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 compare the safety and the long-term outcomes of laparoscopic and open radical resection for rectal cancer. Methods The clinical data of 602 patients who received radical resection at the Second Affiliated Hospital of Fujian Medical University from January 2000 to December 2008 were retrospectively analyzed.All patients were divided into the laparoscope group (324 patients) and the open group (278 patients).The numbers of dissected lymph nodes,lengths of proximal and distal resection margins,local recurrence rate,distal metastasis rate,overall survival rates and disease-free survival rates of the 2 groups were compared.All data were analyzed by the independent t test,chi-square test or Fisher exact probability. The survival rates were calculated by the life table method and were analyzed by the Wilcoxon (Gehan) test.Results The number of lymph nodes dissected in the laparoscope group and the open group were 21 ± 8 and 21 ± 9,with no significant difference between the 2 groups (t =1.120,P ＞0.05).The lengths of proximal resection margin were ( 15.1 ±1.3 )cm in the laparoscope group and (15.0 ±0.8)cm in the open group,with no significant difference between the2groups (t =1.452,P ＞0.05).The lengths of distal resection margin were (4.0 ± 1.6)cm in the laparoscope group and (3.3 ± 1.4) cm in the open group,with a significant difference between the 2 groups ( t =5.587,P ＜ 0.05 ).The overall local recurrence rate was 5.6％ (34/602),and no tumor recurrence was detected in the incision and port-site.The local reccurence rates were 6.2％ (20/324) in the laparoscope group and 5.0％(14/278) in the open group,with no significant difference between the 2 groups (x2 =0.363,P ＞ 0.05 ).The overall distal metastasis rate was 11.5％ (69/602),and the distal metastasis rates were 11.1％ (36/324) in the laparoscope group and 11.9％ (33/278) in the open group,with no significant difference between the 2 groups (x2 =0.085,P ＞0.05).The 3- and 5-year survival rates were 87.8％ and 83.0％ in the laparoscope group,and 84.9％ and 79.3％ in the open group,with no significant difference between the 2 groups (P ＞0.05).The 3- and 5-year tumor-free survival rates were 79.4％ and 69.2％ in the laparoscope group,and 79.7％ and 73.1％ in the open group,with no significant difference between the 2 groups ( P ＞ 0.05 ).The follow-up rate was 81.2％ (489/602).Forty-nine patients died,including 20 patients in the laparoscope group and 29 patients in the open group.Conclusion Laparoscopic radical resection for rectal cancer is reliable in the oncological efficacy,and is possible to achieve the similar long-term outcomes as that of open surgery.

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.

In the latest 50 years,the radical dissection rate of colonic cancer and the 5-year survival rate have been improved as colonic surgery techniques improve.In 1991,Jacob performed the first laparoscopic hemicolorectomy in the world,and data from multiple prospective studies have shown no significant difference between laparoscopic and open radical resection of colonic cancer in aspects of postoperative survival and incidence of tumor recurrence.In the year of 2009,Hohenberger suggested the concept of complete mesocolic excision (CME).Clinical data Showed that CME could further improve the postoperative survival and reduce the incidence of tumor recurrence,and it could become the standard surgical procedure following total mesorectal excision.

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 anatomical mark of attachment edge in mesorectal tail and the effect of its morphologic distribution in performing total mesorectal excision (TME). Methods The gross specimens of 220 consecutive patients with the middle lower rectal cancer were collected by a group of surgeons.Patients were divided into two groups.①Group in saving sphincter. Ⅰa group, low anterior resection (LAR): 81 patients with lesions between 5 and 6 cm from the anal verge underwent LAR ; Ⅰb group, anterior resection (AR): 68 patients with lesions between 7 and 8 cm from the anal verge underwent AR.②Group in resecting sphincter. Abdominoperineal resection (APR): 71 patients with lesions between anal verge and 5 cm from the anal verge underwent APR. Results ①The circular edge of mesorectal tail is attached on rectal wall of 1 cm above anal hiatus of levators,which level parallels the lower margin of lower rectal cancer.In order to reset distal rectal wall of 2 and 3 cm,undergoing LAR must avoid injuring rectal wall when dissecting muscular vessel of rectum continue along the levators fascia to the anal hiatus.②The attachment morphology of mesorectal tail is a circular flake and not circular linear in shape. There are a little of fat tissue between posterior rectal wall and mesorectal tail,the length of its longitudinal attachment is (1.269?0.171) cm (81 cases in LAR group and 71 cases in APR gourp).Because the distal resective margin of rectum undergoing AR just locate in area of flake attachment of mesorectum, removing mesorectum around rectal wall must avoid injuring the rectal wall. Conclusion The mesorectal tail is a circular flake and attaches on rectal wall of 1.0 cm above anal hiatus of levatorani.Undergoing LAR or AR must avoid to injure rectal wall,which may result in leakage of anastomosis when removing mesorectal tissuce around distal rectal wall.

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.