选取60例重度肥胖行腹腔镜胃袖状切除术患者，分为观察组和对照组，结果表明两组在手术时间、吊肝时间、术中出血量方面的差异均有统计学意义（均 P<0.05）；钉仓数量差异无统计学意义（ P>0.05）。W形吊肝法在重度肥胖患者腹腔镜胃袖状切除术中是安全、有效的。

Obesity is a global epidemic with enormous social and economic burdens. Bariatric metabolic surgery (BMS) is the most effective treatment for obesity, and its mechanism has been explored. More and more clinical studies have confirmed that the brain-enteric-bacterial axis plays an important role in the pathophysiological mechanism of obesity, but there is a lack of review in this field. In this paper, the brain-entero-bacterial axis mechanism of changes in the nervous system, metabolism, endocrine system, immune system and microbial group in patients with obesity after BMS was reviewed, in order to clarify the mechanism of BMS treatment for obesity and provide relevant basis and reference for postoperative weight management in patients with obesity.

目的:探究微小RNA-145-5p(miR-145-5p)在结直肠癌组织和细胞中的表达情况及其靶向调控肌动蛋白凝胶蛋白2(TAGLN2)对结直肠癌细胞侵袭和迁移能力的影响.方法:采用实时荧光定量PCR(qPCR)技术对48例结直肠癌患者癌组织、配对癌旁组织、结直肠癌细胞株(HCT8、SW620、HCT116、HT-29)及结直肠黏膜细胞FHC中的miR-145-5p和TAGLN2 mRNA表达进行定量分析.将SW620细胞设为空白对照组、miR-145-5p mimics组、mimics-NC组、pcDNA3.1-TAGLN2组、pcDNA3.1-Vector组和miR-145-5p mimics+pcDNA3.1-TAGLN2组,采用qPCR检测miR-145-5p和TAGLN2 mRNA表达,采用Transwell法检测细胞侵袭及迁移能力,采用免疫印迹法(Western blot)检测TAGLN2蛋白及EMT相关蛋白表达,采用双荧光素酶报告实验检测miR-145-5p和TAGLN2间的靶向关系.结果:miR-145-5p在结直肠癌组织中的表达水平显著低于癌旁组织(P<0.05),并与结直肠癌患者的TNM分期和淋巴结转移相关(均P<0.05);TAGLN2在结直肠癌组织中的表达水平显著高于癌旁组织,并与miR-145-5p表达呈负相关(P<0.05);miR-145-5p和TAGLN2在结直肠癌HCT8、SW620、HCT116和HT-29细胞中的表达水平显著低于或高于FHC细胞(均P<0.05).miR-145-5p过表达可降低SW620细胞的侵袭和迁移能力.miR-145-5p靶向调控TAGLN2表达,单独转染TAGLN2阳性质粒可增加SW620细胞的侵袭和迁移能力,与miR-145-5p mimics同时转染后,TAGLN2蛋白、波形蛋白(Vimentin)和神经钙黏素(N-cadherin)表达降低,上皮钙黏素(E-cadherin)表达升高,TAGLN2对SW620细胞侵袭和迁移能力的增强作用被显著抑制.结论:miR-145-5p在结直肠癌中呈低表达状态,其表达水平与结直肠癌患者的TNM分期和淋巴结转移密切相关,miR-145-5p靶向调控TAGLN2抑制结直肠癌细胞的侵袭和迁移能力.

Objective To explore the expression of long non-coding RNA（lncRNA） Lysyl Oxidase Like Protein 1 antisense RNA 1（LOXL1-AS1） in colorectal cancer（CRC）,and to investigate the influence of lncRNA LOXL1-AS1 on the proliferation,invasion and migration of CRC cells and the possible mechanism.Methods CRC tissue samples were taken from 56 patients who underwent colorectal cancer surgery in Henan Provincial People’s Hospital from January 2016 to December 2018.The expression of lncRNA LOXL1-AS1 in 56 CRC tissue samples and CRC cell lines SW480,SW620,HCT116 and Lovo were detected by quantitative real-time PCR（qRT-PCR）,and the para-carcinoma tissues and human intestinal epithelial cell line FHC were paired as normal controls.Small interfering RNA（si-LOXL1-AS1） targeting the LOXL1-AS1 sequence was constructed and transfected into SW480 and Lovo cells.The effects of silencing lncRNA LOXL1-AS1 expression on the proliferation,invasion and migration of CRC cells were respectively detected by cell counting kit-8（CCK8）,colony formation assays,wound-healing and Transwell assay.Western blotting was used to detect the expression of phosphatidylinositol 3-kinase/protein kinase B（PI3K/Akt） signaling pathway related proteins and epithelial-mesenchymal transformation（EMT） related proteins.Results The relative expression level of LOXL1-AS1 in CRC tissues was significantly higher than that in adjacent normal tissues（1.37±0.05 vs.0.87±0.05,P＜0.05）,which was closely related to tumor differentiation degree,TNM staging,liver metastasis and MSI status of CRC（all P＜0.05）.The expressions of lncRNA LOXL1-AS1 in CRC cell lines SW480,SW620,HCT116 and Lovo were significantly higher than that of FHC cells（1.93±0.10,1.32±0.04,1.50±0.07,1.78±0.09 vs.1.10±0.07,P＜0.05）.The expression of silencing lncRNA LOXL1-AS1 could inhibit the proliferation,invasion and migration of SW480 cells and Lovo cells,up-regulate the expression of E-cadherin,down-regulate the expression of N-cadherin,P-PI3K and p-Akt（all P＜0.05）.Conclusions LncRNA LOXL1-AS1 is highly expressed in CRC tissues and is correlated with clinicopathological features of CRC patients.Silencing LOXL1-AS1 can significantly inhibit the proliferation,invasion and metastasis of CRC cells,which may be related to EMT and PI3K/Akt signaling pathways.

Background Current expectations are that surgeons should be technically proficient in minimally invasive low anterior resection (LAR)—both laparoscopic and robotic-assisted surgery. However, methods to effectively train surgeons for both approaches are under-explored. We aimed to compare two different training programs for minimally invasive LAR, focusing on the learning curve and perioperative outcomes of two trainee surgeons. Methods We reviewed 272 consecutive patients undergoing laparoscopic or robotic LAR by surgeons A and B, who were novices in conducting minimally invasive colorectal surgery. Surgeon A was trained by first operating on 80 cases by laparoscopy and then 56 cases by robotic-assisted surgery. Surgeon B was trained by simultaneously performing 80 cases by laparoscopy and 56 by robotic-assisted surgery. The cumulative sum (CUSUM) method was used to evaluate the learning curves of operative time and surgical failure. Results For laparoscopic surgery, the CUSUM plots showed a longer learning process for surgeon A than surgeon B (47 vs. 32 cases) for operative time, but a similar trend in surgical failure (23 vs. 19 cases). For robotic surgery, the plots of the two surgeons showed similar trends for both operative times (23 vs. 25 cases) and surgical failure (17 vs. 19 cases). Therefore, the learning curves of surgeons A and B were respectively divided into two phases at the 47th and 32nd cases for laparoscopic surgery and at the 23rd and 25th cases for robotic surgery. The clinicopathological outcomes of the two surgeons were similar in each phase of the learning curve for each surgery. Conclusions For surgeons with rich experience in open colorectal resections, simultaneous training for laparoscopic and robotic-assisted LAR of rectal cancer is safe, effective, and associated with accelerated learning curves.

目的 观察腹腔镜右半结肠癌根治术中采用平行重叠吻合法进行胃肠道重建后经阴道取标本的效果,探讨其安全性.方法 42例右半结肠癌女性患者,均行腹腔镜下右半结肠癌根治术,16例采用平行重叠吻合法行胃肠道重建经阴道取标本者为观察组,26例常规应用管状吻合器吻合联合腹部辅助切口取标本者为对照组.比较2组年龄、肿瘤直径、临床分期等临床资料;记录2组术中吻合时间、术中出血量、术后1 d疼痛视觉模拟评分(visual analogue scale,VAS)、术后排气时间及吻合口相关并发症发生情况.结果 2组年龄、肿瘤直径、临床分期等临床资料比较差异均无统计学意义(P＞0.05).2组均于腹腔镜下完成手术.观察组术中出血量[(3.6±0.3)mL]少于对照组[(4.8±0.9)mL](t=-5.299,P＜0.001),术后 1 d VAS评分[(3.9±0.4)分]低于对照组[(6.4±0.8)分](t=-13.849,P＜0.001),术后排气时间[(2.4±0.3)d]短于对照组[(2.9±0.3)d](t=-5.131,P＜0.001),术中吻合时间[(20.4±1.9)min]与对照组[(19.7±1.4)min]比较差异无统计学意义(t=1.426,P=0.162).观察组吻合口相关并发症发生率(6.25％)与对照组(7.69％)比较差异无统计学意义(x2=0.031,P=0.860).结论 女性右半结肠癌患者腹腔镜右半结肠癌根治术中采用平行重叠吻合法行胃肠道重建后经阴道取标本可减少术中出血,减轻术后疼痛,促进肠道功能恢复,且不增加吻合口相关并发症发生率.

D2 lymphadenectomy combined with complete mesentery excision (CME) for advanced gastric cancer in recent years was a hotspot issue in China, while its safety and effectiveness have been proved. According to the Membrane anatomy of the stomach, both surgical approach and mesogastrium interval is particularly important in Laparoscopic radical gastrectomy. We summarized and shared the following clinical experience for medical colleagues. (1) Lymph nodes of right abdominal aorta-No.7,8,9,12-should be resection as an indivisible whole. This integrity tissue above the portal vein was supposed to the end of the dorsal mesentery of stomach and the continuation of Gerota fascia. (2) No.10 (splenic hilar lymph nodes) lymphadenectomy: The surgical approach enters the Gerota fascia between the left gastric artery(LGA) and the left alongside the splenic artery. When the extent of lymphadenectomy performed to cardia and upper margin of the spleen, then the ultrasonic scalpel should excise the lymph node along the splenic artery to the splenic hilum. (3) Esophagogastric junctional cancer: There is no consensus over the type of resection and the extent of lymphadenectomy that could be a standard of care for this category.While we recommended that paraesophageal lymph node dissection and digestive tract reconstruction should be completed in 3D laparoscopy vision. (4) Infracardiac bursa(ICB): Intentional entry into the ICB provides surgeons with a landmark to identify the location of the pleura, and inferior vena cava. (5)The application of endoscopic aspirator with flushing and electrocautery. The CME concept of gastric cancer emphasizes the membrane anatomy theory rather than the regional lymph node. The precision and homogeneity of the D2 procedure therapy of gastric cancer depend on complete mesentery excision, standard the surgical process, or approach. Only in this way can we find the avascular gaps easily and perfectly cover the extent of lymph node dissection required for the D2 procedure.