Objective To compare the clinical outcomes of total laparoscopic pancreatoduodenectomy (TLPD) and open pancreaticoduodenectomy (OPD).Methods From August 2013 to December 2014,137 pancreaticoduodenectomies (PDs) were performed at the Department of General Surgery of our hospital,of which 19 TLPDs were performed at the Department of Minimally Invasive Surgery (the Experimental group).At the same time,another cohort of 19 OPDs were matched for age,gender,body mass index (BMI),ASA score and tumor site and they formed the control group.The clinical data in the perioperative period were evaluated,and the short-term clinical outcomes were compared.Results Operation time in the experimental group was significantly longer than the control group [(407.8 ± 146.5)min vs (263.3 ± 65.3) rmin,P ＜ 0.05].The mean intraoperative blood loss [(309.7 ± 151.2)ml vs (509.4 ± 309.9)ml],mean intensive care time after surgery [(47.5 ±16.8)h vs (68.1 ± 19.1)h],mean postoperative time to pass flatus [(3.5 ± 1.1) d vs (4.3 ± 1.1) d],mean postoperative hospitalization stay [(8.8 ± 2.1) d vs (10.8 ± 2.3)d] and mean incision length [(5.1 ± 0.9)cm vs (14.4 ± 1.3)cm] in the experimental group were significantly different from the control group (P ＜ 0.05).There were no significant differences on the intraoperative R0 resection rates,intraoperative pathology,tumor size [(20.6 ± 9.6) mm vs (25.9 ± 10.2)mm],number of lymph node dissected [(17.7 ± 6.5) vs (19.4 ± 5.6)],complication rates,recurrence rates and mortality between the two groups (P ＞ 0.05).Conclusions TLPD had comparable safety and therapeutic outcome when compared with OPD.Moreover,TLPD has the advantages of less bleeding,smaller wounds and faster postoperative recovery.TLPD requires specialized appliances and equipments,better surgeon experience and patient selection to achieve a high success rate.

Minimally invasive technique has been widely applied and recognized in gastrointestinal surgery. In recent years, technological innovation related to minimally invasive technology emerges in endlessly. The application of 4K ultra-high definition video display technology has played impartment roles in promoting the development of surgery, technical specifications and training of minimally invasive gastrointestinal surgery. Clearly understand the anatomical structure of the inferior pyloric region is an important theoretical basis for the dissection of No. 6 lymph node. Careful anatomy with good patience of the surgeons, and good cooperation between the surgeon and assistants are helpful to reduce and prevent complications. The authors investigate the infrapyloric lymph node dissection in 4K laparoscopic radical gastrectomy with the surgeon on right position.

Metatarsal Bones/surgery* ; Thumb/abnormalities* ; Metacarpal Bones/surgery* ; Plastic Surgery Procedures

Objective:To design a patient self-rating wrist scale suitable for Chinese patients, and evaluate its reliability and validity.Methods:The primary entry pool was established by referring to the existing foreign scales and the opinions of domestic experts. Opinions of 11 hand surgeons and 10 patients with wrist diseases were referred to select better items into the primary scale. During September 2015 to November 2016, 100 inpatients with wrist diseases in the hand surgery department of Beijing Jishuitan Hospital were selected by convenient sampling method, and the primary scale was conducted on them. Eight indices including item response rate, item differentiation, item-dimension attribution, variability, responsiveness, overall item attribution, internal consistency and factor loading were summarized. All the 8 indices were evaluated to establish the wrist patient self-evaluation instrument for Chinese. Test-retest reliability, Cronbach coefficient, expert score, KMO value, explanatory power, χ 2/df, root mean square error of approximation (RMSEA) and comparative fit index (CFI) were used to evaluate the reliability and validity of the scale. Results:A total of 40 subjective items in the primary entry pool were selected to form the primary scale, including 32 items (A1-D4), and 4 dimensions (physiology, safety, pain and emotion). There were 92 valid scale results in 100 cases. All cases' response rate were over 90%. In terms of item differentiation, only the high grouping score [3.20±0.577 points (range, 1-3 points)] and the low grouping score [2.68±0.627 points (range, 2-5 points)] of item B10 had no statistical significance ( t=5.11, P=0.340). There were 17 items: A1, A2, A5, A6, A7, A8, A9, A10, A11, A12, B4, B6, B7, C5, D1, D2, and D3 were considered to be deleted according to the result of item-dimension attribution. A total of 11 items had a variation less than 0.65: A4 (0.645), A7 (0.593), B1 (0.590), B5 (0.617), B8 (0.578), B9 (0.612), B10 (0.526), D1 (0.644), D2 (0.320), D3 (0.169), D4 (0.526). A2, A4, A6, A8, B4, B6, D1, D2, D3, C2, C3, C4, C5, C6 did not meet the reactivity requirements. Items with factor loads less than 0.4: D2 (-0.051), D3 (-0.127), and D4 (0.267). C4 (0.026), C5 (0.023), D1 (0.103), D2 (0.434), D3 (0.387), D4 (0.062) did not meet the internal consistency requirements. In multiple linear regression analysis, 19 items were not included in the final regression equation. Based on the above analysis, D1, D2, and D3 were finally deleted and the rest 29 valid items were remained to form the wrist patient self-evaluation instrument for Chinese. Reliability and validity of the scale: the test-retest reliability of physiology, safety, pain, emotion dimensions were 0.984, 0.976, 0.985 and 0.802 ( P<0.001), respectively. Except for there was only one item in emotion dimension, the Cronbach coefficients of total score, physiology, safety and pain dimensions were 0.943, 0.973, 0.944 and 0.881, respectively. KMO was 0.894 ( P<0.001). Except for there was only one item in emotion dimension, whose validity could not be evaluated. The χ 2/df, CFI, RMSEA results were as follows, physiology: 5.152, 0.817, 0.022, respectively; safety: 5.378, 0.795, respectively; pain: 7.439, 0.865, 0.028, respectively. Conclusion:The wrist patient self-evaluation instrument for Chinese is consisted of 4 dimensions and 29 items. As a subjective wrist self-rating scale suitable for modern Chinese patients, the scale has good reliability and validity, and can be one of the choices of the subjective evaluation for Chinese patients with wrist diseases.

Adhesive intestinal obstruction is the most common type of ileus, and conserva-tive treatment serves as its preferred treatment option. In the course of conservative treatment, gastrointestinal decompression will relieve symptoms, prevent ileus progression and promote gas-trointestinal function recovery, which has significant clinical effects. Currently, decompression effects of nasointestinal tubes and nasogastric tubes are controversial. There is a previous Meta-analysis evaluating decompression effects of these two methods, but this analysis includes non-randomized controlled trial and lacks research about Chinese patients. Therefore, the authors con-duct a Meta-analysis to evaluate decompression effects of nasointestinal tubes versus nasogastric tubes for adhesive intestinal obstruction.