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Objective:To investigate the clinical efficacy of totally laparoscopic pylorus-preserving gastrectomy (TLPPG) with preservation of the first branch of the right gastroepiploic vein in early gastric cancer (EGC).Methods:The retrospective and descriptive study was conducted. The clinicopathological data of 38 EGC patients who were admitted to the Subei Hospital Affiliated to Yangzhou University from July 2018 to May 2021 were collected. There were 18 males and 20 females, aged 60 (range, 39?73) years. All patients underwent TLPPG with preservation of the first branch of the right gastroepiploic vein.Observation indicators: (1) surgical and postoperative condi-tions; (2) postoperative histopathological examination. (3) follow-up. Follow-up was conducted using outpatient examination, WeChat interview and medical record review to detect the nutritional status, residual stomach function, cholecystolithiasis, tumor recurrence and metastasis and death of patients. Follow-up was up to July 2022. Measurement data with normal distribution were represented as Mean± SD, and measurement data with skewed distribution were represented as M(range). Count data were described as absolute numbers. Results:(1) Surgical and postoperative conditions. All 38 patients underwent TLPPG with preservation of the first branch of the right gastroepiploic vein successfully, without laparotomy conversion. The operation time, volume of intraoperative blood loss, time to postoperative first flatus, time to postoperative first liquid food intake and duration of postoperative hospital stay of the 38 patients were (180±28)minutes, (58±38)mL, (2.7±0.6)days, (3.4±0.7)days and (10.3±2.8)days, respectively. Of the 38 patients, there were 6 cases with postoperative complications ≥grade Ⅱ of Clavien-Dindo classification. (2) Postoperative histopatho-logical examination. The tumor diameter, distance from proximal resection margin to tumor and distance from distal resection margin to tumor of the 38 patients were (1.8±0.5)cm, (3.4±0.2)cm and (4.3±0.4)cm, respectively. Both of proximal and distal resection margin was negative. Numbers of lymph node examined and numbers of lymph node examined in the No.6 lymph node of the 38 patients were 23.3±3.9 and 3.4±1.1, respectively. There were 38 cases with pathological T1 stage including 23 cases of T1a stage and 15 cases of T1b stage. There were 36 cases with pathological N0 stage and 2 cases with pathological N1 stage. There were 36 cases with pathological ⅠA stage and 2 cases with pathological ⅠB stage of TNM staging. (3) Follow-up. All 38 patients were followed up for 18(range, 12?48)months. The hemoglobin, serum albumin and total serum protein of the 38 patients were (125.4±5.8)g/L, (42.4±2.3)g/L and (71.6±2.1)g/L, respectively, at postoperative 6 month. Endo-scopy was used to evaluate the function of residual stomach of patients at postoperative 12 month. There were 4 patients with moderate amount of food remaining in the residual stomach. No patient suffered reflux esophagitis, reflux gastritis and bile reflux. None of the 38 patients received post-operative chemotherapy, and there was no tumor recurrence and metastasis or death occured in patient.Conclusion:TLPPG with preservation of the first branch of the right gastroepiploic vein is safe and feasible for the treatment of EGC patients with tumor located at 1/3 of the middle segment of stomach.
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Objective To discuss the imaging manifestations and clinical characteristics of Askin tumor.Methods 12 cases of Askin tumor confirmed by surgically and histopathologically were included in this study.The MSCT signs and clinical data were summarized.Results In 12 cases of Askin tumor,7 cases located in the chest wall;7 case were hospitalised with rapid enlargementd painful lump(58.3%,7/12).9 cases were performed surgery and postoperative radio chemotherapy,6 patients experienced metastatic or recurrent tumors during the following year(66.7%,6/9).Askin tumor often occurred in the chest-lung junction region,had the diameters of 2.0-13.0 cm,11 cases showed inhomogeneous density (91.7%,11/12), 1 case showed calcification (8.3%,1/12), ill-defined margin(100%,12/12),12 cases showed intense but inhomogeneous enhancement following contrast administrationin (100%,12/12),11 cases had the feature of pleura invasion (91.7%,11/12), 9 cases with pleural effusion(75.0%,9/12), 1 case with swollen lymph nodes in mediastinum(8.3%,1/12), and 4 cases with lytic lesion of adjacent bone(33.3%,4/12).Conclusion Askin tumor often occurrs in the chest-lung junction region with rapid enlargementd painful lump as the primary symptom;the tumor show the infiltration diffuse growth;calcification and adjacent lymph node metastasis is not very common.
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Objective To discuss MSCT signs of colon multiple diverticulum in order to improve the accuracy of diagnosis.Meth-ods MSCT signs and clinical data of 30 cases with colon multiple diverticulum of were analyzed retrospectively.Imaging character-istics of colon multiple diverticulum were summarized and comparated with the results of colonoscopic appearance.Results There were 30 cases of colon multiple diverticulum confirmed by colonoscopy,including 1 6 cases in the ascending colon,6 cases the de-scending colon,5 cases the sigmoid colon,1 case transverse colon,2 cases the whole colon,5 cases with diverticulitis.Multiple pro-jecting processes were showed in 1 9 cases(63.3%,1 9/30),lesion diameter were 3.0-10.0 mm,gas or liquid filled in the lesion in 1 1 cases,small bezoar filled in 8 cases and the surrounding fat gaps were fuzzy in 5 cases.There was no any MSCT abnormal sign in 1 1 cases.Conclusion The typical MSCT signs of colon multiple diverticulum are multiple projecting processes,which size is smaller than 1 cm and filled with gas,liquid or small bezoar.The sign of surrounding fat gap fuzzy often means diverticulitis.
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Objective To quantify the heart and liver iron overload in thalassemia patients and discuss the relationship of iron deposition between them,and to evaluate the accuracy of using hepatic iron concentration ＞ 15 mg/g dry tissue as an index to predict heart iron deposition as used in clinical practice.Methods One hundred and three transfusion-dependent patients with thalassemia,who were older than 5 years,underwent MRI heart and liver measurement to obtain T2 * values.The Spearman rank correlation was employed to analyze the relationship between cardiac T2 * and liver T2 * values.By using liver T2 * =0.96 ms as standard setting,patients were divided into two groups,and the differences of cardiac T2 * values between the two groups were compared by Wilcoxon rank sum test.Then by using cardiac T2 * =10,20 ms as standard setting,patients were divided into 3 groups,and the differences of liver T2 * values among the 3 groups were compared by Wilcoxon rank sum test.The ROC curves were drawn to predict the possibility of using hepatic iron concentration ＞ 15 mg/g dry tissue as an index of cardiac iron deposition.Results The cardiac and liver T2 * values of the 103 thalassemia patients showed low correlation(r =0.453,P =0.000).With the liver T2 * value reduced,the cardiac T2* value did not decline proportionally.The cardiac T2 * value range and median of 25 patients' group whose liver T2 * ＜ 0.96 ms were 4.70 to 41.70 ms and 12.10 ms,respectively.The cardiac T2 * value range and the median of 78 patients' group whose liver T2 * ＞ 0.96 ms were 4.80 to 51.10 ms and 26.10 ms,respectively.There was statistically significant difference between those of the two groups(Z =-3.566,P =0.000).The liver T2 * value range and the median of 20 patients'group whose cardiac T2 * ＜ 10 ms was 0.68 to 3.83 ms and 1.06 ms,respectively.The liver T2 * value range and the median of 58 patients' group whose cardiac T2 * ≥20 ms were 0.74 to 14.80 ms and 1.76 ms,respectively.There was statistical difference between those of the two groups(Z =-3.553,P =0.000).The liver T2 * value range and the median of 25 patients' group with cardiac 10 ms≤T2 * ＜20 ms were 0.69 to 13.59 ms and 0.99 ms,respectively.The values were significantly different from that of T2* ≥20 ms group(Z =-3.951,P =0.000).The liver T2 * values of cardiac T2* ＜ 10 ms group was not statistically different from that of 10 ms≤T2* ＜20 ms group(Z =-0.046,P =0.964).To predict cardiac iron deposition with the index of hepatic iron concentration ＞ 15 mg/g dry tissue,the area under the ROC curve was 0.771.The sensibility was 42.2％,the specificity was 89.7％.Conclusions There is low correlation between heart and liver iron level in thalassemia patients with long-term transfusions.Patients with hepatic iron concentration ＞ 15 mg/g dry tissue have a higher incidence of heart iron deposition,but the accuracy of using hepatic iron concentration as an index to predict myocardial iron deposition is low to moderate.