AIM: To study the efficacy of the enhanced recovery after surgery(ERAS) program in laparoscopic radical gastrectomy for stomach carcinomas.METHODS: From June 2010 to December 2012, 61 gastric cancer patients who under...AIM: To study the efficacy of the enhanced recovery after surgery(ERAS) program in laparoscopic radical gastrectomy for stomach carcinomas.METHODS: From June 2010 to December 2012, 61 gastric cancer patients who underwent laparoscopicassisted radical gastrectomy with D2 lymphadenectomy at First Hospital of Jilin University were enrolled in this randomized controlled trial.(Clinical Trials.gov, registration ID: NCT01955096). The subjects were divided into the ERAS program group and the conventional control group. The clinical characteristics, recovery variables, and complications of patients were analyzed.RESULTS: The time to first ambulation, oral food intake, and time to defecation were significantly shorter in the ERAS group(n = 30), compared to the conventional group(n = 31; P = 0.04, 0.003, and 0.01, respectively). The postoperative hospital stay was less in the ERAS group(6.8 ± 1.1 d) compared to the conventional group(7.7 ± 1.1 d)(P = 0.002). There was no significant difference in postoperative complications between the ERAS(1/30) and conventional care groups(2/31)(P = 1.00). There were no readmissions or mortality during the 30-d follow-up period.CONCLUSION: The ERAS program is associated with a shorter hospital stay in gastric cancer patients undergoing laparoscopic radical gastrectomy. The ERAS protocol is useful in the treatment of gastric cancer.展开更多
AIM: To investigate the cooperative laparoscopic and endoscopic techniques used for the resection of upper gastrointestinal tumors.METHODS: A systematic research of the literature was performed in Pub Med for English ...AIM: To investigate the cooperative laparoscopic and endoscopic techniques used for the resection of upper gastrointestinal tumors.METHODS: A systematic research of the literature was performed in Pub Med for English and French language articles about laparoscopic and endoscopic cooperative,combined,hybrid and rendezvous techniques. Only original studies using these techniques for the resection of early gastric cancer,benign tumors and gastrointestinal stromal tumors of the stomach and the duodenum were included. By excluding case series of less than 10 patients,25 studies were identified. The study design,number of cases,tumor pathology size and location,the operative technique name,the endoscopy team and surgical team role,operative time,type of closure of visceral wall defect,blood loss,complications and length of hospital stay of these studies were evaluated. Additionally all cooperative techniques found were classified and are presented in a systematic approach.RESULTS: The studies identified were case series and retrospective cohort studies. A total of 706 patients were operated on with a cooperative technique. The tumors resected were only gastrointestinal stromal tumors(GIST) in 4 studies,GIST and various benign submucosal tumors in 22 studies,early gastric cancer(p T1 a and p T1b) in 6 studies and early duodenal cancer in 1 study. There was important heterogeneity between the studies. The operative techniques identified were:laparoscopic assisted endoscopic resection,endoscopic assisted wedge resection,endoscopic assisted transgastric and intragastric surgery,laparoscopic endoscopic cooperative surgery(LECS),laparoscopic assisted endoscopic full thickness resection(LAEFR),clean non exposure technique and non-exposed endoscopic wallinversion surgery(NEWS). Each technique is illustrated with the roles of the endoscopic and laparoscopic teams; the indications,characteristics and short term results are described.CONCLUSION: Along with the traditional cooperative techniques,new procedures like LECS,LAEFR and NEWS hold great promise for the future of minimally invasive oncologic procedures.展开更多
AIM:To describe the learning curves of hand-assisted laparoscopic D2 radical gastrectomy(HALG) for the treatment of gastric cancer.METHODS:The HALG surgical procedure consists of three stages:surgery under direct visi...AIM:To describe the learning curves of hand-assisted laparoscopic D2 radical gastrectomy(HALG) for the treatment of gastric cancer.METHODS:The HALG surgical procedure consists of three stages:surgery under direct vision via the port for hand assistance,hand-assisted laparoscopicsurgery,and gastrointestinal tract reconstruction.According to the order of the date of surgery,patients were divided into 6 groups(A-F) with 20 cases in each group.All surgeries were performed by the same group of surgeons.We performed a comprehensive and indepth retrospective comparative analysis of the clinical data of all patients,with the clinical data including general patient information and intraoperative and postoperative observation indicators.RESULTS:There were no differences in the basic information among the patient groups(P > 0.05).The operative time of the hand-assisted surgery stage in group A was 8-10 min longer than the other groups,with the difference being statistically significant(P = 0.01).There were no differences in total operative time between the groups(P = 0.30).Postoperative intestinal function recovery time in group A was longer than that of other groups(P = 0.02).Lengths of hospital stay and surgical quality indicators(such as intraoperative blood loss,numbers of detected lymph nodes,intraoperative side injury,postoperative complications,reoperation rate,and readmission rate 30 d after surgery) were not significantly different among the groups.CONCLUSION:HALG is a surgical procedure that can be easily mastered,with a learning curve closely related to the operative time of the hand-assisted laparoscopic surgery stage.展开更多
AIM: To assess the safety of single-incision laparoscopic cholecystectomy(SILC) for acute cholecystitis.METHODS: All patients who underwent SILC at Sano Hospital(Kobe, Japan) between January 2010 and December 2014 wer...AIM: To assess the safety of single-incision laparoscopic cholecystectomy(SILC) for acute cholecystitis.METHODS: All patients who underwent SILC at Sano Hospital(Kobe, Japan) between January 2010 and December 2014 were included in this retrospective study. Clinical data related to patient characteristics and surgical outcomes were collected from medical records. The parameters for assessing the safety of the procedure included operative time, volume of blood loss, achievement of the critical view of safety, use of additional trocars, conversion to laparotomy, intraoperative and postoperative complications, and duration of postoperative hospital stay. Patient backgrounds were statistically compared between those with and without conversion to laparotomy.RESULTS: A total of 100 patients underwent SILC for acute cholecystitis during the period. Preoperative endoscopic treatment was performed for suspected choledocholithiasis in 41 patients(41%). The mean time from onset of acute cholecystitis was 7.7 d. According to the Updated Tokyo Guidelines(TG13) for the severity of cholecystitis, 86 and 14 patients had grade Ⅰ and grade Ⅱ acute cholecystitis, respectively. The mean operative time was 87.4 min. The mean estimated blood loss was 80.6 mL. The critical view of safety was obtained in 89 patients(89%). Conversion laparotomy was performed in 12 patients(12%). Postoperative complications of Clavien-Dindo grade Ⅲ or greater were observed in 4 patients(4%). The mean duration of postoperative hospital stay was 5.7 d. Patients converted from SILC to laparotomy tended to have higher days after onset.CONCLUSION: SILC is feasible for acute cholecystitis; in addition, early surgical intervention may reduce the risk of laparotomy conversion.展开更多
结合胃镜超声和白光内镜可以更准确地识别胃肠道间质瘤.但是现有的多模态方法往往仅关注于图像特征,忽略了诊断文本信息中所包含的语义信息对于精确理解和诊断医学图像的重要性.为此,本文提出一种新的基于文本引导下的多模态医学图像分...结合胃镜超声和白光内镜可以更准确地识别胃肠道间质瘤.但是现有的多模态方法往往仅关注于图像特征,忽略了诊断文本信息中所包含的语义信息对于精确理解和诊断医学图像的重要性.为此,本文提出一种新的基于文本引导下的多模态医学图像分析算法框架(Text-guided Multi-modal Medical image analysis framework,TMM-Net).TMM-Net使用多阶段的诊断文本来引导模型学习,以提取图像中的关键诊断信息特征,然后通过交叉模态注意力机制促进多模态特征之间的交互.值得注意的是,TMM-Net通过预测病变属性来模拟临床诊断过程,从而增强了可解释性.验证实验在两个中心包含10 025个模态数据对的数据集上进行.结果表明,该方法相比目前最优的GISTs诊断方法精度提升7.7%,同时获得了最高的(Area Under the Curve,AUC)值:0.927,其可解释性可以更好地适合临床需求.展开更多
Endoscopic resection(ER) of undifferentiated-type early gastric cancer(UD-EGC) has a lower curative resection(CR) rate than does ER of differentiated-type EGC(D-EGC). However, a low CR rate does not mean that it is un...Endoscopic resection(ER) of undifferentiated-type early gastric cancer(UD-EGC) has a lower curative resection(CR) rate than does ER of differentiated-type EGC(D-EGC). However, a low CR rate does not mean that it is unreasonable to schedule ER of UD-EGC. If ER is in fact curative, the long-term outcomes including survival rate are excellent. Quality of life is good because maximal stomach preservation is possible. However, UD-EGC and D-EGC differ histologically. Thus, when ER is contemplated to treat UD-EGC, a careful approach employing strict criteria is essential because the biology of UD-EGC and D-EGC differ.展开更多
AIM: To evaluate the safety and diagnostic accuracy of endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) in a cohort of pancreatic cancer patients.
The great attention has been paid to the mini-invasive methods of the distribution of the malignant process in the thoracic and abdominal cavities for last time. In the Thoracic department of the Republican Research O...The great attention has been paid to the mini-invasive methods of the distribution of the malignant process in the thoracic and abdominal cavities for last time. In the Thoracic department of the Republican Research Oncological Centre of the Republic of Uzbekistan during the period from 2004 to 2008 in the plan of investigation of the patients with esophageal and stomach cancer including roentgenoscopy and (or) roentgenography of the thoracic chest, contrast esophageal and stomach roentgenoscopy, EPGDS and ultrasonography of the mediastinal and abdominal cavity organs additionally computed tomography and diagnostic thoraco-and (or) laparoscopy were included. The cancer of mesothoracic esophageal part with invasion into the upper thoracic part was diagnosed in 2 patients, the cancer of mesothoracic esophageal part-in 12 patients, the cancer of the middle and the lower parts-in 7 patients, the cancer the lower thorax part-in 7 patients, the cardioesophageal cancer-in 9 patients, a total cancer of a stomach with affection of the bottom third of the oesophagus-in 1 patient. Thoracoscopy and laparoscopy allow determination of the respectability of the tumorous process in the esophageal and stomach cancer considerably lowering the number of exploratory thoracotomies and laparotomies.展开更多
文摘AIM: To study the efficacy of the enhanced recovery after surgery(ERAS) program in laparoscopic radical gastrectomy for stomach carcinomas.METHODS: From June 2010 to December 2012, 61 gastric cancer patients who underwent laparoscopicassisted radical gastrectomy with D2 lymphadenectomy at First Hospital of Jilin University were enrolled in this randomized controlled trial.(Clinical Trials.gov, registration ID: NCT01955096). The subjects were divided into the ERAS program group and the conventional control group. The clinical characteristics, recovery variables, and complications of patients were analyzed.RESULTS: The time to first ambulation, oral food intake, and time to defecation were significantly shorter in the ERAS group(n = 30), compared to the conventional group(n = 31; P = 0.04, 0.003, and 0.01, respectively). The postoperative hospital stay was less in the ERAS group(6.8 ± 1.1 d) compared to the conventional group(7.7 ± 1.1 d)(P = 0.002). There was no significant difference in postoperative complications between the ERAS(1/30) and conventional care groups(2/31)(P = 1.00). There were no readmissions or mortality during the 30-d follow-up period.CONCLUSION: The ERAS program is associated with a shorter hospital stay in gastric cancer patients undergoing laparoscopic radical gastrectomy. The ERAS protocol is useful in the treatment of gastric cancer.
文摘AIM: To investigate the cooperative laparoscopic and endoscopic techniques used for the resection of upper gastrointestinal tumors.METHODS: A systematic research of the literature was performed in Pub Med for English and French language articles about laparoscopic and endoscopic cooperative,combined,hybrid and rendezvous techniques. Only original studies using these techniques for the resection of early gastric cancer,benign tumors and gastrointestinal stromal tumors of the stomach and the duodenum were included. By excluding case series of less than 10 patients,25 studies were identified. The study design,number of cases,tumor pathology size and location,the operative technique name,the endoscopy team and surgical team role,operative time,type of closure of visceral wall defect,blood loss,complications and length of hospital stay of these studies were evaluated. Additionally all cooperative techniques found were classified and are presented in a systematic approach.RESULTS: The studies identified were case series and retrospective cohort studies. A total of 706 patients were operated on with a cooperative technique. The tumors resected were only gastrointestinal stromal tumors(GIST) in 4 studies,GIST and various benign submucosal tumors in 22 studies,early gastric cancer(p T1 a and p T1b) in 6 studies and early duodenal cancer in 1 study. There was important heterogeneity between the studies. The operative techniques identified were:laparoscopic assisted endoscopic resection,endoscopic assisted wedge resection,endoscopic assisted transgastric and intragastric surgery,laparoscopic endoscopic cooperative surgery(LECS),laparoscopic assisted endoscopic full thickness resection(LAEFR),clean non exposure technique and non-exposed endoscopic wallinversion surgery(NEWS). Each technique is illustrated with the roles of the endoscopic and laparoscopic teams; the indications,characteristics and short term results are described.CONCLUSION: Along with the traditional cooperative techniques,new procedures like LECS,LAEFR and NEWS hold great promise for the future of minimally invasive oncologic procedures.
文摘AIM:To describe the learning curves of hand-assisted laparoscopic D2 radical gastrectomy(HALG) for the treatment of gastric cancer.METHODS:The HALG surgical procedure consists of three stages:surgery under direct vision via the port for hand assistance,hand-assisted laparoscopicsurgery,and gastrointestinal tract reconstruction.According to the order of the date of surgery,patients were divided into 6 groups(A-F) with 20 cases in each group.All surgeries were performed by the same group of surgeons.We performed a comprehensive and indepth retrospective comparative analysis of the clinical data of all patients,with the clinical data including general patient information and intraoperative and postoperative observation indicators.RESULTS:There were no differences in the basic information among the patient groups(P > 0.05).The operative time of the hand-assisted surgery stage in group A was 8-10 min longer than the other groups,with the difference being statistically significant(P = 0.01).There were no differences in total operative time between the groups(P = 0.30).Postoperative intestinal function recovery time in group A was longer than that of other groups(P = 0.02).Lengths of hospital stay and surgical quality indicators(such as intraoperative blood loss,numbers of detected lymph nodes,intraoperative side injury,postoperative complications,reoperation rate,and readmission rate 30 d after surgery) were not significantly different among the groups.CONCLUSION:HALG is a surgical procedure that can be easily mastered,with a learning curve closely related to the operative time of the hand-assisted laparoscopic surgery stage.
文摘AIM: To assess the safety of single-incision laparoscopic cholecystectomy(SILC) for acute cholecystitis.METHODS: All patients who underwent SILC at Sano Hospital(Kobe, Japan) between January 2010 and December 2014 were included in this retrospective study. Clinical data related to patient characteristics and surgical outcomes were collected from medical records. The parameters for assessing the safety of the procedure included operative time, volume of blood loss, achievement of the critical view of safety, use of additional trocars, conversion to laparotomy, intraoperative and postoperative complications, and duration of postoperative hospital stay. Patient backgrounds were statistically compared between those with and without conversion to laparotomy.RESULTS: A total of 100 patients underwent SILC for acute cholecystitis during the period. Preoperative endoscopic treatment was performed for suspected choledocholithiasis in 41 patients(41%). The mean time from onset of acute cholecystitis was 7.7 d. According to the Updated Tokyo Guidelines(TG13) for the severity of cholecystitis, 86 and 14 patients had grade Ⅰ and grade Ⅱ acute cholecystitis, respectively. The mean operative time was 87.4 min. The mean estimated blood loss was 80.6 mL. The critical view of safety was obtained in 89 patients(89%). Conversion laparotomy was performed in 12 patients(12%). Postoperative complications of Clavien-Dindo grade Ⅲ or greater were observed in 4 patients(4%). The mean duration of postoperative hospital stay was 5.7 d. Patients converted from SILC to laparotomy tended to have higher days after onset.CONCLUSION: SILC is feasible for acute cholecystitis; in addition, early surgical intervention may reduce the risk of laparotomy conversion.
文摘结合胃镜超声和白光内镜可以更准确地识别胃肠道间质瘤.但是现有的多模态方法往往仅关注于图像特征,忽略了诊断文本信息中所包含的语义信息对于精确理解和诊断医学图像的重要性.为此,本文提出一种新的基于文本引导下的多模态医学图像分析算法框架(Text-guided Multi-modal Medical image analysis framework,TMM-Net).TMM-Net使用多阶段的诊断文本来引导模型学习,以提取图像中的关键诊断信息特征,然后通过交叉模态注意力机制促进多模态特征之间的交互.值得注意的是,TMM-Net通过预测病变属性来模拟临床诊断过程,从而增强了可解释性.验证实验在两个中心包含10 025个模态数据对的数据集上进行.结果表明,该方法相比目前最优的GISTs诊断方法精度提升7.7%,同时获得了最高的(Area Under the Curve,AUC)值:0.927,其可解释性可以更好地适合临床需求.
文摘Endoscopic resection(ER) of undifferentiated-type early gastric cancer(UD-EGC) has a lower curative resection(CR) rate than does ER of differentiated-type EGC(D-EGC). However, a low CR rate does not mean that it is unreasonable to schedule ER of UD-EGC. If ER is in fact curative, the long-term outcomes including survival rate are excellent. Quality of life is good because maximal stomach preservation is possible. However, UD-EGC and D-EGC differ histologically. Thus, when ER is contemplated to treat UD-EGC, a careful approach employing strict criteria is essential because the biology of UD-EGC and D-EGC differ.
文摘AIM: To evaluate the safety and diagnostic accuracy of endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) in a cohort of pancreatic cancer patients.
文摘The great attention has been paid to the mini-invasive methods of the distribution of the malignant process in the thoracic and abdominal cavities for last time. In the Thoracic department of the Republican Research Oncological Centre of the Republic of Uzbekistan during the period from 2004 to 2008 in the plan of investigation of the patients with esophageal and stomach cancer including roentgenoscopy and (or) roentgenography of the thoracic chest, contrast esophageal and stomach roentgenoscopy, EPGDS and ultrasonography of the mediastinal and abdominal cavity organs additionally computed tomography and diagnostic thoraco-and (or) laparoscopy were included. The cancer of mesothoracic esophageal part with invasion into the upper thoracic part was diagnosed in 2 patients, the cancer of mesothoracic esophageal part-in 12 patients, the cancer of the middle and the lower parts-in 7 patients, the cancer the lower thorax part-in 7 patients, the cardioesophageal cancer-in 9 patients, a total cancer of a stomach with affection of the bottom third of the oesophagus-in 1 patient. Thoracoscopy and laparoscopy allow determination of the respectability of the tumorous process in the esophageal and stomach cancer considerably lowering the number of exploratory thoracotomies and laparotomies.
