Objective To compare the effect of laparoscopic surgery and open surgery on the blood coagulation state in patients with gastric cancer, and to provide evidence for the prevention measurement of thrombosis in perioperative period. Methods One hundred patients with gastric cancer who received treatment in our hospital from Feb. 2014 to Aug. 2014, were randomly divided into laparoscopy group and laparotomy group, 50 patients in each group. The patients in laparotomy group were treated by traditionally open surgery, while patients in the laparoscopy group accepted laparoscopic surgery. The clinically therapeutic effect of 2 groups was compared. Results ① Operative indexes. The operation time, blood loss, anal exhaust time, hospital stay, and morbidity of laparoscopy group were all lower than those of laparotomy group (P<0.05). ② Coagulation function. Compared with preoperative indexes, the prothrombin time (PT) at 24 h after operation in laparoscopy group and laparotomy group were both shorter (P<0.05), but there was no significant difference in activated partial thromboplastin time (APTT) and international normalized ratio (INR) between the 2 time points (before operation and 24 h after operation) in both 2 groups (P>0.05). Both at 2 time points (before operation and 24 h after operation), there was no significant difference in PT, APTT, and INR between 2 groups (P>0.05). ③ Fibrinolysis indexes. Compared with preoperative indexes, the fibrinogen (FIB) and D-dimer at 24 h after operation in laparoscopy group and laparotomy group were higher (P<0.05). The FIB and D-dimer at 24 h after operation in laparoscopy group were both higher than those of laparotomy group (P<0.05). ④ Follow-up results. There was no significant difference in metastasis rate, recurrence rate, and mortality between the 2 groups (P>0.05), but the incidence of thrombus was higher in laparoscopy group than that of laparotomy group (P<0.05). Conclusions In the treatment of patients with gastric cancer, laparoscopic surgery has the advantages of less trauma, less blood loss, less complications, and so on. Laparoscopic surgery and open surgery both can lead to hypercoagulable state, but the effect of laparoscopic surgery is stronger than open surgery.
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.
摘要:目的:探讨后腹腔镜输尿管切开取石术治疗嵌顿性输尿管结石的临床价值和技术要点。 方法:2006年12月至 2009年3月,对58例嵌顿性输尿管中上段结石采用后腹腔镜输尿管切开取石术,术中取石后于镜下直接置入双J管,间段缝合输尿管切口。 结果:58例手术均获成功,无中转开放手术,结石清除率100%。术后创腔引流液量少,3～5d拔除引流管,1周出院,术后3周膀胱镜下拔除双J管。随访1～27个月,B超复查显示肾积水明显好转或消失,无结石复发。 结论:后腹腔镜输尿管切开取石术治疗嵌顿性输尿管结石具有创伤小\疗效好、术后恢复快等特点,明显优于开放手术及其它手术,值得推广应用。Abstract: Objective: To summarize our experience and evaluate the outcome of retroperitoneal laparoscopic ureterolithotomy of the upper ureter impacted stone. Methods: Between December 2006 and March 2009, 58 patients underwent retroperitoneal laparoscopic ureterolithotomy of the upper ureter. After removal of the stones, the double J was put in and interrupted suture was performed for upper ureter. Results: Retroperitoneoscopic ureterolithotomy was successful in all patients, there was neither ureteral stricture nor recurrent calculus, the blood loss ranged from 510 mL, without urine leakage occurred.The mean hospital stay was 7 days, after 3 weeks double J was removed by cystoscopy. With 127 months followup, the hydronephrosis relieved and no recurrence of ureter calculus founded. Conclusion:Retroperitoneoscopic ureterolithotomy is a safe and effective minimally invasive operation, and worth to generalization.
Objective To study the causes of abdominal distension in patients with hepatocellular carcinoma (HCC) after laparoscopic hepatectomy, and to explore the corresponding treatment countermeasures. Methods A total of 186 patients with HCC were treated by laparoscopic hepatectomy in our hospital from September 1, 2018 to August 31, 2020. Demographic characteristics [age, gender, body mass index (BMI), liver cirrhosis, child-Pugh classification of liver function], operative time, hilar occlusion time, intraoperative blood loss, scope of hepatectomy, postoperative visual analogue scale (VAS) score and serological indexes (hemoglobin, serum albumin, white blood cell count, platelet count, serum potassium level) were collected retrospectively. The occurrence of postoperative abdominal distension was observed, and the patients were divided into abdominal distension group and non abdominal distension group. The independent influencing factors of abdominal distension after laparoscopic hepatectomy were analyzed, and the corresponding treatment countermeasures were discussed. Results A total of 138 patients developed varying degrees of abdominal distension after operation (74.19%), including 45 cases of mild abdominal distension, 53 cases of moderate abdominal distension, and 40 cases of severe abdominal distension. They were all included in the abdominal distension group, and the occurrence time of abdominal distension was mainly 1-5 days after operation. Forty-eight patients (25.81%) had no abdominal distension after operation and were included in the non-abdominal distension group. Univariate analysis results show that: the proportion of patients with abdominal distension combined with liver cirrhosis was significantly higher than that of the non-abdominal distension group (47.10% vs. 25.00%, P=0.007), the operative time [(143.54±23.48) min vs. (129.45±24.51) min, P=0.001], hilar occlusion time [(18.02±8.12) min vs. (15.38±7.28) min, P=0.048] were significantly longer than those of the non-abdominal distension group, the postoperative VAS score was significantly higher than that of the non-abdominal distension group [5.12±1.14 vs. 4.47±1.05, P=0.004], and the serum potassium level was significantly lower than that of the non-abdominal distension group [(3.12±0.38) mmol/L vs. (3.67±0.42) mmol/L, P＜0.001]. Multivariate unconditional logistic regression analysis showed that patients with liver cirrhosis [OR=1.520, 95%CI (1.104, 2.093), P=0.010], serum potassium level ＜3.40 mmol/L [OR=1.684, 95%CI (1.203, 2.357) , P=0.002], operative time ＞136 min [OR=1.842, 95%CI (1.297, 2.616) , P=0.001], hilar occlusion time ＞16.7 min [OR=1.492, 95%CI (1.047, 2.126) , P=0.027], VAS score ＞5 [OR=1.498, 95%CI (1.021, 2.198), P=0.039] were independent risk factors of abdominal distension after laparoscopic hepatectomy. Conclusions The risk factors of abdominal distension after laparoscopic hepatectomy were liver cirrhosis, serum potassium level ＜3.40 mmol/L, operative time ＞136 min, hilar occlusion time ＞16.7 min and VAS score ＞5. More attention should be paid to high-risk patients and effective treatment measures should be taken in time to reduce the risk of abdominal distension after surgery. For patients with abdominal distension, we should take effective measures to alleviate the symptoms of abdominal distension and promote the recovery of patients with abdominal distension.
ObjectiveTo analyze short-term outcomes of hand assisted laparoscopic (HAL) D2 radical distal gastrectomy for gastric cancer and summarize clinical experiences. MethodsThe clinical data of 199 patients with gastric cancer undergoing D2 radical distal gastrectomy from December 2010 to December 2013 in this hospital were analyzed. HAL (HAL group, n=92) and traditonal open (TO group, n=107) D2 radical distal gastrectomy were performed. The operation time, incision length, intraoperative blood loss, number of lymph nodes harvested, postoperative hospital stay, and postoperative complications were compared between these two groups. ResultsThere was no residue of cancer cells at the surgical margin in the HAL group and the TO group. Compared with the TO group, the average incision length was obviously shorter (P < 0.01) and the average intraoperative blood loss was obviously less (P < 0.05) in the HAL group. The average operation time, the average number of lymph nodes harvested, and the average postoperative hospital stay had no significant differences between the HAL group and the TO group (P > 0.05). One case was died of unknown gastrointestinal bleeding in the HAL group and the TO group, respectively. The postoperative complication rate was 9.78% (9/92) in the HAL group and 11.21% (12/107) in the TO group, there was no significant difference (P > 0.05). ConclusionsHAL D2 radical distal gastrectomy for gastric cancer don't increase operation time. It has some advantages of minimal invasion and safety as compared with traditional open surgery.
ObjectiveTo summarize the changes of inguinal hernia in The First Affiliated Hospital of Anhui Medical University in the past 7 years and the curative effect of each procedure.MethodsRetrospectively searched the clinical data of 1 078 patients with inguinal hernia operated in The First Affiliated Hospital of Anhui Medical University from January 2011 to December 2017. According to the surgical procedure, patients were divided into tissue repair group, laparoscopic hernia repair group (laparoscopic group), and open tension-free hernia repair group (open group). Subsequently, the patients of the open group were divided into the mesh plug technique group, the plain patch technique group, and the Ultrapro Hernia System (UHS) group. The postoperative of each procedure, such as recurrence, chronic pain, foreign body sensation, hard touch of the surgical site, male sexual function, and fertility status were compared.ResultsIn 1 078 patients, 52 patients underwent tissue repair, 889 patients underwent open tension-free hernia repair (687 patients were counted with mesh-seal tablets, 100 patients with plain patch count, 102 patients with preperitoneal hernia repair), and 137 patients underwent laparoscopic hernia repair. There was no significant difference in the incidence of total complication, chronic pain, foreign body sensation, and male sexual function decline in the laparoscopic group and the open group (P>0.05). However, the recurrence rate and hard touch of the surgical site rate of the laparoscopic group were lower (P<0.05), and the Numeric Rating Scale (NRS) score was also slightly lower (P=0.047). There was no significant difference in the incidence of the recurrence, chronic pain, foreign body sensation, and male sexual function decline between the three subgroups of the open group, but the total complication rate and hard touch of the surgical site rate in the UHS group were lower than those in the mesh plug group and the plain patch group (P<0.05).ConclusionsLaparoscopic repair of the inguinal herniorrhaphy has lower incidence of occurrence, it is worthy of clinical promotion. In the open tension-free surgery, the retroperitoneal herniorrhaphy may be a better choice.
ObjectiveTo evaluate the safety and efficacy of unconventional abdominal drainage after laparoscopic hepatectomy.MethodsThe clinicopathologic data of patients who underwent laparoscopic hepatectomy for liver tumors in the Mianyang Central Hospital from June to December 2019 and met the inclusion criteria were retrospectively collected. Based on whether drainage tube was placed in the abdominal cavity during operation, the patients were divided into non-catheterized group (without drainage tube) and catheterized group (with drainage tube). The intraoperative data and postoperative complications (e.g. intraabdominal hemorrhage, bile leakage, abdominal infection, and liver failure) were compared between the two groups. Then, the intraoperative data and postoperative conditions of liver cancer and non-liver cancer patients with or without abdominal drainage tube were compared and analyzed.ResultsA total of 117 eligible patients were included in the study. The non-catheterized group had 59 patients and the catheterized group had 58 patients. The patients with liver cancer had 84 patients (44 non-catheterized patients and 40 catheterized patients) and the patients without liver cancer had 33 patients (15 non-catheterized patients and 18 catheterized patients). ① On the whole, the groups were comparable in the baseline data between the non-catheterized group and the catheterized group, such as gender, age, HBV infection, body mass index, hepatic function index, liver stiffness value, disease category, etc. (P>0.05). Compared with the catheterized group, the non-catheterized group had earlier off-bed activities and earlier flatus time (P<0.001), and shorter postoperative hospital stay (P=0.030). However, no statistically significant differences were found in other indicators between the two groups (P>0.05). ② Whether the patients had liver cancer or not, the non-catheterized patients still had earlier off-bed activities and earlier flatus time as compared with the catheterized patients (P<0.001). Among the patients with liver cancer, no difference was found in postoperative hospital stay. However, among the patients without liver cancer, the non-catheterized patients had shorter postoperative hospital stay than the catheterized patients (P=0.042). No statistically significant differences were found in other indicators between the catheterized patients and non-catheterized patients (P>0.05).ConclusionFor technologically skilled laparoscopic hepatectomy center, selectively not placing peritoneal drainage tube after surgery might better promote the health of patients.
Laparoscopic hepatectomy is routinely used in the surgical treatment of hepatocellular carcinoma, and has formed a standardized operating procedure. Tumors located in the segments Ⅶ and Ⅷ of liver as well as the paracaval subsegment of caudate lobe are considered to be difficult sites for laparoscopic hepatectomy due to the deep anatomical location, proximity to important vascular structures, difficulty in exposing the visual field under laparoscopy, and limited operating space. Based on the experience of our team and related research reports, the authors analyzed and summarized countermeasures for the difficulties of laparoscopic hepatectomy in the treatment of hepatocellular carcinoma in difficult sites. Adhering to the tumor-centered and margin-based principles, accurate preoperative assessment, selection of the correct surgical approach, designing liver resection plane guided by hepatic vena while taking into account portal vein territory, and giving preference to ananatomical hepatectomy while preserving functional liver parenchyma as much as possible are the prerequisites for ensuring minimally invasive and oncology benefits for patients with hepatocellular carcinoma in difficult sites.
ObjectiveTo evaluate the safety and short-term outcome of laparoscopic total mesorectal excision (TME) for the middle-lower rectal cancer in municipal hospital.MethodsThe pathological data of 94 patients with middle-lower rectal cancer (49 cases underwent laparoscopic TME, while 45 cases received open TME), who treated in The First People’s Hospital of Ziyang from Jan. 2015 to Jun. 2017, were retrospectively collected and analyzed.ResultsTwo patients (4.1%) in laparoscopy group were converted to open surgery. Compared with the laparotomy group, the laparoscopic group had significantly less volume of intraoperative bleeding, shorter abdominal incision, earlier time to the first flatus and liquid diet, and lower rate of 30-day postoperative complication (P<0.05), but had longer operative time (P=0.033). While there were no significant difference on postoperative stay, the specimen length, distal margin, and number of harvested lymph nodes between the 2 groups (P>0.05).ConclusionLaparoscopic TME is a feasible, safe, and minimally invasive technique for middle-lower rectal cancer, and produce more favourable short-term outcome than open surgery in municipal hospital.
The caudate lobe of the liver has always been regarded as the deepest segment, with most complicated anatomy. The surgeon’s understanding of the caudate lobe and its subsegments has undergone a complex and tortuous process. In recent years, the special view and fine anatomy of the caudate lobe in laparoscopic resection of caudate lobe of liver have been proved or challenged based on the traditional anatomical knowledge of the liver gross specimen, cast specimen and three-dimensional reconstruction. It is these validations and challenges that keep surgeons revising and restoring the caudate anatomy to its true form. This article will discuss these new ideas and describe the laparoscopic total caudate lobectomy in detail from the point of view of a laparoscopic surgeon.