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Objective To evaluate the clinical efficacy and safety of different stitching methods,over-the-scope-clip (OTSC) and metal clips combined with nylon rope (King closure),for full-layer gastric wall defect.Methods Data of 75 cases,who underwent endoscopic full-thickness resection (EFTR) of gastric SMTs from May 2015 to May 2018 in our endoscopy center were retrospectively analyzed.According to the closure method,the patients were divided into the OTSC group (20 cases) and the King closure group (55 cases).Comparison was made in gender,age,the largest diameter of tumor,the location of tumor,defect surface diameter,total operating time,defect closure time,closure success rate,the length of hospital stays,cost and postoperative complications between the two groups,Results The baseline data were comparable,and there were no significant differences in age,gender,tumor location,tumor diameter,and defect surface diameter between the two groups(all P＞0.05).The success rate of closure was 100％ in both groups.In terms of length of hospital stay,there was no significant difference between the two groups (t =1.13,P=0.268).The total operating time was 63.24±43.22 min in the King closure group versus 47.60± 18.13 min in the OTSC group (t =2.20,P =0.030).The closure time of the defect surface was 20.85 ± 16.35 min in the King closure group versus 10.95±5.20 min in the OTSC group (t =2.65,P=O.010).Hospitalization costs were 24 200±800 yuan in the King closure group versus 36 200±2 350 yuan in the OTSC group (t=6.21,P＜0.001).Postoperative abdominal elevation radiographs in both groups indicated a small amount of subphrenic free gas,and no intervention was given due to the small amount of gas and no obvious symptoms.No late bleeding,recurrent perforation,infection or other complications occurred after operation,and all patients were discharged successfully.Six months after surgery,15 patients (27％) in the King closure group developed metal clips or nylon rope residue,which were successfully removed by endoscopy.The anastomosis clamp of nighteen patients (95％) in the OTSC group were in the original position.None of the patient received open surgery.Conclusion OTSC and King closure are both safe and effective in the treatment of full-thickness defect of gastric wall.OTSC has the advantages of short total operation time and short closure time,but with high cost.
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OBJECTIVE@#To explore the safety, feasibility and short-term efficacy of intracavitary uncut Roux-en-Y (URY) anastomosis in digestive tract reconstruction following laparoscopic total gastrectomy (LTG).@*METHODS@#From November 2015 to January 2018, 67 gastric cancer patients underwent intracavitary URY following LTG to reconstruct the digestive tract at Oncological Surgery Department of Fujian Provincial Hospital. There were 41 males and 26 females with age of 50 to 81 (61.9±7.4) years and body mass index (BMI) of (23.4±3.2) kg/m². Among 67 patients, 19 were gastric cardia carcinomas, 33 were gastric body carcinomas, and 15 were gastric fundus carcinomas; tumor size was (3.4±2.3) cm; 22 were Borrmann type I, 15 were type II, 21 were type III, and 19 were type IV; 29 were highly or moderately differentiated adenocarcinoma, 23 were lowly differentiated adenocarcinoma, and 15 were signet-ring cell carcinoma. After conventional laparoscopic D2 radical gastrectomy, the duodenum was closed and dissociated at 2 cm below the pyloric ring using the Echelon-flex endoscopic articulated linear Endo-GIA stapler, and the esophagus was dissociated above the esophagogastric junction (EGJ).URY and digestive tract reconstruction were performed under the direct vision of laparoscope: (1) Side-to-side esophagojejunostomy: An incision of 0.5 cm was made in the left lower edge of the esophageal closed end; jejunum about 25 cm distal away from the Treitz ligament was elevated to the lower end of esophagus; another incision of 0.5 cm was made in the contralateral of mesenteric side; both arms of the linear Endo-GIA stapler were inserted into the windows opened through esophagus and jejunum respectively to complete side-to-side anastomosis. The common opening of esophagus and jejunum was closed to complete esophagojejunostomy, forming the chyme outflow tract. (2) Side-to-side Braun jejunojejunostomy: Incisions of 0.5 cm were made in the proximal jejunum about 10 cm away from the esophagojejunal anastomosis and 35-40 cm away from the contralateral of mesenteric side of distal jejunum respectively for proximal-distal side-to-side jejunojejunostomy. The common opening was closed to form the biliopancreatic duodenal juice outflow tract. (3) Closure of the input loop jejunum in the esophagojejunal anastomosis: The input loop jejunum 2-3 cm away from the esophagojejunal anastomosis was closed using the non-blade linear stapler (ATS45NK), and the biliopancreatic duodenal juice reflux was blocked. Clinical data of these patients were collected for retrospective case series study. Surgical and digestive tract functional recovery, perioperative complications, as well as postoperative nutritional status were observed. Moreover, related indexes, such as anastomosis function and tumor recurrence were evaluated through endoscopic and imaging examinations during postoperative follows-up.@*RESULTS@#All the 67 patients completed the surgery successfully. The mean operative time was (259.4±38.5) minutes, digestive tract reconstruction time was (38.2±13.2) minutes, intraoperative blood loss was (73.4±38.4) ml, and number of harvested lymph node was 36.2±14.2. The mean distance from upper resection margin to upper tumor edge was (3.3±1.2) cm, distance from upper resection margin to dentate line was (1.2±0.7) cm, and 1 case had positive upper incisal margin, which became negative after the second resection. Moreover, the average length of the auxiliary incision was (3.2±0.4) cm. The mean postoperative intestinal exhaust time was (52.8±26.4) hours, time to liquid diet was (64.8±28.8) hours, and postoperative hospital stay was (8.4±2.5) days. The morbidity of postoperative complication was 10.4%(7/67). Among these 7 cases, 4 cases were grade IIIa of Clavien-Dindo classification, including 2 with esophagojejunal anastomosis leakage, 1 with duodenal stump leakage, and 1 with abdominal infection, and all these patients were recovered after conservative treatment. All the 67 patients were followed up. The mean nutrition index 12 months after surgery was 53.4±4.2, diameter of esophagojejunal anastomosis was (3.9±0.6) cm, the incidence of Roux-en-Y stasis syndrome was 3.0% (2/67), and the incidence of reflux esophagitis was 4.5% (3/67). No patient had recanalization of the closed input loop of esophagojejunal anastomosis, anastomotic stenosis, obstruction, or tumor recurrence at anastomosis.@*CONCLUSION@#Intracavitary URY anastomosis following LTG for digestive tract reconstruction is safe and feasible, leading to fast postoperative recovery of digestive tract function and favorable short-term efficacy.
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Female , Humans , Male , Anastomosis, Roux-en-Y , Methods , Anastomosis, Surgical , Gastrectomy , Methods , Jejunum , Laparoscopy , Retrospective Studies , Stomach Neoplasms , General SurgeryABSTRACT
Objective:To investigate the induction and differentiation potential of ADSCs by tissue culture method,and to preliminary study on the origin of ADSCs.Methods:Using adipose tissue culture method to culture human ADSCs.The third generation of ADSCs for the adipogenic and osteogenesis differentiation,and staining by oil red O and alizarin red S.HE staining was performed after the seventh day culture of adipose tissue.Results:The primary human ADSCs were successfully cultured with adipose tissue culture method.ADSCs cultured to the eighth generation,still maintained a good proliferation ability and cell morphology.ADSCs can be successfully induced into adipose cells and bone cells.ADSCs were mainly distributed around the mesenchymal vascular and connective tissue,by HE staining of adipose tissue after seven days of culture.Conclusion:The cells that were cultured with adipose tissue have the potential to adipogenic and osteogenesis differentiation.The ADSCs were mainly distributed around the mesenchymal vascular and connective tissue.
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Objective To establish a method for detection Tp0259 gene by PCR .To provide basis of diagnosis infection of trepo‐nema pallidum by detection Tp0259 gene .Methods Gene sequences of Tp0259 was obtained from Genebank and analysis by bioin‐formatics .Specific primers were designed .The whole genome was extracted from testis specimens of the New Zealand rabbits infec‐ted by treponema pallidum and control groups .The gene of Tp0259 was amplified by PCR under the optimization reaction condi‐tions which was selected by many tests ,using the new construction of amplification method to detect the common pathogenic micro‐organism in urinary and reproductive tract infection .Results Specific bands of 646 bp was appeared only in New Zealand rabbits which was infected by treponema pallidum ,while none was in the control group and other pathogenic microorganisms .Conclusion Detection the Tp0259 gene could be used to diagnose infection of treponema pallidum .
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Objective To explore the significance of established Tp0259-PCR in diagnosing primary syphilis.To provide basis for establishing new PCR diagnosis method of Treponema pallidum.Methods Specific primers were designed by the gene sequences of Tp0259 which was obtained from Genbank.Tp0259-PCR was established under the optimization reaction condition.Using the new construction of amplification method to detect the common pathogenic microorganism in urinary and reproductive tract infec-tion.42 clinical secretion specimens suspected primary syphilis were tested by Tp0259-PCR.Serum specimens from the same pa-tients were tested by TPPA.Results Only specific amplicons could be found in amplifying the Treponema pallidum by Tp0259-PCR.The detection rate was 73.8% using Tp0259-PCR which was apparently higher than 57.1% using TPPA(P <0.05 ).The specificity of the established method was 100% comparing with TPPA.Conclusion The established method of Tp0259-PCR has high sensibility and specificity.This method might be better than serological method in diagnosis of primary syphilis.but its clinical diagnosis value need to be repeatedly verified by more clinical specimens.
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OBJECTIVE To acquire the information about the gene type and epidemic condition of the hospital to provide scientific proof for monitoring and controlling nosocomial infection.METHODS Meticillin-resistant Staphylococcus aureus(MRSA) was identified by its resistance to cefoxitin of disk diffusion and mecA PCR,randomly amplified polymorphic DNA(RAPD) was carried out with the optimization condition.RESULTS The rate of MRSA infection was 72.15% and the main gene type was A in the hospital.CONCLUSIONS The nosocomial infection may exist in the hospital and the hospital must take effective measure to decline nosocomial infection of the MRSA;RAPD is suitable for molecular epidemiology with high powerful discrimination,simplicity and rapidness.