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Objective:To systematically evaluate manual suture versus mechanical anastomosis in esophagojejunostomy, two methods of digestive tract reconstruction after laparoscopic total gastrectomy. Methods:A computer-based online search of PubMed, CBM, Wanfang database and CNKI database was performed to retrieve clinical studies related to manual suture (manual suture group) and mechanical anastomosis (mechanical anastomosis group) in esophagojejunostomy after laparoscopic total gastrectomy published between January 2015 and October 2020. The quality of eligible literature was evaluated and data were extracted for meta-analysis using Review Manager 5.4 software.Results:Four clinical studies involving 746 patients were included in the final analysis. Meta-analysis results revealed that there was no significant difference in operative time between manual suture and mechanical anastomosis methods [ MD = 8.32, 95% CI (-5.94, 22.57), P > 0.05]. The intraoperative blood loss in manual suture group was significantly less than that in mechanical anastomosis group [ MD = -9.54, 95% CI (-15.54, -3.55), P < 0.05]. The time to exhaust in the manual suture group was shorter than that in the mechanical anastomosis group [ MD = -0.38, 95% CI (-0.59, -0.18), P < 0.05]. The length of hospital stay in the manual suture group was less than that in the mechanical anastomosis group [ MD = -0.88, 95% CI (-1.23, -0.54), P < 0.05]. The incidence of anastomotic leakage in the manual suture group was significantly lower than that in the mechanical anastomosis group [ OR = 0.23, 95% CI (0.06, 0.93), P < 0.05]. The incidence of anastomotic stenosis in the manual suture group was significantly lower than that in the mechanical anastomosis group [ OR = 0.14, 95% CI (0.04, 0.54), P < 0.05]. Conclusion:After total gastrectomy, continuous suture of oesophago-jejuno ends with barbed threads under laparoscopy is safer and less expensive and needs less time to postoperative recovery and shorter length of hospital stay compared with mechanical anastomosis.
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Objective To explore the diagnostic value of ultrasound in thyroid nodular disease.Methods Eighty-seven patients with thyroid nodule in hospital from 2010-2011 were taken ultrasound examination,including 23 cases with benign nodules and 64 cases with malignant nodules.Univariate analysis and mutivariate Logistic regression analysis were taken to test the ultrasonic index (internal echo,boundary,size,shape,microcalcifications,and aspect ratio) for discovery of the best diagnostic ultrasonic index to identify benign and malignant nodules.Results The ultrasound in the patients with malignant thyroid nodules showed the hypoecho,unclear border,irregular shape,microcalcifications,low blood supply,the aspect ratio ＞ 1.The ultrasound in the patients with benign thyroid nodules showed high or equal echo,clear border,regular shape,high blood supply,and the aspect ratio≤ 1.The ultrasonic indices between two groups had statistically significant difference (P ＜ 0.05).The shape and microcalcifications were the best ultrasonic diagnostic index to indentify the benign and malignant nodules with an EXP(B) 20.12 and 19.14,respectively.Conclusions The ultrasound is helpful in the diagnosis of thyroid nodular disease and identification of benign and malignant thyroid nodules.The ultrasonic images are the basic data for the clinical diagnosis of thyroid nodules.
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Hepatic cavernous hemangioma of 32 cases had been undergone embolization by transfemorel catheterization with lipiodol emulision and lipiodol-gelfoam particles.All of the patients showed Lipiodol accumulation and fibrosis in tumor sites and the feeding arteries were blocked,with diminution in size of the masses.The relationships between image features and tumor fibrosis were dis cussed.
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Objective To explore the relationship between the liver fibrosis scales of B-ultrasound and the serological indicators of schistosomiasis liver fibrosis for guiding clinical diagnosis and treatment. Methods A total of 206 schistosomiasis patients including the acute, chronic and advanced were classified by ultrasonic evidences, and serological indicators of liver fibrosis were detected. The correlation among them was analyzed statistically. Results Ultrasonic diagnosis was 0 scale for acute group and control group, and Ⅱscale for chronic group, as well as Ⅲ scale for advanced group. Advanced group had the highest level of 4 serum indicators of liver fibrosis, and chronic group ranked the middle level, and acute group had the lowest level. The more advanced the ultrasonic scales of liver fibrosis, the higher level the 4 serum indicators. Conclusions There is a consistency relationship between ultrasonic classifications of liver fibrosis and serological indicators in schistosomiasis patients. It also conforms to clinical diagnosis. When ultrasound is applied in schistosomiasis, serological detection is essential and it could make up for the shortage of ultrasonic findings and give better guidance for clinical diagnosis and treatment.