Simultaneous laparoscopic excision for rectal carcinoma and synchronous hepatic metastasis / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Rectal carcinoma patients are often accompanied by hepatic metastasis. The aim of this study was to evaluate the therapeutic efficacy of simultaneous laparoscopic excision for rectal carcinoma with synchronous hepatic metastasis.</p><p><b>METHODS</b>A total of 41 patients with rectal carcinoma and synchronous hepatic metastasis detected by CT scan were included in this study. Among them, 23 patients underwent laparoscopic surgery and 18 patients underwent traditional open surgery to simultaneously remove the rectal tumor and hepatic metastasis lesions. All patients received postoperative adjuvant chemotherapy. All the patients were followed up from 36 to 72 months (mean 45.3 months).</p><p><b>RESULTS</b>All the operations were performed successfully and no patient was turned to open surgery in laparoscopic group. The mean blood loss, the mean postoperative hospital stay, the mean blood transfusion and the mean intestinal functional recovery time showed a significant difference between the two groups (P < 0.05). The 1-, 3- and 5-year survival rates were 82.6%, 43.5% and 8.6% in the laparoscopic group, without significant difference compared with the open group (77.8%, 38.9% and 0) (P > 0.05).</p><p><b>CONCLUSIONS</b>Simultaneous laparoscopic excision for rectal carcinoma and synchronous hepatic metastasis is safe and effective with similar survival achieved by the traditional open abdominal surgery.</p>

Laparoscopic placement of total peritoneum intraperitoneal onlay mesh in patients with inguinal hernia / 南方医科大学学报

<p><b>OBJECTIVE</b>To study the efficacy of laparoscopic placement of total peritoneum intraperitoneal onlay mesh (TPIPOM) for treatment of inguinal hernia.</p><p><b>METHODS</b>TPIPOM was placed laparoscopically in 125 cases of inguinal hernia, and the clinical outcomes of the patients were observed and compared with 64 patients receiving transabdominal preperitoneal laparoscopic mesh repair (TAPP) and 53 with total extraperitoneal laparoscopic hernioplasty (TEP).</p><p><b>RESULTS</b>The laparoscopic operations were successfully performed in all the patients. In TPIPOM, TAPP and TEP groups, the operating time was 30.8-/+10.3 min, 68.4-/+22.4 min and 69.5-/+23.4 min (P<0.05), the mean hospital stay was 3.8-/+1.3 days, 4.3-/+1.5 days and 4.5-/+1.6 days (P<0.05), the average time to ambulation was 1.2-/+0.5 days, 1.8-/+0.7 days and 2.2-/+0.8 days (P<0.05), the duration of pain was 1.0-/+0.5 days, 1.6-/+0.9 days and 1.9-/+0.8 days (P<0.05), and the cost was 5000.8-/+800.5 yuan, 8000.5-/+950.6 yuan and 8900.2-/+750.3 yuan (P<0.05), respectively. No scrotum edema occurred in these patients. The patients were followed up for 59.9-/+6.5 months and recurrence was found.</p><p><b>CONCLUSION</b>TPIPOM is safe and effective for management of inguinal hernia with such advantages as minimal invasion, simple procedures, shorter operation time, reduced relapse and quick recovery.</p>

Laparoscopy combined with endoscopic and digital subtraction angiography for treatment of severe acute pancreatitis / 南方医科大学学报

<p><b>OBJECTIVE</b>To study the effect of laparoscopy combined with endoscopic and digital subtraction angiography in the treatment of severe acute pancreatitis (SAP).</p><p><b>METHODS</b>Nine-seven SAP patients were randomly divided into group A (n=32) with conventional treatment and group B (n=35) with combined treatment with laparoscopy, endoscopic and digital subtraction angiography in addition to the conventional treatment. The clinical indices and therapeutic effects in the 2 groups were compared.</p><p><b>RESULTS</b>After treatment, the patients in group B had significantly lower APACHE score than those in group A (P<0.05), with also better hepatic, renal and lung functions (P<0.05). The serum TNF-alpha and IL-1beta levels was significantly lower, but IL-10 significantly higher in group B (P<0.05). The CT SPN was significantly lowered in group B as compared with that in group A (P<0.05). The patients in group B had significantly lower rate of organ failure (P<0.01) and higher successful rate in organ failure management (P<0.05), with also lowered inhospital mortality than those in group A (P<0.05).</p><p><b>CONCLUSION</b>Laparoscopy combined with endoscopic pancreaticobiliary duct drainage and digital subtraction angiography in addition to conventional treatment significantly improves the outcome and decreases the mortality of SAP patients.</p>

Endoscopic thyroidectomy: a comparison of the trans-axilloareolar approach and the trans-thoracoareolar approach / 中华外科杂志

<p><b>OBJECTIVE</b>To evaluate the advantages and shortcomings of endoscopic thyroid surgery by trans-axilloareolar approach and trans-thoracoareolar approach.</p><p><b>METHODS</b>Endoscopic thyroidectomy was performed in 238 cases from December 2003 to January 2006. The patients were randomly divided into two groups. One hundred and twenty-three patients received the trans-axilloareolar approach and 115 patients randomly received the trans-thoracoareolar approach procedure.</p><p><b>RESULTS</b>All the operations were succeed. The operating duration of trans-axilloareolar approach group and trans-thoracoareolar approach group were (69 +/- 29) min and (70 +/- 25) min (P > 0.05), the blood lost were (38 +/- ll) ml and (40 +/- 13) ml (P > 0.05), the average hospitalized days were (4 +/- 1.3) d and (4.5 +/- 1.2) d (P > 0.05), the rate of satisfaction with the cosmetic effects of the procedures were 97.5% and 85.2% (P <0. 05). There were no conversions to open surgery or any complications. The drainage was removed at 24 h to 36 h after the operation.</p><p><b>CONCLUSIONS</b>Endoscopic thyroidectomy through trans-axilloareolar approach and trans-thoracoareolar approach is feasible, safe and cosmetic. The cosmetic effects of the trans-axilloareolar approach is better than the trans-thoracoareolar approach. The procedure selection depends on both the patient request and the technology of the surgeons.</p>

Laparoscopy and digital subtraction angiography in the treatment of severe acute pancreatitis / 中华外科杂志

<p><b>OBJECTIVE</b>To study the effect of laparoscopy and digital subtraction angiography in the treatment of severe acute pancreatitis (SAP).</p><p><b>METHODS</b>Seventy-five SAP patients were randomly divided into tow groups: (1) Conventional treatment group (group A, n = 35); (2) Conventional treatment combined with laparoscopy and digital subtraction angiography treatment group (group B, n = 40). The clinical parameters and treatment results in the 2 groups were compared.</p><p><b>RESULTS</b>After treatment, APACHE II score in group B was significantly lower than that in group A (P < 0.05). The functions of liver, renal and lung were recovered (P < 0.05, respectively), levels of serum TNF-alpha and IL-1 beta were significantly lower, but IL-10 significantly elevated (P < 0.05), the CT SPN was much lower (P < 0.05); rate of organ failure significantly decreased (P < 0.01), the successful rate of organ failure treatment was increased (P < 0.05); the in hospital mortality decreased (all P < 0.05).</p><p><b>CONCLUSIONS</b>Laparoscopy and digital subtraction angiography in combination with conventional treatment for SAP significantly improves the outcome and decrease the mortality of SAP.</p>

Laparoscopic high ligation of hernia sac and median umbilical fold covering internal ring in treating pediatric indirect inguinal hernia / 中华外科杂志

<p><b>OBJECTIVE</b>To investigate the effect and clinic practice of laparoscopic high ligation of hernia sac and median umbilicus fold covering internal ring in pediatric indirect inguinal hernia.</p><p><b>METHODS</b>Five hundred and fifty-two children with indirect inguinal hernia were randomly divided into group A (control group) and group B (combination group) according to their check-in dates (odd or even). In group A, 275 children were treated with laparoscopic high ligation of hernia sac. In group B, 277 children were treated with laparoscopic high ligation of hernia sac and suturing the median umbilical fold to internal ring.</p><p><b>RESULTS</b>The operation was successfully performed in all 552 patients. The operating time in group A and B were (12.3 +/- 5.5) min and (20.6 +/- 4.2) min (P<0.05) respectively; and the hospital stay were (2.2 +/- 1.5) d and (2.4 +/- 1.3) d (P>0.05); the day of restoring normal active were (1.2 +/- 0.5) d and (1.3 +/- 0.6) d (P>0.05); the recurrence rate were 2.2% (6/275) and 0 (0/277) (P<0.05). No complications, such as abdominal cavity infection and scrotum hematoma occurred during the follow-up of 22 months to 55 months.</p><p><b>CONCLUSIONS</b>Laparoscopic high ligation of hernia sac and median umbilical fold covering internal ring is safe and effective in treating indirect inguinal hernia of the children.</p>

Intraoperative radiofrequency ablation and 125I therapy for preventing local recurrence in hepatocellular carcinoma after hepatectorny / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To evaluate the efficacy of intraoperative radiofrequency ablation and 125I therapy for preventing local recurrence in hepatocellular carcinoma (HCC) after hepatectomy.</p><p><b>METHODS</b>Seventy-eight HCC patients with a tumor close to the first or the second hepatic portal underwent hepatectomy with a resection margin less than 1 cm from 1999 to 2001. All patients were randomly divided into control group and combined treatment group according to their check-in date (odd or even). In the control group, 38 patients were treated with hepatectomy alone, whereas in the combined group, 40 patients were treated with hepatectomy plus radiofrequency ablation and 125I implantation on surgical margin. All patients were followed up regularly.</p><p><b>RESULTS</b>the 1-, 3- and 5-year recurrent rate was 7.5%, 30.0% and 45.0% in the combined treatment group versus 18.4%, 60.5% and 86.8% in the control group, respectively, with a significant difference in the 3-year (chi2 = 7.340, P < 0.01) and 5-year recurrent rates (chi2 = 15.740, P < 0.01). The 1-, 3- and 5-year survival rate was 92.5%, 67.5% and 30.0% in the combined group versus 81.5%, 39.4% and 18.4%, respectively.</p><p><b>CONCLUSION</b>Intraoperative radiofrequency ablation and 125I therapy on the resection margin is effective to prevent local recurrence in HCC patients after hepatectomy, and to prolong their postoperative tumor free survival.</p>