OBJECTIVE: To observe the clinical efficacy of umbilical needling therapy of I-Ching at 1 PM to 3 PM for cirrhosis ascites with syndrome of spleen-deficiency and fluid-retention. METHODS: Forty-eight patients of cirrhosis ascites with syndrome of spleen-deficiency and fluid-retention were randomly divided into an observation group and a control group, 24 cases in each one. Both groups were treated with routine treatment of western medicine combined with TCM decoction. In addition, the patients in the observation group were treated with umbilical needling therapy of I-Ching at locations of , , and . The treatment was given at 1 PM to 3 PM, once a day; 10-d treatment was a course of treatment, and a total of 20-d treatment was given. The abdominal circumference, urine volume, body mass, liver function and prothrombin time were observed before and after treatment in the two groups, and the clinical efficacy of the two groups was compared. RESULTS: The total effective rate was 91.7% (22/24) in the observation group, which was higher than 87.5% (21/24) in the control group (<0.05). After treatment, the improvement of abdominal circumference, urine volume, body mass, liver function and prothrombin time between the two groups was significantly different (<0.05), the observation group was better. CONCLUSION Based on the western medicine treatment, the combination of TCM decoction and umbilical needling therapy of I-Ching shows significant efficacy for cirrhosis ascites with syndrome of spleen-deficiency and fluid-retention.
Ascites ; etiology ; therapy ; Humans ; Liver Cirrhosis ; complications ; Needles ; Spleen ; Syndrome ; Umbilicus

Incidence of gastric cancer is high in China and standard radical operation is currently the main treatment for gastric cancer. Postoperative complications, especially some special complications, can directly affect the prognosis of patients, even result in the increase of mortality. But the incidences of these special complications are low, so these complications are often misdiagnosed and delayed in treatment owing to insufficient recognition of medical staff. These special complications include (1) Peterson hernia: It is an abdominal hernia developed in the space between Roux loop and transverse colon mesentery after Roux-Y reconstruction of digestive tract. Peterson hernia is rare and can quickly result in gangrenous ileus. Because of low incidence and without specific clinical symptoms, this hernia does not attract enough attention in clinical practice, so the outcome will be very serious. Once the diagnosis is made, an emergent operation must be performed immediately. Peterson space should be closed routinely in order to avoid the development of hernia. (2) Lymphatic leakage: It is also called chyle leakage. Cisterna chylus is formed by gradual concentration of extensive lymphatic net to diaphragm angle within abdominal cavity. Lymphadenectomy during operation may easily damage lymphatic net and result in leakage. The use of ultrasonic scalpel can decrease the risk of lymphatic leakage in certain degree. If lymphatic leakage is found during operation, transfixion should be performed in time. Treatment includes total parenteral nutrition, maintenance of internal environment, supplement of protein, and observation by clamp as an attempt. (3)Duodenal stump leakage: It is one of serious complications affecting the recovery and leading to death after subtotal gastrectomy. Correct management of duodenal stump during operation is one of key points of the prevention of duodenal stump leakage. Routine purse embedding of duodenal stump is recommend during operation. The key treatment of this complication is to promt diagnosis and effective hemostasis.(4) Blood supply disorder of Roux-Y intestinal loop: Main preventive principle of this complication is to pay attention to the blood supply of vascular arch in intestinal edge. (5) Anastomotic obstruction by big purse of jejunal stump: When Roux-en-Y anastomosis is performed after distal radical operation for gastric cancer, anvil is placed in the remnant stomach and anastomat from distal jejunal stump is placed to make gastrojejunal anastomosis, and the stump is closed with big purse embedding. The embedding jejunal stump may enter gastric cavity leading to internal hernia and anastomotic obstruction. We suggest that application of interruptable and interlocking suture and fixation of stump on the gastric wall can avoid the development of this complication.
Anastomosis, Roux-en-Y ; adverse effects ; China ; Chylous Ascites ; etiology ; prevention & control ; therapy ; Duodenum ; blood supply ; surgery ; Gastrectomy ; adverse effects ; methods ; mortality ; Gastric Outlet Obstruction ; etiology ; prevention & control ; Gastric Stump ; surgery ; Hemostatic Techniques ; Hernia ; etiology ; prevention & control ; therapy ; High-Intensity Focused Ultrasound Ablation ; instrumentation ; Humans ; Jejunum ; blood supply ; surgery ; Lymph Node Excision ; adverse effects ; instrumentation ; Lymphatic System ; injuries ; Postoperative Complications ; classification ; diagnosis ; mortality ; prevention & control ; Prognosis ; Stomach ; surgery ; Stomach Neoplasms ; complications ; surgery ; Suture Techniques ; standards ; Thoracic Duct ; injuries ; Wound Closure Techniques ; standards

OBJECTIVE: Uterine carcinosarcoma (UCS) shared the same staging system with endometrial carcinoma in the International Federation of Gynecology and Obstetrics 2009. The aim of the present study was to compare the clinicopathological and prognostic characteristics between UCS and grade 3 endometrioid endometrial carcinoma (G3EC). METHODS: A retrospective analysis of 60 UCS and 115 G3EC patients with initial treatment at the Department of Gynecology in the Fudan University Shanghai Cancer Center between February 2006 and August 2013. Chi-square analysis was used to compare differences between variables. Prognostic factors were determined using univariate/multivariate analysis, and the survival rates were assessed using the Kaplan-Meier method. The Cox regression model was used to assess the independent prognostic factor. RESULTS: UCS had significantly worse overall survival (OS) compared with G3EC. Carcinosarcoma subtype was an independent factor (hazard ratio [HR], 2.4; 95% confidence interval [CI], 1.0 to 5.8; p=0.039), stratified based on stage. Compared with G3EC, UCS patients had a greater incidence of ascites fluid (55.0% vs. 15.7%, p<0.001) and adnexal involvement (20.0% vs. 8.7%, p=0.048) and larger median tumor volume (4.6 cm vs. 4.0 cm, p=0.046). Subgroup analysis of the prognostic factors revealed that UCS patients exhibited worse OS than G3EC patients in such specific subgroups as patients at younger ages, with postmenopausal status, without ascites fluid, with early stage diseases, without vagina invasion, without lymph node metastases and receiving adjuvant chemo/radiotherapy. Adjuvant radiotherapy with chemotherapy was predictive of better survival in UCS patients compared with chemotherapy or radiotherapy alone (5-year OS, 71.0% vs. 35.8%, p=0.028). Multivariate Cox regression revealed that tumor mesenchymal component (HR, 4.6; 95% CI, 1.4 to 15.8; p=0.014) was an independent prognostic factor for UCS, whereas advanced stages (HR, 5.9; 95% CI, 1.0 to 33.9; p=0.046) and ascites fluid (HR, 5.1; 95% CI, 1.1 to 22.7; p=0.032) were independently correlated with poor prognosis for G3EC patients. CONCLUSION: The distinctions in both clinicopathological and prognostic characteristics between UCS and G3EC suggest that this subtype should be treated separately from high-risk epithelial endometrial carcinoma.
Adnexa Uteri/pathology ; Adult ; Age Factors ; Aged ; Aged, 80 and over ; Aorta ; Ascites/etiology ; Carcinoma, Endometrioid/*secondary/*therapy ; Carcinosarcoma/*secondary/*therapy ; Chemotherapy, Adjuvant ; Cytoreduction Surgical Procedures ; Endometrial Neoplasms/*pathology/*therapy ; Female ; Humans ; Hysterectomy ; *Lymph Node Excision ; Lymphatic Metastasis ; Middle Aged ; Neoplasm Grading ; Neoplasm Invasiveness ; Neoplasm Staging ; Pelvis ; Postmenopause ; Radiotherapy, Adjuvant ; Retrospective Studies ; Survival Rate ; Tumor Burden ; Vagina/pathology

OBJECTIVE: To evaluate risk factors for massive lymphatic ascites after laparoscopic retroperitoneal lymphadenectomy in gynecologic cancer and the feasibility of treatments using intranodal lymphangiography (INLAG) with glue embolization. METHODS: A retrospective analysis of 234 patients with gynecologic cancer who received laparoscopic retroperitonal lymphadenectomy between April 2006 and November 2015 was done. In June 2014, INLAG with glue embolization was initiated to manage massive lymphatic ascites. All possible clinicopathologic factors related to massive lymphatic ascites were determined in the pre-INLAG group (n=163). Clinical courses between pre-INLAG group and post-INLAG group (n=71) were compared. RESULTS: In the pre-INLAG group (n=163), four patients (2.5%) developed massive lymphatic ascites postoperatively. Postoperative lymphatic ascites was associated with liver cirrhosis (three cirrhotic patients, p<0.001). In the post-INLAG group, one patient with massive lymphatic ascites had a congestive heart failure and first received INLAG with glue embolization. She had pelvic drain removed within 7 days after INLAG. The mean duration of pelvic drain and hospital stay decreased after the introduction of INLAG (13.2 days vs. 10.9 days, p=0.001; 15.2 days vs. 12.6 days, p=0.001). There was no evidence of recurrence after this procedure. CONCLUSION: Underlying medical conditions related to the reduced effective circulating volume, such as liver cirrhosis and heart failure, may be associated with massive lymphatic ascites after retroperitoneal lymphadenectomy. INLAG with glue embolization can be an alternative treatment options to treat leaking lymphatic channels in patients with massive lymphatic leakage.
Adult ; Aged ; Ascites/*etiology/therapy ; Embolization, Therapeutic/*methods ; Female ; Genital Neoplasms, Female/*surgery ; Humans ; Lymph Node Excision/*adverse effects ; *Lymphography ; Middle Aged ; Postoperative Complications/*etiology ; Retrospective Studies

OBJECTIVE: To evaluate risk factors for massive lymphatic ascites after laparoscopic retroperitoneal lymphadenectomy in gynecologic cancer and the feasibility of treatments using intranodal lymphangiography (INLAG) with glue embolization. METHODS: A retrospective analysis of 234 patients with gynecologic cancer who received laparoscopic retroperitonal lymphadenectomy between April 2006 and November 2015 was done. In June 2014, INLAG with glue embolization was initiated to manage massive lymphatic ascites. All possible clinicopathologic factors related to massive lymphatic ascites were determined in the pre-INLAG group (n=163). Clinical courses between pre-INLAG group and post-INLAG group (n=71) were compared. RESULTS: In the pre-INLAG group (n=163), four patients (2.5%) developed massive lymphatic ascites postoperatively. Postoperative lymphatic ascites was associated with liver cirrhosis (three cirrhotic patients, p<0.001). In the post-INLAG group, one patient with massive lymphatic ascites had a congestive heart failure and first received INLAG with glue embolization. She had pelvic drain removed within 7 days after INLAG. The mean duration of pelvic drain and hospital stay decreased after the introduction of INLAG (13.2 days vs. 10.9 days, p=0.001; 15.2 days vs. 12.6 days, p=0.001). There was no evidence of recurrence after this procedure. CONCLUSION: Underlying medical conditions related to the reduced effective circulating volume, such as liver cirrhosis and heart failure, may be associated with massive lymphatic ascites after retroperitoneal lymphadenectomy. INLAG with glue embolization can be an alternative treatment options to treat leaking lymphatic channels in patients with massive lymphatic leakage.
Adult ; Aged ; Ascites/*etiology/therapy ; Embolization, Therapeutic/*methods ; Female ; Genital Neoplasms, Female/*surgery ; Humans ; Lymph Node Excision/*adverse effects ; *Lymphography ; Middle Aged ; Postoperative Complications/*etiology ; Retrospective Studies

Adult ; Aged ; Ascites ; drug therapy ; etiology ; therapy ; Drugs, Chinese Herbal ; administration & dosage ; Female ; Humans ; Male ; Middle Aged ; Neoplasms ; complications

Three patients of pseudomyxoma peritonei who were diagnozed by transumbilical endoscopic surgery (TUES) were reviewed retrospectively from September 2014 to November 2014. Three cases of ascites patients underwent TUES were diagnozed as pseudomyxoma peritonei. All operations were successful. No open surgery or laparoscopic surgery was required. The mean operative time was (45±16) min; the mean intraoperative blood loss was 510 mL; the mean hospital stay time was 3 days. During the follow up of 911 months, no obvious scar was observed. Cosmetic results appear to be excellent. All patients were treated with intraperitoneal hyperthermia and chemotherapy. The survival rate was 100%. As a novel scarless endoscopic invasive abdominal surgery, TUES has high clinical value with the advantages such as small trauma, no scars, small risk and low cost in the diagnosis of unexplained ascites.
Antineoplastic Agents ; therapeutic use ; Ascites ; etiology ; Blood Loss, Surgical ; Cicatrix ; prevention & control ; Costs and Cost Analysis ; Humans ; Hyperthermia, Induced ; Laparoscopy ; adverse effects ; economics ; methods ; Length of Stay ; Operative Time ; Peritoneal Neoplasms ; Pseudomyxoma Peritonei ; diagnosis ; mortality ; therapy ; Retrospective Studies ; Treatment Outcome

OBJECTIVETo investigate the efficacy and safety of chemotherapy combined with intraperitoneal perfusion of cytokine-induced killer (CIK) cells for advanced gastric cancer patients with ascites.

METHODSFrom January 2008 to December 2010, 42 advanced gastric cancer patients with ascites in Zhongshan Hospital of Fudan University were enrolled in the study. According to personal choice, patients were divided into 2 groups: XELOX chemotherapy alone (Capecitabine and Oxaliplatin) was applied in 22 patients (chemotherapy group) and XELOX combined with intraperitoneal perfusion of CIK cells in 20 patients (combination group). The efficacy, safety, and immunological function, including the time to progression (TTP), overall survival (OS), Karnofsky performance status (KPS) score, immunity index (CD4+/CD8+ ratio), volume of peritoneal fluid, were compared between two groups.

RESULTSCompared with the chemotherapy group after treatment, the combination group had a higher KPS score (78.0±9.8 vs. 70.0±8.9, P=0.009), less volume of 2-cycle peritoneal fluid drainage [(4500±1218) ml vs. (5527±1460) ml, P=0.018 ], longer median TTP (4.0 vs. 2.5 months, P=0.001) and OS (11.0 vs. 6.0 months, P=0.006), higher ratio of CD4+/CD8+ (1.34±0.36 vs. 0.96±0.26, P=0.001). While no significant significances were found between the two groups in disease response rate (35.0% vs. 22.7%, P=0.499) and disease control rate (75.0% vs. 54.5%, P=0.209). There were no serious adverse reactions in the combination group.

CONCLUSIONSAs compared with XELOX chemotherapy alone, the combination immunological treatment of XELOX chemotherapy and intraperitoneal perfusion of CIK cells possesses better efficacy for the advanced gastric cancer patients with ascites, which can prolong the survival and enhance the immunological function with favorable safety.

Adult ; Aged ; Aged, 80 and over ; Antineoplastic Combined Chemotherapy Protocols ; Ascites ; etiology ; therapy ; Combined Modality Therapy ; Cytokine-Induced Killer Cells ; Deoxycytidine ; analogs & derivatives ; Female ; Fluorouracil ; analogs & derivatives ; Humans ; Immunotherapy, Adoptive ; Male ; Middle Aged ; Pilot Projects ; Stomach Neoplasms ; complications ; therapy ; Treatment Outcome

Chyle leak is a rare complication after abdominal surgery. According to the statistical results from our center, we summarized the experiences in the diagnosis, treatment and prevention of abdominal chyle leak after radical resection of colorectal cancer. Early prevention, early diagnosis, and early treatment may result in earlier recovery, shorter hospital stay, lower incidence, and better prognosis.
Chyle ; Chylous Ascites ; diagnosis ; etiology ; therapy ; Colorectal Neoplasms ; surgery ; Humans ; Postoperative Complications ; diagnosis ; therapy

OBJECTIVE: To investigate the effectiveness of treatment for severe ovary hyperstimulation syndrome (OHSS) complicated by pleural effusion and ascites after in vitro fertilization preembryo transfer (IVF-ET). METHODS: One hundred and thirty-two patients with severe OHSS in our hospital (from January 2007 to December 2010) were retrospectively analyzed and the efficacy of three therapeutic methods was compared. Twenty-five patients in group I were treated with low-molecular dextran and albumin, 67 patients in group II were treated with 6% medium molecular-weight hydroxyethyl starch, and 40 patients in group III were treated with active aspiration of pleural effusion and ascites. RESULTS: All three therapies improved the symptoms of OHSS and various blood biochemical parameters. The duration of hospitalization of group III [(7.4±4.5) d] was significantly less than those of group I [(21.4±9.2) d] or II [(15.6±6.7) d], and the cost of group III [(2656.2±1882.8) Yuan] was also significantly lower than that of group I or II [(11937.6±7989.8) and (5182.7±2991.7) Yuan, respectively]. CONCLUSION Abdominal B ultrasonography-guided trans-abdominal wall aspiration of pleural effusion and ascites combined with blood volume maintenance is an effective and economical way to treat OHSS.
Adult ; Ascites ; etiology ; therapy ; Dextrans ; administration & dosage ; Drainage ; Female ; Fertilization in Vitro ; Humans ; Hydroxyethyl Starch Derivatives ; administration & dosage ; Infusions, Intravenous ; Ovarian Hyperstimulation Syndrome ; complications ; therapy ; Ovulation Induction ; adverse effects ; Pleural Effusion ; etiology ; therapy ; Retrospective Studies ; Serum Albumin ; administration & dosage