Objective:To investigate the application value of robot-assisted parenchyma-sparing pancreatectomy.Methods:The retrospective and descriptive study was conducted. The clinicopathological data of 54 patients who underwent robot-assisted parenchyma-sparing pancrea-tectomy in the Fujian Medical University Union Hospital from January 2017 to February 2023 were collected. There were 22 males and 32 females, aged (44±16)years. Observation indicators: (1) intraoperative conditions; (2) postoperative conditions; (3) follow-up. Measurement data with normal distribution were represented as Mean± SD, and comparison between groups was conducted using the t test. Measurement data with skewed distribution were represented as M(range), and comparison between groups was conducted using the rank sum test. Count data were expressed as absolute numbers, and comparison between groups was performed using the Fisher exact probability. Results:(1) Intraoperative conditions. All 54 patients underwent robot-assisted parenchyma-sparing pancrea-tectomy successfully, without conversion to laparotomy. Of 54 patients, 32 cases underwent pancreatic tumor enucleation and 22 cases underwent central pancreatectomy. Of the 32 patients who underwent pancreatic tumor enucleation, 29 cases underwent conventional pancreatic tumor enucleation, and 3 cases underwent intraoperative repairing of main pancreatic duct injury. Of the 22 patients who underwent central pancreatectomy, 15 cases underwent end-to-end anastomosis, and 7 cases underwent Roux-en-Y pancreaticojejunostomy. There was no significant difference in operation time or volume of intraoperative blood loss between 29 patients undergoing conventional pancreatic tumor enucleation and 3 patients undergoing intraoperative repairing of main pancreatic duct injury ( t=-1.66, Z=-0.82, P>0.05). There were significant differences in operation time and volume of intraoperative blood loss between 15 patients undergoing end-to-end pancreatic anastomosis and 7 patients undergoing Roux-en-Y pancreaticojejunostomy ( t=-3.03, Z=-2.22, P<0.05). (2) Postoperative conditions. There were 38 of the 54 patients with postoperative complications, including 37 cases of pancreatic fistula and 1 case of delayed gastric emptying. There was no significant difference in post-operative pancreatic fistula between 29 patients undergoing conventional pancreatic tumor enuclea-tion and 3 patients undergoing intraoperative repairing of main pancreatic duct injury ( P>0.05). There was a significant difference in postoperative pancreatic fistula between 15 patients under-going end-to-end pancreatic anastomosis and 7 patients undergoing Roux-en-Y pancreaticojejunostomy ( P<0.05). (3) Follow-up. All 54 patients were followed up for 23(range, 3-76)months, and all of them survived without tumor recurrence or metastasis. None of the 32 patients undergoing enuclea-tion of pancreatic tumor experienced pancreatic endocrine or exocrine insufficiency. Of the 15 patients who underwent end-to-end pancreatic anastomosis, there were 2 cases of dilatation of the main pancreatic duct and atrophy of the distal pancreas, 1 case of pancreatic endocrine insufficiency and 1 case of exocrine insufficiency. Of the 7 patients who underwent Roux-en-Y pancreaticojejunostomy, there was 1 case of pancreatic endocrine insufficiency. Conclusion:Robot-assisted parenchyma-sparing pancreatectomy can provide intraoperative protection, repair and anastomosis of the main pancreatic duct.

Objective: To investigate the effects of treatment of hernia sac stump in laparoscopic transabdominal preperitoneal inguinal hernia repair (TAPP) on postoperative seroma. Methods: The prospective study was conducted. The clinical data of 128 male patients with primary indirect inguinal hernia who were admitted to Fujian Medical University Union Hospital from October 2017 to March 2019 were selected. Patients were divided into two groups by random number method. Patients in experimental group had hernia sac stump sutured and fixed at the lower margin of rectus abdominis after transection of hernia sac in TAPP, and patients in control group had hernia sac stump free in the abdominal cavity after dissection and transection of hernia sac in TAPP. Observation indicators: (1) surgical situations; (2) follow-up. Follow-up using outpatient examination and telephone interview was conducted to detect the incidence of postoperative seroma, incision infection, chronic pain, and hernia recurrence up to June 2019. Measurement data with normal distribution were represented as Mean±SD, and comparison between groups was done using the t test. Measurement data with skewed distribution were represented as M (range), and comparison between groups was done using the Mann-Whitney U test. Count data were described as absolute numbers and percentages, and comparison between groups was analyzed using the chi-square test. Results: A total of 128 male patients were screened for eligibility, including 60 patients in the experimental group and 68 patients in the control group. The 128 patients were aged from 47 to 74 years, with an average age of 61 years. (1) Surgical situations: operation time and hospital expenses were (102±34)minutes and (12 813±2 390)yuan for the experimental group, and (97±30)minutes and (12 125±2 205)yuan for the control group, respectively, showing no significant difference between the two groups (t=0.907, 1.685, P>0.05). (2) Follow-up: all the 128 patients received follow-up. There were 8 cases of seroma in both the experimental group and the control group, with no significant difference between the two groups (χ²=0.072, P>0.05). The extraction volume of patients with seroma was 20 mL (range, 4-31 mL) in the experimental group, and 43 mL (range, 23-98 mL) in the control group, showing a significant difference between the two groups (Z=-2.013, P<0.05). There was no incision infection, chronic pain or hernia recurrence in 3 months after operation in patients with seroma of either experimental group or control group. Conclusions During TAPP, suture and fixation of the hernia sac stump to the lower edge of rectus abdominis and free hernia sac stump in the abdominal cavity after dissection and transection of hernia sac can effectively repair indirect inguinal hernia. The former method can reduce the extraction volume of seroma after operation.

Objective:To evaluate the clinical effects of painting therapy on fatigue, anxiety and depression in patients with hematological neoplasms undergoing chemotherapy.Methods:Totally 78 patients with hematological neoplasms admitted to the laminar flow ward in a tertiary hospital in Shanghai from October 2018 to May 2019 were enrolled. Patients who were included from October 2018 to January 2019 constituted the control group (39 cases), others from February to May 2019 constituted the intervention group (39 cases). Patients in both groups received routine health education and psychological care, and the intervention group received extra 4 weeks of painting intervention once a week. The Revised Piper Fatigue Scale (PFS-R), Self-rating Anxiety Scale (SAS) and Self-rating Depression Scale (SDS) were used to assess fatigue and emotional status of two groups during chemotherapy before the intervention, after the intervention and one month after the intervention. One case in control group was lost to follow-up while three cases in intervention group.Results:At 2 times points after painting therapy, total fatigue、anxiety and depression score in the intervention group were (4.04±0.91), (48.81±3.92), (46.06±4.53), (3.55±0.84), (47.47±4.33), (45.17±4.74) points; those in the control group were (5.34±1.18), (51.13±3.88), (50.63±4.36), (5.07±1.40), (52.74±4.04), (51.24±4.01) points.The time effect on fatigue of each dimension and total scores, anxiety and depression scores was significant ( F values were 48.859-126.096, P<0.05); the group effect and the interaction effect of intervention and time on sensory, emotional, behavioral and total fatigue scores, anxiety and depression scores were significant ( F values were 6.037-37.014, P<0.05; F values were 7.696-35.754, P<0.05). Conclusion:Painting therapy can effectively alleviate fatigue and relieve anxiety and depression in patients with hematological neoplasms undergoing chemotherapy.

Abdominal external hernia mainly includes inguinal hernia and ventral hernia. Tension-free repair is the main procedure for adult patients with abdominal external hernia. Sublay repair is an ideal technique for abdominal external hernia repair with the placement of mesh in the retromuscular or prepe-ritoneal space. Sublay repair provides a reliable repair with low incidence of recurrence and other postoperative complications. In addition, no direct contact between the mesh and abdominal organs effectively prevents mesh-related complications including intra-abdominal adhesion. In recent decades, as the update in the principles of abdominal external hernia repair, experts in hernia and abdominal wall surgery prefer to treat external hernia at the abdominal wall. Therefore, sublay technique attract more attention from hernia surgeons. New techniques and procedures based on sublay technique become more and more popular in external hernia repair, including open, laparoscopic and Da Vinci robotic operations. The authors summarize the application of sublay technique in the repair of inguinal and ventral hernias, introduce various types of procedures using sublay technique including classic and newly-developed procedures, aim to extend the standardized treatment of abdominal external hernia.

Objective: To compare the short-term clinical outcomes and cost differences of robotic distal pancreatectomy (RDP) versus laparoscopic distal pancreatectomy (LDP). Methods: The retrospective descriptive study was adopted.The clinical data of 158 patients underwent minimally invasive distal pancreatectomy who were admitted to Fujian Medical University Union Hospital between January 2016 and July 2018 were collected.A 1∶1 matched propensity score (PSM) analysis was performed for the RDP group and the LDP group.Observed indexes included operative time, blood loss, spleen-preserving rate, postoperative hospital stay, morbidity, incidence of pancreatic fistula and hospital costs. T test or rank sum test was used to compare measurement data, χ² test or Fisher exact test was used to compare count data. Results: A well-balanced cohort of 41 patients was analyzed.There were 14 males and 27 females in the RDP group, aged (45.2±16.4)years. There were 15 males and 26 females in the LDP group, aged (47.4±14.9) years.The operation time was (209.7±52.9) minutes for the RDP group and (186.5±56.7) minutes for the LDP group (P=0.073). Median blood loss was less in RDP (50(15-175)ml) compared with LDP (100(50-350)ml) (Z=-2.689, P=0.007). Thirty-eight cases of non-malignant diseases were observed in each group and spleen-preserving rate was higher in RDP (76.3%) compared to LDP(44.7%) (χ²=7.930, P=0.005).Postoperative hospital stay was similar in the RDP group and the LDP group (RDP: 9.4 days vs. LDP: 10.6 days; P=0.372). The overall morbidity and incidence of pancreatic fistula major complication rates (RDP: 12.2% vs. LDP: 14.6%, P=0.746; RDP: 7.3% vs. LDP: 9.8%, P=1.000) were similar.Total cost of RDP group was higher than that of LDP group ((80 563.7±10 641.8) yuan vs. (57 792.8±8 943.0) yuan, t=4.515, P<0.01). Conclusions Both RDP and LDP are safe and feasible procedures. RDP is more expensive, but RDP is associated with significantly less blood loss and higher spleen-preserving rate, which is more suitable for the non-malignant diseases of pancreatic body and tail with an expectation of splenic preservation.

Objective To explore the clinical effects of laparoscopic combined with open mesh repair for abdominal wall incisional hernia.Methods The retrospective cross-sectional study was conducted.The clinical data of 41 patients with abdominal incisional hernia who were admitted to the Fujian Medical University Union Hospital between September 2011 and June 2017 were collected.All the patients underwent laparoscopic combined with open mesh repair,with the sequence from laparoscopic surgery to open surgery and then to laparoscopic surgery.Observation indicators:(1) intra-and post-operative situations;(2) follow-up situation.Follow-up using outpatient examination and telephone interview was performed to detect postoperative long-term complications and hernia recurrence up to November 2017.Measurement data with normal distribution were represented as (x)±s.Results (1) Intra-and post-operative situations:forty-one patients underwent successful laparoscopic combined with open mesh repair for abdominal wall incisional hernia.Diameter of hernia ring and defect area of abdominal wall were respectively (10±3)cm and (75±34)cm2.Among 41 patients,25 underwent laparoscopic combined with open mesh repair due to tight intestinal adhesion induced difficult laparoscopic separation;16 underwent laparoscopic combined with open mesh repair due to the larger diameter of the hernia ring induced difficulty of closing hernia ring under laparoscope.Operation time,cases with indwelling drainage-tube,time of drainage-tube removal and duration of postoperative hospital stay were respectively (188±71)minutes,33,(14±3)days and (4.5±2.6)days.Of 41 patients,2 with postoperative incomplete intestinal obstruction were cured by symptomatic treatment;2 with incisional infection were cured by antibiotic therapy,irrigation and dressing change.(2) Follow-up situation:41 patients were followed up for (29±17)months.The postoperative chronic pain of 2 patients was occasional and cannot affect the normal life.There was no occurrence of seroma,mesh infection,intestinal fistula,abdominal compartment syndrome and hernia recurrence during the follow-up.Conclusion The laparoscopic combined with open mesh repair has a better clinical effect for patients of incisional hernia with large hernia ring and tight intestinal adhesion,and surgical methods should be chosen seriously according to the condition of the patients in clinical application.

Objective To investigate the clinical efficacy of laparoscopic resection for retroperitoneal tumor via transabdominal approach.Methods The retrospective cross-sectional study was conducted.The clinicopathological data of 37 patients with retroperitoneal tumor who underwent laparoscopic resection via transabdominal approach at Fujian Medical University Union Hospital between January 2011 and August 2017 were collected.The surgical approach of resection for retroperitoneal tumor at the left hypochondriac region,left iliac region,right hypochondriac region and right iliac region referred to laparoscopic distal pancreatectomy,laparoscopic left hemicolectomy,laparoscopic pancreatoduodenectomy and laparoscopic right hemicolectomy respectively.Observation indicators:(1) intra-and post-operative recovery situations;(2) follow-up and survival situations.Follow-up using outpatient examination and telephone interview was performed to detect postoperative tumor recurrence,metastasis and survival of patients up to November 2017.Measurement data with normal distribution were represented as (x)±s.Measurement data with skewed distribution were described as M (range).Results (1) Intra-and post-operative recovery situations:37 patients underwent successfully laparoscopic resection for retroperitoneal tumor via transabdominal approach.Among 37 patients,4 were converted to open surgery,4 were completed surgery with assisted small incision,4 were combined with adjacent organ resection and other 25 underwent totally laparoscopic resection for retroperitoneal tumor.The operation time,volume of intraoperative blood loss,postoperative gastrointestinal recovery time,postoperative drainage-tube removal time and duration of postoperative hospital stay were respectively (181±73) minutes,(160±87) mL,(3.0± 1.0) days,(3.0±2.0) days and (7± 4)days.Of 37 patients,3 with postoperative complications including 2 of chylous fistula and 1 of delayed gastric emptying were improved by symptomatic treatment.There was no perioperative death.(2) Follow-up and survival situations:37 patients were followed up for 3-82 months,with a median time of 30 months.During the follow-up,1 patient with inflammatory myofibroblastic tumor had recurrence at 15 months postoperatively and underwent surgical resection,however,the patient had liver metastasis at 9 months after the second operation and underwent interventional therapy repeatly.One patient with Castleman and 5 with lymphoma underwent regular chemotherapy and achieved disease-free survival.The other patients had disease-free survival.Conclusion Laparoscopic resection for retroperitoneal tumor via transabdominal approach is safe and feasible.

Objective: To discuss the methods, skills and experiences of dividing the neck of pancreas in laparoscopic pancreaticoduodenectomy(LPD). Methods: The clinical data of 58 patients with periampullary tumors who received LPD at the Union Hospital of Fujian Medical University from December 2014 to January 2017 were retrospectively analyzed.There were 26 males and 32 females, ranged from 18 to 65 years, with a mean age of (46±12)years. Results: All of the 58 patients underwent operation smoothly.Three cases underwent open anastomosis via an auxiliary incision after the total resection of specimen laparoscopically, due to the early learning curve of LPD.Two cases transformed into open operation as a result of tumor vascular invasion to portal vein(PV) or superior mesenteric vein(SMV). Fifty-three cases underwent laparoscopic or laparoscopic combined with robotic pancreaticoduodenectomy completely.Forty-two cases ligated gastroduodenal artery(GDA), fully penetrated the interspace between rear of pancreatic neck and SMV, suspended the pancreas and then divided the neck of pancreas from inferior to superior. Thirteen cases fully dissected the interspace between rear of pancreatic neck and SMV, divided the neck of pancreas from inferior to superior and then ligated GDA.Three cases ligated GDA, dissected PV and SMV at the superior and inferior margin of the neck of pancreas separately, and then divided pancreas from anterior to posterior.Mean time of dividing pancreas was (34.9±9.7)minutes, mean volume of blood loss while dividing pancreas was (30.1±8.2)ml.The main postoperative complications included pancreatic fistula(7 cases, Biochemical leak 2 cases, B grade 3 cases, C grade 2 cases), biliary fistula(3 cases), gastric fistula(1 case), delayed gastric emptying(1 case, C grade), abdominal infection(5 cases), hepatic failure (1 case), intra-abdominal hemorrhage(2 cases), reoperation(2 cases). One case died at the perioperative period while others recovered.The mean duration of postoperative stay was (14.2±5.1)days. Conclusions Dividing the neck of pancreas is one of the most important steps in LPD, which deserved sufficient attention.At the meantime, a suitable method of dividing the neck of pancreas should be chosen according to intraoperative exploration and preoperative imageological examinations.

Objective To investigate the clinical efficacy of total pancreaticoduodenectomy for the pancreatic head adenocarcinoma with positive neck margin.Methods The clinical data of 15 patients with pancreatic head adenocarcinoma and had positive neck margin who received total pancreaticoduodenectomy at the Union Hospital of Fujian Medical University from August 2009 to May 2014 were retrospectively analyzed.Patients were followed up by out-patient examination or telephone interview till August 2014.Results Total pancreaticoduodenectomy was successfully carried out on the 15 patients.The operation time was 4.0-10.0 hours (mean,6.5 hours),and the volume of blood loss was 300-2 000 mL (mean,800 mL).The duration of postoperative hospital stay was 13.0-35.0 days (mean,22.3 days).The main postoperative complications included pulmonary infection (3 cases),abdominal infection (2 cases)and low blood glucose (2 cases).No interoperative death,bile leakage or gastrointestinal anastomotic fistula occurred.The blood glucose of most of the patients was controlled by insulin or pancreatin.No stomachache,steatorrhea or malnutrition occurred in all the patients.The mean time of postoperative follow-up was 21 months (range,3 months to 5 years).Three patients survived within 1 year,2 survived for 1-2 years,5 survived for more than 2 years and 1 survived for more than 5 years.Four patients with follow-up time under 6 months survived till now.Five patients had liver metastasis at postoperative month 6.Conclusion Total pancreaticoduodenectomy might be necessary for the pancreatic head adenocarcinoma with positive neck margin to achieve R0 resection.

Objective To investigate the correlation between disease severity and pleural effu sion in patients with acute pancreatitis(AP).Methods A retrospective analysis was conducted on a prospectively collected database.The demographic,clinical,and laboratory data of 246 consecutive cases of AP in patients admitted to the Affiliated Union Hospital of Fujian Medical University between January 2008 to December 2012 were reviewed.Acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score and computed tomography severity index (CTSI) were used to evaluate the disease severity of AP.The relationship between the severity and pleural effusion was analyzed.Receiver operator characteristic (ROC) curve was used to compare the values of APACHE Ⅱ score and CTSI in predicting the prognosis of patients with pleural effusion.Results Among the 246 patients,there were 184 patients with pleural effusion and 62 patients without pleural effusion.The incidence of pleu ral effusion in AP was 74.8％.Further study showed that the difference in the incidences of pleural effusion between the severe group and the mild group was significant (P＜0.01).There was a trend that the more serious the patient's condition,the more the pleural effusion.Moreover,the levels of pleural effusion were significantly and positively correlated with the APACHE Ⅱ score (r=0.775,P＜0.01) and CTSI (r=0.525,P＜0.05).Logistic regression analysis showed that the factors significantly associated with pleural effusion formation were a high APACHE Ⅱ score and a high CTSI.Areas under the ROC curve of the APACHE Ⅱ score,CTSI and combined assessment were 0.798,0.687 and 0.812 for predicting mortality of the patients with pleural effusion.Through comparison of the areas under the ROC curve,there was a significant difference between the APACHE Ⅱ score and CTSI as well as combined assessment and CTSI (P＜0.05).Conclusions The disease severity was closely related to pleural effusion in patients with AP.Combining the two scoring systems to evaluate the disease severity and providing active treatment were important to improve the prognosis of patients with pleural effusion.