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OBJECTIVE@#To explore the application value of intraoperative ultrasound (IU) in laparoscopic lymphadenectomy of gastric cancer.@*METHODS@#Patients with gastric cancer undergoing laparoscopic radical D2 gastrectomy at General Surgery of the Second Affiliated Hospital of Anhui Medical University between August 2016 and May 2018 were prospectively enrolled and were randomly divided into IU group (n=78) and conventional group (n=91). The conventional group underwent laparoscopy only. In IU group, the laparoscopy examination was followed with intraoperative ultrasound by ultrasound specialist. The lesser curvature, peripheral gastric organs and gastric lymph nodes were scanned. Lymph nodes were considered positive if maximum diameter was greater than 10 mm or internal hyperechoic features and normal oval shape were lost. The postoperative pathological results were used as the gold standard to analyze the sensitivity of positive lymph nodes by IU detection [true positive lymph nodes/(true positive lymph node+false negative lymph nodes)×100%], specificity [true negative lymph nodes/(true negative lymph nodes+false positive lymph nodes)×100%] and the accuracy rate[(true positive lymph nodes+ true negative lymph nodes/total lymph nodes)×100%]. A consistency check between N staging diagnosed by IU and by postoperative pathology was performed with Kappa test(Kappa>0.75 indicating good consistency). Number of dissected lymph node, number of positive lymph node detected by pathology and the operation time were compared between the IU group and the conventional group.@*RESULTS@#Among 169 gastric cancer patients, 95 were males and 74 were females with age of (63±8) years. Among 1 794 lymph nodes detected by IU from 78 patients in IU group, predicted positive lymph nodes were 832 and 740 positive nodes were confirmed by postoperative pathology. True positive lymph nodes were 679 and true negative lymph nodes were 901 by IU, and a total of 1 580 lymph nodes were accurately diagnosed by IU. The sensitivity and specificity of IU for N staging of gastric cancer were 91.8%(679/740) and 85.5%(901/1 054), respectively. Overall accuracy was 88.1%(1 580/1 794), which was in good accordance with postoperative N staging(Kappa=0.758). There was no significant difference in number of lymph node detected between the IU group and conventional group during laparoscopic gastric cancer surgery(23.0±6.9 vs. 22.0±7.7, t=0.880, P=0.380). However, the numbers of lymph nodes in the third station (No.10, No.11, No.12) in the IU group were significantly higher than those in the conventional group [No.10: median 1 (0-1) vs. 0 (0-1), Z=-6.307, P0.05), but the number of positive lymph nodes dissected in stage III patients of IU group was significantly higher than that in stage III patients of conventional group (14.6±4.8 vs. 14.0±3.6, t=2.531, P=0.011). The operative time of IU group was(272.0±12.0) minutes, which was significantly longer than (249.0±7.0) minutes of conventional group (t=14.638, P<0.001). However, with the increase of patients undergoing IU, the operation time of IU showed a downward trend. The average operation time of the last 20 patients was 264 minutes, and the average IU time was 15 minutes.@*CONCLUSIONS@#Intraoperative ultrasound is more accurate N-staging of gastric cancer. Although increasing operation time, it is helpful for lymph node dissection in laparoscopic gastric cancer surgery, especially by providing good support for laparoscopic No.10, No.11 and No.12 lymph nodes dissection.
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Aged , Female , Humans , Male , Middle Aged , Intraoperative Period , Laparoscopy , Lymph Node Excision , Lymph Nodes , Diagnostic Imaging , General Surgery , Retrospective Studies , Stomach Neoplasms , Diagnostic Imaging , General Surgery , UltrasonographyABSTRACT
Objective To explore the effect of the association of low molecular heparin and Galectin-3 on the cell migration and cell proliferation of vascular endothelial cell from mesenchymal stem cells.Methods Depending on the administration, this study was divided into four groups: low molecular weight heparin group, adding 20 mg/L low molecular weight heparin into the cells;Galectin-3 group, adding 5 mg/L Galectin-3 into the cells;combination group, adding 20 mg/L low molecular weight heparin and 5 μg/ml of Galectin-3 into the cells;control group, equal volume of PBS buffer into the cells.The proliferation of vascular endothelial cell was to be detected by EdU incorporation,the cell growth cycle of vascular endothelial cell was to be detected by flow cytometry,and the cell migration of vascular endothelial cell was to be detected by scrath test.Then to investigate the effect of different conditions on the migration and proliferation of vascular endothelial cell.Results The OD490 of MWH group, Galectin-3 group, combined group and control group were (0.285±0.018), (0.297±0.041), (0.351±0.016), and (0.233±0.005) respectively, which indicates that the combined group could increase the cell proliferation significantly(P<0.05).Cultured for 24 hours, the cell migration rate was(42.02±7.62), (45.82±3.96), (68.53±11.22),and (34.21±3.99), suggesting that combined group have the largest cell migration(P<0.05).Conclusion The association of low molecular heparin and Galectin-3 could improve the cell migration and cell proliferation of vascular endothelial cell from esenchymal stemcells significantly.
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Objective To investigate natural killer(NK) and NKT cells in acute pancreatitis(AP).Methods Changes of NK and NKT cells in peripheral blood of 86 AP cases were detected using muhiparameter flow cytometry.Results Compared with control group,the NKT cells decreased in AP patients (t =5.23,P =0.00),but NK cells didn't (t =-1.15,P =0.25).NKT cells in severe SAP and mnoderate MAP were lower than that in the control group (t =-3.92,P =0.00;t =4.84,P =0.00).There was no statistically significant difference of NK cells between MAP and the controls (t =-0.54,P =0.59),but NK cells in SAP group was obviously higher than that in control group (t =3.12,P =0.00).After one week treatment,NK cells significantly decreased (t =8.43,P =0.00).NKT cells were higher than control group (t =-4.44,P =0.00).Dynamic monitoring in AP patients found continuous declination in NK cells,and NKT cells experienced an increase before a falling.Conclusion Monitoring of NK and NKT cells can be used as an important index for the severity and response to treatment in acute pancreatitis.
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Objective To explore the causes of deep vein thrombosis in lower extremities (DVT). Meth-ods Retrospective analysis of 411 patients with DVT being treated in our hospital from 2004 to 2009. Results 301 (73.2%) cases were with definite causes and 110( 26.8%) cases without definite causes. 195 cases occurred follow-ing operations and 68 cases following wounds and fractures. 122 cases accompanied with medical conditions ,50 cases occurred following pregnancy or child birth,39 cases suffered from cancer, 19 cases suffered from infection of lower extremity or local lesion,67 cases had past history of DVT. Conclusions Suggest that surgery, wound and fractures, postpartum, cancer, chronic illness inducing long-term bed stay and past history of DVT might correlate with DVT.
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Objective To discuss rational diagnosis and treatment of acute infrarenal abdominal aortic occlusion. Methods Retrospective analysis was made on 6 cases with acute infrarenal abdominal aortic occlusion from January 2005 to December 2008. Emergency operations of retrograde catheter were done on 3 cases, 2 cases received transaortic embolectomy, 1 case received anticoagulation therapy successfully. Results Two cases were cured, 2 cases with 3 legs received amputation, 2 cases died. The time in hospital was 4 hours to 122 days, averaged (24±55) days. Conclusions A prompt thrombolytic, anticoagulation therapy and operation are suggested. It is emphasized to prevent reperfusion injury after arterial ischemia during the peri-and post-operation. Conservative treatment may be used in the patients incorporated with seriously multiple organ failure.
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Objective To evaluate the efficacy of endovenous laser treatment(EVLT) plus punctiform stripping therapy for lower extremity varicose veins.Methods Sixty-eight limbs in fifty patients with varicosed vein underwent EVLT plus punctiform stripping therapy in department of vascular surgery of the first affiliated hospital of Anhui medical university.Results All patients were followed for 2～27 months and all the patients had successful occlusions of varicosed veins with no recurrence were observed.Local skin paresthesia were found in 2 patients.No local recurrence and deep vein thrombosis were found.Conclusion EVLT plus punctiform stripping therapy is a simple and effective treatment for lower extremity varicosed veins with fewer complications and recurrences.