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1.
Article in Chinese | WPRIM | ID: wpr-1039583

ABSTRACT

Objective @#To investigate the associations of the single nucleotide polymorphism ( SNP) rs2304733 in TEA domain transcription factor 1 ( TEAD1) , rs7135838 and rs1990330 in TEA domain transcription factor 4 (TEAD4) genes with the risk of non⁃cardia gastric carcinogenesis . @*Methods @#Enzyme linked immunosorbent assay ( ELISA) was used to detect specific antibodies against Helicobacter pylori(Hp)in serum samples of the normal control group . 470 normal controls were divided into Hp infection negative group (n = 223) and positive group ( n = 247) based on antibody titers . In the 450 non⁃cardia gastric cancer cases and 470 controls , polymerase chain reaction⁃restriction fragment length polymorphism (PCR⁃RFLP) was used to genotype the each SNP locus . The unconditional Logistic regression method was used to evaluate the associations between each SNP locus and the risk of non⁃cardia gastric carcinogenesis .@*Results @#The SNPs of TEAD1 and TEAD4 were not associated with Hp infection . TEAD1 rs2304733 was associated with the risk of non⁃cardia gastric cancer. Compared with the carriers of TT genotype , the carries of CT and CC genotypes had an increased risk of non⁃cardia gastric cancer (CT vs TT : OR = 2. 321 , 95% CI : 1 . 690 - 3 . 188 ; CC vs TT : OR = 5 . 140 , 95% CI : 1 . 080 - 24. 463) . TEAD4 rs1990330 was associated with the risk of non⁃cardia gastric cancer. Compared with the carriers of GG genotype , those with GT genotype had an increased risk of non⁃cardia gastric cancer ( OR = 2. 405 , 95% CI : 1 . 480 - 3 . 908 ) . TEAD4 rs7135838 was not associated with the risk of non⁃cardia gastric cancer. TEAD1 rs2304733 , TEAD4 rs7135838 and rs1990330 had interaction effects on the risk of non⁃cardia gastric cancer (P < 0. 05) . @*Conclusion @#In Baotou Han population , TEAD1 rs2304733 and TEAD4 rs1990330 do not play a major role in Hp infection , but may play a role in the risk of non⁃cardia gastric cancer. TEAD4 rs7135838 may not play a major role in the risk of Hp infection and non⁃cardia gastric cancer. TEAD1 rs2304733 and TEAD4 rs1990330 have the strongest synergistic effect on the risk of non⁃cardia gastric cancer , which is the best interaction model .

2.
Article in Chinese | WPRIM | ID: wpr-1029545

ABSTRACT

Objective:To evaluate the efficacy and safety of peroral endoscopic myotomy (POEM) in achalasia of cardia (AC) patients with the long course.Methods:A total of 159 AC patients who received POEM from January 2015 to March 2022 in the First Affiliated Hospital of Soochow University were divided into the long course group (≥10 years) and the non-long course group (<10 years). The baseline information, POEM procedure and postoperative recurrence were compared and the differences between the recurrent patients and non-recurrent patients in the long course group were explored.Results:The age (57.09±14.30 years VS 42.08±15.68 years, t=5.569, P<0.001), the rate of treatment history [28.9% (13/45) VS 9.6% (11/114), χ2=9.319, P=0.020], the proportion of Henderson grade Ⅲ esophagus [17.8% (8/45) VS 6.1% (7/114), χ2=7.020, P=0.030] in the long course group were significantly higher than those in the non-long course group. The recurrence rate in the long course group was significantly higher than that in the non-long course group [33.3% (15/45) VS 14.9% (17/114), χ2=6.811, P=0.009]. In the long course group, the age (62.50 ± 16.94 years VS 53.77 ± 12.95 years, t=-2.121, P=0.040), and the rate of treatment history [53.3% (8/15) VS 16.7% (5/30), χ2=6.544, P=0.016] in the recurrent patients were higher than those in the non-recurrent patients. Conclusion:POEM is safe and effective for long-course AC patients. In patients with the long course, the aged patients with previous treatment are more likely to relapse.

3.
Article in Chinese | WPRIM | ID: wpr-1029546

ABSTRACT

Objective:To investigate the safety and efficacy of submucosal tunnel docking endoscopic resection (SDER) for the treatment of giant submucosal tumors in the cardia.Methods:A retrospective analysis was performed on data of patients with giant submucosal tumors in the cardia who were treated with SDER at the endoscopy center of Zhongshan Hospital, Fudan University and Xuhui District Central Hospital from January 2021 to January 2022. The surgical records, postoperative pathology, complications, hospitalization, and follow-up were analyzed.Results:A total of 6 patients were included. The mean long diameter of the lesions was 4.0 cm, all of which were located in the cardia. All patients successfully underwent SDER treatment with a surgical time of 23-42 min. Postoperative pathology revealed that 4 cases were leiomyomas and 2 cases were gastrointestinal stromal tumors. All lesions were completely resected. The postoperative hospital stay was 3-5 d, and no serious complications occurred after surgery. All patients recovered on follow-up gastroscopy at 3 and 6 months postoperatively.Conclusion:The preliminary conclusion is that SDER for the treatment of giant submucosal tumors in the cardia is safe, effective.

4.
Article in Chinese | WPRIM | ID: wpr-1029548

ABSTRACT

In order to evaluate the efficacy of peroral endoscopic myotomy (POEM) for achalasia, data of 63 patients with achalasia who were treated with POEM in China-Japan Union Hospital of Jilin University from 2017 to 2021 were collected. Postoperative Eckardt score, high-resolution manometry and upper gastrointestinal radiography were compared with preoperative data. The mean age of the 63 patients was 49.0 years, and there were 31 famales. The preoperative Eckardt score was 9 (3), and the postoperative Eckardt score was 2 (2), with significant difference ( V=1 953, P<0.001). The lower esophageal sphincter pressure decreased significantly after operation compared with that before operation [9.90 (3.35) mmHg VS 26.80(13.85)mmHg, V=2 016, P<0.001]. Fifty-three patients (84.1%) had satisfactory curative effects. The incidence of adverse events was 3.2% (2/63). POEM is safe, effective and minimally invasive for the treatment of achalasia.

5.
Article in Chinese | WPRIM | ID: wpr-1036294

ABSTRACT

Objective @#To study the association between single nucleotide polymorphism (SNP) in transcriptional coactivator containing PDZ binding motif (TAZ) gene and the risk of non⁃cardia gastric cancer. @*Methods @#Among 460 patients with non⁃cardia gastric cancer and 470 normal controls , TAZ rs16861985 , rs1055153 , rs6783790, rs12490239 were genotyped by polymerase chain reaction⁃restriction fragment length polymorphism (PCR⁃RFLP) . Unconditional Logistic regression was used to evaluate the association of studied SNPs with the risk of non⁃cardia gastric cancer. @*Results @#TAZ rs16861985 was associated with the risk of non⁃cardia gastric cancer, compared with the CC genotype carriers , the carriers of GC genotype had an increased risk of noncardia gastric cancer ( OR =1. 547 , 95% CI: 1. 145 - 2. 089) . TAZ rs1055153 was associated with the risk of non-cardia gastric cancer, compared with the GG genotype carriers , the carriers of GT + TT genotypes had a decreased risk of non-cardia gastric cancer ( OR = 0. 570 , 95% CI: 0. 400 - 0. 814) . TAZ rs6783790 and rs12490239 were not associated with the risk of non⁃cardia gastric cancer. Among the haplotypes constructed by TAZ rs16861985 , rs1055153 , rs6783790 and s12490239 , C ⁃G ⁃A ⁃A haplotype had a decreased risk of non⁃cardia gastric cancer ( OR = 0. 761 , 95% CI: 0. 612- 0. 945) , while G ⁃G ⁃A ⁃G haplotype had an increased risk of non⁃cardia gastric cancer ( OR = 1. 894 , 95% CI:1. 314 - 2. 730) . The fourth⁃order interaction of TAZ rs16861985 , rs1055153 , rs6783790 and rs12490239 was associated with non⁃cardia gastric cancer risk(P < 0. 05) .@*Conclusion @#TAZ rs16861985 and rs1055153 may play a role in the risk of non⁃cardia gastric cancer. The C ⁃G ⁃A ⁃A haplotype constructed by TAZ rs16861985 , rs1055153, rs6783790 and rs12490239 can reduce the risk of non⁃cardia gastric cancer, and G ⁃G ⁃A ⁃G haplotype can increase the risk of non⁃cardia gastric cancer. The interaction of TAZ rs16861985 , rs1055153 , rs6783790 and rs12490239 has a synergistic effect innon⁃cardia gastric cancer.

6.
Article in Chinese | WPRIM | ID: wpr-990669

ABSTRACT

Objective:To investigate the efficacy of different laparoscopic surgeries for gastrointestinal stromal tumors (GIST) of gastric cardia and fundus.Methods:The retrospective cohort study was conducted. The clinicopathological data of 251 patients with GIST of gastric cardia and fundus who underwent laparoscopic radical resection in 14 medical centers, including Guangdong Provincial People′s Hospital et al, from December 2007 to December 2021 were collected. There were 123 males and 128 females, aged 58(24,87)years. Observation indicators: (1) treatment; (2) clinicopathological data of patients undergoing different laparoscopic surgeries; (3) subgroup analysis for special laparoscopic techniques. Measurement data with normal distribution were represented as Mean± SD, and comparison between groups was conducted using the t test or ANOVA. Measure-ment data with skewed distribution were represented as M( Q1, Q3), and comparison between groups was conducted using the Mann-Whitney U test or Kruskal-Wallis H test. Count data were described as absolute numbers or percentages. Comparison of ordinal data was conducted using the rank sum test. Results:(1) Treatment. Of the 251 patients,202 cases underwent gastric wedge resection, 26 cases underwent special laparoscopic techniques including 10 cases with serotomy and dissection and 16 cases with transluminal gastrectomy, 23 cases underwent structural gastrectomy including 6 cases with total gastrectomy and 17 cases with proximal partial gastrectomy. There were 24 patients had postoperative complications after surgery. (2) Clinicopathological data of patients undergoing different laparoscopic surgeries. The gender (male, female), age, tumor diameter, operation time, volume of intraoperative blood loss, length of incision, time to postoperative initial whole liquid food intake, time to postoperative initial semi-liquid food intake, duration of postoperative hospital stay, cases with perioperative complications, cases with mitotic count as ≤5/50 high power field, 6?10/50 high power field, >10/50 high power field, cases be classified as very low risk, low risk, medium risk, high risk according to the National Institutes of Health risk classification, cases with tumor located at fundus and gastric cardia were 93, 109, (59±11)years, 3.50(0.40,10.00)cm, 88.00(25.00,290.00)minutes,20.00(25.00,290.00)mL, 4.00(2.00,12.00)cm, 3.00(1.00,9.00)days, 4.00(1.00,16.00)days, 5.00(1.00,18.00)days, 14, 164, 31, 7, 47, 83, 50, 22, 30, 172 in patients undergoing gastric wedge resection, respectively. The above indicators were 19, 7, (49±14)years, 2.55(0.20,5.00)cm, 101.00(59.00,330.00)minutes, 27.50(2.00,300.00)mL, 4.50(0,6.00)cm, 2.50(1.00,10.00)days, 4.00(1.00,16.00)days, 6.00(1.00,18.00)days, 3, 20, 5, 1, 15, 5, 2, 4, 24, 2 in patients undergoing special laparos-copic techniques, and 11, 12, (52±10)years, 5.00(0.80,10.00)cm, 187.00(80.00,325.00)minutes, 50.00(10.00,300.00)mL, 6.00(4.00,12.00)cm, 4.00(2.00,8.00)days, 6.00(3.00,14.00)days, 8.00(2.00,18.00)days, 7, 11, 5, 7, 2, 6, 6, 9, 13, 10 in patients undergoing structural gastrectomy. There were significant differences in the above indicators among the three groups of patients ( χ2=6.75, F=10.19, H=17.71, 37.50, 35.54, 24.68, 16.09,20.20, 13.76, χ2=13.32, Z=28.98, 32.17, χ2=82.14, P<0.05). (3) Subgroup analysis for special laparoscopic techniques. The time to postoperative initial whole liquid food intake, time to postoperative initial semi-liquid food intake, classification of tumor location (endophytic type, exophytic type, parietal type) were 4.50(1.00,10.00)days, 8.00(3.00,12.00)days, 0, 8, 2 in patients undergoing serotomy and dissection, versus 2.00(1.00,4.00)days, 3.00(1.00,6.00)days, 16, 0, 0 in patients undergoing transluminal gastrectomy. There were significant differences in time to postoperative initial whole liquid food intake, time to postoperative initial semi-liquid food intake between them ( Z=-2.65, -3.16, P<0.05); and there was a significant difference in classification of tumor location between them ( P<0.05). Conclusions:Gastric wedge resection is the most commonly used laparoscopic technique for GIST of gastric cardia and fundus. The application of special laparoscopic techniques is focused on the GIST of cardia to preserve the function of the cardia.

7.
Article in Chinese | WPRIM | ID: wpr-995390

ABSTRACT

Objective:To investigate the relationship between the cardia morphology under magnetically controlled capsule gastroscopy and the clinical characteristics of subjects.Methods:A total of 216 subjects with gastrointestinal symptoms or receiving physical examination who underwent magnetically controlled capsule gastroscopy at the Department of Gastroenterology, Beijing Chao-Yang Hospital, Capital Medical University from August 2022 to November 2022 were enrolled. All subjects took gastroesophageal reflux disease questionnaire (Gerd-Q) survey. Clinical data of subjects were collected, and images of cardia morphology under magnetically controlled capsule gastroscopy were recorded. The subjects were divided into 4 groups according to differrent cardia morphology based on the degree of relaxation. The clinical characteristics of each group were compared, and the influencing factors for cardia morphology were analyzed.Results:In non-swallowing state, 116 subjects showed good continuous closure of the cardia in plum shape (group A), 33 subjects radial closure of cardia (group B), 46 subjects slightly relaxed linear cardia (group C) and 21 subjects relaxed and continuous opening of cardia in the shape of cave (group D). The ages of subjects in group A, B, C and D were 35.00 (31.00, 42.00) years, 53.00 (37.50, 60.50) years, 61.50 (41.50, 68.25) years and 52.00 (39.00, 70.00) years, respectively, with significant differences ( H=44.348, P<0.001). The Gerd-Q scores of subjects in group A, B, C and D were 1.50 (1.00, 2.00), 3.00 (2.00, 6.50), 8.00 (5.75, 9.00) and 8.00 (7.50, 9.00), respectively, with significant differences ( H=90.788, P<0.001). The body mass index (BMI) of subjects in group A, B, C and D were 22.66 (19.53, 24.70) kg/m 2, 23.44 (21.41, 27.05) kg/m 2, 23.77 (21.19, 26.93) kg/m 2 and 23.73 (19.63,24.79) kg/m 2, respectively, with significant differences ( H=8.114, P=0.044). The degree of cardia relaxation was positively correlated with the age ( rs=0.456, P<0.001), Gerd-Q score ( rs=0.648, P<0.001) and BMI ( rs=0.146, P=0.032) of subjects. Conclusion:The magnetically controlled capsule gastroscopy provides good visualisation of cardia morphology in non-swallowing state. There is a positive correlation between the degree of cardia relaxation under magnetically controlled capsule gastroscopy in non-swallowing state and the subjects' age, Gerd-Q score, and BMI.

8.
Arq. gastroenterol ; Arq. gastroenterol;59(4): 478-482, Out,-Dec. 2022. tab, graf
Article in English | LILACS-Express | LILACS | ID: biblio-1420213

ABSTRACT

ABSTRACT Background: Advanced achalasia cardia (AC) represents the end stage in the natural history of AC. Role of per oral endoscopic myotomy (POEM) in this technically difficult subset is emerging. Methods: Retrospective review of the patients who had undergone POEM for advanced AC with sigmoid esophagus. We assessed the technical success, clinical success and adverse event rate. Pre and post POEM Eckardt score (ES), integrated relaxation pressure-4sec (IRP-4), lower oesophageal sphincter pressure (LESP) and height and width of barium column at 5 minutes were noted. Results: Of the 85 patients who underwent POEM for AC, 10 patients had advanced AC with sigmoid esophagus of which eight were sigmoid and two were advanced sigmoid. The clinical and technical success was 100% with significant reduction of ES, IRP-4, LESP and height and width of barium column at 5 minutes. One patient had a minor adverse event in the form of mucosal injury that was closed with hemoclips. At a median follow up of 17 months there was no recurrence. Conclusion: Our study demonstrates POEM to be a safe and effective modality of treatment in this technically difficult subset of AC with sigmoid morphology.


RESUMO Contexto: Acalasia cárdia avançada representa o estágio final na história natural do megaesôfago. Está emergindo o papel da miotomia endoscópica peroral (POEM) neste subconjunto tecnicamente difícil. Métodos: Foi realizada uma revisão retrospectiva dos pacientes submetidos a POEM para tratamento do megaesôfago avançado. Avaliamos o sucesso técnico, o sucesso clínico e a taxa de eventos adversos. O escore de Eckardt, pré e pós POEM, a pressão integral de relaxamento de 4 seg (IRP-4), a pressão do esfíncter inferior do esôfago e a altura e largura da coluna de bário em 5 minutos, foram anotadas. Resultados: Dos 85 pacientes submetidos a POEM para acalasia cárdia, 10 pacientes apresentaram acalasia cárdia avançado com esôfago com aspecto sigmoide, dos quais dois eram muito avançados. O sucesso clínico e técnico foi de 100% com redução significativa do escore de Eckardt, do IRP-4, da pressão do esfíncter inferior do esôfago e da altura e largura da coluna bário em 5 minutos. Um paciente teve um pequeno evento adverso na forma de lesão mucosa que foi fechada com hemoclipes. Em um seguimento mediano de 17 meses não houve recorrência. Conclusão: Nosso estudo demonstra que a POEM é uma modalidade segura e eficaz de tratamento neste subconjunto tecnicamente difícil de megaesôfago com morfologia sigmoide.

9.
Article | IMSEAR | ID: sea-218650

ABSTRACT

INTRODUCTION: High-resolution esophageal manometry (HREM) is a technique to determine the pressure pattern which is a function of esophageal musculature and integrity of LES. The indications for HREM evaluation include evaluation of nonobstructive dysphagia, symptoms of regurgitation and noncardiac or atypical chest pain unexplained by endoscopic evaluation To analyse profile of esophageal motility disorders in patient presenting with refractoryAIM: gastroesophageal reflux disease (GERD), dysphagia and atypical chest pain in tertiary care centre in Western India METHODS: We enrolled patient presented with refractory GERD, dysphagia and atypical chest pain from Jan 2020 to March 2022 at Department of gastroenterology, National Institute of Medical College & R, Jaipur. Upper GI endoscopy and high-resolution esophageal manometry was done in all patients Ineffective esophageal peristalsis,RESULTS: achalasia cardia, hypercontractile esophagus, fragmented peristalsis and esophagogastric junction outflow obstruction were common diagnosis made by high resolution esophageal manometry In our study ineffectiveConclusion: esophageal motility most common and achalasia cardia second most common diagnosis identified on esophageal manometry

10.
Article in Chinese | WPRIM | ID: wpr-923438

ABSTRACT

@#Objective     To investigate short-term outcomes of robot-assisted Heller-Dor myotomy (RAHM-Dor) for achalasia of cardia and our learning curve experience. Methods     The clinical data and recent follow-up results of 42 patients who received RAHM-Dor from November 2015 to January 2020 in the Department of Thoracic Surgery of the First Affiliated Hospital of Nanchang University were retrospectively analyzed, including 20 males and 22 females with a mean age of 40.8±18.4 years. Results    Dysphagia was the most common symptom, followed by heartburn and regurgitation. The mean operation time was 122.8±23.9 min. The mean blood loss was 47.5±32.7 mL. Two patients suffered mucosal injury, and successfully repaired by suturing during surgery. There was no esophageal fistula, conversion to an open operation or perioperative death in this series. The median length of hospital stay was 8 (6, 9) d. In all patients, the Stooler and Eckardt scores of postoperative 1, 6 and 12 months decreased compared to those of pre-operation (P<0.001). Conclusion     RAHM-Dor is a safe and feasible avenue for the treatment of achalasia of cardia, and can achieve a satisfying short-term results. The learning curve shows a transition to the standard stage from the learning stage after 16-18 operations.

11.
Article in Chinese | WPRIM | ID: wpr-934080

ABSTRACT

Objective:To evaluate the long-term efficacy of double-tunnel peroral endoscopic myotomy (POEM) and traditional POEM in the treatment of achalasia cardia.Methods:A randomized controlled trial was performed on the data of 30 patients with achalasia cardia, who underwent POEM in the First Affiliated Hospital of Nanjing Medical University from June 2018 to June 2019. The 30 consecutive patients were randomly assigned to double-tunnel POEM group (15 cases, a second tunnel was established opposite to the traditional one) and traditional POEM group (15 cases). Intraoperative information was recorded, and patients were followed up regularly to compare the efficacy and complications between the two groups.Results:Double-tunnel POEM and traditional POEM were all completed with technical success. There were no significant differences in the intraoperative complications (5/15 VS 4/15, P=1.000), hospitalization time or cost between the two groups. The follow-up time was 17.20±4.83 months and 15.33±4.67 months in the traditional POEM group and the double-tunnel POEM group, respectively. The Eckardt scores after surgery between the two groups had no significant difference [1.53 (2.00) VS 1.60 (3.00), Z=-0.363, P=0.744]. The symptom relief cases were both 14 in the two groups. The postoperative 4-second integrated relaxation pressure (4 s IRP) of the double-tunnel group (11.27±3.14 mmHg) was significantly lower than that of the traditional group (15.05±4.21 mmHg, t=2.794, P=0.009). There was no significant difference in postoperative gastroesophageal reflux disease questionnaire scores between the two groups (4.40±1.64 VS 4.20±1.42, t=0.357, P=0.724). Conclusion:Double-tunnel POEM has almost the same efficacy as the traditional POEM except for a lower post-POEM 4 sIRP.

12.
Article in Chinese | WPRIM | ID: wpr-934096

ABSTRACT

Objective:To analyze the clinicopathological characteristics of differentiated early cardia cancer and to evaluate the short-term and long-term efficacy of endoscopic submucosal dissection (ESD).Methods:A total of 329 patients (331 lesions) who underwent ESD at Nanjing Drum Tower Hospital from October 2014 to December 2019 and were pathologically confirmed as differentiated early cardia cancer were included in the study and followed up. The endoscopic and pathological data of patients were reviewed to analyze the clinicopathological characteristics of differentiated early cardia cancer. The short-term (including en bloc resection rate, curative resection rate and incidence of short-term complications) and long-term efficacy (including incidence of metachronous cancer, recurrence and distant metastasis, and overall survival rate) of ESD was evaluated.Results:The ratio of male to female in 329 patients with differentiated early cardia cancer was 4∶1, and their age was 65.69±8.02 years. Tumor diameter of ≤2.0 cm accounted for 65.9% (218/331). Most lesions were located on the posterior wall (50.5%, 167/331), followed by the minor curve (36.3%, 120/331). The endoscopic morphology of 0-Ⅱc type accounted for 49.5% (164/331). There were 69.8% (231/331) lesions confined to the mucosal layer. The en bloc resection rate was 100.0% (329/329), and the curative resection rate was 83.3% (274/329). Short-term complications occurred in 28 patients (8.5%). With a median follow-up time of 39 months, 11 patients (3.3%) developed metachronous cancer, 2 (0.6%) developed distant metastasis, and no recurrence occurred. Seven patients died, and the overall survival rate during the follow-up period was 97.9% (322/329). The survival rate of patients with curative resection and additional surgery was 100.0% (3/3), while that without additional surgery was 99.3% (269/271). The survival rate of patients with non-curative resection and additional surgery was 96.0% (24/25), and that without additional surgery was 86.7% (26/30).Conclusion:Most differentiated early cardia cancers are well-differentiated adenocarcinomas, with less than 2 cm in diameter at the time of diagnosis with a low rate of ulcer and vascular invasion. ESD is safe and effective for the treatment of differentiated early cardia cancer with a high rate of curative resection, fewer intraoperative and postoperative complications, low incidences of metachronous cancer, distant metastasis and recurrence, and a high overall survival rate. However, additional surgical treatment is recommended for patients with non-curative resection.

13.
Article in Chinese | WPRIM | ID: wpr-955229

ABSTRACT

Objective:To investigate the application value of laparoscopic intra-gastric surgery (LIGS) in the treatment of gastrointestinal stromal tumors (GIST) around the cardia.Methods:The retrospective and descriptive study was conducted. The clinicopathological data of 5 patients who underwent LIGS for GIST around the cardia in the Renji Hospital Affiliated to Shanghai Jiaotong University School of Medicine from January 2019 to December 2021 were collected. There were 3 males and 2 females, aged 52(range, 35?69)years. All patients underwent LIGS. Observation indicators: (1) intraoperative and postoperative conditions; (2) follow-up. Follow-up was conducted using tele-phone interview or outpatient examination. Patients were followed up once every 3 months to detect long-term complications and tumor recurrence up to April 1st, 2022. Measurement data with skewed distribution were represented as M(range) and count data were described as absolute numbers. Results:(1) Intraoperative and postoperative conditions. All 5 patients underwent LIGS successfully, without conversion to laparotomy or changes in surgical methods. Intraoperative tumor exploration showed that the tumor was located on the lesser curvature of the cardia in 3 patients and on the posterior wall of the gastric fundus in 2 patients. The distance between the tumor and the dentate line of the cardia was 1.5(range, 1.0?3.0)cm. Of the 5 patients, 3 cases with tumor patholo-gically evaluable margins as 0.3, 0.8, and 1.5 cm and 2 cases without tumor pathologically evaluable margins but the tumor had an intact capsule. The operation time, volume of intraoperative blood loss, time to postoperative first anal exsufflation, time to postoperative initial fluid diet intake, time to extubation and duration of postoperative hospital stay were 75(range, 65?112)minutes, 25(range, 15?70)mL, 2(range, 1?3)days, 3(range, 2?4)days, 4(range, 3?5)days and 6(range, 5?8)days in the 5 patients. There was no short-term postoperative complication such as bleeding, anastomotic leakage, and gastroparesis in the 5 patients and results of postoperative histopathological examina-tion showed GIST in all 5 patients, with tumor diameter as 3.0(range, 1.8?5.5)cm. There were 2 patients with tumor diameter ≤2.0 cm and 3 patients with tumor diameter ≥3.0 cm. The 5 patients were classified as very low risk in 2 cases, low risk in 2 cases, and intermediate risk in 1 case. (2) Follow-up. All 5 patients were followed up after operation, with the follow-up time of 9(range, 3?15)months. During the follow-up, there was no long-term complication such as dysphagia and gastroesophageal reflux, and no recurrence or metastasis of tumor occurred in patients by computed tomography examinations.Conclusion:LIGS can be used for the treatment of GIST around the cardia.

14.
Nursing (Ed. bras., Impr.) ; 24(274): 5453-5464, mar.2021.
Article in Portuguese | LILACS, BDENF | ID: biblio-1223537

ABSTRACT

Objetivo: Analisar as recomendações de condutas terapêuticas e educacionais na assistência ao paciente em período pré e pós-transplante cardíaco. Métodos: Trata-se de revisão integrativa baseada na estratégia PICO, realizada com 12 artigos gerados através de pesquisa nas bases de dados LILACS; MEDLINE; BDENF; IBECS; BINACIS e COLECIONASUS em agosto de 2019. Resultados: É recomendado a atuação da equipe multidisciplinar especializada em transplante e a educação em saúde. Maior grau de instrução, melhor condição cognitiva e altos níveis de satisfação social são preditivos de aumento nos anos de sobrevida pós-transplante. Os principais aspectos a serem trabalhados são: ação da insuficiência cardíaca e seu impacto no organismo, tratamentos disponíveis, período de recuperação, rotinas de exames e acompanhamento. Conclusão: Diante da complexidade do tema faz-se necessário uma equipe assistencial especializada e a reflexão sobre a inclusão do cardiopata e familiares no processo. O apoio psicológico gera melhores resultados e adesão ao tratamento.(AU)


Objective: To analyze the recommendations for therapeutic and educational approaches in patient care in the pre- and post-heart transplant period. Methods: This is an integrative review based on the PICO strategy, carried out with 12 articles generated thrçough research in the LILACS databases; MEDLINE; BDENF; IBECS; BINACIS and COLECIONASUS in August 2019. Results: The work of a multidisciplinary team specialized in transplantation and health education is recommended. A higher level of education, a better cognitive condition and high levels of social satisfaction are predictive of an increase in the years of post-transplant survival. The main aspects to be worked on are: heart failure action and its impact on the organism, available treatments, recovery period, exam routines and follow-up. Conclusion: In view of the complexity of the theme, a specialized assistance team and reflection on the inclusion of cardiopath and family members in the process is necessary. Psychological support generates better results and treatment adherence.(AU)


Objetivo: Analizar las recomendaciones de abordajes terapéuticos y educativos en la atención al paciente en el período pre y postrasplante cardíaco. Métodos: Se trata de una revisión integradora basada en la estrategia PICO, realizada con 12 artículos generados a través de la investigación en las bases de datos LILACS; MEDLINE; BDENF; IBECS; BINACIS y COLECIONASUS en agosto de 2019. Resultados: Se recomienda el trabajo de un equipo multidisciplinario especializado en trasplantes y educación para la salud. Un mayor nivel de educación, una mejor condición cognitiva y altos niveles de satisfacción social son predictores de un aumento en los años de supervivencia postrasplante. Los principales aspectos a trabajar son: acción de la insuficiencia cardíaca y su impacto en el organismo, tratamientos disponibles, período de recuperación, rutinas de exploración y seguimiento. Conclusión: Dada la complejidad del tema, es necesario un equipo asistencial especializado y la reflexión sobre la inclusión del cardiópata y familiares en el proceso. El apoyo psicológico genera mejores resultados y adherencia al tratamiento.(AU)


Subject(s)
Humans , Heart Transplantation , Cardiovascular Nursing , Patient Care , Heart Failure , Homeopathic Therapeutic Approaches , Patient Education as Topic
15.
Article in Chinese | WPRIM | ID: wpr-942910

ABSTRACT

Both pylorus-preserving gastrectomy (PPG) and segmental gastrectomy (SG) achieve the preservation of gastric cardia and pylorus through the circumferential resection of stomach, while concepts and surgical procedures of these two operations are obviously different. In this sense, transectional gastrectomy includes both PPG and SG. PPG is one of the standard surgical procedure for early gastric cancer (EGC). The extent of lymph node dissection (No.1, 3, 4sb, 4d, 6, 7, 8a, 9) and the retention of infrapyloric vessels, hepatic and pyloric branch of vagal nerve has formed a consensus. Meanwhile, SG is regarded as an investigational treatment according to the Japanese gastric cancer treatment guidelines. It is still controversial and may generate an ethical risk in the clinical practice. This article distinguishes the difference in the concepts and surgical procedures between PPG and SG, assisting a comprehensive evaluation in further research.


Subject(s)
Humans , Cardia , Gastrectomy , Lymph Node Excision , Pylorus , Stomach Neoplasms/surgery
16.
Article in Chinese | WPRIM | ID: wpr-909230

ABSTRACT

Objective:To analyze the risk factors of a high demand for perioperative blood transfusion in patients with esophageal and cardiac cancer and to accumulate more evidence-based medicine findings for timely and effective clinical intervention to reduce the volume of blood transfused.Methods:The clinical data of 154 patients with esophageal and cardiac cancer who received treatment from January 2012 to October 2018 in Yuncheng Central Hospital were retrospectively analyzed. Among them, 100 patients who received < 5 U blood transfusion were included in the control group, and 54 patients who received ≥ 5 U blood transfusion were included in the observation group. The causes of a high demand for blood transfusion, the possible influential factors, and their effects on related clinical indicators post-surgery were analyzed.Results:The proportion of patients with underlying diseases, the proportion of patients with anemia pre-surgery, and the amount of blood loss in the observation group were 85.19% (46/54), 48.15% (26/54) and (1 127.92 ± 350.70) mL respectively, which were significantly higher than those in the control group [37.00% (37/100), 21.00% (21/100) and (296.47 ± 98.31) mL, χ2 = 6.17, 7.40, t = 7.54, P < 0.01, P = 0.03, P < 0.01]. The incidence of postoperative complications in the observation group was significantly higher than that in the control group [62.96% (34/54) vs. 33.00% (33/100), χ2 = 9.16, P = 0.00]. There were no significant differences in hospital and intensive care unit lengths of stay between the two groups (both P > 0.05). Platelet count after blood transfusion in the observation group was (190.47 ± 73.48) × 10 12/L, which was significantly higher than (159.00 ± 65.17) × 10 12/L in the control group and (234.31 ± 92.07) × 10 12/L before blood transfusion in the observation group ( t = 4.26, 5.33, both P < 0.01). There were no significant differences in prothrombin time and activated partial thromboplastin time between the two groups (both P > 0.05). In the observation group, the international normalized ratio after blood transfusion was significantly higher than that before blood transfusion [(1.06 ± 0.15) vs. (0.94 ± 0.12), t = 2.78, P = 0.03]. In the observation group, serum K + level after blood transfusion was significantly lower than that before blood transfusion [(3.97 ± 0.42) mmol/L vs. (4.21 ± 0.37) mmol/L, t = 4.01, P < 0.01]. There was no significant difference in serum Ca 2+ level after blood transfusion between the two groups ( P > 0.05). Conclusion:Underlying diseases and anemia are the risk factors for a high demand for blood transfusion in patients with esophageal and cardiac cancer. A high demand for blood transfusion is mainly caused by postoperative bleeding. At the same time, blood transfusion can also increase the risks for abnormal coagulation function, abnormal serum ion levels, and complications post-surgery.

17.
Article in Chinese | WPRIM | ID: wpr-912140

ABSTRACT

To explore the application value of pushing endoscopic submucosal dissection (PESD) in treatment of large area of early cardiac cancer or precancerous lesions. Form January 2017 to January 2020, patients diagnosed as having early cardiac cancer or high-grade intraepithelial neoplasia with largest lesion diameter greater than 2.0 cm at the Baoding NO.1 Central Hospital were enrolled in the study. Patients who received PESD with water-injected knife were included in the PESD group (26 cases), and compared with those who received conventional ESD with common mucosal incision (the conventional ESD group, 17 cases) at the same period. The procedure time, the complete resection rate of lesions and the incidence of complications were analyzed.There were no difference in lesion size between the two groups ( P>0.05). The procedure time of PESD group was 53.7±18.2 min, which was 91.5±26.5 min in the conventional ESD group, and the difference was statistically significant ( P<0.001). In the PESD group, 7 cases (26.9%) had intraoperative hemorrhage. In the conventional ESD group, 8 cases (47.1%) had intraoperative bleeding, and 2 (11.8%) had intraoperative perforation. There were significant differences in the incidence of hemorrhage and perforation between the two groups (all P<0.001). Compared with conventional ESD, PESD can effectively improve the dissection speed, reduce the incidence of complications, and make endoscopic surgery safer and faster.

18.
Article in Chinese | WPRIM | ID: wpr-912188

ABSTRACT

Objective:To study the safety and efficacy of endoscopic submucosal dissection (ESD) for early gastric cardia cancer (EGCC) in elderly patients.Methods:A retrospective analysis was performed on data of 499 EGCC patients who underwent ESD from January 2011 to June 2018 in Nanjing Drum Tower Hospital. The patients were divided into two groups by age, the young/middle-aged group (<65 years old) and the elderly group (≥65 years old). The baseline data, lesion features, postoperative complications, short-term efficacy and long-term efficacy of the two groups were compared.Results:The elderly group included 272 patients (283 lesions) and the young/middle-aged group included 227 patients (229 lesions). Except that there were significant differences in the age ( P<0.001) and body mass index ( P=0.002) between the elderly group and the young/middle-aged group, there were no significant differences in the baseline data or pathological features between the two groups. The rate of curative resection in the elderly group was 77.0%, lower than that in the young/middle-aged group (84.3%, P=0.045). No significant differences were found in en bloc resection rate (100.0% VS 99.6%, P=1.000), complete resection rate (94.7% VS 93.9%, P=0.705), postoperative complications incidence (6.4% VS 5.7%, P=0.747), operation time (64.02±39.24 min VS 66.16±44.62 min, P=0.566) or hospitalization time (6.76±2.06 d VS 6.47±1.74 d, P=0.092]. After the median follow-up of 47.9 months, 13.4% patients in the elderly group received additional surgery, which was slightly lower than that in the young/middle-aged group ( P=0.891). There were no significant differences in postoperative recurrence, lymph node metastasis, distant metastasis, overall mortality and disease-related mortality between the two groups. The survival analysis showed that five-year overall survival rates were 94.41% and 96.34% in the elderly group and the young/middle-aged group respectively ( P=0.156), and five-year disease-specific survival rate were 99.18% and 99.03% in the two groups respectively ( P=0.858). Conclusion:ESD is safe and effective for EGCC in elderly patients with satisfactory short-term and long-term efficacy.

19.
Rev. Pesqui. (Univ. Fed. Estado Rio J., Online) ; 13: 428-433, jan.-dez. 2021. ilus
Article in English, Portuguese | BDENF, LILACS | ID: biblio-1151962

ABSTRACT

Objetivo: construir e validar uma tecnologia educacional para mediar o agir educativo do enfermeiro com pacientes e familiares na alta hospitalar. Método: pesquisa de desenvolvimento metodológico, com validação de conteúdo. Dados coletados de junho a agosto de 2017. A pesquisa desenvolvida em três fases: produção, avaliação, adequação. A população foi de 24 juízes entre profissionais da saúde e de outras áreas. Os juízes responderam um questionário com 3 blocos de itens avaliativos. Resultados: dos 22 itens do questionário dos juízes da área da saúde apenas dois obtiveram escore I (inadequado). Considerou-se a tecnologia validada, pois segundo a literatura deve-se obter um índice de validação de conteúdo mínimo de 70%, e o índice obtido foi de 91,1 %. Com base nas sugestões realizou-se a adequação da tecnologia. Conclusão: a tecnologia produzida foi validada e com a adequação se constituir um dispositivo adequado para mediar o agir educativo do enfermeiro


Objective: construct and validate an educational technology to mediate the educational action of nurses with patients and their families at hospital discharge. Method: methodological development research, with content validation. Data collected from June to August 2017. The research developed in three phases: production, evaluation, adequacy. The population was 24 judges among health professionals and other areas. The judges answered a questionnaire with 3 blocks of evaluative items. Results: of the 22 items of the questionnaire of the judges of the health area only two obtained score I (inadequate). The validated technology was considered, since according to the literature it is necessary to obtain a content validation index of at least 70%, and the index obtained was of 91.1%. Based on the suggestions was made the adequacy of the technology. Conclusion: the technology produced was validated and with the adequacy if it constitutes an adequate device to mediate the educational action of the nurse


Objetivo: construir y validar una tecnología educativa para mediar el actuar educativo del enfermero con pacientes y familiares en el alta hospitalaria. Método: investigación de desarrollo metodológico, con validación de contenido. Datos recolectados de junio a agosto de 2017. La investigación desarrollada en tres fases: producción, evaluación, adecuación. La población fue de 24 jueces entre profesionales de la salud y de otras áreas. Los jueces respondieron un cuestionario con 3 bloques de ítems de evaluación. Resultados: de los 22 ítems del cuestionario de los jueces del área de la salud sólo dos obtuvieron escore I (inadecuado). Se consideró la tecnología validada, pues según la literatura se debe obtener un índice de validación de contenido mínimo del 70%, y el índice obtenido fue del 91,1%. Con base en las sugerencias se realizó la adecuación de la tecnología. Conclusión: la tecnología producida fue validada y con la adecuación si constituye un dispositivo adecuado para mediar el actuar educativo del enfermero


Subject(s)
Humans , Male , Female , Patient Discharge , Health Education , Educational Technology , Heart Failure , Validation Study
20.
Article | IMSEAR | ID: sea-209332

ABSTRACT

Introduction: Achalasia cardia is a primary esophageal motility disorder of an unknown etiology, characterized by abnormal peristalsis of the esophageal body and the absence of relaxation of the lower esophageal sphincter. Laparoscopic Heller cardiomyotomy is the surgical procedure of choice for achalasia cardia. Aim: The aim of the study was to the immediate safety and long-term efficacy of laparoscopic Heller’s cardiomyotomy with intraoperative endoscopy and Dor’s anterior partial fundoplication in patients with achalasia cardia. Materials and Methods: In this prospective study, laparoscopic Heller’s myotomy with intraoperative endoscopy and anterior Dor’s fundoplication were performed in all achalasia cardia patients. Patients’ demographic, clinical features such as dysphagia grade and Eckardt score, intraoperative, post-operative parameters, and response to treatment on follow-up were analyzed. Results: In 14 patients, 10 were females (71%), the mean age was 37±14.96 years. Mean pre-operative modified Takita’s dysphagia grade was 2.93±0.73. Endoscopic classic findings and barium swallow bird beak sign were diagnostic in all cases. Preoperative Eckardt score was 8.93±1.44. Eckardt score at discharge was 0.43±0.51 and at 12th month was 0.21±0.43. On analysis, there was a significant improvement in pre-operative values of modified Takita’s dysphagia grade and Eckardt score to normal values postoperatively (P < 0.0001) and the durable effect was persistently observed in 3rd and 6th, 9th, and 12th-month follow-up. Conclusion: Laparoscopic Heller’s myotomy with intraoperative endoscopy and Dor’s fundoplication are safe and effective with significant improvement in post-operative Takita’s dysphagia score and Eckardt score.

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