Objective To assess the tolerance of preoperative carbohydrate-rich beverage, to determine its effect on postoperative insulin resistance and analyze its potential mechanism. Methods Thirty-two patients undergoing elective colorectal cancer resection were recruited to this randomized controlled study and assigned to two groups at random. Patient in control group was fasted before operation, while patient in study group was given oral water. Homeostasis model assessment (HOMA) indexes, activity of PTK, and mRNA and (or) protein expressions of PKB, PI3K and GluT4 were measured before and (or) immediately after surgery. Furthermore preoperative well-beings of patients were studied. Results Among well-beings, feeling of thirst, hunger and anxiety tended to be better in patients receiving carbohydrate-rich beverages compared with fasted ones (P＜0.05). Whole body insulin sensitivity decreased by 33% in the study group while 38% in the control group (P=0.007 2), and the activity of PTK, expressions of PI3K and PKB in study group were higher than those in control group (P＜0.05， P＜0.01), but no significantly difference was observed about GluT4 in both groups (Pgt;0.05）. Conclusion Preoperative consumption of carbohydrate-containing fluids is safe and effective. Provision of carbohydrate energy source prior to surgery may attenuate immediate postoperative insulin resistance. A carbohydrate-rich drink enhances insulin action at the time of onset of anaesthesia or surgery by activating three kinases named PTK, PI3K, PKB which are key enzymes in pathway of insulin signal transduction. It is likely to explain the effects on postoperative insulin resistance.
Objective To investigate the changes of gastrointestinal hormone and body composition in patients with gastric cancer after gastrectomy. Methods Thirty-eight patients with gastric cancer were divided into three groups: distal gastrectomy group, proximal gastrectomy group and total gastrectomy group and 9 volunteers as control group. The nutrition status and gastrointestinal function were evaluated by four times. The time of postoperative first anal exsufflation and defacation, hospital stay and complications were recorded, and the pre-meal and the post-meal level of gastrointestinal hormones 1 month after operation were detected. Results Compared with control group, the basic levels of somatostatin (SS), cholecystokinin (CCK) and motilin (MTL) of distal gastrectomy group, proximal gastrectomy group and total gastrectomy group significantly increased (Plt;0.01). The post-meal level of gastrointestinal hormones significantly increased as compared with the pre-meal level in each group (Plt;0.01). The CCK in proximal gastrectomy group was lower than that of distal gastrectomy group and total gastrectomy group (Plt;0.01). The postoperative body weight and body composition in each group decreased. One month after operation, patients of total gastrectomy group got the lowest body weight (Plt;0.01). The decreasing level of fat free mass (FFM) was listed by total gastrectomy group, proximal gastrectomy group and distal gastrectomy group. The edema index had significant difference in distal gastrectomy group, proximal gastrectomy group and total gastrectomy group (Plt;0.01), and total gastrectomy group was the most obvious. The postoperative passing flatus and defecation time and average hospital stay in total gastrectomy group were significantly prolonged (Plt;0.05). The gastrointestinal symptoms score among three groups was significantly different (Plt;0.05). Conclusion There are different changes of gastrointestinal hormone and body composition in patients with gastric cancer after different gastrectomy, the basic levels of SS, CCK and MTL of distal gastrectomy group, proximal gastrectomy group and total gastrectomy group are higher than those of control group. The CCK of proximal gastrectomy group is lower than that of distal gastrectomy group and total gastrectomy group. Patients received total gastrectomy lose much body weight and FFM and get higher edema index.
Objective To present method and experiences in using the buccal mucosa with the Snodgrass procedure for repair of hypospadias. Methods Between August 2012 and April 2015, 55 boys with hypospadias were treated with Snodgrass procedure combined with buccal mucosa. The age ranged from 1 to 7 years (mean, 4 years). There were 32 cases of distal penile type, 14 cases of proximal penile type, and 9 cases of coronal sulcus type. The buccal mucosa taking from inner cheek was fixed into the incised urethral plate. The urethral plate was tubularized over a catheter. Results All the patients were followed up 3-25 months (mean, 11 months). After operation, 1 patient had urethral stricture and fistula after repaired urethra was infected, and 5 patients had fistula. For the others, the urination was smooth, the appearance of penis was satisfying, the urethral stricture did not occur, and the penis was straightened completely. Conclusion Compared with traditional Snodgrass procedure, the application of buccal mucosa can increase the reconstruction material of urethral and reduce the stricture of the repaired urethra after operation.
【Abstract】 Objective To investigate the blood supply of the expanded skin flap from the medial upper arm andits appl ication for the repair of facial and cervical scar. Methods From May 2000 to February 2007, 20 cases (12 males and 8 females; aging from 7 to 42 years) of facial and cervical scar were treated with the expender flap from medial upper arm. The disease course was 9 months to 20 years. The size of the scar was 8 cm × 6 cm - 22 cm × 18 cm. The operation was carried out for three steps: ① The expander was embed under the superior proper fascia. ② The scar in the face and cervix was loosed and dissected. Combined the expanded skin flap from the medial upper arm(the size of the flap was 9 cm × 7 cm - 24 cm × 18 cm) in which the blood supply to the flap was the superior collateral artery and the attributive branches of the basil ica with auxil iary veins for blood collection with partial scar flap (3.5 cm × 2.5 cm - 8.0 cm × 6.0 cm) was harvested and transferred onto the facial and cervical defect. ③ After being cut off the pedicle, the scar was dissected. The expanded flap was employed to coverthe defect. Results After 3-24 months follow-up with 16 cases, all the grafted skin flaps survived at least with nearly normal skin color, texture and contour. The scars at the donor sites were acceptable. The function and appearance of the face and cervix was improved significantly. No surgery-related significant compl ications were observed. Conclusion Repair of facial and cervical scar with the medial upper arm expanded skin flap is a plausible reconstructive option for head and face reconstructions. However, a longer surgery time and some restrictive motion of the harvested upper l imbs might be a disadvantage.