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 analyze the symptoms and signs in forty-five Lambert-Eaton myasthenia syndrome (LEMS) patients retrospectively. Characteristics of electrophysiological examinations were investgated. Methods Forty-five LEMS patients were reviewed and information gathered regarding clinical complains neurological symptoms, and other concomitant diseases. The records showed that repetitive nerve stimulation (RNS) and nerve conduction velocity (NCV) were performed in all patients. Needle electromyography (EMG) and skin sympathetic response (SSR) were performed in some patients. Results (1) The mean age of neurological clinical onset age was (51.2 ±6. 8) years old. The two most common symptoms were slight weakness of lower extremities ( n = 35 ) and upper extremities (n= 5). Dysarthria was found in 3 patients and neck weakness in 2 patients. Tendon reflex decreased and disappeared in 38 patients. Autonomic nervous system manifestations were presented in 30 patients. (2) RNS increasing was observed in all patients from 156% to 636%. Low frequency RNS abnormalities were found in 29 patients.Sensory nerve conduction velocity abnormalities or sensory nerve conduction velocity combined motor nerve conduction velocity abnormalities were found in 19 patients ( 42% ). Of the 30 patients who underwent a needle EMG examination, 20 had myogenic or neurological damage. Thirteen abnormal findings were observed in 25 patients who underwent SSR examination. Conclusion The most common manifestations were weakness in lower extremities and autonomic nervous system dysfunction. Many abnormal electrophysiological results were found in LEMS patients, including NCV and EMG abnormalities. These findings indicated that clinical manifestations exceed the neuromuscular junction and perhaps included the peripheral nerve and muscle.

Objective To evaluate the application of health education in patients with cholecystectomy. Methods From October 2009 to July 2010, 93 patients in our hospital with cholecystectomy were randomly divided into the control group (45 cases) and the observation group(48 cases). The control group was given routine nursing care, the observation group received perioperative health education in addition to the routine nursing care, then compared the nursing effect of two groups. Results In the observation group, the patients' knowledge and awareness rate of their own disease was 95.8%, and the control group was 80.0%, the difference was statistically significant between two groups. The recovery of gastrointestinal function in the observation group was significantly better than the control group, the difference was statistically significant between two groups. Conclusions Health education can enable patients with cholecystectomy correct understanding of their disease, eliminate negative emotions, and help the recovery of gastrointestinal function in patients, which is worthy of attention.

Objectives To assess the value of external anal sphincter electromyography (EASEMG) in evaluating the related autonomic dysfunction in Parkinson's disease ( PD), parkinsonism dominant multiple system atrophy (MSA-P) and progressive supranuclear palsy (PSP). Methods From the records of EAS-EMG collected in our lab (total 562 cases), 60 PD (male 41, female 19), 68 MSA-P (male 35,female 33) and 13 PSP (male 10, female 3) were included in the analysis in this study. Mean duration,polyphasic ratio and satellite potential occurrence rate were comparable among the groups. Mean duration prolongation were graded as normal ( ＜ 10.0 ms), mild ( 10.0-11.9 ms), moderate ( 12.0-13.9 ms)and severe ( ≥ 14.0 ms). Results Among all related autonomic symptoms, the occurrence rate of constipation, urinary incontinence, urgency and frequency in patients with MSA-P(95.8% (23/24) ,94.6% (53/56) ,87.7% ( 50/57 ), 85.7% (42/49), 76.5% ( 39/51 ) ) were higher than that of PD ( 61.5%(16/26), 62.3% (33/53), 30.6% (15/49), 46.2% (24/52), 45.7% (21/46)) and PSP (75.0%(3/4) , 62.5% (5/8), 50.0% (4/8), 42.9% (3/7), 42.9% (3/7)). The abnormal rate of EAS-EMG in PD, MSA-P and PSP were 60.0%, 94.2% and 84.6%, accordingly. Mean duration ( PD ( 12.0 ± 1.6)ms, MSA-P (15.4±3.0) ms, PSP (13.8±1.8) ms), polyphasic ratio (PD 46.2% ±19.2%, MSA-P 63.9% ± 15.8%, PSP 51.5% ± 12.1% ) and satellite potential occurrence rate ( PD 9.5% ± 8.3%,MSA-P 26.5% ± 15.9%, PSP 19.2% ± 12.5% ) varied significantly different among the groups ( F =31.724, F = 17.412, x2 =45. 335, all P ＜0.01 ). Severe mean duration prolongation was overwhelming in MSA-P (66.2% ) , compared with mild 10.3% and moderate 23.5%. The predominant prolongation degree was moderate in PSP (61.5%, mild 7.7%, severe 30.8% ), and mild in PD (36.7%, moderate 36.7% ,severe 11.7%, normal 15.0% ). Conclusions EAS-EMG could play a role in evaluating the related autonomic dysfunctions in PD, MSA-P and PSP. The EAS-EMG impairment was severe and frequent in MSA-P, mild and infrequent in PD, moderate in PSP. The spectrum of mean duration prolongation suggested the possibility of Onuf's nucleus involvement in these diseases.

Objective To investigate the time and rate of generalization developed from ocular symptoms in adults to generalized myasthenia gravis (GMG).Methods The data from 456 adult patients who started on ocular symptoms during Jan 2005 to Jan 2012 were retrospectively studied,with a follow-up period of 3 months to 17 years.The data included transfer time,Osserman type,difference between steroids group and no-steroids group.Results (1) During the follow-up period,197 (43.2％) patients developed to generalized myasthenia gravis,58.4％ (115/197)in one year after onset of ocular symptoms,74.1％ (146/197) in 2 years and 80.7％ (159/197) in 3 years.86.8％ (171/197) developed to Osserman Ⅱ a or Ⅱ b.(2) Of 233 patients untreated with steroids,134 (57.5％) developed to GMG,while 63 (28.3％) of 223 patients who were treated with steroids developed to GMG (x2 =38.57,P ＜ 0.01).There were no difference between two groups in transfer time and Osserman type.Conclusion MG initiated from ocular syndromes in adults easily develops to GMG in 2 years.Patients treated with steroids have low chance of generalization.

Objective:To evaluate a nano-carbon lymphatic tracing method for patients with rectal cancer after neoadjuvant radiotherapy and chemotherapy .Method:Retrospective analysis was made on 88 patients of rectal cancer undergoing neoadjuvant chemoradiation at the Department of General Surgery, He′nan Cancer Hospital from Jan 2016 to May 2020.According to whether nano-carbon lymph node was used or not, patients were divided into nanocarbon tracer group (study group) and non-nanocarbon tracer group (control group).Results:There was statistically significant in the number of havested lymph nodes between the two groups [15(11-19) vs.9(5-12), Z=5.227, P<0.001], There was no statistically significant in the number of positive lymph nodes between the two groups [0(0-0.25) vs.0(0-1), Z=1.199, P=0.231]. There were significant differences in the ratio of patients with less than 7 lymph nodes(0/34 vs.18/54, χ 2=14.248, P<0.001) and patients with less than 10 lymph nodes (4/34 vs.29/54, χ 2=15.657, P<0.001). Conclusions:The injection of nanocarbon after neoadjuvant chemoradiotherapy can increase the number of harvested postoperative lymph nodes and the ratio of patients with lymph nodes ≥7 and ≥10, which is more beneficial for prediction of the prognosis of patients.

Objective To investigate the application value of the curved cutter stapler device combined with trans-orally inserted anvil (OrVil) in the radical resection of Siewert type Ⅱ adenocarcinoma of the esophagogastric junction (AEG).Methods The retrospective cross-sectional study was conducted.The clinicopathological data of 206 patients with Siewert type Ⅱ AEG who were admitted to the Henan Tumor Hospital between March 2011 and March 2016 were collected.All the 206 patients underwent radical resection and 3-step clock wise total gastrectomy + D2 lymph node dissection.Observation indicators:(1) surgery and postoperative recovery situations:surgical approach,overall operation time,hammer anvil placing time,esophagojejunal anastomosis time,volume of intraoperative blood loss,number of lymph node dissected,time to anal exsufflation,postoperative complications and duration of postoperative hospital stay;(2) postoperative pathological examination and chemotherapy;(3) follow-up and survival situations.Follow-up using telephone interview and outpatient examination was performed to detect tumor-free survival of patients up to April 2016.Measurement data with normal distribution were represented as x±s.The survival rate was calculated by the Kaplan-Meier method.Results (1) Surgery and postoperative recovery situations:all the 206 patients received successful operations,including 85 with abdominal operation,50 with abdominal incision through the diaphragmatic muscle into thoracic surgery and 71 with thoracic-abdominal surgery.Overall operation time,hammer anvil placing time,esophagojejunal anastomosis time,volume of intraoperative blood loss,number of lymph node dissected,time to anal exsufflation and duration of hospital stay were (113.7± 15.4)minutes,(3.5± 1.2)minutes,(10.4±2.9)minutes,(128±25) mL,32± 6,(2.4 ± 0.9) days and (12.3 ± 1.9) days,respectively.Of 206 patients,15 with postoperative complications were cured by conservative treatment,including 6 with implicit anastomotic fistula,3 with dominant anastomotic fistula,2 with pancreatic leakage,2 with intestinal obstruction,1 with anastomotic stenosis and 1 with thoracic and abdominal infection.There was no reoperation due to perioperative complications.(2) Postoperative pathological examination and chemotherapy:postoperative pathological results showed that distance from resection margin of the esophagus to tumor was (5.2±0.4) cm,without cancer cells in the resection margin.Among 206 patients,171 received postoperative chemotherapy by S1 single agent combined with oxaliplatin for 6-8 cycles or oral S1 single agent for 1 year.(3) Follow-up and survival situations:206 patients were followed up for (2.7± 0.3)years,with a tumor-free 3-year survival rate of 58％.During the follow-up,there was no recurrent anastomotic tumor.Conclusion The curved cutter stapler device combined with OrVil in the radical resection of Siewert type Ⅱ AEG can simplify the difficulty of esophagojejunal anastomosis and guarantee the safe resection margin of the lower esophagus.

Objective To explore the risk factors of ulcerative colitis-associated colorectal cancer (UC-CRC).Methods The retrospective case-control study was conducted.The clinicopathological data of 536 patients with ulcerative colitis (UC) who were admitted to the Henan Tumor Hospital from March 2004 to June 2015 were collected.Observation indicators:(1) follow-up results:cases with follow-up,follow-up time,cases of UC-CRC,age of onset,pathological type of UC-CRC;(2) risk factors analysis affecting occurrence of UC-CRC:gender,age of onset,course of disease,severity of disease,disease classification,extent of lesion,smoking history,family history of colorectal cancer,anemia,hypoproteinemia,body weight loss,extraintestinal manifestations,colonic polyps,backwash ileitis,atypical hyperplasia,anxiety or depression,treatment method and regular endoscopy reexamination.Follow-up using outpatient examination and telephone interview was performed to detect prognosis of patients up to April 2017.Patients underwent colonoscopy once every 6 months within 3 years after diagnosis and once every 1 year after 3 years.Measurement data with skewed distribution were described as M (range).The univariate analysis was done using the chi-square test and Fisher exact probability.The multivariate analysis was done using the Logistic regression model.Results (1) Follow-up results:of 536 patients,450 were followed up for 26.0-120.0 months,with a median time of 76.4 months.During the follow-up,16 patients were complicated with UC-CRC,including 9 males and 7 females.Age of onset of colorectal cancer was 14-78 years,with an average age of onset of 44 years.Pathological type:high-differentiated right colon adenocarcinoma was detected in 5 patients,high-and moderate-differentiated left colon adenocarcinoma in 3 patients,left colon signetring cell carcinoma in 2 patients,moderate-differentiated rectal tubular adenocarcinoma in 3 patients,highdifferentiated rectal papillary adenocarcinoma in 2 patients and malignant lymphoma in 1 patient.(2) Risk factors analysis affecting occurrence of UC-CRC:the results of univariate analysis showed that course of disease,extent of lesion,colonic polyps and atypical hyperplasia were risk factors affecting occurrence of UC-CRC (x2 =14.848,18.885,10.554,P＜0.05).The results of multivariate analysis showed that course of disease ＞ 10 years,lesion involving the whole colon,colonic polyps and atypical hyperplasia were independent risk factors affecting occurrence of UC-CRC (OR=12.893,17.847,7.326,19.742,95％ confidence interval:1.726-74.337,1.445-89.793,1.263-43.128,3.625-96.524,P＜0.05).Conclusion The course of disease ＞ 10 years,lesion involving the whole colon,atypical hyperplasia and colonic polyps are independent risk factors affecting occurrence of UC-CRC.

Objective To evaluate the result of early repair for urinary fistula caused by iatrogenic injury to ureter,bladder and urethra during resection of rectal cancer.Methods We retrospectively analyzed 26 cases of urinary fistula after resection of rectal cancer patients encountered in Department of General Surgery,Henan Tumor Hospital from October 2005 to May 2016.Urinary fistula was divided into four types according to the site of fistula.Results Surgery was performed ever after the diagnosis of the fistula was identified.In type Ⅰ fistula (6 cases of posterior urethral fistula) the treatment was stent placement and packing of the greater omentum.2 cases of bladder top fistula (type Ⅱ),were treated by fistula repair and cystostomy.Type Ⅲ involved 12 cases (bladder triangle fistula).The treatment was ureter stenting replantation,and cystostomy Type Ⅳ:ureteral fistula in 6 cases,the treatment was end-to-end anastomosis and stenting.After surgery 24 cases were cured and 2 cases (all of type Ⅲ fistula) ended up with permanent bilateral ureterocutaneostomy.Conclusion It is safe and effective to make early remedy repair for ureter,bladder and urethral fistula iatrogenically during rectal cancer resection.