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Objective:To investigate feasibility, efficiency and safety of kissing pancreatojejunostomy after pancreatoduodenectomy.Methods:From Jan 2006 to Sep 2020, the clinical data of 267 patients undergoing pancreatoduodenectomy and kissing pancreatojejunostomy were retrospectively analyzed.Results:Grade B postoperative pancreatic fistula (POPF) occurred in 6.37%, Grade C POPF in 2.25% of patients. There was no mortality within 30 days postoperatively as to pancreatic fistula, by cut-off of pancreatic duct diameter at 3mm, there was no significant difference between two subgroups (15/140 vs. 8/127, P=0.20). also, when grouped by texture of the pancreas, no there was significant difference (20/194 vs. 3/73, P=0.11). Conclusions:Kissing pancreatojejunostomy is feasible and easy to perform. It also does not increase the POPF rate when applied to the pancreatojejunostomy with thin pancreatic duct and soft texture.
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Objective@#To investigate the safety and feasibility of proximal partial gastrectomy with Cheng's Giraffe esophagogastric reconstruction for the treatment of early Siewert II adenocarcinoma of esophagogastric junction (AEG).@*Methods@#Indication of Cheng's Giraffe esophagogastric reconstruction: (1) Siewert II AEG or Siewert III AEG with diameter < 4 cm; (2) preoperative staging as cT1-2N0M0. A descriptive case series study was carried out. Clinical data of 34 patients with Siewert II AEG undergoing proximal partial gastrectomy and Cheng's Giraffe esophagogastric reconstruction at Department of Abdominal Surgery of Zhejiang Cancer Hospital and Department of Gastrointestinal Surgery, The First Affiliated Hospital of Zhejiang University of Traditional Chinese Medicine from February to July 2018 were retrospectively collected and analyzed, including 14 cases in IA stage, 11 cases in IIA stage and 8 cases in IIB stage. Brief procedure of Cheng's Giraffe esophagogastric reconstruction was as follows: Firstly, 12 cm long tubular stomach was formed by longitudinal incision 4 cm away from the great curvature of the stomach. Secondly, the gastric fundus and His angle were formed. Finally, the distance from His angle to esophagal-tubular gastric anastomosis should be more than 5 cm. The reflux disease questionare (RDQ) scores, radionuclide gastric emptying scintigraphy, and 24-hour multichannel intraluminal (MII)-pH monitoring technology were used to evaluate postoperative gastric emptying and gastroesophageal reflux.@*Result@#All 34 patients successfully completed proximal partial gastrectomy with Cheng's Giraffe esophagogastric reconstruction, including 13 cases by open surgery and 21 cases by laparoscopic surgery. The operation time was (144.6±39.8) minutes, the blood loss during operation was (35.4±17.2) ml. No laparoscopic case was converted to open surgery and no postoperative complication was observed. The postoperative hospital stay was (8.4±2.5) days. The postoperative RDQ score was 4.4±3.1 one month after operation, and 3.3±2.5 six months after operation. Gastric-half emptying time was (67.0±21.5) minutes, and the residual ratio was (52.2±7.7)% in 1 hour, (36.4±3.1)% in 2 hours and (28.8±3.6)% in 3 hours at postoperative 1-month. The 24-hour MII-pH monitoring at postoperative 2-month revealed the frequency of acid reflux was (12.6±7.9) times, frequency of non-acid reflux was (19.6±9.7) times, DeMeester score was 5.8±2.9.@*Conclusion@#Cheng's Giraffe esophagogastric reconstruction is safe and feasible in the treatment of Siewert type II AEG, and has good dynamic and anti-reflux effects.
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Objective To investigate the clinical efficacy of middle segment pancreatectomy (MSP) in treatment for pancreatic neck and body tumors.Methods From Jan.2000 to Dec.2016,the clinicopathological data of 26 patients with pancreatic neck or body tumors were analyzed retrospectively.Results All of the 26 patients received middle segment pancreatectomy.14 cases had serous or mucinous cystadenomas.The tumor diameter was 2.3 to 5.6 cm (averaging from 3.8 cm).9 cases had solid pseudopapillary tumors.The tumor diameter was 3.3 to 5.0 cm(averaging from 3.6 cm);One case had insulinoma and the diameter was 2.0 cm.Two cases had nonfunctional pancreatic neuroendocrine tumors,and the diameter was 2.1 and 2.4 cm.The post-complication morbidity rate was 53.8％.The main post-complications of the group were pancreatic fistula (9 cases,34.2％),intra-abdominal infection(1 case,3.8％),delayed gastric emptying (2 cases,7.6％),lymphatic fistula (1 case,3.8％),and abdominal infection (1 case,3.8％).All of the 26 patients healed after surgery without undergoing surgery again.There were no mortality during perioperative period.All patients were followed up for 6 to 60 months.All of the 26 patients had good life quality,without new-onset diabetes or cancer recurrence during the follow-up period of 6 to 60 months after operation.Conclusion Middle segment pancreatectomy is safe and feasible in treatment of benign or low-graded malignant pancreatic neck and body tumors and is capable of preserving pancreatic endocrine and exocrine function.
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Background and purpose: miR-210 was closely related to the occurrence and development of gastric cancer, but its mechanism and clinical significance were still not clear. The purpose of this study was to explore the expression of miR-210 in gastric cancer tissues and its clinical significance. Methods: The expression of miR-210 was detected in gastric cancer tissues and the corresponding adjacent tissues. The relationship between the expression of miR-210 and clinical pathological factors and prognosis was analyzed. Results: Real-time fluorescent quantitative polymerase chain reaction (RTFQ-PCR) showed that the expression of miR-210 in gastric cancer was higher than that in adjacent tissues, and there was a significant difference between the two groups (P<0.05). The expression of miR-210 was closely related to tumor size, lymph node metastasis and TNM stage, but was not related to age, gender, tumor dif-ferentiation and depth of invasion. The 5-year survival rate of patients with low miR-210 expression was 48.2%, where-as the 5-year survival rate of patients with high miR-210 expression was 30.4% (χ2=4.216, P=0.040). Conclusion: The expression of miR-210 in gastric cancer was higher than that in adjacent tissues, and maybe related to the development and prognosis of gastric cancer. miR-210 is expected to be a new diagnostic marker and therapeutic target for gastric cancer.
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Objective To observe and compare the clinical efficacies between electroacupuncture and warm needling in treating low back pain.Method Seventy-eight eligible low back pain patients were randomized into group A of 28 cases, group B of 26 cases, and group C of 24 cases. Group A was intervened by electroacupuncture, group B was by warm needling, and group C was by medication. The short-form McGill Pain Questionnaire, Japanese Orthopaedic Association Scores (JOA), and Oswestry Disability Index were observed before and after treatment, and the therapeutic efficacies were compared.Result In group A, the McGill item scores [Sensory Pain Rating Index (S-PRI), Affective Pain Rating Index (A-PRI)] respectively after 1-week and 2-week treatment as well as in the 1-month and 3-month follow-up were significantly different from that before treatment (P<0.01,P<0.05). In group B and C, the McGill item scores after 2-week treatment and in the 1-month and 3-month follow-up were significantly different from that before treatment in the same group (P<0.01,P<0.05). The JOA and Oswestry scores were significantly changed respectively after 1-week and 2-week treatment and in the 1-month and 3-month follow-up in the three groups compared with that before treatment (P<0.05,P<0.01). After 1-week and 2-week treatment and in the 1-month and 3-month follow-up, the JOA and Oswestry scores in group A were significantly different from that in group C (P<0.05,P<0.01). In the 1-month and 3-month follow-up, the JOA scores in group B were significantly different from that in group C (P<0.05). The total effective rate was 85.7% in group A and 73.1% in group B, both significantly higher than 58.3% in group C (P<0.05). Conclusion Electroacupuncture and warm needling both can produce a significant efficacy in treating low back pain, but warm needling acts comparatively slowly and is less safe.
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Objective To investigate the effect of the second resection for unsuspected gallbladder carcinoma discovered after cholecystectomy.Methods A retrospective clincopathological analysis was conducted for 45 cases of unsuspected gallbladder carcinoma receiving second operation at our hospital from January 2000 to December 2010.Result Of the 45 cases with unsuspected gallbladder carcinoma (33 pT2,12 pT3 ),40 cases received second radical reeection of the liver bed with lymph dissection; the remaining 5 cases received palliative operation.Amongst 45 patients lymph metastasis (4 pT2,6 pT3 ) was found in 10 cases,liver metastasis ( 2 pT2,1 pT3 ) in 3,parietal seeding in 1 ( pT3 ) and distant metastasis ( pT2 ) in one.The 5 patients receiving palliative operation died in 3 ～ 8 months and 40 patients receiving the radical operation achieved long-term survival ( 40.4 ± 2.7 months) after the operation.The effect of second operation which was done within 4 weeks after the first cholecystectomy was better than that of the operation done beyond 4 weeks ( survival time 37.1 ± 2.2 vs 22.4 ± 5.8months).Conclusions Radical resection for unsuspected gallbladder carcinoma discovered after the initial cholecystectomy helps improve prognosis and prolong patients survival time.
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Objective To investigate the feasibility and safety of designed perioperative surgical treatment for advanced gastric cancer.Method From March 2006 to Sep.2009,24 patients with advanced gastric cancer were enrolled for this study,of which 14 cases were graded as Ⅳ M0,10 as Ⅳ M1,including liver metastasis in 5 cases,peritoneal seeding in 4 and lung metastasis in 1.All patients received 2-4 cycles of chemotherapy of PCF or ECF regimen,followed by intended surgical resection and postoperative 2-3 cycles of adjuvant chemotherapy of the same regimen as used during the preoperative course.Result Seven Cases abandoned surgical therapy,a total of 17 cases completed preoperative chemotherapy,surgical resection and postoperative chemotherapy.R0 resection was achieved in 16 cases(94%).There was no perioperative mortality,and total clinical response rate was 75%,overall pathological response rate was 82%.In 59% surgical cases (10 cases) serum CEA and CA199 has returned to normal;In 71%patients tumor pathological stage degraded at the cost of Ⅲ-Ⅳ grade of neutropenia,thrombocytopenia,anemia,severe nausea and vomiting in 79%,8%,13%,and 54% cases respectively.Fever was encountered in 2 cases with grade Ⅲ-Ⅳ neutropenia.Conclusion Designed perioperative chemotherapy regimen renders advanced gastric carcinoma patients operable at the cost of acceptable complications.
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Objective To investigate the predictive factors and prognosis of early intrahepatic recurrence after curative resection of hepatocellular carcinoma(HCC).Methods Clinicopathological dats of 184 HCC patients with intrahepatic recurrence after curative resection were collected.Thirteen clinicopathological factors and prognosis after recurrence were retrospectively analyzed. Results Univariate analysis showed that preoperative scrota alpha-fetoprotein(AFP)>100 ng/ml,tumour size>5 cm,venous invasion and intra-operative blood transfusion were predictive factors of early intrahepatic recurrence,and selum albumin<35 g/L was marginally predictive factor.Multivariate analysis showed that serum AFP>100 ng/ml,tumour size>5 cm and venous invasion were independent predictive factots of early intrahepatic recurrence.The survival of patients suffering from early recurrence was significantly shorter than those with late recurrence.with median survival period of 12 mos vs 18 mos(P=0.012).Conclusion Serum AFP,tumour size and venous invasion were independent predictive factors of early intrahepatic recurrence in HCC patients after radical resection of the primary tumor.Early intrahepatic recurrence implies poor prognosis.
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Objective To introduce the application of double liver hanging maneuver in anatomical right hemihepatectomy and share our own experience. Methods Twenty-four patients underwent right hemihepatectomy using double liver hanging maneuver, and the data were collected prospectively after operation. Another 49 patients underwent right hemihepatectomy using the traditional methods,serving as the control group. Results Retrohepatic tunnel was constructed in 27 patients, double liver hanging maneuver was successfully performed in 24 anatomical right hemihepatomy and failed in 3 patients due to the near proximity between the tumor and the middle line. Compared with the control group, blood loss was much less (t=3. 191 ,P＜0.05), ALT and liver function recovered more quickly postoperatively and the difference in operative duration between the 2 groups was not significant (t=-1. 695,P＞0. 05). There was about 1-2 cm wide space located between retrohepatic IVC and dorsal liver when the 2 tapes were tracted, and no injury in hepatic short veins and retrohepatic IVC occurred during the operation. Conclusion The double liver hanging maneuver can make anatomical right hemihepatectomy more accessible and safe.
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Objective To explore the multi-resistance pattern of 88 strains of isoniazid-resistant Mycobacteria in recent years,so as to provide reference for prevention and treatment of tuberculosis.Methods Absolute concentration method was applied to performing drug susceptibility test for 181 isolates of Mycobacteria to 10 kinds of antitubercuIosis drugs. Results The primary resistance rate was 19.3%,and the acquired drug resistance rate Was 55.8%.The percentage of isoniazid-or double resistant-Mycobacteria was 37.6%.The Mycobacterium which was resistant to three or above drugs accounted for 85.2 %.Conclusion The majority of isoniazid-resistant Mycobacterium is a multi-resistant strain,which should be thought highly in prevention and treatment of tuberculosis to control or reduce the initial and acquired resistance rates.
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Objective:To elucidate the characterization of antigen-specific memory T cells from PPD~+ individuals after stimulation with BCG in vitro.Methods:PBMCs were isolated from PPD~ -/+ normal human peripheral blood and stimulated with BCG. The level of IFN-? in the culture supernatants was assayed by ELISA and the frequency of IFN-?-producinging cells was detected by ELISPOT. The subsets and frequency of cytokine-producing cells were determined at a single cell level by flow cytometry.Results:After stimulation with BCG, PBMCs from PPD~+ but not PPD~- individuals produced significantly high levels of IFN-? in culture supernatants detected by ELISA(P