Analysis of quality of life in patients after transgastric natural orifice transluminal endoscopic gallbladder-preserving surgery

BACKGROUND At present,laparoscopic cholecystectomy(LC)is the main surgical treatment for gallstones.But,after gallbladder removal,there are many complications.Therefore,it is hoped to remove stones while preserving the function of the gallbladder,and with the development of endoscopic technology,natural orifice transluminal endoscopic surgery came into being.AIM To compare the quality of life,perioperative indicators,adverse events after LC and transgastric natural orifice transluminal endoscopic gallbladder-preserving surgery(EGPS)in patients with gallstones.METHODS Patients who were admitted to The First Affiliated Hospital of Xinjiang Medical University from 2020 to 2022 were retrospectively collected.We adopted propen-sity score matching(1:1)to compare EGPS and LC patients.RESULTS A total of 662 cases were collected,of which 589 cases underwent LC,and 73 cases underwent EGPS.Propensity score matching was performed,and 40 patients were included in each of the groups.In the EGPS group,except the gastr-ointestinal defecation(P=0.603),the total score,physical well-being,mental well-being,and gastrointestinal digestion were statistically significant compared with the preoperative score after surgery(P<0.05).In the LC group,except the mental well-being,the total score,physical well-being,gastrointestinal digestion,the gastrointestinal defecation was statistically significant compared with the preoperative score after surgery(P<0.05).When comparing between groups,gastrointestinal defecation had significantly difference(P=0.002)between the two groups,there was no statistically significant difference in the total postoperative score and the other three subscales.In the surgery duration,hospital stay and cost,LC group were lower than EGPS group.The recurrence factors of gallstones after EGPS were analyzed:and recurrence was not correlated with gender,age,body mass index,number of stones,and preoperative score.CONCLUSION Whether EGPS or LC,it can improve the patient’s symptoms,and the EGPS has less impact on the patient’s defecation.It needed to,prospective,multicenter,long-term follow-up,large-sample related studies to prove.

Spleen-preserving distal pancreatectomy from multi-port to reducedport surgery approach

BACKGROUND Minimally invasive pancreatic surgery via the multi-port approach has become a primary surgical method for distal pancreatectomy(DP)due to its advantages of lower wound pain and superior cosmetic results.Some studies have applied reduced-port techniques for DP in an attempt to enhance cosmetic outcomes due to the minimally invasive effects.Numerous recent review studies have compared multi-port laparoscopic DP(LDP)and multi-port robotic DP(RDP);most of these studies concluded multi-port RDP is more beneficial than multi-port LDP for spleen preservation.However,there have been no comprehensive reviews of the value of reduced-port LDP and reduced-port RDP.AIM To search for and review the studies on spleen preservation and the clinical outcomes of minimally invasive DP that compared reduced-port DP surgery with multi-port DP surgery.METHODS The PubMed medical database was searched for articles published between 2013 and 2022.The search terms were implemented using the following Boolean search algorithm:(“distal pancreatectomy”OR“left pancreatectomy”OR“peripheral pancreatic resection”)AND(“reduced-port”OR“single-site”OR“single-port”OR“dual-incision”OR“single-incision”)AND(“spleen-preserving”OR“spleen preservation”OR“splenic preservation”).A literature review was conducted to identify studies that compared the perioperative outcomes of reduced-port LDP and reduced-port RDP.RESULTS Fifteen articles published in the period from 2013 to 2022 were retrieved using three groups of search terms.Two studies were added after manually searching the related papers.Finally,10 papers were selected after removing case reports(n=3),non-English language papers(n=1),technique papers(n=1),reviews(n=1),and animal studies(n=1).The common items were defined as items reported in more than five papers,and data on these common items were extracted from all papers.The ten studies included a total of 337 patients(females/males:231/106)who underwent DP.In total,166 patients(females/males,106/60)received multi-port LDP,126(females/males,90/36)received reduced-port LDP,and 45(females/males,35/10)received reduced-port RDP.CONCLUSION Reduced-port RDP leads to a lower intraoperative blood loss,a lower postoperative pancreatic fistula rate,and shorter hospital stay and follow-up duration,but has a lower spleen preservation rate.

“Parenchyma transection-first”strategy is superior to“tunnel-first”strategy in robotic spleen-preserving distal pancreatectomy with conservation of splenic vessels

Background: Creating a tunnel between the pancreas and splenic vessels followed by pancreatic parenchyma transection(“tunnel-first” strategy) has long been used in spleen-preserving distal pancreatectomy(SPDP) with splenic vessel preservation(Kimura’s procedure). However, the operation space is limited in the tunnel, leading to the risks of bleeding and difficulties in suturing. We adopted the pancreatic “parenchyma transection-first” strategy to optimize Kimura’s procedure. Methods: The clinical data of consecutive patients who underwent robotic SPDP with Kimura’s procedure between January 2017 and September 2022 at our center were retrieved. The cohort was classified into a “parenchyma transection-first” strategy(P-F) group and a “tunnel-first” strategy(T-F) group and analyzed. Results: A total of 91 patients were enrolled in this cohort, with 49 in the T-F group and 42 in the P-F group. Compared with the T-F group, the P-F group had significantly shorter operative time(146.1 ± 39.2 min vs. 174.9 ± 46.6 min, P < 0.01) and lower estimated blood loss [40.0(20.0–55.0) m L vs. 50.0(20.0–100.0) m L, P = 0.03]. Failure of splenic vessel preservation occurred in 10.2% patients in the TF group and 2.4% in the P-F group( P = 0.14). The grade 3/4 complications were similar between the two groups( P = 0.57). No differences in postoperative pancreatic fistula, abdominal infection or hemorrhage were observed between the two groups. Conclusions: The pancreatic “parenchyma transection-first” strategy is safe and feasible compared with traditional “tunnel-first strategy” in SPDP with Kimura’s procedure.

Current status of function-preserving surgery for gastric cancer

Recent advances in diagnostic techniques have allowed the diagnosis of gastric cancer(GC)at an early stage.Due to the low incidence of lymph node metastasis and favorable prognosis in early GC,function-preserving surgery which improves postoperative quality of life may be possible.Pylorus-preserving gastrectomy(PPG)is one such function-preserving procedure,which is expected to offer advantages with regards to dumping syndrome,bile reflux gastritis,and the frequency of flatus,although PPG may induce delayed gastric emptying.Proximal gastrectomy(PG)is another functionpreserving procedure,which is thought to be advantageous in terms of decreased duodenogastric reflux and good food reservoir function in the remnant stomach,although the incidence of heartburn or gastric fullness associated with this procedure is high.However,these disadvantages may be overcome by the reconstruction method used.The other important problem after PG is remnant GC,which was reported to occur in approximately 5%of patients.Therefore,the reconstruction technique used with PG should facilitate postoperativeendoscopic examinations for early detection and treatment of remnant gastric carcinoma.Oncologic safety seems to be assured in both procedures,if the preoperative diagnosis is accurate.Patient selection should be carefully considered.Although many retrospective studies have demonstrated the utility of function-preserving surgery,no consensus on whether to adopt functionpreserving surgery as the standard of care has been reached.Further prospective randomized controlled trials are necessary to evaluate survival and postoperative quality of life associated with function-preserving surgery.

Are laparoscopic cholecystectomy and natural orifice transluminal endoscopic surgery gallbladder preserving cholecystolithotomy truly comparable?A propensity matched study

BACKGROUND Cholecystectomy is the preferred treatment option for symptomatic gallstones.However,another option is gallbladder-preserving cholecystolithotomy which preserves the normal physiological functions of the gallbladder in patients desiring to avoid surgical resection.AIM To compare the feasibility,safety and effectiveness of pure natural orifice transluminal endoscopic surgery(NOTES)gallbladder-preserving cholecystolithotomy vs laparoscopic cholecystectomy(LC)for symptomatic gallstones.METHODS We adopted propensity score matching(1:1)to compare trans-rectal NOTES cholecystolithotomy and LC patients with symptomatic gallstones.We reviewed 2511 patients with symptomatic gallstones from December 2017 to December 2020;517 patients met the matching criteria(NOTES,110;LC,407),yielding 86 pairs.RESULTS The technical success rate for the NOTES group was 98.9%vs 100%for the LC group.The median procedure time was 119 min[interquartile ranges(IQRs),95-175]with NOTES vs 60 min(IQRs,48-90)with LC(P<0.001).The frequency of post-operative pain was similar between NOTES and LC:4.7%(4/85)vs 5.8%(5/95)(P=0.740).The median duration of post-procedure fasting with NOTES was 1 d(IQRs,1-2)vs 2 d with LC(IQRs,1-3)(P<0.001).The median post-operative hospital stay for NOTES was 4 d(IQRs,3-6)vs 4 d for LC(IQRs,3-5),(P=0.092).During follow-up,diarrhea was significantly less with NOTES(5.8%)compared to LC(18.6%)(P=0.011).Gallstones and cholecystitis recurrence within a median of 12 mo(range:6-40 mo)following NOTES was 10.5%and 3.5%,respectively.Concerns regarding the presence of abdominal wall scars were present in 17.4%(n=15/86)of patients following LC(mainly women).CONCLUSION NOTES provides a feasible new alternative scar-free treatment for patients who are unwilling or unable to undergo cholecystectomy.This minimally invasive organ-sparing procedure both removes the gallstones and preserves the physiological function of the gallbladder.Reducing gallstone recurrence is essential to achieving widespread clinical adoption of NOTES.

Quality of life after laparoscopic vs open sphincter-preserving resection for rectal cancer

AIM: To compare quality of life (QoL) outcomes in Chinese patients after curative laparoscopic vs open surgery for rectal cancer. METHODS: Eligible Chinese patients with rectal cancer undergoing curative laparoscopic or open sphincterpreserving resection between July 2006 and July 2008 were enrolled in this prospective study. The QoL outcomes were assessed longitudinally using the validated Chinese versions of the European Organization for Research and Treatment of Cancer QLQ-C30 and QLQCR38 questionnaires before surgery and at 4, 8, and 12 mo after surgery. The QoL scores at the different time points were compared between the laparoscopic and open groups. A higher score on a functional scale indicated better functioning, whereas a higher score on a symptom scale indicated a higher degree of symptoms.RESULTS: Seventy-four patients (49 laparoscopic and 25 open) were enrolled. The two groups of patients were comparable in terms of sociodemographic data, types of surgery, tumor staging, and baseline mean QoL scores. There was no significant decrease from baseline in global QoL for the laparoscopic group at different time points, whereas the global QoL was worse compared to baseline beginning at 4 mo but returned to baseline by 12 mo for the open group (P = 0.019, Friedman test). Compared to the open group, the laparoscopic group had significantly better physical (89.9±1.4 vs 79.2±3.7, P = 0.016), role (85.0±3.4 vs 63.3±6.9, P = 0.005), and cognitive (73.5±3.4 vs 50.7±6.2, P = 0.002) functioning at 8 mo, fewer micturition problems at 4-8 mo (4 mo: 32.3±4.7 vs 54.7±7.1, P = 0.011; 8 mo: 22.8±4.0 vs 40.7±6.9, P = 0.020), and fewer male sexual problems from 8 mo onward (20.0±8.5 vs 76.7±14.5, P = 0.013). At 12 mo after surgery, no significant differences were observed in any functional or symptom scale between the two groups, with the exception of male sexual problems, which remained worse in the open group (29.2±11.3 vs 80.0±9.7, P = 0.026). CONCLUSION: Laparoscopic sphincter-preserving resection for rectal cancer is associated with better preservation of QoL and fewer male sexual problems when compared with open surgery in Chinese patients. These findings, however, should be interpreted with caution because of the small sample size of the study.

Roles of combined femoral and acetabular anteversion in pathological changes of hip dysplasia and hip reconstructive surgery

Combined femoral and acetabular anteversion is the sum of femoral and acetabular anteversion,representing their morphological relationship in the axial plane.Along with the increasing understanding of hip dysplasia in recent years,numerous scholars have confirmed the role of combined femoral and acetabular anteversion in the pathological changes of hip dysplasia.At present,the reconstructive surgery for hip dysplasia includes total hip replacement and redirectional hip preservation surgery.As an important surgery index,combined femoral and acetabular anteversion have a crucial role in these surgeries.Herein,we discuss the role of combined femoral and acetabular anteversion in pathological changes of hip dysplasia,total hip replacement,and redirectional hip preservation surgery.

A study evaluating the impact of nerve preserving surgery and adjuvant pelvic irradiation for rectal cancer on quality of life

Objective： Preservation of the pelvic autonomic nerves in order to lower bladder and sexual dysfunction after radical rectal cancer surgery ＆ to evaluate functional outcome, local recurrence. Methods： A prospective study was under- taken on Egyptian patients. Forty one patients participated in the study in the period from December 2002 till June 2004 where they underwent radical surgery but with preservation of the pelvic autonomic nerves this was followed by adjuvant pelvic radiotherapy. Results： Six months, 1-year and 2-year follow-up of urinary function was complete in 32 out of 41 （78%）, 30 out of 41 （73%） and 27 out of 41 patients （65%） respectively There was no statistically significant correlation between the extent of nerve preservation and the reported minor voiding dysfunction. None of the patients reported major incontinence. Six months, 1-year and 2-year follow-up of sexual function revealed that 22 out of 41 patients （53%） were sexually active. Three out of 41 patients （7.3%） developed local recurrence. 38 （92.7%） patients were free of local recurrence, regarding pa- tients who received adjuvant radiotherapy 3 out of the 34 （8.8%） patients developed local pelvic recurrence while 9 patients （26.5%） developed distant metastases （3 of them did not receive adjuvant chemotherapy）, while patients who received adju- vant chemotherapy, 2 out of 20 patients （10%） developed local recurrence while distant metastases developed in 6 patients （30%）. Conclusion： Preservation of the pelvic autonomic nerves minimizes bladder and sexual dysfunction especially in male patients after rectal cancer surgery.

Laparoscopic spleen-preserving distal pancreatectomy for pancreatic neoplasms:A retrospective study

AIM: To describe the clinical characteristics, technical procedures, and outcomes of patients undergoing laparoscopic spleen-preserving distal pancreatectomy (LSPDP) for benign and malignant pancreatic neoplasms.

Meta-analysis of subtotal stomach-preserving pancreaticoduodenectomy vs pylorus preserving pancreaticoduodenectomy

AIM: To investigate the differences in outcome following pylorus preserving pancreaticoduodenectomy(PPPD) and subtotal stomach-preserving pancreaticoduodenectomy(SSPPD).METHODS: Major databases including Pub Med(Medline), EMBASE and Science Citation Index Expanded and the Cochrane Central Register of Controlled Trials(CENTRAL) in The Cochrane Library were searched for comparative studies between patients with PPPD and SSPPD published between January 1978 and July 2014. Studies were selected based on specific inclusion and exclusion criteria. The primary outcome was delayed gastric emptying(DGE). Secondary outcomes included operation time, intraoperative blood loss, pancreatic fistula, postoperative hemorrhage, intraabdominal abscess, wound infection, time to starting liquid diet, time to starting solid diet, period of nasogastric intubation, reinsertion of nasogastric tube, mortality and hospital stay. The pooled odds ratios(OR) or weighted mean difference(WMD) with 95% confidence intervals(95%CI) were calculated using either a fixed-effects or random-effects model. RESULTS: Eight comparative studies recruiting 650 patients were analyzed, which include two RCTs, one non-randomized prospective and 5 retrospective trial designs. Patients undergoing SSPPD experienced significantly lower rates of DGE(OR = 2.75; 95%CI: 1.75-4.30, P < 0.00001) and a shorter period of nasogastric intubation(OR = 2.68; 95%CI: 0.77-4.58,P < 0.00001), with a tendency towards shorter time to liquid(WMD = 2.97, 95%CI:-0.46-7.83; P = 0.09) and solid diets(WMD = 3.69, 95%CI:-0.46-7.83; P = 0.08) as well as shorter inpatient stay(WMD = 3.92, 95%CI:-0.37-8.22; P = 0.07), although these latter three did not reach statistical significance. PPPD, however, was associated with less intraoperative blood loss than SSPPD [WMD =-217.70, 95%CI:-429.77-(-5.63); P = 0.04]. There were no differences in other parameters between the two approaches, including operative time(WMD =-5.30, 95%CI:-43.44-32.84; P = 0.79), pancreatic fistula(OR = 0.91; 95%CI: 0.56-1.49; P = 0.70), postoperative hemorrhage(OR = 0.51; 95%CI: 0.15-1.74; P = 0.29), intraabdominal abscess(OR = 1.05; 95%CI: 0.54-2.05; P = 0.89), wound infection(OR = 0.88; 95%CI: 0.39-1.97; P = 0.75), reinsertion of nasogastric tube(OR = 1.90; 95%CI: 0.91-3.97; P = 0.09) and mortality(OR = 0.31; 95%CI: 0.05-2.01; P = 0.22).CONCLUSION: SSPPD may improve intraoperative and short-term postoperative outcomes compared to PPPD, especially DGE. However, these findings need to be further ascertained by well-designed randomized controlled trials.

Function-preserving gastrectomy for gastric cancer in Japan

Surgery used to be the only therapy for gastric cancer, and since its ability to cure gastric cancer was the focus of attention, less attention was paid to functionpreserving surgery in gastric cancer, though it was studied for gastroduodenal ulcer. Maki et al developed pylorus-preserving gastrectomy for gastric ulcer in 1967. At the same time, the definition of early gastric cancer(EGC) was being considered, histopathological investigations of EGC were carried out, and the validity of modified surgery was sustained. After the development of H2-blockers, the number of operations for gastroduodenal ulcers decreased, and the number of EGC patients increased simultaneously. As a result, the indications for pylorus-preserving gastrectomy for EGC in the middle third of the stomach extended, and various alterations were added. Since then, many kinds of function-preserving gastrectomies have been performed and studied in other fields of gastric cancer, and proximal gastrectomy, jejunal pouch interposition, segmental gastrectomy, and local resection have been performed. On the other hand, from the overall perspective, it can be said that endoscopic resection, which was launched at almost the same time, is the ultimate function-preserving surgery under the current circumstances. The current function-preserving gastrectomies that are often performed and studied are pylorus-preserving gastrectomy and proximal gastrectomy. The reasons for this are that these procedures that can be performed with systemic lymph node dissection, and they include three important elements:(1) reduction of the extent of gastrectomy;(2) preservation of the pylorus; and(3) preservation of the vagal nerve. In addition, these operations are more likely to be performed with a laparoscopic approach as minimally invasive surgery. Of the above-mentioned three elements, reduction of the extent of gastrectomy is the most important in our view. Therefore, we should try to reduce the extent of gastrectomy if curability of the gastric cancer can still be achieved. However, if we preserve a wider residual stomach in functionpreserving gastrectomy, we should pay attention to the development of metachronous gastric cancer.

Advances,breakthroughs,and challenges in gastric cancer surgery

Gastric cancer(GC)remains a substantial health burden worldwide,ranking fifth in incidence and third in mortality among all cancer types.Surgeons have persistently attempted to address this growing burden through surgical management of GC encompassing various aspects of surgery,including advances in surgical techniques and tools for minimally invasive surgery,novel technology for real-time image-guided surgery,and function-preserving and oncometabolic surgeries,aimed at improving patients’quality of life.The current perspective discusses the five most critical dimensions of the recent technical improvements and conceptual changes in GC surgery.We recommend further exploration of long-term benefits of these advancements,identification of breakthrough solutions to address current challenges,and delivery of the best quality of care.

Low rectal cancer:Sphincter preserving techniques-selection of patients,techniques and outcomes

Low rectal cancer is traditionally treated by abdominoperineal resection. In recent years, several new techniques for the treatment of very low rectal cancer patients aiming to preserve the gastrointestinal continuity and to improve both the oncological as well as the functional outcomes, have been emerged. Literature suggest that when the intersphincteric resection is applied in T1-3 tumors located within 30-35 mm from the anal verge, is technically feasible, safe, with equal oncological outcomes compared to conventional surgery and acceptable quality of life. The Anterior Perineal Plan E for Ultra-low Anterior Resection technique, is not disrupting the sphincters, but carries a high complication rate, while the reports on the oncological and functional outcomes are limited. Transanal Endoscopic Micro Surgery(TEM) and Trans Anal Minimally Invasive Surgery(TAMIS) should represent the treatment of choice for T1 rectal tumors, with specific criteria according to the NCCN guidelines and favorable pathologic features. Alternatively to the standard conventional surgery, neoadjuvant chemo-radiotherapy followed by TEM or TAMIS seems promising for tumors of a local stage T1sm2-3 or T2. Transanal Total Mesorectal Excision should be performed only when a board approved protocol is available by colorectal surgeons with extensive experience in minimally invasive and transanal endoscopic surgery.

Conservative laparoscopic surgery of adnex torsion for fertility preservation

Objectives:To evaluate the safety and efficacy of conservative laparoscopic surgery for adnexal torsion and the feasibility of secondary operation.Methods:This is a retrospective study that consists of 17 patients with clinically diagnosed adnexal torsion who have a desire for pregnancy in the future.We performed conservative laparoscopic adnexal detorsion operations from January 2014 to June 2016 in Sir Run Run Shaw Hospital.The collected data,including age,onset time,maximum diameter of adnexal lesion,local blood flow signal,torsion degree,and recovery of local blood supply after detorsions,were analyzed.The blood flow of the lesion side,the antral follicles development,the basal endocrine hormone levels and the menstrual cycle were examined one-month and three-month post operation.Future fertility was investigated postoperatively.Results:All cases had no obvious clinical postoperative complications.There were no significant changes on menstrual cycle and ovarian function during the follow-up period.Conclusions:Adnexal torsion in young patients should be carefully treated and fertility reservation should be thoroughly considered.The decision to remove adnexa needs careful consideration.Conservative laparoscopic surgery is safe and does not increase the occurrence of serious complications.There is a higher possibility of a long delay between surgery and onset necrosis,but this is not always the case.Even if there is adnex thromboembolic infarction it does not result in serious complications such as pulmonary infarction.Conservative laparoscopic surgery can be performed first unless the clinician is certain it is already necrotic.We should do our best to reserve patients’fertility as much as possible.If necessary,a secondary surgery can be performed.

Laparoscopic duodenum-preserving total pancreatic head resection, current status and future trends

A recent article published in Surgical Endoscopy entitled“Laparoscopic duodenum-preserving total pancreatic head resection:a novel surgical approach for benign or low-grade malignant tumors”(Surgical Endoscopy 2019;33:633e638)is probably the main reason why Professor Xiujun Cai,Editor-in-Chief of Laparoscopic,Endoscopic and Robotic Surgery sent an email to me on July 8,2019,requesting me to write an Editorial related to this topic.The readers of this journal may wonder why this topic is so important in the eyes of Professor Cai who himself is a world-renowned laparoscopic hepatopancreaticobiliary surgeon?Why is this published article so important in my eyes that I am willing to spend time in my busy daily schedule to write this Editorial?

Development history of hysteromyoma surgery with uterus preservation and introduction to each operation

Hysteromyoma is a gynecological multiple benign tumor disease,but it will still affect women's physical and mental health and may become malignant tumors.Therefore,it is necessary to treat it as soon as possible.Due to the lack of safe and effective medicine treatment with low recurrence rate,surgery is still the main treatment.Surgical treatment has a long history.This article introduces the history of surgical treatment of hysteromyoma.The earliest and most widely implemented is Laparoscopic myomectomy,which began in the 1920s.With the development of science and technology,Laparoscopic myomectomy,Hysteroscopic myomectomy and Transvaginal myomectomy in the late twentieth century gradually made the treatment of hysteromyoma minimally invasive.In recent years,laparoscopic uterine vascular occlusion combined with hysteromyomectomy,uterine artery embolization and high-intensity focused ultrasound have gradually appeared,and the treatment methods of hysteromyoma are becoming more and more perfect.

SADI-S with Extended Duodeno-Bulb Preservation: Case Report

Obesity has been growing in Brazil and in the world. It is reaching epidemic proportions, and bariatric surgery is the most effective treatment for patients with this disease. Among the procedures described in the literature, ileal surgeries such as biliopancreatic diversion with duodenal switch (BPD-DS) and single-anastomosis duodeno-ileal bypass with sleeve gastrectomy (SADI-S) present better long-term results in terms of weight loss and comorbidities control. However, there are concerns regarding long term nutritional problems with these procedures. In this case report the aim is to demonstrate the technical feasibility of preserving an extended duodenal bulb segment, in the SADIS-S procedure, when there are difficulties in dissecting the retrobulbar region, as occurred here, due to fibrosis in this area. This assures the maintenance of the proposed surgical technique, in such a situation. The dissection and transection of the duodenum was done 7 cm distally to the pylorus, under endoscopic view, proximally to the papillae, where the tissue was normal. Additionally, due the importance of the duodenal mucosa on minerals and trace elements absorption and the release of important hormones in this region, this case report elicits the evaluation of the impact of this technical modification, which occurred casually, in the nutritional, hormonal and metabolic results, long term. In this case report, the extended duodenal length has demonstrated reasonable weight loss, adequate comorbidities control and good nutritional status, so far. These aspects must be evaluated in the long term, by clinical trials.

显微镜下保留睾丸的睾丸良性肿瘤切除术临床疗效分析(附16例报道)

目的:探讨显微外科手术技术应用于保留睾丸的睾丸良性肿瘤切除术的安全性及临床疗效。方法:回顾性分析2020年10月至2023年2月青岛大学附属医院男科收治的16例睾丸肿瘤患者的病例资料。患者中位年龄23岁,睾丸肿瘤均为单侧,左侧7例,右侧9例,睾丸肿瘤最长径1.0~3.5 cm(中位数1.85 cm)。患者均在术前完善阴囊彩超(CDFI)、磁共振(MRI)、精液、血清睾酮、甲胎蛋白(AFP)、人绒毛膜促性腺激素(hCG)、乳酸脱氢酶(LDH)检查。16例患者均行显微镜下保留睾丸的睾丸肿瘤切除术(TSMS),术中运用显微外科技术,精准辨别睾丸内肿瘤与正常睾丸组织的边界,距离肿瘤边界约2 mm完整切除肿瘤及少部分邻近正常睾丸组织,使用显微双极电凝镊给予精确止血,最大限度保留正常睾丸组织。将完整切除的睾丸内肿瘤及邻近正常睾丸组织进行快速冰冻病理检查。术后定期复查CDFI、MRI、精液、血清睾酮等项目。结果:16例患者术前血清睾酮、AFP、hCG、LDH及精液检查指标均在正常参考值范围内。所有16例患者的术中快速冰冻病理依据2022年最新版WHO泌尿及男性生殖系统肿瘤分类标准,均诊断为睾丸良性肿瘤,并顺利完成TSMS治疗。16例患者术后康复顺利,术后1个月复查CDFI提示睾丸剩余组织血供良好,所有患者随访14~40个月,随访期内定期复查CDFI和MRI均未见睾丸内肿瘤残留、复发或转移征象,血清睾酮、AFP、hCG、LDH及精液检查较术前无显著变化,2例育龄期患者的配偶分别于术后16、18个月实现自然受孕。结论:睾丸内良性肿瘤可以通过CDFI、MRI检查进行术前鉴别诊断,最终定性诊断仍需组织病理检查。TSMS运用显微外科手术技术,可以在完整切除睾丸内肿瘤的前提下最大限度保留正常睾丸组织,从而有效保存男性生育力。TSMS疗效良好、安全性高,特别适用于有保留生育力需求的患者。

基于SELECT理念腹腔镜下保留脾脏的胰体尾切除

腹腔镜下胰体尾切除术目前已经成为治疗胰腺体尾部肿瘤的标准术式。而腹腔镜下保留脾脏的胰体尾切除术由于可保留脾脏功能,减少脾切除术后并发症,越来越受到重视。然而,胰腺肿瘤发病隐匿、解剖位置复杂,这些对其诊断和保留脾脏的胰体尾切除术带来了挑战。近年来,我们团队积累了丰富的胰腺肿瘤诊疗经验,创新提出“SELECT”(S-Single-Operator Cholangiopancreatoscopy,E-ERCP,L-Laparoscopy,E-Endoscopic ultrasound,C-Choledochoscopy/Confocal laser endomicroscopy,T-Traditional Chinese medicine)多镜组合中西医微创诊治理念。根据胰腺肿瘤的类型及特点,应用多种内镜和腹腔镜技术,多种不同微创诊疗方法的优选组合,围手术期采用中医药,进行中西医结合加速康复。将SELECT理念充分应用于腹腔镜下保留脾脏的胰体尾切除术,有利于术前精准诊断、术中精准切除、术后并发症预判和治疗,一站式诊治胰腺肿瘤,使病人利益最大化。

保留生育功能手术治疗早期上皮性卵巢癌患者的临床疗效及术后妊娠情况的影响因素

目的探讨保留生育功能手术治疗早期上皮性卵巢癌患者的临床疗效及术后妊娠情况的影响因素。方法根据手术方法的不同将104例早期上皮性卵巢癌患者分为对照组(n=53,卵巢癌根治术)和观察组(n=51,保留生育功能手术)。比较两组患者的围手术期指标、并发症发生情况及复发情况,记录观察组患者的月经恢复及妊娠情况。采用Logistic回归模型分析保留生育功能手术后早期上皮性卵巢癌患者妊娠情况的影响因素。结果观察组患者术中出血量明显少于对照组,手术时间明显长于对照组,住院时间明显短于对照组,差异均有统计学意义(P﹤0.01)。两组患者的并发症总发生率及1、2年复发率比较,差异均无统计学意义(P﹥0.05)。随访2年,观察组中27例患者尝试受孕,其中9例患者妊娠成功,纳入妊娠组;另外18例患者妊娠失败,纳入未妊娠组。单因素分析结果显示,妊娠组和未妊娠组患者的临床分期、化疗情况及复发情况比较,差异均有统计学意义(P﹤0.05)。多因素Logistic回归分析结果显示,临床分期、化疗情况及复发情况均是保留生育功能手术后早期上皮性卵巢癌患者妊娠情况的独立影响因素(P﹤0.05)。结论保留生育功能手术治疗早期上皮性卵巢癌患者安全可行,不会增加复发率,有生育意愿者可尝试受孕。对于合并术后妊娠危险因素的患者,临床需采取相应措施以提高妊娠率。