2016年 · 第54卷第03期

Laparoscopic radical gastrectomy is safe and feasible for the treatment of early and partially advanced gastric cancer^[1]。 In recent years, with the renewal of minimally invasive concept, the improvement of aesthetic requirements and the progress of laparoscopic equipment, instruments and technology, single-port laparoscopic technology has emerged. Single-port technique is less invasive, faster recovery, and better aesthetic, but single-port laparoscopic lymph node dissection and digestive tract reconstruction were once considered to present insurmountable technical hurdles^[1,2]。 Recently, we completed 2 cases of single-port laparoscopic radical total gastrectomy with ordinary laparoscopic instruments with satisfactory results.

A 46-year-old female was admitted to the hospital on 24 January 2014 mainly due to "chest pain with choking after eating for 2 months". Two months ago, the patient experienced choking after eating without obvious trigger, progressively aggravated, occasionally accompanied by retrosternal pain, no acid reflux, heartburn, nausea and other symptoms, and no abnormal change in weight. Physical examination: The general condition is good, there are no positive signs in the chest and abdomen examination, there is no tenderness in the sternum, and the superficial lymph nodes are not palpable and swollen. Gastroscopy: A broad basal bulge was seen in the left wall of the esophagus 26~30 cm away from the incisors, and there was no abnormality in the surface mucosa (Figure 1)。 Ultrasound gastroscopy: the lesion was continuous with the muscularis propria, showing uniform hypoechoic changes, 25.1 mm ×13.9 mm in size, considering benign lesions of the esophagus (Figure 2)。 Upper gastrointestinal tract angiography: external pressure changes in the middle esophagus, smooth mucosa (Figure 3)。 Chest enhanced CT examination: A mild enhanced mass was seen in the esophageal wall with clear boundaries, and no obvious enlarged lymph node shadow was found in the mediastinum (Figure 4)。 Preoperative diagnosis: Leiomyoma of the middle esophagus. On 27-Jan-2014, the patient underwent resection of benign esophageal tumor under general anesthesia. Exploration showed that there was a cystic-solid mass with a size of 15 mm ×25 mm ×31 mm on the left side of the esophagus. The border of the mass was clear, and the cystic-solid mass could be completely separated from the mucosa. The postoperative pathological results showed basal cell-like squamous cell carcinoma of the esophagus, the basal cell-like cells were arranged in a solid nest-like structure, the tumor cells around the nest were often arranged in a palisade shape, and acne-like necrosis was seen in the center of the nest (Figure 5)； Immunohistochemistry: cytokeratin (+), CK5/6 (+), p63 (+), p40 (+), CK7 (-), carcinoembryonic antigen (+), Ki-67 (70% +), smooth muscle actin (-). The patient underwent 4 cycles of chemotherapy with cisplatin + paclitaxel regimen. Five months after the operation, CT revealed that the tumor recurred at the original location, and the patient underwent radical esophageal cancer resection. The postoperative pathological results were esophageal basal cell squamous cell carcinoma, the tumor was confined to the muscle layer, the mucosal layer was intact, no tumor cells were found, and no lymph node metastasis was found. The postoperative pathological stage was T2N0M0. No adjuvant chemoradiotherapy was performed after surgery. The patient was reviewed 1 year after surgery, and no obvious signs of recurrence and metastasis were found in clinical and imaging.

Male, 66 years old, was admitted to hospital on April 16, 2015 because "a mass in the left upper abdomen was found for more than 1 month and gradually increased for 1 week". The patient found a mass in the left upper abdomen one month before admission. In the past week, the mass increased significantly, accompanied by distension and pain in the left upper abdomen, cough, no expectoration, fever, nausea and vomiting, no complaint of anal exhaustion and defecation, no complaint of obvious anorexia and fatigue, and no yellowing staining of the skin and sclera. Frequent hunger in the past month, and weight loss of 5 kg since the onset of the disease. Physical examination: The abdomen was flat and soft, the left upper abdomen was swollen, with a mass of 15 cm ×15 cm in size, with a smooth surface, medium quality, poor mobility, deep tenderness in the left upper abdomen, no rebound pain, and percussion pain in the spleen area. There was no mass, tenderness and rebound pain in the rest of the abdomen, mobile voiced sound (-), and normal intestinal sound. Chest X-ray showed that the left diaphragmatic surface was significantly elevated (FIG. 1A)。 CT examination of upper abdomen: considering the huge spleen occupying space (FIG. 1B)。 MRI examination of the upper abdomen revealed a large space-occupying lesion in the left subdiaphragmatic spleen area, about 18.8 cm ×14.8 cm ×20.6 cm in size, with clear boundary, mainly cystic in nature, with intact capsule, and multiple cystic changes in the lesion, with multiple linear separators (Figure 1C)。 There were no abnormalities in serum tumor markers such as alpha-fetoprotein, carcinoembryonic antigen and CA19-9, and the preoperative platelet count, red blood cell count and white blood cell count were all normal. Primary splenic tumor was initially diagnosed.

Intraoperative images of patients with non-muscle invasive bladder tumors treated with narrow-band imaging endoscopy combined with holmium laser transurethral block resection of bladder tumors (Figure 1，Figure 2)。

Intraoperative images of patients with non-muscle invasive bladder tumors treated with narrow-band imaging endoscopy combined with holmium laser transurethral block resection of bladder tumors (Figure 3，Figure 4)。