Pub Date : 2019-10-20DOI: 10.3760/CMA.J.ISSN.1673-9752.2019.10.015
Rui Tang, Xinjing Zhang, Guochen Ning, Ang Li, Lihan Yu, H. Liao, Jiahong Dong, Q. Lu
Objective To investigate the application value of augmented reality (AR) technology in pancreatoduodenectomy (PD). Methods The retrospective and descriptive study was conducted. The clinicopathological data of 3 male patients who underwent PD in Tsinghua University Affiliated Beijing Tsinghua Changgung Hospital from June 2018 to February 2019 were collected. The 3 patients were aged from 52 to 63 years, with a median age of 57 years. Digital imaging and communication standard format data of enhanced computed tomography (CT) scan were collected, the three-dimensional (3D) images of abdominal arteries, portal vein, descending duodenum, pancreatic body and tail, pancreatic head, common bile duct, and pancreatic duct were reconstructed. The results were imported into the AR software. Optical tracking based on two-dimensional codes and manual interactive rigid registration were adopted for intraoperative navigation. Observation indicators: (1) surgical and postoperative conditions; (2) postoperative pathological examination; (3) follow-up. Follow-up using outpatient examination or telephone interview was conducted to detect survival of patients and tumor metastasis and recurrence up to June 2019. The measurement data with skewed distribution were expressed as M (range). Count data were expressed as absolute numbers. Results (1) Surgical and postoperative conditions: all the 3 patients underwent PD with AR technology as intraoperative navigation successfully. The operation time, volume of intraoperative blood loss, and duration of postoperative hospital stay were 6 hours (range, 5-8 hours), 700 mL (range, 300-900 mL), 11 days (range, 9-12 days). There was no perioperative death or complication occured. After surgery, the patients who underwent PD combined with superior mesenteric vein (SMV) resection and reconstruction had patent SMV on the enhanced computed tomography examination. (2) Postoperative pathological examination: results of pathological examination showed 1 case of intraductal papillary mucinous neoplasm (IPMN) of the pancreas with invasive adenocarcinoma (neoplasm invading SMV), 1 case of insulinoma, and 1 case of periampullary neuroendocrine carcinoma, respectively. (3) Follow-up: 3 patients were followed up for 4-12 months, with a median follow-up time of 6 months. During the follow-up, the patient with IPMN of the pancreas and invasive adenocarcinoma had liver metastasis at 3 months after surgery, and received chemotherapy at other hospital. After 4 cycles of chemotherapy, the metastatic nodule shrank, and the patient was still in follow-up up to deadline of follow-up. Other 2 patients had no recurrence or metastasis. Conclusion AR technique assisted PD is safe and feasible, which is helpful to indentify vascular branches and tracks. Key words: Pancreatic neoplasms; Augmented reality technology; Three-dimensional reconstruction; Pancreatoduodenectomy; Surgical navigation
{"title":"Application value of augmented reality technology in pancreatoduodenectomy","authors":"Rui Tang, Xinjing Zhang, Guochen Ning, Ang Li, Lihan Yu, H. Liao, Jiahong Dong, Q. Lu","doi":"10.3760/CMA.J.ISSN.1673-9752.2019.10.015","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1673-9752.2019.10.015","url":null,"abstract":"Objective \u0000To investigate the application value of augmented reality (AR) technology in pancreatoduodenectomy (PD). \u0000 \u0000 \u0000Methods \u0000The retrospective and descriptive study was conducted. The clinicopathological data of 3 male patients who underwent PD in Tsinghua University Affiliated Beijing Tsinghua Changgung Hospital from June 2018 to February 2019 were collected. The 3 patients were aged from 52 to 63 years, with a median age of 57 years. Digital imaging and communication standard format data of enhanced computed tomography (CT) scan were collected, the three-dimensional (3D) images of abdominal arteries, portal vein, descending duodenum, pancreatic body and tail, pancreatic head, common bile duct, and pancreatic duct were reconstructed. The results were imported into the AR software. Optical tracking based on two-dimensional codes and manual interactive rigid registration were adopted for intraoperative navigation. Observation indicators: (1) surgical and postoperative conditions; (2) postoperative pathological examination; (3) follow-up. Follow-up using outpatient examination or telephone interview was conducted to detect survival of patients and tumor metastasis and recurrence up to June 2019. The measurement data with skewed distribution were expressed as M (range). Count data were expressed as absolute numbers. \u0000 \u0000 \u0000Results \u0000(1) Surgical and postoperative conditions: all the 3 patients underwent PD with AR technology as intraoperative navigation successfully. The operation time, volume of intraoperative blood loss, and duration of postoperative hospital stay were 6 hours (range, 5-8 hours), 700 mL (range, 300-900 mL), 11 days (range, 9-12 days). There was no perioperative death or complication occured. After surgery, the patients who underwent PD combined with superior mesenteric vein (SMV) resection and reconstruction had patent SMV on the enhanced computed tomography examination. (2) Postoperative pathological examination: results of pathological examination showed 1 case of intraductal papillary mucinous neoplasm (IPMN) of the pancreas with invasive adenocarcinoma (neoplasm invading SMV), 1 case of insulinoma, and 1 case of periampullary neuroendocrine carcinoma, respectively. (3) Follow-up: 3 patients were followed up for 4-12 months, with a median follow-up time of 6 months. During the follow-up, the patient with IPMN of the pancreas and invasive adenocarcinoma had liver metastasis at 3 months after surgery, and received chemotherapy at other hospital. After 4 cycles of chemotherapy, the metastatic nodule shrank, and the patient was still in follow-up up to deadline of follow-up. Other 2 patients had no recurrence or metastasis. \u0000 \u0000 \u0000Conclusion \u0000AR technique assisted PD is safe and feasible, which is helpful to indentify vascular branches and tracks. \u0000 \u0000 \u0000Key words: \u0000Pancreatic neoplasms; Augmented reality technology; Three-dimensional reconstruction; Pancreatoduodenectomy; Surgical navigation","PeriodicalId":36400,"journal":{"name":"中华消化外科杂志","volume":"18 1","pages":"986-991"},"PeriodicalIF":0.0,"publicationDate":"2019-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45254505","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.1673-9752.2019.09.013
Cheng Zhou, Zhao Gong, W. Wang, Hui Xia, Zhenxiong Xia, W. Karcz
Objective To explore the application value of laparoscopic gastric plication (LGP) combined with duodeno-jejunal omega switch (DJOS) in modified adjustable gastric banding. Methods The retrospective and descriptive study was conducted. The clinical data of a female 46-year-old patient who had failure to undergo the adjustable gastric banding in the Hospital of Ludwig Maximilian University from December 2016 to December 2018 were collected. LGP and DJOS were performed in two-stages after completion of preoperative examinations. Observation indicators: (1) surgical and postoperative situations; (2) follow-up. Follow-up using outpatient examiantion and telephone interview was performed to collect the information of body mass index (BMI), insulin therapy, and long-term complications until December 2018. Count data were represented as absolute numbers. Results (1) Surgical and postoperative situations: the patient underwent LGP in the first stage and DJOS in the second stage successfully. For the LGP, the operation time, time of intestinal reconstruction, volume of intraoperative blood loss, time to first flatus, time to drainage tube removal, time to resume to normal diet, and duration of postoperative hospital stay were 96 minutes, 58 minutes, 210 mL, 32 hours, 48 hours, 42 days, and 3 days, respectively. For the DJOS, the above indicators were 148 minutes, 117 minutes, 260 mL, 47 hours, 72 hours, 21 days, and 7 days, respectively. There was no complication occurred in either LGP or DJOS. (2) Follow-up: the patient was followed up for 24 months after LGP. The BMI of this patient decreased to 45.3 kg/m2 at 6 months after LGP, and decreased to 37.2 kg/m2 at 18 months after DJOS. Insulin therapy was discontinued. There was no long-term complication such as malnutrition, dumping syndrome, or biliary reflux. Conclusion LGP combined with DJOS can enrich treatment methods of obese patient with BMI >50 kg/m2, which offers a safer surgical procedure option for patients after gastric binding. Key words: Obesity; Sleeve gastrectomy; Gastric plication; Biliopancreatic diversion; Adjustable gastric banding; Gastric bypass; Omega anastomosis; Bariatric and metabolic surgery
{"title":"Application value of laparoscopic gastric plication combined with duodeno-jejunal omega switch in modified adjustable gastric banding","authors":"Cheng Zhou, Zhao Gong, W. Wang, Hui Xia, Zhenxiong Xia, W. Karcz","doi":"10.3760/CMA.J.ISSN.1673-9752.2019.09.013","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1673-9752.2019.09.013","url":null,"abstract":"Objective \u0000To explore the application value of laparoscopic gastric plication (LGP) combined with duodeno-jejunal omega switch (DJOS) in modified adjustable gastric banding. \u0000 \u0000 \u0000Methods \u0000The retrospective and descriptive study was conducted. The clinical data of a female 46-year-old patient who had failure to undergo the adjustable gastric banding in the Hospital of Ludwig Maximilian University from December 2016 to December 2018 were collected. LGP and DJOS were performed in two-stages after completion of preoperative examinations. Observation indicators: (1) surgical and postoperative situations; (2) follow-up. Follow-up using outpatient examiantion and telephone interview was performed to collect the information of body mass index (BMI), insulin therapy, and long-term complications until December 2018. Count data were represented as absolute numbers. \u0000 \u0000 \u0000Results \u0000(1) Surgical and postoperative situations: the patient underwent LGP in the first stage and DJOS in the second stage successfully. For the LGP, the operation time, time of intestinal reconstruction, volume of intraoperative blood loss, time to first flatus, time to drainage tube removal, time to resume to normal diet, and duration of postoperative hospital stay were 96 minutes, 58 minutes, 210 mL, 32 hours, 48 hours, 42 days, and 3 days, respectively. For the DJOS, the above indicators were 148 minutes, 117 minutes, 260 mL, 47 hours, 72 hours, 21 days, and 7 days, respectively. There was no complication occurred in either LGP or DJOS. (2) Follow-up: the patient was followed up for 24 months after LGP. The BMI of this patient decreased to 45.3 kg/m2 at 6 months after LGP, and decreased to 37.2 kg/m2 at 18 months after DJOS. Insulin therapy was discontinued. There was no long-term complication such as malnutrition, dumping syndrome, or biliary reflux. \u0000 \u0000 \u0000Conclusion \u0000LGP combined with DJOS can enrich treatment methods of obese patient with BMI >50 kg/m2, which offers a safer surgical procedure option for patients after gastric binding. \u0000 \u0000 \u0000Key words: \u0000Obesity; Sleeve gastrectomy; Gastric plication; Biliopancreatic diversion; Adjustable gastric banding; Gastric bypass; Omega anastomosis; Bariatric and metabolic surgery","PeriodicalId":36400,"journal":{"name":"中华消化外科杂志","volume":"18 1","pages":"879-883"},"PeriodicalIF":0.0,"publicationDate":"2019-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43161478","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.1673-9752.2019.09.004
Jiangfan Zhu
The new technique of single anastomosis duodenal-ileal bypass with sleeve gastrectomy appeared during recent years, which is a modification of biliopancreatic diversion with duodenal switch. The basic principles of this technique are restricted food intake by a sleeve gastrectomy and decreased absorption by the duodenal-ileal anastomosis. The new technique is relatively simple, with less malnutrition, better weight loss and metabolic disorders remission. The principle, surgical technique, results and possible complications are described, and the technique is also compared with existing weight loss operations in this article. Key words: Obesity; Bariatric surgery; Single anastomosis technique; Duodenal switch; Bariatric and metabolic surgery
{"title":"Current status and prospect of single anastomosis duodenal-ileal bypass with sleeve gastrectomy","authors":"Jiangfan Zhu","doi":"10.3760/CMA.J.ISSN.1673-9752.2019.09.004","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1673-9752.2019.09.004","url":null,"abstract":"The new technique of single anastomosis duodenal-ileal bypass with sleeve gastrectomy appeared during recent years, which is a modification of biliopancreatic diversion with duodenal switch. The basic principles of this technique are restricted food intake by a sleeve gastrectomy and decreased absorption by the duodenal-ileal anastomosis. The new technique is relatively simple, with less malnutrition, better weight loss and metabolic disorders remission. The principle, surgical technique, results and possible complications are described, and the technique is also compared with existing weight loss operations in this article. \u0000 \u0000 \u0000Key words: \u0000Obesity; Bariatric surgery; Single anastomosis technique; Duodenal switch; Bariatric and metabolic surgery","PeriodicalId":36400,"journal":{"name":"中华消化外科杂志","volume":"18 1","pages":"830-833"},"PeriodicalIF":0.0,"publicationDate":"2019-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47371976","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.1673-9752.2019.09.005
K. Tao, Jie Bai, X. Shuai, Z. Xia
Bariatric surgery is an effective method for the treatment of obesity and type 2 diabetes mellitus. Morbidly obese patients usually have metabolic syndromes, as such, surgeons need to choose the reasonable surgical methods for patients according to their individuality and particularity. Hiatal hernia is a very common disease prevalent in obese patients and could induce gastroesophageal reflux, which increases the difficulty of bariatric surgery and proposes higher demands on choice of surgical methods to surgeons. It is important to recognize the presence of the hiatal hernia preoperatively and choose a more effective procedure of bariatric surgery to decrease the incidence of postoperative complications. Key words: Obesity; Hiatal hernia; Gastroesophageal reflux; Bariatric surgery; Baria-tric and metabolic surgery
{"title":"Surgical treatment of obesity comorbid with hiatal hernia","authors":"K. Tao, Jie Bai, X. Shuai, Z. Xia","doi":"10.3760/CMA.J.ISSN.1673-9752.2019.09.005","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1673-9752.2019.09.005","url":null,"abstract":"Bariatric surgery is an effective method for the treatment of obesity and type 2 diabetes mellitus. Morbidly obese patients usually have metabolic syndromes, as such, surgeons need to choose the reasonable surgical methods for patients according to their individuality and particularity. Hiatal hernia is a very common disease prevalent in obese patients and could induce gastroesophageal reflux, which increases the difficulty of bariatric surgery and proposes higher demands on choice of surgical methods to surgeons. It is important to recognize the presence of the hiatal hernia preoperatively and choose a more effective procedure of bariatric surgery to decrease the incidence of postoperative complications. \u0000 \u0000 \u0000Key words: \u0000Obesity; Hiatal hernia; Gastroesophageal reflux; Bariatric surgery; Baria-tric and metabolic surgery","PeriodicalId":36400,"journal":{"name":"中华消化外科杂志","volume":"18 1","pages":"834-837"},"PeriodicalIF":0.0,"publicationDate":"2019-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"70016865","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.1673-9752.2019.09.011
Changdong Yang, Yan Shi, S. Xie, Long Du, Jun Chen, Yongliang Zhao, F. Qian, Ying-xue Hao, B. Tang
Objective To analyze the postoperative complications of Da Vinci robotic total gastrectomy for gastric cancer, and explore the risk factors for postoperative complications. Methods The retrospective case-control study was conducted. The clinicopathological data of 173 patients with gastric cancer who were admitted to the First Affiliated Hospital of Army Medical University from March 2010 to March 2019 were collected. There were 138 males and 35 females, aged from 34 to 76 years, with an average age of 60 years. All the 173 patients underwent Da Vinci robotic total gastrectomy for gastric cancer. Observation indicators: (1) postoperative complications; (2) analysis of risk factors for postoperative complications of Da Vinci robotic total gastrectomy for gastric cancer. Count data were expressed as absolute numbers or percentages. Univariate analysis was performed using the chi-square test or Fisher exact probability. Indicators with P<0.1 were included into multivariate analysis, and multivariate analysis was performed using logistic regression model. Results (1) Postoperative complications: of the 173 patients, 45 had postoperative complications, with a incidence rate of 26.0%(45/173). Among the 45 patients, 5 had gradeⅠpostoperative complications, 31 had grade Ⅱ postoperative complications, 2 had grade Ⅲa postoperative complications, 3 had grade Ⅲb postoperative complications, 1 had grade Ⅳa postoperative complications, 1 had grade Ⅳb postoperative complications, and 2 had grade Ⅴ postoperative complications. The incidence of serious complications was 5.2%(9/173). Of the 5 patients with gradeⅠcomplications, 1 of fever was improved after antipyretic treatment, 2 of incisional fat liquefaction were improved after dressing change, 1 of vomiting was improved after being given antiemetic, and 1 of delayed recovery of gastrointestinal function was improved after symptomatic treatment. Among 31 patients with gradeⅡcomplications, 12 patients had pulmonary infection, including 6 of pulmonary infection alone, 3 combined with pleural effusion, 1 combined with abdominal infection, 2 combined with intestinal obstruction, and all were improved after conservative treatment; 7 of fever were improved after anti-infection treatment; 4 patients had deep venous catheter infection including 1 combined with bilateral pleural effusion, and were improved after removing catheter and anti-infection treatment; 3 patients had anastomotic leakage including 1 with pulmonary infection and abdominal infection, and were improved after conservative treatment; 2 patients had duodenal stump leakage (1 combined with pulmonary infection, 1 combined with pulmonary infection and pleural effusion) , and were improved after conservative treatment; 1 patient had abdominal hemorrhage, and was improved after conservative treatment; 1 patient had intestinal obstruction, and was improved after conservative treatment; 1 patient had abdominal infection, and was improved after con
{"title":"Analysis of postoperative complications and risk factors of Da Vinci robotic total gastrectomy for gastric cancer","authors":"Changdong Yang, Yan Shi, S. Xie, Long Du, Jun Chen, Yongliang Zhao, F. Qian, Ying-xue Hao, B. Tang","doi":"10.3760/CMA.J.ISSN.1673-9752.2019.09.011","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1673-9752.2019.09.011","url":null,"abstract":"Objective \u0000To analyze the postoperative complications of Da Vinci robotic total gastrectomy for gastric cancer, and explore the risk factors for postoperative complications. \u0000 \u0000 \u0000Methods \u0000The retrospective case-control study was conducted. The clinicopathological data of 173 patients with gastric cancer who were admitted to the First Affiliated Hospital of Army Medical University from March 2010 to March 2019 were collected. There were 138 males and 35 females, aged from 34 to 76 years, with an average age of 60 years. All the 173 patients underwent Da Vinci robotic total gastrectomy for gastric cancer. Observation indicators: (1) postoperative complications; (2) analysis of risk factors for postoperative complications of Da Vinci robotic total gastrectomy for gastric cancer. Count data were expressed as absolute numbers or percentages. Univariate analysis was performed using the chi-square test or Fisher exact probability. Indicators with P<0.1 were included into multivariate analysis, and multivariate analysis was performed using logistic regression model. \u0000 \u0000 \u0000Results \u0000(1) Postoperative complications: of the 173 patients, 45 had postoperative complications, with a incidence rate of 26.0%(45/173). Among the 45 patients, 5 had gradeⅠpostoperative complications, 31 had grade Ⅱ postoperative complications, 2 had grade Ⅲa postoperative complications, 3 had grade Ⅲb postoperative complications, 1 had grade Ⅳa postoperative complications, 1 had grade Ⅳb postoperative complications, and 2 had grade Ⅴ postoperative complications. The incidence of serious complications was 5.2%(9/173). Of the 5 patients with gradeⅠcomplications, 1 of fever was improved after antipyretic treatment, 2 of incisional fat liquefaction were improved after dressing change, 1 of vomiting was improved after being given antiemetic, and 1 of delayed recovery of gastrointestinal function was improved after symptomatic treatment. Among 31 patients with gradeⅡcomplications, 12 patients had pulmonary infection, including 6 of pulmonary infection alone, 3 combined with pleural effusion, 1 combined with abdominal infection, 2 combined with intestinal obstruction, and all were improved after conservative treatment; 7 of fever were improved after anti-infection treatment; 4 patients had deep venous catheter infection including 1 combined with bilateral pleural effusion, and were improved after removing catheter and anti-infection treatment; 3 patients had anastomotic leakage including 1 with pulmonary infection and abdominal infection, and were improved after conservative treatment; 2 patients had duodenal stump leakage (1 combined with pulmonary infection, 1 combined with pulmonary infection and pleural effusion) , and were improved after conservative treatment; 1 patient had abdominal hemorrhage, and was improved after conservative treatment; 1 patient had intestinal obstruction, and was improved after conservative treatment; 1 patient had abdominal infection, and was improved after con","PeriodicalId":36400,"journal":{"name":"中华消化外科杂志","volume":"18 1","pages":"864-872"},"PeriodicalIF":0.0,"publicationDate":"2019-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48419221","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.1673-9752.2019.09.015
R. Ni, S. Chen, H. Qian, H. Mai, Xiaoyi Li, Yan Zhu, Meng-Ge Yu, Yongtao Yu
{"title":"Multidisciplinary team diagnosis and treatment of obesity complicated with severe obstructive sleep apnea hypopnea syndrome","authors":"R. Ni, S. Chen, H. Qian, H. Mai, Xiaoyi Li, Yan Zhu, Meng-Ge Yu, Yongtao Yu","doi":"10.3760/CMA.J.ISSN.1673-9752.2019.09.015","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1673-9752.2019.09.015","url":null,"abstract":"","PeriodicalId":36400,"journal":{"name":"中华消化外科杂志","volume":"18 1","pages":"890-892"},"PeriodicalIF":0.0,"publicationDate":"2019-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47662203","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.1673-9752.2019.09.003
Cunchuan Wang, Songhao Hu
Bariatric surgery has been widely accepted around the world and recognized for long-term and effective weight loss, based on long-term follow-up of large sample sizes. Though more than 70 years of development, bariatric surgery is not only on open technique, it is usually done by laparoscopy. But with the advance of the new technology, laparoscopy is no longer a unique technique. With the development of new robotic system and endoscopic system, bariatric and metabolic surgery has come to a new era. There is no doubt that bariatric surgery is still on the change as the development of scientific technology. Laparoscopic technique is still the mainstream of bariatric and metabolic surgery. With the decrease in the price of robotic system and the appearance of domestic robotic system, the robotic technique will also be accepted by many surgeons. The endoscopic technique is a tendency for bariatric and metabolic surgery because of effective weight loss, small trauma and low complication rates. Key words: Obesity; Bariatric surgery; Robotic surgical system; Endoscopic surgery; Laparoscopy
{"title":"Strategies and thoughts on selection of bariatric surgery","authors":"Cunchuan Wang, Songhao Hu","doi":"10.3760/CMA.J.ISSN.1673-9752.2019.09.003","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1673-9752.2019.09.003","url":null,"abstract":"Bariatric surgery has been widely accepted around the world and recognized for long-term and effective weight loss, based on long-term follow-up of large sample sizes. Though more than 70 years of development, bariatric surgery is not only on open technique, it is usually done by laparoscopy. But with the advance of the new technology, laparoscopy is no longer a unique technique. With the development of new robotic system and endoscopic system, bariatric and metabolic surgery has come to a new era. There is no doubt that bariatric surgery is still on the change as the development of scientific technology. Laparoscopic technique is still the mainstream of bariatric and metabolic surgery. With the decrease in the price of robotic system and the appearance of domestic robotic system, the robotic technique will also be accepted by many surgeons. The endoscopic technique is a tendency for bariatric and metabolic surgery because of effective weight loss, small trauma and low complication rates. \u0000 \u0000 \u0000Key words: \u0000Obesity; Bariatric surgery; Robotic surgical system; Endoscopic surgery; Laparoscopy","PeriodicalId":36400,"journal":{"name":"中华消化外科杂志","volume":"18 1","pages":"826-829"},"PeriodicalIF":0.0,"publicationDate":"2019-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41358084","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.1673-9752.2019.09.006
S. Qu
As the incidence of obesity increases globally, treatment strategies of obesity emerge continuously. However, the weight loss effect varies between individuals without explicit explanations. In the recent years, many researchers have revealed regulation mechanisms of central nervous system on eating behavior, proposing that obese individuals exhibit brain functional abnormalities implicated in homeostatic regulation of food intake, central reward and motivation, emotion, memory, and attention system. Therefore, these scholars appeal that treating obesity cannot remain "brainless" . The most effective treatment currently available for obesity is bariatric surgery which lead to excess weight loss of 42%-67% in accompany with changes in brain activity. Functional magnetic resonance imaging showed a decreased activation in the central reward network and increased inhibitory control in the cognitive control system after bariatric surgeries. In this article, the authors introduce the central nervous system regulation of eating and investigate the effects of bariatric surgery on central nervous system. Key words: Obesity; Central nerve; Bariatric surgery; Bariatric and metabolic surgery; Regulation mechanisms
{"title":"Effects of bariatric surgery on central nervous system regulation of obesity","authors":"S. Qu","doi":"10.3760/CMA.J.ISSN.1673-9752.2019.09.006","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1673-9752.2019.09.006","url":null,"abstract":"As the incidence of obesity increases globally, treatment strategies of obesity emerge continuously. However, the weight loss effect varies between individuals without explicit explanations. In the recent years, many researchers have revealed regulation mechanisms of central nervous system on eating behavior, proposing that obese individuals exhibit brain functional abnormalities implicated in homeostatic regulation of food intake, central reward and motivation, emotion, memory, and attention system. Therefore, these scholars appeal that treating obesity cannot remain \"brainless\" . The most effective treatment currently available for obesity is bariatric surgery which lead to excess weight loss of 42%-67% in accompany with changes in brain activity. Functional magnetic resonance imaging showed a decreased activation in the central reward network and increased inhibitory control in the cognitive control system after bariatric surgeries. In this article, the authors introduce the central nervous system regulation of eating and investigate the effects of bariatric surgery on central nervous system. \u0000 \u0000 \u0000Key words: \u0000Obesity; Central nerve; Bariatric surgery; Bariatric and metabolic surgery; Regulation mechanisms","PeriodicalId":36400,"journal":{"name":"中华消化外科杂志","volume":"18 1","pages":"838-842"},"PeriodicalIF":0.0,"publicationDate":"2019-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48916676","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.1673-9752.2019.09.012
L. Cao, Jun Lu, Jian-Xian Lin, C. Zheng, Ping Li, Jian-Wei Xie, Jia‐bin Wang, Qi‐yue Chen, Mi Lin, R. Tu, Ze-ning Huang, Ju-Li Lin
Objective To investigate the clinical efficacy of Da Vinci robotic total gastrectomy combined with spleen-preserving splenic hilar lymphadenectomy for gastric cancer. Methods The retrospective cross-sectional study was conducted. The clinicopathological data of 47 patients with gastric cancer who were admitted to Fujian Medical University Union Hospital from September 2016 to June 2018 were collected. There were 37 males and 10 females, aged from 23 to 75 years, with an average age of 60 years. Patients underwent Da Vinci robotic total gastrectomy combined with spleen-preserving splenic hilar lymphadenectomy. Observation indicators: (1) intraoperative situations; (2) postoperative situations; (3) postoperative pathological examination; (4) follow-up. Follow-up was conducted by outpatient examination and telephone interview to detect postoperative survival of patients up to September 2018. Measurement data with normal distribution were represented as Mean±SD, and measurement data with skewed distribution were expressed by M (range). Count data were represented as absolute numbers. Results (1) Intraoperative situations: 47 patients underwent Da Vinci robotic total gastrectomy combined with spleen-preserving splenic hilar lymphadenectomy for gastric cancer, without conversion to open surgery. The operation time, hilar lymph node dissection time, volume of intraoperative blood loss, number of lymph node dissected, number of splenic hilar lymph node dissected, number of metastatic lymph nodes, number of metastatic splenic hilar lymph node were (225±36) minutes, (20±6) minutes, (40±27) mL, 40 (range, 17-112), 2 (range, 0-10), 2 (range, 0-29), 0 (range, 0-3). (2) Postoperative situations: time to first out-of-bed activities, time to first anal flatus, time to gastric tube removal, time to initial liquid diet intake, time to initial semi-liquid diet intake, time to drainage tube removal, and duration of postoperative hospital stay were (2.0±0.3)days, (3.4±0.9)days, (3.4±1.1)days, (4.8±1.0)days, (6.7±1.5)days, (8.5±2.5)days, and (12.0±8.3)days, respectively. Of 47 patients, 3, 2, 1, 1, and 1 were detected pulmonary infection, abdominal bleeding, anastomotic fistula, postoperative intestinal obstruction, and abdominal infection. There were 1, 5, and 2 patients with complications in grade Ⅰ, Ⅱ, and Ⅲ of Clavien-Dindo classification. There was no death in the postoperative 30 days. Two patients with abdominal bleeding were cured by intervene therapy, and patients with other complications were cured by conservative treatment. (3) Postoperative pathological examination: tumor diameter, cases with nodal or vascular or neural invasion, cases with differentiated and undifferentiated tumor (histological differentiation), cases in T1, T2, T3, T4 stages (T staging), cases in N0, N1, N2, N3 stages (N staging), cases in Ⅰ, Ⅱ, Ⅲ stages (TNM staging) were (4.2±1.6)cm, 26, 31, 16, 5, 22, 17, 3, 18, 9, 8, 12, 13, 20, 14, respectively. (4) Follow-up:
{"title":"Clinical efficacy of Da Vinci robotic total gastrectomy combined with spleen-preserving splenic hilar lymphadenectomy for gastric cancer","authors":"L. Cao, Jun Lu, Jian-Xian Lin, C. Zheng, Ping Li, Jian-Wei Xie, Jia‐bin Wang, Qi‐yue Chen, Mi Lin, R. Tu, Ze-ning Huang, Ju-Li Lin","doi":"10.3760/CMA.J.ISSN.1673-9752.2019.09.012","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1673-9752.2019.09.012","url":null,"abstract":"Objective To investigate the clinical efficacy of Da Vinci robotic total gastrectomy combined with spleen-preserving splenic hilar lymphadenectomy for gastric cancer. Methods The retrospective cross-sectional study was conducted. The clinicopathological data of 47 patients with gastric cancer who were admitted to Fujian Medical University Union Hospital from September 2016 to June 2018 were collected. There were 37 males and 10 females, aged from 23 to 75 years, with an average age of 60 years. Patients underwent Da Vinci robotic total gastrectomy combined with spleen-preserving splenic hilar lymphadenectomy. Observation indicators: (1) intraoperative situations; (2) postoperative situations; (3) postoperative pathological examination; (4) follow-up. Follow-up was conducted by outpatient examination and telephone interview to detect postoperative survival of patients up to September 2018. Measurement data with normal distribution were represented as Mean±SD, and measurement data with skewed distribution were expressed by M (range). Count data were represented as absolute numbers. Results (1) Intraoperative situations: 47 patients underwent Da Vinci robotic total gastrectomy combined with spleen-preserving splenic hilar lymphadenectomy for gastric cancer, without conversion to open surgery. The operation time, hilar lymph node dissection time, volume of intraoperative blood loss, number of lymph node dissected, number of splenic hilar lymph node dissected, number of metastatic lymph nodes, number of metastatic splenic hilar lymph node were (225±36) minutes, (20±6) minutes, (40±27) mL, 40 (range, 17-112), 2 (range, 0-10), 2 (range, 0-29), 0 (range, 0-3). (2) Postoperative situations: time to first out-of-bed activities, time to first anal flatus, time to gastric tube removal, time to initial liquid diet intake, time to initial semi-liquid diet intake, time to drainage tube removal, and duration of postoperative hospital stay were (2.0±0.3)days, (3.4±0.9)days, (3.4±1.1)days, (4.8±1.0)days, (6.7±1.5)days, (8.5±2.5)days, and (12.0±8.3)days, respectively. Of 47 patients, 3, 2, 1, 1, and 1 were detected pulmonary infection, abdominal bleeding, anastomotic fistula, postoperative intestinal obstruction, and abdominal infection. There were 1, 5, and 2 patients with complications in grade Ⅰ, Ⅱ, and Ⅲ of Clavien-Dindo classification. There was no death in the postoperative 30 days. Two patients with abdominal bleeding were cured by intervene therapy, and patients with other complications were cured by conservative treatment. (3) Postoperative pathological examination: tumor diameter, cases with nodal or vascular or neural invasion, cases with differentiated and undifferentiated tumor (histological differentiation), cases in T1, T2, T3, T4 stages (T staging), cases in N0, N1, N2, N3 stages (N staging), cases in Ⅰ, Ⅱ, Ⅲ stages (TNM staging) were (4.2±1.6)cm, 26, 31, 16, 5, 22, 17, 3, 18, 9, 8, 12, 13, 20, 14, respectively. (4) Follow-up: ","PeriodicalId":36400,"journal":{"name":"中华消化外科杂志","volume":"18 1","pages":"873-878"},"PeriodicalIF":0.0,"publicationDate":"2019-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44285448","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.1673-9752.2019.09.008
Wenhui Chen, Hua Yang, J. Bian, Xinyi Lei, Shuwen Jiang, Bingsheng Guan, Jingge Yang, Z. Dong
Objective To investigate the application value of caesarean section scar or bikini line incisional approach in laparoscopic sleeve gastrectomy. Methods The retrospective cohort study was conducted. The clinical data of 162 patients with obesity and metabolic diseases who were admitted to the First Affiliated Hospital of Jinan University between March 2018 and April 2019 were collected. There were 51 males and 111 females, aged (35±8)years, with a range from 12 to 47 years. Of 162 patients, 72 undergoing laparoscopic sleeve gastrectomy via caesarean section scar or bikini line incisional approach and 90 undergoing laparoscopic sleeve gastrectomy via traditional incisional approach were respectively allocated into concealed incision group and traditional incision group. Observation indicators: (1) surgical situations; (2) intraoperative situations; (3) postoperative situations; (4) follow-up. Follow-up using outpatient examination, telephone interview, and WeChat was performed to detect the postoperative complications at 1, 3, 6 months and 1, 2, 5 years postoperatively up to May 2019. Measurement data with normal distribution were represented as Mean±SD, and the t test was used for comparison between groups. Count data were represented as absolute numbers, and were analyzed by the chi-square test or fisher exact probability. Ordinal data were analyzed by the Wilcoxon rank sum test. Results (1) Surgical situations: patients in the concealed incision group and traditional incision group underwent successfully laparoscopic sleeve gastrectomy, without conversion to open surgery, reoperation, or perioperative death. (2) Intraoperative situations: the operation time and volume of intraoperative blood loss of the concealed incision group were (102±17)minutes and (11±4)mL, respectively, versus (105±19)minutes and (11±4)mL of the traditional incision group (t=-1.232, -0.676, P>0.05). There were 6 cases and 21 cases with additional surgical ports during operation in the concealed incision group and traditional incision group, respectively, with a significant difference between the two groups (χ2=6.280, P 0.05). There were 19 and 14 patients with gastroesophageal reflux in the concealed incision group and traditional incision group, respectively, with no significant difference between the two groups (χ2=2.894, P>0.05). There was no postoperative complication such as infection, hemorrhage or anastomotic leakage in either group. (4) Follow-up: 32 of 162 patients were lost to follow-up, including 10 in the concealed incision group and 22 in the traditional incision group; other 130 patients were followed up for 1-14 months, with a median follow-up time of 7 months. During the follow-up, 1 patient in the traditional incision group was hospitalized again at 3 months after surgery due to upper gastrointestinal bleeding, and was cured after symptomatic supportive treatment. One patient in the concealed incision group was admitted to the local hospital f
目的探讨剖宫产瘢痕或比基尼线切口入路在腹腔镜袖胃切除术中的应用价值。方法采用回顾性队列研究。收集2018年3月至2019年4月济南大学第一附属医院收治的162例肥胖及代谢性疾病患者的临床资料。男性51例，女性111例，年龄(35±8)岁，年龄12 ~ 47岁。162例患者中，经剖宫产瘢痕或比基尼线切口入路行腹腔镜袖胃切除术72例，经传统切口入路行腹腔镜袖胃切除术90例，分别分为隐蔽切口组和传统切口组。观察指标:(1)手术情况;(2)术中情况;(3)术后情况;(4)随访。随访于术后1、3、6个月及1、2、5年至2019年5月，采用门诊检查、电话访谈、微信等方式，观察术后并发症。计量资料为正态分布，用Mean±SD表示，组间比较采用t检验。计数数据以绝对数字表示，并采用卡方检验或fisher精确概率进行分析。序贯资料采用Wilcoxon秩和检验进行分析。结果(1)手术情况:隐蔽切口组和传统切口组患者均顺利完成腹腔镜袖胃切除术，无中转开腹手术、再手术及围手术期死亡。(2)术中情况:隐蔽切口组手术时间为(102±17)min，术中出血量为(11±4)mL，传统切口组为(105±19)min，术中出血量为(11±4)mL (t=-1.232， -0.676, P < 0.05)。隐切口组术中增加手术口6例，传统切口组术中增加手术口21例，两组间差异有统计学意义(χ2=6.280, p0.05)。隐切口组胃食管反流19例，传统切口组胃食管反流14例，两组差异无统计学意义(χ2=2.894, P < 0.05)。两组术后均无感染、出血、吻合口漏等并发症发生。(4)随访:162例患者中失访32例，其中隐蔽切口组10例，传统切口组22例;其余130例患者随访1 ~ 14个月，中位随访时间7个月。随访中，传统切口组1例患者术后3个月因上消化道出血再次住院，经对症支持治疗治愈。隐切口组1例患者术后1个月因功能性梗阻入院，对症治疗后出院。其他患者无术后并发症再入院。结论经剖宫产瘢痕或比基尼线切口行腹腔镜袖式胃切除术安全可行，美容效果好。关键词:肥胖;代谢疾病;剖宫产术瘢痕切口;比基尼线切口;隐蔽切口;腹腔镜袖式胃切除术;减肥手术;腹腔镜检查
{"title":"Application value of caesarean section scar or bikini line incisional approach in laparoscopic sleeve gastrectomy","authors":"Wenhui Chen, Hua Yang, J. Bian, Xinyi Lei, Shuwen Jiang, Bingsheng Guan, Jingge Yang, Z. Dong","doi":"10.3760/CMA.J.ISSN.1673-9752.2019.09.008","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1673-9752.2019.09.008","url":null,"abstract":"Objective \u0000To investigate the application value of caesarean section scar or bikini line incisional approach in laparoscopic sleeve gastrectomy. \u0000 \u0000 \u0000Methods \u0000The retrospective cohort study was conducted. The clinical data of 162 patients with obesity and metabolic diseases who were admitted to the First Affiliated Hospital of Jinan University between March 2018 and April 2019 were collected. There were 51 males and 111 females, aged (35±8)years, with a range from 12 to 47 years. Of 162 patients, 72 undergoing laparoscopic sleeve gastrectomy via caesarean section scar or bikini line incisional approach and 90 undergoing laparoscopic sleeve gastrectomy via traditional incisional approach were respectively allocated into concealed incision group and traditional incision group. Observation indicators: (1) surgical situations; (2) intraoperative situations; (3) postoperative situations; (4) follow-up. Follow-up using outpatient examination, telephone interview, and WeChat was performed to detect the postoperative complications at 1, 3, 6 months and 1, 2, 5 years postoperatively up to May 2019. Measurement data with normal distribution were represented as Mean±SD, and the t test was used for comparison between groups. Count data were represented as absolute numbers, and were analyzed by the chi-square test or fisher exact probability. Ordinal data were analyzed by the Wilcoxon rank sum test. \u0000 \u0000 \u0000Results \u0000(1) Surgical situations: patients in the concealed incision group and traditional incision group underwent successfully laparoscopic sleeve gastrectomy, without conversion to open surgery, reoperation, or perioperative death. (2) Intraoperative situations: the operation time and volume of intraoperative blood loss of the concealed incision group were (102±17)minutes and (11±4)mL, respectively, versus (105±19)minutes and (11±4)mL of the traditional incision group (t=-1.232, -0.676, P>0.05). There were 6 cases and 21 cases with additional surgical ports during operation in the concealed incision group and traditional incision group, respectively, with a significant difference between the two groups (χ2=6.280, P 0.05). There were 19 and 14 patients with gastroesophageal reflux in the concealed incision group and traditional incision group, respectively, with no significant difference between the two groups (χ2=2.894, P>0.05). There was no postoperative complication such as infection, hemorrhage or anastomotic leakage in either group. (4) Follow-up: 32 of 162 patients were lost to follow-up, including 10 in the concealed incision group and 22 in the traditional incision group; other 130 patients were followed up for 1-14 months, with a median follow-up time of 7 months. During the follow-up, 1 patient in the traditional incision group was hospitalized again at 3 months after surgery due to upper gastrointestinal bleeding, and was cured after symptomatic supportive treatment. One patient in the concealed incision group was admitted to the local hospital f","PeriodicalId":36400,"journal":{"name":"中华消化外科杂志","volume":"18 1","pages":"848-853"},"PeriodicalIF":0.0,"publicationDate":"2019-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46372844","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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