Objectives To analyze risk factors associated with conversion to open surgery of laparoscopic repair for perforated peptic ulcer. Methods From January 2009 to December 2014, 235 patients underwent laparoscopic repair for perforated peptic ulcer in the Chengdu 5th Hospital, were enrolled in this study. These patients were divided into laparoscopic repair group (n=207) and conversion to open surgery group (n=28). The characteristics, clinical outcomes, and prognosis factors were compared between these two groups. The receiver operating characteristic (ROC) curve was used to determine the critical cutoff value for diameter and duration of perforation for predicting conversion to open surgery. Results There were no significant differences of the age, gender, body mass index, comorbidity, history of ulcer, smoking history, history of nonsteroidal antiinflammatory drugs or steroids use, history of alcohol use, American Society of Anesthesiologists classification on admission, white blood cell count on admission, C reaction protein on admission, surgeons, suture method, and location of perforation between these two groups (P>0.05). The patients in the conversion to open surgery group had a higher procalcitonin (PCT) level on admission (P=0.040), longer duration of peroration (P<0.001), larger diameter of peroration (P<0.001), longer hospital stay (P=0.002), higher proportion of patients with Clavien-Dindo classification Ⅰ and Ⅱ (P<0.001), longer gastrointestinal function recovery time (P=0.003), longer analgesics use time (P<0.001), and longer off-bed time (P=0.001) as compared with the laparoscopic repair group. The results of logistic regression analysis showed that the peroration duration on admission〔OR: 2.104, 95%CI (1.124, 3.012),P=0.020〕and peroration diameter on admission〔OR: 2.475, 95%CI (1.341, 6.396),P=0.013〕were two predictors of conversion to open surgery. For the diameter of perforation, 8.0 mm was the critical cutoff value for predicting conversion to open surgery by ROC curve analysis, the sensitivity was 76%, the specificity was 93%, and the area under the curve (AUC) was 0.912. For the duration of perforation, 14 h was the critical cutoff value to predict conversion to open surgery, the sensitivity was 86%, the specificity was 71%, and theAUC was 0.909. Conclusions The preliminary results in this study show that diameter of perforation of 8 mm and duration of perforation of 14 h are two reliable risk factors associated with conversion to open surgery for perforated peptic ulcer. Also, PCT level would mightbe considered as a helpful risk factor for it.
Objective To research the effect of ω-3 polyunsaturated fatty acid (PUFA) on inflammatory response and nutritional condition after operation for patients with gastrointestinal malignancies. Methods Forty patients with gastrointestinal malignancies were included in this study from February 1st, 2009 to June 1st, 2009. Forty cases were randomly allocated to experimental group (20 cases) and control group (20 cases). Parenteral nutrition was conducted in continuous 7 days after operation. Comparing with control group, a dose of 10 g of ω-3 PUFA was given to experimental group every day in 7 days after operation in addition. Blood samples were gained before operation, the 2nd and 8th day after operation respectively to measure relative indexes about inflammatory response (WBC, neutrophilic granulocyte and C-reaction protein) and nutrition (total protein, albumin, prealbumin, siderophilin and lymphocyte). Reduction of body mass was also recorded. Results The baseline between experimental group and control group was comparable (Pgt;0.05). The levels of indexes about inflammatory response (WBC, neutrophilic granulocytem and C-reaction protein) and nutrition (total protein, albumin, prealbumin, siderophilin and lymphocyte) between experimental and control group did not reach statistically significant difference in the 2nd day after operation (Pgt;0.05). The levels of neutrophilic granulocyte and C-reaction protein in experimental group were lower than those of control group, and the level of lymphocyte in experimental group was higher than that of control group in the 8th day after operation, and all of them reached statistical significance (Plt;0.05). There was no statistical different in reduction of body mass between experimentalgroupandcontrolgroup.Conclusion ω-3 PUFA can depress the excessively inflammatory reaction and improve the nutritional condition of patients with gastrointestinal malignancies after operation.
Objective To explore the postoperative influence of intra-abdominal implantation of sustained-releasing 5fluorouracil on the hepato-renal function, immune function, nutritional state and complications in patients with gastric and colorectal cancer. Methods Sixty-five patients with gastric or colorectal cancer were included into this study from January to June 2009. The patients (35 cases of gastric cancer, 18 cases of colon cancer and 12 cases of rectal cancer) were randomly divided into experimental group (n=25) and control group (n=40). In experimental group, 400 mg sustained-releasing 5-fluorouracil was used. Blood samples were gained before operation, the second day and the seventh day after operation to examine the indexes of hepato-renal function, immune function and nutritional state. Complications， venting time and length of stay after operation were also recorded. Results There was no statistical significance for distribution of tumor stages and patients’ gender between experimental group and control group (Pgt;0.05). Preoperative indexes of hepato-renal function, immune function and nutritional state were also not reached statistical significance between two groups (Pgt;0.05). Compared with control group, the indexes of total protein and transferrin were decreased and urea nitrogen and IgM were increased in the second day after operation in experimental group (Plt;0.05). The number of lymphocyte was increased, while CD4, Alb, total protein and IgA were decreased in the seventh day after operation in experimental group, respectively. The time of passage of gas of experimental group was longer than that of control group (Plt;0.05).Conclusion Intra-abdominal implantation of sustained-releasing 5-fluorouracil is safe and feasible, which does not increase the complications and the time of length stay after operation. However, there is a little influence on immune function and gastrointestinal function after operation for intra-abdominal implantation of sustained-releasing 5-fluorouracil.
Objective To research the effect of ω-3 polyunsaturated fatty acid (PUFA) on promoting the postoperative rehabilitation of patients with gastrointestinal malignancies in order to decrease the incidence of postoperative complications and the days of postoperative hospital stay. Methods Forty patients with gastrointestinal malignancies in West China Hospital of Sichuan University from February 1st, 2009 to June 1st, 2009 were included and allocated to experimental group (20 cases) and control group (20 cases) randomly. Seven days parenteral nutrition was provided to them after operation. Compared with control group, ω-3 PUFA with a dose of 10 g was given to experimental group every day additionally. Blood samples were gained before operation, on the morning of day 2 and day 8 after operation respectively to measure hepatorenal and immune indexes. Temperature before and 1-7 d after operation, time of passing flatus to normal, postoperative complications and the postoperative hospital stay were recorded. Results There was no statistical difference in the baselines between experimental group and control group （Pgt;0.05）. The level of total bilirubin in experimental group was lower and the levels of NK cell and B cell in experimental group were higher than those in control group on day 2 after operation, there were statistical differences between them (Plt;0.05). The levels of ALT, AST and blood urea mitrogen in experimental group were lower and the levels of CD4+ cell and NK cell in experimental group were higher than those in control group on day 8 after operation, there were statistical differences between them, too (Plt;0.05). The time of passing flatus to normal and days of staying in hospital after operation in experimental group were shorter than those in control group, there were statistical differences between them (Plt;0.05). There was no statistical difference in postoperative average temperature and incidence of complications between two groups （Pgt;0.05）. Conclusions ω-3 PUFA has positive influence on the recovery of hepatorenal, immune and gastrointestinal function, and can shorten the days of postoperative hospital stay; but there is no effect on incidence of complications after operation.
Objective To investigate the correlation between nutrition related blood biochemical indexes levels and Patient-Generated Subjective Global Assessment (PG-SGA) in preoperative nutritional assessment of patients with gastric cancer. Methods One hundred and seventeen gastric cancer patients who underwent surgery were enrolled in this study by the Department of Gastrointestinal Surgery of West China Hospital. Nutritional status of each patient was evaluated by PG-SGA, in the meantime, nutrition related blood biochemical indexes levels such as transferrin (TRF), prealbumin (PA), albumin (Alb), and hemoglobin (HGB) were measured by analysis of fasting venous blood, then take correlation analysis on the result. Results Eighty cases (68.4%) were in malnutrition (PG-SGA score≥4). The TRF, PA, Alb, and HGB in malnutrition patients were lower than those in non-malnutrition patients (PG-SGA score<4, n=37, P<0.05). The TRF, PA, Alb, and HGB levels of gastric cancer patients had significant negtive correlation with PG-SGA score, the correlation coefficients was –0.629, –0.545, –0.418, and –0.235, respectively (P<0.05). When the PG-SGA score was greater than or equal to 4 points, the optimum cutoff value for TRF, PA, Alb, and HGB was 2.31 g/L, 190.50 mg/L, 38.65 g/L, and 100.50 g/L, respectively (P<0.05). Conclusions The incidence of malnutrition is high in gastric cancer patients preoperatively. The TRF, PA, Alb, and HGB are significantly decreased in the patients with malnutrition, and these indicators has significant negtive correlation with PG-SGA score. The current study indicated that a gastric cancer patient might be in malnutrition when the biochemical levels are less than or equal to TRF 2.31 g/L, PA 190.50 mg/L, Alb 38.65 g/L, HGB 100.50 g/L, and sufficient attention should be paid when any of these occasions appear clinically. The combination of PG-SGA score and nutrition related blood biochemical indexes levels could provide a more accurate assessment of preoperative nutritional status, and the evidence of nutritional intervention for patients with gastric cancer.
Objective To explore risk factors of lymph node metastasis (LNM) in T1 rectal cancer. Methods The retrospective case-control study was conducted. The clinicopathologic data of 247 patients with T1 rectal cancer underwent radical resection were analyzed in the pathological database of the West China Hospital from January 2000 to December 2016, including the tumor size (maximum diameter), gross type, differentiation degree, histological type, lymph vascular infiltration, perineural infiltration, and carcinoma nodule. The univariate analysis and multivariate analysis were done using the Chi-square test and logistic regression model, respectively. Results The rate of LNM in the patients with T1 rectal cancer was 8.50% (21/247). No lymph metastasis was found in the well differentiated T1 rectal cancer. The results of the univariate analysis showed that the differentiation degree, histological type, and carcinoma nodule were related to the LNM in the T1 rectal cancer (P<0.050). The results of the multivariate analysis revealed that the poor differentiation, mucinous adenocarcinoma, signet-ring cell carcinoma, and carcinoma nodule were the independent risk factors of the LNM in the T1 rectal cancer (OR=9.75, P=0.006; OR=5.98, P=0.042; OR=8.33, P=0.017; OR=10.87, P=0.026). Conclusion In this large population dataset, poor differentiation, mucinous adenocarcinoma, signet-ring cell carcinoma, and carcinoma nodule are risk factors of LNM in T1 rectal cancer.
Objective To assess the effectiveness and the safety of clinical use of growth hormone (GH) in burn patients. Method Search were applied to the following electronic databases: Chinese Bio-medicine Database (CBM), MEDLINE, EMBASE and Cochrane Library. Language was restricted in Chinese and English. Data were extracted and evaluated by the two reviewers independently of each other. Applied RevMan 4.1 for statistical analyse. Results Nine trials involving 732 patients were included. The combined results showed that GH can shorten wound healing time [weighted mean difference (WMD) = -11.25, 95%CI (-14.84 to -7.66), Plt;0.000 01], donor site healing times [WMD= -1.87, 95%CI (-2.28 to -1.47), P＜0.000 01), and length of hospital stay [WMD= -8.10, 95%CI (-10.40 to -5.79), P＜0.000 01]. There was no statistical significance on resting energy expenditure [WMD= -0.04, 95%CI ( -0.08 to 0.00), P=0.06], mortality [odds ratio (OR) =1.15, 95%CI (0.15 to 8.53), P=0.9], sepsis [OR=1.08, 95%CI (0.50 to 2.34), P=0.8] and ventilatory support required [OR=1.51, 95%CI (0.72 to 3.16), P=0.3]. Nevertheless, the plasma levels of glucose [standardized mean difference (SMD) =0.98, 95%CI (0.54 to1.42), P＜0.000 01] and insulin [SMD=0.86, 95%CI (0.43 to1.30), P=0.000 1] were increased in GH groups. Conclusions GH for burn patients is effective and safe if blood glucose can be controlled well.