Objective To compare the clinical efficacy of three-dimensional (3D) and two-dimensional (2D) laparoscopic repairs of gastroduodenal perforation.Methods The retrospective cohort study was conducted.The clinicopathological data of 92 patients who underwent laparoscppic repair of gastroduodenal perforation from July 2014 to December 2017 in the Ganzhou People's Hospital were collected.Forty-four patients undergoing 3D laparoscopic repair and 48 patients undergoing 2D laparoscopic repair were respectively allocated into the 3D and 2D groups.Observation indicators:(1) comparisons of intra-and post-operative recovery;(2) postoperative drug sensitivity test and pathological examination;(3) follow-up.Follow-up using outpatient examination and telephone interview was performed to detect complications after discharging from hospital up to August 2018.Measurement data with normal distribution were represented as x-±s and comparison between groups was analyzed using t test.Measurement data with skewed distribution were described as M (range).Comparison between groups of count data was analyzed using the chi-square test.Results (1) Comparison of intra-and post-operative recovery:92 patients underwent successfully laparoscopic gastroduodenal perforation,without conversion to open surgery or perioperative death.The operation time,time of pathological tissue extract at the perforation,time of perforation repair,volume of intraoperative blood loss and time of initial anal exsufflation were respectively (60± 8)minutes,(36± 6) seconds,(137±12)seconds,(9.0±2.2)mL,(23.8±2.8)hours in the 3D group and (70±9)minutes,(39±6) seconds,(143±14) seconds,(10.3±2.5) mL,(25.9±4.8) hours in the 2D group,with statistically significant differences between groups (t =5.795,2.779,2.215,7.740,2.570,P＜0.05).Three patients in the 3D group were complicated with pulmonary infection,localized atelectasis and delirium.Two patients in the 2D group were complicated with pulmonary infection and heart failure.Patients with complications between groups were improved by symptomatic and supporting treatment.There was no statistically significant difference in cases with postoperative complications between groups (x2 =0.010,P＞ 0.05).(2) Postoperative drug sensitivity test and pathological examination:the ascites culture of peritoneal effusion in the 2 groups was positive,and drug susceptibility results were obtained.No malignant cells at the perforation were found in pathological examination.(3) Follow-up:84 patients were followed up for 1-12 months,with a median time of 3 months.There was no related complication after discharging from hospital.Conclusion Compared with 2D laparoscopic repair of gastroduodenal perforation,3D laparoscopic repair of gastroduodenal perforation not only is safe and feasible,but also has advantages of shorter operation time,perforation repair time and time of pathological tissue extract at the perforation,less volume of intraoperative blood loss and shorter time of initial anal exsufflation.

OBJECTIVE: To observe the efficacy and safety of different induction regimens of same total dosage of azacitidine (Aza), including standard dose (standard dose group) and low-dose long-term (adjusted dose group), in the treatment of elderly acute myeloid leukemia (AML). METHODS: A total of 103 elderly patients with AML (non-acute promyelocytic leukemia) from January 2020 to June 2021 were enrolled. Aza was administered at the standard dose of 75 mg/(m²·d) for 7 days in the standard dose group (50 cases), while at 100 mg/d for 7-12 days in the adjusted dose group (53 cases). The administration days in adjusted dose group was calculated based on the total standard dose of the patient's single course of treatment. The efficacy and safety between standard dose group and adjusted dose group were compared. Subgroup analysis were performed in the two groups for Aza alone, Aza combined with BCL-2 inhibitor, and Aza combined with low-dose chemotherapy for efficacy and safety. RESULTS: There were no significant differences in overall response rate (ORR), incidence of adverse reaction, and 1-year overall survival (OS) rate between standard dose group and adjusted dose group (P >0.05). The ORR of combination was higher than that of Aza alone (P < 0.05), while there was no significant difference in ORR between Aza combined with BCL-2 inhibitor and Aza combined with low-dose chemotherapy (P >0.05). The combination of BCL-2 inhibitor did not increase the incidence of adverse reactions compared wtih Aza alone. There was a higher risk of myelosuppression and pulmonary infection with a combination of low-dose chemotherapy than with a combination of BCL-2 inhibitor and Aza alone (P <0.05). No significant difference was observed in 1-year OS between Aza alone, Aza combined with BCL-2 inhibitor, and Aza combined with low-dose chemotherapy (P >0.05). CONCLUSIONS Both two induction regimens can be used in elderly AML patients who cannot tolerate intensive chemotherapy with similar overall effectiveness and safety. Aza combined with low-dose chemotherapy may result in increased ORR and an increased incidence of serious adverse reactions, and may not result in longer survival compared with Aza alone. Aza combined with BCL-2 inhibitor not only has similar effect in complete remission, objective response rate, and OS compared with Aza combined with low-dose chemotherapy, but also has higher safety.
Humans ; Aged ; Azacitidine/therapeutic use* ; Prospective Studies ; Treatment Outcome ; Antineoplastic Combined Chemotherapy Protocols ; Leukemia, Myeloid, Acute/etiology* ; Proto-Oncogene Proteins c-bcl-2