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<p><b>OBJECTIVE</b>To investigate the impact of preoperative oral liquid carbohydrate on postoperative insulin resistance (IR) in gastric cancer patients undergoing elective resection, and to examine the association of IR index (homeostasis model assessment, HOMA-IR) with tumor necrosis factor-α (TNF-α).</p><p><b>METHODS</b>Between January 2013 and September 2013, 35 patients undergoing elective resection for gastric cancer were prospectively enrolled and randomized into two groups. Patients in trial group (n=18) received oral 500 ml of 10% glucose solution two hours before surgery. Patients in control group (n=17) were asked to fast for 8-12 hours before operation. About 300 mg of rectus abdominis and subcutaneous fatty tissues was removed before the closure of abdominal wall. Blood samples were collected to measure the serum concentration of TNF-α with double antibody sandwich ELISA in perioperative period (3-hour before operation, end of operation, 1-day and 3-day after operation). HOMA-IR was calculated on preoperative 3-hour and postoperative 1-day. Western blotting was used to detect protein expression of TNF-α. Correlation of HOMA-IR with TNF-α was examined.</p><p><b>RESULTS</b>HOMA-IR on the first day after surgery was not different from that at 3-hour before surgery in trial group (P=0.090), which was significantly lower than that in control group (P=0.000). In trial group, serum TNF-α at the end of operation was higher than that at 3-hour before surgery, which declined rapidly on the first day after surgery and had no significant difference compared with that on the third day after surgery. In control group, serum TNF-α at the end of operation was also higher than that before surgery, which rose to the peak on the first day after surgery and was still higher than that at 3-hour before surgery. The TNF-α protein expression in muscle tissues of trial group was higher than that of control group (P=0.001), while no significant difference was observed between two groups in adipose tissues (P=0.987). Correlation analysis showed that HOMA-IR was positively correlated with TNF-α on the first day after surgery (r=0.832, P=0.000).</p><p><b>CONCLUSION</b>Oral intake of liquid carbohydrate 2 hours before surgery can reduce the level of TNF-α, which is likely to improve the postoperative insulin resistance.</p>
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Humans , Carbohydrates , Fasting , Insulin Resistance , Postoperative Period , Prospective Studies , Stomach Neoplasms , Tumor Necrosis Factor-alphaABSTRACT
Objective To investigate the effect of oral intake of 10%glucose solution before surgery on the perioperative safety and postoperative insulin resistance in patients undergoing resection for gastric cancer. Methods Between March 2012 and December 2012,36 patients undergoing elective resection for gastric cancer were enrolled and randomized into three groups. Patients in group A were given 500ml of 10%glucose solution for oral intake two hours before surgery. Patients in the group B were given distilled water instead of glucose. Patients in the group C were asked to fast for 8 hours before operation. Patient′s wellbeing scores on a visual analogue scales (VAS) were recorded. Blood samples were collected to measure. Homeostasis model assessment (HOMA) was applied to assess the status of insulin resistance (HOMA-IR) and insulin sensitivity index (ISI) according to the level of blood glucose and the serum concentration of insulin. The gastric residues before anesthesia and the time of exhaustion and defecation were also recorded. Results The gastric residues were not increased significantly after the intake of 10%glucose solution (P > 0.05). Intake of 10% glucose solution before surgery relieved thirst and hunger (P 0.05). The HOMA-IR levels postoperative immediately, on the first day and the third day after surgery were lower in group A than that of group B and group C (P < 0.05), but the ISI levels were higher significantly (P < 0.01). Conclusion Intake of 10%glucose solution 2 hours before surgery for gastric cancer is be safe , which can relieve preoperative thirst and hunger, and improve postoperative insulin resistance.
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Objective To investigate the diagnosis measures and treatment methods of white line hernia. Methods Analyze the clinical data of 12 cases of white line hernia who were treated by surgery. We performed peritoneal adipose tissue before resection on hernia without hernial sac type. And for those with hernial sac type, apothesis of material in hernia were firstly made, then ligated the hernia sac neck and resection were made. Then according to the white line defect size, we used pure involution suture and Onlay without tension patch repair to repair defect in the white line. Results Surgery of all the 12 cases were successful. 2 cases of them merged postoperative renal dysfunction and infection, and after hemodialysis and anti-infection treatment, they both recoverd well without recurrence. Conclusion There is no spe-cific symptoms and signs in white line hernia, but incarceration and strangulation may cause life threaten, so we should pay more attention to it. For symptomatic, large, difficult, incarcerated or strangulated white line hernia,we should take timely surgical treatment.
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Objective To explore the optimum sentinel lymph node (SLN) mapping method in gastric cancer. Methods The clinical data of 59 patients who were confirmed with gastric cancer at Guangzhou General Hospital of Guangzhou Military Command from January 2004 to August 2008 were retrospectively analysed. Patent blue V dye was used in 20 patients (group A), technetium-99m sulfur colloid was used in 20 patients (group B),and a combination of patent blue V dye and technetium-99m sulfur colloid were used in 19 patients (group C).The number of SLNs detected, and accuracy and false-negative rate of SLNs in diagnosing regional lymph node metastasis were analysed by t test and chi-square test. Results The numbers of SLNs detected in groups A, B and C were 38 (1.9 per case), 31 (1.6 per case) and 56 (2.9 per case), respectively. In group C, 46 SLNs were screened out by patent blue V dye and technetium-99m sulfur colloid simultaneously, six SLNs were only detected by patent blue V dye and four only by technetium-99m sulfur colloid. There was a significant difference in the number of SLNs detected among the three groups (t = 4.35, P ＜ 0. 05 ). The number of SLNs detected in group C was significantly greater than that in groups A and B (t = 4. 21, 3. 54, P ＜ 0.05 ). The accuracy and false-negative rate of SLNs in diagnosing regional lymph node metastasis were 95% (19/20) and 5% (1/20) in group A, 90% (18/20) and 10% (2/20) in group B, and 100% (19/19) and 0 in group C. The accuracy was significantly higher (x2 = 163.01, P ＜ 0.05) and the false-negative rate was significantly lower in group C compared with those in groups A and B (x2 = 170. 14, P ＜ 0. 05). Conclusion A combination of dye and radioactive tracer is a favorable method for detecting SLNs in gastric cancer.
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Objective To explore the diagnosis, treatment and prognosis of acute perforation of gnstric cancer. Methods The clinical data of 24 patients with acute perforation of gastric cancer who had been admitted to Guangzhou General Hospital of PLA from July 1996 to December 2008 were retrospectively analyzed. Results Of all patients, 4 were treated by perforation repair, 2 by perforation repair combined with gastrojejunostomy, 11 by palliative subtotal gastrectomy, 2 by radical gastrectomy, and 5 by radical gastrectomy after perforation repair. The mean survival time of patients treated by perforation repair, perforation repair combined with gastro-jejunostomy, partial gastrectomy and radical gastrectomy were (4±5), (6±9), (12±7), and (25±9) months, respectively. Conclusions Early diagnosis and reasonable operation are the keys to decrease the morality and increase life quality for patients who suffered from acute perforation of gastric cancer. Different pathologic stages maybe an important factor in deciding the prognosis.
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Objective: To study the feasibility of fast-track surgery in colorectal surgery. Methods: 61 patients with elective colorectal operation were divided randomly into experimental group (n=31)and control group(n=30), which were treated with fast-track surgery and traditional methods respectively. The data of stress and recovery after surgery were evaluated. Results: Compared to routine methods, the fast-track surgery can lighten stress, accelerate recovery and reduce the rate of overall complication after surgery. Conclusions: Fast-track surgery including intervention during perioperative period is safe and effective in colorectal surgery, significantly lightening stress and improving recovery in patients after colorectal surgery.
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Objective To study a new stuff-block therapy method to promote closure of external gastrointestinal fistula. Methods Twenty-eight patients with different type of external gastrointestinal fistulae in different sites were treated with fibrin glue stuff-blocking technique. The fibrin glue dispensary system designed by the authors has a double-lumen catheter in different size.When the catheter inserted via the fistula to about 1cm from the intestinal fistula,the glue was relased through the catheter to seal the whole fistula. Results The insertion of dispensary catheter into the fistulae was successful in all the cases. No side-effect was observed in all the patients. In 17 patients the fistulae healed about one week after one time treatment, 11 patients′ fistulae healed in about two weeks after 2-3 time treatment. Twenty-five patents were followed up for 3-6 months . The fistula sustained healing and normal deal was restored.Conclusions Stuff-blocking of the fistula with fibrin glue by means of the dispensary system designed by the authors has satisfy results. It provided a new method for the treatment of external gastrointestinal fistula .
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0.05).From ≤40 years to 71～80 years, the proportion of proximal colon cancers remained stable, distal colon cancers increased from 14.7% to 26.9%, and rectal cancers decreasd from 58.6% to 47.8% (P
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Objectives:To investigate the model and effect of nutritional spport in patients with gastrointestinal fistulas and biliary or pancreatic fistulas. Methods:Step by step nutritional spport was studied in 23 patients with gastrointestinal fistulas and biliary or pancreatic fistulas.The calorie and days provided by different ways of nutritional support and routes of enteral nutrition were reviewed.The nutrition state was evaluated in all cases before TPN and after TEN.Liver functions were observed at the end of every phase of nutrition support. Results:The total hospitalization days of 23 patients were 1 498.TPN,PN+EN and TEN days were 901(60.1%),445(29.7%) and 152(10.2%) respectively,providing non protein calorie of 32.5?5.6,29.5?3.4 and 27.8?4.7 kJ/(kg?d).The routes of enteral nutrition were nasal jejunum tube (13 cases),jejunostomy (5 cases) and nasal gastric tube(2 cases).4 patients died and 19 patients recovered.The nutrition state were significantly improved after nutrition treatment. Conclusions:TPN→PN+EN→TEN→EN+oral feeding was a model of step by step nutritional support,which was effective in patients with gastrointestinal fistulas and biliary or pancreatic fistulas.PN remains the main way providing nutrition support,while EN should be used as soon as possible.
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To investigate the distribution and clinical significance of sentinel lymph node(SLN) in gastric cancer, and to provide novel methods for further prospective study, the location of the first node with metastasis, and the correlation between it and primary tumor site were studied in this paper by retrospectively examining 75 cases of gastric cancer with only one positive node demonstrated during operation and pathologic examination. This positive node was regarded as SLN. The results revealed that the solitary metastatic nodes were found in the nearest perigastric nodal area in 55% of cases, in a fairly remote perigastric area in 28% of them, and in the N2-N3 area without N1 involvement in 17%. Among 13 cases of gastric carcinoma with “leaping” metartasis, the depth of invasion was mucosal in one patient, SM, SS or Se in other 12 cases. We conclude that the location of SLN in gastric cancer is random and multidirectional, and the rate of “leaping” metastasis is much higher than expected ,which indicates that the examination of the nodal area close to the primary tumor may not be a reliable method to detect SLN in gastric carcinoma. Although the feasibility of SLN concept in gastric cancer cannot be questioned with these findings, novel techniques combining the dye directed and radioguided methods need to be developed.