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Objective To evaluate the feasibility and clinical value of laparoscopic partial splenectomy to treat benign splenic diseases.Methods The clinical data of 13 patients who underwent laparoscopic partial splenectomy carried out by a single operating surgeon from June 2010 to January 2016 in our hospital were analyzed retrospectively.The enrolled patients included 6 with a splenic epidermoid cyst,4 with a splenic pseudocyst and 3 with splenic hemangioma.The lesion diameters ranged from 5.1 to 12.4 cm,with an average of (7.2 ± 2.3) cm.Results The operations were all successful.There was no conversion to laparotomy and there was no perioperative death.The operations included 4 upper pole splenic resection,5 lower pole resection,2 middle and upper pole resection and 2 middle and lower pole resection.The operative time ranged from 95 to 155 min,with an average of (119 ± 17) min.The volume of intra-operative blood loss ranged from 100 to 350 ml,with an average of (187 ± 78) ml.There was no postoperative bleeding,pancreatic fistula,digestive fistula,intra-abdominal infection,splenic vein thrombosis and other complications after the operation.The average postoperative hospitalization stay was (5 ± 1) d.Conclusions In carefully selected patients,laparoscopic partial splenectomy carried out by experienced surgeons to treat benign splenic diseases is safe and feasible.
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Objective To evaluate the feasibihty and clinical value of laparoscopic hepatectomy for liver tumors.Methods Laparoscopic hepatectomy from May 2010 to Oct 2013 was summarized including 27 cases of primary hepatocellular carcinoma,5 cases of liver hemangioma,3 cases of hepatic nodular hyperplasia,2 cases of liver metastases of colorectal cancer,2 cases of liver cystadenoma and 1 case of liver cyst.The diameter averaged at (4 ± 4) cm.Results All patients were successfully operated,no perioperative death.Irregular hepatectomy was performed in 21cases,hepatic left lateral lobectomy in 12 cases,segment VI resection in 4 cases and left hepatectomy in 3 cases.Operative time averaged (166 ± 109) min.Average blood loss was (480 ± 233) ml.Tumor margin was positive in two HCC cases.Bile leakage and ascites developed in one each patient,who were then cured by conservative treatment.Conclusions Laparoscopic hepatectomy for liver tumors is safe and feasible.
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Objective To compare the efficacy and safety of three different methods of laparoscopic common bile duct exploration (LCBDE).Methods The clinical data of patients with LCBDE treated in our hospital by the same surgeon from January 2010 to December 2012 were retrospectively analyzed.These patients were divided into three groups according to the 3 surgical methods:Group A:15 patients were treated with laparoscopic transcystic common bile duct exploration (LTCBDE).Group B:85 patients were treated with laparoscopic common bile duct exploration followed by primary duct closure (LCBDEPDC).Group C:20 patients were treated with laparoscopic common bile duct exploration and T tube drainage (LCBDE-TD).The study measured the TBIL,inner diameter of common bile duct,costs,length of operation,postoperative hospital stay,peritoneal drainage time,and operation-related complications.Results The operations were successfully carried out in the 3 groups of patients.When compared with group C,group A and group B had significantly shorter operative time,shorter postoperative hospital stay,shorter peritoneal drainage time,lower hospital costs,and earlier return to work (P＜0.05).The only significant difference between group A and group B was the peritoneal drainage time.There was no significant difference in the incidences of postoperative complications between the 3 groups (P＞0.05).Conclusions The three different methods of LCBDE had their own indications.LTCBDE was better than primary suture,and LCBDEPDC was better than T-tube drainage after laparoscopic common bile duct exploration.
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Objective To investigate the diagnosis and treatment of splenic space occupying lesions associated with comorbidity.Methods The clinical data of 5 patients from Jiangyin People' s Hospital and 9 patients from Wuxi People's Hospital from January 2002 to June 2012 were retrospectively analyzed.All the patients suffered from splenic space occupying lesions associated with comorbidity.Splenectomy or multi-visceral resection were selected according to the results of preoperative B sonography and computed tomography examination.Chemotherapy regimes were selected based on postoperative pathological examination.All the patients were followed up till June 2013.Results The symptoms of patients with splenic space occupying lesions were non-specific.The first symptoms of 4 patients were discomfort or distending pain of left upper abdomen,and the other 10patients had no symptoms.The coincidence rate of preoperative diagnosis was 10/14,and the coincidence rate of preoperative diagnosis for patients with malignant tumors was 2/5.Fourteen patients received preoperative B ultra-sonography,and 9 were definitively diagnosed.Nine patients received computed tomography,and 7 were definitively diagnosed.Of the 14 patients,right ovarian cancer,bilateral ovarian cancer and sigmoid colon cancer were correlated with solitary splenic metastasis,and the main lesions of the other 11 patients were not correlated with splenic space occupying lesions.The main lesions of patients with left colon carcinoma,type 2 diabetes and vascular tumor of the spleen,patients with renal carcinoma and splenic sclerosing hemangioma,and patients with hypertension,cholecystolithiasis and splenic lymphangioma were diagnosed simultaneously with the splenic space occupying lesions,and the main lesions of theother 11 patients were diagnosed separately with the splenic space occupying lesions.Ten patients underwent simple splenectomy and 4 patients received multi-visceral resection.Chemotherapy regimens were selected according to the type of main lesions for 5 patients who were diagnosed by pathological examinations.All the patients were recovered smoothly with no occurrence of severe infections.Two patients with splenic sarcoma had tumor metastasis at postoperative 6 months and 1 year,respectively.One patient with right ovarian cancer and solitary splenic metastasis had transverse colonic metastasis at postoperative 3 years.One patient with bilateral ovarian cancer and solitary splenic metastasis had peritoneal metastasis at postoperative 2 years.One patient with sigmoid colon cancer and solitary splenic metastasis died of peritoneal tumor recurrence at postoperative 4 years.One patient with left colon carcinoma,type 2diabetes and vascular tumor of the spleen survived for 6 years and was still sound and well.The other 9 patients with benign disease survived within the period of follow-up.Conclusions The definitive diagnosis for patients with splenic space occupying disease associated with comorbidity depends on the preoperative imaging examination and postoperative pathological examination.Surgical treatment is safe when operative contraindications are excluded.The prognosis of patients is determined by the progress of main lesions and the character of splenic space occupying lesions.
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Objective To investigate the preventive effect of postoperative pancreatic leakage by continuous invaginated pancreaticoenterostomy in pancraticoduodenectomy. Methods Twenty-twopancraticoduodenectomy procedures were performed by continuous invaginated pancreaticoenterostomy with 4-0 absorbable suture and the results were compared with those of 12 end-to-side invagination interrupted suture procedures and 23 pancreatic duct jejunum anastomosis procedures. Results All continuous invaginated pancreaticoenterostomy cases were performed successfully with the average time of 13 minutes, and one biliary leak occurred postoperatively; and there was no pancreatic anastomotic leak and no death. The mean hospital stay of the patients was 15 days. While the mean time of end-to-side invagination interrupted suture procedures was 20 minutes, one biliary leak and one abdominal infection occurred, and one patient died of abdominal bleeding. The mean time of pancreatic duct jejunum anastomosis procedures was 18 minutes, and one pancreatic leak and one upper gastrointestinal bleeding occurred. The mean postoperative hospital stay of these patients was 19 days. Conclusions Continuous invaginated pancreaticoenterostomy is applicable to any situation in the residual pancreas, and has the advantages of easy to operate, time saving and less complications, thus it is an effective improvement of pancreaticoenterostomy.
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Objective To summarize the experience in diagnosis,prention and management of right accessory hepatic duct(AHD)injury during laparoscopic cholecystectomy(LC).Method The clini-cal data of 8 patients with AHD injury during LC diagnosed and managed retrospectively analyzed. Results Of the 8 patients, 5 patients were found during LC,3 patients were found after LC.Management were ad follow:5 patients with the diameter of the AHD smaller than 3.0 mm were ligated,1 patient with the diameter of 5.0 mm were reconstructed,1 patient with the diameter of 3.0 mm,but the AHD connected with other bile duct in vicinal epaticlobes,were ligated.These 7 patients,with the injured AHD ligated or re-constructed,were followed up for 6 months to 5 years and showed good results.The another who did not be found during LC and not be managed appropriately,arose serious bile leakage and infection for a long time,underwent drainage operations for 3 times,cured after haft year.No death in all patients.Conclusions Correct operative rules should be obeyed strictly in LC,and keep the exist of AHD under close guard,if AHD injury occurred,LC should turn to open surgery immediately,early finding of the injury and managing appropriately is the key to achieve successful result.