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Objective To evaluate the effect of enteral nutritional support for the liver cancer patients with precise hepatetomy under fast track process model. Methods 82 patients were prospectively randomized into enteral nutrition group (n = 41) and parenteral nutrition (n = 41). The hemoglobin (HB), total protein (TP), albumin (ALB) and total lymphocyte count (TLC) were measured on 3 days before operation and 7 days after operation respectively. The two groups were compared in terms of time for anal exhaust and defecation after surgery , the postoperative hospital stay, the gastrointestinal adverse reactions and complications after surgery. Results The nutrition and immunity indicators on day 7 after operation were significantly poorer and lower than on day 3 before operation in the parenteral nutrition group (P0.05). Conclusion Enteral nutritional support under fast track process model for the liver cancer patients undergoing precise resection could improve clinical outcome.
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Objective To evaluate the feasibility, methods and effectiveness of using a mechani-cal stapler for choledochojejunostomy.Methods The authors have operated on 118 patients in the management of carcinoma of head of pancreas, or periampullary tumor, or cholelithiasis.In the opera-tion, the bilio-enteric end-to-side, or end-to-end and side-to-side anastomosis was made by a circular stapler device, and then a Roux-en-Y or Brown's loop was formed for the preeedure.Results All the surgery of using stapler was done successfully.No postoperative complications such as stomal leak, bleeding and narrow were found.Meanwhile, no harmful consequences were observed through long-time follow-up.Conclusion Using mechanical stapler for bilio-intestinal anastomosis is time-saving, simple and reliable.It can be a choice for some diseases.
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Objective To evaluate the difference between subrenal capsule assay (SRCA) and monotetrazolium (MTT) assay in anticancer chemosensitivity test and explore the possible cause of bringing the difference,in order to provide theoretical basis for clinical practice.Methods SRCA and MTT assay were carried out with fresh rectum carcinoma in three groups:5-FU,amethopterin(MTX) and mitomycin (MMC).The day 1,3,5 after SRCA,every subgroups was injected with 5-FU ,MMC and MTX respectively and the RR was observed at the sixth day;In MTT assay ,the drug,s concentration was 1/10 PPC of each group's drug and the IR was worked out at the fourth day after MMT assay.Results According to the result of chemosensitivity in the 60 groups,20 groups of them were accorded with,other 40 groups were not.The positive and negative according rate of tumor's sensitivity to drug was 33 3% and there was statistical difference between the two methods.Conclusions There were considerable difference between SRCA and MTT assay in anticanaer chemosensitivity test.
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Objective To investigate the expression of hypoxia inducible factor 1?(HIF-1?),vascular endothelial growth factor(VEGF) and micro vessel density(MVD) in gastric carcinoma and to explore their correlation with clinical pathological features such as cancer invasion and metastasis.Methods Forty-eight samples of gastric carcinoma tissues were examined for the expression of HIF-1?,VEGF and CD34 by immunohistochemical method.Results The positive expression rates of HIF-1? and VEGF were 66.7% and 60.4% in gastric carcinoma respectively.The mean value of MVD was 42.5?14.7 in gastric carcinoma.The expressions of HIF-1?,VEGF and the value of MVD were significantly correlated with the depth of invasion,lymph node metastasis and TNM stage.The HIF-1? expression was positively correlated with VEGF expression and MVD value.Conclusion The overexpression of HIF-1?,VEGF and MVD consist in gastric carcinoma tissue.The HIF-1? expression is positively correlated with VEGF expression and MVD value.The overexpression of HIF-1?,VEGF and MVD value are closely related with invasion,metastasis and poor biological behavior of gastric carcinoma.
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Objective Because of local infiltrated growth and spread,the operative resection of hilar (cholangiocacinoma) is very difficult. Recently,combined extended hepatectomy and vascular resection had been performed for treatment of hilar cholangiocarcinoma and has greatly increased the resection rate and survival rate.However, it is associated with high operative morbidity and mortality. The aim of this study is to explore a reasonable hepatic resection strategy, that is safe and beneficial for the patient. Method Sixteen (consecutive) cases of hilar cholangiocarcinoma with involvement of hilar vessels have been treated in our hospital since 1977. En bloc resection of the hilar tumor that included hepatic segment I,IV and involved blood (vessel), as well as hepato-duodenal ligament skeletonization was performed in 15 patients. Results All 15 cases were successfully operated on with a resection rate of 93.8%, and 12 cases with R_0 resection. The operative mortality and in-hospital mortality rate were 0. Temporary bile leak and abdominal infection (respectively) developed in 1 patienteach,with an overall morbidity of 13.3%,and both were cured by non-(operative) therapy. No case of liver failure occurred. Follow up showed the median survival was 22 months and 7 are still alive. Conclusions (1)The resection rate and survival rate for hilar cholangiocarcinoma could be improved by combination of liver and hilar vascular resection.(2)Hilar cholangiocarcinoma mainly spreads to the medial segment(S4) and caudate(S1), and these segments need to be resected in the combined (operation).(3)Although resection of the middle part of liver takes little more time than hemi-hepatectomy and trisegmentectomy, it could preserve more liver parenchyma and reduce postoperative morbidity (such as liver failure) and mortality rates.(4)The resection of the hilar blood vessel involved by tumor was necessary to improve the resection rate and cure rate. Reconstruction of the blood vessel was made selectively by taking the circumstances into consideration.