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Objective@#To compare the short-term clinical outcomes and cost differences of robotic distal pancreatectomy (RDP) versus laparoscopic distal pancreatectomy (LDP).@*Methods@#The retrospective descriptive study was adopted.The clinical data of 158 patients underwent minimally invasive distal pancreatectomy who were admitted to Fujian Medical University Union Hospital between January 2016 and July 2018 were collected.A 1∶1 matched propensity score (PSM) analysis was performed for the RDP group and the LDP group.Observed indexes included operative time, blood loss, spleen-preserving rate, postoperative hospital stay, morbidity, incidence of pancreatic fistula and hospital costs. T test or rank sum test was used to compare measurement data, χ2 test or Fisher exact test was used to compare count data.@*Results@#A well-balanced cohort of 41 patients was analyzed.There were 14 males and 27 females in the RDP group, aged (45.2±16.4)years. There were 15 males and 26 females in the LDP group, aged (47.4±14.9) years.The operation time was (209.7±52.9) minutes for the RDP group and (186.5±56.7) minutes for the LDP group (P=0.073). Median blood loss was less in RDP (50(15-175)ml) compared with LDP (100(50-350)ml) (Z=-2.689, P=0.007). Thirty-eight cases of non-malignant diseases were observed in each group and spleen-preserving rate was higher in RDP (76.3%) compared to LDP(44.7%) (χ2=7.930, P=0.005).Postoperative hospital stay was similar in the RDP group and the LDP group (RDP: 9.4 days vs. LDP: 10.6 days; P=0.372). The overall morbidity and incidence of pancreatic fistula major complication rates (RDP: 12.2% vs. LDP: 14.6%, P=0.746; RDP: 7.3% vs. LDP: 9.8%, P=1.000) were similar.Total cost of RDP group was higher than that of LDP group ((80 563.7±10 641.8) yuan vs. (57 792.8±8 943.0) yuan, t=4.515, P<0.01).@*Conclusions@#Both RDP and LDP are safe and feasible procedures. RDP is more expensive, but RDP is associated with significantly less blood loss and higher spleen-preserving rate, which is more suitable for the non-malignant diseases of pancreatic body and tail with an expectation of splenic preservation.
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Objective To investigate the clinical efficacy of laparoscopic resection for retroperitoneal tumor via transabdominal approach.Methods The retrospective cross-sectional study was conducted.The clinicopathological data of 37 patients with retroperitoneal tumor who underwent laparoscopic resection via transabdominal approach at Fujian Medical University Union Hospital between January 2011 and August 2017 were collected.The surgical approach of resection for retroperitoneal tumor at the left hypochondriac region,left iliac region,right hypochondriac region and right iliac region referred to laparoscopic distal pancreatectomy,laparoscopic left hemicolectomy,laparoscopic pancreatoduodenectomy and laparoscopic right hemicolectomy respectively.Observation indicators:(1) intra-and post-operative recovery situations;(2) follow-up and survival situations.Follow-up using outpatient examination and telephone interview was performed to detect postoperative tumor recurrence,metastasis and survival of patients up to November 2017.Measurement data with normal distribution were represented as (x)±s.Measurement data with skewed distribution were described as M (range).Results (1) Intra-and post-operative recovery situations:37 patients underwent successfully laparoscopic resection for retroperitoneal tumor via transabdominal approach.Among 37 patients,4 were converted to open surgery,4 were completed surgery with assisted small incision,4 were combined with adjacent organ resection and other 25 underwent totally laparoscopic resection for retroperitoneal tumor.The operation time,volume of intraoperative blood loss,postoperative gastrointestinal recovery time,postoperative drainage-tube removal time and duration of postoperative hospital stay were respectively (181±73) minutes,(160±87) mL,(3.0± 1.0) days,(3.0±2.0) days and (7± 4)days.Of 37 patients,3 with postoperative complications including 2 of chylous fistula and 1 of delayed gastric emptying were improved by symptomatic treatment.There was no perioperative death.(2) Follow-up and survival situations:37 patients were followed up for 3-82 months,with a median time of 30 months.During the follow-up,1 patient with inflammatory myofibroblastic tumor had recurrence at 15 months postoperatively and underwent surgical resection,however,the patient had liver metastasis at 9 months after the second operation and underwent interventional therapy repeatly.One patient with Castleman and 5 with lymphoma underwent regular chemotherapy and achieved disease-free survival.The other patients had disease-free survival.Conclusion Laparoscopic resection for retroperitoneal tumor via transabdominal approach is safe and feasible.
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Objective To explore the clinical effects of laparoscopic combined with open mesh repair for abdominal wall incisional hernia.Methods The retrospective cross-sectional study was conducted.The clinical data of 41 patients with abdominal incisional hernia who were admitted to the Fujian Medical University Union Hospital between September 2011 and June 2017 were collected.All the patients underwent laparoscopic combined with open mesh repair,with the sequence from laparoscopic surgery to open surgery and then to laparoscopic surgery.Observation indicators:(1) intra-and post-operative situations;(2) follow-up situation.Follow-up using outpatient examination and telephone interview was performed to detect postoperative long-term complications and hernia recurrence up to November 2017.Measurement data with normal distribution were represented as (x)±s.Results (1) Intra-and post-operative situations:forty-one patients underwent successful laparoscopic combined with open mesh repair for abdominal wall incisional hernia.Diameter of hernia ring and defect area of abdominal wall were respectively (10±3)cm and (75±34)cm2.Among 41 patients,25 underwent laparoscopic combined with open mesh repair due to tight intestinal adhesion induced difficult laparoscopic separation;16 underwent laparoscopic combined with open mesh repair due to the larger diameter of the hernia ring induced difficulty of closing hernia ring under laparoscope.Operation time,cases with indwelling drainage-tube,time of drainage-tube removal and duration of postoperative hospital stay were respectively (188±71)minutes,33,(14±3)days and (4.5±2.6)days.Of 41 patients,2 with postoperative incomplete intestinal obstruction were cured by symptomatic treatment;2 with incisional infection were cured by antibiotic therapy,irrigation and dressing change.(2) Follow-up situation:41 patients were followed up for (29±17)months.The postoperative chronic pain of 2 patients was occasional and cannot affect the normal life.There was no occurrence of seroma,mesh infection,intestinal fistula,abdominal compartment syndrome and hernia recurrence during the follow-up.Conclusion The laparoscopic combined with open mesh repair has a better clinical effect for patients of incisional hernia with large hernia ring and tight intestinal adhesion,and surgical methods should be chosen seriously according to the condition of the patients in clinical application.
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Objective@#To discuss the methods, skills and experiences of dividing the neck of pancreas in laparoscopic pancreaticoduodenectomy(LPD).@*Methods@#The clinical data of 58 patients with periampullary tumors who received LPD at the Union Hospital of Fujian Medical University from December 2014 to January 2017 were retrospectively analyzed.There were 26 males and 32 females, ranged from 18 to 65 years, with a mean age of (46±12)years.@*Results@#All of the 58 patients underwent operation smoothly.Three cases underwent open anastomosis via an auxiliary incision after the total resection of specimen laparoscopically, due to the early learning curve of LPD.Two cases transformed into open operation as a result of tumor vascular invasion to portal vein(PV) or superior mesenteric vein(SMV). Fifty-three cases underwent laparoscopic or laparoscopic combined with robotic pancreaticoduodenectomy completely.Forty-two cases ligated gastroduodenal artery(GDA), fully penetrated the interspace between rear of pancreatic neck and SMV, suspended the pancreas and then divided the neck of pancreas from inferior to superior. Thirteen cases fully dissected the interspace between rear of pancreatic neck and SMV, divided the neck of pancreas from inferior to superior and then ligated GDA.Three cases ligated GDA, dissected PV and SMV at the superior and inferior margin of the neck of pancreas separately, and then divided pancreas from anterior to posterior.Mean time of dividing pancreas was (34.9±9.7)minutes, mean volume of blood loss while dividing pancreas was (30.1±8.2)ml.The main postoperative complications included pancreatic fistula(7 cases, Biochemical leak 2 cases, B grade 3 cases, C grade 2 cases), biliary fistula(3 cases), gastric fistula(1 case), delayed gastric emptying(1 case, C grade), abdominal infection(5 cases), hepatic failure (1 case), intra-abdominal hemorrhage(2 cases), reoperation(2 cases). One case died at the perioperative period while others recovered.The mean duration of postoperative stay was (14.2±5.1)days.@*Conclusions@#Dividing the neck of pancreas is one of the most important steps in LPD, which deserved sufficient attention.At the meantime, a suitable method of dividing the neck of pancreas should be chosen according to intraoperative exploration and preoperative imageological examinations.
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Objective To investigate the clinical efficacy of total pancreaticoduodenectomy for the pancreatic head adenocarcinoma with positive neck margin.Methods The clinical data of 15 patients with pancreatic head adenocarcinoma and had positive neck margin who received total pancreaticoduodenectomy at the Union Hospital of Fujian Medical University from August 2009 to May 2014 were retrospectively analyzed.Patients were followed up by out-patient examination or telephone interview till August 2014.Results Total pancreaticoduodenectomy was successfully carried out on the 15 patients.The operation time was 4.0-10.0 hours (mean,6.5 hours),and the volume of blood loss was 300-2 000 mL (mean,800 mL).The duration of postoperative hospital stay was 13.0-35.0 days (mean,22.3 days).The main postoperative complications included pulmonary infection (3 cases),abdominal infection (2 cases)and low blood glucose (2 cases).No interoperative death,bile leakage or gastrointestinal anastomotic fistula occurred.The blood glucose of most of the patients was controlled by insulin or pancreatin.No stomachache,steatorrhea or malnutrition occurred in all the patients.The mean time of postoperative follow-up was 21 months (range,3 months to 5 years).Three patients survived within 1 year,2 survived for 1-2 years,5 survived for more than 2 years and 1 survived for more than 5 years.Four patients with follow-up time under 6 months survived till now.Five patients had liver metastasis at postoperative month 6.Conclusion Total pancreaticoduodenectomy might be necessary for the pancreatic head adenocarcinoma with positive neck margin to achieve R0 resection.
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Objective To investigate the correlation between disease severity and pleural effu sion in patients with acute pancreatitis(AP).Methods A retrospective analysis was conducted on a prospectively collected database.The demographic,clinical,and laboratory data of 246 consecutive cases of AP in patients admitted to the Affiliated Union Hospital of Fujian Medical University between January 2008 to December 2012 were reviewed.Acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score and computed tomography severity index (CTSI) were used to evaluate the disease severity of AP.The relationship between the severity and pleural effusion was analyzed.Receiver operator characteristic (ROC) curve was used to compare the values of APACHE Ⅱ score and CTSI in predicting the prognosis of patients with pleural effusion.Results Among the 246 patients,there were 184 patients with pleural effusion and 62 patients without pleural effusion.The incidence of pleu ral effusion in AP was 74.8％.Further study showed that the difference in the incidences of pleural effusion between the severe group and the mild group was significant (P＜0.01).There was a trend that the more serious the patient's condition,the more the pleural effusion.Moreover,the levels of pleural effusion were significantly and positively correlated with the APACHE Ⅱ score (r=0.775,P＜0.01) and CTSI (r=0.525,P＜0.05).Logistic regression analysis showed that the factors significantly associated with pleural effusion formation were a high APACHE Ⅱ score and a high CTSI.Areas under the ROC curve of the APACHE Ⅱ score,CTSI and combined assessment were 0.798,0.687 and 0.812 for predicting mortality of the patients with pleural effusion.Through comparison of the areas under the ROC curve,there was a significant difference between the APACHE Ⅱ score and CTSI as well as combined assessment and CTSI (P＜0.05).Conclusions The disease severity was closely related to pleural effusion in patients with AP.Combining the two scoring systems to evaluate the disease severity and providing active treatment were important to improve the prognosis of patients with pleural effusion.
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Objective To explore the factors affecting the prognosis of pancreatic cancer patients,using COX risk model to carry on the statistical analysis of 154 cases of pancreatic carcinoma.Methods Retrospectively analyzed 154 pancreatic cancer cases' history date treated in April 2001-April 2008 of Fujian Medical University Union Hospital.Survival rate was caculated by Kaplan-Meier estimation while survival cruve was analysed by Log-rank test.Prognostic factors were studied by multivariate analysis with COX proportional hazards survival model.Results In this group,survival time was from 1 to 106 months and the median survival time was 8 months.Overall survival rates at 6 months,12 months,18 months,36 months were 58.4％,29.2％,16.3％ and 3.7％ respectively.Multivariate revealed that independent prognostic factors were follows:TNM tumor staging,operation mode and synthetic therapy.Conclusions The prognosis of patients with pancreatic carcinoma is determined by multiple factors.Patients of advanced TNM staging have a poorer prognosis.Radical resection and comprehensive treatment of patients prognosis is better.
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ObjectiveTo study the changes of serum levels of tumor n(ee)rosis factor-α (TNF-α),diamine oxidase (DAO),the expression of tight junction protein-1 (zonula occludens 1,ZO 1 ) in acute necrotizing pancreatitis (ANP) rats after ulinastatin intervention.Methods SD male rats were randomly divided into sham operation (SO) group,ANP group and ulinastatin treatment group.ANP model was induced by injecting 5％ sodium taurocholate into biliary and pancreatic duct.The rats were sacrificed at 6 and 24 hours,and then the levels of TNF-α,DAO and pathology change in pancreatic and intestinal were determined.The expression of bowel mucosa ZO-1 mRNA and protein was detected by RT-PCR and immunohistochemistry.ResultsSix hours after ANP induction,massive pancreatic necrosis and inflammatory cells infiltration were present,while epithelium necrosis of villi in ileum,vessel hemorrhage and inflammatory cells infiltration was found.The pathologic injury of pancreas and ileum in ulinastatin group was reduced when compared with that in ANP group.The serum levels of TNF-α were ( 10.83 ± 0.96),( 181.89 ± 4.93 ),( 128.23 ± 2.40) ng/L in SO group,ANP group and ulinastatin group; and the activities of DAO were (354.79 ±3.67),(117.21 ±5.58),(282.98 ± 9.12 ) U/L; the expressions of ZO 1 protein were 10.00 ± 1.87,1.20 ± 0.84,5.80 ±2.86; and the expressions ofZO 1 mRNA were 0.878 ±0.015,0.466 ±0.023,0.778 ±0.033.The serum level of TNF-α in ANP group was significantly higher than that in SO group,while the activities of DAO,expressions of ZO 1 mRNA and protein in ileum were significantly lower than that in SO group ( P ＜ 0.05 ).The serum level of TNF-α in ulinastatin group was significantly lower than that in ANP group,while the activities of DAO,expressions of ZO 1 mRNA and protein in ileum were significantly higher than that in ANP group (P ＜ 0.05).ConclusionsUlinastatin may inhibit the over release of TNF-α and improve plasma DAO activity,then increase the expression ofZO-1 mRNA and protein,thus protect the intestinal mucosa barrier.
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ObjectiveTo evaluate the clinical application of Kugel hernioplasty via anterior approach for inguinal hernia repair.MethodsA retrospective study was made to analyze the clinical data of 851 cases(956 hernias) treated with Kugel hernioplasty via anterior approach for inguinal hernias from November 2005 to May 2011.ResultsOperative duration was(42 ± 11) minutes.The postoperative complications were detected on 21 hernias of seroma,8 hernias of hematoma,12 hernias of sub dermal ecchymosis,26 hernias of foreign body sensation and 5 hernias of recurrence.No incision infection occurred.Conclusions Kugel hernioplasty via anterior approach can repair and strengthen the whole anatomy area of myopectineal orifice.It is available for various kinds of inguinal hernias.
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Medullary thyroid carcinoma (MTC) arises from parafollicular or C cells, and accounts for 5% - 10% of all thyroid cancers. MTC is hereditary in about 25% of cases. Lymph node and distant metastasis can appear in an early time, so early diagnosis and treatment is essential. In this review, the main performance of laboratory and imaging are described. The current management and preventive measure are also described.
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Objective To improve the management of blunt pancreatic trauma, and to explore the strategy of preserving the pancreatic endocrine and exocrine function to the full extent. Methods 20 cases of blunt pancreatic trauma were reviewed and analyzed retrospectively. The methods of operative treatment were analysed. Results All patients were cured. Depending on the general condition, abnomial signs and main pancreatic duct(MPD) injuries at the time of admission, patients received immediate operation or nonoperative treatment. Because of severe peritonitis and demonstrated MPD injury, 10 patients underwent immediate operations, including simple drainage in 6 cases, distal pancreatectomy in 1 patient, external drainage of the injured pancreatic duct for the second operation in 3 cases. Without the demonstrated MPD injury or clinical deterioration, 10 patients received nonoperative treatment under strict observation initially. 3 patients completed the nonoperative course and 7 patients underwent delayed operations, including Roux-en-Y pancreatic cyst-jejunostomy in 3 cases, external drainage of pseudocyst in e cases, pancreaticoduodenectomy in 1 patient because of the expanded hematoma in pancreatic head. Conclusions Blunt pancreatic trauma could receive individual pancreas-preserving treatment, which could improve the operational safety, avoid the resection of pancreas and preserve the pancreatic endocrine and exocrine function to the full extent.
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Objective To investigate the role of individualized and staged enteral nutrition in the treatment of severe acute pancreatitis(SAP).Methods The clinical data of 204 cases of SAP treated with individualized stage enteral nutrition in our hospital from January 2000 to March 2008 were retro-spectively analyzed, Results The liver function and serum lipid and diet returned to the normal level after the treatment.Pancreatic encephalopathy disappeared.The patients recovered and were dis-charged from the hospital with the extraction of feeding tube.Enteral nutrition was adjusted based on the monitoring results in the hospitalization period that brought less effect to the pseudocyst of pancre-as, and then discharged from the hospital with the feeding tube.The pseudocyst in 49 cases disap-peared spontaneously and it was cured with internal drainage for 3 months in other 32.The time of en-teral nutrition was 20-95 d.Conclusion Enteral nutrition is safe and necessary after the acute stage of SAP.To ensure the enteral nutrition to play a more important role in the treatment of SAP, we must pay more attention on the individualization and stage of enteral nutrition.
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Objective To evaluate clinical application of Kngel patch in treating recurrent inguinal her-nia. Methods The clinical data of 65 patients with 77 sides recurrent inguinal hernia performed open preperitoneal inguinal hernia repairs from January 2005 to June 2009 were analyzed retrospectively. Kugel hernia patches were used in the operations. Results The operating time for unilateral hernia expended 40 ～ 150(76.5±20. 4) min. Postoperative pain was minimal and no incision infection appeared. The postopera-tive complications were 4 cases of uroschesis,6 cases of inguinoscrotal seroma, 2 cases of inguinoscrotal he-matoma and 3 cases of serotal hydrops. No serious complications such as sensation of foreign body, inguinal chronic pain and recurrence were observed during the follow-up of 3 to 54 months. Conclusions Open preperitoneal hernia repair with Kngel patch for adult recurrent inguinal hernia reparation is rational and fea-sible.
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<p><b>OBJECTIVE</b>To compare the difference in local recurrence Dixon and Miles groups after total mesorectal excision.</p><p><b>METHODS</b>One hundred and seventy-three patients with rectal cancer were divided into two groups (Dixon group, 123 patients; Miles group 50 patients). Total mesorectal excision was made according to Heald's method.</p><p><b>RESULTS</b>The local recurrence in the Dixon and Miles groups was 4.8% (6/123) and 18.0% (9/50) respectively (P < 0.05), and in the Miles group before and after 1997 was 36.8% (7/19) and 6.5% (2/31) respectively (P < 0.05), 4.8% in LRR (P < 0.01). No significant difference was observed in the local recurrence between the two groups (P > 0.05).</p><p><b>CONCLUSION</b>Total mesorectal excision is an important factor reducing local recurrence after radical operation for rectal cancer.</p>
Subject(s)
Adult , Aged , Female , Humans , Male , Middle Aged , Colorectal Surgery , Mesentery , General Surgery , Neoplasm Recurrence, Local , Rectal Neoplasms , Pathology , General SurgeryABSTRACT
Objective To investigate the effect of acute physiology and chronic health evaluationⅡ ( APACHEⅡ) scoring system on evaluating the severity and prognosis in severe acute pancreatitis(SAP). Methods The APACHEⅡ scores were analyzed in 52 patients with SAP. Results The mean APACHEⅡ score of SAP was 16.60?9.07(8～40), and there were significant differences between the scores not only in Grade SAPⅠand Grade SAPⅡ(?