Objective To investigate the safety and feasibility of laparoscopic ELAPE for elderly patients with low advanced rectal cancer.Methods Totally 48 cases patients with low advanced rectal cancer surgery aged over 65 years old were analyzed retrospectively,who come from Beijing Hospital between Jan 2012 and Jan 2015.A total of 26 cases underwent Laparoscopic extralevator abdominoperineal excision (L-ELAPE) and 22 cases underwent Laparoscopic abdominoperineal excision(L-APE).Clinical data including general data,operation time,intraoperative blood loss,complications,pathological data,postoperative in hospitalization were retrospectively analyzed in patients.Results The mean operation time between L-ELAPE and APE group was (312±46)min vs.(245±62)min,mean intraoperative blood loss was(170±74)ml vs.(250± 109)ml,Operative complications was 26.9％ vs.27.3％,harvested lymph node was (16.0 ± 5.8)cm vs.(15.0±7.2)cm,intraoperative bowel perforation(IOP)rate was 0％ vs.18.2％,CRM involvement was 3.8 ％ vs.13.6 ％,mean postoperative hospital stay (days) was (13.1 ± 4.6) d vs.(13.7 ± 6.1) d.The mean operating time of L-ELAPE group was longer and mean intraoperative blood loss was much less than APE group,IOP rate and circumferential resection margin(CRM)involvement were higher in APE group(P＜0.05).Conclusions L-ELAPE is a safe and feasibility alternative approach for elder patients with rectal cancer.It is related with less intraoperative blood loss,IOP rate,CRM involvement and longer operating time contrast with L-APE.

Objective To investigate the clinical value of transanal endoscopic microsurgery (TEM) for the treatment of elderly patients with colorectal adenoma.Methods Totally 21 patients with colorectal villous adenoma underwent TEM from Dec.2007 to Sep.2010.The distance of adenoma from the anal verge was 4-20 cm (average 8.9 cm) and tumor size was 1.1-3.5 cm (average 1.9 cm).There were 12 cases with tubular adenoma and 9 cases with villous adenoma according to pre-operative diagnosis by colonoscopy and endoanal ultrasonography (EUS).Appropriate position and posture were dictated by the location of the tumor under general anesthesia.A special rectoscopy was inserted into the anus with CO2 insufflation to keep the rectum open.Under the stereoscopy and lapaoscopy-type instruments,the tumor was completely resected (submucosal or full-thickness excision) using a 5 mm ultrasonic dissector.The operative wound was closed with intra-lumen continuous sutures.Results The tumor was completely removed with negative resection margins in all the 21 patients (submucosal excision in 12 cases and full-thickness excision in 9 cases).The operating time was 40-100 min (average 76 min) and the intraoperative blood loss was 10-80 ml (average 50 ml).The post-operative stay was 2-10 d (average 4.5 d).The postoperative pathological stages were pT0 in 16 cases and pTia in 5 cases.The postoperative pathological diagnosis were tubular adenoma in 12 cases,villous adenoma in 9 cases,low-grade intraepithelial neoplasia (IN) in 5 cases and high-grade IN in 5 cases.Follow-up checkups in the 20 patients for 2-20 months (average 11 months) revealed no local recurrence.Conclusions TEM is safe and effective with little complication for the treatment of elderly patients with colorectal adenoma.Pre-operative EUS is very important for TEM.

Objective Common bile duct stones are common in elderly patients.The laparoscopic transcystic approach with micro-incision of the cystic duct confluence in common bile duct exploration (LTM-CBDE) is a modified laparoscopic transcystic approach.This study evaluated the safety and efficacy of LTM-CBDE in the elderly (≥65 years) patients with choledocholithiasis and compared the results in the elderly with those in younger patients.Methods In this retrospective analysis,128 patients underwent LTM-CBDE from March 2007 to December 2013.The patients were divided into two groups:aged ≥65 years (n=50,the elderly group) versus aged ＜65 years (n=78,the younger group).The preoperative morbidity rate,American Society of Anesthesiologists (ASA) score,previous abdominal operations,operation time,postoperative hospital stay,open conversion rate,postoperative complication rate,residual stone rate,recurrence rate and mortality rate were compared between the both groups.Results The preoperative morbidity (41 vs.28) and ASA score (2.5± 0.7 vs.1.8±0.6) were higher in the elderly group than in he younger group (x2=26.063,t=-6.030,P =0.000,in both).No significant differences in previous abdominal operations,operation time,postoperative hospital stay,open conversion rate,postoperative complication rate,residual stone rate,recurrence rate and mortality rate (P＞0.05) were found between the two groups from March 2007 to December 2013.Conclusions LTM-CBDE is a safe and effective treatment procedure for elderly patients with choledocholithiasis.For LTM-CBDE-suitable patients,we recommend LTM-CBDE as the treatment of choice.

Objective To evaluate the feasibility of precise hepatic segmentectomy or subsegmentectomy using intraoperative image-guided interventional intravascular segmental vessel balloon catheter occlusion of the segmental hepatic artery and portal vein.Methods 6 patients with liver resection carried out from 2011.3-2011.8 were retrospectively analyzed.Results The mean operating time was (270.83±21.31) min,the median of blood loss was 800 ml,the median of intraoperative transfusion volume was 450 ml.The tumors were mainly located in segments Ⅴ,Ⅵ,Ⅶ,Ⅷ.The mean diameter of tumor was (5.67±1.03) cm.Postoperative liver function in the first postoperative day showed the mean alanine aminotranferase (ALT) was (570.00±157.76) U/L,the mean aspirate aminotrarsferase (AST) was (410.00 ±189.94) U/L,and the mean total bilirubin (TBIL) was (10.83± 1.60) mmol/L.Liver function recovered to normal within 7 days.There was intestinal leakage and wound dehiscence in one patient,pleural and effusion in two patients.Conclusion Imageguided interventional intravascular segmental vessel balloon catheter occlusion was a safe and efficacious maneuver.This technique allowed hepatic segmentectomy or subsegmentectomy to be carried out,decreased intraoperative bleeding,and protected the function of the liver remnant.

OBJECTIVETo evaluate the hemostatic role of hemocoagulase in abdominal operation and its effects on coagulation.

METHODS180 patients receiving abdominal operation were studied prospectively by randomized, double-blind controlled and multicenter design. They were divided into Hemocoagulase group (60 patients), lizhixue group (60), and manitol hexanitrate group (60). The groups were, observed in terms of the effects on hemostatic time, hemorrhagic volume, hemorrhagic volume per square unit, and body coagulation (BT, CT, PT, APTT and PLT) parameters.

RESULTSThe groups received different drugs. The average hemostatic time in the hemocoagulase group was 121.6 s, hemorrhagic volume was 9.6 g, and hemorrhagic volume per square unit was 0.2 g. The similar results were observed in the lizhixue group (P > 0.05), but they were significantly different (P < 0.05) from those of the manitol hexanitrate group (159.2 s, 12.49 g, 0.3 g). In the hemocoagulase and lizhixue groups hemorrhagic and hemoagglution time decreased 30 minutes and 1 day after operation. This finding was significantly differenct from that in the manitol hexanitrate group (P < 0.05).

CONCLUSIONHemocoagulase plays a good hemostatic role in the hemorrhagic capillary at abdominal incision.

Abdomen ; Adolescent ; Adult ; Aged ; Batroxobin ; adverse effects ; pharmacology ; therapeutic use ; Blood Coagulation ; drug effects ; Double-Blind Method ; Female ; Hemostasis, Surgical ; methods ; Hemostatics ; therapeutic use ; Humans ; Male ; Middle Aged ; Prospective Studies