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Objective To determine the relationship between preoperative plasma D-dimer level and the lymphnode metastasis characteristics in colorectal cancer patients.Methods A total of 106 patients with colorectal cancer were studied in order to evaluate this relationship.Their preoperative plasma D-dimer levels were measured.Results were correlated with the clinicopathological findings.Results Significantly different plasma D-dimer levels were found with respect to histologic N(P ＜ 0.001).The number of lymph node metastases was found to have the strongest association with D-dimer level among the significant clinicopathologic factors (Spearman rank correlation,P ＜0.001).The most useful cutoff of the plasma D-dimer levels for diagnosis of lymph node metastasis was determined to be 0.4 μg/mL.Conclusion Plasma D-dimer levels can help assess lymph node metastasis in patients with eophageal cancer and should be measured preoperatively.
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Objective To discuss the effect of the interval between neoadjuvant therapy and surgery on downstaging for local advanced rectal cancer.Method s From May 2003 to December 2008 as earlier period,32 patients with clinical stage T3 or T4 rectal cancer received neoadjuvant therapy followed by surgery after 4 -6 weeks.From January 2009 to December 2010 as later period,21 patients with clinical stage T3 or T4 rectal cancer received neoadjuvant therapy followed by surgery after 8 weeks.Dworak classification,TNM stage and clinical outcome after surgery were compared between two group paitents.Results All patients with local advanced rectal cancer received R0 resection.No surgical complications and mortality were observed in all cases.Pathological results showed that 0 and 2 cases were Dworak classification Ⅳ,5 cases were Dworak classification Ⅲ,3 and 6 cases were Dworak classification Ⅱ and 24 and 8 cases were Dworak classification Ⅰ in earlier period and later period,respectively (x2 = 9.109,P = 0.028).The postoperative staging showed that 6 and 13 cases were ypT1N0M0,22 and 6 cases were ypT2N0M0,1 case was ypT3 N0M0,3 and 1 cases were ypT3N1 M0,respectively (x2 = 10.909,P = 0.012).There were 65.6% or 81.0% cases reserved anus in earlier period and later period,respectively(x2 = 1.468,P = 0.226).Conclusions The neoadjuvant therapy followed by surgery after 8 weeks is associated with a more significant downstaging effect for local advanced rectal cancer.However,the effect of an extended interval between neoadjuvant therapy and surgery on clinical outcome still needs further investigation.
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Objective To evaluate the existence of occult peritoneal metastasis,Douglas′ pouch biopsy was undertaken intraoperatively in patients with gastric cancer. Methods From April 1998 to August 1999, Douglas′ pouch biopsy was performed in 16 cases of gastric cancer during laparotomy in which obvious distant peritoneal metastasis was not found by inspection or palpation.[WT5”HZ] Results Occult peritoneal metastasis in Douglas′s pouch was established in 5 out of the 16 cases,while the invasion depth of primary tumor were all under S stage category and the numbers of regional lymph node metastasis were 7 and up.Conclusion[WT5”BZ] At stages when gastric cancer invaded the visceral serosa, peritoneal biopsy in Douglas′ pouch must be performed as routine procedure in order to detect occult distant peritoneal metastasis.
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or ≤50 in each patient. 5-year survival curves were estimated with the Kaplan-Meier method and compared by the log-rank test. ResultsWT5”BZ Analysis revealed that among node-negative patients, the 5-yerar's survival rate was 23% higher in patients with more than 50 nodes removed than those with less than 50. For node-positive patients, the difference of 5-year′s survival rate between the related two subgroups reached 36%.WT5”HZConclusion The number of lymph node resected has great impact on the long term survival of patients with colorectal cancer.
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Objective In this study we reported our experiences for patients with unresectable advanced hilar cholangiocarcinoma by intracavitary irradiation therapy and discussed some problemsin practice.Method 15 cases with unresectable advanced hilar cholangiocarcinoma were treated with laparotomy and operative dilatation of malignant stenosis and cathetenizing and then followed by intracavitary irradiation therapy.Result 15 cases treated by intracavitary irradiation therapy diedfrom liver function failure with biliary cirrhosis 3～18 months (average 8 months) later. None of the case died from cancer dissemination. Conclusion The patients with advanced holar cholangiocarcinoma could well tolerant of the intracavitary irradiation therapy, but they deteriolated from biliary cirrhosis about 8 months later,not from tumor dissemination.
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Objective To investigate the effects of 7 5% hypertonic saline (HS) on fluid balance after elective major abdominal surgery Methods Twenty two patients undergoing elective major abdominal surgery were assigned to receive either Ringer lactate solution followed by 4 ml/kg of 7 5% HS (study group, n =11) or Ringer lactate solution (control group, n =11) during the early postoperative period in ICU We compared fluid infusion volumes and urine outputs, fluid balance, and body weight change between the 2 groups Results Urine outputs in the operative day and the first postoperative day in study group were significantly more than in control group [(2?650?531)ml vs (2?046?572)ml, t =2 551?7, P
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Objective To study the relation between the surgical extent and number of lymph node dissection and the effect of metastatic lymph node number on the prognosis of proximal gastric cancer. Method Thirty-one patients with proximal gastric cancer underwent D_2 or D_3 operation, and lymph node were harvested from specimen. The number of lymph node dissection in proximal gastrectomy was compared with that in total gastrectomy. Results A total of 1971 lymph nodes were obtained from the 31 specimens, the mean was 63 per case. There were 57 lymph nodes per case for patients with proximal gastrectomy and 71 per case with total gastrectomy,64 per case with left half pancreaticosplenectomy and 63 per case with splenectomy. According to the new 5th N stage system, the 5 year survival of N_1,N_2,N_3 were 36%, 11%, and 0 respectively. Conclusion Along with the wide invasion of the carcinoma wide resection with extended lymph node dissection is mandatory, reserved left half of the pancreas has no influence on the number of harvested lymphnode, the new quantitative N staging is superior to the old in predicting the prognosis.
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Objective To sum up the experience of diagnosis and management of postoperative abdominal bile collection of biliary fluid .Methods Analysis of 36 cases admitted in our department with postoperative abdominal biliary fluid collection were studied and treated in our department.Clinically,these cases can be divided into three groups according to their manisfestation,including asymptomatic cases,acute diffuse peritonitis and cases with obscure clinical course.The clinical feature and morbidities of these three groups were compared.Result The morbidities of cases detected collections of biliary fluid and managed in time were significant lower than that of the cases detected and managed out of time.Conclusions Clinically postoperative collection of abdominal biliary fluid might be divided into asymptomatic cases,acute diffuse peritonitis and cases with obscure course by us,it is for the sake of early diagnosis and immediate management.The diagnosis in time and immedate aspiration or drainage will save the patient from adverse morbidities.
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Objective To sum up the experience on the diagnosis and treatment of abdominal compartment syndrome(ACS). Methods In this report, ACS was diagnosed by special clinical features in all 5 patients. Following emergency decompressive celiotomy, the abdominal viscera were covered with a 3 L sterile plastic bag for nutrition support. Results The first case died despite abdominal decompression through uper midline incision. 4 cases underwent decompressive celiotomy through incision from xiphoid to symphysis, one died postoperatively. The overall mortality in this series was 40% (2 / 5). Conclusions Close attention paid to the abdominal and systemic signs facilitates the diagnosis of ACS.Emergent decompressive celiotomy through a incision from xiphoid to symphysis is effective in treating ACS. Temporary abdominal closure could be fulfiled with 3L sterile plastic bag for nutrition support.
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ObjectiveTo analyze the cause of and the prevention for the postoperative complications in adult patients undergoing Lichtenstein herniorrhaphy for inguinal hernia. Methods Retrospective review was made on 334 inguinal hernia cases receiving Lichtenstein repair in our hospital. Results Recurrence was found in 1 case(0 3%). Significant postoperative pain occurred in 5 patients. Four cases (1 2%) suffered from superficial wound infection, and 5 cases(1 5%) were complicated with subcutaneous seroma. Conclusions Lichtenstein′s tension free repair for the treatment of adult inguinal hernia has the advantage of less postoperative pain and low recurrence.
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Objective To explore the relationship between the histological alterations of Oddi sphincter lesions and clinical manifestations. MethodsFrom October 1995 to May 2003, biopsies of Oddi sphincter were undertaken during transduodenal sphincteroplasty (TSP) in 32 cases. Specimens were stained with Van Gieson Mason staining. ResultsThirty one out of 32 specimens were found with histological alterations in Oddi sphincter including diffuse fibrosis in 87 1% (27/31) , adenomyosis in 2 cases and chronic inflammatory infiltration in 2 cases. Impacted stone in the terminal common bile duct, benign papillary stenosis and visible postpancreatitis parenchymal changes were all found accompanying severe fibrosis of Oddi sphincter. ConclusionIn patients with impacted stones in the ampulla, intracholedochal sludge with recurrent cholangitis, and relapsing pancreatitis, endoscopic sphincterotomy is recommended.