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1.
Chinese Medical Journal ; (24): 1830-1834, 2016.
Article in English | WPRIM | ID: wpr-251295

ABSTRACT

<p><b>BACKGROUND</b>Intraoperative neuromonitoring (IONM) of the recurrent laryngeal nerve (RLN) has been widely applied during thyroid surgery. However, the safe range of stimulation intensity for IONM remains undetermined.</p><p><b>METHODS</b>Total thyroidectomies were performed on twenty dogs, and their RLNs were stimulated with a current of 5-20 mA (step-wise in 5 mA increments) for 1 min. The evoked electromyography (EMG) of vocal muscles before and after supramaximal stimulation were recorded and compared. Acute microstructural morphological changes in the RLNs were observed immediately postoperatively under an electron microscope.</p><p><b>RESULTS</b>The average stimulating threshold for RLNs stimulated with 15 mA and 20 mA showed no significant changes compared to the unstimulated RLNs (15 mA group: 0.320 ± 0.123 mA vs. 0.315 ± 0.097 mA, P = 0.847; 20 mA group: 0.305 ± 0.101 mA vs. 0.300 ± 0.103 mA, P = 0.758). Similar outcomes were shown in average evoked EMG amplitude (15 mA group: 1,026 ± 268 μV vs. 1,021 ± 273 μV, P = 0.834; 20 mA group: 1,162 ± 275 μV vs. 1,200 ± 258 μV, P = 0.148). However, obvious acute microstructural morphological changes were observed in the nerves that were stimulated with 20 mA.</p><p><b>CONCLUSIONS</b>A stimulation intensity less than 15 mA might be safe for IONM of the RLN.</p>


Subject(s)
Animals , Dogs , Electromyography , Male , Monitoring, Intraoperative , Methods , Recurrent Laryngeal Nerve , General Surgery , Thyroid Gland , General Surgery , Thyroidectomy , Methods
2.
Article in English | WPRIM | ID: wpr-176693

ABSTRACT

PURPOSE: To compare the clinicopathological data and long-term survival of gastric cancer patients in China and Korea. MATERIALS AND METHODS: Patients who had undergone gastrectomy for gastric cancer between 1998 and 2009 in 2 high-volume institutions in both China (n=1,637) and Korea (n=2,231) were retrospectively evaluated. Clinicopathological variables, overall survival (OS), progression-free survival (PFS), and surgery-related complications were assessed for all patients and compared between the 2 institutions. RESULTS: Chinese patients included in the study were significantly older and had a significantly lower body mass index (BMI) than the Korean patients. Esophagogastric junction tumors were more frequent in Chinese patients. However, the number of patients with stage I gastric cancer, the number of harvested lymph nodes, and the number of total gastrectomies were significantly higher in the Korean population. Korean patients also presented with fewer undifferentiated tumors than Chinese patients. Furthermore, Korean patients had prolonged OS and PFS for stage III cancers only. BMI, tumor-node-metastasis (TNM) stage, tumor invasion, number of positive lymph nodes, and distant metastases were all independent factors affecting OS and PFS. CONCLUSIONS: Although China and Korea are neighboring Asian countries, the clinicopathological characteristics of Chinese patients are significantly different from those of Korean patients. Korean gastric cancer patients had longer OS and PFS than Chinese patients. Influencing factors included TNM stage, tumor invasion, and lymph node metastasis.


Subject(s)
Asian Continental Ancestry Group , Body Mass Index , China , Disease-Free Survival , Esophagogastric Junction , Gastrectomy , Humans , Korea , Lymph Nodes , Neoplasm Metastasis , Retrospective Studies , Stomach Neoplasms
3.
Article in Chinese | WPRIM | ID: wpr-357144

ABSTRACT

<p><b>OBJECTIVE</b>To explore the safety and feasibility of biodegradable magnesium alloy stapler based on the result of animal experimental study for gastrointestinal anastomosis.</p><p><b>METHODS</b>Sixteen beagle dogs were equally and randomly divided into experimental (magnesium alloy) group and control (titanium alloy) group. A gastrojejunal and a colonic anastomosis were performed in each beagle dog. The anastomosis time, postoperative complications, body weight, blasting pressure of anastomosis and serum glutamic pyruvic transaminase, glutamic oxaloacetic transaminase, creatinine, blood urea nitrogen, and serum magnesium were compared between the two groups. The healing of anastomosis and degradation of magnesium alloy were observed. The histopathological features of heart, liver, spleen and kidney were examined in the two groups.</p><p><b>RESULTS</b>There were no significant differences in anastomosis time, body weight, postoperative complications, anastomotic bursting pressure between the two groups. The anastomosis was healed well, and no dramatic inflammatory cell infiltration was observed. Magnesium alloy could be degraded completely in the animal body within 90 days. There were no significant differences in serum glutamic pyruvic transaminase, glutamic oxaloacetic transaminase, creatinine, blood urea nitrogen and serum magnesium between the two groups. Histopathological examination showed that the degradation of magnesium alloy did not harm the important organs (liver, kidney, heart, brain and spleen).</p><p><b>CONCLUSIONS</b>Magnesium alloy stapler is safe and feasible for gastrointestinal anastomosis in beagle dogs. The degradation of magnesium alloy does not harm the healing of anastomosis and other important organs. Magnesium alloy stapler may be a candidate of biodegradable and safe material of stapler for gastrointestinal anastomosis in human.</p>


Subject(s)
Absorbable Implants , Alloys , Animals , Dogs , Female , Gastroenterostomy , Magnesium , Male , Sutures , Titanium
4.
Chinese Medical Journal ; (24): 4242-4246, 2013.
Article in English | WPRIM | ID: wpr-327595

ABSTRACT

<p><b>BACKGROUND</b>Bloodstream infections (BSIs) remain a major cause of morbidity and mortality in patients undergoing surgery. This study aimed at elucidating the clinical characteristics of community-acquired BSIs (CABs) and nosocomial BSIs (nBSIs) in patients admitted to the surgical wards of a teaching hospital in Beijing, China.</p><p><b>METHODS</b>This cross-sectional study compared 191 episodes of BSIs in 4074 patients admitted to the surgical wards between January 2008 and December 2011. Cases of BSIs were classified as CABs or nBSIs, and the characteristics, relevant treatments, and outcomes of CABs and nBSIs were compared.</p><p><b>RESULTS</b>Of the 191 BSIs, 52 (27.2%) and 139 (72.8%) were CABs and nBSIs, respectively. Escherichia coli, coagulasenegative staphylococci, and Klebsiella spp, were the most frequently isolated microorganisms. There were significant differences between CABs and nBSIs with respect to the use of hormonal drugs, ventilation, acute physiology and chronic health evaluation (APACHE) II and American Society of Anesthesiologists scores, and prevalence of cancer (P < 0.05). Empirical antibacterial therapy did not decrease the crude mortality, but multivariate analysis showed that high APACHE II was independently associated with a risk of mortality (odds ratio = 0.97, 95% confidence interval: 0.93-1.02 for APACHE II).</p><p><b>CONCLUSIONS</b>We found significant differences in the clinical characteristics of surgical patients with CABs and nBSIs. The outcome of patients seems to be related to high APACHE II scores.</p>


Subject(s)
Anti-Bacterial Agents , Bacteremia , Epidemiology , China , Community-Acquired Infections , Epidemiology , Microbiology , Cross Infection , Epidemiology , Microbiology , Cross-Sectional Studies , Escherichia coli , Virulence , Female , General Surgery , Hospitals , Humans , Male , Staphylococcus , Virulence
5.
Chinese Medical Journal ; (24): 172-177, 2012.
Article in English | WPRIM | ID: wpr-333521

ABSTRACT

<p><b>BACKGROUND</b>The continual and rapid development of techniques which are used for diagnosis and treatment makes management of colorectal cancer more difficult depending on single discipline. Colorectal cancer multidisciplinary team (MDT) working model is recommended by UK and other countries, but there is little information on the impact of MDT working on management of colorectal cancer in China. The aim of this study was to assess the effect on management of colorectal cancer after the inception of an MDT.</p><p><b>METHODS</b>A total of 595 consecutive colorectal cancer patients were referred to the Department of Gastroenterological Surgery, the pre-MDT cohort include 297 patients, recruited from January 1999 to November 2002, and the MDT cohort had 298 patients enrolled from December 2002 to September 2006. Information recorded included: TNM stage from histological reports, degree of differentiation, the number of examined lymph nodes and CT TNM staging performed or not, and its accuracy, including local and distant recurrence.</p><p><b>RESULTS</b>The number of examined lymph nodes and the accuracy of TNM staging by CT in the MDT group were significantly more than those in pre-MDT group. CT TNM staging was more accurate in the MDT group compared to the pre-MDT group (P = 0.044). The rate of tumor recurrence in the MDT group was lower than pre-MDT group (log-rank test, P < 0.001). Multivariate analysis revealed that age (P = 0.001), management after inception of the MDT (P = 0.002), degree of differentiation (P = 0.003), number of examined lymph nodes (P = 0.002), and TNM stage (P = 0.000) were important factors that independently influence overall survival.</p><p><b>CONCLUSIONS</b>The inception of MDT working improved the diagnostic accuracy and overall survival of colorectal cancer patients. MDT working promoted communication and cooperation between disciplines and ensured high-quality diagnosis, evidence-based decision making, and optimal treatment planning.</p>


Subject(s)
Aged , Colorectal Neoplasms , Diagnostic Imaging , Pathology , General Surgery , Disease Management , Female , Humans , Interdisciplinary Communication , Male , Middle Aged , Neoplasm Staging , Radiography , Treatment Outcome
6.
Article in Chinese | WPRIM | ID: wpr-312357

ABSTRACT

The liver is the most common site of colorectal cancer metastasis(CRLM). The importance of how to treat CRLM has attracted attention from doctors world wide and specific academic organization and expect consensus has been established. Relative principals of treatment of CRLM also developed in China, for example, guideline of diagnosis and treatment of colorectal cancer liver metastasis(draft) and standard for diagnosis and treatment of colorectal cancer, which were established in 2008 and 2010, respectively. However, we found that the Chinese doctors still understand these treatment policies inadequately, and easily produce deviation on the treatment progress. Based on the problems of current CRLM treatment, we have some thoughts or suggestions as follows: (1)Promoting the core conception of CRLM treatment actively: surgery is the only method to achieve possible cure of the CRLM. (2) Evaluating the status of new adjuvant chemotherapy for CRLM dialectically. (3)Paying attention to multi-disciplinary team(MDT): MDT is the scientific treatment foundation of CRLM. (4)Changing the treatment conception of primary tumor of CRLM: radical resection of primary tumor is essential for the resectable CRLM.(5)Emphasizing the surgical treatment of CRLM combined with lung metastasis. (6)Do not neglect the safety of patients, when we emphasize the surgery is the optimal treatment of CRLM. These guides of treatment of CRLM will improve the outcomes of CRLM around the world, but we still need pay attention to above mentioned points in order to insure the standardization and scientification of CRLM therapy.


Subject(s)
China , Colorectal Neoplasms , Pathology , Therapeutics , Combined Modality Therapy , Humans , Liver Neoplasms , Therapeutics
7.
Article in Chinese | WPRIM | ID: wpr-312353

ABSTRACT

<p><b>OBJECTIVE</b>To explore the short-term outcomes and safety of complete mesocolic excision (CME) in elderly patients with colon cancer.</p><p><b>METHODS</b>The clinical pathological factors of 71 patients with colon cancer undergoing CME procedure by the same group of surgeons were analyzed retrospectively from November 2009 to February 2012. The elderly group(≥70 years) and the non-elderly group(<70 years) were compared regarding short-term outcomes and safety.</p><p><b>RESULTS</b>Similar extent of resection could be achieved in the elderly and non-elderly groups in terms of area of mesentery[(13 049±4332) vs. (13 163±4725) mm2, P=0.916], distance between the tumor and the high ligation site[(95±22) vs. (98±20) mm, P=0.516], distance between normal bowel and high ligation site [(130±25) vs. (128±25) mm, P=0.731], the length of colon [(262±60) vs. (245±49) mm, P=0.212], and lymph nodes retrieved(22.0±6.4 vs. 24.8±9.9, P=0.168). The mean operative time, intraoperative blood loss, postoperative complications, time to first flatus, time to first bowel movement, drainage removal time, diet resumption, drainage volume in three days after surgery, and hospital deaths showed no statistical significances(all P>0.05), while hospital stay and expenses of the elderly group were significantly increased(both P<0.01).</p><p><b>CONCLUSION</b>Elderly patients undergoing elective CME operation can achieve similar operative extent and lymph nodes harvest, and the surgical risk is not increased.</p>


Subject(s)
Aged , Colectomy , Colonic Neoplasms , General Surgery , Elective Surgical Procedures , Humans , Ligation , Lymph Nodes , Mesentery , Mesocolon , General Surgery , Operative Time , Postoperative Complications , Retrospective Studies
8.
Article in Chinese | WPRIM | ID: wpr-290803

ABSTRACT

<p><b>OBJECTIVE</b>To explore the risk factors and prevention strategies of post-operative complications in elderly patients with colorectal cancer.</p><p><b>METHODS</b>Data of 107 elderly patients (≥75 years) undergoing surgery for colorectal cancer were collected from January 2006 to December 2009 in the Department of Gastrointestinal Surgery, Peking University People's Hospital. POSSUM and E-POSSUM scoring systems were used to predict post-operative complications. ROC curve and observe/expect(O/E) were used to assess the validity of scoring systems. Logistic regression was used to evaluate the independent risk factors associated with post-operative complications of elderly patients with colorectal cancer.</p><p><b>RESULTS</b>The predictive complication rates of E-POSSUM and POSSUM in elderly patients with colorectal cancer were 13.9%-86.6%(average, 32.7%) and 19.1%-99.1% (average, 55.5%). The predictive validity of E-POSSUM was better than POSSUM(AUC of ROC: 0.862 vs. 0.576, O/E: 0.771 vs. 0.454), the former was closer to the actual complication rate(25.2%, 27/107). Concurrent diabetes mellitus(P=0.019) and rectal lesion(P=0.005) were independent risk factors associated with surgery-related post-operative complications. Anastomotic leakage was the most common surgery-related post-operative complications. Chronic obstructive pulmonary disease(P=0.026), ASA score(P=0.025), intestinal obstruction(P=0.037) and perforation(P=0.001) were independent risk factors associated with non-surgery-related post-operative complications. Pulmonary infection was the most common non-surgery-related post-operative complication.</p><p><b>CONCLUSIONS</b>The application of E-POSSUM scoring system can provide more accurate prediction of post-operative complications in elderly patients undergoing surgery for colorectal cancer. Positive interventions should be taken for high-risk patients to prevent post-operative complications.</p>


Subject(s)
Aged , Colorectal Neoplasms , General Surgery , Female , Humans , Male , Postoperative Complications , Risk Factors
9.
Article in Chinese | WPRIM | ID: wpr-273864

ABSTRACT

<p><b>OBJECTIVE</b>To screen the clinicopathological factors of synchronous hepatic metastases from colorectal cancer for early diagnosis and therapy.</p><p><b>METHODS</b>Clinicopathological data of 367 cases with colorectal cancer from Jan. 2003 to Dec. 2006 in our department were collected to set up the database. All the patients were divided into two groups according to hepatic metastases or not. Clinicopathological factors were analyzed, such as age, sex, blood type, tumor family history, hepatitis and cirrhosis history, peritoneal or pelvic metastases, bowel obstruction, CEA, CA19-9, tumor localization and size, histological type, infiltration depth, lymph node metastases etc.</p><p><b>RESULTS</b>Out of 367 colorectal cancer cases, there were 56 cases with synchronous hepatic metastases from colorectal cancer, accounting for 15.3%. The age, bowel obstruction, peritoneal or pelvic metastases, and tumor invasion depth were associated with the hepatic metastases. The primary tumor located in the right colon resulted in more right lobe hepatic metastases than those in the left lobe. The serum CEA level was associated with hepatic metastases. When serum CEA was more than 22.1 microg/L, the occurrence rate of hepatic metastases increased.</p><p><b>CONCLUSION</b>Peritoneal or pelvic metastases, bowel obstruction, age and serum CEA level are associated with synchronous hepatic metastases from colorectal cancer.</p>


Subject(s)
Adult , Aged , Aged, 80 and over , Colorectal Neoplasms , Pathology , Female , Humans , Liver Neoplasms , Pathology , Middle Aged , Neoplasm Metastasis , Neoplasm Staging , Young Adult
10.
Chinese Journal of Surgery ; (12): 537-539, 2008.
Article in Chinese | WPRIM | ID: wpr-237767

ABSTRACT

<p><b>OBJECTIVE</b>To explore the clinicopathological relationship between metabolic syndrome (MS) and colorectal cancer.</p><p><b>METHODS</b>The clinical data of 507 cases of colorectal cancer (colorectal cancer group) and 277 cases of nontumorous diseases (control group) treated from January 2002 to March 2007 were collected to set up the database. The patients with colorectal carcinoma were divided into two groups according to the presence of MS: MS group and non-MS group. Some clinicopathological factors were analyzed and compared between the two groups, such as age, gender, blood pressure, tumor family history, hypertension and diabetes mellitus history, body mass index (BMI), glucose (GLU), triglyceride (TG), cholesterol (CHO), high density lipoprotein (HDL), lactate dehydrogenase (LDH), uric acid (UA), carcinoembryonic antigen (CEA) , CA19-9, the tumor position, pathological stage, and liver metastasis.</p><p><b>RESULTS</b>The morbidity rate of metabolic syndrome in the colorectal cancer group was significantly higher than that in control group. The rate of liver metastasis and tumor recurrence in the MS group was significantly higher than that in the non-MS group.</p><p><b>CONCLUSION</b>To understand the relationship between MS and colorectal cancer is important for reducing the incidence of MS and colorectal cancer and the recurrence of the tumor and live metastasis.</p>


Subject(s)
Adult , Aged , Aged, 80 and over , Colorectal Neoplasms , Pathology , Female , Follow-Up Studies , Humans , Male , Metabolic Syndrome , Middle Aged , Prognosis
11.
Chinese Medical Journal ; (24): 443-448, 2006.
Article in English | WPRIM | ID: wpr-267105

ABSTRACT

<p><b>BACKGROUND</b>Laparoscopic Heller cardiomyotomy and Dor fundoplication is the surgical procedure of choice for esophageal achalasia. The aim of this study was to investigate the clinical outcome of laparoscopic Heller-Dor procedure in our initial series of 25 patients with achalasia.</p><p><b>METHODS</b>Between October 2003 and January 2006, a total of 25 patients with achalasia underwent laparoscopic Heller-Dor operation. Among them, 9 were male and 16 were female with an average age of (41.5 +/- 5.1) years (21-66). All the patients received upper gastrointestinal series (barium swallow), esophagogastroscopy, esophageal manometry to exclude esophageal carcinoma and to confirm the diagnosis, and 21 patients also had 24-hour ambulatory pH studies. All the patients were operated by laparoscopic modified Heller's myotomy with Dor fundoplication. In addition, 2 of them had combined laparoscopic cholecystectomy + excision of hepatic hemangioma and laparoscopic cholecystectomy, respectively.</p><p><b>RESULTS</b>The average operating time was (110.6 +/- 12.9) minutes (range, 60-180), operative blood loss averaged (18.6 +/- 7.1) ml (5-50), the median time to oral feeding was (1.6 +/- 0.4) days (1-4) and the median hospital stay was (12.6 +/- 1.2) days (10-20). There was no conversion to open surgery. Intraoperative mucosal perforation was encountered in six patients and was repaired in all of them by laparoscopic suture. All the patients had an uneventful recovery without postoperative complication. After a median follow-up of (10.6 +/- 7.2) months (1-27), 24 patients were asymptomatic and 1 had mild postoperative dysphagia.</p><p><b>CONCLUSIONS</b>Laparoscopic Heller-Dor operation had the advantages of reduced compromise of the cardiopulmonary function, with less disruption of the supporting structures (phrenoesophageal membrane) of the antireflux mechanism, requiring simpler general anesthesia and providing excellent exposure permitting an easy fundoplication, less pain and reduced morbidity, shorter hospitalization and faster convalescence.</p>


Subject(s)
Adult , Aged , Digestive System Surgical Procedures , Methods , Esophageal Achalasia , General Surgery , Esophagus , General Surgery , Female , Follow-Up Studies , Fundoplication , Methods , Humans , Laparoscopy , Methods , Male , Middle Aged , Minimally Invasive Surgical Procedures , Methods
12.
Chinese Journal of Surgery ; (12): 1044-1047, 2004.
Article in Chinese | WPRIM | ID: wpr-360905

ABSTRACT

<p><b>OBJECTIVE</b>To investigate the diagnosis and managements of hepatic artery complications in orthotopic liver transplantation.</p><p><b>METHODS</b>The clinical data of 107 consecutive orthotopic liver transplantation patients was reviewed retrospectively to assess the risk factors and the diagnosis and treatment of the vascular complications.</p><p><b>RESULTS</b>The incidence of the artery related complications in orthotopic liver transplantation was associated with the quality of the donor organ artery and the reconstruction way of donor-recipient artery intimately. The main hepatic artery related complications were hepatic artery thrombosis and stenosis. The incidence of the vascular complications was 6.54%, and the mortality rate was 85.7%.</p><p><b>CONCLUSIONS</b>The main influence factors of vascular complications were the quality of the donor organ artery and the reconstruction way of donor-recipient artery. The key steps of organ salvaging and the patients' life saving were early diagnosis and treatment of those complications.</p>


Subject(s)
Adolescent , Adult , Aged , Constriction, Pathologic , Diagnosis , Therapeutics , Female , Hepatic Artery , Pathology , General Surgery , Humans , Liver Transplantation , Male , Middle Aged , Retrospective Studies , Thrombosis , Diagnosis , Therapeutics , Transplantation, Homologous
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