Zhonghua wei chang wai ke za zhi = Chinese journal of gastrointestinal surgery
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Zhonghua Wei Chang Wai Ke Za Zhi · Dec 2020
Comparative Study[Comparison of clinical efficacy of robotic, laparoscopic and open surgery in the treatment of severe rectal prolapse].
Objective: To analyze and compare the efficacy of robotic, laparoscopic and open dorsal mesh rectopexy in the treatment of severe rectal prolapse. Methods: A retrospective cohort study was performed. Patients who had a full-thickness rectum pulled out of the anus before surgery and the length was greater than 8 cm, and underwent transabdominal dorsal mesh rectopexy were enrolled in the study. ⋯ Postoperative male IIEE score and female FSFI score decreased significantly and then increased gradually with time, whose differences were all significant (all P<0.05). Postoperative IPSS, IIEE, and FSFI scores in the robotic group were superior to those in the laparoscopic and open groups (all P<0.05). Conclusion: Robotic surgery is safe and effective in the treatment of severe rectal prolapse, and is more advantageous in preserving urinary function and sexual function.
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Zhonghua Wei Chang Wai Ke Za Zhi · Nov 2020
Randomized Controlled Trial[Effect of open-lung ventilation strategy on oxygenation-impairment during laparoscopic colorectal cancer resection].
Objective: After general anesthesia and mechanical ventilation for laparoscopic colorectal cancer resection, about 90% of patients would have different degrees of atelectasis. Authors speculated that an open-lung strategy (OLS) comprising moderate positive end-expiratory pressure (PEEP) and intermittent recruitment maneuvers (RM) can reduce atelectrauma and thus reduce the incidence of oxygenation-impairment during low-tidal-volume ventilation for laparoscopic colorectal cancer resection. The purpose of this study was to verify this hypothesis and provide a better intraoperative ventilation scheme for laparoscopic colorectal cancer resection. ⋯ During ventilation, the patients in the OLS group had higher PaO(2)/FiO(2) [T(1): (427±103) mmHg vs. (366±109) mmHg, t=-2.826, P=0.006; T(2): (453±103) mmHg vs. (388±122) mmHg, t=-2.739, P=0.007], lower Q(S)/Q(T) [ T(1): (9.2±6.5) % vs. (12.6±7.7) %, t=2.322, P=0.022; T(2): (7.0±5.8)% vs.(10.9±9.2)%, t=2.408, P=0.019], and lower driving pressure [T(0): (6±3) cm H(2)O vs. (10±2) cm H(2)O, t=7.421, P<0.001; T(2): (13±3) cm H(2)O vs. (17±4) cm H(2)O, t=5.417, P<0.001] than those in the NOLS group, with stratistical differences in all comparisons. In recovery room, though PaO(2)/FiO(2) [(70.3±9.4) mmHg vs. (66.8±9.4) mmHg, P=0.082] was still higher and Q(S)/Q(T) [(18.6±8.3)% vs. (21.8±8.4)%, P=0.070] was still lower in the OLS group as compared to the NOLS group, the differences were not statistically significant (both P>0.05). Conclusion: The application of such an OLS during low-tidal-volume ventilation can greatly reduce the incidence of oxygenation-impairment in laparoscopic colorectal cancer resection, and such effect may last to the period of emergence from anesthesia.
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Zhonghua Wei Chang Wai Ke Za Zhi · Nov 2020
[Establishment and validation of a predictive nomogram model for advanced gastric cancer with perineural invasion].
Objective: Peripheral nerve invasion (PNI) is associated with local recurrence and poor prognosis in patients with advanced gastric cancer. A risk-assessment model based on preoperative indicators for predicting PNI of gastric cancer may help to formulate a more reasonable and accurate individualized diagnosis and treatment plan. Methods: Inclusion criteria: (1) electronic gastroscopy and enhanced CT examination of the upper abdomen were performed before surgery; (2) radical gastric cancer surgery (D2 lymph node dissection, R0 resection) was performed; (3) no distant metastasis was confirmed before and during operation; (4) postoperative pathology showed an advanced gastric cancer (T2-4aN0-3M0), and the clinical data was complete. ⋯ External verification showed a C-index of 0.828 from the model. The calibration curve showed that the predictive results were good in accordance with the actual results (P=0.415). Conclusion: A nomogram model constructed by CEA, tumor length, Lauren classification (mixed, diffuse), cT stage, and lymph node metastasis can predict the PNI of advanced gastric cancer before surgery.
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Zhonghua Wei Chang Wai Ke Za Zhi · Oct 2020
[Long-term outcomes of patients undergoing hepatectomy for bilateral multiple colorectal liver metastases-a propensity score matching analysis].
Objective: Liver is the most common site of distant metastasis in colorectal cancer patients. Currently, surgical resection of colorectal liver metastasis (CRLM) still remains the most curative therapeutic option which is associated with long-term survival. However, the outcome of CRLM patients with bilobar multiple lesions has been reported to be extremely poor due to the complex techniques of the surgery and the difficulties to achieve a negative resection margin. ⋯ Multivariate analysis indicated that diameter of largest liver metastases > 5 cm (HR=1.888, 95% CI: 1.251-2.848, P=0.002), CRS≥3 (HR=1.552,95% CI:1.050-2.294, P=0.027) and RAS gene mutation (HR=1.561, 95% CI: 1.102-2.212, P=0.012) were independent risk factors of poor overall survival after hepatectomy. Conclusions: Tumor distribution may not affect the prognosis of multiple CRLM after resection. Surgical removal in patients with bilobar multiple CRLM provides comparable long-term survival to unilobar multiple CRLM.
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Zhonghua Wei Chang Wai Ke Za Zhi · Jun 2020
[Thoughts of the combination of medicine and engineering and collaborative innovation on surgery in China].
The combination of medicine and engineering is a new interdisciplinary subject, which is a mode of cross integration and collaborative innovation between medical science and engineering. The combination and collaborative innovation of medicine and industry means more about the improvement, innovation and R&D of medical devices. However, the combination of traditional industry with biomedical engineering, modern medical imaging technology, electronic information technology and other high-tech in medical device industry is a reflection of the manufacturing industry and high-tech level of a country. ⋯ We realize that clinical practice is the source of the combination of medical workers and collaborative innovation, and clinicians are the driving force of the combination of medical workers and collaborative innovation. At present, the main problems faced by the development of medical industry integration in China are as follows: insufficient integration of medical industry integration disciplines in the basic research stage; less interaction of clinical application needs in the application research stage; difficult transformation of scientific research achievements; the unconnected whole chain of "production, learning, research and application". If we can increase the investment in scientific research and policy incentives, strengthen the communication and interaction with enterprises, pay more attentions to the social and economic benefits of the promotion of achievements, open the whole process of the combination of medicine and industry, and improve the evaluation mechanism of the innovation ability of such combination, combination of medicine and engineering and collaborative innovation in China will enter the golden period of rapid development.