RESUMO
Tweety-homolog 1 (Ttyh1) is expressed in neural tissue and has been implicated in the generation of several brain diseases. However, its functional significance in pain processing is not understood. By disrupting the gene encoding Ttyh1, we found a loss of Ttyh1 in nociceptors and their central terminals in Ttyh1-deficient mice, along with a reduction in nociceptor excitability and synaptic transmission at identified synapses between nociceptors and spinal neurons projecting to the periaqueductal grey (PAG) in the basal state. More importantly, the peripheral inflammation-evoked nociceptor hyperexcitability and spinal synaptic potentiation recorded in spinal-PAG projection neurons were compromised in Ttyh1-deficient mice. Analysis of the paired-pulse ratio and miniature excitatory postsynaptic currents indicated a role of presynaptic Ttyh1 from spinal nociceptor terminals in the regulation of neurotransmitter release. Interfering with Ttyh1 specifically in nociceptors produces a comparable pain relief. Thus, in this study we demonstrated that Ttyh1 is a critical determinant of acute nociception and pain sensitization caused by peripheral inflammation.
RESUMO
Objective: To explore the safety and efficacy of oxaliplatin plus capecitabine (CapeOX) or oxaliplatin plus S-1 (SOX) regimen neoadjuvant chemotherapy in the treatment of advanced gastric cancer. Methods: A retrospective cohort study was performed. Clinical data of patients diagnosed as advanced gastric cancer undergoing CapeOX/SOX neoadjuvant chemotherapy and standard laparoscopic radical operation for gastric cancer in Ruijin Hospital of Shanghai Jiaotong University School of Medicine from April 2016 to April 2019 were retrospectively collected. Inclusion criteria were as follows: (1) age≥18 years; (2) gastric adenocarcinoma was confirmed by histopathology and the clinical stage was T3-4aN+M0; (3) tumor could be resectable; (4) preoperative neoadjuvant chemotherapy was CapeOX or SOX regimen without radiotherapy or other regimen chemotherapy; (5) no other concurrent malignant tumor; (6) the Eastern Cooperative Oncology Group (ECOG) score ≤ 1; (7) no bone marrow suppression; (8) normal liver and kidney function. Exclusion criteria were as follows: (1) patients with recurrent gastric cancer; (2) patients receiving emergency surgery due to tumor perforation, bleeding, obstruction, etc.; (3) allergy to oxaliplatin, S-1, capecitabine or any drug excipients; (4) diagnosed with coronary heart disease, cardiomyopathy, or the New York Heart Association class III or IV; (5) pregnant or lactating women. A total of 118 patients were enrolled as the neoadjuvant chemotherapy group, and 379 patients with locally advanced gastric cancer who received surgery combined with postoperative adjuvant chemotherapy over the same period simultaneously were included as the adjuvant chemotherapy group. After propensity score matching was performed including gender, age, ECOG score, tumor site, clinical stage, chemotherapy regimen and other factors by 1:1 ratio, there were 40 cases in each group. The differences between the two groups in general conditions, efficacy of neoadjuvant chemotherapy, intraoperative conditions, postoperative conditions, histopathological results, chemotherapy-related adverse events, and survival status were compared and analyzed. Results: Comparison of baseline demographics between the two groups showed no statistically significant difference (all P>0.05). In the neoadjuvant chemotherapy group, 5.0% (2/40) of patients achieved clinical complete response, 57.5% (23/40) achieved partial response, 32.5% (13/40) remained stable disease, and 5.0% (2/40) had disease progression before surgery. Objective response rate was 62.5% (25/40), and disease control rate was 95.0% (38/40). There were no statistically significant differences between neoadjuvant chemotherapy group and adjuvant chemotherapy group in terms of operation time, intraoperative blood loss, number of lymph node harvested, length of postoperative hospital stay, and postoperative mortality and morbidity (all P>0.05). Postoperative complications were well managed with conservative treatment. No Clavien-Dindo IV or V complications were observed in both groups. Pathological results showed that the proportion of patients with pathological stage T1 in the neoadjuvant chemotherapy group was significantly higher than that in the adjuvant chemotherapy group [27.5% (11/40) vs. 5.0% (2/40)], while the proportion of patients with pathological stage T3 was significantly lower than that in the adjuvant chemotherapy group [20.0% (8/40) vs. 45.0% (18/40)], with statistically significant difference (χ(2)=15.432, P=0.001). In the neoadjuvant chemotherapy group, there were 4 cases of tumor regression grade 0, 8 cases of grade 1, 16 cases of grade 2, and 12 cases of grade 3. The pathological complete response rate was 10% (4/40), the overall pathological response rate was 70.0% (28/40). There was no statistically significant difference in the incidence of chemotherapy-related adverse events between neoadjuvant chemotherapy group and adjuvant chemotherapy group [40% (16/40) vs. 37.5% (15/40), P>0.05). There were no statistically significant differences in OS (43 months vs. 40 months) and 3-year OS rate (66.1% vs. 59.8%) between neoadjuvant chemotherapy group and adjuvant chemotherapy group (P=0.428). The disease-free survival (DFS) and 3-year DFS rates of the neoadjuvant chemotherapy group were significantly superior to those of the adjuvant chemotherapy group (36 months vs. 28 months, 51.4% vs. 35.8%, P=0.048). Conclusion: CapeOX or SOX regimen neoadjuvant chemotherapy is a safe, effective and feasible treatment mode for advanced gastric cancer without increasing surgical risk and can improve the DFS of patients.
Assuntos
Humanos , Adenocarcinoma/cirurgia , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Capecitabina/administração & dosagem , Quimioterapia Adjuvante , Combinação de Medicamentos , Terapia Neoadjuvante , Oxaliplatina/administração & dosagem , Ácido Oxônico/administração & dosagem , Radioterapia , Estudos Retrospectivos , Neoplasias Gástricas/cirurgia , Tegafur/administração & dosagem , Resultado do TratamentoRESUMO
Laparoscopic gastrointestinal surgery has experienced 30 years of development in China, and has now entered a high plateau stage at the technical level. Laparoscopic surgery, once an emerging technology, is gradually becoming a "traditional surgery". Meanwhile, laparoscopic gastrointestinal surgery is gradually moving towards a new situation of multi-disciplinary and multi-technical integration. High-quality clinical studies are constantly being reported, and new tools and techniques are emerging. In the next era, the development of laparoscopic gastrointestinal surgery will focus more on international research, digital surgery, high-tech operating rooms, etc. An urging requirement is to understand and face the current intensified involution and other practical problems, and to create another glorious innovation for Chinese laparoscopic gastrointestinal surgery in the next 30 years.
Assuntos
Humanos , China , Procedimentos Cirúrgicos do Sistema Digestório , LaparoscopiaRESUMO
OBJECTIVE: To compare the subjective perception of surgeons with 4K-resolution(4K) and three-dimensional(3D) systems in the laparoscopic colorectal surgery.METHODS: A self-filling questionnaire survey wasdeveloped in the surgeons between August 2018 and February 2019 in Department of Gastrointestinal Surgery,RuijinHospital Affiliated to Shanghai Jiao Tong University School of Medicine. The data of questionnaires from surgeons indifferent position( major surgeons,first assistants,scopists) who performed laparoscopic colorectal surgeries with 4K,3D and 2D systems were collected. The questionnaires concerning asthenopia,motion sickness,topographical orientation,control coordination of visual angle,visual acuity,radiance,resolution ratio,depth description,color resolution,sense ofcontrols,optimum viewing distance,frames and refresh rate and contrast.RESULTS: There were 124 questionnairesscreened eligibility in the survey. Among them,there were 38 questionnaires for 2D group,43 questionnaires for 3D group and 43 questionnaires for 4 K group.(1)Overall comparison of the subjective scores:In the three groups,therewere significant difference in control coordination of visual angle,visual acuity,resolution ratio,depth description,color resolution,optimum viewing distance,frames andrefresh rate(P<0.05).(2)Subjective scores betweenmajor surgeons:In the three groups,there weresignificant difference in resolution ratio,depth description,color resolution and sense of controls(P<0.05);the most advantages could be found on resolution ratio andcolor resolution in 4 K group,and also could be found on depth description and sense of controls in 3 D group.(3)Subjective scores between first assistants: In the three groups,there were significant difference in asthenopia,controlcoordination of visual angle,resolution ratio,depth description,sense of controls,frames and refresh rate(P<0.05);In 4K group,it showed advantages on control coordination of visual angle and resolution ratio. Motion sickness was morepronounced in 3D group,but the most advantages could be found on depth description and sense of controls.(4)Subjective scores between scopists: In the three groups,there were significant difference in visual acuity,resolution ratio,depth description,sense of controls,optimum viewing distance and contrast(P<0.05). The most advantages could befound on visual acuity,resolution ratio and contrast in 4 K group,and also could be found on depth description and senseof controls in 3D group.CONCLUSION: Comparing with the traditional two-dimensional system during laparoscopiccolorectal surgery,4 K system could apply better resolution ratio,control coordination of visual angle,visual acuity andcolor resolution. 3D system could apply better depth description and sense of controls.
RESUMO
OBJECTIVE: To compare dorsal-and-medial hybrid approach and medial-to-lateral approach in laparoscopic right hemicolectomy with complete mesocolic excision(CME). METHODS: Patients undergone laparoscopic right hemicolectomy in Department of Gastrointestinal Surgery in Ruijin Hospital Affiliated to Shanghai Jiaotong University School of Medicine from July 2017 to April 2018 were prospectively included.Patients were divided into two groups:dorsal group and medial group. Clinical and pathological data were collected and compared between the two groups. RESULTS: There were 35 patients in medial group and 40 patients in dorsal group. No significant differences were found between the two groups in baseline characteristics,perioperative outcomes and pathological results. No significant difference was found between the two groups in length of bowel(24 cm vs. 22 cm),A line distance(9.8 cm vs.9.4 cm),B line distance(9.0 cm vs. 8.5 cm),area of mesentery(112.4 cm~2 vs. 109.0 cm~2),total lymph node count(19 vs.19),lymph node adequate ratio(97.1% vs. 97.5%)and CME ratio(80% vs. 85%). Obesity was found to be an independent risk factor of CME ratio(P=0.019). CONCLUSION: Dorsal-and-medial hybrid approach and medial-to-lateral approach are comparable in safety,feasibility and effectiveness in laparoscopic right hemicolectomy with complete mesocolic excision. Randomized clinical trials with larger sample size are needed.
RESUMO
<p><b>OBJECTIVE</b>To evaluate the surgical strategy for laparoscopic approach in recurrent inguinal hernia repair.</p><p><b>METHODS</b>Between January 2001 and December 2011, the clinical data of 213 patients with 225 recurrent inguinal hernias underwent laparoscopic repair were retrospectively analyzed. There were 202 male and 11 female patients and their average age were (67 ± 14) years old (range 22-97 years old). The surgical methods included laparoscopic transabdominal preperitoneal hernia repair (TAPP, n = 174), total extraperitoneal herniorrhaphy (TEP, n = 41) and intraperitoneal onlay mesh (IPOM, n = 10). The follow-up period ranged from 15 to 60 months (median 42 months). No patient lost to follow-up during the investigation.</p><p><b>RESULTS</b>The 48 TAPP and 26 TEP were applied to 77 (32.9%) recurrent hernias after conventional suture repair; 23 TAPP and 15 TEP were utilized to 38 (16.9%) recurrent hernias after Lichtenstein repair; 90 TAPP and 1 IPOM were employed for 91 (40.4%) recurrent hernias after Patch and Plug repair; and the other 22 (9.8%) recurrent hernias after preperitoneal repair were repaired by using 13 TAPP and 9 IPOM techniques. No conversion to open surgery was observed. The average operative time was (39 ± 14) minutes (range 15-90 minutes). No patients required analgesia postoperatively. The postoperative average VAS score was 2.4 ± 1.1 (range 1.2-6.4). The average hospital stay was (1.7 ± 1.5) days (range 1-9 days), and the patients returned to unrestricted activities in 2 weeks was 99.6% (212 cases). No recurrence was observed during the follow-up. The accumulative postoperative complications rates was 11.1% (25 cases), with 1 severe complication (surgical intervention was needed) as intraabdominal infection (0.4%), as well as other 24 complications including 15 cases of seroma (6.7%), 5 cases of urinary retention (2.2%), 3 cases with transient paresthesia (1.3%) and 1 case with paralytic ileus (0.4%).</p><p><b>CONCLUSIONS</b>TAPP and TEP are both feasible and efficacious techniques to treat recurrent hernias after suture repair and Lichtenstein repair, while the choice depends on surgeons' experience. Most recurrent hernias after Patch and Plug repair could be treated successfully by TAPP but TEP technique is not encouraged. For recurrences after preperitoneal repair, the TAPP repair should be recommended as first choice, while IPOM is a good technique to cope with the cases which TAPP failed.</p>
Assuntos
Humanos , Hérnia Inguinal , Cirurgia Geral , Herniorrafia , Laparoscopia , Telas Cirúrgicas , Resultado do TratamentoRESUMO
It is the most important for surgeons to achieve surgical safety and oncological clearance in laparoscopic surgery for gastric cancer. With the widespread adoption oflaparoscopic surgery for gastric cancer, surgeons make great efforts to achieve better safety andlower morbidity. Common abdominal complications (intraoperative and postoperative) after laparoscopic radical gastrectomy include bleeding, anastomotic leakage, anastomotic stenosis, iatrogenic organ injury, pancreatic leakage, etc. The causes and prevention of the complications related with laparoscopic radical gastrectomy was discussed in this article.
Assuntos
Humanos , Fístula Anastomótica , Constrição Patológica , Gastrectomia , Laparoscopia , Complicações Pós-Operatórias , Neoplasias Gástricas , Cirurgia GeralRESUMO
Laparoscopic surgery for gastrointestinal diseases had a remarkable achievement in the past 20 years. To ensure the high quality of minimally invasive gastrointestinal surgery, several issues should be addressed, including correct guidelines and standard based on the consensus, high quality evidence from multi-center randomized control studies, proper training system for the technique, and constant innovations to improve the technique. We believe that with the great efforts of gastrointestinal surgeons, the minimally invasive gastrointestinal surgery in China is promising in the near future.
Assuntos
Humanos , China , Procedimentos Cirúrgicos do Sistema Digestório , Gastroenteropatias , Cirurgia Geral , Laparoscopia , Procedimentos Cirúrgicos Minimamente InvasivosRESUMO
Laparoscopic surgery for gastrointestinal diseases had a remarkable progress in the past 20 years. Laparoscopic surgery for colon cancer is adopted worldwide by increasingly surgeons based on the evidence from randomized controlled studies. Minimally invasive surgery is also adopted as alternative procedure for early gastric cancer. The standardization and spreading of the minimally invasive technique for gastrointestinal surgery is also being implemented efficiently in China. However, how to innovate the new technique and improve the new instrumentation for minimally invasive surgery is still a problem which we have to confront in the current situation. But we believe that with the great efforts of gastrointestinal surgeons, the widespread adoption of minimally invasive gastrointestinal surgery would surely take place in the near future.
Assuntos
Feminino , Humanos , Masculino , China , Trato Gastrointestinal , Cirurgia Geral , Laparoscopia , Métodos , Procedimentos Cirúrgicos Minimamente Invasivos , MétodosRESUMO
Gastrointestinal tract reconstruction is a key procedure in laparoscopic surgery for gastrointestinal diseases. The reconstruction procedure in laparoscopic surgery is not superior to conventional surgery. Reconstruction procedures such as Billroth I, Billroth II( and Roux-en-Y anastomosis are widely used in laparoscopic assisted distal gastrectomy, while esophagojejunostomy by Roux-en-Y reconstruction is a reasonable option for laparoscopic assisted total gastrectomy. The OrVil technique provides an easier alternative to complete the esophagojejunostomy. Esophagogastrostomy is mainly used in laparoscopic assisted proximal gastrectomy. Colorectal anastomosis with double stapling technique and coloanal anastomosis with hand-sewn technique are common reconstruction procedures in laparoscopic surgery for mid and low rectal diseases. In laparoscopic colectomy, a small incision is usually used to facilitate the reconstruction extracorporeally. It is believed that innovation of instrumentation in the near future could bring us safer reconstruction devices with better efficiency and quality for laparoscopic surgery.
Assuntos
Humanos , Anastomose Cirúrgica , Métodos , Procedimentos Cirúrgicos do Sistema Digestório , Métodos , Laparoscopia , MétodosRESUMO
<p><b>OBJECTIVE</b>To examine the role of Polo-like kinase 1(PLK1) in the migration and invasiveness of human colorectal cancer cells.</p><p><b>METHODS</b>Nine colorectal cancer cell lines were cultured. Cell lines with the highest level of PLK1 expression was selected by PCR and Western blot. Three siRNA oligo segments targeting PLK1 were designed and selected cell lines transfected. Successful transfection was confirmed using real-time PCR and Western blot. Changes in migration and invasiveness of the selected cell line were evaluated by Transwell test.</p><p><b>RESULTS</b>Colorectal cancer cell line SW1116 was selected with the highest expression of PLK1 at both mRNA level and protein level. The expression of PLK1 in SW1116 was reduced by the three siRNA oligo segments to varying degrees, and the No.1 siRNA oligo segment was the most efficient. In migration test, the number of cells crossing through chambers in PLK1-siRNA group was 44 ± 14, which was lower than that in the negative control group (242 ± 40) and in blank control group(240 ± 38). In invasion test, the number of cells crossing through chambers in PLK1-siRNA group was 62 ± 3, which was lower than that in negative control group (207 ± 12) and in blank control group (211 ± 15). These differences were statistically significant(P<0.01).</p><p><b>CONCLUSION</b>PLK1 silencing by siRNA may inhibit the migration and invasiveness of colorectal cancer cells, suggesting that PLK1 might play an important role in the infiltration and metastasis of colorectal cancer.</p>
Assuntos
Humanos , Proteínas de Ciclo Celular , Genética , Metabolismo , Linhagem Celular Tumoral , Movimento Celular , Neoplasias Colorretais , Metabolismo , Patologia , Invasividade Neoplásica , Proteínas Serina-Treonina Quinases , Genética , Metabolismo , Proteínas Proto-Oncogênicas , Genética , Metabolismo , RNA Interferente Pequeno , Genética , TransfecçãoRESUMO
<p><b>OBJECTIVES</b>To investigate the impact of previous abdominal operations on the outcome of laparoscopic colorectal cancer surgery and to evaluate the feasibility and safety of laparoscopic reoperation in treatment for colorectal cancer.</p><p><b>METHODS</b>According to the statistical standards, 653 consecutive patients treated from March 2002 and March 2009 were enrolled in this study. The patients were divided into three groups: upper abdominal surgery group (n = 48), middle-lower abdominal surgery group (n = 110) and non-previous abdominal surgery group (n = 495). Demographic, pathoanatomical and surgical data were compared among the three groups.</p><p><b>RESULTS</b>There was no significant differences in demographic, pathoanatomical data and post-operative complications among the three groups. Compared with the other two groups, middle-lower abdominal surgery subgroup had a higher intra-operative conversion rate due to intra-abdominal adhesion (4.2%, 11.8% and 3.8% in upper abdominal surgery group, middle-lower abdominal surgery group and non-previous abdominal surgery group, respectively). And no significant differences was found in operating time [(132 ± 36), (141 ± 42), (132 ± 36) min], intra-operation blood loss [(58 ± 50), (81 ± 99), (57 ± 57) ml], blood transfusion rate (6.3%, 10.9%, 7.9%), low sphincter-preserving surgery rate (47.1%, 44.7%, 55.2%), time of first flatus passage [(2.5 ± 1.4), (2.9 +/- 1.7), (2.5 ± 2.1) d], fasting time [(5 ± 4), (5 ± 4), (4 ± 3) d], hospital stay [(17 ± 9), (15 ± 8), (16 ± 10) d] between the three groups.</p><p><b>CONCLUSIONS</b>The history of previous abdominal operations should not be regarded as a contraindication for laparoscopic colorectal cancer reoperation. The laparoscopic reoperation for colorectal cancer is safe and feasible.</p>
Assuntos
Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Abdome , Cirurgia Geral , Neoplasias Colorretais , Cirurgia Geral , Estudos de Viabilidade , Laparoscopia , Estudos Prospectivos , ReoperaçãoRESUMO
<p><b>OBJECTIVE</b>To evaluate laparoscopic radical gastrectomy for early gastric cancer.</p><p><b>METHODS</b>A total of 204 patients with early gastric cancer undergoing laparoscopic-assisted radical gastrectomy or open radical gastrectomy between October 2004 and December 2009 were retrospectively reviewed and analyzed. Patients were divided into laparoscopic group(LAP, n=78) and open group (OPEN, n=126). Operative time, blood loss, time to passage of flatus, postoperative hospital stay, complications and pathologic findings were compared between the two groups.</p><p><b>RESULTS</b>Compared to the OPEN group, operative time in the LAP group was significantly shorter[(202.9±45.6) min vs.(219.8±45.2) min, P<0.05], blood loss was less[(144.5±146.5) ml vs. (245.0±146.4) ml, P<0.05], time to passage of flatus was shorter[(3.1±1.1) d vs.(4.5±1.6) d, P<0.05], postoperative hospital stay was shorter[(10.8±1.2) d vs. (12.4±3.8) d, P<0.05]. However, the two groups were comparable with regard to postoperative complication rate(10.3% vs. 12.7%, P>0.05), proximal resection margin[(4.0±1.9) cm vs. (4.2±1.7) cm, P>0.05], distal resection margin [(3.6±1.7) cm vs. (3.5±1.8) cm, P>0.05], number of harvested lymph node(13.1±6.5 vs. 14.5±8.2, P>0.05). The median follow up was 22(2-64) months. There were no tumor recurrences or metastases in the LAP group. In the OPEN group, only 1 patient died from peritoneal metastasis. Total hospital costs between the two groups were similar(P>0.05).</p><p><b>CONCLUSION</b>Laparoscopic radical gastrectomy is a safe, feasible, effective, and less invasive surgery for early gastric cancer.</p>
Assuntos
Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Seguimentos , Gastrectomia , Métodos , Laparoscopia , Laparotomia , Excisão de Linfonodo , Estudos Retrospectivos , Neoplasias Gástricas , Cirurgia Geral , Resultado do TratamentoRESUMO
<p><b>OBJECTIVE</b>To explore the relationship between gamma-synuclein gene expression and CpG island demethylation in colorectal cancer(CRC), and the relationship between the demethylation and clinicopathological factors of CRC.</p><p><b>METHODS</b>The expression of gamma-synuclein mRNA was examined in 30 pairs of tumor tissues and tumor-matched non-neoplastic adjacent tissues(NNAT) by RT-PCR. CRC cell lines including COLO205, LoVo, and SW480 were used and treated with a demethylating agent, 5-aza-2'-deoxycytidine(5-aza-C). Before and after the treatment, the expression of gamma-synuclein mRNA in the cells was determined by RT-PCR, and bisulfite sequencing PCR was also used to analyze methylation status of CpG island. The methylation status of gamma-synuclein was then examined in 67 CRC samples and 30 NNAT samples by nested methylation-specific PCR (NMSP) and real time methylation-specific PCR(real-time MSP). The relationship between the demethylation of gamma-synuclein in CRC and clinicopathological factors was analyzed.</p><p><b>RESULTS</b>The mean gamma-synuclein mRNA expression was 0.66+/-0.34 in CRC samples, which was much higher than 0.45+/-0.26 in NNAT samples(P=0.011). 5-aza-C could induce expression and demethylation of gamma-synuclein in COLO205, LoVo and SW480 cells. gamma-Synuclein gene was demethylated in 80.0%(24/30) of the CRC samples and 50.0%(15/30) of the NNAT samples. The demethylated status of gamma-synuclein was much higher in CRC samples than that in NNAT samples(P=0.030), and was significantly correlated with clinical stage, lymph node involvement, and distant metastasis of CRC(P<0.05).</p><p><b>CONCLUSION</b>The upregulation of gamma-synuclein expression in CRC is primarily attributed to the demethylation of CpG island, which may be used as a marker for prognosis.</p>
Assuntos
Humanos , Linhagem Celular Tumoral , Neoplasias Colorretais , Genética , Metabolismo , Patologia , Ilhas de CpG , Metilação de DNA , Regulação Neoplásica da Expressão Gênica , Prognóstico , RNA Mensageiro , Genética , gama-Sinucleína , Genética , MetabolismoRESUMO
<p><b>OBJECTIVE</b>To investigate the prognostic risk factors in incidental gallbladder cancer (IGBC) and evaluate the effect of laparoscopic cholecystectomy (LC) applied in treating IGBC.</p><p><b>METHODS</b>The retrospective study enrolled 55 patients with incidental gallbladder adenocarcinoma treated between January 2001 and December 2008. The patients were divided into three groups according to different surgical approaches: laparoscope group (n = 23), conversion group (n = 6) and laparotomy group (n = 26). Survival analysis and Cox regression model were applied to comparing the difference of survival rate between three groups and to analyzing the related prognostic risk factors of IGBC.</p><p><b>RESULTS</b>The overall 1-, 3- and 5-year survival rates were 74.3%, 47.7% and 35.8% respectively. And the median survival time was 36 months. The outcome of survival rate between three groups was not different statistically. Cox regression analysis indicated that pathologic T stage was an independent risk factor influencing IGBC (OR = 2.75, P = 0.00). The prognosis was getting worse according to the rising depth of tumor invasion. However, the other factors, such as surgical approach, tumor incisional implantation, ect.were not related to the prognosis (P > 0.05).</p><p><b>CONCLUSION</b>The factor of pathologic T stage is related to the prognosis of IGBC for which LC, compared with open cholecystectomy, should not be regarded as a negative factor in treatment.</p>
Assuntos
Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Colecistectomia Laparoscópica , Seguimentos , Neoplasias da Vesícula Biliar , Cirurgia Geral , Estimativa de Kaplan-Meier , Análise Multivariada , Prognóstico , Modelos de Riscos Proporcionais , Estudos Retrospectivos , Fatores de RiscoRESUMO
<p><b>OBJECTIVE</b>To compare the outcomes of laparoscopic colorectal surgery in elderly (> or = 70 years) and younger(< 70 years) patients, and to evaluate the safety of laparoscopic colorectal surgery in elderly.</p><p><b>METHODS</b>From Aug. 2007 to Dec. 2007, 25 patients with colorectal cancer undergone laparoscopic colorectal surgery were studied prospectively. Ten patients aged 70 years or older(Elder Group), and 15 patients less than 70 years(Younger Group). The parameters of perioperative hemodynamics, blood chemistry, and intraabdominal organs perfusion were recorded periodically during operation and compared between the two groups.</p><p><b>RESULTS</b>Elder group had a higher ASA degree(P<0.01). Mean age, height, weight, the classification of the disease, operative time, blood loss and complication were not significantly different between the two groups. The HCO(3) value and PaCO(2) value increased significantly intraoperatively, while the pH value decreased significantly. These parameters returned to basal line at the end of operation, with the decreased electrolytes, especially the kaliopenia and hypocalcemia. The CVP increased significantly at the beginning of operation and after fluid expansion, and decreased postoperatively. Gastric mucosal pH(pHi) decreased when the operation began. The partial pressure of gastric mucosa(PgCO(2)) increased significantly at the end of operation. Other parameters of hemodynamics including HR, CI, and SI were not significantly different during operation. The CVP of elder group was higher than that of younger group at 5 min after the beginning of the operation, while the MAP of elder group was lower than that of younger at 15 min after the end of the operation. Other parameters of hemodynamics including oxygenation, perfusion, and blood chemistry were not significantly different.</p><p><b>CONCLUSIONS</b>For laparoscopic colorectal surgery, no significant adverse response attributes to elderly patients. The compensation capacity of the elderly is lower. With the reasonable anesthesia administration, the adverse response can be controlled effectively.</p>
Assuntos
Idoso , Humanos , Pessoa de Meia-Idade , Fatores Etários , Neoplasias Colorretais , Cirurgia Geral , Laparoscopia , Estudos ProspectivosRESUMO
<p><b>OBJECTIVE</b>To study the regulatory effect of galectin-9 isoforms on some molecules involved in cell adhesion/invasion, and the influence of this regulation action on the adhesion between colon carcinoma LoVo cells and human umbilical vein endothelial cells (HUVECs) in vitro.</p><p><b>METHODS</b>Various expression vectors of galectin-9 isoforms were transfected into LoVo cells. 24 h after transfection, the expression of integrin-beta1, E-cadherin, E-selectin, ICAM-1, CD44 and MMP-9 was detected by RT-PCR and Western blot analysis. LoVo cell-HUVEC adhesion assay was performed under conditions of galectin-9 transfection, galectin-9 transfection + galectin-9 antibody, galectin-9 transfection + E-selectin antibody and galectin-9 transfection + beta-lactose, respectively.</p><p><b>RESULTS</b>Galectin-9L down-regulates the mRNA and protein levels of E-selectin while galectin-9M and galectin-9S up-regulate the expression of E-selectin. In LoVo cell-HUVEC adhesion assay, the average fluorescence intensity of vector transfection group, galectin-9L transfection group, galectin-9M transfection group and galectin-9S transfection group was 0.90 +/- 0.20, 0.94 +/- 0.24, 1.60 +/- 0.11 and 1.45 +/- 0.13, respectively, indicating that galectin-9M and galectin-9S facilitated the adherence of LoVo cells to HUVECs (P < 0.05). E-selectin antibody, galectin-9 antibody or beta-lactose inhibited that effect.</p><p><b>CONCLUSION</b>Galectin-9 isoforms regulate the E-selectin expression in LoVo cells differently and thus influence the adhesion between LoVo cells and HUVECs in vitro in different modes. The mechanisms through which galectin-9 isoforms participate in the metastasis process of colon cancer may not be the same.</p>
Assuntos
Humanos , Adesão Celular , Linhagem Celular Tumoral , Células Cultivadas , Neoplasias do Colo , Metabolismo , Patologia , Selectina E , Genética , Metabolismo , Células Endoteliais , Biologia Celular , Galectinas , Genética , Metabolismo , Regulação Neoplásica da Expressão Gênica , Vetores Genéticos , Isoformas de Proteínas , Genética , Metabolismo , RNA Mensageiro , Metabolismo , Veias Umbilicais , Biologia CelularRESUMO
<p><b>OBJECTIVE</b>To evaluate laparoscopic surgery for gastric and small intestinal stromal tumors.</p><p><b>METHODS</b>The clinical data of patients with laparoscopic resection of gastric and small intestinal tumors, admitted to our center from Dec. 2003 to Jul. 2006, were retrospectively analyzed. The data included the surgical procedure, operative time, blood loss, length of incision, time for passage of flatus, postoperative length of stay, operative complications, pathology and the results of follow-up.</p><p><b>RESULTS</b>All the 33 patients with gastric and small intestinal stromal tumors were treated by laparoscopic procedures successfully, including 8 laparoscopic gastric wedge resections, 8 laparoscopic transgastric tumor-everting resections, and 17 laparoscopic segmental resections of small intestine. The mean operative time was (73.1+/-27.0) min, the mean blood loss was (19.8+/-14.0) ml, the mean length of incision was (3.3+/-1.1) cm, the mean time for passage of flatus was (2.2+/-1.0) d and the postoperative length of stay was (8.1+/-2.0) d. The bleeding of intestinal anastomosis and gastric mucosa occurred on 3 patients (9.1%), who were healed with conservative therapy. No recurrence was found during 2-33 months follow-up.</p><p><b>CONCLUSION</b>Laparoscopic surgery is an effective, safe, less invasive procedure for treatment of gastric and small intestinal stromal tumors.</p>
Assuntos
Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem , Seguimentos , Tumores do Estroma Gastrointestinal , Cirurgia Geral , Intestino Delgado , Laparoscopia , Métodos , Estudos RetrospectivosRESUMO
<p><b>OBJECTIVE</b>To evaluate the clinical use of laparoscopy in diagnosis and surgical treatment in small intestinal tumors.</p><p><b>METHODS</b>Clinical data of 42 patients with small intestinal tumor undergoing laparoscopic diagnosis and surgical procedure from Sep. 2003 to Dec. 2005 were analyzed retrospectively. The operative time, blood loss,length of incision, time for passage of flatus, post-operative hospital stay and operative complications were evaluated.</p><p><b>RESULTS</b>All the patients were diagnosed and treated by laparoscopic procedure successfully, including 4 laparoscopic local resection of the tumors, 36 laparoscopy-assisted partial intestinal resections, 1 right hemicolectomy, and 1 laparoscopic exploration. The mean operative time was (73.1+/-32.9) min, the mean blood loss was (20.7+/-31.2) ml, the mean length of incision was (3.7+/-1.2) cm, the mean time for passage of flatus was (2.2+/-0.8) d, and the post-operative hospital stay was (8.0+/-3.1) d. Postoperative complications occurred in 2 patients (4.8% ) including anastomosis bleeding and adhesive intestinal obstruction in one case respectively. After follow-up from 3 to 30 months, no recurrent tumor was found except one patient with advanced intestinal carcinoma.</p><p><b>CONCLUSION</b>Laparoscopic exploration can diagnose small intestinal tumors accurately, and laparoscopy-assisted surgical treatment is safe with less trauma and fast recovery.</p>
Assuntos
Adulto , Idoso , Feminino , Humanos , Pessoa de Meia-Idade , Neoplasias Intestinais , Diagnóstico , Cirurgia Geral , Intestino Delgado , Laparoscopia , Estudos RetrospectivosRESUMO
<p><b>OBJECTIVE</b>To compare the systemic and local inflammatory response after laparoscopic and conventional surgery for colorectal carcinoma.</p><p><b>METHODS</b>From April 2004 to August 2004, 51 colorectal cancer patients undergoing laparoscopic (n=25) and conventional open (n=26) colorectal resection were enrolled in the study. The general clinical data,and inflammatory response were compared between the two groups.</p><p><b>RESULTS</b>There were no significant differences in age, sex, pre-operative levels of haemoglobin and albumin, Dukes stage and surgical procedure between the two groups (P > 0.05). Laparoscopic surgery had more advantages over conventional open surgery such as incision, operating time, recovery time of bowel function, and hospitalization. On postoperative day (POD) 1, WBC count [(7.30+/- 2.62)x10(9)/L], and the serum levels of IL-10 [(19.46+/- 3.31)pg/ml] and C-reactive protein (CRP) [(2.76+/- 2.17)mg/dl] were significantly lower in laparoscopic group than those in conventional group (P< 0.05), but there were no differences on POD 4 between the two groups (P > 0.05). There were no significant differences in the volume of peritoneal drainage fluid, and levels of IL-10, TNF and CRP in it on POD 1 between the two groups, but the volume of peritoneal drainage fluid decreased significantly from POD 2, and the level of IL-10 in it was significantly lower on POD 4 in laparoscopic group than that in conventional group.</p><p><b>CONCLUSIONS</b>In early stage after operation,intra- peritoneal inflammatory response caused by laparoscopic surgery is similar to that by conventional open surgery, but systemic inflammatory response is slighter than that by conventional open surgery for colorectal carcinoma.</p>