Postoperative Anal Exhaust Time Research Articles

Para-aortic lymph node dissection with or without nerve-sparing in gynecological malignancies.

Para-aortic lymph node dissection (PALND) is a widely used treatment that causes many complications. This study is to evaluate the efficacy and safety of nerve-sparing para-aortic lymph node dissection (NSPALND) by comparing it with conventional PALND in gynecological malignancies and to prove whether locating the superior hypogastric plexus (SHP) can help reveal the para-aortic nerves. This is a retrospective study of the patients who underwent para-aortic lymphadenectomy from January 2020 to December 2022 at Zhejiang Cancer Hospital. All of them were divided into NSPALND and PALND groups according to whether or not nerve-sparing was performed. The surgical, functional and oncological outcomes were evaluated. There were 43 patients enrolled, of which, 20 patients underwent NSPALND and 23 patients underwent PALND. The para-aortic nerves were successfully revealed by locating the SHP in all 20 cases of NSPALND. The post-operative anal exhaust time in the NSPALND group was significantly shorter than that in the PALND group (2.5 vs. 4 days, p=0.006), and the incidence of acute intestinal obstruction in the NSPALND group was significantly lower than that in the PALND group (10% vs. 39%, p=0.029). There was no difference between the two groups in terms of catheterization duration, urinary retention, dysuria, as well as the number of lymph nodes removed and the para-aortic recurrence rate. NSPALND can significantly reduce the rate of acute intestinal obstruction and improve post-operative intestinal function. Locating the SHP and using it as an anatomical landmark to reveal the para-aortic nerves is feasible. Its exact clinical value needs to be further studied.

Comparison efficacy and safety of total laparoscopic gastrectomy and laparoscopically assisted total gastrectomy in treatment of gastric cancer.

The development of laparoscopic technology has provided a new choice for surgery of gastric cancer (GC), but the advantages and disadvantages of laparoscopic total gastrectomy (LTG) and laparoscopic-assisted total gastrectomy (LATG) in treatment effect and safety are still controversial. The purpose of this study is to compare the efficacy and safety of the two methods in the treatment of GC, and to provide a basis for clinical decision-making. To compare the efficacy of totally LTG (TLTG) and LATG in the context of radical gastrectomy for GC. Additionally, we investigated the safety and feasibility of the total laparoscopic esophagojejunostomy technique. Literature on comparative studies of the above two surgical methods for GC (TLTG group and LATG group) published before September 2022 were searched in the PubMed, Web of Science, Wanfang Database, CNKI, and other Chinese and English databases. In addition, the following search keywords were used: Gastric cancer, total gastrectomy, total laparoscopy, laparoscopy-assisted, esophagojejunal anastomosis, gastric/stomach cancer, total gastrectomy, totally/completely laparoscopic, laparoscopic assisted/laparoscopy assisted/laparoscopically assisted, and esophagojejunostomy/esophagojejunal anastomosis. Review Manager 5.3 software was used for the meta-analysis after two researchers independently screened the literature, extracted the data, and evaluated the risk of bias in the included studies. After layer-by-layer screening, 258 pieces of literature were recovered, and 11 of those pieces were eventually included. This resulted in a sample size of 2421 instances, with 1115 cases falling into the TLTG group and 1306 cases into the LATG group. Age or sex differences between the two groups were not statistically significant, according to the meta-analysis, however the average body mass index of the TLTG group was considerably higher than that of the LATG group (P = 0.01). Compared with those in the LATG group, the incision length in the TLTG group was significantly shorter (P < 0.001), the amount of intraoperative blood loss was significantly lower (P = 0.003), the number of lymph nodes removed was significantly greater (P = 0.04), and the time of first postoperative feeding and postoperative hospitalization were also significantly shorter (P = 0.03 and 0.02, respectively). There were no significant differences in tumor size, length of proximal incisal margin, total operation time, anastomotic time, postoperative pain score, postoperative anal exhaust time, postoperative anastomosis-related complications (including anastomotic fistula, anastomotic stenosis, and anastomotic hemorrhage), or overall postoperative complication rate (P > 0.05). TLTG and esophagojejunostomy are safe and feasible. Compared with LATG, TLTG has the advantages of less trauma, less bleeding, easier access to lymph nodes, and faster postoperative recovery, and TLTG is also suitable for obese patients.

Application of metal stent implantation with endoscope and X-ray fluoroscopy combined laparoscopic surgery in the treatment of acute left hemicolon cancer obstruction

BackgroundThis study aimed to conduct a case–control study of endoscopic and fluoroscopic metal stent placement combined with laparoscopic surgery versus conventional open Hartmann’s procedure in treating acute left-sided colon cancer obstruction. Additionally, the study aims to discuss the application value of endoscopic and X-ray-guided metal stent placement combined with laparoscopic surgery in the treatment of acute left-sided colon cancer obstruction.MethodsFrom June 2011 to December 2019, 23 patients with acute left-sided colon cancer obstruction who underwent metal stent implantation combined with laparoscopic surgery under endoscopy and X-ray fluoroscopy in Wenzhou Central Hospital were collected, and 20 patients with acute left-sided colon cancer obstruction who underwent traditional emergency open Hartmann’s surgery during the same period were selected as a control group. All patients were diagnosed with left colon obstruction by plain abdominal film and/or CT before the operation and colon adenocarcinoma by colonoscopic biopsy and/or postoperative pathology. The operation time, intraoperative blood loss, postoperative anal exhaust time, the success rate of one-stage anastomosis, postoperative hospital stay, and postoperative complications were compared between the two groups.ResultsThis study showed a significant difference in the therapeutic effect between the two groups. Compared with the traditional Hartmann’s operation group, the success rate of one-stage anastomosis in endoscopic and X-ray-guided metal stent placement combined with the laparoscopic operation group was significantly higher than that in the Hartmann’s operation group (P < 0.05). The overall incidence of postoperative complications and hospital stay were significantly lower in the observation group than in the Hartmann’s group (P < 0.05). Further subgroup analysis of the overall postoperative complication rate of the two groups showed that the traditional Hartmann’s operation group was more likely to have an incomplete intestinal obstruction (P < 0.05). This study also showed no significant differences between the two groups in operation time, intraoperative blood loss, number of harvested lymph nodes, and postoperative anal exhaust time (all P > 0.05). This study also found no significant differences between the two groups in overall survival rates or recurrence-free survival rates (all P > 0.05).ConclusionsThe comparison of the therapeutic effects of the two groups verified the feasibility of endoscopy combined with X-ray fluoroscopy metal stent placement in combination with laparoscopic surgery in the treatment of acute left-sided colon cancer obstruction. Compared with the traditional emergency open Hartmann’s procedure, metal stent implantation under endoscopy and X-ray fluoroscopy combined with laparoscopic surgery is more minimally invasive, safe, and effective. It avoids the traditional second or even third surgical trauma to effectively improve the quality of life of patients, so that patients can recover quickly after surgery.

Effect of Ultrasound-Guided Transversus Abdominis Plane Block Combined with Lornoxicam on Pain and Recovery Quality After Abdominal Surgery in Patients with Drug Addiction

Objective: This paper aims to analyze the analgesic effect of ultrasound-guided transversus abdominis plane block (TAPB) combined with non-steroidal anti-inflammatory analgesic drug lornoxicam on abdominal surgery in patients with a history of drug addiction. Methods: 32 patients aged 18–60 who underwent lower abdominal surgery in the First People’s Hospital of Liangshan Yi Autonomous Prefecture and Butuo County People’s Hospital of Liangshan Yi Autonomous Prefecture from January 2022 to March 2023 were selected, the patients must have drug abuse history for more than 1 year, with a history of drug withdrawal and relapse. The patients were divided into observation group and control group by the envelope method, with 16 cases in the observation group and 16 cases in the control group. Two groups of patients underwent ultrasound-guided bilateral transversus abdominis plane block after the operation. The observation group was treated with dexmedetomidine hydrochloride 1μg/kg + 0.25% ropivacaine hydrochloride 40ml, and the control group was treated with 40ml 0.9% sodium chloride injection, the two groups of patients returned to the ward after operation and given intravenous infusion of lornoxicam for relieving the pain. The visual analogue scale(VAS) score of postoperative pain, the times of rescue analgesia, the time of postoperative anal exhaust, the time of ambulation, nausea and vomiting, withdrawal symptoms, related adverse reactions, and hospitalization days were compared between the two groups. Results: The VAS score of postoperative pain in the observation group was significantly lower than that in the control group, P &lt; 0.05. Patients in the observation group used less postoperative rescue analgesics than those in the control group, P &lt; 0.05. For postoperative anal exhaust time, the difference between the two groups of patients was relatively small, and the time in the observation group was shorter, P &gt; 0.05. The time to get out of bed and the length of hospital stay were not significantly different between the control group and the observation group, P &gt; 0.05. The withdrawal symptoms of the patients in the observation group were better, P &lt; 0.05, nausea and vomiting, and other adverse reactions were lower in the control group, P &lt; 0.05. Conclusion: Ultrasound-guided transversus abdominis plane block combined with lornoxicam can be used to relieve pain in abdominal surgery for patients with drug addiction, which can effectively improve the therapeutic effect of patients and reduce the number of postoperative rescue analgesia. Thus, it has high clinical application value.

Laparoscopic versus open radical hysterectomy in FIGO 2018 early-stage cervical adenocarcinoma: Long-term survival outcomes after propensity score matching.

To compare the long-term survival outcomes of laparoscopic radical hysterectomy (LRH) and open radical hysterectomy (ORH) in International Federation of Gynecology and Obstetrics (FIGO) 2018 early-stage cervical adenocarcinoma. Based on the clinical diagnosis and treatment for cervical cancer in mainland China (Four C) database, the medical records of 1098 patients with FIGO 2018 early-stage cervical adenocarcinoma were retrospectively reviewed. Long-term and short-term survival outcomes of the two groups were compared using a multivariate Cox regression model and the log-rank method in the whole study population and after propensity score matching. There was no difference in disease-free survival (hazard ratio [HR] 0.921, 95% confidence interval [CI]: 0.532-1.595, p = 0.770) and overall survival (HR 1.168, 95% CI: 0.526-2.592, p = 0.702) between LRH (n = 468) and ORH (n = 468) in the risk-adjusted analysis. LRH resulted in significantly lower estimated blood loss (342.7 vs. 157.5 mL, p < 0.001) and shorter postoperative anal exhaust time (2.8 vs. 2.5 days, p < 0.001) in risk-adjusted analysis. The overall rates of intraoperative complications (2.4% vs. 4.3%, p = 0.100) and postoperative complications (7.5% vs. 6.2%, p = 0.437) showed no significant difference between the two groups. However, the LRH group had a significantly higher incidence of ureter injury (0.4% vs. 2.4%, p = 0.012) and great vessel injury (0.0% vs. 0.9%, p = 0.045) compared to the other group. No statistical variation in the site of recurrence was observed between the two groups (p = 0.613). LRH has comparable survival outcomes with ORH and was associated with earlier recovery in FIGO 2018 early-stage adenocarcinoma of the uterine cervix. However, the LRH group had higher risk of ureter injury and great vessel injury.

Emergency exploratory laparotomy and radical gastrectomy in patients with gastric cancer combined with acute upper gastrointestinal bleeding.

Gastric cancer (GC) is a prevalent malignant tumor worldwide and ranks as the fourth leading cause of cancer-related mortality. Upper gastrointestinal bleeding (UGIB) is a frequent complication of GC. Radical gastrectomy and palliative therapy are widely used surgical procedures in the clinical management of GC. This study intends to probe the clinical efficacy and safety of radical gastrectomy and palliative therapy on the basis of exploratory laparotomy in patients with GC combined with UGIB, hoping to provide valuable information to aid patients in selecting the appropriate surgical intervention. To investigate the clinical efficacy and safety of exploratory laparotomy + radical gastrectomy and palliative therapy in patients with GC and UGIB combined. A total of 89 GC patients admitted to the First Affiliated Hospital of the University of South China between July 2018 and July 2020 were selected as participants for this study. The 89 patients were divided into two groups: radical resection group (n = 46) treated with exploratory laparotomy + radical gastrectomy and Palliative group (n = 43) treated with palliative therapy. The study compared several variables between the two groups, including surgical duration, intraoperative blood transfusion volume, postoperative anal exhaust time, off-bed activity time, length of hospitalization, and incidence of complications such as duodenal stump rupture, anastomotic obstruction, and postoperative incision. Additionally, postoperative immune function indicators (including CD3+, CD4+, CD8+, CD4+/CD8+, and CD3+/HLADR+), immunoglobulin (IgG and IgM), tumor markers (CEA, CA199, and CA125), and inflammatory factors (IL-6, IL-17, and TNF-α) were assessed. The surgical efficacy and postoperative quality of life recovery were also evaluated. The patients were monitored for survival and tumor recurrence at 6 mo, 1 year, and 2 years post-surgery. The results indicated that the duration of operation time and postoperative hospitalization did not differ between the two surgical procedures. However, patients in the radical resection group exhibited shorter intraoperative blood loss, anus exhaust time, off-bed activity time, and inpatient activity time than those in the Palliative group. Although there was no substantial difference in the occurrence of postoperative complications, such as duodenal stump rupture and anastomotic obstruction, between the radical resection group and Palliative group (P > 0.05), the radical resection group exhibited higher postoperative immune function indicators (including CD3+, CD4+, CD8+, etc.) and immunoglobulin levels (IgG, IgM) than the Palliative group, while tumor markers and inflammatory factors levels were lower than those in the radical resection group. Additionally, surgical efficacy, postoperative quality of life, and postoperative survival rates were higher in patients who underwent radical gastrectomy than in those who underwent palliative therapy. Moreover, the probability of postoperative tumor recurrence was lower in the radical gastrectomy group compared to the palliative therapy group, and these differences were all statistically significant (P < 0.05). Compared to palliative therapy, exploratory laparotomy + radical gastrectomy can improve immune function, reduce the levels of tumor markers and inflammatory factors, improve surgical efficacy, promote postoperative quality of life recovery, enhance survival rates, and attenuate the probability of tumor recurrence.

Short-term efficacy of cholecystectomy plus bile duct T-tube drainage or choledochojejunostomy in the treatment of gallbladder cancer and its effects on median survival time and postoperative complications.

To explore the short-term efficacy of cholecystectomy plus bile duct T-tube drainage or choledochojejunostomy (CJ) in the treatment of gallbladder cancer (GC) and its effects on the median survival time and postoperative complications. The clinical data of 121 patients who underwent laparoscopic cholecystectomy (LC) in department of hepatobiliary surgery of the hospital from January 2018 to December 2018 were retrospectively analyzed. According to the adjuvant treatment methods, the patients were divided into 2 groups: the control group (n = 61, LC + bile duct T-tube drainage) and experimental group (n = 60, LC + CJ). The perioperative indicators, short-term efficacy, median survival time, postoperative complications and immune stress response were compared between the 2 groups of patients before and after propensity score matching. The surgical time, postoperative anal first exhaust time, and intraoperative blood loss in the experimental group were no different from those in the control group (P > .05), but the hospital stay was shorter than that in the control group (P < .05). There was no difference in the effective rate of treatment and median survival time between the 2 groups (P > .05). The total incidence rate of complications in the experimental group at 14 days after surgery was lower than that in the control group (P < .05). Day 3 after surgery, the levels of immunoglobulin M (IgM) and immunoglobulin G (IgG) of the experimental group were higher than those of the control group (P < .05), while the level of C-reactive protein (CRP) was lower than that of the control group (P < .05). Compared with bile duct T-tube drainage, LC + CJ in the treatment of GC can better shorten the postoperative hospital stay and reduce the postoperative complications and immune stress response, but and the median survival time of the 2 is similar, which can be promoted in clinical practice.

Efficacy and safety of preoperative chewing gum for undergoing elective surgery: A meta-analysis of randomised controlled trials.

This meta-analysis aimed to investigate the safety and feasibility of preoperative chewing gum in adult patients undergoing elective surgery. Postoperative chewing gum has been shown to be safe and effective for most surgeries, while the safety and efficacy of preoperative chewing gum are still controversial. A meta-analysis of randomised controlled trials was performed. This was a meta-analysis involving no people or animals. The literature search was performed in 9 databases from inception to July 2022. Randomised controlled trials that compared the safety and efficacy of preoperative chewing gum and preoperative chewing no gum in adult patients undergoing elective surgery were included. The study was reported in compliance with PRISMA statement. PROSPERO CRD42022330223. Fourteen trials involving 1433 adult patients who undergo elective surgery were pooled in this meta-analysis. The results showed that preoperative chewing gum group resulted in no significant difference in gastric pH (p=.13) and gastric fluid volume (p=.25) compared with non-gum-chewing group. In comparison with the non-gum-chewing group, the gum-chewing group was associated with shorter preoperative thirst score (p=.02), lower incidence of postoperative nausea (p=.0004), lower incidence of postoperative sore throat, lower incidence of postoperative hoarseness, lower postoperative pain score, shorter first postoperative anal exhaust time (p < .00001), shorter first postoperative defecation time (p < .00001) and shorter hospital days (p=.02). Preoperative chewing gum was associated with lower discomforts and complication rates, without increasing gastric pH and gastric fluid volume. This strategy may be an innovative, feasible and safe choice for elective surgery in adults. This study's results could be used as an evidence for the implementation of preoperative chewing gum in perioperative care for adult patients undergoing elective surgery.

Nutrition management by a multidisciplinary team for prevention of nutritional deficits and morbidity following esophagectomy

This study evaluated the effects of perioperative nutrition management by a multidisciplinary team on nutrition and postoperative complications of patients with esophageal cancer. A total of 239 patients with esophageal cancer who underwent esophagectomy and gastric conduit reconstruction for esophageal or esophagogastric junction cancer between February 2019 and February 2020 were included in the study. They were divided into the experimental group (120 patients) and the control group (119 patients) using the random number table method. Control group patients received routine diet management and experimental group patients received perioperative nutrition management by a multidisciplinary team. The differences of nutriture and postoperative complications between the two groups were compared. At 3 and 7 days after surgery, the experimental group patients had higher total protein and albumin levels (P<0.05), shorter postoperative anal exhaust time (P<0.05), lower incidence of postoperative gastrointestinal adverse reactions, pneumonia, anastomotic fistula, hypoproteinemia (P<0.05), and lower hospitalization costs (P<0.05) than the control group. Nutrition management by a multidisciplinary team effectively improved the nutriture of patients, promoted the rapid recovery of postoperative gastrointestinal function, reduced postoperative complications, and reduced hospitalization costs.

Effect of new-style anterior and posterior vaginal wall repair combined with modified ischial spine fascia fixation on patients with pelvic organ prolapse and their postoperative quality of life.

ObjectiveThis study aims to explore the effect of new-style anterior and posterior vaginal wall repair combined with modified ischial spine fascia fixation on patients with pelvic organ prolapse (POP) and their postoperative quality of life.MethodsA total of 88 patients with POP and elective surgery admitted to Anqing Hospital affiliated to Anhui Medical University from March 2018 to March 2021 were retrospectively analyzed. According to their surgical methods, patients were divided into an observation group [44 cases, all underwent new-style anterior and posterior vaginal wall repair combined with modified ischial spine fascia fixation (new-style APVR-modified ISFF)] and a control group [44 cases, all underwent traditional anterior and posterior vaginal wall repair combined with sacrospinous ligament fixation (traditional APVR- SLF)]. The perioperative indicators were compared between the two groups. The pelvic floor function, pelvic organ prolapse quantification (POP-Q) classification, and quality of life were observed before operation, 3 months after operation, and 6 months after operation. All patients were followed-up.ResultsCompared with the control group, the observation group had more advantages in intraoperative blood loss, operation time, urinary catheter indwelling time, postoperative anal exhaust time, and hospitalization time (P < 0.05). In terms of pelvic floor function, patients of both groups showed significant improvement at 3 months and 6 months after surgery (P < 0.05). In terms of quality of life, the two groups exhibited significant improvement at 6 months after surgery (P < 0.05). PFIQ-7, PFDI-20, and UDI-6P of the observational group were lower than those of the control group, while PISQ-12 was higher than that of the control group but all with no significant difference (P > 0.005). In addition, the total complication rate of the observation group was 2.27% (1/44), which was significantly lower than 22.73% (10/44) of the control group (P < 0.05).ConclusionNew-style APVR-modified ISFF can effectively treat POP and improve the quality of life of such patients, with less postoperative complications and high safety.

Clinical significance of half-hepatic blood flow occlusion technology in patients with hepatocellular carcinoma with cirrhosis.

BACKGROUNDMost patients with primary hepatocellular carcinoma (HCC) have a history of chronic hepatitis B and usually present with varying degrees of cirrhosis. Owing to the special nature of liver anatomy, the blood vessel wall in the liver parenchyma is thin and prone to bleeding. Heavy bleeding and blood transfusion during hepatectomy are independent risk factors for liver cancer recurrence and death. Various clinical methods have been used to reduce intraoperative bleeding, and the Pringle method is most widely used to prevent blood flow to the liver.AIMTo investigate the effect of half-hepatic blood flow occlusion after patients with HCC and cirrhosis undergo hepatectomy.METHODSThis retrospective study included 88 patients with HCC and liver cirrhosis who underwent hepatectomy in our hospital from January 2017 to September 2020. Patients were divided into two groups based on the following treatment methods: the research group (n = 44), treated with half-hepatic blood flow occlusion technology and the control group (n = 44), treated with total hepatic occlusion. Differences in operation procedure, blood transfusion, liver function, tumor markers, serum inflammatory response, and incidence of surgical complications were compared between the groups.RESULTSThe operation lasted longer in the research group than in the control group (273.0 ± 24.8 min vs 256.3 ± 28.5 min, P < 0.05), and the postoperative anal exhaust time was shorter in the research group than in the control group (50.0 ± 9.7 min vs 55.1 ± 10.4 min, P < 0.05). There was no statistically significant difference in incision length, surgical bleeding, portal block time, drainage tube indwelling time, and hospital stay between the research and control groups (P > 0.05). Before surgery, there were no significant differences in serum alanine transaminase (ALT), aspartate aminotransferase (AST), total bilirubin, and prealbumin levels between the research and control groups (P > 0.05). Conversely, 24 and 72 h after the operation the respective serum ALT (378.61 ± 77.49 U/L and 246.13 ± 54.06 U/L) and AST (355.30 ± 69.50 U/L and 223.47 ± 48.64 U/L) levels in the research group were significantly lower (P < 0.05) than those in the control group (ALT, 430.58 ± 83.67 U/L and 281.35 ± 59.61 U/L; AST, 416.49 ± 73.03 U/L and 248.62 ± 50.10 U/L). The operation complication rate did not significantly differ between the research group (15.91%) and the control group (22.73%; P > 0.05).CONCLUSIONHalf-hepatic blood flow occlusion technology is more beneficial than total hepatic occlusion in reducing liver function injury in hepatectomy for patients with HCC and cirrhosis.

Feasibility of Enhanced Recovery After Surgery Protocols Implemented Perioperatively in Endoscopic Submucosal Dissection for Early Gastric Cancer: A Single-Center Retrospective Study.

Background: Endoscopic submucosal dissection (ESD) for early gastric cancer (EGC) has advantages over traditional radical gastrectomy. We investigated whether enhanced recovery after surgery (ERAS) protocols are appropriate in the ESD perioperative period. Materials and Methods: We screened 129 consecutive patients, and 12 were excluded. All study patients underwent ESD for EGC. Of the 117 included patients, 57 received traditional perioperative care between January 2017 and December 2018, and 60 patients received perioperative care according to ERAS protocols between January 2019 and September 2020. The primary study endpoint was ESD-related complications. Secondary endpoints included the following postoperative parameters: anal exhaust time, incidence of nausea or vomiting, length of hospitalization, fever rate, abdominal pain on the visual analog scale (VAS), and reported perioperative satisfaction. Results: Complications were comparable between the 2 groups. In the ERAS group, no patients experienced delayed bleeding or perforation. One traditional group patient bled, and one perforated. Postoperative anal exhaust time, nausea or vomiting incidence, hospitalization, fever rate, and VAS pain scores were significantly lower, and perioperative satisfaction rate was significantly higher in the ERAS group. Conclusions: ERAS protocols are both feasible and safe for patients undergoing ESD. ERAS protocols enhance the advantages of ESD for EGC without increasing complications.

The Impact of Minimally Invasive Surgery on Treating Patients with Early Cervical Adenocarcinoma

Objective To explore the impact of minimally invasive surgery on treating patients with early cervical adenocarcinoma (CA). Methods From April 2016 to December 2019, patients with early CA and underwent surgery were prospectively included in this study. They were randomly divided into 2 groups: the minimally invasive surgery (MIS) group and conventional laparotomy (CL) group. The baseline characteristics, pathological features, surgical related parameters, serum tumor markers, complications and prognosis were analyzed and compared between the 2 groups. The risk factors for disease free survival (DFS) and overall survival (OS) were also analyzed with logistic regression analyses. Result The baseline characteristic and pathological features had no statistical difference between the 2 groups. The mean operation duration in MIS group was significantly longer than CL group (262.39 ± 34.98 vs 241.29 ± 36.98 min, P < 0.001). The intraoperative blood loss volume (189.87 ± 23.87 vs 306.87 ± 24.98 mL, P < 0.001), postoperative anal exhaust time (45.98 ± 4.39 vs 59.87 ± 4.87 days, P < 0.001), catheter removal time (18.29 ± 3.21 vs 21.53 ± 3.19 days, P < 0.001) and length of hospital stay (12.98 ± 2.09 vs 16.98 ± 2.32 days, P < 0.001) were significant lower in MIS group. The serum tumor markers decreased significantly postoperative in both groups with no different levels between the 2 groups. The incidence of complications had no difference between the 2 groups except lymphocysts (P = 0.023). After mean follow up time for 4.23 ± 0.34 years, the DFS rate and OS rate also had no statistical difference between the 2 groups (P = 0.069 and 0.151, respectively). Conclusion Extensive hysterectomy with MIS was equally efficacy and safe to CL.

Clinical Evaluation of Laparoscopic Surgery for Hirschsprung Disease Combined with Colorectal Anastomosis with a Stapling Technique in Infants.

Aim: To evaluate the effect of laparoscopic-assisted resection and colorectal anastomosis with a stapling technique in the treatment of Hirschsprung disease (HSCR) in infants. Methods: From June 2018 to January 2019, 25 cases of HSCR diagnosed by clinical examination and pathology were selected at the Children's Hospital, School of Medicine, Zhejiang University, China. All children were treated with standard laparoscopic-assisted transanal endorectal pull-through surgery (the modified Swenson technique). The short segment type and the typical type with a descending colon-rectum anastomosis were both included. The long segment type had an ascending colon-rectal anastomosis after ascending colon turnover. The colorectal anastomosis was divided into traditional manual anastomosis and straight intraluminal stapler (SIS) anastomosis. According to the different methods of anastomosis, the patients were divided into a traditional group and a SIS group. Age, gender, body weight, operation time, blood loss, postoperative anal exhaust and defecation time, postoperative hospitalization time, and postoperative short-term complications were analyzed retrospectively. Results: A total of 25 children were diagnosed with HSCR. There were 17 boys and 8 girls, and their average age was 10.20 months (interquartile range, 8.60-11.30). Their average body weight was 7.90 kg (interquartile range, 7.50-8.40). There were 17 cases of the typical type, 5 cases of the short segment type, and 3 cases of the long segment type. The different colorectal anastomosis methods were divided into 10 cases in the traditional group and 15 cases in the SIS group. There were no intraoperative complications, wound infections, or anastomotic fistula. Compared with the SIS group, children in the traditional group had an increased operative time (129.5 versus 103.00 minutes; P < .0001), increased intraoperative blood loss (20.00 versus 7.00 mL; P < .0001), increased postoperative hospitalization time (12.00 versus 9.00 days; P = .0003), and increased postoperative defecation time (18.40 versus 13.20 hours; P < .0001). After 6-12 months of follow-up, there was no anastomotic stenosis or enterocolitis in the SIS group. In the traditional group, 1 child had anastomotic stenosis, which improved 6 months after anal dilatation. One case of enterocolitis occurred 4 months after the operation and was cured after enema and infusion. Conclusion: Laparoscopic-assisted resection combined with colorectal anastomosis with the stapling technique in the treatment of HSCR in infants is feasible. It had a short operation time, less bleeding, less trauma, and a rapid recovery of postoperative intestinal function. The anastomosis was smooth, wide, and reliable, and anastomotic fistula and stenosis did not occur.

Meta-analysis of the efficacy of Da Vinci robotic or laparoscopic distal subtotal gastrectomy in patients with gastric cancer.

Background:Robotic-assisted gastrectomy has been used for treating gastric cancer since 2002. This meta-analysis was conducted to systematically evaluate the efficacy of Da Vinci robotic distal subtotal gastrectomy (RDG) or laparoscopic distal subtotal gastrectomy (LDG) in patients with gastric cancer.Methods:We conducted searches in domestic and foreign databases, and collected literature in Chinese and English on the efficacy of RDG and LDG for gastric cancer that have been published since the inception of the database. RevMan 5.4.1 was used for meta-analysis and drawing and Stata14.0 was used for publication bias analysis.Results:A total of 3293 patients in 15 studies were included, including 1193 patients in the RDG group and 2100 patients in the LDG groups respectively. The meta-analysis showed that intraoperative blood loss was significantly lower and the number of resected lymph nodes was higher in the RDG group compared to that in the LDG group. In addition, the times to first postoperative food intake and postoperative hospital stay were shortened, and there was a longer length of distal resection margin and prolonged duration of operation. No significant differences were found between the 2 groups with respect to the first postoperative anal exhaust time, length of proximal resection margin, total postoperative complication rate, postoperative anastomotic leakage rate, incidence of postoperative gastric emptying disorder, pancreatic fistula rate, recurrence rate, and mortality rate.Conclusion:RDG is a safe and feasible treatment option for gastric cancer, and it is non-inferior or even superior to LDG with respect to therapeutic efficacy and radical treatment.

Analysis of Postoperative Complications in Patients with Intestinal Obstruction Under Laparoscopic Information Technology

In order to explore the postoperative complications of laparoscopic adhesive release in the treatment of intestinal obstruction, 70 patients with adhesive intestinal obstruction (IO) who visited Banan District People’s Hospital on March 1, 2017 and received surgical treatment on June 30, 2019 were selected as the research objects. The patients were divided into an experimental group (EG) and control group (CG) using random number table, 35 cases in each group. The EG accepted laparoscopic adhesion release, while the CG accepted laparotomy. The time spent during the operation, intraoperative blood loss (IBL), intestinal injury rate and intestinal resection rate, postoperative anal exhaust (PAE) time, hospital stay, feeding time and concurrent symptoms were recorded and compared between the two groups. Multivariate Logistic regression (MLR) model was adopted for the correlation analysis between symptoms after laparoscopic surgery (LS) and basic characteristics of patients and intraoperative information. It was found that the time of LS, IBL, PAE time, hospital stay and feeding time of the EG are greatly lower than that of the CG (P &lt; 0.05). The number of cases of intestinal injury and intestinal resection in the EG was lower than that in the CG. The incidence of intestinal fistula, pulmonary infection, intestinal paralysis, incision infection, renal dysfunction and malnutrition in the EG was also lower than that in the CG. The regression coefficients of concurrent symptoms of LS and operative time and IBL were 0.376 and 0.343, respectively, showing a significant positive correlation (P &lt; 0.05), which indicated that compared with traditional laparotomy, laparoscopic technique can effectively reduce the occurrence of complicated intestinal fistula, pulmonary infection, intestinal paralysis, incision infection, renal dysfunction, malnutrition, and so on. At the same time, ligation and frequent replacement of surgical instruments should be avoided as far as possible during the operation, and the occurrence of concurrent symptoms can be effectively decreased by reducing the operation time, IBL, and postoperative recovery time of patients with IO.

Advantages of Da Vinci robotic-assisted surgical staging in the early stage of ovarian cancer without inverted position

Objective: To investigate the feasibility and efficacy of Da Vinci robotic-assisted surgery in the early stage of ovarian cancer without inverted position. Method: s A retrospective chart review of the patients with early stage ovarian cancer was performed in the First Affiliated Hospital of Zhengzhou University from October 2014 to October 2018. Patients with early stage ovarian cancer underwent robotic-assisted surgical staging: 26 patients underwent the inverted position approach (inverted group) and 32 received the non-inverted position approach (no-inverted group). The operation time, intraoperative bleeding volume, the number of lymph nodes resection, post-operative anal exhaust time, the average hospitalization days and complications between two groups were compared. Result: s Surgeries were successfully performed between both groups. (1) The perioperative related indicators: the operation time and the postoperative anal exhaust time in the inverted group were significantly longer than those in the no-inverted group [(208±33) minutes vs (158±32) minutes, P<0.01; (2.6±0.5) days vs (2.1±0.8) days, P<0.01, respectively]. There were no significant differences (all P>0.05) in the intraoperative bleeding volume, the average hospitalization days and the number of lymph nodes resection. (2) The comparison of the incidence of surgical complications: there were no significant difference (χ(2)=0.000, P>0.05) in the rate of lymphatic retention cyst [4% (1/26), 6% (2/32)]. Conclusions: Da Vinci robot system without inverted position in omentectomy is safe and feasible. Compared to the inverted position approach, it also provides remarkable advantages, including reduced operative time and faster return of bowel movement, but its long-term effects remain to be followed-up.

Effects of different concentrations of nalbuphine hydrochloride mixed with sufentanil for postoperative patient-controlled intravenous analgesia on inflammatory response in patients undergoing gynecological tumor laparotomy

Objective To evaluate the effects of different concentrations of nalbuphine hydrochloride mixed with sufentanil for postoperative patient-controlled intravenous analgesia (PCIA) on inflammatory response in the patients undergoing gynecological tumor laparotomy. Methods One hundred and twenty-five patients, aged 22-64 yr, weighing 50-75 kg, of American Society of Anesthesiologists physical status Ⅰ or Ⅱ, undergoing elective laparotomy for gynecologic tumors, were divided into 5 groups (n=25 each) by a random number table method: sufentanil 1 μg/ml group (group S), sufentanil 0.75 μg/ml + nalbuphine 0.25 mg/ml group (group N1), sufentanil 0.5 μg/ml + nalbuphine 0.5 mg/ml group (group N2) , sufentanil 0.25 μg/ml + nalbuphine 0.75 mg/ml group (group N3), and nalbuphine 1 mg/ml group (group N4). Postoperative PCA (granisetron 9 mg was added, the PCA solution was diluted to 150 ml in normal saline, a loading dose of 2 ml, background dose of 2 ml/h, a self-controlled dose of 1 ml/time, and a lockout interval of 15 min) was performed.Flurbiprofen 50 mg was intravenously injected for rescue analgesia, maintaining a static visual analog scale score ≤ 4 and a dynamic (cough) visual analog scale score ≤ 6.Venous blood samples were collected from the upper extremity before induction (T1), at 1 h after incision (T2), at the end of operation (T3), and at 24 and 48 h after operation (T4, 5) for determination of serum concentrations of interleukin-6(IL-6), tumor necrosis factor-alpha and IL-10.The effective pressing times of PCIA, requirement for rescue analgesia, development of nausea and vomiting and somnolence, and postoperative anal exhaust time were recorded within 24 h after surgery. Results Compared with group S, the concentrations of IL-6 and tumor necrosis factor-alpha in serum were significantly decreased, and the concentration of IL-10 was increased at T4, 5 in N1 and N2 groups, the anal exhaust time was significantly shortened, and the incidence of nausea and vomiting was decreased in the other groups, the effective pressing times of PCIA and requirement for rescue analgesia were significantly decreased in group N2, and the incidence of somnolence was significantly increased in group N4 (P<0.05). Conclusion Sufentanil 0.5 μg/ml plus nalbuphine hydrochloride 0.5 mg/ml provides good PCIA, effectively reduces inflammatory responses and decreases the occurrence of adverse reactions in the patients undergoing gynecological tumor laparotomy. Key words: Nalbuphine; Sufentanil; Femininity; Neoplasms; Analgesia, patient-controlled; Inflammation

Clinical effects and safety comparison of standard and single-port retroperitoneal laparoscopic surgery in the treatment of patients with upper ureteral calculi

Objective To investigate the influence of standard retroperitoneal laparoscopic surgery and single-port retroperitoneal laparoscopic surgery on clinical effects and safety of patients with upper ureteral calculi. Methods From April 2014 to April 2016, 120 elderly patients with upper ureteral calculi were chosen in our hospital and randomly divided into two groups including standard group(60 patients) with standard retroperitoneal laparoscopic surgery and single-port group (60 patients) with single-port retroperitoneal laparoscopic surgery, and the success rate of stone extraction, the perioperative clinical index, the clinical treatment satisfaction degree, the aesthetic score of incision and postoperative complications incidence of both groups were compared. Results There was no significant difference in the success rate of stone extraction between two groups(P>0.05). There was no significant difference in the operation time between two groups(P<0.05). The volume of intraoperative blood loss, the postoperative anal exhaust time, the postoperative drainage volume, the postoperative extubation time, hospital staying time of single-port group were significantly better than standard group(P<0.05). The clinical treatment satisfaction degree and the aesthetic score of incision of single-port group were significantly higher than standard group(P<0.05). The postoperative complications incidence of single-port group were significantly lower than standard group(P<0.05). There was no significant difference in the incidence of postoperative complications between two groups(P<0.05). Conclusions Compared with standard retroperitoneal laparoscopic surgery, single-port retroperitoneal laparoscopic surgery in the treatment of elderly patients with upper ureteral calculi can efficiently decrease the surgical trauma degree, accelerate the recovery process after surgery, improve the treatment satisfaction and incision aesthetic and be helpful to reduce the complications risk. Key words: Urinary Calculi; Aged; Laparoscopy

Clinical efficacy of laparoscopic versus open hepatectomy for the treatment of hepatocellular carcinoma

Objective To evaluate the clinical efficacy of laparoscopic hepatectomy and open hepatectomy for the treatment of hepatocellular carcinoma. Methods Two hundred and sixteen patients with hepatocellular carcinoma who were admitted to the Chongqing Three Gorges Central Hospital from October 2014 to December 2017 were enrolled in this study, 52 patients undergoing laparoscopic hepatectomy (laparoscopic group) and 164 patients undergoing open hepatectomy, 52 patients(open group) were matched by propensity score matching method to reduce confounding bias. The operation time, tumor sizes, resection margin, time of hepatic inflow occlusion, volume of blood loss, blood transfusion, postoperative complication rate, drainage tube removal time, postoperative anal exhaust time, duration of postoperative hospital stay and survival rates were compared. T test was used for the measurement data in line with the normal distribution, and the results were represented by (Mean±SD) tandard deviation; Wilcoxon test was used for the measurement data in the skewed distribution, and M(range) was used for represention, and the chi-square test or Fisher′s exact probability test was used for the counting data. Kaplan-meier method was used to describe the survival curve, and log-rank test was used to compare the survival rate. Cox regression model was used to evaluate the risk factors affecting the survival of patients with hepatocellular carcinoma. Results All patients were recovered with no perioperative death. The operation time, tumor sizes, resection margin, time of hepatic inflow occlusion were (226.1±67.5) min, (49.2±15.5) mm, (14.3±4.9) mm, (34.1±18.1) min and (227.0±55.7) min, (49.4±16.6) mm, (14.6±4.0) mm, (38.2±16.1) min, with no significant differences between the two groups(P>0.05). The volume of blood loss, blood transfusion, postoperative complication rate, drainage tube removal time, postoperative anal exhaust time, duration of postoperative hospital stay were 325(50-1 200) ml, 11.5%, 15.4%, (4.8±0.9) d, 3(2-5) d, (11.9±3.5) d and 375(100-2 000) ml, 19.2%, 23.1%, (5.9±0.8) d, 4(3-5) d, (14.9±6.2) d, with significant differences between the 2 groups(P 0.05). Cox regression analysis revealed that ICG R15, tumor size and tumor differentiation were independent risk factors of survival(hazard ratio>1, P<0.005). Conclusions Application of Laparoscopic hepatectomy for the treatment of selective hepatocellular carcinoma patients has better short-term efficacy than open hepatectomy and long-term efficacy is comparably. The propensity score matching can reduce confounding bias and have value for clinical research. Key words: Carcinoma, hepatocellular; Hepatectomy; Laparoscopes