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Objective To investigate the clinical effective of laparotomy or laparoscopic total mesorectal excision surgery for patients with colorectal cancer. Methods One hundred and one patients with colorectal cancer in the Beijing Jiangong Hospitalour were selected as our subjects and divided into control group and treatment group. Patients in control group were received laparotomy and patients in treatment group were performed laparoscopic total mesorectal excision surgery. Clinical effective were recorded. Results The blood loss volume,postoperative discharge time,postoperative indwelling catheter time,hospital stay in treatment group were(143. 9 ± 32. 3)ml,(3. 1 ± 1. 2)d,(3. 5 ± 1. 4)d and(11. 9 ± 2. 1)d,less than those in control group ((198. 9 ± 41. 2)ml,(5. 3 ± 1. 3)d,(6. 1 ± 1. 5)d and(16. 9 ± 2. 3)d respectively). And the differenced were significant(t = 4. 994,9. 858,6. 543,6. 593;All P 0. 05). There were no significant difference between two group in terms of NK,CD3 + ,CD4 + and CD8 + level (P > 0. 05)at before treatment. The NK,CD3 + ,CD4 + and CD8 + levels in control group after treatment were 8. 3 ± 0. 9,(64. 5 ± 4. 8)% ,(34. 3 ± 3. 0)% and(32. 8 ± 2. 4)% and those were 13. 0 ± 1. 0,(71. 9 ± 5. 1)% ,(45. 2 ± 3. 2)% and(26. 1 ± 2. 2)% in treatment group after treatment. The differences were significant( t = 5. 488,8. 481,4. 954,7. 493;P 0. 05). Conclusion The clinical effective of laparoscopic total mesorectal excision surgery is better than laparoscopic surgery.
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ObjectiveTo investigate the feasibility and effectiveness of low central venous pressure (LCVP) in the operation of major hepatic resection.MethodsFourty-eight patients underwent major hepatic resection were randomized into two groups: LCVP and control group.In the LCVP group,CVP was maintained ≤5 cm H2O during the hepatic resection and then returned to normal after resection.In the control group,CVP was maintained normal between 6 -12 cm H20.The duration of hepatectomy,volume of blood loss,volume of blood transfused and renal function were compared between the two groups.ResultsFor the LCVP and control group,the time for hepatectomy was (45 ± 8 ) and ( 35 ± 5 ) min,respectively; the volumes of blood loss were ( 850 ± 160) and (436 ±280)ml,respectively; the blood loss during operation was (490 ± 130) and (270 ± 105 ) ml respectively.The differences were statistically significant (t values were 15.53,7.69 and 17.89 separately,P ＜0.05 ).No significant difference in the renal function was observed before and after the operation ( P ＞ 0.05 ).Conclusion Using LCVP technique during liver resection significantly reduced the operation time,blood loss and blood infusion.And there wa.s no obvious adverse effect on renal function.
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Objective To analyze the cause of the syndrome recurrences of postcholecystectomy.Methods Clinical data of 98 patients with syndrome recurrences of postcholecystectomy were retrospectively reviewed.Results Among 98 cases,95 cases were found with organic lesions.The recurrences included residual or recurrent calculi in extra or intrahepatic bile ducts,stricture of common bile duct,cystic duct remnant,chronic pancreatitis,cholangioduodenal fistula,cancer of biliary ducts,periampullary cancer.Conclusion MRCP and B ultra sound should be conducted before operations to localize the lesion sites.Detailed detection or cholangiography during operation may avoid the injury and incomplete surgery and reduce the recurrence.
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Objective The purpose of this study was to assess the value of serial sectioning and immunohistoehemistry(IHC)for the diagnosis of senfinel lymph node(SLNs)metastases in patients with breast cancer,and to evaluate the significance of mierometastases and isolated tunlor cells(ITCs)in the SLNs. Methods Eighty pailents with clinically node-negative breast cancer underwent SLN biopsy with both99mTc-labeled sulfur colloid and iBosulfan blue dye for SLN identification.All SLNS and non-SLNs were evalnated with standard H&E stain and IHC analysis. Results SLNs were successfully identified in 78 of 80 patients(97.5%),the isotope/blue dye concordanee rate was 76.5%for all SLNs.Thirty two patients (41%)had histologically positive SLNs,and 13(40.6%)of these patients hod SLNS with micrometastatic disease.In 14(43.8%)of these patients,the SLNs were the only nodes involved.The sensitivity,specificity and accuracy of SLN biopsy in predicting axillary node stams were 96.9%,100%and 98.7%,reslaeetively.Patients with positive SLNs metastasis had a markedly higher proportion of non-SLNs metastases compared with those with only micrometastasis in the SLNS(78.9% vs 23.1%). Conclusions Serial sectioning and IHC ale sensitive methods for detecting breast cancer metastases in SLNS.The incidence of non-SLNs metastases is rather low in patients with SLNs that contain only micrometsstatic foci and ITCs.The prognostic significance and effect on surgical management of these occult disease have yet to be determined.
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Objective Laparoscopy-assisted distal gsstrectomy (LADG) with D1 + β lymph node dissection has become the most popular treatment for early gastric cancer in Asian countries. However, no one has shown the same clinical advantages with this procedure as with LADG with D1 + α lymph node dissection. The aim of this study was to compare the outcome of LADG with D1 + β to that of LADG with D1 + α lymph node dissection. Methods During the period of June 2002 through June 2006, LADG with D1 + α lymph node dissection was performed in 54 patients, and LADG with D1 + β lymph node dissection was performed in 42 patients. Surgical findings, clinicopathologic data, postoperative course, complications, and blood analysis findings were compared between the two groups. Differences were analyzed with Mann-Whitney U test and chi-square test. Results Patients in the two groups were comparable with respect to age, sex, body mass index, and stage and pathologic characteristics of gastric cancer. A significantly greater number of N2 lymph nodes were harvested by D1 + β lymph node dissection than by D1 + α dissection (5.9vs. 2.7, P<0.01). However, no significanees in the total number of retrieved lymph nodes (24.7 vs. 22.2) or perigastric lymph nodes dissected (18.9 vs. 19.4) were identified between the D1 + β and D1 +α groups. There was also no significant difference between the D1 + α and D1 + β groups with respect to operation time, blood loss, complication rate, time to first walking, first flatus, first eating, and first defecation, frequency of analgesics, volume of oral intake on postoperative day 7, weight loss, and postoperative hospital stay. Blood analysis showed there were no significant differences in white blood cell count, levels of C-reactive protein, and serum albumin. Conclusion The short-term outcome of LADG with D1 + β lymph node dissection is comparable to that of LADG with D1 + α lymph node dissection.
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Objective To detect the expression of genes Her-2/neu,DPC4 and P16 in pancreatic carcinomas and to investigate the role of their alterations in tumorigenesis and progression of pancreatic carcinomas.Methods We studied the immunohistochemical markers Her-2/neu,DPC4 and P16 in 34 adenocarcinomas and 12 nonmalignant specimens of the pancreas,and the relationship between DPC4 alterations and various clinicopathological parameters was evaluated.Results There was a significant difference between normal pancreatic tissues and benign pancreatic lesions and primary pancreatic carcinomas for frequency of Her-2/neu expression and loss of P16 expression(P
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<p><b>OBJECTIVE</b>To evaluate the hemostatic role of hemocoagulase in abdominal operation and its effects on coagulation.</p><p><b>METHODS</b>180 patients receiving abdominal operation were studied prospectively by randomized, double-blind controlled and multicenter design. They were divided into Hemocoagulase group (60 patients), lizhixue group (60), and manitol hexanitrate group (60). The groups were, observed in terms of the effects on hemostatic time, hemorrhagic volume, hemorrhagic volume per square unit, and body coagulation (BT, CT, PT, APTT and PLT) parameters.</p><p><b>RESULTS</b>The groups received different drugs. The average hemostatic time in the hemocoagulase group was 121.6 s, hemorrhagic volume was 9.6 g, and hemorrhagic volume per square unit was 0.2 g. The similar results were observed in the lizhixue group (P > 0.05), but they were significantly different (P < 0.05) from those of the manitol hexanitrate group (159.2 s, 12.49 g, 0.3 g). In the hemocoagulase and lizhixue groups hemorrhagic and hemoagglution time decreased 30 minutes and 1 day after operation. This finding was significantly differenct from that in the manitol hexanitrate group (P < 0.05).</p><p><b>CONCLUSION</b>Hemocoagulase plays a good hemostatic role in the hemorrhagic capillary at abdominal incision.</p>