[Clinical study of laparoscopic rectal surgery without abdominal scar].

OBJECTIVE: To assess the feasibility and safety of laparoscopic rectal surgery without abdominal scar. METHODS: A total of 23 patients of rectal cancer were operated by laparoscopy with the assistance of PPH (procedure for prolapse and hemorrhoids) anal expander and TEM (transanal endoscopic microsurgery) outer-shell according to the principle of TME (total mesorectal excision). RESULTS: All operations were successfully accomplished laparoscopically. There was no conversion into an open procedure. The average operative duration was 129 (105 - 211) minutes. The intra-operative blood loss volume was 152 (85 - 420) ml. No immediate or delayed injury of urinary duct and other intra-operative severe complications, such as massive hemorrhage of presacral venous plexus, occurred. There was no pelvic infection or anastomotic stoma fistula during the post-operative period. The average follow-up period was 13.4 months. Neither anastomotic stoma recurrence nor Trocar implantation occurred. CONCLUSION: The laparoscopic technique of hybrid NOTES (Natural Orifice Transluminal Endoscopic Surgery), plus PPH/TEM is both feasible and convenient for selective rectal cancer surgery. There is no need for extra abdominal incision. It is recommended for laparoscopic rectal surgery.

[Operative experiences on transumbilical single incision laparoscopic cholecystectomy].

OBJECTIVE: To study the feasibility and safety of transumbilical single incision laparoscopic cholecystectomy. METHODS: Eighty-two cases with gallbladder diseases were underwent with transumbilical single incision laparoscopic cholecystectomy. Some difficulties and countermeasure in operations were analyzed. RESULTS: Nine in all patients were converted because of the surrounding inflammation of gallbladder, difficult to dissect in Calot's triangulation and variation of gallbladder artery. Of them, 6 cases converted to two-hole laparoscopic cholecystectomy and 3 cases to open operation. Other 73 cases were successfully operated with transumbilical single incision laparoscopic cholecystectomy. The success rate was 89.0%. The average operative duration was 48.4 min. The average operative blood loss was 20.8 ml. Patients returned to liquid food on the first day after operation. Hospital duration was 3 ~ 6 d. During 13.7 months of follow-up, there was no bile duct injury, large bleeding, incision infection, bile fistula and umbilical hernia. The incision healed well. The scar in umbilicus was concealing and difficult to be observed. CONCLUSIONS: Transumbilical single incision laparoscopic cholecystectomy is safe and feasible. The difficulties in technique are easy to be broken through.

Bacterial Diversity in the Intestinal Mucosa of Dysbiosis Diarrhea Mice Treated with Qiweibaizhu Powder.

The current research tried to explore the effect of Qiweibaizhu powder (QWBZP) on the bacterial diversity and community structure of the intestinal mucosa of dysbiosis diarrhea mice and provide a scientific basis for the efficacy of QWBZP on antibiotic-induced diarrhea. A dysbiosis diarrhea mouse model was constructed with broad-spectrum antibiotics through a mixture of cephradine capsules and gentamicin sulfate (23.33 mL·kg-1·d-1). Intestinal mucosa was collected, and DNA was extracted from each group. The bacterial characteristics in intestinal mucosa were analyzed by MiSeq sequencing based on the 16S rRNA sequencing platform. There were no significant differences in alpha diversity indices among the three groups. The sample distributions in both the normal and QWBZP groups were relatively concentrated, and the distance among individuals was close. However, an opposite result was obtained in the model group. Furthermore, the composition and abundance of species were similar between the normal group and the QWBZP group at both the phylum and genus levels. After treatment with QWBZP, the abundance of Lactobacillus increased, and Proteobacteria decreased, and the Firmicutes/Bacteroidetes ratio decreased to a normal level. Our results indicate that QWBZP can help repair mucosal bacterial structure and recover mucosal microbiota. Specifically, QWBZP increased the abundance of Lactobacillus and Bacteroidales S24-7 group norank.

Mastoscopic skin sparing mastectomy and sentinel lymph node biopsy combined with immediate mammary prosthesis reconstruction for early central breast cancer.

OBJECTIVE: This study aims to evaluate efficacy and safety of mastoscopic skin sparing mastectomy and sentinel lymph node biopsy combined with immediate mammary prosthesis reconstruction for early central breast cancer. MATERIALS AND METHODS: The medical records of patients, who underwent mastoscopic skin sparing mastectomy and sentinel lymph node biopsy combined with immediate mammary prosthesis reconstruction during the period of March 2011 and November 2016, were collected from Fuxing Hospital. Data on clinicopathologic characteristics, operative time, the number of resected sentinel lymph nodes, and complications were analyzed. RESULTS: The procedures were performed in 11 patients with central breast cancer. Among these patients, 10 patients were diagnosed with infiltrating ductal carcinoma, while the remaining patient had Paget's disease with infiltrating ductal carcinoma. The mean operation time was 148.2 minutes with minimal bleeding, and the median number of sentinel lymph nodes dissected from each operation was 4.6. The volume range of implants was 180-245 cc. There were no recurrences and upper limb swelling during the follow-up period. Merely two cases had sporadic axillary pain due to the mastoscopic lymph node dissection performed for the positive sentinel lymph nodes. All patients were satisfied with the reconstructive appearance. CONCLUSION: The present study shows that mastoscopic skin sparing mastectomy and sentinel lymph node biopsy combined with immediate mammary prosthesis reconstruction is a feasible procedure for early central breast cancer. KEY WORDS: Breast cancer, Fat suction, Reconstructive surgery, Sentinel lymph node, Skin sparing mastectomy.

[The anatomical characteristics and its applied significance of laparoscopic rectal surgery].

OBJECTIVE: To realize the anatomical characteristics of laparoscopic rectum surgery and its clinical significance. METHODS: 117 cases with benign and malignant diseases of rectum were operated by laparoscopic methods. The anatomy closely related with operation was analyzed. RESULTS: The median operative time were 144 min. 4 cases were converted to open operations, so the converted rate was 1.7%. The blood loss in operation was rather little with an average of 126 ml. No instant or delayed injury of ureters, large bleeding in front of sacrum and other operation-related severe complications happened intra- and after operation. Dissecting only in one case disrupted the anterior-left wall of rectum. CONCLUSION: Laparoscopic rectal surgery is clinically feasible. Mastering the anatomical characteristics of laparoscopic rectum surgery can make us reduce the operative mistakes and complications.

[Standardized skill of mastoscopic axillary lymph node dissection].

OBJECTIVE: To investigate the standardized skill of mastoscopic axillary lymph node dissection (MALND). METHODS: The clinical results and operation experiences of 473 mastoscopic lymph node dissections performed were analyzed. RESULT: The operation time was 22 - 156 minutes with the average of 42. The operative bleeding was minimal. No case was converted to conventionally open operation because of the uncontrolled bleeding. Fourteen (4 - 38) lymph nodes were removed. There was no intra- or post-operative complication. CONCLUSION: The special view of mastoscopic lymph node dissection makes operative dissection clear. The suitable procedure and standardization of the operative method can stride over the learning curve, so as to quicken the operation and avoid the operative complication.

[Mastoscopic extirpation of benign breast masses by small and concealing incision].

OBJECTIVE: To investigate the feasibility and effect of the mastoscopic extirpation of benign breast masses by small and concealing incision. METHODS: 72 benign breast masses of 64 patients were mastoscopically extirpated. Transaxillary and transareolar small incisions were selected under local and vein analgesia anaesthesia. RESULTS: Most of patients were operated in clinic, only 28 patients in hospital. The average operation time was 46.1 minutes. The sensation and erection of breast nipples were normal in all patients. 2 patients with the more obvious complications (one with skin burned by electric scalpel, another with wide subcutaneous ecchymosis) complained this kind of operation, other patients were greatly satisfied with the cosmetic outcome of the operation. CONCLUSIONS: The mastoscopic extirpation of benign breast masses by small and concealing incision can be completed in most of the patients under local anesthesia. The incision is small and concealing, which raises the quality of life of the patients. This operation procedure meets the needs of wide women on the treatment of breast disease to a great extent and also alters the routine conception of the excision of benign breast mass.

[Mastoscopic axillary lymph node dissection for the patients with breast cancer].

OBJECTIVE: To analyze the clinical effects of mastoscopic axillary lymph node dissection for the patients with breast cancer. METHODS: Following the liposuction of the axilla, axillary lymph node dissection was performed in 86 breast cancer patients by mastoscopy. RESULTS: The median duration of operation was 55.3 min. The operation time was obviously shorter for the last 76 patients than for the first 10 patients (P < 0.001). The bleeding amount in operation was little, and no patient was intraoperatively transferred to routine open axillary lymph node dissection due to uncontrolled bleeding. A mean number of 15.3 lymph nodes were harvested. 37 patients showed involved lymph nodes. The mean number of involved lymph nodes in these patients was 3.6. There was no intra- and post-operation morbidity. After a median follow-up time of 10.4 months, no axillary relapse or trocar site implantation had occurred. CONCLUSION: Mastoscopic axillary lymph node dissection (MALND) based on the liposuction of axilla is a minimally invasive and clinical feasible procedure. It manifests the functional and cosmetic effects and satisfies the breast cancer patients to certain extent.

[Clinical application of mastoscopic axillary sentinel lymph node biopsy].

OBJECTIVE: To evaluate the technique and significance of mastoscopic axillary sentinel lymph node biopsy. METHODS: Sixty-two patients with breast cancer use methylene blue to test axillary sentinel lymph node. Sentinel lymph node was moved with endoscopy, and endoscopic axillary lymph nod dissection was performed. Pathological examination of sentinel lymph node and axillary lymph node was made with HE. To evaluate detection rate and false negative rate in sentinel lymph node. RESULTS: Among the 62 patients, 61 were confirmed by endoscopic axillary sentinel lymph nod biopsy. Detection rate was 98.4%. Thirty-five cases were no metastasis, 27 cases were metastasis, false negative rate was 0. CONCLUSIONS: Mastoscopic axillary sentinel lymph node biopsy has a high detection rate, good efficiency of cosmetic and lower complications. It has higher sensitivity than traditional axillary lymph nod dissection and provide accurate lymph node stages.