ABSTRACT
Objective To investigate the efficacy and safety of transumbilical single-port laparoscopic appendicectomy in acute complicated appendicitis.Methods Retrospective analysis was conducted for the data of 1104 patients with complicated appendicitis who underwent emergency laparoscopic appendectomy at the Department of General Surgery of Aerospace Center Hospital from April 2014 to August 2022;among them,788 patients underwent transumbilical single-port laparoscopic appendectomy(SILA)and 316 cases underwent traditional three-port laparoscopic appendectomy(LA);the operation time,intraoperative blood loss,leukocyte value on the first day after surgery,postoperative exhaust time,hospital stay,postoperative pathology and postoperative complications were statistically analyzed.Results The surgical duration of the single hole laparoscopic appendectomy(SILA)group was(68.26±22.29)minutes,intraoperative blood loss was(15.93±13.10)ml,postoperative exhaust time was(2.29±0.52)days,and white blood cells were(11.12±1.67)× 109/L on the first day after surgery,and the surgical duration of the hree hole laparoscopic appendectomy(LA)groupwas(66.47± 20.40)minutes,intraoperative blood loss was(16.65±12.98)ml,postoperative exhaust time was(2.23±0.58)days,and white blood cells were(11.35±1.54)× 109/L on the first day after surgery,there was no statistically significant difference in the data between each group(P＞0.05).After 1 month of follow-up,no incisional hernia and other complications occurred in the two groups,the cosmetic effect of abdominal incision in SILA group was satisfactory,the hospitalization time of SILA group was(4.60± 1.18)days,which was shorter than that in the traditional LA group(4.93±1.71)days,and the difference was statistically significant(P＜0.05).Conclusion Based on proficiency in traditional LA operations,SILA is safe and viable;in addition to the hidden aesthetic function of scars,it does not prolong the operation time and increase the risk of postoperative complications.
ABSTRACT
Objective:To detect the methylation status of sine oculis homeobox homolog1 (Six1) in patients with gastric cancer and analyze its relationship with the clinicopathological characteristics and prognosis of patients.Methods:The tumor and para-cancerous tissues of 148 patients with gastric cancer diagnosed and treated in Aerospace Center Hospital from September 2015 to December 2017 were collected. The methylation-specific PCR method (MSP) was used to detect the methylation status of the Six1 gene, and 100 normal people who underwent gastroscopy biopsy during the same period served as the control group. Univariate analysis and multivariate Logistic regression model were used to analyze the relationship between Six1 methylation status and clinical pathological characteristics of patients. Kaplan-Meier survival curve was used to analyze the relationship between Six1 methylation status and prognostic survival in patients with gastric cancer.Results:Six1 gene methylation rate in tumor tissue was lower than that in adjacent tissues or in control group, and the differences were statistically significant: 24.32%(36/148) vs. 89.19%(132/148), 96.00%(96/100)( P<0.05). Univariate analysis showed that Six1 gene methylation rate was higher in patients with tumor diameter <5 cm ( χ2 = 8.79, P = 0.003), TNM stage Ⅰ-Ⅱ ( χ2 = 4.93, P = 0.026), highly differentiated tumor ( χ2 = 8.74, P = 0.013), no lymph node metastasis ( χ2 = 4.64, P = 0.031), no distant metastasis ( χ2 = 4.38, P = 0.036), and no invasion of the serosa ( χ2 = 9.85, P = 0.002), and the differences were statistically significant. Multivariate analysis showed that TNM staging ( OR = 4.397, 95% CI 3.141 - 5.157, P = 0.014), tumor differentiation ( OR = 4.491, 95% CI 3.527 - 6.118, P = 0.007), lymph node metastasis ( OR = 4.208, 95% CI 3.823 - 5.195, P = 0.031), distant metastasis ( OR = 4.225, 95% CI 3.956 - 5.437, P = 0.026), and depth of invasion ( OR = 4.509, 95% CI 3.206 - 5.275, P = 0.011) of patients with gastric cancer were independent risk factors for Six1 gene methylation status. Till to March 2020, the mortality rate of the Six1 gene methylation group was lower than that of the Six1 gene unmethylated group: 44.44%(16/36) vs.71.43% (80/112), the difference was statistically significant ( χ2 = 8.70, P<0.05). The median survival time of gastric cancer patients with Six1 gene methylation was higher than that of Six1 gene unmethylated (49 months vs. 37 months), and the difference was statistically significant ( P = 0.019). Conclusions:There is unmethylation of Six1 gene in patients with gastric cancer, which may be involved with the occurrence of gastric cancer. Patients′ TNM stage, tumor differentiation degree, and lymph node metastasis are independent risk factors for Six1 gene methylation status in gastric cancer patients. The prognosis of gastric cancer patients with Six1 gene methylation is better.