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Objective:To explore the clinical effects of uncut Roux-en-Y anastomosis versus Roux-en-Y anastomosis in laparoscopic distal gastrectomy.Methods:The propensity score matching and retrospective cohort study was conducted. The clinicopathological data of 194 patients who underwent laparoscopic distal gastrectomy in the First Affiliated Hospital of Air Force Military Medical University from January 2017 to May 2019 were collected. There were 130 males and 64 females, aged (57±10)years, with a range from 27 to 78 years. Of 194 patients, 62 undergoing uncut Roux-en-Y anastomosis digestive tract reconstruction in laparoscopic distal gastrectomy and 132 undergoing Roux-en-Y anastomosis digestive tract reconstruction in laparoscopic distal gastrectomy were allocated into uncut group and traditional group, respectively. Observation indicators: (1) the propensity score matching conditions and comparison of general data between the two groups after propensity score matching; (2) intraoperative and postoperative situations; (3) follow-up. Follow-up using outpatient examination and telephone interview was conducted at the postoperative 3 months and 6 months to detect Roux stasis syndrome (RSS), tumor recurrence, readmission, and survival of patients. The propensity score matching was conducted by 1∶1 matching using the nearest neighbor method. Measurement data with normal distribution were represented as Mean± SD, and comparison between groups was done using the t test. Measurement data with skewed distribution were represented as M (range). Count data were represented as absolute numbers, and comparison between groups was analyzed using the chi-square test Fisher exact probability. Comparison of ordinal data between groups was analyzed using the nonparametric rank sum test. Results:(1) The propensity score matching conditions and comparison of general data between the two groups after propensity score matching: 104 of 194 patients had successful matching, including 52 in the uncut group and 52 in the traditional group respectively. Before propensity score matching, cases with age ≤60 years or >60 years, cases in stage Ⅰ, Ⅱ, Ⅲ of American Society of Anesthesiologists were 43, 19, 27, 28, 7 for the uncut group, respectively, versus 63, 69, 24, 92, 16 for the traditional group, showing significant differences between the two groups ( χ2=1.279, Z=2.818, P<0.05). After propensity score matching, the above indicators were 33, 19, 20, 25, 7 for the uncut group, versus 34, 18, 15, 33, 4 for the traditional group, showing no significant difference between the two groups ( χ2=0.000, Z=0.500, P>0.05). (2) Intraoperative and postoperative situations: 104 patients underwent laparoscopic distal gastrectomy successfully and received R 0 resection, without intraoperative complications or conversion to open surgery. After propensity score matching, the time of digestive tract reconstruction was (41±10)minutes for the uncut group, versus (52±15)minutes for the traditional group, showing a significant difference between the two groups ( t=4.511, P<0.05). (3) Follow-up: 104 patients were followed up at the postoperative 3 months and 6 months. The incidence of RSS at the postoperative 3 months was 0 for the uncut group, versus 30.8%(16/52) for the traditional group, showing a significant difference between the two groups ( P<0.05). The incidence of RSS at the postoperative 6 months was 0 for the uncut group, versus 9.6%(5/52) for the traditional group, showing no significant difference between the two groups ( P>0.05). There was no tumor recurrence, readmission, death within postoperative 30 days, or cancer-related death in the 104 patients. Conclusion:Uncut Roux-en-Y anastomosis is safe and feasible in the laparoscopic distal gastrectomy, which can effectively shorten the time of digestive tract reconstruction and reduce the occurrence of RSS after 3 months surgery.
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<p><b>OBJECTIVE</b>To investigate the prognostic value of lymphatic vascular invasion (LVI) for stage I( gastric cancer patients after radical gastrectomy.</p><p><b>METHODS</b>Clinicopathological and intact follow-up data of 469 stage I( gastric cancer patients who underwent radical gastrectomy with R0 resection and were pathologically proven as gastric adenocarcinoma without other malignancy at the Department of Digestive Surgery, The First Affiliated Hospital, The Fourth Military Medical University between February 2009 and December 2012 were retrospectively collected. Chi square test was used to examine the relationship between LVI and clinicopathological data; Log-rank test was used for survival analysis; Cox proportional hazards model was used for univariate and multivariate analysis to explore the prognostic influence of LVI on stage I( gastric cancer patients.</p><p><b>RESULTS</b>A total of 469 patients were enrolled, including 360 male (76.8%) and 109 female patients (23.2%). Median age was 58(25-82) years. There were 114 T1a cases (24.3%), 195 T1b cases (41.6%), and 160 T2 cases (34.1%). There were 439 (93.6%) cases without lymph node metastasis and 30 cases with lymph node metastasis. Presence of LVI was found in 52 patients (11.1%). LVI was closely associated with tumor grade, depth of invasion and status of lymph node metastasis (all P<0.05), rather than gender, age, tumor location and tumor diameter (all P>0.05). LVI detection rate was higher in poorly differentiated and undifferentiated group (14.3%, 32/223) than that in moderately and well differentiated group (8.1%, 20/246) (χ=4.590, P=0.032). LVI detection rate was higher in T2 (14.4%, 23/160) and T1b (13.3%, 26/195) group than that in T1a group (2.6%,3/114)(χ=11.020, P=0.004). LVI detection rate was higher in patients with lymph node metastasis (30.0%, 9/30) compared to those without lymph node metastasis (9.8%, 43/439) (χ=11.629, P=0.001). Median follow-up time was 63(3-74) months. There were totally 46 deaths (9.8%). The 5-year overall survival rate was 90.2%. The 5-year overall survival rate was 82.7% in patients with LVI and 91.1% without LVI, which was significantly different (P=0.039). Univariate analysis showed that age (P=0.012), AJCC T stage (8th edition) (P=0.011), and LVI (P=0.043) were closely associated with the prognosis of gastric cancer patients, while gender, tumor location, tumor diameter, tumor grade, lymph node metastasis or postoperative chemotherapy were not associated to the prognosis (all P>0.05). Multivariate analysis revealed that only age(HR=2.038, 95%CI:1.126 to 3.686, P=0.019) and advanced T stage (T1b: HR=1.427, 95%CI:0.554 to 3.678; T2: HR=2.926, 95%CI:1.199 to 7.140; P=0.017) were independent prognostic factors of stage I( gastric cancer patients (both P<0.05).</p><p><b>CONCLUSIONS</b>LVI is not an independent prognostic factor of stage I( gastric cancer patients. In clinical practice, we should consider adjuvant chemotherapy prudently for stage I( gastric cancer patients with LVI.</p>
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Objective To investigate the efficacy of laparoscopic assisted and open surgery for right colectomy.Methods 230 patients underwent right colectomy were selected,and they were randomly divided into laparoscopic group and laparotomy group according to the digital table,each group in 115cases.The laparoscopic group was treated with laparoscopic assisted operation.The laparotomy group was treated with open surgery.The complications after operation,the quality of life and follow up were compared between the two groups.Results The operation time,number of lymph node dissection and total cost of the laparoscopic group were (120.75 ± 28.20) min,(15.89 ± 3.83),(4.5 1 ±0.72) million,respectively,which of the l aparotomy group were (110.44 ± 23.58) min,(11.14 ± 4.01),(3.71 ±0.69) million,respectively,the differences were statistically significant (t =3.008,9.186,8.603,all P ＜ 0.01).The intraoperative blood loss and incision length of the laparoscopic group were (91.23 ± 14.85) mL and (5.85 ± 2.32) cm,respectively,which were significantly lower than those of the laparotomy group [(121.63 ± 12.32) mL,(15.05 ±7.72)cm,t =16.895,12.238,all P ＜ 0.01].The bowel exhaust time,fluid time,postoperative drainage time,postoperative analgesia time,postoperative catheterization time and hospitalization time of the laparoscopic group were (3.47 ± 1.55)d,(4.80 ±2.12)d,(6.31 ±3.21)d,(5.01 ± 1.75)h,(3.25 ± 1.07)d,(15.37 ±4.41)d,respectively,which were significantly shorter than those of the laparotomy group [(4.62 ± 1.68) d,(7.43 ± 2.58) d,(7.67 ±2.80)d,(9.51 ±3.54)h,(6.20 ±2.33) d,(22.62 ±5.39)d,t =16.895,12.238,5.395,8.446,3.424,12.220,12.338,11.163,all P ＜ 0.01].The incidence rate of complication in the laparoscopic group was 1.74％,which was significantly lower than 14.78％ in the laparotomy group(x2 =12.908,P ＜0.01).The scores of quality of life in the laparoscopic group were significantly higher than those in the laparotomy group(all P ＜ 0.01).The two groups were followed up for 9 months,the local recurrence,metastasis and other differences were not statistically significant (all P ＞ 0.05).Conclusion Laparoscopic assisted right colectomy has less wounded in patients,faster recovery after operation,lower incidence of complications,higher quality of life,but relatively expensive medical expenses.
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Objective:To investigate the influence of clinical outcomes and the risk factors of poor prognosis for preoperative nutritional risk in gastric cancer patients.Methods:A prospective study was performed in 140 patients with gastric cancer and the nutritional risk screening 2002 (NRS 2002) was done.The influence of preoperative nutritional risk on postoperative complications,hospital stay,ICU stay,hospital expenses,60 days readmission and mortality was analyzed,and the risk factors of perioperative complication were identified by univariate and multivariate analysis.Results:The significant difference (NRS 2002 ≥ 3 group vs.NRS 2002 ＜ 3 group) was observed in the rates of overall postoperative complications,pulmonary infection,overall hospital stay and postoperative hospital stay (P ＜ 0.05).The rates of anastomotic fistula,pleural effusion,60 days readmission,60 days mortality and hospitalization expenses in NRS 2002 ≥ 3 group were higher than that of NRS 2002 ＜ 3 group,but there were no differences between the two groups (P ＞ 0.05).By univariate and multivariate analysis,preoperative high cholesterol levels and preoperative nutritional risk are the risk factors of poor prognosis and postoperative complications.Conclusion:Preoperative high cholesterol levels and preoperative nutritional risk are independent risk factors of postoperative complications.
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Laparoscopic vagal-sparing esophagogastrectomy for the treatment of early esophageal cancer has the advantages of minimal invasion,functional sparing and better quality of life,and it can radically resect the tumor.The clinical data of 3 patients in the Daping Hospital of Third Military Medical University and 9 patients in the Xijing Hospital of Digestive Diseases who received laparoscopic vagal-sparing esophagogastrectomy from September 2009 to August 2013 were retrospectively analyzed.All the 12 patients were followed up for 1-24 months.One patient was complicated with transit hoarseness and 1 with cervical anastomotic fistular,and they were cured by conservative treatment; 1 patient was complicated with cervical anastomotic stricture,and was cured by dilatation for 3 times; no dysphagia and recurrence was observed in the other 9 patients during the follow-up.Laparoscopic vagal-sparing esophagogastrectomy is a good option for early esophageal cancer and benign esophageal diseases.
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BACKGROUND: Rejection is the main cause of the failure in small intestine transplantation. Cellular immunity mediated by chemotatic factor and the receptor plays an important role in acute rejection. We regard chemokine receptor as target site to design the treatment, which may provide reference for the immunotherapy in clinical small intestine transplantation. OBJECTIVE: To observe the effect of chemokine receptor antagonist, regulated upon activation, normal T cell expressed and secreted (Met-RANTES), on the survival time and histopathological changes of allograft rats which have received heterotopic small intestine transplantation, and the coordinative effects of Met-RANTES used together with low-dose tacrolimus.DESIGN, TIME AND SETTING: Randomized complete-block design and controlled animal experiment, performed in the Department of Gastrointestinal Surgery, Xijing Hospital, the Fourth Military Medical University of Chinese PLA between September 2003 and March 2005.MATERIALS: 180 healthy adult male rats including 90 rats (donors) and 90 Wistar rats (recipients) were involved in this study. Heterotopic segmental small intestine transplantation was performed.METHODS: The rats were randomly divided into 3 groups with 30 rats for each group. Control group: Rats were treated with heterotopic small intestine transplantation alone; Met-RANTES group: Rats were treated with an intraperitoneal injection of Met-RANTES (200 μg/d) at 0-7 days after transplantation; Met-RANTES+low-dose FK506 group: Rats were treated with an intraperitoneal injection of Met-RANTES (200 μg/d)+tacrolimus (0.5 mg/kg/d) at 0-7 days after transplantation.MAIN OUTCOME MEASURES: Gross status and survival time were detected; in addition, every 6 rats were sacrificed at different time points, such as 1,3, 5, and 7 days after transplantation, to compare histopathological changes. RESULTS: Following transplantation, 90 Wistar rats (recipients) were all involved in the final analysis. The survival time median in the control group was 7.2 days (1.5), and all rats died of acute rejection and infection. Histopathological examination showed that mild, moderate and severe rejections were detected at day 3, 5, and 7 after transplantation, respectively. The survival time median in the Met-RANTES group was 19.2 days (16.4), which was significantly longer than the control group (P<0.01). The survival time median in the Met-RANTES+low-dose tacrolimus group was 30.9 days (9.0), and there were significant differences in survival rate as compared with control group and Met-RANTES group (P<0.01). While the rats in the Met-RANTES group and the Met-RANTES+low-dose tacrolimus group showed no obvious indication of rejection.CONCLUSION: Met-RANTES may obviously inhibit acute rejection following small intestine transplantation, effectively protect the function of grafts, and significantly prolong the survival time of the recipients. In addition, Met-RANTES may enhance the immunosuppressive function of low-dose tacrolimus.
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BACKGROUND: AIIograft rejection is the greatest obstacle that influences graft function and survival, and the diagnosis and treatment of small intestine transplantation rejection are particularly difficult.OBJECTIVE: To explore the significance of chemokine receptor antagonist, Met-RANTES, in small intestine transplantation rejection, and the effects of tacrolimus (FK506) on RANTES expression.DESIGN, TIME AND SETTING: Randomized, controlled animal experiment was performed at the Department of General Surgery, the 451 Hospital of Chinese PLA; Laboratory of Department of Gastrointestinal Surgery, Xijing Hospital, Fourth Military Medical University of Chinese PLA; and Electronic Microscope Center, School of Basic Medicine, Fourth Military Medical University of Chinese PLA between September 2003 and March 2005.MATERIALS: A total of 72 healthy adult male SD rats (donor) and 72 healthy adult male Wistar rats (recipient) were included for heterotopic small intestine transplantation.METHODS: Heterotopic small intestine transplantation was performed. All recipients were divided into four groups (n=18): intact control group: Wistar rats as controls with no surgery; isotransplantation group: Wistar--,Wistar; allotransplantation untreated group: SD→Wistar, with no immunosuppressive agent; allograft allotransplantation and FK-506 group: SD→Wistar + FK-506 (1 mg/kg per day, i.m. for 7 days). The grafts were sampled on postoperative days 3, 5 and 7 and were examined pathologically. Successive quantitative measurement was conducted to detect the expression of graft RANTES with immunofluorescence staining and laser scanning confocal microscope technique.MAIN OUTCOME MEASURES: The pathological changes of grafts in each group; RANTES expressions in small intestine grafts of rats in each group at different time points; inhibition of FK-506 on RANTE expression.RESULTS: Postoperatively, 72 Wistar rats (recipient) were involved in the final analysis. The pathological changes of the allotransplantation untreated group rats were consistent with the criteria of mild, moderate and severe rejection on postoperative days 3, 5 and 7, respectively. No obvious rejection was found in the rats of FK506 group and isotransplantation group on the postoperative days 3, 5 and 7. Expression of intragraft RANTES of allotransplantation untreated group rats was significantly greater than the other three groups (P<0.01). The dynamic change and the process of acute rejection showed positive correlation. Expression of intragraft RANTES in FK-506 treated group was significantly less than other three groups without FK-506 (P<0.01).CONCLUSION: RANTES positive cells play an important role in small intestine allograft rejection. Dynamic observation on expression of intragraft RANTES may act as a predicator for diagnosing acute allograft rejection.
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Objective To summarize reasonable therapeutic measures by analyzing the characteristics of tardive intestinal malrotation in childhood. Methods Clinical data of 23 definitely diagnosed cases of intestinal mal-rotation from 1998 to 2008 were studied retrospectively. Results All of 23 patients were processed through plain ab-dominal radiograph;9 were examined with barium meal;2 were examined with barium enema;20 were examined by abdominal Doppler and 13 were examined by abdominal computer tomography. There were 18 patients who got final diagnosis preoperatively and the rate of final diagnosis was 78.3%. All of the cases were cured with Ladd's operative method. Conclusion Because tardive intestinal malrotation has various clinical manifestations,it is more difficult to diagnose than congenital intestinal malrotation in children. The main causes of death are intestinal volvulus and/or necrosis. At present,surgery is a traditional therapeutic way. Ladd procedure is the main traditional way to treat mal-trotation.
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@#ObjectiveTo study the injuries of liver after ischemia-reperfusion of small intestine of the rat.MethodsModels of ischemia-reperfusion of small intestine was made with rats. At 0 min, 30 min, 1h, 2h, 1d, 3d,7d after reperfusion, the concentration of nitric oxide(NO), superoxide dismutase (SOD) in the serum was examed and the expression of Bax, Bcl-2 and p53 in the liver was observed by the immunohistochemical SP method.ResultsThe concentration of NO increased apparently 0 min after reperfusion, but decreased 2 h after, then increased gradually to a peak at 7th day. But for SOD, the concentration decreased 0 min after reperfusion, increased 2 h after,and decreased to the lowest level at 7th day. The immunohistochemical SP positive cells were observed in sinus endothelial cells and hepatocytes. The ratio of positive cells of Bax,p53 and Bcl-2 began to increase 0 minute after reperfusion and increased continuously 30 min after, while that of Bcl-2 was higher than that of Bax(P<0.01). It decreased apparently 2h after, and then increased till 7d after reperfusion,while the ratio of Bax positive cells was higher than that of Bcl-2(P<0.01).ConclusionThe change of concentration of NO, SOD and the expression of positive cells of Bax, Bcl-2 and p53 might play a important role in apoptosis and injuries of the liver after ischemia-reperfusion of small intestine of rat.
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Objective To introduce the management experience in the first cause of living-related small bowel transplantation in China. Methods An 18-year-old male patient with short gut syndrome received a living-related small bowel transplantation with the graft taken from his father(44-year-old). A segment of 150?!cm distal ileum was resected from the donor. Treatment of immunosuppression, antibiotics, antithrombosis and nutrition support were given posttransplantatively. Results Recently the recipient has a good life quality for 19 months. Conclusions Living-related small bowel trnasplantation can be effectively used to treat short gut syndrome, and the posttransplantative management is the key to the successful transplantation.
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Objective To introduce the management experience in the first cause of living related small bowel transplantation in China. Methods An 18 year old male patient with short gut syndrome received a living related small bowel transplantation with the graft taken from his father(44 year old). A segment of 150?cm distal ileum was resected from the donor. Treatment of immunosuppression, antibiotics, antithrombosis and nutrition support were given posttransplantatively. Results Recently the recipient has a good life quality for 19 months. Conclusions Living related small bowel trnasplantation can be effectively used to treat short gut syndrome, and the posttransplantative management is the key to the successful transplantation.