腹腔镜结直肠癌根治术与开腹手术远期疗效对比

目的：对比结直肠癌分别行腹腔镜结直肠癌根治术与开腹手术所取得的远期疗效。方法选择金湖县人民医院及江苏省人民医院收治的结直肠癌116例,随机分为观察组与对照组,每组58例。对照组以开腹结直肠癌根治术治疗,观察组以腹腔镜结直肠癌根治术治疗,对比两组患者的临床资料及其远期效果。结果观察组患者的手术时间及住院时间均短于对照组（均 P ＜0．05）,术中出血量明显少于对照组（P ＜0．05）;观察组术后并发症发生率为6．9％,对照组为29．3％,两组间差异明显（P ＜0．05）。观察组术后1、3与5年生存率分别为94．8％、86．2％、77．6％,对照组为72．4％、65．5％、55．1％,两组间差异显著（均 P ＜0．05）。结论腹腔镜结直肠癌根治术与开腹手术相比较,手术时间较短,术中出血量较少,可缩短住院时间,在治疗过程中所出现的术后并发症较少,且术后的生存率较高,在临床上可优先选择腹腔镜结直肠癌根治术。     

甲状腺良性肿瘤经胸乳入路腔镜切除术与开放性手术Meta分析

目的 探讨胸乳入路腔镜甲状腺切除术与开放甲状腺切除术治疗良性甲状腺肿瘤的安全性及效果。 方法 对2015年1月1日至2018年12月31日，国内期刊发表的胸乳入路腔镜甲状腺切除术与开放甲状腺切除术在治疗良性甲状腺肿瘤方面的文章进行Meta分析。 结果 最终纳入13篇文献，累计腔镜组702例，开放组854例。腔镜组手术时间长于开放组（MD=448，95％CI：300～597，P＜005），术中出血量少于开放组（MD=-2270，95％CI：-2340～-2201，P＜005），术后住院时间少于开放组（MD=-238，95％CI：-249～-228，P＜005），术后引流量少于开放组（MD=-532，95％CI：-601～-463，P＜005），术后并发症发生率少于开放组（OR=031，95％CI：021～048，P＜005），住院费用多于开放组（MD=1 49765，95％CI：1 40386～1 59144，P＜005）。 结论 经胸乳入路腔镜手术是一种安全可靠的手术方式，具有创伤小、恢复快、术后并发症少等优势，且美容效果好，是甲状腺良性肿瘤手术的理想入路选择。     

腹腔镜结直肠癌手术的现状

腹腔镜手术具有切口小、疼痛轻、住院时间短等优点,应用于结直肠手术在技术上被证明是可行的,但是用于结直肠恶性肿瘤切除尚存在争议,主要是人们对手术的安全性和肿瘤的根治效果尚不明确。本文对近几年腹腔镜结直肠癌手术的文献进行综述,了解其手术疗效的初步结果。结论:腹腔镜用于结直肠癌根治经历了“学习曲线”阶段后,手术并发症和病死率与开腹手术相当,现有的回顾性随访资料显示,复发率和生存率与开腹手术相比也无较大差异,但缺少更有说服力的前瞻性临床随机对照研究资料。     

Laparoscopic surgery versus open surgery for colon cancer: short-term outcomes of a randomised trial

BACKGROUND: The safety and short-term benefits of laparoscopic colectomy for cancer remain debatable. The multicentre COLOR (COlon cancer Laparoscopic or Open Resection) trial was done to assess the safety and benefit of laparoscopic resection compared with open resection for curative treatment of patients with cancer of the right or left colon. METHODS: 627 patients were randomly assigned to laparoscopic surgery and 621 patients to open surgery. The primary endpoint was cancer-free survival 3 years after surgery. Secondary outcomes were short-term morbidity and mortality, number of positive resection margins, local recurrence, port-site or wound-site recurrence, metastasis, overall survival, and blood loss during surgery. Analysis was by intention to treat. Here, clinical characteristics, operative findings, and postoperative outcome are reported. FINDINGS: Patients assigned laparoscopic resection had less blood loss compared with those assigned open resection (median 100 mL [range 0-2700] vs 175 mL [0-2000], p<0.0001), although laparoscopic surgery lasted 30 min longer than did open surgery (p<0.0001). Conversion to open surgery was needed for 91 (17%) patients undergoing the laparoscopic procedure. Radicality of resection as assessed by number of removed lymph nodes and length of resected oral and aboral bowel did not differ between groups. Laparoscopic colectomy was associated with earlier recovery of bowel function (p<0.0001), need for fewer analgesics, and with a shorter hospital stay (p<0.0001) compared with open colectomy. Morbidity and mortality 28 days after colectomy did not differ between groups. INTERPRETATION: Laparoscopic surgery can be used for safe and radical resection of cancer in the right, left, and sigmoid colon.     

腹腔镜手术治疗早期胃癌的临床研究

目的探讨腹腔镜手术治疗早期胃癌的临床疗效。方法回顾性选取2016年1月至2019年6月间我院收治的82例早期胃癌患者的临床资料,按照手术方式将患者分为腹腔镜组和开腹组,分别为43例、39例。结果腹腔镜组术中出血量、腹部切口长度、肛门排气时间、下床活动时间、进流质时间、住院时间均短于开腹组(P<0.05),但是手术时间长于开腹组(P>0.05);腹腔镜组术后并发症总发生率为4.6%,低于开腹组的23.1%,差异具有统计学意义(χ~2=5.978,P<0.05);腹腔镜组患者5年复发率为4.6%,开腹组为8.3%。腹腔镜组5年生存率为95.3%,开腹组为92.3%,差异无统计学意义(χ~2=0.947,P>0.05)。结论腹腔镜手术治疗早期胃癌的近期疗效明显优于传统开腹术,两种治疗方式的远期预后相当。     

Bladder recurrence of upper urinary tract cancer after laparoscopic surgery

PURPOSE: We reviewed our cases to determine whether laparoscopic nephroureterectomy is a risk factor for the bladder recurrence. MATERIALS AND METHODS: From 1996 to 2003, 65 nephroureterectomies were performed: 47 by open and 18 by laparoscopic surgery. In 43 (28 by open, 15 by laparoscopic surgery), bladder cancer was not observed at the time of the operation. Two laparoscopic operations were converted to open surgery because of technical problems. The other 13 with laparoscopic and 28 with open surgery were enrolled into this study. RESULTS: Significantly higher recurrence rate was observed in laparoscopic cases (69.2%) than that in open cases (35.7%, P = 0.0484) by log rank test. However, the operation time required in laparoscopic surgery (371.5 +/- 90.8 min) was significantly longer than that in the open surgery (229.9 +/- 46.6 min, P < 0.0001). In multivariate analysis (Cox proportional hazards model), only the longer operation time (>250 min) was a significant variable (P = 0.0305), and laparoscopic surgery in itself was not a significant risk factor (P = 0.5011). CONCLUSIONS: Although frequent bladder recurrence was observed in laparoscopic cases, the most important risk factor was the longer operation time. Technical improvements including shortening of operation time and earlier ureteral ligation may decrease the bladder recurrence.     

肝癌腹腔镜及开腹治疗的临床疗效比较

目的:比较腹腔镜及开腹肝癌切除术的治疗效果.方法:选取2012年4月至2014年12月的22例腹腔镜肝癌切除术(腔镜组)与57例开腹肝癌切除术(开腹组)患者,对比两者的相关临床资料.结果:两组均顺利完成肝癌切除术.腔镜组术中出血量、拔管时间、术后引流量、术后住院时间均明显少于开腹组(P＜0.05),而手术时间两组无明显差异(P＞0.05),治疗后腔镜组并发症发生率、复发率、生存率依次为4.5％、0％、100％,开腹组依次为10.5％、5.3％、94.7％,两组并发症发生率差别无意义(P＞0.05),腔镜组较开腹组生存率高、复发率低(P＜0.05).术后腹腔镜组AST、ALT、ALB以及TBIL水平均明显优于开腹组(P＜0.05).结论:腹腔镜肝癌切除术安全可靠,与开腹手术比较,具有手术创伤小,术后恢复快,住院时间短的优点.     

经胸腔镜微创外科与传统手术治疗原发性纵隔肿瘤的对比分析

目的：比较胸腔镜微创外科与传统手术治疗原发性纵隔肿瘤的临床价值。方法对比性分析214例经胸腔镜微创外科或传统手术治疗的原发性纵隔肿瘤患者的临床资料。所有患者中,胸腺肿瘤108例,神经源性肿瘤29例,生殖细胞肿瘤26例,纵隔囊肿20例,间叶源性肿瘤15例,胸内异位组织肿瘤11例,淋巴瘤2例,透明血管型Castleman病2例,膈肌恶性纤维性肿瘤1例。结果经胸腔镜术式组（n＝84）与传统术式组（n＝130）的性别、年龄和手术时间比较差异均无统计学意义（均P＞0．05）,而胸腔引流量[（677．68±102．26）mL vs （723．69±124．48）mL,P＝0．005]和肿瘤最大径[（5．35±1．75）cm vs （8．61±3．91）cm,P＝0．000]比较差异均具有统计学意义。结论原发性纵隔肿瘤经胸腔镜切除是重要可行的手术方式,对于体积较大或外侵状态复杂者传统开式手术更为可取。     

Comparing laparoscopic surgery with open surgery for long-term outcomes in patients with stage I to III colon cancer

Background

Although the short-term advantages of laparoscopy for colon cancer (CC) over open surgery have been clearly demonstrated, there is little evidence available concerning the long-term outcomes. This study aimed to compare the long-term results of laparoscopic surgery versus open surgery in a cohort of CC patients from a single center.

Laparoscopic surgery in urologic oncology.

BACKGROUND: Techniques in genitourinary oncologic surgery have evolved over the past several years, shifting from traditional open approaches toward minimally invasive routes by laparoscopy. METHODS: We reviewed the literature on laparoscopic surgery for genitourinary cancer, with emphasis on contemporary indications, complications, and oncologic outcome of laparoscopic surgery for urologic malignancies. RESULTS: All urologic oncology procedures have been performed laparoscopically. Laparoscopic radical nephrectomy is becoming the preferred approach for managing kidney cancer. The initial experience with nephroureterectomy is encouraging. Laparoscopic radical prostatectomy is rapidly becoming the standard in Europe and is the procedure of choice in many centers in the United States. CONCLUSIONS: When following the open oncologic principles for the surgical treatment of malignancies, laparoscopy offers similar oncologic clinical outcomes, less morbidity, improved operative precision, and reduced convalescence time.     

妇科恶性肿瘤腹腔镜手术的研究现状

 腹腔镜手术被广泛应用于妇科恶性肿瘤的治疗,早期宫颈癌、子宫内膜癌、卵巢癌的根治性手术或分期手术几乎均可在腹腔镜下完成。其可行性和安全性在妇科恶性肿瘤临床实践中得到认可,术后随访发现腹腔镜手术与开腹手术疗效相似。腹腔镜手术治疗妇科恶性肿瘤尚有争议。气腹对肿瘤细胞恶性生物学行为的影响、穿刺孔部位种植转移的机制将是未来的研究热点。     

Right vocal cord palsy following open heart surgery

Injury to right recurrent laryngeal nerve with unilateral vocal cord paralysis is rare after thoracic surgery. The mechanism of injury to right recurrent laryngeal nerve during open heart surgery is discussed and a case is illustrated.     

Current status of robot-assisted gastric surgery

In an effort to minimize the limitations of laparoscopy,a robotic surgery system was introduced,but its role for gastric cancer is still unclear.The objective of this article is to assess the current status of robotic surgery for gastric cancer and to predict future prospects.Although the current study was limited by its small number of patients and retrospective nature,robot-assisted gastrectomy with lymphadenectomy for the treatment of gastric cancer is a feasible and safe procedure for experienced laparoscopic surgeons.Most studies have reported satisfactory results for postoperative short-term coutcomes,such as:postoperative oral feeding,gas out,hospital stay and complications,compared with laparoscopic surgery;the difference is a longer operation time.However,robotic surgery showed a shallow learning curve compared with the familarity of conventional open surgery;after the accumulation of several cases,robotic surgery could be expected to result in a similar operation time.Robotic-assisted gastrectomy can expand the indications of minimally invasive surgery to include advanced gastric cancer by improving the ability to perform lymphadenectomy.Moreover," total" robotic gastrectomy can be facilitated using a robotsewing technique and gastric submucosal tumors near the gastroesophageal junction or pylorus can be resected safely by this novel technique.In conclusion,robotassisted gastrectomy may offer a good alternative to conventional open or laparoscopic surgery for gastric cancer,provided that long-term oncologic outcomes can be confirmed.     

Is laparoscopic surgery acceptable for advanced colon cancer?

Laparoscopic surgery is widespread in the treatment of colorectal cancer. In Japan, a nationwide survey has shown that the rate of advanced colorectal cancer has increased gradually to 65% of total laparoscopic surgeries in 2007. Many randomized controlled trials have demonstrated that in the short term, laparoscopic surgery is feasible, safe, and has many benefits, including reduction of peri-operative mortality. In terms of long-term outcomes, four randomized controlled trials suggest that there are no differences in laparosupic and open surgery for colon cancer. However, important issues, including long-term oncological outcome, cost effectiveness, and the impact on the quality of life of patients, should be addressed in well-designed large-scale trials. In Japan, a retrospective multicenter study has demonstrated that the short-term outcomes of laparoscopic surgery are beneficial, and the long-term outcomes are the same as for open surgery. In 2004, a prospective large-scale randomized controlled trial (JCOG0404) to compare laparoscopic surgery with open surgery was started to evaluate oncological outcomes for advanced colon cancer. This trial is supported in part by a Grant-in-Aid for Cancer Research from the Japanese Ministry of Health, Labour, and Welfare. In the present study, laparoscopic surgery is found to be acceptable for stage I disease of colon cancer, whereas it is controversial for stage II/III disease because of inadequate clinical evidence. Whether laparoscopic surgery is acceptable for advanced colon cancer or not should be confirmed by the Japanese large-scale prospective randomized controlled trial (JCOG0404) in the near future. ( Cancer Sci 2009; 100: 567–571)     

胃癌腹腔镜辅助手术与开放手术临床疗效回顾性配对研究

目的:评价腹腔镜辅助手术应用于胃癌治疗是否具有与传统开腹手术相同的安全性及可靠性。方法:回顾性研究我院自2010年1月至2015年12月716例确诊为胃癌且行根治性手术治疗的患者。采用1∶1配对设计,最终获得行腹腔镜辅助手术和开腹手术各116例纳入本研究。对比两种手术方式在近期疗效及远期疗效方面的差异。结果:术中出血量腹腔镜组为（115.8±58.2） ml,开腹组为（185.9±165.4） ml;首次下床活动时间腹腔镜组为（2.4±0.7）天,开腹组为（3.3±1.1）天;术后肛门排气时间腹腔镜组为（3.8±1.5）天,开腹组为（4.4±1.7 ）天;术后流质饮食时间腹腔镜组为（3.9±1.5）天,开腹组为（4.7±2.3）天,以上差异均有统计学意义(P＜0.05)。腹腔镜组术中平均清扫淋巴结（24.7±12.1）枚,开腹组为（24.3±10.2）枚;术中淋巴结清扫及术后并发症方面,两组差异均无统计学意义(P＞0.05)。远期临床疗效显示,进展期胃癌患者术后3年的累积生存率腔镜组与开腹组为79.0% vs 75.8%,差异无统计学意义(P=0.236)。结论:对于胃癌患者采用腹腔镜辅助手术方式近期疗效优于开放手术,且该手术方法具有一定的安全可靠性,两者远期临床疗效相似。     

Mini-invasive surgery for colorectal cancer

Laparoscopic techniques have been extensively used for the surgical management of colorectal cancer during the last two decades. Accumulating data have demonstrated that laparoscopic colectomy is associated with better short-term outcomes and equivalent oncologic outcomes when compared with open surgery. However, some controversies regarding the oncologic quality of mini-invasive surgery for rectal cancer exist. Meanwhile, some progresses in colorectal surgery, such as robotic technology, single-incision laparoscopic surgery, natural orifice specimen extraction, and natural orifice transluminal endoscopic surgery, have been made in recent years. In this article, we review the published data and mainly focus on the current status and latest advances of mini-invasive surgery for colorectal cancer.     

Recent advances in minimally invasive colorectal cancer surgery

Laparoscopy has improved surgical treatment of various diseases due to its limited surgical trauma and has developed as an interesting therapeutic alternative for the resection of colorectal cancer. Despite numerous clinical advantages (faster recovery, less pain, fewer wound and systemic complications, faster return to work) the laparoscopic approach to colorectal cancer therapy has also resulted in unusual complications, i.e. ureteral and bladder injury which are rarely observed with open laparotomy. Moreover, pneumothorax, cardiac arrhythmia, impaired venous return, venous thrombosis as well as peripheral nerve injury have been associated with the increased intraabdominal pressure as well as patient's positioning during surgery. Furthermore, undetected small bowel injury caused by the grasping or cauterizing instruments may occur with laparoscopic surgery. In contrast to procedures performed for nonmalignant conditions, the benefits of laparoscopic resection of colorectal cancer must be weighed against the potential for poorer long-term outcomes of cancer patients that still has not been completely ruled out. In laparoscopic colorectal cancer surgery, several important cancer control issues still are being evaluated, i.e. the extent of lymph node dissection, tumor implantation at port sites, adequacy of intraperitoneal staging as well as the distance between tumor site and resection margins. For the time being it can be assumed that there is no significant difference in lymph node harvest between laparoscopic and open colorectal cancer surgery if oncological principles of resection are followed. As far as the issue of port site recurrence is concerned, it appears to be less prevalent than first thought (range 0-2.5%), and the incidence apparently corresponds with wound recurrence rates observed after open procedures. Short-term (3-5 years) survival rates have been published by a number of investigators, and survival rates after laparoscopic surgery appears to compare well with data collected after conventional surgery for colorectal cancer. However, long-term results of prospective randomized trials are not available. The data published so far indicate that the oncological results of laparoscopic surgery compare well with the results of the conventional open approach. Nonetheless, the limited information available from prospective studies leads us to propose that minimally invasive surgery for colorectal cancer surgery should only be performed within prospective trials.     

Antibiotic prophylaxis in endoscopic and minimally invasive surgery

Infections are unusual following minimally invasive surgery but antibiotic prophylaxis is given in the same way as for the open surgery equivalents. Most prophylactic regimens have not been subjected to randomised placebo controlled trials. Antibiotic prophylaxis has been shown to be beneficial in transurethral resection of the prostate. In endoscopic retrograde cholangiopancreatography (ERCP) the incidence of bacteremia, but not cholangitis, is reduced by prophylaxis and some do not recommend its routine use. For arthroscopies and laparoscopies infection is too rare to warrant prophylaxis. There is a theoretical risk of infection in that endoscopes cannot withstand autoclaving so only high level disinfection can be used between patients. However, for most minimally invasive operations, the small wound size, reduced immune challenge and rapid recovery of the patient outweigh any disadvantages compared with open surgery.     

腹腔镜与开腹Miles手术治疗低位直肠癌的临床研究

目的 对比分析腹腔镜与开腹Miles手术治疗低位直肠癌的疗效.方法 选择83例低位直肠癌患者,依据随机数字表法将患者分为腹腔镜组(n=42)和开腹组(n=41),观察记录两组患者的术中指标、术后恢复情况及术后并发症发生率.结果 腹腔镜组与开腹组患者的手术时间和淋巴结清扫数目比较,差异均无统计学意义(P﹥0.05);但腹腔镜组患者的术中出血量少于开腹组(P﹤0.05),胃肠道功能恢复时间、自主排尿时间、术后下床活动时间、术后住院时间、进食恢复时间均明显短于开腹组(P﹤0.01),并发症总发生率低于对照组(P﹤0.05).结论 腹腔镜Miles手术治疗低位直肠癌能达到开腹Miles手术的切除范围,且术中出血量少、创伤小、术后恢复快、住院时间短、术后并发症发生率低,值得临床推广应用.     

Natural orifice transendoluminal surgery and laparoendoscopic single-site surgery: the future of laparoscopic radical prostatectomy

Techniques for minimally invasive radical prostatectomy (RP) have been carefully reviewed by surgical teams worldwide in order to identify possible weaknesses and facilitate further improvement in their overall performance. The initial plan of action has been to carefully study the best-practice techniques for open RP in order to reproduce and standardize performance from the laparoscopic perspective. Similar to open surgery, the learning curve of minimally invasive RP has been well documented in terms of objective evaluation of outcomes for cancer control and functional results. Natural orifice transluminal endoscopic surgery (NOTES) and laparoendoscopic single-site surgery (LESS) have recently gained momentum as feasible techniques for minimal access urological surgery. NOTES-LESS drastically limit the surgeon's ability to choose the site of entry for operative instruments; therefore, the advantages of NOTES-LESS are gained with the understanding that the surgical procedure is more technically challenging. There are several key elements in RP techniques (in particular, dorsal vein control, apex exposure and cavernosal nerve sparing) that can have significant implications on oncologic and functional results. These steps are hard to perform in a limited working field. LESS radical prostatectomy can clearly be facilitated by using robotic technology.