Objective To investigate the safe distance of upper gastric cancer by pokemon protein. Methods In 60 cases of upper gastric cancer， specimens were get from tumors’ tissue and every 0.5 cm from the proximal of tumor margin beginning at the 1.0 cm to distal. Western blot method was used to test the expression of pokemon protein. Results There were 38 cases （63.3%） positively expressed pokemon protein. Compared with the center of tumor， the positive expression rates of pokemon protein at every sites of 2.5-5.0 cm from margin were lower （P＜0.003）， but didn’t signi-ficantly differed at every sites of 1.0-2.0 cm from margin （P≥0.003）. When the incisal margin distance of more than 3.5 cm of both sides， the positive expression rate of pokemon protein were 0. There were no significant difference between the corresponding sites of the upper resection margin and lower resection margin （P＞0.05）. Conclusions The results show that 3.5 cm may be the molecular margin basing on the positive expression of pokemon protein in the surgical margin of upper gastric cancer， which may have guiding significance to the surgical margin.
The effect of proximal subtotal or total gastrectomy by choosing abdominal median incision plus left 7-9 ribs resection in 32 cases of upper gastric cancer had been studied. There was 1 case of residual tumor cells at the esophageal margin, 1 case of hydrothorax and hydrops of costal bed, no costal chondritis, pneumothorax and fistula formation. We consider that it is better to choose abdominal median incision plus left ribs resection in patients with upper gastric cancer in which subphrenic esophageal invasion is under 2cm of length and the function of heart or lung is severely damaged.
Objective To investigate the accuracy of preoperative high-resolution magnetic resonance imaging (MRI) scans to predict tumor stage, lymph node stage, and circumferential resection margin (CRM) involvement. Methods Between September 2006 and May 2009, 42 patients with histologically proven rectal cancer by the colonoscopic biopsy in Peking Union Medical College Hospital were staged preoperatively using MRI. All of the patients underwent total mesorectum excision (TME) operation within 1 week after MRI examination. The specimens were reported according to the 2002 TNM staging system for primary colorectal cancer of the American Joint Committee on Cancer (AJCC). Concordance between radiologic staging of tumor, local lymph node, and CRM involvement and pathologic reporting was assessed by means of the Kappa statistic.Results For all of 42 patients, MRI correctly staged the tumor in 36 patients, understaged in 3 patients and overstaged in 3 patients. Statistically, there was a better correlation between pathologic and radiologic tumor staging (Kappa=0.731, P=0.000). MRI correctly staged lymph node status in 31 patients, understaged in 5 patients and overstaged in 6 patients. Statistically, there was a common correlation between pathologic and radiologic lymph node staging (Kappa=0.410, P=0.009). MRI correctly reported the status of the CRM in 40 patients. Statistically, there was the best correlation between pathologic and radiologic reporting of CRM involvement (Kappa=0.829, P=0.000). Conclusion Preoperative highresolution MRI scans has a good concordance with pathologic tumor stage but common with pathologic lymph node stage. Preoperative highresolution MRI can provide reliable information about CRM and thus help to choose which patient could benefit from the preoperative neoadjuvant therapy.
ObjectiveTo summarize the clinical advantages and the treatment of perineal defect of extra-levator abdominoperineal excision, and to discuss the treatments of postoperative complications. MethodsChinese or English literatures about extra-levator abdominoperineal excision were collected to summarize and analyze the clinical signifi-cance of it. ResultsExtra-levator abdominoperineal excision had a lot of advantages in reducing the circumferential resection margin involvement rate and intraoperative perforation rate for patients with low rectal cancer. The huge perineal defect caused by the operation could achieve good healing after appropriate treatment. At the same time, we should avoid the occurrence of urogenital system dysfunction and perineal pain. ConclusionExtra-levator abdomino-perineal excision is a safe and effective procedure aimed at patients with low rectal cancer, and can be applied during clinical practice.
Objective To summarize the research progress of MRI in the assessment of rectal cancer before surgery. Methods Literatures about the recent studies on the research progress of MRI in the assessment of rectal cancer before surgery were reviewed according to the results searched from Pubmed, CNKI, and WanFang database. Results Preoperative staging, circumferential resection margin, and extramural vascular invasion were closely related to the prognosis of rectal cancer patients, MRI could provide a good assessment of preoperative staging, circumferential resection margin, and extramural vascular invasion for rectal cancer patients, but it still had some deficiencies which needed further studies. Conclusion Application of MRI in the assessment of preoperative staging, circumferential resection margin, and extramural vascular invasion before surgery, is conducive to the development of the most appropriate treatment options for patients with rectal cancer.
ObjectiveTo analyze the assessment and maintenance of 125 donor hearts from brain death donation and explore the use of marginal donor hearts.MethodsA retrospective analysis was conducted on the evaluation, maintenance, operation and follow-up results of 125 donor hearts from April 2016 to August 2019. There were 98 males and 27 females at age of 6-50 (36.0±2.4) years.ResultsTwelve donor hearts were discarded due to unqualified evaluation after heart harvest. 113 patients of heart transplantation were performed with a double lumen venous anastomosis manner. The mean time of cold ischemia was 220.1±6.7 min. Four patients died within 30 days after operation. Postoperative right ventricular assist circulation was performed in 4 patients, intra-aortic balloon counterattack (IABP) in 12 patients and extracorporeal membrane oxygenation (ECMO) in 12 patients. Marginal donors included 15 hepatitis B antigen positive donor hearts, 2 tricuspid regurgitation, 1 mitral regurgitation, 5 coronary calcification, 4 myocardial stunning and 2 severe weight mismatch. The results of follow-up (2 years) after marginal donor heart transplantation were satisfactory.ConclusionImproving the assessment and maintenance of donor hearts can improve the utilization rate of the heart, and the marginal donor heart transplantation needs long-term follow-up.
ObjectiveTo explore the effects of procedure for prolapse and hemorrhoids (PPH) combined with partial internal anal sphincterotomy (Abbreviation: PPH+sphincterotomy) on postoperative wound margin edema and anal function in patients with severe mixed hemorrhoids.MethodsEighty-five patients with severe mixed hemorrhoids admitted to this hospital from February 2017 to February 2018 were selected as the study subjects, then they were divided into a PPH group (n=42) and PPH+sphincterotomy group (n=43) according to the different treatment methods. The patient in the PPH group was treated with the PPH, while in the PPH+sphincterotomy group was treated with the partial internal anal sphincterotomy on the basis of the PPH group. The clinical efficacy, degree of pain, edema of wound margin, anal function, and the recurrence rate of symptoms were observed in two groups.Results① There were no significant differences in the baseline data such as the gender, age, course of disease, grading of internal hemorrhoids, and symptoms between the two groups (P>0.05). ② The total effective rate of the PPH+sphincterotomy group was significantly higher than that of the PPH group [100% (43/43) versus 90.48% (38/42), χ2=4.297, P=0.038]. ③ The VAS score of the PPH+sphincterotomy group was significantly lower than that of the PPH group on the 3rd and 7th day after the treatment (P<0.05), the VAS score of each group at the 3rd or 7th day after the treatment was significantly lower than that before the treatment (P<0.05), and it was significantly lower on the 7th day than that on the 3rd day after the treatment (P<0.05). ④ The postoperative wound margin edema in the PPH group was more serious than that in PPH+sphincterotomy group (χ2=20.237, P<0.001), and the score in the PPH group was significantly higher than that in the PPH+sphincterotomy group (t=13.514, P<0.001). ⑤ The resting pressure of anal canal after the treatment was significantly lower than that before treatment (P<0.05), and the diastolic pressure of anal canal after the treatment was significantly higher than that before the treatment (P<0.05) in the two groups. The resting pressure of anal canal in the PPH+sphincterotomy group was significantly lower than that in the PPH group and the diastolic pressure of anal canal was significantly higher than that in the PPH group (P<0.05) after the treatment. ⑥ In addition, the total recurrence rate of symptoms at 1 year in the PPH+sphincterotomy group was significantly lower than that of the PPH group [6.98% (3/43) versus 23.81% (10/42), χ2=4.647, P=0.031].ConclusionPPH+sphincterotomy could effectively relieve symptoms of severe mixed hemorrhoids, improve clinical efficacy, and reduce recurrence rate.
ObjectiveTo explore the influence of 5 mm surgical margin (SM) width on the prognosis of patients with solitary hepatocellular carcinoma (HCC) and the influence of tumor size and microvascular invasion (MVI) on strategic decision of SM width.MethodsThe clinicopathologic data of patients with solitary HCC underwent the surgical resection in the West China Hospital of Sichuan University from January 2014 to September 2015 were collected. According to the inclusion and exclusion criteria of this study, the prognostic differences of the patients with SM≤5 mm and SM>5 mm were compared after the propensity score matching (PSM), and the influences of the 5 mm SM on the recurrence-free survival rate of large HCC (>5 cm) or small HCC (≤5 cm) and MVI positive or negative patients were analyzed.ResultsA total of 266 eligible patients were included, with a median overall survival of 40.01 months and a median recurrence-free survival of 37.01 months. During the follow-up period, 137 patients recurred and 75 patients died. After PSM, the basic indexes had no significant differences between the patients with SM>5 mm (n=78) and SM≤5 mm (n=78). The results of the multivariate Cox regression analysis showed that the tumor size and MVI were the important factors of the recurrence-free survival (P<0.05) and the tumor size, MVI, HBeAg, and alpha-fetoprotein (AFP) were the important factors of the overall survival (P<0.05) before the PSM; while the MVI and SM were the important factors of the recurrence-free survival (P<0.05), the gender, AFP, and MVI were the important factors of the overall survival (P<0.05) after the PSM. The recurrence-free survival rate of the patients with SM >5 mm had better than that with SM≤5 mm after the PSM, but the overall survival had no difference. In the MVI negative and large HCC subgroups, the patients with SM>5 mm showed the better recurrence-free survival rate. However, in the MVI positive and small HCC subgroups did not show any differences in the recurrence-free survival rate for the different SM widths.ConclusionsAccording to the results of this study, a wider SM (>5 mm) could improve recurrence-free survival in patients with a single tumor within BCLC stage 0/A. For patients without MVI or large HCC, SM>5 mm might be adequate. However, for patients with MVI or small HCC, the determination of an appropriate SM width needs further to be investigated.
Objective To explore the effectiveness of unilateral percutaneous vertebroplasty (PVP) through mild side and severe side approaches in the treatment of elderly osteoporotic vertebral compression fracture (OVCF). Methods The clinical data of 100 patients with OVCF with symptoms on one side who were admitted between June 2020 and June 2021 and met the selection criteria were retrospectively analyzed. The patients were divided into the severe side approach group (group A) and the mild side approach group (group B) according to the cement puncture access during PVP, with 50 cases in each group. There was no significant difference between the two groups in terms of general information such as gender composition, age, body mass index, bone density, damaged segments, disease duration, and chronic comorbidities (P>0.05). The lateral margin height of the vertebral body on the operated side in group B was significantly higher than that of group A (P<0.001). The pain level and spinal motor function were evaluated using the pain visual analogue scale (VAS) score and Oswestry disability index (ODI) before operation, at 1 day, 1 month, 3 months, and 12 months after operation in both groups, respectively. Results No intraoperative or postoperative complications such as bone cement allergy, fever, incision infection, and transient hypotension occurred in both groups. Four cases of bone cement leakage occurred in group A (3 cases of intervertebral leakage and 1 case of paravertebral leakage), and 6 cases of bone cement leakage occurred in group B (4 cases of intervertebral leakage, 1 case of paravertebral leakage, and 1 case of spinal canal leakage), and none of them had neurological symptoms. Patients in both groups were followed up 12-16 months, with a mean of 13.3 months. All fractures healed and the healing time ranged from 2 to 4 months, with a mean of 2.9 months. The patients had no complication related to infection, adjacent vertebral fracture, or vascular embolism during follow-up. At 3 months postoperatively, the lateral margin height of the vertebral body on the operated side in groups A and B were improved when compared with preoperative ones, and the difference between pre- and post-operative lateral margin height of the vertebral body in group A was higher than that in group B, all showing significant differences (P<0.001). The VAS scores and ODI in both groups improved significantly at all postoperative time points when compared with those before operation, and further improved with time after operation (P<0.05). The differences in VAS scores and ODI between the two groups before operation were not significant (P>0.05); VAS scores and ODI in group A were significantly better than those in group B at 1 day, 1 month, and 3 months after operation (P<0.05), but no significant difference was found between the two groups at 12 months after operation (P>0.05). Conclusion Patients with OVCF have more severe compression on the more symptomatic side of the vertebral body, and patients with PVP have better pain relief and better functional recovery when cement is injected through the severe symptomatic side.
Objective To summarize and analyze the application value of triple stomach shaping technique in laparoscopic sleeve gastrectomy (LSG). Methods The clinical data of patients undergoing simple LSG with triple stomach shaping technique carried out by the General Surgery Obesity and Metabolic Diseases Center of Chengdu Third People’s Hospital from January to December 2021 were retrospectively collected, recording the operative time and the occurrence of recent complications such as postoperative nausea/vomiting, gastric leakage, bleeding, obstruction/torsion within 30 days after operation. Results A total of 966 patients were collected, including 294 males and 672 females. The age was 16–65 years, average age was (32.8±8.6) years. Body mass index was 27.5–47.2 kg/m2, average was (34.2±3.5) kg/m2. All operations were successfully completed without conversion to laparotomy. The operative time was 45–170 min, average was (100.2+33.4) minutes. Postoperative nausea/vomiting occurred in 484 cases (50.10%), bleeding in 2 cases (0.21%, intraperitoneal bleeding in 1 case, intragastric bleeding in 1 case), gastric leakage in 1 case (0.10%, grade B leakage), and no perioperative death occurred. Hospitalization time was 4–24 d, average was (7.55±2.47) d. Two patients (0.21%) were hospitalized again due to nausea and vomiting within 30 days after operation, they were relieved and discharged after conservative medical treatment. Conclusion Triple gastric shaping technology is more physiological, safe and suitable for promotion.