ObjectiveTo compare the results of laparoscopic-endoscopic cooperative resection and open surgery for gasric stromal tumor. MethodsFrom January 2010 to March 2015, the clinical data of 56 cases undergoing laparoscopic resection for gasric stromal tumor and 53 cases of traditional operation selected during the same period were retrospectively compared. ResultsThere was no significant difference between two groups in patient's gender, age, body weight, size of tumor, tumor staging, method of operation, intraoperative conditions, postoperative overall complications, local recurrence, and distant metastasis. There were 1 case with the rupture of tumor and 1 case of open surgery transforming in laparoscopic group. In another group, there was the absence of the rupture of tumors. There was no mortality, stomach bleeding, stenosis or leakage occurred between two groups. In laparoscopic group, there were less operative blood loss and abdominal drainage, shorter time of postoperative anal exhaust time, fewer anodyne, a reduction of hospital stay than in convention operation group.However, laparoscopic resection required greater hospital costs and longer operative time. There were significant differences between two groups (P < 0.05). Conciusions With advantages of less blood loss and quicker recovery as compared to conventional operation. Laparoscopic-endoscopic cooperative resection for gasric stromal tumor has similar effect when it is performed by well selection of cases, skilled surgeon with experience on open resection for surgical treatment of gastric stromal tumor.
Objective To explore the safety, effectiveness, operation mode and clinical value of the laparoscopic colorectal resection. Methods The clinical data and experiences of laparoscopic resection for 18 cases with colorectal neoplasm from Jun. 2007 to Mar. 2008 were studied retrospectively. Results Among 18 cases, there were 5 cases of rectal cancer, 6 cases of sigmoid colon carcinoma, 2 cases of sigmoid colonic polyp, 2 cases of descending colon carcinoma, 2 cases of ascending colon carcinoma and 1 case of ascending colonic lipoma. Fifteen cases of laparoscopic colorectal resection were performed successfully, including Dixon procedure 4 cases, Miles operation 1 case, radical resection of sigmoid colon 5 cases, palliative resection of sigmoid colon 2 cases, left hemicolectomy 2 cases and right hemicolectomy 1 case. Three cases converted to laparotomy due to adiposity or advanced status of local disease. Average intraoperative blood loss was 110 ml. The average number of lymph nodes dissected was 13.5. It took about 40 hours to restore intestinal function. The average time of hospitalization was 9 days. No one died during operation and no complications such as anastomotic leakage and postoperative hemorrhage occurred. Conclusion Laparoscopic resection for colorectal neoplasms possesses less trauma and rapid postoperative recovery. Laparoscopic colorectal surgery is safe and effective with skill and indication.
Objective To explore the feasibility and safety of laparoscopic cyst resection and Roux-en-Y hepatojejunostomy in treatment for adult congenital cholangiectasis and to compare the therapeutic effects of laparoscopic procedure with conventional open procedure. Methods The clinical data of 33 adult patients with congenital cholangiectasis from May 2008 to September 2011 in the department of general surgery of Shengjing Hospital of China Medical University were retrospectively analyzed. Fourteen patients received laparoscopic procedure （laparoscopic group），whereas the other 19 patients received conventional open procedure （conventional group）. Results All the operations were carried out successfully through laparoscopic procedure. The mean time of operation in the laparoscopic group was significantly longer than that in the conventional group （195min versus 130min，P＜0.01）. The average intraoperative blood loss in the laparoscopic group was significantly less than that in the conventional group （80ml versus 270ml，P＜0.01）. In contrast，the mean time of bowel peristalsis recovery and postoperative hospital stay in the laparoscopic group were significantly shorter than those in the conventional group （time of bowel motion recovery：76h versus 104 h，P＜0.01；hospital stay：6.1 d versus 9.6 d，P＜0.01）. There were no differences in the early complications between two groups （P＞0.05）. Conclusions Totally laparoscopic treatment for congenital cholangiectasis in adult is feasible and safe. It is worth to be generally applied because of its minimal invasion and fast postoperative recovery.
ObjectiveTo investigate the effectiveness of retroperitoneal laparoscopic approach combined with anterolateral mini-incision for lumbar spine tuberculosis. MethodsA retrospective analysis was made on the cl inical data of 22 patients with lumbar spine tuberculosis undergoing focus clearance, fusion, and internal fixation by retroperitoneal laparoscopic approach combined with anterolateral mini-incision between June 2006 and June 2012. There were 14 males and 8 females, with an average age of 42.6 years (range, 26-57 years) and with a mean disease duration of 7.3 months (range, 3-10 months). There were 17 patients with single-level spinal tuberculosis (L1, 2 in 3, L2, 3 in 6, L3, 4 in 4, L4, 5 in 2, and L5 in 2) and 5 patients with double-level spinal tuberculosis (L1-3 in 2 and L2-4 in 3). The preoperative Cobb's angle of lumbar spine was 5-28° (mean, 20°). In 6 patients having compression symptom, 4 cases were rated as grade D and 2 as grade C according to Frankel classification. The operative time, intraoperative blood loss, and postoperative complications were recorded. At last follow-up, the neurologic function was assessed according to Frankel grade, the Cobb's angle after operation was measured on lumbar lateral X-ray film; the efficacy was evaluated according to Nakai criteria, and the fusion was evaluated according to Suk criteria. ResultsAll operations were successfully completed. The operation time was 110-250 minutes (mean, 140 minutes), and intraoperative blood loss was 120-280 mL (mean, 180 mL). The symptoms of femoral nerve injury and sympathetic nerve injury occurred in 1 case respectively and was relieved at 1-3 weeks after operation. All incisions healed by first intention. The patients were followed up 16-50 months (mean, 21 months). During the follow-up period, no loosening or breakage of implants and no tuberculosis recurrence were found. At last follow-up, the nerve function was recovered to grade E in the others except 1 case at grade D. The Cobb's angle was 2-16° (mean, 7.8°). According to Nakai criteria for efficacy evaluation, the results were excellent in 9 cases, good in 10 cases, and fair in 3 cases, with an excellent and good rate of 86.4%. The bony fusion rate was 95.5% (21/22) according to Suk criteria. ConclusionRetroperitoneal laparoscopic approach combined with anterolateral mini-incision for lumbar spine tuberculosis is a safe and effective approach with minimal invasion and less complications.
【Abstract】Objective To investigate the effects and advantages of laparoscopic hernioplasty for hernia. Methods From June 1995 to June 2005, 222 patients with hernia were treated with laparoscopy. Transabdominal preperitoneal hernia repair (TAPP) were performed in 166 patients. Totally extraperitoneal hernia repair(TEP) were performed in 25 patients. Closure of the internal orifice of hernia was performed in 21 patients. Furthermore, incisional hernia in 2 patients, diaphragmatic hernia in 1 patient and mesenteric hernia in 1 patient were performed by laparoscopic hernioplasty and 6 patients with hernia of oesophagus finestra performed hernioplasty combined collapse gastric fundus with laparoscopy. In this series 45 patients associated with other abdominal disease were simultaneously treated with laparoscopy. Results All cases were operated successfully. The span of operation reduration was 42.5 min 〔(10～180 min)〕. The average length of postoperative hospital stay were 4.6 days. There was one early failure owing to the use of too small a piece of mesh.Conclusion The results indicate that mesh repair of hernias is a satisfactory technique with a low recurrence rate and a low major complication rate.
ObjectiveTo compare the clinical effect of total extraperitoneal inguinal herniorrhaphy (TEP) with open and laparoscopic technique. MethodsThe clinical data of 148 patients with inguinal hernia or femoral hernia in this hospital from January 2012 to July 2013 were analyzed retrospectively, in which 74 patients received TEP with open technique (open TEP group), 74 patients received TEP with laparoscopic technique (laparoscopic TEP group). ResultsAll the operations were successfully completed.Compared with the laparoscopic TEP group, the operative time, intra-operative bleeding, and hospitalization expenses were significantly decreased in the open TEP group (P < 0.05).The post-operative exhaust time, postoperative hospital stay, and the postoperative complications rate had no significant differences between the open TEP group and the laparoscopic TEP group (P > 0.05).All the patients were followed up, no recurr-ence occurred during a 3-19 months of following-up. ConclusionsTEP with open and laparoscopic technique are both safe and efficient.The open technique has the advantages of shorter operative time, lower cost, so it is worth being widely used for primary hospital.
ObjectiveTo further explore and discuss the value of laparoscopic appendectomy. MethodsThe clinical data of 200 patients underwent appendectomy in this hospital from April 2009 to December 2010 were collected. The operation time, postoperative hospital stay, cost of hospitalization, postoperative anal exhaust time, postoperative pain score, and surgical complications were compared between laparoscopic appendectomy and open appendectomy. ResultsThere were 8 cases conversion to the open approach in this series. The cost of laparoscopic appendectomy was higher than that of open appendectomy (Plt;0.05); the cases of chronic appendicitis, acute simple appendicitis, acute suppurative appendicitis within 36 h of onset treated by laparoscopic appendectomy had shorter operation time, shorter postoperative hospital stay, earlier postoperative anal exhaust time, and slighter postoperative pain than those treated by open appendectomy (Plt;0.05); the differences in postoperative hospital stay, postoperative anal exhaust time, postoperative pain of acute suppurative appendicitis more than 36 h of onset and acute gangrenous appendicitis treated by two types of surgery had no statistical significances (Pgt;0.05); the operation time of acute gangrenous appendicitis operated by laparoscopic surgery was longer than that by open appendectomy (Plt;0.05); incision infection rate of laparoscopic appendectomy was lower than that of open appendectomy (Plt;0.05). ConclusionsFor chronic appendicitis, acute simple appendicitis, and acute suppurative appendicitis within 36 h of onset, the outcome and advantages of laparoscopic appendectomy are outstanding, the value of application is clear; and for acute suppurative appendicitis more than 36 h of onset and acute gangrenous appendicitis, laparoscopic appendectomy is difficult and with high rate of conversion, no obvious advantages in recovery after surgery but an increase of medical costs, and the application value is not great.
ObjectiveTo investigate indications,technical points,and outcomes of laparoscopic liver resection in treatment for hepatic hemangioma. MethodThe clinical data of 78 patients with hepatic hemangioma underwent laparoscopic liver resection in our institute from January 2014 to December 2014 were analyzed retrospectively. ResultsSeventy-seven patients were underwent laparoscopic liver resection successfully,1 patient was conversed to open procedure.Operation method:laparoscopic anatomical liver resections were performed in 35 patients including 23 patients with left lateral segmentectomy,4 patients with left hemihepatectomy,3 patients with right hemihepatectomy,1 patient with Ⅲ segmentectomy,1 patient with Ⅵ segmentectomy,2 patients with Ⅵ and Ⅶ segmentectomy,1 patient with left lateral segmentectomy combined with Ⅵ and Ⅶ segmentectomy.Laparoscopic non-anatomical liver resection were performed in 43 patients.The operation time was (163.6 ±62.3) min,the intraoperative blood loss was (273.6±282.4) mL.No operative death occurred.One patient with postoperative functional bowel obstruction and 3 patients with pleural effusion had been recorded.All the patients recovered well.The postoperative hospital stay was (7.2±2.5) d.The results of postoperative pathology confirmed that all the tumors were hepatic cavernous hemangiomas. ConclusionsLaparoscopic liver resection for hepatic cavernous hemangioma is a safe and feasible method with small trauma,rapid recovery,cosmetic incision.Key of this technology is to strictly select surgical indications,to transect liver parenchyma along right plane,effective control of hepatic blood inflow,and properly management of cutting surface of liver.
Objective To summarize the experiences of “three holes and one hook in the end (TOE)” laparoscopic cholecystectomy (LC) in 1 260 cases and to investigate the operation procedures, technical points and the prevention of complications. Methods The data of 1 260 patients suffering from chronic calculous cholecystitis, acute calculous cholecystitis, atrophic cholecystitis, gallbladder polyps etc., who were admitted to this hospital and treated by TOE from March 1999 to March 2008 were included and analysed retrospectively in this study. Results One thousand two hundred and sixty of cases were cured, including 1 252 cases of succeeding LC (99.37%), conversions to open in 8 cases, no death, no bile duct injury, with intraoperative hemorrhage in 3 cases, umbilicus infection in 2 cases, gallbladder fossa hydrops in 3 cases, with operation time for 8-60 min (mean 38.5 min) and hospitalization for 3-7 d (mean 5 d ) after surgery. During the follow up of 1 002 cases for 1 to 7 years (mean 3.5 years), there were no complications such as bile fistula, bile duct stricture, residual stones of biliary duct, etc.. Conclusion TOE is worthy of application and promotion for the excellent effectiveness, few complications, rapid recovery and safety.
Objective To investigate the clinical therapeutic effects of two types of vaginoplasty. Methods From January 1996 to March 2005, 63 patients wih the congenital absence of the vagina were treated by two types of vaginoplasty. Of the 63 patients, 37 underwent vaginoplasty using the amnion and 26 underwent an improved laparoscopic Vecchitti operation. The durations ofthe operation and hospitalization, as well as the blood loss were compared between the two types of vaginoplasty. The vaginal moulds were improved during the operations. Results According to the follow-up for 2 months to 4 years in the 35 patients. Compared with vaginoplasty using the amnion, vaginoplasty by an improved laparoscopic Vecchitti operation had advantages of significantly shorter surgical duration, shorter hospitalization, and less blood loss (Plt;0.05). After the operations, the artificial vagina of all the 63 patients could hold a speculum and the mucosa appeared so soft and smooth with normal lubrication. The married patients were satisfied with the intercourse. However, after vaginoplasty using the amnion, an infection of the amnion occurred in 3 patients, scar contracture in 2 patients, one of whom underwent scar incision 13 months after operation with a success; but the other refuse to accept another operation. But the improved laparoscopic Vecchitti operation achieved a success in the patients without any infectionor scar contracture, according to the 2 month-2.5 years follow-up. Conclusion The improved laparoscopic Vecchitti operation is a preferred procedure of constructing a vagina for the patients suffering from the congenital absence of the vagina.