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Objective:To compare the clinical value of stent assisted intestinal bypass and temporary loop ileostomy in laparoscopic low anterior resection of rectal cancer.Method:In this retrospective analysis, 57 patients undergoing laparoscopic low anterior resection for rectal cancer in the First Affiliated Hospital of Ningbo University from Jan 2020 to Jan 2022 were divided into intestinal bypass group (36 cases) and loop ileostomy group (21 cases).Result:There were no significant differences in postoperative GI function recovery and postoperative complication rate between the two groups (all P>0.05). The levels of albumin, prealbumin and hemoglobin in the intestinal bypass group were better than those in the ileostomy group when evaluated on 3rd months after operation [(40.5±2.3) g/L vs. (38.1±2.6)g/L、(26.4±2.7)mg/dl vs. (24.5±2.0)mg/dl、(137.6±5.9) g/L vs. (134.0±7.0) g/L, t=3.605、2.743、2.085, all P<0.05]. Hospital expenses of the intestinal bypass group was lower [(571 000±7 500) yuan vs. (69 300±9 100) yuan, t=-5.477, P<0.05]. Conclusion:Compared with traditional ileostomy, the stent assisted intestinal bypass reduces trauma with lower expenses and improves patients' status after laparoscopic low anterior resection for rectal cancer.
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Objective:To investigate the effect of sarcopenia on physical performance and nutritional status in elderly patients with gastrointestinal tumors.Methods:a total of 120 eligible in-patients were enrolled from gastrointestinal surgery department of a Grade A tertiary hospital in Ningbo city from September 2021 to January 2022. General clinical data were collected, nutritional risk was screened using Nutritional Risk Screening 2002 (NRS 2002), physical performance was assessed by Short Physical Performance Battery (SPPB), skeletal muscle index at the third lumbar vertebra level (L3 SMI) was calculated using abdominal CT scan, and grip strength/muscle strength, gait speed by 6 Meter Timed Walk Test and calf circumference were measured. Subjects were divided into sarcopenia and non-sarcopenia group according to the diagnostic criteria of the Asian Working Group for Sarcopenia (AWGS). Impacting factors of sarcopenia and the correlation between muscle mass and physical performance in elderly patients with gastrointestinal tumors were analyzed.Results:The overall prevalence rate of sarcopenia in elderly patients with gastrointestinal tumors was 28.3% (34/120) and it was 28.9% (22/76) and 27.3% (12/44) in males and females respectively. There were statistically significant differences in age, tumor stage, nutritional risk, body mass index, calf circumference, L3 SMI, grip strength/muscle strength, gait speed and SPPB score between patients with and without sarcopenia (P<0.05). Muscle strength/grip strength, L3 SMI and gait speed were closely correlated with the occurrence of sarcopenia in elderly patients with gastrointestinal tumors (P<0.05). The L3 SMI was positively correlated with physical performance as assessed with SPPB in both groups.Conclusions:Sarcopenia is a common complication in elderly patients with gastrointestinal tumors with multiple influencing factors. Timely nutritional intervention and exercise intervention should be incorporated into the treatment of elderly gastrointestinal tumor patients with sarcopenia in order to improve nutrition status.
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Objective To investigate the effect of enhanced recovery after surgery (ERAS) on immune function and postoperative recovery in gastric cancer patients undergoing total laparoscopic radical gastrectomy.Methods Patients were randomly divided into ERAS group and control group.Blood CD4 +,CD8+,CD4 + CD25 +,C-reactive protein,postoperative recovery and complications were compared between the two groups.Results On day1,CD4 +,CD8 +,CD4 + CD25 + in the two groups were significantly lower than those before surgery (t =9.070,7.297,5.830,12.870,3.529,10.547,all P＜0.05).The ERAS group had higher CD8 +,CD4 + CD25 + levels than the control group (t =2.163,2.203,P ＜ 0.05).On day3,CD4 + CD25 + in ERAS group was not different from that before surgery (t =1.062,P ＞ 0.05) while the other indexes in the two groups raised but still were lower than preoperative level (t =3.322,5.015,3.418,9.912,all P ＜0.05);CD4 +,CDs +,CD4 + CD25 + in ERAS group were higher than control group (t =2.804,2.040,2.210,all P＜0.05).On day5,CD4+,CD4 + CD25+ in the two groups and CDs+ in ERAS group returned to the preoperative level,while CDs + of the control group was still lower than the preoperative level (t =6.862,P ＜0.05).On day1,3 and 5,the C-reactive protein levels of the two groups were higher than those before surgery(t=-13.338,-13.715,-11.319,-12.286,-13.182,-15.076,all P ＜ 0.05),and ERAS group were lower than the control group (t =-3.246,-2.100,-2.211,all P＜0.05).There was no mortality in neither groups.The time of passage gas by anus,defecation,getting out of bed,oral feeding,and postoperative hospital stay in the ERAS group were less than thoseinthecontrolgroup[(2.8±1.0)dvs.(3.9±0.9)d,t=-5.974;(3.8± 0.9)d vs.(4.3±1.0)d,t=-2.700;(19.1 ±4.0)hvs.(35.9±6.6)h,t=-16.045;(9.9 ±1.6)d vs.(11.5±2.0) d,t =-4.479,all P ＜ 0.05].Conclusions ERAS in the perioperative period of patients with total laparoscopic radical gastrectomy mitigates the stress on the cellular immune system,reduces inflammatory response,and help fast recover the postoperative gastrointestinal function.
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Objective@#To explore the feasibility and clinical efficacy of serosal muscular layers incision and submucosal layers exfoliation technique in laparoscopic surgery for gastric gastrointestinal stromal tumors(GIST).@*Methods@#28 patients with gastric GIST underwent serosal muscular layers incision and submucosal layers exfoliation technique under laparoscopic surgery. Patients′clinicopathologic characteristics, operative outcomes, postoperative complications, and follow up results were analyzed retrospectively.@*Results@#Surgery was successfully completed in all patients, and no one was converted to open surgery.The average operation time was (66±15) min, and the intra operative blood loss was (16±10) ml, the time of passage of gas by anus after operation was (20±10)h, the time starting liquid diet was(2.5±1.6)d, and the length of postoperative hospital stay was (7±3)d. One patient had delayed gastric emptying, one had incisional infection. All the specimen had complete pseudocapsule and negative margin. pathology was all gastric GIST. After a median 22 months followed up, no recurrence or metastasis were found.@*Conclusion@#Serosal muscular layers incision and submucosal layers exfoliation under laparoscopic surgery is a safe and feasible procedure for treating gastric GIST.
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Objective@#To explore the effect of early enteral nutrition(EEN) and parenteral nutrition(PN) on the postoperative outcomes of patients with gastric cancer and nutritional risk in enhanced recovery after surgery.@*Methods@#A total of 130 patients with gastric cancer hospitalized in department of surgery of Ningbo First Hospitalfrom September 2016 to May 2018 were selected and divided into early enteral nutrition support group (EEN) which was placed with jejunal nutrition tube during the operation, and enteral nutrition started within 12-24 hours after the operation, and parenteral nutrition support group (PN) which was given parenteral nutrition support one day after surgery. Patients in both groups were given nutrients of equal heat and nitrogen.The incidence of nutrition-related complications, the incidence of infection-related complications, the length of postoperative hospital stay and the time of anal exhaust were compared between the two groups.@*Results@#The incidence of nutrition-related complications was 10 cases (15.38%) and 4 cases (6.15%)in EEN group and PN group, that was not statistically different (P=0.157). The incidence of infection-related complications was 3 cases (4.61%) and 5 cases (7.69%) in EEN group and PN group, that was not statistically different (P=0.715). The postoperative hospital stay was 11 days (range, 10-15) and 12 days (range, 11-13)in EEN group and PN group, that was not statistically different (P=0.233). The first anal exhaust time and defecation timewere 64 hours (range, 52-77) and 87 hours (range, 76-100) in EEN group and 72 hours(range, 60-86) and 96 hours(range, 86-120) in PN group, that was statistically different(P=0.001, P=0.034).@*Conclusion@#Enhanced recovery after surgery, early enteral nutrition after gastric cancer surgery may promote the recovery of intestinal function, but the complications and hospital stay after operation are not improved.
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Objective To explore the feasibility and clinical efficacy of serosal muscular layers incision and submucosal layers exfoliation technique in laparoscopic surgery for gastric gastrointestinal stromal tumors(GIST).Methods 28 patients with gastric GIST underwent serosal muscular layers incision and submucosal layers exfoliation technique under laparoscopic surgery.Patients' clinicopathologic characteristics,operative outcomes,postoperative complications,and follow up results were analyzed retrospectively.Results Surgery was successfully completed in all patients,and no one was converted to open surgery.The average operation time was (66 ± 15) min,and the intra operative blood loss was (16 ± 10) ml,the time of passage of gas by anus after operation was (20 ± 10)h,the time starting liquid diet was (2.5 ± 1.6) d,and the length of postoperative hospital stay was (7 ± 3) d.One patient had delayed gastric emptying,one had incisional infection.All the specimen had complete pseudocapsule and negative margin.pathology was all gastric GIST.After a median 22 months followed up,no recurrence or metastasis were found.Conclusion Serosal muscular layers incision and submucosal layers exfoliation under laparoscopic surgery is a safe and feasible procedure for treating gastric GIST.
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Objective To explore the effect of early enteral nutrition (EEN) and parenteral nutrition (PN) on the postoperative outcomes of patients with gastric cancer and nutritional risk in enhanced recovery after surgery. Methods A total of 130 patients with gastric cancer hospitalized in department of surgery of Ningbo First Hospitalfrom September 2016 to May 2018 were selected and divided into early enteral nutrition support group (EEN) which was placed with jejunal nutrition tube during the operation, and enteral nutrition started within 12-24 hours after the operation, and parenteral nutrition support group (PN) which was given parenteral nutrition support one day after surgery. Patients in both groups were given nutrients of equal heat and nitrogen. The incidence of nutrition-related complications, the incidence of infection-related complications, the length of postoperative hospital stay and the time of anal exhaust were compared between the two groups. Results The incidence of nutrition-related complications was 10 cases (15. 38％) and 4 cases (6. 15％) in EEN group and PN group, that was not statistically different (P = 0. 157). The incidence of infection-related complications was 3 cases (4. 61％) and 5 cases (7. 69％) in EEN group and PN group, that was not statistically different (P = 0. 715). The postoperative hospital stay was 11 days (range, 10-15) and 12 days (range, 11-13) in EEN group and PN group, that was not statistically different (P = 0. 233). The first anal exhaust time and defecation timewere 64 hours (range, 52-77) and 87 hours (range, 76-100) in EEN group and 72 hours (range, 60-86) and 96 hours (range, 86-120) in PN group, that was statistically different (P=0. 001, P=0. 034). Conclusion Enhanced recovery after surgery, early enteral nutrition after gastric cancer surgery may promote the recovery of intestinal function, but the complications and hospital stay after operation are not improved.
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Objective To investigate the application value of secondary splenic pedicle separation technology through superior posterior approach of the pancreatic tail in laparoscopic partial splenectomy.Methods The retrospective cross-sectional study was conducted.The clinicopathological data of 13 patients who underwent laparoscopic partial splenectomy in the Ningbo First Hospital from March 2016 to October 2017 were collected.After preoperative assessment using computed tomography(CT) angiography,13 patients underwent laparoscopic partial splenectomy using secondary splenic pedicle separation technology through superior posterior approach of the pancrcatic tail.Observation indicators:(1) intra-and post-operative recovery situations;(2) follow-up situations.Follow-up using outpatient examination was performed to detect postoperative changes of peripheral blood platelet (PLT),thrombosis of splenic vein,lesions residual or recurrence up to November 2017.Measurement data were represented as average (range).Results (1) Intra-and post-operative recovery situations:13 patients underwent successful laparoscopic partial splenectomy using secondary splenic pedicle separation technology through superior posterior approach of the pancreatic tail,without conversion to open surgery,including 6 with laparoscopic partial splenectomy of inferior pole of the spleen and 7 with laparoscopic partial splenectomy of upper pole of the spleen.Operation time was 42-93 minutes,with an average of 61 minutes;volume of intraoperative blood loss was 30-260 mL,with an average of 92 mL;postoperative gastrointestinal function recovery time was 22-47 hours,with an average of 34 hours;postoperative drainage tube removal time was 3.0-6.0 days,with an average of 4.2 days.The postoperative pathological examination of 13 patients:7,2,2,1 and 1 patients were respectively confirmed with splenic cysts,splenic hemangiomas,vascular hemangiomas,splenic hamartoma and splenic lymphangioma.Of 13 patients,1 was complicated with splenic recess effusion and fever,and was improved with B ultrasound-guided percutaneous catheter drainage.Duration of hospital stay of 13 patients was 7.0-16.0 days,with an average of 9.6 days.(2) Follow-up situations:13 patients were followed up for 1.0-19.5 months,with a median time of 8.5 months.During the follow-up,PLT level of 13 patients was normal.Color Doppler ultrasound examination showed no venous embolism,and CT angiography showed good vascular perfusion.There was no recurrence of splenic cysts in 7 patients and no tumor residual or recurrence in 6 patients.Conclusion Laparoscopic partial splenectomy using secondary splenic pedicle separation technology through superior posterior approach of the pancreatic tail is safe and effective,and it can precisely dissect splenic hilum,preserve blood supply and function of the remnant spleen,and reduce surgical injury.
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Objective To evaluate circulating tumor cells (CTC) in prognosis prediction of gastric cancer.Method Peripheral blood samples were obtained from 65 patients with gastric cancer and 20 normal volunteers.CTC were detected by using CellSearch(R) CTC Detecting System.Postoperative progress-free survival (PFIS) and overall survival (OS) were evaluated against CTC status and clinicopathological factors.Result CTC were positive in 35 out of 65 (53％) patients compared to 1 out of 20 (5％) healthy controls,P ＜ 0.05.CTC were not statistically corelated with patients' age,sex and lymph node status or distal metastasis,vascular invasion and tumor markers (all P ＞ 0.05).CTC positive patients had poorer OS (P ＜ 0.05) and PFS (P ＜ 0.05) compared with those with negative CTC.Conclusion Positive CTC in gastric cancer patients predict poor prognosis after radical gastrectomy.
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Objective To investigate the clinical value of single-incision laparoscopic inguinal high ligation in children with recurrent inguinal hernia . Methods Clinical data of 30 pediatric recurrent inguinal hernia cases treated with single-incision laparoscopy in our hospital between January 2011 and February 2016 were analyzed retrospectively .The patients were aged 1-11 years old (mean, 6.1 ±3.3 years old).For indirect inguinal hernia, a non-absorbable suture was placed around the extra-peritoneal space of the inguinal inner ring by means of a needle with a thread hole and a hooked needle under laparoscope , and the hernial sac was highly ligated by knotting the purse string suture .If a direct inguinal hernia was identified , a similar method was used to ligate the hernial sac , and the umbilical artery fold was sutured to the Hesselbach ' s triangle in order to enhance the weak tissue . Results After surgeries, we found 28 cases were recurrent indirect inguinal hernia (4 cases with contralateral concealed hernia ), and the other 2 cases were direct inguinal hernia .The operation time ranged from 12 to 45 min (mean, 21.4 ±8.2 min).All th cases recovered with inconspicuous scars , and no recurrence or complications were found during a follow-up for 2-53 months ( mean, 23.9 ±12.5 months). Conclusions Single-incision laparoscopic inguinal high ligation is a safe and effective procedure for children with recurrent inguinal hernia .This procedure does not cause obvious scars for patients , and can diagnose and treat the occult hernia and direct hernia at the same time .
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Objective To evaluate the effect of spleno-left adrenal vein shunt for the treatment of portal hypertensive upper GI bleeding caused by portal vein cavernous transformation in children.Methods Spleno-left adrenal vein shunt was performed in 8 children with portal hypertension due to cavernous transformation.The clinical data was reviewed.Results Portal vein pressure decreased significantly from (30±11)mm Hg to(22±7) mm Hg after shunt.There was no mortality perioperatively and during the follow-up.There were no recurrent hemorrhage nor hepatic encephalopathy occurring in the follow-up and all the children have normal intelligence and normal liver function though blood ammonia level increased significantly from(18±7)μmol/L to (60±17)μmol/L in 4 cases.In 7 cases in which preoperative whole blood cell count significantly decreased,the postoperative WBC,RBC,Hb and PLT was (7.64 ±4.46)×10~9/L,(4.54±0.97)×10~(12)/L,(133±5) g/L and (355.40±107.36)×10~9/L respectively (all P ＜0.05).In one case suffering from preoperative low PLT count the postop PLT reached 333×10~9/L,which was significantly higher than that preoperatively.Esophageal varices ameliorated in 6 cases.No stenosis of anastomotic stoma and thrombosis developed.Conclusion Spleno-left adrenal vein shunt is an effective procedure to treat portal vein cavernous transformation induced portal hypertension in children.
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Objective To investigate the keratin 9 gene mutation in epidermolytic palmoplantar keratoderma (EPPK) and its relationship with clinical manifestations. Methods Three Chinese pedigrees with EPPK were studied. Polymerase chain reaction (PCR) was performed to amplify the seven exons encoded by keratin 9. Denaturing high-performance liquid chromatography (DHPLC), DNA sequencing and allele-specific PCR were used to reveal the sequence variation in the PCR products. Results An insertion-deletion mutation in the exon 1 of keratin 9 497delAinsGGCT, was revealed in all 3 EPPK families, resulting in the keratin 9 change from tyrosine166 to tryptophan and leucine (Y166delinsWL). Allele-specific PCR confirmed that the mutation was not a commonly seen polymorphism, but a novel mutation which has not been reported in The Human Intermediate Filament Mutation Database (http://www.interfil.org). Conclusions A new keratin 9 gene mutation, 497delAinsGGCT, is found in these Chinese EPPK pedigrees, which may be the genetic basis of EPPK.
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Objective To investigate the feasibility of laparoscopy assisted Meckel’s diverticulum resection in children. Methods Meckel’s diverticulum resection was performed under laparoscope in 12 children from October 2000 to April 2002.Two 3 mm incisions were made on the McBurney point and the midpoint between the umbilicus and the pubis,respectively.Three 3 mm trocar were introduced.When the diverticulum was found,the incision was prolonged to 2 cm long along the inferior border of the umbilicus.The lesion was removed externally and the intestine was anastomosed. Results All operations were completed smoothly under laparoscope. The intraoperative blood loss was 2～3 ml and the operation time was 1 2～2 5 h.The diverticulum was 1 cm?2 cm～3 cm?4 cm in size.The patients were dismissed 5～7 days after surgery,without obvious scar formation. Conclusions Laparoscopic Meckel’s diverticulum resection is feasible, with the advantages of the minimal invasion, rapid recovery and unobvious scars.