Abstract:In recent years, laparoscopic spleen-preserving splenic hilar lymph node dissection has gradually been appreciated and applied in clinical practice with the increasing acceptance of the concepts such as organ-function preservation and minimally invasive surgery. However, because of the complexity of the anatomy of the splenic hilus, mastering the technical essentials and tips of laparoscopic spleen-preserving splenic hilar lymph node dissection is critical for successful completion of the operation.

Abstract:The ninth national conference of hernia and abdominal wall surgery was held in Guangzhou from 7 to 9 July 2016. The authors review and summarize the main focuses of the conference and analyze the current status and new perspectives of hernia surgery in China. It is pointed out that the development of hernia surgery cannot be achieved without the improvement and standardization of surgical procedures and application of new materials, and particularly the academic discussion and communication. It is believed that this conference will play a significant role in facilitating clinical diagnosis and treatment as well as basic research of hernia surgery.

Abstract:Objective: To evaluate the efficacy and safety of using 3D laparoscopic technique in gastric carcinoma surgery. Methods: The randomized clinical trials regarding using 3D laparoscopic technique in gastric carcinoma surgery were collected by searching several national and international online databases. Article screening, data extraction and quality assessment were performed by two independent reviewers according to the defined inclusion and exclusion criteria, and then, Meta-analysis was performed by using RevMan 5.2 software. Results: Seven studies were finally included with 650 patients. Results of Meta-analysis showed that the operative time was shortened (MD=–0.59, 95% CI=–0.76––0.42, P<0.000 01), and intraoperative blood loss was reduced (MD=–0.56, 95% CI=–0.73--0.39, P<0.000 01), while hospitalization expense was increased (MD=378.42, 95% CI=171.81–585.04, P=0.000 3) in 3D laparoscopic surgery compared with control group (2D laparoscopic surgery). Results of the included studies indicated that other efficacy parameters and safety of 3D laparoscopic surgery had no significant difference compared with control group (all P>0.05). Conclusion: 3D laparoscopic assisted surgery for gastric carcinoma has advantage in terms of operative duration and blood loss, and it also has better surgical safety, but the hospitalization cost may increase.

Abstract:Objective: To evaluate the effectiveness and safety of neoadjuvant chemotherapy containing docetaxel in treatment of advanced gastric cancer. Methods: The relevant literature was collected by searching several national and international databases. According to the inclusion and exclusion criteria, the eligible randomized controlled trials (RCTs) were selected. After data extraction and the quality assessment, Meta-analysis was performed by using RevMan 5.3 software. Results: A total of 10 RCTs was included involving 845 patients. Results of Meta-analysis for overall group showed that in study group (undergoing neoadjuvant chemotherapy containing docetaxel combined with surgery) compared with control group (undergoing surgery only or neoadjuvant chemotherapy without docetaxel combined with surgery), the R0 resection rate (OR=1.90, 95% CI=1.28–2.81, P=0.001) and overall response rate (OR=1.92, 95% CI=1.05–3.51, P=0.03) were significantly increased, while no statistical difference was noted in surgical resection rate (OR=1.59, 95% CI=0.93–2.73, P=0.09) and incidence of postoperative complications (OR=1.01, 95% CI=0.65–1.59, P=0.95); results of subgroup analysis showed that the R0 resection rate had no statistical difference between patients undergoing preoperative neoadjuvant chemotherapy containing docetaxel and those undergoing preoperative neoadjuvant chemotherapy without docetaxel (P>0.05). Conclusion: Neoadjuvant chemotherapy containing docetaxel can improve the radical resection rate and overall response rate without increase of complications, so it has better efficacy and safety.

Abstract:Objective: To investigate the relations of preoperative neutrophil to lymphocyte ratio (NLR) with clinicopathologic characteristics and prognosis of patients with gastric cancer. Methods: The clinicopathologic and follow-up data of 269 patients with gastric cancer treated in the First Affiliated Hospital of Anhui Medical University between January 2010 and January 2011 were retrospectively analyzed. The cutoff value of NLR was 2.4 (susceptibility: 53.3%, specificity: 71.4%) that was determined by receiver operating characteristic curve, and then, according to that, the patients were divided into low NLR group (NLR<2.4, 153 cases) and high NLR group (NLR≥2.4, 116 cases). The differences in clinicopathologic characteristics and survival rates between the two groups of patients were compared, and the prognostic factors for gastric cancer patients were also analyzed. Results: The results of comparison showed that there was no significant difference in age, gender and lymph node metastasis between the two groups (all P>0.05), but the tumor diameter was larger, depth of tumor invasion was deeper, and TNM stage was higher in high NLR group than those in low NLR group (all P<0.05). The overall 5-year survival rate was 44.3% for the entire group, and the results of survival analysis showed that the overall survival rate in high NLR group was significantly lower than that in low NLR group (χ2=17.511, P<0.01). Univariate analysis indicated that the overall survival of the gastric cancer patients was significantly associated with preoperative NLR, tumor size, the depth of tumor invasion and TNM stage (all P<0.05), and multivariate analysis identified that preoperative NLR and tumor size were independent risk factors for the prognosis of gastric cancer patients (both P<0.05). Conclusion: Preoperative NLR is an independent prognostic factor for gastric cancer patients, and high preoperative NLR may associated with unfavorable clinicopathologic conditions and poor prognosis.

Abstract:Objective: To investigate the clinical effect of using pelvic autonomic nerves as anatomical landmarks to plot a safe surgical plane for performing laparoscopic total mesorectal excision (TME). Methods: The clinical data and operation videos of 157 male patients who underwent laparoscopic low rectal resection between January 2010 and December 2015 were retrospectively analyzed. Of the patients, 81 cases treated after 2012 were categorized as observation group, who underwent TME using pelvic autonomic nerves as landmarks which were dissected and freed through medial approach, and digestive tract reconstruction by double-stapling technique; 76 cases treated before 2012 served as control group who underwent surgery without using the above anatomical landmarks. The relevant surgical variables as well as postoperative urinary and sexual function between the two groups were compared. Results: In observation group compared with control group, the intraoperative blood loss was significantly reduced (14.9 mL vs. 26.5 mL), the rate of level-3 operation quality was significantly elevated (89.2% vs. 59.6%), the number of resected lymph nodes was significantly increased (19 vs. 15), and the incidence of postoperative erectile dysfunction (2.3% vs. 4.5%) and urinary retention (6.2% vs. 10.5%) were significantly decreased, all the differences had statistical significance (all P<0.05). Conclusion: Using pelvic autonomic nerves as anatomical landmarks for TME can achieve maximally complete mesorectal resection and meanwhile reduce pelvic splanchnic nerves injuries. In addition, it may help to standardize and improve the technique of laparoscopic TME in low rectal cancer surgery.

Abstract:Objective: To explore the clinical effect of imatinib targeted therapy on high risk gastrointestinal stromal tumor (GISTS). Methods: The clinical data of 56 patients with high risk GIST undergoing imatinib targeted therapy from January 2010 to June 2015 were reviewed, and the therapeutic efficacy was analyzed. Results: Nineteen patients, who had no chance of surgical resection, received imatinib (400 mg/d) therapy for 6 to 8 months, and of them, none achieved complete response (CR), 14 cases obtained partial response (PR), 4 cases had stable disease (SD), and one case presented progressive disease (PD); 7 PR cases (36.8%) obtained a chance for tumor resection. Thirty-five patients received imtinib (400 mg/d) treatment for one year after surgical resection, and of them, recurrence occurred in 3 cases (8.6%) during follow-up and the one-year recurrence rate was 8.6%; 2 cases did not continue to take the medication and their results could not be determined. Conclusion: Imatinib has significant efficacy in GIST patients, and in those with high risk GIST, its preoperative neoadjuvant chemotherapy may offer a chance of surgical resection for the unresectable tumors, and its postoperative adjuvant chemotherapy may improve the tumor-free survival with tolerable adverse effects.

Abstract:Objective: To compare the clinical efficacy of robotic-assisted colorectal surgery (RCS) and laparoscopic colorectal surgery (LCS). Methods: After systematic retrieval in literature databases, the eligible literature of studies was screened out according to the inclusion and exclusion criteria, and then Meta-analysis was performed by using Review Manager 5.2. Results: A total of 9 studies involving 879 patients were finally included, with 416 cases in RCS group and 463 cases in LCS group. Results of Meta-analysis showed that in RCS group compared with LCS group, the operative time (WMD=65.06, 95% CI=37.14–92.99) was significantly prolonged, but no significant difference was noted in terms of intraoperative blood loss (WMD=–11.55, 95% CI=–32.31–9.21), pain score at postoperative 24 h (WMD=–0.08, 95% CI=–0.55–0.39), time to first flatus (WMD=–0.04, 95% CI=–0.21–0.13), time to first food intake (WMD=–0.08, 95% CI=–0.41–0.25), length of hospitalization (WMD=–0.67, 95% CI=–1.50–0.17), conversion rate (OR=0.60, 95% CI=0.21–1.75) and incidence of complications (OR=1.04, 95% CI=0.67–1.60) (all P>0.05). Conclusion: RCS has similar safety and effectiveness as LCS, and has advantages of clearer and greater stereo operation field, better operational flexibility and alleviating surgeons’ physiological fatigue. So it deserves to be used in clinical practice.

Abstract:Objective: To investigate the affecting factors for lymphovascular tumor cell invasion and its relation with prognosis in patients with stage II colon cancer. Methods: The clinicopathologic data of 152 patients with stage II colon cancer who underwent radical surgery in the Fourth Affiliated Hospital of China Medical University from January 2007 to August 2010 were collected. The relations of lymphovascular tumor cell invasion with clinicopathologic variables and the prognostic factors of the patients were analyzed. Results: The 5-year overall survival rate in the whole group of patients was 73.7%, which in patients with IIa, IIb and IIc disease was 79.6%, 73.3% and 65.8%, respectively. Statistical analysis showed that lymphovascular tumor cell invasion was significantly associated with tumor site, degree of differentiation and T stage of colon cancer (all P<0.05). Univariate analysis indicated that degree of differentiation, positive surgical margin, lymphovascular tumor cell invasion, number of detected lymph nodes and T stage were prognostic factors for patients with stage II colon cancer (all P<0.05); multivariate analysis identified that T stage, positive surgical margin and lymphovascular tumor cell invasion were independent prognostic factors for patients with in stage II colon cancer (all P<0.05). The 5-year survival rate in patients with positive lymphovascular invasion was significantly lower than in those without lymphovascular tumor cell invasion (52.7% vs. 85.6%, P<0.05). In addition, the 5-year survival rate in cases with positive lymphovascular tumor cell invasion undergoing chemotherapy was significantly higher than in those without chemotherapy (60.7% vs. 44.4%, P<0.05). Conclusion: In patients with stage II colon cancer, lymphovascular tumor cell invasion is related to tumor site, degree of differentiation and T stage, which is an independent risk factor for their prognosis. Adjuvant chemotherapy is recommended for stage II colon cancer patients with positive lymphovascular tumor cell invasion.

Abstract:Objective: To investigate the efficacy of stent placement for acute intestinal obstruction combined with advanced colorectal cancer and widespread metastases. Methods: The clinical data of 67 patients with acute intestinal obstruction and colorectal cancer with widespread metastases treated from March 2005 to September 2011 were retrospectively analyzed. Of them, 30 cases received stent placement (stent placement group) and 37 cases underwent conventional emergency surgery (conventional surgery group). The clinical variables between the two groups of patients were compared. Results: In stent placement group, compared with conventional surgery group, the surgical success rate (86.7% vs. 97.3%), operative time (4.32 h vs. 4.78 h) and postoperative mortality within 30 days (0.0% vs. 11.1%) showed no statistical difference (all P>0.05), but the intraoperative blood loss (76.6 mL vs. 274 mL), length of hospital stay (6.7 d vs. 15.5 d) and overall incidence of complications (19.2% vs. 52.8%) were significantly reduced (all P<0.05). There was no significant difference in median survival time (11.4 months vs. 10.7 months) between stent placement group and conventional surgery group (P<0.05). Conclusion: Stent placement has demonstrable efficacy in treatment of acute intestinal obstruction combined with advanced colorectal cancer, with better curative effect, and is safe and more reliable, so it is recommended to be used in clinical practice.

Abstract:Objective: To investigate the photodynamic killing effect mediated by Cu-Cy under X-ray activation on human colon cancer SW620 cells in vitro and the mechanism. Methods: SW620 cells were exposed to different concentrations of Cu-Cy (0–100 mg/L) in combination with or without low dose of X-ray radiation, and then, the cell viability was examined by CCK8 assay and light microscopic observation, mitochondrial membrane potential was detected by JC-1 dye, apoptosis was measured by Annexin V/PI double-staining, the expressions of apoptosis-associated protein Bax and Bcl-2, and autophagy-associated protein LC3B and P62 were determined by Western blot analysis, and cell ultrastructure was observed by transmission electron microscopy. Results: In SW620 cells compared with blank control SW620 cells (without Cu-Cy treatment and X-ray radiation), the cell viability was significantly reduced with certain concentration-dependent manner (part P<0.05), and meanwhile, the ratio of cells with decreased mitochondrial membrane potential and the apoptotic rate were significantly increased, the expression levels of Bax and LC3B-II were significantly increased while the expression levels of Bcl-2 and P62 were significantly decreased (all P<0.05), and the intracellular autophagosomes were remarkably increased; all above indexes showed no significant change in those cells that underwent X-ray radiation alone or Cu-Cy treatment alone. Conclusion: The photodynamic action mediated by Cu-Cy under X-ray activation can effectively inhibit the growth and viability of human colon cancer SW620 cells in vitro, and the mechanism may possibly be associated with its inducing apoptosis and autophagy.

Abstract:Objective: To investigate the expression and function of miRNA-186-5p in colon cancer. Methods: The miRNA-186-5p expressions in 20 paired specimens of colon cancer tissue and adjacent tissues as well as in normal intestinal epithelial NCM460 cells and different colon cancer cell lines (HCT-116, HRT-18 and HT-29) were determined by qPCR. Then, in HCT-116 cells after transfection with miRNA-186-5p mimics or negative control sequences, the cell proliferation, migration and invasion were measured by CCK-8 assay, plate colony-forming assay, scratch wound-healing assay and Transwell invasion assay, respectively. Results: The miRNA-186-5p expression in colon cancer tissue was significantly lower than that in the adjacent tissue, and in each colon cancer cell line was significantly lower than that in normal intestinal epithelial NCM460 cells (all P<0.05). In HCT-116 cells transacted with miRNA-186-5p mimics compared with HCT-116 cells transfected with negative control sequences, the proliferative ability was decreased, colony forming units were reduced (114.0 vs. 311.7), wound healing rate was lowered (28.7% vs. 77.0%), and the number of invaded cells was decreased (119.3 vs. 259.7), and all the differences had statistical significance (all P<0.05). Conclusion: The miRNA-186-5p expression is down-regulated or absent in colon cancer tissues, and restoring miRNA-186-5p expression can suppress the malignant phenotype in colon cancer cells. So it is suggested that miRNA-186-5p may play an anti-cancer role in colon cancer cells.

Abstract:Objective: To investigate the relationship between the expression of Golgi phosphoprotein 3 (GOLPH3) gene and the activity of Wnt signaling pathway in human colon cancer cells. Methods: The GOLPH3 mRNA expressions in 4 different human colon cancer cell lines (HCT116, HT29, SW480 and SW620) were detected by RT-PCR, after which, the cell line with highest GOLPH3 mRNA expression was selected and then underwent GOLPH3 gene interference, and the RNA interference effect was examined by RT-PCR. In the colon cancer cells after interference, the changes in the activity of Wnt signaling pathway, proliferative ability and protein expressions of GOLPH3 and β-catenin were detected by TOPFlash reporter gene assay, flat plate colony-forming assay and Western blot analysis, respectively. Results: SW620 cells showed the highest relative GOLPH3 mRNA expression among the 4 types of colon cancer cell lines. The relative GOLPH3 mRNA expression was significantly reduced after GOLPH3 siRNA transfection in SW620 cells (P<0.001). In SW620 cells after GOLPH3 siRNA transfection compared with untreated SW620 cells, the transcriptional activity of Wnt signaling pathway was significantly decreased (0.342 vs. 1.000, P<0.001), the number of cancer cell colon formation was significantly reduced (82.333 vs. 207.333, P<0.001), and both GOLPH3 and β-catenin protein expressions were significantly down-regulated (0.260 vs. 1.00; 0.182 vs. 1.00, both P<0.001). Conclusion: In human colon cancer cells, increased GOLPH3 expression may up-regulate the acitivity of Wnt/β-catenin signaling pathway, and thereby promote cell proliferation.

Abstract:Objective: To investigate the expression of the long non-coding RNA, maternally expressed gene 3 (MEG3), in colorectal cancer tissues and its relation with tumor angiogenesis. Methods: The MEG3 expressions in specimens of tumor tissues and their adjacent normal tissues from 42 colorectal cancer patients, as well as in human colon cancer SW48 cells and normal human colon NCM460 cells were determined by RT-PCR, and the relations of MEG3 expression with clinicopathologic factors of the patients were analyzed. The expression of vascular endothelial growth factor (VEGF) and vascular density in above specimens were measured by immunohistochemical staining, and the correlations of MEG3 expression with VEGF expression or vascular density were analyzed. Results: The relative MEG3 expression level in colorectal cancer tissue was significantly lower than that in adjacent normal tissue (0.12 vs. 1.00, P=0.003), and in SW48 cells was significantly lower than that in NCM460 cells (0.15 vs. 1.00, P=0.007), and the relative MEG3 expression level showed no significant relation with tumor location, depth of invasion, degree of differentiation and lymph node metastasis of the patients (all P>0.05). In colorectal cancer tissue, both VEGF expression and vascular density were higher than those in cancer adjacent normal tissue (0.13 vs. 0.09; 50.34 vs. 36.57, both P<0.05); the MEG3 expression level was negatively correlated with either the VEGF expression level or vascular density (r=–0.304; –0.342, both P<0.05). VEGF was an independent influential factor for MEG3 level (P=0.005). Conclusion: MEG3 expression is decreased in colorectal cancer tissue, which may probably facilitate VEGF expression and tumor angiogenesis.

Abstract:Objective: To investigate the relationship between expression of PKC-related kinase N3 (PKN3) and the invasion and metastasis of hepatocellular carcinoma (HCC) cells and the mechanism. Methods: The collagen fiber content and PKN3 expression in the specimens of 72 HCC tissues with hemorrhagic/necrotic phenotype (HN-HCC) and 32 HCC tissues without hemorrhagic/necrotic phenotype (NHN-HCC) were determined. HCC HCCLM3 cells were cultured in polyacrylamide hydrophilic gels of different stiffness, and then, the migration and invasion abilities and the PKN3 gene and protein expressions as well as RhoC activity were measured. After PKN3 interference or PKN3 interference with concomitant RhoC overexpression, the changes in migration and invasion abilities and protein expressions of ROCK2, E-cadherin, Fibronectin in HCCLM3 cells were analyzed. Results: Compared with NHN-HCC tissue, collagen fiber content and PKN3 protein expression were significantly increased in HN-HCC (both P<0.05); in HCCLM3 cells cultured in firm matrix compared with HCCLM3 cells cultured in soft matrix, both gene and protein expressions of PKN3, and the migration and invasion abilities as well as the RhoC activity were significantly increased (all P<0.05), while the RhoC activity was suppressed with inhibition of PKN3 expression. Compared with control HCCLM3 cells, the migration and invasion abilities and the protein expressions of FAK, ROCK2 and Fibronectin were significantly decreased, and E-cadherin protein expression was significantly increased in HCCLM3 cells after PKN3 interference (all P<0.05), while the above changes were not obvious in HCCLM3 cells after PKN3 interference with concomitant RhoC overexpression (all P>0.05). Conclusion: Increased matrix stiffness can up-regulate the activity of PKN3-ROCK2 signaling pathway, and thereby promote the invasion and metastasis of HCC, which may be an important mechanism for the high invasion and metastasis ability of HN-HCC.

Abstract:Objective: To evaluate the safety and efficacy of using single incision laparoscopic technique in inguinal hernia repair. Methods: The clinical studies comparing single- and multi-incision inguinal hernia repair were collected by searching several national and international databases. Meta-analysis was performed by using STATA 12.0 software. Results: Seventeen studies were finally enrolled, including 5 randomized controlled trials and 12 retrospective studies, and involving 1 722 patients. The results of Meta-analyses showed that single-incision inguinal hernia repair was superior to multi-incision inguinal hernia repair in respects of postoperative recovery time (SMD=–0.35, 95% CI=–0.56––0.15, P=0.001) and pain score on postoperative day 7 (SMD=–0.27, 95% CI=–0.53––0.01, P=0.044), while there was no significant difference between the two procedures in terms of operative time (SMD=0.03, 95% CI=–0.20–0.26, P=0.811), length of postoperative hospital stay (SMD=–0.07, 95% CI=–0.23–0.09, P=0.393), pain score on first postoperative day (SMD=–0.19, 95% CI=–0.45–0.07, P=0.153), and incidence of postoperative complications (OR=0.98, 95% CI=0.69–1.38, P=0.896) and recurrence of hernia (OR=1.07, 95% CI=0.46–2.48, P=0.872). Conclusion: Compared with multi-incision inguinal hernia repair, single-incision inguinal hernia repair can effectively reduce postoperative recovery time and pain of the patients, and provide favorable cosmetic results, and has similar safety and efficacy.

Abstract:Objective: To investigate the safety and efficacy of laparoscopic inguinal hernia repair with utilization of the enhanced recovery after surgery (ERAS) protocols. Methods: The clinical data of 360 patients undergoing laparoscopic inguinal hernia repair with standard ERAS protocols between July 2013 and September 2016 in Department of General Surgery of Xiangya Hospital were retrospectively analyzed. Results: The median operative time for the entire group was 68 (30 to130) min, for unilateral inguinal hernia was 48 min and for bilateral inguinal hernia was 91 min. The incidence of postoperative complications was 8.9% (32/360), which mainly included urinary retention in 15 cases (4.2%) and seroma in 25 cases (6.9%). No wound infection or perioperative death occurred. The median length of postoperative hospital stay was 1 d. The pain score measured by numeric rating scale (NRS) on the first postoperative day was 1.8±1.2, and the NRS score in the patients under 65 years of age was significantly higher than in those over 65 years of age (P=0.01). The score of Inguinal Pain Questionnaire (IPQ) was 1.6 (0 to 8) at one month postoperatively. Conclusion: Laparoscopic inguinal hernia repair with utilization of ERAS protocols is safe and effective, with low incidence of postoperative complications and high patient satisfaction.

Abstract:Objective: To analyze the clinical characteristics of incarcerated inguinal hernia in adults and summarize the experience in individualized treatment. Methods: The clinical data of 130 adult patients with incarcerated inguinal hernia treated in Chaohu Hospital Affiliated to Anhui Medical University from January 2011 to April 2016 were retrospectively analyzed. Results: Among the 130 cases, 2 cases refused to undergo surgical treatment and were discharged on request; 18 cases had successful manual reduction, and 10 of them received elective operation after reduction; 110 cases underwent emergency surgery that included tension-free hernioplasty (Lichtenstein) in 47 cases, McVay’s repair in 35 cases, Bassini’s repair in 12 cases and high ligation of hernia sac in 16 cases. Of the 110 patients who underwent emergency surgery, bowel necrosis was found in 13 cases. Postoperative complications occurred in 15 cases, including scrotal swelling in 6 cases, pulmonary infection in 5 cases and incision wound infection in 4 cases, and hernia recurrence occurred in 4 cases. Conclusion: During the diagnosis and management of incarcerated inguinal hernia in adults, the patients’ condition should be fully observed and comprehensively analyzed, and personalized treatment plan should be tailored to individual patient.

Abstract:Objective: To investigate the efficacy of laparoscopic percutaneous extraperitoneal closure (LEPC) for unilateral inguinal hernia in children, and effect of intraoperative laparoscopic exploration for finding contralateral patent processus vaginalis (CPPV) on prevention of the metachronous contralateral hernia (MCH). Methods: The clinical data of 161 children with unilateral inguinal hernia undergoing LPEC from January 2013 to December 2014 were retrospectively analyzed (observational group), and another 252 children with unilateral inguinal hernia undergoing open hernia repair from January 2010 to December 2012 were used as a historical control (control group). Patients in observational group received synchronous exploration of the inguinal region and had a ligation if CPPV was diagnosed, while exploration of the inguinal region was not performed in those in control group. The postoperative complications, hernia recurrence and MCH of the two groups as well as the influential factors for MCH were analyzed. Results: There was no statistical difference in incidence of postoperative complications and hernia recurrence between the two groups (both P>0.05), and MCH occurred in 13 cases in the whole group, of whom, one case occurred in observational group and 12 cases occurred in control group, and the difference had statistical significance (0.6% vs. 4.8%, P<0.05), further, 9 cases in control group occurred within postoperative 24 months. CPPV was found in 62 cases (38.5%) in observational group, which in age group of 0.5-<2 years reached 59.0% (23/39), and decreased with age increase. In control group, the incidence of MCH in of CPPV in cases with premature birth was significantly higher than in those with full-term birth (3.6% vs. 1.2%, P<0.05). Overall analysis demonstrated that MCH mainly occurred in male children undergoing open surgery with age less than 4 years and right inguinal hernia. Conclusion: LEPC has proven efficacy in treatment of unilateral inguinal hernia in children, and synchronous laparoscopic exploration for CPPV can reduce the incidence of MCH, which is particularly important for those with premature birth and age less than 4 years.

Abstract:Objective: To investigate the risk factors of paraplegia after thoracic endovascular aortic repair (TEVAR) and its management strategies. Methods: The clinical data of 593 patients with Stanford type B aortic dissection who underwent TEVAR between May 2011 and May 2015 were reviewed. The risk factors for postoperative paraplegia were analyzed and the treatment methods were summarized. Results: Among the 593 patients, post-TEVAR paraplegia occurred in 9 cases (1.5%). Univariate analysis showed that diabetes, hypertension, smoking, left subclavian artery occlusion, and perioperative hypotension were associated with post-TEVAR paraplegia (all P<0.05), and further multivariate Logistic regression analysis showed that perioperative blood pressure was the significant risk factor for paraplegia after TEVAR (P<0.05). The nervous system function was completely recovered in all the patients with post-TEVAR paraplegia after combined treatment that included cerebrospinal fluid drainage, hormone stosstherapy, appropriate blood pressure elevation, anticoagulation, vascular dilation, neuro-nutrition and lowering intracranial pressure Conclusion: Perioperative hypotension is an important risk factor for paraplegia after TEVAR. Early adoption of corresponding conservative treatments to increase spinal cord perfusion may effectively improve the results.

Abstract:Precise and minimally invasive surgery has become a yardstick that reflects the level of the technological advancement of colorectal surgery. As a result, the emergence of the da Vinci surgical system (DVSS) opened a new epoch for the precise and minimally invasive surgery. DVSS has the advantages of providing high definition and stable stereoscopic vision, accurate intuitive movement control, hand-tremor filtration, short learning curve and allowing remote manipulation, while, it also has shortcomings such as lack of force feedback, prolonged operative time and high cost. The authors, in this article, address the constitution and evolution of DVSS as well as its application state in colorectal surgery, and some considerations of the future prospects of advanced intelligent technology are also proposed.

Abstract:The liver is the most common organ for distant metastases of gastric cancer, and gastric cancer liver metastasis (GCLM) is the major threat to gastric cancer patients during treatment. At present, standard treatment program for GCLM has not been established in China and other countries. Surgical treatment with radical resection of the primary lesion and liver metastasis is the only possible curative option for GCLM. The authors, in this review, address the clinical features of GCLM, as well as the advantages and limitations of its surgical treatment.

Abstract:Hepatectomy is currently the most effective treatment for colorectal liver metastases and however, only a small number of studies have shown that hepatectomy may improve survival of patients with liver metastases from noncolorectal primary malignancies, which is still controversial due to lack of evidences from large sample size, prospective and high-quality studies. The authors, in this paper, present the current research results of hepatectomy for noncolorectal cancer liver metastases.