Extended multi-organ resection for cT4 gastric carcinoma: a retrospective analysis

Objective: Combined resection for locally advanced [T4] gastric cancer may result in high morbidity and mortality. The aim of this study was to evaluate the clinicopathologic characteristics to determine the prognostic factors for T4 gastric cancers

Methodology: A total of 463 consecutive patients with gastric cancers were enrolled in this study. Among them, 63 patients received combined resections. Various clinicopathologic factors influencing survival rates were evaluated. Survival rates were calculated according to the Kaplan-Meier method. Prognostic factors were evaluated by the univariate and multivariate analysis

Results: Thirty-one patients [49.2%] received one additional organ resection and 32 patients [50.8%] received two or more additional organ resections. Curative resection was performed in 49 patients [77.8%]. Multivariate analysis identified curative resection [hazard ratio 0.330; 95 percent confidence interval, 0.139-0.784; P = 0.012] and tumor diameter [> 7 cm] [hazard ratio, 3.589; the 95 percent confidence interval, 1.425-9.037; P = 0.007] as independent prognostic factor for patients with T4 gastric cancer undergoing combined resection

Conclusions: The use of aggressive multi-organ resection was recommended for patients with T4 gastric carcinoma, with tumor diameter as a useful indicator. Patients with relatively small tumor diameter [

The contrast of procedure for prolapse and hemorrhoids between the local anesthesia and the combined spinal epidural anesthesia / 中国医师进修杂志

Objective To explore the clinical effect of procedure for prolapse and hemorrhoids (PPH) treating for Ⅲand Ⅳ degree hemorrhoid under the local anesthesia.Methods One hundred and fifty patients with Ⅲ and Ⅳ degree hemorrhoid were divided into two groups randomly.One group was the local anesthesia group (LA group) which included 73 cases,the other one was the combined spinal epidural anesthesia group (CSE group) which included 77 cases.Compared the safety and efficacy of different procedure.Results The original symptom of the two groups were improved.There was a significant difference in the time of hospitalization time and the hospitalization expense between the two groups (P＜0.05).The LA group was(4.8±1.1)days with(3980±639)yuan,and the CSE group was(6.8±1.1) days with(5128±728)yuan.The rates of two groups of urine retention were 9.6% and 24.7% (P＜0.05) after the operation respectively,and there were no significant differences in recovery normal activity time,the pain index,copracrasia and pruritus,the bleed,the anal fistula,the prolapse of hemorrhoid,the skin tag (P ＞0.05).Conclusion PPH under the local anesthesia is safe,compare to the combined spinal epidural anesthesia,it excels in shortening the hospitalization time and reducing the hospitalization expense,also it can reduce significantly the rate of urine retention after operation.

Laparoscopic versus open appendectomy in patients with chronic appendicitis / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To compare the advantages and disadvantages of laparoscopic versus open appendectomy in patients with chronic appendicitis.</p><p><b>METHODS</b>Two hundred twenty- four patients were divided into laparoscopic group (n=98) and open appendectomy group (n=126) according to individual willing. Prospective non- randomized study was performed to compare the operative time, operative bleeding, hospitalization time, the discovery and management concerned in operation. Abdominal pain in these chronic appendicitis cases was followed up.</p><p><b>RESULTS</b>The operative time was (54.8+/-21.8) min in open group and (51.8+/-18.0) min in laparoscopic group (t=0.80,P > 0.05). The operative bleeding was (18.6+/-23.3) ml in open group and (9.8+/-4.7) ml in laparoscopic group (t=3.13, P < 0.05). The hospitalization time was (8.9+/-5.3) d in open group and (6.8+/-3.0) d in laparoscopic group (t=2.66,P < 0.05). Twenty- five cases had abdominal adhesion in laparoscopic group, including 9 cases of adhesion around appendix, 6 cases of adhesion between ileocecum and anterior or lateral abdominal wall, 4 cases of adhesion between epiploon and abdominal wall or intestines, 6 cases of adhesion around colon and others. All adhesion had been dissected. Fourteen cases adhesion around appendix had been discovered in 126 cases of open group and dissected (chi(2) =7.95,P < 0.05). In follow- up research, 24 cases still had chronic abdominal pain in 98 case of open group, and 9 cases had chronic abdominal pain in 87 of laparoscopic group, the difference was significant (chi(2)=6.29,P < 0.05).</p><p><b>CONCLUSION</b>The laparoscopic appendectomy possesses more advantages in treating chronic appendicitis and can decrease the incidence of chronic abdominal pain after operation.</p>

A Clinical Contrast Study on the Tension-free Hernioplasty with Three Operative Methods / 中国医师杂志

Objective To compare the clinical efficacy of tension-free hernioplasty with three operative methods, and analyze the reasons of complications. Methods All Chinese articles dealing with the tension-free hernioplasty included in CNKI from 1997 to 2004 were collected, and divided into three groups according to different operative methods, the clinical efficacy of which was compared. Results The frequecy of foreign matter feel in the Rutknow group was significantly higher than that in the other two groups (P