Discipline construction is an important part of the high-quality development of public hospitals.Under the current single multi-district development trend of public hospitals,it is necessary to layout disciplines in a scientific and systematic way to realize the coordinated development of each district at the geographical and functional levels.From the perspective of top-level design of multi-district discipline layout and practical exploration of Ruijin Hospital affiliated to Shanghai Jiaotong University School of Medicine,it is proposed to clarify the functional orientation of the hospital districts from the perspective of the concept of running the hospital,national tasks and social needs.To achieve the high-quality development of the discipline and the continuous upgrading and innovation of public hospitals,it is also suggested to clarify the current situation of the discipline and determine the classified development direction by constructing a systematic disciplinary evaluation model.The transformation of scientific and technological achievements is a breakthrough to cultivate new momentum for the development of the hospital district,so as to realise the high-quality development of disciplines and the continuous upgrading and innovation of the functions of the hospital district.

Discipline construction is an important part of the high-quality development of public hospitals.Under the current single multi-district development trend of public hospitals,it is necessary to layout disciplines in a scientific and systematic way to realize the coordinated development of each district at the geographical and functional levels.From the perspective of top-level design of multi-district discipline layout and practical exploration of Ruijin Hospital affiliated to Shanghai Jiaotong University School of Medicine,it is proposed to clarify the functional orientation of the hospital districts from the perspective of the concept of running the hospital,national tasks and social needs.To achieve the high-quality development of the discipline and the continuous upgrading and innovation of public hospitals,it is also suggested to clarify the current situation of the discipline and determine the classified development direction by constructing a systematic disciplinary evaluation model.The transformation of scientific and technological achievements is a breakthrough to cultivate new momentum for the development of the hospital district,so as to realise the high-quality development of disciplines and the continuous upgrading and innovation of the functions of the hospital district.

Discipline construction is an important part of the high-quality development of public hospitals.Under the current single multi-district development trend of public hospitals,it is necessary to layout disciplines in a scientific and systematic way to realize the coordinated development of each district at the geographical and functional levels.From the perspective of top-level design of multi-district discipline layout and practical exploration of Ruijin Hospital affiliated to Shanghai Jiaotong University School of Medicine,it is proposed to clarify the functional orientation of the hospital districts from the perspective of the concept of running the hospital,national tasks and social needs.To achieve the high-quality development of the discipline and the continuous upgrading and innovation of public hospitals,it is also suggested to clarify the current situation of the discipline and determine the classified development direction by constructing a systematic disciplinary evaluation model.The transformation of scientific and technological achievements is a breakthrough to cultivate new momentum for the development of the hospital district,so as to realise the high-quality development of disciplines and the continuous upgrading and innovation of the functions of the hospital district.

Discipline construction is an important part of the high-quality development of public hospitals.Under the current single multi-district development trend of public hospitals,it is necessary to layout disciplines in a scientific and systematic way to realize the coordinated development of each district at the geographical and functional levels.From the perspective of top-level design of multi-district discipline layout and practical exploration of Ruijin Hospital affiliated to Shanghai Jiaotong University School of Medicine,it is proposed to clarify the functional orientation of the hospital districts from the perspective of the concept of running the hospital,national tasks and social needs.To achieve the high-quality development of the discipline and the continuous upgrading and innovation of public hospitals,it is also suggested to clarify the current situation of the discipline and determine the classified development direction by constructing a systematic disciplinary evaluation model.The transformation of scientific and technological achievements is a breakthrough to cultivate new momentum for the development of the hospital district,so as to realise the high-quality development of disciplines and the continuous upgrading and innovation of the functions of the hospital district.

Discipline construction is an important part of the high-quality development of public hospitals.Under the current single multi-district development trend of public hospitals,it is necessary to layout disciplines in a scientific and systematic way to realize the coordinated development of each district at the geographical and functional levels.From the perspective of top-level design of multi-district discipline layout and practical exploration of Ruijin Hospital affiliated to Shanghai Jiaotong University School of Medicine,it is proposed to clarify the functional orientation of the hospital districts from the perspective of the concept of running the hospital,national tasks and social needs.To achieve the high-quality development of the discipline and the continuous upgrading and innovation of public hospitals,it is also suggested to clarify the current situation of the discipline and determine the classified development direction by constructing a systematic disciplinary evaluation model.The transformation of scientific and technological achievements is a breakthrough to cultivate new momentum for the development of the hospital district,so as to realise the high-quality development of disciplines and the continuous upgrading and innovation of the functions of the hospital district.

Discipline construction is an important part of the high-quality development of public hospitals.Under the current single multi-district development trend of public hospitals,it is necessary to layout disciplines in a scientific and systematic way to realize the coordinated development of each district at the geographical and functional levels.From the perspective of top-level design of multi-district discipline layout and practical exploration of Ruijin Hospital affiliated to Shanghai Jiaotong University School of Medicine,it is proposed to clarify the functional orientation of the hospital districts from the perspective of the concept of running the hospital,national tasks and social needs.To achieve the high-quality development of the discipline and the continuous upgrading and innovation of public hospitals,it is also suggested to clarify the current situation of the discipline and determine the classified development direction by constructing a systematic disciplinary evaluation model.The transformation of scientific and technological achievements is a breakthrough to cultivate new momentum for the development of the hospital district,so as to realise the high-quality development of disciplines and the continuous upgrading and innovation of the functions of the hospital district.

Discipline construction is an important part of the high-quality development of public hospitals.Under the current single multi-district development trend of public hospitals,it is necessary to layout disciplines in a scientific and systematic way to realize the coordinated development of each district at the geographical and functional levels.From the perspective of top-level design of multi-district discipline layout and practical exploration of Ruijin Hospital affiliated to Shanghai Jiaotong University School of Medicine,it is proposed to clarify the functional orientation of the hospital districts from the perspective of the concept of running the hospital,national tasks and social needs.To achieve the high-quality development of the discipline and the continuous upgrading and innovation of public hospitals,it is also suggested to clarify the current situation of the discipline and determine the classified development direction by constructing a systematic disciplinary evaluation model.The transformation of scientific and technological achievements is a breakthrough to cultivate new momentum for the development of the hospital district,so as to realise the high-quality development of disciplines and the continuous upgrading and innovation of the functions of the hospital district.

Discipline construction is an important part of the high-quality development of public hospitals.Under the current single multi-district development trend of public hospitals,it is necessary to layout disciplines in a scientific and systematic way to realize the coordinated development of each district at the geographical and functional levels.From the perspective of top-level design of multi-district discipline layout and practical exploration of Ruijin Hospital affiliated to Shanghai Jiaotong University School of Medicine,it is proposed to clarify the functional orientation of the hospital districts from the perspective of the concept of running the hospital,national tasks and social needs.To achieve the high-quality development of the discipline and the continuous upgrading and innovation of public hospitals,it is also suggested to clarify the current situation of the discipline and determine the classified development direction by constructing a systematic disciplinary evaluation model.The transformation of scientific and technological achievements is a breakthrough to cultivate new momentum for the development of the hospital district,so as to realise the high-quality development of disciplines and the continuous upgrading and innovation of the functions of the hospital district.

Objective: To investigate the clinical efficacy of Da Vinci robotic total gastrectomy combined with spleen-preserving splenic hilar lymphadenectomy for gastric cancer. Methods: The retrospective cross-sectional study was conducted. The clinicopathological data of 47 patients with gastric cancer who were admitted to Fujian Medical University Union Hospital from September 2016 to June 2018 were collected. There were 37 males and 10 females, aged from 23 to 75 years, with an average age of 60 years. Patients underwent Da Vinci robotic total gastrectomy combined with spleen-preserving splenic hilar lymphadenectomy. Observation indicators: (1) intraoperative situations; (2) postoperative situations; (3) postoperative pathological examination; (4) follow-up. Follow-up was conducted by outpatient examination and telephone interview to detect postoperative survival of patients up to September 2018. Measurement data with normal distribution were represented as Mean±SD, and measurement data with skewed distribution were expressed by M (range). Count data were represented as absolute numbers. Results: (1) Intraoperative situations: 47 patients underwent Da Vinci robotic total gastrectomy combined with spleen-preserving splenic hilar lymphadenectomy for gastric cancer, without conversion to open surgery. The operation time, hilar lymph node dissection time, volume of intraoperative blood loss, number of lymph node dissected, number of splenic hilar lymph node dissected, number of metastatic lymph nodes, number of metastatic splenic hilar lymph node were (225±36) minutes, (20±6) minutes, (40±27) mL, 40 (range, 17-112), 2 (range, 0-10), 2 (range, 0-29), 0 (range, 0-3). (2) Postoperative situations: time to first out-of-bed activities, time to first anal flatus, time to gastric tube removal, time to initial liquid diet intake, time to initial semi-liquid diet intake, time to drainage tube removal, and duration of postoperative hospital stay were (2.0±0.3)days, (3.4±0.9)days, (3.4±1.1)days, (4.8±1.0)days, (6.7±1.5)days, (8.5±2.5)days, and (12.0±8.3)days, respectively. Of 47 patients, 3, 2, 1, 1, and 1 were detected pulmonary infection, abdominal bleeding, anastomotic fistula, postoperative intestinal obstruction, and abdominal infection. There were 1, 5, and 2 patients with complications in grade Ⅰ, Ⅱ, and Ⅲ of Clavien-Dindo classification. There was no death in the postoperative 30 days. Two patients with abdominal bleeding were cured by intervene therapy, and patients with other complications were cured by conservative treatment. (3) Postoperative pathological examination: tumor diameter, cases with nodal or vascular or neural invasion, cases with differentiated and undifferentiated tumor (histological differentiation), cases in T1, T2, T3, T4 stages (T staging), cases in N0, N1, N2, N3 stages (N staging), cases in Ⅰ, Ⅱ, Ⅲ stages (TNM staging) were (4.2±1.6)cm, 26, 31, 16, 5, 22, 17, 3, 18, 9, 8, 12, 13, 20, 14, respectively. (4) Follow-up: 47 patients were followed up for 3-25 months, with a median time of 9 months. During the follow-up, 3 of 47 patients died of tumor recurrence, 1 had tumor-bearing survival, and 43 had tumor-free survival. Conclusion Da Vinci robotic total gastrectomy combined with spleen-preserving splenic hilar lymphadenectomy for gastric cancer is safe and feasible.

Objective To investigate the development trend,safety and clinical effects of laparoscopic radical gastrectomy (LRG) for gastric cancer.Methods The retrospective and descriptive study was conducted.The clinicopathological data of 4 435 patients with gastric cancer who underwent LRG in the Fujian Medical University Union Hospital between January 2008 and December 2017 were collected.There were 3 263 males and 1 172 females,aged (61±11)years,with a range of 12-93 years.According to the operation time,4 435 patients were divided into two periods,including 1 588 patients of the early period (2008-2012) and 2 847 patients of the later period (2013-2017).Observation indicators:(1) the clinicopathological data of patients;(2) intraoperative and postoperative situations;(3) postoperative complications;(4) follow-up and survival situations.Follow-up using outpatient examination,visit to home,mail and telephone interview was performed to detect survival of patients once every 3 months within 2 years postoperatively and once every 6 months after 2 years postoperatively up to June 2018.Survival time was from operation time to the last follow-up,death or deadline of follow-up database such as loss to follow-up or death of other diseases.Measurement data with normal distribution were represented as Mean±SD,and comparison between groups was analyzed by the t test.Measurement data with skewed distribution were represented as M (range).Count data were described as frequency or percentage,comparison between groups was analyzed using the chi-square test.Linear analysis was done using the unitary linear regression.The survival rate and survival curve were respectively calculated and drawn by the Kaplan-Meier method,and Log-rank test was used for survival analysis.Results (1) The clinicopathological data of patients:there were 3 263 males and 1 172 females of the 4 435 patients,accounting for 73.574％(3 263/4 435) and 26.426％ (1 172/4 435),respectively.TNM staging of the 4 435 patients:1 133 cases were detected early gastric cancer (T1 stage) and 3 302 cases were detected advanced gastric cancer including 518,1 431,1 353 in T2,T3 and T4a stages respectively.Linear regression analysis showed a linear correlation between the cases of LRG and operation year (R2 =0.911,P＜0.05) and a gradually increasing in cases of LRG.The sex (male),cases with tumor at upper stomach,middle stomach,lower stomach,＞ 2 regions (tumor location),tumor diameter,cases with undifferentiated and differentiated tumor (pathological types),cases in pT1,pT2,pT3,pT4a stages (pT staging),in pN0,pN1,pN2,pN3a,pN3b stages (pN staging),in Ⅰ A,Ⅰ B,Ⅱ A,Ⅱ B,ⅢA,ⅢB,ⅢC stages (pTNM staging) were 1 204,383,302,714,189,(4.8±2.7)cm,361,1 227,382,193,418,595,588,212,255,318,215,325,137,150,172,253,267,284 in patients of the early period,and 2 059,807,530,1 128,382,(4.3±2.6) cm,976,1 871,751,325,1 013,758,1 138,444,505,486,274,616,258,378,322,528,443,302 in patients of the later period,with statistically significant differences between patients of the two periods (x2 =6.411,15.699,t =10.946,x2 =57.801,90.437,26.502,98.773,P＜0.05).(2) Intraoperative and postoperative situations:the volume of intraoperative blood loss,cases with intraoperative blood transfusion,cases with Billroth Ⅰ,Billroth Ⅱ,residual stomach Roux-en-Y anastomosis,esophagogastric anastomosis,esophageal Roux-en-Y anastomosis of digestive tract reconstruction,number of lymph nodes dissected,time for initial fluid diet intake,time for initial semi-fluid diet intake,duration of postoperative hospital stay were (120±75)mL,38,599,122,0,32,835,32±13,(4.5±l.7)days,(8.6±2.5)days,(13.0± 7.3) days in patients of the early period,(104±68)mL,17,441,673,21,18,1 694,37±15,(4.1± 1.5)days,(7.9±2.8) days,(12.3±7.6) days in patients of the later period,showing statistically significant differences between patients of the two periods (t=2.169,x2 =26.843,397.185,t=-10.764,2.125,3.347,2.779,P＜0.05).Further linear regression analysis showed a linear correlation between the average number of lymph nodes dissected and operation year (R2=0.826,P＜0.05) and a gradually increasing in average number of lymph nodes dissected.(3) Postoperative complications:690 of 4 435 patients had postoperative complications,with an incidence rate of 15.558％ (690/4 435),including 242 patients of the early period and 448 of the later period,showing no statistically significant difference (x2 =0.191,P ＞ 0.05).Eight patients died of severe postoperative complications,with a death rate of 0.180％ (8/4 435),including 5 of the early period and 3 of the later period,showing no statistically significant difference (x2 =2.485,P＞0.05).Of 4 435 patients,561 had stage Ⅰ-Ⅱ complications,with an incidence rate of 12.649％ (561/4 435),129 had stage Ⅲ-Ⅳ complications,with an incidence rate of 2.909％(129/4 435).There were 196 and 46 patients of the early period with stage Ⅰ-Ⅱ complications and stage Ⅲ-Ⅳ complications,365 and 83 of the later period with stage Ⅰ-Ⅱ complications and stage Ⅲ-Ⅳ complications,showing no statistically significant difference between patients of the two periods (x2 =0.211,0.001,P＞0.05).(4) Follow-up and survival situations:4 250 of 4 435 patients including 1 465 of the early period and 2 785 of the later period were followed up for 1-123 months,with a median time of 37 months.The 5-year cumulative survival rate was 63.9％.The 5-year cumulative survival rate was 91.8％,80.2％ and 39.5％ in the stage Ⅰ,Ⅱ,Ⅲ patients,respectively,showing a statistically significant difference (x2 =810.146,P＜0.05).The 5-year cumulative survival rate was 60.8％ and 66.7％ in patients of the early and later period,respectively with a statistically significant difference (x2 =17.887,P＜0.05).Stratified analysis of TNM staging:the 5-year cumulative survival rates of stage Ⅰ A,Ⅰ B,Ⅱ A,Ⅱ B,Ⅲ A,Ⅲ B,Ⅲ C patients in the early period were 92.7％,85.6％,79.4％,74.5％,58.1％,37.6％,18.9％ and 95.6％,90.4％,87.6％,79.5％,52.7％,41.2％,19.5％ in patients of the later period,with no statistically significant difference (x2 =0.414,2.575,2.872,2.119,0.632,0.972,2.212,P＞0.05).Conclusions Surgical volume of the LRG has shown an increasing trend year by year,and the number of lymph nodes dissected and postoperative recovery of patients are improving.LRG is a safe procedure with acceptable clinical efficacy for gastric cancer.