Objective:To analyze the clinicopathological features and prognostic factors of alpha‐fetoprotein‐producing gastric carcinoma (AFPGC).Methods:A retrospective analysis was made on 2 671 GC patients admitted from Jan 1998 to Dec 2018 , AFPGC patients and matching AFP negative GC cases were enrolled and their clinicopathological features and prognostic factors were analyzed. The survival curve was drawn by Kaplan-Meier method. Log-rank test was used to test the significance, Univariate analysis was performed by using COX proportional hazard model.Results:There were 98 AFPGC in this study accounting for 4.5% of all GC of the corresponding time period. The proportion of male to female was 2.16∶1, the average age was (65±12) years. The serum AFP levels significantly decreased after operation in most patients (median: 52 ng/ml vs. 5 ng/ml, Ｚ=-2.736, P=0.001). Serum AFP and CEA levels in patients with AFPGC before treatment were significantly higher than that in patients with AFP negative GC (both P<0.05) . Vascular invasion(62.71% vs. 40.68%) and liver metastasis (31.63% vs .6.12%) were more likely to occur in AFPGC groups (both P<0.05). However, there was no significant difference between the two groups in tumor size, location, differentiation and lymph node metastasis (all P>0.05). The prognosis of AFPGC was significant pooer than that in AFP negative GC ( P<0.05). Prognosis of AFPGC patients was significantly correlated with preoperative serum AFP level, TNM stage, lymph node metastasis, simultaneous liver metastasis and vascular invasion (all P<0.05) . COX multivariate survival analysis found that preoperative serum AFP level was independent risk factors of patients with AFPGC ( P<0.05). Conclusion:AFPGC is a special GC charactering poor prognosis .

Objective:To study the relation ship between the branch patterns of inferior mesenteric artery (IMA) and imaging pelvic measurement parameters for anastomotic leakage (AL) after anterior resection (AR) of rectal cancer.Methods:Five hundred thirty-four patient were enrolled from Jan 2008 to Dec 2018 at the General Surgery Department of Guizhou Provincial People's Hospital. The AL related imaging risk factors were analyzed by chi-square test or Fisher's exact test.Results:AL was found in 36 (6.7%) patients. AL related mortality rate was 11.1% (4/36) compared to 0.4% (2/498) in those without the complications of no AL cases ( P<0.001). Seven pelvic imaging measurement results were attained in 412 patients including anteroposterior diameter of the inlet of the pelvis, anteroposterior diameter of the outlet of the pelvis, upper edge of the symphysis pubis to the tip of the coccyx, sacrococcygeal distance angle from the lower edge of the pubis to the upper edge of the pubis to the sacral promontory, distance between the ischial spines and that of ischial tuberosity. Univariate analysis showed that there was no significant relationship between the above 7 pelvic measurement parameters and the occurrence of AL (all P>0.05). There was no significant relationship between branch patterns of IMA and AL after rectal cancer surgery ( P=0.712). Conclusion:AL as a severe postoperative complication in rectal cancer patients undergoing AR procedure were caused by multiple factors. Neither IMA branch patters nor pelvic imaging measurement seem to be related to the occurrence of AL after AR for rectal cancer.

目的 对比分析直肠癌腹腔镜手术与开腹手术后切口感染的发生率.方法 分析腹腔镜直肠癌Dixon手术及开腹直肠癌Dixon手术的病人各100例,研究其术后切口愈合不良发生率.结果 腹腔镜组和开腹组的切口脂肪液化发生率分别为4％和9％,腹腔镜组和开腹组的切口感染发生率分别为2％和5％,腹腔镜组和开腹组的切口裂开发生率分别为0和2％,两组比较有显著差异(P＜0.05).结论 与开腹手术相比,腹腔镜手术后切口脂肪液化发生率、切口感染发生率、切口裂开发生率均较低.

Objective To evaluate the safety, sample quality and long-term prognosis of complete mesocolic excision (CME) for colorectal cancer. Methods The relevant documents published in PubMed, ScienceDirect, Cochrane, Scopus, CNKI and Wanfang databases were searched by computer from the establishment of the database to December 2018. The results of safety, quality and long-term survival were extracted. Results A total of 8 914 patients from 15 studies were included in this Meta-analysis. Compared with non-complete mesocolic excision (NCME) group, CME group had more complications (RR=1.23, 95% CI: 1.08-1.40), more lymph nodes (WMD=8.42, 95% CI: 4.71-12.13), longer distance from tumor to high ligation of blood vessels (WMD=18.43, 95% CI: 16.18-20.69), larger area of mesentery (WMD=35.07, 95% CI: 12.78-57.36). The 3-, 5- year survival rates of the patients in CME group were both higher (HR=0.72, 95% CI: 0.61-0.86; HR=0.55, 95% CI: 0.42-0.73; both P<0.01). Conclusion CME can effectively improve the quality of surgical specimens and prolong the long-term survival rate, but the incidence of surgical complications is high, so the safety of operation should be concerned. Key words: Colonic neoplasms; Colectomy; Meta-analysis; Complete mesocolic excision

目的 对比分析直肠癌腹腔镜手术与开腹手术对男性排尿及性功能的影响.方法 腹腔镜直肠癌Dixon手术及开腹直肠癌Dixon手术的男性病人各50例(均按照TME原则手术),调查其术后排尿与性功能情况,术后随访12～24个月.结果 两组患者排尿功能障碍、勃起功能障碍、射精功能障碍比较差异均有统计学意义(P＜0.05).结论 与开腹手术相比,腹腔镜手术后男性病人排尿功能障碍与性功能障碍的发生率均较低,对男性排尿功能及性功能的影响较小,病人生活质量更高.

目的 探讨腹腔镜袖状胃切除术(LSG)治疗肥胖症患者的减重效果及其对合并疾病的改善情况,评估手术安全性.方法 回顾性分析2016年1月至2018年12月在贵州省人民医院接受LSG手术的58例肥胖症患者临床资料,观察患者术后减重效果、合并疾病改善情况及术后并发症发生情况.结果 患者均顺利完成LSG手术,术后第3、6、12个月平均多余体质量减轻百分比(％EWL)分别为(65.4±12.3)％、(71.2％±15.2)％、(74.7±16.7)％;合并疾病脂肪肝、肝功能异常、血脂异常、呼吸睡眠暂停综合征、高血压、2型糖尿病和高尿酸血症的术后1年疾病缓解率分别为74.3％、78.3％、70.0％、56.3％、85.7％、100.0％、80.0％,术后均得到显著改善(P<0.05).术后近期并发症发生率为3.4％(2/58),远期并发症主要为胃食管反流症、胆囊结石和急性胰腺炎.结论 LSG可有效减轻肥胖患者的体质量,改善肥胖相关合并疾病,而且手术并发症发生率较低,相对安全,值得推广.

目的 分析直肠癌局部复发(LRRC)患者的临床资料特点.方法 回顾性分析2000年1月至2016年1月于本科室接受治疗的1302例直肠癌患者临床资料,对LRRC患者基于不同解剖分类分析原发肿瘤的临床资料差异,记录LRRC治疗情况.结果 LRRC发生率为8.6％(112/1302),男性占65.2％,老年患者占55.4％.将患者按照不同解剖分类分为中心型45例(40.2％),后向型30例(26.8％),前向型20例(17.9％),侧向型17例(15.2％),不同解剖分类之间性别、年龄、肿瘤距肛缘距离、术前CEA、手术类型、吻合口漏、肿瘤最大径、术后辅助治疗、T分期、N分期及淋巴结检出数目比较,差异均无统计学意义(均P>0.05),手术方式比较差异有统计学意义(P<0.05).67.9％的LRRC在原发肿瘤术后2年内发生,50.9％的患者诊断LR?RC时合并远处转移.不同分型的患者是否存在复发症状、CEA异常情况比较差异均有统计学意义(均P<0.05),复发时间及是否合并远处转移情况比较差异均无统计学意义(均P>0.05),是否接受根治性切除干预情况比较差异有统计学意义(P<0.05).结论 LRRC患者中以中心型最为常见,R0切除率相对较高,但出现复发症状及异常CEA占比一般,开展有效的患者管理和加强随访具有重要的临床意义.

目的 比较原发性胃癌患者腹腔镜下根治术与传统开腹胃癌根治术对淋巴结清扫的效果,为临床胃癌患者根治术的选择提供参考.方法 选择2012年5月-2017年12月在该院择期行胃癌根治术的患者126例为研究对象,根据其手术方式的不同分为观察组和对照组,其中观察组65例,采用腹腔镜根治术;对照组61例,采用开腹根治术.比较两组患者淋巴结清扫情况、切口长度、术中失血量、手术时间、术后住院时间、术后下床活动时间、排气时间、术后并发症及肿瘤复发率.结果 观察组与对照组在清扫淋巴结总数上差异无统计学意义(t=-0.89,P=0.373);在第1站清扫数上差异无统计学意义(t=-0.23,P=0.815);在第2站清扫数上差异无统计学意义(t=-1.71,P=0.089),腹腔镜手术少于开腹手术.观察组患者的切口长度、术中失血量、术后住院时间、术后下床活动时间及排气时间明显小于对照组,差异均有统计学意义(P<0.05);观察组患者的手术时间长于对照组患者,差异有统计学意义(P<0.05).观察组并发症发生率为6.2％,其中切口感染1例,胸腔积液1例,肺部感染2例.对照组并发症的发生率为9.8％,其中切口感染2例,胸腔积液1例,腹腔出血1例,肺部感染2例,两组比较,差异无统计学意义(χ2=0.58,P=0.445).结论 腹腔镜胃癌根治术可达到与开腹手术同样的淋巴结清扫效果,且具有创伤小和恢复快等优点,可用于治疗原发性胃癌.

Objective To investigate the clinical effect and safety of laparoscopic Roux-en-Y gastric bypass for the treatment of non-obese type 2 diabetesmellitus (T2DM). Methods The clinical data of 28 patients with T2DM performed LRYGB surgery between January 2016 and June 2017 in Guizhou Provincial People’s Hospital were analyzed. According to body mass index (BMI), these patients were divided into the non-obese group (11 cases, BMI≤27.5 kg/m2) and obese group (17 cases, BMI>27.5 kg/m2).The changes of fasting blood glucose (FPG), glycosylated hemoglobin (HbA1c), fasting C-peptide (FCp), fasting insulin (FIns) and complications were analyzed before and 3, 6, 9 and 12 months after operation. Results All 28 cases were successfully operated. There were no significant differences in operation time or bleeding volume between the two groups (t=0.642, 0.871, P=0.526, 0.392). No serious complications occurred after operation. BMI, FPG, HbA1c, FCp and FIns in both groups showed a continuous downward trend with time, and the levels were significantly lower than those before operation (P<0.05). The level of FCp in non-obese group was significantly lower than that in obese group at 12 months after operation (t=0.711, P<0.05). The complete remission rates of T2DM in non-obese group and obese group were 72.7% (8/11) and 82.4% (14/17), respectively, with no significant difference (χ2=0.368, P=0.544). Conclusion LRYGB can significantly reduce BMI and improve glucose metabolism for non-obese T2DM, and the short-term postoperative safety is reliable. Key words: Gastric bypass; Diabetes mellitus, type 2; Nonobese; Anastomosis, Roux-en-Y

目的:分析加速康复外科在老年结直肠癌中的应用效果,观察其对患者术后恢复的影响.方法:选择2015年5月—2017年5月拟行腹腔镜结直肠癌根治术的老年结直肠癌患者70例.应用随机数字表法分为对照组和观察组,每组35例.对照组实施常规围术期处理,观察组实施加速康复外科策略,比较两组患者术后恢复情况.结果:观察组术后2 h、6 h及12 h的视觉模拟评分(VAS)均显著低于对照组,差异有统计学意义(P<0.05).观察组镇痛药物使用率28.6％(10/35),显著低于对照组的85.7％(30/35);观察组术后首次肠鸣音时间、首次排气时间、首次进流质食物时间、首次下床活动时间及导尿管拔出时间均显著低于对照组,差异有统计学意义(P<0.05).观察组在术后并发症发生率2.86％,显著低于对照组的20.00％,差异有统计学意义(P<0.05).结论:采用加速康复外科可有效降低腹腔镜老年结直肠癌患者的并发症发生风险,促进其术后康复.

目的 探讨腹腔镜下腹股沟疝无张力修补术的疗效及对术后康复的影响.方法 选择本院2014年6月—2017年6月期间收治的腹股沟疝患者80例,随机数字表法分为两组,对照组40例患者给予开放式无张力疝修补术治疗,观察组40例患者给予腹腔镜下腹股沟疝无张力修补术治疗,比较两组疗效及术后康复情况.结果 观察组手术时间、下床活动时间、住院时间分别为(39.65±7.36)min、(17.94±2.03)h、(5.76±0.94)d,短于对照组相应指标;观察组术中出血量(47.51±8.63)mL、镇痛药使用次数(0.87±0.21)次,少于对照组相应指标,差异有统计学意义(P<0.05).观察组心理情绪、生理功能、社会活动及主观症状评分均显著高于对照组,差异有统计学意义(P<0.05).腹股沟疝手术后常见并发症为感染、血肿、尿潴留,观察组并发症发生率5.00％,显著低于对照组的25.00％,差异有统计学意义(P<0.05).手术后随访12个月,观察组有2例复发,复发率为5.00％,对照组有8例复发,复发率为20.00％,差异有统计学意义(χ2=4.114,P=0.043).结论 对腹股沟疝患者的治疗,采取腹腔镜下腹股沟疝无张力修补术治疗具有手术时间短、疼痛轻、并发症少、复发率低的优点,值得推荐.

胃肠间质瘤(GIST)起源于间叶组织中的 Cajal细胞,约占胃肠道间叶肿瘤 GIMT 的 80％,好发于胃,小 肠,肛 管、直 肠、结 肠 等 部 位[1]. 以 往 由 于GIST 表现多样,缺乏特异 性,主 要与肿瘤的部位、大小、有无梗阻有关.外科治疗和分子靶向治疗是GIST 的主要治疗手段,GIST 不建议穿刺活检,因此外科手术切除显得尤为重要.腹腔镜手 术创伤小、出血少和术后恢复快,而 GIST 手术不必清扫淋巴结的特点也为腹腔镜技术的应用提供了 理论基础[2].本文就我院 2015 年 8 月至 2017 年 11 月收治 20 例胃 GIST 行腹腔镜手术的病例总结分析报告如下.

OBJECTIVES:The safety and surgical oncology of laparoscopy-assisted total gastrectomy (LATG) remain inconclusive and challenging. This study aimed to compare the short-term and long-term outcomes between LATG and open total gastrectomy (OTG) procedures.RESULTS:In the all-included analyses, there were 69 patients in the LATG group and 268 in the OTG group. LATG was as safe as OTG without increasing postoperative morbidity and mortality. Stage imbalance might introduce differences in the numbers of harvested lymph nodes in LATG (34.4 ± 12.0) and OTG (40.9 ± 16.9), whereas 95.7% of patients underwent D2/D2+ dissection during the LATG procedure. After a median 31 months of follow-up, the overall survival outcomes were comparable between the LATG and OTG procedures (HR = 1.16, 95% CI 0.68-1.97). Sensitivity analysis found comparable node retrieval and stage-specific or treatment-specific overall survival.MATERIALS AND METHODS:A retrospective case-control study was conducted among gastric cancer patients who underwent either LATG or OTG with curative intention between June 2006 and December 2015. Data retrieval was based on the Surgical Gastric Cancer Patient Registry in the West China Hospital. The primary outcome was overall survival. The secondary outcomes were postoperative complication incidence and severity, operation duration, blood loss, number of harvested lymph nodes, and postoperative hospital stay. Matched pairwise case-control comparisons were performed as a sensitivity analysis.CONCLUSIONS:LATG by experienced surgeons possibly has comparable short-term surgical outcomes and long-term survival outcomes compared with OTG for gastric cancer patients. However, high-quality RCTs are necessary before confirmative judgment and recommendation as an optional treatment in general practice.

目的 对比腹腔镜与开腹全结肠系膜切除术治疗右半结肠癌近期效果.方法 收集2015年1月至2016年7月贵州省人民医院普外科收治的105例右半结肠癌CME手术患者,其中腹腔镜组45例,开腹组60例,比较手术时间等指标.结果 腹腔镜组手术时间、术中出血量与术后通气时间、进食时间、拔引流管时间以及住院时间均优于开腹组,p<0.05;腹腔镜组手术切口长度与术后近期并发症发生率优于开腹组,p<0.05.结论 腹腔镜右半结肠癌CME根治术具有疼痛轻、创伤小、恢复快等优点,值得借鉴.

目的：通过对比分析单孔腹腔镜及传统多孔腹腔镜直肠癌根治术的相关指标，评价单孔腹腔镜技术在直肠癌根治术中的优势及临床应用价值。方法将符合纳入标准的患者随机分为单孔腹腔镜组与传统多孔腹腔镜组，每组各30例，对比分析两种手术方式的手术安全性、有效性、术前及术后免疫功能的变化、术中副损伤、术后恢复情况，评价两种手术方式的差异及优越性。结果两组手术时间、术中出血量、清扫淋巴结个数、清扫阳性淋巴结个数、近切缘距肿瘤上缘距离、远切缘距肿瘤下缘距离、环周切缘阳性率、术中副损伤、术后并发症方面差异无统计学意义（ P＞0．05），而在术后白细胞介素－6、C反应蛋白、CD3＋T细胞、CD4＋T细胞的变化以及术后首次下床时间、切口长度方面差异有统计学意义（P＜0．05）。结论单孔腹腔镜直肠癌根治术是安全、可行、有效的，同时在免疫功能保护、术后恢复、术后疼痛以及美容效果等方面更具有优越性，能够最大限度地减轻手术带来的创伤，值得在临床中推广运用。

In order to compare the curative effect of the Da Vinci surgical system (DVSS) with laparoscopic surgery (LS) or open surgery for colorectal resection, literature search was conducted in PubMed, Excerpt Medica Database (Embase), and Cochrane library up to January 15, 2016. Odds ratio (OR) and weighted mean difference with their corresponding 95% confidence intervals were used as effect size for evaluation of different outcomes. In total, 10 studies consisting of 2767 patients were included for the meta-analysis. As a result, there were no significant differences between DVSS and LS/open surgery in the long-term oncologic outcomes ( p > 0.05). However, DVSS achieved a significantly lower length of hospital stay and estimated blood loss (EBL), but a longer operation time. Moreover, DVSS showed a significantly reduced conversion to open surgery than LS (OR = 0.19, 95% confidence interval: 0.08–0.48). Subgroup analysis indicated that DVSS had different results in rectal adenocarcinoma and colon cancer subgroups on outcomes of conversion to open surgery and operation time. DVSS is superior to LS/open surgery in length of hospital stay and EBL, but needs longer operation time. Long-term outcomes of DVSS are comparable with the other approaches. From long-term perspective, DVSS has an equivalent effect to the other two techniques.

目的 探讨腹腔镜完全腹膜外疝修补术(TEP)的安全性及可行性,并进一步总结手术经验.方法 回顾性分析2010年1月至2015年1月贵州省人民医院收治的53例(共61侧)腹股沟疝患者行TEP手术的临床资料.结果 全组左侧及右侧腹股沟疝患者分别为22及23例,双侧腹股沟疝患者8例,直疝及斜疝分别为23侧及38侧.共行61侧TEP手术,1例中转行TAPP术.单侧手术时间为45 ～130 min,术中出血量10～30ml.术后住院时间2～5d,平均3.5d.术后主要并发症为阴囊血清肿2例,阴囊气肿或水肿13例,术后早期复发1例.结论 TEP术后疼痛轻、恢复快、并发症少,是一项安全可靠的疝修补手术方式.

目的：探讨该院近20年来胃癌临床病理特征及外科治疗效果的变迁。方法回顾性分析该院1990年1月至2009年12月行胃癌手术切除的500例患者的临床病理资料，分为前阶段组（1990～1999年）和近阶段组（2000～2009年），比较两组患者的临床病理特征及生存差异。结果全组患者5年生存率为48．0％，其中行根治性切除患者5年生存率为53．0％。前阶段组与近阶段组患者肿瘤大小、病理类型、T分期、N分期和淋巴结清扫数目的差异有统计学意义（P＜0．05）。前阶段组和近阶段组患者5年生存率分别为40．2％和50．9％，其中根治性切除患者5年生存率分别为45．8％和58．2％，差异均有统计学意义（ P＜0．05）。多因素预后分析证实，时间段是胃癌患者的独立预后因素（H R＝0．793，95％ C I：0．672～0．881）。结论近20年来，胃癌的外科治疗效果较前得到了显著提高，对影响胃癌预后的高危因素要提高警惕。

目的：比较腹腔镜与开腹直肠癌根治术对患者免疫功能的影响。方法100例直肠癌患者，随机分配到腹腔镜组及开腹组，每组均为50例，分别于术前1 d，术后1、3、5 d 抽取外周血，分别测定并比较患者的 CRP、IL －6、CD3＋、CD4＋、CD4＋／CD8＋水平。结果术前1 d 两组患者的 CRP、IL －6、CD3＋、CD4＋、CD4＋／CD8＋比较差异无统计学意义（P ＞0．05），术后1、3、5 d 开腹组血清 CRP、IL －6水平高于腹腔镜组，差异有统计学意义（P ＜0．05），术后1 d 患者 CD3＋、CD4＋、CD4＋／CD8＋均有所下降，但开腹组下降幅度大于腹腔镜组，差异有统计学意义（P ＜0．05），术后3、5 d 患者 CD3＋、CD4＋、CD4＋／CD8＋均有所上升，但腹腔镜组上升幅度大于开腹组，差异有统计学意义（P ＜0．05）。结论腹腔镜直肠癌根治术对患者免疫功能的影响较开腹手术方式小，且恢复快，在免疫功能保护上具有一定的优势，是一种安全可行、值得推荐的手术方式。

OBJECTIVE To investigate the distribution of pathogens causing surgical site infections in the patients with colorectal cancer and analyze the risk factors so as to reduce the incidence of nosocomial infections . METHODS The clinical data of 196 patients with colorectal cancer who underwent surgeries from Jan 2012 to Mar 2014 were retrospectively analyzed ,the distribution and drug resistance of the pathogens causing the surgical site infections were analyzed , and the statistical analysis was performed with the use of Whonet 5 .4 software . RESULTS The surgical site infections occurred in 38 patients with the infection rate of 19 .39% .A total of 48 strains of pathogens have been isolated ,of which 56 .25% (27 strains) were the gram‐negative bacteria .The drug susceptibility rates of the gram‐negative bacteria to imipenem and piperacillin were more than 90 .00% .The analy‐sis indicated that the body mass index no less than 24 ,complication of diabetic mellitus ,intraoperative hypoten‐sion ,and operation duration no less than 180 min were the related risk factors for the infections .CONCLUSION The risk factors for the postoperative incision infections in the patients with colorectal cancer are complicated ,it is necessary to actively control the body mass index and blood glucose ,raise the surgical efficiency ,and closely mo‐nitor the vital signs so as to prevent the surgical site infections .