ABSTRACT
Objective To investigate the viability and safety of laparoscopic sleeve gastrectomy(LSG)based on the TJ point at the junction of the posterior gastric wall and the apex of the medial edge of the left diaphragm.Methods A retrospective analysis of 135 patients with obesity or obesity with metabolic syndrome who underwent LSG from January 2019 to January 2022 were divided into two groups according to the different free modes of fundogastric body.68 patients underwent surgery using the TPOL model LSG.A control group of 67 patients was treated with conventional LSG surgery.To analyze and compare the duration of operation,gastric fundus free time,intraoperative blood loss time,hospital stay time,postoperative gastric fistula,bleeding rate,and occurrence of gastroesophageal reflux disease(GERD)between the two groups.Results All patients successfully completed LSG surgery and were safely discharged.They were followed for a period of 12 to 36 months.the duration of operation for the study group was(56.13±10.56)minutes,while for the control group it was(62.45±12.74)minutes.The gastric fundus was freed in(6.34±4.16)minutes for the study group and(12.58±6.37)minutes for the control group.The duration of hospitalization was(3.84±0.42)days for the study group and(4.06±0.69)days for the control group.The intraoperative blood loss was(10.87±1.28)ml for the study group and(15.56±3.39)ml for the control group.The incidence of postoperative GERD was 5(7.35％)for the study group and 13(19.40％)for the control group.The differences between the two groups were statistically significant(P＜0.05).The decrease in excess weight at 12 months after surgery,as well as complications such as bleeding and gastric fistula,were not statistically significant(P＞0.05).Conclusion LSG(TPOL model)extends from the TJ point(the Tri-junction point where the gastric left mesangium,gastric posterior mesangium,and pancreatic mesangium meet)to the apex of the medial foot edge of the left diaphragm.LSG(TPOL model)can be efficiently and safely achieve tension-free anastomosis,resulting in a complete free gastric fundus.This method is feasible,and has clinical value for the standardized free gastric fundus of LSG.
ABSTRACT
Objective To research the effect and mechanism of phosphatidylinositol 3‐kinase(PI3K)/serine threonine protein kinase(AKT) and mitogen extracellular signal‐regulated kinase(MEK)/extracellular signal‐regulated kinase(ERK) signaling path‐way in tumor vascular endothelial cell migration .Methods The different concentrations of PI3K/AKT signaling pathway inhibitor LY294002 (2 .50 ,7 .50 ,15 .00 μmol/L) and the MEK/ERK signaling pathway inhibitor PD98059 (2 .50 ,7 .50 ,15 .00 μmol/L) were used to treat the tumor‐derived endothelial cells respectively .The DMEM‐F12 culture medium was added into 0 .10% DMSO culture medium as the control .The cell scratch test ,cell directional migration test and Transwell test were adopted to detect the effects of different signaling pathway inhibitors on the tumor vascular endothelial cells level ,horizontal ,vertical and directional mi‐gration .Results 0 .10% DMSO had no significant effect on endothelial cell migration and the role of endothelial cells′migration a‐bility after its action had no obvious difference compared with the single DMEM‐F12 medium action ,indicating that small doses of DMSO as the solvent of LY294002 ,PD98059 did not affect the tumor vascular endothelial cell migration function ;after treatment by signaling pathway inhibitor LY294002 and PD98059 ,the endothelial cell migration ability was suppressed and increased with the in‐hibitor concentration increase ;compared with the PD98059 group ,the migration distance in the LY294002 group was smaller and the number of migrating cells was less ,the differences had statistical significance (P<0 .05) .Conclusion The inhibition of PI3K/AKT and MEK/ERK signaling pathway can inhibit the level of tumor vascular endothelial cells ,vertical and directional migration , and which is positively correlated with the concentration of inhibitor ;the effect of PI3K/AKT signal pathway on the migration of endothelial cells is more significant than that of the MEK/ERK signal pathway .