Feasibility and application value of autonomic nerve-preserving D3 radical resection for right-sided colon cancer under laparoscope / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To explore the feasibility and application value of the preservation of vegetative nervous functions in radical resection for right-sided colon cancer.</p><p><b>METHODS</b>Clinical data of 55 cases with right-sided colon cancer undergoing laparoscopic D3+ complete mesocolic excision (CME) radical resection from January 2016 to July 2017 at Department of Gastrointestinal Surgery of Guangdong Province Hospital of Traditional Chinese Medicine were retrospectively analyzed. Exclusion criteria included emergency surgery for various reasons, intestinal obstruction or perforation, distant metastasis or locally advanced cancer, previous history of abdominal surgery and preoperative neoadjuvant chemoradiotherapy. Twenty-nine cases underwent lymphadenectomy with intrathecal dissection of superior mesenteric artery (SMA) and part of superior mesenteric plexus was resected (nerve partial resection group, NPR group). Twenty-six cases received lymphadenectomy with the clearance of lymphatic adipose tissue on the right side of SMA by sharp or obtuse method outside the sheath; the sheath of superior mesenteric vein (SMV) was entered at the junction of SMA and SMV; the SMV was naked in the sheath; the third station lymph node dissection was completed with preservation of superior mesenteric plexus (nerve preserved group, NP group). Intra-operative and postoperative complications were compared between two groups.</p><p><b>RESULTS</b>The baseline data were not significantly different between two groups (all P>0.05). The operation time in NP group was significantly shorter than that in NPR group [(164.0±19.8) minutes vs. (176.0±19.7) minutes, t=2.249, P=0.029]. No significant differences in operative blood loss, operative vessel damage, postoperative time to flatus, postoperative hospital stay and abdominal pain were observed between two groups(all P>0.05). The number of harvested lymph node in two groups was 28.5±7.8 and 27.6±6.5 respectively without significant difference(P>0.05). As compared to NPR group, NP group had lower incidence of chylous leakage[3.8%(1/26) vs. 37.9%(11/29), χ²=9.337, P=0.002] and postoperative diarrhea [15.4%(4/26) vs. 41.4%(12/29), χ²=4.491, P=0.034].</p><p><b>CONCLUSION</b>Autonomic nerve-preserving D3+ CME radical resection for right-sided colon cancer is safe and feasible, and can prevent the postoperative gastrointestinal dysfunction caused by nerve injury and decrease the risk of chylous leakage.</p>

Application of laparoscopic technique in the treatment of refractory adhesive intestinal obstruction / 实用医学杂志

Objective To evaluate the efficacy and safety of laparoscopic technique in the treatment of refractory adhesive intestinal obstruction. Methods In a retrospective matched?pair analysis, 68 patients of re?fractory adhesive intestinal obstruction whose relapsed more than 3 times were included in the research. All patients were treated with laparoscopic operation or continued follow?up observation after conservative treatment from Janu?ary 2011 to January 2016. The patients were divided into 2 groups, laparoscopic surgery (32 cases) and observation group (36 cases), to contrast the recurrence rate and safety of the two types of treatment. Results The recurrence rate of laparoscopic surgery group was significantly lower in the observation group (18.8%vs. 77.8%, P<0.05). Re?fractory adhesive intestinal obstruction is further divided into Mixed type, Patchy adhesion type and Cable Belt Com?pression type, in the laparoscopic surgery subgroup analysis, hybrid recurrence rate (66.7%, 4/6 cases) was signifi?cantly higher than that of patchy adhesion type (10.0%, 1/10 cases) and cord compression type (6.3%, 1/16 cases). Conclusion Laparoscopic operation is safe and feasible in the treatment of refractory adhesive intestinal obstruc?tion, and then it can effectively reduce the recurrence rate of refractory adhesive intestinal obstruction;the curative effect is closely related to the type of adhesion.