ABSTRACT
Objective:To investigate the efficacy difference of totally laparoscopic total gastrectomy (TLTG) and laparoscopically assisted total gastrectomy (LATG) on radical gastrectomy for gastric cancer, and further to explore the safety and feasibility of totally laparoscopic esophagojejunostomy.Methods:PubMed, Web of Science, Wanfang and CNKI database were searched for all relevant articles regarding to TLTG versus LATG for gastric cancer published up to September 2019. The search keywords included: gastric/stomach cancer, total gastrectomy, totally/completely laparoscopic, laparoscopic-assisted/laparoscopy-assisted/laparoscopically assisted, esophagojejunostomy/esophagojejunal anastomosis. Meta-analysis was performed with RevMan 5.3 software.Results:A total of 258 articles were retrieved, and 11 studies were finally included after layer by layer screening, with a total sample size of 2421 cases, including 1115 cases in the TLTG group and 1306 cases in the LATG group. There were no statistical difference in age and gender between the two groups, while the mean BMI in the TLTG group was significantly higher than that in the LATG group ( P=0.01). Compared to the LATG group, shorter surgical incision ( P<0.001), less intraoperative blood loss ( P=0.003), larger number of retrieved lymph nodes ( P=0.04), less time to first oral intake ( P=0.03), and shorter postoperative hospital stay ( P=0.02) were found in the TLTG group. There were no significant differences in operation time, anastomotic time, tumor size, proximal resection margin length, postoperative pain score, time to first flatus, rate of postoperative anastomosis-related complication (including anastomotic fistula, stenosis and bleeding) and the overall incidence of postoperative complications ( P>0.05). Conclusions:Totally laparoscopic esophagojejunostomy is safe and feasible, and also suitable for obese patients. TLTG has advantages of minimally invasive, less intraoperative blood loss and easier access to lymph nodes compared to LATG. Totally laparoscopic gastrectomy will probably be the surgical trend for gastric cancer in the future.
ABSTRACT
Objective To investigate the effectiveness and safety of combined heparin and acutobin in the treatment of acute inferior vena cava thrombus in rabbits. Methods The inferior vena cava thrombus model was established in 72 rabbits and they were randomly divided into three groups; heparin group(A) , group for combination of urokinase and heparin (B), group for combination of acutobin and heparin (C) ,each group including 24 rabbits. Drugs were administrated 3 days after thrombosis. Coagulation indexes were tested to assess their safety, and Doppler ultrasound was used to assess their effectiveness, on day 3, day 7, and day 10. Results The prolongation of prothrombin time ( PT) in group C was shorter than that in group B( P < 0. 05 ) , the fibrinogen ( FBG) value in group C was lower than that in group B (P < 0. 05 ) , the prolongation of PT in group B and group C was longer than that in group A (P < 0. 01), the FBG value of group B and C were higher than that in group A ( P < 0. 01 ), D-dimer ( D-D) value in group B and C gradually returned to normal range. There was no difference between the two groups (P > 0. 05). The thrombolytic effect in group B and C were better than that in group A, statistical difference was reached between groups B and A (P <0. 01), and the difference was statistically significant between groups C and A 10 days after administration (P < 0. 01). Thrombolytic effect was not different statistically between groups B and C (P > 0. 05). Conclusion Acutobin combined with heparin in the treatment of acute inferior vena cava thrombus in rabbits was effective and safe.