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Objective:To explore the safety and efficacy of ureteroscopy-assisted laparoscopic ureteroplasty in the healthy side-lying running position for the treatment of ureteral stenosis after pelvic surgery.Methods:The data of 92 patients with ureteral stenosis after surgery admitted to Ganzhou People’s Hospital from June 2017 to February 2023 were retrospectively analysed. There were 31 male patients and 61 female patients, with an average age of (46.4±23.3) years. Of the 92 patients, 53 patients had previously undergone stone fragmentation or stone retrieval surgery for urinary system stones, 35 patients had undergone gynecologic laparoscopic surgery for gynecologic diseases, 2 patients had previous intestinal surgery, and 2 patients had undergone laparoscopic ureteral reconstruction surgery. The mean preoperative serum creatinine was (120.33±16.52) μmol/L, the mean blood urea nitrogen was (14.28 ± 2.47) mmol/L, and the mean renal pelvis dilation was (3.23±2.47) cm. All patients were placed in healthy side-lying running position with general anesthesia. The patient's lower limbs were in the oblique supine position, and the angle of the lower limbs was 60-80°. By using a transabdominal approach, the narrow section of the ureter was mobilized and excised under the guidance of ureteroscopy. The posterior wall of the ureter was sutured and a zebra guidewire was placed into the renal pelvis. An F7 double-J stent was then retrogradely advanced over the guidewire. Then the anterior wall of the ureter was anastomosed to complete the surgery. The operation time, average length of hospital stay, perioperative complications, preoperative and postoperative pyelectasis and renal function changes were recorded, and the clinical efficacy were evaluated by comparative analysis.Results:Of the 92 patients, 90 patients were successfully treated with ureterovesical anastomosis. Two patients underwent ureterovesical reimplantation because of the low position and heavy adhesion of the stenosis segment. There were no cases of conversion to open surgery or intraoperative death. The mean surgery duration was (121.52±22.35) min, the mean drainage tube indwelling time was (3.16±1.23) d, and the mean hospital stay was (6.46±2.37) d. A patient with moderate hydronephrosis exhibited postoperative urinary leakage. Two patients developed symptoms of hematuria after ambulation. Following treatment with bed rest, adequate drainage, and appropriate hemostatic medication, all patients recovered smoothly and were discharged. The double J tube was removed 3 months after operation, and the CT reexamination after extubation showed that the degree of pyelectasis was (2.52±1.54) cm, the average serum creatinine was (89.64±15.21) μmol/L, and urea nitrogen was (9.42±1.36) mmol/L, which was all significantly different from that before operation ( P<0.05). The patients were followed up for 6 to 12 months, and there was no ureteral restenosis. Conclusions:Ureteroscopic-assisted laparoscopic ureteroplasty in the healthy side-lying running position is a safe and effective surgical method for the treatment of short segment (narrow segment <3 cm) ureteral cicatrix stenosis after surgery. And this surgical method has the advantages of accurate positioning of the narrow segment, safe and convenient ureteral free, exact ureteral anastomosis, and easy placement of double J tube.
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Objective To investigate the efficacy of laparoscopic C-type radical hysterectomy through deep uterine vein approach for the treatment of cervical cancer.Methods From January 2021 to December 2022,58 cases of cervical cancer were treated with deep uterine vein approach laparoscopic C-type radical hysterectomy in our hospital.After establishing the operation channel,the ureter was identified in the posterior lobe of the broad ligament,and the uterine artery was exposed after separating the ureter.The connective tissue was separated along the dorsal side of the uterine artery to gradually expose the deep uterine vein.The parametrial lymph nodes surrounding the deep uterine vein were resected and sent to pathology alone.The deep uterine vein was continuously tracked towards the bladder,and its branches were freed.The deep uterine vein and its tributaries were double clipped by vascular clamp.Results The operation time was(307.2±54.1)min,the median bleeding volume was 50(20,100)ml,the lymph node dissection number was(26.3±6.9),the indwelling catheter time was(20.6±4.7)d,the time to removal of abdominal drainage tube was(9.4±4.1)d,the anal exhaust time was(36.7±4.1)h,the antibiotics use time was(9.2±4.2)d,and the hospital stay was(13.4±2.6)d.The postoperative complication rate was 3.4%(2/58),and the postoperative pathological staging upgrade rate was 22.4%(13/58).The postoperative European Organization of Research and Treatment of Cancer(EORTC)Quality of Life Questionnaire-Core 30(QLQ-C30)score was significantly higher than before surgery[(78.6±10.7)points vs.(47.1±7.6)points,t = 17.177,P = 0.000].All the 58 cases were followed up for 4-25 months(mean,13.5±6.2 months),with no recurrence.Conclusion Laparoscopic C-type radical hysterectomy through deep uterine vein approach is effective,safe,and reliable.
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【Objective】 To explore the safety of transrectal ultrasound-guided transperineal injection of sodium hyaluronate to expand the Dirichlet gap in laparoscopic radical prostatectomy. 【Methods】 A total of 14 healthy male purebred beagle dogs were selected and randomly divided into 2 groups, with 7 in either group.The control group was treated with conventional laparoscopic radical prostatectomy, while the experimental group was treated with laparoscopic radical prostatectomy after 2.5 mL sodium hyaluronate was injected into the Dirichlet gap under the guidance of transrectal ultrasound.The total operation time, prostate separation time, intraoperative blood loss and rectal status of the 2 groups were observed. 【Results】 After the injection of sodium hyaluronate into the Dirichlet gap between the prostate and the rectum, no rectal tissue was found in the prostate, and no obvious damage was found in the posterior rectum in either groups.The postoperative hemoglobin (HGB) was [(118.70±2.56) g/L vs.(122.10±2.19) g/L, P=0.02]; the total operation time was [(141.40±9.80) min vs.(119.10±9.16) min, P<0.05]; the prostate separation time was [(24.99±1.75) min vs.(16.64±2.34) min, P<0.05]; the amount of bleeding was [(47.43±4.32) mL vs.(34.86±5.18) mL, P<0.05] in the control group and experimental group. 【Conclusion】 Laparoscopic radical prostatectomy performed after 2.5 mL of sodium hyaluronate injection into the Dirichlet gap under the guidance of transrectal ultrasound can shorten the total operation time, the separation and resection time of the prostate, and reduce the amount of bleeding, which can improve and reduce the incidence of rectal injury, and prove the feasibility of this approach for prostatic cancer.
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Objective To investigate the effects of microsurgical varicocelectomy on testicular function and sexual function in patients with varicocele.Methods The clinical data of 90 patients with varicocele admitted to our hospital were retrospectively analyzed,and the patients were divided into the laparoscopic group(received laparoscopic varicocelectomy)and the microscopic group(received microsurgical varicocelectomy)according to different surgical methods,with 45 cases in each group.The testicular function and sexual function related indexes including sperm density,normal sperm ratio,rate of sperm motility(grades a+b),forward motility sperm rate,international index of erectile function-5(IIEF-5)score,and the levels of testosterone,follicle-stimulating hormone,luteinizing hormone,and androgen levels before and 6 months after surgery in the two groups were compared.The incidence of complications and recurrence 6 months after surgery in the two groups were counted.Results Compared with those before surgery,the sperm density,forward motility sperm rate,rate of sperm motility(grades a+b),normal sperm ratio,IIEF-5 score,testosterone level,and androgen level 6 months after surgery of patients in the two groups were significantly increased(P<0.05),and the levels of luteinizing hormone and follicle-stimulating hormone were decreased(P<0.05).Compared with the laparoscopic group,the levels of follicle-stimulating hormone and luteinizing hormone,and incidence of complications 6 months after surgery of patients in the microscopic group were decreased(P<0.05),and the levels of testosterone and androgens,and IIEF-5 score 6 months after surgery were increased(P<0.05).There was no significant difference in the recurrence rate between the two groups(P>0.05).Conclusion Microsurgical varicocelectomy can improve the testicular function and sexual function of patients with varicocele,with a low incidence of complications.
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Objective To investigate the clinical significance of the chorda arteriae umbilicalis in laparoscopic transabdominal preperi-toneal(TAPP)hernia repair.Methods The clinical data of 60 patients with inguinal hernia admitted to Xinrui Hospital in Xinwu District of Wuxi City from June 2019 to June 2022 were analyzed,and the patients were randomly divided into two groups according to whether the chorda arteriae umbilicalis was used as a marker during operation.Both the control group and the observation group were operated according to the routine procedure.The observation group exposed the chorda arteriae umbilicalis,which was used as a reference to precisely free the surgical plane and gap to complete the parietalization of spermatic cord,meanwhile,the angle formed by the intersection of the deferens and umbilical artery cord was used to assist in fixing the patch.The operation time,time of parietalization of spermatic cord,hospital stay,bladder surface bleeding volume,removal rate of hernial sac,the occurrence of postoperative complications and recurrence of patients were compared between the two groups.Results There was no significant difference in the operation time,removal rate of hernial sac,hospital stay,recurrence rate or the incidence of postoperative complications such as chronic pain,uroschesis of patients between the two groups(P>0.05).The time of parietalization of spermatic cord,bladder surface bleeding volume,and incidence of seroma of patients in the observation group were shorter/lower than those in the control group,the differences were statistically significant(P<0.05).Conclusion The chorda arteriae umbilicalis has a constant morphology and relatively fixed anatomical position and alignment.The chorda arteriae umbilicalis can be used as a reference and guiding mark,especially when the anatomical layer is dense and unclear or strayed into the layer in TAPP hernia repair,whihc can guide to operate at the correct layer,standardize the parietalization of spermatic cord,reduce bleeding and vice-damage,and also assist the fixation of the patch and prevent the displacement of the patch.
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【Objective】 To reduce the incidence of postoperative intestinal obstruction, we tried to improve surgical techniques by closing the cavity formed during radical cystectomy + ileal passage (Bricker) via laparoscopy to prevent the formation of abdominal hernia. 【Methods】 During Oct.2018 and Feb.2022, 41 patients were involved (conventional group). After standard laparoscopic radical cystectomy + pelvic lymphadenectomy, the ileum channel was established. The right medial retroperitoneum was sutured to cover the mesothelium and end of the ileum channel under open operation or endoscope. The space between the ureter and mesothelium of the ileum channel was sealed, and the end of the ileum channel and both ureters were externalized. During Feb.2022 and Dec.2022, 15 patients were involved (modified group). The right inner and outer lateral peritoneums below the ileal conduit were sutured to "bottom out" the gap between the ileal conduit and the right abdominal wall in addition to standard procedures. The recovery of intestinal function and incidence of bowel obstruction were compared between the two groups. 【Results】 In the conventional group, the intestinal function recovered within 2 to 6 days after surgery, with a median ventilation time of 3 days. Intestinal obstruction occurred in 3 patients, 2 of whom improved after conservative treatment while 1 underwent surgical exploration after ineffective conservative therapy. There were no significant differences in the time of discharge and ventilation between the two groups, but no intestinal obstruction occurred in the modified group. 【Conclusion】 Peritoneal externalization at the end of ileal passage can reduce the incidence of intra-abdominal hernia and postoperative intestinal obstruction, which is worthy of clinical application.
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【Objective】 To explore the feasibility and efficacy of laparoscopic bladder muscle flap ureteroplasty in the treatment of long-segment injury in the middle and lower ureter and to summarize the clinical experience. 【Methods】 The clinical data of 6 patients treated in our hospital during Oct.2018 and Aug.2021 were retrospectively analyzed. Four of them had long-segment ureteral mucosal cuff-like avulsion during ureteroscopic lithotripsy and could not undergo end-to-end ureteral anastomosis or reimplantation, and then laparoscopic bladder muscle flap ureteroplasty plus lumbaris major fixation of the bladder was performed immediately. The other 2 patients had to undergo this procedure due to stricture. 【Results】 All operations were successful. The median ureteral avulsion or ureteral stricture length was 14.5(6, 16) cm, muscle flap length 16.5(8,18) cm, operation time 190 (160, 240) min, blood loss 175 (100, 250) mL, postoperative hospital stay 8 (7, 12) days, and postoperative creatinine (89.38±21.74) μmoI/L. No major complications occurred. One patient developed urinary leakage, which returned to normal after active glycemic control and nutritional therapy; one patient developed postoperative absorption fever, which recovered after physical cooling. During the follow-up of 6 to 45 months, CT showed mild hydronephrosis in some patients, but no ureteral stenosis, impaired renal function or other complications, and patients complained no subjective discomfort. 【Conclusion】 Laparoscopic bladder muscle flap ureteroplasty is safe and effective for patients with long-segment injury in the middle and lower ureter. It has the advantages of small trauma, few long-term complications, and rapid recovery and improvement of renal function. If necessary, it can be combined with lumbaris major fixation of the bladder to shorten the distance from the muscle flap to the broken end of the ureter and to reduce the tension of the anastomosis.
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【Objective】 To evaluate the significance of Mayo adhesive probability (MAP) in predicting surgical difficulty and postoperative recovery in patients with renal cell carcinoma (RCC) undergoing laparoscopic radical nephrectomy (LRN). 【Methods】 The clinical data of 168 RCC patients who received transabdominal LRN during Jan.2017 and Dec.2020 were retrospectively analyzed. According to MAP, the patients were divided into low MAP group (n=100) and high MAP group (n=68). The differences in perioperative clinical data were compared between the two groups. 【Results】 Compared with low MAP group, the high MAP group had longer operation time (P<0.001), more intraoperative blood loss (P<0.001), higher Clavien-Dindo grade complications (P=0.008), longer hospital stay (P=0.003), higher levels of c-reactive protein (P=0.030) and IL-6 (P=0.009), lower levels of albumin (P<0.001) and prealbumin (P=0.020). 【Conclusion】 MAP can assess the risk of prolonged operation time, increased bleeding during transabdominal LRN, and postoperative recovery, thus guiding the preoperative planning.
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【Objective】 To compare the clinical efficacy of pneumovesic and open laparoscopic ureteral replantation in the treatment of primary vesicoureteral reflux, and to summarize the characteristics of pneumovesic surgery. 【Methods】 A total of 70 children with vesicoureteral reflux treated at our hospital during 2016 and 2021 were divided into pneumovesic group and open group, with 35 children in either group. The pneumovesic group underwent laparoscopic Cohen’s ureteral replantation, and the open group underwent open Cohen’s ureteral replantation. The operation-related data of the two groups were compared. 【Results】 Compared with the open group, the pneumovesic group had smaller incision size (1.5 cm vs. 4.0 cm), less intraoperative blood loss (2.0 mL vs.10.0 mL), longer operation time [(185.3±54.2)min vs. (150.5±45.5)min], shorter postoperative hematuria time [(4.7±2.1 d) vs. (6.0±1.3 d)], shorter urinary catheter indwelling time [(11.9±4.0) d vs. (14.1±3.8) d], lower FLACC pain score [(d1: 2.5±0.7, d3: 1.5±0.6) vs. (d1: 5.3±0.9, d3: 2.9±0.6)], lower incidence of frequent and urgent urination (3% vs. 17% ), and higher postoperative incision satisfaction (100% vs. 89%). There was no recurrence in either group. 【Conclusion】 The curative effects were significant in both groups. Compared with open surgery, pneumovesic laparoscopic ureteral replantation for the treatment of primary vesicoureteral reflux has the advantages of small trauma, beautiful appearance, quick recovery and little influence on bladder function.
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Objective To explore the protective effect of laparoscopic radical resection of rectal cancer on urinary function based on membrane anatomy.Methods Ninety-two patients with rectal carcinoma underwent surgical treatment in our hospital from August 2019 to August 2021 were enrolled,and divided into two groups according to random number table methods,each with 46 cases.The reference group received laparoscopic radical resection of rectal cancer,and the study group received laparoscopic radical resection of rectal cancer under membrane anatomy.The operation related indexes,urination function indexes,incidence of urination dysfunction,postoperative complications and 1-year prognosis were compared between two groups.Results Compared with reference group,study group had significantly less intraoperative bleeding,shorter postoperative anal exhaust time and significantly longer operative time,with statistical difference(P<0.05).Compared with reference group,the catheter removal time and residual urine volume of study group were significantly reduced(P<0.05),the maximum urine flow rate was significantly increased(P<0.05),and no statistical significance was found in urine volume between two groups(P>0.05).The incidence rate of urination dysfunction was 10.87%in study group,which was notably lower than 30.43%in reference group,with statistical difference(P<0.05).The incidence rate of postoperative complications demonstrated no statistical difference between two groups(P>0.05).One year after surgery,the distant metastasis rate(2.17%vs 4.35%),recurrence rate(4.35%vs 6.52%)and mortality rate(2.17%vs 2.17%)yielded no statistical difference between two groups(all P>0.05).Conclusion Application of laparoscopic radical resection of rectal carcinoma based on membrane anatomy has a certain protective effect on the urinary function of patients and can effectively reduce the incidence of postoperative urinary dysfunction.
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Objective:To explore the effects of different anesthesia methods on anesthesia quality, postoperative recovery, cognitive status and pain in patients undergoing laparoscopic hysterectomy.Methods:A prospective study was conducted among 98 patients who underwent laparoscopic hysterectomy in Donghai County People′s Hospital of Jiangsu Province from July 2020 to December 2022. According to different anesthesia methods, the subjects were divided into group A (48 cases, intravenous-inhalation combined anesthesia) and group B (50 cases, intravenous general anesthesia and epidural anesthesia). The recovery quality, cognitive status and VAS scores before operation (T 0), at 12 h after operation (T 1), 24 h after operation (T 2) and 48 h after operation (T 3) were compared between the groups. The total incidence rates of adverse reactions in the two groups were recorded. Results:The extubation time, respiratory recovery time and awakening time in group B were shorter than those in group A: (5.69 ± 0.75) min vs. (10.02 ± 1.26) min, (4.52 ± 0.65) min vs. (6.59 ± 1.04) min, (8.65 ± 1.12) min vs. (13.52 ± 1.45) min ( P<0.05). The two groups had similar mini-mental state examination (MMSE) scores and VAS scores at T 0 ( P>0.05). MMSE scores of the two groups were lower at T 1-T 3 than T 0. Group B had higher scores than group A at T 1-T 3: (23.14 ± 1.85) scores vs. (20.36 ± 2.15) scores, (25.18 ± 2.47) scores vs. (22.31 ± 2.35) scores, (27.05 ± 1.18) scores vs. (26.31 ± 1.01) scores, P<0.05. VAS scores of the two groups were higher at T 1-T 3 than T 0. Group B had lower scores than group A: (5.17 ± 0.54) scores vs. (6.21 ± 0.75) scores, (4.42 ± 0.51) scores vs. (5.63 ± 0.62) scores, (2.58 ± 0.34) scores vs. (3.14 ± 0.42) scores, P<0.05. The total incidence rates of adverse reactions in the two groups had no statistical difference ( χ2 = 0.17, P>0.05). Conclusions:Compared with intravenous-inhalation combined anesthesia, general anesthesia combined with epidural anesthesia has better anesthesia quality in patients undergoing laparoscopic hysterectomy, which can improve postoperative cognitive function and relieve pain. The two anesthesia methods are both safe.
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Objective:To compare the clinical efficacy of laparoscopic inguinal lymph node dissection(L-ILND)and open inguinal lymph node dissection(O-lLND)in the treatment of penile cancer after radical penile cancer surgery. Methods:The clinical outcomes of 63 patients who were diagnosed with penile cancer(TNM staging:T1_3,N0-3,M0)and received L-ILND(41 cases)or O-ILND(22 cases)after radical penile cancer surgery in Department of Urology,Hubei Cancer Hospital,Tongji Medical College,Huazhong University of Science and Technology from 2008 to 2020 were retrospectively studied.The primary endpoint of this study was overall survival,and the secondary endpoints were 5-year overall survival and 5-year cancer-specific survival.The different clinical characteristics were compared between the L-ILND group and O-ILND group.Univariate and multivariate logistic regression analysis was used to study the risk facotrs for postoperative wound complications.Kaplan-Meier method was used for prognosis analysis.COX regression analysis was used to investigate the factors for overall survival prediction. Results:Among the 63 penile cancer patients studied,41 patients received L-ILND and the remaining 22 received O-ILND.There were no statistically significant differences in the baseline characteristics between the two groups of patients.The median overall survival(78 months vs 72 months,P=0.844),5-year overall survival rate(74.5%vs 78.3%,P=0.144),5-year cancer-specific survival rate(77.2%vs 71.4%,P=0.228)showed no obvious difference between L-ILND and O-ILND group.The rate of postoperative wound complications in the O-ILND group was significantly higher than that in the L-ILND group(74%vs 15%,P=0.01 2).The result of multivariate COX regression analysis showed that tumor grade[hazard ratio(H-R)=2.774,P=0.021]and lymph node pathological stage(HR=1.482,P=0.024)were significantly correlated with patients'prognosis. Conclusion:The clinical efficacy of L-ILND and O-ILND is similar,but L-ILND has a higher safety profile and lower incidence of postoperative wound complications.Therefore,L-ILND is a more ideal surgical approach for inguinal lymph node dissection after radical penile cancer surgery.
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Stage T4 colon cancer is divided into two categories:tumor penetrating the visceral peritoneum(T4a)and tumor directly invading or attaching to adjacent organs or structures(T4b).Treatment of T4 colon cancer requires technically demanding surgical procedures,including total resection of adjacent infiltrating organs or structures,and is characterized by a high incidence of postoperative complications and a high rate of positive surgical margin microscopy.It has been found that taking laparoscopic surgery for T4 colon cancer may decrease long-term survival and increase the rate of peritoneal metastasis,but taking laparoscopic surgery for colon cancer also has the potential advantages in increasing perioperative benefits and improving the prognosis.With the upgrade of laparoscopic equipment and the improvement of surgeons'surgical skills,more and more surgeons have adopted laparoscopic surgery to treat T4 colon cancer.Currently,the oncologic safety of laparoscopic surgery for T4 colon cancer has not been effectively evaluated.Therefore,this article reviews the advantages,risks,and the choice of treatment strategies for laparoscopic surgery for T4 colon cancer,taking into account the current status and progress of domestic and international studies.
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Objective:To study the efficacy of laparoscopic limited anatomical hepatectomy (LLAH) for hepatocellular carcinoma (HCC) within the right anterior section.Methods:The clinical data of 144 patients with HCC confined in the right anterior section undergoing hepatectomy at the First Affiliated Hospital of Army Medical University from January 2015 to December 2022 were retrospectively analyzed, including 122 males and 22 females, aged (54.5±9.7) years. Patients were divided into LLAH ( n=27), laparoscopic anatomical hepatectomy (LAH, n=69), and laparoscopic non-anatomical hepatectomy (LNAH, n=48). Propensity score matching was used to compare the operative time, postoperative hospital stay, postoperative complications, serum total bilirubin and albumin, and the prognostic indicators such as tumor-free survival (DFS) rate and cumulative survival rate between the groups. Results:After propensity score matching, there were 26 cases each in LLAH and LNAH group. There was no significant difference in operative time, intraoperative blood loss and postoperative hospital stay between LLAH group and LNAH group (all P<0.05). The total bilirubin and albumin in LLAH on the third day after operation were [ M( Q1, Q3)] 24.1(20.9, 29.1) μmol/L and (35.8±2.9) g/L, better than those in LNAH group 39.3(33.2, 57.0) μmol/L and (33.9±2.5) g/L, respectively. The 1- and 3-year DFS rates in LLAH group were 92.3% and 57.7%, higher than those in LNAH group (80.8% and 19.2%) (all P<0.05). After propensity score matching, there were 25 patients each in LLAH and LAH group. The operative time, postoperative hospital stay and postoperative complications of LLAH group were lower than those of LAH group, and the liver function parameters of LLAH group was also better than those of LAH group (all P<0.05). There was no significant difference in DSF rate between the two groups LLAH group and LAH group ( χ2=0.10, P=0.800). Conclusions:The perioperative outcome of LLAH for HCC within the right anterior section are similar to that of LNAH and better than that of LAH. The DFS of LLAH were better than that of LNAH and similar to that of LAH.
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Objective:To investigate the safety and efficacy of modified Retzius-sparing robot-assisted laparoscopic radical prostatectomy for localized transitional zone prostate cancer.Methods:From May 2019 to February 2021, the clinical data of 284 patients with transitional zone(TZ) prostate cancer was retrospectively analyzed. Among them, 91 cases underwent modified Retzius-sparing robot-assisted laparoscopic radical prostatectomy(modified RS-RARP), and 193 cases underwent conventional robot-assisted laparoscopic radical prostatectomy (RARP). The Retzius space was directly entered during modified RS-RARP.The mean age of modified RS-RARP group and conventional RARP group was (67.8±9.1) years old and (69.5±8.4) years old, respectively. BMI of the two groups was (21.57±2.25)kg/m 2 and (21.8±1.8)kg/m 2 respectively; prostate volume was (31.2±13.5)ml and (29.3±12.9)ml respectively; preoperative PSA of the two groups were (10.2±6.1)ng/ml and (9.3±5.8)ng/ml respectively; and there was no significant difference in the above mentioned data( P>0.05). For Gleason score, there were 8 cases of score 6, 74 cases of score 7, 9 cases of score 8 in modified RS-RARP group and 21 cases of score 6, 153 cases of score 7, 19 cases of score 8 in conventional RARP group. For Clinical stage, there were 11 cases of T 1 stage, 80 cases of T 2 stage in modified RS-RARP group, and 20 cases of T 1 stage, 173 cases of T 2 stage in conventional RARP group. There was no significant difference in the above mentioned data( P>0.05). The operation time, intraoperative blood loss, ratio of transfusion, incidence of complication, positive rate of surgical margin and recovery of urinary continence were compared. Results:All 284 cases of surgery were completed. The operative time of modified RS-RARP was (89.2±10.1) minutes, which was significantly less than that of conventional RARP group[(100.5±12.3)min]. The intraoperative blood loss of the two groups was (245.0±50.0) ml and (250.0±50.0) ml respectively. The number of positive surgical margin was 14(15.4%) and 33(17.1%) respectively. There was no significant difference between the two groupsfor the above mentioned parameters( P>0.05). The ratio of urinary continence recovery in the modified RS-RARP group within 1 month was 49.45%, which was significantly higher than that of conventional RARP group (31.09%)( P<0.05). Conclusions:Compared with conventional RARP, modified RS-RARP might shorten the operation time and help the recovery of urinary continence for patients with TZ prostate cancer.
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Objective:To investigate the feasibility and clinical efficacy of laparoscopic radical cholecystectomy(LRC) for gallbladder cancer.Methods:The clinical data of 247 patients with gallbladder cancer who underwent radical resection from Jan 2013 to Dec 2019 at Department of General Surgery, Sir Run Run Shaw Hospital affiliated to Zhejiang University School of Medicine was analyzed retrospectively. After propensity score matching, 54 patients were included in laparoscopic group and 103 in laparotomy group. The clinicopathological characteristics and the short- and long-term outcomes were compared.Results:Compared to the laparotomy group, patients in the laparoscopic group had less intraoperative blood loss [100(50,200)ml vs. 200(100,300) ml, Z=4.105, P<0.001], earlier postoperative oral diet[1.0(1.0,2.0) d vs. 2.0(1.0,4.0) d, Z=4.157, P<0.001]and drainage removal[6.5(4.0,12.5) d vs. 9.0(6.0,16.0) d, Z=2.769, P=0.006], shorter hospital stay[7.0(5.0,9.3) d vs. 9.0(8.0,14.0) d, Z=3.923, P<0.001]. The number of lymph node dissection in laparoscopic group was significantly lesser than that in open group [6(4,9) vs. 8(5,12), Z=2.639, P=0.008]. There were no significant differences between the two groups in postoperative complications, short-term and long-term survival outcomes. Conclusions:Laparoscopic radical surgery for gallbladder cancer is as safe and feasible, and identical survival prognosis as open surgery, and moreover a less traumatic procedure.
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Objective:To investigate the clinical difference between primary suture and T tube drainage in laparoscopic choledocholithotomy.Methods:The clinical data of 124 patients treated by laparoscopic choledocholithotomy in Suzhou Municipal Hospital from December 2018 to February 2020 were retrospectively studied. The patients were divided into the primary suture group (71 cases) and the T tube drainage group (53 cases) according to the different surgical methods, and the differences in the relevant treatment indicators were compared between the two groups.Results:There were no statistically significant differences between the two groups in gender, hypertension, diabetes mellitus, preoperative aspartate aminotransferase, preoperative alanine aminotransferase, preoperative total bilirubin, preoperative common bile duct diameter, postoperative length of stay, total cost of hospitalization, postoperative exhaust time, or postoperative biliary leakage, et al. Compared with the T tube drainage group, the primary suture group had more single choledocholithiasis before operation (33 cases vs. 15 cases), shorter operation time: (100.14 ± 38.90) h vs. (140.45 ± 54.17) h, less intraoperative bleeding: (35.70 ± 30.17) ml vs. (49.53 ± 34.58) ml, and later extraction time of Winslow hole drainage tube after operation: (7.15 ± 2.61) d vs. (5.45 ± 3.35) d, and the differences were statistically significant ( P<0.05). Conclusions:Under the condition of strictly controlling the indications of primary suture and being operated by general surgeons who can skillfully operate laparoscope and choledochoscope, laparoscopic choledocholithotomy for primary suture has better curative effect than T tube drainage, and has higher clinical application value.
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Objective:To investigate the techniques used in blood flow control of Kimura laparoscopic spleen-preserving pancreatectomy (LSPDP).Methods:Forty·five patients with benign or low-grade malignant pancreatic diseases undergoing LSPDP at Huzhou Central Hospital from May 2014 to Oct 2021 were analyzed retrospectively. Patients were divided into splenic vascular flow control group ( n=22) and routine management group ( n=23). Results:There was no significant difference in gender, age, BMI, accompanying symptoms, hypertension, diabetes, lesion size and pathological diagnosis between the two groups (all P>0.05). A higher overall spleen preservation rate (90.9% vs. 52.2%, χ2=8.213, P=0.004), lower incidence of morbidity with Clavien grade ≥ Ⅱ (22.7% vs. 73.9%, χ2=9.911, P=0.002) and shorter postoperative hospital stay [(9.6±4.5) d vs. (14.3±6.6) d, t=2.447, P=0.008] were achieved in the vascular flow control group compared with those in the routine group. Conclusion:Splenic vascular flow control techniques improve the success rate of spleen preservation in laparoscopic distal pancreatectomy, reduce the postoperative complications and shorten the postoperative hospital stay.
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The incidence of adenocarcinoma of esophagogastric junction (AEG) is increasing at home and abroad. Laparoscopic surgery has gradually become the main means of surgical treatment of this kind of tumor. However, due to the special anatomical position of the tumor, the high position away from the broken esophagus and the narrow space in the mediastinum, laparoscopic anastomosis has the characteristics of difficult anastomosis and high anastomosis position. There is a high risk of anastomotic leakage after operation, which may cause serious consequences. Early identification of anastomotic leakage and unobstructed drainage by various means are the key to treatment. With the development of endoscopic technology, endoscopic methods such as covered stent and vacuum-assisted closure further improve the treatment efficacy. As a salvage measure, surgical treatment can achieve good treatment outcome, while accompanied by risk of complications and mortality, so we must strictly grasp the indications.
Subject(s)
Humans , Adenocarcinoma/surgery , Anastomosis, Surgical , Anastomotic Leak/surgery , Esophageal Neoplasms/surgery , Esophagogastric Junction/surgery , Gastrectomy/methods , Laparoscopy/methods , Retrospective Studies , Stomach Neoplasms/surgeryABSTRACT
Objective: The study aimed to investigate the safety and feasibility of intrathoracic modified overlap method in laparoscopic radical resection of Siewert type II adenocarcinoma of the esophagogastric junction (AEG). Methods: A descriptive case series study was conducted. The clinical data of 27 patients with Siewert type II AEG who underwent transthoracic single-port assisted laparoscopic total gastrectomy and intrathoracic modified overlap esophagojejunostomy in Guangdong Provincial Hospital of Chinese Medicine from May 2017 to December 2020 were retrospectively analyzed. The intrathoracic modified overlap esophagojejunostomy was performed as follows: (1) The Roux-en-Y loop was made; (2) The jejunum side was prepared extraperitoneal for overlap anastomosis; (3) The esophagus side was prepared intraperitoneal for overlap anastomosis; (4) The overlap esophagojejunostomy was performed; (5) The common outlet was closed after confirmation of anastomosis integrity without bleeding; (6) A thoracic drainage tube was inserted into the thoracic hole with the diaphragm incision closed. The intraoperative and postoperative results were reviewed. Results: All 27 patients were successfully operated, without mortality or conversion to laparotomy. The operative time, digestive tract reconstruction time and esophageal-jejunal anastomosis time were (327.5±102.0) minute, 50 (28-62) minute and (29.0±7.4) minute, respectively. The blood loss was 100 (20-150) ml. The postoperative time to flatus and postoperative hospital stay were (4.7±3.7) days and 9(6-73) days, respectively. Three patients (11.1%) developed postoperative grade III complications according to the Clavien-Dindo classification, including 1 case of anastomotic fistula with empyema, 1 case of pleural effusion and 1 case of pancreatic fistula, all of whom were cured by puncture drainage and anti-infective therapy. Conclusions: The intrathoracic modified overlap esophagojejunostomy is safe and feasible in laparoscopic radical resection of Siewert type II AEG.