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Objective:To investigate the clinical efficacy of totally laparoscopic pylorus-preserving gastrectomy (TLPPG) with preservation of the first branch of the right gastroepiploic vein in early gastric cancer (EGC).Methods:The retrospective and descriptive study was conducted. The clinicopathological data of 38 EGC patients who were admitted to the Subei Hospital Affiliated to Yangzhou University from July 2018 to May 2021 were collected. There were 18 males and 20 females, aged 60 (range, 39?73) years. All patients underwent TLPPG with preservation of the first branch of the right gastroepiploic vein.Observation indicators: (1) surgical and postoperative condi-tions; (2) postoperative histopathological examination. (3) follow-up. Follow-up was conducted using outpatient examination, WeChat interview and medical record review to detect the nutritional status, residual stomach function, cholecystolithiasis, tumor recurrence and metastasis and death of patients. Follow-up was up to July 2022. Measurement data with normal distribution were represented as Mean± SD, and measurement data with skewed distribution were represented as M(range). Count data were described as absolute numbers. Results:(1) Surgical and postoperative conditions. All 38 patients underwent TLPPG with preservation of the first branch of the right gastroepiploic vein successfully, without laparotomy conversion. The operation time, volume of intraoperative blood loss, time to postoperative first flatus, time to postoperative first liquid food intake and duration of postoperative hospital stay of the 38 patients were (180±28)minutes, (58±38)mL, (2.7±0.6)days, (3.4±0.7)days and (10.3±2.8)days, respectively. Of the 38 patients, there were 6 cases with postoperative complications ≥grade Ⅱ of Clavien-Dindo classification. (2) Postoperative histopatho-logical examination. The tumor diameter, distance from proximal resection margin to tumor and distance from distal resection margin to tumor of the 38 patients were (1.8±0.5)cm, (3.4±0.2)cm and (4.3±0.4)cm, respectively. Both of proximal and distal resection margin was negative. Numbers of lymph node examined and numbers of lymph node examined in the No.6 lymph node of the 38 patients were 23.3±3.9 and 3.4±1.1, respectively. There were 38 cases with pathological T1 stage including 23 cases of T1a stage and 15 cases of T1b stage. There were 36 cases with pathological N0 stage and 2 cases with pathological N1 stage. There were 36 cases with pathological ⅠA stage and 2 cases with pathological ⅠB stage of TNM staging. (3) Follow-up. All 38 patients were followed up for 18(range, 12?48)months. The hemoglobin, serum albumin and total serum protein of the 38 patients were (125.4±5.8)g/L, (42.4±2.3)g/L and (71.6±2.1)g/L, respectively, at postoperative 6 month. Endo-scopy was used to evaluate the function of residual stomach of patients at postoperative 12 month. There were 4 patients with moderate amount of food remaining in the residual stomach. No patient suffered reflux esophagitis, reflux gastritis and bile reflux. None of the 38 patients received post-operative chemotherapy, and there was no tumor recurrence and metastasis or death occured in patient.Conclusion:TLPPG with preservation of the first branch of the right gastroepiploic vein is safe and feasible for the treatment of EGC patients with tumor located at 1/3 of the middle segment of stomach.
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Objective:To evaluate the role of permanent sigmoid colostomy created through the extraperitoneal route combined with pelvic floor peritoneal reconstruction after laparoscopic Miles surgery for lower rectal cancer.Methods:A total of 88 patients undergoing laparoscopic Miles surgery at Gastrointestinal Center of Northern Jiangsu People's Hospital from Apr 2016 to Apr 2020 were divided into extraperitoneal ostomy group(40 cases) and transperitoneal ostomy group (48 cases).Results:There were no significant differences in operating time, stoma-forming time, intraoperative blood loss, first exhausting time, first defecation time and hospital stay between the two groups (all P>0.05). There were 17 cases of complications in observation group vs. 16 cases in control group ( χ2=0.782， P=0.376). After 12 months, the complications in observation group were significantly less than control group ( χ2=8.601， P=0.003). There was no parastoma hernia in observation group vs.7 in control group ( χ2=4.502， P=0.034). The satisfaction rate of ostomy control defecation in observation group (70%) was significantly higher than that in control group (38%) after 12 months ( P=0.001). Conclusion:A permanent sigmoid colostomy created through the extraperitoneal route combined with pelvic floor peritoneal reconstruction during laparoscopic Miles surgery is safe and feasible, with fewer complications and better defecation function than that of the stoma through transperitoneal approach.
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The incidence of proximal gastric cancer worldwide is increasing year by year, and radical gastrectomy is still the main treatment. Partial function preserving in laparoscopic proximal gastrectomy has been continuously concerned in recent years, with the development of laparoscopic minimally invasive technology. However, the choice of digestive tract reconstruction is still controversial, due to the specificity of tumor location. This article reviews the current digestive tract reconstruction after laparoscopic proximal gastrectomy, and provides some references for clinicians to choose the digestive tract reconstruction methods rationally.
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Objective:To explore the clinical value of laparoscopic abdominoperineal resection(LAPR) with pelvic peritoneum closure for patients with low rectal cancer.Methods:The clinicopathological data of 90 patients with low rectal cancer who underwent laparoscopic abdominoperineal resection from Mar 2014 to Jan 2019 at the Subei People's Hospital of Jiangsu Province were retrospectively analyzed. These patients were divided into closed pelvic floor peritoneum group (study group, n=42) and without pelvic floor peritoneum group (control group, n=48) . Results:The postoperative hospital stay of the study group was shorter than that of the control group[(10.8±3.0) d vs. (12.4±3.1) d, t=2.569, P=0.013]. There was no statistically significant difference in the operation time , intraoperative blood loss , time to first flatus ,first time of getting out of bed between the two groups. Perineal incision infection and perineal incision dehiscence occurred in 2 cases and 1 case in the study group, and 10 cases and 9 cases in the control group respectively (χ 2= 5.007, P=0.025; χ 2=6.077, P=0.033). In the study group, there were 0 cases of perineal hernia, 1 case of pelvic floor peritoneal hernia and 2 cases of adhesive intestinal obstruction, while those in the control group were 7 cases, 8 cases and 9 cases, respectively (χ 2=6.642, P=0.013; χ 2=5.079, P=0.033; χ 2=4.085, P=0.043). Conclusion:Laparoscopic abdominoperineal resection with pelvic peritoneum closure significantly reduces the incidence of postoperative perineal-related complications and shorten postoperative hospital stay.
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Objective:To compare laparoscopic-assisted distal gastrectomy (LADG) and laparoscopy-assisted pylorus-preserving gastrectomy (LAPPG) for early gastric cancer (EGC). Methods:Firty-two EGC patients from Sep 2018 to Aug 2020 in Northern Jiangsu People's Hospital were divided into LAPPG group ( n=21) and LADG group ( n=31). Results:The average operation time in the LAPPG and LADG groups was (173±30) min and (144±31)min, respectively ( t=3.34, P=0.002). The average levels of Hb and albumin (ALB) in the LAPPG group were (128.7±16.0) g/L and (41.2±4.8) g/L respectively 3 months after gastrectomy, ( t=2.482, P=0.016 and t=2.097, P=0.041) compared to LADG group at (118.2±14.1) g/L, (38.4±4.7) g/L. According to the Clavien-Dindo classification, the incidence of complications above grade Ⅱ was 19.0% in LAPPG group and 22.6% in LADG group, and the difference was not statistically significant ( χ2=0.007, P=0.934). The PGSAS-45 questionnaire scoring results show that LAPPG scores were lower in the dumping syndrome and life dissatisfaction subscales ( t=-2.706, P=0.008 and t=-2.893, P=0.004) Conclusion:LAPPG procedure for the treatment of EGC patients is safe and feasible, promoting early postoperative nutritional recovery. In adition to less dumping syndrome and better postoperative quality of life .
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Objective:To evaluate the safety and feasibility of laparoscopic selective lateral lymph node dissection (LLND) for radical resection of rectal cancer.Methods:From Dec 2018 to Jul 2020, at the Department of Gastrointestinal Surgery of Northern Jiangsu People's Hospital laparoscopic radical resection of rectal cancer was performed in 32 cases and radical resection plus selective LLND in 26 cases.Results:The operation time in the LLND group was significantly longer than that in the simple radical resection group [247(179-405) min vs. 146(118-258) min, Z=-5.169, P<0.001], but there was no significant difference in intraoperative bleeding [68(45-500) ml vs. 56(25-500) ml, Z=-1.598, P=0.110], postoperative ventilation time [2.5(1-6) d vs. 3.0(1-6) d, Z=-0.120, P=0.905], postoperative hospital stay [9.0(7-17) d vs. 9.5(6-14) d, Z=-1.050, P=0.294] and hospitalization costs [(49 000±3 000) RMB vs. (48 000±3 000) RMB, t=-1.072, P=0.289] between the two groups. The incidence of postoperative complications in the two groups was 19% and 27% respectively (χ 2=0.551, P=0.458). The number of lateral lymph node dissection in LLND group was 8(6-16), 5 of 26 patients had lateral lymph node metastasis, with a metastasis rate of 19%. Conclusion:Laparoscopic radical resectim plus selective LLND for rectal cancer harvests more lateral lymph node metastasis without causing higher complications .
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With the further development of endoscopic technology and the application of minimally invasive concept in the diagnosis and treatment of colorectal surgery diseases, the diagnosis and treatment of colorectal related diseases have undergone tremendous changes. Surgical diagnosis and treatment of colorectal diseases have achieved great results in the minimally invasive field, ranging from traditional transabdominal surgery to laparoscopic surgery, transvaginal surgery, and transvaginal specimen removal. One of the most cutting-edge surgical methods in the field of minimally invasive colorectal surgery at present, this method avoids the incision in the abdominal wall by taking specimens through the rectum and vagina, thus further minimally invasive colorectal surgery. The NOSES technology combines the advantages of traditional laparoscopic surgery with the concept of modern minimally invasive surgery. It embodies the characteristics of minimally invasive, fast track rehabilitation in surgery, functional surgery and other concepts on the basis of ensuring the operation effect. This paper mainly summarizes the relevant experience, experience and experience in the development of colorectal surgery diagnosis and treatment by carrying out the nose technology at home and abroad.
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With the development of modem medical technology,the change of operation concept and the innovation of operation mode,more and more patients are able to cure low rectal cancer while achieving the goal of retaining the anus.Anastomotic fistula is the most serious complication after anal sphincter preservation for low rectal cancer,and it is also the main cause of death,and the factors are complicated.In order to prevent anastomotic leakage and reduce the harm caused by it,most scholars at home and abroad recommend the use of preventive stoma.This article reviews the application of prophylactic stoma in anal sphincter preservation for low rectal cancer,and provides valuable information for the application of preventive stoma in anal sphincter preservation for low rectal cancer.
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OBJECTIVE@#To determine the incidence of surgical site infection (SSI) after abdominal surgery and to further evaluate the related risk factors of SSI in China.@*METHODS@#The multicenter cross-sectional study collected clinical data of all adult patients who underwent abdominal surgery from May 1, 2018 to May 31, 2018 in 30 domestic hospitals, including basic information, perioperative parameters, and incisional microbial culture results. The primary outcome was the incidence of SSI within postoperative 30 days. SSI was classified into superficial incision infection, deep incision infection, and organ/gap infection according to the US Centers for Disease Control and Prevention (CDC) criteria. The secondary outcome variables were ICU stay, postoperative hospital stay, total hospital stay, 30-day mortality and treatment costs. Multivariate logistic regression was used to analyze the risk factors of SSI.@*RESULTS@#A total of 1666 patients were enrolled in the study, including 263 cases of East War Zone Hospital of PLA, 140 cases of Affiliated Hospital of Qingdao University, 108 cases of The First Affiliated Hospital of Nanchang University, 87 cases of Central War Zone Hospital of PLA, 77 cases of West China Hospital, 74 cases of Guangdong General Hospital, 71 cases of Chenzhou First People's Hospital, 71 cases of Zigong First People's Hospital, 64 cases of Zhangjiagang First People's Hospital, 56 cases of Nanyang City Central Hospital, 56 cases of Lanzhou General Hospital of Lanzhou Military Command, 56 cases of Shandong Provincial Hospital, 52 cases of Shangqiu First People's Hospital, 52 cases of People's Hospital of Xinjiang Uygur Autonomous Region, 48 cases of The Second Xiangya Hospital of Central South University, 48 cases of Chinese PLA General Hospital, 44 cases of Affiliated Hospital of Xuzhou Medical University, 38 cases of Hunan Province People's Hospital, 36 cases of Dongguan Kanghua Hospital, 30 cases of Shaoxing Central Hospital, 30 cases of Northern Jiangsu People's Hospital, 29 vases of The First Affiliated Hospital of Zhengzhou University, 27 cases of General Hospital of Tianjin Medical University, 22 cases of Zigong Fourth People's Hospital, 21 cases of The Second Hospital of University of South China, 18 cases of Tongji Hospital, 15 cases of Nanchong Central Hospital, 12 cases of The 901th Hospital of PLA, 11 cases of Hunan Cancer Hospital, 10 cases of Lanzhou University Second Hospital. There were 1019 males and 647 females with mean age of (56.5±15.3) years old. SSI occurred in 80 patients (4.8%) after operation, including 39 cases of superficial incision infection, 16 cases of deep incision infection, and 25 cases of organ/interstitial infection. Escherichia coli was the main pathogen of SSI, and the positive rate was 32.5% (26/80). Compared with patients without SSI, those with SSI had significantly higher ICU occupancy rate [38.8%(31/80) vs. 13.9%(220/1586), P<0.001], postoperative hospital stay (median 17 days vs. 7 days, P<0.001) and total hospital stay (median 22 days vs. 13 days, P<0.001), and significantly higher cost of treatment (median 75 000 yuan vs. 44 000 yuan, P<0.001). Multivariate analysis showed that male rise(OR=2.110, 95%CI:1.175-3.791, P=0.012), preoperative blood glucose level rise(OR=1.100, 95%CI: 1.012-1.197, P=0.026), operative time (OR=1.006, 95%CI:1.003-1.009, P<0.001) and surgical incision grade (clean-contaminated incision:OR=10.207, 95%CI:1.369-76.120, P=0.023; contaminated incision: OR=10.617, 95%CI:1.298-86.865, P=0.028; infection incision: OR=20.173, 95%CI:1.768-230.121, P=0.016) were risk factors for SSI; and laparoscopic surgery (OR=0.348, 95%CI:0.192-0.631, P=0.001) and mechanical bowel preparation(OR=0.441,95%CI:0.221-0.879, P=0.020) were protective factors for SSI.@*CONCLUSIONS@#The incidence of postoperative SSI in patients with abdominal surgery in China is 4.8%. SSI can significantly increase the medical burden of patients. Preoperative control of blood glucose and mechanical bowel preparation are important measures to prevent SSI.
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Adult , Aged , Female , Humans , Male , Middle Aged , Abdomen , General Surgery , China , Cross-Sectional Studies , General Surgery , Operative Time , Postoperative Complications , Preoperative Period , Retrospective Studies , Risk Factors , Surgical Wound InfectionABSTRACT
Pancreatic cancer is one of the most common digestive tract malignant tumors with poor prognosis and low rate of the surgical resection,which has been a major difficulty in clinical surgeons.In recent years,the study founds that the interaction relations activated pancreatic stellate cell in the pancreas tumor microenvironment and cancer cells plays a very important role in the development of tumor.The cancer cells promote the activation of pancreatic stellate cells,secretion,and metastasis,at the same time,the pancreatic stellate cells can promote the proliferation,invasion,metastasis of cancer cells,and has a dual function of promotion and suppression the formation of new blood vessels around the tumor and immune suppression.Therefore,deeply study of the PSC will help us figure out the regulation of tumor development and initiate a new way for treatment of pancreas tumor at the cell and molecular level.
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Objective To investigate the safety and feasibility of the modified terminal cannula ileostomy in laparoscopic anus-preserving operation of low rectal cancer (RC).Methods The retrospective cross-sectional study was conducted.The clinicopathological data of 15 patients who underwent laparoscopic radical resection of RC + terminal cannula ileostomy in the Subei People's Hospital of Jiangsu Province between September 2016 and June 2017 were collected.The patients underwent laparoscopic low anterior resection of RC,intra-abdominal sigmoid colon-rectum end-to-end anastomosis after extracting tumor specimens,and terminal cannula ileostomy in vitro.Observation indicators:(1) intraoperative situations:operation time,time of cannula ileostomy,volume of intraoperative blood loss,number of lymph node dissected,surgical margin;(2) postoperative situations:time to initial anal exsufflation,recovery time of defecation,time of tube removal,closing time of stoma,postoperative complications,duration of hospital stay;(3) follow-up situations.Follow-up using outpatient examination and telephone interview was performed to detect the anastomotic leakage-related complications up to December 2017.Measurement data with normal distribution were represented as (x)±s.Results (1) Intraoperative situations:all the 15 patients underwent successful laparoscopic radical resection of RC + terminal cannula ileostomy,without conversion to open surgery and death.The operation time,time of cannula ileostomy,volume of intraoperative blood loss and number of lymph node dissected were respectively (170 ± 34) minutes,(23 ± 4) minutes,(59 ± 27)mL and (13 ± 5) per case.No residual cancer cells were found in resection margins.(2) Postoperative situations:time to initial anal exsufflation and recovery time of defecation in 15 patients were respectively (6± 1) days and (7 ± 1) days.The stoma was automatically closed after tube removal,and time of tube removal and closing time of stoma after tube removal were respectively (23 ± 2) days and (3 ± 1) days.The incidence of postoperative complications was 1/15.One patient with catheterization-related complications was improved by strengthening dressing and antibiotic use,and the stoma was healed at 8 days after tube removal.There was no anastomotic leakage-related complications and death.The duration of hospital stay was (15±3) days.(3) Followup situations:all the 15 patients were followed up for 6-12 months.During the follow-up,there were no anastomotic leakage-related complications and death.Conclusion The modifyied terminal cannula ileostomy is safe and feasible,and is also an ideal surgical method for preventing anastomotic leakage in the laparoscopic anuspreserving operation of low RC.
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Colorectal cancer is the third most common cancer in humans and poses a serious threat to human health.MicroRNAs (miRNAs) affected the mechanism of occurrence and development of colorectal cancer.As an important member of miRNA,miR-224 modulates the migration,proliferation,metastases and drug resistance of colorectal cancer by acting on its downstream targets.The expression of miR-224 affects the prognosis of colorectal cancer.Therefore,this review summarizes the role of miR-224 and its downstream targets in colorectal cancer,it may provide a new method for diagnosis and treatment to colorectal cancer at the cellular and molecular level.
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Objective To compare the early outcomes of laparoscopic and open resection and evaluate the safety and feasibility of laparoscopic surgery in patients with colorectal cancer aged ≥ 70 years.Methods A total of 91 consecutive patients with colorectal adenocarcinoma underwent surgery in Yizheng City People's Hospital between Jan.2009 and Dec.2015.In 91 patients included in this study,38 received laparoscopic surgery and 53 underwent open surgery.Main outcome measures were clinical data,postoperative recovery status and short-term outcomes.Results There were no significant differences between two groups with respect to demographic indicators,clinicopathological results and chronic comorbidities had no significant difference between two groups.No death cases occured in both groups.One patient in the laparoscopic group required conversion to open surgery due to ureteral injury.Laparoscopic surgery was associated with significantly longer operating time [(238 ± 71.3) minutes vs (175 ± 60.8) minutes,P ＜ 0.001],less estimated blood loss [(145 ± 58 ml) vs (186 ± 45) ml,P ＜ 0.001)],a shorter postoperative hospital stay [(11.9 ± 3.9) days vs (14.5 ± 3.7) days],lower overall postoperative complication rate (23.7％ vs 45.3％,P =0.035),wound-related complication rate (2.6％ vs 22.6％,P =0.017) when compared with open surgery.Quality of surgical specimen,lymph nodes harvested were not significantly different between two groups.Conclusion Laparoscopic colorectal cancer surgery is safe and feasible in elderly patients,associated with better short-term outcomes when compared with open surgery.
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Objective To investigate the safety and feasibility of the reversed π-shaped esophagojejunal anastomosis in laparoscope-assisted total gastrectomy (LATG) for gastric cancer (GC).Methods The retrospective corss-sectional study was conducted.The clinicopathological data of 18 GC patients who were admitted to the Subei People's Hospital of Jiangsu Province between January 2015 and October 2016 were collected.All the 18 GC patients underwent LATG,surgical procedures included free stomach and lymph node dissection firstly,side-to-side jejunal anastomosis secondly and laparoscopic gastrointestinal reconstruction using reversed π-shaped anastomosis finally.Observation indicators:(1) surgical situations:side-to-side jejunal anastomosis method,conversion to open surgery,operation time,reversed π-shaped anastomosis time,volume of intraoperative blood loss and number of lymph node dissected;(2) postoperative situations:time for initial out-of-bed activity,time to initial anal exsufflation,time for postoperative water intake,time of drainage tube removal,postoperative complications and duration of hospital stay;(3) postoperative pathological examination;(4) follow-up and survival situations.Follow-up using outpatient examination and telephone interview was performed to detect diet intake,anastomosis patency,gastrointestinal obstruction and patients' survival up to March 2017.Measurement data with normal distribution were represented as (x)±s.Results (1) Surgical situations:18 patients underwent successful LATG and reversed π-shaped esophagojejunal anastomosis,without conversion to open surgery and perioperative death.Five patients used in vitro hand-sewn side-to-side esophagojejunal anastomosis through small incision of specimens sampling,and 13 completed all surgery under laparoscopy.Operation time,reversed π-shaped anastomosis time,volume of intraoperative blood loss and number of lymph node dissected of 18 patients were (187±12)minutes,(37±5) minutes,(735±18)mL and 29±2,respectively.(2) Postoperative situations:time for initial out-of-bed activity,time to initial anal exsufflation,time for postoperative water intake and time of drainage tube removal in 18 patients were (1.6±0.5) days,(2.3±0.4) days,(2.5±0.5) days and (7.5± 1.5) days,respectively.One patient complicated with esophagojejunal anastomosis fistula at postoperative day 3 was cured by drainage and symptomatic treatment and then discharged from hospital.Eighteen patients received regularly angiography using oral water-soluble contrast medium after recovering fluid diet intake,showing anastomosis patency and no contrast medium leakage,and then discharged from hospital.Duration of hospital stay of 18 patients was (12± 11) days.(3) Postoperative pathological examination:of 18 patients,15 were diagnosed with adenocarcinoma and 3 with signet-ring cell carcinoma.T2,T3 and T4 of T staging were respectively detected in 3,3 and 12 patients.N0,N1,N2 and N3 of N staging were respectively detected in 8,3,2 and 5 patients.Stage Ⅰ,Ⅱ and Ⅲ of TNM stage were detected in 3,5 and 10 patients,respectively.(4) Follow-up and survival situations:17 of 18 patients were followed up for 6-25 months,with a median time of 12 months.During the follow-up,2 patients were complicated with sour regurgitation and vomiting after eating at month 6 and 12 postoperatively and received gastrointestinal contrast examination,showing anastomotic stenosis,and then were cured by endoscopic dilation and discharged form hospital.Other patients had good diet and survival,without anastomotic complications.Conclusion The reversed π-shaped esophagojejunal anastomosis in LATG for GC is safe and feasible,with good short-term outcomes.
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Obesity is becoming an increasingly common health problem in the world.People pay more attention to obesity and the way to lose weight is gradually evolving with the development of science and technology.The widely application of the sleeve gastrectomy in recent years makes the operation has become the world's second-ranked use of weight loss surgery.In this paper,indications and contraindications,surgical methods,surgical results and complications were summarized.
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Obesity is becoming an increasingly common health problem in the world.People pay more attention to obesity and the way to lose weight is gradually evolving with the development of science and technology.The widely application of the sleeve gastrectomy in recent years makes the operation has become the world's second-ranked use of weight loss surgery.In this paper,indications and contraindications,surgical methods,surgical results and complications were summarized.
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Objective To explore the clinical efficacy of endoscopic transgastric or transpapillary drainage in treatment of pancreatic pseudocyst. Methods 100 patients with pancreatic pseudocyst from March 2014 to March 2015, 80 cases were underwent endoscopic ultrasound-guided transgastric and the other 20 cases were underwent transpapillary drainage. The treatment effect and complications were recorded. Results The success rate was 95.00 %, and cysts completely disappeared in 84.00 % of the patients. Among all the patients there are 10 cases occurred intraoperative bleeding, 3 cases occurred stent clogging or migration and 7 cases occurred infection, the overall incidence of complications was 20.00 %. Conclusion Endoscopic transgastric or transpapillary drainage in treatment of pancreatic pseudocysts has better clinical curative effect, and can also reduce the occurrence of complications, which is worth popularizing clinically.
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Digestive tract reconstruction is an important part of gastric carcinoma operation as well as tumor resection and lymph node dissection.Surgeons are seeking the optimal reconstruction method that reduces the occurrence of complications and maintains better quality of postoperative life extremely.Uncut Roux-en-Y anastomosis is a modified procedure in which an artificial jejunal occlusion is devised to avoid Roux stasis syndrome based on Billroth Ⅱ and Braun's anastomosis.Compared to the conventional Roux-en-Y anastomosis,the uncut Roux-en-Y anastomosis retains the advantage of preventing biliary and pancreatic secretions reflux,furthermore,it can decrease the symptoms associated with Roux stasis owing to the abnormal myoelectrical conduction of Roux limb.Because the early studies indicated that there was higher incidence of dehiscence or recanalization of the jejunal occlusion,the uncut Roux-en-Y anastomosis has not been widely applied.Since jejunal occlusion has been optimized recently,the uncut Roux-en-Y reconstruction may be an optional and appropriate method of digestive tract reconstruction after distal gastrectomy.
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Colorectal cancer is one of the most common malignant tumor with high mortality rate.About a third of patients with colorectal cancer have either simultaneously or metachronous liver metastasis with poor prognosis.Therefore,the studies on the mechanisms of colorectal liver metastasis is significant.Recently,the research on the molecular mechanisms of colorectal liver metastasis is increasing,this paper summarizes some of them,and we hope providing new ideas for the diagnosis and treatment of colorectal cancer patients with liver metastasis.
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Objective To investigate the diagnostic efficacy of fecal calprotectin(FC) on assessing endoscopic disease activity in colonic or ileo-colonic Crohn disease (CD) and CD-related surgery patients .Methods Totally 56 colonic or ileo-colonic CD pa-tients ,25 CD-related surgery patients and 25 irritable bowel syndrome (IBS) patients with previously confirmed diagnosis of CD and IBS were enrolled into this study .Fecal samples were collected from 1 to 3 day before bowel preparation and FC was measured by ELISA .Endoscopic activity was determined for colonic or ileo-colonic CD with Simple Endoscopic Score for Crohn′s Disease (SES-CD) and CD-related surgery patients with the Rutgeerts′ score .Results Among colonic or ileo-colonic CD patients ,the levels of FC in endoscopic active patients had significantly higher than that of endoscopic remission patients and IBS patients(P 0 .05) ,FC cutoff level of 250 μg /g gave a sensitivity and specificity of 50 .0% ,66 .7% ,respectively .Conclusion FC is a surrogate marker for the evaluation of colonic or ileo-colonic CD endoscopic disease activity .The FC ,however ,can not distinct remission period and active period after CD surgery .