Objective To explore the application value of low ligation of inferior mesenteric artery(IMA) in laparoscopic Dixon of nonⅠsigmoid colon mesangial(SMC). Methods Seventy-one cases of nonⅠSMC rectal cancer patients who evaluated for feasibility of laparoscopic Dixon in the Department of Gastrointestinal Surgery Affiliated Tumor Hospital of Xinjiang Medical University from September 2017 to July 2018 were selected in this study,and they were randomly divided into two groups:the group of left colic artery reserved(low ligation group)and the group of left colic artery not retained(high ligation group). A three-dimensional compu-ted tomography angiography of inferior mesenteric artery was obtained in all patients to guide the intraoperative accurate ligation of vessels. The baseline data,intraoperative and postoperative quantitative parameters of the two groups were compared. Results Three patients in the group of left colic artery reserved were forced to turn to high ligation for it could not meet the requirement of anastomo-sis. The low ligation group showed significant difference to the high ligation group on operation time[170(160,180) vs. 180 (170, 210)](P=0. 026),but there was no significant difference in the aspect of gender,age,BMI,distance between tumor and anal bor-der,TNM stage,intraoperative blood loss,the splenic free rate,prophylactic stoma rate,Length of specimen,maximum diameter of tumor,tissue typing,total lymph node count,D3 lymph node count,postoperative first exhaust time,days in hospital since surgery and anastomotic fistula rate(P>0. 05). Conclusion Low ligation of inferior mesenteric artery can shorten the operation time and signifi-cantly lessen unplanned bowel length and reduce postoperative risk of anastomotic leakage. All of these are beneficial to patients′post-operative recovery and have important clinical guiding value.

Objective To investigate the risk factors of prognosis of intermediate and advanced hepatocellular carcinoma(HCC)after TACE.Methods Totally 103 patients with intermediate and advanced HCC who underwent TACE as initial treatment were retrospectively enrolled,and extrahepatic metastasis(EHM)and overall survival(OS)after TACE during follow-up were recorded.Basic clinical information,laboratory and imaging examinations as well as TACE related data were analyzed with univariate and multivariate Cox regression analysis to screen the risk factors of EHM and OS after TACE in patients with intermediate and advanced HCC.Results One month after the first TACE,among 103 cases,objective remission was observed in 84 cases,while no response was noticed in 19 cases.During follow-up of 3-50 months(median of 16.9 months),EHM occurred in 34 cases,and 70 cases died.Before TACE α-fetoprotein(AFP)≥400 ng/ml(HR=3.451)and ineffective initial TACE(HR=3.049)were both independent risk factors for EHM in intermediate and advanced HCC after TACE(both P＜0.05).Before treatment alkaline phosphatase(ALP)≥100 U/L(HR=2.193),platelet to lymphocyte ratio(PLR)≥125(HR=1.737),liver function Child-Pugh stage B(HR=2.417)and EHM within 1 year after the initial TACE(HR=4.488)were all independent risk factors for OS(all P＜0.05).Conclusion Before treatment AFP≥400 ng/ml and ineffective initial TACE were both independent risk factors for EHM in intermediate and advanced HCC.Increased ALP and PLR,decreased liver function before TACE and early EHM after the initial TACE might shorten OS of patients with intermediate and advanced HCC.