OBJECTIVE To compare the efficacy and safety of lacosamide （LCM） and carbamazepine （CAR） as monotherapy in the treatment of adult patients with newly diagnosed epilepsy. METHODS By methods of retrospective analysis， 84 adult patients with newly diagnosed epilepsy， were admitted to the Department of Neurology， Huaihe Hospital of Henan University during Sept. 2020-Jun. 2022， were divided into the control group （40 cases， receiving CAR treatment） and the observation group （44 cases， receiving LCM treatment） according to different medication regimens. Total response rate， epilepsy seizure frequency， blood lipid levels， and the occurrence of adverse events （AEs） of patients were compared between the 2 groups. RESULTS In the first month after treatment， there was no statistically significant difference in the total response rate between the observation group （63.64%） and the control group （55.00%， P＞0.05）； the frequency of epilepsy seizure in both groups was significantly reduced compared to before treatment （P＜0.05）， but there was no statistically significant difference between 2 groups （P＞0.05）. In the third month after treatment， the total response rate of the observation group （90.91%） was significantly higher than control group （67.50%， P＜0.05）； the frequencies of epilepsy seizure in both groups were significantly reduced compared to before treatment， and the observation group was significantly lower than the control group （P＜0.05）. In the third month after treatment， the levels of total cholesterol （TC）， triglyceride （TG） and low-density lipoprotein cholestrol （LDL-C） in the control group and the level of LDL-C in the observation group were significantly higher than before treatment， and the levels of TC， TG and LDL-C in the observation group were significantly lower than those in the control group （P＜0.05）. There was no statistically significant difference in the incidence of AEs between the observation group （15.91%） and the control group （17.50%， P＞0.05）. CONCLUSIONS Both LCM and CAR have certain effects in the treatment of newly diagnosed epilepsy in adults， which can reduce the frequency of epilepsy seizure in patients and have comparable safety. Meanwhile， LCM has better long-term efficacy than CAR in treating newly diagnosed epilepsy in adults， and its impact on the patient’s blood lipid is smaller than CAR.

From August 2019 to December 2019, 74 patients with choledocholithiasis underwent laparoscopic lithotomy, including 68 cases with primary suture of common bile duct and 6 cases with T-tube drainage. The operation time, postoperative length of hospital stay, hospitalization cost and complications of the two groups were compared. The operation time and length of postoperative hospital stay in primary suture were shorter than those in T-tube drainage group[ (88.1±29.9) min vs. (144.2±30.7) min; (3.9±1.5) d vs. (7.2±3.8) d, both P<0.05]; the hospitalization cost was lower[ (29 578±1 072) Yuan vs. (37 468±2 844) Yuan, P<0.05]. There was no significant difference in the incidence of postoperative complications between two groups ( P>0.05). The primary suture seems to be superior to T-tube drainage in laparoscopic lithotomy, however, two methods have different indications and should be selected according to the individual conditions of patients.

Objective:To compare the efficacy and safety of intermittent regional hepatic vascular inflow occlusion with Pringle’s maneuvre for laparoscopic anterior sectionectomy.Methods:From January 2014 to December 2018, 54 patients who underwent laparoscopic right anterior sectionectomy at the Department of Hepatopancreatobiliary Surgery, the Third Affiliated Hospital, Soochow University were recruited into this study. The patients were 40 to 60 years old, and 27 were males and 27 females. Intermittent regional hepatic vascular inflow occlusion was carried out in 24 patients (the intermittent occlusion group). The remaining patients underwent Pringle’s maneuvre (the Pringle group). Postoperative liver function, intraoperative blood loss, intraoperative blood transfusion, operation time and postoperative complications between the two groups were compared.Results:Intraoperative hemorrhage and blood transfusion of the Pringle group (534±42)ml, (2.88±0.54)U were significantly higher than the intermittent occlusion group (374±21)ml, (1.86±0.29)U (all P<0.05). The operation time of the Pringle group was significantly shorter than the intermittent occlusion group ( P<0.05). Two patients developed CO 2 embolism in each group, which led to 2 patients in the intermittent occlusion group being converted to open operations. Postoperative hepatic function (except albumin) of the intermittent occlusion group was significantly better than the Pringle group, while the hospital stay of the intermittent occlusion group was significantly shorter than the Pringle group (all P<0.05). Six patients (25.0%) developed postoperative complications in the intermittent occlusion group versus 8 (26.7%) in the Pringle group ( P>0.05). Conclusion:Intermittent regional hepatic vascular inflow occlusion reduced intra-operative hemorrage and hepatic impairment, and shortened hospital stay. However, it required higher operation skills and it should gradually be promoted.

Objective:To evaluate partial splenectomy (LPS) in the treatment of benign solid tumors of the spleen.Methods:The clinical data of patients with benign solid tumors of spleen treated by laparoscopy from Jan 2010 to Jun 2018 in the Third Affiliated Hospital of Soochow University was retrospectively analyzed. Patients were divided into LPS group and laparoscopic total splenectomy (LTS) group.Results:There were 21 cases in LPS group and 25 cases in LTS group. Differences between the two groups, operative time, blood loss, transfusion rate, maintenance of drain, postoperative hospital stay, costs, postoperative WBC and platelet count, and postoperative complications such as hemorrhage, fever, splenic fossa effusion, pancreatic fistula, venous thrombosis were statistically insignificant. However, the postoperative incidence of thrombocythemia in the LPS group were significantly lower compared to the LTS group (χ 2 =4.293, P<0.05). Conclusions:Patients with benign solid tumors of the spleen will benefit more from LPS compared to LTS.

Objective:To discuss the surgical approach and the clinical effect of laparoscopic enucleation for hepatic hemangioma(HH).Methods:Forty HH patients admitted in the Third Affiliated Hospital of Soochow University between Aug 2018 and Dec 2019 were analyzed. The technical knowhow involved is to make a good explosure of the pseudocapsular HH from underneath. Herewith a process of HH enucleatoin started.Results:All the 40 patients undergone total laparoscopic hepatectomy successfully.The operative time was (90.3±32.3)min, the intraoperative blood loss was (50±500)ml, the time of hepatic block was (12.5±35.4) min. The volume of postoperative drainage was 10-150 ml on the first postoperative day, and was gradually reduced to <30 ml on the third day after the operation. All patients were up and about from post-op day 2. The length of stay after operation was (5.5±2.7)d. There were significant differences in ALT、AST、TBIL and prealbumin in 1 and 3 days after surgery (seperately, t=-5.481, -4.182, -2.235, 9.722, all P<0.05), before back to normal on day 7 (seperately t=0.167, -1.392, 1.000, -2.531, all P>0.05). Liver function recovered to normal in 7 days after surgery. Conclusion:New approach breaks the traditional stripping method and makes the procedure simple, safe, lessly disturb the liver function.

Objective: To analyze the genetic characteristics of norovirus(NoV) in Jilin province from 2014 to 2016. Methods: Stool samples from children under 5 years of age with diarrhea were collected from Changchun Children′s Hospital. Samples were amplified by RT-PCR. The polymerase and capsid gene of the positive specimens were amplified.Sequences were analyzed by homologous comparison and phylogenetic analysis. Results: A total of 1 335 samples were detected, 177 were positive for NoV, and positive rate was 13.26%. The positive rate was 11.83% in 2014, 12.53% in 2015 and 15.75% in 2016. Genotyping of polymerase region revealed GII.P12 types dominated in 2014 and GII.Pe types dominated in 2015 and 2016. Genotyping of polymerase region revealed that GII.3 types dominated in 2014 and GII.4_Sydney2012 types dominated in 2015 and 2016. The types of both regions included GII.P17/GII.17, GII.Pe/GII.4_Sydney2012, GII.P12/GII.3, GII.Pe/GII.3、GII.P16/GII.2 and GII.P7/GII.6. Conclusions Genotypes of NoV infection are diverse in Jilin province. Most of them are recombinant strains. The main epidemic strains changed from GII.P12/GII.3 in 2014 to GII.Pe/GII.4_Sydney2012 in 2015 and 2016.

Objective: To compare the clinical application of three-dimensional laparoscopic pancreatoduodenectomy (3D-LPD) with that of two-dimensional laparoscopic pancreatoduodenectomy (2D-LPD), and to explore the safety and feasibility of 3D-LPD. Methods: A retrospective analysis was made from the data of 45 patients with 3D-LPD and 45 patients with 2D-LPD who underwent total laparoscopic pancreatoduodenectomy from March 2017 to August 2018 at Department of Hepato-Pancreato-Biliary Surgery, the First People′s Hospital of Changzhou.The differences of intraoperative conditions, postoperative complications and postoperative pathological findings between the two methods were compared.Measurement data were compared with independent sample t-test, enumeration data were statistically analyzed with Chi-square test or Fisher exact probability. Results: The operation time of 3D-LPD group was shorter than that of 2D-LPD group ((335±95) min vs. (419±113) min, t=-3.817, P=0.000), which mainly showed that the time of digestive tract reconstruction was reduced ((92±26) min vs. (131±46) min, t=-4.951, P=0.000). The intraoperative blood loss in the 3D-LPD group was significantly less than that in the 2D-LPD group ((242±124) ml vs. (350±176) ml, t=-3.365, P=0.001), and the perioperative blood transfusion in the 3D-LPD group was significantly less than that in the 2D-LPD group (χ²=4.444, P=0.035). Postoperative hospitalization days and ICU stay time were not significantly different between the two groups(both P>0.05). Postoperative complications such as pancreatic fistula, biliary fistula, postoperative bleeding, gastric emptying disorders, abdominal infection, were not significantly different between the two groups(all P>0.05). Conclusions The operation time of 3D-LPD is shorter than that of 2D-LPD, and the amount of bleeding is less. Short-term clinical data showed that, 3D-LPD is effective, safe and worth popularizing.

Objective: To evaluate the quality of life after Altemeier and Delorme procedures for rectal prolapse patients. Methods: A retrospective cohort study was performed. Clinical data of patients with full-thickness rectal prolapse undergoing surgical treatment in the Sixth Affiliated Hospital, Sun Yat-sen University from February 2013 to January 2018 were retrospectively analyzed. Patients who had no preoperative imaging data, who suffered from internal rectal intussusception, or who did not undergo Altemeier and Delorme operations were excluded. Sixty-seven patients were enrolled, including 32 males with median age of 20.5 (13, 34) years and 35 females with median age of 65.0 (50, 77) years. According to different procedures, patients were divided into the Altemeier group (48 cases) and the Delorme group (19 cases), who received standard Altemeier and Delorme operations respectively. The maximal prolapse length of preoperative squat position, the Longo constipation score, Wexner incontinence score, EQ-5D-5L score, postoperative complications and recurrence rate were analyzed and compared between two groups. Results: The maximal prolapse length of preoperative squat position in Altemeier group and Delorme group was (7.3±3.3) cm and (4.9±2.1) cm respectively with significant difference (t=2.907, P=0.005). The operations in both groups were successfully completed. The operation time and postoperative hospital stay of Altemeier group were longer than those of Delorme group [(112.3±47.0) minutes vs. (80.7±35.4) minutes, t=2.637, P=0.010; (11.3±5.0) days vs. (8.6±3.0) days, t=2.177, P=0.033]. The median follow-up period was 26 (13, 45) months. In the last follow-up, compared to pre-operation, the Longo constipation score [9.0 (6.0, 14.0) vs 4.0 (1.0, 6.5), Z=-4.989, P<0.001], Wexner incontinence score [0 (0, 5.5) vs. 0 (0, 2.0), Z=-3.325, P<0.001] and EQ-5D-5L score [45.0 (40.0, 57.5) vs. 80.0 (70.0, 87.5), Z=-5.587, P<0.001] were all improved obviously in the Altemeier group, meanwhile Longo constipation score [6.0 (5.0, 14.0) vs. 3.0 (1.0, 7.0), Z=-2.186, P=0.029], Wexner incontinence score [0 (0, 12.0) vs. 0 (0, 4.0), Z=-2.325, P=0.020] and EQ-5D-5L score [50.0 (35.0, 60.0) vs. 75.0 (65.0, 90.0), Z=-3.360, P=0.001] in the Delorme group were all improved obviously as well. The postoperative morbidity of complication between the two groups was not significantly different [10/48 (20.8%) vs. 4/19 (21.1%), χ²=0.049, P=0.826]. Sixteen patients (28.0%) relapsed after operation, including 10 patients in the Altemeier group and 6 patients in the Delorme group, without statistically significant difference (P=0.134). Conclusions Both the Altemeier and Delorme procedures are effective treatments for rectal prolapse, which can improve the postoperative quality of life. Delorme procedure has the advantages of shorter operation time and faster postoperative recovery in patients with mild prolapse.

Objective: To study the learning curve of laparoscopic pacreaticoduodenectomy (LPD) with a view to find an appropriate way to develop LPD step by step. Methods: 112 consecutive patients who completely underwent LPD in a single surgery center at the First People’s Hospital of Changzhou from December 2015 to February 2018 were retrospectively reviewed. By using both the cumulative sum (CUSUM) and the risk-adjusted CUSUM (RA-CUSUM) methods to analyze the perioperative data of these patients, the learning curve of LPD was studied in a more scientific way. Results: The learning curve could be divided into three phases: Phase 1, the initial period (the initial 45 patients); Phase 2, the enhancement period (the subsequent 31 patients); Phase 3, the maturation period (the remaining patients). For these 3 phases, the corresponding operative times were (448.4±75.0), (381.3±74.3), and (336.2±52.1) min, respectively (P<0.05). The intraoperative blood losses were (373.3±250.1), (332.3±211.6), and (265.3±253.2) ml, respectively (P<0.05). The times to oral intake were 6.0(5.0, 8.0), 5.0(3.0, 6.0), and 3.0(3.0, 5.0) days, respectively (P<0.05). The number of lymph nodes harvested were (10.0±7.0), (8.8±4.3), and (13.3±6.2), respectively (P<0.05). All these showed significant improvement through the 3 phases. On the other hand, the postoperative stays, the postoperative pancreatic fistula rates were also decreased. But these failed to reach statistical significance. Vascular reconstruction was carried out in the 48th patient in phase 2 of the study. Conclusions The initial phase of LPD passed after LPD for 46 patients, but the maturation phase occurred after LPD on 76 patients. Vascular reconstruction should be considered as passing through the learning phase rather than reaching the maturity phase. Adjustments made in the enhancement phase helped to get through the maturation phase earlier.