Objective To evaluate safety, efficacy, and indications of laparoscopic bile duct reexploration in treatment of bile duct stones. Methods Fifty-seven patients with bile duct stones who underwent laparoscopic common bile duct reexploration (laparoscope group) and 62 patients with bile duct stones who underwent open common bile duct reexploration (laparotomy group) were included into this study from February 2013 to February 2017 in the Renmin Hospital of Wuhan University. The intraoperative and postoperative data of the patients were documented and analyzed. Results All the operations were performed successfully and all the patients had no extra-damage during the operation. One case was converted to the laparotomy due to the intraabdominal serious adhesion in the laparoscope group. Compared with the laparotomy group, the amount of intraoperative blood loss was less, the first time of anal exhaust was earlier, the rates of postoperative analgesia and incision infection were lower, and the length of hospital stay was shorter in the laparoscope group, there were significant differences (P<0.05). There were no significant differences in the operative time, the hospitalization expense, primary suture rate of common bile duct, and the rates of postoperative complications such as the bile leakage, bile duct stricture, and residual stone between the laparoscope group and the laparotomy group (P>0.05). Conclusion With experienced skills and strict surgical indications, laparoscopic common bile duct reexploration is safe and effective in treatment of bile duct stones, and it has some advantages including less bleeding, rapid recovery, and shorter hospitalization time.
Objectives To analyze the efficacy and safety of different operation methods for patients with cesarean scar diverticulum. Methods The clinical data of patients with cesarean section scar diverticulum treated in West China Second University Hospital from July 2012 to December 2016 was collected and followed up. The data of the previous perioperative period data, recovery, the improvement of the symptoms and postoperative condition of incision healing were analyzed by SPSS 22.0 software. Results A total of 125 patients were included, in which 74 cases received hysteroscopy surgery for diverticulum electro section and electric coagulation (ESEC group), and 51 cases received other surgery focused on diverticulum dissection and sewing operations (DS group). Statistical analysis showed that, compared with DS group, bleeding, operation time, time of anal exsufflation and hospitalization duration after the operation of hysteroscopy in ESEC group were significantly reduced (P<0.001). In addition, the results showed that hysteroscopy group had optimal results in hemorrhage volume, operation time, anal exhaust time and hospitalization time indicators. However, the results of laparotomy group was not significant. Conclusions For the treatment of CSD, surgical treatment of this pathology by operative hysteroscopy may represent the best choice in symptomatic women because of its minimal invasiveness and beneficial therapeutic results. Hysteroscopy isthmoplasty appears to be the most popular treatment.
ObjectiveTo analyze the therapeutic effects of open surgery and endovascular treatment for mesenteric venous thrombosis.MethodsThe clinical data of 22 patients with mesenteric venous thrombosis from March 2005 to January 2014 were analyzed retrospectively. One patient underwent open surgery including removal of necrotic small intestine and thrombectomy of superior mesenteric vein immediately admission to the hospital. Five cases were treated with simple anticoagulation and cured. Sixteen cases received thrombolytic therapy after primary anticoagulant therapy.ResultsOne case who underwent open surgery died of multiple organ failure at 72 h after the surgery. Five cases who received simple anticoagulant reached clinical relief finally. Sixteen patients who received thrombolytic therapy achieved recanalization totally or partially. Three cases died during follow-up (3 months to 7 years, average) of which 1 died of recurrence of acute superior mesenteric venous thrombosis, 1 died of myocardial infarction, and 1 died of stroke.ConclusionsFor patients with symptomatic mesenteric venous thrombosis, if there is no intestinal necrosis, there will be encouraging results by interventional thrombolytic therapy. And the treatment effect needs further experience accumulation in more cases.
ObjectiveTo compare the results of laparoscopic-endoscopic cooperative resection and open surgery for gasric stromal tumor. MethodsFrom January 2010 to March 2015, the clinical data of 56 cases undergoing laparoscopic resection for gasric stromal tumor and 53 cases of traditional operation selected during the same period were retrospectively compared. ResultsThere was no significant difference between two groups in patient's gender, age, body weight, size of tumor, tumor staging, method of operation, intraoperative conditions, postoperative overall complications, local recurrence, and distant metastasis. There were 1 case with the rupture of tumor and 1 case of open surgery transforming in laparoscopic group. In another group, there was the absence of the rupture of tumors. There was no mortality, stomach bleeding, stenosis or leakage occurred between two groups. In laparoscopic group, there were less operative blood loss and abdominal drainage, shorter time of postoperative anal exhaust time, fewer anodyne, a reduction of hospital stay than in convention operation group.However, laparoscopic resection required greater hospital costs and longer operative time. There were significant differences between two groups (P < 0.05). Conciusions With advantages of less blood loss and quicker recovery as compared to conventional operation. Laparoscopic-endoscopic cooperative resection for gasric stromal tumor has similar effect when it is performed by well selection of cases, skilled surgeon with experience on open resection for surgical treatment of gastric stromal tumor.
Objective To investigate the clinical effects and safety differences of open surgery and laparoscopy primary lesion resection combined with D2 lymph node dissection in the treatment of elderly patients with advanced gastric cancer. Methods One hundred and forty elderly patients with advanced gastric cancer were chosen and randomly divided into two group including open operative group (70 patients) with primary lesion resection combined with D2 lymph node dissection by open operation and laparoscopic surgery group (70 patients) with primary lesion resection combined with D2 lymph node dissection by laparoscopy; and the operative time, intraoperative bleeding amount, the levels of PaCO2 in operation, liquid diet eating time, postoperative anal exhaust time, postoperative gastric tube indwelling time, postoperative ambulation time, the level of haemoglobin (Hb) after operation, the hospitalization time, the number of lymph node dissection, the survival rate with followed-up and postoperative complication incidence of both groups were compared. Results There was no significant difference in the operative time between 2 groups (P>0.05). The intraoperative bleeding amount, the level of PaCO2 in operation, liquid diet eating time, postoperative anal exhaust time, postoperative gastric tube indwelling time, postoperative ambulation time, the level of Hb after operation and the hospitalization time of laparoscopic surgery group were significantly better than open operative group (P<0.05). The level of PaCO2 in operation of laparoscopic surgery group was significantly higher than open operative group (P<0.05). There were no significant difference in the gastric lymph node dissection number and the peripheral lymph node dissection number of gastric artery between 2 groups (P>0.05). There were no significant difference in the survival rates between the 2 groups after 3-year followed-up (P>0.05). The complication incidence after operation of laparoscopic surgery group was significantly lower than open operative group (P<0.05). The quality of life scores of patients in laparoscopic surgery group were significantly higher than those in open operative group on 7 days and in 3 months after operation, and the difference were statistically significant (P<0.05). Conclusion Compared with open operation, primary lesion resection combined with D2 lymph node dissection by laparoscopy in the treatment of elderly patients with advanced gastric cancer can efficiently possess the advantages including minimally invasive, shorter recovery time and less postoperative complications.
目的 探讨超声刀（ultrasonic harmonic scalpel，UHS）在消化道恶性肿瘤开腹手术中的应用价值。方法 回顾性分析2009年10月至2011年10月期间广西壮族自治区人民医院普通外科-小儿外科收治并由同一手术者进行消化道恶性肿瘤开腹手术的186例患者的临床资料，根据接受手术的种类（UHS开腹手术或传统电刀开腹手术）将其分为UHS组（86例）和传统电刀组（100例），比较2组患者的手术切口长度、手术时间、术中出血量、术后3d引流量、术后住院时间以及住院总费用。结果 UHS组手术切口长度、手术时间、术中出血量以及术后住院时间均短于（少于）传统电刀组（P＜0.05）；术后3d引流量和住院总费用2组间比较差异均无统计学意义（P＞0.05）。结论 将UHS应用于消化道恶性肿瘤开腹手术可获得较好的效果，能提高手术操作的效率，具有很好的应用前景。
Objective To systematically evaluate the effectiveness and cost of laparoscopic myomectomy (LM) vs. traditional abdominal myomectomy (TAM) in treating Chinese patients with hysteromyoma. Methods Such databases as The Cochrane Library (Issue 4, 2012), PubMed, EMbase, CNKI, CBM and WanFang Data were searched from their inception to September, 2012 to collect the randomized controlled trials (RCTs) about LM vs. TAM in treating Chinese patients with hysteromyoma, and the references of the included studies were also retrieved. Two reviewers independently screened the literature according to the inclusion and exclusion criteria, extracted the data and assessed the methodological quality. Then meta-analysis was conducted using RevMan 5.2 software. Results A total of 8 RCTs involving 1 000 Chinese patients were included. The results of meta-analysis showed that, LM was superior to TAM in postoperative exhaust time (WMD= ?15.21, 95%CI ?20.19 to ?10.24, Plt;0.000 01) and postoperative hospital stay (WMD= ?3.07, 95%CI ?4.25 to ?1.90, Plt;0.000 01), with significant differences. But it was inferior to TAM in operation time (WMD=28.33, 95%CI 18.07 to 38.59, Plt;0.000 01) and hospital costs (WMD=2 028.87, 95%CI 1 190.75 to 2 866.98, Plt;0.000 01), with a significant difference. There was no significant difference in intraoperative bleeding amount between the two groups (WMD= ?2.78, 95%CI ?41.56 to 36.00, P=0.89). Conclusion This study shows LM is superior to TAM in fastening postoperative recovery and shortening hospital stay, but it is longer in operation time and higher in cost. The intraoperative bleeding amount is similar in the two groups. Due to low methodological quality and small sample size of the included studies, this conclusion has to be further proved by more high-quality RCTs.
ObjectiveTo compare clinical outcomes between laparoscopic (LAP) and open surgery for non-metastatic colon cancer of T4a stage.MethodsWe retrospectively analyzed clinical data of non-metastatic colon cancer patients of T4a stage with confirmed pathological results who underwent curative resection in Peking Union Medical College Hospital between January 2011 and December 2017. These patients were allocated into LAP group (n=107, underwent laparoscopic radical operation) and open group (n=52, underwent open surgery).ResultsThere were no significant difference in operating time, number of lymph nodes harvested, number of positive lymph nodes, incidence of complications within 30 days, and Clavien-Dindo grading between the LAP group and open group (P>0.05), but intraoperative blood loss, postoperative exhaust time, and postoperative hospital stay in the LAP group were less than (shorter than) those of the open group (P<0.05).ConclusionLaparoscopic approach for non-metastatic colon cancer of T4a stage is safe and feasible, and it has advantages including less intraoperative blood loss, faster recovery, and shorter hospital stay.
Objective To assess the clinical effectiveness and safety of laparoscopy versus laparotomy for endometrial cancer. Methods The databases such as The Cochrane Library, PubMed, EMbase, Ovid, CNKI, WanFang Data, and VIP were searched to collect the randomized control trials (RCTs) about the clinical effectiveness and safety of laparoscopy and laparotomy for endometrial cancer. The retrieval time was from January 1998 to September 2012. Two reviewers independently screened the literature according to the inclusive and exclusive criteria, extracted the data, and assessed the methodological quality of included studies. Then the meta-analysis was performed by using RevMan 5.0 software. Results A total of 10 RCTs involving 6 993 patients were included. Meta-analysis showed that, compared with laparotomy, laparoscopy had lesser amount of intraoperative bleeding, lower decrease of hemoglobin before and 1-day after operation, shorter time of both waiting for postoperative gas and hospital stay, lower incidence of postoperative complications, longer operation time, and higher incidence of intraoperative complications. Additionally, there were no differences between the 2 groups in the number of pelvic and para-aortic lymph nodes removed during operation, as well as the postoperative recurrence and mortality rates in 3-5 year follow-up. Conclusion Compared with laparotomy, laparoscopy shows lesser amount of intraoperative bleeding, lower decrease of hemoglobin before and 1-day after operation, shorter time of both waiting for postoperative gas and hospital stay, lower incidence of postoperative complications. But laparotomy shows lower incidences of intraoperative complications, and shorter operation time. Both operations are similar in the number of pelvic and para-aortic lymph nodes removed during operation, as well as the postoperative recurrence and mortality rates in 3-5 year follow-up. For quantity limitation and low methodological quality of included studies, this conclusion still needs to be further proved by performing more high-quality and large scale RCTs.
Objective To systematically review the efficacy of robotic, laparoscopic-assisted, and open total mesorectal excision (TME) for the treatment of rectal cancer. Methods The PubMed, EMbase, The Cochrane Library, and ClinicalTrials.gov databases were electronically searched to identify cohort studies on robotic, laparoscopic-assisted, and open TME for rectal cancer published from January 2016 to January 2022. Two reviewers independently screened the literature, extracted data, and evaluated the risk of bias of the included studies. Subsequently, network meta-analysis was performed using RevMan 5.4 software and R software. Results A total of 24 studies involving 12 348 patients were included. The results indicated that among the three types of surgical procedures, robotic TME showed the best outcomes by shortening the length of hospital stay, reducing the incidence of postoperative anastomotic fistula and intestinal obstruction, and lowering the overall postoperative complication rate. However, differences in the number of dissected peritumoural lymph nodes were not statistically significant. Conclusion Robotic TME shows better outcomes in terms of the radicality of excision and postoperative short-term outcomes in the treatment of rectal cancer. However, clinicians should consider the patients’ actual condition for the selection of surgical methods to achieve individualised treatment for patients with rectal cancer.