Pub Date : 2019-09-20DOI: 10.3760/CMA.J.ISSN.1673-9752.2019.09.002
Jingang Liu
Nowadays, the incidence of obesity and related metabolic diseases is increasing around the world, which seriously endangers the human health and the quality of life. Obesity has become the most prominent public health issue in the time. With the rapid development of surgical treatment of obesity combined with type 2 diabetes mellitus, bariatric surgery has gradually evolved into a new important branch of upper gastrointestinal surgery or gastrointestinal surgery, that is bariatric and metabolic surgery. To date, bariatric surgery has entered in China since twenty years ago. Following the steps of the rapid development of bariatric and metabolic surgery in the world, bariatric surgery has embarked on a solid and steady journey of development through seizing the opportunity, finding the right direction. On the way forward in the past twenty years, Chinese bariatric and metabolic surgery has not only faced setbacks and confusion, but also gained experience and lessons; it has encountered bottlenecks in its development and provided evidences from China. The number of surgeons in bariatric surgery is still limited compared with a large number of obese people. Therefore, there will be opportunities and challenges coexisting in the future. How to continuously improve the therapeutic effect of surgery, train more professional practitioners, break through the bottleneck, and seek faster development will be an important research topic in metabolic and bariatric surgery with the scientific evidence-based medicine accumulating. Key words: Obesity; Type 2 diabetes mellitus; Bariatric surgery; Bariatric and metabolic surgery; Retrospect and prospect
{"title":"Retrospect of twenty years of development and prospect of bariatric and metabolic surgery in China","authors":"Jingang Liu","doi":"10.3760/CMA.J.ISSN.1673-9752.2019.09.002","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1673-9752.2019.09.002","url":null,"abstract":"Nowadays, the incidence of obesity and related metabolic diseases is increasing around the world, which seriously endangers the human health and the quality of life. Obesity has become the most prominent public health issue in the time. With the rapid development of surgical treatment of obesity combined with type 2 diabetes mellitus, bariatric surgery has gradually evolved into a new important branch of upper gastrointestinal surgery or gastrointestinal surgery, that is bariatric and metabolic surgery. To date, bariatric surgery has entered in China since twenty years ago. Following the steps of the rapid development of bariatric and metabolic surgery in the world, bariatric surgery has embarked on a solid and steady journey of development through seizing the opportunity, finding the right direction. On the way forward in the past twenty years, Chinese bariatric and metabolic surgery has not only faced setbacks and confusion, but also gained experience and lessons; it has encountered bottlenecks in its development and provided evidences from China. The number of surgeons in bariatric surgery is still limited compared with a large number of obese people. Therefore, there will be opportunities and challenges coexisting in the future. How to continuously improve the therapeutic effect of surgery, train more professional practitioners, break through the bottleneck, and seek faster development will be an important research topic in metabolic and bariatric surgery with the scientific evidence-based medicine accumulating. \u0000 \u0000 \u0000Key words: \u0000Obesity; Type 2 diabetes mellitus; Bariatric surgery; Bariatric and metabolic surgery; Retrospect and prospect","PeriodicalId":36400,"journal":{"name":"中华消化外科杂志","volume":"18 1","pages":"822-825"},"PeriodicalIF":0.0,"publicationDate":"2019-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44290588","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-09-20DOI: 10.3760/CMA.J.ISSN.1673-9752.2019.09.014
L. Bian, Danping Wu, Yigang Chen, Zhuiyang Zhang, Jianming Ni, Lei Zhang
Objective To explore the value of computed tomography angiography (CTA) and image fusion technology in preoperative evaluation of laparoscopic radical resection of rectal cancer. Methods The retrospective and descriptive study was conducted. The clinicopathological data of 60 patients who underwent laparoscopic radical resection of rectal cancer in the Affiliated Wuxi Second People′s Hospital of Nanjing Medical University from February 2018 to March 2019 were collected. There were 39 males and 21 females, aged from 45 to 81 years, with an average age of 67 years. All patients underwent abdominal multi-slice spiral computed tomography (CT) plain scan and dual-phase enhanced scan before operation. The original CT images were observed by multiplanar reconstruction and performed three-dimensional (3D) reconstruction of blood vessels by volume rendering. The CT images of arterial vessels with large density difference were abstracted by threshold segmentation and direct abstraction, and the CT images of venous vessels with small density difference were abstracted by region growing method. Then the 3D images of blood vessels were obtained after image fusion with red and blue pseudocolor added. All the 60 patients were performed laparoscopic radical resection of rectal cancer by the same surgical team, and were identified inferior mesenteric artery (IMA) and branches after being bared vessels, including anatomic course of left colonic artery (LCA), sigmoid artery (SA), and superior rectal artery (SRA). Observation indicators: (1) anatomic courses of IMA, LCA, SA, and SRA on the 3D images and their consistency with intraoperative anatomic courses; (2) the first branch of IMA and the distances from the root of IMA to the first branch and from the root of IMA to bifurcation point of the abdominal aorta on 3D images of blood vessels; (3) the spatial relationship between the horizontal level of LCA and the inferior mesenteric vein (IMV) on the 2D CT images and 3D images of blood vessels. Measurement data were represented as Mean±SD, and count data were represented as absolute numbers and percentages. Results (1) Anatomic courses of IMA, LCA, SA and SRA on the 3D images and their consistency with intraoperative anatomic courses: of the 60 patients, 31 (51.7%) had type Ⅰ anatomic course of IMA on the 3D images, with LCA and SA from the common trunk; 9 (15.0%) had type Ⅱ, with LCA and SA from the common trunk; 18 (30.0%) had type Ⅲ, with LCA, SA, and SRA from the common trunk; 2 (3.3%) had type Ⅳ, with no LCA. The consistency of anatomic courses of IMA, LCA, SA, and SRA on the 3D images with intraoperative anatomic courses of bared IMA, LCA, SA, and SRA was 100.0%(60/60). (2) The first branch of IMA and the distances from the root of IMA to its first branch and from the root of IMA to the bifurcation point of abdominal aorta on 3D images of blood vessels: of the 60 patients, 49 (81.7%) had LCA as the first branch of IMA, 11 (18.3%) had SRA or SA as
{"title":"Value of multi-slice spiral CT angiography and image fusion technology in preoperative evaluation of laparoscopic radical resection of rectal cancer","authors":"L. Bian, Danping Wu, Yigang Chen, Zhuiyang Zhang, Jianming Ni, Lei Zhang","doi":"10.3760/CMA.J.ISSN.1673-9752.2019.09.014","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1673-9752.2019.09.014","url":null,"abstract":"Objective \u0000To explore the value of computed tomography angiography (CTA) and image fusion technology in preoperative evaluation of laparoscopic radical resection of rectal cancer. \u0000 \u0000 \u0000Methods \u0000The retrospective and descriptive study was conducted. The clinicopathological data of 60 patients who underwent laparoscopic radical resection of rectal cancer in the Affiliated Wuxi Second People′s Hospital of Nanjing Medical University from February 2018 to March 2019 were collected. There were 39 males and 21 females, aged from 45 to 81 years, with an average age of 67 years. All patients underwent abdominal multi-slice spiral computed tomography (CT) plain scan and dual-phase enhanced scan before operation. The original CT images were observed by multiplanar reconstruction and performed three-dimensional (3D) reconstruction of blood vessels by volume rendering. The CT images of arterial vessels with large density difference were abstracted by threshold segmentation and direct abstraction, and the CT images of venous vessels with small density difference were abstracted by region growing method. Then the 3D images of blood vessels were obtained after image fusion with red and blue pseudocolor added. All the 60 patients were performed laparoscopic radical resection of rectal cancer by the same surgical team, and were identified inferior mesenteric artery (IMA) and branches after being bared vessels, including anatomic course of left colonic artery (LCA), sigmoid artery (SA), and superior rectal artery (SRA). Observation indicators: (1) anatomic courses of IMA, LCA, SA, and SRA on the 3D images and their consistency with intraoperative anatomic courses; (2) the first branch of IMA and the distances from the root of IMA to the first branch and from the root of IMA to bifurcation point of the abdominal aorta on 3D images of blood vessels; (3) the spatial relationship between the horizontal level of LCA and the inferior mesenteric vein (IMV) on the 2D CT images and 3D images of blood vessels. Measurement data were represented as Mean±SD, and count data were represented as absolute numbers and percentages. \u0000 \u0000 \u0000Results \u0000(1) Anatomic courses of IMA, LCA, SA and SRA on the 3D images and their consistency with intraoperative anatomic courses: of the 60 patients, 31 (51.7%) had type Ⅰ anatomic course of IMA on the 3D images, with LCA and SA from the common trunk; 9 (15.0%) had type Ⅱ, with LCA and SA from the common trunk; 18 (30.0%) had type Ⅲ, with LCA, SA, and SRA from the common trunk; 2 (3.3%) had type Ⅳ, with no LCA. The consistency of anatomic courses of IMA, LCA, SA, and SRA on the 3D images with intraoperative anatomic courses of bared IMA, LCA, SA, and SRA was 100.0%(60/60). (2) The first branch of IMA and the distances from the root of IMA to its first branch and from the root of IMA to the bifurcation point of abdominal aorta on 3D images of blood vessels: of the 60 patients, 49 (81.7%) had LCA as the first branch of IMA, 11 (18.3%) had SRA or SA as ","PeriodicalId":36400,"journal":{"name":"中华消化外科杂志","volume":"18 1","pages":"884-889"},"PeriodicalIF":0.0,"publicationDate":"2019-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47713357","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-09-20DOI: 10.3760/CMA.J.ISSN.1673-9752.2019.09.016
Tianyi Zhang
Cholecystolithiasis is one of the long-term complications after bariatric surgery, of which the exact cause is still unclear. Based on the recent domestic and international literature, the contributing factors for new onset cholecystolithiasis after bariatric surgery and countermeasures are reviewed in this article. Key words: Obesity; Cholecystolithiasis; Bariatric surgery; Bariatric and metabolic surgery; Long-term complications
{"title":"New onset cholecystolithiasis after bariatric surgery and countermeasures","authors":"Tianyi Zhang","doi":"10.3760/CMA.J.ISSN.1673-9752.2019.09.016","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1673-9752.2019.09.016","url":null,"abstract":"Cholecystolithiasis is one of the long-term complications after bariatric surgery, of which the exact cause is still unclear. Based on the recent domestic and international literature, the contributing factors for new onset cholecystolithiasis after bariatric surgery and countermeasures are reviewed in this article. \u0000 \u0000 \u0000Key words: \u0000Obesity; Cholecystolithiasis; Bariatric surgery; Bariatric and metabolic surgery; Long-term complications","PeriodicalId":36400,"journal":{"name":"中华消化外科杂志","volume":"18 1","pages":"893-896"},"PeriodicalIF":0.0,"publicationDate":"2019-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49542394","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Objective To investigate the clinical application value of symmetrical three-hole laparoscopic sleeve gastrectomy (LSG). Methods The retrospective and descriptive study was conducted. The clinical data of 232 patients with obesity who were admitted to Zhengzhou Central Hospital Affiliated to Zhengzhou University from April 2017 to December 2018 were collected. There were 40 males and 192 females, aged (32±8)years, with a range of 17-63 years. All the 232 patients underwent symmetrical three-hole LSG. Observation indicators: (1) surgical and postoperative conditions; (2) complications; (3) follow-up. Follow-up was conducted by telephone interview and WeChat to collect the patient satisfaction with cosmetic effects of wounds at 3 months after surgery up to March 2019. Measurement data with normal distribution were expressed as Mean±SD. Count data were expressed as absolute numbers or percentages. Results (1) Surgical and postoperative conditions: of the 232 patients, 230 underwent symmetrical three-hole LSG successfully, without conversion to open surgery. Two patients had one puncture hole added due to spleen bleeding to help pull the omentum to stop bleeding, and no spleen hemorrhage recurred after improving the surgical procedure. Of the 232 patients, the operation time, volume of intraoperative blood loss, and duration of postoperative hospital stay were (115±7)minutes, (10±5)mL, and (3.0±0.8)days. (2) Complications: of the 232 patients, 10 had postoperative complications of fat liquefaction in the umbilical incision, and were cured after repeated dressing changes. All patients had no serious complications such as gastrointestinal bleeding, abdominal bleeding, or gastric fistula. (3) Follow-up: of the 232 patients, 230 undergoing successful symmetrical three-hole LSG were followed up for 3 months. Of the 230 patients, 3 were dissatisfied with the cosmetic effects of wounds, 12 were satisfied, and 215 were very satisfied. The satisfaction rate was 98.70%(227/230). Conclusion Symmetrical three-hole LSG is safe and feasible, with a good cosmetic effects of wounds. Key words: Obesity; Bariatric surgery; Bariatric and metabolic surgery; Symmetrical three-hole method; Sleeve gastrectomy; Laparoscopy
{"title":"Clinical application value of symmetrical three-hole laparoscopic sleeve gastrectomy","authors":"Lei Gao, Yangxi Hu, Desheng Hu, Ying Li, Mutian Niu, Hansong Liu, Huali Meng","doi":"10.3760/CMA.J.ISSN.1673-9752.2019.09.009","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1673-9752.2019.09.009","url":null,"abstract":"Objective \u0000To investigate the clinical application value of symmetrical three-hole laparoscopic sleeve gastrectomy (LSG). \u0000 \u0000 \u0000Methods \u0000The retrospective and descriptive study was conducted. The clinical data of 232 patients with obesity who were admitted to Zhengzhou Central Hospital Affiliated to Zhengzhou University from April 2017 to December 2018 were collected. There were 40 males and 192 females, aged (32±8)years, with a range of 17-63 years. All the 232 patients underwent symmetrical three-hole LSG. Observation indicators: (1) surgical and postoperative conditions; (2) complications; (3) follow-up. Follow-up was conducted by telephone interview and WeChat to collect the patient satisfaction with cosmetic effects of wounds at 3 months after surgery up to March 2019. Measurement data with normal distribution were expressed as Mean±SD. Count data were expressed as absolute numbers or percentages. \u0000 \u0000 \u0000Results \u0000(1) Surgical and postoperative conditions: of the 232 patients, 230 underwent symmetrical three-hole LSG successfully, without conversion to open surgery. Two patients had one puncture hole added due to spleen bleeding to help pull the omentum to stop bleeding, and no spleen hemorrhage recurred after improving the surgical procedure. Of the 232 patients, the operation time, volume of intraoperative blood loss, and duration of postoperative hospital stay were (115±7)minutes, (10±5)mL, and (3.0±0.8)days. (2) Complications: of the 232 patients, 10 had postoperative complications of fat liquefaction in the umbilical incision, and were cured after repeated dressing changes. All patients had no serious complications such as gastrointestinal bleeding, abdominal bleeding, or gastric fistula. (3) Follow-up: of the 232 patients, 230 undergoing successful symmetrical three-hole LSG were followed up for 3 months. Of the 230 patients, 3 were dissatisfied with the cosmetic effects of wounds, 12 were satisfied, and 215 were very satisfied. The satisfaction rate was 98.70%(227/230). \u0000 \u0000 \u0000Conclusion \u0000Symmetrical three-hole LSG is safe and feasible, with a good cosmetic effects of wounds. \u0000 \u0000 \u0000Key words: \u0000Obesity; Bariatric surgery; Bariatric and metabolic surgery; Symmetrical three-hole method; Sleeve gastrectomy; Laparoscopy","PeriodicalId":36400,"journal":{"name":"中华消化外科杂志","volume":"18 1","pages":"854-858"},"PeriodicalIF":0.0,"publicationDate":"2019-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45322827","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Objective To evaluate the application value of quantitative computed tomography for evaluation of changes in abdominal fat after laparoscopic Roux-en-Y gastric bypass in obese patients. Methods The retrospective and descriptive study was conducted. The clinical data of 52 obese patients who underwent laparoscopic Roux-en-Y gastric bypass in the Third Medical Center of Chinese PLA General Hospital from March 2011 to February 2012 were collected. There were 24 males and 28 females, aged (43±9)years, with the range of 23-62 years. All the 52 patients underwent laparoscopic Roux-en-Y gastric bypass. Observation indicators: (1) surgical and postoperative conditions; (2) changes in anthropometric indices; (3) follow-up. Follow-up using outpatient examination was performed to detect complications of patients at 1, 3, 6, 12 months after surgery up to February 2013. Measurement data with normal distribution were represented as Mean±SD, repeated measurement data were analyzed using repeated ANOVA. Count data were represented as absolute numbers. Results (1) Surgical and postoperative conditions: all the patients underwent laparoscopic Roux-en-Y gastric bypass successfully, without conversion to open surgery. The volume of intraoperative blood loss, operation time, and duration of hospital stay were (25±11)mL, (78±14)minutes, and (11±2)days. (2) Changes in anthropometric indices: the body mass index (BMI), fat mass, free fat mass, total abdominal fat volume (TAFV), total subcutaneous fat volume (TSFV), and total visceral fat volume (TVFV) of all the 52 patients were (31.8±1.8)kg/m2, (39.4±4.1)kg, (50.2±6.0)kg, (11 703±3 899)cm3, (7 418±2 969)cm3, and (4 314±1 692)cm3 before surgery, (28.5±1.4)kg/m2, (33.0±1.1)kg, (49.7±4.6)kg, (11 016±3 713)cm3, (7 044±2 970)cm3, (3 969±1 443)cm3 at 3 months after surgery, (27.1±1.7)kg/m2, (30.2±1.3)kg, (45.4±3.1)kg, (9 406±4 452)cm3, (6 442±3 307)cm3, and (2 964±1 694)cm3 at 6 months after surgery, (24.4±2.4)kg/m2, (32.6±1.1)kg, (48.6±2.7)kg, (7 612±3 029)cm3, (5 623±2 650)cm3, and (1 826±360)cm3 at 12 months after surgery, respectively, there were significant differences in the changes of these indices (F=130.2, 30.3, 4.9, 25.6, 11.9, 16.5, P 0.05). The BMI, fat mass, TAFV, and TVFV at 6 months after surgery had significant differences compared with those before surgery (P 0.05). The BMI, fat mass, TAFV, TSFV, and TVFV at 12 months after surgery had significant differences compared with those before surgery (P 0.05). (3) Follow-up: all the 52 patients have completed the follow-up after surgery and the remission number of obesity was 35. No complications such as anastomotic hemorrhage, obstruction, or anastomotic leakage occured in all the 52 patients. Conclusion Laparoscopic Roux-en-Y gastric bypass can reduce abdominal visceral fat significantly, while quantitative computed tomography can help to evaluate the distribution of abdominal visceral fat accurately. Key words: Obesity; Gastric bypass su
{"title":"Application value of quantitative computed tomography for evaluation of changes in abdominal fat after laparoscopic Roux-en-Y gastric bypass in obese patients","authors":"Hui Han, Chenxin Zhang, Xiao-guang Cheng, Shan Miao, Ye Zhang, Xinwei Liu, Hongkai Gao","doi":"10.3760/CMA.J.ISSN.1673-9752.2019.09.010","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1673-9752.2019.09.010","url":null,"abstract":"Objective \u0000To evaluate the application value of quantitative computed tomography for evaluation of changes in abdominal fat after laparoscopic Roux-en-Y gastric bypass in obese patients. \u0000 \u0000 \u0000Methods \u0000The retrospective and descriptive study was conducted. The clinical data of 52 obese patients who underwent laparoscopic Roux-en-Y gastric bypass in the Third Medical Center of Chinese PLA General Hospital from March 2011 to February 2012 were collected. There were 24 males and 28 females, aged (43±9)years, with the range of 23-62 years. All the 52 patients underwent laparoscopic Roux-en-Y gastric bypass. Observation indicators: (1) surgical and postoperative conditions; (2) changes in anthropometric indices; (3) follow-up. Follow-up using outpatient examination was performed to detect complications of patients at 1, 3, 6, 12 months after surgery up to February 2013. Measurement data with normal distribution were represented as Mean±SD, repeated measurement data were analyzed using repeated ANOVA. Count data were represented as absolute numbers. \u0000 \u0000 \u0000Results \u0000(1) Surgical and postoperative conditions: all the patients underwent laparoscopic Roux-en-Y gastric bypass successfully, without conversion to open surgery. The volume of intraoperative blood loss, operation time, and duration of hospital stay were (25±11)mL, (78±14)minutes, and (11±2)days. (2) Changes in anthropometric indices: the body mass index (BMI), fat mass, free fat mass, total abdominal fat volume (TAFV), total subcutaneous fat volume (TSFV), and total visceral fat volume (TVFV) of all the 52 patients were (31.8±1.8)kg/m2, (39.4±4.1)kg, (50.2±6.0)kg, (11 703±3 899)cm3, (7 418±2 969)cm3, and (4 314±1 692)cm3 before surgery, (28.5±1.4)kg/m2, (33.0±1.1)kg, (49.7±4.6)kg, (11 016±3 713)cm3, (7 044±2 970)cm3, (3 969±1 443)cm3 at 3 months after surgery, (27.1±1.7)kg/m2, (30.2±1.3)kg, (45.4±3.1)kg, (9 406±4 452)cm3, (6 442±3 307)cm3, and (2 964±1 694)cm3 at 6 months after surgery, (24.4±2.4)kg/m2, (32.6±1.1)kg, (48.6±2.7)kg, (7 612±3 029)cm3, (5 623±2 650)cm3, and (1 826±360)cm3 at 12 months after surgery, respectively, there were significant differences in the changes of these indices (F=130.2, 30.3, 4.9, 25.6, 11.9, 16.5, P 0.05). The BMI, fat mass, TAFV, and TVFV at 6 months after surgery had significant differences compared with those before surgery (P 0.05). The BMI, fat mass, TAFV, TSFV, and TVFV at 12 months after surgery had significant differences compared with those before surgery (P 0.05). (3) Follow-up: all the 52 patients have completed the follow-up after surgery and the remission number of obesity was 35. No complications such as anastomotic hemorrhage, obstruction, or anastomotic leakage occured in all the 52 patients. \u0000 \u0000 \u0000Conclusion \u0000Laparoscopic Roux-en-Y gastric bypass can reduce abdominal visceral fat significantly, while quantitative computed tomography can help to evaluate the distribution of abdominal visceral fat accurately. \u0000 \u0000 \u0000Key words: \u0000Obesity; Gastric bypass su","PeriodicalId":36400,"journal":{"name":"中华消化外科杂志","volume":"18 1","pages":"859-863"},"PeriodicalIF":0.0,"publicationDate":"2019-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45083094","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-08-20DOI: 10.3760/CMA.J.ISSN.1673-9752.2019.08.004
Yi Xiao, R. Sun
Neochemoradiotherapy has been implemented in the multidisciplinary therapy for advanced rectal cancer. The patients with complete response after neothemoradiation could avoid surgical resection and thereafter might be free of surgical complications, as well as functional impairment. However, the preoperative evaluated clinical complete response is not equally to the pathologic complete response after surgery. The accurate methods to evaluate the status of complete response remained controversy. Based on the digital rectal examination and endoscopic observation, rectal MRI and endorectal ultrasound could verify the integrity of mucosa and the structural changes in rectal wall. These preoperative staging methods, as well as PET-CT and needle biopsy, had been widely used, but with a low sensitivity. Key words: Rectal neoplasms; Rectal cancer; Neoadjuvant chemoradiotherapy; Clinical complete response; Magnetic resonance imaging, rectal; Ultrasound, rectal
{"title":"The clinical evaluation of clinical complete response to neoadjuvant chemoradiotherapy for rectal cancer","authors":"Yi Xiao, R. Sun","doi":"10.3760/CMA.J.ISSN.1673-9752.2019.08.004","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1673-9752.2019.08.004","url":null,"abstract":"Neochemoradiotherapy has been implemented in the multidisciplinary therapy for advanced rectal cancer. The patients with complete response after neothemoradiation could avoid surgical resection and thereafter might be free of surgical complications, as well as functional impairment. However, the preoperative evaluated clinical complete response is not equally to the pathologic complete response after surgery. The accurate methods to evaluate the status of complete response remained controversy. Based on the digital rectal examination and endoscopic observation, rectal MRI and endorectal ultrasound could verify the integrity of mucosa and the structural changes in rectal wall. These preoperative staging methods, as well as PET-CT and needle biopsy, had been widely used, but with a low sensitivity. \u0000 \u0000 \u0000Key words: \u0000Rectal neoplasms; Rectal cancer; Neoadjuvant chemoradiotherapy; Clinical complete response; Magnetic resonance imaging, rectal; Ultrasound, rectal","PeriodicalId":36400,"journal":{"name":"中华消化外科杂志","volume":"18 1","pages":"726-730"},"PeriodicalIF":0.0,"publicationDate":"2019-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45537797","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-08-20DOI: 10.3760/CMA.J.ISSN.1673-9752.2019.08.008
Zhi-chao Fu, Jianwen Liu, Jingwen Fan
Colorectal cancer peritoneal metastasis has traditionally been considered as one of the end-stage manifestations. Recently, cytoreductive surgery combined with hyperthermic intraperitoneal chemotherapy achieved promising results in prolonging survival of patients and reducing tumor recurrences. Many guidelines suggested that the combination of cytoreductive surgery and hyperthermic intraperitoneal chemotherapy is an acceptable treatment for peritoneal metastasis. This article highlighted the treatment method, reviewed the latest evidence in treatment of colorectal cancer peritoneal metastasis and explored future direction. Key words: Colorectal neoplasms; Colorectal cancer; Peritoneal metastasis; Hyperthermic intraperitoneal chemotherapy; Cytoreductive surgery
{"title":"Research progress in cytoreductive surgery combined with hyperthermic intraperitoneal chemotherapy for peritoneal metastasis of colorectal cancer","authors":"Zhi-chao Fu, Jianwen Liu, Jingwen Fan","doi":"10.3760/CMA.J.ISSN.1673-9752.2019.08.008","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1673-9752.2019.08.008","url":null,"abstract":"Colorectal cancer peritoneal metastasis has traditionally been considered as one of the end-stage manifestations. Recently, cytoreductive surgery combined with hyperthermic intraperitoneal chemotherapy achieved promising results in prolonging survival of patients and reducing tumor recurrences. Many guidelines suggested that the combination of cytoreductive surgery and hyperthermic intraperitoneal chemotherapy is an acceptable treatment for peritoneal metastasis. This article highlighted the treatment method, reviewed the latest evidence in treatment of colorectal cancer peritoneal metastasis and explored future direction. \u0000 \u0000 \u0000Key words: \u0000Colorectal neoplasms; Colorectal cancer; Peritoneal metastasis; Hyperthermic intraperitoneal chemotherapy; Cytoreductive surgery","PeriodicalId":36400,"journal":{"name":"中华消化外科杂志","volume":"18 1","pages":"747-752"},"PeriodicalIF":0.0,"publicationDate":"2019-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48411884","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-08-20DOI: 10.3760/CMA.J.ISSN.1673-9752.2019.08.010
Wei-hua Tong, Liang He, Luyao Zhang, Jiaxin Zhang, M. Li, Jianfeng Mu, Quan Wang
Objective To evaluate the defecation function of patients with low rectal cancer after laparoscopic-assisted transanal total mesorectal excision (TaTME), and analyze the influencing factors. Methods The retrospective case-control study was conducted. The clinicopathological data of 55 patients with low rectal cancer who underwent laparoscopic-assisted TaTME in the First Hospital of Jilin University from May 2017 to December 2018 were collected. There were 39 males and 16 females, aged (60±11)years, with a range from 24 to 80 years. Among the 55 patients, 21 were in TNM stage Ⅰ, 14 were in TNM stage Ⅱ, and 20 were in TNM stage Ⅲ; 24 were in pathological stage T1-2 and 31 were in pathological stage T3. Observation indicators: (1) surgical and postoperative conditions; (2) follow-up; (3) analysis of influencing factors for postoperative defecation function. Follow-up was performed using questionnaires by telephone interview to detect the complications at 3 and 6 months after surgery up to June 2019. The measurement data with normal distribution were expressed as Mean±SD, and comparison between groups was done using the t test. Count data were expressed as absolute numbers or percentages, and comparison between groups was analyzed using the chi-square test or Fisher exact probability. Univariate and multivariate analyses were performed using logistic regression models. Results (1) Surgical and postoperative conditions: 55 patients successfully underwent laparoscopic-assisted TaTME without conversion to open surgery. The operation time, volume of intraoperative blood loss, diameter of postoperative pathological specimen, time to urinary catheter removal, distance between the anastomostic stoma and anal verge, and tumor diameter were (246±62)minutes, (69±27)mL, (3.5±0.7) cm, (2.1±0.9)days, (2.4±0.5)cm, and (3.9±1.6)cm, respectively. (2) Follow-up: 55 patients were followed up at 3 months and 6 months after surgery, and the low anterior resection syndrome questionnaires were completed. Among the 55 patients, 35 had low anterior resection syndrome at 3 months after surgery, and 24 had low anterior resection syndrome at 6 months after surgery, showing a significant difference (χ2=4.42, P 5 cm were independent risk factors affecting the defecation function of patients at 3 months after surgery (odds ratio=1.135, 6.057, 95% confidence interval: 1.089-1.323, 1.206-30.435, P<0.05). The distance between the anastomotic stoma and anal verge <2 cm was an independent risk factor affecting the defecation function of patients at 6 months after surgery (odds ratio=2.724, 95% confidence interval: 1.982-3.066, P<0.05). Conclusions The incidence of low anterior resection syndrome after laparoscopic-assisted TaTME for low rectal cancer is high. Distance between the anastomotic storna and anal verge and tumor diameter are independent risk factors for the postoperative defecation founction. Key words: Rectal neoplasms; Rectal cancer; Transanal tot
{"title":"Evaluation of defecation function after laparoscopic-assisted transanal total mesorectal excision for low rectal cancer and influencing factors analysis","authors":"Wei-hua Tong, Liang He, Luyao Zhang, Jiaxin Zhang, M. Li, Jianfeng Mu, Quan Wang","doi":"10.3760/CMA.J.ISSN.1673-9752.2019.08.010","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1673-9752.2019.08.010","url":null,"abstract":"Objective \u0000To evaluate the defecation function of patients with low rectal cancer after laparoscopic-assisted transanal total mesorectal excision (TaTME), and analyze the influencing factors. \u0000 \u0000 \u0000Methods \u0000The retrospective case-control study was conducted. The clinicopathological data of 55 patients with low rectal cancer who underwent laparoscopic-assisted TaTME in the First Hospital of Jilin University from May 2017 to December 2018 were collected. There were 39 males and 16 females, aged (60±11)years, with a range from 24 to 80 years. Among the 55 patients, 21 were in TNM stage Ⅰ, 14 were in TNM stage Ⅱ, and 20 were in TNM stage Ⅲ; 24 were in pathological stage T1-2 and 31 were in pathological stage T3. Observation indicators: (1) surgical and postoperative conditions; (2) follow-up; (3) analysis of influencing factors for postoperative defecation function. Follow-up was performed using questionnaires by telephone interview to detect the complications at 3 and 6 months after surgery up to June 2019. The measurement data with normal distribution were expressed as Mean±SD, and comparison between groups was done using the t test. Count data were expressed as absolute numbers or percentages, and comparison between groups was analyzed using the chi-square test or Fisher exact probability. Univariate and multivariate analyses were performed using logistic regression models. \u0000 \u0000 \u0000Results \u0000(1) Surgical and postoperative conditions: 55 patients successfully underwent laparoscopic-assisted TaTME without conversion to open surgery. The operation time, volume of intraoperative blood loss, diameter of postoperative pathological specimen, time to urinary catheter removal, distance between the anastomostic stoma and anal verge, and tumor diameter were (246±62)minutes, (69±27)mL, (3.5±0.7) cm, (2.1±0.9)days, (2.4±0.5)cm, and (3.9±1.6)cm, respectively. (2) Follow-up: 55 patients were followed up at 3 months and 6 months after surgery, and the low anterior resection syndrome questionnaires were completed. Among the 55 patients, 35 had low anterior resection syndrome at 3 months after surgery, and 24 had low anterior resection syndrome at 6 months after surgery, showing a significant difference (χ2=4.42, P 5 cm were independent risk factors affecting the defecation function of patients at 3 months after surgery (odds ratio=1.135, 6.057, 95% confidence interval: 1.089-1.323, 1.206-30.435, P<0.05). The distance between the anastomotic stoma and anal verge <2 cm was an independent risk factor affecting the defecation function of patients at 6 months after surgery (odds ratio=2.724, 95% confidence interval: 1.982-3.066, P<0.05). \u0000 \u0000 \u0000Conclusions \u0000The incidence of low anterior resection syndrome after laparoscopic-assisted TaTME for low rectal cancer is high. Distance between the anastomotic storna and anal verge and tumor diameter are independent risk factors for the postoperative defecation founction. \u0000 \u0000 \u0000Key words: \u0000Rectal neoplasms; Rectal cancer; Transanal tot","PeriodicalId":36400,"journal":{"name":"中华消化外科杂志","volume":"18 1","pages":"761-767"},"PeriodicalIF":0.0,"publicationDate":"2019-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42484005","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-08-20DOI: 10.3760/CMA.J.ISSN.1673-9752.2019.08.014
C. Fang, Lin-yun He, Wen Zhu, Haoyu Hu, Jian Yang, N. Zeng, Yingfang Fan, S. Wen, N. Xiang
Objective To investigate the clinical efficacy of three-dimensional visualization technique (3DVT) combined with enhanced recovery after surgery (ERAS) in the treatment of hepatolithiasis. Methods The retrospective cohort study was conducted. The clinicopathological data of 64 patients with hepatolithiasis who were admitted to Zhujiang Hospital of Southern Medical University from November 2015 to August 2018 were collected. There were 17 males and 47 females, aged from 30 to 82 years, with a median age of 55 years. Of the 64 patients, 23 who completed preoperative assessment and planning using 3DVT, and furthermore received ERAS for perioperative management were divided into 3DVT + ERAS group, and 41 who received preoperative assessment merely under the guidance of 3DVT, combined with conventional perioperative management were divided into 3DVT + conventional group. Observation indicators: (1) preoperative CT and 3DVT assessment; (2) perioperative conditions; (3) follow-up. The follow-up was conducted by outpatient service, e-mail or telephone interview to detect the postoperative recurrence of hepatolithiasis up to March 2019. The measurement data with normal distribution were expressed as Mean±SD, and the t test was used for comparison between groups. The measurement data with skewed distribution were expressed as M (P25, P75), and the Mann-Whitney U test was used for comparison between groups. The count data were expressed as absolute numbers or percentages, and the comparison between groups was performed using the chi-square test or Fisher exact probability. Results (1) Preoperative CT and 3DVT assessment: 23 patients in the 3DVT + ERAS group underwent preoperative CT examination and 3DVT assessment, the consistency between CT results and intraoperative findings was 91.3%(21/23), and the consistency between 3DVT results and intraoperative findings was 95.7%(22/23). Fourty-one patients in the 3DVT + conventional group underwent preoperative CT examination and 3DVT assessment, the consistency between CT results and intraoperative findings was 90.2%(37/41), and the consistency between 3DVT results and intraoperative findings was 95.1%(39/41). (2) Perioperative conditions: the volume of intraoperative blood loss, duration of postoperative hospital stay, postoperative total bilirubin, postoperative direct bilirubin, postoperative albumin, postoperative alanine aminotransferase, postoperative aspartate aminotransferase and postoperative hemoglobin were 50 mL (10 mL, 100 mL), 8 days (7 days, 9 days), 12 μmol/L (9 μmol/L, 16 μmol/L), 6 μmol/L (4 μmol/L, 8 μmol/L), (37±4)g/L, 44 U/L (18 U/L, 85 U/L), 32 U/L (20 U/L, 65 U/L), (117±18)g/L in the 3DVT + ERAS group, and 100 mL (50 mL, 300 mL), 13 days (10 days, 16 days), 17 μmol/L (12 μmol/L, 33 μmol/L), 11 μmol/L (7 μmol/L, 21 μmol/L), (29±6)g/L, 78 U/L (43 U/L, 122 U/L), 121 U/L (72 U/L, 176 U/L), (106±13)g/L in the 3DVT + conventional group, respectively; there were significant differences
{"title":"Clinical efficacy of three-dimensional visualization technique combined with enhanced recovery after surgery in the treatment of hepatolithiasis","authors":"C. Fang, Lin-yun He, Wen Zhu, Haoyu Hu, Jian Yang, N. Zeng, Yingfang Fan, S. Wen, N. Xiang","doi":"10.3760/CMA.J.ISSN.1673-9752.2019.08.014","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1673-9752.2019.08.014","url":null,"abstract":"Objective \u0000To investigate the clinical efficacy of three-dimensional visualization technique (3DVT) combined with enhanced recovery after surgery (ERAS) in the treatment of hepatolithiasis. \u0000 \u0000 \u0000Methods \u0000The retrospective cohort study was conducted. The clinicopathological data of 64 patients with hepatolithiasis who were admitted to Zhujiang Hospital of Southern Medical University from November 2015 to August 2018 were collected. There were 17 males and 47 females, aged from 30 to 82 years, with a median age of 55 years. Of the 64 patients, 23 who completed preoperative assessment and planning using 3DVT, and furthermore received ERAS for perioperative management were divided into 3DVT + ERAS group, and 41 who received preoperative assessment merely under the guidance of 3DVT, combined with conventional perioperative management were divided into 3DVT + conventional group. Observation indicators: (1) preoperative CT and 3DVT assessment; (2) perioperative conditions; (3) follow-up. The follow-up was conducted by outpatient service, e-mail or telephone interview to detect the postoperative recurrence of hepatolithiasis up to March 2019. The measurement data with normal distribution were expressed as Mean±SD, and the t test was used for comparison between groups. The measurement data with skewed distribution were expressed as M (P25, P75), and the Mann-Whitney U test was used for comparison between groups. The count data were expressed as absolute numbers or percentages, and the comparison between groups was performed using the chi-square test or Fisher exact probability. \u0000 \u0000 \u0000Results \u0000(1) Preoperative CT and 3DVT assessment: 23 patients in the 3DVT + ERAS group underwent preoperative CT examination and 3DVT assessment, the consistency between CT results and intraoperative findings was 91.3%(21/23), and the consistency between 3DVT results and intraoperative findings was 95.7%(22/23). Fourty-one patients in the 3DVT + conventional group underwent preoperative CT examination and 3DVT assessment, the consistency between CT results and intraoperative findings was 90.2%(37/41), and the consistency between 3DVT results and intraoperative findings was 95.1%(39/41). (2) Perioperative conditions: the volume of intraoperative blood loss, duration of postoperative hospital stay, postoperative total bilirubin, postoperative direct bilirubin, postoperative albumin, postoperative alanine aminotransferase, postoperative aspartate aminotransferase and postoperative hemoglobin were 50 mL (10 mL, 100 mL), 8 days (7 days, 9 days), 12 μmol/L (9 μmol/L, 16 μmol/L), 6 μmol/L (4 μmol/L, 8 μmol/L), (37±4)g/L, 44 U/L (18 U/L, 85 U/L), 32 U/L (20 U/L, 65 U/L), (117±18)g/L in the 3DVT + ERAS group, and 100 mL (50 mL, 300 mL), 13 days (10 days, 16 days), 17 μmol/L (12 μmol/L, 33 μmol/L), 11 μmol/L (7 μmol/L, 21 μmol/L), (29±6)g/L, 78 U/L (43 U/L, 122 U/L), 121 U/L (72 U/L, 176 U/L), (106±13)g/L in the 3DVT + conventional group, respectively; there were significant differences","PeriodicalId":36400,"journal":{"name":"中华消化外科杂志","volume":"18 1","pages":"785-791"},"PeriodicalIF":0.0,"publicationDate":"2019-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47163110","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-08-20DOI: 10.3760/CMA.J.ISSN.1673-9752.2019.08.007
A. Wu, Guoli He
Transanal total mesorectal excision is a new surgical procedure which has emerged in the recent years. This procedure performs a "bottom-to-up" resection of the rectum and its surrounding mesenteries through the anus, which provides better view compared with laparoscopic or open total mesorectal excision. However, it is undeniable that as a new surgical procedure, transanal total mesorectal excision is also bound to have some complications of surgery. Therefore, how to prevent and treat the complications of transanal total mesorectal excision is still a problem that must be faced in the future. This article intends to review the prevention and treatment of surgical complications and provide some experience for the development of transanal total mesorectal excision. Key words: Transanal total mesorectal excision; Complications; Prevention; Treatment
{"title":"Prevention and treatment of complications of transanal total mesorectal excision","authors":"A. Wu, Guoli He","doi":"10.3760/CMA.J.ISSN.1673-9752.2019.08.007","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1673-9752.2019.08.007","url":null,"abstract":"Transanal total mesorectal excision is a new surgical procedure which has emerged in the recent years. This procedure performs a \"bottom-to-up\" resection of the rectum and its surrounding mesenteries through the anus, which provides better view compared with laparoscopic or open total mesorectal excision. However, it is undeniable that as a new surgical procedure, transanal total mesorectal excision is also bound to have some complications of surgery. Therefore, how to prevent and treat the complications of transanal total mesorectal excision is still a problem that must be faced in the future. This article intends to review the prevention and treatment of surgical complications and provide some experience for the development of transanal total mesorectal excision. \u0000 \u0000 \u0000Key words: \u0000Transanal total mesorectal excision; Complications; Prevention; Treatment","PeriodicalId":36400,"journal":{"name":"中华消化外科杂志","volume":"18 1","pages":"741-746"},"PeriodicalIF":0.0,"publicationDate":"2019-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41815273","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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