Safety and Efficacy of Video Laparoscopic Surgical Debulking of Recurrent Ovarian,Fallopian Tube,and Primary Peritoneal Cancers

Background and Objective:

Studies on the role of laparoscopy in secondary or tertiary cytoreduction for recurrent ovarian cancer are limited. Our objective is to describe our preliminary experience with laparoscopic secondary/tertiary cytoreduction in patients with recurrent ovarian, fallopian, and primary peritoneal cancers.

Methods:

This is a retrospective analysis of a prospective case series. Women with recurrent ovarian, fallopian tube, or primary peritoneal cancers deemed appropriate candidates for laparoscopic debulking by the primary surgeon(s) were recruited. The patients underwent exploratory video laparoscopy, biopsy, and laparoscopic secondary/tertiary cytoreduction between June 1999 and October 2009. Variables analyzed include stage, site of disease, extent of cytoreduction, operative time, blood loss, length of hospital stay, complications, and survival time.

Results:

Twenty-three patients were recruited. Only one surgery involved conversion to laparotomy. Seventeen (77.3%) of the patients had stage IIIC disease at the time of their initial diagnosis, and 20 (90.9%) had laparotomy for primary debulking. Median blood loss was 75 mL, median operative time 200 min, and median hospital stay 2 d. No intraoperative complications occurred. One patient (4.5%) had postoperative ileus. Eighteen (81.8%) of the patients with recurrent disease were optimally cytoreduced to < 1cm. Overall, 12 patients have no evidence of disease (NED), 6 are alive with disease (AWD), and 4 have died of disease (DOD), over a median follow-up of 14 mo. Median disease-free survival was 71.9 mo.

Conclusions:

In a well-selected population, laparoscopy is technically feasible and can be utilized to optimally cytoreduce patients with recurrent ovarian, fallopian, or primary peritoneal cancers.     

Postgastrostomy tube deformity on upper GI series

Three cases are presented in which a focal concave deformity occurred along the greater curvature of the stomach on upper gastrointestinal (GI) series. These patients all had recent removal of a surgically placed gastrostomy tube from a similar location. This deformity appears to be related, at least in part, to invaginated gastric mucosa intentionally produced during surgical gastrostomy tube placement. This association and appearance should be noted as it may mimic other lesions.     

口鼻咽护理对胃管留置患者口鼻咽喉部舒适感及胃管脱出率的影响

目的：探讨口鼻咽护理对胃管留置患者口鼻咽喉部舒适感及胃管脱出率的影响。方法病例为2012年11月至2014年11月本院留置胃管的住院患者86例,采用数字随机对照表分为两组,各43例。对照组给予常规护理,观察组在对照组基础上给予口鼻咽护理,记录两组鼻咽部黏膜受损、咽部舒适度、并发症发生率及胃管脱出、要求拔管的发生率,护理前后发放Kdcaha舒适状况量表( GCQ)、护理满意度量表。结果观察组0度鼻咽喉部黏膜损伤发生率为81.40%显著高于对照组的58.14%,鼻咽喉部舒适度4分概率为90.70%显著高于对照组46.51%,差异具有统计学意义( P<0.05)。观察组护理后生理、心理、环境、社会文化显著高于对照组,具有统计学意义( P<0.05)。观察组鼻咽部护理、口腔护理、并发症护理的护理满意度评分显著高于对照组,差异具有统计学意义( P<0.05)。观察组咽喉疼痛、口腔溃疡、鼻腔不适发生率分别为6.98%、0.0%、2.33%显著低于对照组23.26%、9.30%、11.63%,胃管脱出、要求拔管概率2.33%、4.65%显著低于对照组16.28%、23.26%,具有统计学意义( P<0.05)。结论口鼻咽护理可减轻胃管留置患者口鼻咽喉部不适感,预防导管脱出。     

新生儿鼻胃管置管长度测量方法的研究

目的 探讨最合适的体表测量方法,准确测量新生儿鼻胃管置管长度.方法 选取60例放置胃管的患儿,每例患儿均采用"前额正中发际-脐"新体表测量法,"前额正中发际-剑突"常规体表测量法以及实际置管长度的测量,并比较新体表测量法与常规体表测量法所测的置管长度与实际置管长度的差别.结果常规体表测量长度与实际置管长度比较差异有统计学意义,P＜0.01;新体表测量长度则与实际长度差异无统计学意义,P＞0.05.结论 新体表测量法所得的置管长度接近于实际胃管置管长度,更适于新生儿,应大力提倡运用"前额正中发际-脐"的体表测量方法来测定新生儿鼻胃管的置管长度.     

鼻胃管与鼻肠管在伴应激性溃疡的重症神经外科患者的联合应用

目的总结在应用鼻胃管引流治疗重症神经外科患者的应激性溃疡同时应用鼻肠管早期恢复患者肠内营养的经验。方法 2011年1月—2011年6月神经外科重症监护病房(NICU)30名出现应激性溃疡患者行鼻胃管引流及同时置鼻肠管,第2天行胸腹部X线检查确认鼻肠管位置后早期行肠内营养。同时监测胃残量。结果 30例患者在鼻胃管引流治疗同时均一次性鼻肠管置管成功,置管后次日恢复早期肠内营养。结论鼻胃管与鼻肠管在伴应激性溃疡的重症神经外科患者的联合应用是治疗应激性溃疡同时早期恢复肠内营养的有效方式。     

Immature teratoma of the tectum mesencephali with histopathological detection of rudimentary eye anlage in a 3‐year‐old boy: Report of a rare case

Intracranial teratoma is a rare neoplasm derived from omnipotent germinal cells that can contain mesoderm, endoderm and/or ectoderm layer tissue. Histologically teratomas are characterized by abnormal structures like teeth or bone that can be further subdivided into mature and immature according to the presence of incompletely differentiated tissue. Characteristic intracranial teratomas are space‐occupying lesions in the pineal region and often present with hydrocephalic symptoms due to aqueduct stenosis. A 3‐year‐old boy presented with a peracute hemiparesis, fatigue and speech deficit. MRI diagnostics showed a cystic, partially solid, inhomogeneous contrast‐enhancing formation at the top of the tectum mesencephali with consecutive aqueduct compression. The patient underwent a sub‐occipital craniotomy via a supracerebellar approach and complete resection was achieved. The histopathological examination mainly showed mature tissue of ectodermal, mesodermal and endodermal origin. However, small areas of undifferentiated neuroectodermal tissue within an optic vesicle formation were detected, leading to the diagnosis of an immature teratoma. In due course, the patient was discharged in good health without neurological deficits. To our knowledge, optic vesicle‐containing intracranial germ cell tumors are extremely rare. Here we report a unique case with immature neuroectodermal tissue within an optic vesicle formation in an otherwise mature teratoma.     

三腔喂养管联合管状胃治疗高龄食管癌的临床研究

目的：探讨术中应用三腔喂养管联合管状胃对老年食管癌患者的临床效果。方法选取2007年2月-2013年2月收治的年龄≥65岁食管癌患者588例。按手术方式不同随机分为三腔喂养管联合管状胃手术组（A组）288例与传统手术组（B 组）300例。观察2组患者手术时间、吻合口瘘等14项临床指标。结果2组患者手术时间、术中出血、术后乳糜胸、术后喉返神经麻痹和吻合口狭窄发生率比较差异均无统计学意义（P ﹥0.05）。2组患者术后吻合口瘘,肛门排气时间、病死率、肛门排便时间、返流性食管炎、胸胃综合症、心律失常、肺部并发症及住院时间比较差异均有统计学意义（P ﹤0.05）。结论对于高龄食管癌手术患者术中应用三腔喂养管空肠营养联合管状胃重建食管,能显著减少食管癌患者术后的并发症,减少吻合口瘘,降低病死率,能其提高生活质量,值得临床应用。     

纵隔负压引流在食管癌、贲门癌根治术中的应用

目的:探讨食管根治术中纵隔负压引流的应用价值。方法:将经左胸行食管癌或贲门癌根治性切除患者220例分为改良组102例和对照组118例,改良组在消化道重建后,吻合口下方留置纵隔引流管,外接负压引流球;对照组未留置纵隔引流管。比较2组患者吻合口瘘的发生情况及出现吻合口瘘后的临床表现、主要并发症以及预后情况。结果:2组均顺利完成手术。改良组发生吻合口瘘5例,术后出现高热、气促、心悸等症状3例,其余患者生命体征平稳;发生吻合口瘘患者合并胸腔感染2例,切口感染1例,1例行食管支架植入,死亡1例。对照组发生吻合口瘘7例,术后均出现高热、气促、心悸等不适;发生吻合口瘘患者合并胸腔感染6例,切口感染3例,4例行食管支架植入,2例行二次手术廓清引流,死亡2例。2组吻合口瘘的发生率比较无显著性差异(P>0.05),但胸腔感染、切口感染、死亡率比较有显著性差异(P<0.05),平均最高体温、平均白细胞计数、术后平均住院时间比较有显著性差异(P<0.05)。结论:纵隔负压引流管不能减少食管癌、贲门癌术后吻合口瘘的发生,但可以明显减轻吻合口瘘所致的全身炎症反应,减少胸腔感染、切口感染、二次手术廓清及死亡,缩短住院时间。