Objective To introduce the application and the surgical cooperation of the transanal endoscopic microsurgery in resection of rectal neoplasms and summarize the nursing points.Method The clinical histories of 135 patients undergoing resection of rectal neoplasms with transanal endoscopic microsurgery were reviewed and analyzed.Results All the surgeries were successful. Four patients developed with wound infections,three of them getting better after treatment and one of them diagnosed with poorly differentiated adenocarcinoma and selected another operation.Conclusion Well-prepared、pre-operation,skillful operation and instrument procedure and postoperative nursing were critical to the success of operations.

Objective To analyze the risk factors of bile duct injuries in laparoscopic cholecystectomy.Methods The clinical data of 11 243 patients who underwent laparoscopic cholecystectomy between October 1992 and December 2013 in the Xianyang Center Hospital were studied retrospectively.The risk factors of bile duct injuries were analyzed using the Chi-square test to determine the independent risk factors of bile duct injuries.Results Univariate analysis showed that bile duct injuries were associated with male,age ≥65 years,BMI ≥25 kg/m2,staging of inflammation,gallbladder atrophy on ultrasonography,thickness of gallbladder wall on ultrasonography,anatomy of Calot 's triangle and operator's experience (all P ＜ 0.05).Multi-factor and non conditional Logistic regression analyses showed that the independent risk factors of bile duct injury were old men,gallbladder atrophy,anatomy of Calot's triangle and operator's experience (All P ＜ 0.05).Conclusion Old men,gallbladder atrophy,anatomy of Calot's triangle and operator's experience were independent risk factors of bile duct injuries.

Objective To explore the effects of modified herringbone-Trendelenburg position in the laparoscopic anterior resection for rectal cancer patients. Methods A total of 108 patients undergoing laparoscopic anterior resection were recruited and randomly assigned to observation group(54 cases) and control group (54 cases). Patients in the observation group were positioned in modified herringbone-Trendelenburg position, while the patients in the control group were placed in conventional Trendelenburg position. The data of heart rate (HR), mean arterial pressure (MAP) were recorded at 3minutes before body position change and 3 minutes after body position change, 3 minutes before recover horizontal position and 3 minutes after recover horizontal position. Intraocular pressure (IOP) were measured at 3 minutes after general anesthesia in supine position (T0), and 3 minutes after pneumoperitoneum while in the operation position (T1), every 1 hour (T2 to T3), 3 minutes before recover horizontal position at the end of pneumoperitoneum (T4), 3 minutes after recover horizontal position (T5) and 30 minutes after recover horizontal position(T6). Investigate the satisfaction of the surgeons regarding the surgical position of the patients.Followed up investigation at 24h and 48h after surgery were enforced to record the situation of the pain in the shoulder and postoperative complications of the lower limbs. Results The heart rate pre-and post the change of body position in observation group were (2.11±0.92), (-2.78±1.01) beats/min respectively, while the control group were (5.98±2.98), (-6.03±1.98) beats/min, the differences were statically significant (t=9.111,9.851, P<0.01).The mean arterial pressure pre-and post the change of body position in observation group were (1.67 ± 1.23), (2.21 ± 0.89) mmHg(1mmHg=0.133kPa) respectively, while the control group were (7.20±2.30), (6.41±1.87)mmHg, the differences were statically significant(t=15.512, 14.811, P<0.01).The differences of intra-ocular pressure between 2 groups had no statistical significance at T0 and T6 (P>0.05). The intra-ocular pressure were (13.64±1.66), (16.56±1.82),(19.78±1.70),(21.00±1.71),(18.53±1.77)mmHg respectively from T1 to T5, lower than that of control group (15.59±2.03),(19.40±1.89), (23.22±2.15), (25.38±2.09), (22.35±1.76)mmHg, the differences were statically significant (t=5.442-11.907, P<0.01).The incidence of shoulder pain and low leg pain in observation group were 9.26％(5/54), 7.41％(4/54) respectively, lower than that of control group 46.29％(25/54),31.48％(17/54), the differences were statically significant (t=17.778,9.755,P<0.01). The scores of shoulder pain and low leg pain in observation group were (1.38±0.38), (2.02±0.34) points, lower than that of control group (4.44 ± 0.48), (3.85 ± 0.57) points, the differences were statically significant (t=36.761, 20.162, P<0.01). The satisfaction rate of surgeons was 87.04％(47/54) in the observation group, higher than that in the control group 55.56％ (30/54), the difference was statically significant (χ2=5.119, P=0.024). Conclusion Modified herringbone-Trendelenburg position can maintain the circulatory system stability better without affecting the operation, reduce the elevation of IOP, effectively improve the comfort of the operation position of the patients,reduce the postoperative complications of the lower limbs and the incidence rate of the shoulder pain in the laparoscopic anterior resection for rectal cancer patients.

Objective? To investigate the feasibility and safety of vacuum modelling pad for patients with lateral position in thoracic surgery to improve the convenience and comfortable experience for medical staff and patients. Methods? From May 2017 to March 2018, 100 patients who underwent thoracic surgery under general anesthesia with lateral position in the operating room of Sun Yat-sen University Cancer Center were randomly selected and divided into observation group(n=50) and control group (n=50) according to random number table. The polyurethane vacuum modelling pad was used for to secure the patients' position in the observation group, while the sand bag baffle was used to secure the patient's position in the control group. Position placement time and skin pressure blisters were recorded in both groups. Questionnaires were sent out after operation to collect the satisfaction of medical staff with this position. The patients' comfort was followed up within 24 hours after operation. Results? The position placement time in the observation group was (183.56±10.36) s, shorter than the control group with (290.80±14.71)s and the difference was statistically significant(P＜ 0.01); there were 11 cases of skin reddening under pressure and 2 cases of blister in the observation group, which is statistically different from the control group with 24 cases of skin reddening under pressure and 9 cases of blister(P＜ 0.05). Patients' comfort score was(6.72±0.39) in the observation group, higher than the control group with (6.02±0.44) and the difference was statistically significant(P＜ 0.01). In terms of the 4 items of "the convenient operation", "comfortable standing position", "patient safety" and"overall evaluation", the observation group scored higher than the control group with statistical differences (P＜0.01); in terms of the "surgical field exposure" and "fasten effects", there was no statistical difference (P＞0.05). Conclusions? The use of modelling pad for patient lateral position in thoracic surgery can not only prevent organ and skin damage and ensure patient safety, but also simplify the operation procedure, improve the comfort of standing position and the working efficiency and satisfaction of the medical staff.