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Background: Laterally spreading tumor (LST) is one of the commonly seen neoplastic lesions under colonoscopy. The risk of malignant transformation is considerably high. Aims: To compare the efficacy and safety of endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD) for treatment of colorectal LST. Methods: Eighty-eight patients with colorectal LST were randomly divided into two groups and received EMR and ESD treatment, respectively, from Oct. 2016 to Dec. 2018 at the Baoshan Hospital of Integrated Traditional Chinese and Western Medicine. For LST larger than 20 mm in diameter in EMR group, piecemeal EMR was recommended. The procedure time, complications, en bloc resection rate and recurrence rate during 1-year follow-up were compared between the two groups. Results: All patients enrolled in this study achieved a complete resection. The procedure time of EMR was shorter than that of ESD [(23.73±6.19) min vs.(65.13±13.76) min], and the en bloc resection rate was higher (97.7% vs. 59.1%) and the recurrence rate was lower (11.4% vs. 31.8%) in ESD group than in EMR group (P0.05). In EMR group, the majority of recurrence occurred in cases with LST larger than 20 mm in diameter. Conclusions: For colorectal LST, the method of endoscopic treatment should be selected based on patients' clinical condition. Although the procedure time of EMR is shorter, ESD is more suitable for lesions larger than 20 mm in diameter.
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Objective@#To evaluate the protective effects of ulinastatin combined with lung-protective ventilation on lungs in patients undergoing laparoscopic colorectal carcinoma surgery.@*Methods@#A total of 120 patients undergoing laparoscopic radical resection of colorectal cancer in Yuncheng Central Hospital were selected in this study.According to thedigital table, they were randomly divided into conventional mechanical ventilation group(G0 group), lung protection mechanical ventilation group(G1 group), conventional mechanical ventilation combined with ulinastatin group(G2 group)and lung protection mechanical ventilation combined with ulinastatin group(G3 group), with 30 cases in each group.Ulinastatin 2 500IU was intravenously infused 10min before induction of anesthesia in G2 group and G3 group.Ventilator parameters were set as tidal volume(VT)10mL/kg, respiratory frequency 12 times/min, inspiration-expiration ratio(I∶E)1∶2 in G0 group and G2 group.VT 6mL/kg in G1 group and G3 group , positive end-expiratory pressure ventilation(PEEP)5-10cmH2O, respiratory frequency 12-18 times/min, once every 30min.Before anesthesia induction(T0), before pneumoperitoneum(T1), 2h after pneumoperitoneum(T2), before extubation(T3), 24h after operation(T4), arterial blood was collected to detect partial pressure of oxygen(PaO2), oxygenation index(OI). And mean airway pressure(Pmean), peak airway pressure(Ppeak)at T1-3 were recorded.Venous blood was collected at T0, T3 and T4 to detect serum concentrations of interleukin-6(IL-6), interleukin-8(IL-8)and tumor necrosis factor-alpha(TNF-α).@*Results@#At T3, the PaO2 of G1 group, G2 group and G3 group were (457±60)mmHg, (460±49)mmHg and (510±45)mmHg, respectively.At T4, the PaO2 of the three groups were (90±6)mmHg, (92±7)mmHg and (96±7)mmHg, respectively.The PaO2 in G1 group and G2 group were lower thanthose in G3 group at T3-4(t=3.872, 3.850, 4.186, 2.513, all P<0.05). At T2, the OI of the three groups were (460±44), (462±37) and (481±31), respectively.At T3, the OI of the three groups were (460±51), (475±62) and (504±38), respectively.The OI in G1 group and G2 group were lower than those in group G3 at T2-3(t=2.142, 3.753, 2.209, 2.170, all P<0.05). At T2, the Pmean of G1 group, G2 group and G3 group were (10.5±1.5)cmH2O, (11.2±1.9)cmH2O and (9.5±0.9)cmH2O, respectively, the Ppeak of the three groups were (22.3±3.0)cmH2O, (24.0±3.3)cmH2O and (22.3±2.9)cmH2O, respectively.At T3, the Pmean of the three groups were (10.9±1.1)cmH2O, (11.1±1.8)cmH2O and (9.8±0.9)cmH2O, respectively, the Ppeak of the three groups were (22.8±2.7)cmH2O, (24.1±2.1)cmH2O and (21.6±2.0)cmH2O, respectively.The Pmean in G1 group and G2 group at T2-3 were lower than those in G3 group(t=3.061, 4.580, 5.759, 4.305, 3.746, all P<0.05), the Ppeak in G2 group at T2-3 were lower than those in G3 group(t=2.952, 4.630, all P<0.05). At T4, the serum concentrations of IL-6 of G1 group, G2 group and G3 group were (151±28)ng/L, (152±20)ng/L and (136±18)ng/L, respectively, the IL-8 levels of the three groups were (468±28)ng/L, (359±65)ng/L and (327±51)ng/L, respectively, the TNF-α levels of the three groups were (1.09±0.20)ng/L, (1.08±0.20)ng/L and (0.94±0.20)ng/L, respectively.The concentrations of IL-6, IL-8 and TNF-α at T4 in G1 group and G2 group were higher than those in G3 group(t=2.428, 4.094, 2.536, 4.251, 2.807, 3.128, 4.119, 2.592, 3.446, 2.555, all P<0.05).@*Conclusion@#The combination of ulinastatin and lung-protective ventilation provides protective effects on lungs and exerts better efficacy than either alone.
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Objective To evaluate the effectiveness and safety of the combination of dexmedetomidine and propofol for sedation in pediatrics undergoing regional anesthesia.Methods Forty-eight children aged 2 -6 years old,scheduled for elective surgery under regional anesthesia,were randomly divided into the two groups.The dexme-detomidine plus propofol group(group DP,n=24)received an infusion over 10 minutes of dexmedetomidine 0.7μg/kg and propofol 1.0 to 2.5 mg/kg bolus for induction,then an infusion of dexmedetomidine 0.5μg·kg-1·h-1 and propofol 100-300μg·kg-1·min-1 for maintenance.The propofol group(group P,n=24)received a propofol 1.0 to 2.5mg/kg bolus for induction,then an infusion of propofol 150 -300μg·kg-1 ·min-1 for maintenance.If body movement was detected during surgery,a bolus of propofol 1 .0mg/kg was administered in both groups,and if there was another body movement within three minutes of the propofol bolus,a bolus of ketamine 1 .0mg/kg was adminis-tered.Hemodynamic data,respiratory rate,and oxygen saturation were recorded by researchers blinded to the study drugs.Recovery time and the primary outcome were evaluated by a modified Aldrete score.The occurrence of adverse events and the amount of supplemental ketamine used were also recorded.Results The consumption of propofol in the group DP was (149.00 ±24.93)μg·kg-1·min-1,and in the group P was (217.00 ±17.90)μg·kg-1· min-1.The propofol consumption was significant lower that in group DP(t=117.94,P=0.00).The needs for sup-plemental ketamine bolus in the group DP was 0.50(1.00)/case,and it was 2.00(1.00)/case in group P.The need for supplemental ketamine was less in group DP(Z=-4.48,P=0.00).Hypopnea occurred in 5 cases in group P, and 0 in group DP.The incidence of hypopnea was more in group P(χ2 =5.58,P=0.03).In group DP,the mean arterial pressure and heart rate at discharge were respectively (74.96 ±5.69)mmHg and (101.17 ±9.65)bpm,and their baseline values were (81.13 ±7.23)mmHg and (112.00 ±13.65)bpm.Both mean arterial pressure and heart rate in the group DP remained decreased at discharge(t=10.78,P=0.00;t=10.08,P=0.00;respectively).The discharge time of the group DP was (40.91 ±10.90)min and it was(39.67 ±14.95)min in group P.There was no significant difference in the discharge time(t=0.11,P=0.74).Conclusion The combination of dexmedetomidine and propofol can provide appropriate depth of sedation in pediatric patients undergoing regional anesthesia.
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Objective To evaluate the effect of dexmedetomidine as a supplementary to combined lumbar plexus-sciatic nerve block for arthroscopic knee surgery.Methods Fifty patients who were scheduled for arthroscopic knee surgery and ASA class Ⅰ or Ⅱ grade,were divided into control group and dexmedetomidine group by random digits table method with 25 cases each.The patients of dexmedetomidine group were given loading dose dexmedetomidine 0.8 μ g/kg(injection time 10 min) by intravenous infusion,then were given maintenance dose 0.4 μμ g/(kg· h) to the end of operation.The patients of control group were given 0.9％ sodium chloride,methods with the dexmedetomidine group.After 10 min,combined lumbar plexus-sciatic nerve block was performed by a nerve stimulator in both groups.Fentanyl 50 μμ g was infused intravenously to the patient whose effect of block was inadequately.The mean arterial pressure (MAP),heart rate (HR),pulse oxygen saturation (SpO2),respiratory frequency at preanesthesia (T0),beginning of dexmedetomidine infusion (T1),beginning of surgery (T2),10 minutes of surgery (T3) and the end of surgery (T4) were recorded,and intraoperative untoward reaction,using of fentanyl and doctor's satisfaction rate were recorded.Results There were no statistical differences in MAP and HR at T0 between the 2 groups (P＞ 0.05).MAP and HR at T2-4 were significantly higher than those at T0 in control group,furthermore MAP and HR at T2-4 in control group were significantly higher than those in dexmedetomidine group [MAP:(137 ± 18) mm Hg(1 mm Hg =0.133 kPa) vs.(107 ± 14) mm Hg,(132 ± 11) mm Hgvs.(107 ± 11) mm Hg,(131±13) mm Hg vs.(95 ± 12) mm Hg;HR:(99 ± 17) times/rmin vs.(88 ± 14) times/min,(99 ± 14) times/min vs.(81 ± 15) times/min,(97 ± 14) times/rmin vs.(76 ± 11) times/min],there were statistical differences (P ＜ 0.05).There were no statistical differences in respiratory frequency and SpO2 between the 2 groups (P ＞0.05),but 2 cases in dexmedetomidine group,5 cases in control group appeared SpO2 ＜0.90,they quickly returned to normal (＞ 0.97) by holding up the submaxilla.The using rate of fentanyl and doctor's satisfaction rate in dexmedetomidine group were significantly better than those in control group [28％(7/25)vs.68％(17/25),100％(25/25) vs.80％(20/25)],there were statistical differences (P＜ 0.05).There were no statistical differences in the using rate of atropine and efedrina,the rate of respiratory depression between the 2 groups (P ＞ 0.05).Conclusion Dexmedetomidine as a supplementary to combined lumbar plexus-sciatic nerve block for arthroscopic knee surgery has effect confirmed,low untoward reaction,high doctor' s satisfaction rate.
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Objective To evaluate the efficacy of dexmedetomidine used to supplement lumbar plexus combined with sciatic nerve block for total hip arthroplasty in the elderly patients.Methods Fifty ASA Ⅱ or Ⅲ patients,aged 80-93 yr,with a body mass index of 17-25 kg/m2,scheduled for unilateral total hip arthroplasty,were randomly divided into 2 groups (n =25 each):normal saline group (group NS) and dexmedetomidine group (group D).Lumbar plexus combined with sciatic nerve block was performed guided by a nerve stimulator in both groups.After a loading dose of dexmedetomidine 0.5 μg/kg was infused over 10 min starting from 20 min after the block,dexmedetomidine was infused at 0.2 μg· kg-1 · h-1 until the end of surgery.While the equal volume of normal saline was given instead of dexmedetomidine in group C.Propofol 20 mg or ketamine 10 mg was infused intravenously when the efficacy of the block was inadequate.The mean arterial pressure (MAP),heart rate (HR),pulse oxygen saturation (SpO2),respiratory rate (RR),side effects during operation,requirement for propofol or ketamine and doctor' s satisfaction were recorded after admission to the operating room,immediately after iv administration,at 0,10 and 30 min after the beginning of surgery,and at the end of surgery (T0-5).Results Compared with the baseline value at T0,MAP and HR were significantly increased at T2-5 in group C (P ＜ 0.05),and no significant change was found in the hemodynamic parameters at each time point in group D (P ＞ 0.05).Compared with group C,the MAP,HR,incidences of respiratory depression and agitation and requirement for propofol or ketamine were significantly decreased,and the doctor's satisfaction was significantly increased (P ＜ 0.05).Conclusion Dexmedetomidine can increase the efficacy of lumbar plexus combined with sciatic nerve block when used for supplementation of total hip arthroplasty in the elderly patients,the hemodynamics is stable and side effects are fewer.