OBJECTIVETo compare the number of harvested perisplenic hilar lymph nodes by laparoscopy-assisted total gastrectomy (LATG) and conventional open total gastrectomy (OTG) for advanced upper and middle gastric cancer.

METHODSThree hundred twelve patients with advanced gastric cancer treated in a single institution between Sept 2008 and Jan 2011 were included in this study. They were divided into two groups: the LATG group and OTG (D2) group. All the surgical operations were performed by one surgeon or under his supervision. The lymph node clearance outcomes of the patients treated by those two surgical procedures were analyzed.

RESULTSThe harvested lymph node numbers of the two groups were (29.57 ± 9.62) and (29.38 ± 11.22) respectively, statistically with no significant difference (P = 0.875). The numbers of lymph node dissected around the splenic area in the LATG group and OTG group (Section 10, 11 group) were (2.01 ± 1.34) and (1.33 ± 1.11), respectively, indicating a significant difference (P = 0.000). The numbers of lymph nodes dissected around the celiac region (Section 7, 8, 9, 11p and 12a(2) group) were (7.90 ± 3.41) and (7.22 ± 2.65), respectively, with a non-significant difference (P = 0.050). There were also no significant differences while comparing with the numbers of lymph nodes dissected in the cardiac area (group 1, 2), pyloric region (5, 6 group) and the greater and lesser omentum area (group 3 and 4) between the two groups (P = 0.605, P = 0.248, P = 0.262).

CONCLUSIONShort-term results of this study indicate that laparoscopy-assisted total gastrectomy (D2) is better than conventional open surgery in perisplenic hilar lymph node dissection.

Adult ; Aged ; Female ; Gastrectomy ; methods ; Humans ; Laparoscopy ; Lymph Node Excision ; methods ; Lymph Nodes ; pathology ; surgery ; Lymphatic Metastasis ; Male ; Middle Aged ; Neoplasm Staging ; Spleen ; Stomach ; Stomach Neoplasms ; pathology ; surgery

It is the most important for surgeons to achieve surgical safety and oncological clearance in laparoscopic surgery for gastric cancer. With the widespread adoption oflaparoscopic surgery for gastric cancer, surgeons make great efforts to achieve better safety andlower morbidity. Common abdominal complications (intraoperative and postoperative) after laparoscopic radical gastrectomy include bleeding, anastomotic leakage, anastomotic stenosis, iatrogenic organ injury, pancreatic leakage, etc. The causes and prevention of the complications related with laparoscopic radical gastrectomy was discussed in this article.
Anastomotic Leak ; Constriction, Pathologic ; Gastrectomy ; adverse effects ; Humans ; Laparoscopy ; adverse effects ; Postoperative Complications ; prevention & control ; Stomach Neoplasms ; surgery

Objective To explore the value of class 100 laminar flow ward in the prevention of infection in patients with hematological malignancies(HM) after chemotherapy.Methods Patients with HM and received chemotherapy in the department of hematology in a hospital from March 2016 to February 2017 were surveyed retrospectively,according to patients' wishes,those who were admitted to the class 100 laminar flow ward and received chemotherapy were as trial group,and those who were admitted to the common ward and received chemotherapy were as control group.The incidence of infection,duration of fever,antimicrobial use time,length of hospital stay,and index of infection were compared and analyzed between two groups.Results A total of 267 patients with HM received chemotherapy,74 cases in trial group and 193 in control group.During the chemotherapy period,incidence of infection in trial group was lower than that of control group (47.3％ vs 72.0％,P＜0.001).Respiratory tract,digestive tract,and urinary tract were main infection sites in both groups.A total of 45 strains of pathogens were isolated from two groups of patients,7 strains were isolated from trial group and 38 from control group.The isolated pathogens were Escherichia coli,Klebsiella pneumoniae,Stenotrophomonas maltophilia,Pseudomonas aeruginosa,and yeast.Duration of fever,antimicrobial use time,and length of hospital stay in trial group were all lower than control group (all P＜0.05);serum procalcitonin (PCT) and C-reactive protein (CRP) levels in trial group were both lower than control group(both P＜0.01),the time for PCT and CRP to return to normal in trial group were both lower than control group(both P＜0.05).Conclusion Patients with MH and receive chemotherapy in class 100 laminar flow ward can reduce the incidence of infection,shorten the length of stay,and reduce the economic burden,it is worthy of further clinical promotion.

Objective To explore the feasibility of "immersion program" in French-taught surgical lessons,as to provide multiple educational methods and practical experiences for the application of bilingual education in clinical medicine.Methods Twenty-nine senior students of French-taught class were randomly divided into group A(n=15) and group B(n=14)."Immersion program" and "transitional bilingual education" were employed for group A and group B,respectively for the first half of teaching session,and "transitional bilingual education" and "immersion program" for the second half,respectively.The differences between the two bilingual education models were compared through quiz.Results In the prior 2 of the 4 quiz,the scores of French quiz and the total scores were much higher in "immersion program" group,and there were significant differences between the two groups(P0.05). Conclusion "Immersion program" helps to improve the ability of presentation,comprehension and application of French in the precondition of equal educational content,and it will be more beneficial when accessing the "immersion program" on the basis of "transitional bilingual education".

OBJECTIVESTo investigate the impact of previous abdominal operations on the outcome of laparoscopic colorectal cancer surgery and to evaluate the feasibility and safety of laparoscopic reoperation in treatment for colorectal cancer.

METHODSAccording to the statistical standards, 653 consecutive patients treated from March 2002 and March 2009 were enrolled in this study. The patients were divided into three groups: upper abdominal surgery group (n = 48), middle-lower abdominal surgery group (n = 110) and non-previous abdominal surgery group (n = 495). Demographic, pathoanatomical and surgical data were compared among the three groups.

RESULTSThere was no significant differences in demographic, pathoanatomical data and post-operative complications among the three groups. Compared with the other two groups, middle-lower abdominal surgery subgroup had a higher intra-operative conversion rate due to intra-abdominal adhesion (4.2%, 11.8% and 3.8% in upper abdominal surgery group, middle-lower abdominal surgery group and non-previous abdominal surgery group, respectively). And no significant differences was found in operating time [(132 ± 36), (141 ± 42), (132 ± 36) min], intra-operation blood loss [(58 ± 50), (81 ± 99), (57 ± 57) ml], blood transfusion rate (6.3%, 10.9%, 7.9%), low sphincter-preserving surgery rate (47.1%, 44.7%, 55.2%), time of first flatus passage [(2.5 ± 1.4), (2.9 +/- 1.7), (2.5 ± 2.1) d], fasting time [(5 ± 4), (5 ± 4), (4 ± 3) d], hospital stay [(17 ± 9), (15 ± 8), (16 ± 10) d] between the three groups.

CONCLUSIONSThe history of previous abdominal operations should not be regarded as a contraindication for laparoscopic colorectal cancer reoperation. The laparoscopic reoperation for colorectal cancer is safe and feasible.

Abdomen ; surgery ; Aged ; Colorectal Neoplasms ; surgery ; Feasibility Studies ; Female ; Humans ; Laparoscopy ; Male ; Middle Aged ; Prospective Studies ; Reoperation

Adolescent ; Duodenum ; surgery ; Female ; Humans ; Laparoscopy ; methods ; Superior Mesenteric Artery Syndrome ; surgery

OBJECTIVETo evaluate laparoscopic surgery for gastric and small intestinal stromal tumors.

METHODSThe clinical data of patients with laparoscopic resection of gastric and small intestinal tumors, admitted to our center from Dec. 2003 to Jul. 2006, were retrospectively analyzed. The data included the surgical procedure, operative time, blood loss, length of incision, time for passage of flatus, postoperative length of stay, operative complications, pathology and the results of follow-up.

RESULTSAll the 33 patients with gastric and small intestinal stromal tumors were treated by laparoscopic procedures successfully, including 8 laparoscopic gastric wedge resections, 8 laparoscopic transgastric tumor-everting resections, and 17 laparoscopic segmental resections of small intestine. The mean operative time was (73.1+/-27.0) min, the mean blood loss was (19.8+/-14.0) ml, the mean length of incision was (3.3+/-1.1) cm, the mean time for passage of flatus was (2.2+/-1.0) d and the postoperative length of stay was (8.1+/-2.0) d. The bleeding of intestinal anastomosis and gastric mucosa occurred on 3 patients (9.1%), who were healed with conservative therapy. No recurrence was found during 2-33 months follow-up.

CONCLUSIONLaparoscopic surgery is an effective, safe, less invasive procedure for treatment of gastric and small intestinal stromal tumors.

Adult ; Aged ; Aged, 80 and over ; Female ; Follow-Up Studies ; Gastrointestinal Stromal Tumors ; surgery ; Humans ; Intestine, Small ; Laparoscopy ; methods ; Male ; Middle Aged ; Retrospective Studies ; Young Adult

OBJECTIVETo investigate the feasibility and efficacy of treating atrial fibrillation (AF) with circumferential pulmonary vein (PV) linear ablation guided by 3 dimensional mapping system and single circular mapping catheter.

METHODSFrom April 2004 to January 2005, PV isolation with circumferential PV linear ablation guided by CARTO system (in 76 patients) or EnSite-NavX system (in 24 patients) was performed in 100 consecutive patients with significantly symptomatic, drug refractory AF. The procedural end-point was complete electrical isolation of bilateral PV.

RESULTSUp to 200 linear circles were produced around each ipsilateral PVs in all 100 cases, and 95.0% (190/200) of PV isolation rate was achieved with a mean procedure time of 150-365 (240 +/- 65) min and a mean fluoroscopy time of 23-61 (37 +/- 12) min, respectively. Eight cases with recurrent AF (8.0%) underwent second session. Cumulative atrial tachyarrhythmias-free rate was 85.0% (85/100) during a mean follow-up of 5.5-12 (10.2 +/- 5.7) months. Atrial tachyarrhythmias-free rate was 66.0% (66/100), 82.0% (82/100), 87.0% (87/100), 85.0% (85/100), 85.0% (85/100), and 88.6% (70/79) during the follow up at 1 month, 2 months, 3 months, 4 months, 5 months and 6 months, respectively. There were 2 complications (1 tamponade and 1 PV stenosis), which were rehabilitated after conservative treatment.

CONCLUSIONPV isolation with circumferential PV linear ablation guided by 3 dimensional mapping system is safe and effective for treating AF.

Adolescent ; Adult ; Aged ; Atrial Fibrillation ; surgery ; Catheter Ablation ; methods ; Feasibility Studies ; Female ; Humans ; Imaging, Three-Dimensional ; Male ; Middle Aged ; Pulmonary Veins ; surgery ; Treatment Outcome ; Young Adult

Carcinoma, Hepatocellular ; metabolism ; pathology ; DNA-(Apurinic or Apyrimidinic Site) Lyase ; genetics ; metabolism ; Female ; Humans ; Liver Neoplasms ; metabolism ; pathology ; Male ; Middle Aged ; RNA, Messenger ; genetics