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Objective To investigate the efficacies of preoperative location with titanium clip and methylene blue staining in laparoscopic colectomy.Methods The clinical data of 31 patients with colorectal polyps which could not be resected under endoscope were admitted to the Third Affiliated Hospital of Sun Yat-Sen University from August 2006 to September 2012 were retrospectively analyzed.According to the methods of preoperative location of colorectal polyps,all patients were divided into the titanium clip group (18 patients) and the methylene blue group (13 patients).Titanium clip group:enteroscopic and pathological examination were firstly performed,and then 1 or 2 titanium clips were placed at the superior and inferior part of the polyps.After enteroscopic examination,abdominal X ray examination was performed to detect the position of polyps according to the positions of the titanium clips.Methylene blue group:after colonoscopy,methylene blue of 1 mL was injected into the adjacent mucosa of the polyps,and 4 positions around the polyps were selected for the injection of methylene blue.If the 2 locating methods were failed,intraoperative enteroscopy was performed.Laparoscopic resection for intestine or mesenterium was performed according to the treatment principle of colorectal neoplasms,and the location efficacy of the 2 methods and the treatment of the 2 groups were analyzed.The measurement data and the count data were analyzed using the t test and chi-square test,respectively.Results The success rates of the titanium clip group and the methylene blue group were 15/18 and 8/13,with no significant difference between the 2 groups (x2=0.284,P ＞0.05).The polyps in 8 patients which were failed to be localized by titanium clip or methylene blue were localized by intraoperative enteroscopy,while the operation time was prolonged to (44 ± 13)minutes.No positioning errors were detected in all the 31 patients.Laparoscopic right colectomy was performed on 4 patients,laparoscopic left colectomy on 11 patients,laparoscopic sigmoid colectomy on 9 patients,laparoscopic anterior resection of rectum on 7 patients.No morbidity or mortality was detected in the 2 groups.The length of specimen,distance between the proximal margin and the superior margin of the tumor,distance between the distal margin and the inferior margin of the tumor (patients with colonic polyps),distance between the distal margin and the inferior margin of the tumor (patients with high rectal polyps),and the number of lymph node resected were (20 ± 7) cm,(11 ± 4) cm,(8.6 ± 3.1) cm,4.2 ± 1.1,8 ± 5 in the titanium clip group,and (20 ± 5) cm,(9 ± 3) cm,(9.1 ± 2.8) cm,4.6 ± 0.5,7 ± 6 in the methylene blue group,with no significant difference between the 2 groups (t =0.053,0.918,0.213,1.486,0.267,P ＞0.05).Fifteen patients had cancerization of the polyps,including 8 patients with TNM Ⅰ stage,6 with TNM Ⅱ] stage and 1 with TNM Ⅲ stage.Conclusions For patients with colorectal polyps located at the intestine above the descending colon,titanium clip locating is easy,safe and effective,and it could be the first choice for locating the colorectal polyps.Endoscopic methvlene blue staining is simple but high technique demanding.Intraoperative enteroscopy is precise for locating the polyps at the intestine below the descending colon.
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Objective To investigate the antioxidative effects of all-trans retinoic acid (ATRA) on the intestinal ischemia reperfusion.Methods Thirty-two male SD rats were randomly divided into the sham operation group,occlusion group,dimethyl sulfoxide (DMSO) group and the ATRA group according to the random number table.There were 8 rats in each group.Rat models of intestinal ischemia reperfusion were established by clamping the superior mesenteric arteries for 60 minutes,and then restore the blood flow for 120 minutes.Superior mesenteric arteries were only separated without clamping in the sham operation group.Rats in the ATRA group received ATRA pretreatment through intragastric infusion at the dosage of 15 μg/g for 5 days,and then ATRA pretreatment at 6 hours before operation.Rats in the DMSO group received intragastric infusion of DMSO at the same dosage.The concentration of ATRA at 5 hours before operation was detected by high performance liquid chromatography.The pathomorphological changes of the ileal mucosa were detected by hematoxylin-eosin staining,and the Chiu's scores on the ileal mucosa were evaluated.The serum content of diamine oxidase (DAO),tissue level of malonaldehyde (MDA) and activity of superoxide dismutase (SOD) were detected by colorimetry.Protein expression of manganese superoxide dismutase (MnSOD) in the ileal tissues was detected by Western blot.All data were analyzed using the analysis of variance or LSD-t test.Results The concentrations of ATRA in the ATRA group was (827 ±276) μg/L,which was significantly higher than (48 ± 12) μg/L of the sham operation group,(55 ± 15) μg/L of the occlusion group and (63 ± 20) μg/L of the DMSO group (t =11.242,11.138,11.013,P ＜ 0.05).The morphology of the ileal mucosa was normal in the sham operation group,while the ileal mucosa was severely damaged in the occlusion group and the DMSO group.The injury of the ileal mucosa in the ATRA group was slight.The Chiu's scores of the occlusion group,DMSO group and the ATRA group were 3.83 ±0.77,3.92 ± 0.87 and 2.42 ± 0.75,which were significantly higher than 0.37 ± 0.28 of the sham operation group (t =9.803,10.040,5.793,P ＜0.05).The Chiu's scores of the ATRA group was significantly lower than that of the occlusion group and the DMSO group (t =4.009,4.247,P ＜ 0.05).The DAO levels of the occlusion group,DMSO group and the ATRA group were (26.3 ±4.4)U/L,(25.1 ± 4.3)U/L and (20.8 ±3.8)U/L,which were significantly higher than (14.2 ± 1.9) U/L of the sham operation group (t =6.493,5.835,3.534,P ＜ 0.05).The level of DAO of the ATRA group was significantly lower than that of the occlusion group and the DMSO group (t =2.959,2.301,P ＜0.05).The levels of MDA of the occlusion group,DMSO group and the ATRA group were (16.9 ± 4.0) μmol/g,(16.0 ± 3.5) μmol/g and (11.3 ± 3.1) μmol/g,which were significantly higher than (5.4 ± 1.0) μmol/g of the sham operation group (t =7.397,6.821,3.821,P ＜ 0.05).The level of MDA of the ATRA group was signifcantly lower than that of the occlusion group and the DMSO group (t =3.575,3.000,P ＜ 0.05).The SOD activity of the occlusion group,DMSO group and the ATRA group were (108 ±22) U/mg,(98 ± 19) U/mg and (181 ± 38)U/mg,which were significantly lower than (243 ± 37)U/mg of the sham operation group (t =8.939,9.647,4.106,P ＜ 0.05).The SOD activity of the ATRA group was significantly higher than that of the occlusion group and the DMSO group (t =4.833,5.541,P ＜ 0.05).The relative protein expressions of the MnSOD of the occlusion group and the DMSO group were 0.36 ± 0.08 and 0.28 ± 0.07,which were significantly lower than 0.93 ± 0.13 of the sham operation group (t =8.972,10.101,P ＜ 0.05).The relative protein expression of the MnSOD of the ATRA group was 0.80 ± 0.19,which was significantly higher than that of the occlusion group and the DMSO group (t =6.948,8.077,P ＜ 0.05),while it was not significantly different from that of the sham operation group (t =2.024,P ＞ 0.05).Conclusion Through up-regulating the expression of MnSOD and improving the antioxidative capacity of tissue,ATRA pretreatment can attenuate intestinal ischemia and reperfusion injury.
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Objective To study the effect of hyperlipidemia on postoperative complications in patients of colorectal cancer (CRC) undergoing open or laparoscopic surgery. Methods Clinical data of 382 CRC patients who received either traditional or laparoscopic operation from Mar. 2005 to Sep. 2009 were reviewed. By preoperative blood lipid levels, patients were divided into hyperlipidemia group and normal blood lipid group. Data were analyzed by Chi-square test and T test. Results In hyperlipidemia group of 201 CRC cases, volume of blood loss ( t = 11.318, P ＜ 0.01 ), time to resume oral intake( t =5.956, P ＜ 0.01 ), drainage tube removing (t = 4.781, P ＜ 0.01 ), hospital stay( t = 2.449, P ＜ 0.05 ), and incidence of wound liquefaction( x2 =3.988 ,P ＜0.05) were inferior to the other 181 cases in normal blood lipid group, while no difference was observed in operation time ( t = 0.374, P ＞ 0.05 ) and incidence of anastomotic leakage( x2 = 0.239, P ＞ 0.05 ). Patients who received laparoscopic operation had less blood loss (t=10.078 ,P ＜0.01 ), less time to resume oral intake(t =6.366,P ＜0.01 ) and earlier drainage tube removing ( t = 7.654, P ＜ 0.01 ), shorter hospital stay ( t = 4.241, P ＜ 0.01 ) and lower incidence of wound liquefaction ( x2 = 5. 203, P ＜ 0.05 ), though longer operation time ( t = 8.456, P ＜ 0.01 ) comparing with those receiving traditional operation. Among patients who received laparoscopic operation, there was no difference observed postoperatively in time to resume oral intake ( t = 0.356, P ＞ 0.05 ) and drainage tube removing (t = 0.261, P ＞ 0.05 ), and hospital stay (t = 0.248, P ＞ 0.05 ) between the hyperlipidemia group and normal blood lipid group, though the former suffered from more blood loss (t =8.784,P ＜0.01).Conclusions Hyperlipidemia impacts adversely on hemorrhage, delayed recovery and increasing rate of wound liquefaction on rectal cancer surgery. Laparoscopic surgery effectively eliminates prolonged postoperative recovery caused by hyperlipidemia.
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Objective To compare the effect and safety of enteral and parenteral nutritional support for gastric cancer patients undergoing laparoscopic radical gastrectomy(LRG). Methods Sixty gastric cancer patients received nutritional support after LRG at The Third Affiliated Hospital of Sun Yat-sen University from December 2007 to April 2010. All patients were randomly divided into the enteral nutrition(EN) group (n = 30)and parenteral nutrition (PN) group (n = 30) according to the random number table. Anthropometry, nutritional indexes, complications and expenses of the two groups were compared after treatment. All data were analysed by using the t test and chi-square test. Results Body mass index, triceps skin fold, mid-upper arm muscle circumference, hemoglobin levels, transferrin levels, and albumin levels were ( 16.9 ± 2.4) kg/m2, ( 10.6 ± 2.5 ) mm,(24.2 ±2.5) cm, (106 ± 15) g/L, (2.2 ±0.4) g/L and (39 ±3) g/Lin the EN group, and they were (16.6 ±2.1) kg/m2, (9.2 ± 1.3) mm, (24.0 ±3.4) cm, (102 ± 18) g/L, (2.0 ±0.4) g/L and (38 ±3) g/L in the PN group, respectively, with no significant differences between the two groups (t =0. 52, 1.72, 0.05, 0.93, 1.94,1.29, P ＞ 0.05). Prealbumin levels, nitrogen balance, time of first flatus, and daily expenses in the EN group were (0.30 ±0.10) g/L,0.8 ±0.3, (29 ± 10) hours and (210 ±30) yuan, while they were (0.25 ±0.09) g/L,0. 4 ± 0.2, (38±6) hours and ( 700 ± 50) yuan in the PN group, respectively, with a significant difference between the two groups ( t = 2. 03, 6. 08, 2. 25, 10. 38, P ＜ 0.05 ). One patient had dysbacteriosis, two were glycometabolic and two had a hepatic disorder in the EN group, while the corresponding numbers in the PN group were 9, 12 and 15 patients, respectively, with a significant difference between the two groups ( x2 =7.68, 9.32,13.87, P ＜ 0.05). Conclusions Nutritional support can promote the recovery of gastric cancer patients undergoing LRG. The efficacy of EN is superior to that of PN, and EN is the method of choice for nutritional support.
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Objective To investigate the effects of laporoscopic resection applied to colorectal cancer patients on metabolism. Methods According to patients' choice of operation, either laparoscopic-assisted (n = 22, experimental group) or open(n = 27, control group) resection of colorectal cancer was performed. The levels of electrolyte were assayed preoperatively, postoperatively and on the time of 24 hours after opera-tion. Rseults There was no significant difference in the level of electrolyte before operation between the two groups (P > 0. 05). Compared with the preoperative period, the level of serum potassium in the both groups were significantly increased after operation(P < 0. 05), and 24 hours later, the levels of electrolyte was not significantly different in both the two groups (P > 0. 05). During the postoperative period, the level of serum potassium in the experimental group was lower than the control group(P <0. 05), while the level of HCO_3~- was higher than the control group(P <0. 05), and there were no significant differences in the level of serum sodium, chloride and calcium between the two groups(P > 0. 05). Conclusions Laparoscopic-assisted re-section of colorectal cancer gives lower levels of stress responses compared to open surgery. However, it shows higher effect on the level of HCO_3~- , and must be paid more attention during operative and postopera-tive period.
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Objective To investigate the clinical value of nutritional risk screening 2002(NRS2002)and malnutritional universal screening tools(MUST)in the preoperative nutrition risk evaluation of patients with gastric cancer.Methods The preoperative nutritional risk of 3 14 patients who had been admitted to the Third Affiliated Hospital of Sun Yat-sen University from January 2004 to December 2007 was assessed by subjective global assessment(SGA),NRS 2002 and M UST,and the influence of nutritional risk on the incidence of postoperative complications and hospital stay was investigated.All data were analyzed by Wilcoxon test,Kappa test and Logistics regression analysis.Results Compared with SGA,the sensitivity,specificity,positive predicting value and negative predicting value were 86.7%,74.2%,86.9% and 73.8% for NRS2002,and were 73.1%,70.6%,74.8% and 68.7% for MUST.Compared with MUST,NRS2002 had a higher consistency with SGA(K_(NRS2002)=0.601,K_(MUST)=0.436).Logistic regression analysis revealed that patients with higher MUST or NRS2002 score had higher incidence of postoperative complications and longer hospital stay.In the aspect of hospital stay,the relative risk of MUST was 2.517,which was lower than 3.426 of NRS2002.The relative risk of MUST was 0.529,which was lower than 0.642 of NRS2002 in the aspect of incidence of postoperative complications.Conclusions NRS2002 and MUST are suitable for preoperative nutritional risk screening of patients with gastric cancer,and the score of NRS2002 or MUST is associated with the incidence of postoperative complications and length of hospital stay.However,NRS2002 is more accurate than MUST in the reflection of nutritional risk of patients with gastric cancer.
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Objective To evaluate the preoperative nutritional status of patients with gastric carcinoma by using the European Nutritional Risk Screening 2002(NRS 2002)and its prediction for postoperative nutrition-related complications.Methods We prospectively evaluated the nutritional risk of 314 gastric cancer patients admitted in one center from 2004 to 2007 with NRS 2002 with China's normal body mass index(BMI),in terms of postoperative complications,mortality and hospital stay.Results NRS 2002 scoring system was applicable in 93.1% cases.Preoperatively 125 patients were of score≥3,accounting for 39.8% of this group.The postoperative complication rate(26.2%)was higher than 13.8% in those with normal preoperative nutritional scores(NRS 2002 score＜3)(P＜0.05);The odds ratio to develop a complication was 0.642 in patients with preoperative nutritional risk score(P＜0.05),and 1.596 in patients with clinicopathological stage of gastric cancer(P＜0.01).The correlation between length of hospital stay and nutritional risk was also assessed by Pearson correlation analysis.The Pearson coefficient was 0.177(P=0.002).Conclusion Preoperative nutrition score(NRS 2002)≥3 predicts higher postoperative complications and longer hospital stay.Preoperative nutritional support is necessary in patients with preoperative nutrition score(NRS 2002)≥3.
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OBJECTIVE: To identify Pogostemon cablin and Cortex Magnoliae Officinalis in Huoxiang zhengqi pills by Gas Chromatography-Mass Spectrometry. METHODS:Pogostemon cablin and Cortex Magnoliae Officinalis in Huoxiang zhengqi pills were extracted by ultrasound extraction technology and identified on SPB-1701 column(30 m?0.25 mm?0.25 ?m) with He as carrier gas and EI as ion source at an electron energy of 70 eV. RESULT:The main components such as Patchouli alcohol from Pogostemon cablin,and Magnolol and Honokiol from Cortex Magnoliae Officinalis were identified simultaneouly. CONCLUSION: The method is simple,rapid,accurate and reliable,and applicable for the quality control of Huoxiang zhengqi pills.