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Objective:To evaluate the preoperative localization value of endoscopic ultrasound guided fine needle tattooing (EUS-FNT) for laparoscopic distal pancreatectomy in pancreatic lesions with a maximum diameter ≤3 cm.Methods:From November 2017 to October 2022, at the Second Affiliated Hospital of Soochow University, the data of patients with pancreatic lesions ≤3 cm who underwent laparoscopic distal pancreatectomy were retrospectively analyzed. Eight patients who underwent EUS-FNT assisted laparoscopic distal pancreatectomy were included in the fine needle tattooing (FNT) combined laparoscopic group. And 14 patients who underwent simple laparoscopic distal pancreatectomy were taken as the simple laparoscopic group. The success rate and complications of EUS-FNT were observed. The differences in operation time, surgery-related complications and complete resection rate of lesions between the two groups were compared. Mann-Whitney U test and descriptive analysis were used for statistical analysis. Results:In the FNT combined laparoscopic group, the lesions of 4 cases were located in the pancreatic body and 4 cases in the pancreatic tail. In the simple laparoscopic group, the lesions of 4 cases were located in the pancreatic body and 10 cases in the pancreatic tail. There was a significant difference in lesion size between the two groups (14.5 mm (10.8 mm, 16.5 mm) vs. 27.0 mm (23.5 mm, 30.0 mm), Z=-3.09, P=0.001). In the FNT combined laparoscopic group, EUS-FNT was successfully performed in all 8 patients. The average time of laparoscopy after EUS-FNT was (98.4±8.8) min. The marks were clearly visible under the laparoscopic field of view, and no complications such as abdominal hemorrhage and hematoma were observed. Laparoscopic pancreaticocaudectomy was performed in 5 cases and pancreaticocaudectomy plus splenectomy in 3 cases. The median operation time was 192.5 min (176.3 min, 203.8 min). The amount of intraoperative bleeding was large in 2 patients and blood transfusion was needed. The lesions were one-time completely resected in all 8 patients. The postoperative pathology were 6 cases of pancreatic neuroendocrine neoplasm, 1 case of intraductal papillary mucinous neoplasm (IPMN), and 1 case of solid pseudopapilloma. In the simple laparoscopic group, laparoscopic pancreaticocaudectomy was performed in 2 cases and pancreaticocaudectomy plus splenectomy in 12 cases. The median operation time was 202.5 min (192.8 min, 235.0 min), which was longer than that of FNT combined laparoscopic group, but the difference was not statistically significant ( P>0.05). The amount of intraoperative bleeding was large in 2 patients and blood transfusion was needed. In 1 patient with pancreatic body lesions, no lesion was found in the specimen examination after the first pancreatectomy, and the lesions were completely resected after the second partial pancreatectomy. Active abdominal hemorrhage occurred in 1 patient on the second day after operation, and underwent interventional embolization for hemostasis. Two weeks after surgery, 1 patient was found to have a encapsulated fluid with a long diameter of 6 cm around the pancreas by computed tomography re-examination 2 weeks after surgery. The postoperative pathology were 5 cases of pancreatic neuroendocrine neoplasm, 2 cases of IPMN, 1 case of solid pseudopapilloma, 1 case of pancreatic cyst with glandular low-grade intraepithelial neoplasia, 1 case of ectopic spleen, and 4 cases of pancreatic ductal adenocarcinoma. Conclusion:EUS-FNT can effectively localize small pancreatic lesions before laparoscopic distal pancreatectomy, shorten the operation time and improve the complete resection rate under laparoscopy.
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Hepatocellular carcinoma (HCC) is prone to invading portal vein system known as portal vein tumor thrombus (PVTT). PVTT is one of the main reasons for poor prognosis of HCC because of its rapid progress and lack of effective treatments, and the optimal treatment strategy remains controversial. With recent advances in techniques, the efficacy and safety of radiation therapy for PVTT has been improved. The optimization of individualized radiotherapy and multimodality treatment is the future direction of research. In this review, we will investigate the current state and future opportunities of radiation therapy and multimodality treatment for HCC with PVTT.
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Objective:To investigate the application value of choledochoscopy in the diagnosis of cholelithiasis related diseases.Methods:The retrospective and descriptive study was conducted. The clinicopathological data of 111 patients with cholelithiasis related diseases who were admitted to the Second Affiliated Hospital of Soochow University between January 2018 and April 2019 were collected. There were 45 males and 66 females, aged (55±16)years, with the range from 20 to 89 years. The mucosal course of biliary system and the submucosal vascular density of the 111 patients were observed by choledochoscopy during operation. Observation indicators: (1) patient examinations; (2) specific case analysis. Measurement data with normal distribution were represented as Mean± SD. Count data were described as absolute numbers or percentages. Results:(1) Patient examinations: 111 patients underwent intraoperative choledochoscopy examination, and 5 patients underwent pathological examination. Five of the 111 patients had the results of intraoperative choledochoscopy examination inconsistent with results of preoperative imaging examination. (2) Specific case analysis. Case 1: the patient was diagnosed with intrahepatic and extrahepatic bile duct stones preoperatively by computed tomography (CT) and magnetic resonance cholangiopancreatography (MRCP) examination. Results of intraoperative choledochoscopy examination and electronic staining under choledochoscope showed abnormal mucosa at the opening of the original cholecyst duct in the common bile duct, thickened and disordered blood vessels, which indicated the possibility of malignant transformation. Results of intraoperative rapid frozen histopathological examination showed inflammatory cell infiltration in gallbladder neck and focal glandular epithelial high-grade intraepithelial neoplasia. Results of postoperative pathological examination showed high-grade intraepithelial neoplasia of the wall of gallbladder cervical ducts, focal infiltrating myowall carcinoma and strongly positive of Cytokeratin 7 diaminobenzine staining. Case 2: results of preoperative doppler ultrasonography and MRCP showed gallbladder polyps. Intraoperative choledochoscopy examination showed gallbladder polyps with adenoma and a blood vessel at polyp root, which was diagnosed as gallbladder polyp combined with adenoma. Results of electronic staining in narrow band imaging (NBI) showed gallbladder polyps with adenoma and thick blood vessels at polyp root. Results of intraoperative rapid frozen histopathological examination showed cholesterol polyps and focal adenomatous hyperplasia. Results of postoperative pathological examination showed chronic cholecystitis with cholesterol polyps and adenomatous hyperplasia of focal glands. Case 3: results of preoperative MRCP examination showed choledocholithiasis and intrahepatic bile duct stones. Results of intraoperative choledochoscopy examination showed intrahepatic bile duct stones of large size. The patient underwent holmium laser lithotripsy and mucosal hyperplasia with soft lesion and smooth mucous epithelium was found after the stone was broken. Results of NBI and methylene electron staining showed multiple submucosal tortuous vessels in proliferative lesions behind bile duct stone. Results of intraoperative rapid frozen histopathological examination showed adenoma with high-grade intraepithelial neoplasia. Case 4: results of preoperative MRCP examination showed intrahepatic and extrahepatic bile duct stones combined with dilatation of bile duct. Results of CT examination showed multiple soft tissue density shadows of intrahepatic and extrahepatic bile ducts, which was considered as biliary papillomatosis. Results of intraoperative choledochoscopy showed small stones in the lower common bile duct and multiple segmental proliferative flocculent hyperplasia lesions on the wall of the intrahepatic and extrahepatic bile ducts. Results of electronic staining in NBI showed multiple proliferative lesions in intrahepatic and extrahepatic bile ducts and multiple curved vascular shadows under the mucosa of the lesions. Results of intraoperative rapid frozen histopathological examination showed a denomatous hyperplasia with low-grade intraepithelial neoplasia. Results of postoperative pathological examination showed adenoma with low-grade intraepithelial neoplasia. Case 5: results of preoperative magnetic resonance imaging examination showed silt-like stones in the lower part of bile duct accompanied with dilatation of intrahepatic and extrahepatic bile ducts, neck of pancreatic duct was narrowed and the remaining areas were thickened. Results of CT examination showed multiple stones in the neck of the gallbladder and in the common bile duct, accompanied by dilatation of the intrahepatic and extrahepatic bile ducts and the main pancreatic duct, and the lower end of the common bile duct was slightly narrow which mean the possibility of ampulla space occupying could not be excluded. Results of preoperative endoscopic ultrasonography examination showed soft tissue occupation at the lower end of the common bile duct which considering as the possibility of entophytic adenoma, and small stones in the common bile duct. Results of preoperative endoscopic ultrasonography biopsy showed chronic inflammation of duodenal papilla. Results of intraoperative rapid frozen histopathological examination showed chronic inflammation of duodenal papilla. Results of intraoperative choledochoscopy examination and electronic staining under choledochoscope showed smooth mucosa of duodenal papilla, without lesion. Results of intraoperative choledochoscopy examination with endobronchial ultrasonography showed clear structure of mucosa and submucosal of duodenal papilla, without lesion.Conclusion:Choledochoscopy can be used in the auxiliary diagnosis of cholelithiasis related diseases.
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Objective: To evaluate the feasibility and safety of a new style of Laparoscope and Endoscope Cooperative gallbladderpreserving Surgery [LECS], an improved method of minimally invasive gallbladder-preserving polypectomy
Study Design: An experimental study
Place and Duration of Study: Department of General Surgery, The Second Affiliated Hospital of Soochow University, China, from January 2009 to July 2013
Methodology: Clinical data of patients subjected to LECS and Laparoscopic Cholecystectomy [LC] was analysed. The inclusion criteria were normal size clear gallbladder bile with total volume [FV] of the gallbladder = 15 - 25 ml, the Residual Volume [RV] = 5 ml, and the Emptying Figure [EF] > 75%, with polyps diagnosed definitively by B-type ultrasonic imaging or CT desirous of preserving gallbladder. Exclusion criteria were a history of midsection surgery, serious diseases of any organ, hepatic injury, or coagulation disturbance. Mean hospital stay and complications were also noted. Independent sample t-test, the frequency comparison used chi-square test [N > 5], and Fisher's exact test [N < 5] were used for statistical test
Results: The mean hospital stay after LECS was 3.50 +/- 0.31 days, and 3.50 +/- 0.31 days for the LC group. The mean age in LC and LECS group was 50 +/- 25.4 and 44 +/- 12.1 years, respectively. Complications after operation in the LECS were indigestion and diarrhea; LC group had indigestion [9.33%], diarrhea [10.67%], and gastroesophageal reflux [6.6.7%]. In the 3 months follow-up after discharging from the hospital, no patient had recurrence of any gallbladder disease; at 1 year follow-up, 1 patient [1.28%] developed cholesterol crystals; at 3-year follow-up, 3 cases [3.84%] were found to have recurring polyps [2 tilde 4 pieces], and 2 [2.56%] patients developed cholesterol crystals
Conclusion: Minimally invasive gallbladder-preserving polypectomy which used a CHIAO cholecystoscopy compared with a laparoscope is safe, feasible, and can effectively reduce the vestiges and recrudescence of polyps in gallbladder preserving surgery
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Laparoscopy , Polyps/surgery , Gallbladder , Endoscopy , Laparoscopes , EndoscopesABSTRACT
ObjectiveTo evaluate gallbladder conserving gallstone removal and polyps resection using combination laparoscopy,hard gallbladder endoscopy and soft choledochoscopy.MethodsClinical data of 122 patients with cholecystolithiasis or polyps undergoing removal of calculus (polyps) and preservation of gallbladder were analyzed retrospectively.ResultsGallstones in 56 patients and polyps in 24 cases was removed or resected successfully by laparoscopy and hard gallbladder endoscopy; In the remaining 34 cases stones were completely removed by combination soft choledochoscopy; 8 cases were converted to laparoscopic cholecystectomy.Romoved stone was single in 25 cases and multiple in 65 cases,with the number ranging from 1to 52,the diameter of stone ranged from 0.2 cm to 3.2 cm.In the 24 gallbladder polyps,7 cases were single,17 cases were multiple,the diameter of polyp ranged from 0.8cm to 1.2 cm.The operation time was 40-125 (78) min. The mean hospitalization was 4 days. No intraoperative and postoperative complications occurred.All patients were followed up for 1year.Gallstones recurred in 3 cases,and the recurrence rate was 3.06％. ConclusionsLaparoscopy combined with hard gallbladder endoscopy and soft choledochoscopy for removing calculi (polyp) and conserving gallbladder is safe and feasible.
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ObjectiveTo study the biologic distribution of 131I-Herceptin in BALB/c-neu nude mice bearing HER-2 positive SK-BR-3 human breast cancer xenografts and the radioimmunoimaging characteristics of nude mouse bearing human SK-BR-3 breast cancer xenografts. MethodSK-BR-3 breast cancer cells were implanted subcutaneously to athymic mice to establish animal model.Tumor bearing mice were continuously imaged with SPECT. The radiocounting per minute (cpm) of different organ on a γ-arithmometer was measured at 4,12,24,48 h postinjection of 131I-Herceptin or 131I-mlgG,and the T/NT ratios and the uptake percentages per gram of the injection dose (％ ID/g) was gained. ResultsModel was established in 96％ nude mouse.Compared with the control group,there was a significantly stronger contrast enhancement of tumor imaging,bigger T/NT and ％ ID/g in experimental group ( P ＜ 0.0l ).Conclusions 131I-Herceptin concentrates obviously in implanting tumor tissues of nude mouse,hence it is a good radiopharmaceutical agent targeting SK-BR-3 xenografts.
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Objective To design a multifunctional laryngeal mask development and can be used in clinical tracheobronchial foreign body removal, surgical lung lavage, lung surgery to stop bleeding and lung biopsy. Methods Three-way Laryngeal Mask is improved base on the traditional laryngeal mask, it adds a three-way channel(adapter), one end(port) of the threeway channel connected with the laryngeal mask, another end covered the seal cap from which can insert the fiberoptic bronchoscope or endoscope, one another end is a 15mm standard interface for connecting with the respiratory machine or anesthetic machine. The fiberopticscope or other kinds of endoscope will be inserted from the end of seal cap through the laryngeal mask body, the glottis enters trachea to bronchus. The standard end can be connected with the respiratory machine, in the process of operation can adjust the ventilation by manual control or machine-controlled. Results Through the clinical application testing, the use of the multifunctional laryngeal mask for all lung diseases surgery is successful completely, the degree of satisfaction is 100% and the effect of ventilation is excellent. Conclusion The multifunctional laryngeal mask can be widely used in the clinical various lung disease operation with safe, reliable, effective and advantages of fewer complications, which significantly expand the traditional use of laryngeal mask and considerably increase the security of anesthesia and operation.