Résumé
Objective:To explore the value of endoscopic ultrasonography-guided carbon nanoparticles tattooing for preoperative localization of laparoscopic surgery for rectal cancer.Methods:Sixty patients diagnosed as having rectal cancer who underwent laparoscopic radical resection in the 900th Hospital of Joint Logistics Support Force from April 2018 to April 2019 were randomly divided into the endoscopic ultrasonography-guided tattoo group (group A), the colonoscopy-guided tattoo group (group B) and the control group (group C) by random number table. The leakage rate of dye in intestinal tract, complications, and the tattooed serosa stained with carbon nanoparticles during laparoscopic surgery were recorded. Identification time of lesions, the total operation time, the length of resected rectal segment, tumor distance to distal resection margin, and the rate of anal preservation were analyzed and the postoperative pathology were compared.Results:In group A, endoscopic ultrasonography revealed 2 cases of suspected tumor extension toward the anal side within distal intestinal wall. The extension length was 0.42 cm and 0.71 cm respectively, and the extension length was 0.36 cm and 0.64 cm under microscope respectively. In group B, the pathology result showed that the extension length was 0.53 cm under microscope. In group C, the pathology result showed that the extension length were 0.43 cm, 0.36 cm and 0.28 cm under microscope respectively. Obvious black staining in the rectal serosa was found in all tattooed patients during the surgery. There were scattered black staining spots at the surface of peritoneum and mesentery in 3 cases in group B. The identification time of lesions in group A and B were shorter than that in group C (1.29 ± 0.87 min, 1.31 ± 0.63 min VS 15.3 ± 10.50 min, P<0.05). The total operation time in group A and B were shorter than that in group C (176.12 ± 27.64 min, 175.67 ± 26.48 min VS 198.65 ± 38.67 min, P<0.05). The length of resected rectal segment in group A and B were shorter than that in group C (11.81 ± 5.76 cm, 12.31 ± 3.94 cm VS 15.24 ± 4.12 cm, P<0.05). The tumor distance to distal resection margin in group A and B were shorter than that in group C (3.61 ± 1.26 cm, 4.57 ± 1.58 cm VS 6.13 ± 2.47 cm, P<0.05). Anal preservation rates of three groups were 65.0% (13/20), 60.0% (12/20), 40.0% (8/20) respectively with no significant difference ( P>0.05). No residual tumor cells were found in any specimens. Conclusion:Carbon nanoparticles tattooing guided by endoscopic ultrasonography could reduce unnecessary intestinal segment incision and shorten the operation time. It can also reveal tumor extension toward the anal side within intestinal wall, which provides more accurate localization for the distal incision of the lower rectal cancer.
Résumé
Background: Resistance to antibiotics is the major cause for failure of Helicobacter pylori (Hp) eradication therapy. Therefore, exploring new eradication regimen has become a hotspot of research. Aims: To investigate the efficacy, safety and optimal dose of antofloxacin-based bismuth quadruple therapy for first-line Hp eradication. Methods: Four hundred patients with Hp infection and naive to eradication therapy were prospectively recruited from January 2019 to December 2019 at the 900th Hospital of Joint Logistics Support Force, PLA and were randomly divided into four groups: low-, normal-, and high-dose antofloxacin groups and control group, 100 cases in each group. Patients in low-, normal-, and high-dose antofloxacin groups received antofloxacin 100 mg, 200 mg, and 300 mg qd, respectively, pantoprazole 40 mg bid, bismuth potassium citrate 220 mg bid, and amoxicillin 1 000 mg bid for 14 days; patients in control group received levofloxacin 500 mg qd and the other three drugs with same dose and frequency for 14 days. Adverse events during treatment were recorded. Hp eradication was confirmed by
Résumé
Background: Endoscopic screening is an effective approach for detecting early gastric cancer. The interval of endoscopic surveillance should be defined based on the risk stratification of gastric cancer, so as to improve the screening efficiency. Aims: To investigate whether gastric cancer risk could be stratified according to endoscopic atrophic gastritis grading. Methods: Subjects who underwent gastroscopy at least two times between Jan. 2015 and Dec. 2019 at the 900th Hospital of Joint Logistics Support Force, PLA were enrolled in a retrospective study. The demographic data and information on endoscopy were recorded. The extent and degree of gastric atrophy under endoscopy was graded using Kimura-Takemoto classification system. Then the subjects were allocated into mild group (none atrophy and C-1), moderate group (C-2 and C-3) and severe group (O-1, O-2 and O-3) based on the grading. The correlation of endoscopic grading of atrophy with the risk of gastric cancer was analyzed. Results: A total of 8 736 subjects were enrolled, 4 154 were in mild group (47.6%), 2 409 in moderate group (27.6%), and 2 173 in severe group (24.9%). The mean endoscopic follow-up time was (1 052±643) d, and the mean endoscopic surveillance interval was (518±271) d. The overall coincidence rate of endoscopic diagnosis and pathological diagnosis for atrophy was 88.9%. During the follow-up period, gastric cancer was detected in 41 cases; the detection rates of mild group, moderate group and severe group were 0.07%, 0.54% and 1.15%, respectively (P<0.001). Conclusions: The risk of gastric cancer can be stratified according to the endoscopic atrophic gastritis grading, which is helpful for the decision of individualized endoscopic surveillance interval.
Résumé
Objective To explore the clinical value of carbon nanoparticles marker before neoadjuvant chemoradiotherapy ( NACRT) of locally advanced rectal cancer. Methods Clinical data of 18 patients ( 11 male and 7 female) with locally advanced rectal cancer admitted to Fuzhou General Hospital from July 2015 to December 2015 was analyzed retrospectively. Patients were 45. 8±12. 5 (35-68) years old. Before NACRT, carbon nanoparticles were injected through an endoscope. The multiple-point injection was 1 cm from the lesion ( 4 quadrants of the upper, lower, left and right) to avoid direct injection into the tumor. The injection suspension of carbon nanoparticles was 5 mg per point. After endoscopic marking, the duration of NACRT plus rest was 8 ± 2 ( 5-11 ) weeks, and then the surgery was performed. Effects of endoscopic carbon nanoparticles markers on judgment of the tumor size, the distance from the lower margin of the tumor to the anal border, the intraoperative condition and the rate of anus preservation were observed. Results The operation time was 10. 0±3. 5(5-15)min. No adverse reactions, and bleeding, perforation or other complications occurred. After NACRT, all tumors were reduced, completely disappeared in 7 cases ( 38. 9％) , and pathologically respond in 6 cases ( 33. 3％) . The distance between the lower margin of the tumor and the margin of the anal border was 6. 4 ± 1. 8 ( 4. 5-10. 0) cm. In the operation, 100％ lesions were found to be stained black outside the intestine, with clear location and partial lymph node dysphasia. Eight cases received anus preserving operation, and the rate of anus preservation was 44. 4％. Conclusion The carbon nanoparticles marker can accurately position the tumor and label the lymph node for locally advanced rectal cancer before NACRT. The dyeing effect is lasting, conducive to the surgery or follow-up observation.