Laparoscopic liver cancer surgery in China has evolved through four distinct stages：exploratory，growth，promotion，and current maturity.During this mature phase，the technical approaches have become standardized，with surgical indications now closely paralleling those of open hepatectomy.Perioperative safety profiles and long-term oncological outcomes have been rigorously validated through multicenter studies.Present efforts focus on nationwide standardization and addressing persistent challenges such as anatomical complexity and training disparities.This article reviews the evolutionary trajectory of laparoscopic liver resection in China，analyzes its current clinical implementation，and discusses remaining barriers alongside future directions for innovation.
With the increasing adoption of laparoscopic liver resection in China，laparoscopic hepatectomy for liver cancer has been shown to be oncologically comparable to traditional open surgery.Laparoscopic liver cancer surgery offers the benefits of reduced trauma and faster recovery.However，due to the complex anatomy of the liver，further advancements in the safety and success rates of laparoscopic liver cancer surgery in the era of precision liver resection require overcoming challenges in preoperative and intraoperative planning，parenchymal transection techniques，and hemorrhage control.Key to the development of laparoscopic hepatectomy for liver cancer in China are comprehensive experience sharing，the establishment of robust training programs，and the development of standardized procedures for laparoscopic liver cancer surgery.
Minimally invasive surgery is a trend in the development of surgery.Laparoscopic technology has been applied in liver surgery for many years，but laparoscopic surgical resection for intrahepatic cholangiocarcinoma，especially combined with regional lymph node dissection，has been gradually carried out in large minimally invasive centers.However，due to the complexity and difficulty of the operation，there is still controversy at present.This article took a video of a right intrahepatic cholangiocarcinoma patient undergoing laparoscopic intrathecal anatomical right hemihepatectomy combined with regional lymph node dissection as an example to explore the surgical process and key points of operation.This surgical procedure firstly involved cholecystectomy，followed by exploration of the 13th and 16th groups of lymph nodes and dissection of the lymph nodes in parallel regions （8th，12th，and 13th groups）.The right hepatic artery and right portal vein were dissected and ligated within the sheath，followed by dissection of the hepatic parenchyma along the ischemic line and the right wall of the middle hepatic vein.Finally，the right hepatic pedicle and right hepatic vein were dissected.Patient discharged from hospital after seven days of rapid recovery after surgery，and received adjuvant treatment with gemcitabine and cisplatin.
Our team frequently confronts problems such as inadequate exposure and time-consuming adjustment during single-port laparoscopic cholecystectomy.Recently，our team has employed T-shaped shape memory alloy wires in single-port laparoscopic cholecystectomy，which entails penetrating the basal layer of the gallbladder and the mesothelium of the cystic duct to pull the gallbladder at different angles for enhanced exposure.This procedure is denominated the marionette single-port laparoscopic cholecystectomy.With the assistance of this instrument，the operation becomes less arduous，the exposure effect is more pronounced，and in comparison with the conventional single-port laparoscopic liver resection，it adds three 1.1mm port holes.The assistant port heals without leaving scars，and its postoperative aesthetic outcome is comparable to that of conventional single-port laparoscopic surgery，and even the umbilical incision is smaller.This video showcases the marionette single-port laparoscopic cholecystectomy，which is a suitable technique worthy of promotion.
To analyze the predictive value of the preoperative immune inflammatory index （SII） and the level of α-L-fucosidase （AFU） for the early recurrence.
Methods
A total of 112 patients who received interventional treatment for hepatocellular carcinoma from July 2021 to July 2023 were selected.According to whether recurrence occurred or not，they were divided into the recurrence group （n=34 cases） and the non-recurrence group （n=78 cases）.The data were imported into SPSS 22.0 for analysis.Measurement data conforming to the normal distribution，such as the levels of SII and AFU，were expressed as （±s），and the independent sample t test was performed.Count data were expressed as［ cases （%）］，and the χ2 test was used.Spearman rank correlation analysis was carried out to analyze the correlation between the preoperative levels of SII and AFU and the early recurrence of patients with hepatocellular carcinoma after interventional treatment.The receiver operating characteristic curve （ROC） was used to evaluate the predictive value of the preoperative levels of SII and AFU for the early recurrence of patients with hepatocellular carcinoma after interventional treatment.A P value less than 0.05 was considered to indicate a statistically significant difference.
Results
The preoperative levels of SII and AFU in the recurrence group were higher than those in the non-recurrence group （P＜0.05）.Spearman rank correlation analysis showed that the preoperative levels of SII and AFU were positively correlated with the early recurrence of patients with hepatocellular carcinoma after interventional treatment （r=0.331，0.306，P＜0.05）.The ROC curve showed that the area under the curve （AUC） of the combined prediction of the early recurrence of patients with hepatocellular carcinoma after interventional treatment by the preoperative levels of SII and AFU was 0.947，the sensitivity was 94.12%，and the specificity was 92.31%.The combined predictive efficiency was better than that of each index alone （P＜0.05）.
Conclusion
The preoperative levels of SII and AFU are closely related to the early recurrence of patients with hepatocellular carcinoma after interventional treatment.Measuring the levels of SII and AFU before operation can provide certain predictive value for the early recurrence of patients after operation.
To analyze the risk factors for primary liver cancer complicating hepatitis B virus （HBV）-related liver cirrhosis，so as to provide a reference for clinical diagnosis and treatment.
Methods
The data of 76 patients with primary liver cancer complicating HBV-related liver cirrhosis from July 2018 to July 2023 were retrospectively analyzed and set as the study group.Another 84 patients with HBV-related liver cirrhosis admitted during the same period were selected as the control group.The statistical software SPSS 23.0 was used for univariate analysis and multivariate Logistic regression analysis of the risk factors for primary liver cancer.
Result
Univariate analysis showed that the proportions of male gender，age ≥ 65 years old，family history of liver cancer，long-term drinking history，no antiviral treatment，and HBV-DNA quantification ＞ 2×10² IU/ml in the study group were all higher than those in the control group，and the differences were statistically significant （P＜0.05）.Incorporating the above factors with differences into the multivariate Logistic regression analysis showed that male gender，age ≥ 65 years old，family history of liver cancer，long-term drinking history，no antiviral treatment，and HBV-DNA quantification ＞ 2×10² IU/ml were independent risk factors for liver cancer complicating HBV-related liver cirrhosis （P＜0.05）.
Conclusion
There are many risk factors for primary liver cancer complicating HBV-related liver cirrhosis，and high-risk patients should be given special attention in clinical practice.
Compare the clinical application effects of laparoscopic anatomical hepatectomy for hepatocellular carcinoma via the approach along the main trunk of the hepatic vein and the traditional approach.
Methods
Retrospectively analyze the data of 112 patients with hepatocellular carcinoma who were diagnosed and underwent laparoscopic anatomical hepatectomy from January 2021 to December 2023.According to the different surgical approaches，they were divided into the hepatic vein group（n=56 cases，via the approach along the main trunk of the hepatic vein） and the traditional group （n=56 cases，via the traditional approach）.The statistical software SPSS 25.0 was used to process the data.Measurement data such as perioperative indexes and liver function indexes were described as （±s）.The paired sample t test was performed within the group，and the independent sample t test was performed between the groups.Count data such as the postoperative complications were described by frequency and percentage，and the χ2 test was performed.A P value less than 0.05 indicated that the difference was statistically significant.
Results
The operation time of patients in the hepatic vein group was shorter than that in the traditional group，and the intraoperative blood loss was less than that in the traditional group （P＜0.05）.Seven days after the operation，the levels of alanine aminotransferase （ALT） and aspartate aminotransferase （AST） in both groups increased compared with those before the operation，but the levels in the hepatic vein group were lower than those in the traditional group （P＜0.05）.There was no statistically significant difference in the incidence of major postoperative complications between the traditional group and the hepatic vein group （12.5% vs. 7.1%）（P＞0.05）.
Conclusion
For patients with hepatocellular carcinoma，laparoscopic anatomical hepatectomy via the approach along the main trunk of the hepatic vein has a shorter operation time and less intraoperative blood loss compared with the traditional approach.Moreover，it can reduce the damage to liver function caused by surgical procedures and has good safety.
To discuss the application effect of individualized hepatic segmentation using CT three-dimensional visualization technology in patients undergoing anatomical liver resection （LALR）.
Methods
A total of 62 patients with liver cancer from January 2020 to December 2023 were selected and divided into two groups by the random number table method，with 31 patients in each group.All patients underwent LALR.The patients in the observation group received individualized hepatic segmentation surgical planning based on CT three-dimensional visualization technology before the operation； the control group used the traditional method to determine the surgical scope.The statistical software SPSS27.0 was used for statistical analysis of the data.Measurement data such as various perioperative indexes were expressed as（±s），and independent samples t test was performed for comparison； χ2 test was performed for counting data indexes such as the incidence of postoperative complications.A P value less than 0.05 was considered statistically significant.
Results
The predicted liver resection volume and the actual resection volume of the patients in the observation group were both smaller than those in the control group （P＜0.05）.The operation time，intraoperative blood loss，length of hospital stay，and intraoperative blood transfusion rate of the patients in the observation group were significantly lower than those in the control group （P＜0.05）.There was no statistically significant difference in the total incidence of postoperative complications between the two groups of patients （9.7% vs. 22.6%，P＞0.05）.During the follow-up from 6 to 18 months after the operation，there were no death cases in both groups.The loss to follow-up rate in the control group was 9.7%，and that in the observation group was 3.2%.The tumor recurrence rate in the observation group was lower than that in the control group （0.0% vs. 21.4%，P＜0.05）.
Conclusion
In LALR，preoperative planning of individualized hepatic segmentation using CT-based three-dimensional visualization technology helps to reduce intraoperative blood loss，shorten the operation time and the length of hospital stay，improve the accuracy of the operation，and is helpful in reducing the risk of tumor recurrence.
To explore the application effect of complete mesocolic excision based on membrane anatomy+D2 radical resection in the treatment of advanced gastric cancer.
Methods
The case data of 175 patients with advanced gastric cancer from June 2020 to February 2023 were retrospectively analyzed.According to different surgical procedures，they were divided into the control group （receiving only D2 radical surgery，n=86 cases） and the observation group （receiving complete mesocolic excision based on membrane anatomy+D2 radical resection，n=89 cases）.The statistical software SPSS 25.0 was used for data processing.Perioperative indexes and gastrointestinal function were expressed as （±s），and independent sample t test was used between groups； Count data such as postoperative complications were expressed as［ cases（%）］，and χ2 test was performed； The Kaplan-Meier method was used to statistically analyze the recurrence risk function of advanced gastric cancer.A P value＜0.05 was considered statistically significant.
Results
The intraoperative blood loss of patients in the observation group was less than that in the control group，the number of lymph node dissections during the operation was more than that in the control group，and the recovery time of bowel sounds after the operation was shorter than that in the control group （P＜0.05）.Seven days after the operation，the levels of motilin and gastrin in both groups increased，and those in the observation group were higher than those in the control group.The level of diamine oxidase （DAO） decreased，and that in the observation group was lower than that in the control group （P＜0.05）.There was no significant difference in the incidence of postoperative complications between the two groups （P＞0.05）.Twelve months after the operation，the recurrence rate of patients in the observation group was lower than that in the control group （6.7% vs.16.3%，P=0.047）.The median recurrence time of patients in the observation group was 7.5 （5.8，9.5） months，which was lower than 6.5 （5.0，9.3） months in the control group （P=0.046）.
Conclusion
Applying complete mesocolic excision based on membrane anatomy + D2 radical resection to patients with advanced gastric cancer can reduce intraoperative blood loss，increase the number of lymph node dissections，accelerate the recovery of gastrointestinal function after the operation，and reduce the recurrence risk of gastric cancer，with a good application effect.
To study the application effect of laparoscopic D2 radical gastrectomy combined with No.16 lymph node dissection in patients with locally advanced gastric cancer.
Methods
A total of 84 patients with locally advanced gastric cancer （LAGC） admitted to the hospital from January 2021 to March 2022 were prospectively selected.They were divided into the observation group （n=42 cases） and the control group （n=42 cases） by the random number table method.The observation group underwent laparoscopic D2 radical gastrectomy combined with No.16 lymph node dissection，and the control group underwent laparoscopic D2 radical gastrectomy.Measurement data such as hospitalization cost and intraoperative blood loss of the two groups of patients were expressed as （±s），and independent samples t test was performed； counting data such as the total incidence of postoperative complications were expressed as percentages，and chi-square test was used； the data of Clavien-Dindo complication grading were expressed as frequencies，and rank sum test was performed.The Kaplan-Meier survival curve was drawn，and the Log-Rank test was used to analyze the differences in disease-free survival rate and overall survival rate between the two groups of patients.
Results
There were no statistically significant differences in hospitalization cost，length of hospital stay，total incidence of postoperative complications，and Clavien-Dindo complication grading between the two groups of patients（P＞0.05）.Compared with the control group，the operation time of the observation group was longer，and the intraoperative blood loss，the total number of dissected lymph nodes and the number of positive dissected lymph nodes were more （P＜0.05）.Two years after surgery，the cumulative disease-free survival rate of the patients in the observation group was higher than that in the control group （92.9% vs. 76.2%，Log-Rank χ²=5.098，P＜0.05）.There was no statistically significant difference in the cumulative overall survival rate between the observation group and the control group （95.2% vs. 88.1%，Log-Rank χ²=1.653，P＞0.05）.
Conclusion
For LAGC patients with limited metastasis of No.16 lymph nodes，laparoscopic D2 radical gastrectomy combined with No.16 lymph node dissection can effectively increase the number of dissected lymph nodes during the operation and improve the disease-free survival rate of patients after surgery，but it will prolong the operation time and increase intraoperative bleeding.
To compare the application effects of different esophagojejunal reconstruction methods in esophagojejunostomy during transhiatal laparoscopic total gastrectomy （TLTG） for gastric cancer patients.
Methods
The clinical data of 150 patients who underwent transhiatal laparoscopic total gastrectomy from June 2021 to June 2024 were retrospectively analyzed.According to different esophagojejunal reconstruction methods，they were divided into the reverse puncture group （n=75 cases） and the Overlap group （n=75 cases）.The reverse puncture group underwent esophagojejunal reconstruction using the reverse puncture method，and the Overlap group underwent esophagojejunal reconstruction using the Overlap method.The propensity score matching method was used to exclude confounding factors such as gender and age in the baseline data.The surgical situations of the two groups of patients （total operation time，intraoperative blood loss，anastomosis time，the distance from the upper margin of the tumor to the esophageal tangent line，length of hospital stay，hospitalization cost） and postoperative recovery situations （the time of the first out-of-bed activity after surgery，the time of the first anal exhaust after surgery，the length of postoperative hospital stay，the time of taking liquid diet after surgery），as well as the occurrence of postoperative complications were compared.
Results
There were no significant differences in the total operation time，intraoperative blood loss，the distance from the upper margin of the tumor to the esophageal tangent line，and the length of hospital stay between the two groups of patients （P＞0.05）.However，the anastomosis time and hospitalization cost in the reverse puncture group were significantly lower than those in the Overlap group （P＜0.05）.There were no significant differences in the postoperative recovery situations and the incidence of complications between the two groups of patients（P＞0.05）.
Conclusion
Both the reverse puncture method and the Overlap method are safe and reliable in esophagojejunostomy during TLTG for gastric cancer patients.However，the anastomosis time of the reverse puncture method is shorter，and the hospitalization cost for patients is lower.The appropriate surgical method can be selected according to the patient's condition.
To study the perioperative safety and anti-reflux effect of different digestive tract reconstructions after laparoscopic proximal gastrectomy.
Methods
The case data of 61 patients who underwent surgery for adenocarcinoma of the esophagogastric junction from December 2022 to December 2023 were retrospectively analyzed.According to different digestive tract reconstruction methods，they were divided into the observation group （n=31 cases） and the control group （n=30 cases）.The observation group underwent modified single muscular flap anastomosis for digestive tract reconstruction，and the control group underwent interposition jejunal anastomosis for digestive tract reconstruction.The statistical software SPSS 22.0 was used for statistical analysis of the data.All data were subjected to a normality test.Measurement data such as perioperative indexes and dynamic esophageal pH monitoring indexes were expressed as （±s），and an independent samples t test was performed.Counting data of postoperative complications were expressed as［cases （%）］，and the chi-square test or Fisher’s exact probability method was used.A P value less than 0.05 indicated a statistically significant difference.
Results
All 61 patients successfully completed total proximal gastrectomy without conversion to laparotomy.The time for digestive tract reconstruction in the observation group was less than that in the control group （P＜0.05）.The statistical results of postoperative follow-up showed that the number of refluxes with pH ＜ 4，the percentage of time with pH ＜ 4，the longest reflux time，the number of times with reflux duration ＞ 5 minutes，and the Biox-Ochoa score in the observation group were all lower than those in the control group，and the differences were statistically significant （P＜0.05）.There was no statistically significant difference in the incidence of complications between the observation group and the control group （3.2%vs. 20.0%，P＞0.05）.
Conclusion
Both modified single muscular flap anastomosis and interposition jejunal anastomosis in proximal gastrectomy are generally safe and feasible.However，the modified single muscular flap anastomosis is simple to operate and has a definite anti-reflux effect，which is worthy of further clinical promotion and application.
To explore the influence of transumbilical single-port laparoscopic cholecystectomy （LESS） under the concept of enhanced recovery after surgery （ERAS） on the postoperative recovery of patients.
Methods
A total of 120 patients with benign gallbladder diseases who underwent LESS from December 2020 to November 2023 were selected.They were randomly divided into a control group（n=60 cases） and an observation group （n=60 cases） at a ratio of 1：1.Patients in the control group received conventional peri-operative management plus LESS，while patients in the observation group received ERAS concept-based management plus LESS.The SPSS 25.0 software was used for statistical analysis of the data.Measurement data such as serum stress indicators，numerical rating scale （NRS） for postoperative pain assessment，and peri-operative indicators were expressed as （±s），and independent sample t test was used for comparison between groups； Count data such as the incidence of postoperative complications were expressed as［ cases （%）］，and the χ2 test was used.A P value ＜ 0.05 indicated a statistically significant difference.
Results
One day after the operation，the levels of reactive oxygen species （ROS），superoxide dismutase （SOD），malondialdehyde （MDA），and C-reactive protein （CRP） in the observation group were lower than those in the control group （P＜0.05）.The NRS scores of the observation group were lower than those of the control group at 6h，12h，24h，and 48h after the operation （P＜0.05）.In terms of the time to first out-of-bed activity，recovery of exhaust，first eating，length of hospital stay，as well as the intraoperative and postoperative fluid infusion volume，the values in the observation group were lower than those in the control group （P＜0.05）.The proportion of patients with adverse reactions in the observation group was 3.3%，which was lower than 15.0% in the control group （P＜0.05）.
Conclusion
Implementing intervention management under the ERAS concept during the peri-operative period of LESS can alleviate surgical stress and inflammatory responses in patients，relieve postoperative pain，promote postoperative recovery，reduce unnecessary fluid infusion，and lower the incidence of postoperative complications，with a remarkable intervention effect.
To explore the mechanism of action of melanoma-associated antigen A6（MAGEA6） in the metastasis and prognosis of gastric cancer.
Methods
The clinical data of 102 patients with gastric cancer from December 2019 to December 2020 were retrospectively analyzed.The cancer tissues and adjacent tissues of the patients were collected for immunohistochemical detection of MAGEA6.SPSS22.0 was used for data analysis.The differences in MAGEA6 expression between cancer tissues and adjacent tissues were compared，and the correlation between MAGEA6 expression and the clinical characteristics of the patients was analyzed.The patients in the study group were followed up for 3 years to analyze the prognosis and survival status.The influencing factors of prognosis and survival were analyzed by COX analysis，and the survival status of gastric cancer patients with different MAGEA6 expressions was analyzed by the Kaplan-Meier curve.
Results
The MAGEA6 score and the high expression rate of MAGEA6 in the gastric cancer group were higher than those in the adjacent tissue group （P＜0.05）.The expression of MAGEA6 was correlated with age，TNM stage，degree of differentiation，and lymph node metastasis （P＜0.05）.After a 3-year follow-up of the patients with gastric cancer，there were no lost-to-follow-up cases.36 cases （35.3%） died，and the survival time was（32.43±5.27） months.COX regression analysis showed that age （≥60 years old），TNM stage （Ⅲ-Ⅳ），degree of differentiation （poorly differentiated），lymph node metastasis，and high MAGEA6 expression were factors related to the reduction of prognosis and survival （P＜0.05）.Kaplan-Meier survival analysis showed that the overall survival of patients with low MAGEA6 expression was better than that of patients with high MAGEA6 expression （P＜0.05）.
Conclusion
The expression of MAGEA6 is high in the tissues of patients with gastric cancer.High MAGEA6 expression is closely related to the clinical characteristics of the patients.Patients with high MAGEA6 expression have a worse postoperative survival.The expression status of MAGEA6 can be used as a clinical observation index for the prognosis of gastric cancer.
To explore the influence of different anastomosis techniques on patients undergoing laparoscopic radical distal gastrectomy.
Methods
The data of 110 patients who underwent laparoscopic radical distal gastrectomy from September 2022 to April 2023 were retrospectively analyzed.According to different anastomosis methods，they were divided into the non-transection group （undergoing nontransection Roux-en-Y anastomosis） and the Billroth II group （undergoing Billroth II + Braun anastomosis）.Propensity matching was used to exclude confounding factors in the baseline data，and 55 patients were obtained in each group.The SPSS22.0 software was used for data analysis.Count data such as postoperative complications and the situation of reflux were expressed as［ cases （%）］，and the χ2 test or Rank Sum test was performed.Measurement data such as perioperative indexes，intestinal barrier indexes，and survival periods were expressed as （±s），and the independent sample t test was carried out.A P value less than 0.05 indicated a statistically significant difference.
Results
The operation time and intraoperative blood loss of patients in the non-transection group were significantly higher than those in the Billroth II group （P＜0.05）.There was no statistically significant difference in the complication rate between the non-transection group （3.6%） and the Billroth II group （12.7%） （P＞0.05）.Three days after surgery，the levels of D-lactic acid and diamine oxidase（DAO），which were indexes of intestinal barrier function，increased significantly in both groups （P＜0.05），and the levels in the non-transection group were significantly higher than those in the Billroth II group （P＜0.05）.The situations of bile reflux and reflux gastritis in patients of the non-transection group were significantly better than those in the Billroth II group （P＜0.05）.After 1-year follow-up，there were no statistically significant differences in the progression-free survival （PFS） between the two groups （Log-Rankχ2=0.529，P=0.467）and in the overall survival （OS） between the two groups （Log-Rankχ2=0.339，P=0.560）.
Conclusion
Both non-transection Roux-en-Y anastomosis and Billroth II + Braun anastomosis can effectively reconstruct the digestive tract of patients undergoing laparoscopic radical distal gastrectomy.Non-transection Roux-en-Y anastomosis has more advantages in aspects such as improving gastrointestinal function and anti-reflux.
To explore the short-term efficacy of thoracoscopic and laparoscopic combined with intrathoracic anastomosis of the esophagus and residual stomach in the treatment of Siewert type Ⅱ adenocarcinoma of the esophagogastric junction （AEG）.
Methods
The clinical data of 33 patients with Siewert type Ⅱ adenocarcinoma of the esophagogastric junction from June 2021 to April 2023 were retrospectively analyzed.The statistical software SPSS25.0 was used for data analysis.Measurement data such as perioperative indexes and the scores of gastroesophageal reflux disease （GERD） scale were expressed as（±s），and paired t test was performed.The postoperative complication grading was evaluated using the Clavien-Dindo grading system，and the counting data were expressed as［ cases （%）］.A P value less than 0.05 was considered statistically significant.
Results
All 33 patients completed the thoracoscopic and laparoscopic combined with intrathoracic anastomosis of the esophagus and residual stomach.The operation time was （262.3±37.3）minutes，the intraoperative blood loss was （178.8±111.8） ml，and the postoperative hospital stay was （11.4±3.6）days.Anastomotic leakage occurred in 2 （6.1%） patients and pulmonary infection occurred in 1 （3.0%） patient after surgery，both of which were Clavien-Dindo grade Ⅱ，and they were cured after symptomatic supportive treatments such as anti-inflammatory and nutritional treatments.All patients had negative surgical margins postoperatively，without anastomotic stricture，anastomotic bleeding or death.
Conclusion
Thoracoscopic and laparoscopic combined with intrathoracic anastomosis of the esophagus and residual stomach is safe and feasible in the treatment of Siewert type Ⅱ AEG，and it will not increase the risk of postoperative complications.
To observe the clinical application effect of three surgical methods （stent placement+laparoscopic surgery，laparotomy+intraoperative enteric cavity irrigation，stent placement+laparotomy） on patients with colorectal cancer （CRC） complicated with intestinal obstruction （IO），and to analyze the influence on gastrointestinal function indicators and inflammatory indicators of patients.
Methods
The clinical data of 108 patients with CRC complicated with IO in the hospital were retrospectively analyzed from June 2021 to June 2024，and the patients were divided into group A （stent placement+laparoscopic surgery，n=39 cases），group B （laparotomy+intraoperative stent placement，n=34 cases） and group C （stent placement+laparotomy，n=35 cases） according to different surgical methods.SPSS 22.0 software was used for data analysis.Measurement data such as surgical indicators and inflammatory indicators were analyzed by One-WayANOVA of variance.Enumeration data such as complications were analyzed by χ2 test.P＜0.05 was considered statistically significant.
Results
There was no significant difference in the operation time among the three groups （P＞0.05）.There were significant differences in the intraoperative blood loss，postoperative exhaust time，time to first get out of bed after surgery，and length of hospital stay among the three groups（P＜0.05）.The intraoperative blood loss in Groups B and C was higher than that in Group A （P＜0.05），and the postoperative exhaust time，time to first get out of bed after surgery，and length of hospital stay in Groups B and C were longer than those in Group A （P＜0.05）.The levels of carbohydrate antigen 125 （CA125） and vascular endothelial growth factor （VEGF） in the three groups decreased significantly 4 weeks after surgery （P＜0.05），but there was no significant difference among the three groups （P＞0.05）.There were significant differences in the levels of lymphocyte - to - monocyte ratio （LMR），motilin，vasoactive intestinal peptide （VIP），tumor necrosis factor - α （TNF - α），and interleukin - 6 （IL- 6） among the three groups after surgery （P＜0.05）.The LMR，motilin，and VIP levels in Groups B and C were lower than those in Group A （P＜0.05），while the levels of TNF - α and IL - 6 were higher than those in Group A （P＜0.05）.There was a significant difference in the total incidence of postoperative complications among the three groups （P＜0.05），and the incidence in Group A was significantly lower than that in Group B （P＜0.05）.
Conclusion
For patients with colorectal cancer complicated by intestinal obstruction，treatment with stent placement + laparoscopic surgery can reduce the patients’ inflammatory response and the impact on gastrointestinal function，thus contributing to postoperative recovery.
To explore and compare the influence of radical resection of colon cancer and complete mesocolic excision （CME） on the expressions of serum miR-21 and miR-25-3p in patients with colon cancer （CC）.
Methods
Patients with stage I-III CC were included from June 2021 to June 2023.According to different surgical methods，they were divided into radical resection group （open radical resection of colon cancer） and CME group （laparoscopic CME）.The propensity matching score was used to exclude the influence of confounding factors of baseline data.Finally，75 patients with comparable baseline data were obtained in radical resection group and CME group.SPSS 27.0 software was used for data analysis.Enumeration data such as complications were expressed by［ cases （%）］ and χ2 test was performed.Measurement data such as bowel resection length and expressions of miR-21 and miR-25-3p were expressed as （±s） by adopting independent sample t test.Kaplan-Meier method and Log-Rank test were used for survival analysis.P＜0.05 was statistically significant.
Results
The intraoperative blood loss in CME group was significantly less than that in radical resection group （P＜0.05），and the drainage tube removal time，exhaust time and hospitalization time were significantly shorter than those in radical resection group （P＜0.05），and the number of lymph node dissection was significantly more （P＜0.05），but there were no significant differences in the surgical time and bowel resection length between groups （P＞0.05）.The incidence rates of complications in CME group were significantly lower than those in radical resection group （P＜0.05）.At 1 week after surgery，the expression levels of miR-21 and miR-25-3p in the two groups were decreased significantly （P＜0.05），and the expression levels were significantly lower in CME group than those in radical resection group （P＜0.05）.Kaplan-Meier analysis showed that there were no statistical differences in cumulative overall survival rate （100.0% vs. 98.7%） and progression-free survival rate （97.3% vs. 90.7%） between groups （P＞0.05）.
Conclusion
Compared with radical resection of colon cancer，CME is more conducive to the recovery of patients with CC，and the latter one has fewer complications and can effectively reduce the risk of potential cancer metastasis and has better postoperative short-term prognosis.
To summarize the key points of intraoperative management of robot-assisted laparoscopic combined with gastroscopic surgery for gastric stromal tumors，and to provide a reference basis for the smooth implementation of the surgery.
Methods
The robot-assisted laparoscopic combined with gastroscopic resection of gastric stromal tumors was retrospectively analyzed，and it was summarized from four aspects： surgical method，preoperative preparation，intraoperative cooperation，and postoperative nursing.
Results
The surgical procedure was smooth，the tumor was resected with R0 resection，and the patient safely returned to the ward after the operation.
Conclusion
The robotic surgical system has flexible and precise operation and a clear surgical field.Robot-assisted laparoscopic combined with gastroscopic resection of gastric stromal tumors has the advantages of small trauma，high precision，and can preserve normal tissues to the greatest extent，which is more conducive to the postoperative recovery of patients.
To study the imaging anatomy of the pelvis during laparoscopic ultra low rectal resection （ISR）.
Methods
Data of 101 patients with ultra-low rectal cancer who underwent laparoscopic ISR from December 2019 to January 2024 were retrospectively analyzed.According to the surgical difficulty score，41 cases were divided into high difficulty group and 60 cases were divided into low difficulty group.SPSS 22.0 analyzed the data.Perioperative indicators，pelvimetry data and other measurement data were expressed as（±s），and independent sample t test was performed.The number of lymph node dissection was expressed as the median （interquartile）.χ2 test was used for counting data combined with basic diseases.Logistics regression analysis of the factors affecting the difficulty of surgery.P＜0.05 indicated that the difference was statistically significant.
Results
There were significant differences in operation time，intraoperative blood loss，hospital stay and complication grade between the two groups （P＜0.05）.Sacrococcygeal arc length SL （t=9.832，P=0.000），anteroposterior diameter of pelvic outlet ADPO （t=-4.470，P=0.000），anteroposterior diameter of pelvic entrance ADPE （t=-3.095，P=0.030），anteroposterior diameter of middle pelvis ADMP （t=-3.442，P=0.000），and anteroposterior diameter of pelvic outlet ADPO （t=-4.470，P=0.000） were observed in the advanced difficulty group.P=0.000），upper and lower diameter SPD of symphysis pubis （t=-4.156，P=0.000），intertubercular diameter IID （t=-2.043，P=0.044） were statistically significant.Logistic regression analysis showed that the anterior and posterior diameter of the middle pelvis and the interischial diameter IID were independent protective factors for ISR of laparoscopic ultra-low rectal cancer.Sacrococcygeal arc length SL and male pelvic characteristics were independent risk factors for ISR of laparoscopic ultra-low rectal cancer （P＜0.05）.
Conclusion
CT three-dimensional reconstructed pelviometry can predict the difficulty of surgery.The shorter the anteroposterior diameter of the middle pelvis and the diameter between the ischial tubercle，the longer the sacrococcygeal arc length，and the more difficult the operation of ISR for ultra-low rectal cancer.
To explore the clinical effect of complete mesocolic excision （CME） plus D3 radical resection with the superior mesenteric artery （SMA） as the medial boundary in patients with advanced colon cancer.
Methods
A total of 62 patients with advanced right-sided colon cancer who underwent CME plus D3 radical resection from January 2020 to December 2023 were selected as the research objects.They were divided into the control group （n=31 cases） and the observation group （n=31 cases） by the random number table method.In the control group，the left edge of the superior mesenteric vein （SMV） was taken as the medial boundary of lymph node dissection，while in the observation group，the left edge of the superior mesenteric artery（SMA） was taken as the medial boundary of lymph node dissection.The statistical software SPSS 27.0 was used for data analysis.Measurement data such as perioperative indexes and postoperative pathological conditions were expressed as （±s），and independent samples t test was performed.The incidence of postoperative complications was expressed as a rate，and the chi-square test was used for comparison between groups.A P value less than 0.05 was considered statistically significant.
Results
There were no statistically significant differences in operation time，intraoperative blood loss，ventilation time，length of hospital stay，tumor diameter，and degree of tumor differentiation between the two groups （P＞0.05）.The drainage tube placement time in the observation group was longer than that in the control group，and the postoperative drainage volume，the number of positive lymph nodes，and the total number of dissected lymph nodes were all more than those in the control group （P＜0.05）.There was no statistically significant difference in the total incidence of postoperative complications between the control group and the observation group （19.4% vs. 6.5%，P＞0.05）.After a 2-year follow-up，there was no statistically significant difference in the cumulative overall survival rate between the two groups （87.1% vs. 93.5%，Log-Rankχ²=0.675，P＞0.05）.The cumulative recurrence-free and metastasisfree survival rate in the observation group was higher than that in the control group，and the difference was statistically significant （90.3% vs. 64.5%，Log-Rankχ²=5.453，P＜0.05）.
Conclusion
For patients with advanced right-sided colon cancer，when performing CME plus D3 radical resection，taking the left edge of the superior mesenteric artery （SMA） as the medial boundary of lymph node dissection can improve the quality of lymph node dissection，which is of positive significance for improving the prognosis of patients.
To explore the influence of laparoscopic radical resection of rectal cancer with preservation of the ascending branch of the left colic artery on the surgical stress response and anal function of patients.
Methods
The data of 98 patients who underwent laparoscopic radical resection of rectal cancer from January 2021 to December 2023 were collected.Among them，50 patients with preservation of the left colic artery were in the observation group，and 48 patients without preservation of the left colic artery were in the control group.The surgical indexes of the two groups of patients，the surgical stress response at 1 day and 7 days after surgery，the anal function before surgery and 1 month after surgery，and the occurrence of postoperative complications were compared.The statistical software SPSS 25.0 was used to process the data.Independent samples t test was used for surgical indexes，surgical stress，and anal function，etc.Postoperative complications were expressed as ［cases （%）］，and the chi-square test was used.A P value less than 0.05 was considered statistically significant.
Results
The operation time of the observation group was significantly longer than that of the control group （P＜0.05）.At 1 day after surgery，the levels of norepinephrine （NE），cortisol （Cor），and epinephrine （E） in the observation group were higher than those in the control group （P＜0.05）.At 7 days after surgery，the levels of Cor，E，and NE in both groups decreased compared with those at 1 day after surgery （P＜0.05）；and there was no statistically significant difference in the levels of Cor，E，and NE between the two groups （P＞0.05）.One month after surgery，the scores of rectal anterior resection syndrome in both groups increased compared with those before surgery，but the scores in the observation group were lower than those in the control group.The resting pressure （RP） and maximum systolic pressure （MSP） of the anal canal in both groups decreased compared with those before surgery，but the values in the observation group were higher than those in the control group （P＜0.05）.There was no statistically significant difference in the incidence of complications between the two groups （P＞0.05）.
Conclusion
Laparoscopic radical resection of rectal cancer with preservation of the ascending branch of the left colic artery can promote the recovery of anal function with definite curative effect.However，it has a long operation time and can increase the surgical stress response to a certain extent.
To explore the short-and medium-term efficacy of laparoscopic cholecystectomy （LC） via different approaches in the treatment of acute cholecystitis.
Methods
The clinical data of 150 patients with acute cholecystitis who underwent LC treatment from January 2022 to January 2024 were retrospectively analyzed.According to different surgical approaches，they were divided into the modified group and the traditional group.The traditional group underwent routine antegrade resection （n=75 cases），and the modified group underwent resection along the “A-B-D” approach （n=75 cases）.The statistical software SPSS 27.0 was used to process the data.Measurement data such as various perioperative indexes were expressed as （±s），and the independent sample t test was performed.Count data such as postoperative complications and the conversion rate to open surgery were expressed as［ cases （%）］，and the χ2 test was used.A P value less than 0.05 was considered to indicate a statistically significant difference.
Results
The conversion rate to open surgery and the intraoperative bile duct injury rate in the modified group were （2.7%，2.7%） respectively，which were significantly lower than those in the traditional group （12.0%，13.3%） （P＜0.05）.There was no statistically significant difference in the incidence of abdominal cavity infection，bile leakage and bleeding between the two groups （P＞0.05）.The incidence of residual stones accompanied by cholecystitis in the modified group （2.7%） was significantly lower than that in the traditional group （13.3%） （P＜0.05）.
Conclusion
Compared with the routine antegrade resection，resection along the “A-B-D” approach can effectively reduce the bile duct injury rate，the conversion rate to open surgery and the incidence of residual stones accompanied by cholecystitis in LC patients.
To explore the clinical efficacy of open preperitoneal tension-free herniorrhaphy and laparoscopic transabdominal preperitoneal herniorrhaphy in elderly patients.
Methods
A total of 233 patients with inguinal hernia who underwent surgical treatment from January 2015 to November 2017 were selected.According to different surgical methods，they were divided into the open surgery group（n=117 cases） and the laparoscopic surgery group （n=116 cases）.The statistical software SPSS21.0 was used for data analysis.Measurement data such as various perioperative indexes were expressed as （±s），and independent samples t test was used； counting data such as postoperative complications were analyzed by chisquare test； univariate and multivariate analyses were performed by Logistics regression analysis.A P value less than 0.05 was considered statistically significant.
Results
The operation time，anesthesia time，postoperative exhaust time，postoperative defecation time and hospitalization cost of the patients in the open surgery group were significantly shorter or lower than those of the patients in the laparoscopic surgery group （P＜0.05）.The incidences of postoperative complications such as nausea and vomiting，delirium，ileus and intestinal obstruction in the open surgery group were significantly lower than those in the laparoscopic surgery group（P＜0.05）.Through univariate analysis，it was found that the operation time ≥ 100 min and the laparoscopic surgical method were influencing factors for the occurrence of long-term postoperative intestinal obstruction.Multivariate analysis showed that the laparoscopic surgical method was not an independent risk factor （P＜0.05）.
Conclusion
Open preperitoneal tension-free herniorrhaphy is more suitable for elderly patients.It has a low incidence of both short-term and long-term postoperative complications.The repair effect is equivalent to that of laparoscopic surgery.It is economical，easy to master，and suitable for promotion in primary medical institutions.
To compare the efficacy of two different spleen-preserving distal pancreatectomies in the treatment of tumors of the body and tail of the pancreas.
Methods
The data of 87 patients who underwent spleen-preserving distal pancreatectomy from January 2020 to December 2022 were retrospectively analyzed.According to different surgical methods，they were divided into the Kimura group （n=44 cases） and the Warshaw group （n=43 cases）.The SPSS25.0 software was used for data analysis.Measurement data such as perioperative indicators and immune function indicators were expressed as （±s），and the independent-sample t test was performed.Count data such as the occurrence of postoperative complications，recurrence rate during follow-up，and re-operation status were analyzed by the χ2 test.A P value＜0.05 was considered statistically significant.
Results
The operation time of patients in the Kimura group was longer than that in the Warshaw group （P＜0.05）.There was no significant difference in intraoperative blood loss and the time of anal flatus between the two groups （P＞0.05）.The time of first getting out of bed，the time of drainage tube removal，and the postoperative hospital stay of patients in the Kimura group were all shorter than those in the Warshaw group （P＜0.05）.On the first day after surgery，the levels of CD3+，CD4+，and CD4+/CD8+ in both groups decreased compared with those before surgery，but the levels in the Kimura group were higher than those in the Warshaw group （P＜0.05）.The incidence of postoperative complications in the Kimura group was 4.6% （2/44），which was lower than 20.9% （9/43） in the Warshaw group （P＜0.05）.During the follow-up period，neither group had recurrence or re-operation.
Conclusion
Both spleen-preserving distal pancreatectomies can achieve ideal efficacy in the treatment of tumors of the body and tail of the pancreas.Compared with the Warshaw procedure，although the Kimura procedure has a longer operation time，it can avoid a significant decline in postoperative immune function，reduce the occurrence of postoperative complications，and promote the early recovery of patients.
To explore the therapeutic advantages of endoscopic transareolar approach for unilateral thyroid cancer surgery in patients with thyroid cancer and its impact on thyroid function.
Methods
A total of 66 patients with thyroid cancer who were treated in Yangquan First People's Hospital from April 2021 to December 2022 were selected.They were divided into the study group （undergoing unilateral thyroid cancer surgery via the transareolar approach） and the control group （undergoing traditional surgery） using the random number method，with 33 patients in each group.The statistical software SPSS26.0 was used to analyze the data.Count data were expressed as［ cases （%）］，and the χ2 test or Fisher's exact test was performed.Measurement data were expressed as （±s），and the independent sample t test was carried out.A P value less than 0.05 was considered to be statistically significant.
Results
Compared with the control group，the operation time and postoperative drainage volume of patients in the study group significantly increased，while the intraoperative blood loss and hospital stay significantly decreased （P＜0.05）.After treatment，the levels of triiodothyronine （T3）and thyroxine （T4） decreased，and the level of thyroid-stimulating hormone （TSH） increased in both groups，but there was no statistically significant difference between the two groups （P＞0.05）.There was no statistically significant difference in the total incidence of postoperative complications between the two groups （P＞0.05）.
Conclusion
Endoscopic transareolar approach surgery for patients with unilateral thyroid cancer can significantly reduce intraoperative blood loss and hospital stay，and has no impact on thyroid function，which is worthy of clinical promotion.
To analyze the risk factors for ipsilateral central lymph node metastasis（CLNM） in patients with solitary papillary thyroid carcinoma （PTC） located in the lateral isthmus，and to construct a preoperative predictive model to guide surgical decision-making.
Methods
A total of 163 patients with solitary cN0 lateral isthmic PTC who underwent initial surgery between January 2016 and June 2022 were included.Univariate and multivariate Logistic regression analyses were performed to identify risk factors for ipsilateral CLNM.A nomogram prediction model was constructed and internally validated.
Results
The incidence of ipsilateral CLNM was 44.8% in the lateral isthmus PTC patients.Risk factors for ipsilateral CLNM included age ＜42 years，maximum tumor diameter ≥10 mm，aspect ratio ≥1，and extrathyroidal extension on ultrasound.The nomogram model for predicting ipsilateral CLNM in the lateral isthmus PTC patients showed an area under the receiver operating characteristic curve （AUC） of 0.814 （95% CI，0.748 to 0.880），with a mean AUC of 0.802 （95% CI，0.787 to 0.817） after 200 rounds of 10-fold cross-validation.
Conclusion
We identified risk factors for ipsilateral CLNM in PTC patients with tumors located in lateral parts of the isthmus and developed a nomogram prediction model.This model serves as an effective tool for preoperative assessment of CLNM，providing valuable guidance for surgeons in tailoring individualized surgical strategies.
To analyze the risk factors for contralateral central lymph node （Cont-CLNs）metastasis in papillary thyroid carcinoma （PTC），construct a prediction model for Cont-CLNs metastasis，and provide a reference for the scope of lymph node dissection in PTC.
Methods
The clinical and ultrasound data of 116 PTC patients who underwent total thyroidectomy + bilateral central lymph node （CLNs） dissection were retrospectively selected.According to the postoperative pathological results，they were divided into the Cont-CLNs metastasis group and the non-metastasis group.The data were analyzed using SPSS 20.0 software.The counting data were expressed as ［cases （%）］ and the chi-square test was performed.Binary logistic regression was used to analyze the independent risk factors for Cont-CLNs metastasis.A prediction model for Cont-CLNs metastasis was constructed，and the receiver operating characteristic （ROC） curve，calibration curve，and Hosmer-Lemeshow goodness-of-fit test were used to evaluate the diagnostic efficacy of the model.A P value less than 0.05 was considered statistically significant.
Results
Among 116 PTC patients，31 cases （26.7%）had Cont-CLNs metastasis.Logistic regression analysis showed that gender，tumor size，capsular invasion，CLNs metastasis on the affected side，lymph node metastasis at the midline of the neck，and microcalcification were independent risk factors affecting Cont-CLNs metastasis （all P＜0.05）.A regression prediction model for Cont-CLNs metastasis was constructed，and it was shown that the area under the curve （AUC） value of this model for predicting Cont-CLNs metastasis was 0.816 （0.697-0.902），with good goodness-of-fit，and there was a good consistency between the predicted values and the actual values.
Conclusion
Male gender，tumor size≥2cm，capsular invasion，CLNs metastasis on the affected side，lymph node metastasis at the midline of the neck，and microcalcification are risk factors for Cont-CLNs metastasis in PTC patients.
To investigate the clinical effect of microwave ablation （MWA） and trans-oral endoscopic thyroidectomy （TOET） in the treatment of stage T1N0M0 papillary thyroid carcinoma （PTC）.
Methods
Totally 215 patients with PTC in the hospital from July 2019 to July 2023 were retrospectively selected，and were divided into two groups according to the different surgical methods.110 patients in the MWA group were treated with MWA，and 105 patients in the TOET group were given TOET.SPSS 25.0 statistical software was used to analyze the data.Count data was represented by［ cases （%）］ and tested using χ2 test.Quantitative data was represented by （±s） and independent sample t test was performed.P＜0.05 was considered statistically significant
Results
All patients successfully completed the surgery.Compared with the TOET group，the MWA group had shorter surgical time，shorter hospital stay，less intraoperative blood loss，and lower VAS scores at 3，12 and 24 hours after surgery （P＜0.05）.Serum calcium and PTH were higher in the MWA group at 7 days after surgery compared with those in the TOET group （P＜0.05）.There was no significant difference in the incidence of postoperative complications between the TOET group and the MWA group （P＞0.05）.After 12 months of follow-up，no serious complications occurred in the two groups，and there were 3 cases of local recurrence in the MWA group and 0 cases in the TOET group.There was no significant difference in the local recurrence rate between the two groups （P＞0.05）.
Conclusion
MWA and TOET have their own advantages in the treatment of stage T1N0M0 PTC.The former one is more advantageous in minimally invasive aspect，but it is not as good as TOET in the prognosis recurrence.In clinical practice，it is necessary to select personalized treatment regimen according to the actual situation of patients.
To compare the effects of neoadjuvant chemotherapy combined with breastconserving surgery or modified radical mastectomy respectively on the serum tumor markers of triple-negative breast cancer.
Methods
The clinical data of 106 patients with triple-negative breast cancer from April 2021 to April 2023 were selected.According to different treatment methods，they were divided into the control group （n=50 cases，neoadjuvant chemotherapy + modified radical mastectomy） and the study group （n=56 cases，neoadjuvant chemotherapy + breast-conserving surgery）.The clinical efficacy，the levels of serum tumor markers before and after treatment，the occurrence of complications，the recurrence and metastasis rates one year after surgery of the two groups of patients were compared，and the breast aesthetic effects of the two groups of patients three months after surgery were evaluated.
Results
There was no significant difference in the total effective rate of treatment between the two groups of patients （P＞0.05）； compared with before treatment，the levels of carcinoembryonic antigen （CEA），carbohydrate antigen 125 （CA125），and carbohydrate antigen 153 （CA153） in both groups decreased after treatment，and there was no significant difference between the two groups （P＞0.05）；the incidence of complications in the study group was lower than that in the control group （P＜0.05）； there was no significant difference in the recurrence rate and metastasis rate one year after surgery between the two groups of patients （P＞0.05）； the breast aesthetic effect of the study group was better than that of the control group（P＜0.05）.
Conclusion
Neoadjuvant chemotherapy combined with breast-conserving surgery or modified radical mastectomy can achieve obvious effects in the treatment of triple-negative breast cancer.Among them，neoadjuvant chemotherapy combined with breast-conserving surgery can reduce complications and improve the breast aesthetic effect.
In recent years，the incidence of obesity has been on a continuous upward trend.Comprehensive treatment mainly based on surgery can enable patients to achieve a relatively good prognosis，but there is still a risk of recurrence after surgical treatment.Currently，there are relatively few studies on the weight rebound in obese patients after sleeve gastrectomy.This article reviews the current research status of weight rebound in obese patients after sleeve gastrectomy，summarizes the high-risk factors for recurrence from multiple aspects such as anatomical factors，hormonal factors，exercise，psychological state，preoperative weight loss measures，and the degree of postoperative weight loss，and evaluates the existing recurrence prediction models，with the aim of providing reference for clinicians in the treatment of obesity.
±s），and the independent sample t test was performed.Count data were expressed as［ cases （%）］，and the χ2 test was used.Spearman rank correlation analysis was carried out to analyze the correlation between the preoperative levels of SII and AFU and the early recurrence of patients with hepatocellular carcinoma after interventional treatment.The receiver operating characteristic curve （ROC） was used to evaluate the predictive value of the preoperative levels of SII and AFU for the early recurrence of patients with hepatocellular carcinoma after interventional treatment.A P value less than 0.05 was considered to indicate a statistically significant difference.