For locally advanced rectal cancer, the standard treatment regimen is neoadjuvant chemoradiotherapy followed by total mesorectal excision.With the advent of the immunotherapy era, the synergistic anti-tumor effects of chemoradiotherapy and immunotherapy have been validated in multiple clinical studies.For pMMR/MSS locally advanced rectal cancer, neoadjuvant chemoradiotherapy combined with immunotherapy has further improved the rates of clinical complete response and pathological complete response, and it holds promise for showing advantages in organ preservation and long-term survival.However,the safety concerns associated with the new treatment modality need close attention.Additionally, the evaluation of treatment efficacy, the screening of beneficiary populations, and the combination with other medications warrant further exploration.

Locally advanced rectal cancer (LARC) is defined as a tumour that has invaded the entire bowel wall and may have spread to adjacent tissues or lymph nodes, but has not yet developed distant metastasis.The goals of treatment for LARC are to reduce local recurrence, improve anal retention, and reduce the risk of distant metastasis.Currently, the standard treatment options for LARC mainly include neoadjuvant radiotherapy (nCRT), total mesorectal excision (TME), and adjuvant chemotherapy.Although nCRT and TME have significantly reduced the rate of local recurrence, distant metastasis and low overall pathological complete remission (pCR) rates remain major challenges.In recent years, immunotherapy, especially immune checkpoint inhibitors (e.g., PD-1/PD-L1 inhibitors), has shown significant promise in cancer treatment.Studies have shown that the combination of immunotherapy and nCRT can significantly increase the pCR rate and clinical complete remission (cCR) rate, and enhance anal retention, especially for microsatellite-stabilised (MSS) patients who are usually insensitive to single immunotherapy.In this paper, we will discuss the issues related to neoadjuvant radiotherapy combined with immunotherapy in locally progressive rectal cancer.

Although neoadjuvant chemoradiotherapy has become the standard treatment for locally advanced rectal cancer (LARC), its efficacy and long-term survival rates still need improvement.The rapid development of immunotherapy, particularly the use of immune checkpoint inhibitors (ICIs), has brought new hope to the treatment of LARC.Studies indicate that combining neoadjuvant chemoradiotherapy with immunotherapy can increase the complete response rate in LARC patients and demonstrates good safety profiles.However, this novel treatment approach faces several challenges in clinical practice, including the identification of effective biomarkers, overcoming immune resistance, and optimizing treatment regimens.This review discusses the breakthroughs and challenges of neoadjuvant chemoradiotherapy combined with immunotherapy in LARC and explores potential future directions for optimization, aiming to provide more effective treatment options for LARC patients..

Typically, TME is performed after nCRT to ensure tumour shrinkage and allow for a smoother and more thorough procedure.For a long time, low rectal cancer has always been the difficulty of surgical treatment in colorectal surgery, and there are mutual constraints and contradictions between radical resection and functional protection.In recent years, with the development of transanal endoscopic microsurgery and other surgical techniques, transanal total mesorectal excision (TaTME) surgery is also widely used in clinical practice.Previous studies have shown that traditional nCRT combined with immunotherapy has even significantly increased the pathological complete remission rate (pCR), which also makes it difficult to accurately identify the tumour location intraoperatively.The magnifying effect of laparoscopy and transanal endoscopy allows fine manipulation of the pelvic floor and clarification of the surgical anatomy of the anal canal.TaTME may be more advantageous in rectal cancer patients with ‘difficult pelvis’ such as low anterior rectal wall tumours, pelvic stenosis, and unclear tissue planes due to neoadjuvant radiotherapy.

laparoscopic cholecystectomy (LC) is currently a standard procedure for laparoscopic cholecystectomy.With the development of technology, single-hole laparoscopic cholecystectomy has gradually become a trend.However, due to the “chopstick effect”, single-hole laparoscopic cholecystectomy has not been widely carried out in basic hospitals.T-shaped metal wire combined with ultramicro wound clamp wire assisted transumbilical single-hole laparoscopic cholecystectomy can fully expose the gallbladder triangle, reduce the“chopstick effect”, and reduce the abdominal wall damage.The initial application is safe and effective, and can assist the implementation of single-hole laparoscopic cholecystectomy.In this study, with the help of self-made T-shaped metal wire and ultramicro wound forceps, the “chopstick effect” can be significantly reduced, and the single-hole laparoscopic cholecystectomy can be completed safely and conveniently.

Objective

To investigate the application value of indocyanine green (ICG) imaging technique in the preservation of left colic artery (LCA) during laparoscopic radical resection of rectal cancer.

Method

The data of 80 patients with LCA who underwent laparoscopic radical resection for rectal cancer from April 2022 to January 2024 were retrospectively analyzed and divided into ICG group (n=40 cases) and control group (n=40 cases) according to different operation methods.The ICG group was assisted by indocyanine green development to preserve LCA, while the control group underwent conventional laparoscopic radical resection of rectal cancer to preserve LCA.SPSS26.0 software was used to analyze the data.The perioperative period and other measurement data of the two groups were expressed as (± s), and independent sample t test was used.Postoperative complications and left colic artery retention rate were measured by χ² test.P＜0.05 was considered statistically significant.

Results

The intraoperative blood loss, postoperative bowel sound recovery time and hospital stay in ICG group were lower than those in control group, and the success rate of LCA retention, total lymph nodes and the number of lymph nodes dissection in group 253 were higher than those in control group,with statistical significance (P＜0.05).There were no significant differences in operation time, lymph node metastasis rate and postoperative complication rate between 2 groups (P＞0.05).

Conclusion

Indocyanine green imaging technology can improve the success rate of LCA retention, increase the lymph node clearance rate, reduce the amount of intraoperative blood loss, and has the value of popularization.

Objective

To compare and analyze the clinical effect of total mesorectal resection (TME)for rectal cancer at different levels of submesenteric vein (IMV) ligation.

Methods

Sixty patients with rectal cancer undergoing laparoscopic TME from January 2020 to December 2022 were prospectively selected as the study objects, and were divided into high ligation group and low ligation group by random number table method, with 30 cases in each group.The IMV was ligated horizontally at the lower pancreatic margin in the high ligation group, and the IMV was ligated horizontally at the root of the inferior mesenteric artery (IMA) in the low ligation group.SPSS 25.0 was used to complete the data analysis.All perioperative indicators and other measurement data were represented by (x±s) and independent sample t test was performed.The statistical data of postoperative complications were expressed by［ cases (%)］ and χ² test was performed.Kaplan-Meier method was used to draw survival curve and parallel Log-Rank test.P＜0.05 indicated that the difference was statistically significant.

Results

There was no significant difference in operation time, intraoperative blood loss, number of lymph nodes dissection, number of positive lymph nodes, intraperitoneal drainage flow and Wexner score between the two groups (P＞0.05), while the recovery time of intestinal function and postoperative hospital stay in the low ligation group were significantly lower than those in the high ligation group (P＜0.05).There was no significant difference in the total incidence of postoperative complications between the two groups(20.0% vs.16.7%) (P＞0.05).Kaplan-Meier survival analysis showed that cumulative disease-free survival (86.7%vs.83.3%) and cumulative overall survival (90.0% vs.86.7%) were not statistically significant between the high ligation group and the low ligation group (P＞0.05).

Conclusion

Both high ligation and low ligation of IMV in TME of rectal cancer are safe and feasible.Low ligation of IMV is more conducive to postoperative intestinal function recovery of patients, accelerates postoperative rehabilitation and has better clinical effect without affecting radical tumor treatment.

Objective

To investigate the clinical effect of selective application of ultrasonic knife and electric hook in laparoscopic Dixon surgery for rectal cancer.

Methods

A retrospective analysis was performed on 125 patients with rectal cancer who received laparoscopic Dixon surgery from September 2017 to August 2023.The patients were divided into two groups according to the surgical anatomy method: 65 patients in the observation group were selectively treated with ultrasonic knife and electric hook during the operation,and 60 patients in the control group were treated with ultrasonic knife throughout the operation.Operationrelated indicators and postoperative complications were compared between the two groups.SPSS 22.0 was used to process the data.Measurement data were expressed as (x±s) and independent sample t test was performed.The counting data is represented by［ cases (%)］ and tested by line χ².P＜0.05 was considered statistically significant.

Results

Compared with the control group, there were statistically significant differences in operation time (P＜0.05), but no statistically significant differences in intraoperative blood loss, postoperative 3d abdominal drainage, drainage tube removal time, urinary tube removal time, intestinal function recovery time and postoperative average hospital stay (P＞0.05).No postoperative anastomotic hemorrhage, anastomotic leakage and urinary retention occurred in both groups.The incidence of anastomotic stenosis within 1 year after surgery was 3.1% in the observation group and 3.3% in the control group, with no statistical significance (P＞0.05).

Conclusion

Laparoscopic Dixon surgery for rectal cancer selectively uses ultrasonic knife and electric hook according to the anatomical location and tissue structure characteristics, which is conducive to accelerating the surgical process, reducing the anesthesia time, and reducing the risk of complications.

Objective

To compare the efficacy and complications of laparoscopic and open rectal resection for middle and low rectal cancer.

Methods

Data of 482 patients with low and middle rectal cancer admitted from January 2019 to January 2023 were retrospectively analyzed and divided into group A (n=245 patients undergoing laparoscopic rectal cancer resection) and group B (n=237 patients undergoing open rectal cancer resection) according to different operation methods.SPSS 24.0 was used to analyze the data.Normal measurement data were expressed as(x±s), and independent sample t test was performed for comparison between groups.The counting data［ e.g.(%)］ were indicated by χ² test.Rank data row Rank Sum test.P＜0.05 indicates statistical difference in data comparison.

Results

The operative time of group A was longer than that of group B, but the intraoperative blood loss, the first postoperative ventilation time and the length of hospital stay were lower than those of group B (P＜0.05).There was no significant difference in the number of lymph node dissection, the number of positive circumferential margin and postoperative clinical stage between the two groups (P＞0.05).The total incidence of postoperative complications in group A was 6.5%, lower than 12.2% in group B (P＜0.05).The local recurrence rate and survival rate were 12.7% and 97.6% in group A and 13.1%and 97.8% in group B, respectively, with no statistical significance (P＞0.05).

Conclusion

Laparoscopic and open rectal cancer resection have similar oncology effects and long-term curative effects in the treatment of middle and low rectal cancer.Compared with open surgery, laparoscopic surgery has the advantages of less trauma, faster postoperative recovery and higher safety.

Objective

To investigate the therapeutic effect of laparoscopic radical resection of right hemicolonic carcinoma (LISH) with ileocecal area preserved in patients with right hemicolonic carcinoma.

Methods

Sixty patients with right half colon cancer between January 2021 and December 2023 were studied.They were divided into observation group (n=30) and control group (n=30) by random number table method.The observation group received LISH, and the control group received traditional laparoscopic radical right hemicolectomy (LRH).SPSS 27.0 software was used to analyze the data.Measurement data such as perioperative indicators were represented by (± s) and independent sample t test was performed.The incidence of postoperative complications was expressed as rate, and the counting data were tested by χ².The quality of life score before and after surgery was expressed as (x±s), and repeated measure ANOVA was used for comparison.P＜0.05 was considered statistically significant.

Results

There was no significant difference in operation time, intraoperative blood loss and hospital stay between the two groups (P＞0.05).The time of defecation, eating and exhaust in observation group was shorter than that in control group (P＜0.05).The incidence of postoperative complications in observation group was lower than that in control group (10.0% vs.33.3%, P＜0.05).There was no interaction between time and method on SF-36 quality of life score (P＞0.05).The main effect of time and method on SF-36 quality of life score was significant (P＜0.05).The SF-36 quality of life scores of both groups showed a gradually increasing trend at 3, 6 and 12 months after surgery, and the scores of patients in the observation group were higher than those in the control group at 3, 6 and 12 months after surgery (P＜0.05).

Conclusion

For patients with right colon cancer, the implementation of LISH to ensure the effect of radical tumor treatment can effectively reduce the time required for postoperative defecation, eating and exhaust, significantly reduce the incidence of complications, and improve the long-term postoperative quality of life of patients.

Objective

To investigate the short and medium term efficacy of laparoscopic radical resection of right half colon cancer by combined head and tail approach.

Method

Data of 99 patients with right half colon cancer who underwent laparoscopic radical resection from August 2018 to August 2021 were retrospectively analyzed, and divided into a cephalic group (n=49 cases, all cephalic approach) and a combined group (n=50 cases, combined cephalic and caudal approach) according to different approaches.SPSS 25.0 software was used to process the data.Measurement data such as surgery-related indicators and postoperative recovery indicators were represented by (x±s) and independent sample t test was used.The statistical data of complications and survival rate were expressed by［ cases (%)］ using χ² test.P＜0.05 was considered statistically significant.

Results

The operative time of the combined group was shorter than that of the cephalic group,and the number of intraoperative blood loss and vascular injury cases was lower than that of the cephalic group(P＜0.05).There was no significant difference in the time of first discharge, first feeding, drainage tube removal and hospital stay between the two groups (P＞0.05).There was no significant difference in the number of lymph nodes removed during operation, the total incidence of postoperative complications and the 2-year overall survival rate between the two groups (P＞0.05).

Conclusion

Compared with the complete cephalic approach,the combined cephalic and caudal laparoscopic radical resection of colon cancer can shorten the operation time,reduce the amount of intraoperative blood loss, and reduce the risk of vascular injury.The safety and nearmedium term prognosis of the combined cephalic and caudal approach for colon cancer are comparable.

Objective

To analyze the risk of recurrence in Barcelona Stage (BCLC) patients with early liver cancer (HCC) after hepatectomy with adjuvant transarterial chemoembolization (PA-TACE) or adjuvant radiotherapy after hepatectomy with radiotherapy (PA-RT), and to construct predictive models.

Methods

A retrospective analysis of 202 HCC patients who underwent hepatectomy and postoperative adjuvant PA-TACE or PA-RT from November 2013 to March 2018 was performed to establish a prognostic scoring system as a model group.Fifty HCC patients who underwent hepatectomy and postoperative adjuvant PA-TACE or PA-RT from March 2018 to December 2018 were used as the validation group to verify the constructed scoring system.SPSS 23.0 software was used for statistical analysis.Qualitative data were compared by χ² test or Fisher exact probability test.The optimal cut-off value of the model was determined by receiver operating characteristic (ROC)curve analysis using t test for quantitative data.Kaplan-Meier method was used to calculate survival results,and Log-Rank test was used to compare differences between groups.Logistic regression was used to identify risk factors that independently predicted early recurrence.P＜0.05 was considered statistically significant.

Results

Microvascular invasion (MVI), Edmondson grade, HBV-DNA level, and tumor diameter were independent risk factors for early recurrence.A scoring system was constructed based on independent risk factors, and 2.177 was used to divide the patients into high rating groups (＞2.177 points) and low rating groups (≤2.177 points).The probability of early recurrence in high rating group was significantly higher than that in control group (P＜0.05).

Conclusion

MVI, Edmondson grading, HBV-DNA levels, and tumor diameter scoring systems can predict early recurrence in early HCC patients treated with PA-TACE or PA-RT.PA-TACE and PA-RT may be helpful for patients with early HCC with low scores (≤2.177).

Objective

The mouse model of postoperative anastomotic leakage of digestive tract was established.

Methods

From June 2023 to December 2023, 30 C57BL/6 mice were randomly divided into two groups: 6 mice in the control group were performed laparotomy only; In the experimental group of 24, the intestinal tube was cut from the vascularized area of the colon and the blood vessels supplying this section were ligation, then anastomosis was performed, and the operation time was recorded.Two days after operation,a laparotomy was performed to investigate the morphological changes in the abdominal cavity of the mice, and the tissues around the anastomosis were collected to further observe the histological changes of the anastomotic leakage.Image J and Graph Pad Prism 9.5 software were used for statistical analysis.Independent sample t test was used for comparison between the two groups, and P＜0.05 was considered statistically significant.

Results

The average construction time of the model was 25min, and the survival rate of the mice was 75%.Methylene blue perfusion test showed leakage of intestinal tube.Laparotomy exploration showed that there was slight adhesion in the anastomosis, the adhesion part could be separated, and there was leakage in the intestinal tube.Compared with the control group, hematoxylin-eosin staining showed muscle discontinuity at the anastomosis in the experimental group.Western Blot showed that the expression of inflammatory factors in the same part of the tissue was significantly different at the protein level.F4/80 immunohistochemistry showed a large number of macrophage infiltrates at the site of muscle break.

Conclusion

Through this method, a mouse model of postoperative anastomotic leakage of digestive tract can be successfully constructed.

Objective

To investigate the safety and efficacy of intravenous indocyanine green navigation surgery in radical gastrectomy.

Methods

Nine patients receiving intravenous indocyanine green guided radical gastrectomy were enrolled.All patients underwent standard D2 lymph node dissection and lymph node sorting.Indocyanine green was injected at 0.5h, 4h and 12h before surgery, respectively.Perioperative indexes, imaging effects of tumor and lymph nodes, the ratio of tumor and lymph nodes to surrounding tissue,the number of lymph nodes sorted at each station and the total number were analyzed.Measurement data with normal distribution were represent as (Mean±SD).

Results

The mean operation time of the included patients was (206.7±33.1) min, the intraoperative blood loss was (161.1±48.6) ml, and the postoperative hospital stay was (10.1±1.8) d.None of the 9 patients had serious complications.The imaging of tumor and lymph nodes could be achieved at all three time points.The highest ratio of tumor to normal gastric mucosal tissue was (2.5±0.4) at 0.5h,and the highest ratio of lymph node to surrounding tissue was (1.9±0.6) at 12h.The total number of lymph nodes was (74.0±29.2).

Conclusions

Intravenous indocyanine green navigation radical gastrectomy is effective.

Objective

To investigate the predictive effect of constructing a nomogram model based on inflammatory response scoring system to predict the prognosis of all esophageal and gastric nodular adenocarcinoma patients after radical surgery.

Methods

A retrospective case-series analysis + cohort study of 364 patients with AEG who underwent radical surgery from January 2013 to November 2020.The patients were randomly divided into a training cohort (n=182 cases) and a validation cohort (n=182 cases) in a 1:1 ratio using a computer random number generator.Multivariate COX regression was used to screen potential independent prognostic factors of AEG, and a column graph was constructed to predict 3-year overall survival (OS) rate of AEG patients.Bootstrapping method was used for internal cross-validation to evaluate the accuracy of the nomogram.Combining the training cohort with the validation cohort, the Harrell method was used to evaluate the differentiation performance of the nomogram model, and the calibration curve, receiver operating characteristic(ROC) curve and decision making (DCA) curve were drawn to further evaluate the prediction ability of the model.The scores of all patients were calculated according to the constructed column graph model, and the optimal cut-off value of the scores was obtained through X-tile software.The overall cohort, training cohort and verification cohort were divided into high-risk group (≥optimal cut-off value) and low-risk group (＜optimal cut-off value) according to the optimal cut-off value.Kaplan-Meier analysis of 3-year OS was performed in high and low risk groups of each cohort.

Results

In the training cohort, 73 patients died and 109 survived.There were significant differences in BMI, TNM stage, T stage, N stage, maximum tumor diameter, vascular invasion,nerve invasion, D-dimer, NLR, PLR and AFR between the two groups (P＜0.05).According to the NPA-IRS scoring system, the OS rate of AEG patients with different scores showed a certain grade trend difference (χ²=24.583,P＜0.001).Multivariate COX regression analysis showed that D-dimer, nerve infiltration, TNM stage, N stage and NPA-IRS scoring system were independent risk factors for the prognosis of AEG patients (P＜0.05).Calibration curves of internal verification and external verification showed that the nomogram prediction was in good agreement with the reality.The time ROC curve showed that the model had good prediction performance (AUC of internal verification was 0.858 and AUC of external verification was 0.789).Kaplan-Meier analysis showed that the nomogram prediction model had good OS risk stratification performance.

Conclusions

The prediction model based on D-dimer, nerve infiltration, TNM stage, N stage and NPA-IRS scoring system can provide an important basis for the prognosis assessment of AEG patients.

Objective

To investigate the safety and anti-reflux effect of modified tubular gastroesophagostomy in laparoscopic proximal gastrectomy for gastrointestinal reconstruction.

Methods

The clinical data of 107 patients who underwent laparoscopic proximal gastrectomy from January 2022 to December 2023 were retrospectively analyzed and divided into 2 groups according to different methods of digestive tract reconstruction.52 patients who received simple esophagostomy were used as control group, and 55 patients who received tubular gastro-esophagostomy were used as observation group.SPSS 27.0 software was used to analyze the data.Measurement data such as perioperative indexes and Gerd Q scores were represented by (± s ), and independent sample t test was performed.The total incidence of postoperative complications was compared by χ² test, and the Clavien-Dindo classification of complications was compared by Z test.P＜0.05 was considered statistically significant.

Results

There was no significant difference in operation time, anastomosis time and Clavien-Dindo grade of complications between observation group and control group (P＞0.05).Compared with the control group, the indexes of first drinking time and average daily flow of gastric tube were significantly improved (P＜0.05).The total complication rate within 6 months after operation was lower than that of control group (5.5% vs.30.8%, P＜0.05).7 days after surgery, Gerd Q scale score of observation group was lower than that of control group (P＜0.05), postoperative nutritional indexes hemoglobin (HB), albumin (ALB) and body mass index (BMI) of observation group were better than those of control group (P＜0.05); 6 to 9 months after surgery, there were 4 patients in the observation group and 16 patients in the control group with mild reflux symptoms.The weight of all patients fluctuated from 4% to 5% of their preoperative body weight, and their diet basically returned to normal.

Conclusion

In patients with laparoscopic end-gastrectomy, tubular gastroesophagostomy can improve perioperative indicators, reduce the risk of complications, alleviate gastroesophageal reflux symptoms, and improve nutritional status.

Objective

To investigate the clinical significance of laparoscopic D2 radical resection combined with paraaortic lymph node dissection (PAND) in the treatment of locally advanced gastric cancer.

Methods

Data of 61 patients with locally advanced gastric cancer from January 2022 to January 2024 were retrospectively analyzed.All patients underwent laparoscopic gastrectomy and were divided into two groups according to the scope of intraoperative lymph node dissection.32 patients in the control group underwent D2 lymph node dissection, and 29 patients in the observation group received ascending PAND on this basis.SPSS 26.0 was used for data statistics.Measurement data such as perioperative indexes were expressed with (x±s),and independent sample t test was performed.Postoperative complications and other statistical data were described by［cases (%)］, and χ² tests were performed.Survival curves were drawn by Kaplan-Meier, and survival conditions of the two groups were analyzed by Log-Rank test.P＜0.05 was considered statistically significant.

Results

The operation time and the number of lymph node dissection in observation group were significantly higher than those in control group (P＜0.05).There was no significant difference in the amount of blood loss, the time of drainage tube removal and the number of days in hospital between the two groups (P＞0.05).There was no significant difference in the incidence of complications between the observation group (15.6%)and the control group (10.0%) (P＞0.05).The cumulative overall survival rate of observation group was 86.2%,which was higher than that of control group (75.0%), but the difference was not statistically significant (P=0.317).

Conclusion

In patients with locally advanced gastric cancer, D2+PAND treatment can prolong the operation time, but more lymph nodes can be removed without increasing the risk of surgical complications, which is safe and feasible.

Objective

To explore the effect of neoadjuvant chemotherapy combined with breast conserving surgery and modified radical surgery in the treatment of stage Ⅱ and Ⅲ breast cancer respectively.

Methods

Clinical data of 99 patients with breast cancer admitted from January 2017 to December 2019 were retrospectively analyzed, and divided into control group (neoadjuvant chemotherapy combined with modified radical surgery, n=49 cases) and observation group (neoadjuvant chemotherapy combined with breastconserving surgery, n=50 cases) according to different treatment methods.SPSS 25.0 software was used to process the data.Perioperative indicators, serum tumor markers and other measurement data were expressed as(x±s), and independent sample t test was used.The incidence of postoperative complications and recurrence survival were analyzed by Chi-square test.P＜0.05 was considered statistically significant.

Results

There was no significant difference in operation time between the two groups (P＞0.05).The duration of hospitalization and drainage tube removal in observation group was shorter than that in control group, and the amount of intraoperative blood loss was lower than that in control group (P＜0.05).The levels of carbohydrate antigen (CA)125 and carcinoembryonic antigen (CEA) in 2 groups were decreased after surgery, but there was no statistical significance between groups (P＞0.05).The total incidence of postoperative complications in observation group (4.0%) was lower than that in control group (18.4%), and the difference was statistically significant(P＜0.05).There was no significant difference in recurrence rate and survival rate between observation group and control group within 3 years after operation (P＞0.05).

Conclusion

Compared with modified radical surgery, breast-conserving surgery has a similar therapeutic effect for breast cancer patients, but the latter has less intraoperative blood loss, shorter hospitalization and drainage tube removal time, and a lower incidence of postoperative complications.

Objective

To investigate the clinical effect and safety of ampulla clock localization and gallbladder abandonment in laparoscopic treatment of acute cholecystitis in patients over 80 years old.

Methods

Sixty-nine patients over 80 years old with acute cholecystitis admitted from December 2015 to September 2023 were retrospectively analyzed, and 44 patients in the early laparoscopic cholecystectomy (LC)group were performed according to the two safety principles of gallbladder ampulla horological localization and gallbladder abandonment.Percutaneous transhepatic gallbladder drainage (PTGD) sequential LC group was performed in 25 cases, PTGD was performed first, and LC was performed in a relatively safe window period of 1 to 3 months.SPSS 22.0 was used to process the data.Normal measurement data were expressed as (x±s)and independent sample t test was used.Non-normal measurement data were represented by［ M (Q₁, Q₃)］, and Wilcoxon rank sum test was performed.Counting data is represented by［ cases (%)］ and χ² test is performed.P＜0.05 was considered statistically significant.

Results

Both the early LC group and the PTGD sequential LC group successfully completed the operation, no conversion to laparotomy, no bile duct, duodenum and right hepatic artery injury, no bile leakage, abdominal hemorrhage and other complications.There were statistically significant differences in the two indexes of intraoperative blood loss and intraperitoneal drainage volume 24 h after surgery (P＜0.05), while there were no statistically significant differences in the four indexes of operation time, drainage tube removal time, intestinal function recovery time and postoperative average hospital stay (P＞0.05).

Conclusion

It is safe and feasible to perform LC in the treatment of acute cholecystitis over 80 years old by following the two safety principles of ampulla timepiece localization and gallbladder abandonment.

Objective

To explore the early prediction value of procalcitonin (PCT) and C-reactive protein (CRP) in the severity of acute cholangitis, and establish a Nomogram model.

Methods

Clinical data of 162 patients with acute cholangitis from January 2021 to June 2023 were retrospectively analyzed, and they were divided into mild group (n=67 cases) and moderate and severe group (n=95 cases) according to the severity of their disease.SPSS 21.0 statistical software was used to process the data.The independent risk factors influencing the severity of acute cholangitis were screened by multivariate Logistic regression analysis.R software “rms” package to build Nomogram model.

Results

Compared with mild group, age, history of hypertension, total bilirubin (TBIL), white blood cell (WBC), albumin (ALB), PCT and CRP in moderate to severe group were significantly increased, and ALB was significantly decreased (P＜0.05).Age, WBC, ALB,PCT and CRP were independent risk factors for acute cholangitis severity (P＜0.05).ROC curve analysis showed that the AUC of PCT and CRP in predicting the severity of acute cholangitis was 0.931, which was significantly higher than that of PCT (P＜0.001), CRP (P=0.002), age +WBC+ALB (P=0.014).The five risk factors selected by multivariate Logistic regression analysis were defined as Nomogram Model 1, and the combined Model of age,WBC and ALB was defined as Model 2.Model 1 was better at predicting the severity of acute cholangitis (AUC:0.955 vs. 0.788).

Conclusion

PCT and CRP can predict the severity of acute cholangitis in early stage.Nomogram based on PCT and CRP has high predictive efficacy and clinical benefit.

Objective

To analyze the effect of minimally invasive laparoscopy and traditional small incision in the second stage of liver rupture in high altitude area.

Methods

A total of 60 patients with traumatic liver rupture who received simple perihepatic gauze packing for hemostasis from January 2017 to December 2022 were selected and divided into two groups by random number table method, with 30 patients in each group.The control group underwent two stage traditional small incision operation and the observation group underwent two stage laparoscopic operation.Statistical software SPSS 23.0 was used to analyze the data.The counting data were presented as［ cases (%)］, and the comparison between groups was performed by χ² test.Rank Sum test was used to compare rank count data.The measurement data conforming to the normal distribution were represented by (± s ), and the independent sample t test was used for comparison between groups.P＜0.05 indicated that the difference was statistically significant.

Results

The operation time of observation group was longer than that of control group, and the amount of blood loss, abdominal incision size, postoperative hospitalization time,hospitalization cost and postoperative 1d and 3d VAS scores were all better than those of control group, with statistical significance (P＜0.05).Compared with preoperative, postoperative WBC, CRP and IL-6 levels in 2 groups were increased, and control group was significantly higher than observation group, the difference was statistically significant (P＜0.05).The total incidence of postoperative complications in the observation group was 10.0%, significantly lower than that in the control group (33.3%), and the difference was statistically significant (P＜0.05).

Conclusion

Compared with traditional small-incision open surgery, laparoscopic gauze pad extraction in the second stage for patients with liver rupture in plateau areas can prolong the operation time, but it has the advantages of less bleeding, small incision and light pain.At the same time, it can reduce postoperative inflammation, reduce the incidence of complications, and is more conducive to postoperative recovery of patients.It has high economic benefits and application value, and is worthy of clinical promotion.

Objective

To investigate the effect and survival prognosis of radiofrequency ablation(RFA) combined with thyroid stimulating hormone (TSH) suppression in the treatment of papillary thyroid microcarcinoma (PTMC).

Methods

The medical records of 148 patients with PTMC in the hospital were retrospectively analyzed from April 2020 to April 2023.According to different treatment methods, they were divided into RFA group (RFA combined with TSH suppression therapy, n=76) and resection group (surgical resection combined with TSH suppression therapy, n=72).The data were analyzed by SPSS 24.0 software.Measurement data such as surgical related indicators, lesion volume and thyroid hormone indicators were expressed as (x±s).LSD-t test was used for between-group comparison, and paired sample t test was adopted for within-group comparison.Enumeration data such as lymph node metastasis rate and tumor recurrence rate were expressed as ［cases (%)］ by adopting χ² test.P＜0.05 was considered statistically significant.

Results

The surgical time, intraoperative blood loss, hospital stay and VSS score in RFA group were shorter or less than those in resection group (P＜0.05).The incidence rates of complications in RFA group were lower than those in resection group (P＜0.05).At 1, 3, 6 and 12 months after surgery, the lesion volume in RFA group showed a decreasing trend, and the VRR showed an increasing trend (P＜0.05).TSH level at 30 days after surgery was increased in RFA group (P＜0.05), and the level was lower in RFA group than that in resection group (P＜0.05).The levels of free triiodothyronine (FT3) and free thyroxine (FT4) at 30 days after surgery were declined in both groups (P＜0.05), but the levels in RFA group were higher than those in resection group (P＜0.05).There was no obvious difference in incidence rate of total poor prognosis between both groups (1.3% vs. 4.2%)(P＞0.05).

Conclusion

RFA combined with TSH suppression therapy and surgical resection can achieve good results, but RFA can better reduce intraoperative blood loss, surgical time and hospital stay, avoid high risk of complications and promote rapid absorption of lesions, and it has better long-term prognosis effect and has more minimally invasive advantages.

Objective

To investigate the clinical effect and postoperative complications of transthoracic approach endoscopy and traditional surgery in the treatment of papillary thyroid carcinoma.

Methods

A total of 60 patients diagnosed with papillary thyroid carcinoma admitted from July 2022 to December 2023 were selected and divided into control group and observation group by random number table method, with 30 patients in each group.The control group underwent traditional open surgery, and the observation group underwent transthoracic approach endoscopy.SPSS 20.0 software was used to process the data, and the measurement data were expressed as (± s).Independent sample t test was used for comparison between groups, and repeated measurement ANOVA was used for comparison at different time points.The count data were represented by［ cases (%)］ and χ² test was performed.TNM stage, pathological classification grade data row rank sum test.P＜0.05 was considered statistically significant.

Results

The operation time of observation group was significantly longer than that of control group, the postoperative blood loss was significantly less than that of control group, and the length of surgical incision was significantly shorter than that of control group (P＜0.05).Observation group postoperative pain visual analogue Scale (VAS) score, Vancouver Scar Rating Scale (VSS) score, C-reactive protein (CRP), interleukin-6 (IL-6), tumor necrosis factor-α(TNF-α), serum free triiodothyronine (FT3), serum free thyroxine (FT4) and serum free thyroxine (FT4) score The incidence of thyroid stimulating hormone (TSH) and complications were significantly lower than those in control group (P＜0.05).

Conclusion

Compared with traditional surgery, transthoracic approach endoscopic surgery for papillary thyroid carcinoma can improve the clinical efficacy and the levels of inflammatory factors and thyroid hormones.

Objective

To compare the clinical effect of two kinds of operation on intrahepatic cholangiocarcinoma.

Methods

The data of 90 patients with intrahepatic cholangiocarcinoma from December 2018 to December 2023 were retrospectively analyzed.They were divided into two groups according to different operation methods.Laparoscopic hepatectomy was performed in 50 cases and the group was set as endoscopic group.40 patients underwent open liver resection and were set as the open group.SPSS 22.0 statistical analysis data.Perioperative indicators and other measurement data were represented by (x±s), independent sample t test was performed, postoperative complications and other statistical data were represented by［ cases (%)］,χ² test was used.Kaplan-Meier method was used to calculate the survival rate.P＜0.05 indicated that the difference was statistically significant.

Results

90 patients with intrahepatic cholangiocarcinoma successfully completed hepatectomy without perioperative death.The operative time, intraoperative blood loss, surgical incision, first exhaust time, time to get out of bed and time to stay in the endoscopic group were all better than those in the laparotomy group, with statistical significance (P＜0.05).The total complication rate was lower than that in the open group (6% vs. 15%), and the difference was not statistically significant (P＞0.05).The mean follow-up time was 30.2 months (2～62 months) and the median disease-free survival time (51.1 vs.41.5 months).In the endoscopic group, 33 patients relapsed and 28 died.In the laparotomy group, 28 patients relapsed and 23 died.The 5-year cumulative overall survival rate and disease-free survival rate (44.0% and 34.0%) in the endoscopic group were higher than those in the open group (42.5% and 30%), and the difference was not statistically significant (P＞0.05).

Conclusion

Laparoscopic hepatectomy is safe and effective in the treatment of intrahepatic cholangiocarcinoma, which can shorten operation time, reduce intraoperative bleeding,accelerate postoperative recovery and shorten postoperative hospital stay.The long-term efficacy of laparoscopic hepatectomy is comparable to that of open hepatectomy for intrahepatic cholangiocarcinoma.

Objective

To investigate the effect of modified self-traction post-dissection (SPLT)esophagojejunostomy in laparoscopic total gastrectomy (LTG).

Methods

The clinical data of 180 patients with gastric cancer who received LTG from January 2019 to October 2023 were retrospectively analyzed.Patients were divided into modified SPLT group and Roux-en-Y group according to different intraoperative esophagojejunal anastomosis methods.In the modified SPLT group, 120 patients underwent modified SPLT esophagojejunostomy, and in the Roux-en-Y group, 60 patients underwent traditional esophagojejunostomy.SPSS 22.0 software was used to analyze the data.Surgical indicators, intestinal mucosal barrier function indicators and other measurement data were expressed as (x±s), and independent sample t test was used.The statistical data of postoperative complications were analyzed by χ² test.P＜0.05 was considered to be statistically significant.

Results

Operation time, anastomosis time, intraoperative blood loss, intestinal sound recovery time and postoperative VAS score in modified SPLT group were significantly lower than those in Roux-en-Y group (P＜0.05).There was no significant difference in hospital stay and number of lymph nodes dissection between the two groups (P＞0.05).The overall incidence of postoperative complications in the modified SPLT group was significantly lower than that in the Roux-en-Y group (5.8% vs.16.7%, P＜0.05).The serum levels of D-lactate (D-LAC), diamine oxidase (DAO) and endotoxin (ET) in 2 groups were significantly increased after surgery (P＜0.05), but the three indexes in modified SPLT group were significantly lower than those in Rouxen-Y group (P＜0.05).

Conclusion

The application of modified SPLT esophagojejunostomy in LTG can not only simplify the anastomosis process, shorten the operation time and reduce the intraoperative injury, but also reduce the postoperative pain of patients and reduce the risk of complications.Besides, it has less impact on the intestinal mucosal barrier function and is more conducive to the recovery of gastrointestinal function, which is worthy of promotion.

Preventive ostomy for patients with low rectal cancer is usually temporary and should be performed at a selected time after the patient's body recovers.However, there is still no uniform standard for the time of ostomy restoration, and a large number of studies are needed to further clarify the advantages and disadvantages of early and late reduction of ostomy.The presence of preventive ostomy also leads to the occurrence of many related complications, including ostomy related complications, early ostomy related complications, ostomy necrosis and periostomy skin complications, as well as late ostomy related complications,stenosis, retraction, prolapse, parastostomy hernia, ostomy cancer, and psychosocial disorders.The duration of the incision affected perioperative complications, including incisional infection, intestinal obstruction and incisional hernia.In this paper, the research progress of prophylactic ostomy reduction time for low rectal cancer was reviewed to provide reference for clinical work.

Gastric cancer, as a gastric mucosal epithelial malignant tumor, is a disease with a high incidence among digestive tract malignant tumors.The early symptoms are hidden and the diagnosis is usually in an advanced stage.Surgical treatment is the main means of treatment, the occurrence of postoperative complications not only affects the recovery process of patients, but also may increase the rate of re-hospitalization and mortality.Based on this, this study analyzed common postoperative complications and risk factors for gastric cancer in order to provide reference and guidance for clinical practice.

Gastrointestinal stromal tumors (gists) are tumors of mesenchymal origin, most commonly found in the stomach, and generally do not develop lymph node metastasis.Surgery is the main treatment for gastrointestinal stromal tumors.In the past, it was mainly open surgery, but with the progress of medical technology, laparoscopic surgery has become the mainstream.Compared with traditional open surgery,laparoscopic surgery is more minimally invasive and results in faster recovery.Because stromal tumors can occur in any part of the gastrointestinal tract, the surgical procedures are different for different sites and growth conditions.Based on the latest research trends at home and abroad and relevant evidence-based medical evidence, the author reviewed the laparoscopic surgical strategies for different sites of gastrointestinal stromal tumors.

Pancreatic fistula is one of the common complications of pancreatic resection, which not only increases the risk of abdominal infection, bleeding, multiple organ failure and other diseases, but also has a high incidence, which seriously threatens the life safety of patients.Therefore, this article reviews its risk factors and treatment progress, in order to provide reference for the prevention and treatment of postoperative pancreatic fistula.

Breast cancer is one of the most common malignant tumors in women.As the incidence of breast cancer continues to increase and the number of patients with breast defect or asymmetric deformity continues to increase, more and more women choose immediate breast reconstruction technology after modified radical breast cancer surgery to improve breast shape and beauty, reduce the psychological burden after surgery,and reshape women's physical integrity.At present, immediate breast reconstruction mainly includes breast reconstruction with autologous tissue and breast reconstruction with implant implantation.Each of the two methods has its advantages and disadvantages.The selection of breast reconstruction scheme in clinical practice is not clear, and the search for breast reconstruction scheme with high safety, high aesthetics and low surgical risk has become a hot spot in clinical research.This article reviews the research progress in the selection of methods for immediate breast reconstruction after modified radical mastectomy for the purpose of providing reference for clinicians.