BACKGROUND:Currently, there are a lack of effective tools for preoperative risk assessment of intestinal resection in patients with inguinal incarcerated hernia. The purpose of this study is to investigate the variable characteristics associated with intestinal resection and develop an interpretable preoperative prediction model, aiming to assist clinicians in preoperative risk for intestinal resection in patients with inguinal incarcerated hernia. METHODS:The data from 2 medical institutions were retrospectively collected, and they were grouped according to whether intestinal resection was performed intraoperatively and the pathologic results. Lasso and multifactor logistic regression screened variables, and 10 machine-learning algorithms built and validated the model, with evaluation using the confusion matrix and SHapley Additive exPlanations value. RESULTS:Lasso regression and multifactorial logistic regression analyses showed that peritonitis, intestinal obstruction, neutrophil count, C-reactive protein, and preoperative total protein were the key characteristic variables. The area under curve of models constructed by 10 algorithms in the external validation set were all above 0.8, and the k-nearest neighbor algorithm had the most comprehensive model performance. The constructed model exhibits good predictive performance on the external validation set. CONCLUSION:Accurate preoperative prediction of intraoperative intestinal ischemia in patients with incarcerated inguinal hernia is crucial. This study identified peritonitis, intestinal obstruction, neutrophil count, C-reactive protein, and preoperative total protein as characteristic variables for predicting intraoperative intestinal ischemia in these patients. The constructed prediction model can assist clinicians in more accurately assessing intestinal viability during surgery, offering valuable insights for evaluating intestinal resection risk.

Clarify the composition of the Posterior wall of the Inguinal Canal(PWIC), the location and composition of the Transverse Fascia(TF), and the tissue origin of the Cremaster(C) by observing the anatomy of the inguinal region of the cadaver. 30 cadavers were dissected to observe the alignment of the muscles and fascia of the inguinal canal and the anterior peritoneal space. the anatomical levels of the posterior wall of the inguinal canal and the alignment of the Spermatic Cord(SC) were observed. (1) The posterior wall of the inguinal canal was white, bright, and tough tendon membrane-like tissue; (2) the transverse fascia was a thin fascial tissue with only one layer of membranous structure located in the abdominal wall under the abdominal wall on the side of the blood vessels of the peritoneal cavity; (3) the internal oblique muscle and its tendon membrane, and the transversus abdominis muscle and its tendon membrane extended on the surface of the spermatic cord, and fused and continued to the cremaster on the surface of the spermatic cord. 1. PWIC is mainly composed of Internal oblique muscle of abdomen (IOMA), Aponeurosis of internal oblique muscle of abdomen (AIOMA), Transverse abdominal muscle (TAM), and Transverse abdominal aponeurosis(TAA) as the following four types: (1) TAM and AIOMA fused to form a tendinous layer; (2) IOMA and TAM form the posterior wall of the muscle in the PWIC; (3) IOMA and AIOMA continue in the PWIC; 4) TAM and TAA continue in the PWIC. 2.TF is a thin fascial tissue with only one layer of membrane structure, TF is not involved in the composition of PWIC, so this fascia has nothing to do with resisting the occurrence of inguinal hernia. 3. The spermatic cord that travels in the inguinal canal is fixed to the lower wall of the inguinal canal by the tendon membrane of the cremaster, which is organized from the internal oblique and transversus abdominis muscles and their tendon membranes, The inguinal canal is a musculotendinous canal.

Background It is difficult to definitively determine the degree of ischemia in the bowel in which an incarcerated groin hernia is embedded. Failure to diagnose and intervene promptly and accurately increases the rate of bowel resection and patient mortality. The aim of this study is to investigate the risk factors for incarcerated inguinal hernia complicating bowel necrosis with resection and to establish a predictive model as a reference for clinical work. Methods Patients with incarcerated groin hernia who were admitted to our hospital were retrospectively analyzed. They were divided into bowel resection and non-bowel resection groups based on whether bowel resection was performed in the surgical record and postoperative pathological results. Risk factors for the development of bowel resection in incarcerated groin hernia were analyzed by univariate analysis and multivariate logistic regression, respectively. The screened independent risk factors were used to establish a prediction model, and finally, the predictive ability and accuracy of the model were validated and the clinical benefit was analyzed. Results A total of 345 patients with incarcerated groin hernia were included, of whom 58 underwent bowel resection for bowel necrosis and 287 did not. Multifactorial logistic regression analysis identified bowel obstruction (OR, 7.285 [95% CI, 2.254–23.542], P = 0.001), peritonitis (OR, 16.786 [95% CI, 5.436–51.838], P = 0.000), duration of incarcerated groin hernia (OR, 1.009 [95% CI, 1. 001-1.018], P = 0.034), heart rate (OR, 1.109 [95% CI, 1.021–1.205], P = 0.014), and preoperative total protein (OR, 0.900 [95% CI, 0.836–0.969], P = 0.005) were independent risk factors for bowel resection in incarcerated groin hernia. The predictive value of the established prediction model was basically in agreement with the measured value with a consistency index of 0.938 (0.901–0.974) and had a good clinical benefit. Conclusion Clinical screening and management of independent risk factors for bowel resection in patients with incarcerated groin hernia should be strengthened. The predictive model developed in this study has high diagnostic efficacy for bowel resection associated with incarcerated inguinal hernia, with the aim of reducing the incidence of bowel resection and unplanned secondary surgery.

PURPOSE:Previous anatomical studies of the urogenital fascia (UGF) have focused on males, and there is a lack of relevant anatomical studies on the distribution of the extraperitoneal UGF in females.METHODS:In this investigation, guided by the embryonic development of the female urogenital system, the ventral pelvic fascia structure of 10 female cadavers was dissected, and the distribution and morphology of female extraperitoneal UGF were observed, recorded in text, photographs and video, and 3D modeling was performed.RESULTS:We find that in the female extraperitoneal space there is a migratory fascial structure, the UGF, which surrounds the urogenital system and extends from the perinephric region to the pelvis along with the development of the urogenital organs. The two layers of the UGF are composed of loose connective tissue rich in fat that surrounds the urogenital organs, their accessory vascular structures, and the nerves of the abdominopelvic cavity. In the pelvis, it participates in the formation of the ligamentous structures around the rectum and uterus. Finally, it surrounds the bladder and gradually moves into the loose connective tissue of the medial umbilical fold.CONCLUSIONS:Sorting out the distribution characteristics of UGF has some reference value for studying the metastasis of gynecological tumors, the biomechanical structure of the female pelvis, and the surgical methods of gynecology, colorectal surgery, and hernia surgery.

BACKGROUND:The architecture of retrorectal fasciae is complex, as determined by different anatomical concepts. The aim of this study was to examine the anatomical characteristics of the inferomedial extension of the urogenital fascia (UGF) involving the pelvis to explore its relationship with the adjacent fasciae. Furthermore, we have expounded on the clinical application of UGF.METHOD:For our study, we examined 20 adult male pelvic specimens fixed in formalin, including 2 entire pelvic specimens and 18 semipelvic specimens. Our department has performed 466 laparoscopic rectal cancer procedures since January 2020. We reviewed the surgical videos involving UGF preservation and analyzed the anatomy of the UGF.RESULTS:The bilateral hypogastric nerves ran between the visceral and parietal layers of the UGF. The visceral fascia migrated ventrally at the fourth sacral vertebra, which formed the rectosacral fascia together with the fascia propria of the rectum; the parietal layer continually extended to the pelvic diaphragm, terminating at the levator ani muscle. At the third to fourth sacral vertebra level, the two layers constituted the lateral ligaments.CONCLUSION:The double layers of the UGF are vital structures for comprehending the posterior fascia relationship of the rectum. The upper segment between the fascia propria of the rectum and the visceral layer has no evident nerves or blood vessels and is regarded as the " holy plane" for the operation.

BACKGROUND:Controversies regarding the anatomical structure of Denonvilliers' fascia and its relationship with surrounding fasciae have sparked a heated discussion, especially concerning whether Denonvilliers' fascia is multilayered. This study aimed to expound on the anatomical structure of Denonvilliers' fascia and its correlation with the peritoneum from the sagittal view and clarify the complex fascial relationship.METHODS:Our study was performed on 20 adult male pelvic specimens fixed in formalin, including 2 entire pelvic specimens and 18 semipelvic specimens. The local adjacent organs and fasciae were dissected, and Denonvilliers' fascia was observed and removed for histological examination.RESULTS:Denonvilliers' fascia was typically single-layered and tough. On the sagittal plane, the peritoneum constituting the peritoneal reflection and Denonvilliers' fascia formed a "Y" shape. Denonvilliers' fascia originated from the peritoneal reflection, extended along the ventral side of the seminal vesicles and prostate, continuing caudally; its bilateral sides closely connected to the urogenital fascia (UGF) of the pelvic wall. In addition, histology preliminarily indicated that the basal cell layers of the peritoneum and Denonvilliers' fascia were continuous and formed a "Y" shape. Furthermore, the basal cells of the two peritonea extended to Denonvilliers' fascia, creating a fused double-layered structure. Some tiny blood vessels or a network of such vessels extended from the peritoneum to Denonvilliers' fascia.CONCLUSION:Denonvilliers' fascia, the extension of the peritoneum in the pelvic floor, appears as a single-layered "Y"-shape on the sagittal plane. Our study provides new support for the peritoneal fusion theory. Understanding the anatomical characteristics of Denonvilliers' fascia and its relationship with the UGF is of guiding significance for inexperienced colorectal surgeons to conduct rectal cancer surgery.

目的 观察"新型子宫悬吊装置"在腹腔镜直肠癌根治术中的应用效果.方法 84例女性直肠癌患者,均行腹腔镜直肠癌根治术,术中采用新型子宫悬吊装置42例(观察组)、自制子宫悬吊装置42例(对照组),对比分析两组患者子宫悬吊时间、术中出血量、手术相关指标及悬吊相关并发症发生情况.结果 与对照组比较,观察组术中子宫悬吊时间短、术中出血量少、术后第1天疼痛模拟评分低(P均<0.05).结论 相比于常规悬吊装置,腹腔镜直肠癌根治术中应用新型子宫悬吊装置操作所需时间短、术中出血量少、术后患者疼痛程度轻.

Purpose Many researchers have different views on the origin and anatomy of the preperitoneal fascia. The purpose of this study is to review studies on the anatomy related to the preperitoneal fascia and to investigate the origin, structure, and clinical significance of the preperitoneal fascia in conjunction with previous anatomical findings of the genitourinary fascia, using the embryogenesis of the genitourinary system as a guide. Methods Publications on the preperitoneal and genitourinary fascia are reviewed, with emphasis on the anatomy of the preperitoneal fascia and its relationship to the embryonic development of the genitourinary organs. We also describe previous anatomical studies of the genitourinary fascia in the inguinal region through the fixation of formalin-fixed cadavers. Results Published literature on the origin, structure, and distribution of the preperitoneal fascia is sometimes inconsistent. However, studies on the urogenital fascia provide more than sufficient evidence that the formation of the preperitoneal fascia is closely related to the embryonic development of the urogenital fascia and its tegument. Combined with previous anatomical studies of the genitourinary fascia in the inguinal region of formalin-fixed cadavers showed that there is a complete fascial system. This fascial system moves from the retroperitoneum to the anterior peritoneum as the preperitoneal fascia. Conclusions We can assume that the preperitoneal fascia (PPF) is continuous with the retroperitoneal renal fascia, ureter and its accessory vessels, lymphatic vessels, peritoneum of the bladder, internal spermatic fascia, and other peritoneal and pelvic urogenital organ surfaces, which means that the urogenital fascia (UGF) is a complete fascial system, which migrates into PPF in the preperitoneal space and the internal spermatic fascia in the inguinal canal.

目的:探究微小RNA-10a(microRNA-10a)联合甲胎蛋白(AFP)、糖类抗原50(CA50)、糖类抗原19-9(CA199)检测在结直肠腺癌早期诊断中的价值.方法:回顾性分析108例早期结直肠腺癌患者临床资料(结直肠腺癌组),并经倾向性得分匹配法收集与结直肠腺癌组1:1匹配的108例结直肠良性病变者临床资料(良性组).比较两组患者一般资料,血清microRNA-10a、AFP、CA50、CA199水平差异,并使用受试者工作特征(ROC)曲线评估血清microRNA-10a、AFP、CA50、CA199及其联合检测对早期结直肠腺癌的诊断价值.结果:两组患者性别、年龄、病变部位比较,差异无统计学意义(均P>0.05).结直肠腺癌组患者血清microRNA-10a、AFP、CA50、CA199水平显著高于良性组(均P<0.05).经ROC曲线分析,血清microRNA-10a、AFP、CA50、CA199对早期结直肠腺癌均有较高诊断价值,且四项联合检测诊断价值更高.结论:血清microRNA-10a联合AFP、CA50、CA199检测对早期结直肠腺癌诊断价值较高,可应用于结直肠腺癌筛查.

Objective:To investigate the clinicopathological features and surgical efficacy of primary hepatic angiosarcoma (PHA).Methods:Clinical data of 4 patients who were pathologically diagnosed with PHA and underwent surgical resection in the First Affiliated Hospital of Xi'an Jiaotong University from January 2000 to December 2019 were retrospectively analyzed. The informed consents of all patients were obtained and the local ethical committee approval was received. Literature was retrieved in CNKI, Wanfang Data and PubMed using the keywords of "primary hepatic angiosarcoma" in both Chinese and English. 49 patients who were pathologically diagnosed with PHA and underwent surgical resection were included. The expression levels of CD31, CD34, Vimentin, coagulation factor Ⅷ (FⅧ) and Ki-67 in the tumor were quantitatively detected. Clinicopathological features and clinical prognosis of PHA were summarized and analyzed.Results:A total of 53 patients with PHA were included in the study, 26 male and 27 female, aged (57±3) years on average. Abdominal pain was observed in 28 cases, abdominal distension or upper abdominal discomfort in 5, fever in 1, abdominal mass in 1, lumbago in 1, costal region pain in 1, cough complicated with chest tightness and shortness of breath in 1, and no evident clinical symptoms in 15. 37 cases were diagnosed with single onset and 16 cases of multiple onset. The tumors of 12 cases were located in the left lobe, 32 in the right lobe, 1 in the middle lobe, 3 in the bilateral lobes, 2 in the whole lobe, and tumor location in 3 cases was not described. The maximum diameter of tumor was ranged from 1.7 to 25.0 cm. The tumor was solid, moderate texture and encapsulated. The tumor cells presented in oval or short-spindle shape, arranged in lamellar or staggered pattern, with significant cellular atypia. Immunohistochemical staining showed that the positive rate of CD31 was 78%(21/27), CD34 was 78%(21/27), Vimentin 58%(21/36), FⅧ 44%(12/27) and Ki-67 30%(8/27). Among 49 patients undergoing surgical resection, 13 cases were treated with preventive intravenous chemotherapy and 6 cases received preventive interventional therapy. 4 patients in our hospital were not treated with chemotherapy or interventional therapy. During the follow-up, 1 patient recurred, 2 cases developed liver failure and 1 metastasis.Conclusions:PHA is rarely seen in clinical practice and is lack of specific clinical manifestations and diagnosis parameters. It is difficult to deliver prompt diagnosis and easily misdiagnosed as other liver tumors. Surgical resection is the main treatment. The diagnostic confirmation relies on the pathological examination. Surgical resection combined with regular postoperative follow-up can yield definite efficacy and improve the clinical prognosis.

目的:比较中间入路与侧方入路腹腔镜右半结肠癌根治术的疗效.方法:回顾性分析行腹腔镜右半结肠癌根治术的106例患者资料,根据术中入路差异分为中间组(56例,中间入路)和侧方组(50例,侧方入路).比较两组患者临床疗效、围手术期参数、术后胃肠功能指标、血清肿瘤标志物水平、外周血T淋巴细胞亚群水平及并发症.结果:中间组与侧方组手术治疗总有效率比较差异无统计学意义(P>0.05).与侧方组相比,中间组手术时间、引流管拔除时间缩短,术中出血量减少,淋巴结清扫数更多,肠鸣音恢复、肛门排气、流质饮食恢复的时间缩短(均P<0.05).术后7 d,两组血清标志物[糖蛋白抗原19-9(CA199)、胸苷激酶1(TK1)、Polo样激酶1(Plk1)]、外周血T淋巴细胞亚群(CD3+、CD4+、CD4+/CD8+)水平较术前降低,中间组CA199、TK1、Plk1水平低于侧方组,而CD3+、CD4+、CD4+/CD8+水平高于侧方组(均P<0.05).中间组和侧方组并发症总发生率比较差异无统计学意义(P>0.05).结论:两种入路方式疗效相当,但中间入路腹腔镜右半结肠癌根治术较侧方入路具有术程短、创伤少、肠胃功能恢复快的优势,更有利于减轻恶性肿瘤的影响,对免疫功能影响小.

目的:研究新型外科可吸收材料与可吸收止血纱在外科手术止血中的有效性和安全性.方法:随机选取多中心临床病例按多中心随机对照原则分为两组,对照组104例、观察组103例,比较两组患者治疗前后的生命体征、血常规、尿常规、肝功能、凝血酶原指标、心电图情况以及不良事件发生情况,以评价新型外科可吸收材料用于手术创面止血的有效性和安全性.结果:两组患者的5 min内止血率、器械黏贴情况比较均无统计学差异(均P>0.05);两组患者生命体征、血常规、尿常规、肝功能、凝血酶原指标、心电图及并发症发生情况比较均无统计学差异(均P>0.05);观察组患者的严重不良事件发生率显著低于对照组(P<0.05).结论:新型外科可吸收材料用于手术创面止血的有效性与可吸收止血纱无差异,但其安全性要优于可吸收止血纱.

Purpose To investigate the urogenital fascia (UGF) anatomy in the inguinal region, to provide anatomical guidance for laparoscopic inguinal hernia repair (LIHR). Methods The anatomy was performed on 10 formalin-fixed cadavers. The peritoneum and its deeper fascial tissues were carefully dissected. Results The UGF's bilateral superficial layer extended and ended in front of the abdominal aorta. At the posterior axillary line, the superficial layer medially reversed, with extension represented the UGF's deep layer. The UGF's bilateral deep layer medially extended beside the vertebral body and then continued with the transversalis fascia. The ureters, genital vessels, and superior hypogastric plexus moved between both layers. The vas deferens and spermatic vessels, ensheathed by both layers, moved through the deep inguinal ring. From the deep inguinal ring to the midline, the superficial layer extended to the urinary bladder's posterior wall, whereas the deep layer extended to its anterior wall. Both layers ensheathed the urinary bladder and extended along the medial umbilical ligament to the umbilicus and in the sacral promontory, extended along the sacrum, forming the presacral fascia. The superficial layer formed the rectosacral fascia at S4 sacral vertebra, and the deep layer extended to the pelvic diaphragm, terminating at the levator ani muscle. Conclusion The UGF ensheaths the kidneys, ureters, vas deferens, genital vessels, superior hypogastric plexus, seminal vesicles, prostate, and urinary bladder. This knowledge of the UGF's anatomy in the inguinal region will help find correct LIHR targets and reduce bleeding and other complications.

粘连性肠梗阻是临床常见急腹症,因多种因素导致肠管、腹腔或腔内脏器粘连,使肠内容物无法正常通过,占所有肠梗阻的40.0％～60.0％[1,2].保守疗法能够缓解肠腔粘连程度,但无法彻底解除异常的解剖结构,导致病情反复,甚至会形成绞窄性肠梗阻[3].手术治疗不仅可以缓解粘连,也能解除异常解剖,成为研究重点.既往医院常用开腹手术,虽然能取得一定效果,但创伤大、并发症多,多数患者难以耐受,并拒绝开腹手术[4].随着腔镜技术发展,腹腔镜手术所具有的微创优势,在各种急腹症疾病的诊治中得到推广,其效果得到认可[5].故腹腔镜手术在粘连性肠梗阻中的应用,有一定应用意义以及研究价值.

DNA-binding protein A (dbpA) is reported to be upregulated in many cancers and associated with tumor progress. The present study aimed to investigate the role of dbpA in 5-fluorouracil (5-FU)-resistant and oxaliplatin (L-OHP)-resistant colorectal cancer (CRC) cells. We found that 5-FU and L-OPH treatment promoted the expression of dbpA. Enhanced dbpA promoted the drug resistance of SW620 cells to 5-FU and L-OHP. DbpA knockdown inhibited cell proliferation, induced cell apoptosis, and cell cycle arrested in SW620/5-FU and SW620/L-OHP cells. Besides, dbpA short hairpin RNA (shRNA) enhanced the cytotoxicity of 5-FU and L-OHP to SW620/5-FU and SW620/L-OHP cells. Meanwhile, dbpA shRNA inhibited the activation of the Wnt/β-catenin pathway that induced by 5-FU stimulation in SW620/5-FU cells. Activation of the Wnt/β-catenin pathway or overexpression of checkpoint kinase 1 (Chk1) abrogated the promoting effect of dbpA downregulation on 5-FU sensitivity of CRC cells. Importantly, downregulation of dbpA suppressed tumor growth and promoted CRC cells sensitivity to 5-FU in vivo. Our study indicated that the knockdown of dbpA enhanced the sensitivity of CRC cells to 5-FU via Wnt/β-catenin/Chk1 pathway, and DbpA may be a potential therapeutic target to sensitize drug resistance CRC to 5-FU and L-OHP.

Background: There is an urgent need for the identification of new, clinically useful biomarkers of CRC to enhance diagnostic and prognostic capabilities. Methods: We performed proteomic profiling on serum samples from paired pre-and post-operative CRC patients, colorectal polyps patients and healthy controls using an approach combining magnetic bead-based weak cation exchange and matrix-assisted laser desorption ionization-time of flight mass spectrometry. We next performed liquid chromatography-electrospray ionization-tandem mass spectrometry to identify the proteins and selected potential biomarker based on bioinformatics analysis of the TCGA and GEO dataset. We examined SETD7 expression in scrum and tissue samples by ELISA and immunohistochemistry respectively and explored the biological function of SETD7 in vitro. Findings: 85 differentially expressed peptides were identified. Five peptides showing the most significant changes in abundance across paired pre- and post-operation CRC patients, colorectal polyps patients and healthy controls were identified as peptide regions of FGA, MUC5AC and SETD7. Bioinformatics analysis suggested that the up-regulation of SETD7 in CRC is relatively specific. Validation studies showed that SETD7 expression increased from healthy controls to those with colorectal polyps and finally CRC patients, and decreased after surgery. The sensitivity and specificity of SETD7 were 92.17% and 81.08%, with a high diagnostic value (AUC = 0.9477). In addition, SETD7 expression was significantly correlated with tumor stage and microsatellite instability. Knockdown of SETD7 inhibited cancer cell proliferation, induced G1/S cell cycle arrest and increased apoptosis. Interpretation: Our data indicate that SETD7 could serve as a potential diagnostic and prognostic biomarker for CRC. (C) 2018 The Authors. Published by Elsevier B.V.

OBJECTIVE:To analyze the common hemorrhage sites during laparoscopic rectal cancer surgery in order to take reasonable prevention and management.METHODS:Clinical data of 355 rectal cancer patients who underwent laparoscopic total mesorectal excision in Shanxi Provincial People's Hospital from January 2012 to December 2014 were retrospectively analyzed. Common bleeding sites, blood loss, and hemostasis time were recorded. According to the date of operation, patients were divided into 2012 group (91 cases), 2013 group (122 cases) and 2014 group(142 cases). Hemorrhage rates were compared among three groups.RESULTS:No significant differences were observed in the baseline data among the three groups(all P>0.05). The location in the order of the hemorrhage rate from high to low was seminal vesicle tail (63.0%, 131/208), inferior mesenteric vessels (27.3%, 97/355), Toldt's space (24.2%, 86/355), lateral rectal ligaments (12.1%, 43/355) and post-rectal spatial (8.2%, 29/355). According to the blood loss, post-rectal spatial[(14.1±7.1) ml], inferior mesenteric vessels [(12.7±6.1) ml] and seminal vesicle tail [(12.4±6.5) ml] were ranked in top three. The hemostasis time of seminal vesicle tail [(11.5±6.6) minutes] and post rectal spatial [(10.3±7.8) minutes] was longer than the others. Compared with 2012 group, shorter operative time [(205±50) minutes vs. (235±55) minutes, t=4.296, P=0.001], less blood loss [(35±19) ml vs. (81±24) ml, t=16.243, P=0.001] and lower hemorrhage rate [Toldt's space: 7.7%(11/142) vs. 39.6%(36/91), inferior mesenteric vessels: 9.2%(13/142) vs. 44.0%(40/91), post-rectal spatial: 0.7%(1/142) vs. 15.4%(14/91), lateral rectal ligaments: 2.1%(3/142) vs. 29.7%(27/91) and seminal vesicle tail: 50.6%(41/81) vs. 79.6%(43/54)] were found in 2014 group. The decline of hemorrhage rate in seminal vesicle tail was the slowest (χ2=11.792, P=0.003).CONCLUSIONS:The common hemorrhage sites during the laparoscopic rectal cancer surgery are inferior mesenteric vessels, Toldt's space, lateral rectal ligaments, post rectal spatial and seminal vesicle tail. Appropriate preventive measures can ameliorate the intraoperative bleeding significantly, however, more attention should be paid to the seminal vesicle tail during operation because of its higher hemorrhage rate, more blood loss and difficult hemostasis.

Objective To evaluate the feasibility of simultaneous right colon cancer and colorec-tal cancerwith laparoscopic surgery. Methods We retrospectively analyzed the clinical and pathological of 13 inpatients with simultaneous right colon cancer and colorectal cancer with laparoscopic surgery. 3 ca-ses in 13 patients were under laparoscopic colectomy and Ileal J-pouch anal anastomosis. The remaining 10 cases treated by phase Ⅰ right colon resection + colorectal cancer resection. The right colon follow the principle of CME implement D3 surgery,Rectal surgery follow the principle of TME,Anterior resection(AR) in 9 cases,Abdominoperineal resection(APR)in 1 cases. Transit operation in 1 case. Results Preoperative&nbsp;colonoscopy exploration coincidence rate was 69. 23%(9 / 13),4 cases were found in laparoscopic exploration. 12 cases phase Ⅰ healed,no incision infection,no anastomotic fistula,no intestinal adhesion and intestinal obstruc-tion. The median time into liquid diets after surgery was 2 d(1 ~ 3 d),The median time to eat any solid food was 7 d(6 ~ 9 d),the average hospital stay after surgery was(8. 7 ± 0. 8)d. Follow-up of 3 ~ 39 months,3 ~ year survival rate was 77. 78%(7 / 9). Conclusion Patients with simultaneous right colon cancer and colorectal cancer,lapa-roscopy is a better and radical surgery,phase Ⅰ resection is safe and effective.