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Objective:To investigate the effect of enhanced recovery after surgery (ERAS) on the surgical treatment of radiation enteritis with intestinal obstruction.Methods:A total of 80 patients with radiation enteritis and intestinal obstruction admitted to the Department of General Surgery, the Eighth Center of Chinese PLA General Hospital from June 2015 to December 2019 were selected and divided into observation group and control group according to the principle of baseline feature matching, with 40 cases in each group.Fourty cases in the control group received conventional surgical treatment combined with conventional rehabilitation intervention, while 40 cases in the observation group received conventional surgical treatment combined with ERAS intervention.According to hemoglobin (HGB), albumin (ALB), prealbumin (PA), transferrin (TRF), the nutritional status of patients in the two groups was compared before and after intervention.According to interleukin-2 (IL-2), interleukin-6 (IL-6), interleukin-8 (IL-8), hypersensitivity C-reactive protein (hs- CRP), tumor necrosis factor-α (TNF-α), the changes of inflammatory factors in the two groups was compared before and after intervention.The immunoglobulin (Ig) A, G and M of the two groups was compared before and after intervention.The postoperative recovery and the incidence of postoperative complications was observed in the two groups.Results:After the intervention, the level of HGB(125.56±11.18) g/L, ALB(42.46±3.95) g/L, PA(0.28±0.03) g/L and TRF(2.60±0.30) g/L in the observation group was higher than that in the control group (102.95±11.12), (36.28±4.25), (0.20±0.05), (2.09±0.27) g/L, respectively, and the differences between the two groups were significant (all P<0.001). After the intervention, the level of IL-2(3.69±0.79) ng/L, IL-6(15.79±7.17) ng/L, IL-8(6.24±1.25) ng/L, hs-CRP(12.51±2.34) ng/L, TNF-α(1.51±0.68) μg/L in the observation group was lower than that in the control group(7.26±1.23) ng/L, (23.82±6.95) ng/L, (9.13±1.71) ng/L, (17.63±2.27) ng/L, (2.02±0.81) μg/L, respectively, and the differences between the two groups were significant ( P<0.001, P<0.001, P<0.001, P<0.001, P=0.003). After the intervention, the level of IgA(1.92±0.63) g/L, IgG(11.36±1.26) g/L, IgM(2.01±0.57) g/L in the observation group was higher than that in the control group (1.62±0.49), (9.58±1.23), (1.60±0.47) g/L, respectively, and the differences between the two groups were significant ( P=0.020, <0.001, =0.001, respectively). In the observation group, the hospital stay(12.1±1.7) d, postoperative ambulation time (1.9±0.6) d and exhaust time (3.1±0.4) d was less than that in the control group(17.2±2.4) d, (2.8±1.0) d, (4.2±0.8) d, respectively, and there were significant differences between two groups(all P<0.001). The postoperative complication rate of 5.0%(2/40) in the observation group was significantly lower than 25.0%(10/40) in the control group (χ 2=6.275, P=0.012). Conclusion:The patients with radiation enteritis and intestinal obstruction treated by conventional surgery were given eras intervention, which improved the nutritional level, immune function and inflammatory stress reaction of the patients, improved the treatment effect of the patients, and shortened the hospitalization time.
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Objective:To explore the clinical effect of intestinal obstruction catheter in patients with tuberculous peritonitis complicated with intestinal obstruction and its influence on inflammatory factors.Methods:Sixty-two patients of tuberculous peritonitis with intestinal obstruction were admitted to the general surgery department of the Eighth Medical Center of Chinese PLA General Hospital from June 2015 to January 2020 in this prospective study.According to the method of digital table, cases were randomly divided into control group and treatment group, 31 cases in each group.The control group was given conventional treatment, while the treatment group was treated with intestinal obstruction catheter on the basis of conventional treatment.The clinical indexes such as abdominal pain relief time, antipyretic time, exhaust time, gas-liquid level disappearance time and hospitalization time were compared between the two groups.According to the levels of C-reactive protein(CRP), Interleukin-6(IL-6), Interleukin-8(IL-8) and Interferon-γ(IFN-γ), the inflammatory stress state of the two groups before and after treatment was compared.The changes of gastrin, motilin, vasoactine intrestinal peptide(VIP) were compared between the two groups before and after treatment.Results:The time to relieve abdominal pain(2.08±1.17) d, the time to reduce fever(3.36±1.89) d, the time to exhaust gas(2.12±1.45) d, the time to disappear gas-liquid level(2.58±1.61) d and the time to stay-in-hospital(9.22±2.13) d in the observation group, and those in the control group were (6.26±2.52), (5.68±2.44), (6.18±2.24), (7.34±2.23), (17.49±3.46) d, respectively.The difference between the two groups was statistically significant( P=0.013, 0.024, 0.035, 0.014 and 0.002, respectively). Before treatment, CRP, IL-6, IL-8, IFN-γ in the control group were (105.62±11.96) mg/L, (657.31±49.67) ng/L, IL-8 (463.53±31.74) ng/L and (47.24±9.66) ng/L , and (106.07±12.03) mg/L, (678.46±51.19) ng/L, (471.68±32.03) ng/L and (46.84±9.28) ng/L in the observation group respectively, and there were no significant differences between the two groups before treatment ( P>0.05). After treatment, CRP, IL-6, IL-8, IFN-γ were (86.25±9.16) mg/L, (373.25±24.18) ng/L, (211.26±20.83) ng/L and (35.42±7.52) ng/L in the control group, and (53.72±7.68) mg/L, (184.27±16.92) ng/L, (82.51±11.35) ng/L and (19.65±3.46) ng/L in the observation group, respectively.After treatment, there were significant differences in the indicators between the two groups ( P=0.021, 0.015, 0.029, 0.011, respectively). There was no difference in the levels of gastrin((180.89±21.17) vs(192.32±21.69) ng/L), motilin((336.73±7.23) vs(357.46±7.29) ng/L) and VIP((102.87±13.49) vs(109.31±13.53)pg/L) between the observation and control group before treatment( P>0.05, respectively). After treatment, the levels of gastrin(65.57±8.72) ng/L, motilin(135.71±14.38) ng/L and VIP(55.07±7.15) pg/L in the observation group were lower than those in the control group((110.35±13.86) ng/L, (231.93±21.95) ng/L, (81.56±10.59) pg/L, respectively), and the differences were statistically significant( P=0.013, 0.021 and 0.014, respectively). Conclusion:Intestinal obstruction catheter can effectively improve the clinical effect, reduce the inflammatory stress response, and promote the recovery of gastrointestinal function in patients with tuberculous peritonitis complicated with intestinal obstruction.
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Objective To evaluate the role of regional chemotherapy via internal iliac artery pump,systemic chemotherapy and total mesorectum excision(TME) in the treatment of rectal cancer.Methods A total of 193 patients with rectal carcinoma divided into 2 groups: The observation group,included 98 cases who underwent TME,regional chemotherapy through internal iliac artery pump and systemic chemotherapy.The other 95 cases,as control group,were treated with systemic chemotherapy after TME.The local recurrence rate,metastasis rate and survival rate were compared between the two groups.Results The local recurrence rate and metastasis rate of the observation group was significantly lower than that of the control group.The local recurrence rate at 1-,3-and 5-year was significantly lower in the observation group[0,2.5%(2/81) and 3.8%(3/79) respectivvely]than that in the control group [1.1%(1/95),11.4%(9/79) and 16.2%(11/68) respectively](P
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0.05).Conclusions Neoadjuvant chemotherapy followed by breast-conserving surgery for stage Ⅱ and Ⅲ breast cancer is safe and can achieve the results of radical operation.Neoadjuvant chemotherapy,strict adherence to standerdize surgical technique and use of postoperative radiotherapy and chemotherapy are crucial to breast-conserving therapy for these patients.
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Objective To evaluate the effects of indigenous staplers on anus-preservation,and postoperative target chemotherapy to prevent local recurrence and distant metastasis of low-situated rectal cancer.Methods 284 patients with low-situated rectal cancer hospitalized during Jan.1990 to Dec.2004 in the Second Affiliated Hospital of PLA General Hospital were treated surgically with indigenous staplers for anus-preservation,interoperative implantation of iliac artery pump and postoperative target infusion chemotherapy.They were followed up for 2~8 years.The clinical data including the result of anus-preservation,local recurrence rate,distant metastasis rate and long-term survival rate were retrospectively analyzed.Results All the 284 patients received anus-preservation operation with successful result.Among them 282 cases(99.3%) undervent the operation once,and the remaining two(0.7%) were operated on twice with success.Control of defecation was good in 247 cases(87.0%),anastomotic fistula occurred in 2 cases(0.7%),stanosis of anastomosis occurred in 1 case(0.4%),and bleeding from anastomotic site occurred in 1 case(0.4%).The follow-up data were completely collected from 236 cases(83.1%).The 1-,3-,5-year local recurrence was found in 2 cases(0.8%),6 cases(2.5%) and 8 cases(3.2%),respectively.The 1-,3-,5-year distant metastasis was found in 11 cases(4.7%),22 cases(9.3%) and 10 cases(4.3%),respectively.The 1-,3-,5-year overall survival rate were 97.0%(229/236),86.0%(203/236) and 65.3%(154/236),respectively.Conclusion The use of indigenous staplers is safe and dependable in operation for anus-preservation in low-situated rectal cancer.Postoperative target chemotherapy may decrease the local recurrence rate and distant metastasis rate,and raise the long-term survival rate as well.
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Objective To investigate the expressions of EphB4 receptor and hypoxia inducible factor 1? (HIF-1?) protein in human primary gastric carcinoma, and to study the biological implication of their expression. Methods The expressions of EphB4 receptor and HIF-1? protein were detected in 74 specimens of human primary gastric carcinoma (gastric carcinoma group) and in 13 normal gastric mucosa tissues (control group) by immunohistochemistry. Correlations between the expression of these proteins, and clinical and pathological features were respectively analyzed. Result High expressions of EphB4 receptor and HIF-1? protein were found to be 62.2% (46/74) and 52.7% (39/74) respectively in gastric carcinoma group, while the expressions of EphB4 receptor and HIF-1? protein in control group were 15.38% (2/13) and 0% (0/13), respectively. The differences were significant between two grrups (P