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.
ObjectiveTo investigate the relationship of epithelial mesenchymal transition (EMT) related proteins expressions in invasive ductal carcinoma of breast to its clinicopathologic features and prognosis. MethodsThe expressions of EMT related proteins (Vimentin, E-cadherin, and MMP2) in the 118 cases of invasive ductal carcinoma of breast and 30 cases of corresponding normal breast tissues adjacent to cancer were detected by immunohistochemistry. The relationship of EMT related proteins expressions to age, tumor site, tumor size, lymph node metastasis, histological grade, TNM stage or prognosis of the patients with invasive ductal carcinoma of breast was analyzed. Results①The positive rates of the Vimentin protein and MMP2 protein in the invasive ductal carcinoma of breast were significantly higher than those in the corresponding normal breast tissues adjacent to cancer﹝Vimentin protein: 50.8% (60/118) versus 10.0% (3/30), P < 0.05; MMP2 protein: 63.6% (75/118) versus 6.7% (2/30), P < 0.05﹞, the positive rate of E-cadherin in the invasive ductal carcinoma of breast was significantly lower than that in the corresponding normal breast tissues adjacent to cancer ﹝56.8% (67/118) versus 93.3% (28/30), P < 0.05﹞.②The positive rate of the Vimentin protein expression in the invasive ductal carcinoma tissue was positively related with the lymph node metastasis and TNM staging (rs=0.346, P < 0.05; rs=0.231, P < 0.05). The positive rate of the E-cadherin or MMP2 protein expression was negatively or positively related with the tumor size, lymph node metastasis, histological grade, and TNM stage (E-cadherin: rs=-0.444, P < 0.05; rs=-0.493, P < 0.05; rs=-0.323, P < 0.05; rs=-0.474, P < 0.05. MMP2: rs=0.361, P < 0.05; rs=0.434, P < 0.05; rs=0.396, P < 0.05; rs=0.376, P < 0.05).③The Kaplan-Meier survival curve analysis showed that the positive expressions of Vimentin and MMP2 were stronger, the tumor free survival time was shorter (P < 0.05), and the positive expression of E-cadherin was stronger, the tumor free survival time was longer (P < 0.05). ConclusionJoint detection of EMT related proteins (Vimentin, E-cadherin, MMP2) of invasive ductal carcinoma tissue of breast could predict the pathological grade and clinical stage, as well as effective prognosis of patients with invasive ductal carcinoma of breast in clinical.
ObjectiveTo explore the curative effect and value of laparoscopic operation in the treatment of acute gangrenous and perforated appendicitis. MethodsThe clinical data of 243 patients with acute gangrenous and perforated appendicitis from February 2011 to February 2014 in our hospital were retrospectively analyzed. Laparoscopic appendectomy was performed in 118 cases (LA group), and open appendectomy was performed in 125 cases (OA group). The operative time, hospital stay, hospital costs, incision bleeding, gastrointestinal function recovery, wound infection, pelvic abscess, and postoperative adhesions of two groups were compared. ResultsThere was no significant difference in the operative time, incision bleeding, and the incidence of pelvic abscess after operation between the LA group and OA group (P>0.05). Compared with the OA group, the recovery time of gastrointestinal function was significantly shortened (P<0.01), eating time was earlier (P<0.01), hospitalization time also shortened significantly (P<0.01), and the incidence of postoperative wound infection and intestinal adhesion were significantly decreased (P<0.01) after operation in LA group. But the cost of hospitalization in LA group increased significantly (P<0.05). ConclusionsThe laparoscopic operation in the treatment of gangrenous and perforated appendicitis are light of pain., recover quickly, shorter of hospital stay, and fewer complications. The increase of hospitalization expenses is the only deficiency.
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.