Objective To evaluate the curative effectiveness and safety of prophylactic chemohyperthermic peritoneal perfusion (CHPP) during the radical surgery of advancing gastric cancer. Methods We searched MEDLINE (1980 to December 2002), EMBASE (1989 to December 2002), BIOSIS Previews (1980 to December 2002), Cochrane Controlled Trials Register (Issue 4, 2003) and CBMdisc (1981 to December 2002). Randomized or quasi-randomized controlled trials comparing curative gastrectomy (CG) plus CHPP with CG for advancing gastric cancer were collected. The methodological quality of included studies was assessed, and a meta-analysis was performed by RevMan 4.2 software. Results Seven RCTs involving 744 patients met the selection criteria, all trials were of lower methodological quality. ① Meta-analysis results showed that no significant difference was found comparing CG plus CDDP (cisplatin) with CG for peritoneal recurrence after operation (The pooled OR 0.69，95%CI 0.43 to 1.12). Compared with CG alone, CG plus CDDP plus MMC significantly reduced peritoneal recurrence after operation during ≥5 years follow up (OR 0.05, 95% CI 0.01 to 0.37), but this effect was not seen during lt; 5 years follow up (OR 0.35，95%CI 0.06 to 2.10). ② CG plus CDDP significantly reduced mortality after operation during ＜5 and ≥5 years follow up, compared with CG alone (OR 0.25, 95%CI 0.08 to 0.75; the pooled OR 0.62, 95%CI 0.41 to 0.95), CG plus CDDP plus MMC significantly reduced mortality after operation during ≥5 years follow up, compared with CG alone (the pooled OR 0.45, 95%CI 0.28 to 0.74), but this effect was not seen during lt; 5 years follow up (OR 0.29, 95%CI 0.08 to 1.15). ③ Side effects were reported in only one study and no significant difference was found between the two groups (P=0.96). Conclusions Because of the small number of included studies, the lower methodological quality, and the differences in diagnostic criteria of peritoneal recurrence after operation, the reviewers feel that no firm conclusion could be drawn. Some well designed RCTs of CHPP for advancing gastric cancer should be undertaken to further evaluate its effectiveness.
摘要:目的：探讨高频电刀在乳腺癌手术皮瓣游离中的临床应用及其功率大小对术后皮瓣坏死的影响。方法：回顾性分析2003年1月至2008年9月,在我院154例行乳腺癌改良根治术患者的临床资料,其中乳腺刀组（A组）37例,小功率电刀组（B组）60例,大功率电刀组（C组）57例,对比分析各组皮瓣坏死情况。结果：共发生皮瓣坏死35例,其中A组用乳腺刀游离皮瓣6例（6/37）,B组用小功率电刀（18～22W）游离皮瓣9例（9/60）,C组用大功率（≥28W）电刀游离皮瓣20例(20/57),B组与A组比较差异无显著意义(Ｐ＞005),C组与A、B组比较差异有显著意义(Ｐ＜005);而B、C组与A组比较,游离皮瓣时出血量明显减少,差异有显著性意义（Ｐ＜005）。结论：合理应用高频电刀游离皮瓣具有术中出血少,术后恢复快的优势,但若功率过高,则会增加皮瓣坏死率。Abstract: Objective: To Analyse influence of Skin Flap Necrosis after Operation of Breast Cancer with different power of radioknife. Methods：The clinical data of 154 breast cancer patients received surgery operation trea tment was analysed retrospectively, among them there are 37 patients operation with lancet (group A), there were 60 patients operation with littlepower radioknife (group B) and there were 57 patients operation with highpower radioknife (group C). Results：There were 35 cases (22.73％) suffured from skin flap necrosis among 154 breast cancer cases received surgery operation. There were 6 cases（6/37）in group A, 9 cases（9/60）in group B and 20 cases（20/57）in group C. Group B and group C has littler hemorrhage in operation compare with group C (Ｐ＜005) . Conclusion： Radioknife for skin flap decoherence in operation of breast cancer can decrease hemorrhage but highpower radioknife will increase necrosis of skin flap.
Objective To explore and summarize the curative effect and experience of emergency devascularization for treatment of upper gastrointestinal bleeding due to portal hypertension. Melthods The clinical data of 42 patients with upper gastrointestinal bleeding due to portal hypertension， undergoing emergency devascularization from March 2006 to July 2011 in Shengjing Hospital of China Medical University were retrospectively analyzed. Results Of the 42 cases， 29 patients underwent emergency splenectomy plus esophagogastric devascularization， 8 patients underwent emergency spleen artery ligation plus esophagogastric devascularization， and 5 patients only underwent emergency esophagogastric devascularization. The hemostasis rate at 3 hours after emergent disconnection operation was 100%. One patient died of liver failure on 8 days after operation. Three patients supervened with hemorrhage in abdominal cavity on 2 days after operation， and succeeded in hemostasis by conservative treatment. Other patients were successfullydischarged from hospital after postoperative rehabilitation for 2-4 weeks. All cases were followed up regular in 1 year after operation， 5 patients were lost to follow-up. Among the 36 cases followed up， rehaemorrhagia occurred in 1 patientin 8 months after operation， cured by endoscopic variceal ligation subsequently. A primary liver cancer occurred in 1 patient during physical examination in 7 months after operation， followed by partial hepatectomy. Other patients could complete daily life and work. Conclusions The patients suffering from upper gastrointestinal bleeding due to portal hypertension are likely to benefit from appropriate operations. Decisive emergency devascularization can stop the bleeding rapidly and effectively， and save the lives of those patients.
Objective To discuss the pathogenesis,clinical manifestations,diagnoses and preventive methods on subsequent Wernicke encephalopathy cases of old gastric cancer patients during perioperation.Methods Collected the data of 237 old gastric cancer patients in perioperation from October 1990 to December 2009 hospitalized in the Department of General Surgery,Lanzhou General Hospital Attached to Military Region,PLA.And then retrospectively analysed 7 patents of them who complicated with Wernicke encephalopathy to summarize the clinical manifestation, accessory examination,diagnosis,prevention, and therapy of the Wernicke encephalopathy,and associated factors with its incidence.Results The clinical manifestations of 7 patients included nystagmus （7 cases）,ataxia（4 cases）,brain disorder（6 cases）.Auxiliary examination：4 cases with anemia,7 cases with unusual blood biochemical examination, 5 cases with urinary ketone bodies positive,2 cases with decreasing blood vitamin B1,1 case with unusual skull MRI examination.Five patients were diagnosed before treatment and 2 case were diagnosed by experimental treatment.Finally，4 patents were cured,1 case obviously improved,1 case improved, and 1 case died.And The patients complicated with preoperative hypoproteinemia or pyloric obstruction and postoperative fistula of intestine or gastroplegia syndrome had statistical higher incidence rates of the Wernicke encephalopathy than those without these complications （P＜0.05）.Conclusions The clinical manifestation of the Wernicke encephalopathy have no specificity, it is hard to diagnose,so clinicians should pay attention to it，and combine different ways to diagnose.Improving or preventing complications during perioperative period,and supplementing enough vitamin B are important preventive and therapeutic measures.
Objective To study the cause of the low rate of breast conservation and reconstruction by investigating the approval degree of breast conserving therapy and breast reconstruction of women with breast diseases, to help the breast surgeons make better communication with the patients and make more pertinent choices of therapeutic methods. Methods The age, occupation, educational background, the attitudes towards breast conserving therapy and breast reconstruction， and the choice of operative method of breast reconstruction of 139 patients with breast cancer and 224 patients with benign breast disease were investigated by questionnaire. Results In breast cancer group, 23.9% （28/117） of patients chose breast conserving therapy and 35.9%（42/117） of patients chose breast reconstruction, while the rates of breast conservation and reconstruction were 53.3% （106/199） and 63.8% （127/199） in benign breast disease group. In both groups, the higher rates of breast conservation and reconstruction were associated with better educational background (in breast cancer group: P=0.029， P=0.296; in benign breast disease group: P=0.081, P=0.019） and lower age (all Plt;0.05). Patients engaged in commerce showed higher rates of breast conservation and reconstruction （in breast cancer group: P=0.013, P=0.042； in benign breast disease group: P=0.032, P=0.044）. Age, occupation or educational background was not related with the choice of operative method of breast reconstruction （Pgt;0.05). Conclusions Patients with lower age, better educational background, and better job condition have ber desire of breast conservation and reconstruction. Breast surgeons should enhance communication with those patients about relevant information of breast conservation and reconstruction to make the more pertinent choice of therapeutic methods.
Objective To explore application of preoperative examination in the colorectal cancer patients. Methods The preoperative examination data of patients diagnosed definitely as colorectal cancer at West China Hospital of Sichuan University from November 2006 to June 2007 was retrospectively study, and the application situation and relationship among all preoperative examination in the colorectal cancer patients were analyzed. Results According to the inclusion criteria, 438 colorectal cancer patients were included which involved 260 males and 178 females. Preoperative examinations included two to sixteen items, with an average of 10.61 items. According to correlation analysis, positive correlation existed among lung function and blood type ( r =0.161, P =0.001), tumor marker ( r =0.118, P =0.014), chest X-ray ( r =0.113, P =0.018), routine electrocardiogram ( r =0.198, P =0.000) , while lung function and immune and stress reaction exhibit a negative correlation ( r =-0.106, P = 0.027) with preoperative examinations. At the same time, immune and stress reaction had positive correlation to CT examinations of abdomen ( r =0.151, P =0.001) as well as endorectal ultrasound ( r =0.330, P =0.000). Using univariate analysis, the influence of tumor location ( P =0.012) and operative method ( P =0.004) on the number of examination items was significant. Conclusion Preoperative examination of colorectal tumor surgery mainly includes routine examination, neoplasm-related examination and important organs function detection. And three levels of preoperative menu can be set up in early stage. Establishment of normalization preoperative combined examination may be helpful to consummate preoperative evaluation and improve medical quality.
Objective To investigate the clinical significance of intra-abdominal pressure measure in patients with liver transplantation by summarizing the data of 143 cases. Methods Intra-abdominal pressure was indirectly measured by urinary bladder pressure. Intra-abdominal pressure over 10 cm H2O (1 cm H2O=0.098 kPa) was regarded as intra-abdominal hypertension (IAH), and 10＜pressure≤15 cm H2O as gradeⅠ, 15＜pressure≤25 cm H2O as grade Ⅱ, 25＜pressure≤35 cm H2O as grade Ⅲ, over 35 cm H2O as grade Ⅳ. The parameters of circulatory system, respiratory system, renal function and the postoperative intra-abdominal pressure for 7 days were recorded to every patient, and the parameters of each grade IAH group were contrasted with non-IAH group. ResultsAmong 143 cases, 45 cases were IAH (31.5%), in which 18 cases belonged to grade Ⅰ, 13 cases belonged to grade Ⅱ, 11 cases belonged to grade Ⅲ, while 3 cases belonged to grade Ⅳ. Compared with those in non-IAH group, SCr and BUN significantly increased (P＜0.05, P＜0.01), PaO2 significantly decreased (P＜0.05, P＜0.01) in each grade IAH group; Respiratory frequency (RF), heart rate (HR) and PaCO2 significantly increased (P＜0.05, P＜0.01) in some grade IAH group (HR in grade Ⅱ, Ⅲ and Ⅳ, RF and PaCO2 in grade Ⅲ and Ⅳ). Conclusions Intra-abdominal hypertension would affect liver function by impaired circulatory, respiratory and renal function. So, it is necessary to measure intra-abdominal pressure for patients after liver transplantation, which can help to choose appropriate treatment.
【Abstract】Objective To study the clinical application of laparoscopic operation. Methods The clinical findings from 13 840 cases of laparoscopic surgery in this hospital from 1992 to 2005 were reviewed retrospectively.Results Laparoscopic operation were performed successfully in 13 653（98.6%）,187 cases were transferred to open operation. Complications were occurred in 115 cases, including common bile duct injury in 3 cases. Combined treatment with laparoscope and endoscope were performed in 162 cases. Eleven thousand three hundred and fiftytwo patients had been succeeded in followup survey. Over 90.0 percent of patients recovered smoothly. Conclusion Laparoscopic operation may be applied in a more extensive scope. The major complications can be reduced by strict procedures of laparoscopic operation. The combined treatment of laparoscope and endoscope should be further studied and widely used.
【Abstract】Objective To establish and assess the rat model of postoperative fatigue syndrome (POFS). Methods The rat model of POFS was developed by the partial resection of the liver. The behavioral changes prior and post to operation, the disorder of nutritive intake after operation, stress reaction (pathological changes of mucous membrane in small intestine) and the hepatic albumin gene expression were observed. Results Low body temperature, lower sensitivity and reactivity were found. The serum levels of the iron, total protein, albumin, globulin and so on as the indexes of nutrition obviously dropped. The injury of the mucous membrane resulted from the stress reaction after the resection of the liver. The gene expression of the albumin decreased in the model group.Conclusion The experimental rat model of POFS by partial resection of the liver can be used for the investigation of POFS.
Objective To evaluate the effects of combined splenorenal shunt with portoazygos devascularization for portal hypertension. MethodsA retrospective analysis of the clinical data of combined splenorenal shunt with portoazygos devascularization for portal hypertension in 58 cases was made. They were 41 male, 17 female and average age was 42.5 and posthepatitic liver cirrhosis in 51 cases, schistosomiasis cirrhosis in 7 cases, and Child A in 26 cases, B in 28, C in 4. There was selective operation in 39 cases (Child A 20, Child B 18, Child C 1), early operation in 10 (Child A 3, Child B 6, Child C 1) and emergency operation in 9 (Child A 3, Child B 4, Child C 2).ResultsAll but two (3.4%) Child C cases died after emergency operation, the others recovered. Esophagus varicoses disappeared or had a great improvement in all cases. There were liver function damage with different degree in 19 cases and subdiaphramatic effusion or infection or pleural effusion in 23 and all were cured by conservative therapy. Followed up for 5-10 years in 48 cases, there were rebleeding in 2 cases (3.5%) and postmeal encephalopathy in 2 (3.5%).ConclusionCombined splenorenal shunt and portoazygos devascularization are the first choice for portal hypertension at present.