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.
Objective To summarize the experience of 23 cases of axillary approach endoscopy-assisted bilateral skin-sparing mastectomy surgery with immediate prosthetic breast reconstruction, and to discuss its superiority and patient satisfaction. Methods The clinical data of 23 female breast cancer patients who underwent axillary approach endoscopy-assisted bilateral skin-sparing mastectomy surgery with immediate prosthetic breast reconstruction from June 2021 to June 2022 in the Sixth Affiliated Hospital of Sun Yat-sen University were retrospectively included. We summarized the surgical procedures, surgical safety, and postoperative patient satisfaction. Results Twenty-three patients have operated the axillary approach endoscopy-assisted bilateral skin-sparing mastectomy surgery with immediate prosthetic breast reconstruction successfully without nipple reconstruction. Among them, 9 patients underwent dual-main surgeons’ surgery, and 14 patients underwent one-main surgeon surgery. The surgery time ranges from 3.5 to 7.0 h, mean of 4.76 h, and the mean operation time of 9 patients underwent dual-main surgeons’ surgery was shorter than that of patients underwent one-main surgeons’ surgery. The blood loss ranges from 20 to150 mL, mean of 45.7 mL. The postoperative hospital stay range from 0 to 24 d, mean of 10.7 d. Four people suffered from complications: 1 patient with prosthesis moving up, 2 patients with nipple-areola complications, and 1 patient with subcutaneous emphysema. All 23 women were followed for 3 months, and no one suffered from recurrence, metastasis, and death during this period. We surveyed people by BREAST-Q scale when pre-operation, 1 month after the operation, and 3 months after the operation. Compared with preoperative patients, the sexual well-being, psychosocial well-being, and chest physical well-being of 1 month postoperative patients were decreased, but obviously increased in 2 months. The satisfaction with breast of 3 months of postoperative patients were higher than preoperative patients. Conclusions Endoscopy-assisted bilateral skin-sparing mastectomy surgery with immediate prosthetic breast reconstruction can achieve good cosmetic results and improve surgical safety. The dual-main surgeons’ surgery can decrease the operation time, so as to reduce the risk of anesthesia for patients.
ObjectivesTo systematically review the efficacy and safety of 3D laparoscopic in the treatment of colorectal cancer.MethodsPubMed, EMbase, The Cochrane Library, CBM, VIP, WanFang Data and CNKI databases were electronically searched online to collect clinical trials of 3D laparoscopic in the treatment of colorectal cancer from inception to September 1st, 2018. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Meta-analysis was then performed using RevMan 5.3 software.ResultsA total of 26 trials, including 4 randomized controlled trials and 22 cohort studies were included. The results of meta-analysis showed that: compared with 2D laparoscopic, 3D laparoscopic had shorter operative time (MD=–16.32, 95%CI –22.61 to –10.03, P<0.000 01), less amount of blood transfusion in operation (MD=–10.80, 95%CI –19.93 to –1.66, P=0.02), more lymph node dissection (MD=0.88, 95%CI 0.30 to 1.45, P=0.003), shorter recovery time of gastrointestinal function (MD=–0.18, 95%CI –0.31 to –0.04, P=0.01), lower incidence of postoperative complication (OR=0.63, 95%CI 0.44 to 0.89, P=0.009), and fewer days in hospital (MD=–0.84, 95%CI –1.40 to –0.28, P=0.003). Additionally, there was no significant difference in hospitalization costs (MD=–0.01, 95%CI –0.23 to 0.21, P=0.94).ConclusionsCurrent evidence shows that, compared with 2D laparoscopy, 3D laparoscopy assisted colorectal cancer surgery has obvious advantages such as less bleeding during operation, shorter operation time, lower incidence of complications after operation, shorter hospitalization time and no increase in hospitalization expenses. Due to limited quality and quantity of the included studies, more high quality studies are required to verify above conclusions.
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 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 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.
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.
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.
ObjectivesTo summarize the latest advances about definition, classification, and TNM stage of adenocarcinoma of esophagogastric junction (AEG).MethodThe available guidelines, consensuses, international conference proceedings, and clinical studies were reviewed and summarized.ResultsThe AEG trended to be an independent entity of malignant tumor at the special location. The previous misunderstanding of AEG definitions from the WHO needed to be corrected and unified in China. The Siewert classification was still a practical clinical approach to guiding treatment strategy, while the new draft of JGCA classification needed to be evaluated and verified in the clinical practice. By contrast, the 8th edition AJCC/UICC classification was relatively controversial in the guiding treatment strategies, mainly due to the staging system, surgical approach, and extent of lymphadenectomy of Siewert Ⅱ type AEG. Based on the available research results, the TNM staging system of the 8th edition of gastric cancer tended to be more reasonable for the Siewert Ⅱ and Ⅲ types AEG.ConclusionWith increasing incidence of AEG, more experimental and clinical studies on AEG are ongoing, and it is expected to have more optimized classification and exclusive staging system for AEG in future.
ObjectiveTo analyze the causes and prevention principles of hepatic venous hemorrhage during laparoscopic hepatectomy.MethodLiteratures about the causes and prevention of hepatic venous hemorrhage during laparoscopic hepatectomy were collected, and then made an review with our own clinical experience.ResultsIntraoperative hepatic venous hemorrhage was one of the most dangerous complications during laparoscopic hepatectomy. The main reasons for its occurrence included subjective and objective factors. Through accurate preoperative assessment, rigorous attitude during operation and superb surgical skills, intraoperative control of the prsessure difference between the internal and external veins, could significantly reduce the incidence of intraoperative venous bleeding. For the hepatic vein bleeding that had occurred, the correct evaluation and treatment during the operation could reduce the adverse effect on the surgical efficacy.ConclusionCorrectly understand the causes of hepatic venous hemorrhage during laparoscopic hepatectomy, prevent and manage various techniques before and during operation can carry out laparoscopic hepatectomy more safely.