Objective To compare the effect of laparoscopic surgery and open surgery on the blood coagulation state in patients with gastric cancer, and to provide evidence for the prevention measurement of thrombosis in perioperative period. Methods One hundred patients with gastric cancer who received treatment in our hospital from Feb. 2014 to Aug. 2014, were randomly divided into laparoscopy group and laparotomy group, 50 patients in each group. The patients in laparotomy group were treated by traditionally open surgery, while patients in the laparoscopy group accepted laparoscopic surgery. The clinically therapeutic effect of 2 groups was compared. Results ① Operative indexes. The operation time, blood loss, anal exhaust time, hospital stay, and morbidity of laparoscopy group were all lower than those of laparotomy group (P<0.05). ② Coagulation function. Compared with preoperative indexes, the prothrombin time (PT) at 24 h after operation in laparoscopy group and laparotomy group were both shorter (P<0.05), but there was no significant difference in activated partial thromboplastin time (APTT) and international normalized ratio (INR) between the 2 time points (before operation and 24 h after operation) in both 2 groups (P>0.05). Both at 2 time points (before operation and 24 h after operation), there was no significant difference in PT, APTT, and INR between 2 groups (P>0.05). ③ Fibrinolysis indexes. Compared with preoperative indexes, the fibrinogen (FIB) and D-dimer at 24 h after operation in laparoscopy group and laparotomy group were higher (P<0.05). The FIB and D-dimer at 24 h after operation in laparoscopy group were both higher than those of laparotomy group (P<0.05). ④ Follow-up results. There was no significant difference in metastasis rate, recurrence rate, and mortality between the 2 groups (P>0.05), but the incidence of thrombus was higher in laparoscopy group than that of laparotomy group (P<0.05). Conclusions In the treatment of patients with gastric cancer, laparoscopic surgery has the advantages of less trauma, less blood loss, less complications, and so on. Laparoscopic surgery and open surgery both can lead to hypercoagulable state, but the effect of laparoscopic surgery is stronger than open surgery.
ObjectiveTo explore the security and feasibility of simultaneous laparoscopic surgery for synchronous colorectal cancer liver metastasis (SCRLM). MethodThe data of 36 patients underwent simultaneous surgery for SCRLM in the Division of Gastrointestinal Surgery, Department of General Surgery, West China Hospital of Sichuan University from March 2015 to December 2021 were retrospectively collected, and the perioperative outcomes, postoperative morbidity and survival were analyzed. ResultsThe surgical procedure of all 36 enrolled patients were accomplished. The operation time was (328.9±85.8) min. The intraoperative blood loss was 100 (50, 150) mL and 4 cases (11.1%) needed intraoperative transfusion. The time to first flatus was (2.9±0.8) d and the time to liquid diet was (3.2±1.0) d. The average postoperative VAS score was 1.9±0.3. The postoperative length of stay was (6.8±4.3) d, 5 (13.9%) cases developed postoperative complications, which were cured by conservative treatment. No severe complications and death occurred within 30 days after surgery. After a median follow-up of 24.7 months, 15 cases (41.7%) experienced recurrence or metastasis and 1 case (2.8%) died. The 1-, 2- and 3-year disease-free survival rates were 89.8%, 55.0%, 29.2%, respectively. The 1-, 2- and 3-year overall survival rates were 100.0%, 100.0%, 87.5%, respectively. There was no significant differences in disease-free survival rates (χ2=1.675, P=0.196) and OS (χ2=0.600, P=0.439) between patients with (n=26) or without (n=10) neoadjuvant. ConclusionsSimultaneous laparoscopic surgery seems to be a secure and feasible strategy for patients with SCRLM, with considerable survival benefits and short-term outcomes including small incision, little bleeding, quick recovery and low complication rate. More high-quality clinical studies are desirable in the future to further confirm the efficacy and safety of this operation.
ObjectiveTo summary the standard treatment for early gastric cancer. MethodsThe current early gastric cancer treatment guidelines around the world were analyzed and the standardized treatment patterns for early gastric cancer were concluded. ResultsThe accurate preoperative evaluation for early gastric cancer is the basis of standardized treatment which can be divided into staging evaluation and histological evaluation.The staging evaluation is focused on the gastric wall invasion and lymph node involvement of the tumor while the histologic evaluation emphasize the histological type and grading of the tumor.According to the precise evaluation for early gastric cancer, endoscopic surgery, laparoscopic surgery, open surgery, and multimodal therapy can be applied individually to the patients.Different treatment methods have their indications, but the indications of the therapies in different guidelines are suggested with slight differences. ConclusionIn clinical practice, the choice of treatment should be made with comprehensive consideration of diagnosis and individual characteristics of patients to achieve the most benefit on prognosis.
ObjectiveTo study the significance, methods, and technique of group No.6 lymphadenectomy of the laparoscopic gastrectomy with D2 lymph node dissection for distal gastric cancer. MethodsThe relevant data of the 141 examples of group No.6 lymphadenectomy of the laparoscopic gastrectomy with D2 lymph node dissection for distal gastric cancer from Jan.1, 2008 to Dec.31, 2011 were retrospectively analysized. ResultsOne hundred and forty-one patients were successfully completed the group No.6 lymphadenectomy of laparoscopic distal gastrectomy with D2 lymph node dissection. With the number of cases of operation increasing, the operation time, bleeding volume, incidence rate of complication, and the number of operation transit cases stepped down year by year, and the number of the lymph node dissection stepped up (P < 0.000 1). No case died of the lymphadenectomy of the group No.6 lymph node. The medium vessels of colon, pancreas, and the gastroduodenal artery were the anatomic landmarks of the group No.6 lymphadenectomy. The space between the anterior lobe and the posterior lobe of transverse mesocolon and the prepancreatic space were the important surgical plane to carry out the group No.6 lymphadenectomy. ConclusionsOnly a team shall complete a certain amount of the operation, take the medium vessels of colon, pancreas, and the gastroduodenal artery as the anatomic landmark, accurately identify the space between the anterior lobe and the posterior lobe of transverse mesocolon, and the prepancreatic space, and take operation on the correct surgical plane, shall the group No.6 lymphadenectomy conform to the principle of the radical cure of the tumour and achieve the aim of the minimal invasion.
目的 探讨腹腔镜胆囊切除术（LC）中因胆囊破裂致腹腔残留胆石对术后机体的影响。方法 2001年3月至2009年8月期间广西桂东人民医院对750例胆囊结石患者进行了LC，术中穿破胆囊30例（4.0%），其中术后发现腹腔内残留胆石者10例（1.3%）。回顾性分析该10例患者的临床和随访资料。结果 本组患者住院时间2～7 d，平均4 d。随访2～36个月（平均10个月），CT、X线或B超检查8例患者腹腔仍残存明显胆石，其中1例合并有腹腔脓肿，给予抗炎治疗后症状消失（脓肿较小）； 另2例腹腔残存胆石消失。10例患者均无慢性腹痛、表皮窦道形成、肠梗阻、腹腔肿瘤等并发症。随访期间10例患者肝功能及T细胞水平与术后第2天比较，差异无统计学意义（P＞0.05），WBC水平则明显降低（P＜0.05）。结论 LC中如果无法寻找到遗留于腹腔的微小胆石时，只要常规腹腔冲洗，术后预防性应用抗生素，少数残留于腹腔的小胆石对术后机体无严重不良影响。
ObjectiveTo compare clinical outcome between single-incision laparoscopic subtotal gastrectomy (SILSG) versus laparoscopy-assisted subtotal gastrectomy (LASG) in treatment of benign gastric ulcer and duodenal ulcer. MethodsClinical data of 37 patients with benign gastric ulcer or duodenal ulcer who underwent laparoscopic subtotal gastrectomy between Jan. 2008 and Feb. 2015 at Shengjing Hospital of China Medical University was collected retrospectively. Among them, 15 patients underwent SILSG and 22 patients underwent LASG. Demographic, intraoperative, and postoperative data was analyzed and compared between the 2 groups. ResultsThe operative time of SILSG group was significantly longer than that of LASG group (P < 0.050). However, the postoperative hospital stay was significantly shorter (P < 0.050), and the total patient scar assesment scale (PSAS) score was significantly lower (P < 0.050) in the SILSG group than those of LASG group. There was no significant difference between the 2 groups with respect to other variables (P > 0.050), such as conversion rate, intraoperative blood loss, postoperative exhaust time, incidence of complication, and visual analog scale score of pain. All patients received postoperative follow up, and the period ranged from 6 months to 25 months, with a median of 11 months. During the follow up period, no one suffered from incision hernia and recurrence of ulcer. ConclusionCompared with LASG, SILSG is a technically feasible procedure with better cosmesis and equivalent curability.