[Effect of shenhuang ointment in promoting the rehabilitation of postoperative gastrointestinal dysfunction patients of Qi stagnation blood stasis syndrome: a clinical observation].

OBJECTIVE: To observe the effect and safety of plastering Chinese Compound Shenhuang Ointment (CSO) at Shenque (RN8) in promoting the rehabilitation of postoperative gastrointestinal dysfunction patients of qi stagnation blood stasis syndrome (QSBSS). METHODS: A prospective, multi-centered, randomized, double-blinded, controlled trial was conducted in 220 postoperative gastrointestinal dysfunction patients of QSBSS. They were randomly assigned to two groups, the CSO group (110 cases) and the placebo group (110 cases). CSO was plastered at Shenque (RN8) for 5 days after operation. The time of exhaustion, defecation, the recovery of intestinal peristalsis, integrals of TCM syndrome, and serum levels of motilin (MOT)and somatostatin (SS) were observed. RESULTS: Compared with the placebo group, the condition of exhaustion and defecation, the recovery of intestinal peristalsis on the 3rd day after operation was all improved (P < 0.05). The integrals of TCM syndrome at day 2, 3, and 4 were more significantly lowered in the CSO group than in the placebo group (P < 0.01, P < 0.05). The total effective rate of TCM syndrome was 95.3% in the CSO group, better than that in the placebo group (91.8%, P < 0.05). Compared with the placebo group, the serum MOT level increased and the serum SS level decreased at day 5 after operation in the CSO group (P < 0.05). CONCLUSIONS: The plastering of CSO at Shenque (RN8) could advance the time of exhaustion and defecation, and improve patients' clinical symptoms. And patients could tolerate well.

[Short-term efficacy comparison of laparoscopic-assisted versus open distal gastrectomy].

OBJECTIVE: To compare the short-term efficacy of laparoscopic-assisted verus open distal gastrectomy for gastric cancer. METHODS: The data of 29 patients with distal gastric cancer from January 2008 to October 2010 were analyzed. RESULTS: Twenty-eight underwent laparoscopic-assisted distal gastrectomy while 1 was switched to open surgery. The operative duration was (253.1 ± 32.6) min and the blood loss volume (268.5 ± 101.4) ml. The postoperative recovery time of gastrointestinal peristalsis was (2.1 ± 0.6) d. The length of incision was (5.6 ± 1.6) cm, the hospital stay duration (10.6 ± 2.4) d and the number of dissected lymph nodes (34.5 ± 5.2). CONCLUSION: Laparoscopic-assisted distal gastrectomy for gastric cancer is both safe and feasible. And it offers many advantages of minimal invasion, less pain and shorter hospital stay.

Laparoscopic resection of Bismuth type I and II hilar cholangiocarcinoma: an audit of 14 cases from two institutions.

OBJECTIVE: To evaluate the feasibility and safety of laparoscopic resection of Bismuth type I and II hilar cholangiocarcinoma. BACKGROUND: Laparoscopic resection of hilar cholangiocarcinoma is uncommon. METHOD: Fourteen cases of Bismuth type I and II hilar cholangiocarcinoma were selected for laparoscopic resection. Eight cases involved local resection and 6 cases included partial hepatectomy. RESULTS: The mean operating time and blood loss were 305 min and 386 ml, respectively. The R0 resection rate was 100 and 60% in patients with type I and II lesions, respectively. The mean postoperative hospital stay was 9 days and 19 days in patients with type I and II tumor, respectively. In-hospital mortality and morbidity were 0 and 35.7% (5 of 14 patients), respectively. Bile leakage occurred in 1 of 7 (14.3%) and 3 of 5 (60%) patients with type I and II tumors, respectively. Port-site metastases were found in 2 cases of type II tumor. The survival rate during a 20-month follow-up period was 85.7% (12 of 14 patients). CONCLUSION: Laparoscopic resection is a potential alternative to open surgery for appropriately selected patients with Bismuth type I hilar cholangiocarcinoma. Due to the lower R0 resection and more complications, the value of laparoscopic resection for patients with type II tumors needs further evaluation.

Management of type I choledochal cyst in adult: totally laparoscopic resection and Roux-en-Y hepaticoenterostomy.

BACKGROUND/OBJECTIVE: Choledochal cysts are congenital dilations of the biliary tree. The accepted mode of treatment is total excision with hepaticojejunostomy. In this retrospective study, we present our technique and results of laparoscopic choledochal cyst excisions. METHODS: We retrospectively studied 45 patients who had undergone laparoscopic choledochal cyst excision in our institutes from September 2006 to August 2009. Data including age, gender, type of cyst, symptoms, surgical technique, conversion rate, morbidity, and mortality were analyzed. RESULTS: There were type Ic (cystic) choledochal cysts in 31 patients (68.9%) and type If (fusiform) in 14 patients (31.1%). An anomalous pancreaticobiliary duct junction union was found in 66.7%. Forty percent (18 out of 45) and 37.8% (17 out of 45) cases had stones within the cysts and gallbladders, respectively. The average size of the cysts was 40.3 +/- 16.9 cm(2). The mean operative time was 307.7 +/- 58.0 min, the estimated operative blood loss was 252.3 +/- 162.5 ml, and the conversion rate was 8.9%. The mean hospital stay was 8.3 +/- 3.2 days. The overall morbidity rate was 17.1%, the reoperation rate was zero, and the mortality rate was also zero. CONCLUSIONS: Totally, laparoscopic management of type I choledochal cysts, although technically challenging, is safe and feasible in experienced hands.