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Objective:To investigate the clinical efficacy of transanal minimally invasive surgery (TAMIS) with glove method and transanal endoscopic microsurgery (TEM) in the treatment of rectal neoplasms.Methods:The retrospective cohort study was conducted. The clinicopathological data of 60 patients with rectal neoplasms who were admitted to the First Affiliated Hospital of Fujian Medical University from March 2015 to May 2017 were collected. There were 34 males and 26 females, aged from 49 to 74 years, with an average age of 62 years. Of the 60 patients, 30 undergoing TAMIS with glove method and 30 undergoing TEM were allocated into TAMIS group and TEM group, respectively. Observation indicators: (1) surgical situations and postoperative recovery; (2) postoperative short-term complications; (3) follow-up. Follow-up using outpatient examination and telephone interview was performed to detect tumor recurrence and metastasis up to August 2018. Measurement data with normal distribution were represented as Mean± SD, and comparison between groups was analyzed using the t test. Count data were represented as absolute numbers or percentages, and comparison between groups was analyzed using the chi-square test or Fisher exact propability. Comparison of ordinal data between groups was analyzed by the Mann-Whitney U test. Results:(1) Surgical situations and postoperative recovery: patients in the two groups underwent surgery successfully. The operation time, volume of intraoperative blood loss, time to postoperative first flatus, time to postoperative semi-fluid diet intake, postoperative anal pain score, duration of postoperative hospital stay and cases with Kirwan classification Ⅰ, Ⅱ, Ⅲ, Ⅳ, Ⅴ of anus function at 3 months after surgery were respectively (35±7)minutes, (9±5)mL, (2.7±0.9)days, (2.9±0.6)days, 2.1±0.9, (3.6±1.9)days, 29, 1, 0, 0, 0 in the TAMIS groups and (38±7)minutes, (9±6)mL, (2.5±0.8)days, (2.7±0.7)days, 1.8±0.9, (4.0±2.3)days, 28, 1, 1, 0, 0 in the TEM group, showing no significant difference in the above indicators between the two groups ( t=-1.377, -0.099, 0.931, 0.770, 1.418, -0.789, Z=-0.607, P>0.05). Total operation time and treatment expenses were (38±7)minutes and (8 507±1 471)yuan in the TAMIS group, versus (46±7)minutes and (9 551±1 747)yuan in the TEM group, showing significant differences between the two groups ( t=-4.628, -2.506, P<0.05). Results of postoperative pathological examination showed negative margin in the two groups. (2) Postoperative short-term complications: of 2 patients with postoperative short-term complications in the TAMIS group, 1 had postoperative urine retention due to preoperative prostatic hyperplasia and was improved after 3 days of bladder training, 1 was diagnosed as sepsis due to postoperative cold and fever at 2 days after operation with escherichia coli detected in blood culture, and the patient was cured after anti-infection treatment. Of 3 patients with postoperative short-term complications in the TEM group, 1 had anal incontinence at 2 days after operation and was improved after 4 days of anus function exercise, 1 had hematochezia and was improved after hemostatic therapy under colonoscopy, 1 had perineal infection and was improved after anti-inflammation. There was no significant difference in the short-term complications between the two groups ( P>0.05). (3) Follow-up: patients in the TAMIS group and TEM group were respectively followed up for (17±4)months and (16±3)months, with no significant difference between the two groups ( t=0.200, P>0.05). During the follow-up, 1 case of rectal tubular adenoma in the TAMIS group had local tumor recurrence at 1 year after surgery, with a diameter of about 0.5 cm and a distance of about 12 cm from the anal margin. The patient had no recurrence after endoscopic retreatment and was confirmed tubular adenoma by postoperative pathological examination. One patient with poorly differentiated adenocarcinoma in the TEM group was detected mesorectal lymph node metastasis at 6 months after surgery by magnetic resonance imaging examination and underwent laparoscopic radical resection of rectal cancer. The postoperative pathological examination showed no residual cancer cells in the rectum specimen and there was 1 positive in 15 lymph nodes for pathological examination. No tumor recurrence or metastasis occurred by the end of follow-up. There was no significant difference in postoperative tumor recurrence and metastasis between the two groups ( P>0.05). Conclusions:The clinical efficacy of TAMIS with glove method in the treatment of upper-middle rectal neoplasms is comparable to TEM, which is safe and feasible. In addition, the TAMIS with glove method has shorter time and lower treatment expenses.
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Objective To investigate the application value of different digestive tract reconstruction methods in laparoscopic distal gastrectomy (LDG).Methods The retrospective cohort study was conducted.The clinicopathological data of 164 with early gastric cancer (GC) who were admitted to the First Affiliated Hospital of Fujian Medical University between June 2010 and April 2015 were collected.Of 164 patients undergoing LDG,45 receiving Billroth Ⅰ (B Ⅰ) anastomosis,39 receiving Billroth Ⅱ (B Ⅱ) anastomosis,44 receiving Roux-en-Y anastomosis and 36 receiving uncut Roux-en-Y anastomosis were allocated into the B Ⅰ group,B Ⅱ group,RY group and uncut RY group,respectively.Observation indicators:(1) surgical and postoperative recovery situations;(2) postoperative short-term complications situations;(3) follow-up situations.Follow-up using outpatient examination and telephone interview was performed to detect postoperative nutriology and long-term complications up to May 2017.Measurement data with normal distribution were represented as x±s.Comparison among groups was analyzed using the ANOVA,and pairwise comparisons were done by the Tukey hsd test.Count data were described as the frequency and percentage,and comparisons among groups were analyzed the chi-square test or Fisher exact probability.Ordinal data were analyzed by the Kruskal Wallis test.Results (1) Surgical and postoperative recovery situations:patients in 4 groups underwent successfully LDG.Cases undergoing total LDG and assisted LDG and digestive tract reconstruction time in the B Ⅰ,B Ⅱ,RY and uncut RRY groups were respectively 0,29,13,15 and 45,10,31,21 and (42±7)minutes,(55±8)minutes,(64±8)minutes,(51±6) minutes,with statistically significant differences among 4 groups (x2 =21.628,F=74.441,P＜0.05).(2)Postoperative short-term complications situations:2,2,3 and 1 patients in the B Ⅰ,B Ⅱ,Roux-en-Y and uncut Roux-en-Y groups had respectively postoperative short-term complications,showing no statistically significant difference among 4 groups (x2 =0.840,P＞0.05).(3) Follow-up situations:all patients were followed up,and follow-up time in the B Ⅰ,B Ⅱ,RY and uncut RY groups were respectively (10.8 ± 3.5) months,(10.9 ±3.4)months,(11.3±3.2) months and (11.2±2.2) months,with no statistically significant difference among 4 groups (F=0.200,P＞0.05).① Comparisons of postoperative 1-year nutritional indexes:rates of changes in body mass index (BMI),hemoglobin (Hb),total protein (TP) and albumin were respectively 93％±7％,91％±7％,90％±7％,90％±9％ and 94％±9％,97％±11％,95％±9％,97％±9％ and 101％±9％,99％±7％,98％±7％,99％±7％ and 101％±10％,103％±7％,100％±10％,103％±9％ in the B Ⅰ,B Ⅱ1,RY and uncut RY groups,showing no statistically significant difference among 4 groups (F=1.182,0.724,1.050,0.971,P＞0.05).②)Of 164 patients within 1 year postoperatively,47 were complicated with gastric retention (27,12,6 and 2 with severity in grade 1,2,3 and 4),87 with residual gastritis (53,24,10 and 0 with severity in grade 1,2,3 and 4),and 38 with bile reflux (severity in grade 1).Of 38 patients with bile reflux,33 were combined with residual gastritis,showing a correlation between residual gastritis and bile reflux (r=0.396,P＜0.05).Cases with gastric retention,residual gastritis and bile reflux within 1 year postoperatively were respectively 16,9,21,1and 35,30,13,9 and 16,18,3,1 in the B Ⅰ,B Ⅱ],RY and uncut RY groups,showing statistically significant differences among 4 groups (x2 =21.261,41.103,30.469,P＜ 0.05).There were statistically significant differences in gastric retention occurrence between uncut RY group and B Ⅰ group or B Ⅱ group or RY group (x2 =12.958,6.675,20.065,P＜0.05),and in residual gastritis occurrence between RY group and B Ⅰ group or B Ⅱ group (x2 =20.831,18.587,P＜0.05) and between uncut RY group and B Ⅰ group or B Ⅱ group (x2 =22.452,20.220,P＜0.05).There were statistically significant differences in bile reflux occurrence between RY group and B Ⅰ group or B Ⅱ group (x2 =10.942,16.926,P＜0.05),and between uncut RY group and B Ⅰ group or B Ⅱ group (x2 =12.958,18.620,P＜0.05).Conclusion Roux-en-Y and uncut Roux-en-Y anastomoses are superior to B Ⅰ and B Ⅱ anastomoses in improving residual gastritis and bile reflux in the postoperative digestive tract reconstruction of LDG,and uncut Roux-en-Y anastomosis can effectively reduce occurrence of postoperative gastric retention.
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Objective To investigate the impact of splenectomy on the prognosis and immune function of patients with end stage carcinoma of the esophagogastric.Methods The clinical data of 61 patients with end stage carcinoma of the esophagogastric junction who were admitted to the First Affiliated Hospital of Fujian Medical University from January 2007 to December 2010 were retrospectively analyzed.All the patients were divided into splenectomy group (22 patients) and spleen preservation group (39 patients).The immune function before operation,on the 10th day and the 6th month after operation was detected.The intra-and postoperative conditions of the patients of the 2 groups were compared.All data were analyzed using the independent sample t test or chisquare test.Results The levels of IgA,IgG,IgM,CD3 and CD4 in the splenectomy group at the 10th day after operation were significantly higher than those before operation (t =2.55,3.33,3.40,2.92,2.10,P ＜ 0.05).The levels of IgA,IgG,IgM,CD3,CD4,the ratio of CD4/CD8 of the spleen preservation group at the 10th day after operation were significantly higher than those before operation (t =3.35,5.29,3.33,2.60,3.53,3.12,P ＜0.05).The levels of IgA,IgG,IgM,CD3,CD4 and the ratio of CD4/CD8 in the splenectomy group at postoperative month 6 were significantly lower than those at postoperative day 10 (t ＝2.75,4.40,3.06,2.51,2.24,2.29,P ＜ 0.05).The levels of IgA,IgG,IgM,CD4,CD8 and the ratio of CD4/CD8 of the spleen preservation group were significantly higher than those of the splenectomy group,while the level of CD8 in the spleen preservation group was significantly lower than that in the splenectomy group (t =1.70,2.10,2.70,2.16,2.13,2.83,P ＜ 0.05).The operation time of the splenectomy group was (152 ± 26) minutes,which was significantly longer than (130 ± 24) minutes of the spleen preservation group (t ＝ 3.42,P ＜ 0.05).There were no significant differences in the operative blood loss,incidence of postoperative infection,median survival time,1-year survival rate between the 2 groups (t =1.38,x2 =0.78,1.22,2.51,P ＞ 0.05).Conclusion Palliative gastrectomy could reverse the immune function of spleen by decreasing tumor burden for patients with end stage carcinoma of the esophagogastric junction who can not be treated by radical resection.Spleen preservation may have positive significance for the immune function and prognosis of patients with end stage carcinoma of the esophagogastric junction.