Objective To determine if laparoscopic assisted Ivor-Lewis cervical stapled esophagogastrostomy via a minor subaxillary incising enables better perioperative and medium-term outcome than Ivor-Lewis cervical stapled esophagogastrostomy via thorax for middle esophageal carcinoma without intumescent lymphnode of neck. Methods The perioperative and medium-term outcome of a series of 55 patients underwent Ivor-Lewis cervical stapled esophagogas-trostomy via thorax between April 2010 and December 2012 were as a historic cohort (group A, 36 males, 19 females at age of 65±8 years). And 46 patients underwent laparoscopic assisted Ivor-Lewis cervical stapled esophagogastrostomy via a minor subaxillary incising between January 2013 and March 2015 were as a prospective cohort (group B, 31males, 15 females at age of 66±7 years). Perioperative indexes, lymphadenectomy, and result at end of one year following up were compared. Results Compared with group A, there was shorter thoracic operation time (t=5.94, P < 0.05), shorter time of restored anus exhaust (t=2.08, P < 0.05), less pulmonary complication (χ2=3.08, P < 0.05) and less total perioperative complications (χ2=4.30, P < 0.05), shorter postoperative hospital stay (t=3.20, P < 0.05) in the group B. While no statistically significant difference was found between the two group in postoperative morbidity of circulation or digestive and associated with surgical techniques (all P>0.05), lymph node metastasis rate of cervico-thoracic (include cervical paraesophageal) or mediastinum or abdominal cavity (χ2=0.03, 0.15, 0.08, all P>0.05), lymph node ratio (LNR) of cervical thoracic (include cervical paraesophageal) or mediastinum or abdominal cavity (χ2=0.01,0.71, 0.01, all P>0.05), recurrence rate of tumour (χ2=0.04, P>0.05), or survival rate (χ2=0.13, P>0.05) one year after the surgery. Conclusion Laparoscopic assisted Ivor-Lewis cervical stapled esophagogastrostomy via a minor subaxillary incising is a more rational surgery of cervicothoracic and cervical paraesophageal lymph nodes dissection via intrathoracic instead of cervical approach for middle esophageal carcinoma.
Objective To explore the application of fast track surgery (FTS) mode through multidisciplinary cooperation for the perioperative period of liver cancer. Methods A total of 188 patients with liver cancer treated between April and December 2014 were randomly divided into two groups: FTS group (n=94) and control group (n=94). The FTS group was treated with multidisciplinary cooperative FTS mode, while the control group was treated with traditional perioperative treatment. The self-care ability of daily life, pain, ambulation time and frequency, anal exhaust time, defecation time, hospital stay, hospitalization expenses and readmission rate were compared between the two groups. Results Compared with the control group, patients in the FTS group had a better ability of self-care one to three days after surgery, more reduced pain 8, 24 and 48 hours after surgery, more frequent ambulation and longer ambulation time three days after surgery, shorter time of defecation and exhaust, shorter hospital stay and lower hospitalization expenses. All the above differences were statistically significant (P<0.05). The readmission rate, self-care ability four to seven days after surgery, pain scores 72 and 96 hours after surgery were not significantly different (P>0.05). Conclusion Multidisciplinary cooperative FTS mode for liver cancer perioperative rehabilitation can improve patients’ self-care ability, promote a speedy recovery, reduce hospitalization costs, save medical resources and improve disciplinary teamwork ability.
ObjectiveTo explain the latest concepts of colorectal surgery, and predict the future direction of it. MethodsA review and summary based on the clinical experience of our hospitals and theses over the past years and new advances on the researches in home and abroad were performed. ResultsDoctors should attach more importance to anal preserving operation; and there should be more usage of fast track in colorectal surgery. Besides, predicting low risk of postoperative complications and digitizing colorectal surgery also needed more attention. ConclusionThose aspects of colorectal surgery in the result need further development.
ObjectiveTo investigate the impact of chronic obstructive pulmonary disease (COPD) and surgical approach on postoperative fast track recovery and hospitalization cost of patients undergoing lung cancer resection, and explore clinical pathways and clinical value of fast track recovery. MethodClinical data of 129 consecutive patients undergoing lung cancer resection by one surgical group in West China Hospital from January 2010 to March 2011 were retrospectively analyzed. According to whether the patients had concomitant COPD, all the patients were divided into COPD group including 53 patients (39 males and 14 females) with their average age of 56.31±10.51 years, and non-COPD group including 76 patients (37 males and 39 females) with their average age of 65.92±7.85 years. According to different surgical approaches, all the patients were divided into complete video-assisted thoracoscopic surgery (VATS) group including 83 patients (44 males and 39 females) with their average age of 61.62±10.80 years, and routine thoracotomy group including 46 patients (32 males and 14 females) with their average age of 62.95±9.97 years. Postoperative morbidity, average hospital stay and hospitalization cost were compared between respective groups. ResultsThere was no statistical difference in postoperative morbidity (53% vs. 40%, P=0.134)or average hospital stay[(7.66±2.95) days vs. (7.36±2.74)days, P=0.539] between COPD group and non-COPD group. Postoperative morbidity (34% vs. 65%, P < 0.001)and average hospital stay[(6.67±2.52)days vs. (8.61±3.01) days, P < 0.001] of VATS group were significantly lower or shorter than those of routine thoracotomy group. Total hospitalization cost (￥44 542.26±11 447.50 yuan vs. ￥23 634.13±6 014.35 yuan, P < 0.001) and material cost (￥37 352.53±11 807.81 yuan vs. ￥12 763.08±7 124.76 yuan, P < 0.001) of VATS group were significantly higher than those of routine thoracotomy group. Average medication cost of VATS group was significantly lower than that of routine thoracotomy group (￥7 473.54±4 523.70 vs. ￥10 176.71±6 371.12, P < 0.001). There was no statistical difference in other cost between VATS group and routine thoracotomy group. ConclusionVATS lobectomy can promote postoperative fast track recovery of lung cancer patients, but also increase material cost of the surgery. COPD history does not influence postoperative fast track recovery or hospitalization cost.
ObjectiveTo investigate the effect of fasttrack (FT) and traditional care (TC) on patients with rectal cancer underwent different surgical strategies in perioperative period. MethodsThe clinical data of 285 patients with rectal cancer from January 2009 to January 2010 in this hospital were retrospectively analyzed. These patients underwent high anterior resection (HAR) or lower/super lower anterior resection (LAR) under FT and TC were divided into four groups: FT+HAR (n=39), FT+LAR (n=17), TC+HAR (n=151), and TC+LAR (n=78), and intraoperative conditions and postoperative rehabilitation were analyzed. ResultsThe baselines characteristics of four groups were basically identical (Pgt;0.05). ①The operative time and blood loss of patients in four groups were not statistically significant (Pgt;0.05). ②Anastomotic leakage occurred in three cases, wound infection in 13 cases, and intestinal obstruction in four cases after operation, and the difference was not significant in four groups (Pgt;0.05). ③The time of first defecation and first flatus of four groups were not statistically significant (Pgt;0.05), but there were significant differences in the time with drainage tube, nasogastric tube, and catheter tube, the time of first intake and first ambulation, and length of stay among four groups (Plt;0.05). Compared with TC+HAR and TC+LAR group, the time with drainage tube, nasogastric tube, and catheter tube, and the time of first intake and first ambulation of patients were shorter in FT+HAR and FT+LAR group, and the length of stay of patients in FT+LAR group was shorter than that in TC+HAR group and TC+LAR group (Plt;0.05). ConclusionsFT can promote postoperative rehabilitation of rectal cancer patients underwent different surgical strategies, but which does not demonstrate the superiority of reducing postoperative complications.
ObjectiveTo investigate the safety, feasibility, and efficacy of fast track surgery (FTS) in gastrointestinal tract injury. MethodsThe data of 61 patients with gastrointestinal tract injury from July 2007 to July 2013 were retrospectively analyzed, among whom 29 patients were received FTS (FTS group) and 32 patients were received conventional care (control group). The first flatus and defecation time, hospital stay, rates of wound infection and lung infection, and the mortality were compared between these two groups. ResultsThe average first flatus and defecation time and the average hospital stay in the FTS group were significantly shorter than those in the control group (2.21 d versus 3.16 d, P=0.000; 7.45 d versus 9.78 d, P=0.000). The rate of lung infection in the FTS group were significantly lower than that in the control group[3.4% (1/29) versus 21.9% (7/32), P=0.033]. The rate of wound infection and the mortality had no significant differences between the FST group and the control group[3.4% (1/29) versus 15.6% (5/32), P=0.111; 0(0/29) versus 3.1% (1/32), P=0.337]. ConclusionsFTS is safe and effective among those gastrointestinal tract injury patients who visited the hospital in time and injury limited. FTS could promote defecate, shorter the hospital stay, and don't increase the complications and mortality.
ObjectiveTo investigate the feasibility and advantage of the da Vinci S Surgical System in operation of the mediastinal tumor without chest tube. MethodsFrom March 2011 up to March 2015, 39 patients in our hospital with mediastinal tumor underwent resection without a chest tube by da Vinci System were as a no chest tube group with 24 males and 15 females at age of 47.28 (18-73) years. In the same period, 50 patients with mediastinal cyst underwent resection with a chest tube insertion by da Vinci System were as a chest tube group with 25 males and 25 females at age of 49.24 (22-82) years. Clinical data of the two groups were collected and compared. ResultThere were statistical differences in mean operative time (61.97±16.41min vs. 79.90±33.19 min, P=0.003), time of ICU stay (1.23±0.48 d vs. 2.16±0.82 d, P=0.000), time of postoperative hospitalization (3.77±1.16 d vs. 5.62±2.22 d, P=0.000), and visual analogue scale (VAS) score (3.05±1.76 vs. 4.54±1.83). The clinical results in the no chest tube group were better than those in the chest tube group. All the procedures were successfully completed by da Vinci System in all the patients without conversions and any compilcation. ConclusionIt's safe and beneficial for patients without a chest tube after a mediastinal tumor resection with da Vinci S Surgical System with shorter hospital stay.
ObjectiveTo study clinical value of perioperative multimodal analgesia for laparoscopic cholecystectomy based on concept of fast track surgery (FTS). MethodsThe clinical data of 268 patients were analyzed retrospectively, who underwent laparoscopic cholecystectomy in the Department of General Surgery, the 2nd Hospital of Baiyin City from July 2013 to July 2015. All these patients were divided into FTS group and traditional group according to the chronological order, 133 patients in the traditional group were performed traditional perioperative analgesia before August 31, 2014, and 135 patients in the FTS group were performed perioperative multimodal analgesia method based on the concept of FTS after September 1, 2014. The data of both groups were collected and analyzed, including point of numerical rating scale, intestinal function recovery time, intake food time, ambulation time, drainage tube duration, postoperative hospital stay, postoperative sleep time at 72 h, and complications. Results①The points of numerical rating scale at 1 h, 4 h, 8 h, 12 h, 24 h, 48 h, and 72 h in the FTS group were significantly lower than those in the traditional group (P < 0.01).②Compared with the traditional group, the intestinal function recovery time, intake food time, ambulation time, drainage tube duration, and postoperative hospital stay were obviously shorter, the postoperative sleep time at 72 h was obviously longer in the FTS group.③The incidence of nausea and vomiting in the FTS group was significantly lower than that in the traditional group (P < 0.01), the incidences of the other complications such as acid reflux, urinary retention, and breathing difficulty had no significant differences between these two groups (P > 0.05). The satisfaction rate of postoperative analgesic effect in the FTS group was significantly higher than that in the traditional group (P < 0.01). ConclusionsPerioperative multimodal analgesia for laparoscopic cholecystectomy based on concept of FTS is safe and effective. It could achieve painless effect of laparoscopic cholecystectomy.
ObjectiveTo investigate the application of fast track surgery (FTS) in hepatobiliary surgery, and discuss the postoperative stress response and its efficacy and safety assessment. MethodsA total of 171 patients undergoing different hepatobiliary operations in our ward from August 2008 to Jule 2011 were randomly divided into control group (n=89) and FTS group (n=82). Patients in the FTS group received the improved methods while those in the control group received traditional care. A series of indicators such as hospital stay, hospital expense, duration of intravenous infusion, postoperative complications, and the C-reaction protein (CRP) and interleukin-6 (IL-6) levels in serum were observed postoperatively. ResultsFor the FTS and control group, the first exhaust time was respectively (2.4±0.3) and (3.3±0.6) days, postoperative hospital stay was (9.1±2.7) and (14.1±4.1) days, hospitalization expense was (16 432±3 012) and (21 612±1 724) yuan, all of which had significant differences (P<0.05). Before surgery and on the 1st, 3rd, 5th and 7th day after surgery, IL-6 serum level for the FTS group was respectively (8.57±2.58), (30.21±12.44), (17.41±11.73), (11.14±7.12), and (10.50±5.19) ng/L, and for the control group was respectively (9.13±2.99), (51.31±19.50), (36.82±12.33), (28.23±9.18), and (15.44±4.33) ng/L. There was no significant difference in the preoperative IL-6 level between the two groups (P>0.05), while IL-6 level was significantly lower in the FTS group than the control group after surgery (P<0.05). Before surgery and on the 1st, 3rd, 5th and 7th day after surgery, CRP serum level for the FTS group was respectively (18.41±4.01), (69.74±26.03), (45.52±20.50), (39.14±11.23), and (29.03±6.47) μg/L, and for the control group was respectively (17.74±2.11), (99.23±23.50), (86.81±17.34), (68.22±15.60), and (37.70±9.55) μg/L. There was no significant difference in the preoperative CRP level between the two groups (P>0.05), while CRP level was significantly lower in the FTS group than the control group after surgery (P<0.05). Postoperative complication rate after surgery was not significantly different between the two groups (P>0.05). ConclusionThe application of FTS in some hepatobiliary operations is effective and safe by decreasing the stress response.
Objective To discuss the safety of fast track surgery for patients with obstructive colorectal cancer. Methods Between February 2008 and February 2009, 157 cases of obstructive colorectal cancer were analyzed retrospectively, 59 in fast track (FT) group and 98 in traditional group. Postoperative early rehabilitations and complications were studied and compared. Results The first time of passing flatus, oral intake and postoperative hospital stay in FT group were significantly earlier or less than those in traditional group （Plt;0.05）, while there were no significant differences in time of first ambulation, time with use of nasogastric tubes, urinary catheter, and drains between the 2 groups （Pgt;0.05）. There was also no statistically significant difference in postoperative complications rate between the 2 groups （Pgt;0.05）. Conclusion Fast track surgery for patients with obstructive colorectal cancer is safe and can accelerate recovery with decreasing length of hospital stay and improving life quality of the patients.