ABSTRACT
Objective:To analyze food intolerance status in children in Qingdao by detecting the serum levels of food-specific IgG (sIgG).Methods:In this cross-sectional study, a total of 4 249 children aged 0 to 14 years (all were permanent residents of Qingdao City) admitted to Women and Children′s Hospital Affiliated to Qingdao University from May 2017 to December 2020 for suspected food intolerance were selected as the study objects with the whole sampling method. According to the age, the objects were divided into 4 groups: 0-<1 year group (440 cases), 1-<3 years group (1 761 cases), 3-<6 years group (1 193 cases), and ≥6 years group (855 cases). Positive condition of serum sIgG antibodies of 14 kinds of food in the children were detected by enzyme-linked immunosorbent assay. Chi-square test was used to compare the positive rate of the antibodies among different foods, gender and age groups.Results:The total positive rate of food sIgG antibody in 4 249 children was 95.32% (4 050/4 249), the highest positive rate was found in eggs (81.50%) and the lowest positive rate was found in pork (1.15%). The positive rates of sIgG antibody in milk (54.98% vs 49.69%, χ2=11.627), crab (5.59% vs 3.71%, χ2=8.049) and shrimp (4.62% vs 2.75%, χ2=9.784) in boys were significantly higher than those in girls, and the positive rates of sIgG antibody in tomato (49.19% vs 45.54%, χ2=5.510), cod (8.53% vs 5.96%, χ2=10.512) and beef (2.58% vs 1.70%, χ2=3.959) in girls were significantly higher than those in boys (all P<0.05). The total positive rate of sIgG antibody in 14 foods was the lowest in 0-<1 year group (89.09%), and it was the highest in 3-<6 years group (96.98%) ( χ2=63.950, P<0.001). The highest positive rate in 0-<1 year group was found in tomato (56.36%), and it was eggs (85.29%, 88.94%, 85.50%) in all the other 3 groups. The positive rates of corn and beef decreased with age ( χ2=44.098, 20.106, P<0.001), while those of cod and mushroom increased with age ( χ2=32.315, 40.338, P<0.001). The positive rate of wheat (57.13%, χ2=42.273), tomato (57.01%, χ2=209.862), soybean (24.99%, χ2=92.580), crab (6.81%, χ2=33.201), shrimp (6.25%, χ2=47.863) were all the highest in 1-<3 years group among the 4 groups (all P<0.001), and the positive rate of chicken was the highest in 3-<6 years group (7.88%, χ2=29.875; P<0.001). Conclusions:Children in Qingdao have a high level of food intolerance, and the highest positive rate is for eggs. Milk, crab and shrimp should be focused on for boys, while tomatoes, cod and beef shoud be paid more attention to for girls. Children of different ages have different kinds of food intolerance, and their diets should be adjusted reasonably according to the characteristics.
ABSTRACT
Objective:To evaluate the safety and efficiency of a modified double-tract reconstruction procedure─proximal gastrectomy with piggyback interposed jejunal single-channel reconstruction (PJIR-STR) for early SiewertⅡ adenocarcinoma of esophagogastric junction (AEG).Method:Data of 8 SiewertⅡ AEG patients at Shanxi Tumor Hospital and undergoing PJIR-STR from May 2018 to Oct 2019 were retrospectively analyzed. The gastroesophageal reflux disease questionnaire (GerdQ) was used to score the patients at 3, 6, 12, and 18 months after surgery. The severity of postoperative reflux esophagitis was assessed by gastroscopy at 3, 6 months after surgery, using the Los Angeles Classification criteria.Result:All patients recovered well after surgery without serious complications. No obvious gastroesophageal reflux was observed in all patients at different periods (All of the GerdQ scores were <8 points.) The results of gastroscopy showed that 1 patient was diagnosed as grade B reflux esophagitis at 3, 6 months after surgery, which was responsive to conservative treatment, and the other 7 patients had no grade B or above reflux esophagitis.Conclusion:PJIR-STR is a feasible, safe reconstruction with excellent efficiency of dual anti-reflux for the SiewertⅡ AEG.
ABSTRACT
Objective:To investigate the application value of self-pulling and latter transection (SPLT) technique in double anti-reflux double-tract reconstruction of totally laparoscopic proximal gastrectomy.Methods:The retrospective cohort study was conducted. The clinicopatholo-gical data of 103 patients with Siewert type Ⅱ adenocarcinoma of esophagogastric junction in clinical stage Ⅰ-Ⅱ who were admitted to Shanxi Cancer Hospital from January 2018 to January 2020 were collected. There were 65 males and 38 females, aged from 45 to 79 years, with a median age of 59 years. Of 103 patients, 49 cases undergoing totally laparoscopic proximal gastrectomy with double-tract reconstruction of SPLT were assigned into the SPLT group, 54 cases undergoing totally laparoscopic proximal gastrectomy with conventional double-tract reconstruction were assigned into the traditional group. Observation indicators: (1) intraoperative situations; (2) postoperative situations; (3) follow-up. Follow-up was conducted by outpatient examination and telephone inter-view to detect postoperative reflux esophagitis of patients up to December 2021. Measurement data with normal distribution were represented as Mean± SD, and the t test was used for comparison between groups. Measurement data with skewed distribution were represented as M(range) or M( Q1, Q3), and the Wilcoxon test was used for comparison between groups. Count data were described as absolute numbers or percentages, and comparison between groups was performed using the chi-square test. Comparison of ordinal data was analyzed using the non-parameter rank sum test. Results:(1) Intraoperative situations: the operation time, digestive tract reconstruction time, volume of intraoperative blood loss, the number of inferior mediastinal lymph nodes dissected, cases with auxiliary incisions for the SPLT group were (261±48)minutes, (26±4)minutes, (114±42)mL, 8.0(6.5,9.5), 1, respectively. The above indicators were (244±42)minutes, (30±6)minutes, (118±46)mL, 5.5(4.0,8.0), 9 for the traditional group, respectively. There were significant differences in the digestive tract reconstruction time, the number of inferior mediastinal lymph nodes dissected and cases with auxiliary incisions between the two groups ( t=-3.34, Z=-4.05, χ2=4.72, P<0.05). There was no significant difference in the operation time or volume of intraoperative blood loss between the two groups ( t=1.87, -0.47, P>0.05). (2) Postoperative situations: duration of postopera-tive hospital stay and cases with postoperative complications were (11.5±2.7)days and 4 for the SPLT group, versus (12.5±4.3)days and 9 for the traditional group, showing no significant difference between the two groups ( t=-1.47, χ2=1.68, P>0.05). There were 13 of 103 patients with postopera-tive complications, including 5 cases of left pleural effusion, 4 cases of anastomotic leakage, 2 cases of mild pneumonia, 1 case of incision infection, 1 case of chylous leakage. Four patients had anasto-motic leakage at the esophagojejunostomy, the abdominal esophagus of whom was invaded by more than 1 cm. During the operation, mediastinal drainage tubes were placed through the abdominal wall. The 4 patients were cured after enteral and parenteral nutrition support and adequate drainage, and the remaining patients with complications were cured after symptomatic treatment. (3) Follow-up: of 49 patients in the SPLT group, 43 cases were followed up for (18±4)months. During the follow-up, 1 case showed reflux esophagitis by gastroscopy, with the incidence of 2.33%(1/43). Of 54 patients in the traditional group, 53 cases were followed up for (17±4)months. During the follow-up, 4 cases showed reflux esophagitis by gastroscopy, with the incidence of 7.55%(4/53). There was no significant difference in the incidence of reflux esophagitis between the two groups ( χ2=0.47, P>0.05). Conclusions:SPLT technology is feasible for double anti-reflux double-tract reconstruction of proximal gastrectomy. Compared with traditional double-tract reconstruction of totally laparos-copic proximal gastrectomy, SPLT technology can reduce the auxiliary incisions, increase the number of lower mediastinal lymph nodes dissected, and shorten the digestive tract reconstruction time.
ABSTRACT
Along with the changes in the epidemiology of gastric cancer in China, the early diagnosis and treatment rate of adenocarcinoma of esophagogastric junction has elevated signifi-cantly, while its surgical methods have also altered and become a hotspot. Total gastrectomy has become the primary surgical allocation for adenocarcinoma of esophagogastric junction. In recent years, a series of studies on proximal gastrectomy and digestive reconstruction after distal stomach preserving have been explored due to recent concept of functional preservation. The main concern about this surgical method is the efficacy of anti-reflux and its influence on nutritional prognosis. Interpositioned jejunum and double tract reconstruction have curative effects. However, they become obstacles for total laparoscopic surgery due to the complexity of surgical operation. Thus there is increasing concern to explor the way to reduce the reflux rate and improve the nutritional status of patients. Baesd on related research at home and abroad, combined with their own experiences, the authors comprehensively analyze and illustrate self-palling and latter transection with esophagojejunostomy and double anti-reflux double tract reconstruction of total laparoscopic proximal gastrectomy.
ABSTRACT
Objective:To compare the clinical features of patients with acute Vogt-Koyanagi-Harada syndrome (VKH syndrome) of optic disc swelling (ODS) and serous retinal detachment (RD).Methods:A retrospective clinical study. From January 2013 to November 2019, 212 patients with acute VKH syndrome diagnosed in the Department of Ophthalmology of Shanghai Xuhui District Central Hospital were included in the study. Among them, there were 105 males (210 eyes) and 107 females (214 eyes). The average age was 40.84±13.90 years. All affected eyes were examined by BCVA, FFA, and OCT. The standard logarithmic visual acuity chart was used for BCVA examination, which was converted into logMAR visual acuity in statistics. According to the changes in the fundus, the patients were divided into the ODS group and the RD group, 36 patients with 72 eyes (16.98%) and 176 patients with 352 eyes (83.02%), respectively. The independent sample t test was performed to compare the age of onset, visit time and BCVA of the two groups of patients, the χ2 test was performed to compare the count data. Results:Among the 72 eyes of 36 patients in the ODS group, there were 16 males with 32 eyes (44.44%), 20 females with 40 eyes (55.56%). The average age was 40.56±16.57 years, the average visit time was 22.47±19.98 days, the average logMAR BCVA was 0.68±0.53. Among the 352 eyes of 176 patients in the RD group, there were 89 male patients with 178 eyes (50.56%), and 87 female patients with 174 eyes (49.43%). The average age was 40.90±13.34 years, the average visit time was 17.25±24.40 days, the average logMAR BCVA was 0.80±0.56. The average age ( t=-0.116), gender composition ratio ( χ2=0.448), average visit time ( t=1.204), average logMAR BCVA ( t=-1.661) comparisons between the two groups showed no statistically significant differences ( P>0.05). There was no statistically significant difference in the average logMAR BCVA between the RD group and the ODS group of different eyes ( t=0.227, 0.810; P>0.05). There were 50 (69.44%, 50/72) and 272 (77.27%, 272/352) eyes in the ODS group and RD group with inflammation of the anterior segment. There were anterior segment reactions between the two groups. There was no statistically significant difference in the number of eyes ( χ2=1.003, P>0.05). There were 34 (19.32%, 34/176) and 2 (5.56%, 2/36) patients with headache and hearing loss, respectively. The comparison of the number of patients with headache and hearing loss between the two groups showed statistically significant differences ( χ2=4.015, P<0.05). Conclusion:Compared the patients with ODS acute VKH syndrome, the patients with serous RD acute VKH syndrome are more likely to have extraocular symptoms such as headache and hearing loss.
ABSTRACT
Objective:By analyzing the relationship between postoperative pathology and lymph node metastasis of the adenocarcinoma of esophagogastric junction patients to explore the effect of surgical resection and lymph node cleaning scope on prognosis in different Siewert type patients.Methods:A retrospective analysis was made on 350 cases of esophageal gastric junction adenocarcinoma at Tumor Hospital of Shanxi Province from July 2014 to May 2018. Patients clinical data such as lymph node metastasis and tumor diameter, differentiation degree, infiltration depth were studied. The value of the third leg of lymph node cleaning in cardia cancer radical were discussed. Risk factors of lymph node metastasis were analyzed by Logistic regression model.Results:A total of 6 718 lymph nodes were dissected in 350 patients with adenocarcinoma of esophagogastric junction, including 1 613 positive lymph nodes, with a metastasis rate of 24.01%. The metastatic rate of Siewert type Ⅰ lymph nodes was 23.30%, 20.16%, 41.90% and 20.87% in the first, second, third and seventh groups, respectively, which was significantly higher than that of other groups. Siewert Ⅱ and Ⅲ focus on the abdominal cavity. with the increase of tumor infiltration depth, the rate of peripheral lymph node metastasis increased, and the difference was statistically significant ( P<0.01). The rate of lymph node metastasis was 83.1% in the low-differentiation group and 58.4% in the middle-high differentiation group, respectively ( P<0.01). When the tumor diameter ≥4 cm, the rate of lymph node metastasis in the patients increased significantly, and the difference was statistically significant ( P<0.05). The rate of lymph node metastasis at the third station was correlated with the depth of invasion of the gastric wall, the longest diameter of the tumor body, and the degree of differentiation of the tumor. Conclusions:The longest diameter of tumor body, the depth of infiltration and the degree of differentiation are independent risk factors for lymph node metastasis in AEG patients. For patients with type AEG Ⅰ, the mediastinal and lower esophageal lymph nodes should be thoroughly dissected during radical surgery, and the abdominal lymph nodes in groups 1, 2, 3 and 7 should be dissected. The remaining groups may have to be examined for enlarged lymph nodes to determine whether to dissect. For type Ⅱ and Ⅲ patients, splenoprotective total gastrectomy and D 2 lymph node dissection are recommended when the tumor invades the full layer of the gastric wall, the longest diameter ≥4 cm, and the differentiation degree is low.
ABSTRACT
Objective@#To evaluate the clinical efficacy of two different digestive tract reconstruction methods in the Siewert Ⅱ or Ⅲ adenocarcinoma of esophagogastric junction underwent proximal gastrectomy and piggyback jejunal interposition.@*Methods@#A total of 84 patients with Siewert Ⅱ or Ⅲ AEG who underwent proximal gastrectomy and interposition jejunal anastomosis were enrolled prospectively according to the exclusion criteria, from October 2015 to August 2017 at Department of Digestive Minimally Invasive Surgery, Shanxi Cancer Hospital. There were 61 male and 23 female patients, aged 48-69 years with an average age of 59.7 years. They were divided into single-tract reconstruction group (n=41) and double-tract reconstruction group (n=43) according to random number table. Both groups underwent proximal gastrectomy and piggyback jejunal interposition. After side-to-side anastomosis of the remnant stomach and jejunum was performed in the single-tract group, jejunum 3 cm below the anastomosis was ligated or closed. The jejunum in the double-tract group was not treated during the operation. Relevant nutritional indicators were collected at 3 months and 6 months after operation. The data were analyzed by repeated measurement of variance analysis to determine the nutritional status.@*Results@#There was no significant difference in preoperative general condition between single-tract reconstruction group and double-tract reconstruction group (P>0.05). There was no significant difference in perioperative related indicators (P>0.05). Nutritional indicators in single-channel reconstruction group were higher than those in double-channel reconstruction group (hemoglobin: F=23.374, P=0.000; albumin: F=6.149, P=0.003; total protein: F=18.362, P=0.000; weight: F=74.255, P=0.000). The quality of life was compared half year after operation, there was no significant difference in the incidence of subjective symptoms such as reflux, heart burning, nausea and vomiting, dysphagia and sternum discomfort in the two groups (P>0.05), as well as the results of QLQ-STO22 score (27.0±3.8 vs. 27.6±3.3, t=-0.688, P=0.494). The results of gastroscopy showed that the incidence and degree of the two groups were almost the same whether in the incidence of reflux esophagitis (2/41 vs. 2/43, P=1) or in the contrast of reflux degree (Z=-1.528, P=0.127).@*Conclusion@#For patients with type Siewert Ⅱ or Ⅲ esophagogastric junction adenocarcinoma who underwent proximal gastrectomy and piggyback jejunal operation, single tract reconstruction is ideal.
ABSTRACT
Objective To investigate the clinical efficacy of jejunal interposed single-tract and doubletract reconstruction after proximal gastrectomy for Siewert type Ⅱ and Ⅲ adenocarcinoma of the esophagogastric junction (AEG).Methods The prospective study was conducted.The clinicopathological data of 108 patients with Siewert type Ⅱ and Ⅲ AEG who were admitted to the Affiliated Tumor Hospital of Shanxi Medical University between August 2013 and November 2016 were collected.All the patients underwent proximal gastrectomy and were allocated into the 2 groups by random number table,including patients using single-tract jejunal interposition reconstruction in the single-tract group and patients using double-tract jejunal interposition reconstruction in the double-tract group.Digestive tract reconstruction:after end-to-side anastomosis between distal jejunum and esophagus and side-to-side anastomosis between posterior wall of the gastric remnant and jejunum,single-tract jejunal reconstruction was done through ligating jejunum at 3 cm below the anastomotic stoma,and then side-to-side anastomosis between proximal jejunum and jejunum was performed in the single-tract group.Patients in the double-tract group used the same digestive tract reconstruction,but jejunum was not ligated.The postoperative pathological examinations showed that patients with positive lymph nodes or tumor invading all layers of gastric wall underwent chemotherapy.Observation indicators:(1) intra-and post-operative situations;(2) follow-up situations.Follow-up using telephone interview was performed to detect postoperative complication,gastrointestinal function and body mass index (BMI) up to November 2017.Measurement data with normal distribution were represented as-x± s and comparison between groups was analyzed using t test.Measurement data with skewed distribution were described as M (range),and comparison between groups was analyzed using the nonparametric test.Repeated measurement data were analyzed by the repeated measures ANOVA.Comparisons of count data were done using chi-square test.Ordinal data were analyzed by the Kruskal Wallis H test.Results One hundred and eight patients were screened for eligibility,including 55 in the single-tract group and 53 in the double-tract group.(1) Intra-and post-operative situations:total operation time,digestive tract reconstruction time,volume of intraoperative blood loss,time to initial anal exsufflation,postoperative complications,cases with gastroesophageal reflux,intestinal obstruction and Visick grading ＞ Ⅱ and duration of postoperative hospital stay were respectively (145±26) minutes,(30±6) minutes,(181±37) mL,(53± 16) hours,1,1,1,(10.0±2.4) days in the singletract group and (139±29)minutes,(26±3)minutes,(176±31)mL,(50±17) hours,3,0,3,(9.4±l.4)days in the double-tract group,with no statistically significant difference between groups (t =0.725,0.219,0.162,-0.576,x2 =2.960,5.830,t =-0.993,P＞0.05).Four patients with gastroesophageal reflux received motilium and omeprazole therapy for 2 weeks,and were improved by symptomatic treatment such as increasing the solid food intake.One patient in the single-tract group had internal hernia-induced intestinal obstruction and was cured by reoperation.There was no anastomotic leakage,bleeding,infection,dumping syndrome and gallstone between groups.Of 108 patients,71 underwent 6-cycle SOX chemotherapy,including 67 with perigastric lymph node metastasis and 4 with tumor invading all layers of gastric wall.(2) Follow-up situations:108 patients were followed up for 12.0-48.0 months,with a median time of 28.6 months.During the follow-up,bowel sound in the double-tract group and single-tract group was 8 times / minute (range,5-12 times / minute) and 3 times /minute (range,2-5 times/ minute),with a statistically significant difference between groups (Z=-0.692,P＜0.05).The single food intake,serum gastrin level,ratio of serum pepsinogen Ⅰ and Ⅱ levels and BMI from preoperation to postoperative 12 months were from (1 117± 129)mL to (817± 127)mL,from (12±5)pmol/L to (41±13) pmol/L,from 11.3±2.8 to 5.1±2.2,(65±7)kg to (63±5) kg in the single-tract group and from (1 095±118)mL to (783±80)mL,from (10±4)pmol/L to (40±10)pmol/L,from 12.4±2.9 to 4.2±1.3,from (63±6) kg to (58±6)kg in the double-tract group,respectively,with no statistically significant difference in single food intake,serum gastrin level and ratio of serum pepsinogen Ⅰ and Ⅱ levels between groups (F =0.468,0.108,0.161,P＞0.05).There was a statistically significant difference in changing trend of BMI between groups (F=24.930,P＜0.05).Conclusion Jejunal interposed single-tract and double-tract reconstruction after proximal gastrectomy for Siewert type Ⅱ and Ⅲ AEG have the same surgical safety and don't affect secretion function of gastric remnant,but there are frequent bowel sounds and obvious weight loss.
ABSTRACT
Immunotherapy targeted on programmed death 1 (PD-1) and programmed death 1 ligand (PD-L1) has been approved by US Food and Drug Administration (FDA) for the treatment of solid tumors such as melanoma, non-small cell lung cancer and renal cell carcinoma. Preliminary study on the gastrointestinal solid tumor has been carried out, which has shown favorable efficacies and promising application prospect. However, some disadvantages have appeared. This article reviews the progress of immunotherapy for gastric adenocarcinoma.
ABSTRACT
<p><b>OBJECTIVE</b>To evaluate the feasibility and safety of the delta-shaped anastomosis in laparoscopic distal gastrectomy and digestive tract reconstruction.</p><p><b>METHODS</b>Clinical data of 34 gastric cancer patients undergoing laparoscopic distal gastrectomy with the delta-shaped anastomosis for digestive tract reconstruction (delta-shaped group) and 83 gastric cancer patients undergoing laparoscopic distal gastrectomy with Billroth I( for digestive tract reconstruction (Billroth group) by same surgeon team from July 2013 to July 2015 at the Department of Digestive Surgery, Affiliated Tumor Hospital of Shanxi Medical University were retrospectively analyzed. Data of two groups were compared.</p><p><b>RESULT</b>Age, gender, tumor stage were not significantly different between the two groups(all P>0.05). Operation time of the first 15 cases in delta-shaped group was longer than that in Billroth group [(254.7±35.4) min vs. (177.8±33.0) min, t=11.190, P=0.000], while after above 15 cases, the operation time of delta-shaped group was significantly shorter than that of Billroth group [(142.1±14.6) min vs. (177.8±33.0) min, t=-4.109, P=0.001]. Delta-shaped group had less blood loss during operation [(87.1±36.7) ml vs. (194.0±55.1) ml, t=-10.268, P=0.000], and shorter length of incision [(4.1±0.4) cm vs. (6.1±1.0) cm, t=-10.331, P=0.000] than Billroth group. Compared with Billroth group, delta-shaped group presented faster postoperative bowel function return [(2.8±0.6) d vs. (3.3±0.5) d, t=-3.755, P=0.000], earlier liquid food intake [(7.4±1.5) d vs. (8.1±1.7) d, t=-4.135, P=0.000], earlier ambulation [(4.0±1.6) d vs. (6.8±1.4) d, t=-7.197, P=0.000] and shorter postoperative hospital stay [(12.6±1.9) d vs.(13.6±2.0) d, t=-20.149, P=0.000]. Morbidity of postoperative complication was 5.9%(2/34) in delta-shaped group, including anastomotic fistula in 1 case and incision infection in 1 case, and 6.0%(5/83) in Billroth group, including anastomotic fistula, incision infection, anastomotic stricture and dumping syndrome, without significant difference(P>0.05). Difference value of total protein and albumin between pre-operation and post-operation, and average decreased value of total protein, albumin, body weight between pre-operation and postoperative 6-month were not significantly different between two groups(all P>0.05). As for patients with BMI > 25 kg/m, compared to Billroth group, delta-shaped group presented less blood loss during operation [(94.1±36.7) ml vs. (203.0±55.1) ml, t=-10.268, P=0.000], lower injective dosage of postoperative analgesics [(1.9±1.1) ampule vs.(3.3±2.0) ampule, t=-2.188, P=0.032], faster intestinal recovery [(2.9±0.7) d vs. (3.2±0.9) d, t=-3.755, P=0.009], shorter hospital stay [(10.5±1.2) d vs. (11.7±1.5) d, t=-2.026, P=0.004], and lower morbidity of postoperative complication [7.1%(1/14) vs. 13.6%(3/22), χ=4.066, P=0.031].</p><p><b>CONCLUSION</b>In laparoscopic distal gastrectomy and digestive tract reconstruction, the delta-shaped anastomosis is safe and feasible, especially suitable for obese patients.</p>
Subject(s)
Female , Humans , Male , Anastomosis, Surgical , Methods , Blood Loss, Surgical , Comparative Effectiveness Research , Constriction, Pathologic , Epidemiology , Defecation , Digestive System Fistula , Epidemiology , Drinking , Dumping Syndrome , Epidemiology , Gastrectomy , Methods , Gastroenterostomy , Methods , Laparoscopy , Methods , Length of Stay , Operative Time , Postoperative Complications , Epidemiology , Postoperative Period , Recovery of Function , Retrospective Studies , Stomach Neoplasms , General Surgery , Surgical Wound , Surgical Wound Infection , Epidemiology , Treatment OutcomeABSTRACT
Objective To investigate the application value of vessel-guided lymph node dissection (LND) in the laparoscopic distal gastrectomy (D2) of distal gastric cancer.Methods The retrospective crosssectional study was conducted.The clinicopathological data of 157 patients who underwent laparoscopic distal gastrectomy (D2) of distal gastric cancer in the Affiliated Tumor Hospital of Shanxi Medical University from October 2012 to July 2015 were collected.Patients used vessel-guided LND that was divided into 4 steps:middle colic vessel-guided LND in the upper pyloric region,gastroduodenal artery-guided LND in the lower pyloric region,common hepatic artery-guided LND in the right upper margin of pancreas and splenic artery-guided LND in the left upper margin of pancreas.Observation indicators:(1) surgical and intraoperative situations,(2) postoperative pathological results,(3) follow-up situations.Follow-up using outpatient examination and telephone interview was performed to detect the postoperative 3-year survival rate up to June 2017.Measurement data with normal distribution were represented as xes.The survival rate was calculated using the Kaplan-Meier method.Results (1) Surgical and intraoperative situations:157 patients underwent successful laparoscopic distal gastrectomy (D2) of distal gastric cancer.Operation time,LND time,volume of intraoperative blood loss,time for initial out-of-bed activity,time to initial anal exsufflation and time of postoperative abdominal drainage-tube removal were (178± 38) minutes,(61 ± 27) minutes,(87 ± 40) mL,(1.2± 0.4) days,(2.8 ± 1.3) days and (7.5 ± 2.6) days,respectively.Of 157 patients,10 with postoperative complications were improved by conservative treatment,including 5 with intestinal obstruction,3 with anastomotic fistula and 2 dying of pulmonary infection;other patients didn't have complications.Duration of hospital stay of 157 patients was (9±3)days.(2) Postoperative pathological results:total number of LND,numbers of LND in the lower pyloric region and in the upper margin of pancreas were 34.6±11.0,4.8±2.1 and 12.3±4.7,respectively.TNM staging:26,33,18,24,37 and 19 patients were respectively detected in stage Ⅰ a,Ⅰ b,Ⅱa,Ⅱ b,Ⅲa and Ⅲb.(3) Follow-up situations:142 of 157 patients were followed up for 6-56 months,with a median time of 27 months,and postoperative 3-year survival rate was 67.6％.Conclusion The vessel-guided LND is safe and effective in the laparoscopic distal gastrectomy (D2) of distal gastric cancer,and the operation steps can be simplified.
ABSTRACT
Objective To investigate the feasibility and safety of delta-shaped anastomosis in totally laparoscopic distal gastrectomy digestive tract reconstruction of gastric cancer. Methods Clinical data of 26 patients with distal gastric cancer who received total laparoscopic distal gastrectomy with delta-shaped anastomosis from August 2013 to December 2014 were retrospectively analyzed. Results A total of 26 patients were successfully performed by laparoscopic distal gastrectomy with delta-shaped anastomosis. The operative time and delta-shaped anastomosis time was (186 ±28) min and (30 ±24) min respectively. The lengths of upper and lower segment of resection from gastric cancer were (4.9±1.2) cm and (3.5±1.5) cm respectively. Blood loss was (67±39) ml and the number of dissected lymph nodes was (27±11) for every patient. First time to ground activities, first flatus, time to fluid diet and hospital stay were respectively (1.7±0.8) d, (3.5±1.3) d, (4.2±1.6) d and (12±4 ) d. Pathological results showed upper and lower segment of resection cancers were not found. Only 1 patient had gastric small curved stump fistula and recovered after conservative treatment. There were no complications related to the anastomosis in all patients. Conclusion The delta-shaped anastomosis is safe and feasible for totally laparoscopic distal gastrectomy digestive tract reconstruction of gastric cancer with satisfactory short-term efficacy.
ABSTRACT
Objective To explore the application value of circulating tumor cell (CTC) counting in the diagnosis of patients with colorectal cancer.Methods From July to October in 2015,a total of 61 patients firstly diagnosed with colorectal cancer,at stagc] to Ⅳ were enrolled.At the same period,20 individuals (healthy volunteers or patients with benign colorectal diseases) were selected as controls.Peripheral blood (7.5 mL) was taken before therapy.Peripheral blood CTC were counted by immunomagnetic beads enrichment combined with fluorescent staining method in two hours.The positive detection rate of CTC for colorectal cancer,especially early colorectal cancer was analyzed.And the priority of combination it with carcino-embryonic antigen (CEA) was also investigated.Chi-square test,t test and rank-sum test were used for statistical analysis.Results Two patients could not be pathological staged,due to the lack of whole body imaging evaluation.There were 30 patients with colorectal cancer at early stage (stage Ⅰ to Ⅱ) and 29 patients at advanced stage (stage Ⅲ to Ⅳ).The difference in CEA level between patients at early stage and advanced stage ((3.3±1.1) μg/L vs (20.4±3.3) μg/L) was statistically significant (t=-2.74,P=0.008).The median cell number of CTC of colorectal cancer group and control group was 1 (interquartile range=4) and 0,respectively,and the difference was statistically significant (Z=2.721,P=0.007).Taken 0/7.5 mL and 5 μg/L as the cut-off value of CTC and CEA,the detection rates of CTC for colorectal cancer and early colorectal cancer were 65.6％ (40/61) and 63.3％ (19/30),respectively;the detection rates of CEA for colorectal cancer and early colorectal cancer were 29.5 ％ (18/61) and 13.3％ (4/30).When CTC combined with CEA,the detection rates for colorectal cancer and early colorectal cancer were 73.8％ (45/61) and 66.7％ (20/30),respectively.Conclusions CTC has certain detection value in colorectal cancer especially early colorectal cancer.If it combined with CEA,the detection rate is much higher.
ABSTRACT
Background Inflammation is one of the most popular aspects in the studies of diabetic retinopathy (DR) mechanisms.Researches showed that S100A8/A9 participate in the inflammatory procedure of many diseases,however,the relationship between S100A8/A9 complex and retinal inflammation of DR needs to be researched.Objective This study was to detect the serum S100A8/A9 level of diabetes mellitus (DM) and DR patients,and explore its role in DM an DR development.Methods A cases-controlled study was carried out.The DR patients,type 2 DM patients without retinal change and heathy controls were enrolled in Shanghai Xuhui Central Hospital from January to June 2014,and 30 patients for each group.The DR patients were subgrouped to non-proliferative DR (NPDR) group and proliferative DR (PDR) group.The periphery blood was collected to isolate the serum,and serum S100A8/A9 complex level was detected by ELISA.Serum high-sensitivity C-reactive protein (hsCRP) and glycosylated hemoglobin A1C (HbAlc) level was assayed by immunity turbidimetry and immune agglutination respectively.Results Serum S100A8/A9 complex levels in the DR group,DM group and normal control group were (9.74±0.59),(11.41 ±0.64) and (6.46 ±0.62) μg/L,respectively,and the serum S100A8/A9 complex level in the DM group and DR group was significantly higher than that in the normal control group,and the serum S100A8/A9 complex level in the DM group raised in compared with the DR group (all at P＜0.01).Serum hsCRP levels in the DR group,DM group and normal control group were (1.40±0.34),(1.27±0.13) and (1.11 ± 0.12)mg/L,respectively,with the highest value in the DR group and the lowest value in the normal control group (all at P=0.00).The serum HbAlc levels were higher in the DR group and DM group than those in the normal control group (both at P =0.00),while no significant difference was found in the serum HbAlc level between DR group and DM group (P =0.12).There was no significant differece in the serum S100A8/A9,hsCRP and HbAlc levels between NPDR group and PDR group (t=-0.10,P =0.92;t =-0.17,P =0.87;t =0.66,P =0.51).A weak positive correlation was seen between serum S100A8/A9 level and serum hsCRP level (r =0.36,P =0.00).Conclusions As an inflammatory marker,S100A8/A9 complex might play an important role in the pathogenesis and development of DR.Intensive control of glycemia can alleviate retinal inflammation in DM patients.
ABSTRACT
The delta-shaped anastomosis is an emerging operation method in digestive tract reconstruction following total laparoscopic distal gastrectomy (TLDG).With the advantages of small surgical trauma,short anastomosis time and simple manipulation,it has been gradually accepted by surgeons.However,restricted by small manipulation range,restrictive visual range and large anastomotic lumen,there are controversies in complete resection of tumor,intraoperative indexes,postoperative recovery and prevention and treatment of complications about TLDG with delta-shaped anastomosis.In this paper,the operative indications,intraoperative indexes and postoperative recovery of TLDG with delta-shaped anastomosis were reviewed.
ABSTRACT
Objective To analyze the postoperative quality of life index and survival of Ⅱ,Ⅲ type adenocarcinoma of the esophagogastric junction (AEG) patients who were implemented radical surgery through the transthoracic approach or abdominal transhiatal approach.To explore the reasonable operative approach of Ⅱ,Ⅲ type AEG.Methods 139 cases of patients with Ⅱ,Ⅲ type AEG were prospectively enrolled into the group in Shanxi Cancer Hospital during March 2012 to September 2012.64 cases of them were in transthoracic approach (TT) group,and 75 cases in abdominal transhiatal approach (TH) group.The operative time,the residual incision margin cancer rate,the average number of lymph node dissection,postoperative hospital stay,the average number of days required for gastrointestinal function recovery,the incidence of cardiopulmonary complications,anastomotic leakage rate,postoperative bleeding rate,perioperative mortality,postoperative respiratory function decline rate within 1 year,the average weight loss after 1 year,postoperative reflux rate within 1 year,recurrence and metastasis rate within 1 year,and 1-year survival rate of two groups were respectively compared.Results Statistical analysis was done on the perioperative data of 139 patients,and regular follow-up was carried out for these 139 patients after they discharged from hospital,of which 26 cases were lost,the lost rate was 18.7 ％,so the followed-up cases were 113 cases.Postoperative hospital stay in transthoracic approach group was longer than abdominal transhiatal approach group with significant difference,(20.2±8.9) d vs (17.1±6.4) d (P ＜ 0.05),the average number of lymph node dissection in transthoracic approach group (15.2±7.5) was less than abdominal transhiatal approach group (23.0±13.0) with significant difference (P ＜ 0.05).No significant difference were observed in the operative time,the residual incision margin cancer rate,the average number of days required for gastrointestinal function recovery,the incidence of cardiopulmonary complications,anastomotic leakage rate,postoperative bleeding rate,perioperative mortality,postoperative respiratory function decline rate within 1 year,the average weight loss after 1 year,postoperative reflux rate within 1 year,recurrence and metastasis rate within 1 year,and 1-year survival rate of the two operation approaches (all P ＞ 0.05).Conclusions Abdominal approach,through the esophageal hiatus radical surgery is a preferred operative approach of Ⅱ,Ⅲ type AEG.The average number of lymph node dissection in abdominal transhiatal approach group was more than transthoracic approach group.It may have some influence on the prognosis.
ABSTRACT
Objective To study the feasibility and safety of laparoscopy-assisted D2 radical gastrectomy for advanced gastric cancer. Methods From June, 2006 to July 2009, 11 patients with gastric cancer received laparoscopy-assisted gastrectomy for gastric cancer. According to UICC TNM classification of gastric cancer, 6 cases were with Stage Ⅱ, 2 cases with Stage Ⅲ A, 1 case with Stage Ⅲ B, and 2 cases with Stage Ⅳ. Under the assistance of laparoscope, dissociation of the stomach and lymph nodes clearance were performed first; then gastrectomy was performed on a 6 cm incision, samples were collected, and alimentary tract was inoculated. Results Among the 11 cases, 2 cases were performed radical total gastrectomy, 1 case was performed proximal partial gastrectomy, 7 cases were performed distal partial gastrectomy and 1 case with open surgery. The mean operation time: 350 min for total gastrectomy, 320 min for proximal partial gastrectom,266 min for distal partial gastrectomy. The mean number of harvested lymph nodes was 21.3 (11-38), incisal edge was 5.6 (4.0-9.6) cm. The mean time was 72 (36-110) hrs for gastrointestinal function recovery, 59 (26-86) hrs for patients to take general activity, and 76 (48-116) hrs to take liquid food. No complication was observed. Conclusion Laparoscopy-assisted D2 radical gastrectomy for advanced gastric cancer is safe and feasible. Compared with open surgery, it also has the advantages of small wound and fast recovery.
ABSTRACT
Objective To probe into the value of the evaluation of left ventricular myocardial function by two dimensional strain(2DS) for coronary artery disease(CAD) patients with different degrees of left anterior descending(LAD) branch stenosis. Methods Fifty-five eases without myocardial infarction among a total of 72 patients with CAD were divided in to 3 groups based on the extent of LAD stenosis,that was group A(stenosis<50%, n = 24) ,group B(stenosis50% to 75%, n = 19) ,and group C(stenosis>75%, n = 12). Another 17 eases of CAD with myocardial infarction were selected as group D. Strain and strain rate of the whole 11 segments that blood supplied by LAD of all cases were measured with 2DS. Results The 2DS ultrasound showed that the peak strain(S), the peak systolic strain rate(SRs) and the peak early diastolic strain rate (SRE) in all the 11 segments of group A were high and sharp. The above mentioned parameters of group B decreased compared with that of group A, however, there was no statistical significant difference (P >0.05). The S, SRs and SRE of group C cases decreased in some segments compared with that of group A and group B (P< 0.05 or P<0.01). As for group D, the S, SRS and SRE decreased significantly in all segments. In terms of the peak late diastolic strain rate (SRA), there were no statistical significant differences among group A,B and C (P>0.05). While in group D cases, the SRA decreased markedly. The SRE/SRA was more than 1 in group A. However, in group B, C and D cases, the SRE/SRA were all less than 1. Conclusions 2DS can sensitively reflect the decrease of regional myocardial systolic and diastolic function caused by the reduction of perfusion,and it may be beneficial to find myocardial ischemia for patients as early as possible.
ABSTRACT
Objective To probe into the characteristics of strain and strain rate in different time points of coronary artery disease (CAD) patients before and after the improvement of myocardial ischemia, to evaluate the value of two-dimensional strain (2DS) imaging in assessing curative effect of CAD patients. Methods The changes of strain and strain rate in local lesion segments before revascularization,and one week,one month and three months after revascularization of 24 CAD patients accepting revascularization therapy were detected by 2DS. Results Before revascularization treatment,the outlines of strain-time curves and strain-rate-time curves of lesion segments of CAD patients in whole cardiac circle were cluttered. The peak strain (S),the peak systolic strain rate (SRS) and the peak early diastolic strain rate (SRE) were low and calm. The peaks of strain-time curves in some segments of CAD patients were inverted. One week after treatment,the S, SRS,SRE and the peak late diastolic strain rate (SRA) of lesion segments of CAD cases elevated to certain extent. However, there were no statistical significant differences between them (P0.05). One month after treatment,the S and SRE of lesion segments of CAD patients elevated significantly compared to that of before the treatment (P<0.01). Three months after treatment,the outlines of strain-time curves and strain-rate-time curves of lesion segments of CAD patients trended to be regular,and the S, SRS, SRE and SRA elevated markedly compared to that of before treatment (P<0.01). There were statistical significant differences in terms of the S, SRS and SRA compared to that of one week and one month after treatment (P<0.01). Conclusions 2DS can evaluate the strain and strain rate non-invasively and quantitatively at different time points after revascularization of CAD patients. And it can evaluate regional myocardial systolic and diastolic function for CAD patients.
ABSTRACT
In order to clarify the limitative factors in the management of severe acute pancreatitis (SAP) especially the problems of the complicated multiple organ failure (MOF),70 cases of SAP,of which 17 were complicated with MOF,admitted to our hospital in the past 16 years were reviewed.The overall mortality rate of the series was 20.0% (14/70),and the death of 12 cases out of the 14 was associated with MOF (85.7%) and that of the other 2 with single organ failure (14.3%).MOF occurred in 17 cases with a mortality rate of 70.0%.Two patterns of MOF manifestations identified:A rapid single-phase of MOF was found in 7 cases.It developed rather early after the onset of SAP and was associated with severe pancreatic necrosis and early shock.And a delayed two-phaseof MOF was seen in 10 cases.It developed progressively with a lagging interval and from the pancre-atic necrosis and subsequent infection.The clinical manifestations of MOF were characterized by a severe and systemic inflammatory response.It is believed that the systemic inflammatory response trigged by the septic material released from the pancreatic necrotic focus seems to be the pathological channel to link SAP with MOF.