38 ℃),while in the open group,3 patients showed complications,12 had the body temperature over 38 ℃.Conclusions Laparoscopic repair,which is feasible and safety for acute gastroduodenal ulcer perforation,should be the first choice in emergency,while non-surgical treatments and emergency subtotal gastrectomy can be two alternatives.

Objective To investigate the influence of fast track surgery (FTS) on insulin resistance indexes and inflammatory reaction in colorectal cancer patients who received laparoscopic surgery.Methods A total of 62 patients were randomly divided into control group (n=31) or FTS group (n=31).The postoperative first flatus and defecation time, postoperative hospital stay, hospitalization expenditure, and postoperative complications were recorded.Insulin resistance indexes and inflammatory reaction were measured before operation (T0) as well as on the 1st, 3rd, and 7th postoperative days (T1, T3, and T7), including fasting blood-glucose (FBG), fasting insulin (FINS), serum level of interleukin-6 (IL-6), C-reactive protein (CRP), and tumor necrosis factor (TNF-α).The insulin resistance index (HOMA-IR) was calculated at the same time points.Results The postoperative time of flatus and defecation in the FTS group was significantly shorter than that in the control group (t=3.088, P=0.003;t=4.227, P=0.000), the postoperative hospital stay and total hospitalization expenditure were significantly lower in FTS group (t=3.937, P=0.000;t=3.478, P=0.003).No significant difference was found in the complication rate between the two groups (χ2=0.267,P=0.605).The inflammatory indexes and insulin resistance indexes in the two groups at T1 and T3 time points were higher than those at T0 time points (P<0.05).Compared to the FTS group at T1 and T3 time points, the levels of IL-6, CRP, TNF-α, FINS, and HOMA-IR in the control group increased more obviously (P<0.05), but the elevation blood FBG was not obvious (T1: t=0.870, P=0.388;T3: t=0.870, P=0.388).There were no significant differences in IL-6 and TNF-α in the two groups between the T7 and T0 time points (P>0.05), but the levels of CRP, FBG, FINS, and HOMA-IR at T7 time points were significantly higher than those at the T0 time points in the two groups (P<0.05).The levels of IL-6, TNF-α, FBG, FINS, and HOMA-IR at T7 had no significant differences between the two groups (P>0.05), but the level of CRP in the control group was significantly higher than that in the FTS group (t=-4.527, P=0.000).Conclusion FTS may promote the early recovery of gastrointestinal functions, reduce stress reactions and postoperative insulin levels, thus being conducive to fast rehabilitation in colorectal cancer patients with laparoscopic surgery.

Objective To explore the correlation between hyponatremia at admission and all-cause mortality within one year after discharge in elderly patients with intestinal obstruction.Methods The 331 cases of elderly patients with intestinal obstruction(aged ≥ 60 years)who visited the General Surgery Department of Nanjing Meishan Hospital from January 2017 to December 2020 were selected as the research objects for retrospective cohort study analysis.According to the patient's blood sodium level at admission,they are divided into two groups:the hyponatremia group(Na＜135 mmol/L)and the non hyponatremia group(Na≥135 mmol/L).Divided into death group and survival group based on whether death occurred within one year after discharge.SPSS 25.0 software was used for statistical analysis.Independent sample t test,x2 test,Kaplan Meier method,and multivariate Cox regression analysis were used to observe the correlation between admission hyponatremia and all-cause mortality within one year after discharge in elderly patients with intestinal obstruction.Results A total of 331 patients were enrolled.The incidence of hyponatremia was 32.3％,and 56 deaths occurred within one year,accounting for 16.92％.The one-year mortality rate in the hyponatremia group was 23.4％(25/107),which was higher than 13.8％(31/224)in the non hyponatremia group.The difference was statistically significant(P＜0.05).The survival analysis(Kaplan Meier)results showed that the survival rate of the hyponatremia group was lower than that of the non hyponatremia group(Log Rank P＜0.05).After adjusting for other confounding factors in multivariate Cox regression analysis,hyponatremia(HR=1.88,95％CI:1.07-3.29)was an independent risk factor for one-year all-cause mortality in elderly patients with intestinal obstruction(P＜0.05).Conclusion Hyponatremia at admission is an independent risk factor for all cause mortality in elderly patients with intestinal obstruction within one year after discharge.