ObjectiveTo investigate the individualized management of severe gastroesophageal reflux disease (GERD) secondary to scleroderma, particularly the safety and feasibility of laparoscopic Toupet fundoplication for this entity. MethodsFrom June, 2011 to June, 2014 six inpatient cases had severe GERD secondary to scleroderma were documented. Endoscopy, esophageal high-resolution manometry and 24 hours reflux monitoring were applied for GERD evaluation. Maintenance of conservative treatment was carried out for the 2 cases who responsed well to medication therapy, laparoscopic Toupet fundoplication was done for the 4 cases who had extraesophageal symptom and not well controlled by medication. The patients were followed-up for an average of 2.2 years (1 to 4 years) after discharge, and endoscopic was rechecked during the followed-up. ResultsThe esophageal symptom of regurgitation, heartburn and dysphagia, as well as the extraesophageal symptom of cough and asthma significantly relieved during followed-up, meanwhile the anti-reflux medication was reduced or stopped in all the patients. For the 4 surgical patient, one had partial recurrence and no complication occurred. ConclusionsThe management of severe GERD secondary to scleroderma could follow the strategy of controlling the primary disease, living adjustment, anti-reflux medication and surgery step by step. The laparoscopic Toupet fundoplication may be safe, effective and feasible for the medication unmet patients, it deserves further studies.
ObjectiveTo discuss the influence of ultracision versus electrotome on the immune function and stress reaction in patients after rectal cancer Miles operation. MethodA retrospective analysis was performed on 82 rectal cancer patients who received Miles operation between February 2007 and August 2012. Among them, 45 accepted ultracision, and 37 received electrotome operation. We compared the two groups in terms of abdominal and perineum surgery time, blood loss volume, drainage volume within 72 hours after operation, and analyzed the CD3+, CD4+, CD8+, CD4+/CD8+ ratio by flow cytometry before and after operation. In addition, we tested the white blood cell count, percentage of granulocyte, C-reaction protein (CRP), and interleukin (IL)-6 three days after operation. ResultsThere was no obvious difference in CD3+, CD4+, CD8+, CD4+/CD8+ ratio between the two groups. However, the incidence of blood loss volume, abdominal operation time, perineum operation time, drainage volume within 72 hours after operation, white blood cell count, percentage of granulocyte, CRP, IL-6 in the ultracision group was dramatically lower compared with the electrotome group (P<0.05). ConclusionsThere is no significant difference in the influence on the immune function between the two kinds of operation methods, but ultracision can achieve faster recovery and smaller stress reaction after operation. It is worthy of clinical popularization.