Fast track surgery(FTS) can reduce the patients' surgery stress response, maintain the physiological state of the patients, decrease the risk of postoperative complications and then accelerate recovery after surgery.At present, the FTS protocol in laparoscopic radical gastrectomy for gastric cancer is still in a preliminary stage, and its safety and validity remains to be verified.This systemic and comprehensive review focused on the concept of rapid rehabilitation surgery, the program of perioperative treatment, the economic benefit and its future outlook.

Objective To evaluate the feasibility,safety and outcome of laparoscopic total mesorectal excision with sphincter preservation in the treatment of low rectal cancer.Methods From April 2004 to April 2007,laparoscopic total mesorectal excision with sphincter preservation for low rectal carcinoma was performed in 25 cases.The intraoperative risk.recovery,short-term and oncological outcomes of these patients were compared with 25 cases of conventional Dixon's operation.The controls,matched for age,sex,mass margin distance from the anus,Dukes stage,were selected from conventional Dixon's operations performed at the same period as laparoscopic group.T test and Chi-square test were used.Results Laparoscopic procedure was successful in 24 cases while one was converted to Bacon operation.The mean operation time(197±36)min in laparoscopic group was significantly longer than those(172±51)min in open group(t=2.12,P=0.04).The mean operative blood loss was(157±105)ml in laparoscopic group and(304±237)ml in open group(t=-2.95,P=0.01).No significant differences were detected between two groups in specimen length and number of lymph nodes excised.The bowel function was restored earlier in laparoseopic group than that in open group.The overall morbidity rates were 16%and 28%,and the local recurrence rates were 8%and 4%in the two groups respectively.Conclusion Laparoscopic total mesorectal excision is a feasible,safe,minimally invasive technique for rectal cancer.which provides better short-term outcomes and similar oncological outcomes compared with the traditional open procedure.

Objective To evaluate the feasibility,safety and therapeutic efficacy of laparoscopic radical resection for gastric carcinoma. Method In this study,15 patients with gastric carcinoma underwent laparoscopic radical resection from May 2005 to Aug 2006,clinical parameters including surgical procedures,operation time,blood loss,time for passage of flatus,complications and pathological findings were recorded. Result All operations were successful.Five cases received laparoscopic radical distal gastrectomy,5 cases received hand-assisted laparoscopic radical distal gastrectomy,laparoscopic total gastrectomy was performed in 4 cases,laparoscopic proximal gastrectomy was performed in 1 case.The operation time ranged from 195 to 350 min,the blood loss was 100 to 600 ml.The average time of intestinal function recovery was(2.9 ± 0.8)days.The average number of lymph nodes dissected were(28±6).There was no major postoperative complications.Postoperative follow-up were 24 months in 15 cases,there were no metastasis and tumor recurrence.Conclusion Laparoscopie radical gastrectomy is a feasible and safe surgical procedure for patients of gastric carcinoma.

Objective To study the influence of laparoscopic gastric surgery on the gut barrier function (GBF).Methods There were 64 gastric cancer patients undergoing respectively laparoscopic radical procedures (32 cases) and open gastric surgery (32 cases).Blood was drawn on day one before surgery,day 1,day 3 and day 7 after the surgery for the measurement of plasma D-lacate and plasma diamine oxidase activity by using ultraviolet spectrophotometry.Results There was no statistical difference among demographic,clinicopathological characterastics between the two groups (P ＞ 0.05).The difference on the operative time,blood loss and the time starting to take food after the surgery was significant between the two groups,P ＜ 0.05.The differences of plasma D-lacate level and the diamine oxidase (DAO) on perioperatively respective all time points were not significant between the two groups,P ＞ 0.05.Conclusion Laparoscopic radical gastrectomy is comparable to open procedures in causing damage to patient's gut barrier functions.

Objective To investigate the safety,feasibility and effectivity of laparoscopic left hemihepatectomy for left hepatolithiasis.Methods From Jan.2005 to Dec.2013,36 patients with left hepatolithiasis underwent laparoscopic left hemihepatectomy (group LH),in comparison with 39 other patients who underwent conventional open left hemihepatectomy (group OH).The blood supply to left liver was dissected and cut off first.The liver parenchyma was transected and the left hepatic vein was dissected and clamped.Intraoperative choledochoscopy was carried out through the stump of left bile duct,laparoscopic choledocholithotomy and T-tube drainage were carried out when stones were found in the common or right bile duct.Blood loss,rate of residual stone,complication rate between the two groups were compared.Results The success rate of operation was 100％.Compared with group OH,group LH had shorter postoperative hospitalization,less incision infection and fewer analgesia needed(t =3.75,x2 =4.11,x2 =22.12,P ＜0.05).There was no statistical difference for blood loss,rate of transfusion,and postoperative complications such as bile leakage,pleural effusion,ascites,residual stones (t =0.66,x2 =0.70,x2 =0.01,x2 =0.52,x2 =0.01,x2 =0.28,x2 =0.01,P ＞ 0.05).Conclusions Laparoscopic left hemihepatectomy is safe,feasible,and effective for hepatolithiasis of the left liver lobe.

Objective To evaluate the feasibility,safety,post-operative short and long-term outcomes of laparoscopic-assisted D2 radical distal gastrectomy in treating advanced gastric carcinoma without serosal invasion.Method From May 2007 to May 2013,54 cases of advanced gastric antral cancer without serosal invasion underwent laparoscopic-assisted D2 radical distal gastrectomy (laparoscopic group),54 demographically and pathologically-matched cases undergoing open surgery served as control.The surgical risk,post-operative recovery and follow-up results were compared.Result Surgery was successful in all patients.The mean operation time in laparoscopic group and open group was (168 ± 31) mins and (157 ±20) min respectively,the difference was significant (t =2.237,P =0.027) ; Intra-operative blood loss was (151 ± 56) ml and (213 ± 86) ml (t =4.45,P =0) ; Post-operative intestinal function recovery time was (2.7 ± 0.7) d and (3.4 ± 0.5) d (t =5.4,P =0) ; Lymph node dissection number was (26.4 ± 4.2) and (24.8 ±5.2) (t =1.769,P=0.08).Post-operative complication rate was 4％ and 11％ (P =0.142).There was no perioperative mortality in either group.Post-operative pathological stage of Ⅰ B,Ⅱ A,Ⅱ B,ⅢA was 8,17,24,5 cases in laparoscopic group and 9,14,23,8 cases in open surgery group.108 cases were followed up from 7 to 79 months.In laparoscopic group,8 cases had local recurrence or distal mestastasis,and 4 cases died from tumor; In open group,9 cases had local recurrence or distal mestastasis,and 6 cases died from tumor.Conclusions Laparoscopic-assisted D2 radical distal gastrectomy in treating advanced gastric cancer without serosal invasion is feasible,safe and advantageous in minimal invasion and rapid recovery,with good short and long-term outcomes.

Objective:To study the effects of expansion of ropivacaine hydrochloride liquid on the postoperative analgesia,sedation, hemodynamic effects and adverse drug reactions of the patients underwent endoscopic thyroidectomy,and to explore its clinical effectiveness and safety. Methods:Forty patients who were to undergo endoscopic thyroidectomy via chest-breast approach were randomly assigned to saline solution group and expansion liquid of ropivacine hydrochloride group (ropivacaine group,n = 20).The mean arterial pressure (MAP )and heart rate (HR)were also evaluated at the following time points:preoperative evaluation (T0 ),before local anesthetic infiltration (T1 ),at the end of the operation (T2 );the blood loss,the operation time,the postoperative drainage,and the hospital duration of the patients in two groups were recorded; the nausea and vomiting,the respiratory depression,the toxicity response,the infection,and the recurrent laryngeal nerve injury during 24 h after operation were recorded.The postoperative pain scores were assessed at extubaltion (T3 ),30 min (T4 ),2 h (T5 ),6 h (T6 ),12 h (T7 )and 24 h (T8 )after extubation using Visual Analog Scale (VAS).The postoperative Ramsay scores were assessed at T3 and T4 .Results:There were no significant differences in MAP and HR at T0 and T1 of the patients between two groups (P >0.05).Compared with saline solution group,the MAP and HR at T2 and T3 of the patients in ropivacaine group were significantly decreased (P < 0.05).There were significant differences in the blood loss,the operation time, the postoperative drainage,and the hospital duration of the patients between two groups (P <0.05).The number of patients required postoperative analgesia and the number patients with nausea and vomiting in ropivacaine group were decreased compared with saline solution group (P <0.05).Compared with saline group,the VAS scores at T3 ,T4 ,T5 ,T6 ,T7 and T8 of the patients in ropivacaine group were significantly decreased (P <0.05);the Ramsay scores at T3 and T4 of the patients in ropivacaine group were also decreased significantly (P <0.05).Conclusion:Expansion liquid of ropivacaine hydrochloride can reduce the stress response during endoscopic thyroidectomy effectively and reduce the postoperative pain and injury induced by operation.

Objective To study the value of combination detection of four markers in predicting the early recurrence and metastasis after hepatectomy.Methods Peripheral blood samples were obtained from 40 primary hepatocellular carcinoma and controls,Reverse transcription-polymerase chain reaction (RT-PCR) was used to detect AFP mRNA,h-TERT mRNA,CD44v6 mRNA and MAGE-1 mRNA in PBMC.Results The positive rate of AFP mRNA,h-TERT mRNA,CD44v6 mRNA,MAGE-1 mRNA was 50％,62.5％,55％,37.5％ in PHC patients.The positive expression rate of AFP mRNA and hTERT mRNA were 15％,30％ in patients with chronic active hepatitis,there was significant difference in the positive expression rate of two groups (respectively,~ =6.910,5.640,all P ＜ 0.05).There was no expression of the four markers in peripheral blood of healthy adults.Eight patients showed recurrence or metastasis in 9 PHC patients who has positive expression of the four markers,while none of patients who has no expression of any of four markers showed recurrence or metastasis.The difference among the groups was statistically significant (x2 =9.244,P ＜ 0.01).Conclusions The combinatorial detection of AFP mRNA,h-TERT mRNA,CD44v6 mRNA and MAGE mRNA expression increased the accuracy of predicting recurrence or metastasis of PHC patients in early postoperative phase.

Objective To compare the clinical efficacy of open and laparoscopic left hepatectomy for the treatment of left intrahepatic bile duct stones.Methods The clinical data of 136 patients treated with hepatectomy admitted to the Department of General Surgery of the Second Hospital of Yinzhou District,Ningbo from January 1,2016 to January 1,2022 were retrospectively collected.132 patients treated with left hepatectomy were included,and the propensity score matching method was used to perform 1∶1 matching between the open left lobe hepatectomy(OLH)and laparoscopic left lobe hepatectomy(LLH)groups.Forty-seven patients were matched in each group.The main observations were:operative time,intraoperative bleeding,intraoperative blood transfusion rate,postoperative hospital stay,complication rate,biliary fistula rate,stone removal rate and stone recurrence rate.Results The LLH group had a shorter postoperative hospital stay,a lower postoperative complication rate and a lower postoperative biliary fistula rate(P<0.05).There was no statistically significant difference in the initial stone removal rate,final stone removal rate and stone recurrence rate between the two groups.Multifactorial analysis showed that open surgery and postoperative complications were independent risk factors for prolonge postoperative hospital stay.Open surgery was an independent risk factor for postoperative biliary fistula;left extrahepatic lobectomy,postoperative biliary fistula and combined multiple stones were independent risk factors for stone independent risk factors for recurrence.Conclusion Laparoscopic left hepatectomy for left intrahepatic bile duct stones is safe and effective.Postoperative biliary fistula and the combination of multiple stones were independent risk factors for recurrence of intrahepatic bile duct stones after surgery.