Objective:To investigate the feasibility of employing high-resolution colon manometry (HRCM) in conjunction with natural orifice specimen extraction surgery (NOSES) during laparoscopic Jinling surgery for the treatment of colonic slow transit constipation (STC).Methods:This study retrospectively analyzed data from nine patients with STC who underwent HRCM preoperative evaluation and subsequently received NOSES Jinling surgery at Tianjin Union Medical Center between October 2016 and March 2023. The general intraoperative conditions and postoperative evaluation indicators were recorded.Results:All 9 patients underwent HRCM examination before surgery. High amplitude propagation contraction (HAPC) was observed in the ascending colon segment of all patients. The occurrence frequency of HAPC was 4.22±1.86 (times/day). The operation time of 9 patients was 200.0 (167.5, 250.0) minutes, the intraoperative blood loss was 100 (50, 150) ml, the postoperative hospitalization time was 13.0 (12.5, 24.0) days, and the first postoperative exhaust time was 3.0 (2.0, 3.5) days, the first postoperative defecation time was 5.0 (4.5, 5.5) days, the first postoperative eating time was 5.0 (5.0, 5.5) days, and the first postoperative time out of bed was 5.0 (5.0, 8.0) days. Notably, none of the 9 patients experienced postoperative complications. The Wexner scores at 6 months [5 (4, 7)], and 12 months [4 (3, 5)] post-surgery were significantly lower than the preoperative score [20 (16, 21)] ( P<0.05). Additionally, the patient assessment of constipation quality of life (PAC-QOL) scores at 6 months [22 (20, 25)], and 12 months [18 (12, 45)] after surgery showed a significant decrease compared to preoperative scores [79 (72, 82)] ( P<0.05). Conclusions:The combination of HRCM preoperative assessment and NOSES Jinling surgery is both safe and feasible for the treatment of slow transit constipation, warranting further development and promotion.

Objective:To investigate the feasibility of employing high-resolution colon manometry (HRCM) in conjunction with natural orifice specimen extraction surgery (NOSES) during laparoscopic Jinling surgery for the treatment of colonic slow transit constipation (STC).Methods:This study retrospectively analyzed data from nine patients with STC who underwent HRCM preoperative evaluation and subsequently received NOSES Jinling surgery at Tianjin Union Medical Center between October 2016 and March 2023. The general intraoperative conditions and postoperative evaluation indicators were recorded.Results:All 9 patients underwent HRCM examination before surgery. High amplitude propagation contraction (HAPC) was observed in the ascending colon segment of all patients. The occurrence frequency of HAPC was 4.22±1.86 (times/day). The operation time of 9 patients was 200.0 (167.5, 250.0) minutes, the intraoperative blood loss was 100 (50, 150) ml, the postoperative hospitalization time was 13.0 (12.5, 24.0) days, and the first postoperative exhaust time was 3.0 (2.0, 3.5) days, the first postoperative defecation time was 5.0 (4.5, 5.5) days, the first postoperative eating time was 5.0 (5.0, 5.5) days, and the first postoperative time out of bed was 5.0 (5.0, 8.0) days. Notably, none of the 9 patients experienced postoperative complications. The Wexner scores at 6 months [5 (4, 7)], and 12 months [4 (3, 5)] post-surgery were significantly lower than the preoperative score [20 (16, 21)] ( P<0.05). Additionally, the patient assessment of constipation quality of life (PAC-QOL) scores at 6 months [22 (20, 25)], and 12 months [18 (12, 45)] after surgery showed a significant decrease compared to preoperative scores [79 (72, 82)] ( P<0.05). Conclusions:The combination of HRCM preoperative assessment and NOSES Jinling surgery is both safe and feasible for the treatment of slow transit constipation, warranting further development and promotion.

Fecal incontinence is a refractory disease in colorectal surgery. The main clinical manifestation is that patients cannot control the discharge of gas, solid or liquid feces in the rectum autonomously. It is easy to bring shame to patients and seriously affect their physical and mental health. Reducing the frequency of fecal incontinence, restoring anal sphincter function, and improving patient quality of life are important goals for treating fecal incontinence. With the development of medical technology and the improvement of treatment plans for fecal incontinence, patients with fecal incontinence usually undergo conservative treatment first, and if conservative treatment is ineffective, surgery can be chosen. Non-surgical treatment methods commonly used in clinical practice include biofeedback therapy, magnetic stimulation therapy, pelvic floor muscle training, anal sphincter training, Kegel training, and other rehabilitation treatments. This article discusses the non-surgical treatment methods for fecal incontinence, hoping to provide a choice for clinical treatment of fecal incontinence.

Fecal incontinence is a refractory disease in colorectal surgery. The main clinical manifestation is that patients cannot control the discharge of gas, solid or liquid feces in the rectum autonomously. It is easy to bring shame to patients and seriously affect their physical and mental health. Reducing the frequency of fecal incontinence, restoring anal sphincter function, and improving patient quality of life are important goals for treating fecal incontinence. With the development of medical technology and the improvement of treatment plans for fecal incontinence, patients with fecal incontinence usually undergo conservative treatment first, and if conservative treatment is ineffective, surgery can be chosen. Non-surgical treatment methods commonly used in clinical practice include biofeedback therapy, magnetic stimulation therapy, pelvic floor muscle training, anal sphincter training, Kegel training, and other rehabilitation treatments. This article discusses the non-surgical treatment methods for fecal incontinence, hoping to provide a choice for clinical treatment of fecal incontinence.

OBJECTIVETo investigate the risk factors of prolonged postoperative ileus (PPOI) after gastric cancer surgery.

METHODSDefinition of PPOI was that gastrointestinal function did not return to normal within 96 hours after operation. Diagnostic criteria of PPOI were as follows: according with over 2 below conditions at postoperative 97-hour: (1) moderate to severe sick (mild: 1-3 points, moderate: 4-7 points, severe: 8-10 points) or vomiting occurred in past 12 hours. (2) patient was intolerable of solid food in the last 2 meals and reported the food-intake as less than 25%. (3) no flatus and defecation occurred in past 24 hours. (4) moderate to severe abdominal distension was diagnosed by doctor with knocking abdomen. (5) iconography examination (abdominal X-ray or CT) in past 24 hours revealed gastrectasis, gas-fluid plane, intestinal or colorectal loop extension, indicating the ileus. A total of 83 patients with gastric carcinoma confirmed by preoperative gastroscopic pathology undergoing operation at the Department of General Surgery, Chinese PLA General Hospital from August 2016 to October 2016 were prospectively enrolled in the study. The incidence and risk factors of PPOI after gastric cancer surgery were calculated and analyzed with univariate and logistic regression multivariate analyses.

RESULTSOf 83 gastric cancer patients, 62 were male and 21 were female with an average age of (60.1±11.0)(39-89) years. Postoperative pathology showed 41 cases with III(-IIII( stage, 42 cases with I(-II( stage. According to the above diaguostic criteria, 22(26.5%) patients were diagnosed as PPOI postoperatively. Among 22 cases, 3 cases had no flatus and defecation with moderate-severe sick and vomiting within postoperative 96 hours; 15 cases had no flatus and defecation with moderate-severe abdominal extension within postoperative 96 hours; 4 cases had no flatus and defecation with moderate-severe sick, vomiting and moderate-severe abdominal extension within postoperative 96 hours. Clinical symptoms of all the POOI patients were improved following conservative treatment. Univariate analysis showed that age ≥65 years[13/26(50.0%) vs. 9/57(15.8%), χ=10.727, P=0.001], postoperative body temperature ≥38.0centi-degree [8/17(47.1%) vs. 14/66(21.2%), χ=4.636, P=0.031], postoperative serum potassium level[20/81(24.7%) vs. 2/2, χ=5.682, P=0.017], and use of opioid agent Dezocine [15/38(39.5%) vs. 7/45(15.6%), χ=6.050, P=0.014] were associated with POOI. Logistic regression analysis showed that age ≥65 years (OR=17.415, 95%CI:17.151-17.750, P=0.015), postoperative body temperature ≥38centi-degree(OR=15.855, 95%CI:15.422-16.214, P=0.013), use of Dezocine after surgery (OR=21.379, 95%CI:20.814-21.654, P=0.010) were the independent risk factors of PPOI after gastric cancer surgery.

CONCLUSIONGastric patients with older age, increased body temperature and the use of Dezocine after surgery have higher risk of POOI and need special perioperative management and treatment.

Adult ; Aged ; Aged, 80 and over ; Digestive System Surgical Procedures ; Female ; Humans ; Ileus ; etiology ; Male ; Middle Aged ; Postoperative Complications ; Risk Factors ; Stomach Neoplasms ; surgery

OBJECTIVETo investigate the clinicopathological characteristics, diagnosis, treatment and prognosis of gastric hepatoid adenocarcinoma(HAS).

METHODSRetrospective analysis of clinicopathological data of 24 cases with gastric HAS diagnosed by surgery and pathology in Chinese PLA General Hospital from January 2013 to May 2016 were carried out. All the patients underwent preoperative serum alpha fetoprotein (AFP), carcinoembryonic antigen (CEA), endoscopy and imaging examination (CT or B-mode ultrasonography), and those with elevated AFP were excluded from liver cancer, cirrhosis, endodermal sinus tumor and other diseases. The follow-up ended in June 2016 or the death of the patient. The survival was from the operation to the death of the patient or the end of follow-up.

RESULTSThere were a total of 24 cases with gastic HAS, accounting for 1.03%(24/2 326) of the total number of patients with gastric cancer diagnosed at the same time in our center. There were 19 males and 5 females, the ratio of male to female was 3.8:1.0, the mean age of the patients was 55.9 (31 to 72) years, and 2 of them had liver metastasis. The first symptom in 50% (12/24) patients was epigastric pain, in 25%(6/24) was abdominal distension with vomiting, and the rest included dysphagia (12.5%, 3/24), hematemesis (8.3%, 2/24) and melena (4.2%, 1/24). Preoperative serum levels of AFP and CEA were elevated in 10 (41.7%) and 5 patients (20.8%) respectively. All the patients underwent surgical treatment, including 23 cases with D2 radical resection of gastric cancer and R0 resection, and the other of palliative gastrojejunostomy. Lesions of HAS located in gastric antrum in 11 cases (45.8%), in cardia in 7 cases (29.2%), and in gastric body in 6 cases (25%). Tumor maximum diameter of 10 cases was larger than 5 cm, and the average diameter was 5.7(1.0 to 12.0) cm. Postoperative pathological TNM staging: stage I(b was in 1 cases, stage II( in 7 cases, stage III( in 14 cases, stage IIII( in 2 cases; lymph node metastasis in stage N1-3 in 20 cases (83.3%). Poorly-differentiated tumors were found in 21 cases (87.5%), and no well-differentiated tumors were found. There were 11 cases (45.8%) with formation of intravascular tumor thrombi. In immunohistochemistry, AFP positive expression was found in 11 cases(45.8%). Seventeen HAS cases (70.8%, 17/24) received postoperative SOX(oxaliplatin + S-1) or XELOX (oxaliplatin + capecitabine) as adjuvant chemotherapy, 5 cases postoperative immune therapy, and 2 cases postoperative traditional Chinese medicine. All the patients were followed up for 0.7 to 42.0 months (median 8 months). A total of 9 patients died, of whom, 1 case underwent gastrojejunostomy because of liver and peritoneal metastasis before operation, and died 20 days after surgery; 4 cases died of multiple liver metastases after 1.5 to 12.0 months with survival of 3 to 18 months; 3 cases presented local recurrence after 2 to 17 months with survival of 6 to 22 months; 1 cases had peritoneal metastasis after 12 month with survival of 26 months.

CONCLUSIONSHAS is a rare type of gastric cancer with poor prognosis. The diagnosis is mainly based on histopathology, and radical resection is the mainstay treatment.

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

OBJECTIVE:To promote the standardization and rationality of medical order for chemotherapeutic drugs,and im-prove its safety use in clinic. METHODS:Through developing the investigation of relevant status quo,the design factors and infor-mation that should be involved and considered of the medical order management module for chemotherapeutical drugs in hospital-ized information system(HIS)were determined. The reference standard chemotherapy regimen used in medical orders was put for-ward. The basic data was maintained and menu setting was conducted. Based on HIS,the function module of automatically import-ing patients'information,drug and program selection,warning were designed;the docking and effective application of medical or-der management module for chemotherapeutical drugs in hospital medical order management information system was achieved. Its application effects were evaluated by summarizing monthly irrational rate of medical orders within 2 years. RESULTS & CONCLU-SIONS:The medical order management module for chemotherapeutical drugs developed in our hospital can achieve physician autho-rized management,automatically importing patient-related information,preservative chemotherapy regimen for easy entry and selec-tion. The irrational numbers of chemotherapy orders were decreased from 28 orders (1.15%) in prime (Jun. 2014) to 4 orders (0.14%)2 years later(Jun. 2016). Procedures of medical orders for chemotherapeutical drugs are standardized,initially realize in-formation management,improve input efficiency and accuracy of medical orders,which have provided protection and support for standardizing physicians'diagnosis and treatment behavior and avoiding the hospital risk,and promote correct,safe and rational use of chemotherapeutic drugs.

Objective:To optimize the formula of regorafenib solid dispersion .Methods: On the basis of preliminary studies on the carrier and drug/carrier ratio, an orthogonal test was used to study the formula of regorafenib solid dispersion .The orthogonal table of L9 (34 ) was designed to study the drug/carrier ratio, ultrasound time and bath temperature .Results: Regorafenib solid dispersion was prepared by a solvent method with polyvinylpyrrolidone K 30 as the carrier.The drug/carrier ratio was 1 ∶7, the ultrasound time was 4min, and the bath temperature was 30℃.Regorafenib solid dispersion showed good stability confirmed by differential scanning calorimetry and X-ray diffraction .The dissolution in 30 min reached above 90 %.Conclusion: The preparation process is stable and reproducible , which can be used to prepare regorafenib solid dispersion .

Objective To reproduce an animal model of acute hepatic failure at high altitude areas for use in the research of extracorporeal artificial liver support. Methods General condition, survival time, relevant biochemistry indexes and pathological changes of the pigs treated by two peritoneal injections of thioacetamide in the dose of 50mg/kg, 100mg/kg and 150mg/kg respectively. Results All the pigs in the 3 experimental groups displayed clinical symptoms and signs and biochemistry changes similar to that of human patients with acute hepatic failure, and the 100mg/kg group may be the most ideal model. Conclusion The animal model of pig treated with two peritoneal injections of thioacetamide 100mg/kg is suitable for the research of extracorporeal artificial liver support for hepatic failure at high altitude.