Investigation of diagnostic method and treatment on acute appendicitis with acute intestinal obstruction as presenting manifestation / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>Prevention of the misdiagnosis of acute appendicitis when it first manifested as acute intestinal obstruction, and to search proper way of diagnosis and treatment for such event to provide the reference.</p><p><b>METHODS</b>Clinical data of 33 acute appendicitis cases presented with acute intestinal obstruction in Beijing Tong Ren Hospital during January 2000 and December 2015 were analyzed retrospectively.</p><p><b>RESULTS</b>All 33 patients were admitted to the Emergency Department with symptoms of various degrees abdominal pain and abdominal distension. There was no passage of gas and feces. The mean time of onset was (62.2±25.0) hours. The imaging examination showedthat all patients had complete bowel obstruction. Twenty one patients(63.6%) had peritonitis, three of whom developed with septic shock. Abdominal CT was performed in 17 patients preoperatively, which showed retention of gas and fluid in the small intestine in all the patients and 13 were suggestive of acute appendicitis. All of these patients received surgical treatment, 12 patients underwent laparoscopic exploration, and the remaining 21 patients received exploratory laparotomy during which acute appendicitis was confirmed to be the cause of intestinal obstruction, of whom 14(42.4%) was identified as mechanical intestinal obstruction. Nine patients underwent appendectomy and lysis of adhesion, five appendectomy and partial excision of the greateromentum. Nineteenpatients(57.6%) were identified as paralytic ileus and underwent appendectomy only. Twelve patients required respiratory and circulatory support and were admitted to ICU postoperatively. The mean duration time in ICU was(8.8±5.2) days. Postoperative pathology showedgangrene accompanied with perforation in the appendix. All patients were discharged without any complication. The length of hospital stay was (15.4±4.6) days. All patients were followed up for 3 ~ 12 months. One patient with chronic obstructive pulmonary disease developed repeated pulmonary infection and died of respiratory failure at 185 days postoperatively. The remaining patients were followed up and there were no patients developed intra-abdominalsepsis, intestinal obstruction, surgery-related complications, or death.</p><p><b>CONCLUSION</b>Patients with acute appendicitis presenting with acute intestinal obstruction are mostly in severe condition. Clinical diagnosis for this patients is difficult and surgery should be performed as soon as possible.</p>

Role of the small intestinal decompression tube and Gastrografin in the treatment of early postoperative inflammatory small bowel obstruction / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To evaluate the role of the small intestinal decompression tube (SIDT) and Gastrografin in the treatment of early postoperative inflammatory small bowel obstruction (EPISBO).</p><p><b>METHODS</b>Twelve patients presented EPISBO after abdominal surgery in our department from April 2011 to July 2012. Initially, nasogastric tube decompression and other conventional conservative treatment were administrated. After 14 days, obstruction symptom improvement was not obvious, then the SIDT was used. At the same time, Gastrografin was injected into the small bowel through the SIDT in order to demonstrate the site of obstruction of small bowel and its efficacy.</p><p><b>RESULTS</b>In 11 patients after this management, obstruction symptoms disappeared, bowel function recovered within 3 weeks, and oral feeding occurred gradually. Another patient did not pass flatus after 4 weeks and was reoperated. After postoperative follow-up of 6 months, no case relapsed with intestinal obstruction.</p><p><b>CONCLUSION</b>For severe and long course of early postoperative inflammatory intestinal obstruction, intestinal decompression tube plus Gastrografin is safe and effective, and can avoid unnecessary reoperation.</p>

Perioperative treatment effects of colorectal cancer in elderly patients / 中华老年医学杂志

Objective To explore the clinical features and perioperative treatment effects of colorectal cancer in elderly patients.Methods Retrospective analysis of clinical data especially focusing on perioperative treatment from 104 elderly patients with coloreetal cancer were performed.Results A total of 99 patients (95.2%) were cured or improved at discharge.Perioperative pulmonary infection occurred in 13 cases (12.5%), of whom 6 cases (5.8%) suffered from respiratory failure.Lower extremity deep venous thrombosis occurred in 3 cases (2.9%), incision infection in 6 cases (5.8%), wound dehiscence in 2 cases (1.9%), intestinal fistula in 1 case (1.0%) and gastroparesis in 1 case (1.0%).About 5 cases (4.8%) died from multiple organ failure.Conclusions Old age is not a contraindication in surgical treatment for colorectal cancer.Paying attention to accurate and timely treatment in perioperative peroid can reduce postoperative complications and improve patients' quality of life.

The diagnosis and surgical treatment of primary gastric lymphoma / 中华普通外科杂志

Objeetive To probe the clinical diagnosis and surgical treatment of primary gastric lymphoma (PGL). Methods Clinical data of 23 PGL patients identified by postoperative pathology were analyzed retrospectively. Sixteen patients underwent subtotal gastrectomy,3 patients underwent total gastrectomy,2 patients underwent palliative resection and 2 patients underwent exploratory laparotomy only. Postoperatively 21 patients received adjuvant treatment(chemotherapy and/or radiotherapy).The variables analyzed were type of surgery, histological type in accordance with Kiel's classification, Involvement of lymph nodes. Ann Arbor stage classification. Results The overall 5-year survival rate of these patients Was 80%,that of low grade malignancy patients was 90%,and of high grade malignancy was 40%.Thirteen patients were classified as stage Ⅰ E and seven as stageⅡE and three as stageⅢor Ⅳ,the 5-year survival rate was 90%,67%and 0,respectively.Nineteen patients underwent radical resection with 5-year survival rate of 92.3%.No patients undergoing palliative resection have survived more than 5 years. The prognosis of PGL with low grade malignancy and that of early stages(IE and Ⅱ E)and those undergoing radical excision was better than those with high grade malignancy, that of advanced stage(Ⅲand Ⅳ),and that undergoing palliative resection. Conclusions Preoperative diagnosis relies mainly on gastroscopy with biopsy and CT scan. For patients with early stage disease,radical resection combined with adjuvant therapy is the key factor in improving the prognosis. Chemotherapy or/and radiotherapy is useful management for patients with advanced stage disease.

Application of magnifying colonoscopy in diagnosis and treatment of colorectal neoplastic lesions / 中国康复理论与实践

@#ObjectiveTo evaluate the clinical value of magnifying endoscopy in diagnosis and treatment of colorectal benign neoplastic lesions.Methods78 colorectal lesions in 61 patients were examined with magnifying colonoscopy after indigo carmine dye, and a pit pattern diagnosis was made for every lesion according to Kudo's classification.All the lesions were totally resected, and the specimen were sent for pathologic examinations.ResultsThe diagnostic sensitivity of neoplastic lesions was 98.4% and specificity was 85.7% when types Ⅰ and Ⅱ represented the pit pattern of nonneoplastic lesions, whereas types Ⅲ, Ⅳ, and Ⅴ represented adenoma and early colorectal cancer. The overall accuracy in differentiating adenoma and early colorectal cancer from nonneoplastic lesions was 96.2%.94.5% of adenomarous lesions were treated by colonoscopy.ConclusionThe magnifying colonoscopy can provide an instantenous accurate diagnosis of tumorous lesions in colon and rectum. Synchronize, minimally invasive and curative treatment is possible to be completed by using it for a large number of lesions.

Effects on micro-vessel density after pre-operative intra-arterial infusion chemotherapy in colorectal cancer / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To evaluate the effects of pre-operative intra-arterial infusion chemotherapy on colorectal cancer.</p><p><b>METHODS</b>Twenty-eight patients with colorectal cancer, treated by surgery from February to October 2000, were divided into two groups randomly. There were 12 patients in group A (pre-operative intra-arterial infusion chemotherapy) and 16 in group B (control). Arterial contrast technique was used in group A, then mitromycin 10 mg, 5-Fu 1,000 mg, epirubicin 60 mg were given through Weidner's way.</p><p><b>RESULTS</b>Micro-vessel density in the center, surface of the tumor and adjacent tissue around the tumor were 40.46 +/- 7.06, 52.27 +/- 18.40, 49.92 +/- 8.15 in group A, and 46.09 +/- 12.21, 73.44 +/- 22.06, 51.94 +/- 12.64 in group B. Micro-vessel density on the surface in group A was significantly lower than that of group B (P < 0.05), with no significance between the center and the adjacent tissue.</p><p><b>CONCLUSION</b>Pre-operative intra-arterial infusion chemotherapy is able to reduce micro-vessel density on the surface of colorectal tumor.</p>

Colonoscopy in preoperative staging and treatment of colorectal cancer / 中华外科杂志

<p><b>OBJECTIVES</b>To investigate the value of colonoscopy for the diagnosis and preoperative staging of colorectal cancer, and evaluate the significance of correct preoperative staging in guiding treatment.</p><p><b>METHODS</b>28 patients with colorectal cancer were examined by general colonoscopy, magnifying endoscopy and endoscopic ultrasonography before operation. Preoperative staging, and proper treatment protocols were made.</p><p><b>RESULTS</b>Endoscopy revealed that 15 of the 28 patients had early colorectal cancer and 13 advanced colorectal cancer. The correct diagnosis rate for preoperative staging was 100%; the accuracy of penetrating depth was 89% (25/28). In the early cases, tumour invasion was confined to mucosal layer in 11 patients and submucosal layer in 4. Six patients with early cancers 6 cm from the anus were treated by endoscopic mucosa resection (EMR) or EMR combined with open surgery. No postoperative recurrence was found by endoscopy during the period of follow-up for 12 - 40 months.</p><p><b>CONCLUSION</b>Correct preoperative staging for colorectal cancer is of important significance in guiding treatment, especially in early staging cases. In order to improve the quality of life for colorectal cancer patients, we should treat them with individualized operation based on curative resection.</p>

The use of drainage after radical resection for rectal carcinoma / 临床外科杂志

Objective To summarize the experience of the use of drainage after radical resection for rectal carcinoma.Methods 87 cases of patients who underwent radical resection for rectal carcinoma from May 1996 to May 2000 were reviwed retrospectively.Results Among 40 cases who underwent abdominoperineal resection(APR),perineal wounds were healed at one stage in 37 case,perineal wound infections occurred in 3 case,bleeding in one case and bowel obstruction in one case.among the other 47 cases who underwent low anterior resection(LAR),intrapelvic infection occurred in one case,anastomosis leakage occurred in one case.Conclusions The use of drainage after radical resection for rectal carcinoma is a very important method to reduce the occurrence of local complications.

Effect of preoperative regional intra-arterial chemotherapy on serum vascular endothelial growth factor and endotatin levels in patients with colorectal carcinoma / 中国普通外科杂志

Objective To determine serum vascular endothelial growth factor (s-VEGF) and serum endostatin (s-endostatin) levels in patients with colorectal cancer after preoperative regional intraarterial chemotherapy (PRAC). Methods Peripheral venous blood was sampled preoperatively and postoperatively, and was assayed for VEGF and endostatin by ELISA. Results Patients' preoperative level of s-VEGF and s-endostatin elevated significantly, which was in close correlation with Dukes' stage. The level of s-VEGF and s-endostatin before chemotherapy elevated significantly compared with that on day 7 after chemotherapy and on postoperational day 1 and 14 after operation. In patients undergoing palliative resection, only the level of s-endostatin before chemotherapy was significantly higher than that on day 1 after operation. Conclusions PRAC, inhibiting angiogenesis, is of antitumor effect, the decrease of s-endostatin after chemotherapy may suggest the combination of chemotherapy and antiangiogenesis for a better antitumor effect.