Postoperative development of sarcopenia is a strong predictor of a poor prognosis in patients with adenocarcinoma of the esophagogastric junction and upper gastric cancer

Background

There were few studies assessed the postoperative sarcopenia in patients with cancers. The objective of present study was to assess whether postoperative development of sarcopenia could predict a poor prognosis in patients with adenocarcinoma of esophagogastric junction, (AEG) and upper gastric cancer (UGC).

门脉高压症断流术后上消化道再出血的外科治疗探讨

目的探讨门脉高压症断流术后上消化道再出血的外科治疗方法及其疗效.方法对(1999-2000)年本科收治的34例门脉高压症断流术后上消化道再出血的病人行外科治疗及疗效分析.其中肝功能Child A组10级,B级18例,C级6例.治疗前钡餐或胃镜检查确诊.结果有14例行非手术外科治疗,2例经药物治疗止血;4例行胃镜下食道静脉套扎(EVL)止血,效果较好;6例行食管胃底曲张静脉脉硬化剂注射,2例行三腔二囊管止血,疗效不确切,再出血率62.5%(5/8).20便行手术治疗,9例行肠腔分流,2例(2/9)术后再次发生上消化道出血;术中食管胃底曲张静脉缝扎1例,食管胃底曲张静脉硬化剂注射2例,术后均再次出现上消化道出血;贲门血管再次离断2例,改良食管下段横断术3例,术后近远期疗效均可;贲门周围血管离断加肠腔分流水2例,术后有1例上消化道再出血.结论胃镜下食道静脉套扎术在非手术止血中效果较好,适合于不不宜手术的病人.手术治疗常选肠腔分流.对前次断流不彻底需再次断流,再次断流门静脉压仍高,则考虑行断流加分流.     

断流术并吻合器横断食管治疗食管曲张静脉出血疗效观察

目的探讨采用断流术并吻合器横断食管治疗门静脉高压症所致食管曲张静脉破裂出血的手术方法和临床效果。方法对48例包括急性出血期急诊手术22例,有出血病史作择期手术的19例和无出血病史作预防性手术的7例,经腹采用吻合器横断食管下段同时进行食管下段及贲门周围血管的选择性离断,观察其近期和远期止血效果。结果术后近期和远期止血效果都比较满意。结论该手术为食管下段横断和对食管下段与贲门周围血管选择性离断的联合应用,术中使用一次性吻合器进行食管下段的横断与吻合,使手术方法简便快捷,可减少手术创伤。     

断流术治疗肝硬化门静脉高压症的疗效观察

目的探讨断流术治疗肝硬化门静脉高压症并发食道、胃底静脉曲张破裂出血(EVB)的临床疗效。方法断流术治疗EVB 56例,观察其近期临床疗效,并随访0.5-5年,了解远期疗效及预后。结果56例患者近期治愈52例,治愈率92.86%,近期死亡4例(7.14%)。52例患者随访最短半年,最长5年。曲张的食道、胃底静脉消失者37例(71%)、好转12例(23%),再出血3例(6%)。结论断流术治疗EVB即时止血率高,近期及远期疗效满意,有一定的远期再出血率。     

食管癌和贲门癌患者胸内食管胃分层吻合术的治疗体会

目的评价胸内食管黏膜延长不同平面与胃、食管分层吻合术,探讨预防食管吻合口瘘和吻合口狭窄发生的吻合方法。方法回顾性总结1985年5月-2002年12月共进行胸腔内食管黏膜延长不同平面与胃、食管分层吻合术2 240例,统计手术后和出院后随访资料发生吻合口瘘和吻合口狭窄的情况。结果所有手术病例均未发生吻合口瘘和吻合口严重狭窄。结论食管、胃黏膜延长不同平面分层吻合术是预防吻合口瘘和吻合口狭窄的有效吻合方法。     

肝硬化病人首次食管胃底静脉曲张破裂出血现状及其危险因素的调查分析

目的:探讨肝硬化病人首次食管胃底静脉曲张破裂出血(EVB)现状及其危险因素。方法:收集2017年12月—2019年1月收治的307例肝硬化病人为研究对象,经治疗后将未发生首次EVB的229例病人设为对照组,首次出现EVB的78例病人设为观察组。分析两组病人临床基本信息及相关资料,统计静脉曲张破裂出血现状,采取单因素分析及多元Logistic回归模型分析发生出血状况的危险因素。结果:多元Logistic回归分析结果显示,饮酒史(OR=1.912)、门静脉主干内径(OR=2.760)、肝功能Child-Pugh分级(OR=2.375)、失血量(OR=3.682)、食管静脉曲张分级重度率(OR=5.013)、红色征(OR=2.704)为肝硬化病人首次EVB独立危险因素。结论:肝硬化病人发生首次EVB的独立危险因素包括饮酒史、门静脉主干内径、肝功能Child-Pugh分级、失血量、食管静脉曲张分级重度率、红色征。医护人员应加强危险因素监测,帮助病人戒烟酒、忌粗糙饮食,定期复查,加强早期预防及诊断,以改善病人生活质量和生命健康水平。     

Indocyanine green retention is a potential prog-nostic indicator after splenectomy and pericar-dial devascularization for cirrhotic patients

BACKGROUND: Splenectomy and pericardial devasculariza-tion (SPD) is an effective treatment of upper gastrointestinal bleeding and hypersplenism in cirrhotic patients with portal hypertension. Indocyanine green retention at 15 minutes (ICGR15) was reported to offer better sensitivity and speciifc-ity than the Child-Pugh classiifcation in hepatectomy, but few reports describe ICGR15 in SPD. The present study was to evaluate the prognostic value of ICGR15 for cirrhotic patients with portal hypertension who underwent SPD.
METHODS: From January 2012 to January 2015, 43 patients with portal hypertension and hypersplenism caused by liver cirrhosis were admitted in our center and received SPD. The ICGR15, Child-Pugh classiifcation, model for end-stage liver disease (MELD) score, and perioperative characteristics were analyzed retrospectively.
RESULTS: Preoperative liver function assessment revealed that 34 patients were Child-Pugh class A with ICGR15 of 13.6%-43.0% and MELD score of 7-20; 8 patients were class B with ICGR15 of 22.8%-40.7% and MELD score of 7-17; 1 patient was class C with ICGR15 of 39.7% and MELD score of 22. The optimal ICGR15 threshold for liver function com-pensation was 31.2%, which offered a sensitivity of 68.4% and a speciifcity of 70.8%. Univariate analysis showed preopera-tive ICGR15, MELD score, surgical procedure, intraoperative blood loss, and autologous blood transfusion were signiifcant-ly different between postoperative liver function compensated and decompensated groups. Multivariate regression analysis revealed that ICGR15 was an independent risk factor of post-operative liver function recovery (P=0.020).
CONCLUSIONS: ICGR15 has outperformed the Child-Pugh classiifcation for assessing liver function in cirrhotic patients with portal hypertension. ICGR15 may be a suitable prognos-tic indicator for cirrhotic patients after SPD.     

Systemic effects of angiogenesis inhibition alter pharmacokinetics and intratumoral delivery of nab-paclitaxel

Angiogenesis is critical to the growth of tumors. Vascularization-targeting agents, with or without cytotoxic drugs, are widely used for the treatment of several solid tumors including esophagogastric adenocarcinoma. However, little is known about the systemic effects of anti-angiogenic therapies and how this affects the pharmacokinetics and intratumoral delivery of cytotoxic agents. In this study, patient-derived xenograft mouse models of esophageal adenocarcinoma were used to identify the effects of DC101, a murine vascular endothelial growth factor receptor 2 (VEGFR2) inhibitor, on the pharmacokinetics and the intratumoral uptake of nab-paclitaxel (NPTX). We showed that DC101 had large systemic effects resulting in decreased vasculature of intraperitoneally located organs. As a consequence, after intraperitoneal administration of NPTX, plasma uptake (5.029?±?4.35 vs. 25.85?±?2.27?µM) and intratumoral delivery (5.48?±?5.32 vs. 38.49?±?2.805?pmol/mg) of NPTX were greatly impaired in DC101-treated animals compared to control animals. Additionally, routes of NPTX elimination were altered upon angiogenesis inhibition; unchanged renal clearance and intraperitoneal accumulation of NPTX were observed, but NPTX levels were significantly lower in the liver. Histological examination of the intestine revealed a reduced thickness of the intestinal wall following DC101 therapy and suggested seepage of intraperitoneally injected NTPX through the intestinal wall to explain its reduced uptake in liver, plasma, and tumor tissue. These data explain several adverse effects observed in the clinic when using anti-angiogenic therapies and also imply that the combined use of anti-angiogenesis and cytotoxic agents in both preclinical and clinical setting is still suboptimal.