Laparoscopic hernia surgery has developed rapidly in China for 20 years. Its characteristics of minimal invasive, fast recovery, and low complications have been highly sought after by doctors and patients.The proportion of laparoscopic surgery has also significantly increased, not only in the field of inguinal hernia,but also in other abdominal wall hernias such as incisional hernia, parastomal hernia, and hiatal hernia. The progress in technology and materials, as well as the application of new technologies such as single-incision hernia repair, robotic surgery, and MINIM technique, have led to continuous improvement in the efficacy of laparoscopic hernia surgery. However, there are still many problems, such as mesh related complications,general anesthesia trauma, and new technology learning curve related issues, which restrict the development of laparoscopic hernia surgery. In the future, laparoscopic technology will become the preferred method for most hernia surgeries, and telemedicine and artificial intelligence will provide broader development space for minimally invasive technology.
The field of laparoscopic hernia surgery in China hass ecial Care Spedeveloped rapidly in the past 30 years. The number of inguinal hernia surgeries in China has exceeded 1 million cases every year,among which the rate of laparoscopic surgery is getting higher and higher, and rapid progress has been made8 in basic research, 53, Chinadiagnosis and treatment guidelines, surgical operation specifications, progress in materials science, big data analysis, robotic surgery, etc. However, there are still many difficulties, such as the selection of indications, the selection of complex hernia surgery, how to avoid complications, the selection of surgical procedures and hernia repair materials for adolescents of different ages, the cost control under the implementation of the medical insurance system, and the popularization of day surgery. The above questions deserve in-depth discussion.
Surgical repair is the primary method for treating abdominal wall hernias. Laparoscopic hernia repair, based on the concept of minimally invasive surgery, has gradually gained popularity in our country. Modern hernia surgery focuses on restoring abdominal wall function while pursuing less trauma.With the continuous update of new materials, new technology and new operating platform, a variety of surgical methods have been derived on the basis of traditional endoscopic hernia repair. Different operation methods have different theoretical basis, advantages and disadvantages and adaptation range. Strictly grasp the surgical indications, combined with the individual conditions of patients and the experience of surgeons, choose the most reasonable surgical methods, so as to maximize its advantages. It is believed that laparoscopic hernia repair in China will have broad development prospects in the future.
A curvilinear incision of the peritoneum was made approximately 2cm above the margin of the internal ring defect, extending from the right umbilical fold to the right anterior superior iliac spine. The Retzius and Bogros space were sequentially dissected. Partial transversalis fascia and the “U-shaped” sling were divided, followed by high-point ligation of the hernia sac to achieve 8cm of parietalization of the spermatic cord. Approximately 1.0cm of the upper peritoneal margin was dissected. A hernia mesh was placed to cover the right myopectineal orifice. The peritoneum was closed by a continuous suture, and the hernia sac defect was repaired after excision of redundant sac.
Transumbilical single-port laparoscopic surgery is a new technique developed in recent years，which is basically limited to cholecystectomy，appendectomy and hepatic cyst opening and drainage，and its application in high-risk and difficult hepatic surgery started later，and most of them are partial hepatectomy.In order to explore the feasibility of transumbilical single-port laparoscopy in hepatectomy，further reduce the trauma of laparoscopic hepatectomy，and promote the rapid recovery of the patients after surgery，our team has carried out single-port laparoscopic surgery since 2008，and so far we have completed a total of more than 1,000 cases of various types of single-port laparoscopic surgeries，of which more than 100 cases of single-port laparoscopic partial hepatectomy，and more than 10 cases of single-port laparoscopic left hemihepatectomy，and accumulated a large number of single-port The team has accumulated a lot of experience in single-hole laparoscopic surgery.The team started to carry out laparoscopic hepatectomy earlier in China in 2006，and is able to skillfully complete more complex surgeries such as laparoscopic hemihepatectomy and hepatic trilobar resection，which provides sufficient technical guarantee for the feasibility and safety of single-hole laparoscopic hepatectomy.However，single-hole laparoscopic hepatic right anterior lobectomy is still rarely reported.This video demonstrates the process of completing transumbilical single-hole laparoscopic hepatic right anterior lobectomy with the assistance of the self-developed ultramicrotomy forceps.
To explore the effects of different approaches in endoscopic radical resection of thyroid cancer for patients with thyroid cancer.
Methods
The data of 115 patients who underwent endoscopic radical resection of thyroid cancer from January 2021 to December 2023 were retrospectively analyzed. 57 patients with the total areola approach were included in the total areola group, and 58 patients with the gasless axillary approach were included in the axillary group. All data were analyzed and processed using the SPSS 25.0 statistical software. Measurement data with a skewed distribution were described as［M(P25, P75)］, and the Mann-Whitney U test was used for data of different groups. Measurement data with a normal distribution were expressed as (), an independent sample t test was used between groups, and a paired sample t test was used within groups; Enumeration data were expressed as［ cases (%)］, and the χ2 test was used, and the Rank Sum test was used for ranked data. P<0.05 was considered to indicate a statistically significant difference.
Results
There was no statistically significant difference in the number of lymph node dissections between the two groups (P>0.05); The operation time in the axillary group was shorter than that in the total areola group, and the postoperative drainage volume was less than that in the total areola group (P<0.05).Three days after the operation, the levels of blood calcium and parathyroid hormone (PTH) in the patients of the axillary group were higher than those in the total areola group, and the levels of serum tumor necrosis factor-α(TNF-α) and interleukin-6 (IL-6) were lower than those in the total areola group (P<0.05). The scores of the Numerical Rating Scale (NRS) and the Vancouver Scar Scale (VSS) of the patients in the axillary group were lower than those in the control group (P<0.05). The incidence of postoperative complications in the axillary group was lower than that in the total areola group (P<0.05), and there was no statistically significant difference in the recurrence rate between the groups (P>0.05).
Conclusion
Compared with the total areola approach,the gasless axillary approach in endoscopic radical resection of thyroid cancer has a shorter operation time and less postoperative drainage volume, causes mild stimulation to the function of the parathyroid gland, has better postoperative aesthetic appearance, and can reduce the occurrence of complications.
To study the clinical influence of the modified retroperitoneal-priority in situ laparoscopic pancreatoduodenectomy (LPD) on regional lymph node dissection and postoperative complications.
Methods
A total of 66 patients with periampullary carcinoma admitted from January 2021 to December 2023 were prospectively selected as the research subjects, and all patients underwent LPD. They were divided into a modified group and a reference group by the random number table method, with 33 cases in each group. The modified group adopted the modified retroperitoneal-priority in situ LPD (MPPLPD), and the reference group adopted the conventional venous approach LPD. The statistical software SPSS24.0 was used for data analysis.Measurement data such as the operation time and the total number of dissected lymph nodes were expressed as(), and an independent sample t test was performed; Rank sum test was adopted for rank data such as ASA classification; Count data were expressed as percentages, and a chi-square test was performed. The survival curve was drawn by the Kaplan-Meier method, and the survival status of the patients was examined by the Log-Rank test.
Results
All patients underwent R0 resection, and there was no case converted to open surgery.There were no statistically significant differences in the number of positive lymph nodes dissected, the time to start eating, the time to exhaust, and the length of hospital stay between the two groups (P>0.05). Compared with the reference group, the operation time in the modified group was shorter, the intraoperative blood loss was less, and the total number of dissected lymph nodes was larger (P<0.05). In the modified group, there were 3 cases of Clavien-Dindo grade I, 3 cases of grade II, and 2 cases above grade III, which were lower than 7 cases of grade I, 10 cases of grade II, and 5 cases above grade III in the reference group (P<0.05), and the incidence of postoperative bleeding in the modified group was significantly lower than that in the reference group (6.1%vs. 24.2%, P<0.05). From 3 to 45 months after surgery, there was no statistically significant difference in the overall survival rate between the two groups (P>0.05), and the disease-free survival rate of the modified group was higher than that of the reference group (84.8% vs. 63.6%, Log-Rank χ²=9.643, P<0.05).
Conclusion
Compared with the standard venous-first approach LPD, the modified retroperitoneal-priority in situ LPD can increase the total number of dissected lymph nodes, reduce the risk of postoperative complications and bleeding,enhance the surgical safety, and reduce the possibility of disease recurrence.
To compare the short- and medium-term curative effects of hepatectomy with different inflow blood flow occlusion of the liver under laparoscopy in the treatment of primary liver cancer (PLC).
Methods
The clinical data of 115 patients who underwent laparoscopic hepatectomy for PLC from March 2021 to September 2023 were collected. According to different methods of intraoperative inflow blood flow occlusion of the liver, the patients were divided into group A (intermittent blood flow occlusion, n=57 cases) and group B(regional blood flow occlusion, n=58 cases). The statistical software SPSS 25.0 was used for data processing.The perioperative indexes, liver function indexes, tumor markers, etc. were expressed as (), and a t test was used. The levels of liver function and tumor markers were examined by general linear repeated measures analysis of variance. The incidence of postoperative complications was compared by the chi-square test.
Results
The intraoperative blood loss in group B was less than that in group A (P<0.05). The time of the first exhaust, eating, and defecation after surgery in group B was shorter than that in group A (P<0.05). Seven days after surgery, the levels of aspartate aminotransferase (AST) and alanine aminotransferase (ALT) in both groups were higher than those before surgery, but the levels in group B were lower than those in group A. The levels of cholinesterase (ChE) in both groups decreased, but the levels in group B were higher than those in group A (P<0.05).One month after surgery, the levels of AST and ALT in both groups were lower than those before surgery and 7 days after surgery, and the level of ChE was higher than that before surgery and 7 days after surgery (P<0.05).One month after surgery, there was no statistically significant difference in the levels of AST, ChE, and ALT between group A and group B (P>0.05). One month and 12 months after surgery, the levels of alpha-fetoprotein(AFP) and carcinoembryonic antigen (CEA) in both groups were lower than those before surgery (P<0.05), but there was no statistically significant difference in the levels of AFP and CEA between group A and group B one month and 12 months after surgery (P>0.05). There was no statistically significant difference in the incidence of postoperative complications between the two groups (P>0.05).
Conclusion
Compared with the intermittent inflow blood flow occlusion method of the liver, the application of the regional inflow blood flow occlusion method of the liver in laparoscopic hepatectomy can reduce the intraoperative blood loss and has less impact on the gastrointestinal function and liver function of patients. However, the safety of the two methods and their impacts on the oncological effects are similar.
To compare the efficacy and safety of two different surgical protocols in the treatment of children with Meckel diverticulum complicated by intestinal duplication malformation.
Methods
The clinical data of 102 children with Meckel diverticulum complicated by intestinal duplication malformation from January 2019 to October 2024 were retrospectively analyzed. According to different surgical methods, the children were divided into group A (n=44 cases, receiving conventional open surgery) and group B (n=58 cases,receiving laparoscopic surgery). The data were analyzed using SPSS 25.0 software. The intraoperative related indexes, postoperative recovery status and inflammatory indexes of the children were all expressed as (), and independent sample t tests were used; χ2 tests were used for categorical variables such as clinical efficacy and postoperative complications. P<0.05 indicated a statistically significant difference.
Results
The operation time of children in group B was longer than that in group A (P<0.05), the intraoperative blood loss in group B was significantly less than that in group A (P<0.05), and the incision length in group B was significantly smaller than that in group A (P<0.05); The postoperative recovery status of children in group B was better than that in group A, and the time of first exhaust and the time of first feeding were both earlier than those in group A (P<0.05);The abdominal pain degree (VAS) score of children in group B was significantly lower than that in group A(P<0.05); Three days after the operation, the intestinal function recovery rate of children in group B was faster,and the concentrations of lactate dehydrogenase (LDH) and serum D-lactic acid were significantly lower than those in group A (P<0.05); Three days after the operation, the inflammatory response of children in group B was better than that in group A, that is, the levels of C-reactive protein (CRP) and white blood cell count (WBC)in children of group B were lower than those in group A (P<0.05); The clinical efficacy of children in group B was significantly improved compared with that in group A (93.1% vs. 79.5%, P<0.05); The incidences of complications such as intra-abdominal infection, intestinal fistula, intestinal obstruction and incision bleeding in children of group B after the operation were significantly lower than those in group A (13.7% vs. 40.9%,P<0.05).
Conclusion
Laparoscopic surgery shows significant minimally invasive advantages in the treatment of Meckel diverticulum complicated by intestinal duplication malformation, with rapid postoperative recovery and fewer complications.
To explore the clinical effects of laparoscopic partial hepatectomy (LPH)and laparoscopic common bile duct exploration and stone removal (LCBDE) in the treatment of intrahepatic cholangiolithiasis.
Methods
A total of 88 patients with intrahepatic cholangiolithiasis from April 2014 to March 2020 were retrospectively selected. According to the different surgical methods, they were divided into the LPH group (n=46 cases, undergoing LPH) and the LCBDE group (n=42 cases, undergoing LCBDE).The SPSS27.0 statistical software was used to process the data. Measurement data conforming to the normal distribution were expressed as (). Independent sample t tests were used for comparisons between groups,and paired sample t tests were used for comparisons within groups. Enumeration data were expressed as［ cases(%)］, and χ2 tests were performed. P<0.05 was considered to indicate a statistically significant difference.
Results
Compared with the LCBDE group, the patients in the LPH group had a longer operation time and more intraoperative blood loss (P<0.05). The levels of alanine aminotransferase (ALT), aspartate aminotransferase(AST), gamma-glutamyl transpeptidase (γ-GGT), and total bilirubin (TBIL) of the patients in both groups were higher than those before the operation at 1 day and 3 days after the operation (P<0.05), and the above indicators in the LPH group were higher (P<0.05). There was no significant difference in the incidence of postoperative complications between the LPH group and the LCBDE group (P>0.05). Compared with the LCBDE group,the patients in the LPH group had a lower residual stone rate after the operation (P<0.05). After a 36-month follow-up after the operation, there was no significant difference in the recurrence rate between the two groups(P>0.05).
Conclusion
Different minimally invasive surgical methods can achieve good effects in the treatment of intrahepatic cholangiolithiasis. LCBDE has more advantages in terms of minimal invasiveness, but it is inferior to LPH in reducing the intraoperative residual stone rate. Therefore, in clinical practice, individualized treatment plans should be selected according to the actual situation of patients.
To explore the clinical efficacy of different laparoscopic cholecystectomies (LC)in the treatment of gallstone disease.
Methods
A total of 486 patients with gallstone disease who underwent LC from February 2023 to July 2023 were retrospectively selected. According to different surgical methods,they were divided into the three-port group (n=255, receiving three-port LC) and the two-port group (n=231,receiving two-port LC). The SPSS 25.0 statistical software was used to analyze the data. Enumeration data were expressed as［ cases (%)］, and χ2 tests were performed; Measurement data were expressed as (), and independent sample t tests were used for comparison between groups. P<0.05 was considered to indicate a statistically significant difference.
Results
Compared with the three-port group, the patients in the two-port group had less intraoperative blood loss, a longer operation time, and shorter postoperative exhaust time and hospital stay. The Visual Analogue Scale (VAS) scores of the patients in both groups at 24 hours and 48 hours after the operation were lower than those at 6 hours after the operation (P<0.05). Moreover, compared with the three-port group, the VAS scores of the two-port group at 6 hours, 24 hours, and 48 hours after the operation were lower (P<0.05). There were no significant differences in the incidence of intraoperative conversion to open surgery and the incidence of postoperative complications between the three-port group and the two-port group (P>0.05). After a 6-month follow-up, there were no significant differences in the levels of total bilirubin(TBIL) and alanine aminotransferase (ALT) between the two groups compared with those immediately after the operation, and there were no significant differences between the groups (P>0.05). The prognosis of the patients in both groups was good.
Conclusion
Both the two-port and three-port LC can meet the requirements for the radical surgery of gallstone disease. However, the two-port LC has the advantages of less blood loss and faster postoperative recovery, and causes less pain due to its smaller invasiveness. The two methods have similar incidences of complications and both have a good prognosis.
To study the clinical application effect of the Marcille triangular approach in pelvic organ combined resection for locally advanced rectal cancer.
Methods
The clinical data of 18 patients with locally advanced rectal cancer who underwent pelvic organ combined resection from October 2020 to October 2023 were retrospectively selected. The perioperative indexes and postoperative complications of the patients were analyzed; the survival status of the patients was statistically analyzed through follow-up,and the data were analyzed using the statistical software SPSS22.0. Measurement data that conformed to the normal distribution, such as the operation time and intraoperative blood loss, were expressed as (), and the Kaplan-Meier method was applied to analyze the prognostic survival of the patients.
Results
All 18 patients successfully completed the pelvic organ combined resection, and there was no perioperative death. The average operation time was (420.7±52.6) min, the intraoperative blood loss was (780.4±80.2) ml, the first postoperative exhaust time was (3.2±0.5) d, and the hospital stay was (11.6±2.5) d. The involvement of adjacent organs was as follows: 8 cases of the cervix, 4 cases of the endometrium, 7 cases of the prostate, 5 cases of the bladder,and 6 cases of the seminal vesicles. Among them, there were 8 cases of well-differentiated carcinoma and 10 cases of moderately differentiated carcinoma. All patients underwent the treatment of the empty pelvic cavity with a basement membrane biological patch during the intraoperative reconstruction. Reproductive system reconstruction was performed in 5 cases, vascular reconstruction was performed in 1 case using an acellular bovine pericardium patch, ureteral reconstruction was performed in 2 cases, bladder substitution with the ileum was performed in 1 case, and suture repair was performed in 1 case. Postoperatively, there was 1 case of intestinal obstruction, 1 case of abdominal cavity infection, 1 case of lower extremity venous thrombosis, 1 case of urinary tract infection, 1 case of ischemia in the middle of the pelvis, 3 cases of perineal dead space infection,and 2 cases of presacral bleeding. All the above complications were cured after conservative treatment, and the total complication rate was 55.6%. According to the Kaplan-Meier survival analysis, the cumulative median survival time of the included patients at 3 years was 33.5 months, and the cumulative median disease-free survival time was 19.8 months.
Conclusion
The Marcille triangular approach is safe and feasible in pelvic organ combined resection for locally advanced rectal cancer, and it is recommended for clinical promotion and application.
To investigate whether conventional ultrasound can be used in combination with clinical characteristics to diagnose central lymph node metastases in papillary thyroid microcarcinoma(PTMC).
Methods
We conducted a retrospective study on 1113 consecutive PTMC patients admitted to the First Affiliated Hospital of Army Medical University between January 2018 and December 2020. Analyses were conducted to examine the correlation between ultrasonic imaging features combined with clinical characteristics and the presence of central lymph node metastases.
Results
Male gender, younger age, greater maximum diameter, multiple nodules, calcifications, and abnormal structure of the central lymph node hilum were significantly correlated with an increased risk of central lymph node metastasis (P<0.05). According to the regression model, area under the ROC curve was 0.7151 (95% CI: 0.685-0.745), with a sensitivity and specificity of 62.9% and 41.6%, respectively. Further analysis of factors such as multiple nodules,calcifications within nodules, and abnormal structure of the central lymph node hilum revealed that PTMC with 1, 2, and 3 risk factors had a 1.81-fold, 3.07-fold, and 4.76-fold higher risk of central lymph node metastases compared to the patients without risk factors.
Conclusion
Combining conventional ultrasonic imaging features with clinical characteristics provides a simple and efficient method of assessing the risk of central lymph node metastasis in PTMC, which is valuable when determining the surgical extent before surgery. Aims To investigate whether conventional ultrasound can be used in combination with clinical characteristics to diagnose central lymph node metastases in papillary thyroid microcarcinoma (PTMC).
To compare the clinical efficacy of laparoscopic radical surgery with different guided anatomical approaches in the treatment of early rectal cancer.
Methods
A retrospective analysis was conducted on 101 patients with early rectal cancer who underwent surgical treatment and follow-up at the hospital from January 2021 to December 2023. The patients underwent laparoscopic radical rectal cancer surgery. According to the different anatomical approaches chosen for surgery, 53 patients who underwent laparoscopic rectal cancer radical surgery under autonomous nerve guidance were included in the nerve guided group, while the remaining 48 patients who underwent laparoscopic rectal cancer radical surgery under vascular guidance were included in the vascular guided group. SPSS 25.0 statistical software was used to analyze the data. Perioperative related indicators and gastrointestinal hormone indicators were expressed as (), and independent sample t tests were performed. The occurrence of urinary dysfunction was analyzed using χ2 test, and the grading of urinary function was performed using a Rank Sum test. P<0.05 indicated a statistical significant difference.
Results
The intraoperative bleeding volume in the nerve guided group was less than that in the vascular guided group, and the first exhaust time was shorter than that in the vascular guided group,with statistical significant differences (P<0.05). There was no statistical significant difference in surgical time,lymph node dissection count, and hospital stay between the two groups (P>0.05). On the 2nd day after surgery,the serum GAS and MOT levels in both groups decreased compared to before surgery, but the serum GAS and MOT levels in the nerve guided group were higher than those in the vascular guided group, with statistical significant differences (P<0.05). At 7 days after surgery, the urinary function grading of the nerve guided group was better than that of the vascular guided group, and the incidence of postoperative urinary dysfunction (18.7%)was lower than that of the vascular guided group (39.6%), with statistical significant differences (P<0.05).
Conclusion
Both autonomous nerve guided and vascular guided laparoscopic radical surgery have good clinical effects in the treatment of early rectal cancer. However, the former has less intraoperative bleeding,faster postoperative intestinal function recovery, and can reduce postoperative urinary dysfunction.
To understand the clinical efficacy of endoscopic submucosal dissection(ESD) in the treatment of intraluminal protruding colorectal tumors and laterally spreading tumors of the large intestine, and to analyze the risk factors affecting the complete resection rate of ESD.
Methods
Prospectively,50 patients with laterally spreading colorectal tumors with a diameter of ≥ 20 mm (group A) and 50 patients with intraluminal protruding colorectal tumors with a diameter of ≥ 20 mm (group B) who underwent ESD treatment from January 2022 to January 2024 were selected as the research subjects. The SPSS 25.0 software was used for statistical analysis of the data. Measurement data were expressed as () and analyzed by independent sample t test; Enumeration data were expressed as［ cases (%)］and compared by χ2 test or Fisher’s exact probability method; Multivariate Logistic regression analysis was used to analyze the influencing factors of incomplete ESD resection. P<0.05 was considered to indicate a statistically significant difference.
Results
There were no statistically significant differences in the fibrosis classification, ESD operation time, en bloc resection rate, and ESD-related complications between the two groups of patients (P>0.05); The complete resection rate and curative resection rate of patients in group A were higher than those in group B (P<0.05);The results of univariate analysis showed that the complete resection rate of ESD for colorectal tumors was significantly correlated with the morphological characteristics of the tumor lesions and the fibrosis classification of the patients (P<0.05); The results of Logistic regression analysis showed that intraluminal protruding tumors and F2-type fibrosis were independent risk factors for incomplete ESD resection of colorectal tumors (P<0.05).
Conclusion
ESD has a good clinical efficacy in the treatment of intraluminal protruding colorectal tumors.Intraluminal protruding tumors and F2-type fibrosis are risk factors for incomplete resection of colorectal tumors.
To explore the application effect of the evidence-based nursing program of “five fixations and four observations” in patients with stoma after rectal cancer surgery and its influence on complications and quality of life.
Methods
A total of 80 patients with stoma after rectal cancer surgery admitted from January 2021 to June 2024 were selected as the research subjects. They were randomly divided into the observation group and the control group according to the random number table method, with 40 patients in each group. The control group received routine nursing care, and the observation group adopted the evidence-based nursing program of “five fixations and four observations” on the basis of routine nursing care.The SPSS 22.0 statistical software was used to analyze the data. Measurement data were expressed as (),and independent sample t tests were used; Enumeration data were expressed as ［cases (%)］, and χ2 tests were performed. P<0.05 was considered to indicate a statistically significant difference.
Results
The nursing satisfaction of the patients in the observation group was significantly higher than that in the control group (95.0% vs. 77.5%, P<0.05), and the total incidence of complications was significantly reduced (12.5%vs. 35.0%, P<0.05). After the intervention, the scores of self-care ability (ESCA) and quality of life (EORTC QLQ-C30) in the observation group were both higher than those in the control group (both P<0.05).
Conclusion
The evidence-based nursing program of “five fixations and four observations” can effectively improve the nursing satisfaction of patients with stoma after rectal cancer, reduce the incidence of complications, and improve their self-care ability and quality of life, which has clinical promotion value.
To explore the influence of laparoscopic natural orifice transluminal endoscopic surgery (NOSES) on the gastrointestinal function and long-term efficacy of patients with colorectal cancer.
Methods
The clinical data of 102 patients with colorectal cancer from June 2019 to June 2022 were retrospectively analyzed. According to different surgical methods, they were divided into the conventional group (n=62) and the NOSES group (n=40). The conventional group received conventional laparoscopic radical resection of colorectal cancer, and the NOSES group received NOSES treatment. The SPSS 22.0 software was used to analyze the data. Measurement data were expressed as (), and independent sample t tests were performed; Enumeration data were expressed as［ cases (%)］, and χ2 tests were performed; Rank Sum tests were performed for ranked data. The test criterion was α=0.05.
Results
Compared with the conventional group,the patients in the NOSES group had a longer operation time and less intraoperative blood loss (P<0.05),and the postoperative exhaust time and hospital stay were significantly shortened (P<0.05). At 72 hours after the operation, compared with the conventional group, the levels of serum C-reactive protein (CRP), white blood cell count (WBC), and tumor necrosis factor-α (TNF-α) in the NOSES group were lower (P<0.05),and the levels of motilin and gastrin were higher (P<0.05). There were no statistically significant differences in the total incidence of postoperative complications, the distant metastasis rate and local recurrence rate of tumors within 2 years, and the survival rate of patients between the two groups (P>0.05).
Conclusion
NOSES used in the treatment of colorectal cancer can effectively improve the perioperative indexes, reduce the body's inflammatory response of patients, and promote the recovery of their gastrointestinal function. It has no obvious influence on the long-term recurrence of the disease and tumor metastasis.
To explore the therapeutic effect of laparoscopic radical resection via the head-side and central mixed approach for right-sided colon cancer.
Methods
The clinical data of 36 patients with right-sided colon cancer who underwent laparoscopic radical resection via the head-side and central mixed approach from May 2018 to May 2023 were retrospectively collected (mixed group). At the same time, the clinical data of 36 patients who underwent the central approach were collected (control group). The statistical software SPSS 25.0 was used for analysis. Measurement data such as preoperative and intraoperative indexes were described by (), and t test was performed; Enumeration data such as complications were described by［ cases (%)］, and chi-square test was performed. The survival situation was analyzed by the Kaplan-Meier curve.
Results
The intraoperative blood loss in the mixed group was less than that in the control group, and the operation time was shorter than that in the control group (P<0.05). There was no significant difference in the number of lymph node dissections between the two groups (P>0.05). There were no significant differences in postoperative indexes such as the first meal intake and the first exhaust after surgery between the two groups(P>0.05). There was no conversion to open surgery in the mixed group, while there was 1 case in the control group. There was no significant difference in the conversion rate to open surgery between the two groups (P>0.05).One week after surgery, the levels of gastrin (GAS) and motilin (MTL) in both groups of patients decreased,and the differences were statistically significant (P<0.05); however, there was no significant difference between the two groups (P>0.05). One week after surgery, the levels of carcinoembryonic antigen (CEA),carbohydrate antigen 199 (CA199), and CA125 in both groups of patients decreased (P<0.05), but there was no significant difference between the two groups (P>0.05). There was no significant difference in the incidence of complications between the two groups (P>0.05). The follow-up period was 6 to 12 months, and the median follow-up period was 12 months. There was no significant difference in the survival situation between the two groups (Log-Rank χ2=0.765, P=0.382).
Conclusion
Compared with the central approach, the head-side and central mixed approach for patients with right-sided colon cancer can achieve a comparable long-term curative effect, but it can effectively shorten the operation time and reduce the intraoperative blood loss.
To explore the application of laparoscopic Nissen fundoplication and Toupet fundoplication in patients with esophageal hiatal hernia complicated with gastroesophageal reflux disease (GERD).
Methods
The clinical data of patients with esophageal hiatal hernia complicated with GERD admitted from April 2022 to April 2023 were retrospectively analyzed. According to different surgical methods, the patients were divided into the Nissen group (undergoing Nissen fundoplication) and the Toupet group (undergoing Toupet fundoplication). Confounding factors in the baseline data of the patients were excluded by the propensity score matching method (caliper value 0.02), and 53 patients with comparable baseline data (P>0.05) were obtained in each group. The statistical analysis software SSPS21.0 was used to analyze and integrate the data. Enumeration data were expressed as［ cases (%)］, and χ2 test and Rank Sum test were performed; Measurement data were expressed as (), and independent sample t tests were performed. P<0.05 was considered to indicate a statistically significant difference.
Results
There were no significant differences in intraoperative blood loss,operation time, first exhaust time, drainage tube removal time, and length of hospital stay between the two groups of patients (P>0.05); The incidence of complications in the Toupet group was significantly lower than that in the Nissen group (P<0.05); Six months after the operation, the number of reflux episodes, reflux time, and gastroesophageal reflux disease questionnaire (GERD-Q) scores of the patients in both groups were significantly decreased (P<0.05), and the number of reflux episodes and reflux time in the Nissen group were significantly lower than those in the Toupet group (P<0.05), while there was no significant difference in GERD-Q scores between the groups (P>0.05); Six months after the operation, the lower esophageal sphincter pressure (LESP)and integrated relaxation pressure (IRP) of the patients in both groups were significantly increased (P<0.05),and the distal esophageal contractile integral (DCI) was significantly decreased (P<0.05), while there were no significant differences between the groups (P>0.05); After the operation, the nutritional status of the patients in the Toupet group was significantly better than that in the Nissen group (P<0.05).
Conclusion
Both Nissen fundoplication and Toupet fundoplication can effectively treat esophageal hiatal hernia complicated with GERD.Nissen fundoplication is superior in improving reflux, and Toupet fundoplication has fewer postoperative complications. Clinically, the type of surgery can be selected according to the actual situation.
To investigate the application effects of two modified esophagojejunostomy methods，namely the modified reverse puncture and the modified overlap，in laparoscopic total gastrectomy.
Methods
A prospective study was conducted on 82 patients with Siewert type Ⅱ or Ⅲadenocarcinoma of the esophagogastric junction（AEG）from January 2021 to April 2023.All patients underwent laparoscopic total gastrectomy（TLTG）and were randomly divided into two groups（41 cases in each group）using the random number table method.The overlap anastomosis group received the modified esophagojejunal overlap anastomosis，while the reverse puncture anastomosis group underwent the modified reverse puncture esophagojejunostomy.Measurement data（such as anastomosis time and quality-of-life scores）were expressed as（），and an independent-samples t test was performed between groups.The incidence of complications was expressed as a percentage，and a chi-square test was performed between groups.
Results
The operations in both groups were successfully completed without any cases converted to open surgery，and all patients received RO resection.There were no statistically significant differences between the two groups in terms of intraoperative blood loss，total number of lymph node dissections，time to flatus，time to start eating，and length of hospital stay（P﹥0.05）.The anastomosis time，operation time，and the distance between the esophageal resection margin and the upper edge of the tumor were all longer in the reverse puncture anastomosis group than in the overlap anastomosis group（P﹤0.05）.There was no statistically significant difference in the total incidence of complications between the two groups（9.8%vs.14.6%，P﹥0.05）.There were no statistically significant differences in the QLQ-C30 and QLQ-STOR22 scores between the two groups before surgery，6 months after surgery，and 12 months after surgery（P﹥0.05）.
Conclusion
In the treatment of Siewert typeⅡ or Ⅲ AEG with TLTG，the modified overlap anastomosis method is easy to operate and helps to shorten the operation time.In contrast，the modified reverse puncture anastomosis method can provide a higher upper esophageal resection margin，significantly reducing the risk of positive upper resection margins caused by the high position of the esophagus in Siewert type Ⅱ AEG.
To explore the influencing factors of the short-term prognosis of patients with advanced gastric cancer (AGC) of different pathological types after laparoscopic-assisted radical resection(LAG).
Methods
A total of 100 patients with AGC from February 2018 to February 2022 were selected as the research subjects. According to different pathological types, they were divided into gastric adenocarcinoma(n=45 cases), gastric mucinous adenocarcinoma (n=30 cases), and gastric signet ring cell carcinoma (n=25 cases). A multivariate Cox regression model was used to analyze the influencing factors of their prognosis, and a Nomogram prediction model was constructed. The calibration curve and the receiver operating characteristic curve (ROC) were used to evaluate its diagnostic efficacy, and the Kaplan-Meier survival curve was used to calculate the survival rate.
Results
There were significant differences in tumor diameter, tumor location,invasion depth, lymphatic vessel cancer embolus, regional lymph node metastasis, and pTNM stage among AGC patients of different pathological types (P<0.05). The 1-year survival rate of patients with gastric adenocarcinoma showed significant differences in tumor diameter, regional lymph node metastasis, pTNM stage, tumor location, and invasion depth. For patients with gastric mucinous adenocarcinoma, there were significant differences in pTNM stage and regional lymph node metastasis. For patients with gastric signet ring cell carcinoma, there were significant differences in pTNM stage, regional lymph node metastasis, and invasion depth (all P<0.05). Multivariate Cox regression model analysis showed that the independent risk factors for the prognosis of patients with gastric adenocarcinoma after LAG were pTNM stage, tumor site, invasion depth,tumor diameter, and regional lymph node metastasis. For gastric signet ring cell carcinoma, they were regional lymph node metastasis and tumor invasion depth, and for gastric mucinous adenocarcinoma, it was regional lymph node metastasis (all P<0.05). A nomogram prediction model was constructed, with an AUC of the model of 0.881 (95% CI: 0.863-0.884), a sensitivity of 0.827, a specificity of 0.795, and a good discriminability.The calibration curve indicated that the model had a high accuracy.
Conclusion
There are differences in the clinicopathological characteristics and prognosis among AGC patients of different pathological types. Clinically,targeted treatment should be carried out according to specific conditions to improve the quality of life of patients.
To explore the clinical efficacy of laparoscopic radical gastrectomy with a single incision in the treatment of early and middle-stage gastric cancer.
Methods
The data of 150 patients with early and middle-stage gastric cancer from June 2021 to June 2024 were retrospectively analyzed. 86 patients who underwent laparoscopic radical gastrectomy with a single incision were included in the single-port group, and 64 patients who underwent traditional laparoscopic radical gastrectomy with five ports were included in the multi-port group. The SPSS 25.0 statistical software was used to analyze the data. Measurement data such as gastrointestinal hormone indexes, Visual Analogue Scale (VAS) scores, and Self-Rating Anxiety Scale(SAS) scores were expressed as (), and independent sample t test was performed; χ2 tests were performed on count data such as the occurrence of postoperative complications. P<0.05 indicated a statistically significant difference.
Results
The operation time of patients in the single-port group was longer than that in the multiport group, the intraoperative blood loss was less than that in the multi-port group, and the first exhaust time was shorter than that in the multi-port group (P<0.05). However, there was no statistically significant difference in the number of lymph node dissections and the length of hospital stay between the two groups (P>0.05). Two days after the operation, the levels of serum motilin (MOT) and gastrin (GAS) in both groups were lower than those before the operation, but those in the single-port group were higher than those in the multi-port group(P<0.05). There was no difference in the total incidence of postoperative complications between the two groups(P>0.05). There was no difference in the VAS scores between the two groups 7 days after the operation (P>0.05);the SAS score of the single-port group 7 days after the operation was lower than that of the multi-port group(P<0.05).
Conclusion
Compared with the traditional multi-port laparoscopic radical gastrectomy, although the operation time of laparoscopic radical gastrectomy with a single incision is longer, the intraoperative blood loss is less, the postoperative gastrointestinal function of patients recovers faster, and it does not affect the lymph node dissection. It can reduce the degree of postoperative anxiety of patients.
To retrospectively analyze clinical and pathological factors related to the prognosis of gastrointestinal stromal tumor (GIST) patients, construct a dynamic risk assessment model for different treatment modalities, and provide evidence-based support for optimizing postoperative adjuvant treatment decisions.
Methods
A total of 250 GIST patients diagnosed between May 2009 and June 2019 were included. Univariate Kaplan-Meier survival analysis (Log-Rank test) was used to screen factors related to recurrence-free survival (RFS), and a prognostic prediction model and risk stratification were constructed based on the random survival forest (RSF) algorithm.
Results
In the group not receiving postoperative adjuvant therapy, male sex, intestinal origin, tumor size > 5cm, mitotic count > 5/50HPF, elevated Ki-67 proliferation index, epithelioid cell type, and KIT exon 11 codon 557/558/559 deletion mutation were significantly associated with recurrence. In the imatinib adjuvant therapy group, only intestinal origin, mitotic count > 5/50HPF,elevated Ki-67 proliferation index, and cell morphology were related to recurrence risk. Epithelioid cell type had a better survival outcome in the imatinib group, suggesting potential sensitivity to tyrosine kinase inhibitor therapy.
Conclusion
The constructed RSF dynamic prediction model has good performance, compensating for the NIH classification deficiency in the imatinib group. The dual characteristics of epithelioid cell type offer new evidence for histological subtype-guided precise treatment.
To evaluate the efficacy of preserving the ascending branch of the left colic artery (LCA) during laparoscopic total mesorectal excision for rectal cancer and its effects on surgical stress response and anal function.
Methods
The cases of 100 patients who underwent laparoscopic total mesorectal excision for rectal cancer from August 2021 to August 2023 were included. According to the preservation status of the left colic artery (LCA), they were divided into group A (without preserving LCA, n=50 cases) and group B (preserving LCA, n=50 cases). The general surgical conditions, gastrointestinal hormones, stress response,anal function, and complications were evaluated between the groups. In the statistical analysis, the homogeneity of variance test was first carried out for age, gender, etc. between different groups, the chi-square test was performed for complications, and the t test was conducted for general surgical conditions, gastrointestinal hormones, stress response, and anal function. P<0.05 was considered as a statistically significant difference.
Results
The number of dissected lymph nodes in group B was larger, the operation time was longer, and the recovery time of intestinal function and the time to anal exhaust were shorter (P<0.05). After surgery, the levels of gastrointestinal hormones ［gastrin (GAS), motilin (MTL)］and anal function ［maximum tolerable volume (MTV),length of the high-pressure zone (HPZ), maximum systolic pressure of the anal canal (MSP)］in group B were higher, while the stress response ［aldosterone (ALD), angiotensin II (Ang II), norepinephrine (NE)］was lower(P<0.05). The incidence of complications in group B (4.0%) was lower than that in group A (16.0%) (P<0.05).
Conclusion
Preserving the LCA during laparoscopic total mesorectal excision for rectal cancer may prolong the operation time, but it does not affect the lymph node dissection. Moreover, it can promote the recovery of gastrointestinal function, reduce complications, alleviate the stress response, and reduce the impact on anal function, which has clinical reference significance.
To analyze the laboratory detection strategies and clinical value for the early screening of colorectal cancer (CRC).
Methods
The laboratory detection data of 300 patients with colorectal cancer (colorectal cancer group) admitted to Mentougou Traditional Chinese Medicine Hospital and Mentougou District Hospital from January 2021 to December 2024 and 100 healthy controls (control group) were retrospectively analyzed. The data were processed using SPSS 23.0. Measurement data such as carcinoembryonic antigen (CEA), carbohydrate antigen 19-9 (CA19-9), platelet-to-lymphocyte ratio (PLR),and neutrophil-to-lymphocyte ratio (NLR) were expressed as (), and the independent sample t test was used for comparison between groups; Enumeration data were expressed as percentages, and the chi-square test was used. A P value < 0.05 was considered statistically significant.
Results
The positive rate of fecal occult blood test (FOBT) in the colorectal cancer group was 85.3%, and that in the control group was 11.0%, with a statistically significant difference (P<0.05). The levels of CEA and CA19-9, as well as the values of PLR and NLR, were significantly higher than those in the control group (P<0.001); The combined detection of fecal occult blood test (FOBT), tumor markers (CEA, CA19-9), and systemic inflammatory response indicators (PLR,NLR) had a sensitivity of 92.2% and a specificity of 88.5% (AUC=0.933), which was significantly better than single-item detection (P<0.05).
Conclusion
The combined laboratory detection (FOBT + tumor markers +inflammatory indicators) can significantly improve the screening efficiency of colorectal cancer.
To study the clinicopathological characteristics and prognosis of young patients with colorectal cancer.
Methods
A total of 1,551 patients with colorectal cancer who underwent radical surgery in the Department of Digestive Surgery, the First Affiliated Hospital of Air Force Medical University from December 2010 to December 2020 were included. According to the age, the patients were divided into the young group (≤ 40 years old) and the middle-aged group (55-64 years old). The data were analyzed using SPSS 27.0 software. Enumeration data were expressed as［ cases (%)］, and the χ2 test was used; measurement data were expressed as (), and the independent samples t test was performed. Univariate and multivariate analyses of risk factors affecting the prognosis of patients were carried out using the COX regression; the Kaplan-Meier method was used for the comparison of survival curves. P<0.05 was indicated a statistically significant difference.
Results
There were 268 patients (17.3%) in the young group and 1,283 patients (82.7%) in the middle-aged group. There were significant differences in the distribution of tumor location, tumor size, degree of differentiation, T stage, and N stage between the two groups (P<0.05). The number of lymph node dissections in the young group was significantly higher than that in the middle-aged group (P<0.05). The results of the multivariate analysis showed that the primary tumor site, T stage, N stage, intraoperative blood loss, and the number of lymph node dissections were independent prognostic risk factors for patients (P<0.05), and age was not a prognostic risk factor (P>0.05).
Conclusion
There are significant differences in the distribution of clinicopathological characteristics between young patients with colorectal cancer and middle-aged patients with colorectal cancer, but their prognosis is comparable to that of middle-aged patients with colorectal cancer.
To analyze the clinical application effect of the modified extrahepatic Glissonian pedicle transection in laparoscopic anatomical left hepatectomy (LALH).
Methods
The data of 60 patients with primary liver cancer from January 2019 to June 2023 were retrospectively analyzed. According to different methods of intraoperative blood flow occlusion, they were divided into two groups, with 30 patients in each group. The observation group adopted the modified extrahepatic Glissonian pedicle transection to occlude the blood flow, while the control group adopted the conventional intrahepatic Glissonian pedicle transection to occlude the blood flow. The software SPSS 20.0 was used for statistical analysis of the data. Measurement data that conformed to the normal distribution, such as perioperative indexes and liver function indexes, were expressed as (), and independent sample t test was used; the intraoperative blood loss and other data that did not conform to the normal distribution were expressed as median (interquartile range), and nonparametric test was used; the chi-square test was used for the comparison of counting data such as complications; and the Kaplan-Meier survival analysis was used to evaluate the prognosis of the patients in the two groups. P<0.05 indicated that the difference was statistically significant.
Results
The operation time, the anatomical time of the left hepatic pedicle, the intraoperative blood loss and the time of postoperative drainage tube removal in the observation group were all less than those in the control group (P<0.05); the levels of postoperative serum total bilirubin (TBIL), aspartate aminotransferase (AST) and alanine aminotransferase (ALT) in the observation group were lower than those in the control group (P<0.05); there was no statistically significant difference in the total incidence of complications between the two groups (P>0.05); there was no statistically significant difference in the postoperative cumulative disease-free survival (76.7% vs. 73.3%) and cumulative overall survival(86.7% vs. 80.0%) between the two groups (Log-Rank χ²=0.061/0.172, P=0.873/0.678).
Conclusion
The application of the modified extrahepatic Glissonian pedicle transection during LALH can safely and efficiently open the bloodless extrahepatic pathway, accurately and rapidly control the inflow blood flow of the left half of the liver, and simplify the surgical operation. It has the same surgical safety and clinical prognosis as the traditional intrahepatic Glissonian pedicle transection for blood flow occlusion.
To study the clinical application of egg yolk oil combined with the external washing prescription for wound healing in the Department of Anorectal Surgery in promoting wound healing after hemorrhoid surgery and improving the postoperative quality of life.
Methods
A total of 75 patients who underwent external stripping and internal ligation for mixed hemorrhoids from August 2023 to August 2024 were selected for this study. According to different treatment methods, they were divided into a control group with 35 cases and an observation group with 40 cases. On the basis of routine dressing changes, the control group was treated with potassium permanganate hip bath, and the observation group was treated with egg yolk oil combined with the external washing prescription for wound healing in the Department of Anorectal Surgery.The statistical software SPSS 26.0 was used for data analysis, and the clinical efficacy, clinical related indexes,negative emotions, and quality of life of the two groups were compared.
Results
The total effective rate of the observation group was 90.0%, which was higher than 68.6% of the control group, and the difference was statistically significant (P<0.05). The days of wound healing, the days of purulent and necrotic tissue shedding,and the days of a sense of anal swelling and prolapse in the observation group were shorter than those in the control group, and the scores of wound exudation and pain VAS in the observation group were lower than those in the control group, with statistically significant differences (P<0.05). After treatment, the scores of negative emotions (SAS self-rating anxiety scale) of the patients in both groups were lower than those before treatment,and the scores of the observation group were lower than those of the control group, with statistically significant differences (P<0.05). After treatment, the scores of physical function, vitality, and general health in the SF-36 scale of the patients in both groups were higher than those before treatment, and the scores of the observation group were higher than those of the control group, with statistically significant differences (P<0.05).
Conclusion
Egg yolk oil combined with the external washing prescription for wound healing in the Department of Anorectal Surgery can significantly promote the wound healing after hemorrhoid surgery, improve the wound exudation and pain of patients, relieve their negative emotions, and improve the quality of life.
With the changes in lifestyle habits and dietary structures in modern society, obesity has become a global disease, and its incidence rate is gradually increasing. Moreover, as a risk factor for the onset of many chronic diseases, obesity is closely related to the occurrence of type 2 diabetes mellitus (T2DM).Obesity often leads to a higher incidence of diabetes. Therefore, how to lose weight for the obese population has become a focal topic. Due to the corresponding limitations of conservative treatment, bariatric surgery has become an effective method for treating obesity and also has a definite therapeutic effect on T2DM. However,the applicability of each surgical procedure still has no clear conclusion. This article reviews a large number of clinical studies and explores the therapeutic effects of sleeve gastrectomy (SG), Roux-en-Y gastric bypass(RYGB), and one anastomosis gastric bypass (OAGB) on obesity complicated with T2DM. Through the review, it is found that all three surgical procedures can effectively reduce weight and significantly improve blood glucose levels after surgery. However, sleeve gastrectomy is inferior to gastric bypass surgery in terms of the therapeutic effect on improving diabetes. Therefore, when dealing with patients with obesity complicated with T2DM,gastric bypass surgery may be a better choice. Among gastric bypass surgeries, OAGB is more recommended by the author because it has only one anastomosis. Laparoscopic sleeve gastrectomy (LSG) has become the most widely performed bariatric surgical procedure globally due to its simple operation, without changing the original physiological anatomy of the gastrointestinal tract, and its definite therapeutic effect. It may be more suitable for patients with mild to moderate obesity and type 2 diabetes mellitus with a shorter disease course.
Serum tumor markers have shown certain value in the early diagnosis, efficacy evaluation,and prognosis assessment of colorectal cancer (CRC). However, their effectiveness in predicting the long-term postoperative recurrence of patients still needs to be explored in depth. Postoperative recurrence of CRC is a complex multi-factorial process, and its mechanisms mainly involve the occult metastasis and proliferation of cancer cells, changes in the tumor microenvironment, and immune escape. Risk factors include the patient's age, family history, degree of pathological differentiation, surgical approach, effectiveness of adjuvant therapy,and lifestyle habits, etc. Although commonly used serum tumor markers such as carcinoembryonic antigen (CEA)and carbohydrate antigen 19-9 (CA19-9) have a significant correlation with the pathological characteristics of CRC and play a certain role in predicting postoperative recurrence, they face challenges such as surgical stress response and limitations in sensitivity and specificity. Future development directions include the in-depth integration of multimodal data such as serum markers, imaging, and genomics, the use of artificial intelligence and machine learning technologies to construct and optimize prediction models, as well as strengthening interdisciplinary cooperation to provide patients with more comprehensive and effective prognosis assessment,diagnosis, and treatment strategies.
), an independent sample t test was used between groups, and a paired sample t test was used within groups; Enumeration data were expressed as［ cases (%)］, and the χ2 test was used, and the Rank Sum test was used for ranked data. P<0.05 was considered to indicate a statistically significant difference.