ObjectiveTo evaluate the operative technique and clinical efficacy of laparoscopic splenectomy (LS) combined with esophagogastric devascularization in treatment of portal hypertension induced by liver cirrhosis. MethodsTwelve cases with esophageal and gastric varices induced by portal hypertension and liver cirrhosis were treated by the LS combined with esophagogastric devascularization in our department from March 2009 to August 2010, which clinical data were analyzed and summarized retrospectively. ResultsThe splenic artery was ligated before the treatment of splenic pedicle in 12 cases, LS combined with pericardial devascularization was successfully performed in 10 cases, 7 cases of which were treated by the level two transection method of splenic pedicle, and 2 cases were converted to open surgery due to intraoperative bleeding. In 10 cases, the operative time was 180-300 min (average 210 min), and intraoperative blood loss was 200-1 000 ml (average 480 ml). The postoperative hospital stay was 8-15 d (average 9 d)， the postoperative complications included plural effusion （lt;300 ml） in 2 cases， mild ascites （lt;300 ml） in 2 cases, and mild pancreatic leakage in 1 case， but all were cured eventually， and no mortality occurred. Followup was conducted in 12 patients for 4 to 20 months (average 7 months), and no rebleeding occurred. ConclusionsLS combined with pericardial devascularization is relatively safe and effective methods in treatment of portal hypertension induced by liver cirrhosis. The keys to success include ligation of splenic artery, and the use of harmonic scalpel combined with ligasure to treat splenic pedicle.
Objective To evaluate the clinical experience and skills of laparoscopic totally extraperitoneal hernia repair with non-stapling of mesh and without using a balloon dissection in order to spread and popularize this kind of operation. Methods Under general anesthesia, 32 patients (42 sides) with inguinal hernias were repaired by laparoscopic totally extraperitoneal hernia repair with non-stapling of mesh and without using a dissection balloon from August 2005 to December 2007. Results All of operations were successfully performed. The operative time was 60-120 minutes, the blood loss was 20-60 ml, and the length of postoperative hospitalization was 3 days. All cases were followed up for 8 to 18 months and found no recurrence. Conclusion Laparoscopic totally extraperitoneal hernia repair with non-stapling of mesh and without using a balloon dissection is feasible, reliable and effective, offering a low recurrence rate, while its price is higher than tension-free herniorrhaphy by traditional method.
ObjectiveTo investigate the safety and feasibility of the treatment of laparoscopic splenectomy for patients with traumatic splenic rupture. MethodsBetween October 2006 and October 2009, 48 cases of traumatic splenic rupture underwent laparoscopic splenectomy were analyzed in this hospital. According to the differrent styles of splenic stalk, different operative methods were taken， including titanic clipping in 12 cases， titanic clipping combining silk suture ligation in 8 cases， snare combining titanic clipping in 10 cases， LigaSure in 8 cases， and EndoGIA in 8 cases. ResultsLaparoscopic splenectomy was successfully completed in 32 cases; Handassisted laparoscopic splenectomy was applied in 14 cases, and 2 cases were converted to laparotomy because of tight spleen adhesion with surrounding tissues and bleeding rupture of the short gastric vessels. The operation time was 120－170 min with an average 140 min; the estimated intraoperative amount of blood loss was 300－1 200 ml with an average 800 ml. No postoperative complication occurred such as gastric fistula, pancreatic fistula or hemorrhage. Conclusion According to the differrent styles of splenic stalk, individual operative method can improve mission success rate in the laparoscopic splenectomy in traumatic splenic rupture.
ObjectiveTo investigate the importance of nursing observation and intervention for extrahepatic bile duct stones with gallbladder stones treated by electronic duodenoscopic sphincterotomy (EST) combined with laparoscopic cholecystectomy (LC). MethodsFrom July 2011 to February 2014, 157 patients with extrahepatic bile duct stones with gallbladder stones underwent EST and LC at the same time in our department. Combined with the surgery characteristics, we focused on the close observation and nursing of postoperative complications and drainage tubes for patients' timely recovery. ResultsOne patient with duodenal diverticulum papilla did not complete EST and LC surgery, which was then transformed to LC, bile duct incision and choledochoscopy with T tube drainage. All the remaining 156 patients completed endoscopic retrograde cholangio-pancreatography and LC with a completion rate of 99.36%. Under close observation and careful nursing care, this group of patients did not have duodenum perforation, bile leakage or other complications. No patient died. Seven to thirteen days after hospitalization, all the patients were cured and discharged from the hospital. ConclusionFor patients undergoing EST and LC at the same time, observation and timely intervention are very important in reducing serious complications, improving the quality of surgery, enhancing patients' comfort, and promoting postoperative recovery.
Objective To explore the diameter change of the extrahepatic bile duct before and after laparoscopic cholecystectomy (LC). Methods From Jan. 2006 to Dec. 2007， 113 patients including chronic gallstone cholecystitis （n=55）, inactive cholecystolithiasis （n=46） and gallbladder polyps （n=12） were collected and treated by LC. The diameters of their extrahepatic bile ducts were measured by B ultrasonography before operation， 3 months and 6 months after operation. These data were collected and analyzed retrospectively. Results The diameters of the extrahepatic bile ducts of all patients before LC， 3 months and 6 months after LC were (5±2) mm, (8±2) mm and (6±2) mm respectively. And in chronic gallstone cholecystitis patients they were (5±2) mm, (9±2) mm and (6±2) mm respectively， in inactive gallstone cholelithiasis patients they were (5±2) mm, (8±2) mm and (6±2) mm respectively， and in gallbladder polyps ones they were (5±2) mm, (7±2) mm and (5±2) mm respectively. Conclusion The change of the extrahepatic bile duct diameter after LC is a dynamic process. It is enlarged on the third month after operation than before operation. In the sixth month after operation marked retraction occurs, and compared with before operation, it shows no obvious statistic significance.
Objective To investigate the feasibility and safety of laparoscopic operation of gastric and gastroesophageal junction diseases. Methods Between May 2004 and June 2009, 59 patients with gastric and gastroesophageal diseases were treated laparoscopically. The operative methods and maneuvers were evaluated and perioperative interventions, complications and efficacy of patients were analyzed. Results All operations were successfully completed laparoscopically except for one patient with gastric cancer who required a conversion to open surgery. No short-term complications occurred in all cases. No port transplant metastasis occurred for the patients with gastric cancer after an average of 36 months (1-60 months) follow-up. One patient died of liver metastasis 12 months after operation. The 3-year survival rate was 93.3% (14/15). Conclusion Laparoscopic surgery of the gastric and gastroesophageal junction diseases is feasible and safe with minimal invasiveness, which is worth popularizing.
Day surgery has been developed in China for over 30 years. However, the admission decisions for day surgery patients are still mainly based on expert experience, brainstorming, and institutional recommendation, and lack scientific admission criteria and universality. West China Hospital of Sichuan University has implemented methods such as semi-supervised learning based on heterogeneous data, to construct a more objective and accurate patient admission model based on large amounts of diagnosis and treatment data. This initiative aims to assist the country and hospital in reducing medical costs and alleviating the acute problem of the current contradiction between supply and demand of medical resources. It also seeks to optimize the utilization and allocation of bed resources, reduce the cost of patient management, enhance the theoretical research on patient admission methods in day surgery in China, and provide reference and inspiration for other hospitals in the day surgery industry in China.
Objective?To approach feasibility, safety, and the application range of pure laparoscopic resection （PLR）, hand-assisted laparoscopic resection （HALR）, and robotic liver resection （RLR） in the minimally invasive liver resection （MILR）. Methods?The clinical data of 128 patients underwent MILR in the Surgical Department of the Shanghai Ruijin Hospital from September 2004 to January 2012 were analyzed retrospectively. According to the different methods, the patients were divided into PLR group, HALR group, and RLR group. The intraoperative findings and postoperative recovery of patients in three groups were compared.?Results?There were 82 cases in PLR group, 3 cases of which were transferred to open surgery；the mean operating time was （145.4±54.4） minutes （range：40-290 minutes）；the mean blood loss was （249.3±255.7） ml （range：30-1 500 ml）；abdominal infection was found in 3 cases and biliary fistula in 5 cases after operation, but all recovered after conservative treatment；the mean length of hospital stay was （7.1±3.8） days （range：2-34 days）. There were 35 cases in HALR group, 3 cases of which were transferred to open surgery；the mean operating time was （182.7±59.2） minutes （range：60-300 minutes）；the mean blood loss was （754.3±785.2） ml （range：50-3 000 ml）；abdominal infection was found in 1 case, biliary fistula in 2 cases, and operative incision infection in 2 cases after operation, but all recovered after conservative treatment；the mean length of hospital stay was （15.4±3.7） days （range：12-30 days）. There were 11 cases in RLR group, 2 cases of which were transferred to open surgery； the mean operating time was （129.5±33.5） minutes （range：120-200 minutes）； the mean blood loss was （424.5±657.5） ml （range：50-5 000 ml）； abdominal infection was found in 1 case and biliary fistula in 1 case after operation, but all recovered after conservative treatment； the mean length of hospital stay was （6.4±1.6） days （range：5-9 days）. The operating time （P=0.001） and length of hospital stay （P=0.000） of the RLR group were shortest and the blood loss （P=0.000） of the PLR group was least among three groups. Conclusions?Minimally invasive resection is a safe and feasible. Different surgical procedures should be chosen according to different cases. The robotic liver resection provides new development for treatment of liver tumor.
Objective To evaluate the clinical effectiveness of laparoscopic and open appendectomy. Methods Literatures relating to randomized controlled trials in English and Chinese on the comparison of clinical effectiveness after laparoscopic and open appendectomy in appendicitis from PubMed，Wiley Online Library，Medline，Embase，Cochrane，CNKI，VIP，CBM databases were extracted，and methodological quality was evaluated by two reviewers independently with designed extraction form. The Cochrane Collaboration’s RevMan 4.2.2 software was used for data analysis. The wound infection，hospitalization time，operation time，hospitalization expenses，and peritoneal abscess were compared between laparoscopic and open appendectomy. Results Eight published reports of eligible studies were extracted. Compared with the open appendectomy， laparoscopic appendectomy had significant differences in lower wound infection rate 〔OR=0.19，95%CI （0.09，0.38），P＜0.000 01〕， longer operation time 〔WMD=3.66，95%CI （0.50，6.82），P=0.02〕，and more hospitalization expenses〔WMD=503.96，95%CI （337.23，670.70），P＜0.000 01〕.But there were no significant differences in hospitalization time〔WMD=-0.11，95%CI （-3.64，3.43），P=0.95〕 and incidence rate of peritoneal abscess 〔OR=1.40，95%CI （0.23，8.64），P=0.71〕 between laparoscopic and open appendectomy. Conclusions The wound infection rate is lower，but the operation time is longer，the hospitalization expenses is more in laparoscopic appendectomy as compared with open appendectomy. There are no statistically significant differences of hospitalization time and incidence rate of abdominal abscess between laparoscopic and open appendectomy.
ObjectiveTo investigate the application of imbedding pancreaticojejunostomy in pure laparoscopic pancreaticoduodenectomy. MethodsEighty-five cases of laparoscopic pancreaticoduodenectomy in our hospital from May 2014 to December 2015 were analyzed retrospectively. According with inclusion criteria and exclusion criteria, 78 cases were investigated. They were divided into pancreatic duct-to-jejunum mucosa pancreaticojejunostomy group as controlled group (n=42) and imbedding pancreaticojejunostomy (technique of duct-to-mucosa PJ with transpancreatic interlocking mattress sutures) group as modified group (n=36). The rates of pancreatic fistula, abdominal infection/abscess, bile leakage, delayed gastric emptying, gastrointestinal/intraabdominal hemorrhage, pulmonary infection, and incision infection were investigated as well as hospital stays and pancreaticojejunostomy time in two groups were compared. ResultsThe rate of pancreatic fistula especially B to C grade pancreatic fistula in the modified group was obviously lower compared with which in the controlled group (8.3% vs. 31.0%, P < 0.05), pancreaticojejunostomy time ofmodified group was significantly shortened [(35.6±12.4) min vs. (52.8±24.6) min, P < 0.05] and total operative time also shortened [(322.4±23.6) min vs. (384.2±30.2) min, P < 0.05). There were no significant difference of the rates of abdominal infection/abscess, bile leakage, delayed gastric emptying, gastrointestinal/intraabdominal hemorrhage, pulmonary infection, ?incision infection, and hospital stays (P > 0.05)]. Conciusions The type of pancreaticojejunostomy has a significant impact on the rate of pancreatic fistula after laparoscopic pancreaticoduodenectomy. Imbedding pancreaticojejunostomy can decrease the rate of pancreatic fistula after operation, and shorten the pancreaticojejunostomy time and total operative time.