR=1.752, 95% CI: 0.972-6.721) were risk factors for intestinal obstruction one month after radical surgery in elderly patients with colorectal cancer, and laparoscopic surgery (OR=1.678, 95% CI:0.533-3.492) was the protective factor.Conclusions The incidence of intestinal obstruction one month after radical surgery in patients with colorectal cancer is high. We should focus on high-risk groups to avoid the occurrence of intestinal obstruction by means of necessary preventive measures such as selecting appropriate operation and improving the general situation of the patients.

Lymphatic leakage after gastro-duodenal surgery is mainly caused by surgical or other trauma factors, leading to rupture of lymphatic vessels in thoracic duct or celiac cavity, causing lymphatic fluid into chest and abdominal cavity. The flow with high lymphatic leakage often leads to fat, protein, water and electrolyte loss. On the one hand, malnutrition and failure appear; on the other hand, the loss of lymphatic fluid containing a large number of lymphocytes can cause lymphocyte dysfunction, subsequently resulting in infection, which not only delays the recovery time, but also causes deaths in severe cases. Positive nutrition support therapy after lymphatic leakage can help patients recover smoothly. In this paper, the causes, clinical manifestations, diagnosis and treatment of lymphatic leakage are mainly discussed and analyzed.

Primary retroperitoneal sarcoma is rare in clinical practice, however there are many pathological types. Surgical resection is the main treatment, but the high recurrence rate after surgery is a major problem in the treatment of such diseases. The results showed that the prognosis of patients with retroperitoneal sarcoma was mainly related to pathological type, tumor grade, surgical range and tumor number.

Objective To evaluate the efficacy and safety of comprehensive treatment based on surgical resection, local ablation and transcatheter arterial chemoembolization (TACE) for postoperative recurrence of primary hepatocellular carcinoma (HCC). Methods The clinical data of 293 cases of postoperative HCC recurrence diagnosed in Tongji Hospital in 2010-2012 were analyzed retrospectively. Thirty-three patients underwent hepatectomy again and 89 were given TACE therapy plus local ablation, 118 patients were treated with TACE therapy only and 53 received palliative treatment. Results All patients receiving hepatectomy discharged without serious complication. Two patients with hepatic dysfunction after TACE recovered after supportive liver protection therapy. One esophageal perforation occurred after PMCT, and repaired by thoracotomy surgery. The 1-, 3-, and 5-year overall survival rate and median survival time were 72.72%, 45.45%, 32.14% and 30 months in operative group, 62.92%, 31.46%, 17.14% and 21 months in TACE + local ablation group, 47.46%, 29.66%, 8.42% and 11.5 months in TACE alone group, and 20.75%, 3.77%, 0% and 7.75 months in palliative treatment group, respectively. Conclusions Individualized comprehensive treatment based on surgical resection combined with local ablation and TACE was the best treatment modalities for postoperative recurrent HCC. Surgical resection is still the preferred treatment for recurrent HCC. Regular review after surgery was the most effective measures to improve the surgical resection rate and overall survival rate.

Objective To study the diagnosis and treatment of acute superior mesenteric venous thrombosis.Methods During the study period of 2002 to 2016, 39 patients were diagnosed as acute mesenteric thrombosis and accepted treatment in our hospital. All the data were collected.Results Of the 39 patients, there were 24 males and 15 females with the median age of 49 years old and the median history of disease of 10 days. Eight patients had the history of deep venous thrombosis, including 1 case complicated with pulmonary embolism. Eight patients had the history of portal hypertension, including 2 cases undergoingsplenectomy and devasculation. Of 39 cases,10 patients accepted anticoagulation therapy, 13 cases accepted catheter-directed therapy, 8 cases acceptedsurgical operation, and 8 cases accepted initial catheter-directed therapy with subsequent surgery therapy. There was one deathduring the treatment in the anticoagulation therapy group. Patients in the catheter-directed therapy group were given superior mesenteric arteryaccessorpercutaneoustranshepatic access. The medial interval between catheter-directed therapy and surgical operation was 2.5 days (range, 1-36 days). Sixteen patients were subjected to partial bowel resection, including 13 cases of primary anastomosisand 3 cases of enterostomy.Conclusions Acute superior mesenteric venous thrombosis is a rare and fatal acute abdomen. Early diagnoses by the imaging and proper treatment strategies were very important for satisfactory effectiveness.

Bariatric-metabolic surgery, a new concept emerging in recent years, is a discipline that reduces the body weight of obese patients and improves the blood glucose of type Ⅱ diabetics to reduce the harm of its complications by surgery. Since bariatric-metabolic surgery was put forward, it has been exerting a great impact on the metabolic research. Bariatric-metabolic surgery could control or cure type 2 diabetes and its complications, such as microvascular disease, hyperlipidemia, polycystic ovary syndrome, cancer, by alleviating insulin resistance and improving insulin receptor sensitivity. This paper summarized the historical status, safety, effectiveness and mechanisms of bariatric-metabolic surgery by reviewing the pertinent literature at home and abroad to promote clinical understanding and application of bariatric-metabolic surgery in clinical practice.

Budd-Chiari syndrome(B-CS) is a severe hepatic vascular disease in which hepatic congestion occurs due to stenosis or segmental occlusion of the hepatic veins and/or posterior hepatic segments, and its chronic progression may lead to the development of hepatocellular carcinoma (HCC). In the development process of B-CS treatment, surgery has been used as the main means. With the continuous maturity of interventional techniques and the progress in the field of diagnosis and treatment of hepatocellular carcinoma, the diagnosis and treatment plan for B-CS-related liver cancer is also more diverse. The diagnosis and treatment of different types of B-CS and different stages of HCC has formed an individualized, standardized and precise mode of multidisciplinary cooperation. In this paper, we discuss the comprehensive diagnosis and treatment of B-CS with HCC by summarizing the progress in the field of B-CS and HCC diagnosis and treatment in recent years, combined with the experience of case diagnosis and treatment.

Objective To evaluate the surgical technique and clinical effect of laparoscopic hepatectomy. Methods The liver parenchyma dissection can be performed easily and safely by building tunnels aside vital ducts with the advantage of laparoscopy in building tunnels. The clinical data of 52 patients who underwent laparoscopic hepatectomy from Sep. 2014 to June 2016 were retrospectively. The mean operative time, intraoperative blood loss, postoperative hospital stay and complication rate were analyzed. Results All the operations were completed successfully, and there was no perioperative death or conversion to laparotomy. The mean operative time for right hemihepatectomy was 220±45 min, and intraoperative blood loss was 210±92 mL. The mean operative time for hepatic segmentectomy was 100±35 min, and intraoperative blood loss was 300±130 mL. The postoperative hospital stay was 11±2 days. One patient experienced biliary leakage and the complication rate was 1.9%. Conclusions Laparoscopic hepatectomy by building tunnels aside vital ducts can reduce the risk of intraoperative bleeding, and it is feasible and safe, which is worth to be spread

The General Hospital of Central Theater Command is a general hospital in the epidemical area of coronavirus disease 2019(COVID-19). The general surgery department undertakes the treatment of abdominal trauma, malignant tumor and acute abdominal disease.According to the guidelines formulated by the National Health and Family Planning Commission and relevant hospital management regulations, the General Surgery Department has formulated the measures and plans for the prevention and control of COVID-19 in the department. From January 23, 2020 to February 29, 2020, a total of 46 patients were treated in the department, of which 2 patients were suspected and 1 patient was diagnosed with COVID-19, which were timely screened and properly handled, without causing cross infection among the staff, other patients and attendants. Its prevention and control measures and plans effectively prevent the spread of COVID-19 in general surgery and achieve better prevention and control results.

Objective To analyze the diagnosis and treatment of mucinous cholangiocarcinoma (MCC).Methods A retrospective study was made on the clinicopathological features of 6 MCC patients in Zhengzhou University People's Hospital from May 2015 to July 2017.The clinical and pathological features,diagnosis and treatment of these 6 cases of MCC were summarized,and the relative literatures were reviewed.Results There were 2 males and 4 females with age ranging from 38 to 67 years old (average of 52.3 years old).The common symptoms were abdominal pain,fever and jaundice.Intra-and extra-hepatic bile duct dilation to varying degrees was seen in CT and MRI scans.Nodal,mammillary,plaque relative low signal mass was displayed in MRCP scan.Six patients were discharged after surgery.At a median follow up for 18 months (range 1 to 27 months),all patients survived.Conclusions The diagnosis of MCC is very difficult preoperatively.MRCP has obvious advantages compared with other methods.Radical surgical resection is the most effective method for MCC patients.

Objective To prevent and treat the severe complications of the hemorrhoid operations. Methods Nineteen cases of severe complications after hemorrhoids operation From June 2010 to June 2016 were retrospectively analyzed. Results All of the 19 cases including 5 cases of anorectal sepsis, 4 cases of rectal perforation, 6 cases of severe postoperative bleeding (2 cases combined with hemophilia A), and 4 cases of anal stenosis were cured. Conclusions The hemorrhoids operation is not difficult, but post-operative complications are not rare. Timely and proper treatment can avoid the aggravation of the disease and even the risk of life.

Objective To investigate the efficacy and summarize the treatment experience of extended multi-organ resection for T4b gastric cancer. Methods The clinical data of 128 cases for T4b gastric cancer from January 2012 to December 2015 were analyzed retrospectively in our hospital. Results Eighty-five patients received extended multi-organ resection (ER group), and 43 patients palliative surgery (NER group). During the follow-up period, one-, 2- and 3-year survival rate in ER group was significantly higher than in NER group (P<0.05). The incidence of postoperative complications in ER group was significantly higher than in NER group (P<0.05). The perioperative mortality in ER group was slightly higher than in NER group (P>0.05). Conclusions The extended multi-organ resection is safe and feasible, and can prolong the survival and improve clinical symptoms and quality of life.

Objective To explore the effect of conservative treatment for acute superior mesenteric venous thrombosis.Methods The clinical data of 28 patients with acute mesenteric venous thrombosis admitted to the Department of General Surgery, the General Hospital of Central Theater Command from January 2010 to December 2019 were retrospectively analyzed.Results 26 cases of acute mesenteric venous thrombosis were successfully discharged with conservative treatment, the success rate was 92.86%. 2 cases of intestinal necrosis underwent open partial small bowel resection, and were discharged smoothly. The follow-up time was 2 years. 1 case was admitted to the hospital without regular use of warfarin after discharge. None of the other patients had recurrence of thrombosis during the follow-up period.Conclusion For patients with acute superior mesenteric vein thrombosis, most of the patients can effectively avoid intestinal necrosis caused by the spread of thrombosis through early comprehensive treatment measures based on anticoagulation and tube expansion in the acute phase, so as to obtain clinical cure, and its efficacy observation still needs further accumulation of more cases.

Objective To explore the risk factors of bile leakage after laparoscopic choledocholithotomy and primary closure for choledocholithiasis.Methods The clinical data of patients with choledocholithiasis who underwent laparoscopy combined with choledochoscopy for primary suture of common bile duct exploration in the First People's Hospital of Chuzhou from Jan. 2017 to Jun. 2019 were collected, including age, BMI, onset time, gallstone number, common bile duct diameter, preoperative alanine transaminase, creatinine, total bilirubin, white blood cells, platelets, serum albumin, serum amylase, operation time, intraoperative blood loss, positive bile culture during surgery and the cure of postoperative bile leakage.Results Of the 200 patients, 44 (22%) had bile leakage. the clinical data of patients with bile leakage and those without bile leakage were compared. Univariate analysis showed that the onset time [(6.8±1.9) d vs. (3.7±2.3) d], preoperative alanine transaminase[265.0 (212.0,300.0) U/L vs. 73.2(54.0,203.0) U/L], creatinine[151(78.0,177.0) μmol/L vs. 90.0(66.0,171.0) μmol/L], total bilirubin[63.8(30.4,68.4) μmol/L vs. 43.2(27.4,52.6) μmol/L] in the bile leakage group were higher than those in the non-bile leakage group, and the differences were statistically significant (P<0.05). long preoperative course of disease and high level of alanine transaminase were independent risk factors for bile leakage (OR>1, P<0.05),High level of serum albumin is a protective factor for bile leakage (OR=0.764, P<0.05). The ROC curve analysis of the working characteristics of the subjects showed that the cut-off value of the onset time was 5.5 days, the cut-off value of alanine transaminase was 208.5 U/L and the cut-off value of serum albumin was 28.25 g/L (P<0.05).Conclusion Preoperative course of disease more than 5.5 d, alanine aminotransferase more than 208.5 U/L and serum albumin level less than 28.25 g/L can be used as an important basis for predicting bile leakage after primary suture of common bile duct for choledocholithiasis.

Objective To evaluate the safety and efficacy of robotic-assisted pancreaticoduodenectomy for pancreatic head ductal adenocarcinoma. Methods The clinical data of 120 patients with pancreatic head ductal adenocarcinoma who underwent robot-assisted pancreaticoduodenectomy from June 2012 to December 2017 were retrospectively analyzed. Results The overall incidence of postoperative complications was 27.5%, with 5.0% of Clavien-Dindo grade≥Ⅲ complications. The perioperative mortality was 0, and the 90-day mortality rate was 0.8%. The incidence of clinically relevant pancreatic fistula was 6.7%. The median disease-free survival was 14 (11-22) months, the one-year disease-free survival rate was 53.9%, and the three-year disease-free survival rate was 16.3%. The median overall survival was 27 (19-35) months, the one-year overall survival rate was 78.1%, and the three-year overall survival rate was 24.9%. Conclusion Robot-assisted pancreaticoduodenectomy is safe and effective in the treatment of pancreatic head ductal adenocarcinoma.

Objective To investigate the safety and efficacy of ICG fluorescence guided laparoscopic hepatectomy for hepatocellular carcinoma (HCC).Methods From August 2016 to September 2019, 229 patients who underwent conventional laparoscopic liver resection(LLR) and 69 patients who underwent ICG fluorescence guided laparoscopic liver resection(FLLR) were retrospectively analyzed. Propensity score matching (PSM) method was used to compare the surgical conditions and postoperative complications between the two groups, and Log-Rank test was used to analyze the disease-free survival (DFS) and overall survival (OS) of the two groups.Results Among 298 patients with laparoscopic hepatectomy, 229 patients in LLR group and 69 patients in FLLR group were included in the study, with 65 patients in both groups after matching. The operation time of FLLR group was shorter than that of LLR group both before and after pairing (P<0.05); there was no statistical difference between the two groups before and after matching, such as intraoperative hemorrhage, intraoperative blood transfusion, postoperative complications, DFS and OS.Conclusion ICG fluorescence imaging guided laparoscopic hepatectomy can effectively shorten the operation time without increasing postoperative complications, and has the same effect as laparoscopic hepatectomy alone in the long-term prognosis of tumors.

The TNM stage of gastric cancer has become the first reference for clinical diagnosis and treatment of gastric cancer.Through the collection and analysis of data on gastric cancer worldwide,the Union for International Cancer Control (UICC),International Gastric Cancer Association (IGCA) and American Joint Committee on Cancer (AJCC) jointly issued the 8th edition of the gastric cancer TNM staging system,in October 2016.The 8th edition of the TNM staging system has a clear definition of the staging criteria for esophago-gastric junction cancer and cardia cancer,and adds clinical TNM staging (cTNM) and new adjuvant therapy (ypTNM) on the basis of a single stage system.In addition,the new staging system incorporates two subgroups of N3 (N3a and N3b) as independent group into the system,and makes some adjustments to the histological grade.In general,compared with the 7th edition of gastric cancer TNM staging system,the new edition of staging system may guide clinicians more rational treatment,more scientific evaluation of treatment effect,more accurate assessment of the prognosis for gastric cancer patients.However,with the widespread clinical application and further validation,as well as the discovery of new predictors,there will be new staging systems to replace and refine the old staging system.

Objective To investigate the clinical characteristics and surgical treatment of primary hepatic tuberculosis, and summarize the experience of clinical diagnosis and treatment.Methods The clinical characteristics, clinical management and follow-up of 11 patients with primary liver tuberculosis admitted to Tongji Hospital, Tongji Medical College of Huazhong University of Science and Technology from 2012 to 2017 were retrospectively analyzed.Results There were 7 males and 4 females, aged 18-66 years, with a mean age of 42.7 years. None of them had a history of tuberculosis. the most common symptom was abdominal pain (45%), and laboratory tests were unremarkable. The lesion showed hypoechogenicity on ultrasound, heterogeneous internal echoes, hypodensity with varying degrees of enhancement on CT, and mixed signals on MRI. The preoperative diagnosis was hepatocellular carcinoma (2 cases), cholangiocarcinoma (1 case), hilar tumor (2 cases), benign liver tumor (3 cases), liver abscess (2 cases), of which 1 case of hepatic tuberculosis, hepatic echinococcosis or liver tumor (1 case), with a misdiagnosis rate as high as 91%. Surgical methods included partial hepatectomy in 5 cases, laparotomy + liver biopsy in 2 cases, incision and drainage of liver abscess + abscess wall biopsy in 2 cases, and liver biopsy in 2 cases. Postoperative conventional anti-TB treatment, follow-up to date showed no signs of tuberculosis recurrence.Conclusion The clinical manifestations of primary hepatic tuberculosis are different, and it is easy to be misdiagnosed. Surgical intervention can remove the lesion and confirm the diagnosis. Postoperative routine anti-tuberculosis treatment can effectively control tuberculosis.

Objective To explore the change of serum bile acid concentration and assess its clinical value of early warning in patients with gallbladder cancer (GC).Methods The relevant clinical data were collected from 89 GC patients and 796 healthy individuals undergoing serum bile acid testing from June 2016 to December 2018 at Sixth People's Hospital and Renji Hospital. Retrospective analysis was performed to compare the concentrations of 15 serum bile acid components between healthy control and GC groups. The serum bile acids with early warning performance for GC were evaluated and screened by receiver operating characteristic (ROC) curve and Logistic regression analysis.Results Gender or age had no impact on serum bile acid concentrations in both healthy individuals and GC patients. Compared to healthy control group, GC patients had significantly elevated levels of serum glyocholic acid (GCA)(770.64 vs. 124.12 nmol/L, P＜0.001), glycochenodeoxycholic acid (GCDCA)(2 513.32 vs. 658.78 nmol/L, P＜0.001), taurocholic acid (TCA)(100.35 vs. 14.10 nmol/L, P＜0.001), taurochenodeoxycholic acid (TCDCA)(221.57 vs. 54.70 nmol/L, P＜0.001), lithocholic acid (LCA)(17.33 vs. 9.70 nmol/L, P=0.002), glycoursodeoxycholic acid (GUDCA)(352.23 vs. 104.75 nmol/L, P＜0.001), taurolithocholic acid (TLCA) (2.14 vs. 1.35 nmol/L, P=0.030) and tauroursodeoxycholic acid (TUDCA)(23.49 vs. 5.38 nmol/L, P＜0.001). And they exhibited significantly lowered levels of serum deoxycholic acid (DCA)(94.52 vs. 309.53 nmol/L, P＜0.001) and a marked reduction in the ratio of serum free/conjugated bile acids from 0.65 to 0.24 (P＜0.001). Serum GCA had the highest early warning performance for GC with an area under curve (AUC) of 0.818, a sensitivity of 71.59% and a specificity of 80.49%. Additionally, the composite index composed of GCA, GCDCA, TCA, TCDCA, DCA, LCA, GUDCA, TLCA and TUDCA further improved the early warning performance for GC with an AUC of 0.903, a sensitivity of 83.10% and a specificity of 85.24%.Conclusion GC patients exhibit a reduced ratio of serum free/conjugated bile acids. Serum bile acid concentration testing holds significant potential as an important screening tool for GC.

围生期深静脉血栓形成是导致孕产妇发病及死亡的主要原因之一，但其主要是产后下肢深静脉血栓形成。产后肠系膜上静脉和（或）门静脉血栓形成伴肠坏死极为罕见。该文报道了1例顺产后肠系膜上静脉血栓形成并肠坏死的诊治过程；同时回顾了相关文献，从流行病学、发病机制、诊断及治疗几个方面对这一疾病的诊治进行了讨论。

Objective To explore the clinical application of Mixed Reality Holographic image in perioperative period of hepatectomy.Methods The clinic-pathological data of one case in TongJi Hospital of hepatectomy using Mixed Reality Holographic image were analyzed retrospectively. This was a patient with liver metastasis after radical operation for gastric cancer. It was planned to perform left hemi-hepatectomy. Preoperative Mixed Reality Holographic image was reconstructed to formulate operation mode and confirm resection range.Results Mixed Reality Holographic image can clearly display the range of tumor and ubiety between tumor and vessels.Conclusion Mixed Reality holographic image can be safely and effectively applied in hepatectomy.

Objective To explore the free level of total extraperitoneal hernia repair (totally extraperitoneal herniorrhaphy, TEP) and seek a standard model of hernia membrane anatomy.Methods Retrospective analysis was performed for 118 males of unilateral primary hernia. Combining literature and clinical practices, local anatomy of inguinal region was examined.Results All operations were successful with less intraoperative hemorrhage. There were peritoneal rupture (n=5), seroma (n=23) and scrotal hematoma (n=3). And neither patch infection nor recurrence was found. All important structures were distinctly displayed during the operation and the entry and penetration of all gaps were completed with the concept of membrane anatomy. There were three important gaps:R gap in the center of abdominal wall (Retzius gap), B gap on the side (Bogros gap) and D gap in danger triangle.Conclusion Thorough understanding of various fascia and gaps in inguinal region, higher fluency of operation and surgical complications and a standard model of hernia repair membrane anatomy contribute greatly to clinical practices

Objective To evaluate the feasibility and clinical applied value of laparoscopic distal pancreatectomy (LDP).Methods The clinical data of 28 patients undergoing LDP from May 2014 to September 2016 in our hospital were retrospectively analyzed.Among the 28 patients,9 were male and 19 were female,with the age ranging from 17 to 69 years old.Results LDP with splenectomy was performed on 16 cases,and laparoscopic spleen-preserving distal pancreatectomy with Kimura's procedure or Warshaw's method was performed on 7 cases and 5 cases respectively.Pathologic examination showed serous cystadenoma in 2 patients,mucous cystadenoma in 9 patients,solid pseudo-papillary tumor in 6 patients,intraductal papillary mucinous neoplasm(IPMN) in 3 patients,insulinoma in 3 patients,pseudo cyst in 1 patient,chronic pancreatitis in 1 patient and pancreatic ductal adenocarcinoma in 3 patients.The average operation time was (203±54) min,mean blood loss was (115±138) mL,and the mean postoperative stay was (10±5) days.There were 9 cases of pancreatic fistula (32.1%) with clinical pancreatic fistula of 3 cases which were cured by irrigation and drainage.Spleen infarction occurred in 2 cases following Warshaw procedure,and cured by conservative treatment.Conclusions LDP is safe,feasible and effective with minimally invasive advantage,and it is worth of wide application.

Precision medicine is suitable to apply in the management of abdominal operative complications for the species diversity, complicated influencing factors and different managing methods. The scope of the management of abdominal operative complications covered whole perioperative period, including preoperative comprehensive assessment, intraoperative accurate performance, early detection and management of postoperative complications. It is necessary to obey the modern concept about minimally invasive surgery and enhanced recovery after surgery, and apply them in the whole process of the management of abdominal operative complications. The management of operative complications of gastric cancer will be discussed in the following as an example.

Objective To investigate the safety and efficacy of Dual-knife in difficult bile duct intubation during ERCP.Methods The clinical data of 2 564 patients who underwent ERCP from March 2014 to August 2019 in Union Hospital, Tongji medical college of Huazhong University of Science and Technology were analyzed retrospectively. A total of 215 patients were diagnosed with difficulty in bile duct intubation during ERCP, and Dual-Knife Fistulosphincterotomy (DKF) was applied.Results Among the 215 patients, 212 patients were successfully intubated, and the success rate of intubation was 98.60%. The mean intubation time was 3.5 minutes (2-8 minutes). Compared with standard intubation, the complication rate was not significantly increased (P>0.05). Mild surgical marginal bleeding occurred in 15 patients, followed by local spraying of norepinephrine, Dual-Knife coagulation and Metal clamp hemostasis. 3 patients showed potential perforation after DKF, but no peritoneal infection was found after the operation, and these patient was discharged after conservative treatment. A total of 21 patients (9.8%) with mild or moderate pancreatitis and 15 patients (6.9%) with cholangitis after DKF were cured with conservative treatment. No patients were surgically treated for perforation and no deaths were associated with the procedure.Conclusion For patients with failed difficult bile duct intubation, DKF can complete ERCP selective biliary intubation, and this procedure does not increase the incidence or mortality of postoperative complications after ERCP. It is an effective, simple and safe method in difficult bile duct intubation.

Objective To investigate the incidence and risk factors associated with anastomotic leakage after anterior resection in ultra-low rectal cancer.Methods A retrospective case-control study was conducted. In total, 311 patients with ultra-low rectal cancer who underwent anterior resection surgery between January 2014 and August 2018 in Wuhan Union Hospital were included in this study. Patients’ clinical data were analyzed by χ² test or Fisher's exact test to identify the relationship between the occurrence of anastomotic leakage and clinical features. Meanwhile, the independent risk factors of anastomotic leakage were analyzed via binary logistic regression.Results In total, anastomotic leakage occurred in 23 of 311 (7.40%) patients. The occurrence of anastomotic leakage was associated with smoking history (χ² = 11.390, P=0.001), drinking history (χ²=11.502, P=0.001), diabetes history (P=0.038), defunctioning stoma (χ² = 6.659, P=0.010). Multivariate analysis showed that defunctioning stoma[P=0.015, OR=0.325, 95% CI(0.131,0.807)]was an independent protective factor of anastomotic leakage after anterior resection in patients who had the ultra-low rectal cancer.Conclusion The incidence of anastomotic leakage after anterior resection in ultra-low rectal cancer is 7.4%. The occurrence of anastomotic leakage was associated with smoking, drinking and diabetes. Defunctioning stoma could effectively prevent the occurrence of anastomotic leakage.

With the improvement of laparoscopic radical resection of rectal cancer and its widespread application, the safety, feasibility and long-term efficacy have been gradually recognized. Laparoscopic radical resection, rather than open procedure has been recommended by the recent guidelines. However, there are still many problems to be solved due to the prolonged learning curve, the difficulties in operation, and the clearer concept of "membrane anatomy". To provide reference for clinical practice, the controversies and difficulties in laparoscopic radical resection for rectal cancer need further discussion.

Objective To summarize the experience of diagnosis and treatment for para-duodenal hernia (PDH).Methods The clinical data of 7 cases of paraduodenal hernia admitted to Dalian Central Hospital of Dalian Medical University from January 1, 2014 to January 1, 2019 were retrospectively analyzed.Results Abdominal CT examinations were performed in all the 7 patients, and only 2 patients were suspected para-duodenal hernia. Emergency surgical explorations were performed in 6 patients, among which 3 patients underwent laparotomy, the internal hernias were recovered, and the mesothelium of the para-duodenal recess was closed. Three laparoscopic explorations were performed, and the small intestine was restored after laparotomy. One patient had an incidental finding of a paraduodenal hernia during metabolic surgery and underwent laparoscopic closure of the duodenal accessory recess. All patients were recovered and discharged without complications. There was no recurrence of intra-abdominal hernia and intestinal obstruction during follow-up.Conclusion Para-duodenal hernia is rare in clinic and difficult to be diagnosed preoperatively. It is necessary to fully understand the characteristics of the disease and avoid missed diagnosis or misdiagnosis.

Objective To investigate the risk factors of pancreatic fistula after pancreatic tail duct adenocarcinoma surgery.Methods The clinical data of consecutive patients who had undergone DP of PDA between January 2016 and December 2018 Union Hospital, Tongji Medical College, Huazhong University of Science and Technology at a single institution were analyzed retrospectively by SPSS to evaluate their correlation with the incidence of POPF. POPFs were defined by 2016 International Study Group of Pancreatic surgery criteria. All cases were followed up for up to 90 days.Results A total of 91 consecutive patients were identified. The overall pancreatic fistula rate was 25.27% (23/91) and no death occurred within 90 days after operation. Three predictors were independently associated with POPF: pancreatic texture [OR=8.965, 95% CI(2.400,33.490), P=0.001], cardiovascular disease [OR=9.148, 95% CI(1.936,43.225), P=0.005] and serum albumin on postoperative day 1 [OR=6.100, 95% CI(1.846,20.157), P=0.003].Conclusion Soft pancreatic texture, cardiovascular disease and low albumin level on the first day after operation are independent risk factors for pancreatic fistula after pancreatic tail duct adenocarcinoma surgery. Due to the limitations of this paper, the results have yet to be further validated.