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Objective:To explore the efficacy and safety of intraoperative hyperthermic intraperitoneal chemotherapy combined with total laparoscopic D2 radical gastrectomy in the treatment of gastric cancer.Methods:The clinical data of 127 patients with gastric cancer who were admitted to the Central Hospital of Hanzhong in Shaanxi Province from August 2017 to July 2019 were retrospectively analyzed. All patients underwent total laparoscopic D2 radical gastrectomy, of which 58 patients underwent total laparoscopic D2 radical gastrectomy combined with intraoperative hyperthermic intraperitoneal chemotherapy (observation group), and 69 patients underwent total laparoscopic D2 radical gastrectomy (control group). Observation indicators included surgical and postoperative recovery situations and postoperative tumor-related indicators. Follow-up was performed by using outpatient examination and telephone interview, and the content of follow-up included patient's adjuvant chemotherapy, tumor recurrence and metastasis, and surgery-related complications.Results:In the observation group, the intraoperative blood loss was (199±48) ml, the number of lymph node dissection was 35±8, the total hospitalization cost was (53 261±4 316) yuan, alanine aminotransferase was (30±10) U/L, and creatinine was (124±26) μmol/L; in the control group, the intraoperative blood loss was (184±46) ml, the number of lymph node dissection was 34±13, the total hospitalization cost was (52 146±4 817) yuan, alanine aminotransferase was (31±10) U/L, and creatinine was (128±33) μmol/L; there were no significant differences between the two groups ( t values were 1.833, 0.618, 1.363, 0.721, and 0.856, all P > 0.05). In the observation group, the operating time was (352±44) min, carcinoembryonic antigen (CEA) at 1 month after operation was (3.9±2.1) ng/ml,CEA at 6 months after operation was (12.7±7.2) ng/ml, tumor abnormal protein (TAP) at 1 month after operation was (75±36) μm 2,TAP at 6 months after operation was (131±33) μm 2; in the control group, the operating time was (308±58) min,CEA at 1 month after operation was (8.3±4.5) ng/ml, CEA at 6 months after operation was (15.8±4.2) ng/ml, TAP at 1 month after the surgery was (88±24) μm 2, TAP at 6 months after operation was (149±37) μm 2; there were significant differences between the two groups ( t values were 4.792, 7.185, 2.832, 2.284, and 2.984, all P<0.05). One hundred and twenty seven patients were followed up for 12-24 months. Fifty-one and 58 patients in the observation group and control group received postoperative adjuvant chemotherapy, and there was no significant difference between the two groups ( χ2 = 0.389, P = 0.533). Tumor recurrence was respectively detected in 0 and 6 patients in the observation group and control group at 6 months after operation; tumor recurrence was respectively detected in 2 and 11 patients in the observation group and control group at 1 year after operation; the differences in the recurrence rates between the two groups were statistically significant (both P < 0.05). Conclusion:Intraoperative hyperthermic intraperitoneal chemotherapy combined with total laparoscopic surgery for gastric cancer does not increase the patient's perioperative risk and the incidence of postoperative complications, and it can reduce the risk of postoperative recurrence and improve the short-term efficacy.
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Objective@#To investigate the value of enhanced recovery after surgery (ERAS) in D2 radical resection of distal gastric cancer under total laparoscopy and its effect on inflammatory factors.@*Methods@#The clinical data of 50 patients with distal gastric cancer at Hanzhong Central Hospital from March 2016 to October 2017 were retrospectively analyzed. The patients were divided into the observation group (25 cases) and the control group (25 cases). The observation group received totally laparoscopic radical D2 gastrectomy for distal gastric cancer under the guideline of ERAS; the control group received totally laparoscopic radical D2 gastrectomy for distal gastric cancer under the guideline of the traditional method. The changes of perioperative related indexes, postoperative recovery and postoperative inflammatory indexes were compared between the two groups.@*Results@#All 50 patients successfully completed the operation. The operation time was (287.2±52.3) min and (296.8±57.9) min, respectively of the observation group and the control group; the number of lymph node dissection was (34.0±11.0) and (34.6±14.3), respectively of the observation group and the control group. There were no significant differences in the above indexes between the two groups (all P > 0.05). The hospitalization time, the hospitalization cost, the postoperative time of getting out of bed of the observation group was (22.0±2.8) d, (61 044.4±4 692.7) yuan, (12.8±1.8) h. The hospitalization time, the hospitalization cost, the postoperative time of getting out of bed of the control group was (23.9±1.9) d, (63 875.81±4 392.6) yuan, (23.7±8.2) h. And there were statistically significant differences between the two groups (all P < 0.05). The pain score on the 1st day was (5.0±0.8) score and (6.4±1.0) score, and on the 4th day was (2.7±0.9) score and (3.9±0.9) score, respectively of the observation group and the control group, and there was a statistical difference (all P < 0.05). There was no statistical difference in the 7th day pain score between the two groups (P > 0.05). There were no statistically significant differences in the tumor necrosis factor α, interleukin-6 (IL-6), C-reactive protein and procalcitonin on the day before the operation of both groups (all P > 0.05); the levels of above four factors in the observation group were lower than those in the control group on the 1st, 4th and 7th day after the operation, and the differences were statistically significant (all P < 0.05).@*Conclusion@#The application of ERAS in totally laparoscopic radical resection of gastric cancer can improve the postoperative condition, significantly reduce the inflammatory reaction of patients, which has a certain value of improving the quality of life of patients.
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Objective To compare the vascularization of collagen scaffolds with or without growth factors and their efficacy on cardiac function in postinfarcted rats underwent surgical ventricular restoration.Methods Collagen scaffolds were activated with 1-ethyl-3-[3-dimethylaminopropyl]carbodiimide hydrochloride chemistry (EDC) as control or continually covalently immobilized with vascular endothelial growth factor (VEGF) and VEGF + basic fibrohlast growth factor (bFGF) as experimental groups.Adult SD male rats underwent left anterior descending artery (LAD) ligation to generate transmural myocardial infarction(MI).Four weeks later,by echocardiography,rats with moderate scar size(25％-35％ akinetic area of freedom wall of left ventricle) were screened out,assigned into 3 groups randomly and received the surgical ventricular restocation (SVR).Then,cardiac function was measured by echocardiography at 1w,2w and 4w after patch implantation.At endpoint of study (4w after patch implantation),the rats were sacrificed and the hearts were harvested.Vascularization of patch were determined by capillary density (evidenced by vWFⅧ staining) or mature vessel density (evidenced by SMA staining) respectively.Results The general mortality of the animal model is 15％ (6/40).A significant improvement of cardiac function was observed in all animals at 1 w after patch implantation but that was better preserved in both cytokine-conjugated groups 4w later (control group vs.VEGF group,P ＜ 0.05,control group vs.VEGF + bFGF group,P ＜ 0.01).More capillaries were present in patch with growth factors (P ＜0.05),while significant functional vessel formation was observed only in VEGF + bFGF group (P ＜0.01 vs.control or VEGF group).Additionally,we identified a positive correlation between heart function and mature vessel density (P =0.0297,r2 =0.998).Conclusion The mechanical property of collagen scaffold can be effectively improved by EDC,the growth factors immobilized in scaffold were in favor of vascularization of patch,which may facilitate the preservation of cardiac function posterior to SVR.