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 application value of indocyanine green (ICG) fluorescence imaging in lymphadenectomy of laparoscopic radical gastrectomy for gastric cancer.Methods The retrospective cohort study was conducted.The clinicopathological data of 702 patients with primary gastric cancer who underwent laparoscopic radical gastrectomy and D2 lymphadenectomy in the Fujian Medical University Uuion Hospital between April and December 2017 were collected.There were 517 males and 185 females,aged from 22 to 91 years,with an average age of 61 years.Of the 702 patients,39 using ICG fluorescence imaging in the surgery and 663 not using ICG fluorescence imaging were allocated into ICG group and non-ICG group,respectively.Observation indicators:(1) surgical situations and postoperative recovery;(2) postoperative complications;(3) average number of lymph node dissected and positive lymph nodes;(4) follow-up situations.The number of lymph node dissected in the first station (No.1-7 group) and second station (No.8-12 group) were analyzed respectively.Follow-up using outpatient examination and telephone interview was performed to detect complications of patients up to June 2018.Measurement data with normal distribution were represented as Mean±SD,comparison between groups was analyzed using the t test.Measurement data with skewed distribution were described as M (range),comparison between groups was analyzed using the Mann-Whitney U test.Count data were represented as absolute number or percentage,comparison between groups was analyzed using the chi-square test.Comparisons of ordinal data were analyzed by the Mann-Whitney U test.Results (1) Surgical situations and postoperative recovery:702 patients underwent successfully laparoscopic radical gastrectomy and D2 lymphadenectomy,without injuries of important vessels and adjacent organs,without combined multiple organs resection or conversion to open surgery.Of 39 patients in the ICG group,cases undergoing total radical gastrectomy,distal subtotal gastrectomy and proximal subtotal gastrectomy,cases with Roux-en-Y esophagojejunostomy,Billroth Ⅰ anastomosis,Billroth Ⅱ anastomosis,Roux-en-Y gastrojejunostomy and esophagogastric anastomosis,operation time,volume of intraoperative blood loss,time for out-of-bed activities,time to initial anal exsufflation,time to first fluid diet intake and duration of postoperative hospital stay were 21,16,2,21,3,13,2,0,(173±28) minutes,40 mL (range,5-200 mL),(2.1±0.6)days,(3.5±1.4)days,(4.8± 1.3)days,(8.6±3.6) days.The above indexes were 363,299,1,363,27,267,1,5,(174±41)minutes,50 mL(range,0-1 750 mL),(2.2±0.8)days,(3.4± 1.1) days,(4.6± 1.5) days,(9.4± 5.0) days in the non-ICG group.There were statistically significant differences in the surgical type and digestive reconstruction method (x2 =9.550,11.388,P＜ 0.05) and no statistically significant difference in the operation time,volume of intraoperative blood loss,time for out-of-bed activities,time to initial anal exsufflation,time to first fluid diet intake and duration of postoperative hospital stay (t =0.221,Z =-0.651,t =0.492,-0.826,-0.842,0.995,P＞0.05).(2) Postoperative complications:92 out of the 702 patients had postoperative complications,without death of complications.The incidence of complication was 15.38％(6/39) and 12.97％(86/663) in the ICG group and non-ICG group,with no statistically significant difference between the two groups (x2=0.188,P＞0.05).Six patients with complications (1 of Clavien-Dindo Ⅳ,2 of Clavien-Dindo Ⅲa,3 of Clavien-Dindo Ⅰ) in the ICG group and 86 (6 of Clavien-Dindo Ⅳ,16 of Clavien-Dindo Ⅲ,61 of Clavien-Dindo Ⅱ,3 of Clavien-Dindo Ⅰ) in the non-ICG group were cured after symptomatic treatment.(3) Average number of lymph node dissected and positive lymph nodes:the average number of lymph node dissected and positive lymph nodes was 37 (range,3-112) and 1 (range,0-68) of 702 patients,38 (range,24-70) and 2 (range,0-42) in the ICG group,37 (range,3-112) and 1 (range,0-68) in the non-ICG group,with no statistically significant difference between the two groups (Z=-1.454,-0.514,P＞0.05).Stratified analysis:the average number of No.1-7 group lymph nodes dissected and positive lymph nodes was 34 (range,16-67) and 2 (0-38) in the ICG group,33 (range,3-91) and 1 (range,0-56) in the non-ICG group.The average number of No.8-12 group lymph nodes dissected and positive lymph nodes was 11 (range,4-22) and 0 (range,0-13) in the ICG group,9 (range,0-31) and 0 (range,0-25) in the non-ICG group.There was a statistically significant difference in the average number of No.8-12 group lymph nodes dissected between the two groups (Z=-1.984,P＜0.05).There was no statistically significant difference in the average number of No.1-7 group lymph nodes dissected,positive No.1-7 group lymph nodes and the average number of positive No.8-12 group lymph nodes between the two groups (Z =-1.302,-0.463,-0.758,P＞0.05).(4) Follow-up situations:702 patients were followed up for 6-14 months,with a median time of 10 months.There was no readmission caused by postoperative complications in the two groups.Conclusion ICG fluorescence imaging in lymphadenectomy of laparoscopic radical gastrectomy for gastric cancer is beneficial to dissection of perigastric lymph nodes and increase number of lymph nodes dissected,but cannot increase operation time and incidence of postoperative complications.