目的探讨在腹腔镜阑尾切除术（laparoscopic appendectomy，LA）中应用Lapro-Clip可吸收生物夹的优势。 方法回顾性分析2011年7月至2013年4月期间于秦皇岛市抚宁县人民医院微创外科施行LA术的294例阑尾炎患者的临床资料，对其效果进行分析和评价。 结果294例阑尾炎患者行LA术时，均采用Lapro-Clip可吸收生物夹（12 mm）处理阑尾及其系膜。所有患者术中出血均＜10 mL，手术时间13～48 min（平均24 min），住院时间为2～7 d（平均4 d）。术后均无切口感染、肠瘘、腹腔出血、粘连性肠梗阻等并发症发生。术后以电话随访294例，随访时间为3～12个月，平均6个月，均无腹胀、腹痛等并发症发生。 结论LA术中应用Lapro-Clip可吸收生物夹处理阑尾根部及其系膜的操作简单、安全，能节省手术时间。
ObjectiveThe low anterior resection syndrome (LARS) score is a simple and visual instrument assessing sphincter preserving surgery for low rectal cancer. The purpose of this study is to analyze the feasibility of using LARS score to assess the function after intersphincteric resection for low rectal cancer. MethodsBetween March 2013 and June 2015, 76 patients underwent sphincter preserving surgery for low rectal cancer, 23 cases underwent intersphincteric resection set as ISR group, the other 53 cases received low anterior resection set as LAR group. LARS score, Saito function questionnaire, Wexner score, and European organization for research and treatment of cancer (EORTC) quality of life questionnaire core 30 (QLQ-C30), questionnaire module for colorectal cancer (QLQ-CR29) were compared for the two groups. ResultsThere were 63.2 percent patients (48/76) appeared major LARS, 27.6 percent (21/76) minor LARS and 9.2 percent (7/76) no LARS, there were no statistically difference between the ISR and LAR groups (P=0.727), but the item of incontinence due to liquid stools appeared more obvious in ISR group (P=0.009). The items of faecel incontinence and sore skin for EORTC QLQ-CR29 were serious in ISR group (P < 0.05), the other item of EORTC QLQ-CR29 and EORTC QLQ-C30, Saito function questionnaire, Wexner score were similar between the two groups (all P > 0.05). ConclusionThe anal function after intersphincteric resection is non-inferior to the low anterior resection for low rectal cancer, but both can appear serious low anterior resection syndrome.
Objective To compare preventive effect between continuous dissecting suture and traditional interrupted suture, silver ion dressing and traditional dressing, on the incisional surgical site infection (SSI) after ostomy for colorectal surgery, and to explore the influencing factors of SSI. Methods ① Sixty patients underwent the firstly elective open ostomy for colorectal surgery, who were treated in Department of Colorectal Tumor Surgery and Department of Colorectal&Hernial Minimally Invasive Surgery of Shengjing Hospital from Mar. 2015 to Jan. 2016, were collected to equivalently divided into continuous dissecting suture group and traditional interrupted suture group randomly. ② Twenty-seven patients with emergency open ostomy for colorectal surgery, who were treated in Department of Colorectal Tumor Surgery and Department of Colorectal&Hernial Minimally Invasive Surgery of Shengjing Hospital from Jan. 2009 to Jun. 2015, as well as 33 patients with elective open ostomy for colorectal surgery, who were treated in the same 2 Departments from Jul. 2015 to May. 2016, were collected to equivalently divided into silver ion dressing group and traditional dressing group. ③ Clinical data of 184 patients with elective open ostomy for colorectal surgery who were treated in Department of Colorectal Tumor Surgery and Department of Colorectal&Hernial Minimally Invasive Surgery of Shengjing Hospital from Jan. 2009 to May. 2016 were collected to analyze the influencing factors of SSI after elective open ostomy for colorectal surgery. Results ① There was no significant difference in the incidence of SSI between continuous dissecting suture group (3.3%, 1/30) and traditional interrupted suture group (16.7%, 5/30), P=0.085. ② The incidence of SSI in silver ion dressing group (6.7%, 2/30) was significantly lower than that of traditional dressing group (30.0%, 9/30), P=0.020. ③ There were 28 patients (15.2%) of the 184 elective patients and 11 patients (40.7%) of the 27 emergency patients suffered from SSI after open ostomy for colorectal surgery, and the incidence of SSI in elective surgery group was lower than that of emergency surgery group (P=0.001). ④ Results of logistic regression model showed that, patients with body mass index (BMI) <25 kg/m2 had lower risk of SSI than patients with BMI≥25 kg/m2(OR=0.383, P=0.023), patients received permanent colostomy had higher risk of SSI than patients received protective ileostomy (OR=4.370, P=0.004), patients underwent Mile’s surgery had higher risk of SSI than patients received distal anastomosis (OR=4.406, P=0.005). Conclusions The ostomy is a high risk factor for incisional SSI after elective open ostomy for colorectal surgery, especially for the obesity patients and patients who receive colostomy. The using of silver ion dressing play an important role in preventing the incisional SSI.
ObjectiveTo compare anal function and quality of life between partial longitudinal resection of the anorectum and sphincter (PLRAS) and intersphincteric resection (ISR) for rectal cancer. MethodsNinety-nine cases of very low rectal cancer were classified as PLRAS group (n=23) and ISR group (n=76) according to different surgical method. Anal function was assessed by Saito function questionnaire and the Wexner scale in 6, 12, and 24 months after operation. At the same time, quality of life was assessed by European Organization for research and treatment of cancer quality of life questionnaire CR29 (EORTC-QLQ-CR29). Results①Anastomosis stenosis:compared with ISR group, the situation on anastomosis stenosis was worse in 6 months (P < 0.001) and 12 months (P=0.003) after operation, but didn't significantly differed in 24 months after operation (P=0.230).②Results of the Saito function questionnaire:compared with ISR group, there were higher incidence on stool fragmentation (P=0.016), dyschesia (P=0.008), and feces-flatus discrimination (P < 0.001) in PLRAS group in 6 months after operation, and the incidence of feces-flatus discrimination was still higher in 12 months (P=0.017), but there was no any significant difference in 24 months after operation (P > 0.05).③Results of Wexner scale:there were no statistical difference between the 2 groups at all recorded times (P > 0.05).④Results of EORTC-QLQ-CR29 questionnaire:in 6 months after operation, the scores of flatulence (P=0.003), faecal incontinence (P=0.043), and sexual interest in women (P=0.023) of PLARS group were lower than ISR group but higher in buttock pain (P=0.031) and dyspareunia (P=0.006). In 12 months after operation, the scores of flatulence (P=0.012) and sexual interest in women (P=0.017) were both lower than ISR group, but score of dyspareunia was higher (P=0.012). In 24 months after operation, there was no any significant difference (P > 0.05). ConclusionsPLRAS surgery have worse situation of anastomosis stenosis and sexual function in women than ISR surgery before 12 months after operation, but have analogous effect in 24 months after operation.
ObjectiveTo analyze the safety and feasibility of laparoscopic intersphincteric resection with stapled colo-anal anastomosis under direct vision for low rectal cancer. MethodsFrom January 2001 to March 2012, 138 patients were underwent intersphincteric resection for low rectal cancer, 45 cases of whom were received laparoscopic surgery and stapled colo-anal anastomosis (SCAA group), and the other 93 cases (55 open and 38 laparoscopic) of whom were received hand-sewn colo-anal anastomosis (HCAA group). The morbidity comparison only involed the data of relevant to the anastomosis. The anus functional outcomes, including those from the Saito function questionnaire and Wexner score, were compared and only involved the data of relevant to the laparoscope. Results①The anastomotic complications rates were similar for the fistula, bleeding, and rectal mucosal prolapse (P > 0.05); the rate of anastomosis leakage and the degree of anastomotic stricture in the SCAA group were significantly lower (or milder) than those in the HCAA group (P=0.001 and P=0.022, respectively).②As for the functional results, the incidence of dyschesia in the SCAA group was significantly lower than that in the HCAA group (P=0.016), and the other 7 items of Saito function questionnaire and Wexner score were similar between these two groups (P > 0.05). ConclusionsCompared with traditional intersphincteric resection for low rectal cancer, laparoscopic surgery with stapled colo-anal anastomosis could reduce the morbidity and the anus function is non-inferior to the former.