Objective To evaluate perioperative portal hemodynamic alterations in cirrhotic patients undergoing subtotal splenectomy,podicled spleen remnant retroperitoneal transplantation plus lower esophagus transection in the treatment of portal hypertension.Method Forty patients with cirrhotic portal hypertension were randomly allocated into 2 groups:splenic transplantation group (n = 20),in which patients underwent subtotal splenectomy with pedicled remnant spleen retroperitoneal transplantation and cardia-esophageal devascularization and transection,and control group (n = 20),in which splenectomy and cardia-esophageal devascularization and transection were performed.The cross section area,blood velocity and flow and collateral circulation of portal parameters were comparatively evaluated by 3D DEC MRA,and the size of remnant spleen,blood flow and collateral circulation of retroperitoneal transplanted spleen were comparatively assessed.Results At 6-month after operation,the disappearance of esophageal-gastric varices in two groups was similar,and the cross section areas of main portal vein (MPV) in two groups all decreased postoperatively,in study group it was (1.81±0.73) cm~2 vs.(1.20±0.52) cm~2,P ＜ 0.01;in control group it was (1.78±0.52) cm~2 vs.(1.30±0.12) cm~2,p ＜0.01.The mean blood velocity of MPV decreased postoperatively,in study group it was (9.86±0.10) cm/s vs.(7.06±1.92) cm/s,P ＜0.01;In control group it was (10.0 ±0.6)cm/s vs.(8.2±2.4) cm/s,P ＜0.01.The mean blood flow velocity of MPV in study group was lower postoperatively than that in control group(P＜0.01).The mean blood flow volume of MPV decreased postoperatively from (15.0±1.9) ml/s to (10.5 ±2.7)ml/s,P ＜0.01 in study group;and from (14.9±2.1) ml/s to (11.6±2.1) ml/s,P ＜ 0.01 in control group.The mean blood flow volume of MPV in study group was lower postoperatively than that in control group(P＜0.05).A significant collateral formation was observed around the retroperitoneally translocated pedicled remnant spleen.Conclusions Compared with splenectomy,subtotal splenectomy,retroperitoneal translocation of the pedicled remnant speen helps to preserve splenic function as well as to increase retroperitoneal collateral formation which is conducive to further decreasing the portal veinous pressure.

Objective To evaluate early diagnosis by gastroscopy for the causes of gastroduodenal perforation after successful non-surgical treatment.Method Gastroduodenal perforation patients suspected of benign ulcer in origin on hospital admission undergoing successful non-surgical treatment were examined by gastroscopy within days after the closure.Results Among 284 patients undergoing gastroscopy,277 cases (97.5％) were diagnosed as gastroduodenal ulcer,3 cases (1.1％) as gastric carcinoma,1 case (0.4％) of duodenal diverticulum.There were not major complications developing after gastroscopy.Conclusion Early gastroscopy performed after closure by non-surgical treatment in gastroduodenal perforation patients is safe,helping make definite diagnosis for the cause of perforation.

Objective:To investigate the reasons of anastomotic leakage following learning curve by laparoscopic anterior resection of rectal cancer.Methods:From December,2011 to March,2015,the clinical information of 179 patients in our hospital who underwent dixon of rectal cancer were collected.The patients were divided into a laparoscopic learning group,a laparotomy group and a laparoscopic group,The reasons of anastomotic leakage for each group were comparatively analyzed.Repeated cutting of anastomotic stoma was compared between the laparoscopic learning group and the laparoscopic group.The male,age,obesity,nutrition complications and the position of anastomotic stoma were compared among the 3 groups.Results:The rate of anastomotic leakage in the laparoscopic learning group was significantly higher than that in the laparotomy group and the laparoscopic group (P＜0.05).Repeated cutting was a significant risk factor in the laparoscopic learning group (P＜0.05),but not in the laparoscopic group.Except obesity,the four factors were significant risk factors in the laparoscopic learning group (P＜0.05).All of the five factors were not the significant risk factors in the laparotomy group and the laparoscopic group (P＞0.05).Conclusion:The operation technical shortcoming is the major factor in the learning of the laparoscopic anterior resection of rectal cancer.In order to reduce the rate of anastomotic leakage in the learning curve period,the selection of patients following the laparoscopic anterior resection of rectal cancer should avoid the following factors:male,older age,the low position of the tumor and the nutrition complications.

Objective To investigate the effect of section of pancreatic envelope combined with vacuum sealing drainage under laparoscopy on inflammatory mediators of patients with early severe acute pancreatitis (SAP). Methods Forty-two SAP patients were admitted to Foshan Hospital of Traditional Chinese Medicine in Guangdong Province from January 2008 to December 2016. That 22 patients underwent pancreatic membrane incision and vacuum sealing drainage under laparoscopy was in the experimental group, and that 20 patients underwent the routine pancreatic membrane incision and double tube drainage was in the control group. The venous blood was collected, the levels of C-reactive protein (CRP), interleukin-6 (IL-6) and tumor necrosis factor-α (TNF-α) were measured before and after operation for 1, 3, 7 and 14 days, and the clinical therapeutic effects were observed in the two groups. Results With the prolongation of therapy, the levels of CRP, IL-6 and TNF-α were decreased continuously in both groups, the degrees of decrease of above indexes in experimental group were more significant than those in the control group, and the differences in these indexes between the two groups were statistically significant [CRP (mg/L): 1 day was 203.80±25.12 vs. 271.79±60.41, 3 day was 117.26±19.70 vs. 174.53±42.37; IL-6 (ng/L): 1 day was 40.63±3.38 vs. 57.10±11.46, 3 days was 23.14±3.51 vs. 46.87±10.69; TNF-α (ng/L): 1 day was 23.91±10.42 vs. 36.73±15.90, 3 days was 19.13±8.34 vs. 32.58±15.81, all P < 0.05]. There were no statistical significant differences in the levels of above indexes on 7 days and 14 days after treatment between the two groups (all P > 0.05). The therapeutic efficacy of the experimental group was significantly higher than that of the control group [95.45% (21/22) vs. 90.0% (18/20), P < 0.05]. Conclusion Under laparoscopy, pancreatic envelope incision combined with vacuum sealing drainage performed for early SAP patients can control the body inflammation more rapidly, reduce complications and shorten the disease course.