Objective To discuss the perioperative nursing method for patients receiving colorec-tal tumor surgery under peritoneoscope. Methods Using the nursing procedure, through appraisal of patients' health situation→listing the nursing diagnosis or the nursing questions→formulation of nursing plan→ implementation of nursing plan→appraisal of the expected effect, combination of the surgical nursing's characteristic, to practice the idea of "the perfect person health and concern", cooperation with medical and nursing team, we provided a complete treatment and nursing plan for 38 patients receiving colorectal tumor surgery under peritoneoscope. Results 38 patients made satisfactory results with no surgery complications. The average in-hospital time was 9 days. Conclusions This technology has slight wound,light hemorrhage,slight draw-off, less pain, short exposure time of intestine, fast recovery of intestine function and early food intake. Systematic and intact perioperative nursing can improve the nursing quality and the success rate and reduce the complications so that the patients can live through the surgery safely.

Objective To investigate the CT manifestations of inflammatory and tumorous diseases in peritoneum, and to improve the abilities of diagnosis and differential diagnosis. Methods Conventional non-enhanced and enhanced CT were performed in 63 patients. The mean value of peritoneal structures in normal persons and patients were measured and calculated. The CT features of abnormal peritoneum were divided into 5 classes that were collated with their pathological changes. The numbers of each CT class appeared in inflammatory and tumorous diseases were countered. The data were treated with statistical methods for comparing the differences.Results (1) In normal persons, the non-enhanced and enhanced mean CT values were (-88.60?18.30) and (-78.73?16.90) HU, respectively, while in patients, they were(-38.63?15.64) and (-1.42?14.42) HU, respectively. CT value of abnormal peritoneum was significantly higher than that of normal group. (2) There were 183 places of abnormal peritoneum in five classes: firstly, fine and blur attenuation in 65 places (56 inflammations and 9 tumors); secondly, linear or strip thickening of peritoneum in 25 places (12 inflammations and 13 tumors); thirdly, attenuation of disorganized strip and piece or nodus in 50 places (8 inflammations and 42 tumors); fourthly, soft tissue mass in 28 places (5 inflammations and 23 tumors); and fifthly, cake peritoneum in 15 places ((2 inflammations) and 13 tumors). The data showed statistical differences (P

Nasopharyngeal carcinoma (NPC) is a common head and neck malignant tumor with high incidence in southern China. Local recurrence is one of the main failure modes of locally advanced NPC. The dose-escalation after radical radiotherapy for locally advanced NPC remains controversial. In the era of modern radiotherapy, the mainstream treatment mode of locally advanced NPC is neoadjuvant chemotherapy plus concurrent chemoradiotherapy. There is no consensus on whether to prescribe dose-escalation, how and when to conduct dose-escalation, how much dose to prescribe for patients with residual lesion proved by MRI or pathology. How to accurately determine the target volume and dose / fraction to maximize the local control of the tumor are the directions of clinical practice for locally advanced NPC, which remain to be further studied.

OBJECTIVETo investigate the clinical application of 256 multi-slice spiral computed tomography angiography (MSCTA) technique in the preoperative evaluation of mesenteric angiography in order to provide a reference to vessel anatomy and dissociation in laparoscopic radical operation for colorectal carcinoma.

METHODSClinical data of 50 patients with colorectal cancer who underwent preoperative MSCTA+FDCT and laparoscopic curative operation at our hospital from October 2013 to March 2015 were collected (MSCTA group). The evaluation item was visualization of mesenteric artery, which was compared with the findings under laparoscopic surgery. Meanwhile, another 50 colorectal cancer patients undergoing laparoscopic radical operation by the same surgeon team without preoperative MSCTA examination were used as control(control group). Clinical data were compared between the two groups.

RESULTSMSCTA precisely and correctly demonstrated anatomy and variations of the mesenteric artery and relative nutrient vessel in carcinoma. The angiography reconstruction images were consistent with the visual anatomy and variation from laparoscopic findings, whose diagnostic conformity rate of 100%. As compared to control group, operative time was shorter [(195.0±23.2) minutes vs.(218.0±19.6) minutes, t=8.326, P=0.015], and blood loss was less[(168.1±18.8) ml vs. (206.5±14.3) ml, t=-19.369, P=0.002] in MSCTA group. Differences of number of harvested lymph node, postoperative complication morbidity, postoperative hospital stay and hospitalization cost were not significant between two groups(all P>0.05).

CONCLUSIONPreoperative MSCTA can demonstrate anatomy and variations of the mesenteric artery precisely and correctly, thus it is beneficial to shorten the operation time and to reduce blood loss.

Angiography ; Colorectal Neoplasms ; diagnostic imaging ; surgery ; Humans ; Image Processing, Computer-Assisted ; Laparoscopy ; Lymph Nodes ; Mesenteric Arteries ; diagnostic imaging ; Operative Time ; Tomography, Spiral Computed

Objective:To analyze the impact of lymph node dissection on textbook outcomes (TO) and the prognosis of intrahepatic cholangiocarcinoma (ICC).Methods:The retrospective cohort study was conducted. The clinicopathological data of 376 ICC patients who underwent hepatectomy in 4 medical centers, including Mengchao Hepatobiliary Hospital of Fujian Medical University et al, from December 2011 to December 2017 were collected. There were 242 males and 134 females, aged 57(range, 48-63)years. According to the criteria of TO, patients were classified as two cate-gories, including patients achieving TO and not achieving TO. Measurement data with normal distri-bution were represented as Mean± SD, and comparison between groups was conducted using the independent sample t test. Measurement data with skewed distribution were represented as M(range) or M( Q1, Q3), and comparison between groups was conducted using the Mann-Whitney U test. Count data were represented as absolute numbers, and comparison between groups was conducted using the chi-square test, Yates adjusted chi-square test or Fisher exact probability. Comparison of ordinal data was conducted using the non-parameter rank sum test. Univariate and multivariate analyses were conducted using the Logistic regression model. The Kaplan-Meier method was used to draw survival curve. Survival analysis was conducted using the Log-rank test. Results:(1) TO situations. Of the 376 ICC patients who underwent hepatectomy, 199 cases achieved TO, including 40 cases with lymph node dissection and 159 cases without lymph node dissection, 177 cases did not achieve TO, including 76 cases with lymph node dissection and 101 cases without lymph node dissection. (2) Influencing factors for TO after hepatectomy of ICC patients. Results of multivariate analysis showed that lymph node dissection, microvascular invasion, nerve invasion and the volume of intraoperative blood loss >800 mL were independent risk factors for achieving TO after hepatec-tomy of ICC patients ( odds ratio=2.22, 2.95, 3.58, 4.09,95% confidence interval as 1.34-3.69, 1.43-6.07, 1.40-9.17, 1.35-12.43, P<0.05). Of the 116 patients with lymph node dissection, 40 cases achieved TO, 103 cases achieved R 0 resection, 38 cases had postoperative complications, 67 cases had delayed hospital stay. The above indicators were 159, 255, 41, 65 of 260 patients without lymph node dissection. There were significant differences in the above indicators between patients with and without lymph node dissection ( χ2=22.90, 15.16, 13.95, 37.78, P<0.05). (3) Follow-up. All the 376 patients were followed up for 19(range, 1-74)months. Of 199 patients achieving TO, the 1-, 2-and 3-year survival rates of 40 patients with lymph node dissection were 54.0%, 36.6% and 26.1%, respectively, versus 67.7%, 42.7% and 34.4% of 159 patients without lymph node dissection, showing no significant difference between them ( χ2=1.89, P>0.05). Of 177 patients not achieving TO, the 1-, 2-and 3-year survival rates of 76 cases with lymph node dissection were 58.9%, 25.7% and 10.3%, respectively, versus 53.0%, 28.5% and 17.2% of 101 cases without lymph node dissection, showing no significant difference between them ( χ2=0.25, P>0.05). Conclusions:Lymph node dissec-tion, microvascular invasion, nerve invasion and the volume of intraoperative blood loss >800 mL are independent risk factors for achieving TO after hepatectomy of ICC patients. Lymph node dissec-tion may increase the postoperative complication rate, prolong the hospital stay and decrease the rate of achieving TO. However, it does not affect the prognosis of patients.