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Objective:To explore the value of endoscopic ultrasonography-guided carbon nanoparticles tattooing for preoperative localization of laparoscopic surgery for rectal cancer.Methods:Sixty patients diagnosed as having rectal cancer who underwent laparoscopic radical resection in the 900th Hospital of Joint Logistics Support Force from April 2018 to April 2019 were randomly divided into the endoscopic ultrasonography-guided tattoo group (group A), the colonoscopy-guided tattoo group (group B) and the control group (group C) by random number table. The leakage rate of dye in intestinal tract, complications, and the tattooed serosa stained with carbon nanoparticles during laparoscopic surgery were recorded. Identification time of lesions, the total operation time, the length of resected rectal segment, tumor distance to distal resection margin, and the rate of anal preservation were analyzed and the postoperative pathology were compared.Results:In group A, endoscopic ultrasonography revealed 2 cases of suspected tumor extension toward the anal side within distal intestinal wall. The extension length was 0.42 cm and 0.71 cm respectively, and the extension length was 0.36 cm and 0.64 cm under microscope respectively. In group B, the pathology result showed that the extension length was 0.53 cm under microscope. In group C, the pathology result showed that the extension length were 0.43 cm, 0.36 cm and 0.28 cm under microscope respectively. Obvious black staining in the rectal serosa was found in all tattooed patients during the surgery. There were scattered black staining spots at the surface of peritoneum and mesentery in 3 cases in group B. The identification time of lesions in group A and B were shorter than that in group C (1.29 ± 0.87 min, 1.31 ± 0.63 min VS 15.3 ± 10.50 min, P<0.05). The total operation time in group A and B were shorter than that in group C (176.12 ± 27.64 min, 175.67 ± 26.48 min VS 198.65 ± 38.67 min, P<0.05). The length of resected rectal segment in group A and B were shorter than that in group C (11.81 ± 5.76 cm, 12.31 ± 3.94 cm VS 15.24 ± 4.12 cm, P<0.05). The tumor distance to distal resection margin in group A and B were shorter than that in group C (3.61 ± 1.26 cm, 4.57 ± 1.58 cm VS 6.13 ± 2.47 cm, P<0.05). Anal preservation rates of three groups were 65.0% (13/20), 60.0% (12/20), 40.0% (8/20) respectively with no significant difference ( P>0.05). No residual tumor cells were found in any specimens. Conclusion:Carbon nanoparticles tattooing guided by endoscopic ultrasonography could reduce unnecessary intestinal segment incision and shorten the operation time. It can also reveal tumor extension toward the anal side within intestinal wall, which provides more accurate localization for the distal incision of the lower rectal cancer.
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Objective@#To explore the application of endoscopic tattooing with carbon nanoparticles in the treatment of advanced colorectal cancer (ACRC).@*Methods@#A randomized controlled study was used. Inclusion criteria: (1) age more than 18 years old, and colorectal cancer was found for the first time and confirmed by colonoscopy and biopsy; (2) advanced colorectal cancer (preoperative TNM stage of T3/N1 or above, local unresectable lesion, M1 stage and simultaneously resectable metastatic lesion), and patients agreed to receive neoadjuvant therapy; (3) advanced colorectal cancer (TNM stage of T3/N1 or above) with simultaneous unresectable metastatic lesion, and patients refused operation and consented to chemoradiotherapy. Patients with previous abdominal surgery history, radiotherapy and chemotherapy history, urgent need for surgery or endoscopic stent placement and those with severe allergic constitution were excluded. Based on the above criteria, 120 patients diagnosed with ACRC in No.900 Hospital of the Joint Logistics Team from January 2016 to December 2017 were prospectively enrolled and randomly divided into tattoo group and non-tattoo group by random number table method. Tattoo group were tattooed within 1-7 days before chemoradiotherapy. The labeling location of the lesions: (1) if the colonoscopy could pass smoothly, 4 points were injected into the intestinal wall of the both opposite sides 1 cm cephalad and caudad of the tumor; (2) if the colorectal cavity was severely narrow and the colonoscopy could not pass, only 4 points were injected in 4 quadrants at 1 cm caudad of the tumor. Each injection point was injected with 0.1 ml carbon nanoparticles, and the size of the tumor was measured according to the range of carbon nanoparticles staining. The efficacy was evaluated after 8 weeks of chemoradiotherapy. Patients who were defined to be suitable for operation underwent operation 6 weeks after chemoradiotherapy. The following parameters were compared between two groups: lesion identification time, operation time, blood loss, distance from lesion to distal margin, the rate of first positive margin and the rate of anal sphincter preservation (rectal cancer). Among patients who had been evaluated as having no indication for surgery, those who were effective in chemoradiotherapy continued to receive chemotherapy in the original regimen; if the treatment failed, the chemotherapy regimen was replaced, and the efficacy was finally evaluated after six months [referring to the revised RECIST guidelines (version 1.1)].@*Results@#Three patients withdrew from this study, and 117 patients were enrolled in this study finally, including 59 cases in tattoo group and 58 cases in the non-tattoo group. There were no significant differences in baseline data between two groups (all P>0.05). All the patients had slight adverse reactions of radiotherapy and chemotherapy before operation, and could tolerate after symptomatic management without interruption of treatment. All the patients in the tattoo group had no discomfort such as fever, abdominal pain, abdominal distention, hematochezia, etc. and the intestinal mucosa could be seen clearly with black staining after being tattooed. A total of 77 patients were evaluated with surgical indications, including 39 cases in the tattoo group (tattoo-operable) and 38 cases in the non-tattoo group (non-tattoo-operatable). There were no significant differences in baseline data between the two groups (all P>0.05). Forty patients without operation indications continued chemoradiotherapy, including 20 cases in tattoo group (tattoo-inoperable) and 20 cases in non-tattoo group (non-tattoo-inoperable), whose differences in baseline data between the two groups were not significant as well (all P>0.05). No obvious edema, necrosis or abscess were found in the tattooed segments and the black spots could be seen quickly and clearly on the serosa of rectum in tattoo-operable patients. As compared to non-tattoo group, tattoo group had significantly shorter lesion identification time [(3.4±1.4) minutes vs. (11.8±3.4) minutes, t=-14.07,P<0.001], shorter operation time [(155.7±44.5) minutes vs. (177.2±30.2) minutes, t=-2.48,P=0.015], less blood loss [(101.3±36.7) ml vs.(120.2±38.2) ml, t=-2.22,P=0.029], shorter distance from lesion to distal margin [(3.7±1.0) cm vs. (4.6±1.7) cm, t=-2.20, P=0.034], while tattoo group had slightly higher rate of anal sphincter preservation [66.7%(16/24) vs. 45.5%(10/22), χ2=2.10,P=0.234] and lower rate of first positive resection margin [0 vs. 4.5%(1/22), χ2=0.62,P=0.480], but their differences were not significant. There were no significant differences in the degree of tumor differentiation and TNM stage between two groups. Patients without operative indication were evaluated for efficacy of chemoradiotherapy again after half a year. One case of complete response (CR), 8 of partial response (PR), 10 of stable disease (SD) and 1 of progressive disease (PD) were found and the improvement rate was 45.0% (9/20) in tattoo-inoperable patients. No case of CR, 6 of PR, 11 of SD and 3 of PD were found and the improvement rate was 30.0% (6/20) in non-tattoo-inoperable patients. There was no significant difference in the improvement rate between the two groups (P=0.514).@*Conclusions@#Endoscopic tattooing with carbon nanoparticles injection is safe and reliable for colorectal tumor positioning. It can assist rapid detection of lesions during surgery after neoadjuvant treatment, perform accurate resection, significantly shorten the operation time and reduce surgical trauma; can assist colonoscopy accurately to measure the size of the lesions before and after chemoradiotherapy, and increase the means of assessing the efficacy to guide the follow-up treatment plan. This technique is worth clinical promotion and application.
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Objective@#To investigate the clinical value of gallbladder-preserving cholelithotomy by natural orifice transumbilical endoscopic surgery on patients with cholecystolithiasis.@*Methods@#A retrospective study was performed on data of 15 patients with cholecystolithiasis, who underwent gallbladder-preserving cholelithotomy by natural orifice transumbilical endoscopic surgery from April 2018 to July 2018. The operative data, including situation of operation, operative time, intraoperative hemorrhage, and postoperative complications were recorded.@*Results@#The procedure was performed successfully in all patients with a mean operative time of 108±12 min (ranged from 92-129 min). The intraoperative hemorrhage was 10-30 mL. Eight patients suffered from slight right upper abdominal pain, and 7 patients felt slight pain in umbilical a week after surgery. No fever, incision infection, umbilical hemia, peritonitis, and ascites were reported. The clear-liquid diet was recommended for one day after operation, and postoperative activity was allowed since the second day after operation. All patients were discharged on the fourth or fifth day, and all recovered to their normal life at one week after discharge. Follow-up showed that the scar was small and hidden in umbilical without visible incision after one month. Ultrasonic examination results showed that gallbladder contractile function worked perfectly in four patients and no gallbladder stone was found after three months.@*Conclusion@#Gallbladder-preserving cholelithotomy by natural orifice transumbilical endoscopic surgery is a safe and effective option for patients with cholecystolithiasis, provides excellent cosmetic outcomes, and can be appropriately carried out under the strict control of surgical indications.
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Objective To investigate the clinical value of gallbladder-preserving cholelithotomy by natural orifice transumbilical endoscopic surgery on patients with cholecystolithiasis. Methods A retrospective study was performed on data of 15 patients with cholecystolithiasis,who underwent gallbladder-preserving cholelithotomy by natural orifice transumbilical endoscopic surgery from April 2018 to July 2018. The operative data,including situation of operation,operative time,intraoperative hemorrhage,and postoperative complications were recorded. Results The procedure was performed successfully in all patients with a mean operative time of 108±12 min (ranged from 92-129 min). The intraoperative hemorrhage was 10-30 mL. Eight patients suffered from slight right upper abdominal pain,and 7 patients felt slight pain in umbilical a week after surgery. No fever,incision infection,umbilical hemia,peritonitis,and ascites were reported. The clear-liquid diet was recommended for one day after operation,and postoperative activity was allowed since the second day after operation. All patients were discharged on the fourth or fifth day,and all recovered to their normal life at one week after discharge. Follow-up showed that the scar was small and hidden in umbilical without visible incision after one month. Ultrasonic examination results showed that gallbladder contractile function worked perfectly in four patients and no gallbladder stone was found after three months. Conclusion Gallbladder-preserving cholelithotomy by natural orifice transumbilical endoscopic surgery is a safe and effective option for patients with cholecystolithiasis,provides excellent cosmetic outcomes,and can be appropriately carried out under the strict control of surgical indications.
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Objective To discuss effects of different injection methods of nanocarbon tracer on gastrectomy for patients with gastric cancer. Methods Patients, who underwent D2 gastrectomy in Fuzhou General Hospital from January 2014 to December 2015, were randomly divided into group A and group B. The patients in group A were injected with nanocarbon into gastric submucosa of peripheral area of tumor under gastroscope 24 hours before operation. The patients in group B were injected with normal saline firstly, and then injected with nanocarbon. The operations were performed by 5 high qualification physicians and 3 low qualification physicians. The detection of lymph nodes and black stain nodes,detection time,and lymph node metastatic rate were compared between the two groups.Results A total of 248 patients were enrolled in this study,and each group had 124 cases. There was no statistical difference on basic characteristics between the two groups(P>0.05). A total of 2 975 and 3 855 lymph nodes were detected in group A and group B, respectively. The mean number of detected lymph nodes in group A was significantly lower than that of group B(23.9±7.9 VS 31.1±3.6, P=0.00). The rate of black stain nodes in group A was significantly lower than that of group B[71.3%(2 121/2 975)VS 78.1%(3 011/3 855), P= 0.00].There were no statistical differences on lymph node detection time(24.3±5.7 min VS 23.5±6.2 min), tiny lymph node detection rate(33.1% VS 34.9%),and lymph node metastatic rate(27.3% VS 25.8%)between the two groups(P>0.05).In subgroup of low qualification physicians, the number of lymph nodes(16.9± 4.0 VS 30.1±3.7)and the rate of black stain nodes(61.3% VS 77.2%)in group A were significantly lower than those of group B(P<0.05). The corresponding indicators(31.1±3.3 VS 31.5±3.5,76.8% VS 79.0%) had no statistical differences in the subgroup of high qualification physicians(P>0.05). Conclusion For low qualification physicians, injection of normal saline then of nanocarbon into gastric submucosa under gastroscope could improve lymph node and black stain nodes detection rate for patients with gastric cancer on gastrectomy.
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Objective To compare the efficacy and safety between local injection of triamcinolone and oral methylprednisolone in preventing esophageal stricture formation after endoscopic submucosal dissection (ESD) in patients with early esophageal cancer.Methods From January 2014 to January 2016,67 patients with early esophageal cancer were enrolled,all of them received ESD and were divided into triamcinolone injection group (22 cases),oral methylprednisolone group (22 cases) and control group (23 cases).Patients of triamcinolone group received injection of triamcinolone at injured mucosal under endoscope immediately after ESD.Patients of oral methylprednisolone group took methylprednisolone 30 mg per day since the third day after ESD,and then dosage reduced 5 mg every other week until drug withdrawal.Patients of control group only received ESD.After operation,gastroendoscopy examination was repeated to evaluate the extent of esophageal stricture.Patients with esophageal stricture were treated with an additional endoscopic balloon dilatation (EBD).The rate of esophageal stricture and the frequency of EBD treatment of the three groups were compared.Chi-square test,Wilcoxon rank sum test and Kruskal-Wallis rank sum test were used for statistical analysis.Results The rates of esophageal stricture of triamcinolone injection group,oral methylprednisolone group and control group were 18.2％ (4/22),13.6％0 (3/22) and 73.9％ (17/23),respectively,and the difference was statistically significant (x2 =22.20,P＜0.01).There was no significant difference in the rates of esophageal stricture between triamcinolone injection group and oral methylprednisolone group (x2 =0.17,P=0.50),but the rate of esophageal stricture in triamcinolone injection group was lower than control group,and the difference was statistically significant (x2 =14.03,P＜0.01);the rate of esophageal stricture in oral rnethylprednisolone group was lower than control group,and the difference was also statistically significant (x2 =16.55,P＜0.01).The median frequency of EBD treatment of triamcinolone injection group,oral methylprednisolone group and control group were 2.1 (range 0 to 4.0),1.6 (range 0 to 3.0) and 6.0 (range 0 to 13.0) times,respectively,and the difference was statistically significant (H =17.80,P ＜ 0.01).There was nosignificant difference in the frequency of EBD treatment between triamcinolone injection group and oralmethylprednisolone group (Z=1.21,P=0.23);but the frequency of EBD treatment in triamcinolone injection group was less than control group,and the difference was statistically significant (Z=4.96,P＜ 0.01);the frequency of EBD treatment in oral methylprednisolone group was less than control group,and the difference was also statistically significant (Z=4.32,P＜0.01).There was no severe adverse effect in the three groups.Conclusions Local injections of triamcinolone and oral methylprednisolone both reduced the rate of esophageal stricture after ESD,and decreased frequency of EBD treatment in patients with esophageal stricture.The two regimens showed equal efficacy and good safety.
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Bismuth quadruple therapy is recommended as a first-line therapeutic regimen for Helicobacter pylori (Hp) infection in China.However, the renal toxicity induced by bismuth resulted in limitation of its clinical use.Aims: To assess the efficacy and safety of hybrid therapy for initial eradication of Hp infection.Methods: One hundred and fifty-two patients proved to be positive for Hp infection and treatment-na(i)ve at the Fuzhou General Hospital of Nanjing Military Command of Chinese PLA from Jan.2014 to Dec.2015 were enrolled and randomized to receive either hybrid therapy (esomeprazole and amoxicillin for 7 days, followed by esomeprazole, amoxicillin, clarithromycin and metronidazole for 7 days) or bismuth quadruple therapy (esomeprazole, amoxicillin, clarithromycin and colloidal bismuth pectin for 14 days).Hp eradication was assessed by 14C/13C-urea breath test at a minimum of 4 weeks after the end of treatment.Results: No significant differences were found in general status between the two groups at baseline (P>0.05).A total of 149 patients completed the therapy.In hybrid therapy group the eradication rate was 97.4% (75/77) by ITT analysis and 98.7% (75/76) by PP analysis;while in bismuth quadruple therapy group the eradication rates by ITT and PP analyses were 89.3% (67/75) and 91.8% (67/73), respectively.Hybrid therapy was superior to bismuth quadruple therapy (P all <0.05).Although the incidence of adverse events was higher in hybrid therapy group than in bismuth quadruple therapy group (29.9% vs.16.0%, P<0.05), none of the patients discontinued the therapy because of severe adverse events.Conclusions: Hybrid therapy showed better efficacy than bismuth quadruple therapy for treatment of Hp infection, and the adverse events were well tolerated.Hybrid therapy might be used as first-line treatment for Hp infection.
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Objective To compare the efficacy of transumbilical-ultrafine gastroscope sympathectomy for severe palmar hyperhidrosis using two distinct levels of T3 and T4.Methods A total of 84 cases with severe primary hyperhidrosis were randomly allocated to undergo either T3 sympathectomy treatment (T3 group, n =42) or T4 sympathectomy treatment (T4 group, n =42) with no difference between the two groups.The operation time, postoperative hospital stay, patient's hands hyperhidrosis, axillary hyperhidrosis,complications were recorded at follow-up in 1,3,6,12 months.Results Operation on 84 patients were successful with mean operative time of T3 group being 55.02 ± 10.61 min and T4 group being 55.36 ± 10.51 min(P ＞ 0.05).The mean postoperative hospital stay were both 1.5 days.Patients were followed up for diaphragmatic hernia, umbilical hernia, Horner's syndrome and other serious complications for 12 months.No postoperative recurrence of palmar hyperhidrosis, severe compensatory sweating occurred in either group.The number of improved patients in T3 group's palmar hyperhidrosis,axillary hyperhidrosis, and foot hyperhidrosis were :42/42 cases, 10/16 cases, 21/29 cases, while those in T4 group were: 42/42 cases,16/17 cases 18/28 cases.Axillary hyperhidrosis improved to a larger extent in T4 group than in T3 group (P ＜0.05).There were 16(15 mild and 1 moderate)compensatory sweating in T3 group and 7(6 mild and 1 moderate) compensatory sweating in T4 group (P ＜ 0.05).Conclusion T3 and T4 thoracic sympathectomy using transumbilical-ultrafine gastroscope for primary palmar hyperhidrosis are safe, effective, and feasible.T4 sympathectomy is more effective in improving axillary hyperhidrosis than T3 and shows lower occurrence of postoperative compensatory hyperhidrosis.
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Objective To investigate the preventive effect of somatostatin and nitroglycerin on post-ERCP pancreatitis (PEP) and hyperamylasemia.Methods A total of 184 patients who underwent endoscopic retrograde cholangiopancreatograph (ERCP) were enrolled,and randomly divided into three groups to receive somatostatin or nitroglycerin or normal saline according to random number table.Incidence of PEP and hyperamylasemia were observed and compared among the three groups.Results Nine patients stopped the medication and dropped out of the study after occurence of adverse reactions from receiving nitroglycerin injections.The incidence rates of hyperamylasemia were 38.7％ (24/62),51.8％ (28/54) and 37.3％ (22/59) in somatostatin,nitroglycerin and control group respectively,with no significant differences among the three groups (P ＞ 0.05).The incidence rates of PEP were 6.4％ (4/62),9.3 ％ (5/54) and 23.7％ (14/59) in somatostatin,nitroglycerin and control group,respectively.The incidence rates of PEP in somatostatin and nitroglycerin group were both significantly lower than that in control group (somatostatin group vs control group:x2 =7.13,P =0.01 ; nitroglycerin group vs control group:x2 =4.22,P =0.03).There was no significant difference between somatostatin group and nitroglycerin group (x2 =0.32,P =0.41).Conclusion Somatostatin and nitroglycerin injections after ERCP show similar efficacy on preventing PEP,but the former is safer.Both have little effects on the prophylaxis of hyperamylaemia.
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Objective To investigate the diagnostic value of the modified esophageal capsule endoscopy (stringed esophageal capsule endoscopy,SCE) for esophageal diseases.Methods A total of 80 patients with esophageal related symptoms underwent SCE followed by esophagogastroduodenoscopy (EGD).The examination time,detection rate of esophageal lesions,complications and adverse effects were compared.Results All patients completed the study.The mean examination time of SCE and EGD was 226.18 ± 1 10.30 seconds and 21.28 ± 8.01 seconds respectively (t =-16.665,P =0.000).A total of 119 lesions were detected by SCE and EGD,and the diagnostic accordance rate of SCE and EGD was 82.4％ (98/119).Ten lesions of advanced squamous carcinoma,5 lesions of high grade intraepithelial neoplasia and 3 lesions of early squamous carcinoma were detected by both examinations,all of which were confirmed by histopathologic examination.The overall rate of complication in SCE (1.3％,1/80) was significantly lower than that of EGD (8.8％,7/80,x2 =4.238,P =0.040) and the rates of swallow difficulty (P =0.022),throat discomfort (P =0.007) and vomiting (P =0.000) of SCE were significantly lower than those of EGD.Conclusion SCE is a feasible,easy-to-operate,safe,well tolerated and accurate method for detection of esophageal diseases,and could be a non-invasive alternative for conventional EGD.
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Objective To investigate the safety,efficacy of CO2 insufflations during ERCP.Methods One hundred and forty eligible patients who underwent ERCP in Fuzhou General Hospital of Nanjing Military Command from January to December 2012 were randomized according to random digits in a double blind manner to receive either CO2 insufflations or air insufflations (65 vs 75).The patient's experience of abdominal pain and distension at 1 h,2 h,6 h and 24 h post-ERCP were evaluated by visual analogue scale (VAS).The heart rates,blood pressure,SpO2,PaCO2 were recorded before,during,after ERCP,and 24 h after the examination.Plain abdominal radiographic images were collected to show abdominal distention before and after ERCP,waist circumference,operative time,recovery time,intraoperative and post-ERCP complications were also determined.Results Post-ERCP the VAS of abdominal pain at 3 h was (4.08 ± 1.36) in CO2 group,which was significantly lower than that in air group [(4.59 ± 1.66),P ＜ 0.01].The VAS of abdominal distension at 1 h,3 h,6 h after ERCP were(1.78 ± 1.90),(0.72 ± 1.15),(0.12 ±0.45),which were significantly lower than those in air group [(3.53 ± 2.71),(2.51 ± 2.04),(0.84 ± 1.24),P ＜ 0.05] ; the intraoperative SpO2 was (93.29 ± 1.40)％,which was significantly lower than that in air group [(93.52 ± 1.06) ％,P ＜ 0.01].The waist circumference at 1 h after ERCP increased by (2.48 ± 1.33)cm,which was significantly lower than that in air group [(3.56 ± 2.13) cm,P =0.00).Recovery time was (11.2 ± 2.5) rain in CO2 group,which was significantly longer than that in air group [(9.7 ± 1.7) min,P =0.00].And the difference between the two groups was statistically significant.The plain abdominal radiographic images showed the degree of bowel distension was severer in air group than that in CO2 group (P =0.04).Conclusions CO2 insufflations are safe and efficacy during ERCP.CO2 can better alleviate abdominal pain and distension than air.
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Objective To investigate the clinical value of transumbilical endoscopic thoracic sympathectomy on women patients with palmar hyperhidrosis.Methods A total of 25 consecutive women patients with palmar hyperhidrosis underwent transumblical thoracic sympathectomy with ultra-thin endoscope.The operative data,including duration of operation,intra-operative and postoperative complications were recorded.Results The procedure was performed successfully in all 25 patients with a mean operative time of 64 min(58-113 min).No umbilical hernia,diaphragmatic hernia,Horner's syndrome or hemothorax were observed.Minor pneumothorax was found in postoperative chest X-ray in 3 patients,all of which were completely resolved with conservative treatment.All patients recovered to their normal life at 1 week after discharge.The scar was small and hidden in umbilical with no visible incisions.After a follow-up of 4 to 12 months,all patients' hands sweating symptoms completely disappeared,axillary sweat symptoms completely resolved in 6 patients,significantly improved in 4 and mildly improved in 1.Conclusion Transumbilical thoracic sympathectomy with ultrathin flexible endoscope is a safe and effective option for women patients with severe palmar hyperhidrosis,which provides excellent cosmetic outcomes.
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Objective To evaluate the safety and feasibility of endoscopic transumbilical thoracic sympathectomy.Methods The technique was performed in 4 swine models.Under general anesthesia,a newly developed long abdominal trocar (60 cm in lengths) was placed through the umbilicus,which was also used to establish pneumoperitoneum.After insertion of gastroscope through this trocar,two small incisions of diagrams were created by needle-knife,through which the gastroscope was sent into the thoracic cavity to ablate the T3 ganglia by Hot biopsy forceps under One-lung ventilation.The animals were killed at the completion of the procedure.Results This procedure was completed in four pigs.The sympathetic chain was successfully ablated in all swine,as confirmed by gross surgical pathology and histology,the mean operative time was (81.7 ±15.4) minutes.There was no major bleeding.All bilateral T3 sympathetic chains were successfully ablated in the 4 swines as confirmed by gross surgical pathology and histology.There was no severe bleeding and damage to peripheral organs during the operation in any of the cases,and no prominent pneumothorax was revealed by postoperative chest X-ray radiography.Conclusion Endoscopic transumbilical thoracic sympathectomy is safe,feasible and effective with good cosmetic result.
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Objective To establish an animal model of pancreatic juice reflux esophagitis, and compare the roles of single pancreatic juice with pancreatic juice plus bile acids reflux in the pathogenesis of gastroesophageal reflux disease (GERD). Methods Fifty SD rats were randomly divided into 3 groups, group A: gastrectomy and end- to- side esophagojejunostomy (pancreatic juice and bile combination group, n=20); group B, gastrectomy and end-to-side esophagojejunostomy and bile-duct-jejunostomy (single pancreatic juice group, n = 20 ); group C: simple laparotomy ( n = 10). The rats were sacrificed 1, 2, 4 weeks after operation, and the change of weight of the rats and esophageal morphology was observed. Results Four rats in combination group died during or after operation, and the success rate of the model was 80%, 6 rats in single pancreatic juice group died, and the success rateof the model was 70%, both group A and B rats lost more weight significantly than that in control group, and the weight gradually increased 2 weeks later, but it was still lower than that in control group [(218 ±21), (216 ±20)g vs. (286 ±28)g, P＜0.05]. Reflux esophagitis of different degree was present in both groups, which was more severe in the lower part of esophagus, and severity increased with time. The main histologic changes were inflammation, erosion, ulcer and epithelial cell hyperplasia and metaplasia. The severity of esophagitis was not significantly different between group A and group B. Conclusions The models of single pancreatic juice reflux esophagitis can be successfully made. It establishes the foundation for experimental research of pancreatic juice induced esophageal mucosa injury.
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Objective To evaluate the efficacy of different methods of biliary stenting for intractable choledocholithiasis.Methods A total of 137 patients with intractable choledocholithiasis were randomly divided into 4 groups to receive different managements.The treatments included single biliary stent placement in group A (n=32),single stent placement plus oral medication in group B (n=35),double stents placement in group C (n=33) and double stents placements plus oral medication in group D (n=37).All biliary stents were placed via endoscopic retrograde cholangiopancreatography (ERCP).Oral medication included ursodeoxycholic acid and/or anethol trithione after the procedure.All patients were closely followed up.Results The size of stones in common bile duct (CBD) decreased in all cases at 3 months after stent placement,with most significant changes in groups C and D than in groups A and B (P＜0.05).The stents kept unobstructed for a mean time of 7.6 months (3.5-20 months),with a significant difference between every 2 groups (P＜0.05) and a longest duration time in group D.A second procedure of ERCP was performed in 72 patients (52.6%),with achievement of total choledocholithiasis clearance in 51 (84.7%).Hyperamylasemia (HA) occurred in 41 cases (29.9%),which were mainly observed in the groups C and D (P ＜0.05).Conclusion Biliary stent placement is a safe and effective palliative therapy for intractable choledocholithiasis,while double stents placements combined with pharmacotherapy is most effective.
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Objective To study the role of nuclear factor-?B(NF-?B) and peroxisome proliferation activator receptor-?(PPAR-?) in the development of Barrett's esophagus(BE) and esophagus adenocarcinoma(EA).Methods Fifty BE patients including 25 EA patients admitted in Fuzhou General Hospital of Nanjing Command from Jul.2005 to Jul.2006 were involved in the present study.The expressions of NF-?B and PPAR-? in squamous epithelial cells of normal esophagus,BE and EA were investigated with immunohistochemical staining.The correlation between the expression of both NF-?B and PPAR-? and their clinicopathological features were analyzed.Results Positive staining of NF-?B was situated in cytoplasm,and that of PPAR-? in nuclei.No expression of NF-?B and PPAR-? was found in normal esophageal squamous epithelium,while they expressed in a medium extent in BE(positive staining in cytoplasm of goblet cells and surface glandular epithelium),and extensively expressed in EA.There existed significant difference in expression of NF-?B and PPAR-? in EA compared with those in BE and normal esophageal squamous epithelium(P