Small bowel autotransplantation after resection of lesions involving the roots of mesenteric vessels / 中华普通外科杂志

Objective:To summarize our experience in 13 cases of intestinal autotransplantation (IATx) after resection of lesions involving the roots of mesenteric vessels.Methods:The clinical data of 13 patients undergoing IATx in Xijing hospital were retrospectively analyzed. The etiology, surgical procedure and complications were analyzed. The patients were followed up by telephone and regular evaluations.Results:All 13 cases of IATx were successfully completed. For 12 patients who were diagnosed with tumors involving the mesenteric roots, the tumors were removed for cure intent avoiding massive intestinal resection. Pancreaticoduodenectomy was carried out simultaneously in 11 cases. The postoperative complication rate was 85% (11/13). The autograft was resected in 1 patient on the 1st postoperative day due to necrosis from mesenteric thrombosis, leading to short bowel syndrome. One-year survival was 69% (9/13). Among 4 deaths, 1 patient died of liver metastasis, and another died of liver and lung metastases. Five patients were alive 2 years postoperatively.Conclusion:IATx while-technically challenging, avoiding short small bowel syndrome in properly selected patients after resection of lesions especially benign ones involving the roots of mesenteric vessels that were traditionally considered to be "unresectable".

Investigation on nutrition status and clinical outcome of patients with common cancers in Chinese patients: a multicenter prospective study protocol

Background:Malnutrition is common in patients with cancer, whichadversely affectsthesurvival and quality of life ofcancer patients.However, there is no national data on the prevalence of malnutrition inChinese cancer patients. Thisstudy aims to evaluate the prevalenceof malnutrition and quality of life(QOL)ofChinese patients with localregional, recurrentor metastatic cancer,to address the prognostic value of nutritional status and QOLon the survival of cancer patients in China and to validate the patient-generated subjective global assessment (PG-SGA) questionnaire in Chinese cancer patients.Methods:Thisisanobservational,multi-centered,and hospital-based prospective cohort study.We aimed to recruit 50,000 cancer patients (age 18and above)overan 8-year period.Data collection will occur within 48hrafter patientsare admitted to hospital, 30-days after hospital admission, and the follow-up will be conducted1-8years after enrolment. The primary outcomeisoverall survival, and secondaryoutcomes arelength of hospital stay and hospital costs. Factors measured are demographic characteristics, tumor characteristics, anthropometry measurements,hematological measurement, body composition, PG-SGAscores,Karnofsky performance status scores,and QLQ C30 scores. This protocol wasapproved by local ethical committees of all the participant hospitals.Conclusions: This multi-centered, large-scale, long-time follow-up prospective study will help diagnose malnutrition in cancer patients in China, and identify the related risk factors associated with the negative outcomes. The anticipated results will highlight the need for a truly scientific appraisal of nutrition therapy, and help to improve outcomes among cancer patients in China.Trial Registration: The trial has been registered with the Chinese Clinical Trial Registry, ChiCTR1800020329. Registered on 19 December 2018

Epidural versus intravenous analgesia following radical gastrectomy for gastric cancer: A systematic review and Meta-analysis / 国际外科学杂志

Objective:To compare the application of epidural analgesia (EA) with intravenous analgesia (IA) in radical gastrectomy for gastric cancer.Methods:A systematic review and meta-analysis of randomized controlled trials of EA and IA in radical gastrectomy was conducted. Primary outcome was pain scores at 24 h after surgery, while the secondary outcomes included incidence of postoperative complications, first flatus time and (LOS).Results:A total of 6 randomized controlled studies was identified and 393 patients were enrolled in this review, 4 published in English and 2 in Chinese. Meta-analysis revealed that, the EA group had lower pain score at 24h either pain at rest ( WMD=-0.74, 95% CI: -1.35~-0.13, P=0.02) or pain on movement or coughing( WMD=-1.5, 95% CI: -1.95~-1.05, P<0.001) than that of the IA group. In terms of complications, postoperative nausea and vomiting ( RR=0.32, 95% CI: 0.18~0.58, P<0.001) and respiratory complications ( RR=0.50, 95% CI: 0.29~0.85, P=0.01) in EA group were obviously lower than those of the IA group. No difference was observed in postoperative urinary complications between the two groups ( RR=0.87, 95% CI: 0.38~1.96, P=0.73). However, the incidence of hypotension was obviously higher than that of IA group ( RR=3.27, 95% CI: 1.28~8.32, P=0.01). Time of first exhaust time after operation ( WMD=-14.01, 95% CI: -22.85~-5.17, P=0.002), postoperative length of hospital stay ( WMD=-0.69, 95% CI: -0.90~-0.49, P<0.001) were shorter than IA group. Conclusions:For patients who undergoing radical gastrectomy for gastric cancer, epidural analgesia could provide better pain control either pain at rest or on movement, although a rising incidence of hypotension was leaded, reduced pulmonary complications, nausea and vomiting were found, and promote the bowel function and shorten the duration of hospital stay.

Research progress of the open abdomen in the treatment of gastrointestinal fistula with complicated intra-abdominal infection / 中华胃肠外科杂志

Gastrointestinal fistula patients may suffer from complicated intra-abdominal infection and sepsis with improper treatment, which is characterized by high mortality ranging from 20% to 60%, as well as high medical costs. Gastrointestinal fistula patients with complicated intra-abdominal infections are not often diagnosed early, and proper treatment remains an unsolved problem. Therefore it is a great challenge for surgeons to repair broken intestines under complicated intra-abdominal infection conditions and to repair ruptured intestines under conditions of severe abdominal adhesions and swelling of the intestinal wall and mesentery. After the open abdominal approach was first adopted to treat complicated intra-abdominal infection patients by Duff and Moffat in 1981, it gradually began to be used more widely. However, some investigators have reported that the open abdomen approach has not been effective in controlling controlled mortality, instead, it may even increase mortality. For this reason, the approach has only been used in large medical centers rather than having been widely popularized. In this review, the effect, timing, indications of open abdomen approach and the principles for the open abdominal wound management are summarized, and the reason for the various efficacy among different centers is also analyzed. We provide a new perspective for clinicians to manage the gastrointestinal fistula patients with complicated intra-abdominal infection.

Systematic review and Meta-analysis of incidence of oral feeding intolerance in acute pancreatitis / 国际外科学杂志

Objective To systemically review andquantify the incidence of oral feeding intolerance in acute pancreatitis. Methods Randomized controlled trials that reported the oral feeding intolerance rates of acute pancreatitis were searchedfrom PubMed, EMBASE, Medline, Cochrane Library, WanFang, CNKI, CMCC and VIP dal,abase wilh the" Acute pancreatitis " " Feeding intolerance" " Incidence" " Meta- analysis "from January 2002 to May 2017. Date were analyzed by using R 3. 4. 0 software. The heterogeneity of data were analyzed using 12test. Results Eleven randomized controlled trials including 658 cases were enrolled in Meta-analysis. The incidence of oral feeding of intolerance was 12. 2% . The result of subgroup analysis showed that there were no significant difference in the incidence of oral feeding intolerance when region, sample size and published year were taken into analysis (P > 0. 05). The oral feeding intolerance rate of mild acute pancreatitis was lower than that when moderately severe acute pancreatitis and severe acute pancreatitis were, included (8. 2% and 19. 9% , respectively; P = 0. 002 7). Conclusion Oral feeding intolerance affects approximately l in 8 patients with acute pancreatitis. The incidence of oral feeding intolerance of patients with severe acute pancreatitis is higher than that of patients with mild acute pancreatitis

Effect of lymphatic vascular invasion on the prognosis of stage I( gastric cancer patients after radical gastrectomy / 中华胃肠外科杂志

<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>

Cell apoptosis pathway in the development of alcoholic pancreatitis in mice / 中华胰腺病杂志

Objective To explore the role of cell apoptosis pathway in alcoholic pancreatitis.Methods C57BL/J mice were divided into control group (NC) and Alcohol group (AC),Acute pancreatitis group (AP) and Alcoholic acute pancreatitis group(AAP).Alcohol treatment was 10％ w/v ethanol feeding for 2 d,15％ w/v ethanol for 5 d,and then 20％ w/v ethanol until 13 weeks.AP model was established by the intraperitoneal injection of 50μg caerulein/kg body weight once an hour for a total of 7 times.Blood samples were collected for detecting serum amylase and lipase activity.Part pancreatic tissue was collected and the wet and dry weight were both measured to calculate the water content.The routine pathological exanination of the pancreatic tissues were conducted.The expression of apoptosis associated protein caspase3 and caspase8 was determined by Western blot.And cell apoptosis was determined using TUNNEL method.Results The level of serum amylase in NC group,AC group,AP group and AAP group were(3 630 ± 259),(3 196 ± 187),(35 955 ± 4607) and (53 607 ± 3 848) U/L;the level of serum lipase were (502 ± 41),(745 ± 42),(7 346 ± 665) and(12 764 ± 2 544) U/L;the water content were (70.2 ± 3.1) ％,(69.6 ± 2.0) ％,(78.2 ± 1.5) ％ and(85.0 ± 3.0) ％ and (12.75 ± 0.25);the expression of caspase3 were (1.017 ± 0.0784),(1.287 ± 0.097),(178 ± 0.07785) and (0.2443 ± 0.0243);the expression of caspase8 were (0.8289 ± 0.0096),(0.5985 ±0.0735),(1.27 ±0.08) and (0.145 ±0.015);the number of apoptotic cells were 1,6,214,97/10 high power field.The pathological score of pancreas injure in NC group,AC group,AP group and AAP group were 0,0,(7 ± 0.4) and (12.8 ± 0.3),respectively.Serum anylase,lipase,water content and pathological scores in AP group were obviously higher than those in NC group (P ＜ 0.05),which in AAP group were also obviously higher than those in AP group,and all the differences were statistically significant (all P ＜0.05).Compared with NC group,the expressions of apoptosis associated protein caspase3 and caspase8 and the number of apoptotic cells were obviously increased in AP group,which were obviously higher than those in AAP group,but the expression of caspase3 and caspase8 in AAP group were decreased compared with NC group,and all the differences were statistically significant (all P ＜ 0.05).Conclusions Chronic alcohol exposure may aggravate the severity of pancreatitis,and the inhibition of apoptosis pathway and the enhancement of acinar cell necrosis may be involved in this process.

Laparoscopic versus open D2 gastrectomy for advanced gastric cancer: A meta-analysis on long-term outcomes / 国际外科学杂志

Objective To evaluate the long-term clinical outcomes between laparoscopic gastrectomy and open gastrectomy with D2 lymph dissection for advanced gastric cancer.Methods Clinical studies that compared clinical outcomes of laparoscopic gastrectomy and open gastrectomy for advanced gastric cancer were searched from PubMed,EMBASE,Medline,Cochrane Library,WanFang,CNKI,CMCC and VIP database with the Gastric neoplasms Laparoscopy Gastrectomy Long-term outcomes Meta-analysis between Jan.2002 and Oct.2016.Data of long-term survival and recurrence were analyzed by using of RevMan 5.2 software.Survival data were present by the odds ratio(OR) and 95％ CI.The heterogeneity of the data was analyzed using the I2 test.Results Fifteen studies including 4,053 cases were enrolled.There were 2,091 patients in LG group and 1,962 patients in the open gastrectomy group.There was no significant difference in the 3-year overall survival rate(OR =1.00,95％ CI:0.83-1.20,P =0.98),5-year overall survival rate (OR =1.14,95％ CI:0.95-1.36,P =0.15),5-year disease-free survival rate(OR =1.13,95％ CI:0.93 ～ 1.39,P =0.22)and cancer recurrence rate (OR =0.96,95％ CI:0.79 ～ 1.18,P =0.71)between the patients treated with laparoscopic gastrectomy,or open gastrectomy (P ＞ 0.05).Conclusion Laparoscopic gastrectomy with D2 lymph dissection for advanced gastric cancer has similar long-term outcomes as compared to open gastrectomy.

Experience of the three-stage strategy for intestinal fistula complicated with complex abdominal infection / 中华胃肠外科杂志

Intestinal fistula, as a serious complication after abdominal surgery, not only leads to a series of pathophysiological changes such as fluid loss, malnutrition and organ dysfunction, but also causes the severe abdominal infection, which often threatens the life of patients. How to make the diagnosis and give the treatment of intestinal fistula is the key to save the lives of high-risk patients. In our hospital, during the past course of diagnosis and treatment for intestinal fistula complicated with severe abdominal infection, based on the combination of literatures at home and abroad with our clinical experiences for many years, an effective three-stage prevention and treatment strategy was formed gradually, which included early diagnosis, effective treatment of infection source, open drainage of abdominal infection and early enteral nutrition support. This strategy subverts the traditional concept of surgery alone, and becomes an effective means to save patients with severe abdominal infection.

Enhanced recovery after surgery based on medical ethics / 中华胃肠外科杂志

Enhanced recovery after surgery (ERAS), a new model of perioperative management developed in recent years, can shorten hospital stay, reduce medical cost and postoperative discomfort. However, some of these measures under the strategy are negation of the traditional recommendation and many surgeons are concerned about the medical tangle by the complications coming with the ERAS strategy. In this paper, ERAS strategy is evaluated from an ethical standpoint and the assessment factors of medical behavior are introduced based on medical virtues and medical ethnics. It is also analyzed that how to deal with the conflicts between the textbooks and the ERAS strategy, and elaborated that the medical ethics should be observed if the ERAS strategy is implemented. The scientific principles must be followed, the rights and interests of the patients need to be protected, and the informed consent should be guaranteed.

Clinical value of preventive analgesia in patients with radical gastrectomy for gastric cancer: a prospective study / 中华消化外科杂志

Objective To investigate the clinical value of preventive analgesia in patients with radical gastrectomy for gastric cancer.Methods The clinical data of 161 patients undergoing radical gastrectomy for gastric cancer at the Xijing Hospital from July 2012 to June 2013 were prospectively analyzed.A single-blind,randomized,controlled study was performed in the eligibe patients who were randomly divided into the preventive analgesia group and the control group based on a random number table.All the patients received major gastrectomy + Billroth Ⅱ anastomy or total gastrectomy + esophagojejunastomy,and then they received vein combined anesthesia and tracheal intubation.In the preventive analgesia group,10 mg dexamethasone and 200 mg parecoxib were administered by intravenous infusion before operation,7-8 mL ropivacaine (0.5％) were injected at the incisional site and transversus abdominis infiltration at open and close surgery and celecoxib was taken orally for 3 days.In the control group,vein analgesia pump was used after operation.The visual analogue scale (VAS),proportion of patients with postoperative out-off-bed activity time ＞ 8 hours,time of flatus,time of defecation and duration of hospital stay were recorded between the 2 groups.The measurement data with normal distribution were presented as x ± s.The comparison between groups was evaluated with the t test and repeated measures ANOVA.The data with skew distrubution and ordinal data were analyzed by the analysis of variance,and the count data were analyzed using the chi-square test.Results All the 161 patients who were screened for eligibility were randomly divided into the preventive analgesia group (87 patients) and the control group (74 patients).The scores of the VAS at postoperative day 1,2 and 3 were 2.8 ± 0.6,2.6 ± 0.4 and 1.8 ± 0.4 in the preventive analgesia group,and 5.3 ± 0.5,4.2 ± 0.6 and 2.4 ± 0.3 in the control group,with a significant difference between the 2 groups (F =4.25,P ＜ 0.05).The proportion of patients with postoperative first abmulation time ＞ 8 hours at postoperative day 1,2 and 3 were 8,17 and 20 in the preventive analgesia group,and 0,3 and 11 in the control group,with a significant difference between the 2 groups (x2 =7.60,10.26,3.16,P ＜ 0.05).The time of flatus,time of defecation and duration of hospital stay were (51 ± 24) hours,(61 ± 24) hours and (5.5 ± 3.0) days in the preventive analgesia group,compared with (71 ± 23) hours,(83 ± 30) hours and (6.3 ± 2.1) days in the control group,showing a significant difference between the 2 groups (t =5.32,5.04,0.17,P ＜ 0.05).All the patients in the 2 groups normally survived after surgery without respiratory depression,incision infection and adverse drug reaction.Conclusions Preventive analgesia in the perioperative treatment of patients with radical gastrectomy for gastric cancer could relieve the postoperative pain of patients,improve the bowel function and enhance the recovery of patients.Registry This study was registered with the Chinese Clinical Trial Registry with the registry number of ChiCTRTRC-11001440.

The feasibility research of ADC value in dynamic monitoring to chemotherapy response of advanced gastric carcinoma / 实用放射学杂志

Objective To evaluate the value of DWI and ADC value in monitoring the chemotherapy response of advanced gastric carcinoma dynamically.Methods 42 advanced gastric carcinoma patients who were confirmed by histopathology underwent T2 WI and DWI examinations at pre-chemotherapy,post-chemotherapy 3 d,7 d,30 d and 60 d respectively.The longest diameters of tumor pre-chemotherapy and post-chemotherapy 60 d were measured on axial T2 WI,meanwhile the ADC values at different time points were calculated.The mean ADC value among pre-and post-chemotherapy of each group (PR and SD)was compared.Results The ADC value of PR group increased gradually.The mean ADC value before therapy was statistically lower than those at differ-ent time points post-chemotherapy (P < 0.05).The ADC value of SD group increased gradually from pre-chemotherapy to post-chemotherapy 30 d,and then the ADC value decreased at post-chemotherapy 60 d.The differences of the mean ADC values in differ-ent time points were statistically significant (P < 0.05).Conclusion DWI and ADC value can dynamically,quantitatively and early detect and monitor the chemotherapy response of advanced gastric carcinoma.

A follow-up study on laparoscopy-assisted and open gastrectomy for advanced gastric cancer / 中华普通外科杂志

Objective This study was to compare surgical safety and oncologic adequacy of laparoscopy-assisted gastrectomy (LAG) versus open gastrectomy (OG) for advanced gastric cancer.Methods 120 consecutive AGC patients undergoing LAG with D2 lymph node dissection between September 2005 to December 2009 were compared with 120 AGC patients undergoing OG during the same period.In each group,50 underwent distal gastrectomy,70 for total gastrectomy.Results There was no conversion to open surgery in LAG.The operative time was significantly longer in LAG than OG [(307 ± 84) min vs.(203 ± 52) min,t'=11.556,P ＜ 0.01].The estimated blood loss was significantly less in LAG group than OG group [(258 ± 78) ml vs.(318 ± 89) ml,t =5.550,P ＜ 0.01].The number of lymph nodes retrieved was(17 ±11) in LAG,(16 ±10)in OG (t =0.723,P＞0.05).All margins were tumor free in both groups.9 patients had the postoperative complication in LAG,8 patients in OG (P ＞ 0.05).Length of postoperative stay was significantly shorter in LAG than OG [(10.6 + 4.7) vs.(14.3 ± 2.9) days,t' =7.339,P ＜0.01].There was no mortality in both groups.The 5-year recurrence-free survival rate were comparable (47.6％ in LAG vs.42.8％ in OG,x2 =0.577,P ＞ 0.05) between the two groups.Conclusions This study suggested that laparoscopy-assisted gastrectomy is safe and feasible in terms of surgical outcome and oncologic adequacy for advanced gastric cancer.

Sacral neuromodulation in the treatment of intractable constipation / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To assess the efficacy of sacral neuromodulation (SNM) in patients with intractable constipation.</p><p><b>METHODS</b>A total of 7 patients with intractable constipation were treated with pereutaneous test stimulation of the S3 nerve root and were assessed by sacral never stimulation system in our department from January 2013 to January 2014. Four of these 7 patients received operation for constipation before. The efficacy was assessed by bowel habit diary, clinic constipation scores, subjective questionnaire and clinical signs.</p><p><b>RESULTS</b>The constipation symptoms were improved significantly in all the 7 patients. The frequency and volume of defecation per week were increased obviously, and the average urine was increased. Six patients underwent permanent implantation of the SNS system. After a median 4 months follow-up, the defecation frequency increased from 0.6 ± 0.5 to 8.0 ± 2.5 per week (P<0.01), and the defecation time decreased from (22.9 ± 11.5) to (3.7 ± 0.8) min (P<0.01). The Cleveland clinic constipation score decreased from 24.6 ± 4.2 to 9.0 ± 0.9 (P<0.01), and the visual analogue scale(VAS) score increased from 8.1 ± 0.9 to 82.5 ± 5.2 (P<0.01).</p><p><b>CONCLUSION</b>SNM is a clinically efficacious, minimally invasive and safe new technique, which offers an alternative treatment for the patients with intractable constipation resistant to conservative treatment, especially for the patients refractory to traditional operations.</p>

Prospect of cetuximab in the treatment of colorectal cancer / 中华消化外科杂志

Colorectal cancer is one of the most common malignant tumors.With the improvement of living condition and peoples' life-span,the incidence rate of colorectal cancer has been ascending year by year.In developed countries and developed district of China,colorectal cancer has become the second common malignant tumor.More than one million people were diagnosed as with colorectal cancer,and 500,000 of them died yearly.Colorectal cancer is one of the most common reasons of the death of cancer patients.With the development of molecular targeted agents research,the therapeutic effects for colorectal cancer patients have been improved,and the current status and prospect of targeted therapy for colorectal cancer patients were introduced in this review.

Transition from anatomic to functional minimally invasive surgery / 中华消化外科杂志

With the development of minimally invasive management,laparoscopic operation has become more and more prevalent.As a surgical procedure,a serial of events,such as psychological damage,fasting,bleeding,hypothermia,pain,introduce of cathartic,gastric tube,urinary catheter and aggressive resuscitation of crystal fluid,can produce stress and delay the rehabilitation. Evidence-based medicine has demonstrated that during the laparoscopic surgery,alleviating these events is associated with milder stress reaction and fast recovery.The focus of minimally invasive surgery should be shifted from the local injury to the stress of the whole body,from the wound size to the psychological,physiological and pathological changes of the whole body,from the technique of operation to the comprehensive management during perioperative period.In summary,the minimally invasive surgery focuses more and more on minimizing the stress influence on the whole body rather than merely on the minimal incision.It is reasonable to conclude that this kind of research will bring significant innovation in minimally invasive surgery in the future.

Effects of Apr-1 gene on cell cycle regulation of cholangiocarcinoma QBC939 cell lines / 中华普通外科杂志

Objective To investigate the role and the mechanism of Apr-1 gene on cholangiocarcinoma QBC939 cell lines proliferation and cell cycle regulation. Methods Apr-1 gene was transfected into QBC939 cells by using liposomes to establish a QBC939 cell model ( QBC939-Apr-1 ) stably expressing Apr-1 gene. Apr-1 mRNA expression and the changes in cell cycle and cell growth of QBC939 cells were analyzed by RT-PCR, flow cytometry ( FCM ) and growth curve before and after transfection. The regulatory effect of Apr-1 gene on the expression of cell cycle-related genes was investigated in QBC939 cells before and after Apr-1 transfection using cell cycle gene microarrays. Results Significant suppression of cell growth was observed with the cell model stably expressing Apr-1 gene. Apr-1 over-expression caused cell arrest from 9% to 13% (P ＜0. 01 ) increase in G2 population. Cell cycle gene microarrays demonstrated that the expression of Skp2 、UBE1 was up-regulated, while the expression of MRE11A 、CKS2 、CDK8 、CDC45 was down-regulated by more than 3 folds. Conclusions Apr-1 gene suppresses QBC939 cell proliferation in vitro, QBC939 cells presented with differences in the expression of cell cycle-related genes after Apr-1 gene transfection.

A comparision of total laparoscopic gastrectomy and laparoscopy-assisted gastrectomy for gastric carcinoma / 中华普通外科杂志

Objectives To compare total laparoscopic gastrectomy with intracorporeal hand-sewn Gl reconstruction and laparoscopy-assisted gastrectomy for gastric cancer. Methods Between July 2009 and July 2010, 21 patients of gastric cancer underwent total laparoscopic D2 radical gastrectomy with intracorporeal hand-sewn reconstruction and 28 did laparoscopy-assisted D2 radical gastrectomy in Xijing Hospital of Digestive Diseases. All patients were operated on by an experienced surgeon. Patient demographics, TNM stage, location of tumor, the intraoperative and postoperative details of the two groups were compared. Results In the 21 patients undergoing total laparoscopic gastrectomy, there were 15 of distal gastrectomy and 6 of total gastrectomy, compared with 21 and 7 in laparoscopy-assisted group. In total laparoscopic group, intracorporeal hand-sewn technique was used for gastro-jejunal and jejuno-jejunal (J-J)anastomosis, and 25 mm circular stapler was used for esophago-jejunal anastomosis. The operation time was significant longer in total laparoscopic group than in laparoscopy-assisted group of (279 ± 65 ) min vs.(232 ±40) min (P ＜ 0.05 ). No significant difference was observed between the two groups in proximal margin [(5.7 ± 1.5 )cm vs. (5.1 ± 1.4) cm, P ＞ 0.05] and distal margin [( 3.1 ± 0.9 )cm vs. ( 2.9 ±0.9) cm,P ＞0.05]. The iv narcotic use in laparoscopy-assisted group was 1.8 d but it was not used in total laparoscopic group. The first passing flatus was on day 3 in total laparoscopic group compared with 4.8 d in laparoscopy-assisted group. Both groups had 2 postoperative early complications, one intra-abdominal infection and one lung infection in total laparoscopic group compared with one wound infection and one lung infection in laparoscopy-assisted group. There was no anastomosis-related complications after 4 months of follow-up. Conclusions The operation time and postoperative early complication was acceptable for selected patients treated by total laparoscopic D2 radical gastrectomy with intracorporeal hand-sewn GI tract reconstruction in hands of experienced laparoscopic surgeon.

The expression of heat shock protein 70 and its early diagnostic significance in acute allograft rejection of liver-transplanted rats / 中华器官移植杂志

Objective To investigate the expression and the early diagnostic significance of heat shock protein 70 in acute allograft rejection of liver-transplamed rats. Methods The model of rat orthotopic liver transplantation was made by using a modified "two-cuff technique". The rats were randomly divided into 3 groups. For each group, donors and receptors all included 15 rats respectively. The control group: Wistar to Wistar liver transplantation; The untreated group: SD to Wistar liver transplantation, not receiving any immunosuppressant after liver transplantation; The treatment group: SD to Wistar liver transplantation, receiving intramuscular injection of tacrolimus (FKS06, 2mg kg-1. day-1) after operation. Five rats were executed randomly in every group on the post-transplantation day 3, 5 and 7 and the graft samples were obtained for optical microscopic observation. The expression of HSPT0 in grafts was detected by using immunohistochemical method and RT-PCR. The correlation between acute rejection following liver transplantation and the expression of HSP70 in grafted liver was studied. Results There was no acute rejection examined in the control group. The untreated group showed typical allograft rejection and the rejection activity index (RIA) went up gradually after the operation (P<0.01). The treatment group showed no rejection or borderline allograft rejection. The level of HSP70 was increased transiently after operation, then reduced in the control group (P<0.05). The level of HSP70 in the untreated group was higher than in the control groupand gradually increased with the prolongation of time after transplantation (P<0.01). A significant correlation was found between HSP70 and pathological score in the untreated group (P<0.01). The treatment group showed low levels of HSP70 of all the time. Conclusions The expression of HSP70 in grafts is closely related to the occurrence and development of the acute rejection and can be useful for early diagnosis of acute allograft rejection following liver transplantation.

RhoA gene expression and clinicopathology parameters in HCC patients / 中华普通外科杂志

Objective To investigate the expression of RhoA gene in human hepatocellular carcinoma (HCC) and to discuss its significance during hepatocellular carcinogenesis. Methods Intratumor RhoA expression level was determined and compared with that in adjacent nontumorous hepatic tissues using quantitative real time reverse transcription polymerase chain reaction and Western blot in 64 HCC patients. Results The mRNA levels of RhoA were significantly higher in tumor tissues than that in the unaffected portions (t =3.445 ,P =0.0006). The expression of RhoA mRNA in the primary lesion was higher in patients with venous invasion (t = 2.667, P = 0.009), microscopic satellite lesions (t=2.172,P =0.038), and advanced pTNM stage (stage Ⅱ/Ⅳ; t=2.551,P=0.013) than in those without. There was a significant difference between high RhoA protein levels in the tumor tissues and noncancerous liver tissues in HCC patients (t = 3.532, P = 0.0002), and there was a significant association between high tumor RhoA protein levels and the presence of venous invasion (t = 2.087, P = 0.042), microscopic satellite lesions (t = 2.254, P = 0.031), and advanced pTNM stage (t = 2.812, P = 0.007). Conclusions There is a significant correlation between RhoA expression, tumor stage, and intrahepatic metastasis. The expression of RhoA could be used as a good tumor marker for invasive and advanced carcinoma as well as a prognosis predictor.