1.Surgical treatment of gastrointestinal stromal tumors: a report of 486 cases
Zhiqiang MA ; Jianchun YU ; Weiming KANG
Chinese Journal of Digestive Surgery 2013;(4):276-279
Objective To investigate the surgical treatment of gastrointestinal stromal tumor (GIST) based on the clinical characteristics of GIST in different locations.Methods The clinical data of 486 GIST patients who received surgical treatment at the Peking Union Hospital from January 2003 to December 2012 were retrospectively analyzed.There were 461 patients with primary GIST and 25 with secondary GIST.The clinical characteristics and surgical treatment methods were analyzed.All data were analyzed using the chi-square test.Results Of the 461 patients with esophageal stromal tumors,6 received partial esophagectomy.Of the 234 patients with gastric stromal tumors,183 received partial gastrectomy,23 received proximal gastrectomy + cardiectomy,23 received distal gastrectomy,2 received total gastrectomy and 3 received exploratory laparotomy.Of the 51 patients with duodenal stromal tumors,34 received partial duodenectomy,9 received pancreatico-duodenectomy,5 received pylorus-preserving pancreaticoduodenectomy,3 received palliative surgery.Of the 116 patients with small intestinal stromal tumors,110 received partial small intestinal resection and 6 received palliative surgery.Of the 29 patients with rectal stromal tumors,13 received posterial transsphincteric surgery of the rectum,12 received transanal local resection of rectal tumors and 4 received abdominoperineal resection; laparotomy was performed on 25 patients with GIST in other positions.Of the 25 patients with secondary GIST,10 patients with liver metastasis of GIST received hepatic segmentectomy,1 received hepatobiopsy; 6 received abdominopelvic tumor resection; 5 received portial resection of the small intestine or colon; 1 received sigmoid colostomy; 1 received splenectomy and 1 received intracranial tumor resection.Of the 461 patients with primary GIST,patients who received combined devisceration accounted for 12.58% (58/461),and the ratio of combined cholecystectomy was the highest,which was 34.5% (20/58).Combined devisceration was considered for patients with duodenal stromal tumors,gastric stromal tumors and small intestinal tumors.Laparoscopic surgery accounted for 20.39% (94/461) of all the surgery,and the ratio of laparoscopic surgery which carried out in recent 5 years was 28.52% (77/270),which was significantly higher than 8.90% (17/191) of the earlier 5 years (x2=36.67,P < 0.05).Conclusion Different surgical treatment methods including minimally invasive surgery could be adopted according to different clinical characteristics of GIST in different locations,and radical resection of GIST is the main objective.
2.Effect of sleeve gastrectomyon intestinal barrier of obesity rats fed with high-fat diet
Xin YE ; Jianchun YU ; Weiming KANG ; Zhiqiang MA ; Zhanjiang CAO
Basic & Clinical Medicine 2017;37(8):1113-1116
Objective To investigate the effect of sleeve gastrectomy on the intestinal barrier of obesity rats fed with high-fat diet.Methods Thirty obesity rats fed with high-fat diet were randomly divided into three groups including common diet group (CD,n=10),sham operation group (SO,n=10) and sleeve gastrectomy group (SG,n=10).The lactulose/mannitol ratios (L/M) in 24-hour urine and endotoxin in portal vein were evaluated four weeks after surgery.The levels of tight junction proteins including claudin-1 and occludin in intestinal mucosa were analyzed by western blot.Results The body weight of SG group was significantly decreased than those of CD group (P<0.001) and SO group (P<0.001) four weeks after surgery.The L/M ratio in 24-hour urine of SG group was significantly lower than those of CD group (P<0.001) and SO group (P<0.01).The endotoxin level in portal vein of SG group was significantly lower than those of CD group (P<0.01) and SO group (P<0.05).The claudin-1 level in intestinal mucosa of SG group was significantly higher than those of CD group (P<0.001) and SO group (P<0.01) four weeks after surgery.The occludin level in intestinal mucosa of SG group was significantly higherthan those of CD group (P<0.001) and SO group (P<0.001).Conclusions Sleeve gastrectomy can reduce body weight,L/M ratio in 24-hour urine and endotoxin level in portal vein of obesity rat fed with high-fat diet and increase the levels of claudin-1 and occludin in intestinal mucosa.
3.Laparoscopic adjustable gastric banding in a multidisciplinary modality for morbid obesity
Xin YE ; Jianchun YU ; Weiming KANG ; Zhiqiang MA
Journal of Endocrine Surgery 2013;7(6):483-486,508
Objective To investigate the multidisciplinary modality for obesity treatment and evaluate the safety and long-term efficacy of laparoscopic adjustable gastric banding(LAGB) on weight loss and obesity related metabolic diseases in obesity patients.Methods The clinical and follow-up data of 28 consecutive morbid obesity patients receiving LAGB in Dept.General Surgery of PUMC hospital in a multidisciplinary modality from Oct 2009 to May 2012 were retrospectively analyzed.The strategy of perioperative and follow-up management was summarized and the safety and long-term efficacy of LAGB on weight loss and comorbidity were evaluated.Results Mean body weight of the subjects was 129.1kg and mean body mass index(BMI)44.9 kg/m2.All patients underwent LAGB successfully without perioperative mortality.Early postoperative complications included 1 case (3.6%) of pulmonary infection and long-term complications included 2 cases (7.1%)of port infection.Mean body weight and BMI decreased gradually after LAGB.The mean percentage of excess weight loss(% EWL)at postoperative 24 months was 41.3%.% EWL of the group with regular follow-up and good compliance was significantly better than the other group.Complete or partial remission was observed in obesity related metabolic diseases at the last follow-up.Conclusions LAGB is safe and has good long-term efficacy on weight loss and comorbidity improvement of obesity patients.Better services can be provided for obesity patients in a multidisciplinary modality,It is important for the patients to follow up regularly after surgery in order to maintain long-term weight loss.
4.Expression of urokinase-type plasminogen activator in non-small cell lung cancer
Zhiqiang KANG ; Bin JIANG ; Ping LI ; Yajie WANG ;
Academic Journal of Second Military Medical University 2000;0(08):-
3 cm,66.67%,18/27) than those in smaller tumors(
5.Preventive effect of Unaccompanied Ginseng decoction joint Xuanfu Daizhe decoction on complications in gastric cancer patients with post-operative adjuvant chemotherapy
Jinke KANG ; Zhiqiang WANG ; Mi SHEN ; Mingjie MA
Chinese Journal of Biochemical Pharmaceutics 2015;(11):58-60
Objective To investigate the effect of Unaccompanied Ginseng decoction joint Xuanfu Daizhe decoction on complications in patients with gastric cancer adjuvant chemotherapy, and select the best method to reduce the incidence of complications.Methods 80 patients of gastric cancer with postoperative adjuvant chemotherapy from May 2010 to May 2015 were divided into two groups, 40 cases in each group.The control group received Western medicine treatment and observation group received Unaccompanied Ginseng decoction joint Xuanfu Daizhe decoction , with a consecutive of one week.The clinical efficacy, adverse reactions and quality of life were compared between two groups.Results There was no significant difference in total efficacy between observation group and control group(77.5% vs.75.0%; χ2 =0.069,P>0.05).The KPS score, symptom and physical sign score, alanine aminotransferase, serum creatinine and systolic pressure in observation group post-treatment improved more than those in control group ( P<0.05).The adverse reaction rates of thrombocytopenia and myelosuppression in observation group was significantly lower than that in control group , respectively(P<0.05).Conclusion Unaccompanied Ginseng decoction joint Xuanfu Daizhe decoction could decrease the complications in gastric cancer patients with postoperative adjuvant chemotherapy.
6.Comparison of clinical efficacy between standard sequential early enteral nutrition plus parenteral nutrition and parenteral nutrition support in patients undergoing gastrointestinal surgery: a clinical randomized controlled trial
Weiming KANG ; Jianchun YU ; Zhiqiang MA ; Jin WANG ; Junna GE ; Zhitian LI
Chinese Journal of Clinical Nutrition 2011;19(3):148-153
Objective To compare the clinical efficacy between standard sequential early enteral nutrition (EEN) plus parenteral nutrition (PN) and PN alone in patients undergoing gastrointestinal surgery. Methods Werandomly divided 126 patients who underwent laparotomy gastrointestinal surgery into EEN + PN group (n = 62) and PN group (n = 64). The levels of blood nutrition-related indicators, biochemical indicators, and inflammatory indicators were determined before surgery and 3 and 7 days after surgery, and the gastrointestinal function recovery time, complications, nutritional support cost, and length of hospital stay were compared between two groups. Results The preoperative nutrition-related indicators, biochemical indicators, and inflammatory indicators showed no significant differences between two groups (P >0. 05). Three days after operation, however, the levels of prealbumin in EEN + PN group were significantly higher than those in PN group [(160. 3 ±23. 0) g/L vs. (137.0±28.7) g/L, P=0.000]. Seven days after operation, the levels of albumin [(33.6±3.8) g/L vs. (31.8±4.7) g/L, P = 0.042], prealbumin [(210.6±34.6) g/L vs. (154.8 ±36.9) g/L, P=0.000], and lymphocyte cell count [(2.33±0.53) x 109/L vs. (1.04±0.36) × 109/L, P = 0. 046] in EEN + PN group were significantly higher than those in PN group, and the levels of serum γ-glutamyltransferase [(48. 12 ± 33.84) U/L vs. (71.54±34.00)U/L, P=0.048], C-reactive protein [(31.15 ± 19.00) mmol/L vs. (45.90 ± 23.21) mmol/L, P=0.042], total cholesterol [(3.09±0.83) mmol/L vs. (3.29±0.91) mmol/L, P = 0. 045] and low density lipoprotein [(2.01 ± 0. 39) mmol/L vs. (2. 31 ± 0. 72 ) mmol/L, P = 0. 049] were significantly lower than those in PN group. The postoperative gastrointestinal function recovery time in EEN + PN group was significantly shorter than that in PN group [(65. 7 ± 15. 6) hours vs. (75. 1 ± 27. 0) hours, P = 0. 036], and the total cost of perioperative nutrition in EEN + PN group was also significantly lower than in PN [(2634. 5 ±1306. 8) RMB vs. (3058. 6 ± 1216. 0) RMB, P= 0.046]. Conclusion Standard sequential EEN plus PN can increase the post-operative prealbumin level, improve the immune function, promote the recovery of gastrointestinal function, and decrease the cost of nutritional support.
7.Correlation analysis between prognostic nutritional index and clinicopathological features and long-term prognosis of resectable gastric cancer
Xin YE ; Jianchun YU ; Weiming KANG ; Zhiqiang MA ; Qingbin MENG ; Zhanjiang CAO ; Shubo TIAN
Chinese Journal of General Surgery 2014;29(2):93-97
Objective To investigate the correlation between the prognostic nutritional index (PNI) and clinicopathological features and long-term prognosis of gastric cancer patients after radical gastrectomy.Methods The clinical data of 135 gastric cancer patients who underwent radical gastrectomy in this hospital from 2002 to 2006 was analyzed retrospectively.The PNI value was calculated by serum albumin (g/L) + 5 x lymphocyte count (× 109/L).The receiver operating characteristic (ROC) curve and Youden index was used to determine the cutoff value of the PNI.Survival curves were described by the Kaplan-Meier method and compared by the Log-rank test.The univariate and multivariate analyses were performed with the Cox proportional hazard model to identify the prognostic factors.Result The mean PNI value was 47.3 ± 5.9.The mean values of the PNI in age (t =2.909,P =0.004),tumor size (t =2.227,P =0.028),tumor depth (t =3.314,P =0.001),negative lymph node (t =2.381,P =0.019),negative lymphovascular invasion (t =2.781,P =0.006) were significantly higher than those in patients without such factors.When the PNI was 47,the Youden index was maximal,with a sensitivity of 70% and specificity of 63%.The mean age in high PNI group was significantly lower than that in low PNI group (x2 =6.443,P =0.011).Tumor infiltration depth in high PNI group was less than in low PNI group (x2 =7.394,P =0.007).The proportion of lymphovascular invasion in high PNI group was significantly lower than in low PNI group (x2 =4.540,P =0.033).The overall survival rate in high PNI group was higher than in low PNI group (P =0.002).The univariate and multivariate analyses showed that tumor location (OR,2.144 ; 95 % CI 1.239-3.712 ; P =0.006),lymph node metastasis (OR,4.887 ; 95 % CI 1.856-12.866 ; P =0.001),lymphovascular invasion (OR,1.842 ; 95% CI 1.078-3.145 ; P =0.025) and the PNI value (OR,2.282 ; 95 % CI 1.344-3.874 ; P =0.002) were independent factors for predicting overall survival rate.Conclusions The PNI value is a simple and useful tool to predict the prognosis of patients with gastric cancer.
8.Relationship between glycemic control and platelet parameters in newly diagnosed type 2 diabetic patients
Jiandong TANG ; Qingchu LI ; Zhiqiang KANG ; Li HE ; Fang LUO ; Longtao LEI
Clinical Medicine of China 2011;27(3):267-269
Objective To study the relationship between glycemic control and platelet parameters in newly diagnosed type 2 diabetic patients. Methods Ninety patients newly diagnosed as type 2 diabetes and 90 healthy people were enrolled into the study. Their blood pressure, platelet parameters, including blood platelets count (PLT), mean platelet volume (MPV), platelet distribution width (PDW), fasting blood glucose (FPG),HbA1c ,triglyceride ( TG ), total cholesterol ( TC ), high density lipoprotein cholesterol (HDL-C ), low density lipoprotein cholesterol(LDL-C) were examined and the data were analyzed. Results The level of FBG, TG, TC,MPV and PDW of patients newly diagnosed as type 2 diabetic were significantly higher than those of healthy people (t =6. 405,2. 069,2. 633,2. 178,2. 103 ;P =0. 001,0. 046,0. 010,0. 031 and 0. 043 respectively); The level of FBG, HbA1c, TC, TG, MPV and PDW in the diabetic patients, with their HbA1 c > 7%, were significantly higher than the patients with HbA1c ≤ 7 % ( t = 5.691,2.013,2. 345,3. 467,4. 016,2. 893, P = 0. 001, 0. 038,0. 029,0. 013, 0. 004, 0. 026 ). There were positive correlations between MPV and HbA1c ( r = 0. 389 P =0. 020), MPV and PDW ( r = 0. 324 P = 0. 01 ) in diabetic patients, but no correlation between MPV and FBG,MPV and Systolic BP or MPV and Diastolic BP (Ps > 0. 05 ). The level of FBG, HbA1c, TG, MPV and PDW decreased significantly in the diabetic patients with HbA1c > 7% after treatment (t = 5. 591,2. 301,2. 410,2.204,2.105; P=0.001,0.031,0.023,0.035,0.041, respectively).Conclusion The platelet activity enhanced in newly diagnosed type 2 diabetic patients, platelet activity can be recovered through glycemic control,which may prevent the role of platelet in diabetes complications in these patients.
9.Stability of 3 kinds of traditional Chinese drug injection with different solvent under different temperature
Yubin KANG ; Lili YANG ; Wenting TU ; Xiuhua ZHANG ; Zhiqiang WANG ; Xu ZHANG ; Huijuan TANG ; Yanjun CAO
Chinese Journal of Practical Nursing 2010;26(1):18-21
Objective To know the stability of 3 kinds of traditional Chinese drug injection with different solvent under different temperature and different storage time,and then reference to safty of clinical durgs. Methods Use particle analyzer,UV SpectropHotometer,pH Determination of three traditional Chinese medicine injection,at different temperatures and different times,the nuanber of particles,pH value,the value of UV absorbance Observe changes. Results The records of experimental data by repeated measures analysis of statistics: Ciwujia Injection,Aidi injection combined with normal saline solution after the particles of ≥ 10μm excess pharmacopoeia standards; ≥ 2μm number of particles is considerable,in the 32~35℃,Ciwujia at T=O min Aidi at T=I80 min ,the number of particles are smaller and with statistical significance,its pH value of the standard range. Xuesaitong injection with glucose injection ≥ 10μm particulate mixture at a higher temperature in excess of pH annacopoeia standards,number of ≥ 2 μm particles in the 4~8℃ and 20~23℃,T=30 min and 60 min time less with statistical significance,and its range of pH value less than pHarmacopoeia. Three kinds of Chinese medicine in the Department's largest UV absorbance peak value and appearance almost unchanged. Conclusions Different drugs in their relative Suggestions of temperature,time and place under intravenous drug use,or better terminal filter,in order to improve the safety of clinical medication.
10.A primary study of the relationship between apparent diffusion coefficient value of rectal adenocarcinoma on DWI and its pathological grading
Jin ZHU ; Zhiqiang CHENG ; Mingli YANG ; Wenyan KANG ; Jingshan GONG ; Ligang XIA ; Jianmin XU
Journal of Practical Radiology 2015;(6):938-941
Objective To investigate the relationship between apparent diffusion coefficient (ADC)value of rectal adenocarcinoma on DWI and its pathological grading.Methods The ADC values of 46 rectal adenocarcinomas were measured and compared with their histopathological grades.Results The 46 rectal adenocarcinomas included well differentiated adenocarcinomas in 14,moderate-ly differentiated ones in 20,and poorly differentiated ones in 12.The ADC values of well,moderately and poorly differentiated ade-nocarcinomas were (1.125±0.103)×10 -3 mm2/s,(1.030±0.098)×10 -3 mm2/s and (0.922±0.091)×10 -3 mm2/s,respective-ly,exhibiting a statistical difference (χ2 =1 7.35 1,P =0.000).Mann-Whitney U test showed that difference in ADC value between different histopathological grades was statistically significant.Conclusion ADC value of rectal adenocarcinoma can be used as a bio-marker for cell grading to guide treatment decision and prognosis assessment.