目的 探讨手助腹腔镜胰十二指肠切除术的技术路线。方法 笔者所在科室于2011年10月17日完成1例手助腹腔镜胰十二指肠切除术。术中采用术者双侧站位、左右侧对称戳孔的策略，站立于患者右侧，游离胃网膜左血管和胃左血管，包括清扫No.7、No.8和No.9淋巴结；站立于患者左侧，游离十二指肠环和清扫下腔静脉旁淋巴结。经手助切口直视下完成消化道重建。结果 上腹部正中手术切口长7cm；手术时间为420min；术中出血量约600ml。术后病理报告：送检胃、十二指肠和胰腺标本，十二指肠球部低级别神经内分泌癌，浸润至深肌层，胃及胰腺未受累；两端切缘未见癌细胞，肝十二指肠韧带淋巴结未见癌转移（0/2）；慢性胆囊炎。手术后患者生命体征平稳，术后第5天肛门排气，第7天排便。术后发生腹腔积液并感染，经保守治疗治愈。术后28d出院。结论 术者双侧站位、左右对称戳孔是手助腹腔镜胰十二指肠切除术的新模式，安全、可行、微创，值得进一步探索。
ObjectiveTo evaluate the curative effect of laparoscopic assisted and open D2 radical resection in treatment of advanced gastric cancer. MethodsThe clinical data of 76 cases performed by laparoscopic assisted D2 radical resection (laparoscopic group) and 104 cases performed by open operation (open group) from October 2010 to October 2012 in our center were retrospective analized.Operation related index, postoperative recovery, and extent of radical resection of tumor of 2 groups were compared. ResultsThe operative time of the laparoscopic group[(192.5±14.8) min]was longer than that open group[(171.5±16.5) min, P < 0.05].But the blood loss, postoperative drainage, length of incision, and hospital stay of the laparoscopic group were significantly less or shorter than those of open group (P < 0.05).There were no significant difference in postoperative complications and extent of radical resection of tumor between the 2 groups (P > 0.05).There were no residual tumor in distal margin and operatiive death case in both 2 groups. ConclusionComparing with open operation, the laparoscopic assisted surgery for advanced gastric cancer could achieve the same clinical outcomes, and obvious advantage of minimal invasion.
Objective To evaluate the effect of ultrasound guided percutaneous drainage on acute perforation of gastroduodenal ulcer in elderly patients. Methods The clinical features, treatments, and the curative effects of 86 elderly cases (≥65 years) of acute perforation of gastroduodenal ulcer in our hospital between January 2004 and October 2009 were retrospectively analyzed. Twenty-one cases were treated by ultrasound guided percutaneous drainage (drainage group), and 65 cases were treated by exploring operation (operation group). Results Drainage group was cured and had no complications. In 15 patients which accepted recheck one month after drainage, gastroscope showed the ulcer healed in 12 cases， and improved in 3 cases. In operation group, 63 cases were cured and 2 cases died. Compared with the drainage group, there was no significant difference in cure rate (Pgt;0.05). However, 11 patients had operative complications in operation group, which was significantly more than that in the drainage group （Plt;0.05）. In 45 patients which accepted recheck one month after operation, gastroscope showed the ulcer healed in 38 cases， and improved in 7 cases. Conclusion For elderly patients with acute perforation of gastroduodenal ulcer， if the patients do not fit for exploring operation， ultrasound guided percutaneous drainage is proved to be a simple, safe, and effective means.
Objective To evaluate the significance of serum colon cancer-specific antigen-2 （CCSA-2） in diagnosisof colorectal cancer （CRC）. Methods By using ELISA method， the serum CCSA-2 was measured from 105 patients with 5 kinds of diseases， including CRC， gastric cancer， inguinal hernia， acute appendicitis， and breast cancer， who weretreated in our hospital from Jul. to Dec. in 2008， and 20 health donors were enrolled in addition. The blood samples were collected on 3 days before surgery， but blood samples from patients with acute appendicitis were collected before emergencysurgery， blood samples of health donors were collected on 1 day before ELISA test. Results The level of serum CCSA-2 in CRC patients was （99.27±6.25） μg/L， which was significantly higher than those of other patients and health individuals〔（53.58±2.73） μg/L， t=48.29， P=0.000〕. Serum CCSA-2 at a cutoff of 73.96μg/L had a sensitivity of 100% （95% CI：100%-100%） and a specificity of 100% （95% CI：100%-100%） in separating CRC populations from all other indivi-duals by using receiver operator characteristic curve （ROC） analysis. As compared with carcinoembryonic antigen （CEA） and CA19-9， the serum CCSA-2 assay （at a cutoff of 73.96μg/L） was significantly more sensitive than CEA and CA19-9 assay in CRC detection （P＜0.01）. Serum CCSA-2 was not related with patients’ gender （P=0.81）， age （P=0.59）， TNM stage （P=0.85）， Dukes stage （P=0.63）， nuclear grade （P=0.44）， as well as expressions of multidrug resistance associated protein （P=0.33）， P-glycoprotein （P=0.72）， and topoisomeraseⅡ（P=0.95）， but higher in patients with colon cancer than those of patients with rectal cancer （P=0.02）. Conclusion Serum CCSA-2 may be a useful biomarker in diagnosis of CRC， and it may be only related to tumorigenesis， but is irrelated to tumor progression and chemotherapy.
Objective To detect the anti-colon cancer ability of whole cell lysates pulsed dendritic cell (DC) which acts as an adjuvant. Methods Whole cell lysates of LoVo cells were extracted with freeze thawing method, then the monocyte-derived DC were pulsed with this cellular antigen. Subsequently, the capability of antigen pulsed DC to promote T lymphocytes proliferation and the ability of T lymphocytes to kill LoVo cells were detected by 3H-TdR incorporation and lactate dehydrogenase release methods, respectively. Results The whole cell lysates of LoVo cells pulsed DC significantly stimulated T cells proliferation, and the cytotoxicity abilities of primed T cells to kill LoVo cells were also enhanced. Conclusion Tumor cell lysates which act as the cellular antigen to pulse DC can improve the efficacy of anti-cancer immune response， which provides us an experimental evidence for cancer immunotherapy.
ObjectiveTo explore the early diagnosis and treatment of acute non-tumor perforation of the back wall of ascending colon. MethodsWe retrospectively analyzed the clinical data of 17 patients with acute non-tumor perforation of the back wall of ascending colon treated between July 2007 and April 2014 in our hospital. Among them, 8 patients who underwent perforation repair combined with abdominal cavity drainage were regarded as the experimental group, and the other 9 patients who underwent operation of right hemicolectomy (or ascending colon resection) were designated as the control group. Clinical indexes and biochemical indexes of both the two groups were compared and analyzed. ResultsAll patients were cured. The operation time[(74.20±12.45), (120.23±15.20) minutes; t=-3.224, P<0.001], the intraoperative blood loss[(40.24±12.20), (80.69±18.98) mL; t=-4.114, P<0.001], the postoperative anal exhaust[(75.62±6.56), (84.54±7.82) hours; t=1.108, P=0.037], the medical expenses[(18.2±5.7) thousand yuan, (26.5±8.3) thousand yuan; t=-5.556, P<0.001], and the hypersensitive C-reaction protein on the third day after operation[(89.45±8.98), (99.85±10.78) mg/L; t=-3.004, P=0.029] in the experimental group and the control group all had significant differences. There was no significant difference between the two groups in the hospital stay time[(9.80±3.16), (9.81±3.20) days; t=1.501, P=0.080]. There was one case of incision infection in the experimental group and one case of fat liquefaction of incision in the control group, and both of them were cured after treatment. ConclusionThe early abdominal sign of perforation of the back wall of ascending colon is not obvious, which can easily lead to misdiagnosis as acute appendicitis. Early diagnosis mainly depends on the clinical symptom, vital sign, blood routine examination and CT examination. Among them, CT findings of gaseous sign behind peritoneum is a definite diagnosis, and operation should be arranged as early as possible. Perforation repair combined with abdominal cavity drainage is preferred due to its advantages of being simple, saving time, less bleeding and lighter traumatic reaction.
Objective To investigate the infection rate and observe the healing courses of the incision after gastrointestinal surgery which was managed by positioning extraperitoneal U-type latex drainage strip. Methods Two hundred patients after abdominal operation were divided into drainage group (n=97) and control group (n=103). Drainage group were treated with positioning extraperitoneal U-type latex drainage strip, while control group were treated with no latex drainage strip. The infection rate of incision, the mean time in hospital and mean time of incision healing were observed. Results The infection rate of drainage group was significantly lower than that of control group 〔7.22% (7/97) vs. 18.45% (19/103), P=0.024〕. The mean time in hospital and the mean time of incision healing in drainage group were significantly shorter than those in control group 〔(8.86±1.48) d vs. (14.12±2.63) d， P=0.000； (8.24±1.02) d vs. (12.32±3.47) d， P=0.000〕. Conclusion The infection rate and the healing course of incision of gastrointestinal surgery could be improved by positioning extraperitoneal U-type latex drainage strip.
Objective To explore the applying value of laparoscopic partial gastrectomy for gastric stromal tumors. Methods The clinical data of 22 patients with gastric stromal tumors between July 2007 and December 2009 in this hospital were analyzed retrospectively. And the laparoscopic resection was performed in all the patients. Results The laparoscopic resections were performed successfully in all the patients, and the tumors were completely resected. The length of operative incision on abdominal wall was 4－6 cm with average 5.3 cm. The mean operation time was 70 min. Postoperative recovery was smooth, no procedure related complications happened. The mean hospital stay was 7.2 d. Specimens of 20 cases were with CD117 (+), and 15 with CD34 (+) by immunohistochemistry. No recurrence or metastasis happened with average follow-up of 13 months (2－23 months). Conclusion Laparoscopic partial gastrectomy for gastric stromal tumors could be performed safely, postoperative recovery quickly and effectively with the advantage of minimal invasiveness.