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Reviews of Exposure Technology of Gastroesophageal Region in Laparoscopic Surgery

ObjectiveTo explore various exposure technology of gastroesophageal region and their advantages and disadvantages by laparoscopic surgery in upper abdominal. MethodThe related literatures on various exposure technology of gastroesophageal region by laparoscopic surgery in upper abdominal at home and abroad in recent years were collected and reviewed. ResultsNow, there were main three exposure technologies of gastroesophageal region by laparoscopic surgery in upper abdominal, including traditional retractor liver retraction, suspension liver retraction, and adhesion liver retraction. Each method had its own advantages and disadvantages. Conclusionthe most suitable exposure method of gastroesophageal region by laparoscopic surgery in upper abdominal should be selected according to situations of surgery and patient.

Causes and Preventions of Pain after Laparoscopic Cholecystectomy

ObjectiveTo explore the causes and preventive measures of pain after laparoscopic cholecystectomy (LC). MethodsDomestic and international literatures were collected to summary the causes and preventions of pain after LC. ResultsPain after LC had several origins:the irritative effect of carbon dioxide (CO2) gas, residual pockets of CO2 in the abdominal cavity, peritoneal and diaphragmatic stretching and injury, and complications related to the operation. The main measures included:nitrous oxide (N2O) gas insufflation or abdominal wall lift, low-pressure of pneumoperitoneum, shortened the time of pneumoperitoneum, active gas aspiration, intra-abdominal instillation of isotonic saline, the use of local anesthesia as well as Traditional Chinese medicine. ConclusionsThe causes of pain after LC are multifactorial. It is the key to reduce postoperative pain that we should pay more attention to every perioperative aspect.

Retrospective Comparative Study of Transumbilical Single-Incison Laparoscopic Assisted and Laparotomy Ventriculoperitoneal Shunting: A Single Center Experience

ObjectiveTo analyze safety and feasibility of transumbilical single-incision laparoscopic assisted ventriculoperitoneal shunting. MethodsThe clinical data of 36 patients who diagnosed as hydrocephalus underwent ventriculoperitoneal shunting from May 2013 to August 2015 in this hospital were collected. Twelve patients were performed transumbilical single-incision laparoscopic assisted ventriculoperitoneal shunting (laparoscopy group) and 24 patients were performed laparotomy ventriculoperitoneal shunting (laparotomy group). The abdominal operation time, postoperative exhaust time, postoperative hospital stay, postoperative pain score, and postoperative complications rate were compared between the laparoscopy group and the laparotomy group. ResultsAll the operations were completed successfully. Compared with the laparotomy group, the abdominal operation time (P < 0.05), postoperative exhaust time (P < 0.05), and postoperative hospital stay (P < 0.05) were significantly shorter, the postoperative pain score was significantly less (P < 0.05) in the laparoscopy group. The postoperative complications rate had no significant difference between the laparoscopy group and the laparotomy group (P > 0.05). ConclusionsThe preliminary results of limited cases in this study show that transumbilical single-incision laparoscopic assisted ventriculoperitoneal shunting is safe and feasible, with better cosmetic. more comparative studies or randomized controlled trials are required to make a confirmed conclusion.

Correlation between cholecystectomy or gallbladder disease and bile reflux gastritis

ObjectiveTo study the relationship among cholecystectomy/gallbladder disease and bile reflux gastritis.MethodsA retrospective collection of 123 patients with bile reflux gastritis who were diagnosed as outpatients and hospitalized from January 2014 to February 2019 in Shengjing Hospital Affiliated to China Medical University, and 221 patients with non-biliary reflux gastritis at the same period were collected. According to the gallbladder status, the patients were divided into three groups: gallbladder disease, cholecystectomy, and gallbladder disease-free group. The relationship between gallbladder status and bile reflux gastritis was analyzed.ResultsAmong 123 patients with bile reflux gastritis, there were 22 cases (17.89%) with cholecystectomy and 26 cases (21.14%) with gallbladder disease; 221 cases of non-biliary reflux gastritis with cholecystectomy in 7 cases (3.17%) and gallbladder disease in 30 cases (13.57%). Univariate analysis showed that the gallbladder status was different between the bile reflux gastritis group and the non-biliary reflux gastritis group (χ2=21.089, P<0.001). The study showed that the gallbladder status was related to the occurrence of bile reflux gastritis. In contrast, patients with cholecystectomy and gallbladder disease had a higher risk of occurrence than those with no gallbladder disease (OR>1, P<0.012 5). Independent risk factors were considered by logistic multivariate regression analysis, including cholecystectomy, gallbladder disease, and age (P<0.05).ConclusionsThere is a correlation between cholecystectomy/gallbladder disease and bile reflux gastritis. Cholecystectomy and gallbladder disease may be the independent risk factors for bile reflux gastritis.

胰腺 Castleman 病 1 例報道并文獻復習

目的 總結 1 例胰腺 Castleman 病患者的臨床資料，并復習以往文獻，總結該病的流行病學特點及診治體會。 方法 回顧性分析 2016 年 1 月筆者所在醫院收治的 1 例胰腺 Castleman 病患者的臨床資料，進行文獻復習及總結。 結果 該例患者無特殊臨床表現，術前行 CT 檢查發現胰腺占位，行手術切除，術后病理學診斷為胰腺 Castleman 病。術后 1 個月復查CT未見腫瘤復發及轉移，已獲訪 6 個月，患者恢復良好。經查閱文獻，共檢索出胰腺 Castleman 病 32 例，男 11 例，女 21 例；年齡 23～74 歲，平均年齡為 46 歲；臨床表現僅為腹部疼痛 7 例，腹痛伴發熱 1 例，腹痛伴面部、雙下肢水腫 1 例，腹痛伴乏力 1 例，腹脹 1 例，背部疼痛 1 例，頸部淋巴結腫大 1 例，吞咽困難 1 例，發熱、乏力、體質量下降 1 例，無明顯臨床表現 17 例；腫瘤位于胰腺頭部 9 例，胰腺頸部 3 例，胰腺體、尾部 16 例，胰周 4 例；腫瘤直徑最小 1.5 cm，最大 7.2 cm；病理學分型為透明血管型（hyaline vascular，HV）19 例，漿細胞型（plasma cell，PC）4 例，混合型（mixed/HV-PC，MV）4 例，未給出明確病理分型 5 例。 結論 胰腺 Castleman 病是少見的淋巴組織增生性疾病，通常無特異臨床表現，影像學檢查也無特異性，目前僅能通過病理組織學檢查確診。胰腺 Castleman 病的治療以手術為主，療效較好。

先天性膽囊缺如 1 例報道

單孔腹腔鏡膽囊逆行切除術的學習曲線分析

目的 總結采用常規腹腔鏡器械進行逆行切除法在單孔腹腔鏡膽囊切除術中應用的學習曲線。 方法 回顧性分析中國醫科大學附屬盛京醫院單一主刀醫生于 2012 年 7 月至 2015 年 12 月期間施行的連續單孔腹腔鏡手術的 120 例患者的臨床資料，單孔腹腔鏡膽囊切除術中采用常規腹腔鏡器械進行膽囊逆行切除。 結果 所有患者的手術都順利進行。手術施行期間，手術時間隨手術例數增加而明顯減少，10 例以后手術時間基本穩定。前期組和后期組患者的手術花費、帕瑞昔布鈉劑量和美容評分比較差異均無統計學意義（P>0.05），但與前期組比較，后期組的手術時間較短，術中出血量較少，術后住院時間較短，中轉多孔率和并發癥發生率較低，視覺模擬評分（visual analogue scale，VAS）較低，差異均有統計學意義（P<0.05）。 結論 單孔腹腔鏡膽囊切除術中采用常規腹腔鏡器械進行膽囊逆行切除的學習曲線短，易于術者掌握。

Laparoscopic Operation of Gastric and Gastroesophageal Junction Disease (Report of 59 Cases)

Objective To investigate the feasibility and safety of laparoscopic operation of gastric and gastroesophageal junction diseases. Methods Between May 2004 and June 2009, 59 patients with gastric and gastroesophageal diseases were treated laparoscopically. The operative methods and maneuvers were evaluated and perioperative interventions, complications and efficacy of patients were analyzed. Results All operations were successfully completed laparoscopically except for one patient with gastric cancer who required a conversion to open surgery. No short-term complications occurred in all cases. No port transplant metastasis occurred for the patients with gastric cancer after an average of 36 months (1-60 months) follow-up. One patient died of liver metastasis 12 months after operation. The 3-year survival rate was 93.3% (14/15). Conclusion Laparoscopic surgery of the gastric and gastroesophageal junction diseases is feasible and safe with minimal invasiveness, which is worth popularizing.

Single Centre Retrospective Control Study on Laparoscopic Versus Open Radical Rectectomy and Colectomy for Colorectal Cancer

Objective To study the feasibility and curative effect of laparoscopic vs. open radical rectectomy and colectomy for colorectal cancer. Methods Sixty-two cases who underwent laparoscopic operation (17， 2， 10， 23， 9 and 1 case underwent radical right colectomy， radical transverse colectomy， radical left colectomy， Dixon， Miles and Hartmann operation respectively) and 78 cases who underwent open operation (17， 4， 11， 27， 18 and 1 case underwent radical right colectomy， radical transverse colectomy， radical left colectomy， Dixon， Miles and Hartmann operation respectively) in our department from Aug. 2001 to Jun. 2008 were included. The clinical data of patients in two groups were compared. Results There were no severe complications and death occurred in both groups and 4 cases in laparoscopic group were converted to open operation during the procedure. The mean operation time of laparoscopic group and open group were (230.6±23.5) min and (145.5±17.6) min respectively, there was a statistical difference between them (P＜0.01). The intra-operative blood loss of laparoscopic group was obviously less than that in open group 〔(135.5±22.5) ml vs. (300.6±34.5) ml， P＜0.01〕. There was no statistical difference of the number of cleared lymph nodes between two groups 〔(11.8±1.5) pieces vs. (13.3±1.7) pieces， Pgt;0.05〕. The length of distal incision margin of rectal anterior resection in laparoscopic group was obviously longer than that in open group 〔(3.1±0.4) cm vs. (2.6±0.3) cm， P＜0.01〕. The gastrointestinal and urinary function of laparoscopic group recovered more quickly than those in open group 〔(2.3±0.7) d vs. (3.6±0.9) d for intake of liquid diet， P＜0.05； (3.5±1.1) d vs. (4.7±1.2) d for intake of solid diet， P＜0.05； (2.3±0.4) d vs. (4.4±1.2) d for duration of urethral catheterization， P＜0.01， respectively〕. The length of hospital stay in laparoscopic group was shorter than that in open group 〔(8.5±0.7) d vs. (12.8±0.9) d， P＜0.01〕. But the cost of hospitalization in laparoscopic group was higher than that in open group 〔(3.14±0.25)×104 yuan vs. (2.02±0.75)×104 yuan， P＜0.05〕. There was no statistical difference of the three-year survival rate between two groups (89.5% vs. 89.1%， Pgt;0.05). Conclusion Laparoscopic radical rectectomy and colectomy for colorectal cancer is feasible and safe with minimal invasiveness.