手辅助腹腔镜全胃切除术治疗巨大胃淋巴瘤

目的探索手辅助方式在腹腔镜胃癌D2根治术中应用的可行性和技术路径。方法设计手术技术路径,选择1例男性78岁胃恶性淋巴瘤患者,采用手辅助方式进行全胃切除术,同时切除部分肿大的淋巴结。结果全胃切除术和部分腹腔淋巴结切除术均取得了成功,组织切缘未见肿瘤残留,腹腔淋巴结未发现肿瘤转移。手术用时206min。患者术后第3天进食流质饮食,第7天出院。结论我们设计的手术路径完成了首例手辅助腹腔镜全胃切除术,改进后可适用于手辅助腹腔镜胃癌D2根治术。     

Side-to-side esophagojejunostomy during totally laparoscopic total gastrectomy for malignant disease: a multicenter study

Background  

Esophagojejunostomy (EJS) represents the most difficult steps during totally laparoscopic total gastrectomy (TLTG). Over the past few years, several techniques have been developed. This study aimed to evaluate the feasibility and surgical outcomes of the laparoscopic intracorporeal side-to-side EJS during TLTG used to treat malignant disease of the stomach.     

腹腔镜脾部分切除术治疗脾脏良性疾病体会

目的 总结腹腔镜脾部分切除术治疗脾脏良性疾病的经验和体会.方法 回顾性分析2014年1月至2020年12月在金华市中心医院14例行腹腔镜脾部分切除术的患者临床资料.结果 14例中脾脏上叶切除8例,脾脏下叶切除6例,均顺利完成腹腔镜手术,无中转开腹,其中2例在3D腹腔镜下完成.术后病理:脾囊肿6例,血管瘤4例,脉管瘤2例...     

Initial experience with laparoscopic gastrectomy in benign and malignant tumors]

From May 1993 to May 1998 at our hospital 12 classic gastric resections were operated on by laparoscopic procedure. A 2/3 distal Billroth resection was performed in 5 patients, for gastric ulcer (2) and for GIST (3). Other 7 patients were curatively operated on for a malignant disease. Any case was resected by oncosurgical gastrectomy including a D2-lymphadenectomy. The histological diagnoses were an adenocarcinoma in 6 cases, and one highly malignant maltoma. The mean operating time was 230 min in Billroth I resections and 295 min in total gastrectomies. As a complication, we saw postoperatively a duodenal leakage in one case, we could successfully manage also laparoscopically on the day after the operation. All the courses were extremely uncomplicated, connected with rapid mobility, early gut motility, little pain, and a comfortable cosmetic result. The resection result in any case of malignoma was R0, the mean lymphonode amount was 34. Tumour cell dissemination and trokar site metastases we could'nt note either. Oncosurgically, there are no disadvantages in comparison to the open approach.     

不同入路单孔腹腔镜子宫切除术治疗子宫良性疾病的疗效分析

目的:探讨单切口腹腔镜手术、专用入路及手套入路单孔腹腔镜子宫切除术治疗子宫良性疾病的临床疗效.方法:回顾分析2018年1月至2020年9月收治的行子宫切除术的117例子宫良性疾病患者的临床资料,其中48例行专用入路单孔腹腔镜手术(A组),36例行单切口腹腔镜手术(B组),33例行手套入路单孔腹腔镜手术(C组);比较三组...     

Completely laparoscopic versus open gastrectomy for early and advanced gastric cancer: a matched cohort study

Introduction

The application of laparoscopic gastric surgery has rapidly increased for the treatment of early gastric cancer. However, laparoscopic gastrectomy for advanced tumor remains controversial, particularly in terms of oncologic outcomes. This study was designed to compare 3-year survival of laparoscopic versus open curative gastrectomy in early and advanced gastric cancer.

Methods

This was a retrospective matched cohort study. We included patients between 2003 and 2010 with an R0 resection. A totally laparoscopic technique was used and D2 lymph node dissection was practiced routinely. We performed an intracorporeal hand-sewn esophagojejunostomy in all laparoscopic total gastrectomy cases. We matched all laparoscopic cases 1:1 with open cases according to TNM AJCC seventh edition. We used Mann–Whitney or t test and Chi-square test to compare both groups. Kaplan–Meier analysis with log-rank test was performed to compare survival.

Results

We included 31 open and 31 laparoscopic cases (mean age 63?±?14?years; 66% males). Both groups were identical in type of gastrectomy (71% total and 29% subtotal). There were no statistical difference between laparoscopic and open groups in age, sex, N category, tumor location and size, histological differentiation, and T category (48% T1, 13% T2, 16% T3, and 23% T4 in both groups), with 48% early and 52% advanced tumors. The median number of resected lymph nodes was similar: 35 (23–53) for laparoscopic and 39 (23–45) for open cases (P?=?0.81). The median follow-up was 50?months. The overall 3-year survival was 82% for laparoscopic surgery and 87% for the open surgery group (P?=?0.56). There were no difference in 3-year survival for the laparoscopic versus the open surgery groups for advanced tumors (74 vs. 75%, P?=?0.88), N+?tumors (73 vs. 73%, P?=?0.99) and for the different AJCC stages (stage 1: 94 vs. 100%, stage 2: 89 vs. 82%, and stage 3: 50 vs. 50%, P?=?0.32, 0.83, and 0.98 respectively).

Conclusions

In this preliminary report, with 52% of advanced tumor, the 3-year overall and stage-by-stage survival was comparable for laparoscopic and open curative gastrectomy.     

Surgical and nutritional outcomes of laparoscopic proximal gastrectomy versus total gastrectomy: a meta-analysis

Surgical Endoscopy - Laparoscopic proximal gastrectomy (LPG) is regarded as a less invasive surgery than laparoscopic total gastrectomy (LTG) for early gastric cancer located on the proximal side...     

Role of the laparoscopic approach to biliary bypass for benign and malignant biliary diseases: a systematic review

Background  

The laparoscopic approach for biliary bypass surgery is a contemporary management option. This article reviews the evidence available for its role and effectiveness.     

完全腹腔镜与腹腔镜辅助胃癌根治术的比较

目的 研究缝合重建完全腹腔镜下胃癌根治术与腹腔镜辅助下胃癌根治术的优缺点,探讨在完全腹腔镜下缝合重建吻合方式的安全性与可行性.方法 回顾性分析2009年7月至2010年7月在第四军医大学西京消化病医院完全腹腔镜下缝合重建胃癌D2根治术与腹腔镜辅助胃癌D2根治术49例患者的临床资料,手术均由同一位经验丰富的普通外科医师完成.结果 完全腹腔镜胃癌根治21例中行远端胃切除15例,全胃切除6例,均采用镜下手工缝合胃肠吻合和空肠-空肠吻合,应用25mm管型吻合器完成食管空肠吻合;腹腔镜辅助胃癌根治28例中行远端胃切除21例,全胃切除7例.完全腹腔镜组与腹腔镜辅助组平均手术时间分别为(279±65)min、(232±40)min(P＜0.05),平均肿瘤下切缘为(3.1±0.9)cm、(2.9±0.9)cm(P＞0.05),平均上切缘为(5.7±1.5)cm、(5.1±1.4)cm(P＞0.05),两组切缘均无癌残留.完全腹腔镜组术后无需用镇痛药,腹腔镜辅助组平均使用镇痛药1.8 d;完全腹腔镜组术后通气时间为3 d,腹腔镜辅助组为4.8 d;完全腹腔镜组术后发生早期并发症2例,其中1例腹腔感染,1例肺部感染.腹腔镜辅助组2例,其中1例切口感染,1例肺部感染.术后中位随访时间4个月,两组均无吻合口瘘与狭窄发生.结论 完全腹腔镜下缝合重建的胃癌D2根治术具有可以接受的手术时间和早期并发症的发生率,可在有选择的患者中由经验丰富的外科医师应用.

Abstract：

Objectives To compare total laparoscopic gastrectomy with intracorporeal hand-sewn Gl reconstruction and laparoscopy-assisted gastrectomy for gastric cancer. Methods Between July 2009 and July 2010, 21 patients of gastric cancer underwent total laparoscopic D2 radical gastrectomy with intracorporeal hand-sewn reconstruction and 28 did laparoscopy-assisted D2 radical gastrectomy in Xijing Hospital of Digestive Diseases. All patients were operated on by an experienced surgeon. Patient demographics, TNM stage, location of tumor, the intraoperative and postoperative details of the two groups were compared. Results In the 21 patients undergoing total laparoscopic gastrectomy, there were 15 of distal gastrectomy and 6 of total gastrectomy, compared with 21 and 7 in laparoscopy-assisted group. In total laparoscopic group, intracorporeal hand-sewn technique was used for gastro-jejunal and jejuno-jejunal (J-J)anastomosis, and 25 mm circular stapler was used for esophago-jejunal anastomosis. The operation time was significant longer in total laparoscopic group than in laparoscopy-assisted group of (279 ± 65 ) min vs.(232 ±40) min (P ＜ 0.05 ). No significant difference was observed between the two groups in proximal margin [(5.7 ± 1.5 )cm vs. (5.1 ± 1.4) cm, P ＞ 0.05] and distal margin [( 3.1 ± 0.9 )cm vs. ( 2.9 ±0.9) cm,P ＞0.05]. The iv narcotic use in laparoscopy-assisted group was 1.8 d but it was not used in total laparoscopic group. The first passing flatus was on day 3 in total laparoscopic group compared with 4.8 d in laparoscopy-assisted group. Both groups had 2 postoperative early complications, one intra-abdominal infection and one lung infection in total laparoscopic group compared with one wound infection and one lung infection in laparoscopy-assisted group. There was no anastomosis-related complications after 4 months of follow-up. Conclusions The operation time and postoperative early complication was acceptable for selected patients treated by total laparoscopic D2 radical gastrectomy with intracorporeal hand-sewn GI tract reconstruction in hands of experienced laparoscopic surgeon.     

Conventional laparoscopic and robot-assisted laparoscopic liver resection for benign and malignant pathologies: a cohort study

The aim of our study was to evaluate different minimally invasive surgical approaches for liver resection in a tertiary surgical center. The study cohort comprised 104 consecutive patients who underwent total laparoscopic liver resection (n?=?17), hand-assisted laparoscopic liver resection (n?=?55), or robot-assisted laparoscopic liver resection (n?=?32) in our center between October 1998 and January 2011. Surgical complications, postoperative course, disease-free survival, and overall survival for malignancy were assessed. These 104 resections were performed on 55 men and 49 women with a mean age of 60.4?years; 43.3% of patients had liver cirrhosis. The liver pathologies comprised malignant tumors (64.4%) and benign lesions (35.6%). The most common laparoscopic liver resection was left lateral sectionectomy (53.9%), wedge resection (26.9%), segmentectomy (13.5%), right hepatectomy (3.8%), and left hepatectomy (1.9%). Conversion from laparoscopy to open approach and from laparoscopy to hand-assisted approach occurred in 1.9 and 1% of the cases, respectively. Overall mortality was 0%, and morbidity was 17.3%. The median follow-up period was 24?months. The 5-year overall survival for hepatocellular carcinoma (HCC) was 52%, and the 3-year overall survival for colorectal liver metastasis was 88%. Based on these results, we conclude that laparoscopic liver resection is feasible and safe in appropriately selected patients. In our patient cohort, it was associated with a low complications rate and favorable survival outcome.     

Comparison of laparoscopic and open gastrectomy for malignant disease

This study compares the outcome of a series of totally laparoscopic cases with that of matched open controls for the treatment of malignant gastric disease. Laparoscopic techniques can follow oncologic principles and obtain adequate margins. Short-term follow-up evaluation shows no difference in survival rates between the two approaches. BACKGROUND: Few studies have examined a totally laparoscopic approach to gastrectomy for malignancy. This is the first study to compare the outcome of a series of totally laparoscopic cases with matched open surgeries for gastric cancer. METHODS: A retrospective case-matched study was performed comparing open and laparoscopic partial gastrectomies for cancer. A total of 25 cases (12 laparoscopic and 13 open) were matched for age and indication for surgery. Stage, extent of lymphadenectomy, and survival at 18 months were examined. The intraoperative and postoperative details were compared. RESULTS: The stages ranged from I to IV, with no statistical difference between the two groups. All resected margins in the laparoscopic group were free of tumor. The extent of lymphadenectomy did not differ. Follow-up assessment at 18 months showed no difference in survival. CONCLUSIONS: Laparoscopic gastrectomy for malignancy is a viable alternative to open surgery. Laparoscopic techniques can obtain adequate margins and follow oncologic principles. Short-term follow-up evaluation shows no difference in survival rates between the two approaches.     

腹腔镜左侧结肠良恶性肿瘤手术的临床分析

目的:探讨腹腔镜左侧结肠肿瘤切除术的临床应用价值。方法:回顾性分析2008年3月至2009年12月新华医院肛肠外科收治之54例腹腔镜下左侧结肠的良恶性肿瘤切除的临床资料。结果:全部病例均顺利完成手术,无重大术中并发症发生。平均手术时间(160±35)min;术后并发症8例,其中切口感染6例,淋巴漏1例,性功能障碍1例。病人平均住院天数为9.5 d。所有病例随访至今,无切口种植,无局部复发,无远处转移及死亡病例。结论:腹腔镜左侧结肠肿瘤切除是临床上较安全可靠的手术方式。     

经脐单孔腹腔镜下胆囊切除术应用体会（附80例报告）

目的了解胆囊良性疾病行经脐单孔腹腔镜下胆囊切除术（SILC）的学习曲线。方法80例胆囊良性疾病患者按常规手术步骤行SILC,记录并分析围手术期相关资料,以手术时间定义学习曲线。结果80例患者成功接受SILC,其中胆囊结石56例,胆固醇性息肉16例,腺瘤性息肉3例,胆囊腺肌症1例和胆囊复杂病例4例,无患者中转为传统腹腔镜下胆囊切除术或开放手术。平均手术时间为（46．9±14．6）min,平均术后住院时间为（1．8±1．3）d。无围手术期并发症。学习曲线显示有经验的腹腔镜医师需要积累40例左右的手术经验才能度过学习期。结论SILC对于有经验的外科医生是一个简单而安全的手术,对于患者具有疼痛更轻微、更低的戳孔并发症、更好的美观度及更快的恢复等优点。SILC可能会成为良性胆囊疾病的另一种手术选择。     

Hand-assisted laparoscopic total gastrectomy for early gastric cancer

Laparoscopy-assisted distal gastrectomy has been applied to the treatment of early gastric cancer in Japan. However, there have been few reports on the laparoscopy-assisted total gastrectomy mainly because of the difficulty of the procedure. Here, we report a series of cases where hand-assisted laparoscopic total gastrectomies were performed successfully. The mobilization of the greater curvature was performed laparoscopically. About 7-cm mini-laparotomy was made at the epigastrium and duodenal transection was performed with linear stapler. After dissection of suprapyloric and anterosuperior lymph nodes was performed through the mini-laparotomy, dissection of lymph nodes along the celiac artery, and the left gastric artery was performed by hand-assisted laparoscopic surgery. Roux-en-Y reconstruction was performed through the mini-laparotomy. We successfully performed this procedure in 5 patients. The mean operating time and blood loss were 275 minutes and 177.5 mL, respectively. Hand-assisted laparoscopic total gastrectomy is suitable and feasible for early gastric cancer.     

Laparoscopic pancreaticoduodenectomy for benign and malignant diseases

Background Laparoscopy still is not universally accepted as an alternative approach for pancreatoduodenectomy. This study aimed to assess the feasibility and safety of laparoscopic pancreatoduodenectomy for benign and malignant lesions of the pancreas, and to examine whether this procedure obtains adequate margins and follows oncologic principles. To the best of the authors’ knowledge, their series of laparoscopic pancreatoduodenectomies is the largest reported to date. Methods A prospective study of laparoscopic pancreatoduodenectomy was undertaken between March 1999 and June 2005. The study enrolled 25 patients (16 women and 9 men) with a mean age of 62 ± 14 years. All the operations were performed in a single institution. Results The operations were performed without serious complications. Three patients underwent conversion to open surgery. For 13 patients, the anastomosis was performed intracorporeally. For the remaining 9 patients, the resection was performed laparoscopically, with the reconstruction performed through a small midline incision. There was no intraoperative mortality. The mean operating time was 287 ± 39 min, and the mean blood loss was 107 ± 48 ml. The mean time to the first bowel movement was 6 ± 1.5 days, and the mean time to independent self-care was 4.8 ± 0.8 days. Seven patients experienced postoperative complications. One patient died of a cardiac event 3 days after uncomplicated surgery. The mean hospital stay was 16.2 ± 2.7 days. All resected margins were tumor free. The mean number of retrieved lymph nodes for the malignant lesions was 18 ± 5. Conclusion: Laparoscopic pancreatoduodenectomy for selected cases of benign and malignant lesions performed by highly skilled laparoscopic surgeons is feasible and safe. This method can obtain adequate margins and follow oncological principles. Larger series and longer follow-up periods are needed to establish the current results.     

双示踪导航腹腔镜胃癌根治术的单臂开放前瞻性研究

目的探讨双示踪（吲哚菁绿联合纳米碳）导航在腹腔镜胃癌根治术中的安全性与有效性。 方法开展单臂开放前瞻性临床研究，自2021年7月至2021年9月共纳入符合纳排标准的患者共15例，入组患者同时接受吲哚菁绿与纳米碳示踪，其中吲哚菁绿注射采用腹腔镜下浆膜面“六点法”，纳米碳注射采用胃镜下黏膜面“三明治法”，实施规范化D2腹腔镜胃癌根治术及标本淋巴结检取。15例患者中男性11例（73.3%），女性4例（26.7%），平均年龄（57.1±12.8）岁，腹腔镜根治性全胃切除术（π吻合）6例（40.0%）、腹腔镜根治性远端胃大部切除术（毕Ⅱ式+Braun吻合）9例（60.0%），分析手术时长、术中出血量、术后住院天数、并发症及二次手术率、存活率，术后病理分期、各站淋巴结检取数目及总数目。 结果入选患者的平均手术时间（254.7±40.1）min，术中出血量（90.0±51.7）ml，术后住院天数（10.5±1.5）d，无严重并发症或非计划二次手术，至今均存活。各站淋巴结清扫数目不等，总清扫数为（44.6±13.1）枚。 结论双示踪（吲哚菁绿联合纳米碳）导航在腹腔镜胃癌根治术中安全有效。     

Pylorus-preserving procedure in partial and total gastrectomy

Summary 1. The operative technique and the postoperative results of the original pylorus-preserving gastrectomy (PPG) and those of the Maki procedure as applied to cases of total gastrectomy are reported briefly.2. The essence of these operations is to retain the pyloric cuff of 1.0–1.5 cm in length in order to preserve sphincteric function without the use of the drainage procedure. Ingested food was seen to empty gradually and rhythmically through the pyloric ring into the duodenum thereby avoiding dumping syndrome and reflux esophagitis.3. As gastric acidity is reduced sufficiently by PPG, this method is to be recommended for treatment of intractable gastric ulcer cases and other benign lesions in which the foci are located in the distal half of the stomach. Though the method seems to be also useful in selected cases of duodenal ulcer, stenosis at the level of the pylorus and duodenum may preclude the application of the method.4. The Maki procedure with jejunal interposition following nearly-total proximal gastrectomy is recommended in patients whose pylorus and its surroundings have remained free of tumor.     

完全性腹腔镜全结肠切除治疗家族性腺瘤性息肉病(附8例报告)

目的:探讨腹腔镜完全性全结肠切除术治疗家族性腺瘤性息肉病(fam ilial adenom atous polyposis,FAP)的可行性与安全性。方法:应用腹腔镜全结肠切除术治疗家族性腺瘤性息肉病8例,总结手术过程及术后恢复情况。结果:8例手术均获成功,下腹部正中切口长度平均为5 cm,手术时间260~340m in,术中失血约80~350m l。术后2~3d排便排气,住院时间6~10d。随访2~3个月无近期并发症发生。结论:腹腔镜完全性全结肠切除治疗FAP创伤小、恢复快,安全、可行,但尚需进一步的手术病例积累。