The laparoscopic surgery is increasingly widely used in the treatment of malignant gastrointestinal cancer.Its technical feasibility has been recognized,however,there are disagreements in the evaluation of its safety,the tumor metastasis of port-site and intra-abdominal after operation has been the focus of controversy in medical community.Its major impact mechanism including the change of peritoneal microenvironment,immunity,mechanical pressure of pneumoperitoneum,biological behavior of tumor cells and so on.The specification must be taken before surgery,strictly control the laparoscopic gastrointestinal cancer surgery indications,minimize the pneumoperitoneum pressure,shortem operative time,with He gas instead of CO2 pneumoperitoneum or free pneumoperitoneum laparoscopic techniques and other effective measures to reduce the risk of tumor metastasis.

Objective To study the effect of the MafA therapy for blood slucose control in diabetic rats.Methods Rats were divided into 3 groups:treatment group,DM group and control group.In DM group,Wistar rats were rendered diabetic by intrvenous injection of streptozotocin(STZ).In treatment group,mixture of MafA and liposomes at the volume ratio of 1:1 was injected to the portal vein of the diabetic rats.Blood glucose change in the diabetic rats Was measured.Results ① For treatment group,blood slucose decreased from 20.6 mmol/L-22.8 mmol／L to 13.6 mmol／L-14.8 mmol／L and plasma insulin level was significantly elevated for a duration about 2 weeks.②After treatment,blood slucose level significantly decreased compared to DM group (P<0.05).③ Plasma insulin level Was significantly higher than that in DM group(P<0.05).④ Expression of MafA mRNA can be detected in the liver oftreatment group while it Was not found in DM group.Immunohistochemical analysis revealed that insulin expression Was found in the liver of treatment group while it Was not found in the liver of DM group.Conclusion Injection of MafA and liposomes at the volume ratio of 1:1 via the portal vein can effectively decrease blood glucose in diabetic rats.

ObjectiveTo investigate the lethal effect of hyperthermic CO2 pneumoperitoneum on gastric cancer cells and then further study the feasility and safety of inflating hyperthermic CO2 in gastric cancerpatients when performing laparoscopic operation.MethodsAn in vitro hyperthermic CO2 pneumoperitoneum experimental model was built,then according to the experimental purpose,the stomach carcinoma cell-7901 was grouped:hyperthermic CO2 pneumoperitoneum group; pure hyperthermia group; pure CO2 group;control group.After processing according to groups,cell proliferation was detected by Cell Counting Kit-8(CCK-8),cell apoptosis was detected by Annexin V-fluorescein isothiocyanate/propidium iodide flow cytometry and Hoechst 33342/propidium iodide fluorescent microscopy.ResultsThe reaults of cell proliferation detection showed that hyperthermic CO2 pneumoperitoneum could significantly inhibit proliferation of stomach carcinoma cell-7901 when compared with pure hyperthermia group,pure CO2 group and control group (P ＜ 0.05 ).The results of apoptosis detection showed that hyperthermic CO2 pneumoperitoneum could significantly induce apoptosis of stomach carcinoma cell-7901 and the gastric cancer cells apoptosis showing bright blue under the fluorescent microscope.ConclusionsHyperthermic CO2 pneumoperitoneum could significantly inhibit proliferation of stomach carcinoma cell-7901 and probably kill it by inducing apoptosis.

Objective To compare the early outcomes of laparoscopic and open resection and evaluate the safety and feasibility of laparoscopic surgery in patients with colorectal cancer aged ≥ 70 years.Methods A total of 91 consecutive patients with colorectal adenocarcinoma underwent surgery in Yizheng City People's Hospital between Jan.2009 and Dec.2015.In 91 patients included in this study,38 received laparoscopic surgery and 53 underwent open surgery.Main outcome measures were clinical data,postoperative recovery status and short-term outcomes.Results There were no significant differences between two groups with respect to demographic indicators,clinicopathological results and chronic comorbidities had no significant difference between two groups.No death cases occured in both groups.One patient in the laparoscopic group required conversion to open surgery due to ureteral injury.Laparoscopic surgery was associated with significantly longer operating time [(238 ± 71.3) minutes vs (175 ± 60.8) minutes,P ＜ 0.001],less estimated blood loss [(145 ± 58 ml) vs (186 ± 45) ml,P ＜ 0.001)],a shorter postoperative hospital stay [(11.9 ± 3.9) days vs (14.5 ± 3.7) days],lower overall postoperative complication rate (23.7％ vs 45.3％,P =0.035),wound-related complication rate (2.6％ vs 22.6％,P =0.017) when compared with open surgery.Quality of surgical specimen,lymph nodes harvested were not significantly different between two groups.Conclusion Laparoscopic colorectal cancer surgery is safe and feasible in elderly patients,associated with better short-term outcomes when compared with open surgery.

ObjectiveTo analyze the reasons of complications after laparoscopic gastrectomy with D2.MethodsThe clinical courses of 150 cases who suffered from gastric cancer treated by laparoscopy in the First Affiliated Hospital of Yangzhou University from March 2007 to December 2010 were retrospectively analyzed.ResultsFourteen cases showed complications after operation,the rate being 9.33％ (14/150).The remaining patients with postoperative complications were discharged after treatment,no death occurred during the perioperation.ConclusionEnhancing the refinement of surgical operations,the postoperative observation and the management of drainage tube are the key to the prevention and treatment of complications after laparoscopic gastrectomy.

ObjectiveTo evaluate the feasibility,safety and therapeutic efficiency of laparoscopic total mesorectal excision (TME) with anal sphincter preservation in the treatment of the middle-lower rectal cancer.MethodsFrom February 2008 to June 2010,37 patients with middle-lower rectal cancer received laparoscopic TME with anal sphincter preservation,while 45 patients underwent conventional open TME with anal sphincter preservation according to their wills.The operative procedures,postoperative recovery,postoperative complication and short-term outcome were collected and compared between the two groups.ResultsBlood loss was (60.6 ± 20.9) mL in laparoscope group which was significantly less than that in laparotomy group (P＜0.01),time for bowel movement retrieval and hospital stay were (3.3 ±0.6) and (9.2 ±2.8) days respectively,which were significantly shorter than those in laparotomy group (P ＜ 0.01 ).The incidence of postoperative complications was 8.1％ in laparoscope group,which was significantly lower than those in laparotomy group (P ＜ 0.05 ).The mean distance between resected margin and the tumor,the mean number of disected lymph nodes were not different between the two groups.The rate of sphincter preservation was 91.9％ in laparoscope group,which was higher than those in laparotomy group (73.3％) ( P ＜ 0.05 ).All patients were followed-up from 6 to 36 months,the recurrent rate and overall survival rate were 10.8％ and 94.6％ in laparoscope group,with no significant difference compared to those in laparotomy group (11.1％ and 91.1％,P ＞ 0.05).ConclusionsLaparoscopic TME with anal sphincter preservation which achieved the same effect of oncological clearance is a safe and feasible procedure for middle-lower rectal cancer,with less postoperative complications and better recovery after treatment,and enhances the rate of sphincter preservation,which is worthy of clinical application.

Objective To evaluate the safety and feasibility of totally laparoscopic cholecystolithotomy.Methods Patient baseline characteristics of all 34 totally laparoscopic cholecystolithotomy (TLC) were collected in a database.This group was compared with 34 matched patients who underwent the laparoscopic cholecystectomy (LC) in the same period.Retrospectively,intraoperative and postoperative data were added.Results Operatingtime was significantly longer in the TLC group(124.56 min vs 78.50 min,P ＜0.01).The mean hospitalization expenses of operation was significantly higher in the TLC group(10 970.85 yuan vs 8 666.72 yuan,P ＜0.01).Although not significant less patients have the symptoms of postoperative dyspepsia or diarrhea were seen in the TLC group compared with the LC group (2 vs 6,P =0.26).Intraoperative details and postoperative results such as,blood loss,hospital stay,exhaust time,abdominal bleeding,bile leakage,incision infection have no significant difference.One case of gallstone recurrence was detected in TLC group.No stone recurrence was reported in common bile duct in LC group.Conclusions TLC is effective and feasible for chronic calcular cholecystitis and is particularly favorable for thepatients with medical insurance.However,this approach is technically demanding and should be performed by experienced surgon.

This study was aimed to establish traditional Chinese medicine (TCM) diagnosis and treatment procedure of varicella zoster virus (VZV) in AIDS, and to construct questionnaires for key points and revision of the procedure. The TCM draft of diagnosis and treatment procedure for VZV in AIDS was established through literature retrieval and peer review. Two rounds of surveys were carried out to investigate the confirmation and advice of in-group specialist to key points of TCM or integrative medicine draft including diagnosis, treatment and nursing. Then, diagnosis and treatment procedure were revised according to survey results. The results showed that the recovery of complete ques-tionnaires in the first-round survey was 96%. More confirmation of specialists were given to concept, clinical feature, cause, mechanism, case history and general examination, diagnostic criteria, syndrome differentiation and treatment of dampness-heat of liver channel syndrome, skin, dietary and psychological nursing, treatment course and therapeutic effect standard. The coefficient of variations (CVs) of experiential effective recipe, moxibustion and massage, auxiliary examination, syndrome differentiation and treatment of dampness stagnancy due to spleen deficiency syndrome and qi stagnation and blood stasis syndrome, and western medicine treatment were large. The weight coefficients of all items were within 0.043 6 and 0.046 2. The Cronbach Coefficient Alpha (CCA) was 0.996 and the split-half reliability R was 0.86. Recovery of complete questionnaires in the second-round survey was 100%. More confirmation of special-ists were given to outline, cause, mechanism, case history and general examination, diagnostic criteria, syndrome dif-ferentiation and treatment of three syndromes, experiential effective recipe, skin, dietary and psychological nursing. The CV was 0. The CV of auxiliary examination, moxibustion and massage was 0.063 8, which was less than those of first-round survey. The consistency of specialist was relatively increased. The weight coefficients of all items in the second-round survey were within 0.058 2 and 0.059 0. The CCA was -0.041 and the split-half reliability R was 0.79. A new revised procedure was preliminarily established according to results of two rounds of surveys. It was concluded that the activeness, concentration and coordination of specialists were good in two rounds of surveys. Con-sensus in key points of the procedure draft was reached including diagnosis, treatment and nursing.

Objective:To explore the clinical value of laparoscopic abdominoperineal resection(LAPR) with pelvic peritoneum closure for patients with low rectal cancer.Methods:The clinicopathological data of 90 patients with low rectal cancer who underwent laparoscopic abdominoperineal resection from Mar 2014 to Jan 2019 at the Subei People's Hospital of Jiangsu Province were retrospectively analyzed. These patients were divided into closed pelvic floor peritoneum group (study group, n=42) and without pelvic floor peritoneum group (control group, n=48) . Results:The postoperative hospital stay of the study group was shorter than that of the control group[(10.8±3.0) d vs. (12.4±3.1) d, t=2.569, P=0.013]. There was no statistically significant difference in the operation time , intraoperative blood loss , time to first flatus ,first time of getting out of bed between the two groups. Perineal incision infection and perineal incision dehiscence occurred in 2 cases and 1 case in the study group, and 10 cases and 9 cases in the control group respectively (χ 2= 5.007, P=0.025; χ 2=6.077, P=0.033). In the study group, there were 0 cases of perineal hernia, 1 case of pelvic floor peritoneal hernia and 2 cases of adhesive intestinal obstruction, while those in the control group were 7 cases, 8 cases and 9 cases, respectively (χ 2=6.642, P=0.013; χ 2=5.079, P=0.033; χ 2=4.085, P=0.043). Conclusion:Laparoscopic abdominoperineal resection with pelvic peritoneum closure significantly reduces the incidence of postoperative perineal-related complications and shorten postoperative hospital stay.

BACKGROUND:Orthopedic osteotomy at the apex of kyphosis is best for treatment of ankylosing spondylitis from a biomechanical aspect, but there is a high risk for intraoperative spinal cord injury.
OBJECTIVE:To explore the clinical efficacy of vertebral plate osteotomy+vertebra osteotomy+long-segment pedicle screw fixation in the treatment of ankylosing spondylitis with kyphotic deformity.
METHODS:Thirty-six patients with ankylosing spondylitis were subjected to pedicle subtraction osteotomy and Smith-Peterson osteotomy, and then fol owed up for 3 months to 2 years.
RESULTS AND CONCLUSION:After implantation, sagittal imbalance did not occur in 36 patients, and the improvement rate of sagittal imbalance was 64%. The improvement rates of thoracolumbar kyphosis and chin-brow vertical angle were 60%and 98%, respectively. The pain relief rate was 64%, and the Oswestry Disability Index was 95%. There were no pul ed nails, broken nails and broken robs after implantation. These findings indicate that the combination of selective osteotomy technique and long-segment internal fixation can achieve stable fixation effects, prevent sagittal imbalance, and avoid the occurrence of pul ing nails, breaking nails and breaking robs caused by osteoporosis.