Short and long-term outcomes of laparoscopic colectomy in obese patients

AIM:To investigate the impact of laparoscopic colectomy on short and long-term outcomes in obese patients with colorectal diseases.METHODS:A total of 98 obese(body mass index>30kg/m2)patients who underwent laparoscopic(LPS)right or left colectomy over a 10 year period were identified from a prospective institutionally approved database and manually matched to obese patients who underwent open colectomy.Controls were selected to match for body mass index,site of primary disease,American Society of Anesthesiologists score,and year of surgery(±3 year).The parameters analyzed included age,gender,comorbid conditions,American Society of Anaesthesiologists class,diagnosis,procedure,and duration of operation,operative blood loss,and amount of homologous blood transfused.Conversion rate,intra and postoperative complications as were as reoperation rate,30 d and long-term morbidity rate were also analyzed.For continuous variables,the Student’s t test was used for normally distributed data the Mann-Whitney U test for nonnormally distributed data.The Pearson’sχ2tests,or the Fisher exact test as appropriate,were used for proportions.RESULTS:Conversion to open surgery was necessary in 13 of 98 patients(13.3%).In the LPS group,operative time was 29 min longer and blood loss was 78 mL lower when compared to open colectomy(P=0.03,P=0.0001,respectively).Overall morbidity,anastomotic leak and readmission rate did not significantly differ between the two groups.A trend toward a reduction of wound complications was observed in the LPS when compared to open group(P=0.09).In the LPS group,an earlier recovery of bowel function(P=0.001)and a shorter length of stay(P=0.03)were observed.After a median follow-up of 62(range 12-132)mo 23patients in the LPS group and 38 in the open group experienced long-term complications(LPS vs open,P=0.03).Incisional hernia resulted to be the most frequent long-term complication with a significantly higher occurrence in the open group when compared to the laparoscopic one(P=0.03).CONCLUSION:Laparo     

Conversion rate in 300 laparoscopic rectal resections and its influence on morbidity and oncological outcome

Introduction The negative influence of conversion from laparoscopic to open colorectal resection on early postoperative morbidity and outcome has been demonstrated several times. In this study, we analyzed the conversion rate and its influence on early postoperative morbidity and short-term oncological outcome following laparoscopic rectal resections. Methods From January 1998 to December 2006, 300 patients underwent laparoscopic resection due to rectal carcinoma at our institution. We compared the converted patient group with the non-converted patient group regarding demographical, clinical, surgical, and histological data, compounded with the early and late postoperative results. Results Two hundred seventy-four (91.3%) patients underwent laparoscopic rectal resection (LR), while conversion resection (CR) was necessary in 26 cases (8.6%). Conversion rate was 13% during the first 100 resections and decreased to 3% during the last 100 procedures (p = 0.035). Male gender, higher body mass index, and presence of T4-tumor were risk factors for conversion. Early postoperative complications were more frequent in the CR group than in the LR group. Concerning local tumor recurrence and overall survival, there was no significant difference between both groups (local recurrence, CR at 3.8% vs. LR at 4.5% and overall survival rate, CR at 76.9% vs. LR at 89.1%) after a median follow-up period of 22.5 months. Conclusion Conversion to an open procedure during laparoscopic rectal resection correlates with an increased postoperative morbidity, however, without impairment of the short-term oncological outcome. The conversion rate is minimized by the growing experience of the operating surgeon and, therefore, is a marker of the learning curve. Authors A. Agha and A. Fürst contributed equally     

腹腔镜抗反流手术术后并发症的处理

目的探讨腹腔镜抗反流手术术后并发症的评估及处理方法。 方法回顾性分析2005年9月至2014年4月,新疆维吾尔自治区人民医院施行腹腔镜抗反流手术725例患者的临床资料,并对并发症患者进行治疗分析。 结果725例患者均成功完成食管裂孔疝修补＋胃底折叠术。术后并发症患者45例,其中吞咽困难21例,食管裂孔疝复发(折叠的胃底疝入胸腔)4例,症状复发14例,胃肠胀气综合征6例。随访6个月至9年,平均36.6个月。 结论腹腔镜抗反流手术并发症的发生率及其后果主要与术前评估、术者经验、围手术期饮食指导和患者的依从性相关。     

Total mesorectal excision: Assessment of the laparoscopic approach

PURPOSE: Total mesorectal excision offers the lowest reported rates of local recurrence for rectal cancer; however, the ability to perform total mesorectal excision laparoscopically remains unproven. The aim of this study was to assess the feasibility and adequacy of a totally laparoscopic total mesorectal excision for rectal cancer. METHODS: A prospective review of all patients undergoing laparoscopic-assisted surgery for rectal cancer by a single surgeon was undertaken. These were compared with a control group undergoing open rectal resections by another colorectal consultant in the unit (n=22). Comparison of total specimen length, longitudinal and radial excision margins, and lymph node yield was made between groups. RESULTS: Of 42 laparoscopic-assisted rectal resections attempted, 14 (33 percent) were converted to open procedures and six had their dissection completed open. One resection was considered noncurative. Twenty-one total mesorectal excisions (50 percent) were completed totally laparoscopically. No significant difference was detected between groups for specimen length, radial margin, or lymph node yield. Longitudinal margin of excision was longer in the laparoscopic group (4 (3.5–5)vs. 2.5 (1.05–3.5) cm;P=0.02, Mann-Whitney). Operating time was significantly longer in the laparoscopic group (180 (168–218)vs. 125 (104–144) minutes;P=0.003, Mann-Whitney). Data are medians (inter-quartile ranges). Four patients in the laparoscopic-assisted group had clinical anastomotic leakagevs. one in the open group (P=0.329, Fisher's exact test). At median follow-up of 38 (range, 6–53) months, one local recurrence had occurred in each group and crude mortality rates were 29 and 23 percent in the laparoscopic-assisted and open groups, respectively (P=0.736, Fisher's exact test). CONCLUSION: Totally laparoscopic excision of the mesorectum is feasible in 50 percent of patients and where possible yields histologic parameters comparable to open surgery. Early survival and recurrence figures also appear to be comparable.Drs. Hartley and Mehigan are University Research Fellows supported by Autosuture UK.Read at the meeting of The American Society of Colon and Rectal Surgeons, Washington, D.C., May 1 to 6, 1999.     

Systematic review of emergent laparoscopic colorectal surgery for benign and malignant disease

Laparoscopic surgery has become well established in the management of both and malignant colorectal disease.The last decade has seen increasing numbers of surgeons trained to a high standard in minimallyinvasive surgery.However there has not been the same enthusiasm for the use of laparoscopy in emergency colorectal surgery.There is a perception that emergent surgery is technically more difficult and may lead to worse outcomes.The present review aims to provide a comprehensive and critical appraisal of the available literature on the use of laparoscopic colorectal surgery(LCS)in the emergency setting.The literature is broadly divided by the underlying pathology;that is,inflammatory bowel disease,diverticulitis and malignant obstruction.There were no randomized trials and the majority of the studies were case-matched series or comparative studies.The overall trend was that LCS is associated with shorter hospital stay,par or fewer complications but an increased operating time.Emergency LCS can be safely undertaken for both benign and malignant disease providing there is appropriate patient selection,the surgeon is adequately experienced and there are sufficient resources to allow for a potentially more complex operation.     

A comparative clinical study of short-term results of laparoscopic surgery for rectal cancer during the learning curve

Objectives The aim of this study was to assess the results of laparoscopic surgery for rectal carcinoma (LSRC) during the learning curve throughout the introduction of this technique at our medical center.Materials and methods From January 2003 to April 2004, 40 patients undergoing surgery were assigned to laparoscopic surgery group (LSG) (n=20) or conventional surgery group (CSG) (n=20). Data were prospectively collected to statistically analyze clinical, anatomopathological, and economic variables.Results Groups were comparable in age, sex, body mass index, American Society of Anesthesiologists score, surgical technique performed, tumor size and distance, Dukes’ stage, and proportion of patients with previous abdominal surgery and radiotherapy. There was no difference in operative time. LSG blood loss was lower (p<.0001). LSG peristalsis and oral intake began earlier (p<.0001). LSG hospital stay was shorter (p<.0001). Intraoperative complications (10% LSG vs 15% CSG) and overall morbidity (35% LSG vs 45% CSG) were no different. LSG did not record any anastomotic leakages. Two patients (10%) were converted to open surgery. Regarding oncologic adequacy of resection, specimen length and number of nodes harvested were no different. LSG distal and radial resection margins were greater (p<.0001; p=.03). LSG operative costs were greater (p<.0001). However, CSG hospitalization costs were higher (p<.001). There was no overall difference (p=0.1).Conclusions LSRC has been a reliable and efficient technique during the learning curve at our hospital.     

Considerations on the learning curve for laparoscopic colorectal surgery: a view from the bottom

Introduction

Those who have surmounted the learning curve for laparoscopic colorectal resection state that considerable numbers of highly selected cases should comprise a department’s early experience to ensure reliability of technique before routine implementation. The objective of this study was to determine how this advice may interrupt case flow.

Methods

Details on all colorectal operations performed in a single institution over a 4-year period were gleaned from a prospectively maintained database. Patient profiles were scrutinised to identify how the application of various published exclusion criteria would impact upon the theoretical completion rates of our proposed learning curve.

Results

In total, 317 colorectal resections were performed; 259 operations were for adenocarcinoma (including 100 rectal tumours) while 58 were for benign disease. Of those with malignancy, 25(10%) were obese, 61(24%) had previous intra-abdominal surgery, while 52(20%) were aged over 80 years and 60(23%) were ASA ¾. Strictest exclusion criteria would halve the number of cases to be commenced laparoscopically. A specialist registrar rotating through the department would have case exposure cut from a mean of 33 to 11 in 6 months under this regimen. Prioritising benign cases in the initial experience as has been recommended by certain groups would mean that, at most, 1.2 cases would be performed every 4 weeks during the learning period.

Conclusion

Although our caseload seems sufficient to allow the acquisition of expertise in a timely fashion, procedural flow would be markedly interrupted by stringent pre-selection. A low threshold for initiating the procedure laparoscopically seems a pragmatic way of ensuring departmental confidence through familiarity.

     

Single-incision laparoscopic colorectal surgery for cancer: State of art

A number of clinical trials have demonstrated that the laparoscopic approach for colorectal cancer resection provides the same oncologic results as open surgery along with all clinical benefits of minimally invasive surgery. During the last years, a great effort has been made to research for minimizing parietal trauma, yet for cosmetic reasons and in order to further reduce surgery-related pain and morbidity. New techniques, such as natural orifice transluminal endoscopic surgery (NOTES) and single-incision laparoscopy (SIL) have been developed in order to reach the goal of “scarless” surgery. Although NOTES may seem not fully suitable or safe for advanced procedures, such as colectomies, SIL is currently regarded as the next major advance in the progress of minimally invasive surgical approaches to colorectal disease that is more feasible in generalized use. The small incision through the umbilicus allows surgeons to use familiar standard laparoscopic instruments and thus, perform even complex procedures which require extraction of large surgical specimens or intestinal anastomosis. The cosmetic result from SIL is also better because the only incision is made through the umbilicus which can hide the wound effectively after operation. However, SIL raises a number of specific new challenges compared with the laparoscopic conventional approach. A reduced capacity for triangulation, the repeated conflicts between the shafts of the instruments and the difficulties to achieve a correct exposure of the operative field are the most claimed issues. The use therefore of this new approach for complex colorectal procedures might understandingly be viewed as difficult to implement, especially for oncologic cases.     

CO2 pneumoperitoneum does not enhance tumor growth and metastasis: study of a rat cecal wall inoculation model

INTRODUCTION: Although many studies have evaluated the effects of carbon dioxide pneumoperitoneum on port site recurrence, little is known about its outcome on tumor growth and metastasis. The effect of pneumoperitoneum with carbon dioxide on cecal tumor growth and metastasis was compared with laparotomy using a rat colon cancer cell line. METHODS: Time Course Study: Fifty WF/BN F₁ hybrid rats were inoculated with 2,000,000 WB2054M₅ tumor cells into the cecal wall and explored two to ten weeks after injection. Main Study: 152 rats were randomly assigned either to 6-mmHg CO₂ pneumoperitoneum (30 minutes) or 4-cm laparotomy (30 minutes) two weeks after tumor inoculation and were explored four weeks after treatment. RESULTS: Time Course Study: Thirty-seven (95 percent) of the surviving rats developed a cecal wall tumor, and there was progressive tumor growth and metastasis over the ten-week period. At six weeks, metastasis occurred to the liver in 25 percent, to the lung in 38 percent, and to the lymph node in 63 percent, and peritoneal seeding occurred in 38 percent; this time period was chosen for the main study. Main Study: At the time of treatment (2 weeks), 124 rats were eligible for randomization. One hundred two rats survived the six-week period (50 pneumoperitoneum, 52 laparotomy) and were killed. There were no differences between the CO₂ pneumoperitoneum and laparotomy groups regarding cecal tumor growth (1.043vs. 0.894 g) and metastases to the liver (32vs. 37 percent), lung (34vs. 17 percent), lymph node (84vs. 77 percent), and wound or port (20vs. 23 percent). CONCLUSIONS: A cecal wall inoculation model mimics the natural cascade of colon cancer growth and metastasis. CO₂ pneumoperitoneum did not affect the tumor growth and metastasis to the liver and other organs when compared with laparotomy in this model.Read at the meeting of The American Society of Colon and Rectal Surgeons, Boston, Massachusetts, June 24 to 29, 2000, and recipient, Chicago Society of Colon & Rectal Surgeons Award.     

腹腔镜手术与开腹手术治疗结直肠癌的临床疗效比较

目的比较腹腔镜手术与开腹手术治疗结直肠癌患者的临床疗效。方法选取2012-02~2015-10该院收治的结直肠癌患者76例,根据手术方式的不同分为腹腔镜组(n=39)和开腹组(n=37)。腹腔镜组采用腹腔镜手术治疗,开腹组采用传统开腹手术治疗,比较两组患者切口长度、手术时间、术中失血量、术后肛门排气时间、开始进流食时间、下床活动时间、住院时间、淋巴结清扫数目以及术后并发症发生情况。结果腹腔镜组切口长度、术中失血量、术后肛门排气时间、开始进流食时间、下床活动时间、住院时间均明显小于或低于开腹组,差异有统计学意义(P0.05),两组淋巴结清扫数目比较差异无统计学意义(P0.05)。腹腔镜组并发症发生率为7.69%(3/39),开腹组为27.03%(10/37),差异有统计学意义(P0.05)。结论腹腔镜下结直肠癌手术具有安全、创伤小、恢复快、并发症少等优点。     

Hand-assisted laparoscopic surgery for complex gallstone disease： A report of five cases

AIM:To describe the use of hand-assisted laparoscopic surg-ery(HALS) as an alternative to open conversion for complex gall-stone diseases, including Mirizzi syndrome (MS) and mimic MS. METHODS: Five patients with MS and mimic MS of 232 consecutive patients undergoing laparoscopic cholecyst-ectomies were analyzed. HALS without a hand-port device was performed as an alternative to open conversion if the anatomy was still unclear after the neck of the gallbladder was reached. RESULTS: HALS was performed on three patients with MS type I and 2 with mimic MS owing to an unclear or abnormal anatomy, or an unusual circumstance in which an impacted stone was squeezed out from the infundibulum or the aberrant cystic duct impossible with laparoscopic approach. The median operative time was 165 min (range, 115-190 min). The median hand-assisted time was 75 min (range, 65-100 min). The median postoperative stay was 4 d (range, 3-5 d). The postoperative course was uneventful, except for 1 patient complicated with a minor incision infection. CONCLUSION: HALS for MS type I and mimic MS is safe and feasible. It simplifies laparoscopic procedure, and can be used as an alternative to open conversion for complex gallstone diseases.     

Effect of laparoscopic abdominal surgery on splanchnic circulation: Historical developments

With the developments in medical technology and increased surgical experience, advanced laparoscopic surgical procedures are performed successfully. Laparoscopic abdominal surgery is one of the best examples of advanced laparoscopic surgery (LS). Today, laparoscopic abdominal surgery in general surgery clinics is the basis of all abdominal surgical interventions. Laparoscopic abdominal surgery is associated with systemic and splanchnic hemodynamic alterations. Inadequate splanchnic perfusion in critically ill patients is associated with increased morbidity and mortality. The underlying pathophysiological mechanisms are still not well understood. With experience and with an increase in the number and diversity of the resulting data, the pathophysiology of laparoscopic abdominal surgery is now better understood. The normal physiology and pathophysiology of local and systemic effects of laparoscopic abdominal surgery is extremely important for safe and effective LS. Future research projects should focus on the interplay between the physiological regulatory mechanisms in the splanchnic circulation (SC), organs, and diseases. In this review, we discuss the effects of laparoscopic abdominal surgery on the SC.     

Postoperative ileus: Impact of pharmacological treatment,laparoscopic surgery and enhanced recovery pathways

Almost all patients develop postoperative ileus (POI) after abdominal surgery.POI represents the single largest factor influencing length of stay (LOS) after bowel resection,and has great implications for patients and resource utilization in health care.New methods to treat and decrease the length of POI are therefore of great importance.During the past decade,a substantial amount of research has been performed evaluating POI,and great progress has been made in our understanding and treatment of POI.Laparos...     

达芬奇机器人与腹腔镜手术在直肠癌根治术中的病例对比研究

目的达芬奇机器人手术系统在直肠癌根治性切除术中的作用仍不明确。本文总结我科开展达芬奇机器人直肠癌根治手术以来的初步临床经验,对手术的安全性、术后近期疗效和并发症与腹腔镜直肠癌根治手术对比进行分析。 方法2013年11月至2014年8月我科共施行达芬奇机器人根治性直肠癌切除手术33例。选择年龄、性别、体重指数(BMI)、肿瘤部位≤15 cm和术前临床分期大致相同的33例接受腹腔镜直肠癌根治手术的患者进行病例对比研究。 结果达芬奇组较腹腔镜组术中出血量显著减少(89.1±44.5 ml vs 116.7±60.8 ml,P＝0.04),但手术时间较腹腔镜组延长(168.0±39.0 min vs 148.5±40.2 min,P＝0.05)。两组均无中转开腹病例。达芬奇组术后首次排气时间明显早于腹腔镜组(53.3±15.4 h vs 62.5±11.9 h,P<0.01),尿管拔除时间亦早于腹腔镜组(3.0±0.9 d vs 4.8±0.9 d,P<0.01)。达芬奇组术后第24小时疼痛指数明显低于腹腔镜组。两组所有患者肿瘤远侧切缘均未查见癌细胞。两组淋巴结清扫数目、肿瘤远切缘距离及术后平均住院日方面均无明显差别。术后平均随访124天(6～302天),达芬奇组和腹腔镜组各出现一例吻合口瘘,经保守治疗治愈。 结论达芬奇机器人行直肠癌根治性切除术是一项安全有效的新技术,较传统腹腔镜手术具有创伤小、术后疼痛轻、肠功能和排尿功能恢复快的优点。两者对直肠癌手术的长期疗效有待进一步观察。     

Clinical comparison of laparoscopy vs open surgery in a radical operation for rectal cancer: A retrospective case-control study

AIM: To assess the diverse immediate and long-term clinical outcomes, a retrospective comparison between laparoscopic and conventional operation was performed.METHODS: A total number of 916 clinical cases, from January 2006 to December 2013 in our hospital, were analyzed which covered 492 patients underwent the laparoscopy in radical resection (LRR) and 424 cases in open radical resection (ORR). A retrospective analysis was proceeded by comparing the general information, surgery performance, pathologic data, postoperative recovery and complications as well as long-term survival to investigate the diversity of immediate and long-term clinical outcomes of laparoscopic radical operation.RESULTS: There were no statistically significance differences between gender, age, height, weight, body mass index (BMI), tumor loci, tumor node metastasis stages, cell differentiation degree or American Society of Anesthesiologists scores of the patients (P > 0.05). In contrast to the ORR group, the LRR group experienced less operating time (P < 0.001), a lower blood loss (P < 0.001), and had a 2.44% probability of conversion to open surgery. Postoperative bowel function recovered more quickly, analgesic usage and the average hospital stay (P < 0.001) were reduced after LRR. Lymph node dissection during LRR appeared to be slightly more than in ORR (P = 0.338). There were no obvious differences in the lengths and margins (P = 0.182). And the occurrence rate in the two groups was similar (P = 0.081). Overall survival rate of ORR and LRR for 1, 3 and 5 years were 94.0% and 93.6% (P = 0.534), 78.1% and 80.9% (P = 0.284) and 75.2% and 77.0% (P = 0.416), respectively.CONCLUSION: Laparoscopy as a radical operation for rectal cancer was safe, produced better immediate outcomes. Long-term survival of laparoscopy revealed that it was similar to the open operation.     

Prospective, randomized trial examining the role of gentamycin-containing collagen sponge in the reduction of postoperative morbidity in rectal cancer patients: early results and surprising outcome at 3-year follow-up

Objective The study was carried out to evaluate the efficacy of the gentamycin collagen sponge placed in the pelvic cavity after excision of rectal cancer in view of postoperative complications and the risk of cancer recurrence.Methods A total of 229 patients were recruited into the study and randomized into two groups: GRM(+), in which a gentamycin collagen sponge was used, and GRM(–), without the sponge. Tumors were resected using a TME technique. In the GRM(+) group, the sponge was placed into the tumor bed.Results Analysis covered 218 patients for whom all follow-up data were available. There were fewer early postoperative complications in the GRM(+) group: 20.7 vs. 37.5%; p=0.044. This effect was found mainly in patients with surgery lasting longer than 3 h. After 36 months follow-up, the overall survival after R0 resection for the GRM(+) and GRM(–) groups was: 88.66 vs. 73.96%. There was significant reduction in the distant metastasis rate in favor of the GRM(+) group.Conclusion The use of the gentamycin collagen sponge after excision of rectal cancer is safe and reduces the rate of early postoperative complications. The reasons for the lower rate of distant metastasis in the GRM(+) group are not clear, but the patients enjoy significant survival benefits.     

超能剪在胃肠恶性肿瘤腹腔镜手术中的应用效果观察

目的观察超能剪在胃肠恶性肿瘤腹腔镜手术中的应用效果。方法收集2011-10~2014-10于广西壮族自治区人民医院普外科由同一手术者进行胃肠恶性肿瘤腹腔镜手术的264例患者,将其随机分为超能剪手术组148例和超声刀手术组116例,分别接受超能剪辅助的腹腔镜手术及超声刀辅助的腹腔镜手术,比较两组患者的平均手术时间、术中出血量、淋巴结清扫数量、术后3 d平均引流量、术后住院时间。结果超能剪手术组的平均手术时间明显短于超声刀组(P0.01);两组术中出血量、淋巴结清扫数量、术后3 d平均引流量、术后住院时间比较差异无统计学意义(P0.05)。结论将超能剪应用于胃肠恶性肿瘤腹腔镜手术能提高手术操作的效率,且使用成本相对较低,有较好的应用前景。     

Mechanical bowel preparation for colorectal surgery: a meta-analysis on abdominal and systemic complications on almost 5,000 patients

BACKGROUND: Several studies concluded that mechanical bowel preparation (MBP) does not confer any advantage on reducing the anastomotic leak rate or wound infections. The aim of this meta-analysis was to review all prospective randomised controlled trials on the use of MBP before colorectal surgery in order to find differences in the rates of abdominal and systemic complications in view of recent published articles. METHODS: Review of all randomised prospective trials compare MBP vs. non-MBP. Primary outcome measures were anastomotic leakages, abdomino-pelvic abscesses and postoperative ileus. Secondary outcomes were wound infections, extra-abdominal complications (urinary infections, pulmonary infections, deep venous thrombosis or pulmonary embolism, cardiac events), sepsis and mortality. RESULTS: Twelve articles met the inclusion criteria with 4,919 patients. The non-MBP group showed no significant increase of the anastomotic leakages (3.4% vs. 4.1%; p = NS) and wound infections (8.7% vs. 9.6%; p = NS) but had a lower rate of postoperative cardiac events (2.5% vs. 4.0%; p = 0.04). CONCLUSION: The evidence from recent studies, combined with previous ones, further suggests that the dogma of the necessity of mechanical bowel preparation before elective colorectal surgery should be reconsidered.     

Long-term oncologic outcomes of laparoscopic vs open surgery for stages II and III rectal cancer: A retrospective cohort study

AIM: To evaluate the 5-year survival after laparoscopic surgery vs open surgery for stages II and III rectal cancer.METHODS: This study enrolled 406 consecutive patients who underwent curative resection for stages II and III rectal cancer between January 2000 and December 2009 [laparoscopic rectal resection (LRR), n = 152; open rectal resection (ORR), n = 254]. Clinical characteristics, operative outcomes, pathological outcomes, postoperative recovery, and 5-year survival outcomes were compared between the two groups.RESULTS: Most of the clinical characteristics were similar except age (59 years vs 55 years, P = 0.033) between the LRR group and ORR group. The proportion of anterior resection was higher in the LRR group than that in the ORR group (81.6% vs 66.1%, P = 0.001). The LRR group had less estimated blood loss (50 mL vs 200 mL, P < 0.001) and a lower rate of blood transfusion (4.6% vs 11.8%, P = 0.019) compared to the ORR group. The pathological outcomes of the two groups were comparable. The LRR group was associated with faster recovery of bowel function (2.8 d vs 3.7 d, P < 0.001) and shorter postoperative hospital stay (11.7 d vs 13.7 d, P < 0.001). The median follow-up time was 63 mo in the LRR group and 65 mo in the ORR group. As for the survival outcomes, the 5-year local recurrence rate (16.0% vs 16.4%, P = 0.753), 5-year disease-free survival (DFS) rate (63.0% vs 63.1%, P = 0.589), and 5-year overall survival (OS) rate (68.1% vs 63.5%, P = 0.682) were comparable between the LRR group and the ORR group. Stage by stage, there were also no statistical differences between the LRR group and the ORR group in terms of the 5-year local recurrence rate (stage II: 6.3% vs 8.7%, P = 0.623; stage III: 26.4% vs 23.2%, P = 0.747), 5-year DFS rate (stage II: 77.5% vs 77.6%, P = 0.462; stage III: 46.5% vs 50.9%, P = 0.738), and 5-year OS rate (stage II: 81.4% vs 74.3%, P = 0.242; stage III: 53.9% vs 54.1%, P = 0.459).CONCLUSION: LRR for stages II and III rectal cancer can yield comparable long-term survival while achieving short-term benefits compared to open surgery.     

不同雾化吸入方案对老年腹部手术后肺部并发症影响的疗效观察

目的观察布地奈德混悬液联合氨溴索氧气驱动雾化吸入治疗老年腹部手术患者术后肺部行发症的效果,方法将2011年1月至2013年7月上海市安亭医院外科收治的老年腹部手术患者202例随机分为2组,每组101例所有患者均于气管内插管全凭静脉麻醉下行腹部手术治疗。治疗组采用布地奈德混悬液联合氨溴索雾化吸入,对照组采用地塞米松加糜蛋白酶、庆大霉素雾化吸入,记录和比较2组术后血常规、C反应蛋白（CRP）、血气分析、痰液量及患者的咳嗽咳痰症状评分。结果术后连续3d内2组的白细胞计数、中性粒细胞比例和CRP差异无统计学意义。术后第3天治疗组的氧分压高于对照组（P=0．000）,治疗组在痰液量、咳嗽咳痰症状改善方面优于对照组,治疗组的术后肺部并发症发病率（9．90％）比对照组（22．77％）低,两者差异有统计学意义（P=0．026）。结论布地奈德混悬液联合氨溴索雾化吸入治疗老年患者术后肺部并发症的效果优于传统的地塞米松加糜蛋白酶、庆大毒素。能改善患者术后咳嗽、咳痰症状,改善老年患者术后肺部氧合功能,能降低术后肺部行发症发病率,值得进一步推广。