ABSTRACT
Objective To investigate the application value of the adhesive suspension of left lateral lobe of liver in transumbilical single-port laparoscopic left upper abdominal surgery.Methods The retrospective crosssectional study was conducted.The clinical data of 112 patients who underwent single-port laparoscopic left upper abdominal surgery in the Shengjing Hospital of China Medical University between January 2010 and October 2016 were collected.Patients underwent single-port laparoscopic left upper abdominal surgery,and intraoperative surgical fields were exposed through adhesive suspension of left lateral lobe of liver.Observation indicators:(1)intraoperative situations:surgical completion,surgical procedures,time of liver adhesive suspension,total operation time and intraoperative liver adhesive suspension-related complications;(2) postoperative situations:pre-and post-operative alanine transaminase (ALT) and aspartate transaminase (AST) levels,hospital expenses and duration of hospital stay;(3) follow-up:number of patients with follow-up,follow-up time,complications during follow-up.Follow-up using outpatient examination and telephone interview was performed to detect postoperative complications up to June 2017.Measurement data with normal distribution were represented as (x)+s.Repeated measurement data were analyzed using the repeated measures ANOVA.Results (1) Intraoperative situations:112 patients underwent successfully single-port laparoscopic left upper abdominal surgery,without conversion to multi-port surgery or open surgery.Of 112 patients,30,23,13,11,11,10,3,3,3,3,1 and 1 underwent radical resection of gastric cancer,partial gastrectomy,esophageal Heller myotomy + Dor fundoplication,subtotal gastrectomy,resection of body and tail of pancreas,paraoesophageal hiatal hernia repair + fundoplication,total gastrectomy,splenectomy,splenectomy + devascularization,pancreatic tail resection,simple fundoplication and splenic artery aneurysm resection,respectively.Time of liver adhesive suspension and total operation time in 112 patients were respectively (1.4±0.4)minutes and (192.0±91.3) minutes.There was no hepatic laceration,hepatic subcapsular hematoma and other complications.(2) Postoperative situations:of 112 patients,preoperative ALT and AST levels of 6 patients were mildly elevated,postoperative ALT and AST levels in 2 of 6 patients returned to normal,that in 1 of 6 patients were elevated at day 1 postoperatively and returned to normal at day 3 postoperatively,and that in 2 of 6 patients remained mildly elevated at week 1 postoperatively;preoperative ALT and AST levels of 106 patients were normal,ALT and AST levels in 31 of 106 patients were elevated at day 1 postoperatively (that in 28 patients returned to normal within week 1 postoperatively,and that in 3 patients remained mildly elevated),and that in 75 of 106 patients returned to normal.ALT and AST levels of 112 patients were (16± 11) U/L,(18±7) U/L before operation and (31 ±21) U/L,(34±26) U/L at day 1 postoperatively and (19 ± 17) U/L,(19 ± 12) U/L at week 1 postoperatively,respectively,with statistically significant differences in ALT and AST levels before operation and at day 1 postoperatively (F=36.353,29.792,P＜ 0.05),and no statistically significant difference in ALT and AST levels before operation and at week 1 postoperatively (F=2.905,1.284,P＞0.05).Hospital expenses,surgery-related expenses and duration of hospital stay were (45 231±20 440)yuan,(23 511±9 609)yuan and (6.0±l.9)days,respectively.(3) Follow-up:112 patients were followed up for 1.0-3.0 months,with a median time of 1.6 months.During the follow-up,there were no obvious complications.Conclusion Adhesive suspension of left lateral lobe of liver is simple and safe,with satisfactory exposure effects,and it is suitable for the better operative field exposure in single-port laparoscopic left upper abdominal surgery.
ABSTRACT
Objective To study the application of the cold cutting technique in transumbilical sin gle-incision laparoscopic liver resection (TUSI-LLR),and to evaluate its feasibility and treatment results.Methods The clinical data of 35 patients with liver lesions treated by transumbilical single-incision laparoscopic liver resection from 2013 to 2017 were retrospectively analyzed in Shengjing Hospital of China Medical University.In all these patients,the liver parenchyma was transected with the cold cutting technique.The operation time,intraoperative blood loss,postoperative complications,time to remove abdominal drain,and total hospital stay in the patients were analyzed.Results 11 of the 35 patients were male.The average age was (49.9 ± 10.8) years.The average body weight was (63.2 ± 11.1) kg.The diagnoses were hemangiomas in 18 patients,hepatolithiasis in 5 patients,malignant hepatocellular tumors in 5 patients,focal nodular hyperplasia in 3 patients,and others in 4 patients.There were 22 left lateral sectionectomies,2 left hemihepatectomies,11 wedge resections (8 in the left and 3 in the right).The operations were all successfully performed,with no conversion to conventional laparoscopic hepatectomy or open surgery.The average operation time was (112.2 ±51.0) minutes,and the intraoperative blood loss was (105.4 ±70.1) ml.No patients required intraoperative blood transfusion.The average surgery cost was (36 336.7 ± 5 938.2) yuan.All patients recovered well,with no postoperative hemorrhage,bile leakage,or incisional wound infection.The average time periods for removal of the abdominal drain,and hospital stay were (4.5 ± 1.2) days and (5.2 ± 1.4) days,respectively.All the 35 patients were followed up (1 ～ 3 months),with no patients complaining of abdominal distension or abdominal pain.Conclusions The cold cutting technique in transumbilical single-incision laparoscopic liver resection was safe and feasible.Its benefits included the operative speed,the small amount of intraoperative blood loss and the rapid postoperative recovery of the patients.
ABSTRACT
Objective:To observe the influence of inhaled anesthetic isoflurane in the neuronal protein damage and aggregation in the APP transgenic mouse hippocampus,and to investigate the intervention effect of trehalose. Methods:Sixty APP transgenic mice aged 12 months were divided into control group,isoflurane group (Iso group) and trehalose group (Tre group)(n=20).The rats in control group were not given any drugs and were put into the anesthetic box with continuonsly entering 2 L·min-1 oxygen for 2 h;the rats in Iso group and Tre group were respectively injected intraperitoneally with 2 mL saline or trehalose (400 μg·kg-1 )30 min before anesthesia,and then inhalated 1.4% isoflurane for 2 h.6 h after anesthesia,the hippocampus tissue of the mice was prepared,and DCFH-DA fluorescence was applied to detect the reactive oxygen species (ROS)level; 24 h after anesthesia, immunohistochemical method and Western blotting method were used to detect the contents of carbonyl compounds and nitrotyrosine and the Aβ1-42 protein expression level in hippocampus;TEM was applied to observe the formation of protein aggregates; TUNEL staining was performed to observe the apoptotic rate of hippocampal neurons. Results:Compared with control group, the ROS level, the expression levels of oxidative protein carbonyl compounds and nitrotyrosine,the expression level of Aβ1-42 protein,and the apoptotic rate of hippocampal neurons in Iso group were significantly increased (P < 0.05);compared with Iso group,the ROS level,the expression levels of oxidative protein carbonyl compounds and nitrotyrosine,the Aβ1-42 protein expression level, and the apoptotic rate of hippocampal neurons in Tre group were significantly decreased (P < 0.05).Conclusion:Isoflurane can induce the protein damage and aggregation,the apoptotic rate of hippocampal neurons,aggravate oxidative stress reaction,increase the apoptotic rate of brain hippocampal neurons in the APP transgenic mice;trehalose can intervene the neurotoxicity induced by inhaled anesthetics.