Objective To investigate the reversal of the multidrug resistant gene mdr1 in vivo by antisense oligodeoxynucleotide （ASODN） on the basis of study in vitro. Methods The cultured drug-resistant human hepatocellular carcinoma cells were injected under the skin of axilla to establish the tumor model of nude mice. mdr1 ASODN accompanied by Lipofectamine were injected locally and ADM was injected intraperitoneally. Control 1 and control 2 were locally injected by Lipofectamine and normal saline separately, and ADM was also injected intraperitoneally. Results As time went on the tumor size increased and from the 5th day on alterations were marked, tumor size in different time phase showed marked difference to the prior time phase with significant difference (P＜0.05）. Tumor size in group ASODN was marked smaller than that of other 3 groups after the 5th day (P＜0.05)，while tumor size of group control 1,2 and group SODN in different phase showed no significant difference (Pgt;0.05). The results suggested that SODN and Lipofectamine showed no marked effect on tumor growth of nude mice and ASODN had marked inhibition effect on tumor growth. Conclusion mdr1 ASODN can also reverse multidrug resistance of drug-resistant human hepatocellular carcinoma cells in vivo. After the treatment the tumor’s growth in nude mice will slow down in a range of time.
Objective To investigate the significance and surgical skill for lymphadenectomy of No.12a lymph node around proper hepatic artery in gastric cancer. Methods Among data of stageⅣ gastric cancer patients who received curative R0 gastrectomy, sixty-eight patients performed gastrectomy with D2 lymph node dissection, including No.12a lymph node were identified. Experiences and understanding of No.12a lymphadenectomy for gastric cancer were concluded. Results The number of dissected No. 12a lymph node was 556 （5-11 per capita，mean 8.17 per capita） in 68 patients with stageⅣ gastric cancer, and the positive lymph node of No.12a was 33.27% （185/556）. There were no lymphadenectomy related complications： anastomotic leakage, lymphatic fistula， and postoperative hemorrhage in this series. Conclusions Being familiar with the anatomy around proper hepatic artery and intrathecal liberation of proper hepatic artery, ligation of left gastric vein and right gastric artery at its onset, and exposure of gastroduodenal artery’s root and anterior wall of portal vein are important to dissection of No.12a lymph nodes.
ObjectiveTo investigate the relationship between preoperative C-reactive protein (CRP)/albumin ratio (CAR) and National Institutes of Health (NIH) risk classification in patients with gastric stromal tumors.MethodsClinical data of 108 patients with gastric stromal tumors admitted to the First Affiliated Hospital of Kunming Medical University from February 2010 to November 2016 were retrospectively collected. With the median of CAR as the critical value, patients were divided into high CAR group (CAR>0.048) and low CAR group (CAR≤0.048). Then observed the general clinicopathological characteristics and survival status of patients with higher and lower CAR value.ResultsThere were significant differences in NIH classification, tumor diameter, and mitosis between the high CAR group and low CAR group (P<0.05). Compared with the low CAR group, the tumors in the high CAR group had larger diameter, higher mitotic figure, and higher NIH grade. Survival analysis showed that the prognosis of the low CAR group was better than that of the high CAR group (χ2=15.152, P<0.001).ConclusionsCAR is closely related to the malignant index and NIH risk classification of gastric stromal tumors. It can be used as an index for evaluating the malignant degree of gastric stromal tumors, and it is expected to be an important reference factor for clinical NIH risk classification and prognosis.
ObjectiveThe aim of this paper is to summarize the advantages and disadvantages of non-surgical treatments of the enterocutaneous fistula, in order to give some advice.MethodsPubmed, EMBASE, Medline, CNKI, and Wanfang databases were retrieved for the published article addressing the non-surgical treatments of enterocutaneous fistula between 2004 to 2018. The keywords were " enterocutaneous fistula” in English and Chinese, respectively. The non-surgical treatments of enterocutaneous fistula were reviewed.ResultsThe results of this search suggested that non-surgical treatments of the enterocutaneous fistula mainly include fibrin glue, endoscopic treatment, laser ablation, and somatostatin. Fibrin glue was widely used at domestic and abroad, but it needed repeated operations. Endoscopic treatment of enterocutaneous fistula required a certain professional foundation; laser ablation technology was still immature and required theoretical data support. Now, the use of somatostatin was controversial.ConclusionEach of measures have its advantages and disadvantages, we should determine according to the patient’s condition and economic situation.
ObjectiveTo summarize the experience of diagnosis and treatment of a patient with liver and lung metastasis and retroperitoneal metastasis from right colon cancer.MethodsA retrospective analysis of a patient with liver, lung, and retroperitoneal metastasis from right colon cancer who received treatment at The First Affiliated Hospital of Kunming Medical University in August 2016 was conducted. In order to provide reference for domestic doctors to treat advanced colorectal cancer.ResultsAfter receiving several cycles of chemotherapy and three surgical resections of the primary and metastatic lesions before the MDT, the patient again found a retroperitoneal mass. After discussions of Department of Imaging, Oncology, Radiotherapy, and Gastrointestinal and Hernia Surgery, we thought that, at present, the treatment of the patient was mainly surgery and oral chemotherapy. So the patient underwent retroperitoneal tumor resection+abdominal adhesion release, and had been interviewed for 3 months. No recurrence or metastasis was found during follow-up.ConclusionThe therapy of liver-lung metastasis and retroperitoneal metastasis in right colon cancer are mainly based on surgical resection of lesions, postoperative combined with radiotherapy and chemotherapy, molecular targeted therapy, and postoperative monitoring of CEA changes.
There is a bidirectional association between tumor-associated macrophage (TAM) and colorectal cancer. Small molecular substances metabolized by colorectal cancer affect the reprogramming of TAM, and TAM in turn regulates the biological behavior of colorectal cancer cells by secreting small molecular substances, and promotes the progression of colorectal cancer. In addition, gut microbiota metabolites are closely related to TAM reprogramming, and intestinal flora imbalance leads to gut barrier damage, favoring bacterial translocation and causing chronic tumorigenic inflammation. Studying the reprogramming mechanism affecting TAM and its relationship with the occurrence and development of colorectal cancer may provide new ideas for the study of immunotherapy in patients with colorectal cancer. This article reviews the research progress of TAM in patients with colorectal cancer, aims to provide a reference for clinical research.
ObjectiveTo investigate the surgical skills and clinical effects of the laparoscopic transabdominal preperitoneal (TAPP) inguinal hernia repair in treatment of recurrent inguinal hernia with plug prefix mesh. MethodsThe clinical data such as operation time, intraoperative blood loss, postoperative hospital stay, and postoperative complications of 87 patients with recurrent inguinal hernia reoperated in laparoscopic TAPP after inguinal hernioplasty with plug prefix mesh (recurrent hernia group), in the Department of Gastroenterology and Hernia surgery of the First Affiliated Hospital of Kunming Medical University from January 2011 to December 2013, were retrospectively analyzed, which were compared with the 834 incipient inguinal hernia patients operated first by TAPP (incipient hernia group) at the same time. ResultsThe operations were completed successfully in all of the 921 patients without conversion to open surgery. The operation time and intraoperative blood loss in the recurrent hernia group were significantly more than those in the incipient hernia group (P=0.000, P=0.000), the postoperative hospital stay had no signifcant difference between two groups (P=0.057). No recurrences were observed in the recurrent hernia group and incipient hernia group for following-up of (31±4) months and (28±6) months, respectively. Compared with the incipient hernia group, the rates of postoperative pain on day 30 and seroma on day 1 and 3 were higher in the recurrent hernia group (P=0.001, P=0.040, P=0.003, respectively). There were no severe complications such as collateral damage, foreign body sensation, incision infection, intestinal obstruction and so on in the two groups. ConclusionsThe laparoscopic TAPP inguinal hernia repair is safe and effective for patients with recurrent inguinal hernia with plug prefix mesh. More skills are required to reduce the complications. The operation time and intraoperative blood loss in reoperated patients with recurrent inguinal hernia are more than those in patients with incipient inguinal hernia. The rates of seroma on day 1 and 3 are also higher.
ObjectiveTo study the efficacy, the operation skills, and the complications of laparoscopic totally extraperitoneal prosthesis (TEP). MethodsThe clinical data of 1 020 patients received TEP from April 2011 to March 2014 were retrospectively analyzed. The oral feeding time, out of bet time, operation time, hospital stay, hospitalization costs, postoperative complications, and so on were recorded. ResultsAmong the 1 020 patients, the types of hernias were 810 indirect inguinal hernias (including unilateral hernia and bilateral hernia), 118 direct inguinal hernias, 24 femoral hernias, and 68 recurrent inguinal hernias. The surgeries were basically successfully completed in all the patients, including 12 cases (both recurrent hernia) of conversion to laparoscopic transabdominal preperitoneal prosthesis (TAPP). All the patients could take food in a day and get out of bed on day 1 after operation. The unilateral operation time was (48±9.8) min, bilateral was (65±8.6) min. The postoperative hospital stay was 0.5-2.0 d, total hospital stay was (3.48±2.40) d, hospitalization costs was (8 958±1 685) yuan. Main complication was 61 (5.98%) cases of seroma, 48 (4.70%) cases of temporary nerve paresthesia, 23 (2.78%) cases of urinary retention, 9 (0.88%) cases of chronic pain, and 5 (0.49%) cases of abdominal artery injury. No incision infection, visceral injury, small intestinal obstruction, and other serious complications happened. No occurrence occurred with following-up for 1 year. Classification of different hernia complications, the statistical analysis showed that the total incidence of complications of the typeⅣwas highest, then which was in sequence of typeⅢ, typeⅡ, typeⅠ(P < 0.001). ConclusionLaparoscopic TEP is a safe, reasonable repair without tension with small incision, lighter abdominal interference, less pain, early return to normal activities, but it is a difficult technology and has a higher cost.