ObjectiveTo study the significance, methods, and technique of group No.6 lymphadenectomy of the laparoscopic gastrectomy with D2 lymph node dissection for distal gastric cancer. MethodsThe relevant data of the 141 examples of group No.6 lymphadenectomy of the laparoscopic gastrectomy with D2 lymph node dissection for distal gastric cancer from Jan.1, 2008 to Dec.31, 2011 were retrospectively analysized. ResultsOne hundred and forty-one patients were successfully completed the group No.6 lymphadenectomy of laparoscopic distal gastrectomy with D2 lymph node dissection. With the number of cases of operation increasing, the operation time, bleeding volume, incidence rate of complication, and the number of operation transit cases stepped down year by year, and the number of the lymph node dissection stepped up (P < 0.000 1). No case died of the lymphadenectomy of the group No.6 lymph node. The medium vessels of colon, pancreas, and the gastroduodenal artery were the anatomic landmarks of the group No.6 lymphadenectomy. The space between the anterior lobe and the posterior lobe of transverse mesocolon and the prepancreatic space were the important surgical plane to carry out the group No.6 lymphadenectomy. ConclusionsOnly a team shall complete a certain amount of the operation, take the medium vessels of colon, pancreas, and the gastroduodenal artery as the anatomic landmark, accurately identify the space between the anterior lobe and the posterior lobe of transverse mesocolon, and the prepancreatic space, and take operation on the correct surgical plane, shall the group No.6 lymphadenectomy conform to the principle of the radical cure of the tumour and achieve the aim of the minimal invasion.
Objective To study the effect of indirect calorimetry-guided nutritional support on energy metabolism, cellular immunity and oxidative stress in patients with colorectal cancer after laparoscopic surgery. Methods A total of 96 patients with colorectal cancer after laparoscopic surgery in our hospital from December 2019 to December 2021 were selected and randomly divided into the control group (used the formula prediction method to guide enteral nutrition support, n=48) and the observation group (used indirect calorimetry to guide enteral nutrition support, n=48). The target resting energy expenditure (REE) value and nutritional support energy intake were compared between the two groups. The cellular immune indexes (CD3+, CD4+, CD8+, CD4+/CD8+) and oxidative stress indexes [serum superoxide dismutase (SOD), malondialdehyde (MDA), the changes of glutathione peroxidase (GSH-Px)], and the changes of REE at different time points (1 day before operation and 1, 2 and 3 days after operation) of the two groups were compared. The incidence of complications in the two groups were observed. Results The target REE value of the observation group was lower than that of the control group (P＜0.05), and there was no significant difference in the enteral energy intake and parenteral energy intake compared with the control group (P＞0.05). After treatment, CD3+, CD4+ and CD4+/CD8+ in the two groups were lower than those before treatment (P<0.05), and CD8+ was higher than before treatment (P<0.05). The levels of CD3+, CD4+ and CD4+/CD8+ in the observation group after treatment were higher than those in the control group (P<0.05) , while the level of CD8+ in the observation group was lower than that in the control group (P<0.05). After treatment, the levels of SOD and GSH-Px in the two groups were lower than those before treatment (P<0.05), and the levels of MDA were higher than those before treatment (P<0.05). The levels of GSH-Px and SOD in the observation group were higher than those in the control group (P<0.05), while the level of MDA in the observation group was lower than that in the control group (P<0.05). There was no significant difference in the REE value between the two groups at 1 day before operation (P>0.05); compared with the 1 day before operation, the REE values of the two groups at 1, 2, and 3 days after operation were significantly increased, and there was a statistically significant difference between the two groups at each time point (P<0.05), but the REE value at 3 days after operation was significantly lower than that at 1 and 2 days after operation (P<0.05). The REE values in the observation group were lower than those in the control group at 1, 2 and 3 days after operation (P<0.05). The incidence of complications in the observation group was 6.25%, which was lower than 20.83% in the control group (P<0.05). Conclusion Enteral nutrition support guided by indirect calorimetry in colorectal cancer patients after laparoscopic surgery can help reduce postoperative energy consumption, improve cellular immune function and oxidative stress response, and reduce the risk of postoperative complications, which is worthy of promotion.
ObjectiveTo systematically review the efficacy and safety of laryngeal mask versus endotracheal tubes for laparoscopic surgery.MethodsPubMed, EMbase, The Cochrane Library, CNKI, WanFang Data and CBM databases were electronically searched to collect the randomized controlled trials (RCTs) about the efficacy and safety of laryngeal mask versus endotracheal tubes for laparoscopic surgery from inception to April, 2017. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Then meta-analysis was performed by using RevMan 5.3 software.ResultsA total of 16 RCTs involving 1 593 patients were included. The results of meta-analysis showed that: there was no significant difference in the success rate of the first insertion (RR=0.99, 95%CI 0.96 to 1.02, P=0.55). The airway pressure of patients whose position were head higher than foot was significantly lower in the laryngeal mask group than in the tracheal intubation group (MD=–1.20, 95%CI –1.81 to –0.59, P=0.000 1), but there was no significant difference between two groups in reverse position patients (MD=0.48, 95%CI –0.90 to 1.87, P=0.49). The incidence of sore throat (RR=0.58, 95%CI 0.46 to 0.74, P<0.000 01), the incidence of blood stain (RR=0.48, 95%CI 0.30 to 0.77, P=0.002), the incidence of laryngeal spasm/bronchial spasm (OR=0.30, 95%CI 0.11 to 0.80, P=0.02) and the incidence of cough/hiccup (RR=0.10, 95%CI 0.07 to 0.15, P<0.000 01) in the laryngeal mask group were significantly lower than those in the tracheal intubation group.ConclusionThe current evidence shows that compared with tracheal intubation, laryngeal mask can effectively reduce airway pressure of patients whose position are head higher than foot. The risks of various complications are significant higher in tracheal intubation in laparoscopic surgery. Laryngeal mask can maintain patients' normal respiratory functions while reduce damage and do not increase the occurrence of reflux aspiration. Due to limited quantity and quality of the included studies, more high quality studies are needed to verify above conclusion.
ObjectiveTo summarize the changes of inguinal hernia in The First Affiliated Hospital of Anhui Medical University in the past 7 years and the curative effect of each procedure.MethodsRetrospectively searched the clinical data of 1 078 patients with inguinal hernia operated in The First Affiliated Hospital of Anhui Medical University from January 2011 to December 2017. According to the surgical procedure, patients were divided into tissue repair group, laparoscopic hernia repair group (laparoscopic group), and open tension-free hernia repair group (open group). Subsequently, the patients of the open group were divided into the mesh plug technique group, the plain patch technique group, and the Ultrapro Hernia System (UHS) group. The postoperative of each procedure, such as recurrence, chronic pain, foreign body sensation, hard touch of the surgical site, male sexual function, and fertility status were compared.ResultsIn 1 078 patients, 52 patients underwent tissue repair, 889 patients underwent open tension-free hernia repair (687 patients were counted with mesh-seal tablets, 100 patients with plain patch count, 102 patients with preperitoneal hernia repair), and 137 patients underwent laparoscopic hernia repair. There was no significant difference in the incidence of total complication, chronic pain, foreign body sensation, and male sexual function decline in the laparoscopic group and the open group (P>0.05). However, the recurrence rate and hard touch of the surgical site rate of the laparoscopic group were lower (P<0.05), and the Numeric Rating Scale (NRS) score was also slightly lower (P=0.047). There was no significant difference in the incidence of the recurrence, chronic pain, foreign body sensation, and male sexual function decline between the three subgroups of the open group, but the total complication rate and hard touch of the surgical site rate in the UHS group were lower than those in the mesh plug group and the plain patch group (P<0.05).ConclusionsLaparoscopic repair of the inguinal herniorrhaphy has lower incidence of occurrence, it is worthy of clinical promotion. In the open tension-free surgery, the retroperitoneal herniorrhaphy may be a better choice.
目的 探讨腹腔镜胆囊切除术（LC）中因胆囊破裂致腹腔残留胆石对术后机体的影响。方法 2001年3月至2009年8月期间广西桂东人民医院对750例胆囊结石患者进行了LC，术中穿破胆囊30例（4.0%），其中术后发现腹腔内残留胆石者10例（1.3%）。回顾性分析该10例患者的临床和随访资料。结果 本组患者住院时间2～7 d，平均4 d。随访2～36个月（平均10个月），CT、X线或B超检查8例患者腹腔仍残存明显胆石，其中1例合并有腹腔脓肿，给予抗炎治疗后症状消失（脓肿较小）； 另2例腹腔残存胆石消失。10例患者均无慢性腹痛、表皮窦道形成、肠梗阻、腹腔肿瘤等并发症。随访期间10例患者肝功能及T细胞水平与术后第2天比较，差异无统计学意义（P＞0.05），WBC水平则明显降低（P＜0.05）。结论 LC中如果无法寻找到遗留于腹腔的微小胆石时，只要常规腹腔冲洗，术后预防性应用抗生素，少数残留于腹腔的小胆石对术后机体无严重不良影响。
Objective To summarize the research progress of CO2 pneumoperitoneum impacts on invasiveness of cancer cells. Methods Currently published experimental and clinical researches related to the effect of CO2 pneumoperitoneum on invasiveness of cancer cells were reviewed. Results CO2 pneumoperitoneum may affect the invasiveness of cancer cell through several ways， such as changing the structure and function of mesothelial cell， changing microenvironment of peritoneum， influencing the expression of oncogen， affecting the secretion of cell factor， and changing the adhesion of cancer cell. Conclusions The consequences of these alterations to cancer cell and the microenvironment are not well understood， but they may facilitate tumor invasion and implantation. Further investigations in this area are very urgent.
Objective To evaluate the changes of liver function after laparoscopic-assisted radical gastrectomy for gastric cancer and analyze related impact factors. Methods Patients with gastric cancer or colon cancer, who underwent radical gastrectomy or hemicolectomy between Jun 2008 and Jun 2010 in General Hospital of PLA, were included in this study. These patients were divided into open gastrectomy （OG group, n=43）, laparoscopic-assisted gastrectomy （LAG group, n=35）, and laparoscopic-assisted hemicolectomy （LAC group, n=23）. The serum AST, ALT, TB, and ALP levels of all patients enrolled on the preoperative day and post operative day （POD） 1, POD3, POD5, and POD7, and related impact factors were analyzed. Results Compared with the preoperative results, serum AST and ALT levels of patients increased until POD5 in both LAG and OG groups （P＜0.05）, and there was no changes in liver function after operation of patients in LAC group （P＞0.05）. In addition to that serum AST and ALT levels of patients in LAG group in POD1 were significantly higher than those in OG group （P=0.035 and P=0.041）， and that serum ALT level of patients in LAG group was significantly lower than that in OG group in POD3 （P=0.048）, serum AST and ALT levels of patients in two groups in the remaining time points were not statistically significant difference （P＞0.05）. The serum AST and ALT levels of patients in LAG group were significantly higher than those in LAC group during 5 d after operation （P＜0.05）.There was no significant changes of serum ALP and TB levels of patients in LAG and OG groups on the before and after operation （P＞0.05）. The increased serum ALT level of gastric cancer patients after operation related to body mass index （BMI, P=0.038）, operative time （P=0.011）, intraoperative hepatic injury （P=0.035）, and abnormal ligation of hepatic artery （P=0.048）, instead of the type of operation （OG vs.LAG, P＞0.05）. Conclusions Gastric cancer patients who underwent radical gastrectomy have transient liver dysfunction, which attributes mainly to direct liver manipulation or abnormal ligation of hepatic artery, but not CO2 pneumoperitoneum. Laparoscopic-assisted radical gastrectomy is feasible and safe to the patients without serious liver damage or other vital organs disorders.
Objective This study aimed to explore the experience of secondary excision for retrorectal cystic lesions. Method We retrospectively reviewed the medical records of patients who underwent secondary laparoscopic excision of retrorectal cystic lesions at the Department of General Surgery at our hospital between August 2012 and August 2021. Results Twelve patients [male: 5; female: 7; age: (31.8±11.5) years old (18–60 years old)] were evaluated. The lesions ranged from 5.8 to 15.0 cm in diameter [(10.0±3.5) cm]. Seven patients had epidermoid cysts, three patients had mature teratoma, one patient had mature teratoma with low-grade mucinous neoplasm and one patient had cyst with mucinous carcinoma. Laparoscopic excision of retrorectal cystic lesions was performed in ten patients, and laparoscopy combined transsacrococcygeal approach was performed in two patients. The median operative time was 137.5 min (80–240 min), and the median blood loss was 30 mL (10–200 mL). No patient experienced complications of Clavien-Dindo grade Ⅲa or worse, one patient experienced complications of Clavien-Dindo grade Ⅱa after operation. The mean duration of hospitalization was (5.9±1.4) d (3–7 d). The follow-up period ranged from 3 to 108 months, and the median follow-up time was 43-month, and one patient recurred during the follow-up period. Conclusions Attention should be paid to the initial diagnosis and treatment of retrorectal cystic lesions, particularly in children. Routine evaluation using preoperative pelvic MRI and the adoption of an appropriate surgical approach are recommended to reduce secondary operations. Surgery should be performed by surgeons experienced in rectal andpelvic surgeries.
ObjectiveTo assess the outcomes of laparoscopy-assisted surgery for treatment of advanced gastric cancer.MethodsA total of 115 patients with advanced gastric cancer were included between January 2014 and December 2018 were analyzed retroprospectively, the patients were divided into two groups: open surgery group (OS group, n=63) and laparoscopy-assisted surgery group (LAS group, n=52). Baseline characteristics, intraoperative parameters and postoperative items, and long-term efficacy were compared between the two groups.ResultsThere was no significant difference in preoperative baseline data including gender, age and preoperative serum parameters between the two groups (P>0.05). Intraoperative blood loss in the LAS group was significantly less than that in the OS group (P<0.05). In addition, the first feeding time after operation and postoperative hospital stay in the LAS group were significantly shorter than the OS group (P<0.05). Furthermore, numbers of white blood cells and neutrophils in the LAS group were fewer than that in the OS group at postoperative 2 days (P<0.05); the level of serum albumin in the LAS group was higher than that OS group (P<0.05). The number of lymph nodes detected during operation in the LAS group was more than that in the OS group (P<0.05). Operative time and occurrence of postoperative complications were not statistically significant between the two groups (P>0.05). One hundred and ten of 115 patients were followed- up, the follow-up rate was 95.7%. The follow-up time ranged from 6 to 48 months, with a median follow-up time of 12.4 months. The disease-free survival time of the OS group was 12.2±6.5 months, while that of the LAS group was 13.5±7.4 months. There was no significant difference between the two groups (P>0.05).ConclusionsLaparoscopic technique in treatment of advanced gastric cancer has the minimally invasive advantage, less intraoperative blood loss, less surgical trauma, and faster postoperative recovery in comparing to the traditional open surgery. Also the lymph node dissection is superior to open surgery. The curative effect is comparable to that of open surgery.