目的 探讨消化道吻合器在中、低位直肠癌保肛手术中的应用。方法 回顾分析120例直肠癌患者应用吻合器行保肛手术的临床资料。结果 本组保肛手术成功率为98.3%（118/120），吻合口漏发生率为3.3%（4/120），吻合口狭窄发生率为4.2%（5/120）。结论 在中、低位直肠癌行直肠前切除低位或超低位吻合术中使用吻合器，具有吻合成功率高，并发症少，操作安全简便的优点。
Objective To evaluate the effect of ultrasound guided percutaneous drainage on acute perforation of gastroduodenal ulcer in elderly patients. Methods The clinical features, treatments, and the curative effects of 86 elderly cases (≥65 years) of acute perforation of gastroduodenal ulcer in our hospital between January 2004 and October 2009 were retrospectively analyzed. Twenty-one cases were treated by ultrasound guided percutaneous drainage (drainage group), and 65 cases were treated by exploring operation (operation group). Results Drainage group was cured and had no complications. In 15 patients which accepted recheck one month after drainage, gastroscope showed the ulcer healed in 12 cases， and improved in 3 cases. In operation group, 63 cases were cured and 2 cases died. Compared with the drainage group, there was no significant difference in cure rate (Pgt;0.05). However, 11 patients had operative complications in operation group, which was significantly more than that in the drainage group （Plt;0.05）. In 45 patients which accepted recheck one month after operation, gastroscope showed the ulcer healed in 38 cases， and improved in 7 cases. Conclusion For elderly patients with acute perforation of gastroduodenal ulcer， if the patients do not fit for exploring operation， ultrasound guided percutaneous drainage is proved to be a simple, safe, and effective means.
ObjectiveTo evaluate the curative effect of laparoscopic assisted and open D2 radical resection in treatment of advanced gastric cancer. MethodsThe clinical data of 76 cases performed by laparoscopic assisted D2 radical resection (laparoscopic group) and 104 cases performed by open operation (open group) from October 2010 to October 2012 in our center were retrospective analized.Operation related index, postoperative recovery, and extent of radical resection of tumor of 2 groups were compared. ResultsThe operative time of the laparoscopic group[(192.5±14.8) min]was longer than that open group[(171.5±16.5) min, P < 0.05].But the blood loss, postoperative drainage, length of incision, and hospital stay of the laparoscopic group were significantly less or shorter than those of open group (P < 0.05).There were no significant difference in postoperative complications and extent of radical resection of tumor between the 2 groups (P > 0.05).There were no residual tumor in distal margin and operatiive death case in both 2 groups. ConclusionComparing with open operation, the laparoscopic assisted surgery for advanced gastric cancer could achieve the same clinical outcomes, and obvious advantage of minimal invasion.
Objective To detect the anti-colon cancer ability of whole cell lysates pulsed dendritic cell (DC) which acts as an adjuvant. Methods Whole cell lysates of LoVo cells were extracted with freeze thawing method, then the monocyte-derived DC were pulsed with this cellular antigen. Subsequently, the capability of antigen pulsed DC to promote T lymphocytes proliferation and the ability of T lymphocytes to kill LoVo cells were detected by 3H-TdR incorporation and lactate dehydrogenase release methods, respectively. Results The whole cell lysates of LoVo cells pulsed DC significantly stimulated T cells proliferation, and the cytotoxicity abilities of primed T cells to kill LoVo cells were also enhanced. Conclusion Tumor cell lysates which act as the cellular antigen to pulse DC can improve the efficacy of anti-cancer immune response， which provides us an experimental evidence for cancer immunotherapy.
【摘要】 目的 研究腹腔镜行进展期胃癌根治术较传统开腹手术在围手术期临床和生化指标的变化，进一步探讨其临床应用的优越性。 方法 采用统一入组标准、同期临床对比研究方法，对2010年1-12月腹腔镜手术组和开腹手术组完成的112例进展期胃癌根治术患者在围手术期临床指标和生化指标的比较分析，其中腹腔镜手术组59例，开腹手术组53例。 结果 腹腔镜组手术切口长度为（5.77±0.74） cm，开腹手术组为（12.05±1.30） cm，组间差异有统计学意义（t=-30.921，P=0.000）；腹腔镜组术中失血量为（107.20±27.23） mL，开腹手术组为（168.87±96.76） mL，组间差异有统计学意义（t=-4.483，P=0.000）；腹腔镜组术后住院时间为（7.19±0.97） d，开腹手术组为（8.32±1.16） d，组间差异有统计学意义（t=-5.634，P=0.000）；腹腔镜组手术时间为（202.12±15.71） min，开腹手术组为（196.32±16.73） min，组间差异无统计学意义（t=1.891，P=0.061）；腹腔镜组清扫淋巴结枚数（14.15±4.51）枚，开腹手术组（15.25±5.17）枚，组间差异无统计学意义（t=0.736，P=0.471）；腹腔镜组肠功能恢复时间为（57.88±9.70） h，开腹手术组为（59.16±10.82） h，组间差异无统计学意义（t=-0.655，P=0.514）。两组前白蛋白和血红蛋白水平差异无统计学意义（Pgt;0.05）。 结论 进展期胃癌行腹腔镜手术与传统开腹手术比较，并不加重患者创伤反应，也不增加手术并发症，具有手术切口小、术中出血少、术后恢复快等优点。【Abstract】 Objective To evaluate the differences between laparoscopy and open surgery for treating advanced gastric cancer in peri-operative clinical and biochemical indexes, in order to investigate the superiority of laparoscopy in treating the disease. Methods The same including standards and double-blind randomized control study were carried out to compare the peri-operative clinical and biochemical indexes of 112 patients who underwent radical treatment for advanced gastric cancer from January to December 2010. Among them, 59 patients were included in the laparoscopic group, and 53 in the traditional open operation group. Results Compared with the open surgery group, the incision length [(5.77±0.74) cm vs. (12.05±1.30) cm; t=-30.921, P=0.000], intraoperational blood loss [(107.20±27.23) mL vs. (168.87±96.76) mL; t=-4.483, P=0.000] and hospital stay time [(7.19±0.97) days vs. (8.32±1.16) days; t=-5.634, P=0.000] were significantly shorter or lower in the laparoscopic group. However, the operation time [(202.12±15.71) minutes vs. (196.32±16.73) minutes; t=1.891, P=0.061], number of lymph nodes removed (14.15±4.51 vs. 15.25±5.17; t=0.736, P=0.471), and intestinal functioning time [(57.88±9.70) hours vs. (59.16±10.82) hours; t=-0.655, P=0.514] were not significantly different between the two groups. There was no significant difference between the two groups in the level of prealbumin and hemoglobin. Conclusion Compared with the traditional open operation, laparoscopic surgery for gastric cancer has obvious advantages including smaller incision, lower blood loss during the operation, and fast recovery, without aggravating patients′ traumatic response or increasing the incidence of operational complications.
Objective To explore the applying value of laparoscopic partial gastrectomy for gastric stromal tumors. Methods The clinical data of 22 patients with gastric stromal tumors between July 2007 and December 2009 in this hospital were analyzed retrospectively. And the laparoscopic resection was performed in all the patients. Results The laparoscopic resections were performed successfully in all the patients, and the tumors were completely resected. The length of operative incision on abdominal wall was 4－6 cm with average 5.3 cm. The mean operation time was 70 min. Postoperative recovery was smooth, no procedure related complications happened. The mean hospital stay was 7.2 d. Specimens of 20 cases were with CD117 (+), and 15 with CD34 (+) by immunohistochemistry. No recurrence or metastasis happened with average follow-up of 13 months (2－23 months). Conclusion Laparoscopic partial gastrectomy for gastric stromal tumors could be performed safely, postoperative recovery quickly and effectively with the advantage of minimal invasiveness.
目的 探讨术中应用缓释5-氟尿嘧啶在结直肠癌治疗中的价值及安全性。方法 回顾性分析173例结直肠癌患者术中应用缓释5-氟尿嘧啶后的疗效和不良反应。结果 171例患者顺利出院，1例患者死于严重骨髓抑制，1例死于真菌败血症； 无出血、吻合口漏、肠穿孔、肠梗阻等严重并发症发生。155例患者获6个月至3年的随访，随访期间死亡23例，发生局部复发5例，肝脏等远处转移3例。结论 结直肠癌术中使用缓释5-氟尿嘧啶是安全、有效的。
Objective To investigate the infection rate and observe the healing courses of the incision after gastrointestinal surgery which was managed by positioning extraperitoneal U-type latex drainage strip. Methods Two hundred patients after abdominal operation were divided into drainage group (n=97) and control group (n=103). Drainage group were treated with positioning extraperitoneal U-type latex drainage strip, while control group were treated with no latex drainage strip. The infection rate of incision, the mean time in hospital and mean time of incision healing were observed. Results The infection rate of drainage group was significantly lower than that of control group 〔7.22% (7/97) vs. 18.45% (19/103), P=0.024〕. The mean time in hospital and the mean time of incision healing in drainage group were significantly shorter than those in control group 〔(8.86±1.48) d vs. (14.12±2.63) d， P=0.000； (8.24±1.02) d vs. (12.32±3.47) d， P=0.000〕. Conclusion The infection rate and the healing course of incision of gastrointestinal surgery could be improved by positioning extraperitoneal U-type latex drainage strip.
ObjectiveTo explore the early diagnosis and treatment of acute non-tumor perforation of the back wall of ascending colon. MethodsWe retrospectively analyzed the clinical data of 17 patients with acute non-tumor perforation of the back wall of ascending colon treated between July 2007 and April 2014 in our hospital. Among them, 8 patients who underwent perforation repair combined with abdominal cavity drainage were regarded as the experimental group, and the other 9 patients who underwent operation of right hemicolectomy (or ascending colon resection) were designated as the control group. Clinical indexes and biochemical indexes of both the two groups were compared and analyzed. ResultsAll patients were cured. The operation time[(74.20±12.45), (120.23±15.20) minutes; t=-3.224, P<0.001], the intraoperative blood loss[(40.24±12.20), (80.69±18.98) mL; t=-4.114, P<0.001], the postoperative anal exhaust[(75.62±6.56), (84.54±7.82) hours; t=1.108, P=0.037], the medical expenses[(18.2±5.7) thousand yuan, (26.5±8.3) thousand yuan; t=-5.556, P<0.001], and the hypersensitive C-reaction protein on the third day after operation[(89.45±8.98), (99.85±10.78) mg/L; t=-3.004, P=0.029] in the experimental group and the control group all had significant differences. There was no significant difference between the two groups in the hospital stay time[(9.80±3.16), (9.81±3.20) days; t=1.501, P=0.080]. There was one case of incision infection in the experimental group and one case of fat liquefaction of incision in the control group, and both of them were cured after treatment. ConclusionThe early abdominal sign of perforation of the back wall of ascending colon is not obvious, which can easily lead to misdiagnosis as acute appendicitis. Early diagnosis mainly depends on the clinical symptom, vital sign, blood routine examination and CT examination. Among them, CT findings of gaseous sign behind peritoneum is a definite diagnosis, and operation should be arranged as early as possible. Perforation repair combined with abdominal cavity drainage is preferred due to its advantages of being simple, saving time, less bleeding and lighter traumatic reaction.