ABSTRACT
Objective:To study the relationship between gastric fundus size and postoperative gastroparesis and to find effective ways to prevent postoperative gastroparesis in high-risk patients.Methods:We retrospectively reviewed the clinical data of 276 gastric cancer patients undergoing radical gastrectomy from 2015 to 2016. The gastric fundus volume/total gastric volume (FV/TV) ratio was measured by computed tomography (CT) and comparative study between the gastroparesis group and the non-gastroparesis group was carried out in terms of postoperative gastroparesis. Receiver operating characteristic (ROC) curve analysis was used to evaluate the predictive performance. Single-factor and multiple-factor analyses were performed to filter clinically significant predictive factors of gastroparesis. Then, we increased the sample size to 304 patients whose FV/TV ratio was >19.4%. The different surgical methods and perioperative management of these patients were analysed. The chi-square test and logistic regression analysis were performed to identify effective independent factors for preventing gastroparesis.Results:The FV/TV ratio in the gastroparesis group was significantly higher than that in the non-gastroparesis group ( P<0.05). A cut-off value of 19.4% was selected by ROC curve analysis, at which the FV/TV ratio had a sensitivity of 76.2% and a specificity of 53.7%. In 304 patients in the second retrospective study, the incidence of gastroparesis was 9.2%. Gastroparesis was significantly reduced in patients with residual gastric size <1/3 ( P<0.05) and early postoperative gastrointestinal decompression ( P<0.05). Conclusions:The FV/TV ratio can effectively predict the risk of postoperative gastroparesis preoperatively. Small residual stomach and early postoperative gastrointestinal decompression are effective measures to prevent gastroparesis in high-risk patients.
ABSTRACT
Objective@#The purpose of this study is to explore the method and effect of autogenous costal cartilage combined with polytetrafluoroethylene in comprehensive rhinoplasty.@*Methods@#Among the 519 included cases, 441 cases underwent primary rhinoplasty, and 78 cases underwent revision after initial rhinoplasty. The 6th or 7th costal cartilage, with 4-5 cm in thickness, was taken to make a columella supporting graft, a nasal septum extension graft, a lateral foot support graft, and a nose tip shield graft. The nasal shape is corrected by the reconstruction of nasal tip supporting structure. Polytetrafluoroethylene was used as a nasal dorsal graft.@*Results@#After 3-24 months of follow-up, 510 patients received satisfactory nasal tip and nasal dorsum esthetics. One patient had a prosthesis removement one year after surgery. Eight cases showed a decrease in nasal tip excursion 2-6 months postoperatively, with reduced nasal tip prominence. However, satisfactory results obtained, after further correction 6 months later.@*Conclusions@#The combination of autogenous costal cartilage and polytetrafluoroethylene for rhinoplasty is an appropriate surgical procedure for Chinese.
ABSTRACT
Pancreatic ductal adenocarcinoma is a highly aggressive disease with a grim prognosis. Surgical resection offers the best chance for long-term survival. Negative-margin resection still remains the goal, the influence of margin status on outcomes in pancreatic head carcinoma remains controversial, as conflicting data have been plagued by a lack of standardization in R0 resection and margin definitions, pathologic analysis, and reporting. In contrast to common belief, a high rate of R1 resections in pancreatic cancer is not a marker of low-quality surgery but rather of high-quality pathology. The international pathological consensus of pancreatic head carcinoma is still needed to fully understand the prognostic value of margin status in order to optimize treatment strategy for this disease.