Objective:To investigate the effect of different postoperative nutritional support on the gastrointestinal function and nutritional status in acute colon peforation patients.Methods:60 cases of acute emergency operation patients with perforation of the colon,according to the given nutritional support treatment of the different ways,were divided into enteral parenteral joint nutrition (EN + PN) group and total parenteral nutrition (TPN) group.Clinical therapeutic effects of two groups were compared.Results:The results of EN + PN group were significantly better than the those in TPN group (P ＜ 0.05).Conclusion:EN + PN model can improve the postoperative nutritional status and accelerate the recovery of patients with acute colonic perforation.

The unresectable gastric cancer refers to be unable to accept radical gastrectomy because of advanced stage,which is mainly treated with adjuvant chemotherapy,and obtains only poor prognosis in the past.In recent years,however,some scholars found that the unresectable gastric cancer cases which were treated with systematic chemotherapy,radiochemotherapy,interventional therapy,hyperthermic intraperitoneal peroperative chemotherapy and so on,could be converted into resectable (radical D2 gastrectomy) cases successfully,and their survival time and quality of life are promoted significantly.The conversion therapy for unresectable gastric cancer provides a novel surgical strategy for the comprehensive treatment of part of the advanced gastric cancer patients.

The unresectable gastric cancer refers to be unable to accept radical gastrectomy because of advanced stage,which is mainly treated with adjuvant chemotherapy,and obtains only poor prognosis in the past.In recent years,however,some scholars found that the unresectable gastric cancer cases which were treated with systematic chemotherapy,radiochemotherapy,interventional therapy,hyperthermic intraperitoneal peroperative chemotherapy and so on,could be converted into resectable (radical D2 gastrectomy) cases successfully,and their survival time and quality of life are promoted significantly.The conversion therapy for unresectable gastric cancer provides a novel surgical strategy for the comprehensive treatment of part of the advanced gastric cancer patients.

Objectives To investigate the clinical feature and surgical procedures of gastric stump carcinoma (GSC) and to identify the prognostic factors which influence survival rate of GSC patients.Methods Clinical data of 167 patients who underwent R0 resection for gastric stump carcinoma at Chinese People's Liberation Army General Hospital between January 1990 and December 2012 was collected.There were 144 male and 23 female cases.The clinicopathological features of GSC patients were compared between those who underwent initial surgery for benign disease (GSC-B group,78 cases) and for gastric cancer (GSC-M group,89 cases).The analysis of therapeutic methods and survival time were also performed.t-test was used to compare the quantitative data between two groups.Pearson x2 test was used to compare the various clinicopathological characteristics between the two groups.Kaplan-Meier method was used to analyze the survival rate.Multivariate survival analysis was based on the Cox proportional hazard model.Results Compared with GSC-M group,the interval time between initial gastrectomy and surgery in GSC-B group was longer ((28.2 ± 10.2) years vs.(10.8 ± 1.0) years,t =15.902,P =0.001).There were 56 patients (71.8％) who received Billroth Ⅰ reconstruction in GSC-B group,and 49 patients (55.1％) who received Billroth Ⅱ reconstruction in GSC-M group,the difference of anastomosis method between the two groups was statistically significant (x2 =25.770,P =0.001).Compared with GSC-M group,the tumor of GSC-B group was usually located at the anastomotic site (x2 =6.975,P =0.031).The overall 1-,3-,and 5-year survival rates of the 167 patients were 87％,60％,and 41％.The 5-year survival rates for TNM stages Ⅰ,Ⅱ,and Ⅲ were 65％,43％,and 22％,respectively (P =0.001).Multivariate analysis showed that small intestinal or esophageal infiltration (HR =1.957,95％ CI:1.096 to 3.494,P =0.023),tumor location (HR =1.618,95％ CI:1.104 to 2.372,P =0.014),and TNM stage (HR =2.307,95％ CI:1.708 to 3.118,P =0.001) have independent effect on survival.The metastasis rates of perigastric lymph nodes,jejunum anastomosis and mesenteric lymph nodes were very high (56.3％ and 65.2％,respectively).Conclusions The GSC appears earlier in patients with gastrectomy for malignant disease than those with benign disease.Appropriate curative resection including residual lymph node dissection is very important to improve the prognosis.Small intestinal or esophageal infiltration,tumor location,and TNM stage have independent effect on survival.

Objectives To investigate the clinical feature and surgical procedures of gastric stump carcinoma (GSC) and to identify the prognostic factors which influence survival rate of GSC patients.Methods Clinical data of 167 patients who underwent R0 resection for gastric stump carcinoma at Chinese People's Liberation Army General Hospital between January 1990 and December 2012 was collected.There were 144 male and 23 female cases.The clinicopathological features of GSC patients were compared between those who underwent initial surgery for benign disease (GSC-B group,78 cases) and for gastric cancer (GSC-M group,89 cases).The analysis of therapeutic methods and survival time were also performed.t-test was used to compare the quantitative data between two groups.Pearson x2 test was used to compare the various clinicopathological characteristics between the two groups.Kaplan-Meier method was used to analyze the survival rate.Multivariate survival analysis was based on the Cox proportional hazard model.Results Compared with GSC-M group,the interval time between initial gastrectomy and surgery in GSC-B group was longer ((28.2 ± 10.2) years vs.(10.8 ± 1.0) years,t =15.902,P =0.001).There were 56 patients (71.8％) who received Billroth Ⅰ reconstruction in GSC-B group,and 49 patients (55.1％) who received Billroth Ⅱ reconstruction in GSC-M group,the difference of anastomosis method between the two groups was statistically significant (x2 =25.770,P =0.001).Compared with GSC-M group,the tumor of GSC-B group was usually located at the anastomotic site (x2 =6.975,P =0.031).The overall 1-,3-,and 5-year survival rates of the 167 patients were 87％,60％,and 41％.The 5-year survival rates for TNM stages Ⅰ,Ⅱ,and Ⅲ were 65％,43％,and 22％,respectively (P =0.001).Multivariate analysis showed that small intestinal or esophageal infiltration (HR =1.957,95％ CI:1.096 to 3.494,P =0.023),tumor location (HR =1.618,95％ CI:1.104 to 2.372,P =0.014),and TNM stage (HR =2.307,95％ CI:1.708 to 3.118,P =0.001) have independent effect on survival.The metastasis rates of perigastric lymph nodes,jejunum anastomosis and mesenteric lymph nodes were very high (56.3％ and 65.2％,respectively).Conclusions The GSC appears earlier in patients with gastrectomy for malignant disease than those with benign disease.Appropriate curative resection including residual lymph node dissection is very important to improve the prognosis.Small intestinal or esophageal infiltration,tumor location,and TNM stage have independent effect on survival.

Objective:To examine the correlation factors of acute appendicitis associated with appendiceal neoplasms.Methods:Consecutive 712 patients with acute appendicitis who treated at Department of General Surgery, Beijing Chaoyang Hospital, Capital Medical University from January 2002 to December 2016 were analyzed retrospectively. There were 314 females and 398 males, aging (42.5±16.2) years (range: 14 to 94 years). Among the 712 cases, 36 patients were diagnosed with acute appendicitis associated with appendiceal neoplasms, the other 676 patients had no appendiceal neoplasm. The patients ′ clinical baseline characteristics and clinical parameters were compared between the two groups. The correlation factors of acute appendicitis associated with appendiceal neoplasms were evaluated by using the univariate (χ 2 test or t test) and multivariate Logistic regression analysis. The area under curve of receiver operating characteristic curves was utilized to evaluate the discriminatory power of the predictive models. Results:According to the univariate analysis, gender, age, body mass index, the duration of chronic right low abdominal pains≥3 months, the frequency of recurrently acute right lower abdominal pain≥2, the frequency of acute right lower abdominal pain, past history of diabetes, hypertension or coronary heart disease, the level of neutrophils and leukocytes preoperatively, stercolith and periappendiceal effusion, and modified Alvarado score were positively correlated with appendiceal neoplasms (all P<0.05). Then four variables were incorporated into the model eventually by multivariate Logistic regression analysis, which were as follows: age (increased per decade) ( OR=2.23, 95% CI: 1.68 to 2.95, P<0.01), gender (female) ( OR=4.21, 95% CI: 1.74 to 10.19, P=0.001), the duration of chronic right low abdominal pains (more than 3 months) ( OR=2.53, 95% CI: 1.01 to 3.37, P=0.048), and modified Alvarado score (decreased per 1 score) ( OR=2.54, 95% CI: 1.87 to 3.34, P<0.01). The area of curve was 0.93 (95% CI: 0.88 to 0.97), which indicated that the model exhibits an excellent ability to discriminate between appendiceal neoplasms and acute appendicitis. Conclusions:The older age, female, the duration of chronic right low abdominal pains, and lower modified Alvarado score are independent correlation factors for acute appendicitis associated with appendiceal neoplasms. Clinicians should be alert for the above clinical characteristics and choose optimal treatment for acute appendicitis associated with appendiceal neoplasms.

Objective:To examine the correlation factors of acute appendicitis associated with appendiceal neoplasms.Methods:Consecutive 712 patients with acute appendicitis who treated at Department of General Surgery, Beijing Chaoyang Hospital, Capital Medical University from January 2002 to December 2016 were analyzed retrospectively. There were 314 females and 398 males, aging (42.5±16.2) years (range: 14 to 94 years). Among the 712 cases, 36 patients were diagnosed with acute appendicitis associated with appendiceal neoplasms, the other 676 patients had no appendiceal neoplasm. The patients ′ clinical baseline characteristics and clinical parameters were compared between the two groups. The correlation factors of acute appendicitis associated with appendiceal neoplasms were evaluated by using the univariate (χ 2 test or t test) and multivariate Logistic regression analysis. The area under curve of receiver operating characteristic curves was utilized to evaluate the discriminatory power of the predictive models. Results:According to the univariate analysis, gender, age, body mass index, the duration of chronic right low abdominal pains≥3 months, the frequency of recurrently acute right lower abdominal pain≥2, the frequency of acute right lower abdominal pain, past history of diabetes, hypertension or coronary heart disease, the level of neutrophils and leukocytes preoperatively, stercolith and periappendiceal effusion, and modified Alvarado score were positively correlated with appendiceal neoplasms (all P<0.05). Then four variables were incorporated into the model eventually by multivariate Logistic regression analysis, which were as follows: age (increased per decade) ( OR=2.23, 95% CI: 1.68 to 2.95, P<0.01), gender (female) ( OR=4.21, 95% CI: 1.74 to 10.19, P=0.001), the duration of chronic right low abdominal pains (more than 3 months) ( OR=2.53, 95% CI: 1.01 to 3.37, P=0.048), and modified Alvarado score (decreased per 1 score) ( OR=2.54, 95% CI: 1.87 to 3.34, P<0.01). The area of curve was 0.93 (95% CI: 0.88 to 0.97), which indicated that the model exhibits an excellent ability to discriminate between appendiceal neoplasms and acute appendicitis. Conclusions:The older age, female, the duration of chronic right low abdominal pains, and lower modified Alvarado score are independent correlation factors for acute appendicitis associated with appendiceal neoplasms. Clinicians should be alert for the above clinical characteristics and choose optimal treatment for acute appendicitis associated with appendiceal neoplasms.

Neoadjuvant chemoradiotherapy for rectal cancer could significantly reduce the tumor stage, improve the radical resection and increase the overall survival rate of the patients. Recently researches reported that patients who acquired complete response after neoadjuvant chemoradiotherapy might accept "wait and see" strategy or local excision and could earn promising long-term outcomes as those accepted radical surgery. The diagnostic criteria and efficacy of tumor response for chemoradiotherapy are insufficient and controversial. Moreover, clinical practice showed that chemoradiotherapy-related surgical complications, including anastomotic leakage, incision complications and colon stricture, remarkably increased, so the benefits and risks of patients should be reconsidered further in choosing the surgical strategies after neoadjuvant chemoradiotherapy.

Objective To investigate the application value of biological mesh in the pelvic floor reconstruction of extralevator abdominoperineal excision (ELAPE) for advanced low rectal cancer (RC).Methods The retrospective cohort study was conducted.The clinicopathological data of 228 patients with advanced low RC who underwent ELAPE in the Beijing Chaoyang Hospital of Capital Medical University between August 2008 and December 2016 were collected.Of 228 patients,174 using biological mesh closure and 54 using primary closure were respectively allocated into the biological mesh group and primary closure group.Observation indicators:(1)intra-and post-operative situations;(2) postoperative complications (including short-term and long-term complications);(3) follow-up and survival situations.Follow-up using outpatient examination and telephone interview was performed to detect postoperative long-term complications,tumor recurrence or metastasis and overall survival up to December,2017.Measurement data with normal distribution were represented as（ x） ±s,and comparison between groups was analyzed using the independent-sample t test.Measurement data with skewed distribution were described as M (range),and comparison between groups was analyzed using the nonparametric test.Comparisons of count data were evaluated by the chi-square test or Fisher exact probability.Results (1)Intra-and post-operative situations:all the patients underwent successful ELAPE.The perineal operation time,time of indwelling perineal drainage-tube and hospital expenses were respectively (60 ± 50)minutes,(11.6 ± 2.4) days,(57 781± 11 337) yuan in the biological mesh group and (50±21) minutes,(8.9± 1.7) days,(53 714± 13 395)yuan in the primary closure group,with statistically significant differences between groups (t =3.327,7.691,-2.203,P＜0.05).The total operation time and duration of postoperative hospital stay were respectively (242±53) minutes,(13.0±5.0) days in the biological mesh group and (228±51) minutes,(12.0±5.0) days in the primary closure group,with no statistically significant difference between groups (t =1.701,1.309,P＞0.05).(2) Postoperative complications:26 and 19 patients in the biological mesh group and primary closure group had respectively perineal wound complications (1 patient combined with multiple complications),showing a statistically significant difference between groups (x2 =10.660,P＜0.05).The perineal wound infection,perineal hernia and disruption of perineal wound were respectively detected in 20,6,1 patients in the biological mesh group and 12,7,3 patients in the primary closure group,showing statistically significant differences between groups (x2 =3.931,5.282,P＜0.05).(3) Follow-up and survival situations:174 patients in the biological mesh group were followed up for 64 months (range,13-112 months),and 54 patients in the primary closure group were followed up for 51 months (range,23-76 months).The local recurrence rate,distal metastasis rate and overall survival rate were respectively 5.17％ (9/174),20.11％ (35/174),77.59％ (135/174) in the biological mesh group and 7.41％(4/54),24.07％(13/54),79.63％(43/54) in the primary closure group,with no statistically significant difference between groups (x2 =0.080,0.389,0.101,P＞0.05).Conclusions The biological mesh in the pelvic floor reconstruction of ELAPE for advanced low RC is safe and feasible.Compared with primary closure,biological mesh closure will extend perineal operation time and time of indwelling perineal drainage-tube,and increase hospital expenses,but doesn't affect total operation time and duration of postoperative hospital stay,meanwhile,it can also reduce the overall perineal wound complications,especially in perineal wound infection,perineal hernia and disruption of perineal wound.

OBJECTIVE: To compare the safety and feasibility between modified circumferential purse-string closure and conventional primary linear closure of the wound following loop stoma reversal. METHODS: Clinical data of 88 consecutive patients who underwent loop colostomy or loop ileostomy closures at our hospital from July 2011 to June 2013 were retrospectively analyzed. Among them, 43 cases underwent modified purse-string technique (modified purse-string group), 45 cases underwent direct suture (direct suture group). The operation method of modified purse-string suture was as follows: (1) the circumferential subcutaneous adipose tissue was sutured with the absorbable suture, avoiding tightening at knotting and retaining a 1 cm pore;(2)absorbable suture was used to perform purse-string suture of the dermis, retaining a 0.5 cm central pore when knotting; (3) a rubber drain was placed through the pore. The clinical parameters, surgical results and postoperative complication of two groups were recorded and compared. RESULTS: There were 56 males and 32 females with age of (65.0±11.5) years old. Seventy-nine cases were malignant tumors, 6 were benign tumors and 3 were traumatic. There was no significant difference in the baseline data between two groups (all P>0.05). Compared with the direct suture group, the modified purse-string group had significantly lower wound infection rate [7.0%(3/43) vs. 24.4%(11/45), χ²=5.015, P=0.025]; significantly shorter postoperative hospital stay (mean 7.1 days vs. 8.6 days, t=-2.656, P=0.010); significantly lower total hospitalization costs (mean 25 668.4 yuan vs. 27 718.1 yuan, t=-2.488, P=0.015); however, the wound healing time of the modified purse-string group was significantly longer (mean 22.0 days vs. 13.0 days, t=5.701, P<0.001). The average healing time of the wounds in the direct suture group was 29.8 days, which was significantly longer than that of the first-stage healing cases (7.5 days, t=-15.446,P<0.001). The average wound healing time of the infected cases in the modified purse-string suture group was 22.0 days, compared with 22.1 days in the first-stage healing cases, the difference was not statistically significant(t=0.077,P=0.943). CONCLUSIONS Modified purse-string closure after loop stoma reversal is an appropriate technique with lower stoma site infection rate, shorter postoperative hospital stay and lower hospitalization cost than conventional primary closure, although wounds may take longer to heal in this approach.
Aged ; Bacterial Infections ; prevention & control ; Colostomy ; Female ; Humans ; Ileostomy ; Intestines ; surgery ; Male ; Middle Aged ; Retrospective Studies ; Surgical Stomas ; Suture Techniques ; standards ; Sutures ; Wound Healing