Analysis and prevention of postoperative delayed hemorrhage associated with radical D2 gastrectomy / 中国肿瘤临床

Objective:To investigate the cause, treatment, and prognosis of delayed hemorrhage in patients who underwent radical gastrectomy. Methods:The clinical data of 294 patients who underwent radical gastrectomy in the Second Hospital Affiliated from Nanchang University from January 2015 to October 2015 were retrospectively analyzed. Results:A total of 15 patients suffered from delayed hemorrhage and accounted for 5.1%of the gastric cancer cases in our hospital for the same period of radical gastrectomy. Of the 15 patients, 9 underwent laparoscopic radical gastrectomy and 6 received open radical gastrectomy resection. Large vascular hemorrhage was found in 7 cases. Anastomosis and anastomotic ulcer induced hemorrhage were observed in 3 cases. Duodenal stump rupture induced hemorrhage was detected in 2 cases. Hemorrhage was also observed in some parts in 2 cases. Likewise, hemorrhage occurred in 1 case, but the affected parts were unknown. Of the 11 patients who underwent a second operation, 2 were subjected to digital subtraction angiography (DSA) and transcathete arterial embolization (TAE) to stop hemorrhage. Endoscopic hemostasis was performed to stop hemorrhage in 1 case. Conservative treatment was administered to stop hemorrhage in 1 case. The secondary surgery rate was 73.3%(11/15) with mortality and curative rates of 40%(6/15) and 60%(9/15), respectively. Conclusion:For delayed hemorrhage after D2 of gastric cancer, a second radical surgery and death rates were high. Therefore, patients suffering from hemorrhage should be subjected to comprehensive clinical treatment and positive measures. Major vascular bleeding, anastomotic leakage, anastomotic ulcer, and duodenal stump rupture are relevant risk factors. Anastomotic fistula and celiac artery bleeding complications caused hemorrhage is the leading cause of death. Extensive bleeding and unstable vital signs should be checked. A second operation and abdominal drainage should also be timely conducted to as effective methods. Realistic and conservative treatment can be administered to patients with stable vital signs and low amount of blood loss. Endoscopic hemostasis can be applied to alleviate simple anastomotic ulcer bleeding. DSA can be initially performed to detect unknown bleeding sites. TAE can be subsequently used to treat hemorrhage.

Updates on lymph node metastasis in early gastric cancer / 中华消化外科杂志

Japanese gastric cancer treatment guidelines list options for treatment of each stage of early gastric cancer (EGC).The treatment of EGC is closely related to the lymph node metastasis, and the accurate prediction of lymph node metastasis is related to the choice of the treatment options and the prognosis of the patients.The lymph node metastasis of EGC is evaluated according to the clinicopathological factors, imaging,molecular markers and sentinel lymph node (SLN) tracer biopsy.A two-step method for the management of EGC treated with endoscopic mucosal resection/endoscopic submucosal dissection (EMR/ESD) is recommended.While for those EGC patients not suitable to receive EMR/ESD, imaging or molecular marker and SLN tracer biopsy technology are applied to determine lymph node status.

Updates in the management of en-bloc mesogastric excision applied to radical resections for gastric cancer / 中华消化外科杂志

D2 radical gastrectomy is widely accepted as surgical procedures for the resectable gastric cancer.However,cancer recurrence and five-year survival rate after radical resection are not satisfactory,and the surgical procedures should be further improved.En bloc mesogastric excision (EME) is one of the new attempts to change the status based on the embryoloical and anatomical understanding of mesogastrium.

Application progress of different approaches splenic hilar lymph node dissection in laparoscopic radical gastrectomy for gastric cancer / 中华外科杂志

Laparoscopic spleen-preserving splenic hilar lymphadenectomy (LSPL) is a operation conducted experimentally in the current. Current reports showed that it can be safely completed through different approach, such as the right, left, medial and retropancreatic approach. This paper summarized the steps and characteristics of different approaches LSPL and compared the differences between each other. The application status of LSPL in laparoscopy-assisted radical gastrectomy were reviewed. The security, feasibility and the problem to be solved of LSPL, improvement measure also be explored in this paper.

Effect of body mass index on postoperative short-term outcomes of laparoscopy radical gastrectomy: a meta-analysis / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To evaluate the effect of body mass index (BMI) on postoperative short-term outcomes of laparoscopy radical gastrectomy by meta-analysis.</p><p><b>METHODS</b>A literature search was performed in PubMed, EMBASE, Cochrane Library databases, CNKI, and CBM, Wanfang database to screen clinical trials published before October 2014 that compared short-term outcomes between high BMI and low BMI patients undergoing laparoscopy radical gastrectomy. RevMan 5.2 was used to perform the meta-analysis. Begg's and Egger's tests were carried out with Stata 12.0 software to evaluate the publication bias of enrolled literatures.</p><p><b>RESULTS</b>Twelve studies involved a total of 4798 gastric cancer patients after laparoscopy radical gastrectomy. There were 1215 patients in high BMI group(BMI≥25 kg/m2) and 3583 patients in the low BMI group (BMI<25 kg/m2). Compared with the low BMI group, the high BMI group were associated with longer operation time (SMD=0.64, 95%CI:0.35-0.93, P=0.000), more intraoperative blood loss(SMD=0.63, 95%CI:0.24-1.03, P=0.002), less retrieved lymph nodes(SMD=-0.44, 95%CI:-0.72--0.17, P=0.002), and more postoperative complications(OR=1.44, 95%CI:1.19-1.74, P=0.000). There were no significant differences in postoperative hospital stay, the time to first flatus and initial complication(P>0.05).</p><p><b>CONCLUSION</b>The higher BMI may result in a longer operation time, more intraoperative blood loss and a higher rate of postoperative complication after laparoscopy radical gastrectomy.</p>

Effect of calcitonin gene-related peptide (CGRP) on myocardial ischemic injury in rat / 中国病理生理杂志

AIM: To study the protective effects of intravenous (iv) CGRP on myocardial injury in rat. METHODS: Establish a rat myocardial ischemic injury model by subcutaneous injection of single dose of isoproterenol (ISO), and treat the model with single dose of iv CGRP. Two hours later, serum CK, LDH, MDA and SOD levels were measured, MDA and SOD in myocardial tissue were tested, and myocardial tissue structures were observed. RESULTS:(1) Serum MDA and tissue MDA levels increased significantly and serum SOD and tissue SOD decreased significantly in injury group, in the CGRP treated group, the above changes were reversed (P