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Objective:To investigate feasibility, efficiency and safety of kissing pancreatojejunostomy after pancreatoduodenectomy.Methods:From Jan 2006 to Sep 2020, the clinical data of 267 patients undergoing pancreatoduodenectomy and kissing pancreatojejunostomy were retrospectively analyzed.Results:Grade B postoperative pancreatic fistula (POPF) occurred in 6.37%, Grade C POPF in 2.25% of patients. There was no mortality within 30 days postoperatively as to pancreatic fistula, by cut-off of pancreatic duct diameter at 3mm, there was no significant difference between two subgroups (15/140 vs. 8/127, P=0.20). also, when grouped by texture of the pancreas, no there was significant difference (20/194 vs. 3/73, P=0.11). Conclusions:Kissing pancreatojejunostomy is feasible and easy to perform. It also does not increase the POPF rate when applied to the pancreatojejunostomy with thin pancreatic duct and soft texture.
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Objective:Analyze the epidemiological data and the clinical data of local foodborne botulism, summarize the influencing factors and clinical characteristics of the foodborne botulism, mitigate future misdiagnosis.Methods:An epidemiological investigation was conducted to a local outbreak with botulism, which involved 24 individuals consuming homemade bean curd and 14 cases with foodborne botulism through analyzing the influencing factors of the poisoning. For 14 patients with botulism, their clinical manifestations, first laboratory test and imaging data, treatment and prognosis, were documented and explored.Results:All 14 cases were diagnosed as type A foodborne botulism, of which 2 were misdiagnosed. The incidence of the foodborne botulism was reduced by 81.7% in alcoholic drinkers ( P=0.009). The median incubation period of the 14 patients with botulism was 2.0 (1.0~3.0) days. The initial clinical symptom of 10 patients was diplopia, while that of the other 4 patients was blurred vision. Nine patients subsequently suffered from paralysis of oropharyngeal muscles, leading to dysphagia, speech impairment, etc. Four patients progressed to dyspnea and chest tightness due to respiratory muscle involvement. All of the patients had clear consciousness without sensory abnormalities, no fever and abdominal symptoms such as diarrhea and abdominal pain. There were no obvious abnormal findings in 14 patients with laboratory tests and cranial CT/MRI assessment. 14 patients with the poisoning were relieved after injection of botulinum antitoxin for 8.0 (7.0~8.5) days. Follow-up of all the patients 6 months later found that 9 patients still had slight blurred vision. Conclusions:The typical clinical manifestation of foodborne botulism was symmetric descending flaccid paralysis. Drinking liquor could reduce the incidence of foodborne botulism. Botulinum antitoxin was effective in the treatment of botulism and should be used as early as possible.
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Objective@#To investigate the safety and feasibility of proximal partial gastrectomy with Cheng's Giraffe esophagogastric reconstruction for the treatment of early Siewert II adenocarcinoma of esophagogastric junction (AEG).@*Methods@#Indication of Cheng's Giraffe esophagogastric reconstruction: (1) Siewert II AEG or Siewert III AEG with diameter < 4 cm; (2) preoperative staging as cT1-2N0M0. A descriptive case series study was carried out. Clinical data of 34 patients with Siewert II AEG undergoing proximal partial gastrectomy and Cheng's Giraffe esophagogastric reconstruction at Department of Abdominal Surgery of Zhejiang Cancer Hospital and Department of Gastrointestinal Surgery, The First Affiliated Hospital of Zhejiang University of Traditional Chinese Medicine from February to July 2018 were retrospectively collected and analyzed, including 14 cases in IA stage, 11 cases in IIA stage and 8 cases in IIB stage. Brief procedure of Cheng's Giraffe esophagogastric reconstruction was as follows: Firstly, 12 cm long tubular stomach was formed by longitudinal incision 4 cm away from the great curvature of the stomach. Secondly, the gastric fundus and His angle were formed. Finally, the distance from His angle to esophagal-tubular gastric anastomosis should be more than 5 cm. The reflux disease questionare (RDQ) scores, radionuclide gastric emptying scintigraphy, and 24-hour multichannel intraluminal (MII)-pH monitoring technology were used to evaluate postoperative gastric emptying and gastroesophageal reflux.@*Result@#All 34 patients successfully completed proximal partial gastrectomy with Cheng's Giraffe esophagogastric reconstruction, including 13 cases by open surgery and 21 cases by laparoscopic surgery. The operation time was (144.6±39.8) minutes, the blood loss during operation was (35.4±17.2) ml. No laparoscopic case was converted to open surgery and no postoperative complication was observed. The postoperative hospital stay was (8.4±2.5) days. The postoperative RDQ score was 4.4±3.1 one month after operation, and 3.3±2.5 six months after operation. Gastric-half emptying time was (67.0±21.5) minutes, and the residual ratio was (52.2±7.7)% in 1 hour, (36.4±3.1)% in 2 hours and (28.8±3.6)% in 3 hours at postoperative 1-month. The 24-hour MII-pH monitoring at postoperative 2-month revealed the frequency of acid reflux was (12.6±7.9) times, frequency of non-acid reflux was (19.6±9.7) times, DeMeester score was 5.8±2.9.@*Conclusion@#Cheng's Giraffe esophagogastric reconstruction is safe and feasible in the treatment of Siewert type II AEG, and has good dynamic and anti-reflux effects.
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Objective@#To investigate the effect of triptolide, a specific inhibitor of heat shock protein 70 (HSP70), on apatinib resistance in gastric cancer cells line MKN45.@*Methods@#The apatinib-resistant cells (MKN45/AR) and MKN45 parental cells were treated with apatinib, triptolide and apatinib combined with triptolide, respectively. CCK-8 assay was performed to determine the half maximal inhibitory concentration (IC50) of MKN45/AR and MKN45 cells in the presence of different treatment. The mRNA expression of heat shock protein gene (HSPA1A and HSPA1B) was detected by RT-PCR, while the protein expression of heat shock protein 70 was analyzed using Western blot in MKN45/AR and MKN45 cells.@*Results@#The IC50 values of apatinib-sensitive and apatinib-resistant MKN45 cells were 10.411 μmol/L and 70.527 μmol/L, respectively, showing a significant difference (P<0.05). The mRNA expression of HSPA1A and HSPA1B in MKN45/AR cells was significantly higher than that in MKN45 cells (P<0.001). The protein expression of heat shock protein 70 was significantly decreased after 0.25 μmol/L triptolide treatment in MKN45/AR cells (P<0.01). When heat shock protein 70 was inhibited by triptolide, the IC50 value of apatinib in MKN45/AR cells was reduced to 11.679 μmol/L, which was significantly lower than cells treated with apatinib alone (P<0.05).@*Conclusions@#The apatinib-resistant MKN45 cells have high levels of heat shock protein 70. Low doses of triptolide can significantly inhibit heat shock protein 70, leading to reverse the resistance phenotype of MKN45/AR cells. Therefore, inhibition of heat shock protein 70 provides a new therapy strategy for patients with apatinib resistance.
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<p><b>OBJECTIVES</b>To study the correlation between MRI apparent diffusion coefficient (ADC) and expression of Ki-67 in gastric cancers, and to investigate the application of ADC value in diagnosing the malignance of gastric cancer.</p><p><b>METHODS</b>A retrospective cohort analysis was performed on 87 gastric cancer patients who received MRI examination and radical resection at Zhejiang Provincial Hospital of Traditional Chinese Medicine from November 2014 to August 2015. All the postoperative resected samples were confirmed as gastric cancer. Preoperative MRI examination was performed by using Siemens 3.0-T Verio MRI with following parameters: section thickness 3 mm, gap 1 mm, matrix 182×320, field of view 40 cm. Plain scan was followed by T1-weighted fat suppression technique VIBE 3D(TR3.92/TE1.39,90degree) scans at arterial phase (the 30th second), portal venous phase (the 60th second), lag period (the 90th second), axial planes and coronal planes (the 180th second), and sagittal planes (the 210th second), respectively. ADC value of tumor was measured at b-factor of 800 s/mmand ADC map was generated from DWI data on the work station. The expression of Ki-67 in cancer tissue was detected by routine immunohistochemical (SP) staining after surgery. Correlation between ADC value and the expression of Ki-67 in gastric cancer was analyzed.</p><p><b>RESULTS</b>Irregular thickening of the gastric wall and inhomogeneous enhancement of the tumor after injection of the contrast material appeared in gastric cancer. Gastric cancer tissue presented hyperintensity and normal gastric wall presented isointensity in DWI image (b=800 s/mm). Compared with normal gastric tissue, mean ADC value of gastric cancer tissue was significant lower [(1.114±0.265)×10mm/s vs. (2.032±0.202)×10mm/s, t=26.209, P=0.000]. The ADC values of high-middle differentiation group, middle-low differentiation group, low differentiation group and signet ring cell carcinoma/mucinous adenocarcinoma group were (1.347±0.234)×10mm/s, (1.179±0.257)×10mm/s, (0.996±0.185)×10mm/s and (1.082±0.230)×10mm/s, respectively. The difference of mean ADC value among different tumor stages was significant(F=8.498, P=0.000). Along with the Ki-67 expression up-regulated, the ADC value decreased in cancer tissue. The Ki-67 expressions in cancer tissue was negatively correlated with cancer ADC values (r=-0.570, P=0.000). Furthermore, negative correlations of Ki-67 expressions with ADC values of high-middle differentiation group (r=-0.627, P=0.016), low differentiation group (r=-0.787, P=0.000) and signet ring cell carcinoma/mucinous adenocarcinoma group (r=-0.792, P=0.000) were observed respectively, while Ki-67 expression was not correlated with ADC value of middle-low differentiation group.</p><p><b>CONCLUSION</b>The ADC value of gastric cancer can reflect the level of tumor differentiation, and is negatively correlated with Ki-67 expression in cancer tissues.</p>
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There are 30% to 40% of advanced gastric cancer patients who lose the opportunity of curative surgery at initial diagnosis, so chemotherapy is recommended as the main treatment modality, however, the overall prognosis is poor. Recently, a number of phase II( studies show an enormously ideal potential of conversion therapy in these patients. Conversion therapy uses rational chemotherapy, radiotherapy and targeted therapy and so on combined with MDT assessment to translate initial unresectable case to resectable one, which obviously prolongs survival time and improves quality of life. In this review, we address the indications, development and our experiences of conversion therapy in advanced GC, which looks forward to providing the reference to clinical diagnosis and treatment.
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<p><b>OBJECTIVE</b>To investigate the diagnostic value of contrast-enhanced ultrasonography (CEUS) in preoperative Borrmann classification of gastric cancer.</p><p><b>METHODS</b>Asulfur hexafluonde-filled microbubble ultrasound contrast agent and continuous real-time imaging technique of contrast pulse sequencing were used. Two hundred and eighty-five patients with gastric cancer confirmed by biopsies who received preoperative CEUS examination were involved in this study. CEUS results were compared with postoperative pathological findings.</p><p><b>RESULTS</b>The accuracy rate of CEUS in determining the Borrmann classification of gastric cancer was 92.3%(263/285). The accuracy rates of BorrmannI(, II(, III(, IIII(, and IIIII( were 100%(12/12), 90.6%(77/85), 92.6%(126/136), 95.7%(45/47), and 60.0%(3/5) respectively.</p><p><b>CONCLUSION</b>CEUS is a useful diagnostic method for preoperative Borrmann classification of gastric cancer.</p>
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Humans , Biopsy , Contrast Media , Stomach Neoplasms , Diagnostic Imaging , UltrasonographyABSTRACT
Objective:To investigate if in vitro chemotherapy can induce the EMT progress in gastric cancer (GC) cells. Method:The GC cell line, SGC7901, was treated using 5-Fu at a concentration of 30 μg/mL. The residual cells after four cycles of 5-Fu therapy were named as SGC7901/Fu. The morphological changes and malignant biological features, including the invasiveness and clone formation ability and the characteristics of cancer stem cell and biomarkers of EMT between SGC7901 and SGC7901/Fu, were compared. Results:The SGC7901/Fu cells displayed a mesenchymal appearance, decreased the expression of epithelial markers, and increased the expression of mesenchymal markers. The 50% inhibitory concentrations in the SGC7901/Fu and SGC7901 cells were (43.8 ± 7.2) and (64.6 ± 5.5)μg/mL, respectively. The number of cells that migrated through the basement-membrane of the Transwell chamber was 51.4 ± 8.7 and 93.2 ± 9.5, respectively. The rate of clone formation was 5.2%± 1.0%and 13.2%± 2.2%, respectively. The portions of the CD44+/CD24-cells were 4.13%±0.81%and 7.97%±0.50%, respectively. All differences were statistically significant (P<0.05). Conclusion:The residual GC cells underwent EMT progress after 5-Fu treatment, with increased chemoresistance and ability of invasiveness and acquired the property of cancer stem cells.
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Objective To observe the application of endoscopy combined with 125I seed implantation in the pancreatic cancer palliative surgery in elderly patients.Methods A total of 78 elderly patients with pancreatic cancer who can not be treated with radical operation were divided into observation group and control group (n=39 each group).All patients were treated with stent intervention.Patients in the ation group were treated with 125I seed implantation guided by CT or ultrasonangraphy additionally.The clinical symptoms were compared between groups.The survival time and complications of the patients were recorded during the follow-up.Results The clinical symptoms of patients in both two groups were greatly improved (x2 =0.06,P＞0.05).Compared with the control group,the pain remission was better and the incidence of pain caused by pancreatic cancer was lower in the observation group (46.2％ vs.76.9％,x2 =7.80,P＜0.05).There was a significant difference in the average of survival time between the observation group and control group [(13.7±3.4) months vs.(8.4±3.8) months,t=3.73,P＜0.01],but no statistical difference was found in the long-term survival rate between groups.There was no significant difference in the incidence of complications between the two groups (10.3％ vs.7.7％,x2=0.15,P＞0.05).Conclusions Endoscopy combined with 125Ⅰ seed implantation is an effective treatment for elderly patients with advanced pancreatic cancer,which can effectively relieve the clinical symptoms,proiong the survival time,reduce the pain and complications.
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Objective To evaluate the feasibility and safety of the modified panceaticojejunostomy called Kissing panceaticojejunostomy by animal experiment,and to explore the pathological process of primary healing between the pancreatic duct and the jejunal mucous.Methods The tolerance pressure at the anastomotic intestine was measured during surgery to ensure close contact suture of Kissing panceaticojejunostomy.Exploratory laparotomy,pancreatic ductography and pathology was performed at 2,4 weeks after panceaticojejunostomy.Results Kissing panceaticojejunostomy was performed successfully on 6 Beagle dogs.Tolerance pressure in all dogs was 90 cm H2O and above.No bleeding、fistula or contrast extravasation was found,and healing anastomosis was identified by laparotomy and pancreatic ductography.Cicatricial healing was found between pancreatic duct and jejunal mucosa 4 weeks after anastomosis.Conclusions Kissing panceaticojejunostomy is easy to perform,ensuring close-up cicatricial healing without hydrops or abscess between pancreatic duct and jejunal mucosa.
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Objective To investigate the feasibility and safety of designed perioperative surgical treatment for advanced gastric cancer.Method From March 2006 to Sep.2009,24 patients with advanced gastric cancer were enrolled for this study,of which 14 cases were graded as Ⅳ M0,10 as Ⅳ M1,including liver metastasis in 5 cases,peritoneal seeding in 4 and lung metastasis in 1.All patients received 2-4 cycles of chemotherapy of PCF or ECF regimen,followed by intended surgical resection and postoperative 2-3 cycles of adjuvant chemotherapy of the same regimen as used during the preoperative course.Result Seven Cases abandoned surgical therapy,a total of 17 cases completed preoperative chemotherapy,surgical resection and postoperative chemotherapy.R0 resection was achieved in 16 cases(94%).There was no perioperative mortality,and total clinical response rate was 75%,overall pathological response rate was 82%.In 59% surgical cases (10 cases) serum CEA and CA199 has returned to normal;In 71%patients tumor pathological stage degraded at the cost of Ⅲ-Ⅳ grade of neutropenia,thrombocytopenia,anemia,severe nausea and vomiting in 79%,8%,13%,and 54% cases respectively.Fever was encountered in 2 cases with grade Ⅲ-Ⅳ neutropenia.Conclusion Designed perioperative chemotherapy regimen renders advanced gastric carcinoma patients operable at the cost of acceptable complications.
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Objective To investigate the predictive factors and prognosis of early intrahepatic recurrence after curative resection of hepatocellular carcinoma(HCC).Methods Clinicopathological dats of 184 HCC patients with intrahepatic recurrence after curative resection were collected.Thirteen clinicopathological factors and prognosis after recurrence were retrospectively analyzed. Results Univariate analysis showed that preoperative scrota alpha-fetoprotein(AFP)>100 ng/ml,tumour size>5 cm,venous invasion and intra-operative blood transfusion were predictive factors of early intrahepatic recurrence,and selum albumin<35 g/L was marginally predictive factor.Multivariate analysis showed that serum AFP>100 ng/ml,tumour size>5 cm and venous invasion were independent predictive factots of early intrahepatic recurrence.The survival of patients suffering from early recurrence was significantly shorter than those with late recurrence.with median survival period of 12 mos vs 18 mos(P=0.012).Conclusion Serum AFP,tumour size and venous invasion were independent predictive factors of early intrahepatic recurrence in HCC patients after radical resection of the primary tumor.Early intrahepatic recurrence implies poor prognosis.
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Objective To introduce the application of double liver hanging maneuver in anatomical right hemihepatectomy and share our own experience. Methods Twenty-four patients underwent right hemihepatectomy using double liver hanging maneuver, and the data were collected prospectively after operation. Another 49 patients underwent right hemihepatectomy using the traditional methods,serving as the control group. Results Retrohepatic tunnel was constructed in 27 patients, double liver hanging maneuver was successfully performed in 24 anatomical right hemihepatomy and failed in 3 patients due to the near proximity between the tumor and the middle line. Compared with the control group, blood loss was much less (t=3. 191 ,P＜0.05), ALT and liver function recovered more quickly postoperatively and the difference in operative duration between the 2 groups was not significant (t=-1. 695,P＞0. 05). There was about 1-2 cm wide space located between retrohepatic IVC and dorsal liver when the 2 tapes were tracted, and no injury in hepatic short veins and retrohepatic IVC occurred during the operation. Conclusion The double liver hanging maneuver can make anatomical right hemihepatectomy more accessible and safe.
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Objective To study the effects of intraoporative radio-frequency ablation on immune functions and survival of patients with multiple large hepatic cancer. Methods Forty five admitted patients with multiple large hepatic cancer from January 2003 to January 2007 were devided into: simple hepatic artery embohzation chemotherapy group (TACE group, n = 20) , local resection of multiple lesion + TACE (LR group, n = 13), and TACE + intraoperative radio-frequency ablation (IRFA group, n = 12). The changes of peripheral blood T-cell subsets were evaluated using flow cytometry, and a comparison of the complete remission rate and survival rate between the 3 groups was made and the survival rate analyzed with Kaplan-Meier method, the validity check with long-rank method. Results CD4+ , NK, and CD4+/ CD8+radio significantly increased 4 weeks after treatment only in IRFA group. The immune function was suppressed during the first week after treatment in local resection group. Tumor complete remission rate in IRFA group, local resection group and simple TACE group were 41.70%, 46. 20% and 25.50% respectively, the difference was not statistically significant between the 3 groups (x2 = 1.81, P > 0.05). the 1.5 year and 2.0 year survival rate in the 3 groups were 75.00%, 69. 20%, 30% (x2 = 7.96, P < 0.05) and 50.00%, 23.10%, 10. 00% respectively (x2 = 18.98 ,P <0.05), the mean survival period of patients in the 3 groups was 26. 56 months, 21.04 months, and 16.41 months respectively (x2 = 14.69, P < 0.001). Kaplan-Meier survival curve showed the overall survival rate in the IRFA group was significantly higher than that of the other 2 groups (x2 = 4.635, P < 0.05). The prolongation of the survival period in patient with multiple macronodular hepatic cancer after IRFA treatment was mainly due to the prolongation of survival period in tumor bearing patients (IRFA group vs LR group, x2= 4.615, P < 0.05). Conclusion IRFA prolongs the survival of patients with multiple macranodular hepatic cancer possibly by enhancing the functions of cellular immunity.
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Objective To explore the feasibility of orthotopic spleen-p re served operation characterized of taking advantage of collateral circulation.Methods 12 cases with severe injuries of the spleen and its pedicle underwent splenic pedicel ligation and irregular subtotal splenectomy.R esults All patients had good operative and postoperative results and no postoperative complications.Ultrasonography and CT scanning showed that the remn ant of spleen had no infarct and secondary hemorrhage.Conclusion Orthotopic spleen-preserved operation using collateral circulation is useful i n treating severe traumatic rupture of spleen accomplied by destruction of sple nic pedicles.