ObjectiveTo analyze the therapeutic effects of open surgery and endovascular treatment for mesenteric venous thrombosis.MethodsThe clinical data of 22 patients with mesenteric venous thrombosis from March 2005 to January 2014 were analyzed retrospectively. One patient underwent open surgery including removal of necrotic small intestine and thrombectomy of superior mesenteric vein immediately admission to the hospital. Five cases were treated with simple anticoagulation and cured. Sixteen cases received thrombolytic therapy after primary anticoagulant therapy.ResultsOne case who underwent open surgery died of multiple organ failure at 72 h after the surgery. Five cases who received simple anticoagulant reached clinical relief finally. Sixteen patients who received thrombolytic therapy achieved recanalization totally or partially. Three cases died during follow-up (3 months to 7 years, average) of which 1 died of recurrence of acute superior mesenteric venous thrombosis, 1 died of myocardial infarction, and 1 died of stroke.ConclusionsFor patients with symptomatic mesenteric venous thrombosis, if there is no intestinal necrosis, there will be encouraging results by interventional thrombolytic therapy. And the treatment effect needs further experience accumulation in more cases.
Objective To investigate the clinical effects and safety differences of open surgery and laparoscopy primary lesion resection combined with D2 lymph node dissection in the treatment of elderly patients with advanced gastric cancer. Methods One hundred and forty elderly patients with advanced gastric cancer were chosen and randomly divided into two group including open operative group (70 patients) with primary lesion resection combined with D2 lymph node dissection by open operation and laparoscopic surgery group (70 patients) with primary lesion resection combined with D2 lymph node dissection by laparoscopy; and the operative time, intraoperative bleeding amount, the levels of PaCO2 in operation, liquid diet eating time, postoperative anal exhaust time, postoperative gastric tube indwelling time, postoperative ambulation time, the level of haemoglobin (Hb) after operation, the hospitalization time, the number of lymph node dissection, the survival rate with followed-up and postoperative complication incidence of both groups were compared. Results There was no significant difference in the operative time between 2 groups (P>0.05). The intraoperative bleeding amount, the level of PaCO2 in operation, liquid diet eating time, postoperative anal exhaust time, postoperative gastric tube indwelling time, postoperative ambulation time, the level of Hb after operation and the hospitalization time of laparoscopic surgery group were significantly better than open operative group (P<0.05). The level of PaCO2 in operation of laparoscopic surgery group was significantly higher than open operative group (P<0.05). There were no significant difference in the gastric lymph node dissection number and the peripheral lymph node dissection number of gastric artery between 2 groups (P>0.05). There were no significant difference in the survival rates between the 2 groups after 3-year followed-up (P>0.05). The complication incidence after operation of laparoscopic surgery group was significantly lower than open operative group (P<0.05). The quality of life scores of patients in laparoscopic surgery group were significantly higher than those in open operative group on 7 days and in 3 months after operation, and the difference were statistically significant (P<0.05). Conclusion Compared with open operation, primary lesion resection combined with D2 lymph node dissection by laparoscopy in the treatment of elderly patients with advanced gastric cancer can efficiently possess the advantages including minimally invasive, shorter recovery time and less postoperative complications.
Objective To systematically review the efficacy and safety of laparoscopic hepatectomy (LH) and open hepatectomy (OH) for patients with hepatocellular carcinoma (HCC). Methods PubMed, EMbase, The Cochrane Library, CBM, WanFang Data, CNKI databases were electronically searched to collect the case-control studies about LH vs. OH for patients with HCC from inception to December, 2015. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies, then meta-analysis was performed by using RevMan 5.3 software. Results A total of 28 studies involving 1 908 patients were included. The results of meta-analysis showed that: the LH group was superior to OH group on complications (OR=0.35, 95%CI 0.26 to 0.48, P<0.000 01), hospital stay (MD=–4.18, 95%CI (–5.08, –3.29),P<0.000 01), and five years overall survival rate (OR=1.65, 95%CI 1.23 to 2.19,P=0.000 7) and disease-free survival rate (OR=1.51, 95%CI 1.12 to 2.03, P=0.006). However, no significant differences were found in one year and three years overall survival rate, disease-free survival rate, and postoperative recurrence rate. Conclusion Current evidence shows that the LH is superior to OH for the treatment of HCC, and may be amenable to surgery because of its safety and longtime efficacy. Due to limited quality and quantity of the included studies, more high quality studies are needed to verify above conclusion.
ObjectiveThis meta-analysis aimed to systematically evaluate the feasibility and the safety of total laparoscopic pancreatoduodenectomy (TLPD) by comparing it with open pancreatoduodenectomy (OPD).MethodsWe searched the relative domestic and international data bases systematically, such as the Cochrane Library, Medline Database, SCI, CBM, VIP-data, CNKI-data, and WanFang Data. We selected case control studies or cohort studies, and used the Review Manager 5.3 to perform statistical analysis.ResultsIn total, thirteen single-center retrospective case-control studies were included, totally 808 patients involved, and there were 401 cases in the TLPD group and 407 cases in the OPD group. There were no significant difference in terms of the cumulative morbidity, incidence of the Clavien Ⅲ-Ⅴ complication, pancreatic fistula, B/C pancreatic fistula, biliary fistula, postoperative hemorrhage, pulmonary infection, and gastric emptying delay, as well as the ratio of secondary operation, mortality of perioperative period, the ration of R0 resection, and the number of lymph nodes dissected between the 2 groups (P>0.05). Although the operative time was significant longer, TLPD had significant superiority in terms of the amount of bleeding and blood transfusion during operation, the hospital stays after operation, the bowel function recovery time, the time to restart eating, and the time to reactivate (P<0.05).ConclusionIn terms of the relative complications and the parameters of oncology such as the ration of R0 resection, the number of lymph nodes dissected, both of the procedures are safe and feasible, while TLPD is more favorable to control operative bleeding and accelerate rehabilitation.
目的比较腹腔镜阑尾切除术（LA）与传统开腹阑尾切除术（OA）在治疗老年（60岁）急性阑尾炎患者的临床疗效。方法回顾性分析2008年6月至2009年12月期间我院收治的67例老年急性阑尾炎患者的临床资料，根据接受的不同手术方式分为LA组（n=28）和OA组（n=39），对2组患者术中及术后相关指标进行比较。结果 LA组患者均顺利完成手术，无中转开腹; 术后无切口感染; 1例出现腹腔残余感染，经抗感染治疗后痊愈。OA组患者术后6例发生切口感染，经换药后痊愈; 5例发生腹腔残余感染，经抗感染治疗后痊愈。2组患者均无出血、阑尾残端漏、残株炎、粘连性肠梗阻等并发症发生。LA组患者手术时间与OA组比较差异无统计学意义（Pgt;0.05）。尽管LA组患者综合费用明显多于OA组（Plt;0.05），但术中出血量、术后下床时间、肛门排气时间、止痛剂使用率、切口感染率、腹腔残余感染率以及住院时间均小（少）于OA组（Plt;0.05）。 结论对老年急性阑尾炎患者的治疗，LA明显优于OA，且可作为老年急性阑尾炎患者治疗的首选术式。
ObjectiveTo assess the outcomes of laparoscopy-assisted surgery for treatment of advanced gastric cancer.MethodsA total of 115 patients with advanced gastric cancer were included between January 2014 and December 2018 were analyzed retroprospectively, the patients were divided into two groups: open surgery group (OS group, n=63) and laparoscopy-assisted surgery group (LAS group, n=52). Baseline characteristics, intraoperative parameters and postoperative items, and long-term efficacy were compared between the two groups.ResultsThere was no significant difference in preoperative baseline data including gender, age and preoperative serum parameters between the two groups (P>0.05). Intraoperative blood loss in the LAS group was significantly less than that in the OS group (P<0.05). In addition, the first feeding time after operation and postoperative hospital stay in the LAS group were significantly shorter than the OS group (P<0.05). Furthermore, numbers of white blood cells and neutrophils in the LAS group were fewer than that in the OS group at postoperative 2 days (P<0.05); the level of serum albumin in the LAS group was higher than that OS group (P<0.05). The number of lymph nodes detected during operation in the LAS group was more than that in the OS group (P<0.05). Operative time and occurrence of postoperative complications were not statistically significant between the two groups (P>0.05). One hundred and ten of 115 patients were followed- up, the follow-up rate was 95.7%. The follow-up time ranged from 6 to 48 months, with a median follow-up time of 12.4 months. The disease-free survival time of the OS group was 12.2±6.5 months, while that of the LAS group was 13.5±7.4 months. There was no significant difference between the two groups (P>0.05).ConclusionsLaparoscopic technique in treatment of advanced gastric cancer has the minimally invasive advantage, less intraoperative blood loss, less surgical trauma, and faster postoperative recovery in comparing to the traditional open surgery. Also the lymph node dissection is superior to open surgery. The curative effect is comparable to that of open surgery.
目的 探讨超声刀（ultrasonic harmonic scalpel，UHS）在消化道恶性肿瘤开腹手术中的应用价值。方法 回顾性分析2009年10月至2011年10月期间广西壮族自治区人民医院普通外科-小儿外科收治并由同一手术者进行消化道恶性肿瘤开腹手术的186例患者的临床资料，根据接受手术的种类（UHS开腹手术或传统电刀开腹手术）将其分为UHS组（86例）和传统电刀组（100例），比较2组患者的手术切口长度、手术时间、术中出血量、术后3d引流量、术后住院时间以及住院总费用。结果 UHS组手术切口长度、手术时间、术中出血量以及术后住院时间均短于（少于）传统电刀组（P＜0.05）；术后3d引流量和住院总费用2组间比较差异均无统计学意义（P＞0.05）。结论 将UHS应用于消化道恶性肿瘤开腹手术可获得较好的效果，能提高手术操作的效率，具有很好的应用前景。
目的 探讨腹腔镜胆囊切除术(LC)术中中转开腹的原因，评估LC术前难易的程度及如何减少LC手术并发症。 方法 回顾性分析广州市解放军第421医院1998年10月至2008年6月期间实施1 200例LC中38例中转开腹患者的临床资料。结果 LC术中中转开腹发生率为3.16%，其原因包括胆囊周围严重粘连，近期急性发作，Calot三角严重充血水肿，解剖不清，术中无法控制出血，胆总管损伤。 结论 胆囊周围粘连严重，近期急性发作，应慎重选择LC。掌握好中转开腹的时机及处理方法，是降低LC手术并发症的有效措施。