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Objective:To investigate the clinical value of esophageal-jejunal OrVil TM anas-tomosis and Overlap anastomosis in laparoscopic radical total gastrectomy of adenocarcinoma of esophagogastric junction (AEG). Methods:The retrospective cohort study was conducted. The clinicopathological data of 112 patients with AEG who were admitted to the First Hospital of Jilin University from July 2017 to August 2022 were collected. There were 87 males and 25 females, aged (64±8)years. All 112 patients underwent laparoscopic total gastrectomy and D 2 lymphadenectomy, in which 61 cases with esophageal-jejunal OrVil TM anastomosis were divided into the OrVil TM group, 51 cases with esophageal-jejunal Overlap anastomosis were divided into the Overlap group. Observa-tion indicators: (1) surgical situations; (2) postoperative complications; (3) influencing factors for patients undergoing esophageal-jejunal OrVil TM anastomosis. Measurement data with normal distri-bution were represented as Mean± SD, and comparison between groups was conducted using the independent sample t test. Measurement data with skewed distribution were represented as M( Q1, Q3), and comparison between groups was conducted using the non-parameter test. Count data were described as absolute numbers, and comparison between groups was conducted using the chi-square test or Fisher exact probability. Logistic regression model was used for multivariate analysis. Results:(1) Surgical situations. The esophageal invasion length and tumor diameter was 1.0(0.7,2.0)cm and (6.3±2.7)cm in patients of the OrVil TM group, versus 0.2(0.1,0.5)cm and (4.7±2.2)cm, respectively, in patients of the Overlap group, showing significant differences in the above indicators between the two groups ( Z=?6.14, t=3.26, P<0.05). (2) Postoperative complications. Cases with complications ≥Ⅲa grade of Clavien-Dindo classification, cases with respiratory system complications, cases with hydrothorax were 13, 17, 13 in the OrVil TM group, versus 4, 5, 4 in the Overlap group, showing significant differences in the above indicators between the two groups ( χ2=3.91, 5.74, 3.91, P<0.05). Cases underwent readmission within postoperative 30 days were 3 and 1 in the OrVil TM group and the Overlap group, respectively, and all patients recovered after symptomatic treatment. There were 2 cases died after operation in the OrVil TM group and none of patients died after operation in the Overlap group. (3) Influencing factors for patients undergoing esophageal-jejunal OrVil TM anastomosis. Results of multivariate analysis showed that esophageal invasion length was an independent factor influencing for patients undergoing esophageal-jejunal OrVil TM anastomosis ( odds ratio=8.25, 95% confidence interval as 3.41?19.96, P<0.05). Conclusions:Compared with esophageal-jejunal Overlap anastomosis, choosing the esophageal-jejunal Orvil TM anastomosis during laparoscopic radical total gastrectomy can take benefit to the proximal margin of patients with AEG. However, the ratios of complications ≥ Ⅲa grade of Clavien-Dindo classification, respiratory system complications and hydrothorax associated to OrVil TM anastomosis are relatively increased. Esophageal invasion length is an independent influencing factor for patients undergoing esophageal-jejunal OrVil TM anastomosis.
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Objective:To investigate the characteristics and related risk factors for postoperative surgical site infection(SSI) for patients of left-sided colon radical operation , so as to guide clinical intervention measures.Methods:Three hundred and twenty-two patients who underwent left-sided colon radical operation between January 2015 and December 2019 were surveyed retrospectively in the Department of Gastrointestinal and Anal Surgery, Jilin university First Hospital, including 205 male, and 117 female, aged from 18 to 80 years old. The clinical data for each patient were collected and analyzed. The influencing factors and possible risk factors were conducted by single factor analysis and Logistic analysis.Results:Among 332 patients, 79 patients developed SSI, total SSI rate was 24.5%, among which 56 cases of superficial incision infection and 23 cases of organ/lacunar infection. Single factor analysis showed that hypoalbuminema(<35 g/L), BMI≥24 kg/m 2, ASA≥3, operation time≥120 min, hospitalization time≥10 d, diabetes, hospitalization expenses, anastomotic leakage were high risk factors for SSI. Logistic analysis showed the risk factors for SSI infection were diabetes, ASA≥3, operation time≥120 min, hypoalbuminema(<35 g/L). Conclusions:The occurrence of SSI was related to multiple factors. The patients with hypoalbuminema(<35 g/L), BMI≥24 kg/m 2, ASA≥3, operation time≥120 min were high-risk factors for SSI. The implementation of relevant prevention or intervention measures should be intensified.
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Objective To evaluate the defecation function of patients with low rectal cancer after laparoscopic-assisted transanal total mesorectal excision (TaTME),and analyze the influencing factors.Methods The retrospective case-control study was conducted.The clinicopathological data of 55 patients with low rectal cancer who underwent laparoscopic-assisted TaTME in the First Hospital of Jilin University from May 2017 to December 2018 were collected.There were 39 males and 16 females,aged (60-± 11) years,with a range from 24 to 80 years.Among the 55 patients,21 were in TNM stage Ⅰ,14 were in TNM stage Ⅱ,and 20 were in TNM stage Ⅲ;24 were in pathological stage T1-2 and 31 were in pathological stage T3.Observation indicators:(1) surgical and postoperative conditions;(2) follow-up;(3) analysis of influencing factors for postoperative defecation function.Follow-up was performed using questionnaires by telephone interview to detect the complications at 3 and 6 months after surgery up to June 2019.The measurement data with normal distribution were expressed as Mean± SD,and comparison between groups was done using the t test.Count data were expressed as absolute numbers or percentages,and comparison between groups was analyzed using the chi-square test or Fisher exact probability.Univariate and multivariate analyses were performed using logistic regression models.Results (1) Surgical and postoperative conditions:55 patients successfully underwent laparoscopic-assisted TaTME without conversion to open surgery.The operation time,volume of intraoperative blood loss,diameter of postoperative pathological specimen,time to urinary catheter removal,distance between the anastomostic stoma and anal verge,and tumor diameter were (246±62) minutes,(69±27) mL,(3.5±0.7) cm,(2.1±0.9) days,(2.4±0.5) cm,and (3.9-± 1.6)cm,respectively.(2) Follow-up:55 patients were followed up at 3 months and 6 months after surgery,and the low anterior resection syndrome questionnaires were completed.Among the 55 patients,35 had low anterior resection syndrome at 3 months after surgery,and 24 had low anterior resection syndrome at 6 months after surgery,showing a significant difference (x2 =4.42,P＜0.05).There was no new onset low anterior resection syndrome in 55 patients after 3 months.(3) Analysis of influencing factors for defecation function:univariate analysis showed that the distance between the anastomotic stoma and anal verge and tumor diameter were influencing factors affecting defecation function of patients at 3 months after surgery (x2 =19.075,8.185,P＜ 0.05).The distance between the anastomotic stoma and anal verge was a influencing factor affecting the defecation function of patients at 6 months after surgery (x2=9.183,P＜0.05).Multivariate analysis showed that the distance between the anastomotic stoma and anal verge ＜ 2 cm,and tumor diameter ＞5 cm were independent risk factors affecting the defecation function of patients at 3 months after surgery (odds ratio =1.135,6.057,95％ confidence interval:1.089-1.323,1.206-30.435,P＜0.05).The distance between the anastomotic stoma and anal verge ＜ 2 cm was an independent risk factor affecting the defecation function of patients at 6 months after surgery (odds ratio =2.724,95％ confidence interval:1.982-3.066,P＜0.05).Conclusions The incidence of low anterior resection syndrome after laparoscopic-assisted TaTME for low rectal cancer is high.Distance between the anastomotic stoma and anal verge and tumor diameter are independent risk factors for the postoperative defecation founction.
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Objective To compare the clinical effect and safety of percutaneous vertebroplasty between unipedicular and bipedicular approach for patients with osteoporosis vertebral compressive fractures. Methods A retrospective study was carried out on 147 patients with single osteoporotic vertebral compressive fractures from 2008 to 2014. Ninety-five cases were treated by PVP via a unipedicular approach (unipedicular group) and 52 cases were treated by the bipedicular approach (bipedicular group). The operation time, Cobb, frequency of X-ray exposure,complications like bone cement and postoperative VAS score were compared. Results No significant differences on the VAS score, cobb and complications were found (P > 0.05). However, there were significant differences on the operation time and X-ray exposure frequency (P<0.05). Conclusions No significant differences on clinical effects were found between the unipedicular and the bipedicular approach to percutaneous vertebroplasty for osteoporosis vertebral compressive fractures. However, the unipedicular approach can shorten the operation time and reduce X-ray exposure.
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BACKGROUND:Increasing studies have found that, percutaneous vertebroplasty and bone cement are characterized by few traumas, few bleeding, simple operation, rapid recovery, rapid pain relief, and effective efficacy. However, tumor recurrence, symptom improvement, bone cement leakage and other complications make people controversial. OBJECTIVE: To explore and summarize clinical outcomes and safety of percutaneous vertebroplasty and bone cement for treating symptomatic vertebral hemangioma. METHODS:Fifty-two cases patients of symptomatic vertebral hemangioma (including 21 male and 31 female, aged 16-63 years) were treated with percutaneous vertebroplasty and bone cement. The lesions were found at T5-T12 in 36 cases and at L1-L3 RESULTS AND CONCLUSION: Al 52 patients were folowed up for at least 6 months after the operation. The Visual Analogue Scale and Oswestry Disability Index were significantly increased at 1 day, 3 weeks and 6 months post-surgery, when compared to before surgery (P< 0.05); the modified Macnab evaluation was excelent in 40 cases, good in 7 cases, fair in 3 cases, and poor in 2 cases, and the excelent and good rate was 90%. Only one patient had recurrence at 6 months after surgery and one patient had the leakage of bone cement. No other complications were found. Percutaneous vertebroplasty and bone cement could effectively cure vertebral hemangioma and relieve the pain, which is a safe treatment. in 16 cases. Clinical outcomes such as Visual Analogue Scale, Oswestry Disability Index and modified Macnab criteria, as wel as complication before and after surgery were evaluated.