Minimally invasive surgery experienced a rapid development in the past thirty years, of which the laparoscopy has been widely used in gastrointestinal surgery. Lymph node dissection is one of the difficulties of laparoscopic radical resection of gastric cancer. The lymph node dissection along the left gastroepiploic vessels is a difficult part, which usually causes bleeding and splenic injury. This article mainly introduce the indications, contraindications, surgical preparations, the difficulties and techniques during the lymph nodes dissection when the operator stood on the left side of the patients, and perioperative complications of lymph nodes dissection along the left gastroepiploic vessels.

Objective To observe the OCT angiography imaging features of choroidal neovascularization (CNV) with different activity in age-related macular degeneration (AMD).Methods A retrospective case analysis.Forty-two eyes of 33 patients (21 males and 12 females,aged 65.3 ± 8.61 years) who were diagnosed with AMD by multi-mode fundus imaging examination at the Ophthalmology Department of Yunnan Second People's Hospital during January 2017 and October 2018 were enrolled in this study.All patients underwent BCVA,slit-lamp biomieroscopy,indirect ophthalmoscopy,fundus colorized photography,FAF,FFA and OCT examinations.The patients were divided into active CNV (27 eyes of 19 patients) and inactive CNV (15 eyes of 14 patients) by comprehensive analysis of fundus imaging characteristics and treatment process.The imaging features of OCTA in the two groups were compared.The number of eyes of each active or inactive indicator in the active CNV group and the inactive CNV group was calculated,and the composition ratio of each group of the indicators was subjected to the x2 test.Results Among the 27 eyes of active CNV,22 eyes (81.5％) of OCTA showed abundant small capillary branching structure,while 13 eyes (13.3％) of 15 eyes of inactive CNV showed more coarse blood vessel.Among the 27 eyes of active CNV,26 eyes (96.3％) of OCTA showed that the marginal vascular end points of CNV lesions were "arcaded" or "ring",while 12 eyes (80.0％) of 15 eyes of inactive CNV showed the presence of isolated branches of peripheral vessels.Among the 27 eyes with active CNV lesions,there were no large feeder vessels inside the lesions,and 8 (53.3％) of the 15 inactive CNV lesions showed feeder vessels in the center of the lesion.Among the 27 eyes with active lesions,23 eyes (85.2％) of OCTA showed a low-reflection "halo" around the CNV lesion,and no low-reflection "halo" structure was observed in the 5 eyes of the inactive CNV lesion.The statistical results showed that there were abundant small blood vessel branches (x2=22.759,P=0.000),annular anastomosis around the lesion (x2=31.704,P=0.000),lowreflection halo (x2=32.327,P=0.000),and large nourishing blood vessels (x2=26.063,P=0.000),dilated choroidal vessels (x2=32.912,P=0.000).All the above indicators were statistically different between the two groups.Conclusion The abundant small vessel branches in OCTA,the surrounding anastomosis in a ring structure and the low reflex halo around the lesion are markers of active CNV,while the large feeding vessels and dilated choroidal vessels are indicators of inactive CNV.

Objective To compare the effect of anesthesia management between enhanced recovery after surgery (ERAS) protocol and traditional protocol on stress level of thyroid surgery.Methods Sixty-two patients receiving thyroid surgery from May 2016 to August 2016, 13 males and 49 females, aged 18-65 years, of ASA physical status Ⅰ or Ⅱ, were randomly divided into group ERAS (n=29) and traditional group (group C, n=33).Each group had its own anesthesia management protocol.Operation method, operation duration, the level of pain during emergence and on the first postoperative day, the occurrence rate of complications and the satisfaction evaluation of pain and nausea and vomiting after the operation day were recorded.C-reactive protein (CRP), serum cortisol, interleukin-6 (IL-6), interleukin-8 (IL-8) and tumor necrosis factor (TNF-α) before and after the operation day were evaluated.Results The visual analogue scale (VAS) pain score in group ERAS was lower than that in group C during emergence [(0.42±0.83) points vs (0.95±1.16) points]and on the first postoperative day [(1.90±1.21) points vs (2.73±1.40) points] (P<0.05).Group ERAS was more satisfied with pain relief at first day after the surgery than that of group C (P<0.05).The level of CRP in group ERAS was lower than that in group C on the operative day and the first postoperative day (P<0.05).In group C, the level of CRP on the operative day and the first postoperative day were much higher than those before the surgery (P<0.05).The occurrence rate of complications between the two groups had no statistical difference.Conclusion The perioperative ERAS anesthesia management of thyroid surgery is safe and effective in pain management, patient satisfaction and accelerated recovery.

Objective:To evaluate the analgesic effects of two kinds of preoperative peripheral nerve block drug in patients with tri-geminal neuralgia undergoing radiofrequency thermocoagulation(RFT)of gasserian ganglion.Methods:90 patients with classic trigemi-nal neuralgia of the 3rd branch were scheduled to undergo RFT of the gasserian ganglion and were randomly divided into 3 groups(n =30).The patients in group N without nerve block were served as the controls.The patients in group A and B were treated by the nerve block of inferior alveloar with 2 ml of 2% lidocaine hydrochloride and 2 ml of compound lidocaine hydrochloride for each respectively 2 d before RFT.The pain control was studied by VAS method before and 24,48 h after nerve blocking and during pucture for RFT.Re-sults:Compared with the control group,24 h after nerve blocking,the average pain and the most pain VAS value of group A and B were significantly reduced(P <0.01);sleep quality and analgesia satisfaction were improved in group A and B(P <0.05).48 h after nerve blocking the pain relief and sleep quality improvement of group B were more than those of group A(P <0.05).In addition,during RFT puncture the pain intensity of group A and B were less than that of group N(P <0.05).The pain control in group B was more effective than that in group A.Conclusion:A single peripheral nerve block with long-term narcotic compound lidocaine hydrochloride can be an effective way to relieve preoperative and operative pain for RFT of trigeminal neuralgia.