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With the popularization of health awareness and the progress of gastroscopy, the proportion of early gastric cancer is increasing year by year in China. Early gastric cancer has a good prognosis and long-term survival time. Improving postoperative life quality of patients with early gastric cancer will become one of the key directions of gastric cancer research. Therefore, on the premise of ensuring radical tumor treatment, function-preserving gastrectomy for the purpose of improving patients′ quality of life has become a hot topic in early gastric cancer. In recent years, with the deep study on the rule of lymph node metastasis in gastric cancer, the application extent of function-preserving gastrectomy has gradually expanded to advanced gastric cancer. Function-pre-serving gastrectomy includes segmental gastrectomy, proximal gastrectomy and local gastrectomy. The authors summarize important research progress of function-preserving gastrectomy at home and abroad and their own practical experience in recent years, aiming to provide references for clinical surgeons to carry out function-preserving gastrectomy.
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The incidence of adenocarcinoma of esophagogastric junction (AEG) is on the rise. Due to its special lesion location and biological behavior, AEG is considered as a relatively independent disease by more and more scholars, which is different from esophageal cancer or gastric cancer. AEG is anatomically located at the junction of esophagus and stomach. The lymph node metastasis of AEG can be directed to the mediastinal and abdominal. At present, the rule of lymph node metastasis of AEG is not completely clear, and the scope of lymph node dissection has not reached a consensus. The authors summarize the hot issues and clinical evidence of lymph node dissection for AEG, in order to provide references for more reasonable lymph node dissection of AEG.
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Objective:To investigate the short-term efficacy of totally laparoscopic distal gastrectomy (TLDG) after endoscopic submucosal dissection (ESD) versus direct TLDG for early gastric cancer.Methods:The propensity score matching and retrospective cohort study was conducted. The clinicopathological data of 623 patients with early gastric cancer who were admitted to the First Affiliated Hospital of Nanjing Medical University from March 2014 to December 2019 were collected. There were 405 males and 218 females, aged from 26 to 86 years, with a median age of 62 years. Of 623 patients, 25 cases undergoing TLDG after ESD were divided into ESD+TLDG group and 598 cases undergoing TLDG directly were divided into TLDG group. Observation indicators: (1) the propensity score matching conditions and comparison of general data between the two groups after propensity score matching; (2) intraoperative and postoperative situations of TLDG; (3) stratification analysis of the ESD+TLDG group. The propensity score matching was conducted by 1∶2 matching using the nearest neighbor method. Measurement data with normal distribution were represented as Mean±SD, and comparison between groups was done using the t test. Measurement data with skewed distribution were represented as M (range) and comparison between groups was done using the Mann-Whitney U test. Count data were represented as absolute numbers, and comparison between groups was analyzed using the chi-square test or Fisher exact probability. Comparison of ordinal data between groups was analyzed using the Mann-Whitney U test. Results:(1) The propensity score matching conditions and comparison of general data between the two groups after propensity score matching: 75 of 623 patients had successful matching, including 25 in the ESD+TLDG group and 50 in the TLDG group. Before propensity score matching, the body mass index (BMI), cases with tumor diameter ≤20 mm, 21 to 30 mm or>30 mm, cases with tumor classified as stage Ⅰ, stage Ⅱ or stage Ⅲ of clinical staging were (22.3±3.6)kg/m 2, 16, 6, 3, 24, 1, 0 of the ESD+TLDG group, respectively, versus (24.3±2.7)kg/m 2, 238, 125, 235, 312, 126, 160 of the TLDG group, showing significant differences in the above indicators between the two groups ( t=2.744, Z=?2.834, ?4.209, P<0.05). After propensity score matching, the BMI, cases with tumor diameter ≤20 mm, 21 to 30 mm or >30 mm, cases with tumor classified as stage Ⅰ or stage Ⅱ of clinical staging were (22.3±3.6)kg/m 2, 16, 6, 3, 24, 1 of the ESD+TLDG group, versus (23.6±2.9)kg/m 2, 29, 12, 9, 48, 2 of the TLDG group, showing no significant difference between the two groups ( t=1.542, Z=?0.597, 0.000, P>0.05). (2) Intraoperative and postoperative situations of TLDG: after propensity score matching, the operation time and time to postoperative drainage tube removal were 180 minutes(range, 124 to 289 minutes) and 6 days(range, 4 to 13 days) of the ESD+TLDG group,respectively,versus 170 minutes(range, 106 to 250 minutes) and 6 days (range, 4 to 9 days) of the TLDG group, showing significant differences between the two groups ( Z=-2.396, -3.039, P<0.05). Cases with the volume of intraoperative blood loss <50 mL, 50 to 100 mL or >100 mL, the number of lymph node dissected, duration of postoperative hospital stay, cases with perioperative complications as incision fat liquefaction, delayed gastric emptying, anastomotic bleeding or pulmonary infection were 7, 9, 9,34(range, 16 to 58), 8 days(range, 6 to 31 days), 1, 1, 0, 0 of the ESD+TLDG group,respectively,versus 18, 26, 6, 39 (range, 22 to 68), 8 days (range, 6 to 29 days), 0, 0, 1, 1 of the TLDG group, showing no significant difference between the two groups ( Z=-1.703, -1.958, -1.139, χ2=0.033, P>0.05). Cases with anastomotic bleeding were recovered after hemostasis under endoscopy and cases with other perioperative complications were recovered after conservative treatment. (3) Stratification analysis of the ESD+TLDG group. ① For 5 cases undergoing TLDG ≤14 days after ESD and 20 cases undergoing TLDG >14 days after ESD, the operation time of TLDG, cases with the volume of intraoperative blood loss <50 mL, 50 to 100 mL or >100 mL during TLDG, the number of lymph node dissected, time to postoperative drainage tube removal, duration of postoperative hospital stay, cases with perioperative complications were 200 minutes(range, 170 to 289 minutes), 0, 3, 2, 36(range, 9 to 57), 7 days(range, 5 to 9 days), 8 days(range, 7 to 9 days), 1 and 180 minutes (range, 124 to 253 minutes), 8, 6, 6, 34(range, 8 to 78), 6 days(range, 4 to 13 days), 8 days(range, 6 to 31 days), 1, respectively, showing no significant difference in the operation time of TLDG, volume of intraoperative blood loss during TLDG, the number of lymph node dissected, time to postoperative tube removal and duration of postoperative hospital stay between the two groups ( Z=?1.536, ?1.993, ?0.238, ?0.932, ?0.589, P>0.05), and no significant difference in cases with perioperative complications between the two groups ( P>0.05). ② For 13 cases undergoing TLDG ≤21 days after ESD and cases undergoing TLDG >21 days after ESD, the operation time of TLDG, cases with the volume of intraoperative blood loss as <50 mL, 50 to 100 mL or >100 mL during TLDG, the number of lymph node dissected, time to postoperative drainage tube removal, duration of postoperative hospital stay, cases with perioperative complications were 200 minutes(range, 145 to 289 minutes), 2, 6, 5, 34(range, 8 to 57), 6 days(range, 4 to 11 days), 8 days(range, 6 to 11 days), 1 and 179 minutes(range, 124 to 240 minutes), 6, 3, 3, 34(range, 16 to 78), 6 days(range, 5 to 13 days), 8 days(range, 6 to 31 days), 1, respectively, showing a significant difference in the operation time of TLDG between the two groups ( Z=?2.241, P<0.05), while showing no significant difference in the volume of intraoperative blood loss during TLDG, the number of lymph node dissected, time to postoperative drainage tube removal, duration of postoperative hospital stay between the two groups ( Z=?1.471, ?0.163, ?0.084, ?0.194, P>0.05) and no significant difference in cases with perioperative complications between the two groups ( P>0.05). ③ For 15 cases undergoing TLDG ≤28 days after ESD and 10 cases undergoing TLDG >28 days after ESD, the operation time of TLDG, cases with the volume of intraoperative blood loss <50 mL, 50 to 100 mL or >100 mL during TLDG, the number of lymph node dissected, time to postoperative drainage tube removal, duration of postoperative hospital stay, cases with perioperative complications were 190 minutes (range, 145 to 289 minutes), 2, 7, 6, 33(range, 8 to 57), 6 days(range, 4 to 11 days), 8 days(range, 6 to 31 days), 1 and 179 minutes(range, 124 to 240 minutes), 6, 2, 2, 37(range, 16 to 78), 6 days (range, 5 to 13 days), 8 days(range, 6 to 14 days), 1, respectively, showing no significant difference in the operation time of TLDG, volume of intraoperative blood loss during TLDG, the number of lymph node dissected, time to postoperative tube removal and duration of postoperative hospital stay between the two groups ( Z=?1.619, ?2.000, ?0.667, ?0.370, ?0.057, P>0.05), and no significant difference in cases with perioperative complications between the two groups ( P>0.05). Conclusions:Compared with cases undergoing TLDG directly, the operation time to TLDG and time to drainage tube removal after TLDG for cases undergoing ESD+TLDG are prolonged, but there is no difference in the short-term efficacy. For cases undergoing TLDG ≤21 days after ESD and cases undergoing TLDG >21 days after ESD, there is a significant difference in the operation time of TLDG.
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The incidence of proximal gastric cancer and esophagogastric junction cancer have increased gradually worldwide. At present, total gastrectomy is still the most commonly used method for the treatment of proximal gastric cancer and esophagogastric junction cancer. However, total gastrectomy inevitably leads to postoperative nutritional and metabolic disorders. The nutritional status of patients after proximal gastrectomy is better than that of total gastrectomy due to the preservation of partial gastric function. With the increase in the detection rates of early gastric cancer and esophagogastric junction cancer and the deepening understanding of lymph node metastasis, proximal gastrectomy has been received more attention and applied in more and more cases. Traditional esophagogastrostomy may cause severe reflux esophagitis. To overcome it, various kinds of anti-reflux digestive tract reconstructions after proximal gastrectomy have been created. Based on the relevant literature and combined with their practical experience, the authors summarize the progress in anti-reflux digestive tract reconstruction after proximal gastrectomy, in order to provide reference for choosing optimal reconstruction methods.
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The incidence of the esophagogastric junction (EGJ) cancer tends to increasing in recent years.Comprehensive treatment based on surgical treatment is currently a general strategy for the treatment of EGJ cancer.Because of the particularity of the anatomy and pathology of EGJ cancer,there were difficulties and controversies existing in the surgical treatment of EGJ cancer.Medical researchers have attached great importance to the treatment of EGJ cancer and made remarkable progress in it.Therefore,the authors summarize the progress of surgical treatment of EGJ cancer,and present it in four aspects of surgical approach lymph,node dissection,esophagogastric resection and digestive tract reconstruction.
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The incidence of adenocarcinoma of the esophagogastric junction (AEG) has been raised in recently years.Comprehensive treatment based on surgical treatment is currently a general strategy for the treatment of AEG.As a minimally invasive treatment,laparoscopic surgery has been gradually applied to the treatment of AEG.Because of the particularity of the anatomy and pathology of AEG,laparoscopic radical resection still has many difficulties and controversies.Up to now,there are a few high-level evidences for the range of lymph node dissection and gastrectomy and the selection of digestive tract reconstruction,and the treatment strategy of total laparoscopic surgery for AEG has not reached a consensus.Therefore,laparoscopic surgery for AEG has gradually become a hot topic in clinical research.Here,combined with the experience of laparoscopic surgery for AEG and the latest guidelines and literatures,authors presented the general strategies for the laparoscopic treatment of AEG in our center.
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Gastric cancer is the second most common malignancy in China.In recent years,with the development of laparoscopic technology and improved skills of gastrointestinal surgeons,total laparoscopic radical gastrectomy for gastric cancer has been developed rapidly.The digestive tract reconstruction is the key procedure and one of the difficulties of total laparoscopic radical gastrectomy.Each method of digestive tract reconstruction has its own characteristic,however,there has not yet reached a unified consensus until today.In this article,the advantages and disadvantages of these reconstruction methods and technical points were reviewed based on relative literatures and our application experiences.
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Objective To explore the timing of laparoscopic cholecystectomy in patients with acute calculous cholecystitis.Methods The clinical data of 112 patients with acute calculous cholecystitis were divided into observation group and operation group.58 patients with the onset time distance operation time less than 72 h were assigned into observation group,54 patients with the onset time distance operation time ＞ 72h were assigned into control group.The situations of surgery,transit rate and postoperative complications were compared between the two groups.Results The operation time [(50.0 ± 10.3) min],anal exhaust time [(32.5 ± 1.2) h],postoperative pain time [(23.2 ± 2.3) h] and hospitalization time[(2.5 ±0.4)h] in the observation group were significantly shorter than those in the control group[(80.2 ± 15.1)min,(80.3 ±3.7)h,(55.6 ±2.5)h,(5.0 ± 1.6)d] (t =19.03,P =0.001;t =32.83,P =0.000;t =25.86,P =0.000;t =6.56,P =0.028).The observation group had 1 case of transit to laparotomy,the transit rate was 1.72％.The control group had 8 cases of transit to laparotomy,the transit rate was 14.81％.The transit rate of the observation group was lower than that of the control group,the difference was statistically significant (x2 =6.86,P =0.035).The observation group had 4 patients with bile leakage,the incidence rate of complication was 6.89％.The control group had 6 cases of bile leakage,5 cases of hepatic duct laceration,the incidence rate of complication was 20.37％.The incidence rate of complication of the control group was higher than that of the observation group,the difference was statistically significant (x2 =4.71,P =0.042).Conclusion Laparoscopic cholecystectomy has significant effect for patients with acute calculous cholecystitis at 72 hours after onset,and has good safety and it is worthy of clinical application.
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In recent years, with the development of laparoscopic technology, more and more totally laparoscopic gastrectomy has been applied. The reconstruction of digestive tract is the key procedure of laparoscopic gastrectomy and is associated with the postoperative quality of life. Each method of digestive tract reconstruction has its own characteristic, however, unified consensus on how to choose the optimal method for digestive tract reconstruction has not yet been reached till today. In this article, we will discuss and evaluate the advantages, disadvantages and indications of these reconstruction methods after totally laparoscopic distal gastrectomy, total gastrectomy and proximal gastrectomy combined with relative literatures and our practical experience in order to provide the reference to choose the reasonable reconstruction method at the premise of radical resection, which may decrease the morbidity of postoperative complication, increase the quality of life, and bring benefits to patients definitely.
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Transient receptor potential(TRP)channels as an important non-selective cation channels family mainly permeate Ca2 + ,Na + and other cations. TRPC channel is a subtribe of TRP family which regu-lates the second messenger of Ca2 + concentration and variety of protease activity,and which can directly or in-directly affect the biological behavior of cells. Recently,more and more evidences have certificated the TRPC channels affect the tumorigenesis and development,such as regulation of proliferation,differentiation,migra-tion,apoptosis and resistance of chemotherapeutic agents during cancer progression.
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Objective To explore effects of different doses of rosuvastatin on serum soluble OX40 ligand (sOX40L), matrix metalloproteinase-9 (MMP-9) in patients with acute coronary syndrome (ACS). Methods Sixty patients with ACS were evenly divided into 20 mg rosuvastatin treatment group (20 mg group) and 10 mg rosuvastatin treatment group (10 mg group). Twenty healthy volunteers were randomly assigned to control group. The serum levels of sOX40L and MMP-9 were measured and analyzed before and after treatment in three groups. Results The levels of sOX40L and MMP-9 before treat-ment were significantly higher in two treatment groups than those in control group (P<0.01). After two-week treatment with rosuvastatin, serum levels of sOX40L and MMP-9 decreased significantly in two treatment groups compared with those of pre-treatment (P<0.01). Moreover, the levels of sOX40L and MMP-9 were significantly lower in 20 mg group than those in 10 mg group after two-week treatment with rosuvastatin (P<0.05). But the levels of sOX40L and MMP-9 were still higher than control group (P<0.01). Conclusion Larger doses of rosuvastatin may decrease the degradation of extraceller matrix of coronary atherosclerotic plaque and inflammatory reaction, stabilize coronary atherosclerotic vulnerable plaque, and play an important role in improving prognosis in patients with ACS.
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Objective To investigate the effect of percutaneous transluminal angioplasty(PTA) by minor-caliber and long balloon on diabetic patients with below-knee artery. Methods 16 consecutive DM patients(21 limbs)were treated with PTA by minor-caliber and long balloon and followed 7 months(1 ～22 months). The success rate,complication,clinical effects and the changes of ABI were investigated and analyzed. Results The technical success rate is 90.5% (19/21) ,no serious complication occurred. The clinical symptoms of all patients improved after successful PTA. The median ABI marginally increased from the baseline value of (0.31 ±0. 15) to (0.57 ±0.23) after intervention,the difference is significant (P ＜ 0.05). Post-operative pain in patients with rest pain disappeared 9 (60.0%), relieved 4 (26.7%), reduce 2 (13.3 %). Ulcer healing in patients with foot gangrene 4 (66.7 %), Ulcer area was significantly reduced 1 (16.7%), high amputation 1 (16.7%). Postoperative follow-up, two limbs reoperation because of increased symptoms. Conclusion The treatment of percutaneous transluminal angioplasty by minorcaliber and long balloon was effective on diabetic patients with below-knee arterial disease.
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Objective To test the accuracy of American College of Cardiology (ACC)/American Heart Association (AHA) guidelines for preoperative cardiovascular evaluation for noncardiac surgery in Chinese patients and to compare ACC/AHA guidelines with Goldman index and Lee index. Methods From January to December 2003, all patients aged ≥70 yr or patients aged 40-69 yr with a history of cardio- and cerebro-vascular disease, abnormal ECG or diabetes scheduled for noncardiovascular surgery were included in this study. A total of 1 248 patients were eligible. Their clinical data including demographic data, history of cardiovascular disease, routine physical examination and laboratory tests, the scheduled surgery and type of anesthesia were collected. The patients were then evaluated for cardiac risk and classified according to ACC/AHA guidelines (high, moderate, low and no risk), Lee index (class I -IV ) and Goldman index (class I - III ). The cardiac risk of the scheduled surgery was then stratified according to ACC/AHA guidelines. The patients were followed up until discharged from hospital. Cardiac events were defined as cardiac death, myocardial infarct, myocardial ischemia, minor myocardial cell injury, ventricular dysfunction and serious arrhythmia. Likelihood ratio of the 3 methods was calculated. Risk factors for adverse events were identified by univariate analysis and multivariate Logistic regression analysis. Results Of the 1 248 patients 694 were male and 554 female. Their age ranged from 40-102 years (mean age 65.4 yr). 44.7 % of the patients were aged ≥ 70 years. High risk operation accounted for 6.3 % and emergency operation 7.9% . One patients died of cardiac event and ten patients of other causes. Seventy-three perioperative cardiac events occurred in 53 patients. The morbidity rate was 4.2% . Goldman index and ACC/AHA cardiac risk stratification were correlated with adverse cardiac outcomes ( P