laparoscopic total gastrectomy， a complex procedure in gastric surgery， encounters technical difficulties with esophagojejunal anastomosis， which slows its progression and hinders its application.Currently， the most common methods for this anastomosis include circular stapler， linear stapler， and hand suturing anastomosis techniques.The challenge of achieving an efficient and safe esophagojejunal anastomosis is a pressing clinical issue for surgeons.This article reviews the progress of intracorporeal esophagojejunal anastomosis in laparoscopic total gastrectomy and proposes future directions based on personal experience and practice.
The incidence and mortality rates of gastric cancer rank fifth and fourth globally，respectively.Although the overall incidence of gastric cancer is declining worldwide， the incidence of adenocarcinoma of esophagogastric junction （AEG） is on the rise.In recent years， laparoscopic surgery has become an important method for treating AEG due to its minimal invasiveness， rapid recovery， and fewer postoperative complications.This article reviews and discusses the digestive tract reconstruction methods following laparoscopic total and proximal gastrectomy， including Roux-en-Y， tubular esophagogastrostomy，double-flap technique， and their derivative techniques.By analyzing the advantages and disadvantages of various reconstruction methods， this review aims to provide clinical surgical guidance and improve patients'postoperative quality of life and long-term outcomes.
The incidence of adenocarcinoma of esophagogastric junction （AEG） has been rising， With the development of minimally invasive surgical techniques， laparoscopic surgery has continued to mature and be widely applied.Generally， the transthoracic procedure has advantages for patients with Siewert I and those with longer esophageal invasion， while the transhiatal approach is suitable for patients with Siewert III AEG.The controversies regarding surgical methods and lymph node dissection strategies mainly focus on Siewert II AEG.This article mainly summarizes the hot issues of AEG lymph node dissection and the strategies of laparoscopic lymph node dissection by combining the existing expert consensus and the author's experience， aiming to provide a reference for clinical practice..
This article elucidates the procedures involved in lower mediastinal lymph node dissection via the right diaphragmatic crus approach.Initially， the abdominal esophagus was retracted caudally and ventrally.The diaphragmatic crus attachment of the esophagogastric junction was incised cranially along the right diaphragmatic crus.Subsequently， the air-containing loose space of the diaphragm-esophageal fascia was entered.The infra-cardiac bursa of the right lower mediastinum was gradually exposed， the infra-cardiac bursa was incised， and the lymph nodes of groups No.110 and No.112 were dissected along the pleura of the right mediastinum.The azygos vein was exposed dorsally， and the inferior pulmonary vein was exposed cranially.The infra-pulmonary vein was located dorsally and cranially.The dissection of group No.110 and No.112ao lymph nodes was continued cranially along the anterior fascia of the aortic， and the diaphragm was incised dorsally to ventrally to reveal group No.111 lymph nodes and adipose tissue anteriorly below the pericardium and resected.The esophagus was retracted to the right and caudally， and the No.112 Lpul group lymph nodes were cleared cranially along the left mediastinal pleura until the infra-pulmonary vein was revealed.Finally， the esophagus was denuded along the esophageal adventitia， and the lower mediastinal lymphatic and adipose tissues were excised in en-bloc.
The author's team frequently confronted issues like insufficient exposure and timeconsuming drawdown adjustment during single-hole laparoscopic surgery.Recently， we independently developed a type of ultramicroscopic instrument to assist single-hole laparoscopic surgery， encompassing single-hole laparoscopic cholecystectomy， single-hole laparoscopic appendectomy， and single-hole hemihepatectomy.Compared with conventional single-hole laparoscopic hepatectomy， merely one or two 2mm auxiliary traction holes are added， and no scar is left upon the healing of the auxiliary holes.The postoperative cosmetic outcome is comparable to that of conventional single-hole laparoscopic hepatectomy， and even the umbilical incision is smaller.With the assistance of the instrument， the operational difficulty can be mitigated，and the exposure effect is more pronounced.This video mainly presents the clinical application of this 2mm ultramicroscopic instrument in single-hole laparoscopic partial splenectomy， which is an auxiliary instrument worthy of promotion.
To explore the clinical effect of laparoscopic proximal gastrectomy （LPG）combined with modified esophagogastrostomy to reconstruct His Angle on postoperative reflux esophagitis （RE）.
Methods
108 patients with LPG from January 2021 to September 2023 were prospectively selected as the study objects， and were divided into traditional group and improved group by envelope method， with 54 patients in each group.Both groups were treated with LPG.In the process of digestive tract reconstruction， traditional esophagogastric anastomosis was used in the traditional group， and modified esophagogastrostomy was used in the improved group to reconstruct His Angle.SPSS 25.0 was used for data analysis.Measurement data such as perioperative indicators and total score of RDQ were expressed with （x± s ）.Independent sample t test was used for comparison.The statistical data of complication rate， Visick score grade and RE severity grade were expressed by ［cases （%）］， and compared by χ2 test or Rank Sum test.P＜0.05 was considered to be statistically significant.
Results
There were no significant differences in operation time， digestive tract reconstruction time， number of lymph nodes dissection， intraoperative blood loss， intestinal function recovery time and postoperative hospitalization time between the improved group and the traditional group （P＞0.05）.The overall incidence of complications in the improved group was significantly lower than that in the traditional group （22.2%vs. 40.7%， P＜0.05）.The Visick score and the distribution of RE severity in the improved group were better than those in the traditional group， and the total score of RDQ was significantly lower than that in the traditional group， with statistical significance （P＜0.05）.
Conclusion
LPG combined with modified esophagogastrostomy to reconstruct His Angle is safe and feasible， does not increase perioperative related risks， and can effectively reduce the risk of postoperative complications， and has significant anti-reflux effect， so it is a relatively ideal operation.
To compare the efficacy of laparoscopic radical gastrectomy （TLTG） with two different approaches in the treatment of overweight gastric cancer.
Methods
Clinical data of 105 patients with overweight gastric cancer who received TLTG from January 2019 to May 2023 and completed 2-year follow-up were retrospectively analyzed， and they were divided into left approach group （n=52 cases） and right approach group （n=53 cases） according to different surgical approaches.The data were analyzed with SPSS 25.0 software， and the measurement data such as perioperative indicators were expressed as （x± s ）， and independent sample t test was performed.The count data were represented by ［cases （%）］ and χ2 test was performed.Disease recurrence and survival were analyzed by Kaplan-Meier curve.P＜0.05 was considered statistically significant.
Results
Compared with the left approach group， the right approach group had shorter operation time， less intraoperative blood loss， more lymph node dissection， shorter time for first anal exhaust and first getting out of bed， fewer disease recurrence cases within 2 years after surgery， and longer tumor free survival （P＜0.05）.There was no significant difference in postoperative complications， 2-year postoperative survival and overall survival between the two groups （P＞0.05）.
Conclusion
The safety and short-term survival of TLTG in the treatment of overweight gastric cancer under the two approaches are comparable.However， compared with the left approach，the right approach has shorter operation time， less intraoperative bleeding， more intraoperative lymph node dissection， faster postoperative recovery， and relatively fewer cases of disease recurrence 2 years after surgery.
To investigate the short-term and medium-term effects of total laparoscopic radical gastrectomy （TLDG） and laparoscopic assisted radical gastrectomy （LADG） in the treatment of advanced gastric cancer.
Method
A total of 120 patients with advanced gastric cancer from March 2020 to February 2022 were selected and randomly divided into LADG group and TLDG group according to numerical table method， with 60 patients in each group.Data were processed by SPSS 25.0 software.Measurement data such as perioperative indicators were represented by （x ± s） and M（P25， P75）.Independent sample t and non-parametric Mann-Whitney U test were used.The complication rate within 30d and recurrence rate within 2 years were tested by χ2 test.The recurrence time was tested by Log-Rank.P＜0.05 indicated that the difference was statistically significant.
Results
The amount of intraoperative blood loss， first exhaust time and hospital stay in TLDG group were lower than those in LADG group （P＜0.05）.There was no significant difference in other perioperative indexes （P＞0.05）.There was no significant difference in complications within 30d， recurrence rate within 2 years and recurrence time between the two groups （P＞0.05）.
Conclusion
The near and medium-term follow-up results of TLDG and LADG in the treatment of advanced gastric cancer are comparable.Compared with LADG， TLDG can relatively reduce the amount of intraoperative blood loss， promote the rapid recovery of postoperative gastrointestinal function， and shorten the length of hospital stay.
To investigate the short and medium term efficacy of complete mesangectomy（CME） plus standard D2 radical resection for advanced gastric cancer.
Methods
A total of 130 patients with advanced gastric cancer from January 2019 to December 2020 were selected and divided into study group（CME+D2） and control group （D2 radical resection） by random munber table method， with 65 patients in each group.SPSS 25.0 software was used for data analysis， and measurement data such as perioperative indicators were expressed with （x ± s）.Independent sample t test； The complication rate and other statistical data were measured by χ2 test.Survival analysis was tested by Kaplan-Meier method in parallel with Log-Rank.P＜0.05 was considered statistically significant.
Results
The operative time and blood loss in the study group were less than those in the control group， and the number of lymph nodes dissection was more than that in the control group （P＜0.05）.The first postoperative exhaust time， the time of getting out of bed and the time of hospitalization in the study group were shorter than those in the control group （P＜0.05）.The total incidence of postoperative complications in the study group was 4.6% （3/65） lower than that in the control group （15.4%（10/65） （P＜0.05）.The 1-year and 3-year follow-up local recurrence rate of the study group was lower than that of the control group， the overall survival rate was higher than that of the control group， and the 1-year and 3-year follow-up progression-free survival （PFS） and overall survival （OS） were longer than those of the control group （P＜0.05）.
Conclusion
The application of CME+D2 in the treatment of advanced gastric cancer promotes postoperative recovery of patients， has significant effects on shortening operation time， reducing intraoperative blood loss， thorough dissection of lymph nodes， and can reduce the incidence of complications，which is conducive to reducing local recurrence 1 and 3 years after surgery， improving the overall survival rate of patients， and prolonging PFS and OS in the near and medium term.
To observe the effects of laparoscopic total gastrectomy and interposition jejunal replacement on postoperative nutritional status and gallbladder empties in patients with gastric cancer.
Methods
The clinical data of 116 patients with laparoscopic total gastrectomy from January 2016 to March 2021 were retrospectively analyzed， and divided into the reference group （n=58 cases， digestive tract reconstruction by Roux-en-Y anastomosis） and the study group （n=58 cases， digestive tract reconstruction by interposition jejunum replacement） according to the method of digestive tract reconstruction.SPSS 25.0 software was used to analyze the data.Intraoperative blood loss， digestive tract reconstruction time， intestinal function recovery time and feeding recovery time were described as（x ± s）.Paired sample t test was used for intra-group comparison， and independent sample t test was used for inter-group comparison.The statistical data of complications were shown as［ cases （%）］ and χ2 test was performed.P＜0.05 was considered statistically significant.
Results
Serum albumin （ALB）， hemoglobin （HB） and total protein （TP） levels， fasting gallbladder volume （FV）， residual gallbladder volume （RV） and residual gallbladder index （RF） after fat meal were significantly decreased in 2 groups 1 month after surgery， and gallbladder emptier volume （EV） and gallbladder emptier rate （EF） were significantly increased （P＜0.05）.FV， RV and RF in study group were significantly lower than those in reference group， serum ALB， HB， TP， EV and EF were significantly higher than those in reference group （P＜0.05）.The incidence of perioperative and postoperative complications in the study group was significantly lower than that in the reference group （P＜0.05）.
Conclusion
It is safe and feasible to replace the stomach with jejunum after laparoscopic total gastrectomy， which can improve the nutritional status of patients and promote gallbladder empelation.
To explore the influence of visceral obesity on early complications after radical resection of rectal cancer.
Methods
The clinicopathological and preoperative imaging data of 234 patients who underwent laparoscopic radical resection for rectal cancer from October 2017 to October 2022 were retrospectively analyzed.According to visceral fat area （VFA）， the patients were divided into visceral obesity group （n=108 cases） and non-visceral obesity group （n=126 cases）.The clinicopathological features， intraoperative and postoperative conditions and early postoperative complications were compared between the two groups.SPSS25.0 statistical software was used to process the data， and the measurement data such as intraoperative and postoperative conditions were subjected to independent sample t test or Rank Sum test.The complication rate and other statistical data were chi-square test.Logistic regression model was used to analyze the risk factors of early complications after radical resection of rectal cancer.P＜0.05 indicated that the difference was statistically significant.
Results
There were no significant differences in gender， age， tumor size， tumor distance from anal margin， T stage， TNM stage， differentiation degree and albumin between the two groups （P＞0.05）.BMI of visceral obesity group was higher than that of nonvisceral obesity group， with statistical significance （P＜0.05）.There was no significant difference in the first time of ventilation and the time of drainage tube removal between the two groups （P＞0.05）.Compared with non-visceral obesity， visceral obesity had longer operation time， more intraoperative blood loss and longer postoperative hospital stay （P＜ 0.05）.Early complications were more likely to occur in patients with visceral obesity （P＜0.05）.Univariate analysis showed that VFA≥100 cm2， tumor distance from anal margin ≤5 cm，TNM stage Ⅲ/Ⅳ stage were risk factors for early postoperative complications （P＜0.05）.
Conclusion
Visceral obesity can increase the risk of intraoperative bleeding， prolong operation time and postoperative hospital stay.VFA≥100 cm2 is a risk factor for early postoperative complications of rectal cancer.
To compare the effect of two anatomical approaches in lateral lymph node dissection of rectal cancer.
Methods
Clinical data of 123 patients with rectal cancer who underwent total mesorectal resection from January 2019 to January 2022 and completed 3-year follow-up were retrospectively collected.According to different anatomical approaches of lateral lymph node dissection， 60 patients were divided into fascia group （fascia-oriented anatomical approach） and 63 patients were divided into vascular group（vaso-oriented anatomical approach）.SPSS25.0 software was used to process the data.Surgical indicators， the number of lateral lymph nodes detected and other measurement data were expressed as （x± s）， and independent sample t test was performed.The positive lymph node detection rate and postoperative complication rate were analyzed by χ2 test.Kaplan-Meier method and Log-Rank test were used for survival analysis， and P＜0.05 was considered statistically significant.
Results
There was no significant difference in intraoperative blood loss，operation time and hospital stay between the two groups （P＞0.05）.The number of lymph nodes detected in fascia group was higher than that in blood vessel group （P＜0.05）， and there was no significant difference in the positive lymph node detection rate between the two groups （P＞0.05）.The incidence of postoperative urinary dysfunction and sexual dysfunction in fascia group was lower than that in vascular group （P＜0.05）.Log-Rank test results showed that there was no significant difference in progression-free survival between the two groups during follow-up （P＞0.05）.
Conclusion
The positive lymph node detection rate and progression-free survival rate were similar between fascia-guided approach and vaso-guided approach in rectal cancer lateral lymph node dissection， but more lateral lymph nodes could be detected by fascia-guided approach， which could reduce the occurrence of postoperative urinary dysfunction and sexual dysfunction.
To investigate the clinical effect of indocyanine green （ICG） fluorescence imaging in laparoscopic lateral lymph node dissection （LLND） for rectal cancer.
Methods
Data of 32 patients who underwent LLND surgery for middle and low rectal cancer from May 2020 to June 2023 were retrospectively analyzed.The patients were divided into conventional group （n=22 cases） and ICG group （n=10 cases） according to whether ICG fluorescence imaging was used during operation.SPSS 26.0 software was used for statistical analysis.All perioperative indicators were expressed as （x± s）， and independent sample t test was used between groups.The statistical data of postoperative complications were shown as［ cases （%）］ and χ2 test was used.P＜0.05 was considered statistically significant.
Results
In the ICG group， the operative time was shortened［ （6.8±0.9）h vs.（5.8±0.6）h， P=0.004］， and the amount of intraoperative blood loss was decreased［（266±149）ml vs.（155±86）ml， P=0.037］.Postoperative hospital stay was shortened［ （10.6±2.4）d vs.（8.7±1.3）d，P=0.025］.There was no significant difference in postoperative complications between the two groups （P＞0.05）.The number of lateral lymph nodes detected in ICG group increased ［（4.4+3.1） vs.（6.9+2.5）， P=0.032］，but the positive lymph node detection rate did not increase （9.1% vs.30%， P=0.131）.
Conclusions
ICG fluorescence imaging assisted LLND can remove more lymph nodes without affecting the postoperative recovery of patients， which is clinically safe and feasible.
To investigate whether sarcopenia is an independent risk factor for parastostomy hernia， and build a prediction model based on sarcopenia.
Methods
Data of 126 patients undergoing enterostomy from January 2018 to December 2022 were retrospectively analyzed.Skeletal muscle index （SMI） was calculated by preoperative abdominal CT scan.Sarcosis was defined as female ＜32.4cm2/m2 and male ＜44.3cm2/m2.According to whether the patients had postoperative parastostomy hernia， the patients were divided into parastostomy hernia group （n=17 cases） and non-parastostomy hernia group （n=109 cases）.The baseline， intraoperative and postoperative data of the patients were analyzed to determine whether sarcopenia was an independent risk factor for parastostomy hernia by univariate and multifactorial analysis， and Nomogram was drawn to show the risk factors for parastostomy hernia.SPSS 25.0 and R 4.1.3 statistical software were used for analysis.Continuous variables are expressed as （x± s）.Chi-square test， Fisher exact probability method and t test were used to analyze the difference between categorical variables and continuous variables.P＜0.05 was considered to be statistically significant.
Results
Among the 126 patients， the incidence of sarcopenia was 38.9% （49/126）， and the incidence of parastostomy hernia was 24.5% （12/49） in the sarcopenia group， while the incidence of parastostomy hernia was 6.5% （5/77） in the non-sarcopenia group， suggesting a correlation between sarcopenia and parastostomy hernia （P=0.004）.Further univariate and multivariate Logistic regression analysis indicated that age ≥71 years， colostomy and sarcopenia were independent risk factors for parastostomy hernia.
Conclusion
Abdominal CT is a simple method to evaluate SMI in the diagnosis of sarcopenia.Sarcopenia is an important risk factor for parastostomy hernia after enterostomy （P=0.015）， and the prediction model of parastostomy hernia based on sarcopenia has good clinical practicability.Preoperative screening of enterostomy patients for sarcopenia and corresponding intervention measures may reduce the incidence of parastostomy hernia and improve symptoms.
To compare the effects of hepatectomy with different approaches in the treatment of primary hepatocellular carcinoma.
Method
The data of 103 patients with primary hepatocellular carcinoma who underwent hepatectomy from January 2019 to January 2023 were retrospectively analyzed.According to different surgical approaches， they were divided into suspension group （n=53 cases with anterior liver suspension approach） and traditional group （n=50 cases with traditional approach）.SPSS 25.0 software was used to analyze the data.Intraoperative blood loss， operation time and other measurement data were expressed as （x ± s）， and independent sample t test was performed.The incidence of postoperative complications were counted by χ2 test.Rank Sum test was used for liver function grades.Kaplan-Meier method and Log-Rank test were used for survival analysis.P＜0.05 was considered to be statistically significant.
Results
The amount of intraoperative blood loss and plasma infusion in suspension group was lower than that in traditional group（P＜0.05）.There was no significant difference in operation time， postoperative feeding time and getting out of bed time between the two groups （P＞0.05）.The length of hospital stay and incidence of complications in suspension group were lower than those in traditional group （P＜0.05）.The progression-free survival rate and overall survival rate of the two groups were higher in the suspension group than in the traditional group （P＜0.05）.
Conclusion
Compared with the traditional approach， hepatectomy by suspending the liver around the anterior approach can reduce the amount of intraoperative blood loss and plasma infusion， reduce the incidence of postoperative complications， promote the recovery of patients， and improve the short-term survival rate of patients.
To investigate the efficacy and safety of high intensity focused ultrasound ablation （HIFU） combined with hepatic arterial chemoembolization （TACE） in the treatment of primary liver cancer （PLC）.
Methods
The clinical data of 133 patients with PLC from March 2020 to February 2022 were retrospectively analyzed.According to different treatment methods， 65 patients were treated with TACE alone（control group） and 68 patients were treated with HIFU combined with TACE （combination group）.The data were processed by SPSS 25.0 software， and the statistical data of disease remission rate and complications were analyzed by χ2 test.Tumor marker data were expressed as （x± s） and independent sample t test was performed.Rank Sum test was used for CNCL staging and Child-Pugh classification.Kaplan-Meier was used to draw the survival curve.P ＜ 0.05 indicated that the difference was statistically significant.
Results
The objective response rate （ORR） in combination group was 82.4% higher than that in control group 66.2% （P ＜ 0.05）.There was no significant difference in disease control rate （DCR） between the two groups （P ＞ 0.05）.After
treatment， serum alpha-fetoprotein （AFP）， α-L-fucoidase （AFU） and abnormal prothrombin Ⅱ （PIVKA-Ⅱ）in 2 groups were lower than before treatment， and the combined group was lower than the control group （P ＜ 0.05）.The incidence of abdominal pain in combination group was higher than that in control group （P ＜ 0.05）.There was no significant difference in overall survival time （OS） between the two groups （P ＞ 0.05）.The progression-free survival time （PFS） of the combined group was longer than that of the control group （P ＜ 0.05）.
Conclusion
HIFU combined with TACE in the treatment of PLC can improve the remission rate， reduce the level of tumor markers， prolong the time of tumor progression， but increase the risk of abdominal pain.
To explore the efficacy of endoscopic retrograde cholangiopancreatography（ERCP） and laparoscopic choledocholithotomy （LCBDE） in the treatment of acute severe cholangitis （ACST）secondary to choledocholithiasis.
Methods
The clinical data of one hundred and twenty patients with ACST secondary to CBDS who received surgical treatment were retrospectively analyzed from January 2022 to January 2024.AccorThe clinical data of 120 patients with ACST secondary to choledocholithiasis who underwent surgical treatment from January 2022 to January 2024 were retrospectively analyzed.According to different surgical methods， patients receiving ERCP treatment were assigned to the ERCP group （n=68 cases） and those receiving LCBDE treatment were assigned to the LCBDE group （n=52 cases）.SPSS 26.0 was used for data processing.Measurement data such as perioperative indicators were expressed as （x± s）， and independent sample t test was performed.The incidence of complications and other statistical data were χ2 test.Test level α=0.05.
Results
The amount of intraoperative blood loss in ERCP group was lower than that in LCBDE group， and the operation time， activity recovery time， first exhaust time and hospital stay were shorter than that in LCBDE group（P＜0.05）.There was no significant difference in stone removal rate between ERCP group and LCBDE group（98.5% vs.96.2%， P＞0.05）.The liver and bile biochemical indexes of serum total bilirubin （TBIL）， alanine aminotransferase （ALT） and aspartate aminotransferase （AST） in ERCP group and LCBDE group were lower than those before surgery （P＜0.05）， but there was no statistical significance between the two groups （P＞0.05）.The inflammatory markers of white blood cell count （WBC）， neutrophil count （ANC） and serum high mobility group protein B1 （HMGB1） in 2 groups were lower than those before surgery （P＜0.05）， and ERCP group was significantly lower than LCBDE group （P＜0.05）.The overall complication rate in the ERCP group was lower than that in the LCBDE group （1.5% vs.11.5%） （P＜0.05）.
Conclusion
ERCP is more effective than LCBDE in the treatment of ACST secondary to choledocholithiasis.This procedure can significantly improve the surgical and postoperative recovery indicators of patients， promote the rapid recovery of liver and gallbladder and inflammation， and the risk of complications is small， so it can be used as the first choice in clinical treatment of ACST secondary to choledocholithiasis.
To investigate the relationship between the expression of electron transfer flavin protein A （ETFA） and Hematopoietic progenitor cell antigen （CD34） and clinicopathological parameters and prognosis in breast cancer.
Methods
A total of 115 female breast cancer patients who underwent surgical treatment from December 2020 to February 2024 were retrospectively collected and followed up for 36 months.Statistical software SPSS 22.0 was used to analyze the data.The measurement data conforming to the normal distribution were represented by （x ± s）， and the independent sample t was compared.The counting data were represented by［ cases （%）］ and compared by χ2 test.The positive expression of ETFA and CD34 in breast cancer tissues was correlated with different pathological parameters by Spearson analysis.Kaplan-Meier survival curve was used to analyze the 3-year survival rate of breast cancer patients.P＜0.05 indicated that the difference was statistically significant.
Result
There were significant differences in the expression of ETFA and CD34mRNA in adenocarcinoma tissues and adjacent tissues （P＜0.05）.The positive expression rates of ETFA and CD34 in breast cancer tissues were 73.9% and 77.4%， respectively， and the expression rates in adjacent tissues were 25.2% and 9.6%， respectively， with statistical significance （P＜0.05）.The positive expression rates of ETFA and CD34 in breast cancer tissues were significantly different in tumor stage， differentiation degree and lymph node metastasis （P＜0.05）.Spearson correlation analysis showed that the positive expression of ETFA and CD34 in breast cancer tissues was positively correlated with tumor stage and lymph node metastasis， and negatively correlated with tumor differentiation.The 3-year survival rate of ETFA-positive breast cancer patients was 55.3%， lower than that of ETFA-negative breast cancer patients （59.0%， P=0.021）.The 3-year survival rate for patients with CD34-positive breast cancer was 51.6%， compared with 62.7% for patients with CD34-negative breast cancer （P=0.000）.
Conclusion
The high expression of ETFA mRNA and CD34mRNA in breast cancer tissues is closely related to the development of tumor deterioration and poor prognosis of patients，with a view to becoming a marker to evaluate the severity of breast cancer patients.
To investigate the predictive value of systemic immunoinflammatory index （SII）in patients with acute pancreatitis complicated with organ function injury.
Methods
The data of 168 patients with acute pancreatitis from January 2020 to June 2023 were retrospectively analyzed.According to whether the patients had organ function injury， the patients were divided into injury group （n=48 cases） and control group（n=120 cases）.SPSS26.0 statistical software was used to analyze the data， SII and other measurement data were expressed as （x ± s）， and independent sample t test was performed.Receiver operating characteristic curve（ROC） was used to analyze the predictive value of SII in organ function injury in patients with acute pancreatitis.Multi-factor Logistics regression analysis was used to investigate the independent risk factors of organ function injury in patients with acute pancreatitis.When P＜0.05， the difference was considered statistically significant（bilateral）.
Results
Compared with the control group， SII was significantly increased in the injured group［（1012.2±281.2） vs. （662.0±167.9）， P=0.000］.Multi-factor Logistics regression analysis showed that SII＞818.0， APPACHE Ⅱ score ＞8.5 and pancreatic necrosis infection were independent risk factors for organ function impairment in patients with acute pancreatitis （P＜0.05）.SII was significantly positively correlated with Ranson score， APPACHEⅡ score， C-reactive protein and IL-6 in patients with acute pancreatitis （P＜0.05）.SII， Ranson score and APPACHEⅡ score all have certain predictive value for organ function injury in patients with acute pancreatitis， among which SII has a higher predictive value， and the area under the curve is 0.902（95% confidence interval: 0.846-0.958， P=0.000）.Compared with the control group， the mechanical ventilation rate， continuous hemofiltration rate， surgical drainage rate and in-hospital mortality were significantly increased in the injured group， and the length of hospitalization was extended （P＜0.05）.
Conclusion
The increase of SII is an independent factor of organ function impairment in patients with acute pancreatitis， and can be used as a new predictor of organ function impairment in patients with acute pancreatitis.
To explore the curative effect of different operation methods in the treatment of obstructive left colorectal cancer.
Methods
Clinical data of 103 patients with obstructive left half colorectal cancer from January 2019 to January 2021 were retrospectively analyzed.According to the operative plan， they were divided into the elective group （receiving intestinal stent combined elective surgery， n=54 cases） and the conventional group （receiving routine emergency stage I tumor resection and anastomosis， n=49 cases）.Data were analyzed using SPSS22.0 statistical software.The incidence of postoperative complications， stage I anastomosis rate， stomy rate and laparotomy rate were expressed as［ cases （%）］， χ2 test was performed.Perioperative indexes and intestinal barrier function （DAO， D-lactic acid） 3 months after surgery were expressed in the form of （x± s ）， and independent sample t test was performed.Kaplan-Meier was used to draw the survival curve for the 3-year survival.P＜0.05 was statistically significant.
Results
The operative time， intraoperative blood loss， number of lymph node dissection， permanent stomy rate and laparotomy rate of the elective group were significantly lower than those of the conventional group （P＜0.05）， and the anastomosis rate of stageⅠwas significantly higher than that of the conventional group （P＜0.05）.The complication rate of the selective group（13.0%） was significantly lower than that of the conventional group （30.6%） （P＜0.05）.Three months after surgery， DAO and D-lactic acid were significantly increased in 2 groups （P＜0.05）， and the selective group was significantly lower than the conventional group （P＜0.05）.All patients were successfully followed up for 3 years with a median follow-up time of 27 months.The progression-free survival （PFS） and overall survival （OS） in the selective group were （31.6±8.3） months and （33.9±5.3） months respectively.PFS and OS in the conventional group were （33.0±6.6） months and （34.8±3.4） months， and there was no statistical significance in OS and PFS in the two groups （P＞0.05）.
Conclusion
Intestinal stents combined with elective surgery have significant advantages in shortening operation time， reducing intraoperative blood loss， reducing the rate of permanent ostomy and laparotomy， and improving the rate of stage I anastomosis.Besides， the prognosis of patients is good with few complications， and it is worthy of application.
To explore the efficacy and safety of colonoscopy-assisted endoscopic mucosal resection （EMR）， cold snare resection （CSP） and radiofrequency ablation （RFA） in the treatment of colorectal polyps ＜1cm in diameter.
Methods
A total of 297 patients with colorectal polyps admitted from January 2020 to January 2022 were prospectively selected and divided into EMR group （n=99 cases）， CSP group （n=99 cases） and RFA group （n=99 cases） according to random number table method.The three groups were treated with EMR， CSP and RFA， respectively.SPSS23.0 software was used to analyze the data and Rank Sum test was performed.The incidence of complications was measured by χ2 test， perioperative indexes and inflammatory indexes were expressed as （x± s）， t test was performed between two groups， and One-way ANOVA was performed between multiple groups.P＜0.05 was considered statistically significant.
Results
At 2 weeks after operation， there was no significant difference in total effective rate between CSP group and RFA group （P＞0.05）.The total effective rate of CSP group and RFA group was higher than EMR group （P＜0.05）.The intraoperative blood loss， operation time and 2d visual analogue VAS score in RFA and CSP groups were lower than those in EMR group （P＜0.05）.There was no significant difference between RFA group and CSP group （P＞0.05）.The 2d C-reactive protein （CRP） and interleukin-6 （IL-6） levels in RFA group and CSP group were lower than those in EMR group （P＜0.05）， but there was no significant difference between RFA group and CSP group （P＞0.05）.The total incidence of postoperative complications in CSP and RFA groups was lower than that in EMR group（P＜0.05）.The total incidence of postoperative complications in RFA group was lower than that in CSP group，but the difference was not statistically significant （P＞0.05）.
Conclusion
Compared with EMR， CSP and RFA have higher efficacy in the treatment of colorectal polyps ＜1cm in diameter， faster recovery of patients， lower levels of inflammatory factors， fewer complications， and higher safety.
To investigate the effects of different ultrasound-guided ablation on the volume reduction rate and recurrence rate of benign thyroid nodules （BTN）.
Methods
The clinical data of 280 BTN from 227 patients from January 2019 to January 2023 were retrospectively analyzed.136 BTN from 115 patients admitted for radiofrequency ablation （RFA） treatment from January 2019 to January 2021 were included in the radiofrequency group.144 BTN from 112 patients admitted to hospital for microwave ablation（MWA） from February 2021 to January 2023 were included in the microwave group and analyzed by SPSS 22.0 statistical software.Measurement data such as nodule volume and reduction rate of patients in the two groups were expressed with（x ± s）， and independent sample t test was used.The data of immediate ablation， recurrence rate and complications after 1 year of follow-up were analyzed by χ2 test.P＜0.05 indicated that the difference was statistically significant.
Results
The immediate ablation rates of 1 to 2cm and 3 to 5cm BTN in microwave group were 96.2% and 67.9%， significantly higher than those in radiofrequency group （79.7% and 41.8%，P＜0.05）.At each time point after operation， the nodule volume in both groups was significantly decreased，and the microwave group was significantly smaller than the radiofrequency group （P＜0.05）.The reduction rate of nodules in both groups was significantly higher than that before surgery， and the microwave group was significantly higher than the radiofrequency group （P＜0.05）.After 1 year follow-up， the recurrence rate of nodules in microwave group was significantly lower than that in radiofrequency group （P＜0.05）.During the follow-up period and 12 months after treatment， there were no significant differences in the rate of immediate ablation of nodules ＜1cm in diameter， the incidence of complications and aesthetic scores between the two groups （P＞0.05）.
Conclusion
Ultrasound-guided MWA ablation of BTN can reduce its volume and increase the reduction rate significantly， which can effectively reduce the recurrence rate.
To compare the effect of transvestibular approach endoscopic thyroid surgery（TOETVA） with different methods of space establishment.
Methods
A total of 120 patients with thyroid disease who received TOETVA treatment from June 2020 to June 2023 were collected as research objects， and the enrolled patients were randomly divided into group A and group B according to random number method，with 60 patients in each group.Surgical space was established in group A by conventional method， and in group B by dilatant liquid-water separation method.Statistical software SPSS 22.0 was used to analyze the data.Measurement data such as perioperative indicators， SSA and VHI scores were expressed by （x ± s）， and independent sample t test was performed.The statistical data of postoperative complications were expressed by［ cases （%）］ and analyzed by χ2 test.P＜0.05 indicated that the difference was statistically significant.
Results
The time of lumen formation in group A was significantly lower than that in group B， but the operative time and intraoperative blood loss were significantly higher than those in group B （P＜0.05）.There were no significant differences in drainage tube removal time， postoperative hospitalization time and postoperative aesthetic satisfaction between the two groups （P＞0.05）.The total incidence of complications in group B was slightly lower than that in group A （15.0% vs.23.3%）， but the difference was not statistically significant （P＞0.05）.The VHI-10 score and SSA score of group B were significantly lower than those of group A at 1 week and 1 month after surgery （P＜0.05）.
Conclusion
Although the conventional operation space establishment method has few steps and short time， the dilatation liquid water separation method has a clearer level， can effectively shorten the operation time， reduce intraoperative bleeding， and is more conducive to protecting the function of recurrent laryngeal nerve， and is worthy of clinical promotion.
To analyze the relationship between abdominal morphological CT parameters and blood loss during total laparoscopic gastrectomy.
Methods
80 patients with gastric cancer admitted from January 2022 to January 2024 underwent laparoscopic total gastrectomy.SPSS 21.0 statistical software was used to analyze the data， and the counting data were tested in line 2.Measurement data were represented by （x± s ）， and independent sample t test was performed.Logistic regression model was used to analyze the influencing factors of blood loss during laparoscopic total gastrectomy.P＜0.05 was considered statistically significant.
Results
All patients successfully completed laparoscopic total gastrectomy and obtained R0 resection.Preoperative CT measurements of abdominal visceral fat area （VFA）， transverse abdominal diameter（TD）， minimum distance from pancreas to anterior abdominal skin （PAAD）， and substernal Angle （LSA） were 100 （56.3， 129.4） cm2， 30 （14.2， 46.5） cm， 59.7 （20.0）， respectively.119.7） mm， 74.2 （46.1， 106.9）°.The intraoperative blood loss of VFA≥100cm2， TD≥30cm， PAAD≥59.7mm， LSA≥74.2° group was significantly higher than that of the other group， and the difference was statistically significant （P＜0.05）.Logistic regression analysis shows: Operative time， BMI， VFA， TD， PAAD and LSA were correlated with intraoperative blood loss（P＜0.05）， and operative time， VFA （≥100cm2）， PAAD （≥59.7mm） and LSA （≥74.2°） were independent risk factors affecting intraoperative blood loss （P＜0.05）.
Conclusion
In laparoscopic total gastrectomy， when the abdominal morphology CT parameters VFA≥100cm2， PAAD≥59.7mm， LSA≥74.2°， the difficulty of surgery is increased， and intraoperative bleeding should be highly vigilant.
To explore the effects of different anastomotic methods of total laparoscopic distal subtotal gastrectomy on gastric function recovery and complication rate in patients with gastric cancer.
Methods
The clinical data of 106 patients with distal gastric cancer from January 2019 to January 2021 were retrospectively analyzed.According to different anastomosis methods， they were divided into Bi's group（underwent distal subtotal gastrectomy and Bi's anastomosis） and triangle group （underwent distal subtotal gastrectomy and triangular anastomosis）.Confounding factors were excluded according to propensity matching score （caliper value 0.02）.There were 53 patients in each group.SPSS 22.0 software was used to analyze the data.Measurement data such as perioperative indexes and gastric function indexes were expressed in the form of （x± s）， and independent sample t test was performed between groups.The complication rate and other statistical data were χ2 test.P＜0.05 was considered statistically significant.
Results
The operative time， intraoperative blood loss， time to get out of bed and time to first feed fluid in triangle group were significantly lower than those in Bi Ⅰ group （P＜0.05）， while the length of hospital stay and number of lymph node dissection were not significantly different between the two groups （P＞0.05）.The complication rate of triangle group was significantly lower than that of Bi Ⅰ group （P＜0.05）.Gastrin （GAS） in the two groups was significantly decreased 1 day after surgery （P＜0.05）， and significantly increased 7 days after surgery （P＜0.05）， and the recovery of the triangle group was significantly better than that of the Bi's group（P＜0.05）， and the gastric empting rate and the number of stomach peristalsis in the two groups were significantly increased 90 days after surgery （P＜0.05）.The triangulation group was significantly higher than that of Bi's group （P＜0.05）.Follow-up was 3 years and the median follow-up was 27 months.There was no significant difference in progression-free survival （PFS） between the two groups （Log-Rankχ2=0.884， P=0.347），and overall survival （OS） between the two groups （Log-Rankχ2=1.182， P=0.279）.
Conclusion
Distal subtotal gastrectomy combined with Bidi's or triangular anastomosis can effectively treat distal gastric cancer and restore gastric function.Compared with Bidi's operation， triangular anastomosis has significant advantages in improving gastric function and reducing surgical complications， and is worthy of application.
To study the application effect of problem-based learning （PBL） combined with surgical video teaching in the standardized training of general surgery specialists.
Methods
A retrospective analysis was performed on 42 trainees who received standardized training of specialist physicians from January 2017 to December 2022， and they were divided into control group （traditional PBL group， n=22 cases） and experimental group （PBL+ surgical video clip teaching group， n=20 cases）.SPSS 16.1 statistical software was used to analyze the data.Theoretical test scores and surgical operation test scores were expressed as （x± s），independent sample t test was used， and clinical work time was used as χ2 test.P＜0.05 indicated that the difference was statistically significant.
Results
The theoretical scores in the first year of experimental group were lower than those in the control group （P=0.57）， and the test scores in the second year were higher than those in the control group （P＜0.05）.In the first two years， the test scores of the experimental group were higher than those of the control group （P＜0.05）.Surgical design （t=3.877， P＜0.001）， significant anatomical exposure（t=3.452， P=0.002） and surgical duration （t=2.956， P=0.032） of the experimental group were better than those of the control group.
Conclusion
PBL combined with surgical video clip teaching has achieved good results in the standardized training of general surgery specialists， and can be used as a new form of clinical teaching.
To investigate the value of dynamic enhanced magnetic resonance imaging（DCE-MRI） in evaluating the efficacy and prognosis of middle and advanced low rectal cancer after concurrent chemoradiotherapy.
Methods
A total of 112 patients with concurrent chemoradiotherapy for middle and advanced low rectal cancer treated from January 2019 to January 2022 were selected and divided into stable group （n=53 cases， stable lesion） and progressive group （n=59 cases， progressive lesion） according to the evaluation criteria of solid tumor efficacy.All patients were examined by DCE-MRI.DCE-MRI parameters （volume transfer yield （Ktrans）， rate constant （Kep）， extracellular space volume fraction （Ve）） were compared between the two groups before and after simultaneous chemoradiotherapy.SPSS 22.0 was used to process the data.Tumor morphological indexes and DCE-MRI parameters were expressed as （x ± s）， and independent sample t test was used for comparison between groups.The composition ratio was calculated by counting data such as recurrence rate and Chi-Square test was used.Kappa test was used for consistency analysis.P＜0.05 was considered statistically significant.
Results
Compared with before chemoradiotherapy， the length of rectal cancer tumor and the thickness of tumor intestinal wall were significantly decreased after chemoradiotherapy and 1 month after chemoradiotherapy （P＜0.05）， but there was no statistical significance between the two groups （P＞0.05）.There was no significant difference in the length and thickness of rectal cancer before chemoradiotherapy between the two groups （P＞0.05）.The length and thickness of rectal cancer after chemoradiotherapy and 1 month after chemoradiotherapy in the stable group were lower than those in the advanced group （P＜0.05）.Before chemoradiotherapy， Ktrans and Kep in stable group were higher than those in advanced group（P＜0.05）， but there was no statistical difference in Ve group （P＞0.05）.Ktrans， Kep and Ve were decreased after chemoradiotherapy in both groups compared with before chemoradiotherapy （P＜0.05）.After concurrent chemoradiotherapy， Ktrans and Kep in stable group were lower than those in advanced group （P＜0.05）， and there was no statistical significance in Ve group compared with advanced group （P＞0.05）.1 year follow-up， 112 patients with middle and advanced low rectal cancer， 6 cases lost follow-up， including 6 cases died； Among the other 100 patients with middle and advanced low rectal cancer， 16 cases recurred by pathological examination，with a recurrence rate of 16% （16/100）， and 14 cases recurred by DCE-MRI examination， with a recurrence rate of 14% （14/100）.Compared with the results of pathological examination， there was a good consistency between DCE-MRI and pathological examination （Kappa=0.813， P=0.000）.
Conclusion
DCE-MRI has important value in the prognosis assessment of concurrent chemoradiotherapy for middle and advanced low rectal cancer，and is worth popularizing.
To investigate the clinical effect of CT scanning 3D reconstruction in laparoscopic hepatectomy （LH） for intrahepatic cholangiocarcinoma （ICC）.
Methods
A total of 46 ICC patients who underwent LH based on CT scanning 3D reconstruction from January 2021 to June 2023 were retrospectively selected as the study group， and 50 ICC patients who underwent LH based on routine CT examination during the same period were selected as the control group.SPSS 25.0 was used to complete the data analysis.Perioperative indicators， liver function indicators and other measurement data were represented with （x ± s），and independent sample t test was performed.The statistical data of postoperative complications and degree of liver function injury were expressed by［ cases （%）］ and χ2 or Rank Sum test was performed.Survival analysis was tested using Kaplan-Meier method and Log-Rank test.P＜0.05 was considered statistically significant.
Results
The operative time， blood loss， volume of liver resection， positive rate of postoperative pathological margin， primary anal exhaust time， drainage tube indentation time and postoperative hospital stay in the study group were significantly reduced compared with the control group （P＜0.05）.The degree of liver function injury in the study group was significantly lower than that in the control group， the difference was statistically significant （P＜0.05）.The total incidence of postoperative complications in the study group （8.7%） was significantly higher than that in the control group （24.0%） （P＜0.05）.The cumulative disease-free survival（DFS） of the study group was significantly higher than that of the control group （87.0% vs.70.0%）， and the difference was statistically significant （Log-Rankχ2=3.894， P=0.046）.There was no significant difference in cumulative overall survival （OS） between the two groups （89.1% vs.74.0%） （Log-Rankχ2=2.983， P=0.084）.
Conclusion
The clinical effect of three-dimensional reconstruction of CT scan in ICC patients with LH is significant， which not only effectively reduces the operation time and intraoperative injury， but also reduces the degree of liver function injury of patients， reduces the risk of postoperative complications， improves the accuracy and safety of surgery， reduces the positive rate of resection margin， and improves the prognosis of patients.
Sig-ring cell carcinoma is a special type of adenocarcinoma， which has the characteristics of high malignant degree in the advanced stage， high recurrence and metastasis rate， and poor survival prognosis.This article reviewed the literature on the definition and classification， genetic characteristics，clinicopathological features， early and advanced treatment， and chemotherapy resistance mechanism of gastric sig-ring cell carcinoma， in an attempt to summarize the progress of diagnosis and treatment of gastric sig-ring cell carcinoma， and provide necessary reference for clinical diagnosis and treatment.
Locally advanced thyroid cancer （TC） can invade important surrounding structures，including trachea， esophagus， recurrent laryngeal nerve （RLN）， etc.There are many clinical treatment options，but no effective treatment consensus has been formed.The main principle of selection is to reduce surgical risk as much as possible and protect the physiological function of surrounding tissues while radical treatment of the lesion according to the degree of tissue involvement.To achieve the best level of treatment.
