Feasibility and safety of minimally invasive multivisceral resection for T4b rectal cancer:A 9-year review

BACKGROUND Colorectal cancer is the third most common cancer and the second highest cause of cancer-related mortality worldwide.About 5%-10%of patients are diagnosed with locally advanced rectal cancer(LARC)on presentation.For LARC invading into other structures(i.e.T4b),multivisceral resection(MVR)and/or pelvic ex-enteration(PE)remains the only potential curative surgical treatment.MVR and/or PE is a major and complex surgery with high post-operative morbidity.Minimally invasive surgery(MIS)has been shown to improve short-term post-operative outcomes in other gastrointestinal malignancies,but there is little evi-dence on its use in MVR,especially so for robotic MVR.This is a single-center retrospective cohort study from 1st January 2015 to 31st March 2023.Inclusion criteria were patients diagnosed with cT4b rectal cancer and underwent MVR,or stage 4 disease with resectable systemic metastases.Pa-tients who underwent curative MVR for locally recurrent rectal cancer,or me-tachronous rectal cancer were also included.Exclusion criteria were patients with systemic metastases with non-resectable disease.All patients planned for elective surgery were enrolled into the standard enhanced recovery after surgery pathway with standard peri-operative management for colorectal surgery.Complex sur-gery was defined based on technical difficulty of surgery(i.e.total PE,bladder-sparing prostatectomy,pelvic lymph node dissection or need for flap creation).Our primary outcomes were the margin status,and complication rates.Cate-gorical values were described as percentages and analysed by the chi-square test.Continuous variables were expressed as median(range)and analysed by Mann-Whitney U test.Cumulative overall survival(OS)and recurrence-free survival(RFS)were analysed using Kaplan-Meier estimates with life table analysis.Log-rank test was performed to determine statistical significance between cumulative estimates.Statistical significance was defined as P<0.05.Meier estimates with life table analysis.Log-rank test was performed to determine statistical significance between cumulative estimates.Statistical significance was defined as P<0.05.RESULTS A total of 46 patients were included in this study[open MVR(oMVR):12(26.1%),miMVR:36(73.9%)].Patients’American Society of Anesthesiologists score,body mass index and co-morbidities were comparable between oMVR and miMVR.There is an increasing trend towards robotic MVR from 2015 to 2023.MiMVR was associated with lower estimated blood loss(EBL)(median 450 vs 1200 mL,P=0.008),major morbidity(14.7%vs 50.0%,P=0.014),post-operative intra-abdominal collections(11.8%vs 50.0%,P=0.006),post-operative ileus(32.4%vs 66.7%,P=0.04)and surgical site infection(11.8%vs 50.0%,P=0.006)compared with oMVR.Length of stay was also shorter for miMVR compared with oMVR(median 10 vs 30 d,P=0.001).Oncological outcomes-R0 resection,recurrence,OS and RFS were comparable between miMVR and oMVR.There was no 30-d mortality.More patients underwent robotic compared with laparoscopic MVR for complex cases(robotic 57.1%vs laparoscopic 7.7%,P=0.004).The operating time was longer for robotic compared with laparoscopic MVR[robotic:602(400-900)min,laparoscopic:Median 455(275-675)min,P<0.001].Incidence of R0 resection was similar(laparoscopic:84.6%vs robotic:76.2%,P=0.555).Overall complication rates,major morbidity rates and 30-d readmission rates were similar between la-paroscopic and robotic MVR.Interestingly,3-year OS(robotic 83.1%vs 58.6%,P=0.008)and RFS(robotic 72.9%vs 34.3%,P=0.002)was superior for robotic compared with laparoscopic MVR.CONCLUSION MiMVR had lower post-operative complications compared to oMVR.Robotic MVR was also safe,with acceptable post-operative complication rates.Prospective studies should be conducted to compare short-term and long-term outcomes between robotic vs laparoscopic MVR.

Investigation on complementarity between total mesorectal excision and radical resection in relation to postoperative local recurrence in patients receiving anus-reserve operation on rectal cancer

Objective:To investigate the difference and complementarity between total mesorectal excision(TME)and radical resection in relation to postoperative local recurrence in patients receiving anus-reserve operation on rectal cancer.Methods:Clinical data of 81 cases during a period from 1975 to 2001 were retrospectively analyzed.Results:In the 81 cases with local recurrence,49 of them laid to anastomosis and mesorectum,17 lymph nodes and 15 multi-site relapse.The choice of operative procedure included abdominoperineal resection in 58 cases,Hartmann’s operation in 4 cases,simple double-pelvic stoma in 12 cases,exploration in 7 cases,and total pelvic or rear-pelvic resection in combination with other organs in 6 cases. The rate of resection was 84.0%(68/81).32 cases reached clinical radical degree,and the rate of radical resection was 39.5% (32/81).The 5-year survival rate was 34.4%(11/32).Conclusion:Based on actual condition of the patients,attention to radi- cal resection and total mesorectal excision are necessary,and reasonable adoption of the operative procedure could reduce the local recurrence of rectal cancer.

Recent advances in the surgical treatment of pancreatic cancer

INTRODUCTIONPancreatic cancer remains the fourth commonest cause of cancer related death in the western world[1]. The prognosis remains dismal due partly to late presentation, with associated low resectability rates, and the aggressive biological nature of these tumors. The median survival time from diagnosis in unresectable tumors remains only 4 6 months.For those patients amenable to surgical resection over the last 20 years have seen marked improvements in postoperative mortality and morbidity, especially in specialist pancreatic centres 23. Despite these changes long-term survival remains low. with a total 5-year survival rate remaining less than 5%.Patients with ampullary cancer have a better 5-year survival of 40°%-60°%.

Surgical Treatment of Carcinoma of Esophagus and Gastric Cardia—A 34—year Investigation

Objective To understand the progress in surgical treatment of 12 970 patients with carcinoma of esophagus and gastric cardiac during 1965-1998.Methods The patients were divided into A, B and C groups: 3 155 patients (group A) were treated surgically in the first 14 years, 5952 patients (group B) in the next 10 years, and 3 863 patients (group C) in the last 10 years. The early stage lesions (Tis, Tl) were assigned as a separate group. The results of these groups were compared.Results The resectability for esophageal and gastric cardiac carcinoma was 94.0% and 84.4% respectively, and the overall resectability was 91.3% . The resectabih'ty for groups A, B, C and the early stage group was 82.1% , 85.1% , 90.2% and 100% , respectively. The overall operative mortality was 1.8%, it was 4.4% for group A, 1.6% for group B, and 0.5% for group C. The overall 5-year survival was 31.6% . The 5-year survival for groups A, B, C and the early stage group was 27.0% , 29.1%, 32.0% and 92.6%, respectively . Among the 3 temporal groups, differences were observed in terms of lesion stage, location and size, surgery with or without combined therapy and postoperative complications.Conclusion Best results were achieved in the early cases, with a resectability of 100% and a 5-year survival of 92.6% . The indications for surgical treatment were extended with increased resectability and decreased mortality. Subtotal esophagectomy combined with cervical esophagogastrostomy was advocated as the procedure of first choice for esophageal carcinoma in attempt to diminish the chance of recurrence, and to achieve better outcomes by using combined therapy for patients with e" stage b! lesion.

Radiotherapy combined with surgical treatment for gastric cancer:a meta-analysis

Objective:We carried out a meta-analysis to assess the effectiveness and safety of radiotherapy combined with surgery for gastric cancer.Methods:Randomized Clinical Trials (RCTs) in which radiotherapy (preoperative,intraoperative and postoperative),was compared with surgery alone in resectable gastric cancer were identified by searching Cochrane Library (Issue 2,2009),PubMed (Jan 1966-Jun 2009),EMBASE (Jan 1974-Jun 2009),Chinese Biomedical Literature Database (Jan 1978-Jun 2009),Chinese Science and Technology Periodicals Database (Jan 1989-Jun 2009),China National Knowledge Infrastructure (Jan 1994-Jun 2009) and Wanfang database (Jan 1997-Jun 2009) in English and Chinese languang.Two researchers assessed the quality of included randomized controlled trials (RCT) extracted data independently.The RevMan 5.0 software was used for meta-analysis.Our researchers assessed the quality of included randomized controlled trials (RCT) extracted data independently.The RevMan 5.0 software was used for meta-analysis.Results:Nine randomized controlled trials of 1 548 patients were selected for meta-analysis.Five randomized controlled trials were related with comparison of preoperative radiotherapy plus surgery with single surgery.Two randomized controlled trials were the comparative studies between surgery plus postoperative and single surgery.The meta-analysis results showed that:(1) compared with surgery alone,preoperative radiotherapy combined with surgery can increase 3 years (OR=1.78;95% CI 1.14-2.78,P=0.01),5 years (OR=1.67;95% CI 1.22-2.29,P=0.001),10 years (OR=1.64;95% CI 1.03-2.60,P=0.04) survival rate and resection rate (OR=2.15;95% CI 1.31-3.54,P=0.003);reduce the of tumor recurrence rate (OR=0.59;95% CI 0.37-0.92,P=0.02) and metastasis rate (OR=0.44;95% CI 0.27-0.73,P=0.001);(2) The tumor recurrent rates (OR=0.19,95% CI 0.03-1.14,P=0.07) and tumor metastasis rate (OR=0.09;95% CI 0.00-1.77,P=0.11) had no difference between single surgery group and peri-operative radiotherapy plus surgery group;(3) Postoperative radiotherapy compared with surgery alone had no significant effects on 1 year (OR=0.83;95% CI 0.60-1.15,P=0.26) and 3 years (OR=0.75;95% CI 0.51-1.11,P=0.15) survival rate compared with single surgery,but the 5-year survival rates (OR=0.57;95% CI 0.34-0.95,P=0.03) of the patients who received surgery alone was higher than those who received combined therapy.No difference of the tumor recurrence rate (OR=0.59;95% CI 0.33-1.05,P=0.07),tumor metestasis rate (OR=0.90;95% CI 0.51-1.59,P=0.71) and anastomotic leak (OR=0.98;95% CI 0.25-3.65,P=0.98) were observed between the two groups.Conclusion:Preoperative radiotherapy combined surgery is more rational and effective than surgery alone of gastric cancer.However,in terms of the clinical effects of perioperarive or postoperative radoiotherapy combined with surgery,much multicenter,largescale,high-quality,double-blind and rigorously designed studies would be needed than currently available in the future.

Preoperative rectal tumor embolization as an adjunctive tool for bloodless abdominoperineal excision:A case report

BACKGROUND Abdominoperineal excision(APE)-related hemorrhage can be challenging due to difficult access to pelvic organs and the risk of massive blood loss.The objective of the present study was to demonstrate the use of preoperative embolization(PE)as a strategy for blood preservation in a patient with a large low rectal tumor with a high risk of bleeding,scheduled for APE.CASE SUMMARY A 56-year-old man presented to our institution with a one-year history of anal bleeding and rectal tenesmus.The patient was diagnosed with bulky adenocarcinoma limited to the rectum.As the patient refused any clinical treatment,surgery without previous neoadjuvant chemoradiation was indicated.The patient underwent a tumor embolization procedure,two days before surgery performed via the right common femoral artery.The tumor was successfully devascularized and no major bleeding was noted during APE.Postoperative recovery was uneventful and a one-year follow-up showed no signs of recurrence.CONCLUSION Therapeutic tumor embolization may play a role in bloodless surgeries and increase surgical and oncologic prognoses.We describe a patient with a bulky low rectal tumor who successfully underwent preoperative embolization and bloodless abdominoperineal resection.

Application of mastoscopic in modified radical operation for preserving nipple-areolar complex

Objective: To probe the effect of mastoscopic in modified radical mastectomy operation for preserving nipple-areolar complex in the treatment of breast cancer. Methods: Thirty patients, with breast cancer of a diameter≤3 cm and a distance≥3 cm from the mammary areola were treated by mastoscopic from November 2003 to August 2006. After the lipoly- sis and suction of axillary fat, mastoscopic axillary lymph node dissection was performed. Results: The average operation time was 128.9 min (120–156 min), the intraoperative blood loss was 56 mL (30–100 mL). The mean lymph nodes harvested by endoscopy were 16 (6–34). Excellent cosmetic outcomes were obtained with symmetrical breast development and all the patients were satisfied with the treatment. Postoperative follow-up for 2–29 months (mean, 16.6 months) found no local recur-rence. Conclusion:This model of operation can protect the upper limb function and has value of aesthetics of the brisket. What’s more, improve the quality of survive of the patients.

Surgical treatment effects in cancer of the cardia and esophagogastric junction

Objective： To evaluate the treatment effects of total gastrectomy （TG） and proximal gastrectomy （PG） for cancer of the cardia and esophagogastric junction. Methods： forty-five patients with cancer of the cardia and esophagogastric junction underwent surgical resection. Of them, 29 were treated using proximal gastrectomy and 16 total gastrectomy. The 3-year and 5-year survival rate and the postoperative complication rate and mortality rate were followed up and compared between the two groups. Results： The 3-year and 5-year survival rates of group PG were 44.8% and 20.7%, of group TG were 37.5% and 18.8%, respectively, and the differences were not statistically significant （X^2= 3.84, P 〉 0.05; X^2= 3.89, P 〉 0.05）. The postoperative complication and mortality rate of group PG were 13.7% and 6.8%, of group TG was all 6%, respectively. Conclusion： Proximal and total gastrectomy treatment effects can not significantly influence the prognosis of patients in progressive stage of cancer of cardia and esophagogastric junction.

基于倾向性评分匹配的机器人与腹腔镜全直肠系膜切除术的短期疗效分析

目的:对比机器人与腹腔镜全直肠系膜切除术的短期临床疗效。方法:回顾分析2020年8月至2022年12月行机器人与腹腔镜全直肠系膜切除术的112例患者的临床资料。采用倾向评分匹配法对两组患者的临床资料进行1∶1匹配,两组各30例患者匹配成功,匹配后对比分析两组手术情况、术后恢复情况及术后30 d并发症。结果:匹配后两组患者临床资料差异无统计学意义(P>0.05)。机器人组中1例中转腹腔镜手术,腹腔镜组无中转开腹。两组左结肠动脉保留、盆底腹膜关闭、环周切缘阳性率、远切缘距离、淋巴结清扫数量差异无统计学意义(P>0.05)。机器人组预防性回肠造口率低于腹腔镜组,术中出血量少于腹腔镜组,吻合口加固缝合数量多于腹腔镜组,术后第1天C-反应蛋白水平低于腹腔镜组,总手术时间长于腹腔镜组,差异均有统计学意义(P<0.05);两组首次排气时间、拔除尿管时间、肛管留置时间、首次进食时间、术后住院时间、术后30 d并发症差异均无统计学意义(P>0.05)。结论:机器人全直肠系膜切除术可获得与腹腔镜手术相似的短期临床疗效,机器人手术时间更长,但具有组织损伤轻、术中出血少、回肠造口率低的优势。

神经内分泌肿瘤肝转移的外科干预策略

神经内分泌肿瘤是一组较罕见的肿瘤性疾病,可发生于身体多种脏器,具有高度肿瘤异质性,常形成以肝脏为最主要受累器官的继发性肿瘤并伴发类癌综合征。肝转移是造成神经内分泌肿瘤患者治疗失败的重要临床事件,通过及时、合理的外科干预有效控制病情发展、争取达到肿瘤无病状态或根治目标,有效延长患者总体生存,是近年来临床医师和研究者聚焦的重要课题。本文综合近年来国内外神经内分泌肿瘤肝转移的外科治疗策略和我国最新诊治指南,并结合笔者实际临床工作经验进行综述和讨论。

90例儿童颅内残留或复发性室管膜瘤的手术疗效分析

目的探讨儿童颅内残留或复发性室管膜瘤的手术治疗效果。方法回顾性分析2014年3月至2023年8月北京大学第一医院小儿外科收治的90例行外科手术治疗颅内残留或复发性室管膜瘤患儿的临床资料,其中32例为首次手术后肿瘤残留,58例为肿瘤复发;肿瘤位于后颅窝60例,小脑幕上23例,后颅窝肿瘤转移至侧脑室7例。术后通过门诊或电话方式进行随访,末次随访时间为2023年10月,获知患儿生存及后续治疗情况,通过头颅MRI检查评估患儿肿瘤是否再次复发或转移。结果90例患儿手术均顺利完成,其中肿瘤扩大全切除10例,全切除71例,近全切除9例。术后78例(86.7%)患儿出现并发症,其中发热70例,皮下积液39例,出现声音嘶哑、吞咽困难等后组脑神经损伤症状16例,面瘫13例;术后13例(14.4%)患儿因继发性脑积水行脑室-腹腔分流术,其中2例分别出现消化道大出血、心力衰竭于术后24h死亡;1例因术后并发肺炎出院后死亡。术后经病理学证实,69例患儿的肿瘤病理学诊断与首次诊断相同,其中世界卫生组织(WHO)2级5例,3级62例,2~3级2例;21例肿瘤病理学诊断与首次诊断不同,其中7例由WHO2级转为3级,1例由1级转为2级,9例由2~3级转为3级,4例由3级转为2级。87例患儿均获得临床随访,随访时间[M(范围)]为16个月(3~116个月)。49例患儿术后行首次或二次放疗,3例行单纯化疗3例行放疗和化疗。末次随访显示,27例患儿死于肿瘤复发或转移;存活的60例患儿中,局部再复发5例,脊髓转移2例。结论儿童颅内残留或复发性室管膜瘤的治疗效果欠佳,目前仍以手术切除辅助术后放疗为主要治疗手段。

海信CAS辅助下高强度聚焦超声消融治疗晚期胰腺癌效果

目的探讨海信计算机辅助系统(CAS)辅助下高强度聚焦超声(HIFU)治疗胰腺癌的效果。方法选取2020年1月-2021年5月于我院拟行HIFU治疗的22例胰腺癌患者。术前采用海信CAS将二维CT图像进行三维重建,明确胰腺肿瘤与周围肠道、脏器的毗邻关系,通过实体瘤疗效评价标准评价局部消融疗效,并记录患者术后并发症发生情况。结果海信CAS数字化三维重建结果可清晰显示胰腺肿瘤与周围肠道、脏器的毗邻关系,协助实现精准消融。22例胰腺癌患者中完全缓解率为9.1%,部分缓解率为68.2%,疾病稳定率为13.6%,疾病进展率为9.1%。所有患者在HIFU术后均未出现胃肠道穿孔、急性胰腺炎、胰瘘及消化道出血等严重并发症,仅1例患者出现浅Ⅱ度皮肤灼伤。结论海信CAS辅助下HIFU治疗晚期胰腺癌效果较好,值得在临床推广。

MR多模态成像在直肠癌TN分期及手术方式选择中的应用

目的探讨MR多模态成像在直肠癌TN分期及手术方式选择中的应用价值。方法回顾性分析我院2020年1月—2022年5月396例直肠癌患者的MR征象,以此进行术前TN分期并模拟制定手术方式,分析手术前后TN分期的准确性,并比较拟定手术方式与实际手术方式的一致性。结果MR多模态成像辅助术前拟定直肠癌T分期的符合率为90.15%,与术后病理结果的一致性较高(K=0.82,P<0.01),且对于T2~T4分期的诊断准确率较高;N分期的符合率为71.46%,与术后病理结果的一致性适中(K=0.53,P<0.01)。MR多模态成像辅助拟定手术方式的符合率为89.14%,与实际术式一致性较高(K=0.79,P<0.01),且对于直肠癌各种术式拟定的准确率均较高。结论MR多模态成像对直肠癌的术前TN分期以及手术方式的制定有较高的临床价值。

不同免充气腔镜术式治疗甲状腺癌的效果比较

目的比较免充气经口腔前庭入路与免充气经腋窝入路对腔镜治疗甲状腺癌效果的影响。方法回顾性分析2019年1月至2023年6月中国科学技术大学附属第一医院西区(安徽省肿瘤医院)收治的95例单侧甲状腺癌患者的临床资料,其中45例患者选自同期行经腋窝入路腔镜手术患者,50例选自同期行经口腔前庭腔入路腔镜手术患者。比较2种手术方式的疗效。结果2组患者在手术时间、术中出血量、住院时间、术后3 d引流量、术后并发症及美容满意度方面比较,差异无统计学意义(P>0.05);经口腔前庭组中央区淋巴结清扫数目多于经腋窝组(P<0.05)。结论经口腔前庭入路腔镜甲状腺手术体表无瘢痕较经腋窝入路腔镜手术在中央区淋巴结清扫上更有优势。

Clinical Experience of Primary Retroperitoneal Tumor: Report of 600 Cases

Objective： To summarize the experience of management for primary retroperitoneal tumor （PRPT） and to analyze the factors influencing the outcome after operation. Methods： The data of 600 cases of PRPT in General Hospital of PLA were reviewed retrospectively. Results： Of 600 cases of PRPT, 546 were surgically treated. Among theme 369 were malignant and 177 benign. 366 cases were followed up for 1 month to 15 years. The 1-years 3-year, and 5-year survival rate in the patients subject to complete resection was 90.5%, 73.2% and 53.6%, respectively, and that in incomplete resection patients was 70.6%, 32.0%, 5.7% respectively （P〈0.01）. The Cox multi-various regression analysis revealed showed completeness of tumor resection, sex and histologic type were associated closely with local recurrence. Conclusion： Sufficient preoperative preparation and complete tumor resection play important roles for reducing recurrence and improving survival.

浅表食管癌内镜黏膜下剥离术与外科手术疗效对比的研究进展

浅表食管癌(SEC)的传统治疗以内镜治疗和外科手术治疗为主。外科手术是食管肿瘤治疗的标准方法,但其围手术期并发症发生率和病死率均较高。近年来,内镜黏膜下剥离术已取得较大进展,为SEC患者提供了有效的诊断和治疗方法。本文就SEC内镜黏膜下剥离术与外科手术的疗效对比和超出内镜黏膜下剥离术适应证的SEC的治疗策略作一综述,以期提高临床医师对SEC治疗的认知。

原发性腹膜后平滑肌肉瘤初次术后影响生存期的因素分析

目的分析初次手术后对原发性腹膜后平滑肌肉瘤患者生存期的影响因素,并了解其临床特征。方法搜集2018年1月—2023年1月67例原发性腹膜后平滑肌肉瘤患者的临床资料进行回顾性分析。根据患者的手术情况、年龄、性别、病理类型及其他相关因素,对其生存期进行统计和分析。符合正态分布的计量资料以xˉ±s表示、采用t检验;计数资料以%表示、采用χ2检验。对影响患者预后因素的分析采用单因素分析,其中差异有统计学意义的因素采用多因素Logistic回归分析。结果67例患者的平均生存期为(18.25±2.41)个月,病理证实肿瘤类型均为平滑肌肉瘤。生存分析显示,年龄>60岁、肿瘤最大径>10 cm、肿瘤分期Ⅲ~Ⅳ期、肿瘤分化程度低~差、肿瘤累及其他脏器均是影响患者术后生存期的危险因素(P均<0.05);性别、体质量指数、吸烟史、饮酒史、手术方式对患者的生存期无明显影响(P均>0.05)。经多因素Logistic回归分析,表明年龄≥60岁、显微镜下切缘看到肿瘤细胞(R1切除)、肿瘤最大径≥10 cm、肿瘤分期Ⅲ~Ⅳ期、肿瘤低~差分化、肿瘤累及其他脏器均是影响原发性腹膜后平滑肌肉瘤初次手术后生存率的独立危险因素。结论患者年龄、肿瘤最大径、肿瘤分期等是影响患者预后的主要因素,准确评估这些影响因素有助于指导临床决策,进一步改善患者的预后结果。

《肿瘤外科学年鉴:肝外胆管癌和胆囊癌临床诊疗指南》推荐意见

胆道恶性肿瘤是一类发病率低但侵袭性强的消化道肿瘤,主要包括肝内胆管癌、肝外胆管癌和胆囊癌,常常伴随着局部进展或远处转移等特征。对于局部可切除的患者而言,手术往往是首选的治疗方法。然而,即便患者接受根治性手术其术后复发风险依然很高。因此,对于胆道恶性肿瘤患者而言,通常需要采取多种治疗模式,包括手术切除、全身治疗(如靶向治疗、化学治疗、免疫治疗)以及/或局部治疗的综合方案。随着胆道恶性肿瘤领域的逐渐发展,对于外科肿瘤学家而言,了解并掌握最新的外科诊疗策略以及最佳患者的选择和管理体系至关重要。鉴于治疗的复杂性和诊疗技术不断发展的特点,美国肿瘤外科学权威期刊《肿瘤外科学年鉴》于近期发表了关于肝胆肿瘤的实践诊疗指南,主要包括肝细胞癌、肝内胆管癌、肝外胆管癌和胆囊癌,旨在为肝胆肿瘤患者的临床管理和决策制定提供更多基于循证医学的证据。限于篇幅和不同侧重点,本文着重介绍该指南中关于肝外胆管癌和胆囊癌的评估要点和临床治疗的相关建议,以供临床参考。

机器人直肠癌根治术后并发症Clavien-Dindo 分级及危险因素分析

目的:探讨达芬奇机器人直肠癌根治术后并发症的分级及影响术后并发症的危险因素。方法:回顾分析2012年3月至2022年12月接受机器人直肠癌根治术的923例患者的临床、病理资料及并发症情况,采用Clavien-Dindo系统对术后并发症进行分级评价,分析影响术后并发症的危险因素。结果:923例患者中143例出现术后并发症,并发症发生率为15.5%(143/923),其中术后严重并发症(Ⅲ级以上)发生率为6.4%,术后Ⅲ级以上吻合口漏(4.2%)为术后严重并发症最常见的原因。多因素分析结果显示,年龄>65岁是影响术后总体及系统并发症发生的独立危险因素,BMI>25 kg/m~2是影响术后总体、局部、严重并发症发生的独立危险因素,术者经验≤20例是影响术后局部及严重并发症发生的独立危险因素。结论:达芬奇机器人直肠癌根治术后并发症以Ⅱ级、Ⅲ级并发症为主。年龄、BMI、术者经验、肿瘤位置、合并症、术中出血量是影响术后并发症发生的主要独立危险因素。临床开展机器人直肠癌手术时应重点关注此类高危人群,积极防治并发症,降低术后并发症发生率。

加速康复外科护理理念在腹腔镜下低位直肠癌根治保肛术中的应用

目的:探讨加速康复外科(ERAS)护理理念在腹腔镜下低位直肠癌根治保肛术中的应用效果。方法:选取2021年1月1日~2022年2月28日住院治疗的35例低位直肠癌患者为对照组,给予常规围术期护理;选取2022年3月1日~2023年4月30日住院治疗的35例低位直肠癌患者为观察组,给予ERAS护理理念的干预护理;所有患者均行腹腔镜下低位直肠癌根治保肛术。比较两组术后首次排气时间、术后首次排便时间、术后恢复饮食时间、平均住院时间及并发症发生率。结果:观察组术后首次排气时间、术后首次排便时间、术后恢复饮食时间、平均住院时间均短于对照组(P<0.05);观察组并发症发生率低于对照组,但两组比较差异无统计学意义(P>0.05)。结论:对腹腔镜下低位直肠癌根治保肛术患者实施ERAS护理理念,可促进患者术后恢复。