Objective To evaluate the curative effectiveness and safety of transanal endoscopic microsurgery (TEM) vs. radical surgery (RS) for the patients with rectal malignant tumor, and to provide information for clinical research and practice. Methods Through computer searching The Cochrane Central Register of Controlled Trials, PubMed, OVID, CBM and CNKI from inception to April 2010, and hand searching relevant journals including Chinese Journal of Surgery and Chinese Journal of Evidence-Based Medicine, the randomized controlled trails (RCTs) and non-randomized controlled trails (NRCTs) comparing TEM with RS for rectal malignant tumor were collected. Data were extracted and evaluated by two reviewers independently according to the Cochrane Handbook for Systematic Reviews. Meta-analyses were conducted using the Cochrane collaboration’s software RevMan 5.0. Results One RCT and four NRCTs met the selection criteria, involving 929 patients. The methodological quality of all trials was low with possibility of bias. The meta-analyses showed that: a) Three studies reported local recurrence in T1 stage patients. There was a significant difference in local recurrence between the two groups (OR=12.61, 95%CI 2.59 to 61.29, P=0.002); b) Two studies reported disease-free survival in T1 stage patients. There was no significant difference between the two groups in disease-free survival (OR=1.12, 95%CI 0.31 to 4.12, P=0.86); c) Three studies reported overall survival in T1 stage patients. There was no significant difference between the two groups (OR=1.09, 95%CI 0.57 to 2.08, P=0.80); and d) Three studies reported postoperative complications in T1 stage patients. There was a significant difference between the two groups in terms of complications (OR=0.05, 95%CI 0.02 to 0.10, Plt;0.00001). Conclusion For T1 stage patients, TEM is associated with less injury of tissue, less operative bleeding, short duration of hospital stay, and low incidence of postoperative complications. The disease-free and overall survivals are comparable to those of RS, but the local recurrence rate is higher. The role of TEM in T2 stage patients is still under discussion. However, the trails available for this systematic review are of lower methodological quality, and bias may exist due to NRCTs. Therefore, more high quality RCTs are required.
Objective To evaluate the effect of endoscopic surgery combined with intraoperative color Doppler ultrasound on removing the injected breast augmentation agents and share our experiences. Methods Sixteen female who accepted the bilateral removal of injected breast augmentation agents through endoscopic surgery combined with intraoperative color Doppler ultrasound between 2008 and 2010 were enrolled in this study. The results, techniques, and advantages of management were analyzed retrospectively. Results One incision was made in 18 breasts, 2 in 4 breasts, 3 in 10 breasts. The length of incision was 0.5 to 1 cm. The mean operative time was 128.70 min per person. The average amount of bleeding was 52.67 ml per person. Complications such as postoperative bleeding, infection, poor drainage, or breast augmentation agents remain did not happened in all cases. No case was turned into normal operation. Female who accepted this operation were all satisfied with the appearance of incisions. During 1-3 months follow up, neither clinically palpable mass nor sensory disturbance in nipple or areola of breast was observed. Color Doppler ultrasound or magnetic resonance showed 16 cases had been cleared free of breast augmentation agents. Conclusion With the advantages of beauty, safe, minimal invasion, and partial resection of lesions at the same time, endoscopic surgery combined with intraoperative color Doppler ultrasound was an effective approach in the removal of injected breast augmentation agents.
目的 探讨经胆道镜联合钬激光碎石治疗肝内外胆管难取性结石的价值。方法 纤维胆道镜窥视下用钬激光碎石治疗肝内外胆管难取性结石29例，观察临床效果。结果 经1～3次胆道镜下钬激光碎石治疗，28例患者结石全部取尽，1例未完全取净，成功率为96.55%（28/29）； 近期无胆道出血、漏胆、黄疸等并发症发生。26例获得随访，随访时间6～20个月，平均13个月，未发现结石复发及胆管狭窄。结论 经胆道镜钬激光碎石是一种治疗肝内外胆管难取性结石简便、安全及有效的方法。
Objective To summarize diagnosis and treatment outcomes of coronary arterial fistulas （CAFs） so as to improve surgical results. Methods Clinical data of 23 patients with CAFs who underwent surgical repair in Xinhua Hospital，School of Medicine，Shanghai Jiaotong University from July 2006 to January 2013 were retrospectively analyzed. There were 15 male and 8 female patients with their age of 35.4±8.7 years. CAFs originated from left anterior descendingartery in 7 patients，right coronary artery in 13 patients，dual coronary arteries in 1 patient，left main coronary artery in 1 patient，and obtuse marginal artery in 1 patient. CAFs drained into pulmonary artery in 16 patients，right ventricle in 5patients，and right atrium in 2 patients. Twelve patients received surgical repair under off-pump condition with beating heart，and the other 11 patients underwent surgery under cardiopulmonary bypass （CPB）. Surgical techniques included extracardiacgasket interrupted suture ligation，intracardiac mattress suture ligation，intracardiac gasket interrupted suture for fistula repair，and a combination of intracardiac suture ligation and extracardiac repair. Results There was no in-hospital death or seriouspostoperative complication in this group. For the 11 patients undergoing surgical repair under CPB，average CPB time was 78.6±7.4 minutes，and average aortic cross-clamping time was 39.0±5.9 minutes. Postoperatively，patients’ heart functionrecovered well，their symptoms disappeared，and there was no myocardial ischemia or residual fistula. Twelve patients werefollowed up at the outpatient department and via telephone for 3 months to 6 years after discharge. During follow-up，theirheart function all recovered well，and echocardiogram detected no abnormality. There was no late death，myocardial ischemiaor residual fistula. Conclusion All CAFs patients need early surgical repair once their diagnosis is clear. Appropriate surgical strategies should be chosen according to the characteristics of pathological anatomy and associated intracardiaclesions. Surgical outcomes are satisfactory.
Objective To explore the feasibility，safety and clinical applicability of combined complete thoracoscopicand laparoscopic esophagectomy for the treatment of esophageal carcinoma. Methods Clinical data of 34 patients with esophageal carcinoma who underwent combined complete thoracoscopic and laparoscopic esophagectomy in the Departmentof Thoracic Surgery of our hospital from January 2012 to June 2013 were analyzed retrospectively. There were 33 males and1 female with their age of 63 （41-76） years. Results One patient received conversion to laparotomy and 1 patient diedpostoperatively. Mean operation time was 362.1 （300-560） minutes，including 90.6 （60-220） minutes for thoracoscopicprocedure in 34 patients and 61.1 （45-85） minutes for laparoscopic procedure in 33 patients. Mean intraoperative blood loss was 206.5 （100-500） ml. Average number of dissected lymph nodes was 18.0 （13-31） for each patient with positivemetastatic rate of 44.1% （15/34）. Postoperative pathological diagnosis was squamous cell carcinoma in 33 patients and smallcell carcinoma in 1 patient. Postoperative pathological staging was stageⅠB in 1 patient，stageⅡA in 1 patient，stageⅡB in 15 patients，stageⅢA in 11 patients，stageⅢB in 3 patients and stageⅢC in 3 patients. Postoperative hospital stay was 15.2 （6-35） days. Two patients received bedside bronchoscopic sputum suction. Postoperative complications occurred in32.4% （11/34） of all patients，including pulmonary infection in 4 patients （11.8%），respiratory failure in 2 patients （5.9%），chylothorax in 1 patient （2.9%），cervical anastomotic leak in 4 patients （11.8%） and hoarseness in 2 patients （5.9%）. We followed up 33 patients for 1-16 months. Two died，Two were lost. The other 29 patients survived. Conclusion Combined complete thoracoscopic and laparoscopic esophagectomy is a minimally invasive，feasible and safe surgical procedure for the treatment of esophageal carcinoma with quick postoperative recovery，and is worthy of furtherclinical application.
Objective To review the progress of the robotic applications in vascular surgery. Methods Recent literature about the robotic applications in vascular surgery was reviewed and analyzed. Results Robotic system is composed of surgery robotic system and endovascular interventional robotic system. The time of aortic clamping and anastomosis is reduced considerably during the robotic-assisted aorta bypass surgery, and the dissection of aorta is completed successfully in totally robotic approach. Endovascular interventional robotic system has good performance in navigation and stability, and shows apparent advantages in passing special anatomical segment and complicated lesion. However, the robotic systems are still limited in application for high cost. The problem of tactile feedback should also be solved quickly. Conclusion Robotic systems have apparent advantages and good prospect in vascular surgery. Nevertheless, it still require many clinical trials to formulate the indication and contraindication, to establish standard procedure, to assess the long-term effectiveness of the robotic systems and so on.
Objective To review the latest comparative research of minimally invasive transforaminal lumbar interbody fusion (TLIF) and traditional open approach. Methods The domestic and foreign literature concerning the comparative research of minimally invasive TLIF and traditional open TLIF was reviewed, then intraoperative indicators, length of hospitalization, effectiveness, complication, fusion rate, and the effect on paraspinal muscles were analyzed respectively. Results Minimally invasive TLIF has less blood loss and shorter length of hospitalization, but with longer operation and fluoroscopic time. Minimally invasive surgery has the same high fusion rate as open surgery, however, its effectiveness is not superior to open surgery, and complication rate is relatively higher. In the aspect of the effect on paraspinal muscles, in creatine kinase, multifidus cross-sectional area, and atrophy grading, minimally invasive surgery has no significant reduced damage on paraspinal muscles. Conclusion Minimally invasive TLIF is not significantly superior to open TLIF, and it does not reduce the paraspinal muscles injury. But prospective double-blind randomized control trials are still needed for further study.