Laparoscopy has become a commonly used approach to diagnosis and treatment of acute abdomen, and it has good diagnostic value and therapeutic effect in selective cases. It should be practiced by experienced surgeons in laparoscopic surgery and emergency abdominal surgery. Hemodynamic instability, severe abdominal distension, fecal peritonitis, and tumor perforation are contraindications to laparoscopy. In recent years, more and more acute abdominal diseases can be successfully treated by laparoscopy. Randomized controlled trials have proved the laparoscopic treatment in acute appendicitis, acute cholecystitis, peptic ulcer perforation, acute gynecological diseases was comparable to open surgery, and had advantages of fewer complications and faster postoperative recovery. The utilization of laparoscopy in other diseases such as blunt and penetrating abdominal trauma, small intestinal obstruction, and diverticulitis with perforation remains controversial, and needs more randomized controlled trials to investigate the feasibility of laparoscopic surgery.
ObjectiveCD44 and CD54 are two specific biomarkers of gastric cancer stem cells and were used as targets in this study. The number of CD45–CD44+CD54+ cell subsets in peripheral blood of gastric cancer patients was detected by flow cytometry. Further, we combined these results with the clinicopathological characteristics of gastric cancer patients to analyze the significance of CD45–CD44+CD54+ cell subsets.MethodsFrom December 2016 to September 2017, 38 patients with gastric cancer in gastrointestinal surgery of West China Hospital of Sichuan University were included as the study object. The content of CD45–CD44+CD54+ cell subsets in their peripheral blood was detected by flow cytometry and its clinical significance was analyzed.ResultsThe median number of CD45–CD44+CD54+ cells were 541.9/mL (71.7–8 057.0/mL) in 38 patients and 555.9/mL (71.7–8 057.0/mL) in the group of patients with R0 resection. Patients without lymph node metastasis were found to have more CD45–CD44+CD54+ cells than patients with lymph node metastasis [941.4/mL (183.5–8 057.0)/mL vs 379.3/mL (71.7–2 269.7/mL, P=0.002], and more CD45–CD44+CD54+ cells in patients with TNM stage Ⅰ–Ⅱ than in TNM stage Ⅲ–Ⅳ [858.6/mL (183.5–8 057.0/mL) vs 364.6/mL (71.7–2 269.7/mL, P=0.015]. The patients with T3–4 stages (P= 0.025), N+ stage (P=0.009) and TNM Ⅲ–Ⅳ stage (P=0.012) had low ratios of the subgroup with high number of CD45–CD44+CD54+ cells, respectively. We made a more accurate judgment of N stage and TNM stage when we combined tumor size and the number of CD45–CD44+CD54+ cells together. However, there was no significant correlation between the number of CD45–CD44+CD54+ cells and other clinicopathological features and prognosis.ConclusionsThe number of CD45–CD44+CD54+ cell subsets is correlated with tumor progression, which might be used to predict TNM stage and N stage. However, the number of patients included in this study is too small, and the clinical significance of CD45–CD44+CD54+ subsets in gastric cancer patients needs to be further demonstrated by expanding the sample size.
ObjectiveTo evaluate the safety, feasibility, and efficacy of single-incision plus one-port laparoscopic sleeve gastrectomy (SILS+1) for patients with obesity. MethodsA retrospective analysis was conducted on obese patients undergoing laparoscopic sleeve gastrectomy (LSG) from January 2023 to November 2024. Patients were stratified into two groups: SILS+1 and conventional multi-port LSG (MPLSG). Comparative parameters included operative time, postoperative hospital stay, complication rates, weight loss outcomes, and improvement in metabolic indicators [including hemoglobin A1c (HbA1c), triglyceride (TG), total cholesterol (TC), and high-density lipoprotein cholesterol (HDL-C)]. ResultsA total of 95 patients with obesity were enrolled, including 40 in the SILS+1 group and 55 in the MPLSG group. The SILS+1 group had significantly lower preoperative BMI, HbA1c, and TC levels compared to the MPLSG group (P<0.05), and a significantly higher proportion of female patients (P<0.05). Other baseline characteristics, such as age, TG, and HDL-C levels, showed no statistically significant differences (P>0.05). Operative time was significantly longer in the SILS+1 group than in the MPLSG group [(100.16 ± 17.53) min vs. (93.82 ± 20.83) min, P<0.001]. The proportion of patients requiring drainage tube placement was significantly lower in the SILS+1 group [55.0% (22/40) vs. 76.4% (42/55), P=0.049]. There were no statistically significant differences between the two groups in the need for additional trocar sites, change in Hb level from preoperative to postoperative day 1, postoperative hospital stay, or incidence of postoperative complications (Clavien-Dindo grade I) (P>0.05). No 30-day readmissions occurred in either group. One patient in the SILS+1 group required an additional trocar site. Gastrointestinal patency was normal in all patients, with no signs of contrast agent leakage or stricture observed. Both SILS+1 and MPLSG procedures demonstrated equivalent efficacy in weight loss outcomes (P>0.05) and in their effects on HbA1c, TG, and TC levels (P>0.05). The SILS+1 procedure showed a significant advantage in improving HDL-C levels (F=6.221, P=0.015), with significantly higher postoperative HDL-C levels observed at 6 months postoperatively compared to the MPLSG group (F=2.500, P=0.027). ConclusionsFor selected obese populations, SILS+1 represents a feasible and safe alternative to MPLSG. This technique demonstrates equivalent efficacy to MPLSG in early-stage weight loss and metabolic improvement, serving as a transitional approach toward pure single-incision laparoscopic sleeve gastrectomy.