Meta-analysis of extralevator abdominoperineal excision and conventional abdominoperineal excision for low rectal cancer / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To evaluate the perforation, circumferential resection margin (CRM) and postoperative perineal wound complications after extralevator abdominoperineal excision (ELAPE) and conventional abdominoperineal excision (APE) for low rectal cancer by using systematic review method.</p><p><b>METHODS</b>The Cochrane Library, PubMed, EMbase, CNKI and VIP database were searched for literatures in which ELAPE and APE were compared for the treatment of low rectal cancer. Meta-analysis was performed to deal with data extracted by Cochrane Systematic Reviews methods.</p><p><b>RESULTS</b>Six studies met the inclusion criteria including one randomized control study and five non-randomized control studies with a total of 656 cases including 346 cases of ELAPE and 310 cases of APE. Meta-analysis showed a lower positive CRM rate (RR=0.48, 95%CI:0.36-0.65) and a lower local recurrence rate (RR=0.43, 95%CI:0.19-0.99) in ELAPE compared with APE. There were no significant differences in operative perforation rate (RR=0.45, 95%CI:0.15-1.37) and post-operative perineal wound complications rate (RR=1.20, 95%CI:0.57-2.50) between the two surgical procedures.</p><p><b>CONCLUSION</b>ELAPE is associated with lower rates of positive CRM and local recurrence compared with APE.</p>

Simulation and experimental study on trajectory tracking of the assistive standing-up robot / 医用生物力学

Objective To establish a new trajectory tracking algorithm combined with trapezoidal velocity, so as to realize the trajectory control of the assistive standing-up robot and help subjects complete the standing-up training. Methods Forces of the assistive standing-up robot acting on subjects were analyzed by deducing the force and moment balance equations. According to the interpolation points of the target curve, trapezoidal velocity and current position points of the end-effector, the trajectory tracking algorithm of the assistive standing-up robot was developed, and a simulation platform was built up by Simulink/Stateflow software. Based on the established Xpc target and host computer, assistive standing-up robot and 3D motion analysis system, trajectory tracking of the straight line, curves in different shapes, standing-up curve of the subjects were tested. Parameters that affected the velocity and accuracy of trajectory tracking as well as the differences in trapezoidal velocity and standing-up velocity were discovered. Results Accurate positon control of the assistive standing-up robot was achieved by trajectory tracking algorithm. The standing-up trajectory curve and trapezoidal velocity could meet the requirement of standing-up velocity for the subjects and fulfill their requirements for different curve shapes and velocities. Conclusions The assistive standing-up robot using trajectory tracking algorithm combined with trapezoidal velocity can accurately track the target curves without limitation of curve shapes, and help the standing-up training for subjects. The established simulation and test platform in consideration of different subjects’ standing-up trajectory curve, velocity and accelaraion will assist standing-up more effectively.

Clinical efficacy and safety of selective trans-cystic intra-operative cholangiography in primary suture following three-port laparoscopic common bile duct exploration / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Intra-operative cholangiography has been shown to be a sensitive and specific method of demonstrating bile duct stones. This study investigated the feasibility, safety, and clinical value of selective trans-cystic intra-operative cholangiography in primary suture following three-port laparoscopic common bile duct exploration, and identified the factors that positively predict the presence of common bile duct stones.</p><p><b>METHODS</b>From January 2008 to January 2011, 252 of 1013 patients undergoing laparoscopic cholecystectomy received selective trans-cystic intra-operative cholangiography and primary suture following three-port laparoscopic common bile duct exploration. Their clinical data were analyzed retrospectively.</p><p><b>RESULTS</b>All operations were successful and none was converted to open surgery. The intra-operative cholangiography time was (8.3 ± 2.5) minutes, and the operative duration was (105.4 ± 23.1) minutes. According to selective intra-operative cholangiography, the positive predictive values of current jaundice, small gallstones (< 0.5 cm) and dilated cystic duct (> 0.3 cm), dilated common bile duct (> 0.8 cm), history of jaundice or gallstone pancreatitis, abnormal liver function test, and preoperative demonstration of suspected common bile duct stones on imaging were 87%, 25%, 42%, 15%, 32%, and 75% for common bile duct stones, respectively. Patients with several factors suggestive of common bile duct stones yielded higher numbers of positive cholangiograms. Unexpected stones were found in 13 patients (5.2%) by intra-operative cholangiography. The post-operative hospital stay was (4.7 ± 2.2) days. Post-operative bile leakage occurred in two cases, and these patients recovered by simple drainage for 3 - 7 days without re-operation. Of the 761 patients who underwent laparoscopic cholecystectomy alone, 5 (0.7%) presented with a retained common bile duct stone requiring intervention. The median follow-up was 12 months, and only one patient who once suffered from bile leakage presented with obstructive jaundice due to bile duct stenosis 6 months postoperatively. The other patients recovered without any serious complications.</p><p><b>CONCLUSIONS</b>Selective intra-operative cholangiography yields acceptably high positive results. It is a safe, effective, and minimally invasive approach in patients with suspected choledocholithiasis and primary suture following three-port laparoscopic common bile duct exploration.</p>