Pub Date : 2019-12-20DOI: 10.3760/CMA.J.ISSN.1673-9752.2019.12.007
Y. Mei, Ji-Hu Jia, Jun Ding, Li Chen, Jun Wang, P. Zeng, Wen-Ping Li, Kun Xiong, Wei Chen, C. Feng, K. Leng, Guo-xing Wang, Yan Luo, Chao Du, Libo Luo, J. Peng
Objective To explore the clinical application value of enhanced recovery after surgery (ERAS) in the laparoscopic surgery for cholecystolithiasis comorbid with choledocholithiasis. Methods The prospective study was conducted. The clinicopathological data of 52 patients with cholecystolithiasis comorbid with choledocholithiasis who were admitted to the Third Affiliated Hospital of Zunyi Medical University from September 2016 to September 2018 were collected. Patients were divided into 2 groups by random number table: patients in observation group received laparoscopic cholecystectomy + choledocholithotomy + choledochoscopic exploration + T-tube drainage (or primary suture of common bile duct) and perioperative management guided by the concept of enhanced recovery after surgery (ERAS), and patients in control group received traditional perioperative management. Observation indicators: (1) surgical situations; (2) postoperative situations; (3) postoperative complications; (4) postoperative pain scores; (5) changes in hepatic function and blood routine during perioperative period. Follow-up using outpatient examination and telephone interview was performed to detect complications during the postoperative 6 months up to March 2019. Measurement data with normal distribution were represented as Mean±SD, and comparison between groups was analyzed using the paired t test or repeated ANOVA. Count data were described as absolute numbers and percentages, and comparison between groups was analyzed using the chi-square test or Fisher exact probability. Results Fifty-two patients were screened for eligibility, including 20 males and 32 females, aged 25-68 years, with an average age of 53 years. There were 30 patients in the observation group and 22 in the control group. (1) Surgical situations: the operation time and volume of intraoperative blood loss were (133±19)minutes and (47±21)mL in the observation group, and (136±22)minutes and (49±23)mL in the control group, respectively, showing no significant difference between the two groups (t=-0.386, -0.211, P>0.05). (2) Postoperative situations: time to out-of-bed activity, time to initial food intake, time to first anal flatus, duration of postoperative hospital stay, and hospital expenses were (18±4)hours, (19±5)hours, (28±2)hours, (4.0±1.0)days, and (1.82±0.22)×104 yuan in the observation group, and (29±7)hours, (46±9)hours, (37±4)hours, (6.6±1.6)days, and (2.25±0.29)×104 yuan in the control group, respectively, showing significant differences between the two groups (t=-7.054, -14.169, -9.426, -6.582, -5.809, P 0.05). Conclusion ERAS is safe and effective in the laparoscopic surgery for choledocholithiasis comorbid with cholecystolithiasis. Key words: Choledocholithiasis; Cholecystolithiasis; Enhanced recovery after surgery; Efficacy; Laparoscopy
{"title":"Application value of enhanced recovery after surgery in the laparoscopic surgery for cholecystolithiasis comorbid with choledocholithiasis","authors":"Y. Mei, Ji-Hu Jia, Jun Ding, Li Chen, Jun Wang, P. Zeng, Wen-Ping Li, Kun Xiong, Wei Chen, C. Feng, K. Leng, Guo-xing Wang, Yan Luo, Chao Du, Libo Luo, J. Peng","doi":"10.3760/CMA.J.ISSN.1673-9752.2019.12.007","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1673-9752.2019.12.007","url":null,"abstract":"Objective \u0000To explore the clinical application value of enhanced recovery after surgery (ERAS) in the laparoscopic surgery for cholecystolithiasis comorbid with choledocholithiasis. \u0000 \u0000 \u0000Methods \u0000The prospective study was conducted. The clinicopathological data of 52 patients with cholecystolithiasis comorbid with choledocholithiasis who were admitted to the Third Affiliated Hospital of Zunyi Medical University from September 2016 to September 2018 were collected. Patients were divided into 2 groups by random number table: patients in observation group received laparoscopic cholecystectomy + choledocholithotomy + choledochoscopic exploration + T-tube drainage (or primary suture of common bile duct) and perioperative management guided by the concept of enhanced recovery after surgery (ERAS), and patients in control group received traditional perioperative management. Observation indicators: (1) surgical situations; (2) postoperative situations; (3) postoperative complications; (4) postoperative pain scores; (5) changes in hepatic function and blood routine during perioperative period. Follow-up using outpatient examination and telephone interview was performed to detect complications during the postoperative 6 months up to March 2019. Measurement data with normal distribution were represented as Mean±SD, and comparison between groups was analyzed using the paired t test or repeated ANOVA. Count data were described as absolute numbers and percentages, and comparison between groups was analyzed using the chi-square test or Fisher exact probability. \u0000 \u0000 \u0000Results \u0000Fifty-two patients were screened for eligibility, including 20 males and 32 females, aged 25-68 years, with an average age of 53 years. There were 30 patients in the observation group and 22 in the control group. (1) Surgical situations: the operation time and volume of intraoperative blood loss were (133±19)minutes and (47±21)mL in the observation group, and (136±22)minutes and (49±23)mL in the control group, respectively, showing no significant difference between the two groups (t=-0.386, -0.211, P>0.05). (2) Postoperative situations: time to out-of-bed activity, time to initial food intake, time to first anal flatus, duration of postoperative hospital stay, and hospital expenses were (18±4)hours, (19±5)hours, (28±2)hours, (4.0±1.0)days, and (1.82±0.22)×104 yuan in the observation group, and (29±7)hours, (46±9)hours, (37±4)hours, (6.6±1.6)days, and (2.25±0.29)×104 yuan in the control group, respectively, showing significant differences between the two groups (t=-7.054, -14.169, -9.426, -6.582, -5.809, P 0.05). \u0000 \u0000 \u0000Conclusion \u0000ERAS is safe and effective in the laparoscopic surgery for choledocholithiasis comorbid with cholecystolithiasis. \u0000 \u0000 \u0000Key words: \u0000Choledocholithiasis; Cholecystolithiasis; Enhanced recovery after surgery; Efficacy; Laparoscopy","PeriodicalId":36400,"journal":{"name":"中华消化外科杂志","volume":"18 1","pages":"1122-1128"},"PeriodicalIF":0.0,"publicationDate":"2019-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44779181","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 : 2019-12-20DOI: 10.3760/CMA.J.ISSN.1673-9752.2019.12.011
M. He, Xinsen Xu, Wei Chen, Wei Wang, Linhua Yang, R. Hua, Yong-wei Sun, Kewei Li
Objective To summarize the diagnosis and treatment of biliary pancreatic duct dilatation. Methods The retrospective and descriptive study was conducted. The clinical data of 22 patients with biliary pancreatic duct dilatation who were admitted to Renji Hospital of Shanghai Jiaotong University School of Medicine between October 2013 to September 2017 were collected. There were 6 males and 16 females, aged from 33 to 82 years, with an average age of 66 years. Surgical exploration was decided according to clinical symptoms, results of laboratory test and imaging examinations. For patients with space occupying lesions, surgical procedure was selected based on results of pathological examination. Patients without surgical exploration or space occupying lesions were allocated into follow-up. Observation indicators: (1) surgical exploration; (2) relationship of clinical symptoms and preoperative examinations with surgical exploration positive for space occupying lesions; (3) surgical treatment; (4) follow-up. Follow-up using outpatient examination was performed on patients up to October 2018. Follow-up was performed on patients with positive surgical exploration to detect postoperative complications.For patients with positive results of imaging examinations, no jaundice, normal laboratory indicators or mild abnormality, liver function, tumor markers and B-ultrasound were re-examined each month, and computed tomography (CT) and magnetic resonance imaging (MRI) was performed once every 3 months. Surgical exploration was performed when total bilirubin (TBil) or tumor markers showed a progressive increase. Follow-up was performed on patients with negative results of imaging examination, jaundice, and mildly elevated CA19-9. TBil and CA19-9 were re-examined monthly, and if they were progressively elevated, patients were transferred to surgical exploration. For patients with negative results of imaging examination, no symptoms, and negative laboratory test, liver function, tumor markers, and B-ultrasound were re-examined once every 3 months, and enhanced CT and MRI were re-examined once every 6 months within one year. Follow-up was performed once every 6 months during the second year, and once a year after two years. Measurement data with normal distribution were represented as Mean±SD, and comparison between groups was analyzed using the t test. Count data were descibed as absolute numbers, and they were analyzed using the chi-square test under R×C chart or Fisher exact probability. Results (1) Surgical exploration: of 22 patients, 11 underwent surgical exploration, and 11 underwent follow-up. Of the 11 patients with surgical exploration, 4 were positive for space occupying lesions including 1 of false negative, and 7 were negative for space occupying lesions. (2) Relationship of clinical symptoms and preoperative examinations with surgical exploration positive for space occupying lesions. ① Relationship of clinical symptoms and laboratory test
{"title":"Diagnosis and treatment of biliary pancreatic duct dilatation","authors":"M. He, Xinsen Xu, Wei Chen, Wei Wang, Linhua Yang, R. Hua, Yong-wei Sun, Kewei Li","doi":"10.3760/CMA.J.ISSN.1673-9752.2019.12.011","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1673-9752.2019.12.011","url":null,"abstract":"Objective \u0000To summarize the diagnosis and treatment of biliary pancreatic duct dilatation. \u0000 \u0000 \u0000Methods \u0000The retrospective and descriptive study was conducted. The clinical data of 22 patients with biliary pancreatic duct dilatation who were admitted to Renji Hospital of Shanghai Jiaotong University School of Medicine between October 2013 to September 2017 were collected. There were 6 males and 16 females, aged from 33 to 82 years, with an average age of 66 years. Surgical exploration was decided according to clinical symptoms, results of laboratory test and imaging examinations. For patients with space occupying lesions, surgical procedure was selected based on results of pathological examination. Patients without surgical exploration or space occupying lesions were allocated into follow-up. Observation indicators: (1) surgical exploration; (2) relationship of clinical symptoms and preoperative examinations with surgical exploration positive for space occupying lesions; (3) surgical treatment; (4) follow-up. Follow-up using outpatient examination was performed on patients up to October 2018. Follow-up was performed on patients with positive surgical exploration to detect postoperative complications.For patients with positive results of imaging examinations, no jaundice, normal laboratory indicators or mild abnormality, liver function, tumor markers and B-ultrasound were re-examined each month, and computed tomography (CT) and magnetic resonance imaging (MRI) was performed once every 3 months. Surgical exploration was performed when total bilirubin (TBil) or tumor markers showed a progressive increase. Follow-up was performed on patients with negative results of imaging examination, jaundice, and mildly elevated CA19-9. TBil and CA19-9 were re-examined monthly, and if they were progressively elevated, patients were transferred to surgical exploration. For patients with negative results of imaging examination, no symptoms, and negative laboratory test, liver function, tumor markers, and B-ultrasound were re-examined once every 3 months, and enhanced CT and MRI were re-examined once every 6 months within one year. Follow-up was performed once every 6 months during the second year, and once a year after two years. Measurement data with normal distribution were represented as Mean±SD, and comparison between groups was analyzed using the t test. Count data were descibed as absolute numbers, and they were analyzed using the chi-square test under R×C chart or Fisher exact probability. \u0000 \u0000 \u0000Results \u0000(1) Surgical exploration: of 22 patients, 11 underwent surgical exploration, and 11 underwent follow-up. Of the 11 patients with surgical exploration, 4 were positive for space occupying lesions including 1 of false negative, and 7 were negative for space occupying lesions. (2) Relationship of clinical symptoms and preoperative examinations with surgical exploration positive for space occupying lesions. ① Relationship of clinical symptoms and laboratory test ","PeriodicalId":36400,"journal":{"name":"中华消化外科杂志","volume":"18 1","pages":"1149-1157"},"PeriodicalIF":0.0,"publicationDate":"2019-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41722198","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 : 2019-12-20DOI: 10.3760/CMA.J.ISSN.1673-9752.2019.12.013
Yangyang Sun, L. Qian, W. Gu, Gengfang Wang, Wei Gao, X. Geng, Xudong Zhang, Xiaoli Zhou
Objective To investigate the clinicopathological characteristics of cardial mixed adenoneuroendocrine carcinoma (MANEC) and analyze its prognostic factors. Methods The retrospective and descriptive study was conducted. The clinicopathological data of 34 patients with primary cardial MANEC who were admitted to the Changzhou No.2 People′s Hospital of Nangjing Medical University from January 2008 to January 2018 were collected. There were 20 males and 14 females, aged from 39 to 81 years, with an average age of 66 years. All the 34 patients underwent resection of cardia cancer and postoperative pathological examination. Observation indicators: (1) surgery and treatment; (2) clinical manifestations and pathological conditions; (3) pathological examination of surgical resection specimens; (4) follow-up and survival; (5) analysis of prognostic factors. Follow-up using outpatient examination and telephone interview was conducted to detect the survival of patients and tumor recurrence and metastasis up to December 2018. Measurement data with normal distribution were represented as Mean±SD. Measurement data with skewed distribution were expressed as M (range). Count data were expressed as absolute numbers or percentages. Kaplan-Merier method was used to calculate the survival time and rate and draw the survival curve, and log-rank test was used for the survival analysis. Univariate and multivariate analyses were performed using the COX proportional risk model. Results (1) Surgery and treatment: all the patients underwent surgery successfully and postoperative systemic chemotherapy based on cisplatin + etoposide. (2) Clinical manifestations and pathological conditions: patients had epigastric discomfort, abdominal pain and abdominal distension as the first symptoms. Of 34 patients, number of males, cases with age ≥60 years, cases with esophageal involvement, cases with stable microsatellite, cases with higher CA19-9, cases with elevated cancer embryonic antigen, cases of tumor pathologic TNM stage Ⅲ-Ⅳ, cases with tumor diameter ≥5 cm, cases with vascular tumor emboli, cases with positive lymph node metastasis, cases with nerve invasion were 20, 29, 31, 28, 4, 3, 29, 30, 27, 30, 29, respectively. (3) Pathological examination of surgical excision specimens: the masses of patients were mainly ulcer-type, with the diameter of 3.0-8.4 cm. Of the 34 patients, 1 had tumor infiltrated into submucosa, 5 infiltrated into muscle layer, 18 infiltrated into serosal layer, and 10 infiltrated into extra-serous fibrous adipose tissues. Microscopy examination showed that all tumors were composed of two components including adenocarcinoma and neuroendocrine carcinoma, and the two components accounted for more than 30%. Among adenocarcinoma components of the 34 patients, 14 were poorly differentiated tubular adenocarcinoma, 6 were mucinous adenocarcinoma, 6 were moderately differentiated tubular adenocarcinoma, 5 were low-adhesion carcinoma, 1 was highly differe
{"title":"Clinicopathological characteristics and prognostic factors of cardial mixed adenoneuroendocrine carcinoma","authors":"Yangyang Sun, L. Qian, W. Gu, Gengfang Wang, Wei Gao, X. Geng, Xudong Zhang, Xiaoli Zhou","doi":"10.3760/CMA.J.ISSN.1673-9752.2019.12.013","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1673-9752.2019.12.013","url":null,"abstract":"Objective \u0000To investigate the clinicopathological characteristics of cardial mixed adenoneuroendocrine carcinoma (MANEC) and analyze its prognostic factors. \u0000 \u0000 \u0000Methods \u0000The retrospective and descriptive study was conducted. The clinicopathological data of 34 patients with primary cardial MANEC who were admitted to the Changzhou No.2 People′s Hospital of Nangjing Medical University from January 2008 to January 2018 were collected. There were 20 males and 14 females, aged from 39 to 81 years, with an average age of 66 years. All the 34 patients underwent resection of cardia cancer and postoperative pathological examination. Observation indicators: (1) surgery and treatment; (2) clinical manifestations and pathological conditions; (3) pathological examination of surgical resection specimens; (4) follow-up and survival; (5) analysis of prognostic factors. Follow-up using outpatient examination and telephone interview was conducted to detect the survival of patients and tumor recurrence and metastasis up to December 2018. Measurement data with normal distribution were represented as Mean±SD. Measurement data with skewed distribution were expressed as M (range). Count data were expressed as absolute numbers or percentages. Kaplan-Merier method was used to calculate the survival time and rate and draw the survival curve, and log-rank test was used for the survival analysis. Univariate and multivariate analyses were performed using the COX proportional risk model. \u0000 \u0000 \u0000Results \u0000(1) Surgery and treatment: all the patients underwent surgery successfully and postoperative systemic chemotherapy based on cisplatin + etoposide. (2) Clinical manifestations and pathological conditions: patients had epigastric discomfort, abdominal pain and abdominal distension as the first symptoms. Of 34 patients, number of males, cases with age ≥60 years, cases with esophageal involvement, cases with stable microsatellite, cases with higher CA19-9, cases with elevated cancer embryonic antigen, cases of tumor pathologic TNM stage Ⅲ-Ⅳ, cases with tumor diameter ≥5 cm, cases with vascular tumor emboli, cases with positive lymph node metastasis, cases with nerve invasion were 20, 29, 31, 28, 4, 3, 29, 30, 27, 30, 29, respectively. (3) Pathological examination of surgical excision specimens: the masses of patients were mainly ulcer-type, with the diameter of 3.0-8.4 cm. Of the 34 patients, 1 had tumor infiltrated into submucosa, 5 infiltrated into muscle layer, 18 infiltrated into serosal layer, and 10 infiltrated into extra-serous fibrous adipose tissues. Microscopy examination showed that all tumors were composed of two components including adenocarcinoma and neuroendocrine carcinoma, and the two components accounted for more than 30%. Among adenocarcinoma components of the 34 patients, 14 were poorly differentiated tubular adenocarcinoma, 6 were mucinous adenocarcinoma, 6 were moderately differentiated tubular adenocarcinoma, 5 were low-adhesion carcinoma, 1 was highly differe","PeriodicalId":36400,"journal":{"name":"中华消化外科杂志","volume":"18 1","pages":"1163-1170"},"PeriodicalIF":0.0,"publicationDate":"2019-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43361373","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 : 2019-12-20DOI: 10.3760/CMA.J.ISSN.1673-9752.2019.12.101
Lang Xia, Yulin Zhang, P. Jiang, J. Huo, Linlin Shen, Yingfen Zou, D. Tao
{"title":"Minutes of the tenth Chinese academic conference on digestve surgery and Tsinghua-Harvard surgery forum","authors":"Lang Xia, Yulin Zhang, P. Jiang, J. Huo, Linlin Shen, Yingfen Zou, D. Tao","doi":"10.3760/CMA.J.ISSN.1673-9752.2019.12.101","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1673-9752.2019.12.101","url":null,"abstract":"","PeriodicalId":36400,"journal":{"name":"中华消化外科杂志","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49196851","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 : 2019-12-20DOI: 10.3760/CMA.J.ISSN.1673-9752.2019.12.006
Zuo-liang Shi, Z. Haitao
Immunoglobulin G (IgG)4-related pancreatitis, also named as type Ⅰ autoimmune pancreatitis, is recognized as a pancreatic manifestation of IgG4-related disease. It is very hard to differentiate it from pancreatic cancer due to similar clinical manifestations with pancreatic cancer. Diagnosis of IgG4-related pancreatitis mainly relies on pathological examination and imaging examination. Corticosteroids are the main treatment for IgG4-related pancreatitis, and the risk of relapse is still high with steroid taper or following withdrawal of steroids. Based on researches on IgG4-related pancreatitis and our clinical experience, the authors have analyzed and summarized pathogenesis, clinical manifestations, clinical diagnosis, differentiation from pancreatic cancer, clinical treatment of IgG4-related pancreatitis, and suggested that elucidation of its mechanism and induction of immunotherapy may improve its efficacy. Key words: IgG4-related pancreatitis; Diagnosis; Treatment
{"title":"Diagnosis and treatment of IgG4-related pancreatitis","authors":"Zuo-liang Shi, Z. Haitao","doi":"10.3760/CMA.J.ISSN.1673-9752.2019.12.006","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1673-9752.2019.12.006","url":null,"abstract":"Immunoglobulin G (IgG)4-related pancreatitis, also named as type Ⅰ autoimmune pancreatitis, is recognized as a pancreatic manifestation of IgG4-related disease. It is very hard to differentiate it from pancreatic cancer due to similar clinical manifestations with pancreatic cancer. Diagnosis of IgG4-related pancreatitis mainly relies on pathological examination and imaging examination. Corticosteroids are the main treatment for IgG4-related pancreatitis, and the risk of relapse is still high with steroid taper or following withdrawal of steroids. Based on researches on IgG4-related pancreatitis and our clinical experience, the authors have analyzed and summarized pathogenesis, clinical manifestations, clinical diagnosis, differentiation from pancreatic cancer, clinical treatment of IgG4-related pancreatitis, and suggested that elucidation of its mechanism and induction of immunotherapy may improve its efficacy. \u0000 \u0000 \u0000Key words: \u0000IgG4-related pancreatitis; Diagnosis; Treatment","PeriodicalId":36400,"journal":{"name":"中华消化外科杂志","volume":"18 1","pages":"1118-1121"},"PeriodicalIF":0.0,"publicationDate":"2019-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48932120","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 : 2019-12-20DOI: 10.3760/CMA.J.ISSN.1673-9752.2019.12.003
Jian Xu, Jian-he Sun, Zhongyang Li, S. Pan, Dongming Li, Lu Lu, Xiao Xu, Shusen Zheng
Surgical minimally invasive techniques such as image intervention, laparoscopy, endoscopy, and assisted medical robotics have become the mainstream of minimally invasive surgery (MIS). However, the vague concept, diverse misunderstanding, and the lack of standards have led to a lot of malpractice in current MIS. Based on the analysis of the clinical situation and the domestic and foreign literatures, the authors have put forward the theory of comprehensive minimally invasive surgery (CMIS), and established the concepts of minimally invasive prevention, minimally invasive diagnosis and minimally invasive follow-up in the view of hepatobiliary surgery. The authors have proposed "three-All" principles of all personnel, all aspects and all processes, and established a comprehensive four-level criteria of outcomes, complications, time and costs for CMIS, in an attempt to provide feasible and practical concepts and standards for MIS from a clinical practice and theoretical level, with a view to standardizing minimally invasive procedures and solving the problem of MIS. Key words: Hepatobiliary diseases; Minimally invasive surgery; Comprehensive; Criterion; Standard; Malpractice; Complications; Cost
{"title":"Initial investigation of comprehensive minimally invasive surgery","authors":"Jian Xu, Jian-he Sun, Zhongyang Li, S. Pan, Dongming Li, Lu Lu, Xiao Xu, Shusen Zheng","doi":"10.3760/CMA.J.ISSN.1673-9752.2019.12.003","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1673-9752.2019.12.003","url":null,"abstract":"Surgical minimally invasive techniques such as image intervention, laparoscopy, endoscopy, and assisted medical robotics have become the mainstream of minimally invasive surgery (MIS). However, the vague concept, diverse misunderstanding, and the lack of standards have led to a lot of malpractice in current MIS. Based on the analysis of the clinical situation and the domestic and foreign literatures, the authors have put forward the theory of comprehensive minimally invasive surgery (CMIS), and established the concepts of minimally invasive prevention, minimally invasive diagnosis and minimally invasive follow-up in the view of hepatobiliary surgery. The authors have proposed \"three-All\" principles of all personnel, all aspects and all processes, and established a comprehensive four-level criteria of outcomes, complications, time and costs for CMIS, in an attempt to provide feasible and practical concepts and standards for MIS from a clinical practice and theoretical level, with a view to standardizing minimally invasive procedures and solving the problem of MIS. \u0000 \u0000 \u0000Key words: \u0000Hepatobiliary diseases; Minimally invasive surgery; Comprehensive; Criterion; Standard; Malpractice; Complications; Cost","PeriodicalId":36400,"journal":{"name":"中华消化外科杂志","volume":"18 1","pages":"1101-1107"},"PeriodicalIF":0.0,"publicationDate":"2019-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43343797","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 : 2019-12-20DOI: 10.3760/CMA.J.ISSN.1673-9752.2019.12.103
Yingfen Zou, J. Huo, Lang Xia, Yulin Zhang, Linlin Shen, P. Jiang, D. Tao
{"title":"Minutes of clinical research symposium of Elite Group of Chinese Journal of Digestive Surgery","authors":"Yingfen Zou, J. Huo, Lang Xia, Yulin Zhang, Linlin Shen, P. Jiang, D. Tao","doi":"10.3760/CMA.J.ISSN.1673-9752.2019.12.103","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1673-9752.2019.12.103","url":null,"abstract":"","PeriodicalId":36400,"journal":{"name":"中华消化外科杂志","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47805821","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 : 2019-12-20DOI: 10.3760/CMA.J.ISSN.1673-9752.2019.12.008
Weike Gao, C. Dai, Yong-qing Xu, Yang Zhao, X. Bu, Yang Su, Liang Zhao
Objective To evaluate the postoperative quality of life after surgery of patients with hepatic hemangioma. Methods The retrospective and descriptive study was conducted. The clinical data of 104 patients who underwent surgery for hepatic hemangioma at Shengjing Hospital of China Medical University from September 2011 to February 2017 were collected. There were 28 males and 76 females, aged (49±8)years, with a range of 27-78 years. Enucleation of hepatic hemangioma or hepatectomy was selected according to tumor location of patients. Observation indicators: (1) surgical and postoperative situations; (2) assessment of quality of life in patients; (3) assessment of quality of life in patients comorbid with other chronic digestive diseases. Measurement data with normal distribution were represented as Mean±SD, and measurement data with skewed distribution were represented as M (range). Repeated data were analyzed using repeated ANOVA. Count data were represented as absolute numbers. Results (1) Surgical and postoperative situations: of 104 patients, 67 underwent enucleation of hepatic hemangioma, 37 underwent hepatectomy. The tumor diameter, volume of intraoperative blood loss, duration of postoperative hospital stay were (10±4)cm, 200 mL (range, 10-3 000 mL), (11±5)days. Seven patients had complications, including 5 of massive abdominal ascites, 1 of abdominal infection, and 1 of pulmanory obstruction. There was no death occurred. (2) Assessment of quality of life in patients with hepatic hemangioma: the total scores of Gastrointestinal-related Quality of Life Index (GIQLI), the scores of subjective symptoms, physiological status, mental and psychological status, and social activities were 121.0±8.3, 69.2±4.1, 18.5±2.6, 19.5±1.8, and 13.8±1.4 at preoperation. The above indices were 121.9±6.9, 71.2±3.8, 17.2±2.5, 19.6±2.3, and 13.8±1.3 of 104 patients with hepatic hemangioma at one month after surgery, respectively. The above indices were 127.8±6.2, 73.2±3.6, 19.8±2.5, 20.8±2.4, and 14.1±1.0 at 6 months after surgery. There were significant differences in changing trends of above indices (F=68.4, 64.6, 71.4, 17.8, 3.3, P 0.05). The total scores of GIQLI, scores of subjective symptoms, physiological status, and mental and psychological status at 6 months after surgery showed significant differences compared with those of preoperation (t=-8.897, -9.919, -5.375, -5.024, P 0.05). The total scores of GIQLI, the scores of subjective symptoms, physiological status, mental and psychological status, and social activities at 6 months after surgery were significantly different from those at one month after surgery (t=-10.835, -6.787, -12.277, -4.560, -2.476, P 0.05) . The scores of subjective symptoms and physiological status at one month after surgery showed significant differences compared with those of preoperation (t=-2.612, 2.191, P 0.05). The total scores of GIQLI, scores of subjective symptoms, physiological status, and social activities at 6
目的评价肝血管瘤患者术后生活质量。方法采用回顾性和描述性研究。收集2011年9月至2017年2月在中国医科大学附属盛京医院行肝血管瘤手术治疗的104例患者的临床资料。男性28例，女性76例，年龄(49±8)岁，年龄27 ~ 78岁。根据患者的肿瘤部位选择肝血管瘤去核或肝切除术。观察指标:(1)手术及术后情况;(2)患者生活质量评估;(3)合并其他慢性消化系统疾病患者的生活质量评估。正态分布计量资料用Mean±SD表示，偏态分布计量资料用M(极差)表示。重复数据采用重复方差分析。计数数据以绝对数字表示。结果(1)手术及术后情况:104例患者中67例行肝血管瘤去核术，37例行肝切除术。肿瘤直径(10±4)cm，术中出血量(200 mL)，术后住院时间(11±5)d。7例患者出现并发症，其中腹部大量腹水5例，腹部感染1例，肺梗阻1例。没有人员死亡。(2)肝血管瘤患者生活质量评价:术前胃肠道相关生活质量指数(GIQLI)总分、主观症状评分、生理状态评分、精神心理状态评分、社会活动评分分别为121.0±8.3、69.2±4.1、18.5±2.6、19.5±1.8、13.8±1.4。104例肝血管瘤患者术后1个月上述指标分别为121.9±6.9、71.2±3.8、17.2±2.5、19.6±2.3、13.8±1.3。术后6个月，上述指标分别为127.8±6.2、73.2±3.6、19.8±2.5、20.8±2.4、14.1±1.0。各指标变化趋势差异有统计学意义(F=68.4、64.6、71.4、17.8、3.3,P < 0.05)。术后6个月GIQLI总分、主观症状评分、生理状态评分、精神心理状态评分与术前比较差异均有统计学意义(t=-8.897、-9.919、-5.375、-5.024,P 0.05)。术后6个月GIQLI总分、主观症状评分、生理状态评分、精神心理状态评分、社会活动评分与术后1个月比较差异均有统计学意义(t=-10.835， -6.787， -12.277， -4.560， -2.476, P 0.05)。术后1个月主观症状和生理状态评分与术前比较差异有统计学意义(t=-2.612, 2.191, P 0.05)。术后6个月GIQLI总分、主观症状评分、生理状态评分、社交活动评分与术前比较差异均有统计学意义(t=-4.002， -3.441， -4.604， -3.266, P 0.05)。术后6个月GIQLI总分、主观症状评分、生理状态评分、社交活动评分与术后1个月比较差异有统计学意义(t=-4.819， -2.313， -7.081， -3.172, P < 0.05)。结论肝血管瘤手术治疗可提高患者的生活质量。对于合并其他消化系统疾病的患者，手术治疗对于改善GIQLI总分、主观症状评分、生理状态评分和社交活动评分仍然有效。关键词:肝血管瘤;手术;肝血管瘤去核术;肝切除术;生活质量
{"title":"Assessment of quality of life after surgery for patients with hepatic hemangioma","authors":"Weike Gao, C. Dai, Yong-qing Xu, Yang Zhao, X. Bu, Yang Su, Liang Zhao","doi":"10.3760/CMA.J.ISSN.1673-9752.2019.12.008","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1673-9752.2019.12.008","url":null,"abstract":"Objective \u0000To evaluate the postoperative quality of life after surgery of patients with hepatic hemangioma. \u0000 \u0000 \u0000Methods \u0000The retrospective and descriptive study was conducted. The clinical data of 104 patients who underwent surgery for hepatic hemangioma at Shengjing Hospital of China Medical University from September 2011 to February 2017 were collected. There were 28 males and 76 females, aged (49±8)years, with a range of 27-78 years. Enucleation of hepatic hemangioma or hepatectomy was selected according to tumor location of patients. Observation indicators: (1) surgical and postoperative situations; (2) assessment of quality of life in patients; (3) assessment of quality of life in patients comorbid with other chronic digestive diseases. Measurement data with normal distribution were represented as Mean±SD, and measurement data with skewed distribution were represented as M (range). Repeated data were analyzed using repeated ANOVA. Count data were represented as absolute numbers. \u0000 \u0000 \u0000Results \u0000(1) Surgical and postoperative situations: of 104 patients, 67 underwent enucleation of hepatic hemangioma, 37 underwent hepatectomy. The tumor diameter, volume of intraoperative blood loss, duration of postoperative hospital stay were (10±4)cm, 200 mL (range, 10-3 000 mL), (11±5)days. Seven patients had complications, including 5 of massive abdominal ascites, 1 of abdominal infection, and 1 of pulmanory obstruction. There was no death occurred. (2) Assessment of quality of life in patients with hepatic hemangioma: the total scores of Gastrointestinal-related Quality of Life Index (GIQLI), the scores of subjective symptoms, physiological status, mental and psychological status, and social activities were 121.0±8.3, 69.2±4.1, 18.5±2.6, 19.5±1.8, and 13.8±1.4 at preoperation. The above indices were 121.9±6.9, 71.2±3.8, 17.2±2.5, 19.6±2.3, and 13.8±1.3 of 104 patients with hepatic hemangioma at one month after surgery, respectively. The above indices were 127.8±6.2, 73.2±3.6, 19.8±2.5, 20.8±2.4, and 14.1±1.0 at 6 months after surgery. There were significant differences in changing trends of above indices (F=68.4, 64.6, 71.4, 17.8, 3.3, P 0.05). The total scores of GIQLI, scores of subjective symptoms, physiological status, and mental and psychological status at 6 months after surgery showed significant differences compared with those of preoperation (t=-8.897, -9.919, -5.375, -5.024, P 0.05). The total scores of GIQLI, the scores of subjective symptoms, physiological status, mental and psychological status, and social activities at 6 months after surgery were significantly different from those at one month after surgery (t=-10.835, -6.787, -12.277, -4.560, -2.476, P 0.05) . The scores of subjective symptoms and physiological status at one month after surgery showed significant differences compared with those of preoperation (t=-2.612, 2.191, P 0.05). The total scores of GIQLI, scores of subjective symptoms, physiological status, and social activities at 6","PeriodicalId":36400,"journal":{"name":"中华消化外科杂志","volume":"18 1","pages":"1129-1135"},"PeriodicalIF":0.0,"publicationDate":"2019-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42759111","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 : 2019-12-20DOI: 10.3760/CMA.J.ISSN.1673-9752.2019.12.004
Zhu Weiming, Wu Enhao, Guo-zhi Zhen
Accurate evaluation of Crohn′s disease is critical for determination of a therapeutic plan. Computed tomography (CT)/magnetic resonance imaging (MRI) can not only display the intraluminal and intraperitoneal inflammation objectively, but also reveal accurately the affected mesentery and related complications comprehensively, which attracted more and more attention in recent years. This review discussed the choice of CT/MRI examination methods, their roles in determining the severity of intestinal and mesenteric inflammation, the nature of intestinal stenosis, the extent of fistula, abscess and cellulitis, and the value in diagnosing postoperative complications, in order to investigate the application value of CT/MRI examination in clinical diagnosis and treatment of Crohn′s disease. Key words: Crohn′s disease; Computed tomography; Magnetic resonance imaging; Clinical diagnosis; Clinical treatment
{"title":"Application value of CT/MRI examination in clinical diagnosis and treatment of Crohn′s disease","authors":"Zhu Weiming, Wu Enhao, Guo-zhi Zhen","doi":"10.3760/CMA.J.ISSN.1673-9752.2019.12.004","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1673-9752.2019.12.004","url":null,"abstract":"Accurate evaluation of Crohn′s disease is critical for determination of a therapeutic plan. Computed tomography (CT)/magnetic resonance imaging (MRI) can not only display the intraluminal and intraperitoneal inflammation objectively, but also reveal accurately the affected mesentery and related complications comprehensively, which attracted more and more attention in recent years. This review discussed the choice of CT/MRI examination methods, their roles in determining the severity of intestinal and mesenteric inflammation, the nature of intestinal stenosis, the extent of fistula, abscess and cellulitis, and the value in diagnosing postoperative complications, in order to investigate the application value of CT/MRI examination in clinical diagnosis and treatment of Crohn′s disease. \u0000 \u0000 \u0000Key words: \u0000Crohn′s disease; Computed tomography; Magnetic resonance imaging; Clinical diagnosis; Clinical treatment","PeriodicalId":36400,"journal":{"name":"中华消化外科杂志","volume":"18 1","pages":"1108-1112"},"PeriodicalIF":0.0,"publicationDate":"2019-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49027191","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 : 2019-11-20DOI: 10.3760/CMA.J.ISSN.1673-9752.2019.11.015
Jingrui Wang, Bei Lu
{"title":"Diagnosis and treatment of acute incomplete intestinal obstruction caused by congenital diaphragmatic hernia incarceration","authors":"Jingrui Wang, Bei Lu","doi":"10.3760/CMA.J.ISSN.1673-9752.2019.11.015","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1673-9752.2019.11.015","url":null,"abstract":"","PeriodicalId":36400,"journal":{"name":"中华消化外科杂志","volume":"18 1","pages":"1080-1081"},"PeriodicalIF":0.0,"publicationDate":"2019-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49323581","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}
京公网安备 11010802042870号
京ICP备2023020795号-1
扫码关注我们
求助内容：
应助结果提醒方式：