Purpose: To observe the clinical efficacy on acupuncture treatment of functional dyspepsia. Methods: Major points including Zusanli (ST 36) were selected on the basis of meridian theory to treat functional dyspepsia with even reinforcing-reducing manipulations and electric stimulation. While commonly-used western medication domperidone was used in a control group. Results and conclusions: The total effective rate and the markedly effective rate were 93.8% and 63.3% respectively in the acupuncture group and 82.2% and 43.1% respectively in the medication group. The curative effect on nonspecific functional dyspepsia was better in the acupuncture group than in the medication group (P<0.05).Both treatments had marked effects on the dyskinetic type without a significant difference (P>0.05).

ObjectiveTo evaluate the clinical value of magnifying endoscopy in diagnosis and treatment of colorectal benign neoplastic lesions.Methods78 colorectal lesions in 61 patients were examined with magnifying colonoscopy after indigo carmine dye, and a pit pattern diagnosis was made for every lesion according to Kudo's classification.All the lesions were totally resected, and the specimen were sent for pathologic examinations.ResultsThe diagnostic sensitivity of neoplastic lesions was 98.4% and specificity was 85.7% when types Ⅰ and Ⅱ represented the pit pattern of nonneoplastic lesions, whereas types Ⅲ, Ⅳ, and Ⅴ represented adenoma and early colorectal cancer. The overall accuracy in differentiating adenoma and early colorectal cancer from nonneoplastic lesions was 96.2%.94.5% of adenomarous lesions were treated by colonoscopy.ConclusionThe magnifying colonoscopy can provide an instantenous accurate diagnosis of tumorous lesions in colon and rectum. Synchronize, minimally invasive and curative treatment is possible to be completed by using it for a large number of lesions.

Objective To determine serum vascular endothelial growth factor (s-VEGF) and serum endostatin (s-endostatin) levels in patients with colorectal cancer after preoperative regional intraarterial chemotherapy (PRAC). Methods Peripheral venous blood was sampled preoperatively and postoperatively, and was assayed for VEGF and endostatin by ELISA. Results Patients' preoperative level of s-VEGF and s-endostatin elevated significantly, which was in close correlation with Dukes' stage. The level of s-VEGF and s-endostatin before chemotherapy elevated significantly compared with that on day 7 after chemotherapy and on postoperational day 1 and 14 after operation. In patients undergoing palliative resection, only the level of s-endostatin before chemotherapy was significantly higher than that on day 1 after operation. Conclusions PRAC, inhibiting angiogenesis, is of antitumor effect, the decrease of s-endostatin after chemotherapy may suggest the combination of chemotherapy and antiangiogenesis for a better antitumor effect.

Extralevator abdominoperineal excision (ELAPE) has been described to improve the outcomes of advanced low rectal cancer, probably because of more pelvic dissection and less positive circumferential resection margin (CRM). Recent improvements of ELAPE have focused on the reconstruction of the large pelvic defect. Different approaches have been focused on the reconstruction including primary closure, uterus retroversion, omentoplasty, myocutaneous flaps, and biological mesh. The optimal method is still controversial. Recent reviews showed that the perineal wound complications of biological mesh reconstruction were comparable to those of myocutaneous flaps. Moreover reviews suggested the use of biologic materials to close the perineal defect because it offers a significant cost saving mostly attributable to reduction in hospital length of stay. The combination of different techniques may be the best way to reconstruct the pelvic defect following ELAPE.
Digestive System Surgical Procedures ; methods ; Humans ; Pelvic Floor ; surgery ; Perineum ; surgery ; Reconstructive Surgical Procedures ; methods ; Rectal Neoplasms ; surgery ; Rectum ; surgery

Gastroesophageal reflux disease (GERD) is a common digestive tract disease. Obesity is an independent risk factor for GERD. Laparoscopic sleeve gastrectomy (laparoscopic sleeve gastrectomy, LSG) is becoming more popular in bariatric metabolic surgery and is simple to perform with fewer complications, but its efficacy in treating postoperative anti-reflux in obese patients remains controversial. LSG has been reported to disrupt anti-reflux barrier function, such as altered cardiac notch, disruption of diaphragmatic continuity, and increased hiatal hernia after surgery. The cardiac notch is one of the important anti-reflux barriers at the gastroesophageal junction, and its accentuation has been shown to be effective in alleviating the symptoms of GERD, and LSG combined with angle of cardiac notch accentuation is expected to be an effective measure to prevent GERD after obesity surgery. Therefore, this article mainly reviews the research on the prevention of GERD by bariatric surgery, aiming to explore the effective treatment of GERD in obese patients after surgery, so as to improve the symptoms and quality of life of patients with GERD, and provide reference for the surgical treatment of GERD.

Extralevator abdominoperineal excision (ELAPE) has been described to improve the outcomes of advanced low rectal cancer, probably because of more pelvic dissection and less positive circumferential resection margin (CRM). Recent improvements of ELAPE have focused on the reconstruction of the large pelvic defect. Different approaches have been focused on the reconstruction including primary closure, uterus retroversion, omentoplasty, myocutaneous flaps, and biological mesh. The optimal method is still controversial. Recent reviews showed that the perineal wound complications of biological mesh reconstruction were comparable to those of myocutaneous flaps. Moreover reviews suggested the use of biologic materials to close the perineal defect because it offers a significant cost saving mostly attributable to reduction in hospital length of stay. The combination of different techniques may be the best way to reconstruct the pelvic defect following ELAPE.

Objective: To evaluate the long-term healing rate of transsphincteric anal fistula treated with anal fistula plug procedure and the risk factors affecting the healing of anal fistula. Methods: A retrospective case-control study was conducted to analyze the clinical data of 207 patients with transsphincteric anal fistulas who received anal fistula plug procedure at the Department of General Surgery, Beijing Chaoyang Hospital of Capital Medical University from August 2008 to September 2012. Inclusion criteria: (1) consistent with the diagnosis of transsphincteric anal fistula: the anal fistula passed through the internal and external sphincter; (2) complete data; (3) initial treatment with anal fistula plug procedure. Exclusion criteria: (1) acute rectal or perianal infection or poorly controlled focal infection; (2) recent incision and drainage of perianal abscess or spontaneous rupture of abscess; (3) patients with malignant tumor; (4) patients with Crohn′s disease or ulcerative colitis; (5) patients with heart, liver, brain, lung or renal insufficiency; (6) cachexia due to various chronic wasting diseases; (7) patients could not tolerate surgery. Patients were followed up for anal fistula healing. The cumulative healing rate of patients with transsphincteric anal fistula was plotted using the Kaplan-Meier method, and the factors affecting anal fistula healing were explored by univariate and multivariate logistic regression analysis. Results: There were 186 males and 21 females with age of 15 to 69 (mean 38) years. The duration of anal fistula was 3-60 (mean 15) months. Three patients had a history of previous episodes of perianal abscess and underwent incision and drainage of perianal abscess (all more than 3 months). During follow-up ending on October 31, 2018, 72 patients (34.8%) were lost to follow-up. Among 135 patients who were successfully followed up, the average follow-up period was 96 (75-124) months. Seventy-five patients had anal fistula healing, with healing rate of 55.6%. Kaplan-Meier survival curve showed that the healing time of anal fistula was prolonged and finally stabilized at 55.6%. In the patients who failed initial treatment with anal fistula plug packing, there were 6 cases whose anal fistula healed spontaneously without other treatment. Among them, 3 cases healed spontaneously 2 years and 3 cases 3 years after operation without recurrence. From 2008 to 2012, the annual healing rates of anal fistula plug treatment were 3/6, 61.5% (24/39), 42.1% (24/57), 12/15 and 12/18, respectively. Multivariate logistic regression analysis showed that the duration of anal fistula≥6 months (OR=3.187, 95% CI: 1.361-7.466, P=0.008) was an independent risk factor for anal fistula healing after treatment with anal fistula plug. Conclusion The long-term efficacy of anal fistula plug procedure in the treatment of transsphincteric anal fistula is positive, and this procedure should be implemented as soon as possible.

Humans ; Diabetes Mellitus, Type 2/surgery* ; Gastrectomy ; Gastric Bypass ; Obesity/surgery* ; Obesity, Morbid/surgery* ; Treatment Outcome ; Laparoscopy ; Retrospective Studies

The multimodality treatment has significantly increased local control of locally advanced rectal cancer, with a superior oncologic efficacy and reduced local recurrence rate from 35% to less than 10%, and the proportion of patients receiving “watch and wait” strategy or delaying surgery increased as well. However, distant relapse is still the leading cause of cancer-related death without improved long-term survival outcomes. To improve treatment compliance and overall survival benefits, a novel strategy that delivered upfront chemotherapy prior to surgery, which is termed total neoadjuvant therapy (TNT), has been proposed. TNT has two major patterns, including induction and consolidation therapy; the former treatment pattern requires systemic chemotherapy before neoadjuvant chemoradiotherapy, while consolidation therapy refers to additional cycles of chemotherapy between neoadjuvant chemoradiotherapy and surgery. As a radiosensitizer, upfront chemotherapy not only reduces gross tumor volume, but targets occult micro-metastatic disease at an early stage. Several clinical trials have also reported that TNT achieves better local control of disease with a promising treatment compliance. And organ preservation rate is supposed to increase with an improved pathologic or clinical complete response rate. Besides, there existed no established consensus regarding to specific patterns and chemotherapy regimens and doses, which results in remarkable differences among studies. In conclusion, the exact oncologic efficacy and survival benefits of total neoadjuvant therapy still need clinical trials to confirm.

Currently, obesity and its complications have become increasingly serious health issues. Bariatric surgery is an effective method of treating obesity and related metabolic complications. Among them, Roux-en-Y gastric bypass (RYGB) is still considered the “gold standard” procedure for bariatric surgery. Small bowel obstruction is one of the possible complications after RYGB, and in addition to the formation of intra-abdominal hernias, kinking of the jejunojejunal anastomosis is an important cause of small bowel obstruction. The early clinical symptoms of kinking of the jejunojejunal anastomosis often lack clarity in the early stages. Therefore, early diagnosis, prevention, and effective treatment of kinking of the jejunojejunal anastomosis are challenging but crucial. The occurrence of kinking of the jejunojejunal anastomosis may be related to surgical techniques and the surgeon′s experience. The use of anti-obstruction stitch, mesenteric division, and bidirectional jejunojejunal anastomosis may be beneficial in preventing kinking of the jejunojejunal anastomosis. If kinking of the jejunojejunal anastomosis occurs, timely abdominal CT scans and endoscopic examinations should be performed. Gastric and intestinal decompression should be initiated immediately, and exploratory surgery should be prepared.