RESUMO
Objective:To study the effect of visceral fat area (VFA) on postoperative complications and pancreatic fistula in patients undergoing laparoscopic assisted radical gastrectomy for gastric careinoma.Methods:Clnical data of 214 primary gastric cancer patients undergoing laparoscopic assisted radical gastrectomy between Jan 2017 and Jan 2022 at the Department of General Surgery, Shouguang People's Hospital were retrospectively reviewed.Results:There were 85 patients in high VFA group and 129 patients in the low VFA group. The body mass index (25.1±3.4) kg/m 2 and visceral fat area (143.4±41.1) cm 2 in the high VFA group were higher than those in the low VFA group (21.2±2.9) kg/m 2 and visceral fat area (58.7±31.9) cm 2. The operative time was (228.3±53.1) min vs. (206.3±62.9) min ( t=5.538, P=0.017). The intraoperative blood loss was (264.6±173.6) ml vs. (213.9±156.2) ml ( t=3.373, P=0.035). The postoperative hospital stay was (12.5±4.0) d vs. (10.3±3.7) d ( t=7.781, P=0.013). Twenty-three cases developed postoperative complications in the high VFA group vs. 20 cases in the low VFA group ( χ2=4.261, P=0.039). Patients in the high VFA group had an incidence of clinically relevant pancreatic fistula of 10.6% vs. 3.1% in patients in the low VFA group ( χ2=5.034, P=0.038). Univariate and multivariate analysis of clinically relevant pancreatic fistulas in patients with different VFA groups showed that men ≥134.6 cm 2 and women ≥91.1 cm 2 with VFA and operative time ≥250 min were independent risk factors for the occurence of clinically relevant pancreatic fistulas after laparoscopic assisted radical gastrectomy. Conclusions:VFA increases the difficulty of laparoscopic-assisted radical gastrectomy, resulting in increased postoperative complications. VFA and operation time are independent risk factors for clinically relevant pancreatic fistula after radical gastrectomy for gastric cancer.
RESUMO
Objective:To investigate the related factors that affect the occurrence of severe pancreatic fistula after radical gastrectomy.Methods:The clinical data of 460 patients undergoing radical gastrectomy in The People's Hospital of Shouguang from January 2015 to January 2021 were retrospectively analyzed. These patients were divided into severe pancreatic fistula group ( n = 24) and non-severe pancreatic fistula group ( n = 436) according to whether they developed severe pancreatic fistula after surgery. Preoperative clinical data, surgical data, and abdominal drainage fluid amylase level in the first postoperative days were compared. The receiver operating characteristics (ROC) curve was used to calculate the cutoff value of abdominal drainage fluid amylase level on the 1 st and 3 rd days of developing severe pancreatic fistula after radical gastrectomy. The incidence of pancreatic fistula was compared between different amylase level groups. Multivariate logistic regression was performed to analyze the independent risk factors of severe pancreatic fistula after surgery. Results:There were significant differences in body mass index, operative time, intraoperative blood loss, peritoneal drainage fluid amylase level on the 1 st and 3 rd days after surgery, and the number of cases undergoing splenectomy between the two groups (all P < 0.05). The cutoff values of amylase level in peritoneal drainage fluid (D-AMY) on the 1 st and 3 rd days after surgery were 2 156 IU/L and 596 IU/L respectively, which had high sensitivity and specificity. On the 1 st and 3 rd days after surgery, the incidence of pancreatic fistula in the high-level amylase group was significantly higher than that in the low-level amylase group [26.2% (16/61) vs. 0.8% (3/334), χ2 = 62.82, P < 0.05). Multivariate logistic analysis showed that obesity, splenectomy, and abdominal drainage fluid amylase level higher than the cut-off value on the 1 st and 3 rd days after surgery were independent risk factors for severe pancreatic fistula, and the differences were statistically significant (all P < 0.05). Conclusion:Obesity, splenectomy, and abdominal drainage fluid amylase level higher than the cut-off value on the 1 st and 3 rd days after surgery are independent risk factors affecting the occurrence of severe pancreatic fistula. D-AMY (> 2 156 IU/L) on the 1 st day and D-AMY (> 596 IU/L) on the 3 rd day in the early postoperative days can be used as cutoff values to predict the occurrence of severe pancreatic fistula after radical gastrectomy.
RESUMO
Objective:To evaluate the relationship between abdominal amylase, C-reactive protein (CRP), procalcitonin (PCT) and clinically relevant pancreatic fistula in the early stage after radical gastrectomy for gastric cancer, and to explore whether they can be used as early predictors of pancreatic fistula and their accuracy, in order to help identify pancreatic fistula in the early stage after gastrectomy.Methods:The clinical data of 372 patients diagnosed as gastric cancer and underwent gastrectomy in Shouguang People′s Hospital from January 2017 to December 2021 were retrospectively analyzed, including 190 males and 182 femals, aged from 28 to 32 years old, with the average years of 63.5±10.6. The receiver operating characteristic (ROC) curves of abdominal amylase on the first day and serum CRP and procalcitonin on the third day after surgery for gastric cancer were analyzed. The ROC curve was used to determine the optimal cutoff value and the sensitivity, specificity, positive and negative predictions, and accuracy of the optimal cutoff value were calculated. Single factor and multivariate analysis were used to analyze the risk factors of pancreatic fistula after gastric cancer surgery. SPSS 25.0 software was used for statistical analysis.Results:The incidence of clinically relevant pancreatic fistula after surgery for gastric cancer was 5.37%(20/372), including 18 cases of grade B pancreatic fistula and 2 cases of grade C pancreatic fistula. The critical values of amylase on the first postoperative day of clinically relevant pancreatic fistula after surgery for gastric cancer are predicted to be 2036 U/L, serum CRP 18 mg/dL, and procalcitonin 0.85 μg/L. In univariate analysis, body mass index, abdominal amylase concentration on the 1st postoperative day, serum CRP and procalcitonin on the 3rd postoperative day were the influencing factors for the occurance of pancreatic fistula after gastric cancer surgery. Multivariate Logistic regression analysis showed that body mass index>25 kg/m 2, abdominal amylase >2036 U/L on the first postoperative day and serum CRP>18 mg/dL on the third postoperative day were the independent predictors for pancreatic fistula. The sensitivity and specificity of the combination of intraperitoneal amylase on the first day and serum CRP on the third day after surgery for gastric cancer in predicting the occurrence of clinically relevant pancreatic fistula were 87.6% and 90.4%, respectively. Conclusions:The combination of amylase in abdominal cavity on the 1st day and CRP on the 3rd day after radical gastrectomy has high sensitivity and specificity in predicting clinically related pancreatic fistula. PCT on the 3rd day after gastric cancer surgery has limited accuracy in predicting clinically related pancreatic fistula, so it is not recommended as an early prediction index of pancreatic fistula after gastric cancer surgery.
RESUMO
Objective To evaluate the risk of cardiovascular adverse events using nonsteroidal anti-inflammatory drugs during the perioperative period.Methods A systematic review of formally published in English and Chinese literature was conducted by using computerized database on PubMed, Web of Science, Medline, Cochrane Library, CNKI and Wanfang database.The literature about controlled clinical study of nonsteroidal anti-inflammatory drugs in perioperative use, a prospective cohort study and a retrospective review were collected.The cardiovascular risk was evaluated by the number of adverse cardiovascular events cases (myocardial infarction, angina, myocardial ischemia, arrhythmia) occurred during the period of drug use.The relevant data was extracted and their heterogeneity was tested.Results A total of 8 articles including 15 623 patients met the inclusion criteria, including 5 articles (n=13 019) on non-selective nonsteroidal anti-inflammatory drugs, and 3 articles (n=2 604) about selective (cyclooxygenase 2) COX-2 inhibitors.Nonsteroidal anti-inflammatory drugs used in the perioperative or a short term would reduce the risk of adverse cardiovascular events (OR=0.59, 95%CI 0.45-0.77, P=0.000 1), non-selective nonsteroidal anti-inflammatory drugs using in the perioperative or a short term would reduce the risk of adverse cardiovascular events, the difference being statistically significant (OR=0.42, 95%CI 0.31-0.58, P＜0.001).A selective COX-2 inhibitor using in the perioperative or short-term might increase cardiovascular adverse events (OR=2.53, 95%CI 1.26-5.09, P=0.009).Conclusion Non-selective nonsteroidal anti-inflammatory drugs should be chosen for patients at high risk of adverse cardiovascular events during the perioperative period.
RESUMO
Objective To compare the impact of patient controlled epidural analgesia with patient controlled intravenous analgesia on postoperative recovery and complications in patients undergoing laparotomy pancreatic surgeries.Methods Forty patients undergoing pancreatic surgeries, 27 males and 13 females, aged 18-70 years, ASA physical status Ⅰ or Ⅱ, were randomly divided into two groups (n=20 each).Patients in group E received T8-9 or T9-10 epidural block, 2% lidocaine test dose was given to ensure the location of epidural catheter, after that, each patient in group E was given 0.375% ropivacaine 5 ml into epidural space before skin incising and incision closures.Meanwhile, patients in groups E and V received propofol-sevoflurane combined intravenous inhalation anesthesia.After surgery, patients in group E received patient controlled epidural analgesia while patients in group V received patient controlled vein analgesia.Length of hospital stay, time to ambulation and exhaust defecation were recorded.Other complications were compared.Results Compared to group V, patients in group E showed earlier ambulation [(50.4±4.2) h vs (64.2±5.0) h, P<0.01], shorter hospital stays [(18.5±8.5) d vs (21.5±6.8) d, P<0.05].There was no statistically significant difference in flatus time between the two groups [(39.7±4.1) h vs (39.5±8.4) h].There was no significant difference in complications between the two groups.Conclusion The present study shows that for patients undergoing pancreatic surgeries, patient controlled epidural analgesia could effectively release post-operative pain, shorten the ambulation time and length of hospital stay with no extra complications.
RESUMO
Objective To evaluate the clinical application value of active carbon nanoparticles to guide breast cancer tiny lymphadenectomy.Methods 50 patients with breast cancer were enrolled in the study and were divided into two groups by random number table.Active carbon particle was injected locally to guide the regional lymph nodes dissection in 25 cases as study group,and the traditional method was performed in 25 cases as observation group.Numbers of dissected lymph nodes were compared between two groups.Results The average number of eliminated small lymph nodes in the study group was dramatically more than that in the observation group[(23.60 ±4.61)vs. (14.60 ±5.16),t =3.47,P <0.05].There was significant difference between the study group and the observation group in the small ambulant lymph nodes[(5.80 ±1.49)vs.(2.89 ±1.66),t =2.91,P <0.05)].Conclusion Active carbon injected locally can eliminate not only more small lymph nodes,but also more small ambulant lymph nodes.