Analysis of the related factors of complications after laparoscopic D2 radical operation in the treatment of advanced gastric cancer / 中国基层医药

Objective@#To analyze the related factors of postoperative complications after laparoscopic assisted D2 radical resection for advanced gastric cancer.@*Methods@#From August 2015 to July 2017, 80 patients with advanced gastric cancer admitted to the First Hospital of Jiaxing were selected.All the patients were treated with laparoscopic-assisted D2 radical resection, and the risk factors related to postoperative complications were analyzed by logistic regression analysis model.@*Results@#There were 33 cases (41.25%) with postoperative system complications, 19 cases (23.75%) with complications of level Ⅱ and above; 15 cases (18.75%) with postoperative local complications, among them 12 cases (15.00%) appeared level Ⅱ and above local complications.The number of concomitant diseases and age were related risk factors for systemic complications in patients with advanced gastric cancer after laparoscopic D2 radical resection (OR=1.982, 95%CI: 2.183-34.405, OR=6.587, 95%CI: 1.738-23.495, all P<0.05). The preoperative neoadjuvant chemotherapy, reconstruction method and age were the risk factors for local complications in patients with advanced gastric cancer after laparoscopic D2 radical resection (OR=8.273, 95%CI: 4.982-35.394, OR=12.304, 95%CI: 2.384-88.921, OR=6.365, 95%CI: 2.183-21.384, all P<0.05).@*Conclusion@#Treatment of advanced gastric cancer patients with laparoscopic D2 radical mastectomy, attention should be paid to control the patients' age, preoperative neoadjuvant chemotherapy, reconstruction mode, associated disease and other related risk factors.In order to ensure the safety of patients and to avoid postoperative complications.

Analysis of the related factors of complications after laparoscopic D2 radical operation in the treatment of advanced gastric cancer / 中国基层医药

Objective To analyze the related factors of postoperative complications after laparoscopic assisted D2 radical resection for advanced gastric cancer.Methods From August 2015 to July 2017,80 patients with advanced gastric cancer admitted to the First Hospital of Jiaxing were selected.All the patients were treated with laparoscopic-assisted D2 radical resection,and the risk factors related to postoperative complications were analyzed by logistic regression analysis model.Results There were 33 cases (41.25％) with postoperative system complications,19 cases (23.75％) with complications of level Ⅱ and above;15 cases (18.75％) with postoperative local complications,among them 12 cases (15.00％) appeared level Ⅱ and above local complications.The number of concomitant diseases and age were related risk factors for systemic complications in patients with advanced gastric cancer after laparoscopic D2 radical resection (OR =1.982,95 ％ CI:2.183-34.405,OR =6.587,95 ％ CI:1.738-23.495,all P ＜ 0.05).The preoperative neoadjuvant chemotherapy,reconstruction method and age were the risk factors for local complications in patients with advanced gastric cancer after laparoscopic D2 radical resection (OR =8.273,95 ％ CI:4.982-35.394,OR =12.304,95 ％ CI:2.384-88.921,OR =6.365,95 ％ CI:2.183-21.384,all P ＜ 0.05).Conclusion Treatment of advanced gastric cancer patients with laparoscopic D2 radical mastectomy,attention should be paid to control the patients'age,preoperative neoadjuvant chemotherapy,reconstruction mode,associated disease and other related risk factors.In order to ensure the safety of patients and to avoid postoperative complications.

Analysis of risk factors of intra-abdominal infection after surgery for colorectal cancer / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To investigate the risk factors of intra-abdominal infection(IAI) after colorectal cancer surgery.</p><p><b>METHODS</b>Clinical and follow-up data of 773 colorectal cancer patients undergoing operation in our hospital from October 2011 to December 2014 were retrospectively analyzed. Patients were divided into intra-abdominal cavity infection group (110 cases, IAI group) and non intra-abdominal infection group(663 cases, non-IAI group). All the patients administered prophylactic antibiotics 30 minutes to 2 hours before operation. Univariate and multivariate analysis were performed to evaluate the risk factors of IAI.</p><p><b>RESULTS</b>Preoperative factors associated with postoperative IAI included hepatic cirrhosis, kidney diseases, diabetes or other basic diseases, prophylactic use of drugs, hypoalbuminemia, anemia, intestinal obstruction, and American Society of Anesthesiologists (ASA) anesthetic grading score (all P<0.05). Postoperative factors associated with postoperative IAI included use of laparoscopy or stapler, united exenteration, existence of anastomotic fistula, time of drainage tube placement, operation time and tumor staging (all P<0.05). Multivariate logistic regression analysis showed that preoperative diabetes(OR=2.36, 95% CI:1.45 to 4.76, P<0.01), combined exenteration (OR=2.02, 95% CI:1.02 to 4.00, P<0.01), anastomotic leak (OR=4.41, 95% CI:1.77 to 10.99, P=0.001), operation time≥140 minutes (OR=2.88, 95% CI:1.78 to 4.67, P<0.01) and period of postoperative drainage≥10 days(OR=4.57, 95% CI:2.78 to 7.52, P<0.01) were independent risk factors of postoperative IAI, while the use of stapler was protective factor (OR=0.37, 95% CI: 0.23 to 0.60, P<0.01). Compared with prophylactic use of cephamycins plus metronidazole, cefuroxime plus metronidazole had a higher rate of IAI(OR=2.10, 95% CI:1.23 to 3.58, P=0.007).</p><p><b>CONCLUSIONS</b>Prevention of postoperative IAI is required for colorectal cancer patients, particularly in those with preoperative diabetes, combined exenteration, anastomotic leak, operation time longer than 140 minutes and postoperative drainage period longer than 10 days. Preoperative use of cephamycins plus metronidazole has better efficacy in prevention of postoperative IAI.</p>

Clinical significance of CD40, Ki-67 and CD34 expressions in gastric cancer and adjacent tissues / 中国医师杂志

Objective To investigate the relationship between CD40,Ki-67,and CD34 expressions and clinical significance of gastric cancer.Methods The expressions of CD40,Ki-67,and CD34 were detected by immunohistochemistry in 80 cases of gastric carcinomas and adjacent mucosas.Results The high expression of CD40 was detected in 36.3％ (29/80) cases of gastric cancer tissues,and Ki-67 was 53.8％ (43/80).The high expression of CD40 was related to lymph node metastasis,depth of invasion,and the patient's prognosis.The high expression of Ki-67 was related to histological differentiation,depth of invasion,vascular invasion,and lymph node metastasis (P ＜ 0.05).Expression of CD40 was positively related to Ki-67 and CD34 in gastric carcinomas (P ＜ 0.05).Conclusions The high expressions of CD40,Ki-67,and CD34 in gastric cancers are related to the tumor proliferation,tumor angiogenesis,and the prognosis of patients.

Expression and significance of Sirtuin 1 in human colorectal cancer / 国际肿瘤学杂志

Objective To research the expressions of Sirtuin 1 (SIRT1) in colorectal cancer and normal tissue and the relationship with clinicopathologic features.Methods The expression levels of SIRT1 mRNA and protein were detected respectively by quantitative real-time reverse transcriptase PCR (RT-QPCR) and immunohistochemistry (IHC) in 45 cases of colorectal carcinoma and 30 cases of normal mucous membrane tissue,and the relationships between the expression status and clinicopathologic features were analyzed.Results In colorectal carcinoma,the expression of SIRT1 mRNA were higher than that in control group [M(QR):2.488(3.447) vs.1.563(2.867),Z =-2.304,P ＜0.05],so was the protein level (71.1％ vs.43.3％,x2 =5.787,P =0.029).The expression of SIRTI was associated with lymph node metastasis (RT-QPCR:Z =-2.160,P =0.031;IHC:P =0.043),neoplasm stages (RT-QPCR:Z =-2.411,P =0.016;IHC:P =0.008),and might associated with the tissue differentiation (RT-QPCR:x2 =10.864,P =0.004;IHC:P =0.322).On the other hand,no significant differences were observed regarding age,sex,tumor size,gross type,depth of invasion,tumor site and distant metastasis.Conclusion The expression of SIRT1 in colorectal cancer is higher than that in control group,the high level of SIRT1 is related to the tumorigenesis and progression of colorectal cancer as well as correlated with prognosis in colorectal cancer.

Clinical Observation of Mirabilite Combined with Cisplatin Intraperitoneal in the Treatment of Elderly Colorectal Malignant Ascites / 中国药房

OBJECTIVE:To observe the clinical efficacy and ADR of Mirabilite combined with intrapetitoneal in the treatment of elderly colorectal malignant ascites. METHODS:77 cases of patients with elderly colorectal malignant ascites were randomly di-vided into treatment group (n=40) and control group (n=37). The control group received the treatment of intraperitoneal alone, while the treatment group was based on the control group additionally received Mirabilite combined with intrapetitoneal. The clini-cal efficacy,quality of life (QOL),and ADR in 2 groups were compared and statistically analyzed. RESULTS:Compared with control group,the effective rate in treatment group was 77.5% and the disease control rate was 87.5%,with significant difference (P<0.05);the QOL score in treatment group was better than control group,with significant difference(P<0.05);the incidence of local ADR in Mirabilite for external use was low. CONCLUSIONS:Mirabilite combined with intraperitoneal has better efficacy in the elderly colorectal malignant ascites and better QOL.

Risk factors of surgical site infection in patients with colorectal cancer / 中华临床感染病杂志

Objective To investigate the incidence and risk factors of surgical site infection ( SSI ) in patients with colorectal cancer .Methods Clinical data of patients with colorectal cancer undergoing surgical treatment in Jiaxing First Municipal People’ s Hospital from October 2011 to December 2014 were retrospectively reviewed.The gender, age, underlying diseases, smoking history, preventive medication, abdominal surgery history , type of surgery , preoperative levels of hemoglobin and albumin , use of laparoscopy, use of stapler, combined organ resection, TNM staging, American Society of Anesthesiologists ( ASA) score was documented .Multivariate logistic regression analysis was performed to identify the risk factors of SSI .Results A total of 773 patients were enrolled in the study , and SSI was observed in 144 cases (18.63%).Multivariate logistic regression analysis showed that use of laparoscopy ( OR =0.35, 95%CI:0.15-0.79,P <0.05), use of stapler (OR =0.59, 95% CI: 0.39-0.88,P <0.05) were protective factors for SSI, while diabetes (OR=2.11, 95% CI: 1.25-3.58,P<0.01), liver cirrhosis (OR=2.12,95%CI:1.18-3.79,P<0.05), ASA score (3-4 points) (OR=2.01,95%CI:1.20-3.58, P<0.01), combined organ resection (OR=2.17,95% CI:1.20-3.92,P<0.05), and anastomotic leak (OR=6.85, 95%CI:3.01-15.63,P<0.01) were risk factors for SSI.Conclusions The incidence of SSI is high in patients with colorectal cancer undergoing surgery .Use of laparoscopy and stapler may reduce the incidence of SSI .

Application of hypocaloric parenteral nutrition in postoperative elderly patients with gastric cancer / 中华老年医学杂志

Objective To investigate the application of hypocaloric parenteral nutrition in postoperarive elderly patients with gastric cancer. Methods 59 elderly patients aged 60- 79 years with gastric cancer after operation were randomly assigned to receive 84 kJ · kg -1.d -1 hypocaloric parenteral nutrition (29 cases) and 126 kJ · kg-1 · d -1 standard-calorie parenteral nutrition (30cases),totally 6 d from postoperative 2 d. Complications, serum proteins, immune function,inflammation,blood glucose, liver function and recovery time of gastrointestinal function were observed during nutritional support. Results The postoperative complication rate were 37.9％(11/29) in hypocalorie group and 43.3 ％ (13/30) in standard calorie group ( P＞0.05),mainly pulmonary infection.There were no ditferences in levels of serum albumin,total protein and prealbumin between two groups at postoperative 3 d and 6 d (P＞0.05).Peripheral blood lymphocytes and T lymphocyte subsets CD3+,CD4+,CD4+/CD8- ratio were decreased after sugery,but CD8 1 values increased in two groups (P＞0.05).C reactive protein was increased significantly at postoperative 3 d compared with preoperation,and decreased at 6d than 3 d (P＞0.05).Blood glucose was decreased gradually at 3 and 6 d (P＞0.05).Postoperative liver function paraneters were elevated,no difference was found at 3 d (P＞0.05),and continued to rise at 6 d in standard calorie group than in hypocalorie group (P＜0.05). There was no difference in times of aerofluxus and cacation after operation between hypocalorie and standard calorie groups (P＞0.05). Conclusions Hypocaloric parenteral nutrition is a safe and effective method for nutrition support in postoperative elderly patients with gastric cancer.