Objective:To evaluate internal fixation via only the modified Stoppa approach in the treatment of central hip dislocation complicated with fracture of the posterior acetabular wall.Methods:A retrospective study was conducted in the 13 patients with central hip dislocation and fracture of the posterior acetabular wall who had been treated at Department of Orthopedic Trauma, Nanfang Hospital between February 2015 and February 2018. They were 10 men and 3 women, aged from 31 to 65 years (average, 46.7 years). All patients were treated with internal fixation via only the modified Stoppa approach. The reduction of double-column and posterior wall fractures was evaluated according to the X-ray Matta scoring system, as well as to the Wiberg central-edge (CE) angles between the vertical line of the center point of the femoral head and the lateral edge of the acetabulum and acetabular tolerance on the normal and affected sides immediately after operation; the hip function was evaluated by the modified Merle d'Aubigne and Postel scoring system at 12 months after operation.Results:All patients were followed up for 16 to 52 months (average, 25.6 months). In all of them, reduction and fixation of central hip dislocation and acetabular fracture was completed successfully, and indirect reduction of posterior wall fracture and acetabular tolerance were satisfactory. Operation time ranged from 130 to 270 min, averaging 155.5 min; intraoperative blood loss from 600 to 5,600 mL, averaging 1,150.5 mL; intraoperative infusion of concentrated red blood cells from 2 to 12 U, averaging 6 U. By the X-ray Matta scoring system immediately after operation, anatomical reduction was achieved in 4 posterior wall fractures and satisfactory reduction in 9 ones. There was no significant difference between the normal and affected sides in the CE angle (43.53°±3.46° for the affected side versus 43.19°±3.28° for the normal side) or in the acetabular tolerance (76.56%±15.50% for the affected side versus 75.32%±16.24% for the normal side) ( P>0.05). The modified Merle d'Aubigne and Postel scores at 12 months after operation ranged from 12 to 18 points, averaging 16.5 points; the hip function was assessed as excellent in 9 cases, as good in 3 and as fair in one. By the last follow-up, none of the 13 patients lost fracture reduction, and their internal fixation was firm with no loosening or breakage. Conclusion:In the treatment of central hip dislocation complicated with fracture of the posterior acetabular wall, internal fixation via only the modified Stoppa approach can lead to satisfactory fracture reduction, firm fixation, good hip joint tolerance, and fine clinical efficacy.

Objective:To explore the clinical value of laparoscopic abdominoperineal resection(LAPR) with pelvic peritoneum closure for patients with low rectal cancer.Methods:The clinicopathological data of 90 patients with low rectal cancer who underwent laparoscopic abdominoperineal resection from Mar 2014 to Jan 2019 at the Subei People's Hospital of Jiangsu Province were retrospectively analyzed. These patients were divided into closed pelvic floor peritoneum group (study group, n=42) and without pelvic floor peritoneum group (control group, n=48) . Results:The postoperative hospital stay of the study group was shorter than that of the control group[(10.8±3.0) d vs. (12.4±3.1) d, t=2.569, P=0.013]. There was no statistically significant difference in the operation time , intraoperative blood loss , time to first flatus ,first time of getting out of bed between the two groups. Perineal incision infection and perineal incision dehiscence occurred in 2 cases and 1 case in the study group, and 10 cases and 9 cases in the control group respectively (χ 2= 5.007, P=0.025; χ 2=6.077, P=0.033). In the study group, there were 0 cases of perineal hernia, 1 case of pelvic floor peritoneal hernia and 2 cases of adhesive intestinal obstruction, while those in the control group were 7 cases, 8 cases and 9 cases, respectively (χ 2=6.642, P=0.013; χ 2=5.079, P=0.033; χ 2=4.085, P=0.043). Conclusion:Laparoscopic abdominoperineal resection with pelvic peritoneum closure significantly reduces the incidence of postoperative perineal-related complications and shorten postoperative hospital stay.

Objective:To evaluate the safety and feasibility of laparoscopic selective lateral lymph node dissection (LLND) for radical resection of rectal cancer.Methods:From Dec 2018 to Jul 2020, at the Department of Gastrointestinal Surgery of Northern Jiangsu People's Hospital laparoscopic radical resection of rectal cancer was performed in 32 cases and radical resection plus selective LLND in 26 cases.Results:The operation time in the LLND group was significantly longer than that in the simple radical resection group [247(179-405) min vs. 146(118-258) min, Z=-5.169, P<0.001], but there was no significant difference in intraoperative bleeding [68(45-500) ml vs. 56(25-500) ml, Z=-1.598, P=0.110], postoperative ventilation time [2.5(1-6) d vs. 3.0(1-6) d, Z=-0.120, P=0.905], postoperative hospital stay [9.0(7-17) d vs. 9.5(6-14) d, Z=-1.050, P=0.294] and hospitalization costs [(49 000±3 000) RMB vs. (48 000±3 000) RMB, t=-1.072, P=0.289] between the two groups. The incidence of postoperative complications in the two groups was 19% and 27% respectively (χ 2=0.551, P=0.458). The number of lateral lymph node dissection in LLND group was 8(6-16), 5 of 26 patients had lateral lymph node metastasis, with a metastasis rate of 19%. Conclusion:Laparoscopic radical resectim plus selective LLND for rectal cancer harvests more lateral lymph node metastasis without causing higher complications .

With the further development of endoscopic technology and the application of minimally invasive concept in the diagnosis and treatment of colorectal surgery diseases, the diagnosis and treatment of colorectal related diseases have undergone tremendous changes. Surgical diagnosis and treatment of colorectal diseases have achieved great results in the minimally invasive field, ranging from traditional transabdominal surgery to laparoscopic surgery, transvaginal surgery, and transvaginal specimen removal. One of the most cutting-edge surgical methods in the field of minimally invasive colorectal surgery at present, this method avoids the incision in the abdominal wall by taking specimens through the rectum and vagina, thus further minimally invasive colorectal surgery. The NOSES technology combines the advantages of traditional laparoscopic surgery with the concept of modern minimally invasive surgery. It embodies the characteristics of minimally invasive, fast track rehabilitation in surgery, functional surgery and other concepts on the basis of ensuring the operation effect. This paper mainly summarizes the relevant experience, experience and experience in the development of colorectal surgery diagnosis and treatment by carrying out the nose technology at home and abroad.

Objective:Surgical site infection (SSI) is the most common infectious complication after emergency abdominal surgery (EAS). To a large extent, most SSI can be prevented, but there are few relevant studies in China. This study mainly investigated the current situation of SSI occurrence after EAS in China, and further explored risk factors for SSI occurrence.Methods:Multi-center cross-sectional study was conducted. Clinical data of patients undergoing EAS in 33 hospitals across China between May 1, 2019 and June 7, 2019 were prospectively collected, including perioperative data and microbial culture results from infected incisions. The primary outcome was the incidence of SSI after EAS, while the secondary outcomes were postoperative hospital stay, ICU occupancy rate, length of ICU stay, hospitalization cost, and mortality within postoperative 30 days. Univariate and multivariate logistic regression models were used to analyze the risk factors of SSI after EAS.Results:A total of 660 EAS patients aged (47.9±18.3) years were enrolled in this study, including 56.5% of males (373/660). Forty-nine (7.4%) patients developed postoperative SSI. The main pathogen of SSI was Escherichia coli [culture positive rate was 32.7% (16/49)]. As compared to patients without SSI, those with SSI were more likely to be older (median 56 years vs. 46 years, U=19 973.5, P<0.001), male [71.4% (35/49) vs. 56.1% (343/611), χ 2=4.334, P=0.037] and diabetes [14.3% (7/49) vs. 5.1% (31/611), χ 2=5.498, P=0.015]; with-lower preoperative hemoglobin (median: 122.0 g/L vs. 143.5 g/L, U=11 471.5, P=0.006) and albumin (median: 35.5 g/L vs. 40.8 g/L, U=9452.0, P<0.001), with higher blood glucose (median: 6.9 mmol/L vs. 6.0 mmol/L, U=17 754.5, P<0.001); with intestinal obstruction [32.7% (16/49) vs. 9.2% (56/611), χ 2=25.749, P<0.001], with ASA score 3-4 [42.9% (21/49) vs. 13.9% (85/611), χ 2=25.563, P<0.001] and with high surgical risk [49.0% (24/49) vs. 7.0% (43/611), χ 2=105.301, P<0.001]. The main operative procedure resulting in SSI was laparotomy [81.6%(40/49) vs. 35.7%(218/611), χ 2=40.232, P<0.001]. Patients with SSI experienced significantly longer operation time (median: 150 minutes vs. 75 minutes, U=25 183.5, P<0.001). In terms of clinical outcome, higher ICU occupancy rate [51.0% (25/49) vs. 19.5% (119/611), χ 2=26.461, P<0.001], more hospitalization costs (median: 44 000 yuan vs. 15 000 yuan, U=24 660.0, P<0.001), longer postoperative hospital stay (median: 10 days vs. 5 days, U=23 100.0, P<0.001) and longer ICU occupancy time (median: 0 days vs. 0 days, U=19 541.5, P<0.001) were found in the SSI group. Multivariate logistic regression analysis showed that the elderly (OR=3.253, 95% CI: 1.178-8.985, P=0.023), colorectal surgery (OR=9.156, 95% CI: 3.655-22.937, P<0.001) and longer operation time (OR=15.912, 95% CI:6.858-36.916, P<0.001) were independent risk factors of SSI, while the laparoscopic surgery (OR=0.288, 95% CI: 0.119-0.694, P=0.006) was an independent protective factor for SSI. Conclusions:For patients undergoing EAS, attention should be paid to middle-aged and elderly patients and those of colorectal surgery. Laparoscopic surgery should be adopted when feasible and the operation time should be minimized, so as to reduce the incidence of SSI and to reduce the burden on patients and medical institutions.

Objective:Surgical site infection (SSI) is the most common infectious complication after emergency abdominal surgery (EAS). To a large extent, most SSI can be prevented, but there are few relevant studies in China. This study mainly investigated the current situation of SSI occurrence after EAS in China, and further explored risk factors for SSI occurrence.Methods:Multi-center cross-sectional study was conducted. Clinical data of patients undergoing EAS in 33 hospitals across China between May 1, 2019 and June 7, 2019 were prospectively collected, including perioperative data and microbial culture results from infected incisions. The primary outcome was the incidence of SSI after EAS, while the secondary outcomes were postoperative hospital stay, ICU occupancy rate, length of ICU stay, hospitalization cost, and mortality within postoperative 30 days. Univariate and multivariate logistic regression models were used to analyze the risk factors of SSI after EAS.Results:A total of 660 EAS patients aged (47.9±18.3) years were enrolled in this study, including 56.5% of males (373/660). Forty-nine (7.4%) patients developed postoperative SSI. The main pathogen of SSI was Escherichia coli [culture positive rate was 32.7% (16/49)]. As compared to patients without SSI, those with SSI were more likely to be older (median 56 years vs. 46 years, U=19 973.5, P<0.001), male [71.4% (35/49) vs. 56.1% (343/611), χ 2=4.334, P=0.037] and diabetes [14.3% (7/49) vs. 5.1% (31/611), χ 2=5.498, P=0.015]; with-lower preoperative hemoglobin (median: 122.0 g/L vs. 143.5 g/L, U=11 471.5, P=0.006) and albumin (median: 35.5 g/L vs. 40.8 g/L, U=9452.0, P<0.001), with higher blood glucose (median: 6.9 mmol/L vs. 6.0 mmol/L, U=17 754.5, P<0.001); with intestinal obstruction [32.7% (16/49) vs. 9.2% (56/611), χ 2=25.749, P<0.001], with ASA score 3-4 [42.9% (21/49) vs. 13.9% (85/611), χ 2=25.563, P<0.001] and with high surgical risk [49.0% (24/49) vs. 7.0% (43/611), χ 2=105.301, P<0.001]. The main operative procedure resulting in SSI was laparotomy [81.6%(40/49) vs. 35.7%(218/611), χ 2=40.232, P<0.001]. Patients with SSI experienced significantly longer operation time (median: 150 minutes vs. 75 minutes, U=25 183.5, P<0.001). In terms of clinical outcome, higher ICU occupancy rate [51.0% (25/49) vs. 19.5% (119/611), χ 2=26.461, P<0.001], more hospitalization costs (median: 44 000 yuan vs. 15 000 yuan, U=24 660.0, P<0.001), longer postoperative hospital stay (median: 10 days vs. 5 days, U=23 100.0, P<0.001) and longer ICU occupancy time (median: 0 days vs. 0 days, U=19 541.5, P<0.001) were found in the SSI group. Multivariate logistic regression analysis showed that the elderly (OR=3.253, 95% CI: 1.178-8.985, P=0.023), colorectal surgery (OR=9.156, 95% CI: 3.655-22.937, P<0.001) and longer operation time (OR=15.912, 95% CI:6.858-36.916, P<0.001) were independent risk factors of SSI, while the laparoscopic surgery (OR=0.288, 95% CI: 0.119-0.694, P=0.006) was an independent protective factor for SSI. Conclusions:For patients undergoing EAS, attention should be paid to middle-aged and elderly patients and those of colorectal surgery. Laparoscopic surgery should be adopted when feasible and the operation time should be minimized, so as to reduce the incidence of SSI and to reduce the burden on patients and medical institutions.

Objective To investigate the safety and feasibility of the modified terminal cannula ileostomy in laparoscopic anus-preserving operation of low rectal cancer (RC).Methods The retrospective cross-sectional study was conducted.The clinicopathological data of 15 patients who underwent laparoscopic radical resection of RC + terminal cannula ileostomy in the Subei People's Hospital of Jiangsu Province between September 2016 and June 2017 were collected.The patients underwent laparoscopic low anterior resection of RC,intra-abdominal sigmoid colon-rectum end-to-end anastomosis after extracting tumor specimens,and terminal cannula ileostomy in vitro.Observation indicators:(1) intraoperative situations:operation time,time of cannula ileostomy,volume of intraoperative blood loss,number of lymph node dissected,surgical margin;(2) postoperative situations:time to initial anal exsufflation,recovery time of defecation,time of tube removal,closing time of stoma,postoperative complications,duration of hospital stay;(3) follow-up situations.Follow-up using outpatient examination and telephone interview was performed to detect the anastomotic leakage-related complications up to December 2017.Measurement data with normal distribution were represented as (x)±s.Results (1) Intraoperative situations:all the 15 patients underwent successful laparoscopic radical resection of RC + terminal cannula ileostomy,without conversion to open surgery and death.The operation time,time of cannula ileostomy,volume of intraoperative blood loss and number of lymph node dissected were respectively (170 ± 34) minutes,(23 ± 4) minutes,(59 ± 27)mL and (13 ± 5) per case.No residual cancer cells were found in resection margins.(2) Postoperative situations:time to initial anal exsufflation and recovery time of defecation in 15 patients were respectively (6± 1) days and (7 ± 1) days.The stoma was automatically closed after tube removal,and time of tube removal and closing time of stoma after tube removal were respectively (23 ± 2) days and (3 ± 1) days.The incidence of postoperative complications was 1/15.One patient with catheterization-related complications was improved by strengthening dressing and antibiotic use,and the stoma was healed at 8 days after tube removal.There was no anastomotic leakage-related complications and death.The duration of hospital stay was (15±3) days.(3) Followup situations:all the 15 patients were followed up for 6-12 months.During the follow-up,there were no anastomotic leakage-related complications and death.Conclusion The modifyied terminal cannula ileostomy is safe and feasible,and is also an ideal surgical method for preventing anastomotic leakage in the laparoscopic anuspreserving operation of low RC.

Objective To investigate the diagnostic efficacy of fecal calprotectin(FC) on assessing endoscopic disease activity in colonic or ileo-colonic Crohn disease (CD) and CD-related surgery patients .Methods Totally 56 colonic or ileo-colonic CD pa-tients ,25 CD-related surgery patients and 25 irritable bowel syndrome (IBS) patients with previously confirmed diagnosis of CD and IBS were enrolled into this study .Fecal samples were collected from 1 to 3 day before bowel preparation and FC was measured by ELISA .Endoscopic activity was determined for colonic or ileo-colonic CD with Simple Endoscopic Score for Crohn′s Disease (SES-CD) and CD-related surgery patients with the Rutgeerts′ score .Results Among colonic or ileo-colonic CD patients ,the levels of FC in endoscopic active patients had significantly higher than that of endoscopic remission patients and IBS patients(P < 0 .01) ,there was significant correlation between levels of FC and the SES-CD (r= 0 .802 ,P< 0 .01) .FC threshold of 250 μg/g was tested to in-dicated active endoscopic disease with 97 .1% sensitivity and 71 .4% specificity .Among CD-related surgery patients ,FC level in IBS patients were significantly lower than that of endoscopic remission patients and endoscopic active patients ,but the FC in endoscopic remission patients and endoscopic active patients had no statistic difference(P> 0 .05) ,FC cutoff level of 250 μg /g gave a sensitivity and specificity of 50 .0% ,66 .7% ,respectively .Conclusion FC is a surrogate marker for the evaluation of colonic or ileo-colonic CD endoscopic disease activity .The FC ,however ,can not distinct remission period and active period after CD surgery .

Gastric cancer is one of the most common gastrointestinal malignant tumor in our country,with the continuous development of minimally invasive surgical technology,laparoscopic radical gastrectomy has gradually been developed,but whether CO2 pneumoperitoneum can cause peritoneal metastasis remains controversial.This article has synthesized the recent reports to illustrate the influence of Heat-CO2 pneumoperitoneum on adhesion molecules,and introduce the latest viewpoint of adhesion molecules affect gastric cancer metastasis.This article can provide clues to evaluate the clinical application value of Heat-CO2 pneumoperitoneum.

Objective To compare the effectiveness of hyperbaric oxygen (HBO) therapy and normal pressure oxygen inhalation for lung infection in patients with severe brain injury and tracheotomy.Methods Sixty lung infection patients with severe brain injury and tracheotomy were stratified by age and Glasgow coma scale (GCS) score into an HBO group (30) and a conventional therapy group (30).Both groups were given treatments to reduce intracranial hypertension and protect the brain,surgery,antibiotics,and symptomatic and support therapy.In the conventional group the patients received oxygen therapy at normal oxygen pressure by tracheal cannula.In the HBO group,the patients received HBO therapy through self-made oxygen devices by the authors.The body temperature,cough and expectoration,respiratory sounds and white blood cell (WBC) count were compared between the groups.Results There were statistically significant differences in body temperature,cough and expectoration,respiratory sounds and the normalized time for the count and classification of WBC between the groups.Conclusion HBO had good treatment effectiveness for excretion and expectorant in lung infection patients with severe brain injury and tracheotomy.