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
Transanal minimally invasive surgery(TAMIS)was first described in 2010 as an alternative to transanal endoscopic microsurgery(TEM).The TAMIS technique can be access to the proximal and mid-rectum for resection of beni...Transanal minimally invasive surgery(TAMIS)was first described in 2010 as an alternative to transanal endoscopic microsurgery(TEM).The TAMIS technique can be access to the proximal and mid-rectum for resection of benign and earlystage malignant rectal lesions and also used for noncurative intent surgery of more advanced lesions in patients who are not candidates for radical surgery.TAMIS has a shorter learning curve,reduced device setup time,flexibility in instrument use,and versatility in application than TEM.Also,TAMIS shows similar results in a view of the operation time,conversion rate,reoperation rate,and complication to TEM.For these reasons,TAMIS is an easily accessible,technically feasible,and cost-effective alternative to TEM.Overall,TAMIS has enabled the performance of high-quality local excision of rectal lesions by many colorectal surgeons.As TAMIS becomes more broadly utilized such as pelvic abscess drainage,rectal stenosis,and treatment of anastomotic dehiscence,the acquisition of appropriate training must be ensured,and the continued assessment and assurance of outcome must be maintained.展开更多
Background Transanal total mesorectal excision(taTME)or intersphincteric resection(ISR)has recently proven to be a valid and safe surgical procedure for low rectal cancer.However,studies focusing on the combination of...Background Transanal total mesorectal excision(taTME)or intersphincteric resection(ISR)has recently proven to be a valid and safe surgical procedure for low rectal cancer.However,studies focusing on the combination of these two technologies are limited.This study aimed to evaluate perioperative results,long-termoncologic outcomes,and anorectal functions of patients with low rectal cancer undergoing taTME combined with ISR,by comparing with those of patients undergoing laparoscopic abdominoperineal resection(laAPR).Methods After 1:1 propensity score matching,200 patients with low rectal cancer who underwent laAPR(n=100)or taTME combined with ISR(n=100)between September 2013 and November 2019 were included.Patient demographics,clinicopathological characteristics,oncological outcomes,and anal functional results were analysed.Results Patients in the taTME-combined-with-ISR group had less intraoperative blood loss(79.6672.6 vs 107.3665.1 mL,P=0.005)and a lower rate of post-operative complications(22.0%vs 44.0%,P<0.001)than those in the laAPR group.The overall local recurrence rates were 7.0%in both groups within 3 years after surgery.The 3-year disease-free survival rates were 86.3%in the taTME-combined-with-ISR group and 75.1%in the laAPR group(P=0.056),while the 3-year overall survival rates were 96.7%and 94.2%,respectively(P=0.319).There were 39 patients(45.3%)in the taTME-combined-with-ISR group who developed major low anterior resection syndrome,whereas 61 patients(70.9%)had good post-operative anal function(Wexner incontinence score≤10).Conclusion We found similar long-term oncological outcomes for patients with low rectal cancer undergoing laAPR and those undergoing taTME combined with ISR.Patients receiving taTME combined with ISR had acceptable post-operative anorectal function.展开更多
《腹腔镜或机器人辅助胰腺癌根治术中国专家共识(2022年版)》是由中国抗癌协会胰腺癌专业委员会微创诊治学组与中华医学会外科学分会胰腺外科学组组织全国部分胰腺外科专家制定,2022年首次发表于Journal of Pancreatology。在此共识中,...《腹腔镜或机器人辅助胰腺癌根治术中国专家共识(2022年版)》是由中国抗癌协会胰腺癌专业委员会微创诊治学组与中华医学会外科学分会胰腺外科学组组织全国部分胰腺外科专家制定,2022年首次发表于Journal of Pancreatology。在此共识中,相关专家针对腹腔镜或机器人辅助手术的安全性、肿瘤学获益、学习曲线及挑战性等方面做了详细阐述,旨在为腹腔镜或机器人辅助手术治疗胰腺癌的临床应用提供参考与指导意见。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Transanal minimally invasive surgery(TAMIS)was first described in 2010 as an alternative to transanal endoscopic microsurgery(TEM).The TAMIS technique can be access to the proximal and mid-rectum for resection of benign and earlystage malignant rectal lesions and also used for noncurative intent surgery of more advanced lesions in patients who are not candidates for radical surgery.TAMIS has a shorter learning curve,reduced device setup time,flexibility in instrument use,and versatility in application than TEM.Also,TAMIS shows similar results in a view of the operation time,conversion rate,reoperation rate,and complication to TEM.For these reasons,TAMIS is an easily accessible,technically feasible,and cost-effective alternative to TEM.Overall,TAMIS has enabled the performance of high-quality local excision of rectal lesions by many colorectal surgeons.As TAMIS becomes more broadly utilized such as pelvic abscess drainage,rectal stenosis,and treatment of anastomotic dehiscence,the acquisition of appropriate training must be ensured,and the continued assessment and assurance of outcome must be maintained.
基金supported by a grant from the Shenzhen“San Ming Projects”Research[Grant No.lc202002 to L.K.]the Fundamental Research Funds for the Central Universities[Grant No.16ykjc25 to L.K.]+1 种基金Sun Yat-sen University Clinical Research 5010 Program[Grant No.2016005 to L.K.]the National Key Clinical Discipline.
文摘Background Transanal total mesorectal excision(taTME)or intersphincteric resection(ISR)has recently proven to be a valid and safe surgical procedure for low rectal cancer.However,studies focusing on the combination of these two technologies are limited.This study aimed to evaluate perioperative results,long-termoncologic outcomes,and anorectal functions of patients with low rectal cancer undergoing taTME combined with ISR,by comparing with those of patients undergoing laparoscopic abdominoperineal resection(laAPR).Methods After 1:1 propensity score matching,200 patients with low rectal cancer who underwent laAPR(n=100)or taTME combined with ISR(n=100)between September 2013 and November 2019 were included.Patient demographics,clinicopathological characteristics,oncological outcomes,and anal functional results were analysed.Results Patients in the taTME-combined-with-ISR group had less intraoperative blood loss(79.6672.6 vs 107.3665.1 mL,P=0.005)and a lower rate of post-operative complications(22.0%vs 44.0%,P<0.001)than those in the laAPR group.The overall local recurrence rates were 7.0%in both groups within 3 years after surgery.The 3-year disease-free survival rates were 86.3%in the taTME-combined-with-ISR group and 75.1%in the laAPR group(P=0.056),while the 3-year overall survival rates were 96.7%and 94.2%,respectively(P=0.319).There were 39 patients(45.3%)in the taTME-combined-with-ISR group who developed major low anterior resection syndrome,whereas 61 patients(70.9%)had good post-operative anal function(Wexner incontinence score≤10).Conclusion We found similar long-term oncological outcomes for patients with low rectal cancer undergoing laAPR and those undergoing taTME combined with ISR.Patients receiving taTME combined with ISR had acceptable post-operative anorectal function.
文摘《腹腔镜或机器人辅助胰腺癌根治术中国专家共识(2022年版)》是由中国抗癌协会胰腺癌专业委员会微创诊治学组与中华医学会外科学分会胰腺外科学组组织全国部分胰腺外科专家制定,2022年首次发表于Journal of Pancreatology。在此共识中,相关专家针对腹腔镜或机器人辅助手术的安全性、肿瘤学获益、学习曲线及挑战性等方面做了详细阐述,旨在为腹腔镜或机器人辅助手术治疗胰腺癌的临床应用提供参考与指导意见。
