目的评价完全腹腔镜根治性全胃切除术(totally laparoscopic total gastrectomy,TLTG)在胃上部癌外科治疗中的应用价值。方法回顾性分析浙江大学医学院附属杭州市第一人民医院自2018年1月至2019年6月因胃上部癌实施TLTG的81例患者资料...目的评价完全腹腔镜根治性全胃切除术(totally laparoscopic total gastrectomy,TLTG)在胃上部癌外科治疗中的应用价值。方法回顾性分析浙江大学医学院附属杭州市第一人民医院自2018年1月至2019年6月因胃上部癌实施TLTG的81例患者资料。结果81例患者均顺利完成完全腹腔镜下的TLTG和食管空肠顺蠕动侧侧吻合,无中转开腹病例,平均手术时间(211±22.4)min,平均术中出血量(78±27.2)ml;平均清扫淋巴结(26.3±3.8)枚,总淋巴结阳性病例率为29.6%(24/81),胰腺上区(第7/8/9组淋巴结)阳性病例率为21.0%(17/81),其中37例行脾门淋巴结清扫,阳性病例率为8.1%(3/37);平均术后排气时间(2.3±0.8)d,平均术后住院时间(9.1±3.2)d。其中1例患者术后出现吻合口瘘,经双套管冲洗保守治疗14 d后愈合,4例患者术后出现食管空肠吻合口轻度狭窄,保守治疗后均好转,其余患者未见并发症。结论TLTG治疗胃上部癌中是安全、可行的。展开更多
AIM: To investigate how complete laparoscopic anterior resection with natural orifice specimen extraction(NOSE), as a novel minimally invasive surgery, compares to conventional laparoscopic surgery.METHODS: Twenty pat...AIM: To investigate how complete laparoscopic anterior resection with natural orifice specimen extraction(NOSE), as a novel minimally invasive surgery, compares to conventional laparoscopic surgery.METHODS: Twenty patients who underwent complete laparoscopic anterior resection with NOSE and 50 patients who underwent laparoscopic assisted anterior resection by the conventional method between 2011 and 2012 were studied. Selection for complete laparoscopic anterior resection with NOSE was decided on the basis of tumor size, localization of the tumor, and body mass index. Outcomes related to surgery, including operation time, postoperative wound pain, hospital stay after surgery, the number of totally dissected lymph nodes, postoperative complications(suture failure and wound infection), and anal function, were reviewed retrospectively. Anal function was assessed at 3 and 6 mo after surgery using the Wexner fecal incontinence scoring system.RESULTS: Complete laparoscopic resection with NOSE was performed to completion in all 20 patients. There was no patient emergency that required conversion to conventional laparoscopic surgery or open surgery. The comparison between complete laparoscopic resection with NOSE and conventional laparoscopic surgery showed no significant differences in the maximal diameter of the tumor, number of totally dissected lymph nodes, bleeding volume, mean operation time, time to start of oral ingestion, postoperative hospital stay, and postoperative complications. On the other hand, with regard to pain after epidural anesthesia, the total usage of analgesia in this novel surgical technique was 1.85 ± 1.8 times, whereas it was 5.89 ± 2.86 in conventional laparoscopic surgery(P < 0.001). The postoperative pain period was 1.9 ± 1.9 d in this novel surgical technique, whereas it was 3.43 ± 1.41 d in conventional laparoscopic surgery(P < 0.004). In complete laparoscopic surgery with NOSE, the mean postoperative follow-up period was 20 mo(range: 12-30 mo). Neither local recurrence nor remote met展开更多
文摘目的评价完全腹腔镜根治性全胃切除术(totally laparoscopic total gastrectomy,TLTG)在胃上部癌外科治疗中的应用价值。方法回顾性分析浙江大学医学院附属杭州市第一人民医院自2018年1月至2019年6月因胃上部癌实施TLTG的81例患者资料。结果81例患者均顺利完成完全腹腔镜下的TLTG和食管空肠顺蠕动侧侧吻合,无中转开腹病例,平均手术时间(211±22.4)min,平均术中出血量(78±27.2)ml;平均清扫淋巴结(26.3±3.8)枚,总淋巴结阳性病例率为29.6%(24/81),胰腺上区(第7/8/9组淋巴结)阳性病例率为21.0%(17/81),其中37例行脾门淋巴结清扫,阳性病例率为8.1%(3/37);平均术后排气时间(2.3±0.8)d,平均术后住院时间(9.1±3.2)d。其中1例患者术后出现吻合口瘘,经双套管冲洗保守治疗14 d后愈合,4例患者术后出现食管空肠吻合口轻度狭窄,保守治疗后均好转,其余患者未见并发症。结论TLTG治疗胃上部癌中是安全、可行的。
文摘AIM: To investigate how complete laparoscopic anterior resection with natural orifice specimen extraction(NOSE), as a novel minimally invasive surgery, compares to conventional laparoscopic surgery.METHODS: Twenty patients who underwent complete laparoscopic anterior resection with NOSE and 50 patients who underwent laparoscopic assisted anterior resection by the conventional method between 2011 and 2012 were studied. Selection for complete laparoscopic anterior resection with NOSE was decided on the basis of tumor size, localization of the tumor, and body mass index. Outcomes related to surgery, including operation time, postoperative wound pain, hospital stay after surgery, the number of totally dissected lymph nodes, postoperative complications(suture failure and wound infection), and anal function, were reviewed retrospectively. Anal function was assessed at 3 and 6 mo after surgery using the Wexner fecal incontinence scoring system.RESULTS: Complete laparoscopic resection with NOSE was performed to completion in all 20 patients. There was no patient emergency that required conversion to conventional laparoscopic surgery or open surgery. The comparison between complete laparoscopic resection with NOSE and conventional laparoscopic surgery showed no significant differences in the maximal diameter of the tumor, number of totally dissected lymph nodes, bleeding volume, mean operation time, time to start of oral ingestion, postoperative hospital stay, and postoperative complications. On the other hand, with regard to pain after epidural anesthesia, the total usage of analgesia in this novel surgical technique was 1.85 ± 1.8 times, whereas it was 5.89 ± 2.86 in conventional laparoscopic surgery(P < 0.001). The postoperative pain period was 1.9 ± 1.9 d in this novel surgical technique, whereas it was 3.43 ± 1.41 d in conventional laparoscopic surgery(P < 0.004). In complete laparoscopic surgery with NOSE, the mean postoperative follow-up period was 20 mo(range: 12-30 mo). Neither local recurrence nor remote met