摘要:目的:探讨老年人梗阻性大肠癌的围手术期处理。方法:回顾性分析2003年至2008年间71例60岁以上老年人梗阻性大肠癌的围手术期处理情况。 结果:术前发现并存病者43例,术中出现并发症19例,术后发生并发症37例得,除5例死亡外,均得到有效控制,死亡原因与并存疾病有关。结论:加强围手术期处理,积极治疗并存疾病,老年人梗阻性大肠癌的治疗同样能取得满意的效果。Abstract: Objective:To study the perioperative measures for the aged patients with Obstructive Colorectal Cancer. Methods: Seventyone cases above 60 years with Obstructive Colorectal Cancer were analysed retrospectively on their individual accompanied diseases and perioperative treatments, from 2003 to 2008.Results: Fortythree cases of them had suffered from other diseases. Midoperative complications occurred in 19 cases. Postoperative complications occurred in 37 cases. Except 5 cases of death, complications occurring in others cases were well controlled. The death causes mainly were correlated with accompanied chronic diseases. Conclusion: Strengthen care, active management of other chronic diseases are important significantly for senile patients with colorectal carcinoma to get satisfied outcome.
Objective To investigate the safety and efficiency of a blood glucose control method in diabetic patients with gastrointestinal neoplasm who were subjected to postoperative early enteral nutrition (EEN). Methods Thirty-seven diabetic patients with gastrointestinal neoplasm received enteral nutriment——Glucerna SR through nasojejunal tubes 24 hours after operation. The blood glucose level was safely controlled through injecting insulin intravenously and subcutaneously. Meanwhile, any change of blood and urine glucose level was monitored and the indexes representing the levels of nutrition, biochemistry and immunity were measured before the implementation of EN, 5 d and 8 d of EN after operation, respectively. Results All the patients were able to bear EEN and there was no severe complications occurred. Significant increase of serum levels of albumin, prealbumin and transferrin were observed after EEN support （P＜0.05）, as well as the serum levels of IgG， IgA and IgM （P＜0.01）. However, body weight， HGB and the serum levels of ALT and TBIL showed no significant changes （Pgt;0.05）. There were 81.1%（30/37） of patients whose blood glucose levels were controlled steadily within the range of (7.8±1.1) mmol/L. Conclusion Injecting insulin intravenously and subcutaneously after operation may be a safe and effective method to control blood glucose level. And the postoperative implementation of EEN can be considered as the first choice of nutrition support for diabetic patients with gastrointestinal neoplasm.
A modified abstructingpressing therapy done on 14 patients with high or low external intestinal fistulas following postoperative infection after abdominal operations was reported. The results showed that high or low external intestinal fistulas could be cured by the combined method of obstruction and compression. This therapy decreased the mortality rate, saved the patients from the risk period and shortened curing course of treatment. Finally the characteristics, the surgical procedure, precautions and advantages of the method were disscussed.
Objective To observe the effect of fresh orange peel flavor inhalation on the improvement of gastrointestinal reactions such as nausea and vomiting in tumor patients during chemotherapy. Methods Ninety-one inpatients undergoing chemotherapy with PF and TP regimens between May 2012 and September 2013 were included in this study. The patients were randomly divided into orange group (n=45) and control group (n=46). Patients in the control group received conventional care, while those in the orange group were treated with fresh orange peel flavor inhalation during chemotherapy. We observed the effect of orange peel flavor inhalation on such gastrointestinal reactions as nausea and vomiting in tumor patients during chemotherapy. Results All the patients completed each cycle of chemotherapy. At the fifth day during chemotherapy, compared with the control group, the incidence rates of grade Ⅲ-Ⅳ gastrointestinal reactions (nausea and vomiting) in the orange group were significantly lower (P=0.023). At the fourth day, when gastrointestinal reactions were the most significant, the food intake of patients in the orange group was significantly higher than that in the control group (P=0.012). During chemotherapy, the addition rate of antiemetic drugs in the orange group was significantly lower than that in the control group (P=0.038). In the orange group, 80.0% of the patients had good self-feeling after orange peel flavor inhalation. Conclusions The study results have shown that fresh orange peel flavor inhalation can effectively improve the gastrointestinal reactions (such as nausea and vomiting), appetite, and degree of comfort in tumor patients during chemotherapy, and reduce the use of antiemetic drugs. This study is of great significance to guide the future research on how to reduce the discomfort of on-chemotherapy patients and provide more comfortable care.
Objective to determine the modulus of elasticity (E) of small intestinal submucosa (SIS), a new biological graft material. Methods The longitudinal tensile testing was performed on 21 specimens of canine jejunum with the electronic material test machine. Results Stress (σ)strain (ε) data were obtained. It was found that the stress (σ)strain (ε) data fitted the expressionσ＝Kεα very well, the mean correlation coefficients R2 was0.991 6.Then the expression of the modulus of elasticity (E) of SIS was E=K1/ασ1-1/α. The mean values of α and K were 3.966 9 and 374.55，so E=4.3992σ0.75. Conclusion The modulus of elasticity was found to increase with increasing stress. The variations law is similar to that of the vessels. Furthermore when σ is 001333 MPa(100 mmHg),E is about 0.16 MPa, which is similar to that of the vessels.
Objective To summarize the imaging manifestation and identification of ectopic pancreas (EP), so as to improve clinicians and radiologists’ knowledge of EP and aid in accurate preoperative diagnosis, thereby reducing the misdiagnosis rate and avoiding unnecessary surgery. Methods Combined with clinical experience and relevant literatures in recent years, the histopathology, common imaging manifestations and main differential diagnosis of ectopic pancreas were summarized. Results EP is a rare congenital developmental anomaly of pancreas, the most common location is the upper digestive system. At present, the commonly used imaging technology is computed tomography. The imaging findings of ectopic pancreas were similar to those of normal pancreas, and its density and enhancement characteristics were related to its histopathological composition. The specific signs of ectopic pancreas include “central umbilical sign” “ductal structure” and “flat/adherent sign”. Heterotopic pancreas should be differentiated from submucosal tumor of gastrointestinal tract. Conclusions The imaging findings of EP have certain characteristics. For some cases with atypical imaging findings, imaging diagnosis is difficult.
【Abstract】ObjectiveTo generally analyze the current situations of clinical research and applications in early enteral nutrition (EEN) after abdominal surgery. MethodsThe published papers about the current situations of clinical research and applications in EEN after abdominal surgery were reviewed. ResultsEEN after abdominal surgery seems to be safe and effective, produces a positive nitrogen balance, keeps the integrality of structure and function of the apparatus, protects gut barrier, and reduces or prevents septic complications. ConclusionEEN may be of more benefits and will be one of the best methods of nutrition support after abdominal surgery.
Objective To investigate the changes of gastrointestinal hormone and body composition in patients with gastric cancer after gastrectomy. Methods Thirty-eight patients with gastric cancer were divided into three groups: distal gastrectomy group, proximal gastrectomy group and total gastrectomy group and 9 volunteers as control group. The nutrition status and gastrointestinal function were evaluated by four times. The time of postoperative first anal exsufflation and defacation, hospital stay and complications were recorded, and the pre-meal and the post-meal level of gastrointestinal hormones 1 month after operation were detected. Results Compared with control group, the basic levels of somatostatin (SS), cholecystokinin (CCK) and motilin (MTL) of distal gastrectomy group, proximal gastrectomy group and total gastrectomy group significantly increased (Plt;0.01). The post-meal level of gastrointestinal hormones significantly increased as compared with the pre-meal level in each group (Plt;0.01). The CCK in proximal gastrectomy group was lower than that of distal gastrectomy group and total gastrectomy group (Plt;0.01). The postoperative body weight and body composition in each group decreased. One month after operation, patients of total gastrectomy group got the lowest body weight (Plt;0.01). The decreasing level of fat free mass (FFM) was listed by total gastrectomy group, proximal gastrectomy group and distal gastrectomy group. The edema index had significant difference in distal gastrectomy group, proximal gastrectomy group and total gastrectomy group (Plt;0.01), and total gastrectomy group was the most obvious. The postoperative passing flatus and defecation time and average hospital stay in total gastrectomy group were significantly prolonged (Plt;0.05). The gastrointestinal symptoms score among three groups was significantly different (Plt;0.05). Conclusion There are different changes of gastrointestinal hormone and body composition in patients with gastric cancer after different gastrectomy, the basic levels of SS, CCK and MTL of distal gastrectomy group, proximal gastrectomy group and total gastrectomy group are higher than those of control group. The CCK of proximal gastrectomy group is lower than that of distal gastrectomy group and total gastrectomy group. Patients received total gastrectomy lose much body weight and FFM and get higher edema index.
Objective To make clear the effect of gastrointestinal tract ischemia on multiple organ dysfunction syndrome (MODS). Methods The literature in the recent years was reviewed.Results The low-flow states of gastrointestinal tract and decrease of gastrointestinal intramucosal pH, which occured following a variety of insults (sever trauma, hemorrhagic shock, et al), as well as overgrowth of enterobacteria, may result in a significant increase of permeability of bowel and lead to endotoxemia and bacterial translocation. Ischemia also resulted in release of TNF, IL-6 into the systemic circulation, dysfunction of gastrointestinal tract motility, and activation of neutrophile which was integral in local and distant organ damage. Conclusion These data suggest that the management of correct ischemia of gastrointestinal tract, which include fluid infusion to replacement of blood volume, early enteral nutrition, improvement of gastrointestinal movement, could contribute to improve the intestinal barrier function, and prevent the development of MODS.
ObjectiveTo summarize the pathogenesis and epidemiology features of gastrointestinal stromal tumor(GIST), explore its diagnosis and therapy, and analyze its prognosis. MethodThe pertinent literatures about the pathogenesis, epidemiology features, diagnosis, therapy, and prognosis of GIST in recent years were reviewed. ResultsGIST was non-epithelial tumor which derived from interstitial cells of Cajal, was the most common mesenchymal tumor about accounting for 1%-3% in the digestive tract tumor. The median onset age of patients with GIST was 40-60 years. The gastric stromal tumor was about 60% in all the digestive tract tumor. The current consensus statement was that there was a relation between the pathogenesis of the GIST and proto-oncogene c-kit or platelet-derived growth factor receptor alpha(PDGFRα)gene mutation. But the mutations of PDGFRαand c-kit gene did not emerge at the same time in the same patient. The clinical manifestations of GIST were not specific, and the diagnosis mainly depended on endoscope and image technology, the correct diagnosis depended on pathological examination. The treatment of GIST was given priority of surgery and molecular targeted drug therapy, and the prognosis was closely related to risk assessment stratify of GIST. ConclusionsGISTs are mesenchymal tumors that has a potential of malignant transformation, the risk classification criteria for aggressive clinical course of primary GIST is an important indication for guiding the clinical therapy and prognostic evaluation. Further research would be needed in prevention, diagnosis, treatment, and relapse prevention of GIST.