A Comparative Study of the Short-Term Efficacy of Laparoscopic Radical Resection of Right-Sided Colon Cancer with Two Different Surgeon Positions and Trocar Placements

Objective: To investigate the short-term efficacy of laparoscopic radical resection of right-sided colon cancer with two different surgeon positions and trocar placements. Methods: The data of 78 patients who underwent laparoscopic radical resection of right-sided colon cancer between January 2018 and August 2019 were retrospectively analysed. The surgical method was selected by the patients. The patients were divided into two groups according to the surgeons’ positioning habits and trocar placements. The group with the lead surgeon standing between the patient’s legs had 35 patients, and the group with the lead surgeon standing at the left side of the patient had 43 patients. The operation time, intraoperative blood loss, postoperative anal gas evacuation time, postoperative urinary catheter indwelling time, postoperative hospital stay, C-reactive protein (CRP) level on the first day after surgery, and postoperative pathological data and complications were compared between the two groups. Results: All patients underwent the laparoscopic radical resection of right-sided colon cancer, none converting to laparotomy. No significant difference (P > 0.05) in intraoperative blood loss (57.6 ± 21.3 ml vs 60.2 ± 35.3 ml), postoperative anal gas evacuation time (3.5 ± 1.1 d vs 3.8 ± 1.3 d), postoperative urinary catheter indwelling time (2.6 ± 1.3 d vs 2.4 ± 1.2 d), postoperative hospital stay (7.1 ± 1.8 d vs 7.5 ± 2.1 d), or CRP level on the first day after surgery (54.7 ± 9.6 mg/L vs 53.9 ± 8.2 mg/L) was detected between the two groups. The operation time was shorter in the group with the lead surgeon standing between the patient’s legs (185.2 ± 25.6 min vs 196.2 ±19.7 min) (P < 0.05). The two groups did not differ significantly in the tumour length (4.2 ± 1.3 cm vs 3.9 ± 1.5 cm), number of dissected lymph nodes (27.5 ± 11.6 vs 25.1 ± 15.4), pathological type, or postoperative pathological tumour-node-metastasis stage (P > 0.05). No patients died or had anastomotic fistula during their postoperative hospital stay, and the incidence of postoperative complications did not differ between the two groups (22.9% (8/35) vs 23.3% (10/42);P > 0.05). Conclusion: Under the principle of radical resection, the surgeon should adopt the most suitable standing position and trocar placement according to the specific situation. If the surgeon stands between the patient’s legs, this might shorten the operation time and promote a smoother surgery.

Laparoscopic vs open extended right hemicolectomy for colon cancer

AIM:To evaluate the feasibility,safety,and oncologic outcomes of laparoscopic extended right hemicolectomy(LERH)for colon cancer.METHODS:Since its establishment in 2009,the Southern Chinese Laparoscopic Colorectal Surgical Study(SCLCSS)group has been dedicated to promoting patients’quality of life through minimally invasive surgery.The multicenter database was launched by combining existing datasets from members of the SCLCSS group.The study enrolled 220 consecutive patients who were recorded in the multicenter retrospective database and underwent either LERH(n=119)or open extended right hemicolectomy(OERH)(n=101)for colon cancer.Clinical characteristics,surgical outcomes,and oncologic outcomes were compared between the two groups.RESULTS:There were no significant differences in terms of age,gender,body mass index(BMI),history of previous abdominal surgery,tumor location,and tumor stage between the two groups.The blood loss was lower in the LERH group than in the OERH group[100(100-200)mL vs 150(100-200)mL,P<0.0001].The LERH group was associated with earlier first flatus(2.7±1.0 d vs 3.2±0.9 d,P<0.0001)and resumption of liquid diet(3.6±1.0 d vs 4.2±1.0 d,P<0.0001)compared to the OERH group.The postoperative hospital stay was significantly shorter in the LERH group(11.4±4.7 d vs 12.8±5.6 d,P=0.009)than in the OERH group.The complication rate was 11.8%and17.6%in the LERH and OERH groups,respectively(P=0.215).Both 3-year overall survival[LERH(92.0%)vs OERH(84.4%),P=0.209]and 3-year disease-free survival[LERH(84.6%)vs OERH(76.6%),P=0.191]were comparable between the two groups.CONCLUSION:LERH with D3 lymphadenectomy for colon cancer is a technically feasible and safe procedure,yielding comparable short-term oncologic outcomes to those of open surgery.

Laparoscopic radical resection for situs inversus totalis with colonic splenic flexure carcinoma:A case report

BACKGROUND Situs inversus totalis(SIT)is a rare group of congenital developmental malformations in the clinical setting,with all organs in the chest and abdomen existing in a mirror image reversal of their normal positions.Few reports have described laparoscopic surgery for colorectal cancer in patients with SIT,and it is considered difficult even for an experienced surgeon because of the mirror positioning.We present a case report of laparoscopic radical resection of a colonic splenic flexure carcinoma in a patient with SIT.CASE SUMMARY A 72-year-old male was referred to our hospital with colonic splenic flexure carcinoma,and computed tomography showed that all the organs in the chest and abdomen were inverted.Laparoscopic hemicolectomy with complete mesocolic excision was safely performed.The operating surgeon stood on the patient’s left side,which is opposite of the normal location.CONCLUSION Abdominal computed tomography is an effective method for diagnosing SIT preoperatively in patients with colonic splenic flexure carcinomas.Laparoscopic radical resection is difficult,but it is well established and safe.The surgeon should stand in the opposite position and perform backhand operations.

Effect of laparoscopic radical resection of colon cancer on immune function, stress response and gastrointestinal hormones in patients with colon cancer

Objective:To investigate the effect of laparoscopic radical resection of colon cancer on immune function, stress response and gastrointestinal hormones in patients with colon cancer. Method:140 patients with colon cancer admitted to a hospital from January 2016 to November 2017 were divided into control group and observation group according to the operation method, 70 cases in each group. The control group was treated with open radical resection of colon cancer, while the observation group was treated with laparoscopic radical resection of colon cancer. The changes of immune function, stress response, visceral protein and gastrointestinal hormone were compared between the two groups before and after treatment.Results:There was no significant difference in immune function, stress response, visceral protein and gastrointestinal hormone between the two groups before operation (P>0.05). The ratio of Th1 cells was decreased, while the ratio of Th2, Th17 and Treg cells was increased in the two groups (P<0.05). The proportion of Th1 cells in the observation group was higher than that in the control group,while the ratio of Th2, Th17 and Treg cells in the observation group was lower than that of the control group (P<0.05). The levels of Cor, E and NE were increased in the two groups (P<0.05). And the levels of Cor, E and NE in the observation group were lower than those in the control group (P<0.05). The levels of PA, TRF and RBP were decreased in the two groups (P<0.05). And PA, TRF and RBP levels were higher in the observation group than in the control group (P<0.05). The GAS, MTL and GIP levels were lower in the two groups (P<0.05). And the GAS, MTL and GIP levels in the observation group were higher than those in the control group (P<0.05).Conclusion: Laparoscopic radical mastectomy has little effect on the immune function of patients. It can alleviate the surgical stress response to a certain extent, which is beneficial to the recovery of gastrointestinal function and can be extended to clinical application.

Effect of laparoscopic radical resection of rectal cancer on gastrointestinal hormones, visceral protein and pain stress in patients

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.

Does cranial-medial mixed dominant approach have a unique advantage for laparoscopic right hemicolectomy with complete mesocolic excision?

BACKGROUND Complete mesocolic excision(CME)with central vascular ligation(CVL)was proposed by Hohenberger in 2009.The CME principle has gradually become the technical standard for colon cancer surgery.How to achieve CME with CVL in laparoscopic right hemicolectomy(LRH)is controversial,and a unified standard approach is not yet available.In recent years,the authors’team has integrated the theory of membrane anatomy,tried to combine the cephalic approach with the classic medial approach(MA)for technical optimization,and proposed a cranialmedial mixed dominant approach(CMA).AIM To explore the feasibility of operational approaches for LRH with CME.METHODS In this retrospective cohort study,the clinical data of 57 patients with right-sided colon cancer(TNM stage I,II,or III)who underwent LRH with CME from January 2016 to June 2020 were collected and summarized.There were 31 patients in the traditional MA group and 26 in the CMA group.RESULTS There were no significant differences in baseline data between the two groups.The operation was shorter and the number of lymph nodes dissected was higher in the CMA group than in the MA group,but there was no significant difference in the number of positive lymph nodes,intraoperative blood loss,postoperative exhaust time,feeding time,postoperative hospital stay or postoperative complication incidence.CONCLUSION Our study shows that the CMA is a safe and feasible procedure for LRH with CME and has a unique advantage.

Patients with Crohn’s disease have longer post-operative in-hospital stay than patients with colon cancer but no difference in complications’ rate

BACKGROUND Right hemicolectomy or ileocecal resection are used to treat benign conditions like Crohn’s disease(CD)and malignant ones like colon cancer(CC).AIM To investigate differences in pre-and peri-operative factors and their impact on post-operative outcome in patients with CC and CD.METHODS This is a sub-group analysis of the European Society of Coloproctology’s prospective,multi-centre snapshot audit.Adult patients with CC and CD undergoing right hemicolectomy or ileocecal resection were included.Primary outcome measure was 30-d post-operative complications.Secondary outcome measures were post-operative length of stay(LOS)at and readmission.RESULTS Three hundred and seventy-five patients with CD and 2,515 patients with CC were included.Patients with CD were younger(median=37 years for CD and 71 years for CC(P<0.01),had lower American Society of Anesthesiology score(ASA)grade(P<0.01)and less comorbidity(P<0.01),but were more likely to be current smokers(P<0.01).Patients with CD were more frequently operated on by colorectal surgeons(P<0.01)and frequently underwent ileocecal resection(P<0.01)with higher rate of de-functioning/primary stoma construction(P<0.01).Thirty-day post-operative mortality occurred exclusively in the CC group(66/2515,2.3%).In multivariate analyses,the risk of post-operative complications was similar in the two groups(OR 0.80,95%CI:0.54-1.17;P=0.25).Patients with CD had a significantly longer LOS(Geometric mean 0.87,95%CI:0.79-0.95;P<0.01).There was no difference in re-admission rates.The audit did not collect data on post-operative enhanced recovery protocols that are implemented in the different participating centers.CONCLUSION Patients with CD were younger,with lower ASA grade,less comorbidity,operated on by experienced surgeons and underwent less radical resection but had a longer LOS than patients with CC although complications'rate was not different between the two groups.

地佐辛静脉麻醉联合罗哌卡因局部浸润麻醉镇痛对腹腔镜结直肠癌根治术患者镇痛效果及围术期免疫和应激反应影响

目的探讨腹腔镜结直肠癌根治术患者使用地佐辛静脉麻醉联合罗哌卡因局部浸润麻醉镇痛效果及对围术期免疫和应激反应影响。方法选取2020年4月—2022年5月择期行腹腔镜结直肠癌根治术患者100例,据麻醉镇痛方式不同均分为观察组和对照组,观察组给予全麻及地佐辛静脉麻醉联合罗哌卡因局部浸润麻醉镇痛,对照组给予全麻及罗哌卡因局部浸润麻醉镇痛。记录2组麻醉诱导前5 min(T0)、术毕(T1)、拔管即刻(T2)、拔管后30 min(T3)、拔管后60 min(T4)时平均动脉压(MAP)、心率(HR)及血清皮质醇(Cor)、丙二醛(MDA)水平;比较术前、术后24 h 2组外周血CD4+、CD8+和CD4+/CD8+水平,术毕12、24、48 h视觉模拟评分法(VAS)评分,术前、术后3 d简易智力状态检查量表(MMSE)评分,以及2组麻醉恢复期间不良反应。结果T3时,2组MAP、HR高于T0时,且观察组低于对照组(P<0.05);T1、T2、T3、T4时,2组Cor、MDA均高于T0时,且观察组低于对照组(P<0.05)。术后24 h,2组CD4+、CD4+/CD8+降低,CD8+升高,且观察组CD4+、CD4+/CD8+较对照组升高,CD8+较对照组降低(P<0.05)。观察组术毕12、24、48 h VAS评分均较对照组降低(P<0.05)。术后3 d,2组MMSE评分均降低,且观察组低于对照组(P<0.05)。观察组麻醉恢复期间躁动发生率为6.00%(3/50)低于对照组的20.00%(10/50)(P<0.05)。结论全麻及地佐辛静脉联合罗哌卡因局部浸润麻醉镇痛对腹腔镜结直肠癌根治术患者免疫功能影响小,可减轻手术应激,镇痛效果好,且安全性高。

腹腔镜经肠系膜上动脉优先入路与中间入路右半结肠癌根治术的疗效和安全性比较

目的探讨腹腔镜经肠系膜上动脉优先入路和中间入路治疗右半结肠癌的效果和安全性差异。方法选取丹阳市人民医院于2018年1月—2023年9月收治的60例接受腹腔镜右半结肠癌手术患者为研究对象,按照手术路径分成两组,分别采用中间入路(对照组)和肠系膜上动脉优先入路(研究组),各30例。对比两组术中、术后临床指标、肿瘤标志物水平、炎症因子及并发症发生率。结果研究组术中和术后各指标均优于对照组,差异有统计学意义(P均<0.05)。研究组癌胚抗原、癌抗原-125、恶性肿瘤特异性生长因子、白细胞介素-6、C反应蛋白、白细胞计数水平均低于对照组,差异有统计学意义(P均<0.05)。术后,研究组并发症总发生率为5.00%低于对照组的26.66%,差异有统计学意义(χ^(2)=4.320,P<0.05)。结论肠系膜上动脉优先入路腹腔镜右半结肠癌根治术,能改善临床指标、抑制肿瘤标志物,降低炎症因子水平,减少并发症发生情况,增加手术治疗效果。

喉罩全身麻醉联合“圈麻”阻滞用于结肠癌手术的麻醉效果

目的 观察喉罩全身麻醉联合腹部“圈麻”阻滞用于腹腔镜下结肠癌切除手术的麻醉效果。方法 选取2022年1月至2023年3月于厦门市第三医院行腹腔镜下结肠癌切除手术的患者60例,根据随机数字表法将其分为L组(喉罩全身麻醉,30例)和U组(喉罩全身麻醉联合腹部“圈麻”阻滞,30例)。记录并比较两组患者麻醉维持的丙泊酚和瑞芬太尼用量、手术完成时间、意识清醒后视觉模拟评分法(visual analogue scale,VAS)评分和舒芬太尼用量。比较两组患者术后12h的镇痛满意度。结果 两组患者的性别、年龄、体质量、身高、手术时间比较差异均无统计学意义(P>0.05)。U组患者的瑞芬太尼和丙泊酚总用量均显著少于L组(P<0.001);U组患者麻醉恢复室内的VAS评分显著低于L组,舒芬太尼用量显著少于L组(P<0.001)。U组患者的镇痛满意度显著高于L组(χ^(2)=6.772,P=0.031)。结论 与单一喉罩全身麻醉相比,喉罩全身麻醉联合腹部“圈麻”阻滞可减少腹腔镜下结肠癌切除手术中麻醉维持药物和麻醉恢复室内舒芬太尼的用量,改善术后镇痛满意度。

腹腔镜右半结肠切除同期行肝方叶转移癌切除1例

目的分析腹腔镜下同期治疗结肠癌及其肝转移的过程,探讨腹腔镜同期手术在治疗结肠癌肝转移中的作用。方法回顾性分析2023年3月安徽医科大学第一附属医院1例结肠癌伴肝方叶转移患者的临床资料,同期行混合入路腹腔镜右半结肠切除、Glisson蒂横断法肝方叶转移癌切除。结果RO切除右半结肠及肝转移癌,术中出血量约50 mL,第4天拔引流管,无并发症,顺利出院。病理结果:结肠溃疡型低分化腺癌,肠周(12/21)个淋巴结有癌转移,低分化肝转移癌。结论腹腔镜同期行右半结肠切除和肝转移癌切除的治疗安全可行,采用新的手术路径和操作模式可保证手术安全,值得推广。

腹腔镜结直肠癌术后吻合口瘘的原因分析与预防策略

目的研究分析腹腔镜结直肠癌手术后发生吻合口瘘的原因,并探讨相应的预防对策。方法选取2018年1月至2022年12月柳州市人民医院胃肠外科接受腹腔镜手术的676例结直肠癌患者作为研究对象,根据患者在手术后是否发生吻合口瘘将其分为研究组(发生吻合口瘘,49例)与对照组(未发生吻合口瘘,627例)。采取回顾性方式分析两组病例的临床资料,采用logistic回归分析方法分析腹腔镜结直肠癌手术后发生吻合口瘘的影响因素。结果单因素分析结果提示,研究组与对照组的性别、年龄、体重指数、糖尿病、术前血清白蛋白、手术时间比较,差异有统计学意义(P<0.05)。多因素分析结果提示,男性(β=0.335,OR=2.561,95%CI:1.489~3.082)、年龄≥60岁(β=0.361,OR=2.457,95%CI:1.193~3.107)、体重指数≥24.9 kg/m^(2)(β=0.329,OR=2.379,95%CI:1.140~3.278)、合并糖尿病(β=0.328,OR=2.369,95%CI:1.207~3.114)、术前血清白蛋白<35 g/L(β=0.357,OR=2.418,95%CI:1.245~3.098)、手术时间≥3.5 h(β=0.348,OR=2.406,95%CI:1.352~3.069)是腹腔镜结直肠癌手术后发生吻合口瘘的危险因素(P<0.05)。结论结直肠癌患者在腹腔镜手术后受到性别、年龄、体质量指数、糖尿病等因素的影响,易发生吻合口瘘。

国产图迈■内窥镜手术机器人辅助右半结肠癌根治术的应用分析

目的:初步探讨图迈■内窥镜手术机器人辅助右半结肠癌根治术的安全性及可行性。方法:收集甘肃省人民医院普外科一病区于2022年04月至06月收治的6例右半结肠癌患者的临床病例资料,其中男性4例,女性2例,中位年龄57岁,范围37~68岁;患者均行图迈■内窥镜手术机器人辅助右半结肠癌根治术,即右半结肠D3+全结肠系膜切除术。结果:6例患者均顺利完成手术;平均手术时间204.16 min,术中出血量108.31 mL,术后下床活动时间为3.16 d,术后胃肠功能恢复时间为4.16 d,术后进食流质食物时间为5 d,腹腔引流管引流时间8 d,淋巴结清扫数目为23.33枚,术后住院时间9.5 d;术中、术后均无器械相关的不良事件发生;6例患者均行全身静脉化疗,方案为FOLFOX,疗程为6~8个周期;1年总体生存率为100%。结论:图迈■内窥镜手术机器人辅助右半结肠癌根治术安全、可行,临床疗效良好;该机器人系统有望成为国内辅助根治结肠癌的主要手段。

基于膜解剖理论的胸、腹腔镜联合食管癌根治术

目的探讨膜解剖理论应用于胸、腹腔镜联合食管癌根治术的可行性及临床意义。方法回顾性分析2018年12月~2021年10月行基于膜解剖理论的胸、腹腔镜联合食管癌根治术142例资料。将食管系膜、食管癌以及食管系膜内的神经、血管、淋巴系统、脂肪组织、胃上部、胃左系膜、胃左淋巴结作为一个整体切除。术中可见食管周围含疏松结缔组织的间隙为食管筋膜融合间隙。前10例使用纳米炭示踪标记,显示食管淋巴液引流至胃左淋巴结。结果142例手术顺利,手术时间150~230(184.6±21.3)min,术中出血量20~100(46.7±16.8)ml,清扫淋巴结12~41(23.5±7.3)枚,97例淋巴结阳性;术后胸腔引流时间3~10(7.1±2.5)d,经口进流食时间5~10(7.6±1.7)d,总住院时间9~20(14.0±4.6)d。术后并发症发生率21.8%(31/142),包括吻合口漏7例(4.9%),吻合口狭窄9例(6.3%),声音嘶哑9例(6.3%),残胃炎6例(4.2%)。无术后出血、乳糜漏、感染或术后30 d内死亡。142例随访11~35个月,中位数26个月,无复发和死亡。结论食管周围存在构成“信封”的系膜结构,膜解剖理论适用于食管癌的治疗,基于膜解剖理论的食管癌根治术安全、有效、可行。

不同入路腹腔镜手术对右半结肠癌患者肠屏障功能和红细胞免疫的影响

目的探讨不同入路腹腔镜手术对右半结肠癌患者肠屏障功能、红细胞免疫及预后的影响。方法选取2019年4月至2021年4月我院收治的110例右半结肠癌患者,简单随机化法分为A组(n=55)和B组(n=55),治疗期间,A组失访2例,B组失访3例,最终A组和B组分别纳入53例和52例。2组均行腹腔镜手术,A组采取头侧入路,B组采取中间入路。统计2组围手术期指标、并发症、预后及手术前后肠屏障功能(内毒素、D-乳酸、二胺氧化酶)、红细胞免疫[红细胞免疫复合物花环率(RBC-ICR)、红细胞C3b受体花环率(RBC-C3bRR)、红细胞黏附肿瘤细胞花环率(TRR)]。结果与B组相比,A组术中出血量较少,中央淋巴结清扫时间、手术时间较短,并发症发生率较低(P<0.05);术后3 d 2组内毒素、二胺氧化酶、D-乳酸水平均高于术前(P<0.05);术后3 d 2组RBC-ICR高于术前,TRR、RBC-C3bRR低于术前(P<0.05);术后1年随访,2组远处转移、局部复发、生存率比较,差异无统计学意义(P>0.05)。结论2种入路方案在右半结肠癌中效果相当,其中头侧入路腹腔镜手术可缩短手术时间,降低并发症发生率。

单中心腹腔镜与开腹手术治疗T_(3)~T_(4a)期结肠癌的近远期疗效比较

目的:比较腹腔镜与开腹手术治疗T_(3)~T_(4a)期结肠癌围术期疗效及远期生存情况。方法:选取2018年1月1日至2019年12月31日采用腹腔镜与开腹手术治疗的T_(3)~T_(4a)期结肠癌患者,分为腹腔镜组(n=102)与开腹组(n=43),分析两组围手术期资料、术后并发症、总生存期、无瘤生存期、1年与3年生存率及无瘤生存率、总生存率、总无瘤生存率、肿瘤复发转移情况。结果:两组患者基线资料差异无统计学意义(P>0.05)。腹腔镜组术中出血量少于开腹组[50.00(20.00,50.00)mL vs. 50.00(50.00,100.00)mL,P<0.001],获取淋巴结数量多于开腹组[17.00(14.00,22.00)枚vs. 14.00(11.00,20.00)枚,P=0.018],术后恢复进食时间[3.00(3.00,4.00)d vs. 4.00(3.00,6.00)d,P<0.001]、排气时间[3.00(3.00,3.00)d vs. 4.00(3.00,5.00)d,P<0.001]短于开腹组,术后总体并发症与不完全肠梗阻发生率低于开腹组(32.35%vs. 51.16%,3.92%vs. 16.28%,P<0.05)。两组术后1年、3年生存率及无瘤生存率、总生存率、总无瘤生存率、肿瘤复发转移率差异无统计学意义(P>0.05)。在T_(4a)亚组中,腹腔镜组与开腹组的各项生存指标差异均无统计学意义(P>0.05)。结论:腹腔镜手术治疗T_(3)~T_(4a)期结肠癌是安全、可行的,更利于术后恢复,可取得与开腹手术相当的肿瘤治疗效果。

吲哚菁绿荧光标记肠脂垂在腹腔镜结肠癌根治术中引导层面解剖的应用

目的评估改良封装吲哚菁绿(indocyaninegreen,ICG)荧光标记肠脂垂用于腹腔镜结肠癌术中引导系膜层面解剖的可行性和有效性。方法采用描述性病例系列研究方法,回顾性收集并分析2022年2月至4月在南方医科大学附属广东省人民医院(广东省医学科学院)胃肠外科接受改良封装ICG标记肠脂垂在腹腔镜结肠癌术中引导系膜解剖层面识别的患者临床资料。观察并记录患者临床信息、ICG用量、荧光肠脂垂显影率、荧光外溢率、围手术期及手术信息(包括手术时间、术中出血量、围手术期并发症发生情况)和术后住院天数等。结果共9例患者被纳入研究,其中4例行腹腔镜辅助升结肠癌根治术,5例行腹腔镜辅助乙状结肠癌根治术。所有病例均在术中观察到目标区域的改良封装ICG标记肠脂垂荧光信号,显影率100%,且未发生额外的荧光泄漏和术中并发症,平均手术时间(184.4±52.6)min,中位出血量为20(20,75)ml,平均术后住院天数(6.0±1.6)d术后全部患者顺利出院且术后30d内未出现并发症。结论改良封装ICG荧光标记肠脂垂在腹腔镜结肠癌根治术中可引导术者进入正确的解剖层面,避免相关副损伤,该辅助手段安全有效。

经腹膜外入路腹腔镜前列腺癌根治术治疗前列腺癌的临床效果

目的:探讨经腹膜外入路腹腔镜前列腺癌根治术治疗前列腺癌的临床效果。方法:选取2019年12月—2022年12月无锡市第二人民医院收治的78例前列腺癌患者作为研究对象。根据1︰1的比例随机将其分为对照组与观察组,各39例。对照组给予经腹腔入路腹腔镜前列腺癌根治术治疗,观察组给予经腹膜外入路腹腔镜前列腺癌根治术治疗。比较两组围手术期指标,控尿率,术前及术后1周勃起功能,并发症。结果:观察组手术时间、留置尿管时间、住院时间均短于对照组,术中出血量少于对照组,差异有统计学意义(P<0.05)。观察组控尿率为87.18%,高于对照组的64.10%,差异有统计学意义(P<0.05)。术后1周,观察组国际勃起功能评分表(IIEF-5)评分高于对照组,差异有统计学意义(P<0.05)。观察组并发症发生率为2.56%,显著低于对照组的17.59%,差异有统计学意义(P<0.05)。结论:经腹膜外入路腹腔镜前列腺癌根治术治疗前列腺癌具有明显优势,能够有效改善围手术期指标、控尿率及勃起功能,并降低并发症发生率。

阑尾杯状细胞腺癌1例报告

目的探讨阑尾杯状细胞腺癌(goblet cell adenocarcinoma of the appendix,GCA)的规范诊断与治疗。方法查阅国内外相关文献,对1例GCA患者的临床诊治进行回顾性分析。结果患者男,64岁,当地医院行腹腔镜下阑尾切除术,术后病理诊断为GCA后,于南昌大学第一附属医院行腹腔镜下右半结肠根治性切除术,术后恢复可,无严重并发症,术后9 d出院,现已行2次奥沙利铂+左亚叶酸钙+氟尿嘧啶化疗方案以及6次奥沙利铂+卡培他滨规律化疗,术后随访19个月,未见明确肿瘤复发或转移。结论阑尾肿瘤诊断缺乏特异性,若阑尾切除患者年龄较大、术前肿瘤标志物升高、阑尾管壁增厚、质硬或触及肿块时,应考虑阑尾肿瘤的可能性,必要时行术中冰冻切片送检,以达到一期根治的目的。

保护性造口在腹腔镜下超低位直肠癌根治术中的安全性及有效性研究

目的:探讨保护性造口在腹腔镜下超低位直肠癌根治术中的安全性及有效性。方法:回顾性分析2019年9月—2023年4月萍乡市人民医院收治的70例行腹腔镜下超低位直肠癌根治术患者的临床资料,将未接受保护性造口患者设为对照组(n=38),接受预防性末端回肠造口术患者设为观察组(n=32)。比较两组围手术期指标、炎症因子水平、大便失禁状况及并发症。结果:观察组手术时间长于对照组,首次排便时间、首次通气时间及术后住院时间均短于对照组(P<0.05);两组术中出血量比较,差异无统计学意义(P>0.05);术后72 h两组C反应蛋白(CRP)与中性粒细胞(N)均较术后24 h下降,且观察组CRP、N均低于对照组(P<0.05);术后6个月两组Wexner失禁评分均下降,术后1、3、6个月欧洲癌症研究与治疗组织(EORTC)生命质量问卷-C30(QLQ-C30)得分呈上升趋势,且观察组Wexner失禁评分低于对照组,EORTC QLQ-C30得分均高于对照组(P<0.05);观察组并发症总发生率(6.25%)低于对照组(23.68%)(P<0.05)。结论:对腹腔镜下超低位直肠癌根治术患者予以保护性造口具有较好安全性,能促进肛门功能恢复,对机体影响较小,并可提升生活质量。