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Objective To investigate the clinical efficacy of thoracoscopic and laparoscopic radical resection for adenocarcinoma of the esophagogastric junction (AEG) with side-to-side tubular gastroesophagostomy.Methods The retrospective and descriptive study was conducted.The clinicopathological data of 4 patients with AEG who were admitted to the First Affiliated Hospital of Xiamen University between November 2017 and June 2018 were collected.All the patients underwent thoracoscopic and laparoscopic radical resection for AEG using side-to-side tubular gastroesophagostomy and received 6 cycles of postoperative adjuvant chemotherapy with SOX regimen.Observation indicators:(1) surgical and postoperative recovery situations;(2) postoperative pathological examination;(3) follow-up and survival situations.The follow-up using outpatient examination and telephone interview was performed to detect postoperative adjuvant therapy situations and survival of patients up to Semptember 2018.Results (1) Surgical and postoperative recovery situations:4 patients successfully underwent thoracoscopic and laparoscopic radical resection for AEG using side-to-side tubular gastroesophagostomy,without conversion to thoracotomy,open surgery or perioperative death.Operation time,volume of intraoperative blood loss,time for postoperative fluid diet intake and postoperative drainage-tube removal time of case 1,2,3,4 were respectively 420 minutes,400 minutes,320 minutes,300 minutes and 100 mL,100 mL,150 mL,100 mL and 9 days,8 days,8 days,8 days and 11 days,10 days,10 days,10 days.Case 1 with mild pneumonia and hiccup and case 2 with mild pneumonia were improved by symptomatic treatment,case 3 and 4 didn't have complication.All the patients had postoperative patent anastomosis.Duration of postoperative hospital stay of case 1,2,3,4 were respectively 12 days,11 days,11 days,11 days.(2) Postoperative pathological examination:all the 4 patients had negative surgical margin.Number of lymph node dissected,number of positive lymph node,tumor diameter,Siewert type,depth of tumor infiltration,tumor histopathologic stage of case 1,2,3,4 were respectively 32,31,17,23 and 0,4,2,6 and 3.5 cm,5.0 cm,5.0 cm,4.0 cm and type Ⅱ,Ⅰ,Ⅱ,Ⅰ and subserosa,entire wall of the esophagogastric junction,subserosa,entire wall of the esophagogastric junction and Ⅱ A staging,Ⅲ B staging,Ⅱ B staging,Ⅲ A staging.Degree of tumor differentiation and pathological type were moderately differentiated adenocarcinoma in the 4 patients.(3) Follow-up and survival situations:4 patients were followed up for 3-10 months,with a median time of 5 months.During the follow-up,4 patients underwent chemotherapy and achieved disease-free survival.Conclusion Thoracoscopic and laparoscopic radical resection for AEG using side-to-side tubular gastroesophagostomy is safe and feasible.
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Objective To investigate clinical effects and prognostic factors of transabdominal laparoscopic-assisted and open radical resection for Siewert type Ⅱ and Ⅲ adenocarcinoma of the esophagogastric junction (AEG).Methods The retrospective cohort and case-control studies were conducted.The clinicopathologieal data of 84 patients with Siewert type Ⅱ and Ⅲ AEG who were admitted to the First Affiliated Hospital of Xiamen University from January 2014 to January 2017 were collected.Among 84 patients,42 undergoing transabdominal laparoscopic-assisted radical gastectomy (LARG) were allocated into LARG group and 42 undergoing transabdominal open radical gastectomy (ORG) were allocated into ORG group.Observation indicators:(1) comparison of intraoperative and postoperative recovery situations between groups;(2)comparison of follow-up and survival situations between groups;(3) prognostic analysis of patients with Siewert type Ⅱ and Ⅲ AEG undergoing transabdominal radical resection.Follow-up using outpatient examination and telephone interview was performed to detect postoperative survival situations,tumor recurrence and metastasis of patients up to January 2018.Measurement data with normal distribution were representde as-x±s,and comparison between groups was analyzed using the t test.Measurement data with skewed distribution were described as M (range).Comparison of count data were analyzed using the ehi-square test or Fisher exact probability.Ordinal data were compared between groups using the Mann-Whitney U nonparametric test.The survival rate and curve were respectively calculated and drawn by the Kaplan-Meier method,and Log-rank test was used for survival and univariate analyses.Multivariate analysis was done by COX proportional hazard model.Results (1) Comparison of intraoperative and postoperative recovery situations between groups:patients with Siewert type Ⅱ and Ⅲ AEG in the LARG and ORG group underwent successful transabdominal radical resection,without conversion to thoracotomy.All patients in the LARG group underwent esophagojejunostomy with circular stapler device,38 and 4 patients in the ORG group underwent esophagojejunostomy with circular stapler and linear cut stapler respectively.Operation time,volume of intraoperative blood loss,length of incision,time of postoperative analgesia,cases with anastomotic bleeding,anastomotic leakage,abdominal bleeding,incisional infection,pulmonary infection,abdominal infection and reflux esophagitis of grade Ⅰ ～ Ⅱ postoperative complications and duration of postoperative stay were respectively (261±50)minutes,(119±111)mL,(7.8±1.6)cm,(2.1±1.3)days,1,1,0,0,1,0,0,(12.8 ± 1.9) days in LARG group and (216 ± 52) minutes,(230± 178) mL,(17.3± 1.8) cm,(3.4±1.2)days,2,0,2,2,2,1,2,(18.4±15.3)days in ORG group,with statistically significances between groups (t =2.357,2.960,2.195,2.013,x2 =5.486,t =2.125,P＜0.05).All patients with complications were improved by symptomatic treatment.(2) Comparison of follow-up and survival situations between groups:81 of 84patients including 41 in LARG group and 40 in ORG group were followed up for 6-48 months,with a median time of 29 months.The postoperative 2-year overall and tumor-free survival rates were respectively 85.1％ and 82.1％ of 41 patients in LARG group and 83.1％ and 79.3％ of 40 patients in ORG group,with no statistically significance between groups (x2 =0.013,0.049,P＞0.05).(3) Prognostic analysis of patients with Siewert type Ⅱ and Ⅲ AEG undergoing transabdominal radical resection:results of univariate analysis showed that tumor diameter,tumor TNM staging,tumor T staging,tumor N staging and postoperative adjuvant chemotherapy were related factors affecting prognosis of patients with Siewert type Ⅱ and Ⅲ AEG undergoing transabdominal radical resection (x2 =8.349,14.376,9.732,17.250,8.012,P＜0.05).Results of multivariate analysis showed that tumor TNM staging and postoperative adjuvant chemotherapy were independent factors affecting prognosis of patients with Siewert type Ⅱ and Ⅲ AEG undergoing transabdominal radical resection (risk ratio =4.305,0.031,95％ confidence interval:1.858-9.977,0.004-0.246,P＜0.05).Conclusions Transabdominal laparoscopicassisted radical resection for AEG is safe and feasible,with advantage of minimally invasiveness,having equivalent long-term effects compared to open surgery.Tumor TNM staging and postoperative chemotherapy are independent factors affecting prognosis of patients with Siewert type Ⅱ and Ⅲ AEG undergoing transabdominal radical resection.
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Objective To study content of interleuin-2 receptor(SIL-2R) pathologic relation with inflammation and fibrosis degree in patient with hepatitis of chronic B type.Methods 250 cases in hepatitis of chronic B type and 40 cases in fat liver were alive examined,according to inflammation degree different divided in to the G_1 80 example,G_2 75 example,G_3 50 example,G_4 45 example;According to fibrosis degree different S_0 40 example,S_1 60 example,S_2 50 example,S_3 50 example with the S_4 50 example;40 example fat liver of control group;The comtents of sIL-2R,HA,Ⅳ?C,PLD,LN,PCⅢ had been detected by radioimmunoassy(RIA) and enzyme immunity.Results The contents of SIL-2R of S_1,S_2,S_3 were obviously higher than that S_0(P