ABSTRACT
4K laparoscopy brings opportunities and challenges to the development of rectal surgery. 4K laparoscopy can truly provide the structure of abdominal and pelvic fascia, so that surgeons can see more subtle anatomical structure. The clear and real picture under 4K laparoscopic system can reduce visual fatigue of surgeons, which make the operation easier and safer. Radical resection of right colon cancer includes complete mesocolic excision and D 3 lymphadenectomy. Through 4K laparoscopic system, surgeons can easily observe the fascia structure of right mesocolon and its mesenteric bed, distinguish the vascular anatomical relationship at the mesenteric root, which make D 3 lymphadenectomy safer with dissection of lymph nodes completely. The authors comprehensively analyze the related research progress at home and abroad, and systematically elaborate the region of dissection and significance of 4K laparoscopic right hemicolectomy for right colon cancer.
ABSTRACT
Objective:To explore the value of chest CT features and clinical indexes in the differential diagnosis between suspected COVID-19 with two or more negative nucleic acid tests and confirmed COVID-19.Methods:The clinical data and chest CT images of 105 cases with confirmed COVID-19 (55 males and 50 females, aged from 2 month to 88 years) and 97 cases with suspected COVID-19 (59 males and 38 females, aged from 1 month to 93 years) were analyzed retrospectively in Shiyan Taihe Hospital from January 21 to February 10, 2020. χ 2test and two independent sample t test were used to analyze the clinical data and CT signs of the two group cases, with P<0.05 for statistically significant difference. Results:Compared with the suspected patients, the average age of confirmed ones was higher ( t=2.460, P=0.01). The main pathological changes were pure ground glass (68 cases) and mixed ground glass density (53 cases) (χ 2=50.016, P<0.01). Interstitial thickening (83 cases) (χ 2=55.395, P<0.01), vascular widening (73 cases) (χ 2=57.527, P<0.01), air bronchogram sign or bronchiectasis (67 cases) (χ 2=17.899, P<0.01), fibrous streak shadow (54 cases) (χ 2=5.500, P=0.02), commonly distributed under the pleura and the long axis of the lesion was parallel to the pleura (89 cases) (χ 2=23.597, P<0.01), most of them had no pleural effusion (χ 2= 7.017, P<0.01); both lesions were mainly distributed in patches (89 confirmed cases, 87 suspected cases) (χ 2=19.573, P< 0.01). In addition, the lesions of patients with confirmed COVID-19 showed progress in short term (72/87, 82.76%), and those with suspected COVID-19 showed remission in short term (63/89, 70.78%). The difference was statistically significant (χ 2=51.114, P< 0.01). There was no significant difference in gender and distribution of pulmonary lobes (χ 2=1.462, P=0.23; χ 2= 7.381, P=0.19). The number of white blood cells (χ 2=17.891, P<0.01) and the percentage of lymphocytes (χ 2=11.151, P<0.01) of COVID-19 were mostly normal or decreased, creatine kinase (χ 2=9.589, P<0.01) was mostly normal, and erythrocyte sedimentation rate was mostly normal or increased (χ 2=4.240, P=0.04). Conclusions:The imaging features and biochemical indexes of diagnosed COVID-19 are different from those of suspected ones. The comparative analysis of imaging features, clinical indexes and follow up examination are helpful for the differential diagnosis of COVID-19.
ABSTRACT
Digestive tract reconstruction with side-to-side esophagojejunostomy is one of the most commonly used digestive tract reconstruction methods after laparoscopic total gastrectomy. It does not need an auxiliary incision. The linear stapler is used to directly enter the abdominal cavity through the Trocar to perform side-to-side anastomosis of esophagojejunostomy. The common hole can be closed by hand suture or linear stapler. 4K laparoscopy can present a clearer and more realistic view to the operators, so as to realize side-to-side esophagojejunostomy more accurately, to reduce the postoperative anastomo-tic related complications and improve the safety of the operation. This article will elaborate the technical key points and difficulties of esophagojejunostomy in 4K laparoscopic total gastrectomy, as well as the prevention and treatment of anastomotic related complications.
ABSTRACT
Laparoscopic radical surgery for rectal can-cer involves total mesorectal excision (TME), D 3 lymphadenectomy, and pelvic autonomic nerve preservation, the goal of which is trying to achieve completely radical cure for cancer and urogenital function preservation. In the actual operation procedure, the understanding of fascial anatomy in abdominal and pelvic cavity will help us to improve the quality of TME surgery for rectal cancer and to preserve the pelvic autonomic nerves. When entering the pelvic cavity, the identification of fascia propria of mesorectum, visceral fascia, pre-hypogastric nerve fascia, presacral fascia, ligament structures around the rectum and the Denonvilliers′ fascia in front of the rectum will help us to protect the pelvic autonomic nerves and avoid surgical injury. So the authors focus on how to identify the pelvic fascia structure clearly in laparoscopic radical resection for rectal cancer, furthermore, to master the concepts of fascia anatomy to realize TME for rectal cancer and to achieve pelvic autonomic nerve preservation.
ABSTRACT
Digestive tract reconstruction with side-to-side esophagojejunostomy is one of the most commonly used digestive tract reconstruction methods after laparoscopic total gastrectomy. It does not need an auxiliary incision. The linear stapler is used to directly enter the abdominal cavity through the Trocar to perform side-to-side anastomosis of esophagojejunostomy. The common hole can be closed by hand suture or linear stapler. 4K laparoscopy can present a clearer and more realistic view to the operators, so as to realize side-to-side esophagojejunostomy more accurately, to reduce the postoperative anastomo-tic related complications and improve the safety of the operation. This article will elaborate the technical key points and difficulties of esophagojejunostomy in 4K laparoscopic total gastrectomy, as well as the prevention and treatment of anastomotic related complications.
ABSTRACT
Objective@#To explore the value of chest CT features and clinical indexes in the differential diagnosis between suspected COVID-19 with two or more negative nucleic acid tests and confirmed COVID-19.@*Methods@#The clinical data and chest CT images of 105 cases withconfirmedCOVID-19 (55 males and 50 females, aged from 2 month to 88 years) and 97 cases with suspected COVID-19(59 males and 38 females, aged from 1 month to 93 years) were analyzed retrospectively in Shiyan Taihe Hospital from January 21 to February 10, 2020. χ2test and two independent sample t test were used to analyze the clinical data and CT signs of the two cases, with P<0.05 for the difference statistically significant.@*Results@#Compared with the suspected patients, the average age of diagnosis of covid-19 was higher (t = 2.460, P = 0.01). The main pathological changes were pure ground glass (68 cases) and mixed ground glass density (53 cases) (χ2 = 50.016, P< 0.01). Interstitial thickening (83 cases) (χ2 = 55.395, P< 0.01), vascular thickening (73 cases) (χ2 = 57.527, P< 0.01), air bronchoscopic sign or bronchiectasis Zhang (67 cases) (χ2 = 17.899, P< 0.01), cord focus (54 cases) (χ2 = 5.500, P = 0.02), easily distributed under the pleura and the long axis of the lesion was parallel to the pleura (89 cases) (χ2 = 23.597, P< 0.01), most of them had no pleural effusion (χ2 = 7.017, P< 0.01); both lesions were mainly distributed in patches (89 cases were confirmed, 87 suspected) (χ2 = 19.573, P< 0.01). In addition, the lesions of patients with confirmed covid-19 showed progress in short term (72 / 87, 82.76%), and those with suspected covid-19 showed remission in short term (63 / 89, 70.78%). The difference was statistically significant (χ2 = 51.114, P< 0.01). There was no significant difference in gender and distribution of pulmonary lobes (χ2 = 1.462, P= 0.23; χ2 = 7.381, P= 0.19). The number of white blood cells (χ2 = 17.891, P< 0.01) and the percentage of lymphocytes (χ2 = 11.151,P< 0.01) of covid-19 were mostly normal or decreased, creatine kinase (χ2 = 9.589, P< 0.01) were mostly normal, and erythrocyte sedimentation rate was mostly normal or increased (χ2 = 4.240, P= 0.04).@*Conclusions@#The imaging features and biochemical indexes of diagnosed COVID-19 are different from those of suspected COVID-19. The comparative analysis of imaging features, clinical indexes and reexamination are helpful for the differential diagnosis of COVID-19 and suspected COVID-19.
ABSTRACT
Single-port and reduced-port laparoscopic radical gastrectomy as the innovative surgery for gastric cancer are gradually accepted nowadays,and more attentions are also paid to single-port and reduced-port laparoscopic radical gastrectomy due to its better cosmetic effect,less pain,lower incidence rate of surgical site infection and more advantages in enhanced recovery after surgery.However,in the early stage,the development of single-port and reduced-port laparoscopic radical gastrectomy were facing challenges and obstacles on account of limited surgical skills,the lack of special laparoscopic instruments,laparoscope and multi-port Trocar.In recent years,the dilemma and difficult situations were gradually resolved following by surgical techniques innovation,laparoscopic instruments and facilities improvement.It is believed that single-port and reduced-port laparoscopic radical gastrectomy will have a good prospect and breakthrough in the field of gastric cancer treatment in the future.
ABSTRACT
BACKGROUND: At present, the transplantation of bone marrow-derived endothelial progenitor cells (BM-EPCs) or bone marrow-derived hepatocyte stem cells (BDHSCs) is common in the treatment of liver fibrosis, but the combined treatment for liver fibrosis is rarely reported. Combined transplantation of BM-EPCs possessing the function of angiogenesis and BDHSCs possessing the function of hepatocyte regeneration might play a dual anti-fibrosis role. OBJECTIVE: To evaluate the reversal effect on liver fibrosis by the combined transplantation of BM-EPCs and BDHSCs in rats. METHODS: The liver fibrosis rat models were induced with CCl4 subcutaneous injections for 6 weeks. BM-EPCs of rats with liver fibrosis were obtained by culture induction in vitro.BDHSCs of rats with liver fibrosis were obtained by magnetic bead cell sorting.BM-EPCs and/or BDHSCs were transplanted into liver fibrosis rats via the tail vein and branch of the portal vein,and then the effects of BDHSCs transplantatiron on liver fibrosis and liver function were observed. RESULTS AND CONCLUSION: (1) Masson staining results showed transplantations of BDHSCs and BM-EPCs, alone or both, could suppress the formation of collagen fibers. However, the staging scores of liver fibrosis showed that only the combined transplantation of BM-EPCs and BDHSCs could significantly improve liver fibrosis,which was significantly different from the model group(1.75±0.25 vs. 3.00±0.19, P < 0.05). (2) The liver biochemical assay in the blood showed that the levels of all five parameters of alanine aminotransferase, aspartate aminotransferase, total bilirubin, prothrombin time, and activated partial thromboplastin time in the BM-EPCs/BDHSCs group were significantly improved to be equivalent to normal levels, compared with those in the model group (P < 0.05). To conclude, it is an effective treatment for liver fibrosis by the co-transplantation of BM-EPCs and BDHSCs.
ABSTRACT
Objective To investigate the effect of preoperative prophylactic parenteral nutrition on prognosis of advanced gastric cancer.Methods A total of 159 patients with advanced gastric cancer in our hospital were collected,and randomly divided into experimental group and control group.80 cases in experimental group were treated with prophylactic parenteral nutrition,and 79 cases in control group were treated with traditional nutrition.The partial indexes of liver function,complications and mortality rate were compared between the two groups before and after surgery.Results The levels of aspartate aminotransferase (AST),alanine aminotransferase (ALT),total bilirubin (TBIL) and direct bilirubin (DBIL) were much lower in experimental group than in control group at 8 days after surgery (t=6.542,6.460,5.634,5.275,all P＜0.001).The levels of ALB and PAB were much higher in experimental group than in control group at 2 and 8 days after surgery (t=12.580,12.471,6.757,12.821,all P＜0.001).The incidence of complications and mortality rate were much lower in experimental group than in control group (x2 =23.409,4.818,P＜0.001 or 0.05).Conclusions Preoperative prophylactic parenteral nutrition can speed up the recovery of liver function and reduce the complications and mortality rate after surgery in patients with advanced gastric cancer.