2019年 · 第57卷第05期

With the maturity of surgical technique and the development of instruments, transnasal endoscopic surgery of lateral skull base is gradually carried out, and protecting the internal carotid artery of skull base is the difficulty of lateral skull base surgery. Most of the internal carotid arteries in the cavernous sinus segment and paraslope segment in the midline area have corresponding bone protuberances in the sphenoid sinus to help identify them; The anterior knee (ruptured foramen segment) of the internal carotid artery in petrous segment can be localized through the pterygoid nerve^[1,2,3]However, its localization is only localized, and the anatomical localization of the whole segment of internal carotid artery in the horizontal segment of petrous bone is rarely reported in the literature. Therefore, we conducted corresponding anatomical studies.

Complete extraperitoneal laparoscopic inguinal hernia repair was performed in 1993 by Mckernan and Laws^[1]First reported, subsequently refined and standardized, it has now become one of the standard procedures for the treatment of inguinal hernia in adults. The external peritoneal layer of the lower abdomen and pelvis is loose, which can separate enough space and use large mesh for enhanced repair, which is an ideal approach for the treatment of inguinal hernia. In recent years, we have attempted to treat middle and upper abdominal wall hernia with complete endoscopic posterior rectus abdominis repair^[2,3]In practice, it was found that there was also an anatomical gap between the outer peritoneal layer of the middle and upper abdomen and the posterior rectus abdominis sheath. Based on this, we performed endoscopic totally extraperitoneal approach (TEA) to treat primary abdominal wall hernias including umbilical hernia and upper abdominal line albus hernia, and achieved good results, which are reported below.

In clinical research design, different research purposes need to select corresponding research types. It is generally not difficult to determine the type of study if the investigator has a clear study protocol before the study is conducted. However, in actual situations, not all clinical workers have clear research plans and schemes, and many people just conduct exploratory analysis by looking through past medical records; Some even have no research purpose, only analyze according to the existing medical record data, and they don't know what results can be obtained. Strictly speaking, this analysis lacks research hypotheses and is not a real study, yet this analysis is common in medical papers. For this situation, how to judge the type of study has always been the doubt of clinical workers.

A 67-year-old female with preoperative diagnosis of "rectal cancer after neoadjuvant chemoradiotherapy"; Neoadjuvant chemoradiotherapy (50 Gy, 25 sessions, 5 weeks long-term radiotherapy with oral capecitabine) was completed 7 weeks before surgery. Preoperative rectal MRI showed (Figure 1): The tumor was 4.7 cm from the anal margin and 1.5 cm from the puborectal ring, penetrated the rectal muscularis propria into the mesorectum up to 4 mm deep, and the deepest invasion was 8.9 mm from the mesorectal fascia. No distant metastases were observed on CT of thoracic and abdominopelvic cavities. Preoperative diagnosis: lower rectal cancer (ycT3bN0M0). Laparoscopic transanal total mesorectal resection is proposed.