Objective To investigate the clinical effect and safety of fast track surgery in perioperative management in elderly patients with hepatic cancer.Methods 56 cases with hepatic cancer undergoing hepatic surgery were chosen,and randomly divided into observation group and control group (n=28 for each).Patients in observation group were treated with fast track surgery in perioperative management,and patients in control group were treated with conventional treatment.The C reactive protein level,liver function indexes,anal exhaust time,length of stay,adverse reactions and complications were compared between the two groups.Results The C reactive protein level had no difference between the observation group and control group 7 days after surgery [(8.6± 1.4) mg/L vs.(9.2± 2.1) mg/L,P＞0.05].There were significant differences in the levels of alanine aminotransferase,glutamic oxalacetic transaminase,total bilirubin and serum albumin between observation and control groups [(58.0±10.3)U/L vs.(100.3±25.7) U/L,(59.5±21.5) U/L vs.(99.1±29.7) U/L,(21.2±10.0) mmol/L vs.(35.9±8.6) mmol/L and (35.8±2.4) g/L vs.(32.1±2.1) g/L,all P＜0.001].The anal exhaust time and length of stay were less in observation group than in control group [(17.4±2.3) hours vs.(26.3±9.6) hours and (11.5±1.8) days vs.(14.8±3.4) days,both P＜0.001].There were 7 cases with nausea,4 cases with vomiting,8 cases with abdominal distention and 3 cases with abnormal liver function in observation group,and 9 cases with nausea,5 cases with vomiting,7 cases with abdominal distention and 4 cases with abnormal liver function in control group after surgery.There was no significant difference in the rate of adverse reactions between the two groups (P＞ 0.05).Conclusions Fast track surgery in perioperative management is safe for elderly patients with hepatic cancer,which can reduce the stress reaction,improve liver function,shorten anal exhaust time and length of stay,reduce complications and promote the rehabilitation,and it is worthy of clinical application.

Background and purpose: miR-210 was closely related to the occurrence and development of gastric cancer, but its mechanism and clinical significance were still not clear. The purpose of this study was to explore the expression of miR-210 in gastric cancer tissues and its clinical significance. Methods: The expression of miR-210 was detected in gastric cancer tissues and the corresponding adjacent tissues. The relationship between the expression of miR-210 and clinical pathological factors and prognosis was analyzed. Results: Real-time fluorescent quantitative polymerase chain reaction (RTFQ-PCR) showed that the expression of miR-210 in gastric cancer was higher than that in adjacent tissues, and there was a significant difference between the two groups (P<0.05). The expression of miR-210 was closely related to tumor size, lymph node metastasis and TNM stage, but was not related to age, gender, tumor dif-ferentiation and depth of invasion. The 5-year survival rate of patients with low miR-210 expression was 48.2%, where-as the 5-year survival rate of patients with high miR-210 expression was 30.4% (χ2=4.216, P=0.040). Conclusion: The expression of miR-210 in gastric cancer was higher than that in adjacent tissues, and maybe related to the development and prognosis of gastric cancer. miR-210 is expected to be a new diagnostic marker and therapeutic target for gastric cancer.

0.05). Conclusion The value of muscular loop substitute valve of the popliteal vein in the treatment of DVI remains to be further evaluated.

Objective To investigate the clinical efficacy of middle segment pancreatectomy (MSP) in treatment for pancreatic neck and body tumors.Methods From Jan.2000 to Dec.2016,the clinicopathological data of 26 patients with pancreatic neck or body tumors were analyzed retrospectively.Results All of the 26 patients received middle segment pancreatectomy.14 cases had serous or mucinous cystadenomas.The tumor diameter was 2.3 to 5.6 cm (averaging from 3.8 cm).9 cases had solid pseudopapillary tumors.The tumor diameter was 3.3 to 5.0 cm(averaging from 3.6 cm);One case had insulinoma and the diameter was 2.0 cm.Two cases had nonfunctional pancreatic neuroendocrine tumors,and the diameter was 2.1 and 2.4 cm.The post-complication morbidity rate was 53.8％.The main post-complications of the group were pancreatic fistula (9 cases,34.2％),intra-abdominal infection(1 case,3.8％),delayed gastric emptying (2 cases,7.6％),lymphatic fistula (1 case,3.8％),and abdominal infection (1 case,3.8％).All of the 26 patients healed after surgery without undergoing surgery again.There were no mortality during perioperative period.All patients were followed up for 6 to 60 months.All of the 26 patients had good life quality,without new-onset diabetes or cancer recurrence during the follow-up period of 6 to 60 months after operation.Conclusion Middle segment pancreatectomy is safe and feasible in treatment of benign or low-graded malignant pancreatic neck and body tumors and is capable of preserving pancreatic endocrine and exocrine function.

Objective To evaluate the effect of microecologic treatment combined enteral nutrition on serum endotoxin,tumor necrosis factor-α (TNF-α),interleukin-18 (IL-18),blood ammonia levels and nutritional status in patients with hepatic encephalopathy.Methods 60 patients with hepatic encephalopathy were allocted randomly into 3 groups,on the basis of conventional liver protective therapy and uragogue with one group given probiotics plus enteral nutrition,one given probiotics only,and the 3rd group given intravenous nutrition.The whole course of treatment was four weeks.Serum levels of endotoxin,TNF-α,IL-18,ammonia and albumin were determined before and on the 7th and 14th day after treatment.Results The levels of serum endotoxin,TNF-α,IL-18 and blood ammonia in the combined treatment group decreased remarkably after treatment,while the level of serum albumin elevated markedly.The difference was significant at statistics as compared with the only probiotics group and intravenous nutrition group (P＜0.05).Conclusion Microecologic treatment combined enteral nutrition could effectively reduce blood ammonia and serum endotoxin levels,protect intestinal mucosal barrier,as well as improve nutritional status of patients with hepatic encephalopathy,which was considered as a safe and efficient therapy.

Objective: To investigate the safety and feasibility of proximal partial gastrectomy with Cheng's Giraffe esophagogastric reconstruction for the treatment of early Siewert II adenocarcinoma of esophagogastric junction (AEG). Methods: Indication of Cheng's Giraffe esophagogastric reconstruction: (1) Siewert II AEG or Siewert III AEG with diameter < 4 cm; (2) preoperative staging as cT1-2N0M0. A descriptive case series study was carried out. Clinical data of 34 patients with Siewert II AEG undergoing proximal partial gastrectomy and Cheng's Giraffe esophagogastric reconstruction at Department of Abdominal Surgery of Zhejiang Cancer Hospital and Department of Gastrointestinal Surgery, The First Affiliated Hospital of Zhejiang University of Traditional Chinese Medicine from February to July 2018 were retrospectively collected and analyzed, including 14 cases in IA stage, 11 cases in IIA stage and 8 cases in IIB stage. Brief procedure of Cheng's Giraffe esophagogastric reconstruction was as follows: Firstly, 12 cm long tubular stomach was formed by longitudinal incision 4 cm away from the great curvature of the stomach. Secondly, the gastric fundus and His angle were formed. Finally, the distance from His angle to esophagal-tubular gastric anastomosis should be more than 5 cm. The reflux disease questionare (RDQ) scores, radionuclide gastric emptying scintigraphy, and 24-hour multichannel intraluminal (MII)-pH monitoring technology were used to evaluate postoperative gastric emptying and gastroesophageal reflux. Result: All 34 patients successfully completed proximal partial gastrectomy with Cheng's Giraffe esophagogastric reconstruction, including 13 cases by open surgery and 21 cases by laparoscopic surgery. The operation time was (144.6±39.8) minutes, the blood loss during operation was (35.4±17.2) ml. No laparoscopic case was converted to open surgery and no postoperative complication was observed. The postoperative hospital stay was (8.4±2.5) days. The postoperative RDQ score was 4.4±3.1 one month after operation, and 3.3±2.5 six months after operation. Gastric-half emptying time was (67.0±21.5) minutes, and the residual ratio was (52.2±7.7)% in 1 hour, (36.4±3.1)% in 2 hours and (28.8±3.6)% in 3 hours at postoperative 1-month. The 24-hour MII-pH monitoring at postoperative 2-month revealed the frequency of acid reflux was (12.6±7.9) times, frequency of non-acid reflux was (19.6±9.7) times, DeMeester score was 5.8±2.9. Conclusion Cheng's Giraffe esophagogastric reconstruction is safe and feasible in the treatment of Siewert type II AEG, and has good dynamic and anti-reflux effects.