Objective To investigate the relationship between single nucleotide polymorphisms (SNPs),serum CD31 and HCC.Methods We analyzed three single nucleotide polymorphisms of CD31 gene Leu125Val,Asn563Ser and Gly670Arg in 190 HCC patients and 210 age and sex matched controls in a Chinese population,using a polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) strategy,and the serum level of CD31 was determined by enzyme-linked immunosorbent assay (ELISA).Results The distributions of CD31 gene Asn563Ser and Gly670Arg polymorphisms were not significantly different between HCC and control group (x2 =0.491,P ＞ 0.05),but the CD31 gene Leu125Val polymorphism was significantly different (x2 =10.988,P ＜ 0.05).The relative risk suffering from HCC of Val allele was 1.583 times of the Leu allele carriers(OR =1.583,95％ CI,1.197-2.093,P =0.001) ; Serum level of CD31 Val allele carriers was significantly higher than that of no carriers(x2 =10.408,P ＜ 0.05).Consistent with the results of the genotyping analyses,CD31 gene Leu125Val,Asn563Ser and Gly670Arg polymorphisms showed strong linkage disequilibrium,the Val-Ser-Arg haplotype was associated with a significantly increased risk of HCC as compared with the controls (OR =1.496,95％CI:1.095-2.046,P =0.011).Conclusions CD31 gene Leu125Val polymorphism and its Val-Ser-Arg haplotype were associated with HCC,Val allele is an important genetic susceptibility gene for HCC.CD31 Val allele carriers may subject to higher risk of HCC with enhanced CD31 expression.

Obesity has been seriously endangering the human health,and it is one of the most serious chronic diseases in the modem society.Losing excess weight can decrease the incidence of obesity-related diseases and mortality.Currently,surgical treatment is the most successful and durable therapy for obesity.Since 1952,when the first metabolic surgery was reported,there has been a variety of metabolic surgeries appearing,which got confirmation and innovation continually worldwide.The metabolic surgery started in China in 1980s,until now closing to the world level gradually from a relative disadvantage.Metabolic surgery transformed from open surgery to laparoscopic surgery,and then it has been changing from the extensive mode to the precision mode.Surgical treatment for obesity and metabolic diseases has great potential and vast development prospects in China.

0.05).The operation time was longer,volume of bleeding was less,and postoperative time of bowel gas passage and hospital stay were shorter in laparoscopic group compared to those in open group(P0.05).Conclusions This study reveals that totally laparoscopic D2 gastrectomy is safe and feasible for advanced gastric cancer,and it presents the superior character of minimal invasion.

Body Mass Index ; Gastric Bypass ; Gastroplasty ; Humans ; Laparoscopy

Objective To study the technique of totally extraperitoneal laparoscopic hernioplasty(TEP). Methods 16 patients with inguinal hernia were treated with TEP.There were 14 indirect inguinal hernia and 2 direct inguinal hernia.All patients were treated by laperoscopic herhisplasty through extraperitoneal route. Results All cases were operated on successfully.Operation time was 65.5(40～120)min.The average postoperative hospital stay was 3.7(3～7)days.No complication occurred.There was no recurrence. Conclusionss TEP is a satisfactory technique with a low recurrence rate and a low major complication rate.

Objective To analyze reasons of postoperat iv e relapse of inguinal hernia and to explore the clinical significance of laparos copic transabdominal preperitoneal (TAPP) repair for recurrent hernia. Methods We retrospectively analyzed clinical data of 24 cases of recurr ent inguinal hernia treated by laparoscopic TAPP repair from June 1998 to Octobe r 2003 in this hospital. There were 11 cases of direct hernia and 13 cases of in direct hernia. Results Operations were completed successfully in all the 24 cases without conversions to open surgery. The operation time was 47~128 min (mean, 69 min), and the postoperative hospital stay, 2~5 days (mean, 3 days). Urinary retention happened in 6 cases after the operation, in which a F oley urethral catheter was indwelled for 1~3 days. There were no complications s uch as wound infection, scrotal hematoma or pneumatosis. Follow-up checkups were made for 2~66 months (mean, 27 months) in all the 24 cases. No recurrence was o bserved. Conclusions Laparoscopic TAPP repair for recurrent in guinal hernia has advantages of minimal invasion and few complications, being a safe and feasible option for treating recurrent inguinal hernia.

Objective To study the benefits and drawbacks of endoscopic thyroidectomy via breast approach by using gasless anterior neck skin lifting method.Methods A total of 21 patients with thyroid diseases were enrolled in this study,including 16 cases of nodular goiter and 5 cases of primary hyperthyroidism.All the cases underwent endoscopic subtotal thyroidectomy through breast approach while the operational space was established by using an abdomen suspending device and 2 Kirschner pins to mechanically suspend and retract the anterior neck skin.Results The endoscopic subtotal thyroidectomy was completed successfully in all of the cases without conversion to open surgery.The mean operation time was 82.5 minutes(ranging from 57 to 125 minutes).Intraoperative blood loss was less than 20 ml.Post-operational recovery was satisfying in all the patients.Drainage volume averaged 80.6 ml(50 to 150 ml).The patients were followed up for 1 to 12 months after the operation,during which no complications occurred.Conclusions Endoscopic thyroidectomy via breast approach using gasless anterior neck skin lifting method is a safe and low-cost procedure.By using the method,CO2 insufflation-related complications can be avoided.Although the operational space established by this method is relatively small,the operation can be completed without much difficulies.

Objective To compare the results of laparoscope and laparotomy total mesorectal excision(TME)with anal sphincter preservation in the treatment of low rectal cancer.Methods From January 2006 to June 2008,106 patients with low rectal cancer which the distance from the lowest margin of tumor to the dentate line ranged from 3.0 to 7.0 cm underwent TME with anal sphincter preservation.Among them,51 patients received laparoscope operation(laparoscope group)and the other 55 patients received laparotomy(laparotomy group)according to their wills.Results Two groups had no serious complications and death case.after surgery,the rate of sphincter preservation was 100%.Blood loss was(20.2±5.7)ml inlaparoscope group,which was significantly less than that in laparotomy group(P ＜ 0.01),aerofluxus,time to eat half-flow food and hospital stay were(2.4±0.6),(5.4±0.6)and(9.2±3.2)days respectively,which were significantly shorter than those in laparotomy group(P ＜ 0.01 or ＜ 0.05).Bowel function was back to normal in 35 patients of laparoscope group(68.6%)and 39 patients of laparotomy group(70.9%)within 1 month.All patients were followed-up from 6 to 36 months,there were no recurrence in situ local recurrence and mortality in the both groups.Conclusion Laparoscope TME with anal sphincter preservation can be achieved the same effect of oncological clearance,it is feasible and it is a minimal invasive and perspective technique with the benefits of much less blood loss during operation,higher rate of sphincter preservation,earlier return of bowel function and shorter hospitalization.

Objective To investigate the effects and advantages of laparoscopic hernioplasty for hernia.Methods From June 1995 to June 2005,222 patients with hernia were treated with laparoscopy.Transabdominal preperitoneal hernia repair(TAPP) were performed in 166 patients.Totally extraperitoneal hernia repair(TEP) were performed in 25 patients.Closure of the internal orifice of hernia was performed in 21 patients.Furthermore,incisional hernia in 2 patients, diaphragmatic hernia in 1 patient and mesenteric hernia in 1 patient were performed by laparoscopic hernioplasty and 6 patients with hernia of oesophagus finestra performed hernioplasty combined collapse gastric fundus with laparoscopy.In this series 45 patients associated with other abdominal disease were simultaneously treated with laparoscopy.Results All cases were operated successfully.The span of operation reduration was 42.5 min((10～180 min)).The average length of postoperative hospital stay were 4.6 days.There was one early failure owing to the use of too small a piece of mesh.Conclusion The results indicate that mesh repair of hernias is a satisfactory technique with a low recurrence rate and a low major complication rate.

At present, the formal bariatric surgery approved by the American Society for Metabolic and Bariatric Surgery (ASMBS) includes adjustable gastric banding (AGB), sleeve gastrectomy (Sleeve gastrectomy, SG). ), Roux-en-Y gastric bypass (Roux-en-Y gastric bypass, RYGB), biliopancreatic diversion with duodenal switch (BPD-DS), mini gastric bypass (Mini-gastric bypass, MGB), single anastomosis gastric bypass (OAGB) and partial endoscopic surgery. According to the Chinese Society for Metabolic and Bariatric Surgery (CSMBS), the Chinese Obesity and Metabolic Surgery Database (COMES Database), and the Chinese Obesity and Metabolic Surgery Database (COMES Database), the Chinese Society for Metabolic and Bariatric Surgery (CSMBS) Chinese Obesity and Metabolic Surgery Collaborative, COMES Collaborative), Shanghai Weight Loss and Diabetes Surgery Data Management System, Shandong Province Weight Loss and Metabolic Surgery Case Registration System, Jiangsu Province Weight Loss and Metabolic Surgery Data Registration System, Great North China Weight Loss and Metabolic Surgery Statistics from the clinical data database and the Greater China Weight Loss and Metabolic Surgery Database. The domestically developed and approved bariatric surgery methods include RYGB, SG, MGB, OAGB, BPD-DS, AGB, combined sleeve gastrectomy (SG Plus), Jejunoileal Bypass (Jejunoileal Bypass, JJB), single stoma duodenal transposition (SADI-S), intragastric balloon (Balloon). However, there are still some irregular bariatric surgeries in China, which will cause some uncommon complications and bring great pain to patients. At the same time, it is also a huge challenge for regular bariatric surgeons who perform corrective surgeries. This article will review the revision surgery after bariatric surgery in China in the past 20 years, discusses a series of problems caused by non-standard bariatric surgery and the development of regular bariatric surgery.