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Objective To investigate the comparison of clinical effects between two models of alimentary reconstruction after total gastrectomy in the elderly patients with gastric cancer.Methods 70 patients receiving alimentary tract reconstructions of Orr-type Roux-en-Y reconstruction (Orrtype,40 cases) and modified Brawn Ⅰ (30 cases) from January 2007 to December 2012 were retrospectively analyzed.The operative time,amount of bleeding,early postoperative complications and mortality,food intake,nutritional status and alimentary tract function were compared at 6 months after surgery.Results There were no significant differences between the two methods in the operative time [(198.8±14.0)min vs 233.5±30.7)min,t=-l.697,P＞0.05)],amount of bleeding [(420 ± 43) ml vs (340 ± 25) ml t =-1.956,P ＞ 0.05],and early postoperative complications [(17.5％ vs 16.7％),x2 =0.008,P＞0.05].However,times of liquid diet intake and semi liquid diet intake of the Orr-type reconstruction method was comparatively shorter than that of the modified Brawn Ⅰ [(4.8±2.1) d vs (7.6±2.4) d,and (9.5±3.6) d vs (11.5±3.7) d,t=-5.192,P＜0.05)].Nutritional status (weight,hemoglobin,total serum proteins and serum albumin) at 6 months after operation showed no significant differences between the two methods.But constituent ratio of Visick scores Ⅰ-Ⅱ of Orr-type was bigger than that of modified Brawn Ⅰ (86.7％ vs 62.5％,x2 =5.063,P＞0.05).Conclusions Orr-type Roux-en-Y reconstruction method can avoid reflux esophagitis,and the procedure is more simple than the modified Brawn Ⅰ method.Therefore,Orr-type Roux-en-Y reconstruction should be recommended as an adoptable method of digestive reconstruction after total gastrectomy for gastric cancer in the elderly patients.
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Objective To investigate the clinical value of transanal endoscopic microsurgery (TEM) for the treatment of elderly patients with colorectal adenoma.Methods Totally 21 patients with colorectal villous adenoma underwent TEM from Dec.2007 to Sep.2010.The distance of adenoma from the anal verge was 4-20 cm (average 8.9 cm) and tumor size was 1.1-3.5 cm (average 1.9 cm).There were 12 cases with tubular adenoma and 9 cases with villous adenoma according to pre-operative diagnosis by colonoscopy and endoanal ultrasonography (EUS).Appropriate position and posture were dictated by the location of the tumor under general anesthesia.A special rectoscopy was inserted into the anus with CO2 insufflation to keep the rectum open.Under the stereoscopy and lapaoscopy-type instruments,the tumor was completely resected (submucosal or full-thickness excision) using a 5 mm ultrasonic dissector.The operative wound was closed with intra-lumen continuous sutures.Results The tumor was completely removed with negative resection margins in all the 21 patients (submucosal excision in 12 cases and full-thickness excision in 9 cases).The operating time was 40-100 min (average 76 min) and the intraoperative blood loss was 10-80 ml (average 50 ml).The post-operative stay was 2-10 d (average 4.5 d).The postoperative pathological stages were pT0 in 16 cases and pTia in 5 cases.The postoperative pathological diagnosis were tubular adenoma in 12 cases,villous adenoma in 9 cases,low-grade intraepithelial neoplasia (IN) in 5 cases and high-grade IN in 5 cases.Follow-up checkups in the 20 patients for 2-20 months (average 11 months) revealed no local recurrence.Conclusions TEM is safe and effective with little complication for the treatment of elderly patients with colorectal adenoma.Pre-operative EUS is very important for TEM.
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Objective To explore the effect of age on clinical postoperative outcomes of elderly patients with colorectal cancer undergoing surgical treatment. Methods The clinical data of 1249 patients from January 1999 to December 2007 were analyzed retrospectively, and patients were divided into two groups according to age; the study group (≥75 years, n=312) and the control group (<75 years, n=937). Results (1) The average age was significantly higher in study group than in control group (t=33.09,P<0.05), and the rates of malnutrition risk, co-morbidity, tumor in right colon and local Iymphonodus metastasis were significantly higher in study group than in control group (x2=47.33, 130.75, 21.24 and 45.33, P<0.05). ( 2 ) The rates of preoperative surgical complications, bowel obstruction and emergency operation were significantly higher in study group than in control group (x2 =26.81, 34.14 and 10.72, P<0.05) . The rate of resection was significantly lower in study group than in control group (x2 =9.732, P<0.05). (3) The overall incidences of postoperative complications, general complications and mortality of perioperative period were significantly higher in study group than in control group (x2= 19.38, 20.75 and 10.11,P<0.05). (4) The two-year survival and five-year survival were significantly lower in study group than in control group (x2=11.91 and 27.17, P<0.05), but there were no significant differences in the cancer-specific two-year survival and five-year survival between the both groups. Conclusions Preoperative complications and co-morbidities, local tumor metastasis and postoperative nonsurgical complications adversely affect the postoperative outcomes for elderly patients with colorectal cancer.
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<p><b>OBJECTIVE</b>To evaluate the effect of simultaneous open prostatectomy and preperitoneal inguinal herniorrhaphy.</p><p><b>METHODS</b>Twenty-one patients with benign prostatic hyperplasia(BPH) and inguinal hernia, underwent simultaneous suprapubic or retropubic prostatectomy and preperitoneal inguinal herniorrhaphy through Pfannenstiel's incision. In 4 cases with bigger inguinal mass, hernia repair was performed with polypropylene meshwork (PPM).</p><p><b>RESULTS</b>The 21 patients were followed up for 6 months to 7 years. There were 2 cases of recurrence (9.5%), with no morbidity and mortality in the other 19 cases.</p><p><b>CONCLUSIONS</b>Open prostatectomy and preperitoneal inguinal herniorrhaphy can be performed during the same session without increasing infection and recurrence. The operation method is simple and the effect is positive, especially for older men.</p>
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Aged , Humans , Male , Middle Aged , Hernia, Inguinal , General Surgery , Prostatectomy , Methods , Prostatic Hyperplasia , General SurgeryABSTRACT
Objective:To observe the roles of p50 protein in pathologic responses of cerulein(CR)pancreatitis in mice deficient in p50 protein of NF-?B.Methods:Pancreatitis was induced by i.p.injection of 50?g/kg CR.The express and compensation of p65,p50 and cRel proteins of NF-?B,NF-?B activity were measured using electromobility shift assay;parameters of pancreatitis,eg,amylase,lipase and trypsin were evaluated.The apoptosis,necrosis and caspase-3 activity were observed.Results:p50 knockout(KO)mice had no p50 protein expression and increased p65 and cRel proteins expression.p50 KO mice's NF-?B activity decreased and apoptosis increased in pancreatitis compared with wild type(WT)mice.There was no caspase-3 activition in both mice before and after pancreatitis.All KO mice had an increased necrosis and amylase,lipase,trypsin activity compared with WT mice in pancreatitis.Conclusions:The results indicated that NF-?B p50 genetic deletion might attenuate cerulean induced pancreatitis.
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Objective To compare the values of a screening methods by OC-Hemodia and chemical fecal occult blood test (COB) for colorectal cancer in elderly people. Methods The screening programme targeted colorectal cancer in old people was conducted on 1 100 participants aged 60-92 years (mean was 81.3 years). All subjects received OC-Hemodia and COB examinations. Positive subjects were examined by colonoscopy and/or barium enema. Out of 1 100 subjects 1 046 were followed up in the next five years. Results Among 1 100 subjects, 231 subjects (21.0%) were positive by OC-Hemodia test and 159 subjects (14.5%) were positive by COB. There was a significant difference in positive rate between OC-Hemodia test and COB (P
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renal dysfunction.Logisitic regression showed that cardiovascular disease and hypoalbuminemia were correlated with perioperative death rate significantly. Conclusions Improving the perioperative management is very important for lowering the perioperative mortality in elderly patients with digestive tract disease.
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Objective To investigate the efficacy of sodium hyaluronate on reducing adhesions in patients undergoing peritoneal cavity surgery. Methods Peritoneum and the surface of the related organs was coated with 3～15 ml sodium hyaluronate gel before closing the peritoneal cavity. Findings on 23 reoperations out of 1 360 sessions of primary abdominal surgery with sodium hyaluronate were compared with that of 26 reoperations without the use of sodium hyaluronate in their first episode of laparotomy during the same period. Results The severity of adhesion was graded as 4 degrees. In treatment group, adhesion Ⅰ?,Ⅱ?,Ⅲ?,Ⅳ? were in 11,9,3 and 0 cases, respectively. Compared with adhesion Ⅰ?,Ⅱ?,Ⅲ?,Ⅳ? in 1,5,17 and 3 cases in control group,respectively( P