Objective To compare the difference of traumatic related index in serum and its significance between minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) and open TLIF. Methods Sixty patients were enrolled by the entry criteria between May and November 2012, and were divided into MIS-TLIF group (n=30) and open TLIF group (n=30). There was no significant difference in gender, age, type of lesions, disease segment, and disease duration between 2 groups (P gt; 0.05). The operation time, intraoperative blood loss, and postoperative hospitalization time were recorded, and the pain severity of incision was evaluated by visual analog scale (VAS). The serum levels of C-reactive protein (CRP) and creatine kinase (CK) were measured at preoperation and at 24 hours postoperatively. The levels of interleukin 6 (IL-6), IL-10, and tumor necrosis factor α (TNF-α) in serum were measured at preoperation and at 2, 4, 8, and 24 hours after operation. Results The operation time, intraoperative blood loss, and postoperative hospitalization time of MIS-TLIF group were significantly smaller than those of open TLIF group (P lt; 0.05), and the VAS score for incision pain in MIS-TLIF group was significantly lower than that of open TLIF group at 1, 2, and 3 days after operation (P lt; 0.05). The levels of CRP, CK, IL-6, and IL-10 in MIS-TLIF group were significantly lower than those in open TLIF group at 24 hours after operation (P lt; 0.05), but there was no significant difference between 2 groups before operation (P gt; 0.05). No significant difference was found in TNF-α level between 2 groups at pre- and post-operation (P gt; 0.05). Conclusion Compared with the open-TLIF, MIS-TLIF may significantly reduce tissue injury and systemic inflammatory reactions during the early postoperative period.
ObjectiveTo compare effectiveness and safety of video-assisted thoracic surgery (VATS) and thoracotomy in lymph node (LN) dissection for lung cancer. MethodsA comprehensive search of PubMed, Ovid Medline, EMbase, Web of Science, ScienceDirect, the Cochrane Library, Scopus and Google Scholar was performed to identify studies (from January 1990 to July 2015) comparing VATS with thoracotomy in LN dissection. The data were analyzed by RevMan 5.3 software. Quality of literature was evaluated by Newcastle-Ottawa scale or Jadad scale. ResultsFifty-one articles met the inclusion criteria involved 7 127 patients in the VATS group and 9 217 patients in the thoracotomy group. Thirty-eight articles were of good quality and the remaining thirteen were medium. Meta-analysis showed that fewer N1 LN stations in the VATS group (95% CI -0.23 to -0.04, P=0.005), although VATS harvested more left-side LNs (95% CI 0.51 to 3.22, P=0.007). The number of total LNs (95% CI -1.81 to 0.28, P=0.15), total LN stations (95% CI -0.34 to 0.15, P=0.44), N2 LNs (95%CI -1.77 to 0.79, P=0.45), N2 LN stations (95% CI -0.22 to 0.16, P=0.78), N1 LNs (95% CI -0.95 to 0.11, P=0.12), and right-side LNs (95% CI -1.52 to 2.23, P=0.71) harvested in the two groups were not significantly different. ConclusionIn the surgical treatment of lung cancer, VATS can achieve the same efficacy of LN dissection as thoracotomy. This conclusion still needs to be further proved by more high-quality and large-scale RCTs.
ObjectiveTo systematically evaluate the stress response of laparoscopic surgery (LS) and conventional open surgery (OS) in patients with colorectal cancer. MethodsThe literatures about the immune stress response of LS and OS for colorectal cancer were collected from PubMed, Springer, OVID, Cochrane library, CNKI, VIP Database, and Wanfang Database from May 2001 to September 2014. RevMan 5.3 software was used for data analysis. ResultsFifteen randomized controlled trials including 881 patients were brought into this Meta analysis, of 881 patients, 424 patients were treated with LS and 457 patients were treated with OS. The results of Meta-analysis showed that:①At 24, 72, and 120 hours after surgery, the levels of interleukin (IL-6) in LS group were all lower than those of OS group at same time point[24 h (WMD=-27.78, 95% CI:-43.24--12.32, P < 0.01), 72 h (WMD=-13.23, 95% CI:-19.89--6.57, P < 0.01), 120 h (WMD=-16.51, 95% CI:-30.13--2.89, P=0.02)]. ②At 24, 72, and 120 hours after surgery, the levels of C reactive protein (CRP) in LS group were all lower than those of OS group at same time point[24 h (WMD=-31.11, 95% CI:-47.49--14.73, P < 0.01), 72 h (WMD=-29.81, 95% CI:-49.99--9.64, P < 0.01), 120 h (WMD=-32.03, 95% CI:-45.34--18.71, P < 0.01)]. ③There was no significant difference between the 2 groups in WBC level at 24 hours after surgery (WMD=-0.63, 95% CI:-1.80-0.54, P=0.29), but the WBC levels of LS group at 72 hours and 120 hours after surgery were lower than those of OS group[72 h (WMD=-0.21, 95% CI:-0.41--0.01, P=0.04), 120 h (WMD=-0.86, 95% CI:-1.66--0.06, P=0.03). ④There was no significant difference between the 2 groups in cortisol level at 24 hours and 72 hours after surgery[24 h (WMD=-60.19, 95% CI:-194.77-74.39, P=0.38), 72 h (WMD=-13.83, 95% CI:-43.94-16.28, P=0.37). ⑤There was no significant difference between the 2 groups in blood glucose level at 24 hours and 72 hours after surgery[24 h (WMD=-0.95, 95% CI:-2.74-0.84, P=0.30), 72 h (WMD=-0.69, 95% CI:-2.05-0.66, P=0.32)]. ⑥There was no significant difference between the 2 groups in insulin level (WMD=-0.52, 95% CI:-1.87-0.82, P=0.45) at 24 hours after surgery. ⑦There was no significant difference between the 2 groups in tumor necrosis factor (TNF) level at 24 hours after surgery (WMD=-4.18, 95% CI:-9.39-1.04, P=0.12). ConclusionCompared with open radical surgery, laparoscopic radical surgery for colorectal cancer causes less stress and less effect on the immune function, it also can reduce postoperative complications and can be propitious to faster body recovery.
ObjectiveTo systematically review the effectiveness and safety of laparoscopic total mesorectal excision(LTME) vs. open total mesorectal excision (OTME) in treating rectal cancer. MethodsRandomized controlled trials (RCTs) about LTME vs. OTME for rectal cancer were searched in PubMed, The Cochrane Library (Issue 4, 2014), EMbase, CNKI, CBM and WanFang Data from the date of their establishment to April 2014. Other relevant journals and references of included studies were also searched manually. Two reviewers independently screened literature according to the inclusion and exclusion criteria, extracted data and assessed methodological quality of included studies. Meta-analysis was then conducted using RevMan 5.2. ResultsA total of fifteen RCTs involving 2 268 patients were enrolled. The results of meta-analysis indicated that:a) for effectiveness, LTME and OTME were alike in resection length of the intestine (MD=-0.52, 95%CI-1.29 to 0.25, P=0.18), dissection number of lymph nodes (MD=-0.11, 95%CI-0.75 to 0.52, P=0.73), 1-year survival rate (RR=0.99, 95%CI 0.96 to 1.02, P=0.52), and 3-year survival rate (RR=0.99, 95%CI 0.93 to 1.04, P=0.63) with no significant difference. For safety, LTME had longer operation time (MD=29.64, 95%CI 14.90 to 44.39, P < 0.000 1); caused less intra-operative bleeding (MD=-105.51, 95%CI-133.95 to-77.08, P < 0.000 01); and shortened post-operative anal exsufflation time (MD=-0.99, 95%CI-1.35 to-0.62, P < 0.000 01), catheterization time (MD=-2.02, 95%CI-2.20 to-1.83, P < 0.000 01) as well as hospital stay (MD=-3.47, 95%CI-4.20 to-2.74, P < 0.000 01). Besides, LTME had less postoperative complications such as anastomotic leak (RR=0.67, 95%CI 0.37 to 1.22, P=0.19) and wound infection (RR=0.43, 95%CI 0.26 to 0.73, P=0.002). However, LTME and OTME were alike in the incidence of intestinal obstruction (RR=0.53, 95%CI 0.28 to 1.00, P=0.05). ConclusionCurrent evidence indicates that LTME and OTME are alike in effectiveness, but LTME could cause less bleeding, shorten time of catheterization, post-operative anal exsufflation and hospital stay with less post-operative complications. Due to the limited quantity and quality of the included studies, more larger sample, multicenter, high quality RCTs are needed to verify the above conclusion.
ObjectiveTo compare the postoperative complications following laparoscopic and open radical resection for rectal cancer. MethodsThe clinical data of 681 patients with rectal cancer from January 2011 to December 2014 in the Sixth Affiliated Hospital of Sun Yat-sen University were analyzed retrospectively, of whom 583 patients underwent laparoscopic surgery (laparoscopic group) and 98 patients underwent open surgery (open group). The complications were compared between the two groups. Results①There were no statistically significant differences in the gender, age, total protein, albumin, and body mass index between the two groups (P > 0.05). As compared with the open group, the proportions of previous abdominal operation, Dixon operation, and TNM stageⅡandⅢwere lower (P < 0.05), while the use of neoadjuvant chemotherapy was more common (P < 0.05), the distance of the tumor lower margin from the anal verge was shorter (P < 0.05) in the laparoscopic group.②No differences were seen in terms of anastomotic leakage, pulmonary infection, urinary retention, intestinal obstruction, wound infection, abdominal sepsis, urinary tract infection, stoma complications, poor incision healing, bleeding, intestinal hemorrhage, and deep vein thrombosis between the two groups (P > 0.05). ConclusionsThe development of postoperative complications in the laparoscopic group is similar to the open group, which are both available approach to the treatment of rectal cancer. But more randomized clinical trials are warranted to confirm which one is better.
Objective To review the progress in the treatment of acute Achilles tendon rupture. Methods Recent literature about the treatment of acute Achilles tendon rupture was reviewed and analyzed. Results Treatments of acute Achilles tendon rupture include operative and non-operative treatments. Operative treatments include open surgery and percutaneous minimally invasive surgery. Compared with non-operative treatment, operative treatment can effectively reduce the re-rupture incidence, but it had higher complication incidences of wound infection and nerve injury. Although early functional rehabilitation during non-operative treatment could reduce the re-rupture incidence, there is no consistent orthopaedic device and guideline for functional rehabilitation. Conclusion Both operative and non-operative treatments have advantages and disadvantages for the treatment of acute Achilles tendon rupture. No consistent conclusion is arrived regarding functional recovery. Future studies should explore the strategy of early functional rehabilitation during non-operative treatment and its mechanism of promoting tendon healing.
Objective To compare the short and mid-term outcomes of open surgery and hybrid technique for the treatment of complex type B aortic dissection (AD). Methods A total of 45 patients (37 acute AD and 8 chronic AD) with complex type B AD were admitted to Nanjing First Hospital from January 2012 to June 2016, including 37 males and 8 females. All patients were confirmed by computed tomography angiography (CTA), and ultrasonic cardiogram (UCG) to rule out valvular diseases, aortic root and ascending aorta lesion, and pericardial effusion. According to different treatments, patients were divided into two groups: the open surgery group (OS group) with a total of 25 patients (20 males, 5 females, a mean age of 50.16±10.87 years); the hybrid technique group (HT group) with a total 20 patients (18 males, 2 females, mean age of 51.31±8.11 years). The short and mid-term outcomes of open surgery and hybrid technique for the treatment of complex type B AD were compared. Results All the patients were discharged successfully. There was no death, cognitive impairment, cerebral infarction, hemiplegia, paraplegia, coma and other neurological complications in both groups. In the OS group, one patient suffered acute kidney injury and received renal replacement therapy (RRT), whose renal function was returned to normal prior to discharge; one patient was transferred to ICU again owing to pericardial effusion, respiratory failure and lung infection; one patient underwent debridement surgery because of postoprative sternal dehiscence. In the HT group, one patient with recurrent chest pain five days after endovascular aortic repair, whose CTA showed hematoma of aortic arch and ascending aorta caused by reverse tear, underwent Sun’s procedure immediately. All patients received CTA examination three months after operation in outpatient room. In the OS Group, the tear of AD was closed well by stent-graft and no leakage or shunt was detected in CTA. The rate of thrombosis formation in thoracic aortic false lumen was 100.0%. Meanwhile, in the HT Group, there was one patient with type Ⅱ leakage and the rate of thrombosis formation in thoracic aortic false lumen was 94.7%. Conclusion For complex type B AD without optimal "landing zone" in descending aorta, open surgery is recommended as the first choice for experienced team because of its less costs and perfect results; hybrid technique which can achieve quicker recovery with less surgical trauma still has serious complications such as leakage, reverse tear, and so on.
Objective To review the latest comparative research of minimally invasive transforaminal lumbar interbody fusion (TLIF) and traditional open approach. Methods The domestic and foreign literature concerning the comparative research of minimally invasive TLIF and traditional open TLIF was reviewed, then intraoperative indicators, length of hospitalization, effectiveness, complication, fusion rate, and the effect on paraspinal muscles were analyzed respectively. Results Minimally invasive TLIF has less blood loss and shorter length of hospitalization, but with longer operation and fluoroscopic time. Minimally invasive surgery has the same high fusion rate as open surgery, however, its effectiveness is not superior to open surgery, and complication rate is relatively higher. In the aspect of the effect on paraspinal muscles, in creatine kinase, multifidus cross-sectional area, and atrophy grading, minimally invasive surgery has no significant reduced damage on paraspinal muscles. Conclusion Minimally invasive TLIF is not significantly superior to open TLIF, and it does not reduce the paraspinal muscles injury. But prospective double-blind randomized control trials are still needed for further study.
Objective To compare the short-term effectiveness of minimally invasive surgery-transforaminal lumbar interbody fusion (MIS-TLIF) versus open-TLIF in treatment of single-level lumbar degenerative disease. Methods Between February 2010 and February 2011, 147 patients with single-level lumbar degenerative diseases underwent open-TLIF in 104 cases (open-TLIF group) and MIS-TLIF in 43 cases (MIS-TLIF group), and the clinical data were analyzed retrospectively. There was no significant difference in gender, age, disease type, lesion level, disease duration, preoperative visual analogue scale (VAS), and preoperative Oswestry disability index (ODI) between 2 groups (P gt; 0.05). The operation time, intraoperative radiological exposure time, intra- and post-operative blood loss, postoperative hospitalization time, and postoperative complications were compared between 2 groups. The VAS score and ODI were observed during follow-up. The imaging examination was done to observe the bone graft fusion and the locations of internal fixator and Cage. Results There was no significant difference in operation time between 2 groups (t=0.402, P=0.688); MIS-TLIF group had a decreased intra- and post-operative blood loss, shortened postoperative hospitalization time, and increased intraoperative radiological exposure time, showing significant differences when compared with open-TLIF group (P lt; 0.05). Cerebrospinal fluid leakage (2 cases) and superficial infection of incision (2 cases) occurred after operation in open-TLIF group, with a complication incidence of 3.8% (4/104); dorsal root ganglion stimulation symptom (3 cases) occurred in MIS-TLIF group, with a complication incidence of 7.0% (3/43); there was no significant difference in the complication incidence between 2 groups (χ2=0.657, P=0.417). The patients were followed up 18-26 months (mean, 21 months) in MIS-TLIF group, and 18-28 months (mean, 23 months) in open-TLIF group. The VAS scores and ODI of 2 groups at each time point after operation were significantly improved when compared with those before operation (P lt; 0.05). There was no significant difference in VAS score between 2 groups at discharge and 3 months after operation (P gt; 0.05); VAS score of MIS-TLIF group was significantly lower than that of open-TLIF group at last follow-up (t= — 2.022, P=0.047). At 3 months and last follow-up, no significant difference was found in the ODI between 2 groups (P gt; 0.05). The imaging examination showed good positions of Cage and internal fixator, and bone graft fusion in 2 groups. Conclusion The short-term effectiveness of MIS-TLIF and open-TLIF for single-level degenerative lumbar diseases was similar. MIS-TLIF has the advantages of less invasion and quick recovery, but the long-term effectiveness needs more observation.
ObjectiveTo investigate the advantage and short- and medium-term effectivenesses of paramedian incision minimally invasive transforaminal lumbar interbody fusion (mini-TLIF) by comparing with open TLIF. MethodsA retrospective analysis was made on the clinical data of 54 patients with single segmental lumbar degenerative disease who accorded with the inclusion criteria between January 2012 and March 2014. Open TLIF was performed in 26 patients (open group), mini-TLIF in 28 cases (minimally invasive group). There was no significant difference in gender, age, disease duration, etiology, and affected segments between 2 groups (P>0.05). The indexes of surgical trauma, systemic inflammatory response, clinical outcome, and interbody fusion rate were compared between 2 groups. ResultsDural rupture occurred in 1 case of open group, L5 nerve root injury in 1 case of minimally invasive group. All patients obtained primary healing of incision. The operation time, intraoperative blood loss, and postoperative drainage of minimally invasive group were significantly lower than those of open group (P<0.05). C-reactive protein, leucocyte count, and creatine kinase-MM (CK-MM) of open group were significantly higher than those of minimally invasive group at 24 hours after operation (P<0.05). At 7 days after operation, the CK-MM of minimally invasive group was significantly lower than that of open group (P<0.05), but no significant difference was found in C-reactive protein and leucocyte count between 2 groups (P>0.05). The follow-up time was 1.2-3.1 years in open group and 1.4-2.9 years in minimally invasive group. At 1 year after operation, the Oswestry disability index (ODI) and visual analogue scale (VAS) scores were significantly improved in 2 groups (P<0.05). Minimally invasive group was better than open group in ODI and VAS score of back pain (P<0.05), but VAS score of leg pain showed no significant difference (P>0.05). According to the Suk interbody fusion standard, solid fusion was obtained in 18 cases, probable fusion in 4 cases, and nonunion in 4 cases, and the fusion rate was 84.61% in open group; solid fusion was obtained in 21 cases, probable fusion in 3 cases, and nonunion in 4 cases, and the fusion rate was 85.71% in minimally invasive group; and the interbody fusion rates showed no significant difference between 2 groups (χ2=0.072, P=0.821). ConclusionCompared with open TLIF, paramedian incision mini-TLIF has advantages of minimal surgical trauma and little blood loss for single-level lumbar degenerative disease. The short- and medium-term effectivenesses are satisfactory.