Laparoscopic gastro-jejunal anastomosis using novel r2 deflectable instruments in an ex vivo model

Objective A novel 5?mm steerable instrument system (r2-DRIVE) was developed with active tip deflection and tip and shaft rotation. The feasibility and training effect of the r2 instruments were determined in a phantom model. Material and methods Experienced laparoscopic surgeons and untrained novices performed laparoscopic gastro-jejunal anastomoses using porcine tissue and r2 DRIVE-instruments. Mean anastomosis time, anastomosis width and burst pressure were measured. Number of stitches, skipped stitches and dropped needles were counted. Results of trained and untrained subjects were compared. Results Mean time for suturing decreased rapidly for all participants, but was more evident for untrained persons. After five anastomoses no relevant improvement in anastomotic time was seen for the skilled group. The ease of use, efficacy of manipulation and swift training effect with the novel r2 instruments for both experienced laparoscopic surgeons and untrained non-surgeons could be demonstrated and after few cases stable anastomosis times and a fast learning curve were obtained. Conclusions This study demonstrates the ease of use, efficacy of manipulation and swift training effect with the novel r2 instruments for both experienced laparoscopic surgeons and untrained non-surgeons. After few cases stable anastomosis times and a fast learning curve were obtained.     

套入式结肠直肠黏膜吻合保肛术在肥胖患者的临床应用

目的探讨套入式结肠直肠黏膜吻合保肛术在肥胖患者中应用的可行性及安全性。方法回顾性分析2010年1月至2012年12月我院收治的128例拟行套入式结肠直肠黏膜吻合保肛术治疗患者的临床资料,按体重指数（BMI）分为A组（BMI〈25kg／m2）和B组（BMI≥25kg／m2）,比较两组患者的一般资料和手术相关情况。结果两组病例在手术时间、术中出血量及保护性造口患者数等因素方面差异无统计学意义（P〉0．05）,但B组转行Mile手术的患者数显著高于A组（P〈0．05）。两组病例下切缘距离,清扫淋巴结数目相比差异无统计学（P〉0．05）,除了切口脂肪液化及感染这一并发症（P〈0．05）,两组病例在其他术后并发症发生率及术后通气时间等方面也无明显差异（P〉0．05）。结论套入式结肠直肠黏膜吻合保肛术应用于肥胖患者是安全可行的,可达到同样的根治目的。     

股骨头内吻合断裂支持带动脉重建血供的可行性研究

目的 探究模型动物股骨头内吻合断裂支持带动脉重建血供的可行性。 方法 选取20例成年家猪髋关节标本,用硫酸钡悬液通过囊外动脉环对股骨头进行灌注,观察各支持带动脉的分布及入股骨头后的走行特点。另20例标本建立头下型股骨颈骨折模型后,在股骨头表面凿一个三角形骨槽,显露头内最粗支持带动脉与股骨颈侧的血管断端进行端端吻合。用硫酸钡悬液检测吻合血管的通畅情况和股骨头的灌注情况。 结果 20例灌注标本可观察到有3组支持带动脉为股骨头供血,各支持带动脉入头后的起始部分沿皮质下走行。向20例头下型股骨颈骨折模型动物的头内吻合的支持带动脉灌注硫酸钡悬液,均能顺利通过吻合口且在持续灌注后股骨头内的其它动脉均有硫酸钡悬液充盈。 结论 股骨头内吻合断裂支持带动脉的方法可行,可以恢复股骨头血供。     

3D腹腔镜平行重叠吻合联合经自然腔道取标本在近端胃癌根治术中的应用价值

目的观察女性近端胃癌患者3D腹腔镜根治术中行平行重叠吻合法消化道重建,并经自然腔道取标本在淋巴结清扫、术后胃肠功能恢复中的作用,探讨其治疗效果及安全性。方法女性近端胃癌患者36例,其中16例行3D腹腔镜近端胃癌根治术,术中行平行重叠吻合法消化道重建,并经自然腔道取标本者为观察组;20例行2D腹腔镜近端胃癌根治术,术中经腹部切口取标本者为对照组。比较2组手术时间、术中吻合时间、术中出血量及淋巴结清扫数;记录2组术后排气时间、下床时间、住院时间、流质饮食时间及并发症发生情况;随访2~20个月,观察2组肿瘤复发、转移及死亡情况。结果观察组术中吻合时间[(32.5±5.5)min]、术后排气时间[(2.1±0.9)d]、术后下床时间[(1.2±0.7)d]、住院时间[(7.3±1.5)d]均短于对照组[(36.4±3.6)min、(2.9±1.1)d、(2.1±1.3)d、(8.5±1.3)d](P<0.05),术中出血量[(120.6±70.1)mL]少于对照组[(165.2±53.6)mL](P<0.05),术中淋巴结清扫数[(28.4±4.2)枚]多于对照组[(25.1±3.2)枚](P<0.05),手术时间、术后流质饮食时间与对照组比较差异均无统计学意义(P>0.05)。观察组术后无相关并发症发生,对照组术后发生吻合口狭窄1例,切口脂肪液化1例。2组随访期间无复发、转移、死亡病例。结论女性近端胃癌患者采用3D腹腔镜下平行重叠吻合法消化道重建联合经自然腔道取标本术治疗可提高淋巴结清扫数,促进胃肠道功能的恢复,缩短住院时间。     

胆管残端双舌瓣在胆肠吻合口狭窄中的应用

目的探讨胆肠吻合口狭窄再次手术的新方法,以降低胆肠吻合口再狭窄的发生率。方法对38例胆肠吻合口狭窄的患者再次行胆管残端双舌瓣空肠一层外翻吻合术,观察手术效果。结果胆管残端双舌瓣空肠一层外翻吻合术使胆肠吻合口直径增大0.5⁰.8倍、吻合时间短、吻合口再狭窄发生率低,效果良好。结论胆管残端双舌瓣空肠一层外翻吻合术操作简单易行,手术时间短,术后效果良好且安全可靠,是有效预防胆肠吻合口再狭窄的手术方式。     

Transanal Inside-Out Rectal Resection for Ultra-Low Rectal Cancer

ABSTRACT

Two major issues encountered in the surgical resection of low rectal cancers (tumor located <6 cm from anal verge) are tumor-free surgical resection margin and adequate fields of colo-anal pull-through anastomosis. The clinical consequences of ensuring gross tumor-free surgical resection margin by transanal inside-out rectal resection technique were assessed for ultra-low rectal cancer patients. From February 2009 to September 2011, ultra-low anterior resection with a new method of eversion of the rectum through the anal canal after resecting the distal rectum and colo-anal anastomosis extracorporally performed in 30 patients (age range, 41–80 years) was reviewed. All patients received preoperative neoadjuvant concurrent chemoradiotherapy (CCRT) before the surgical resection. The median operating time was 265 min (range, 220–400 min), and the median intraoperative blood loss was 325 ml (range, 80–855 ml). No in-hospital mortality was noted among these patients. R0 resection (tumor-free margin range, 0.9–2.5 cm) was confirmed in all patients by pathologic reports, except one patient with 0.5 cm tumor-free margin. The new surgical technique of transanal inside-out rectal resection and colo-anal pull-through anastomosis for selected patients with ultra-low rectal cancers seems to be a safe and alternative procedure.     

The Effects of Hyperbaric Oxygen Therapy on Colonic Anastomosis in Rats With Peritonitis

The aim of this study is to investigate the healing effect of hyperbaric oxygen (HBO) on colonic anastomoses in the presence of experimentally induced peritonitis. Thirty-two rats were allocated randomly into short-term anastomosis (STA), short-term anastomosis + HBO treatment (STA+HBO), long-term anastomosis (LTA), and long-term anastomosis + HBO (LTA+HBO) treatment groups. The STA and LTA groups were administered fluid resuscitation and antibiotics for 3 and 7 days, respectively, whereas the HBO treatment groups received additional HBO therapy for 3 and 7 days, respectively. The rats were reoperated on the third and the seventh days of anostomoses for evaluation. The bursting pressures in STA+HBO and LTA+HBO therapy groups were significantly higher than those in groups with anastomoses alone (p <. 001 and p <. 01). HBO therapy did not affect the fibrotic index neither in STA nor in LTA groups (p >. 05 for both); however, it was significantly higher in LTA+HBO group than that in STA+HBO group (p <. 05). The hydroxyproline level was significantly higher in LTA group than in STA group (p <. 05), yet HBO therapy did not affect the hydroxyproline levels in STA or LTA groups (p >. 05 for both). It is concluded that hyperbaric oxygen treatment has positive effects on colonic anastomotic healing in case of peritonitis.     

胃癌根治术后3种消化道重建术的对比研究

目的:探讨胃癌根治术后3种不同消化道重建术式的应用效果。方法:回顾性分析我院2007年5月—2011年9月完成的胃癌手术147例,按消化道重建方式不同分为袢式Braun吻合术组、Roux-en-Y食管(胃)空肠吻合术组、改良Roux-en-Y食管(胃)空肠吻合术组(改良组)。比较各组患者消化道重建时间、术后并发症发生率及术后1年Visick分级指数。结果:所有病例均顺利完成手术,无手术死亡。消化道重建吻合完成时间Roux-en-Y吻合术组长于Braun吻合术组和改良组。Braun吻合术组的吻合口溃疡、碱性反流胃炎、倾倒综合征发生率均明显高于Roux-en-Y吻合术组及改良组,差异有统计学意义(P<0.05);而Roux-en-Y吻合术组的Roux-en-Y滞留综合征发生率明显高于改良组,差异有统计学意义(P<0.05);术后1年Visick分级改良组Ⅰ级例数明显高于另外两组,Ⅲ级例数明显低于另外两组,差异有统计学意义(P<0.05)。结论:改良Roux-en-Y食管(胃)空肠吻合术能明显改善患者的生活质量,是胃癌术后消化道重建较合适的术式。     

食管吻合口狭窄气囊导管扩张术与放置内支架疗效对比

目的对比评价食管贲门癌术后吻合口狭窄单纯气囊导管扩张术与辅以食管支架置入术的治疗效果。方法两种病例共103例吻合口狭窄均作了气囊导管扩张术,其中79例作单纯气囊导管扩张术,24例作气囊导管扩张术辅以支架置入术(5例为裸支架,19例为覆膜支架)。结果全部103例作单纯气囊导管扩张术后经4～38个月随访观察,有效者79例,占76.7%;另24例扩张无效者辅以放置食管支架,经4～38个月随访,有效者17例,有效率70.8%;与单纯作气囊导管扩张术比较差异无统计学意义(χ2=0.36,P>0.05)。结论食管贲门癌术后吻合口狭窄,应以气囊导管扩张术作为首选的治疗方法,气囊导管扩张无效者再考虑辅以放置食管支架作为治疗的补救措施。     

Comparative Study between Staplers and Conventional(Hand-Sewn) Anastomosis in Gastrointestinal Surgery

Conventional (hand-sewn) technique of intestinal anastomosis has been in vogue for decades. Staplers which were developed to simplify surgery began to have significant impact. To compare staplers versus conventional anastomosis with respect to certain intra operative and post operative parameters. Prospective study from November 2008 to October 2010 in Hyderabad at OSMANIA, GANDHI, MNJ CANCER hospitals. 120 patients were divided into three groups of 40 each, depending on the surgery like posterior gastrojejunostomy, distal gastrectomy and reconstruction (Billroth II) and colorectal anastomosis. Of these 40 patients, 20 were in hand-sewn group and the other 20 in stapler group. Unpaired ‘t’ test was used to find ‘p’ value . ‘p’ value less than 0.05 was considered statistically significant. Total operating time was shortened in stapler group. No significant difference was found in terms of restoration of intestinal function, post-operative hospital stay, post-operative complications like anastomotic leak. Staplers can expedite surgery. They have better access to difficult—to—reach areas. Thus staplers can be beneficial though one should not forget the art of conventional suturing.