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Objective:To investigate the status of participation in treatment and nursing decision-making in patients with chronic obstructive pulmonary disease (COPD), and analyze its influencing factors.Methods:A cross-sectional survey was conducted on 230 COPD patients hospitalized in the Affiliated Hospital of Hangzhou Normal University from October 2021 to May 2022 by using the general situation questionnaire, questionnaire of patients′ decision-making regarding treatment and care, Patient Doctor Relationship Questionnaire, 13-Item Version, Nursing-Patient Relationship Trust Scale and Chronic Obstructive Pulmonary Disease knowledge Questionnaire, Logistic regression was used to analyze the influencing factors of patients′ participation in treatment and nursing decision-making.Results:The participation attitude score of COPD patients′ treatment decision-making was (1.93 ± 0.55) points, the participation degree score of COPD patients′ treatment decision-making was (2.29 ± 0.46) points, the participation attitude score of COPD patients′nursing decision-making was (1.84 ± 0.42) points, and the participation degree score of COPD patients′ nursing decision-making was (2.03 ± 0.35) points. Gender, education level, occupation or occupation before retirement, the number of hospitalizations due to acute exacerbation of COPD in the past year, modified medical research council, doctor-patient relationship, and nurse-patient relationship were the influencing factors for patients to participate in treatment and nursing decision-making ( OR values were 0.070 to 18.368, all P<0.05). Conclusions:The participation attitude of COPD patients in treatment and nursing decision-making is negative and the degree of participation is low. Medical staff should correctly assess the reasons for the low participation of patients, and take targeted individualized measures to support patients to actively participate in treatment and nursing decision-making.
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Objective:To study the feasibility and safety of redo laparoscopic operations for choledochojejunostomy stenosis after minimally invasive pancreaticoduodenectomy.Methods:The clinical data of 7 patients with choledochojejunostomy stenosis which developed after minimally invasive pancreaticoduodenectomy who were treated with redo laparoscopic surgery from August 2019 to July 2021 at the Division of Gastrointestinal and Pancreatic Surgery, Zhejiang Provincial People's Hospital were retrospectively studied. There were 3 males and 4 females, with the age of (41.7±4.3) (ranged 27 to 54) years. The timing of reoperation, intraoperative blood loss, and postoperative complications were analyzed. An anastomotic restenosis was looked for on followed-up by outpatient interviews or phone calls.Results:The time interval of between diagnosis of the first postoperative anastomotic stenosis and surgery was 3-20 months, with a median of 9 months. Of the 7 patients, 5 patients underwent laparoscopic biliary anastomotic resection and reconstruction, and the remaining 2 patients underwent laparoscopic exploration of the anastomosis, removal of intrahepatic bile duct stones, and re-anastomosis. The median operative time was 180 (150-350) minutes. The median postoperative hospital stay was 6 (ranged 5 to 21) days. The intraoperative blood loss was 50 (ranged 20 to 300) ml. There was no intraoperative blood transfusion. One patient developed grade B biliary leakage after the surgery, improved with puncture and drainage. The remaining patients had no serious complications. There was no mortality. The median follow-up was 8 (ranged 1 to 23) months, during which no recurrence of biliary anastomotic stenosis occurred in all these patients.Conclusion:For patients with biliary anastomotic stenosis after minimally invasive pancreaticoduodenectomy, redo laparoscopic operations offered an alternative treatment option with satisfactory outcomes.
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Relapse remains the worst life-threatening complications after allogeneic hematopoietic stem cell transplantation (allo-HSCT) in patients with acute myeloid leukemia (AML), whose prognosis has been historically dismal. Given the rapid development of genomics and immunotherapies, the interference strategies for AML recurrence have been changing these years. More and more novel targeting agents that have received the U.S. Food and Drug Administration (FDA) approval for
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Objective:To evaluate the effect of multidimensional model of laparoscopic suture training in spread of laparoscopic pancreatic surgery.Methods:The surgeons who took advanced training in Department of Gastroenterology and Pancreatic Surgery in Zhejiang Provincial People’s Hospital from September 2018 to March 2020 were enrolled. Theoretical presentation, simulation training and assessment, clinical practices were included in the multidimensional training model. The " mattress suture" module (2 mattress sutures) in the LAP Mentor laparoscopic advanced simulator was used as the initial assessment and post-training assessment. The average needle loading time, time to form a knot, total time, accuracy rate of precise needle passage through the entrance and exit dots, and total aggressive tissue handing provided in the LAP Mentor were analyzed pre- and post-training. The trained surgeons were followed up for their clinical work in own hospitals.Results:A total of 13 surgeons were trained, including 4 deputy chief physicians, 7 attending physicians over 3 years, and 2 attending physicians under 3 years. The trainees had only primary laparoscopic surgery experience and no laparoscopic pancreatic surgery experience. After training in the above scheme, the average needle loading time was shortened from (93.6±31.6) s to (45.7±13.6) s, and the time to form a knot was reduced from (138.9±46.2) s to (62.1±22.9) s, and total time to accomplish the suture shortened from (15.9±3.8) min to (6.7±3.5) min. The accuracy rate of precise needle passage through the entrance and exit dots increased from (63.7±10.3)% to (89.6±9.8)%. The total aggressive tissue handing decreased from (18.2±12.5) to (6.7±4.9). All those data showed statistical differences ( P<0.05). During follow-up, all traineescan operate the laparoscopic pancreatic surgery proficiently. One trainee completed his first laparoscopic pancreaticoduodenctomy as the primary surgeon, and one trainee complete the splenic vein branch suture to stop hemostasis during laparoscopic pancreatectomy with spleen-preserving spleen, and 3 trainees completed laparoscopic pancreaticoduodenctomy as the first assistant surgeons with good outcomes. Conclusion:Multidimensional model of laparoscopic suture training can improve the trainee's suture skill and help perform complex laparoscopic pancreatic surgery with self-confidence.
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This review focused on the progress in laparoscopic pancreaticoduodenectomy(LPD) in the past six years.With the appropriate approaches under laparoscopy, including the resection and reconstruction, LPD has been proved to be safe and feasible. In some centers, LPD has been routine with rapid growth of numbers, it not only benefit the patients with fast recovery, but also benefit the trainees with similar sights as the primary surgeon and good videos of the procedures. However, LPD is still controversial as the more complications in some centers and inconclusive oncologic outcomes. Thus, in the further, a long-time outcome monitoring of LPD is essential. A registry of a prospectively maintained database may be a need for LPD to evaluate its outcomes by multicenter randomized control trials, and real world research may be of value. Structured LPD training programs are valuable for the new surgeons.
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Objective@#To evaluate the accuracy of endoscopic titanium clip localization combined with CT three-dimensional reconstruction for the control of incision margin in early gastric cancer under laparoscopy.@*Methods@#A prospective analysis was made for gastric cancer whose lesions were located in the middle of the stomach and T stage was 1 to 2 from October 2017 to January 2019 at Department of Gastrointestinal and Pancreatic Surgery, Zhejiang Provincial People′s Hospital. Totally 25 patients were eventually enrolled in the study. There were 17 males and 8 females aging of (63.6±7.2) years (range: 48 to 77 years). All cases were treated with titanium clip localization under endoscope combined with CT three-dimensional(3D) reconstruction to construct a virtual panorama of gastric cavity and lesions, and to design surgical margins. Laparoscopic surgical resection was performed according to the surgical margins designed before operation. The distance from the gastric angle to the origin of the minor curvature of the incisional margin, the distance from the gastric angle to the the center of lesion and the distance of the upper incision margin were measured under three-dimensional CT reconstruction and under actual specimen. Paired t test was used to compare the three distances measured by two methods.@*Results@#The measured distances from the gastric angle to the center of the lesion and the proximal incisional margin under 3D reconstruction CT were according to the measured values of actual specimens ((2.67±1.38) cm vs. (2.83±1.56) cm, t=1.51, P=0.14; (5.23±0.60) cm vs. 5 cm, t=1.93, P=0.07); the measured distances from the gastric angle to the origin of the minor curvature of the incisional margin under CT 3D reconstruction were different with the measured values of solid specimens ((5.94±0.94) cm vs. (6.37±0.90) cm, t=3.52, P=0.00).@*Conclusion@#The method of titanium clip localization combined with CT 3D reconstruction can provide a feasible laparoscopic localization method and incision edge solution for T1 to T2 gastric central cancer.
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Objective@#To evaluate the safety and feasibility of laparoscopic radical antegrade modular pancreatosplenectomy(Lap-RAMPS) for left-sided pancreatic adenocarcinoma.@*Methods@#Clinical data of total 12 patients underwent Lap-RAMPS for left-sided pancreatic adenocarcinoma at Department of Gastrointestinal and Pancreatic Surgery, Zhejiang Provincial People′s Hospital from March 2016 to August 2017 were reviewed retrospectively.There were 7 male patients and 5 female patients, with median age of 60.5 years old(47-68 years old). Abdominal enhanced CT, pancreatic MRI, PET-CT were performed on all patients to evaluate the lesion and exclude metastasis.Follow-up were done with out-patient clinic or telephone consultancy until October 2017.@*Results@#All patients underwent pure Lap-RAMPS.The medium operative time was 250 minutes(180-445 minutes), and the blood loss was 150 ml(50-500 ml). The medium first flatus time and diet resumption time were 3.0 days(1-5 days) and 3.5 days(1-7 days) respectively.The medium postoperative hospital stay was 9 days(4-18 days). Morbidity occurred in 8 patients with gastric empty delay(n=1), bleeding(n=1), fluid collection(n=3). There was no mortality.The medium overall number of retrived lymph nodes was 15.6 and the positive rate was 41.7%. The R0 rate was 100%.The medium follow-up was 10 months.One patient was diagnosed as liver metastasis after 8 months and accepted chemotherapy.One patient died after 14 months for tumor recurrence and metastasis.Others survived without tumor recurrence or metasitasis.@*Conclusion@#Lap-RAMPS is safe and feasible with accepted oncological outcomes for selected left side pancreatic adenocarcinoma under skilled hands.
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Objective@#To summarize the incidence and characteristics of postoperative complications after laparoscopic pancreaticoduodenectomy(LPD), and to share our experience on management of complications.@*Methods@#The clinical data of 320 LPD performed by a single team in Sir Run Run Shaw Hospital and Zhejiang Provincial People′s Hospital between September 2012 and September 2017 were retrospectively analyzed, among which there were 196 males and 124 females with age of (60.2±11.6) years old.There were 306 patients who underwent standard LPD, and 14 patients who underwent extended LPD. The patients were divided into 2 groups of former 160 LPD and later 160 LPD according to the time order. By analyzing the differences of clinical outcomes between the two groups, especially focusing on the incidence of postoperative complications.The experience on management of complications was concluded. The prior surgical history of latter group was significantly higher than the former group(30.0%(48/160)vs. 18.8%(30/160), χ2=5.49, P=0.019), and the rest of baseline characteristics remained the comparable (P>0.05). For resectable lesions, LPD was performed by "No back" approach, following the principle of "From distal to cephalad, from ventral to dorsal, and from left to right" . As for the borderline resectable patients, LPD was performed by "Easy first" strategy. Student t test, χ2 test or Fisher test was used to analyzed the data between the two groups respectively.@*Results@#Of 320 LPD patients, 306 cases underwent standard LPD, 14 cases underwent LPD with resection of other organs.There were 278 LPD cases who followed "No back" approach, and 42 cases who followed "Easy first" strategy because of difficulty in creating the retro-pancreatic tunnel. And the overall morbidity was 32.2%(103/320) with reoperation rate of 5.3%(17/320). The perioperative mortality was 0.6%(2/320). The operation time of latter group was ((346.6±48.8)minutes), which was shorter than that of former group((358.0±54.4)minutes)(t=1.97, P=0.048). The blood loss of former and latter group remained comparable((207.9±135.8)ml vs.(189.6±121.4)ml, P=0.205). However, in subgroup analysis, the patients with blood loss less <200 ml of latter group decreased significantly from 59.4%(95/160) to 47.5%(76/160)(χ2=4.53, P=0.033). The overall morbidity of latter group was 28.8%(46/160), indicated a decrease from 35.6%(57/160) of former group without significant difference(P=0.188). Moreover, Grade A/B/C pancreatic fistula rate, Grade A/C bile leakage rate, Grade B/C postoperative hemorrhage rate of the later group tended to decrease, although they also didn′t reach a significant difference. However, the abdominal infection rate decreased significantly(χ2=3.93, P=0.047). The length of hospital stay remained comparable(P=0.156).@*Conclusions@#The most common complications after LPD were postoperative hemorrhage and pancreatic fistula. With specialized team and accumulated experience, the morbidity can decrease progressively by analyzing the leading cause and improving the technical skills.
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Objective@#To summary the experience of 233 cases of laparoscopic pancreaticoduodenectomy (LPD) performed by a single surgical team.@*Methods@#Data of patients undergoing LPD from September 2012 to October 2016 were reviewed. There were 145 males and 88 females with the mean age of(60.3±13.0)years old, ranging from 19 to 92 years old, and the mean body mass index of (22.8±3.5)kg/m2, ranging from 16.3 to 36.8 kg/m2. There were 195 patients with clinical manifestation and 54 patients who had the history of abdominal surgery.@*Results@#LPD were performed on 233 patients by same surgical team consecutively. The mean operative time was(368.0±57.4)minutes. Mean blood loss was(203.8±138.6)ml. The postoperative morbidity rate was 33.5%, with 6.9% of grade B or C pancreatic fistula and 9.9% of bleeding. The reoperation rate was 5.6%. The mortality during 30 days after operation was 0.9%. Mean postoperative hospital stay was (18.1±11.2)days. Mean tumor size was (3.9±2.4)cm, and the mean number of lymph nodes harvested was 21.3±11.9.One hundred and sixty-three patients were diagnosed as malignant tumor, including pancreatic adenocarcinoma(n=84), cholangiocarcinoma(n=17), ampullary adenocarcinoma(n=55), duodenal adenocarcinoma(n=5), gastric cancer(n=1)and duel cancer (n=1) located in distal stomach and duodenum.@*Conclusion@#The key point to make laparoscopic pancreaticduodenectomy a routine safe procedure is to operate the procedure under skilled hands in selected patients via suitable surgical approaches.
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Pancreatic cancer is one of the most common and malignant tumor in the field of digestive system.Surgery still is potential method to cure pancreatic cancer.Laparoscopic surgery with the advantage of minimal invasion has been applied in the treatment of benign and low malignant tumors,but it is in great controversy whether laparoscopic surgery could be used in treatment of pancreatic cancer.This study reviews the literatures of laparoscopic surgery for pancreatic cancer and the clinical outcomes,and explores its current development and prospects.
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<p><b>OBJECTIVE</b>To evaluate the feasibility and safety of laparoscopic pancreaticoduodenectomy(LPD).</p><p><b>METHODS</b>Data of 66 patients from Sir Run Run Shaw Hospital undergoing LPD from September 2012 to September 2014 were reviewed. There were 44 male and 22 female with the mean age of (58.7±10.3) years and mean body mass index of (23.5±3.9)kg/m(2). Forty-five patients presented the symptoms and four of all had the history of abdominal surgery, including 2 cases of laparoscopic pancreatic surgery.</p><p><b>RESULTS</b>Of 66 patients underwent laparoscopic procedure, 1 patient underwent LPD combined with right hepatic resection, 1 patient underwent laparoscopic distal gastrectomy with LPD, and 1 patient underwent LPD after laparoscopic distal pancreatectomy. The mean operative time was (367±49) minutes. The mean blood loss was(193±126)ml. The rate of overall postoperative complications was 36.4%(24/66), with 4.5%(3/66) of B or C pancreatic fistula and 7.6% (5/66) of bleeding. The mean postoperative hospital stay was (18.9±12.1) days. Mean tumor size was (3.8±2.3) cm, and the mean number of lymph nodes harvested was (20.3±10.9). Forty-severn patients were diagnosed as pancreatic adenocarcinoma(n=18), cholangiocarcinoma(n=7), ampullary adenocarcinoma(n=21), and gastric cancer(n=1), respectively.</p><p><b>CONCLUSION</b>LPD is feasible and safe under the skilled hand.</p>
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Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adenocarcinoma , Cirurgia Geral , Anastomose Cirúrgica , Laparoscopia , Tempo de Internação , Duração da Cirurgia , Pancreatectomia , Fístula Pancreática , Patologia , Neoplasias Pancreáticas , Cirurgia Geral , Pancreaticoduodenectomia , Complicações Pós-OperatóriasRESUMO
Objective To investigate clinical efficacy of Easy First strategy in laparoscopic pancreaticoduodenectomy (PD) for borderline resectable pancreatic cancer.Methods The clinical data of 9 patients with borderline resectable pancreatic cancer who were admitted to the Sir Run Run Shaw Hospital of Zhejiang University (8 patients) and Zhejiang Provincial People's Hospital (1 patient) from June 2013 to March 2015 were retrospectively analyzed.Nine patients underwent laparoscopic pancreaticoduodenectomy based on the Easy First strategy (to sequentially dissect and amputate jejunum,stomach,hepatoduodenal ligament,common bile duct,main portal vein,head of pancreas,second segment and third segment of the duodenum,uncinate process and neck of pancreas).The operation time,volume of intraoperative blood loss,postoperative pathological examination,complications and duration of hospital stay were recorded.Patients were followed up once every 3 months by outpatient examination and telephone interview up to June 2015.Results Of 9 patients,4 received totally laparoscopic PD (2 received partial resection and repair of portal venous wall),1 received laparoscopic assisted resection and digestive tract reconstruction,and 4 received laparoscopic transection of jejunum,bile tract and stomach and conversion to open surgery for resection and digestive tract reconstruction (1 with severe adhesion between tumor and portal vein,3 with bleeding due to dissection of neck and unciform process of pancreas).The operation time and volume of intraoperative blood loss in all patients and in 4 patients with totally laparoscopic PD were (404 ± 49) minutes and (456 ± 348) mL,(395 ± 61) minutes and (188 ± 25) mL,respectively.Of 9 patients,5 with postoperative complications were cured without perioperative death,including 2 with Grade B pancreatic fistula,1 with biliary leakage,1 receiving reoperation due to gastric stump bleeding at postoperative day 7 and 1 with abdominal infection.The extubation time of right drainage tube and left drainage tube was (9 ± 5) days and (11 ± 4) days,respectively.The duration of hospital stay was (24 ± 10)days.All patients were diagnosed as with pancreatic cancer by pathological examinations with the tumor diameter of (3.2 ± 0.8) cm.The number of harvested lymph nodes in all patients and in 4 patients with totally laparoscopic PD were 16.8 (range,6.0-25.0) and 19.8 (range,15.0-25.0).All the patients were followed up for mean time of 12 months (range,4-24 months),including 1 death at postoperative month 3,1 with tumor survival of 20 months and others with tumor-free survival.The postoperative survival time of 4 patients was more than 18 months at the end of follow-up.Conclusion Easy First strategy in laparoscopic PD is safe,feasible and practical for borderline resectable pancreatic cancer.
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Objective To study the mechanisms of Re Bi granule on treating RA.Methods Make SD maleness rats Adjuvant-Induced Arthritis(AA)which was derived by Freund's complete adjuvant(CFA)as investigation object.Make Wang Bi granule as positive control medicine,and divide it into six groups(blank group,model group,control group,Infusion of Re Bi granule high dose group and midst dose group and low dose group).Observe Re Bi granule's influence and mechanism to synovial cell apoptosis and T cell subsets.Results Re Bi granule could distinctly heighten synovial cell apoptosis ratio of AA rats,heighten CD8+cell's number and reduce CD4+cell's number,lower CD4+/CD8+ ratio,adjust T cells for two-way.Conclusion Re Bi granule not only is an effective treatment way for rheumatoid arthritis,but also can improve the abnormal immune status.