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Objective:To investigate the cause, treatment, and prognosis of delayed hemorrhage in patients who underwent radical gastrectomy. Methods:The clinical data of 294 patients who underwent radical gastrectomy in the Second Hospital Affiliated from Nanchang University from January 2015 to October 2015 were retrospectively analyzed. Results:A total of 15 patients suffered from delayed hemorrhage and accounted for 5.1%of the gastric cancer cases in our hospital for the same period of radical gastrectomy. Of the 15 patients, 9 underwent laparoscopic radical gastrectomy and 6 received open radical gastrectomy resection. Large vascular hemorrhage was found in 7 cases. Anastomosis and anastomotic ulcer induced hemorrhage were observed in 3 cases. Duodenal stump rupture induced hemorrhage was detected in 2 cases. Hemorrhage was also observed in some parts in 2 cases. Likewise, hemorrhage occurred in 1 case, but the affected parts were unknown. Of the 11 patients who underwent a second operation, 2 were subjected to digital subtraction angiography (DSA) and transcathete arterial embolization (TAE) to stop hemorrhage. Endoscopic hemostasis was performed to stop hemorrhage in 1 case. Conservative treatment was administered to stop hemorrhage in 1 case. The secondary surgery rate was 73.3%(11/15) with mortality and curative rates of 40%(6/15) and 60%(9/15), respectively. Conclusion:For delayed hemorrhage after D2 of gastric cancer, a second radical surgery and death rates were high. Therefore, patients suffering from hemorrhage should be subjected to comprehensive clinical treatment and positive measures. Major vascular bleeding, anastomotic leakage, anastomotic ulcer, and duodenal stump rupture are relevant risk factors. Anastomotic fistula and celiac artery bleeding complications caused hemorrhage is the leading cause of death. Extensive bleeding and unstable vital signs should be checked. A second operation and abdominal drainage should also be timely conducted to as effective methods. Realistic and conservative treatment can be administered to patients with stable vital signs and low amount of blood loss. Endoscopic hemostasis can be applied to alleviate simple anastomotic ulcer bleeding. DSA can be initially performed to detect unknown bleeding sites. TAE can be subsequently used to treat hemorrhage.
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Japanese gastric cancer treatment guidelines list options for treatment of each stage of early gastric cancer (EGC).The treatment of EGC is closely related to the lymph node metastasis, and the accurate prediction of lymph node metastasis is related to the choice of the treatment options and the prognosis of the patients.The lymph node metastasis of EGC is evaluated according to the clinicopathological factors, imaging,molecular markers and sentinel lymph node (SLN) tracer biopsy.A two-step method for the management of EGC treated with endoscopic mucosal resection/endoscopic submucosal dissection (EMR/ESD) is recommended.While for those EGC patients not suitable to receive EMR/ESD, imaging or molecular marker and SLN tracer biopsy technology are applied to determine lymph node status.
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D2 radical gastrectomy is widely accepted as surgical procedures for the resectable gastric cancer.However,cancer recurrence and five-year survival rate after radical resection are not satisfactory,and the surgical procedures should be further improved.En bloc mesogastric excision (EME) is one of the new attempts to change the status based on the embryoloical and anatomical understanding of mesogastrium.
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Laparoscopic spleen-preserving splenic hilar lymphadenectomy (LSPL) is a operation conducted experimentally in the current. Current reports showed that it can be safely completed through different approach, such as the right, left, medial and retropancreatic approach. This paper summarized the steps and characteristics of different approaches LSPL and compared the differences between each other. The application status of LSPL in laparoscopy-assisted radical gastrectomy were reviewed. The security, feasibility and the problem to be solved of LSPL, improvement measure also be explored in this paper.
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Humans , Gastrectomy , Methods , Laparoscopy , Lymph Node Excision , Methods , Lymph Nodes , Spleen , Stomach Neoplasms , General SurgeryABSTRACT
<p><b>OBJECTIVE</b>To evaluate the effect of body mass index (BMI) on postoperative short-term outcomes of laparoscopy radical gastrectomy by meta-analysis.</p><p><b>METHODS</b>A literature search was performed in PubMed, EMBASE, Cochrane Library databases, CNKI, and CBM, Wanfang database to screen clinical trials published before October 2014 that compared short-term outcomes between high BMI and low BMI patients undergoing laparoscopy radical gastrectomy. RevMan 5.2 was used to perform the meta-analysis. Begg's and Egger's tests were carried out with Stata 12.0 software to evaluate the publication bias of enrolled literatures.</p><p><b>RESULTS</b>Twelve studies involved a total of 4798 gastric cancer patients after laparoscopy radical gastrectomy. There were 1215 patients in high BMI group(BMI≥25 kg/m2) and 3583 patients in the low BMI group (BMI<25 kg/m2). Compared with the low BMI group, the high BMI group were associated with longer operation time (SMD=0.64, 95%CI:0.35-0.93, P=0.000), more intraoperative blood loss(SMD=0.63, 95%CI:0.24-1.03, P=0.002), less retrieved lymph nodes(SMD=-0.44, 95%CI:-0.72--0.17, P=0.002), and more postoperative complications(OR=1.44, 95%CI:1.19-1.74, P=0.000). There were no significant differences in postoperative hospital stay, the time to first flatus and initial complication(P>0.05).</p><p><b>CONCLUSION</b>The higher BMI may result in a longer operation time, more intraoperative blood loss and a higher rate of postoperative complication after laparoscopy radical gastrectomy.</p>
Subject(s)
Humans , Blood Loss, Surgical , Body Mass Index , Gastrectomy , Laparoscopy , Length of Stay , Lymph Nodes , Operative Time , Postoperative Complications , Postoperative Period , Stomach Neoplasms , Treatment OutcomeABSTRACT
<p><b>OBJECTIVE</b>To systemically assess the feasibility and safety of complete mesocolic excision (CME) for colon cancer.</p><p><b>METHODS</b>A computer-based online research of prospective, randomized or nonrandomized, controlled studies addressing CME versus traditional surgery published in the last five years was performed in electronic databases (Wanfang Database, China National Knowledge Infrastructure, Chinese Medical Current Contents, VIP, PubMed, Medline, Ovid, Elsevier, ISI Web of Knowledge, Cochrane Database of Systematic Reviews). With strictly screening according to the standard, the quality of studies was evaluated. Selective trials were analyzed by the Review Manager 5.1 software.</p><p><b>RESULTS</b>A total of eight nonrandomized clinical trials, involving a total of 1209 patients (615 patients in CME group and 594 patients in control group), were identified. Meta-analysis showed that the intraoperative blood loss in CME group was less than that in control group [WMD=-13.05, 95%CI:-25.03 to -1.07, P=0.03]. No significant difference in the operation time was found [WMD=0.46, 95%CI:-26.50 to 27.41, P=0.97], and significant differences in the number of lymph node retrieved from postoperative pathologic specimens, the average length of large bowel resected, the area of mesentery resected, and the high vascular ligation were revealed between two groups. Besides there were no significant differences in the time to first flatus and the hospital stay between two groups (P=0.87, P=0.05). The postoperative complication morbidity did not increase in CME group as compared to control group (P=0.74).</p><p><b>CONCLUSION</b>CME is safe and effective in accordance with the concept of embryonic anatomy, oncological surgery and delicate surgery, and is expected to become a standardization operation method for colon cancer.</p>
Subject(s)
Humans , Clinical Trials as Topic , Colonic Neoplasms , General Surgery , Feasibility Studies , Mesentery , General SurgeryABSTRACT
OBJECTIVE To investigate the resistance status of pathogens from surgical incision infection.METHODS The secretion of infected wounds was cultured to detect pathogens by routine methods from Jan 2001 to Dec 2006.The identifications and antimicrobial-susceptible tests of pathogens causing incision infection were determined by Full Automated Analyzer.All data were analyzed retrospectively.RESULTS A total of 246 pathogen strains were cultured from the secretion of surgical incision infection in 6 years,of which Gram-negative bacilli,Gram-positive cocci and fungi accounted for 57.7%,34.1% and 8.2%,respectively.The first place of isolates was Escherichia coli,followed by Staphylococcus aureus,Pseudomonas aeruginosa,Klebsiella pneumoniae,Acinetobacter baumannii,etc.74.5% of S.aureus isolates and 83.3% of S.epidermidis isolates were resistant to oxacillin.45.1% of E.coli of the isolates and 35.0% of isolates of K.pneumoniae were extended-spectrum ?-lactamases producing.Almost all of the detected resistant strains showed serious multiple resistance.Vancomycin and imipenem still had better activity for antimicrobial multiple resistant bacteria.CONCLUSIONS Surgical incision infection is serious.Infection surveillance should be taken to control surgical infection.Pathogens infected surgical incision are multi-resistant to antibiotics.
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Objective To investigate the diagnosis and treatment of gastric stromal tumor(GST). Methods Retrospective analysis was made on the clinical data of 18 cases of GST. The diagnosis of 18 cases was confirmed by pathology. Local resection of the tumor was performed in 2 cases,partial gastrectomy in 5 cases, subtotal gastrectomy in 9 cases, and total gastrectomy with lymph node clearance in 2 cases. Results Most of the patients were over forty years old.In 55.5% of cases,the location of tumor was at the middle of the stomach,and 61.0% of cases were intragastric growth type.The preoperative diagnostic rate was 27.8%,misdiagnostic rate was 72.2%.The resectability rate was 100%. No postoperative complications and operative death occurred in this series. Fifteen cases were followed up for 1 to 10 years. During follow up,2 cases died of recurrence of the tumor, and the other patients were still alive. Conclusion The GST patients lack typical clinical manifestations, and the preoperative diagnosis is difficult.Barium meal examination and gastroscopy are the main supplementary examinations.A combination of histological and immunohistochemical examinations is helpful to confirm the diagnosis.Surgical resection is the only effective therapeutic method.
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Objective To compare of the effect of portaazygous devascularization(PADV) and combination operation(splenorenal shunt plus portaazygous devascularization)on the treatment of esophageal variceal bleeding(EVB).Methods 28 cases of EVB admitted from October 1995 to October 2000 were divided randomly into two groups:(1)PADV group (14 cases);(2) combination operation(14 patients).The free portal pressure(FPP) and portal veinous flow(PVF)were measured intraoperatively; and pre and post-operative barium meal and therapeutic effect between 2 groups were compared.Results The average value of FPP of PADV group and combination operation group reduced (4.81?7.26)cmH 2O and (10.03?2.66)cmH 2O respectively after operation, there were significant difference (both P