快速康复外科在老年胃癌手术中的应用

目的探讨快速康复外科(FTS)在老年胃癌手术中的应用价值。方法回顾性分析2007年9月至2013年6月收治的81例老年胃癌患者资料,其中2010年8月以前的39例按传统胃癌治疗规范处理(对照组),之后的42例采用FTS治疗(FTS组),比较两组的手术情况、恢复效果和并发症情况。结果 FTS组麻醉时间、输液量、住院时间、住院费用和肺部并发症发生率均少于对照组(P=0.000),且FTS组患者术后肛门排气、排便和下床活动、进食时间均短于对照组(P=0.000),而两组手术时间、出血量和淋巴结清扫数量、术后总并发症发生率差异无统计学意义(P0.05)。结论 FTS应用于老年人胃癌手术安全有效,适合临床推广。     

应用精细肝脏外科理念治疗原发性肝癌53例

目的:评价应用精细肝脏外科理念治疗原发性肝癌的价值.方法:回顾性分析我院2008-08/2009-11行肝切除的125例原发性肝癌患者临床资料,其中采用精细肝切除术(精细肝切除组)53例,传统肝切除术(传统肝切除组)72例.比较两组手术时间、术中出血量及输血率、切缘癌残留率、住院时间、住院费用、术后肝功能、并发症发生率,以及术后1年肿瘤复发率和1年生存率.结果:精细肝切除组与传统肝切除组相比,手术时间延长(233.2 min±90.2 min vs 138.4 min ±42.0 min,P<0.05),术中出血量和输血例数、住院费用均无显著差异(P>0.05).但切缘癌残留率低(1.9%vs13.9%,P<0.05),住院时间短(12.2d±2.1dvs14.7d±3.5d,P<0.05),术后丙氨酸氨基转移酶(454.8U/L±127.4U/Lvs714.6U/L±216.4U/L,P<0.05)、总胆红素水平低(25.3μmol/L±8.0μmol/Lvs 33.0μmol/L±10.0μmol/L,P<0.05),术后并发症发生率低(9.4% vs23.6%,P<0.05).34例随访1年以上,术后1年肿瘤复发率低(8.3%vs40.9%,P<0.05),1年生存率未显示明显差异(P>0.05).结论:应用精细肝脏外科理念治疗原发性肝癌安全有效,相比传统的肝切除具有明显的优势.     

快速康复外科在结直肠癌患者中的应用

目的:对比应用快速康复外科(f a s t t r a c k surgery,FTS)治疗方案和传统治疗方案的结直肠癌患者在医疗效率指标和费用方面进行对照研究.方法:对2013-01/2013-12在青海大学附属医院胃肠外科收治的经肠镜病理诊断确诊为结直肠癌60例患者,随机分组,30例应用FTS方案为FTS组,30例应用常规治疗方案为对照组,比较两组患者的恢复胃肠排气时间,术后住院天数、总住院天数、住院总费用和并发症.结果:FTS组患者术后恢复胃肠排气时间明显低于对照组(P=0.000).FTS组患者术后住院天数明显短于对照组(P=0.000).FTS组患者住院天数亦明显短于对照组(P=0.002).FTS组患者住院费用也远低于对照组(P=0.013).两组患者并发症的发生率差异无统计学意义(P=0.306).结论:结直肠癌患者经FTS方案治疗,加速术后康复,缩短术后住院时间及总住院时间,减少医疗费用产生,并不增加肺部感染,切口感染,泌尿系感染等并发症的发生.     

肥胖体型对腹腔镜胃癌根治术术后恢复效果和预后的影响

目的研究肥胖体型对腹腔镜胃癌根治术患者术后恢复效果和预后的影响。方法回顾性分析本院90例腹腔镜胃癌根治术患者临床病历资料,根据体重指数(BMI)分为观察组(体型肥胖者,BMI≥25 kg/m2,36例)和对照组(非肥胖者,BMI 25 kg/m2,54例)。比较两组手术基本情况、术后恢复效果及术后3年生存情况。结果两组胃癌患者肿瘤直径和淋巴结阳性数差异无统计学意义(P 0.05),观察组手术时间较对照组显著延长,淋巴结清扫总数和术中出血量较对照组减少,差异均有统计学意义(P 0.05)。观察组术后住院时间较对照组显著缩短,差异有统计学意义(P 0.05),两组术后肛门首次排气时间和术后并发症总发生率差异无统计学意义(P 0.05)。观察组术后3年肿瘤进展11例,无进展生存率为69.44%(25/36),其中死亡8例,总生存率为77.78%(28/36)。对照组肿瘤进展19例,无进展生存率率为64. 81%(35/54),其中死亡11例,总生存率率为79.63%(43/54)。两组患者总生存率和无进展生存率差异均无统计学意义(P 0.05)。结论体型肥胖的腹腔镜胃癌根治术患者手术时间长,术后恢复时间较非肥胖患者显著延长,但并不影响术后并发症和预后。     

腔内外加固缝合在腹腔镜辅助胃癌消化道重建中的应用

目的探索腹腔镜胃癌手术器械吻合后加固缝合方法,比较不同方法安全性及短期效果.方法回顾性分析2008-06/2016-06长江大学附属第一医院胃肠外科行腹腔镜辅助远端胃癌根治术BillrothⅡ式胃肠吻合327例患者的临床资料.胃肠吻合后腔内加固缝合组119例,腔外加固缝合组155例,未加固缝合组53例;对比观察3组手术的总手术时间、术中出血量、术后下床时间、肛门恢复通气时间、进食半流质时间、术后住院时间.采用SPSS17.0软件进行统计学处理,住院时间的组间比较采用t检验,3组患者术后并发症及病死率的比较采用?2检验或Fisher确切概率法检验,P0.05为差异有统计学意义.结果3组患者在术中出血量、手术时间、术后下床时间、肛门恢复通气时间、进食半流质时间、住院时间均无统计学意义(P0.05);腔内缝合组和腔外缝合组及未缝合组并发症发生率分别为13.4%(16/119)、9.0%(14/155)和22.6%(12/53),差异不具有统计学意义(P=0.121);未缝合组吻合口出血显著高于其他2组(?2=7.046,P=0.03);未缝合组吻合口瘘高于其他2组,但差异无统计学意义(?2=6.130,P=0.05).结论腹腔镜辅助胃远端癌根治术应用吻合器行BillrothⅡ式吻合后手工加固缝合吻合口可降低术后吻合口出血并发症,增加手术的安全性.     

达芬奇机器人胃癌根治术与开腹胃癌根治术治疗胃癌近期疗效的对比研究

目的比较达芬奇机器人胃癌根治术与开腹胃癌根治术治疗胃癌的近期疗效。方法选取2014年1月—2016年6月解放军总医院普通外科收治的胃癌患者97例,其中50例患者行开腹胃癌根治术(对照组)、47例患者行达芬奇机器人胃癌根治术(观察组)。比较两组患者手术相关指标、病理学检查结果、术后情况,术前1 d及术后1、3、7 d外周血中性粒细胞计数(N)、淋巴细胞计数(L)及中性粒细胞计数与淋巴细胞计数比值(N/L),并观察两组患者术后并发症发生情况。结果两组患者手术类型、淋巴结清扫数目、近端切缘距肿瘤距离、远端切缘距肿瘤距离、肿瘤大小及分化程度比较,差异无统计学意义(P>0.05);观察组患者手术时间长于对照组,术中出血量少于对照组(P<0.05)。观察组患者术后首次进食时间和术后首次排气时间早于对照组,住院费用多于对照组(P<0.05);两组患者住院时间比较,差异无统计学意义(P>0.05)。多变量重复测量方差分析结果显示,时间和方法在N、L及N/L上无交互作用(P>0.05);时间在N、L及N/L上主效应显著(P<0.05);方法在N、L及N/L上主效应不显著(P>0.05)。术后1、3、7 d两组患者N、L及N/L比较,差异无统计学意义(P>0.05)。两组患者术后并发症发生率比较,差异无统计学意义(P>0.05)。结论达芬奇机器人胃癌根治术与开腹胃癌根治术对细胞免疫的抑制作用及安全性相当,但达芬奇机器人胃癌根治术具有术中出血量少、术后患者胃肠功能恢复快等优势及手术时间长、手术费用高等不足。     

加速康复外科理念对胰腺癌胰十二指肠切除术患者临床预后的影响分析

目的探讨加速康复外科理念(enhanced recovery after surgery,ERAS)对胰腺癌胰十二指肠切除术(pancreatoduodenectomy, PD)患者临床预后的影响.方法选取天津市宝坻区人民医院自2015-01/2017-08收治的拟行PD的胰腺癌患者共计52例,采取随机数表发随机将患者分为两组,取得患者知情同意,分为ERAS组24例,传统策略组28例,所有患者诊断明确,PD,ERAS组患者按照ERAS治疗护理患者,传统组患者按照传统常规治疗护理,比较分析两组患者住院时间、术后消化道功能恢复时间、住院费用、胰瘘、胃排空延迟、腹腔出血或消化道出血、病死、再入院等各种并发症发生情况.结果 ERAS组患者术后住院时间、术后消化道功能恢复时间较传统组短,住院费用较传统组低,两组差异有统计学意义(P0.05), ERAS组患者并发症发生率为45.83%,低于传统组75.00%,两组差异有统计学意义(P 0.05).结论 ERAS在胰腺癌PD患者的治疗中较传统方法治疗更为有效,安全性高,具有较高的可行性.     

陈氏胰肠吻合技术在胰十二指肠切除术中的应用效果观察

目的 观察胰十二指肠切除术中采取陈氏胰肠吻合技术的临床应用效果及安全性。方法 回顾性选择行胰十二指肠切除术的患者100例,术中行陈氏胰肠吻合技术60例(陈氏改良组)、行传统胰管空肠黏膜吻合技术42例(传统组)。比较两组术中相关指标(胰肠吻合时间、出血量)及住院时间,术后胰瘘(分为A、B、C级)、再次手术、腹腔感染、胃排空障碍、消化道出血发生情况及存活情况。结果 陈氏改良组术中胰肠吻合时间及住院时间均短于传统组(P均<0.05);两组术中出血量比较无统计学差异(P>0.05)。陈氏改良组术后发生胰瘘10例(16.7%),其中A级2例(3.3%)、B级5例(8.4%)、C级3例(5.0%);传统组术后发生胰瘘14例(33.3%),其中A级4例(9.5%)、B级6例(14.3%)、C级4例(9.5%);陈氏改良组术后胰瘘发生率低于传统组(P<0.05)。两组再次手术及术后腹腔感染、胃排空障碍、消化道出血发生率比较均无统计学差异(P均>0.05)。陈氏改良组病死3例(5.0%),传统组5例(11.9%),两组比较无统计学差异(P>0.05)。结论 与传统胰管空肠黏...     

快速康复外科技术在结直肠癌患者围手术期的应用

将同期拟行手术治疗的80例结直肠癌患者随机分为观察组和对照组各40例，分别采用快速康复外科（FTS）技术及传统方法进行围手术期处理，观察两组术后排气、排便时间及住院时间、住院费用、术后并发症发生率、再入院率等。结果观察组排气、排便时间及住院时间明显短于对照组，住院费用、术后并发症发生率明显低于对照组。认为采用FTS技术对结直肠癌患者进行围手术期处理可促进患者康复、减少费用。     

老年胃癌的手术治疗方法及对术后并发症的影响

目的探讨不同手术治疗方法在老年胃癌患者中的应用效果及对术后并发症的影响。方法选择2014年1~12月该院收治的老年胃癌患者100例,根据手术方法将其分为研究组(行腹腔镜胃癌根治术)50例与对照组(传统开腹胃癌根治术)50例。对比两组各项手术指标的变化及术后并发症情况。结果研究组手术时间、肠道恢复时间、术中出血量、住院时间显著低于对照组(P0.05);两组淋巴结清除数对比无统计学差异(P0.05)。研究组并发症发生率为6.00%,显著低于对照组20.00%(P0.05)。术后随访3~18个月,研究组生存率93.7%,对照组为91.7%,两组无显著差异(P0.05)。结论腹腔镜治疗老年胃癌具有创伤较小、术后恢复快等优点,且临床疗效确切,安全性高,适于临床应用。     

Fast-track surgery could improve postoperative recovery in radical total gastrectomy patients

AIM: To assess the impact of fast-track surgery (FTS) on hospital stay, cost of hospitalization and complications after radical total gastrectomy. METHODS: A randomized, controlled clinical trial was conducted from November 2011 to August 2012 in the Department of Digestive Surgery, Xijing Hospital of Digestive Diseases, the Fourth Military Medical University. A total of 122 gastric cancer patients who met the selection criteria were randomized into FTS and conventional care groups on the first day of hospitalization. All patients received elective standard D2 total gastrectomy. Clinical outcomes, including duration of flatus and defecation, white blood cell count, postoperative pain, duration of postoperative stay, cost of hospitalization and complications were recorded and evaluated.Two specially trained doctors who were blinded to the treatment were in charge of evaluating postoperative outcomes, discharge and follow-up. RESULTS: A total of 119 patients finished the study, including 60 patients in the conventional care group and 59 patients in the FTS group. Two patients were excluded from the FTS group due to withdrawal of consent. One patient was excluded from the conventional care group because of a non-resectable tumor. Compared with the conventional group, FTS shortened the duration of flatus (79.03 ± 20.26 hvs 60.97 ± 24.40 h, P = 0.000) and duration of defecation (93.03 ± 27.95 h vs 68.00 ± 25.42 h, P = 0.000), accelerated the decrease in white blood cell count [P < 0.05 on postoperative day (POD) 3 and 4], alleviated pain in patients after surgery (P < 0.05 on POD 1, 2 and 3), reduced complications (P < 0.05), shortened the duration of postoperative stay (7.10 ± 2.13 dvs 5.68 ± 1.22 d,P = 0.000), reduced the cost of hospitalization (43783.25 ± 8102.36 RMBvs 39597.62 ± 7529.98 RMB,P = 0.005), and promoted recovery of patients. CONCLUSION: FTS could be safely applied in radical total gastrectomy to accelerate clinical recovery of gastric cancer patients.     

善宁、大黄附子汤及喜能三联疗法治疗术后急性粘连性肠梗阻45例

目的:探讨醋酸奥曲肽(善宁)、大黄附子汤及N(2)-L-丙氨酰-L-谷氨酰胺(喜能)三联疗法治疗术后急性粘连性肠梗阻的作用和意义.方法:采用前瞻性、单中心、随机对照临床试验,将大连大学附属中山医院2009-05/2011-01收治的85例术后急性粘连性肠梗阻患者,采用随机数字法分为对照组(n=40)和治疗组(n=45).对照组采用常规治疗,包括禁食,胃肠减压,肥皂水保留灌肠,补液及抗感染治疗等.治疗组在常规治疗的基础上,大黄附子汤保留灌肠替代对照组温皂水灌肠;加用善宁,起始0.1mg静脉注射,后以0.6mg分24h静脉泵入;喜能静点(20g/d),均给药至梗阻解除.观察两组患者临床表现恢复情况、临床疗效、手术中转例数及住院时间.结果:对照组与治疗组相比,两组患者排气时间(70.7±10.4hvs45.3±9.8h,P<0.05),排便时间(112.4±16.8hvs70.5±12.7h,P<0.05),胃管留置时间(135.8±26.7hvs91.5±14.1h,P<0.05),饮食恢复时间(158.8±26.4hvs109.4±15.7h,P<0.05),住院时间(13.9±3.4dvs8.2±2.6d,P<0.05).对照组治愈19例,好转13例,无效8例,治疗组治愈31例,好转11例,无效3例;治疗组总有效率93.3%,而对照组仅为80.0%;对照组中转手术例数8例,治疗组仅为3例,差异均有统计学意义(P<0.05).结论:善宁、大黄附子汤及喜能三联疗法可明显改善术后急性粘连性肠梗阻患者的临床症状,促进肠道功能的恢复,降低手术中转率,缩短住院天数,值得临床应用推广.     

肌少症对老年胃癌病人术前评估与术后并发症的影响

目的探讨肌少症对老年胃癌病人术前评估与术后并发症的影响。方法回顾性分析2008~2018年南京医科大学附属南京医院收治的102例老年胃癌病人资料,根据有无肌少症分为肌少症组49例和非肌少症组53例。比较2组术前营养状况、术前住院时间、术后并发症发生率、ICU入住率与入住时间、术后住院时间、病死率等指标。结果2组病人术前Hb水平,术后腹腔感染、消化道瘘、2次及以上手术人数比例和病死率的差异均无统计学意义(P>0.05)。肌少症组术前白蛋白、前白蛋白水平低于非肌少症组,术前住院时间、术后ICU入住率、ICU入住时间、通气时间、术后住院时间、肺部感染及胸腔积液的发生率均高于非肌少症组,差异有统计学意义(P<0.05)。结论肌少症可作为老年胃癌病人术前评估的客观指标,术前合并肌少症会增加老年胃癌病人的术后并发症发生率和ICU入住率。     

Laparoscopic versus open appendectomy： Which way to go？

AIM： To compare the outcome of laparoscopic versus open appendectomy. METHODS： Prospectively collected data from 293 consecutive patients with acute appendicitis were studied. These comprised of 165 patients who underwent conventional appendectomy and 128 patients treated laparoscopically. The two groups were compared with respect to operative time, length of hospital stay, postoperative pain, complication rate and cost. RESULTS： There were no statistical differences regarding patient characteristics between the two groups. Conversion to laparotomy was necessary in 2 patients （1.5%）. Laparoscopic appendectomy was associated with a shorter hospital stay （2.2 d vs 3.1 d, P = 0.04）, and lower incidence of wound infection （5.3% vs 12.8%, P = 0.03）. However, in patients with complicated disease, intra-abdominal abscess formation was more common after laparoscopic appendectomy （5.3% vs 2.1%, P = 0.002）. The operative time and analgesia requirements were similar in the two groups. The cost of treatment was higher by 370 in the laparoscopic group. CONCLUSION： Laparoscopic appendectomy is as safe and efficient as open appendectomy, provided surgical experience and equipment are available.     

高龄患者胰十二指肠切除术分析

目的分析70岁以上老年人胰十二指肠切除术（PD）临床资料并探讨其安全性。方法回顾性分析老年人行PD的临床资料,将90例50岁以上PD手术病例分成≥70岁（高龄组,n＝27）和＜70岁（低龄组,n＝63）两组,分析两组术前Karnofsky功能状态（KPS）评分、入院时血红蛋白（Hb）、血细胞比容（Hct）、血浆白蛋白（ALB）、血清总胆红素（TBIL）、血浆前白蛋白（PALB）、血糖、血钾、手术时间、术中失血量、术后重症监护病房（ICU）入住率、术后住院日、术后并发症发生率及术后死亡率。结果高龄组与低龄组比较,术前KPS评分低[（71.11±6.98） vs （85.40±6.43）,P＜0.01]、血浆ALB低[（34.86±4.54） vs （37.02±4.13）g/L,P＜0.05]、PALB低（127.36±41.19） vs （160.27±57.11）g/L,P＜0.05）、血糖高[（8.47±3.68） vs （6.41±2.12）mmol/L,P＜0.05]、血钾低[（3.38±0.48） vs （3.81±0.45）mmol/L,P＜0.01]、术后ICU入住率高（81.48%vs 39.68%,P＜0.01）,两组间的差异均有统计学意义。两组并发症发生率差异无统计学意义（48.15% vs 39.42%,P＞0.05）。高龄组无住院期间手术死亡,低龄组有2例术后30d内死于并发症。结论严格掌握适应证,重视术前内环境调整,术后积极ICU治疗,≥70岁高龄患者行PD是安全可行的。     

老年食管癌患者术后早期肠内营养对预后影响的临床研究

目的 研究老年食管癌患者术后早期肠内营养(EEN)对预后的影响. 方法 将我院2006年1月至2011年6月收治老年食管癌手术患者120例,按不同的营养方式分为2组,EEN组60例,给予EEN支持;肠外营养(PN)组60例,常规深静脉PN,对2组老年患者术后肠功能恢复时间、住院时间、并发症的发生率以及术后1周营养、免疫等相关指标进行统计学分析. 结果 EEN组在术后患者肛门排气时间[(44.3±12.5)h比(73.6±11.8)h]、肛门排便时间[(81.5±15.1)h比(138.1±13.2)h]和住院时间[(14.0±1.9)d比(16.2±3.0)d]均短于PN组(P＜0.05);EEN组术后1周的血清白蛋白(ALB)、外周血淋巴细胞、转铁蛋白、24h尿素氮(BUN)均高于PN组;EEN组患者的IgG、IgA、IgM及CD3+、CD4+、CD8+、CD4+/CD8+外周血T淋巴细胞亚群等免疫指标较PN组均显著改善,差异均具有统计学意义(P＜0.05);2组间术后并发症发生方面比较,EEN组明显优于PN组(P＜0.05). 结论 老年食管癌患者术后EEN能促进术后代谢和免疫功能恢复、减少并发症,对患者的预后具有重要的临床意义,值得进一步推广和应用.     

Early enteral nutrition vs parenteral nutrition following pancreaticoduodenectomy: Experience from a single center

AIM: To analyze and compare postoperative morbidity between patients receiving total parenteral nutrition(TPN) and early enteral nutrition supplemented with parenteral nutrition(EEN + PN).METHODS: Three hundred and forty patients receiving pancreaticoduodenectomy(PD) from 2009 to 2013 at our center were enrolled retrospectively. Patients were divided into two groups depending on postoperative nutrition support scheme: an EEN + PN group(n = 87) and a TPN group(n = 253). Demographic characteristics, comorbidities, preoperative biochemicalparameters, pathological diagnosis, intraoperative information, and postoperative complications of the two groups were analyzed. RESULTS: The two groups did not differ in demographic characteristics, preoperative comorbidities, preoperative biochemical parameters or pathological findings(P 0.05 for all). However, patients with EEN + PN following PD had a higher incidence of delayed gastric emptying(16.1% vs 6.7%, P = 0.016), pulmonary infection(10.3% vs 3.6%, P = 0.024), and probably intraperitoneal infection(18.4% vs 10.3%, P = 0.059), which might account for their longer nasogastric tube retention time(9 d vs 5 d, P = 0.006), postoperative hospital stay(25 d vs 20 d, P = 0.055) and higher hospitalization expenses(USD10397 vs USD8663.9, P = 0.008), compared to those with TPN.CONCLUSION: Our study suggests that TPN might be safe and sufficient for patient recovery after PD. Postoperative EEN should only be performed scrupulously and selectively.     

电视胸腔镜手术在非小细胞肺癌治疗中的优势

目的探讨电视胸腔镜手术（VATS）相对于传统开胸手术在非小细胞肺癌（NSCLC）诊断和治疗中的优势。方法收集2008年11月至2010年11月行全胸腔镜肺叶切除术患者83例,并与同期97例行传统开胸肺叶切除术的患者进行比较,术前患者均行胸部CT等常规检查临床诊断为NSCLC,观察两组患者的术中出血量、手术时间、淋巴结清扫数目、术后胸腔闭式引流天数、术后住院时间,并将数据输入SPSS17．0统计软件包,计算两组均数±标准差（x±S）,统计方法采用两样本均数t检验,P≤0．05为差异有统计学意义。结果VATS组在平均术中出血量、淋巴结清扫数目、术后胸腔闭式引流天数方面与传统开胸组比较无统计学差异,而平均手术时间多于传统开胸组,术后平均住院时间少于传统开胸组,差异具有统计学意义。结论VATS在与传统开胸手术治疗NSCLC相比,其能达到相似的手术效果,并能明显减少术后并发症及术后住院时间,将手术创伤降至最低,提高患者术后生存质量。虽然有关VATS与传统手术术后生存效果的比较有待多中心、长期大宗完整病例的观察和分析。但有理由相信VATS应用前景将会更加广阔。     

Outcome of laparoscopic cholecystectomy is not influenced by chronological age in the elderly

AIM： To evaluate the outcome of laparoscopic cholecystectomy （LC） in patients aged 80 years and older.
METHODS： A total of 353 patients aged 65 to 79 years （group 1） and 35 patients aged 80 years and older （group 2） underwent LC. Patients were further classified into two other groups： those with uncomplicated gallbladder disease （group A） or those with complicated gallbladder disease （group B）.
RESULTS： There were no significant differences between the age groups （groups 1 and 2） with respect to clinical characteristics such as age, gender, comorbid disease, or disease presentation. Mean operative time, conversion rate, and the incidence of major postoperative complications were similar in groups 1 and 2. However, the percentage of high-risk patients was significantly higher in group 2 than in group 1 （20.0% vs 5.7%, P 〈 0.01）. Group A comprised 322 patients with a mean age of 71.0 ± 5.3 years, and group B comprised 51 patients with a mean age of 69.9 ± 4.8 years. Ingroup B, mean operative time （78.4 ± 49.3 min vs 58.3 ± 35.8 min, P 〈 0.01）, mean postoperative hospital stay （7.9 ± 6.5 d vs 5.0 ± 3.7 d, P 〈 0.01）, and the incidence of major postoperative complications （9.8% vs 3.1%, P 〈 0.05） were significantly greater than in group A. The conversion rate tended to be higher in group B, but this difference was not significant.
CONCLUSION： Perioperative outcomes in elderly patients who underwent LC seem to be influenced by the severity of gallbladder disease, and not by chronologic age. In octogenarians, LC should be performed at an earlier, uncomplicated stage of the disease whenever possible to improve perioperative outcomes.     

Minimally invasive spleen-preserving distal pancreatectomy: Does splenic vessel preservation have better postoperative outcomes? A systematic review and meta-analysis

BACKGROUND: Minimally invasive spleen-preserving distal pancreatectomy(SPDP) can be performed with either splenic vessel preservation(SVP) or resection [Warshaw procedure(WP)]. The aim of this study was to evaluate the postoperative clinical outcomes of patients undergoing both methods.DATA SOURCES: Database search of PubM ed, Embase, Scopus,Cochrane, and Google Scholar was performed(2000-2014); key bibliographies were reviewed. Qualified studies comparing patients undergoing SPDP with either SVP or WP, and assessing postoperative complications were included. Calculated pooled risk ratio(RR) with the corresponding 95% confidence interval(CI) by random effects methods were used in the meta-analyses. RESULTS: The search yielded 215 studies, of which only 14 observational studies met our selection criteria. The studies included 943 patients in total; 652(69%) underwent SVP and 291(31%) underwent WP. Overall, there was a lower incidence of splenic infarction(RR=0.17; 95% CI: 0.09-0.33; P0.001),gastric varices(RR=0.16; 95% CI: 0.05-0.51; P=0.002), and intra/postoperative splenectomy(RR=0.20; 95% CI: 0.08-0.49; P0.001) in the SVP group. There was no difference in incidence of pancreatic fistula(WP vs SVP, 23.6% vs 22.9%;P=0.37), length of hospital stay, operative time or blood loss. There was moderate cross-study heterogeneity.CONCLUSIONS: SVP is a safe, efficient and feasible technique that may be used to preserve the spleen. WP may be more suitable for large tumors close to the splenic hilum or those associated with splenomegaly. Randomized clinical trials are justified to examine the long-term benefits of SVP-SPDP.