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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.
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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.
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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.
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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.
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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.
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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.