Comparative study on digestive reconstruction after tota1 gastrectomy / 中国基层医药

Objective To explore the type of the rational digestive reconstruction after total gastrectomy for gastric malignancy.Metlhods Three types of digestive reconstruction were performed after total gastrectomy in 121 cases with gastric carcinoma.The operating time,morbidity and mortality,digestive tract symptoms,nutritional status in 1 year after operation were compared.Results There were no signifioant differences among the three procedures in operative morbidity and mortality,postoperative food intake,nutritional status,incidences of diarrhea and dumping syndrome.Roux-en-Y esophajejunostomy and P-type esophajejunostomy had an advantage d anti-esophageal reflux,and are obviously superior to Lahey + Braun anastomosis.Roux-en-Y esophajejunostomy was simpler with shorter operating time and less complication.Condusion Roux-en-Y esophajejunostomy and P-type esophajejunostomy could be recommended as suitable methods for digestive reconstruction after total gastrectomy.

Application of dynamic APACHEⅡscore and POSSUM score in patients with severe acute pancreatitis / 中国基层医药

Objective To discuss the value of combining the physiological and operative severity score for enumeration of mortality and morbidity(POSSUM)and acute physiology and chronic health evaluation Ⅱ(APACHE Ⅱ)in severe acute pancreatitis(sAP).Methods 60 cases of SAP were divided into surgery group(n=15)and non-surgical group(n=45),Non-surgical group was vahde with APACHE Ⅱ score,the surgery group with POSSUM score,decided to continue conservative treatment or surgery treatment,Observation of two ways with the complications and death.Results The rates of compHcafions and death were(0.37±0.08)and(0.27±0.09)in Single-operation group(n=15)higher than(0.76±0.14)and(0.61±0.15)in surgical group(n=11)(t1=3.125,t2=3.211,P＜0.01);APACHEⅡ score of mortality in operation group and non-surgical group were no significant difference(x2=2.28,x2=1.98,P＞0.05);APACHE Ⅱ score were(10.12±6.27)in survival group(n=46)were lower than (25.75±7.90)in death group(n=14)(t=2.525,P＜0.05.Conclusion The score of dynamic APACHE Ⅱ has better effect to judge the timing of surgery,and the score of POSSUM has high value to predict post-operative complications and deaths occurred in patients with severe acute pancreatitis.

Surgical treatment of severe acute cholangitis in aged patients / 中国基层医药

Objective To analyze the characteristics and therapeutic effects in the elderly patients with acute eholangitis of severe type(ACST) Methods The clinical data of 60 cases of elderly patients with ACST. Results The cured 44 cases(73.3% )and 16 deaths(26.7% ) ,the cause of death:septic shock four cases (25.0%) ,3 cases of acute renal failure(18.8%) ,ARDS four cases(25.0% ) ,multi - organ failure five cases(31.3% ). Incidence surgery within 24 h the deaths of three cases( 18.8% ) ,significantly less than 24 h after surgery incidence death in 13 cases (81.3%) ( X2= 7.72, P<0.01 );correct preoperative shock has been 40 cases, six cases of death ( 15.0% ) was significantly lower than the preoperative shock not corrected in 20 cases,death in 10 patients(50.0% ) ( X2=6.75 ,P <0.01 ). Conclusion The cure rate was improved from early diagnosis and perioperative management in the elderly patients with acute cholangitis of severe type.

Effects of pre-operative intraarterial infusion chemotherapy on micro-vessel density in colorectal cancer / 中国基层医药

Objective To evaluate the effects of pre-operative intra-arterial infusion chemotherapy on colorectal Cancer.Methods 35 patients with colorectal cancer,treated by surgery were divided into two groups randomly.There were 20 patients in group A(pre-operative intra-arterial infusion chemotherapy) and 15 in group B(control).Arterial contrast technique Was used in group A then mitromye in 10mg,5-Fu 1000mg epirubic in 60mg were given through Weidner way-Results Microveasel density in the center,surface of the tumor and adjacent tissue around the tunlor were (40.46±7.06),(52.27±18.40),(49.92±8.15) in group A,and (46.09±12.21),(73.44±22.06),(51.94±12.64)in group B.Microvessel density on the surface in group A was significantly lower than that of group B(P＜0.05),with no significance between the center and the adjacent tissue.Conclusion Pre-operative intraarterial infusion chemotherapy is able to reduce micro-vessel density on the surface of eolorectal tumor.

Radiofrequency hyperthermia in combination with internvention chemotherapy in the treatment of advanced colorectal cancer / 中国基层医药

Objective To observe the therapeutic efficacy of continuous arterial infusion chemotherapy combined with radiofrequency hyperthermia in the treatment of patients with advanced colorectal cancer.Methods A total of 20 advanced colorectal cancer patients with various distant metastasis were treated by the combined continuous intra-arterial infusion chemotherapy and radiofrequency hyperthermia.For the chemotherapy,a dose of 200mg/m2 surface body area of calcium folinate(CF) was given for 1 to 3 days.80mg/m2 of cisplation was infused intravenously for the first day and repalced by etoposide Vp16,60mg/m2 for 1 to 3 days in patients with renal dysfunction.For intra-arterial infusion,a dose of 500mg/m2 5-FU was given for 72 hours.For patients with liver metastases,chemoembolization(ADM 30mg/m2+MMC 6mg/m2 mixed with ultra-lique fied lipiodol) was carried out.Radiof requency hyperthermia with a frequency of 41MHz was performed on the second day after chemotherapy.Results Response rates were as sessed by CT scan and ultrasonography.The overall response rate(CR+PR) of the cases was 70.0%.No serious side effect or complication was found in the course of chemotherapy.Local pain and lipid nodule were occasionally observed in some patients after hyperthermia.Conclusion Continuous intra-arterial infusion chemotherapy in combination with radiofrequency hyperthermia is an useful and safe method for the treatment of patients with advanced colorectal cancer.

Expression and implication of P-gp in colorectal cancer / 中国基层医药

Objective To evaluate the expression and significance of P-glycoprotein(P-gp) in colorectal carcinoma. Methods The expression patterns of P-gp in 48 patients with colorectal carcinoma were examined by immunohistochemistry SP mothod and were analyzed its correlation to clinic opathological features. Results The expression of P-gp was related to lympy node metastasis. Its expression was not related to sex and age of the patients, localization of the primary tumor, tumorsize, histological grade, localinvasion, distant metastasis and Duke's stage. Conclusion Detecting the expression of P-gp might play an important role in chemotherapy strategy of colorectal carcinoma.