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Objective To explore main risk factors of post-operative severe complications in elderly patients with gastric cancer.Methods From January 2006 to June 2011,a total of 236 elderly patients to receive gastrectomy for gastric carcinoma were retrospectively analyzed in this casecontrol study.The factors affecting post-operative severe complications were analyzed by multivariate logistic regression analysis.Results Age was younger in patients without than those with postoperative complications [(72.9±5.8) years vs.(80.6±6.7) years,t=-9.194,P=0.000].Serum levels of hemoglobin and albumin were higher in patients without than with post-operative complications [(109.94±18.72) g/L vs.(98.75±18.82) g/L,(38.37±5.52) g/L vs.(33.69± 3.35) g/L,t=4.391,7.080,both P=0.000].Operation time was shorter in patients without than with post-operative complications [(3.1 ± 1.0) hours vs.(3.6 ± 1.1) hours,t =-3.507,P =0.001)].Intraoperative blood transfusion volume was less in patients without than with post-operative complications [(2.5±4.4) L vs.(2.8±5.5) L,t=-4.901,P=0.000)].The long diameter of tumor was shorter in patients without than with post-operative complications [(4.5 ± 2.8) cm vs.(5.3± 2.7) cm,t =-2.111,P =0.036)].Logistic regression analysis revealed that chronic obstructive pulmonary disease (COPD),serum albumin level,age,operation time and blood transfusion volume were associated with postoperative severe complications.Logistic regression equation was as follow:P=1/[1+e(16.22-033X1+0.99X3-390X4-192X5-493X9)].Conclusions COPD,operation time,blood transfusion volume,serum albumin level and age are the main independent risk factors for post-operative severe complications in elderly patients with gastric cancer.
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Objective To evaluate the safety and efficacy of self-expanding metallic stents (SEMS) in one-stage surgery for patients with left-sided malignant colorectal obstruction. Methods The clinical data of 97 patients with left-sided colorectal cancer who had been admitted to the First Affiliated Hospital of Zhejiang Chinese Medical University from May 2005 to September 2008 were retrospectively analyzed. Forty-six patients with left-sided malignant colorectal obstruction were in the test group, after the placement of SEMS, they received one-stage resection and anastomosis; 51 patients with left-sided colorectal cancer (without obstruction) were in the control group, and they received one-stage surgery. The defecation and anal exhaust time, hospital stay and incidence of postoperative complications between the 2 groups were analyzed. All data were analyzed via t test or chi-square test. Results One patient in test group had acute diffuse peritonitis which was induced by intestinal perforation at postoperative day 4, and was treated with radical resection for sigmoid cancer. One-stage surgery was successfully performed on 45 patients, and they were discharged at postoperative day 11-16. One patient died of respiratory infection and heart failure at postoperative day 10. All patients were followed up for 4-48 months. There was no significant difference in defecation and anal exhaust time, hospital stay, incidence of perioperative complications, recurrence, metastasis and survival within follow-up interval between the 2 groups (t=0.164, 1.358, χ~2 = 0.252, 1.200, 0.580, P >0.05). Conclusion SEMS is effective and safe in the treatment of left-sided malignant colorectal obstruction.
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Objective To explore the aesthetic efficacy of modified endoscopic rhytidectomy by using the techniques to minimize tissue damage,to obviate injury to the vessels and nerves,and to control bleeding and to firm fixation.Methods Two discontinuous incisions were made in the temporal scalp during the procedure,obviating injury to the branches of the superficial temporal vessels.Endoscopic technique was used to facilitate elevating,hemostasis,slinging and fixation in the plane under superficial temporal fascia.Three transverse incisions were made after the hairline in the forhead scalp,the operation was carried out by using endoscopic equipment,and the elevated forhead flap was slinged and fixed upward to the lamina externa cranii.Results 58 cases were received endoscopic forehead and temporal rhytidectomy,only slight edema was observed after surgery,and no obvisous ecchymosis was found.All patients returned home 7 days after operation.Degree of satisfaction on long-term follow-up showed that 56 cases(96.55%)improved obviously one year postoperatively;35 cases followed up 2 years,33(94.29%)of them improved obviously.None case was suffered from facial nerve injury.Conclusion The purpose of endoscopic rhytidectomy is to avoid carrying out the operation out of sight,to minimize unexpected damage to vessels and nerves,and to facilitate dissection,hemostasis,suturing,slingling and fixation.By refining the technique,we can achieve minimal injury,shorten recovery period,and obtain more satisfactory results,so the indication for operation is extended.
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OBJECTIVE: To observe the effects of salvianolate on rats with postoperative intestinal adhesion and to explore the prevention mechanism. METHODS: Forty SD male rats with intestinal adhesion were randomly divided into four groups: untreated group, low-dose salvianolate-treated group (12 mg/kg), medium-dose salvianolate-treated group (24 mg/kg) and high-dose salvianolate-treated group (48 mg/kg), with another ten SD male rats as normal control. Intraperitoneal injection of glucose was administered to the rats in the normal control group and the untreated group, and intraperitoneal injection of salvianolate was administered to the rats in the low-, medium- and high-dose salvianolate-treated groups. They were all treated for 8 days and once a day. On the eighth day after surgery the blood samples of each group were collected. Grades of intestinal adhesion were ranked by macroscopic observation. The adhesive tissues between viscera and belly wall were taken for pathological observation. The levels of interleukin-1beta (IL-1beta), interleukin-4 (IL-4) and tumor necrosis factor-alpha (TNF-alpha) were determined by enzyme linked immunosorbent assay. RESULTS: Salvianolate can significantly reduce the extent of postoperative intestinal adhesion, obviously decrease the levels of IL-1beta, TNF-alpha and inhibit the hyperplasy of fibrous connective tissue. However, there was no significant impact on the level of IL-4. CONCLUSION: Salvianolate can reduce the extent of postoperative intestinal adhesion, decrease the expression of IL-1beta and TNF-alpha and inhibit the hyperplasy of fibrous connective tissue. This may be the mechanism of salvianolate in preventing intestinal adhesion.
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Objective To investigate causes of recurrence of hepatic cysts after laparoscopic fenestration. Methods We retrospectively summarized the experience of 54 cases of hepatic cysts treated with laparoscopic fenestration from June 1998 to August 2003. Results A follow-up in 52 cases for 1~6 years found 5 cases of recurrence, the recurrence rate being 9.6% (5/52). Among the 5 cases, the artificial opening had been made too small in size in 3 cases because of unusual position of the cysts, the septum within the lesion had not been fully opened in 1 case, and the recurrence of polycystic liver was confirmed in 1 case. Conclusions Improper selection of patients, too small fenestration of cyst, omission of multiple cysts and inappropriate management of mucous membrane are main causes leading to the recurrence.
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Objective To evaluate the effect of p reoperative regional intra-arterial infusion chemotherapy on the prognosis of a dvanced gastric cancer. Methods The clinical data of 80 patients who u nderwent curative resection for advanced gastric cancers were summarized.Among t hem,33 patients carried out preoperative regional intra-arterial infusion chemo therapy were as the interventional chemotherapy group,and the remaining 47 patie nts were the control group.Eleven factors including clinical and pathological da ta,treatment procedures and molecular biological makers that contributed to the long-term survival rate were analyzed by Cox multivariate regression analysis.Results The 5-year survival rate of the interv entional group was 59.3%,and the control group 47.6% .There was significant difference between two groups ( P
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<p><b>OBJECTIVE</b>To study the effect of angiogenesis inhibitor Rg3 on the growth and metastasis of gastric cancer in SCID mice.</p><p><b>METHODS</b>Metastatic model simulating human gastric cancer was established by orthotopic implantation of histologically intact human tumor tissue into the gastric wall of SCID mice. Rg3 was administered by gastric perfusion at doses of 0, 2.5, 5.0, 10.0 mg/kg every day for 6 weeks 1 week after tumor implantation. One week after last administration, the mice were killed and their tumor weight was measured and the presence of metastasis recorded. Intratumoral microvessel density was examined by immunohistochemical staining with anti-CD31 monoclonal antibody.</p><p><b>RESULTS</b>Compared to the untreated controls, the growth of the orthotopically implanted tumor was significantly reduced in weight in mice treated with Rg3 with an inhibition rate of 52.3%, 63.3% and 71.6% at doses of 2.5, 5.0, 10.0 mg/kg, respectively. Tumor metastasis to the liver and peritoneum was also significantly inhibited in a dose-dependent manner. Decreased intratumoral microvessel density was noted in the treated mice.</p><p><b>CONCLUSION</b>Angiogenesis inhibitor Rg3 has strong inhibitory effect on tumor growth and metastasis of human gastric cancer in SCID mice.</p>