Outcomes of laparoscopic sleeve gastrectomy with and without antrectomy in severely obese subjects. Evidence from randomized controlled trials

BackgroundLaparoscopic sleeve gastrectomy (SG) has been proven safe and effective in achieving weight loss. However, the distance from the pylorus where resection should begin has been debated.ObjectivesTo compare the clinical outcomes of laparoscopic SG with antrum resection (AR) versus preservation (AP) for bariatric purposes by conducting a meta-analysis of randomized controlled trials (RCT).SettingAcademic hospital, United States.MethodsPubMed and Cochrane Library were queried for RCTs from establishment to August 2020. The following key search terms were used: “sleeve gastrectomy” AND (“antrectomy” OR “antrum”) AND (“randomized” OR “random”). The following data were extracted: author, publication year, country, sample size, follow-up duration, and clinical outcomes, including weight-related: excess weight loss (EWL), total weight loss (TWL), body mass index (BMI), operation time, length of hospital stay, complication rates, and resolution of obesity-related comorbidities.ResultsA total of 9 unique RCTs including 492 AR and 385 AP patients were screened and included in the final quantitative analysis. Patients who underwent SG with AR showed higher EWL and TWL at 6 months (EWL: P < .001; TWL: P = .006), and 1 year (EWL: P = .013; P < .001) postoperatively. The BMI was also lower in the AR group 3 months (P = .013) and 6 months (P = .003) postoperatively. However, the EWL and BMI at 2 years were comparable between both groups (P = .222 and P = .908, respectively). No statistical significance was observed in terms of operating time, staple line disruption, bleeding, complications with a Clavien-Dindo Grade >III, resolution of comorbidities (hypertension, diabetes, hyperlipidemia, arthritis/back pain), and de novo gastroesophageal reflux disease (P > .05). AP was associated with a slightly shorter postoperative hospital stay (4.0 versus 3.1 days, P = .039).ConclusionLaparoscopic SG with AR is associated with superior weight loss in the short-term compared with AP. However, mid-term follow-up beyond 1 year showed no significant differences in BMI or incidence of de novo gastroesophageal reflux disease.     

加速康复外科联合中医药对腹腔镜全直肠系膜切除术患者手术指标和临床效果的影响

目的:分析加速康复外科(ERAS)联合中医药对腹腔镜全直肠系膜切除术患者手术指标和临床效果的影响。方法:选取2014年1月至2016年10月溧阳市中医医院收治的直肠癌患者128例作为研究对象,按不同治疗方式分组,Ⅰ组予以传统开腹全直肠系膜切除术治疗,Ⅱ组予以ERAS联合腹腔镜全直肠系膜切除术治疗,Ⅲ组予以ERAS、中医药联合腹腔镜全直肠系膜切除术治疗。比较各组手术情况,应激指标,炎性反应,免疫功能,并发症和预后情况比较。结果:Ⅱ组及Ⅲ组手术时间均多于Ⅰ组,Ⅲ组出血量、肛门排气时间、进食时间及住院时间均少于Ⅱ组及Ⅰ组,差异有统计学意义(P<0.05),各组淋巴结清扫数目、肿瘤下缘距离远切缘距离比较,差异无统计学意义(P>0.05)。术后,各组应激指标、炎性反应指标水平均上升,Ⅲ组炎性反应指标水平均低于Ⅱ组且低于Ⅰ组(P<0.05)。各组CD3+、CD4+、CD4+/CD8+水平均下降,Ⅲ组CD3+、CD4+、CD4+/CD8+水平均高于Ⅱ组且高于Ⅰ组,差异有统计学意义(P<0.05)。Ⅱ组及Ⅲ组并发症发生率低于Ⅰ组(P<0.05),Ⅱ组及Ⅲ组比较差异无统计学意义(P>0.05)。各组预后情况比较差异无统计学意义(P>0.05)。结论:ERAS联合中医药在腹腔镜全直肠系膜切除术患者的应用中优越性明显,可减轻机体创伤性,维持内环境稳定,为其临床推广提供理论依据。     

Laparoscopic anatomic segmentectomy 8 using the outer-Laennec approach

BackgroundLaparoscopic anatomic segmentectomy 8 is a difficult and technically demanding procedure owing to exposure of two major hepatic veins. To safely and accurately perform this procedure, the outer-Laennec approach was developed (Kiguchi et al., 2019) [1], which is based on the structure of Laennec's capsule (Sugioka et al., 2017; Laennec, 1802; Hayashi et al., 2008) [2,3,4]. The capsule comprises two layers: the hepatic and cardiac Laennec's capsules surrounding the major hepatic vein (Kiguchi et al., 2019) [1]. The outer-Laennec approach maintains the strength of the hepatic vein wall, preserving the two layers of Laennec's capsule. We describe a laparoscopic anatomic segmentectomy 8 using the outer-Laennec approach for hepatocellular carcinoma (HCC).MethodsParenchymal transection was initiated to expose the root of the middle hepatic vein and right hepatic vein with the cranio-caudal view. The space between the hepatic Laennec's capsule and liver parenchyma was invaded using the outer-Laennec approach. The cavitron ultrasonic surgical aspirator was used from the root side toward the peripheral side to retain the hepatic Laennec's capsule on the vein wall and avoid splitting the bifurcation of the hepatic vein. The parenchymal dissection process was completed by an S8 Glissonean pedicle dissection.ResultsThe operative time was 296 min, and the estimated blood loss was 10 mL. The postoperative course was uneventful, and the patient was discharged on postoperative day 5. A pathological examination confirmed that the 2.0-cm mass was HCC with negative margins.ConclusionThe outer-Laennec approach is feasible and useful to standardize the safe laparoscopic anatomic segmentectomy 8.     

可吸收明胶海绵棒在椎弓根内止血的应用

[目的]观察评价可吸收明胶海绵棒在椎弓根置钉过程中的止血效果。[方法]2017年10月~2018年6月,48例胸腰椎骨折即将行后路手术的患者纳入本研究,采用随机数字表法分为明胶海绵组和骨蜡组。明胶海绵组共23例,置钉过程中应用明胶海绵棒填塞至椎弓根孔道止血;骨蜡组共25例,在透视定位时应用骨蜡封闭椎弓根孔道。记录置钉情况;记录术中出血量、自体血回输量、置钉过程中的出血量、输血量;检测术前和术后5 d RBC、HB和HCT。[结果]两组在置钉总数、伤椎置钉数、伤椎位置各椎置钉数量的差异均无统计学意义(P>0.05)。术后两组各出现1例小腿肌间静脉血栓,抗凝治疗后于复查时消失。术后两组均无明胶海绵或骨蜡导致的不良反应。两组在术中出血量、术中自体血回收量、输血量的差异无统计学意义(P>0.05),但明胶海绵组上述指标均小于骨蜡组。每钉置入过程中明胶海绵组的出血量显著少于骨蜡组,差异有统计学意义(P<0.05)。两组术后5 d的RBC、HB和HCT均较术前显著减少,两时间点间差异均有统计学意义(P<0.05)。术前两组在RBC、HB和HCT的差异均无统计学意义(P>0.05),术后5 d两组在RBC、HB和HCT的差异亦均无统计学意义(P>0.05)。[结论]应用明胶海绵棒填塞椎弓根孔道止血可显著减少安置椎弓根螺钉过程中的出血,是一种简单、安全、有效的脊柱外科术中止血方法。     

基于VAS评价右美托咪定在宫颈癌根治术后镇痛及术后快速康复中的临床效果

目的:研究右美托咪定在宫颈癌根治术后镇痛及术后快速康复中的临床应用效果。方法:将2015年7月至2018年7月在本院行宫颈癌根治术的86例患者随机分为对照组和观察组各43例。对照组术后镇痛采用舒芬太尼和格拉司琼，观察组术后镇痛加用右美托咪定。采用视觉模拟评分法（VAS）评价患者术后1 h、6 h、12 h、24 h、48 h疼痛情况，采用Ramesay评分法评价患者不同时间点镇静状况，记录并比较两组患者不同时间点收缩压、舒张压、心率及呼吸频率变化，比较两组患者不良反应发生情况。结果:观察组患者术后6 h、12 h、24 h、48 h VAS评分均明显低于对照组（P＜0.05），Ramesay评分均明显高于对照组（P＜0.05）；观察组和对照组患者术后不同时间点呼吸频率比较，差异无统计学意义，但术后6 h、12 h、24 h观察组患者收缩压、心率均明显低于对照组（P＜0.05），术后1 h、6 h观察组患者舒张压明显低于对照组（P＜0.05）；观察组患者恶心呕吐、高血压发生率较对照组明显减低。结论:右美托咪定用于宫颈癌根治术后镇痛，可以提高镇痛镇静效果，稳定患者血流动力学，有助于术后快速康复。     

脑血管畸形致脑出血患者手术治疗效果观察

目的分析脑血管畸形致脑出血患者应用手术治疗的临床疗效。方法纳入本院2018年1月—2020年1月收治的60例脑血管畸形致脑出血患者,随机分组(每组样本容量共计30例),参照组给予保守治疗,观察组给予手术治疗,对比两组临床疗效、治疗前、治疗1月后NIHSS评分、住院时间。结果临床总有效率观察组(93.33%)明显高于参照组(63.33%),观察组治疗1月后NIHSS评分明显低于参照组,观察组住院时间明显比参照组短,差异均具有统计学意义(P<0.05)。结论脑血管畸形致脑出血患者采纳手术治疗,可有效减轻患者神经功能受损情况,缩短治疗时间。