Application value of combined organ radical resection in patients with recurrent gastric cancer / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To investigate the outcomes after combined organ radical resection for the recurrent gastric cancer.</p><p><b>METHODS</b>Complete clinicopathological data of 48 recurrent gastric cancer patients who received radical resection before and underwent reoperation again in the Sun Yat-sen Memorial Hospital and The Second Affiliated Hospital of Xinjiang Medical University from January 2008 to December 2013 were analyzed retrospectively. Of 48 patients, 32 received combined organ radical resection(radical group) and 16 received combined organ palliative gastric stump resection (palliative group).</p><p><b>RESULTS</b>In the radical group, one case(3.1%,1/32) died 5 days after operation due to hepatorenal syndrome and 9 had postoperative complications (28.1%,9/32), including external intestinal fistula, pancreatic fistula, biliary fistula and anastomotic bleeding. In the palliative group, only one patient(6.2%, 1/16) had postoperative pneumonia and partial intestinal obstruction, with lower complication morbidity as compared to the radical group(P<0.05). The median survival time was significantly longer in the radical group(36.0 vs. 11.5 months, P<0.01). The 1- and 3-year survival rates were 93.1%, 72.4% in the radical group, and 31.3%, 18.8% in palliative group, whose differences were statistically significant. Multivariate Cox regression analysis showed that clinical stage (HR:3.106, 95% CI:1.357-6.321, P=0.008), peritoneal metastasis (HR:10.167, 95% CI:3.230-35.234, P=0.000) and radical cure situation(HR:3.256, 95% CI:1.267-9.389, P=0.009) were independent prognostic factors.</p><p><b>CONCLUSION</b>The combined organ radical resection can provide better survival for recurrent gastric cancer patients, while the indications should be controlled strictly with preoperative multidisciplinary assessment and precise surgical judgment in order to decrease the complication.</p>

Clinical analysis of 19 cases of ectopic appendicitis with laparoscopic exploration and appendectomy / 国际外科学杂志

Objective To explore the clinical manifestations,diagnosed main points,laparoscopic trestment strategy of ectopic appendicitis.Methods The 19 clinical data of ectopic appendicitis,from April 2011 to April 2015 in our hosipital,were retrospective analysised,and we sum up the clinical manifestation,diagnosis and treatment,laparoscopic exploration indications and the technique of laparoscopic appendectomy.Laparoscopy exploration and laparoscopic appendectomy were made on all patients under general anesthesia by tracheal cannula.Results Of 19 patients,16 cases by ultrasonic examination get correct diagnosis before operation,of which the ultrasound diagnosis rate is 92.63％,3 limitations of acute peritonitis patients were preoperative misdiagno~s,they were the right kidney stones,acute cholecystitis and the right side of the annex inflammation;there were 2 patients converted to open operation,and the transfer rate is 10.53％.The blood loss of the operation is about 5-20 mL.They were ambulant after 9 hours,in full flow diet after 12 hours,and the average hospitalization time is 4 days.One patient,no other long-term complications were found postoperatively follow-up of 12 to 18 months,were poke holes in infection,and the complications of laparoscopic surgery is 5.27％.Conclusions Ectopic acute appendicitis has no specific clinical manifestation,and is easy to misdiagnosis.In the auxiliary examination,ultrasound is the first choice for the diagnosis of ectopic appendictis.Laparoscopy exploration and laparoscopic appendectomy are the ideal treatments of emergency treatment of ectopic appendicitis,and are worth of clinic application.