The diagnosis and treatment of primary abdominal cocoon / 中华普通外科杂志

Objective To investigate the clinical characteristics,diagnosis and treatment of primary abdominal cocoon.Methods The clinical data of 16 cases of primary abdominal cocoon were reviewed and analyzed.Results Only in 2 cases in which correct preoperative diagnosis was estabished by CT scan.The other 14 cases were diagnosed during operation.Parts or all small intestines were covered with a layer of milky white dense fibrous thin membrane,formed mass-likely adhesion,and fibrous film attached to the mesenteric roots.Extensive adhesion existed in between intestines.The operation included lysis of peritoneal adhesion plus fibrous membrane excision in 14 cases,lysis of peritoneal adhesion plus fibrous membrane excision and segmental enterectomy in 2 cases,and in 2 cases appendectomy was done.There was no anastomotic leakage or other major complications except for wound infection in 1 case.All the patients were followed up from 3 months to 7 years with a median follow-up time of 3.6 years,and no recurrent cases were found.Conclusions Surgery is the main method for the treatment of abdominal cocoon with evident clinical symptoms,and the prognosis is largely fair.

Clinical features, diagnosis and treatment of abdominal lymphangioma / 中华普通外科杂志

Objective To investigate the clinicopathological features of abdominal lymphangioma and its diagnosis and treatment.Methods The clinical data of 37 patients with abdominal lymphangioma were analyzed retrospectively.Results The clinical presentations were slight abdominal distention and discomfort in 6 cases (16％),abdominal pain or lumbago in 13 cases (35％),found by health screening in 14 cases (38％) and abdominal mass in 4 cases (11％).Tumor located in retroperitoneal space in 20 cases,small bowel in 7 cases,colon mesentery in 4 cases,small mesentery in 2 cases,duodenum in 2 cases,stomach in one case and pancreas in one case.The surgical procedures were complete resection in 31 cases and incomplete resection in 6 cases.Except 3 cases lost to fol]ow-up,no recurrence was found during the postoperative follow-up period.Conclusions It is difficult to diagnose abdominal lymphangioma before operation,and complete resection of tumor is the first choice.

Zhu's trocar placement in laparoscopic appendectomy in the treatment of complicated appendicitis / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To evaluate the feasibility and efficacy of Zhu's trocar placement (ZTP) in laparoscopic appendectomy (LA) in the treatment of complicated appendicitis.</p><p><b>METHODS</b>Clinical data of 139 complicated appendicitis patients undergoing LA at the First Affiliated Hospital of Wenzhou Medical University from June 2013 to December 2017 were retrospectively analyzed. ZTP-LA group comprised 59 cases and its procedure was as follows: 10 mm umbilical trocar was used as lens port; 12 mm trocar at crossing point of umbilical hole horizontal line and right midclavicular line was used as main operating port; 5 mm trocar at the crossing point of horizontal line 0-3 cm below umbilicus and right anterior axillary line was used as assist operating port with the drainage function for Douglas fossa and right iliac fossa; The operator and the assistant stood on the right side and the left side of the patient respectively. Traditional three-port group comprised 80 cases (8 cases converted to laparotomy, 72 cases enrolled finally) and its procedure was as follows: 10 mm lens port below umbilicus; 10-12 mm main operating port at lateral border of left lower rectus abdominis; 5 mm assist operating port above pubis; The operator and the assistant stood on left side of the patient. The operative time, time to oral semi-fluid, postoperative hospital stay, cost during hospitalization, and postoperative morbidity of complication were compared between two groups.</p><p><b>RESULTS</b>Baseline data such as gender, age, WBC count, percentage of leukocyte, pathological finding and type were not significantly different between two groups(all P>0.05). The conversion rate in ZTP-LA was significantly lower than that in traditional three-port group [0%(0/59) vs. 10.0%(8/80),χ²=4.552,P=0.033]. Compared with traditional three-port group, ZTP-LA group showed shorter operative time [(47.8±20.1) minutes vs. (66.0±27.3) minutes, t=4.383,P<0.001], shorter time to oral semi-fluid [(35.0±20.7) hours vs. (59.3±32.8) hours, t=5.158,P<0.001], shorter postoperative hospital stay [(4.1±1.6) days vs. (5.5±2.2) days, t=4.162, P<0.001], lower postoperative morbidity of complication [3.4% (2/59) vs. 18.1%(13/72), χ²=6.879, P=0.009], lower incidence of postoperative intra-abdominal abscess [0%(0/59) vs. 11.1%(8/72), χ²=5.179, P=0.023], lower incidence of paralytic ileus [1.7%(1/59) vs. 12.5%(9/72), χ²=3.946, P=0.047] and less cost during hospitalization[(13 585±2909) yuan vs.(16 861±5334) yuan, t=4.463, P<0.001].</p><p><b>CONCLUSION</b>ZTP-LA is safe, feasible and effective with advantages of faster recovery and less cost in the treatment of complicated appendicitis.</p>

Efficacy and safety of first-line chemotherapy plus bevacizumab in patients with metastatic colorectal cancer: a meta-analysis / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>What benefits and toxicities patients acquire from the use of bevacizumab combined with firstline chemotherapy remains controversial. This study was performed to evaluate the efficacy and safety of first-line chemotherapy plus bevacizumab in patients with metastatic colorectal cancer (mCRC).</p><p><b>METHODS</b>Several databases, including PubMed, Embase, and Cochrane Library, were searched up to April 30, 2013. Eligible studies were only randomized, controlled trials (RCTs) with a direct comparison between mCRC patients treated with and without bevacizumab. Overall risk ratio (RR), hazard ratio (HR), odds ratio (OR), and 95% confidence intervals (CI) were calculated employing fixed or random-effects models depending on the heterogeneity of the included trials.</p><p><b>RESULTS</b>Six RCTs, including 1582 patients in chemotherapy plus bevacizumab group and 1484 patients in chemotherapyalone group, were included. Overall, the addition of bevacizumab to first-line chemotherapy increased overall response rate (ORR) by 4.5%, prolonged both progression-free survival (PFS) and overall survival (OS), and increased the rate of total Grades 3 or 4 adverse events (G3/4AEs) by 6.9%. Significant differences were found in ORR (RR = 1.22 (95% CI 1.01-1.46), P = 0.03), PFS (HR = 0.60 (95% CI 0.47-0.77), P < 0.0001), OS (HR = 0.83 (95% CI 0.70-0.97), P = 0.02), and any G3/4AEs (OR = 1.56 (95% CI 1.29-1.89), P < 0.00001).</p><p><b>CONCLUSION</b>Bevacizumab is a valuable addition to the current first-line chemotherapy regimens used in patients with mCRC, because of conferring a significant improvement in ORR, PFS, and OS, even though it increased adverse events.</p>

Effects of ileal transposition on non-obese type 2 diabetic rats / 中华普通外科杂志

Objective To evaluate effects and possible mechanisms of ileal transposition on spontaneous non-obese type 2 diabetic GK rats.Methods 20 GK rats were randomly divided into two groups:ileal transposition group and sham operation group (n =10).We observed and determined the weight change,daily average food consumption and FBG (fasting blood-glucose) level of rats before the operation (0 weeks) and 1,4,8,16 and 24 weeks after the surgery.Glucose tolerance test (GTT) was carried out and GLP-1 (glucagon-like peptide-1) concentration measured before the operation (0 weeks) and 4,8,16 and 24 weeks after the surgery and the fasting insulin concentration before the surgery (0 weeks)and 4,24 weeks after the surgery measured,and the indicator of HOMA-IR calculated.Results There was no significant difference in the operating time between the two groups [(87 ± 8) min vs.(84 ± 7)min],P ＞ 0.05.Compared with those before surgery,body weight and food consumption of the two groups of rats decreased significantly a week after surgery (P ＜ 0.05),and then the body weight and food consumption of the two groups of rats all gradually increased,but the difference of the two groups of rats has no statistical significance 1-24 weeks after surgery (P ＞ 0.05).The FBG of the two groups of rats a week after surgery [ileal transposition group (6.1 ± 0.6) mmol/L,sham operation group (6.2 ± 0.8) mmol/L]decreased significantly compared with that before surgery [(7.0 ± 0.5) mmol/L and (6.9 ± 0.5) mmol/L](P ＜ 0.05),and then FBG of the two groups of rats all rose again.The FBG of the rats in surgery group decreased slowly from 8 to 24 weeks after surgery,while the FBG of the rats in the sham surgery group maintained the preoperative level,and the differences of the FBG of the two groups all have statistical significance 8-24 weeks after surgery (P ＜ 0.05).Four weeks after surgery,OGTT of the ileal transposition group significantly improved (P ＜ 0.01).24 weeks after surgery,fasting insulin levels of the ileal transposition group were lower [(0.26 ± 0.08) ng/mL vs.(0.42 ± 0.09) ng/ml],P ＜ 0.05.Compared with the sham surgery group,and HOMA-IR was lower (1.1 ± 0.4) vs.(2.6 ± 0.4),P ＜ 0.05.Four weeks after surgery,oral glucose-stimulated peak (30 min) levels of blood GLP-1 increased markedly in operation groups after surgery (P ＜ 0.01).Conclusions Ileal transposition is effective for the treatment of non-obese T2DM rats,and the control of blood glucose does not depend on the reduction of body weight and food comsumption,and the high secretion of GLP-1 after ileal interposition seem to be helpful in diabetes control.