2016年 · 第31卷第06期

gastroenteropancreatic neuroendocrine neoplasm (GEP-NEN) is a rare digestive disease. The disease was first named carcinoid by the German doctor Oberndorfer in 1907 to show the characteristics of its benign tumor. When cases of GEP-NEN with liver and lymph node metastases were gradually reported, its malignant biological behavior was recognized, but the nomenclature of carcinoid tumors was preserved and widely used. Thereafter, such tumors, which are believed to originate from diffuse neuroendocrine cells, are also referred to as amine precursor uptake and decarboxylation tumors (APUDoma) because of their amine precursor uptake and dehydroxylation functions. The 4th edition of WHO Classification of Digestive System Tumors in 2010 introduced the concept of neuroendocrine tumors and recommended that the nomenclature of carcinoid tumors should no longer be used. At the same time, the standard further clarified that neuroendocrine tumors as a disease classification as a whole are malignant, and neuroendocrine neoplasm (NEN) can be used instead of neuroendocrine tumor (NET) in description. The incidence of this century-old disease has increased rapidly in the past 30 years, especially with the unification and popularization of nomenclature and diagnostic norms, the research in this field has developed rapidly. gastric neuroendocrine neoplasm (G-NEN) accounts for a high proportion of GEP-NEN in China. Compared with pancreatic and intestinal neuroendocrine tumors, there are certain particularities in epidemiology, pathogenesis, diagnosis and treatment. At present, there are still many blind spots in the understanding of this disease. This article will analyze and discuss some controversial issues based on the recent progress of G-NEN diagnosis and treatment.

Breast-conserving surgery is an important surgical treatment for patients with early breast cancer. Successful breast-conserving surgery requires both safe tumor edge and good breast shape. For breast cancer patients with moderate to severe breast sagging, especially those with poor tumor location (e.g. below the breast), how to perform breast conservation is a challenge. From December 2011 to December 2014, we completed breast-conserving surgery in 26 breast cancer patients with moderate to severe breast ptosis through breast reduction technology, achieving the dual purpose of tumor resection and large breast reduction, and obtained satisfactory clinical results, which are reported below.

laparoscopic cholecystectomy (LC) has been used as a conventional minimally invasive procedure in surgery, and pneumoperitoneum is an indispensable part of laparoscopic technique. Among the 12 600 cases of LC surgery performed in our hospital, 6 cases of pneumoperitoneum complicated with hepatic capsule avulsion hemorrhage. Six patients in this group were treated at different times and in different ways, and satisfactory results were obtained, which are reported below.

Laparoscopic radical gastrectomy has been widely developed in China in recent ten years. Although the development of stapler has gradually reduced the incidence of gastrointestinal fistula, anastomotic fistula is still a serious complication after gastrointestinal reconstruction, and the mortality rate is still about 15%^[1]。 In this study, 17 patients with anastomotic leakage after laparoscopic radical gastrectomy were treated with Rhee drainage tube irrigation.

Since the 1990s, laparoscopic radical resection of rectal cancer has been widely carried out and has achieved good results. However, due to the lack of sense of depth in traditional (2D) laparoscopic imaging, it increases the difficulty of surgical operation and the possibility of intraoperative secondary injury, which affects the surgical outcome^[1]。 In order to overcome these shortcomings, 3D laparoscopic system came into being. This study analyzed the data of rectal cancer patients who underwent laparoscopic surgery in our hospital to explore the feasibility, safety and short-term efficacy of 3D laparoscopic surgery for advanced rectal cancer.

Intestinal obstruction is a common surgical acute abdomen, and persimmon stone intestinal obstruction is not uncommon in clinic. Patients are more common in the elderly, and the symptoms are relatively concealed and lack of specific manifestations, so the misdiagnosis rate is high. This article retrospectively analyzed the clinical data of 30 patients with persimmon stone intestinal obstruction admitted to our hospital from 2010 to 2013, and reported as follows.

Echinococcosis is an important zoonotic parasitic disease in northwest China, which can occur in almost all parts of human body, among which liver is the most vulnerable. Cytokines play a regulatory role in anti-parasitic immunity. interleukin-10 (IL-10) is secreted by human Th2 cells and is influenced by T, B lymphocytes and other immune cells. Hydatid infection in the liver often has no self-conscious symptoms in the early stage, and most patients often become more serious after discovery. Larger volumes of liver hydatid not only bring risks to surgery, but also are prone to bleeding, bile leak, infection and hydatid residues after surgery. Therefore, the early detection of hepatic hydatidosis and its effective treatment are particularly important. The dynamic changes of serum IL-10 levels in patients with hepatocystic hydatidosis before and after surgery in high altitude area were detected to explore the role and clinical significance of IL-10 expression in the occurrence, development and prognosis of hepatocystic hydatidosis, and provide reference for clinical diagnosis and prognosis of hepatocystic hydatidosis.

Anastomotic hemorrhage is an extremely serious complication after colorectal cancer surgery, and some patients even need secondary surgery if not managed properly. Colonoscopy is an extremely important tool for anorectal surgeons in the treatment of anastomotic hemorrhage. This study is to retrospectively analyze and summarize the clinical experience of using titanium clip clipping under colonoscopy to treat anastomotic bleeding after colorectal cancer surgery in our hospital in recent years, which is reported below.

Central South University, Tianjin University and other scientific research institutions have developed a low-cost and compact new surgical robot system "Miaoshou S", and a total of 5 surgical operations have been successfully performed, which are reported as follows.

Castleman's disease, also known as vascular follicular lymphoid tissue hyperplasia or giant lymph node hyperplasia, is an unexplained chronic lymphoid tissue proliferative disease^[1]Thoracic mediastinal lymph nodes are the most common, while retroperitoneal localized Castleman disease accounts for only 2% of Castleman disease^[2]。 This disease has the characteristics of abundant blood supply, deep location, difficult operation and easy intraoperative hemorrhage. Three-dimensional visualization reconstruction system and three-dimensional printing technology have achieved good results in preoperative evaluation of related diseases^[3,4]。 This technique was used to evaluate the data of a patient with retroperitoneal localized Castleman's disease admitted to our department before operation, and to explore the application value of three-dimensional visual reconstruction and three-dimensional printing technology in surgical resection of retroperitoneal tumor.

A 41-year-old male suffered from upper abdominal distension and discomfort for 1 month, which aggravated after eating. Physical examination: A ductile mass of about 10 cm straight meridian can be palpable in the left upper abdomen, with unclear boundary, no tenderness and rebound pain. CT examination: A huge soft tissue mass of 9.6 cm ×6.9 cm was seen in the spleen-stomach space. The lesion was closely adhered to the gastric serosa layer, and the gastric mucosa was not damaged (Figure 1)。 Surgical exploration: A tumor with a diameter of about 9 cm on the large curvature of the stomach invaded the transverse colon and the lower pole of the spleen. Laparoscopic partial gastrectomy + partial transverse colonectomy + partial splenectomy were performed. Postoperative pathological report: desmoid-type fibromatosis (DTF)Figure 2)。 Immunohistochemical staining results: β-Catenin (nuclear positive, 3+), S-100 (-), SMA (-), Vimentin (3+), CD34 (-), estrogen receptor β (+), Ki-67 (+,<4%)。

A 19-year-old female was admitted for more than 1 month due to repeated lower abdominal pain. One year ago, the patient had undergone "intussusception reduction + intestinal volvulus reduction + partial small intestine resection" in the emergency department for "intussusception". Postoperative pathological report: multiple tubular-villous adenomas of the small intestine. The patient complained that dark spots began to appear on his small lips and fingers, and his father and two younger brothers both had this manifestation. Among them, his father had partial small intestine resection due to "intussusception" at the age of 40. Physical examination: A large amount of pigmentation and dark spots can be seen on the nose, around the mouth, lips and fingers. A surgical scar about 15 cm long was visible in the middle of the abdomen. Soft abdomen, mild tenderness around the umbilicus, no rebound pain and muscle tension. Multiple polyps of the large intestine were seen under colonoscopy. Abdominal CT examination revealed multiple polyps in small intestine and colorectum and multiple intussusceptions in small intestine. The diagnosis of polyposis maculosa nigra was definite. During the operation, the small intestine was spring-like, with pedicled polyps of about 3 cm palpable about 3 cm away from the Treitz ligament, and 3 polyps of the rest of the small intestine, ranging in size from 2 to 3 cm, were palpable. Intussusception was visible in the small intestine where the polyps were located.Figure 1。 Polyps about 5 cm in diameter can be palpable at the transverse colon near the hepatic flexure, and polyps about 3 cm in diameter can be palpable at the rectal peritoneal reflex and 3 cm above it. Intussusception reduction, small intestinal polypectomy, partial transverse colectomy and Dixon's operation were performed. Postoperative pathological report: tubular-villous adenoma of small intestine with moderate atypical hyperplasia in small foci; Tubular-villous adenoma of sigmoid, ascending colon, seeFigure 2。

A 75-year-old male was admitted to hospital due to "yellow staining of skin and sclera all over the body for 1 week". Abdominal B-ultrasound examination revealed gallbladder enlargement and multiple calculi in the common bile duct. Physical examination on admission: no anemia, yellowing skin all over the body, no congestion and ecchyma, no liver palm and spider nevus, severe yellowing sclera, flat and soft abdomen, no varicose veins on abdominal wall, no gastrointestinal pattern and peristaltic wave, no palpation of liver and spleen under the costs, no tenderness and rebound pain in the whole abdomen, and no percussion pain in the liver and kidney areas. Laboratory tests: Serum alanine aminotransferase 385 U/L, aspartate aminotransferase 299 U/L, alkaline phosphatase 446 U/L, total bilirubin 244 μ mol/L, direct bilirubin 122 μ mol/L, indirect bilirubin 122 μ mol/L, alpha-fetoprotein 14 ng/ml, carcinoembryonic antigen 6.1 ng/ml, CA125 11 U/ml, CA199 25.6 U/ml. Abdominal CT examination: space-occupying lesion of duodenal papilla with obstructive dilation of biliary tract, considering malignant tumor; Prominent lesions of the mucosa on the large curvature of the gastric body, considering gastric cancer (Figure 1)。 Endoscopic ultrasound and tissue biopsy showed: duodenal adenocarcinoma, gastric adenocarcinoma (Figure 2)。 Radical pancreaticoduodenectomy + radical gastric cancer resection was performed. Postoperative pathological report: Moderately differentiated papillary adenocarcinoma of duodenal invasive ulcer type, the size of cancer is 4 cm ×3.5 cm ×1 cm, the cancer infiltrates into the serous layer to the adjacent adipose tissue and invades the surrounding pancreatic tissue, and there is no cancer metastasis in the lymph nodes adjacent to the mass (0/5); Moderately differentiated tubular adenocarcinoma of the body of the stomach, the size of the tumor was 4 cm ×3 cm ×1 cm, the carcinoma infiltrated into the submucosa, and there was no metastasis in the lymph nodes adjacent to the mass (0/17) (Figure 3)。 The patient recovered well after operation and was discharged smoothly.

A 78-year-old male was admitted to the hospital with sudden epigastric pain for 8 h. The patient suddenly developed sharp pain in the upper abdomen after taking "pain relief tablets" 8 hours ago, without releasing pain, nausea and vomiting. The patient had a history of "gastric ulcer" for 10 years, and did not undergo systemic treatment. Stomachache can be relieved after taking "pain relief tablets". Physical examination on admission: body temperature 38.8 ℃, heart rate 110 beats/min, flat abdomen, obvious tenderness in the upper abdomen, positive rebound pain and muscle tension, and attenuated intestinal sounds. Abdominal CT and vertical abdominal X-ray showed free air under the diaphragm. The admission diagnosis was "perforation of the digestive tract and peritonitis". Exploratory laparotomy was performed in the emergency department. Exploration of the abdominal cavity: About 800 ml of purulent exudate and digestive juice were aspirated, and a perforation with a diameter of about 0.5 cm was seen in the anterior wall of the gastric antrum. No mass was palpable, considering the possibility of perforation caused by gastric ulcer. After the perforation was intermittently sutured with silk thread, exploration was continued. Another perforation, about 0.5 cm in diameter, was seen in the anterior wall of the duodenal bulb, and white tablets were seen at the perforation (Figure 1)。 After taking out the tablets, apply non-absorbable silk threads to intermittently suture them, and repeatedly rinse the abdominal cavity with warm saline until the irrigation fluid is clear. A drainage tube is placed in the right upper abdomen and led out through a hole in the abdominal wall. After operation, the patient was given the treatment of fasting water, continuous gastrointestinal decompression, acid suppression, parenteral nutrition, etc., and the carbapenem drug ertapenem was selected to fight infection (ertapenem was sensitive to the postoperative pus culture result, and the application was continued until the 7th day). The gastric tube was removed after exhaustion on the 3rd day after surgery, and no blue fluid was seen from the drainage tube after oral administration of methylene blue, and enteral nutrition support was given. Gastrointestinal angiography was performed on the 7th day after operation, which showed good continuity of digestive tract and acceptable gastrointestinal motility, and the drainage tube was pulled out and discharged.

Case 1: A 64-year-old male was admitted to the hospital mainly for "intermittent melena for 8 days". Emergency blood routine : Hb 56 g/L, HCV 0.167. Gastroscopy: red blood outflow was seen at the pyloric orifice, 3 active bleeding was seen at the junction of the duodenal bulb and the descending part, and there was still active bleeding after irrigation with saline norepinephrine. Endoscopy: Telangiectasia and bleeding at the junction of the duodenal bulb and descending part, seeFigure 1。 Emergency surgery was performed. The anterior wall of the stomach was incised near the gastric antrum, and dark red blood was seen overflowing into the gastric cavity from the pylorus. After the blood was sucked, it was placed into the gastroscope through the gastric wall incision, and active bleeding was seen in the duodenal bulb. Considering the duodenal bulb telangiectasia and bleeding, distal gastrectomy (Bi II anastomosis) was performed. Postoperative pathological report: Moderate chronic inflammation of gastric mucosa with local erosion, hyperplasia, dilation and congestion of lamina propria and submucosa vessels, consistent with telangiectasia, seeFigure 2。

The patient was a 58-year-old male. He came to the hospital on October 30, 2015 due to "increased frequency of stool for 5 years". Five years ago, the patient had increased stool frequency without obvious trigger, 5 to 7 times a day. At first, it was formed yellow soft stool, and then it was mostly thin paste stool, yellow in color, often with mucous stool, no nausea, vomiting, abdominal pain, abdominal distension, no purulent and bloody stool, no difficulty in defecation, no fever, dizziness, fatigue, progressive weight loss, etc. Self-observation found that when eating beef, bovine blood, shell-shelled turtle, chocolate and other foods, the color of defecation was dark; But he never saw a doctor. The patient denied a history of "hypertension, diabetes, heart disease" and denied a history of surgery; Denial history of drug food allergies; Denial of smoking history; Have a history of drinking alcohol for 10 years, and drink about 150~250 ml of "Acanthopanax" wine every day. In 1989, he suffered from "acute hepatitis B" and was treated regularly. The details cannot be complained in detail, and his liver function was normal. His father has a history of "schistosomiasis hepatitis, liver cirrhosis and hypersplenism", and his brother, sister and younger brother are all in good health. Physical examination: No abnormal signs were found in the physical examination. Laboratory tests: Hepatitis B three lines: hepatitis B surface antigen, hepatitis B e antibody and hepatitis B core antibody were all positive. Hepatitis C antibody and hepatitis A antibody were negative. Albumin 42.1 g/L, alanine aminotransferase 186 U/L and glutamine transferase 179 U/L. Sixteen autoimmune antibodies: anti-RO52: positive, other indexes (anti-nuclear antibody, anti-SM, anti-NRNP, anti-SCL-70, anti-PCNA) were normal; Blood routine, alpha-fetoprotein, carcinoembryonic antigen and thyroid function were all normal. Both syphilis and human immunodeficiency virus tests were normal. Imaging examination: abdominal + pelvic enhanced CT: extensive calcification of intracolonic vein and superior mesenteric vein branch, consistent with phlebosclerotic colitis. Plain scan showed that the ascending colon, transverse colon and descending colon walls and the superior mesenteric vein were generally calcified. After enhancement, the colon wall strengthened and weakened, and the intestinal wall was generally thickened, with the ascending colon as the obvious, and the abdominal aorta and bilateral common iliac artery walls were calcified. No obvious enlarged lymph nodes were found in the retroperitoneum (Figure 1,Figure 2)。 Colonoscopy: the mucosa of the whole colon was dull in color, the intestinal lumen was yellow-purple-brown, the colon wall was thickened, the mucosa was pale and edema, and the intestinal wall was stiff; deterioration of stretchability, presence of a colonic bag; No erosion of intestinal mucosa was observed (Figure 3)。 The patient is instructed to abstain from drinking, and the patient has gradually reduced the amount of alcohol he drinks, drinking about 100 ml of "Wujiapi" wine every day. Follow-up for 4 months, the patient defecated 2 to 3 times a day, yellow in color and thin paste; There was no significant weight loss. The patient was generally in good condition, without complications such as intestinal obstruction and intestinal perforation, and was given conservative treatment.

The patient was a 46-year-old male. He was admitted to the Department of Gastrointestinal Medicine on June 23, 2015 after defecating black stool for 3 days. He had a history of hypertension for 30 years, and his blood pressure was as high as 190/110 mmHg. He was now treated orally with Baixintong 30 mg daily for symptomatic treatment. Deny history of diabetes and coronary heart disease, deny history of hepatitis, tuberculosis and close contact, and have a history of penicillin allergy. He underwent thyroid cancer surgery in 2014 and is now taking Euthylox 137.5 μ g/d orally. The patient underwent three resection of rectal abscess in 1994, 1995 and 2000, respectively. Physical examination: body temperature 36.5 ℃, 18 breaths/min, 90 pulses/min, blood pressure 130/100 mmHg, lips slightly pale, palpebral conjunctiva no pale, skin and sclera no yellowing stain, no palpable superficial lymph node swelling, no spider nevus, liver palm. The abdomen was flat and soft, the intestinal sound was 5 times/min, there was no obvious tenderness, rebound pain and muscle tension, the liver and spleen were not palpable under the costs, the mobile voiced sound was negative, and there was no depressed edema of both lower limbs. Admission blood routine: red blood cell count 3.90×10¹²/L, hematocrit 0.352 L/L, hemoglobin 109.0 g/L. Colonoscopy was performed on the day of admission: no blood was found from the end of the ileum, no abnormalities in the ileocecal valve and appendix opening, yellow fecal residue was seen in the ascending colon without obvious blood stains, and a large amount of dark red and black sticky and dry feces were seen in the transverse colon from the rectal lumen, which affected the observation of mucosa. No active bleeding was found after repeated saline washing. The mucosa was still smooth and the intestinal lumen was unobstructed in the visible range. Admission diagnosis: lower gastrointestinal hemorrhage. On June 24th, the patient had two more bowel movements with dark red blood stains, each time about 300 ml, accompanied by sweating, and a pulse of 105 beats/min; Emergency blood test routine: red blood cell count 3.10×10¹²/L, hemoglobin 97.0 g/L, hematocrit 0.281 L/L. And emergency colonoscopy: fresh blood can be seen constantly gushing out at the opening of the appendix (Figure 1), transferred to gastrointestinal surgery and underwent laparoscopic appendectomy under emergency general anesthesia. Intraoperative findings: no pus in the abdominal cavity, congestion and swelling of the appendix, about 10 cm long and 0.8 cm in diameter, no organic lesions were found in the exploration of the whole small intestine and colon, the appendix was anterograde removed, the appendix was dissected, fresh clots were seen in the appendix cavity, and the mucosa of the blind end of the appendix was congested and eroded (Figure 2)。 The patient recovered smoothly after operation, and no blood in stool and melena appeared after 5 months of follow-up. Postoperative pathological examination: Chronic appendicitis with acute attack, focal mucosal detachment, shallow ulcer formation, small blood vessel dilation on the surface of the ulcer, thrombosis in the interior, and obvious epithelial hyperplasia.

A 75-year-old female was admitted to the hospital on July 19, 2014 due to "intermittent claudication of the left lower limb for more than half a year, black and painful second toe of the left foot for 2 months". Six months ago, the patient's claudication distance was reduced from 200 meters to 100 meters, and the left calf was painful, numb and chill when walking, which could be relieved after rest. The left ankle brachial index (ABI) measured by an outside hospital was 0.56, and no treatment was performed. Two months ago, resting pain in the left foot occurred, the walking distance was reduced to 10 meters, and the second toe of the left foot was black and painful. Hypertension for 10 years, well controlled by drugs; Type 2 diabetes for many years, well controlled by medications; Has undergone stent treatment for coronary heart disease. Physical examination: the pulsation of the left femoral artery was palpable, weaker than that of the contralateral, and the pulsation of the left popliteal artery, dorsal pedis artery and posterior tibial artery was not palpable; The right femoral artery, popliteal artery, dorsal pedis artery and posterior tibial artery pulsation are palpable; The left ABI was 0.14.

A 64-year-old male was admitted to the hospital due to poor eating for 1 month and aggravation for 3 days. Physical examination: No positive signs. Gastroscopy: There was 1 irregular ulcer in the cardia, and the pathological diagnosis of gastric adenocarcinoma by tissue biopsy. Gastric cancer resection was performed. Postoperative pathological report: There was an ulcer-type mass in the gastric cardia, the size was 4.0 cm ×3.0 cm ×2.5 cm, the section surface was gray-white and hard, and the gray-white tissue infiltrated into the whole thickness of the gastric wall. Squamous cell carcinoma and adenocarcinoma can be seen under light microscope. The boundary between the two carcinomas is obvious, and there is no transition in the middle. Squamous cell carcinoma is arranged in sheet and nest shape, with great cell atypia and more mitotic images; Adenocarcinoma is a poorly differentiated adenocarcinoma with abnormal cells and more mitotic images (Figure 1)。 Immunohistochemical markers: CK7, CEA, 34BE12, nm23, Ki-67, P53 were positive in adenocarcinoma cells, nm23, Ki-67, P53 were positive in squamous cell carcinoma cells, and CK7 was negative in cancer tissues (Figure 2)。 The pathological diagnosis was gastric cardia collision carcinoma, which invaded the serosa, but did not break through the adventitia layer, and the carcinoma tissue invaded the vessels and nerves. Cancer metastasis was observed in the lymph nodes paracardia (1/13) and the lymph nodes parastomach left artery (1/2). The tumor TNM stage is T₃N₁M₀。 The patient was treated with 5-fluorouracil combined with cisplatin chemotherapy and died of liver metastasis 7 months later.

A 38-year-old male was admitted to hospital for "nausea and vomiting after eating for more than 40 days". Physical examination: No positive signs in the abdomen. Abdominal MRI showed that the abnormal signal foci at the duodenojejunal junction showed progressive uneven enhancement, and the enhancement was most obvious in the last stage. Considering the tumor at the duodenojejunal junction, combined with intestinal stenosis and duodenal obstruction (Figure 1)。 Laboratory tests: serum total bilirubin 33 μ mol/L, direct bilirubin 11 μ mol/L, indirect bilirubin 22 μ mol/L, alanine aminotransferase 302 U/L, aspartate aminotransferase 182 U/L, gamma-glutamyl transpeptidase 82 U/L, serum total bile acids 21 μ mol/L, glutamate deaminase 190 U/L, lactate deaminase 314 U/L. Preliminary diagnosis: tumor of the duodenojejunal flexure. Excision of duodenal tumors was performed electively. During the operation, duodenojejunal flexural tumor was found, about 4.0 cm ×3.5 cm ×3.5 cm in size, hard in texture, invading Treiz ligament, tail of pancreas, large curvature of stomach and splenic vein, without metastasis to liver, biliary tract, stomach, pelvic cavity, hepatic hilum and para-abdominal aortic lymph nodes. Complete resection of the tumor, intraoperative frozen pathological examination suggests that the possibility of stromal tumor is not excluded. The operation went smoothly. Postoperative pathological report: (Duodenum) mesenchymal tumor, tumor cells are spindle-shaped, atypia is not obvious, infiltrate the surrounding adipose tissue, no mitotic image is observed (Figure 2)。 Immunohistochemical staining results: CD117 (-), CD34 (-), Vim (+), S100 (-), SMA (-), Ki-67 (individual cells +), Desmin (weak +), CK (-), DOG-1 (-), β-catenin (+) (Figure 3), PDGFR-α (−). Pathological diagnosis: intraabdominal fibromatosis.

pylorus-preserving gastrectomy (PPG) was first used to treat benign gastric ulcer. This procedure preserves the function of the pyloric ring and achieves satisfactory results in improving the postoperative quality of life of patients. Since the late 1980s, some surgeons have begun performing PPG surgery on specific patients with early gastric cancer. In recent years, laparoscopy-assisted pylorus-preserving gastrecotomy (LAPPG) has been reported in the literature for the treatment of early gastric cancer with satisfactory postoperative results^[1,2]。 However, as a limited surgical method, PPG surgery has been controversial in the treatment of early gastric cancer, which limits the clinical application of PPG surgery.

Common risk factors for abdominal aortic aneurysm (AAA) include advanced age, smoking, male sex, family history of AAA, atherosclerosis, hypercholesterolemia, hypertension, coronary heart disease, cerebrovascular disease, etc. Although diabetes is an independent risk factor for cardiovascular disease, which can lead to aortic atherosclerosis and vascular endothelial dysfunction, a large number of epidemiological evidences show that diabetes can inhibit the occurrence and progression of AAA, and is a protective factor of AAA^[1]。 This article reviews the possible mechanisms of the protective effect of diabetes on AAA.