Short-term outcomes of laparoscopic total mesorectal excision compared to open surgery

AIM:To investigate the short-term outcome of laparoscopic total mesorectal excision(TME) in patients with mid and low rectal cancers.METHODS:A consecutive series of 138 patients with middle and low rectal cancer were randomly assigned to either the laparoscopic TME(LTME) group or the open TME(OTME) group between September 2008 and July 2011 at the Department of Colorectal Cancer of Shanghai Cancer Center,Fudan University and pathological data,as well as surgical technique were reviewed retrospectively.Short-term clinical and oncological outcome were compared in these two groups.Patients were followed in the outpatient clinic 2 wk after the surgery and then every 3 mo in the first year if no adjuvant chemoradiation was indicated.Statistical analysis was performed using SPSS 13.0 software.RESULTS:Sixty-seven patients were treated with LTME and 71 patients were treated with OTME(sex ratio 1.3:1vs 1.29:1,age 58.4 ± 13.6 years vs 59.6 ± 9.4 years,respectively).The resection was considered curative in all cases.The sphincter-preserving rate was 65.7%(44/67) vs 60.6%(43/71),P = 0.046;mean blood loss was 86.9 ± 37.6 mL vs 119.1 ± 32.7 mL,P = 0.018;postoperative analgesia was 2.1 ± 0.6 d vs 3.9 ± 1.8 d,P = 0.008;duration of urinary drainage was 4.7 ± 1.8 d vs 6.9 ± 3.4 d,P = 0.016,respectively.The conversion rate was 2.99%.The complication rate,circumferential margin involvement,distal margins and lymph node yield were similar for both procedures.No port site recurrence,anastomotic recurrence or mortality was observed during a median follow-up period of 21 mo(range:9-56 mo).CONCLUSION:Laparoscopic TME is safe and feasible,with an oncological adequacy comparable to the open approach.Further studies with more patients and longer follow-up are needed to confirm the present results.     

Prognostic value of preoperative mean corpuscular volume in esophageal squamous cell carcinoma

AIM: To evaluate whether preoperative mean corpuscular volume (MCV) is a prognostic indicator in patients with resectable esophageal squamous cell carcinoma (ESCC). METHODS: A total of 298 consecutive, prospectively enrolled patients with histologically diagnosed ESCC who underwent surgery with curative intent from 2001 to 2011 were retrospectively evaluated. Patients were excluded if they had previous malignant disease, distant metastasis at the time of primary treatment, a history of neoadjuvant treatment, had undergone nonradical resection, or had died of a non-tumor-associated cause. Survival status was verified in September 2011. Pathological staging was performed based on the 2010 American Joint Committee on Cancer criteria. Preoperative MCV was obtained from blood counts performed routinely within 7 d prior to surgery. Receiver operating characteristic (ROC) curve analysis was used to determine a cutoff for preoperative MCV. RESULTS: The 298 patients consisted of 230 males and 68 females, with a median follow-up of 30.1 mo. ROC analysis showed an optimal cutoff for preoperative MCV of 95.6 fl. Fifty-nine patients (19.8%) had high (> 95.6 fl) and 239 (80.2%) had low (≤ 95.6 fl) preoperative MCV. Preoperative MCV was significantly associated with gender (P=0.003), body mass index (P=0.017), and preoperative red blood cell count (P<0.001). The predicted 1-, 3and 5-year overall survival (OS) rates were 72%, 60% and 52%, respectively. Median OS was significantly longer in patients with low than with high preoperative MCV (27.5 mo vs 19.4 mo, P<0.001). Multivariate analysis showed that advanced pT (P=0.018) and pN (P<0.001) stages, upper thoracic location (P=0.010), lower preoperative albumin concentration (P=0.002), and high preoperative MCV (P=0.001) were negative prognostic factors in patients with ESCC. Preoperative MCV also stratified OS in patients with T3, N1-N3, G2-G3 and stage Ⅲ tumors. CONCLUSION: Preoperative MCV is a prognostic factor in patients with ESCC.     

Effects of Nigella sativa on outcome of hepatitis C in Egypt

AIM: To evaluate the safety, efficacy and tolerability of Nigella sativa (N. sativa ) in patients with hepatitis C not eligible for interferon (IFN)-α. METHODS: Thirty patients with hepatitis C virus (HCV) infection, who were not eligible for IFN/ribavirin therapy, were included in the present study. Inclusion criteria included: patients with HCV with or without cirrhosis, who had a contraindication to IFN-α therapy, or had refused or had a financial constraint to IFN-α therapy. Exclusion criteria included: patients on IFN-α therapy, infection with hepatitis B or hepatitis Ⅰ virus, hepatocellular carcinoma, other malignancies, major severe illness, or treatment non-compliance. Various parameters, including clinical parameters, complete blood count, liver function, renal function, plasma glucose, total antioxidant capacity (TAC), and polymerase chain reaction, were all assessed at baseline and at the end of the study. Clinical assessment included: hepato and/ or splenomegaly, jaundice, palmar erythema, flapping tremors, spider naevi, lower-limb edema, and ascites. N. sativa was administered for three successive months at a dose of (450 mg three times daily). Clinical response and incidence of adverse drug reactions were assessed initially, periodically, and at the end of the study. RESULTS: N. sativa administration significantly improved HCV viral load (380808.7 ± 610937 vs 147028.2 ± 475225.6, P = 0.001) and TAC (1.35 ± 0.5 vs 1.612 ± 0.56, P = 0.001). After N. sativa administration, the following laboratory parameters improved: total protein (7.1 ± 0.7 vs 7.5 ± 0.8, P = 0.001), albumin (3.5 ± 0.87 vs 3.69 ± 0.91, P = 0.008), red blood cell count (4.13 ± 0.9 vs 4.3 ± 0.9, P = 0.001), and platelet count (167.7 ± 91.2 vs 198.5 ± 103, P = 0.004). Fasting blood glucose (104.03 ± 43.42 vs 92.1 ± 31.34, P = 0.001) and postprandial blood glucose (143.67 ± 72.56 vs 112.1 ± 42.9, P = 0.001) were significantly decreased in both diabetic and non-diabetic HCV patients. Patients with lower-limb edema de     

Minimally invasive esophagectomy—left neck anastomosis

Minimally invasive esophagectomy (MIE) is supplementary to open surgery in the thoracic surgery. A 65-year-old male was identified with middle thoracic esophageal squamous cell carcinoma by gastroscopy. In preoperative examinations, neither obvious abnormality nor distant metastasis was noted, and he could tolerate the esophagectomy according to his heart and lung function tests. Chest computed tomography (CT) and endoscopic ultrasonography showed no visible swollen lymph node in the mediastinum. The cTNM classification was T2N0M0. Therefore, MIE was performed. The patient recovered well after the surgery.KEYWORDS : Minimally invasive esophagectomy (MIE), esophagectomy, thoracoscope, laparoscope     

Thoracoscopic and laparoscopic radical esophagectomy with left neck anastomosis

We described a 50-year-old female, who came to our institute with the diagnosis of esophageal squamous cell carcinoma. The preoperative clinical diagnosis was stage II esophageal squamous cell carcinoma. The minimally invasive esophagectomy (MIE), combined thoracoscopic-laparoscopic esophagectomy with cervical anastomosis, was performed in this case. Total surgery time was 190 min and blood loss was 100 mL. Postoperative pathological exam suggested squamous cell carcinoma, without evidence of lymph node metastasis in any station (T2N0M0 IIb stage). The patient was discharged home on the 12^th postoperative day.     

Steatotic livers are susceptible to normothermic ischemia-reperfusion injury from mitochondrial Complex-I dysfunction

AIM: To assess the effects of ischemic preconditioning (IPC, 10-min ischemia/10-min reperfusion) on steatotic liver mitochondrial function after normothermic ischemia-reperfusion injury (IRI). METHODS: Sixty male Sprague-Dawley rats were fed 8-wk with either control chow or high-fat/high-sucrose diet inducing > 60% mixed steatosis. Three groups (n = 10/group) for each dietary state were tested: (1) the IRI group underwent 60 min partial hepatic ischemia and 4 h reperfusion; (2) the IPC group underwent IPC prior to same standard IRI; and (3) sham underwent the same surgery without IRI or IPC. Hepatic mitochondrial function was analyzed by oxygraphs. Mitochondrial Complex-I, Complex-II enzyme activity, serum alanine aminotransferase (ALT), and histological injury were measured. RESULTS: Steatotic-IRI livers had a greater increase in ALT (2476 ± 166 vs 1457 ± 103 IU/L, P < 0.01) and histological injury following IRI compared to the lean liver group. Steatotic-IRI demonstrated lower Complex-I activity at baseline [78.4 ± 2.5 vs 116.4 ± 6.0 nmol/(min.mg protein), P < 0.001] and following IRI [28.0 ± 6.2 vs 104.3 ± 12.6 nmol/(min.mg protein), P < 0.001]. Steatotic-IRI also demonstrated impaired Complex-I function post-IRI compared to the lean liver IRI group. Complex-II activity was unaffected by hepatic steatosis or IRI. Lean liver mitochondrial function was unchanged following IRI. IPC normalized ALT and histological injury in steatotic livers but had no effect on overall steatotic liver mitochondrial function or individual mitochondrial complex enzyme activities. CONCLUSION: Warm IRI impairs steatotic liver Complex-I activity and function. The protective effects of IPC in steatotic livers may not be mediated through mitochondria.     

Changes of neurotensin and endotoxin in rats with intestinal ischemia

AIM: To investigate the changes of neurotensin (NT) and endotoxin in rats with segmental intestinal ischemia. METHODS: The distal ileal mesenteric arteries in rats were ligated to make segmental intestinal ischemia models. At the 2^nd, 6^th and 12^th hours after intestinal ischemia, endotoxin levels in portal blood were tested by limulus lysate test and NT levels in plasma from the heart and in intestine tissues (ischemia and peri-ischemia areas) were assayed by radioimmunoassay. Histological changes of the mucosa were examined under light and electron microscopes. RESULTS: NT levels decreased significantly in intestinal ischemia and peri-ischemia areas (34.07 ± 5.93 vs 40.14 ± 5.38, P < 0.05; 7.47 ± 1.38 vs 40.14 ± 5.38, P < 0.01), especially lower in ischemia area (34.07 ± 5.93 vs 7.47 ± 1.38, P < 0.05. However, NT level increased obviously in plasma (0.76 ± 0.16 vs 0.47 ± 0.10, P < 0.05). Levels of endotoxin elevated obviously in portal blood (389.0 ± 105.0 vs 55.1 ± 6.7, P < 0.01), and the mucosa was injured both in ischemia and peri-ischemia areas. CONCLUSION: Intestinal ischemia injures intestinal mucosa and leads to decrease of intestinal NT level, which is accelerated by endotoxemia and increase of blood NT level.     

Gardenia jasminoides attenuates hepatocellular injury and fibrosis in bile duct-ligated rats and human hepatic stellate cells

AIM:To investigate the anti-hepatofibrotic effects of Gardenia jasminoides in liver fibrosis.METHODS:Male Sprague-Dawley rats underwent common bile duct ligation(BDL) for 14 d and were treated with Gardenia jasminoides by gavage.The ef-fects of Gardenia jasminoides on liver fibrosis and the detailed molecular mechanisms were also assessed in human hepatic stellate cells(LX-2) in vitro.RESULTS:Treatment with Gardenia jasminoides decreased serum alanine aminotransferase(BDL vs BDL + 100 mg/kg Gardenia jasminoides,146.6 ± 15 U/L vs 77 ± 6.5 U/L,P = 0.0007) and aspartate aminotransferase(BDL vs BDL + 100 mg/kg Gardenia jasminoides,188 ± 35.2 U/L vs 128 ± 19 U/L,P = 0.005) as well as hydroxyproline(BDL vs BDL + 100 mg/kg Gardenia jasminoides,438 ± 40.2 μg/g vs 228 ± 10.3 μg/g liver tissue,P = 0.004) after BDL.Furthermore,Gardenia jasminoides significantly reduced liver mRNA and/or protein expression of transforming growth factor β1(TGF-β1),collagen type?Ⅰ?(Col?Ⅰ) and α-smooth muscle actin(α-SMA).Gardenia jasminoides significantly suppressed the upregulation of TGF-β1,Col?Ⅰand α-SMA in LX-2 exposed to recombinant TGF-β1.Moreover,Gardenia jasminoides inhibited TGF-β1-induced Smad2 phosphorylation in LX-2 cells.CONCLUSION:Gardenia jasminoides exerts antifibrotic effects in the liver fibrosis and may represent a novel antifibrotic agent.     

Substance P,vasoactive intestinal peptide,and leu-enkephalin in plasma and gastric juice of patients with precancerous lesions and gastric cancer

AIM: To investigate the changes of the brain-gut-peptide concentrations in the plasma and gastric juice and their relations to gastric diseases. METHODS: A total of 83 subjects were part of the study. Of those, 28 had chronic atrophic gastritis with precancerous lesions, 22 had gastric cancer in an advanced stage, and 33 were healthy subjects for a control group. Samples of fasting blood and gastric juice were collected. Levels of substance P (SP), vasoactive intestinal peptide (VIP) and leu-enkephalin (LEK) in plasma and gastric juice were measured with radioimmunoassay kits expressed as ng/L. RESULTS: In patients with gastric cancer, the SP levels (83.7 ± 11.0 vs 39.6 ± 4.5, P < 0.01; 24.0 ± 1.6 vs 17.8 ± 1.5, P < 0.05) and LEK in plasma and gastric juice (226.2 ± 15.4 vs 180.3 ± 13.1, P < 0.01; 55.0 ± 3.4 vs 30.7 ± 2.4, P < 0.05), and VIP of gastric juice (80.5 ± 2.9 vs 64.3 ± 4.1, P < 0.05) were higher than those in the controls. The SP and LEK levels of plasma correlated with those of gastric juice (r = 0.432 and 0.516, P < 0.05). In the post-surgical gastric cancer, plasma levels of SP and gastric juice LEK were lower than the pre-surgical levels (P < 0.05). In the precancerous lesions, plasma and gastric juice LEK levels and gastric juice VIP levels were increased (P < 0.05), and the plasma LEK level correlated with the gastric juice LEK level (r = 0.398, P < 0.05). CONCLUSION: Measurement of concentrations of SP, VIP, and LEK in plasma and gastric juice is of clinical significance in detecting certain stomach diseases.     

Growth hormone abolishes the negative effects of everolimus on intestinal wound healing

AIM: To investigate whether the simultaneous treatment with human growth hormone(h GH) abolishes the negative effects of everolimus on anastomotic healing.METHODS: Forty-eight male Sprague-Dawley-rats were randomized to three groups of 16 animals each(Ⅰ: vehicle; Ⅱ: everolimus 3 mg/kg po; Ⅲ: everolimus 3 mg/kg po + h GH 2.5 mg/kg sc). Animals were pretreated with h GH and/or everolimus daily for seven days. Then a standard anastomosis was created in the descending colon and treatment was continued for another seven days. The anastomosis was resected in toto and the bursting pressure was assessed as a mechanical parameter of intestinal healing. Moreover, biochemical(Hydroxyproline, PCNA, MPO, MMP-2 and MMP-9) and histological(cell density, angiogenesis, amount of granulation tissue) parameters of intestinal healing were assessed.RESULTS: Anastomotic bursting pressure was significantly reduced by everolimus and a simultaneous treatment with h GH resulted in considerably higher values(Ⅰ: 134 ± 19 mm Hg, Ⅱ: 85 ± 25 mm Hg, Ⅲ: 114 ± 25 mm Hg; P 0.05,Ⅰvs Ⅱ; P = 0.09,Ⅰvs Ⅲ and Ⅱ vs Ⅲ) Hydroxyproline concentration was significantly increased by h GH compared to everolimus alone(Ⅰ: 14.9 ± 2.5 μg/mg, Ⅱ: 8.9 ± 3.6 μg/mg, Ⅲ: 11.9 ± 2.8 μg/mg; P 0.05,?Ⅰvs Ⅱ/Ⅲ and Ⅱ vs Ⅲ). The number of MPO-positive cells was reduced significantly by h GHcompared to everolimus alone(Ⅰ: 10 ± 1 n/mm~2, Ⅱ: 15 ± 3 n/mm~2, Ⅲ: 9 ± 2 n/mm~2; P 0.05,Ⅰvs Ⅱ and Ⅱ vs Ⅲ), while the number of PCNA-positive cells were increased by h GH(Ⅰ: 28 ± 3 /mm~2, Ⅱ: 12 ± 3 /mm~2, Ⅲ: 26 ± 12 /mm~2; P 0.05,?Ⅰ?vs Ⅱ and Ⅱ vs Ⅲ). Corresponding to these biochemical findings, HEhistology revealed significantly increased amount of granulation tissue in h GH-treated animals.CONCLUSION: Inhibition of intestinal wound healing by everolimus is partially neutralized by simultaeous treatment with h GH. Both inflammation as well as collagen deposition is influenced by h GH.     

Elevated serum levels of human relaxin-2 in patients with esophageal squamous cell carcinoma

AIM: To assess the prognostic value of serum human relaxin 2 (H2 RLN) level in patients with esophageal squamous cell carcinoma (ESCC). METHODS: From October 1998 to September 2009, 146 patients with histopathologically confirmed ESCC were enrolled in this study. One hundred patients underwent en bloc esophagectomy, and 46 patients with unresectable tumors underwent palliative surgery. Five of the 146 patients died of surgical complications. Serum levels of H2 RLN were measured by enzyme linked immunosorbent assay. The relationship between serum H2 RLN level and each of the clinicopathological parameters was analyzed using the χ2 test. Patients were classified into two groups according to their H2 RLN level (< 0.462 ng/mL vs ≥ 0.462 ng/mL). When any analysis cell had fewer than five cases, the Fisher’s exact test was used. The statistical difference between groups A and B in each clinicopathological category was determined by the Student’s t test (two-tailed) or analysis of variance. Survival curves were plotted using the Kaplan-Meier method. The statistical difference in survival between the different groups was compared using the log-rank test. Survival correlation with the prognostic factors was further investigated by multivariate analysis using the Cox proportional hazards model with backward stepwise likelihood ratio. RESULTS: ESCC patients tended to have significantly higher serum H2 RLN concentrations (0.48 ± 0.17 ng/ mL, n=141) compared with the healthy control group (0.342 ± 0.12 ng/mL, n=112). There was a significant difference between patients with lymph node involvement (0.74 ± 0.15 ng/mL, n=90), distant metastasis (0.90 ± 0.19 ng/mL, n=32) and those without lymph node involvement (0.45 ± 0.12 ng/mL, n=51), and distant metastasis (0.43 ± 0.14 ng/mL, n=109), respectively (P < 0.01). Patients with high H2 RLN levels (≥ 0.462 ng/mL) had a poorer prognosis than patients with low serum H2 RLN levels (< 0.462 ng/mL; P=0.0056). The H2 RLN level was also correlated with survival and     

Correlation of human epidermal growth factor receptor 2 expression with clinicopathological characteristics and prognosis in gastric cancer

AIM:To investigate human epidermal growth factor receptor 2(HER2) gene amplification and protein expression in Chinese patients with resectable gastric cancer and the association with clinicopathological characteristics and survival.METHODS:One hundred and ninety-seven gastric cancer patients who underwent curative surgery procedures were enrolled into this study.HER2 gene amplification and protein expression were examined using fluorescence in-situ hybridization(FISH) and immunohistochemistry(IHC) analysis on formalin-fixed paraffinembedded gastric cancer samples from all patients.For scoring,Hofmann’s HER2 gastric cancer scoring system was adopted.All cases showing IHC3+ or FISH positiv-ity were defined as HER2 positive.Patient clinicopathological data and survival information were collected.Finally,χ 2 statistical analysis was performed to analyze the HER2 positivity rate amongst the subgroups with different clinicopathological characteristics including;gender,age,tumor location,Lauren classification,differentiation,TNM staging,depth of invasion,lymph node metastases and distant metastasis.The probability of survival for different subgroups with different clinicopathological characteristics was calculated using the Kaplan-Meier method and survival curves plotted using log rank inspection.RESULTS:According to Hofmann’s HER2 gastric cancer scoring criteria,31 cases(15.74%) were identified as HER2 gene amplified and 19 cases(9.64%) were scored as strongly positive for HER2 membrane staining(3+),25 cases(12.69%) were moderately positive(2+) and 153 cases(77.66%) were HER2 negative(0/1+).The concordance rate between IHC and FISH analyses was 88.83%(175/197).Thirty-six cases were defined as positive for HER2 gene amplification and/or protein expression,with 24 of these cases being eligible for Herceptin treatment according to United States recommendations,and 29 of these cases eligible according to EU recommendations.Highly consistent results were detected between IHC3+,IHC0/1 and FISH(73.68% and 95.42%),but l     

Increased duodenal expression of miR-146a and -155 in pediatric Crohn&rsquo;s disease

AIM: To evaluate the role of microRNA (miR)-146a, -155 and -122 in the duodenal mucosa of pediatric patients with Crohn’s disease (CD) and the effect of transforming growth factor-β (TGF-β) on these miRs in duodenal epithelial and fibroblast cells. METHODS: Formalin-fixed, paraffin-embedded biopsies derived from the macroscopically inflamed (CD inflamed: n = 10) and intact (CD intact: n = 10) duodenal mucosa of pediatric CD patients and control children (C: n = 10) were examined. Expression of miR-146a, -155 and -122 was determined by real-time polymerase-chain reaction (PCR). The expression of the above miRs was investigated in recombinant human TGF-β (1 nmol/L, 24 h) or vehicle treated small intestinal epithelial cells (CCL-241) and primary duodenal fibroblast cells derived from healthy children as well. RESULTS: Expression of miR-146a was significantly higher in the inflamed duodenal mucosa compared to the intact duodenal mucosa of children with CD (CD inflamed: 3.21 ± 0.50 vs CD intact: 0.62 ± 0.26, P≤ 0.01) and to the control group (CD inflamed: 3.21 ± 0.50 vs C: 1.00 ± 0.33, P≤ 0.05). The expression of miR-155 was significantly increased in the inflamed region of the duodenum compared to the control group (CD inflamed: 4.87 ± 1.02 vs Control: 1.00 ± 0.40, P≤ 0.001). The expression of miR-122 was unchanged in the inflamed or intact mucosa of CD patients compared to controls. TGF-β treatment significantly decreased the expression of miR-155 in small intestinal epithelial cells (TGF-β: 0.7 ± 0.083 vs Control: 1 ± 0.09, P≤ 0.05) and also the expression of miR-146a (TGF-β: 0.67 ± 0.04 vs Control: 1 ± 0.15, P≤ 0.01) and miR-155 (TGF-β: 0.72 ± 0.09 vs Control: 1 ± 0.06, P≤ 0.05) in primary duodenal fibroblasts compared to corresponding vehicle treated controls. TGF-β treatment did not influence the expression of miR-122. CONCLUSION: The elevated expression of miR-146a and -155 in the inflamed duodenal mucosa of CD patients suggests the role of these miRs in the pathomechanism of inflammatory bowel disease. Anti-inflammatory TGF-β plays an important role in the regulation of the expression of these miRs.     

磨玻璃样影与实性结节型肺癌并发陈旧性肺结核的临床特点

目的 对比分析表现为磨玻璃样影(ground-glass opacity,GGO)型肺癌(简称“GGO型肺癌”)并发陈旧性肺结核与实性结节(subsolid-nodule,SN)型肺癌(简称“SN型肺癌”)并发陈旧性肺结核的不同临床特点,以达到早期识别及治疗磨玻璃样影肺癌并发陈旧性肺结核的目的。方法 收集我院自2008年1月 至 2018年2月确诊并符合入组标准的 45 例肺癌并发陈旧性肺结核的患者,将GGO型肺癌并发陈旧性肺结核的患者设为研究组(简称“GGO组”,共16例),SN型肺癌并发陈旧性肺结核患者设为对照组(简称“SN组”,共29例),回顾性分析两组患者临床表现、CT扫描表现、手术方式、病理类型等。计量资料组间比较采用t检验,计数资料组间比较采用χ ²检验,均以P<0.05为差异有统计学意义。结果 (1)年龄:GGO组平均年龄(51.0±6.1)岁,SN组(59.6±8.4)岁,两组比较差异有统计学意义(t=3.58, P<0.001)。(2)结核病史:GGO组平均(19.5±2.6)年, SN组平均(23.3±3.1)年,两组比较差异有统计学意义(t=4.16, P<0.001)。(3)确诊时间:GGO组平均(382.0±27.0)d,SN组平均(9.5±5.1)d,两组比较差异有统计学意义(t=77.69, P=0.000)。(4)区域淋巴结是否转移:GGO组16例(100.0%)均未见局部淋巴结转移(N0);同侧支气管周围和(或)同侧肺门淋巴结及肺内淋巴结有转移(N1) 0例(0.0%);同侧纵隔内和(或)隆突下淋巴结转移(N2) 0例(0.0%)。SN组16例(55.2%)未见N0;N1 9例(31.0%);N2 4例(13.8%);两组比较差异有统计学意义(χ ²=9.99, P=0.003)。(5)肿瘤与结核病灶的位置关系:GGO组同叶4例(25.0%),异叶12例(75.0%);SN组同叶18例(62.1%),异叶11例(37.9%);两组比较差异有统计学意义(χ ²=4.28,P=0.038)。(6)病理类型:GGO组 鳞癌1例(6.3%),腺癌14例(87.5%),大细胞癌 1例(6.3%);SN组鳞癌12例(41.4%),腺癌15例(51.7%),腺鳞癌2例(6.9%);两组比较差异有统计学意义(χ ²=6.78,P=0.029)。(7)手术方式:GGO组行肺叶切除11例(68.8%,11/16),肺段切除1例(6.2%,1/16),肺楔形切除2例(12.5%,2/16),肺叶加楔形切除2例(12.5%,2/16);SN组全部行肺叶切除(100.0%,29/29);两组比较差异有统计学意义(χ ²=15.66,P=0.000)。结论 GGO型肺癌与SN型肺癌并发陈旧性肺结核相比较,具有临床表现无特异性,发病年龄低,确诊周期长,肿瘤分布与结核病灶无明显相关,纵隔淋巴结肿大与淋巴结转移无相关性,手术方式多样及病理类型以腺癌为主等特点,为肺癌并发肺结核的一种特殊类型。     

Conservative treatment of early postoperative small bowel obstruction with obliterative peritonitis

AIM:To investigate the effect of somatostatin and dexamethasone on early postoperative small bowel obstruction with obliterative peritonitis(EPSBO-OP).METHODS:This prospective randomized study included 70 patients diagnosed with EPSBO-OP from June2002 to January 2009.Patients were randomized into two groups:a control group received total parenteral nutrition and nasogastric(NG)tube feeding;and an intervention group received,in addition,somatostatin and dexamethasone treatment.The primary endpoints were time to resolution of bowel obstruction and length of hospital stay,and the secondary endpoints were daily NG output and NG feeding duration,treatment-related complications,postoperative obstruction relapse,and patient satisfaction.RESULTS:Thirty-six patients were allocated to the intervention group and 34 to the control group.No patient needed to undergo surgery.Patients in the intervention group had an earlier resolution of bowel obstruction(22.4±9.1 vs 29.9±10.1 d,P=0.002).Lower daily NG output(583±208 vs 922±399 mL/d,P<0.001),shorter duration of NG tube use(16.7±8.8vs 27.7±9.9 d,P<0.001),and shorter length of hospital stay(25.8 vs 34.9 d,P=0.001)were observed in the intervention group.The rate of treatment-related complications(P=0.770)and relapse of obstruction(P=0.357)were comparable between the two groups.There were no significant differences in postoperative satisfaction at 1,2 and 3 years between the two groups.CONCLUSION:Somatostatin and dexamethasone for EPSBO-OP promote resolution of obstruction and shorten hospital stay,and are safe for symptom control without increasing obstruction relapse.     

Video capsule endoscopy in left ventricular assist device recipients with obscure gastrointestinal bleeding

AIM: To assess whether video capsule endoscopy(VCE) affects the outcomes of left ventricular assist devices(LVADs) recipients with gastrointestinal bleeding.METHODS: This is a retrospective study of LVAD recipients with obscure gastrointestinal bleeding(OGIB) who underwent VCE at a tertiary medical center between 2005 and 2013. All patients were admitted and monitored with telemetry and all VCE and subsequent endoscopic procedures were performed as inpatients. A VCE study was considered positive only when P2 lesions were found and was regarded as negative if P1 or P0 were identified. All patients were followed until heart transplant, death, or the end of the study.RESULTS: Between 2005 and 2013, 30 patients with LVAD underwent VCE. Completion rate of VCE was 93.3% and there was no capsule retention. No interference of VCE recording or the function of LVAD was found. VCE was positive in 40% of patients(n = 12). The most common finding was active small intestinal bleeding(50%) and small intestinal angiodysplasia(33.3%). There was no difference in the rate of recurrent bleeding between patients with positive and negative VCE study(50.0% vs 55.6%,P = 1.00) during an average of 11.6 ± 9.6 mo follow up. Among patients with positive VCE, the recurrent bleeding rate did not differ whether subsequent endoscopy was performed(50% vs 50%, P = 1.00).CONCLUSION: VCE can be safely performed in LVAD recipients with a diagnostic yield of 40%. VCE does not affect recurrent bleeding in LVAD patients regardless of findings.     

Can common hepatic artery lymph node dissection be safely omitted in surgery for clinical T1N0 thoracic esophageal squamous cell carcinoma?

Common hepatic artery lymph node dissection is regarded as a standard procedure in esophageal cancer surgery because of aggressive lymphatic dissemination of esophageal cancer. However, lymph node dissection can prolong operation time and may be associated with complications such as chylous ascites. Here, we aimed to evaluate the effectiveness of common hepatic artery lymph node dissection in clinical T1N0 thoracic esophageal squamous cell carcinoma. Between 1996 and 2009, 1390 patients underwent surgery for esophageal cancer in our institution, and 209 were found to have clinical T1N0 disease. Exclusion criteria were nonsquamous carcinoma, double primary cancer, definite distant metastasis, administration of neoadjuvant treatment, and incomplete abdominal lymph node dissection. We retrospectively analyzed medical records, operative and pathologic data, and follow‐up information. Forty‐two patients were excluded from the study. Among the 167 enrolled patients, preoperative endoscopic ultrasound evaluation was performed in 160 patients. Fifty‐two patients had distal esophageal or esophagogastric junction tumor. Surgery included 2 cases of tri‐incisional esophagectomy, 17 cases of transhiatal esophagectomy, and 148 cases of two‐field esophagectomy (Ivor Lewis operation). Common hepatic artery lymph node dissection was performed in all cases, and none of the patients had metastasis. Mean follow‐up period was 35.4 ± 28.7 months. In‐hospital mortality was one, and 5‐year survival rate was 80.6%. Among the 15 patients with recurrence, there were two distant metastases and five distant and local recurrences but no intra‐abdominal recurrence with common hepatic artery lymph node. Common hepatic artery lymph node dissection may be safely omitted in surgery for clinical T1N0 esophageal squamous cell carcinoma when preoperative evaluations including chest computed tomography, positron emission tomography and computed tomography, and esophagogastroduodenoscopy or endoscopic ultrasound are performed.     

单孔胸腔镜行纤维板剥脱术治疗结核性脓胸的疗效观察

目的: 探讨单孔胸腔镜行纤维板剥脱术治疗结核性脓胸的疗效。方法: 收集武汉市肺科医院行纤维板剥脱术的132例患者的临床资料,根据手术方式分为传统开胸组(2017年6月至2018年8月期间入院的74例患者)和单孔胸腔镜组(2020年5月至2021年6月期间入院的58例患者),对两组患者的手术时间、术中出血量、术后48h引流量、术后住院时间、带管时间、并发症(再次手术止血率、切口感染率、术侧胸壁感觉异常发生率)和治疗效果等进行统计分析。结果: 单孔胸腔镜组的手术时间[210.0(165.0,240.0)min]、术后48h引流量[585(450,813)ml]和术后住院时间[9.0(8.0,11.0)d]均低于传统开胸组[分别为270.0(210.0,330.0)min、865(695,1040)ml和14.0(11.0,16.0)d],差异均有统计学意义(U值分别为1134.725、995.463、635.841,P值均<0.01)。单孔胸腔镜组术中出血量[400(300,800)ml]、术后带管时间[8.0(7.0,9.3)d]、再次手术止血率[0.0%(0/58)]和切口感染率[1.7%(1/58)]与传统开胸组[分别为350(200,600)ml、9.0(7.0,14.0)d、1.4%(1/74)、4.1%(3/74)]比较差异均无统计学意义(U=1774.672、U=1879.735、χ²=1.163、χ²=0.637,P值分别为0.086、0.267、0.281、0.425);而术侧胸壁感觉异常发生率传统开胸组为95.9%(71/74),显著高于单孔胸腔镜组的15.5%(9/58),差异有统计学意义(χ²=101.834,P<0.01)。随访5个月以上,传统开胸组总有效率为93.2%(69/74),单孔腔镜组的总有效率为94.8%(55/58),差异无统计学意义(χ²=0.149,P=0.928)。结论: 与传统开胸相比,单孔胸腔镜行纤维板剥脱术治疗Ⅲ期结核性脓胸安全有效,且创伤更小,值得临床推广。