Objective To summarize the treatment of pancreatic pseudo cyst in recent years. Methods Through the retrieval of relevant literatures, the progress in the treatment of pancreatic pseudo cyst in recent years were reviewed. Results Pancreatic pseudo cyst is a common complication of pancreatitis or pancreatic injury. Severe symptoms are often caused by large cysts or complications, and it can cause serious consequences. The main treatment methods are conservative treatment, percutaneous drainage, surgical treatment, endoscopic drainage technology, combined with traditional Chinese and Western medicine treatment, and each method has its own indications and advantages and disadvantages. Conclusion The treatment of pancreatic pseudo cyst is varied, and it should be individualized treatment according to different indications, different patients and the development stage of the disease.
ObjectiveTo explore the cause, clinical diagnosis and treatment, and prevention strategies of iatrogenic bile duct injury (IBDI). MethodsBy means of literature retrieval, the clinical diagnosis and treatment measures of patients with IBDI were summarized. ResultsThe related risk factors of IBDI include man-made factors, the local anatomy variation factors, and pathological factors. According to the damage diagnosis time and local pathological state, the repair operations such as bile duct suture repair, biliary tract end to end anastomosis, bile duct jejunum Roux-en-Y anastomosis, bile duct jejunum Roux-en-Y anastomosis, and jejunal artificial valve forming, or liver resection, and liver transplantation were performed. Moreover, it was also available that biliary stent or papillary balloon dilation through ERCP for the bile duct distal stricture. ConclusionsIt is important that prevention of IBDI. Operation should pay attention to upper abdominal operation prior to the implementation of the correct understanding of IBDI. In case of IBDI, the reasonable repair operation mode should be choose according to the damage types and time, and it can significantly improve the treatment effect and quality of life of patients.
ObjectiveTo observe effect and safety of interstitial chemotherapy with 5-fluorouracil sustained release agent in radical operation of colorectal cancer. MethodsOne hundred and sixty patients with colorectal cancer from October 2011 to December 2013 were randomly divided into observation group and control group according to an incomplete random method, 78 cases of them were in the observation group and 82 cases of them were in the control group. All the patients were performed radical resection of colorectal cancer. The abdominal cavity and pelvic cavity were washed after surgery. 5-fluorouracil sustained release agent was implanted in the observation group patients for interstitial chemotherapy, the implant site was at the tumor resection area and the mesenteric artery. Routine chemotherapy was performed in these two groups after operation. The postoperative complications were observed. The postoperative local recurrence rate, liver metastasis rate, and 24-month survival rate were recorded. ResultsThe rates of abdominal complications and toxic effects had no significant differences between these two groups (P > 0.05). The rates of 12-month and 24-month local recurrence and the rate of liver metastasis in the observation group were significant lower than those in the control group[1.3% (1/78) versus 8.5% (7/82), x2=8.934, P=0.023; 5.2% (4/78) versus 23.2% (19/82), x2=14.834, P=0.004; 10.3% (8/78) versus 18.3% (15/82), x2=12.034, P=0.016]. The rate of 24-month survival in the observation group was significant higher than that in the control group[94.9% (74/78) versus 84.1% (69/82), x2=11.465, P=0.010]. ConclusionThe good safety of interstitial chemotherapy with 5-fluorouracil sustained release agent could effectively decrease local recurrence rate and liver metastasis rate of colorectal cancer after radical operation and improve survival time of patients.
ObjectiveTo describe the research status of programmed death receptor protein 1 (PD-1) and its ligand(PD-L1) inhibitors in advanced gastric cancer and to understand the key issues of PD/PD-L1 inhibitors in order to provide atheoretical basis for future research.MethodThe classical and up to date literatures on the immunotherapy, especially thePD-1/PD-L1 inhibitors in the advanced gastric cancer were reviewed.ResultsThe PD-1/PD-L1 inhibitors were the hot spot in the current research of tumor immunotherapy. The pembrolizumab and nivolumab were the commonly immunosuppressive agents in the current clinical research, which had also achieved the great success in the clinical research of gastriccancer since it was shown the good results in the malignant melanoma and hematological malignancies. In some clinical studies, the PD-1/PD-L1 inhibitors treatment showed the longer overall survival than the conventional chemotherapy, especially in the patient with positive PD-1. However the study still had some issues to be solved, such as no accurate prediction for the beneficiary population, the tumor hyperprogression and so on. It was gratifying that the current research on the basic research of tumor immunity was increasing, then it provided a theoretical support for solving these problems.ConclusionsTumor immunosuppressive therapy such as PD-1/PD-L1 inhibitors brings a new idea in treatment of patients with advanced gastric cancer. Although there are still many problems need to be solved in clinical research, it is believed that PD-1/PD-L1 inhibitors will become one of key players in treatment of patients with advanced gastric cancer in the further study.
ObjectiveTo summarize the mechanism of hydrogen sulfide (H2S) in regulating autophagy and ameliorating multi-organ dysfunction in the treatment of sepsis.MethodThe relevant literatures at home and abroad in recent years were systematically searched and read to review the mechanism of H2S in regulating autophagy and ameliorating multi-organ dysfunction during sepsis.ResultsAs a new medical gas signal molecule, H2S could regulate autophagy by regulating multiple signal pathways such as Nrf2, NF-κB, MAPK, AMPK, etc., then ameliorated multi-organ dysfunction in sepsis.ConclusionH2S inhibits inflammation, oxidative stress, and apoptosis by regulating autophagy, thus ameliorating multi-organ dysfunction in sepsis, which is expected to become an effective therapeutic target for sepsis.
ObjectiveTo systematically evaluation the efficacy and safety of laparoscopic cholecystectomy(LC) and open cholecystectomy(OC) for chronic atrophic cholecystitis. MethodsStandard electronic database such as PubMed, Web of science, Cochrane library, CNKI, VIP, CBM, and Wanfang database were searched to retrieve relevant randomized controlled trials(RCTs) that comparing LC with OC, which were analyzed systematically using RevMan5.2. ResultsSeven RCTs including 758 patients were brought into this Meta analysis. There were significant differences between two groups regarding operative time(MD=-27.70, 95% CI:-44.25--11.16, P=0.001), amount of blood loss during operation(MD=-113.25, 95% CI:-141.68--84.81, P < 0.000 01), the recovery time of gastrointestinal function(MD=-28.49, 95% CI:-29.80--27.18, P < 0.000 01), and length of hospital stay(MD=-3.83, 95% CI:-6.01--1.65, P=0.000 6), There were statistically significant difference in utilization rate of anodynes after operation(MD=0.12, 95% CI:0.06-0.23, P < 0.000 1) and terrible postoperative complications(MD=0.24, 95% CI:0.12-0.47, P < 0.000 01) between LC and OC. ConclusionsIn both efficacy and safety, LC for chronic atrophic cholecystitis are significantly superior than the traditional OC. But now the clinical randomized controlled trials about LC is less and the quality is poor, so that its long-term safety evaluation still needs large sample quality RCTs to be further verified.
目的總結結腸冗長癥合并結直腸癌的臨床病理特征，并文獻復習結腸冗長癥與結直腸癌的關系。 方法回顧性分析蘭州大學第一醫院普外一科2011年1月至2012年12月期間收治的17例結腸冗長癥合并結直腸癌患者的臨床資料。 結果184例結直腸癌患者中合并結腸冗長癥17例（9.24%），合并家族性息肉病惡變2例（1.09%），合并遺傳性非息肉病性結直腸癌1例（0.54%），合并炎癥性腸病1例（0.54%）。合并結腸冗長癥的比例較高（P＜0.05）。其中術前經結腸氣鋇灌腸檢查診斷為結腸冗長癥5例，術中診斷為結腸冗長癥12例。所有患者均行手術治療，切除結腸13～80 cm，平均33.8 cm。術后發生肺部感染、切口液化1例，腹水1例，腸瘺1例，骶前感染1例。術后17例患者均獲隨訪，隨訪時間6～12個月，中位數為10個月。隨訪期間，1例患者于術后1年出現卵巢轉移。 結論結腸冗長癥合并頑固性便秘可能是結直腸癌發病的高危因素。