Objective To evaluate the curative effect of laparoscopic radical gastrectomy combined with Roux-en-Y reconstruction of the digestive tract in treatment of advanced gastric cancer complicated with type 2 diabetes mellitus.Methods 73 advanced gastric cancer complicated with type 2 diabetes mellitus patients between May 2014 to May 2016 underwent distal partial gastrectomy or total gastrectomy with Rouxen-Y GI reconstruction.Results Compared with preoperative data,postoperative level at after 1 month and 3 months were respectively for FPG (14.9 ± 1.9 vs.8.7 ± 0.9,8.8 ± 0.9) mmol/L,OGTT 2 h PG (15.4±1.8 vs.8.68±0.9,8.7 ±0.9) mmol/L,HbA1 (10.4％ ±0.8％ vs.7.4％ ±0.6％,7.4± 0.6),BMI (29.9±1.2vs.25.4±0.7,25.2±0.6) kg/m2,TC (8.4±0.6 vs.6.7±0.6,6.7±0.4) mmol/LandTG (2.53±0.53 vs.1.86±0.27,1.91±0.33) mmol/L(withallP＜0.05).Conclusion Laparoscopic radical gastrectomy combined with Roux-en-Y reconstruction of the digestive tract for advanced gastric cancer significantly improves patients' co-occurring.

ObjectiveTo assess the surgical results and implications of clinicopathologic features on the prognosis of patients with hepatic matastases from gastric adenocarcinoma. MethodsNinety one of 834 patients with primary gastric cancer were diagnosed with synchronous ( n =79) or metachronous ( n =12)hepatic metastases. Twenty-one cases underwent hepatectomy for the metastasis. Results The actuarial 1-year, 3-year survival rates after hepatic resection were respectively 69% and 30%. Solitary and metachronous metastases were significant determinants for a favorable prognosis after hepatic resection. Pathologically, tumor pseudomembrane was found in 13 out of 21 patients which was associated with a favorable prognosis. ConclusionsSolitary and metachronous hepatic metastases from gastric cancer should be treated by a surgical approach which confers a good prognosis. The formation of pseudomembrane of the metastatic tumor predicts a favourable postoperative survival.

Between May 2009 and February 2012,60 patients scheduled for laparoscopic appendectomy were randomly assigned to receive either transumbilical single-port laparoscopic appendectomy (TUSPLA) or three-port laparoscopic appendectomy (TPLA).The operative duration was significantly longer in TUSPLA than TPLA cases.No statistically significant differences existed in hospital stay,visual analog scale (VAS) score,analgesia requirement or complication rate.The abdominal scar was inconspicuous for TUSPLA.It suggested that TUSPLA with conventional instrumentation is technically feasible and safe with scarless healing.

Objective To compare the clinical efficacy of laparoscopic repair of laparoscopic transabdominal preperitoneal(TAPP)and Lichtenstein tension-free repair herniorrhaphy in the treatment of recurrent inguinal hernia in adults,and to explore the clinical advantages of TAPP in the treatment of recurrent inguinal hernia.Methods A retrospective analysis was conducted in 54 adult patients with recurrent inguinal hernia from December 2010 to January 2015.The patients were randomly divided into TAPP group and Lichtenstein group.The operation time,intraoperative bleeding volume,postoperative hospitalization time,cost of hospitalization,postoperative complications,early postoperative pain and the recurrence of hernia were compared between the two groups.Results All patients were successfully completed surgery.The operation time of TAPP group (47.2 ±9.4)min was significantly shorter than (73.1 ±10.4)min of Lichtenstein group (t=-2.503,P=0.034).The median amount of bleeding during operation of TAPP group was 40(15 -110)ml,which was significantly less than 73(11 -130)ml in Lichtenstein group (t=-6.018,P=0.000). Postoperative hospital stay of TAPP group[(6.5 ±1.4)d]was shorter than (8.2 ±1.6)d of the Lichtenstein group (t=-2.613,P=0.028).Early postoperative pain score of TAPP group[(1.8 ±1.2)points]was better than (2.9 ± 1.4)points in Lichtenstein group (t=-7.006,P=0.000),the difference was statistically significant.However,the hospitalization cost of TAPP group[(8 842.8 ±415.2)yuan]was higher than (6 676.9 ±327.6)yuan of the Lichtenstein group,the difference was statistically significant(t=6.782,P<0.05).In TAPP group,2 cases had complications after operation,which were less than 5 cases of Lichtenstein group.Postoperative follow up ranged from 6 to 48 months,1 case of recurrence in Lichtenstein group,the recurrence rate was 3.8%.There was no recurrence in the TAPP group.Conclusion TAPP has the advantages of short operation time,less bleeding,rapid postoperative recovery,less postoperative pain and so on.It can be used as a recommended procedure for the treatment of recurrent inguinal hernia in adults.

Objective To investigate the causes and prevention of postoperative pain of laparoscopic transabdominal preperitoneal (TAPP) and Lichtensteinrepair in the treatment of adult recurrent inguinal hernia.Methods Sixty adult recurrent inguinal hernia patients were enrolled in this study.They were divided into TAPP group and Lichtenstein group by random digits table,with 30 cases in each group.At 6 h Mter operation,the pain degree was evaluated by visual analogue scale (VAS) and compared between two groups.The level of VAS in TAPP group was (3.76 ± 1.47) scores,in Lichtenstein group was (6.36 ± 1.54) scores,and there was significant difference (t =-5.978,P =0.000).In TAPP group,pain was mainly moderate (17 cases,56.67％) and mild (11 cases,36.67％).In Lichtenstein group,pain was mainly moderate (14 cases,46.66％) and severe (13 cases,43.33％).Postoperative follow-up ranged from 6 to 48 months.No chronic pain appeared in TAPP group.There were 4 cases with chronic pain in Lichtenstein group,and the incidence rate of chronic pain was 13.3％.Conclusions The operation of TAPP in the treatment of recurrent inguinal hernia in adult patients has the advantage of shorter operation time,less postoperative pain,faster postoperative recovery,and can effectively reduce the incidence of postoperative pain.

OBJECTIVETo summarize the treatment status of gastric gastrointestinal stromal tumor (GIST) in Shandong province,by analyzing the clinicopathological features and prognostic factors.

METHODSClinicopathological and follow-up data of 1 165 patients with gastric GIST between January 2000 and December 2013 from 23 tertiary referral hospitals in Shandong Province were collected to establish a database. The risk stratification of all cases was performed according to the National Institutes of Health(NIH) criteria proposed in 2008. Kaplan-Meier method was used to calculate the survival rate. Log-rank test and Cox regression model were used for univariate and multivariate prognostic analyses.

RESULTSAmong 1 165 cases of gastric GIST, 557 were male and 608 were female. The median age of onset was 60 (range 15-89) years. Primary tumors were located in the gastric fundus and cardia in 623 cases(53.5%), gastric body in 346 cases(29.7%), gastric antrum in 196 cases(16.8%). All the cases underwent resection of tumors, including endoscopic resection (n=106), local resection (n=589), subtotal gastrectomy(n=399), and total gastrectomy(n=72). Based on the NIH risk stratification, there were 256 cases (22.0%) at very low risk, 435 (37.3%) at low risk, 251 cases (21.5%) at intermediate risk, and 223 cases (19.1%) at high risk. A total of 1 116 cases(95.8%) were followed up and the median follow-up period was 40 (range, 1-60) months. During the period, 337 patients relapsed and the median time to recurrence was 34 (range 1-60) months. The 1-, 3-, and 5-year survival rates were 98.6%, 86.1% and 73.4%, respectively. The 5-year survival rates of patients at very low, low, intermediate, and high risk were 93.1%, 85.8%, 63.0% and 42.3% respectively, with a statistically significant difference (P=0.000). Multivariate analysis showed that primary tumor site (RR=0.580, 95%CI:0.402-0.835), tumor size (RR=0.450, 95%CI:0.266-0.760), intraoperative tumor rupture(RR=0.557, 95%CI:0.336-0.924), risk classification (RR=0.309, 95%CI:0.164-0.580) and the use of imatinib after surgery (RR=1.993, 95%CI:1.350-2.922) were independent prognostic factors.

CONCLUSIONSThe choice of surgical procedure for gastric GIST patients should be based on tumor size. All the routine procedures including endoscopic resection, local excision, subtotal gastrectomy and total gastrectomy can obtain satisfactory curative outcomes. NIH classification has a high value for the prediction of prognosis. Primary tumor site, tumor size, intraoperative tumor rupture, risk stratification and postoperative use of imatinib are independent prognostic factors in gastric GIST patients.