Objeetlve To avoid inserting the tip of the central venous catheter into internal jugular vein (IJV) through subclavian vein under ultrasound guidance.Methods sixty breast cancel patients aged 28-63 yr weighing 41-70 kg who needed long-term intravenous infusion and chemotherapy through central venous catheter were randomly divided into 2 groups (n=30 each):control group (group C) and ultrasound group (group U).In group C the insertion of central venous catheter through subclavian vein was guided by pulsatile injection of ice-cold saline.In group U ultrasound detector (type HFL 38/13-6 MH,Sonosite Co,USA) was used to guide the insertion of tbe central vesons catheter.The position of the catheter tip was verified by X-ray radiography.The rate of successful placement at 1st attempt was calculated.Results The tip of the central venous catheter was correctly placed in the vena cava and right atrium in all patients in group U (success rate 100%),while in group C the tip was misplaced in IJV in 6 patients (success rate 80%) and had to be replaced.Conclusion Ultrasound guidance is effective for correct placement of the tip of central venous catheter in the vema cava and right atrium through subclavian vein.

Objective:To verify the transforming therapeutic efficacy of apatinib combined with oxaliplatin + tegiol (SOX regimen) in advanced gastric cancer with peritoneal metastasis.Methods:Using the method of descriptive case series study, the data of gastric cancer patients with peritoneal metastasis treated in Zhejiang Provincial People′s Hospital and Shulan (Hangzhou) Hospital from March 2016 to August 2021 were collected and treated with apatinib combined with SOX regimen. Oxaliplatin 130 mg/m 2, intravenous drip, day 1; Apatinib mesylate tablets 500 mg/d, oral, once a day, 1-21 days; Teggio: calculate the dosage according to the body surface area (<1.25 m 2, 40 mg; 1.25-1.50 m 2, 50 mg; >1.50 m 2, 60 mg). Take it orally for 1-14 days, twice a day. From the first day of chemotherapy, a cycle of 3 weeks. The short-term efficacy was evaluated every 2 cycles. After that, the multidisciplinary treatment team will decide whether the conversion operation can be accepted. When the requirements of surgical resection were met, the operation will be carried out after 1 cycle of drug withdrawal. Results:The median survival time (MST) of 23 patients was 14.1 months (95% CI: 12.3-16.4); The median overall survival (OS) after transformation therapy was 19.1 months (95% CI: 15.5-22.8). After transformation therapy, 14 cases of partial remission (PR), 3 cases of stable disease (SD) and 6 cases of progression disease (PD) in 23 patients, and the objective remission rate (ORR) was 73.9%(17/23). 12(52.2%) patients underwent surgery after transformation therapy. The 1-year OS of 12 patients was (17.0±1.5)months; Among them, 5 cases underwent R0 resection, and the R0 resection rate was 5/12. Conclusions:Transformation treatment with apatinib combined with oxaliplatin + tegio (SOX regimen) in advanced gastric cancer can achieve a high R0 resection rate with better conversion effect.

Objective:To study the short-term effect of early application of intestinal microecological therapy after gastric cancer surgery.Methods:A retrospective analysis was made on 96 patients with early and middle stage gastric cancer who underwent surgical treatment in the department of gastrointestinal surgery of Shulan (Hangzhou) Hospital from June 1, 2020 to May 31, 2021. Among them, 48 patients in the observation group were given enteral nutrition support treatment in the early stage after operation and intestinal microecological preparation, while the control group of 48 patients in the early postoperative were given enteral nutrition support. The serum total protein, albumin, prealbumin and other nutrition related indexes and immune related indexes such as CD4 + , CD8 + , CD4 + /CD8 + were detected before and 7 days after operation. The clinical indexes such as the time of first anal exhaust and the incidence of infectious complications were recorded. Results:There was no significant difference between the two groups in preoperative serum total protein, albumin, prealbumin and immune related indexes such as CD4 + , CD8 + , CD4 + /CD8 + ( P>0.05). 7 days after operation, the above indexes in the observation group were significantly higher than those in the control group (all P<0.05). The anal exhaust recovery time of observation group was faster ( P<0.05); There was no significant difference in the incidence of postoperative infectious complications between the two groups ( P>0.05). Conclusions:Early application of intestinal microecological agents in patients with gastric cancer after operation can significantly improve the nutritional status and immune function, promote the recovery of intestinal function, and will not increase the incidence of complications.

Objective:To introduce the operation process of laparoscopic total gastrectomy assisted by small incision and gastrointestinal reconstruction using tubular instrument anastomosis in esophageal and small bowel reconstruction, and evaluate its feasibility, safety during perioperative period, and advantages of anastomosis.Methods:A total of 56 patients with gastric cancer who underwent laparoscopic total gastrectomy assisted by small incision and gastrointestinal reconstruction using tubular instrument anastomosis in esophageal and small bowel reconstruction were selected as study subjects from Zhejiang Provincial People′s Hospital between May 2022 and June 2023. Gender, age, body mass index (BMI), tumor location, tumor stage, tumor type and other related indicators were collected. The main parameters during the operation process were collected, including operation time, anastomosis time, intraoperative blood loss, postoperative recovery status, exhaust time, feeding time, complications related to anastomosis, and length of hospital stay. The differences between other digestive tract reconstruction methods such as Overlap method, reverse puncture method, and handmade anastomosis were compared and analyzed.Results:A total of 56 patients with gastric cancer were included in this study. The anastomosis time of the tubular instrument group was (42.3±15.7)min, which was superior to the handmade anastomosis group ( P<0.05). The operation time of the tubular instrument group was (176.3±25.8)min, which was superior to other methods (all P<0.05). The intraoperative blood loss of the tubular instrument group was (75.68±20.34)ml, which was less than other methods (all P<0.05). The exhaust time of the tubular instrument group was (2.6±0.2)d, which was similar to the Overlap method ( P>0.05), but earlier than the handmade anastomosis method and the reverse puncture method (all P<0.05). The incidence of anastomotic leakage in the tubular instrument group was similar to the handmade anastomosis method, the reverse puncture method, and the Overlap method (all P>0.05). There were no significant differences in postoperative hospital stay, incision infection rate, and other complications related to anastomosis between groups (all P>0.05). Conclusions:The tubular instrument anastomosis method has a shorter operation time and a smaller incision compared to traditional laparotomy surgery. It has the advantages of laparoscopic assistance with intuitive and clear visualization during the operation, while also taking into account the convenience and safety of direct visualization under laparoscopy. It is a surgical method worthy of promotion.

Objective:To investigate the clinical effect of enteral nutrition support in the transformation therapy of advanced gastric cancer.Methods:Eighty-two patients with advanced gastric cancer treated by transformation in Zhejiang Provincial People′s Hospital from September 2019 to August 2021 were analyzed retrospectively. 41 patients in the observation group were treated with enteral nutrition support on the basis of routine transformation treatment; 41 patients in the control group received only routine transformation treatment. The nutritional related indexes such as prealbumin, total serum protein and albumin and immune related indexes such as CD4 + , CD8 + , CD4 + /CD8 + were detected before treatment and on the 7th day after the end of 3-cycle transformation treatment, and the above indexes and transformation success rate of the two groups were compared. Results:There was no significant difference in prealbumin, total serum protein, albumin, CD4 + , CD8 + , CD4 + /CD8 + between the two groups before treatment (all P>0.05). On the 7th day after three cycles of transformation treatment, the above indexes in the observation group were higher than those in the control group, with significant difference (all P<0.05). The success rate of transformation in the observation group was higher than that in the control group ( P<0.05). Conclusions:The rational use of enteral nutrition support in the transformation treatment of patients with advanced gastric cancer can significantly improve the nutritional status and immune function of patients, increase the tolerance to chemotherapy and improve the success rate of transformation.