Objective: To investigate the effects of laparoscopic radical resection of rectal cancer on gastrointestinal hormones, visceral protein and pain stress. Methods: A total of 96 patients with rectal cancer radical resec...Objective: To investigate the effects of laparoscopic radical resection of rectal cancer on gastrointestinal hormones, visceral protein and pain stress. Methods: A total of 96 patients with rectal cancer radical resection from January 2017 to December 2017 in our hospital, were selected as the research objects, the patients were randomly divided into the observation group (48 cases) and the control group (48 cases). The observation group received laparoscopic radical resection of rectal cancer, while the control group underwent open radical resection of rectal cancer. The levels of gastrin (GAS), motilin (MTL), vasoactive intestinal peptide (VIP), transferrin (TRF), retinol binding protein (RbP), albumin (ALB), prealbumin (PRE), P substance (SP), bradykinin (BK), and prostaglandin-E2 (PGE2) were measured and compared in the two groups. Results: Before operation, there was no significant difference in GAS, MTL and VIP between the two groups. 1, 3, and 5 d after operation, the GAS, MTL and VIP of the two groups were significantly lower than those before operation, and the differences were statistically significant. 1, 3, and 5 d after operation, GAS of the observation group were (66.60±5.79) μmol/L, (71.95±6.16) μmol/L and (77.68±6.38) μmol/L respectively, MTL were (225.68±19.83) pg/mL, (253.76±21.42) pg/mL and (289.98±24.74) pg/mL, VIP were (1.99±0.42) μmol/L, (2.43±0.46) μmol/L, (2.80±0.51) μmol/L, respectively, which were higher than that of the control group at the same time, and the difference was statistically significant. Before operation, there was no significant difference in TRF, RbP, ALB and PRE levels in the two groups. 1, 3 and 5 d after operation, the TRF, RbP, ALB and PRE levels in the two groups were significantly lower than those before operation, and the differences were statistically significant. 1, 3 and 5 d after operation, TRF of the observation group were (1.64±0.33) ng/L, (1.44±0.30) ng/L, (1.46 ±0.32) ng/L, RbP were (19.05±3.85) mg/L, (21.83±4.26) mg/L and (24.54±4.45) mg/L respectively, and ALB were (31.49±2.54) ng/L, (28.21±2.05) ng/L and (28.43±1.99) ng/L, PRE were (0.20±0.06) ng/L, (0.16±0.05) ng/L, (0.15±0.05) ng/L, which were all higher than those in the control group at the same time, and the differences were statistically significant. Before operation, there was no significant difference in SP, BK and PGE2 between the two groups. 1, 3 and 5 d after operation, the SP, BK and PGE2 of the two groups were significantly higher than those before operation and the differences were statistically significant. 1, 3 and 5 d after operation, SP of the observation group was (7.31±0.87) μg/mL, (5.43±0.51) μg/mL and (3.10±0.24) μg/mL, BK was (9.53±0.80) μg/L, (7.81±0.79) μg/L and 6.30±0.53) pg/mL, and PGE2 were (152.42±14.80) pg/mL, (131.22±13.35) pg/mL, (117.86±11.95) pg/mL, which were all lower than those in the control group at the same time, and the differences were statistically significant. Conclusion: Laparoscopic radical resection of rectal cancer can help patients recover gastrointestinal function faster and cause less pain stress.展开更多
The purpose of this study was to analyze the clinical efficacy of laparoscopic total mesorectal excision for the treatment of middle and low rectal cancer.First,30 patients who received treatment in the hospital from ...The purpose of this study was to analyze the clinical efficacy of laparoscopic total mesorectal excision for the treatment of middle and low rectal cancer.First,30 patients who received treatment in the hospital from March 2013 to May 2018 were randomly selected as the laparotomy group to receive laparotomy.30 patients who received treatment in the hospital from March 2013 to May 2018 were randomly selected as the laparoscopic group to receive laparoscopic surgery.The postoperative and complications of total rectal mesorectal excision were compared between the two groups.The results showed that the amount of blood loss during laparoscopy was(169.36±106.96)mL,and that during laparoscopy was(180.65±153.22)mL,which was significantly lower than that of the open group(209.65±186.65)mL and(356.54±170.32)mL.Intraoperative blood loss in laparoscopic patients was significantly lower than that in the open group,and the difference was statistically significant(t=2.95,2.87,P<0.05).The duration of anal sparing surgery in the laparoscope group was(232.65±56.35)min,which was longer than that in the laparoscope group(227.65±68.65)min.The duration of non-sparing anal surgery in the laparoscopic group was(246.95±52.65)min,which was significantly shorter than that in the open group(299.65±64.32)min.There was no statistically significant difference in the duration of operation between the laparoscopic group and the open group.The recovery time of intestinal function in the laparoscopic group was(2.11±1.82)days,which was significantly shorter than that in the open group(4.63±1.52)days.The postoperative hospital stay in the laparoscopic group was(11.32±10.01)d,which was significantly shorter than that in the open group(26.62±12.43 d).The recovery time of intestinal function and postoperative hospital stay of patients in the laparoscopic group were shorter than those in the open group,with statistically significant differences(T=2.31,2.43,P<0.05).The tumor diameter was(4.03±1.20)cm in the laparoscopic group and(3.95±1.43)cm in the open group.The number of lymph nodes in the laparoscopic group was(12.75±6.51)cm,while that in the open group was(13.62±7.05).There was no significant difference in the number of lymph nodes dissected or tumor diameter between the two groups(t=0.11,0.22,P>0.05).The complication rate of the abdominal group was 20.00%,significantly lower than that of the open group(66.67%).Complications after total mesorectal resection were significantly higher in the open group than in the laparoscopic group,and the difference between the two groups was statistically significant(χ2=13.30,P<0.05).Therefore,laparoscopic total rectal mesorectal resection for patients with middle and low rectal cancer is safer and can be used as a reliable treatment plan.展开更多
BACKGROUND Multiple linear stapler firings during double stapling technique(DST)after laparoscopic low anterior resection(LAR)are associated with an increased risk of anastomotic leakage(AL).However,it is difficult to...BACKGROUND Multiple linear stapler firings during double stapling technique(DST)after laparoscopic low anterior resection(LAR)are associated with an increased risk of anastomotic leakage(AL).However,it is difficult to predict preoperatively the need for multiple linear stapler cartridges during DST anastomosis.AIM To develop a deep learning model to predict multiple firings during DST anastomosis based on pelvic magnetic resonance imaging(MRI).METHODS We collected 9476 MR images from 328 mid-low rectal cancer patients undergoing LAR with DST anastomosis,which were randomly divided into a training set(n=260)and testing set(n=68).Binary logistic regression was adopted to create a clinical model using six factors.The sequence of fast spin-echo T2-weighted MRI of the entire pelvis was segmented and analyzed.Pure-image and clinical-image integrated deep learning models were constructed using the mask region-based convolutional neural network segmentation tool and three-dimensional convolutional networks.Sensitivity,specificity,accuracy,positive predictive value(PPV),and area under the receiver operating characteristic curve(AUC)was calculated for each model.RESULTS The prevalence of≥3 linear stapler cartridges was 17.7%(58/328).The prevalence of AL was statistically significantly higher in patients with≥3 cartridges compared to those with≤2 cartridges(25.0%vs 11.8%,P=0.018).Preoperative carcinoembryonic antigen level>5 ng/mL(OR=2.11,95%CI 1.08-4.12,P=0.028)and tumor size≥5 cm(OR=3.57,95%CI 1.61-7.89,P=0.002)were recognized as independent risk factors for use of≥3 linear stapler cartridges.Diagnostic performance was better with the integrated model(accuracy=94.1%,PPV=87.5%,and AUC=0.88)compared with the clinical model(accuracy=86.7%,PPV=38.9%,and AUC=0.72)and the image model(accuracy=91.2%,PPV=83.3%,and AUC=0.81).CONCLUSION MRI-based deep learning model can predict the use of≥3 linear stapler cartridges during DST anastomosis in laparoscopic LAR surgery.This model might help determine the best anastomosis strategy by avoiding DST when there is a high probability of the need for≥3 linear stapler cartridges.展开更多
文摘Objective: To investigate the effects of laparoscopic radical resection of rectal cancer on gastrointestinal hormones, visceral protein and pain stress. Methods: A total of 96 patients with rectal cancer radical resection from January 2017 to December 2017 in our hospital, were selected as the research objects, the patients were randomly divided into the observation group (48 cases) and the control group (48 cases). The observation group received laparoscopic radical resection of rectal cancer, while the control group underwent open radical resection of rectal cancer. The levels of gastrin (GAS), motilin (MTL), vasoactive intestinal peptide (VIP), transferrin (TRF), retinol binding protein (RbP), albumin (ALB), prealbumin (PRE), P substance (SP), bradykinin (BK), and prostaglandin-E2 (PGE2) were measured and compared in the two groups. Results: Before operation, there was no significant difference in GAS, MTL and VIP between the two groups. 1, 3, and 5 d after operation, the GAS, MTL and VIP of the two groups were significantly lower than those before operation, and the differences were statistically significant. 1, 3, and 5 d after operation, GAS of the observation group were (66.60±5.79) μmol/L, (71.95±6.16) μmol/L and (77.68±6.38) μmol/L respectively, MTL were (225.68±19.83) pg/mL, (253.76±21.42) pg/mL and (289.98±24.74) pg/mL, VIP were (1.99±0.42) μmol/L, (2.43±0.46) μmol/L, (2.80±0.51) μmol/L, respectively, which were higher than that of the control group at the same time, and the difference was statistically significant. Before operation, there was no significant difference in TRF, RbP, ALB and PRE levels in the two groups. 1, 3 and 5 d after operation, the TRF, RbP, ALB and PRE levels in the two groups were significantly lower than those before operation, and the differences were statistically significant. 1, 3 and 5 d after operation, TRF of the observation group were (1.64±0.33) ng/L, (1.44±0.30) ng/L, (1.46 ±0.32) ng/L, RbP were (19.05±3.85) mg/L, (21.83±4.26) mg/L and (24.54±4.45) mg/L respectively, and ALB were (31.49±2.54) ng/L, (28.21±2.05) ng/L and (28.43±1.99) ng/L, PRE were (0.20±0.06) ng/L, (0.16±0.05) ng/L, (0.15±0.05) ng/L, which were all higher than those in the control group at the same time, and the differences were statistically significant. Before operation, there was no significant difference in SP, BK and PGE2 between the two groups. 1, 3 and 5 d after operation, the SP, BK and PGE2 of the two groups were significantly higher than those before operation and the differences were statistically significant. 1, 3 and 5 d after operation, SP of the observation group was (7.31±0.87) μg/mL, (5.43±0.51) μg/mL and (3.10±0.24) μg/mL, BK was (9.53±0.80) μg/L, (7.81±0.79) μg/L and 6.30±0.53) pg/mL, and PGE2 were (152.42±14.80) pg/mL, (131.22±13.35) pg/mL, (117.86±11.95) pg/mL, which were all lower than those in the control group at the same time, and the differences were statistically significant. Conclusion: Laparoscopic radical resection of rectal cancer can help patients recover gastrointestinal function faster and cause less pain stress.
文摘The purpose of this study was to analyze the clinical efficacy of laparoscopic total mesorectal excision for the treatment of middle and low rectal cancer.First,30 patients who received treatment in the hospital from March 2013 to May 2018 were randomly selected as the laparotomy group to receive laparotomy.30 patients who received treatment in the hospital from March 2013 to May 2018 were randomly selected as the laparoscopic group to receive laparoscopic surgery.The postoperative and complications of total rectal mesorectal excision were compared between the two groups.The results showed that the amount of blood loss during laparoscopy was(169.36±106.96)mL,and that during laparoscopy was(180.65±153.22)mL,which was significantly lower than that of the open group(209.65±186.65)mL and(356.54±170.32)mL.Intraoperative blood loss in laparoscopic patients was significantly lower than that in the open group,and the difference was statistically significant(t=2.95,2.87,P<0.05).The duration of anal sparing surgery in the laparoscope group was(232.65±56.35)min,which was longer than that in the laparoscope group(227.65±68.65)min.The duration of non-sparing anal surgery in the laparoscopic group was(246.95±52.65)min,which was significantly shorter than that in the open group(299.65±64.32)min.There was no statistically significant difference in the duration of operation between the laparoscopic group and the open group.The recovery time of intestinal function in the laparoscopic group was(2.11±1.82)days,which was significantly shorter than that in the open group(4.63±1.52)days.The postoperative hospital stay in the laparoscopic group was(11.32±10.01)d,which was significantly shorter than that in the open group(26.62±12.43 d).The recovery time of intestinal function and postoperative hospital stay of patients in the laparoscopic group were shorter than those in the open group,with statistically significant differences(T=2.31,2.43,P<0.05).The tumor diameter was(4.03±1.20)cm in the laparoscopic group and(3.95±1.43)cm in the open group.The number of lymph nodes in the laparoscopic group was(12.75±6.51)cm,while that in the open group was(13.62±7.05).There was no significant difference in the number of lymph nodes dissected or tumor diameter between the two groups(t=0.11,0.22,P>0.05).The complication rate of the abdominal group was 20.00%,significantly lower than that of the open group(66.67%).Complications after total mesorectal resection were significantly higher in the open group than in the laparoscopic group,and the difference between the two groups was statistically significant(χ2=13.30,P<0.05).Therefore,laparoscopic total rectal mesorectal resection for patients with middle and low rectal cancer is safer and can be used as a reliable treatment plan.
基金Shanghai Jiaotong University,No.YG2019QNB24This study was reviewed and approved by Ruijin Hospital Ethics Committee(Approval No.2019-82).
文摘BACKGROUND Multiple linear stapler firings during double stapling technique(DST)after laparoscopic low anterior resection(LAR)are associated with an increased risk of anastomotic leakage(AL).However,it is difficult to predict preoperatively the need for multiple linear stapler cartridges during DST anastomosis.AIM To develop a deep learning model to predict multiple firings during DST anastomosis based on pelvic magnetic resonance imaging(MRI).METHODS We collected 9476 MR images from 328 mid-low rectal cancer patients undergoing LAR with DST anastomosis,which were randomly divided into a training set(n=260)and testing set(n=68).Binary logistic regression was adopted to create a clinical model using six factors.The sequence of fast spin-echo T2-weighted MRI of the entire pelvis was segmented and analyzed.Pure-image and clinical-image integrated deep learning models were constructed using the mask region-based convolutional neural network segmentation tool and three-dimensional convolutional networks.Sensitivity,specificity,accuracy,positive predictive value(PPV),and area under the receiver operating characteristic curve(AUC)was calculated for each model.RESULTS The prevalence of≥3 linear stapler cartridges was 17.7%(58/328).The prevalence of AL was statistically significantly higher in patients with≥3 cartridges compared to those with≤2 cartridges(25.0%vs 11.8%,P=0.018).Preoperative carcinoembryonic antigen level>5 ng/mL(OR=2.11,95%CI 1.08-4.12,P=0.028)and tumor size≥5 cm(OR=3.57,95%CI 1.61-7.89,P=0.002)were recognized as independent risk factors for use of≥3 linear stapler cartridges.Diagnostic performance was better with the integrated model(accuracy=94.1%,PPV=87.5%,and AUC=0.88)compared with the clinical model(accuracy=86.7%,PPV=38.9%,and AUC=0.72)and the image model(accuracy=91.2%,PPV=83.3%,and AUC=0.81).CONCLUSION MRI-based deep learning model can predict the use of≥3 linear stapler cartridges during DST anastomosis in laparoscopic LAR surgery.This model might help determine the best anastomosis strategy by avoiding DST when there is a high probability of the need for≥3 linear stapler cartridges.
