Objective:To investigate the influencing factors of anastomotic leakage after laparoscopic intersphincter resection (ISR) for extremely low rectal cancer and construction of nomogram prediction model.Methods:The retrospective case-control study was conducted. The clinicopathological data of 812 patients who underwent laparoscopic ISR for extremely low rectal cancer in the Second Affiliated Hospital of Naval Medical University (Shanghai Changzheng Hospital) from February 2012 to February 2022 were collected. There were 459 males and 353 females, aged (51±11)years. Observation indicators: (1) surgical situations; (2) follow-up; (3) influencing factors of postoperative anastomotic leakage; (4) construction and evaluation of nomogram prediction model for postoperative anastomotic leakage. Measurement data with normal distribution were represented as Mean± SD, and measurement data with skewed distribution were represented as M(range). Count data were described as absolute numbers. The COX proportional hazard model was used for univariate and multivariate analyses. The R software(3.5.1 version) was used to construct nomogram prediction model. The receiver operating characteristic (ROC) curve was drawn and the area under curve (AUC) was used to evaluate the efficacy of the nomogram prediction model. The Bootstrap method was used for internal verification and to calculate the average consistency index (C-index). Results:(1) Surgical situations. All 812 patients underwent laparoscopic ISR for extremely low rectal cancer, including 388 cases undergoing partial ISR, 218 cases undergoing subtotal ISR and 206 cases undergoing complete ISR. All 812 patients underwent ileal protective ostomy, and there were 306 cases with double anastomosis and 203 cases with left colic artery preserved, respectively. The operation time and volume of intraoperative blood loss of 812 patients was (179±33)minutes and (33±13)mL, respectively. (2) Follow-up. All 812 patients were followed up for (13.5±0.9)months. Of the 812 patients, there were 62 cases with postoperative anastomotic leakage and the healing time of these cases was (33±6)days. (3) Influencing factors of postoperative anastomotic leakage. Results of multivariate analysis showed that male, neoadjuvant chemoradiotherapy, failure of reser-ving left colic artery were independent risk factors of anastomotic leakage after laparoscopic ISR for extremely low rectal cancer ( hazard ratio=5.98, 4.00, 16.26, 95% confidence interval as 1.66-24.12, 1.30-12.42, 3.00-90.89, P<0.05). (4) Construction and evaluation of nomogram prediction model for postoperative anastomotic leakage. According to the results of multivariate analysis, male, neoadju-vant chemoradiotherapy and failure of reserving left colic artery were used to construct the nomogram prediction model for anastomotic leakage after laparoscopic ISR for extremely low rectal cancer, and the score of these indexes in the nomogram prediction model was 50, 49, 93, respectively. The total score of these index corresponded to the incidence rate of anastomotic leakage. Results of ROC curve showed that the AUC of nomogram prediction model of anastomotic leakage after laparoscopic ISR for extremely low rectal cancer was 0.87 (95% confidence interval as 0.80-0.93, P<0.05), with sensi-tivity and specificity 0.96 and 0.60, respectively. Results of internal verification showed that the C-index of nomogram prediction model was 0.87. Conclusion:Male, neoadjuvant chemoradiotherapy, failure of reserving left colic artery are independent risk factors of anastomotic leakage after laparo-scopic ISR for extremely low rectal cancer, and the nomogram prediction model based on these indexes can predict the incidence rate of postoperative anastomotic leakage.

Objective:To investigate the risk factors of lateral lymph node positivity in middle and low rectal cancer.Methods:The data of 102 patients with middle and low rectal cancer who underwent laparoscopic radical resection and lateral lymph node dissection from January 1，2019 to December 30，2020 were retrospectively analyzed，and they were divided into positive group（n=21cases）and negative group（n=81cases）according to the lateral lymph node metastasis. The clinical data were statistically analyzed by SPSS 22.0 software，and the count data were expressed as［n（%）］，using χ2 or Fisher's exact test. Logistic multifactor analysis was used for risk factors of positive lateral lymph nodes，and P<0.05 was considered as statistically significant difference.Results:A total of 1347 lateral lymph nodes were dissected in 102 patients with low and middle rectal cancer，and 8.1% of them were positive lymph nodes. Univariate analysis showed that age，tumor diameter，degree of differentiation，tumor type，T stage and degree of intestinal wall invasion were significantly correlated with the occurrence of lateral lymph nodes（P<0.05）. Logistic regression analysis showed that the degree of low differentiation，invasive type，T3-4 stage and extrapserous tumor infiltrating intestinal wall were independent risk factors for positive lateral lymph nodes in low and middle rectal cancer（P<0.05）.Conclusion:Low differentiation of tumor tissue，invasive cancer，tumor stage T3-4 and infiltration of intestinal wall beyond serous membrane in patients with low and medium rectal cancer can be used as independent risk factors for lateral lymph node metastasis，and lateral lymph node dissection is recommended for patients with these risk factors.

目的 探讨进展期胃癌SOX方案新辅助化疗(NAT)的疗效及影响疗效的因素.方法 回顾性分析我院2010年2月至2016年4月收治的128例接受SOX方案NAT的进展期胃癌患者(NAT组)及128例行手术治疗未接受NAT的进展期胃癌患者(对照组)的临床资料.采用多因素Cox比例风险回归模型分析影响总生存期的因素,并基于相关变量建立预测NAT疗效的列线图预测模型.结果 NAT组患者中位生存时间为31个月,对照组为21个月,两组比较差异有统计学意义(P<0.05).多因素Cox比例风险回归模型分析显示,年龄、肿瘤位置、肿瘤大小、癌胚抗原、CA 19-9、临床T分期、临床N分期、淋巴结转移及未接受SOX方案NAT是胃癌患者预后的独立危险因素(P均<0.05).成功构建列线图预测模型,经内部验证该模型符合率良好,有较好的区分度和准确度,该预测模型与TNM分期相比具有较高的灵敏度和特异度.结论 SOX方案NAT能够改善进展期胃癌患者的状况,根据年龄、肿瘤大小、肿瘤部位、癌胚抗原、CA 19-9、临床T分期、临床N分期、是否有淋巴结转移和是否接受SOX方案NAT建立的列线图预测模型能够较好地预测进展期胃癌患者的预后.

目的 探讨同一术者腹腔镜下结直肠癌肝转移同期切除的临床疗效.方法 回顾性分析长征医院结直肠外科2014年2月至2017年4月实施的20例腹腔镜下结直肠癌肝转移同期切除的临床资料.结果 所有手术均顺利完成,无一例中转开腹.手术时间为175～280 min,平均216 min;出血量50～350 mL,平均140 mL;住院时间8～11 d,平均9.5 d;无一例出现术后严重并发症.随访4～39个月,1例死于腹腔转移,3例肝转移灶切除术后复发并再次给予切除.结论 腹腔镜下结直肠癌肝转移同期切除是安全和可行的.

Objective To explore the feasibility and safety of laparoscopic resection for rectal stromal tumor.Methods Sixteen (10 male and 6 female) patients underwent laparascopic resection of rectal stromal tumor in our department from May 2013 to Dec.2016,and the tumor diameter of all patients was less than 5 cm.The patients with the distance of more than 5 cm from the lower margin of the tumor to the anal verge received laparoscopic anterior resection of the rectal carcinoma (Dixon),the patients with the distance of less than 5 cm and more than 3 cm received laparoscopic local resection,and the patients with the distance of less than 3 cm,whose tumor boundary with the surrounding tissue were unclear,received laparoscopic abdominal perineal resection (Miles).Results The rectal stromal tumors of 16 cases were successfully removed under laparoscope without conversion to laparotomy,and no post-operative complications such as perforation,bleeding,obstruction or anastomotic leakage occurred.Of 16 cases,12 underwent laparoscopic anterior resection of the rectal carcinoma (Dixon),3 underwent laparoscopie local resection,and 1 underwent laparoscopic perineal resection (Miles).The average operation time was (103.0±23.8) min,the average hospital stay was (7.0 ± 1.2) days,and the average volume of intra-operative bleeding was (14 ± 4.1) mL.The pathological findings were confirmed as stromal tumor with negative margin.There was no recurrence during the followup of 8 to 40 months.Two cases with the tumor transferring to the liver eventually died of liver metastasis.Conclusion Laparoscopic resection of rectal stromal tumors is safe and feasible,with less trauma,shorter hospitalization time and quicker post-operative recovery.

问题式学习(PBL)从问题出发,通过引导学生主动学习解决问题,具有较好的教学效果.但是,PBL教学存在一定的时间和空间局限性,而且需要大量的时间来进行资料准备和面对面交流.通过在结直肠外科研究生及规培生教学中尝试利用微信平台辅助PBL教学,结果发现,不仅有助于调动学生的学习积极性,还实现了师生之间的及时交流,有助于学生了解结直肠外科的诊疗新进展.