腹腔镜D2根治术治疗进展期胃癌41例效果观察

目的观察腹腔镜D2根治术治疗进展期胃癌的疗效及安全性。方法将同期收治的82例进展期胃癌患者随机分为观察组和对照组各41例,分别行腹腔镜D2根治术及传统开腹根治术,观察两组手术时间、术中出血量、淋巴结清扫数量、术后肛门排气时间、切口愈合情况、术后住院时间及并发症发生情况。结果观察组手术时间明显长于对照组、术中出血量少于对照组、术后肛门排气时间及住院时间均短于对照组、切口液化率及并发症发生率均显著短于对照组（P〈0.05、0.01）。结论腹腔镜下D2根治术治疗进展期胃癌效果确切且具有微创性。     

妇科急腹症腹腔镜与开腹手术的临床效果比较

目的探讨腹腔镜技术在妇科急腹症中的临床应用价值。方法120例妇科急腹症患者,其中58例（观察组）实施腹腔镜手术,62例（对照组）实施常规剖腹手术,对两组术中、术后情况进行比较。结果两组均顺利完成手术,均未出现并发症,与对照组比较,观察组虽然手术时间明显增加,但术中出血量减少（P〈0．05）。观察组术后疼痛程度、肠道功能恢复及住院时间等明显优于对照组,有显著性差异（P〈0．05）。结论腹腔镜手术为妇科急腹症治疗理想方法,但要严格掌握指征;术中发现粘连严重或病情复杂者,应中转开腹手术。     

腹腔镜与传统开腹手术治疗中国老年胃癌疗效对比的Meta分析

目的从循证医学角度系统评价腹腔镜与传统开腹手术治疗中国老年胃癌的安全性和可行性。方法计算机检索Pub Med、Cochrane Library、EMBASE、中国生物医学文献数据库(CMB)、中国期刊全文数据库(CNKI),对2004~2014年间发表的有关腹腔镜与传统开腹手术治疗中国老年胃癌的对照试验进行定量综合分析,按纳入与排除标准筛选文献、提取资料和质量评价后,利用Rev Man5.3统计软件进行Meta分析。结果按纳入标准,共9篇文献被纳入Meta分析,其中随机对照试验(RCT)2篇,非随机对照试验(RNT)7篇,共计1 132例老年胃癌患者,其中腹腔镜组535例,开腹组597例。Meta分析结果显示:与开腹组相比,腹腔镜组术中出血少[WMD=-79.70,95%CI(-96.89~-62.51),P<0.000 01]、术后首次排气时间早[WMD=-1.08,95%CI(-1.41~-0.75),P<0.000 01]、术后住院时间短[WMD=-2.82,95%CI(-3.94~-2.15),P<0.000 01]、术后进食早[WMD=-0.90,95%CI(-1.03~-0.76),P<0.000 01]、手术切口长度短[WMD=-7.19,95%CI(-10.33~-4.06),P<0.000 01]、术后卧床时间短[WMD=-2.29,95%CI(-2.61~-1.96),P<0.000 01]、术后并发症发生率低[OR=0.46,95%CI(0.33~0.62),P<0.000 01],且术中淋巴结清扫数目无统计学差异(P>0.05),但手术时间延长[WMD=7.81,95%CI(1.43~14.20),P=0.02]。结论腹腔镜手术治疗中国老年胃癌安全可行,可取得与传统开腹手术相当的手术疗效,且具有术中出血少、术后肠道功能恢复快、术后住院时间短、术后并发症发生率低、术后切口美观等优点。     

腹腔镜辅助与传统开腹胃癌根治术临床疗效及对免疫功能影响的比较

目的比较腹腔镜辅助手术与传统开腹手术治疗胃癌的临床疗效及对机体免疫应激功能的影响。方法行胃癌D2根治手术的胃癌患者260例,其中行腹腔镜辅助胃癌根治术102例[腹腔镜辅助手术(LAG)组],行传统开腹胃癌根治手术158例[传统开腹手术(TOG)组],对比两组一般情况[年龄、性别、体重指数(BMI)、肿瘤直径、TNM分期]、手术情况(手术切口长度、手术时间、术中出血量、术后肛门排气时间、术后进食时间、淋巴结清扫情况、住院时间),炎症因子相关指标、并发症发生率、术后随访情况。结果 LAG组的手术时间明显多于TOG组(P0.05),但手术切口长度、术中出血量、术后肛门排气时间、术后进食时间及住院时间均明显少于或短于TOG组(P0.01)。两组淋巴结清扫情况相似,差异无统计学意义(P0.05)。术后1、3、5 d两组白细胞介素(IL)-6、超敏C反应蛋白(hs-CRP)、肿瘤坏死因子(TNF)-α水平比术前均明显升高(P0.05),并且LAG组术后并发症总发生率明显低于TOG组,差异具有统计学意义(P0.05)。术后随访,LAG组与TOG组的1年、5年无复发生存率无显著差异(P0.05)。结论与LAG相比,TOG在临床应用中具有相似的安全性和临床疗效,并且具有术后恢复快、创伤小、炎症应激反应轻及手术并发症总发生率较低等特点。     

腹腔镜手术与传统开腹手术治疗卵巢囊肿的效果比较

目的比较腹腔镜手术与传统开腹手术两种方式治疗卵巢囊肿的临床疗效。方法选取2012-01~2015-01该院收治的200例卵巢囊肿患者为研究对象,按治疗方法不同分为观察组(100例,腹腔镜手术治疗)和对照组(100例,传统开腹手术治疗),比较两组临床疗效及并发症发生率。结果观察组治疗后手术时间、术中出血量、术后排气时间、住院时间等均显著低于对照组,差异有统计学意义(P0.01);观察组治疗总有效率为98.0%、并发症发生率为2.0%,对照组治疗总有效率为89.0%、并发症发生率为15.0%,两组比较差异均有统计学意义(P0.01)。结论与传统开腹手术比较,腹腔镜手术具有创伤小、手术时间短、出血量小、恢复快、并发症少等优点,且疗效更加确切,值得临床推广应用。     

腹腔镜胃癌手术与开腹手术对患者凝血功能的影响

胃癌是我国最常见的恶性肿瘤,以往多采用开腹手术治疗,随着腹腔镜技术的发展,由于其具有创伤小、恢复快等优点,逐渐成为治疗早期胃癌的主要方式之一〔1〕。但是由于腹腔镜手术过程中需要建立气腹,而CO2气腹的建立又不可避免地     

腹腔镜胃癌根治术15例临床回顾分析

腹腔镜胃癌根治术作为一种微创手术技术,正获得越来越多人的认同。日本学者已证实对早期胃癌开展腹腔镜根治性切除可获得与传统开腹手术相当的远期生存效果,同时可减少术中出血,减轻术后疼痛,缩短术后住院时间。在我国,腹腔镜胃癌根治术的开展仍局限于少数几家大型医院,且集中于对手术安全性、有效性的研究。本文回顾总结我院15例腹腔镜胃癌根治术患者的临床资料,希望能对同行有所帮助。     

老年宫颈癌腹腔镜与开腹手术的疗效比较

随着手术设备的日益先进和操作技术的日趋完善,腹腔镜手术已经广泛应用于妇科良恶性肿瘤的治疗。与开腹手术相比,腹腔镜手术具有创伤小、出血少、术后恢复快等优势。我院对早期宫颈癌患者行腹腔镜下根治术+盆腔淋巴结清扫术(腹腔镜组),同期对同年龄段的早期宫颈癌患者行开腹手术治疗(开腹组),对两组临床疗效进行比较。     

腹腔镜下远端胃癌根治术与传统开腹手术治疗早期胃癌的疗效比较

目的比较腹腔镜下远端胃癌根治术与传统开腹手术治疗早期胃癌的临床效果。方法选取该院2013-11~2014-11收治的72例早期胃癌患者,按随机数字表法分为对照组(36例)和观察组(36例)。对照组行传统开腹手术治疗;观察组于腹腔镜下行远端胃癌根治术治疗。统计两组患者手术时间、切口长度、术中出血量、淋巴结清扫数量、术后肛门排气时间、下床活动时间、恢复半流质时间及住院天数,观察两组患者术后并发症发生情况,随访12个月,了解患者术后复发、癌细胞转移及存活情况。结果观察组手术时间、切口长度、术中出血量[(168.8±30.9)min、(6.6±2.3)cm、(131.8±63.4)ml]和术后肛门排气时间、下床活动时间、恢复半流质时间及住院天数[(2.9±1.4)、(2.4±0.9)、(7.4±1.6)及(10.7±3.6)d]均短于或少于对照组(P0.05);观察组患者术后并发症发生率(8.3%)较对照组(27.6%)低,两组比较差异有统计学意义(P0.05)。随访12个月,两组患者均无肿瘤局部复发、癌细胞转移及死亡病例,存活率为100.0%。结论腹腔镜下远端胃癌根治术治疗早期胃癌可获得与开腹手术相同的效果,但其手术时间短,术中出血量少,有利于患者术后尽早恢复,优势更显著。     

腹腔镜与开腹手术治疗卵巢囊肿的临床对比探讨

目的探讨腹腔镜与开腹手术治疗卵巢囊肿进行临床治疗效果的对比。方法选择院内从2012年6月至2013年6月间需要进行手术的卵巢囊肿患者100例,平均分成两组,一组为对照组50例,进行传统的开腹手术治疗,另一组为观察组50例,进行腹腔镜手术治疗。结果对照组与观察组两组在手术时间上进行对比,无明显差异,不具有统计学意义（P〉0.05）;腹腔镜手术和开腹手术相比,具有出血量少和术后排气时间短,止痛药使用率低,术后下床时间较短,住院周期短,所有指标都有明显差异,具有统计学意义（P〈0.05）。结论观察组使用的腹腔镜手术在卵巢囊肿的治疗方面,与传统的开腹手术相比,明显治疗效果好,创作面小,疼痛较轻,术后恢复快,而且很少有并发症发生,是治疗卵巢囊肿的最理想手术治疗方式。     

Use of a lead shield for laparoscopic detection of the sentinel lymph nodes in gastric cancer

Background: Accurate staging of lymph node metastasis by sentinel node biopsy is easily achieved in conventional open gastric surgery. Staging is not easily achieved in laparoscopic surgery, however, because of the technical dif?culty in identifying sentinel nodes. We developed a laparoscopic method that involves lead shielding for detection of sentinel nodes in gastric cancer and examined the ef?cacy of this method. Methods: Laparoscopic sentinel node biopsy was performed in 18 patients with early gastric cancer. A combined dye‐ and radio‐guided method was used in the ?rst 10 patients; our radio‐guided lead shield method was used in the subsequent eight cases. Laparoscopy‐assisted distal gastrectomy was performed in all patients, and dissected nodes were examined by routine hematoxylin and eosin staining. The detection rate was compared between the two groups. Results: The detection rate for sentinel nodes was higher with the radio‐guided lead shield method (88%) than with the combined dye‐ and radio‐guided method (40%). Regional lymph node metastasis was recognized in one of 18 patients, and the sentinel node was positive in this case. Conclusions: Use of a lead shield is bene?cial for accurate laparoscopic detection of sentinel lymph nodes.     

Distribution of solitary lymph nodes in primary gastric cancer： A retrospective study and clinical implications

AIM To investigate the distribution pathway of metastatic lymph nodes in gastric carcinoma as a foundation for rational lymphadenectomy.METHODS We investigated 173 cases with solitary or single station metastatic lymph nodes (LN) from among 2476 gastric carcinoma patients. The location of metastatic LN, histological type and growth patterns were analyzed retrospectively.RESULTS Of 88 solitary node metastases cases, 65 were limited to perigastric nodes (N1), while 23 showed skipping metastasis. Among 8 tumors in the upper third stomach, 3 involved right paracardial LN (station number No.1), and one in the greater curvature was found in No.1. In the 28 middle third stomach tumors, 10were found in LN of the lesser curvature (No.3) and 6 in LN of the left gastric artery (No.7); 5 of the 20 cases on the lesser curvature spread to No.7, while 2 of the 8 on the greater curvature metastasized to LN of the spleen hilum (No.10). Of 52 lower third stomach tumors, 13 involved in No.3 and 19 were detected in inferior pyloric LN (No.6); 9 of the 29 cases along the lesser curvature were involved in No.6.CONCLUSION Transversal and skipping metastases of sentinel lymph nodes (SLN) are notable, and rational lymphadenectomy should, therefore, be performed.     

D2 dissection in laparoscopic and open gastrectomy for gastric cancer

AIM: To evaluate the radicalness and safety of laparoscopic D2 dissection for gastric cancer. METHODS: Clinicopathological data from 209 patients with gastric cancer, who underwent radical gastrectomy with D2 dissection between January 2007 and February 2011, were analyzed retrospectively. Among these patients, 131 patients underwent laparoscopyassisted gastrectomy (LAG) and 78 underwent open gastrectomy (OG). The parameters analyzed included operative time, blood loss, blood transfusion, morbidity, mortality, the number of harvested lymph nodes (HLNs), and pathological stage.RESULTS: There were no significant differences in sex, age, types of radical resection [radical proximal gastrectomy (PG + D2), radical distal gastrectomy (DG + D2) and radical total gastrectomy (TG + D2)], and stages between the LAG and OG groups (P 0.05). Among the two groups, 127 cases (96.9%) and 76 cases (97.4%) had 15 or more HLNs, respectively. The average number of HLNs was 26.1 ± 11.4 in the LAG group and 24.2 ± 9.3 in the OG group (P = 0.233). In the same type of radical resection, there were no signifi cant differences in the number of HLNs between the two groups (PG + D2: 21.7 ± 7.5 vs 22.4 ± 9.3; DG + D2: 25.7 ± 11.0 vs 22.3 ± 7.9; TG + D2: 30.9 ± 13.4 vs 29.3 ± 10.4; P 0.05 for all comparisons). Tumor free margins were obtained in all cases. Compared with OG group, the LAG group had signifi cantly less blood loss, but a longer operation time (P 0.001). The morbidity of the LAG group was 9.9%, which was not signifi cantly different from the OG group (7.7%) (P = 0.587). The mortality was zero in both groups. CONCLUSION: Laparoscopic D2 dissection is equivalent to OG in the number of HLNs, regardless of tumor location. Thus, this procedure can achieve the same radicalness as OG.     

Clinical significance of the number of retrieved lymph nodes in early gastric cancer with submucosal invasion

The prognosis of early gastric cancer (EGC) with submucosal invasion is favorable; however, several cases of recurrence have been reported even after curative gastrectomy. This study aimed to investigate risk factors and evaluate the clinical significance of the number of retrieved lymph nodes (LNs) in EGC with submucosal invasion. We retrospectively analyzed the data of 443 patients with gastric cancer with submucosal invasion after curative gastrectomy for recurrent risk factors. Recurrence was observed in 22 of the 443 gastric cancer patients with submucosal invasion. In the univariate analysis, the risk factors for recurrence were the number of retrieved LNs ≤ 25 and node metastasis. In the multivariate analysis, retrieved LNs ≤ 25 (hazard ratio [HR] = 5.754, P-value = .001) and node metastasis (HR = 3.031, P-value = .029) were independent risk factors for recurrence after curative gastrectomy. Body mass index was related to retrieved LNs ≤ 25 in univariate and multivariate analyses (HR = .510, P = .002). The number of retrieved LNs and node metastases were independent risk factors for EGC with submucosal invasion. For EGC with submucosal invasion, retrieved LNs > 25 are necessary for appropriate diagnosis and treatment.     

Comparison of laparoscopic proximal gastrectomy with double-tract reconstruction and laparoscopic total gastrectomy for proximal gastric cancer with stage cT1–2

This study aimed to evaluate the feasibility and nutritional benefits of laparoscopic proximal gastrectomy (LPG) with double-tract reconstruction (DTR) in comparison with laparoscopic total gastrectomy (LTG).The demographic, clinical, and pathological data and postoperative nutritional status of patients undergoing LPG with DTR (n = 21) or LTG (n = 26) at Sir Run Run Shaw Hospital between January 2016 and January 2019 were retrospectively reviewed and compared.The operative time in the LPG group was slightly longer than that in the LTG group; however, the difference was not statistically significant. Blood loss was not significantly different between groups. The mean number of retrieved lymph nodes was higher in the LTG group than in the LPG group (P = .02). The time to first flatus, postoperative hospital stay, and postoperative complications were comparable between the groups. During the 3-year postoperative follow-up, a statistically significant decrease in hemoglobin level was observed in the LTG group. There were no differences between the two groups of patients before and after the operation regarding albumin levels. The mean vitamin B₁₂ level was higher in the LPG group than in the LTG group from 12 to 18 months postoperatively.LPG with DTR is an acceptable procedure for patients with upper gastric cancer. LPG with DTR has numerous potential advantages in preserving the physiological and nutritional functions of the remnant stomach and the conservation of the gastric reservoir.     

Application of indocyanine green-enhanced near-infrared fluorescence-guided imaging in laparoscopic lateral pelvic lymph node dissection for middle-low rectal cancer

BACKGROUND As one effective treatment for lateral pelvic lymph node(LPLN)metastasis(LPNM),laparoscopic LPLN dissection(LPND)is limited due to the complicated anatomy of the pelvic sidewall and various complications after surgery.With regard to improving the accuracy and completeness of LPND as well as safety,we tried an innovative method using indocyanine green(ICG)visualized with a near-infrared(NIR)camera system to guide the detection of LPLNs in patients with middle-low rectal cancer.AIM To investigate whether ICG-enhanced NIR fluorescence-guided imaging is a better technique for LPND in patients with rectal cancer.METHODS A total of 42 middle-low rectal cancer patients with clinical LPNM who underwent total mesorectal excision(TME)and LPND between October 2017 and March 2019 at our institution were assessed and divided into an ICG group and a non-ICG group.Clinical characteristics,operative outcomes,pathological outcomes,and postoperative complication information were compared and analysed between the two groups.RESULTS Compared to the non-ICG group,the ICG group had significantly lower intraoperative blood loss(55.8±37.5 mL vs 108.0±52.7 mL,P=0.003)and a significantly larger number of LPLNs harvested(11.5±5.9 vs 7.1±4.8,P=0.017).The LPLNs of two patients in the non-IVG group were residual during LPND.In addition,no significant difference was found in terms of LPND,LPNM,operative time,conversion to laparotomy,preoperative complication,or hospital stay(P>0.05).CONCLUSION ICG-enhanced NIR fluorescence-guided imaging could be a feasible and convenient technique to guide LPND because it could bring specific advantages regarding the accuracy and completeness of surgery as well as safety.     

Laparoscopic vs open D2 gastrectomy for locally advanced gastric cancer: A meta-analysis

AIM:To conduct a meta-analysis comparing laparoscopic(LGD2)and open D2 gastrectomies(OGD2)for the treatment of advanced gastric cancer(AGC).METHODS:Randomized controlled trials(RCTs)and non-RCTs comparing LGD2 with OGD2 for AGC treatment,published between 1 January 2000 and 12January 2013,were identified in the Pub Med,Embase,and Cochrane Library databases.Primary endpoints included operative outcomes(operative time,intraoperative blood loss,and conversion rate),postoperative outcomes(postoperative analgesic consumption,time to first ambulation,time to first flatus,time to first oralintake,postoperative hospital stay length,postoperative morbidity,incidence of reoperation,and postoperative mortality),and oncologic outcomes(the number of lymph nodes harvested,tumor recurrence and metastasis,disease-free rates,and overall survival rates).The Cochrane Collaboration tools and the modified Newcastle-Ottawa scale were used to assess the quality and risk of bias of RCTs and non-RCTs in the study.Subgroup analyses were conducted to explore the incidence rate of various postoperative morbidities as well as recurrence and metastasis patterns.A Begg’s test was used to evaluate the publication bias.RESULTS:One RCT and 13 non-RCTs totaling 2596patients were included in the meta-analysis.LGD2 in comparison to OGD2 showed lower intraoperative blood loss[weighted mean difference(WMD)=-137.87 m L,95%CI:-164.41--111.33;P<0.01],lower analgesic consumption(WMD=-1.94,95%CI:-2.50--1.38;P<0.01),shorter times to first ambulation(WMD=-1.03d,95%CI:-1.90--0.16;P<0.05),flatus(WMD=-0.98d,95%CI:-1.30--0.66;P<0.01),and oral intake(WMD=-0.85 d,95%CI:-1.67--0.03;P<0.05),shorter hospitalization(WMD=-3.08 d,95%CI:-4.38--1.78;P<0.01),and lower postoperative morbidity(odds ratio=0.78,95%CI:0.61-0.99;P<0.05).No significant differences were observed between LGD2 and OGD2 for the following criteria:reoperation incidence,postoperative mortality,number of harvested lymph nodes,tumor recurrence/metastasis,or three-or five-year diseasefree and overall survival rates.However,LGD2 had longer operative times(WMD=57.06 min,95%CI:41.87-72.25;P<0.01).CONCLUSION:Although a technically demanding and time-consuming procedure,LGD2 may be safe and effective,and offer some advantages over OGD2 for treatment of locally AGC.     

Vascularizing lymph node dissection for advanced gastric cancer: A single-institution experience

AIM: To compare the short- and long-term outcomes of vascularizing lymph node dissection(VLND) and nonvascularizing lymph node dissection(NVLND) from a single institution.METHODS: Data of 315 patients with advanced gastric cancer who underwent standard D2 lymphadenectomy with curative intent was collected between January 1994 and December 2006. One hundred and fifty-two patients received VLND while 163 patients received NVLND. Short- and long-term clinical outcomes were compared between the two groups. RESULTS: The median followed-up time was 82 mo. The rate of postoperative complications in the VLND group was 13.2%, while that in the NVLND group was 11.7%(P = 0.686). The overall 5-year survival rate was 64% in the VLND group and 59% in the NVLND group(P = 0.047). When subgroup analyses were performed according to Bormann type, type of differentiation and lymph node status, survival benefit was demonstrated in patients with Bormann type Ⅲ or Ⅳ(59% vs 50%, P = 0.032), undifferentiated type(63% vs 49%, P = 0.021) or presence of lymph node metastasis(53% vs 38%, P = 0.010) in the VLND group. CONCLUSION: D2 VLND in advanced gastric cancer treatment allows survival benefit with acceptable morbidity and mortality. VLND for patients with potentially curable advanced gastric cancer is feasible and safe when performed by a well-trained surgical team.