Effects and indications of non-operative management for acute upper gastrointestinal perforation / 中华普通外科杂志

Objective:To evaluate the curative effect of non-surgical treatment of acute upper gastrointestinal perforation and analyze the risk factors.Methods:We retrospectively reviewed medical records of patients who were diagnosed with acute upper gastrointestinal perforation from Jan 2016 to Dec 2018 in Liaocheng People's Hospital. At first, all patients were put on non-surgical treatment. According to whether or not converted to surgery, they were divided into non-surgical treatment group (163 cases) and surgery group (29 cases). Univariate analyses and multivariate analyses were conducted.Results:192 patients with acute upper gastrointestinal perforation were cured without serious complications and death. The non-surgical treatment efficiency was 84.9%. The onset time ( OR=0.238, P=0.046), heart rate ( OR=1.043, P=0.004), serum albumin ( OR=0.869, P=0.002) are independent risk factors. Conclusion:Non-surgical treatment of acute upper gastrointestinal perforation is safe and effective. Onset time, heart rate and serum albumin are independent risk factors. In patients when time of onse t>12h, heart rate >100 beats/min, hypoalbuminemia, and high level of procalcitonin , conversion to surgery should be considered.

The efficacy and safety of morinidazole combined with appendectomy in treating purulent or gangrenous appendicitis: a randomized, controlled, double-blind, multi-center clinical trial / 中华普通外科杂志

Objective To assess the efficacy and safety of morinidazole combined with appendectomy in treating purulent or gangrenous appendicitis.Methods Double-blind randomized controlled multicenter clinical trial was designed and conducted.Totally 437 patients were included,219 in the control group and 218 in the experimental group.Cases of purulent or gangrenous appendicitis were enrolled and assigned to each of the two groups.The control group received ornidazole injection for 5 to 7 days while the experimental group received morinidazole injection.Both groups underwent appendectomy.Clinical response,micrombiological outcomes,overall response were evaluated.Adverse events and side effects were recorded.Results No significant difference was observed between the two groups regarding the clinical healing rate at 5-10 days after medicine withdrawal,anaerobia clearance and overall healing rates.Adverse events occurred in 140 patients (32.1％).Incidence of adverse events in the control group and the experimental group was 34.7％ and 29.4％,respectively (P ＞ 0.05).The overall incidence of side effects was 15.1％ (66 cases).Side effects were less seen in the experimental group compared with that in the control group (11.5％ vs.18.7％,P ＜ 0.05).The most frequent side effects were aminotransferase rising,thrombocytosis,nausea,vomiting and electrocardiographic abnormality.Conclusions The effect of morinidazole plus operation was comparable with ornidazole in treating purulent or gangrenous appendicitis.The safety of morinidazole is better than ornidazole.

Analysis of gastric gastrointestinal stromal tumors in Shandong Province: a midterm report of multicenter GISSG1201 study / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To summarize the treatment status of gastric gastrointestinal stromal tumor (GIST) in Shandong province,by analyzing the clinicopathological features and prognostic factors.</p><p><b>METHODS</b>Clinicopathological and follow-up data of 1 165 patients with gastric GIST between January 2000 and December 2013 from 23 tertiary referral hospitals in Shandong Province were collected to establish a database. The risk stratification of all cases was performed according to the National Institutes of Health(NIH) criteria proposed in 2008. Kaplan-Meier method was used to calculate the survival rate. Log-rank test and Cox regression model were used for univariate and multivariate prognostic analyses.</p><p><b>RESULTS</b>Among 1 165 cases of gastric GIST, 557 were male and 608 were female. The median age of onset was 60 (range 15-89) years. Primary tumors were located in the gastric fundus and cardia in 623 cases(53.5%), gastric body in 346 cases(29.7%), gastric antrum in 196 cases(16.8%). All the cases underwent resection of tumors, including endoscopic resection (n=106), local resection (n=589), subtotal gastrectomy(n=399), and total gastrectomy(n=72). Based on the NIH risk stratification, there were 256 cases (22.0%) at very low risk, 435 (37.3%) at low risk, 251 cases (21.5%) at intermediate risk, and 223 cases (19.1%) at high risk. A total of 1 116 cases(95.8%) were followed up and the median follow-up period was 40 (range, 1-60) months. During the period, 337 patients relapsed and the median time to recurrence was 34 (range 1-60) months. The 1-, 3-, and 5-year survival rates were 98.6%, 86.1% and 73.4%, respectively. The 5-year survival rates of patients at very low, low, intermediate, and high risk were 93.1%, 85.8%, 63.0% and 42.3% respectively, with a statistically significant difference (P=0.000). Multivariate analysis showed that primary tumor site (RR=0.580, 95%CI:0.402-0.835), tumor size (RR=0.450, 95%CI:0.266-0.760), intraoperative tumor rupture(RR=0.557, 95%CI:0.336-0.924), risk classification (RR=0.309, 95%CI:0.164-0.580) and the use of imatinib after surgery (RR=1.993, 95%CI:1.350-2.922) were independent prognostic factors.</p><p><b>CONCLUSIONS</b>The choice of surgical procedure for gastric GIST patients should be based on tumor size. All the routine procedures including endoscopic resection, local excision, subtotal gastrectomy and total gastrectomy can obtain satisfactory curative outcomes. NIH classification has a high value for the prediction of prognosis. Primary tumor site, tumor size, intraoperative tumor rupture, risk stratification and postoperative use of imatinib are independent prognostic factors in gastric GIST patients.</p>

Postoperative delirium in elderly patients after gastrointestinal surgery / 中华普通外科杂志

Objective To study postoperative delirium in elderly patients.Methods We investigate the morbidity of postoperative delirium in 142 elderly patients (≥ 60 years)after gastrointestinal surgery by using Confusion Assessment Method (CAM) and Delirium Rating Scale Revised-98 (DRS-R98) scores.Data were analyzed using Student's t test and Chi-squaretest respectively with SPSS 19.0.Results Of 142 patients,delirium was diagnosed in 36 patients(25.4％),delirium developed in 4,7,17,7,1 patients in posto perative 1,2,3,4-7,7 + days respectively.There were significant difference in hospital stay:17.7 ± 2.6 days (postoperative delirium) and 13.4 ± 2.3 days (no postoperative delirium),t =4.608,P =0.000 1.The postoperative complications (52.8％ / 23.6％,x2 =10.710,P =0.001) and ICU admission (22.2％/6.6％,x2 =6.939,P =0.008) significantly increased.Conclusions Postoperative delirium is recognized as one of the most common surgical complications in elderly patients with gastrointestinal surgery leading to other major postoperative complications,and prolonged hospitalization.

Observation of the effect of Miles laparoscopic sigmoid colostomy surgery for elderly patients with colorectal cancer / 中国基层医药

Objective To investigate the effect of Miles laparoscopic sigmoid colostomy surgery for elderly patients with colorectal cancer .Methods The clinical data of 78 elderly patients with colorectal cancer underwent surgery were chosen .According to the different operation method , they were randomly divided into the observation group and control group ,39 cases in each group .The observation group was treated with laparoscopic Miles ,and the control group underwent surgery for abdominal Miles .The safety,efficacy,early complications of the two groups were analyzed and compared .Results The incidence rate of postoperative complication , excellent rate of ostomy surgery 6 months after operation in the observation group were 5.13%, 66.67%, respectively, which were better than 38.46%,20.51%in the control group (χ2 =12.70,9.69,all P<0.05).The defecate feeling of the observation group was better than that of the control group (χ2 =29.40,P<0.05).The difference of patients'quality of life and physical function between the two groups was statistically significant (t=3.30,P<0.05).Conclusion The clinical effect of laparoscopic sigmoid colostomy surgery Miles in the treatment of elderly patients with colorectal cancer is bet -ter than traditional open surgery ,it has obvious practical significance such as reducing the short and long term compli -cations and improving the quality of life of patients .

Impact of microbial immune enteral nutrition on postoperative insulin resistance and infectious complication of patients with abdominal infection / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To investigate the effect of microbial immune enteral nutrition composed of probiotics, deep sea fish oil, glutamine and nutrison on postoperative immune status, insulin resistance and infectious complication morbidity in patients with abdominal infection.</p><p><b>METHODS</b>From September 2010 to April 2013 in Shandong Liaocheng City Hospital, 96 patients with upper gastrointestinal perforation were prospectively randomized into the treatment group (microbial immune enteral nutrition, n=48) and the control group(conventional enteral nutrition, n=48). Number of T cell subsets (CD3(+), CD4(+), CD8(+), CD4(+)/CD8(+)) and natural killer (NK) cell, procalcitonin (PCT), fasting blood glucose (FBG), fasting insulin (FINS), insulin resistance index (InHOMA-IR) calculated by the homeostasis model assessment(HOMA) were detected before operation and on days 3 and 7 after operation and compared between the two groups. The incidence of postoperative infectious complication was collected and compared as well.</p><p><b>RESULTS</b>There were no significant differences in immune indexes and insulin resistance-associated indexes between the two groups before operation and on the day 3 after operation(all P>0.05). On postoperative day 7, CD4(+), CD4(+)/CD8(+) and NK cells in treatment group were significantly higher than those in control group [(39.1±4.3)% vs. (30.1±5.7)%, P=0.043; 1.76±0.21 vs. 1.36±0.12, P=0.038; (19.3±4.8)% vs. (13.3±3.2)%, P=0.032], while FINS, lnHOMA-IR and PCT in treatment group were significantly lower than those in control group [(7.3±1.7) mU/L vs. (10.2±2.1) mU/L, P=0.041; 0.60±0.05 vs. 0.88±0.06, P=0.039; (0.12±0.07) μg/L vs. (0.35±0.12) μg/L, P=0.028]. Postoperative infectious complication morbidity was significantly lower in treatment group as compared to control group [18.8%(9/48) vs. 39.6%(19/48), P=0.025].</p><p><b>CONCLUSION</b>Microbial immune enteral nutrition composed of probiotics, deep sea fish oil, glutamine and nutrison can improve the immune status, decrease the level of insulin resistance, and reduce the incidence of postoperative infectious complication for patients with abdominal infection due to upper gastrointestinal perforation.</p>

Effect of indomethacin on insulin resistance after operation and metabolic response to surgical injury in patients with gastrointestinal tumor / 中华临床营养杂志

ObjectiveTo investigate the effect of indomethacin on insulin resistance and metabolic response to surgical injury in patients with gastrointestinal tumor.MethodsFifty-eight cases with gastric cancer or colon cancer were divided into an indomethacin group (n =28) and a control group (n =30).All the operations were performed under general anesthesia.Patients in both groups were given parenteral nutrition 24 hours after operation for 5 ～ 7 days.The patients in the indomethacin group were treated with indomethacin suppository ( 100 mg/12 h).Fasting blood glucose (FBG),fasting serum insulin (FINS),creatinine (Cr),blood urine nitrogen (BUN),triglyceride (TG),free fatty acid (FFA) and C-reactive protein (CRP) of the two groups were detected on the day before operation,and 24,72,120 hours after operation.Insulin resistance index (HOMA-IR) was calculated by using the homeostasis model assessment (HOMA).The vital signs were observed in 72 hours after operation.ResultsThe vital signs in the indomethacin group were more steady.The levels of FBG,FINS,and InHOMA-IR of the control group 24 hours and 72 hours after operation were higher than before operation ( all P =0.000) and those of the indomethacin group ( all P ＜0.01 ).In both of the two groups,the levels of Cr,BUN,TG,and FFA were higher than those before operation,but declined over time.All the indexes in the indomethacin group 120 hours after operation decreased significantly compared with the levels 24 hours after operation ( all P =0.000 ),as well as with the levels in the control group 120 hours after operation ( all P ＜ 0.05 ).No significant difference was found in the level of CRP between the two groups and between before and after operation.ConclusionIndomethacin could reduce the postoperative stress hyperglycemia and insulin resistance in patients with gastrointestinal tumor.

Effect of gastric signet ring cell cancer on T,N,M stages / 国际外科学杂志

Objective To evaluate the effect of the gastric signet ring cell cancer(SIG)on the T,N,M stages. Methods Three hundred and fifty-one patients undergoing D2 or greater gastrectomy for gastric cancer were ana lyzed retrospectively.The T,N,M stages of 59 patients with SIG and 161 patients with tubular adenocarcmonla (TUB)were compared using univariate and multivariate analysis.Results The chi-square test showed that there were not significant differences in T,N,M stages between TUB and SIG.Multivariate Logistic regression analysis indicated that SIG Was not a independent factor influencing the T,N.M stage.Conclusion Gastric cancer with SIG has not higher T,N,M stages than that with TUB.