[Impacts of different nephrostomy tubes and their fixation ways on patients with nephrolithiasis complicated with renal insufficiency after percutaneous nephrolithotomy].

OBJECTIVE: To investigate impacts of different nephrostomy tubes and their fixation ways on patients with nephrolithiasis complicated with renal insufficiency after percutaneous nephrolithotomy. METHODS: A total of 72 renal insufficiency patients were enrolled in this study, who were randomized into three groups with 24 patients in each group according to nephrostomy tube diameter and its fixation way: Group I, i.e. stretch group with 14 Fr silicon tube (Urovision)with balloon; Group II, i.e. not strech group with 14 Fr silicon tube (Urovision) with balloon; Group III, i.e. not strech group with 20Fr latex tube without balloon. The data collected included preoperative serum cretinine, hemoglobin value, midstream urine culture, stone volume, and operative time, and number of operative tract. It was also recorded that the change of hemoglobin between preoperation and 24 h or 72 h postoperation, presence of postoperative extravasation, systemic inflammatory respose syndrome, narcotic usage and blood transfusion. RESULTS: There were no statistically significant differences among the three groups in terms of the incidence of postooperative extravasation (P=0.301), SIRS(P=0.099) and narcotic usage (P=0.898). In the aspects of the change of hemoglobin between preoperation and 24 h or 72 h postoperation, there were significant differences between group I and group II (P=0.001, P=0.009) or group III (P=0.021, P=0.003). No difference was found between groups II and III (P=0.989, P=0.962). In the aspect of blood transfusion cases, group I (1 case) < group III (6 cases) < group II (10 cases). The number of patients needing blood transfusion in group I was significantly lower than that in group II (P=0.002), but the differences between group III and group I (P=0.102) or group II (P=0.221) were not statistically significant. CONCLUSION: It is worth recommending indwelling 14 Fr silicon nephrostomy tube with balloon oppressing the operative tracts, because it could reduce blood loss 24 h and 72 h after operation in patients with nephrolithiasis complicated with renal insufficiency.

Laparoscopic versus open right hemicolectomy with curative intent for colon carcinoma.

AIM: Laparoscopic surgery, especially laparoscopic rectal surgery, for colorectal cancer has been developed considerably. However, due to relatively complicated anatomy and high requirements for surgery techniques, laparoscopic right colectomy develops relatively slowly. This study was designed to compare the outcomes of laparoscopic right hemicolectomy (LRH) with open right hemicolectomy (ORH) in the treatment of colon carcinoma. METHODS: Between September 2000 and February 2003, 30 patients with colon cancer who underwent LRH were compared with 34 controls treated by ORH in the same period. All patients were evaluated with respect to surgery-related complications, postoperative recovery, recurrence and metastasis rate, cost-effectiveness and survival. RESULTS: Among 30 LRH, 2 (6.7%) were converted to open procedure. No significant differences were observed in terms of mean operation time, blood loss, post-operative complications, and hospital cost between LRH and ORH groups. Mean time for bowel movement, hospital stay, and time to resume early activity in the LRH group were significantly shorter than those in the ORH group (2.24+/-0.56 vs 3.25+/-1.29 d, 13.94+/-6.5 vs 18.25+/-5.96 d, 3.94+/-1.64 vs 5.45+/-1.82 d respectively, P<0.05). As to the lymph node yield, the specimen length and total cost for operation and drugs, there was no significant difference between the two groups. Local recurrence rate and metachronous metastasis rate had no marked difference between the two groups. Cumulative survival probability at 40 mo in LRH group (76.50%) was not obviously different compared to the ORH group (74.04%). CONCLUSION: LRH in patients with colon cancer has statistically and clinically significant advantages over ORH. Thus, LRH can be regarded as a safe and effective procedure.

[Current status and prevention of complications after laparoscopic radical gastrectomy].

It is the most important for surgeons to achieve surgical safety and oncological clearance in laparoscopic surgery for gastric cancer. With the widespread adoption oflaparoscopic surgery for gastric cancer, surgeons make great efforts to achieve better safety andlower morbidity. Common abdominal complications (intraoperative and postoperative) after laparoscopic radical gastrectomy include bleeding, anastomotic leakage, anastomotic stenosis, iatrogenic organ injury, pancreatic leakage, etc. The causes and prevention of the complications related with laparoscopic radical gastrectomy was discussed in this article.

Laparoscopic pancreaticoduodenectomy for ductal adenocarcinoma of common bile duct: a case report and literature review.

BACKGROUND: Minimal access techniques have gained wide acceptance in surgical practice, but the role of laparoscopic pancreaticoduodenectomy is still controversial. Laparoscopic pancreaticoduodenectomy has seldom been described. In this report, we assessed the feasibility and safety of laparoscopic pancreaticoduodenectomy for ductal adenocarcinoma of the common bile duct. CASE REPORT: According to imaging findings, a 71-year-old Chinese man was diagnosed with malignancy of the common bile duct, and successfully underwent laparoscopic pancreaticoduodenectomy in our center. The operation's safety, postoperative recovery, complications, oncological clearance, and short-term follow-up results of the patient are evaluated. No severe intraoperative or postoperative complications were observed. The operation time was 390 minutes, and the blood loss was about 50 ml; the flatus, time to resume early activity and hospital stay were 3, 4, and 30 days respectively. The patient remained well at a follow-up of 6 months. CONCLUSIONS: Laparoscopic pancreaticoduodenectomy can be performed feasibly and safely by surgeons with advanced laparoscopic skills, and could be considered for the treatment of common bile duct tumors.