ABSTRACT
The unique multi perspective and magni-fying effect of laparoscopic surgery make gastric surgery more precise and minimally invasive. The technical innovation of 4K laparoscopy enable surgeons to understand the finer submicrostructure-membrane anatomy. The advantages of perigastric lymph node dissection with less trauma and bleeding under the guidance of membrane anatomy theory are widely recognized. As a common metastatic site of advanced distal gastric cancer, lymph nodes in the infrapyloric region play an important role in radical gastrectomy. Blood vessels variation is common in the inferior pyloric region, and the layer between gastric and mesenteric membrane is complex. Complete resection of the right gastric omentum membrane can yield greater surgical benefits. In this article, the author discuss the key points of lymph node dissection in the subpyloric region based on their surgical experience, aiming to promote the standard surgical procedure of 4K laparoscopic lymph node dissection in the inferior pyloric region based on membrane anatomy.
ABSTRACT
The unique multi perspective and magni-fying effect of laparoscopic surgery make gastric surgery more precise and minimally invasive. The technical innovation of 4K laparoscopy enable surgeons to understand the finer submicrostructure-membrane anatomy. The advantages of perigastric lymph node dissection with less trauma and bleeding under the guidance of membrane anatomy theory are widely recognized. As a common metastatic site of advanced distal gastric cancer, lymph nodes in the infrapyloric region play an important role in radical gastrectomy. Blood vessels variation is common in the inferior pyloric region, and the layer between gastric and mesenteric membrane is complex. Complete resection of the right gastric omentum membrane can yield greater surgical benefits. In this article, the author discuss the key points of lymph node dissection in the subpyloric region based on their surgical experience, aiming to promote the standard surgical procedure of 4K laparoscopic lymph node dissection in the inferior pyloric region based on membrane anatomy.
ABSTRACT
Objective To investigate the clinical significance of nasointestinal tube placement in facilitating recovery after Roux-en-Y gastric bypass surgery.Methods The clinical data of patients with gastric neoplasms who underwent Roux-en-Y gastric bypass surgery were analyzed retrospectively.28 patients who had nasointestinal tube inserted were compared to 33 patients who didn't.Indicators for nutrition [body mass index (BMI),Nutrition Risk Screening 2002 (NRS 2002) score,serum total protein (TP),albumin (Alb) and prealbumin] and prognosis (bowel sound and anal exhaust or defecation time,anastomotic leakage rate,abdominal abscess or infection,incision infection or delayed healing,postoperative pulmonary infection rate,postoperative hospitalization time,unplanned reoperation or readmission rate) were analyzed.Results There was no statistically significant difference (all P＞0.05) between the two groups at baseline (sex,age,BMI,NRS 2002 score,operation time and blood loss during operation).The two groups had no statistically significant difference (all P＞0.05) in TP,Alb and prealbumin before the operation or at day 2 or day 6 after the operation.There were significant difference between the two groups in partial indicators for nutrition and prognosis:prealbumin at sixth days after operation (t =-2.05,P =0.045),bowel sound (t =7.71,P =0.000),anal exhaust or defecation time (t=4.52,P=0.000),postoperative hospitalization time (t=4.43,P=0.000),incision infection or delayed healing rate (x2 =4.78,P =0.029).No statistically significant difference (all P＞ 0.05) was found in anastomotic leakage rate,abdominal abscess or infection rate,postoperative pulmonary infection rate,and unplanned reoperation and readmission rate (x2=1.94,P=0.164).There was significant difference (Fisher,P =0.029) between patients aged 70 or above in the two groups in terms of postoperative pulmonary infection rate.Conclusions Enteral nutrition via nasointestinal tube after Roux-en-Y operation in patients with gastric neoplasms can promote protein synthesis,facilitate recovery of intestinal function,shorten hospitalization time and accelerate patient recovery.However,extra caution is needed in patients aged 70 or above,and early extubation should be considered based on the lung conditions of these patients.
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Objective To explore the change of postoperative pancreatic fistula (POPF) in modified pancreaticoenteric anastomosis in pancreaticoduodenectomy.Methods This paper retrospectively analyzed clinical data of 122 patients who suffered pancreaticoduodenectomy or enlarged pancreaticoduodenectomy from Apr.2008 to Sep.2017 in West China Hospital of Sichuan University.All surgeries were operated by a surgeon.30 patients from Apr.2008 to Dec.2010 were divided to control group,and 92 patients from Jan.2011 to Sep.2017 were the experimental group.Pancreatic duct-jejunum mucosa anastomosis was adopted in the two groups,but the method in experimental group was modified.Clinically relevant POPF was compared between the two groups.Results The rate of clinically relevant POPF was 0％ (0/92) in the experimental group,while it was 13.3(4/30) in the control group.Conclusion Modified technique for duct-to-mucosa pamcreaticojejunostomy can reduce the incidence of POPF.
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Objective To investigate the expression of hypoxia-inducible 1 alpha(HIF-lα)and glucose transporter 1(Glut1)in human breast cancer and its relationship to proliferating cell nuclear antigen (PCNA)protein and clinical pathologic factors.Methods Immunohistochemical staining was used to measure the expression of HIF-lα.Glut1 and PCNA in human breast fibroadenoma,usual hyperplasia and breast carcinoma.Results HIF-1α expression was not found in breast fibroadenoma and hyperplastic Iesions.In contrast.the positive rate of HIF-1α was found in the ductal carcinoma in situ 55%(DCIS,11/20)and the invasive breast carcinoma 85%(51/60).Glut1 positivity in breast carcinoma was 58.8%(47/80).The totsl positive rate of PCNA in breast carcinoma was 75%(60/80),that in DCIS was 65%(13/20)and that in invasive carcinoma was 78.3%(47/60).There was a positive correlation between HIF-lα and Glut 1 level (r=0.653,P＜0.01),a positive correlation between HIF-1α and PCNA level(r=0.693,P＜0.01);and also a positive correlation between Glutl and PCNA level(t=0.742.P＜0.01).conclusion The overexpression of HIF-lα and its target gene Glut1 played important roles in carcinogenesis and progression of breast carcinoma and closely correlated with cell proliferation of breast carcinoma and may become a new target for treatment of breast carcinoma.