Background and Aims:Intestinal obstruction is a common acute abdominal condition,and early diagnosis and timely surgical intervention are critical to patient prognosis.After radical gastrectomy for gastric cancer,due to abnormal digestive tract reconstruction,mesenteric space formation,and peritoneal injury,the incidence of intestinal obstruction is relatively high,often accompanied by ascites of varying characteristics.Bloody ascites usually suggest intestinal wall ischemia and necrosis;however,current clinical indicators have limited effectiveness in the early identification of this condition.This study was performed to investigate the clinical characteristics of postoperative small bowel obstruction with different types,with a particular focus on identifying markers with diagnostic values for bloody ascites.Methods:The clinical data of 65 patients with small bowel obstruction and ascites after radical gastrectomy for gastric cancer admitted to the Department of Gastrointestinal Surgery of Jiangyin People's Hospital between January 2010 and December 2021 were retrospectively analyzed.Based on the ascites characteristics,patients were divided into serous ascites group(n=42),chylous ascites group(n=9),and bloody ascites group(n=14).Clinical parameters and preoperative white blood cell count(WBC),neutrophil count(NEU),lymphocyte count,and neutrophil-to-lymphocyte ratio(NLR)were compared among the groups.Receiver operating characteristic(ROC)curve analysis was used to evaluate the diagnostic value of inflammatory markers for bloody ascites.Results:The time from onset to hospital admission was significantly longer in the serous ascites group compared to the chylous and bloody ascites groups(P＜0.05).Postoperative hospital stay was significantly prolonged in the bloody ascites group compared to the other two groups(P＜0.05).The rate of small bowel resection in the bloody ascites group(6/14)was significantly higher than that in the chylous ascites group(0/9)or serous ascites group(7/42)(P＜0.05).Although the recurrence rate in the bloody ascites group(3/14)was higher than in the chylous ascites group(1/9)or serous(2/42)ascites group,the difference was not statistically significant(P＞0.05).WBC,NEU,and NLR levels increased progressively from the serous to chylous to bloody ascites groups,with statistically significant differences(P＜0.05).ROC curve analysis showed that NLR had superior diagnostic performance in predicting bloody ascites(AUC:0.84;sensitivity:75％;specificity:85％)compared to WBC and NEU.Conclusion:NLR is closely associated with the characteristics of ascites in patients with small bowel obstruction after radical gastrectomy and is significantly elevated in those with bloody ascites.Compared to traditional inflammatory markers WBC and NEU,NLR demonstrates higher sensitivity and specificity for identifying bloody ascites,making it a valuable adjunct diagnostic tool for predicting intestinal wall ischemia and necrosis.Furthermore,patients with bloody ascites showed higher rates of bowel resection and more extended hospital stays,suggesting a poorer clinical prognosis.

Background and Aims:Intestinal obstruction is a common acute abdominal condition,and early diagnosis and timely surgical intervention are critical to patient prognosis.After radical gastrectomy for gastric cancer,due to abnormal digestive tract reconstruction,mesenteric space formation,and peritoneal injury,the incidence of intestinal obstruction is relatively high,often accompanied by ascites of varying characteristics.Bloody ascites usually suggest intestinal wall ischemia and necrosis;however,current clinical indicators have limited effectiveness in the early identification of this condition.This study was performed to investigate the clinical characteristics of postoperative small bowel obstruction with different types,with a particular focus on identifying markers with diagnostic values for bloody ascites.Methods:The clinical data of 65 patients with small bowel obstruction and ascites after radical gastrectomy for gastric cancer admitted to the Department of Gastrointestinal Surgery of Jiangyin People's Hospital between January 2010 and December 2021 were retrospectively analyzed.Based on the ascites characteristics,patients were divided into serous ascites group(n=42),chylous ascites group(n=9),and bloody ascites group(n=14).Clinical parameters and preoperative white blood cell count(WBC),neutrophil count(NEU),lymphocyte count,and neutrophil-to-lymphocyte ratio(NLR)were compared among the groups.Receiver operating characteristic(ROC)curve analysis was used to evaluate the diagnostic value of inflammatory markers for bloody ascites.Results:The time from onset to hospital admission was significantly longer in the serous ascites group compared to the chylous and bloody ascites groups(P＜0.05).Postoperative hospital stay was significantly prolonged in the bloody ascites group compared to the other two groups(P＜0.05).The rate of small bowel resection in the bloody ascites group(6/14)was significantly higher than that in the chylous ascites group(0/9)or serous ascites group(7/42)(P＜0.05).Although the recurrence rate in the bloody ascites group(3/14)was higher than in the chylous ascites group(1/9)or serous(2/42)ascites group,the difference was not statistically significant(P＞0.05).WBC,NEU,and NLR levels increased progressively from the serous to chylous to bloody ascites groups,with statistically significant differences(P＜0.05).ROC curve analysis showed that NLR had superior diagnostic performance in predicting bloody ascites(AUC:0.84;sensitivity:75％;specificity:85％)compared to WBC and NEU.Conclusion:NLR is closely associated with the characteristics of ascites in patients with small bowel obstruction after radical gastrectomy and is significantly elevated in those with bloody ascites.Compared to traditional inflammatory markers WBC and NEU,NLR demonstrates higher sensitivity and specificity for identifying bloody ascites,making it a valuable adjunct diagnostic tool for predicting intestinal wall ischemia and necrosis.Furthermore,patients with bloody ascites showed higher rates of bowel resection and more extended hospital stays,suggesting a poorer clinical prognosis.

Objective:To analyze and discuss the clinical significance of preoperative planning and guidance based on three-dimensional reconstruction of perigastric vessels in precision surgery for gastric cancer.Methods:A prospective study was conducted to analyze the data of 50 patients with gastric cancer who received surgical treatment in Jiangyin People′s Hospital from December 2020 to December 2022, including 35 males and 15 females, aged from 38 to 79 years old, with an average age of 66.3 years old. All patients were divided into control group ( n=25) and experimental group ( n=25) according to random number table method. Both groups underwent enhanced multi-slice spiral CT scan of the chest, abdomen and pelvis before surgery. The experimental group underwent 3D reconstruction based on CT data for preoperative planning and guidance, while the control group did not undergo 3D reconstruction. Patients in both groups received radical surgery for gastric cancer. Operation time, intraoperative blood loss, total postoperative drainage volume, postoperative hospital stay, number of lymph node dissection and postoperative complications were compared between the two groups. The statistical software SPSS27.0 was used to obtain the relevant data analysis results. Results:The intraoperative blood loss, total drainage volume and postoperative hospital stay of the experimental group were lower than those of the control group( P<0.05). The operative time, number of lymph node dissection and postoperative complications of the experimental group were not significantly different from those of the control group( P>0.05). Conclusions:Preoperative three-dimensional reconstruction of gastric perivascular with CT data can provide better preoperative evaluation, surgical planning and intraoperative guidance, reduce intraoperative accidental vascular injury, blood loss, total postoperative drainage and postoperative hospital stay. It has positive clinical application value to complete accurate radical resection of gastric cancer.

Objective:To investigate the correlation of human epidermal growth receptor 2 (HER2) with clinicopathological characteristics and its postoperative prognostic value in patients with gastric cancer.Methods:The clinicopathological data of 543 patients with gastric cancer who underwent open radical gastrectomy were retrospectively analyzed in the Gastrointestinal Surgery Department of Jiangyin People′s Hospital Affiliated to Southeast University from June 2011 to December 2016, including 404 males and 139 females, aged from 26 to 84 years old. According to the results of HER2 immunohistochemical staining, gastric cancer patients were divided into HER2 0+ group ( n=427), HER2 1+ group ( n=56), HER2 2+ group ( n=29) and HER2 3+ group ( n=31), and the differences in clinicopathological indicators of the four groups were compared. Furthermore, HER2 0+ and 1+ gastric cancer patients were classified as HER2-negative group( n=26), and HER2 3+ as HER2-positive group( n=26). Propensity score matching method was used to balance the basic data variables related to prognosis of the two groups, and Kaplan-Meier method was used for survival analysis. Cox risk regression model was used to analyze the risk factors associated with postoperative survival in patients with HER2-positive gastric cancer. Results:The overexpression rate of HER2 in gastric cancer patients was 5.7% (31/543). The expression level of HER2 was significantly correlated with gender ( χ2=8.30, P=0.040), tumor longitudinal location ( χ2=22.86, P=0.029) and histological differentiation ( χ2=13.27, P=0.004). There was no significant correlation between median survival time and HER2 expression level( χ2=5.44, P=0.142). After propensity score matching, the median survival time of gastric cancer in the HER2-positive group was 23 months. Univariate and multivariate analysis showed that ABO blood group ( HR: 1.619, 95% CI: 1.081-2.423, P=0.019) was an independent risk factor for prognosis of HER2-positive gastric cancer. Conclusion:The expression of HER2 is higher in men, cardia fundus and high and medium differentiated gastric adenocarcinoma, but there is no significant correlation between the expression level of HER2 and the median survival time of gastric cancer. ABO blood group may be an independent risk factor for the survival of HER2-positive gastric cancer.

The association between colorectal cancer and gut microbiota imbalance has became a hot research topic along with the increase of its irevalance.In this article, we search for the potential specific carcinogenic strainand their metabolite markers in the development of colorectal cancer, with an attempt to provide an important basisfor early diagnosis and primary prevention of colorectal cancer, elucidate the potential roles and mechanisms of in-testinal microbioecological preparation and improve the management of colorectal cancer.