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Objective To investigate the clinical value of 64-slice spiral computed tomography(64-MSCT)triple-phase enhanced scan in diagnosis of lymphatic metastasis of gastric cancer.Methods Thirty patients with gastric cancer underwent plain and triple-phase enhanced scan by using 64-MSCT to analyze the relevant parameters of lymphatic metastasis.Results The four parameters de-termined metastatic perigastric lymph node as follows:①the short diameter ≥6 mm,②the ratio of short-to-long diameter ≥0.6,③the CT value in the portal venous phase≥ 65 HU,④the difference of CT values between portal venous phase and plain scan≥35 HU.The sensitivity and specificity of combining two parameters (①+②)in diagnosing metastatic lymph node were 90.5% and 29.0%,respectively.The sensitivity and specificity of combining three parameters (①+②+③)were 98.2% and 1 9.4%,respec-tively.The sensitivity and specificity of combining four parameters (①+②+③+④)were 99.7% and 13.2%,respectively.In ad-dition,metastatic lymph nodes were considered if they were ring-enhancement,or adhesions of several lymph nodes.Conclusion The use of 64-MSCT triple-phase enhanced scan and synthesis of various parameters of lymph nodes could lead to reliable diagnosis of lymphatic metastasis in gastric cancer with rapid,non-invasive,high sensitive and specific features.
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Objective To evaluate laparoscopic D2 lymph node dissection gastrectomy in the treatment of advanced gastric cancer.Methods The clinical data of 239 cases of advanced gastric cancer admitted from January 2004 to June 2011 were respectively analyzed,patients were divided into laparoscopic resection group and open surgery group.Data analysis was performed by SPSS 19.0 statistical software.Results There were 102 cases in laparoscopic group,and 137 cases in open group.The length of incision,operative blood loss,recovery time of gastrointestinal function,food-taking time and postoperative hospital stay in laparoscopic operation group were (5.0 ± 1.1) cm,(70 ± 44) ml,(57 ± 14) h,(68 ± 12) h,(7.1 ± 1.4) d and in open operation group were (17.4 ± 2.1) cm,(107 ± 59) ml,(75 ± 12) h,(91 ±15) h,(9.9 ± 1.8) d respectively.There were significant differences between the two groups (t =-58.86,-5.50,-10.72,-12.58,-12.58,all P =0.00).There was no significant differences between the two groups in operative time (t =1.63,P =0.11),with operative time in laparoscopic operation group of (192 ± 32) min,and (185 ± 30) min in open group.Average proximal,distal cutting edge and the average number of lymph node harvested were (5.0 ± 1.0) cm,(4.7 ± 0.8) cm,(27.6 ± 7.2) in laparoscopic operation group,and (5.1 ±0.9) cm,(4.7 ±0.9) cm,(27.0 ±6.5) in open group (t =-0.61,0.10,0.68,P ＞ 0.05).The 3-,5-,7 d white blood cell counts in laparoscopic group was (11.1 ± 1.3) ×109/L,(9.5 ± 1.4) × 109/L,(7.0 ± 1.5) × 109/L,and (12.8 ± 1.3) × 109/L,(11.1 ± 1.5) × 109/L,(8.6 ± 1.3) × 109/L,in open group (t =-9.83,-8.88,-9.40,all P =0.00).Complications developed in 9.8 ％ (10/102) in laparoscopic operation group,and 17.5 ％ (24/137) in open group (x2 =0.285,P =0.09).The 1-year,3-year,5-year survival rate of patients in laparoscopic group were 96.1％,74.1％,47.2％,and 95.6％,70.0％,50.9％ in open group (x2=0,0.04,0.21,P ＞0.05).Conclusions In selected cases,laparoscopic D2 lymph node dissection gastrectomy for advanced gastric cancer is safe and effective,and long-term outcomes are satisfactory.
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Objective To evaluate the safety and feasibility of laparoscopic hepatectomy for hepatocellular carcinoma(HCC). Methods From January 2002 through December 2007,86 HCC cases were divided into laparoscopic hepatectomy group and open hepatectomy group.Clinical data were analyzed. Results There were 36 cases in LH group,and 50 cases in OH group.Significant differences were noticed in the length of incision,operative blood loss,food-taking time,postoperative hospital stays,and analgesic usage between the two groups (respectively t =-37.608、-2.396、-13.073、-4.283 、x2 = 35.765,all P＜0.05),in which LH group was superior to OH group.Differences appeared in ALT,AST,ALP,r-GT and LDH on post-op day 1,and 3.APTT,ALB response on the fifth day after operation were different in the two groups (separately t =-3.465,-3.236,-3.470,-6.812,-4.837 and-3.998,-2.894,-4.286,-7.887,-5.388,6.131,7.292; all P ＜0.05);ALT,AST,ALP,r-GT value on the fifth day post-operation,and T-BIL on the day 1,5 post-operation were different in two groups (separately t =-4.795,-2.155,-3.442,-4.194,-2.712,-1.600,all P ＜0.05),Meanwhile,as the results all showed that,injuries were all less severe in LH than OH group.There were no significant differences between the two groups in operative time,resection method,overall complications,1-year,3-year survival rate,disease free survival (t =-0.893,separately x2 =0.066,0.026,0.468,0.156,0.106,2.732,all P ＞0.05) while 3-year survival rate in LH group and OH group were 50.0%,25% respectively (x2=2.732,P = 0.098). Conclusion Laparoscopic hepatectomy was safe and feasible for treatment of HCC,and its short-term efficacy was better than open hepatectomy.Furthermore,laparoscopic hepatectomy had promising long-term effectiveness.
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Objective To investigate management strategy of minimally invasive surgery for common bile duct stones. Methods Three hundred and four cases of common bile duct stones were divided into 3 groups receiving respectively endoscopic papillary balloon delation plus laparoscopic cholecystectomy ( EPBD group, 35 cases ), endoscopic sphincterotomy plus LC ( EST group, 138 cases), and Laparoscopic common bile duct exploration plus LC (LCBDE group, 131 cases). Results There was no significant difference in treatment success rate, short-term complications and bile duct retained stones among these three group ( x2 = 1. 930, 0. 038, and 0. 427 respectively, P > 0. 05 ). There was significant difference among these three groups in operation time ( F = 17.941, P = 0. 000 ), and the operation time in LCBDE group was shorter than that in other two groups( EPBD-EST: P = 0. 122, EST-LCBDE:P = 0. 000, EPBD-LCBDE:P = 0. 020 ). There was significant difference among these three groups in postoperative hospital stay (F =24. 016,P =0. 000) ,and the postoperative hospital stay in EPBD group was shorter than that in other two groups ( EPBD-EST: P = 0. 000, EST-LCBDE : P = 0. 198, EPBD-LCBDE : P = 0. 000 ). In EPBD group,bile duct recurrent stones was found in 2 cases(6. 7% ) and cholangitis in 1 case(33% ) and no duodenal papilla stenosis was encountered; In LCBDE group, bile duct recurrent stones were found in 7 cases (6. 0% ), cholangitis in 3 cases ( 2. 6% ), and there was no duodenal papilla stenosis; In EST group, bile duct recurrent stones were complicated in 18 cases ( 15.8% ), duodenal papilla stenosis in 9 cases (7.9%), and cholangitis in 14 cases( 12. 3% ). There were significant differences among these three groups for these three complications( x2 = 6. 482, 9. 160, and 12. 020 respectively,P < 0. 05 ), and the rate of complications in EST group was higher than that in other two groups. Conclusion For common bile duct stones, EPBD is the first choice followed by LCBDE while EST is only indicated for very few cases.
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Objective To explore the value of Ligasure vessel sealing system(LVSS)during resection of retroperitoneal tumor.Methods Group 1 including 32 cases were performed resection of retroperitoneal tumor with LVSS and electrosurgical seapel from Jun.2004 to Oct.2008.group 2 including 26 cases were done with electrosurgieal seapel from Jan.2001 to Jun.2004.Operating blood loss,operating time,iatrogenic injury,postoperative blood loss and hospital stay were compared between the two groups.Results There was no significant difference in hospital stay[(11.7±0.7)d vs.(12.3±1.4)d)]and iatrogenic injury(9.38%vs.16.00%)between two groups statistically(P＞0.05),but the intraoperative blood lose[(403.1±37.1)ml vs.(704.0±129.0)m1)s,postoperative blood loss[(131.5±18.4)ml vs.(214.8±29.2)ml)]and operating time[(166.5±8.9)min vs.(186.8±15.4)min]were less in group 1 than that in group 2(P＜0.05).Conclusion Ligasure vessel sealing system has advantages of safe coagulation,shortening operation time in resection of retroperitoneal tumor.
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Objective To observe the effects of Shenhong (SH) combined with chemotherapeutic drugs on curative effect, symptoms improvement, and immunology function in metaphase or terminal cancer patients.Methods All 598 patients were divided into two groups. The control group had 205 patients treated with chemotherapeutic drugs. The SH-treated group had 393 patients treated with SH combined with chemotherapeutic drugs. Results Compared with control patients, the total remission was 42.0% in SH-treated patients. The improvement rates of pain, cough, debilitation, and anepithymia were 71.9%. The Karnofsky grade was increased by 27.0%. CD+3 and CD+4 were increased by 11.6% and 19.3%, but CD+8was decreased by 22.6% at the same time. The patients CD+4 / CD+8 was enhanced by 54.2%, while the NK cell activity and marophage phagocysis were significantly improved. The content of Ig G and Ig A were increased in the same group. Conclusion The curative effect of SH combined with chemotherapeutic drugs was higher than that of control group. The therapeutic effect of SH is explained by its potential regulation activity on immun system.
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Objective To investigate the safety and therapeutic effect of modified laparoscopic Dixon surgery for mid-low rectal carcinoma. Methods From September 2004 to April 2007,26 patients with mid-low rectal carcinoma were selected to receive modified laparoscopic Dixon surgery.Through the anus,the rectum was pulled out,the tumor was removed,and then colon-rectum anastomosis was performed.Results All the operation was completed successfully.The average operation time was(166.3 ? 48.1) min,and the mean blood loss was(235.4 ? 124.7) ml.No patient had urethral injury,dysuria,anastomotic leakage,or other complications after the operation.The patients expelled gas(2.9?0.7) days after the operation.Their mean hospital stay was(8.8?1.4) days.During a follow-up of 15.7 months(6 to 27 months),3 patients had local recurrence,5 patients showed increased frequency of stool,and 18 had satisfied anal function.Conclusion The short-term results indicate that the modified laparoscopic Dixon surgery is safe and effective for mid-low rectal carcinoma,and is associated with minimal invasion.
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Objective To investigate the feasibility and clinical value of laparoscope combined with choledochoscope in the treatment of intra- and/or extrahepatic bile duct cholelithiasis. Methods 10 patients with intra- and/or extrahepatic bile duct stones underwent common bile duct incision exploration to remove stones under laparoscope combined with fiber-choledochoscope from September 2000 to March 2002. Common bile duct was directly sutured or T-tube drainage was performed. Results All cases were operated on successfully without conversion to open operation. There was no serious complication except 1 case of postoperative bile leakage cured by conservative treatment. The residual stones of 2 cases were removed by choledochoscope. Conclusions Laparoscope combined with choledochoscope in the management of intra- and/or extrahepatic bile duct stones is a safe, reliable and minimally invasive procedure. However, it is important to choose indications.
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Ojective To evaluate the value of laparoscopic gastrectomy in the management of gastric diseases. Methods 18 laparoscopic gastric operation were performed in our hospital from August 2000 to April 2001. The ages of the patients ranged from 28 to 87 years. One patient received Billroth-Ⅰ gastrectomy, 7 Billroth-Ⅱ gastrectomy, 3 proximal subtotal gastrectomy, 4 distal subtotal gastrectomy and 3 total gastrectomy. Results All the operations were successfull, the duration of operation was 150～340min, the estimated blood loss was 20～120ml, and the average postoperative hospitalized days were 8 days. All patients recovered quickly without any postoperative complication. Flatus was present quickly. no death occurred in all the patients. Conclusions Laparoscopic gastrectomy is an effective and safe technique for the manaqement of gastric disease, if used properly.
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Objective To evaluate the feasibility and effectiveness of laparoscopic-assisted modified Swenson’s operation for Hirschsprung’s disease in infants. Methods A total of 13 infants with Hirschsprung’s disease including 11 males and 2 females were treated by laparoscopic-assisted modified Swenson’s surgery. Three- or four-trocar technique was used under a CO2 pressure of 8-10 mm Hg. The seromuscular layer of the colon was obtained for pathological examination. The mesenteries of the sigmoid colon and rectum were dissected by Ligasure, and the rectum was dissected down to 0.5-1.0 cm above the dentate line. Through the anus, the angusty and transmigration segment of the intestinal canal were evaginated, pulled out, and resected. Whole-layer colon-rectum anastomosis was performed,?21 mm stapler was used in 3 cases. Results All the operations were completed with laparoscopy in 85-161 min (mean, 115 min). The blood loss was less than 12 ml in all the patients. No intraoperative complications occurred. After the operation, 3 patients developed intestinal inflammation, 1 had anastomotic leakage, and 1 feces stain. All the compilations were cured by conservative treatments. The patients were followed up for 6 to 42 months (mean, 26 months), during which no one had complications. Conclusion Laparoscopic-assisted modified Swenson’s operation is feasible and effective for Hirschsprung’s disease in infants.
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Objective To explore the safety and feasibility of laparoscope-assisted radical gastrectomy for gastric cancer.Methods Fifty-four cases of gastric cancer were selected to carry out laparoscope-assisted radical gastrectomy,including 12 radical total gastrectomies,18 proximal gastrectomies,and 24 distal gastrectomies.Lymphonodes were dissected by D1 in 29 cases and D2 in 25 cases.Results All of the 54 operations were performed successfully.The average operative time was(164.4?38.7)min in total gastrectomies,(142.4?35.2)min in proximal gastrectomies,and(149.1?35.4)min in distal gastrectomies.The mean volume of bleeding was(164.6?80.1)mL in total gastrectomies,(149.5?94.7)mL in proximal gastrectomies,and(152.5?87.7)mL in distal gastrectomies.The average number of lymphonodes dissected was 19.1?6.5 per case.After operation,the mean time of passage of gas via anus was(3.7? 0.7)d,and the mean length of hospital stay was(9.2?1.7)d.Two cases experienced postoperative anastomotic bleeding,and was controlled by conservative treatment.No other complications,such as anastomotic leakage,anastomotic obstruction,or duodenal stump leakage were experienced.Conclusions This results reveal that laparoscope-assisted radical gastrectomy is safe and feasible for gastric cancer.As long as the principles of cancer surgery are strictly followed,it can maintain radical tumor removal and exhibit the character of minimal invasion.