Objective To assess the impact of adjuvant chemotherapy (ACH) on the survival of patients with pT3 urothelial carcinoma of the bladder (UCB) after radical cystectomy (RC). Methods We retrospectively analyzed the clinical and follow-up data of 223 UCB patients who underwent RC between January 2005 and June 2015. None of the patients received neoadjuvant chemotherapy. Of all the patients, 75 (33.6%) were diagnosed as pT3 cancer (including 32 pT3a and 43 pT3b patients). The follow-up data were up to June 2015. Kaplan-Meier method with log-rank test was used to estimate and compare overall survival (OS) and cancer-specific survival (CSS) between groups. Multivariate Cox proportional hazard models were used to identify predictors of OS and CSS. Results The short-term total effective rate of gemcitabine and cisplatin assisted chemotherapy in the treatment of pT3 UCB was 60.0%. Five-year OS rate (47.9%vs. 43.3%) and CSS rate (57.4%vs. 57.6%) were similar in the pT3a and pT3b groups (P=0.682 and 0.796, respectively). In pT3 patients, adjuvant chemotherapy was an independent predictor for OS (P=0.032). On multivariate analysis, according to the pT3 sub-stage, ACH was significantly associated with improved OS [hazard ratio (HR) =0.37; 95% confidence interval (CI) (0.15, 0.68),P=0.006] and CSS [HR=0.34, 95%CI (0.12, 0.86),P=0.022] in the pT3b group only. Conclusion Because pT3b cancer is characterized by macroscopic peri-vesical tissue invasion, patients may obtain an OS benefit from the administration of adjuvant chemotherapy.
Objective To observe effect of self-designed drug-loaded nanofilm in preventing postoperative peritoneal cavity adhesion during cholecystectomy in New Zealand white rabbit. Methods The 40 New Zealand white rabbits were randomly divided into blank control group, chitosan group, nanofilm group, and drug-loaded nanofilm group using random number table, the peritoneal cavity adhesions after cholecystectomy at different time (on day 7, 14, 21, and 28) were observed among these 4 groups. Results The adhesion of gallbladder forssa was serious in the blank control group and the adhesion situation had obviously improved among the other three groups, furthermore, the adhesion of the drug-loaded nanofilm group was the slightest. The adhesion score was significantly decreased in the chitosan group, the nanofilm group, or the drug-loaded nanofilm group as compared with the blank control group (P<0.05), which in the drug-loaded nanofilm group was significantly decreased as compared with the chitosan group (P<0.05) or the nanofilm group (P<0.05), which had no significant difference between the chitosan group and the nanofilm group (P>0.05). The nanofilm was degraded on day 14 after surgery and basically completely degraded on day 28 after surgery. The nanofilm degradation points had no significant differences between the nanofilm group and the drug-loaded nanofilm group at different time (P>0.05). Conclusions Drug-loaded nanofilm could prevent postoperative peritoneal cavity adhesion from physical barrier and drug therapy. It provides a new idea for prevention of peritoneal cavity adhesion after general surgery and research and development of new material to prevent peritoneal cavity adhesion in future.
【Abstract】Objective To investigate prophylactic measures for nontraumatic complications of laparoscopic cholecystectomy (LC).Methods The data of 13 000 patients who underwent LC in Kunming general hospital of PLA over 13 years(1991-2004) were retrospectively reviewed. Results Nine malignant tumors and 47 common bile duct stones were missed at LC. The 9 malignant tumors included hepatic cancer (n=1), gastric cancer (n=1), gallbladder cancer (n=2), pancreatic cancer (n=2) and right colon cancer (n=3). Of all the carcinomas, 3 patients with right colon cancer underwent colectomy, the other 6 patients couldn’t be cured radically. All the 47 patients with choledocholithiasis were cured successfully, among them 31 patients were performed with ERCP and 16 were reoperated on with cholangiotomy. Conclusion This study emphasizes the necessity to analyze carefully patients’ symptoms before operation and pay attention to pathological changes of gallbladder and intraabdominal situation intraoperatively. If necessary, laparoscopic ultrosonography can be used to avoid missing malignant tumors and biliary stones.
【Abstract】Objective To study the clinical application of laparoscopic operation. Methods The clinical findings from 13 840 cases of laparoscopic surgery in this hospital from 1992 to 2005 were reviewed retrospectively.Results Laparoscopic operation were performed successfully in 13 653（98.6%）,187 cases were transferred to open operation. Complications were occurred in 115 cases, including common bile duct injury in 3 cases. Combined treatment with laparoscope and endoscope were performed in 162 cases. Eleven thousand three hundred and fiftytwo patients had been succeeded in followup survey. Over 90.0 percent of patients recovered smoothly. Conclusion Laparoscopic operation may be applied in a more extensive scope. The major complications can be reduced by strict procedures of laparoscopic operation. The combined treatment of laparoscope and endoscope should be further studied and widely used.
ObjectiveTo explore the reliability and safety of diagnosis and treatment for cholecystocolonic fistula during laparoscopic cholecystectomy. MethodsData of patients with cholecystocolonic fistula in department of general surgery, Gansu provincial hospital from Jan 2002 to Dec 2015 were analyzed retrospectively. There were 112 cases diagnosed by routine intraoperative cholangiography from 11 472 laparoscopic cholecystectomy patients, including 33 males and 79 females, age from 58 to 84 years〔(67.4±12.6) years〕. ResultsOne hundred and twelve cases of cholecystocolonic fistula were diagnosed by routine intraoperative cholangiography in laparoscopic cholecystectomy. There were 105 cases of cholecystocolonic fistula performed laparoscopic cholecystectomy and colon repair, and 7 cases performed colostomy, no surgical complications occurred. Seventy cases were followed-up for 6-27 months〔(16.4±5.3)months〕after operation, no long-term complications occurred. ConclusionsThere is a lack of specific symptoms and special diagnosis for cholecystocolonic fistula before operation. Intraoperative cholangiography is a only objective method for diagnosis, and treatment of cholecystocolonic fistula by laparoscopic cholecystectomy and colon repair or colostomy is safe and reliable based on experienced laparoscopic skill.
ObjectiveTo investigate and compare the advantages and disadvantages of laparoscopic cholecystolithotomy and laparoscopic cholecystectomy for patients with gallbladder stone. MethodsThe eligible patients with gallbladder stones hospitalized in our department between January 2007 and December 2011 were included, and all of them received either laparoscopic cholecystolithotomy (observation group) or laparoscopic cholecystectomy (control group) minimally-invasive surgery. The operation time, bleeding volume, enterokinesia recovery time, hospital stay, post-operative complication and follow-up results were compared between the two groups. ResultsA total of 148 patients were included, with 68 patients in the observation group and 80 patients in the control group. In this cohort, the success rate of surgery for the observation group and the control group was 100.0% (68/68) and 98.8% (79/80), respectively; and the success rate of complete stone removal was 100% for both two groups. B-ultrasound examination after 2 weeks of treatment showed that gallbladder wall was normal and gallbladder contraction rate was more than 30% for all patients with laparoscopic cholecystolithotomy. The operation time was (49.6±5.2) minutes for the observation group and (50.5±6.2) minutes for the control group, and bleeding volume was (9.5±1.4) mL for the observation group and (50.2±8.1) mL for the control group; the difference in bleeding volume was significant between the two groups (P<0.05). The difference in enterokinesia recovery time[(33.9±2.2) and (34.4±2.6) minutes] or hospital stay[(3.4±1.0) and (3.6±1.2) days] between the observation group and the control group was not significant (both P >0.05). The post-operative complications of bleeding, bile leakage and wound infection were not observed in both two groups, and all patients were followed up for 6 to 12 months with no stone recurrence; and only 2.7% of patients (1/37) had stone recurrence after 3-year follow-up. ConclusionBoth laparoscopic cholecystolithotomy and laparoscopic cholecystectomy procedures are safe and efficient. However, laparoscopic cholecystolithotomy not only reserves gallbladder but also has superiority of less bleeding volume.
ObjectiveTo explore the feasibility and characteristics of three-port laparoscopic cholecystectomy (LC) in the treatment of cholecystitis with gallbladder calculi incarceration. MethodsThe clinical data of 160 patients with gallbladder calculi incarceration treated by three-port LC between July 2010 and December 2014 were analyzed retrospectively. Among the patients, there were 104 cases of calculi incarcerated in the gallbladder neck area, 20 cases in the cystic gall duct, and 36 cases in the gallbladder ampullar region. Elective operations were carried out for 120 patients and 40 underwent emergency operation. ResultsThree-port LC was successfully completed in 154 patients (96.25%), and the other 6 patients were converted to open surgery among whom 2 underwent elective operation (1.67%) and 4 underwent emergency operation (10.00%). Two converted patients in the elective operation group had Mirizzi syndrome and gallbladder carcinoma respectively; all the 4 converted patients in the emergency operation group had a disease course of about one week with compacted triangle structure and gallbladder edema thickening of 1.0 cm, causing difficult separation under laparoscope. Seventy patients had varying degrees of enlargement and edema of gallbladder, 60 had varying degrees of gallbladder atrophy, and 30 had almost normal gallbladder. There were 80 cases of dark green thick bile, 10 of purulent bile, 40 of white bile, and 30 of empty gallbladder and no bile. No complications were found during the follow-up of 6 to 36 months, except that one patient was found to have secondary common bile duct stones three months after discharge, and the patient was cured by endoscopic retrograde cholangiopancreatography. Conclusions Elective or emergency three-port LC is safe and feasible for gallbladder calculi incarceration as long as the operator had skilled technique and made the right decision on opportunity of conversion.
摘要:目的:探讨腹腔镜胆囊大部分切除在复杂胆囊结石手术中应用的可行性及安全性。方法:回顾性分析2003年1月至2008年10月间41例行腹腔镜胆囊部分切除术的复杂胆囊结石病人。行腹腔镜胆囊切除术指征为:胆囊管不能明确辨认时,诸如:胆囊积脓、Mirris综合征、Calot三角致密粘连呈“冰冻样”、萎缩性胆囊等。手术方法为:切除胆囊前壁,取净结石,腹腔置管引流。结果:41例复杂胆囊结石病人中1例中转开腹手术外,其余全部在腹腔镜下完成,手术时间为45～145分钟,平均(57.42±19.41)分钟,1例术后出现胆漏,其余术后住院时间为2～7天。 结论:在胆囊三角不能安全辨认前提下,对于复杂胆囊结石行腹腔镜胆囊部分切除术是一种安全的手术方式,不但能简化手术、降低手术风险,而且能避免行开腹手术治疗。Abstract: Objective: To study the possibility and safty of laparoscopic subtotal cholecystectomy in complicated cholecystectomy. Methods: Laparoscopic subtotal cholecystectomy was performed when the cystic duct cannot be identified safely, such as empyema cholecystitis, Mirris syndrome, frozen Calot’triangle, shrunken gallbladder. The operation consists of resecting the anterior wall of the gallbladder, removing all stones, and placing a large drain. 41 patients who underwent a laparoscopic subtotal cholecystectomy between 1 January 2003 and 31 October 2008 were retrospectively analyzed. Results: Fortyone cases of complex laparoscopic cholecystectomy were performed. 1 cases in which were changed to open cholecystectomy. Operating time was 45145 min, average (57.42±19.41) min. 1 cases were reoperated because of the bile leak. Hospital stays were 27 days. Conclusion: Laparoscopic subtotal cholecystectomy is a viable procedure during cholecystectomy in which Calot’s triangle cannot be safely dissected. It may simplify the operation and decrease the risk in complicated cholecystectomy and averts the need for a laparotomy.
摘要:目的:探讨腹腔镜胆囊切除术(laparoscopic cholecystectomy, LC)后发生严重并发症的原因、治疗措施和经验教训。方法:分析 2007 年 8 月至2009 年 4月期间华西医院胆道外科收治的LC术后发生严重并发症的7例患者的临床资料。结果:2例继发性胆总管结石合并化脓性胆管炎患者,采用内镜下十二指肠乳头切开(endoscopic sphincterotomy, EST)取出结石;3例胆道损伤患者,均进行肝门胆管成形和肝总管空肠吻合术;1例绞窄性肠梗阻患者,切除坏死空肠管后,行空肠对端吻合术;以上6例患者均顺利出院,随访8～20个月,均生活良好。1例患者LC术后发生肺动脉栓塞,积极抢救后因呼吸衰竭而死亡。结论:术中仔细轻柔的操作以及辩清肝总管、胆总管与胆囊管的三者关系是预防LC术后发生严重并发症的关键。合理可行的治疗措施是提高发生并发症的患者生活质量的保障。LC术时,胆道外科医生思想上要高度重视,不可盲目追求速度,必要时及时中转开腹。Abstract: Objective: To investigate the causes and therapeutic measures and the experience and lesson of sever complications after laparoscopic cholecystectomy (LC). Methods:Clinical data of 7 patients with severe complications after LC from August 2007 to April 2009 were analyzed retrospectively. The clinical data was got from biliary department of West China Hospital. Results: Two cases of secondary common bile duct stone with acute suppurative cholangitis got cured by endoscopic sphincterotomy. Three cases of severe bile duct injury after LC had stricture of the hilar bile duct, and all of the cases were performed RouxenY hepaticojejunostomy with the diameter of stoma 2.03.0 centimeters. One case of strangulating intestinal obstruction was cured through jejunum endtoend anastomosis after cutting off the necrotic jejunum. All of the above 6 patients recovered well. Following up for 820 months, all lived well. One patient got pulmonary embolism after LC and dead of respiratory failure after active rescue. Conclusion: Carefully making operation and distinguishing the relationship of hepatic bile duct and common bile duct and the duct of gallbladder are the key points to prevent sever complications during LC. Reasonable and feasible treatment is the ensurement of increasing the living quality of the patients with sever complications after LC. And the surgeons of biliary department must have a correct attitude toward LC and should concern think highly during LC and should not pursue speed blindly. In necessary, the operation of LC should be turned into open cholecystectomy.
Objective To systematically review the effectiveness and safety of single-incision laparoscopic cholecystectomy (SILC) versus conventional multiport laparoscopic cholecystectomy (CMLC). Methods We electronically searched PubMed, EMbase, The Cochrane Library (Issue 1, 2013), CBM, CNKI, VIP and WanFang Data for randomized controlled trials (RCTs) on SILC versus CMLC from inception to January 1st, 2013. According to the Cochrane methods, the reviewers screened literature, extracted data, and assessed the methodological quality. Then, meta-analysis was performed using RevMan 5.2 software. Results Finally, 17 RCTs involving 1 233 patients were included. The results of meta-analysis showed that, compared with CMLC, SILC was lower in 24 h postoperative pain score (visual analogue scale, VAS) (SMD= –0.40, 95%CI –0.76 to –0.04, P=0.03), higher in cosmetic results score (SMD=1.56, 95%CI 0.70 to 2.43, P=0.000 4), and longer in operative time (MD=13.11, 95%CI 7.06 to 19.16, Plt;0.000 1). However, no significant difference was found in 6 h postoperative pain scores (VAS), postoperative complications, port-site hernia and hospital stay between the two groups. Conclusion SILC is a safe and effective technique for the treatment of uncomplicated benign gallbladder diseases, and it has certain advantages compared with CMLC, which is recommended in clinical application.