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【Objective】 To explore the feasibility, safety and clinical application value of laparoscopic radical rectal cancer surgery with natural orifice specimen extraction (NOSE) by comparing the postoperative pathological data, surgery-related variables and postoperative recovery between laparoscopic radical rectal cancer surgery with NOSE and laparoscopic-assisted radical rectal cancer surgery. 【Methods】 A retrospective analysis was conducted on 74 patients who underwent radical rectal cancer surgery with anus preservation in the Department of General Surgery of The First Affiliated Hospital of Xi’an Jiaotong University from July 2017 to April 2022. Among them, 38 cases underwent surgery with specimen extraction through an abdominal auxiliary incision (auxiliary incision group), and 36 cases underwent surgery with specimen extraction through a natural orifice (NOSES group). The differences in the efficacy of the two surgeries were evaluated by comparing the postoperative pathological data, surgical variables, and postoperative recovery of the two groups. 【Results】 There were no statistically significant differences in general data and postoperative pathological data between the two groups (all P>0.05). The NOSES group exhibited significantly shorter operative time, time to first flatus, time to first oral intake postoperatively, and postoperative hospital stay compared to the auxiliary incision group (all P0.05). 【Conclusion】 Laparoscopic surgery with NOSE for rectal cancer is safe and feasible with minimally invasive and accelerated recovery, which is worth promoting and applying in clinical practice.
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ABSTRACT:Objective To compare the short-term efficacy of hand-assisted laparoscopic surgery and laparoscopy-assisted radical operation,and evaluate the safety of hand-assisted laparoscopic surgery and its effect on systemic stress inflammation in colorectal cancer.Methods Totally 100 patients who had colorectal cancer and underwent radical operation from September 2012 to March 2016 were selected and divided into hand-assisted laparoscopy group (Group A,n=6 3 )and laparoscopy-assisted group (Group B,n=3 7 )according to the random number table.We compared operation index,postoperative complications and systemic inflammatory response levels in the two groups.Results Group B outperformed Group A in operation time,bleeding volume and drainage volume (P0 .0 5 ).Systemic inflammatory reaction index of neutral granulocyte number and C reactive protein (CRP)showed no significant differences between the two groups (P>0 .0 5 ),but inflammatory cytokine IL-6 level in Group B was significantly higher than the that in Group A (P<0.05).Conclusion Hand-assisted laparoscopic surgery has shorter operation time,lower bleeding volume than laparoscopy-assisted operation in the treatment of colorectal cancer,but the latter one has more advantages in postoperative gastrointestinal function recovery.The inflammatory cytokine IL-6 level in hand-assisted laparoscopic surgery is higher than that in laparoscopy,suggesting that the choice of operation methods should be based on the actual situation in clinical application.
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Objective To evaluate the expressions of Cyr61 and β‐catenin protein in gallbladder carcinoma tissues and investigate their association with the clinicopathologic features of gallbladder carcinoma patients . Methods The expressions of Cyr61 and β‐catenin protein in 50 cases of gallbladder carcinoma and 19 cases of normal tissue were detected by immunohistochemical S‐P method .Results ① The positive expression rate of Cyr61 in gallbladder carcinoma tissues was 66 .0% (33/50) ,which was significantly higher than that in the normal tissues group (26 .3% ) .The expression of Cyr61 was related to tumor differentiation ,TNM stage and lymph node metastasis of gallbladder carcinoma (P=0 .010 ,P=0 .014 ,P=0 .007;P<0 .05) .② The positive expression rate ofβ‐catenin in gallbladder carcinoma tissues was 84 .0% (42/50) ,which was significantly higher than that in the normal tissues group 15 .7% (3/19);the expression of β‐catenin was related to tumor differentiation ,TNM stage and lymph node metastasis of gallbladder carcinoma (P=0 .018 ,P=0 .002 ,P=0 .024;P<0 .05) .③ Correlation test showed that Cyr61 andβ‐catenin were positively correlated in gallbladder carcinoma and adjacent normal tissues (r=0 .378 , P< 0 .05) .Conclusion Cyr61 and β‐catenin are highly expressed in gallbladder carcinoma tissues . Cyr61 andβ‐catenin expressions are closely related to the clinicopathologic features (tumor differentiation ,TNM staging and lymph node metastasis) in gallbladder carcinoma .Cyr61 and β‐catenin may have a synergistic effect in promoting progression and development of gallbladder carcinoma .Combined detection of Cyr61 and β‐catenin in gallbladder carcinoma tissues will contribute to the clinical diagnosis and prognosis .
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Objective To investigate the effects of ropivacaine infiltration combined with dezocine on the agitation during recovery from general anesthesia in the patients undergoing cerebral surgery.Methods Sixty patients of both sexes,aged 18-64 yr,of ASA physical status Ⅰ or Ⅱ,undergoing elective neurosurgery under general anesthesia,were randomly divided into 4 groups (n =15 each) using a random number table:control group (group C),ropivacaine group (group R),dezocine group (group D),and ropivacaine + dezocine group (group RD).Group C received local infiltration with normal saline 20 ml at 10 min before skin incision,and normal saline 2 ml was injected intravenously at 30 min before the end of operation.The patients received local infiltration with 0.5％ ropivacaine 20 ml at 10 min before skin incision,and normal saline 2 ml was injected intravenously at 30 min before the end of operation in group R.Group D received local infiltration with normal saline 20 ml at 10 min before skin incision,and dezocine 10 mg was injected intravenously at 30 min before the end of operation.The patients received local infiltration with 0.5％ ropivacaine 20 ml at 10 min before skin incision,and dezocine 10 mg was injected intravenously at 30 min before the end of operation in group RD.The time for recovery from anesthesia,extubation time,and development of agitation after extubation in PACU were recorded.Agitation was assessed and scored.Ramsay sedation score and VAS score were recorded immediately after extubation.The development of cardiovascular events and respiratory depression was recorded within 10 min after extubation.Before induction of anesthesia (T0),at the end of surgery (T1) and immediately after extubation (T2),blood samples were collected from the dorsal artery of foot for deter mination of the levels of blood glucose,plasma cortisone,epinephrine and norepinephrine.Results Compared with group C,the agitation score,incidence of agitation,VAS score,and incidence of postoperative hypertension were significantly decreased in R,D and RD groups,especially in R and D groups.The time for recovery from anesthesia and time for extubation were significantly shorter in R and RD groups than in group C.Ramsay sedation scores were significantly higher at the onset of extubation in R,D and RD groups than in group C.Ramsay sedation scores were significantly higher in D and RD groups than in group R.Compared with group C,the levels of blood glucose,plasma cortisone,epinephrine and norepinephrine were significantly decreased in R,D and RD groups,especially in group RD.Conclusion Ropivacaine infiltration combined with dezocine can reduce the agitation during recovery from general anesthesia in the patients undergoing cerebral surgery.
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Objective To determine the expression of human telomerase reverse transcriptase (hTERT) and P53 in thyroid carcinoma and its relationship with development and prognosis of the carcinoma. Methods Totally 90 cases of thyroid specimens (60 thyroid carcinomas, 10 thyroid adenomas, 10 goitres and 10 normal thyroid tissues) were studied by SP immunohistochemical method. Results Positive immunoreactivity of hTERT and P53 was higher in thyroid carcinoma (P<0.05). The positive rates of hTERT and P53 were higher in undifferentiated carcinomas, carcinomas with lymph nodes metastasis or at stage Ⅲ+Ⅳ than in well-differentiated carcinomas, carcinomas without lymph nodes metastasis or at stage Ⅰ+Ⅱ (P<0.05). The expression of hTERT was significantly related with that of P53 (P<0.05). Conclusion Over-expressed hTERT and P53 may be related to the carcinogenesis and progression of thyroid carcinoma and hTERT expression is related to P53 protein. Examination of expression of hTERT and P53 proteins may be helpful to judge the thyroid cancer's behavior and prognosis.
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Objective To determine the expression of P53 and P21 (WAF1/CIP1) in thyroid carcinomas and its relationship with development and prognosis of the carcinoma. Methods 90 cases of thyroid tissues (60 thyroid carcinomas, 10 thyroid adenomas, 10 goitres and 10 normal thyroid tissues) were studied by SP immunohistochemical method. Results Positive immunoreactivity of P53 and P21(WAF1/CIP1) was found only in thyroid carcinomas. The positive rate of the P53 and P21 is 53.3% and 41.7% respectively. The positive-staining rates of P53 were higher in cases of undifferentiated carcinomas, positive metastasis lymph nodes or in stage Ⅲ, Ⅳ than those in the cases of well-differentiated, no metastasis lymph nodes, or in stage Ⅰ,Ⅱ. In addition, the positive-staining of P21(WAF1/CIP1) were lower in cases of undifferentiated carcinomas, positive metastasis lymph nodes or stage Ⅲ, Ⅳ than that in the cases of well-differentiated, no metastasis lymph nodes or in stage Ⅰ,Ⅱ. The P21 (WAF1/CIP1) expression rate in the P53 positive group was lower than that in the P53 negative group (P<0.05). Conclusion The expression of P21(WAF1/CIP1) protein in thyroid cancer is related to P53-depend pathway and P53-independent pathway, mainly the P53-depend pathway. Examination of expression of P53 and P21 (WAF1/ CIP1) proteins may be helpful to judge the thyroid cancers behavior and prognosis.
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Objective To investigate the effect of short bowel syndrome treated with living-related small bowel transplantation(SBT).Methods A male patient with residual intestine 20cm in length,which resulted from subtotal small bowel resection and right hemi-colectomy owing to intestinal volvulus,received a living-related SBT.The donor was the patient′s mother.Donor specific blood transfusion,50mL/per week,was carried out for 8 weeks.Cytomegalovirus infection status in both donor and recipient was negative.A 160cm segment of intestine was transplanted.The graft ileocolic artery and vein was anastomosed to the recipient′s infrarenal aorta and inferior vena cava end-to-side,respectively.A distal ileostomy was performed.(Immunosuppression),anti-infection and anticoagulation therapy,and nutritional support were given(postoperatively).Results The donor had an uneventful recovery.No technical complications were observed.The recipient was alive and well 31 weeks after operation.No graft rejection or infection was found.The(patient) was taken off TPN 8 weeks after operation,and got a low-fat meal.The result of D-xylose test was near normal.Conclusions Living-related small intestine transplantation is an effective treatment for short bowel syndrome.
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Objective To investigate the risk factors of complication rate after colorectal cancer operation.Methods This study recruited a total of 254 non-emergency colorectal cancer patients admitted to our hospital between December 2005 and December 2006,and then evaluated the effects of life style,preoperative factors and intraoperative factors on postoperative complications.Results Single factor analysis showed that the postoperative complication rate was not significantly affected by gender,age,obesity,palliative/curative resection,anesthesia style as well as preoperative drinking or smoking history.Preoperative complications(P=0.001),tumor stage and operation time(P=0.025) affected the postoperative complicatin rate.Multi-factor logistic regression analysis showed that preoperative complications were the only risk factor of postoperative complications [P=0.001,OR=5.871,(95% CI 2.958-11.651)].Conclusion Old age as such does not represent a contraindication for surgical treatment.Preoperative complications,operation time and tumor stage significantly affect the postoperative complication rate.Preoperative complications are the strongest risk factor of all.Therefore,reasonable perioperative managements and shortening operation time are the key to reducing postoperative complications.