ObjectiveTo evaluate feasibility of laparoscopic radical resection and re-resection for suspicious and incidental gallbladder cancer.MethodsWe searched PubMed and other databases, reviewed relevant literatures and summarized from aspects like whether efficacy comparable to laparotomy and enough lymph node dissection could be achieved through laparoscopy, timing of reoperation for incidental gallbladder cancer.ResultsLaparoscopic radical resection and re-resection were theoretically and technically feasible, but its efficacy and timing of re-resection were controversial, and its long-term efficacy needed further discussions in multi-center and large-scale cohort studies.ConclusionsLaparoscopy shows prospects of resection and re-resection for suspicious and incidental gallbladder cancer. Tentative explorations could be done in properly selected patients by well-experience medical centers and to achieve efficacy comparable to laparotomy is the fundamental principle.
Objective To compare efficacy of laparoscopic surgery and open surgery in treatment of rectal cancer after neoadjuvant chemoradiotherapy. Methods The relevant literatures were retrieved from databases including CNKI, CBM, Wanfang, VIP, PubMed, Cochrane Library, and Embase from 2007 to 2017, all the relevant randomized controlled trial (RCT) or non-randomized controlled trial (NRCT) of laparoscopic surgery versus open surgery in patients with rectal cancer were collected according to the inclusion and exclusion criterial. Two reviewers independently screened the literatures, extracted the data, and assessed the bias risk of the included studies. Then, the meta-analysis was performed using RevMan 5.3 software. Results A total of 11 RCTs and 9 NRCTs involving 2 036 patients with rectal cancer were included, of these, including 1 021 cases of laparoscopic surgery and 1 015 cases of open surgery. The results of the meta-analysis showed that the operation time was increased ［WMD=14.21, 95% CI (1.92, 26.51)］, the intraoperative blood loss ［WMD=–38.96, 95% CI (–60.29, –7.63)］, first postoperative exhaust time ［WMD=–0.86, 95% CI (–1.14, –0.57)］, first postoperative intake food time ［WMD=–0.89, 95% CI (–1.15, –0.62)］, and postoperative hospitalization time ［WMD=–2.38, 95% CI (–3.44, –1.32)］ were reduced in the laparoscopic surgery as compared with the open surgery; the rate of the sphincter-saving was increased ［OR=2.35, 95% CI (1.67, 3.30)］, the rates of the local recurrence ［OR=0.25, 95% CI (0.13, 0.47)］, postoperative overall complications ［OR=0.34, 95% CI (0.26, 0.43)］, infection of incision ［OR=0.39, 95% CI (0.25, 0.62)］, intestinal obstruction ［OR=0.30, 95% CI (0.17, 0.53)］, lung infection ［OR=0.32, 95% CI (0.18, 0.57)］, and anastomotic fistula ［OR=0.40, 95% CI (0.22, 0.73)］ were decreased in the laparoscopic surgery as compared with the open surgery; the intraoperative lymph node resection ［WMD=–0.99, 95% CI (–2.11, 0.12)］, the rates of the 3-year disease-free survival ［OR=0.91, 95% CI (0.54, 1.54)］, pelvic infection ［OR=0.64, 95% CI (0.17, 2.45)］, anastomotic bleeding ［OR=0.54, 95% CI (0.22, 1.34)］, urinary retention ［OR=0.71, 95% CI (0.34, 1.48)］, and urinary tract infection ［OR=1.22, 95% CI (0.45, 3.30)］ had no significant differences between these two surgeries. Conclusion Laparoscopy surgery is still safer, more effective, and more reliable than conventional open surgery after neoadjuvant chemoradiotherapy in rectal cancer, but it needs more clinical RCTs to further provide accurate and reliable results.
ObjectiveTo explore the clinical value and experience of enhanced recovery after surgery (ERAS) of “LEER” model with “less pain” “early move” “early eat” and “reassuring” as its ultimate goal in perioperative period of laparoscopic anatomical hepatectomy of patients with primary liver cancer.MethodsThe basic clinical data of 98 patients treated in our department from May 2017 to March 2020 who were diagnosed as primary liver cancer and underwent laparoscopic anatomical hepatectomy were retrospectively analyzed. The incidence of postoperative complications, postoperative recovery and patients’ satisfaction were compared between 40 patients managed with traditional model (traditional group) and 58 patients managed with measures of ERAS of “LEER” model (“LEER”-ERAS group).ResultsCompared with the traditional group, the “LEER”-ERAS group had lower postoperative pain scores (t=2.925, P=0.004), earlier postoperative anal exhaustion, bowel movement and normal diet (t=3.071, t=3.770, t=3.232, all P<0.005) , shorter time to postoperative off-bed activity (t=5.025, P<0.001) and earlier postoperative removal time of drainage tube (t=3.232, P=0.001). Postoperative hospital stay was shorter (t=4.831, P<0.001), the cost of hospitalization was lower (t=3.062, P=0.003), and the patient’s satisfaction with medical treatment was higher (χ2=9.267, P=0.002). There were no statistical difference in the operative time, intraoperative blood loss, rate of conversion to laparotomy, blocking time of porta hepatis, postoperative complications and postoperative adverse events between the two groups (P>0.05).ConclusionsCompared with the traditional model, the measures of ERAS of “LEER” model that applied to laparoscopic anatomical hepatectomy of patients with primary liver cancer, is safe and effective, and can relieve postoperative pain, accelerate postoperative rehabilitation, improve satisfaction of patients, shorten hospital stay, and reduce medical costs. It has further promotion and research value.
ObjectiveTo evaluate the efficacy of myomectomy via transumbilical laparoendompic single-site surgery (TU-LESS) and traditional multiport laparoscopy.MethodsThe study was conducted at Chengdu Western Hospital from June 2019 to June 2020. Fifty patients underwent TU-LESS myomectomy (TU-LESS group), while another 50 patients underwent traditional multiport laparoscopic myomectmy (multiport laparoscopy group). The conditions of operation, extra analgetic usage, VAS grade, and patients’ satisfaction degree were compared between two groups.ResultsPatients in both groups had similar age, BMI, fibroma volume, operative time, expelling gas day, blood loss, complication rate, and hospitalized costs (P>0.05). Compared with traditional multiport laparoscopy, the TU-LESS group resulted in significantly shorter hospitalization day, lower VAS score of the 1st/3nd/7th days after surgery, less use of analgetic after surgery, and higher satisfaction degree.ConclusionsTU-LESS is safe and feasible for myomectomy, and it is associated with less pain, shorter hospitalization day, and higher satisfaction degree.
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.
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.
ObjectiveTo compare clinical efficacy of single-incision laparoscopic surgery (SILS) and conventional laparoscopic surgery (CLS) in treatment of colorectal cancer.MethodsThe Pubmed, Embase, Cochrane library, CBM, CNKI, VIP, and Wanfang Data were searched to collect the comparative study of the SILS and CLS in the treatment of colorectal cancer. The data were extracted and evaluated by the RevMan 5.3 software.ResultsEventually, 13 articles were included, including 3 randomized controlled trials and 10 case-control studies with a total of 1 466 patients. The meta-analysis results suggested that the SILS could shorten the postoperative hospital stay [MD=–0.63, 95% CI (–1.10, –0.16), P=0.009] and time to the first flatus [MD=–0.23, 95% CI (–0.33, –0.13), P<0.000 01] and the lymph node dissection was relatively completed [MD=0.77, 95% CI (0.05, 1.48), P=0.04] as compared with the CLS. In the total complications of surgery [OR=0.73, 95% CI (0.51, 1.03), P=0.08], operation time [MD=–0.33, 95% CI (–11.36, 10.69), P=0.95], intraoperative blood loss [MD=5.61, 95% CI (–4.20, 15.43), P=0.26], conversion to laparotomy [OR=1.06, 95% CI (0.18, 6.13), P=0.95], distance between tumor and proximal margin [MD=0.11, 95% CI (–0.48, 0.69), P=0.71], distance between tumor and distal margin [MD=0.32, 95% CI (–0.23, 0.87), P=0.25] had no statistically significant differences between the SILS and CLS.ConclusionsSILS is safe and effective for radical resection of colorectal cancer. However, results of study still need to be validated by a randomized controlled trial with a large sample designed strictly.
摘要:目的:探討后腹腔鏡輸尿管切開取石術治療嵌頓性輸尿管結石的臨床價值和技術要點。 方法:2006年12月至 2009年3月,對58例嵌頓性輸尿管中上段結石采用后腹腔鏡輸尿管切開取石術,術中取石后于鏡下直接置入雙J管,間段縫合輸尿管切口。 結果:58例手術均獲成功,無中轉開放手術,結石清除率100%。術后創腔引流液量少,3～5d拔除引流管,1周出院,術后3周膀胱鏡下拔除雙J管。隨訪1～27個月,B超復查顯示腎積水明顯好轉或消失,無結石復發。 結論:后腹腔鏡輸尿管切開取石術治療嵌頓性輸尿管結石具有創傷小\療效好、術后恢復快等特點,明顯優于開放手術及其它手術,值得推廣應用。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.
摘要:目的:探討經腹腔鏡行輸尿管膀胱再植手術的臨床療效。 方法:對3例先天性巨輸尿管疾病患者采用經腹腔鏡行輸尿管下段整形膀胱移植術。結果:3例手術順利,均獲成功,術中出血量20～80 mL,術后吻合口或切口無漏尿,術后住院時間7～12 d。所有患者隨訪3～6個月,靜脈腎盂造影(IVU)或B超均提示造影劑通過良好,腎積水均得到明顯改善,輸尿管不擴張,無輸尿管吻合口狹窄。結論:經腹腔鏡輸尿管膀胱再植手術具有創傷小、出血少、術后恢復快、住院時間短等特點,療效肯定,值得臨床推廣。Abstract: Objective: To evaluate the clinical efficacy of transperitoneal laparoscopic ureterovesical reimplantation. Methods: Three patients who were diagnosed with simple congenital ureter outlet stricture,underwent transperitoneal laparoscopic ureterovesical reimplantation. Results: All the operations were successful. The intraoperative blood loss was 2080 mL (mean 45 mL). And the postoperative hospitalization was 712 day.No complications were occurred during operation and the follow up period for 36 months in 3 cases. 〖WTHZ〗Conclusion〖WTBZ〗: Transperitoneal laparoscopic ureterovesical reimplantation has the advantages of minimal invasion,less blood loss and rapid postoperative rehabilitation,which is an effective and practical procedure.
Objective To investigate the difference of effect between laparoscopic and open surgery in patients with traumatic rupture of spleen. Methods The literatures on comparison of laparoscopic and open surgery in patients with traumatic rupture of spleen were retrieved in PubMed, Web of Science, CNKI, Wanfang, and VIP databases from Jan. 2007 to Jan. 2017, and then Stata 12.0 software was applied to present meta-analysis. Results ① The condition during operation: compared with the OS group, operative time of the LS group was shorter [SMD=–0.71, 95% CI was (–1.12, –0.30), P=0.001] and intraoperative blood loss of the LS group was less [SMD=–1.53, 95% CI was (–2.28, –0.78), P<0.001]. ② The postoperative condition: compared with the OS group, the postoperative anal exhaust time [SMD=–2.47, 95% CI was (–3.24, –1.70), P<0.001], postoperative ambulation time [SMD=–2.97, 95% CI was (–4.32, –1.62), P<0.001], and hospital stay [SMD=–1.68, 95% CI was (–2.15, –1.21), P<0.001] of the LS group were all shorter. ③ The overall incidence of complications and the incidence of complications: on the one hand, compared with the OS group, patients in the LS group had a lower overall incidence of postoperative complications [OR=0.29, 95% CI was (0.19, 0.43), P<0.001]. On the other hand, compared with the OS group, patients in the LS group had lower incidences of infection [OR=0.27, 95% CI was (0.13, 0.55), P<0.001], ascites [OR=0.36, 95% CI was (0.13, 1.00), P=0.049], bleeding [OR=0.29, 95% CI was (0.10, 0.90), P=0.032], ileus [OR=0.34, 95% CI was (0.13, 0.90), P=0.030], incision fat liquefaction [OR=0.27, 95% CI was (0.08, 0.94), P=0.040], and incision rupture [OR=0.17, 95% CI was (0.03, 0.96), P=0.045]. However, there was no statistical difference on splenectomy fever [OR=0.41, 95% CI was (0.13, 1.27), P=0.123], pancreatic fistula [OR=0.40, 95% CI was (0.06, 2.63), P=0.343], liver function lesion [OR=0.36, 95% CI was (0.10, 1.34), P=0.127], and thrombosis [OR=0.33, 95% CI was (0.09, 1.22), P=0.097] between the 2 groups. Conclusions Laparoscopic surgery can not only significantly reduce the incidence of multiple complications of traumatic rupture of spleen, but also can speed up the recovery rate of postoperative recovery. Therefore, it is safe and beneficial in treatment of patients with traumatic rupture of spleen.