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The residual pelvic floor cavity formed by laparoscopic low anterior resection for rectal cancer can result in some complications, such as spread of pelvic infection following anastomotic leakage, adhesive intestinal obstruction, and may increase the probability of radiation intestinal injury in case of postoperative radiotherapy. Reconstructing the pelvic floor can prevent the small intestine from entering the residual cavity, reduce the risk of intestinal obstruction and radiation induced intestinal injury; prevent or reduce the occurrence and severity of anastomotic leakage. Reconstructing the pelvic floor can also improve the anal function after low anterior resection to a certain extent and enhance the quality of life of patients. Direct suturing of the pelvic floor peritoneum and pedicled greater omentum flap graft transplantation are currently two commonly used pelvic floor reconstruction methods, which are relatively simple to operate, easy to promote, and worthy of routine application.
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Objective:To explore the efficacy and safety of laparoscopic technology in the treatment of gastric cancer which using proximal subtotal gastrectomy and distal subtotal gastrectomy.Methods:A retrospective analysis was conducted on the clinical data of 98 gastric cancer patients admitted to the Department of General Surgery, General Hospital of Huainan Eastern Hospital Group from January 2016 to January 2020, including 71 males and 27 females with an average age of (62.03±10.6) years old(ranged from 32 to 80 years). All cases were divided into proximal group ( n=28) and distal group ( n=70) according to different surgical methods. The proximal group was treated with laparoscopic proximal subtotal gastrectomy, while the distal group was treated with laparoscopic distal subtotal gastrectomy. SPSS 20.0 software was used to analyze the differences in surgical related clinical indicators, postoperative complications, nutritional status, quality of life, and survival rate between two groups. Kaplan-Merier was used to draw survival curves, and Log-rank test was used to compare the survival differences between the two groups. Results:The number of lymph node dissection in the proximal group was less than that in the distal group, and the difference was statistically significant ( t=2.02, P=0.045). The incidence rate of reflux esophagitis in the proximal group was higher than that in the distal group (57.14% vs 4.29%, χ2=35.75, P<0.001), the incidence rate of reflux gastritis was lower than that of the distal group, the difference was statistically significant(3.57% vs 22.86% P=0.035). The levels of red blood cells, hemoglobin, and albumin in the proximal group were lower than those in the distal group after surgery, and the differences were statistically significant ( t=2.62, P=0.010; t=2.12, P=0.036; t=3.54, P=0.001). One month after surgery, the Karnofsky functional status score in the proximal group was lower than that in the distal group, and the difference was statistically significant ( t=2.27, P=0.025). The postoperative 1, 3, and 5-year survival rates of the proximal group were 85.71%, 64.29%, and 46.43%, respectively, while the postoperative 1, 3, and 5-year survival rates of the distal group were 88.57%, 71.43%, and 57.14%, respectively. There was no statistically significant difference in the survival curves between the two groups ( P>0.05). Conclusions:The incidence rate of reflux esophagitis after laparoscopic proximal subtotal gastrectomy is higher than that of distal subtotal gastrectomy, and the number of lymph nodes cleared during operation is less than that of distal subtotal gastrectomy. Compared with laparoscopic distal subtotal gastrectomy, the nutritional status of patients after proximal subtotal gastrectomy is significantly worse, but there is no significant difference in long-term survival rate between the two groups.
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With the rapid development of laparoscopic techniques, the safety of laparoscopic surgery has gradually been recognized. Its advantages, including clear visualization, minimal trauma and faster recovery, are increasingly favored by surgeons and patients. Common postoperative complications of laparoscopic pancreaticoduodenectomy include pancreatic fistula, bleeding, gastric paresis, pancreatic insufficiency, and wound infection. Among them, postoperative pancreatic fistula and its related complications are the leading causes of mortality after laparoscopic pancreaticoduodenectomy. This article present an overview of the understanding of postoperative pancreatic fistula, combined with recent research progress in this field, to explore the potential mechanisms of pancreatic fistula occurrence and development, and also summarize the predictive models for postoperative pancreatic fistula and discuss the future trends in laparoscopic pancreaticoduodenectomy.
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Objective:To investigate the effect of the explain-simulate-practice-communication-support (ESPCS) nursing model on perioperative stress and postoperative rehabilitation in patients undergoing laparoscopic radical gastrectomy for gastric cancer. Provide a basis for the application of ESPCS nursing model in patients undergoing radical gastrectomy for gastric cancer.Methods:This was a quasi-experimental study. A total of 212 patients who underwent laparoscopic radical gastrectomy for gastric cancer in the First Affiliated Hospital of China Medical University from May 2019 to May 2023 were selected by convenience sampling and divided into the observation group and the control group by random digital table method, with 106 patients in each group. The control group received routine nursing intervention, while the observation group received ESPCS nursing intervention for 3 months. The perioperative stress hormones (serum cortisol and epinephrine), Self-rating Depression Scale (SDS) score, Self-rating Anxiety Scale (SAS) score, gastrointestinal function indicators, and the 36-item Short Form Health Survey Questionnaire (SF-36) score were compared between the two groups.Results:Two groups of patients were lost to follow-up, with a total of 104 patients in each group. The control group consisted of 65 males and 39 females, aged (61.59 ± 3.42) years old, while the observation group consisted of 61 males and 43 females, aged (60.78 ± 3.63) years old. Six days after operation, serum cortisol and epinephrine levels in the observation group were (221.46 ± 24.15) nmol/L and (28.11 ± 3.47) pmol/L, respectively, which were lower than those in the control group (261.84 ± 27.91) nmol/L and (31.49 ± 3.86) pmol/L, respectively, and the differences were statistically significant ( t=11.16, 6.64, both P<0.05). After 1 week of operation, the SDS and SAS scores in the observation group were (41.39 ± 2.21), (39.62 ± 2.31) points, respectively, which were lower than those in the control group (45.27 ± 2.34), (44.35 ± 2.37) points, and the differences were statistically significant ( t=12.29, 14.58, both P<0.05). The time of first exhaust, first defecation, intestinal ringing and first solid eating in the observation group were (55.38 ± 6.23), (68.84 ± 7.92), (38.73 ± 4.31), (62.31 ± 7.67) h, respectively, which were lower than those in the control group (67.51 ± 8.39), (84.17 ± 9.25), (48.43 ± 5.79), (75.65 ± 8.52) h, the differences were statistically significant ( t values were 11.84-13.71, all P<0.05). After intervention, the scores of physiological function, role physical, general health, mental health, social function and the total score of SF-36 in the observation group were (82.17 ± 4.12), (83.21 ± 3.67), (75.27 ± 3.64), (80.63 ± 4.31), (77.58 ± 4.13), (73.89 ± 4.86) points, respectively, which were higher than those in the control group (75.61 ± 4.39), (74.24 ± 3.88), (69.45 ± 4.38), (71.28 ± 4.05), (72.35 ± 3.84), (68.81 ± 5.14) points, the differences were statistically significant ( t values were 7.32-17.13, all P<0.05). Conclusions:The ESPCS nursing model can effectively alleviate the perioperative stress reaction of gastric cancer patients undergoing laparoscopic radical gastrectomy, promote the recovery of gastrointestinal function and improve the quality of life.
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Objective To evaluate the effect of driving pressure(DP)-guided individualized positive end-expiratory pressure(PEEP)combined with regular lung recruitment maneuvers(RMs)on atelectasis in elderly patients undergoing laparoscopic surgery in the Trendelenburg position using lung ultrasound.Methods A total of 62 patients aged 65-85 years old and classified by ASA status Ⅰ-Ⅲ undergoing laparoscopic radical resection of colorectal cancer were included and randomly divided into the experimental group(n=31)and the control group(n=31).Both groups received one RM after the beginning of pneumoperitoneum,followed immediately by titration of individualized PEEP with the lowest DP,and both groups received another RM after the end of pneumoperitoneum.The experimental group received additional RM every 30 min from the beginning of pneumoperitoneum,while the control group received no intervention.Recording time points for observation were:before induction of anesthesia(T0),30 min after pneumoperitoneum(T1),90 min after pneumoperitoneum(T2),at the end of surgery(T3)and 45 min after entering the postanesthesia care unit(PACU,T4).Lung ultrasound score(LUS)was recorded at T0,T3 and T4.Dynamic lung compliance(Cdyn)was recorded at T1-T3.Oxygenation index(OI),mean arterial pressure(MAP)and heart rate(HR)were recorded at T0-T4.Hypotension during RM,hypoxic saturation events in PACU and the incidence of pulmonary complications(POPC)within the first 7 days after surgery were recorded.Results Compared with the control group,LUSs at T3 and T4 were significantly decreased in the experimental group(P<0.05),and OI and Cdyn at T2 and T3 were significantly increased(P<0.05).In addition,the incidence of hypoxia saturation events in PACU was lower in the experimental group than that in the control group(P<0.05).There were no significant differences in the incidence of hypotension during lung recruitment and the incidence of POPC within 7 days after surgery between the two groups.Conclusion The individualized PEEP combined with regular RMs can effectively reduce the atelectasis observed by lung ultrasound immediately after laparoscopic radical resection of colorectal cancer and in PACU in elderly patients.
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Objective To observe the value of laparoscopic ultrasound(LUS)combined with CT three-dimensional reconstruction for guiding laparoscopic hepatectomy(LH).Methods Data of 78 hepatocellular carcinoma(HCC)patients who underwent LH were retrospectively analyzed.The patients were divided into observation group(n=46)or control group(n=32)based on whether underwent preoperative CT three-dimensional reconstruction and LUS.Clinical data,perioperative data and prognosis were compared between groups.Results No significant difference of clinical data was found(all P＞0.05),whereas significant differences of tumor body mainly location,resection method,tumor resection margin,surgical operation time,intraoperative blood loss,postoperative hospital stay,postoperative complication grading and incidence were found between groups(all P＜0.05).During follow-up period,15 patients died in observation group and 14 died in control group.Significant difference of disease-free survival rate was detected between groups(x2=4.210,P=0.040).Conclusion LUS combined with CT three-dimensional reconstruction for guiding LH could reduce intraoperative injury and complication incidence,improving disease-free survival rate of HCC patients.
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Objective:To study the feasibility of laparoscopic anatomical hepatectomy of segment VII for hepatocellular carcinoma (HCC) with dorsal-ventral combined approach.Methods:Clinical data of 23 patients with HCC undergoing laparoscopic anatomical hepatectomy of segment VII with dorsal-ventral combined approach in Jiangnan University Affiliated Hospital from December 2020 to April 2023 were retrospectively collected, including 11 males and 12 females, aged (58.5±7.9) years old. The patient's perio-perative data, postoperative complications, and follow-ups were analyzed.Results:All patients underwent the surgery successfully without conversion to laparotomy. The operation time was (286.7±63.4) min, the amount of intraoperative blood loss [ M( Q1, Q3)] was 200(150, 400) ml without blood transfusion. There were no major complications such as abdominal bleeding, bile leakage, liver failure or abdominal infection. Two cases had right pleural effusion and were managed with thoracic drainage. The patients could ambulate on postoperative day 2, and the postoperative hospital stay was (9.36±1.72) d. The diameter of the lesion was (4.38±1.42) cm. The serum level of alpha fetoprotein (AFP) three months after surgery was (3.26±0.93) ng/ml, lower than the preoperative baseline (46.75±9.43) ng/ml ( t=38.24, P=0.008). All patients showed normal serum levels of AFP and there were no tumor recurrence or metastasis during postoperative follow-ups. Conclusion:Laparoscopic anatomical hepatectomy of segment VII for HCC with dorsal-ventral combined approach is feasible and worth spreading.
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Objective:To analyze the feasibility and advantages of gastric triangle suspension technique in laparoscopic radical anterograde modular pancreatiplenectomy (L-RAMPS) for patients of pancreatic body and tail malignant tumor.Methods:The clinical data of 29 patients with L-RAMPS in Li Huili Hospital of Ningbo Medical Center from January 2019 to October 2023 were retrospectively analyzed, including 14 males and 15 females, aged (67.6±7.5) years. According to whether gastric triangle suspension was used during operation, 29 patients were divided into suspension group ( n=14) and control group ( n=15). The two groups were compared with several indexes of body mass index, tumor length, postoperative pathological type, operation time, intraoperative blood loss, intraoperative incision margin, intraoperative blood transfusion, pancreatic fistula, postoperative massive bleeding, postoperative gastroparesis, length of hospital stay and so on. Results:There were no significant differences in age, sex, body mass index, tumor length and pathological type between the two groups (all P>0.05). Postoperative pathologic findings of the 29 patients included 21 cases of pancreatic adenocarcinoma (72.4%), 2 cases of intraductal papillary mucinous tumors (6.9%), 2 cases of pancreatic neuroendocrine tumors (6.9%), 1 case of pancreatic adenosquamous carcinoma (3.4%), and 3 cases of mucinous cystadenocarcinoma (10.3%). There was no significant difference in the proportion of positive first incision margin, intraoperative blood transfusion, postoperative B/C pancreatic fistula, postoperative massive hemorrhage and postoperative gastroparesis between the two groups (all P>0.05). The operative time and intraoperative blood loss in the suspension group were (200.3±13.5) min and (148.6±42.2) ml respectively, less than that in the control group (223.5±36.3) min and (205.3±63.3) ml, and the hospital stay in the suspension group was 14 (12, 17) d, shorter than that in the control group 26 (17, 32) d. The differences were statistically significant (all P<0.05). Conclusion:Gastric triangle suspension in L-RAMPS for patients of pancreatic body and tail malignant tumor can reduce the amount of intraoperative bleeding, shorten the operation time and hospital stay, is a reliable and simple suspension method.
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Objective:To investigate the effect of dexmedetomidine (DEX) on intestinal barrier function impairment in gynecologic neoplasms patients undergoing laparoscopic surgery and the possible role of silent information regulator 1 (SIRT1) in this process.Methods:A prospective randomized controlled study was conducted. Forty patients who were to undergo laparoscopic surgery of gynecologic neoplasms under general anesthesia in the Second Hospital of Shanxi Medical University from May 2022 to May 2023 were prospectively selected. All patients were divided into the experimental group and the control group using the method of randomized numerical table, with 20 cases in each group. The experimental group was given a loading dose of DEX 0.5 μg/kg (intravenously pumped in 10 min) before induction of general anesthesia, and then maintained with DEX 0.2 μg·kg -1·h -1 until 30 min before the end of surgery. In the control group, the same dose of 0.9% sodium chloride injection was pumped intravenously. Taking 5 ml of peripheral venous blood from the upper extremities 10 min before induction of anesthesia (T 1), 1 h after the release of pneumoperitoneum (T 2) and 24 h after the release of pneumoperitoneum (T 3), respectively, the serum levels of SIRT1 and Claudin-1 proteins were measured by enzyme-linked immunosorbent assay. Then the concentrations of SIRT1 and Claudin-1 proteins and the time of first postoperative exhaust in the two groups of patients were compared. Results:The differences in age, body mass index, pneumoperitoneum time, operation time and anesthesia time between the two groups were not statistically significant (all P >0.05). At T 1, there was no statistically significant difference in concentrations of SIRT1 [(10.2±1.5) ng/ml vs. (10.0±1.3) ng/ml, t = 0.46, P = 0.468] and Claudin-1 [(405±45) pg/ml vs. (404±40) pg/ml, t = 0.13, P = 0.901] proteins between the control group and the experimental group. At T 2, the concentrations of SIRT1 [(8.4±1.3) ng/ml vs. (6.1±1.3) ng/ml, t=-5.55, P<0.001] and Claudin-1 [(383±39) pg/ml vs. (331±44) pg/ml, t=-4.02, P<0.001] proteins in the experimental group were higher than those in the control group, the differences were statistically significant. At T 3, the concentrations of SIRT1 [(8.4±1.2) ng/ml vs. (6.7±1.1) ng/ml, t=-4.56, P<0.001] and Claudin-1 [(388±40) pg/ml vs. (341±43) pg/ml, t=-3.63, P<0.001] proteins in the experimental group were higher than those in the control group, the differences were statistically significant. The time of first postoperative exhaust in the experimental group was shorter than that in the control group [(21.7±2.2) h vs. (27.9±3.4) h], and the difference was statistically significant ( t =6.78, P < 0.001). Conclusions:Dexmedetomidine may reduce the intestinal epithelial cell injury induced by laparoscopic surgery in patients with gynecologic neoplasms via activating SIRT1, and exert a protective effect on intestinal barrier function.
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Objective:To explore the application value of laparoscopic contrast enhanced ultrasound in laparoscopic surgery for patients with hepatocellular carcinoma combined with cirrhosis.Methods:The clinical data of 71 patients with hepatocellular carcinoma combined cirrhosis from February 2018 to February 2020 in Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology were retrospectively analyzed. The patients underwent preoperative enhanced CT and multi-parameter MRI examination, followed by laparoscopic partial hepatectomy, and intraoperative laparoscopic contrast enhanced ultrasound examination. Based on histological examination and follow-up results, the diagnostic efficacy of preoperative imaging and preoperative imaging combined with intraoperative laparoscopic contrast enhanced ultrasound in patients with hepatocellular carcinoma combined with cirrhosis was compared.Results:Among the 71 patients, 69 completed laparoscopic surgery and 2 converted to open surgery. One hundred and ten HCC lesions were diagnosed by preoperative imaging examination, 105 lesions were detected by intraoperative ultrasound among them, of which 98 lesions were diagnosed as HCC by intraoperative laparoscopic contrast enhanced ultrasound. There were no statistically significant difference in sensitivity, specificity, accuracy, positive predictive value and negative predictive value between preoperative imaging and preoperative imaging combined with intraoperative laparoscopic contrast enhanced ultrasound in the diagnosis of malignant liver lesions: 94.4% (102/108) vs. 99.1% (107/108), 81.0% (34/42) vs. 66.7% (28/42), 90.6% (136/150) vs. 90.0% (135/150), 92.7% (102/110) vs. 88.4% (107/121) and 85.0% (34/40) vs. 96.6% (28/29), P>0.05. Laparoscopic contrast enhanced ultrasound revealed an additional 11 suspected malignant lesions, of which 5 lesions were histologically confirmed as HCC. Seven patients underwent surgical strategy changes. Conclusions:Laparoscopic contrast enhanced ultrasound in patients with HCC combined with cirrhosis during laparoscopic surgery can be used to detect, identify, accurately locate of the lesions and modify the surgical plan.
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Objective:To explore the characteristic and influencing factors of temperature trajectories of patients undergoing laparoscopic hysterectomy, to provide reference for intraoperative temperature management.Methods:Using retrospective analysis methods, the patients undergoing laparoscopic hysterectomy hospitalized in Zhoushan Branch of Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine from January 2019 to December 2022 were collected as the research subjects by convenient sampling method. The patient′s body temperature data at the beginning of the surgery, 30 minutes, 60 minutes, 90 minutes, 120 minutes during the surgery, and at the end of the surgery were recorded. The latent class growth model was used to identify the potential trajectory category. Multiple Logistic regression analysis was used to analyze the influencing factors of trajectory category.Results:The intraoperative temperature changes of patients could be divided into three trajectories: 30.0% (45/150) in the normal temperature group, 38.7% (58/150) in the hypothermia resuscitation group, and 31.3% (47/150) in the hypothermia non resuscitation group. There was a statistically significant difference in the three potential categories of intraoperative body temperature trajectory among patients in indicators such as age, BMI, intraoperative infusion volume, surgical time, and anesthesia time ( F values were 3.39-30.01, all P<0.05). Multiple Logistic regression analysis showed that BMI, intraoperative infusion volume, surgical time, and anesthesia time were the prediction factors for temperature trajectory of patients undergoing laparoscopic hysterectomy (all P<0.01). Conclusions:The temperature in patients undergoing laparoscopic hysterectomy demonstrates three different trajectories, medical staff should implement targeted interventions based on the different trajectory characteristics of temperature.
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Objective:To investigate the role of septum incision technique in laparoscopic transcystic common bile duct exploration (LTCBDE).Methods:The data of 22 patients with choledocholithiasis undergoing LTCBDE by septum (a membrane-like wall of the cystic duct running parallel to the common hepatic duct) incision technique at the Suzhou Ninth Hospital Affiliated to Soochow University from April 2020 to March 2023 were retrospectively analyzed, including 13 males and 9 females, aged (54.4±20.3) years. The operative time, postoperative hospital stay, postoperative complications (bile leakage, abdominal hemorrhage, abdominal infection, etc.) and follow-up data were collected and analyzed.Results:All 22 patients (including two patients undergoing common bile duct exploration through the residual cystic duct) underwent the exploration of common hepatic duct, left and right hepatic duct openings, and secondary branch openings successfully. It was confirmed using this procedure that there were no obstruction of the common hepatic duct and intrahepatic bile ducts, or residual stones. The operation time was (79.6±23.2) min and the postoperative hospital stay was (6.3±1.7) d. No complications such as biliary leakage, abdominal hemorrhage or infection occurred after surgery. No cases of biliary stricture or residual stones were observed during short-term postoperative follow-ups.Conclusion:The septum incision technique improved the visualization of hilar bile duct in LTCBDE, which could be a safe and effective procedure to facilitate the LTCBDE and increase its success rate.
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Objective:To investigate the control strategies of intraoperative bleeding in total laparoscopic complex splenectomy.Methods:The clinical data of 11 patients who underwent total laparoscopic complex splenectomy from May 2016 to October 2021 in the First Affiliated Hospital of Zhengzhou University were retrospectively analyzed, including 3 males and 8 females, aged (43.5±16.3) years. Splenectomy was performed in 8 cirrhotic patients with portal hypertension and 3 patients with hematologic diseases. Intraoperative bleeding was controlled by priority splenic artery blocking, bleeding prevention strategies of perisplenic and splenic pedicle dissociation. The operative time, intraoperative blood loss, postoperative exhaust time, postoperative drainage tube removal time and postoperative complications were analyzed.Results:All 11 patients underwent total laparoscopic complex splenectomy successfully. The operative time of 11 patients was (242.8±43.6) min, and the intraoperative blood loss was 180(50-1 480) ml. The postoperative exhaust time was (3.9±0.8) d, the removal time of abdominal drainage tube was (6.4±0.8) d, and the postoperative hospitalization time was (13.1±3.9) d. The 11 patients had no postoperative complications such as hemorrhage, pancreatic fistula, gastric fistula, colon injury, infection, etc. One patient had splenic vein thrombosis, 2 patients had mild pancreatitis, and 4 patients had moderate ascites.Conclusion:Intraoperative bleeding could be controlled by priority splenic artery blocking, bleeding prevention strategies of perisplenic and splenic pedicle dissociation, which is one of the important guarantees for the success of total laparoscopic complicated splenectomy.
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Objective:To compare the postoperative anorectal and urogenital function in patients undergoing Da Vinci robot vs laparoscopic total mesorectal excision (TME) for middle and low rectal cancer.Methods:A prospective controlled study was conducted to analyze the clinical data of 120 patients with middle and low rectal cancer receiving low anterior resection (Dixon procedure) at the Department of Gastrointestinal Surgery, Guizhou Provincial People's Hospital from Jun 2020 to Oct 2022, including 65 patients in the laparoscopic surgery group and 55 patients in the robotic surgery group.All patients underwent colonoscopy and pelvic MRI, and the distance of the tumor from the anal margin was less than 10 cm.The clinical data of the patients were collected and followed up by questionnaire at 12 months after operation. The anal defecation function was assessed by Wexner constipation score and low anterior resection syndrome scale (LARS).The urinary function was measured by International Prostate Symptom Score (IPSS) and International Advisory Committee on Urinary Incontinence Lower Urinary Tract Symptom Scale (ICIQ-MLUTS/ ICIQ-FluTS).Reproductive function was valued by International Index of Erectile Function (IIEF-5 score) was used for male function and the sexual function index (FIFS-19) for females.Results:The postoperative anal defecation function in robotic group was better than that of the laparoscopic group, and the LARS score was (4.3±2.2) vs. (9.8±1.5), t=9.151, P=0.038.There was no serious urinary dysfunction in neither groups. The robot group had a certain advantage in the protection of male urinary function [ICIQ-MLUTS, (1.8±5.8) vs. (13.8±4.9), t=4.128, P=0.038], while there was no significant difference in the female urinary function between the two groups .ICIQ-FLUTS [(-0.3±1.0) vs. (-0.2±0.9), t=0.015, P=0.844].There was no significant difference in reproductive function between the two groups, IIEF-5 score [(-13.4±2.7) vs. (-11.7±3.4), t=0.35, P=0.615]. FIFS-19 [(-5.2±4.6) vs. (-10.5±6.4), t=4.128, P=0.254]. Conclusions:Compared with laparoscopic surgery, robotic surgery has a better possibility of anal defecation after middle-low rectal cancer surgery. The robotic group has certain advantages in male urinary function protection, and the two surgical methods have similar effects on reproductive function protection.
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Objective:To compare the clinical efficacy of laparoscopic pelvic floor three-level internal repair and stapled transanal rectum resection (STARR) in the treatment of male patients with intrarectal prolapse. Mlethds A total of 101 male patients with rectal intrarectal prolapse from Feb 2013 to Oct 2017 were enrolled into this study. Fifty-two patient in group A received laparoscopic pelvie floor three-level internal repair, and 49 patients in group B received STARR. The Wexner incontinence scale (WIS), Wexner constipation scale (WCS) score, gastrointestinal quality of life index (GIQLI) and degree of internal rectal prolapse (DIRP) were systematically evaluated before surgery and 3 months, 1 year and 3 years after surgery. Results:There were no significant differences in age, BMI, number of bowel movements(BM), WIS, WCS, GIQLI and DIRP between the two groups before surgery(all P>0.05). The WIS, WCS, GIQLI and DIRP in 3 months, 1year and 3 years after surgery in both two groups were significantly better than those before surgery ( t=20.169, 25.229, 27.278, 23.818, 23.489, 21.152, -3.550, -23.042, -22.901, 82.852, 40.915, 30.010, 11.323, 13.237, 11.452, 19.473, 18.647, 17.108, -8.791, -5.254, -5.846, 37.439, 30.598, 22.852, all P<0.001). The GIQLI in Group A was significantly better than that of group B at 1 year and 3 years after surgery ( P<0.001) but close to that in Group B at 3 months after surgery ( t=1.428, P=0.156). The WIS, WCS and DIRP in group A were significantly better than those in group B at 3 months, 1 year and 3 years after surgery, with statistical significance ( t=-8.243, -15.688, -20.193, -4.268, -4.768, -4.851, 11.329, 13.543, -5.399, -4.745, -4.598, all P<0.001). There was no signifcant difference in grade Ⅰ-Ⅲ complications between the two groups (χ 2=0.046, P=1.00). Conclusion:Laparoscopic pelvic floor three-level internal repair is more effective than transanal STARR in the treatment of male internal rectal prolapse.
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To compare the efficacy, safety and economic cost of endoscopic ultrasound (EUS)-guided puncture sclerotherapy and laparoscopic decapitation decompression for the renal cysts in the upper pole, data of patients with renal cysts in the upper pole who received EUS-guided puncture sclerotherapy (the EUS group, n=9) or laparoscopic decapitation decompression (the laparoscopy group, n=16) in the Second Affiliated Hospital of Soochow University from January 2021 to August 2022 were analyzed retrospectively. The effective rate, operation time, intraoperative blood loss, incidence of complications, hospital stay and treatment cost of the EUS group and the laparoscopy group were compared. Results showed that the effective rate was comparable in the EUS group and laparoscopy group (9/9 VS 14/16, P=0.520). The operation time was shorter (29.8±4.8 min VS 70.1±11.1 min, t=10.207, P<0.001), intraoperative blood loss less (0 mL VS 26.1±5.9 mL, t=13.089, P<0.001), postoperative hospital stay shorter (3.5±0.7 days VS 5.4±2.0 days, t=2.663, P=0.014), and total cost lower (10 547.85±2 388.19 yuan VS 15 316.09±5 352.45 yuan, t=2.517, P=0.019) in the EUS group compared with those in the laparoscopy group. There was no significant difference in the total hospital stay (8.1±2.0 days VS 9.3±3.1 days, t=1.019, P=0.319) or operation cost (3 946.79±490.82 yuan VS 3 860.18±857.42 yuan, t=-0.277, P=0.784) between the EUS group and laparoscopy group. There was 1 case of puncture bleeding, 1 case of hematuria, and 1 case of lumbago in the laparoscopy group, while no complication occurred in the EUS group. In conclusion, it is preliminarily believed that EUS-guided puncture sclerotherapy for renal cysts in the upper pole has similar clinical effects with higher safety, shorter postoperative hospital stay and lower total hospitalization cost compared with those of laparoscopic decapitation decompression, which is worth of clinical promotion.
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Objective:To analyze the effect of different lithotomy positions on hemodynamics in patients undergoing laparoscopic total hysterectomy.Methods:A total of 50 patients who underwent laparoscopic total hysterectomy at Zhoushan Women and Children's Hospital between January 2020 and June 2021 were included in this study. The patients were randomly divided into a control group and an observation group using a random number table method, with 25 patients in each group. The control group underwent conventional lithotomy position total laparoscopic hysterectomy, while the observation group underwent high and low lithotomy position total laparoscopic hysterectomy. The general surgical indicators, respiratory function indicators, blood gas analysis indicators, hemodynamic levels, incidence of complications, and clinical efficacy were compared between the two groups.Results:The general surgical indicators and airway peak pressure indicators in the observation group were significantly lower than those in the control group (both P < 0.05). There was no statistically significant difference in partial pressure of end-tidal carbon dioxide (PCO 2) and arterial carbon dioxide partial pressure (PaCO 2) between the two groups (both P < 0.05). At 15 minutes after pneumoperitoneum, the PaCO 2 level increased in each group, and the PaCO 2 level in the observation group was significantly higher than that in the control group (all P < 0.05). At the same time, the HCO 3- level decreased in each group, and the HCO 3- level in the observation group was significantly lower than that in the control group (all P < 0.05). At 5 minutes before recovery of body position, heart rate, systolic blood pressure, and diastolic blood pressure in the control group were (76.52 ± 8.61) beats/minute, (113.52 ± 5.36) mmHg (1 mmHg = 0.133 kPa), and (86.91 ± 4.21) mmHg, respectively. At 5 minutes after recovery of body position, heart rate, systolic blood pressure, and diastolic blood pressure in the control group were (89.52 ± 8.61) beats/minute, (106.85 ± 5.63) mmHg, and (80.96 ± 3.65) mmHg, respectively. At 5 minutes before recovery of body position, heart rate, systolic blood pressure, and diastolic blood pressure in the observation group were (76.36 ± 8.61) beats/minute, (112.79 ± 5.28) mmHg, and (86.89 ± 4.54) mmHg. At 5 minutes after recovery of body position, heart rate, systolic blood pressure, and diastolic blood pressure in the observation group were (75.63 ± 6.86) beats/minute, (111.99 ± 5.51) mmHg, and (85.06 ± 3.21) mmHg, respectively. At 5 minutes after recovery of body position, heart rate in the control group was increased and that in the observation group was decreased compared with heart rate measured at 5 minutes before recovery of body position. At 5 minutes after recovery of body position, heart rate in the observation group was significantly lower than that in the control group. Diastolic blood pressure and systolic blood pressure decreased in each group, and the amplitudes of reductions in diastolic blood pressure and systolic blood pressure in the observation group were significantly lower than those in the control group. ( t = 6.04, 3.26, 4.22, all P < 0.05). There was no statistically significant difference in incidence of adverse reactions between the two groups ( P > 0.05). The overall response rate in the observation group was significantly higher than that in the control group ( P < 0.05). Conclusion:Compared with conventional lithotomy position total laparoscopic hysteretsotomy, high and low lithotomy position total laparoscopic hysterectomy takes a shorter duration for total laparoscopic hysterectomy, leads to a shorter length of hospital stay, results in less blood loss, causes fewer postoperative infections, and results in more stable hemodynamics and a lower incidence of complications.
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Objective:To explore the effects of different doses of dexmedetomidine (DEX) on inflammatory factors and immune function in patients with gynecological malignant tumors who underwent laparoscopic surgery.Methods:A total of 60 patients with gynecological malignant tumors who underwent laparoscopic surgery from January 2021 to December 2021 in the Second Hospital of Shanxi Medical University were selected as the research objects. All patients were divided into the control group, low-dose DEX group (group D1) and high-dose DEX group (group D2) by using random number table method, 20 cases in each group. Patients in D1 and D2 groups were intravenously pumped DEX 0.5 μg/kg and 1.0 μg/kg 10 minutes before induction of anesthesia, and then maintained with DEX 0.5 μg·kg -1·h -1 and 1.0 μg·kg -1·h -1 until 30 minutes before the end of operation; and patients in the control group were given the same amount of Nacl solution. The 10 ml peripheral venous blood were collected at 10 minutes before induction of anesthesia (T 1), 1 h after pneumoperitoneum relief (T 2) and 24 h after pneumoperitoneum relief (T 3). The changes of interleukin-6 (IL-6), interleukin-10 (IL-10), the proportion of CD4 +, the proportion of CD8 + and CD4 +/CD8 + ratio of the three groups were compared, and the cases of bradycardia and hypotension in perioperative period and the time of first exhaust after operation were recorded. Results:At T 1,T 2 and T 3, the expression level of IL-6 in the control group was (7.95±0.26) pg/ml, (8.30±0.24) pg/ml and (8.35±0.28) pg/ml, respectively, and the difference was statistically significant ( F = 14.14, P < 0.001); the expression level of IL-10 in the control group was (38.9±2.6) pg/ml, (44.5±6.6) pg/ml and (46.3±4.6) pg/ml, respectively, and the difference was statistically significant ( F = 12.45, P < 0.001); the proportion of CD4 + in the control group was (38.5±2.1)%, (29.5±4.6)% and (29.6±3.5)%, respectively, and the difference was statistically significant ( F = 40.82, P < 0.001); the ratio of CD8 + in the control group was (30.1±3.7)%, (35.1±6.3)% and (40.3±8.2)%, respectively, and the difference was statistically significant ( F = 13.02, P < 0.001); the CD4 +/CD8 + ratio in the control group was 1.29±0.14, 0.84±0.09 and 0.75±0.14, respectively, and the difference was statistically significant ( F = 99.94, P < 0.001). The expression level of IL-6 in group D1 and group D2 was (8.10±0.32) pg/ml and (8.01±0.30) pg/ml at T 2, and (8.12±0.35) pg/ml and (8.05±0.34) pg/ml at T 3,which were lower than those in the control group, and the differences were statistically significant (all P < 0.05). The expression level of IL-10 in group D2 was (40.6±3.5) pg/ml at T 2, which was lower than that in the control group, and the difference was statistically significant ( P < 0.05). At T 3, the expression level of IL-10 in group D1 and group D2 was (43.7±3.5) pg/ml and (42.4±3.9) pg/ml, which were lower than those in the control group, and the differences were statistically significant (all P < 0.05). At T 2, the proportion of CD4 + in group D2 was (34.5±4.3)%, which was higher than that in the control group, and the difference was statistically significant ( P < 0.05). At T 3, the proportion of CD4 + in group D1 and group D2 was (32.1±4.2)% and (33.7±2.8)%, which were higher than those in the control group, and the differences were statistically significant (all P < 0.05). At T 2, the proportion of CD8 + in group D2 was (30.7±5.5)%, which was lower than that in the control group, and the difference was statistically significant ( P < 0.05). At T 3, the proportion of CD8 + in group D1 and group D2 was (35.4±5.8)% and (32.5±5.1)%, which were lower than those in the control group, and the differences were statistically significant (all P < 0.05). The CD4 +/CD8 + ratio in group D1 and D2 was 0.99±0.17 and 1.14±0.16 at T 2, 0.93±0.19 and 1.05±0.16 at T 3, which were higher than those in the control group, and the differences were statistically significant (all P < 0.05). Meanwhile, 1 case of hypotension occurred in the the control group and group D1, respectively; 3 cases of bradycardia and 2 cases of hypotension occurred in the group D2. The time of exhaust in the control group was later than that in group D1 and D2, and the difference was statistically significant ( P < 0.05). Conclusions:DEX can inhibit the inflammatory reaction during laparoscopic surgery in patients with gynecological malignant tumors, reduce immune damage. The anti-inflammatory action and immune protection of high-dose of DEX is more significant compared with low-dose of DEX, while high dose of DEX is more likely to cause hemodynamic fluctuations in perioperative period.
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Objective:Three-dimensional simulation modeling technology was used to conduct three-dimensional reconstruction, classification and measurement for the anatomic structures of colorectal canal, tumor and key blood vessels in patients with rectal cancer before operation. And the accuracy of the data and information obtained for the prediction of anastomotic tension, important types of vascular variant, positioning of anatomical landmarks, etc. in laparoscopic-assisted radical resection of rectal cancer, and the guiding effect of operation was evaluated.Methods:The clinical data of 50 patients with laparoscopic-assisted radical resection of rectal cancer treated in the General Surgery Department, Beijing Ditan Hospital Capital Medical University from January 2019 to February 2021 were analyzed retrospectively, including 31 males and 19 females, aged from 42 to 83 years old, with an average age of (62.72 ±15.21) years. The patients were divided into two groups according to whether the patients underwent three-dimensional simulation reconstruction before operation. The patients who underwent abdomen pelvic enhancement CT and further three-dimensional reconstruction before surgery were taken as reconstruction group ( n=24), and the patients who were only routinely performed abdomen pelvic enhancement CT before operation were taken as control group ( n=26). For the patients in the reconstruction group, the CT images were modeled by Mimics software before operation, and the key data such as the length of colorectal and tumor, the correlation length of rigid structure of pelvic wall, the length of inferior mesenteric artery (IMA) from the bifurcation point of left and right arteria iliaca communis, the type and proportion of IMA variation, the length of left colonic artery (LCA) from the beginning of IMA and the distance between LCA and IMV were measured, and the consistency correlation coefficient (CCC) was analyzed with the actual data obtained during operation. And then the accuracy of three-dimensional simulation modeling technology for surgical guidance was evaluated. MedCalc 19.0 software was used for statistical analysis. Results:In the reconstruction group, regarding the data of each dimension of the model (intestinal tract, pelvic cavity, blood vessels) and the corresponding structural measurements during the operation, the consistent correlation coefficient (CCC) evaluation was more than 0.9. One case was predicted to have free splenic flexure of colon and one case actually had free splenic flexure of colon. The prediction accuracy was 100%. The IMA variants in the reconstruction group were divided into 4 types, all of which were verified by operation. Compared with the control group, the operation time ( P=0.011) and the location time (IMA, P=0.043; LCA, P=0.007; IMV, P=0.034) of each vessel in the reconstruction group were shorter, and the amount of intraoperative blood loss was less ( P=0.017). Conclusion:The application of three-dimensional simulation modeling technology before operation is helpful for the operator to accurately predict the intraoperative anastomotic tension, the type of IMA variation and the related diameter length, based on which the accurate operation plan can be made to guide the operation.
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Laparoscopy technology is widely used in urology. The mastery of laparoscopic surgery by urologists is very important to improve the quality of surgery and improve the prognosis of patients. However, there is no evaluation system for the maturity of laparoscopic technology of urologists. Based on this situation, in recent years, some evaluation criteria or evaluation elements have emerged to try to evaluate the laparoscopic skills of urologists. This article mainly summarizes the common evaluation tools, application scenarios, and limitations of laparoscopic technology in urology, and made an idea to establish a laparoscopic technology evaluation system in urology, providing a certain reference for the application and development of training and evaluation tools of laparoscopic technologyin urology.