目的 探讨手助腹腔镜胰十二指肠切除术的技术路线。方法 笔者所在科室于2011年10月17日完成1例手助腹腔镜胰十二指肠切除术。术中采用术者双侧站位、左右侧对称戳孔的策略，站立于患者右侧，游离胃网膜左血管和胃左血管，包括清扫No.7、No.8和No.9淋巴结；站立于患者左侧，游离十二指肠环和清扫下腔静脉旁淋巴结。经手助切口直视下完成消化道重建。结果 上腹部正中手术切口长7cm；手术时间为420min；术中出血量约600ml。术后病理报告：送检胃、十二指肠和胰腺标本，十二指肠球部低级别神经内分泌癌，浸润至深肌层，胃及胰腺未受累；两端切缘未见癌细胞，肝十二指肠韧带淋巴结未见癌转移（0/2）；慢性胆囊炎。手术后患者生命体征平稳，术后第5天肛门排气，第7天排便。术后发生腹腔积液并感染，经保守治疗治愈。术后28d出院。结论 术者双侧站位、左右对称戳孔是手助腹腔镜胰十二指肠切除术的新模式，安全、可行、微创，值得进一步探索。
ObjectiveTo evaluate the curative effect of laparoscopic assisted and open D2 radical resection in treatment of advanced gastric cancer. MethodsThe clinical data of 76 cases performed by laparoscopic assisted D2 radical resection (laparoscopic group) and 104 cases performed by open operation (open group) from October 2010 to October 2012 in our center were retrospective analized.Operation related index, postoperative recovery, and extent of radical resection of tumor of 2 groups were compared. ResultsThe operative time of the laparoscopic group[(192.5±14.8) min]was longer than that open group[(171.5±16.5) min, P < 0.05].But the blood loss, postoperative drainage, length of incision, and hospital stay of the laparoscopic group were significantly less or shorter than those of open group (P < 0.05).There were no significant difference in postoperative complications and extent of radical resection of tumor between the 2 groups (P > 0.05).There were no residual tumor in distal margin and operatiive death case in both 2 groups. ConclusionComparing with open operation, the laparoscopic assisted surgery for advanced gastric cancer could achieve the same clinical outcomes, and obvious advantage of minimal invasion.
ObjectiveTo investigate the effect of lymph node size on the pathological stage of colorectal cancer patients and analyze the relation between lymph node size and prognosis. MethodsThe patients with colorectal cancer underwent elective surgery in the People’s Hospital of Xindu District from 2017 to 2021 were retrospectively collected. The visible and palpable lymph nodes were harvested and the routine histological examination was performed. The effect of lymph node size on the pathological stage and prognosis of colorectal cancer patients were analyzed. ResultsA total of 300 patients with colorectal cancer were enrolled, with harvested 4 442 lymph nodes. Among them, measurement of lymph node size was completed in 4 086 lymph nodes, 198 lymph nodes (108 patients) of whom were found to be positive. There were 1 360 small lymph nodes (diameter <3 mm), 32 lymph nodes (24 patients) of whom were positive. Among the 24 patients, only 4 patients when detecting large lymph nodes (diameter ≥3 mm) was negative, but which was positive when detecting small lymph nodes (diameter <3 mm). The results of logistic regression analysis showed that the lymph node diameter <3 mm had a lower probability of positive lymph node (lymph node diameter 3–6 mm as a reference, OR=0.49, P=0.015). After excluding 4 cases of subtotal colon resection and 4 patients with obvious abnormalities of lymph node, 292 cases were included to analyze the relation between the lymph node size and the number of detected lymph nodes, no correlation was found between the lymph node size and the number of detected lymph nodes in 292 integral patients or 106 patients with positive lymph node (r=0.148, P=0.075; r=–0.032, P=0.821). Moreover, no statistical difference of the lymph node size was found between the patients with ≥12 and <12 lymph nodes detected (P>0.05). However, in the 186 patients with negative lymph nodes, a positive correlation was found between the lymph node size and the number of detected lymph nodes (r=0.317, P=0.002), and lymph node diameter was significantly larger in the patients with ≥12 lymph nodes detected than in the patients with <12 lymph nodes detected (P=0.002). There were no statistical differences in the disease-free survival and overall survival among the patients with different lymph node sizes (<3 mm, 3–6 mm, and >6 mm) in both patients with positive and negative lymph nodes (P>0.05). ConclusionFrom the analysis results of this study, it is found that lymph node size has little effect on lymph node pathological staging, and no correlation between lymph node size and disease-free survival or overall survival is found in both patients with positive and negative lymph nodes.
Objective To evaluate the significance of serum colon cancer-specific antigen-2 （CCSA-2） in diagnosisof colorectal cancer （CRC）. Methods By using ELISA method， the serum CCSA-2 was measured from 105 patients with 5 kinds of diseases， including CRC， gastric cancer， inguinal hernia， acute appendicitis， and breast cancer， who weretreated in our hospital from Jul. to Dec. in 2008， and 20 health donors were enrolled in addition. The blood samples were collected on 3 days before surgery， but blood samples from patients with acute appendicitis were collected before emergencysurgery， blood samples of health donors were collected on 1 day before ELISA test. Results The level of serum CCSA-2 in CRC patients was （99.27±6.25） μg/L， which was significantly higher than those of other patients and health individuals〔（53.58±2.73） μg/L， t=48.29， P=0.000〕. Serum CCSA-2 at a cutoff of 73.96μg/L had a sensitivity of 100% （95% CI：100%-100%） and a specificity of 100% （95% CI：100%-100%） in separating CRC populations from all other indivi-duals by using receiver operator characteristic curve （ROC） analysis. As compared with carcinoembryonic antigen （CEA） and CA19-9， the serum CCSA-2 assay （at a cutoff of 73.96μg/L） was significantly more sensitive than CEA and CA19-9 assay in CRC detection （P＜0.01）. Serum CCSA-2 was not related with patients’ gender （P=0.81）， age （P=0.59）， TNM stage （P=0.85）， Dukes stage （P=0.63）， nuclear grade （P=0.44）， as well as expressions of multidrug resistance associated protein （P=0.33）， P-glycoprotein （P=0.72）， and topoisomeraseⅡ（P=0.95）， but higher in patients with colon cancer than those of patients with rectal cancer （P=0.02）. Conclusion Serum CCSA-2 may be a useful biomarker in diagnosis of CRC， and it may be only related to tumorigenesis， but is irrelated to tumor progression and chemotherapy.
Objective To evaluate the clinical application of hand assisted laparoscopic radical surgery for gastric cancer. Methods From June 2010 to September 2011，a series of 51 patients were undertook hand assisted laparoscopic D2 gastrectomy （hand assisted group），49 patients were undertook laparoscopic assisted D2 gastrectomy （laparoscopic group），the secure indexes of surgery effect in perioperative period were compared betwee two groups. Results The incision length was （6.82±0.33） cm and （5.74±1.11） cm （t=6.57，P=0.00），numbers of harvested lymph nodes were 16.10±5.11 and 14.16±3.60 （t=2.18，P=0.03），intraoperative bleeding was （249.40±123.40） ml and （251.00±90.40） ml （t=-0.74，P=0.94），operation time was （177.7±23.8） min and （188.1±16.9） min （t=-2.53，P=0.01），postoperative hospital stay was （11.12±5.02） d and （10.88±3.13） d （t=0.29，P=0.78） in the hand assisted group and in the laparoscopic group，respectively. One case of gastric atony happened in the hand assisted group，one case of gastric atony and incision infection happened in the laparoscopic group. No mortality case was found in two groups. Conclusions Hand assisted laparoscopic D2 gastrectomy is less difficult，and shorter operation time，and considerable treatment effection as compared with laparoscopic operation.
ObjectiveTo analyze short-term outcomes of hand assisted laparoscopic (HAL) D2 radical distal gastrectomy for gastric cancer and summarize clinical experiences. MethodsThe clinical data of 199 patients with gastric cancer undergoing D2 radical distal gastrectomy from December 2010 to December 2013 in this hospital were analyzed. HAL (HAL group, n=92) and traditonal open (TO group, n=107) D2 radical distal gastrectomy were performed. The operation time, incision length, intraoperative blood loss, number of lymph nodes harvested, postoperative hospital stay, and postoperative complications were compared between these two groups. ResultsThere was no residue of cancer cells at the surgical margin in the HAL group and the TO group. Compared with the TO group, the average incision length was obviously shorter (P < 0.01) and the average intraoperative blood loss was obviously less (P < 0.05) in the HAL group. The average operation time, the average number of lymph nodes harvested, and the average postoperative hospital stay had no significant differences between the HAL group and the TO group (P > 0.05). One case was died of unknown gastrointestinal bleeding in the HAL group and the TO group, respectively. The postoperative complication rate was 9.78% (9/92) in the HAL group and 11.21% (12/107) in the TO group, there was no significant difference (P > 0.05). ConclusionsHAL D2 radical distal gastrectomy for gastric cancer don't increase operation time. It has some advantages of minimal invasion and safety as compared with traditional open surgery.