To use the surgical difficulty scoring model for laparoscopic liver resection to evaluate the difficulty of surgery, and to analyze the practicability of scoring model by comparing the differences between each difficulty groups.

The clinical data of 68 patients were reviewed in this study, who underwent a pure laparoscopic liver resection in the department of (minimally invasive) Hepatobiliary of General Surgery, Jinzhou Medical University Affiliated First Hospital, from Oct. 2016 to Oct.2019. First, the characteristics and surgical outcomes during perioperative period were collected. Next, these cases were scored by using the scoring models, respectively presented by Hasegawa (scoring model of Hasegawa, SM-H) and Ban (scoring system of Ban, SS-B), then divided into groups of different difficulty. Finally, the practicability of the scoring model in practical application was evaluated by comparing differences among each groups on the factors of the blood loss in surgery, the length of surgical time and the length of hospital stay.

There were significant differences(P<0.05) in the blood loss, length of surgical time and length of hospital stay between the low difficulty group and medium difficulty group by adopting SM-H. And by applied the SM-B, there were no significant differences(P>0.05) could be found between the low difficulty group and medium difficulty group, in the factors of blood loss, surgical time or length of hospital stay.

SM-H, this laparoscopic liver resection surgical difficulty scoring model could provide a very intuitive quantitative way for hepatobiliary surgeons to evaluate the difficulty of surgery before performing laparoscopic liver resection in low or medium difficulty cases. SM-B has some reference significance in estimating blood loss, surgical time or length of hospital stay in the case of low and mid-difficult laparoscopic liver removal.

To screen out the more suitable prediction model of preoperative accurate assessment of gastric bypass (GBP) for the treatment of type 2 diabetes mellitus (T2DM) in mainland China by comparing several scoring systems of predicting T2DM after metabolic surgery.

The data of patients with T2DM who received GBP was retrospectively collected, and all the patients were seen from Apr.2012 to Dec. 2015 in Beijing Tian Tan Hospital, compared changes of related clinical indicators before and one year after surgery. We compared the predictive accuracy by ROC curve for T2DM complete remission after GBP between ABCD, DiaRem, IMS, and Tian Tan predictive scoring systems.

A total of 101 patients (58 women) were enrolled in our study. Complete remission rate of T2DM after GBP was 70.3% (71/101). Mean age of the T2DM patients was (45.3±11.1)years, mean BMI was (30.3±5.5)kg/m², mean HbA1c and disease duration were (8.5±1.7)% and (7.1±4.8 )years, respectively. BMI, TCHO, TG, LDL, FPG, HbA1c, fasting C-peptide, fasting insulin, HOMA-IR and serum ferritin were significantly lower than those before operation (P<0.05). The AUC values of IMS, Tian Tan, DiaRem, and ABCD scoring systems were 0.833, 0.825, 0.764, and 0.724 respectively.

The IMS and Tian Tan scoring systems were accurate estimate of T2DM complete remission of patients after GBP, allowing metabolic surgeon to optimized treatment plan based on individualized risk prediction.

To explore the safety and clinical effect of the robotic hepatobiliary and pancreatic surgery combined with vascular resection and reconstruction.

From Jan. 2016 to Oct. 2019, the clinical data of 14 cases of robotic hepatobiliary and pancreatic surgery with vascular resection and reconstruction completed in the second department of hepatobiliary surgery of the First Medical Center of PLA General Hospital were analyzed retrospectively.

All the 14 operations were successfully completed under the daVinci robotic system, without conversion to laparotomy, and without thromboembolism occlusion in the early stage after revascularization. 10 cases were reconstructed by combined partial portal vein resection, of which 2 cases were used artificial blood vessels, 3 cases were combined with partial artery resection and reconstruction, and 1 case was combined with partial middle hepatic vein resection and reconstruction. The average operation time was (294.9 ± 80.7) min, intraoperative bleeding volume was 150 ml, postoperative average hospital stay was (12.0 ± 5.1) days, and perioperative death was 0. Among the 14 cases, 13 achieved R0 resection (92.9%). As of Jan. 2020, 1 case of solid pseudopapilloma of the pancreas has been followed up for 3 years without recurrence, and 13 cases of malignant tumors have been followed up for an average of 15.5 months. Among them, 3 cases of pancreatic cancer died due to recurrence, with a median survival period of 14 months. One case of hilar cholangiocarcinoma died due to recurrence 26 months after operation, and the remaining 9 surviving patients are still in the follow-up.

The combination of vascular resection and reconstruction under the daVinci robotic system is safe and feasible, and its oncology advantages need to be further evaluated.

To evaluate the safety and efficacy of endoscopic submucosal tunnel dissection for large early esophageal cancer.

A total of 68 patients with large early esophageal cancer accepted endoscopic submucosal dissection (ESD) or endoscopic submucosal tunnel dissection (ESTD) in our center from Jan. 2018 to Aug. 2019. Based on the operation strategy, 45 patients underwent ESD and 23 patients underwent ESTD treatment. Hemorrhage, perforation, dissection speed, curative resection rate and relative clinical date of ESD and ESTD group were collected and analyzed.

Delayed bleeding occurred in 1 patient (2.2%) of ESD group. There was no significant difference compared with 2 patients (8.7%) of ESTD group (P=0.545). Hemostatic forceps were used to manage bleeding successfully. No perforation was observed in ESD group and intraoperative perforation occurred in 1 patient of ESTD group. No significant difference was observed between two groups (P=0.730). The perforation was treated with fibrin sealant and tissue forceps. 40 patients (88.9%) achieved curative resection and there was no significant difference compared with 21 patients(91.3%) of ESTD group (P=1.000). The dissection speed of ESTD was significantly quicker than that of ESD group(41.8±17.3)mm²/min vs (33.2±13.4)mm²/min(P=0.027).

ESTD appeared to be comparable with ESD in terms of safety and effficacy for large esophageal cancer. Besides, ESTD could provide a quicker dissection speed.

To evaluate the feasibility and safety of non-draining after laparoscopic totally extraperitoneal herniorrhaphy (TEP) for inguinal hernia repair.

Retrospective analysis of clinical data of 832 cases of inguinal hernia treated by TEP in the second hospital affiliated to Soochow University from Jan. 2010 to Mar. 2016. A retrospective and comparative analysis was carried on among 537 cases used drainage and 295 cases did not use drainage. We devise the research by analyzing the demography, morbidity parameters, hernia characteristics, hernia level, perioperative and complications of both team, gave a statistical analysis to show the effectiveness of non-use of drainage.

There are no differences between the two teams in demography, morbidity parameters, hernia characteristics and hernia level (P>0.05). Non-draining team showed a shorter operating time [(38.52 ± 16.43)min vs (45.30 ± 15.71) min, P<0.001], hospital stay after operation [(2.84 ± 0.45)d vs (3.36 ± 0.67)d, P<0.001] and time return to work [(4.57 ± 0.43)weeks vs (5.84 ± 0.95) weeks, P< 0.001], also there were less pain in the non-draining team by measure by the pain score at postoperative 24 h and 1 week (P< 0.05). The complications like seroma [10.99% vs 12.88%, P=0.4153] also had no difference (P<0.05) except uroschesis [6.70% vs 10.85%, P=0.036 9] which happened less in the non-draining team.

No use of drainage after laparoscopic totally extraperitoneal herniorrhaphy is safe, leads to less hospital stay and earlier return to work without cause more complications compares giving a postsurgical drainage.

To evaluate the effectiveness of arthroscopic debridement for the treatment of gout arthritis.

Computer retrieval of MEDLINE, EMBASE, CBM, CNKI, VIP and WangFang database (are building database to 2015) collected on arthroscopy and drug treatment, clinical control study of cases of gouty arthritis, into the method of quality evaluation, and using revman 5.0 software statistical analysis.

A total of 10 randomized controlled studies were included, with a total of 409 patients, the quality of the method was B. The results of Meta analysis showed that the excellent rates of [RR=1.43, 95%CI 0.77, 2.66, P = 0.26] were not significantly different between the arthroscopic treatment group and the drug conservative treatment group. But the two groups of postoperative VAS score [MD=-1.96, 95%CI -3.10, -0.82, P = 0.000 7], Lysholm score [MD=5.64, 95%CI 2.57, 8.71, P=0.000 3] were statistically significant differences(P<0.05).

Based on the Meta analysis results, although the excellent rate of the two groups was not statistically significant(P> 0.05), but the difference of VAS and Lysholm scores between the two groups was statistically significant(P<0.05), that arthroscopic debridement for treatment of gout arthritis and Department of internal medicine drug treatment group has a certain advantage. The above conclusions are of some reference to the clinical treatment of gout arthritis.