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Objective To explore the clinical value of enhanced recovery after surgery (ERAS) in the perioperative period of biliary surgery.Methods The prospective study was adopted.The clinical data of 800 patients diagnosed as benign biliary tract diseases who were admitted to the Cangzhou's Central Hospital from March 2011 to January 2015 were collected.Patients were randomly divided into the case and control groups by random sequence method.The patients of case group received the ERAS management and patients of the control group received traditional perioperative management.(1) Stress state evaluation:the insulin resistance (IR) index and level of serum C-reactive protein (CRP) were calculated.(2) Levels of inflammatory cytokines:levels of IL-6 and TNF-α in the 2 groups were detected by enzyme-linked immunosorbent assay (ELISA).(3)Nutritional status:level of serum prealbumin (PA) was detected.(4) Postoperative status:time to anal exsufflation,time of defecation,duration of hospital stay and treatment expenses were recorded.(5) Postoperative complications were observed.Measurement data with normal distribution were represented as x ± s and comparison between groups was analyzed using t test.Repeated measurement data were analyzed by the repeated measures ANOVA.Count data were represented as ratio and analyzed using the chi-square test.Results The 800 patients were screened for eligibility,including 400 in each group.(1) Stress state evaluation:the levels of IR and CRP from pre-operation to 7 days after operation were from 3.8 ± 0.8 to 3.7 ± 0.7 and from (18 ± 5) μg/L to (27 ±8) μg/L in the case group,from 3.9 ±0.9 to 3.8 ±1.0 and from (18 ±5) μg/L to (38 ±9) μg/L in the control group,respectively,with statistically significant differences in the changing trends (F =12.38,17.85,P ＜0.05).(2) Comparisons of levels of inflammatory cytokines:levels of IL-6 and TNF-α from pre-operation to 7 days after operation were from (9.3 ± 3.1) ng/L to (12.5 ± 2.8) ng/L and from (10.2 ± 3.5) ng/L to (12.8 ±3.3)ng/L in the case group,from (8.9 ±3.3)ng/L to (17.3 ±6.5)ng/L and from (9.9 ±2.8) ng/L to (14.3 ±4.2)ng/L in the control group,with statistically significant differences in the changing trends (F =19.93,15.74,P ＜ 0.05).(3) Comparison of nutritional status:level of PA from pre-operation to 7 days after operation was from (335 ± 53)mg/L to (332 ±50)mg/L in the case group and from (330 ± 49)mg/L to (331 ± 45)mg/L in the control group,with a statistically significant difference in the changing trends (F =4.46,P ＜ 0.05).(4)Comparisons of postoperative status:time to anal exsufflation,time of defecation,duration of hospital stay and treatment expenses were (30 ± 10)hours,(51 ± 13) hours,(7.7 ± 2.5) days,(10.2 ±2.3) × 103 yuan in the case group and (54 ± 8) hours,(70 ± 16) hours,(15.4 ± 3.1) days,(15.6 ± 4.7) × 103 yuan in the control group,with statistically significant differences (t =37.73,18.62,38.67,20.64,P ＜0.05).(5) Comparisons of postoperative complications:incidence of complications was 15.00％ (60/400)in the case group and 22.50％(90/400) in the control group,and the numbers of patients with incision infection,nausea and vomiting,abdominal infection,intra-abdominal infection,urinary tract infection,intro-abdominal hemorrhage and bile leakage were 23,15,8,5,4,3,2 in the case group and 30,20,13,10,7,5,5 in the control group,respectively,showing statistically significant differences in the incidence of complications (x2=7.39,P ＜ 0.05).Conclusion ERAS management in the perioperative period of biliary surgery is beneficial to postoperative recovery of patients,and it can also relieve postoperative stress state and inflammatory response,reduce the duration of hospital stay,treatment expenses and incidence of postoperative complications.
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Objective To explore the clinical features of patients with surgical malignant peritoneal mesothelioma.Methods From April 2008 to November 2012,the clinical data of 14 patients with surgery and pathologically diagnosed malignant peritoneal mesothelioma were retrospectively analyzed.Results Among the 14 patients,13 cases had a history of asbestos exposure.There were 10 cases with abdominal pain,seven cases with bloatting,and one case with intermittent vaginal bleeding.There were 13 cases with asbestos plaques,14 cases with organ infiltration,nine cases with little or no ascites,one case with mild lymph nodes enlargement in peritoneal cavity,but no case was found with distant metastasis.There were three cases with diffuse type and 11 cases with localized type.Serum CA125 level increased in seven cases.Seven cases received postoperative chemotherapy,and the average survival time was five months after surgery.To the closing date,two patients with localized peritoneal lesions are still alive.Conclusions The incidence of the group of patients with malignant peritoneal mesothelioma is closely related to the contact with asbestos.Localized type is the dominant type,without lymph nodes enlargement and distant metastases.Survival rate may improve in patients with early surgery.
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<p><b>OBJECTIVE</b>To analyze the efficacy and prognosis of different treatments on small intestinal gastrointestinal stromal tumors(SIGIST).</p><p><b>METHODS</b>Clinical data of 63 patients with SIGIST who were admitted to the Chinese PLA General Hospital from January 2004 to December 2013 were analyzed retrospectively. According to resection procedure and postoperative use of imatinib, patients were divided into R0 resection plus imatinib group (13 cases), R0 resection without imatinib group (42 cases), non-R0 resection plus imatinib group (7 cases), non-R0 resection without imatinib group (1 case). Survival was compared among groups. Result All the patients were followed up with a median length of 24 months(3 to 120 months), and the over survival (OS) rates at 1-year, 3-year, 5-year were 97%, 94% and 80%. In R0 resection plus imatinib group, R0 resection without imatinib group, and non-R0 resection plus imatinib group, the progression free survival(PFS) time was 24, 24 and 23 months; the 1-year PFS were 100%, 97% and 83%; the 3-year PFS were 100%, 45% and 83%; the 5-year PFS were 100%, 28% and 42%. R0 resection plus imatinib group had significantly higher PFS(all P<0.05). The case of non-R0 resection without imatinib died 6 months after operation. Among 55 patients undergoing R0 resection, recurrence was found in 16 patients, whose recurrence rates of 1-year, 3-yeart and 5-year were 2%,43% and 58%. Local recurrence was found in 8 cases, hepatic recurrence in 3 cases and widespread recurrence in 5 cases, who received simple imatinib, operation plus imatinib and imatinib intervention, with median survival time of 66.5 months, 92.5 months and 48 months respectively. One patient initiatively abandoned treatment and died 17 months later.</p><p><b>CONCLUSION</b>The total resection and postoperative imatinib administration can improve the prognosis and raise the progression free survival of patients with small intestinal stromal tumors.</p>