【摘要】 目的 评价在鼻烟壶及腕部行动静脉造瘘术的疗效。 方法 将2007年6月-2009年6月收治的156例肾功能衰竭患者随机分成两组，分别在鼻烟壶及腕部行动静脉造瘘术，术后经彩色超声随访其吻合口通畅情况，临床观察瘘管使用时间及其并发症。 结果 术后随访2年，鼻烟壶处行动静脉造瘘术的患者，瘘管术后1年初级通畅率及累积次级通畅率分别为76.9%、92.1%；术后2年初级通畅率及累积次级通畅率分别为57.9%、78.9%。而腕部组瘘管1年初级通畅率及累积次级通畅率分别为64.1%、81.3%；术后2年初级通畅率及累积次级通畅率分别为56.0%、76.0%。两组在术后1年初级通畅率及累积次级通畅率差异有统计学意义（Plt;0.01），术后2年初级通畅率及累积次级通畅率差异无统计学意义（Pgt;0.05）。 结论 鼻烟壶处行动静脉造瘘术的瘘管在短期内通畅率较腕部高，长期并无显著性差异。【Abstract】 Objective To evaluate the effect of artificial arteriovenous fistula between tabatiere anatomique and wrist. Methods From June 2007 to June 2009, 156 cases of renal failure were randomly divided into two groups, and underwent artificial arteriovenous fistula on tabatiere anatomique or wrist, respectively. The patency of the anastomotic stoma was observed via B ultrasonography. Results The patients were followed up for two years postoperative. After the operation, the primary patency was 76.9% at the first year and 57.9% at the second year in tabatiere anatomique group; cumulative secondary patency was 92.1% at the first year and 78.9% at the second in tabatiere anatomique group; primary patency was 64.1% at the first year and 56.0% at the second in wrist group; cumulative secondary patency was 81.3% at the first year and 76.0% at the second year in wrist group. The primary patency and cumulative secondary patency were significantly different between tabatiere anatomique group and wrist group at the first year postoperatively (Plt;0.01) and not significant at the second year postoperatively (Pgt;0.05). Conclusion Prophase patency of tabatiere anatomique is higher than that of wrist. There was no significant difference between them in a long term.
ObjectiveTo analyze the causes and prevention principles of hepatic venous hemorrhage during laparoscopic hepatectomy.MethodLiteratures about the causes and prevention of hepatic venous hemorrhage during laparoscopic hepatectomy were collected, and then made an review with our own clinical experience.ResultsIntraoperative hepatic venous hemorrhage was one of the most dangerous complications during laparoscopic hepatectomy. The main reasons for its occurrence included subjective and objective factors. Through accurate preoperative assessment, rigorous attitude during operation and superb surgical skills, intraoperative control of the prsessure difference between the internal and external veins, could significantly reduce the incidence of intraoperative venous bleeding. For the hepatic vein bleeding that had occurred, the correct evaluation and treatment during the operation could reduce the adverse effect on the surgical efficacy.ConclusionCorrectly understand the causes of hepatic venous hemorrhage during laparoscopic hepatectomy, prevent and manage various techniques before and during operation can carry out laparoscopic hepatectomy more safely.
ObjectiveTo explore the safety and feasibility of mixed approach laparoscopic anatomical left hepatectomy for left hepatolithiasis.MethodThe clinical data and follow-up results of 23 patients with left hepatolithiasis admitted to the Department of Hepatobiliary Pancreatic Surgery in Leshan People’s Hospital from June 2018 to June 2020 were retrospectively analyzed.ResultsAll 23 patients underwent anatomical left hepatectomy under laparoscopy. The median of total operation time was 185 min (153–460 min), the median of operation time of liver dissection was 110 min (90–125 min), the median of total blood loss during operation was 175 mL (100–800 mL), the median of blood loss from liver dissection was 120 mL (60–560 mL), blood transfusion was performed in 2 patients during operation. Postoperative day 1: median of AST was 75 U/L (32–437 U/L), median of ALT was 83 U/L (25–537 U/L),median of TBIL was 24 μmol/L (15.6–42.7 μmol/L); postoperative day 3: median of AST was 31 U/L (23–129 U/L),median of ALT was 27 U/L (14–108 U/L), median of TBIL was 13.5 μmol/L (10.4–24.3 μmol/L). Postoperative blood transfusion was performed in 1 patient, and the median of postoperative hospital stay was 7 days (5–20 days), median of postoperative extubation time was 2.5 days (2–5 days). Postoperative complications occurred in 3 patients. All 23 patients were followed up after the operation for median of 12 months (6–18 months). During the follow-up period, the patients had no special discomfort, no stone recurrence, reoperation, and death.ConclusionMixed approach laparoscopic anatomical left hepatectomy is safe and feasible in the treatment of left hepatolithiasis.
ObjectiveTo investigate the effect of the round ligament fissure approach in re-hepatectomy.MethodsA total of 40 patients with recurrence of hepatocellular carcinoma (HCC) who underwent re-hepatectomy in the Department of Hepatopancreatobiliary Surgery of Leshan People’s Hospital from June 2017 to August 2020 were collected and divided into two groups according to different surgical approaches: study group (transhepatic round ligament fissure approach) and control group (conventional surgical approach), 20 cases in each group. The perioperative general indicators, peripheral blood laboratory indicators, and complications of the two groups were compared.ResultsCompared with the control group, the operation time, postoperative drainage tube removal time, and postoperative hospital stay of study group were shortened, and intraoperative blood loss was reduced (P<0.05). Compared with preoperatively in the same group, postoperative TBIL and ALT levels of the two groups decreased, and HGF levels increased (P<0.05). There was no significant difference in the levels of TBIL, ALT, and HGF between the two groups before surgery (P>0.05); at 1 month after surgery, there was no significant difference in the levels of TBIL and ALT between the two groups (P>0.05), but the HGF level of the study group was higher than that of the control group at1 month after operation, the difference was statistically significant (P<0.05). The changes before and after operation of TBIL and ALT were similar between the two groups (P>0.05), but the rising value of HGF in the study group was higher than that of the control group (P<0.001). There was no death in the two groups during the perioperative period, and the total postoperative complications were not statistically different (P=0.677). There was no statistically significant difference in the postoperative follow-up results between the two groups in recurrence, metastasis, and death (P>0.05).ConclusionRe-hepatectomy through the round ligament fissure approach can reduce the amount of intraoperative blood loss, shorten the operation time, and reduce the damage to the residual liver, which has high safety.
Objective To evaluate the effectiveness and safety of early enteral nutrition (EN) versus total parenteral nutrition (TPN) after pancreaticoduodenectomy (PD). Methods Such databases as MEDLINE, EMbase, The Cochrane Library, CBM, VIP, CNKI were electronically searched to collect the randomized controlled trials (RCTs) about EN versus TPN after PD published from 2000 to March 2010. The quality of the included trials was assessed according to the inclusive and exclusive criteria, and the data were extracted and analyzed by using RevMan 5.0 software. Results A total of 4 RCTs involving 322 PD patients were included. The meta-analysis showed that the EN (the treatment group) was superior to the TPN (the control group) in the average postoperative hospital stay (MD= –2.34, 95%CI –3.91 to –0.77, Plt;0.05), the total incidence rate of complication (RR=0.75, 95%CI 0.57 to 0.99, P=0.04), the recovery time of enterocinesia (MD= –29.87, 95%CI –33.01 to –26.73, Plt;0.05) and the nutrition costs (MD= –30.51, 95%CI –35.78 to –25.24, Plt;0.05); there were no differences in mortality (RR=0.23, 95%CI 0.03 to 2.03, P=0.19), pancreatic leakage (RR=0.78, 95%CI 0.45 to 1.35, P=0.38), infectious complications (RR=0.71, 95%CI 0.43 to 1.18, P=0.19), non-infectious complications (RR=0.78, 95%CI 0.5 1 to 1.20, P=0.26) and postoperative serum albumin level (MD= –0.79, 95%CI –2.84 to 1.27, P=0.45). Conclusion Compared with total parenteral nutrition, the enteral nutrition used earlier after pancreatoduodenectomy shows significant advantages. But more reasonably-designed and double blind RCTs with large scale are expected to provide high quality proof.
ObjectiveTo compare the short- and long-term efficacy of artery-first approach pancreatico-duodenectomy (AF-PD) and standard approach pancreaticoduodenectomy (S-PD).MethodsThe PubMed, EMbase, The Cochrane Library, Web of Science, CBM, WanFang, and CNKI databases were searched, relevant literatures were included, and relevant data were extracted for meta-analysis.ResultsA total of 30 articles were included, including 2 750 cases underwent pancreaticoduodenectomy. The results of meta-analysis showed that in terms of short-term efficacy when compared with S-PD group, the AF-PD group had less intraoperative blood loss (WMD=–175.87, P<0.001), lower intraoperative blood transfusion rate (OR=0.36, P=0.002), higher R0 resection rate (OR=1.83, P<0.001), lower postoperative pancreatic leakage rate (OR=0.71, P=0.005), and shorter postoperative hospital stay (WMD=–2.69, P=0.007). However, there were no statistically significant differences in the operation time and overall postoperative complication rate between the two groups (P>0.05). In terms of long-term efficacy when compared with S-PD group, the AF-PD group had lower tumor local recurrence rate (OR=0.43, P=0.004) and tumor liver metastasis rate (OR=0.60, P=0.010), but had higher 1-year (OR=1.95, P=0.007), 2-year (OR=2.04, P<0.001), 3-year (OR=2.09, P=0.001), and 5-year (OR=2.06, P=0.003) overall survival rates, and there were no significant differences in the rates of lung metastasis and peritoneal metastasis between the two groups (P>0.05).ConclusionsAF-PD is better than S-PD in some short-term and long-term outcome indicators such as R0 resection rate, pancreatic leakage rate, overall survival rate, and so on. However, due to the limited quality of the included literatures, more high-quality studies are still needed to verify in the future.
Objective To investigate the application effect of LEER (less pain, early move, early eat, and reassuring) mode in laparoscopic pancreaticoduodenectomy (LPD). Methods The clinical data of patients who underwent LPD in our hospital from March 2020 to March 2022 were retrospectively analyzed. Forty patients treated with the traditional mode during the perioperative period were classified as the traditional group, and 47 patients treated with the LEER mode were classified as the LEER group. The perioperative indicators, inflammatory stress indicators, immune indicators, nutritional indicators and postoperative complications were compared between the two groups. Results The visual analogue scale (VAS) score and hospitalization cost of the LEER group were lower than those of the traditional group (P<0.05). The postoperative ambulation time, anal exhaust/defecation time, drainage tube removal time, time to normal diet and hospital stay in the LEER group were shorter than those of the traditional group (P<0.05). Compared with preoperative, the WBC count and C-reactive protein (CRP) level of patients in the two groups increased after operation, but the changes of WBC count and CRP level in the LEER group were smaller than those in the traditional group (P<0.05). The IgA, IgM and IgG levels of patients in the two groups were not statistically different before and after operation (P>0.05), and the postoperative IgA, IgM and IgG of patients in the LEER group were higher than those in the traditional group (P<0.05). The change values of IgM and IgG in the LEER group were smaller than those of the traditional group (P<0.05), but there was no statistical difference in the change value of IgA between the two groups before and after operation (P>0.05). Compared with preoperative value, postoperative prealbumin (PA) and lymphocyte (LYM) levels in the two groups were decreased (P<0.05). The postoperative PA and LYM levels in the LEER group were higher than those in the traditional group (P<0.05). but the change value of PA before and after operation in the LEER group was smaller than that in the traditional group (P<0.05). There was no statistical difference in the change of LYM between the two groups before and after operation (P>0.05). The incidence of postoperative complications in the LEER group was 8.5% (4/47), and that in the traditional group was 35.0% (14/40). The incidence of postoperative complication in the LEER group was significantly lower than that in the traditional group (P=0.002). Conclusion Applying LEER mode in LPD can promote postoperative recovery of the patients, reduce postoperative stress response, improve nutritional status and protect immunity in the patients.
ObjectiveThis meta-analysis aimed to systematically evaluate the feasibility and the safety of total laparoscopic pancreatoduodenectomy (TLPD) by comparing it with open pancreatoduodenectomy (OPD).MethodsWe searched the relative domestic and international data bases systematically, such as the Cochrane Library, Medline Database, SCI, CBM, VIP-data, CNKI-data, and WanFang Data. We selected case control studies or cohort studies, and used the Review Manager 5.3 to perform statistical analysis.ResultsIn total, thirteen single-center retrospective case-control studies were included, totally 808 patients involved, and there were 401 cases in the TLPD group and 407 cases in the OPD group. There were no significant difference in terms of the cumulative morbidity, incidence of the Clavien Ⅲ-Ⅴ complication, pancreatic fistula, B/C pancreatic fistula, biliary fistula, postoperative hemorrhage, pulmonary infection, and gastric emptying delay, as well as the ratio of secondary operation, mortality of perioperative period, the ration of R0 resection, and the number of lymph nodes dissected between the 2 groups (P>0.05). Although the operative time was significant longer, TLPD had significant superiority in terms of the amount of bleeding and blood transfusion during operation, the hospital stays after operation, the bowel function recovery time, the time to restart eating, and the time to reactivate (P<0.05).ConclusionIn terms of the relative complications and the parameters of oncology such as the ration of R0 resection, the number of lymph nodes dissected, both of the procedures are safe and feasible, while TLPD is more favorable to control operative bleeding and accelerate rehabilitation.
ObjectiveTo evaluate the short-term effectiveness of robotic distal pancreatectomy (RDP) and laparoscopic distal pancreatectomy (LDP) by meta-analysis.MethodsWe searched for manuscripts about RDP versus LDP form PubMed, The Cochrane Library, EMbase, CKNI, CBM, and WanFang Databases. The parallel quality assessment was selected according to the literature inclusion and exclusion criteria. Relevant data were extracted and meta-analysis was performed by using Revman 5.3 software.ResultsA total of 23 articles were included, and a total of3 487 patients enrolled who underwent pancreatic body resection. Meta-analysis results showed that compared with the LDP group, the RDP group had a longer operation time [MD=15.52, 95%CI was (0.60, 30.45), P=0.04], but the intraoperative blood loss was less [MD=–59.18, 95%CI was (–111.62, –6.73), P=0.03], the intraoperative spleen preservation rate was higher [OR=1.74, 95%CI was (1.02, 2.96), P=0.04], the intraoperative conversion to open rate was lower [ OR=0.45, 95%CI was (0.34, 0.60), P<0.000 01], and postoperative hospital stay was shorter [MD=–0.90, 95%CI was (–1.70, –0.10), P=0.03], while there were no significant differences in intraoperative blood transfusion rate [OR=0.88, 95%CI was (0.60, 1.30), P=0.52], incidence of postoperative overall complication [OR=0.88, 95%CI was (0.68, 1.13), P=0.32] and pancreatic leakage [OR=0.91, 95%CI was (0.72, 1.14), P=0.41], 90-day readmission rate [OR=1.32, 95%CI was (0.95, 1.83), P=0.10], and 90-day reoperation rate [OR=0.73, 95%CI was (0.40, 1.33), P=0.30].ConclusionsRDP has the advantages of less bleeding, low turnover rate, and short postoperative hospital stay. However, due to the quality limitations of the included studies, the above conclusions still need to be verified by more high-quality studies.
ObjectiveTo explore the clinical value and experience of enhanced recovery after surgery (ERAS) of “LEER” model with “less pain” “early move” “early eat” and “reassuring” as its ultimate goal in perioperative period of laparoscopic anatomical hepatectomy of patients with primary liver cancer.MethodsThe basic clinical data of 98 patients treated in our department from May 2017 to March 2020 who were diagnosed as primary liver cancer and underwent laparoscopic anatomical hepatectomy were retrospectively analyzed. The incidence of postoperative complications, postoperative recovery and patients’ satisfaction were compared between 40 patients managed with traditional model (traditional group) and 58 patients managed with measures of ERAS of “LEER” model (“LEER”-ERAS group).ResultsCompared with the traditional group, the “LEER”-ERAS group had lower postoperative pain scores (t=2.925, P=0.004), earlier postoperative anal exhaustion, bowel movement and normal diet (t=3.071, t=3.770, t=3.232, all P<0.005) , shorter time to postoperative off-bed activity (t=5.025, P<0.001) and earlier postoperative removal time of drainage tube (t=3.232, P=0.001). Postoperative hospital stay was shorter (t=4.831, P<0.001), the cost of hospitalization was lower (t=3.062, P=0.003), and the patient’s satisfaction with medical treatment was higher (χ2=9.267, P=0.002). There were no statistical difference in the operative time, intraoperative blood loss, rate of conversion to laparotomy, blocking time of porta hepatis, postoperative complications and postoperative adverse events between the two groups (P>0.05).ConclusionsCompared with the traditional model, the measures of ERAS of “LEER” model that applied to laparoscopic anatomical hepatectomy of patients with primary liver cancer, is safe and effective, and can relieve postoperative pain, accelerate postoperative rehabilitation, improve satisfaction of patients, shorten hospital stay, and reduce medical costs. It has further promotion and research value.