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Objective To analyze the clinical significance of aberrant hepatic artery which originated from superior mesenteric artery in liver cancer and gastric cancer operations.Method Four hundred liver cancer patients who underwent digital subtraction angiography (DSA) and multislice spiral computed tomography angiography (MSCTA) and 86 gastric cancer patients who underwent MSCTA between June 2008 and June 2010 and operated at the First Affiliated Hospital of Guangxi Medical University were included in this study.Preoperatively,the origins of the aberrant hepatic arteries from superior mesenteric arteries were detected by medical imaging.Postoperatively,immunohistochemistry of lymphoid tissues around the aberrant hepatic arteries of the gastric cancer patients were performed using recombinant human cytokeratin 20 (CK20) and carcino-embryonic antigen (CEA) to determine the incidence of lymph node metastases around the aberrant arteries.Results Among 486 patients,49 patients with liver cancer and 14 patients with gastric cancer had an aberrant hepatic artery which originated from the superior mesenteric artery.The rate was 12.96％ (63/486).The hepatic artery ran in front of the pancreas in 2 patients (3.17％) and behind the pancreas in 61 patients (96.83％).Immunohistochemical analyses of CK20 and CEA were negative which revealed no metastases in the lymphoid tissues surrounding the aberrant arteries.Conclusions Aberrant hepatic artery originated from the superior mesenteric artery can be classified into the pre-pancreas type and postpancreas type.The majority of aberrant hepatic artery belonged to the post-pancreas type.The clinical significance of aberrant hepatic artery is that the hepatic hilar lymph nodes should be dissected in liver cancer and gastric cancer operations.
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ObjectiveTo study the dissecting necessity of lymph node around normal and abnormal hepatic artery in distal gastric cancer undergoing D2 lymphadenectomy.MethodsSixty gastric cancer patients receiving distal D2 lymphadenectomy by the same surgeon between June 2008 to June 2010 at the Department of Gastrointestinal Surgery, First Affiliated Hospital of the Guangxi Medical University were included in this study. The lymph adipose tissue around the anatomically normal and aberrant hepatic artery was carefully dissected, and the lymph nodes sent for recombinant human cytokeratin 20 (CK20) and carcino-embryonicantigen( CEA )micrometastasisimmunohistochemistry.ResultsWiththe micrometastasis immunohistochemistry of CK20 and CEA, we found the metastasise rate of lymph node around the normal hepatic artery was 27％.Patient age, tumor size, Borrmann type, TNM staging were correlated with the lymph node metastase. There were 7 cases with abnormal hepatic artery originating from the superior mesenteric artery. The hepatic artery ran in front of the pancreas in 1 case and behind the pancreas in 6 cases. We found there are no metastases in the lymph adipose tissue surrounding the abnormal artery.ConclusionsCK20,CEA are suitable immunohistochemical targets for estimating the lymph node micrometastasis. In distal gastric cancer age at 60 or older years, tumor larger than 3 cm and Borrmann Ⅲ-Ⅳ type were risk factors for metastasis of lymph nodes around normal hepatic artery, while aberrant hepatic arteries originating from the superior mesenteric artery are much less likely to have positive lymph nodes in D2 lymphadenectomy.
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Objective Evaluate the diagnostic value of PET/CT in the preoperative advanced gastric carcinoma comparing with mult;-slice spiral computed tomography. Methods Thirty-nine advanced gastric carcinoma patients taking PET/CT and abstract 40 advanced gastric carcinoma patients performing MSCT before operation,were done the TNM staging, and the Results were compared with the operation histopathology. Results For diagnosing primary lesions, regional lymph nodes, N3 lymph nodes ,PET/CT was accurate in 92.3% , 66.7% and 100.0%.Instead, MSCT was accurate in 82.0% , 50.0% and 62.5%. Conclusions (1) PET/CT and MSCT have high accuracy in diagnosing primary lesions and regional lymph nodes. But for detecting the N3 lymph nodes and distant metastasis, PET/CT has higher accuracy than MSCT. PET/CT combining abdominoscopy may decrease or avoid exploratory laparotomy.
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Objective To discuss the training method to promote nursing error reporting initiative and investigate its effects on nursing error and accident incidence.Methods Totally 70 nursing units in our hospital were divided into the test group and the control group with 35 units in each group.One nurse was selected from each unit in the test group to composite the training group and received tripartite training,which included the relevant theoretical knowledge lectures,group discussions and analysis,training scenarios under the guidance of professional teachers.The control group received no special training.Before and after the training,the nulpses'attitude of the erroneous theory of cultural knowledge sharing.nursing error reporting initiative.and its effects on nursing error and accident rate were investigated and compared in the two groups by paired t test.Results After the training,the nurses'sharing the erroneous theory of cultural knowledge and attitude and willingness to report nursing error were statistically different(P＜0.01).Conclusions The training method Can improve initiative and willingness of nursing error reporting,decrease nursing error and accident incidence.
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Objective To discuss how to improve the current status on clinical therapy for advanced gastric carcinoma. Methods Related literatures searched on Medline were collected and reviewed. Results The 5th edition of UICC/AJCC TNM staging system of gastric carcinoma is useful to evaluate the prognosis of patients with advanced gastric carcinoma followed by extended lymphadenectomy. There are many factors influencing their prognosis including disease stage, extent of lymphadenectomy, assistant therapy and so on. Conclusion It is significant for patients with advanced gastric carcinoma to undergo individualized extended lymphadenectomy and comprehensive therapy to improve their prognosis after radical gastrectomy
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Objective To investigate the expression of vascular endothelial growth factor-C(VEGF-C) and matrix metalloproteinase-7(MMP-7) in gastric carcinoma and their correlation with tumor invasion and(metastasis).Methods Streptavidin peroxidase immunohistochemistry technique(SP)was used to detect the(expression) of VEGF-C and MMP-7 in 60 gastric carcinoma specimens,60 specimens of gastric mucosa(adjacent) to carcinoma,and 30 regional lymph node specimens.Results The positive expression rate of VEGF-C,MMP-7 in gastric carcinoma was markedly higher than that in normal gastric mucosa and gastric mucosa adjacent to carcinoma.The positive expression rates of VEGF-C and MMP-7 in metastatic regional lymph nodes were significantly higher than that in non-metastatic regional lymph nodes(P