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Objective@#To assess the clinical value of neutrophil-to-lymphocyte ratio (NLR) in predicting anastomotic leak of postoperative rectal cancer patients.@*Methods@#The clinical data of 787 rectal cancer patients who underwent anterior resection from January 2014 to December 2017 in Affiliated Tumor Hospital of Zhengzhou University were collected. The postoperative numbers of white blood cell (WBS) on postoperative day (POD)1, 3 and 5 were detected, and the NLR was calculated. The relationship of NLR and the incidence of anastomotic leak was analyzed, and the area under the receiver-operating characteristic (ROC) curves was calculated. The accuracy of postoperative NLR in predicting the incidence of anastomotic leak was evaluated.@*Results@#WBC counts of patients with leak on POD1, POD3 and POD5 were 13.2×109/L, 9.1×109/L and 8.9×109/L, respectively, while those of patients without leak were 12.9×109/L, 9.0×109/L and 8.8×109/L. The WBC count was not significantly different between patients with or without leak (P>0.05). The average NLR values of patients with or without leak were 13.3 and 11.6 on POD1, 10.9 and 7.6 on POD3, 9.3 and 5.3 on POD5, respectively. The NLR values of patients with leak on POD3 and POD5 were significantly higher than those of patients without leak (P<0.05). The cutoff value of NLR on POD3 was 8.6, the sensitivity and specificity of detecting the leakage was 73.2% and 75.6%, respectively, and the area under curve (AUC) was 0.744. The cutoff value of NLR on POD5 was 5.5, the sensitivity and specificity was 69.6% and 75.5%, the AUC was 0.726. The multivariate analysis result showed that NLR >8.6 was an independent factor for anastomotic leak prediction.@*Conclusion@#Postoperative NLR on day 3 is useful in predicting anastomotic leak and can decrease the incidence of complication in rectal cancer patients who underwent anterior resection.
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Objective@#To explore the method of relieving intestinal obstruction in patients with recurrent cervical cancer accompanied with intestinal obstruction after radical radiotherapy.@*Methods@#The data of 10 recurrent cervical cancer patients accompanied with high risk weak constitution and intestinal obstruction after radical radiotherapy from May 2012 to May 2018 were retrospectively analyzed, including preoperative radiotherapy dose, physique and obstruction status, operation time, operation blood loss, postoperative digestive tract patency and diet. All of the 10 patients with cervical cancer recurrence accompanied with intestinal obstruction and disturbance of independent walking after radical radiotherapy.@*Results@#The median fasting time of the 10 patients was 21 days, the median weight was 35.5 kg, the median body mass index (BMI) was 13.3 kg/m2, the median value of hemoglobin was 67 g/L, and the median value of platelet was 44×109 /L. All of the patients underwent enterostomy. the median operation time was 6.0 min and the median amount of bleeding was 5.0 ml. All of the patients defecated after operation, fed on the first day after operation, and were able to walk on their own 5 days after operation.@*Conclusions@#Although the cervical cancer patients with recurrent intestinal obstruction after radical radiotherapy are extremely weak, some patients still have the opportunity to relieve intestinal obstruction if the treatment strategy and surgical method are appropriate.
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Objective@#To establish a scoring system to predict the risk of anastomotic leakage in patients with rectal cancer older than 60 years.@*Methods@#The study included 995 patients (≥ 60 years) with rectal cancer locating 3-12 cm from the anal verge who underwent anterior resection or intersphincteric resection at the Department of General Surgery, Henan Cancer Hospital from January 2012 to December 2016. Potential risk factors for leakage were subjected to univariate analysis. Multivariate logistic regression analysis was used to identify the independent risk factors for anastomotic leakage. The scoring system was developed based on regression coefficient for each significant risk factor. One point was allocated to the risk factor with a regression coefficient β < 1, and two points were allocated to the risk factor with β > 1. The proposed scoring system was tested by the area under curve (AUC) of the receiver operating characteristic curve (ROC) .@*Results@#Surgery was successfully performed in all 995 patients. The incidence of anastomotic fistula was 4.6% (46/995) . Among these 46 patients, 31 recovered after conventional treatment, and 13 patients underwent transverse colostomy, and 2 died of multiple organ failure. Independent risk factors included age (β = 0.643, OR = 1.902, 95%CI: 1.020 - 3.614, P = 0.048) , body mass index (BMI) (β = 1.218, OR = 3.379, 95%CI: 1.607 - 7.105, P = 0.001) , albumin levels (β = 0.986, OR = 2.681, 95%CI: 1.432-5.021, P = 0.002) , and level of anastomosis from the anal verge (β = 1.395, OR = 4.034, 95%CI: 2.086-7.801, P = 0.000) . The scoring system was created base on coefficient β of the independent risk factors (age≥70 years for 1, BMI≥25 kg/m2 for 2, albumin levels < 35 g/L for 1, level of anastomosis from anal verge < 4.0 cm for 2) . All the scores were added up, and all patients were divided into the high-risk group (4-6 points, n=71) and intermediate-low-risk group (0-3 points, n=924) based on the scoring system. The incidence of anastomotic leakage in the two groups was 23.9% (17/71) and 3.1% (29/924) , respectively (χ2 = 60.092, P = 0.000) . The AUC of age, BMI, albumin levels, and level of anastomosis from the anal verge were 0.598, 0.591, 0.622, and 0.635 respectively. The AUC of the scoring system was 0.656, which was higher than above parameters with a sensitivety of 0.37 and specificity of 0.94.@*Conclusions@#The scoring system is effective and accurate for identifying a subgroup at high risk for postoperative anastomotic leakage in rectal cancer patients over 60 years old.
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Objective To Summary the first 40 cases underwent robotic atrial septal defect (ASD) closure or atrial septal defect closure combined bicuspid valve plasty (TVP) using da Vinci S surgical System on beating heart. Methods 40 cases of atrial septal defect or combined sever tricuspid valve regurgitation were repaired using da Vinic S surgical system on beating heart from March 2009 to December 2010 in cardiovascular department of PLA general hospital. The average age was (38 ± 13) yeas old. 23 cases were female and 17 cases were male. All patients were ostium atrial septal defect with or without pulmonary hypertension. The atrial defect diameter was 1.5 -3.5 cm, and the mean diameter was(2. 8 ±1.3)cm. 9 patients had sever tricuspid valve regurgitation. Without sternotomy, the extracorporeal circulation was established through groin artery,groin vein and internal jugular vein cannulation with the guidance of transeophageal echocardiography. 3 ports of 8 mm and 1 working port of 2 cm were made in the right chest wall. After da Vinci S syetem was set up, with the assistant of bed-side surgeon, the surgeon completed the atrial septal defect closure or combined tricuspid valve plasty in the surgeon console with three dimensions visualization. During the operation, without cardioplegia administrated and aortic occlusion, the procedure was completed through right atriotomy. The pleural space was insufflated with carbon dioxide to avoid the air embolism. The direct suturing was used in 22 cases and pericardial patch were used in 18 cases. 9 patients accepted concurrent De Vega tricuspid valve plasty. The transesophageal echocardiography were used to evaluate the result of atrial defect closure or tricuspid valve repair. The operation time, robotic using time and cardiopulmonary time were compared with totally robotic atrial defect repair in arrested heart. Results All cases were accomplished successfully without complication. There was no residual shunt and air embolism. The operation time, robotic using time and cardiopulmonary time were less than the arrested group. Conclusion Robotic atrial septal defect closure or combined tricuspid valve repair on beating heart can avoid aortic ocllusion and can be utilized effectively and safely.