Objective To investigate the impact of conversion to open in laparoscopic rectal cancer radical resection (LRR) on postoperative recovery. Methods The data from Feb. 2003 to Feb. 2007 of 176 cases who were given LRR and 32 cases receiving conversion in LRR (CRR) were analyzed retrospectively, and were compared about operation time, hospitalization time, hospitalization expenses, intraoperative blood loss, recovery time of bowel movement and postoperative complications with 59 cases of open rectal cancer radical resection (ORR). Results There were no differences among LRR, CRR and ORR about operation time, hospitalization time, intraoperative blood loss and recovery time of bowel movement (Pgt;0.05). The hospitalization expenses of LRR and CRR were higher than that of ORR (P=0.001, P=0.001), there was no difference between CRR and LRR (P=0.843). But the postoperative complications rate of ORR was higher than those of LRR and CRR （P=0.023,P=0.004）. Conclusion Compared with ORR, LRR has relatively conversion rate, and then increases the hospitalization expenses.
Objectives To analyze risk factors associated with conversion to open surgery of laparoscopic repair for perforated peptic ulcer. Methods From January 2009 to December 2014, 235 patients underwent laparoscopic repair for perforated peptic ulcer in the Chengdu 5th Hospital, were enrolled in this study. These patients were divided into laparoscopic repair group (n=207) and conversion to open surgery group (n=28). The characteristics, clinical outcomes, and prognosis factors were compared between these two groups. The receiver operating characteristic (ROC) curve was used to determine the critical cutoff value for diameter and duration of perforation for predicting conversion to open surgery. Results There were no significant differences of the age, gender, body mass index, comorbidity, history of ulcer, smoking history, history of nonsteroidal antiinflammatory drugs or steroids use, history of alcohol use, American Society of Anesthesiologists classification on admission, white blood cell count on admission, C reaction protein on admission, surgeons, suture method, and location of perforation between these two groups (P>0.05). The patients in the conversion to open surgery group had a higher procalcitonin (PCT) level on admission (P=0.040), longer duration of peroration (P<0.001), larger diameter of peroration (P<0.001), longer hospital stay (P=0.002), higher proportion of patients with Clavien-Dindo classification Ⅰ and Ⅱ (P<0.001), longer gastrointestinal function recovery time (P=0.003), longer analgesics use time (P<0.001), and longer off-bed time (P=0.001) as compared with the laparoscopic repair group. The results of logistic regression analysis showed that the peroration duration on admission〔OR: 2.104, 95%CI (1.124, 3.012),P=0.020〕and peroration diameter on admission〔OR: 2.475, 95%CI (1.341, 6.396),P=0.013〕were two predictors of conversion to open surgery. For the diameter of perforation, 8.0 mm was the critical cutoff value for predicting conversion to open surgery by ROC curve analysis, the sensitivity was 76%, the specificity was 93%, and the area under the curve (AUC) was 0.912. For the duration of perforation, 14 h was the critical cutoff value to predict conversion to open surgery, the sensitivity was 86%, the specificity was 71%, and theAUC was 0.909. Conclusions The preliminary results in this study show that diameter of perforation of 8 mm and duration of perforation of 14 h are two reliable risk factors associated with conversion to open surgery for perforated peptic ulcer. Also, PCT level would mightbe considered as a helpful risk factor for it.
Objective To compare the effect of laparoscopic surgery and open surgery on the blood coagulation state in patients with gastric cancer, and to provide evidence for the prevention measurement of thrombosis in perioperative period. Methods One hundred patients with gastric cancer who received treatment in our hospital from Feb. 2014 to Aug. 2014, were randomly divided into laparoscopy group and laparotomy group, 50 patients in each group. The patients in laparotomy group were treated by traditionally open surgery, while patients in the laparoscopy group accepted laparoscopic surgery. The clinically therapeutic effect of 2 groups was compared. Results ① Operative indexes. The operation time, blood loss, anal exhaust time, hospital stay, and morbidity of laparoscopy group were all lower than those of laparotomy group (P<0.05). ② Coagulation function. Compared with preoperative indexes, the prothrombin time (PT) at 24 h after operation in laparoscopy group and laparotomy group were both shorter (P<0.05), but there was no significant difference in activated partial thromboplastin time (APTT) and international normalized ratio (INR) between the 2 time points (before operation and 24 h after operation) in both 2 groups (P>0.05). Both at 2 time points (before operation and 24 h after operation), there was no significant difference in PT, APTT, and INR between 2 groups (P>0.05). ③ Fibrinolysis indexes. Compared with preoperative indexes, the fibrinogen (FIB) and D-dimer at 24 h after operation in laparoscopy group and laparotomy group were higher (P<0.05). The FIB and D-dimer at 24 h after operation in laparoscopy group were both higher than those of laparotomy group (P<0.05). ④ Follow-up results. There was no significant difference in metastasis rate, recurrence rate, and mortality between the 2 groups (P>0.05), but the incidence of thrombus was higher in laparoscopy group than that of laparotomy group (P<0.05). Conclusions In the treatment of patients with gastric cancer, laparoscopic surgery has the advantages of less trauma, less blood loss, less complications, and so on. Laparoscopic surgery and open surgery both can lead to hypercoagulable state, but the effect of laparoscopic surgery is stronger than open surgery.
Objective To investigate the clinical effects and safety differences of open surgery and laparoscopy primary lesion resection combined with D2 lymph node dissection in the treatment of elderly patients with advanced gastric cancer. Methods One hundred and forty elderly patients with advanced gastric cancer were chosen and randomly divided into two group including open operative group (70 patients) with primary lesion resection combined with D2 lymph node dissection by open operation and laparoscopic surgery group (70 patients) with primary lesion resection combined with D2 lymph node dissection by laparoscopy; and the operative time, intraoperative bleeding amount, the levels of PaCO2 in operation, liquid diet eating time, postoperative anal exhaust time, postoperative gastric tube indwelling time, postoperative ambulation time, the level of haemoglobin (Hb) after operation, the hospitalization time, the number of lymph node dissection, the survival rate with followed-up and postoperative complication incidence of both groups were compared. Results There was no significant difference in the operative time between 2 groups (P>0.05). The intraoperative bleeding amount, the level of PaCO2 in operation, liquid diet eating time, postoperative anal exhaust time, postoperative gastric tube indwelling time, postoperative ambulation time, the level of Hb after operation and the hospitalization time of laparoscopic surgery group were significantly better than open operative group (P<0.05). The level of PaCO2 in operation of laparoscopic surgery group was significantly higher than open operative group (P<0.05). There were no significant difference in the gastric lymph node dissection number and the peripheral lymph node dissection number of gastric artery between 2 groups (P>0.05). There were no significant difference in the survival rates between the 2 groups after 3-year followed-up (P>0.05). The complication incidence after operation of laparoscopic surgery group was significantly lower than open operative group (P<0.05). The quality of life scores of patients in laparoscopic surgery group were significantly higher than those in open operative group on 7 days and in 3 months after operation, and the difference were statistically significant (P<0.05). Conclusion Compared with open operation, primary lesion resection combined with D2 lymph node dissection by laparoscopy in the treatment of elderly patients with advanced gastric cancer can efficiently possess the advantages including minimally invasive, shorter recovery time and less postoperative complications.
Objective To summarize selection of therapeutic method for isolated iliac aneurysms and analyze its advantages and disadvantages. Method The clinical data of 21 patients with isolated iliac aneurysms from January 2006 to January 2017 in this hospital were analyzed retrospectively. Results Four patients were treated with an open surgery such as the unilateral iliac prosthetic graft interposition, aorto-biiliac or aorto-bifemoral arterial bypass graft, ligation of internal iliac artery, etc.. Seventeen patients were treated with an endovascular treatment such as the unilateral iliac stent-grafts, bifurcated aortic stent-grafts, or coil embolization alone, etc.. One patient with ruptured isolated iliac aneurysms died during the endovascular repair, and the rest patients were cured after the operation. The average operative time was 2.83 h and 1.58 h, the average hospital stay was 17.5 d and 7.7 d respectively for the patients with the open surgery and the endovascular treatment. Except 1 case of type Ⅰ and 1 case of type Ⅱ endoleaks were found in the patients with the endovascular treatment, no complications such as the ureteral and intestinal injuries, the gluteal muscle claudication, and the sigmoid ischemia were found in all the patients. Seventeen cases were followed-up. The following-up rate was 85%. The following-up time was 1–60 months with an average of 22 months. During the following-up period, the grafts and stent grafts were patent and the aneurysm sac diameter was unchanged. The abscess of the iliac fossa occurred in 1 patient with systemic lupus erythematosus and improved after the symptomatic treatment. Two patients died of other diseases during the following-up period, and the rest had no obvious clinical symptoms. Conclusions Preliminary results of limited cases in this study show that endovascular repair and open surgery in treatment of appropriately selected patients with isolated iliac artery aneurysms is safe and effective. But in special situation, technical controllability of open surgery might be better than endovascular repair, treatment should be selected according to patient’s general condition and anatomy of aneurysm.
Objective To investigate the difference of effect between laparoscopic and open surgery in patients with traumatic rupture of spleen. Methods The literatures on comparison of laparoscopic and open surgery in patients with traumatic rupture of spleen were retrieved in PubMed, Web of Science, CNKI, Wanfang, and VIP databases from Jan. 2007 to Jan. 2017, and then Stata 12.0 software was applied to present meta-analysis. Results ① The condition during operation: compared with the OS group, operative time of the LS group was shorter [SMD=–0.71, 95% CI was (–1.12, –0.30), P=0.001] and intraoperative blood loss of the LS group was less [SMD=–1.53, 95% CI was (–2.28, –0.78), P<0.001]. ② The postoperative condition: compared with the OS group, the postoperative anal exhaust time [SMD=–2.47, 95% CI was (–3.24, –1.70), P<0.001], postoperative ambulation time [SMD=–2.97, 95% CI was (–4.32, –1.62), P<0.001], and hospital stay [SMD=–1.68, 95% CI was (–2.15, –1.21), P<0.001] of the LS group were all shorter. ③ The overall incidence of complications and the incidence of complications: on the one hand, compared with the OS group, patients in the LS group had a lower overall incidence of postoperative complications [OR=0.29, 95% CI was (0.19, 0.43), P<0.001]. On the other hand, compared with the OS group, patients in the LS group had lower incidences of infection [OR=0.27, 95% CI was (0.13, 0.55), P<0.001], ascites [OR=0.36, 95% CI was (0.13, 1.00), P=0.049], bleeding [OR=0.29, 95% CI was (0.10, 0.90), P=0.032], ileus [OR=0.34, 95% CI was (0.13, 0.90), P=0.030], incision fat liquefaction [OR=0.27, 95% CI was (0.08, 0.94), P=0.040], and incision rupture [OR=0.17, 95% CI was (0.03, 0.96), P=0.045]. However, there was no statistical difference on splenectomy fever [OR=0.41, 95% CI was (0.13, 1.27), P=0.123], pancreatic fistula [OR=0.40, 95% CI was (0.06, 2.63), P=0.343], liver function lesion [OR=0.36, 95% CI was (0.10, 1.34), P=0.127], and thrombosis [OR=0.33, 95% CI was (0.09, 1.22), P=0.097] between the 2 groups. Conclusions Laparoscopic surgery can not only significantly reduce the incidence of multiple complications of traumatic rupture of spleen, but also can speed up the recovery rate of postoperative recovery. Therefore, it is safe and beneficial in treatment of patients with traumatic rupture of spleen.
Objective To compare efficacy of laparoscopic surgery and open surgery in treatment of rectal cancer after neoadjuvant chemoradiotherapy. Methods The relevant literatures were retrieved from databases including CNKI, CBM, Wanfang, VIP, PubMed, Cochrane Library, and Embase from 2007 to 2017, all the relevant randomized controlled trial (RCT) or non-randomized controlled trial (NRCT) of laparoscopic surgery versus open surgery in patients with rectal cancer were collected according to the inclusion and exclusion criterial. Two reviewers independently screened the literatures, extracted the data, and assessed the bias risk of the included studies. Then, the meta-analysis was performed using RevMan 5.3 software. Results A total of 11 RCTs and 9 NRCTs involving 2 036 patients with rectal cancer were included, of these, including 1 021 cases of laparoscopic surgery and 1 015 cases of open surgery. The results of the meta-analysis showed that the operation time was increased ［WMD=14.21, 95% CI (1.92, 26.51)］, the intraoperative blood loss ［WMD=–38.96, 95% CI (–60.29, –7.63)］, first postoperative exhaust time ［WMD=–0.86, 95% CI (–1.14, –0.57)］, first postoperative intake food time ［WMD=–0.89, 95% CI (–1.15, –0.62)］, and postoperative hospitalization time ［WMD=–2.38, 95% CI (–3.44, –1.32)］ were reduced in the laparoscopic surgery as compared with the open surgery; the rate of the sphincter-saving was increased ［OR=2.35, 95% CI (1.67, 3.30)］, the rates of the local recurrence ［OR=0.25, 95% CI (0.13, 0.47)］, postoperative overall complications ［OR=0.34, 95% CI (0.26, 0.43)］, infection of incision ［OR=0.39, 95% CI (0.25, 0.62)］, intestinal obstruction ［OR=0.30, 95% CI (0.17, 0.53)］, lung infection ［OR=0.32, 95% CI (0.18, 0.57)］, and anastomotic fistula ［OR=0.40, 95% CI (0.22, 0.73)］ were decreased in the laparoscopic surgery as compared with the open surgery; the intraoperative lymph node resection ［WMD=–0.99, 95% CI (–2.11, 0.12)］, the rates of the 3-year disease-free survival ［OR=0.91, 95% CI (0.54, 1.54)］, pelvic infection ［OR=0.64, 95% CI (0.17, 2.45)］, anastomotic bleeding ［OR=0.54, 95% CI (0.22, 1.34)］, urinary retention ［OR=0.71, 95% CI (0.34, 1.48)］, and urinary tract infection ［OR=1.22, 95% CI (0.45, 3.30)］ had no significant differences between these two surgeries. Conclusion Laparoscopy surgery is still safer, more effective, and more reliable than conventional open surgery after neoadjuvant chemoradiotherapy in rectal cancer, but it needs more clinical RCTs to further provide accurate and reliable results.
ObjectivesTo systematically review the efficacy and safety of ultrasound-guided percutaneous microwave ablation versus traditional open surgical operation in the treatment of benign thyroid nodules.MethodsPubMed, The Cochrane Library, EMbase, CBM, CNKI and VIP databases were electronically searched to collect randomized controlled trials (RCTs) on ultrasound-guided percutaneous microwave ablation versus traditional open surgery for benign thyroid nodules from inception to June 30th, 2018. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Then, meta-analysis was then performed by RevMan 5.3 software.ResultsA total of 38 RCTs involving 4 078 patients were included. The results of meta-analysis showed that: ultrasound-guided percutaneous microwave ablation might be more effective than traditional open surgery for the treatment of benign thyroid nodules (RR=1.09, 95% CI 1.00 to 1.19, P=0.04), and compared with traditional open surgery, ultrasound-guided percutaneous microwave ablation reduced the rate of postoperative complication (RR=0.26, 95%CI 0.21 to 0.31, P<0.000 01), shortened postoperative hospital stay (MD=–3.60, 95%CI –4.04 to –3.15, P<0.000 01) and the time consumed in operation (MD=–48.79, 95%CI –54.16 to –43.41, P<0.000 01), and reduced operative blood loss (MD=–22.02, 95%CI–23.87 to –20.17, P<0.000 01). Meanwhile, microwave ablation reduced the elevated levels of serum IL-6 content (MD=–10.34, 95%CI –10.70 to –9.97, P<0.000 01), serum CRP content (MD=–9.70, 95%CI –10.95 to –8.44, P<0.000 01) and serum TNF-α content (MD=–7.94, 95%CI –9.00 to –6.88, P<0.000 01).ConclusionsCurrent evidence shows that ultrasound-guided percutaneous microwave ablation may improve clinical efficacy and can reduce postoperative complications, bleeding volume, operation time, hospitalization days and postoperative inflammatory reaction. Due to limited quality and quantity of the included studies, more high quality studies are required to verify above conclusions.
ObjectiveTo retrospective summarize the experience of endovascular repair and open surgery in the treatment of renal aneurysms in our single center.MethodsClinical data of 24 patients with renal aneurysm treated in our hospital from August 2012 to May 2018 were analyzed retrospectively. Nine patients undergoing surgical intervention were categorized as the open operation group, and ten patients who received endovascular repair were classified as the endovascular repair group. To compare and analyze the results of the two groups. Five patients who had refused surgery therapy will be analyzed separately.ResultsTwenty-four patients with seventeen females (70.8%) and seven males (29.2%) were enrolled in this study and nineteen patients with twenty-three aneurysms got repaired successfully. The endovascular repair group had shorter hospital stay compared with the open operation group [median: 10.5 (P25 6.3, P75 15.0) d vs. 21.0 (P25 17.0, P75 27.5) d］. One patient in the open operation group developed renal artery stenosis at 11 months after surgery and underwent reoperation by repair by successful stent placement. There were no other significant postoperative complications occurred in the two groups. No abnormal enlargement or rupture of the aneurysms were observed during the follow-up period in 5 unoperated patients.ConclusionsBoth open surgery and endovascular repair are effective means of treating renal artery aneurysms. Once the renal aneurysm ruptures, serious consequences will occur. Once a renal aneurysm is diagnosed, regardless of the size of the aneurysm, active surgical treatment is recommend.
ObjectiveTo assess the outcomes of laparoscopy-assisted surgery for treatment of advanced gastric cancer.MethodsA total of 115 patients with advanced gastric cancer were included between January 2014 and December 2018 were analyzed retroprospectively, the patients were divided into two groups: open surgery group (OS group, n=63) and laparoscopy-assisted surgery group (LAS group, n=52). Baseline characteristics, intraoperative parameters and postoperative items, and long-term efficacy were compared between the two groups.ResultsThere was no significant difference in preoperative baseline data including gender, age and preoperative serum parameters between the two groups (P>0.05). Intraoperative blood loss in the LAS group was significantly less than that in the OS group (P<0.05). In addition, the first feeding time after operation and postoperative hospital stay in the LAS group were significantly shorter than the OS group (P<0.05). Furthermore, numbers of white blood cells and neutrophils in the LAS group were fewer than that in the OS group at postoperative 2 days (P<0.05); the level of serum albumin in the LAS group was higher than that OS group (P<0.05). The number of lymph nodes detected during operation in the LAS group was more than that in the OS group (P<0.05). Operative time and occurrence of postoperative complications were not statistically significant between the two groups (P>0.05). One hundred and ten of 115 patients were followed- up, the follow-up rate was 95.7%. The follow-up time ranged from 6 to 48 months, with a median follow-up time of 12.4 months. The disease-free survival time of the OS group was 12.2±6.5 months, while that of the LAS group was 13.5±7.4 months. There was no significant difference between the two groups (P>0.05).ConclusionsLaparoscopic technique in treatment of advanced gastric cancer has the minimally invasive advantage, less intraoperative blood loss, less surgical trauma, and faster postoperative recovery in comparing to the traditional open surgery. Also the lymph node dissection is superior to open surgery. The curative effect is comparable to that of open surgery.