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In recent years, with the emergence of new research evidence, the domestic and foreign guidelines in the field of gastrointestinal stromal tumors (GISTs) have been updated. The adjusted contents cover almost every link of GISTs management, from GISTs diagnosis, biological behavior, surgical treatment to targeted drug treatment. Since 2020, the NCCN of the United States has separated the contents related to GISTs from the clinical practice guide for soft tissue sarcoma for the first time to form 2021 V.1 versions. The CSCO has also adjusted and upgraded the previous consensus of Chinese experts on the diagnosis and treatment of GISTs to 2020 and 2021 versions of the guidelines for the diagnosis and treatment of GISTs. This opens a new model of accurate diagnosis and treatment of GISTs under the guidance of evidence-based medicine. The listing of new targeted drugs afatinib and ripretinib is expected to get rid of the drug-resistant treatment dilemma of metastatic GISTs, enrich the back-line treatment camp, provide more opportunities for surgical intervention, and then bring survival benefits to patients with advanced GISTs.
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Chronic critical illness (CCI) refers to a group of critically ill patients who survive the acute phase of intensive care, but with persistent organ dysfunction, thus entering a chronic period of continuous dependence on life support system, and still need to stay in intensive care unit (ICU) for a long time. Persistent inflammatory response-immunosuppression-catabolic syndrome (PICS) is the main pathophysiological feature of CCI. Three factors interact to form a vicious circle, leading to poor prognosis. Nutritional support therapy is a key link in the comprehensive treatment of CCI. Enteral nutrition (EN) should be started as soon as possible if conditions permit. If EN can not be implemented, temporary or transitional parenteral nutrition (PN) should be used, and EN should be added gradually in time. At the same time, the amount of PN should be gradually reduced. When EN meets more than 60% of patients’ energy and protein requirements, PN can be considered to be discontinued. The main strategies and functions of CCI nutritional support therapy are as follows: strengthening high protein supply to correct negative nitrogen balance and inhibit catabolism, selecting branched chain amino acids (BCAA) to promote anabolism, using immunomodulators (arginine, ω3 polyunsaturated fatty acids) to improve immune suppression and inflammatory response, supplementing micronutrients (vitamins and trace elements) to counteract the decrease in intake and the increase in consumption, and adding probiotics to maintain the intestinal microecological balance, and so on. Reasonable nutritional support therapy not only improve malnutrition of CCI patients, but also help to reduce complications, thus speeding up rehabilitation, improving prognosis, shortening ICU hospitalization time, and even reducing mortality.
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Objective@#Preliminary study on the clinical effect of preoperative ultrasound endoscopy combined with staining labeling technique to locate the actual boundary of esophageal and gastric cancer@*Methods@#From September 1, 2015 to October 30, 2017, 18 patients with esophageal adenocarcinoma were enrolled in this study. The actual boundaries of esophageal and gastric-derived adenocarcinoma lesions were localized by endoscopic ultrasonography and staining. There were 10 males and 8 females. After completing the preoperative examination, 1-2 days before operation, endoscopic ultrasonography was used to locate the edge of the lesion. Two point injection of carbon nano suspension was used to mark the location of 1cm at the longest distance from the longitudinal axis of the tumor. According to the length of longitudinal axial staining, the thoracotomy was performed. Intraoperative proximal margin resection was used to send frozen pathology. According to the results of freezing, the operation was decided. After the operation, the specimens from the margin of the tumor were segmented into paraffin section, which was about 0.5cm in each segment, and the tumor cells were observed under the electron microscope at all levels of the paraffin sections.@*Results@#The average time of preoperative endoscopic ultrasonography staining was(10.16±1.38) min, and the diameter of nano carbon diffusion was(1.43±0.41)cm. All patients in the operation could clearly see the nano carbon staining area under the naked eye. In the field, the average time of locating lesions was(1.27±0.53)min. 5 patients underwent thoracoabdominal surgery and 13 underwent abdominal surgery. The average length of the cut margin of the tumor was(4.74±1.12)cm, and the frozen pathology of the incision margin was negative, and no additional operation was performed. The routine pathology confirmed that all the specimens were negative.@*Conclusion@#The staining and labeling technique for adenocarcinoma of the esophagogastric junction under endoscopic ultrasonography can detect the tumor edge and the scope of invasion accurately. It provides guidance and guarantee for the smooth implementation of AEG precision surgery. It is a safe, rapid and effective positioning technique.
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Objective Preliminary study on the clinical effect of preoperative ultrasound endoscopy combined with stai-ning labeling technique to locate the actual boundary of esophageal and gastric cancer Methods From September 1, 2015 to October 30, 2017, 18 patients with esophageal adenocarcinoma were enrolled in this study. The actual boundaries of esophage-al and gastric-derived adenocarcinoma lesions were localized by endoscopic ultrasonography and staining. There were 10 males and 8 females. After completing the preoperative examination, 1-2 days before operation, endoscopic ultrasonography was used to locate the edge of the lesion. Two point injection of carbon nano suspension was used to mark the location of 1cm at the lon-gest distance from the longitudinal axis of the tumor. According to the length of longitudinal axial staining, the thoracotomy was performed. Intraoperative proximal margin resection was used to send frozen pathology. According to the results of freezing, the operation was decided. After the operation, the specimens from the margin of the tumor were segmented into paraffin section, which was about 0. 5cm in each segment, and the tumor cells were observed under the electron microscope at all levels of the paraffin sections. Results The average time of preoperative endoscopic ultrasonography staining was(10. 16 ± 1. 38) min, and the diameter of nano carbon diffusion was(1.43 ±0.41)cm. All patients in the operation could clearly see the nano carbon staining area under the naked eye. In the field, the average time of locating lesions was(1.27 ±0.53)min. 5 patients under-went thoracoabdominal surgery and 13 underwent abdominal surgery. The average length of the cut margin of the tumor was(4. 74 ±1.12)cm, and the frozen pathology of the incision margin was negative, and no additional operation was performed. The routine pathology confirmed that all the specimens were negative. Conclusion The staining and labeling technique for adeno-carcinoma of the esophagogastric junction under endoscopic ultrasonography can detect the tumor edge and the scope of invasion accurately. It provides guidance and guarantee for the smooth implementation of AEG precision surgery. It is a safe, rapid and effective positioning technique.
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Objective@#To explore the efficacy of closed negative pressure irrigation and suction device (Patent number: Z200780013509.8) in the treatment of high perianal abscess.@*Methods@#From January 2015 to December 2016, ≥18-year-old patients with primary high perianal abscess who were treated at our department were prospectively enrolled. Exclusion criteria: (1) recurrent perianal abscess; (2) complicated with anal fistula formation; (3) preoperative, intraoperative or postoperative physical therapy, and curettage treatment, negative pressure irrigation; (4) Crohn′s disease-related perianal abscess; (5) with immunosuppressive status, such as transplant recipients; (6) co-existence of malignant tumors, such as leukemia; (7) with diabetes; (8) those who could not receive long-term follow-up and were not suitable to participate in this study. According to the random number table method, the patients were randomly divided into negative pressure irrigation and suction group and routine drainage group. All patients were clearly diagnosed and the location and size of the perianal abscess were marked before surgery. These two groups were treated as follows: (1) Negative pressure irrigation and suction group: the skin was incised at a diameter of 1-2 cm at the site where the abscess fluctuated most obviously. After the abscess was removed, a closed negative pressure irrigation and suction device was installed and the pressure of -200 to -100 mmHg (1 mmHg=0.133 kPa) was maintained to keep the abscess cavity collapsed. Generally, the irrigation was stopped 5 days later or when the drainage was clear. The closed vacuum suction was maintained for 2 additional days, before the wound was sutured. (2) Conventional drainage group: conventional incision and drainage was carried out. The skin was cut at a diameter of 8 to 10 cm at the site of abscess with most obvious fluctuation. After the abscess was removed, normal saline gauze was used for dressing. Dressing was changed regularly until the wound healed. The efficacy, operative time, intraoperative bleeding, incision length, frequency of dressing change, pain index (visual analogue score, VAS score), postoperative healing time, complications, recurrence rate of perianal abscess, anal fistula formation rate were observed. The t test and χ2 test were used for comparison between the 2 groups.@*Results@#There were both 40 patients in the negative pressure irrigation and suction group and the conventional drainage group. There were 28 males and 12 females in negative pressure irrigation and suction group with a mean age of (38.3±12.0) years and mean disease course of (6.6±2.1) days. The abscess in pelvic-rectal space accounted for 50.0% (20/40) and the mean diameter of abscess was (8.0±3.7) cm. There were 26 males and 14 females in the conventional drainage group with a mean age of (37.1±11.8) years and mean disease course of (6.4±2.5) days. The abscess in pelvic-rectal space accounted for 55.0% (22/40) and the diameter of abscess was (8.2±3.5) cm. The differences in baseline data between two groups were not statistically significant (all P>0.05). Both groups successfully completed the operation. There was no significant difference in operative time between two groups (P>0.05). As compared to conventional drainage group, intraoperative blood loss in negative pressure irrigation and suction group was less [(12.1±5.5) ml vs. (18.3±4.4) ml, t=5.606, P<0.001], incision length was shorter [(2.3±0.8) cm vs. (7.6±1.7) cm, t=17.741, P<0.001], postoperative VAS pain scores at 1-, 3-, 7-, and 14-day after operation were lower [3.7±1.4 vs. 7.6±1.8, t=10.816, P<0.001; 3.0±1.3 vs. 6.8±1.6, t=11.657, P<0.001; 2.7±0.9 vs. 5.1±1.1, t=10.679, P<0.001; 1.2±0.3 vs. 1.6±0.4, t=5.060, P=0.019], the dressing change within 7 days after operation was less (3.5±1.2 vs. 12.6±2.7, t=19.478, P<0.001), postoperative healing time was shorter [(10.4±3.0) d vs. (13.5±3.8) d, t=4.049, P<0.001] and postoperative complication rate was lower [17.5% (7/40) vs. 2.5% (1/40), χ2=5.000, P=0.025]. During follow-up of 12 to 36 (24±5) months, the recurrence rate of perianal abscess within 1 year after operation and anal fistula formation rate in negative pressure irrigation and suction group were lower than those in conventional drainage group [5.0% (2/40) vs. 20.0% (8/40), χ2=4.114, P=0.042 and 2.5% (1/40) vs. 17.5% (7/40), χ2=5.000, P=0.025, respectirely]. The one-time cure rate of negative pressure irrigation and suction group and conventional drainage group was 92.5% (37/40) and 62.5%(25/40), respectirely (χ2=10.323, P=0.001).@*Conclusions@#The application of the negative pressure irrigation and suction device in the treatment of high perianal abscess can improve the efficiency of one-time cure, reduce postoperative pain, accelerate healing time, decrease the morbidity of postoperative complication and the rates of abscess recurrence and anal fistula formation, indicating an improvement of the treatment.
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Objective To investigate the expression of immunophenotype in gastrointestinal stromal tumors and analyze its clinical value in the diagnosis and prognosis of gastrointestional stromal tumors.Methods Reviewed the clinical data of 323 patients with gastrointestinal stromal tumors in Fuzhou General Hospital of PLA from January 2004 to January 2014.Detected expressions of CD-117,DOG-1,CD-34,alpha-SMA,S-100.Desmin and Ki-67 by immunohistochemical S-P method,frequency statistics,independent sample t test and correlation analysis was carried out with SPSS 20.Results The positive rates of CD-117,DOG-1 and GIST in the group CD-34 were 97％,95.6％ and 86％ respectively,the positive rates of alpha-SMA,S-100 and Desmin were 59.8％,27.7％ and 17％ respectively,the positive expression of CD-117,CD-34,alpha α-SMA and Desmind in intestinal gastrointestinal stromal tumors and gastric gastrointestinal stromal tumors were significantly different,among them (P ＜ 0.05),the positive rates of gastrointestinal stromal tumors and alpha-SMA in intestinal CD-117 were significantly higher than those in gastric gastrointestinal stromal tumors (3.37 vs 2.99,P =0.002;1.59 vs 1.09 P =0.005).The positive expression of CD-34 and Desmin was significantly lower than that of gastric gastrointestinal stromal tumors (1.90 vs 3.02,P =0.000;0.12 vs 0.50,P =0.001).The expression of CD-117 was significantly correlated with location and risk grade (P =0.000,0.002).The expression of DOG-1 was significantly correlated with the risk grade,and the overall survival (P ＜0.05).The expression of CD-34 was significantly correlated with location,size,risk grade,status,and overall survival (P =0.000,0.007,0.016,0.001).There was a significant correlation between the expression of alpha-SMA and location (P =0.036).There was a significant correlation between the expression of S-100 and the overall survival (P =0.036).The expression of Desmin was significantly correlated with the age and location of the first visit (P =0.001).Conclusion In the diagnosis of gastrointestinal stromal tumors,CD-117,DOG 1 and CD-34 combined alpha-SMA and Desmin have good complementation,it is also helpful to judge the location of the intestine and stomach of gastrointestinal stromal tumors,if necessary,it can also be detected by gene mutation,with reference to the level of mitotic figures,which can reduce the misdiagnosis rate and increase the detection rate.
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<p><b>OBJECTIVE</b>To explore the effect of nano carbon tattooing on the lesion localization in the early colon cancer for additional surgical procedure after endoscopic resection.</p><p><b>METHODS</b>Thirty-five patients with early colon cancer accepted additional surgical procedures after endoscopic resection in Fuzhou General Hospital of PLA from May 2014 to November 2016. All the patients underwent nano carbon tattooing before the end of endoscopic resection: 0.1 ml carbon nanoparticles suspension was respectively injected into the normal intestinal submucosa from 1 cm outside the 4 sites (upper, lower, left and right) of the lesion border by colonoscopy, marking the original lesion location and guiding the subsequent additional surgery. Data of these 35 cases were summarized.</p><p><b>RESULTS</b>All the 35 cases, including 22 males and 13 females, with a mean age of 46.5 years(range 35-70), completed the endoscopic disposable carbon nano marking, and the mean operative time was 7.5 minutes(range 5-10). No bleeding, no perforation and no adverse reaction occurred. Four to 21(10±3.5) days after endoscopic resection, the patients received the additional surgery as a result of pathological specimens of endoscopic resection in 10 cases of vascular invasion, 7 cases of severe submucosal infiltration, 7 cases of more than grade G2 in tumor budding, 6 cases of poorly differentiated adenocarcinoma and undifferentiated carcinoma, and 5 cases of positive margin. All the patients underwent laparoscopic surgery. The mean time of intraoperative detection and lesion location was 3.0 minutes(range 1-5). All tattooings were clearly visible under the naked eye. The colon wedge resection were performed in 5 cases, colon segment resection in 14 cases, and radical resection of colon cancer in 16 cases. The operative time was 45 to 180(120±30) min, and the blood loss was 50 ~ 200(50±15) ml. There was no intraoperative complications. The first gas passage time was 12 to 48(24±8) h. The postoperative hospital stay was 10 to 3(6.5±2.5) d. There was no postoperative complication and no perioperative mortality.</p><p><b>CONCLUSION</b>Nano carbon tattooing is helpful for the accurate location of primary lesions in the additional surgical operation after endoscopic resection of early colon cancer, and it can improve the safety and precision of surgical procedures, especially for laparoscopic surgery.</p>
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Nutrition support is an important part of the comprehensive treatment for the critically ill patients with the pathophysiology changes of stress responses related to hypercatabolism, immunity inflammatory reaction disordered and organ dysfunction. Compared with other critical illness, gastrointestinal surgical critically ill patients have the complex characteristics of altered gastrointestinal anatomy and (or) function. Therefore, the nutritional support especially the enteral nutrition support for critical illness patients in gastrointestinal surgery is more difficult and demanding. Mastering the principles, including the timing, route, type and amount of nutrients delivered, and developing an individualized nutritional plan according to the patient's own characteristics, may help to improve its safety and tolerance. Early nutrition support, especially early enteral nutrition, can reduce complications and mortality, enhance recovery and improve outcome for gastrointestinal surgical severely ill patients.
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Humans , Critical Illness , Digestive System Surgical Procedures , Enteral Nutrition , Nutritional SupportABSTRACT
Combined laparoscopic endoscopic procedures (CLEP) is a technical advance in minimally invasive approaches, combining the advantages of both laparoscopy and endoscopy. CLEP expands the use of minimally invasive surgery, and improves the safety, precision and efficacy in the treatment of colorectal neoplasms.Endoscopy-assisted laparoscopic surgery (EALS), laparoscopy- assisted endoscopic surgery (LAES), and laparoscopy endoscopy cooperative surgery (LECS) are being used. The combined application of laparoscopy and colonoscopy or transanal endoscopic microsurgery (TEM) provides a new minimally invasive approach for the treatment of colorectal benign and malignant tumors, especially suitable for the patients undergoing single laparoscopic or endoscopic surgery with greater difficulty and higher risk, or those who would have undergone open operation in the past. CLEP enhances the safety and efficacy of minimally invasive surgery, and achieves the minimal invasiveness and maximal preservation of physiological function at the same time. To a large extent, the integrated operating room and multidisciplinary team help to promote the development of these new minimally invasive procedures.
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Humans , Colectomy , Colonoscopy , Colorectal Neoplasms , Laparoscopy , Minimally Invasive Surgical ProceduresABSTRACT
Objective To evaluate the feasibility,security and efficiency of general anaesthesia compared with regional anaesthesia for minimally-invasive thyroid surgery(MITS)with short-stay discharge.Methods 103 cases undergoing MITS with short-stay discharge from Jan.2013 to Jun.2013 in Fuzhou General Hospital were collected.54 patients were operated under regional anaesthesia and 49 under general anaesthesia.All variables of patients including demographic characteristics,vital signs (blood pressure,heart rate,blood glucose) during the operation,duration and type of operation,postoperative complications,difficulty in airway management and anesthesia consumption were recorded and analyzed.Results There was no difference in respect to level of blood glucose,length of hospital stay,discharge time,patient or operator satisfaction rate,anesthesia or operation complications rate between the two groups.Blood pressure (T1:(90 ± 7.0) vs (79 ± 8.3) mmHg,T2:(88 ± 6.8) vs (80 ±7.6) mmHg,P ＜0.05) and heart rate(T1:(130 ± 18.2) vs(101 ± 12.0)/min,T2:(120 ± 19.7) vs(103 ± 13.3)/min,P ＜ 0.05)level were higher,while the recovery time of anesthesia((0.3 ± 0.14)vs(0.8 ± 0.35)h,P ＜ 0.05)) and anesthesia consumption ((1350 ± 78) vs (2580 ± 220) yuan,P ＜ 0.05)) were lower in the regional anaesthesia group compared with those in the general anaesthesia group.Conclusions Both general anaesthesia and regional anaesthesia for MITS with short-stay discharge are safe and effective.General anesthesia has less psychological trauma,while regional anaesthesia has shorter recovery time and lower anesthetic consumption.
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Molecular targeted therapy is a treatment bed emerging recent years for the treatment of malignant tumors,imatinib mesylate in the treatment of gastrointestinal stromal tumor (GIST) is a successful example ofmolecular targeted therapy.Imatinib mesylate can inhibit tyrosine kinase andinhibition of cell proliferation by treatment of gastrointestinal stromal tumor.With the positive effect of imatinib in the treatment of GIST,the related adverse reactions and the prevention and treatment strategies are worth to be discussed.
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Objective To investigate the clinical features , diagnosis and treatment of ectopic thyroid in order to avoid misdiagnosis and mismanagement .Methods Six cases of ectopic thyroid admitted to Fuzhou Gen-eral Hospital from Jan .2000 to Oct.2011 were retrospectively analyzed and the literatures were reviewed .Re-sults Three cases of ectopic thyroid were located in the anterior cervical area , 2 cases were at the base of the tongue and 1 case in the gall bladder .Two cases of aberrant thyroid were confirmed preoperatively in patients whose gland wasn't discovered by imaging examinations at the normal position of the thyroid gland .A symptomless individual of aberrant thyroid did not need other treatment but follow-up.One case with foreign body sensation in pharynx had a good response to thyroxine therapy .Four cases with accessory thyroid were operated because of misdiagnosis .Three cases were ectopic thyroid tissue and one was nodular goiter confirmed by pathology .None of these patients developed hypothyroidism after surgery .Conclusions Ectopic thyroid gland is a rare disease fre-quently misdiagnosed and mistreated .Goiters in the commonly location of ectopic thyroid gland such as the anteri-or cervical area and the base of the tongue should be paid special attention .Hormonal therapy or surgical inter-vention should be chosen according to clinical features , type of the goiter , thyroid function and whether it is be-nign or malignant .Long term follow-up and thyroid function tests are absolutely necessary .
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Objective To compare the effects of venous port access ( VPA ) with peripherally inserted central catheters ( PICC) in patients with breast cancer .Methods 120 cases with breast cancer were divided into 2 groups from Jan.2009 to Dec.2010,among whom 60 cases were with VPA when receiving operation , and the other 60 cases were with PICC after the operation .The success rate of catheterization , duration of catheter in-dwelling and catheter-related complications of the 2 groups were compared .Results The one-time success rate of catheterization was 100%in VPA group and 66.7%in PICC group .The catheters were retained for more than 12 months in 59 cases in VPA group,while only 4 cases in PICC group retained catheter for more than 12 months. The complications occurred to 1 case in VPA group ( 1.7%) and 9 cases in PICC group ( 15%) .Conclusion VPA is an ideal pathway for chemotherapy of patients with breast cancer , which can reduce nursing work and is worth to be promoted in clinical practice .
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Objective To compare the clinical safety and efficacy of complete mesoeolic excision (CME) for right-hemi colorectal cancer with traditional surgical treatment.Methods Collectting the clinical data of 69 cases,who randonly divided into two groups,A group induced 38 cases and were implemented regular CME,and B group induded 31 cases which were implemented traditional surgery of right-hemi colorectal cancer patients from the Department of General surgery,Fuzhou General Hospital of Nanjing Military Region from Jan.1 2010 to Oct.1 2010,and comparing the safety and efficacy.Results The differences between and traditional surgery in terms of operation time,blood loss,exhaust and defecation time,hospitalization time,the rate of postoperative complication,the number of removed lymph node of Ⅰ and Ⅱ phase,3-year recurrence rate of Ⅱ phase,3-year survival rate of Ⅱ phase and the number of removed lymph node of Ⅲ phase in mesentery root were not significant.The differences in terms of the number of removed lymph node of Ⅲ phase(22.76 ± 6.94,15.11 ± 7.85),3-year recurrence rate of Ⅲ phase(5.88％,45.45％),3-year survival rate of Ⅲ phase (94.12％,63.64％),the total number of removed lymph node(20.56 ± 7.11,13.92 ± 6.62),3-year overall recurrence rate(7.89％,29.03％)and 3-year overall survival rate (94.74％,77.42％) were significant.Conclusions Comparing with traditional surgery,CME significantly benefits the patients of right-hemi colorectal cancer with stage Ⅲ,but not for patients with stage Ⅰ and Ⅱ.
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<p><b>OBJECTIVE</b>To compare the efficacy between continuous negative pressure-flush through extraperitoneal dual tube and conventional drainage in the treatment and prevention for anastomotic leakage after low anterior resection in patients with rectal cancer.</p><p><b>METHODS</b>Clinical data of 627 rectal cancer patients undergoing low anterior resection by the same surgical team from January 2007 to March 2012 were reviewed retrospectively. Of 627 patients, 370 received self-made easy extraperitoneal dual tube which was placed in the dorsal site of an anastomosis for drainage (dual tube group), and the other 257 received conventional drainage tube from abdominal cavity (convention group) prophylactically. The incidence of postoperative anastomotic leakage, reoperation rate, drainage tube indwelling duration, hospitalization duration, hospitalization expense, quality of life score, incidence of anastomotic stricture within 6 months after operation were compared between the two groups.</p><p><b>RESULTS</b>Anastomotic leakage after low Dixon operation was found in 25 cases (4.0%, 25/627), including 14 cases (3.8%, 14/370) in dual tube group, and 11 cases (4.3%, 11/257) in convention group, and the difference was not statistically significant. After anastomotic leakage occurrence, all the patients in dual tube group were managed by continuous negative pressure (50 mmHg)-flush through another self-made easy intra-rectal dual tube without reoperation, while 5 patients in conventional group underwent operation again because of treatment failure with continuous negative pressure-flush through intra-rectal dual tube for half a month. Drainage tube indwelling duration was (9.7±2.7) d and (16.4±3.6) d, hospitalization duration was (15.7±4.3) d and (21.5±6.4) d, hospitalization expenses was (42 470±3190) Yuan and (53 480±5630) Yuan in dual tube group and conventional group respectively, the differences were all statistically significant (all P<0.05). Quality of life on the 15th day of anastomotic leakage treatment was significantly better in dual tube group as compared to conventional group (P<0.05).</p><p><b>CONCLUSION</b>Though continuous negative pressure-flush through extraperitoneal dual tube can not decrease the incidence of anastomotic leakage in rectal cancer patients after low anterior resection, it may increase the successful rate of conservative therapy, decrease the reoperation rate, and improve the quality of life when combined with the use of an intra-rectal dual tube.</p>
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Aged , Humans , Middle Aged , Anastomotic Leak , Postoperative Complications , Rectal Neoplasms , General Surgery , Retrospective Studies , Therapeutic Irrigation , Methods , Treatment OutcomeABSTRACT
Objective To compare the clinical efficiency between laparoscopic and open complete mesocolic excision for right-sided colon cancer.Methods Between January 2011 and August 2012,a total of 134 patients with right-sided colon cancer who underwent CME at Fuzhou General Hospital of Nanjing Military Command were divided into laparoscopic (71) and open (63) groups.The intraoperative parameters,pathology,postoperative course and short-term outcomes were compared between groups.The chi-test and the student t test were used for statistics.Result There were no significant differences in the length of distal (P=0.427) and proximal margin (P=0.515),tumor diameter (P =0.440) and number of lymph nodes dissected (P =0.377).Postoperatively patients were followed for up to 12 months,no significant differences were found in local regional recurrence rates (4.2％ vs 1.6％) (P =0.622) and distal metastasis rates (5.6％ vs 3.2％) (P =0.684) between the two groups.The mean operative time (P =0.134) and postoperative complication rate (P =0.977) were similar.The mean intraoperative blood loss was less (P =0.000),bowel flatus passed earlier (P =0.000) and hospital stay shorter (P =0.000) in laparoscopic than that in open group.Conclusions Laparoscopic CME has the same oncologic clearance effects and short-term follow-up result compared with open CME for right-sided colon cancer,and laparoscopic CME is minimally invasive,less bleeding,less pain and quick recovery.
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Objective To evaluate the efficacy and safety of different concentrations of propranolol gel in treatment of infantile hemangiomas(IH).Methods Sixty-three consecutive infants with hemangiomas from Mar.2011to Sep.2012 in Department of General Surgery,Fuzhou General Hospital of Nanjing Military Command,were divided randomly into A,B,C groups and respectively treated with propranolol hydrochloride 1％ (20 g ∶ 200 mg,A group),2％ (20 g:400 mg,B group),3％ (20 g:600 mg,C group),evenly applied to the surface of the hemangiomas,3 times a day.Follow-up treatment was performed for 6 months.Details of adverse reactions,gender,age,tumor location,complications,and hemangioma size,texture,color and recurrence after stopping were recorded,and hospital review and efficacy evaluation were performed every month.Results After 6 months of treatment,A group had effective treatment in 11 patients(52.38％),ineffective treatment in 10 patients (47.62％),B group had effective treatment in 12 patients (57.14％),ineffective treatment in 9 patients (42.86％),and C group had effective treatment in 19 patients (90.48％),ineffective treatment in 2 patients(9.52％).After taking color Doppler ultrasound examination revealed IH thickness revealed significantly thinner.Conclusions External use of propranolol hydrochloride gel is an effective option for superficial hemangiomas,And 3％ concentration of propranolol gel is superior to the efficacy of the other 2 drugs.
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Objective To observe the effect of duodenal endoluminal sleeve (ELS)on.glucose metabolism of non-obese type 2 diabetes mellitus (T2DM)rats.Methods 24 male spontaneously diabetic Goto-Kakizaki (GK) rats were randomly divided into surgery group(ELS,n =12)and sham-operated group (SO,n =12).Fasting plasma glucose(FPG) levels of the 2 groups were observed before surgery(0 weeks),or on 1 st,3rd 6th,12th,and 24th week after surgery.Oral glucose tolerance test(OGTT) was performed before surgery (0 weeks),or on 6th and 24th week after surgery.Blood glucose versus time curve was depicted and glucose tolerance area under the curve(AUC)was calculated.Glucagon-like peptide-1 (GLP-1)concentration levels were measured 2 hours after glucose load.Results There was no significant difference between the 2 groups in various indicators before surgery.For ELS group,FPG level significantly decreased on 1 st,3rd 6th,12th,and 24th week after surgery (Fintra-group =5.982,P ＜ 0.01)compared with that before surgery.AUC and blood glucose peak were both loweron 6th and 24th week after surgery than those before surgery (Fintya-group =11.602,P =0.003).OGTT glucose peak reduced to 30 minutes from the original 60 minutes.GLP-1 level significantly increased after glucose load (Fintra-group =43.24,P ＜ 0.05) ; All the index of SO group had no significant change.Conclusion Duodenal ELS has effect on blood glucose control and glucose tolerance improvement in non-obese T2DM rats.
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Objective To evaluate the clinical significance of low ligation and high ligation of inferior mesenteric artery (IMA) and lymph nodes dissection on radical resection for rectal cancer.Methods One hundred and fifty-six patients who were diagnosed rectal cancer in our hospital between May 2007 and May 2008 were divided into low ligation group (80 cases)and high ligation group (76 cases).The low ligation group was treated with low ligation of IMA and lymph nodes dissection,the high ligation group was cured by high ligation of IMA and lymph nodes dissection.cases.The IMA lymph nodes metastasis,number of lymph nodes,cancer recurernce rate,5-year survival rate,complication rate were compared and analyzed.Results The rate of lymph nodes metastasis around the origin of inferior mesenteric artery was 15.0％ in the low ligation group,the rate of lymph nodes metastasis around the origin of inferior mesenteric artery was 14.5％ in the high ligation group,and the difference was not statistically significant (P ＞ 0.05).Compared two groups of postoperative recurrence rate,5-year survival rate,anastomotic leakage rate,sexual dysfunction rate and urinary retention rate,there was no significant differences (P ＞ 0.05).The intestinal function recovery time and low anterior resection syndrome incidence of the low ligation group were lower than the high ligation group,there were significant differences (P ＜ 0.05).Conclusions Low ligation of inferior mesenteric artery and lymph nodes dissection can achieve radical resection for rectal cancer.Compared with traditional high ligation of inferior mesenteric artery,there were no differences for patients on recurrence rate,5-year survival rate and complication rate.
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Because of hardness to heal and easiness to recurrence,chronic ulcer of lower limp has become one of the hardest diseases in clinic,which brings physical and mental pain to the patients.Although medical technology develops rapidly,to find a simple,effective and economic method is still the focus.Here,progress and current situation of treatment were summarized for chronic ulcer of lower limp.