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.
Objectives To analyze risk factors associated with conversion to open surgery of laparoscopic repair for perforated peptic ulcer. Methods From January 2009 to December 2014, 235 patients underwent laparoscopic repair for perforated peptic ulcer in the Chengdu 5th Hospital, were enrolled in this study. These patients were divided into laparoscopic repair group (n=207) and conversion to open surgery group (n=28). The characteristics, clinical outcomes, and prognosis factors were compared between these two groups. The receiver operating characteristic (ROC) curve was used to determine the critical cutoff value for diameter and duration of perforation for predicting conversion to open surgery. Results There were no significant differences of the age, gender, body mass index, comorbidity, history of ulcer, smoking history, history of nonsteroidal antiinflammatory drugs or steroids use, history of alcohol use, American Society of Anesthesiologists classification on admission, white blood cell count on admission, C reaction protein on admission, surgeons, suture method, and location of perforation between these two groups (P>0.05). The patients in the conversion to open surgery group had a higher procalcitonin (PCT) level on admission (P=0.040), longer duration of peroration (P<0.001), larger diameter of peroration (P<0.001), longer hospital stay (P=0.002), higher proportion of patients with Clavien-Dindo classification Ⅰ and Ⅱ (P<0.001), longer gastrointestinal function recovery time (P=0.003), longer analgesics use time (P<0.001), and longer off-bed time (P=0.001) as compared with the laparoscopic repair group. The results of logistic regression analysis showed that the peroration duration on admission〔OR: 2.104, 95%CI (1.124, 3.012),P=0.020〕and peroration diameter on admission〔OR: 2.475, 95%CI (1.341, 6.396),P=0.013〕were two predictors of conversion to open surgery. For the diameter of perforation, 8.0 mm was the critical cutoff value for predicting conversion to open surgery by ROC curve analysis, the sensitivity was 76%, the specificity was 93%, and the area under the curve (AUC) was 0.912. For the duration of perforation, 14 h was the critical cutoff value to predict conversion to open surgery, the sensitivity was 86%, the specificity was 71%, and theAUC was 0.909. Conclusions The preliminary results in this study show that diameter of perforation of 8 mm and duration of perforation of 14 h are two reliable risk factors associated with conversion to open surgery for perforated peptic ulcer. Also, PCT level would mightbe considered as a helpful risk factor for it.
Objective To explore the incidence of postoperative recurrence of abdominal incisional hernia and its related risk factors. Methods The clinical data of 213 patients with abdominal incisional hernia treated in the General Surgery of Shaanxi Provincial People’s Hospital from January 2015 to December 2019 were collected retrospectively, and the incidence of postoperative recurrence of abdominal incisional hernia and its related influencing factors were analyzed. Results A total of 213 patients underwent a complete follow-up. The follow-up time was 3 to 60 months, and the median follow-up time was 46 months. A total of 24 cases (11.27%) of hernia recurred after surgery. The univariate analysis results showed that body mass index (BMI), hernia ring size, incarceration, recurrent hernia, history of multiple abdominal operations, postoperative incision complications, factors such as increased abdominal pressure, and whether the patch were used for postoperative recurrence of abdominal incisional hernia influences (P<0.05). Further logistic multi-factor analysis results showed that BMI [OR=1.14, 95%CI (1.01, 1.29), P=0.040], incarcerated hernia [OR=8.94, 95%CI (1.94, 40.98), P=0.005], recurrent hernia [OR=10.91, 95%CI (2.09, 56.84), P=0.005], and hernia ring size [OR=1.15, 95%CI (1.03, 1.28), P=0.010] were related to the recurrence of abdominal incisional hernia after surgery (P<0.05). Conclusions The risk factors for hernia recurrence after abdominal incisional hernia repair include recurrent hernia, incarcerated hernia, hernia ring size, and BMI. For patients with high-risk factors, corresponding measures should be taken to prevent hernia recurrence.
ObjectiveTo evaluate the effectiveness of robot-guided percutaneous fixation and decompression via small incision in treatment of advanced thoracolumbar metastases. Methods A clinical data of 57 patients with advanced thoracolumbar metastases admitted between June 2017 and January 2021 and met the selection criteria was retrospectively analyzed. Among them, 26 cases were treated with robot-guided percutaneous fixation and decompression via small incision (robot-guided group) and 31 cases with traditional open surgery (traditional group). There was no significant difference in gender, age, body mass index, lesion segment, primary tumor site, and preoperative Tokuhashi score, Tomita score, Spinal Instability Neoplastic Score (SINS), visual analogue scale (VAS) score, Oswestry disability index (ODI), Karnofsky score, and Frankel grading between groups (P>0.05). The operation time, hospital stays, hospital expenses, intraoperative blood loss, postoperative drainage volume, duration of intensive care unit (ICU) stay, blood transfusion, complications, and survival time were compared. The pedicle screw placement accuracy was evaluated according to the Gertzbein-Robbins grading by CT within 4 days after operation. The pain, function, and quality of life were evaluated by VAS score, ODI, Karnofsky score, and Frankel grading. Results During operation, 257 and 316 screws were implanted in the robot-guided group and the traditional group, respectively; and there was no significant difference in pedicle screw placement accuracy between groups (P>0.05). Compared with the traditional group, the operation time, hospital stays, duration of ICU stay were significantly shorter, and intraoperative blood loss and postoperative drainage volume were significantly lesser in the robot-guided group (P<0.05). There was no significant difference in hospital expenses, blood transfusion rate, and complications between groups (P>0.05). All patients were followed up 8-32 months (mean, 14 months). There was no significant difference in VAS scores between groups at 7 days after operation (P>0.05), but the robot-guided group was superior to the traditional group at 1 and 3 months after operation (P<0.05). The postoperative ODI change was significantly better in the robot-guided group than in the traditional group (P<0.05), and there was no significant difference in the postoperative Karnofsky score change and Frankel grading change when compared to the traditional group (P>0.05). Median overall survival time was 13 months [95%CI (10.858, 15.142) months] in the robot-guided group and 15 months [95%CI (13.349, 16.651) months] in the traditional group, with no significant difference between groups (χ2=0.561, P=0.454) . Conclusion Compared with traditional open surgery, the robot-guided percutaneous fixation and decompression via small incision can reduce operation time, hospital stays, intraoperative blood loss, blood transfusion, and complications in treatment of advanced thoracolumbar metastases.
ObjectivesTo systematically review the efficacy and safety of ultrasound-guided percutaneous microwave ablation versus traditional open surgical operation in the treatment of benign thyroid nodules.MethodsPubMed, The Cochrane Library, EMbase, CBM, CNKI and VIP databases were electronically searched to collect randomized controlled trials (RCTs) on ultrasound-guided percutaneous microwave ablation versus traditional open surgery for benign thyroid nodules from inception to June 30th, 2018. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Then, meta-analysis was then performed by RevMan 5.3 software.ResultsA total of 38 RCTs involving 4 078 patients were included. The results of meta-analysis showed that: ultrasound-guided percutaneous microwave ablation might be more effective than traditional open surgery for the treatment of benign thyroid nodules (RR=1.09, 95% CI 1.00 to 1.19, P=0.04), and compared with traditional open surgery, ultrasound-guided percutaneous microwave ablation reduced the rate of postoperative complication (RR=0.26, 95%CI 0.21 to 0.31, P<0.000 01), shortened postoperative hospital stay (MD=–3.60, 95%CI –4.04 to –3.15, P<0.000 01) and the time consumed in operation (MD=–48.79, 95%CI –54.16 to –43.41, P<0.000 01), and reduced operative blood loss (MD=–22.02, 95%CI–23.87 to –20.17, P<0.000 01). Meanwhile, microwave ablation reduced the elevated levels of serum IL-6 content (MD=–10.34, 95%CI –10.70 to –9.97, P<0.000 01), serum CRP content (MD=–9.70, 95%CI –10.95 to –8.44, P<0.000 01) and serum TNF-α content (MD=–7.94, 95%CI –9.00 to –6.88, P<0.000 01).ConclusionsCurrent evidence shows that ultrasound-guided percutaneous microwave ablation may improve clinical efficacy and can reduce postoperative complications, bleeding volume, operation time, hospitalization days and postoperative inflammatory reaction. Due to limited quality and quantity of the included studies, more high quality studies are required to verify above conclusions.
Objective To summarize selection of therapeutic method for isolated iliac aneurysms and analyze its advantages and disadvantages. Method The clinical data of 21 patients with isolated iliac aneurysms from January 2006 to January 2017 in this hospital were analyzed retrospectively. Results Four patients were treated with an open surgery such as the unilateral iliac prosthetic graft interposition, aorto-biiliac or aorto-bifemoral arterial bypass graft, ligation of internal iliac artery, etc.. Seventeen patients were treated with an endovascular treatment such as the unilateral iliac stent-grafts, bifurcated aortic stent-grafts, or coil embolization alone, etc.. One patient with ruptured isolated iliac aneurysms died during the endovascular repair, and the rest patients were cured after the operation. The average operative time was 2.83 h and 1.58 h, the average hospital stay was 17.5 d and 7.7 d respectively for the patients with the open surgery and the endovascular treatment. Except 1 case of type Ⅰ and 1 case of type Ⅱ endoleaks were found in the patients with the endovascular treatment, no complications such as the ureteral and intestinal injuries, the gluteal muscle claudication, and the sigmoid ischemia were found in all the patients. Seventeen cases were followed-up. The following-up rate was 85%. The following-up time was 1–60 months with an average of 22 months. During the following-up period, the grafts and stent grafts were patent and the aneurysm sac diameter was unchanged. The abscess of the iliac fossa occurred in 1 patient with systemic lupus erythematosus and improved after the symptomatic treatment. Two patients died of other diseases during the following-up period, and the rest had no obvious clinical symptoms. Conclusions Preliminary results of limited cases in this study show that endovascular repair and open surgery in treatment of appropriately selected patients with isolated iliac artery aneurysms is safe and effective. But in special situation, technical controllability of open surgery might be better than endovascular repair, treatment should be selected according to patient’s general condition and anatomy of aneurysm.
ObjectiveTo compare the differences of clinical effects between the bilateral endoscopic breast reconstruction and the open breast reconstruction. MethodsThe clinical data of 28 female patients who underwent bilateral breast graft reconstruction in the Department of Breast Surgery of West China Hospital from January 2017 to January 2021 were analyzed retrospectively. The patients were divided into two groups: an endoscopic group (n=12, aged 41.3±8.9 years) and an open group (n=16, aged 41.6±8.8 years). The clinical data of the two groups of patients were compared. Results There was no significant difference in demographic and oncological data between the two groups (P>0.05). There was a significant difference in the implants between the two groups (P=0.008). The operation time (298.2±108.6 min vs. 326.5±95.8 min, P=0.480) and anesthesia time (373.4±91.2 min vs. 400.3±97.1 min, P=0.463) were not significantly different. The total complications (P=0.035) and major complications (P=0.024) in the open group were more than those in the endoscopic group. For the comparison of breast satisfaction, psychosocial well-being and sexual well-being, the scores at six months and one year after surgery were higher in the endoscopic group than those in the open group (P<0.05). ConclusionThe endoscopic reconstruction is safe and effective, with high satisfaction rates regarding breast reconstruction and quality of life, and is superior to conventional open surgery.
Objective To investigate the impact of conversion to open in laparoscopic rectal cancer radical resection (LRR) on postoperative recovery. Methods The data from Feb. 2003 to Feb. 2007 of 176 cases who were given LRR and 32 cases receiving conversion in LRR (CRR) were analyzed retrospectively, and were compared about operation time, hospitalization time, hospitalization expenses, intraoperative blood loss, recovery time of bowel movement and postoperative complications with 59 cases of open rectal cancer radical resection (ORR). Results There were no differences among LRR, CRR and ORR about operation time, hospitalization time, intraoperative blood loss and recovery time of bowel movement (Pgt;0.05). The hospitalization expenses of LRR and CRR were higher than that of ORR (P=0.001, P=0.001), there was no difference between CRR and LRR (P=0.843). But the postoperative complications rate of ORR was higher than those of LRR and CRR （P=0.023,P=0.004）. Conclusion Compared with ORR, LRR has relatively conversion rate, and then increases the hospitalization expenses.
ObjectiveTo compare clinical outcomes between laparoscopic (LAP) and open surgery for non-metastatic colon cancer of T4a stage.MethodsWe retrospectively analyzed clinical data of non-metastatic colon cancer patients of T4a stage with confirmed pathological results who underwent curative resection in Peking Union Medical College Hospital between January 2011 and December 2017. These patients were allocated into LAP group (n=107, underwent laparoscopic radical operation) and open group (n=52, underwent open surgery).ResultsThere were no significant difference in operating time, number of lymph nodes harvested, number of positive lymph nodes, incidence of complications within 30 days, and Clavien-Dindo grading between the LAP group and open group (P>0.05), but intraoperative blood loss, postoperative exhaust time, and postoperative hospital stay in the LAP group were less than (shorter than) those of the open group (P<0.05).ConclusionLaparoscopic approach for non-metastatic colon cancer of T4a stage is safe and feasible, and it has advantages including less intraoperative blood loss, faster recovery, and shorter hospital stay.