Abstract:Abstract:Objective:To compare the clinicopathologic characters and survival rates between upper and lower part gastric carcinoma.
Methods :The clinicopathologic data of 73 patients with upper part gastric carcinoma (group U) and 366 patients with lower part gastric carcinoma (group L) were analyzed retrospectively.
Results:The clinicopathologic characteristics in group U were more male patients（P<0.01）, more tumor diameter larger than 5 cm（P<0.05）, more diffused tumor growth（P<0.05）, more T3 and T4 stages （P<0.05）, more N2+N3 stage（P<0.05）, more undifferentiated type（P<0.05） and less patients with degree A excision （P<0.05） than those in group L. Median survival time was 42 months in group U and 60 months in group L, and 5-year survival rate in group U was significantly lower than that in group L（P<0.01）.
Conclusions:The patients in guoup U showed many differences compared with patients in group L, including more male patients, larger tumor diameter, diffused tumor growth, less early stage, later TNM stage, more lymph node metastasis, more undifferentiated type, and less radical operation. The survival rate in group U was significantly lower than in group L. Accordingly, the main treatment for the upper gastric carcinoma should be surgical excision as chief component of combined therapy.

Abstract:Abstract:Objective:To study the regulatory factors of perigastric and para-aortic lymph node(LN) metastasis in gastric adenocarcinoma.
Methods :Immunohistochemical staining for the expressions of survivin, p53, C-erbB-2, PCNA, Ki-67, MMP-2, MMP-7 and MMP-9 was done and those were used to analyse the relation with lymph node metastasis by analysis of single and multiple variables.
Results:The average number of metastasized LN was (5.61±0.68)/case in 238 cases, which was（27.78±24.45）% as an average rate of LN metastasis. The LN metastasis was found in 207 of the 238 cases(total metastasized rate: 86.97%). Among 53 cases with D3 operation, 13 cases(24.53%) had para-aorta LN metastasis. The average number of para-aorta LN harvested was (6.36±1.83)/case. There were 58 metastasized para-aortic LN, an average of (4.46±2.05)/case. The metastasized rate of para-arota LN was 24.52%. The combined positive expressions of p53 and survivin had significant relation with LN metastasis (P<0.01) by single analysis and was an independent risk factor for perigastric LN metastasis by multiple analysis. The Ki-67 labeling index(LI) and the MMP-2 expression indicated para-aortic LN metastasis (P<0.05, respectively) and were independent risk factors for para-aortic LN metastasis.
Conclusions:The combined expressions of p53 and survivin could be used as predictive factors for LN metastasis. Ki-67LI and MMP-2 expression are predictive factors and independent risk factors for para-aorta LN metastasis.

Abstract:Abstract:Objective:To explore the operative procedure and perioperative management of gastric cancer with liver cirrhosis.
Methods :Clinical data of 28 cases of gastric cancer with liver cirrhosis who were surgically treated in our hospital during the last seven years were retrospectively analyzed. Preoperatively, a detailed examination, and improvement of their nutritional status, liver function, and prothrombin time were aggressively made, and the possibility of tumor removal was estimated. Seven patients underwent radical proximal subtotal gastrectomy, and 4 of these cases underwent splenectomy and pericardial devascularizaion simultaneously. Five cases underwent total gastrectomy, and 3 of them had splenectomy and pericardial devascularizaion simultaneously. Twelve patients underwent radical distal subtotal gastrectomy, and 5 of these cases had splenectomy and suture of pericardial varices simultaneously. Four patients had palliative distal subtotal gastrectomy. The support of liver function and intense monitoring and management of complications were carried out postoperatively.
Results:Varying degrees of ascites occurred in all the 28 patients postoperatively, and other complications such as early liver coma occurred in five patients, extensive wound bleeding in three patients, left subdiaphragmatic abscess in one patient and wound infection in two patients. The morbidity rate was 100%(28/28). However, all the complications were recovered by non-surgical treatment. There were no perioperative deaths in this series.
Conclusions:Gastric cancer patients with liver cirrhosis are at a significant risk of developing postoperative complications. The surgical procedure should the “individual” principle based on liver function, history of upper gastrointestinal bleeding and the location of gastric carcinoma. Good hepatic reserve and perioperative care, meticulous hemostasis during operation, and prevention and treatment of postoperative complications are the likely determinants of operative prognosis.

Abstract:Abstract:Objective:To explore the value of CT in the preoperative assessment of resectability of advanced gastric carcinoma.
Methods :The relation of CT findings and operative data in 93 cases of advanced gastric carcinoma were retrospectively analyzed.
Results:There were 23 cases of fundus and cardia carcinoma, 59 cases of carcinoma of gastric corpus, and 11 cases of carcinoma of antrum. All cases showed increased thickness of gastric wall in various degrees, some of the cases showed tumor growth in the gastric wall, ulcer of the mucosa, stricture of gastric cavity and cardia, increased thickness of cardiac wall, and invasion of lower esophagus and perigastric organs.The accuracy of location and definitive diagnosis by CT, compared to gastroscopic biopsy and postoperative pathology, was considerable, and the detecting rate of tumor by CT was 100 %.CT had important reference value in preoperative evaluation of tumor resectability.The excision rate in the predicted operable group was 93.3 %; in the predicted unresectable group, the non-excision rate was 75.0%.
Conclusions:Preoperative CT diagnosis of gastric carcinoma has important clinical significance. CT provides a high reference value for assessing the resectability of gastric carcinoma, and it is worthy of widespread use.

Abstract:Abstract:Objective:To explore the safety and feasibility of laparoscope-assisted radical gastrectomy for gastric cancer.
Methods :Fifty-four cases of gastric cancer were selected to carry out laparoscope-assisted radical gastrectomy, including 12 radical total gastrectomies, 18 proximal gastrectomies, and 24 distal gastrectomies. Lymphonodes were dissected by D1 in 29 cases and D2 in 25 cases.
Results:All of the 54 operations were performed successfully. The average operative time was （164.4±38.7） min in total gastrectomies, （142.4±35.2） min in proximal gastrectomies, and （149.1±35.4） min in distal gastrectomies. The mean volume of bleeding was (164.6±80.1) mL in total gastrectomies, (149.5±94.7) mL in proximal gastrectomies, and (152.5±87.7) mL in distal gastrectomies. The average number of lymphonodes dissected was 19.1±6.5 per case. After operation, the mean time of passage of gas via anus was (3.7± 0.7) d, and the mean length of hospital stay was (9.2±1.7) d. Two cases experienced postoperative anastomotic bleeding, and was controlled by conservative treatment. No other complications, such as anastomotic leakage, anastomotic obstruction, or duodenal stump leakage were experienced.
Conclusions:This results reveal that laparoscope-assisted radical gastrectomy is safe and feasible for gastric cancer. As long as the principles of cancer surgery are strictly followed, it can maintain radical tumor removal and exhibit the character of minimal invasion.

Abstract:Abstract:Objective:To study the risk factors of postoperative gastroparesis syndrome（PGS） after operaton for gastric cancer.
Methods :The clinical data of 486 gastric cancer cases who underwent operation during recent 6 years were analyzed with binary logistic regression.
Results:There were 43 （8.85%）cases of PGS after operation for gastric cancer. Among 11 factors,5 factors were proved to be risk factors for PGS after operaton by analysis of single and multiple variables. Those were preoperative pyloric obstruction, distal radical subtotal gastrectomy,postoperative hyperglycemia,postoperative abdominal cavity infection and hypoproteinemia in perioperative period. Serum albumin level >30 g/L was protective factors for prevention of PGS after operation for gastric cancer.
Conclusions:PGS is affected by many factors after operation for gastric cancer. It is important to pay attention to perioperative management in preventing the onset of PGS.

Abstract:Abstract:Objective:To investigate the effect of short-term neoadjuvant chemotherapy (NC) with 5-FU/CF on tumor cell apoptosis, tumor cell proliferation, expression of p53, postoperative complications and prognosis of colorectal carcinoma.
Methods :Apoptosis index (AI) of tumor cells was assayed by TUNEL, proliteration index (PI) and expression of p53 were examined by immunohistochemical S-P method in 68 colorectal carcinoma samples，while postoperative complications and prognosis were compared in NC groups and non-NC control group.
Results:AI in NC group（x=3.56% ）was significantly higher than that in control group（x=2.29%）（P＜0.01）.PI in NC group（22.60%） was significantly lower than that in control group（33.60%）（P＜0.01）.The p53 positive expression rate in NC group（28.9%，11/38） was significantly lower than that in control group（56.7%，17/30）（P＜0.05）. There was no significant difference in the occurrence rate of postoperative complications between NC group and control group. There was significant negative association between AI and PI in both groups（r=-0.790;r=-0.663）（P＜0.01）. There was significant difference in the rate and average time of recurrence and metastasis between NC group and control group（P＜0.05）.
Conclusions:Short-term neoadjuvant chemotherapy with 5-FU/CF could significantly induce cell apoptosis, inhibit tumor cell proliferation and decrease the positive rate of p53 expression in carcinoma of large intestine. Short-term 5-FU/CF neoadjuvant chemotherapy could delay and decrease the postoperative recurrence and metastasis in colorectal carcinoma without increasing the occurrence of postoperative complications.

Abstract:Abstract:Objective:To study the relationship of the site of original tumor and the local infiltraton of colon carcinoma with lymph node metastasis, in order to provide a basis for better surgical therapy for patients with colon cancer.
Methods :The pathological and clinical data of 118 cases of the colon carcinoma were recorded and analyzed. The invasive depth of tumor was divided into T1, T2, T3, and T4 stage according to AJCC standard. The lymph node stage was determind according to our country′s and Japanese′s standard.
Results:Of 118 cases, 49 cases (41.5%) showed LN metastasis. In a total retrieved and examined 1824 LNS (average of 15.29 lymph nodes per case), 277 lymph nodes (15.2%) showed metastasis. In three groups of the pericolon lymph nodes (Group 0~5 cm, Group 5~10 cm, and Group >10 cm respectively from the tumor), the metastatic rate of lymph nodes was 34.7%, 2.5% and 1.7%, respectively. The metastatic rate of LN in right colon was significantly higher than that in left colon (52.0% vs 33.8%, P<0.05). All cases were divided into four groups (T1, T2, T3, and T4), based on the depth of tumor invasion. The metastatic rate of N1，N2, N3 and N4 was 18.2％, 9.1%, 4.5% and 0.0% in Group T2; 40.8%,18.4%, 8.2% and 2.0% in Group T3;The LN metastasis of
and 53.8%, 28.2%, 12.8% and 5.1% in Group T4, respectively. There was significant difference among the group T2, T3, and T4 (P<0.01).
Conclusions:As the depth of tumor invasion is increased, the metastatic rate of lymph nodes is markedly increased. The metastasis of pericolon lymph nodes is mainly in those nodes located within 0~5 cm of the tumor, but rarely in those nodes located more than 10 cm from the tumor. The metastatic rate of lymph node in right colon cancer is significantly higher than that in left colon cancer. D3 radical resection is necessary for colon carcinoma and dissection of the central lymph nodes should especially be carried out. The length of excised bowel should be 10 cm above and below the tumor.

Abstract:Abstract:Objective:To analyze the outcome of patients with acute obstruction of left colorectal cancer treated by modified antegrade colonic lavage with primary tumor resection and anastomosis.
Methods :From April 2002 to April 2007, 112 patients with acute obstruction of left colorectal cancer underwent surgery. During the operation the left colon was exteriorized and placed into a sterilized plastic bag to protect the surgical field from contamination, then a catheter was inserted via the appendix, and after antegrade colonic lavage, primary resection and anastomosis was performed.
Results:Tumor resection and primary anastomosis was successfully done in the 112 cases. Postoperatively, 1 case had anastomotic leak which healed after reoperation with proximal colostomy, and one patient died.
Conclusions:Modified antegrade colonic lavage is a simple procedure, the bowel can be rapidly decompressed with essentially no contamination, and has a high level of bowel cleansing. It is possible to safely perform primary resection and anastomosis for left colon cancer after the modified antegrade lavage.

Abstract:Abstract:Objective:To evaluate the value and safety of the anterior transsphincteric operation for treating rectal villous adenoma.
Methods :The clinical data of 17 cases with rectal villous adenoma, including 6 cases with malignant change, operated by anterior transsphincteric approach at Changzheng hospital, from February 2000 to August 2006, were analyzed retrospectively. The distance between the anal verge and the lower margin of the tumor was 5～ 8 cm（average 7 cm）.The tumors were 2～ 5 cm in diamater.
Results:The rectal villous adenoma was completely removed with negative resection margins in all the 17 patients. Fecal continence，urinary function and sexual function were preserved successfully in all the patients. No postoperative complications developed．The postoperative pathological stage of rectal villous adenoma with malignant change was pTisN0M0 in 3 cases，pT1N0M0 in 2， and pT2N0M0 in 1．At a median follow-up of 46 months，no patients had recurrence.
Conclusions:Anterior transsphincteric approach is useful and safe for operation of rectal villous adenomas and those with early mmalignant change. It is particularly valuable for large midrectal villous adenoma.

Abstract:Abstract:Objective:To study the relationship between the molecular biology and the clinicopathologic characters with prognosis of colorectal cancer.
Methods :The molecular biology traits and clinical characters and prognosis of 317 colorectal cancer patients were compared by mono-factorial analysis; some of them regarded as statistical difference by mono-factorial analysis were analyzed with Cox model.
Results:There was statistical difference for the p53,C-erb-2,nm23,CEA,cell differentiation and Dukes stages with Kaplan-meier′s method (P>0.05). p53,C-erb-2,nm23 and Dukes stages with Cox model (P>0.05). The prognosis was worse with increase in Dukes stage, negative expression of gene nm23, and positive expression of gene p53 and C-erb-2. Reverse expressions had better prognosis.
Conclusions:It can be likely to get a more reliable prognosis predication if a combine examination together with p53, C-erb-2, nm23 and their clinical pathology such as Dukes stages, was done in colorectal cancer patients.

Abstract:Abstract:Objective:To study the effect of adenoviral vector expressing human IFNγ for transfecting human monocyte-derived DC (Ad-IFNγ-DC) on T cells prolifortion and differatition, and detect the anti-colonic cancer LoVo cells ability of actived T cells.
Methods :The recombinant adenovirus vector carrying IFNγ gene(Ad-IFNγ) was constructed using Adeno-XTM Expession System, then it was transfected into human monocyte-derivion DC(Ad-IFNγ-DC). After transfected, the IFNγ protein expression and cytokines secretion by DC were detected with LiquidChip method, the DC phenotypes were assayed with flow cytometry analysis, and the phagocytic ability of DC was assayed using FITC-Dextran uptake method. Subsequently, the capability of antigen pulsed Ad-IFNγ-DC to promote T cell proliferation and differentiation was detected using 3H-TdR incorporation and RT-PCR/ELISA method respectively. Finally, the ability of T cells to kill LoVo cells was detected with LDH release methods.
Results:Ad-IFNγ did not impact the phagocytic function of DC even after 24 h of transfection. DC transfected with Ad-IFNγ expressed IFNγ protein significantly stimulated T cells proliferation and enhanced T cells differatiated to TH1 cells, the which had especial kill ability of LoVo cells wa.
Conclusions:Ad-IFNγ transfection can promote DC maturation, enhance its capacities of antigen presentation and T cells stimulation, induce Th1 polarization and strong anti-LoVo cell immunities. These suggest that intratumoral administration of Ad-IFNγ-DC can eradicate tumors through a T cell-dependent mechanism.

Abstract:Abstract:Objective:To observe the effect of PKB gene silencing on the growth of gastric cancer cell line SGC-7901 in vitro.
Methods :Gene transfection technique was used to transfect AKt2 siRNA into gastric cancer cells. Akt2 expression was detected by RNAi technique, Akt2 protein level was detected by Western blot, and the change of cell cycle distribution and apoptosis of SGC-7901 cells were detected by flow-cytometry, SGC-7901 proliferation was measured by MTT method.
Results:After SGC-7901 cells transfected with Akt2 siRNA, the expression of protein level decreased obviously (P＜0.01）. Compared with control group, the transfected group had more SGC-7901 cells accumulated at G2/M phase, and proliferation rate was reduced (P＜0.01）. It also showed that the transfected group had apoptosis ladder, and the cell growth concentrated at G2/M phase.
Conclusions:siRNA targeting Akt2 could inhibit the proliferation of SGC-7901 cells in vitro. Induction of apoptosis and inhibition of PI3/K signaling pathway may be involved in its mechanism. Akt2 could be a novel target for gene therapy of gastric cancer.

Abstract:Abstract:Objective:To study the effect of macrophage migration inhibitory factor(MIF) on cell proliferation and angiogenesis of human colon carcinoma.
Methods :Effect of different concentrations of Anti-human MIF antibody(Anti-MIF) on cell proliferative and expression of vascular endothelial growth factor(VEGF) of human colon carcinoma cell line HCT-116 cells was examined.
Results:After HCT-116 cells were exposed to Anti-MIF (100，200，400，and 800 μg/L)for 48 and 72 h, HCT-116 cells growth was strongly inhibited in a dose and time-dependent manner;After exposure of the cells to Anti-MIF (100，200，400，and800μg/L) for 72 h，FCM analysis showed the ratio of G0/G1 phase cells increased,and the ration of S and G2/M phase cells decreased. Comparison with the negative group, the expression of VEGF after the cells exposure to Anti-MIF for 72h were significantly decreased, and was in dose-dependent manner （P＜0.05）.
Conclusions:MIF participates can modulat the cell growth cycle and can affect tumor neovascularization via VEGF. MIF plays an important role in the pathogenesis of colon carcinoma.

Abstract:Abstract:Objective:To determine the changes of gene expression profile in small intestinal allograft in rats after ischemic preconditioning (IPC), and to study the mechanism of graft protection of IPC.
Methods :Rats are randomly divided into 3 groups: sham operation (S group), small bowel transplant (SBT group) and IPC small bowel transplant group (ISBT group). Total RNAs was extracted from intestine of the 3 groups 1h after the intestine remored and cold preservation/reperfusion, and then purified to mRNA. mRNAs was then reversely transcribed to cDNA and to prepare hybridization probes. The mixed probes were hybridized to the cDNA microarray.After high-stringent washing, the fluorescent signals on cDNA microarray were scanned and analyzed.
Results:Among the 4 096 target genes, 297 differentially expressed genes were identified between normal intestine and intestinal allograft in ISBT group; among those 84 genes which have been reported, including 18 genes expressing down and 66 genes expressing up regulation. Differentially expressing genes could be related to the protective effect of IPC.
Conclusions:The mechanisms of protective effect of IPC on cells of the graft are by modulation of genes related to cell adhesion, related to cellular energy and metabolism, and related to the signal transmission of the cells.

Abstract:Abstract:Objective:To investigate the changes of TLR4 expression in ileum of the rat after ischemia/reperfusion (I/ R) injury, and the relationship between TLR4 gene expression and TNF-α、IL-6 level in blood of portal vein.
Methods :A totol of 90 adult male SD rats were randomized into 3 groups: normal control group(n=10), sham-operated group(n=40) and ileum ischemia / reperfusion group(n=40).Animals were sacrificed after undergoing ileum ischemia/reperfusion injury for 6、12、24 and 48 h，and expression of TLR4 mRNA was determined by RT-PCR. Meanwhile, blood in portal vein was obtained to assay TNF-α and IL-6 concentration in plasma.Correlation analysis between TLR4 mRNA and TNF-α、IL-6 levels was made. Expression of TLR4 in ileum was evaluated with immunohistochemistry.
Results:The expression of TLR4mRNA in ileum and TNF-α and IL-6 level in portal vein plasma was significantly higher in experimental group, compared with sham group (P<0.05). TLR4mRNA expression peaked at 12 h after I/ R injury, and TNF-αand IL-6 concentration peaked at 24h. TLR4mRNA expression and TNF-αand IL-6 level showed significant relativity(r=0.812 and 0.752). Immunohistochemical exam showed TLR4 was mainly expressed in ileum mucous membrane.
Conclusions:Expression of TLR4 in ileum was up-regulated after I/ R injury in rat, and that could be one of the mechanisms of intestinal mucosal barrier function injury, as well as the trigger for initiation of systemic inflamatory response syndrome(SIRS).

Abstract:Abstract:Objective:To study the diagnosis and treatment of acute gastric dilatation.
Methods :The clinical data of 19 cases of acute gastric dilatation treated in the past 35 years in our hospital were retrospectively analyzed.
Results:Of 19 patients, 11 were misdiagnosed. Fifteen patients underwent operation, including gastrostomy (6 cases), gastrotomy (4 cases), partial gastric fundus resection (2 cases), others operations (2 case), and laparotomy exploration (1 case); among them four patient died. Four patients received conservative treatment and one of them died. The conservative therapy for acute gastric dilatation consisted of nasogastric decompression and fluid resuscitation.
Conclusions:Acute gastric dilatation is rare, rapidly progressive and fatal acute abdomeninal condition with atypical clinical manifestations and high misdiagnosis rate. If conservative therapy fails or typical signs of peritonitis are present, aggressive surgical intervention would be the best choice.

Abstract:Abstract:Objective:To assess the value of detecting bacterial DNA in rats′ blood with PCR technique for early diagnosis of jejunojejunal anastomotic leakage and ileaoileal anastomotic leakage.
Methods :Fifty healthy female Wistar rats were randomly divided into five groups:Group A(n=10), sham operation group; Group B(n=10), jejunojejunal anastomosis group; Group C(n=10), jejunojejunal anastomotic leakage group; Group D(n=10) ileaoileal anastomosis group, Group E(n=10), ileaoileal anastomotic leakage group.Group B and D rats had a complete anastomosis (end-to-end single layer anastomoses with 0# silk sutures).Group C and E rats had an anastomosis with a 5mm opening in intestinal anastomosis anterior wall. Group B and C rats had 3 cm jejunum resection at 15 cm from the Treitz ligament. Group D and E rats had 3 cm ileum resection at 15 cm proximal to the ileocecal junction. Pre-and post-operative venous blood, and postoperative ascites samples were collected. DNAs was extracted from these blood and ascites samples, and PCR techniques were used to amplify lacZ genes and 16S ribosomal RNA genes(16SrRNA genes).
Results:(1) Comparing Group B with Group C, or Group D with Group E,there was no difference in positive ratio of lacZ genes in peripheral blood (PB) (P>0.05), but the positive ratio of 16SrRNA genes expression in PB in Group C and Group E was significantly higher than that in group B and Group D respectively (P<0.05). (2) In ascites samples,the positive expressing ratios of lacZ genes and 16SrRNA genes in Group C and Group E were both higher than in Group B and Group D(P<0.05); In jejunal anastomotic leakage and ileal anastomotic leakage groups, the positive ratios of lacZ genes in ascites were higher than the positive ratios in PB(P<0.05); but there were no significant differences between the the positive ratios of 16SrRNA genes in ascites and in PB (P>0.05).
Conclusions:(1) Detecting 16SrRNA genes from PB with PCR has certain significance for early diagnosis of jejunal anastomotic leakage and ileal anastomotic leakage, (2) PCR might be a useful tool for early diagnosis of jejunal anastomotic leakages and ileal anastomotic leakages by detecting lacZ genes or 16SrRNA genes from ascites.

Abstract:Abstract:Objective:To study the management of enterostomy in children.
Methods :The clinical data of 425 cases of enterostomy in children were analyzed retrospectively.
Results: The primary diseases of 425 cases underwent enterostomy included: intestinal perforation (119 cases), intestinal necrosis (36 cases), necrotizing enterocolitis (45 cases), congenital megacolon (61 cases), congenital anal atresia with rectourethral fistula (86 cases), and congenital anal atresia with rectovaginal fistula (78 cases). Among the 425 cases, 159 cases underwent small bowel enterostomy and 266 cases had colostomy; single-stoma enterostomy was done in 225 cases, and double-stoma enterostomy in 197 cases. Follow-up was acquired in 389 patients，and all the stomas were closed successfully. The closure time of small bovvel enterostomy was 1-3 month (ayerage 1.87 months) later, and of colostomy was 3-12 month (averag 4.95 months) later.
Conclusions:When an enterostomy is to be adopted in pediatric surgery, a suitable time and enterostomal location should be chosen according to the state of illness. The timing of enterostomy closure is also very important.

Abstract:Abstract:Objective:To investigate the role of multislice spiral CT in diagnosing adhesive intestinal obstruction.
Methods :Whole abdominal multislice spiral CT scanning was performed in 35 cases of adhesive intestinal obstruction that were confirmed by operation. The CT signs were retrospectively analyzed and were evaluated in accordance with operative and pathologic results.
Results:All patients were identified to have intestinal obstruction on CT. For 31 patients with single site of obstruction, the site of obstruction was accurately identified on CT in all the pationts; for 4 patients with multiple site of obstruction, 9 of 11 obstruction sites were accurately identified on CT. Among 26 cases of non-carcinoma adhesive intestinal obstruction, 23 cases had corresponding CT signs to support the diagnosis; among 9 cases of carcinoma adhesive intestinal obstruction, 5 had direct signs of carcinoma adhesions on CT, and 2 had signs indicating the recurrence of carcinoma. The CT signs indicating intestinal strangulation were as follows: “beak sign”, “target sign”, poor or no contrast enhancement of the bowel wall, “whirl sign”, mesenteric vascular engorgement, mesenteric haziness, ascites, and “C” or “U” shaped loops. When the presentation of 2 or more signs listed above was used as the standard to diagnose the strangulated intestinal obstruction, it had a sensitivity of 93.3%, specificity of 87.5% and accuracy of 91.4%.
Conclusions:Multislice spiral CT is very useful in the diagnosis of adhesive intestinal obstruction, and is a helpful guide for the clinical management of adhesive intestinal obstruction.

Abstract:Abstract:Objective:To explore the diagnostic value of spiral CT for the intestinal obstruction of unknown causes.
Methods :The CT findings of 115 intestinal obstructive patients with unknown causes were analyzed retrospectively.
Results:Of the 115 patients, the diagnosis of intestinal obstruction was comfirmed by CT in 110 cases patients, the correct diagnostic rate was 95.7%.
Conclusions:Abdominal CT is a rapid、simple and effective means for diagnosis of the location、cause and degree of obstruction in cases of intestinal obstruction with unknown cause. It can act as an important basis for the treatment program by doctors.

Abstract:Abstract:Objective:To discuss the value of tension-free hernia repair for umbilical hernia in adults.
Methods:Fourty-five adult patients with umbilical hernia were treated with tension-free hernia repair，including mesh plug-patch in 29 cases and prolene hernia system in 16 cases. The operative procedure, postoperative pain, patient′s ability recovery time, and complication and recurrence rate were studied.
Results:All cases were operated successfully. The mean operation time was 60 min. The only postoperative complications were 4 cases of subcutaneous seroma. The follow-up period ranged from 6 to 48 months and no recurrence was observed.
Conclusions:Tension-free hernia repair is a better surgical operation for umbilical hernia in adults, and it has many advantages, such as safety, rapid recovery, good early therapeutic effect and lower recurrence rate.