ObjectiveTo study the feasibility of laparoscopic assisted splenectomy for massive splenomegaly and devascularization in the treatment of patients with cirrhosis and portal hypertension.MethodA retrospective study was carried out on 12 patients who underwent laparoscopic assisted splenectomy and devascularization from October 2003 to January 2010.ResultsThe operation was successfully carried out in eight patients.The remaining four patients were converted to open surgery due to intra-operative bleeding.The mean operation times for the 12 patients and the 8 patients who underwent laparoscopic surgery were 350 min (range,190-470 min) and 313 min (range,190-410 min),respectively.The corresponding mean intra-operative blood losses were 1300 ml (range,200-2200 ml) and 700 ml (range,200-1700 ml),respectively.For the 8 patients who received laparoscopic surgery,flatus were passed 3-5 days after operation,and the postoperative hospitalization was 10-20 days.ConclusionsLaparoscopic assisted splenectomy for massive splenomegaly and devascularization is feasible.It is a treatment option for patients with cirrhosis and portal hypertension.

OBJECTIVETo study the biomass structure of Epimedium acuminatum Franch in the different ecological environments for the development and protection.

METHODThrough the scientific investigation in four typical habitats, the sampling spots were set up, the functional modules' biomass structure and relationship of E. acuminatum were researched.

RESULTThe average of rhizome, as the largest biomass, and the average total biomass had the same pattern: the open areas of forest edge > shrub lumber > shrub-weed > stream drains. The ratio of the functional modules' biomass had different rates under different habitat conditions. By analyzing and combining investigation, the aerial part of E. acuminatum in the shrub-weed were comparative advantage, and the roots of nutrient accumulation of E. acuminatum in the open areas of forest edge were the highest efficient. Under different ecological condition, the distribution of water metabolism was different strategies.

CONCLUSIONIn the open areas of forest edge, E. acuminatum growing well, followed by shrub-weed. These two habitats are the ideal ecological environments while the rhizome or the whole plant used as medicine, but also the protection of E. acuminatum.

Objective To discuss the diagnosis and laparoscopic treatment for superior mesenteric artery compressing syndrome (SMACS).Methods A retrospective analysis was conducted on 62 SMACS patients who had received total laparoscopy treatment from October 2006 to May 2016.Results All 62 cases received upper gastrointestinal series and definite diagnosis was achieved on 51 cases;Definite diagnosis was made on 31 cases among 44 cases undergoing CTA (CTA,CT angiography) examination,19 cases were diagnosed with the disease among 26 cases who had received ultrasound examination.Total laparoscopic duodenojejunostomy was conducted on 41 cases,total laparoscopic gastrointestinal anastomosis was conducted on 14 cases,total laparoscopic gastroduodenal double shortcut anastomosis was conducted on 7 cases.All patients were cured or alleviated and discharged from hospital.Conclusions Upper GI contrast series made definite diagnosis on most SMACS cases.For patients with relapsing symptoms and poor conservative treatment result a surgery is recommended.Total laparoscopic duodenojejunostomy is the mainstay of treatment and is safe and reliable.

Objective To study the surgical treatment strategies,techniques and results of laparoscopic surgery for space occupying lesions in pancreatic body and tail.Methods To retrospectively analyze the clinical data of 65 patients with space occupying lesions in pancreatic body and tail.These patients were consecutively treated in Department of Minimally Invasive Surgery,the First Affiliated Hospital of Zhengzhou University from January 2010 to November 2017.Results All operations on the 65 patients were performed laparoscopically.The operations included laparoscopic distal pancreatectomy with splenectomy (n =22),spleen preserving laparoscopic distal pancreatectomy (n =43,with Kimura's method,n =38;and Warshaw's method,n =5).The mean size of the lesions was 5.5 cm (range 1.0 ～ 11.2 cm).The mean intraoperative blood loss was 120 ml (range 30～350 ml).The mean operation time was 230 min (range 160～310 min).Complications developed in 11 patients (16.9％).There were no tumour recurrence on follow-up which ranged from 1 to 81 months.Conclusions For patients with space occupying lesions in pancreatic body and tail,surgical strategies should be planned according to the site of the lesion and its relation to the blood vessels of the spleen.With good surgical techniques,laparoscopic treatment of lesions in pancreatic body and tail can be carried out safely,with a low complication rate and with an increased spleen preservation rate.

Objective:To investigate the control strategies of intraoperative bleeding in total laparoscopic complex splenectomy.Methods:The clinical data of 11 patients who underwent total laparoscopic complex splenectomy from May 2016 to October 2021 in the First Affiliated Hospital of Zhengzhou University were retrospectively analyzed, including 3 males and 8 females, aged (43.5±16.3) years. Splenectomy was performed in 8 cirrhotic patients with portal hypertension and 3 patients with hematologic diseases. Intraoperative bleeding was controlled by priority splenic artery blocking, bleeding prevention strategies of perisplenic and splenic pedicle dissociation. The operative time, intraoperative blood loss, postoperative exhaust time, postoperative drainage tube removal time and postoperative complications were analyzed.Results:All 11 patients underwent total laparoscopic complex splenectomy successfully. The operative time of 11 patients was (242.8±43.6) min, and the intraoperative blood loss was 180(50-1 480) ml. The postoperative exhaust time was (3.9±0.8) d, the removal time of abdominal drainage tube was (6.4±0.8) d, and the postoperative hospitalization time was (13.1±3.9) d. The 11 patients had no postoperative complications such as hemorrhage, pancreatic fistula, gastric fistula, colon injury, infection, etc. One patient had splenic vein thrombosis, 2 patients had mild pancreatitis, and 4 patients had moderate ascites.Conclusion:Intraoperative bleeding could be controlled by priority splenic artery blocking, bleeding prevention strategies of perisplenic and splenic pedicle dissociation, which is one of the important guarantees for the success of total laparoscopic complicated splenectomy.