Condition mimicking peritoneal metastasis associated with preoperative staging laparoscopy in advanced gastric cancer

Preoperative staging laparoscopy is used to search for peritoneal dissemination or distant metastasis as part of the treatment strategy for advanced gastric cancer. We observed pseudo‐peritoneal metastasis during laparotomy in 6 of 49 patients in whom lack of peritoneal dissemination had been confirmed by preoperative staging laparoscopy. In all cases, suspected nodules were biopsied and subjected to rapid histological diagnosis. However, a definite malignant or benign diagnosis could not be obtained via a rapid histological examination during surgery. A final histological examination combined with immunohistological analysis using formalin‐fixed embedded tissues confirmed no malignancy after surgery in all cases. These rapidly growing nodules that mimic peritoneal metastasis are thought to be associated with the use of grasping forceps during staging laparoscopy. No cases have been reported in which peritoneal nodules mimicking peritoneal metastasis occurred after staging laparoscopy, and surgeons should consider this possibility in patients treated shortly after staging laparoscopy.     

Anatomical variation of pancreatobiliary ducts in biliary stone diseases

Endoscopic retrograde cholangiopancreatography examinations were prospectively analyzed to determine whether anatomical variations of ductal systems have a role in the pathogenesis of cholecystolithiasis and choledocholithiasis. Included were 140 normal examinations (control group), 102 patients with cholecystolithiasis, and 68 patients with choledocholithiasis (primary stones in the common bile duct). Low entry of the cystic duct was observed frequently in patients with cholecystolithiasis (15.7% vs. 2.1% in control, p < 0.01). No preferential type of course of the cystic duct was observed in patients with cholecystolithiasis and choledocholithiasis. Separate openings of the bile and pancreatic ducts were significantly prevalent in patients with choledocholithiasis (53.5% vs. 30.6% in control, p < 0.01). Common channel was significantly short in patients with cholecystolithiasis. Incidence of juxtapapillary duodenal diverticula was significant in patients with choledocholithiasis. These observations suggest that some of the pancreatobiliary ductal anatomy may be closely implicated in the development of gallstone diseases.     

Percutaneous transhepatic portography in pancreatobiliary carcinoma: Evaluation of resectability

Direct portography using the percutaneous, transhepatic approach provides a rapid and accurate visualization of the portal, splenic, and superior mesenteric veins. In 7 patients with a malignant tumor of the pancreatobiliary region and in 1 patient with pancreatitis, the method was reliable in predicting resectability of the lesion.     

Evaluation of normal bile duct and cholangitis by intraductal ultrasonography

BACKGROUND: The intraductal ultrasonographic findings of normal bile duct and cholangitis were examined. METHODS: We studied 9 autopsy cases and evaluated the clinical records of 76 patients who had been subjected to papillotomy for bile duct stones removal retrospectively. RESULT: In vitro study: Under a low pressure, the bile duct wall was thick, and the inner surface and outer contour were irregular. The wall became thinner, and the inner surface and outer contour became smooth as the pressure was increased. The thickness was 0.68 +/- 0.12 mm (mean +/- SD) all along the duct at all pressure, and 0.55 +/- 0.12 mm at a pressure above 15 cm H(2)O. The internal echo was homogenous regardless of the internal pressure used. In vivo study: We could evaluate in 70 patients (92.1%). The wall was 1.30 +/- 0.77 mm thick. There was no relationship between the severity of cholangitis and the wall thickness. The irregular inner surface, heterogeneous internal echo, and irregular outer contour correlated with the severity of cholangitis. CONCLUSION: The normal bile duct wall was between 0.31 and 0.79 mm thick, the inner and outer surfaces were smooth, and internal echo was homogenous. An irregular inner surface, heterogeneous internal echo and an irregular outer contour were important findings of severe cholangitis.     

腹腔镜胃癌分期的初步临床观察

目的：探讨腹腔镜检查对胃癌分期的价值。方法：2007年1月至2007年11月收治的胃癌患者14例胃癌患者在全麻下行腹腔镜检查。结果：腹腔镜T分期与术后病理检查结果符合率为92．9％,术前临床T分期与术后病理检查结果符合率为64．3％。腹腔镜分期显著优于临床分期P〈0．05。在14例术前临床分期均未发现腹膜转移的病例中,腹腔镜探查发现有腹膜转移（P1-P3）者4例,腹腔镜对腹膜转移的评估显著优于临床分期P〈0．05。结论：腹腔镜可作为常规检查手段的一种补充,能对进展期胃癌进行准确的诊断和分期,有助于手术决策制定及估计治疗结果与预后,避免不必要的剖腹探查。     

吉西他滨联合化疗在晚期胰腺癌治疗中的作用探讨

目的探讨吉西他滨联合化疗治疗晚期胰腺癌的临床疗效。方法 50例局部晚期胰腺癌患者随机分为联合化疗组25例和对照组25例,对照组使用吉西他滨单药治疗,联合化疗组应用吉西他滨联合顺铂或奥沙利铂。观察2组患者客观疗效、临床受益反应及毒副反应发生情况。结果联合化疗组疾病控制率明显高于对照组,毒副反应发生率略高于对照组。结论吉西他滨联合方案与单药治疗晚期胰腺癌比较,临床疗效相似。     

Laparoscopic subtotal proctocolectomy for synchronous triple colorectal cancers: a case report

A 42‐year‐old woman presented with abdominal pain. On the basis of CT results, we diagnosed her condition as bowel obstruction caused by advanced transverse colon cancer. Colonoscopy findings showed three lesions: (i) an advanced tumor in the transverse colon; (ii) a laterally spreading descending colon tumor; and (iii) a rectal polyp. The tumors and the polyp were all pathologically diagnosed as adenocarcinoma. After inserting a self‐expanding metallic stent into the main tumor of the transverse colon to decompress the bowel, we performed endoscopic submucosal dissection of the laterally spreading descending colon tumor. Pathological examination results showed submucosal invasion and a positive margin. Because we endoscopically identified that the rectal polyp was invading the submucosa, we performed laparoscopic subtotal proctocolectomy and ileorectal anastomosis with lymph node dissection along the surgical trunk; we also performed central vascular ligation of the ileocolic artery, right and left branches of the middle colic artery, and inferior mesenteric artery. The patient's postoperative course was uneventful. We present this case because there have been few reports on laparoscopic subtotal or total proctocolectomy for synchronous multiple colorectal cancers.     

直肠腔内超声对直肠癌术前新辅助放化疗疗效评估简

目的评估直肠腔内超声（endorectal ultrasound,ERUS）对直肠癌术前新辅助放化疗后分期的应用价值。方法回顾性分析2011年9月至2012年9月北京协和医院收治的直肠癌患者62例,所有患者在放化疗前后完成ERUS检查并分期,最终经直肠全系膜切除术（total mesorectal excision,TME）切除肿瘤,并进行病理分期,比较ERUS分期与手术病理分期结果。结果62例患者中8例放化疗后肿瘤消失,达到病理完全缓解（pT0N0）,但ERUS均未准确诊断;30例对放化疗反应较好的患者中仅7例肿瘤浸润深度超声分期（uT分期）准确。ERUS的uT总准确性仅40．3％（25例）,过高分期58．1％（36例）,过低分期1．6％（1例）。ERUS诊断转移淋巴结的敏感性、特异性、阳性预测值、阴性预测值分别为60．O％、84．6％、42．9％、91．7％。结论ERUS对直肠癌放化疗后肿瘤浸润深度超声分期（uT分期）,尤其是对放化疗反应较好的肿瘤分期准确性偏低,且无法诊断肿瘤完全病理缓解。ERUS对淋巴结转移诊断的特异性和阴性预测值较高,可对直肠癌预后作出很好的预判。     

腹腔镜联合十二指肠镜术中同步治疗胆囊结石合并急性胆道梗阻的疗效分析

目的 探讨腹腔镜联合术中十二指肠镜同步治疗胆囊结石合并急性胆道梗阻的临床治疗效果.方法 实验组:30例胆囊结石合并急性胆道梗阻患者采用腹腔镜联合术中十二指肠镜同步治疗,对照组:30例同类患者行传统开腹胆囊切除+胆总管切开(胆道镜)取石+T管引流术;对两组患者手术时间,术后胃肠道恢复时间,所需总治疗时间,术后并发症(胆漏、胆道结石残留、胆道感染)发生情况进行统计分析.结果 在整个治疗过程中,实验组所需治疗时间明显小于对照组,术后出现胆道结石残留、胆道感染情况,两组差异有显著性(P＜0.05).结论 采用腹腔镜联合术中十二指肠镜同步法治疗胆囊结石合并急性胆道梗阻住院时间短、恢复快、术后并发症少,有推广普及价值.     

口服甘露醇充盈肠腔后超声诊断对胃癌的术前分期意义

目的 为提高超声检查对胃癌术前分期诊断的准确性。方法 采用新的TNM分期法对胃癌进行术前分期。胃癌患者87例,同批实验,以常规超声检查为对照组,以口服甘露醇肠腔液性充盈后超声检查为实验组。将超声检查结果与手术病理分期对照。结果 术前胃癌浸润深度T4期的诊断符合率,局部腹腔淋巴结转移N1、N2期的诊断符合率,远隔淋巴结转移M1期的诊断符合率和临床胃癌分期Ib-Ⅳ期的诊断符合率,实验组均显著高于对照组。结论 实验方法显著提高了胃癌术前分期的准确性,所检出的Ⅳ期胃癌,应考虑放弃根治性手术。     

输卵管导管联合腹腔镜治疗胆总管结石的临床体会

目的 探讨采用输卵管导管联合腹腔镜治疗胆总管结石的临床技巧。方法 回顾性分析该院2017年2月－2018年1月48例因胆总管结石行输卵管导管联合腹腔镜胆总管切开探查的患者的临床资料。结果 所有患者均在腹腔镜下成功取出并取尽胆总管内结石,一期胆总管缝合43例,放置T管引流5例;手术时间45～180 min,平均116 min。术后住院时间为6～14 d,平均8 d。术后发生胆瘘1例,保守引流9 d后痊愈;5例放置Ｔ管引流者,术后4～6周行Ｔ管造影,均无结石残留,拔除T管。术后随访3个月～１年,未见胆管狭窄及残留结石等情况发生。结论 输卵管导管联合腹腔镜治疗胆总管结石是安全、可行和有效的,娴熟的输卵管导管冲洗取石技巧、丰富的腹腔镜经验及术中细致的操作是手术成功的关键。     

腹腔镜联合十二指肠镜治疗胆结石合并胆总管结石的疗效观察

目的观察腹腔镜联合十二指肠镜治疗胆结石合并胆总管结石的疗效。方法选取2008年9月—2010年11月本院收治的168例胆囊结石合并胆总管结石的患者根据患者自愿选择术式分为腹腔镜联合十二指肠镜手术治疗组(A组)和传统开腹胆囊切除加胆总管切开取石加胆道探查"T"管引流术组(B组),观察各组手术时间,术中出血,术后镇痛药使用情况,术后恢复情况,术后并发症等指标。结果 A组与B组相比手术时间短,术中出血少,术后镇痛药使用少,术后恢复快,并发症少。结论腹腔镜联合十二指肠镜治疗胆结石合并胆总管结石比传统开腹胆囊切除加胆总管切开取石加胆道探查"T"管引流术更加安全实用,可以作为治疗胆结石合并胆总管结石的首选术式。     

免气腹腹腔镜在妇科手术中应用的临床研究

目的 研究免气腹腹腔镜在妇科手术中的应用价值.方法 应用免气腹腹腔镜行妇科手术56例(卵巢囊肿剥除24例,子宫肌瘤挖除32例),气腹腹腔镜行妇科手术61例(卵巢囊肿剥除33例,子宫肌瘤挖除28例),比较两组手术时间、术中出血量及术后恢复情况.结果 免气腹组卵巢囊肿剥除的平均时间多于气腹组(P<0.05),而肌瘤挖除所需时间和术中出血量均显著少于气腹组(P<0.01),术后体温升高、腹痛及肛门排气时间两组比较差异无显著性(P>0.05).结论 免气腹腹腔镜手术不但可避免二氧化碳气腹的并发症,而且缝合、打结等操作简单易行,特别在子宫肌瘤挖除术中占有明显优势,值得推广运用.     

Operative technique for the laparoscopic staging of pancreatic malignancy

Summary

Special technique and equipment is required for staging and pre-operative assessment of patients with pancreatic cancer. The operative steps to explore the pancreas through an infragastric route used in 21 consecutive patients with pancreatic neoplasms are described in this paper. This entails the use of distally curved coaxial instruments and of endosurgical staplers to open the gastro-colic ligament. A wide exposure of the pancreatic body and tail allows laparoscopic contact ultrasonography of the whole gland. Both longitudinal and transversal sections of the pancreas are obtained for the purpose of defining tumour limits, lymph nodal involvement and possible spread to regional vessels. Analysis of preliminary results supports the view that laparoscopic assessment of pancreatic cancer is safe and effective in achieving the goal of an accurate staging. Laparoscopic related information in this series led to a change in diagnosis or surgical strategy in 9.5% and 38% of patients, respectively. This approach obviates exploratory laparotomy in patients not suitable for resection and carries a potential value in the selection of patients for future adjuvant treatments.     

原发性肝癌合并胆管癌栓围手术期的观察及护理

目的 探讨原发性肝癌合并胆管癌栓围手术期的观察及护理.方法 对2002年1月～2009年1月我科62例原发性肝癌合并胆管癌栓患者围手术期的观察及护理体会进行了回顾性总结.结果 62例患者中其中1例患者合并胆漏、腹腔出血、肝功能衰竭而死亡,其余均治愈出院.结论 加强围手术期观察及护理,密切观察患者的生命体征及病情变化,特...     

腹腔镜辅助和开腹在进展期远端胃癌根治术临床疗效的初步比较

目的 探讨腹腔镜辅助远端进展期胃癌根治术的可行性和近期效果.方法 对12例行腹腔镜辅助远端胃癌根治术(腹腔镜组)及18例开腹远端胃癌根治术(开腹组)患者的术中、术后指标进行初步比较.结果 腹腔镜组和开腹组在手术时间、术中出血量、淋巴结清除数方面差异无统计学意义(P>0.05),但是腹腔镜组切口长度明显小于开腹组(P<0.01);腹腔镜组术后肛门排气时间、开始下床活动时间、开始进食时间早于开腹组(P<0.05),且术后住院天数亦少于开腹组(P<0.05).结论 腹腔镜辅助远端进展期胃癌根治术是安全可行的,能达到与开腹手术相当的根治效果,其微创优势明显,具有优于开腹手术的近期疗效.     

腔镜辅助乳腺癌改良根治术患者的护理

目的探讨腔镜辅助下乳腺癌改良根治术的护理要点。方法 2012年3月~2013年10月对本院11例乳腺癌患者采用腔镜辅助下乳腺癌改良根治术,并配合做好护理工作。结果 11例患者手术均顺利进行,术后1例患者发生手术区域轻度皮下气肿,1例发生患肢水肿。结论全面细致的术前宣教、准确娴熟的术中配合和认真周到的术后护理是保证手术顺利进行和术后正常康复的关键因素。     

胰管支架安置在胰管狭窄中的治疗作用

目的 采用胰管支架安置治疗胰管狭窄病例,以缓解胰管梗阻症状,同时对胰管支架的适应证及操作技术进行探讨.方法 对诊断明确的胰腺癌及慢性胰腺炎伴胰管狭窄的病例,先行内镜下逆行胰胆管造影及胰管腔内超声检查,确定狭窄长度及距乳头的距离,选择合适的胰管支架,在导丝的引导下,用推送器将支架送到目的部位,然后摄片定位.结果 该组18例安置顺利,支架都超过狭窄的远端,吸引后胰液外流,患者症状很快缓解.结论 胰管支架是治疗各种原因引起的胰管狭窄的有效的姑息治疗措施,对于胰管阻塞的病例能起到缓解症状、提高生活质量的目的,尤其是塑料胰管支架安置及取出较方便,并发症少.