Objective To explore the efficacy of surgery in the treatment of hepatolithiasis .Methods The clinical data of 98 patients with hepatolithiasis treated with different surgical procedures were retrospectively anan -lyzed,there were 91 cases transhepatic cholangiolithotomy treatment and 7 cases hepatolobectomy .Results 25 cases were found residual stone after operation .Recurrence calculus(10 cases),liver abscess(2 cases),and complicated by bile duct carcinoma(4cases) were found in following -up.2 cases were dead.The total effective rate was 97.96%. Conclusion Correct operation methods of calculus of intrahepatic duct was the key of reduction residual stone after operation.Resection extra-lateral lobe and choledchoscope are main means of reduction residual stone after opera -tion.

Objective To explore the effect of surgical management of left colon cancer with acute obstruction.Methods A retrospective analysis was made on the clinical data of 85 cases with acute obstructive colorectal carcinoma treated by one-stage resection.Among the 85 cases,there were 48 cases of left colon obstruction (treatment group),and the control group included 37 cases of right colon cancer.To compare the occurrence of postoperative complications.Results 20 cases had postoperative complication in the treatment group,among which,2 cases had anastomosis fistula,4 cases of pulmonary infection,5 cases of abdominal abscess,6 cases of incision infection and 3 cases of intestinal adhesion.In control group,there were 15 cases had complication,among which,1 case had anastomosis fistula,3 cases of pulmonary infection,3 cases of abdominal abscess,5 cases of incision infection and 3 cases of intestinal adhesion.There was no significant difference in incidence rate of complication between two groups (P ＞ 0.05).Conclusion One stage resection in the treatment of left colon cancer with acute obstruction is safe and feasible.

Objective To explore the levels of leptin(LEP) and soluble leptin receptor (sOB‐R) in breast cancer patients′ser‐um ,and to discuss the relationship between LEP ,sOB‐R ,free leptin index(FLI) and the patients′clinical pathologic features .Meth‐ods 70 serum specimens of breast cancer patients who confirmed by pathological diagnosis were collected before the surgery ,the serum of benign breast disease group(n=50) and normal group(n=50) were also collected as control .The levels of LEP and sOB‐Rinserumweredetected,andtheresultafterbodymassindex(BMI)correctionwereanalyzed.Finally,therelationshipbetweenthe expression of LEP ,sOB‐R and clinical pathologic features were analyzed .Results The serum level of LEP in breast cancer group was highly increased than the other two groups (P<0 .05) ,and sOB‐R was reduced(P<0 .05) .After BMI correction ,LEP was still highly increased(P<0 .05) ,but sOB‐R was no significant difference (P>0 .05) .The level of LEP in the postmenopausal breast cancer patients were highly increased than menopause patients (P>0 .05) ,and the expression of LEP in cancer group were signifi‐cant higher than two control groups by both postmenopausal and menopause (P>0 .05) .The result suggested the serum level of LEP and FLI are associated with pTNM stages and lymph node metastases (P<0 .05) ,and elevated level of LEP in postmenopausal patients had differences in pTNM stages and lymph node metastases (P< 0 .05) .Conclusion The serum LEP level and the FLI may be potential indicators to evaluate the prognosis of the patient with breast cancer .The serum LEP may promoted the process of the postmenopausal patients of breast cancer .

Objective To compare the influence of laparoscopic inguinal hernia repair ( TAPP) and open inguinal hernia repair(Lichtenstein) on clinical serum swelling and the prevention and treatment strategy.Methods From September 2015 to September 2016,117 patients with inguinal hernia in the Second People's Hospital of Shantou were selected.The patients were divided into TAPP group and Lichtenstein group according to the operation mode .The incidence of seroma,occurrence,characteristics and diagnosis and treatment of the two groups were compared.Results There were 64 cases in the TAPP group,aged 25-73 years old,the median age was 57 years,58 cases of indirect inguinal hernia,4 cases of direct hernia ,2 cases of femoral hernia ,3 cases of refractory hernia.There were 53 cases in the Lichtenstein group,aged 24-84 years old,the median age was 63 years,41 cases of indirect inguinal hernia , 10 cases of direct hernia,2 cases of femoral hernia ,7 cases of refractory hernia.There was no statistically significant difference in the incidence rate of seroma between the two groups (P＝0.875).There were no statistically significant differences in the incidence rate of different types of seroma (all P＞0.05).There was no need for treatment of 0-II type seroma.The type III -IVa clinical seroma could be given local puncture parallel compression treatment , improved after treatment.After drainage and anti -inflammatory treatment, type IVb seroma was improved. Conclusion There is no difference in the incidence of seroma and the treatment between the two surgical procedures after inguinal hernia repair.

The construction of a countywide community for medical and health services is designed to upgrade the service capacity of primary medical and health institutions, to promote resource sharing and collaborative services, and promote the hierarchical medical system. Huzhou of Zhejiang province has launched its initiative in building a countywide community for medical services since 2018. The authors summarized its main practices in promoting the integration of the management system and optimizing operating mechanism of countywide medical and health institutions, promoting the reform of the county medical and health governance system, as well as the achievements and shortcomings, with a view to providing reference for promoting the high-quality development of the countywide medical and health service system.