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.

Objective:To investigate the mechanism of miR-518c-5p regulating the apoptosis of colorectal cancer HT-29 cells.Methods:The expression of miR-518c-5p in human colorectal cancer cells and human normal colorectal cells was detected by real-time fluorescent quantitative PCR. By overexpression or knockdown of miR-518c-5p, the apoptosis level of HT-29 cells was detected. Targets of miR-518c-5p were screened and verified by TargetScan and luciferase reporting tests. By knocking down Polypyrimidine tract binding protein 1 (PTBP1) or Transmembrane Protein 61 (TMEM61), the apoptosis level of HT-29 cells was detected. By knocking down miR-518c-5p and PTBP1 or overexpressing miR-518c-5p and PTBP1, the apoptosis level of HT-29 cells. Statistical analysis was performed using PRISM7 software.Results:The expression levels of miR-518c-5p in HCT116 (0.94±0.23), HT29 (2.41±0.40), RKO (0.84±0.22), COLO-678 (1.04±0.33), C2BBe1 (1.45±0.41), and GP2d (0.97±0.30) cells were significantly lower than those in normal colorectal cells NCM460 (0.32±0.05, F=14.010, P<0.01). Overexpression of miR-518c-5p (2.40±0.36 vs. 4.14±1.01, t=2.811, P<0.05) could ledd to the increased apoptosis level of HT-29 cells (0.22±0.07 vs. 0.77±0.22, t=4.126, P<0.05); Knocking down miR-518c-5p (2.51±0.70 vs. 0.45±0.11, t=5.011, P<0.05) could lead to the decreased apoptosis level of HT-29 cells (0.20±0.10 vs. 0.10±0.03, t=2.970, P<0.05). After knocking down PTBP1, the apoptosis level of HT-29 increased (0.23±0.04 vs. 0.67±0.03, t=15.240, P<0.05); however, there was no significant difference in the apoptosis level of HT-29 cells after knocking down TMEM61 (0.24±0.04 vs. 0.26±0.01, t=0.840, P> 0.05). After overexpression of miR-518c-5p (2.31±0.30 vs. 4.02±1.01, t=2.828, P<0.05) and PTBP1, there was no significant difference in the apoptosis level of HT-29 cells (0.24±0.08 vs. 0.23±0.04, t=0.194, P> 0.05); after miR-518c-5p (2.40±0.70 vs. 0.38±0.09, t=4.957, P<0.05) and PTBP1 were knocked down, no significant difference was found in the apoptosis level of HT-29 cells (0.21±0.07 vs. 0.25±0.09, t=0.608, P> 0.05). Conclusion:MiR-518c-5p can reduce the expression of PTBP1 by targeting the 3’ untranslated regions (3’UTR) of PTBP1 mRNA, so as to achieve the purpose of promoting the apoptosis of HT-29 cells.

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：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 .

目的：探讨完全腹腔镜下乙状结肠或直肠节段切除的手术操作技巧及可行性。方法：选取2008年5月～2012年11月我院收治的10例直肠良性病变和先天性无阴道患者，在完全腹腔镜下行乙状结肠或直肠节段切除。结果：20例手术均获成功，无中途转开腹手术，手术时间平均90min，术中出血量平均20ml，无手术并发症，术前、术后未留置胃管，术后住院时间6～8d，平均7d，均未发生吻合口瘘、肠梗阻、腹腔感染等严重术后并发症。结论：乙状结肠或直肠节段切除安全可行，腹部无辅助切口，痛苦小，恢复快，微创效果显著，值得推广。

目的：探讨恶性蝾螈瘤的临床特点、诊断、治疗。方法：结合文献回顾分析1例腹膜后巨大恶性蝾螈瘤的临床资料。结果：行根治性手术切除，镜下肿瘤由梭形细胞构成，并见散在的神经节细胞，有病理性核分裂，伴横纹肌分化，免疫组化标记Myoglobin(+),desmin(+)，S-100(+)。结论：恶性蝾螈瘤是一种罕见的恶性神经鞘瘤，恶性程度高，极易复发，预后差。

目的:探讨高龄胃癌患者围手术期处理的有关问题。方法:分析我院2004年1月～2008年12月收治的经手术治疗的65例高龄(70岁以上)胃癌患者的临床资料。结果:65例患者中57例行胃癌切除术,切除率为87.69%,其中行根治性切除术45例(69.23%),姑息性切除术12例(18.46%),胃空肠短路手术6例(9.23%),剖腹活检术2例(3.08%)。术前有54例(83.08%)并存其他疾病。术前并存其他疾病者术后并发症的发生率为46.30%(25/54),而术前无合并其他疾病者术后并发症的发生率为18.18%(2/11),二者差异有统计学意义(P<0.05)。结论:应高度重视高龄胃癌患者围手术期的处理,对提高手术的安全性、降低手术风险、减少术后并发症等有着重要的意义。

<正>残胃功能性排空障碍(FDGE)是指胃大部切除术后不伴吻合口或输出空肠袢等机械性梗阻因素的残胃无力症,以胃排空障碍为主要症状的胃动力紊乱综合症。近年来虽报道越来越多,但由于多因素参与其发生,临床上时有误诊、误治,甚至有部分患者再次行无意义的手术探查而加重病情的报道。我

目的:探讨肠结核的诊断及治疗方法。方法:回顾9例肠结核患者的一般临床资料、实验室检查结果及病理学诊断,分析治疗方法与治疗结果。结果:6例肠结核患者经非手术治疗后治愈;3例肠结核患者经手术治疗,2例治愈,1例因高龄,腹腔感染重,术后并发感染中毒性休克、急性心肺功能衰竭,治疗无效死亡。结论:肠结核患者大部分经抗结核及营养支持治疗基本可以治愈,只有出现严重并发症时才考虑行手术治疗。