Zhu's trocar placement in laparoscopic appendectomy in the treatment of complicated appendicitis / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To evaluate the feasibility and efficacy of Zhu's trocar placement (ZTP) in laparoscopic appendectomy (LA) in the treatment of complicated appendicitis.</p><p><b>METHODS</b>Clinical data of 139 complicated appendicitis patients undergoing LA at the First Affiliated Hospital of Wenzhou Medical University from June 2013 to December 2017 were retrospectively analyzed. ZTP-LA group comprised 59 cases and its procedure was as follows: 10 mm umbilical trocar was used as lens port; 12 mm trocar at crossing point of umbilical hole horizontal line and right midclavicular line was used as main operating port; 5 mm trocar at the crossing point of horizontal line 0-3 cm below umbilicus and right anterior axillary line was used as assist operating port with the drainage function for Douglas fossa and right iliac fossa; The operator and the assistant stood on the right side and the left side of the patient respectively. Traditional three-port group comprised 80 cases (8 cases converted to laparotomy, 72 cases enrolled finally) and its procedure was as follows: 10 mm lens port below umbilicus; 10-12 mm main operating port at lateral border of left lower rectus abdominis; 5 mm assist operating port above pubis; The operator and the assistant stood on left side of the patient. The operative time, time to oral semi-fluid, postoperative hospital stay, cost during hospitalization, and postoperative morbidity of complication were compared between two groups.</p><p><b>RESULTS</b>Baseline data such as gender, age, WBC count, percentage of leukocyte, pathological finding and type were not significantly different between two groups(all P>0.05). The conversion rate in ZTP-LA was significantly lower than that in traditional three-port group [0%(0/59) vs. 10.0%(8/80),χ²=4.552,P=0.033]. Compared with traditional three-port group, ZTP-LA group showed shorter operative time [(47.8±20.1) minutes vs. (66.0±27.3) minutes, t=4.383,P<0.001], shorter time to oral semi-fluid [(35.0±20.7) hours vs. (59.3±32.8) hours, t=5.158,P<0.001], shorter postoperative hospital stay [(4.1±1.6) days vs. (5.5±2.2) days, t=4.162, P<0.001], lower postoperative morbidity of complication [3.4% (2/59) vs. 18.1%(13/72), χ²=6.879, P=0.009], lower incidence of postoperative intra-abdominal abscess [0%(0/59) vs. 11.1%(8/72), χ²=5.179, P=0.023], lower incidence of paralytic ileus [1.7%(1/59) vs. 12.5%(9/72), χ²=3.946, P=0.047] and less cost during hospitalization[(13 585±2909) yuan vs.(16 861±5334) yuan, t=4.463, P<0.001].</p><p><b>CONCLUSION</b>ZTP-LA is safe, feasible and effective with advantages of faster recovery and less cost in the treatment of complicated appendicitis.</p>

Clinical application of laparoscopy hepatectomy: a single center's experience / 中华肝胆外科杂志

The clinical data of 97 patients who underwent laparoscopic hepatectomy from July 2007 to November 2014 in the First Affiliated Hospital of Wenzhou Medical University was collected.Of the 97 patients,46 cases were diagnosed with hepatolithiasis,20 with primary liver cancer,26 with benign liver tumor,1 with liver abscess,and 4 with metastatic liver cancer.The surgical approaches included laparoscopic left hepatectomy (n =16),left lateral lobectomy (n =35),right hepatectomy (n =2),right posterior lobectomy (n =1),hepatic wedge resection (n =42),and left lateral lobectomy with segment Ⅶ resection (n =1),and 4 cases underwent multi-visceral resection.88 patients underwent laparoscopic hepatectomy and 9 patients were transferred to open hepatectomy.Postoperative complications included bile leakage (n =9),abdominal cavity infection (n =7),ascites (n =1),wound infection (n =1),pleural effusion (n =3) and pulmonary infection (n =1).There was no perioperative death.Taken together,laparoscopic hepatectomy is feasible and efficient for treating liver diseases and it has the advantages of minimal invasion and rapid recovery.

Efficacy and safety of first-line chemotherapy plus bevacizumab in patients with metastatic colorectal cancer: a meta-analysis / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>What benefits and toxicities patients acquire from the use of bevacizumab combined with firstline chemotherapy remains controversial. This study was performed to evaluate the efficacy and safety of first-line chemotherapy plus bevacizumab in patients with metastatic colorectal cancer (mCRC).</p><p><b>METHODS</b>Several databases, including PubMed, Embase, and Cochrane Library, were searched up to April 30, 2013. Eligible studies were only randomized, controlled trials (RCTs) with a direct comparison between mCRC patients treated with and without bevacizumab. Overall risk ratio (RR), hazard ratio (HR), odds ratio (OR), and 95% confidence intervals (CI) were calculated employing fixed or random-effects models depending on the heterogeneity of the included trials.</p><p><b>RESULTS</b>Six RCTs, including 1582 patients in chemotherapy plus bevacizumab group and 1484 patients in chemotherapyalone group, were included. Overall, the addition of bevacizumab to first-line chemotherapy increased overall response rate (ORR) by 4.5%, prolonged both progression-free survival (PFS) and overall survival (OS), and increased the rate of total Grades 3 or 4 adverse events (G3/4AEs) by 6.9%. Significant differences were found in ORR (RR = 1.22 (95% CI 1.01-1.46), P = 0.03), PFS (HR = 0.60 (95% CI 0.47-0.77), P < 0.0001), OS (HR = 0.83 (95% CI 0.70-0.97), P = 0.02), and any G3/4AEs (OR = 1.56 (95% CI 1.29-1.89), P < 0.00001).</p><p><b>CONCLUSION</b>Bevacizumab is a valuable addition to the current first-line chemotherapy regimens used in patients with mCRC, because of conferring a significant improvement in ORR, PFS, and OS, even though it increased adverse events.</p>

Diagnosis and treatment of Mirizzi syndrome: a single-centre experience / 中华肝胆外科杂志

Objective To study the diagnosis and surgical treatment of Mirizzi syndrome (MS).Method The clinical data of patients with Mirizzi syndrome treated in our center from July 2001 to July 2011 were retrospectively studied and the diagnostic methods,operative strategies and outcomes of surgical treatment were analyzed.Results Mirizzi syndrome (MS) was identified in 56 out of 13800patients who received cholecystectomy (0.4％). MS was diagnosed preoperatively in 30 patients (53.6％).There were 29 patients with Mirizzi syndrome type Ⅰ,17 patients with type Ⅱ,9 patients with type Ⅲ,and 1 patient with type Ⅳ using the Csendes's classification.In two patients (3.6％) coincidental gallbladder carcinoma was detected.An initial laparoscopic approach was attempted in 33patients,and 16 were converted to open surgery.The remaining 23 patients underwent open operation.Surgical procedures included cholecystectomy,choledochotomy and T-tube insertion,simple closure and drainage (via T tube) of the biliary fistula,Roux-en-Y hepaticojejunostomy,radical resection of gallbladder and hepaticojejunostomy.Inadvertent bile duct injury occurred in 2 patients who had an initial laparoscopic approach for a preoperative undiagnosed MS. Postoperative morbidities included biliary leak (n =4) and residual common bile duct stone (n=2).All patients recovered completely and there was no hospital mortality.Conclusions Preoperative diagnosis of Mirizzi syndrome is still challenging despite the availability of multiple imaging modalities.Open surgery remains the standard of care,although laparoscopic treatment may be used in selected patients,especially for type Ⅰ Mirizzi syndrome.Patients with Mirizzi syndrome should be managed differently,basing on intraoperative findings and the type of Mirizzi syndrome.

The diagnosis and surgical treatment of hyperthyroidism complicating thyroid carcinoma / 中华普通外科杂志

Objective To evaluate the diagnosis and surgical treatment of primary hyperthyroidism with concurrent thyroid carcinoma. Methods The clinical data of 43 hyperthyroidism cases complicating thyroid carcinoma, confirmed by pathology at our hospital from January 1999 to September 2010 were retrospectively analyzed. Results Preoperatively 40 patients were examined by ultrasound,29 cases were diagnosed with carcinoma, the diagnostic accuracy of ultrasound was 72. 5%. Thyroidectomy was performed in all the 43 patients, including subtotal thyroidectomy (5 patients), homolateral total thyroidectomy and contralateral subtotal thyroidectomy with neck dissection (25 patients ), total thyroidectomy with neck dissection or radical neck dissection (11 patients ) and lobectomy plus isthmus resection (2 patients ).Postoperative pathology identified papillary carcinoma in 38 cases, and follicular carcinoma in 5 cases.Postoperative temporary hypocalcemia developed in 3 cases and one suffered from irritating when drinking.No hoarseness or blooding. 39 patients were followed-up from 2 to 110 months averaging 45 months, there was no tumor recurrence. Conclusions Preoperative routine ultrasonography helps to identify thyroid carcinoma that coexists with primary hyperthyroidism. The postoperative prognosis of thyroid papillary carcinoma concurrent with hyperthyroidism is satisfactory.

Neiguan Massaged to Prevent Ache and Nausea and Vomit after Laparoscopic Cholecystectomy—A Randomized Controlled Clinical Trial / 浙江中医药大学学报

[Objective] To confirm the effects of Neiguan massaged to prevent ache nausea and vomit after laparoscopic cholecystectomy(LC).[Methods] 400 patients were randomly divide into 2 groups;the group 1 were treated by Neiguan massage during the LC,the group 2 nothing during the operation.[Results]Group 1 suffered the same ache in the 1st hour as group 2,but less in the last 24h,and less nausea and vomit too.[Conclusions ]Neiguan massage could obviously prevent ache nausea and vomit after LC.