ObjectiveTo summarize the clinical effect of Da Vinci robot radical gastrectomy for gastric cancer.MethodsA retrospective analysis was performed on 200 patients undergoing radical surgery for Da Vinci robotic gastric cancer from the General Surgery of the 940th Hospital of the Chinese People's Liberation Army from December 2016 to January 2018.ResultsThere were 200 cases of robotic radical gastric cancer, 99 cases of radical distal gastrectomy, and 101 cases of radical total gastrectomy. The operative time was (241.0±33.3) min, intraoperative blood loss was (146.2±110.4) mL, and the number of lymph nodes cleaned was (42±14). The time of first anal exhaustion was (3.1±0.7) d, the time of first meal was (4.3±0.7) d, the postoperative extubation time was (5.3±0.5) d, and the postoperative hospitalization cost was (96 366.50±16 992.87) yuan. Tumor diameter was (4.5±2.0) cm. The degree of tumor differentiation was high differentiation in 7 cases, moderate differentiation in 61 cases and poor differentiation in 132 cases. TNM stage was 1 case in stage Ⅰ, 62 cases in stage Ⅱ and 137 cases in stage Ⅲ. Iauren was divided into intestinal type (78 cases), diffuse type (65 cases) and mixed type (57 cases). The tumor infiltrated into submucosa in 1 case, intrinsic muscularis in 3 cases, subserosal layer in 31 cases and serosal layer in 165 cases. The tumors were located in the upper part of the stomach in 45 cases, the lower part of the stomach in 106 cases, the body of the stomach in 46 cases, the whole stomach in 1 case, and the gastroesophageal junction in 2 cases. Postoperative complications occurred in 8 cases (4%), including anastomotic leakage in 4 cases, duodenal stump fistula in 1 case, tracheoesophageal fistula in 1 case, pulmonary infection in 1 case, and gastroparesis in 1 case.ConclusionThe DaVinci robotic surgical system has less surgical injuries, quicker postoperative recovery, and better clinical efficacy.
ObjectiveTo summarize the influence and mechanism of visceral fat on the treatment and prognosis of gastric cancer patients.MethodLiteratures on the correlation and mechanism between visceral fat and treatment and prognosis of gastric cancer were collected and reviewed.ResultsHigh visceral fat may promote the incidence and progress of gastric cancer, and increase the incidence of complication of radical gastrectomy, including surgical site infection, pancreatic fistula, etc., as well as prolong the length of hospital stay. Reducing patients’ visceral fat level before operation could reduce the incidence of surgical complication. However, the persistent decrease of visceral fat level after operation may indicate poor prognosis. The effect of visceral fat on gastric cancer and its treatment was mainly due to the local chronic inflammation caused by excessive visceral fat tissue, the change of adipocytokine secretion, insulin resistance, and other mechanisms.ConclusionWe need to use visceral fat and other indicators to evaluate gastric cancer patients’ weight and body composition, in order to better guide the treatment and prognosis evaluation of gastric cancer.
Objective To investigate the detection of peritoneal free cancer cells and its clinical significance. Methods The peritoneal free cancer cells, the positive rates of CK20 protein and CK20 mRNA expressions of peritoneal lavage fluid were detected by peritoneal lavage cytology (PLC), flow cytometry (FCM) and real-time fluorescent quantitative RT-PCR in 50 cases of gastric cancer patients, respectively. The sensitivity of three kinds of detection method to peritoneal free cancer cells was compared. Results The positive rates of peritoneal free cancer cells, CK20 protein and mRNA expression of peritoneal lavage fluid were 20.0% (10/50), 36.0% (18/50) and 58.0% (29/50), respectively. The positive rate of CK20 mRNA expression detected by real-time fluorescencequantitative RT-PCR in peritoneal lavage fluid was significantly higher than those of the CK20 protein expression detected by FCM and peritoneal free cancer cells detected by PLC (Plt;0.05 or Plt;0.001). The difference of positive rate of CK20 protein expression and peritoneal free cancer cells was not significant (Pgt;0.05). The positive rate of CK20 mRNA expression of peritoneal lavage fluid was related to the tumor invasion depth, differentiation degree, TNM stage, and lymph node metastasis (Plt;0.05). Conclusion Real-time fluorescence quantitative RT-PCR is an effective method for the detection of peritoneal free cancer cells.
ObjectiveTo investigate the clinical efficacy and short-term complications of total laparoscopic distal gastrectomy, which adopting Billroth Ⅱ combining with Braun anastomosis. MethodsClinical data of 186 cases of distal gastric cancer who underwent total laparoscopic distal gastrectomy in our hospital from June 2012 to June 2014, including 86 cases who adopted Billroth Ⅱ combining with Braun anastomosis, and 100 cases who adopted Billroth Ⅱ anastomosis. The clinical efficacy was compared between these two groups. ResultsThere was no significant difference in the opera-tion time, digestive tract reconstruction time, intraoperative blood loss, postoperative exhaust time, and hospital stay (P>0.05). However, compared with Billroth Ⅱ anastomosis group, the incidence rates of alkaline reflux gastritis, duodenal fistula, anastomositis, and postsurgical gastroparesis syndrome were lower in Billroth Ⅱ combining with Braun anastomosis group (P<0.05). ConclusionThe application of Billroth Ⅱ combining with Braun anastomosis in total laparoscopic distal gastrectomy could reduce the incidence rates of alkaline reflux gastritis, duodenal fistula, anastomositis, and postsur-gical gastroparesis syndrome, and it is an ideal operation method to improve the quality of life for gastric cancer patients.
Objective To summarize the progress on diagnosis and treatment of gastric stump cancer. Methods Related literatures in recent 5 years were collected, and the progress on diagnosis and treatment of gastric stump cancer were reviewed. Results The diagnosis of gastric stump cancer mainly depends on endoscopy, mucosal biopsy and other imaging examinations. At present, the main treatment of gastric stump cancer is the total gastrectomy, combined with laparoscopic therapy and endoscopic therapy. On the basis of No.1-No.4 and No.7-No.13 lymph node dissection, the extent of lymph node dissection is enlarged according to the different surgical procedures. Conclusions The main treatment of gastric stump cancer is total gastrectomy, and there are many factors affecting the prognosis, which should be early diagnosis and early treatment. Laparoscopic radical gastrectomy for gastric stump caner provides a more convenient and accurate method for the treatment of gastric stump caner.
ObjectiveTo investigate the relationship of epithelial mesenchymal transition (EMT) related proteins expressions in invasive ductal carcinoma of breast to its clinicopathologic features and prognosis. MethodsThe expressions of EMT related proteins (Vimentin, E-cadherin, and MMP2) in the 118 cases of invasive ductal carcinoma of breast and 30 cases of corresponding normal breast tissues adjacent to cancer were detected by immunohistochemistry. The relationship of EMT related proteins expressions to age, tumor site, tumor size, lymph node metastasis, histological grade, TNM stage or prognosis of the patients with invasive ductal carcinoma of breast was analyzed. Results①The positive rates of the Vimentin protein and MMP2 protein in the invasive ductal carcinoma of breast were significantly higher than those in the corresponding normal breast tissues adjacent to cancer﹝Vimentin protein: 50.8% (60/118) versus 10.0% (3/30), P < 0.05; MMP2 protein: 63.6% (75/118) versus 6.7% (2/30), P < 0.05﹞, the positive rate of E-cadherin in the invasive ductal carcinoma of breast was significantly lower than that in the corresponding normal breast tissues adjacent to cancer ﹝56.8% (67/118) versus 93.3% (28/30), P < 0.05﹞.②The positive rate of the Vimentin protein expression in the invasive ductal carcinoma tissue was positively related with the lymph node metastasis and TNM staging (rs=0.346, P < 0.05; rs=0.231, P < 0.05). The positive rate of the E-cadherin or MMP2 protein expression was negatively or positively related with the tumor size, lymph node metastasis, histological grade, and TNM stage (E-cadherin: rs=-0.444, P < 0.05; rs=-0.493, P < 0.05; rs=-0.323, P < 0.05; rs=-0.474, P < 0.05. MMP2: rs=0.361, P < 0.05; rs=0.434, P < 0.05; rs=0.396, P < 0.05; rs=0.376, P < 0.05).③The Kaplan-Meier survival curve analysis showed that the positive expressions of Vimentin and MMP2 were stronger, the tumor free survival time was shorter (P < 0.05), and the positive expression of E-cadherin was stronger, the tumor free survival time was longer (P < 0.05). ConclusionJoint detection of EMT related proteins (Vimentin, E-cadherin, MMP2) of invasive ductal carcinoma tissue of breast could predict the pathological grade and clinical stage, as well as effective prognosis of patients with invasive ductal carcinoma of breast in clinical.
ObjectiveTo explore the curative effect and value of laparoscopic operation in the treatment of acute gangrenous and perforated appendicitis. MethodsThe clinical data of 243 patients with acute gangrenous and perforated appendicitis from February 2011 to February 2014 in our hospital were retrospectively analyzed. Laparoscopic appendectomy was performed in 118 cases (LA group), and open appendectomy was performed in 125 cases (OA group). The operative time, hospital stay, hospital costs, incision bleeding, gastrointestinal function recovery, wound infection, pelvic abscess, and postoperative adhesions of two groups were compared. ResultsThere was no significant difference in the operative time, incision bleeding, and the incidence of pelvic abscess after operation between the LA group and OA group (P>0.05). Compared with the OA group, the recovery time of gastrointestinal function was significantly shortened (P<0.01), eating time was earlier (P<0.01), hospitalization time also shortened significantly (P<0.01), and the incidence of postoperative wound infection and intestinal adhesion were significantly decreased (P<0.01) after operation in LA group. But the cost of hospitalization in LA group increased significantly (P<0.05). ConclusionsThe laparoscopic operation in the treatment of gangrenous and perforated appendicitis are light of pain., recover quickly, shorter of hospital stay, and fewer complications. The increase of hospitalization expenses is the only deficiency.