ABSTRACT
Objective:To study the use of double gastric hanging in laparoscopic spleen-preserving distal pancreatectomy.Methods:A retrospective analysis was conducted on the clinical data of 74 patients who underwent laparoscopic spleen-preserving distal pancreatectomy at the Second Affiliated Hospital of Kunming Medical University from January 2016 to December 2018. There were 23 males and 51 females, with age ranging from 26 to 69 years (average 46.7 years). The patients were divided into the suspension group ( n=39) and the control group ( n=35) according to whether the gastric double suspension technique was used during the operation. The gastric body and gastric pylorus in the suspension group were suspended by self-made rubber slings. These rubber slings were not used in the control group. The operative time, intraoperative blood loss, blood transfusion, tumor diameter, length of resected pancreas, postoperative pancreatic fistula grade B/C, postoperative bleeding and postoperative hospital stay were compared between the two groups. Results:There were no significant differences between the two groups in gender, age, body mass index, operation time, blood transfusion rates, length of resected pancreas, and postoperative pancreatic fistula grade B/C (all P>0.05). The tumor diameter of the suspension group was (3.7±0.8) cm, which was significantly longer than that of the control group (2.5±0.6) cm. The intraoperative blood loss was (130±20) ml, and the postoperative hospital stay was (8±3) d, which were significantly less than those in the control group (250±20) ml, (16±5) d (all P<0.05). Conclusion:The use of gastric double suspension technique in laparoscopic spleen-preserving pancreatic tail resection resulted in significantly reduced intraoperative blood loss and postoperative hospital stay.
ABSTRACT
Objective To study the clinical value of three-dimensional CT reconstruction model of portal venous system combined with finite element analysis to measure portal venous pressure in patients with portal hypertension.Methods A retrospective study was conducted on 27 patients who were diagnosed to have portal hypertension at the Second Affiliated Hospital of Kunming Medical University from May 2016 to May 2018.There were 17 males and 10 females,with ages ranging from 34 to 77 years (mean 56 years).All these patients underwent transjugular intrahepatic portal venous shunt (TIPS) during which the portal venous pressure was measured.The imaging data was imported into the three-dimensional software of medical imaging to reconstruct the three dimensional model of portal vein,and the finite element analysis software of ANSYS was used to calculate the portal venous pressure by calculation with given boundary conditions.Pearson correlation was used to analyze the correlation between the actual measurement of portal venous pressure and the predicted value.Results The actual measured value of portal vein pressure before TIPS in 27 patients with portal hypertension was (3 783 ±930) Pa,and the predicted value was (4 238 ± 1 218) Pa.There was no significant difference (P ＞ 0.05).The predicted value of portal venous pressure was positively correlated with the actual measured value (r =0.402,95 ％ CI:0.026-0.678,P ＜ 0.05).Conclusion Non-invasive measurement of portal venous pressure based on three-dimensional portal venous reconstruction combined with finite element analysis correlated with actual portal venous pressure in patients with portal hypertension.
ABSTRACT
Objective To study the impact of surgical teamwork in totally laparoscopic splenectomy and pericardial devascularization (LSPD) in the treatment of portal hypertension,and advice on technical hints.Methods A retrospective study was conducted on the clinical features of eighty-four patients who underwent totally laparoscopic splenectomy and pericardial devascularization in the Second Affiliated Hospital of Kun Ming Medical University from January,2014 to December,2017.Results Totally laparoscopic procedures were performed successfully in 80 patients.The procedure was converted to hand-assisted laparoscopic splenectomy and pericardial devascularization in 3 patients because of uncontrollable bleeding.One patient who initially underwent laparoscopic cholecystectomy developed an intraoperative blood loss of 1 500 ml.The surgery was terminated and was continued one week later after stabilization of the patient.Of the 80 patients who underwent totally LSPD,the operation time ranged from 116.0 to 243.0 (146.0 ± 33.0) min.The intraoperative blood loss ranged from 60.0 to 600.0 (214.0 ± 31.0) ml.Routine coagulation function and portal vein color Doppler ultrasound examination carried out within 3 months after surgery detected postoperative portal vein thrombosis in four patients.They responded successfully to antiplatelet and anticoagulant therapy.There were no perioperative deaths,variceal bleeding,gastrointestinal fistula and infection.Conclusions With proper surgical steps and skilled laparoscopic technique carried out by an experienced team of surgeons,totally laparoscopic splenectomy and pericardial devascularization was safe and effective in treating portal hypertension.Strict perioperative management provided a guarantee for the safe operation.
ABSTRACT
Objective To compare the feasibility and safety of laparoscopic Roux-en-Y choledochojejunostomy versus open Roux-en-Y choledochojejunostomy.Methods From October 2011 to June 2013,37 patients underwent laparoscopic Roux-en-Y choledochojejunostomy (observation group) and 42 underwent open Roux-en-Y choledochojejunostomy (control group).We retrospectively compare the two groups in terms of operation time,intraoperative blood loss,length of incision,postoperative hospital stay,postoperative gastrointestinal function recovery time,incision infection rate and the incidence of biliary fistula after surgery.Results In observation group operation time was (275.43 t 12.28) min,higher than that of control group (189.12 ± 19.35) min (P =0.031),intraoperative blood loss was (83.13 ±6.34) ml,incision length (5.76 ±0.7) cm,postoperative recovery time of gastrointestinal tract of (43.33 ±3.15) h,postoperative hospital stay (12.65 ± 2.19) d,were in favor of the observation group which were respectively (180.37 ±9.67) ml,(18.51 ±1.9) cm,(70.45 ±4.97) h and (22.16 ±4.61) d (t =33.17,36.73,33.17,P ＜ 0.05).Postoperative incision infection rate in observation group was 5.4％,lower than the control group (19.07％) (chi-square =22.12,P ＜ 0.05).Between the two groups there was no significant difference in the incidence of biliary fistula.Conclusions Laparoscopic Roux-en-Y hepatojejunostomy is safe,effective,and less traumatic procedure.