Objective To explore application value of three-dimensional (3D) laparoscopic visualization during bariatric surgery. Methods From January 2015 to May 2017, 64 patients underwent laparoscopic bariatric surgery in our department were included. Among these cases, 19 patients underwent 3D laparoscopic sleeve gastrectomy, and 21 patients underwent two-dimensional (2D) laparoscopic sleeve gastrectomy. Thirteen patients underwent 3D laparoscopic Roux-en-Y gastric bypass, and 11 patients underwent 2D laparoscopic Roux-en-Y gastric bypass. The total operative time, the digestive tract reconstruction time, the intraoperative blood loss, the postoperative hospitalization stay, and the operative complications were analyzed statistically. Results The laparoscopic bariatric surgery were performed successfully in all the 64 patients, no case was converted to the laparotomy, and no 3D laparoscopy was converted to the 2D laparoscopy. The suture time of the gastric incisal margin was shorter and the intraoperative blood loss was less with the 3D laparoscopic sleeve gastrectomy as compared with the 2D laparoscopic sleeve gastrectomy (P<0.05), but the total operative time and the postoperative hospitalization stay had no significant differences and none of postoperative complications happened between these two modes (P>0.05). The total operative time, the time to make gastric pouch, the time of the gastro-jejunal anastomosis or jejunum-jejunum anastomosis, and the intraoperative blood loss with the 3D laparoscopic Roux-en-Y gastric bypass were significantly less than those with the 2D laparoscopic Roux-en-Y gastric bypass (P<0.05), but the postoperative hospitalization stay had no significant difference between these two modes (P>0.05). Conclusion Pre-liminary results of limited cases in this study shows that 3D laparoscope could provide 3D stereoscopic visualization, which facilitateto clearly identify anatomical structures, and be helpful to complex operations, and then might reduce operating time, both physicians and patients could benefit from it.
目的观察持续冲洗负压引流技术在腹部外科应用的临床效果。方法回顾性分析2006年1月至2011年3月期间我院将自制双套管实施持续冲洗负压引流技术应用于172例腹部外科患者的临床资料。结果全部患者的消化道瘘均治愈，瘘道愈合的平均时间为36 d。治疗过程中，1例患者出现上消化道出血，另1例出现腹腔出血，无腹腔感染、皮肤破溃感染、脓毒症等并发症。结论采用持续冲洗负压引流的双套管制作简单，经济有效，在腹部外科中对术后肠瘘、出血、胆汁漏及感染的防治具有重要临床意义。
Objective To analyse the clinico-pathological characteristics of young patients with colorectal cancer. Methods From January 1980 to January 2000, among 1 030 patients with colorectal cancer admitted for surgical treatment, 143 (13.9%) patients were ＜35 years of age. The clinicopathological data of these young patients were reviewed and compared with those of patients in the other age groups. Results In this series of young patients, males were predominat. Most of them were with poorly differentiated (37.8%) and muco-cellular (29.6%) adenocarcinoma. The mast common gross morphology was infiltrating type (56.6%) and colloid carcinoma type (31.5%). The majority of patients (89.5%) were in Dukes stage B and stage C. Conclusion The prognosis of young patients with colorectal cancer surgically treated is worse, due to the fact that most of them are in late stage and their cancers are worse in differentiation. To increase the awareness of cancer in the young is important for early diagnosis and treatment and better prognosis.
Objective To approach the clinical effect，feasibility， and advantages and disadvantages of laparoscopic liver resection for liver tumor. Methods The clinical data of 32 patients with liver tumor underwent laparoscopic liver resection from January 2009 to August 2011 in this hospital were analyzed retrospectively. Results The laparoscopic liver resection of 32 patients with liver tumor were performed successfully，including 23 cases of primary liver cancer，5 cases of metastatic liver，3 cases of liver hemangioma，1 case of focal liver nodular hyperplasia. Laparoscopic liver resection included left lateral lobectomy （Ⅱ＋Ⅲ segments） in 17 cases，left internal lobectomy （Ⅳ segment） in 2 cases （left lateral lobe was already removed），left hemihepatectomy （Ⅱ＋Ⅲ＋Ⅳ segments） in 8 cases，Ⅴsegmentectomy in 1 case，and Ⅵ segmentectomy in 1 case，and Ⅲ，Ⅳ，and Ⅴ segments hemihepatectomy in 3 cases. The average operation time of hepatectomy was 75-285 min with an average 215 min. Intraoperative bleeding was 115-760 ml with an average 365 ml. No complications such as bile leakage，hemorrhage，air embolism, and so on happened. The time of gastrointestinal function recovery was 1-3 d. The hospital stay was 5-11 d with an average 6 d. Thirty-one cases were followed-up，the follow-up time was 6-32 months with an average 18 months，except one case was died of tumor recurrence and metastasis in one year after operation，the rest were alive，no tumor recurrence and metastasis happened. Conclusions Laparoscopic liver resection for liver tumor has a small wound，less suffering，quick recovery，which is safe and feasible. The clinical effect is good．
Objective To discussion the surgical approach of laparoscopic resection of left hepatic lobe. Methods The clinical data of 86 patients with Intr- and extra-hepatic bile duct stones and liver hemangioma were analyzed retros-pectivly. Eighty-six patients underwent laparoscopic hepatectomy. Forty-nine cases underwent the left hepatic lobe resectionby the left longitudinal groove （left longitudinal groove group）， 37 cases underwent the left hepatic lobe resection by the first hepatic portal （first porta hepatis group）. The operative time， intraoperative bleeding volume， postoperative hospital stay， and postoperative complications of two kinds of operation were compared. Results The operative time and intraoperative bleeding volume of left longitudinal groove group were shorter or less than those of the first porta hepatis group 〔（142±123）min vs. （208±58）min，P＜0.05； （320.5±38.3）mL vs. （450.9±39.1）mL，P＜0.05〕. There were no statistically significant difference between the 2 groups in complication and hospitalization after operation （P＞0.05）. Conclusion The left hepatic lobe resection by the left longitudinal groove is more safe and fast.