The Application Of Laparoscopic Surgery In Colorectum Benign And Malignant Disease

PART I Hand-AssistedLaparoscopicRestorativeProctocolectomy with Ileal Pouch Anal Anastomosisfor Ulcerative ColitisObject:This study aimed to evaluate the feasibility and safety of undergoing restorative proctocolectomy with ileal pouch anal anastomosis(RPC IPAA)with HALS in patients with ulcerative colitis(UC).Methods:We reviewed 40 consecutive patients who underwent RPCIPAA with HALS or open technique for treatment of UC between 2010 and 2013.Moreover,the intra-/post-operative outcomes were compared.Results:We found the median operative time was significantly longer in the HALS group while the blood loss was significantly less in patients with HALS than with open surgery.In the HALS group,the median duration of bed rest and the length of hospital stay were significantly shorter.Moreover,the rate of early post-operative complications in the HALS group was significantly less than that in the open surgery group,among which one patient died in the 30th day after surgery for the extensive use of steroids before the operation.Conclusion:These findings clearly show that HALS RPC IPAA is safe and less invasiveness.HALS can become a more comfortable and standardised procedure for UC with the adoption of evolving technologies.PART II Comparative analysis of clinical effect and security of different surgical methods on patients with right colon carcinoma and its influence on the level of inflammatory factorObjectlive:To investigate the clinical effect and security of different surgical methods on patients with right colon carcinoma and its influence on the level of inflammatory factor.Methods:100 patients were randomly divided into laparoscopic group(n = 50)and open group(n = 50).The age,sex,operation time,operation blood loss,postoperative Dukes stage,time to first passage of flatus,and postoperative hospital stay were recorded.The levels of hypersensitive C reactive protein(hsCRP)and tumor necrosis factor-a(TNF-a)in serum and abdominal exudate were measured by ELISA at the time of preoperative 2 h and postoperative 6 h and 24 h.Results:There was no significant difference in age,sex,Dukes stage and preoperative inflammatory mediators between the two groups(P>0.05).The operation time,intraoperative blood loss,time to first passage of flatus and postoperative hospital stay were significantly better in laparoscopic group than those in open operation group.At 6 h and 24 h after operation,the levels of hsCRP and TNF-a in serum and abdominal exdate in laparoscopic group were significantly lower than those in open operation group.Conclusion:Laparoscopic surgery for the treatment of right colon carcinoma has the advantages of fewer traumas,less systemic and local inflammatory response,rapider postoperative recovery and shorter hospital stay.It is worthy of clinical application.