Minimally invasive surgery has been one of the main trend of surgical practice in 21 century,while the laparoscopic technique,as one of the product of high-tech,shows the minimally invasive surgery a more lactiferous prospect.However,with the popularity of laparoscopic technique,its high complications rate is gradually being highly regarded.By analyzing various causes comprehensively,we found that the complications rate had direct correlation with the operant level of the operator.Combining the successful experience of twice laparoscopic technique training courses,which were conducted by our department,this article will give rise to a discussion about the training of the general surgery doctor.

Objective To explore the role of nuclear factor-kappa B(NF-?B)in regulating tumor necrosis factor-?(TNF-?)expression in acute pancreatitis (AP)in rats.Methods Sixty-four Wistar rats were randomly divided into two groups:the control group(n=32)and the AP group(n=32).Acute pancreatitis was induced by introperitoneal injection of caerulein,and the animals were killded at 12 hours,24 hours,36 hours,and 72 hours respectively.The activity of NF-?B and expression of TNF-? mRNA in the pancreas were determined by flow cytometry (FCM) method and semi-quantitave RT-PCR analysis,respectively,and the correlation coefficients were analyzed.Results The levels of activated NF-?B protein and TNF-?mRNA were all significantly higher in the AP group than those in the control group at any time point(P

Objective To observe the apoptosis or oncosis of pancreatic acinar cells of different severity of acute pancreatitis (AP) and the release level of enzymes in vitro, and to investigate the relationship between them. Methods Two-step enzymatic digestion method was used to separate pancreatic acinar cells into 4 groups. 0. 1 μg/ml of the caerulein was added in the AP group. Caerulein and LPS (bacterial lipopolysaccharide, 10 mg/L) were added in LPS group. Caerulein and OCT (octreotide, 100 ng/ml) were added in OCT group. Medium was added in the control group. AO (acridine orange) and EB (ethidium bromide) double staining method was used to detect the incidence of apoptosis or oncosis of acinar cell. The release of intracellular enzyme was detected by measuring the concentrations of amylase and LDH in cell culture media by colorimetry method. Results The apoptosis index was 2.2 + 0.4, 6.4 ± 0.6, 4.6 + 0.4, 11.2 +1.2 in the control group, AP group, LPS group, OCT group; while the oncosis index was 3.0 +0.4, 17.2 ±1.6, 23.0 ± 2.2, 12.8 ± 1.4 in the control group, AP group, LPS group, OCT group; the release of LDH was (2180 ±240), (8060 ±930), (9460 +920), (6860 ±740) U/dl, the level of amylase was (1750 ± 190),(3820 ±460), (4420 ±480), (2260 ±260)U/L. All the values in the experiment groups were significantly higher than that in control group ( P ＜ 0.05 ). The oncosis index, LDH, amylase in LPS group was significantly higher than that in AP group ( P ＜ 0.05 ), but the apoptosis index in LPS group was significantly lower than that in AP group ( P ＜ 0.05 ). The apoptosis index in OCT group was significantly higher than that in AP group ( P ＜ 0. 05 ), but the oncosis index, LDH, amylase was significantly lower than that in AP group ( P ＜ 0. 05 ).Conclusions Induction of apoptosis and reduction of oncosis in AP pancreatic acinar cells can reduce the release of enzyme in acinar cells.

Objective To explore the reason of colon cancer with appendicitis and reduce the rate of misdiagnosis. Methods We car-ried out analysis retrospectively to analyze 1 094 hospitalized patients with colon cancer in the First Affiliated Hospital of Harbin Medical Uni-versity from January 2006 to March 2013. Results Among 1 094 colon cancer patients,31 patients who firstly diagnosed with acute appendi-citis received appendectomy,1 patient with appendiceal abscess received non-surgical treatment. Among 31 patients with acute appendicitis,6 patients were found to be with ileocecal tumors during surgeries;24 patients were diagnosed with colon cancer within one year;incision of 1 patient did not heal, with continuous drainage of brown liquid;the appendicitis of 1 patient who received non-surgical treatment was recur-rent. Conclusion As lack of typical symptoms,colon cancer is prone to misdiagnose and diagnose incorrectly when the cancer co-exists with appendicitis and symptoms of appendicitis were showed firstly. Therefore,clinicians should be vigilant for patients with appendicitis. In order to induce the rate of misdiagnosis,it is essential that requesting disease history carefully,timely and relevant inspection and appropriate ex-ploratory surgery for the patients with appendicitis.

Objective:To investigate the clinical significance of changes of platelet count after splenectomy in patients with cirrhosis and portal hypertension.Methods:In this study,from January 2002 to January 2006,the platelet count and liver function in 153 splenomegaly and hypersplenism due to cirrhosis patients who had been carried out splenectomy were selected.The change tendency of platelet count was observed,the relationship of changes of platelet count and liver function was analysed,and compared with patients of spleen trauma.Results:Postoperative platelet count was higher than preoperatively in most patients with cirrhosis,the portion did not elevate,even decreased.The change tendency of platelet count was correlated with the liver function.The change in cirrhosis patients is not more than patients of spleen trauma.Conclusions:The reason of thrombocytopenia in patients with cirrhosis may be correlated with the change of liver function besides the splenomegaly.

Problem-based learning(PBL)teaching mode was applied in general surgery practice of the seven-year system externs.The externs were organized to analyze and discuss a real case,having grasped enough knowledge of relative diseases,and try to provide their advice about the diagnosis and treatment,and then their conclusions were verified by post-operational follow-up.PBL teaching mode can increase the students'study motivations and interests and the ability to resolve practical problems,master medical knowledge,train their clinical thinking and eventually pave a way to become qualified clinicians.

Objective To detective the carcinogenesis and operation principle of cyst canceration after internal drainage(ID) operation for congenital choledocal cyst (CCC).Methods The clinical data of 25 patients with cyst carcinoma after ID operation for CCC in the past 28 years were analysed retrospectively.Results The total canceration rate after internal drainage of CCC were 30.49%(25/82); after cystoduodenostomy was 35.29%(14/51),after cystojejunostomy was 22.58%(11/31), respectively. In the 25 cases, three of them were operated with Wipple operation , 4 with tumour resection plus biliary reconstrustion operation, 4 local resection with external drainage ,14 with external drainage only. Conclusions Internal drainage of CCC should be aborted becaus of the high canceration rate after the operation.

Objective To explore the learning curve characteristics of Mckeown-type minimally invasive esophagectomy and effects of the para-recurrent laryngeal nerve lymphadenectomy on efficacy.Methods The retrospective cohort study was conducted.The clinicopathological data of 163 patients with esophageal squamous cell carcinoma (ESCC) who underwent Mckeown-type minimally invasive esophagectomy in the Affiliated Tumor Hospital of Xinjiang Medical University between January 2011 and December 2015 were collected.According to the para-recurrent laryngeal nerve lymphadenectomy in the different learning curve stages (early,medium and later stages),49 patients who didn't undergo right para-recurrent laryngeal nerve lymphadenectomy were allocated into the group A,65 who underwent para-recurrent laryngeal nerve lymphadenectomy were allocated into the group B,and 49 underwent bilateral para-recurrent laryngeal nerve lymphadenectomy were allocated into the group C.Observation indicators:(1) comparisons of intra-and post-operative recovery among groups;(2) comparisons of follow-up and survival among groups;(3) correlation analysis between operation time or volume of intraoperative blood loss and cases of learning curve of Mckeown-type minimally invasive esophagectomy.Follow-up using outpatient examination and telephone interview was performed to detect postoperative survival up to April 2017.Measurement data with normal distribution were represented as-x±s.Comparison among groups was analyzed using the ANOVA,and pairwise comparison was done using the independent-sample t test.Measurement data with skewed distribution were described as M (range),and comparison of count data was done using the chi-square test.The survival time was calculated by the Kaplan-Meier method,and Log-rank test was used for survival analysis.Correlation analysis was done by Spearman rank correlation.Results (1) Comparisons of intra-and post-operative recovery among groups:patients in the 3 groups underwent successful Mckeown-type minimally invasive esophagectomy of ESCC,without conversion to open surgery.The operation time,total number of lymph node dissected,number of thoracic lymph node dissected and volume of intraoperative blood loss were respectively (395±94) minutes,14.7±6.9,9.6±5.4,(175± 100) mL in the group A and (329±67) minutes,20.4±9.1,11.4±7.3,(117±49) mL in the group B and (301±51)minutes,25.8±11.0,14.8±10.1,(115±50) mL in the group C,with statistically significant differences in above indicators among groups (F=21.962,1.992,5.775,12.744,P＜0.05),between group A and group B (t =3.135,3.741,4.324,4.375,P＜0.05) and between group A and group C (t=5.120,3.415,5.712,6.130,P＜0.05).There was no statistically significant difference in operation time and volume of intraoperative blood loss between group B and group C (t =2.325,2.459,P＞0.05).There were statistically significant differences in total number of lymph node dissected and number of thoracic lymph node dissected between group B and group C (t =2.751,3.245,P＜0.05).Cases with unilateral recurrent laryngeal nerve injury,anastomotic leakage and pneumonia were respectively 7,8,7 in the group A and 17,19,10 in the group B and 11,15,10 in the group C,with no statistically significant differences (x2 =0.968,3.292,0.773,P＞0.05).Number of lymph node dissected at right and left para-recurrent laryngeal nerve were respectively 0,0 in the group A and 1.9±1.8,0 in the group B and 2.6±2.1,1.1±0.8 in the group C.Of 35patients with unilateral recurrent laryngeal nerve were treated with symptomatic and supportive treatment of neuro nutrition,18 encountered permanent hoarseness and 17 recovered well.Patients with anastomotic fistula and pneumonia were improved by sufficient drainage and antibiotic therapy.(2) Comparisons of follow-up and survival among groups:149 of 163 patients were followed up for 17-65 months,with a median time of 32 months,including 43 in the group A,61 in the group B and 45 in the group C.Survival time of patients who received follow-up was recpectively (31.3±2.6) months,(32.2± i.6) months and (25.5±2.5) months in group A,B and C,with no statistically significant differences (x2=4.412,P＞0.05).(3) Correlation analysis between operation time or volume of intraoperative blood loss and cases of learning curve of Mckeown-type minimally invasive esophagectomy:results of correlation analysis showed that there was a significant negative correlation between operation time or volume of intraoperative blood loss and cases of learning curve of Mckeown-type minimally invasive esophagectomy (r=-0.632,-0.451,P＜0.05),showing a decreasing trend in operation time and volume of intraoperative blood loss with increasing surgical cases.Conclusions The operation time and volume of intraoperative blood loss are gradually declining with learning curve process of Mckeown-type minimally invasive esophagectomy.Para-recurrent laryngeal nerve lymphadenectomy cannot increase the incidence of recurrent laryngeal nerve injury,with more completely lymphadenectomy.

Objective:To investigate the influences of age-adjusted Charlson comorbidity index (ACCI) on prognosis of patients undergoing laparoscopic radical gastrectomy.Methods:The retrospective cohort study was conducted. The clinicopathological data of 242 gastric cancer patients who underwent laparoscopic radical gastrectomy in 19 hospitals of the Chinese Laparoscopic Gastrointestinal Surgery Study Group-04 study, including 54 patients in Fujian Medical University Union Hospital, 32 patients in the First Hospital of Putian City, 32 patients in Renji Hospital Affiliated to Shanghai Jiaotong University School of Medicine, 31 patients in Zhangzhou Affiliated Hospital of Fujian Medical University, 17 patients in Nanfang Hospital of Southern Medical University, 11 patients in the First Affiliated Hospital with Nanjing Medical University, 8 patients in Qinghai University Affiliated Hospital, 8 patients in Meizhou People′s Hospital, 7 patients in Fujian Provincial Hospital, 6 patients in Zhongshan Hospital of Fudan University, 6 patients in Longyan First Hospital, 5 patients in the First Affiliated Hospital of Xinjiang Medical University, 5 patients in the First Hospital Affiliated to Army Medical University, 4 patients in the Second Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine, 4 patients in West China Hospital of Sichuan University, 4 patients in Beijing University Cancer Hospital, 3 patients in the First Affiliated Hospital of Xiamen University, 3 patients in Guangdong Provincial People′s Hospital, 2 patients in the First Affiliated Hospital of Xi′an Jiaotong University, from September 2016 to October 2017 were collected. There were 193 males and 49 females, aged 62(range, 23?74)years. Observation indicators: (1) age distribution, comorbidities and ACCI status of patients; (2) the grouping of ACCI and comparison of clinicopathological characteristics of patients in each group; (3) incidence of postoperative early complications and analysis of factors affecting postoperative early complications; (4) follow-up; (5) analysis of factors affecting the 3-year recurrence-free survival rate of patients. Follow-up was conducted using outpatient examination or telephone interview to detect postoperative survival of patients up to December 2020. Measurement data with normal distribution were represented as Mean± SD, and comparison between groups was conducted using the t test. Measurement data with skewed distribution were represented as M( Q1, Q3) or M(range), and comparison between groups was conducted using the Mann-Whitney U test. Count data were described as absolute numbers or percentages, and comparison between groups was conducted using the chi-square test or Fisher exact probability. Comparison of ordinal data was conducted using the nonparametric rank sum test. The X-Tile software (version 3.6.1) was used to analyze the best ACCI grouping threshold. The Kaplan-Meier method was used to calculate survival rates and draw survival curves. The Log-Rank test was used for survival analysis. The Logistic regression model was used to analyze the factors affecting postoperative early complications. The COX proportional hazard model was used for univariate and multivariate analyses of factors affecting the 3-year recurrence-free survival rate of patients. Multivariate analysis used stepwise regression to include variables with P<0.05 in univariate analysis and variables clinically closely related to prognosis. Results:(1) Age distribution, comor-bidities and ACCI status of patients. Of the 242 patients, there were 28 cases with age <50 years, 68 cases with age of 50 to 59 years, 113 cases with age of 60 to 69 years, 33 cases with age of 70 to 79 years. There was 1 patient combined with mild liver disease, 1 patient combined with diabetes of end-organ damage, 2 patients combined with peripheral vascular diseases, 2 patients combined with peptic ulcer, 6 patients combined with congestive heart failure, 8 patients combined with chronic pulmonary diseases, 9 patients with diabetes without end-organ damage. The ACCI of 242 patients was 2 (range, 0-4). (2) The grouping of ACCI and comparison of clinicopathological characteristics of patients in each group. Results of X-Tile software analysis showed that ACCI=3 was the best grouping threshold. Of the 242 patients, 194 cases with ACCI <3 were set as the low ACCI group and 48 cases with ACCI ≥3 were set as the high ACCI group, respectively. Age, body mass index, cases with preoperative comorbidities, cases of American Society of Anesthesiologists classification as stage Ⅰ, stage Ⅱ, stage Ⅲ, tumor diameter, cases with tumor histological type as signet ring cell or poorly differentiated adenocarcinoma and cases with tumor type as moderately or well differentiated adenocarcinoma, cases with tumor pathological T staging as stage T1, stage T2, stage T3, stage T4, chemotherapy cycles were (58±9)years, (22.6±2.9)kg/m 2, 31, 106, 85, 3, (4.0±1.9)cm, 104, 90, 16, 29, 72, 77, 6(4,6) in the low ACCI group, versus (70±4) years, (21.7±2.7)kg/m 2, 23, 14, 33, 1, (5.4±3.1)cm, 36, 12, 3, 4, 13, 28, 4(2,5) in the high ACCI group, showing significant differences in the above indicators between the two groups ( t=-14.37, 1.98, χ2=22.64, Z=-3.11, t=-2.91, χ2=7.22, Z=-2.21, -3.61, P<0.05). (3) Incidence of postoperative early complications and analysis of factors affecting postoperative early complications. Of the 242 patients, 33 cases had postoperative early complications, including 20 cases with local complications and 16 cases with systemic complica-tions. Some patients had multiple complications at the same time. Of the 20 patients with local complications, 12 cases had abdominal infection, 7 cases had anastomotic leakage, 2 cases had incision infection, 2 cases had abdominal hemorrhage, 2 cases had anastomotic hemorrhage and 1 case had lymphatic leakage. Of the 16 patients with systemic complications, 11 cases had pulmonary infection, 2 cases had arrhythmias, 2 cases had sepsis, 1 case had liver failure, 1 case had renal failure, 1 case had pulmonary embolism, 1 case had deep vein thrombosis, 1 case had urinary infection and 1 case had urine retention. Of the 33 cases with postoperative early complications, there were 3 cases with grade Ⅰ complications, 22 cases with grade Ⅱ complications, 5 cases with grade Ⅲa complications, 2 cases with grade Ⅲb complications and 1 case with grade Ⅳ complica-tions of Clavien-Dindo classification. Cases with postoperative early complications, cases with local complications, cases with systemic complications were 22, 13, 9 in the low ACCI group, versus 11, 7, 7 in the high ACCI group, respectively. There were significant differences in cases with postoperative early complications and cases with systemic complications between the two groups ( χ2=4.38, 4.66, P<0.05), and there was no significant difference in cases with local complications between the two groups ( χ2=2.20, P>0.05). Results of Logistic regression analysis showed that ACCI was a related factor for postoperative early complications of gastric cancer patients undergoing laparoscopic radical gastrectomy [ odds ratio=2.32, 95% confidence interval ( CI) as 1.04-5.21, P<0.05]. (4) Follow-up. All the 242 patients were followed up for 36(range,1?46)months. During the follow-up, 53 patients died and 13 patients survived with tumor. The 3-year recurrence-free survival rate of the 242 patients was 73.5%. The follow-up time, cases died and cases survived with tumor during follow-up, the 3-year recurrence-free survival rate were 36(range, 2-46)months, 29, 10, 80.0% for the low ACCI group, versus 35(range, 1-42)months, 24, 3, 47.4% for the high ACCI group. There was a significant difference in the 3-year recurrence-free survival rate between the two groups ( χ2=30.49, P<0.05). (5) Analysis of factors affecting the 3-year recurrence-free survival rate of patients. Results of univariate analysis showed that preoperative comorbidities, ACCI, tumor diameter, histological type, vascular invasion, lymphatic invasion, neural invasion, tumor pathological TNM staging, postoperative early complications were related factors for postoperative 3-year recurrence-free survival rate of gastric cancer patients undergoing laparoscopic radical gastrectomy [ hazard ratio ( HR)=2.52, 3.64, 2.62, 0.47, 2.87, 1.90, 1.86, 21.77, 1.97, 95% CI as 1.52-4.17, 2.22-5.95, 1.54-4.46, 0.27-0.80, 1.76-4.70, 1.15-3.12, 1.10-3.14, 3.01-157.52, 1.11-3.50, P<0.05]. Results of multivariate analysis showed that ACCI, tumor pathological TNM staging, adjuvant chemotherapy were indepen-dent influencing factors for postoperative 3-year recurrence-free survival rate of gastric cancer patients undergoing laparoscopic radical gastrectomy ( HR=3.65, 11.00, 40.66, 0.39, 95% CI as 2.21-6.02, 1.40-86.73, 5.41-305.69, 0.22-0.68, P<0.05). Conclusions:ACCI is a related factor for post-operative early complications of gastric cancer patients undergoing laparos-copic radical gastrectomy. ACCI, tumor pathological TNM staging, adjuvant chemotherapy are indepen-dent influencing factors for postoperative 3-year recurrence-free survival rate of gastric cancer patients undergoing laparoscopic radical gastrectomy.

In recent years, the incidence of digestive disorders has risen steadily. Among which, biliary dyskinesia, particularly biliary hyperkinesia, has become a growing concern. The basic concept, epidemiology, pathogenesis, pathology, clinical and imaging manifestations, diagnosis, and treatment of biliary hyperkinesia are systematically reviewed in this paper based on the current status of research in this field worldwide. On this basis, prospective future research directions are also provided.