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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.

胰腺 Castleman 病 1 例报道并文献复习

目的 总结 1 例胰腺 Castleman 病患者的临床资料，并复习以往文献，总结该病的流行病学特点及诊治体会。 方法 回顾性分析 2016 年 1 月笔者所在医院收治的 1 例胰腺 Castleman 病患者的临床资料，进行文献复习及总结。 结果 该例患者无特殊临床表现，术前行 CT 检查发现胰腺占位，行手术切除，术后病理学诊断为胰腺 Castleman 病。术后 1 个月复查CT未见肿瘤复发及转移，已获访 6 个月，患者恢复良好。经查阅文献，共检索出胰腺 Castleman 病 32 例，男 11 例，女 21 例；年龄 23～74 岁，平均年龄为 46 岁；临床表现仅为腹部疼痛 7 例，腹痛伴发热 1 例，腹痛伴面部、双下肢水肿 1 例，腹痛伴乏力 1 例，腹胀 1 例，背部疼痛 1 例，颈部淋巴结肿大 1 例，吞咽困难 1 例，发热、乏力、体质量下降 1 例，无明显临床表现 17 例；肿瘤位于胰腺头部 9 例，胰腺颈部 3 例，胰腺体、尾部 16 例，胰周 4 例；肿瘤直径最小 1.5 cm，最大 7.2 cm；病理学分型为透明血管型（hyaline vascular，HV）19 例，浆细胞型（plasma cell，PC）4 例，混合型（mixed/HV-PC，MV）4 例，未给出明确病理分型 5 例。 结论 胰腺 Castleman 病是少见的淋巴组织增生性疾病，通常无特异临床表现，影像学检查也无特异性，目前仅能通过病理组织学检查确诊。胰腺 Castleman 病的治疗以手术为主，疗效较好。

先天性胆囊缺如 1 例报道

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.

单孔腹腔镜胆囊逆行切除术的学习曲线分析

目的 总结采用常规腹腔镜器械进行逆行切除法在单孔腹腔镜胆囊切除术中应用的学习曲线。 方法 回顾性分析中国医科大学附属盛京医院单一主刀医生于 2012 年 7 月至 2015 年 12 月期间施行的连续单孔腹腔镜手术的 120 例患者的临床资料，单孔腹腔镜胆囊切除术中采用常规腹腔镜器械进行胆囊逆行切除。 结果 所有患者的手术都顺利进行。手术施行期间，手术时间随手术例数增加而明显减少，10 例以后手术时间基本稳定。前期组和后期组患者的手术花费、帕瑞昔布钠剂量和美容评分比较差异均无统计学意义（P>0.05），但与前期组比较，后期组的手术时间较短，术中出血量较少，术后住院时间较短，中转多孔率和并发症发生率较低，视觉模拟评分（visual analogue scale，VAS）较低，差异均有统计学意义（P<0.05）。 结论 单孔腹腔镜胆囊切除术中采用常规腹腔镜器械进行胆囊逆行切除的学习曲线短，易于术者掌握。

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.