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.

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.

Air Force Medical University has constructed an integrated clinical diagnosis curriculum system for undergraduate students based on military medical service and established the teaching methods of diagnostic evidence orientation, diagnostic method guidance, and diagnosed case practice. In the context of the new epidemic situation, we have also formed the blended teaching model of "triad training" and "four methods", optimized the teaching process of theory and practice, incorporated the contents of military medicine, determined the teaching objectives of this curriculum system at the three levels of knowledge, ability, and quality, completed the construction of the core curriculum, and applied it to the teaching practice. This curriculum system has achieved significant improvements in the degree of satisfaction among teachers and students and the excellent rate of military medical skill examination, which better meets the practical needs of medical service personnel training in air force.