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Scientific and technological innovation is the most important role in driving the development of minimally invasive surgery. After more than 30 years of development, modern mini-mally invasive surgery represented by laparoscopic surgery has gradually matured. Various types of minimally invasive surgeries have been popularized, and the difficulty of surgery has changed from extreme to limit. Surgical equipments and instruments can meet the needs of most clinical operations. The future of minimally invasive surgery has reached a crossroad, and only scientific and technological innovation can promote the development of minimally invasive surgery change lanes and overtake, ushering in new development, new methods, and a new world. For innovation, the most important thing is not knowledge, but vision and ideas. A new technological revolution will inevitably bring about changes in the industry. What changes will be ushered in the operation and treatment of diseases in the future? What will be the breakthrough of minimally invasive surgery? It is worth to wait and see. The authors discuss the development direction of minimally invasive surgery based on the recent application of hot technologies in laparoscopic surgery.
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After nearly 30 years of high-speed development of minimally invasive gastric surgery in China, the surgical techniques are well developed. The concept of gastric cancer treatment is constantly changing as the deepening understanding of gastric cancer. Minimally invasiveness and precision is an inevitable trend in gastric surgery. At the same time, science and technology are fast-evolving, which greatly improved the performance of both soft- and hardware. In the future, surgical technology, real-time data and artificial intelligence will be further integrated to facilitate the evolution of minimally invasive surgery to digital surgery era. Therefore, in this article, the authors elaborate on the technical practice and future directions of minimally invasive surgery in this digital medicine era from technology and scientific progress.
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Thoracic endovascular aortic repair has served as the predominant treatment approach for patients with thoracic aortic diseases. In order to ensure the successful release of the stent as well as a good proximal anchoring effect, it is necessary to preserve or reconstruct the left subclavian supply as much as possible. With the advance of various endovascular assistive technologies, different left subclavian artery revascularization techniques have gained widespread acceptance. So far, techniques include carotid-subclavian bypass or transposition, chimney grafts, fenestrations, branched aortic devices can reconstruct the left subclavian artery and other branch vessels on the arch. This article reviewed the present situation of left subclavian artery reconstruction and the selection of surgical methods of thoracic endovascular aortic repair.
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Objective:To investigate the short-term effects of staged hybrid abdominal aortic debranching technique in the treatment of thoracoabdominal aorta.Methods:From January 2018 to December 2018, 22 patients with thoracoabdominal aortic aneurysms underwent surgical treatment in Nanjing Drum Tower Hospital. Among them, 12 underwent staged hybrid abdominal aortic debranching (AAD), and 10 underwent traditional thoracoabdominal aortic replacement (TAR). AAD consisted of two phases: the first phase of surgery was mid-opening, Y-type artificial blood vessels replaced the lower abdominal aorta and bilateral common iliac arteries, and the abdominal aortic branches were reconstructed at the same time: right branch artificial blood vessels-right renal artery-left renal artery, the left branch artificial blood vessel-superior mesenteric artery-common hepatic artery; the second phase was endovascular repair anchoring normal and long-term normal aorta or artificial blood vessel. The clinical effected of two methods for the treatment of thoracoabdominal aortic aneurysms were compared and analyzed.Results:The overall mortality rate was 13.6%, and the mortality rate in the TAR group increased significantly (0 vs. 30%). The main cause was dissection (91.7% vs. 90.0%, P=0.895). Crawford classification was predominantly type Ⅱ in both groups(58.3% vs. 50.0%, P=0.082). The proportion of patients with Marfan syndrome in the TAR group was higher (30% vs. 0, P=0.046). The TAR group was significantly more drained 24 h after surgery [(355.0±199.2)ml vs. (1244.0±716.1)ml, P= 0.003]. The TAR group had a higher proportion of lung infections (40% vs. 0, P= 0.018). The average cost was higher in the AAD group [(28.4±8.3) ten thousands yuan vs. (19.3±10.4) ten thousands yuan, P= 0.033]. Conclusion:The staged hybrid abdominal aortic debranching technique can effectively treat thoracoabdominal aortic aneurysms. Compared with traditional thoracoabdominal aortic replacement, the surgical trauma is smaller but more expensive.
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Gastric cancer is one of the most common malignant tumors in China, with a high incidence and poor prognosis. It is still the focus of current work to improve the diagnosis rate and investigate the new treatment for gastric cancer. In recent years, intelligent medicine represented by artificial intelligence has been gradually applied in gastric cancer diagnosis and treatment, especially in gastroscopy examination, imaging examination, pathological diagnosis and so on. In terms of minimally invasive surgery for gastric cancer, the emergence of new technologies such as 4K and 3D have further improved the accuracy of surgery. At the same time, laparoscopic fluorescence imaging technology represented by indocyanine green imaging is gradually becoming a new direction for the development of minimally invasive surgery. Combined with the literature at home and abroad, the authors expound the application of minimally invasive intelligent technology in the process of diagnosis and treatment of gastric cancer to fully understand the opportunities and challenges faced by gastric cancer intelligent diagnosis and treatment, break the boundaries of disciplines, and carry out a wide range of 'medical-engineering integration′ research. This will finally benefit patients with gastric cancer.
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Objective@#To evaluate the efficacy of gastric pull-up and complex laryngotracheal flap in reconstruction for circumferencial defects after resection of hypopharyngeal and cervical esophageal cancers.@*Methods@#A total of 163 cases (152 males, 11 females) with circumferencial defect after resection of hypopharyngeal and cervical esophageal cancers received reconstructive surgeries by gastric pull-up (42 cases) and complex laryngo-tracheal flaps (121 cases), of them 115 cases simultaneously underwent unilateral neck dissection and 20 cases had bilateral neck dissection. Postoperative radiotherapy was used in 67 cases, with a dosage of 40-60 Gy.@*Results@#There were 127 (77.9%) cases with positive metastatic lymph nodes. Of 42 patients with gastric pull-up reconstruction, 39 cases (92.8%) recovered the function of oral swallowing after operation, and 8 cases with cervical esophageal cancer recovered the functions of oral swallowing and speech after gastroesophageal anastomosis reconstruction. There were 3 (7.1%) cases died of surgery and 8 cases with surgical complications. Reconstruction of upper digestive tract with combined laryngotracheal flap was successful in all 121 cases, with recovered oral swallowing function after operation. No patient died of surgery but 24 cases had complications, mainly pharynx skin fistula or wound infection, which were cured by conservative treatments. The 1-, 3- and 5-year survival rates for 163 patients were 69.8%, 50.5% and 34.3%, respectively. The independent factors for prognosis included T4 (P<0.001) and N+ (P=0.042).@*Conclusions@#The complex of laryngotracheal flap with pectoralis major myocutaneous flap is suitable for most advanced hypopharyngeal cancer after resection of the tumor and reconstruction of circumferencial defect. It is simple technology, low and slight complication rate. The minority is not suitable for the application of pectoralis major myocutaneous flap can be used instead of free anterolateral thigh flap. Gastric pull-up for reconstruction of upper digestive tract is suitable for most patients with cervical esophageal cancer and hypopharyngeal carcinoma invading the cervical esophagus who are not suitable for laryngotracheal flap reconstruction, with good swallowing function after surgery. However, it is prudent to choose operative indications because of serious surgical trauma and risks for complications.
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Adenocarcinoma of esophagogastric junction (AEG) is the adenocarcinoma locating in the boundary of esophagus and cardia. Because of its increasing incidence, it has drawn attention widely around the world. In the 11th edition of Japanese Classification of Esophageal Cancer, the diagnosis of AEG should integrate endoscopy, upper gastrointestinal barium contrast and pathology. There are two classifications for AEG, Siewert classification and Nishi classification. In the 8th TNM staging manual, cancer crossing the esophagogastric junction (EGJ) with their epicenter within the proximal 2 cm of the stomach is incorporated into the esophagus chapter, whereas cancer crossing the EGJ with their epicenter in the proximal 2 to 5 cm of the stomach is addressed in the stomach chapter. All the tumors in stomach that do not cross the EGJ are classified as stomach cancer. The surgical approach of AEG remains controversial. Previous researches have suggested that abdominal transhiatal approach should be applied to Siewert type II and III. With respect to minimally invasive surgery, for Siewert I, the mediastinal and abdominal lymphadenectomy is conducted by thoracoscopy and laparoscopy respectively. After that a gastric tube is placed and the reconstruction is performed in the cervix. For Siewert type II, the whole procedure is accessed by laparotomy, and the lower mediastinum is accessed transhiatally. After lymphadenectomy the anastomosis can be laparoscopy-assisted or totally laparoscopic. As for Siewert type III, both circular and linear stapler can be used to perform reconstruction. With the development of surgical technology and continuous renovation of equipment, laparoscopic resection for AEG will be more and more popular.
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Humans , Adenocarcinoma , General Surgery , Cardia , General Surgery , Esophageal Neoplasms , General Surgery , Esophagogastric Junction , General Surgery , Minimally Invasive Surgical Procedures , Stomach Neoplasms , General SurgeryABSTRACT
Methods of digestive tract reconstruction after distal gastrectomy include Billroth I, Billroth II and Roux-en-Y. Each of them has advantages and disadvantages respectively. Alkaline reflux gastritis (ARG) is one of the complications after distal gastrectomy, which is common after Billroth II. In the past 100 years, the ways of digestive tract reconstruction have been continuously improved and developed to prevent the occurrence of alkaline reflux gastritis, and Roux-en-Y is one of them. Still, there is a high incidence of Roux stasis syndrome resulting from Roux-en-Y, with impact on quality of life. Therefore, the appropriate reconstruction is needed urgently. Braun anastomosis was proposed in 1892 to lower the incidence of afferent syndrome. Because of its effect of diverting some alkaline digestive juice, it was applied to pancreaticoduodenectomy and distal gastrectomy. Some studies have proved its effect of diverting some alkaline digestive juice, but the diverted quantity was rarely shown. Besides, compared with Roux-en-Y, Billroth II with Braun anastomosis is safer and more convenient. Meantime it is likely to have benefits in aspect of preventing anemia and malnutrition. In order to provide evidence to clinical practice, this article summarizes the history and research advance of Billroth II with Braun anastomosis by reviewing previous reports.
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Humans , Anastomosis, Roux-en-Y , Anastomosis, Surgical , Gastrectomy , Methods , Gastroenterostomy , Methods , Quality of Life , Stomach Neoplasms , General SurgeryABSTRACT
Objective@#To investigate the metastatic sequence of cervical lymph node in hypopharyngeal carcinoma aimed at guiding neck exploration.@*Methods@#Seventy-five serial sections of integrally dissected lateral neck specimens from 67 patients of hypophayryngeal carcinoma were histopathologically observed, and the metastatic sequence of cervical lymph node of hypophayryngeal carcinoma were analysed.@*Results@#In 75 integrally dissected lateral neck specimens, 63 laterals were found to occur cervical lymph node metastases, the metastatic ratio was 84.0%. The analytic result of 63 dissected lateral neck specimens with positive lymph nodes showed that the metastatic lymph node ratio in descending order was level Ⅱ (90.5%), level Ⅲ (76.2%), level Ⅳ (41.3%), level Ⅴ (15.9%), level Ⅰ (7.9%) and level Ⅵ (3.2%). The metastatic ratio of lymph node between level Ⅰ~Ⅵ were significantly different from each other (P<0.01). When the tumor metastasized to one cervical lymph node, this could be found in levels Ⅱ or Ⅲ, when metastasized to two cervical lymph nodes, these could be found in levels Ⅱ, Ⅲ, Ⅳ, and when metastasized to more than 5 of cervical lymph nodes, these could be found in levels Ⅱ, Ⅲ, Ⅳ, Ⅴ, Ⅰand Ⅵ. According to the occurring sequence, metastatic ratio and number of cervical lymph node metastasis (LNM), levels Ⅱ and Ⅲ were identified as the first station, level Ⅳ was the second station and levels Ⅴ, Ⅰ and Ⅵ were the third station of cervical LNM in hypopharyngeal carcinoma.@*Conclusion@#The confirmation of metastatic sequence of cervical lymph node in hypophayryngeal carcinoma provides a reliable evidence for neck lymph node dissection and reference value for clinic therapy.
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<p><b>OBJECTIVE</b>To investigated the clinicopathologic features of familial papillary thyroid carcinoma (PTC) compared to sporadic PTC.</p><p><b>METHODS</b>Between January 2008 and August 2014, 20 patients who underwent surgery at Liaoning Cancer Hospital and Institute were diagnosed with familial PTC. We compared the clinicopathologic characteristics between familial PTC and sporadic PTC.</p><p><b>RESULTS</b>The prevalence of familial PTC was 1.3% (20/1 587). The median age of patients at diagnosis was 37 years and there were 12 females and 8 males. Thirty percent of the familial PTC cases exhibited a parent-offspring relationship, and 70% exhibited a sibling relationship. There were significant differences between familial PTC and sporadic PTC in terms of concomitant chronic thyroiditis (P < 0.01), nodular goiter (P = 0.04), tumor multicentricity (P < 0.01), bilaterality (P < 0.01), histological subtype (P < 0.01), and central lymph node metastasis (P = 0.02). When familial PTC patients were classified based on parent-child and sibling relationship, there were significant differences in preoperative TSH level (P = 0.02) and concomitant chronic thyroiditis (P = 0.01) between the two categories.</p><p><b>CONCLUSIONS</b>There are significant differences in clinicopathologic features between familial PTC and sporadic PTC and between familial PTC with parent-child and those with sibling relationship. Familial PTC appears more aggressive than sporadic carcinoma. Optimal treatment for familial PTC is not yet established, but improved awareness and screening will permit earlier detection, more timely intervention, and improved outcomes for patients and their families.</p>
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Adult , Female , Humans , Male , Carcinoma , Diagnosis , Pathology , Carcinoma, Papillary , Diagnosis , Pathology , Family Health , Goiter, Nodular , Lymphatic Metastasis , Thyroid Neoplasms , Diagnosis , Pathology , ThyroiditisABSTRACT
OBJECTIVE@#To summary the clinical therapy experience of thyroid carcinoma invading cervical esophagus and trachea full thickness and reconstruction of them to improve the survival rate and quality of life of these patients.@*METHOD@#In 33 patients with thyroid carcinoma inviding cervical esophagus and trachea, 7 patients were operated with total thyroid resection, 22 patients were operated with one lobectomy and the other side subtotal thyroid resection,and 4 patients were operated with partial lobectomy. Trachea local recection and intubation were performed on 19 patients, partial laryngectomy and pyriform sinus resection with trachea local recection and intubation were performed on 4 patients,and 10 cases were operated with tracheal sleeve resection and end to end anastomos.@*RESULT@#All patients were primary healing without tracheal anastomosis fistula, tracheal wall necrosis, esophageal fistula and pharyngeal fistula. One case had hypoparathyroidism after the operation and took a favorable turn a month later. Seven cases were dead (21. 21%). 1-year, 3-year, 5-year survival rates of the thyroid papillary carcinoma inviding cervical esophagus and trachea were 100.0%, 93.8% and 70.3%; 1-year, 3-year, 5-year survival rates of the thyroid carcinoma inviding cervical esophagus and trachea were 96.6%, 79.0% and 61.4%.@*CONCLUSION@#Thyroid carcinoma invading cervical esophagus and trachea full-thickness can be treated with surgical methods, and tracheal sleeve resection and end to end anastomos are the suitable methods.
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Humans , Carcinoma , Pathology , General Surgery , Carcinoma, Papillary , Esophagus , Pathology , Laryngectomy , Neoplasm Invasiveness , Quality of Life , Plastic Surgery Procedures , Survival Rate , Thyroid Cancer, Papillary , Thyroid Neoplasms , Pathology , General Surgery , Trachea , Tracheal Neoplasms , Pathology , General SurgeryABSTRACT
Peptide self-assembled multilayers ( SAMs ) was coated onto the quartz surface. The assembly conditions, such as the assembly agent concentration and assembly time, were examined. The SAMs was characterized via UV-vis absorption spectrometry and scanning electron microscope. Our results showed that the optimal concentration and assembly time for the 3-aminopropyl-triethoxysilane aqueous were 1% ( V/V ) and 3 h respectively, and those of gold nanoparticles were 2. 4 × 10-4 mol/L and 12 h, respectively, while those of peptide solution were 1 × 10-4 mol/L and 12 h, respectively. A new sensitive method, based on the theory that peptide could be cleaved at the site of Arg-Gly by thrombin, was established to detect thrombin. In addition, a good linear relationship was obtained in the range from 2. 8×10-12 mol/L to 9. 9×10-10 mol/L, and the detection limit was 1. 4×10-12 mol/L. The peptide self-assembled multilayers were also used in the analysis of blood serum samples, and the recovery rate was within the range from 91. 6% to 107. 6%.
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Objective To summarize the clinical experience of reconstruction by using free flap after operation of head and neck tumor. Method A retrospective review was performed of 36 cases who were operated with free flap to reconstruct postoperative defects in head and neck tumor from March 2007 to March 2009, 28 cases repaired by free anterolateral thigh(ALT) flap, 8 cases repaired by free forearm flap. Results The operations of 26 cases repaired with free ALT flap were successful, 2 cases were necrosis. Vascular pedicle flap was 8-18 cm long, mean 12.5 cm, 25 cases were muscle skin perforator, 3 cases were muscle clearance wear. Eight cases of free forearm flap were successful. All of 36 cases recovered well. Conclusions The successful rate of free flap is perfect, and there is no serious complication in doner-site. The flap can be shaped into various forms. Free flap is an ideal measure to reconstruct hypopharynx and to preserve the laryngeal function.
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OBJECTIVE To explore and evaluate the efficacy of preventing the central venous catheter-related infection using catheter-sealing separately with gentamicin and heparin.METHODS One hundred and thirty six hemodialysis patients with temporary indwelling central venous catheters were enrolled in this study,and randomly assigned into 3 groups: Group A(catheter-sealing separately with gentamicin and heparin,n=46),Group B(catheter-sealing with gentamicin mixted heparin,n=45) and Group C(catheter-sealing with heparin,n=45).Complications such as infection were monitored.RESULTS Rate of catheter-related infection and intravenous catheter infection were without significant difference between Groups A and B,but were obviously lower than that in Group C(6.5% and 4.4% vs 22.2%,P
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0.05).Tongue base resection(P=0.0164)and different methods of reconstruction(P=0.0011)had significant effects on the swallowing function.CONCLUSION The main factors of influencing swallowing function after resection of oral and oropharyngeal cancers are presence or absence of tongue base resection and different methods of reconstruction.
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Objective:To evaluate the effects of modified neck dissection (MND)preserving jugular vein on patients with supraglottic laryngeal carcinoma,the clinical data of 88 cases were analyzed retrospectively.Methods:There were 48 males and 40 females,ranging in age from 37 to 72 years old who were diagnosed supraglottic laryngeal squamous cell carcinoma.The clinical stages were T18,T2 30,T3 28,T4 22,cN1 38,cN2 48,cN3 2;pN0 11,pN1 21,pN2 54 and pN3 2,respectively.Among 146 lateral neck dissections in 88 cases (bilateral 58 cases,one lateral 30 cases),106 were MND,40 being radical neck dissections (RND).Of 106 MND,64 were simultaneously performed bilateral neck dissections (18 cases preserved bilateral jugular veins,14 cases preserved on side jugular veins),52 subsequently bilateral neck dissections(first time was RND ,and the second time was all MND).One side MND was performed in 30 cases,which preserved jugular veins.Results:The 3-year survival rate was 81.5%(22/27)in the simultaneous bilateral neck dissection,60.9%(14/23)in the subsequent neck dissection,75.0%(15/20)in the one lateral neck dissection.The 5-year survival rate was 61.5%(16/26),40.9%(9/22),70.6%(12/17)respectively.The recurrent rate of lymph node postoperative was 12.9%(11/85)in the lymph node less than 3cm in diameter,47.6%(10/21)more than 3cm in diameter.The recurrent rate of lymph node was 22.5%(9/40)in the group of RND,19.8%(12/106)in the group of MND.Conclusions:Because the neck lymph node metastasis often occurred in supraglottic carcinoma,the bilateral neck dissection is necessary during which one side jugular vein must be preserved.Results suggested that if the metastasis lymph node was less than 3cm in diameter and had not adhered to jugular vein,the jugular vein should be preserved,which could lesson complications and get better life quality.