BACKGROUND Non-alcoholic fatty liver disease(NAFLD)is characterized by the accumulation of fat in the liver in individuals who do not consume alcohol.Several risk factors influencing the onset of NAFLD after laparosco...BACKGROUND Non-alcoholic fatty liver disease(NAFLD)is characterized by the accumulation of fat in the liver in individuals who do not consume alcohol.Several risk factors influencing the onset of NAFLD after laparoscopic pancreaticoduodenectomy(LPD)have been identified.This study investigated the risk factors associated with the development of fatty liver after laparoscopic duodenum-preserving pancreatic total head resection(LDPPHRt)and LPD.AIM To compare the effects of LDPPHRt and LPD on the development of postoperative NAFLD.METHODS This retrospective cohort study included 59 patients who were histologically diagnosed with benign or low-grade malignant pancreatic tumors and who underwent laparoscopic pancreatic surgery(LDPPHRt or LPD)between May 2020 and April 2023.Patient data on perioperative and postoperative variables were analyzed and compared.Multivariate logistic regression was used to identify pre-,peri-,and postoperative risk factors for NAFLD,with statistical significance set at P<0.05.RESULTS Of the 59 patients included in the study,17(28.8%)developed NAFLD within 6-12 months post-surgery.The incidence of NAFLD was significantly higher in the LPD group compared to the LDPPHRt group(40.0%vs 12.5%,P=0.022).Multivariable analysis identified the LDPPHRt surgical approach(compared to LPD)as an independent protective factor against the development of postoperative NAFLD,with an odds ratio of 0.208(95%confidence interval:0.046-0.931;P=0.040).CONCLUSION Our findings indicate that LDPPHRt is more effective than LPD in reducing the incidence of postoperative NAFLD,which may inform surgical decision-making and optimize patient outcomes after laparoscopic pancreatic surgery.展开更多
A pancreas surgeon’s constant goal is to do"less damage,more radical".Currently,a small number of highly trained surgeons opt for single-incision laparoscopic pancreaticoduodenectomy(SILPD)or single-incisio...A pancreas surgeon’s constant goal is to do"less damage,more radical".Currently,a small number of highly trained surgeons opt for single-incision laparoscopic pancreaticoduodenectomy(SILPD)or single-incision plus one-port LPD(SILPD+1)to minimize post-operative pain,improve convalescence,and provide a more pleas-ing cosmetic outcome[1,2].Additionally,some skilled surgeons have claimed that laparoscopic duodenum-preserving complete pancreatic head resections(LDPPHR)result in less trauma and en-hanced quality of life[3,4].However,LDPPHR is still challenging because of its lengthy learning curve and"sword-fighting"impact.Additionally,there has not been any global reporting on the suit-ability of single-incision plus one-port DPPHR with pancreaticogas-trostomy(SILDPPHR-T+1)in place of SILPD+1.This study aimed to illustrate the SILDPPHR-T+1 procedure specifics for a patient with pancreatic head intraductal papillary mucinous neoplasm(IPMN)(main pancreatic duct type)(MD-IPMN).展开更多
The first-ever case of a 54-year-old woman who overdosed on non-steroidal anti-inflammatory drugs in an attempt at suicide.Before that incident,she had not been treated for coexisting diseases such as rheumatoid arthr...The first-ever case of a 54-year-old woman who overdosed on non-steroidal anti-inflammatory drugs in an attempt at suicide.Before that incident,she had not been treated for coexisting diseases such as rheumatoid arthritis or depression.At the time of admission to the General Surgery Department,the patient reported pains in the epigastric region with accompanying nausea and vomiting with mucous content as well as the inability to ingest food orally.Despite parenteral and enteral feeding,the patient exhibited a drop in body mass.The histopathologic examination of a sample taken from the stomach during gastroscopy showed some non-specific necrotic and inflammatory masses with granulation.Intraoperatively,a very small,infiltrated stomach with an initial section of duodenum was identified.A total stomach resection together with the reconstruction of digestive tract continuity was performed using the Roux-Y method.Histopathologic examination of the stomach revealed a deep,chronic and exacerbated inflammatory condition with an extensive ulceration over the entire length of the stomach,reaching up to the pylorus.Additionally,numerous lymphatic glands with inflammatory reaction changes were observed.展开更多
Benign duodenal tumors are rare and less commonthan malignant tumors.Furthermore,vascular lesionsof the duodenum,including hemangiomas,are rarecauses of gastrointestinal bleeding.This report describes a case with blee...Benign duodenal tumors are rare and less commonthan malignant tumors.Furthermore,vascular lesionsof the duodenum,including hemangiomas,are rarecauses of gastrointestinal bleeding.This report describes a case with bleeding hemangiomas in the thirdportion of the duodenum and jejunum and their successful treatment using a laparoscopic approach.Thereis no report of totally laparoscopic resection for tumorin the third portion of duodenum.After performinga laparoscopic Kocher maneuver,the location of theduodenal hemangioma was confirmed by endoscopicand laparoscopic observation.The lesion was excisedusing ultrasonic coagulating shears and the defect inthe duodenal wall was sutured laparoscopically.Thehemangioma of the jejunum was treated extracorporeally through a 3.0 cm umbilical incision.The operatingtime was 241 min and blood loss was negligible.Thepostoperative course was uneventful.For benign duodenal tumors in the third portion,if endoscopic resection is not adapted,this less invasive technique may be a standard treatment.展开更多
BACKGROUND： No staging systems of hepatocellular carcinoma（HCC） are tailored for assessing recurrence risk. We sought to establish a recurrence risk scoring system to predict recurrence of HCC patients receiving su...BACKGROUND： No staging systems of hepatocellular carcinoma（HCC） are tailored for assessing recurrence risk. We sought to establish a recurrence risk scoring system to predict recurrence of HCC patients receiving surgical curative treatment（liver resection or transplantation）.METHODS： We retrospectively studied 286 HCC patients with preserved liver function receiving liver resection（n=184） or transplantation（n=102）. Independent risk factors were identified to construct the recurrence risk scoring model. The recurrence free survival and discriminatory ability of the model were analyzed. RESULTS： Total tumor volume, HBs Ag status, plasma fibrinogen level were included as independent prognostic factors for recurrence-free survival and used for constructing a 3-factor recurrence risk scoring model. The scoring model was as follows： 0.758×HBs Ag status（negative： 0; positive： 1）＋0.387×plasma fibrinogen level（≤3.24 g/L： 0; 〉3.24 g/L： 1）＋0.633×total tumor volume（≤107.5 cm3： 0; 〉107.5 cm3： 1）. The cutoff value was set to 1.02, and we defined the patients with the score ≤1.02 as a low risk group and those with the score 〉1.02 as a high risk group. The 3-year recurrence-free survival rate was significantly higher in the low risk group compared with that in the high risk group（67.9% vs 41.3%, P〈0.001）. In the subgroup analysis, liver transplantation patients had a better3-year recurrence-free survival rate than the liver resection patients in the low risk group（80.0% vs 64.0%, P〈0.01）. Additionally for patients underwent liver transplantation, we compared the recurrence risk model with the Milan criteria in the prediction of recurrence, and the 3-year recurrence survival rates were similar（80.0% vs 79.3%, P=0.906）.CONCLUSION： Our recurrence risk scoring model is effective in categorizing recurrence risks and in predicting recurrencefree survival of HCC before potential surgical curative treatment.展开更多
The purpose of this study was to analyze the clinical efficacy of laparoscopic total mesorectal excision for the treatment of middle and low rectal cancer.First,30 patients who received treatment in the hospital from ...The purpose of this study was to analyze the clinical efficacy of laparoscopic total mesorectal excision for the treatment of middle and low rectal cancer.First,30 patients who received treatment in the hospital from March 2013 to May 2018 were randomly selected as the laparotomy group to receive laparotomy.30 patients who received treatment in the hospital from March 2013 to May 2018 were randomly selected as the laparoscopic group to receive laparoscopic surgery.The postoperative and complications of total rectal mesorectal excision were compared between the two groups.The results showed that the amount of blood loss during laparoscopy was(169.36±106.96)mL,and that during laparoscopy was(180.65±153.22)mL,which was significantly lower than that of the open group(209.65±186.65)mL and(356.54±170.32)mL.Intraoperative blood loss in laparoscopic patients was significantly lower than that in the open group,and the difference was statistically significant(t=2.95,2.87,P<0.05).The duration of anal sparing surgery in the laparoscope group was(232.65±56.35)min,which was longer than that in the laparoscope group(227.65±68.65)min.The duration of non-sparing anal surgery in the laparoscopic group was(246.95±52.65)min,which was significantly shorter than that in the open group(299.65±64.32)min.There was no statistically significant difference in the duration of operation between the laparoscopic group and the open group.The recovery time of intestinal function in the laparoscopic group was(2.11±1.82)days,which was significantly shorter than that in the open group(4.63±1.52)days.The postoperative hospital stay in the laparoscopic group was(11.32±10.01)d,which was significantly shorter than that in the open group(26.62±12.43 d).The recovery time of intestinal function and postoperative hospital stay of patients in the laparoscopic group were shorter than those in the open group,with statistically significant differences(T=2.31,2.43,P<0.05).The tumor diameter was(4.03±1.20)cm in the laparoscopic group and(3.95±1.43)cm in the open group.The number of lymph nodes in the laparoscopic group was(12.75±6.51)cm,while that in the open group was(13.62±7.05).There was no significant difference in the number of lymph nodes dissected or tumor diameter between the two groups(t=0.11,0.22,P>0.05).The complication rate of the abdominal group was 20.00%,significantly lower than that of the open group(66.67%).Complications after total mesorectal resection were significantly higher in the open group than in the laparoscopic group,and the difference between the two groups was statistically significant(χ2=13.30,P<0.05).Therefore,laparoscopic total rectal mesorectal resection for patients with middle and low rectal cancer is safer and can be used as a reliable treatment plan.展开更多
AIM:To evaluate the results of hepatic resection with ex-situ hypothermic perfusion and without veno-venous bypass.METHODS:In 3 patients with liver tumor,the degree of the inferior vena cava and/or main hepatic vein i...AIM:To evaluate the results of hepatic resection with ex-situ hypothermic perfusion and without veno-venous bypass.METHODS:In 3 patients with liver tumor,the degree of the inferior vena cava and/or main hepatic vein involvement was verified when the liver was dissociated in the operation.It was impossible to resect the tumors by the routine hepatectomy,so the patients underwent ex-situ liver surgery,vein cava replacement and hepatic autotransplantation without veno-venous bypass.All surgical procedures were carried out or supervised by a senior surgeon.A retrospective analysis was performed for the prospectively collected data from patients with liver tumor undergoing ex-situ liver surgery,vein cava replacement and hepatic autotransplantation without veno-venous bypass.We also compared our data with the 9 cases of Pichlmayr's group.RESULTS:Three patients with liver tumor were analysed.The first case was a 60-year-old female with a huge haemangioma located in S1,S4,S5,S6,S7 and S8 of liver;the second was a 64-year-old man with cholangiocarcinoma in S1,S2,S3 and S4 and the third one was a 55-year-old man with a huge cholangiocarcinoma in S1,S5,S7 and S8.The operation time for the three patients were 6.6,6.4 and 7.3 h,respectively.The anhepatic phases were 3.8,2.8 and 4.0 h.The volume of blood loss during operation were 1200,3100,2000 mL in the three patients,respectively.The survival periods without recurrence were 22 and 17 mo in the first two cases.As for the third case complicated with postoperative hepatic vein outflow obstruction,emergency hepatic vein outflow extending operation and assistant living donor liver transplantation were performed the next day,and finally died of liver and renal failure on the third day.Operation time(6.7 ± 0.47 h vs 13.7 ± 2.6 h) and anhepatic phase(3.5 ± 0.64 h vs 5.7 ± 1.7 h) were compared between Pichlmayr's group and our series(P = 0.78).CONCLUSION:Ex-situ liver resection and liver autotransplantation has shown a potential for treatment of complicated hepatic neoplasms that are unresectable by traditional procedures.展开更多
Large comparative studies and multiple prospective randomized control trials (RCTs) have reported equivalence in short and long-term outcomes between the open and laparoscopic approaches for the surgical treatment of ...Large comparative studies and multiple prospective randomized control trials (RCTs) have reported equivalence in short and long-term outcomes between the open and laparoscopic approaches for the surgical treatment of colon cancer which has heralded widespread acceptance for laparoscopic resection of colon cancer. In contrast, laparoscopic total mesorectal excision (TME) for the treatment of rectal cancer has been welcomed with significantly less enthusiasm. While it is likely that patients with rectal cancer will experience the same benefits of early recovery and decreased postoperative pain from the laparoscopic approach, whether the same oncologic clearance, specifically an adequate TME can be obtained is of concern. The aim of the current study is to review the current level of evidence in the literature on laparoscopic rectal cancer surgery with regard to short-term and long-term oncologic outcomes. The data from 8 RCTs, 3 metaanalyses, and 2 Cochrane Database of Systematic Reviews was reviewed. Current data suggests that laparoscopic rectal cancer resection may benefit patients with reduced blood loss, earlier return of bowel function, and shorter hospital length of stay. Concerns that laparoscopic rectal cancer surgery compromises short-term oncologic outcomes including number of lymph nodes retrieved and circumferential resection margin and jeopardizes long-term oncologic outcomes has not conclusively been refuted by the available literature. Laparoscopic rectal cancer resection is feasible but whether or not it compromises short-term or long-term results still needs to be further studied.展开更多
The main treatment strategies for chronic pancreatitis in young patients include therapeutic endoscopic retrograde cholangio-pancreatography （ERCP） intervention and surgical intervention. Therapeutic ERCP interventi...The main treatment strategies for chronic pancreatitis in young patients include therapeutic endoscopic retrograde cholangio-pancreatography （ERCP） intervention and surgical intervention. Therapeutic ERCP intervention is performed much more extensively for its minimally invasive nature, but a part of patients are referred to surgery at last. Historical and follow-up data of 21 young patients with chronic pancreatitis undergoing duodenum-preserving total pancreatic head resection were ana- lyzed to evaluate the outcomes of therapeutic ERCP intervention and surgical intervention in this study. The surgical complications of repeated therapeutic ERCP intervention and surgical intervention were 38% and 19% respectively. During the first therapeutic ERCP intervention to surgical intervention, 2 patients developed diabetes, 5 patients developed steatorrhea, and 5 patients developed pancreatic type B pain. During the follow-up of surgical intervention, 1 new case of diabetes occurred, 1 case of stea- torrhea recovered, and 4 cases of pancreatic type B pain were completely relieved. In a part of young patients with chronic pancreatitis, surgical intervention was more effective than therapeutic ERCP in- tervention on delaying the progression of the disease and relieving the symptoms.展开更多
Glioblastoma multiform(GBM)is the most common malignant brain tumor characterized by poor prognosis,increased invasiveness,and high relapse rates.The relative survival estimates are quite low in spite of the standard ...Glioblastoma multiform(GBM)is the most common malignant brain tumor characterized by poor prognosis,increased invasiveness,and high relapse rates.The relative survival estimates are quite low in spite of the standard treatment for GBM in recent years.Now,it has been gradually accepted that the amount of tumor mass removed correlates with longer survival rates.Although new technique advances allowing intraoperative analysis of tumor and normal brain tissue and functional paradigms based on stimulation techniques to map eloquent areas have been used for GBM resection,visual identification of tumor margins still remains a challenge for neurosurgeons.This article attempts to review and summarize the evolution of surgical resection for glioblastomas.展开更多
Background:Myxofibrosarcoma(MFS),especially radiation-Induced MFS(RIMFS)in the head and neck,is an extremely rare malignant fibroblastic tumor.The diagnosis and treatment of MFS remain great challenges.In the present ...Background:Myxofibrosarcoma(MFS),especially radiation-Induced MFS(RIMFS)in the head and neck,is an extremely rare malignant fibroblastic tumor.The diagnosis and treatment of MFS remain great challenges.In the present study,we presented one case of RIMFS.Combined with previous literature,the clinical features,essentials of diagnosis,and treatment modalities of MFS in the head and neck were reviewed to better understand this rare entity.Case presentation:We reported a case of RIMFS under the left occipital scalp in a 20-year-old girl with a history of medulloblastoma surgery and radiotherapy in 2006.A total tumor resection was performed with preservation of the overlying scalp the underlying bone,and no adjuvant therapy was administered after the first operation.The postoperative pathological diagnosis was high-grade MFS.The tumor relapsed 6 months later,and then,a planned extensive resection with negative surgical margins was carried out,followed by radiotherapy.No relapse occurred in a 12-month postoperative follow-up.Conclusions:Planned gross total resection(GTR)with negative margins is the reasonable choice and footstone of other treatments for MFS.Ill-defined infiltrated borders and the complicated structures make it a great trouble to achieve total resection of MFS in the head and neck,so adjuvant radiotherapy and chemotherapy seem more necessary for these lesions.展开更多
基金Supported by National Natural Science Foundation of China,No.82273442.
文摘BACKGROUND Non-alcoholic fatty liver disease(NAFLD)is characterized by the accumulation of fat in the liver in individuals who do not consume alcohol.Several risk factors influencing the onset of NAFLD after laparoscopic pancreaticoduodenectomy(LPD)have been identified.This study investigated the risk factors associated with the development of fatty liver after laparoscopic duodenum-preserving pancreatic total head resection(LDPPHRt)and LPD.AIM To compare the effects of LDPPHRt and LPD on the development of postoperative NAFLD.METHODS This retrospective cohort study included 59 patients who were histologically diagnosed with benign or low-grade malignant pancreatic tumors and who underwent laparoscopic pancreatic surgery(LDPPHRt or LPD)between May 2020 and April 2023.Patient data on perioperative and postoperative variables were analyzed and compared.Multivariate logistic regression was used to identify pre-,peri-,and postoperative risk factors for NAFLD,with statistical significance set at P<0.05.RESULTS Of the 59 patients included in the study,17(28.8%)developed NAFLD within 6-12 months post-surgery.The incidence of NAFLD was significantly higher in the LPD group compared to the LDPPHRt group(40.0%vs 12.5%,P=0.022).Multivariable analysis identified the LDPPHRt surgical approach(compared to LPD)as an independent protective factor against the development of postoperative NAFLD,with an odds ratio of 0.208(95%confidence interval:0.046-0.931;P=0.040).CONCLUSION Our findings indicate that LDPPHRt is more effective than LPD in reducing the incidence of postoperative NAFLD,which may inform surgical decision-making and optimize patient outcomes after laparoscopic pancreatic surgery.
基金supported by grants from the National Natu-ral Science Foundation of China(81302161 and 82003103)the Science and Technology Department of Sichuan Province(2021YFS0375 and 2020YJ0450).
文摘A pancreas surgeon’s constant goal is to do"less damage,more radical".Currently,a small number of highly trained surgeons opt for single-incision laparoscopic pancreaticoduodenectomy(SILPD)or single-incision plus one-port LPD(SILPD+1)to minimize post-operative pain,improve convalescence,and provide a more pleas-ing cosmetic outcome[1,2].Additionally,some skilled surgeons have claimed that laparoscopic duodenum-preserving complete pancreatic head resections(LDPPHR)result in less trauma and en-hanced quality of life[3,4].However,LDPPHR is still challenging because of its lengthy learning curve and"sword-fighting"impact.Additionally,there has not been any global reporting on the suit-ability of single-incision plus one-port DPPHR with pancreaticogas-trostomy(SILDPPHR-T+1)in place of SILPD+1.This study aimed to illustrate the SILDPPHR-T+1 procedure specifics for a patient with pancreatic head intraductal papillary mucinous neoplasm(IPMN)(main pancreatic duct type)(MD-IPMN).
文摘The first-ever case of a 54-year-old woman who overdosed on non-steroidal anti-inflammatory drugs in an attempt at suicide.Before that incident,she had not been treated for coexisting diseases such as rheumatoid arthritis or depression.At the time of admission to the General Surgery Department,the patient reported pains in the epigastric region with accompanying nausea and vomiting with mucous content as well as the inability to ingest food orally.Despite parenteral and enteral feeding,the patient exhibited a drop in body mass.The histopathologic examination of a sample taken from the stomach during gastroscopy showed some non-specific necrotic and inflammatory masses with granulation.Intraoperatively,a very small,infiltrated stomach with an initial section of duodenum was identified.A total stomach resection together with the reconstruction of digestive tract continuity was performed using the Roux-Y method.Histopathologic examination of the stomach revealed a deep,chronic and exacerbated inflammatory condition with an extensive ulceration over the entire length of the stomach,reaching up to the pylorus.Additionally,numerous lymphatic glands with inflammatory reaction changes were observed.
文摘Benign duodenal tumors are rare and less commonthan malignant tumors.Furthermore,vascular lesionsof the duodenum,including hemangiomas,are rarecauses of gastrointestinal bleeding.This report describes a case with bleeding hemangiomas in the thirdportion of the duodenum and jejunum and their successful treatment using a laparoscopic approach.Thereis no report of totally laparoscopic resection for tumorin the third portion of duodenum.After performinga laparoscopic Kocher maneuver,the location of theduodenal hemangioma was confirmed by endoscopicand laparoscopic observation.The lesion was excisedusing ultrasonic coagulating shears and the defect inthe duodenal wall was sutured laparoscopically.Thehemangioma of the jejunum was treated extracorporeally through a 3.0 cm umbilical incision.The operatingtime was 241 min and blood loss was negligible.Thepostoperative course was uneventful.For benign duodenal tumors in the third portion,if endoscopic resection is not adapted,this less invasive technique may be a standard treatment.
基金supported by grants from the Guang dong Natural Science Foundation(S2013010016023)National Natural Science Foundation of China(81572368)+2 种基金Science and Technology Planning Project of Guangdong Province,China(2014A020212084)the Fundamental Research Funds for the Central Universities(12ykpy47 and 12ykpy43)National 12th Five-Year Science and Technology Plan Major Projects of China(2012ZX10002017-005)
文摘BACKGROUND： No staging systems of hepatocellular carcinoma（HCC） are tailored for assessing recurrence risk. We sought to establish a recurrence risk scoring system to predict recurrence of HCC patients receiving surgical curative treatment（liver resection or transplantation）.METHODS： We retrospectively studied 286 HCC patients with preserved liver function receiving liver resection（n=184） or transplantation（n=102）. Independent risk factors were identified to construct the recurrence risk scoring model. The recurrence free survival and discriminatory ability of the model were analyzed. RESULTS： Total tumor volume, HBs Ag status, plasma fibrinogen level were included as independent prognostic factors for recurrence-free survival and used for constructing a 3-factor recurrence risk scoring model. The scoring model was as follows： 0.758×HBs Ag status（negative： 0; positive： 1）＋0.387×plasma fibrinogen level（≤3.24 g/L： 0; 〉3.24 g/L： 1）＋0.633×total tumor volume（≤107.5 cm3： 0; 〉107.5 cm3： 1）. The cutoff value was set to 1.02, and we defined the patients with the score ≤1.02 as a low risk group and those with the score 〉1.02 as a high risk group. The 3-year recurrence-free survival rate was significantly higher in the low risk group compared with that in the high risk group（67.9% vs 41.3%, P〈0.001）. In the subgroup analysis, liver transplantation patients had a better3-year recurrence-free survival rate than the liver resection patients in the low risk group（80.0% vs 64.0%, P〈0.01）. Additionally for patients underwent liver transplantation, we compared the recurrence risk model with the Milan criteria in the prediction of recurrence, and the 3-year recurrence survival rates were similar（80.0% vs 79.3%, P=0.906）.CONCLUSION： Our recurrence risk scoring model is effective in categorizing recurrence risks and in predicting recurrencefree survival of HCC before potential surgical curative treatment.
文摘The purpose of this study was to analyze the clinical efficacy of laparoscopic total mesorectal excision for the treatment of middle and low rectal cancer.First,30 patients who received treatment in the hospital from March 2013 to May 2018 were randomly selected as the laparotomy group to receive laparotomy.30 patients who received treatment in the hospital from March 2013 to May 2018 were randomly selected as the laparoscopic group to receive laparoscopic surgery.The postoperative and complications of total rectal mesorectal excision were compared between the two groups.The results showed that the amount of blood loss during laparoscopy was(169.36±106.96)mL,and that during laparoscopy was(180.65±153.22)mL,which was significantly lower than that of the open group(209.65±186.65)mL and(356.54±170.32)mL.Intraoperative blood loss in laparoscopic patients was significantly lower than that in the open group,and the difference was statistically significant(t=2.95,2.87,P<0.05).The duration of anal sparing surgery in the laparoscope group was(232.65±56.35)min,which was longer than that in the laparoscope group(227.65±68.65)min.The duration of non-sparing anal surgery in the laparoscopic group was(246.95±52.65)min,which was significantly shorter than that in the open group(299.65±64.32)min.There was no statistically significant difference in the duration of operation between the laparoscopic group and the open group.The recovery time of intestinal function in the laparoscopic group was(2.11±1.82)days,which was significantly shorter than that in the open group(4.63±1.52)days.The postoperative hospital stay in the laparoscopic group was(11.32±10.01)d,which was significantly shorter than that in the open group(26.62±12.43 d).The recovery time of intestinal function and postoperative hospital stay of patients in the laparoscopic group were shorter than those in the open group,with statistically significant differences(T=2.31,2.43,P<0.05).The tumor diameter was(4.03±1.20)cm in the laparoscopic group and(3.95±1.43)cm in the open group.The number of lymph nodes in the laparoscopic group was(12.75±6.51)cm,while that in the open group was(13.62±7.05).There was no significant difference in the number of lymph nodes dissected or tumor diameter between the two groups(t=0.11,0.22,P>0.05).The complication rate of the abdominal group was 20.00%,significantly lower than that of the open group(66.67%).Complications after total mesorectal resection were significantly higher in the open group than in the laparoscopic group,and the difference between the two groups was statistically significant(χ2=13.30,P<0.05).Therefore,laparoscopic total rectal mesorectal resection for patients with middle and low rectal cancer is safer and can be used as a reliable treatment plan.
文摘AIM:To evaluate the results of hepatic resection with ex-situ hypothermic perfusion and without veno-venous bypass.METHODS:In 3 patients with liver tumor,the degree of the inferior vena cava and/or main hepatic vein involvement was verified when the liver was dissociated in the operation.It was impossible to resect the tumors by the routine hepatectomy,so the patients underwent ex-situ liver surgery,vein cava replacement and hepatic autotransplantation without veno-venous bypass.All surgical procedures were carried out or supervised by a senior surgeon.A retrospective analysis was performed for the prospectively collected data from patients with liver tumor undergoing ex-situ liver surgery,vein cava replacement and hepatic autotransplantation without veno-venous bypass.We also compared our data with the 9 cases of Pichlmayr's group.RESULTS:Three patients with liver tumor were analysed.The first case was a 60-year-old female with a huge haemangioma located in S1,S4,S5,S6,S7 and S8 of liver;the second was a 64-year-old man with cholangiocarcinoma in S1,S2,S3 and S4 and the third one was a 55-year-old man with a huge cholangiocarcinoma in S1,S5,S7 and S8.The operation time for the three patients were 6.6,6.4 and 7.3 h,respectively.The anhepatic phases were 3.8,2.8 and 4.0 h.The volume of blood loss during operation were 1200,3100,2000 mL in the three patients,respectively.The survival periods without recurrence were 22 and 17 mo in the first two cases.As for the third case complicated with postoperative hepatic vein outflow obstruction,emergency hepatic vein outflow extending operation and assistant living donor liver transplantation were performed the next day,and finally died of liver and renal failure on the third day.Operation time(6.7 ± 0.47 h vs 13.7 ± 2.6 h) and anhepatic phase(3.5 ± 0.64 h vs 5.7 ± 1.7 h) were compared between Pichlmayr's group and our series(P = 0.78).CONCLUSION:Ex-situ liver resection and liver autotransplantation has shown a potential for treatment of complicated hepatic neoplasms that are unresectable by traditional procedures.
文摘Large comparative studies and multiple prospective randomized control trials (RCTs) have reported equivalence in short and long-term outcomes between the open and laparoscopic approaches for the surgical treatment of colon cancer which has heralded widespread acceptance for laparoscopic resection of colon cancer. In contrast, laparoscopic total mesorectal excision (TME) for the treatment of rectal cancer has been welcomed with significantly less enthusiasm. While it is likely that patients with rectal cancer will experience the same benefits of early recovery and decreased postoperative pain from the laparoscopic approach, whether the same oncologic clearance, specifically an adequate TME can be obtained is of concern. The aim of the current study is to review the current level of evidence in the literature on laparoscopic rectal cancer surgery with regard to short-term and long-term oncologic outcomes. The data from 8 RCTs, 3 metaanalyses, and 2 Cochrane Database of Systematic Reviews was reviewed. Current data suggests that laparoscopic rectal cancer resection may benefit patients with reduced blood loss, earlier return of bowel function, and shorter hospital length of stay. Concerns that laparoscopic rectal cancer surgery compromises short-term oncologic outcomes including number of lymph nodes retrieved and circumferential resection margin and jeopardizes long-term oncologic outcomes has not conclusively been refuted by the available literature. Laparoscopic rectal cancer resection is feasible but whether or not it compromises short-term or long-term results still needs to be further studied.
文摘The main treatment strategies for chronic pancreatitis in young patients include therapeutic endoscopic retrograde cholangio-pancreatography （ERCP） intervention and surgical intervention. Therapeutic ERCP intervention is performed much more extensively for its minimally invasive nature, but a part of patients are referred to surgery at last. Historical and follow-up data of 21 young patients with chronic pancreatitis undergoing duodenum-preserving total pancreatic head resection were ana- lyzed to evaluate the outcomes of therapeutic ERCP intervention and surgical intervention in this study. The surgical complications of repeated therapeutic ERCP intervention and surgical intervention were 38% and 19% respectively. During the first therapeutic ERCP intervention to surgical intervention, 2 patients developed diabetes, 5 patients developed steatorrhea, and 5 patients developed pancreatic type B pain. During the follow-up of surgical intervention, 1 new case of diabetes occurred, 1 case of stea- torrhea recovered, and 4 cases of pancreatic type B pain were completely relieved. In a part of young patients with chronic pancreatitis, surgical intervention was more effective than therapeutic ERCP in- tervention on delaying the progression of the disease and relieving the symptoms.
文摘Glioblastoma multiform(GBM)is the most common malignant brain tumor characterized by poor prognosis,increased invasiveness,and high relapse rates.The relative survival estimates are quite low in spite of the standard treatment for GBM in recent years.Now,it has been gradually accepted that the amount of tumor mass removed correlates with longer survival rates.Although new technique advances allowing intraoperative analysis of tumor and normal brain tissue and functional paradigms based on stimulation techniques to map eloquent areas have been used for GBM resection,visual identification of tumor margins still remains a challenge for neurosurgeons.This article attempts to review and summarize the evolution of surgical resection for glioblastomas.
文摘Background:Myxofibrosarcoma(MFS),especially radiation-Induced MFS(RIMFS)in the head and neck,is an extremely rare malignant fibroblastic tumor.The diagnosis and treatment of MFS remain great challenges.In the present study,we presented one case of RIMFS.Combined with previous literature,the clinical features,essentials of diagnosis,and treatment modalities of MFS in the head and neck were reviewed to better understand this rare entity.Case presentation:We reported a case of RIMFS under the left occipital scalp in a 20-year-old girl with a history of medulloblastoma surgery and radiotherapy in 2006.A total tumor resection was performed with preservation of the overlying scalp the underlying bone,and no adjuvant therapy was administered after the first operation.The postoperative pathological diagnosis was high-grade MFS.The tumor relapsed 6 months later,and then,a planned extensive resection with negative surgical margins was carried out,followed by radiotherapy.No relapse occurred in a 12-month postoperative follow-up.Conclusions:Planned gross total resection(GTR)with negative margins is the reasonable choice and footstone of other treatments for MFS.Ill-defined infiltrated borders and the complicated structures make it a great trouble to achieve total resection of MFS in the head and neck,so adjuvant radiotherapy and chemotherapy seem more necessary for these lesions.
