Objective:To discuss the feasibility and safety of stage I anastomosis and T-tube fistulation in laparoscopic local resection of duodenal tumors.Methods:A descriptive case series study was used to retrospectively analyze the clinical diagnosis and treatment data of 14 patients with duodenal tumors who successfully underwent laparoscopic local resection of duodenal tumors + phase I anastomosis + T-tube ostomy in the Guangdong Provincial Hospital of Chinese Medicine and the First Affiliated Hospital of Guangzhou University of Chinese Medicine from October 2021 to March 2024. The resection and reconstruction steps of laparoscopic local resection of duodenal tumor + phase I anastomosis + T-tube ostomy are as follows: (1) after the safe margin is clear, the duodenal tumor is completely removed in full thickness, and the specimen bag is taken out and sent to frozen section to determine the nature of the tumor and the negative margin; (2) Perforate the anterior duodenal wall below the tumor plane, place a 16# T tube, and fix it with laparoscopic purse string suture. The abdominal wall is led out through the duodenum, and the duodenal T tube fistulation is performed; (3) The duodenum was continuously sutured in a full-thickness transverse shape, and the seromuscular layer was strengthened to form a phase I anastomosis. The nutritional improvement of patients after operation was mainly observed, and the intraoperative situation and postoperative complications were recorded.Results:No conversion to laparotomy, postoperative emergency reoperation, intraoperative and postoperative complications occurred in 14 patients with duodenal tumors who completed laparoscopic local resection of duodenal tumors + phase I anastomosis + T-tube ostomy. The operation time was (225.43 ± 56.54) min, and the intraoperative blood loss was (72.14 ± 74.65) ml. The patient recovered well after operation, and no severe postoperative abdominal bleeding occurred. Postoperative gastrointestinal angiography showed that the anastomotic stoma was unobstructed, and there were no stenosis, anastomotic leakage and other related complications. There was no significant difference in serum albumin [(37.09 ± 3.53) g/L vs. (37.52 ± 4) g/L] and hemoglobin [(100.79 ± 31.93) g/L vs. (103.07 ± 19.6) g/L] between before and 1 week after operation ( P > 0.05). Conclusion:Laparoscopic local resection of duodenal tumor + phase I anastomosis + T-tube fistulation can be used as one of the safe and feasible improved methods for local resection of duodenal tumor to effectively reduce the occurrence of related complications.

Objective:To discuss the feasibility and safety of stage I anastomosis and T-tube fistulation in laparoscopic local resection of duodenal tumors.Methods:A descriptive case series study was used to retrospectively analyze the clinical diagnosis and treatment data of 14 patients with duodenal tumors who successfully underwent laparoscopic local resection of duodenal tumors + phase I anastomosis + T-tube ostomy in the Guangdong Provincial Hospital of Chinese Medicine and the First Affiliated Hospital of Guangzhou University of Chinese Medicine from October 2021 to March 2024. The resection and reconstruction steps of laparoscopic local resection of duodenal tumor + phase I anastomosis + T-tube ostomy are as follows: (1) after the safe margin is clear, the duodenal tumor is completely removed in full thickness, and the specimen bag is taken out and sent to frozen section to determine the nature of the tumor and the negative margin; (2) Perforate the anterior duodenal wall below the tumor plane, place a 16# T tube, and fix it with laparoscopic purse string suture. The abdominal wall is led out through the duodenum, and the duodenal T tube fistulation is performed; (3) The duodenum was continuously sutured in a full-thickness transverse shape, and the seromuscular layer was strengthened to form a phase I anastomosis. The nutritional improvement of patients after operation was mainly observed, and the intraoperative situation and postoperative complications were recorded.Results:No conversion to laparotomy, postoperative emergency reoperation, intraoperative and postoperative complications occurred in 14 patients with duodenal tumors who completed laparoscopic local resection of duodenal tumors + phase I anastomosis + T-tube ostomy. The operation time was (225.43 ± 56.54) min, and the intraoperative blood loss was (72.14 ± 74.65) ml. The patient recovered well after operation, and no severe postoperative abdominal bleeding occurred. Postoperative gastrointestinal angiography showed that the anastomotic stoma was unobstructed, and there were no stenosis, anastomotic leakage and other related complications. There was no significant difference in serum albumin [(37.09 ± 3.53) g/L vs. (37.52 ± 4) g/L] and hemoglobin [(100.79 ± 31.93) g/L vs. (103.07 ± 19.6) g/L] between before and 1 week after operation ( P > 0.05). Conclusion:Laparoscopic local resection of duodenal tumor + phase I anastomosis + T-tube fistulation can be used as one of the safe and feasible improved methods for local resection of duodenal tumor to effectively reduce the occurrence of related complications.

Objective    To analyze the efficacy and safety of Toumai® endoscopic surgery robot in right upper lobe resection. Methods    The clinical data of 2 patients with non-small cell lung cancer who received right upper lobe resection with Toumai® endoscopic surgery robot in Shanghai Chest Hospital, Shanghai Jiao Tong University in November 2021 were retrospectively analyzed. Both patients were male, aged 66 years and 44 years, respectively. Results    The operation was successful in both patients with no conversion to thoracotomy, surgical complication or death. The operation time was 65 min and 48 min, and the amount of intraoperative bleeding was 80 mL and 50 mL, respectively. The postoperative hospital stay was 3 days. There was no blood transfusion during the perioperative period. Conclusion    The application of Toumai® endoscopic surgery robot in lobectomy is preliminarily proved to be safe and effective. Compared with Da Vinci robotic surgery system, it has similar clear 3D vision and flexible and stable operation, which can become one of the important choices for the new generation of minimally invasive chest surgery.

Objective:To investigate the curative effect of triangular mechanical reconstruction in revision of failed fixation of intertrochanteric factures.Methods:A retrospective case series study was conducted for data of 11 patients with failed treatment of intertrochanteric fractures treated at First Medical Centre, Chinese PLA General Hospital from January 2017 to December 2019, including 7 males and 4 females, aged 41-75 years [(57.9±11.4)years]. The patients underwent revision surgery to achieve mechanical reconstruction of the proximal femoral triangular structure by two different implants. Among them, 6 patients were fixed using the dynamic condylar screw (DCS) combined with anteromedial plate and 5 patients were fixed using the cephalomedullary nail combined with anteromedial plate. The fracture healing rate and time, neck-shaft angle, neck anteversion angle and complications were detected. The lower extremity functional scale (LEFS), short form 12 health survey questionnaire (SF-12) and pain visual analogue scale (VAS) were measured at postoperative 6 and 12 months to evaluate functional recovery and quality of life.Results:All patients were followed up for 12-45 months [(19.1±10.8)months]. The fracture healing rate was 100%, with the healing time of 3-8 months [(4.7±1.8)months]. Compared with the unaffected limb, the neck-shaft angle and neck anteversion angle of the affected side were reduced ( P>0.05), and no secondary fracture reduction loss occurred before healing ( P>0.05). There were no postoperative complications such as femoral head avascular necrosis and implant failure. The LEFS score was (44.7±8.2)points at postoperative 12 months, significantly improved compared with that at postoperative 6 months [(61.6±10.4)points] ( P<0.05). The VAS was 1.5 (0, 2)points at postoperative 12 months, significantly decreased compared with that at postoperative 6 months [3.5(2, 4)points] ( P<0.05). The SF-12 score in physical state [(42.5±9.0)points] and mental state [(55.7±5.7)points] were also significantly improved compared with those at postoperative 6 months [(30.0±6.4)points, (43.6±6.2)points] ( P<0.05). Conclusions:Based on the characteristics of structural mechanics of the proximal femur, the DCS or cephalomedullary nail combined with anteromedial plate used to construct a triangular stable structure can achieve stable fracture reduction and maintenance reduction, relieve pain and improve function recovery as well as quality of life. This may provide an optimized revision strategy for failed fixation of intertrochanteric fractures.

http://www.kqjbfz.com/article/2021/2096-1456/2096-1456-29-8-567.shtml

Objective    To summarize the perioperative outcome of patients undergoing robot-assisted thoracic surgery (RATS) or four-port single-direction video-assisted thoracic surgery (VATS) right upper lobectomy (RUL), and to discuss the safety and the essentials of the surgery. Methods    The clinical data of 579 patients with non-small cell lung cancer (NSCLC) undergoing minimally invasive RUL in Dr. Luo Qingquan’s team of our center from 2015 to 2018 were retrospectively analyzed. There were 246 males and 333 females aged 33-78 years. The 579 patients were divided into a RATS group (n=283) and a VATS group (n=296) according to surgical methods. Baseline characteristics and perioperative outcomes including dissected lymph nodes, postoperative duration of drainage, postoperative hospital stay, postoperative complications and surgery cost were compared between the two groups. Results    There was no significant difference in baseline data between the two groups (P>0.05), and no postoperative 30 d mortality or intraoperative blood transfusion was observed. Compared with VATS, RATS had shorter operation time (90.22±12.16 min vs. 92.68±12.26 min, P=0.016), postoperative hospital stay (4.67±1.43 d vs. 5.31±1.59 d, P<0.001) and time of drainage (3.55±1.38 d vs. 4.16±1.58 d, P<0.001). No significant difference was observed between the two groups in the lymph nodes dissection, blood loss volume, conversion rate or complications. The cost of RATS was much higher than that of VATS (93 275.46±13 276.69 yuan vs. 67 082.58±12 978.17 yuan, P<0.001). Conclusion    The safety and effectiveness of robot-assisted and video-assisted RUL are satisfactory, and they have similar perioperative outcomes. However, RATS costs relatively shorter operation time and postoperative hospital stay.

Objective To analyze the perioperative outcome of consecutive 1 000 patients undergoing robotic lung resection and summarize surgical experience. Methods We retrospectively reviewed the clinical data of 1 000 patients undergoing robotic lung resection between May 2009 and June 2018 in Shanghai Lung Tumor Clinical Medical Center. Robotic lobectomy was compared with traditional VATS over the same period using a propensity-matched analysis. There were 327 males and 673 females at average age of 56.21±11.33 years. Lobectomy was performed in 866 patients (11 bilobectomy included), sublobar resection was performed in 129 patients, sleeve lobectomy was performed in the remaining 5 patients. Pathology was as follows: adenocarcinoma in 875 patients, squamous carcinoma in 52 patients, benign tumors in 73 patients. 90.5% of the primary lung cancer were in stage Ⅰ. Results The mean operative time was 90.31±19.70 min; 95.70% of patients’ estimated blood loss was less than 100 ml. Conversion rate to thoracotomy was 0.90% (9 patients) . The average lymph node station and count harvested was 5.59±1.36 and 9.60±3.21 respectively. The mean volume of chest tube drainage on the first postoperative day was 229.19±131.67 ml. Median chest tube time was 3.85±1.43 d. There was 1 in-hospital death due to pulmonary embolism. A total of 189 patients had postoperative complications (18.90%) whose majority was postoperative air leak more than 5 days. The mean overall hospital costs was 92 710.53±12 367.23 Yuan. Compared with VATS, RATS was associated with significant reduction in intraoperative blood loss, time to chest tube removal and postoperative hospital stay. The operative time, conversion rate, lymph nodes removed, morbidity and mortality were similar between the two groups. Conclusion Robotic-assisted lung resection is safe and effective with low conversion rate and less complications, and it can overcome many disadvantages of traditional VATS.

Objective To evaluate the miRNA change between hypothermia circulatory arrest at different temperature and its impact on intestinal protection.Methods Sixteen piglets were randomly(n =4) divided into four groups:deep hypothermia circulatory arrest (DHCA,18℃) group,moderate hypothermia circulatory arrest(MHCA,24℃) group,cardiopulmonary bypass(CPB) group and sham operation(SO) group.They were subjected to 80 min hypothermia circulatory arrest,305 min CPB or thoracotomy,respectively.Pick-and-mix custom miRNA real-time PCR panels were utilized to detect intestinal samples.miRNA expression between DHCA and MHCA were compared directly(DHCA vs.MHCA) and indirectly(DHCA/SO vs.MHCA/SO,DHCA/CPB vs.MHCA/CPB).Results Exposure to DHCA caused less intestinal miRNA dysregulation than MHCA.Besides,seven miRNAs(miR-122,miR-145-5p,miR-421-5p,miR-99a,miR-365-5p,miR-31 and miR-192)were differentially expressed between the two hypothermia circulatory arrest groups.Conclusion Better intestinal miRNA protection was provided by DHCA than MHCA.Intestinal miRNA were differentially expressed between hypothermia circulatory arrest at different temperature.

Objective    To investigate the perioperative outcome of robot-assisted pulmonary lobectomy in treating pathological stage Ⅰ non-small cell lung cancer (NSCLC). Methods    We retrospectively analyzed the clinical data of 333 consecutive p-T1 NSCLC patients who underwent robotic-assisted pulmonary lobectomy in our hospital between May 2013 and April 2016. There were 231 females (69.4%) and 102 males (30.6%) aged from 20–76 (55.01±10.46) years. Cancer was located in the left upper lobectomy in 37 (11.1%) patients, left lower lobectomy in 71 (21.3%) patients, right upper lobectomy in 105 (31.5%) patients, right middle lobectomy in 32 (9.6%) patients, right lower lobectomy in 88 (26.4%) patients. Adenocarcinoma was confirmed in 330 (99.1%) patients and squamous cell cancer was confirmed in 3 (0.9%) patients. Results    Total operative time was 46–300 (91.51±30.80) min. Estimated intraoperative blood loss was 0–100 ml in 319 patients (95.8%), 101–400 ml in 12 patients (3.6%), >400 ml in 2 patients (0.6%). Four patients were converted to thoracotomy, including 2 patients due to pulmonary artery branch bleeding and 2 due to pleural adhesion.No patient died within 30 days after surgery. And no perioperative blood transfusion occurred. Postoperative day 1 drain was 0–960 (231.39±141.87) ml. Chest drain time was 2–12 (3.96±1.52) d. And no patient was discharged with chest tube. Length of hospital stay after surgery was 2–12 (4.96±1.51) d. Persistent air leak was in 12 patients over 7 days. No readmission happened within 30 days. All patients underwent lymph node sampling or dissection with 2–9 (5.69±1.46) groups and 3–21 (9.80±3.43) lymph nodes harvested. Total intraoperative cost was 60 389.66–134 401.65 (93 809.23±13 371.26) yuan. Conclusion    Robot-assisted pulmonary lobectomy is safe and effective in treating p-Stage Ⅰ NSCLC, and could be an important supplement to conventional VATS. Regarding to cost, it is relatively more expensive compared with conventional VATS. RATS will be widely used and make a great change in pulmonary surgery with the progressive development of surgical robot.

Objective To evaluate the effects of β1 adrenergic receptor (β1-AR) autoantibodies on the micro-mechanics of a single rat ventricular myocyte and the concentration of intracellular calcium for investigating the pathogenic mechanism of heart disease caused by β1-AR autoantibody on both cellular and molecular levels .Methods The micro-mechanics of an acutely isolated single myocardial cell from rat was detected by using the atomic force microscopy ( AFM) in combination with laser scanning confocal micro-scope (LSCM) before and after binding to β1-AR autoantibodies.The ventricular myocyte contraction and the intracellular calcium concentration were observed as well .Results The micro-mechanics of a single ventricular myocyte was increased from (44-51) nN to (76-82) nN after binding to β1-AR autoantibodies. Its contraction frequency was also increased from (0.17±0.04) Hz to (0.40±0.03) Hz (P<0.05).More-over, the intracellular calcium fluorescence intensity was increased significantly during contraction in com -parison with that before binding to β1-AR autoantibodies [ ( 102.1 ±12.3 ) % vs ( 154.3 ±16.7 ) %, P<0.01 ] .Conclusion β1-AR autoantibody could affect the contraction and the micro-mechanics of ventricu-lar myocytes and the intracellular calcium concentration in ventricular myocytes .