【Abstract】Objective To investigate the irradiating effect of low intensive microwave (LIM) on pathological process of blood vessel restenosis(RS) and assess the probability of LIM irradiation to prevent was used RS.Methods Fortyfour male healthy New Zealand rabbits were randomly divided into 2 groups. Fogarty catheter traumatize to the tunica intima of iliac artery so as to establish RS models. Two thousand four hundred and fifty MHz microwave with different power of 2 ,5 and 10 mW/cm2 was used, locally to irradiate EIA in irradiating group (1 h/d). Specimens were obtained at different time of 3,7,14 and 28 d after operation. Morphological changes of tissues were observed with HE and EF staining and the area of tunica intima, tunica media and the rate of cavity stenosis were analyzed with image analysis system; apoptosis was detected with TUNEL; phenotype and microstructure of VSMC were observed with TEM. Results After microwave irradiating, inflammatory reaction in early period was suppressed, mural thrombus decreased, the proliferation and migration of VSMC depressed, the area of tunica intima and the rate of cavity stenosis obviously reduced comparing with the control group (P＜0.01). The rate of apoptosis cells showed that there were no obvious differences among each group on 3 d after operation (Pgt;0.05). At other different time, however, the rate of apoptosis cells in irradiating groups obviously increased than that of the control group (P＜0.01), particularly in the one with power of 5 mW/cm2 .The number of synthesis form VSMC in the control group occupied (93.50±3.45)% of the total number of VSMC on 14 d after operation. Most of VSMC appear contractile in irradiating group in which a lot of morphological changes of apoptosis in fibroblast and VSMC existed.Conclusion LIM irradiation could obviously prevented from pathologic procedure of RS. After LIM irradiating, inflammatory reaction in early period is suppressed, the proliferation and migration of VSMC depressed. LIM irradiation promotes cell apoptosis, effectively prohibites the occurring and development of RS. LIM irradiation has had relationship between quantity and effect, power span to effectively prohibit RS, particularly in the one with power of 5 mW/cm2.
【摘要】 目的 评价在鼻烟壶及腕部行动静脉造瘘术的疗效。 方法 将2007年6月-2009年6月收治的156例肾功能衰竭患者随机分成两组，分别在鼻烟壶及腕部行动静脉造瘘术，术后经彩色超声随访其吻合口通畅情况，临床观察瘘管使用时间及其并发症。 结果 术后随访2年，鼻烟壶处行动静脉造瘘术的患者，瘘管术后1年初级通畅率及累积次级通畅率分别为76.9%、92.1%；术后2年初级通畅率及累积次级通畅率分别为57.9%、78.9%。而腕部组瘘管1年初级通畅率及累积次级通畅率分别为64.1%、81.3%；术后2年初级通畅率及累积次级通畅率分别为56.0%、76.0%。两组在术后1年初级通畅率及累积次级通畅率差异有统计学意义（Plt;0.01），术后2年初级通畅率及累积次级通畅率差异无统计学意义（Pgt;0.05）。 结论 鼻烟壶处行动静脉造瘘术的瘘管在短期内通畅率较腕部高，长期并无显著性差异。【Abstract】 Objective To evaluate the effect of artificial arteriovenous fistula between tabatiere anatomique and wrist. Methods From June 2007 to June 2009, 156 cases of renal failure were randomly divided into two groups, and underwent artificial arteriovenous fistula on tabatiere anatomique or wrist, respectively. The patency of the anastomotic stoma was observed via B ultrasonography. Results The patients were followed up for two years postoperative. After the operation, the primary patency was 76.9% at the first year and 57.9% at the second year in tabatiere anatomique group; cumulative secondary patency was 92.1% at the first year and 78.9% at the second in tabatiere anatomique group; primary patency was 64.1% at the first year and 56.0% at the second in wrist group; cumulative secondary patency was 81.3% at the first year and 76.0% at the second year in wrist group. The primary patency and cumulative secondary patency were significantly different between tabatiere anatomique group and wrist group at the first year postoperatively (Plt;0.01) and not significant at the second year postoperatively (Pgt;0.05). Conclusion Prophase patency of tabatiere anatomique is higher than that of wrist. There was no significant difference between them in a long term.
Objective To compare the immediate therapeutic effects between endovenous laser treatment and conventional surgery for lower extremity varicosity. Methods Data of 350 limbs of 275 patients treated by endovenous laser treatment (endovenous laser treatment group) and 310 limbs of 210 patients by traditional surgery (traditional surgery group) were analyzed and compared in terms of operation time, number of the incision, postoperative pain, complications, postoperative hospitalized duration and 1-year recurrence rate. Results Endovenous laser treatment group had shorter operation time, fewer incisions, less postoperative pain and shorter postoperative hospitalized duration than traditional surgery group (Plt;0.05). The complications and 1-year recurrence rate had no significant differences between two groups (Pgt;0.05). Conclusion As a safe and effective new treatment for lower extremity varicosity with minimal invasiveness and no left scars, endovenous laser treatment has the potential to replace conventional surgery and extend the surgical indications for lower extremity varicosity treatment.
Objective To evaluate the effectiveness and safety of early enteral nutrition (EN) versus total parenteral nutrition (TPN) after pancreaticoduodenectomy (PD). Methods Such databases as MEDLINE, EMbase, The Cochrane Library, CBM, VIP, CNKI were electronically searched to collect the randomized controlled trials (RCTs) about EN versus TPN after PD published from 2000 to March 2010. The quality of the included trials was assessed according to the inclusive and exclusive criteria, and the data were extracted and analyzed by using RevMan 5.0 software. Results A total of 4 RCTs involving 322 PD patients were included. The meta-analysis showed that the EN (the treatment group) was superior to the TPN (the control group) in the average postoperative hospital stay (MD= –2.34, 95%CI –3.91 to –0.77, Plt;0.05), the total incidence rate of complication (RR=0.75, 95%CI 0.57 to 0.99, P=0.04), the recovery time of enterocinesia (MD= –29.87, 95%CI –33.01 to –26.73, Plt;0.05) and the nutrition costs (MD= –30.51, 95%CI –35.78 to –25.24, Plt;0.05); there were no differences in mortality (RR=0.23, 95%CI 0.03 to 2.03, P=0.19), pancreatic leakage (RR=0.78, 95%CI 0.45 to 1.35, P=0.38), infectious complications (RR=0.71, 95%CI 0.43 to 1.18, P=0.19), non-infectious complications (RR=0.78, 95%CI 0.5 1 to 1.20, P=0.26) and postoperative serum albumin level (MD= –0.79, 95%CI –2.84 to 1.27, P=0.45). Conclusion Compared with total parenteral nutrition, the enteral nutrition used earlier after pancreatoduodenectomy shows significant advantages. But more reasonably-designed and double blind RCTs with large scale are expected to provide high quality proof.
ObjectiveTo compare the short- and long-term efficacy of artery-first approach pancreatico-duodenectomy (AF-PD) and standard approach pancreaticoduodenectomy (S-PD).MethodsThe PubMed, EMbase, The Cochrane Library, Web of Science, CBM, WanFang, and CNKI databases were searched, relevant literatures were included, and relevant data were extracted for meta-analysis.ResultsA total of 30 articles were included, including 2 750 cases underwent pancreaticoduodenectomy. The results of meta-analysis showed that in terms of short-term efficacy when compared with S-PD group, the AF-PD group had less intraoperative blood loss (WMD=–175.87, P<0.001), lower intraoperative blood transfusion rate (OR=0.36, P=0.002), higher R0 resection rate (OR=1.83, P<0.001), lower postoperative pancreatic leakage rate (OR=0.71, P=0.005), and shorter postoperative hospital stay (WMD=–2.69, P=0.007). However, there were no statistically significant differences in the operation time and overall postoperative complication rate between the two groups (P>0.05). In terms of long-term efficacy when compared with S-PD group, the AF-PD group had lower tumor local recurrence rate (OR=0.43, P=0.004) and tumor liver metastasis rate (OR=0.60, P=0.010), but had higher 1-year (OR=1.95, P=0.007), 2-year (OR=2.04, P<0.001), 3-year (OR=2.09, P=0.001), and 5-year (OR=2.06, P=0.003) overall survival rates, and there were no significant differences in the rates of lung metastasis and peritoneal metastasis between the two groups (P>0.05).ConclusionsAF-PD is better than S-PD in some short-term and long-term outcome indicators such as R0 resection rate, pancreatic leakage rate, overall survival rate, and so on. However, due to the limited quality of the included literatures, more high-quality studies are still needed to verify in the future.
Objective To investigate the application effect of LEER (less pain, early move, early eat, and reassuring) mode in laparoscopic pancreaticoduodenectomy (LPD). Methods The clinical data of patients who underwent LPD in our hospital from March 2020 to March 2022 were retrospectively analyzed. Forty patients treated with the traditional mode during the perioperative period were classified as the traditional group, and 47 patients treated with the LEER mode were classified as the LEER group. The perioperative indicators, inflammatory stress indicators, immune indicators, nutritional indicators and postoperative complications were compared between the two groups. Results The visual analogue scale (VAS) score and hospitalization cost of the LEER group were lower than those of the traditional group (P<0.05). The postoperative ambulation time, anal exhaust/defecation time, drainage tube removal time, time to normal diet and hospital stay in the LEER group were shorter than those of the traditional group (P<0.05). Compared with preoperative, the WBC count and C-reactive protein (CRP) level of patients in the two groups increased after operation, but the changes of WBC count and CRP level in the LEER group were smaller than those in the traditional group (P<0.05). The IgA, IgM and IgG levels of patients in the two groups were not statistically different before and after operation (P>0.05), and the postoperative IgA, IgM and IgG of patients in the LEER group were higher than those in the traditional group (P<0.05). The change values of IgM and IgG in the LEER group were smaller than those of the traditional group (P<0.05), but there was no statistical difference in the change value of IgA between the two groups before and after operation (P>0.05). Compared with preoperative value, postoperative prealbumin (PA) and lymphocyte (LYM) levels in the two groups were decreased (P<0.05). The postoperative PA and LYM levels in the LEER group were higher than those in the traditional group (P<0.05). but the change value of PA before and after operation in the LEER group was smaller than that in the traditional group (P<0.05). There was no statistical difference in the change of LYM between the two groups before and after operation (P>0.05). The incidence of postoperative complications in the LEER group was 8.5% (4/47), and that in the traditional group was 35.0% (14/40). The incidence of postoperative complication in the LEER group was significantly lower than that in the traditional group (P=0.002). Conclusion Applying LEER mode in LPD can promote postoperative recovery of the patients, reduce postoperative stress response, improve nutritional status and protect immunity in the patients.
ObjectiveThis meta-analysis aimed to systematically evaluate the feasibility and the safety of total laparoscopic pancreatoduodenectomy (TLPD) by comparing it with open pancreatoduodenectomy (OPD).MethodsWe searched the relative domestic and international data bases systematically, such as the Cochrane Library, Medline Database, SCI, CBM, VIP-data, CNKI-data, and WanFang Data. We selected case control studies or cohort studies, and used the Review Manager 5.3 to perform statistical analysis.ResultsIn total, thirteen single-center retrospective case-control studies were included, totally 808 patients involved, and there were 401 cases in the TLPD group and 407 cases in the OPD group. There were no significant difference in terms of the cumulative morbidity, incidence of the Clavien Ⅲ-Ⅴ complication, pancreatic fistula, B/C pancreatic fistula, biliary fistula, postoperative hemorrhage, pulmonary infection, and gastric emptying delay, as well as the ratio of secondary operation, mortality of perioperative period, the ration of R0 resection, and the number of lymph nodes dissected between the 2 groups (P>0.05). Although the operative time was significant longer, TLPD had significant superiority in terms of the amount of bleeding and blood transfusion during operation, the hospital stays after operation, the bowel function recovery time, the time to restart eating, and the time to reactivate (P<0.05).ConclusionIn terms of the relative complications and the parameters of oncology such as the ration of R0 resection, the number of lymph nodes dissected, both of the procedures are safe and feasible, while TLPD is more favorable to control operative bleeding and accelerate rehabilitation.
ObjectiveTo evaluate the short-term effectiveness of robotic distal pancreatectomy (RDP) and laparoscopic distal pancreatectomy (LDP) by meta-analysis.MethodsWe searched for manuscripts about RDP versus LDP form PubMed, The Cochrane Library, EMbase, CKNI, CBM, and WanFang Databases. The parallel quality assessment was selected according to the literature inclusion and exclusion criteria. Relevant data were extracted and meta-analysis was performed by using Revman 5.3 software.ResultsA total of 23 articles were included, and a total of3 487 patients enrolled who underwent pancreatic body resection. Meta-analysis results showed that compared with the LDP group, the RDP group had a longer operation time [MD=15.52, 95%CI was (0.60, 30.45), P=0.04], but the intraoperative blood loss was less [MD=–59.18, 95%CI was (–111.62, –6.73), P=0.03], the intraoperative spleen preservation rate was higher [OR=1.74, 95%CI was (1.02, 2.96), P=0.04], the intraoperative conversion to open rate was lower [ OR=0.45, 95%CI was (0.34, 0.60), P<0.000 01], and postoperative hospital stay was shorter [MD=–0.90, 95%CI was (–1.70, –0.10), P=0.03], while there were no significant differences in intraoperative blood transfusion rate [OR=0.88, 95%CI was (0.60, 1.30), P=0.52], incidence of postoperative overall complication [OR=0.88, 95%CI was (0.68, 1.13), P=0.32] and pancreatic leakage [OR=0.91, 95%CI was (0.72, 1.14), P=0.41], 90-day readmission rate [OR=1.32, 95%CI was (0.95, 1.83), P=0.10], and 90-day reoperation rate [OR=0.73, 95%CI was (0.40, 1.33), P=0.30].ConclusionsRDP has the advantages of less bleeding, low turnover rate, and short postoperative hospital stay. However, due to the quality limitations of the included studies, the above conclusions still need to be verified by more high-quality studies.
ObjectiveTo explore the clinical value and experience of enhanced recovery after surgery (ERAS) of “LEER” model with “less pain” “early move” “early eat” and “reassuring” as its ultimate goal in perioperative period of laparoscopic anatomical hepatectomy of patients with primary liver cancer.MethodsThe basic clinical data of 98 patients treated in our department from May 2017 to March 2020 who were diagnosed as primary liver cancer and underwent laparoscopic anatomical hepatectomy were retrospectively analyzed. The incidence of postoperative complications, postoperative recovery and patients’ satisfaction were compared between 40 patients managed with traditional model (traditional group) and 58 patients managed with measures of ERAS of “LEER” model (“LEER”-ERAS group).ResultsCompared with the traditional group, the “LEER”-ERAS group had lower postoperative pain scores (t=2.925, P=0.004), earlier postoperative anal exhaustion, bowel movement and normal diet (t=3.071, t=3.770, t=3.232, all P<0.005) , shorter time to postoperative off-bed activity (t=5.025, P<0.001) and earlier postoperative removal time of drainage tube (t=3.232, P=0.001). Postoperative hospital stay was shorter (t=4.831, P<0.001), the cost of hospitalization was lower (t=3.062, P=0.003), and the patient’s satisfaction with medical treatment was higher (χ2=9.267, P=0.002). There were no statistical difference in the operative time, intraoperative blood loss, rate of conversion to laparotomy, blocking time of porta hepatis, postoperative complications and postoperative adverse events between the two groups (P>0.05).ConclusionsCompared with the traditional model, the measures of ERAS of “LEER” model that applied to laparoscopic anatomical hepatectomy of patients with primary liver cancer, is safe and effective, and can relieve postoperative pain, accelerate postoperative rehabilitation, improve satisfaction of patients, shorten hospital stay, and reduce medical costs. It has further promotion and research value.
Objective To investigate the value of multidisciplinary team (MDT) diagnosis and treatment model in the conversion therapy of liver cancer. Method The clinical data of a patient with high-risk giant liver cancer of the right liver who was admitted to People’s Hospital of Leshan in April 2019, and who was successfully conversion therapy and safely underwent hepatectomy after MDT discussion was retrospectively analyzed. Results A 62 years old male patient was admitted to our hospital with “abdominal distension for more than 1 month, and liver mass was found for 10 days”. The relevant auxiliary examinations were perfected. The patient was diagnosed as huge primary hepatocellular carcinoma in the right liver. One-stage surgical resection cannot be performed safely due to the huge tumor. After MDT discussion, transcatheter arterial chemoembolization (TACE) combined with sorafenib targeted therapy was decided to reduce the lesions, and two-stage surgical resection was performed safely after conversion therapy. After two cycles of TACE combined with sorafenib targeted drug therapy, MDT discussed the feasibility of safe surgical resection, and underwent fluorescence-guided laparoscopic right posterior lobectomy. The postoperative pathological examination revealed moderately differentiated hepatocellular carcinoma. The patient recovered and was discharged from the hospital one week later. Outpatient followed-up for 32 months showed no obvious abnormality. Conclusions MDT discussion can formulate a more individualized treatment plan, improve the conversion rate and resectable rate of advanced liver cancer, and has important value in the diagnosis and treatment of advanced liver cancer.