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Objective To discuss the correlation between histological evaluation of primary lesions and prognosis of gastric cancer patients treated with neoadjuvant chemotherapy.Methods A total of 117 patients with stage Ⅱ-Ⅲ gastric cancer who received neoadjuvant chemotherapy in our hospital from January 2006 to December 2012 were enrolled.All patients received 2 courses of neoadjuvant chemotherapy and underwent CT,gastrointestinal radiography or endoscopic examination to evaluate the response to neoadjuvant chemotherapy,and the histochemical staining results of the surgical specimens were also used for chemotherapy responsive validation.Kappa (κ) coefficient was used to analyzed the consistency of different evaluation methods for chemotherapy reactivity.The 5-year survival rate was used for compared the effective assessments in three different approaches.Results There were 38 cases (32.5％),78 cases (66.7％) and 43 cases (36.8％) were considered to be CT,gastrointestinal radiography or endoscopic examination and histologic responders,respectively.Histological evaluation of primary lesions was less correlated with CT,gastrointestinal radiography or endoscopic evaluation (κ values were 0.10 and 0.19 respectively).Based on CT evaluation,the median survival time of patients with chemotherapy response was longer than 60 months,and the median survival time of patients without response was 43 months,and the difference was not statistically significant (x2 =2.978,P =0.076).Based on gastrointestinal radiography or endoscopy evaluation,the median survival time of patients with chemotherapy response was longer than 60 months,and the median survival time of patients without response was 29 months,and the difference was not statistically significant (x2 =1.230,P =0.239).Based on histological evaluation,the median survival time of patients with chemotherapy response was longer than 60 months,and the median survival time of patients without response was 18.5 months,and the difference was statistically significant (x2 =29.020,P ＜ 0.001).Multivariate Cox regression analysis showed that nonrespond of adjuvant chemotherapy under histologic evaluation (HR =4.021,95％ CI:1.548-8.767,P =0.002) and non-respond of gastrointestinal radiography or endoscopic examination (HR =8.210,95％ CI:4.333-17.980,P ＜ 0.001) were independent risk factors for poor prognosis in patients with gastric cancer,and intestinal gastric cancer (HR =0.241,95％ CI:0.080-0.871,P =0.019) was an independent predictor of survival improvement in patients with gastric cancer.Conclusion The degree of neoadjuvant chemotherapy response assessed by histological evaluation of primary lesions can effectively predict the long-term survival outcomes for gastric cancer patients.
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Objective To investigate the application value of pancreatic duct guide wire and transpancreatic septotomy with precutting technique in difficult endoscopic retrograde cholangiopancreatography.Method258 patients who underwent difficult endoscopic retrograde cholangiopancreatography from April 2014 to April 2016 were selected as study subject, 128 patients among them received the technique of pancreatic duct guide wire, the other 130 patients received transpancreatic septotomy with precutting techniques. The success rate, intubation time and incidence of complications were compared between these two methods for cannulation.Result There was no signiifcant difference in preoperative clinical data between the two groups, the success rate did not differ signiifcantly between the two groups (93.75 % vs 93.85 %). Compared with transpancreatic septotomy with precutting techniques group, pancreatic duct guide wire group is less intubation time consuming (5.92 ± 0.69 vs 12.81 ± 3.67) min, the difference was statistically significant (t = -2.27,P < 0.05). 25 patients experienced complications, with 6 cases of acute pancreatitis, 2 cases of biliray tract infection in pancreatic duct guide wire group, and 8 cases of acute pancreatitis, 3 cases of hemorrhage,6 cases of biliray tract infection in transpancreatic septotomy with precutting techniques group. The pancreatic duct guide wire group had a signiifcantly lower incidence of complications (6.25 % vs 13.08 %). the difference was statistically signiifcant (χ2 = 3.27,P < 0.05). The incidence of acute pancreatitis did not differ signiifcantly between the two groups (4.69 % vs 6.15 %).ConclusionsPancreatic duct guide wire and transpancreatic septotomy with precutting techniques both can further improve the success rate of bile duct cannulation with ERCP. The incidence of acute pancreatitis did not differ significantly between two groups. But pancreatic duct guide wire group is less intubation time consuming, and had a significantly lower incidence of complications. Because of the convenience and safety of the pancreatic duct guide wire technique, and the insertion of the pancreatic duct does not increase the risk of postoperative acute pancreatitis. We think that this method is more worthy of Clinical promotion.
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Objective To determine the effectiveness and safety of endoscopic botulinum toxin injection versus pneumatic dilation in treatment of achalasia.Methods A systematic review of all the relevant randomized controlled trials was performed according to international Cochrane Collaboration.Results Twelve trials involving 559 patients were included in the systematic review.Meta analysis showed:(1)Pneumatic dilation was superior to botulinum toxin injection in short term symptom relief(83.21% VS 71.27%.P=0.0007);(2)It was also superior to botulinum toxin injection in long term symptom relief(54.59% vs 27.60%,P=0.005);(3)The recurrent rate is lower in botulinum toxin injection than in pneumatic dilation(55.66% vs 18.84%,P<0.0001);(4)There were more side-effects and complications in pneumatic dilation than in botulinum toxin injection(13.01% VS 1.35%,P=0.0008).Conclusion The limited current evidence showed that endoscopic botulinum toxin injection and pneumatic dilation are safe and effective in the short term treatment for achalasia.Pneumatic dilation is more effective than endoscopic botulinum toxin injection in the long term treatment for achalasia.