Objective To summarize the experience of single incision laparoscopic colorectal surgery and to discuss the operative techniques. Methods The clinical data of 21 cases who underwent single incision laparoscopic colorectal surgery in Shengjing Hospital from Jan. 2010 to Jun. 2011 were collected and analyzed. Results Of 21 cases underwent single incision laparoscopic surgery， right hemicolectomy performed in 5 cases， sigmoidectomy performed in 2 cases， rectal anterior resection performed in 9 cases， rectal abdominoperineal resection performed in 2 cases， total colectomy performed in 1 case， and colostomy performed in 2 cases. Twenty cases completed by single incision， but 1 case was added an extra 12 mm incision in order to dissect the lower segment of rectum. The operative time was （189±75） min （40-335min）；the postoperative hospitalization time was （11.5±3.4） d （7-16d）. There were no bleeding， anastomosis leakage or intestinal obstruction after operation， and no incision infection， rupture or hernia were founded. No recurrence was found within 6 months’ follow up after operation. Conclusions Under reasonable selection of indication， single incision laparoscopic colorectal surgery is safe and feasible， and it also has a satisfactory cosmetic effect and better minimally invasive effect.
ObjectiveTo provide theoretical and technological support for further study of liver metabolism and disease by comparing the advantages and disadvantages of various artificial liver models (biological). MethodsLiteratures were searched and compared to summarize the requirement for liver donor, isolation, and culture of hepatocyte. ResultsIn the separation method of hepatocyte, mechanical separation method had no requirement for liver donor, and was easy to acquire hepatocyte, while the acquired hepatocyte would be destructed severely, and the survival rate was low. On the other hand, the restriction of the digestion of the hepatocytes to the liver cell samples was unlimited, while the key of the enzyme digestion method was to regulate the balance between enzyme concentration and digestion time, which was limited to function researches of hepatocyte, and research about the responds of hepatocyte against outside, and other few researches. Perfusion digestion method had been widely applied for animal test. The Ca2+, collagenase and perfusion rate, pH value, buffer, and intubation method all play vital roles. During the cultivation, we needed to choose different methods according to several experiments, and add different additives in the appropriate medium. Different biological reactors had different advantages, disadvantages, and applicable conditions. ConclusionsThe donor selection is based on various experimental purposes to harvest hepatocytes from different sources. Whether on the separation process or on the cultivation process, according to the specific circumstances, such as the concentration, perfusion time, and the choice of different kinds of culture medium, we can choose different kinds of bioreactors, but all kinds of methods are still remained with multiple insufficiencies, which require more researchers to improve.
ObjectiveTo compare clinical outcome between single-incision laparoscopic subtotal gastrectomy (SILSG) versus laparoscopy-assisted subtotal gastrectomy (LASG) in treatment of benign gastric ulcer and duodenal ulcer. MethodsClinical data of 37 patients with benign gastric ulcer or duodenal ulcer who underwent laparoscopic subtotal gastrectomy between Jan. 2008 and Feb. 2015 at Shengjing Hospital of China Medical University was collected retrospectively. Among them, 15 patients underwent SILSG and 22 patients underwent LASG. Demographic, intraoperative, and postoperative data was analyzed and compared between the 2 groups. ResultsThe operative time of SILSG group was significantly longer than that of LASG group (P < 0.050). However, the postoperative hospital stay was significantly shorter (P < 0.050), and the total patient scar assesment scale (PSAS) score was significantly lower (P < 0.050) in the SILSG group than those of LASG group. There was no significant difference between the 2 groups with respect to other variables (P > 0.050), such as conversion rate, intraoperative blood loss, postoperative exhaust time, incidence of complication, and visual analog scale score of pain. All patients received postoperative follow up, and the period ranged from 6 months to 25 months, with a median of 11 months. During the follow up period, no one suffered from incision hernia and recurrence of ulcer. ConclusionCompared with LASG, SILSG is a technically feasible procedure with better cosmesis and equivalent curability.
Objective To compare the clinicopathological features of hilar cholangiocarcinoma (HCCA) and hilar benign diseases, and then explore the value of carbohydrate antigen 19-9 (CA19-9) and carcinoembryonic antigen (CEA) in the differential diagnosis between them. Methods Clinical data of 65 patients (54 patients with HCCA and 11 patients with hilar benign diseases) who were diagnosed as HCCA and received treatment from January 2011 to October 2015 in our hospital were retrospectively analyzed. Comparison of clinical data of HCCA patients and patients with hilar benign diseases in age, gender, disease duration, clinical manifestation, laboratory examination, and imaging examination was performed, and the receiver operating characteristic curve (ROC) was used to explore the value of CA19-9 and CEA in differential diagnosis between hilar benign diseases and HCCA. Results The age, levels of serum CA19-9, CEA, alanine aminotransferase (ALT), total bilirubin (BILT), and direct bilirubin (BILD) of HCCA group were significantly higher than that in benign group (P<0.05). However, the gender, disease duration, clinical manifestations (including jaundice, abdominal discomfort, fever, and weight loss), serum aspartate aminotransferase (AST), serum alkaline phosphatase (ALKP), and imaging findings (including hilar mass, intrahepatic bile duct dilatation, thickening of the bile duct wall, lymph node enlargement, vascular invasion, and gallbladder invasion) had no significant difference between the 2 groups (P>0.05). The ROC curve results showed that, when cut-off point for CA19-9 was 233.15 U/mL, the sensitivity was 56% and specificity was 91%; when cut-off point for CEA was 2.98 ng/mL, the sensitivity was 61% and specificity was 90%. Conclusions For the differential diagnosis between HCCA and hilar benign diseases, the elderly patients with high levels of serum transaminase and bilirubin were more likely to be malignant. It is more likely to be malignant when the serum CA19-9>233.15 U/mL or CEA>2.98 ng/mL.
目的 探讨利用常规腹腔镜器械完成经脐单孔腹腔镜结直肠手术的可能性和技术要点。方法 收集中国医科大学附属盛京医院微创外科于2009年4月至2010年1月期间施行的12例经脐单孔腹腔镜结直肠手术的临床资料。阑尾炎8例，均为女性，平均年龄40岁； 回盲部肿物2例，均为女性，其中1例为回盲部淋巴水瘤（68岁），另1例为回盲部溃疡性结肠炎（47岁）； 乙状结肠息肉1例，女，55岁； 直肠癌1例，男，52岁。 12例均于脐部行2.5~3.0 cm长单切口，利用常规腹腔镜手术器械完成手术。结果 8例阑尾手术，手术时间20~50 min，出血量均少于10 ml； 2例回盲部切除术手术时间分别为60 min和90 min，出血量分别为10 ml和20 ml； 1例乙状结肠切除术用时120 min，术中出血约50 ml，术后4 d拔除引流管； 直肠癌手术时间210 min，术中出血少于200 ml，术后1周拔除引流管并出院。结论 利用常规腹腔镜手术器械完成经脐单孔腹腔镜结直肠手术安全可行。
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.
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.
ObjectiveTo summarize the procedure of transumbilical single incision laparoscopic surgery (SILS) with conventional laparoscopic instruments for different tumor diameter and different site of gastric stromal tumor. MethodThe clinical data, intraoperative procedure, and postoperative recovery of 34 patients with gastric stromal tumor from December 2009 to February 2014 in this hospital were analyzed retrospectively. ResultsThe transumbilical SILS was performed successfully in all the 34 patients.Among these patients, the wedge resection of stomach was perfor-med in 27 patients, distal subtotal gastrectomy was performed in 6 patients, distal subtotal gastrectomy complicated with multivisceral resection was performed in 1 patient.The pathology confirmed that the diameter of tumors was from 0.6 cm to 10.0 cm (average 3.4 cm).The resection margins were tumor free.The risk assessment showed that tumors with extremely low risk were in 9 cases, low risk were in 17 cases, intermediate risk were in 6 cases, high risk were in 2 cases.During surgery, 9 tumors were located on the fundus of stomach, 6 tumors on the gastric greater curvature, 7 tumors on the gastric lesser curvature, 2 tumors on the anterior and posterior wall of the stomach respectively, 3 tumors on the cardia below, 4 tumors on the gastric antrum, tumor invaded the surrounding organs in 1 case.There was no conversion to open or conventional laparoscopic surgery.no intraoperative or postoperative complications were experi-enced in all the patients except one was postoperative intraperitoneal bleeding and one was incision infection.All the patients were followed for an average of 25 months (range 3-49 months), there was no evident recurrence of disease. ConclusionsThe transumbilical SILS for gastric stromal tumor is a feasible and safe technique when performed by an experienced laparoscopic surgeon.The suitable procedure of SILS should be selected for gastric stromal tumor according their different size and location.