Objective To investigate anesthesia efficacy and safety between two drugs joint propofol intrave-nous anesthesia for colonoscopy,to provide reference for clinical treatment.Methods 120 routine colonoscopy patients were selected,they were randomly divided into control group and observation group,60 cases in each group. Patients of the control group were given ketamine and propofol before examination.Patients in the observation group were given fentanyl and propofol for intravenous anesthesia before the examination.The arterial pressure MAP,heart rate,HR,pulse oximetry SpO2 ,recovery time,time away from the hospital,anesthetic effects and adverse reactions were compared between the two groups.Results Anesthesia excellent rate in the observation group was 86.67%,that was 85.00% in the control group,the difference was not significant (χ2 =0.984,P =0.114).In the observation group,the recovery time and time away from the hospital were (7.44 ±1.24)min,(19.11 ±2.67)min,which were significantly shorter than those in the control group,the differences were statistically significant (t =5.847,P =0.004;t =6.922,P =0.001).The MAP,SpO2,HR at different time points showed statistically significant differences between the two groups(P >0.05).The incidence rate of adverse reactions in the observation group was 21.67%, that in the control group was 36.67%,the difference was not statistically significant (χ2 =5.665,P =0.007). Conclusion Fentanyl and propofol for intravenous anesthesia in colonoscopy has good anesthetic effect and good safety,which is worthy of clinical application.

Objective To investigate the clinical efficacy of enhanced recovery after surgery (ERAS) in the radical gastrectomy for gastric cancer.Methods The clinical data of 140 patients undergoing radical gastrectomy for gastric cancer at the Affiliated Hospital of Qingdao University from April 2011 to June 2013 were prospectively analyzed.A double-blind,randomized,controlled study was performed in the 140 patients,and all of them were divided into the ERAS group (patients undergoing perioperative management according to enhanced recovery rehabilitation program) and the control group (patients undergoing perioperative management) based on a random numble table.The inflammatory markers,nutritional index and postoperative recovery of patients were observed.Patients of the ERAS group were followed up by telephone interview within the first 24 hours after discharge,and by outpatient examination since the second week after discharge.The follow-up was ended at postoperative day 30.Patients of the control group were reexamined at the third week after discharge.The measurement data with normal distribution was presented as x ± s.The comparison between groups was evaluated with an independent sample t test.The trend analyses for variables were done using repeated measures ANOVA.The count data were analyzed using the chi-square test or Fisher exact probability.Results Eighty patients were screened for eligibility,and were allocated into the ERAS group (40 patients) and the control group (40 patients).The total protein in serum (TP),albumin (Alb),prealbumin,TNF-α,IL-6,c-reactive protein,resting energy expenditure (REE),glycemic index,insulin index and Insulin resistance index in the 2 groups showed a range of variations at postoperative day 1,3,and 5,and these were (61 ±5)g/L,(34 ±3)g/L,(160 ± 18)g/L,(12.3 ±2.3)mmol/L,(101 ±34)ng/L,(43 ± 11)g/L,(1 336 ± 105)kal/d,(7.6 ±0.8)mmol/L,(16.8 ±3.5)mU/L and 5.7 ±1.3 in the ERAS group at postoperative day 1,and (58 ± 4) g/L,(31 ± 4) g/L,(147 ± 18) g/L,(15.3 ± 2.2) mmol/L,(122 ±37)ng/L,(56 ±27) g/L,(1 450 ± 164)kal/d,(9.3 ± 1.4) mmol/L,(30.5 ±6.8) mU/L and 12.5 ±3.2 in the control group,respectively,showing a significant difference between the 2 groups (F =31.63,8.03,67.36,147.04,9.63,6.84,16.10,54.85,104.51,139.47,P ＜0.05).The duration of fever,time to flatus,duration of hospital stay,hospital expenses,numeric rating scale and quality of life (QOL) were (2.9 ±0.9) days,(2.9 ± 0.6) days,(7.6 ± 2.1) days,(28 495 ± 4 722) yuan,1.4 ± 1.0 and 15.4 ± 0.9 in the ERAS group after operation,and (3.8 ±0.6)days,(3.5 ±0.7)days,(8.9 ±2.6)days,(35 318 ±7 610)yuan,2.4 ± 1.1 and 14.4 ± 1.2 in the control group,respectively,with a significant difference between the 2 groups (t =-0.91,-3.66,-2.85,-4.82,-4.20,3.92,P ＜0.05).Two patients were complicated with respiratory diseases,1 patient received reoperation and 1 was readmitted to the hospital at postoperative day 30 in the ERAS group.Three patients had respiratory diseases,1 received reoperation and 2 were readmitted to the hospital at postoperative day 30 in the control group,with no significant difference between the 2 groups (P ＞ 0.05).Conclusions ERAS is safe and feasible for the perioperative treatment of patients with gastric cancer,meanwhile it could reduce the surgical stress,shorten the duration of hospital stay and improve QOL and postoperative complications,ERAS might take effects by reducing insulin resistance and decreasing REE.Registry This study was registered with the Chinese Clinical Trial Registry with the registry number of ChiCTR-TRC-10001611.

OBJECTIVETo investigate the impact of depression and anxiety assessment performed in gastrointestinal cancer patients on postoperative depression and anxiety symptom and mental health service visit.

METHODSA total of 254 gastrointestinal cancer patients who underwent surgical procedure were assigned into assessment group (n=121) and control group (n=133). Depression and anxiety assessment were performed with PHQ-9 and GAD-7 in assessment group on admission, discharge and at 3-month follow-up while in control group only at 3-month follow-up. The point prevalence of depression and anxiety were evaluated in assessment group with established cut-off reported by ASCO defining depression as a PHQ-9 score no less than 8 and anxiety as a GAD-7 score no less than 5. PHQ-9 and GAD-7 scores at 3-month follow-up were compared using Mann-Whitney U test.

RESULTSAccording to the PHQ-9 and GAD-7 score, the prevalence of depression was 28.9%(35/121) and anxiety was 37.2%(45/121) in assessment group, and depression was found in 9.9%(12/121) with comorbid anxiety. During the 3-month follow-up, the PHQ-9 and GAD-7 score in assessment group (6.02±4.67 and 4.19±3.95) were both lower than those in control group (8.83±6.63 and 6.41±5.80) with statistically significant differences (all P<0.05). Patients in assessment group were more likely to seek for help in mental health service than those in control group [10.7%(13/121) vs. 3.0%(4/133), χ(2)=9.726, P=0.014] in 3-month follow-up after surgery.

CONCLUSIONSThe prevalence of depression and anxiety is high in gastrointestinal cancer patients. Depression and anxiety assessment routinely performed for gastrointestinal cancer patients can enhance utilization of mental health service and reduce postoperative depression and anxiety symptom thus potentially improve quality of life.

Anxiety ; diagnosis ; Depression ; diagnosis ; Gastrointestinal Neoplasms ; psychology ; surgery ; Humans ; Mental Health Services ; Postoperative Period ; Quality of Life ; Surveys and Questionnaires

Objective To evaluate the accuracy of the middle finger length in predicting the depth of placement of oral endotracheal tube (ETT) in patients of different ages.Methods One hundred and twenty patients of both sexes,of American Society of Anesthesiologists physical status Ⅰ-Ⅲ,undergoing elective surgery under general anesthesia requiring insertion of ETT,were divided into adult (18-84 yr) group (n =98) and children (5-14 yr) group (n =22) according to age.After anesthesia induction,the length of trachea was measured through mouth with a fiberoptic bronchoscope,and the patients were endotracheally intubated with the depth of three times the length of the left middle finger.The length from ETT tip to carina was measured after positioning.The optimal depth of placement of ETT was calculated,and the rate of appropriate placement depth of ETT was calculated.Linear correlation of three times the length of the middle finger with the optimal placement depth of ETT was analyzed.Results The rate of appropriate placement depth of ETT was 88％,the excessively deep placement of ETT was 7％,and the excessively shallow placement of ETT was 5％ in adult group.The rate of appropriate placement depth of ETT was 90％,the excessively deep placement of ETT was 10％,and no excessively shallow placement of ETT was found in children group.The tip and cuff of ETT were all in the main trachea in the two groups.The optimal placement depth of ETT was positively correlated with three times the length of the left middle finger (r =0.774,P＜0.01) in adult group and (r=0.911,P＜0.01) in children group.Conclusion Three times the length of the left middle finger can predict the appropriate placement depth of oral ETT in patients of 18-84 yr and 5-14 yr.

OBJECTIVETo evaluate the clinicopathological features and prognostic factors of carcinoma in the remnant stomach (CRS).

METHODSClinicopathological data of 217 consecutive CRS patients from January 2000 to March 2017 at Department of Gastrointestinal Surgery, The Affiliated Hospital of Qingdao University were retrospectively analyzed. CRS was defined as the primary cancer arising from the remnant stomach following gastrectomy, regardless of the initial disease or operation, and at no special time interval. The clinicopathological features and treatment were compared between CRS after benign disease operation (CRS-B) group and CRS after gastric cancer operation (CRS-C) group, and factors influencing prognosis were analyzed using Cox regression model analysis.

RESULTSOf 217 patients, 189 were male and 28 were female with mean age of (60.9±11.2) years. The interval between the first and the second operations was (18.3±15.1) years. The CRS-B group comprised 108 patients and the CRS-C group comprised 109 patients. Compared to CRS-C group, CRS=B group had higher ratio of male [92.6% (100/108) vs. 81.7% (89/109), χ=5.779, P=0.016], longer interval [30(25-40) years vs. 4(1.5-8.0) years, Z=-1.685, P=0.000], longer tumor diameter [(5.9±3.2) cm vs. (3.9±2.4) cm, t=3.390, P=0.000] and later tumor stage [patients in stage I(, II(, III(, and IIII(: 6 (8.0%), 14 (18.7%), 41 (54.7%), and 14 (18.7%) vs. 16 (25.4%), 14 (22.2%), 21(33.3%), and 12(19.0%), respectively, Z=-2.018, P=0.044]. A total of 138 patients underwent surgery, including 118(85.5%) patients of curative resection and 20(14.5%) patients of palliative resection. The other 79 patients did not receive surgery due to extensive metastasis or miscellaneous reasons. Among 138 patients receiving surgery, 3 patients underwent endoscopic resection, 6 patients underwent minimally invasive surgery (laparoscopy or robot), and 129 patients underwent laparotomy. Forty-eight patients underwent surgery involving combined resection. The median postoperative hospital stay was 10(8-14) days. The incidence of postoperative complication was 23.2%(32/138). A total of 91 patients were followed up for 7-120 months, including 51 patients in CRS-B group and 40 in CRS-C group. The overall 1-, 3-, and 5-year survival rates of the 75 patients receiving curative resection were 80.7%, 55.1%, and 41.6%, respectively. The overall 1-, 3-, and 5-year survival rates were 73.5%, 48.3%, and 29.0% respectively in CRS-B group and 83.1%, 51.2%, and 32.5% respectively in CRS-C group. There was no significant difference between two groups (P=0.527). Multivariate analysis showed that age (RR=1.879, 95%CI: 1.015-3.479, P=0.045), radical procedure (RR=2.956, 95%CI: 1.421-6.150, P=0.004) and TNM stage (RR=1.570, 95%CI: 1.047-2.354, P=0.029) were independent prognostic factors for CRS.

CONCLUSIONSAs compared to the CRS-C group, the CRS-B group has higher percentage of male, longer interval, larger tumor diameter and later TNM stage. Radical resection indicates better prognosis.

Aged ; Female ; Gastrectomy ; Gastric Stump ; pathology ; surgery ; Humans ; Lymphatic Metastasis ; Male ; Middle Aged ; Neoplasm Staging ; Prognosis ; Retrospective Studies ; Stomach Neoplasms ; pathology ; surgery ; Survival Rate

OBJECTIVE: To compare the effects of robotic and laparoscopic-assisted radical total gastrectomy on lymph node dissection and short-term outcomes in patients with Siewert type II adenocarcinoma of esophagogastric junction (AEG). METHODS: Inclusion criteria: the tumor center was located between 2 cm above and below the esophagogastric junction and was confirmed as adenocarcinoma by endoscopic biopsy. EXCLUSION CRITERIA: tumor with local invasion of the liver,spleen, pancreas or other organs; intraoperative finding of tumor dissemination or distant metastasis; patients undergoing palliative surgical treatment or preoperative neoadjuvant chemotherapy; patients with serious heart diseases, lung diseases, liver diseases, kidney diseases and other comorbidities; patients with multiple primary cancers;patients receiving emergency surgery. According to the above criteria, 82 patients with Siewert type II AEG who underwent gastrointestinal surgery at the Affiliated Hospital of Qingdao University from October 2014 to October 2018 were enrolled in the study. They were randomly divided into robotic surgery groups (41 cases) and laparoscopic group (41 cases) according to a computer-generated randomized allocation table. Both groups underwent radical total gastrectomy plus D2 lymph node dissection through the transabdominal esophageal hiatus approach. The intraoperative conditions and postoperative short-term outcomes were compared between two groups, including surgery time, intraoperative blood loss, length of esophagectomy, postoperative complications, postoperative gastrointestinal recovery time, length of hospital stay, postoperative unplanned reoperation rate and rehospitalization rate. Mean±SD is used for the measurement data that conforms to the normal distribution, and two independent sample t-tests are used to compare the two groups; the comparison of the count data is performed by the χ² test. RESULTS: There were 35 males (85.4%) with age of (62.3±10.0) years and body mass index of (24.4±3.2) kg/m² in the robotic surgery group. There were 37 males (90.2%) with age of (62.5±10.0) years and body mass index of (23.8±2.6) kg/m² in the laparoscopic group. No significant differences in the baseline data between two groups were found (all P>0.05). All the patients of both groups completed R0 resection successfully without conversion to laparotomy or perioperative death. Compared with the laparoscopic group, the robotic group had less intraoperative blood loss [(70.7±39.9) ml vs. (110.2±70.6) ml, t=3.118, P=0.003], longer resected esophagus [(3.0±0.7) cm vs. (1.9±0.5) cm, t=8.759, P<0.001], but longer setup time [(56.5±7.4) minutes vs. (36.0±6.6) minutes, t=4.241, P<0.001], and higher hospitalization costs [(122 317.31±57 789.33) yuan vs. (99 401.56±39 349.53) yuan, t=2.099, P=0.039], whose differences were statistically significant (all P<0.05). The total number of harvested lymph node in the robotic surgery group was 39.2±15.3,which was significantly higher than that in the laparoscopic group (33.0±12.1) (t=0.733, P=0.047). In the robotic group and the laparoscopic group, the mediastinal lymph node No.110 and No.111 were 3.6±1.2 vs. 1.5±1.0 and 3.7±2.0 vs. 1.8±1.1, respectively, with significant difference (t=10.138, P<0.001, t=8.227, P<0.001); axillary lymph node No.19 and No.20 were 2.3±1.2 vs. 1.1±0.9 and 2.0±1.0 vs. 1.0±0.1, respectively, with significant difference (t=7.082, P<0.001,t=8.672,P<0.001). There were no significant differences in the total number of abdominal lymph node and the number of lymph node in abdominal stations between two group (all P>0.05). The highest lymph node metastasis rate was approximately 20% and observed in No.1, No.2, No.3, and No.7, followed by No.8a, No.9, No.11p, and No.110 with around 5%. The lymph node metastasis rate in other stations (No.4sa, No.4sb, No.4d, No.5, No.6, No.11d, No.12a, No.19, No.20 and No.111) was less than 5%.There were no significant differences in postoperative complication rate, postoperative fever time, postoperative exhaust and defecation time, fluid diet time, and postoperative hospital stay (all P>0.05). There were 2 patients(4.9%) with unplanned reoperation and 1 patient (2.4%) with unplanned re-admission in the laparoscopic group,while 3 patients (7.3%)with unplanned reoperation and 2 patients (4.9%)with unplanned re-admission in the robotic surgery group, whose differences were also not statistically significant (χ²=0.240,P=0.675;χ²=0.346,P=1.000). CONCLUSION Robot-assisted radical total gastrectomy for Siewert II AEG is safe and feasible, which is characterized by more sophisticated operation, less blood loss and higher quality of lymph node dissection, especially for subphrenic and inferior mediastinal lymph nodes.
Adenocarcinoma ; classification ; pathology ; surgery ; Aged ; Esophageal Neoplasms ; classification ; pathology ; surgery ; Esophagectomy ; Esophagogastric Junction ; pathology ; surgery ; Female ; Gastrectomy ; Humans ; Laparoscopy ; Lymph Node Excision ; methods ; Male ; Middle Aged ; Retrospective Studies ; Robotic Surgical Procedures ; Stomach Neoplasms ; classification ; pathology ; surgery ; Treatment Outcome