الملخص
Objective:To evaluate the efficacy of total laparoscopic surgery vs. open surgery for hilar cholangiocarcinoma. Methods:The clinical data of 45 patients undergoing laparoscopic radical resection of hilar cholangiocarcinoma and 42 patients by open surgery from Mar 2017 to Mar 2021 were retrospectively analyzed.Results:There was no significant difference in demographics, Bismuth classification and excision extension between the two groups (all P>0.05). The laparoscopic surgery used longer time ( t=-1.366, P<0.05). The intraoperative blood loss, number of lymph node dissection and postoperative hospital stay favored laparoscopic method( t=0.043, t=0.026, t=-1.852, P<0.05). R 0 radical resection rate，postoperative complications were also in favor of laparoscopic surgery ( χ2=3.216, χ2=2.566, all P<0.05). There was no significant difference in postoperative pathology and in hospital expenses (all P>0.05). The 1- and 3-year survival rate of the laparoscopic group was superior (all P<0.05). Conclusions:In spite of longer operational time，patients in laparoscopic hilar cholangiocarcinoma radical resection group have shorter postoperative in hospital stay and longer postoperative survival time.
الملخص
Objective:To compare the embedding anastomosis with the intermittent eversion anastomosis on the pancreatic fistula rates after laparoscopic pancreaticoduodenectomy (LPD).Methods:The clinical data of 116 patients who underwent LPD at the Center Hospital of Xianyang City affiliated to Xi' an Jiaotong University Health Science Center from March 2016 to March 2020 were retrospectively studied. According to the method of pancreaticojejunostomy used, these patients were divided into the following two groups: the embedding anastomosis group ( n=55) and the intermittent eversion anastomosis group ( n=61). The duration of pancreaticojejunostomy, bilioenterostomy and gastrointestinal anastomoses, and the amounts of intraoperative blood loss and postoperative complication rates were compared between the two groups. Results:Of 116 patients in this study, there were 67 males and 49 females, with a median age of 61.5 years. No perioperative death occurred in the 2 groups. The operation time, digestive tract reconstruction time and pancreaticojejunostomy time in the embedded anastomosis group were (260±20), (65±15) and (35±15) min, respectively, which were significantly lower than those in the intermittent eversion anastomosis group (305±25), (81±25) and (45±12) min, (all P<0.05). The grade A and B pancreatic fistula rates in the embedded anastomosis group were 27.3%(15/55) and 21.8%(12/55), respectively, which were significantly higher than those in the intermittent eversion anastomosis group [8.2%(5/61) and 6.6%(4/61)], (all P<0.05). The postoperative hospital stay in the intermittent eversion anastomosis group (10.3±1.1) d was significantly lower than that in the embedding anastomosis group [(15.2±3.2) d, P<0.05]. Conclusion:In LPD, when compared with embedded pancreaticojejunostomy, intermittent eversion pancreaticojejunostomy reduced the postoperative pancreatic fistula rate and shortened the postoperative hospital stay.
الملخص
Objective:To study the impact of traditional versus artery first approach in laparoscopic pancreaticoduodenectomy (LPD).Methods:The clinical data of 58 patients who underwent laparoscopic pancreaticoduodenectomy using the two different approaches from February 2016 to August 2018 at the Xianyang Central Hospital affiliated to Xi'an Jiaotong University Medical Department were retrospectively analyzed.Results:All 58 patients successfully underwent the complete laparoscopic Whipple operation using the Child digestive tract reconstruction and anastomosis. There was no conversion to laparotomy. The average operation times for the conventional approach group (35 cases) was (302.0±20.0) min and the digestive tract reconstruction time was (36.0±15.0) min. The intraoperative blood loss was (365.0±150.0) ml. Negative pathological resection margins on intraoperative frozen section examination were achieved in 33 patients. Early postoperative complications happened in 6 patients which included grade A pancreatic fistula in 3 patients (1 patient complicated with biliary fistula and 1 patient complicated with gastric emptying disorder), and grade B pancreatic fistula in 2 patients who were complicated with abdominal hemorrhage, successfully treated by conservative treatment. Postoperative pathological examination showed that 32 patients (91.4%) had R 0 resection and 3 patients (8.6%) had R 1 resection. The number of lymph node dissection was (7.5±5.5). On the other hand, the average operation time of the artery first access group (23 cases) was (355.0±25.0) min, and the reconstruction time of digestive tract was (41.0±12.0) min. The amount of bleeding was (410.0±200.0) ml. During the operation, 22 patients had negative resection margins shown on pathological frozen sections. Early postoperative complications occurred in 3 patients, including 1 patient with grade A pancreatic fistula which was complicated with gastric emptying disorder, and 2 patients with grade B pancreatic fistulas which were complicated with abdominal hemorrhage. The patients were successfully managed by conservative treatment. Postoperative pathological examination showed that 22 patients (95.7%) had R 0 resection and 1 patient (4.3%) R 1 resection. The number of lymph node dissection was (6.8±4.2). Conclusion:The LPD surgical approach was selected according to the general conditions of patients, locations of tumors, relationship of tumors with blood vessels, and technical skills of surgeons with the aims to achieve adequate lesion clearance, organ protection, damage control, and safety and efficiency of minimally invasive surgery.
الملخص
Objective To compare the efficacies of laparoscopic versus open splenectomy plus portaazygous devascularization in the treatment of patients with portal hypertension with recurrent upper gastrointestinal bleeding.Methods The clinical data of patients who underwent laparoscopic (n =60) versus open (n =52) splenectomy plus open portaazygous devascularization in the Department of Hepatobiliary Surgery,the Center Hospital of Xianyang City,Xi'an Jiaotong University Health Science Center from March 2014 to February 2017 were retrospectively analyzed.Results There was no perioperative death in the 2 groups.The amounts of intraoperative bleeding,the durations of the operation,the time of first flatus passed after operation and the duration of postoperative hospitalization were compared,and the differences were significantly different (t =3.288,2.533,3.325,2.823,P ＜ 0.05).There was no significant difference in the total hospitalization expenses (t =0.651,P ＞0.05).The incidence of postoperative complications was significantly higher in the open surgery group (x2 =7.622,P ＜ 0.05).At 1-month after surgery,color doppler flow imaging (CDFI) showed no significant difference on the portal blood flow between the two groups (t =0.625,P ＞ 0.05).On gastroscopy,the esophageal and gastric varices were significantly improved,and there was no significant difference between the two groups (x2 =0.718,P ＞ 0.05).Liver function was better in the laparoscopic group than the open group (x2 =3.765,P ＜ 0.05).Comparison of the rebleeding rates and the incidences of hepatic encephalopathy for the two groups at 1 year after operation showed significantly better outcomes for the laparoscopic group (x2 =2.351,1.245,P ＜ 0.05).The 1-year and 3-year survival rates after operation (x2 =0.218,0.361,P ＞ 0.05) were not significantly different.Conclusion Compared with laparotomy,laparoscopic splenectomy plus portaazygous devascularization had the advantages of less trauma,better short-term and long-term efficacies.
الملخص
Objective To investigate the effect of percutaneous transhepatic gallbladder drainage(PTGBD) on different American Society of Anesthesiologists(ASA) grading of laparoscopic cholecystectomy in patients with acute cholecystitis. Methods The 324 patients with acute cholecystitis undeigoing laparoscopic cholecystectomy who were hospitalized in Department of Hepatobiliary Surgery, Xianyang Central Hospital from March 2010 to December 2014 were enrolled in the retrospective analysis. According to the history of the patients with or without PTGBD before laparoscopic cholecystectomy, all patients were divided into 2 groups. One hundred and eighty four patients who underwent directly laparoscopic cholecystectomy were the control group, and the other 140 patients who underwent PTGBD + elective laparoscopic cholecystectomy were the study group. The rates of conversion to laparotomy, total days of hospitalization, hospitalization days after cholecystectomy incidence, postoperative complications incidence, postoperative drainage were compared between two groups. The difference of clinical data between the two groups were compared under different ASA classification. Measurement data were expressed as ((x)±s) and t-test were used for comparison between groups. Count data were compared by X2 test. Results The rate of intraoperative laparotomy was 23.6％(33/140) in the study group and 20.7％(38/184) in the control group; the mean length of hospital stay was (7.3 ±3.3) days in the study group and (6.8 ±2.3) days in the control group; the postoperative complication rate was 2.8％(4/140) in the study group and 0.5％(1/184) in the control group; the abdominal cavity drainage rate was 80.0％(112/140) in the study group and 73.9％(136/184) in the control group; intraoperative laparotomy rate, postoperative hospital stay, postoperative complications incidence, and abdominal cavity drainage rate between the two groups had no significant difference(P> 0.05). The total length of hospital stay was(17.6 ±4.4) days in the study group and(10.6 ±3.0) days in the control group, and there was a statistically significant difference between the two groups(P <0.001). According to the subgroup analysis by ASA classification, the two groups of ASA-I patients in the experimental group were significantly higher than the control group in the temperature, C reactive protein and the total number of days of hospitalization, and the difference was statistically significant(P< 0.05). The two groups of ASA-Ⅱ patients in the experimental group were significantly higher than those of the control group in age, white blood cell count, C reactive protein and total hospitalization days, and the difference was statistically significant(P<0.05). In ASA-Ⅲ patients, the rate of intraoperative laparotomy was 28.3％ (13/46) in the study group and 32.1％ (9/28) in the control group; the mean hospital stay after surgery was(10.8 ± 3.7) days in the study group and(11.2±4.8) days in the control group; The total length of hospital stay was (19.7 ±7.2) days in the study group and (16.8 ± 8.6) days in the control group; the rate of intraoperative laparotomy, the mean length of hospital stay and postoperative hospital stay in the two groups of ASA-Ⅲ patients had no statistically significant difference(P>0.05). Conclusions PTGBD has different effects on laparoscopic cholecystectomy in patients with different ASA grading of acute cholecystitis. PTGBD combined with laparoscopic cholecystectomy is a safe and effective method that can turn emergent operation intoselective operation. It is worthy of extensive application.
الملخص
Objective To investigate the therapeutic effect of total laparoscopic vs open surgery for gallbladder carcinoma.Methods Clinical data of 51 cases of laparoscopic surgery and 41 cases of open operation for gallbladder cancer from Mar 2012 to Dec 2016 were analyzed retrospectively.Results There were no perioperative death in both groups.The blood loss during operation,operative time,the first anal exhaust after operation and the hospital stay were in favour of laparoscopic procedure (t =2.756,2.325,1.362,2.252,P ＜ 0.05).There was no significant difference in total hospitalization expenses (t =0.655,P ＞ 0.05),the short-term postoperative complications were in favor for laparoscopic surgery (x2 =5.522,P ＜ 0.05).The 1,3,5-year survival rates of laparoscopic group and laparotomy group were comparable (x2 =0.356,0.428,0.388,P ＞0.05).Conclusion Laparoscopic radical surgery for gallbladder cancer is safe,feasible and less traumatic than open surgery,with long term survival comparable to open surgery.
الملخص
Objective To study the combined used of endoscopic retrograde cholangiopancreatography (ERCP) and laparoscopic surgery in the treatment of Mirizzi syndrome and in the prevention of bile duct injury in minimally invasive surgery.Methods A retrospective analysis was conducted on patients who suffered from Mirizzi syndrome treated with ERCP and laparoscopic surgery from March 2011 to February 2016 at the Center Hospital of Xianyang City,Southern Medical University.Results Of 1762 patients who underwent ERCP,56 patients were diagnosed to suffer from Mirizzi syndrome (3.2％).Thirty-six patients with type Ⅰ disease successfully completed LC.The adjacent tissues were used to repair the defects in the first stage for type Ⅱ disease in 12 patients and for type Ⅲ disease in 4 patients.T tube was not used.The bile was drained with a ENBD drainage tube.After LC,a bile duct to jejunum Roux-en-Y anastomosis was carried out for the type Ⅱ disease in 2 patients and for the type Ⅲ disease in 2 patients.There was no perioperative death for the whole group of patients.Two patients developed symptoms of cholangitis,and the disease was stable after non-operative treatment.For the other patients,follow-up for more than 2 years showed good results.Conclusions ERCP was useful in the diagnosis of Mirizzi syndrome and in the Csendes typing before operation.ENBD could be used as a guide to find the hepatic duct,thus avoiding bile duct injury during laparoscopic surgery and for the placement of T tube drainage.ERCP combined with laparoscopic surgery in the treatment of Mirizzi syndrome was safe and effective.It is an operation which has the advantage of minimal trauma,less pain and rapid recovery.
الملخص
Objective To study the combined used of endoscopic retrograde cholangiopancreatography (ERCP) and laparoscopic surgery in the treatment of Mirizzi syndrome and in the prevention of bile duct injury in minimally invasive surgery.Methods A retrospective analysis was conducted on patients who suffered from Mirizzi syndrome treated with ERCP and laparoscopic surgery from March 2011 to February 2016 at the Center Hospital of Xianyang City,Southern Medical University.Results Of 1762 patients who underwent ERCP,56 patients were diagnosed to suffer from Mirizzi syndrome (3.2％).Thirty-six patients with type Ⅰ disease successfully completed LC.The adjacent tissues were used to repair the defects in the first stage for type Ⅱ disease in 12 patients and for type Ⅲ disease in 4 patients.T tube was not used.The bile was drained with a ENBD drainage tube.After LC,a bile duct to jejunum Roux-en-Y anastomosis was carried out for the type Ⅱ disease in 2 patients and for the type Ⅲ disease in 2 patients.There was no perioperative death for the whole group of patients.Two patients developed symptoms of cholangitis,and the disease was stable after non-operative treatment.For the other patients,follow-up for more than 2 years showed good results.Conclusions ERCP was useful in the diagnosis of Mirizzi syndrome and in the Csendes typing before operation.ENBD could be used as a guide to find the hepatic duct,thus avoiding bile duct injury during laparoscopic surgery and for the placement of T tube drainage.ERCP combined with laparoscopic surgery in the treatment of Mirizzi syndrome was safe and effective.It is an operation which has the advantage of minimal trauma,less pain and rapid recovery.
الملخص
Objective To explore the clinical efficacy of laparoscopic improved ileal bypass (LIB)for treatment of type 2 diabetes mellitus(T2DM).Methods The clinical data of 52 patients who received LIB for T2DM at the Center Hospital Xianyang City,Southern Medical University,from May.2012 to Jul.2015 were retrospectively analyzed.On the basis of their body mass index (BMI),all cases were divided into two groups:group A (16 cases,BMI≥28 kg/m2) and group B(36 cases,BMI ＜28 kg/m2).LIB surgery were complete by laparoscopic ultrasound knife and the cutting anastomat etc.Before and during one year after surgery fasting blood glucose(FBG),fasting c-peptide,glycosylated hemoglobin (HbA1c) and BMI were detected to evaluate the outcome of T2DM.Count data and comparison of rates were analyzed by chi-square test.Measurement data with normal distribution were presented as ±s and analyzed by the t test.Repeated measurement data were analyzed by the repeated measuresanalysis of variance.Results All the 52 patients underwent successful LIB without perioperative death during the follow-up of 12 months.There were significant differences in FBG and HbA1c at admission and 12 months after surgery:group A (t=4.223,3.602,P＜0.05);group B (t=4.356,5.613,P＜0.05).With reference to the literature[1] curative effect evaluation standard,13 patients had complete remission,2 patients had partial remission and 1 patient had non-remission in group A,accounting for 81.25％,12.5％,and 6.25％ respectively.For 36 patients in group B,32 patients had complete remission,3 patients had partial remission and 1 patient had non-remission,accounting for 88.9％,8.3％,and 2.8％ respectively.Total treatment effectiveness was 96.2％ (50/52).No significant differences was found between group A and group B at 12 months after surgery (X2=0.053,P＞0.05).BMI at admission and 12 months after surgery had no significant differences in group A (t=1.581,P＞0.05),nor group B(t=2.124,P＞0.05).Conclusions LIB for T2DM improved the glucose metabolism significantly,with unconspicuous influence for BMI and was indications for the non-obese T2DM.Due to the poor weight loss,LIB choose carefully in obese patients with T2DM.The therapy has small trauma,fewer complications,simple operation skills and facilitated clinical promotion.
الملخص
Objective To analyze the risk factors of bile duct injuries in laparoscopic cholecystectomy.Methods The clinical data of 11 243 patients who underwent laparoscopic cholecystectomy between October 1992 and December 2013 in the Xianyang Center Hospital were studied retrospectively.The risk factors of bile duct injuries were analyzed using the Chi-square test to determine the independent risk factors of bile duct injuries.Results Univariate analysis showed that bile duct injuries were associated with male,age ≥65 years,BMI ≥25 kg/m2,staging of inflammation,gallbladder atrophy on ultrasonography,thickness of gallbladder wall on ultrasonography,anatomy of Calot 's triangle and operator's experience (all P ＜ 0.05).Multi-factor and non conditional Logistic regression analyses showed that the independent risk factors of bile duct injury were old men,gallbladder atrophy,anatomy of Calot's triangle and operator's experience (All P ＜ 0.05).Conclusion Old men,gallbladder atrophy,anatomy of Calot's triangle and operator's experience were independent risk factors of bile duct injuries.
الملخص
PURPOSE: The avian origin canine influenza virus H3N2 has been recently isolated and found to be currently in dog population in South Korea and China. The purpose of this study was to clarify the relationship between immunosuppressive glucocorticoids used in veterinary clinical practice and viral shedding pattern of influenza in dogs. MATERIALS AND METHODS: Eight conventional beagle dogs were divided into control infection group and immunocompromised group. Dogs of both groups were infected with H3N2 canine influenza virus (2x106.0 EID50/0.1 mL). Dogs in immunocompromised group were given orally 3.0 mg/kg prednisolone for 7 days. Virus shedding was monitored using real-time polymerase chain reaction. After necropsy, histopathologic lesions were compared. RESULTS: We found that immunocompromised dogs exhibited more prolonged (8 days vs. 13 days) and higher magnitude viral shedding than control group (peak titer of viral shedding 4.6 vs. 5.5 EID50). CONCLUSION: Restricted use of immunosuppressive drugs in the clinical setting might help control the rapid spread of H3N2 through local dog populations.
الموضوعات
Animals , Dogs , China , Glucocorticoids , Immunosuppression Therapy , Influenza A Virus, H3N2 Subtype , Influenza, Human , Orthomyxoviridae , Prednisolone , Real-Time Polymerase Chain Reaction , Republic of Korea , Viral Load , Virus Sheddingالملخص
Objective To evaluate the efficacy of laparoscope, choledochoscope and duodenoscope in the treatment of extrahepatic bile duct stones. Methods The clinical data of 610 patients with extrahepatic bile duct stones who had received the treatment with laparoscope, choledochoscope and duodenoscope in our hospital from September 1997 to January 2007 were retrospectively analyzed. Patients with bile duct stones received ERCP or EST, and patients with cholecystolithiasis + choledocholithiasis underwent the treatment with laparoscope+ duodenoscope, or laparoscope + choledochoscope, or laparoscope + duodenoscope + choledochoscope. Results The operation was successful in 589 patients, with the successful rate of 96.6%. The duration of hospital stay was 7-28 days (mean, 13 days). No severe complications such as bile leakage, duodenal leakage, duodenal papilla bleeding, acute cholangitis occurred. Four hundred and eleven patients had been followed up for 1 to 3 years (mean, 13 months), and no bile duct stone recurrence or other complications occurred. Conclusions For patients with bile duct stones, the treatment with ERCP or EST is appropriate. Laparoscope + endoscopes in the treatment of cholecystolithiasis combined with choledocholithiasis is safe and effective.
الملخص
Objective To investigate the safety and feasibility of operation on complex laparoscopic cholecystectomy. Methods The clinical data of patients underwent complex laparoscopic cholecystectomy since 1990 in our hospital were retrospectively analyzed. Results Except 2 patients treated by abdominal operation, other patients were treated by laparoscopic cholecystectomy successfully. Conclusion The complex laparoscopic cholecystectomy is safe and feasible with sufficient evaluation before operation and proper management during operation.
الملخص
Objective To evaluate the value of endoscopic treatment for severe acute biliary pancreatitis (SABP). Methods A total of 36 patients with SABP, who received emergency operation were enrolled into this study. Among the patients, 16 received endoscopic naso-biliary drainage (ENBD) because of acute cholecystitis or cholecystolithiasis; 11 underwent endoscopic sphincterotomy (EST) and ENBD due to stenotic papillitis or choledocholithiasis; 4 were treated with EST using needle knife and ENBD due to difficulties in inserting bow knife and cannula catheter into the common bile duct; and 2 experienced the guide wire entering into the wirsung’s duct for over 3 times, when the cannula catheter was inserted into the common bile duct. Thus, the sphincter of Oddi was incised by bow knife to expose the opening of the cystic duct, and then ENBD was performed. Open surgery was performed in 3 cases because of failure of ENBD. In all the patients, systemic medical treatment was carried out after the operations.Results ENBD was completed in 33 cases, among which 29 (81%) patients were cured and 4 (11%) patients died. The operation failed in 3 cases. After the operation, 3 patients developed peripancreatic infection. No hemorrhage of the duodenum papilla, duodenal perforation, or cholangitis occurred in this series. The mean hospital stay was 22 d (15-75 d). 26 of the cured patients were followed up for 12-36 months (mean, 18 months), no recurrence of the symptoms of pancreatitis was found. Conclusions Endoscopic treatment combined with systemic medical therapy may reduce the course of disease and increase the cure rate for patients with SABP.
الملخص
Objective To explore the protective effect of portal vein administration of propofol on hepatic ischemia reperfusion injury(HIRI) and its mechanism.Methods Thirty-two male rabbits were randomly allocated into four groups:Group A(sham operation group),the abdomen was only opened and closed;group B,the hepatic inflow was occluded for 30 min,and reperfused for 60 min;group C,the same managment as group B + propofol injected through jugular vein;group D,the treatment same as group B + propofol injected through portal vein.Drug injection was completed 20 min before hepatic inflow occlusion.Serum ALT and AST,and endothelin-1(ET-1) and nitric oxide(NO)in the hepatic tissue and blood,and the content of ATP in hepatic tissue were determined.Results The level of ET-1 in plasma and hepatic tissue was significantly increased in group B compared to group C and D(P
الملخص
Objective To evaluate the long term effects of laparoscopic surgery on duodenal ulcer with acute perforation. Methods From 1995, Twenty-five patients with duodenal ulcer perforation and diffused peritonitis were diagnosed definitely by TV laparoscopic technique, and the perforations were sutured and repaired by greater omentum under laparoscopy. Six cases of them were performed parietal cell vagotomy simultaneously. After operation the drain was put into abdominal cavity and H2 receptor blocking agent, proton pump inhibitor or plus antihelicabater pylori therapy were used. Results All operations of 25 cases were accomplished under laparoscopy. Whatever operative complications had not happened. Average operation times were 55 minutes. The total hospital days were 6 in average. Postoperative follow-up ranged from 0. 5 -3 years, no duodenal ulcer recurred. Conclusion The laparoscopy adopted in treating duodenal ulcer perforation is a procedure with minimal invasion and scarceness of postoperative complication; its clinical effectiveness is as good as laparotomized operation.
الملخص
Objective To investigate the safety of laparoscopic cholecystectomy(LC) under the use of cardiac pacemaker for the patients with cholelithiasis and serious cardiac arrhythmia.Methods The clinical data of 8 cases undergoing LC under the use of vvI cardiac pacemaker were analysed.Results All the 8 cases undergoing LC by cardiac pacemaker had successful results. There was no cardiac accident or complication of the pacemaker in perioperative period in this series, and the postoperative course was smooth . Conclusions LC is safe under the use of cardiac pacemaker, if the decompensation of heart is controlled and the anaesthesia and operation are estimated correctly.