AIM:To investigate the impact of es-ketamine-mediated opioid-free anesthesia(OFA)on postoperative gastrointestinal function in patients undergoing laparoscopic distal gastrectomy for gas-tric cancer.METHODS:A total of 150 pa-tients,scheduled for elective laparoscopic distal gas-trectomy for gastric cancer and meeting the inclu-sion and exclusion criteria,were randomly assigned to either the OFA group or the opioid-based anes-thesia(OBA)group using a random number ta-ble,with 75 patients in each group.The OFA group was administered an anesthesia regimen pri-marily consisting of esketamine,while the OBA group received conventional opioid anesthesia,pri-marily consisting of sufentanil and remifentanil.The primary outcome measure was postoperative flatus time,defined as the interval from the end of sur-gery to the first passage of gas.RESULTS:The OFA group exhibited a shorter postoperative flatus time compared to the OBA group(P＜0.01).Intraopera-tive blood loss and norepinephrine consumption were significantly less in the OFA group compared to the OBA group(P＜0.05);the postoperative HADS-D score was better in the OFA group than in the OBA group,and both the OFA and OBA groups showed significantly lower postoperative HADS-A and HADS-D scores compared to their preoperative levels(P＜0.05);the incidence rate of abdominal distension was significantly lower in the OFA group compared to the OBA group(P＜0.05).CONCLUSION:The use of esketamine-mediated opioid-free anesthesia can expedite gastrointestinal function recovery,reduce hospital stay duration,and decrease postoperative adverse reactions in patients undergoing laparo-scopic distal gastrectomy for gastric cancer.

AIM:To investigate the impact of es-ketamine-mediated opioid-free anesthesia(OFA)on postoperative gastrointestinal function in patients undergoing laparoscopic distal gastrectomy for gas-tric cancer.METHODS:A total of 150 pa-tients,scheduled for elective laparoscopic distal gas-trectomy for gastric cancer and meeting the inclu-sion and exclusion criteria,were randomly assigned to either the OFA group or the opioid-based anes-thesia(OBA)group using a random number ta-ble,with 75 patients in each group.The OFA group was administered an anesthesia regimen pri-marily consisting of esketamine,while the OBA group received conventional opioid anesthesia,pri-marily consisting of sufentanil and remifentanil.The primary outcome measure was postoperative flatus time,defined as the interval from the end of sur-gery to the first passage of gas.RESULTS:The OFA group exhibited a shorter postoperative flatus time compared to the OBA group(P＜0.01).Intraopera-tive blood loss and norepinephrine consumption were significantly less in the OFA group compared to the OBA group(P＜0.05);the postoperative HADS-D score was better in the OFA group than in the OBA group,and both the OFA and OBA groups showed significantly lower postoperative HADS-A and HADS-D scores compared to their preoperative levels(P＜0.05);the incidence rate of abdominal distension was significantly lower in the OFA group compared to the OBA group(P＜0.05).CONCLUSION:The use of esketamine-mediated opioid-free anesthesia can expedite gastrointestinal function recovery,reduce hospital stay duration,and decrease postoperative adverse reactions in patients undergoing laparo-scopic distal gastrectomy for gastric cancer.

Objective To explore a new technique to treat the benign stricture at hilar bile duct of plastic anastomosis, so as to obtain the theoretical basis and the feasibilities of practical application in treating the benign stricture at hilar bile duct with plastic anastomosis through the animal experiments. Methods 30 miniature pigs were randomly divided into three groups. Group A (control group):2 centimeters of the bile duct above the duodenum was isolated;Group B:The same separation of bile duct with group A, then making physical injury on it with the clamps and electric heat;Group C:Making bile duct injury model in group C as group B,and then monitoring of the diet, feces, urine, ALT, AST and bilirubin etc. When the bile duct stricture was formed, taking the plastic anastomosis operation in this group. After all the operations, we observed the diet, mental state and the color of the urine of animals in all the three groups, and tested ALT,AST,T-BIL and D-BIL levels on the pre- and post-day and every 7 days after surgery respectively. After three months of the surgery,we executed all the pigs,picked up part of the liver tissue,then preserved them by liquid nitrogen for pathological examination. Results From the day before operative-day to the 30 days after operation, there was no significant change in ALT, AST, T-BIL and D-BIL in group A,while the relative indicators of group B and C had obvious changes ( <0.05) . The indicators of group B were significantly increased 21 days after surgery, compared with pre-operation and 14 days after operation respectively ( <0.05) . In group C, the indicators were significantly declined 14 to 21 days after the plastic anastomosis compared with pre-operation (<0.05) . Conclusions Treating benign stricture at hilar bile duct of miniature pigs by plastic anastomosis is feasible and practicable. This study provides an experimental basis for clinical application of plastic anastomosis in treatment of benign stricture at hilar bile duct.

Objective To explore the clinical value of serum cathepsin L (CL),matrix metalloproteinase-9 (MMP-9) and heparanase (Hpa) detection in determining the degree of ovarian cancer invasion and metastasis.Methods Enzyme-linked inmunosorbent assay (ELISA) and electrochemiluminescencl immunoassay (ECLIA) were used to detect the serum content of MMP-9,Hpa,CL in 217 cases with untreated ovarian cancer before surgery( in FIGO Ⅰ - Ⅱ stage 83 cases,Ⅲ-Ⅳstage 134 cases),100 cases with benign ovarian tumors and 101 healthy women control.All of the patients from Guangxi Medical University Affiliated Tumor Hospital,from September 2003 to October 2009.The relationship between the clinical pathological factors of ovarian cancer and serum content of MMP-9,Hpa,CL was analyzed.On the basis of clinical pathological diagnosis as “gold standard”,the ROC curves was drawed to evaluate the clinical value of serum CL,MMP-9,Hpa combined detection in determining the degree of ovarian cancer invasion and metastasis before surgery.Results The serum content of CL,MMP-9 and Hpat in patients with ovarian cancer were (21.23 ± 8.17),( 193.95 ± 42.49),(7.68 ± 2.32) μg/L respectively,which was higher than that in patients with benign ovarian tumors [ ( 10.97 ± 3.84),( 143.66 ± 28.47),( 4.86 ± 1.37) μg/L respectively ] and normal control [ (5.59 ± 1.75),( 57.99 ± 1 1.42),( 2.77 ± 0.80) μg/L respectively ],there was difference statistically significant ( t value CL was - 13.242,- 13.498 respectively; MMP-9 was - 14.521 and - 21.290 respectively; Hpa was - 10.896 and - 18.280 respectively,P ＜ 0.001).The serum content of CL [ ( 21.59 ± 8.24) μg/L ] in patients with epithelial ovarian cancer ( EOC) was significantly higher than that [ ( 19.57 ± 7.69) μg/L ] in non-epithelial carcinoma ( F =1 1.209,P =0.048).The serum CL,MMP-9 and Hpa content in FIGO Ⅰ -Ⅱ stage patients was (19.66 ± 7.83),(182.63 ±42.30),(7.21 ±2.05) μg/L,which was lower than that (22.64 ±8.31),(202.81 ±39.74),(8.51 ± 1.92) μg/L in FIGO Ⅲ-Ⅳ stage patients ( F value was 12.452,70.565 and 195.122respectively,P value was 0.030,0.002 and 0.000 respectively).In patients with EOC,the serum CL,MMP-9 and Hpa content in eases with poorly differentiated was ( 23.04 ± 7.67),( 200.12 ± 40.82),(8.22 ± 1.92) μg/L respectively,which was also higher than that in cases with high-moderate differentiated [ ( 18.54 ± 7.30),( 173.43 ± 39.37),(7.20 ± 2.51) iμg/L respectively;F value was 24.545,60.286 and 9.077 respectively; P was 0.004,0.035 and 0.001 respectively ].The serum content of CL and MMP-9(22.96 ± 8.41),(200.44 ±43.82) μg/L respectively in patients with invasion and metastasis in the abdominal cavity was higher than that without invasion and metastasis in the abdominal cavity [ ( 19.07 ±7.36),( 181.04 ± 36.10) μg/L,F value was 12.210,18.084 ; P value was 0.030,0.010 ] ; There was statistically significant relatioship between serum levels of Hpa and patients with distant metastasis ( F =9.430,P =0.042).On base of pathological diagnosis as gold standard,ROC curve showed the sensitivity was 60.9％ (70/115),69.6％ ( 80/115) and 72.2％ ( 83/115) and specificity was 57.4％ ( 26/62),67.2％(20/62) and 68.9％ (19/62),as serum levels of CL,Hpa,MMP-9 preoperative were detected as tumor markers to determine whether there was cancer invasion and metastasis outside the pelvis.Conclusions There is related with CL,MMP-9 and Hpa levels increase and tumor occurrence and progression in ovarian cancer.The serum content of MMP-9,Hpa,CL detection would be certain clinical reference value to determine extent of invasion and metastasis of ovarian cancer before surgery.