Objective To investigate the detection of peritoneal free cancer cells and its clinical significance. Methods The peritoneal free cancer cells, the positive rates of CK20 protein and CK20 mRNA expressions of peritoneal lavage fluid were detected by peritoneal lavage cytology (PLC), flow cytometry (FCM) and real-time fluorescent quantitative RT-PCR in 50 cases of gastric cancer patients, respectively. The sensitivity of three kinds of detection method to peritoneal free cancer cells was compared. Results The positive rates of peritoneal free cancer cells, CK20 protein and mRNA expression of peritoneal lavage fluid were 20.0% (10/50), 36.0% (18/50) and 58.0% (29/50), respectively. The positive rate of CK20 mRNA expression detected by real-time fluorescencequantitative RT-PCR in peritoneal lavage fluid was significantly higher than those of the CK20 protein expression detected by FCM and peritoneal free cancer cells detected by PLC (Plt;0.05 or Plt;0.001). The difference of positive rate of CK20 protein expression and peritoneal free cancer cells was not significant (Pgt;0.05). The positive rate of CK20 mRNA expression of peritoneal lavage fluid was related to the tumor invasion depth, differentiation degree, TNM stage, and lymph node metastasis (Plt;0.05). Conclusion Real-time fluorescence quantitative RT-PCR is an effective method for the detection of peritoneal free cancer cells.
ObjectiveTo investigate the clinical efficacy and short-term complications of total laparoscopic distal gastrectomy, which adopting Billroth Ⅱ combining with Braun anastomosis. MethodsClinical data of 186 cases of distal gastric cancer who underwent total laparoscopic distal gastrectomy in our hospital from June 2012 to June 2014, including 86 cases who adopted Billroth Ⅱ combining with Braun anastomosis, and 100 cases who adopted Billroth Ⅱ anastomosis. The clinical efficacy was compared between these two groups. ResultsThere was no significant difference in the opera-tion time, digestive tract reconstruction time, intraoperative blood loss, postoperative exhaust time, and hospital stay (P>0.05). However, compared with Billroth Ⅱ anastomosis group, the incidence rates of alkaline reflux gastritis, duodenal fistula, anastomositis, and postsurgical gastroparesis syndrome were lower in Billroth Ⅱ combining with Braun anastomosis group (P<0.05). ConclusionThe application of Billroth Ⅱ combining with Braun anastomosis in total laparoscopic distal gastrectomy could reduce the incidence rates of alkaline reflux gastritis, duodenal fistula, anastomositis, and postsur-gical gastroparesis syndrome, and it is an ideal operation method to improve the quality of life for gastric cancer patients.
Objective To use a meta-analytic technique to estimate the survival of implants between immediate loading/early loading and delayed loading. Methods We carried out a systematic search of electronic databases for all prospective trials comparing conventional delayed implant loading with early or immediate implant loading, reported between 1997 and 2007. The outcome of interest was implant failure rate. Quality assessment was performed for prospective trials that met the eligibility criteria and the data were then extracted and analyzed. Results Sixteen articles were found to meet the eligibility criteria, but two studies were reported in four articles, so that 14 articles were analyzed. There were five randomized controlled trials (RCTs). Compared to delayed loading, implant failure occurred sl ightly, but not statistically significant,less often with early implant loading (OR=0.54, 95%CI 0.22 to 1.33, P =0.18). We combined all cohort studies and this analysis was consistent with this result. Immediate implant loading was associated with slightly, but not statistically significant, worse outcomes (OR=1.51, 95%CI 0.53 to 4.25, P =0.44). We only pooled the RCTs and results showed better implant success rate with immediate implant loading, but with no significant difference. When sensitivity analyses were performed by the sequential dropping of a single study, no significant differences were observed except when the study of Jo et al was excluded. Conclusion Early implant loading was associated with better outcomes compared to delayed loading when the implants were placed into good quality bone. There was no significant difference of the implant success rate between immediate loading and delayed loading. Further evaluations in adequately powered large RCTs are needed to confirm these findings.
ObjectiveTo investigate effect of laparoscopic radical gastrectomy on gastrointestinal motility and gastrointestinal hormones in patients with gastric cancer. MethodsTwo hundred and eighty-nine patients who underwent laparoscopic radical gastrectomy from December 2013 to December 2015 were selected as observation group, 325 patients underwent laparotomy radical gastrectomy during the same period were selected as control group. The postoperative bowel sounds recovery time, the first anal exhaust time, and gastrin, motilin and vasoactive intestinal peptide levels in blood at 12 h before operation and at 24 h after operation were compared between these two groups. ResultsThe baselines had no significant differences between these two groups (P > 0.05). The postoperative bowel sounds recovery time and the first anal exhaust time in the observation group were significantly shorter than those in the control group (P < 0.05). Compared with the levels at 12 h before operation, the gastrin and motilin levels were significantly decreased and the vasoactive intestinal peptide level was significantly increased at 24 h after operation in these two groups (P < 0.05); Compared with the control group, the gastrin and motilin levels at 24 h after operation were significantly increased (P < 0.05) and the vasoactive intestinal peptide level was significantly decreased in the observation group (P < 0.05). ConclusionsPostoperative gastrointestinal motility recovery time in patients undergoing laparoscopic radical gastrectomy is significantly faster than that of laparotomy radical gastrectomy. There is a certain relation between gastrin, motilin or vasoactive intestinal peptide change and operation mode, it might be one of mechanisms of faster recovery of gastrointestinal motility after laparoscopic radical gastrectomy for gastric cancer.
ObjectiveTo observe the efficiency of endovenous laser therapy combined with planning sucking operation in the treatment of great saphenous varicose veins. MethodsTotally 48 patients (60 limbs) were treated from May 2011 to May 2014 in general surgery department of our hospital. The main trunk of great saphenous vein was ablated by endovenous laser treatment; and the varicose veins in calf were resected by planning sucking operation. ResultsAll 48 patients (60 limbs) were cured without recurrent during 6-36 months followed-up. The operative time of each side was 18-43 min, the average operative time was 22.6 min; with 1-3 skin incisions. Hospital stay was 5-8 d, the average hospitalization time was 6.7 d. After operation, the varicose veins and the felling of swelling were disappeared, the pigmentation was reduced or disappeared. Local skin numbness showed in 6 cases and recovered in 3-7 months after operation. Felling of burns appeared in 2 cases, and was healed after treatment. Ankle swelling presented in 5 cases, and released in 6-13 d with related treatment. Different degree of subcutaneous bruising appeared without any hematoma, and recovered in 2-4 weeks. Two cases were lost during the followed-up. ConclusionsEndovenous laser therapy combined with planning sucking operation is safe and effective in the treatment of great saphenous varicose. It is worthy of promotion with minimum damage, less pain, fast recovery, no scars, shorter operative time, and shorter hospital stay.
ObjectiveTo investigate safety and feasibility of early oral feeding after laparoscopic radical distal gastrectomy. MethodsOne hundred and fifty patients with gastric cancer admitted to hospital from May 2015 to Feb-ruary 2016 were divided into early oral feeding (EOF) group and traditional feeding (TF) group by a randomized contro-lled way. The relevant postoperative indicators, including postoperative complications (wound infection, inflammatory intestinal obstruction, anastomotic leakage, pulmonary infection, gastric retention), feeding tolerance (nausea, vomiting, and reinserting of gastric tube), nutritional status (serum albumin, prealbumin), immune function (IgA, IgG, IgM), recovery of gastrointestinal function (postoperative the first anal exhaust time and defecation time), hospitalization time, and hospitalization expenses, were observed and analyzed. Results① One hundred and thirty-nine patients were included in this study, there were 72 cases in the EOF group, 67 cases in the TF group. The gender, age, boby mass index, etc. had no statistic significances between these two groups (P>0.05). ② All the patients of the two groups were cured and discharged, no patients died during perioperative period. The postoperative the first anal exhaust time, defecation time, and hospitalization time of the EOF group were significantly less than those of the TF group (P<0.05). The operative time, intraoperative blood loss, and postoperative hospitalization expenses had no significant differences between these two groups (P>0.05).③ The levels of serum albumin, prealbumin, and IgA on day 7 after operation in the EOF group were significantly higher than those in the TF group (P<0.05). The levels of IgG and IgM on day 7 after operation had no significant differences between these two groups (P>0.05). ④The tolerance rates of oral feeding of the EOF group and TF group patients was 91.7% (66/72) and 94.0% (63/67) respectively, the difference was not statistically significant (χ2=0.044, P=0.833). While 2 patients needed to be inserted gastric tube again due to nausea and abdominal distention in the EOF group, the symptoms were cured with conservative treatment about 3 d.⑤ The postoperative complications of the EOF group were 10 cases, TF group were 10 cases, the difference was not statistically significant (χ2=0.173, P=0.677). And postoperative complications were cured and discharged after active conservative treatment. Postoperative follow-up of 102 (102/139) cases were completed, follow-up time was 1-6 months, no patients admitted to hospital again for postopera-tive complications. ConclusionEarly oral feeding after laparoscopic radical distal gastrectomy is safe and feasible, which don't only increase incidence of complications, but also improve nutritional status of patients, and promote recoveries of immune function and intestinal function, and shorten postoperative hospitalization time.
ObjectiveTo explore the clinical efficacy and application significance of continuous irrigation and drainage for intestinal fistula combined with abdominal infection.MethodsClinical data of 62 patients with intestinafistula combined with abdominal infection admitted by Department of General Surgery of The 940th Hospital of The People’s Liberation Army Joint Service Support Force from March 2012 to March 2017 were retrospectively analyzed. All patients were treated with continuous abdominal flushing and drainage after emergency surgery. The duration of peritoneal flushing, antibiotic use, blood picture recovery, fistula healing, and total hospitalization were summarized.ResultsAll 62 patients were treated successfully without death or septic shock. Among them, 49 cases of intestinal fistula were treated with continuous abdominal flushing and drainage, and 13 cases of intestinal fistula were treated by continuous flushing and drainage of the abdominal cavity. There were 6 cases of abdominal abscess, 5 cases of incision infection, 5 cases of pleural effusion, and 2 cases of pulmonary infection after surgery. The continuous abdominal cavity washing time was (45±21) d, antibiotic use time was (14±7) d, blood image recovery time was (16±8) d, the healing time of fistula was (47±24) d, total length of hospital stay was (56±27) d.ConclusionsFor intestinal fistula combined with abdominal cavity infection, peritoneal continuous flushing and drainage is related with curative effect, high cure rate, fewer complications, simple washing equipment, simple technology, lower cost, and convenient nursing, which can create a good condition for the complexity or refractory patients with intestinal fistula, and has a high clinical application significance.
ObjectiveTo detect level of circulating tumor cells (CTCs) in peripheral venous blood of fasting patients with gastric cancer (GC) and to analyze relationships between CTCs and clinicopathologic features and prognosis of patients with GC.MethodsOne hundred patients with GC were selected (GC group), who underwent the surgery and confirmed by the histopathology in the 940 Hospital of Joint Service of PLA, from August 2015 to December 2016. Thirty-eight patients with gastric benign lesions who were treated in this hospital at the same time were selected as the control group. The 7 mL peripheral venous blood of the elbow in the morning was taken from the fasting patients and the CTCs were detected by the immunomagnetic microparticle negative enrichment combined with immunofluorescence in situ hybridization within 24 h. The positive rate of CTCs was calculated and its relationships with the clinicopathologic features (tumor location, tumor invasion depth, degree of differentiation, TNM stage, lymph node metastasis, and vascular tumor thrombus) and the progression-free survival of the patients with GC were analyzed.ResultsThe positive rate of peripheral venous blood CTCs in the GC group was 89.0% (89/100), which was higher than that in the control group (10.5%, 4/38), and the difference was statistically significant (P<0.001). The levels of CTCs in the patients with GC were significantly correlated with the tumor invasion depth (P=0.017), lymph node metastasis (P=0.038), and TNM stage (P=0.016), which were not associated with the age, gender, tumor location, degree of differentiation, and vascular tumor thrombus (P>0.050). The predictive value of CTCs for the diagnosis of GC was significantly superior to that of the tumor markers CEA, CA19-9, or CA125. The progression-free survival of patients with low CTCs expression was significantly longer than that in the patients with high CTCs expression (χ2=5.172, P=0.023).ConclusionsDetecting CTCs of patients with GC by immunomagnetic particle negative enrichment combined with immunofluorescence in situ hybridization has a high sensitivity. And it can improve early diagnosis of patients with GC. Preoperative CTCs detection has a certain value in guiding staging of GC and predicting prognosis of patients with GC.