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25 July 2018, Volume 23 Issue 04 Previous Issue    Next Issue

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Experiences of laparoscopic repair for suprapubic hernia YUE Fei, HAO Xiaohui, LI Jianwen, WANG Wenrui, SUN Jing, HE Zirui, XUE Pei, Feng Bo, ZHENG Minhua 2018, 23 (04):  333-336.  DOI: 10.16139/j.1007-9610.2018.04.012 Abstract ( 613 )   PDF (447KB) ( 104 )   Objective To evaluate the feasibility, safety and effectiveness of laparoscopic repair of suprapubic hernia. Methods The clinical data of 90 patients underwent laparoscopic repair of suprapubic hernia between July 2004 and December 2016 were analyzed retrospectively. The therapeutic effects and complications were reviewed. Results Totally 90 cases were in this study including 7 cases using transabdominal preperitoneal(TAPP), 6 cases traditional intraperitoneal onlay mesh (IPOM), 76 cases transabdominal partial extraperitoneal (TAPE) and 1 case converted to open Onlay repair due to severe adhesions. The defects were (12.54±5.72)(2-30) cm in max diameter and (92.98±62.09)(4-360) cm2 in size. The meshes applied were (311.24±112.89)(80-600) cm2 in size. The operation time was (54.04±16.60)(25-110) min and length of hospital stay was (5.53±3.61)(1-33) d. Eight cases used analgesics 8.99% (8/89) postoperatively and 4 cases were found recurrent 4.49% (4/89) during the follow-up of 72(13-161) months. Conclusions TAPP would be suitable for primary suprapubic hernias and small incisional hernias with intact peritoneum. TAPE is considered as a rational, safe and effective laparoscopic procedure for suprapubic hernia repair. References | Related Articles | Metrics

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Open mesh ventral incisional hernia repair: a report of 210 cases MENG Yunxiao, CHEN Ge, LI Shaojie, HU Xingchen, HUANG Lei, CAI Zhao, TANG Jianxiong 2018, 23 (04):  337-341.  DOI: 10.16139/j.1007-9610.2018.04.013 Abstract ( 521 )   PDF (623KB) ( 175 )   Objective To analyze the clinical outcome of open mesh repair in treating ventral incisional hernia. Methods A retrospective analysis was performed for 210 patients with ventral incision hernia who had open mesh repaired from October 2013 to March 2018 in this hospital. The postoperative complications including seroma, incision infection, mesh infection, chronic pain, intestinal fistula, hernia recurrence and mortality were evaluated between 2 repairs [intraperitoneal onlay mesh (IPOM) and sublay] and between 2 mesh fix methods. Results After operation, there were 25 cases (11.90%) of seroma, 14 cases (6.67%) of incision infection, 3 cases (1.43%) of mesh infection, 7 cases (3.33%) of chronic pain, 3 cases (1.43%) of intestinal fistula, 7 cases (3.33%) of recurrence and 2 cases(0.95%) of death. The patients with postoperative seroma using IPOM repair were lower than those using Sublay repair(P<0.05) with significant difference. There was no significant difference in other complications and hernia recurrence rate between 2 repairs (P>0.05). There was no statistically significant difference in complications between the patients using reinforcement and bridging after Sublay repair (P>0.05). The case with chronic pain and recurrence rates had no statistically significant difference (P>0.05) using non-absorbable hernia nail when compared those using absorbable hernia nail. Conclusions Open ventral incisional hernia mesh repair is considered as safe and effective. References | Related Articles | Metrics

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Intraoperative hemorrhage related to perioperative events and prognosis of patients with early stage hepatocellular carcinoma ZHANG Yongqiang, ZHANG Ti, KONG Yinlong, HOU Zhenyu, LI Huikai, CUI Yunlong, SONG Tianqiang, LI Qiang 2018, 23 (04):  342-345.  DOI: 10.16139/j.1007-9610.2018.04.014 Abstract ( 357 )   PDF (517KB) ( 97 )   Objective To explore intraoperative bleeding of patients with early stage hepatocellular carcinoma which may relate to perioperative events and the prognosis. Methods A retrospective analysis was performed on 222 patients with early stage hepatocellular carcinoma who underwent surgical resection in Tianjin Medical University Cancer Hospital from January 2008 to December 2013. According to the receiver operating characteristic curve analysis of the volume of intraoperative blood loss, 185 cases with blood loss 200 mL or less were assigned into group A and 37 cases with blood loss more than 200 mL into group B. Hospital stay, complication and overall survival were compared between two groups. Results There were no significant difference in gender, age, preoperative platelet counting, prothrombin time and total serum bilirubin and diameter and number of tumor between two groups statistically (P>0.05). Longer median survival time of the patients, shorter hospital stay, less cases with ascites and infection were found in group A when compared those in group B (P<0.05). Conclusions For patients with early stage hepatocellular carcinoma, intraoperative bleeding may be a negative factor for the perioperative complications and long term survival. It is necessary to reduce the bleeding during hepatectomy. References | Related Articles | Metrics

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Comparison between robotic liver resection and laparoscopic liver resection GUAN Ruoyu, YANG Kui, MA Di, YANG Yuchen, CHEN Yongjun 2018, 23 (04):  346-351.  DOI: 10.16139/j.1007-9610.2018.04.015 Abstract ( 570 )   PDF (632KB) ( 121 )   Objective To perform a matched comparison of surgical and postsurgical outcomes between robotic and laparoscopic liver resections (LLR) and evaluate the advantages of robotic liver resections(RLR). Methods Clinical outcomes among patients undergoing RLR (n=44) and LLR (n=44) in our hospital between March 2010 and August 2017 were reviewed. A 1:1 matched analysis was performed using propensity score matching between patients in RLR group and patients in LLR group based on gender, age, hepatitis, cirrhosis, body mass index, American Society of Anesthesiologists grade and the extent of liver resections. Results Matched patients undergoing robotic and laparoscopic liver resections displayed no significant differences in blood loss, transfusion rate, hospital stay, postsurgical complications and R0 resection rate. RLR was associated with longer operative time, (183.36±64.40) min vs (156.25±71.53) min, P=0.013. The conversion rate in RLR group was lower than in LLR group(4.5% vs 22.7%), P=0.013. Conclusions Lower conversion rate of RLR was observed when compared with LLR in spite of longer operative time. RLR and LLR had similar safety and feasibility. References | Related Articles | Metrics

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Robotic pancreatectomy with vascular resection and reconstruction of locally advanced pancreatic cancer ZHAO Shulin, SHEN Baiyong, DENG Xiaxing, ZHAN Xi, WANG Wei, SHI Yuan, WENG Yuanchi, SUN Changjie, PENG Chenghong 2018, 23 (04):  352-357.  DOI: 10.16139/j.1007-9610.2018.04.016 Abstract ( 451 )   PDF (824KB) ( 133 )   Objective To examine feasibility and safety of robotic pancreatectomy with vascular resection and reconstruction in patients with locally advanced pancreatic cancer. Methods The authors evaluated 59 patients who underwent pancreatectomy with vascular resection and reconstruction from August 2011 to September 2017 dividing into robotic pancreatic surgery group (n=20) and open pancreatic surgery group (n=39) retrospectively. Pancreatic ductal adenocarcinoma was diagnosed 53 cases pathologically and intraductal papillary mucinous cancer 6 cases. The patients were all locally advanced pancreatic cancer including 53 cases in stage Ⅱ and 6 cases in stage Ⅲ. Intraoperative data and postoperative recovery in two groups were compared. Results Mean operative time in robotic pancreatic surgery group was (328.9±17.8) min. Mean blood loss was(568.4±72.6) mL. Grade B/C pancreatic fistula was found in 4 cases, biliary leak in 1 case and postoperative hemorrhage in 4 cases of whom 3 cases were re-operated. Mean postoperative hospital stay was (28.8±5.7) d. Mean operating time in open pancreatic surgery group was(358.5±17.2) min. Mean blood loss was (801.3±113.2) mL. Grade B/C pancreatic fistula was found in 12 cases, biliary leak in 5 cases and postoperative hemorrhage in 4 cases of whom 3 cases were re-operated. Mean postoperative hospital stay was (31.3±5.1) d. The patients of two groups were all recovered after postoperative treatment and discharged without mortalily. The mean blood loss was less （P=0.032） and the postoperative hospital stay was shorter （P=0.011）in robotic pancreatic surgery group when compared those in open pancreatic surgery group, respectively. Conclusions Robotic pancreatectomy with vascular resection and reconstruction was safe and feasible. References | Related Articles | Metrics

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Preoperative white blood cell count predicts prognosis in patients with hepatocellular carcinoma beyond Milan criteria after hepatic resection HOU Zhenyu, KONG Yinlong, ZHANG Yongqiang, ZHU Keyun, YANG Xuejiao, CHEN Ping, LI Huikai, CUI Yunlong, SONG Tianqiang, LI Qiang, ZHANG Ti 2018, 23 (04):  358-362.  DOI: 10.16139/j.1007-9610.2018.04.017 Abstract ( 387 )   PDF (524KB) ( 111 )   Objective To study the prognostic value of preoperative white blood cell (WBC) count in patients with hepatocellular carcinoma(HCC) beyond Milan criteria after hepatic resection. Methods Clinical data of 237 patients with HCC beyond Milan criteria from Tianjin Medical University Cancer Hospital who underwent hepatectomy from June 2007 to December 2013 were retrospectively studied. The cut-off value of WBC count was determined by receiver operating characteristic curve, which was used to divide the patients in two groups. Survival curves were formed with Kaplan-Meier method and were analyzed using Log-Rank test. Cox proportional hazards model was developed to identify the risk factors of survival. Results WBC count 6.0 ×109/L was the cut-off point between two groups. The median survival time of lower WBC count group and higher WBC count group were 53.4 and 27.6 months, respectively (P=0.002). The median recurrence-free survival of lower WBC count group and higher WBC count group were 20.7 and 12.2 months, respectively(P=0.029). The statistical differences in both survival time and recurrence-free survival remained between two groups after match analysis. Conclusions Preoperative WBC count might predict the prognosis of HCC patients beyond Milan criteria after hepatic resection. References | Related Articles | Metrics

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Learning curve of endoscopic thyroidectomy via areola approach at a single centre for differentiated thyroid carcinoma WU Qinghua, YU Li, BAO Xiting, KONG Lei, LIU Xin, QIU Weihua, XIANG Ming, ZHAO Ren 2018, 23 (04):  363-368.  DOI: 10.16139/j.1007-9610.2018.04.018 Abstract ( 476 )   PDF (1088KB) ( 124 )   Objective To investigate the short outcome and the learning curve of endoscopic thyroidectomy via areola approach at a single centre for differentiated thyroid carcinoma. Methods A retrospective analysis was made with 100 patients undergoing endoscopic thyroidectomy via areola approach in the treatment of differentiated thyroid carcinoma from November 2015 to May 2017. The consecutive cases were divided into 5 groups as group A, B, C, D and E each 20 cases. Surgical data including the time of procedure such as flap dissection, thyroid resection and lymphadectomy, total operating time, operative blood loss, lymph node harvest, injury to the parathyroid glands, conversion and intraoperative complications, and postoperative data including hospital stay, drainage volume and postoperative complications were compared among 5 groups. Learning curve was analyzed using mathematical model. Results All patients underwent endoscopic thyroidectomy via areola approach without conversions. There was statistical difference of total operating time and the time of procedures among groups (P<0.001). Group A had 3 cases with intraoperative complications more than other groups (P=0.035). Groups A had 12 cases with subcutaneous ecchymosis more than other groups (P<0.001). Analysis of multivariate learning curve showed that the learning phase included 31 patients. Conclusions It was shown that endoscopic thyroidectomy via areola approach for differentiated thyroid carcinoma has longer learning phase. Effective and standard manipulation in view of special characteristics would make endoscopic thyroidectomy via areola approach safe and feasible. References | Related Articles | Metrics

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Comparison of three guidance placement of implantable venous access port LIU Jingjing, HUANG Wei, WU Zhiyuan, WANG Qingbing, DING Xiaoyi, WANG Zhongmin, LIU Qin, WANG Ziyin 2018, 23 (04):  369-373.  DOI: 10.16139/j.1007-9610.2018.04.019 Abstract ( 651 )   PDF (701KB) ( 301 )   Objective To compare digital subtraction arteriography(DSA) guidance, CT guidance and B-ultrasound guidance of implantable venous access port placement. Methods The clinical data of 82 cases with implanted internal jugular venous access port including 30 cases in DSA-guided group, 22 cases in CT-guided group and 30 case in B-ultrasound-guided group from April 2017 to February 2018 in our hospital were analyzed retrospectively. Operation time, radiation dose and complications were compared. Results The placement of port was successful in all the patients. The operation time of cases in CT-guided group was significantly longer and the radiation dose higher than in the other two groups (P<0.05). Several complications were observed in three groups. Pneumothorax in one case, hemothorax in one case and pulling sensation of neck in one case were found respectively in DSA-guided group. Only pulling sensation of neck discomfort was found in one case of CT-guided group. The pulling sensation of neck was present in one case and the catheter with angle formed in another case in B-ultrasound guided group. There was no significant difference statistically in complications among three groups(P>0.05). Local and systemic infection, gas embolism, arrhythmia and other serious complications were all not seen in three groups. Conclusions The placement of an internal jugular vein port through DSA guidance is convenient, time-saving and low radiation exposure, and there is risk of internal jugular vein puncture without guiding. References | Related Articles | Metrics

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Analysis of long non-coding RNA TUG1 expression in colorectal cancer ZHOU Yong, CUI Rong, SHI Xingyao 2018, 23 (04):  374-378.  DOI: 10.16139/j.1007-9610.2018.04.020 Abstract ( 399 )   PDF (648KB) ( 88 )   Objective To investigate the expression of long non-coding RNA TUG1 (taurine upregulated gene 1) in co-lorectal cancer tissues and the correlation between TUG1 expression and clinicopathological factors in patients with colorectal cancer. Methods Real-time quantitative polymerase chain reaction was used to detect TUG1 expression in cancer tissues and paracancerous tissues (>5 cm from the edge of cancer tissues) of 106 patients with colorectal cancer. The correlations between TUG1 expression and clinicopathological factors, and between TUG1 expression and the survivals of patients with colorectal cancer were analyzed. The patients were followed up from 3 to 60 months. Results In comparison with the expression of TUG1 in adjacent normal tissues, the expression of TUG1 in colorectal cancer tissues was significantly higher (P=0.003). We found that high expression of TUG1 related with tumor diameter (P<0.001), serum CEA (P=0.049) and TNM stage (P=0.005) significantly. Higher expression of TUG1 in patients with colorectal cancer had shorter overall survival times compared with the patients with lower expression of PUG1 (P=0.0025). Multivariate regression analysis showed that TUG1 expression could be an independent prognostic factor in patients with colorectal cancer. Conclusions TUG1 might play an important role in the development of colorectal cancer and may be used as predictor of prognosis for colorectal cancer. References | Related Articles | Metrics