Surgery for gastric cancer is based on basic surgical techniques and modern theory of surgery.Accurate and safe surgical procedures are carried out based on application of scientific principles.The knowledge of gastric anatomy,physiology and pathophysiology is the basis of the gastric cancer surgery.The technical aspects of vascular control,lymph node dissection,digestive tract resection and reconstruction are important for the gastric cancer surgery.Full use of these techniques and mastery of the technology is an important guarantee for reducing surgical complications,improving the quality of life and longterm survival of gastric cancer patients.

Gastrectomy ; Gastroenterostomy ; Humans ; Laparoscopy ; Reconstructive Surgical Procedures ; Stomach Neoplasms

Scirrhous gastric carcinoma is a special type of gastric carcinomas and accompanied with highly interstitial fibrosis and diffuse cellular infiltration.Scirrhous gastric carcinoma is mainly composed of poor-differentiated adenocarcinoma and signet-ring cell carcinoma,with the clinical features of Borramann 4,thickening and stenosis of stomach wall,high peritoneal and lymph node metastases rates and poor prognosis.R0 resection and postoperative chemotherapy with S-1 as a main way are necessary for the patients who are able to undergo curable resection.The palliative operation should be applied to patients with ileus and urinary obstructions caused by peritoneal metastasis because of limited effect of surgical treatment.Chemotherapy is the best choice for patients who are not able to undergo curable resection,conversional therapy can improve the prognosis of patients,and preoperative S-1/CDDP combination chemotherapy is an expectable therapy.Moreover,controlling peritoneal metastasis and effect of intraperitoneal chemotherapy are much anticipated.The efficiency of molecular targeted therapy by bevacizumab and gene therapy by adenovirus remain further study.

Radical operation is very essential for gastric cancer, and the reasonable digestive tract reconstruction is an important part affecting the prognosis and quality of life of patients.After gastrectomy, the most basic requirements for reconstruction include prevention of gastrointestinal fluid reflux, keeping food storage and emptying function, physiological pathways and endoscopic inspection of biliary tract, pancreas and gastric remnant.In addition, technical level of reconstruction,safe operation, low invasion and suture technique cannot be ignored.Since complex digestive tract reconstruction can cause many complications, the method in the research stage should be carefully chosen.

Scirrhous gastric carcinoma is a special type of advanced gastric cancer accompanied by extensive interstitial fibrosis and diffuse cellular infiltration. Scirrhous gastric carcinomas are commonly classified as Borrmann 4 gastric carcinomas. Poorly differ-entiated adenocarcinoma and gastric signet ring cell carcinoma are observed during histologic typing. Thickening of the stomach and stenosis are characteristic of scirrhous gastric carcinomas. The prognosis of this type of gastric cancer is poor because of the likelihood of peritoneal metastasis and lymph node metastasis and the limited cure rates of simple surgery. However, operation should be conduct-ed when scirrhous gastric carcinomas are associated with ileus and urinary obstruction induced by peritoneal metastasis. R0 resection and postsurgical chemotherapy with S-1 are necessary for patients who are able to undergo recoverable operations. Preoperative S-1/CDDP combination chemotherapy is the preferred therapy. Moreover, chemotherapy is the best choice for patients who are unable to un-dergo recoverable surgery. Intraperitoneal chemotherapy is practical for controlling the behavior of scirrhous gastric carcinomas, partic-ularly peritoneal metastasis. Moreover, the efficiency of molecular-targeted therapy using bevacizumab and gene therapy through adeno-virus gene therapy still requires further study.

Resection of the automonic nervous system in the process of lymph nodes dissection is a major factor leading to postoperative gastrointestinal dysfunction.The era of blind expansion of the wide excision has been questioned,and safety first,radical dissection of the metastatic lymph nodes,low invasive rate and organ function-saving surgery have been highly emphasized.Preserving the gastric autonomic nerve effectively reduces postoperative diarrhea,shortens the time for weight recovery,and prevents insulin secretion disorders and postoperative cholelithiasis.In the process of laparoscopic or open autonomic nerve preservation in lymph node dissection for gastric cancer,full understanding of the anatomy of the autonomic nervous system,recognizing the landmark of the nerves,proper designing the surgical space,dissecting according to the extracellular space in the membrane of the nerve fibers and nerve plexus are factors which ensures the quality and effects of the surgery.

Objective:To investigate the content of cancer stem-like cells in different human colorectal cancer ce11 lines and explore the methods for enriching cancer stem-like cells in SW480.Methods:The percentage of side population cells(SP)in human colorectal cancer cell lines LOVO,SW480,HCT116 were detected by flow cytometry.SW480 cell line was cultivated in serum-free medium(SFM)supplemented with growth factors and cancer stem-like cells reforming into floatingspheres were isolated.The isolated cancer stem-like cells were identified by limiting-dilution assay,differentiation assay,self-renewal assay,alternative cultivation assay.Results:The percentage of SP cells was 1.0% in LOVO,1.2% in SW480 and 1.3% in HCT116.In the absence of serum,a minority(0.54%￣0.62%)of cancer stem-like cells in SW480 cells survived,proliferated and assembled into the suspended tumor cell spheres.SW480 cancer stem-like cells possessed proliferative,self-renewal and differentiation potential,which were responsible for the floating tumor clone.Serum addition into SFM resulted in the proliferation of cancer stem-like cells;after several generations and alternated cultivation in SSM and SFM,cancer stem-like cells maintained their characters.Conclusion:LOVO,SW480 and HCT116 cell lines contain a tiny minority of SP cells with stem cell properties.The cancer stem-like cells in SW480 line can be maintained in SFM using a floating culture method.

Stage Ⅳ gastric cancer is defined as gastric cancer with non-curative factors,and the long-term survival rate of patients with stage Ⅳ gastric cancer is around 10％.Chemotherapy has been used for the main therapy of the patients with unresectable stage Ⅳ gastric cancer.Palliative resection of the primary tumor has been recommended only for presence of obstruction,bleeding and other surgical emergency.Debulking operation was irrelevant to the outcome that has been considered by research results.However,the patients with stage Ⅳ gastric cancer of only one non-curative factors (No.16a2,b1 lymph node enlargement;degree of peritoneal metastasis as P0 and positive peritoneal cytology;a small number of liver metastases)have good long-term survival when these patients have achieved R0 or R1 resection.In this regard,comprehensive treatment including surgical resection is the main treatment policy for the patients with stage Ⅳ gastric cancer.In recent years,some clinical studies on improvement of prognosis through surgical resection after conversion therapy have received extensive attention.

Objective To investigate the risk factors of pneumonia in patients with non ST segment elevation-acute cononary syndromes (NSTE-ACS).Methods A total of 183 cases with NSTE-ACS was divided into pneumonia and non-pneumonia groups.The possible risk factors were screened firstly,then nonconditional logistic model multivariate analysis was used to investigate risk factors including age,sex,weight,smoking,chronic obstructive pulmonary disease (COPD),hypertention,diabetes,left ventricular failure,renal failure,low serum albumin,early revascularization and early rehabilitation exercise on the occurrence of pneumonia in NSTE-ACS.Results The differences were statistically significant in factors including age,smoking,COPD,diabetes,left ventricular failure,renal failure,low serum albumin,early revascularization,and early rehabilitation exercise between two groups (P ＜ 0.05).By analysis of logistic,risk factors on the occurrence of pneumonia in NSTE-ACS were age,smoking,COPD,diabetes,left ventricular failure,renal failure,and low serum albumin(P ＜0.05).Early revascularization and early rehabilitation exercise were the protective factors to avoid pneumonia.Conclusions Left ventricular failure,age,smoking,COPD,diabetes,renal failure,and low serum albumin were the risk factors of pneumonia occurred in NSTE-ACS,but early revascularization and early rehabilitation exercise were the protective factors to avoid pneumonia.Actively treating the risk factors and early initiating the protective factors can effectively reduce the incidence of pneumonia.

Objective To evaluate the methods for improving diagnostic ratio of unruptured ectopic pregnancy with ultrasonography. Methods A total of 139 patients of small adnexal cysts with thick wall were predicted respectively with sonographic indexes. All patients (61 with unruptured ectopic pregnancy and 78 with small corpusluteum) were confirmed postoperatively or with long-term follow up, and the results were compared. Results The diagnostic sensitivity of with hyperecho or isoecho compared with endometrium, hyperecho compared with ovarian tissue, adnexal cyst without small follicle around was 86.89%, 93.44% and 96.72%, and the specificity of three predictors was 93.59%, 85.90% and 70.51%, respectively. Two sonographic indexes together had a sensitivity of 98.36% and a specificity of 94.87% for diagnosing ectopic pregnancy. Conclusion Observing the relation of adnexal cyst and ovarian and the echogenic of cyst wall are specific and sensitive for the diagnosis of ectopic pregnancy.