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After placing stents undergoing elective surgery and emergency surgery in comparative study of obstructive colorectal cancer

Hui LIU ; Xianzhang ZHU

Chinese Journal of Current Advances in General Surgery.2017;20(3):184-187. doi:10.3969/j.issn.1009-9905.2017.03.005

Objective:To investigate the clinical value of two kinds of treatment methods of selective operation and emergency surgery after implantation of stents.Methods:Methods the clinical data of 90 patients with obstructive colorectal cancer were analyzed retrospectively.Temporary placement of metal stents in 30 cases,Elective surgical treatment (stent group);60 cases of emergency operation (emergency operation group).Comparing stent group and a emergency surgical resection and self-agreement,operation time,postoperative ventilation time,complications and hospitalization mortality indicators.Results:stent group one stage resection self-agreement (96.67％) were significantly higher than those of emergency surgery group(56.67％,P＜ 0.001).Postoperative complications(6.67％) stent group was obviously lower emergency surgical group(26.67％,P＜ 0 05).Support group hospitalization mortality compared with emergency surgery group,The difference was not statistically significant(P＞0.05).Support the operative time,postoperative ventilation time (156.13 ± 49.79) min and (3.60 ± 1.40) d,respectively,significantly lower than the emergency treatment (P＜ 0.05).Conclusion:Implant stents can rapidly and effectively alleviate symptoms of obstructive co orecta cancer After placing stents undergoing elective surgery compared with emergency surgery can increase the resection and self-agreement,reduce the complications and can be used as aeffect ve relieve obstructive colorectal cancer treatment.

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Modified method for umbilical reconstruction after single-incision laparoscopic surgery

Yongsheng CHEN ; Shuodong WU ; Jing KONG

Chinese Journal of Current Advances in General Surgery.2017;20(3):182-183. doi:10.3969/j.issn.1009-9905.2017.03.004

Objective:To introduce a modified method for umbilical reconstruction after single-incision laparoscopic surgery.Methods:Between June 2012 and June 2015,173 patients underwent single-incision laparoscopic cholecystectomy at our institution.All the patients adopted our modified method for umbilical reconstruction.Results:All the surgeries were successful.The umbilical incision healed well with good cosmetic result.Conclusion:The modified method for umbilical reconstruction can improve cosmesis and decrease the possibility of incision hernia after single-incision laparoscopic surgery.More studies are needed to evaluate definitive clinical advantages of this technique.

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Inhibitory effect of iNOS inhibitor on the apoptosis of rat abdominal aortic aneurysm smooth muscle cells

Huapeng LIN ; Sen QIAO

Chinese Journal of Current Advances in General Surgery.2017;20(3):178-181. doi:10.3969/j.issn.1009-9905.2017.03.003

Objective:To explore the establishment of an animal model of abdominal aortic aneurysm(AAA),and elaborate the role of iNOS inhibitor in the smooth muscle apoptosis of abdominal aortio aneurysm in rats,to find a new theoretical basis for the clinical treatment of small drugs AAA.Methods:SD rats underwent intra-aortic elastase (25U/mL) perfusion to induce AAAs,the positive control group (30) and experiment group (30) use elastase perfusion while the negative control group(30) gives the saline perfusion.After operation the positive and negative control groups were treated with intraperitoneal injections of saline,experimental group injects the iNOS inhibitor Aminoguanidi hydrochloride;Postoperative second,7,and 14 days,The NO content in the serum and specimen of abdominal aortic aneurysm was detected by iNOS Immuno histochemistry and Terminal Transferase-mediated dUTP Nick End-Labeling (TUNEL) to evaluate distribution of smooth muscle apoptosis in abdominal aortic aneurysm.Results:Underwent intra-aortic elastase perfusion to induce AAAs have a high-success-rate.Rate of AAA formation in positive control group 10％,60％,80％,respectively.The treatment group was 0％,10％,20％,and the negative control group was not formed.The treatment group and the negative control group were lower than the positive control group,there were significant differences.In the positive control group,NO content increased gradually from second days,7 days to reach the peak and maintained at a higher level,the treatment group serum NO content was lower than the other two groups,there was significant difference (P＜0.05),iNOS was strong expression in the positive control group,in the other two groups of mild expression.TUNEL results showed that a lot of apoptotic cells in the positive control group,after 7 days showed a significant increase trend,to observe the end (2 weeks) gradually increased.,The positive control group was higher than the negative control group and the negative control group,there was significant difference(P＜0.05).Conclusion:iNOS inhibitors significantly decreased the content of NO in serum,reduced the apoptosis of smooth muscle cells,and inhibited the formation of abdominal aortic aneurysm.To provide theoretical basis for clinical application of iNOS inhibitors in the treatment and control of AAA.

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Effect of CO2 pneumoperitoneum and ABT-737 on the expression of VEGF in GCC/TAMs co-culture system

Wei LIU ; Jie AN ; Huichi HOU ; Kang LI ; Zhi LI ; Sihu ZHEN ; Shaowen WANG

Chinese Journal of Current Advances in General Surgery.2017;20(3):174-177. doi:10.3969/j.issn.1009-9905.2017.03.002

Objective:Study on proliferation of gastric cancer cells (GCCs) and expressions of VEGF under the CO2 pneumoperitoneum environment,and effect of Bcl-2 specific inhibitor on the expression of VEGF in GCCs/TAMs co-culture system.Methods:TAMs induced by PMA and IL-4 in vitro.TAMs and MKN-45 cells were co-cultured in Transwell chamber,in pseudo CO2 pneumoperitoneum environment.Proliferation activity of GCCs was detected by MTT assay,and ELISA method was used to detect VEGF concentration in the cell culture supernatant.Results:Co-culture system was divided into CO2 pneumoperitoneum group and control group.Proliferation activity of MKN-45 cell and expression of VEGF of 5mmHg,10mmHg and 15mmHg groups are no difference with the control group;25 mmHg group is opposite to the former.The cells in co-culture group and CO2 pneumoperitoneum group (15 mmHg) were added to ABT-737,VEGF expression of co-culture + ABT-737 group was significantly lower than that of in the control group(P=0.001).Co-cultured cells VEGF expression in pneumoperitoneum group was significantly lower than the control group without inhibitor (P=0.000).Conclusion:Normal laparoscopic pneumoperitoneum is no stimulation of tumor cell proliferation defects,And higher pneumoperitoneum pressure might increase the hypoxia status of tumor microenvironment,promote tumor malignant progression.The interaction between tumor cells and TAMs may be achieved by paracrine Bcl-2-VEGF loop.

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Nano-carbon tracer technology mapping lymph node dissection in laparoscopic mid-low rectal cancer resection

Xiangan TIAN ; Chengju YANG ; Yuansheng DING ; Jianguo HUANG ; Liguang YANG ; Qinli SUN ; Naiqing LIU

Chinese Journal of Current Advances in General Surgery.2017;20(3):188-192. doi:10.3969/j.issn.1009-9905.2017.03.006

Objective:To investigate the clinical application value of nano-carbon tracer technology in lymph node dissection and postoperative pathological examination in laparoscopic mid-low rectal cancer resection.Methods:Fifty-two patients with mid-low rectal cancer were randomly divided into experimental group (n=27) and control group (n=25).Before surgery,the Nano-group were injected nano activated carbon suspension liquid under the mucosa.Both groups were accepted the same principles of open colorectal cancer radical surgery.The total number of lymph nodes,number of tiny lymph nodes,number of black dye and number of metastasis lymph node confirmed by pathology in the two groups were statistical analysised.Results:There were 905 pieces of lymph node seized in two groups toally,including (20.67 ± 5.751) medals in Nano-carbon group and (13.88 ±4.466) medals in control group.Lymph node number in nano carbon group was more than control group (P＜0.01).Nano-carbon group seized 113 tiny lymph nodes,significantly higher than 49 in the control group (P＜0.05).The metastasis rate of lymph node was no significant difference in the two groups (P＞0.05).Nano-carbon group seized lymph node metastasis was no significant difference in the rate of the control group (P＞0.05).Nano-carbon group seized 341 black dyed lymph nodes and 217 not black dye lymph nodes.And 67 cases of metastasis lymph nodes in Black dye lymph nodes,15 cases of metastasis lymph nodes in not the black dye lymph nodes.The metastasis rate of black dye lymph node was higher(P＜0.01).Conclusions:Nano-carbon tracer technique can guide the surgeon to accurately lymph nodes dissection during the operation,and can add to the number of lymph nodes in the postoperative surgical specimens,improve lymph nodes in patients with colorectal cancer radical seized quantity.Nano-carbon tracer technique can ensure the accuracy of the pathological staging,there was important clinical significance to lymph node dissection in Mid-low colorectal cancer,which provide an important basis for the development of postoperative adjuvant therapy programs.

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Influence on the proliferation of breast cancer with silencing YKL-40 by siRNA interference

Hao CHENG ; Jiejie DONG ; Bo ZHAI ; Jun XU

Chinese Journal of Current Advances in General Surgery.2017;20(3):169-173. doi:10.3969/j.issn.1009-9905.2017.03.001

Objective:To explore the relationship between YKL-40 and the proliferation of breast cancer and its mechanism.Methods:The expression of YKL-40 in breast cancer MCF-7 cells was detected by immunofluorescence assay.Fluorescence microscope was used to observe the conversion efficiency,and Real-time PCR was used to screen the most effective YKL-40 siRNA.Expression levels of PI3K,P-PI3K,AKT,P-AKT of the PI3K/AKT pathway associated proteins was test by Western blot.At the same time,MTT and flow cytometry were validated by YKL-40 siRNA treatment of human breast cancer MCF-7 ceils,the differences of 24h,48h and 72h groups of cell proliferation ability and cell cycle.Result:MCF-7 cell express YKL-40 protein,mainly located in the cytoplasm.Real-time PCR show that siRNA01,siRNA02,siRNA03 compared with NC group YKL-40 gene silencing effect is remarkable.Among of them the strongest silencing effect is siRNA02 (P＜0.01),Western blot show the experimental group than the control group,Total PI3K and AKT remain unchanged while P-PI3K,P-AKT expression decreased (P＜0.05).In the experimental group,the number of G1 cells in the control group was increased (P＜0.01),while the S phase cells decreased (P＜0.01).MTT results showed that the experimental group compared with the control group,the proliferation ability is decreased(P＜0.01).Conclusions This study suggests that YKL-40 can be used as the upstream regulatory factor of PI3K/AKT signaling pathway and affect the process of cell cycle in breast cancer,and then regulate the proliferation of breast cancer,YKL-40 may be a crucial target for the treatment of breast cancer.

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Comparison of three kinds of nutritional screening tools in clinical application of general surgery patients application

Xiaoming GAO ; Chunyan HAO ; Peihua ZHU ; Junjing WANG ; Peng YAN ; Rong CHEN

Chinese Journal of Current Advances in General Surgery.2017;20(6):454-457. doi:10.3969/j.issn.1009-9905.2017.06.009

Objective:To compare the applicability and consistency of NRS2002,SGA and MNA in general surgery hospitalized patients and analyze the effect in clinical outcomes of NRS resuits with respect to each tool.Method:The 150 patients hospitalized in our hospital were chosen as object of study,to screen and evaluate nutritional risk of patients by NRS 2002,SGA and MNA,respectively,on the second hospital day,then to compare the consistency of NRS results with respect to the four tools on clinical outcomes.Results:The applicabilities of hospital NRS2002,SGA and MNA were alternatively 97.25,97.25％ and 98.35％.The evaluation of patients' NRS corresponding to different four tools was consistent.The effects of screening results of MNA,NRS2002 and SGA on clinical outcomes were most closely related.Conclusion:The three nutritional evaluation tools can be applied to the screening of malnutrition in General Surgery.The effects of screening results of NRS2002 and SGA on clinical outcomes were most closely related.

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Clinical effect of a combined ultrasound and pneumatic lithotripter on intrahepatic and extrahepatic bile duct stones

Fangxing PENG ; Sanying YUAN ; Liang LUO ; Hui CHEN ; Chen WU ; Jin CHEN

Chinese Journal of Current Advances in General Surgery.2017;20(6):451-453,457. doi:10.3969/j.issn.1009-9905.2017.06.008

Objective:The application of a combined ultrasound and pneumatic lithotripter for cholelithiasis was investigated.Methods:A total of 59 cases of cholelithiasis diagnosed by ultrasonography and CT were included in the study.All the patients had surgical treatment from January 2013 to December 2015,in which 30 patients were treated with a combined ultrasound and pneumatic lithotripter protocol (EMS group),and 29 patients were treated with traditional choledochoscope protocol(control group).All the patients were followed up for 3 months postoperation.The outcomes of patients in EMS group and control group were compared.Results:The postoperative stone free rate after the first operation is higher in EMS group than in control group(P＜0.05).The operation time and total lengths of hospital stay were shorter in EMS group than in control group(P＜0.05).There was no significant difference in intraoperative hematobilia rate,intraoperative bile duct injury rate,postoperative biliary tract infection rate,hepatic biochemical index and mortality between two groups(P＞0.05).Conclusion:The combined ultrasound and pneumatic lithotripter is useful for treatment of cholelithiasis.

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Clinical effect of blood purification and sustained glucocorticoid therapy on severe pancreatitis with respiratory distress syndrome

Hong LING

Chinese Journal of Current Advances in General Surgery.2017;20(6):444-446,450. doi:10.3969/j.issn.1009-9905.2017.06.006

Objective:To study the clinical effect of blood purification and sustained glucocorticoid therapy on severe pancreatitis with respiratory distress syndrome,for providing clinical reference for such concomitant diseases.Methods:A total of 132 patients from April 2012 to June 2014in our hospital with severe pancreatitis and respiratory distress syndrome were studied,they were randomly divided into two groups,patients in the two groups were given conventional anti-infective,gastrointestinal decompression,rehydration therapy and other infrastructure,the control group were treated with continuous blood purification treatment,the observation group were treated with continuous blood purification and high-dose dexamethasone,the clinical symptoms,laboratory indicator in time,the levels of inflammatory cytokines,the APACHE Ⅱ scores and MODS scores and survival were compared.Results:The time of abdominal distention disappeared,blood amylase,urine amylase and pancreatic edema improvement in observation group was significantly improved than the control (P＜0.05);when compared with before,the CRP,IL-6,IL-8 and TNF-α of two groups were significantly decreased,and the index in observation group decreased more significantly,the difference was statistically significant (P＜0.05);when compared with before,the score of APACHE Ⅱ and MODS were significantly lower than control,the difference was statistically significant(P＜0.05);The final survival rate in observation group was 90.8％,which significantly higher than 61.5％ in control,the difference was statistically significant(P＜0.05).Conclusion:The effect of continuous blood purification combined with glucocorticoids (eg dexamethasone) in patients with severe pancreatitis and respiratory distress syndrome is remarkable,the clinical symptoms can significantly improved,the levels of inflammatory factors,effective recovery laboratory indicators,APACHE Ⅱ score and MODS score were decreased,the survival was higher,it was worthy of clinical use.

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Influence of preoperative biliary drainage on morbidity rate of severely obstructive jaundice patients after pancreaticoduodenectomy

Ning LIU ; Dongdong CHENG ; Longgang WANG

Chinese Journal of Current Advances in General Surgery.2017;20(6):440-443. doi:10.3969/j.issn.1009-9905.2017.06.005

Objective:To investigate the influence of preoperative biliary drainage (PBD) on morbidity of severely obstructive jaundice patients after pancreaticoduodenectomy (PD).Methods:A total of 98 severely obstructive jaundice(Serum total bilirubin＞300 μ mool/L) patients underwent PD between February 2010 and October 2015 were enrolled in the study.The patients were divided into two groups based on undergoing PBD or not.The no-PBD group comprised 52 patients and the PBD group comprised another 46 patients.Perioperatives parameters,including operative time,intraoperative blood loss,postoperative mortality and morbidity and postoperative hospital stay were compared between the two groups.Results:The demographics,preoperative examinations and pathological results were similar between the two groups (P＞0.05).Operative time of the no-PBD group was statistically longer than the PBD group (379.44 ± 88.57min vs 346.98 ± 57.17 min,P＜0.05).Besides,intraoperative blood loss of the no-PBD group were much more than the PBD group (365.00 ± 187.07mL vs 297.83 ± 139.57 mL,P＜0.05).There was no statistical difference of mortality rate between the no-PBD group and the PBD group(3.85％ vs 2.17％,P＞0.05).The overall morbidity rate of the 2 groups were similar (53.85％ vs 43.48％,P＞0.05),but the pancreatic fistula rate of no-PBD group was significantly higher than the PBD group (30.77％ vs 13.04％,P＜0.05).Conclusion:PBD could reduce operative time,intraoperative blood loss and pancreatic fistula rate after PD.Meanwhile,the mortality and overall morbidity rates were similar between the two groups.PBD should be considered for severely obstructive jaundice patients.

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