Objective To explore the clinical application in the prevention of post-ERCP pancreatitis (PEP) for high-risk patients undergoing endoscopic duct stent placement. Methods The clinical data of 112 patients with high-risk PEP between January 2005 and June 2010 in this hospital were analyzed retrospectively. According to stents placement or not, 112 patients were divided into stent placement group (n=52) treated by ERCP and stents placement and non-stent placement group (n=60) treated by ERCP without stent retaining. PEP was diagnosed according to Cotton standard, the incidence rate of PEP was compared between two groups and the high-risk influencing factors were analyzed. Results According to Cotton standard, there were only 3 patients (5.8%) diagnosed PEP in the stent placement group, all symptoms disappeared on 48 h after operation, without a diagnosis for severe acute pancreatitis. There were 9 patients (15.0%) diagnosed PEP in the non-stent placement group, and 2 patients were severe acute pancreatitis, The status was better undergoing fasting, aprotinin, anti-inflammatory, and enteral nutrition supporting treatment. The incidence of PEP was associated with younger women (age ≤45 years), Oddi sphincter dysfunction, and no dilation of bile duct (Plt;0.05). Conclusion It can obviously reduce PEP occurrence in high-risk patients with stent placement.
Objective To investigate clinical application and safety evaluation of sedative demulcent anesthesia in therapeutic endoscopic retrograde cholangiopancreatography (ERCP).Methods Totally 1660 patients underwent ERCP at the First Hospital of Lanzhou University were prospectively divided into two groups: venous sedative demulcent group (n=800, using sufentanil and midazolam and propofol continuing infusion) and conventional sedative demulcent group (n=860, using common medicine). The heart rate (HR), respiration (R), blood pressure (BP) and peripheral oxygen saturation (SpO2) of pre-anesthesia, post-anesthesia, during operation and after analepsia in every group were detected. The narcotism was evaluated by Ramsaymin grading method and the related adverse reactions such as cough, restlessness, harmful memory, and abdominal pain after operation were recorded. Results Compared with conventional sedative demulcent group, vital signs of patients in venous sedative demulcent group were more stable. For postoperative adverse reactions, abdominal pain, abdominal distension and nausea and vomiting were respectively 4.4%(35/800), 2.6%(21/800) and 3.6%(29/800) in venous sedative demulcent group, which were respectively higher of the incidence of 36.3%(312/860), 49.0%(421/860) and 53.0%(456/860) in conventional sedative demulcent group (P＜0.01). The postoperative satisfaction and adverse reactions recall between venous sedative demulcent group and conventional sedative demulcent group was respectively significant different (96.9% vs. 2.9%, 4.8% vs. 97.9%, P＜0.01). Conclusion Sufentanil and midazolam and propofol continuing infusion have good effect of sedative demulcent anesthesia, which can be widely used.
ObjectiveTo investigate the safety and clinical efficacy of dendritic cell (DC)-cytokine induced killer (CIK) cell adoptive immunotherapy combined with chemotherapy in patients with gastric cancer after radical gastrectomy.MethodsForty-eight patients with gastric cancer after the radical gastrectomy receiving the DC-CIK cell adoptive immunotherapy combined with XELOX or FOLFOX chemotherapy were enrolled as a study group in the First Hospital of Lanzhou University from January 2014 to January 2016. In addition, 48 patients with gastric cancer after the radical gastrectomy in the same period and only receiving XELOX or FOLFOX chemotherapy were collected as a control group. The CD3+, CD3+CD4+, CD3+CD8+, CD3–CD56+ (NK cell), and CD3+CD56+ (NKT cell), toxic reaction, quality of life were evaluated in both groups before and after the treatment, and the long term effect were compared in both groups.Results① There were no significant differences in the gender, age, clinical stage, etc. between the two groups (P>0.05). ② The CD3+, CD3+CD4+, CD3+CD8+, CD3–CD56+, and CD3+CD56+ cells in the peripheral blood had no significant changes between before and after treatment in the study group (P>0.05), which were decreased after the treatment in the control group as compared with before the treatment and were significantly lower than those in the study group (P<0.05). ③ The levels of CEA, CA19-9, and CA724 in the peripheral blood after the treatment in the study group and the control group were significantly lower than those before the treatment (P<0.05), which in the study group were significantly lower than those in the control group after the treatment (P<0.05). ④ The incidences of leukopenia, thrombocytopenia, and diarrhea in the study group were significantly lower than those in the control group (P<0.05). ⑤ Compared with before the treatment, the body function and emotional function after the treatment were significantly improved in the study group (P<0.05). And in the body function, emotion function, role function, cognitive function, and social function were significantly improved than those in the control group (P<0.05) after the treatment. ⑥ The progression-free survival in the study group was significantly better than that in the control group (P<0.05). There was no significant difference in the overall survival between the study group and the control group (P>0.05).ConclusionDC-CIK cell adoptive immunotherapy combined with chemotherapy could significantly improve immune status and quality of life of patients with gastric cancer after radical gastrectomy, reduce adverse effects of chemotherapy, improve long term effect, and prolong progression-free survival.