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With the continuous development of endoscopic technology, more and more early-stage colorectal cancer and precancerous lesions have been found by endoscopy, and endoscopic treatment has dominated the treatment of early-stage colorectal cancer for its characteristics of small trauma, rapid recovery and good effect. At present, there are many methods of endoscopic treatment, but their indications are still controversial, and some new technologies still need further verified. Based on the latest guidelines at home and abroad and some hot issues, this article reviews the progress of endoscopic treatment of early-stage colorectal cancer and precancerous lesions, mainly including the indications of various endoscopic treatment methods, some important technical improvement of endoscopic treatment methods, and the application of some new endoscopic treatment technologies, in order to provide some references for the minimally invasive treatment of early-stage colorectal cancer and precancerous lesions.
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Objective:To explore different strategies of central repair first or malperfusion first to treat type A aortic dissection complicated with limb malperfusion.Methods:From January 2020 to December 2021, 302 patients were diagnosed with acute type A aortic dissection, and 17 consecutive patients were diagnosed as type A acute aortic dissection complicated with limb malperfusion and underwent Sun’s procedure. There were 16 males and 1 female with an average of(52.6±4.2)years. Surgical strategies were as follows: immediate central repair-Sun’s procedure in 14 patients, endovascular stenting followed by central repair in 3 patients, endovascular stenting after central repair in 1 patient.Results:The incidence rate of limb malperfusion of acute Stanford A aortic dissection was 5.6%(17/302). Average extracorporeal circulation time was(271.8±38.9)min, average aortic cross-clamp time was (186.3±31.8)min, and the average circulatory arrest time was (48.75±11.3)min. Early mortality rate was 17.6%(3/17). Two patients were left hospital voluntarily because of cerebral infarction. One patient underwent leg incision osteofascial compartment syndrome and discharged unevently. Five patients underwent continuous renal replacement therapy and hemoperfusion. Follow-up results showed that patients with serious limb malperfusion have symptoms of nerve dysfunction including amyosthenia and sensory disturbance, but recovered gradually with rehabilitation.Conclusion:Sun’s procedure is safe and feasible for type A acute aortic dissection complicated with mild limb malperfusion. For serious limb malperfusion, endovascular stent followed by Sun’s procedure is a good choice with CRRT and hemoperfusion.
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Objective To investigate the prognostic value of preoperative fibrinogen and albumin ratio (FAR) in patients with gallbladder carcinoma.Methods The clinicopathological data of 100 patients with gallbladder carcinoma who undergoing radical resection at Beijing Hospital from Feb 2007 to Feb 2019were retrospectively analyzed.The receiver operating characteristic (ROC) curve was drawn to determine the optimal cut-off value of FAR,and the prognostic factors were evaluated by Kaplan-Meier method,univariate and multivariate analysis.Results The optimal cut-off value of preoperative FAR for postoperative overall survival was 0.08.FAR was significantly associated with preoperative total bilirubin (TBil)levels,tumor differentiation,T stage,TNM stage,resection margin status,and preoperative CA199 levels (all P＜0.05).Multivariate analysis indicated that TNM staging (HR =3.562,95％ CI:1.075-11.798,P =0.038) and FAR (HR =2.482,95％ CI:1.263-4.875,P =0.008) were independent prognostic factors in patients with gallbladder carcinoma who underwent radical surgery.Conclusion Preoperative FAR is closely related to the prognosis of patients with gallbladder carcinoma and might be useful for the evaluation of prognosis of patients with gallbladder carcinoma.