Objective:To investigate the application value of mesocolon approach in transanal total mesorectal excision (TaTME).Methods:The retrospective cohort study was conducted. The clinicopathological data of 61 patients with middle or low rectal cancer who were admitted to the Nanchong Central Hospital of North Sichuan Medical College from January to December in 2018 were collected. There were 41 males and 20 females, aged from 43 to 81 years, with an average age of 62 years. Of the 61 patients, 30 patients undergoing TaTME with the conventional approach were allocated into traditional approach group, and 31 patients undergoing TaTME with mesocolon approach were allocated into mesocolon approach group. Observation indicators: (1) surgical situations; (2) postoperative recovery; (3) follow-up. Follow-up was conducted by outpatient examination and telephone interview once every 3 months to detect local recurrence and metastasis of tumors in patients up to June 2019. Measurement data with normal distribution were expressed as Mean± SD, and comparison between groups was conducted using the t test. Measurement data with skewed distribution were expressed as M (range), and comparison between groups was conducted using the Mann-Whitney U test. Count data were expressed as absolute numbers or percentages, and comparison between groups were analyzed using the chi-square test or Fisher exact probability. Comparison of ordinal data between groups was analyzed using the Mann-Whitney U test. Results:(1) Surgical situations: patients in the two groups underwent TaTME successfully, without conversion to laparotomy. The transabdominal operation time, volume of intraoperative blood loss, length of distal margin from surgical specimen, length of proximal margin from surgical specimen, cases with complete mesentery or with nearly complete mesentery ( the integrity of mesentery ), positive rate of circumferential margin, positive rate of distal margin, and the number of lymph node dissected of the traditional approach group were (126±56)minutes, 41.0 mL (range, 17.5-71.4 mL), 1.3 cm (range, 0.8-2.0 cm), (10.0±5.0)cm, 10, 20, 3.3%(1/30), 0, 13.7 (range, 9.0-17.0), respectively, versus (101±30)minutes, 44.0 mL (range, 25.0-67.5 mL), 1.6 cm (range, 1.1-2.2 cm), (12.0±3.0)cm, 23, 8, 6.5%(2/31), 0, 13.0 (range, 10.9-17.3) of the mesocolon approach group. There were significant differences in the transabdominal operation time, length of proximal margin from surgical specimen, and the integrity of mesentery between the two groups ( t=2.133, -2.286, χ2=10.250, P<0.05). There was no significant difference in the volume of intraoperative blood loss, length of distal margin from surgical specimen, or the number of lymph node dissected between the two groups ( Z=-0.662, -1.107, 0.304, P>0.05). There was also no significant difference in the positive rate of circumferential margin or positive rate of distal margin between the two groups ( P>0.05). (2) Postoperative recovery: the time to first anal flatus of the traditional approach group was 51 hours (range, 48-64 hours). There were 3 patients with complications in the traditional approach group. One patient in the traditional approach group had postoperative anastomotic fistula of Clavien-Dindo classification Ⅱ, and was cured after conservative treatment including sufficient drainage, parenteral nutrition and anti-infective treatment. One patient had chylous fistula of Clavien-Dindo classification Ⅱ, and was cured after conservative treatment. One patient had pulmonary infection of Clavien-Dindo classification Ⅳa, and was cured after treatment in ICU. The duration of postoperative hospital stay of the traditional approach group was (11.3±4.5)days. The time to first anal flatus of the mesocolon approach group was 59 hours (range, 49-70 hours). One patient in the mesocolon approach group had paralytic ileus of Clavien-Dindo classification Ⅰ, and was cured after conservative treatment. The duration of postoperative hospital stay of the mesocolon approach group was (9.6±1.8)days. There was no significant difference in the time to first anal flatus or duration of postoperative hospital stay between the two groups ( Z=-0.554, t=1.884, P>0.05). There was no significant difference in the complications between the two groups ( P>0.05). (3) Follow-up: 61 patients were followed up for 6-18 months, with a median time of 12 months. There was no local recurrence or metastasis of tumors in patients during the follow-up. Conclusion:The mesocolon approach is safe and feasible in TaTME, which abides by the principle of radical resection, and can decrease the difficulty of mesocolon excision, shorten the time of transabdominal operation, increase the length of proximal margin from tumor specimen, improve the integrity of mesentery.

Objective:To investigate the effect of adjuvant radiotherapy on the prognosis of patients with N 2 stage non-small cell lung cancer (NSCLC) undergoing radical resection. Methods:The data of 1 208 patients with NSCLC who received radical lung cancer resection combined with chemotherapy or post-operative adjuvant radiotherapy and chemotherapy from SEER database of the United States from 2004 to 2016 were included in the study. 627 patients received radical lung cancer resection combined with chemotherapy (surgery + chemotherapy group), and 581 patients received radical lung cancer resection combined with radiochemotherapy (surgery + radiochemotherapy group). We analyzed and compared the effect of postoperative adjuvant radiotherapy on the prognosis of patients with N 2 stage NSCLC undergoing radical resection. The 1∶1 propensity matching method was used to analyze the prognosis of the two groups. Results:In the two groups of patients with stage N 2 NSCLC included in the study, the median survival time was 51 months in the operation + radiotherapy and chemotherapy group, and the 3- and 5-year cancer specific survival rates were 58.3% and 44.9%, respectively. The median survival time was 50 months in operation + chemotherapy group, and the 3- and 5-year cancer specific survival rates were 59.9% and 46.5%, respectively. There was no statistically significant difference between the two groups in cancer specific survival ( P>0.05). The result of subgroup analysis showed that the cancer specific survival of patients in operation + radiotherapy and chemotherapy group was significantly worse than that in operation + chemotherapy group ( χ2=5.085, P<0.05). Multivariate Cox regression analysis showed that age, gender, G stage, T stage and the number of lymph node metastasis were the important factors affecting the cancer specific survival of patients with N 2 NSCLC ( Wald =15.236, 7.039, 4.841, 10.155, 11.192, respectively, P<0.05). After propensity matching, there was no statistically significant difference in cancer specific survival ( P>0.05) between the two groups. However, in the T 1 NSCLC patients, the cancer specific survival of operation + radiochemotherapy group was significantly worse than that of operation + chemotherapy group ( χ2=5.364, P<0.05), while the cancer specific survival of operation + radiochemotherapy group was significantly better than that of operation + chemotherapy group in T 3-4 subgroup( χ2=4.486, P<0.05). According to the tendency matching of pathological subgroups, the cancer specific survival of surgery + radiochemotherapy group was significantly better than that of surgery + chemotherapy group ( χ2=6.279, P<0.05) in the non adenocarcinoma subgroup. And the multivariate Cox regression analysis indicated that postoperative radiotherapy was an important factor for cancer specific survival in patients with N 2 non adenocarcinoma non-small cell lung cancer ( Wald=7.300, P<0.05). However, before and after propensity matching in lung adenocarcinoma subgroup, there was no statistically significant difference in cancer specific survival between the surgery + radiochemotherapy group and the surgery + chemotherapy group ( P>0.05). Conclusions:Postoperative adjuvant radiotherapy can improve the prognosis of patients with T 3-4 or non-adenocarcinoma N 2 NSCLC. But, for other patients with N 2 non-small cell lung cancer, the choice of postoperative adjuvant radiotherapy should be cautious, especially for T 1 stage.

Objective:To discuss the emergency nursing management procedure in Department of Microsurgery during novel coronavirus pneumonia(COVID-19) and evaluate the effect of the prevention and control procedures.Methods:From January, 20- February 20, 2020, in order to prevent the medical staff and patients from infection of COVID-19, prevention and control measures were put in place which included screening and diagnosis of emergency pa- tients at the Department of Emergency through check body temperature and lung CT scan, monitoring body temperature and finger blood oxygen saturation on all inpatients and their accompanies, confirming the diagnosis and quarantine the patients who were in high temperature with abnormal lung CT scans, disinfecting and summary disinfection of the quaran- tine wards where suspected patients stayed, training medical staff for personal protections, standardizing the use and man- agement of personal protection equipment (PPE), managing medical staff in wards, educating patient about the COVID-19 to relive their nervousness, etc.Results:Of the 4 patients with persistent fever, 2 were diagnosed as new coronavirus infection. Of the 2 COVID-19 patients, 1 had confirmed diagnosis and transferred, the other who with highly suspected COVID-19 was quarantined at home. All medical staffs were trained with COVID-19 prevention and control proce- dures, with a qualification rate at 100%. Fourty-eight medical staffs were put on front-line duty and the rest of 17 were put on standby. Apart from one medical staff had been infected at the early phase of COVID-19, no one was in- fected after the emergency management and protective measures were implemented. All medical devices were used strictly to follow the controlled procedures. All patient wore masks.Conclusion:During the COVID-19 epidemic, emergency management measures were taken to avoid cross infection in hospital, which ensured the safety of medical staff and patients. The COVID-19 prevention and control measures were practical, in time and effective.

Objective To investigate the influences of transitional care on early quality of life in esophageal cancer patients after surgery.Methods A total of 1 95 patients with esophageal cancer were randomly divided into control group (98 cases,regular follow-up)and observation group (97 cases,transitional care)according to random number table.And then,the readmission rate of 2 months post discharge was compared in patients between two groups.Besides,quality of life of patients was evaluated with the quality of life questionnaire core 30 (QLQ-C30)at discharge and 2 months after intervention.Results The readmission rate of 2 months post-discharge of observation group and control group were 5.2%,16.3% with a significant difference (χ2 =6.332,P =0.01 2).There were no statistically significant differences in the scores of functional items and symptom items of QLQ-C30 (P >0.05).After the interventions,the scores of general health,emotional function and social function in observation group were higher than those in control group;the scores of fatigue, pain,insomnia,difficult breathing,loss of appetite in observation group were lower than those in control group;there were statistically significant differences between two groups (P <0.05).Conclusions Transitional care can provide positive guidance for living condition of patients with esophageal cancer,improve patients′living condition so as to improve patients′early quality of life.

Objective To discuss influence of continuous collaboration care model (CCM) on postoperative function training effect of anal sphincter in patients with anus preserving surgery for low rectal cancer.Methods 86 cases with low rectal cancer treated by anus preserving surgery from July to December in 2013 were selected as control group,to whom routine nursing care was carried out.88 patients with low rectal cancer treated by anus preserving surgery from July to December in 2014 were selected as observation group,to whom continuous CCMwas implemented on the basis of routine nursing care in the control group.Defecation function and quality of life of patients in the two groups were compared 3 months and 6 months after the surgery.Results After 3 months of nursing intervention,81.8% of patients in the observation group had fine anal function,higher than the number in the control group,47.7%;after 6 months,the proportions of the two groups were 90.9% and 67.4% (χ2 =8.632,7.523;P <0.05).Physiological function,psychological function,social function,self-awareness of health and score of quality of life of patients in the observation group were all higher than those of the control group (t =5.264,4.635,4.265,4.145,3.958;P <0.01 ).Conclusions Implementation of continuous collaborative family care management can promote recovery of patients′defecation function and improve their quality of life.

OBJECTIVETo investigate the clinical effect of anastomosis of superficial veins for improving the drainage of perforator propeller flaps.

METHODSFrom Sept. 2011 to Dec. 2012, 11 cases with soft tissue defects and chronic ulcer wound at extremities were treated with adjacent perforator propeller flaps, which were pedicled by the peroneal artery(5 cases), or the lateral supramalleolar artery(3 cases), or the ulnar artery (2 cases), or the posterior interrosseous artery (1 case). The wound size ranged from from 3.0 cm x 2. 5 cm to 11. 0 cm x 4. 0 cm, and the falps size ranged from 6 cm x 3 cm to 21 em x 5 cm. One superficial vein in all the flaps was anastomosed with superficial vein in the recipient area. The blood supply of the flaps were recorded after operation 1 - 3 months after operation, the fluency of anastomosed vein was detected by color Doppler ultrasound. Flap swelling evaluations were performed in early 3 months and later 3 - 6 months, and the results were classified into 4 grading degrees. 6 months later, Questionnaire of the flap aesthetic satisfactory was performed for seven patients during follow-up period.

RESULTS9 flaps survived completely, two flaps had partial marginal skin necrosis in the distal end, which were both managed with surgical debridement, and both wounds healed in two months. 9 cases were followed up for more than 12 - 19 months. The early rsults of flap swelling evaluations were: I degree 0 case, II degree 8 cases, III degree 3 cases, IV degree 0 case, and the later results were: I degree 7 cases, II degree 4 cases, III degree 0 case, IV degree 0 case. The flaps had ideal appearance, good contour, and high aesthetic satisfactory (100%). The mean flap survival area rate of veins anastomosed was (98. 6 ± 9. 7) %.

CONCLUSIONSPerforator propeller flaps with anastomosis of superficial veins can improve the flap venous drainage, avoid transient venous venous congestion, so as to increase the flap survival. It is an effective way for improving the vein drainage.

Anastomosis, Surgical ; methods ; Debridement ; Extremities ; blood supply ; Graft Survival ; Humans ; Leg Ulcer ; pathology ; surgery ; Perforator Flap ; transplantation ; Regional Blood Flow ; Tibial Arteries ; Ulnar Artery ; Ultrasonography, Doppler, Color ; Veins ; surgery

Objective To investigate the methods and results of perforator pedicled flaps by anastomosis of superficial veins for reconstructing the extremity defects.Methods From February, 2012 to September, 2012, a total of 14 patients with traumatic skin and soft tissue and artery defects in extremities were repaired by perforator pedicled flaps anastomosed superficial veins with the recipient vessels.Fourteen flaps were based on five kinds of perforator arteries, the posterior interrosseous artery in 5 cases, the ulnar artery in 3 cases, the metacarpal artery in 2 cases, the peroneal artery in 3 cases, the lateral supramalleolar artery in 2 cases, the ulnar artery in 2 cases,and the posterior interrosseous artery in 1 case.After the operation, the blood supplies of flaps were observed severely,postoperative flap swelling were evaluated by edema level classification.After 1 month the blood flow of vein anastomosis were examed by color Doppler ultrasound.Questionnaire of the flap aesthetic satisfactory were performed during fellow-up periods.Results Twelve flaps were all survived well, 2 flaps had partial marginal skin necrosis in the distal, which was managed with surgical debridement, and wound healed in 1 month.Flap swelling were light, edema level classification were one degree in 4 cases,two degree in 10 cases postoperation 7 days, one degree in 11 cases and two degree in 3 cases, after 6 months.Color Doppler ultrasound examinations showed 9 vein anastomosises were all bypassed well.Eleven cases had 6-12 months' fellow-up periods.The flaps had like-like appearance, good contour, high aesthetic satisfactory.Conclusion Perforator pedicledr flaps by anastomosis of superficial veins can reduce the flap venous pressure obviously, avoid transientvenous venous congestion, improve the survival quality of the flap.It's a safe and effective method for soft tissue coverage of traumatic extremity wounds.

Objective To investigate the methods and results of lateral leg propeller pedicled flaps based on multi-perforators for coverage of soft-tissue defects on the foot and ankle.Methods From May,2012 to June,2013,8 patients with soft-tissue defects were treated,including 5 cases by trauma,2 cases by chronic unlcers,1 case by infection on the foot and ankle with exposed osseous and tendinous.Lateral leg propeller pedicled flaps based on multi-perforators were elevated and rotated with the angle from 150° to 180° for coverage of soft-tissue de-fects.Flap size ranged from 15.0 cm × 7.0 cm to 23.0 cm × 9.0 cm.Skin graft was applied to cover the donor sites.After the operation,the blood supplies of flaps were observed severely over 10 days.Questionnaire of the flap aesthetic satisfactory and AOFAS evaluation were performed in 7 patients during fellowed-up periods.Results Seven flaps were all survived well,1 flap had partial marginal skin necrosis on the distal,which was managed with surgical debridement,and wound healed in 1 month.Seven patients had a mean of 10.7 months' fellowed-up periods.The flaps had like-like appearance,good contour,and high aesthetic satisfactor (100％).The mean AOFAS score was 90.5.Conclusion Lateral leg propeller pedicled flaps based on multi-perforators can supply the blood of the larger volume of tissue,which can be safely sustained to repair distal and larger defects on the foot and ankle.

Objective To investigate the clinical application of neighboring digital artery flow-through flaps for one-staged skin coverage and revascularisation after severe finger injuries.Methods From May 2008 to July 2010,there were ischemic fingers had severe injuries,aged 19 to 52 years old,which were male in 5 cases,female in 2 cases,with skin and arterier defected.One-staged coverage and revascularisation of traumatised fingers were used with neighboring digital artery flow-through flaps.Functional exercise and physical therapy were done 3 weeks later.All cases had more than 12 months' fellowed-up periods.The sensibility testing,Questionnaire of the flap aesthetic satisfactory and TAM evaluations were all performed in all patients.All the results were measured and evaluated.Results All flaps survived completely and digit blood circulations were good in 7 patients.The flaps had good appearance and aesthetic satisfactory (100％).At 12 months after operations,the pain and touch perception reinnervated until 6 months and two-point discrimination testing were 6.1 to 9.6 mm,mean was (7.1 ± 1.3) mm,and the flap sensibility assessment were S3 * and TAM evaluation ratio were 0.81 ±0.16.Conclution Neighboring digital artery flap ideally suited as a thin and pliable flow-through flap in digital replantation/revascularization.It is helpful for salvage of the ischemic fingers after injury with skin and arteries defects.

OBJECTIVETo investigate the clinical application of flow-through deep inferior epigastric perforator flaps for reconstruction of large defects at the extremities.

METHODSThe deep inferior and superior epigastric arteries were designed as the axial vessel and the arterial supply to the flap was the paraumbilical perforator artery. Free deep inferior epigastric perforator flaps were harvested in flow- through manners to reconstruct associated arterial defect in the wound. The sensation assessment,Enneking score,and questionnaire of the flap aesthetic were all performed during follow-up period.

RESULTSFrom December 2011 to September 2012, 5 patients with large defects at extremities were treated. The deep inferior and superior epigastric arteries were designed as the axial vessel and the arterial supply to the flap was the paraumbilical perforator artery. The wound defects ranged form 11 cm x 5 cm to 30 cm x 11 cm. And the flap size ranged from 13 cm x7 cm to 33 cm x 13 cm. All flaps survived completely. The recipient arteries were all bypassed well documented by color Doppler examinations. All cases had 12-24 months' follow-up period. The flaps had good appearance and high aesthetic satisfactory(100%). 12 months after operations, sensation assessment were all S3+, and the Enneking score ratios were 82%-95% ,with 87.2% in average.

CONCLUSIONSFlow-through deep inferior epigastric perforator flaps are reliable and effective for reconstruction of large defects at the extremities with maintenance of the vascular status of the extremities. The flaps can also be designed in transverse or oblique mode for clinical application.

Aged ; Arteries ; Epigastric Arteries ; Esthetics ; Extremities ; blood supply ; surgery ; Humans ; Leg Injuries ; surgery ; Perforator Flap ; blood supply ; Reconstructive Surgical Procedures