BACKGROUND:As the base of hepatitis B patients has been increasing annually, it has developed into a high incidence source of primary liver cancer worldwide. The fatality rate of liver cancer is still relatively high. Among the many treatment methods, liver resection is the first-line treatment of primary liver cancer. Although precision hepatectomy has achieved rapid development in recent years, the understanding of its efficacy is still not completely clear. This study aimed to analyze and compare the safety and effectiveness of precision hepatectomy and traditional hepatectomy in the treatment of primary liver cancer.METHODS:We performed a literature search of the CNKI, Wanfang, Weipu.com, PubMed, Cochrane Library, Web of Science databases for studies on precision liver resection (precision group) and traditional liver resection (traditional group) for the treatment of primary liver cancer. Data including the operation time, intraoperative blood loss, hospital stay, postoperative complications, liver function, and survival rate were analyzed using RevMan 5.3 software to compare the differences in the effects of the two surgical procedures.RESULTS:Ten articles were included in the study, involving a total of 1,969 patients, including 1,045 cases in the precision group and 924 cases in the traditional group. Meta-analysis results showed that compared with the traditional group, the precision group had a longer operation time [mean difference (MD) =8.01, P=0.004], and total bilirubin (TBiL; MD =-2.78, P=0.055) was similar. Meanwhile, the precision group exhibited advantages in terms of intraoperative blood loss (MD =-149.37, P=0.000), hospital stay (MD =-5.59, P=0.000), postoperative liver function indexes [aspartate aminotransferase (AST; MD =-11.61, P=0.000) and alanine aminotransferase (ALT; MD =-18.53, P=0.000)], postoperative complication rate [relative risk (RR) =0.51, P=0.000], and 1-year survival rate (RR =1.11, P=0.000).DISCUSSION:The application of precision surgery in the treatment of primary liver cancer can be a safe and effective method. It can minimize intraoperative blood loss, mitigate surgical risk, reduce postoperative complications, improve patient prognosis and quality of life, and provide better short-term curative effect and patient benefits.

Objective: The objective of this study is to explore the imaging features of abdominal Computed Tomography (CT) in patients with surgical acute abdominal perforation and to improve the diagnostic ability of perforated acute appendicitis (PAA). Method: Patients with suspected acute appendicitis and abdominal pain are selected as the study objects. According to the surgical records and pathological results, the patients are divided into PAA group and nonperforated acute appendicitis (NPAA) group. All patients are examined by abdominal CT. Postprocessing reconstruction technology such as multiple planar reconstruction (MPR) algorithm and curved planar reformat (CPR) algorithm are used as assistance to display the appendix, analyze and compare the images, observe the image performance of abdominal CT, and measure the diameter of the appendix. Results: The incidence of PAA specific signs (i.e. cellulitis around the appendix, abscess around the appendix, enhancement defect of the appendix wall, air accumulation outside the appendix cavity, fecal stone outside the appendix cavity) in PAA group is significantly higher than that in NPAA group (P < 0.05). Appearance of at least one specific sign for the diagnosis of PAA is 95.65%, the specificity is 92.59%, and the accuracy is 94.00%. The diameter of appendix in PAA group is significantly larger than that in NPAA group (P < 0.05). Compared with the diagnosis of simple specific signs, the specificity and accuracy of the combination of appendiceal diameter and specific signs in the diagnosis of PAA have been improved. Conclusion: With the help of MPR algorithm and CPR algorithm, abdominal CT imaging technology can accurately identify PAA and NPAA, which has important diagnostic value.

Objectives To study application efficiencies of two types of intestinal ostomy in the treatment of elderly patients with obstructive sigmoid colon cancer and colorectal cancer.Methods 62 elderly patients with obstructive sigmoid colon cancer and rectal cancer from January 2013 to January 2016 in our hospital were chosen.The patients were divided into loop ileostomy group(n=32) and colostomy group(n=30)depending on the type of therapy.And the stage Ⅰ and Ⅱ operative time,hospital stay,postoperative fasting time and postoperative complication incidence rates were compared between the two groups.Results The postoperative fasting time was significantly shorter in loop ileostomy group than in colostomy group during stage Ⅰ surgery(2.5 ± 0.5)d vs.(4.6 ± 0.6)d(t=14.3644,P =0.0000).In stage Ⅱ surgery,the operative time,hospital stay,postoperative fasting time (2.9 ± 0.6)d vs.(4.9 ± 0.4)d,(1.4 ± 0.4)d vs.(2.5 ±± 0.3)d,(6.3± 1.4d)vs.(8.8±1.2)d were significantly lower in the loop ileostomy group than in the colostomy group(t=-15.2762、-10.9714、-7.6601,all P =0.0000).Conclusions Compared with colostomy technique,the loop ileostomy has advantages including shorter operation time,lower incidence of postoperative complications and quicker recovery after surgery for elderly patients with obstructive sigmoid colon cancer and colorectal cancer.

Objective:To evaluate the influence of arginine and glutamine on the immunologic function and nutritional status of patients with colorectal cancer (CRC) in perioperative period.Methods:A total of 85 patients with CRC were selected and randomly divided into observation group (n=43) and control group (n=42).Both groups received parenteral nutrition (PN) support and enteral nutrition (EN) support,on which basis observation group was added with arginine and glutamine.The changes of immunologic function,inflammatory responses and nutritional status were observed in both groups.Results:CD4/CD8 and immunoglobulin A (IgA) increased notably in observation group on postoperative 2d and 7d (P<0.01),and were evidently higher than those in control group (P<0.01).On postoperative 7d,tumor necrosis factor-α (TNF-α) and C-reactive protein (CRP) decreased prominently in observation group (P<0.01),while body mass index (BMI) increased evidently in observation group (P<0.01),which changed more significantly in observation group than those in control group,and there were significant difference (P<0.05 or P<0.01).Conclusion:Application of arginine and glutamine can effectively improve the immunologic function,relieve inflammatory responses,correct the abnormal metabolism of tumor tissue cells,and improve the nutritional status of patients with CRC in perioperative period.

目的用POSSUM、P-POSSUM、Cr-POSSUM及ACPGBl 评分系统分别预测结直肠癌手术风险的效果探讨分析。方法选取150例结直肠癌患者，术前以POSSUM、P-POSSUM、Cr-POSSUM及ACPGBI评分系统分别对结直肠癌患者并发症发生率、死亡率进行前瞻性预测，并与术后实际并发症、死亡率进行对照。结果 POSSUM评分系统预测并发症的发生率（76例、50．67％）及死亡率（42例、28．00％）分别显著高于实际并发症率（38例、25．33％，P＜0．01）及死亡率（7例、4．67％，P＜0．01）。但老年患者的并发症预测发生率与实际发生率差异统计学无意义，P-POSSUM、Cr-POSSUM及ACPGBI评分系统预测死亡率（分别为9例、6．00％，10例、6．67％及11例、7．33％）与实际死亡率（7例、4．67％）差异无统计学意义。结论 P-POSSUM、Cr-POSSUM及ACPGBI评分系统均能较准确地预测结直肠癌患者手术死亡率，而POSSUM评分系统可能高估了直肠癌患者的术后并发症发生率及手术死亡率。

Aim: To assess the effects of GSTT1 null genotype on the risk of gastric cancer (GC), an updated metaanalysis was performed in the Chinese population. Methods: Related studies were identified from PubMed, Springer Link, Ovid, Chinese Wanfang Data Knowledge Service Platform, Chinese National Knowledge Infrastructure (CNKI), and Chinese Biology Medicine (CBM) to up 5th March 2015. The odds ratios (ORs) and 95% confidence intervals (CIs) were calculated to estimate the strength of the associations. Results: A total of 19 case-control studies including 2861 GC cases and 5064 controls were involved in this meta-analysis. Overall, significantly increased GC risk was associated with the null GSTT1 with OR of 1.20 (95% CI: 1.04-1.38) in the Chinese population. In subgroup analyses stratified by geographic area and source of controls, the significant results were found in South China and population-based studies. We also undertook gene-gene interaction analysis between GSTT1 and GSTM1 genes for GC risk, and the results indicated that the dual null genotypes of GSTT1 and GSTM1 might elevate the risk of GC (OR = 2.02, 95% CI: 1.63-12.51). Conclusion: This meta-analysis suggests that GSTT1 null genotype is associated with elevated GC risk in Chinese, but these associations vary in different geographic location.

The microenvironment encompassing a variety of non-malignant cells in close proximity with malignant tumor cells has been well known to significantly affect the behavior of tumor cells. In this study, we therefore studied the mechanism of bone marrow stromal cells in protection of lymphoma cells from spontaneous apoptosis. We demonstrated that adhesion of the freshly isolated lymphoma B cells to bone marrow stromal cells or freshly isolated lymphoma stromal cells inhibited B cell spontaneous apoptosis in culture. This inhibition of apoptosis correlated with decreased cleavage of caspase-3/8 and increased activation of canonical and non-canonical NF-κB signaling pathway. In addition to BAFF signaling which has been reported as a functional determinant for B lymphoma cell survival in the bone marrow environment, we demonstrated RANKL from BMSCs works synergistically with BAFF to activate NF-κB signaling pathway and thus protects lymphoma B cells from spontaneous apoptosis.

自1983年德国 Semm 教授首次成功施行腹腔镜阑尾切除术（LA）以来［1］，腹腔镜阑尾切除术已被广泛应用于临床。它具有创伤小、腹腔脏器干扰少、术后恢复快、住院时间短、术后并发症少等优点［2-3］。随着腹腔镜技术的广泛应用，手术技术得到不断改进，现报告我院行腹腔镜阑尾切除术132例的经验。

Objective:To summarize the experience of laparoscopy in the open abdominal injury, for future clinical reference. Methods:Choose 52 cases with open abdominal injury from 2011 January to 2013 September in our hospital as the research object, adopt laparoscopic diagnosis and treatment, observe the clinical diagnosis and treatment. Results:All patients in the laparoscopic diagnosis, and evaluation of trauma, including 8 cases of patients from operation treatment, 36 patients received laparoscopic operation, 8 patients underwent open operation timely. All the patients were cured after treatment discharge, there was not a death cases. Conclusion:Laparoscopic plays an important role in the diagnosis and treatment of the open abdominal injury, can avoid the blindness of open, most patients can be treated under laparoscopy laparotomy operation, during laparoscopy laparotomy operation should strictly control the timing of open operation.

Objective To investigate the clinical effect of somatostatin and intestinal obstruction catheter in the treatment for adhesive intestinal obstruction.Methods 107 patients with adhesive intestinal obstruction were selected in Luhe Teaching Hospital,Capital Medical University from January 2011 to August 2012,who were randomly divided into 4 groups.28 patients used nasogastric tube in the treatment as the control Ⅰgroup.26 patients used intestinal obstruction catheter in the treatment as the controlⅡgroup.26 patients used somatostatin and nasogastric tube in the treatment as the control Ⅲ group.27 patients used somatostatin and intestinal obstruction catheter in the treatment as the observation group.Clinical indicator improving situation,transshipment operation situation,clinical efficacy,patient satisfaction were compared between 4 groups after the treatment.Results In the bloating pain relief time and recovery exhaust time,the controlⅠgroup,the controlⅡgroup,the control Ⅲ group,the observation group showed significant decreasing trend.In the gastrointestinal decompression amount,the controlⅡgroup,the observation group,the controlⅠgroup,the control Ⅲ group showed significant decreasing trend.The differences were statistically significant between each other(P 0.05).In the transit operation situation,the controlⅠgroup,the controlⅡgroup,the control Ⅲ group,the observation group showed decreasing trend(P = 0.032).The transit operation rate in the observation group was significantly lower than the controlⅠgroup and controlⅡgroup.In the patient satisfaction,the controlⅠgroup,the controlⅡgroup,the control Ⅲ group,the observation group showed increasing trend(P = 0.004).Patients satisfaction in the observation group and control Ⅲ group were significantly higher than the controlⅠgroup.In the curative effect,the controlⅠgroup,the controlⅡgroup,the control Ⅲ group,the observation group showed increasing trend(P = 0.032).Total efficiency in the observation group was significantly higher than the controlⅠgroup and controlⅡgroup.The difference was statistical significance(P 0.05).Conclusion Somatostatin and intestinal obstruction catheter in the treatment for adhesive intestinal obstruction have remarkable clinical effect,which can significantly improve clinical indications of patients.That can improve the success rate of conservative treatment.That is worthy of clinical use.

Objective To investigate the clinical effect on colonic stent insertion combined with laparoscopic operation in the treatment for acute left colonic obstruction.Methods 72 patients with acute left colonic obstruction were selected in Luhe Teaching Hospital of Capital Medical University and the Second Artillery General Hospital of Chinese People′s Liberation Army from July 2009 to July 2012.According to the surgery methods,patients were divided into two groups,36 patients used traditional open operation in the treatment were served as the control group,36 patients used colonic stent insertion combined with laparoscopic operation in the treatment were served as the observation group.Clinical indicators were compared between two groups.Results Operation time(152.4±20.3) min,bleeding volume in operation(121.7±26.9) mL,postoperative anal exhaust time(2.9±0.8) d,postoperative hospitalization time(6.7±1.8) d,complication rate(2.8%) in observation group were significantly less than those in control group [(179.6±25.1) min,(162.8±37.5) mL,(3.7±1.3) d,(9.3±2.4) d,(19.4%)];number of lymph node dissection(15.7±2.9),patient satisfaction(97.2%) in the observation group were significantly higher than those in control group [(12.6±3.1),(83.3%)],the differences were all statistically significant(all P < 0.05).Conclusion Colonic stent insertion combined with laparoscopic operation in the treatment for acute left colonic obstruction has less trauma,rapid recovery after operation,low complication rate,which is a safe and effective treatment method and worthy of clinical use.

<正>痔上黏膜环切钉合术(Procedure for prolapse and hemorrhoids,PPH)自1998年首次应用报道以来,成为治疗痔病的新方法,具有手术方法简单、符合病理生理、手术时间短、术后痛苦小、恢复快等优点,在国内得到迅速普及。但在治疗一些混合痔尤其是外痔较重患者时,往往存在外痔残留,痔回缩不全等不足。我院自引进PPH技术以来,尝试在PPH基础上联合应用外痔剥除、外痔切除缝合

随着我国人口的老龄化,老年人胆道结石的发病率逐年上升,发病率8%～10%[1],相应急性结石性胆囊炎也随之增多,已成为常见的急腹症之一.老年急性胆囊炎除具有一般急性胆囊炎的临床特点外,还具有症状、体征不典型,易坏疽穿孔及伴发病多等特点.本科2004年1月至2009年4月手术治疗146例老年急性结石性胆囊炎患者,现作一回顾性分析.报告如下.

吻合器痔上黏膜环切术(PPH)治疗痔病方法简单,手术时间短,术后痛苦小,恢复快,但也存在一定的术中、术后并发症,直接影响手术治疗效果,甚至危及患者生命,如血肿形成、下腹胀痛、钉合切割不全、出血、尿潴留、疼痛、吻合口狭窄、感染、直肠阴道瘘、痔回缩不全、肛门坠胀不适等.现将儿种常见并发症的预防措施总结如下.

胆囊结石患者中约有4%～15%的患者伴有胆总管结石[1-2].笔者对57例具有胆道探查取石指征的患者采用经胆囊管行胆道镜胆道探查取石术,疗效满意.现报告如下.