Objective To compare the quality of life,nutritional status,and immune function after radical proximal gastrectomy,radical total gastrectomy,or radical distal gastrectomy.Methods Totally 163 patients underwent radical gastrectomy for gastric cancer in our department from Jun 2002 to Jun 2008,among whom 36 cases underwent proximal gastrectomy,and 78 cases underwent total gastrectomy,and 49 cases underwent distal gastrectomy.The indicators for their quality of life,nutritional status,and immune function were compared among these three groups.Results The scores for anxiety was significantly higher in the radical proximal gastrectomy group compared with radical total gastrectomy and radical distal gastrectomy groups 1 year(79.8 ± 4.3 vs 72.2 ± 5.2and 70.6±5.5,P=0.037)and 2 years(80.3 ±4.4 vs 70.2±4.8 and 68.6±5.3,P=0.041)after surgery.The scores for the sense of taste was significantly higher in the radical total gastrectomy group compared with radical proximal gastrectomy and radical distal gastrectomy groups 1 year(82.6 ± 1.3 vs 71.1 ±4.8 and 72.3 ± 3.6,P =0.033)and 2 years(88.1 ± 3.4 vs 65.6 ± 5.2 and 69.6 ± 4.8,P =0.046)after surgery.The scores for body appearance was significantly higher in the radical total gastrectomy group compared with radical proximal gastrectomy and radical distal gastrectomy group 0.5 years(45.5 ± 2.4 vs 35.6 ± 2.2 and 33.3 ± 2.5,P =0.031),1 year(49.2 ± 1.9 vs 33.2 ±2.8 and 32.7 ±2.3,P =0.039),and 2 years(47.6 ±2.5 vs 32.4 ±4.0 and 30.0 ± 2.2,P =0.025)after surgery.The scores for dysphagia was significantly lower in the radical distal gastrectomy group compared with radical proximal gastrectomy group and radical total gastrectomy group 1 year (26.6±3.0vs38.1±2.2 and 35.1 ±2.3,P=0.043)and 2 years(17.3±2.5 vs 36.3±3.1 and 34.1 ±2.4,P =0.021)after surgery.The scores for stomach pain was significantly higher in the radical proximal gastrectomy group compared with radical total gastrectomy 0.5 years(41.2 ± 3.3 vs 37.1 ± 2.5,P =0.039),1year(38.1±2.2vs35.1±2.2,P=0.023),2 years(36.3±3.1 vs 34.1±2.4,P=0.034)after surgery.Radical distal gastrectomy group were significantly lower than those in radical proximal gastrectomy group and radical total gastrectomy group 0.5 years(38.6 ± 3.7 vs 55.3 ± 4.2 and 42.3 ± 3.9,P =0.034),1 year(35.4 ± 3.4 vs52.3 ±3.9 and 39.3 ±4.2,P=0.040),and 2 years(31.6±3.7 vs 53.3 ±4.2 and 35.5 ±3.7,P=0.011)after surgery.Radical proximal gastrectomy group compared with radical total gastrectomy,0.5 years(55.3 ± 4.2vs 42.3±3.9,P=0.036),1 year(52.3±3.9 vs 39.3±4.2,P=0.042),2 years(53.3±4.2 vs 35.5±3.7,P =0.019)after surgery,the difference has statistically significant.The scores for hiccup was significantly lower in the radical distal gastrectomy group compared with radical proximal gastrectomy group and radical total gastrectomygroup,0.5 years(16.8±3.3 vs 45.6±2.5 and 40.3±2.8,P=0.019),1 year(15.6±3.4 vs 40.7±2.3 and 36.5 ± 3.1,P =0.025),2 years(14.4 ± 2.6 vs 39.3 ± 1.9 and 35.6 ± 3.2,P =0.042)after surgery.Radical proximal gastrectomy group compared with radical total gastrectomy 0.5 years(45.6 ± 2.5 vs 40.3 ± 2.8,P=0.039),1 year(40.7±2.3 vs 36.5±3.1,P=0.019),2 years(39.3±1.9 vs 35.6±3.2,P=0.028)after surgery,the difference has statistically significant.In the restricted diet,the radical distal gastrectomy group had significantly lower scores compared with radical proximal gastrectomy group and radical total gastrectomy group 0.5 years(22.4 ±3.8 vs 38.4 ±2.3 and 42.1 ±3.1,P=0.020),1 year(18.7 ±2.3 vs 35.3 ±3.2 and 36.8 ±3.4,P =0.018),and 2 years(16.5 ± 2.7 vs 33.4 ± 2.7 and 32.4 ± 2.8,P =0.026)after surgery.The level of albumin in different periods was significantly lower in radical total gastrectomy groups compared with radical proximal gastrectomy and radical distal gastrectomy group 0.5 years[(30.6 ± 2.5)vs(34.3 ± 2.6)and(35.4 ±2.5)g/L,P=0.025],1 year[(32.4±2.1)vs(35.3 ±2.2)and(38.9 ±2.0)g/L,P=0.041],2 years [(32.1 ±2.4)vs(36.4 ±2.1)and(42.4 ±2.3)g/L,P=0.016]after surgery.The level of prealbumin in different periods was significantly lower in radical total gastrectomy groups compared with radical proximal gastrectomy and radical distal gastrectomy group 0.5 years[(209.1 ±5.7)vs(218.2 ±5.9)and(225.5 ±7.6)mg/L,P =0.030],1 year[(215.5 ±4.6)vs(223.1±3.7)and(236.1 ±4.4)mg/L,P=0.019],2 years[(216.1 ±3.1)vs(221.5 ± 4.3)and(240.5 ± 5.6)mg/L,P =0.024)]after surgery.The level of transferrin in different periods was significantly lower in radical total gastrectomy groups compared with radical proximal gastrectomy and radical distal gastrectomy group 0.5 years[(153.1 ± 3.2)vs(167.9 ± 2.4)and(170.3 ± 3.8)mg/L,P =0.017],1 year[(157.1 ±3.8)vs(169.4±2.2)and(175.4±3.7)mg/L,P=0.040],2 years[(156.4±2.7)vs(173.1 ± 1.8)and(174.1 ±2.8)mg/L,P =0.031]after surgery.The level of hemoglobin in different periods was significantly lower in radical total gastrectomy groups compared with radical proximal gastrectomy and radical distal gastrectomy group 0.5 years[(109.5 ± 4.6)vs(120.2 ± 2.7)and(122.6 ± 3.9)g/L,P =0.016],1 year[(103.6±2.9)vs(117.5 ±16.6)and(125.2±1.5)g/L,P =0.030],2 years[(105.5 ±1.6)vs(106.6 ± 2.9)and(132.6 ± 2.9)mg/L,P =0.028]after surgery.The level of retinol binding protein in different periods was significantly lower in radical total gastrectomy groups compared with radical proximal gastrectomy and radical distal gastrectomy group 0.5 years[(32.3 ± 2.1)vs(167.9 ± 2.4)and(37.6 ± 2.8)mg/L,P =0.013],1 year[(33.9 ± 1.6)vs(39.3 ±2.5)and(38.5 ±3.5)mg/L,P=0.009],2 years[(35.3 ±2.7)vs(38.9 ± 1.4)and(39.1 ±2.3)mg/L,P =0.034]after surgery.The weight in different periods was significantly higher in radical distal gastrectomy groups compared with radical proximal gastrectomy and radical total gastrectomy group 0.5 years[(63.4±2.5)vs(60.7 ±3.2)and(59.4±1.1)kg,P=0.017],1 year [(66.1 ±3.7)vs(59.4±2.1)and(56.4±6.1)kg,P=0.028],2 years[(67.4 ±4.1)vs(57.4 ±4.1)and(53.3 ± 2.4)kg,P =0.035]after surgery.The level of CD4 + in different periods was significantly lower in radical total gastrectomy groups compared with radical proximal gastrectomy and radical distal gastrectomy groups 0.5 years(30.46 ±4.45 vs 33.32 ±5.6 and 34.24 ±2.54,P =0.036),1 year(32.84 ± 3.61 vs 35.30 ±4.27and 35.49±3.01,P=0.025),and 2 years(31.61±4.04 vs36.24±4.71 and 37.74±4.15,P=0.030)after surgery.Also,the radical total gastrectomy group had significantly lower CD8 + than radical proximal gastrectomy and radical distal gastrectomy groups 0.5 year(24.16 ± 5.07 vs 24.12 ± 5.9 and 25.25 ± 3.54,P =0.036),1 year(32.84 ±3.61 vs 35.30 ±4.27 and 35.49 ±3.01,P =0.025),and 2 years(31.61 ±4.04 vs36.24 ±4.71 and 37.74 ±4.15,P =0.030)after surgery.The level of IgM in different periods was significantly lower in radical total gastrectomy groups compared with radical proximal gastrectomy and radical distal gastrectomy group 0.5 year(1.20 ±0.17 vs 1.36 ±0.22 and 1.41 ±0.27,P =0.026),1 year(1.25 ±0.14 vs 1.38 ±0.19 and 1.40 ± 0.15,P =0.037),and 2 years(1.29 ± 0.17 vs 1.39 ± 0.16 and 1.42 ± 0.13,P =0.017)after surgery.Also,the radical total gastrectomy group had significantly lower IgA than radical proximal gastrectomy and radical distal gastrectomy groups 0.5 year(2.03 ± 0.21 vs 2.47 ± 0.32 and 2.43 ± 0.25,P =0.020),1 year(2.14 ±0.21 vs 2.64 ±0.23 and 2.52 ±0.17,P =0.025),and 2 years(2.25 ±0.19 vs 2.63 ±0.18and 2.74 ± 0.16,P =0.033)after surgery.Conclusion The distal gastrectomy may have better quality of life,nutrititional status,and immune function than the proximal gastrectomy and total gastrectomy,whereas the latter two procedures also have certain advantages.

Objective To report a new approach of splenic hilar lymph nodes dissection in radical gastrectomy for gastric cancer. Methods 193 cases of gastric cancer patient receiving radical resection of gastric cancer between May 2008 and October 2008 were studied. The tail and body of spleen and pancreas were thoroughly freed with retroperitoneal way retrogressively and extruded out of abdominal cavity in 80 cases. The other 113 cases received operation with routine way. Results In 80 cases who received operation with retroperitoneal approach retrogressively, the total splenic hilar lymph nodes were 519, the positive ones were 65, the positive rate was 12.5 %; In the other 113 cases the total splenic hilar lymph nodes were 565, the positive ones were 58, the positive rate was 10.3 %. The positive rate had statistic significance between these two groups. Conclusion Extruded splenic hilar lymph nodes dissection with retroperitoneal approach retrogressively is safe and has the same effect with splenectomy in gastric cancer operation.

Objective To investigate the clinical effects of pedicled omentum covering the intestinal anastomotic stoma in preventing anastomotic fistula.Methods The clinical data of 133 patients with high risk of intestinal anastomotic stoma who were admitted to the Henan Tumor Hospital from May 2009 to May 2012 were retrospectively analyzed.All patients were divided into the improvement group (69 patients) and the control group (64 patients) according to whether the anastomotic stoma was covered by pedicled omentum.All the operations were done by the surgeons in the same group,and the intestinal reconstruction was done by the equipment produced by the same company.All the patients with intestinal tumors received radical resection.The clinical data of the patients in the 2 groups were reviewed and the therapeutic effects of the 2 approaches were compared.All data were analyzed using the chi-square test.Results Three (4.3％) patients had intestinal fistula in the improvement group,including 1 had small bowel anastomotic fistula,1 had small bowel and colonic anastomotic fistula,1 had colonic anastomotic fistula.Eight (12.5％) patients in the control group had intestinal anastomotic fistula,including 1 had duodenal anastomotic fistula,2 had small bowel anastomotic fistula,2 had small bowel and colonic anastomotic fistula,and 3 had colonic anastomotic fistula.There was a significant difference in the incidence of anastomotic fistula between the 2 groups (x2 =5.483,P ＜ 0.05).The highest body temperatures of the 3 patients in the improvement group were under 38.2 ℃,and the mean white blood cell count was 8.4 × 109/L;no peritonitis was detected; turbid drainage was observed in the peritoneal tube around the anastomotic stoma.The results of computed tomography showed local inflammation.The highest body temperatures of the 8 patients in the control group were above 38.5 ℃,and the mean white blood cell count was 14.4 × 109/L; obvious pressing pain and rebound tenderness were detected; intestinal contents were observed in the peritoneal drainage tube.The 3 patients in the improvement group were cured by symptomatic treatment.Of the 8 patients in the control group,7 received two-stage debridement,and 1 received jejunostomy and 3 received ileostomy.The condition of the 7 patients was recovered after operation,and reversion of the ileum at postoperative month 4.One patient died of multiple organs dysfunction syndrome and systemic inflammatory response syndrome.Conclusion Intestinal anastomotic stoma covered by pedicled omentum could effectively decrease the incidence of anastomotic fistula and alleviate systemic inflammatory response syndrome caused by anastomotic fistula.

Objective To explore the relations between the post pancreatoduodenectomy pancreatic anastomotic hemorrhage and the length of pancreatic duct endoprosthesis placed in the jejunum.Methods From August 2006 to August 2011,63 patients underwent pancreaticoduodenectomy with the adopted child method for digestive tract reconstruction,while pancreaticojejunostomy reconstruction was divided into A,B,C groups.There were 22 cases in A group,and patients underwent pancreaticojejunostomy with anastomosis of the pancreatic stump into the jejunum strapping method,the length of pancreatic duct endoprosthesis placed in the jejunum was 15 cm; there were 21 cases in B group,and patients received the same operation as patients in group A,but the length of pancreatic duct endoprosthesis placed in the jejunum was 5 cm; there were 20 cases in C group,and patients received pancreatic stump and jejunal mucosa anastomosis,the length of pancreatic duct endoprosthesis placed in the jejunum was 5 cm.Results In group A,two cases (9.1％) of pancreatic anastomotic hemorrhage occurred,and patients were cured by conservative treatment.In group B,eight cases (38.1％) of pancreatic anastomotic hemorrhage occurred,and two cases died of gastrointestinal bleeding; 3 cases received surgical operation to stop bleeding,and 3 patients were cured by conservative treatment.There was no anastomotic hemorrhage occurred in group C.The bleeding times of group A and group B were about 15 days after surgery,the difference of incidence of anastomotic bleeding between the two groups was statistically significant (x2 =9.428,P =0.009).Conclusions Post pancreaticojejunostomy anastomotic hemorrhage is associated with short length of pancreatic duct endoprosthesis placed in the jejunum.

Objective To study the trans-bladder operative approach in resection of the complicated pelvic tumors with bladder invasion.Methods Twelve patients with complicated pelvic tumors were analyzed from Oct.2007 to Oct.2010.There were 8 males and 4 females.Patient's age was ranging from 35 to 65 years.There were 3 patients with tumor diameter from 10 to 16 cm and 9 patients with tumor diameter greater than 16 cm.All the tumors were located in the pelvic and the stage of all tumors was T4N0M0.The technology of trans-bladder to approach the lower edge of the pelvic tumor and then retrograde up to remove the tumor out of the presacral tissue,pelvic wall,and pelvic organ was applied.The length of hospital stay,operative time,blood loss,death during peri-operative period and the post-operative survival were analyzed retrospectively.Results The median operative time was 126 (110-150) min.The median blood loss was 521 (300-1200) ml.The median hospital stay was 22 (14-28) d.No patient died after surgery.Ten patients were followed up for 6 to 48 months.Three cases died of metastasis or recurrence.Conclusion With the trans-bladder operative approach,the resection of pelvic retroperitoneal tumors is effective and safe.

Objective To investigate the effects of pancreaticoenterostomy by separating and continuous suture on pancreatoduodenectomy.Methods The clinical data of 76 patients who underwent curative pancreaticoduodenectomy from March 2002 to October 2014 in Tumor Hospital of Zhengzhou University were retrospectively analyzed.Of all the patients,43 received pancreaticoenterostomy by separating and continuous suture (study group),and the other 33 patients received BPJ anastomosis (control group).All the patients used Child reconstruction,the diagnosis of pancreatic fistula was made according to ISGPF criteria.The operation time of pancreaticoenterostomy,the incidence of hemorrhage of anastomosis and the incidence of pancreatic fistula were retrospectively analyzed.Results The age,sex,hemoglobin,albumin,total bilirubin,the incidence of co-morbidity of diabetes,extent of surgical resection between 2 groups were comparable without significant difference.In study group,the time of pancreaticoenterostomy was 11 min(8 ～ 15 min),there were 4 patients with class Ⅰ pancreatic fistula,and 1 patient with class Ⅱ pancreatic fistula.No patient developed class Ⅲ pancreatic fistula or anastomotic bleeding.In control group,the time of pancreaticoenterostomy was 16 min(12 ～25 min) which was only available for 5 patients,and no records for other patients.There were 6 patients with pancreatic fistula including 4 patients with class Ⅱ,2 patients with class Ⅲ,while no records for class Ⅰ.Four patients were found to have anastomotic bleeding.Conclusions With the pancreaticoenterostomy by separating and continuous suture method,the surgical field is fully exposed,the suture time is shortened and the incidence of anastomotic bleeding and pancreatic fistula is reduced.

Objective To investigate the efficacy of wrapping and suturing of pancreatic stump with the avascular zone of the transverse mesocolon for preventing pancreatic leakage after distal pancreatectomy.Methods The clinical data of 69 patients who received distal pancreatectomy at the Affiliated Tumor Hospital of Zhengzhou University from May 2011 to March 2014 were retrospectively analyzed.The pancreatic stump was wrapped with the avascular zone of the transverse mesocolon after suturing the pancreatic stump in 34 patients (the modified group),and the pancreatic stump of 34 patients was sutured without any other treatment (the control group).The time for pancreatic stump management,complications,time for drainage tube placement and duration of postoperative hospital stay of the 2 groups were compared.Patients were followed-up through outpatient examination and telephone interview till June 2014.The measurement data and the count data were analyzed using the t test and the chi-square test,respectively.Results The time for pancreatic stump management of the modified group and the control group were (15.2 ± 2.1) minutes and (13.2 ± 3.2) minutes,with no significant difference between the 2 groups (t =1.565,P ＞ 0.05).No patient was complicated with other diseases in the modified group,while 9 patients in the control group was complicated with pancreatic fistula,with significant differences between the 2 groups (x2=9.399,P ＜0.05).The time for drainage tube placement of the modified group and the control group were (6.1 ± 2.2) days and (16.6 ± 3.5) days,the duration of postoperative hospital stay were (12.5 ± 2.5) days and (21.5 ± 3.5) days,with significant difference between the 2 groups (t =-11.902,-9.853,P ＜ 0.05).Sixty-three patients were followed up from 1 to 35 months with a mean time of 15 months.Fifteen patients died,and the condition of other patients was normal.Conclusion Wrapping and suturing of the pancreatic stump with the avascular zone of the transverse mesocolon is effective for preventing the pancreatic leakage after distal pancreatectomy and shortens the time of postoperative hospital stay.

Objective To investigate the clinical efficacy of three dividing lines in radical right hemicolectomy for right colon cancer.Methods The clinical data of 166 patients with right colon cancer (including ileocecal cancer,ascending colon carcinoma and hepatic flexure of the colon) who were admitted to the Affiliated Tumor Hospital of Zhengzhou University from March 2009 to August 2014 were retrospectively analyzed.Eightythree patients who underwent radical right hemicolectomy via three dividing lines were allocated to the modified group and 83 patients who underwent radical right hemicolectomy via medial approach were allocated to the control group.The operation time,volume of intraoperative blood loss,number of lymph node dissection and processing time and volume of the superior mesenteric vein (surgical trunk) hemorrhage were analyzed between the 2 groups.Patients were followed up by outpatient examination and telephone interview till November 2014.The measurement data with normal distribution were presented as x ± s.The comparison between groups was analyzed using t test.The count data were analyzed by the chi-square test.Results The operation time in the modified group and in the control group were (75 ± 7) minutes and (109 ± 13) minutes,respectively,with a significant difference (t =-36.700,P ＜0.05).The volume of intraoperative blood loss and number of lymph node dissection in the modified group were (118 ± 15)mL and 19 ±4,which were not significantly different from (116 ±22)mL and 18 ± 3 in the control group (t =0.104,12.300,P ＞ 0.05).During D3 lymph node dissection,the incidence of hemorrhage of the superior mesenteric vein,processing time of hemostasis and volume of blood loss were 3.6％ (3/83),(7 ± 3) minutes and (103 ± 25) mL in the modified group and 9.6％ (8/83),(20 ± 5) minutes and (209 ± 37)mL in the control group,respectively.There was no significant difference in the incidence of hemorrhage of the superior mesenteric vein between the 2 groups (x2 =2.434,P ＞ 0.05).There were significant differences in the processing time of hemostasis and volume of blood loss between the 2 groups (t =38.100,29.200,P＜0.05).The patients were followed up for 3 months to 5 years with a median time of 22 months.Of 166 patients,23 died,11 were loss to follow-up and others survived at the end of follow-up.Conclusion Three dividing lines is safe and feasible in radical right hemicolectomy for right colon cancer,with a good clinical efficacy.

Objective To prepare a new thrombus model by fluid model method , which is suitable for evaluation of mechanical thrombectomy devices for acute stroke.Methods The fluid model adopted the Chandler loop theory , while the static model adopted conventional method.Mechanical properties of thrombi prepared by fluid model and static model were measured by manual elongation test ( 15 samples in each group) and catheter injection test (15 samples in each group ).Histological structure was compared among the above thrombus models ( 5 samples in each group ) and specimens of five patients with stroke by hematoxylin-eosin staining method.Then, thrombi in fluid model were utilized to establish embolization of vessels in swine model ( two pigs ) for evaluation of radiopacity.Independent-Sample test was performed to compare the maximum tensile length of two methods , and Fisher′s exact test was used to compare the rate of thrombus fragmentation after catheter injection test.Results The maximum tensile length of two models were (4.28 ±0.23) and (3.16 ±0.13) cm, respectively, and the difference was statistically significant (t=16.38, P<0.01);After catheter injection, the fracture rates of thrombus were 13% (2/15) and 60%(9/15), which were also statistically significant (P<0.05).As to histological structure, thrombi prepared by fluid model showed mixed thrombus structure , which similar to thrombi of stroke patients , But thrombi prepared by static model were replete with erythrocytes under the microscope .A total of eight vessels ( lingual arteries and superficial cervical arteries ) in two swines were successfully occlusive ( TIMI 0 or 1 ) , and sufficient radiopacity of each injected thrombus was observed.Conclusions The thrombi prepared by fluid model not only have good mechanical stability and sufficient radiopacity , but their histological structure is similar to thromboemboli retrieved from cerebral arteries of patients with acute stroke.

Objective:To investigate the value and molecular mechanism of gastric cancer stem cells in invasion and metastasis of gastric cancer.Methods:Gastric cancer stem cells were isolated by spheroid culture method, and the biological characteristics were identified. The role of gastric cancer stem cells in multidrug resistance, invasion and metastasis was analyzed. The important molecules involved in the biological behavior of gastric cancer stem cells were identified by gene chip. Screening of the signaling pathway revealed that anthrax toxin receptor 2 (ANTXR2)plays an important role in invasion, metastasis, glomerization and tumor formation.Results:Sox2 and Bmi1 expression in SGC7901 and MGC803 cells were significantly higher than monolayer culture cells (15.39±3.23). Oct4 express increased to (4.19±0.62). The expression levels of the dry-related genes Bmi1, Sox2 and Oct4 in SGC7901-SC cells were (3.29±0.52), (3.12±0.49), (2.58±0.35), respectively, which were higher than those of SGC7901-MN cells, Bmi1, Sox2 and Oct4, respectively. The differences were statistically significant ( t=5.392, 7.316, 6.449, all P<0.05) for (1.41±0.39), (2.04±0.33), (1.39±0.32); in primary cells XN0422-SC and in SGC7901-SC cells, miR-638 was in high expression (0.69±0.11), and miR-181b and miR-181a in low expression (0.12±0.05) and (0.15±0.07). ANTXR2 expression in SGC7901-SC cells was higher than that in SGC7901-MN cells ( t=6.216, P<0.05). The ANTXR2 positive cells in SGC7901-SC was 85.48%. The proportion of ANTXR2 positive cells in SGC7901 was 4.98%. Gastric cancer cells XN0422 and SGC7901 were affected by PLVT713, and ANTXR2 expression protein decreased. Conclusion:ANTXR effects a regulatory role by activating the Src/ERk signaling pathway, which can be used to predict the biological beharious of gastric cancer.