ABSTRACT
Objective:To prevent postoperative reflux symptoms in patients undergoing proximal gastrectomy for esophagogastric junction cancer by using a new method of anti-reflux anastomosis.Methods:The clinical data of 15 patients with esophagogastric junction cancer at Department of Gastrointestinal Surgery , Second Hospital of Hebei Medical University from Jan 2018 to Apr 2019 were analyzed, and a new method of anti-reflux anastomosis was used to compare the difference of reflux between preoperative and postoperative status.Results:All patients recovered well after operation, 2 patients suffered moderate swallow disturbance after one month of operation, and the symptoms disappeared by gastroscope anastomosis dilation. The scores of reflux disease questionnaire before and after operation were in accordance with normal distribution (16 ±12 vs. 10 ±4, t=1.877, P=0.081), the results showed that there was no significant difference. Conclusion:This new method of anti-reflux anastomosis has a definite anti-reflux effect on postoperative patients with esophagogastric junction cancer.
ABSTRACT
Objective:To compare and analyze the clinical efficacy of hand-assisted laparoscopic surgery (HALS) and laparoscopic assisted surgery (LAS) in the treatment of advanced gastric cancer.Methods:Articles of the efficacy comparison of HALS and LAS in D2 radical gastrectomy for gastric cancer from 2000 to 2019 published in PubMed, Cochrane library, EM-BASE, China National Knowledge Infrastructure (CNKI), Wanfang, Weipu, Chinese full-text database of Chinese Sci-Tech journals, Chinese biomedical literature database were retrieved, and the literatures were screened according to the pre-established inclusion and exclusion criteria. The quality of the two groups was evaluated, and the short-term indexes and complications for meta-analysis of the two groups were analyzed by using Revman 5.3 software.Results:A total of 1277 patients were included in 10 articles, including 629 in the HALS group and 648 in the LAS group. The results of the meta-analysis showed that compared with the LAS group, the operation time was shorter in the HALS group (WMD=24.02, 95% CI: -40.41--7.62, P=0.004), but the auxiliary incision was slightly longer (WMD=0.27, 95% CI: 0.06-0.47, P=0.01), and there were no statistically significant difference in the remaining number of lymph node dissections (WMD=0.58, 95% CI: -1.22-2.39, P=0.53), intraoperative blood loss (WMD=-7.94, 95% CI: -16.21-0.33, P=0.06), gastrointestinal tract recovery time (WMD=0.00, 95% CI: -0.03- 0.04, P=0.85), total length of hospital stay (WMD=-0.14, 95% CI0: -0.36-0.09, P=0.23) and postoperative complications ( OR=0.89, 95% CI: 0.58-1.37, P=0.61). Conclusions:Compared with the LAS for D2 radical surgery of advanced gastric cancer, HALS has significantly shorter operation time and is easier to perform than LAS, but the incision length is slightly increased. Physicians can choose the appropriate operation method according to the specific conditions of the operation and themselves.
ABSTRACT
The comprehensive paper of thyroid Hurthle cell neoplasms(NCNs) is made on the literatures review.This paper reveals the follows:(1)HCNs differ significantly from follicular neoplasms on a molecular level;(2)Clinical and morphological parameters were not helpful in predicting recurrence and in differentiating benign from malignancy neoplasms;(3) The treatment of choice for adenoma is lobo-isthmectomy. For malignant Hurthle cell tumor, total thyroidectomy is the most rational treatment associated with cervical lymphadenectomy in the presence of matastatic nodes. In all cases, long-term periodical follow-up should be done; (4)HCNs represent a pathological entity;(5)The criteria of differentiating adenoma from carcinoma needs further investigation to guide the clinical treatment ;(6)Treatment process of HCNs should be individualized according to the clinical and histopathological results.