Precise delivery of obeticholic acid

Primary bile acids were reported to augment secretion of chemokine (C‒X‒C motif) ligand 16 (CXCL16) from liver sinusoidal endothelial cells (LSECs) and trigger natural killer T (NKT) cell-based immunotherapy for liver cancer. However, abundant expression of receptors for primary bile acids across the gastrointestinal tract overwhelms the possibility of using agonists against these receptors for liver cancer control. Taking advantage of the intrinsic property of LSECs in capturing circulating nanoparticles in the circulation, we proposed a strategy using nanoemulsion-loaded obeticholic acid (OCA), a clinically approved selective farnesoid X receptor (FXR) agonist, for precisely manipulating LSECs for triggering NKT cell-mediated liver cancer immunotherapy. The OCA-nanoemulsion (OCA-NE) was prepared

Application of Overlap anastomosis to Billroth I digestive tract reconstruction after laparoscopic distal gastrectomy in gastric cancer / 中华胃肠外科杂志

Objective@#To investigate the application value of Overlap anastomosis in Billroth I digestive tract reconstruction after laparoscopic distal gastrectomy in gastric cancer.@*Methods@#Clinical data of 68 stage T1-2 gastric cancer patients undergoing laparoscopic distal gastrectomy for D2 radical gastrectomy from January 2015 to January 2016 at China Japan Union Hospital of Jilin University were retrospectively analyzed. Inclusion criteria: (1) no distant metastasis of gastric cancer confirmed by gastroscopy and pathology before surgery; (2) T1-2 tumor with diameter <3 cm; (3) the lesion locating in the antrum of the stomach with distance >1 cm from the pylorus, and no invasion into middle area; (4) R0 resection confirmed by postoperative pathology; (5) no history of abdominal surgery. Among 68 cases,23 cases were in Overlap anastomosis group and 45 cases in Billroth I anastomosis group. D2 lymph node dissection and distal gastrectomy were performed in both groups. In the Overlap anastomosis group, the duodenum and stomach were severed by a linear stapler under endoscopy, and the residual gastric curve anastomotic opening was selected. According to the tension between the duodenum and the remnant stomach, the anastomotic opening was selected at the upper edge of the remnant duodenum, and the anastomosis between the posterior wall of the remnant stomach and the upper wall of the duodenum was completed by placing the stapler under endoscopy. Then the common opening was closed and the remnant duodenum was resected. In the traditional Billroth I anastomosis group, pneumoperitoneum was discontinued after amputation of the duodenum under laparoscopy. The median incision of the upper abdomen was 9-12 cm. The distal stomach was pulled out to complete the excision of specimens, the extraction of specimens and Billroth I digestive tract reconstruction. The intraoperative and postoperative conditions of the two groups were compared with student t test (continuous variable) and chi-square test (categorica variable).@*Results@#Of the 68 patients,39 were males and 29 were females,with age of (65.5±10.2)(51 to 77)years. Differences in baseline data between Overlap group and Billroth I group were not statistically significant (all P>0.05). Laparoscopic surgery was successfully performed in both groups without conversion to open operation. As compared with the Billroth I group, the Overlap group had significantly shorter operation time [(149.8±10.1) minutes vs. (169.8±15.3) minutes, t=5.658,P=0.008], shorter anastomotic time of digestive tract reconstruction [(31.2±3.8) minutes vs. (36.3±3.3) minutes, t=3.389, P=0.003] and shorter abdominal incision length [(4.5±0.9) cm vs.(11.0±2.3) cm, t=13.244,P=0.004]. There were no significant differences between two groups in intraoperative blood loss [(92.9±22.4) ml vs. (87.0±7.3) ml,t=1.186,P=0.366], number of lymph node dissected (28.4±5.7 vs. 27.3±5.2, t=0.838, P=0.383), postoperative flatus time [(4.4±2.1) days vs.(4.2±1.8) days, t=0.391, P=0.563], morbidity of postoperative complication [4.3%(1/23) vs. 6.7%(3/45), χ2=0.148,P=0.701]. All the patients were followed up for 28±10 (10-46) months. There were no long-term complications, recurrence or death in two groups.@*Conclusion@#Overlap anastomosis in Billroth I digestive tract reconstruction after laparoscopic distal gastrectomy is safe and effective, and can reduce the anastomosis time.

Advances in the research of gastric signet ring cell carcinoma / 中华胃肠外科杂志

Epidemiological studies in recent years have found that the incidence of gastric signet ring cell carcinoma (SRCC) has increased significantly. In this paper, we first reviewed cell origin and biomarkers of SRCC, and the relationship between SRCC and various pathological types of gastric cancer. The early diagnosis rate of gastric SRCC is low, which may be due to the unclear mechanism of pathology and precancerous lesions. In clinical practice, SRCC has the characteristics of low differentiation and high degree of malignancy. Most of patients with gastric cancer Borrmann IV(diffuse infiltrative type) are gastric SRCC, and their prognosis is poor. The average age of gastric SRCC was 55 to 61 years old. Besides, in female, the incidence of SRCC was significantly higher than that of non-SRCC gastric cancer. It is found that the expressions of estrogen and progesterone receptors in SRCC tissues are high. The relationship between gastric SRCC and sex hormones may be the cause of gender differences in the pathogenesis of gastric SRCC. Due to the low risk of lymph node metastasis in early SRCC, endoscopic mucosal resection and endoscopic submucosal dissection can be performed for <3 cm, submucosal invasive, medium differentiated tumors, or <3 cm, highly differentiated, ulcerative and submucosal lesions. For non-metastatic advanced gastric SRCC, surgical resection and adequate lymph node dissection should be performed owing to the high risk of lymph node metastasis. Adjuvant chemotherapy is also considered to improve the long-term prognosis of patients. Taxane therapy may be more effective in gastric SRCC. Recent data show that gastric SRCC and diffuse gastric cancer are more sensitive to mitomycin C, doxorubicin and docetaxel than intestinal type gastric cancer, but are not sensitive to fluorouracil and cisplatin. These treatment perspectives still need to be confirmed in future studies.

Comparative study of 3D and 2D laparoscopic surgery for gastrointestinal tumors / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To evaluate the technical advantages of 3D laparoscopic and 2D laparoscopic surgery for gastrointestinal tumors.</p><p><b>METHODS</b>Clinical data of gastrointestinal cancer patients undergoing 3D laparoscopic or 2D laparoscopic surgery from January 2015 to January 2017 in our department were retrospectively analyzed These patients included 93 gastric cancer cases undergoing laparoscopic radical resection (total gastrectomy, 48 cases in 3D group, 45 cases in 2D group), 45 rectal cancer cases undergoing radical resection combined with lateral lymph node dissection (27 cases in 3D group, 18 cases in 2D group) and 76 right colon cancer cases undergoing radical resection (37 cases in 3D group, 39 cases in 2D group). The enrolled criteria of cases were 18-80 years old and diagnosed as advanced gastric or colorectal cancer by pathological examination. Patients with preoperative distant metastasis, severe heart or lung diseases who were not suitable for laparoscopic surgery, combined organ resection and conversion to open surgery were excluded. The choice of surgical procedure was determined by the discussion between patients and surgeon. Operations were performed by the same surgical team. Total operation time, complex operation time (deep lymph node dissection time, endoscopic intestinal anastomosis time), number of harvested lymph node, number of times in wrong grasp (accurate grasp for the same site needs to position for two times or more) and intraoperative bleeding were compared between 3D group and 2D group.</p><p><b>RESULTS</b>There were no significant differences in baseline data between 3D group and 2D group. All the patients completed laparoscopic radical operation successfully without conversion to open surgery. In patients with gastric cancer, compared with 2D group, the total operation time was shorter [(185±25) min vs. (190±27) min, P<0.05]; dissection time of No.10 and 11d lymph node [(40±8) min vs. (55±12)min, P<0.05], and No.7, 8, 9 and 12 lymph node [(30±6) min vs. (41±9) min, P<0.05] was shorter; the number of times in wrong grasp (5±2 vs. 11±2, P<0.05) was less in 3D group. In patients with rectal cancer, compared with group 2D, 3D group had shorter time of lateral lymph node dissection [(27±6) min vs. (35±9) min, P<0.05] and laparoscopic anastomosis [(45±7) min vs. (58±11) min, P<0.05]; less number of times in wrong grasp (4±2 vs. 13±2, P<0.05]. In patients with right colon cancer, 3D group had shorter laparoscopic anastomosis time [(38±7) min vs. (44±5) min, P<0.05] and less number of times in wrong grasp (5±1 vs. 13±3, P<0.05] as compared to 2D group.</p><p><b>CONCLUSION</b>3D laparoscopic surgery for gastrointestinal tumors, compared with 2D laparoscopic technology has significant advantages, which can improve the spatial location and depth of operation, decrease the difficulty of fine operation, and shorten the operation time.</p>

Application value of programmed D2 radical gastrectomy for advanced gastric cancer / 中华消化外科杂志

Gastric cancer is one of the high incidence of malignant tumors in China,the incidence of which is in the second among the world and is only inferior to Japan.But the mortality of gastric cancer in China is 2 times of world's average level,which is often associated with low early diagnostic rate,big regional differentials in the surgical quantity of gastric cancer (especially D2 radical gastrectomy) and prognosis of patients influenced by surgical quantity.Therefore,a standardized treatment of gastric cancer is the current development trend and hotspot.The correct and programmed staging,evaluation,operation methods,approaches,lymph node dissection and digestive tract reconstruction are selected,thus improving the long-term survival of patients with advanced gastric cancer and reducing mortality in China.

Sternocleidomastoid lateral path in the application of the thyroid cancer lateral neck lymph node cleaning / 临床外科杂志

Objective To explore the the application of sternocleidomastoid lateral path for thyroid cancer surgery lateral neck lymph node cleaning.Methods 40 patients with thyroid carcinoma were detected in the lateral neck lymph node cleaning using sternocleidomastoid lateral path(experimental group)and 40 cases of patients with thyroid cancer in the lateral neck lymph node cleaning cleaning scope with traditional operation method(control group),comparing with success rates,operation time,quality of life and incidence of complications.Results Experimental group can achieve the purpose of curing in the operation,operation field showed more clearly,the lymph node zone Ⅱ,Ⅲ,Ⅳ,Ⅴ number (32,58,50,35)were higher than traditional surgery group(17,35,33,20).Experimental group can significantly shorten the operation time[(30.0±1.20)min vs(45.0±3.10)min].The difference of incidence of near and forward future overall complications was statistically significant between the two group(P<0.05).Conclusion Sternocleidomastoid lateral path in thyroid carcinoma in the lateral neck lymph node cleaning can achieve the purpose of curing,significantly improve the lymph node zone Ⅱ,Ⅲ,Ⅳ,Ⅴ,shorten the operation time,reduce the recent and long-term complications and improve patient's quality of life.

Intestinal derotation maneuver for resection of intestinal neoplasm near the ligament of Treitz / 中华普通外科杂志

Objective To study the the feasibility of intestinal derotation maneuver in the resection of gastrointestinal neoplam localized in the vicinity of the ligament of Treitz.Method Intestinal derotation maneuver was applied in all the 9 case of gastrointestinal neoplasms near the ligament of Treitz,from January 2014 to January 2016,at the Second Hospital of Jilin University.The clinical date were retrospectively analyzed.Results Intestinal derotation maneuver were applied without failure in all the nine patients,the mean operation time were (195 ± 50) min,and the mean intestinal derotation maneuver time were (19 ±5) min;No derotation procedure-related injury occured,and the mean estimated blood loss were (132 ±94) ml.Early postoperative ileus developed in one case and gastroparesis in two cases.All were recovered by conservative treatment.The follow-up period were 3-24 month,tumor recurrence occurred in two cases and one case died.One case lossed to follow-up after postoperative 3 month.Conclusion The present data suggest that clinical use of intestinal derotation maneuver was feasible for surgical management of gastrointestinal neoplasms near the ligament of Treitz.

Advantage investigation of totally laparoscopic modified Roux-en-Y reconstruction / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To investigate the clinical advantage of the application of modified Roux-en-Y reconstruction after totally laparoscopic total gastrectomy.</p><p><b>METHODS</b>Clinical data of 36 patients who underwent totally laparoscopic total gastrectomy with Roux-en-Y reconstruction by one medical team for gastric adenocarcinoma between January 2014 and December 2014 in the Second Hospital of Jilin University were retrospectively analyzed. Patients were divided into classic Roux-en-Y group (CRY, 16 cases) and modified Roux-en-Y group (MRY, 20 cases) according to reconstructive methods. The data concerning the intraoperative and postoperative situation in two groups were compared.</p><p><b>RESULTS</b>Operation was successfully completed in all the cases without conversion to laparotomy. Compared to CRY group, MRY group had shorter mean operative time [(260.9 ± 21.2) min vs. (287.9 ± 19.0) min, P=0.000], shorter mean reconstruction duration [(32.4 ± 9.2] min vs. (45.4 ± 13.2) min, P=0.001] and less intraoperative bleeding [(50.9 ± 23.5) ml vs. (67.0 ± 20.5) ml, P=0.000]. Jejunum mesentery dissection and jejunum resection were not necessary in MRY group. However, there were no significant differences in lymph nodes harvested, time to flatus, hospital stay and postoperative complications between two groups.</p><p><b>CONCLUSIONS</b>As compared to classic Roux-en-Y reconstruction, the modified Roux-en-Y reconstruction can simplify the surgical procedures and achieve similar efficacy. It is feasible and safe, and worth further promotion in clinical practice.</p>

Comparative study of three-dimensional and two-dimensional laparoscopic-assisted D2 radical gastrectomy in short-term efficacy / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To evaluate the advantage and short-term efficacy of three-dimensional (3D) laparoscopic-assisted D2 radical gastrectomy for gastric cancer.</p><p><b>METHODS</b>Clinical data of 116 gastric cancer patients who underwent laparoscopic-assisted D2 radical gastrectomy in our department from January 2014 to August 2015 were analyzed retrospectively. Among 116 patients, 56 received 3D and 60 received two-dimensional(2D) technique respectively. All the surgeries were performed by the same team. The operative parameters, short-term efficacy and hospital expense were compared between the two groups.</p><p><b>RESULTS</b>There were no significant differences between the two groups in baseline data(all P>0.05). All the operations were performed successfully without conversion. Compared with 2D group, 3D group had shorter operative time [(186.2±22.8) minutes vs. (198.1±26.4) minutes, t=2.589, P=0.011], less intraoperative blood loss [(73.6±28.5) ml vs. (88.1±32.3)ml, t=2.555, P=0.012]. Whereas no significant differences in dissected lymph nodes(36.5±6.6 vs. 34.5±5.4, P=0.073), time to first flatus[(3.1±1.5) days vs. (3.3±1.8) days, P=0.729], length of hospital stay[(11.7±2.9) days vs. (12.6±3.1) days, P=0.088], incidence of postoperative complications [8.9%(5/56) vs. 11.7%(7/60), P=0.628] and hospitalization cost [(8.6±1.4)×10(4) yuan vs. (8.1±1.2)×10(4) yuan, P=0.055] were found between two groups.</p><p><b>CONCLUSION</b>Three-dimensional laparoscopic-assisted D2 radical gastrectomy may be advantageous over two-dimensional laparoscopic-assisted D2 radical gastrectomy.</p>

Application of en-bloc mesogastric excision in the treatment of advanced gastric cancer / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To evaluate the value of en-bloc mesogastric excision (EME) in the treatment of advanced gastric cancer.</p><p><b>METHODS</b>A retrospective analysis on clinical data of 98 gastric cancer patients who underwent total gastrectomy in China-Japan Union Hospital of Jilin University from January 2013 to December 2015 was carried out, including EME group of 48 cases (according to the mesangial space) and D2 radical group of 50 cases(D2 lymphadenectomy according to the vascular markers). Operations were performed by the same single surgeon team. Surgical indexes and recent efficacy indexes were compared between two groups.</p><p><b>RESULTS</b>General informations pertaining to two groups were comparable (P>0.05). All the operations were performed successfully. Compared with D2 radical group, EME group had a shorter operative time [(155.3±13.6) vs. (171.2±14.9) minutes, P=0.012] and less intraoperative blood loss [(95.1±19.5) vs.(122.6±28.0) milliliters, P=0.011]. There were no significant differences in the number of harvested lymph node (30.8±3.9 vs. 31.5±4.7, P=0.675), time to postoperative bowel function return [(3.2±1.2) vs.(3.9±1.4) days, P=0.179], postoperative hospital stay [(10.9±2.7) vs.(11.3±3.2) days, P=0.788], and the incidence of postoperative complication [8.3% vs. 10.0%, P=0.775]. During the follow-up of 1 year, all the patients had no long-term complications, no tumor recurrence or death.</p><p><b>CONCLUSIONS</b>For advanced gastric cancer, EME result in the same clinical efficacy compared with standard D2 resection. At the same time, EME can shorten the operative time and reduce the intraoperative blood loss, which is a new technology and worthy promoting.</p>

Therapeutic effects of sequential chemoradiotherapy with pemetrexed and cisplatin on locally advanced laryngeal cancer

Objective: To explore the therapeutic effects of sequential chemoradiotherapy with pemetrexed and cisplatin on locally advanced laryngeal cancer [LALC]

Methods:Fifty LALC patients who were treated in our hospital between January 2010 and January 2012 were selected and randomly divided into an observation group and a control group [n=25]. The two groups were given conventional radiotherapy in the same manner, before which two cycles of chemotherapy were performed. The observation group intravenously infused with 500 mg/m[2] pemetrexed on d1 and 25 mg/ m[2] cisplatin on d1-3, with 28 days as a cycle. The control group was intravenously infused with 25 mg/m[2] cisplatin on d1-3 and 400 mg/m[2] fluorouracil, with 28 days as a cycle. The short-term effects and adverse reactions of both groups were observed after treatment, and their survival was observed by follow-up for five years

Results:The response rate was 84% [21/25] in the observation group and 64% [16/25] in the control group, between which the difference was statistically significant [P<0.05]. The differences in the incidence rates of short-term adverse reactions such as grade III-IV gastrointestinal reactions and bone marrow suppression were not statistically significant between PC regimen [pemetrexed combined with cisplatin] and PF regimen [cisplatin combined with fluorouracil] [P>0.05]. The incidence of long-term adverse reactions such as grade III-IV laryngeal edemas, laryngeal cartilage inflammation and laryngeal cartilage necrosis showed no significant differences between the two groups [P>0.05]. The median survival was 3.3 years after PC chemotherapy and 2.8 years after PF chemotherapy, between which the difference was not statistically significant [P>0.05]. The levels of serum tumor markers significantly decreased after PC and PF treatments compared with those before [P<0.05]

Conclusion:Combining PC chemotherapy with radiotherapy has satisfactory short-term therapeutic effects on LALC, and the resulting adverse effects can be tolerated. Therefore, this strategy is worthy of promotion and application in clinical practice

Study on the Preparation and Pharmacokinetics of Baicalin Proliposomes in Rats in vivo / 中国药房

OBJECTIVE:To prepare Baicalin proliposomes (PBA) containing sodium deoxycholate (SD) with optimized for-mulation,and to study pharmacokinetics of it in rats in vivo. METHODS:PBA were prepared by spray drying method. Response surface method based on Box-behnken design was adopted to optimize the formulation of PBA with the amount of HSPC,cholester-ol and SD as factors using entrapment efficiency of PBA as index. The particle size,morphology,leakage rate and stability of the optimal PBA were evaluated along with the pharmacokinetics of it(compared to raw materials)in rats after ig administration of 15 mg/kg. RESULTS:The optimal formulation of PBA was that the amounts of baicalin,HSPC,cholesterol and SD were 100,214, 68 and 53 mg,respectively;the predicted and practical values of entrapment efficiency were 86.42% and 84.32%,respectively, and particle size of the optimal PBA was 358.4 nm. The leakage rate of reconstituted liposomes was low and the stability of PBA was good. Compared with baicalin raw material,t1/2,tmax,MRT,cmax and AUC0-t of PBA were all increased significantly(P<0.05 or P<0.01 or P<0.001). CONCLUSIONS:PBA were prepared successfully using the spray drying method. This method is simple and easy,and the optimized formulation is feasible and can improve the oral bioavailability of baicalin.

Effect analysis of three-dimensional and two-dimensional imaging systems in laparoscopic radical resection of rectal cancer / 中华消化外科杂志

Objective To compare the clinical effect of three-dimensional(3D)and two-dimensional(2D)imaging systems in laparoscopic radical resection of rectal cancer.Methods The retrospective cohort study was adopted.The clinical data of the 97 patients who underwent laparoscopic radical resection of rectal cancer at the Xinmin Branch of the China-Japan Union Hospital of Jilin University between May 2012 and December 2014 were collected.Of 97 patients,47 undergoing 3D laparoscopic radical resection of rectal cancer were allocated into the 3D group and 50 undergoing 2D laparoscopic radical resection of rectal cancer were allocated into the 2D group.The operation followed strictly tumor-free and total mesorectal excision principles.Observation indicators included:(1)surgical situations:operation time,time of deep lymph nodes dissected,volume of intraoperative blood loss,bleeding volume of obturator lymph nodes dissected,number of lymph nodes dissected,postoperative complications and duration of hospital stay.(2)Follow-up situations:follow-up using outpatient examination and telephone interview was performed to detect the survival of patients and tumor recurrence and metastasis up to December 2015.Measurement data with normal distribution were presented as-x±s and comparison between groups was analyzed using the t test.Count data were analyzed using the chi-square test.Results(1)Surgical situations:all the patients underwent successful laparoscopic radical resection of rectal cancer,without conversion to open surgery.Operation time,time of deep lymph nodes dissected,volume of intraoperative blood loss,bleeding volume of obturator lymph nodes dissected,number of lymph nodes dissected and duration of postoperative hospital stay were(134.6±18.5)minutes,(21.2±2.7)minutes,(65±20)mL,(16±3)mL,23.6±3.5,(8.2±2.3)days in the 3D group and(157.4±17.8)minutes,(25.2±2.5)minutes,(89±27)mL,(23±5)mL,20.5±2.8,(9.4±2.1)days in the 2D group,respectively,with statistically significant differencesbetween the 2 groups(t=2.999,3.739,2.327,4.221,2.337,1.274,P＜0.05).The postoperative complications were detected in 7 patients in the 3D group and 9 patients in the 2D group,with no statisfically significant difference between the 2 groups(x2=0.170,P＞0.05).(2)Follow-up situations:75 of 97 patients were followed up for 12-36 months with a median time of 24 months,including 35 in the 3D group and 40 in the 2D group,and they were tumor-free survival.Conclusion Compared with 2D laparoscopic radical resection of rectal cancer,3D laparoscopic radical resection of rectal cancer can shorten the operation time and reduce tissue damage and intraoperative blood loss,and it is beneficial to deep lymph node dissection.

Multidisciplinary comprehensive treatment of gastric cancer / 中华消化外科杂志

At present surgical treatment is a main method for gastric cancer,while multidisciplinary comprehensive treatment for gastric cancer has gradually become the mainstream direction of treatment,which is based on regarding patients as the core part of treatment,aiming at specific disease,building multidisciplinary team and making individualized,standardized,scientific and continuous comprehensive treatment plan.Meanwhile,it can provide the best treatment option and efficacy for particular patients,and raise the diagnostic and treatment skills and academic level.There are obvious promotions in the integration between medical education and health management and the progresses of medicine and science.

Clinical efficacy of laparoscopy-assisted radical gastrectomy for gastric cancer in elderly patients / 中华老年医学杂志

Objective To investigate the safety and feasibility of laparoscopy-assisted radical gastrectomy in elderly gastric cancer patients aged over 70 years.Methods Clinical data of 222 elderly gastric cancer patients aged over 70 years receiving surgery from January 2010 to January 2015 were retrospectively analyzed.Patients were divided into the laparoscopy-assisted radical gastrectomy group (LAG group,n=106) and the conventional open gastrectomy group (OG group,n=116),depending on the surgery type.General information,surgical parameters,intra-operative blood pressure fluctuations & blood gas analysis,postoperative recovery and complication rates were compared between the two groups.Results There were no significant differences between the two groups in gender,age,preoperative coexisting diseases,tumor size and location,TNM staging or extent of resection (all P＞0.05).Compared with the OG group,blood loss (86.9±38.9) ml vs.(168.8±49.1) ml,t=10.923,P＜0.01),operative incision length [(9.20±1.55) cm vs.(16.50± 2.12) cm,t=8.788,P＜0.01],time to bowel function recovery [(3.20±1.09) d vs.(5.50±1.16) d,t=4.590,P＜0.01],hospital stay [(11.82±3.92) d vs.(16.14±4.69) d,t=2.234,P＜0.05] and postoperative complications (12.3％ vs.26.4％,x2 =5.186,P＜0.05) were reduced in the LAG group.The LAG group had higher levels of partial pressure of carbon dioxide in arterial blood (PaCO2) and lower levels of base excess than the OG group [(48.10±5.53) mmHg vs.(40.25± 4.66) mmHg,(-7.45±3.72) mmol/L vs.(-3.35±1.98) mmol/L,t=6.908 and 3.619,P＜ 0.01 and 0.05].However,there were no significant differences between the two groups in partial pressure of oxygen (PaO2),arterial oxygen saturation (SaO2) or hydrogen ion concentration (all P＞ 0.05).No significant differences in operation time or number of retrieved lymph nodes were found between the two groups [(196.1 ± 23.4) min vs.(184.2 ± 26.9) min,(28.7 ± 6.5) vs.(27.3 ± 5.6),t=1.174 and 0.515,both P＞0.05].Conclusions Laparoscopy-assisted radical gastrectomy is safe and practical in elderly patients aged over 70 years with gastric cancer and can achieve comparable effects of open radical gastrectomy with less invasiveness and faster recovery.

Efficacies of hand and stapler suture in preventing pancreatic fistula after distal pancreatectomy: a Meta analysis / 中华消化外科杂志

Objective To compare the incidence of pancreatic fistula after hand and stapler suture in preventing pancreatic fistula after distal pancreatectomy.Methods The literatures published before December 2011 were retrieved from SinoMed and electronic database.Prospective controlled trials and retrospective reports were screened out for Meta analysis.The diagnostic criteria of pancreatic fistula were based on the criteria formulated by the International Study group of Pancreatic Fistula.The heterogeneity of the studies was analyzed using the Ⅰ2 test.The data were integrated using the fixed or random effect model.The results of the Meta analysis were presented with odds ratio (OR) and 95％ confidence interval (95％ CI).Results According to the selection criteria,lO literatures were selected which included 1 prospective randomized controlled study,3 prospective nonrandomized controlled studies and 6 retrospective studies.There were 1 441 cases in the hand suture group and 612 cases in the stapler suture group.There was no significant difference in the incidences of the pancreatic fistula between the hand suture group and the stapler suture group (OR =1.10,95％ CI:0.86-1.40,P ＞0.05).Six studies compared the incidences of severe pancreatic fistula (grade B or C) between the hand suture group and the stapler suture group.There were 1 182 cases in the hand suture group and 383 cases in the stapler suture group.There was no significant difference in the incidence of severe pancreatic fistula between the hand suture group and the stapler suture group (OR=1.33,95％CI:0.94-1.88,P＞0.05).Conclusion The efficacies of hand suture and stapler suture in preventing pancreatic fistula after distal pancreatectomy are comparable.Stapler suture provides an another option in distal pancreatectomy.

Application of three-dimensional laparoscopic system in obturator lymph node dissection of progressive rectal cancer / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To compare the handling and efficacy between three-dimensional(3D) imaging system and two-dimensional(2D) imaging system for laparoscopic surgery of rectal cancer deep obturator lymph node dissection.</p><p><b>METHODS</b>Clinical data of 36 patients who underwent rectal cancer resection and obturator lymph node dissection with 3D or 2D imaging system from January 2013 to May 2014 in our department were retrospectively analyzed. There were 16 cases and 20 cases in 3D group and 2D group respectively. Completion time of obturator lymph node dissection, total operation time, total number of lymph node dissected, number of wrong grasping (more than twice for correct positioning in the same site) times and blood loss during obturator lymph node dissection were compared between two groups.</p><p><b>RESULT</b>The laparoscopic rectal cancer resections were successfully completed without laparotomy in both groups. The completion time of obturator lymph node dissection was (23.5 ± 2.5) min and (25.0 ± 3.0) min respectively (P<0.05); the number of wrong grasping was 5.0 ± 2.0 and 6.0 ± 4.0(P<0.01); the blood loss during obturator lymph node dissection was (15.5 ± 1.5) ml and (17.5 ± 2.5) ml (P<0.01). The differences were all statistically significant. The total operation time of 3D and 2D group was (206.0 ± 26.0) min and (222.5 ± 27.5) min (P<0.05); the total number of lymph node dissected was 24 ± 6 and 21 ± 9 (P<0.05). The differences were statistically significant as well. Six cases in 3D group and 11 cases in 2D group were followed up for 1 year and there was no tumor recurrence or death case.</p><p><b>CONCLUSION</b>3D laparoscopic technique has more obvious advantages as compared with 2D laparoscopic system in rectal cancer deep obturator lymph node dissection, so it is worthy to spread.</p>

Measures to anatomical variation of perigastric vessels during laparoscopic gastric cancer surgery / 中华胃肠外科杂志

Laparoscopic gastric cancer surgery, which has been gradually accepted by surgeons and popularized worldwide, is a less invasive alternative compared with an open procedure. However, the lack of cognition of the variation in perigastric vessels, and the difficulty to obtain a full-view image and to estimate the three-dimensional (3D) relationships between organs during laparoscopic procedures may lead to unexpected injuries of these vessels, causing massive bleeding, which would prevent surgeon from having access to a good view of the operative field. We retrospectively summarize the data of laparoscopic gastric cancer operation in our hospital, separate the perigastric vessels into three areas according to the procedure, respectively the inferior pylorus, superior pancreas, and hilum of spleen, and analyze the common anatomical variation of vessels and its characters. We propose that, following the right anatomical spaces, the familiarity of perigastric vessels and skills of treating its common anatomical variations, may contribute to the safe and effective operation, improve the level of lymph node dissection, and reduce the injury in the operation.

Superior mesentericoportal vein resection end to end anastomosis without graft interposition in patients of colonic cancer involving portal vein undergoing combined pancreatoduodenectomy / 中华普通外科杂志

Objective To evaluate the feasibility and safety of portal-superior mesenteric vein resection and end-to-end anastomosis in cases of colonic carcinoma invading portal vein undergoing combined right hemicolectomy (RH) and pancreaticoduodenectomy (PD) without the need of graft interposition.Methods From 2004 to 2011,5 patients underwent resection of right-sided colon and pancreaticoduodenectomy combined mesentericoportal vein resection at a length from 3 to 4 cm and end-toend anastmoses without graft.Results Surgery was successful in all 5 patients,with complete resection,no severe complications occurred,and all 5 patients were cured.Conclusions Cancers in hepatic flexure of the colon frequently infiltrates the head of the pancreas and duodenum,involving the portal vein.Conservative radical right hemicolectomy and pancreaticoduodenectomy combined long mesentericoportal vein resection and end-to-end anastmoses without graft is a reasonable and safe procedure.

Correlation between expressions of PTEN and C-myc in colorectal carcinoma / 吉林大学学报(医学版)

Objective To investigate the correlation between the expressions of tumour suppressor gene PTEN and oncogene C-myc in colorectal carcinoma.Methods The expressions of PTEN and C-myc protein in normal colorectal mucosa(n=8), adjacent non-cancerous tissues(n=10) and primary colorectal carcinoma tissues(n=60) were observed by S-P immunohistochemical assay.Results Of 60 colorectal carcinoma tissues,C-myc protein was detected in 46 cases.The expression rate of C-myc in the primary colorectal carcinoma tissues(76.70%) was significantly higher than that in the normal(0) and adjacent non-cancerous tissues(10%)(P0.05).The positive expression rate of PTEN protein in the primary colorectal carcinoma tissues(25.00%,15/60) was significantly lower than that in the normal(100%) and adjacent non-cancerous tissues(90%)(P