Objective To evaluate the feasibility of laparoscopic rectal resection (LR) in elderly and younger patients with rectal cancer. Methods From January 2008 to March 2009, 76 patients with rectal cancer undergoing elective rectal resection were included in this study. Older than 70 years named elderly group, in which LR was given to 16 cases, and open resection (OR) to 18 cases. Younger than 70 years named younger group, in which LR was performed in 23 cases, and OR in 19 cases. The results after LR and OR in rectal cancer between 2 groups of patients were compared. Results No surgery-assisted death occurred in either group. In 2 groups, ventilation time, intake food time and hospitalization after operation in LR were shorter than those of OR (P＜0.05， P＜0.01); intraoperative blood loss and the proportion of postoperative analgesia in LR were less than those of OR in 2 groups (P＜0.01); there were no significant differences between LR and OR (Pgt;0.05) in mean operation time or number of lymph node resected. In addition to the incision infection rate, the other complications rates and the postoperative life self-care rate between LR and OR were no significantly different in younger group (Pgt;0.05). In the elderly group, every complication rates of LR were lower than those of OR (P＜0.05), oppositely, the postoperative life self-care rate was higher (P＜0.01). Conclusions LR of rectal cancer can be applied to both elderly and younger patients. It is suggested that advanced age should not be the contraindication for LR, and by contrary elderly patients may be particularly indicated for lower postoperative complications rate compared to open surgeries.
目的:分析D3根治术在右半结肠癌中的意义。方法:回顾分析我院19874～20037年间的右半结肠癌175例分别采用D3和D2两种术式临床疗效。结果:采用D3术式较D2术式其预后有显著差别(Plt;001)。结论:D3根治术在右半结肠癌手术中有重要意义,应作为标准的根治方式。
Objective To study the occurrence mechanism and the clinical practice feasibility of cases of cavum tympani natural shaping after partial radical mastoidectomy. Methods A total of 18 radical mastoidectomy cases between June, 1996 and June, 2006 were analyzed, and the relationship between pathological characteristics, operation-performing features as well as dressing change after the operation and the phenomenon of tympanic membrane regeneration and healing were studied. Results In 21 out of 46 cases, tympanic membrane was regenerated and healed after the operation, among which hearing recovered completely in 2 cases, noticeably improved in 6 cases, partly improved in 11 cases and not improved at all in 2 cases. Conclusion Attention paid to the protection of remnant tympanic membrane and middle ear biography tone structure in radical mastoidectomy, together with rational use of medication after the operation, can generally contribute to the natural regeneration and healing of the cavum tympani and obvious improvement of hearing.
ObjectiveTo investigate the applicated value of carbon nanoparticle lymphatic tracer in laparoscopic assisted radical gastrectomy for advanced gastric cancer. MethodsForty-two patients with advanced gastric cancer who were admitted to the Department of General Surgery in The Affiliated Cancer Hospital of Zhengzhou University from March to September in 2014, were collected prospectively and randomly divided into two groups (carbon nanoparticle group and control group), each group enrolled in 21 cases. After improving relevant auxiliary inspection, subserosal injection of carbon nanoparticle around the tumor was performed via venous infusion needle laparoscopically at the beginning of surgery in carbon nanoparticle group, while the patients routinely underwent laparoscopic assisted radical gastrectomy in control group. Comparison of the results of harvested lymph nodes and its detection time between the two groups was performed, and the perioperative complications were also evaluated. ResultsA total of 678 lymph nodes were detected in carbon nanoparticle group and 447 lymph nodes were detected in control group. The number of harvested lymph nodes in carbon nanoparticle group (32.28±4.10) was significantly higher than that of control group (21.28±2.74), P < 0.05. The mean harvest time in carbon nanoparticle group was shorter than that of control group[(24.09± 3.58) min vs. (32.76±4.76) min, P < 0.05]. The proportion of harvested small lymph node (≤5 mm) in carbon nanoparticle group was higher than that of control group[71.68% (486/678) vs. 48.99% (219/447), P < 0.01]. The number of black-dyed harvested lymph node was 506 (74.63%) and the metastasis rate of black-dyed lymph node was 26.28% (133/506) in carbon nanoparticle group, that the metastasis rate of black-dyed lymph node group was significantly higher than those of without black-dyed lymph node group[6.40% (11/172)] and control group[19.24% (86/447)], P < 0.05. No serious side effect caused by carbon nanoparticle was observed. ConclusionsThe application of diluted carbon nanoparticle lymphatic tracer has a good effect in the dissection of lymph nodes in laparoscopic assisted radical gastrectomy for advanced gastric cancer. It improves the detection rate of lymph nodes, especially the small lymph nodes, and it is safe and feasible.
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.
ObjectiveTo explore the incidence and influencing factors of moderate-to-poor quality of recovery (QoR) in patients undergoing minimally invasive esophagectomy (MIE). MethodsA secondary analysis was conducted based on data from a randomized controlled study on the effects of different anesthesia methods on postoperative pulmonary complications after MIE. Patients who underwent elective MIE at West China Hospital of Sichuan University from May 2019 to December 2021 were included. The QoR-15 scale was used to assess the QoR 30 days postoperatively, and logistic regression analysis was performed to identify factors affecting moderate-to-poor QoR (defined as a QoR-15 score≤121). ResultsA total of 541 patients were included, including 426 males and 115 females, with an average age of (63.0±8.3) years. At 30 days postoperatively, the numbers of patients with excellent, good, moderate, and poor QoR were 101 (18.7%), 273 (50.5%), 147 (27.2%), and 20 (3.7%), respectively. Multivariate logistic regression analysis indicated that preoperative pain [OR=1.527, 95%CI (1.032, 2.258), P=0.034] and a nutrition risk screening-2002 score≥3 [OR=1.617, 95%CI (1.069, 2.447), P=0.023] were influencing factors for moderate-to-poor QoR 30 days postoperatively. ConclusionAbout 30.9% of patients undergoing MIE have a moderate-to-poor QoR 30 days postoperatively. Improving preoperative pain management and nutritional status may enhance postoperative QoR.
目的 探讨急诊条件下胆囊结石合并胃恶性肿瘤的诊断与治疗。方法 回顾性分析6例因胆囊结石行胆囊切除、术中意外发现胃恶性肿瘤患者的临床资料及治疗过程。结果 6例患者中5例发现胃癌，1例发现原发性胃恶性淋巴瘤。5例施行胃癌根治术，1例施行全胃切除术，无术后并发症，术后定期化疗，随访6～43个月，至术后随访截止日（2008年12月）均存活。结论 老年胆囊结石患者应注意合并胃恶性肿瘤的可能，胆囊切除术中仔细探查胃及周围器官极为重要，同时施行根治性切除是最佳选择。