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.

Endoscopic Mucosal Resection: Therapy for Early Colorectal Cancer

We review the use of Endoscopic Mucosal Resection in the treatment of early colorectal cancer. Newer endoscopic imaging modalities have lead to earlier detection of advanced lesions thus enabling endoscopic curative therapy of lesions that would otherwise need surgery. Early outcomes data suggest promising results. But further long term prospective studies are needed.

Early colon cancer within a diverticulum treated by magnifying chromoendoscopy and laparoscopy

We report a unique case of intramucosal carcinoma in a tubulovillous adenoma arising from a single diverticulum.Endoscopic mucosal resection(EMR)was carried out successfully and completely with the assistance of laparoscopy.A 71-year-old man was admitted to our hospital because of melena and anemia.Emergent colonoscopy showed diverticulosis in the right-sided colon.However,endoscopy could not exactly detect the bleeding site.A flat elevated polyp was found within a single diverticulum located in the descending colon and diagnosed as an intramucosal carcinoma,as magnifying chromoendoscopy revealed a type Ⅳ pit pattern.As his diverticular bleeding repeated,a rightsided hemicolectomy was decided for treatment,the polyp within the diverticulum was also completely removed by EMR with the assistance of laparoscopy.Although a colonic perforation was detected immediately after EMR,the perforation was closed with endoclips intraluminally and also repaired laparoscopically from the serosal side.Histologically,the resected lesion was an intramucosal well-differentiated adenocarcinoma and the surgical margin was free of tumor.

Management of malignant colon polyps:Current status and controversies

Colon cancer remains a significant clinical problem worldwide and in the United States it is the third most common cancer diagnosed in men and women.It is generally accepted that most malignant neoplasms of the colon arise from precursor adenomatous polyps.This stepwise progression of normal epithelium to carcinoma,often with intervening dysplasia,occurs as a result of multiple sequential,genetic mutations-some are inherited while others are acquired.Malignant polyps are defined by the presence of cancer cells invading through the muscularis mucosa into the underlying submucosa(T1).They can appear benign endoscopically but the presence of malignant invasion histologically poses a difficult and often controversial clinical scenario.Emphasis should be initially focused on the endoscopic assessment of these lesions.Suitable polyps should be resected en-bloc,if possible,to facilitate thorough evaluation by pathology.In these cases,proper attention must be given to the risks of residual cancer in the bowel wall or in the surrounding lymph nodes.If resection is not feasible endoscopically,thenthese patients should be referred for surgical resection.This review will discuss the important prognostic features of malignant polyps that will most profoundly affect this risk profile.Additionally,we will discuss effective strategies for their overall management.

Endoscopic management of colorectal polyps: From benign to malignant polyps

Colorectal cancer(CRC)is the third most common cancer worldwide and the second leading cause of cancer related death in the world.The early detection and removal of CRC precursor lesions has been shown to reduce the incidence of CRC and cancer-related mortality.Endoscopic resection has become the first-line treatment for the removal of most precursor benign colorectal lesions and selected malignant polyps.Detailed lesion assessment is the first critical step in the evaluation and management of colorectal polyps.Polyp size,location and both macro-and micro-features provide important information regarding histological grade and endoscopic resectability.Benign polyps and even malignant polyps with superficial submucosal invasion and favorable histological features can be adequately removed endoscopically.When compared to surgery,endoscopic resection is associated with lower morbidity,mortality,and higher patient quality of life.Conversely,malignant polyps with deep submucosal invasion and/or high risk for lymph node metastasis will require surgery.From a practical standpoint,the most appropriate strategy for each patient will need to be individualized,based not only on polyp-and patient-related characteristics,but also on local resources and expertise availability.In this review,we provide a broad overview and present a potential decision tree algorithm for the evaluation and management of colorectal polyps that can be widely adopted into clinical practice.

Early colon cancer with enteropathy-associated T-cell lymphoma involving the whole gastrointestinal tract:A case report

BACKGROUND Enteropathy-associated T-cell lymphoma(EATL)is a rare invasive lymphoma derived from gastrointestinal epithelial T lymphocytes.EATL involving the whole gastrointestinal tract accompanied with early colon cancer is extremely rare.CASE SUMMARY We present the case of a 67-year-old man with diarrhea for more than 5 mo whose colonoscopy in another hospital showed multiple colonic polyps,which indicated moderate to severe dysplasia and focal early cancer.Therefore,he was referred to our hospital for further endoscopic treatment.Colonoscopy after admission showed that the mucosa of the terminal ileum and the entire colon were slightly swollen and finely granular.Endoscopic mucosal resection was performed for colonic polyps located in the liver flexure of the colon and descending colon,respectively.Histopathological findings revealed diffuse infiltration of mediumsized lymphoid cells in the colonic mucosa and visible lymphoepithelial lesions.The histopathology of the polyp in the descending colon indicated moderately differentiated adenocarcinoma limited to the mucosa with negative resection margins.Additionally,immunohistochemical analysis showed positive staining for CD7 and CD8.Therefore,we arrived at a diagnosis of EATL with early colon cancer.Subsequently,the patient was transferred to the hematology department for chemotherapy.The patient’s diarrhea was not significantly relieved after receiving chemotherapy,and he ultimately died of severe myelosuppression.CONCLUSION EATL should be considered in unexplained chronic diarrhea.EATL progresses rapidly with a poor prognosis,especially when accompanied with early colon cancer.

Meta-analysis comparing differing methods of endoscopic therapy for colorectal lesions

AIM： To compare the outcomes of endoscopic mucosal resection （EMR） and endoscopic submucosal dissection （ESD） of colorectal lesions.METHODS： An electronic systematic literature search of four computerized databases was performed in July 2014 identifying studies reporting the outcomes of colorectal ESD and EMR. The primary outcome measures were en-bloc resection rate, endoscopic clearance rate and lesion recurrence rate of the patients followed up. The secondary outcome was the complication rate （including bleeding, perforation and surgery post EMR or ESD rate）. Statistical pooling and random effects modelling of the studies calculating risk difference, heterogeneity and assessment of bias and quality were performed.RESULTS： Six observational studies reporting the outcomes of 1324 procedures were included. The en-bloc resection rate was 50% higher in the ESD group than in the EMR group （95%CI： 0.17-0.83, P 〈 0.0001, I2 = 99.7%）. Endoscopic clearance rates were also signifcantly higher in the ESD group （95%CI： -0.06-0.02, P 〈 0.0001, I2 = 92.5%）. The perforation rate was 7% higher in the ESD group than the EMR group （95%CI： 0.05-0.09, P 〉 0.05, I2 = 41.1%） and the rate of recurrence was 50% higher in the EMR group than in the ESD group （95%CI： 0.20-0.79, P 〈 0.001, I2 = 99.5%）. Heterogeneity remained consistent when subgroup analysis of high quality studies was performed （with the exception of piecemeal resection rate）, and overall effect sizes remained unchanged for all outcomes.CONCLUSION： ESD demonstrates higher en-bloc resection rates and lower recurrence rates compared to colorectal EMR. Differences in outcomes may beneft from increased assessment through well-designed comparative studies.

右半结肠癌根治术患者发生围术期出血的影响因素

目的:分析右半结肠癌根治术患者发生围术期出血的影响因素。方法:选取2021年6月至2023年6月于吉林省肿瘤医院行右半结肠癌根治术的68例患者进行横断面研究,统计右半结肠癌根治术患者围术期出血发生情况,并根据是否发生围术期出血将其分为发生组与未发生组,采用Logistic回归分析右半结肠癌根治术患者发生围术期出血的影响因素。结果:68例右半结肠癌根治术患者中,发生围术期出血20例,发生率为29.41%(20/68);两组性别、年龄、体质量指数、吸烟史、饮酒史、结肠癌家族史、术前血小板计数、临床分期、组织学分型、手术方式、术前凝血酶原时间、术前活化部分凝血活酶时间、术前纤维蛋白原水平比较,差异均无统计学意义(P>0.05);发生组合并基础疾病、术前贫血、肿瘤最大直径≥5cm、有吻合口瘘、有术后感染占比高于未发生组,手术时间长于未发生组,差异均有统计学意义(P<0.05);Logistic回归分析结果显示,合并基础疾病、手术时间长、术前贫血、肿瘤最大直径≥5 cm、有吻合口瘘、有术后感染均为右半结肠癌根治术患者发生围术期出血的危险因素(OR>1,P<0.05)。结论:合并基础疾病、手术时间长、术前贫血、肿瘤最大直径≥5cm、有吻合口瘘、有术后感染均为右半结肠癌根治术患者发生围术期出血的危险因素。

全腹腔镜下肠吻合与辅助切口肠吻合在右半结肠癌根治术中的临床疗效对比

目的:对比分析全腹腔镜下肠吻合与辅助切口肠吻合在腹腔镜右半结肠癌根治术中的临床疗效。方法:回顾分析2017年1月至2022年10月收治的拟手术治疗的右半结肠癌患者的临床资料,根据消化道重建方式分为观察组(全腹腔镜下肠吻合)与对照组(辅助切口肠吻合)。收集两组患者临床资料(年龄、性别、体质指数)、手术时间、术中出血量、手术切口长度、淋巴结清扫数量、术后疼痛评分、术后首次排气时间与排便时间、术后下床活动时间、切口愈合时间、住院时间及术后并发症发生率。结果:共纳入152例患者,其中观察组74例,对照组78例。与对照组相比,观察组术后疼痛评分低,手术切口、术后首次排气时间、术后首次排便时间、术后下床行走时间、切口愈合时间短,差异有统计学意义(P<0.05);两组手术时间、淋巴结清扫数量、术中出血量及术后并发症发生率差异无统计学意义(P>0.05)。结论:与腹腔镜辅助切口肠吻合术相比,全腹腔镜肠吻合的临床疗效更佳,值得临床推广。

腹腔镜扩大结肠癌根治术与单纯中横结肠癌根治术解剖学及临床意义

目的探索中横结肠癌解剖学及生物学特性的关联,研究术式选择的差异与预后关系,确定最佳手术方式。方法利用解剖学和影像学数据,研究大体标本、三维血管重建图,回顾性分析中横结肠癌患者不同腹腔镜手术方式的临床效果和生存情况。结果(1)解剖并观察大体标本,发现一、二级血管结扎可确保结肠吻合口的血液供应;(2)术前三维血管重建与术中血管探查符合率大于90%;(3)横结肠切除组与扩大结肠切除组相比,术中出血量、手术时间、术后并发症、总生存率无统计学差异,两组淋巴结清扫数目有统计学差异。结论腹腔镜下单纯横结肠切除较扩大结肠癌根治术有降低术后并发症风险趋势,两者预后无统计学差异,横结肠切除是中横结肠癌最佳手术方式。

右美托咪定对老年腹腔镜结肠癌根治术患者免疫保护及血微循环转移影响的临床观察

目的探讨右美托咪定对老年腹腔镜结肠癌根治术患者免疫保护及血微循环转移的影响。方法选取2021年6月至2023年6月在上海市第七人民医院78例行腹腔镜结肠癌根治术患者为研究对象,随机分为2组,其中试验组(n=39)于麻醉诱导前采用右美托咪定复合喷他佐辛,对照组(n=39)采用等速率等量生理盐水以及喷他佐辛。比较两组围麻醉期指标,分别于麻醉诱导前(T_(0))、手术结束即刻(T_(1))、术后30 min(T_(2))、术后6 h(T_(3))比较患者血流动力学指标变化,于麻醉诱导前(T_(0))、术后6 h(T_(3))、24 h(T_(4))、48 h(T_(5))对患者免疫功能及血微循环转移进行评估,并比较两组术后不良反应发生率。结果试验组呛咳评分为(2.02±0.36)分、对照组呛咳评分为(2.61±0.49)分;试验组躁动评分为(1.66±0.21)分、对照组躁动评分为(2.07±0.35)分;差异具有统计学意义(P<0.05)。两组患者T_(0)时刻HR、SpO2及MAP比较差异无统计学意义P>0.05),T_(2)时刻实验组HR显著低于对照组(76.38±7.33 vs.95.64±9.32),差异具有统计学意义(P<0.05);T_(1)、T_(2)时刻试验组MAP显著低于对照组(73.84±7.94 vs.106.85±10.37,80.37±8.39 vs.102.84±9.38),差异具有统计学意义(P<0.05)。T_(3)~T_(5)时间点,两组CD3^(+)、CD4^(+)及CD4^(+)/CD8^(+)均低于T_(0),试验组各指标均低于对照组,差异有统计学意义(P<0.05)。T_(0)时刻,两组CK19、CK20阳性率比较无差异(P>0.05);T_(3)~T_(5),试验组CK19、CK20阳性率均低于对照组,差异具有统计学意义(P<0.05)。对照组、试验组不良反应发生率分别为15.4%和10.4%。结论右美托咪定可优化老年腹腔镜结肠癌根治术围麻醉期指标,有效减轻免疫抑制,降低血微循环转移风险,且安全性良好,值得临床进一步应用。

腹腔镜下右半结肠癌根治术中头侧-中央混合入路的可行性分析

目的分析腹腔镜下右半结肠癌根治术中应用头侧-中央混合入路的可行性。方法选取新乡市第一人民医院于2019年2月至2023年1月择期接受腹腔镜下右半结肠癌根治术的患者180例,按照入路方式分为中央入路组(CW组)及头侧-中央混合入路组(HCMW组),其中CW组85例,HCMW组95例。对比两组术中情况、术后情况、根治术完成质量、并发症发生情况。结果两组中转开腹率差异无统计学意义(P>0.05),HCMW组手术时间短于CW组,术时出血量少于CW组,输血率低于CW组(P<0.05)。两组术后情况、根治术质量、手术安全性差异无统计学意义(P>0.05)。结论腹腔镜下右半结肠癌根治术中应用头侧-中央混合入路具有可行性,在保证手术效果的基础上不增加并发症风险,并且能缩短手术时间,减少术时出血量。

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。

完整结肠系膜切除术在老年结肠癌手术治疗中的应用

目的探究完整结肠系膜切除术(complete mesocolic excision,CME)用于老年结肠癌的手术治疗效果。方法选取2017年9月—2022年9月湖北省潜江市中心医院收治的120例老年结肠癌患者为研究对象,根据接受的不同手术方式分为两组,对照组(n=58)行常规腹腔镜结肠癌根治术,观察组(n=62)行腹腔镜CME。比较两组手术指标(手术切口长度、术中出血量、手术时间、术后排气时间、术后下床时间及术后住院时间)、淋巴结(右半结肠淋巴结、左半结肠淋巴结、阳性转移淋巴结)清除数目、应激反应、并发症发生率及术后6个月与术后12个月总复发率。结果比较两组手术时间、术中出血量、手术切口长度、术后排气时间、术后下床时间、术后住院时间,差异无统计学意义(P均>0.05)。观察组右半结肠淋巴结、左半结肠淋巴结、阳性转移淋巴结的清除数目均多于对照组,差异有统计学意义(P均<0.05)。术后2 h两组的肾上腺素、皮质醇及促肾上腺皮质激素均高于术前,差异有统计学意义(P均<0.05);但两组间应激反应(肾上腺素、皮质醇及促肾上腺皮质激素)指标比较,差异无统计学意义(P均>0.05)。观察组并发症发生率低于对照组,差异无统计学意义(P>0.05)。观察组术后6个月和12个月的总复发率为3.23%(2/62),低于对照组的15.52%(9/58),差异有统计学意义(χ^(2)=5.437,P<0.05)。结论与常规腹腔镜结肠癌根治术比较,腹腔镜CME能提高淋巴结清扫数量,降低肿瘤复发风险,不影响手术进程与术后恢复,且不会加大患者机体应激反应。

双歧杆菌三联活菌结合化疗对老年结肠癌根治术患者细胞因子水平的影响

目的 分析双歧杆菌三联活菌结合化疗对老年结肠癌根治术患者细胞因子水平的影响。方法 非随机选取2022年3月—2023年3月于中山市人民医院肿瘤内科行结肠癌根治术的60例老年患者为研究对象,根据治疗方式不同分组,每组30例。对照组术后行奥沙利铂复合卡培他滨化疗方案,研究组在对照组基础上联合双歧杆菌三联活菌肠溶胶囊治疗,对比两组治疗前后炎性因子水平及不良反应发生情况。结果 治疗前,两组患者炎性因子水平对比,差异无统计学意义(P均>0.05);治疗后,两组炎性因子水平均较治疗前改善,且研究组优于对照组,差异有统计学意义(P均<0.05)。研究组不良反应率为3.33%(1/30),低于对照组的20.00%(6/30),差异有统计学意义(χ^(2)=4.043,P<0.05)。结论 双歧杆菌三联活菌辅助化疗用于老年结肠癌术后患者,有助于增强患者身体免疫力,且不良反应少。

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。

头侧入路与中间入路在改良腹腔镜辅助右半结肠癌D3根治术中的应用效果比较

目的比较头侧入路与中间入路在改良腹腔镜辅助右半结肠癌D3根治术中的应用效果。方法选取2019年6月至2022年6月收治的100例行改良腹腔镜辅助右半结肠癌D3根治术患者为研究对象,根据入路方式不同将其分为A组和B组,各50例。A组采用头侧入路,B组采用中间入路。比较两组的治疗效果。结果A组的中央淋巴结清扫时间、总手术时间短于B组,术中失血量少于B组,血管损伤发生率低于B组(P<0.05)。术后1 d,两组的醛固酮(ALD)、皮质醇(Cor)、促肾上腺皮质激素(ACTH)水平明显升高,但A组低于B组(P<0.05)。术后7 d,两组的Polo样激酶1(PLk1)、胸苷激酶1(TK1)、Livin水平均降低,且A组低于B组(P<0.05)。结论头侧入路与中间入路在改良腹腔镜辅助右半结肠癌D3根治术中均能取得较好的效果,但头侧入路有助于缩短手术时间,减少失血量,降低血管损伤发生率,减轻机体应激反应,也能下调癌活力,值得推广。

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。

对腹腔镜结肠癌根治术患者行标准化护理联合健康宣教的效果

目的:探究标准化护理联合健康宣教对行腹腔镜结肠癌根治术患者手术指标的影响。方法:以上海市嘉定区中医医院综合科60例行腹腔镜结肠癌根治术患者为研究对象,研究时间在2021年4月至2023年4月,将患者按护理方式的不同分为参照组(n=30)与实验组(n=30)。参照组采用常规护理,实验组采用标准化护理联合健康宣教,记录并比较两组患者的手术指标、健康知识掌握评分、并发症发生情况及护理质量评分。结果:护理干预后,实验组患者的各项手术指标均较优,身体恢复情况、健康知识掌握评分显著优于参照组(P<0.05)。结论:对行腹腔镜结肠癌根治术患者实施标准化护理联合健康宣教护理干预能提高患者生活质量、降低医疗费用,有利于病情恢复,值得在临床中推广应用。