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Objective:To investigate the effect of transorally inserted anvil (OrVil TM) in patients with relapsed or denovo carcinoma at the esophagogastric junction. Methods:The clinical data of 60 patients who underwent radical intent resection for locally relapsed or denovo esophagogastric junction adenocarcinoma at Zhengzhou University Cancer Hospital from Jan 2011 to Jun 2021 were retrospectively analyzed. The patients were divided into two groups according to whether transorally inserted anvil was used. Twenty-six patients who had used the system were assigned to the experimental group. Thirty-four patients without transorally inserted anvil were set to control group.Results:The incisor distance of the experimental group was shorter than that of the control group [36(34-40)cm vs. 39(36-41)cm, Z=-4.948, P<0.05]. Operation time in experimental group was 177 (145-260) min, compared to control group of 172 (140-225) min ( Z=-0.735, P=0.463). Intraoperative blood loss was 200 (100-900) ml in the experimental group and 300 (100-800) ml in the control group ( Z=-1.244, P=0.213). Postoperative upper margin distance of the experimental group was (3.6±1.7) cm compared to control group of (1.8±1.1) cm ( t=-0.735, P<0.01). The positive rate of margin in the experimental group was 4% vs. 15% in the control group ( χ2=1.931, P=0.165). The length of postoperative hospital stay in the experimental group was (18.6±5.2) d vs. (20.5±4.7) d ( t=-1.455, P=0.151). Surgery-related complications developed in 19% in the experimental group vs. 27% in the control group ( P>0.05). Conclusion:The application of the transorally inserted anvil in the operation of patients with locally relapsed or denovo esophagogastric junction cancer after initial operation reduces the difficulty of operation and decreases the positive rate of margin.
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Object:To explore surgical treatments for duodenal fistula with intra-abdominal infection.Methods:The data of 19 patients with duodenal fistula treated at the Affiliated Tumor Hospital of Zhenzhou University between Jan 2015 and Dec 2021 were analyzed retrospectively. Surgery is performed with duodenostomy or modified duodenal shunt procedures.Result:All patients were accompanied by intra-abdominal infection, including 9 duodenal stump fistulas. All patients successfully completed the operation,11cases underwent duodenostomy, 8 case underwent modified duodenal shunt procedures. operating time was 110(60-140)min, postoperative hospitalization time was 29(9-103)d. Two patients died postoperatively. Fistula heals in other patients.Conclusion:Surgical intervention for duodenal fistula should focus on controlling the source of infection, strengthening intestinal and abdominal drainage, and reducing postoperative complications.
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Object:To investigate the impact of carbon nanoparticle tracing on the number of lymph nodes harvested in obese patients during radical gastrectomy for gastric cancer.Methods:Clinical data of 127 patients undergoing D 2 radical gastrectomy in the Affiliated Tumor Hospital of Zhengzhou University from Jan 2015 to Dec 2019 were retrospectively analyzed. According to whether the patients were injected with carbon nano particles during operation, they were divided into two groups: 64 patients without carbon nano particles during operation served as control group; 63 patients with carbon nano particles were included into experimental group. Results:The operation time of the control group was (160±31) min and that of the experimental group was (168±28) min ( t=-1.521, P=0.445). Intraoperative blood lose in the control group was (234±82) ml and that in the experimental group was (238±84) ml ( t=-0.295, P=0.846). The number of lymph nodes harvested in the first station, in the second station, the number of total lymph nodes and the number of lymph nodes with diameter <5 mm in the control group were less than those in the experimental group(10.4±3.8 vs. 24.5±10.6, t=-10.054),(6.6±2.8 vs. 16.8±7.3, t=-10.381),(17.1±6.4 vs. 41.2±17.6, t=-10.293),(3.9±2.5 vs. 21.2±9.1, t=-14.662) (all P<0.05), while the number of positive lymph nodes was not statistically different between the two groups all (5.9±6.2 vs. 4.2±3.4, t=-1.963, P>0.05). Black staining of lymph nodes in nano carbon group: 1 542 black stained lymph nodes were detected in the experimental group, the black staining rate of lymph nodes was 59.44% (1 542/2 594). Conclusion:Intraoperative application of carbon nanoparticles can significantly increase the number of harvested lymph nodes in obese (BMI≥25 kg/m 2) gastric cancer patients after radical resection.
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Objective:To investigate the clinical significance of MRI dynamic enhancement in defining the upper edge of adenocarcinoma of esophagogastric junction.Methods:The clinical data of 73 patients with adenocarcinoma on the esophagogastric junction operated from Jul 2018 to Aug 2019 in the Affiliated Cancer Hospital of Zhengzhou University were retrospectively analyzed. All patients underwent MRI examination within one week before surgery. First, the T 2WI, diffusion-weighted imaging and dynamic enhanced images of each patient were carefully observed to define the tumor location, size, shape, signal and enhancement mode, then the distances between the upper edge of the tumor and the cardiac incisure on MRI dynamic enhancement were measured independently, and compared with the measured distance in surgical fresh specimens. Results:The mean location of tumor upper edge measured in MRI of 73 patients was (1.75±1.98)cm, while measured in the surgical specimen was (1.72±1.97)cm. There was no significant difference between the two groups ( t=0.572, P=0.569). The intraclass correlation efficient between the two groups was excellent (ICC=0.974, 95% CI: 0.959-0.984, P<0.01). Conclusion:The measurement result of tumor upper edge in MRI is basically consistent with that of surgical specimens. MRI can be used to locate the tumor upper edge for adenocarcinoma of esophagogastric junction before operation.
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Objective:To investigate whether adjuvant chemotherapy could be beneficial for patients with pT1N1M0 (stage ⅠB) gastric cancer.Methods:From Jan 2010 to Dec 2016, 185 patients with pT1N1M0 gastric cancer who were surgically resected at Henan Cancer Hospital were retrospectively analyzed. The patients were divided into chemotherapy group ( n=100) and non chemotherapy group ( n=85). Results:For disease-free survival (DFS) analysis, univariate survival analysis showed that age, examined lymph nodes, vascular invasion, nerve invasion and adjuvant chemotherapy were associated with DFS (all P<0.05); multivariate analysis showed that lymph node resection ≥ 16 ( HR=0.363, 95% CI: 0.160-0.827, P=0.016), vascular invasion ( HR=4.117, 95% CI: 1.796-9.436, P=0.001) and postoperative chemotherapy ( HR=4.530, 95% CI: 1.932-10.622, P=0.001) were independent risk factors for DFS. For disease-specific survival (DSS) analysis, univariate survival analysis showed that lymph node resection, vascular invasion, nerve invasion and adjuvant chemotherapy were associated with DSS; multivariate analysis showed that lymph node resection ≥ 16 ( HR=0.344, 95% CI: 0.144-0.822, P=0.016), vascular invasion ( HR=5.113, 95% CI: 2.029-12.887, P=0.001) and postoperative chemotherapy ( HR=4.694, 95% CI: 1.854-11.888, P=0.001)were independent risk factors for DSS. According to examined lymph nodes and vascular invasion , pT1N1M0 patients were divided into three risk categories (high, medium and low). DFS and DSS were significantly different among the three risk groups (all P<0.001, respectively). Conclusion:pT1N1M0 gastric cancer patients are expected to benefit from adjuvant chemotherapy. Patients with less than 16 lymph nodes and vascular invasion may be particularly suitable for adjuvant chemotherapy.
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Objective:To evaluate a nano-carbon lymphatic tracing method for patients with rectal cancer after neoadjuvant radiotherapy and chemotherapy .Method:Retrospective analysis was made on 88 patients of rectal cancer undergoing neoadjuvant chemoradiation at the Department of General Surgery, He′nan Cancer Hospital from Jan 2016 to May 2020.According to whether nano-carbon lymph node was used or not, patients were divided into nanocarbon tracer group (study group) and non-nanocarbon tracer group (control group).Results:There was statistically significant in the number of havested lymph nodes between the two groups [15(11-19) vs.9(5-12), Z=5.227, P<0.001], There was no statistically significant in the number of positive lymph nodes between the two groups [0(0-0.25) vs.0(0-1), Z=1.199, P=0.231]. There were significant differences in the ratio of patients with less than 7 lymph nodes(0/34 vs.18/54, χ 2=14.248, P<0.001) and patients with less than 10 lymph nodes (4/34 vs.29/54, χ 2=15.657, P<0.001). Conclusions:The injection of nanocarbon after neoadjuvant chemoradiotherapy can increase the number of harvested postoperative lymph nodes and the ratio of patients with lymph nodes ≥7 and ≥10, which is more beneficial for prediction of the prognosis of patients.
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Objective:To investigate the application value of one-stitch prophylactic ileostomy in late ileostomy closure.Methods:The prospective randomized control study was conducted. The clinicopathological data of 141 patients with rectal cancer who underwent low anterior resection combined with prophylactic ileostomy in the Affiliated Tumor Hospital of Zhengzhou University from January 2016 to July 2020 were selected. There were 127 patients being selected after excluding 14 cases who did not undergo ileostomy closure. Patients undergoing one-stitch prophylactic ileostomy were divided into observation group, and patients undergoing traditional ileostomy were divided into control group. Observation indicators: (1) grouping situations of the enrolled patients; (2) surgical situations of ileostomy closure; (3) postoperative situations; (4) follow-up. Follow-up was conducted using outpatient examination and telephone interview once a month after low anterior resection combined with prophylactic ileostomy to detect complication and death of patients. The end point was at 3 months after ileostomy closure. The follow-up was up to July 2020. Measurement data with normal distribution were represented as Mean±SD, and comparison between groups was conducted using the independent sample t test. Measurement data with skewed distribution were represented as M( P25, P75) or M (range), and comparison between groups was conducted using the Mann-Whitney U test. Count data were described as absolute numbers, and comparison between groups was conducted using the chi-square test. Comparison of ordinal data between groups was conducted using the Mann-Whitney U test. Results:(1) Grouping situations of the enrolled patients: a total of 127 patients were selected for eligibility, aged from 31 to 83 years, with a median age of 64 years. Of 127 patients, there were 66 cases in observation group and 61 cases in control group. (2) Surgical situations of ileostomy closure: all patients from the two groups underwent ileostomy closure successfully. The incision length, operation time, volume of intraoperative blood loss, cases with abdominal adhesion degree as slight adhesion or obvious adhesion were 4.25 cm(4.00 cm, 5.00 cm), 48.00 minutes(33.75 minutes, 58.00 minutes), 30 mL(20 mL, 50 mL), 34, 32 of the observation group, versus 7.50 cm(7.00 cm, 8.50 cm), 70.00 minutes(57.00 minutes, 80.00 minutes), 30 mL(30 mL, 50 mL), 13, 48 of the control group, showing significant differences between the two groups ( Z=-9.549, -6.133, -2.758, χ2=12.405, P<0.05). (3) Postoperative situations: cases with incision infection of the observation group and the control group were 5 and 13, respectively, showing a significant difference between the two groups ( χ2=4.917, P<0.05). (4) Follow-up: all the 127 patients were followed up for 6-21 months, with a median follow-up time of 10 months. During the follow-up, 3 cases of the control group had postoperative incisional hernia and were cured after conservative treatment. None of patient had anastomotic leakage related complications or died during the follow-up. Conclusion:The one-stitch preventive ileostomy has the advantage of ileostomy closure, which can reduce the operation time, volume of intraoperative blood loss and shorten the incision length effectively, so as to reduce the incidence of postoperative incision infection related complications.
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Objective:To evaluate the efficacy and perioperative safety of FLOT regimen in neoadjuvant chemotherapy for gastric adenocarcinoma.Methods:Data of 128 cases of neoadjuvant chemotherapy for gastric adenocarcinoma at the General Surgery Department of He′nan Cancer Hospital from Jan2018 to July 2019 were divided into FLOT group and SOX/XELOX group.Results:The disease control rate in the FLOT group was 81%, while that in the SOX/XELOX group was only 60% ( P=0.040). In terms of TRG classification and ypT staging, the proportion of TRG0 / 1 in the FLOT group was 49%, which was significantly higher than 21% in the SOX / XELOX group ( P=0.001). In the FLOT group, ypT 0-4 was 2, 10, 8, 17 and 6, respectively, while in the SOX/XELOX group, ypT 0-4 was 1, 9, 15, 26 and 34, respectively, ( P=0.022). In the FLOT group, ypTNM stages Ⅰ, Ⅱ, and Ⅲ were 11, 20, and 12, respectively, while in the SOX/XELOX group, ypTNM stages Ⅰ, Ⅱ, and Ⅲ were 12, 30, and 43, respectively ( P=0.040). Complications occurred in 10 patients (23%) in the FLOT group and 18 patients (21%) in the SOX/XELOX group ( P>0.05). Conclusions:FLOT neoadjuvant chemotherapy for advanced gastric adenocarcinoma does not increase the incidence of perioperative complications while effecting tumor regression and downstaging compared to SOX/XELOX regimen.
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Objective:To evaluate a new nano-carbon lymphatic tracing method to increase the number of lymph nodes acquired in patients with neoadjuvant chemotherapy for gastric cancer.Method:From Jan 2015 to Mar 2016, 159 patients with gastric cancer were recruited including 66 cases in study group receiving nano carbon injection under the mucosa layer one day before the operation, and 93 cases with intraoperative subserosal layer injection as control.Results:The average number of lymph nodes obtained in the study group was 47.0±14.7, while that in control was 38.0±14.5, P<0.05. The number of fibrotic lymph nodes obtained in the study group was 3.1 ± 1.9, compared with 3.0±1.8 in control, P>0.05. The number of black-stained lymph nodes in the former was 22.3±4.4, and the later was 14.7±4.8, P<0.05. The lymph nodes harvested in the first station in study group was 26.6±8.5, while that in the control group was 24.1±9.9, P>0.05. The lymph nodes obtained in the second station was 20.4±6.9 in study group, while in control was 13.8±5.7, P<0.05. Conclusions:The submucosal injection of nanocarbon one day before surgery increase the number of lymph nodes obtained in gastric cancer patients with neoadjuvant chemotherapy.
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Objective:To investigate the effects of preoperative endoscopic mucosal injection of carbon nanoparticle tracer and intraoperative serosa injection of carbon nanoparticle tracer on the acquisition of lymph nodes in total gastrectomy for gastric cancer.Methods:The retrospective cohort study was conducted. The clinical data of 118 patients with gastric cancer who underwent total gastrectomy in the Affiliated Tumor Hospital of Zhengzhou University between May 2017 and April 2018 were collected. There were 79 males and 39 females, aged from 26 to 81 years, with an average age of 59 years. Of 118 patients, 56 patients undergoing preoperative endoscopic mucosal injection of carbon nanoparticle tracer were divided into observation group and 62 patients undergoing intraoperative serosa injection of carbon nanoparticle tracer were divided into control group. Observation indicators: the total number of lymph node dissected, the number of positive lymph node dissected, the number of lymph node dissected at the first station and the number of lymph node dissected at the second station. Measurement data with normal distribution were represented as Mean± SD, and comparison between groups was analyzed using the independent-sample t test. Measurement data with skewed distribution were represented as M (range), and comparison between groups was analyzed using the Mann-Whitney U test. Count data were described as absolute numbers, and comparison between groups was analyzed using the chi-square test or Fisher exact probability. Comparison of ordinal data was analyzed using the rank sum test. Results:The total number of lymph node dissected, the number of positive lymph node dissected, the number of lymph node dissected at the first station, the number of lymph node dissected at the second station of the observation group were 48±16, 3(range, 0-25), 26±9, 23±7, respectively. The above indicators of the control group were 41±13, 4(range, 0-28), 25±8, 16±5, respectively. There were significant differences in the total number of lymph node dissected and the number of lymph node dissected at the second station between the two groups ( t=2.494, 6.588, P<0.05), and there was no significant difference in the number of positive lymph node dissected and the number of lymph node dissected at the first station between the two groups ( Z=0.747, t=1.689, P>0.05). Conclusions:Carbon nanoparticle labeled lymph node staining using preoperative endoscopic mucosal injection of carbon nanoparticle tracer or intraoperative serosa injection of carbon nanoparticle tracer is safe and effective in total gastrectomy for gastric cancer. Compared with intraoperative serosa injection of carbon nanoparticle tracer, preoperative endoscopic mucosal injection of carbon nanoparticle tracer can increase the total number of lymph node dissected, especially the number of lymph node dissected at the second station of gastric cancer.
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OBJECTIVE:To establish a method for simultaneous determination of danshensu,salvianolic acid B,protocatechu-ic aldehyde,paeoniflorin and ferulic acid in Jingzhi guanxin granule. METHODS:HPLC was performed on the column of Zorbax Eclipse XDB-C18 with mobile phase of acetonitrile-methanol-0.5% H3PO4(gradient elution)at a flow rate of 1.0 ml/min,the detec-tion wavelength was 280 nm(for danshensu,protocatechuic aldehyde,salvianolic acid B),230 nm(for ferulic acid)and 320 nm (for paeoniflorin),column temperature was 30 ℃,injection volume was 10 μl. RESULTS:The linear range was 1.19-478.34 μg/ml for danshensu(r=0.999 9),0.11-44.93 μg/ml for protocatechuic aldehyde(r=0.999 9),7.49-995.20 μg/ml for salvianolic acid B (r=0.999 7),0.95-379.39 μg/ml for paeoniflorin (r=0.999 9) and 0.01-3.12 μg/ml for ferulic acid (r=0.999 5);the limits of quantitation were 1.91 ng,0.36 ng,150.00 ng,2.74 ng and 0.10 ng,limit of detection were 0.96 ng,0.10 ng,45.00 ng,1.52 ng and 0.03 ng;RSDs of precision,stability and reproducibility tests were lower than 2%;recoveries were 98.06%-99.47%(RSD=0.52%,n=6),98.01%-99.49%(RSD=0.70%,n=6),98.44%-99.45%(RSD=0.37%,n=6),96.94%-100.71%(RSD=1.27%,n=6)and 95.44%-100.44%(RSD=1.90%,n=6). CONCLUSIONS:The method is simple and accurate,and suitable for the simultaneous determination of danshensu,salvianolic acid B,protocatechuic aldehyde,paeoniflorin and ferulic acid in Jingzhi guanxin granule.
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OBJECTIVE:To establish a method for the simultaneous determination of chlorogenic acid,paeoniflorin,ferulic ac-id,berberine hydrochloride and baicalin in Lianqiao baidu pill. METHODS:HPLC was performed on the column of Agilent Eclipse XDB-C18 with mobile phase of 0.5% phosphoric acid(triethylamine adjusted to pH 3.0)-methanol(gradient elution)at a flow rate of 1.0 ml/min,the column temperature was 30 ℃,the detection wavelength was 230 nm(for paeoniflorin and berberine hydrochlo-ride),324 nm(for chlorogenic acid and ferulic acid)and 278 nm(for baicalin),and the injection volume was 5 μl. RESULTS:The linear range was 1.884-30.144 μg/ml for chlorogenic acid(r=0.999 9),0.392-6.272 μg/ml for paeoniflorin(r=0.999 7), 0.102-1.632 μg/ml for ferulic acid(r=0.999 7),1.326-21.216 μg/ml for berberine hydrochloride(r=0.999 8) and 1.95-31.2 μg/ml for baicalin(r=0.999 9),respectively;RSDs of precision,stability and reproducibility tests were lower than 2.0%;recoveries were 99.58%-102.47%(RSD=0.93%,n=9),99.21%-102.18%(RSD=0.90%,n=9),98.28%-101.23%(RSD=0.86%,n=9), 99.66%-101.84%(RSD=0.82%,n=9)and 99.18%-101.05%(RSD=0.62%,n=9). CONCLUSIONS:The method is accurate,re-liable,simple and fast,and can be used for the simultaneous determination of chlorogenic acid,paeoniflorin,ferulic acid,berber-ine hydrochloride and baicalin Lianqiao baidu pill.
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OBJECTIVE:To establish a method for simultaneous determination of tanshinol,protocatechuic aldehyde,paeoni-florin,ferulic acid and salvianolic acid B in Shenshao oral liquid. METHODS:RP-HPLC was performed on the column of Eclipse XDB C18 with mobile phase of 0.5%phosphoric acid-methanol-acetonitrile(gradient elution)at the flow rate of 1.0 ml/min,the de-tection wavelength was 280,230 and 320 nm,column temperature was 30 ℃ and volume was 10 μl. RESULTS:Under the chro-matographic conditions,5 kinds of components could be completely separated,the linear range of tanshinol,protocatechuic alde-hyde,paeoniflorin,ferulic acid and salvianolic acid B were respectively 24-384 μg/ml(r=0.999 9),1.25-20 μg/ml(r=0.999 9), 40.5-648 μg/ml(r=0.999 8),1.5-24 μg/ml(r=0.999 9),145-2 320 μg/ml(r=0.999 9);RSDs of precision,stability and reproduc-ibility tests were no more than 2.2%;the average recovery was respectively 100.7%(RSD=1.23%,n=9),100.0%(RSD=2.19%,n=9),99.6%(RSD=0.87%,n=9),100.3%(RSD=1.11%,n=9) and 99.3%(RSD=2.46%,n=9). CONCLUSIONS:The method is specific with good precision and reproducibility,and can be used for the content determination of 5 components in Shenshao oral liquid.
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OBJECTIVE:To establish a method for the content determination of tanshinol,protocatechuic aldehyde,salvianolic acid B,paeoniflorin and ferulic acid in Xinning tablets. METHODS:Multi-target with multi-wavelength HPLC was performed on the column of Agilent Zorbax Eclipse XDB-C18 with the mobile phase of acetonitrile-methanol-0.5% H3PO4 aqueous solution(gradi-ent elution) at the flow rate of 1.0 ml/min. The column temperature was 30 ℃,volume was 10 μl and the detection wavelength was 280 nm for tanshinol,protocatechuic aldehyde and salvianolic acid B,230 nm for paeoniflorin and 320 nm for ferulic acid. RESULTS:The linear range was 66.25-1060.00 μg/ml for tanshinol(r=0.999 9),5.55-88.86 μg/ml for protocatechuic aldehyde (r=0.999 9),187.20-2 995.20 μg/ml for salvianolic acid B(r=0.999 7),23.71-379.39 μg/ml for paeoniflorin(r=0.999 9)and 0.20-3.12μg/ml for ferulic acid(r=0.999 7);the RSDs of precision,stability and repeatability tests were all less than 2%;the av-erage recoveries were respectively 98.85%(RSD=0.12%,n=6),97.95%(RSD=0.19%,n=6),99.18%(RSD=0.37%,n=6), 98.14%(RSD=0.25%,n=6) and 97.16%(RSD=1.36%,n=6). CONCLUSIONS:The method is simple and convenient with good separation effect,and can be used for the content determination of the 5 components in Xinning tablets.
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OBJECTIVE:To establish a method for the contents determination of tanshinol,protocatechuic aldehyde,ferulic ac-id and salvianolic acid B in Yixinshu capsule. METHODS:Dual-wavelength HPLC was performed on the column of Eclipse XDB-C18 with mobile phase of 0.5%phosphoric acid-methanol-acetonitrile(gradient elution)at the flow rate of 1.0 ml/min,the de-tection wavelength was 280 nm(tanshinol,protocatechuic aldehyde,salvianolic acid B)and 320 nm(ferulic acid),column tempera-ture was 30℃and volume was 10 μl. RESULTS:The linear range of tanshinol,protocatechuic aldehyde,ferulic acid and salvianolic acid B were respectively 9-144μg/ml(r=0.999 9),0.5-8μg/ml(r=0.999 9),0.65-10.4μg/ml(r=0.999 9)and 221.25-3 540μg/ml (r=0.999 9);RSDs of precision,stability and reproducibility tests were no more than 1.90%;the average recovery was respective-ly 100.8%(RSD=1.65%,n=9),100.1%(RSD=2.87%,n=9),100.1%(RSD=3.01%,n=9) and 99.4%(RSD=2.05%,n=9). CONCLUSIONS:The method is simple and reproducible,and can be used for the quality control of Yixinshu capsule.