Objective To investigate the clinicopathological characteristics and factors influencing the prognosis of rectal carcinoid. Methods Clinical data of 31 cases with rectal careinoid, which identified diagnosis through operation and pathologic examination from January 2003 to March 2010 were retrospectively reviewed. Primary tumors were classified by size （≤1.0 cm， 1.0-2.0 cm， and ＞2.0 cm）and muscularis invasion respectively, compared therapeutic effect of different groups. Results Median age of 31 cases was 49 years (22-83 years). Median follow-up time was 36 months (15-86 months), follow-up rate was 80.6% （25 /31）. During the follow-up period, there were no cases with recurrence among the 15 patients with tumor size≤l.0 cm, 1 case recurred in the 7 patients with turmor size between 1.0 cm to 2.0 cm, and 2 cases died from postoperative liver metastasis among the 3 patients with tumor size＞2.0 cm.There were relations between the tumor size, invasion depth, and metastasis （P＜0.05）. Metastasis and invasion depth of tumor were possibility increment to follow the aggrandizement of the diameter of rectal carcinoid. Conclusion The diameter of rectal carcinoid and muscularis invasion may be important factors affecting survival, which may be an important basis for the choice of operative mode.
Objective To compare the clinical effects of early enteral and parenteral nutrition, and to study their effects on cytokine release, cellular immune function and protein metabolism in early postoperative patients with gastrointestinal cancer. Methods Thirty-six patients with gastrointestinal cancer were randomly divided into early postoperative enteral nutrition (EN) group (19 cases) and parenteral nutrition (PN) group (17 cases), and they were supported with EN or PN during postoperative period of 1-7 days, respectively. The levels of serum tumor necrosis factor-α (TNF-α), interleukin-1β (IL-1β), interleukin-6 (IL-6), and interleukin-10 (IL-10) were measured by ELISA. The total lymphocyte count (TLC) and subgroups of lymphocyte (CD3, CD4, CD8, CD4/CD8 and NK cell) were determined with flow cytometer. The urea and creatinine of the 24 h excretory urine were examined at four different phases: preoperative (pre), 1st d, 3rd d and 5th d after operation (pod). The clinical recovery indicators and the complication incidence were also observed. Results All the patients followed the project of nutritional support and relevant examinations, and there was no severe complication and no patient died during the research. The IL-1β, IL-6 and IL-10, the 24 h urea and creatinine increased, while the serum TNF-α and TLC (except 3, 5 pod of EN group) decreased. There was no marked change of the proportion of lymphocyte subgroups after operation and there was no significant difference of the changes of IL-1β, IL-10 and TNF-α between the two groups as well. The levels of IL-6 (3, 5 pod), the 24 h urea (3, 5 pod) and creatinine (3, 5 pod) were significantly lower in EN group than those in PN group （P＜0.05）, whereas TLC (3, 5 pod) were significantly higher than that in EN group （P＜0.05）. In addition, the postoperative infection incidence （10.5% vs 35.3%）, fever duaration, rehabilitation time and medical cost were significantly lower in EN group than those in PN group （P＜0.05）.Conclusion The early postoperative EN has an advantage over PN in the patients with gastrointestinal cancer, which could decrease the release of cytokine and suppress protein metabolism resulting from operational stress, and could reduce the incidence of postoperative infection and inflammatory reaction time. They could also improve the cellular immune function and decrease the rebilitation duration and medical cost.
Objective To investigate the clinical effect of the DaVinci robot system and laparoscopic radical gastrectomy. Methods Propensity score matching and retrospective cohort study were adopted. Data of 446 patients who underwent robotic or laparoscopic radical gastrectomy in the Department of Gastrointestinal Surgery, Xijing Hospital, the First Affiliated Hospital of Air Force Military Medical University from January 2014 to April 2021 were collected. Among them, 174 cases underwent robotic and 272 cases underwent laparoscopic surgery. Using the method of propensity score matching, 133 cases were selected from robotic operation group and laparoscopic operation group respectively as the research object. The perioperative indexes of the two groups were compared. Kaplan-Meier survival analysis was used to draw the survival curve and calculate the survival rate. Cox regression model was used to analyze the risk factor of prognosis. Results There was no significant difference in baseline data between the robotic surgery group and the laparoscopic surgery group after propensity score matching (P>0.05). The operative time of the two groups [(236.47±50.32) min vs. (230.64±44.51) min, t=1.000, P=0.318], the number of lymph nodes dissected [(23.32±6.58) vs. (23.95±6.03), t=–0.826, P=0.410], the time of first anal exhaust [(3.46±0.77) days vs. (3.38±0.75) days, t=0.882, P=0.378], and the length of postoperative hospital stay [(6.98±2.84) days vs. (6.94±3.61) days, t=0.094, P=0.925] were similar, the differences were not statistically significant. Compared with the laparoscopic surgery group, the robotic surgery group had less intraoperative bleeding [(83.76±58.23) mL vs. (116.54±58.58) mL, t=–4.577, P<0.001], but the total hospitalization expenses was higher [(10.04±1.92) ten-thousand Yuan vs. (6.80±1.27) ten-thousand Yuan, t=16.211, P<0.001]. The incidence of postoperative complications between the two groups (χ2=0.057, P=0.812) and Clavien-Dindo classification of complications (Z=–0.440, P=0.965) were similar between the two groups, the differences were not statistically significant. The 3-year survival situation was similar between the two groups (P=0.356). Body mass index [RR=0.803, 95%CI (0.698, 0.924), P=0.002], TNM-staging [Ⅱ -stage vs.Ⅰ -stage, RR=4.152, 95%CI (1.121, 15.385), P=0.033; Ⅲ -stage vs.Ⅰ -stage, RR=5.476, 95%CI (1.458, 20.558), P=0.012] and postoperative complications [with vs. without, RR=3.262, 95%CI (1.283, 8.293), P=0.013] were prognostic factors for 3-year survival. Conclusion Compared with laparoscopic radical gastrectomy, robotic radical gastrectomy has the same short-term and long-term prognosis.
Objective To research clinic characteristics, therapies and 2-year progress of female patients with Non-ST-segment Elevation Acute Coronary Syndrome (NSTE-ACS). Methods This study was part of the internationalized Organization to Assess Strategies for Ischemic Syndromes (OASIS) registry. There was no intervention in the therapy. Patients admitted to hospital with NSTE-ACS (including unstable angina and non-Q wave myocardial infarction) were enrolled. The patients’ clinical characteristics, treatment procedure, major events in hospital and two-year progress were recorded by filling in Case Report Forms. Single-variate analyses were made between patients of difference genders. Results A total of 2 294 patients with NSTE-ACS were enrolled in China. The female patients were 37.7% (n=864), whose mean age was 65.1±6.7 years. Unstable angina dominant (90.7%) was noted on admission. The percentage of patients with abnormal ECG was 92.6%. The prior hypertension and diabetes were 64.1% and 23.4%, respectively, in female patients which were evidently higher than those of males (P≤0.001). The prior coronary heart disease, old myocardial infarction, smoking, and percutaneous coronary intervention (PCI) were 39.4%, 16.8%, 11.7%, and 2.3% respectively, in females, which were evidently lower than in males (P≤0.001). The prior history of coronary artery bypass graft (CABG) surgery was 0.5% in females, which was evidently lower than in males (P≤0.05). During hospitalization, the therapeutic rates of anti-platelets and β-adrenergic blockers were 92.8% and 64.8%, respectively, in female patients, which were observably lower than in males (P≤0.05). The therapeutic rates of nitrates, angiotensin-converting enzyme inhibitor (ACEI), calcium antagonists, lipid lowering agents were 96.9%, 60.0%, 59.1%, and 47.1%, respectively, in females, which were not significantly different from those of males. The medication rate in females fell off gradually after discharge, which was more evident than in males. In two-year follow up, the therapeutic rates of anti-platelets, β-adrenergic blockers, ACEI, and lipid lowering agents were 68.4%, 39.5%, 27.4%, and 19.4%, respectively, in female patients, which were markedly lower than those in males (P≤0.05). During hospitalization, the therapeutic rates of PCI and CABG were 10.5% and 2.7%, respectively. In two year follow-up, their therapeutic rates were 13.4% and 4.8%, respectively. The rate of females performing revascularization procedures was evidently lower than that of males (P≤0.001), either during hospitalization or in two-year follow up. In two years of follow up, mortality and incidence rates of new myocardial infarction, stroke, heart failure, hospitalization because of refractory angina were 7.4%, 4.7%, 6.8%, 15.4%, and 31.3%, respectively, in female patients. There were no significant differences between females and males (Pgt;0.05). Conclusion Compared with male patients, female patients with NSTE-ACS are less likely to adopt and / or attach importance to treatment. As to the reason why there are no significant differences in major events of NSTE-ACS between females and males under the current circumstance that females’ treatment is inferior to males’, gender of females is an important protective factor.
Objective To evaluate the feasibility, safety, radicality, and short-term and mid-term clinical outcomes of laparoscopic total mesorectal excision （TME） in comparison with open procedure for the middle-lower rectal cancer. Methods From October 2005 to October 2008， 52 patients with middle-lower rectal cancer received laparoscopic TME （Dixon’operation） without preventive stoma， while 46 patients underwent conventional open TME （Dixon’operation） without preventive stoma. The operative procedures, clinicopathological data， and short-term and mid-term outcomes were collected and compared between the two groups. Results The other patients were successful in both groups in addition to 2 （3.8%） patients were converted to open procedure in laparoscopic TME group. There was no perioperative death in both groups. The intraoperative blood loss, the time for bowel movement retrieval （first flatus）， and the incision healing in laparoscopic TME group were better than that in open TME group （P＜0.05）. No significant differences were observed between two groups in anastomotic leakage and pulmonary infection （P＞0.05）. Comparison of specimen, no significant differences were observed between two groups in negative distal margin and circumferential resection margin, number of lymph nodes resected, distance of distal resection margin to the tumor （P＞0.05）. No significant differences were observed between two groups in cancer-related death, local recurrence, distant metastasis, and 3-year survival rate （P＞0.05）. Conclusions Laparoscopic TME for middle-low rectal cancer is a safe, feasible, and minimally invasive technique, and can achieve satisfactory oncological outcome, which provides similar short-term and mid-term outcome compared with the traditional open procedure.
目的 評價選擇性介入治療在原發性肝癌（HCC）門脈高壓癥中的應用價值。 方法 2008年11月－2011年3月，收治65例臨床明確診斷的HCC伴門脈高壓癥患者，選擇性使用肝動脈化學療法（化療）栓塞術、脾栓塞術、門靜脈化療栓塞術、門靜脈支架、胃冠狀靜脈栓塞術等介入術式，術后通過觀察臨床指標、定期復查影像檢查等了解病變轉歸，隨訪生存期并評價療效。 結果 65例HCC患者均合并不同程度門靜脈高壓，其中門靜脈癌栓46例中有37例顯示肝動脈-門靜脈分流，通過肝動脈及門靜脈化療栓塞術進行主瘤體及癌栓治療。11例行門靜脈支架置入術，支架置入后門靜脈壓較術前明顯下降（P＜0.01），支架中位通暢時間為5.8個月。39例行胃冠狀靜脈和（或）胃短靜脈栓塞術，術后有4例再次發生門脈高壓性出血，再出血率10.26%。18例行脾動脈栓塞術，術后3個月血小板較術前顯著升高（P＜0.01）。隨訪術后3、6、12及24個月的生存率分別為90.77%、69.23%、35.38%及13.85%。 結論 選擇性聯合使用各種介入術式是治療HCC及其相關性門脈高壓癥的一種有效方法，可有效預防高危風險，延長患者生存期。
目的 探討急診行子宮動脈灌注藥物栓塞術治療剖宮產后切口妊娠的可行性和臨床價值。 方法 2009年10月－2011年12月，對17例臨床證實切口瘢痕妊娠并陰道出血患者，急診行雙側子宮動脈灌注甲氨蝶呤并超選擇栓塞術，術后通過觀察人絨毛膜促性腺激素（HCG）水平、陰道出血及術后清宮術來評價療效。 結果 17例患者急診行子宮動脈灌注栓塞術成功，術后陰道出血均停止或減少，HCG水平均明顯下降，3例因孕囊自行排除而未行清宮，14例術后2～4 d行胚胎鉗刮術，術中出血量較少。所有患者1周后均治愈出院。 結論 子宮動脈灌注栓塞術是治療剖宮產術后切口瘢痕妊娠的一種有效方法，可及時治療陰道大出血，促進殺胚，并為術后清宮提供安全保障。
【摘要】 目的 探討磁共振動態增強掃描及磁共振彌散加權成像（diffusion weighted imaging，DWI）對肝癌經導管動脈內化學栓塞（transcatheter arterial chemoembolization，TACE）治療后的腫瘤殘余及復發的判斷價值。 方法 2009年1月-2010年10月，對28例經證實的肝癌患者在TACE治療前、治療后3~7 d及治療后1~2個月、3~6個月行磁共振動態增強及DWI掃描，動態測量表觀彌散系數（apparent diffusion coefficient，ADC）值，與數字減影血管造影（digital substraction angiography，DSA）檢查對照，評價動態增強掃描及DWI對腫瘤殘留或復發的檢出能力。〖HTH〗結果 對腫瘤殘余及復發的顯示，動態增強掃描靈敏度為90.0%，特異度為96.9%；DWI靈敏度為96.7%，特異度為93.8%；動態增強掃描與DWI相結合的靈感度為100.0%，特異度為99.5%；DSA靈敏度和特異度分別為96.7%、100.0%。TACE治療前所有腫瘤實質的ADC值為（1.134±0.014）×10-3 mm2/s；TACE治療后3~7 d ADC值為（1.162±0.016）×10-3 mm2/s；TACE治療后1~2個月碘油沉積較好，無明顯殘余或復發病灶的ADC值為（1.175±0.015）×10-3 mm2/s，3~6個月后隨訪病灶ADC值為（1.179±0.017）×10-3 mm2/s；TACE治療后1~2個月碘油沉積不完全或無明顯沉積病灶ADC值為（1.147±0.016）×10-3 mm2/s，3~6個月后隨訪病灶實質平均ADC值（1.142±0.012）×10-3 mm2/s。 結論 將動脈增強掃描與DWI相結合可提高對TACE治療后肝癌殘余及復發判斷的靈敏度及特異度；對腫瘤組織平均 ADC值的動態測量、觀察可及早判斷腫瘤復發的可能性。【Abstract】 Objective To evaluate the dynamic contrast-enhanced MRI and diffusion weighted imaging (DWI) in judging the remnant and recurrence on hepatocellular carcinoma (HCC) after transcatheter arterial chemoembolization (TACE). Methods Between January 2009 and October 2010, 28 patients with HCC underwent dynamic contrast-enhanced MRI and DWI before and after TACE 3-7 days, 1-2 months and 3-6 months, respectively, and the apparent diffusion coefficient (ADC) value of the tumor were also measured at above mentioned time points. The sensitivity and specificity of dynamic contrast-enhanced MRI and DWI in diagnosis of residual tumor and recurrent cancer was qualitatively evaluated by comparing with the DSA results. Results Compared with DSA, the sensitivity and specificity of dynamic contrast-enhanced MRI were 90.0% and 96.9% by revealing the remnant and recurrence of HCC, while the sensitivity and specificity of DWI were 96.7% and 93.8% respectively. Combining dynamic contrast-enhanced MRI and DWI the sensitivity and specificity were improved to 100.0% and 99.5%, respectively. The mean ADC value of tumor before and after 3-7 days of TACE were (1.134±0.014)×10-3 and (1.162±0.016)×10-3 mm2/s, respectively. The mean ADC value of tumor without and with remnant and recurrence after 1-2 months and 3-6 months follow up were (1.175±0.015)×10-3, and (1.179±0.017)×10-3 mm2/s; (1.147±0.016)×10-3 and (1.142±0.012)×10-3 mm2/s, respectively. Conclusions Combining dynamic contrast-enhanced MRI and DWI could improve the sensitivity and specificity to detect the remnant and recurrence of HCC after TACE. Measuring the ADC value during follow up of HCC patients after TACE could predict the probability of tumor recurrence.
Objective To evaluate the effectiveness of three-dimensional (3-D) printing assisting minimally invasive for intraarticular calcaneal fractures with percutaneous poking reduction and cannulate screw fixation. Methods A retrospective analysis was performed of the 19 patients (19 feet) with intraarticular calcaneal fracture who had been treated between March 2015 and May 2016. There were 13 males and 6 females with an average age of 38.2 years (range, 24-73 years). There were 3 open fractures and 16 closed fractures. By Sanders classification, 12 cases were type Ⅱ, 7 cases were type Ⅲ. By Essex-Lopresti classification, 13 cases were tongue type, 6 cases were joint-depression type. The time from injury to surgery was 1-10 days (mean, 4.7 days). A thin slice CT scan was taken of bilateral calcaneus in patients. By using the mirror imaging technique, the contralateral mirror image and the affected side calcaneus model were printed according to 1∶1 ratio. The displacement of fracture block was observed and contrasted, and the poking reduction was simulated. Calcaneal fracture was treated by percutaneous minimally invasive poking reduction and cannulate screw fixation. The B?hler angle and Gissane angle at immediate after operation and last follow-up was measured on X-ray films, and compared with preoperative measurement. The functional recovery was evaluated by American Orthopaedic Foot and Ankle Society (AOFAS) scores. Results The operation time was 25-70 minutes (mean, 45 minutes). The intraoperative blood loss was 10-40 mL (mean, 14.5 mL). All the incisions healed by first intention and had no relevant postoperative complications such as skin necrosis, nail tract infection, and osteomyelitis. All the patients were followed up 12-25 months (mean, 14.6 months). All patients obtained fracture healing, and the fracture healing time was 8-14 weeks (mean, 10.3 weeks). No screw withdrawal or breakage occurred during follow-up; only 1 patient with Sanders type Ⅱ fracture, whose calcaneus height was partially lost at 6 weeks after operation, the other patients had no reduction loss and fracture displacement, and no traumatic arthritis occurred. The B?hler angle and Gissane angle at immediate after operation and last follow-up were significantly improved when compared with preoperative ones (P<0.05), but there was no significant difference between at immediate after operation and last follow-up (P>0.05). The AOFAS score was 76-100 (mean, 88.2), and the results were excellent in 10 feet, good in 7, and fair in 2, the excellent and good rate was 89.5%. Conclusion 3-D printing assisting minimally invasive for intraarticular calcaneal fractures with percutaneous poking reduction and cannulate screw fixation can reduce the surgical trauma, improve the quality of reduction and fixation, and make the operation more safe, accurate, and individualized.
Aiming at the limitations of clinical diagnosis of Parkinson’s disease (PD) with rapid eye movement sleep behavior disorder (RBD), in order to improve the accuracy of diagnosis, an intelligent-aided diagnosis method based on few-channel electroencephalogram (EEG) and time-frequency deep network is proposed for PD with RBD. Firstly, in order to improve the speed of the operation and robustness of the algorithm, the 6-channel scalp EEG of each subject were segmented with the same time-window. Secondly, the model of time-frequency deep network was constructed and trained with time-window EEG data to obtain the segmentation-based classification result. Finally, the output of time-frequency deep network was postprocessed to obtain the subject-based diagnosis result. Polysomnography (PSG) of 60 patients, including 30 idiopathic PD and 30 PD with RBD, were collected by Nanjing Brain Hospital Affiliated to Nanjing Medical University and the doctor’s detection results of PSG were taken as the gold standard in our study. The accuracy of the segmentation-based classification was 0.902 4 in the validation set. The accuracy of the subject-based classification was 0.933 3 in the test set. Compared with the RBD screening questionnaire (RBDSQ), the novel approach has clinical application value.