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Objective To compare the clinical data and postoperative complications between defunctioning stoma and non-defunctioning stoma in laparoscopic low anterior resection for rectal carcinoma,and study the clinical significance of non-defunctioning stoma.Methods The clinical data of 70 cases who accepted laparoscopic low anterior resection was collected.According to the operative methods,all patients were divided into two groups,defu ctioning stoma group included 42 cases and non-defunctioning stoma group induded 28 cases.The situation of postoper rative complications of patients bob two groups were compared by SPSS 19.0.Results The operation time,bleeding volume,eating time in defunctioning stoma groups and non-defunctioning stoma groups were no statistical significant.The time staying in hospital in defunctioning stoma groups was longer than that of non-defunctioning stoma groups (P ＜ 0.05).defunctioning stoma groups,anastomotic leakages happened in 2 case,anastomotic hemorrhage in 1 case,incision complications in 2 cases,anastomotic strictures in 8 cases,stoma complications in 1 case.The total morbidity was 28.5％.In non-defunctioning stoma group anastomotic leakages happened in 1 case,anastomotic hemorrhage happened in 1 case,incision complications happened in 1 case,internal complications happened in 1 case.The postoperative morbidity was 17.8％.The total complications had significant difference in the two groups(P ＜0.05).The anastomotic leakage and hemorrhage in two groups had no difference significantly.Conclusion Defunctioning stoma with no indication can not decrease the complication in laparoscopic low anterior resection for rectal cancer case.
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Objective To explore the role and possible mechanism of transforming growth factor (TGF)-β autocrine in CDH17 regulating invasion of gastric cancer cells.Methods Construction and transfection of siRNA-CDH17 into MKN-45 gastric cancer cell line to silence the expression of CDH17.Expression of TGF-β and concentrations of TGF-β in supernatants were detected before and after CDH17 silence by immunofluorescence,immunoblotting and ELISA.The autocrine situation of TGF-β was observed.Meanwhile,the activation of TGF-β/Smad3 signaling pathway was also detected by immunoblot.After giving signaling pathway inhibitor,the changes of invasion ability of MKN-45 cells were observed by Transwell invasion experiment.The role of TGF-β autocrine and related signaling pathway activation in CDH17-regulated invasion of gastric cancer cells was evaluated.Results After transfecting siRNA-CDH17 for silencing CDH17 expression in MKN-45 cells,the expression of TGF-β was significantly decreased compared with non-transfection group,its concentration in supernatants was also significantly reduced[(510 ±55)pg/mL vs.(115±20) pg/mL,P<0.01].The immunoblots revealed that phosphorylation level of Smad3 after CDH17 silence was also significantly diminished.However,giving the TGF-β/Smad3 signaling inhibitor SIS3 (10 μmol/L) could also suppress the phosphorylation level of Smad3 when CDH17 was highly expressed,meanwhile silencing CDH17 and inhibiting Smad3 phosphorylation could significantly decrease the invasion of MKN-45 gastric cancer cells (P<0.05).Conclusion CDH17 could participate in the invasion of gastric cancer cells by promoting TGF-β autocrine to activate TGF-β/Smad3 signaling pathway.
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Objective To compare the clinical data and postoperative complications between defunctioning stoma and non-defunctioning stoma in laparoscopic low anterior resection for rectal carcinoma,and study the clinical significance of non-defunctioning stoma.Methods The clinical data of 70 cases who accepted laparoscopic low anterior resection was collected.According to the operative methods,all patients were divided into two groups,defu ctioning stoma group included 42 cases and non-defunctioning stoma group induded 28 cases.The situation of postoper rative complications of patients bob two groups were compared by SPSS 19.0.Results The operation time,bleeding volume,eating time in defunctioning stoma groups and non-defunctioning stoma groups were no statistical significant.The time staying in hospital in defunctioning stoma groups was longer than that of non-defunctioning stoma groups (P ＜ 0.05).defunctioning stoma groups,anastomotic leakages happened in 2 case,anastomotic hemorrhage in 1 case,incision complications in 2 cases,anastomotic strictures in 8 cases,stoma complications in 1 case.The total morbidity was 28.5％.In non-defunctioning stoma group anastomotic leakages happened in 1 case,anastomotic hemorrhage happened in 1 case,incision complications happened in 1 case,internal complications happened in 1 case.The postoperative morbidity was 17.8％.The total complications had significant difference in the two groups(P ＜0.05).The anastomotic leakage and hemorrhage in two groups had no difference significantly.Conclusion Defunctioning stoma with no indication can not decrease the complication in laparoscopic low anterior resection for rectal cancer case.
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Objective To investigate the clinical results and prognosis between proximal and total gastrectomy in proximal advanced gastric cancer.Methods The clinicopathological data of 221 patients with proximal advanced gastric cancer who undcrwent radical gastrectomy were retrospectively analyzed.82 patients and 139 patients underwent proximal and total gastrectomy respectively.The number of dessected lymph nodes,postoperative complications and mortality were compared.Kaplan-Meier survival rate curves and Log-rank test were drawn and compared.Results A total of 1 411 (11-34) and 3 345 (14-35) lymph nodes were harvested from the surgical specimens of 82 and 139 patients with proximal and total gastrectomy respectively,the average number of harvested lymph nodes was 17 ± 11 and 24 ± 10 (t =2.586,P ＜0.05).The overall complications in proximal gastrectomy were higher than total gastrectomy (73.2％ vs.30.2％,x2 =38.291,P ＜0.01).The ratio of functional delayed gastric emptying,anastomotic leakage and stenosis,reflux esophagitis in proximal gastrectomy patients was higher than total gastrectomy.The survival rate in proximal gastrectomy were lower than total gastrectomy in proximal advanced gastric cancer (P ＜0.01).Conclusion Total gastrectomy is recommended for proximal advanced gastric cancer.
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Objective To compare the safety and efficiency of endoscopic total extraperitoneal patchplasty(TEP)and modified Kugel hernioplasty for inguinal hernia.Methods The clinical data of 284 cases(312 surgeries)of preperitoneal inguinal hernia repair,including 134 cases(152 surgeries)of TEP and 150 cases (160 surgeries)of modified Kugel hernioplasty,were retrospectively evaluated from June 2009 to June 2011.Mean operative time,postoperative hospital stay,postoperative complications and recur-rence were compared between groups.Results There were no significant differences in mean operative time [(48.75 ±12.14)min vs(51.46 ±24.76)min,P=0.248],postoperative hospital stay [(5.23 ± 1.85)d vs(5.84 ±1.52),P=0.126],postoperative complications [5 cases(3.3%)vs 8 cases(5.0%), P=0.598]and recurrence [1 case(0.7%)vs 2 cases(1.3%),P=1.00]between TEP and modified Kugel hernioplasty,espectively.Conclusion TEP and modified Kugel hernioplasty are both methods for preperitoneal hernia repair and they can completely repair the defect of myopectineal orifice.They are safe and effective,which is worthy of being spread in clinical practice.
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Objective To discuss the effect of the interval between neoadjuvant therapy and surgery on downstaging for local advanced rectal cancer.Method s From May 2003 to December 2008 as earlier period,32 patients with clinical stage T3 or T4 rectal cancer received neoadjuvant therapy followed by surgery after 4 -6 weeks.From January 2009 to December 2010 as later period,21 patients with clinical stage T3 or T4 rectal cancer received neoadjuvant therapy followed by surgery after 8 weeks.Dworak classification,TNM stage and clinical outcome after surgery were compared between two group paitents.Results All patients with local advanced rectal cancer received R0 resection.No surgical complications and mortality were observed in all cases.Pathological results showed that 0 and 2 cases were Dworak classification Ⅳ,5 cases were Dworak classification Ⅲ,3 and 6 cases were Dworak classification Ⅱ and 24 and 8 cases were Dworak classification Ⅰ in earlier period and later period,respectively (x2 = 9.109,P = 0.028).The postoperative staging showed that 6 and 13 cases were ypT1N0M0,22 and 6 cases were ypT2N0M0,1 case was ypT3 N0M0,3 and 1 cases were ypT3N1 M0,respectively (x2 = 10.909,P = 0.012).There were 65.6% or 81.0% cases reserved anus in earlier period and later period,respectively(x2 = 1.468,P = 0.226).Conclusions The neoadjuvant therapy followed by surgery after 8 weeks is associated with a more significant downstaging effect for local advanced rectal cancer.However,the effect of an extended interval between neoadjuvant therapy and surgery on clinical outcome still needs further investigation.
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This article analyzes the characteristics of lymph node metastasis in proximal advanced gastric cancer,in order to guide the extent of stomach resection (proximal or total gastrectomy) and the resection of spleen or splenic preservation. The metastasis of lymph node in proximal advanced gastric cancer has certain characteristics, which can provide a significant guidance for lymphadenectomy. Total gastrectomy plus splenectomy is a feasible radical surgery for proximal advanced gastric cancer, because of the requirement of lymphadenectomy.
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Objective To investigate the effects of 7 5% hypertonic saline (HS) on fluid balance after elective major abdominal surgery Methods Twenty two patients undergoing elective major abdominal surgery were assigned to receive either Ringer lactate solution followed by 4 ml/kg of 7 5% HS (study group, n =11) or Ringer lactate solution (control group, n =11) during the early postoperative period in ICU We compared fluid infusion volumes and urine outputs, fluid balance, and body weight change between the 2 groups Results Urine outputs in the operative day and the first postoperative day in study group were significantly more than in control group [(2?650?531)ml vs (2?046?572)ml, t =2 551?7, P
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Objective To sum up the experience on the diagnosis and treatment of abdominal compartment syndrome(ACS). Methods In this report, ACS was diagnosed by special clinical features in all 5 patients. Following emergency decompressive celiotomy, the abdominal viscera were covered with a 3 L sterile plastic bag for nutrition support. Results The first case died despite abdominal decompression through uper midline incision. 4 cases underwent decompressive celiotomy through incision from xiphoid to symphysis, one died postoperatively. The overall mortality in this series was 40% (2 / 5). Conclusions Close attention paid to the abdominal and systemic signs facilitates the diagnosis of ACS.Emergent decompressive celiotomy through a incision from xiphoid to symphysis is effective in treating ACS. Temporary abdominal closure could be fulfiled with 3L sterile plastic bag for nutrition support.
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This article discusses the relationship between ecological environment、ethical awareness and ecological moral.It tells us that only when we esteem the natural rights,establish the natural power,maintain ecological balance and erect the ethical awareness of ecological civilization that the human benefits can be adequately obtained and social enlightenment can be unceasingly developed.
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Objective To explore the relationship between the histological alterations of Oddi sphincter lesions and clinical manifestations. MethodsFrom October 1995 to May 2003, biopsies of Oddi sphincter were undertaken during transduodenal sphincteroplasty (TSP) in 32 cases. Specimens were stained with Van Gieson Mason staining. ResultsThirty one out of 32 specimens were found with histological alterations in Oddi sphincter including diffuse fibrosis in 87 1% (27/31) , adenomyosis in 2 cases and chronic inflammatory infiltration in 2 cases. Impacted stone in the terminal common bile duct, benign papillary stenosis and visible postpancreatitis parenchymal changes were all found accompanying severe fibrosis of Oddi sphincter. ConclusionIn patients with impacted stones in the ampulla, intracholedochal sludge with recurrent cholangitis, and relapsing pancreatitis, endoscopic sphincterotomy is recommended.