With the rapid development of China's economy,obesity and diabetes have become a serious social problem.Metabolic surgery has grown mature abroad,while it started relatively late in China.There is obvious lack of operative indications,mode and procedure,preventions of complications,perioperative management and follow-up in the early time.To standardize nationwide surgical treatment of diabetes,to make the treatment of type 2 diabetes mellitus (T2DM) patients with the best way,to reduce the incidence of postoperative complications,the domestic famous experts assembled by the Branch of Obesity and Diabetes Surgeons Committee of the Chinese Medical Doctor Association composed the Surgical Treatment Guidance of Obesity and Type 2 Diabetes in China (2014).Metabolic surgery rapidly be popularized across the country.The number of surgery is rising year by year,especially making further standardization of operative indications and modes.Many academic meetings are conveyed to promote the discipline to develop,and provide the communication platform for metabolic surgeons.The future development of metabolic surgery will be accompanied by technological progress,equipment updates,operation excellence and continuous improvement.

With the rapid development of minimally invasive techniques,the emergence of three-dimensional (3D) laparoscope leading minimally invasive surgical accessPrecise Time.In the past 60 years,bariatric surgery provides a large number of clinical evidences to confirm:metabolic and bariatric surgery is lasting and effective for obesity combined with type 2 diabetes mellitus (T2DM),and it is also the best treatment method for T2DM.The author believes that 3D laparoscopic system can help beginners quickly master laparoscopic surgical techniques and shorten the learning curve to master the technical points.Compared with two-dimensional (2D) laparoscopic surgery,3D laparoscopic stereo vision can help experienced bariatric surgeons shorten operation time which is related to surgical procedures.The shorter surgical procedure in laparoscopic sleeve gastrectomy is hardly affecting the operation time.Because gastric bypass surgery is relatively complex,3D laparoscopic techniques which are fully utilized in gastric bypass surgery can effectively shorten the operation time.

The first blood product albumin was developed during World War Ⅱ.Since then, blood products began to play an irreplaceable role in military trauma and emergency cares .Currently, the supporting system of blood and blood products has become increasingly sophisticated .Development of novel blood products also improved dramatically .Universal virus inactivated freeze-dried plasma has also been purchased by the military .Albumin is used as antishock blood volume expansion for emergency treatment of military trauma .Different kinds of albumin including albumin of various concentra-tions, high purity albumin and albumin in soft packages are available .Specific immunoglobulin has become the regular stra-tegic storage of some developed countries , used for the prevention and treatment of infection in military trauma , emerging infectious diseases and against the potential threat of bioagents and bioterrorism .Local hemostatic produced upon fibrinogen and thrombin as well as coagulator Factor Ⅶperforming integral hemostasis effect have become increasingly significant for treating hemorrhage in military trauma .Development of anticoagulants including human protein C and antithrombin has got great improvement .These medicines have the potential for preventing and treating sepsis caused by military trauma .Prote-ase inhibitors including α2-macroglobulin are expected to work in the specific medicine .In conclusion , blood products will play a greater role in the future war and non war military operations .

The curative effect of surgical treatment for obesity and type 2 diabetes mellitus has been internationally recognized.In mainland China,the number of the minimally invasive gastric volume reduction surgery has been increased from 110 cases in 2008 to 2000 cases in 2012.While some of the patients suffered from poor curative effects or severe postoperative complications due to lack of unified standard treatment guidelines.Authoritative statistical agencies and the Chinese clinical database has not been formed till now,therefore the specification and promotion of Chinese surgical treatment standards for obesity and type 2 diabetes mellitus is imperative.

Gastrectomy ; Gastric Bypass ; Humans

Obesity-induced insulin resistance and metabolic syndrome continue to pose an important public health challenge worldwide.Metabolic surgery was developed with the aim of weight reduction.In recent years,authors have witnessed great advancement in metabolic surgery,including the development of new and safe procedures or devices.During the last decade,improvements in glycemic control and decreases in cardiovascular events and mortality after surgery have been consistently reported.Therefore,there is an urgent need to identify the type of patients that may benefit the most from metabolic surgery,morbidly obese or not,and selection criteria must be reviewed and updated based on the current surgical outcomes.This article reviews the history of metabolic surgery and summarizes the new perceptions in obesity treatment.

In recent decades, human lifestyle has undergone tremendous changes with the development of society,obesity, type 2 diabetes mellitus and related metabolic diseases have been prevalent around the world.In addition to the traditional treatment including diet control, lifestyle modification and drug intervention, bariatric and metabolic disease surgeries have become the significant therapeutic means.In recent years, the international community has made some breakthroughs in the mechanisms of surgical treatment for obesity and metabolic disease, the mechanism that gastrointestinal surgery activates the body to increase energy expenditure and white adipose tissues convert to brown become the new hot spot.In western countries,bariatric surgery has already undergone semicentennial renewal and evolution.Currently, classical metabolic surgery methods basically reach a consensus worldwide, however, along with the changes of the surgery methods, patients who accept early surgical treatments of obesity and metabolic disease or who are not satisfied with the initial surgery can be further remedied through repairing operation.In addition, the rapid development of endoscopic technique provides a new idea for renewal of bariatric surgery.This review focuses on the latest international developments about the mechanisms of metabolic disease surgery and the innovation of operation methods.

Objective To summarize the experience of prevention and treatment of sinus after laparoscopic ap-pendectomy. Methods Operation method was decided by the sinus condition: method A, fistula incision and inflam-matory granulation shaving;method B, removing he sinus completely. Then compare the efficacy and the risk of op-eration. Results Cure rate of method A was 66.7 %, cure rate of method B was 100.0 %. The total cure rate was 90.5 %. Sinus wall ruptured in 1 during the process of removing. Conclusions Suitable operation method should decided by the sinus condition, and make the premunition for fistula formation.

OBJECTIVE:To observe the clinical efficacy of metadoxine combined with tiopronin in the treatment of alcoholic liver disease.METHODS:In retrospective study,70 patients with alcoholic liver disease were selected from Shanxi Provincial People's Hospital and Taiyuan Third People's Hospital during Oct.2013-Dec.2015,and then divided into treatment group and control group with 35 cases in each group according to therapy plan.Control group was additionally given Tiopronin enteric-coated tablet 0.2 g,po,tid,based on routine treatment;treatment groups was additionally Metadoxine tablet 1.0 g,po,bid,on the basis of control group.Both groups received treatment for 6 weeks.Serum indicators as ALT,AST,γ-GT,TBIL,TC,TG and A/G and serum hepatic fibrosis indicators as Ⅳ-C,HA and Ln were observed in 2 groups before and after treatment as well as the diameters of MPV and SPV,spleen thickness and clinical efficacy.The occurrence of ADR was recorded.RESULTS:The serum levels of ALT,AST,y-GT,TBIL,TC and TG were decreased significantly in 2 groups,while A/G level was increased significantly;above indicators of treatment group were more significant than those of control group,with statistical significance (P＜0.05).Serum levels of Ⅳ-C,HA,Ln,MPV,SPV and spleen thickness in treatment group were significantly decreased and lower than in control group,with statistical significance (P＜0.05).Total response rate of treatment group (94.29％) was significantly higher than that of control group (62.86％),with statistical significance (P＜0.05).No obvious ADR was found in 2 groups.CONCLUSIONS:Metadoxine combined with tiopronin shows good therapeutic efficacy for alcoholic liver disease with good safety.

ObjectiveTo study the feasibility,safety and efficacy of laparoscopic cyst excision and Roux-en-Y hepaticojejunostomy for adult congenital choledochal cyst.MethodA retrospective study was conducted on 7 adult patients with congenital choledochal cyst who received total laparoscopic cyst excision and Roux-en-y hepaticojejunostomy from May 2008 to February 2011 in the Department of General Surgery of Shengjing Hospital,China Medical University.ResultsAll the laparoscopic surgery was successful.The mean operation time was 210 minutes.The average intraoperative blood loss was 80 ml.All patients were out of bed within the first 24 h after surgery.The mean time to first flatus/bowel motion was 2.4 days.Except 1 patient who had small amount of bile leakage,all patients recovered smoothly without any major postoperative complications.The average hospital stay was 8.1 days.No patients suffered from abdominal pain,fever or jaundice during follow-up from 3 to 30 months.ConclusionTotal laparoscopic cyst excision and Roux-en-Y hepaticojejunostomy was a safe,efficacious,and minimally invasive procedure.