Application of circular anastomotic stapler for sigmoid colostomy in laparoscopy abdominoperineal resection / 重庆医学

Objective To evaluate the value of circular anastomotic stapler for sigmoid colostomy in laparoscopy abdominoperi-neal resection .Methods 62 patients of low colorectal cancer treated in our hospital from October 2010 to February 2013 was retro-spectively analyzed .All the patients were treated by laparoscopy abdominoperineal resection ,34 patients received sigmoid colostomy with circular anastomotic stapler(group A) ,and the other 28 patients received sigmoid colostomy with conventional suturing tech-niques(group B) .The medical records including operation time ,the time of return of bowl function ,postoperative hospital stay and postoperative complication rate were analysed statistically .Results All patients received the operations successfully .No conversion to open procedure and no operative death occured in two groups .The result of statistical analysis showed that in group A ,the opera-tion time ,the time of return of bowl function ,postoperative hospital stay time were shorter than group B ,and the rate of edema of sigmoid in group A were lower than group B(P<0 .05) .Conclusion The application of circular anastomotic stapler for sigmoid co-lostomy in LAPR is a safe ,effective and minimally invasive technique ,which can shorten operation time ,postoperative hospital stay and reduce the related complications of colostomy .

Clinical analysis of laparoscopic resection of colorectal cancer / 中国普通外科杂志

Objective To study the feasibility of laparoscopic resection of colorectal cancer.Methods A(retrospectively) analysis of the clinical data of 110 patients with colorectal cancer treated by laparoscopic(resection) during last three years was made.Of them,24 cases were converted to open operation.In 86 (cases),laparoscopic resection of colorectal cancer was completed.Among them,5 cases underwent right(hemicolectomy),2 cases left hemicolectomy,10 cases sigmoidectomy,22 cases Dixon′s operation,46 cases of Miles operation,and 1 case total colorectomy.Results No patient died within 30 days postoperatively in this series.The average operation time was 225(120-360) min with average 135(20-400) mL blood loss.The average number of lymph nodes excised was 8.7(1-30).The average number of positive lymph nodes was 2.2(0-24).Six cases had intraoperative complications,including 1 case of ureteral injury and 5 cases of intra-abdominal bleeding.These patients were immediately converted to open surgery.There were 6 cases with postoperative complications,among them,2 cases of urinary leakage,2 cases of massive bleeding and 2 cases of intestinal obstruction.All of them recovered after reoperation.The time of bowel funtion(recovering) was 12-72h after operation.The hospital stay after operation was 8.6(7-15)days.The median follow-up was 14.3 months(range 1-33) for 100(90.9%) patients.There was no port-site tumor(metastasis) and no tumor recurrence at the small abdominal incision.Six to fifteen months after opteration,3 cases had diffase peritoneal metastases.1 case of Miles resection had perineal metastasis 3 months after(surgery).Conclusions Laparoscopic resection of colorectal cancer is technically feasible,and have(advantages),such as less surgical trauma,less bleeding,less gastrointestinal interference and quicker(recovery).Laparoscopic radical operation for colorectal cancer can meet the requirements of safety and radical operation.

The application of laparoscopic total mesorectal excision with preservation of anal sphincter for rectal cancer / 中国普通外科杂志

Objective To explore the feasibility and efficacy of laparoscopic total mesorectal excision(TME) with preservation of anal sphincter for rectal cancer.Methods From October 2001 to March 2004,54(patients) with rectal cancer underwent laparoscopic total mesorectal excision(TME) with preservation of anal sphincter.In 51 of the 54 cases,the operation was completed laparoscopically,including 14 cases of(laparoscopic) anterior resection(AR) with the anastomosis level above the peritoneal reflection;20 cases of laparoscopic low anterior resection(LAR) with the anastomosis level more than 2cm above the dentate line;16 cases of laparoscopic ultralow anterior resection(ULAR) with the level of anastomosis within 2cm of the dentate line;and 2 cases of laparoscopic coloanal anastomosis(CAA) with the level of the anastomosis at or below the dentate line.whereas conversion to an open approach was required in three cases.Results The average operating time was 145 minutes(range 110~210min),and mean operative blood loss was 50 mL(range 30~80mL).Bowel function was restored and diet was resumed at 48 to 36 hours after operation.The average hospital stay was 9 days(range 7~14d).TME was completed successfully in 51 patients.Postoperative analgesics were used in 20 patients.No intraoperative or postoperative complications were(observed).Follow-up time was from 6~36 months in 51 patiebts,and there was no port-site or local tumor recurrence.Conclusions Laparoscopic TME is feasible and safe.It is a perspective technique with the(benefits) of minimally invasive technique and lower blood loss during operation,and rapid recovery.

Clinical study on diagnosis and treatment of small intestinal hemorrhage / 临床外科杂志

Objective To investigate the diagnostic and therapeutic methods of small intestinal hemorrhage.Method Clinical data of forty-nine cases of small intestinal hemorrhage were analyzed retrospectively.Results Small intestinal tumors were found in 21 cases (42.9%),among wtich,most were benign;infectious diseases in 12(24.5%);diverticula's in 8(16.3%);and vascular malformations in 6(12.2%).Radionuclide scanning was positive in 10 out of 13 cases (76.9%).Angiography was performed in 12,7 of them were abnormal (58.3%).Small bowel series made diagnosis in 25% of 36 cases.Postoperative bleeding was found in 5 cases and short bowel syndrome in 1 case.Conclusions Tumors are the most common cause of small bowel bleeding,and acute hemorrhagic nercotizing enteritis and typhoid often cause small bowel massive bleeding.Radionuclide scanning is one of the most useful diagnostic methods for diverticula's.Angiography is a valuable procedure in diagnosis of vascular lesions and malignants.Small bowel series is also helpful in diagnosis of solid lesions and diverticula's. Exploratory surgery coupled with intraoperative endoscopy can be helpful in diagnosis of small bowel bleeding.

Effect of HSP70 gene transfection to rat peripheral blood cytokines in the early phase of sepsis / 中国普通外科杂志

Objective To investigate the effect of HSP70 gene transfection to peripheral blood cytokines in the early phase of sepsis in rats. Methods A rat model of sepsis was established by cecal ligation and puncture(CLP),and adenovirus-mediated HSP70 gene transfection was performed in the CLP rats. Serum TNF-?,IL-1?,IL-6,IL-10 were measured before and after HSP70 gene transfection. Results In CLP rats, serum TNF-? increased at 3h and peaked at 6h(t_(TNF-?)=16.506, P

Study of alimentary reconstruction after total gastrectomy / 中国普通外科杂志

Objective To investigate the ideal procedure of digestive tract reconstruction after tota l gastrectomy . MethodsThe clinical data of 86 cases underg oing total gastrectomy were reviewed retrospectively. ResultsTotal gastrectomy was performed in 86 cases, including 76 cases of ga stric carcinoma, 8 cases of malignant lymphoma and 2 of leiomyosarcoma;and 17 cases in stage II, 48 cases in stage III, and 21 cases in stage IV. Radical tot al gastrectomy was performed in 48 cases and palliative total gastrectomy in 38 cases. Gastrectomy combining with resection of tail of pancreas, splenec tomy, transverse colectomy or partial hepatectomy was performed in 28 cases; and with drug delivery system implanted into hepatic artery in 28 cases. The recon struction of digestive tract included esophagoduodenostomy in 12 cases, Braun es ophagojejunostomy in 15 cases, Roux-en-Y esophagojejunostomy in 29 cases, and jejunal pouch interposition in 30 cases. Postoperative complications occurred i n 18 cases, including anastomosis leakage in 3 cases and pancreatic fistula in 1 case. Postoperative heartburn occurred in 21 cases, dumping syndrome in 18 cases, epigastric fullness in 15 cases, diarrhoea in 12 cases, and dysphagia in 9 cases. Conclusions Jejunal pouch interposition is an i deal procedure for reducing the patients′ postoperative symptoms and improving the quality of life after total gastrectomy.