Laparoscopic radical resection of rectal neoplasms is still under clinical research currently due to the following 2 reasons. Firstly, compared with open surgery, the longterm efficacy of laparoscopic surgery remains unclear; secondly, the pelvic autonomic nerves are difficult to be exposed and easy to be damaged during the surgery under laparoscope. Till present time, our department has completed 800 cases of laparoscopic radical resection of colorectal neoplasms, in which rectal neoplasms accounted for 70%. For most cases, the pelvic autonomic nerves have been exposed and protected properly. This paper summarized the skills to protect the pelvic autonomic nerves in the laparoscopic total mesorectal excision used for the treatment of rectal neoplasms.

OBJECTIVE:To establish a simple method of the magnesium measurement i n the sodium-magnesium fructose-1,6-diphosphate METHODS:Ion exchange-EDTA titration was adopted RESULTS:The RSDs of both the precision and accuracy wer e less than 0 51% by the method(n=6) CONCLUSION:This method is convenient ,and the results are accurate It can satisfy the determination of sodium-magn esium fructose-1,6-diphosphates

Objective To investigate the risk factors of complications induced by intraperitoneal chemotherapy after radical resection for colorectal cancer,and to summarize the prevention and treatment methods.Methods The clinical data of 234 colorectal cancer patients who received intraperitoneal chemotherapy after radical resection at the Union Hospital of Fujian Medical University from January 1997 to March 2007 were retrospectively analyzed.Risk factors influencing the incidence of complications were determined by analyzing 12 relevant factors with one-way analysis of variance(ANOVA)and Logistic multivariate regression analysis.Results The incidence of complications after intraperitoneal chemotherapy for colorectal cancer was 37.2%(87/234),incidence of catheter-associated complications was 20.5%(48/234),incidence of adhesive ileus was 12.4%(29/234),and the incidence of chemical peritonitis was 19.2%(45/234).The results of one-way ANOVA and Logistic multivariate regression analysis showed that abdominal surgery history,surgical modality,postoperative complications,courses and frequencies of chemotherapy and chemotherapeutics were the risk factors influencing the incidence of complications after intraperitoneal chemotherapy.Conclusions One or two courses of intraperitoneal chemotherapy after radical resection for colorectal cancer is safe with few complications.Chemical peritonitis is the main cause for adhesive ileus after intraperitoneal chemotherapy,maintaining intestinal tract unobstracted during intraperitoneal chemotherapy is effective in preventing adhesive ileus.

Objective To investigate the incidence, cause,prevention and treatment of early postoperative inflammatory intestinal obstruction(EPIIO)in patients undergoing laparoscopic and open radical resection of colorectal cancer. Methods From September 2000 to September 2006,483 cases of colorectal cancer were divided into two groups according the procedures received: laparoscopic surgery(232 cases)and open surgery(251 cases).The incidence of early postoperative intestinal obstruction was compared between the two groups. Results 1.In laparoscopic group,14 cases(5.69%,14/246)were converted to open surgery;2.The incidences of EPIIO in LS and OS group were respectively 3.02%(7/232)and 7.97%(20/251)(P＜0.05,x2=5.60＝.In LS group,6 EPIIO caseswere cured conservatively, one underwent surgery, while in open surgery group,18 cases recovered conservatively, two received surgery. Conclusions 1.Significantly less cases suffered from EPIIO in laparoscopic group.2.Most EPIIO cases will recover conservatively, in cases with repeated symptoms or when strangulation of bowel is suspected open surgery should be attempted.

Recurrence and peritoneal metastases are the major factors for the survival of colorectal cancer. With the development in the theory and technique of intraperitoneal chemotherapy,it has become a indispensable adjuvant chemotherapy of the advanced colorectal cancer.

OBJECTIVE:To investigate the utilization of aztreonam in perioperative patients in order to promote rational use of antimicrobial agents. METHODS: 215 discharged surgery cases were collected in Mar. 2009 and analyzed retrospectively to evaluate the rationality of drug use. RESULTS: Of 215 cases, preventive use accounted for 122 cases, among which rational use 29 cases and irrational use 93 cases; treatment use accounted for 93 cases, among which reasonable use 54 cases and unreasonable use 39 cases. CONCLUSION: Perioperative use of aztreonam was not in line with Guiding Principles for Clinical Use of Antibacterial Drugs, Notice for Further Strengthen Management of Clinical Use of Antibacterial Drugs Issued by General Office of the Ministry of Health. Unreasonable utilization require to arouse attention of medical personnel and strengthen management.

Objective To investigate the clinical outcomes of transanal local excision (LE) and transabdominal radical surgery (RS) for T1 rectal cancer with distance from anal verge (DAV) ≤ 8.0 cm,and analyze the prognostic factors after non-palliative resection of T1 rectal cancer with DAV ≤8.0 cm.Methods Theretrospective cohort study was conducted.The clinicopathological data of 82 T1 rectal cancer patients with DAV ≤8.0 cm who were admitted to the Fujian Medical University Union Hospital between December 2000 and December 2014 were collected.Among 82 patients,42 undergoing transanal LE and 40 undergoing transabdominal RS were allocated into the LS and RS groups,respectively.Forty-two patients in the LE group received transabdominal RS or postoperative adjuvant radiochemotherapy if results of postoperative pathological examination showed high risk.Observation indicators:(1) comparisons of surgical and postoperative situations between the 2 groups;(2) followup situations;(3) prognostic factors analysis after non-palliative resection of T1 rectal cancer with DAV ≤ 8.0 cm.Follow-up using outpatient examination and telephone interview was performed to detect the defecation and sexual functions,survival and tumor recurrence up to January 2017.Measurement data with normal distribution were represented as (x)±s,and comparisons between groups were evaluated with an independent sample t test.Comparisons of count data were analyzed using the chi-square test or Fisher exact probability.The Kaplan Meier method was used for calculating overall survival rate and tumor-free rate,and survival was analyzed using the Logrank test.Multivariate analysis was done using the COX regression model.Results (1) Comparisons of surgical and postoperative situations between the 2 groups:all the 82 patients underwent successful surgery.Of 42 patients in the LE group,28 underwent single transanal LE,2 underwent additional transabdominal RS within 1 month postoperatively,6 underwent postoperative adjuvant radiochemotherapy,5 underwent postoperative adjuvant radiotherapy and 1 underwent postoperative adjuvant chemotherapy (didn't complete course due to poor tolerance).Forty patients in the RS group underwent transabdominal anterior resection of rectum or combined with abdominal perineal resection for rectal cancer.DAV,operation time,volume of intraoperative blood loss,time of postoperative gastrointestinal function recovery,cases with pulmonary infection and duration of postoperative hospital stay were (4.9±1.3)cm,(65±33) minutes,(11±7)mL,(1.2±0.4) days,0,(2.2±0.9)days in the LEgroupand (6.7±1.9)cm,(256±35)minutes,(65±47) mL,(2.4±0.8)days,6,(6.9±1.1) days in the RS group,respectively,with statistically significant differences (t =4.882,12.448,3.553,4.025,x2 =6.797,t =10.367,P＜0.05).Cases with intraperitoneal infection,wound infection,urinary tract infection,inflammatory intestinal obstruction,anastomotic fistula,chyle leakage,rectovaginal fistula and positive surgical margin were 0,0,0,0,0,0,0,1 in the LE group and 1,0,0,1,0,2,l,0 in the RS group,respectively,with no statistically significant differences between the 2 groups (x2 =1.063,1.063,2.153,1.063,P＞0.05).All patients with complications were cured by conservative treatment.(2) Follow-up situations:of 82 patients,67were followed up for defecation function (37 in the LE group and 30 in the RS group),40 were followed up for sexual function (25 in the LE group and 15 in the RS group),76 were followed up for survival.Follow-up time was 1-145 months,with a median time of 31 months.Cases with fecal incontinence and sexual dysfunction were respectively 0,0 in the LE group and 4,3 in the RS group,showing statistically significant differences (x2 =5.247,5.405,P＜0.05).Cases with 5-year local recurrence,5-year overall survival rate and 5-year tumor-free survival rate were respectively 1,94.1％,91.0％ in the LE group and 0,87.6％,87.6％ in the RS group,showing no statistically significant differences (x2 =0.833,2.313,0.849,P＞0.05).(3) Prognostic factors analysis after non-palliative resection of T1 rectal cancer with DAV ≤ 8.0 cm:results of multivariate analysis showed that age was an independent factor affecting prognosis of T1 rectal cancer patients with DAV ≤8.0 cm after non-palliative resection (RR =1.254,95％ confidence interval:1.055-1.491,P＜0.05).Conclusions Transanal LE in treatment of T1 rectal cancer patients with DAV ≤ 8.0 cm is consistent with RS in local control and long term prognosis,and the protection of defecation and sexual functions in LE is superior to that in RS.Age is an independent factor affecting prognosis of T1 rectal cancer patients with DAV ≤ 8.0 cm after non-palliative resection.

Neoadjuvant chemoradiotherapy (nCRT)and subsequent radical resection have become the standard care of locally advanced rectal cancer (LARC).However,conventional radical surgery is associated with high intra-and postoperative morbidities,and a temporary or permanent stoma in some cases,impaired sexual and urinary function,and it eventually impair the quality of life.Rectum-preserving surgery is a novel concept in the era of nCRT,which will maximally benefit patients through the minimized injuries.This strategy has been increasingly utilized in LARC following nCRT.Nevertheless,it lacks high-level evidence of evidence-based medicine,and the long-term oncological safety remains to be determined by larger,multicenter,randomized clinical trials.The crucial aspect of rectum-preserving surgery is to accurately evaluate the status of primary tumor and metastatic lymph nodes,and thus to selective patients who could benefit from this strategy most.

Colorectal cancer is a common malignancy in the digestive tract,open and laparoscopic surgery are the main treatment methods.Anastomotic fistula,anastomotic bleeding,ileus,voiding and sexual dysfunction are the common postoperative complications.Chylous fistula,incision infection,pulmonary infection and incision metastasis occasionally occurred.Compared with open surgery,laparoscopic surgery does not increase the postoperative complications,and it can be safely applied in the radical resection of colorectal cancer.