AIM: To investigate the safety and feasibility of needlescopic grasper-assisted single-incision laparoscopic common bile duct exploration(n SIL-CBDE) by comparing the surgical outcomes of this technique with those of ...AIM: To investigate the safety and feasibility of needlescopic grasper-assisted single-incision laparoscopic common bile duct exploration(n SIL-CBDE) by comparing the surgical outcomes of this technique with those of conventional laparoscopic CBDE(CL-CBDE).METHODS: We retrospectively analyzed the clinical data of patients who underwent CL-CBDE or n SILCBDE for the treatment of common bile duct(CBD) stones between January 2000 and December 2014. For performing n SIL-CBDE, a needlescopic grasper was also inserted through a direct puncture below the right subcostal line after introducing a single-port through the umbilicus. The needlescopic grasper helped obtain the critical view of safety by retracting the gallbladder laterally and by preventing crossing or conflict between laparoscopic instruments. The gallbladder was then partially dissected from the liver bed and used for retraction. CBD stones were usually extracted through a longitudinal supraduodenal choledochotomy, mostly using flushing a copious amount of normal saline througha ureteral catheter. Afterward, for the certification of CBD clearance, CBDE was performed mostly using a flexible choledochoscope. The choledochotomy site was primarily closed without using a T-tube, and simultaneous cholecystectomies were performed.RESULTS: During the study period, 40 patients underwent laparoscopic CBDE. Of these patients, 20 underwent CL-CBDE and 20 underwent n SIL-CBDE. The operative time for n SIL-CBDE was significantly longer than that for CL-CBDE(238 ± 76 min vs 192 ± 39 min, P = 0.007). The stone clearance rate was 100%(40/40) in both groups. Postoperatively, the n SIL-CBDE group required less intravenous analgesic(pethidine)(46.5 ± 63.5 mg/kg vs 92.5 ± 120.1 mg/kg, P = 0.010) and had a shorter hospital stay than the CL-CBDE group(3.8 ± 2.0 d vs 5.1 ± 1.7 d, P = 0.010). There was no significant difference in the incidence of postoperative complications between the two groups.CONCLUSION: The results of this study suggest that n SIL-CBDE could be safe and feasible while improving cosmetic outcomes when performed by surgeons trained in conventional laparoscopic techniques.展开更多
Objective: to explore the value of ADC and relative ADC (rADC) in differentiating non lumpy mastitis from non lumpy invasive ductal carcinoma. Methods: 39 cases of breast lesions confirmed by pathology in Cangzhou Peo...Objective: to explore the value of ADC and relative ADC (rADC) in differentiating non lumpy mastitis from non lumpy invasive ductal carcinoma. Methods: 39 cases of breast lesions confirmed by pathology in Cangzhou Peoples Hospital from January 2015 to January 2021 were retrospectively analyzed, including 19 cases of non lumpy mastitis and 20 cases of non lumpy invasive ductal carcinoma. Use Philips ingenia 3.0T superconducting MR scanner to scan, measure the ADC value of the lesion area and its ipsilateral breast normal gland, and calculate the rADC value (lesion ADC value / ipsilateral breast normal gland ADC value). Do independent sample t-test for the ADC value of non lumpy mastitis group and non lumpy invasive ductal carcinoma group, non lumpy mastitis group rADC value and non lumpy invasive ductal carcinoma group rADC value respectively, and draw the ROC curve. Results: ADC value of non lumpy mastitis group was (1.32 ± 0.25) × 10-3mm2/s, ADC value of non mass invasive ductal carcinoma group (0.98 ± 0.13) × 10- 3mm2/s(t 5.179,P <0.001);RADC value in non lumpy mastitis group was 0.73 ± 0.18, and rADC value in non lumpy invasive ductal carcinoma group was 0.55 ± 0.11 (t 3.764, P < 0.001). The best diagnostic cut-off point of ADC value is 1.15 × 10-3mm2/s, the area under the ROC curve is 0.911, the sensitivity is 78.9%, the specificity is 95%, the best diagnostic dividing point of rADC value is 0.655, the area under the ROC curve is 0.791, the sensitivity is 68.4%, and the specificity is 90%. Conclusion: ADC value and rADC value can be used to distinguish non lumpy mastitis from non lumpy invasive ductal carcinoma, and the diagnostic accuracy of ADC value is higher.展开更多
文摘AIM: To investigate the safety and feasibility of needlescopic grasper-assisted single-incision laparoscopic common bile duct exploration(n SIL-CBDE) by comparing the surgical outcomes of this technique with those of conventional laparoscopic CBDE(CL-CBDE).METHODS: We retrospectively analyzed the clinical data of patients who underwent CL-CBDE or n SILCBDE for the treatment of common bile duct(CBD) stones between January 2000 and December 2014. For performing n SIL-CBDE, a needlescopic grasper was also inserted through a direct puncture below the right subcostal line after introducing a single-port through the umbilicus. The needlescopic grasper helped obtain the critical view of safety by retracting the gallbladder laterally and by preventing crossing or conflict between laparoscopic instruments. The gallbladder was then partially dissected from the liver bed and used for retraction. CBD stones were usually extracted through a longitudinal supraduodenal choledochotomy, mostly using flushing a copious amount of normal saline througha ureteral catheter. Afterward, for the certification of CBD clearance, CBDE was performed mostly using a flexible choledochoscope. The choledochotomy site was primarily closed without using a T-tube, and simultaneous cholecystectomies were performed.RESULTS: During the study period, 40 patients underwent laparoscopic CBDE. Of these patients, 20 underwent CL-CBDE and 20 underwent n SIL-CBDE. The operative time for n SIL-CBDE was significantly longer than that for CL-CBDE(238 ± 76 min vs 192 ± 39 min, P = 0.007). The stone clearance rate was 100%(40/40) in both groups. Postoperatively, the n SIL-CBDE group required less intravenous analgesic(pethidine)(46.5 ± 63.5 mg/kg vs 92.5 ± 120.1 mg/kg, P = 0.010) and had a shorter hospital stay than the CL-CBDE group(3.8 ± 2.0 d vs 5.1 ± 1.7 d, P = 0.010). There was no significant difference in the incidence of postoperative complications between the two groups.CONCLUSION: The results of this study suggest that n SIL-CBDE could be safe and feasible while improving cosmetic outcomes when performed by surgeons trained in conventional laparoscopic techniques.
文摘Objective: to explore the value of ADC and relative ADC (rADC) in differentiating non lumpy mastitis from non lumpy invasive ductal carcinoma. Methods: 39 cases of breast lesions confirmed by pathology in Cangzhou Peoples Hospital from January 2015 to January 2021 were retrospectively analyzed, including 19 cases of non lumpy mastitis and 20 cases of non lumpy invasive ductal carcinoma. Use Philips ingenia 3.0T superconducting MR scanner to scan, measure the ADC value of the lesion area and its ipsilateral breast normal gland, and calculate the rADC value (lesion ADC value / ipsilateral breast normal gland ADC value). Do independent sample t-test for the ADC value of non lumpy mastitis group and non lumpy invasive ductal carcinoma group, non lumpy mastitis group rADC value and non lumpy invasive ductal carcinoma group rADC value respectively, and draw the ROC curve. Results: ADC value of non lumpy mastitis group was (1.32 ± 0.25) × 10-3mm2/s, ADC value of non mass invasive ductal carcinoma group (0.98 ± 0.13) × 10- 3mm2/s(t 5.179,P <0.001);RADC value in non lumpy mastitis group was 0.73 ± 0.18, and rADC value in non lumpy invasive ductal carcinoma group was 0.55 ± 0.11 (t 3.764, P < 0.001). The best diagnostic cut-off point of ADC value is 1.15 × 10-3mm2/s, the area under the ROC curve is 0.911, the sensitivity is 78.9%, the specificity is 95%, the best diagnostic dividing point of rADC value is 0.655, the area under the ROC curve is 0.791, the sensitivity is 68.4%, and the specificity is 90%. Conclusion: ADC value and rADC value can be used to distinguish non lumpy mastitis from non lumpy invasive ductal carcinoma, and the diagnostic accuracy of ADC value is higher.
