To evaluate the short-term and long-term curative effecacy in colon cancer patients who were treated with laparoscopic radical resection or open radical resection.

A total of 116 patients who received laparoscopic radical resection or open radical resection of colon cancer in our hospital from January 2013 to December 2015 were enrolled and divided into two groups named laparoscopic group and laparotomy group respectively according to the surgical procedure. There were 58 individuals in each group. SPSS18.0 statistical software was adopted for data analysis. The clinical data of perioperative indicators and recovering conditions after the operation were compared by Independent Samples t test .The incidence rate of postoperative complications and long-term curative efficacy were compared by chi square test. P<0.05 indicated that the difference was statistically significant.

There were no significant difference in operation time and number of removed lymph nodes between the two groups (P>0.05). The amount of bleeding, postoperative analgesic time, exhaust time and hospital stays in the laparoscopic group were significantly less than those in the laparotomy group (P<0.05). The incidence of postoperative complications in laparoscopic group was 8.6%, which was significantly lower than that in the laparotomy group (χ²=9.183, P<0.05). There were no significant difference between the two groups in the rate of tumor metastasis, recurrence rate and survival rate within 2 years. This result indicated that the long-term efficacy in the two groups was similar (P>0.05).

Laparoscopic colon resection has advantage of postoperative recovery and is equivalent to open surgery in long-term efficacy. Thus, laparoscopic colon resection is worthy of application for colon cancer patients.

With the introduction and popularization of complete mesocolic excision( CME) and extended lymphadenectomy (D3) for the surgical treatment of right colon cancer, expert practitioners have achieved excellent good pathological results as well as good improvements in overall survival, disease free survival and local recurrence. Similar to total mesorectal excision (TME) for rectal cancer, CME surgery follows the same oncological principles that is removal of all lymphatic, vascular, and neural tissue in the drainage area of the tumour in a complete mesocolic envelope with intact mesentery, peritoneum and encasing fascia. D3 has the same equivalent procedures based on the similar principle. However, there is conflicting evidence that the benefit of CME or D3 is limited by methodological defects and some potential confounding factors, therefore, there is still an urgent need for large cases of randomized controlled long-term observation research.

The concept of localization by imaginary clock for ampulla of gallbladder is definited to ensure security of laparoscopic cholecystectomy. According to the direction of the line of sight, three kinds of positioning method including vertical plane, horizontal plane and inclined plane is introduced. Ampulla of gallbladder could be classified into five types including 3 o’clock location, 6 o’clock location, 9 o’clock location, 12 o’clock location and axial view in the face of the dial plate. Ampulla of gallbladder in 3 o’clock location is more likely to be punctured, with a potential risk of injury to the common hepatic duct, right hepatic duct and right hepatic artery by excessive manipulation. Ampulla of gallbladder in 6 o’clock location might fall into Winslow hole and push the common bile duct to the ventral and left side. Dissection along the left and caudal edge of dilated ampulla, the common bile duct located the ventral side of ampulla might be misunderstood as the cystic duct to be cut off. Ampulla of gallbladder in 9 o’clock location might be adhere to duodenum seriously. Exenteration of the corresponding gallbladder wall is mandatory to avoid injuring duodenum. Ampulla of gallbladder in 12 o’clock location is frequently covering the ventral side of the common hepatic duct and the common bile duct. The common bile duct might be misunderstood for the cystic duct to be transected if dissecting along the left and caudal edge of ampulla. Localization by imaginary clock for ampulla of gallbladder could help to identify the anatomy correctly, avoid injuring extrahepatic bile duct and blood vessels, reduce bleeding, decrease iatrogenic cystic duct calculi and iatrogenic choledocholithiasis, overcome the significant difficulties of laparoscopic cholecystectomy safely.

To analyze the effect of low ligation and high ligation of inferior mesenteric artery (IMA) on laparoscopic radical resection of rectal cancer.

A total of 215 patients undergoing laparoscopic radical resection for rectal cancer were selected from March 2013 to March 2017 for this retrospective study. According to the operative method, 127 patients treated with low ligation of IMA were enrolled in the low ligation group (n=127), while the patients with high ligation of IMA were enrolled in the high ligation group (n=88). The data was analyzed by SPSS 18.0, short-term postoperative complications were examined by χ² test; the data of operation and recovery were represented by (±s) and examined by t test, P<0.05 showed that the difference was statistically significant.

The margin ischemic change rate, postoperative exhaust time for the first time of low ligation group were lower than those in the high ligation group, the postoperative sexual dysfunction or urinary incontinence rate was higher than that of the latter, the differences were statistically significant (P<0.05).

The effect of two ligation methods is quite good. IMA low ligation has positive significance for early postoperative recovery, but it has higher risk of pelvic autonomic nerve damage than high ligation. The decisions should be made based on the patient's actual situation.

To explore the effect of minimally invasive gallbladder preserving lithotomy combined with choledochoscope and laparoscopic cholecystectomy in the treatment of gallbladder stone.

96 gallstone patients from July 2014 to June 2016 treated in our hospital were collected and randomly divided into double lens group (minimally invasive gallbladder preserving lithotomy combined with choledochoscope) and the laparoscopic group (laparoscopic resection), 48 cases in each group. Statistical analysis was performed by using SPSS 17.0 software. The recovery circumstances, recovery time and gastrointestinal recovery time were represented in (±s) and compared by t test; The postoperative complications and recurrence were compared using χ² test; the difference was statistically significant in P<0.05.

There were no significant diffenrence in the amount of bleeding, pain VAS score at postoperative 24h, hospitalization time and recurrence rate between the two groups (P>0.05); Compared with the laparoscopic group, the operation time, incision length, first exhaust time, gallbladder wall thickness before and after the surgery, ambulation time, stomach function recovery time and complication rate in double lens group were better, the differences were statistically significant (P<0.05).

Minimally invasive gallbladder preserving lithotomy combined with choledochoscope can promote the postoperative recovery of patients, reduce the incidence of complications, which has certain clinical value in treatment of gallbladder calculi.

With the skill improvement of radical surgery for laparoscopic rectal cancer, its application is also more and more widely, and the safety, feasibility and long-term outcome of which are gradually recognized. There are still some controversy of technical difficulties and understanding in such operation, including the surgical level, vascular ligation, lymph node dissection, preventive stoma and so on. The author reported clinical experience of the treatment and variation of the inferior mesenteric artery, lateral lymph node dissection, the need for prophylactic stoma as well as technical difficulties of TaTME for low rectal cancer.

To explore the clinical outcome of improved medial approach in laparoscopic right hemicolectomy for patients with right colon cancer, including complications and quality of life.

From January 2014 and February 2017, clinical data of 86 patients who underwent laparoscopic right hemicolectomy were enrolled into study, including 43 cases in lateral approach group and 43 cases in medial approach group. All data were analyzed by using SPSS 21.0 software. Perioperative measurement data and tumor index were expressed as (±s), and were examined by using t test.The postoperative complication rate were analyzed by Chi-square test. A P value <0.05 was considered as statistically significant difference.

The number of harvested lymph nodes, intraoperative bleeding and the operation time of the medial approach group were (17.7±3.3), (55.7±36.1) ml and (122.4±25.6) min and were better than those of the lateral approach group respectively (P<0.05). 5 d post operation, colon cancer index in the medial approach group were lower than those in the lateral approach group, including Xiap, Livi, TK1 and Plk1 (P<0.05). In terms of life quality, scores of psychological and emotional status, subjective symptom and social activity in the middle approach group were shown to be higher than those in the lateral approach group, with statistically significant difference (P<0.05). The incidence of complications was 4.7% in the medial approach group and 7.0% in the lateral approach group, with no statistically significant difference between two groups (P>0.05).

Improved medial approach for right hemicolectomy could improve the patients’ quality of life and harvested lymph nodes, and could reduce the impact of postoperative malignant tumor with less postoperative complications.

To compare the effect between laparoscopic complete mesocolic resection and traditional radical colectomy in the treatment of young and middle-aged and elderly aged patients with stage Ⅲ colon cancer.

153 patients with stage Ⅲ colon cancer were collected in our hospital from January 2013 to June 2016 and analyzed retrospectively. The patients were divided into the CME group (78 cases, with 34 cases of young and middle-aged patients, and 44 cases of elderly patients, who received laparoscopic complete mesocolic resection) and the traditional group (75 cases, with 37 cases of young and middle-aged patients, and 38 cases of elderly patients, who received traditional radical colectomy) according to the operation method. Statistical analysis was performed by using SPSS 17.0 software, intraoperative and postoperative indicators and conditions of lymph node dissected were presented as (±s) and examined by using t test; the incidence of postoperative complications were presented as [n (%)] and examined by chi square test. A P value of <0.05 was considered as significant difference.

There was no significant difference of intraoperative and postoperative related indicates, lymph node dissection and postoperative complications among the different aged patients (young and middle-aged and elderly patients) in both of the two groups (P>0.05); Compared with the traditional group, the operative blood loss of young and middle-aged and elderly patients in CME group was significantly reduced, and the operative time, postoperative exhaust time, drainage time and hospitalization time were significantly shortened (P<0.05). Compared with the traditional group, the number of lymph node dissected, lymph node in left and right colon, number of positive lymph node metastases of young and middle-aged and elderly patients in CME group were increased significantly (P<0.05). The total incidence of postoperative complications in the traditional group was 8 (10.7%), and in the CME group was 2 (2.6%), and the difference was statistically significant (P<0.05).

Laparoscopic complete mesocolic resection is effective in the treatment of young and middle-aged and elderly patients with stage Ⅲ colon cancer, with less blood loss, faster postoperative recovery and higher safety.

To investigate the clinical effect of transcecum tube ileostomy in prevention of anastomotic leakage in patients with rectal cancer received neoadjuvant chemoradiotherapy.

From Jun 2013 to Dec 2015, 16 patients with locally advanced rectal cancer underwent preoperative chemoradiotherapy in our hospital were retrospectively analyzed. Total mesorectal excision(TME) and transcecum tube ileostomy were performed 5-8 weeks after chemoradiotherapy. Clinical variables including the incidence of anastomotic fistula and postoperative rehabilitation were observed.

There were two patients, accounting for 12.5%, occurred anastomotic fistula. And the anastomotic fistula healed after somatostatin and conservative treatment. 14 patients, accounting for 87.5%, recovered well with the hospitalization of 10~14 days.

Transcecum tube ileostomy is an effective and safe method in prevention of anastomotic leakage in pitients with rectal cancer received neoadjuvant chemoradiotherapy.

The lateral lymph node dissection in laparoscopic lower rectal cancer surgery remained a challenge. It may lead to collateral damage in the operation and some postoperative complications. Comprehensive understanding of the perirectal neurotomy and excellent surgical skills of preservation of autonomic nerves in lateral lymph node dissection are key points. These skills are also important in reducing the difficulty and collateral damage in the operation.

There are still significant differences between Western and Eastern in terms of current guidelines for the criterion of lymphadenectomy in laparoscopic right colectomy for colon cancer. In recent years, with the proposal and improvement of complete mesocolic excision (CME) and the wide application of laparoscopic technique in colon cancer surgery, many colorectal specialists believe that laparoscopic CME surgery should become a " standard" operation for the right colon cancer. The CME principle plays critical role in the surgical approach and quality control of the right colectomy. Based on CME principle, anatomical level should always be kept during laparoscopic surgery, which ensured the radical resection of metastatic and disseminated enteric mesenteric membrane, as well as regional lymph nodes. Such excision and lymph node dissection did not significantly increase the complications related to the operation, and could improve postoperative survival. However, due to the limitation of retrospective studies, its advantages of surgical safety and oncology benefit are unconvincing. The findings of high level evidence-based medical evidence are still needed in the future.

To investigate the effect of the breast reconstruction of nipple areola sparing modified radical mastectomy by serratus anterior muscle flap combined with prosthesis implantation in young and middle-aged breast cancer patients.

64 cases of breast cancer were collected from January 2015 to February 2017 in our hospital, according to the different operation ways, they were divided into improved group (32 cases) and traditional group (32 cases), the improved group was given the modified radical mastectomy with nipple areola sparing by serratus anterior muscle flap combined with prosthesis implantation, the traditional group was given traditional modified radical mastectomy. Statistical analysis were performed by using SPSS 19.0 software, preoperative related indicators and the total score of FACT-B were presented as and examined by using t test; postoperative complications were examined by chi square test, a P<0.05 was considered as significant difference.

Compared with the traditional group, the intraoperative blood loss, operation time of the improved group were both significantly increased (P<0.05), but there was no significant difference in the number of lymph node dissection between the two groups (P>0.05); Before operation, there were no significant difference in the each component and total score of the FACT-B between the two groups (P>0.05); After operation, compared with the traditional group, the physical condition, emotional state, social/family situation, additional attention and the total score of FACT-B were significantly increased of the improved group, the difference was statistically significant (P<0.05). The total incidence of postoperative complications was 9.4% in the improved group and 15.6% in the traditional group, the difference was not statistically significant (P>0.05).

Breast reconstruction of nipple areola sparing modified radical mastectomy by serratus anterior muscle flap combined with prosthesis implantation in young and middle-aged breast cancer patients has good clinical effect and good safety, can significantly improve the quality of life.

To investigate the application effects of sphincter preserving Dixon surgery combined with prophylactic ileostomy in low rectal cancer.

From July 2012 to July 2016, 62 cases of low rectal cancer treated in our hospital were retrospectively analyzed and were divided into sphincter preserving group (n=29) and combined ileostomy group (n=33) according to the operational manner. Patients in sphincter preserving group were only given low Dixon rectal surgery while patients in combined ileostomy group were given the same surgery combined with preventive ileostomy treatment. Statistical analysis were performed using SPSS statistical software 18.0, measurement data such as postoperative recovery index, anal function before surgery, 3 months and 6 months as well as postoperative life quality score were represented by (±s), compared with t test; the incidence of postoperative complications and count data were compared using the χ² test. The difference of P<0.05 was statistically significant.

Compared with sphincter preserving group, the operation time, exhaust time, recovery time, ambulation time and hospitalization time were significantly lower in combined ileostomy group (P<0.05). Besides, the anastomotic leakage rate and anastomotic stenosis rate were lower in combined ileostomy group, the differences were statistically significant (P<0.05); 3 months and 6 months after surgery, the Wexner score in the combined ileostomy group was significantly lower than in sphincter preserving group (P<0.05); 6 months after surgery, patients in combined ileostomy group had higher scores on urination, pus and blood stool, defecation frequency, exhaust defecation incontinence, incontinence and anxiety score (P<0.05).

Application of sphincter preserving Dixon surgery combined with preventive ileostomy can promote the recovery of patients in low rectal cancer Dixon rate, reduce the postoperative incidence of anastomotic fistula and other complications, improve the postoperative quality of life, which is worth application clinically.

To investigate the clinical efficacy of reduced incision laparoscopic-assisted right hemicolectomy in the elderly patients with right colon cancer.

The clinical data of 86 elderly patients with right colon cancer admitted into our hospital from January 2012 to January 2014 were analyzed retrospectively. According to surgical procedures, the patients were divided into two-port group (45 patients) and five-port group (41 patients). SPSS22.0 software was used for data analysis, the operation effect indicators and post-operative recovery indicators were expressed as (±s), and compared by using Student's t test. The post-operative complication rate, recurrence rate and mortality rate within 3 years were compared by using the Chi-square test. P<0.05 was considered statistically significant.

Two-port group had shorter length of abdominal incisions (P<0.05); Postoperative pain scores were lower in the two-port group at 1d, 2d, 3d (P<0.05); The first flatus time, ground activity time in the two-port group were significantly shorter than those in the five-port group (P<0.05); No significant difference was observed in operation time, catheter removal time, intraoperative blood loss, average hospitalization time, number of removed lymph nodes, proximal margin length, distal margin length between the two groups (P>0.05). No significant difference was observed in postoperative complication rate, recurrence rate and mortality rate within 3 year between the two groups (P>0.05).

Reduced incision laparoscopic-assisted right hemicolectomy in the treatment of elderly patients with right colon cancer is feasible and safe, and has the benefits of less postoperative pain, better cosmetic effect, which is valuable to be applied in clinical.

To study the effect of total laparoscopic radical resection of rectal cancer (Dixon) in the treatment of rectal cancer.

96 patients of rectal cancer treated in our hospital from September 2011 to September 2013 were retrospectively analyzed. According to different surgical methods, they were divided into laparotomy group and laparoscopic group, 48 cases in each group. The laparoscopic group was treated with total laparoscopic radical resection, Using SPSS18.0 software, the perioperative data and operative data of the two groups were expressed by mean±standard deviation (±s) and compared with the t test; the complications and 3 year survival rate of the two groups were counted by χ² test, P<0.05 indicated significant difference.

The operation time in the laparoscopic group was longer than that of the laparotomy group, and the intraoperative blood loss, incision length, anal exhaust time, ambulation time, and postoperative hospital stay were less/shorter than that of the laparotomy group, the differences were statistically significant (P<0.05); there was no significant difference in the length of removed colon, the length of removed rectum, the distance from the incisal margin and the number of lymph node dissection of pericolonic, membrane and vascular root between two groups (P>0.05); the total incidence of complications in laparoscopic group was 8.3%, which was significantly less than 31.3% in the laparotomy group (χ²=5.485, P<0.05); the 1~3 years survival rate of laparoscopic group was 91.7%, 77.1% and 64.6%, compared with laparotomy group 89.6%, 72.9%, 62.5%, the difference was not statistically significant (P>0.05).

Total laparoscopic radical resection of rectal cancer is well for rectal cancer, it have the advantages of less trauma, faster recovery and less complications, the curative effect of tumor is similar to that of open surgery.

To investigate the safety, feasibility and clinical outcome of laparoscopic radical resection of low rectal cancer with telescopic anastomosis through transanal resection without abdominal incisions.

From Mar 2010 to Dec 2017, 102 patients with low rectal cancers, including 43 males and 59 females with an average age of 59.6 years (ranging from 36 to 81 years) underwent laparoscopic radical resection of low rectal cancer with telescopic anastomosis through transanal resection without abdominal incisions. The distance between the anus and inferior margin of the tumor ranged from 5 cm to 7 cm (85 cases) and 4 cm (23 cases). TNM staging showed that 79 patients had cT₁N₀M₀ staging, 23 had cT₂N₀M₀ staging. Through the middle approach, the sigmoid mesentery was freed at the root with an ultrasonic scalpel, and the inferior mesenteric artery and vein was clamped and cut. Following the total mesorectal excision (TME) principle, the rectum was dissected to the anorectal ring and 3-5 cm from the distal end of the tumor. The electric knife was used to cut open the mucosa 1.5-2.0 cm above the dentate line. Sharp dissection was performed along the rectal mucosa, upwards, to peel off the rectal mucosa for 2-4 cm, to reach the levator ani muscles, and the rectum was cut circularly. The rectal tumor and distal sigmoid colon were removed from the anus together, then telescopic anastomosis of proximal sigmoid colon and the distal colon and rectal muscle sheath were performed.

All of 102 patients received successful laparoscopic surgery without conversion. The average operation time was 179 min and the average harvested lymph nodes was 13. There were 3 cases (2.9%) of stoma leakage, who were cured by temporary colostomy and closure of the stoma 3 months later. The postoperative follow-up ranged from 6 to 84 months (average of 45 months), with 2 cases (1.9%) of stoma stenosis who received expansion treatment. Postoperative pathological results showed that 49 patients had pT_1-2N₀M₀ staging, 53 had pT₂N₁M₀ staging. Twelve months after surgery, 94.1% patients achieved anal function Kirwan grade 1, indicating that their anal function returned to normal. There were 4 cases (3.9%) of local recurrence within 3 years after surgery, with 100% 3-years-survival.

Laparoscopic radical resection of low rectal cancer with telescopic anastomosis through transanal resection without abdominal incisions is safe, reliable and mini-invasive, without incision and scar on the abdominal wall with satisfactory clinical outcome.

To explore the clinical effects of laparoscopic common bile duct exploration (LCBDE) combined with laparoscopic cholecystectomy (LC) on elderly patients with cholecystolithiasis and common bile duct stones.

98 cases of elderly patients with cholecystolithiasis and common bile duct stones treated in our hospital from January 2012 to December 2016 were given the prospective study, and they were randomly divided into the LCBDE+ LC group (n=49) and the ERCP/EST+ LC group (n=49). The LCBDE+ LC group was given the LCBDE+ LC treatment, and the ERCP/EST+ LC group was given the endoscopic retrograde cholangiopancreatography/endoscopic sphincterotomy (ERCP/EST) combined with LC treatment. The SPSS 21.0 was used for statistical analysis, and the success rate of operation, the residual stone rate and the incidence rate of complications were compared between groups by chi-square test analysis, and the intraoperative and postoperative indexes of the measurement data were expressed by mean±standard deviation, and the t test was used for comparison between groups, and the P<0.05 showed that the difference was statistically significant.

There was no significant difference in the success rate of surgery and the residual stone ratebetween the LCBDE+ LC group and the ERCP/EST+ LC group (P>0.05), which showed that the two operation methods could have equivalent effects. The intraoperative and postoperative indexes in the LCBDE+ LC group were significantly better than those in the ERCP/EST+ LC group such as shorter operative time, less bleeding and lower operation cost (P<0.05). The incidence rate of postoperative complications in the LCBDE+ LC group was lower than that in the ERCP/EST+ LC group, which indicated that the operation safety was higher in the LCBDE+ LC group (P<0.05).

The LCBDE+ LC and ERCP/EST+ LC have equivalent clinical efficacy in the treatment of elderly patients with cholecystolithiasis and common bile duct stones, but the LCBDE+ LC have bettter safety, shorter operative time, less bleeding and lower operation cost and incidence rate of postoperative complications, which can be used as one of the preferred method for clinical treatment of senile cholecystolithiasis with common bile duct stones.

Complete mesocolic excision of radical right hemicolectomy was performed as following: medial approach was employed and accurate interfacial space and sufficient lymph node dissection was highlighted in this operation. First, peritoneum was dissected along the anatomical position of ileocolic vessels, ileocolic vessels and the distal section of superior mesenteric vein (SMV) were then dissociated. Second, proximal section of SMV was exposed to the inferior margin of pancreas neck. Thereafter, the ileocolic vessels, the middle colic vessels and the right colic vessels were located. Third, after the dissection of lymph nodes along SMV, right Toldt’s fascia space was exposed from inside out. Next, the duodenum, the head of pancreas, the right side of SMV and Henle trunk were exposed. Finally, the right colon was dissociated by lateral procedure. Research indicated that this approach could ensure the D3 lymph node dissection, which was associated with the low local recurrence and distant metastasis, and the significant prolongation of overall survival.

The surgical procedure should obey the principles of complete mesocolic excision (CME). Surgical procedure includes: abdominal exploration, first dissection was performed at the root of the meso-ilium caudally, then to enter and expand the right retro-colic space (RRCS) to the third part of duodenum, and back to medial approach, to open the mesocolon below the ileocolic vessel, to meet the opened RRCS, and followed by a high ligation and dissection of vessels, including the superior mesocolic vessel, right colic vessel and right branch of middle colic vessel, after dissection of Toldt’s space and ligament of hepatic flexure, whole right hemicolon was mobilized, and specimen was removed extracorporeally, finally reconstruction of the GI were achieved.