Introduction: Systematic lymphadenectomy and ligation of the feeding artery is extremely important when performing radical resection in colorectal cancer. However, vascular surgery via laparoscopy requires advanced sk...Introduction: Systematic lymphadenectomy and ligation of the feeding artery is extremely important when performing radical resection in colorectal cancer. However, vascular surgery via laparoscopy requires advanced skills and techniques;thus, this procedure needs to be simplified while maintaining quality of the surgery to make it a preferred technique for the surgeons. Methods: There were 49 patients who underwent laparoscopic sigmoidectomy or anterior resection till T2 level for sigmoid colon cancer and recto-sigmoid colon cancer. We analyzed short-term and long-term outcomes between stapling ligation and clipping ligation techniques used in these surgeries. Results: The mean volume of blood loss in the stapling ligation group was 12.8 ± 12.3 ml, which was significantly lower than 41.9 ± 71.2 ml of mean volume of blood loss in the clipping ligation group. There was no significant difference in the mean duration of surgery, the mean number of harvested lymph nodes, morbidity, recurrence, and 5-year relapse free survival rates between the 2 groups. Conclusions: This study demonstrates a surgical technique using staplers for vascular treatment of tumor-feeding arteries as a new technical improvement in laparoscopic colectomy for the treatment of early-stage colon cancer. We found that the described procedure was technically safe, simple, convenient, and oncologically valid.展开更多
Introduction: Myomectomy during cesarean section has long been a controversial subject. The increased risk of intraoperative hemorrhage and potential hysterectomy has led many teams to contraindicate it, postponing it...Introduction: Myomectomy during cesarean section has long been a controversial subject. The increased risk of intraoperative hemorrhage and potential hysterectomy has led many teams to contraindicate it, postponing it three to six months after delivery, thus giving more time for uterine involution, myoma shrinkage and reducing operative time and blood loss. Clinical Observation: We report the case of a polymyomectomy after use of a segmental tourniquet and bilateral ligation of the hypogastric arteries during a cesarean section for hemorrhagic placenta previa at the end of a spontaneous pregnancy of 28 weeks of amenorrhea in a 42-year-old nulliparous primigravida patient. Conclusion: Polymyomectomy during cesarean section is possible and requires knowledge of preventive hemostasis techniques and surgical experience.展开更多
Aim of the study is to comprehensively review the latest trends in laparoscopic complete mesocolic excision(CME) with central vascular ligation(CVL) for the multimodal management of right colon cancer. Historical and ...Aim of the study is to comprehensively review the latest trends in laparoscopic complete mesocolic excision(CME) with central vascular ligation(CVL) for the multimodal management of right colon cancer. Historical and up-to-date anatomo-embryological concepts are analyzed in detail,focusing on the latest studies of the mesenteric organ,its dissection by mesofascial and retrofascial cleavage planes,and questioning the need for a new terminology in colonic resections. The rationale behind Laparoscopic CME with CVL is thoroughly investigated and explained. Attention is paid to the current surgical techniques and the quality of the surgical specimen,yielded through mesocolic,intramesocolic and muscularis propria plane of surgery. We evaluate the impact on long term oncologic outcome in terms of local recurrence,overall and disease-free survival,according to the plane of resection achieved. Conclusions are drawn on the basis of the available evidence,which suggests a pivotal role of laparoscopic CME with CVL in the multimodal management of right sided colonic cancer: performed in the right mesocolic plane of resection,laparoscopic CME with CVL demonstrates better oncologic results when compared to standard non-mesocolic planes of surgery,with all the advantages of laparoscopic techniques,both in faster recovery and better immunological response. The importance of minimally invasive mesoresectional surgery is thus stressed and highlighted as the new frontier for a modern laparoscopic total right mesocolectomy.展开更多
BACKGROUND Quality control in colon cancer surgery is an ongoing debate ever since standardization proved to be highly efficient in improving survival in rectal cancer. Complete mesocolic excision(CME) is widely accla...BACKGROUND Quality control in colon cancer surgery is an ongoing debate ever since standardization proved to be highly efficient in improving survival in rectal cancer. Complete mesocolic excision(CME) is widely acclaimed as the new goldstandard in colon cancer resections, thus it is imperative to establish quality criteria of CME in order to make it easily understood and verified by surgeons worldwide. One simple and reproducible tool could be the measurement of arterial stumps postoperatively and a straightforward way to test its reliability is to test it in a comparative study between CME and non-CME surgery.AIM To validate arterial stump measurement as a surgical quality tool by comparing CME with conventional radical colectomies.METHODS This was a retrospective study, carried out on a prospective database. We collected data from two groups of patients, divided according to standard CME with D2 central vascular ligation(group A) and non-standardized surgery(group B). The two groups were compared with regard to the arterial stump length after right-and left-sided colectomies for colon cancer. The actual stump lengths of the ileocolic artery(ICA) and inferior mesenteric artery(IMA) were compared with their theoretical best D2 position of predicted ligation levels(D2 PLLs) for calculating the potential for improvement. Measurements on follow-up computed tomography scans were carried out by three observers. Pathological data were recorded(specimen length, lymph node yield) and correlated with stump length.RESULTS We analysed 58 colectomies. The stump lengths(mean ± SD) in group A were16.97 ± 4.77 mm for ICA and 31.70 ± 15.71 mm for IMA, whereas group B had 49.93 ± 20.29 mm for ICA and 67.24 ± 28.71 mm for IMA. Shorter lengths were obtained in group A, by a mean difference of 35.66 mm(χ~2 = 27.38, P < 0.001),which was significant for all types of colectomies. Except for a 5.85 ± 4.71 mm difference for right colectomies, all the ligations from group A significantly reached their potential height(0.26 ± 12.1展开更多
目的探究腹腔镜下全结肠系膜切除术联合肠系膜血管根部结扎治疗右半结肠癌的临床效果。方法回顾性选取于2015年5月至2017年3月在西京医院消化外科接受根治治疗的右半结肠癌患者80例,根据术式不同分为观察组、对照组,各40例。对照组接受...目的探究腹腔镜下全结肠系膜切除术联合肠系膜血管根部结扎治疗右半结肠癌的临床效果。方法回顾性选取于2015年5月至2017年3月在西京医院消化外科接受根治治疗的右半结肠癌患者80例,根据术式不同分为观察组、对照组,各40例。对照组接受开腹全结肠系膜切除术治疗,观察组接受腹腔镜下全结肠系膜切除术联合肠系膜血管根部结扎治疗。对比两组围术期指标及术前、术后1 d T淋巴细胞亚群、血清炎症指标水平,评估两组术后总并发症发生率、术后3年局部复发率及存活率。结果观察组手术时间、术中出血量、切口长度、术后肛门排气时间及术后住院时间均明显少于对照组,清扫淋巴结数目明显多于对照组,差异均有统计学意义(P<0.05)。术后1 d,两组患者CD4^(+)含量和CD4^(+)/CD8^(+)比率均较治术前降低,差异均有统计学意义(P<0.05),而两组术后1 d与术前相比以及两组间术后1 d比较CD8^(+)含量差异均无统计学意义(P>0.05);观察组术后1 d CD4^(+)含量和CD4^(+)/CD8^(+)比率明显高于对照组,差异均有统计学意义(P<0.05)。术后1 d,两组患者血清IL-6、HMGB1水平均比术前升高,但观察组血清IL-6、HMGB1水平明显低于对照组,差异均有统计学意义(P<0.05)。观察组术后总并发症发生率(5.00%)远低于对照组(22.50%),差异有统计学意义(P<0.05)。观察组术后3年局部复发率(17.50%)远低于对照组(40.00%),存活率(65.00%)远高于对照组(42.50%),差异有统计学意义(P<0.05)。结论腹腔镜下全结肠系膜切除术联合肠系膜血管根部结扎治疗右半结肠癌术后恢复快,可明显减轻机体炎症反应,且对机体免疫功能损伤小,并发症少,远期效果可观。展开更多
文摘Introduction: Systematic lymphadenectomy and ligation of the feeding artery is extremely important when performing radical resection in colorectal cancer. However, vascular surgery via laparoscopy requires advanced skills and techniques;thus, this procedure needs to be simplified while maintaining quality of the surgery to make it a preferred technique for the surgeons. Methods: There were 49 patients who underwent laparoscopic sigmoidectomy or anterior resection till T2 level for sigmoid colon cancer and recto-sigmoid colon cancer. We analyzed short-term and long-term outcomes between stapling ligation and clipping ligation techniques used in these surgeries. Results: The mean volume of blood loss in the stapling ligation group was 12.8 ± 12.3 ml, which was significantly lower than 41.9 ± 71.2 ml of mean volume of blood loss in the clipping ligation group. There was no significant difference in the mean duration of surgery, the mean number of harvested lymph nodes, morbidity, recurrence, and 5-year relapse free survival rates between the 2 groups. Conclusions: This study demonstrates a surgical technique using staplers for vascular treatment of tumor-feeding arteries as a new technical improvement in laparoscopic colectomy for the treatment of early-stage colon cancer. We found that the described procedure was technically safe, simple, convenient, and oncologically valid.
文摘Introduction: Myomectomy during cesarean section has long been a controversial subject. The increased risk of intraoperative hemorrhage and potential hysterectomy has led many teams to contraindicate it, postponing it three to six months after delivery, thus giving more time for uterine involution, myoma shrinkage and reducing operative time and blood loss. Clinical Observation: We report the case of a polymyomectomy after use of a segmental tourniquet and bilateral ligation of the hypogastric arteries during a cesarean section for hemorrhagic placenta previa at the end of a spontaneous pregnancy of 28 weeks of amenorrhea in a 42-year-old nulliparous primigravida patient. Conclusion: Polymyomectomy during cesarean section is possible and requires knowledge of preventive hemostasis techniques and surgical experience.
文摘Aim of the study is to comprehensively review the latest trends in laparoscopic complete mesocolic excision(CME) with central vascular ligation(CVL) for the multimodal management of right colon cancer. Historical and up-to-date anatomo-embryological concepts are analyzed in detail,focusing on the latest studies of the mesenteric organ,its dissection by mesofascial and retrofascial cleavage planes,and questioning the need for a new terminology in colonic resections. The rationale behind Laparoscopic CME with CVL is thoroughly investigated and explained. Attention is paid to the current surgical techniques and the quality of the surgical specimen,yielded through mesocolic,intramesocolic and muscularis propria plane of surgery. We evaluate the impact on long term oncologic outcome in terms of local recurrence,overall and disease-free survival,according to the plane of resection achieved. Conclusions are drawn on the basis of the available evidence,which suggests a pivotal role of laparoscopic CME with CVL in the multimodal management of right sided colonic cancer: performed in the right mesocolic plane of resection,laparoscopic CME with CVL demonstrates better oncologic results when compared to standard non-mesocolic planes of surgery,with all the advantages of laparoscopic techniques,both in faster recovery and better immunological response. The importance of minimally invasive mesoresectional surgery is thus stressed and highlighted as the new frontier for a modern laparoscopic total right mesocolectomy.
文摘BACKGROUND Quality control in colon cancer surgery is an ongoing debate ever since standardization proved to be highly efficient in improving survival in rectal cancer. Complete mesocolic excision(CME) is widely acclaimed as the new goldstandard in colon cancer resections, thus it is imperative to establish quality criteria of CME in order to make it easily understood and verified by surgeons worldwide. One simple and reproducible tool could be the measurement of arterial stumps postoperatively and a straightforward way to test its reliability is to test it in a comparative study between CME and non-CME surgery.AIM To validate arterial stump measurement as a surgical quality tool by comparing CME with conventional radical colectomies.METHODS This was a retrospective study, carried out on a prospective database. We collected data from two groups of patients, divided according to standard CME with D2 central vascular ligation(group A) and non-standardized surgery(group B). The two groups were compared with regard to the arterial stump length after right-and left-sided colectomies for colon cancer. The actual stump lengths of the ileocolic artery(ICA) and inferior mesenteric artery(IMA) were compared with their theoretical best D2 position of predicted ligation levels(D2 PLLs) for calculating the potential for improvement. Measurements on follow-up computed tomography scans were carried out by three observers. Pathological data were recorded(specimen length, lymph node yield) and correlated with stump length.RESULTS We analysed 58 colectomies. The stump lengths(mean ± SD) in group A were16.97 ± 4.77 mm for ICA and 31.70 ± 15.71 mm for IMA, whereas group B had 49.93 ± 20.29 mm for ICA and 67.24 ± 28.71 mm for IMA. Shorter lengths were obtained in group A, by a mean difference of 35.66 mm(χ~2 = 27.38, P < 0.001),which was significant for all types of colectomies. Except for a 5.85 ± 4.71 mm difference for right colectomies, all the ligations from group A significantly reached their potential height(0.26 ± 12.1
文摘目的探究腹腔镜下全结肠系膜切除术联合肠系膜血管根部结扎治疗右半结肠癌的临床效果。方法回顾性选取于2015年5月至2017年3月在西京医院消化外科接受根治治疗的右半结肠癌患者80例,根据术式不同分为观察组、对照组,各40例。对照组接受开腹全结肠系膜切除术治疗,观察组接受腹腔镜下全结肠系膜切除术联合肠系膜血管根部结扎治疗。对比两组围术期指标及术前、术后1 d T淋巴细胞亚群、血清炎症指标水平,评估两组术后总并发症发生率、术后3年局部复发率及存活率。结果观察组手术时间、术中出血量、切口长度、术后肛门排气时间及术后住院时间均明显少于对照组,清扫淋巴结数目明显多于对照组,差异均有统计学意义(P<0.05)。术后1 d,两组患者CD4^(+)含量和CD4^(+)/CD8^(+)比率均较治术前降低,差异均有统计学意义(P<0.05),而两组术后1 d与术前相比以及两组间术后1 d比较CD8^(+)含量差异均无统计学意义(P>0.05);观察组术后1 d CD4^(+)含量和CD4^(+)/CD8^(+)比率明显高于对照组,差异均有统计学意义(P<0.05)。术后1 d,两组患者血清IL-6、HMGB1水平均比术前升高,但观察组血清IL-6、HMGB1水平明显低于对照组,差异均有统计学意义(P<0.05)。观察组术后总并发症发生率(5.00%)远低于对照组(22.50%),差异有统计学意义(P<0.05)。观察组术后3年局部复发率(17.50%)远低于对照组(40.00%),存活率(65.00%)远高于对照组(42.50%),差异有统计学意义(P<0.05)。结论腹腔镜下全结肠系膜切除术联合肠系膜血管根部结扎治疗右半结肠癌术后恢复快,可明显减轻机体炎症反应,且对机体免疫功能损伤小,并发症少,远期效果可观。
