With increase in the incidence of right colon cancer, the proportion of laparoscopic right colon resection is increasing. Though the advantage of laparoscopy in minimal invasiveness has been widely accepted, its procedure still possesses certain difficulty. In this article, we shared the experience of laparoscopic right colectomy, including entering the correct Toldt's place, management of ileocolic and middle colic vessels and the problems of D3 lymph node dissection. Basic surgical techniques and several difficulties are discussed here, which may be helpful for beginners.
Colectomy ; methods ; Colonic Neoplasms ; surgery ; Humans ; Laparoscopy ; methods ; Lymph Node Excision ; methods

With increace in the incidence of right colon cancer, the proportion of laparoscopic right colon resection is increasing. Though the advantage of laparoscopy in minimal invasiveness has been widely accepted, its procedure still possesses certain difficulty. In this article, we shared the experience of laparoscopic right colectomy, including entering the correct Toldt′s place, management of ileocolic and middle colic vessels and the problems of D3 lymph node dissection . Basic surgical techniques and several difficulties are discussed here, which may be helpful for beginners.

With increace in the incidence of right colon cancer, the proportion of laparoscopic right colon resection is increasing. Though the advantage of laparoscopy in minimal invasiveness has been widely accepted, its procedure still possesses certain difficulty. In this article, we shared the experience of laparoscopic right colectomy, including entering the correct Toldt′s place, management of ileocolic and middle colic vessels and the problems of D3 lymph node dissection . Basic surgical techniques and several difficulties are discussed here, which may be helpful for beginners.

Objective: To investigate the relationship between the use of earphone and hearing impairment and its influencing factors among students aged 14-28, so as to provide a reference for appropriate earphone usage and hearing impairment prevention. Methods: A cross sectional survey was conducted through the questionnaire star platform, and 983 students aged 14 to 28 were recruited across China by snowball sampling during April 3 to May 1, 2022. The χ 2 test was used to identify indicators affecting hearing, the Logistic regression model was used to further selection. Results: There were 366 students with hearing impairment, accounting for 37.23%. Univariate analysis showed significant differences in hearing impairment by gender, earphone usage duration and volume, wearing during sleep, and replacement frequency ( χ 2=6.03, 6.86, 14.87, 12.22, 11.15, P <0.05). The Logistic regression model analysis showed that girls ( OR=1.43, 95%CI =1.10-1.88), maximum earphone volume ( OR=3.08, 95%CI = 1.56- 6.08), earphone usage for >1.5-3 h each time ( OR=1.44, 95%CI =1.04-1.99), sleep with headphone ( OR= 1.53 , 95%CI = 1.11- 2.11) were positively associated with hearing impairment ( P <0.05), earphone replacement every 4-<6 months ( OR= 0.38, 95%CI =0.17-0.86) and earphone replacement every six months or longer ( OR=0.39, 95%CI =0.18-0.85) were negatively associated with hearing impairment ( P < 0.05 ). Conclusion Students aged 14 to 28 earphone usage shows adverse impact on hearing. When using earphone, it is recommended to limit time spent on earphone usage, low the volume of earphone, avoid sleeping with earphone and replace earphone frequently.

Vasomotor symptoms(VMS)are among the typical manifestations in perimenopausal and menopausal women, with a high incidence and prolonged duration, and have long been afflicting many menopausal women.Cardiovascular disease has become one of the main causes of death in postmenopausal women.Previous studies suggest that postmenopausal VMS are related to the occurrence of cardiovascular disease in postmenopausal women, but the view is controversial.There have been many studies on the association of VMS in menopausal women with the risk of cardiovascular disease, cardiovascular disease risk factors and subclinical indicators, and the results suggest that menopausal VMS may predict the occurrence of cardiovascular disease after menopause.

Objective: To investigate the feasibility and safety of the medial approach "four-step method" in the laparoscopic mobilization of splenic flexure. Methods: A retrospective cohort study was performed. Clinical data of 157 colorectal cancer patients undergoing the medial approach "four-step method" in the laparoscopic mobilization of splenic flexure at Gastrointestinal Surgical Department of Guangdong Provincial People′s Hospital from July 2015 to June 2018 were retrospectively analyzed. Of 157 cases, 17 were transverse colon cancer, 94 were descending colon cancer, 25 were sigmoid cancer and 21 were rectal cancer; 89 were male and 68 were female; mean age was (61.8±10.3) years and mean body mass index was (23.2±3.7) kg/m². The medial approach "four-step method" in the laparoscopic mobilization of splenic flexure was performed as follows: (1) The root vessels were treated with the "provocation" technique to expand the Toldt′s gap. This expansion was extended from the lateral side to the peritoneum reflex of left colonic sulcus, from the caudal side to the posterior rectal space, and from the cephalad side to the lower edge of pancreas. (2) The left colonic sulcus was mobilized, converging with the posterior Toldt′s gap. Mobilization was carried out from cephalad side to descending colon flexure, freeing and cutting phrenicocolic ligament and splenocolic ligament, and from caudal side to peritoneal reflex. (3) Gastrocolic ligament was moblized. Whether to enter the great curvature of stomach omentum arch when the gastrocolic ligament was cut, that was, whether to clean the fourth group of lymph nodes, should be according to the tumor site and whether serosal layer was invaded. (4) Transverse mesocolon was moblized and transected at the lower edge of the pancreatic surface, merging with the posterior Toldt′s gap, and from lateral side to lower edge of the pancreatic body, merging with the lateral left paracolonic sulcus. Safety and short-term clinical efficacy of this surgical procedure was summarized. Results: All the patients completed this procedure. During operation, 3 cases were complicated with organ injury, including 1 case of colon injury, 1 case of spleen injury and 1 case of pancreas injury. No operative death and conversion to open surgery was found. The average operation time was (147.5±35.1) minutes, the average intra-operative blood loss was (40.8±32.7) ml and the average number of harvested lymph node was (16.1±5.8), including (4.0±2.3) of positive lymph nodes. The first exhaust time after surgery was (41.3±20.6) hours, the fluid intake time was (1.5±1.3) days, the postoperative hospital stay was (5.2±2.3) days. Eight (5.1%) cases developed postoperative complications, and all were improved and discharged after conservative treatments. According to the TNM classification system, postoperative pathology revealed that 31 patients were stage I, 51 were stage II, 53 were stage III, 22 were stage IV. Conclusion The medial approach "four-step method" is safe and feasible, which can effectively decrease the operation difficulty of the laparoscopic mobilization of the splenic flexure.

Objective To investigate the feasibility and safety of the medial approach "four?step method" in the laparoscopic mobilization of splenic flexure. Methods A retrospective cohort study was performed. Clinical data of 157 colorectal cancer patients undergoing the medial approach "four?step method" in the laparoscopic mobilization of splenic flexure at Gastrointestinal Surgical Department of Guangdong Provincial People′s Hospital from July 2015 to June 2018 were retrospectively analyzed. Of 157 cases, 17 were transverse colon cancer, 94 were descending colon cancer, 25 were sigmoid cancer and 21 were rectal cancer; 89 were male and 68 were female; mean age was (61.8±10.3) years and mean body mass index was (23.2±3.7) kg/m2. The medial approach "four?step method" in the laparoscopic mobilization of splenic flexure was performed as follows: (1) The root vessels were treated with the "provocation"technique to expand the Toldt′s gap. This expansion was extended from the lateral side to the peritoneum reflex of left colonic sulcus, from the caudal side to the posterior rectal space, and from the cephalad side to the lower edge of pancreas. (2) The left colonic sulcus was mobilized, converging with the posterior Toldt′s gap. Mobilization was carried out from cephalad side to descending colon flexure, freeing and cutting phrenicocolic ligament and splenocolic ligament, and from caudal side to peritoneal reflex. (3) Gastrocolic ligament was moblized. Whether to enter the great curvature of stomach omentum arch when the gastrocolic ligament was cut, that was, whether to clean the fourth group of lymph nodes, should be according to the tumor site and whether serosal layer was invaded. (4) Transverse mesocolon was moblized and transected at the lower edge of the pancreatic surface, merging with the posterior Toldt′s gap, and from lateral side to lower edge of the pancreatic body, merging with the lateral left paracolonic sulcus. Safety and short?term clinical efficacy of this surgical procedure was summarized. Results All the patients completed this procedure. During operation, 3 cases were complicated with organ injury, including 1 case of colon injury, 1 case of spleen injury and 1 case of pancreas injury. No operative death and conversion to open surgery was found. The average operation time was (147.5±35.1) minutes, the average intra?operative blood loss was (40.8±32.7) ml and the average number of harvested lymph node was (16.1±5.8), including (4.0±2.3) of positive lymph nodes. The first exhaust time after surgery was (41.3±20.6) hours, the fluid intake time was (1.5 ± 1.3) days, the postoperative hospital stay was (5.2 ± 2.3) days. Eight (5.1%) cases developed postoperative complications, and all were improved and discharged after conservative treatments. According to the TNM classification system, postoperative pathology revealed that 31 patients were stage I, 51 were stage II, 53 were stage III, 22 were stage IV. Conclusion The medial approach "four?step method" is safe and feasible, which can effectively decrease the operation difficulty of the laparoscopic mobilization of the splenic flexure.

Objective To investigate the feasibility and safety of the medial approach "four?step method" in the laparoscopic mobilization of splenic flexure. Methods A retrospective cohort study was performed. Clinical data of 157 colorectal cancer patients undergoing the medial approach "four?step method" in the laparoscopic mobilization of splenic flexure at Gastrointestinal Surgical Department of Guangdong Provincial People′s Hospital from July 2015 to June 2018 were retrospectively analyzed. Of 157 cases, 17 were transverse colon cancer, 94 were descending colon cancer, 25 were sigmoid cancer and 21 were rectal cancer; 89 were male and 68 were female; mean age was (61.8±10.3) years and mean body mass index was (23.2±3.7) kg/m2. The medial approach "four?step method" in the laparoscopic mobilization of splenic flexure was performed as follows: (1) The root vessels were treated with the "provocation"technique to expand the Toldt′s gap. This expansion was extended from the lateral side to the peritoneum reflex of left colonic sulcus, from the caudal side to the posterior rectal space, and from the cephalad side to the lower edge of pancreas. (2) The left colonic sulcus was mobilized, converging with the posterior Toldt′s gap. Mobilization was carried out from cephalad side to descending colon flexure, freeing and cutting phrenicocolic ligament and splenocolic ligament, and from caudal side to peritoneal reflex. (3) Gastrocolic ligament was moblized. Whether to enter the great curvature of stomach omentum arch when the gastrocolic ligament was cut, that was, whether to clean the fourth group of lymph nodes, should be according to the tumor site and whether serosal layer was invaded. (4) Transverse mesocolon was moblized and transected at the lower edge of the pancreatic surface, merging with the posterior Toldt′s gap, and from lateral side to lower edge of the pancreatic body, merging with the lateral left paracolonic sulcus. Safety and short?term clinical efficacy of this surgical procedure was summarized. Results All the patients completed this procedure. During operation, 3 cases were complicated with organ injury, including 1 case of colon injury, 1 case of spleen injury and 1 case of pancreas injury. No operative death and conversion to open surgery was found. The average operation time was (147.5±35.1) minutes, the average intra?operative blood loss was (40.8±32.7) ml and the average number of harvested lymph node was (16.1±5.8), including (4.0±2.3) of positive lymph nodes. The first exhaust time after surgery was (41.3±20.6) hours, the fluid intake time was (1.5 ± 1.3) days, the postoperative hospital stay was (5.2 ± 2.3) days. Eight (5.1%) cases developed postoperative complications, and all were improved and discharged after conservative treatments. According to the TNM classification system, postoperative pathology revealed that 31 patients were stage I, 51 were stage II, 53 were stage III, 22 were stage IV. Conclusion The medial approach "four?step method" is safe and feasible, which can effectively decrease the operation difficulty of the laparoscopic mobilization of the splenic flexure.

Objective To compare the effect of laparoscopy-assisted gastrectomy (LAG) and open D2 radical gastrectomy (OG) for gastric cancer.Methods The retrospective cohort study was conducted.The clinicopathological data of 117 patients who underwent D2 radical gastrectomy at the Guangdong General Hospital from January 2014 to December 2014 were collected.Of 117 patients,60 undergoing LAG and 57 undergoing OG were respectively allocated into the LAG group and OG group.Total gastrectomy,distal subtotal gastrectomy and proximal subtotal gastrectomy were performed according to the location of the tumor.The perigastric lymph nodes dissection was performed according to the Japanese " Gastric cancer treatment protocol" (the 14th edition).Eligible patients received the adjuvant chemotherapy of XELOX regimen according to the Guideline published by National Comprehensive Cancer Network (NCCN).Observation indicators:(1) comparison of intra-and postoperative recovery between groups;(2) stratified analysis of number of lymph node dissected;(3) relationship among surgical method,number of lymph node dissected and postoperative complication;(4) follow-up and survival.Follow-up using outpatient examination and telephone interview was performed to detect the postoperative adjuvant chemotherapy,tumor-free survival and tumor recurrence or metastasis up to December 2016.Measurement data with normal distribution were represented as (x)± s and comparison between groups was analyzed using the independent-sample t test.Count data were analyzed using the chi-square test or Fisher exact probability.The relationship between number of lymph node dissected and postoperative complication was done using the Logistic regression model.Results (1) Comparison of intra-and post-operative recovery between groups:all the patients completed the operation successfully.Volume of intraoperative blood loss,time to postoperative anal exsufflation and duration of postoperative hospital stay were (113±36) mL,(4.3±2.1) days,(9.7±2.9) days in the LAG group and (209 ± 77) mL,(5.3 ± 2.2) days,(11.2 ± 3.9) days in the OG group,respectively,with statistically significant differences between groups (t =6.850,-2.604,-2.405,P＜0.05).Number of lymph node dissected,numbers of patients with overall complication,incisional infection,intestinal obstruction,digestive tract fistula,intra-abdominal bleeding,cardiovascular accident,pulmonary infection,urinary tract infection and death within postoperative 30 days were respectively 31±7,6,1,0,4,0,0,1,0,0 in the LAG group and 34±6,12,0,1,2,2,1,4,1,1 in the OG group,with no statistically significant difference between groups (t=0.177,x2=2.743,0.126,0.563,0.837,P＞0.05).All the patients with complications received symptomatic treatment,1 patient with abdominal bleeding in the OG group died and other patients recovered smoothly.(2) Stratified analysis of number of lymph node dissected:number of lymph node dissected in patients with total gastrectomy,distal subtotal gastrectomy and proximal subtotal gastrectomy were 35±8,29±5,27±4 in the LAG group and 34± 5,34±6,29±6 in the OG group,respectively,with no statistically significant difference between groups (t =0.846,1.052,0.934,P＞0.05).Number of lymph node dissected in patients with stage Ⅰ,Ⅱ and Ⅲ of TNM staging were respectively 31±5,32±9,31±6 in the LAG group and 34±7,32±4,35±6 in the OG group,with no statistically significant difference between groups (t =0.494,1.657,0.136,P＞0.05).(3) Relationship among surgical method,number of lymph node dissected and postoperative complication:surgical method (LAG and OG) and number of lymph node dissected were used as the independent variable and postoperative complication between groups was used as the dependent variable,the Logistic regression model showed that surgical method and number of lymph node dissected were not related factors affecting the postoperative complication (OR =1.062,2.049,95％ confidence interval:0.998-1.140,0.695-6.042,P＞0.05).(4) Follow-up and survival:108 of 117 patients (54 in each group) were followed up for 2-35 months,with a median time of 28 months.During the follow-up,numbers of patients undergoing postoperative adjuvant chemotherapy,with tumor-free survival and with tumor recurrence were 45,43,10 in the LAG group and 42,42,10 in the OG group,respectively,with no statistically significant difference in the tumor-free survival and tumor recurrence between groups (x2 =0.055,0.002,P＞0.05).Conclusion Laparoscopy-assisted D2 radical gastrectomy is safe and feasible,which equivalent to clinical effect of open radical gastrectomy,meanwhile,it also can reduce volume of intraoperative blood loss and duration of postoperative hospital stay,and accelerate recovery of postoperative gastrointestinal function.

Objective: To investigate the value and feasibility of C reactive protein (CRP) in predicting postoperative anastomotic leakage in rectal cancer patients with enhanced recovery after surgery (ERAS) for safer implementation of this ERAS. Methods: A cohort study on serum CRP of 455 rectal cancer patients undergoing laparoscopic radical resection according to the ERAS procedure at Gastrointestinal Unit of General Surgery Department, Guangdong General Hospital from August 2014 to June 2017 was retrospectively carried out. The serum CRP level was measured before operation and at postoperative days 1-7, and the serum CRP level of the groups with and without anastomotic leakage was compared to analyze its prediction for anastomotic leakage. Diagnostic standard of anastomotic leakage was based on the definition of postoperative anastomotic leakage in rectal cancer from International Study Group of Rectal Cancer (ISREC) : (1) Postoperative localized or diffuse peritonitis occurred, or fecal liquid was found from the abdominal drainage tube; (2) When anastomotic leakage was uncertain, peritoneal or pelvic computed tomography scan should be used to confirm. Results: All the 455 patients underwent surgery successfully, and 41 patients (9.0%) had anastomotic leakage postoperatively. Patients with anastomotic leakage were diagnosed (4.0 ± 2.0) days postoperatively, of whom 8 cases (19.5%) were diagnosed more than 5 days postoperatively. Serum CRP levels in patients with anastomotic leakage continued to increase within 1-4 days postoperatively[ (50.04 ± 27.98) mg/L to (122.75 ± 52.98) mg/L]and decreased 5 days postoperatively[ (92.02 ± 58.26) mg/L], both were higher than those of non-anastomotic leakage group, and the difference was statistically significant (all P < 0.05, except postoperative day 2) . The serum CRP level of non-anastomotic leakage group reached the peak on the second postoperative day[ (83.10 ± 37.45) mg/L] and decreased 3 days postoperatively[ (48.01 ± 27.59) mg/L]. The ROC curve was drawn with the anastomotic leakage as the state variable, and the CRP level as the detection variable. The area under the curve (AUC) at postoperative 1, 2, 4, 5, 6 and 7 days was 0.74, 0.58, 0.83, 0.82, 0.65, and 0.70, respectively. The maximum was at postoperative day 3[0.93 (95%CI: 0.86-0.99) ]. The Youden index was 0.72, and the threshold of CRP was 80.09 mg/L, as the cut-off point to predict anastomotic leakage, with sensitivity, specificity, and positive predictive value of 79.3%, 92.3%, and 74.2%, respectively. Conclusions Monitoring the postoperative serum CRP level can help predict the occurrence of anastomotic leakage after laparoscopic surgery for rectal cancer. When the serum CRP level is > 80.09 mg/L on the third postoperative day, the CRP level has the largest value in predicting postoperative anastomotic leakage, and the safety of ERAS has a certain clinical significance as well.