Objective:To investigate the clinical efficacy of double tract reconstruction of proximal gastric resection and Roux-en-Y total gastrectomy in the treatment of adenocarcinoma of the esophagogastric junction, in order to provide reference for clinical selection.Methods:From June 2016 to June 2018, patients with adenocarcinoma of the esophagogastric junction in Chifeng City hospital were prospectively selected and randomly divided into proximal gastrectomy double channel anastomosis group (PG group) and total gastrectomy Roux-en-Y anastomosis group (TG group). The perioperative indexes, clinical pathology, early (≤ 30 days) and late (> 30 days) complications of the two groups were compared, and the nutritional status [body mass index (BMI), prealbumin, albumin, total protein], and anemia degree [hemoglobin (Hb), red blood cell count (RBC)] of the two groups at 3 months, 6 months and 12 months after operation were compared.Results:A total of 83 patients with adenocarcinoma of the esophagogastric junction were admitted, including 62 patients who were eligible for surgery, 31 cases in each group, 1 case in each group was lost to follow-up, and 30 cases in each group. There were no tumor recurrence or death in two groups. There were no statistically significant differences in age, gender, tumor size, tumor stage, preoperative complications, preoperative nutritional status and anemia between the two groups ( P>0.05). The time of first exhaust, time of starting fluid feeding and postoperative hospitalization in PG group was significantly earlier than that in TG group [(3.0±0.7)days vs (4.2±0.7)days, (7.9±0.9)days vs (9.0±0.9)days, (13.3±1.1)days vs (14.6±0.9)days, P<0.05], while the operation time was slightly longer [(252.0±36.9)min vs (225.8±31.1)min, P<0.05]. There was no significant difference in intraoperative blood loss and number of lymph node dissection between PG group and TG group [(241.7±81.0)ml vs (245.8±71.9)ml, (40.5±12.2)nodes vs (43.2±10.3)nodes, P>0.05]. There was no statistically significant difference in the occurrence of early and late postoperative complications ( P>0.05). The incidence of reflux esophagitis in PG group was less than that in TG group ( P<0.05). The nutritional status of PG group was significantly better than TG group in 3 months, 6 months and 12 months after the operation ( P<0.05). The Hb and RBC decreased in both groups at 3 and 6 months after operation, and the Hb and RBC in PG group were higher than those in TG group. There was no anemia in PG group and TG group 12 months after operation. Conclusions:Double tract reconstruction of proximal gastric resection is effective in the treatment of adenocarcinoma of the esophagogastric junction. It is worthy of further clinical promotion.

ObjectiveTo understand the development of basic rehabilitation services for people with disabilities in the regions of Eastern China. MethodsTo measure and evaluate the efficiency of basic rehabilitation services for people with disabilities in ten provinces and cities in eastern China from 2018 to 2020 based on the improved three-stage Window DEA model. ResultsThe efficiency of basic rehabilitation services for people with disabilities in eastern China was generally high, and Beijing and Zhejiang were the most efficient and DEA effective. The gross domestic product promoted the efficiency, and the number of people with disabilities limited the efficiency of basic rehabilitation services for people with disabilities. The low scale efficiency was an important reason for the imbalance of development among regions and the restriction of the efficiency of basic rehabilitation services for people with disabilities. ConclusionLocatities need to adjust the scale and structure of input according to the strong and effective target value, improve the social security system and the living standards. The top ones can focus on quality development, and the regions with more slack movement should focus on resource allocation and synchronization of the scale of resources, to improve the efficiency of basic rehabilitation services for people with disabilities.

Objective     To explore the clinical efficacy and learning curve of robot-assisted thymectomy via subxiphoid approach. Methods    The clinical data of patients with robot-assisted thymectomy surgery via subxiphoid approach performed by the same surgical team in the Department of Thoracic Surgery of Shanghai Pulmonary Hospital from February 2021 to August 2022 were retrospectively analyzed. The cumulative sum (CUSUM) analysis and best fit curve were used to analyze the learning curve of this surgery. The general information and perioperative indicators of patients at different learning stages were compared to explore the impact of different learning stages on clinical efficacy of patients. Results    A total of 67 patients were enrolled, including 31 males and 36 females, aged 57.10 (54.60, 59.60) years. The operation time was 117.00 (87.00, 150.00) min. The best fitting equation of CUSUM learning curve was y=0.021 2x3–3.192 5x2 +120.17x–84.444 (x was the number of surgical cases), which had a high R2 value of 0.977 8, and the fitting curve reached the top at the 25th case. Based on this, the learning curve was divided into a learning period and a proficiency period. The operation time and intraoperative blood loss in the proficiency stage were significantly shorter or less than those in the learning stage (P<0.001), and there was no statistical difference in thoracic drainage time and volume between the two stages (P>0.05). Conclusion    The learning process of robot-assisted thymectomy via subxiphoid approach is safe, and this technique can be skillfully mastered after 25 cases.