Clinical analysis of 10 patients with Wernicke encephalopathy after major abdominal surgery / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To explore the pathogenesis, clinical features, diagnosis and treatment of Wernicke encephalopathy after major abdominal surgery.</p><p><b>METHODS</b>Clinical data of 10 patients with Wernicke encephalopathy after major abdominal surgery in the Zhejiang Provincial People's Hospital from 2000 to 2012 were retrospectively analyzed.</p><p><b>RESULTS</b>Wernicke encephalopathy occurred during 5 to 36 days (mean 22.9 days) after surgery. The main symptoms included vertigo, vagueness, blurred vision, and gait incoordination. MRI showed bilaterally symmetrical enhancement of T1 and T2 signal in thalamus, third ventricle, lateral ventricle and periaqueductal region. With treatment of vitamin B1, 6 patients were completely recovered, and 2 partly recovered, but 2 died.</p><p><b>CONCLUSIONS</b>Surgeons should be aware of Wernicke encephalopathy when treating patients undergoing major abdominal operation who need prolonged fasting postoperatively. Early detection and timely supplement of vitamin B1 can avoid irreversible brain damage.</p>

Effect of andrographolide on proliferation and apoptosis of gastric cancer BGC-823 cells / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To investigate the effect of andrographolide (AD) on proliferation, cell cycle and apoptosis of human gastric cells line BGC-823.</p><p><b>METHODS</b>MTT assay, flow cytometry and Annexin-V/PI double-staining flow cytometry assay were used to evaluate the effect of AD on proliferation, cell cycle and apoptosis of BGC-823 cells respectively. Optical microscope and transmission electron microscopy were used to observe the cell morphological changes.</p><p><b>RESULTS</b>A time- and concentration-dependent proliferative inhibition effect of AD was demonstrated in BGC-823 cells. AD concentration lower than 7.5 mg/L possessed weak inhibitory effect,while concentration between 15.0-60.0 mg/L possessed higher inhibitory effect. The concentration higher than 60.0 mg/L had no significant increase of inhibitory effect. IC50 of AD at 24, 48 and 72 h was (35.3±4.3), (25.5±3.5) and (18.2±2.7) mg/L respectively. Compared with the negative control group, the number of G0/G1 phase cells increased significantly (P<0.05), while the number of S and G2/M phase cells decreased after incubation with AD for 48 h, and the alteration was in a concentration-dependent manner. AD arrested BGC-823 cells at the G0/G1 phase of the cell cycle. After incubation with 7.5, 10.0 and 15.0 mg/L AD for 24 h, the early apoptotic rates of BGC-823 cells were (19.3±4.7)%, (29.4±4.1)% and (52.7±6.7)% respectively, and the late apoptotic rates were (10.8±1.8)%, (10.9±4.7)% and (14.7±4.8)% respectively. Both the early apoptotic rates and the late apoptotic rates increased significantly compared to the control group (all P<0.05),and the alteration was in a concentration-dependent manner.</p><p><b>CONCLUSION</b>Andrographolide can inhibit BGC-823 cells proliferation, arrest BGC-823 cells in G0/G1 phase and induce apoptosis, and may be a potential traditional Chinese medicine with anti-cancer effect.</p>

Expression of aldo-keto reductase family 1 member B10 in gastric cancer tissues and its clinical significance / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To investigate the association of AKR1B10 expression in gastric cancer tissues with clinicopathologic features and prognosis of gastric cancer patients.</p><p><b>METHODS</b>Real-time polymerase chain reaction (RT-PCR) was conducted to detect AKR1B10 mRNA expression in gastric cancer and adjacent gastric mucosa tissues (n=36). AKR1B10 protein expression was measured by immunohistochemistry in primary gastric cancer tissues (n=100) and non-tumorous gastric mucosa tissues (n=70).</p><p><b>RESULTS</b>RT-PCR results confirmed that AKR1B10 was significantly down-regulated in gastric cancer tissues compared with that in paired adjacent mucosa [8.3% (3/36) vs. 91.7% (33/36), P=0.000]. Immunohistochemistry revealed that the percentage of AKR1B10 positive specimens in gastric carcinoma was lower than that in normal specimens [33.0% (33/100) vs. 92.9% (65/70), P=0.000]. The frequencies of positive AKR1B10 in patients was significantly correlated with tumor size (P=0.000), invasive depth (P=0.004), lymph node metastasis (P=0.028), distant metastasis (P=0.031) and TNM stages (P=0.000). The 5-year survival rate of positive AKR1B10 group was significantly higher as compared to negative group (60.6% vs. 32.8%, P<0.01).</p><p><b>CONCLUSION</b>The down-regulation of AKR1B10 expression in gastric cancer may be associated with the progress of gastric cancer is suggestive of poor prognosis.</p>

Current status and prospect of surgical treatment for diabetes mellitus / 中华胃肠外科杂志

Diabetes surgery is a new concept in recent years, which means controlling blood sugar or curing diabetes through some surgical methods. From the commencement of bariatric surgery in the 1950s to the discovery of the special function of decreasing blood sugar after these surgeries in 1970s, and then the fast developing of diabetes surgery in the past 30 years, now there seems be a different answer to the question that if we can cure diabetes. In this article, we review the historical evolution, surgical procedure, potential mechanism and outlook of diabetes surgery.

Association of SOX9 expression and prognosis in patients with gastric cancer / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To investigate the association of SOX9 expression and clinicopathologic factors and prognosis of gastric cancer.</p><p><b>METHODS</b>A retrospective cohort study including 112 gastric cancer patients admitted to the Zhejiang Provincial People's Hospital from 2004 to 2006 was performed. Immunohistochemical analysis was used to evaluate the expression of SOX9 in the 112 specimens of gastric cancer tissues and 70 non-cancerous tissues adjacent to the tumor.</p><p><b>RESULTS</b>Low expression of SOX9 was seen in 5(7.1%) tissues out of 70 non-cancerous tissues adjacent to the tumor. A total of 94(83.9%) patients had varying expression of SOX9, of whom 51(45.4%) had overexpression. Univariate analysis demonstrated that the expression of SOX9 was significantly associated with Lauren classification (P<0.05), tumor invasion(P<0.01), lymph node metastasis(P<0.05), distant metastasis(P<0.05) and tumor stage(P<0.05), however there was no significant association between SOX9 expression and sex, age, histological type, histology differentiation or tumor size. Kaplan-Meier analysis showed that the 5-year survival rate of patients with SOX9 over-expression was significantly lower than that of patients with low expression(29.4% vs. 49.2%, P=0.031). Multivariate Cox regression analysis showed that histology differentiation(P=0.046), tumor invasion(P=0.001), and distant metastasis(P<0.01) were independent prognostic factors for gastric cancer, however the over-expression of SOX9 was not significant(P=0.948).</p><p><b>CONCLUSIONS</b>The expression SOX9 is associated with the growth, invasion, and metastasis of gastric cancer, as well as the prognosis. However, SOX9 expression is not an independent factor for the prognosis in patients with gastric cancer.</p>

The application of uncut Roux-en-Y esophagojejunostomy with distal jejunal pouch on behalf of the stomach surgery in the digestive tract reconstruction after total gastrectomy / 中华外科杂志

<p><b>OBJECTIVE</b>To study the clinical value of uncut Roux-en-Y esophagojejunostomy with distal jejunal pouch on behalf of the stomach (URYAJP) surgery in the digestive tract reconstruction after total gastrectomy.</p><p><b>METHODS</b>A retrospective analysis of radical resection of the whole stomach in 486 cases of gastric cancer patients, divided into the URYAJP group (n = 189), the P-loop Roux-en-Y behalf of the stomach surgery (PRY) group (n = 150) and pure Roux-en-Y reconstruction (RY) group (n = 147). Three groups were compared in patients with surgical reconstruction time, the occurrence of postoperative complications, the postoperative weight after 6, 12 and 24 months, the single meal food intake and prognostic nutritional index (PNI) and Visick points class situation after 12 and 24 months.</p><p><b>RESULTS</b>(1) The URYAJP group and RY group had no significant difference in digestive tract reconstruction time ((37 ± 6) minutes and (38 ± 6) minutes respectively), but PRY group was significantly prolonged ((47 ± 6) minutes, t = 7.52 and 6.54, P < 0.05). (2) In the comparison of the incidence of complications, URYAJP group has 2.1% rate of Roux stay syndrome (RSS) incidence, significantly less than PRY group (21.3%) and RY group (19.7%) (χ² = 14.84, P < 0.05). (3) In the comparison the postoperative nutritional status, URYAJP group clear asset, showing the degree of ((3.1 ± 1.0) kg) weight loss after 12 months (t = 25.03 and 22.99, P < 0.05). And after 12, 24 months, a single meal eating reached the preoperative level is 94.8% and 96.9% in URYAJP group, while PRY group and RY group is less than 50% (χ(2) = 61.10, 69.17, 65.17 and 73.29, P < 0.05). URYAJP Group reach the preoperative levels of PNI in 24 months after surgery, while PRY and RY group were still lower than per-operation (t = 106.97 and 100.37, P < 0.05). (4) The Visick points class I-II postoperative 12 and 24 months in URYAJP group were 92.7% and 93.8%, significantly better than group B and C (χ² = 10.63, 14.19, 10.10 and 10.74, P < 0.05).</p><p><b>CONCLUSIONS</b>URYAJP surgery give full play to maintain intestinal continuity, simple operation, and advantages of food storage bags, it can reduce the long-term postoperative complications, improve the nutritional status of patients and improve quality of life. It is worthy of promoting a way of gastrointestinal reconstruction.</p>

Clinicopathological characteristics and prognosis of early gastric cancer after gastrectomy / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Assessment of lymph node metastasis (LNM) is important in early gastric cancer (EGC) and affects treatment decisions. However, the relationship between clinicopathological characteristics and LNM in EGC remains unclear. This study therefore explored favorable predictors of LNM in EGC.</p><p><b>METHODS</b>A total of 716 specimens from gastric cancer patients who underwent curative gastrectomy between 1996 and 2003 at Zhejiang Provincial People's Hospital were reviewed. Forty-five cases were EGC, and clinicopathological characteristics such as gender, age, tumor size, location, gross type, differentiation, invasion depth, and vessel involvement were assessed to identify predictive factors for LNM and survival time.</p><p><b>RESULTS</b>The overall cumulative 5-year survival rate of EGC patients was 88.92%. Among these, 22.4% developed LNM, which was associated with a poor 5-year survival rate of only 72.7%. Patients with tumors larger than 2 cm in diameters, with depth of tumor invasion to the submucosa, and with positive lymphatic or nerve involvement were also inclined to have poorer survival performances. EGC limited to the mucosa but poorly differentiated also had a high risk for LNM. Multivariate analysis identified lymphatic invasion and tumor size as independent prognosis factors related to survival in EGC patients.</p><p><b>CONCLUSIONS</b>Careful planning is required in EGC patients at high risk of lymph node metastases. Endoscopic mucosal resection or endoscopic submucosal dissection and laparoscopic partial gastrectomy should be cautiously used in EGC, and curative gastrectomy including lymphatic dissection and postoperative adjuvant therapy might be considered to improve the prognosis.</p>

Laparoscopic versus open wedge resection for gastrointestinal stromal tumors of the stomach: a clinical controlled study / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To compare the surgical outcomes between laparoscopic and open wedge resection for gastrointestinal stromal tumors of the stomach.</p><p><b>METHODS</b>Clinical data of 18 cases undergoing laparoscopic wedge resection from June 2000 to August 2009 at the Zhejiang Provincial People's Hospital were compared with 30 patients treated by open surgery. The perioperative parameters and prognosis data of the two groups were compared.</p><p><b>RESULTS</b>Compared to the open group, laparoscopic group was found with longer operative time, less blood loss, less requirement of postoperative analgesia, earlier resumption of oral intake, earlier return of first flatus, and shorter postoperative hospital stay(all P<0.05). There were no postoperative deaths in both groups. Postoperative complication rate was significantly lower in the laparoscopic group(5.5% vs. 33.3%, P<0.05). The postoperative recurrence rates were 11.8%(2/17) and 10.7%(3/28); the 5-year survival rates were 78% and 63%, respectively, and the difference was not statistically significant(P>0.05).</p><p><b>CONCLUSION</b>Laparoscopic wedge resection is a feasible treatment option for GISTs of the stomach.</p>

Oral glucose tolerance test and insulin response in Beagle dogs after subtotal distal gastrectomy / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To evaluate the impact of reconstruction techniques after subtotal gastrectomy on postoperative glucose and insulin levels after oral glucose tolerance test (OGTT).</p><p><b>METHODS</b>Distal gastrectomy was performed in 38 Beagle dogs. Reconstruction techniques used included integral continual jejunal interposition (n=9), Billroth I( (n=6), Billroth II( (n=7), and isolated jejunal interposition (n=8). Eight controls were used. OGTT was conducted to examine the changes in glucose and insulin levels.</p><p><b>RESULTS</b>Compared to controls, glucose significantly increased in all the 4 operative groups and peaked at 60 min. Billroth II( was associated with the most significant increase. Insulin level significantly increased in all the experimental groups in response to food stimulus and peaked at 60 min. However, the increase of insulin in Billroth II( group was not as prominent as in other groups.</p><p><b>CONCLUSIONS</b>Fluctuation of blood glucose after gastrectomy may be mitigated and insulin elevated if duodenal passage is preserved. Continual jejunal interposition should be given priority when Billroth I( reconstruction is not feasible.</p>

Effect of early enteral nutrition supplemented with glutamine on postoperative intestinal mucosal barrier function in patients with gastric carcinoma / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To investigate the effect of early enteral nutrition (EEN) supplemented with glutamine on postoperative intestinal mucosal barrier function of patients with gastric carcinoma.</p><p><b>METHODS</b>Eighty patients with gastric carcinoma who underwent intraoperative peritoneal hyperthermic chemotherapy(IPHC) were randomized into two groups: EEN+glutamine (EEN+Gln) group(n=40) and EEN group(n=40). Intestinal mucosal barrier function was evaluated by serum diamine oxidase (DAO), ratio of lactulose to mannitol(L/M), endotoxin lipopolysaccharides(LPS), and tumor necrosis factor-α(TNF-α) at 1 day before operation, 1 day, 7 days, 12 days after operation. Time to first flatus and tolerance to EEN were recorded as well.</p><p><b>RESULTS</b>There were no significant differences in the two groups in demographics(all P>0.05). Two cases(5%) in the EEN+Gln group and 1 case (2.5%) in the EEN group could not tolerate well(P>0.05). On postoperative day 1, there were no differences in serum DAO, L/M ratio, LPS, TNF-α between the two groups (P>0.05). On postoperative day 7, all the parameters for mucosal barrier function were significantly lower in the EEN+Gln group. On postoperative day 12, the urinary L/M and DAO, LPS, and TNF-α were still significantly lower in the EEN+Gln group, however, urinary L/M was comparable between the two groups. There were no differences between the two groups in the time to first flatus (P>0.05).</p><p><b>CONCLUSION</b>The immunologic tolerance of enteral nutrition supplemented with glutamine is favorable, which provides protective effect on intestinal mucosal barrier in patients with gastric carcinoma undergoing IPHC.</p>

Application of purse-string suture for management of duodenal stump in radical gastrectomy / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Gastric cancer (GC) is the second leading cause of cancer mortality worldwide, and surgical resection is currently the only possible curative approach. Duodenal stump leakage is the most serious complication after radical gastrectomy, and optimal treatment is still lacking.</p><p><b>METHODS</b>We retrospectively reviewed 2034 cases of total or subtotal gastrectomy for GC from January 1995 to December 2009, including 465 cases of duodenal stump closure using purse-string suture (group A), 835 cases of duodenal stump treated with linear cutting stapler and seromuscular layer suture (group B), and 734 cases of duodenal stump closure using full-thickness and seromuscular layer suture (group C). We evaluated the surgical cost, operative time for duodenal stump closure, short-term postoperative complications, perioperative blood loss, and postoperative recovery.</p><p><b>RESULTS</b>There was no perioperative mortality in any group. Ninety-four postoperative (within 1 month) complications occurred: 18 abdominal bleeding, 14 anastomotic leakage, 15 abdominal infection, 36 wound infection, and 11 duodenal stump leakage. There was no significant difference among the groups in intra-abdominal hemorrhage, anastomotic leakage, abdominal infection and wound infection. No postoperative duodenal stump leakage occurred in group A, which had a significant difference compared with groups B and C (6 cases in group B and 5 cases in group C suffered duodenal stump leakage. P < 0.01). The surgical cost in groups A and C was significantly lower than in group B (P < 0.01), with no significant difference between groups A and C. The processing time for duodenal stump closure in groups A and B was significantly shorter than in group C (P < 0.01), with no significant difference between groups A and B. There was no significant difference in blood loss and postoperative recovery among the groups.</p><p><b>CONCLUSIONS</b>Duodenal stump closure using purse-string suture seems to be a promising approach with shorter operative time, and lower cost and incidence of duodenal stump leakage in radical gastrectomy.</p>

Comparative analysis between biopsy-diagnosed high grade intraepithelial neoplasia in the gastric mucosa and postoperative pathological findings / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To investigate the association between the morphological features of biopsy-diagnosed high grade intraepithelial neoplasia in the gastric mucosa and the postoperative pathology.</p><p><b>METHODS</b>Fifty-one patients with biopsy-diagnosed high grade intraepithelial neoplasia in the gastric mucosa were retrospectively analyzed. Thirty-three patients underwent surgery. The morphology of lesions under endoscopy and histopathological findings of the surgical specimens were investigated.</p><p><b>RESULTS</b>Of the 51 patients, 43 had superficial lesions similar to early gastric cancer under endoscopy, 8 were similar to advanced carcinoma. In the 33 surgical cases, high grade intraepithelial neoplasia of gastric mucosa was confirmed on postoperative pathological examination in 13 (39.4%) patients, adenocarcinoma was identified in the remaining 20 patients (60.6%), including 14 early gastric cancers and 6 advanced carcinomas. Thirteen cases with high grade intraepithelial neoplasia confirmed postoperatively were superficial elevated or flat lesions less than 20 mm.</p><p><b>CONCLUSIONS</b>Patients with biopsy-diagnosed high grade intraepithelial neoplasia in the gastric mucosa have a high risk of cancer. Thus aggressive follow-up and appropriate surgical interventions are recommended to avoid misdiagnosis.</p>

Nutritional therapy of duodenocutaneous fistula / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To summarize the experience in nutritional support for the management of duodenocutaneous fistula.</p><p><b>METHODS</b>Data of 32 patients with duodenocutaneous fistula in Zhejiang provincial people's hospital from January 1999 to December 2009 were analyzed retrospectively.</p><p><b>RESULTS</b>The mean duration of nutritional support was 35.6 days (range, 8-82 days). Eight received total parenteral nutrition, 2 total enteral nutrition, and 22 parenteral nutrition combined with enteral nutrition respectively. Succus entericus reinfusion with enteral nutrition was used in 11 cases, glutamine-enriched nutritional support in 28 cases, somatostatin in 12 cases. In these patients, the healing rate was 75.0% after conservative treatment. In the 8 patients who underwent surgery, 6 were cured and 2 died (due to severe abdominal infection and multiple organ failure). A total of 30 patients had the fistulas cured and discharged.</p><p><b>CONCLUSIONS</b>Parenteral nutrition combined with enteral nutrition, succus entericus reinfusion combined with enteral nutrition, glutamine-enriched nutritional support and somatostatin are important factors for the healing of duodenocutaneous fistulas.</p>

Experimental research of integral continuous jejunal interposition after subtotal distal gastrectomy / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To evaluate nutritional status, myoelectrical activity, and gastrointestinal tract emptying capacity after integral continuous jejunal interposition following subtotal gastrectomy.</p><p><b>METHODS</b>According to different re-construction techniques, 30 Beagle dogs were divided into four groups after subtotal distal gastrectomy: group 1(n=9, integral continuous jejunal interposition), group 2(n=6, Billroth I(), group 3(n=7, Billroth II(), group 4(n=8, isolated jejunal interposition). Blood cell counts, liver function, myoelectrical activity and the rate of gastrointestinal tract emptying were compared among the four groups.</p><p><b>RESULTS</b>At week 12 after operation, the body weight in group 1 [(9.65±1.54) kg] was significantly higher than that in group 2[(9.25±1.76)kg], group 3[(9.31±1.54)kg] and group 4[(7.77±1.46)kg]. At week 4, the prognostic nutritional index in group 1(2671.9±49.9) was significantly higher than that in group 3(2555.9±54.7) and group 4(2440.9±54.3), but similar to that in group 2(2791.8±54.3). At week 6, the fasting and postprandial frequency of jejunal pacesetter potentials in group 1 were higher than those in group 3 and group 4(P<0.05) but comparable with those in group 2. The emptying rate of food in the four groups were 95.4%, 91.3%, 93.1% and 94.2%, respectively and there were no significant differences(P>0.05). However, as compared with group 2 and group 3, group 1 had longer operative time and later regular diet resumption, more severe abdominal adhesion(P<0.05).</p><p><b>CONCLUSION</b>Continuous jejunal interposition should be considered when Billroth I( is not feasible after subtotal gastrectomy.</p>

Clinical study of gastrointestinal stromal tumors / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To investigate the clinicopathological characteristics, surgical treatment and prognosis of gastrointestinal stromal tumors(GIST).</p><p><b>METHODS</b>The clinicopathological data of 84 patients with GIST undergone resection between April 1997 and June 2008 were analyzed retrospectively, and the prognosis was evaluated.</p><p><b>RESULTS</b>Out of 84 cases, 42 tumors located in stomach, 24 in small intestine, 18 in other sites. Tumor sizes ranged from 0.5 to 25 cm(average 5.6 cm). Positive rate of CD117 expression determined by immunohistochemical methods was 96.4%. Seventy-nine cases underwent complete tumor resection, while 5 cases received palliative resection or biopsy. Seventy-eight patients were followed up and their 1-, 3-, 5-year survival rates were 92.0%, 79.2%, 72.0% respectively. The Fletcher's classification of malignancy risk groups for GIST was related to the survival rates(P=0.001). The differences of survival rate among very low risk group, low risk group and high-risk group were significant(P=0.003, P=0.000).</p><p><b>CONCLUSIONS</b>Complete tumor resection in the initial operation of GIST should be emphasized. The Fletcher's classification of malignancy risk groups for GIST is related to the survival rate. Extended surgical resection is required for GIST of higher malignancy risk.</p>

Surgical treatment for primary gastrointestinal stromal tumors: a report of 73 cases / 中华外科杂志

<p><b>OBJECTIVE</b>To investigate the effects and prognosis of surgical treatment in primary gastrointestinal stromal tumors (GIST).</p><p><b>METHODS</b>The clinicopathological data of 73 patients with primary GIST underwent operation from April 1997 to December 2007 was retrospectively analyzed, and the prognosis was evaluated too.</p><p><b>RESULTS</b>Among the 73 cases, 68 cases received complete tumor resection, among which 12 cases underwent laparoscopic operation; while palliative resection and biopsy only were carried out in the other 5 cases. There was significant difference in survival rate between the two groups (P = 0.000). The 1-, 3-, 5-year survival rates of the 66 cases had been followed up was 91.0%, 78.2% and 74.1%, respectively. The malignancy risk grades of GIST was related to the survival rates on statistical analysis (P = 0.002). Significant differences were found in the survival rates between the patients with very low grade, low grade and high grade malignancy tumors (P = 0.012, 0.002).</p><p><b>CONCLUSIONS</b>Complete tumor resection should be emphasized in primary GIST, and more attention should be paid to the initial surgical treatment. Extended surgical resection is required for tumors of higher malignancy risk. The indications of laparoscopic surgery in GIST should be selected with caution for tumor complete resection.</p>

Clinical study on the alimentary canal reconstruction of uncutted Roux-en-Y with jejunal pouch for total gastrectomy / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To investigate the efficacy of uncutted Roux-en-Y esophagojejunostomy with jejunal pouch (URYJP) after total gastrectomy.</p><p><b>METHODS</b>Total gastrectomy was performed on 168 patients of gastric cancer, and 3 methods were used for reconstruction: the uncutted Roux-en-Y esophagojejunostomy with a jejunal pouch was performed on 69 patients(group A),Roux-en-Y esophagojejunostomy with the P-type jejunal pouch on 50 patients(group B),and Roux-en-Y esophagojejunostomy with the Orr-type jejunal pouch on 49 patients (group C). The alimentary tract reconstruction time, morbidity and mortality were compared. The 121 cases that survived for more than 1 year were analyzed for quality of life(QOL),including body weight, intake quantity, prognosis nutritional index (PNI), and Visick scores 6 and 12 months after the operations.</p><p><b>RESULTS</b>All the patients recovered quickly and no anastomosis leakage or duodenal fistulas were found. It took (30+/-7) minutes to finish the reconstruction in group A, which was significantly shorter than that in group B [(57+/-6) minutes] or in group C [(48+/-6) minutes]. There were no significant differences among 3 groups in the incidence of alkaline reflux gastritis. The incidence of Roux stasis syndrome was 2.2% in group A, which was significantly lower than 17.9% and 19.4% in group B and C. Weight loss and food intake gain in group A was superior to those in group B and C 6 months and 12 months postoperatively. As compared with prognosis nutritional index(PNI) postoperatively, those of 3 groups decreased significantly 6 months postoperatively. At 12 months after operation, the PNI of group A returned to the level before operation, while PNI of both group B and C remained significantly lower than those before operation (both P < 0.05). The Visick score of group A was superior to those of group B and C 6 months and 12 months postoperatively.</p><p><b>CONCLUSIONS</b>The new uncutted Roux operation with jejunal pouch can prevent alkaline reflux gastritis and Roux-en-Y stasis syndrome. It may be a standard procedure for reconstruction after total gastrectomy.</p>

Radical pancreatoduodenectomy combined with retroperitoneal nerve, lymph, and soft-tissue dissection in pancreatic head cancer / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Recent studies have revealed that the reason for the low surgical resection rate of pancreatic carcinoma partly lies in its biological behavior, which is characterized by neural infiltration. This study aimed to investigate the clinical significance of radical pancreatoduodenectomy combined with retroperitoneal nerve, lymph, and soft-tissue dissection for carcinoma of the pancreatic head.</p><p><b>METHODS</b>Forty-six patients with pancreatic head cancer were treated in our hospital from 1995 to 2005. The patients were divided into two groups: radical pancreatoduodenectomy combined with retroperitoneal nerve, lymph and soft-tissue dissection (group A, n = 25) and routine Whipple's operation (group B, n = 21). There were no significant differences between the two groups in relation to age, gender and preoperative risk factors, and perioperative conditions, pathological data and survival rates were studied.</p><p><b>RESULTS</b>There were no significant differences in tumor size, surgical procedure time, postoperative complications, and time of hospitalization. However, the number and positive rate of resected lymph nodes in group A were significantly higher than those in group B (P < 0.05). The 1- and 3-year survival rate in group A were 80% and 53%, respectively, which was higher than those in group B (P < 0.05). There were significant differences in the survival rates between patients with and without nerve infiltration in group A (P < 0.05).</p><p><b>CONCLUSIONS</b>Radical pancreatoduodenectomy combined with retroperitoneal nerve, lymph and soft-tissue dissection, can effectively remove the lymph and nerve tissues that were infiltrated by tumor. Meanwhile, this method can reduce the local recurrence rate so as to improve the long-term survival of patients.</p>

Study on serum levels of E- selectin, integrin beta 1 subunit and intercellular adhesion molecule-1 in gastric cancer patients and their clinical implications / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To evaluate the serum concentrations of E- selectin, integrinbeta(1) subunit and intercellular adhesion molecule-1 in gastric cancer patients and their clinicopathological significance.</p><p><b>METHODS</b>The serum levels of adhesion molecules E- selectin,intercellular adhesion molecule- 1 (ICAM- 1), and integrinbeta(1) were measured by enzyme-linked immunosorbent assay (ELISA) in 47 health subjects (control group) and in 57 patients with gastric cancer (gastric cancer group) before operation and 7 days after operation. Serum levels of above three factors were compared between the two groups.</p><p><b>RESULTS</b>The serum concentrations of E- selectin, integrinbeta(1) subunit and ICAM- 1 were higher in gastric cancer group with positive rate of 24.6% ,33.3% ,28.1% respectively. ICAM- 1 and integrinbeta(1) were significant higher in gastric cancer group than that in the control group (P< 0.01),but there was no significant difference in E- selectin between two groups (P=0.64). Serum concentrations of E-selectin, ICAM-1,and integrinbeta(1) were significantly correlated with clinicopathological features as following: clinicopathological stage,invasion depth,lymph node involvement,and presence of distant metastases(P< 0.05,P< 0.01). The serum levels of E- selectin, ICAM- 1, and integrinbeta(1) were decreased significantly after radical resection of gastric cancer,but not in patients with unresectable tumor. Elevated levels of three molecules were significant prognostic factors for patients with gastric cancer,but it could not independently be used to evaluate tumor stage.</p><p><b>CONCLUSIONS</b>Serum concentrations of E- selectin, ICAM- 1,and integrinbeta(1) may reflect tumor progression and metastasis.</p>

Biological behavior of cardial cancer and its effect on surgical management / 中华外科杂志

<p><b>OBJECTIVE</b>To study the biological behavior of cardial cancer and its influence on surgical management.</p><p><b>METHODS</b>Complete clinicopathologic data of 46 cases with cardial cancer undergoing radical gastrectomy was investigated retrospectively. The relationships between tumor Borrmann type, depth of invasion, growth pattern, lymph node metastasis and 5-year survival rate postoperative were analyzed.</p><p><b>RESULTS</b>Of 46 cases, Borrmann type III, Type IV and Type II was 76% (35/46), 18% (8/46) and 6% (3/46) respectively; 5-year survival rate was 40% (14/35), 0 (0/8) and 100% (3/3) respectively. In respect of the depth of invasion, pT(2) was 31% (14/46) cases with 71% (10/14) lymph node metastasis; and 5-year survival rate was 64% (9/14). pT(3) was 15% (7/46) cases with 86% (6/7) lymph node metastasis; and 5-year survival rate was 57% (4/7). And pT(4) was 54% (25/46) cases with 92% (23/25) lymph node metastasis; and 5-year survival rate was 12% (3/25). The growth pattern in 87% (40/46) cases was infiltrative; and 5-year survival rate was 28% (11/40); the growth pattern in 13% (6/46) cases was expansive; and 5-year survival rate was 100% (6/6).</p><p><b>CONCLUSION</b>D(2)(+) radical total gastrectomy should be performed on the developed cardial cancer, and if necessary, resection of body and tail of pancreas should be chosen.</p>