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Objective To compare the efficacy of laparoscopic surgery with combined medial and caudal approach and cephalic medial-to-lateral approach for right hemicolon cancer patients combined with incomplete ileus. Methods The clinical data of 98 right hemicolon cancer (T1- 4 M0) patients combined with incomplete ileus in Fukuang General Hospital of Liaoning Health Industry Group from January 2014 to December 2018 were retrospectively analyzed. All patients underwent laparoscopic right hemicolectomy, complete mesocolic excision (CME) and D3 lymphadenectomy. Among them, the combined medial and caudal approach was used in 50 patients (observation group), and the cephalic medial-to-lateral approach was used in 48 patients (control group). The operation time, bleeding volume, condition of lymph nodes dissected, length of hospital stay after operation and complication after operation were compared between 2 groups. Results Both groups successfully completed the operation, with no conversion to laparotomy and perioperative death. The bleeding volume and operation time in observation group were significantly lower than those in control group: (105.3 ± 22.6) ml vs. (309.6 ± 28.0) ml and (165.2 ± 17.9) min vs. (219.5 ± 21.5) min, and there were statistical differences (P﹤0.01 or ﹤0.05). There were no statistical differences in the number of lymph nodes dissected, proportion of lymph nodes dissected ≥ 12, number of positive lymph, length of hospital stay after operation and complication after operation between 2 groups (P＞0.05). Conclusions Laparoscopic surgery for right hemicolon cancer patients combined with incomplete ileus is safe and feasible. Compared with the cephalic medial-to-lateral approach, the combined medial and caudal approach can reduce the amount of intraoperative bleeding and shorten the operation time significantly.
ABSTRACT
Objective@#To compare the efficacy of laparoscopic surgery with combined medial and caudal approach and cephalic medial-to-lateral approach for right hemicolon cancer patients combined with incomplete ileus.@*Methods@#The clinical data of 98 right hemicolon cancer (T1-4 M0) patients combined with incomplete ileus in Fukuang General Hospital of Liaoning Health Industry Group from January 2014 to December 2018 were retrospectively analyzed. All patients underwent laparoscopic right hemicolectomy, complete mesocolic excision (CME) and D3 lymphadenectomy. Among them, the combined medial and caudal approach was used in 50 patients (observation group), and the cephalic medial-to-lateral approach was used in 48 patients (control group). The operation time, bleeding volume, condition of lymph nodes dissected, length of hospital stay after operation and complication after operation were compared between 2 groups.@*Results@#Both groups successfully completed the operation, with no conversion to laparotomy and perioperative death. The bleeding volume and operation time in observation group were significantly lower than those in control group: (105.3 ± 22.6) ml vs. (309.6 ± 28.0) ml and (165.2 ± 17.9) min vs. (219.5 ± 21.5) min, and there were statistical differences (P<0.01 or <0.05). There were no statistical differences in the number of lymph nodes dissected, proportion of lymph nodes dissected ≥ 12, number of positive lymph, length of hospital stay after operation and complication after operation between 2 groups (P>0.05).@*Conclusions@#Laparoscopic surgery for right hemicolon cancer patients combined with incomplete ileus is safe and feasible. Compared with the cephalic medial-to-lateral approach, the combined medial and caudal approach can reduce the amount of intraoperative bleeding and shorten the operation time significantly.
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PURPOSE: To compare two combined surgical techniques, endoscopic endonasal surgery with transconjunctival reconstruction and transcaruncular surgery with transconjunctival reconstruction, when used to treat both medial and inferior orbital wall fractures. METHODS: A retrospective review of 63 patients who were followed up from January 2011 to December 2014 at Inha University Hospital for surgical reconstruction of combined medial and inferior orbital wall fractures was undertaken. We compared between the patients the computed tomographic scans, diplopia, extraocular muscle (EOM) movements, and Hertel's exophthalmometer exams pre- and post-6 months surgery. A total of 29 patients received endoscopic transnasal surgery with trasconjunctival reconstruction, and 34 received transcaruncular surgery with trans-conjunctival reconstruction. RESULTS: There were no significant differences between the two combined methods in terms of the primary and peripheral gaze diplopia or the restriction of EOM movement 6 months after surgery. However, statistically significant differences were observed in exophthalmometer measurements 6 months after surgery. CONCLUSIONS: The two combined surgical methods showed similar results in terms of postoperative primary and peripheral gaze diplopia, EOM restriction, and enophthalmos. With respect to postoperative peripheral diplopia, endoscopic endosnasal surgery with transconjunctival reconstruction showed several advantages over the other method considered in this study. An appropriate surgical method should be selected by comparing the relative advantages and disadvantages.