ObjectiveTo investigate the effectiveness of the tubal reconstruction after laparoscopic tubal pregnancy operation by comparing with simple laparoscopic tubal pregnancy operation. MethodsBetween May 2007 and May 2010, 63 patients with tubal pregnancy underwent laparoscopic tubal pregnancy operation and tubal reconstruction in 30 cases (trial group) or simple laparoscopic tubal pregnancy operation in 33 cases (control group). There was no significant difference in age, pregnancy time, and position between 2 groups (P gt; 0.05). The tube patency test and hysterosalpingography (HSG) were carried out to evaluate the efficacy. ResultsThe operation was successfully completed in 29 cases of trial group; 1 case had too severe adhesion to receive re-anastomosis and was excluded. The tube patency test showed that the tube was patency in 26 cases of trial group and in 2 cases of control group during operation, showing significant difference (Z=5.86, P=0.00); it was patency in 25 cases of trial group and in 26 cases of control group at 1 month after operation, showing no significant difference (Z=0.48, P=0.63). HSG examination showed tube was patency in 25 cases of trial group and in 2 cases of control group at 2 months after operation, showing significant difference (Z=5.35, P=0.00). After 24 months, intrauterine pregnancy of trial group (n=25, 86.20%) was significantly higher than that of control group (n=19, 57.58%) (χ2=7.72, P=0.01). ConclusionThe reconstruction after laparoscopic tubal pregnancy operation can significantly increase the intrauterine pregnancy rate, and it is better than simple laparoscopic tubal pregnancy operation.
Objective To evaluate the clinical application of the different operative approaches of the laparoscopicrepair of inguinal hernia and provide a more rational and scientific choice for the surgeon. Methods The strict inclusion and exclusion criteria were set up. All the randomized controlled trials （RCT） about laparoscopic transabdominal preperi-toneal （TAPP） and totally extraperitoneal （TEP） approaches of laparoscopic inguinal hernia repair were collected. Meta an-alysis was performed according to the recommendation by the Cochrane handbook. Results Seven RCTs including 552 patients were analyzed， who were divided into TAPP group （n=302） and TEP group （n=250）. Compared with TAPP group， there were no significant differences of the operation time〔WMD=8.49， 95% CI （-1.37， 18.35）， P=0.09〕， postoperative hospitalization〔SMD=0.11， 95% CI （-0.12， 0.34）， P=0.34〕， postoperative recurrence rate 〔OR=1.37， 95% CI （0.36， 5.20）， P=0.64〕， and complications （incision infection， urinary retention） 〔Incision infection：OR=4.27， 95% CI （0.85， 21.57）， P=0.08；Urinary retention：OR=0.61， 95% CI （0.21， 1.78）， P=0.36〕in the TEP group. But the postoperative 24 h pain in the TEP group was significantly milder than that in the TAPP group 〔WMD=0.72， 95% CI （0.58， 0.87）， P＜0.000 01〕. Conclusions The currently available evidence shows that postoperative 24 h pain in the TEP group is more milder than that in the TAPP group. The time of the operation， postoperative hospitalization， postoperative recurrence， and complications are no significant differences between TAPP group and TEP group. Large-scale， high-quality RCTs are still needed to confirm or refuse the available evidence.
ObjectiveTo observe the effects and security of dexmedetomidine in combined spinal epidural anesthesia (CSEA) for laparoscopic total extraperitoneal hernia repair (TEP).
MethodsFrom January 2010 to January 2013, we selected 90 patients who were going to receive TEP surgery as our study subjects. The patients were divided into three groups:M1, M2 and M3 with 30 patients in each. The patients had left lateral position, and anesthesia was done between 3-4 lumbar epidural line. Injection of 0.5% bupivacaine 2 mL was carried out, and epidural catheter was 3-5 cm. Anesthesia plane was adjusted from the chest 4 or 6 vertebra to the sacral vertebra. The three groups of patients were treated with micro pump using dexmedetomidine given at a pre-charge of 0.5 μg/kg, and then group M1 was maintained by 0.3 μg/(kg·h), M2 by 0.5 μg/(kg·h), and M3 by 0.7 μg/(kg·h). The changes of mean arterial pressure (MAP), heart rate, respiration and pulse oximetry (SpO2) were observed at each time point, and bispectral index (BIS) monitor and Ramsay sedation score test were also conducted.
ResultsThe changes of MAP, heart rate and respiration in group M1 were not obvious; the Ramsay score for group M1 was 2 to 3, and BIS value after pre-charge was 65-84. For group M2, MAP, heart rate and respiration had a slight decline; Ramsay score was 3-5 points, and BIS value was 60-79. In group M3, patients had a milder decline in their MAP and respiration; the heart rate declined obviously after receiving dexmedetomidine and one patient with severe decline of the heart rate alleviated after active treatment; Ramsay score was 5 to 6 points, and BIS value was between 55 and 75. There was little change in SpO2 in all the three groups, and the difference was not statistically significant (P>0.05).
ConclusionContinuous injection of dexmedetomidine at 0.3-0.5 μg/(kg·h) in CSEA is an alternative way for anesthesia, which can effectively promote sedation and reduce pain and discomfort.
ObjectiveTo evaluate the security and feasibility of transumbilical laparoendoscopic single-site cholecystectomy (TULESC) with conventional laparoscopic instruments.
MethodsThe clinical data of 62 adult patients undergoing TULESC between October 2011 and June 2013 were analyzed retrospectively. There were 13 males and 49 females aged between 22 and 70 years old averaging 40±15. Forty-nine patients suffered from chronic cholecystitis with cholelithiasis, 10 from asymptomatic cholelithiasis and 3 from cholecystic polyposis. A single arc incision was cut on the edge of the umbilicus, and two 10 mm Trocars and one 5 mm Trocar were placed by puncture. Cholecystectomy was performed with conventional laparoscopic instruments and equipment.
ResultsAll the 62 patients underwent TULESC successfully without severe complications such as bile leakage or biliary injury. The operation time was 20-70 minutes with the average of (40±15) minutes; The blood loss was 5-40 mL with the average of (15±10) mL. All the patients were discharged from the hospital within 3 to 7 days after surgery, averaging 4.0±1.0. During the 1 to 12-month follow-up (averaging 3 months), there was no obviously visible scars on the abdominal wall and the aesthetic effect was significant.
ConclusionTULESC with conventional laparoscopic instruments and equipment is safe, feasible and cosmetic.
ObjectiveTo investigate the feasibility of laparoscopy in the diagnosis and treatment of acute abdomen.
MethodsThe clinical data of 81 patients with acute abdomen treated in our hospital from January 2012 to December 2013 were retrospectively analyzed.
ResultsOf the 81 patients with acute abdomen, there were 38 cases of acute appendicitis, 15 cases of gastric perforation, 10 cases of duodenal ulcer perforation, 10 cases of acute cholecystitis, 1 case of mesenteric artery embolism, 2 cases of internal hernias, 2 cases of ileocecal tumor, 2 cases of sigmoid colon rupture, 1 case of intestinal adhesion. The 81 cases were treated by laparoscopy, including 79 cases (97.5%) were clearly diagnosed; 73 cases were succeeded by laparoscopy, and 8 cases converted to laparotomy. The operation time were 35-191 minutes, with an average of 76 minutes; the intraoperative blood loss were 20-130 mL, with an average of 43 mL; the postoperative hospital stay were 3-13 days, with an average of 5.6 days. Seventy-six patients received followed-up for 2-24 months, and the median time were 14 months, no special complications occurred during follow-up period, but 1 case of ileocecal tumor suffered from lung metastases in 12 months after operation.
ConclusionsLaparoscopy can be used in the preferred way of diagnosis and treatment of acute abdomen.
ObjectiveTo investigate the changes of peritoneal macrophages function of mice with gastric cancer in the CO2 pneumoperitoneum environment, as well as its effect on the peritoneal metastasis of gastric cancer. MethodsAn orthotopic implantation model of mouse forestomach cancer was established using the 615 mouse. The mice bearing tumors were randomly divided into five groups (n=30): anesthesia alone, laparotomy, and 2, 4, and 6 mm Hg CO2 insufflation groups. Peritoneal macrophages were collected from six mice in each group and cultured. The macrophage phagocytic function on neutral red and the levels of NO and TNF-α produced by macrophages were measured after 12, 24, 48, and 72 h of culture. The remaining mice were observed after two weeks for the rate of peritoneal metastasis of forestomach cancer cells and the total weight of implanted nodules. ResultsNo death and ascites were found and the difference of weight body was not significant in all mice (Pgt;0.05). The uptake of neutral red by peritoneal macrophages and the levels of NO and TNF-α secreted by peritoneal macrophages in the laparotomy group after 12 h of culture were all significantly higher than those in other four groups (Plt;0.05). The corresponding values in the 2, 4， and 6 mm Hg CO2 insufflation groups after 12 h were all significantly lower than those in the anesthesia alone group (Plt;0.05). Among three insufflation groups, the corresponding values in the 2 mm Hg after 12 h were significantly higher than those in the 4 and 6 mm Hg CO2 insufflation group, though the difference in the two latter was not significant (Pgt;0.05). The uptake of neutral red by peritoneal macrophages and the levels of NO and TNF-α secreted by peritoneal macrophages in the 6 mm Hg CO2 insufflation group after 24 h of culture were all significantly lower than those in other four groups (Plt;0.05), while the difference in the four groups was not significant (Pgt;0.05). The uptake of neutral red by peritoneal macrophages and the levels of NO and TNF-α secreted by peritoneal macrophages after 48 h and 72 h were not significantly different in the five groups (Pgt;0.05). The rate of peritoneal metastasis of mice was significantly lower in the 6 mm Hg insufflation CO2 group (75.0%, 15/20) than that in the anesthesia alone group (100%, 24/24), Plt;0.05, but higher than other three groups(Plt;0.05), which was not different in 2 mm Hg (47.8%, 11/23), 4 mm Hg insufflation group (45.45%, 10/22) and laparotomy group (50.0%, 10/20), Pgt;0.05. The total weight of implanted nodules of mouse forestomach cancer was (1.24±0.48) g, (1.02±0.38) g, (0.96±0.33) g, (0.93±0.45) g, and (1.18±0.37) g in the anesthesia alone group, the laparotomy group, and 2, 4, and 6 mm Hg CO2 insufflation group, and the difference was not significant (Pgt;0.05). ConclusionHigh pressure (6 mm Hg) CO2 pneumoperitoneum can constantly inhibit the phagocytosis and cytokine secretion functions of peritoneal macrophages in gastric cancer-bearing mice and promote peritoneal implantation of gastric cancer.
ObjectiveTo investigate the feasibility of totally laparoscopic distal gastrectomy (TLDG) based on delta-shaped gastroduodenostomy in the treatment of gastric cancer.
MethodsNinety patients with gastric cancer who treated in our hospital from December 2013 to December 2015 were retrospectively analyzed. Forty-five patients with gastric cancer received delta-shaped gastroduodenostomy by using laparoscopic linear stapler after they were treated with TLDG and D2 lymphadenectomy (TLDG group), while 45 patients with gastric cancer received laparoscopic assisted distal gastrectomy (LADG) and D2 lymphadenectomy (LADG group). The operative time, digestive tract reconstruction time, blood loss, number of dissected lymph nodes, length of proximal and distal margin to the cancer, time of the first flatus, recovery time of drinking water, time of resuming semi-fluid diet, postoperative hospital stay, and complications during follow-up period were observed and evaluated.
Results① Intraoperative findings. The operative time, digestive tract reconstruction time, and length of distal margin to the cancer of TLDG group were significantly longer than those corresponding index of LADG group (P < 0.050), but the blood loss was significantly less than that of LADG group (P < 0.050). There was no significant difference between two groups in proximal margin to the cancer and number of dissected lymph nodes (P > 0.050). ② Postoperative findings. There was no significant difference between two groups in time of the first flatus, recovery time of drinking water, time of resuming semi-fluid diet, postoperative hospital stay, and incidence of complication (P > 0.050). All patients were followed for 6-16 months (median with 10 months), and there was no one suffered from recurrence, anastomotic stricture, and anastomotic obstruction.
ConclusionThe TLDG based on delta-shaped gastroduodenostomy in the treatment of gastric cancer was feasible and safe, and it will be an ideal method for digestive tract reconstruction in patients with gastric cancer, so it is worthy to clinical application.
ObjectiveTo systematically evaluate the stress response of laparoscopic surgery (LS) and conventional open surgery (OS) in patients with colorectal cancer.
MethodsThe literatures about the immune stress response of LS and OS for colorectal cancer were collected from PubMed, Springer, OVID, Cochrane library, CNKI, VIP Database, and Wanfang Database from May 2001 to September 2014. RevMan 5.3 software was used for data analysis.
ResultsFifteen randomized controlled trials including 881 patients were brought into this Meta analysis, of 881 patients, 424 patients were treated with LS and 457 patients were treated with OS. The results of Meta-analysis showed that:①At 24, 72, and 120 hours after surgery, the levels of interleukin (IL-6) in LS group were all lower than those of OS group at same time point[24 h (WMD=-27.78, 95% CI:-43.24--12.32, P < 0.01), 72 h (WMD=-13.23, 95% CI:-19.89--6.57, P < 0.01), 120 h (WMD=-16.51, 95% CI:-30.13--2.89, P=0.02)]. ②At 24, 72, and 120 hours after surgery, the levels of C reactive protein (CRP) in LS group were all lower than those of OS group at same time point[24 h (WMD=-31.11, 95% CI:-47.49--14.73, P < 0.01), 72 h (WMD=-29.81, 95% CI:-49.99--9.64, P < 0.01), 120 h (WMD=-32.03, 95% CI:-45.34--18.71, P < 0.01)]. ③There was no significant difference between the 2 groups in WBC level at 24 hours after surgery (WMD=-0.63, 95% CI:-1.80-0.54, P=0.29), but the WBC levels of LS group at 72 hours and 120 hours after surgery were lower than those of OS group[72 h (WMD=-0.21, 95% CI:-0.41--0.01, P=0.04), 120 h (WMD=-0.86, 95% CI:-1.66--0.06, P=0.03). ④There was no significant difference between the 2 groups in cortisol level at 24 hours and 72 hours after surgery[24 h (WMD=-60.19, 95% CI:-194.77-74.39, P=0.38), 72 h (WMD=-13.83, 95% CI:-43.94-16.28, P=0.37). ⑤There was no significant difference between the 2 groups in blood glucose level at 24 hours and 72 hours after surgery[24 h (WMD=-0.95, 95% CI:-2.74-0.84, P=0.30), 72 h (WMD=-0.69, 95% CI:-2.05-0.66, P=0.32)]. ⑥There was no significant difference between the 2 groups in insulin level (WMD=-0.52, 95% CI:-1.87-0.82, P=0.45) at 24 hours after surgery. ⑦There was no significant difference between the 2 groups in tumor necrosis factor (TNF) level at 24 hours after surgery (WMD=-4.18, 95% CI:-9.39-1.04, P=0.12).
ConclusionCompared with open radical surgery, laparoscopic radical surgery for colorectal cancer causes less stress and less effect on the immune function, it also can reduce postoperative complications and can be propitious to faster body recovery.
Objective To summarize the surgical technique and curative effect of laparoscopic repair for suprapubic incisional hernia using composite patch. Methods The clinical data of 25 cases performed laparoscopic repair of suprapubic incisional hernia using composite patch from March 2007 to October 2010 were reviewed retrospectively. There were 13 males and 12 females， and aged 35-83 years （median age was 52 years）. Among them 2 patients were recurrences. The distance between the lower margin of hernia defect and pubic arc was less than 5 cm. The composite patch was fixed to the abdominal wall using spiral tacks （Protack） in direct vision. The lower margin of the patch was lower to the pubic arc in 2 cm， and to be fixed to the pubic arc and bilateral pectineal ligament， and it should be extended. Results Laparoscopic repair were successfully performed in all patients without convert to open repair. The max diameter of the hernia ring was 6.1-12.5cm and the average was 9.5 cm. The average operating time was 128 min （ranging from 90 to 180 min）. And the total complication rate was 28% （7/25）， including bladder damage during operation in 1 case， wound seroma upon the patch in 4 cases and cured by aspiration， pain in the operative area and disappeared within one month without intervention in 1 case. Twenty-two patients were followed-up with a follow-up rate of 88%. During a follow-up range of 6-48 months（average 30 months）， one case recurrence occurred in 2 months after the repair with the recurrent rate of 4%. Conclusions Laparoscopic repair of suprapubic incisional hernia is a safe and feasible technique， and the patch should cover and exceed the margin of the defect for 5 cm in all direction. The lower margin of the patch should be fixed to the bilateral pectineal ligament so as to strengthen the fix， and lower the recurrence rate.
Objective To investigate the way of closed establishment of pneumoperitoneum（CEPP） in patients with peritoneal cavity adhesion in laparoscopy, and to sum up the successful experience and the lesson of visceral injury. Methods CEPP experiences of 1 046 cases of peritoneal adhesion were retrospective analysed in 6 600 cases laparoscopy in our unit from September 1991 to September 1999.The difficulty of establishment of pneumoperitoneum was classified as real difficulty in establishment of pneumoperitonum (RDEPP) and false difficulty in establishment of pneumoperitonum (FDEPPD). RDEPP was due to Veress needle penetrating into viscera or peritoneal extensive adhesion in peritoneal cavity, and CO2 air flowing into difficulty. FDEPP was due to veress needle penetrating into extraperitoneum fat, round hepatic ligament or larger messentry. The formal situation required conversion to open laparotomy, and the latter situation could establish pneumoperitoneum successfully by regulating the Veress needle direction or penetrating depth in second penetration. Results In this group 1 046 patients, 1 028 cases (98.3%) had been established pneumoperitoneum successfully by way of CEPP, 6 cases of RDEPP and 12 cases of FDEPP required open laparotomy. No complication related to CEPP had been found in this group except two cases visceral injury cured by laparotomy and repairment. Conclusion CEPP in patients with peritoneal adhesion is safe and feasible in laparoscopy. The main reason of CEPP failure is regarding FDEPP as RDEPP due to deficiency of experience and confidence of laparoscopist.
