BACKGROUND Although en bloc dissection of hepatic hilum lymph nodes has many advantages in radical tumor treatment,the feasibility and safety of this approach for laparo-scopic pancreaticoduodenectomy(LPD)require furt...BACKGROUND Although en bloc dissection of hepatic hilum lymph nodes has many advantages in radical tumor treatment,the feasibility and safety of this approach for laparo-scopic pancreaticoduodenectomy(LPD)require further clinical evaluation and investigation.AIM To explore the application value of the"five steps four quadrants"modularized en bloc dissection technique for accessing hepatic hilum lymph nodes in LPD patients.METHODS A total of 52 patients who underwent LPD via the"five steps four quadrants"modularized en bloc dissection technique for hepatic hilum lymph nodes from April 2021 to July 2023 in our department were analyzed retrospectively.The patients'body mass index(BMI),preoperative laboratory indices,intraoperative variables and postoperative complications were recorded.The relationships between preoperative data and intraoperative lymph node dissection time and blood loss were also analyzed.RESULTS Among the 52 patients,36 were males and 16 were females,and the average age was 62.2±11.0 years.There were 26 patients with pancreatic head cancer,16 patients with periampullary cancer,and 10 patients with distal bile duct cancer.The BMI was 22.3±3.3 kg/m²,and the median total bilirubin(TBIL)concentration was 57.7(16.0-155.7)µmol/L.All patients successfully underwent the"five steps four quadrants"modularized en bloc dissection technique without lymph node clearance-related complications such as postoperative bleeding or lymphatic leakage.Correlation analysis revealed significant associations between preoperative BMI(r=0.3581,P=0.0091),TBIL level(r=0.2988,P=0.0341),prothrombin time(r=0.3018,P=0.0297)and lymph node dissection time.Moreover,dissection time was significantly correlated with intraoperative blood loss(r=0.7744,P<0.0001).Further stratified analysis demonstrated that patients with a preoperative BMI≥21.9 kg/m²and a TIBL concentration≥57.7μmol/L had significantly longer lymph node dissection times(both P<0.05).CONCLUSION The"five steps four quadrants"modularized en bloc dissection technique for accessing the hepatic hilum lymph node is safe and feasible for LPD.This technique is expected to improve the efficiency of hepatic hilum lymph node dissection and shorten the learning curve;thus,it is worthy of further clinical promotion and application.展开更多
针对传统蚁群算法在机器人路径规划中路径不是最短距离、运行时间长以及收敛速度慢等问题,提出多邻域蚁群算法(multi-neighborhood ant colony algorithm,ACO-MN)。为了解决路径不是最短距离的问题,引入多邻域搜索,使得搜索邻域扩大,机...针对传统蚁群算法在机器人路径规划中路径不是最短距离、运行时间长以及收敛速度慢等问题,提出多邻域蚁群算法(multi-neighborhood ant colony algorithm,ACO-MN)。为了解决路径不是最短距离的问题,引入多邻域搜索,使得搜索邻域扩大,机器人的路径距离减小;为了解决运行时间长的问题,在快速判断的基础上运用象限概率和象限概率控制参数,使得算法运行加快;为了解决收敛速度慢的问题,结合步长和邻域夹角改进启发函数,使得算法在后期的收敛速度加快。最后,在不同大小、不同复杂程度的栅格地图下,将ACO-MN与传统蚁群算法和其他改进算法进行仿真对比实验。实验表明,在小规模简单环境下ACO-MN的收敛速度相比于传统蚁群算法加快了76.19%,在大规模复杂环境下ACO-MN的运行时间相比于其他改进算法缩短了49.84%,最短路径缩短了5.6%,验证了该算法的有效性和优越性。展开更多
基金Supported by Health Research Program of Anhui,No.AHWJ2022b032。
文摘BACKGROUND Although en bloc dissection of hepatic hilum lymph nodes has many advantages in radical tumor treatment,the feasibility and safety of this approach for laparo-scopic pancreaticoduodenectomy(LPD)require further clinical evaluation and investigation.AIM To explore the application value of the"five steps four quadrants"modularized en bloc dissection technique for accessing hepatic hilum lymph nodes in LPD patients.METHODS A total of 52 patients who underwent LPD via the"five steps four quadrants"modularized en bloc dissection technique for hepatic hilum lymph nodes from April 2021 to July 2023 in our department were analyzed retrospectively.The patients'body mass index(BMI),preoperative laboratory indices,intraoperative variables and postoperative complications were recorded.The relationships between preoperative data and intraoperative lymph node dissection time and blood loss were also analyzed.RESULTS Among the 52 patients,36 were males and 16 were females,and the average age was 62.2±11.0 years.There were 26 patients with pancreatic head cancer,16 patients with periampullary cancer,and 10 patients with distal bile duct cancer.The BMI was 22.3±3.3 kg/m²,and the median total bilirubin(TBIL)concentration was 57.7(16.0-155.7)µmol/L.All patients successfully underwent the"five steps four quadrants"modularized en bloc dissection technique without lymph node clearance-related complications such as postoperative bleeding or lymphatic leakage.Correlation analysis revealed significant associations between preoperative BMI(r=0.3581,P=0.0091),TBIL level(r=0.2988,P=0.0341),prothrombin time(r=0.3018,P=0.0297)and lymph node dissection time.Moreover,dissection time was significantly correlated with intraoperative blood loss(r=0.7744,P<0.0001).Further stratified analysis demonstrated that patients with a preoperative BMI≥21.9 kg/m²and a TIBL concentration≥57.7μmol/L had significantly longer lymph node dissection times(both P<0.05).CONCLUSION The"five steps four quadrants"modularized en bloc dissection technique for accessing the hepatic hilum lymph node is safe and feasible for LPD.This technique is expected to improve the efficiency of hepatic hilum lymph node dissection and shorten the learning curve;thus,it is worthy of further clinical promotion and application.
文摘针对传统蚁群算法在机器人路径规划中路径不是最短距离、运行时间长以及收敛速度慢等问题,提出多邻域蚁群算法(multi-neighborhood ant colony algorithm,ACO-MN)。为了解决路径不是最短距离的问题,引入多邻域搜索,使得搜索邻域扩大,机器人的路径距离减小;为了解决运行时间长的问题,在快速判断的基础上运用象限概率和象限概率控制参数,使得算法运行加快;为了解决收敛速度慢的问题,结合步长和邻域夹角改进启发函数,使得算法在后期的收敛速度加快。最后,在不同大小、不同复杂程度的栅格地图下,将ACO-MN与传统蚁群算法和其他改进算法进行仿真对比实验。实验表明,在小规模简单环境下ACO-MN的收敛速度相比于传统蚁群算法加快了76.19%,在大规模复杂环境下ACO-MN的运行时间相比于其他改进算法缩短了49.84%,最短路径缩短了5.6%,验证了该算法的有效性和优越性。
