Tissue wasting and perioperative treatment strategies of pancreatic cancer patients / 中华消化外科杂志

Pancreatic cancer is a highly malignancy of the digestive system, with low early diagnosis rate and poor prognosis. Cancer cachexia, muscle and adipose tissue wasting are important factors affecting surgical complications and long-term prognosis of patients with pancreatic cancer. On one hand, the occurrence and development of pancreatic cancer cachexia are associated with the decrease of food intake. On the other hand, the characteristic of tumor hypermetabolism, many inflammatory factors, fat and protein regulatory factors and many neuroendocrine pathways are also involved in pancreatic cancer cachexia. At present, the understanding of cancer cachexia and tissue wasting is not comprehensive, and the diagnostic methods are not unified. The main screening method is based on body mass index, but it is not applicable to obese patients. The detection of serum cytokines and determination of intramuscular fat content based on the abdominal computed tomography scan also play pivotal roles in the diagnosis of pancreatic cancer cachexia. Perioperative inhibition of tissue wasting can not only reduce surgical complications, but also improve the prognosis of pancreatic cancer patients. However, there is no effective method to completely reverse cancer cachexia. Multidisciplinary treatment is the routine therapy. Surgical treatment to remove the tumor is the fundamental measure to impede the development of cachexia. In addition, strengthening nutritional support, reducing inflammation and stress reaction, reducing the muscle wasting are also important in the treatment of cachexia during the perioperative period. Combined with self experience, the authors comprehensively analyze research advances, summarize the etiology, molecular mechanism, diagnosis and treatment of tissue wasting, in order to investigate tissue wasting and perioperative treatment strategies of pancreatic cancer patients.

miR-320 mediates diabetes amelioration after duodenal-jejunal bypass via targeting adipoR1.

BACKGROUND: Duodenal-jejunal bypass (DJB) surgery can improve type 2 diabetes (T2D) dramatically. Accumulating evidence implicates deficiency of hepatic adiponectin signaling as a contributor to gluconeogenesis disorders, and some microRNAs (miRNAs) regulate adiponectin receptors (AdipoR1, AdipoR2). We investigated the effects of DJB on hepatic gluconeogenesis, lipid metabolism, and inflammation as well as the effects of miRNA-320 (AdipoR1-targeting miRNA) on DJB-induced T2D amelioration. OBJECTIVES: To investigate the essential role of miRNAs in regulation of adiponectin signaling by targeting AdipoR1 in DJB and the underlying mechanisms. SETTING: University Hospital, China. METHODS: We studied hepatic adiponectin signaling changes and hepatic miRNAs involved in a rat model of DJB. We investigated the effects of miR-320 on AdipoR1 signaling in buffalo rat liver cell lines. Liver tissues and glucose tolerance tests were analyzed in DJB rats injected with lentivirus encoding a miR-320 mimic. RESULTS: Transfection with a miR-320 mimic reduced AdipoR1 protein levels and inhibited downstream adiponectin signaling; transfection with a miR-320 inhibitor elicited the opposite effects. A luciferase assay confirmed that miR-320 binds to the 3'-untranslated regions of AdipoR1. Global upregulation of miR-320 expression in DJB rats showed impaired gluconeogenesis, lipid metabolism, and relatively higher expression of inflammation markers. CONCLUSION: miR-320 regulates the adipoR1-mediated amelioration of T2D in DJB and should be explored as a potential target for T2D treatment.

Liver Exposure Using Sterile Glove Pouch During Laparoscopic Right Liver Surgery in Hepatocellular Carcinoma Patients.

BACKGROUND: Although laparoscopy is widely accepted for liver resection, lesions in the posterior and superior segments and deep region in the right lobe are difficult for visualization during laparoscopic liver resection (LLR). In this study, we aim examine the effects of using sterile gloves (SG) pouch padding during LLR. METHODS: Forty-two hepatocellular carcinoma (HCC) patients were included in our study. We performed LLR using SG (n = 24, SG group) and without SG during LLR (n = 18, NSG). We also compared the time of various procedures, blood loss, and liver function between the two groups. RESULTS: We did not observe any major complications or death in all patients. The time of liver parenchyma transection and portal triad clamping in SG group is significantly shorter than those in NSG group (30.29 ± 5.55 vs. 39.00 ± 3.68 min p < .001 for liver parenchyma transection, 23.00 ± 5.60 vs. 31.60 ± 5.03 min p < .001 for portal triad clamping). Blood loss in SG group (162.91 ± 90.91 ml) was significantly lower than in NSG group (236.66 ± 101.67 ml p = .024). The levels of alanine aminotransferase (ALT) and aspartate aminotransferase (AST) were increased one day after LLR, and decreased to normal level on day 7 after LLR in both groups. CONCLUSIONS: Our data suggests that a sterile glove pouch could enhance exposure in surgical field, which results in decrease in blood loss and procedure time. More studies with large sample size, large tumor size, and longer follow-up are needed.

Surgical strategies and techniques of laparoscopic surgery in hepatobiliary, splenic and pancreatic diseases / 中华消化外科杂志

Laparoscopic surgery in hepatobiliary,splenic and pancreatic diseases is being widely used.However,the incidence of postoperative complications is relatively higher due to the complexity of the operative procedures.Surgeons are expected to have familiarity with normal and variant anatomy,as well as a good command of prevention and management of bleeding.Different separation techniques should be used based on the different characteristics of tissues.Moreover,digestive tract reconstruction is the technical bottleneck in laparoscopic hepatobiliary,splenic and pancreatic surgeries,and depending on the team work.Different anastomotic methods should be applied according to patients' condition.Three-dimensional laparoscopy and Da Vinci robot surgical system have greatly promoted the development of complex laparoscopic surgery in hepatobiliary,splenic and pancreatic surgeries.Comprehensive perioperative management and enhanced recovery after surgery are the guarantee of safe and quick postoperative recovery,which also fully embody the advantages of minimally invasive surgery.

The effects of sleeve gastrectomy on renal function in type 2 diabetic rats / 中华外科杂志

<p><b>OBJECTIVE</b>To examine the renal function changes and mechanisms on rats with diabetes through a sleeve gastrectomy operation.</p><p><b>METHODS</b>Thirty-six rats were induced diabetes through injection of streptozotocin (STZ), and 30 of these diabetic rats that blood glucose levels at the midrange (blood sugar 17.88-23.65 mmol/L, mean: 20.32 mmol/L) were randomly assigned to the sleeve gastrectomy group, Sham-operation group and control group. The serum creatinine, lipid parameters were measured postoperatively. The 24 h urine volume obtained and urine albumin excretion rate (UAER) was calculated. Serum and urinary creatinine were examined and glomerular filtration rate (GFR) was counted. Kidney sections were stained with periodic acid-Schiff, and then the index of mesangial expansion was determined. The expression of synaptopodin for podocytes was also performed through the immunohistochemical procedure. A one-way ANOVA and t-test were performed to evaluate differences between groups and each other.</p><p><b>RESULTS</b>Only one rat of SG group died after operation. The GFR ((8.44 ± 2.10) ml · g⁻¹ · d⁻¹), 24 h UAER ((36.04 ± 11.10) mg/d), plasma lipids level (total cholesterol (1.66 ± 0.23) mmol/L, triglycerides (1.25 ± 0.17) mmol/L), kidney weight ((1.61 ± 0.06) g), the index of mesangial expansion ((6.14 ± 1.50)%) and synaptopodin expression ((20.44 ± 2.99)%) were improved in the SG group compared with the sham-operation group ((15.05 ± 3.01) ml · g⁻¹ · d⁻¹, (57.01 ± 11.34) mg/d, (2.15 ± 0.29) mmol/L, (1.65 ± 0.23) mmol/L, (1.93 ± 0.07) g, (11.32 ± 2.09)%, (10.34 ± 1.43)%) and control group ((14.79 ± 2.38) ml · g⁻¹ · d⁻¹, (62.71 ± 16.46) mg/d, (2.23 ± 0.21) mmol/L, (1.59 ± 0.20) mmol/L, (1.91 ± 0.06) g, (10.82 ± 1.79)%, (11.13 ± 2.43)%) (t = 0.781-5.025, all P < 0.05).</p><p><b>CONCLUSION</b>The sleeve gastrectomy procedure can improve the renal function in a diabetes rat model may be through protecting the podocytes function and preventing the mesangial expansion of glomeruli.</p>

Renal function is ameliorated in a diabetic nephropathy rat model through a duodenal-jejunal bypass.

AIMS: Diabetes surgery is growing in popularity and has been shown to have marked effects on diabetes. However, several studies have shown it may induce some renal injury, and, currently, the impact of diabetes surgery on renal function is unclear. In this study, we examined renal function and histological changes in rats with diabetic nephropathy (DN) following a duodeno-jejunal bypass (DJB) operation. METHODS: Rats with streptozotocin (STZ)-induced diabetes were randomly assigned to 3 groups: DJB group (DJB), Sham-DJB group (S-DJB) and diabetes group (DM). Six age-matched normal rats were assigned as the control group. DJB and sham surgery were performed. Body weight, food intake, glucose levels, lipid parameters, cystatin C (Cys_C) levels, serum and urinary creatinine, 24h urine albumin excretion rate (UAER) and glomerular filtration rate (GFR) were measured. Histological analysis and immunohistochemical studies of renal sections were also performed. RESULTS: DJB ameliorated renal function by improving UAER, GFR and Cys_C levels 4 and 8 weeks after surgery. It also improved lipid metabolism by decreasing fasting total serum cholesterol (TC) and triglyceride (TG) levels. Immuno-staining of synaptopodin showed podocyte injury was also improved in DJB glomeruli compared with sham and DM groups. Histological analysis showed that the mesangial expansion was not significantly prevented 8 weeks after DJB surgery. CONCLUSION: DJB ameliorated renal function in UAER and GFR but not mesangial expansion in a DN rat model. The improvement of renal function may be attributed to reversing the injury or loss of podocytes after DJB surgery.

Duodenal-jejunal bypass surgery on type 2 diabetic rats reduces the expression of matrix metalloproteinase-9 and tissue inhibitor of matrix metalloproteinase-1 in the thoracic aorta / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Bariatric surgery offers a productive resolution of type 2 diabetes mellitus (T2DM). The development of T2DM vasculopathy is due to chronic inflammation, which increases matrix metalloproteinase-9 (MMP-9) and tissue inhibitor of matrix metalloproteinase-1 (TIMP-1) expression. This study sought to examine MMP-9 and TIMP-1 expression in the thoracic aorta after duodenal-jejunal bypass (DJB) surgery on a T2DM rat model induced by a high-fat diet and low dose streptozotocin (STZ).</p><p><b>METHODS</b>Twenty-one T2DM Wistar rats induced by high-fat diet and low dose STZ were randomly divided into DJB and sham duodenal-jejunal bypass (S-DJB) groups. Ten Wistar rats were fed a normal diet as a control. Recovery of gastrointestinal function post-operation and resumption of a normal diet completed the experiment. Body weight, blood glucose, blood lipid levels, and MMP-9 and TIMP-1 expression levels in aortic endothelial cells were measured throughout.</p><p><b>RESULTS</b>DJB rats showed significant weight loss 2 weeks post-operation compared with S-DJB rats. After surgery, DJB rats showed significant improvement and steady glycemic control with improved insulin sensitivity and glucose tolerance. They also exhibited improved lipid metabolism with a decrease in fasting free fatty acids (FFAs) and triglycerides (all P < 0.05). Immunohistochemistry showed decreased MMP-9 and TIMP-1 expression 12 weeks after surgery (P < 0.01).</p><p><b>CONCLUSIONS</b>DJB surgery on an induced T2DM rat model improves blood glucose levels and lipids, following a high-fat diet and low dose STZ treatment. In addition, DJB decreased MMP-9 and TIMP-1 expression in vascular endothelial cells, which may play an important role in delaying the development of T2DM vascular disease.</p>

Role and mechanism of duodenal-jejunal bypass in the management of type 2 diabetes mellitus / 中华胃肠外科杂志

Type 2 diabetes mellitus (T2DM) is one of the most common chronic diseases and public health problems. Roux-en-Y gastric bypass (RYGB) can rapidly, effectively and sustainably improve glycemic control in morbidly obese patients with T2DM. However, the mechanisms of glycemic control after RYGB are still unclear now. Duodenal-jejunal bypass (DJB) is an improved RYGB sparing intact stomach, which is mainly used to investigate the mechanisms of RYGB to treat T2DM. DJB has also been used to treat non-obese T2DM patients. In the present article, we review the results and mechanisms of DJB to treat T2DM on the basis of the previous studies to further elucidate the mechanisms of RYGB in the management of T2DM.

Application of hepatic segment vascular occlusion technology in precise fiver segmentectomy for hepatocellular carcinoma / 中华普通外科杂志

Objective To evaluate hepatic segment vascular occlusion technology in precise resection of liver segment.Methods Sixty-seven cases of liver cancer patients who underwent precision liver segment resection from August 2007 to May 2012 in Qilu Hospital were analyszed retrospectively.There were 51 male patients and 16 female patients,age ranging from 45 to 66 yrs.Results All operations were performed successfully.All cases were with single tumor,the diameter ranged from 2 cm to 6 cm.Resection of segment Ⅲ was performed in 22 cases,segment Ⅳ in 10 cases and segment Ⅵ in 35 cases.Operation time was 50-120 minutes,and the average time was 73 minutes.Blood loss was 50-200 ml,averaging 86 ml.No patient needed blood transfusion.Postoperative incisional liquefaction was found in 6 cases which were cured with interference in time.There was no bile leakage,hemorrhage,celiac infection and complications such as liver failure.The average hospital stay was 7.8 days.No rccurrence was found during 3 months follow-up.Conclusions Hepatic segment vascular occlusion technology was safe and feasible in precise resection of liver segment in liver cancer patients.It effectively controlled blood loss and reduced liver damage.

Prognosis and management of recurrent primary clear cell carcinoma of liver / 中华肝胆外科杂志

Objective To evaluate the prognosis and management of recurrent primary clear cell carcinoma of liver (PCCCL).Methods 214 patients with PCCCL treated by curative resection from January 1996 to March 2006 were retrospectively studied.Tumour recurrences were classified into early (≤1 year) and late (＞1 year) recurrences.Results Of 99 patients who developed recurrences,28 developed early recurrence while 71 developed late recurrence.The patients with recurrences were treated with re-resection (n=33),percutaneous ethanol injection (PEI,n=7),radiofrequency ablation (RFA,n=10),transcatheter arterial chemoembolization (TACE,n =27),systemic chemotherapy (n=1),Chinese medicine (n=1),and conservative management (n=20).The re-resection rate was higher in the late than in the early recurrence group (P=0.04).In this study,reresection,PEI,and RFA were considered as curative therapies.There was no significant difference in the overall survival (OS) for patients who received these different curative therapeutic procedures (P=0.68).The 1,3-,and 5-year OS of patients with recurrences who were treated with curative treatment were comparable to those patients who did not develop recurrences (100％,86.0％,63.5％ vs 85.2％,72.2％,64.3％,P=0.71).The 1-,3-,and 5-year OS of patients who received TACE for recurrences were 100％,66.7％,and 44.4％ respectively.The results were poorer than patients who received curative treatment for recurrences (P=0.03),but were better than those who received conservative management after recurrences (80.0 ％,25.0 ％,and 10.0 ％,P＜ 0.01).Conclusions Reresection,PEI and RFA are optimal curative methods for recurrent PCCCL.TACE plays an important role in the management of patients with recurrent PCCCL who cannot be treated with curative methods.

The mechanism of pseudomonasaeruginosa mannose sensitive hamemagglutination vaccine in inducing apoptosis of hepatocellular carcinoma / 中华肝胆外科杂志

Objective To investigate the mechanism of pseudomonasaeruginosa mannose sensitive hamemagglutination vaccine (PA-MSHA) in inducing apoptosis in hepatocellular carcinoma (HCC).MethodsA metastatic model of human hepatocellular carcinoma (HCC) was established by orthotopic implantation of histologically intact human HCC tissue into the liver of nude mice.Mice bearing xenografts in liver were randomly divided into three groups:control group,PA-MSHA intraperitoneal administration group,and PA-MSHA subcutaneous administration group.The agent was administered every day after the third day post-tumor implantation.At the end of the sixth week,the mice were killed.Serum levels of TNF-α,IL-4,IL-6 and IFN-γ were measured by ELISA and the activities of caspase 3,caspase 8 and caspase 9 in the tumor samples were tested by spectrophotometric method.Fas/FasL expressions were evaluated by Western blotting.ResultsSerum TNF-α levels in the control group,PA-MSHA subcutaneous administration group and PA-MSHA intraperitoneal administration group were 25.24±3.22 pg/ml,25.50±4.55 pg/ml(P＞0.05) and 34.22±2.42 pg/ml (P＜0.01),respectively,while there were no significant differences in serum IL-4,IL-6 and IFN-γ among these three groups(P＞0.01).Compared with the control group,the activities of caspase 3,caspase 8 and caspase 9 in tumors in the intraperitoneal administration group increased by 4.1,2.3 and 1.9 fold(P＜0.01),respectively,and Fas/FasL expressions were significantly elevated in the intraperitoneal administration group and subcutaneous administration group.ConclusionWhen given intraperitoneally,PA-MSHA can induce apoptosis in HCC by promoting the secretion of TNF-α and expression of Fas/FasL,thereby inhibiting HCC growth and metastasis.

Detection and clinical significance of microvascular density labeled by CD105 in hepatocellular carcinoma and adjacent non-tumorous tissues / 中华肝胆外科杂志

Objective To evaluate the specificity of CD105 labeled microvessel density (MVD)and its clinical significance.Methods Formalin fixed,paraffin wax embedded specimens from 63 patients with hepatocellular carcinoma (HCC) were stained with anti-CD105 monoclonal antibody.A correlation was analyzed between the expression and distribution of MVD-CD105 in HCC/adjacent non-tumorous tissues and clinicopathological features.Results CD105 immunoreactivity was seen in all the specimens of HCC and adjacent non-tumorous tissues.Immunoreactivity intensity was higher in adjacent non-tumorous tissues than in HCC (χ2=9.184,P＜0.01).The mean scores of M VD-CD105 were also higher in adjacent non-tumorous tissues than in HCC.The levels of expression and distribution of MVD-CD105 in HCC were associated with tumor metastasis and TNM staging (P＜0.01).The levels of expression and distribution of MVD-CD105 in adjacent non-tumorous tissues were associated with TNM staging and 2-year survival rate (P＜0.01).Conclusions CD105 showed no specificity in labeling MVD of HCC specimens.The higher level of expression and distribution of MVD-CD105 in HCC was associated with local tumor metastasis and progression.CD105 cannot be used as a target for anti-angiogenesis therapy for HCC.

Fast track surgery in laparoscopy-assisted radical distal gastrectomy / 中华普通外科杂志

ObjectiveTo evaluate the safety and effectiveness of fast track surgery (FTS) in l aparoscopy-assisted radical distal gastrectomy (LADG) for gastric cancer.MethodsSixty-one patientswith distal gastric cancer were randomly divided into three groups:FTS + LADG group (n =19) undergoing LADG and FTS treatments,LADG group (n =22) undergoing LADG and traditional perioperative cares,and FTS + ODG ( open distal gastrectomy) group ( n =21 ) undergoing ODG and FTS treatments.FTS treatments included avoidance of mechanical bowel cleansing,restrictive perioperative intravenous infusion,early ambulation,early enteral nutrition.The age,sex,body weight,anastomotic mode,number of lymph node dissected,and tumor stage,serum albumin (ALB),blood urea nitrogen (BUN),C-reaction protein (CRP),flatus time,postoperative hospital stay,medical cost,and postoperative complications were compared between three groups. ResultsThe level of ALB in FTS + LADG group were higher than in LADG group at the 4th and 7th day after surgery ( P ＜ 0.05,P ＜ 0.01 ).Compared to LADG group,the variation of ALB from preoperation to 4th day after surgery in FTS + LADG group and FTS + ODG group was significant( P ＜ 0.01,P ＜ 0.05 ).CRP level between FTS + LADG group and FTS + ODG group were different significantly at 4th and 7th day after surgery ( P ＜ 0.05,P ＜ 0.05).FTS + LADG group has earlier recovery of gastrointestinal peristalsis than other two groups ( P ＜ 0.05,P ＜ 0.05 ).The medical cost in FTS + LADG group was less than in LADG group ( P =0.003 ),but higher than in FTS + ODG group (P ＜0.01 ).ConclusionsThe practice of FTS in LADG was safe,effective,improves nutritional status,eases stress reaction,accelerates gastrointestinal peristalsis and postoperative rehabilitation.

Hemihepatic vascular occlusion with extrahepatic control of major hepatic veins for hepatectomy in cirrhotic carcinoma / 中华普通外科杂志

Objective To evaluate the significance of hemihepatic vascular occlusion with extrahepatic control of major hepatic veins for hepatectomy in cirrhotic carcinoma. Methods A retrospective comparative study for hepatectomy in patients with hepatocellular carcinoma(HCC) using Pringle maneuver (groupA,n=44),hemihepatic vascular occlusion(group B,n=76) and hemihepatic vascular occlusion plus extrahepatic control of major hepatic veins(group C,n=85)were made from March 2006 to September 2008.The amount of intraoperative bleeding,time of operation,postoperative liver function,liver function recovering and complications were compared.Results There was significant difference in the amount of intraoperative blood loss between the three groups(543.7 ml、415.8 ml、324.5 ml,respectively,F=98.96,P<0.001).There was no difference in the time of operation.The level of serum alanine transaminase(ALT) and that of serum bilirubin on the 3rd and 6th day postoperatively in group B,and C was significantly lower than that in group A.Conclusions Hemihepatic vascular occlusion with control of major hepatic veins results in selective liver isolation from the systemic circulation,which is more effective than Pringle maneuver for controlling intraoperative bleeding without interruption of hemodynamic stability in liver cancer patients.

Laparoscopic abdominal wall components separation in a porcine model of intra-abdominai hypertension / 中华普通外科杂志

Objective To determine the effect of laparoscopic abdominal wall components separation procedure on a porcine model of intra-abdominal hypertension (IAH). Methods IAH to 25 nun Hg was created by insufllating carbon dioxide into abdominal cavity of eight anesthetized pigs. Bilateral subcutaneous tunnels above the plane of the abdominal musculature were developed. Dissection of the external oblique insertion and development of the plane between external and internal oblique muscles was performed using ultrasonic scalpel monitored by laparoscopy. Changes in intra-abdominal pressure (IAP), waistline (WL), mean arterial pressure (MAP), heart rate (HR), central venous pressure (CVP) were recorded. Results Following intra-abdominal hypertension, WL, MAP, HR and CVP changed significantly. After laparoscopic abdominal wall components separation, there was a significant decrease in IAP from 25 mm Hg to ( 16. 0 ± 1.5 ) mm Hg ( P < 0. 01 ). Also, this procedure increased WL by (5.6 ± 2. 0) cm [ from (65.3 ± 2. 5 ) cm to (88 ± 14) cm; P < 0. 01 ]. Due to abdominal depression, the MAP was significantly increased from to (88 ± 14) mm Hg to ( 100 ± 12) mm Hg ( P <0. 01 ). Moreover, there were significant improvements in circulation status including HR from (115 ± 9) beat per minute (bpm) to (97 ± 7) bpm (P<0.01), CVP from (10.8±2.2) cm H2O to (7.3 ± 1.8) cm H2O (P<0.01), etc. Conclusions IAH results in changes of hemedynnmies. Laparoscopic abdominal wall components separation significantly decreases IAH improving porcine hemodynamics.

Detections of tenascin and microvascular density in hepatocellular carcinoma and their clinical significance / 中国现代普通外科进展

Objective:To study the expression of tenascin in hepatocellular carcinoma(HCC)and to investigate the roles of tenascin expression in microvessel angiogenesis,invasion,metastasis and prognosis of HCC.Methods:Formalin fixed,paraffin wax embedded specimens from 63 HCC patients were stained with an anti-tenascin monoclonal antibody,and the measurements were also done for paracancerous specimens from the same patients and specimens from 15 patients with liver cirrhosis and 10 normal liver.The correlation was analyzed between expression of tenascin and clinicopathological features as well as microvessel angiogenesis.Results:Tenascin immunoreactivity was observed in 65.1% samples of HCC,69.8% of paracarcinoma,20.0% of liver cirrhosis and negative of normal liver samples.Positivity and intensity of tenascin expressions in samples of HCC and paracarcinoma were higher than those in samples of cirrhotic and normal liver.Tenascin expression was correlated with Edmondson-Steiner grades,tumour numbers,capsule invasion,tumour metastasis and microvessel angiogenesis.Conclusion:The up-regulation of tenascin expression may play an important role in invasion and metastasis of HCC.

Clinical Application of Laparoscopy in Treatment of Pancreatic Diseases (Report of 12 Cases) / 中国普外基础与临床杂志

Objective To explore the clinical value of laparoscopy in the treatment of pancreatic diseases.Methods Twelve patients with pancreatic diseases received laparoscopic surgery.Among which 9 patients with cystic diseases,4 cases underwent laparoscopic spleen-preserving distal pancreatectomy,2 cases received distal pancreatectomy and splenectomy,and 3 cases underwent pancreatic cystectomy.Laparoscopic insulinoma enucleation was performed for 2 patients who suffered from insulinoma.Besides,a patient suffered from pancreatic carcinoma recurrence received left thoracoscopic splanchnicectomy.Results All the operations were accomplished successfully,including 8 total laparoscopic surgery and 4 laparoscopic assisted surgery.The average operative time was 225 min(range 100-420 min),and the average volume of blood loss was 80 ml(range 2-150 ml).Pancreatic fistula was observed in 1 patient which was cured by conservative therapy.The postoperative average hospital stay was 7.2 d(range 5-13 d).The patient with recurrent pancreatic carcinoma survived for 6 months after operation and the pain-killing effect was satisfactory.With a follow-up of 10-36 months for other patients,the surgical effects were ideal and no recurrence occurred.Conclusion With the advantages of less trauma,less pain,fast recovery,and low morbidity rate,laparoscopic surgery is an effective and safe method for the treatment of pancreatic diseases,and thus may be widely used in the clinical settings in the future.

An experimental study on the effect of lost gallstones in peritoneal cavity / 中国普通外科杂志

Objective To study the outcome of lost gallstones in peritoneal cavity. Methods Gallstones and bile collected from 51 patients undergoing laparoscopic cholecystectomy were analysed and cultured.One to three gallstones from each patient were placed into the peritoneal cavity of a corresponding Wistar rat on sterile condition. Results 8 rats died of peritoneal infection, intestinal fistula and ileus within one month. Abdominal wall abscess occured to one rat. All survival rats were sacrificed three months later. Pathologic results showed that the nidus of abscess appeared in tissue around the stone. Conclusions Lost gallstone is harmful to body. We should avoid gallstone lost in peritoneal cavity.

Laparoscopy plus small incision splenectomy in the treatment of haematologic diseases / 中国普通外科杂志

Objective To evaluate the feasibility and effect of the treatment of hematopathy by laparoscopy plus small incision splenectomy. Methods Dissection and separation of the ligaments of the spleen with laparoscopy first. And then made a small abdominal incision to ligate and divid the pedicle of spleen to finish splenectomy. Sixteen cases of idiopathic thrombocytopenic purpura(ITP) and 4 cases of heriditary spherocytosis(HS), who were treated by medication but no effect or recurrence, were treated by this procedure. Results All the patients recovered smoothly without infection of the wound ,without fluid collection in the spleen fossa,and without great intraoperative blood loss.The operating time was 1.5～2.5h(average 2.2h), intraoperative blood loss was 30～85ml(average 65ml).Hospital stay was 4～7d( average 6d). No recurrence was found during the follow-up for 0.5 to 2.5 years in this series. Conclusions Laparoscopy plus small incision splenectomy in the treatment of some hematopathy has many advantages,such as less trauma, safety, effective and quick recovery.

Laparoscopy and small incision splenectomy in the treatment of idiopathic thrombocytopenic purpura:a report of 13 cases / 中国普通外科杂志

Objective To investigate the results of laparoscopy and small incision splenectomy in the treatment of Idiopathic Thrombocytopenic Purpura (ITP). Methods Under CO2 pneumoperitoneum, laparoscopy and small incision splenectomy was performed in 13 patients . After freeing of the spleen with laparoscopy , we performed a small incision under the left costal margin. The splenic pedicle was 1-igated under direct vision, and the spleen was excised and extracted. Analysis was made of the pre-and post-operative platelet counts, and the complication rate and recovery condition of the patients. Results No complications occurred in the 13 palients, and the effect-iveness of ITP treatment was 100%.Conclusions Laparoscopy and small incision splenectomy is a safe and effective method to treat ITP.