Objective To compare the results of laparoscope and laparotomy total mesorectal excision(TME)with anal sphincter preservation in the treatment of low rectal cancer.Methods From January 2006 to June 2008,106 patients with low rectal cancer which the distance from the lowest margin of tumor to the dentate line ranged from 3.0 to 7.0 cm underwent TME with anal sphincter preservation.Among them,51 patients received laparoscope operation(laparoscope group)and the other 55 patients received laparotomy(laparotomy group)according to their wills.Results Two groups had no serious complications and death case.after surgery,the rate of sphincter preservation was 100%.Blood loss was(20.2±5.7)ml inlaparoscope group,which was significantly less than that in laparotomy group(P ＜ 0.01),aerofluxus,time to eat half-flow food and hospital stay were(2.4±0.6),(5.4±0.6)and(9.2±3.2)days respectively,which were significantly shorter than those in laparotomy group(P ＜ 0.01 or ＜ 0.05).Bowel function was back to normal in 35 patients of laparoscope group(68.6%)and 39 patients of laparotomy group(70.9%)within 1 month.All patients were followed-up from 6 to 36 months,there were no recurrence in situ local recurrence and mortality in the both groups.Conclusion Laparoscope TME with anal sphincter preservation can be achieved the same effect of oncological clearance,it is feasible and it is a minimal invasive and perspective technique with the benefits of much less blood loss during operation,higher rate of sphincter preservation,earlier return of bowel function and shorter hospitalization.

Objective To summarize the emergency treatment and nursing for patients with serious abdominal injury. Methods Preoperative emergency nursing care, postoperative intensive care, observation and nursing care of all kinds of complications were performed in 58 cases of patients with serious abdominal injury. Results 55 cases were rescued successfully, the success rate was 94.83%, 3 cases died, the death rate was 5.17%. 1 case died of hepatic failure, 2 cases died of hemorrhagic shock. Conclusions It's necessary to pay attention to preoperative emergency treatment for serious abdominal injury, preoperative monitoring of respiratory function, central venous pressure, urine volume and color and volume of the drainage fluid should be strengthened.

Objective To investigate the correlation between femoral popliteal artery stent fracture and in-stent restenosis (ISR) in patients with arteriosclerosis obliterans of superficial femoral artery and proximal popliteal artery after receiving stent implantation.Methods The clinical data of a total of 97 consecutive patients with arteriosclerosis obliterans of superficial femoral artery and proximal popliteal artery (107 diseased limbs in total),who were treated with primary stent implantation during the period from March 2012 to March 2016,were retrospectively analyzed.The imaging materials,including Doppler ultrasonography,plain radiography,contrast-enhanced CT scan,DSA,etc.were collected,and Kaplan-Meier survival analysis and other statistical analysis methods were used to analyze the related data.Results During the follow-up period,71 patients (72 limbs in total) developed ISR and the incidence of ISR was 67.3％ (72/107).The incidences of ISR in the stent-fracture group and non-fracture group were 84.2％ (32/38) and 58.0％ (40/69) respectively,the difference between the two groups was statistically significant (P=0.01).Conclusion After stent implantation of femoral popliteal artery,fracture of stent is one of the important risk factors for the occurrence of ISR.

Objective To evaluate the diagnostic accuracy of half-Fourier single-shot TSE MR cholangiopancreatography (HASTE-MRCP) of 0.5 T MR scanner, and to assess its imaging advantage and clinical value by comparing with 3D-TSE-MRCP MIP. Methods All 95 patients were examined by HASTE-MRCP and 3D-TSE-MRCP with respiratory-triggering (Philips 0.5 T T5-NT). The results, including anatomies and diseases, were evaluated after operation. Results By HASTE-MRCP, common bile ducts, 1-3 branches of hepatic ducts, gallbladder, and pancreatic ducts were demonstrated in 100.0%, 94.7%, 74.1%, and 63.2% of the cases. Stones, malignant diseases, and postoperative stenosis were revealed in 100.0% of the cases. Compared with 3D-TSE-MRCP, the demonstrating rates of 4-5 hepatic ducts,neck of the gallbladders,and calculi,especially mud calculi, were higher in HASTE-MRCP, and there was significant difference between the two ways. Stones displayed as low signal in the bile ducts. Block obstruction and mass contour were revealed in malignant diseases. Conclusion Comparing with 3D TSE-MRCP, HASTE-MRCP was better and faster, especially in serious patients or in cases with small and mud calculus.

ObjectiveTo investigate the safety and curative effect of common bile duct primary closure in laparoscopic and choledochoscopic choledocholithotomy.MethodsClinical data of 178 patients with choledocholithiasis diagnosed and treated in Chaozhou Central Hospital between January 2011 and December 2014 were retrospectively studied. Among the 178 patients, 83 were males and 95 were females with the average age of (46±3) years old. The informed consents of all patients were obtained and the local ethical committee approval had been received. All patients underwent laparoscopic and choledochoscopic choledocholithotomy and were divided into the primary closure group and the T-tube drainage group according to the different treatment for the incision of choledocholithotomy. The patients in the primary closure group underwent primary closure of common bile duct and the patients in the T-tube drainage group received T-tube drainage following choledocholithotomy. The operation duration, exhaust time, length of stay, hospitalization expenses and postoperative complication of two groups were observed. The observation indexes of two groups were compared usingt test or Chi-square test.ResultsThe patients in two groups completed choledocholithotomy successfully. The operation duration, exhaust time, length of stay, hospitalization expenses were respectively (119±18) min, (25±7) h, (6±1) d, (12 000±2 000) yuan in the primary closure group, and were respectively (136±20) min, (38±8) h, (10±1) d, (15 000±2 000) yuan in the T-tube drainage group. And significant difference was observed (t=2.38, 5.00, 7.21, 3.87;P<0.05). The incidence of postoprative complication in the primary closure group was 8%(3/37), which was signiifcantly lower than 12%(17/141) in the T-tube drainage geoup (χ2=3.28,P<0.05). In the primary closure group, 3 patients developed bile leakage and 1 developed incision infection. In the T-tube drainage group, 1 patient developed bile leakage, 5 gallbladder fossa hydrops, 11 incision infection and 10 adhesive intestinal obstruction. All patients recovered after symptomatic treatments.ConclusionCommon bile duct primary closure in laparoscopic and choledochoscopic choledocholithotomy is safe, effective and has the advantages of quick recovery, low costs and low complication incidence.