Objective To investigate the effects of hand assistant laporoscopic splenectomy plus pericardial devascularization on systemic stress responses. Methods Forty patients with cirrhotic portal hypertension were selected， 20 cases of which were underwent hand assistant laparoscopic splenectomy plus pericardial devascularization (LAP group)， and the other 20 were underwent open splenectomy plus pericardial devascularization (OP group). The levels of blood glucose （BG）, insulin (Ins), triiodothyronine （T3）, tetraiodothyronine （T4）, corticosteroid （CS） and other related clinical data were measured before operation and on day 1-3 after operation, which were compared between two groups. Results There was no statistical significance between two groups on those levels before operation. On day 1 after operation， BG and CS level in both two groups were higher than those before operation (P＜0.05), but they were recovered on day 2 after operation in LAP group (Pgt;0.05), and on day 3 after operation in OP group (Pgt;0.05). BG and CS level in OP group were markedly higher than those in LAP group on day 2 after operation (P＜0.05). On day 1 after operation， Ins, T3 and T4 level of two groups were lower than those before operation (P＜0.05), but they were recovered on day 2 after operation in LAP group (Pgt;0.05) and on day 3 after operation in OP group (Pgt;0.05). Ins, T3 and T4 level in OP group were lower than those in LAP group on day 2 after operation (P＜0.05). There was no significant difference in operation time between two groups (Pgt;0.05). But laparoscopic surgery had more advantages than conventional open surgery such as reducing bleeding quantity in operation, shortening recovery time of bowel and urinary bladder function and the length of stay. Conclusion Compared with laparotomy, the laparoscope not only imposes less impact on physical stress system, but also makes recovery after operation more quickly.
ObjectiveTo summarize the experience of colon interposition for esophageal replacement. MethodThe clinical data of 108 consecutive patients underwent colon interposition for esophageal replacement in our hospital between January 2005 and March 2013 were reviewed for benign and malignant lesions. Their ages ranged from 2 to 71 years (mean age at 34.3 years). There were 81 males and 27 females. ResultThere was no surgical death. Esophago-colic anastomotic insufficiency occurred in 7 patients. One case of graft necrosis was observed. Injury of recurrent laryngeal nerve occurred in 8 patients, incomplete intestinal obstruction in 2 patients, and wound infection of the abdominal wall in 1 patient, and deep venous thrombosis in 1 patient. In-hospital mortality was 15.7% (17/108). The postoperative follow-up was made for 12 months in 97 patients (91.5%) and all of them were alive. The patients' body weight and appetite improved. ConclusionColon interposition is a valuable alternative with a good long-term function.