Clinical efficacy of the gap above the splenic pedicle in laparoscopic splenectomy / 中华消化外科杂志

Objective To explore the clinical efficacy of the gap above the splenic pedicle in laparoscopic splenectomy (LS).Methods The retrospective cohort study was conducted.The clinical data of 189 patients who underwent LS in the Union Hospital Affiliated to Tongji Medical College of Huazhong University of Science and Technology between August 2012 and March 2015 were collected.Among 189 patients receiving splenic pedicle division,42 without the application of the gap above the splenic pedicle were allocated into the group A and 147 with the application of the gap above the splenic pedicle were allocated into the group B.Observation indicators included:(1) operation situations:combined operation,operation time (excluding combined operation time),volume of intraoperative blood loss (excluding blood volume of spleen),cases with conversion to open surgery;(2) postoperative situations:time to initial anal exsufflation,time for fluid diet intake,occurrence of postoperative complications and duration of hospital stay;(3) follow-up.Patients were followed up by telephone interview and outpatient examination up to August 2016.Follow-up included routine blood test,coagulation function,liver function,with or without long-term complications.Measurement data with normal distribution were represented as x±s and comparison between groups was analyzed using the t test.Comparisons of count data were analyzed by the chi-square test.Results (1) Operation situations:of 189 patients undergoing LS,136 combined with laparoscopic pericardial devascularization,13 combined with laparoscopic cholecys-tectomy,9 combined with laparoscopic radio frequency ablation (RFA) of liver tumors and 26 combined with pathological examination using laparoscopic liver tissues sampling.Operation time,volume of intraoperative blood loss and cases with conversion to open surgery were (118±31) minutes,(80±38) mL,2 in the group A and (70± 22) minutes,(50± 28) mL,1 in the group B,respectively,with statistically significant differences between the 2 groups (t =12.579,-8.516,x2=4.912,P＜0.05).(2) Postoperative situations:time to initial anal exsufflation,time for fluid diet intake,number of patients with postoperative complications and duration of hospital stay were (22± 10)hours,(3.1 ± 1.3) days,8,(9±3)days in the group A and (23±11)hours,(3.8±1.8)days,13,(8±3)days in the group B,respectively.Pancreatic fistula,intra-abdominal hemorrhage,asymptomatic portal vein thrombosis,pulmonary infection and intraperitoneal infection were respectively detected in 2,2,2,1,1 patients in the group A and 1,2,5,2,3 patients in the group B.There was no significant difference in time to initial anal exsufflation,time for fluid diet intake and duration of hospital stay between the 2 groups (t =1.102,0.745,0.583,P＞0.05),and a statistically significant difference in number of patients with postoperative complications between the 2 groups (x2 =7.259,P＜ 0.05).There were statistically significant differences in cases with pancreatic fistula and intra abdominal hemorrhage (x2=16.021,5.812,P＜0.05) and no significant difference in cases with asymptomatic portal vein thrombosis,pulmonary infection and intraperitoneal infection (x2 =1.391,0.396,0.865,P＞0.05).Patients with postoperative complications were cured by symptomatic treatment.(3) Follow-up:156 of 189 patients (33 in the group A and 123 in the group B) were followed up for 1-18 months,with an average time of 12 months.During the follow-up,13 patients had recurrent hematemesis and melena,including 3 in the group A and 10 in the group B.Eight patients stopped bleeding after conservative treatment,3 stopped bleeding after proxial gastrectomy and 2 died of excessive bleeding and organ failure.Conclusion Splenic pedicle division using Endo-GIA through the gap above the splenic pedicle in LS can reduce operation time,volume of intraoperative blood loss,rate of conversion to open surgery and postoperative complications.

Clinical experience of laparoscopic splenectomy and pericardial devascularization on the treatment of portal hypertension / 中华普通外科杂志

Objective To investigate the operational technique of laparoscopic splenectomy and pericardial devascularization (LSPD) and evaluate the clinical efficiency of this method for the treatment of portal hypertension.Methods With the new understanding of anatomical space around the spleen,the cardia and the fundus,two gaps and two tunnels can be created in LSPD.Retrospective analysis was made on the clinical data of patients who underwent LSPD from Jun 2013 to Mar 2015.The operative time,intraoperative blood loss,postoperative hospital stay,conversion rate and postoperative complication rate were measured.Results A total of 189 cases underwent surgery successfully,including 34 cases of splenomegaly and 21 cases of severe esophageal varices.The operative time was (125 ± 52) min,intraoperative blood loss (58 ± 32) ml,postoperative hospital stay (7.5-2.1) d.There were 4 conversion cases in this study.Conclusions The splenic pedicle and stomach pedicle can be safely dissected with the two gaps and two tunnels principle,which makes LSPD safe and convenient.

The value of parenteral fish oil lipid emulsion supplementation in patients after surgical operation of hepatobiliary malignancy / 肠外与肠内营养

Objective: The impact of parenteral fish oil lipid emulsion on liver function and nutritional status of malignant tumors of the liver and gallbladder patients. Methods: From December 2007 to A-pril 2008, 32 post-operative hepatobiliary cancer patients were randomly divided into control and study groups. Two groups were treated with isocaloric, isonitrogenic parenteral nutrition and the study group was added fish oil lipid emulsion. Comparison of plasma protein, glucose, jaundice index, transaminase, ALP and the rate of infection complications was made betweent the two groups. Results: The blood glucose, transaminase and ALP levels were not significantly different between the two groups. But the plasma proteins and bilirubin levels were improved significantly (P < 0.05) with reduced infection complication in the study group. Conclusion : Fish oil lipid emulsion is conducive to the recovery of post-operative liver and gallbladder cancer patients in live function and nutritional status.

Eukaryotic expression of human Arresten gene and its effect on the proliferation and migration of vascular smooth muscle cells / 中国病理生理杂志

AIM: To express human Arresten gene in eukaryotic cell,and to investigate its effect on the proliferation and migration in vitro of rat primary cultured thoracic aortic vascular smooth cells (VSMCs).METHODS: COS-7 cells were transfected with recombinant eukaryotic expression plasmid pSecTag2-AT or control plasmid pSecTag2 mediated by liposome.48 hours after transfection,polymerase chain reaction(RT-PCR) was used to detect the expression of Arresten mRNA in the cells,while Western blotting assay was applied to detect expressed Arresten protein in concentrated supernatants.VSMCs were then co-cultured with the concentrated supernatants;and its proliferation was detected using cell counting kit-8(CCK-8) in vitro.Migration of VSMCs was assayed by a microchemotaxis chamber and a polycarbonate filter (Transwell's chamber) with pores of 8 ?m in diameter.RESULTS: RT-PCR revealed that the genome of Arresten-transferred cells contained a 449bp specific fragment of Arresten gene.Successful protein expression in supernatants was confirmed by Western blotting.CCK-8 assay showed that the proliferation of VSMCs was inhibited significantly by Arresten protein as compared with control group(P

The effect of enteral nutrition on gut barrier in patients with hepatic dysfunction / 肠外与肠内营养

Objectives:To determine if enteral nutrition can protect the gut barrier in patients with damaged hepatic function and draw the clinical significance from it. Methods:76 patients whose hepatic function was in Child B or C grade were randomly assigned in enteral nutrition group(EN,30 cases),total parenteral nutrition group(TPN,26 cases) and control group(CON,20 cases).They were given with different nutritional support. Nutritional parameter and hepatic function indexes were massured at the day before operation,5th day and 10th day after the operation respectively.The concentrations of lactulose(L) and Mannitl(M) were detected in the urines with pulsed electrochemical detection(HPLC PED) and the L/M ratio was calculated. Results:No significant differences of hepatic function changes were observed between EN group and TPN group.It was the earlist that EN group reached the positive nitrogon equilibrium among the 3 groups and the loss of body weight after operation was the lowest in EN group There wes no change in L/M ratio in EN group, but the change was significant in TPN group( P