目的 探讨腹腔镜与小切口直肠癌根治术对患者机体细胞免疫功能的影响。方法 选取2010年1月至2011年6月期间我院行腹腔镜及小切口直肠癌根治患者102例，其中腹腔镜组53例，小切口组49例。 采用流式细胞仪测定患者术前1d及术后第1及第5天外周血中CD3、CD4+、CD8+、CD19及NK细胞比例的变化，研究不同手术方式对患者细胞免疫功能的影响。结果 术后第1及第5天，腹腔镜组和小切口组患者的CD3、CD4+、CD8+、CD19及NK细胞比例（数）均较术前明显降低（P＜0.05）。同腹腔镜组比较，小切口组术前及术后CD3、CD4+、CD8+、CD19及NK细胞比例（数）的差异均无统计学意义（P＞0.05）。结论 腹腔镜与小切口直肠癌根治对患者机体细胞免疫功能的无明显影响。
ObjectiveTo investigate current status of anal sphincter preservation in low rectal cancer.MethodThe recent literatures on the progress of anal sphincter preservation in the low rectal cancer were reviewed.ResultsIn the past, the surgical treatment of the low rectal cancer was mainly based on the Miles. With the deepening of the anatomical understanding, the improvement of surgical concepts, and the development of minimally invasive techniques, the treatment concept of the low rectal cancer had gradually entered the era of retaining anal and anal function. At present, many surgical methods including the transanal local excision, intersphincteric resection, transanal total mesorectal excision, etc. could be applied to the anal sphincter preservation of the lower rectal cancer, but the advantages and disadvantages of each surgical procedure and the scope of application were slightly different.ConclusionsAlthough there are many surgical procedures that can be applied to patients with low rectal cancer, none of them can achieve perfection in terms of retaining anal and anal function, reducing complications and recurrence rates, and improving survival. It is believed that with continuous understanding of rectal anatomy by surgeons, emergence of various neoadjuvant chemoradiation and new devices, and more anal sphincter preservation procedures and even artificial anal surgery, treatment of low rectal cancer will also be more good care for anal and maintenance function, so that patients can obtain a higher quality and a long-term survival opportunity.
目的探讨肝癌切除后行区域性化疗治疗肝癌的效果。方法原发性肝癌18例，转移性肝癌3例，均行肿瘤切除，病侧肝动脉结扎，胃网膜右静脉置入药泵，于术中经药泵注入5Fu，拆线后用5Fu（总量6 g）、丝裂霉素（总量8 mg）及阿霉素（总量60 mg）经药泵注入化疗。术后前3年，每年化疗3个疗程，第4～5年，每年化疗1～2个疗程。结果21例中随访3年以上12例，6例失访，3例死亡，本组资料3年生存率为57%。结论肝癌切除后，结扎病侧肝动脉，行门静脉区域性化疗，疗效显著。
ObjectiveTo investigate postoperative complications and their risk factors after laparoscopic-assisted radical surgery for gastric cancer. MethodsThe clinical data of 300 patients with gastric cancer who underwent laparoscopic-assisted radical surgery in Affiliated Hospital of North Sichuan Medical College from October 2010 to October 2013 were analyzed retrospectively. Risk factors associated with postoperative complications were assessed by univariate and multivariate analysis, and survival situation of patient with postoperative complications and without postoperative complications was compared by log-rank test. ResultsOf the 300 patients, postoperative complications occurred in 51 patients (17.0%). Univariate analysis results showed that, postoperative complication was associate with age, preoperative comorbidity, American Society of Anesthesiologists (ASA) grade, operative time, and experience of surgeon (P<0.050). Logistic regression analysis results revealed that, age, preoperative comorbidity, and experience of surgeon were independent risk factors for postoperative complications (P<0.050), patients with old age, preoperative comorbidity, and underwent surgery by less experience of surgeon had higher incidence of postoperative complication. Two hundred and forty patients were followed-up for 3-35 months, with the median time of 21 months. There was no significant difference in survival situation between patients with and without postoperative complications (χ2=0.941,P=0.332). ConclusionAge, preoperative comorbidity, and experience of surgeon are independent risk factors for postoperative complicatons after laparoscopic-assisted radical surgery for gastric cancer, and the survival situation between patients with and without postoperative complications is similar.
ObjectiveTo explore the effect of liver metastases of intraoperative and postoperative portal vein chemotherapy and combined with folfox4 regimen chemotherapy for patients with obstrutive colorectal cancer. MethodsA total of 94 obsrutive colorectal cancer patients that could be radical resection were collected from February 2007 to May 2011 in our hospital and divided into two group. Forty-six patients in treatment group received portal vein chemotherapy after the portal vein pump were placed intraoperative, and 3-4 weeks after operation taken FOLFOX4 chemotherapy combined with portal vein infusion chemotherapy 6 courses. Forty-eight patients in the control group received only FOLFOX4 chemotherapy 6 courses 3-4 weeks after operation. Ninety-four patients were followed up for 3 years to observe the incidence of postoperative liver metastasis, at the same time comparing two groups of clinic toxicity during chemotherapy. ResultsIn three years after operation the incidence of liver metastasis were 21.7% in treatment group (10 cases had hepatic metastases), 58.3% in control group (28 cases had liver metastases), the difference in two groups was statistically significant(P < 0.01). Comparing the clinical toxicity in two group, AST in treatment group increased on first day (P < 0.01), and recovered normal on third day (P > 0.05) after operation. There were no marked difference in renal function, ALT, ALP, GGT, and LDH of liver function, medullary restraining, and reaction of gastrointestinal tract (P > 0.05). ConclusionChemotherapy via portal vein intraoperative and postoperativ combined postoperative FOLFOX4 chemotherapy can reduce the risk of postoperative liver metastasis for the patients with obstrutive colorectal cancer.
ObjectiveTo investigate the effect of tension suture on healing quality of incision after abdominal surgery, and to provide a theoretical basis for reducing post-operative wound complications. MethodLiteratures on the tension suture in the application of abdominal incision were searched from January 2005 to January 2015, and then a Meta-analysis was carried out based on the data obtained from CBM, CNKI, and WanFang database. ResultsEight articles involving 2 001 patients with abdominal surgery, including 1 044 cases in tension suture group, and 957 cases in the conventional suture group, were incorporated. The Meta analysis results showed that, the technique of tension suture could reduce the incidence of post-operative wound infection (OR=0.40, 95% CI: 0.28-0.57, P<0.05), fat liquefaction (OR=0.51, 95% CI: 0.37-0.69, P<0.05), incisional hernia (OR=0.11, 95% CI: 0.04-0.34, P<0.05), wound dehiscence (OR=0.13, 95% CI: 0.07-0.25, P<0.05), and second stage surgery (OR=0.16, 95% CI: 0.09-0.30, P<0.05). But, it would also augment the risk of post-operative skin incision necrosis (OR=15.14, 95% CI: 2.79-82.08, P<0.05). On the other hand, the method of tension suture had no effect on the subcutaneous hemorrhage in the incision area (OR=0.58, 95% CI: 0.30-1.13, P>0.05). ConclusionsCompared with conventional suture, tension suture can reduce the hazard of wound infection, fat liquefaction, incisional hernia, wound dehiscence, and reoperation after abdominal surgery. In contrast, it can also increase the risk of post-operative skin incision necrosis.
Objective To investigate the effect of postoperative recovery between trans-abdominal drainage and trans-perineum drainage in patients with rectal cancer. Methods The randomized controlled trials which were related with the comparison between trans-abdominal drainage and trans-perineum drainage of rectal cancer patients were searched from January 2006 to January 2016, and then a meta-analysis was performed by using RevMan 5.2 software, basing on the data obtained from PubMed, CBM, CNKI, WanFang, and VIP database. Results The results of meta-analysis showed that, in the aspect of postoperative drainage, there was no significant difference in the postoperative drainage duration 〔MD=–0.03, 95% CI is (–1.63, 1.57), P=0.97〕 , volume of drainage liquid 〔MD=–9.53, 95% CI is (–104.95, 85.90), P=0.84〕 , and extubation time 〔MD=0.25, 95% CI is (–0.31, 0.82), P=0.38〕 between the trans-abdominal drainage group and the trans-perineum drainage group. In terms of postoperative infection, the trans-abdominal drainage could effectively reduce the incidence rate of drainage tube incision infection 〔OR=0.32, 95% CI is (0.21, 0.48), P<0.000 01〕 . However, there was no significant difference in the abdominal incision infection 〔OR=0.84, 95% CI is (0.51, 1.36), P=0.48〕 and pelvic infection 〔OR=0.77, 95% CI is (0.52, 1.15), P=0.20〕 . In addition, compared to the trans-perineum drainage, the trans-abdominal drainage could shorten the time of pain in drainage 〔MD=–5.07, 95% CI is (–6.96, –3.17), P<0.000 01〕 . But, there was no significant difference in the duration of hospitalization 〔MD=0.82, 95% CI is (–0.39, 2.03), P=0.19〕 , incidence of anastomotic bleeding 〔OR=0.95, 95% CI is (0.58, 1.54), P=0.82〕 , and incidence of anastomotic leakage 〔OR=1.33, 95% CI is (0.93, 1.92), P=0.12〕 between the two groups. Conclusion The trans-abdominal drainage could obviously decrease the incidence of drainage tube incision infection and shorten the time of pain in drainage, so it may promote the postoperative rehabilitation of rectal cancer patients.
ObjectiveTo investigate factors associated with postoperative complications after laparoscopic radical surgery in rectal cancer.MethodsThe clinical data of patients with rectal cancer performed by the laparoscopic radical resection from February 2013 to December 2016 were analyzed retrospectively. All the data were analyzed by the t test, chi-square test or logistic regression analysis.ResultsThere were 343 patients with rectal cancer performed by the laparoscopic radical resection. The postoperative complications occurred in the 97 (28.3%) patients. The result of univariate analysis showed that the postoperative complications rate was associated with the gender, age, body mass index, preoperative anemia, preoperative comorbidity, location and diameter of tumor, operative time, and surgeon experience (all P<0.050). The results of logistic regression analysis revealed that the gender, age, body mass index, preoperative anemia, preoperative comorbidity, location of tumor, operative time, and surgeon experience were the independent risk factors for the postoperative complications (all P<0.050).ConclusionGender, age, body mass index, preoperative anemia, preoperative comorbidity, location of tumor, operative time, and surgeon experience are independent risk factors for postoperative complications in laparoscopic radical rectal surgery for rectal cancer.