Objective To summarize the research progress of preoperative staging diagnosis for gastric cancer. Methods Both the domestic and international literatures involving the preoperative staging diagnosis of gastric cancer in recent years were collected and reviewed. Results Transabdominal ultrosonography, EUS, CT, MRI, PET and diagnostic laparoscopy could provide objective evidences, and enhanced the accuracy of preoperative staging diagnosis for gastric cancer. Conclusion With the development of examination methods, the assessment of preoperative staging diagnosis of gastric cancer has been improved, and operation strategy can be made according to the correct preoperative staging.
Objective To determine whether regional arterial infusion (RAI) of 5-Fu and imipenem could decrease infection and mortality of acute necrotic pancreatitis (ANP) or not. Methods Fifty three patients with ANP were devided into three groups, group A, 16 patients who received intravenous 5-Fu and imipenem, group B, 22 patients who received 5-Fu by RAI and imipenem intravenously, and group C, 15 patients who received both 5-Fu and imipenem by RAI. Results The incidence of infection of ANP in group C (0%) was significantly lower than that in group A (50.0%) and B (27.2%), and the mortality rates in group B (18.1%) and C (13.3%) were significantly reduced as compared with group C (43.8%). Conclusion RAI of 5-Fu and imipenem was effective in reducing ANP infection and mortality rates.
Objective To summarize recent progress of three types of basic digestive tract reconstruction methods after distal gastrectomy for gastric cancer. Methods Recent domestic and international literatures about three types of basic digestive tract reconstruction methods after distal gastrectomy for gastric cancer were collected and analyzed. Results Of the three types of basic digestive tract reconstruction methods, BillrothⅠanastomosis had the most obvious advantage compared to BillrothⅡanastomosis and Roux-en Y anastomosis, but it was limited by tumor' size. The performance of BillrothⅡanastomosis was relatively easier but its complication risk was higher. Roux-en-Y anastomosis was superior in body weight control and treatment of type 2 diabetes mellitus, and had a wider indication than the other two types of methods. The modified uncut Roux-en-Y anastomosis was easier to perform under laparoscopic surgery. Conclusions Each method of the three types of basic digestive tract reconstruction methods after distal gastrectomy has its own superiority and indication. Therefore, the choice of digestive tract reconstruction method after distal gastrectomy should be case by case.
目的 通过对二腹肌后腹大体和显微解剖，观察二腹肌后腹的位置与毗邻关系，为临床治疗提供依据。 方法 2011年2月－2012年6月，对10具20侧成人尸体标本作解剖学研究，观察二腹肌后腹与周围相邻组织结构的位置。 结果 二腹肌后腹位置恒定，其深面有重要的神经血管。依次有寰椎横突、颈内静脉、枕动脉、副神经、颈外动脉、面动脉、舌下神经及耳后动脉等重要结构。 结论 掌握二腹肌后腹的外科解剖特点，在进行颌面外科手术时，可以避免损伤有关神经和血管等重要结构，具有重要的临床指导意义。
Objective To evaluate the role of preoperative 64 multi-detector spiral CT (MDCT) in predicting the extent of radical resection for advanced gastric cancer (AGC)． MethodsThe imaging data of 70 patients with AGC were collected and analyzed. The N2 lymph node metastasis was predicted by the MDCT indications, and compared with that postoperative pathological results. Results Sixty-two patients were treated with surgical intervention. The sensitivity, specificity, and accuracy of N2 positive prediction by MDCT was 92.0% (46/50), 75.0% (9/12) and 88.7% (55/62), respectively. Extended resection was performed in 81.6% (40/49) patients who were predicted as N2 positive, and D2 resection was performed in 92.3% (12/13) patients who were predicted as N2 negative.Conclusion The MDCT is a valuable technique to predict N2 lymph node metastasis, and to determine the extent of resection for AGC.
Objective To explore the effects of bile from anomalous parcreaticobiliary ductal union (APBDU) patients on the growth of hunan cells of bile ducts, and the relationship between APBDU with bile duct carcinoma. Methods Bile sample from APBDU patients and normal persons were used for cells of bile ducts. The proliferative effect of bile was measured by mathabenzthiazuron (MTT) assay; Cell cycle and apoptosis were analyzed by flow cytometry (FCM); Expression level of c-erbB-2 was detected by Western blot assay. Results Bile from APBDU patients significantly promoted the proliferation of human cells of bile ducts compared with normal bile （P＜0.05）. The effect was abolished by addition of COX-2 inhibitor or iNOS inhibitor. The percentage of S period cells in group pretreated with APBDU bile was significantly increased compared with pretreated with normal bile (P＜0.001). The expression level of c-erbB-2 was increased in cell pretreated with APBDU bile. Conclusion Bile from APBDU patients can promote the proliferation of normal cells of bile ducts and may have potential carcinogenesis.
ObjectiveTo analyze the related risk factors of influencing on postoperative severe complications (PSC) in elderly patients with gastric cancer. MethodsAltogether 202 cases of elderly patients with gastric cancer who received surgical treatment between January 2003 and December 2008 in this hospital were analyzed. On the basis of the degree of complications, the patients were divided into the group with PSC and the group without PSC. The relevant clinical and laboratory data were evaluated, and compared with statistical analysis. ResultsClinically the preoperative comorbidity, total gastrectomy, more than 800 ml intraoperative blood loss, intraoperative transfusion, and combined organ resection were significantly correlated with PSC (Plt;0.05). In laboratory data, the lower preoperative serum albumin and the blood glucose level on the first day after operation were significantly correlated with PSC (Plt;0.05). ConclusionThe preoperative comorbidity, lower serum albumin, and extended radical resection are the danger factors leading to PSC.
ObjectiveTo investigate the efficacy of anterolateral thigh (myocutaneous) flap designed with computed tomography angiography (CTA) to reconstruct oral and maxillofacial soft tissue defects.MethodsBetween January 2011 and December 2015, 23 cases of oral and maxillofacial tumors were treated. There were 14 males and 9 females with the age range from 45 to 72 years (mean, 56.8 years). There were 12 cases of tongue carcinoma, 5 cases of buccal mucosa carcinoma, 4 cases of mouth floor carcinoma, and 2 cases of oropharynx carcinoma; all were squamous cell carcinoma. According to standard TNM staging of the Union for International Cancer Control (UICC), 8 cases were rated as T2N0M0, 3 cases as T2N1M0, 1 case as T2N2M0, 4 cases as T3N0M0, 2 cases as T3N1M0, 2 cases as T3N2M0, 2 cases as T4N1M0, and 1 case as T4N2M0. The course of disease was 1-6 months (mean, 2.4 months). CTA was performed before operation to locate the perforator vessel and its surface projection of emerging point and to design anterolateral thigh (myocutaneous) flap by computer. The defects of soft tissue ranged from 6 cm×4 cm to 11 cm×7 cm after resection of tumor. The flap was used to repair defects, including 14 thinned anterolateral thigh flaps, 7 anterolateral thigh myocutaneous flaps, and 2 anterolateral bilobed flaps; and the flap area ranged from 7 cm× 5 cm to 12 cm×8 cm. The donor sites were sutured directly.ResultsCTA showed that myocutaneous perforators penetrated at the fascias of the vastus lateralis muscles in 22 cases with a location rate of 95.7% (22/23). Submandibular fistula occurred in 1 case at 5 days after operation and fistula healed after changed dressings. Other wounds at recipient site and donor site healed at primary stage. Anastomose with 2 vein was performed because of poor venous return in 1 case, and the flap survived. The other flaps survived well. All the patients were followed up 6-36 months (mean, 16.4 months). At 3 months after operation, the simplified recovery standard of speech function and swallow function was established according to the University of Washington Quality of Life Scale (UW-QOL). The speech and swallow function recovered satisfactorily in 22 cases, and not very satisfactorily in 1 case of well differentiated squamous cell carcinoma of the right mouth floor (T 4N1M0). No obvious tissue atrophy was observed in 23 cases. No dysfunction was found at the donor site. There was no tumor recurrence in 21 patients; 1 patient accepted the second operation due to lymphonodi metastasis of contralateral neck at 6 months after first operation, who died after 23 months; 1 patient died of distant metastasis at 10 months after first operation.ConclusionThe anterolateral thigh (myocutaneous) flap designed with CTA could well recover the morphology and function of the recipient site.
Objective To evaluate short-term effect of laparoscopic and open Miles operations for lower rectal carcinoma. Methods A total of 119 patients with lower rectal carcinoma were retrospectively collected from March 2012 to March 2017 in this hospital, among which 65 were in the laparoscopic operation group and 54 in the open operation group. The perioperative data, pathological results, recovery courses, and complications were compared between the two groups. Results Compared with the open operation group, the laparoscopic group showed a longer operation time (t=6.035, P=0.002), quicker bowel function recovery (t=4.919, P<0.001), faster off-bed activity (t=2.221, P<0.001), and shorter hospital stay time (t=3.795, P=0.025). The intraoperative blood loss (t=0.154, P=0.698) and the number of harvested lymph nodes (t=0.532, P=0.595) were similar between the two groups. The laparoscopic operation group showed a significant lower total complication rate (χ2=7.174, P=0.009) as compared with the open operation group, but the incision infection, urinary tract injury, lung infection, thrombosis of lower extremities, etc. had no significant differences between the two groups (P>0.050). Conclusion Laparoscopic Miles operation improves postoperative recovery and reduces postoperative complications as compared with open approach in treatment of lower rectal cancer, with similar oncological and short-term results.
Objective To investigate the reasonable indication of splenectomy in radical resection for advanced proximal gastric cancer (APGC). Methods Fifty patients with APGC were studied and classified into total gastrectomy with splenectomy (TGS) group (n=18) and total gastrectomy without splenectomy (TG) group (n=32). The operation time, hospitalized duration, complications, and lymphe node metastasis at the spleen hilus were compared between two groups. Results The operation time, hospitalized duration and subphrenic infection rate in the TGS group were significantly higher than those in the TG group (Plt;0.05). The rate of lymph node metasitasis of No.10 and No.11 in the TG group was not different from that in TGS group (Pgt;0.05). Conclusion Direct spleen and its vessel invasion are the reasonable indication of splenectomy in radical resection for APGC.