Résumé
Objective To analyze the safety and efficacy of laparoscopic radical resection of colorectal cancer for elderly patients over 70 years old. Methods From January 2014 to January 2017,a retrospective analysis of the patients with radical surgery for colorectal cancer in Department of General Surgery,Beijing Anzhen Hospital,Capital Medical University was performed. According to the patient′s age, the patients were divided into ≥70 years old group (68 cases) and＜70 years old group (84 cases). The preoperative clinical data of the two groups were analyzed. The surgeons strictly followed the standard lymph node cleaning and the principle of no tumor for colorectal cancer radical operation. The surgical conditions, pathology,short-term efficacy and the follow-up conditions of the two groups were compared. Statistical analysis was performed using SPSS 20. 0. The normal distribution of the data was expressed as Mean±SD,and the t-test was used for comparison between the group. The count data was compared using the χ2 test or the Fisher exact probability method. Results The operation was successfully completed in both groups. In the group of≥70 years old,2 cases were converted to open due to extensive adhesion of the abdominal cavity,no perioperative death. Compared with the＜70 years old group,≥70 years old group had more hypertension and coronary heart disease, respectively ( 38. 2%( 26/68 ) vs. 14. 3%( 12/84 )), and the difference was statistically significant ( P＜0. 05 ) . There was no significant difference in intraoperative blood loss and operation time between the two groups (P＞0. 05) . There was statistically significant difference in incidence of postoperative cardiovascular events between the groups (26. 4%(18/68) vs. 7. 14%(6/84)χ2＝ 6. 428, P＝0. 010) . However,there were no significant differences between the two groups in implications,rate of death and the time stayed in hospital. (P＞0. 05). Conclusion Laparoscopic radical resection for colorectal cancer patients over 70 years old is safe and feasible with strict indications and attention to perioperative management.
Résumé
Objective To investigate the efficacy and safety of laparoscopic surgery of rectal cancer for different stages of rectal cancer . Methods A retrospective analysis was made on clinical data of 96 cases of rectal cancer from January 2009 to December 2013.Among 42 cases of TNM staged 0-Ⅰ, there were 22 cases of laparoscopic surgery ( laparoscopic group A ) and 20 cases of open surgery ( laparotomy group A ) .Among 54 cases of TNM staged Ⅱ-Ⅲ, there were 20 cases of laparoscopic surgery (laparoscopic group B) and 34 cases of open surgery (laparotomy B group).At the end of follow-up ended in May 2015, the tumor markers, postoperative complications , local recurrence , distant metastasis rate and 1-year and 3-year survival rates were compared in different stages of patients between the laparoscopic surgery and open surgery . Results As compared with the laparotomy group A , the laparoscopic group A had shorter surgery time [(121.7 ±13.5) min vs.(142.4 ±23.5) min, t=-3.530, P=0.000] and less blood loss [(80.9 ±10.6) ml vs.(136.3 ±32.6), t=-7.559, P=0.000].As compared with the laparotomy group B , the laparoscopic group B had less blood loss [(110.3 ±15.3) ml vs.(186.5 ±22.6) ml, t=-12.202, P=0.000].As compared with the laparotomy group A, the laparoscopic group A had significantly reduced distal resection margin distance [(2.3 ±0.6) cm vs. (3.0 ±0.7) cm, t=-3.489, P=0.001].As compared with the laparotomy group B, the number of lymph node metastasis was significantly reduced in the laparoscopic group B (2.7 ±0.4 vs.3.1 ±0.4, t =-3.298, P=0.002).The conversion rate to laparotomy in the laparoscopic group B was 20%.There were no significant difference between the laparoscopic group A and laparotomy group A in local recurrence rate [9.5% (2/21) vs.5.0% (1/20), χ2 =0.000, P=1.000], distant metastasis rate [4.8%(1/21) vs.5.0%(1/20),χ2 =0.000, P=1.000], and survival rate (log-rankχ2 =0.102, P=0.750).There were no significant difference between the laparoscopic group B and laparotomy group B in local recurrence rate [6.2%(1/16) vs.6.2%(2/32),χ2 = 0.000, P=1.000], distant metastasis rate [6.2%(1/16) vs.3.1%(1/32), Fisher test, P=1.000], and survival rate (log-rankχ2 =0.158, P=0.691). Conclusions Laparoscopic radical surgery for TNM stage 0-Ⅰ of rectal cancer has a good effect and safety.The conversion rate to laparotomy in TNM staged Ⅱ-Ⅲrectal cancer patients is still high with relatively high surgical risks , which requires strict preoperative assessment .
Résumé
Objective To evaluate the clinical efficacy of laparoscopy combined with colonoscopy for small colorectal space occupying lesions (equal or less than 3 cm). Methods From January 2010 to January 2015,a total of 41 cases of small colorectal space occupying lesions (equal or less than 3 cm)were treated under general anesthesia with laparoscopic surgery combined with colonoscopy.The patients were placed at the lithotomy position.After the establishment of pneumoperitoneum,injection of methylene blue for staining was carried out under colonoscopy. Laparoscopic titanium clipping positioning was conducted, and then the colonoscope was withdrawn.According to the intraoperative frozen pathological results,bowel resection surgery or colorectal surgical resection was selected. Results All the 41 cases of laparoscopic combined with colonoscopic surgery were successfully completed, with no conversion to laparotomy.There were 9 cases of preoperative diagnosis of precancerous lesions,6 of which were found neoplasia in the colon epithelium with intraoperative pathological diagnosis,with 3 cases of Tis adenocarcinoma.Among 32 cases of preoperative diagnosis of stage 0 -Ⅰ colorectal cancer,there were 29 cases of intraoperative and postoperative diagnosis of stage Ⅰ (23 cases of T1 N 0 M0 adenocarcinoma and 6 cases of T2 N 0 M0 adenocarcinoma)and 3 cases of stage Ⅲ (T2 N 1 M0 adenocarcinoma).Two cases were multiple lesions.Bowel resection was performed in colon intraepithelial neoplasia and Tis lesions of colorectal cancer,while resection of colorectal cancer was conducted in stage T1 -T2 colorectal cancer.Two patients with colonic epithelial neoplasia were followed up for 9 and 12 months,without recurrence.The remaining 39 cases were followed up for 24 -49 months,with a median of 38.6 months. Among the 35 cases of colorectal cancer,colonoscopy detected local recurrence in 1 case of T2 N 1 M0 adenocarcinoma (stage Ⅲ)after 34 postoperative months.No metastasis was found in all the patients. Conclusion Laparoscopy combined with colonoscopy for small diameter (equal or less than 3 cm)benign tumor or stage Tis -T2 malignant colorectal cancer has advantages of both endoscopy,especially suitable for difficultly located or removed lesions,which can improve the positioning precision and surgical safety.
Résumé
@#Objective To investigate the related factors of postoperative pulmonary complications with abdominal operation. Methods 193 cases after abdominal operation were reviewed. The age, smoking history, surgery duration, surgical site, pulmonary function, artery blood gas analysis, and the incidence of post-operative pulmonary complications were analyzed. Results Pulmonary complications were found in 29 cases. The age was higher and surgery duration was longer in patients with pulmonary complications than those without pulmonary complications (P<0.05). The patients with abnormal forced expiratory volume in the first second (FEV1)%, FEV1/ forced vital capacity (FVC)%, maximum ventilatory volume (MVV)% and smoking history before operation were in higher risk for post-operative pulmonary complications (P<0.05). There was significant difference in artery blood gas analysis between the 2 groups (P<0.05). Conclusion The age,smoking history, surgery duration and pulmonary dysfunction may be the risk factors of pulmonary complications after abdominal operation,while it is important to monitor the blood gas analysis.
Résumé
Objective To discuss the influential factors of postoperative pulmonary complications in elder patients accepted abdominal operation. Methods The clinical data of 95 cases accepted abdominal operation were analyzed retrospectively,and all the patients aged over 60. These patients were divided into two groups based on whether they had pulmonary complications or not. Seven relative factors including the age,sex,smoking history,surgery duration ,operation place,pulmonary function,anesthesia were analyzed and the relationship between these factors and the incidence of postoperative pulmonary complications were explored,too. Results Among the 95 patients,19 cases had pulmonary complications. The surgery duration in patients with pulmonary complications ((3.4 ± 1.1)h)were significantly higher than in those without pulmonary complications ((2. 6 ± 0. 9)h)(P ＜0.05). We also found significant differences in the comparison of FEV1%(59.2 ±9.5),FEV1/FVC(61.3 ±7.7)% ,MVV%(59.3 ±8.6)% in the group with pulmonary complications,with FEV1%(79.7 ± 11.5)%、FEV1/FVC(73.2 ±8. 3)% 、MVV%(74. 2 ±6. 4)% in the group without pulmonary complications. The epigastric operation and general anesthesia before operation were risk factors for post-operative pulmonary comphcations(P ＜0. 05). Conclusions Surgery duration,operation place,pulmonary dysfunction and anesthesia may be the risk factors of pulmonary complications after abdominal operation.
Résumé
Objective To explore the safety and effectiveness of using low molecular weight heparin (LMWH) in place of warfarin for anticoagulation in patients with a previous cardiac valve replacement. Methods We reviewed 70 patients hospitalized from Jan 2002 to Apr 2009 undergoing abdominal surgery who have had a previous cardiac valve replacement and had been on warfarin anticoagulation therapy. LMWH began to replace warfarin for anticoagulation 3 clay before the surgery in 33 cases, while the other 37 patients simply ceased to use any anticoagulant since 3 days before the surgery. Postoperative bleeding and embolism risk were compared between these two groups. Results There were 2 patients suffering from postoperative bleeding in the operative field in LMWH group, while there was no postoperative bleeding in patients on anticoagulant suspension group (χ~2=0.641, P>0.05). There was no valve embolism occurred in these two groups. Conclusions It is a safe way to stop using warfarin with LMWH taking the task for perioperative anticoagulation in patients with a history of cardiac valve replacement 3 days before an elective abdominal surgery. This protocol decreases the risk rate of valve embolism not at the expense of increasing postoperative bleeding.
Résumé
Objective To investigate the characteristics of laparoscopic cholecystectomy(LC) in the elderly. Methods A retrospective analysis was made on clinical data of 118 elderly patients treated with LC in this hospital between January 2000 and January 2005. Results The LC was successfully completed in 116 patients,while conversions to open surgery were required in 2 patients due to low level of insertion of the cystic duct(1 patient) and common bile duct injury(1 patient).The operation time was(30~120 min)(mean,50 min).The postoperative recovery was uneventful in all the patients.The length of hospital stay after operation was 3~7 d(mean,4.5 d).The patient with common bile duct injury was followed for 2 years and 6 months.Transient onsets of abdominal pain and fever were noted and cured with antibiotics for 2~5 days.No biliary tract stenosis or bile duct calculus was seen.Follow-up observations in the remaining 117 patients for 6~12 months(mean,10.5 months) revealed no abdominal pain,fever,or jaundice. Conclusions Laparoscopic cholecystectomy is acceptable and safe for elderly patients.Proper peri-operative management and careful surgical performance are essential to the success of surgery.
Résumé
Objective To sum up our experience in the preoperative management for anticoagulated valve replacement patients undergoing selective biliary tract surgery Methods Thirty eight patients were divided into normal liver function group of 23 cases (group A) suspending anticoagulant 3 days before the surgery and group B of 15 cases with abnormal liver function suspending anticoagulant plus VitK 1 injection 12 hours before the surgery Prothrombin time was measured, and result was compared with 115 normal controls Results There were no significant difference in prothrombin time between the two groups Conclusion A biliary tract surgery could be safe if anticoagulated patients receive adequate preoperative management