Objective To evaluate the effect of esophagogastric intramural implantation anastomosis after esophagectomy. Methods One thousand and two hundred thirty-six patients with esophageal and cardial cancers were treated by esophagogastric intramural implantation anastomosis after esophagectomy. The mucosal layer, the esophageal and gastric muscular layers were on three different levels after the anastomosis. Results Among 1236 patients, 842 cases were esophageal cancer,and 394 cases were cardial cancer.The anastomoses were performed in different levels including 15 cases below the pharynx, 193 cases on neck,634 case above the aortic arch and 394 cases below the aortic arch. One of the patients died 24 hours after the operation due to myocardial ischemia, and two of them died of respiratory failure. Anastomotic leakage, stenosis and refluxing esophagitis did not appear in this series. Conclusions Esophagogastric intramural implantation anastomosis can decrease the incidence of anastomotic leakage, stenosis and refluxing esophagitis after esophagectomy.

Objective To study the relationship between micro-vessel density(MVD), proliferating cell nuclear antigen(PCNA) expression and clinicopathological characteristics in cervix squamous cell carcinoma. Methods PCNA and CD 34 expression in 32 cervix squamous cell carcinomas were examined by SP immunohistochemical staining. MVD and proliferation index (PI) were calculated. Results PI and MVD were significantly correlated with the differentiatial degree and FIGO stage of cervix squamous cell carcinomas, and in the low differential cancers with high FIGO stage were obviously higher than those in the high differential cancers with low FIGO stage. In addition, PI and MVD in the cancers with lymph node metastasis were significantly higher than those in the cancers without one (P

Objective To investigate the relationship between apoptcsis, expressions of VEGF and clinicopathological characteris- tics, and prognosis in esophageal squamous cell carcinoma (ESCC). Methods Sixty-one surgical specimens of primary esophageal squa- mous cell carcinomas were examined for VEGF by immunohistochemical staining (S-P). Apoptcsis was determined by TUNEL (TdT media- ting dUTP-biotin nick end-labeling) method. Clinicopathologic features were examined by histopathology. The prognostic impacts of these pa- rameters were analyzed by univariate and survival analysis. Results AI and VEGF were well correlated with differentiation, TNM stage. Lower tumor differentiation and higher TNM stage were related to decreasing AI and VEGF. In addition, VEGF in the groups of invasion be- yond muscularis and lymph node metastasis is significant higher than that in invasion reaching muacularis and no lymph node metastasis (P <0.01). But there were no significant correlation between AI and invasion( P>0.05). The simple-factor analysis results showed that the decrease of AI, VEGF, lymph node metastases, lower tumor differentiation, and invasion reaching muscularis were related to decrease of sur- vival rate. However, multivariate Cox analysis demonstrated that only AI and VEGF were the significant prognostic factors. Conclusions Apoptosis and angiagenesis participate in ESCC and promote its growth. VEGF is related to angiogenesis of ESCC. The increase of VEGF may promote invasion and lymph node metastasis. AI and VEGF are significant prognostic factors in ESCC.

Objective To explore the technique and effect of selected three-field lymphadenectomy by left thoracotomy in treatment of thoracic middle or lower section esophageal squamous carcinoma. Methods From Jun. 2005 to Mar. 2009, 213 patients with thoracic middle or lower section of esophageal carcinoma received esophagectomy, bilateral mediastinal lymphadenectomy and pleural membrane resection.Group 1 -5, 7 - 12a, 16al, and 19 were performed to dissect abdominal lymph node and extended thoracic and abdominal lymphadenectomy and only lymph node extraction of mesoesophagus in neck field. Results 14197 lymphatic nodes(LN) were detected in 213 case. The average number of resected LN was 66. 65 ±24. 73. The metastatic lymph node was detected in 105 cases. The metastatic rate was 49.05% (105/213).There were 423 metastatic lymph nodes. The lymph nodes metastasis was 2. 97% (423/14197) of all dissected lymphatic nodes. No remnant carcinoma in the upper and lower cutting edge was found in pathological examination. The operation time ranged from 2. 92 ～ 4. 67 ( 3. 37 ± 0. 42) hours. Blood transfusion during perioperative period was 0 ～ 6u ( 1.08 ± 0. 93 ) u. Perioperative plasma transfusion was 0 ～ 1400( 103.77 ± 184. 89) ml. The hospital-time was 14 ～ 39 ( 17.64 ±4. 12) days. There were no anastomotic leakage and recurrent laryngeal nerve injury. One case died from respiratory failure, the mortality was 0. 04% ( 1/213). Conclusion Surgical approach in the management of left thoracotomy in the sixth intercostals could extend resection of chest-field lymph node dissection, decrease neck field lymph node dissection. Abdomen-field lymph node dissection reached selected D3. The selected lymphadenectomy procedure had the advantages of small traumas and few complications.

Objective To compare the differences between the schizophrenics with negative and positive symptoms on prefrontal lobe and thalamus by proton magnetic resonance spectroscopy ( 1 H-MRS). Methods 58 negative subtype and 51 positive subtype schizophrenics were examined at prefrontal lobe and thalamus by multivoxel 1H-MRS before antipsychotic treatment The N-acetylaspartate (NAA), choline-containing compounds ( Cho), and creatine compounds (Cr) were measured and the ratios of NAA/Cr, Cho/Cr were determined. Results On right thalamus,the NAA/Cr ratio in negative subtype patients ( 1.40 ± 0.29 ) demonstrated lower than that in positive subtype ( 1.62 ± 0.33 ), the same phenomenon were appeared on male, female, non-first-episode, with-medicine and without-medicine patients (P ＜ 0.05 or 0.01 ). The Cho/Cr ratio on right thalamus in negative subtype of female,non-first-episode,without-medicine schizophrenics were lower than those in positive subtype (P ＜ 0.05 ).On left prefrontal lobe,left thalamus and right thalamus, the NAA/Cr ratios both in negative subtype and positive subtype schizophrenics were significantly negatively related with age of onset(P＜0. 05 or 0.01 ). In negative subtype schizophrenics,the Cho/Cr ratio on right thalamus was positively related with age of onset ( r = 0. 25, P ＜0.05 ). In negative subtype schizophrenics of non-first-episode, without-medicine, the correlation was negative between the NAA/Cr ratio and the course of disease( r= -0.48, -0.46, P＜0.05 ) ,and was positive between Cho/Cr ratio and the course of disease on right thalamus( r= 0.58,0.56, P＜ 0.01 ). Conlusion Compared with positive subtype schizophrenics,negative subtype schizophrenics have greater impairments on 1 H-MRS on right thalamus. The course of disease has greater effects on 1 H-MRS in negative subtype schizophrenics.

Objective To explore the efficacy of laparoscopic Toupet fundoplication treatment of hiatal hernia combined with gastroesophageal reflux disease.Methods Forty one patients' medical record information of hiatal hernia combined with gastroesophageal reflux disease that underwent laparoscopic Toupet fundoplication were collected in Xinjiang Uygur Autonomous Region People's Hospital from October 2012 to October 2015.Thirty six cases were adopted pure hiatal hernia suture,2 cases were used biological patch repair,1 case used Johnson PHY patch repair,1 case used Bade patch repair,and 1 case used Tyco hiatal hernia dedicated anti-blocking patch repair.These patients were carried out 24 hours esophageal pH monitoring,esophageal manometry,gastroesophageal reflux disease questionnaire (GERDQ) score and postoperative complications before surgery and 6 months postoperative.The clinical efficacy of laparoscopic Floppy Nissen fundoplication treatment of hiatal hernia combined with gastroesophageal reflux disease was retrospectively analyzed.Results There was no perioperative deaths and serious complications during perioperation.The reflux symptoms were significantly improved postoperative.There was significantly lower in reflux time [(1.40 ± 2.10) h],the number of reflux (29.83 ± 19.71),acid reflux time percentage [(6.47 ± 8.79) ％],and DeMeester score (7.28 ± 7.38) than the preoperative [(2.04 ± 1.91) h,(120.40 ±82.72),(9.90 ±9.27)％,and (28.23 ±42.16),respectively].GERD Q scale score (7.18 ± 1.33) was significantly lower than preoperative (10.91 ± 2.02) with statistically significant difference (P ＜0.05).lower esophagealsphincter (LES) pressure [minimum resting breathing (7.24 ± 6.86) mmHg,and mean resting breathing (12.91 ± 6.89) mmHg] was significantly increased than preoperative [(0.70 ±6.15) mmHg,and (7.33 ± 7.72) mmHg,respectively].Residual pressure [average (8.16 ± 3.82) mmHg,and maximum (16.10 ± 12.05)mmHg] was significantly increased than preoperative [(4.36 ±4.77) mmHg,and (7.49 ± 5.15) mmHg,respectively].Relaxation rate [(58.50 ± 25.47) ％] was significantly reduced than preoperative [(62.27 ± 27.55) ％].However,swallowing invalid [(11.25 ± 21.04) ％]was increased than preoperative [(6.36 ± 10.26)％],with statistically significant difference (P ＜0.05).The median follow-up was 10 months,and there was no recurrence during follow-up.ConclusionsLaparoscopic Toupet fundoplication can effectively inhibit reflux symptoms,and increase LES pressure,which is worthy of promotion.However,there is slightly higher incidence of postoperative dysphagia.

Objective: To explore the risk factors of diabetic foot ulcer (DFU) in diabetic patients of Uyghur nationality and Han nationality in the Xinjiang Uygur Autonomous Region. Methods: Clinical data of 640 diabetic patients admitted to our ward from January 2015 to November 2016, conforming to the study criteria, were retrospectively analyzed. Patients were divided into DFU group (n=403) and non-DFU group (n=237) according to whether DFU occurred or not. The data of gender, age, nationality, body mass index (BMI), smoking, drinking, binge eating, triglyceride (TG), total cholesterol (TC), and high-density lipoprotein (HDL) of patients between two groups were compared with chi-square test and t test. Indexes with statistically significant differences between two groups were selected, and they were processed with non-conditional multivariate logistic regression analysis to screen the independent risk factors of DFU. The possible risk factors of DFU of patients of Uyghur nationality and Han nationality were further processed with non-conditional multivariate logistic regression analysis respectively to screen the independent risk factors of DFU of patients of Uyghur nationality and Han nationality. Results: (1) There were no statistically significant differences in gender, age, TC, and HDL of patients between two groups (with χ²=0.149, t values respectively 1.163, 1.033, and 1.026, P values above 0.05). There were statistically significant differences in nationality, BMI, smoking, drinking, binge eating, and TG of patients between two groups (with χ² values from 4.778 to 13.694, t values respectively 4.703 and 4.237, P<0.05 or P<0.01). (2) Nationality, BMI, smoking, drinking, binge eating, and TG were the independent risk factors of DFU(with odds ratios respectively 1.488, 1.527, 1.736, 1.738, 1.382, and 1.648, 95% confidence intervals respectively 1.315-3.175, 1.488-4.393, 1.834-4.675, 1.474-2.695, 1.342-4.678, and 1.105-6.747, P values below 0.05). (3) Smoking, drinking, binge eating, and TG were the independent risk factors of DFU in diabetic patients of Uyghur nationality (with odds ratios respectively 1.673, 1.387, 1.328, and 1.486, 95% confidence intervals respectively 1.384-1.765, 1.414-1.659, 1.423-1.687, and 1.150-1.670, P values below 0.05). BMI, smoking, and drinking were the independent risk factors of DFU in diabetic patients of Han nationality (with odds ratios respectively 2.442, 1.604, and 1.251, 95% confidence intervals respectively 2.223-2.699, 1.268-2.028, and 1.164-1.344, P<0.05 or P<0.01). Conclusions Smoking, drinking, binge eating, and TG were the independent risk factors of DFU in diabetic patients of Uyghur nationality. BMI, smoking, and drinking were the independent risk factors of DFU in diabetic patients of Han nationality.

Objective To discuss the treatment program and experience of " 4P" theory in the treatment of severe infection wounds of perineum.Methods Retrospective analysis of 123 cases of severe infection wounds of perineum in our hospital from March 2016 to February 2018.Following the "4P" theory (T wound debridement-preparation,I prevention and treatment of infection-protection,M dry-wet balanceprogress,E wound edge management-promotion),personalized treatment program was implemented to ensure the normal physiological activities of patients while closing the wound and promoting wound healing.Results There was no death and no serious complications.All the patients were discharged from the hospital after the wound healed well.Wound healing time was (10.37 ±3.25)days.The follow-up time was 2 to 10 months,the median follow-up was 6 months.The recurrence occurred in 3 case and chronic pain in 5 cases during the follow-up.Conclusions According to the main factors affecting wound healing,"4P Theory" can protect the wound to the maximum extent and is safe and effective in the treatment of severe infection of perineal wound.

OBJECTIVETo compare the efficacy and safety among laparoscopic Nissen, Toupet and Dor fundoplication in the treatment of hiatal hernia complicated with gastroesophageal reflux disease (GERD).

METHODSClinical data of 276 patients of hiatal hernia complicated with GERD undergoing operation in our hospital from December 2012 to January 2015 were retrospectively analyzed, including 149 patients of laparoscopic Nissen fundoplication (Nissen group), 41 of laparoscopic Toupet fundoplication (Toupet group), and 86 patients of laparoscopic Dor fundoplication (Dor group). Esophageal reflux status, esophageal manometry, GERD Q rating scale, and postoperative recovery were compare among the three groups.

RESULTSReflux status was improved significantly in the three groups after operation(all P<0.05),except that the efficacy in reducing reflux episodes and reflux longest time was not obvious in Toupet group(P>0.05). There were no significant differences in postoperative reflux time, acid reflux time ratio, reflux longest time ratio, DeMeester score among the three groups (all P>0.05). Pairwise comparison showed that Dor group was significantly better than Toupet group in reducing the number of reflux episode(14.36±10.58 vs. 29.83±19.71) and long-reflux (0.64±0.21 vs. 6.20±3.48)(both P<0.05), but Nissen group was better than these two groups in reducing the number of long-reflux (0.38±0.16, P<0.05). As compared to pre-operation, the postoperative esophageal sphincter pressure and residual pressure increased significantly, and the relaxation rate reduced significantly (all P<0.05), while the episode of ineffective swallowing increased significantly in Toupet group (11.25±2.04 vs. 6.36±3.26, P<0.05). The contrast in esophageal manometry between Toupet and Dor group showed that Dor group was better than Toupet group in the recovery of lower esophageal sphincter pressure (mean resting breathing) [(20.69±13.95) mmHg vs.(12.91±6.89) mmHg] and the decrease of ineffective swallowing [9.15±6.44 vs. 11.25±2.04](both P<0.05), while such results of Dor group were similar to Nissen group[(19.87±10.40) mmHg, 6.15±2.95, all P>0.05]. The GERD Q scores were significantly decreased after operation in 3 groups(Nissen group:10.94±2.20 vs.7.41±1.43, t=11.667, P=0.001; Toupet group: 10.91±2.02 vs.7.18±1.33, t=5.109, P=0.005; Dor group: 10.69±1.69 vs. 7.10±1.30, t=7.610, P=0.002). There was no significant difference in GERD Q scores among three groups (F=1.465, P=0.207). The operative time, blood loss, hospital stay and complications were not significantly different among 3 groups (all P>0.05). Follow-up period was 12-51 months (median 19 months), and no significant difference in recurrence was found [Nissen group: 2 cases (1.3%), Toupet group: 1 case (2.4%), Dor group: 1 case (1.2%), χ=0.363, P=0.834].

CONCLUSIONSIt is safe and feasible for these three laparoscopic fundoplications to the treatment of hiatal hernia complicated with GERD. But laparoscopic Nissen and Dor fundoplication are better than Toupet fundoplication in reducing the number of reflux episodes, suppressing long reflux, increasing lower esophageal sphincter pressure (mean resting respiration) and decreasing the incidence of postoperative dysphagia.

Blood Loss, Surgical ; Comparative Effectiveness Research ; Endoscopy, Gastrointestinal ; methods ; Esophageal Sphincter, Lower ; physiology ; surgery ; Fundoplication ; methods ; Gastroesophageal Reflux ; complications ; surgery ; Hernia, Hiatal ; complications ; surgery ; Humans ; Length of Stay ; Manometry ; Operative Time ; Postoperative Complications ; epidemiology ; Recurrence ; Retrospective Studies ; Treatment Outcome

OBJECTIVETo investigate the clinical efficacy of argon plasma coagulation (APC) combined with laparoscopic hiatal hernia repair and fundoplication in the treatment of hiatal hernia associated with Barrett esophagus.

METHODSA total of 61 cases of hiatal hernias with Barrett esophagus from June 2010 to January 2014 in the Department of Minimal Invasive Surgery, Hernia and Abdominal wall Surgery, People's Hospital of Xinjiang Uyhur Autonomous Region were prospectively enrolled and were randomly allocated into two groups by computer system. Twenty-nine patients received esomeprazole 40 mg/d after APC treatment for 8 weeks (APC with medicine group). Thirty-two patients underwent laparoscopic hiatal hernia repair and Nissen fundoplication after APC treatment (APC with surgery group). All the patients were reviewed by gastroscope and pathologic examination at half a year and one year after operation respectively. Differences of disease improvement and recurrence between the two groups were evaluated.

RESULTSIn APC with medicine group, the Barrett's esophagus was relieved after one or two times of APC treatment, however, gastroscope and pathology revealed recurrence of Barrett's esophagus in 7 cases at half a year, and cumulative 16 cases of recurrences were detected after one year follow-up(16/29, 55.2%). In APC with surgery group, only one patient had recurrent Barrett's esophagus at half a year, and a total of two at one year follow-up by gastroscope examination(2/32, 6.3%). Significantly low recurrence rate of Barrett's esophagus was observed in APC with surgery group compared to APC with medicine group(P<0.01). Furthermore, recurrent hiatal hernia was detected in only one case in APC with surgery group. No esophageal cancer was found in both groups during follow-up.

CONCLUSIONAPC combined with laparoscopic hiatal hernia repair and fundoplication is an ideal method for patients with hiatal hernia and Barrett's esophagus.