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From August 2019 to December 2019, 74 patients with choledocholithiasis underwent laparoscopic lithotomy, including 68 cases with primary suture of common bile duct and 6 cases with T-tube drainage. The operation time, postoperative length of hospital stay, hospitalization cost and complications of the two groups were compared. The operation time and length of postoperative hospital stay in primary suture were shorter than those in T-tube drainage group[ (88.1±29.9) min vs. (144.2±30.7) min; (3.9±1.5) d vs. (7.2±3.8) d, both P<0.05]; the hospitalization cost was lower[ (29 578±1 072) Yuan vs. (37 468±2 844) Yuan, P<0.05]. There was no significant difference in the incidence of postoperative complications between two groups ( P>0.05). The primary suture seems to be superior to T-tube drainage in laparoscopic lithotomy, however, two methods have different indications and should be selected according to the individual conditions of patients.
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Objective:To discuss the surgical approach and the clinical effect of laparoscopic enucleation for hepatic hemangioma(HH).Methods:Forty HH patients admitted in the Third Affiliated Hospital of Soochow University between Aug 2018 and Dec 2019 were analyzed. The technical knowhow involved is to make a good explosure of the pseudocapsular HH from underneath. Herewith a process of HH enucleatoin started.Results:All the 40 patients undergone total laparoscopic hepatectomy successfully.The operative time was (90.3±32.3)min, the intraoperative blood loss was (50±500)ml, the time of hepatic block was (12.5±35.4) min. The volume of postoperative drainage was 10-150 ml on the first postoperative day, and was gradually reduced to <30 ml on the third day after the operation. All patients were up and about from post-op day 2. The length of stay after operation was (5.5±2.7)d. There were significant differences in ALT、AST、TBIL and prealbumin in 1 and 3 days after surgery (seperately, t=-5.481, -4.182, -2.235, 9.722, all P<0.05), before back to normal on day 7 (seperately t=0.167, -1.392, 1.000, -2.531, all P>0.05). Liver function recovered to normal in 7 days after surgery. Conclusion:New approach breaks the traditional stripping method and makes the procedure simple, safe, lessly disturb the liver function.
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Objective:To evaluate partial splenectomy (LPS) in the treatment of benign solid tumors of the spleen.Methods:The clinical data of patients with benign solid tumors of spleen treated by laparoscopy from Jan 2010 to Jun 2018 in the Third Affiliated Hospital of Soochow University was retrospectively analyzed. Patients were divided into LPS group and laparoscopic total splenectomy (LTS) group.Results:There were 21 cases in LPS group and 25 cases in LTS group. Differences between the two groups, operative time, blood loss, transfusion rate, maintenance of drain, postoperative hospital stay, costs, postoperative WBC and platelet count, and postoperative complications such as hemorrhage, fever, splenic fossa effusion, pancreatic fistula, venous thrombosis were statistically insignificant. However, the postoperative incidence of thrombocythemia in the LPS group were significantly lower compared to the LTS group (χ 2 =4.293, P<0.05). Conclusions:Patients with benign solid tumors of the spleen will benefit more from LPS compared to LTS.
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Objective:To compare the efficacy and safety of intermittent regional hepatic vascular inflow occlusion with Pringle’s maneuvre for laparoscopic anterior sectionectomy.Methods:From January 2014 to December 2018, 54 patients who underwent laparoscopic right anterior sectionectomy at the Department of Hepatopancreatobiliary Surgery, the Third Affiliated Hospital, Soochow University were recruited into this study. The patients were 40 to 60 years old, and 27 were males and 27 females. Intermittent regional hepatic vascular inflow occlusion was carried out in 24 patients (the intermittent occlusion group). The remaining patients underwent Pringle’s maneuvre (the Pringle group). Postoperative liver function, intraoperative blood loss, intraoperative blood transfusion, operation time and postoperative complications between the two groups were compared.Results:Intraoperative hemorrhage and blood transfusion of the Pringle group (534±42)ml, (2.88±0.54)U were significantly higher than the intermittent occlusion group (374±21)ml, (1.86±0.29)U (all P<0.05). The operation time of the Pringle group was significantly shorter than the intermittent occlusion group ( P<0.05). Two patients developed CO 2 embolism in each group, which led to 2 patients in the intermittent occlusion group being converted to open operations. Postoperative hepatic function (except albumin) of the intermittent occlusion group was significantly better than the Pringle group, while the hospital stay of the intermittent occlusion group was significantly shorter than the Pringle group (all P<0.05). Six patients (25.0%) developed postoperative complications in the intermittent occlusion group versus 8 (26.7%) in the Pringle group ( P>0.05). Conclusion:Intermittent regional hepatic vascular inflow occlusion reduced intra-operative hemorrage and hepatic impairment, and shortened hospital stay. However, it required higher operation skills and it should gradually be promoted.
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Objective To evaluate regional left sided in and out flow hepatic flow occlusion in laparoscopic left hemi-hepatectomy compared with in hepatic flow occlusion.Methods From Jan.2016 to Dec.2017,34 patients underwent laparoscopic left hemi-hepatectomy with regional hepatic in-out flow occlusion.Results were compared with 52 patients undergoing laparoscopic left hemi-hepatectomy under leftsided hepatic inflow occlusion only.Results Compared to hepatic inflow occlusion,regional hepatic in and out flow occlusion in laparoscopic left hemi-hepatectomy lead to a 0.46 hour longer operation time,20 ml less intraoperative blood loss and 0.62U less blood transfusion,reduced hepatic function impairment and 1.41 days shorter hospital stay.Conclusions Regional hepatic in-out flow occlusion in laparoscopic left hemi-hepatectomy can reduce intraoperative hemorrhage and lower the risk of CO2 embolism.
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Objective To explore the safety,feasibility,clinical efficacy and prognosis of gallbladder carcinoma treated by laparoscopy.Methods The clinical data of 43 patients with gallbladder carcinoma treated by laparoscopy radical cholecystectomy from Jan 2010 to Oct 2017 in the Third Affiliated Hospital of Soochow University were retrospectively analyzed.Results 15 cases underwent simple laparoscopic cholecystectomy,13 cases underwent laparoscopic cholecystectomy + lymphadenectomy and 15 cases underwent laparoscopic cholecystectomy + liver wedge resection + lymphadenectomy.The average operation time was (64 ± 32) min,(100 ± 45) min,and (217 ± 74) min,respectively.The average intraoperative blood loss was (67 ± 83) ml,(58 ± 63) ml and (182 ± 165) ml.The average postoperative hospital stay was (4.3 ± 2.2) days,(5.2 ± 2.0) days,(7.0 ± 1.7) days.All patients were diagnosed as gallbladder carcinoma by postoperative pathology.The median follow-up time was 14.5 months (range from 3 to 97 months).The cumulative survival rates of Tis,T1b,T2 and T3 stage were 100％,90％,52.7％ and 0,respectively (x2 =25.333,P ＜ 0.05).Conclusions It is safe and feasible to treat early gallbladder carcinoma by laparoscopy.
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Objective@#To study the learning curve of laparoscopic pacreaticoduodenectomy (LPD) with a view to find an appropriate way to develop LPD step by step.@*Methods@#112 consecutive patients who completely underwent LPD in a single surgery center at the First People’s Hospital of Changzhou from December 2015 to February 2018 were retrospectively reviewed. By using both the cumulative sum (CUSUM) and the risk-adjusted CUSUM (RA-CUSUM) methods to analyze the perioperative data of these patients, the learning curve of LPD was studied in a more scientific way.@*Results@#The learning curve could be divided into three phases: Phase 1, the initial period (the initial 45 patients); Phase 2, the enhancement period (the subsequent 31 patients); Phase 3, the maturation period (the remaining patients). For these 3 phases, the corresponding operative times were (448.4±75.0), (381.3±74.3), and (336.2±52.1) min, respectively (P<0.05). The intraoperative blood losses were (373.3±250.1), (332.3±211.6), and (265.3±253.2) ml, respectively (P<0.05). The times to oral intake were 6.0(5.0, 8.0), 5.0(3.0, 6.0), and 3.0(3.0, 5.0) days, respectively (P<0.05). The number of lymph nodes harvested were (10.0±7.0), (8.8±4.3), and (13.3±6.2), respectively (P<0.05). All these showed significant improvement through the 3 phases. On the other hand, the postoperative stays, the postoperative pancreatic fistula rates were also decreased. But these failed to reach statistical significance. Vascular reconstruction was carried out in the 48th patient in phase 2 of the study.@*Conclusions@#The initial phase of LPD passed after LPD for 46 patients, but the maturation phase occurred after LPD on 76 patients. Vascular reconstruction should be considered as passing through the learning phase rather than reaching the maturity phase. Adjustments made in the enhancement phase helped to get through the maturation phase earlier.
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Objective To study the learning curve of laparoscopic pacreaticoduodenectomy ( LPD) with a view to find an appropriate way to develop LPD step by step. Methods 112 consecutive patients who completely underwent LPD in a single surgery center at the First People ' s Hospital of Changzhou from December 2015 to February 2018 were retrospectively reviewed. By using both the cumulative sum ( CUSUM) and the risk-adjusted CUSUM ( RA-CUSUM) methods to analyze the perioperative data of these patients, the learning curve of LPD was studied in a more scientific way. Results The learning curve could be divided into three phases:Phase 1, the initial period (the initial 45 patients);Phase 2, the enhancement period (the subsequent 31 patients);Phase 3, the maturation period (the remaining patients). For these 3 phases, the corresponding operative times were (448. 4 ± 75. 0), (381. 3 ± 74. 3), and (336. 2 ± 52. 1) min, respectively (P<0. 05). The intraoperative blood losses were (373. 3 ± 250. 1), (332. 3 ± 211. 6), and (265. 3 ± 253. 2) ml, respectively (P<0. 05). The times to oral intake were 6. 0(5. 0,8. 0), 5. 0 (3. 0,6. 0), and 3. 0(3. 0,5. 0) days, respectively (P<0. 05). The number of lymph nodes harvested were (10. 0 ± 7. 0), (8. 8 ± 4. 3), and (13. 3 ± 6. 2), respectively (P<0. 05). All these showed signifi-cant improvement through the 3 phases. On the other hand, the postoperative stays, the postoperative pan-creatic fistula rates were also decreased. But these failed to reach statistical significance. Vascular reconstruction was carried out in the 48th patient in phase 2 of the study. Conclusions The initial phase of LPD passed after LPD for 46 patients, but the maturation phase occurred after LPD on 76 patients. Vascular reconstruction should be considered as passing through the learning phase rather than reaching the maturity phase. Adjustments made in the enhancement phase helped to get through the maturation phase earlier.
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Objective@#To compare the clinical application of three-dimensional laparoscopic pancreatoduodenectomy (3D-LPD) with that of two-dimensional laparoscopic pancreatoduodenectomy (2D-LPD), and to explore the safety and feasibility of 3D-LPD.@*Methods@#A retrospective analysis was made from the data of 45 patients with 3D-LPD and 45 patients with 2D-LPD who underwent total laparoscopic pancreatoduodenectomy from March 2017 to August 2018 at Department of Hepato-Pancreato-Biliary Surgery, the First People′s Hospital of Changzhou.The differences of intraoperative conditions, postoperative complications and postoperative pathological findings between the two methods were compared.Measurement data were compared with independent sample t-test, enumeration data were statistically analyzed with Chi-square test or Fisher exact probability.@*Results@#The operation time of 3D-LPD group was shorter than that of 2D-LPD group ((335±95) min vs. (419±113) min, t=-3.817, P=0.000), which mainly showed that the time of digestive tract reconstruction was reduced ((92±26) min vs. (131±46) min, t=-4.951, P=0.000). The intraoperative blood loss in the 3D-LPD group was significantly less than that in the 2D-LPD group ((242±124) ml vs. (350±176) ml, t=-3.365, P=0.001), and the perioperative blood transfusion in the 3D-LPD group was significantly less than that in the 2D-LPD group (χ2=4.444, P=0.035). Postoperative hospitalization days and ICU stay time were not significantly different between the two groups(both P>0.05). Postoperative complications such as pancreatic fistula, biliary fistula, postoperative bleeding, gastric emptying disorders, abdominal infection, were not significantly different between the two groups(all P>0.05).@*Conclusions@#The operation time of 3D-LPD is shorter than that of 2D-LPD, and the amount of bleeding is less. Short-term clinical data showed that, 3D-LPD is effective, safe and worth popularizing.
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Objective@#To evaluate the clinical significance of C-reactive protein/albumin ratio in predicting the postoperative prognosis of pancreatic cancer patients.@*Methods@#The clinical date of 97 patients with resectable pancreatic cancers who treated at Department of Hepatobiliary and Pancreatic Surgery, the third Affiliated Hospital of Soochow University from January 2005 to December 2015 were analyzed retrospectively. The cut-off value of CRP/Alb ratio was determined by the receiver operating characteristic(ROC) curve. According to the CRP/Alb ratio, patients were respectively divided into two groups: the high group(CRP/Alb ratio≥0.109) and the low group(CRP/Alb<0.109). The relationships between CRP/Alb ratio and clinical characteristics were analyzed by χ2 test. Median survival and 1-year overall survival rate(OS) was calculated by Kaplan-Meier method.The risk factors of patients with poor prognosis were analyzed by univariate and multivariate Cox regression analysis model.@*Results@#Tumor TNM stage(χ2=4.280, P=0.039) and differentiation(χ2=6.635, P=0.010) had significant relationship with CRP/Alb ratio. The median survival of higher CRP/Alb ratio group and lower CRP/Alb ratio group was 15 months and 23 months respectively. Compared with lower CRP/Alb ratio group, the 1-year OS of higher CRP/Alb ratio group decreased remarkablely, and the difference was statistically(χ2=10.207, P=0.001). Moreover, median survival and OS were decreased in patients with advanced age(≥65 years old: χ2 =5.338, P=0.021), high TNM stage(ⅡB-Ⅲ: χ2 =10.529, P=0.001), poor tumor differentiation(χ2=5.380, P=0.020), vascular invasion(χ2 =7.856, P=0.005) and positive surgical margin(χ2=9.059, P=0.003). A high CRP/Alb ratio was identified as an independent risk factor of poor prognosis for patients with pancreatic cancer(HR=1.832, 95% CI: 1.067-3.144, P=0.028). Besides, old age(HR=1.684, P=0.014), high TNM stage(HR=1.666, P=0.031), vascular invasion(HR=1.834, P=0.024) and positive surgical margin(HR=2.205, P=0.023) were also included.@*Conclusion@#Preoperative CRP/Alb ratio can be an important clinical factor for assessing the prognosis of patients with resectable pancreatic cancers, and high CRP/Alb ratio suggests poor prognosis.
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Objective To study the diagnosis and treatment of CO2 embolism in laparoscopic hepatectomy (LH).Methods A retrospective study was conducted on 80 patients who underwent various types of LH from June 2016 to November 2017.The clinical data of 4 patients who suffered from severe CO2 embolism were analyzed.Results The operation time of 80 patients varied from 65 min to 345 min (average 170 min).Tbe amount of blood loss ranged from 50 ml to 2 500 ml (average 450 ml).28 patients (35％) required blood transfusion.Two patients were converted to open operation because of uncontrollable bleeding.Four patients suffered from severe CO2 embolism with significant changes in circulation and respiration.After active and effective treatment,none required open conversion and all recovered well.Conclusions Any sudden respiratory and circulatory changes during LH should lead us to think of severe CO2 embolism.Timely and effective treatment could convert a dangerous situation to become safe.
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Objective To investigate the strategies in dealing with intraoperative CO2 embolizm during Laparoscopic hepatectomy (LH).Methods We collected and analyzed data from patients who underwent laparoscopic hepatectomy (LH) in our hospital from Jan.2013 to Aug.2017.There were 321 patients.The criteria for the diagnosis of CO2 embolism were rapid intraoperative decrease in petCO2 and SPO2 accompanied with tachyarrhythmia.Results 12 patients were diagnosed to have CO2 embolism.The rate was 3.7％.For these 12 patients,10 patients were dealt with laparoscopically and 2 patients were converted to open surgery.Conclusion CO2 embolism did not rarely occur in LH patients.Sophisticated operations and careful manipulation in LH are the only ways to prevent CO2 embolism.
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Objective Hepatocellular carcinoma with bile duct tumor thrombus (BDTT) is rare,and surgical treatment is currently considered as the most effective treatment.Whether resectional surgery should be carried out on these patients remains controversial.Therefore,this Meta-analysis aimed to find out the long-term survival after resectional surgical treatment.Methods We conducted a literature search on PubMed,Embase and Web of Science from inception to September 2016.11 studies were included which involved 5295 patients.Each study was evaluated using the Newcastle-Ottawa Scale.The pooled effect was calculated and the associations between BDTT and overall survival (OS) or disease-free survival (DFS)were reevaluated using Meta-analysis with hazard ratio (HR) and 95％ confidence interval (CI).Results The HR for OS and DFS was 2.34 and 1.81,the 95％ CI were 1.26 ～ 4.36 and 1.17 ～ 2.78,respectively.Conclusion HCC patients with BDTT had a bad prognosis after hepatic resection or liver transplantation.
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Chemokines participate in many biological functions including immune inflammatory response,various metabolic reactions and damage stress response.Meanwhile,they also play a crucial role in the process of tumor progression including regulating tumor proliferation,invasion and metastasis,and mediating immune cells infiltration and angiogenesis in tumor tissue as well as the tolerance to antitumor treatment.Pancreatic cancer is one of the highly malignant digestive system neoplasms with relatively high risk of early local invasion and distant metastasis,resulting in high mortality.At present,the specific mechanism of the development of pancreatic cancer has not been clarified yet.In recent years,the role of chemokine CXC (chemokine subfamily) and its receptor CXCR (CXC chemokine receptors) in pancreatic cancer has become a hot research topic and great progress has been made in this field.This paper overviewed the recent research advance on the functions of chemokine CXC and their receptors in pancreatic cancer.
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Background and purpose:Thyroid carcinoma is a common endocrine tumor with an incidence that has increased over recent decades. The aim of the present study was to investigate the effectiveness of carbon nano-par-ticles-labeled lymph nodes in neck dissection for papillary thyroid cancer (PTC), focusing on the protectiveness for the recurrent laryngeal nerve (RLN) and parathyroid glands.Methods:Forty-eight patients with PTC treated from Apr. to Aug. 2015 were randomly divided into two groups. Group A patients (24 patients) were treated with lobectomy/total thyroidectomy plus unilateral/bilateral central lymph node dissection by conventional meticulous capsular dissection technique; Group B patients (24 patients) were treated with the same surgical procedures as group A, 5 min after the injection of carbon nano-particles. The operative time, intra-operative blood loss, incidence of RLN injury, incidence of transient hypocalcemia, the number of total lymph nodes and the ratio of metastatic nodes were collected and analyzed. Results:For unilateral lobectomy, the number of lymph nodes in group B was signiifcantly greater than that in group A (P<0.05). For total thyroidectomy, the operative time, and the incidence of transient hypocalcemia in group B were both lower than those in group A (P<0.05), and the number of total lymph nodes was signiifcantly higher than that in group A (P<0.05). In group B, the ratio of metastatic nodes were 26.7% (unilateral) and 33.3% (bilateral) in stained lymphnodes, and 11.8% and 25.9% in non-stained lymph nodes.Conclusion:The carbon nano-particles-labeled lymph nodes in neck dissection could facilitate to protect parathyroids and increase the number of lymph nodes, especially in total thyroidectomy plus bilateral central lymph node dissection.
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Objective To summarize the experience of the prevention and treatment of iatrogenic hypo-parathyroidism in total thyroidectomy .Methods 377 patients received total thyroidectomy performed by the Thy-roid Professional Group of Hepatobiliary Surgery Department of the Third Affiliated Hospital of Soochow University from Jan.2010 to Dec.2012.Their clinical date were retrospectively analyzed .Results There was no perma-nent postoperative hypoparathyroidism .The incidence of temporary hypoparathyroidism was 13.79%( 52/377 ) . The occurrence of transient hypocalcemia was 10.61%( 40/377 ) .Conclusions Iatrogenic hypoparathyroidism can be prevented by intraoperative in situ protection of parathyroid glands and their blood supply using fine cap -sule anatomy method .Postoperative improvement of microcirculation and calcium supplement also help prevent postoperative hypoparathyroidism .
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Objective To investigate the safety, feasibility and results of laparoscopic assisted distal radical gastrectomy for gastric cancer. Methods Twenty-three cases of gastric cancer were subjected to laparoscopic assisted distal radical gastrectomy, D_(1+α)/D_(1+β) lymphadenectomy on 3 cases and D_2 lymphadenectomy on 20 cases. All cases received Billroth I reconstruction. Results Laparoscopic assisted distal radical gastrectomy was carried out in all cases successfully. The mean operative time was (205 ±38 )min, mean blood loss was (105 ± 66) ml and mean number of lymph nodes dissected was 19.7 ± 6.2 each case. The mean postoperative time of recovery of bowel function was (3.5 ±1.2) d,mean postoperative time of liquid intake was (4.9 ±0.9) d and mean hospitalization was (10.2 ± 2.7) d. No postoperative death or anastomotic fistula was found. Postoperative upper gastrointestinal bleeding occurred in 1 case and was cured by conservative treatment. Follow-up for 1-12 months revealed no recurrence or metastasis. Conclusions Laparoscopic assisted distal radical gastrectomy is a safe and feasible procedure with satisfactory short-term outcomes.Moreover,the short-term outcomes may be improved if the patients are treated under the notion of fast track surgery.