Objective:To compare the short-term efficacy of Kamikawa anastomosis and double-tract reconstruction (DTR) after proximal gastrectomy.Methods:This was a propensity score matched, retrospective, cohort study. Inclusion criteria comprised age 20–70 years, diagnosis of gastric cancer by pathological examination of preoperative endoscopic biopsies, tumor diameter ≤4 cm, and location in the upper 1/3 of the stomach (including the gastroesophageal junction), and TNM stage IA, IB, or IIA. The study cohort comprised 73 patients who had undergone laparoscopic proximal gastric cancer radical surgery in the Department of Gastroenterology, Tangdu Hospital, Air Force Medical University between June 2020 and February 2023, 19 of whom were in the Kamikawa group and 54 in the DTR group. After using R language to match the baseline characteristics of patients in a ratio of 1:2, there were 17 patients in the Kamikawa group and 34 in the DTR group. Surgery-related conditions, postoperative quality of life, and postoperative complications were compared between the two groups.Results:After propensity score matching, there were no statistically significant differences in baseline data between the two groups ( P>0.05). Compared with the DTR group, the Kamikawa group had longer operative times (321.5±15.7 minutes vs. 296.8±26.1 minutes, t=32.056, P<0.001), longer anastomosis times (93.0±6.8 minutes vs. 45.3±7.7 minutes, t=56.303, P<0.001), and less bleeding (76 [54~103] mL vs.112 [82~148) mL, Z=71.536, P<0.001); these differences are statistically significant. There were no statistically significant differences between the two groups in tumor size, time to first postoperative passage of gas, postoperative hospital stay, number of lymph nodes removed, duration of lymph node dissection, or total hospitalization cost (all P>0.05). The median follow-up time was 6.1 ± 1.8 months. As to postoperative quality of life, the Kamikawa group had a lower rate of upper gastrointestinal contrast reflux than did the DTR group (0 vs. 29.4% [10/34], χ 2=6.220, P=0.013); this difference is statistically significant. However, differences between the two groups in quality of life score on follow-up of 3 months and 6 months on the Gastroesophageal Reflux Disease (GERD) scale were not statistically significant (all P>0.05). The incidence of postoperative complications was 2/17 in the Kamikawa group, which is significantly lower than the 41.2% (14/34) in the DTR group (χ 2=4.554, P=0.033). Conclusion:Kamikawa anastomosis and DTR are equally safe and effective procedures for reconstructing the digestive tract after proximal gastric surgery. Although Kamikawa anastomosis takes slightly longer and places higher demands on the surgical team, it is more effective at preventing postoperative reflux.

Objective:To compare the short-term efficacy of Kamikawa anastomosis and double-tract reconstruction (DTR) after proximal gastrectomy.Methods:This was a propensity score matched, retrospective, cohort study. Inclusion criteria comprised age 20–70 years, diagnosis of gastric cancer by pathological examination of preoperative endoscopic biopsies, tumor diameter ≤4 cm, and location in the upper 1/3 of the stomach (including the gastroesophageal junction), and TNM stage IA, IB, or IIA. The study cohort comprised 73 patients who had undergone laparoscopic proximal gastric cancer radical surgery in the Department of Gastroenterology, Tangdu Hospital, Air Force Medical University between June 2020 and February 2023, 19 of whom were in the Kamikawa group and 54 in the DTR group. After using R language to match the baseline characteristics of patients in a ratio of 1:2, there were 17 patients in the Kamikawa group and 34 in the DTR group. Surgery-related conditions, postoperative quality of life, and postoperative complications were compared between the two groups.Results:After propensity score matching, there were no statistically significant differences in baseline data between the two groups ( P>0.05). Compared with the DTR group, the Kamikawa group had longer operative times (321.5±15.7 minutes vs. 296.8±26.1 minutes, t=32.056, P<0.001), longer anastomosis times (93.0±6.8 minutes vs. 45.3±7.7 minutes, t=56.303, P<0.001), and less bleeding (76 [54~103] mL vs.112 [82~148) mL, Z=71.536, P<0.001); these differences are statistically significant. There were no statistically significant differences between the two groups in tumor size, time to first postoperative passage of gas, postoperative hospital stay, number of lymph nodes removed, duration of lymph node dissection, or total hospitalization cost (all P>0.05). The median follow-up time was 6.1 ± 1.8 months. As to postoperative quality of life, the Kamikawa group had a lower rate of upper gastrointestinal contrast reflux than did the DTR group (0 vs. 29.4% [10/34], χ 2=6.220, P=0.013); this difference is statistically significant. However, differences between the two groups in quality of life score on follow-up of 3 months and 6 months on the Gastroesophageal Reflux Disease (GERD) scale were not statistically significant (all P>0.05). The incidence of postoperative complications was 2/17 in the Kamikawa group, which is significantly lower than the 41.2% (14/34) in the DTR group (χ 2=4.554, P=0.033). Conclusion:Kamikawa anastomosis and DTR are equally safe and effective procedures for reconstructing the digestive tract after proximal gastric surgery. Although Kamikawa anastomosis takes slightly longer and places higher demands on the surgical team, it is more effective at preventing postoperative reflux.

Objective:To investigate the effect of neoadjuvant chemotherapy on the safety of laparoscopic D 2 radical resection and prognosis of patients with locally advanced gastric cancer. Methods:The propensity score matching and retrospective cohort study was conducted. The clinicopathological data of 351 patients with locally advanced gastric cancer who underwent laparos-copic D 2 radical resection in the Second Affiliated Hospital of Air Force Medical University from December 2016 to December 2021 were collected. There were 256 males and 95 females, aged (58±9)years. Of the 351 patients, 124 cases undergoing neoadjuvant chemotherapy were divided into the neoadjuvant chemotherapy group, 227 patients undergoing postoperative adjuvant chemotherapy were divided into the adjuvant chemotherapy group. Observation indicators: (1) propensity score matching and comparison of general data of patients between the two groups after matching; (2) effect evaluation of neoadjuvant chemotherapy; (3) intraoperative and postoperative situations; (4) postoperative histopathological examinations; (5) follow-up. Propensity score matching was done by the 1∶1 nearest neighbor matching method. Measurement data with normal distribution were represented as Mean± SD, and comparison between groups was conducted using the t test. Measure-ment data with skewed distribution were represented as M(range) or M( Q1, Q3), and comparison between groups was conducted using the rank sum test. Count data were described as absolute numbers, and comparison between groups was conducted using the chi-square test. The Kaplan-Meier method was used to draw survival curves, and the Log-Rank test was used for survival analysis. Results:(1) Propensity score matching conditions and comparison of general data of patients between the two groups of patients after matching. Of 351 patients, 154 cases were successfully matched, including 77 cases in the neoadjuvant chemotherapy group and 77 cases in the adjuvant chemotherapy group. The elimination of gender, age, preoperative body mass index, clinical T staging and clinical N staging confounding bias ensured comparability between the two groups after propensity score matching. (2) Effect evaluation of neoadjuvant chemotherapy. Of the 77 patients receiving neoadjuvant chemotherapy, none of patient achieved complete response, 26 patients achieved partial response, 46 patients showed stable disease, 5 patients had progression of disease, showing the objective response rate as 33.8%(26/77) and the disease control rate as 93.5%(72/77). There were 15 males and 11 females sensitive to neoadjuvant chemotherapy, while 46 males and 5 females not sensitive, showing a significant difference between them ( χ2=11.05, P<0.05). (3) Intra-operative and postoperative situations. The operation time, volume of intraoperative blood loss, cases with intraoperative blood transfusion, time to postoperative first flatus, time to postoperative first liquid food intake, duration of postoperative hospital stay, cases with postoperative immediate complications, cost of hospital stay were (308±71)minutes, 100(range, 20?600)mL, 5, 3.0(range, 2.0?10.0)days, 4.0(range, 2.0?12.0)days, 9.0(range, 4.0?31.0)days, 7, 7.96(7.37,8.58) ten thousand yuan in patients of the neoadjuvant chemotherapy group, versus (296±67)minutes, 100(range, 20?500)mL, 4, 3.5(range, 1.0?14.0)days, 4.0(range, 2.0?15.0)days, 8.0(range, 5.0?45.0)days, 11, 8.18(7.52,9.19) ten thousand yuan in patients of the adjuvant chemotherapy group, showing no signifi-cant difference in the above indicators between the two groups ( t=1.13, Z=?0.37, χ2=0.12, Z=?1.26, ?0.33, ?0.70, χ2=1.01, Z=?1.04, P>0.05). (4) Postoperative histopathological examinations. Results of postoperative histopatho-logical examinations showed that all 154 patients achieving R 0 resection. Cases with pathological T staging as stage T1, stage T2, stage T3, stage T4, cases with pathological N staging as stage N0, stage N1, stage N2, stage N3, number of positive lymph nodes, cases with human epidermal growth factor receptor 2 (negative, positive) were 3, 7, 5, 62, 27, 19, 19, 12, 1(range, 0?28), 59, 18 in patients of the neoadjuvant chemotherapy group, versus 0, 0, 2, 75, 17, 15, 21, 24, 3(range, 0?31), 44, 33 in patients of the adjuvant chemotherapy group, showing significant differences in the above indicators between the two groups ( Z=?3.39, ?2.55, ?3.12, χ2=6.60, P<0.05). (5) Follow-up. Of the 154 patients, 143 patients were followed up for 37(range, 5?69)months. The 3-year overall survival rate and 3-year disease-free survival rate was 72.1% and 70.0%, respectively, in patients of the neoadjuvant chemotherapy group, versus 74.8% and 76.6% in patients of the adjuvant chemo-therapy group, showing no significant difference in the above indicators between the two groups ( χ2=0.14, 0.60, P>0.05). Conclusions:Compared to postoperative adjuvant chemotherapy, neoadjuvant chemotherapy does not bring additional surgical risks, but can reduce the tumor stage of patients who underwent laparoscopic D 2 radical resection for locally advanced gastric cancer. However, it does not show any advantage in improving survival of patients.

Objective:Objective To explore the special role of nutrition specialists in the one-day-care clinic of gestational diabetes mellitus (GDM), and provide a basis for strengthening the standardized construction of one-day-care clinic.Methods:It was a retrospective observation study that the pregnant women who participated in the one-day-care clinic of GDM in our hospital without nutrition specialists in November and December 2017 were divided into control group (177 cases), and who participated in the one-day-care clinic of GDM in our hospital with nutrition specialists in January and February 2018 were divided into observation group (307 cases). The differences of pregnancy outcomes between the two groups were compared after the propensity score matching.Results:176 pairs of patients were successfully matched with a 1:1 propensity score. The incidence of macrosomia in pregnant women with GDM in the observation group (2.8%) was significantly lower than that in the control group (8.5%) ( P=0.036). There were no significant differences in the weight gain during pregnancy, the gestational week of delivery and the incidences of insulin use, hypertension during pregnancy, preeclampsia, cesarean section, premature infants, premature rupture of membranes, umbilical cord around the neck, and fetal distress between the two groups ( P>0.05). Conclusion:Nutrition specialists are indispensable in the multidisciplinary cooperation of one-day-care clinic of GDM, and they play a key role in considerably lowering the prevalence of macrosomia in GDM pregnant women.

Objective: To understand the current situation and associated factors of myopia among primary school students, and to provide scientific basis for prevention and control of myopia among primary school students. Methods: In Gansu, Guangdong, Guangxi, Guizhou, Liaoning, Shandong, Shanxi and other provinces, 1 prefecture was selected, and a number of primary schools were selected from each region. All the students in the class were selected as the object of this survey. A total of 8 365 middle school students were examined for their eyesight, and the data of general population economic indicators and natural environment indicators were obtained through the statistical yearbook of various provinces and cities. The influencing factors of primary school students myopia were analyzed by chi-square test and multivariate Logistic regression. Results: Univariate analysis showed that different provinces and different sex, different nationalities, different grade, parents average salary, sunshine duration, air temperature, altitude, longitude, latitude, different economic zone(χ2=116.22, 18.08, 26.33, 1 059.04, 14.86, 10.28, 16.95, 10.01, 23.15, 29.43, 88.14, P<0.05). Multivariate analysis results showed that gender, grade, sunshine duration, longitude were risk factor for poor vision(OR=1.31, 1.71, 1.45, 1.54, P<0.05); Economic zone and parents salary were protective factors for poor eyesight of students (OR=0.65, 0.86, P<0.05). Conclusion Myopia of primary school students is affected by a variety of factors, economic and social factors and natural environmental factors have an impact on the screening.

Objective: To understand the current situation and associated factors of myopia in junior middle school students, and to provide scientific basis for prevention and control of myopia in junior middle school students. Methods: A total of 5 393 junior middle school students were selected from middle schools in Guangdong, Guangxi, Guizhou, Liaoning, Shandong, Shanxi provinces. The visual acuity of middle school students was examined, and the data of general population, economy, sociology and natural environment were obtained through statistical yearbook of each province. The influencing factors of myopia of middle school students were analyzed by univariate and multivariate Logistic regression. Results: The results of single factor analysis showed that the myopia rate of junior high school students was different by gender, grades, parents average wage, sunshine duration, temperature, altitude, longitude and latitude(χ2=47.76，59.05，10.79，106.19，53.56，85.02，76.23，107.07，P<0.05). The results of multi factor analysis showed that gender, grade, average wage, temperature and latitude was positively associated with myopia vision; sunshine duration and longitude were negatively associated with the risk for myopia(OR=1.54，1.34，1.62，7.58，27.10，0.42，0.39，P<0.05). Conclusion The myopia of junior high school students is affected by a variety of factors, economic and social factors and natural environmental factors have an impact on the screening of sexual myopia in junior high school students. Economic and social factors and natural environmental factors should be taken into account in the formulation of myopia prevention and control measures.

OBJECTIVETo investigate the application value of the Overlap method in digestive tract reconstruction of totally laparoscopic left colectomy(TLLC) and its potential advantage.

METHODSThe retrospective cohort study was adopted. Clinicopathological data of 16 patients with left colon cancer who underwent TLLC and Overlap anastomosis between August 2016 and August 2017 at Tangdu Hospital were retrospectively collected as Overlap group. Twenty-one patients who underwent laparoscopic assisted left colectomy (LALC) between January 2015 and July 2016 at Tangdu Hospital were used as control (traditional group). The intraoperative and postoperative data were compared between the two groups. During digestive tract reconstruction in the Overlap group, the proximal colon and distal colon were lined up side by side; a side-to-side anastomosis was conducted on colic band with a 60 mm linear stapler; and the common entry hole was closed using running suture. While in traditional group, the bowel was pulled out of abdominal wall through the assisted incision; the sample was resected and a proximal and distal end-to-end anastomosis was performed.

RESULTSIn Overlap group, 10 cases were male and 6 cases were female, with a mean age of (66.4±4.8) years and a BMI of (23.6±2.3) kg/m; the tumor located in distal transverse colon in 1 case, in splenic flexure in 2 cases, in descending colon in 4 cases, in upper sigmoid colon in 9 cases. TLLC was successfully completed in all the cases without conversion to laparotomy. In traditional group, 12 cases were male and 9 cases were female, with mean age of (65.9±5.8) years and BMI of (22.7±2.8) kg/m; the tumor located in the distal transverse colon in 1 case, in the splenic flexure in 3 cases, in the descending colon in 6 cases, in the upper sigmoid colon in 11 cases. No statistically significant differences in baseline data were found between the two groups (all P>0.05). Compared to the traditional group, the total operation time was shorter [(143.4±11.1) minutes vs. (166.4±16.5) minutes, t=4.792, P=0.000], the anastomosis time was prolonged [(44.3±3.3) minutes vs. (22.4±3.0) minutes, t=-20.948, P=0.000], the amount of bleeding was reduced [(46.6±13.6) ml vs. (70.5±20.0) ml, t=4.106, P=0.000], and the incision length was shorter [(3.9±0.9) cm vs. (6.7±1.3) cm, t=7.056, P=0.000] in the Overlap group. There were no significant differences in lymph nodes harvested (17.3±2.9 vs. 15.5±3.0), time to flatus [(2.8±1.3) days vs. (2.6±1.0)days], postoperative complications [6.2%(1/16) vs. 9.5%(2/21)] and postoperative hospitalization [(4.6±1.4) days vs.(4.7±1.2) days] between the two groups (all P>0.05).

CONCLUSIONThe Overlap reconstruction method in totally laparoscopic left colectomy is a safe and feasible procedure, and provides less injury and better cosmetic outcome of abdominal wall.

Aged ; Colectomy ; Colonic Neoplasms ; surgery ; Female ; Humans ; Laparoscopy ; Laparotomy ; Male ; Middle Aged ; Reconstructive Surgical Procedures ; Retrospective Studies ; Treatment Outcome

OBJECTIVETo investigate the application value of the clearance of No.253 lymph nodes with priority to fascial space and preserving left colic artery (LCA) in patients undergoing laparoscopic radical proctectomy.

METHODSFrom August 2015 to August 2016, 97 consecutive middle-low rectal cancer patients underwent laparoscopic radical proctectomy using the clearance of No.253 lymph nodes with priority to fascial space and preserving LCA at Department of General Surgery, Tangdu Hospital. Among 97 patients, 45 were females , 52 were males, mean age was (64.3±5.5) years and mean BMI was (22.4±1.8) kg/m. Brief steps of this clearance: traditional medial approach was the commencement of the dissection at the membrane bridge line in front of iliac vascular bifurcation, then entering into the Toldt's space; superior rectal artery served as the top of the tent and the Toldt's space was extended as far as possible; blunt separation was developed caudally (reaching 2 cm below the sacral promontory), cephalad (reaching the lower part of the pancreas), left laterally (reaching Toldt's line), dextrally (reaching abdominal aorta); after giving priority to fascias space, from the root of inferior mesenteric artery, LCA was exposed and No.253 lymph nodes were dissected. This regimen was suitable for the rectal adenocarcinoma patients without distant metastasis.

RESULTSThere was no tension in the intestine and mesenteria after anastomosis in all the 97 patients. One patient received LCA ligation during the clearance, because of thinner LCA resulting in bleeding. The other 96 cases completed the clearance and operation successfully. The mean No.253 lymphadenectomy time was 11-27(17.1±5.3) minutes. The mean number of harvested No.253 lymph node was 0-6(4±2). The No.253 lymph nodes of 6 patients were positive. No.253 regional mesentery was complete in 95 patients. The total harvested number of lymph node was 11-26(17.3±5.3). Six patients with positive lymph nodes aged from 68 to 72 years old and all of them underwent TME operation 6-8 weeks after neoadjuvant chemoradiotherapy. The mean operative time was 89-189(125±35) minutes. The mean estimated blood loss was 10.5-38.6(22.4±10.5) ml. The first exhaust time was 3.0-6.0(5.6±2.1) days. The mean time to extracting the drainage tube was 3.0-5.0(4.5±2.5) days. Anastomotic fistula appeared in 1 case and hemorrhage appeared in 1 case, and these 2 cases were cured by conservative treatment. No perioperative death occurred. The mean postoperative hospital stay was 3.0-10.0(3.6±2.6) days.

CONCLUSIONThe clearance of No.253 lymph nodes with priority to fascial space and preserving LCA in laparoscopic radical proctectomy is safe and feasible.

Aged ; Digestive System Surgical Procedures ; methods ; Female ; Humans ; Laparoscopy ; Lymph Node Excision ; Lymph Nodes ; Male ; Mesenteric Artery, Inferior ; surgery ; Middle Aged ; Rectal Neoplasms ; surgery

At present, Laparoscopy has become a professional skill that surgeons have to master. In cultivating surgeons in laparoscopy in our country, there are some deficiencies such as unbalanced regional development, technical difficulties, long learning curve, lack of standardized training mode and so on. Based on the original foundations, the Department of Gastrointestinal Surgery, Tangdu Hospital, the Air Force Military Medical University, has been constructing and improving the cultivating system by modifying the course contents, improving the training of endoscopic simulator, endoscopic surgery training on animal and endoscopic clinical practice, and managing the processes. Based on the above measures, certain results have been achieved.

Objective To investigate the application value of the modified Overlap method in digestive tract reconstruction of totally laparoscopic total gastrectomy (TLTG).Methods The retrospective cohort study was conducted.The clinicopathological data of 50 patients with gastric cancer who underwent TLTG with Overlap anastomosis between January 2016 and December 2016 in the Tangdu Hospital of the Fourth Military Medical University were collected.Twenty-six patients using classic Overlap method and 24 patients using modified Overlap method were respectively allocated into the classic Overlap group and modified Overlap group.All the patients underwent D2 lymph node dissection.Patients in the classic Overlap group underwent totally laparoscopic catastalsis side-to-side esophagojejunostomy.During digestive tract reconstruction in the modified Overlap group,there was no esophageal transection before anastomosis,and gastric fundus traction fully exposed to the lower esophagus.Esophagus was spun anticlockwise,and a hole was opened at the left posterior esophageal wall.Transection of jejunum was 25 cm away from Treitz ligment,and opening a hole at mesenteric margin was 6 cm away from distal jejunum to transected end of jejunum.Esophagus-distal jejunum side-to-side anastomosis was done using 60 mm linear stapler,and then laterally closing openings and transecting esophagus.Observation indicators:(1) intra-and post-operative recovery:total operation time,time of esophagus-jejunum anastomosis,volume of intraoperative blood loss,number of lymph node dissected,time to anal exsufflation,cases with complications and duration of postoperative hospital stay;(2) follow-up and survival.Follow-up using outpatient examination and telephone interview was performed to detect the postoperative tumor-free survival and tumor recurrence or metastasis up to March 2017.Measurement data with normal distribution were represented as (x)±s and comparison between groups was analyzed using the independent-sample t test.Comparison of count data was analyzed using the chi-square test or Fisher exact probability.Results (1) Intra-and post-operative recovery:all the 50 patients underwent successful TLTG using Overlap method,without conversion to open surgery.Total operation time and time of esophagus-jejunum anastomosis were respectively (278.6± 14.9) minutes,(46.5 ± 4.4) minutes in the classic Overlap group and (253.3 ± 12.8) minutes,(20.4 ± 2.3) minutes in the modified Overlap group,with statistically significant differences between the 2 groups (t =5.459,22.482,P＜0.05).Volume of intraoperative blood loss,number of lymph node dissected,time to anal exsufflation,cases with complications and duration of postoperative hospital stay were respectively (73±25) mL,34±6,(2.7± 1.0) days,2,(9.7± 1.6) days in the classic Overlap group and (71 ± 22) mL,35± 5,(2.6± 1.3) days,2,(9.8± 1.5) days in the modified Overlap group,with no statistically significant difference between the 2 groups (t =0.175,-0.616,0.293,-0.217,P＞ 0.05).Two patients in the classic Overlap group were respectively complicated with esophagus-jejunum anastomotic fistula and pancreatic leakage,2 patients in the modified Overlap group were respectively complicated with pulmonary infection and subcutaneous emphysema,and they were improved by symptomatic treatment.(2) Follow-up and survival:41 of 50 patients were followed up for 3-15 months,with a median time of 7 months,including 20 in the classic Overlap group and 21 in the modified Overlap group.During follow-up,patients had tumor-free survival,without tumor recurrence and metastasis.Conclusion Compared with classic Overlap method,the modified Overlap method can simplify the anastomotic procedures,shorten operation time and achieve similar efficacy,and it is also a simple and effective method for digestive tract reconstruction after TLTG.