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Gastrointestinal neoplasms is the most common digestive tract neoplasms, and its incidence rate is increasing year by year. Compared with other solid tumors, the application of immune checkpoint inhibitors in gastrointestinal neoplasms is still in the stage of continuous exploration. This paper intends to review the relevant research and latest progress of immune checkpoint inhibitors in advanced gastric cancer, mismatch repair function defect/microsatellite high instability and mismatch repair function integrity/microsatellite stability or microsatellite low instability, and further evaluate the effectiveness and safety of immunotherapy combined with relevant studies.
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Objective:To explore the value and advantages of perioperative nutritional support in enhanced recovery after surgery (ERAS).Methods:The clinical data of patients admitted to Jinjiang City Hospital for acute abdomen and undergoing surgery from April 2018 to January 2021 were collected. They were divided into two groups: the enhanced recovery after surgery group (ERAS group, 78 cases) and the traditional perioperative management group (CPM group, 75 cases). The nutritional risk assessment of NRS2002 was performed on admission to the two groups. The postoperative inflammatory indexes, nutrition and rehabilitation related indexes were compared between the two groups.Results:There was no significant difference in preoperative NRS 2002 score, operation method, operation time and blood loss between ERAS group and CPM group ( P>0.05). There was no significant difference in C-reactive protein (CRP), albumin (Alb) and prealbumin (PA) between ERAS group and CPM group before operation ( P>0.05). The ALb and PA of the two groups on the first day after operation were significantly lower than those before operation, and the CRP levels on the first, third, fifth and seventh day after operation were higher than those before operation( P<0.05), with significant difference. The CRP level of ERAS group was lower than that of CPM group on the third day after operation, with significant difference ( P<0.05). On the 7th day after operation, the levels of Alb and PA in ERAS group were higher than those in CPM group ( P<0.05). The recovery time of gastrointestinal function and hospitalization days in ERAS group were significantly reduced, and the total cost of hospitalization was significantly less than that in CPM group ( P<0.05). Conclusions:Perioperative effective nutritional support is helpful to accelerate the recovery of patients with acute abdomen. The application of enhanced recovery after surgery can effectively improve the nutritional status of patients with acute abdomen, reduce the incidence of complications and improve the clinical outcome of patients.
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Objective:To explore the relationship between the level of C-reactive protein/serum albumin ratio (CAR) and early postoperative anastomotic leakage in patients with colorectal cancer.Methods:From September 2016 to September 2019, all colorectal cancer patients who were treated in gastrointestinal surgery of Jinjiang hospital in Fujian Province were collected for retrospective analysis. The baseline data of the patients were collected. The blood C-reactive protein (CRP), procalcitonin (PCT) and serum albumin (ALB) were monitored on the first, third, fifth and seventh days after operation, and the results were statistically analyzed.Results:There was no significant difference in baseline data such as age, body mass index (BMI), operation time and intraoperative hemorrhage between the anastomotic leakage group and the non anastomotic leakage group ( P>0.05), but the hospitalization time of the anastomotic leakage group was longer than that of the non anastomotic leakage group ( P<0.05). The CRP level on the 3rd and PCT level on the 5th day after operation in the anastomotic leakage group were higher than those in the non anastomotic leakage group, with significant difference ( P<0.05). The CAR value on the 3rd and 5th day after operation in the anastomotic leakage group was higher than those in the non anastomotic leakage group with significant difference ( P<0.05). Conclusions:CAR can predict early anastomotic leakage in patients with colorectal cancer.
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Objective To discuss the clinical value of new- utility anal vacuum tube in preventing anastomotic fistula after colorectal cancer anterior resection. Methods Ninety-six patients having underwent the colorectal cancer anterior resection were divided into new-utility anal vacuum tube group and normal anal vacuum tube group by random digits table method with 48 cases each. The complication, anus exhaust time and postoperative drainage volume were compared between 2 groups. Results The incidences of tube defluxion, proctalgia, anus skin damage, bed sheet pollution and anastomotic fistula in new-utility anal vacuum tube group were significantly lower than those in normal anal vacuum tube group: 6.25% (3/48) vs. 31.25% (15/48), 10.42% (5/48) vs. 41.67% (20/48), 0 vs. 25.00%(12/48), 6.25%(3/48) vs. 60.42%(29/48), 2.08%(1/48) vs. 12.50%(6/48), the anus exhaust time was significantly shorter than that in normal anal vacuum tube group:(44.1 ± 8.9) h vs. (48.9 ± 9.6) h, the postoperative drainage volumes form the first day to fifth day were significantly more than those in normal anal vacuum tube group: (31.2 ± 15.1) ml vs. (15.6 ± 8.2) ml, (25.3 ± 13.2) ml vs. (15.8 ± 6.5) ml, (15.6 ± 9.1) ml vs. (10.3 ± 4.5) ml, (104.3 ± 38.2) ml vs. (90.6 ± 12.3) ml and (93.7 ± 32.5) ml vs. (80.7 ± 18.9) ml, and there were statistical differences (P<0.01 or <0.05). The patients in new-utility anal vacuum tube group had different symptoms, but patients could tolerate. Conclusions The new-utility anal vacuum tube can reduce the incidence of anastomotic fistula, and be safe and reliable, which is worthy of wide application.
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Objective To explore the short-term clinical outcome of percutaneous posterior lumbar interbody fusion using B-twin stand-alone expandable spinal spacer in the degenerative lumbar diseases.Methods From January 2006 to March 2009,41 consecutive patients with lumbar degenerative disc diseases were enrolled and 44 intervertebral spaces were observed in this study.There were 20 males and 21 females,with an average age of 57.51(ranging from 31 to 77 years old).Indications for treatment included degenerative lumbar disc herniation(LDH) with intervertebral instability or Ⅰ? spondylolisthesis(25 cases),LDH with intervertebral space collapse(15 cases) and lumbar discogenic pain(1 case).Fusion segments included 3 cases of L3,L4 and L5,3 cases of L3 and L4,27 cases of L4 and L5,and 8 cases of L5 and S1.After percutaneous discectomy and endplate,curettage were meticulously carried out.A B-twin expandable spinal spacer was introduced into the intervertebral space and then expanded and an allograft cancellous bone of 4 to 5 g was implanted around the B-twin in the intervertebral space.The whole operation was monitored by C-arm fluoroscopy.The clinical outcome was evaluated by JOA scale and X-rays and CT examination before the operation,and 1 week,3 and 12 months after the operation.Results After follow-up of 3 to 38 months(mean 16 months),all the patients were evaluated,and excellent was obtained in 13 cases,good in 21 cases,fair in 5 cases,and poor in 2 cases.The excellent and good rate was 82.93% according to the JOA scale.X-rays and CT showed that the subsidence of the B-twin was found in 3 cases,and 1 case was significantly subsided by more than 20%.Cage shift was seen in 1 case.Conclusion Percutaneou posterior lumbar interbody fusion with B-twin is efficient with minimal surgical trauma,blood loss,better rehabilitation and reliable short-term outcome.Strict indications and pinpoint skills for surgery are the precondition to obtain satisfactory outcome in the treatment of degenerative disc disease.