Objective： To evaluate the clinical value of laparoscopic inguinal hernia repair in hernioplasty and simultaneous cholecystectomy. Methods： Twenty-eight patients with symptomatic chronic calculous cholecystitis and ...Objective： To evaluate the clinical value of laparoscopic inguinal hernia repair in hernioplasty and simultaneous cholecystectomy. Methods： Twenty-eight patients with symptomatic chronic calculous cholecystitis and synchronous unilateral primary inguinal hernia were performed combined surgery between October 2001 and March 2005. Of them, 10 cases underwent laparoscopic totally extraperitoneal mesh hernia repair （TEP） and laparoscopic cholecystectomy （LC）, 3 cases underwent laparoscopic transabdominal preperitoneal mesh hernia repair （TAPP） and LC, and 15 cases underwent LC and open tension-free hernia repair. Results： All the procedures were performed successfully, 2 patients occurred urinary retention in LC＋open group and 1 patient occurred scrotum seroma in LC＋TEP procedures. During the 6 to 24 months＇ follow-up, no hernia recurrences occurred in all patients. There were 6 patients （40%） in LC ＋open group had discomfort pain in the inguinal region and lasted 1 to 3 months. The operating time was longer in the totally laparoscopic group （TEP＋LC and TAPP＋LC） （104±31 min） than in the LC＋open group （80±28 min） （P〈0. 05）. The intensity of postoperative pain at rest was greater in the LC＋open group at 24 h （P〈0.05） and 48 h （P〈0.05）. No differences between the 2 groups were found in the mean operating costs and oral intake of the postoperative period. But the time resume to walking （2.9 vs 1. 8 d） （P〈0.01） and the mean hospital stay （8.2 vs 4.6 d） （P〈0.001） was longer in the LC＋open group than in the totally laparoscopic group. Conclusion： In the same operating costs, the totally laparoscopic precedure has more advantages of low postoperative pain, quicker resume to walking and less hospital stay than open tension-free hernia repair in hernioplasty and simultaneous LC. Thus, the totally laparoscopic approach is considered to be advantage of the hernioplasty and simultaneous LC.展开更多
A curative-intent approach may improve survival in carefully selected patients with oligometastatic colorectal cancer.Aggressive treatments are most frequently administered to patients with isolated liver metastasis,t...A curative-intent approach may improve survival in carefully selected patients with oligometastatic colorectal cancer.Aggressive treatments are most frequently administered to patients with isolated liver metastasis,though they may be judiciously considered for other sites of metastasis.To be considered for curative intent with surgery,patients must have disease that can be definitively treated while leaving a sufficient functional liver remnant.Neoadjuvant chemotherapy may be used for upfront resectable disease as a test of tumor biology and/or for upfront unresectable disease to increase the likelihood of resectability(so-called‘conversion’chemotherapy).While conversion chemotherapy in this setting aims to improve survival,the choice of a regimen remains a complex and highly individualized decision.In this review,we discuss the role of RAS status,primary site,sidedness,and other clinical features that affect chemotherapy treatment selection as well as key factors of patients that guide individualized patient-treatment recommendations for colorectal-cancer patients being considered for definitive treatment with metastasectomy.展开更多
文摘Objective： To evaluate the clinical value of laparoscopic inguinal hernia repair in hernioplasty and simultaneous cholecystectomy. Methods： Twenty-eight patients with symptomatic chronic calculous cholecystitis and synchronous unilateral primary inguinal hernia were performed combined surgery between October 2001 and March 2005. Of them, 10 cases underwent laparoscopic totally extraperitoneal mesh hernia repair （TEP） and laparoscopic cholecystectomy （LC）, 3 cases underwent laparoscopic transabdominal preperitoneal mesh hernia repair （TAPP） and LC, and 15 cases underwent LC and open tension-free hernia repair. Results： All the procedures were performed successfully, 2 patients occurred urinary retention in LC＋open group and 1 patient occurred scrotum seroma in LC＋TEP procedures. During the 6 to 24 months＇ follow-up, no hernia recurrences occurred in all patients. There were 6 patients （40%） in LC ＋open group had discomfort pain in the inguinal region and lasted 1 to 3 months. The operating time was longer in the totally laparoscopic group （TEP＋LC and TAPP＋LC） （104±31 min） than in the LC＋open group （80±28 min） （P〈0. 05）. The intensity of postoperative pain at rest was greater in the LC＋open group at 24 h （P〈0.05） and 48 h （P〈0.05）. No differences between the 2 groups were found in the mean operating costs and oral intake of the postoperative period. But the time resume to walking （2.9 vs 1. 8 d） （P〈0.01） and the mean hospital stay （8.2 vs 4.6 d） （P〈0.001） was longer in the LC＋open group than in the totally laparoscopic group. Conclusion： In the same operating costs, the totally laparoscopic precedure has more advantages of low postoperative pain, quicker resume to walking and less hospital stay than open tension-free hernia repair in hernioplasty and simultaneous LC. Thus, the totally laparoscopic approach is considered to be advantage of the hernioplasty and simultaneous LC.
基金This research was funded in part by the NIH/NCI Cancer Center Support Grant[P30 CA015704(SAC)].
文摘A curative-intent approach may improve survival in carefully selected patients with oligometastatic colorectal cancer.Aggressive treatments are most frequently administered to patients with isolated liver metastasis,though they may be judiciously considered for other sites of metastasis.To be considered for curative intent with surgery,patients must have disease that can be definitively treated while leaving a sufficient functional liver remnant.Neoadjuvant chemotherapy may be used for upfront resectable disease as a test of tumor biology and/or for upfront unresectable disease to increase the likelihood of resectability(so-called‘conversion’chemotherapy).While conversion chemotherapy in this setting aims to improve survival,the choice of a regimen remains a complex and highly individualized decision.In this review,we discuss the role of RAS status,primary site,sidedness,and other clinical features that affect chemotherapy treatment selection as well as key factors of patients that guide individualized patient-treatment recommendations for colorectal-cancer patients being considered for definitive treatment with metastasectomy.
