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The incidence of adenocarcinoma of esophagogastric junction (AEG) is increasing at home and abroad, and surgical treatment is still the main treatment. At present, subtypes of AEG mainly include Siewert and Nishi types. According to the location and stage of the tumor, the appropriate surgical approaches and methods are different, and with the application of minimally invasive technologies such as laparoscopy and robot assisted surgery, there is a certain impact on the occurrence of postoperative complications. However, the postoperative complications of AEG have not been explained in detail. This article will review and summarize the research progress of different surgical methods for AEG postoperative complications, in order to provide some reference for clinical treatment.
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Objective To evaluate GIPR protein expression in predicting prognosis of appendical neuroendocrine tumors (A-NET) patients.Methods The clinical data of 40 A-NET cases surgically treated from June 2007 to June 2017 at Tianjin Police Hospital were analyzed.The expression of GIPR markers was detected by immunohistochemistry (IHC).Results There were 25 male and 15 female patients,with an median age of 59 years.Sex,tumor site,tumor size,tumor stage and lymph node metastasis were not related to prognosis (P ＞ 0.05).The expression of GIPR was positive in 18 cases and negative in 22 cases.There were 16 cases in G1 stage,20 cases in G2,4 cases in G3.The expression of GIPR protein and pathological grades were related to prognosis (P ＜ 0.05).Conclusions Symptoms of appendix neuroendocrine tumor are nonspecific.Diagnosis is dependent on pathological examination and immunohistochemistry.Positive GIPR protein expression predicts poor prognosis for A-NETs patients.
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Objective To discuss the feasibility,the advantages and disadvantages,the clinical efficacy and the indications of minimally invasive transforaminal endoscopic debridement combined with allograft and posterial percutaneous internal fixation for thoracolumbar spinal tuberculosis.Methods All of 22 patients with thoracolumbar tuberculosis treated in our department from January 2012 to December 2013 were retrospectively reviewed.There are 11 male and female cases separately,with an average age of 54.1 ±10.2 years and with an average disease duration of 5.3 ± 1.9 months.Endoscopic lesion removal and allograft bone grafting combined with posterial percutaneous immobilization were performed on all these cases.The data of these patients were complete,and all patients had been followed up for more than 36 months.The clinical and radiographic results were recorded and analyzed.Results In this group,22 patients were followed-up for 41.9±2.5 months(36-48 months).The spinal kyphosis was not improved 3 months after surgery (t=0.3546,P=0.7029),but the amount of blood loss (30.5±7.9 ml) was less in the operation,the amount of postoperative analgesics(0.3±0.1 g) was low and the bed time(1.5±0.3 days) was short.No recurrence and no internal fixation failure was found after long term follow-up.Good clinical outcomes were achieved with the fusion rate reached above grade 2 in all patients(95.5％) except one.The neuralgia was relieved,and the spinal cord injury was recovered to ASIA E.The VAS score and SF-36 score which were recorded 1 month and 3 months after operative were all improved significantly compared with those before operation,and patients' life quality in the early period after operation was excellent.The incidence of complications was low(9.0％),and the patients were satisfied with the treatment process.Conclusion It may be a potential way to treat spinal tuberculosis with minimally invasive transforaminal endoscopic debridement combined with allograft and percutaneous internal fixation,which could be a powerful supplement to other therapeutic measures,and is worthy of further research and development.
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Objective To explore the clinical pathological characteristics and prognostic factors of patients with neuroendocrine tumor of the appendix.Methods Data of 42 cases of the appendiceal neuroendocrine tumor from June 2006 to June 2016 at Tianjin Police Hospital were analyzed.Tumors were classified according to 2010 WHO classification.The survival curves were drawn using Kaplan-Meier method.Univariate analysis was performed by the Log-rank test.Results There were 27 males and 15 females,with median age of 60 years.Tumors located in the head of the appendix in 37 cases,in the body in 2 cases and at the base in 3 cases.The median of tumor sizes were 1.2 cm.G1 in 17 cases,G2 in 21 cases,G3 in 4 cases.The follow-up rate was 100％.The overall 1-year survival rate was 92％.Conclusions The clinical symptoms of appendiceal neuroendocrine tumors are most often nonspecific.The diagnosis depends on pathological examination and immunohistochemistry,and prognosis varies with pathological grades.
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Objective To compare the value for predicting prognosis between ENETS and AJCC TNM staging system in G-NEC patients.Methods Clinical data of 28 G-NEC cases from January 2005 to September 2015 in Tianjin Medical University General Hospital were analyzed and follow-up data were staged by he ENETS and AJCC TNM staging system.The survival curves were drawn using Kaplan-Meier method.Univariate analysis was performed by Log-rank test.Results Evaluated by ENETS TNM staging system on these 28 G-NEC patients,5 cases (18％) were classified at stage Ⅱ,20 cases (71％) were at stage Ⅲ,3 cases (11％) at stage Ⅳ,and significant difference in survival time was found between the three stages (P ＜ 0.05).By the AJCC TNM staging system,1 case (4％) was classified at stage Ⅱ,24 cases (86％) were at stage Ⅲ,and 3 cases (11％) at stage Ⅳ,and significant difference in survival time was found between three stages.Conclusions AJCC TNM staging system is more valuable for predicting prognosis of G-NEC,while the ENETS TNM staging system is more accurate in evaluating G-NEC biologic behavior.
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Objective To explore the clinicopathological and immunohistochemical features, diagnosis and treatment,prognosis of hepatoid adenocarcinoma of the stomach with neuroendocrine tumor.AFP, Syn, CgA, Ki-67, P53 were stained by immunohistochemistry and follow-up was conducted by telephone.Methods Hepatoid adenocarcinoma of the stomach with coexisting neuroendocrine tumor was identified in 13 cases from June 2004 to June 2014 in Ren Ji Hospital.Results Among the 13 cases of hepatoid adenocarcinoma of the stomach coexisting with neuroendocrine tumor patients, there were 7 males and 6 females, with an median age of 62 years.Tumors located in the gastric cardia in 2 cases, in the gastric antrum in 8 cases and in the gastric body in 3 cases.Tumor ranged from 1-19 cm.The follow-up rate was 100％.The median overall survival rate was 12 months, two patients died of liver metastasis and one patient died of anastomotic recurrence.Serum AFP increased in 10 patients with hepatoid adenocarcinoma of the stomach coexisted with neuroendocrine tumor.The structure consisted of hepatoid cell differentiation and adenocarcinoma differentiation and neuroendocrine differentiation area by histological microscope examination.Immunohistochemical staining showed that tumor regional AFP, Syn, CgA, Ki-67, P53 were positive.Conclusions Hepatoid adenocarcinoma of the stomach coexisting with neuroendocrine tumor is very rare, it is made up of three structures : hepatoid cell differentiation, adenocarcinoma differentiation and neuroendocrine differentiation area.Diagnosis relies on immunohistochemical and histological examination.
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Objective To compare the clinical efficacy of Freka trelumina (FT) vs.feeding jejunostomy (FJ) in carrying out postoperative early enteral nutrition (EEN) in old patients with gastric cancer.Method 168 old gastric cancer cases were derided into FT group (n =54) with EEN, FJ group (n =50) with gastric tube and EEN, and total parenteral nutrition (TPN) group (n =64).Results Compared with TPN group, postoperative body weight, serum albumin and prealbumin level in FT and FJ groups were significantly higher, intestinal function recovery time, days of postoperative hospitalization and costs were significantly lower.The incidence of cough, sputum and sore throat of patients in FT group were significantly higher than those in FJ and TPN groups (P ＜ 0.05).Conclusions Postoperative EEN through FT and FJ was effective to improve nutritional parameter, accelerate intestinal function recovery, reduce the number of days of postoperative hospitalization, total costs, anastomotic stomal leak and gastroparesis rate.
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Objective To analyze the clinico-pathological characteristics and prognostic factors of patients with gastric neuroendocrine carcinoma(G-NEC).Methods Clinical data of 40 cases of G-NEC form January 2003 to August 2013 at Ren Ji Hospital of Shanghai Jiaotong University were analyzed.Tumors were classified into different grades and stages according to the 2010 WHO classification and the 2006 European neuroendocrine tumor society (ENETS).Follow-up was conducted by telephone.The survival curves were drawn using Kaplan-Meier method.Univariate analysis was performed by the Log-rank test and multivariate analysis was performed by the COX proportional hazards model.Results Among the 40 G-NECs patients,29 were male(72％) and 11 were female(28％),with an median age of 61 years.Tumors located in the gastric cardia in 20 cases,in the gastric antrum in 11 cases and in the gastric body in 9 cases.Tumor ranged from 1 cm-20 cm.All patients were G-NEC (G3).Follow-up rate was 100％ (40/40).The median overall survival rate was 12 months,and one-year survival rate was 82％.Immunohistochemically G-NEC cells were positive for CgA and Syn in 11 cases.Gender (x2 =5.673,P ＜ 0.05),Ki-67 index (x2 =8.612,P ＜ 0.05),and lymphnode involvement (x2 =0.559,P ＜ 0.05) were prognostic factors of G-NEC patients.Conclusions The symptoms of G-NEC are nonspecific.Its diagnosis relies on pathological examination and immunohistochemistry.Syn and CgA are the most important markers.Female gender,lower Ki-67 index and lower lymph node metastasis predict a survival advantage.
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Objective: To observe the effect of ginkgo biloba extract (GBE) (total ginkgo flavone 50% and qinkgolide 25%) on experimental hyperlipidemic quail.Methods: 60 quail were randomly grouped six:normal group, hyperlipidemic model group and low, middle and high dose GBE groups, as well as lipanthyl group. Except for the normal group, the other five groups were firstly given high fat food for two weeks. Then among them, three groups were treated with GBE(20mg/kg?d, 40mg/kg?d, 80mg/kg?d, respectively) by ig administration, and one group was given lipanthyl(25mg/kg?d)by ig administration as the positve drug, another group was received aqua destillata by ig administration as the hyperlipidemic model. The treatments were consecutively carried out for four weeks. At the end, the vena jugularis externa blood of all the quail was taken and the serum lipid level of each quail was tested.Results: GBE in low dose group could significantly decrease the levels of TC, LDL C( P