手助腹腔镜与全腹腔镜外科治疗结直肠癌的对比研究

目的比较手助腹腔镜与全腹腔镜在外科治疗结直肠癌中的近期疗效,另外对手辅助腹腔镜外科治疗结直肠癌的安全性做出评估。 方法选取2011年11月至2014年4月哈尔滨医科大学附属第二医院结直肠肿瘤外科的79例结直肠癌患者,其中接受腹腔镜下结直肠癌根治术者41例,接受手辅助腹腔镜下结直肠癌根治术者38例。根据2种术式分为全腹腔镜组（LAC组）和手助腹腔镜组（HALS组）。通过回顾性分析,比较2组患者的一般资料包括年龄、性别、肿瘤位置、肿瘤病理类型、分期、ASA分级、BMI指数等;手术资料包括手术时间、麻醉时间、术中出血量、中转开腹率、取标本切口长度、Trocar数目等;术后资料包括术后第一次排气时间、术后住院时间、住院费用、术后并发症情况等。 结果HALS组和LAC组两组手术时间、麻醉时间、术中出血量、Trocar使用数目、取标本切口长度、术后首次排气时间存在差异（P<0.05）;术后住院时间、住院费用、术后并发症差异无统计学意义（P>0.05）。 结论手辅助腹腔镜下结直肠癌根治术与全腹腔镜下结直肠癌根治术相比具有手术时间短、创伤小、术后恢复快等优点,是一种安全有效,可靠的技术。     

Laparoscopic vs. Hand-Assisted Laparoscopic Sigmoidectomy for Diverticulitis

Introduction Sigmoid colectomy for diverticulitis can be technically challenging because of severe inflammation in the left-lower quadrant and pelvis. We hypothesized that hand-assisted laparoscopic technique may facilitate laparoscopic completion of this surgery while retaining the short-term benefits associated with “pure” laparoscopic surgery, in which an incision is made only for extracting the specimen. This study was designed to compare the outcomes of patients who underwent totally laparoscopic or hand-assisted laparoscopic sigmoidectomy for diverticulitis. Methods We reviewed our prospectively collected patient database from July 2001 to June 2004 and compared the intraoperative data and postoperative outcomes of patients who underwent elective laparoscopic or hand-assisted laparoscopic sigmoidectomies for diverticulitis. Complicated patients (with abscess or fistulas) also were separately analyzed. Results The hand-assisted laparoscopic (mode age, 57 years; 48 percent male) and laparoscopic sigmoidectomy (mode age, 56 years; 90 percent male) groups were similar with regard to age and gender. Overall, patients who underwent laparoscopic (n = 21) vs. hand-assisted laparoscopic (n = 21) sigmoidectomies had a significantly longer operative time (197 ± 42 vs. 171 ± 34 minutes, P = 0.04) and shorter incision length (5 ± 2.1 vs. 9.3 ± 4.1 cm, P = 0.0001). Patients with complicated diverticulitis (n = 14; abscess, colovesical fistula, enterocolic fistula) who underwent laparoscopic sigmoidectomies (n=4) had a significantly longer operative time compared with hand-assisted laparoscopic sigmoidectomy (n = 10) group (255 ± 18 vs. 177 ± 34 minutes, P = 0.001). Conversion rate for the laparoscopic group was significantly higher (3/4 vs. 1/10, P = 0.04, Fisher exact) when complicated diverticulitis was present. There were no differences in postoperative outcomes or incision lengths in thecomplicated group. Conclusions Outcomes after hand-assisted laparoscopic sigmoidectomy for diverticulitis are similar to those seen in the pure laparoscopic method, with lower conversion rates and shorter operative times. Hand-assisted laparoscopic sigmoid resection for diverticulitis is an attractive alternative to a “pure” laparoscopic method in complicated cases. Podium presentation at the meeting of The American Society of Colon and Rectal Surgeons, Philadelphia, Pennsylvania, April 30 to May 5, 2005. Reprints are not available.     

闭合式切除术在直肠癌腹腔镜全系膜切除根治术中的应用效果研究

目的评价闭合式切除术（CE）在直肠癌腹腔镜全系膜切除（TME）根治术中的临床应用效果。 方法以潍坊医学院附属寿光市人民医院2011年2月至2014年6月收治的54例原发性直肠癌患者为研究对象,30例为实验组进行CE＋ TME腹腔镜根治术,24例为对照组进行TME腹腔镜根治术。术中均联合动脉灌注化疗。比较两组患者手术时间、术中出血量、淋巴结清扫数目、环周切缘（CRM）阳性比例、术后恢复饮食时间、肛门排气时间、尿管留置时间、住院时间、术后并发症发生比例及术后1年局部复发比例等指标。 结果术中出血量（t=11.775,P<0.001)显著低于TME组,CE＋TME组手术时间（t=2.207,P=0.035）、术后肛门排气时间（t=2.059,P=0.045）、导尿管置留时间（t=2.083,P=0.042）、术后1年内局部复发率（χ²=3.97,P=0.047）显著低于TME组;淋巴结清扫数目显著高于TME组（t=9.613,P<0.001）。 结论CE可显著降低TME术后局部复发率,具有一定的临床应用价值。     

经脐单孔腹腔镜胆囊切除术及术中使用超声刀直接处理胆囊动脉的疗效分析

目的探讨经脐单孔腹腔镜胆囊切除术及术中超声刀直接处理胆囊动脉的临床可行性及使用价值。方法回顾性分析本科室自2011年3月-2012年12月施行腹腔镜胆囊切除术并术中超声刀直接处理胆囊动脉231例患者的临床资料。根据患者要求手术方式分为经脐单孔腔镜组125例(A组)和三孔腔镜组106例(B组),比较2种术式的手术时间、术中出血量、术后镇痛、术后进食、术后住院时间、术后并发症发生情况以及超声刀直接处理胆囊动脉的效果。计量资料组间比较采用t检验,计数资料比较采用卡方检验。结果 A组手术时间平均为(20.21±1.86)min,长于B组的(18.43±1.37)min,差异有统计学意义(P0.05);A组术中出血量平均为(23.23±6.25)ml,B组为(22.34±5.49)ml,差异无统计学意义(P0.05);A组术后5例须要镇痛,B组21例,差异有统计学意义(P0.05);A组术后进食时间为(6.56±1.23)h,B组为(6.67±1.45)h,差异无统计学意义(P0.05);A组术后住院平均时间为(2.98±0.23)d,B组为(3.02±0.18)d,差异无统计学意义(P0.05);2组患者术后均未留置引流管。2组术后均无出血、胆管损伤、胆漏及切口感染等并发症发生。超生刀直接凝断胆囊动脉止血效果可靠,术后无继发性出血发生。所有患者术后随访2~12个月,平均6.5个月,患者康复良好,无切口疝发生,脐部瘢痕不明显,美容效果较好。结论经脐单孔腹腔镜胆囊切除术具有三孔腹腔镜胆囊切除术相同临床效果,并且具有创伤小,术后疼痛轻、美容效果好等优势,特别适用外貌美容要求较高的患者。超声刀直接离断胆囊动脉能够减少由于仔细分离胆囊动脉而意外造成的大出血,同时也相应缩短手术时间,是一种安全、可行的手术方式,值得临床推广应用。     

NOSESⅡ式与常规腹腔镜中位直肠癌根治术疗效对比

目的通过与常规腹腔镜手术临床疗效对比探究NOSESⅡ式在中位直肠癌根治术中的应用价值,探讨NOSESⅡ式在腹腔镜中位直肠癌根治术中安全性及有效性。方法回顾性分析2013年8月至2018年11月于哈尔滨医科大学附属第二医院结直肠肿瘤外科就诊的直肠癌患者141例,其中腹部无辅助切口手术患者55例,腹腔镜手术患者86例。比较两组的手术时间、术中出血量、术后排气时间、进食时间、住院时长、并发症、预后等差异。结果共有NOSESⅡ式组47例、常规腹腔镜组47例成功配对,两组手术时长、术中出血量、淋巴结清扫、及术后肛门功能评价差异无统计学意义(P>0.05)。与常规腹腔镜组相比,NOSESⅡ式组术后总并发症发生率较低(6.4%vs.21.3%,χ²=6.085,P=0.036);术后排气时间明显短于常规腹腔镜组(38 h vs.48 h,t=-2.639,P=0.008);术后进食时间也明显短于常规腹腔镜组(59 h vs.84 h,t=-3.330,P=0.001);在术后总住院时长上也较腹腔镜组明显缩短[12(6~18)vs.12(9~30),t=-1.460,P=0.004];术后患者疼痛评分第一日(t=-4.463,P<0.001)、第三日(t=-4.975,P<0.001)、第五日(t=-5.706,P<0.001)镇痛药物的使用明显低于腹腔镜组(t=-4.325,P<0.001);此外,在生存分析方面,两组患者术后无疾病生存时间(DFS)和总生存时间差异均无统计学意义(P>0.05)。结论NOSESⅡ式作为一种安全有效的直肠癌根治手术方式,在确保完成手术根治直肠癌的治疗效果前提下,并不增加手术风险,并且在降低手术后总并发症、缩短术后排气时间、进食时间、术后住院时长,术后减痛等方面较常规腹腔镜手术具有明显优势。     

Hand-Assisted Laparoscopic vs. Laparoscopic Colorectal Surgery: A Multicenter, Prospective, Randomized Trial

Purpose  This study was designed to compare short-term outcomes after hand-assisted laparoscopic vs. straight laparoscopic colorectal surgery. Methods  Eleven surgeons at five centers participated in a prospective, randomized trial of patients undergoing elective laparoscopic sigmoid/left colectomy and total colectomy. The study was powered to detect a 30-minute reduction in operative time between hand-assisted laparoscopic and straight laparoscopic groups. Results  There were 47 hand-assisted patients (33 sigmoid/left colectomy, 14 total colectomy) and 48 straight laparoscopic patients (33 sigmoid/left colectomy, 15 total colectomy). There were no differences in the patient age, sex, body mass index, previous surgery, diagnosis, and procedures performed between the hand-assisted and straight laparoscopic groups. Resident participation in the procedures was similar for all groups. The mean operative time (in minutes) was significantly less in the hand-assisted laparoscopic group for both the sigmoid colectomy (175 ± 58 vs. 208 ± 55; P = 0.021) and total colectomy groups (time to colectomy completion, 127 ± 31 vs. 184 ± 72; P = 0.015). There were no apparent differences in the time to return of bowel function, tolerance of diet, length of stay, postoperative pain scores, or narcotic usage between the hand-assisted laparoscopic and straight laparoscopic groups. There was one (2 percent) conversion in the hand-assisted laparoscopic group and six (12.5 percent) in the straight laparoscopic group (P = 0.11). Complications were similar in both groups (hand-assisted, 21 percent vs. straight laparoscopic, 19 percent; P = 0.68). Conclusions  In this prospective, randomized study, hand-assisted laparoscopic colorectal surgery resulted in significantly shorter operative times while maintaining similar clinical outcomes as straight laparoscopic techniques for patients undergoing left-sided colectomy and total abdominal colectomy. Read at the meeting of The American Society of Colon and Rectal Surgeons, St. Louis, Missouri, June 2 to 6, 2007. Reprints are not available Drs. Marcello, Read, and Mutch are consultants for Applied Medical and have received honoraria and potential stock options. Drs. Milsom and Whelan have received honoraria for speaking on behalf of Applied Medical. Applied Medical provided financial support to the institutions for the project.     

手辅助腹腔镜结直肠癌根治术的发展、优势与应用

手辅助腹腔镜技术是将腹腔镜微创外科技术与传统开腹手术进行最大程度结合的一个典范,近年来在结直肠癌根治术中的应用越来越普遍,并逐渐被越来越多的医生所接受。进行手辅助腹腔镜手术的步骤虽然大致与全腹腔镜相同,但是由于其恢复了术者的触觉,因此其兼顾了微创手术与开腹手术的双重优势;另外手辅助腹腔镜结直肠癌根治术还具有适应症广泛,医生学习曲线短,手术时间短,术后并发症少等优点,并且术中可以快速控制出血,对于术中出现的意外能进行最快的补救,间接提高了手术的安全性。尽管手辅助腹腔镜技术在外科治疗结直肠癌疾病中有以上诸多优势,但是也尚存在一些不足,如手在腹腔中占据空间对术者暴露视野不利,同时也可能造成气腹的严密性减低;长时间的手术造成术者疲劳等。本文旨在客观对手辅助腹腔镜外科治疗在结直肠癌的发展、优势及应用做出陈述。     

Laparoscopic colonic resections versus open surgery: a prospective non-randomized study on 310 unselected cases

BACKGROUND/AIMS: Laparoscopic colorectal surgery, particularly for malignancy, is still debated. The aim of this study was to prospectively evaluate the postoperative outcome as well as the short- and medium-term results of laparoscopic surgery compared with those after open conventional surgery. METHODOLOGY: A series of 310 consecutive patients, operated on by the same surgical team, have been included in this study; 150 patients (75% with malignant lesions) underwent laparoscopic surgery, whereas 160 patients (73% with malignant lesions) were treated by open surgery. The treatment modality was selected by the patients after reading the informed consent form. RESULTS: Laparoscopic surgery was technically feasible in 91.4% of cases. Mean operative time for laparoscopic surgery was longer than for open surgery (251 vs. 175 min) (P < 0.001). Mean postoperative hospital stay after laparoscopic surgery was 10.5 days, as compared to 13.3 days after open surgery (P < 0.05). In the laparoscopic surgery group minor complications' rate was 3.6% and compared favorably to the 7.5% observed after open surgery (P = 0.261). No statistically significant difference was observed in the major complications rate (9.4% after laparoscopic surgery and 6.8% after open surgery) and in operative mortality (1.4% for laparoscopic surgery and 0.6% for open surgery). The local recurrence rate was lower after laparoscopic surgery as compared to open surgery: 3% versus 9.2% (P = 0.152), respectively. Mean follow-up was 34.2 months during which time we observed 2 cases of port site recurrence. After implementing adequate prophylactic measures, no parietal implants were observed in the last 80 patients who underwent laparoscopic surgery for malignancy. Distant site metastases occurred in 11% in both groups. At 36 months cumulative survival probability in laparoscopic surgery completed malignant cases was 0.74% as compared to 0.66% after open surgery. CONCLUSIONS: Morbidity and mortality were similar in the 2 groups. Laparoscopic patients experienced less pain. A slightly higher incidence of local recurrence was observed in the open surgery group, whereas the percentage of distant site metastases and the cumulative survival probability in the 2 groups were similar. Port site recurrences are a cause of concern but they can be prevented with adequate prophylactic measures. The short- and medium-term results of laparoscopic surgery compared favorably with those of open surgery in this prospective non-randomized study. Long-term oncological result are not known yet. In patients with malignancy prospective randomized trials on larger patient numbers are required.     

腹腔镜TME联合ISR对低位直肠癌的疗效及对患者控便功能的影响

目的探讨腹腔镜下全直肠系膜切除术（TME）联合经肛门内括约肌间切除术（ISR）对低位直肠癌的治疗效果及肛门控便功能的影响。 方法选取宜昌市第二人民医院手术治疗的低位直肠癌患者159例,收集时间为2014年1月至2017年1月,根据手术方式不同分为腹腔镜组69例（腹腔镜下TME＋ISR手术）、开腹组90例（采用传统开腹手术实施TME＋ISR手术治疗）,对比两组的手术相关指标及术后肛门控便功能。 结果腹腔镜组的手术时间、清扫淋巴结数目与开腹组比较差异均无统计学意义（t=1.209,1.585;P<0.05）;腹腔镜组患者的手术出血量、肛门排气时间及住院时间均小于开腹组,差异均有统计学意义（t=13.834,5.930,6.556;P<0.05）;腹腔镜组术后肛门控便功能显著的优于开腹组,差异具有统计学意义（Z=-2.183,P=0.029）;术前,两组患者的肛管收缩压（t=1.381,P=0.397）、肛管最大收缩时间（t=1.047,P=0.297）及肛管静息压（t=0.483,P=0.495）差异均无统计学意义;术后3个月,腹腔镜组患者的肛管收缩压、肛管最大收缩时间及肛管静息压显著高于开腹组,差异均有统计学意义（t=3.571,5.188,3.448;P<0.05）。腹腔镜组患者手术并发症率为7.25%,显著低于开腹组患者的17.78%（χ²=4.003,P=0.045）。 结论腹腔镜下TME联合ISR对低位直肠癌的治疗效果良好,并且具有创伤小、术后患者肛门功能恢复好的优点。     

腹腔镜右半结肠癌根治术优先处理Henle干的近期疗效分析

目的对比胃结肠静脉干（Henle干）的优先处理与传统处理在腹腔镜右半结肠癌根治术的近期疗效分析。 方法回顾性分析2018年6月至2019年6月期间同济大学附属上海东方医院胃肠外科80例行腹腔镜右半结肠癌根治术治疗结肠癌的临床资料，根据手术视频录像筛选，术中优先处理Henle干38例（优先组），同期未优先处理Henle干（传统组）42例，比较两组的手术安全性及其近期疗效。 结果两组患者年龄、性别、体质量指数、肿瘤部位、肿瘤直径、肿瘤分期经比较，差异均无统计学意义（P>0.05）。与传统组相比，优先组术中出血量减少[（62.89±29.31）mL vs.（86.90±33.89）mL，t=3.372；P=0.001]，手术时间缩短[（146.61±10.40）min vs.（159.21±21.60）min，t=3.270；P=0.002]，术中血管损伤率降低[5.3%（2/38）vs. 21.4%（9/42），χ²=4.396；P=0.036]；两组术后并发症发生率、术后首次排气时间、术后首次排便时间、术后引流时间、术后住院时间、手术标本质量评价及病理学检查结果经比较，差异均无统计学意义（P>0.05）。 结论两组手术方式均为符合肿瘤根治性原则的有效手术，手术效果相当。在腹腔镜右半结肠癌根治术中优先处理Henle干在减少术中出血量，缩短手术时间，减少术中血管损伤方面具有优势，是安全可行的手术方式。     

Hand-assisted laparoscopic colorectal surgery

The use of laparoscopic techniques in the treatment of colorectal diseases was first described in the early 1990s. Even though its clinical benefits have been well documented, laparoscopic colorectal surgery has been slow to gain adoption in the surgical community, given its technical demands. To help overcome these challenges while preserving the clinical benefits derived from a minimally invasive approach, hand-assisted laparoscopic surgery (HALS) was proposed. HALS can decrease the learning curve by restoring tactile sensation and improving proprioception, and it may be more accessible for surgeons already in practice. A meta-analysis of the 3 published RCTs comparing hand-assisted laparoscopic to conventional laparoscopic colorectal resection showed a significantly lower rate of conversion in the hand-assist patients, while morbidity rates were equivalent. The meta-analysis further indicated that short-term postoperative benefits of conventional laparoscopic colectomies were preserved and costs were likely to be offset by reduced operative time and specific need of laparoscopic equipment. HALS represents a valuable option for performing colorectal resections.     

Comparison of hand-assisted laparoscopic nephroureterectomy with open surgery for upper urinary tract tumor

Herein we report on our initial experience in performing nephroureterectomy by hand-assisted laparoscopic surgery, and compare the results with those performed by traditional open methods. From December 2000 to September 2001, 10 patients with upper urinary tract tumors underwent hand-assisted laparoscopic nephroureterectomy. Except for one patient who required elective conversion to open surgery due to renal vein injury, this cohort of 9 patients was compared to a group of 35 patients who had received traditional open nephroureterectomy over the last 2 years. Demographic, intraoperative and postoperative data were compared retrospectively. These two groups were similar in age, body mass index, operation time and time to postoperative oral intake. However, the hand-assisted laparoscopy group was found to have significantly less blood loss, less need for parenteral narcotic and a shorter length of time needed for postoperative hospitalization than the open group. Thus, in this report we have demonstrated hand-assisted laparoscopic nephroureterectomy to be a safe and efficacious treatment of malignant urinary collecting tumors. We believe the benefits of this minimally invasive surgery make it a viable alternative technique for management of upper urinary tract tumor.     

腹腔镜D2根治术联合完整系膜切除术治疗进展期胃癌的临床疗效分析

目的分析腹腔镜D2根治术联合完整系膜切除术(CME)治疗进展期胃癌的临床疗效。方法回顾性分析2018-01~2018-12于郑州大学第二附属医院行腹腔镜治疗的80例胃癌患者的临床资料,根据接受术式不同分为研究组(采用腹腔镜下D2根治术+CME治疗)和对照组(采用腹腔镜下标准D2根治术治疗),每组40例。比较两组手术时间、术中出血量、淋巴结清扫个数、术后功能恢复情况、术后并发症发生率以及术后1年生存情况。结果与对照组相比,研究组手术时间更短,术中出血量更少,淋巴结清扫个数更多,差异有统计学意义(P<0.05)。研究组首次排气时间、首次进食时间和住院时间显著短于对照组(P<0.05),腹腔引流管引流量显著少于对照组(P<0.05)。研究组术后并发症发生率显著低于对照组(22.50%vs 52.50%;χ²=10.912,P=0.000)。在随访过程中,研究组有8例(20.00%)出现肿瘤复发,对照组有16例(40.00%)出现肿瘤复发;研究组有2例(5.00%)死亡,对照组有5例(12.50%)死亡。log-rank检验结果显示,两组术后生存情况差异无统计学意义(χ²=2.735,P=0.143)。结论与标准D2根治术相比,D2根治术+CME术式手术时间更短,术中出血量更少,淋巴结清扫更彻底,术后肠道功能恢复更快,且术后并发症更少,值得临床推荐。     

Benefits of hand-assisted laparoscopic restorative proctocolectomy: a comparative study

PURPOSE: Hand-assisted laparoscopic colectomy is thought to facilitate colonic mobilization while maintaining the benefits of laparoscopic surgery. Although previous studies of hand-assisted colectomy have focused on segmental colonic resection, the use of hand-assisted laparoscopic restorative proctocolectomy has not been investigated. This study evaluated the effectiveness of hand-assisted laparoscopic approach compared with a conventional laparoscopic method in patients undergoing restorative proctocolectomy.METHODS: From a prospective database, a consecutive series of patients were identified undergoing conventional and hand-assisted laparoscopic restorative proctocolectomy and results were compared. Twenty-three patients, comprising 10 hand-assisted and 13 conventional laparoscopic patients, were identified. Patient characteristics, perioperative parameters, and outcomes were assessed.RESULTS: Both groups were well matched with no differences in age, gender, body mass index, operative indication, diagnosis, comorbidity, or steroid usage. There were no differences among incision size between the hand-assisted (8 (range, 8–20) cm) and conventional laparoscopic cases (8 (range, 5–10) cm). The median operative time was significantly shorter in the hand-assisted group (247 (range, 210–390) minutes) compared with the conventional laparoscopic group (300 (range, 240–400) minutes; P < 0.01). The length of stay was similar between groups (hand-assisted: 4 (range, 3–13) days vs. conventional: 6 (range, 4–17) days). Complications occurred in four hand-assisted patients (40 percent; 2 ileus, mechanical obstruction, and dehydration) and in four patients undergoing conventional laparoscopic method (31 percent; 2 anastomotic leak, ileus, and mechanical obstruction).CONCLUSIONS: Compared with conventional laparoscopic restorative proctocolectomy, the hand-assisted method resulted in a significant reduction in operative time without detriment to bowel function, length of stay, or patient outcome. The hand-assisted approach to restorative proctocolectomy is likely to replace conventional laparoscopic methods as the preferred laparoscopic approach for this technically challenging procedure.Reprints are not available.Read at the meeting of The American Society of Colon and Rectal Surgeons, New Orleans, Louisiana, June 21 to 26, 2003.     

Learning curve of transumbilical suture-suspension single-incision laparoscopic cholecystectomy

AIM: To investigate the learning curve of transumbilical suture-suspension single-incision laparoscopic cholecystectomy (SILC). METHODS: The clinical data of 180 consecutive transumbilical suture-suspension SILCs performed by a team in our department during the period from August 2009 to March 2011 were retrospectively analyzed. Patients were divided into nine groups according to operation dates, and each group included 20 patients operated on consecutively in each time period. The surgical outcome was assessed by comparing operation time, blood loss during operation, and complications between groups in order to evaluate the improvement in technique.RESULTS: A total of 180 SILCs were successfully performed by five doctors. The average operation time was 53.58 ± 30.08 min (range: 20.00-160.00 min) and average blood loss was 12.70 ± 11.60 mL (range: 0.00-100.00 mL). None of the patients were converted to laparotomy or multi-port laparoscopic cholecystectomy. There were no major complications such as hemorrhage or biliary system injury during surgery. Eight postoperative complications occurred mainly in the first three groups (n = 6), and included ecchymosis around the umbilical incision (n = 7) which resolved without special treatment, and one case of delayed bile leakage in group 8, which was treated by ultrasound-guided puncture and drainage. There were no differences in intraoperative blood loss, postoperative complications and length of postoperative hospital stay among the groups. Bonferroni’s test showed that the operation time in group 1 was significantly longer than that in the other groups (F = 7.257, P = 0.000). The majority of patients in each group were discharged within 2 d, with an average postoperative hospital stay of 1.9 ± 1.2 d. CONCLUSION: Following scientific principles and standard procedures, a team experienced in multi-port laparoscopic cholecystectomy can master the technique of SILC after 20 cases.     

应用重叠式三角吻合技术的3D完全腹腔镜右半结肠切除术的近期疗效分析

目的比较应用重叠式三角吻合技术的3D与2D完全腹腔镜右半结肠切除术的近期疗效资料,探讨重叠式三角吻合技术在3D完全腹腔镜右半结肠切除术中的可行性和安全性。 方法回顾性分析中国医学科学院北京协和医学院肿瘤医院2017年5月至2018年10月收治的67例右半结肠恶性肿瘤患者的资料,其中行2D完全腹腔镜右半切除术的患者35例,设为2D组;行3D完全腹腔镜右半切除术的患者32例,设为3D组。对比其手术及术后恢复情况、病理情况以及围手术期并发症等。 结果两组之间,3D组手术时间、消化道重建时间明显小于2D组（均P<0.05）,但术中出血量、手术切口长度差异无统计学意义（P>0.05）。两组患者术后行走时间、排气时间、排便时间、术后住院时间差异无统计学意义（均P>0.05）。两组在肿瘤大小、远近切缘距离、淋巴结清扫数目、肿瘤TNM分期等方面,差异无统计学意义（P>0.05）。两组术后并发症发生率分别为6.2%和5.7%,差异亦无统计学意义（P=0.928）。 结论重叠式三角吻合技术在3D完全腹腔镜右半结肠切除术切实可行,安全可靠,具有满意的近期疗效。与2D腹腔镜手术相比,在3D腹腔镜下可明显缩短手术时间和消化道重建时间。     

Delayed Laparoscopic Cholecystectomy After Percutaneous Transhepatic Gallbladder Drainage Versus Emergency Laparoscopic Cholecystectomy for Acute Cholecystitis: A Meta-Analysis

Background: The purpose of this meta-analysis is to appraise the efficacy and safety of delayed laparoscopic cholecystectomy after percutaneous transhepatic gallbladder drainage (PTGBD) versus emergency laparoscopic cholecystectomy (ELC) for acute cholecystitis.Methods: The kinds of literature were searched by Web of Science, PubMed, OVID, Cochrane Library, and EMBASE between the year 2000 and 2019. RevMan 5.3 was used for meta-analysis.Results: Seventeen studies with 2135 participants were included in our study. Compared with the ELC group, delayed laparoscopic cholecystectomy after percutaneous transhepatic gallbladder drainage group (PTGBD group) had a significant better effect in intraoperative bleeding (P = .002), conversion rate to open surgery (P = .02), postoperative complications (P ＜ .00001), bile leakage (P = .01), bile duct injury (P = .02), and wound infection (P = .02). There was no significant difference between the two groups in operative time (P= 32), postoperative hospital stay (P = .30), and intraperitoneal hemorrhage (P = .39). PTGBD group had a significantly longer overall hospital stay than the ELC group (P ＜ .00001).Conclusion: Compared with the ELC group, the PTGBD group has several advantages, including bile duct injury, intraoperative bleeding, bile leakage, conversion rate to open surgery, postoperative complications, and wound infection. The only drawback in the PTGBD group is to lengthen the total hospital stay.     

Laparoscopic versus conventional open resection of rectal carcinoma： A clinical comparative study

AIM: To evaluate the feasibility of laparoscopic resection of rectal carcinoma and to compare the short-term outcome of laparoscopic procedure with conventional open surgery for rectal cancer. METHODS: Thirty-eight patients with rectal cancer were included in a prospective non-randomized study. The patients were assigned to laparoscopic (n=18) or open (n=18) colorectal resection. Case selection, surgical technique, and clinical and pathological results were reviewed. RESULTS: The operative time was longer in laparoscopic resection group (LAP) than in open resection group (189+/-18 min vs 146+/-22 min, P<0.05). Intraoperative blood loss and postoperative complications were less in LAP resection group than in open resection group. An earlier return of bowel motility was observed after laparoscopic surgery. The overall postoperative morbidity was 5.6% in the LAP resection group and 27.8% in open resection group (P<0.05). No anastomotic leakage was found in both groups. The pathologic examination showed that the length of the resected specimen, the mean number of harvested lymph nodes in laparoscopic resection group were comparable to those in open resection group. CONCLUSION: Laparoscopic total mesorectal excision (TME) for rectal cancer is a feasible but technically demanding procedure. The present study demonstrates the safety of the procedure, while oncologic results are comparable to the open surgery, with a favorable short-term outcome.     

Effects of multimodal fast-track surgery on liver transplantation outcomes

BACKGROUND: Fast-track surgery and enhanced recovery after surgery have been applied to many surgical procedures;however, data on fast-track surgery and enhanced recovery after surgery following liver transplantation is limited. This study aimed to conduct a prospective study to determine the effects of fast-track surgery on prognosis after liver transplan-tation. METHODS: This was a prospective, single-blinded, random-ized study. One hundred twenty-eight patients undergoing liver transplantation were selected for the fast-track (FT group, n=54) or conventional process (NFT group, n=74). The prima-ry endpoints were intensive care unit (ICU) stay and hospital stay. The secondary endpoints were as follows: operative time, anhepatic phase time, intraoperative blood loss, intraopera-tive blood transfusion volume, postoperative complications, readmission rate, and postoperative mortality. RESULTS: There was no significant difference in preoperative demographics between the two groups. The median ICU stay was 2 days (range 1-7 days) in the FT group and 5 days (range 3-12 days) in the NFT group (P<0.01). Furthermore, the hospital stay was also significantly reduced in the FT group (P<0.01). The operative time, anhepatic phase time, intraop-erative blood loss, and intraoperative blood transfusion vol-ume were decreased in the FT group compared with the NFT group (P<0.05). Based on Spearman correlation analysis, the ICU stay and hospital stay may be positively correlated with operative time, anhepatic phase time and intraoperative blood loss. There were no differences in the incidence of postopera-tive complications, readmissions, and postoperative mortality between the two groups. CONCLUSION: Fast-track procedures effectively reduce the ICU stay and hospital stay without adversely affecting progno-sis. This study demonstrated that fast-track protocols are safe and feasible in liver transplantation.     

儿童开腹与腹腔镜食管裂孔疝修补＋胃底折叠术的疗效比较

目的比较儿童开腹与腹腔镜食管裂孔疝（HH）修补+胃底折叠术的疗效及安全性。 方法回顾性分析2008年1月至2018年1月新疆维吾尔自治区人民医院收治的经上消化道造影检查诊断为HH的42例患儿。其中20例行开腹HH修补＋胃底折叠术（开腹手术组）,22例行腹腔镜HH修补＋胃底折叠术（腹腔镜手术组）。记录并比较2组患儿的切口长度、手术时间、术中出血量、术后进食时间、术后住院时间,同时观察2组患儿术后疼痛及并发症发生情况,并比较2组患儿术后并发症发生率。 结果腹腔镜手术组患儿切口长度短于开腹手术组患儿［（2.2±0.3）cm vs （7.5±1.1）cm］,且差异有统计学意义（t=20.833,P<0.05）;但2组患儿手术时间、术中出血量差异均无统计学意义［（115.4± 20.5）min vs （104.2±18.6）min,（2.9±0.3）ml vs （3.1±0.5）ml,t=1.552、1.857,P均>0.05］。腹腔镜手术组患儿术后进食时间、术后住院时间均短于开腹手术组患儿［（1.3±0.3）d vs （2.2±0.4）d,（5.2±1.6）d vs （9.3±1.1）d］,且差异均有统计学意义（t=8.182、9.753,P均<0.05）。2组患儿术后并发症发生率差异无统计学意义［9.1% （2/22）vs 5.0% （1/20）,χ²=0.264,P>0.05］。开腹与腹腔镜HH修补＋胃底折叠术均为小儿HH安全、有效的治疗方法。与开腹手术比较,腹腔镜手术术后禁食时间短,术后恢复快,更美观。