Objective To investigate the choleenterostomy type and the longterm results in treatment of benign diseases of biliary tract. MethodsA total of 614 cases of choleenterostomy from January 1981 to December 2000 were followed up and analysed. The original diseases: 321 were original hepatolithiasis and/or bileduct stricture (52.3%)， 106 congenital cyst of common bile duct (17.3%), 151 iatrogenic bile duct injury (24.6%) and others 36 cases (5.9%). Choledochoduodenostomy was performed in 89 cases and choledochojejunostomy in 525 cases. Five hundred and twentyfour cases have been followed up for 1 to 20 years. The rate of followup was 87.9%. ResultsIn 84.5% of the cases, excellent or good longterm results were achieved. Reoperation rate were 49.4% in cases of choledochoduodenostomy or cystoduodenostomy, 14.2% in sideside (cyst) cholangiojejunostomy and 4.4% in endside cholangiojejunostomy, respectively. Conclusion The choledochoduodenostomy should be abolished. The endside cholangiojejunostomy shoud be the best choice when it is needed to perform choledochojejunostomy in benign bile duct diseases and can promise a satisfactory longterm result.
ObjectiveTo observe the efficacy of restrictive bare stent released on the distal end of the trunk of Stanford type A aortic dissection. Methods The clinical data of 22 patients with Stanford type A aortic dissection requiring aortic arch replacement and trunk surgery and selected for restrictive bare stent placement from November 2016 to February 2018 in our hospital were retrospectively analyzed. Among them, there were 19 males and 3 females, aged 34-68 (49.72±8.05) years. The bare stent was released in the descending thoracic aorta, and the stented elephant trunk was placed in the bare stent. The aortic computerized tomography angiography was reviewed before discharge and the stent position and complications were observed. ResultsOne patient failed to be implanted with bare stents due to a greater resistance and prolapse during implantation. Bare stents were successfully implanted in the remaining 21 patients. One patient died of large-area cerebral infarction after surgery and one patient suffered paraplegia. Twenty patients who survived and successfully implanted bare stents were followed up at regular intervals for 4-21 (13.00±6.14) months. No stroke or death occurred during the follow-up. The computerized tomography angiography showed good stent morphology and position, and no displacement or type Ⅲ endoleak. No stent graft-induced new entry was found. ConclusionAs an adjunct to stented elephant trunk, the use of restrictive bare stents can reduce the possibility of recurrence of a distal stent fracture, significantly expand the narrowest segment and true lumen caliber near the endoluminal graft. Aortic remodeling works well.
Objective To investigate effects of fast track surgery (FTS) combined with laparoscopy on perioperative inflammatory mediators, immune indices, and clinical short-term recovery effect in patient with colorectal cancer. Methods A prospective randomized controlled trial was conducted. The patients underwent laparoscopic colorectal cancer surgery at the Department of Gastrointestinal Surgery, The Third People’s Hospital of Chengdu from July 2014 to March 2017 were included in this study. The patients were randomly divided into FTS group and traditional group by the random digital table. The FTS mode and the traditional method were adopted during the perioperative period in the FTS group and the traditional group respectively. The inflammatory mediators such asC reactive protein (CRP) and interleukin 6 (IL-6) and cellular immune indexes such as CD4, CD8 and CD4/CD8 on the preoperative 1 d, postoperative 1 d, 3 d and 7 d, as well as the index of clinical short-term rehabilitation were compared between these 2 groups. Results ① Eighty-four patients were included in this study, there were 43 patients in the FTS group and 41 patients in the traditional group. There were no significant differences in the baseline characteristics and the surgical-related indicators between the two groups (P>0.050). ② There were no significant difference in the levels of CRP and IL-6 between the two groups at different time points (P>0.050). The change trend of CRP and IL-6 levels in FTS group and traditional group before and after operation were the same, the CRP and IL-6 levels at the first day after operation were significantly higher than those on 1 d before operation (P<0.001), but on the 7th day after operation decreased significantly. ③ There were no significant difference of CD4, CD 8 and CD4/CD8 levels between the two groups at different time points (P>0.050). The CD4 decreased significantly in 2 groups at the first day after operation (P<0.050), it began to rise on the 3rd day after operation and was close to the preoperative level on the 7th day after operation, but the increase in the traditional group was smaller. The changes of CD8 level at different time points before and after operation were not significant in two groups (P>0.050). The changes of CD4/CD8 ratio at different time points before and after operation were not significant in two groups (P>0.050), only the first day after operation of FTS group was significantly lower than that in preoperative 1 d (P<0.001), and on the third day after operation, it increased significantly and was close to the level of 1 day before operation. ④ The time of the first postoperative anal exhaustion or defecation in the FTS group was significantly shorter than that in the traditional group (P<0.001). The overall incidence of postoperative complications and the incidence of hypoproteinemia in the FTS group were significantly lower than those in the traditional group (P<0.050). Conclusion Compared with traditional perioperative management in combination with laparoscopic surgery, FTS combined with laparoscopic surgery has no effects on postoperative inflammatory mediators and immune parameters in patient with colorectal cancer, and it could reduce complications, reduce traumatic stress, and accelerate postoperative recovery for patient with colorectal cancer.
ObjectiveTo compare the short-term clinical outcomes of laparoscopic pancreaticoduodenectomy (LPD) with open pancreatoduodenectomy (OPD).MethodsClinical data of 29 patients receiving LPD and 27 patients receiving OPD in the department of hepatobiliary surgery of the Second Affiliated Hospital of Chongqing Medical University from March 2016 to December 2018 were collected. Note that both LPD and OPD were performed by the same chief surgeon. Effectiveness and safety of LPD were compared with those of OPD.ResultsThere was no significant difference in age, sex, body mass index, total bilirubin level, direct bilirubin level, preoperative morbidities, focus size, TNM stage and ASA grade between the LPD group and the OPD group (P>0.05). The operative time of the LPD group was significantly longer than that of the OPD group ［(482±86 ) min vs. (349±73) min, P<0.01］. Patients in the LPD group had shorter postoperative anal exhaust time than that in the OPD group ［(3.3±0.8) d vs. (5.3±1.0) d , P<0.05］. There was no significant difference in the length of hospital stay after operation, blood loss in operation, transfusion, second operation, death and postoperative complications between the LPD group and the OPD group (P>0.05).ConclusionsThe preliminary results of this study suggest that compared with OPD, LPD can shorten the postoperative anal exhaust time but not increase the incidence of postoperative complications and blood loss in operation. Nevertheless, this conclusion is needed to be validated by clinical studies with large sample size.
ObjectiveTo investigate the curative effect of C-shaped mucosal resection and anastomosis above the dentate line in the treatment of mixed hemorrhoids and its effect on anal function. MethodsA total of 78 patients with degree Ⅳ mixed hemorrhoids treated in Nanjing Liuhe District People’s Hospital from June 2015 to February 2018 were retrospectively collected. The patients were divided into control group (n=39) and observation group (n=39) according to treatment methods. Patients of the control group received traditional procedure for prolapse and hemorrhoids operation, while patients of the observation group received C-shaped mucosal resection and anastomosis above the dentate line. The perioperative indexes (operation time, intraoperative blood loss, hospital stay, etc.), subjective function evaluation indexes (Wexner constipation score, Kirwan grade, etc.), clinical efficacy and recurrence rate were compared between the two groups. The random walking model was used to evaluate the clinical curative effect. ResultsThe intraoperative blood loss [(27.9±3.4) mL vs. (43.2±5.2) mL, P<0.001], 24 h visual analogue scale score [(4.2±1.5) points vs. (5.6±1.5) points, P<0.001], duration of first defecation pain [(22.1±3.2) min vs. (34.2±5.0) min, P<0.001], the time of carrying blood [(4.1±0.4) d vs. (5.7±0.6) d, P<0.001], and the time of edema [(3.2±0.6) d vs. (4.7±0.9) d, P<0.001] in the observation group were shorter (lower) than those in the control group. The difference between pre-and post-operation of Wexner constipation score [(13.2±2.4) points vs. (11.7±2.1) points, P=0.004], resting pressure [(23.1±4.9) mmHg vs. (17.8±3.4) mmHg, P<0.001] and maximum squeeze pressure [(33.5±7.3) mmHg vs. (23.1±5.6) mmHg, P<0.001] in the observation group were significantly higher than those in the control group. There was a long-term correlation between changes in random fluctuating power rate values of Wexner constipation score, Kirwan grade, rectoanal inhibitory reflex positive rate, resting pressure, maximum squeeze pressure and the surgical procedure received by the patient of the two groups. The total effective rate [97.4% (38/39) vs. 66.7% (26/39)] and non-recurrence rate [92.3% (36/39) vs. 76.9% (29/39)] in the observation group were higher than those in the control group, while there was no significant difference in the incidence of total complications between the two groups [5.1% (2/39) vs. 12.8% (5/39), P=0.235)]. ConclusionCompared with PPH, C-shaped mucosal resection and anastomosis above the dentate line for the treatment of degree Ⅳ mixed hemorrhoids can improve the therapeutic effect, reduce postoperative recurrence, maintain anal function and facilitate the recovery of patients.
Objective To investigate the clinical effect of the DaVinci robot system and laparoscopic radical gastrectomy. Methods Propensity score matching and retrospective cohort study were adopted. Data of 446 patients who underwent robotic or laparoscopic radical gastrectomy in the Department of Gastrointestinal Surgery, Xijing Hospital, the First Affiliated Hospital of Air Force Military Medical University from January 2014 to April 2021 were collected. Among them, 174 cases underwent robotic and 272 cases underwent laparoscopic surgery. Using the method of propensity score matching, 133 cases were selected from robotic operation group and laparoscopic operation group respectively as the research object. The perioperative indexes of the two groups were compared. Kaplan-Meier survival analysis was used to draw the survival curve and calculate the survival rate. Cox regression model was used to analyze the risk factor of prognosis. Results There was no significant difference in baseline data between the robotic surgery group and the laparoscopic surgery group after propensity score matching (P>0.05). The operative time of the two groups [(236.47±50.32) min vs. (230.64±44.51) min, t=1.000, P=0.318], the number of lymph nodes dissected [(23.32±6.58) vs. (23.95±6.03), t=–0.826, P=0.410], the time of first anal exhaust [(3.46±0.77) days vs. (3.38±0.75) days, t=0.882, P=0.378], and the length of postoperative hospital stay [(6.98±2.84) days vs. (6.94±3.61) days, t=0.094, P=0.925] were similar, the differences were not statistically significant. Compared with the laparoscopic surgery group, the robotic surgery group had less intraoperative bleeding [(83.76±58.23) mL vs. (116.54±58.58) mL, t=–4.577, P<0.001], but the total hospitalization expenses was higher [(10.04±1.92) ten-thousand Yuan vs. (6.80±1.27) ten-thousand Yuan, t=16.211, P<0.001]. The incidence of postoperative complications between the two groups (χ2=0.057, P=0.812) and Clavien-Dindo classification of complications (Z=–0.440, P=0.965) were similar between the two groups, the differences were not statistically significant. The 3-year survival situation was similar between the two groups (P=0.356). Body mass index [RR=0.803, 95%CI (0.698, 0.924), P=0.002], TNM-staging [Ⅱ -stage vs.Ⅰ -stage, RR=4.152, 95%CI (1.121, 15.385), P=0.033; Ⅲ -stage vs.Ⅰ -stage, RR=5.476, 95%CI (1.458, 20.558), P=0.012] and postoperative complications [with vs. without, RR=3.262, 95%CI (1.283, 8.293), P=0.013] were prognostic factors for 3-year survival. Conclusion Compared with laparoscopic radical gastrectomy, robotic radical gastrectomy has the same short-term and long-term prognosis.
ObjectiveTo compare short- and medium-term effects of Leonardo da Vinci robot-assisted and traditional mitral valvuloplasty.MethodsWe conducted a retrospective analysis of 74 patients who underwent mitral valvuloplasty in our hospital from January 2015 to March 2017. The patients were divided into two groups according to the mode of operation: a da Vinci group (n=29, 13 males, 16 females at an average age of 52 years) and a routine group (n=45, 18 males, 27 females at an average age of 53 years). The perioperative data of patients in the two groups were compared and analyzed.ResultsThere was no significant difference in sex, age, weight, height, body mass index (BMI), cardiac function (NYHA), hypertension, diabetes, postoperative blood transfusion and postoperative complications between the two groups (P>0.05). The tracheal intubation time, ICU retention time, hospital stay time, blood loss and postoperative drainage in the da Vinci group were shorter or less than those in the routine group (P<0.05). The operation time, cardiopulmonary bypass time and aortic clamping time in the da Vinci group were longer than those in the routine group (P<0.05). Different surgical procedures had no significant effect on left atrial diameter (LAD), left ventricular end-diastolic diameter (LVEDD), left ventricular ejection fraction (LVEF) and mitral regurgitation (MR) 3 years after operation. There was no interaction between the mode of operation and the time of follow-up. There was no significant difference in echocardiographic evaluation in the same period (P>0.05).ConclusionDa Vinci operation shortens the rehabilitation process of patients compared with traditional surgery. For short- and medium-term follow-up results, there is no difference between Leonardo da Vinci and traditional mitral valve surgeries, and the clinical effect of da Vinci robot-assisted mitral valvuloplasty is satisfactory, which is worthy of further clinical promotion.
Objective To compare the effect of high ligation and spot stripping (HLSS) and high ligation and foam sclerotherapy (HLFS) in the treatment of great saphenous varicose veins (GSVV). Methods A retrospective analysis was conducted on the clinical data of 385 patients with GSVV who received HLFS or HLSS treatment at Guizhou Provincial People’s Hospital from January 2018 to June 2022. The differences in surgical time, intraoperative bleeding, complications, and postoperative hospital stay between the two groups were compared. Results The surgical time, intraoperative bleeding, postoperative hospital stay, visual analog scale for pain, incidence of postoperative hematoma, skin sensory disorders, and infection in the HLFS group were less or lower than those in the HLSS group (P<0.05), but there was no statistically significant difference in recurrence rate between the two groups (P>0.05). Compared with preoperative indicators at the same group, the modified venous clinical severity score (VCSS) decreased and the chronic lower limb venous insufficiency questionnaire (CIVIQ) score increased (P<0.05). However, there was no statistically significant difference in the degree of improvement in VCSS and CIVIQ between the two groups at three months after surgery and before surgery (P>0.05). Conclusions HLFS has a definite therapeutic effect on GSVV, with smaller trauma, faster recovery after surgery, and lower incidence of postoperative complication compared to HLSS. It can be used as a surgical option for GSVV patients in clinical practice.
ObjectiveTo investigate the long-term efficacy of intersphincter approach combined with virtual solid and hanging line in the treatment of posterior high complex anal fistulas and risk factors for recurrence. Methods A total of 167 patients with posterior high complex anal fistula treated in our hospital from April 2020 to June 2023 were retrospectively included. According to different treatment methods, the patients were divided into observation group (n=88) and control group (n=79). The observation group was treated with the combination of virtual solid and hanging line via intersphincter approach, while the control group was treated with cutting and wire hanging drainage. The general clinical data, the height of the internal fistula opening and the anorectal pressure before and after 1, 2 and 3 months were compared between the two groups. The patients were divided into recurrence group (n=50) and non-recurrence group (n=117) according to the recurrence situation during the follow-up period. Univariate and multivariate logistic regression were used to analyze the risk factors of postoperative anal fistula recurrence, and Kaplan-Meier method was ued to draw relapse-free curve. ResultsCompared with the control group, the observation group had longer operative time, shorter wound healing time and shorter hospital stay (P<0.05). At 1, 2 and 3 months after operation, the anal resting pressure and maximum anal retraction pressure in the observation group were significantly increased, while the height of the inner mouth was significantly decreased, with statistical significance (P<0.05). There were statistically significant differences in age, body mass index, gender, regular dressing change to hospital after discharge, history of anal fistula surgery, clarity of internal opening and treatment methods between the recurrence group and the non-recurrence group (P<0.05). The results of multivariate logistic regression analysis showed that the independent risk factors for postoperative recurrence of patients with posterior high complicated anal fistula were that they didn’t regularly go to the hospital for dressing change after discharge, had a history of anal fistula operation, had unclear internal orifice and underwent thread-drawing drainage (P<0.05). The cumulative relapse-free rate of patients in the observation group and the control group was 84.58% and 67.73% respectively, and the difference was statistically significant (P<0.05). ConclusionsThe treatment of posterior high complex anal fistulas by intersphincter approach combined with virtual solid and hanging line has a good effect in protecting anal function and promoting wound healing. After discharge, the factors affecting postoperative recurrence in patients with posterior high complex anal fistula are not regularly changed dressing, history of anal fistula surgery, unclear internal mouth, cutting and wire hanging drainage, which should be paid attention to.
Objective To evaluate the safety and mid- to long-term efficacy of surgical correction of isolated partial anomalous pulmonary venous connection (IPAPVC). Methods We retrospectively collected consecutive patients who were diagnosed with IPAPVC and underwent surgical correction at Fuwai Hospital of Chinese Academy of Medical Sciences and Fuwai Yunnan Cardiovascular Hospital from June 2009 to May 2019, summarized the basic preoperative and intraoperative data of patients, analyzed the postoperative and mid- to long-term follow-up results. Results A total of 54 patients were enrolled, including 29 males and 25 females, with an average age of 16.20±2.40 years, ranging from 1 month to 62 years. There were 28 (51.9%) patients with varying degrees of arrhythmia, 22 (40.7%) patients with cardiac insufficiency, and 39 (72.2%) patients with pulmonary hypertension. According to Bordy's typing, 14 (25.9%) patients were classified as type A, 23 (42.6%) type B, 4 (7.4%) type C, 5 (9.3%) type D and 8 (14.8%) mixed type. Transthoracic echocardiography was performed in the whole group of patients and the accuracy of staging diagnosis was 66.7% (36/54), and cardiac CT angiography (CTA) was performed in 37 patients and the accuracy of staging diagnosis was 94.6% (35/37). All surgical procedures were assisted with cardiopulmonary bypass, aortic cross-clamping time was 0-219 (67.02±5.23) min, cardiopulmonary bypass time was 40-261 (105.09±5.23) min, and there was no serious intraoperative complication. Postoperative tracheal intubation time was 0-230 (13.33±4.20) h, intensive care unit stay was 0-13 (1.89±0.28) days, postoperative hospital stay was 5-18 (7.20±0.38) days, and follow-up time was 16-140 (62.58±5.12) months. There were 2 (3.7%) all-cause postoperative deaths, including 1 in-hospital death and 1 death during the follow-up, and there was no intraoperative death. Among the survivors, there were 3 patients with surgery-related complications: 1 patient had atrial septal defect with the second surgical treatment, 1 early obstruction of the superior vena cava and 1 arrhythmia. Two patients had complications of IPAPVC (atrial fibrillation, collateral circulation) prior to surgery and underwent the second surgery with a poor prognosis, and 1 patient had preoperative cardiac insufficiency and atrial fibrillation, whose symptoms persisted for a long time during the follow-up. Conclusion IPAPVC accounts for a lower percentage of partial anomalous pulmonary venous connection, transthoracic echocardiography combined with CTA improves diagnostic accuracy, and IPAPVC should be treated with elective surgery after diagnosis. The surgical approach should be individualized with imaging features such as disease staging, number of drains and drainage location. Surgical treatment of IPAPVC is safe and effective, and regular follow-up is warranted.