OBJECTIVE: To observe the effect of electroacupuncture (EA) at "Zusanli" (ST 36) combined with mosapride on gastric emptying rate and gastric motility in the rats with diabetic gastroparesis. METHODS: Using random number table method, 68 male SD rats were divided into a blank group (12 rats) and a model establishment group (56 rats). In the model establishment group, the models of diabetic gastroparesis were established with intraperitoneal injection of streptozotocin combined with high-fat and high-sugar diet. Six weeks later, the successful rat models in the model establishment group were randomized into a model group, an EA group, a mosapride group and a combined treatment group, 12 rats in each one. In the EA group, EA was exerted at "Zusanli" (ST 36) (disperse-dense wave, 2 Hz/15 Hz in frequency, 2 mA in intensity) for 20 min. In the mosapride group, mosapride was intervened with intragastric administration (2 mg/kg). In the combined treatment group, electroacupuncture at "Zusanli" (ST 36) was combined with intragastric administration of mosapride. The intervention was given once daily in each group. There was 1 day at interval after 6-day intervention, consecutively for 5 weeks. At the end of intervention, the random blood glucose, gastric emptying rate and the data of gastric motility (average intra-gastric pressure, amplitude and frequency of gastric motility) were detected. RESULTS: Compared with the blank group, blood glucose was increased in the model group (P<0.001). Blood glucose was reduced in the EA group, the mosapride group and the combined treatment group as compared with the model group separately (P<0.001, P<0.01), whereas, compared with the mosapride group, blood glucose was decreased in the combined treatment group (P<0.05). In comparison with the blank group, the gastric emptying rate, the average intra-gastric pressure and the amplitude of gastric motility were all decreased in the model group (P<0.001) and the frequency of gastric motility was increased (P<0.001). Gastric emptying rate, the average intra-gastric pressure and the amplitude of gastric motility were increased in the EA group, the mosapride group and the combined treatment group (P<0.01, P<0.05, P<0.001) and the frequency of gastric motility was decreased (P<0.001) as compared with the model group respectively. Compared with the EA group, the average intra-gastric pressure and the amplitude of gastric motility were increased in the combined treatment group (P<0.001). In comparison with the mosapride group, the gastric emptying rate, the average intra-gastric pressure, the amplitude and frequency of gastric motility in the combined treatment group, as well as the frequency of gastric motility in the EA group were all increased (P<0.05, P<0.001, P<0.01). CONCLUSION Electroacupuncture at "Zusanli" (ST 36) combined with intragastric administration of mosapride could regulate blood glucose and improve the gastric motility in the rats with diabetic gastroparesis. The effect is better than either simple electroacupuncture or mosapride.
Acupuncture Points ; Animals ; Benzamides ; Diabetes Mellitus/therapy* ; Electroacupuncture ; Gastrointestinal Motility/physiology* ; Gastroparesis/etiology* ; Male ; Morpholines ; Rats ; Rats, Sprague-Dawley

OBJECTIVE: To establish a modified endoscopic Freka Trelumina placement (mEFTP) for modifying or substituting the traditional endoscopic Freka Trelumina placement (EFTP) and to explore the safety and feasibility of mEFTP in patients requiring enteral nutrition and gastrointestinal decompression in general surgery. METHODS: A retrospective cohort study was conducted to analyze the clinical data of patients undergoing EFTP or mEFTP at General Surgery Department of 920 Hospital of the Joint Logistics Support Force of the Chinese People's Liberation Army from January 2016 to January 2018. INCLUSION CRITERIA: the function of lower digestive tract was normal; patients who could not eat through mouth or nasogastric tube needed to have enteral nutrition and gastrointestinal decompression; the retention time of Freka Trelumina (FT) was not expected to exceed 2 months. EXCLUSION CRITERIA: contraindication for gastroscopy; suspected shock or digestive tract perforation; suspected mental diseases; infectious diseases of digestive tract; thoracoabdominal aortic aneurysm. mEFIP procedure was as follow. FT was inserted into stomach through one side nasal cavity, gastroscope was inserted into stomach cavity, and the front part of FT was clamped with biopsy forceps through biopsy hole. Biopsy forceps and FT were inserted into the pylorus or anastomosis under gastroscope, and they were pushed into the duodenum or output loop. During pushing, the gastroscope did not pass through the duodenum or output loop. The biopsy forceps was released and pushed out, and FT was pushed with biopsy forceps synchronously into the duodenum or output loop more than 5 cm. The foreign body forceps was inserted through the biopsy hole, and the FT tube was held in the stomach and pushed to the duodenum or output loop. The previous steps repeated until the suction cavity reached the pylorus or anastomosis. The gastroscope was exited gently; the guide wire was pulled out slowly. EFTP procedure: foreign body forceps was used to clamp the front part of FT, and gastroscope, foreign body forceps and FT pass the pylorus or anastomosis simultaneously to reach the descendent duodenum or output loop as a whole. The time of catheterization was recorded and position of FT was examined by X-ray within 1 h after catheterization. The success rate of catheterization and morbidity of complications after catheterization were evaluated and compared between the two groups. RESULTS: A total of 141 patients were enrolled, 72 in the mEFTP group and 69 in the EFTP group. In mEFTP group, 45 cases were males and 27 were females with an average age of 55.8(37-76) years; 27 cases had normal upper gastrointestinal anatomy (postoperative gastroplegia syndrome due to colon cancer in 17 cases, due to rectal cancer in 10 cases) and 45 had upper gastrointestinal anatomic changes (gastric cancer with pylorus obstruction in 18 cases and anastomotic block after gastroenterostomy in 27 cases). In the EFTP group, 41 were males and 28 were females with an average age of 55.3(36-79) years; 33 cases had normal upper gastrointestinal anatomy (postoperative gastroplegia syndrome due to colon cancer in 20 cases, due to rectal cancer in 13 cases) and 36 had upper gastrointestinal anatomic changes (gastric cancer with pylorus obstruction in 15 cases and anastomotic block after gastroenterostomy in 21 cases). In patients with normal upper digestive tract anatomy, the average catheterization time of mEFTP was (4.9±1.7) minutes which was shorter than (7.6±1.7) minutes of EFTP(t=6.683, P<0.001). In patients of gastric cancer with pyloric obstruction, the average catheterization time of mEFTP was (6.6±1.6) minutes which was shorter than (10.5±2.6) minutes of EFTP (t=4.724, P<0.001). In patients with anastomotic block after gastroenterostomy, the average catheterization time of mEFTP was (11.3±2.5) minutes which was shorter than (15.1±3.5) minutes of EFTP (t=4.513, P<0.001). In patients with normal upper gastrointestinal anatomy, there were no significant differences in the success rate of catheterization and the morbidity of catheterization complication between mEFTP and EFTP (all P>0.05). In patients with upper gastrointestinal anatomic changes, the success rate of catheterization in mEFTP was even higher than that in EFTP, but the difference was not significant [97.8%(41/45) vs. 86.1%(31/36), χ²=2.880, P=0.089]; while the morbidity of catheterization complication in mEFTP was lower than that in EFTP [0 vs. 8.3%(3/36), χ²=3.894, P=0.048]. CONCLUSIONS Whether the upper gastrointestinal anatomy is normal or not, mEFTP presents shorter catheterization time, higher success catheterization rate than EFTP, and is safety. mEFTP can be widely applied to clinical practice for patients requiring enteral nutrition and gastrointestinal decompression.
Adult ; Aged ; Decompression, Surgical ; instrumentation ; methods ; Enteral Nutrition ; instrumentation ; methods ; Female ; Gastric Outlet Obstruction ; etiology ; surgery ; Gastroparesis ; etiology ; surgery ; Gastroscopy ; instrumentation ; methods ; Humans ; Intubation, Gastrointestinal ; instrumentation ; methods ; Male ; Middle Aged ; Retrospective Studies ; Stomach Diseases ; etiology ; surgery

OBJECTIVETo investigate the feasibility of segmental pylorus-reservation gastrectomy in patients with early gastric cancer.

METHODA retrospective cohort study on clinical data of 6 patients strictly met the criteria of early gastric cancer locating in the middle of the stomach undergoing laparoscopic segmental gastrectomy from January 2014 to April 2016 at Department of General Surgery, Peking Union Medical College Hospital was carried out. Preoperative clinical staging revealed T1N0M0 for all the cases. One case received endoscopic mucosa resection(EMR) first, and postoperative pathology showed moderate differentiated adenocarcinoma invading substratum of mucosa, so a complementary laparoscopic segmental gastrectomy was performed. Surgical procedure was laparoscopic segmental gastrectomy with D1 or D2 lymph node dissection. Vagus nerve was not reserved during lymph node dissection in lesser curvature side. Number of resected lymph node, postoperative complication and long-term gastric function were observed.

RESULTOf 6 cases, 3 were male and 3 were female with age ranging from 55 to 59 years old. The distal resection margin was (4.6±0.5) cm away from pylorus. The average number of resected lymph node was 18.3±7.5 without metastasis. Follow-up time was 1 to 29 months for all the 6 cases and no relapse or metastasis was found during the follow-up. In 4 cases with follow-up beyond 1 year, 3 cases had slight distension in superior belly after meal and dyspepsia; another one case had vomiting nocturnal occasionally. Gastroscope examination one year after operation found food residue in all the cases. Images indicated the decrease of stomach size in all the cases. Two cases had esophagogastric reflux. All the patients had delayed gastric emptying symptoms after operations and were relieved within one year.

CONCLUSIONSIt is technically feasible to perform laparoscopic segmental gastrectomy in patients with early gastric cancer. Whether vagus nerve should be reserved requires further investigation.

Female ; Gastrectomy ; adverse effects ; methods ; Gastroesophageal Reflux ; epidemiology ; etiology ; Gastroparesis ; epidemiology ; etiology ; Humans ; Laparoscopy ; adverse effects ; methods ; Lymph Node Excision ; adverse effects ; methods ; statistics & numerical data ; Male ; Middle Aged ; Neoplasm Staging ; Postoperative Complications ; epidemiology ; etiology ; Retrospective Studies ; Stomach Neoplasms ; surgery ; Treatment Outcome ; Vagus Nerve ; surgery ; Vomiting ; epidemiology ; etiology

OBJECTIVETo compare clinically relevant postoperative complications after open, laparoscopic, and robotic gastrectomy for gastric cancer.

METHODSClinical data of patients with gastric cancer who underwent gastrectomy between January 1, 2014 and October 1, 2016 at Chinese People's Liberation Army General Hospital were analyzed retrospectively. All the patients were diagnosed by upper endoscopy and confirmed by biopsy without distant metastasis. They were confirmed with R0 resection by postoperative pathology. Patients with incomplete data were excluded. The complications among open group, laparoscopic group and robotic group were compared. The continuous variables were analyzed by one-way ANOVA, and categorical variables were analyzed by χtest or Fisher exact test.

RESULTSA total of 1 791 patients (1 320 males and 471 females) were included in the study, aged from 17 to 98 (59.0±11.6) years, comprising 922 open, 673 laparoscopic and 196 robotic gastrectomies. There were no significant differences among three groups in baseline data (gender, age, BMI, comorbidity, radiochemotherapy) and some of operative or postoperative data (blood transfusion, number of lymph node dissection, combined organ resection, resection site, N stage, postoperative hospital stay). The blood loss in laparoscopic and robotic groups was significantly lower than that in open group[(185.7±139.6) ml and (194.0±187.6) ml vs. (348.2±408.5) ml, F=59.924, P=0.000]. The postoperative complication occurred in 197 of 1 791(11.0%) patients. The Clavien-Dindo II(, III(a, III(b, IIII(a, and IIIII( complications were 5.5%, 4.0%, 1.2%, 0.1%, and 0.2% respectively. The anastomotic leakage (2.4%), intestinal obstruction(1.3%) and pulmonary infection(1.2%) were the three most common complications, followed by wound infection(0.8%), cardiovascular disease(0.7%), anastomotic bleeding (0.7%), delayed gastric emptying (0.6%), duodenal stump fistula(0.5%), intraperitoneal hemorrhage (0.5%), pancreatic fistula (0.3%), intra-abdominal infection(0.2%), chylous leakage (0.1%) and other complications(1.7%). There were no significant differences among three groups as the complication rates of open, laparoscopic and robotic gastrectomy were 10.6%(98/922), 10.8%(73/673) and 13.3%(26/196) respectively (χ=1.173, P=0.566). But anastomotic leakage occurred more common after laparoscopic and robotic gastrectomy compared to open gastrectomy [3.1%(21/673) and 5.1%(10/196) vs. 1.3%(12/922), χ=12.345, P=0.002]. The rate of cardiocerebral vascular diseases was higher in open group[1.3%(12/922) vs. 0.1%(1/673) and 0, χ=8.786, P=0.012]. And the rate of anastomotic bleeding was higher in robotic group [2.0%(4/196) vs. open 0.4%(4/922) and laparoscopic 0.6%(4/673), χ=6.365, P=0.041]. In view of Clavien-Dindo classification, III(a complications occurred more common in laparoscopic group [5.5%(37/673) vs. open 3.3%(30/922) and robotic 2.6%(5/196), χ=6.308, P=0.043] and III(b complications occurred more common in robotic group [3.1%(6/196) vs. open 1.1%(10/922) and laparoscopic 0.7%(5/673), χ=7.167, P=0.028].

CONCLUSIONSMorbidities of postoperative complications are comparable among open, laparoscopic and robotic gastrectomy for gastric cancer. However, in consideration of the high difficulty of anastomosis, the minimally invasive surgery should be performed by more experienced surgeons.

Adolescent ; Adult ; Aged ; Aged, 80 and over ; Anastomotic Leak ; epidemiology ; etiology ; Blood Loss, Surgical ; statistics & numerical data ; Cerebrovascular Disorders ; epidemiology ; etiology ; Chylous Ascites ; epidemiology ; etiology ; Comorbidity ; Comparative Effectiveness Research ; Duodenal Diseases ; epidemiology ; etiology ; Female ; Gastrectomy ; adverse effects ; methods ; Gastrointestinal Hemorrhage ; epidemiology ; etiology ; Gastroparesis ; epidemiology ; etiology ; Gastroscopy ; Hemoperitoneum ; epidemiology ; etiology ; Humans ; Intestinal Fistula ; epidemiology ; etiology ; Intraabdominal Infections ; epidemiology ; etiology ; Laparoscopy ; adverse effects ; Length of Stay ; Lymph Node Excision ; Male ; Middle Aged ; Postoperative Complications ; epidemiology ; etiology ; Postoperative Hemorrhage ; epidemiology ; etiology ; Postoperative Period ; Respiratory Tract Infections ; epidemiology ; etiology ; Retrospective Studies ; Risk Assessment ; Robotic Surgical Procedures ; adverse effects ; Stomach Neoplasms ; surgery ; Surgical Wound Infection ; epidemiology ; etiology

OBJECTIVETo examine the relationship between gastric conduit width and postoperative early delayed gastric emptying (DGE) in patients with middle-lower esophageal carcinoma who underwent Ivor-Lewis operation.

METHODSClinical data of 282 consecutive patients with middle-lower esophageal cancer who underwent the Ivor-Lewis operation by same surgical team in our department from January 2013 to June 2015 were retrospectively analyzed. Patients were divided into three groups according to the width of gastric conduit: width > 5.0 cm as broad group (n=93); width 3.0-5.0 cm as moderate group (n=70); width < 3.0 cm as narrow group (n=119). The gastric conduits of patients in narrow group were completely positioned the esophageal bed and fixed to the pericardium posterior wall. None of patients received pyloroplasty or pylorotomy. Perioperative data, operation-associated complications, and postoperative upper gastrointestinal radiographic results(1 week and 4 weeks after operation) were compared among groups.

RESULTSThe baseline data among these groups were comparable in terms of age, gender, tumor TNM staging, pathological types, serum albumin level, and the rate of receiving neoadjuvant therapy(all P>0.05). There were no significant differences in operative time, blood loss, and postoperative hospital stay among groups(all P>0.05). No patients died during perioperative peried. Anastomotic leakage occurred in 2 cases, one from broad group and another from narrow group. The incidences of arrhythmia and postoperative pulmonary complications, including infection, atelectasis, pneumothorax, and pleural effusion were similar among groups (all P>0.05). The average amount of gastric juice drainage in narrow group was (98±57) ml/day, which was markedly lower than that in broad group [(157±62) ml/day, P=0.000] and in moderate group [(123±68) ml/day, P=0.008]. One week after operation, the overall incidence of DGE was 10.6%(30/282), the incidence of DGE in broad, moderate, narrow groups was 17.2%(16/93), 14.3%(10/70), and 3.4%(4/119) respectively, and broad and moderate groups had higher incidence as compared to narrow group (P=0.001 and P=0.006).

CONCLUSIONDuring the Ivor-Lewis operation, application of a narrow gastric conduit (width < 3.0 cm), which completely position the esophageal bed with fixation to the pericardium posterior wall, can significantly reduce the incidence of postoperative early DGE.

Anastomotic Leak ; etiology ; Blood Loss, Surgical ; Carcinoma ; surgery ; Drainage ; Esophageal Neoplasms ; surgery ; Esophagectomy ; adverse effects ; Gastric Juice ; secretion ; Gastroparesis ; epidemiology ; etiology ; Humans ; Length of Stay ; Operative Time ; Pericardium ; surgery ; Postoperative Complications ; epidemiology ; etiology ; Reconstructive Surgical Procedures ; adverse effects ; methods ; Retrospective Studies ; Upper Gastrointestinal Tract ; anatomy & histology ; surgery

OBJECTIVETo compare the short-term efficacy and long-term survival between Sweet and Ivor-Lewis esophagectomy for patients with middle-lower esophageal squamous cell carcinoma.

METHODSClinicopathologic data of 1 308 patients with middle-lower esophageal squamous cell carcinoma undergoing Sweet or Ivor-Lewis procedures in our department from January 2007 to December 2014 were retrospectively analyzed, including 1 021 patients of Sweet operation (Sweet group) and 287 patients of Ivor-Lewis operation(Ivor-lewis group). Lymph node clearance, lymphatic metastasis, postoperative complication morbidity and long-term survival were compared between the two groups.

RESULTSThere were no significant differences in baseline data between the two groups(all P>0.05). There were more lymph nodes resected during the Ivor-Lewis procedure compared with the Sweet procedure (20.8 vs.19.3, P=0.030). Compared with Ivor-Lewis group, the incidence of wound infection in Sweet group was significantly lower[(3.2%(33/1 021) vs. 8.0%(23/287), P=0.000]. Sweet group had a significantly lower rate of delayed gastric emptying[1.9%(19/1 021) vs. 5.2%(15/287), P=0.002] and significantly shorter hospital stay (14.7 days vs. 17.2 days, P=0.029). With respect to other postoperative complications, such as pulmonary complications, cardiac events, anastomotic leakage, vocal cord palsy, chylothorax and pyothorax, the differences between the two groups were not statistically significant. The 5-year survival rate was not significantly different between the two group (54.0% vs. 56.9%, P=0.873). Stratified analysis based on TNM staging showed that no significant difference of 5-year survival rate was found between the two groups in stageI( and stageIII( patients (P>0.05), while the 5-year survival rate of stageII( patients in Sweet group was significantly lower than that in Ivor-Lewis group (56.4%% vs. 70.4%, P=0.039).

CONCLUSIONSFor patients with middle-lower esophageal squamous cell carcinoma, Sweet procedure has certain superiority regarding the incidence of wound infection and delayed gastric emptying compared with the Ivor-Lewis procedure. Ivor-Lewis esophagectomy can harvest more lymph nodes. The 5-year survival rate of these two procedures is similar. Sweet procedure is still valuable in clinical practice, especially for stageI( and stageIII( patients, while it requires thorough considerations for stageII( patients.

Anastomotic Leak ; Antineoplastic Protocols ; Carcinoma, Squamous Cell ; mortality ; surgery ; Esophageal Neoplasms ; mortality ; surgery ; Esophagectomy ; adverse effects ; methods ; Gastroparesis ; etiology ; Humans ; Incidence ; Length of Stay ; Lymph Node Excision ; statistics & numerical data ; Lymph Nodes ; Lymphatic Metastasis ; Neoplasm Staging ; statistics & numerical data ; Postoperative Complications ; etiology ; Recovery of Function ; Retrospective Studies ; Surgical Wound Infection ; etiology ; Survival Rate ; Treatment Outcome

OBJECTIVETo explore the risk factors of delayed gastric emptying after gastrectomy.

METHODSMeta-analysis was performed to screen risk factors of delayed gastric emptying after gastrectomy based on 19 associated articles published from 2003 to 2013.

RESULTSGender, operative time, blood loss during operation, surgical settings(emergency, elective surgery), radical surgery were not significantly different between two groups for delayed gastric emptying (all P>0.05). Age more than or equal to 60 years [combined odds ratio(OR)=1.65, 95% confidence interval(CI):1.31-2.09, P<0.01], preoperative gastrointestinal obstruction(combined OR=3.72, 95%CI:3.05-4.55, P<0.01), Billroth-II( (combined OR=3.35, 95%CI:2.72-4.13, P<0.01), anemia(combined OR=1.48, 95%CI:1.08-2.02, P=0.01), intra-abdominal complication (combined OR=2.41, 95%CI:1.77-3.29, P<0.01), perioperative blood glucose greater than 8 mmol/L(combined OR=2.64, 95%CI:2.00-3.49, P<0.01), postoperative albumin levels lower than 30 g/L (combined OR=2.13, 95%CI:1.62-2.79, P<0.01), use of analgesics pump after operation (combined OR=1.74, 95%CI:1.33-2.26, P<0.01), having adverse psychological reactions (combined OR=5.94, 95%CI:1.79-19.73, P=0.004) were risk factors affecting delayed gastric emptying.

CONCLUSIONAge more than or equal to 60, preoperative gastrointestinal obstruction, perioperative blood glucose greater than or equal to 8 mmol/L, postoperative albumin levels less than 30 g/L, Billroth-II(, anemia, intra-abdominal complication, using pain pump after operation, having adverse psychological reactions are risk factors affecting delayed gastric emptying after gastrectomy.

Gastrectomy ; adverse effects ; Gastroenterostomy ; Gastroparesis ; etiology ; Humans ; Risk Factors

Acupuncture Therapy ; Adult ; Burns ; complications ; Female ; Gastroparesis ; etiology ; therapy ; Humans

No abstract available.
Aged ; Chronic Disease ; Female ; Gastroparesis/complications/*diagnosis/radiography ; Gastroscopy ; Hernia, Diaphragmatic/complications/*diagnosis ; Humans ; Stomach Volvulus/*diagnosis/etiology/surgery ; Tomography, X-Ray Computed

OBJECTIVETo investigate the risk factors of postsurgical gastroparesis syndrome (PGS) after subtotal gastrectomy in gastric cancer and the impact of PGS on prognosis.

METHODSClinical data of 422 patients who underwent subtotal gastrectomy for gastric cancer in the Central Hospital of Huzhou Sity from January 2004 to May 2010 were analyzed retrospectively. Risk factors of PGS were indentified and the recurrence-free survival was compared between the patients with and without PGS.

RESULTSPGS occurred in 42 patients (9.5%). Univariate analysis showed that: age over 65, combination of anxiety disorder, low-albuminemia in perioperative period, pyloric obstruction in preoperative period, high serume glucose level (≥ 11.2 mmol/L) in postoperative period, Billroth II (gastroenterostomy, operation time over 4 hours, using patient-controlled analgesia, or intravenous fluid over 3500 ml/d (all P<0.05) were prone to develop PGS. These might be potential clinical risk factors associated to PGS. Correlation analysis showed the number of clinical risk factors was positively correlated with the incidence of PGS (r=0.967, P<0.05). A total of 215 cases (50.9%) were followed up for 3-60 months. The mean recurrence-free survival time of patients with PGS was 26.1 months, which was shorter than that of those without PGS (33.4 months, P=0.029).

CONCLUSIONSGastric cancer patients with the clinical risk factors mentioned above are prone to develop PGS after subtotal gastrectomy. PGS is associated with poor prognosis.

Adult ; Aged ; Aged, 80 and over ; Female ; Gastrectomy ; adverse effects ; methods ; Gastroparesis ; etiology ; Humans ; Male ; Middle Aged ; Prognosis ; Retrospective Studies ; Risk Factors ; Stomach Neoplasms ; surgery ; Young Adult