ObjectiveTo compare the short-term outcomes of Da Vinci robot-assisted minimally invasive esophagectomy (RAMIE) and video-assisted thoracoscopic-laparoscopic minimally invasive esophagectomy (VAMIE) for esophageal cancer. MethodsA retrospective analysis was conducted on the data of patients with esophageal cancer admitted to Gansu Provincial People's Hospital from January 2021 to February 2025. Based on the surgical method, patients were divided into a RAMIE group and a VAMIE group. Both groups underwent standard McKeown three-incision surgery and systematic three-field lymph node dissection. Intraoperative blood loss, number of lymph nodes dissected, postoperative recovery indicators, and complication rates were compared. ResultsA total of 126 patients with esophageal cancer were included, of which 109 were male and 17 were female, with an average age of (64.6±8.8) years. The RAMIE group consisted of 36 patients and the VAMIE group 90 patients. There was no statistical difference in baseline indicators such as age, sex, and body mass index between the two groups (P>0.05). The difference in operation time between the two groups was not statistically significant [305.0 (280.0, 348.0) min vs. 300.0 (268.8, 340.0) min, P=0.457]. Compared with the VAMIE group, the RAMIE group had less intraoperative blood loss [100.0 (100.0, 120.0) mL vs. 100.0 (100.0, 200.0) mL, P=0.035], more intraoperative fluid infusion [(2244.7±610.3) mL vs. (1954.4±457.9) mL, P=0.013], a higher number of lymph nodes dissected [(27.9±10.6) nodes vs. (21.3±5.1) nodes, P<0.001], and the difference in the number of lymph node dissection groups was not statistically significant [8.0 (6.0, 8.0) groups vs. 7.0 (5.0, 8.0) groups, P=0.268]. In terms of postoperative recovery indicators, compared with the VAMIE group, the RAMIE group had shorter postoperative hospital stay [12.5 (9.0, 18.0) d vs. 17.0 (14.0, 22.0) d, P＜0.001] and shorter time with tubes [9.0 (8.0, 10.0) d vs. 10.0 (9.0, 12.0) d, P=0.007]. In terms of postoperative complications, the incidence of recurrent laryngeal nerve injury in the RAMIE group was significantly lower than that in the VAMIE group (2.8% vs. 16.7%, P=0.039), there was no statistical difference in pulmonary infection, anastomosis leakage, and incision infection between the two groups (P>0.05). The total hospitalization cost of the RAMIE group was significantly higher than that of the VAMIE group (P<0.001). ConclusionRAMIE has significant advantages over VAMIE in terms of intraoperative bleeding control, the number of lymph node dissections, postoperative recovery speed, and reducing the risk of incision infection and recurrent laryngeal nerve injury, with good safety and feasibility.
目的 探讨Prolift系统全盆底重建术在治疗盆腔脏器脱垂疾病中的应用价值及疗效。 方法 回顾性分析四川大学华西第二医院妇科2010年1月－2011年5月收治的119例盆腔脏器脱垂患者的临床资料，其中47例应用Prolift系统进行全盆底重建术（A组），51例应用曼氏手术治疗（B组），21例应用经阴道全子宫切除术+阴道前后壁修补术治疗（C组）。分析比较各组的临床近期疗效。术后随访1年。 结果 A、B、C组在手术时间、术中出血量、术后安置尿管天数、术后住院天数间差异均无统计学意义（P＞0.05）。A组1例、B组11例、C组4例复发，A组与B、C组复发率比较差异有统计学意义（P＜0.05）。 结论 Prolift系统全盆底重建术安全性高，不增加脏器损伤的几率，且明显降低了患者的术后复发率，近期疗效肯定，是治疗盆腔脏器脱垂的一种理想术式。
ObjectiveTo evaluate the clinical feasibility and safety of CT-guided percutaneous microwave ablation for peripheral solitary pulmonary nodules.MethodsThe imaging and clinical data of 33 patients with pulmonary nodule less than 3 cm in diameter treated by CT-guided microwave ablation treatment (PMAT) in our hospital from July 2018 to December 2019 were retrospectively analyzed. There were 21 males and 12 females aged 38-90 (67.6±13.4) years. Among them, 26 patients were confirmed with lung cancer by biopsy and 7 patients were clinically considered as partial malignant lesions. The average diameter of 33 nodules was 0.6-3.0 (1.8±0.6) cm. The 3- and 6-month follow-up CT was performed to evaluate the therapy method by comparing the diameter and enhancement degree of lesions with 1-month CT manifestation. Short-term treatment analysis including complete response (CR), partial response (PR), stable disease (SD) and progressive disease (PD) was calculated according to the WHO modified response evaluation criteria in solid tumor (mRECIST) for short-term efficacy evaluation. Eventually the result of response rate (RR) was calculated. Progression-free survival was obtained by Kaplan–Meier analysis.ResultsCT-guided percutaneous microwave ablation was successfully conducted in all patients. Three patients suffered slight pneumothorax. There were 18 (54.5%) patients who achieved CR, 9 (27.3%) patients PR, 4 (12.1%) patients SD and 2 (6.1%) patients PD. The short-term follow-up effective rate was 81.8%. Logistic analysis demonstrated that primary and metastatic pulmonary nodules had no difference in progression-free time (log-rank P=0.624).ConclusionPMAT is of high success rate for the treatment of solitary pulmonary nodules without severe complications, which can be used as an effective alternative treatment for nonsurgical candidates.
Objective To evaluate the impact of body mass index （BMI） on short-term outcomes after intersphi-ncteric resection （ISR） for rectal cancer and anal cancer. Methods One hundred and ninety-nine cases of rectal cancer and anal cancer who were treated in Department of Gastrointestinal Surgery of West China Hospital of Sichuan University from Jan. 2009 to Dec. 2011 were enrolled retrospectively，and these cases were divided into underweight group （n=23），normal group （n=114），and overweight group （n=62） according to BMI. Postoperative indexes in early rehabilitation and complication of 3 groups were studied and compared. Results On the recovery indexes after ISR in early stage，there were no significant differences on the duration of first flatus，first defecation，first oral intake，first ambulation，and hospital stay among 3 groups （P＞0.05）. On the tube management，there were no significant differences on the duration of pulling out nasogastric tube and urinary catheter （P＞0.05），but duration of pulling out drain was longer in normal group and over-weight group （P＜0.05）. There were no significant differences on the incidence of postoperative complications among the 3 groups （P＞0.05），including anastomotic leakage，anastomotic bleeding，perianal infection，ileus，gastric retention，urinary retention， septicemia，wound infection，and recto-vaginal fistula. Conclusions BMI has little impact on short-term outcomes after ISR. Obesity does not increase the incidence of common complications for patients after ISR and does not influence recovery indexes with proper postoperative managements.
Objective To discuss whether age has an influence on short-term effect of intersphincteric resection (ISR) for elderly (≥75 years old) patients with ultra-low rectal or canal cancer or not. Methods From February 2016 to February 2017, 196 patients with ultra-low rectal or canal cancer received ISR in the Gastrointestinal Surgery Center of West China Hospital were eligible to include in this study, then they were divided into ≥75 years old group and <75 years old group according to the patients’ age. The intraoperative index, postoperative index, and complications rate were compared between these two groups. Results There were 113 cases in the ≥75 years old group, 83 cases in the <75 years old group, the baselines such as the gender composition, body mass index, tumor histology type, differentiation degree, tumor size, and distance from the anal margin had no significant differences ( P>0.05), but the preoperative anaesthetized ASA grade, proportions of pulmonary insufficiency, hypoproteinemia, anemia, hypertension, diabetes, and cardiac insufficiency of the ≥75 years old group were significantly higher than those of the <75 years old group (P<0.05). The operative time, intraoperative bleeding, and total complications rate had no differences between these two groups (P>0.05), the first exhaust time, the first eating time, the first defecation time, the first ambulation time, and hospitalization time of the ≥75 years old group were significantly longer than those of the <75 years old group (P=0.023, 0.037, 0.019, 0.020, and 0.012, respectively). There were no significant differences in the incidences of the anastomotic leakage, perianal infection, intestinal obstruction, and wound infection between these two groups (P>0.05). All the 196 patients were followed-up with an average follow-up of 7 months, there were 4 cases of recurrent patients, of which 3 were in the ≥75 years old group and 1 in the <75 years old group; there were 3 cases of death, of which 2 were in the ≥75 years old group and 1 in the <75 years old group. Conclusions Short-term recovery of elderly patients with ultra-low rectal or canal cancer is slower than younger patients because of poor preoperative conditions. ISR surgery is still safe and effective for elderly patients with ultra-low rectal or canal cancer and postoperative complications rate has no obvious increase, but it needs a surgeon’s skilled operation technology and multi-disciplinary team cooperation.
Objective To investigate the short-term effectiveness of reconstruction plate internal fixation via improved Stoppa approach combined with iliac fossa approach and Kocher-Langenbeck approach for complex acetabular fractures. Methods Between January 2015 and January 2020, 30 patients with complex acetabular fractures were treated with reconstruction plate internal fixation via improved Stoppa approach combined with iliac fossa approach and Kocher-Langenbeck approach. There were 20 males and 10 females with an average age of 52.1 years (range, 25-71 years). The cause of injury included traffic accident in 17 cases and falling from height in 13 cases. Among them, 14 cases were left acetabular fractures and 16 cases were right acetabular fractures. According to Letournel classification, there were 16 cases of double column fractures, 2 cases of transverse fracture with posterior wall fracture, 4 cases of anterior column and posterior hemi-transverse fractures, 8 cases of T-shaped fracture. The displacement distance of fracture ranged from 6 to 30 mm (mean, 11.6 mm). The time from injury to operation was 6-14 days (mean, 8.7 days). Results The operation time was 2.0-4.5 hours (mean, 3.0 hours). The intraoperative blood loss was 200-800 mL (mean, 450.0 mL). All patients were treated with autologous blood transfusion during operation. All incisions healed by first intention after operation, and no infection occurred. All patients were followed up 12-15 months (mean, 13.4 months). The drainage tube was removed at 2-3 days after operation. After extubation, X-ray film and three-dimensional CT were performed to recheck the fracture reduction. According to Matta score system, 20 cases were excellent, 5 were good, and 5 were poor, the excellent and good rate was 83.3%. All fractures healed with the healing time of 16-25 weeks (mean, 17.7 weeks). According to Merle d’Aubigne-Postel score system, the hip function at 1 year after operation was rated as excellent in 18 cases, good in 6 cases, and fair in 6 cases, and the excellent and good rate was 80.0%. Two cases suffered from sciatic nerve injury due to traction during operation, 7 cases had heterotopic ossification, 2 cases had traumatic hip arthritis, and no other complications occurred. Conclusion For complex acetabular fractures, the reconstruction plate internal fixation via improved Stoppa approach combined with iliac fossa approach and Kocher-Langenbeck approach can obtain good short-term effectiveness with good reduction and hip joint function, and less complications.
ObjectiveTo evaluate the safety and short-term outcome of laparoscopic total mesorectal excision (TME) for the middle-lower rectal cancer in municipal hospital.MethodsThe pathological data of 94 patients with middle-lower rectal cancer (49 cases underwent laparoscopic TME, while 45 cases received open TME), who treated in The First People’s Hospital of Ziyang from Jan. 2015 to Jun. 2017, were retrospectively collected and analyzed.ResultsTwo patients (4.1%) in laparoscopy group were converted to open surgery. Compared with the laparotomy group, the laparoscopic group had significantly less volume of intraoperative bleeding, shorter abdominal incision, earlier time to the first flatus and liquid diet, and lower rate of 30-day postoperative complication (P<0.05), but had longer operative time (P=0.033). While there were no significant difference on postoperative stay, the specimen length, distal margin, and number of harvested lymph nodes between the 2 groups (P>0.05).ConclusionLaparoscopic TME is a feasible, safe, and minimally invasive technique for middle-lower rectal cancer, and produce more favourable short-term outcome than open surgery in municipal hospital.