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Small bowel diverticulum with enterolith causing intestinal obstruction: A case report

World Journal of Gastrointestinal Surgery 2023年第6期15卷 1256-1261页

作者： Li-Wen Wang Peng Chen jiang Liu zhi-wei jiang Xin-Xin Liu Department of General Surgery Jiangsu Province Hospital of Chinese MedicineAffiliated Hospital of Nanjing University of Chinese MedicineNanjing 210000Jiangsu ProvinceChina

BACKGROUND Small bowel diverticula are rare in clinics,and small intestinal obstruction caused by coprolites is rarer and difficult to diagnose early.The true incidence of these diverticula may be underestimated due to their clinical symptoms not differing from those of small bowel obstruction resulting from other causes.It is common in the elderly,although it can occur at any age.CASE SUMMARY This is a case report of a 78-year-old man with epigastric pain for 5 d.Conservative treatment does not effectively relieve pain,inflammatory indicators are elevated,and computed tomography suggests jejunal intussusception and mild ischemic changes in the intestinal wall.Laparoscopic exploration showed that the left upper abdominal loop was slightly edematous,the jejunum mass at the near Flex ligament was palpable,the size was about 7 cm×8 cm,the local movement was slight,and the diverticulum was seen 10 cm downward,and the local small intestine was dilated and edema.Segmentectomy was performed.After the short parenteral nutrition after surgery,the fluid and enteral nutrition solution were pumped through the jejunostomy tube,and the patient was discharged after the treatment was stable,and the jejunostomy tube was removed in an outpatient clinic one month after the operation.Postoperative pathology:Jejunectomy specimen:(1)Small intestinal diverticulum with chronic inflammation,ulcer with full-thickness activity,and necrosis of the intestinal wall in some areas;(2)also see that the hard object is consistent with stone changes;and(3)the incision margin on both sides shows chronic inflammation of mucosal tissue.CONCLUSION Clinically,the diagnosis of small bowel diverticulum is difficult to distinguish from jejunal intussusception.Combined with the patient’s condition,rule out other possibilities after a timely disease diagnosis.According to the patient’s body tolerance adopt personalized surgical methods to achieve better recovery after surgery.

关键词： Small bowel diverticulum Surgery Complications Case report

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Application of electroacupuncture in the prevention of low anterior resection syndrome after rectal cancer surgery

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World Journal of Gastrointestinal Surgery 2023年第12期15卷 2765-2773页

作者： Lu-Lu Xu Neng-Jun Xiang Tian-Cheng Cheng Yi-Xian Li Peng Chen zhi-wei jiang Xin-Xin Liu The First Clinical Medical College Nanjing University of Traditional Chinese MedicineNanjing 210023Jiangsu ProvinceChina Department of General Surger Jiangsu Provincial Hospital of Traditional Chinese Medicine Affiliated to Nanjing University of Traditional Chinese MedicineNanjing 210029Jiangsu ProvinceChina

BACKGROUND Low anterior resection syndrome(LARS)is one of the common postoperative complications in patients with rectal cancer,which seriously affects their postoperative recovery and quality of life(QoL).Electroacupuncture therapy is one of the characteristic therapies of traditional Chinese medicine.There are few reports on the prevention and treatment of LARS by electroacupuncture therapy.AIM To explore the clinical effectiveness of electroacupuncture in managing rectal cancer patients with postoperative LARS.METHODS A total of 50 patients with LARS after rectal cancer surgery were retrospectively selected as the research subjects.According to the treatment methods,they were divided into an observation group(n=25)and a control group(n=25).During the four-week treatment period,the control group received standard defecation function training,while the observation group received electroacupuncture care and traditional defecation function training.The anal pressure index(which includes anal resting pressure,anal systolic pressure,and maximum tolerable volume),European Organization of Research and Treatment of Cancer(EORTC)QoL C30(QLQ-C30)score,LARS Scale(LARSS)score,Wexner anal incontinence scale score,Xu Zhongfa five-item 10-point scale score,and the occurrence of adverse reactions were compared between the two groups before and after treatment.RESULTS The experimental group showed considerably enhanced LARSS scores compared to those in the control group after four weeks of treatment.In the first week,second week,and fourth week,the LARSS score and Wexner anal incontinence scale score decreased,and the Xu Zhong method five-item 10-point scale score increased,with significant differences(P<0.05).The experimental group showed substantial improvements in anal resting pressure,anal systolic pressure,and maximum tolerance volume after undergoing 4 wk of therapy in the untreated group(P<0.05).The experimental group's QLQ-C30 score on the EORTC QoL questionnaire was higher than that of the control group during the 1st,

关键词： Electroacupuncture Low anterior resection syndrome Rectal cancer

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Patients Administered Neoadjuvant Chemotherapy Could be Enrolled into an Enhanced Recovery after Surgery Program for Locally Advanced Gastric Cancer

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Chinese Medical Journal 2018年第4期131卷 413-419页

作者： Jian Zhao Gang Wang zhi-wei jiang Chuan-wei jiang jiang Liu Can-Can Xia Jie-Shou Li Research Institute of General Surgery Jinling Hospital Medical School of Nanjing University Nanjing Jiangsu 210002 China

Background： Most studies on enhanced recovery after surgery （ERAS） for gastric cancer exclude patients who received neoadjuvant chemotherapy. Here, we aimed to evaluate whether patients who received neoadjuvant chemotherapy can be enrolled into the ERAS program for locally advanced gastric cancer. Methods： From April 2015 to July 2017, 114 patients who received neoadjuvant chemotherapy for locally advanced gastric cancer were randomized into ERAS and standard care （SC） groups. Postoperative length of stay, complications, bowel function, and nutritional status were recorded. Results： The postoperative length of stay of the ERAS group was shorter compared with that of the SC group （5.9 ± 5.6 vs. 8.1 ± 5.3 days, P=0.037）.The postoperative complication rate was 9.3% in the ERAS group and 11.5% in the SC group（P=0.700）.The time to first flatus （2.7 ± 2.0 vs. 4.5 ± 4.6 days, P = 0.010） and time to a semi-liquid diet （3.2 ± 2.1 vs. 6.3 ± 4.9 days, P 〈 0.001） in the ERAS group were shorter compared with those in the SC group. On the 10thday after surgery, the values of weight, total protein, albumin, and prealbumin of the ERAS group were lower compared with those of the SC group. Conclusions： Patients who received neoadjuvant chemotherapy could be enrolled into ERAS programs for locally advanced gastric cancer. The nutritional status of these patients was not adversely affected.

关键词： Advanced Gastric Cancer Enhanced Recovery after Surgery Gastrectomy Length of Stay Neoadjuvant Chemotherapy

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Effects of Branches on the Crystallization Kinetics of Polypropylene-gPolystyrene and Polypropylene-g-Poly(n-butyl acrylate) Graft Copolymers with Well-defined Molecular Structures

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Chinese Journal of Polymer Science 2014年第3期32卷 333-349页

作者： Lu Wang zhi-wei jiang Feng Liu zhi-jie Zhang 唐涛 State Key Laboratory of Polymer Physics and Chemistry Changchun Institute of Applied ChemistryChinese Academy of Sciences University of Chinese Academy of Sciences

Effects of branches on the crystallization kinetics of polypropylene-g-polystyrene （PP-g-PS） and polypropylene-g- poly（n-butyl acrylate）（PP-g-PnBA） graft copolymers with well-defined molecular structures were systematically investigated by DSC. The Avrami equation was used to analyze the isothermal crystallization process, while the analysis of nonisothermal crystallization process was based on the Jeziorny-modified Avrami model and Mo model. The kinetics results of isothermal and nonisothermal crystallization verified the peculiar effects of branches on the crystallization process of PP backbones in PP-g-PS and PP-g-PnBA graft copolymers： on one hand, the interaction between branches （n-n interaction between PS branches, or dipole-dipole interaction between PnBA branches） restrained the mobility and reptation ability of the PP backbones, which hindered the crystallization process; on the other hand, the heterogeneous nucleation effect resulting from the branched structure and fluctuation-assisted nucleation mechanism （caused by microphase separation between the PS or PnBA rich phase and the PP rich phase） became more pronounced with increasing branch length, which facilitated the crystallization process.

关键词： Polypropylene Polypropylene-g-polystyrene graft copolymer Polypropylene-g-poly（n-butyl acrylate） graftcopolymer Isothermal crystallization Nonisothermal crystallization.

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＂Fast-track＂ and ＂Minimally Invasive＂ Surgery for Gastric Cancer

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Chinese Medical Journal 2016年第19期129卷 2294-2300页

作者： Xin-Xin Liu Hua-Feng Pan zhi-wei jiang Shu Zhang zhi-Ming Wang Ping Chen Yan Zhao Gang Wang Kun Zhao Jie-Shou Li Department of General Surgery Jinling Hospital School of Medicine Nanjing University Nanjing Jiangsu 210002 China Department of General Surgery The First People's Hospital of Yangzhou Clinical Medical School Yangzhou University Yangzhou Jiangsu 225001 China Department of Gastrointestinal Surgery Northern Jiangsu People's Hospital Clinical Medical School Yangzhou University Yangzhou Jiangsu 225001 China

Background：Enhanced recovery after surgery （ERAS） protocols or fast-track （FT） programs enable a shorter hospital stay and lower complication rate.Minimally invasive surgery （MIS） is associated with a lesser trauma and a quicker recovery in many elective abdominal surgeries.However,little is known of the safety and effectiveness made by ERAS protocols combined with MIS for gastric cancer.The purpose of this study was to evaluate the safety and effectiveness made by FT programs and MIS in combination or alone.Methods：We summarized an 11-year experience on gastric cancer patients undergoing elective laparotomy or minimally invasive gastric resection in standard cares （SC） or FT programs during January 2004 to December 2014.A total of 984 patients were enrolled and assigned into four groups：open gastrectomies （OG） with SC （OG ＋ SC group,n =167）;OG with FT programs （OG ＋ FT group,n =277）;laparoscopic gastrectomies （LG） with FT programs （LG ＋ FT group,n =248）;and robot-assisted gastrectomies （RG） with FT programs （RG ＋ FT group,n =292）.Patients＆#39; data were collected to evaluate the clinical outcome.The primary end point was the length of postoperative hospital stay.Results：The OG ＋ SC group showed the longest postoperative hospital stay （mean：12.3 days,median：11 days,interquartile range [IQR]：6-16 days）,while OG ＋ FT,LG ＋ FT,and RG ＋ FT groups recovered faster （mean：7.4,6.4,and 6.6 days,median：6,6,and 6 days,IQR：3-9,4-8,and 3-9 days,respectively,all P 〈 0.001）.The postoperative rehabilitation parameters such as flatus time after surgery （4.7 ± 0.9,3.1 ± 0.8,3.0± 0.9,and 3.1 ± 0.9 days） followed the same manner.After 30 postoperative days＆#39; follow-up,the total incidence of complications was 9.6% in OG ＋ SC group,10.1% in OG ＋ FT group,8.1% in LG ＋ FT group,and 10.3% in RG ＋ FT group.The complications showed no significant differences between the four groups （all P 〉 0.05）.Conclusions：ERAS protocols alone could significantly bring fast recovery after surgery regardless of the surgical technique.MIS further reduces

关键词： Enhanced Recovery after Surgery Fast-track Surgery Gastrectomy Minimally Invasive Surgery Optimized Care

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Fast-track rehabilitation program vs conventional care after colorectal resection:A randomized clinical trial

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World Journal of Gastroenterology 2011年第5期17卷 671-676页

作者： Gang Wang zhi-wei jiang Jing Xu Jian-Feng Gong Yang Bao Li-Fei Xie Jie-Shou Li Research Institute of General Surgery Jinling Hospital School of Medicine Nanjing University Nan-j ing 210002 Jiangsu Province China Department of Medical Oncology Jinling HospitalSchool of Medicine Nanjing University Nanjing 210002 Ji-angsu Province China

AIM:To compare the fast-track rehabilitation program and conventional care for patients after resection of colorectal cancer.METHODS:One hundred and six consecutive patients who underwent fast-track rehabilitation program were encouraged to have early oral feeding and movement for early discharge,while 104 consecutive patients underwent conventional care after resection of colorectal cancer.Their gastrointestinal functions,postoperative complications and hospital stay time were recorded.RESULTS:The restoration time of gastrointestinal functions in the patients was significantly faster after fasttrack rehabilitation program than after conventional care(2.1 d vs 3.2 d,P < 0.01).The percentage of patients who developed complications was significantly lower 30 d after fast-track rehabilitation program than after conventional care(13.2% vs 26.9%,P < 0.05).Also,the percentage of patients who had general complications was significantly lower 30 d after fast-track rehabilitation program than after conventional care(6.6% vs 15.4%,P < 0.05).The postoperative hospital stay time of the patients was shorter after fast-track rehabilitation program than after conventional care(5 d vs 7 d,P < 0.01).No significant difference was observed in the readmission rate 30 d after fast-track rehabilitation program and conventional care(3.8% vs 8.7%).CONCLUSION:The fast-track rehabilitation program can significantly decrease the complications and shorten the time of postoperative hospital stay of patients after resection colorectal cancer.

关键词：大肠癌护理康复临床试验 VS 快速通道恢复时间随机

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Avoidance of urinary drainage during perioperative period of open elective colonic resection within enhanced recovery after surgery programme

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Gastroenterology Report 2021年第6期9卷 589-594页

作者： Yun Li zhi-wei jiang Xin-Xin Liu Hua-Feng Pan Guan-Wen Gong Cheng Zhang Zheng-Rong Li Department of Gastrointestinal Surgery The First Affiliated Hospital of Nanchang UniversityNanchangJiangxiP.R.China jiangxi Institute of Digestive surgery NanchangJiangxi 330006P.R.China Department of General Surgery The Affiliated Hospital of Nanjing University of Chinese MedicineNanjingJiangsuP.R.China

Background:Urinary catheterization(UC)is a conventional perioperative measure for major abdominal operation.Optimization of perioperative catheter management is an essential component of the enhanced recovery after surgery(ERAS)programme.We aimed to investigate the risk factors of urinary retention(UR)after open colonic resection within the ERAS protocol and to assess the feasibility of avoiding urinary drainage during the perioperative period.Methods:A total of 110 colonic-cancer patients undergoing open elective colonic resection between July 2014 and May 2018 were enrolled in this study.All patients were treated within our ERAS protocol during the perioperative period.Data on patients’demographics,clinicopathologic characteristics,and perioperative outcomes were collected and analysed retrospectively.Results:Sixty-eight patients(61.8%)underwent surgery without any perioperative UC.Thirty patients(27.3%)received indwelling UC during the surgical procedure.Twelve(10.9%)cases developed UR after surgery necessitating UC.Although patients with intraoperative UC had a lower incidence of post-operative UR[0%(0/30)vs 15%(12/80),P=0.034],intraoperative UC was not testified as an independent protective factor inmultivariate logistic analysis.The history of prostatic diseases and the body mass index were strongly associated with post-operative UR.Six patients were diagnosed with post-operative urinary-tract infection,among whom two had intraoperative UC and four were complicated with post-operative UR requiring UC.Conclusion:Avoidance of urinary drainage for open elective colonic resection is feasible with the implementation of the ERAS programme as the required precondition.Obesity and a history of prostatic diseases are significant predictors of postoperative UR.

关键词： colectomy urinary catheterization urinary retention enhanced recovery after surgery

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Compression anastomosis clip for gastrointestinal anastomosis

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World Journal of Gastroenterology 2008年第31期14卷 4938-4942页

作者： Pi-Chu Liu zhi-wei jiang Xiao-Lin Zhu zhi-Ming Wang Yan-Qing Diao Ning Li Jie-Shou Li Department of General Surgery Jinling Hospital School of Medicine Nanjing University Nanjing 210002 Jiangsu Province China Department of Nutrition Sciences University of Alabama at Birmingham Birmingham AL 35294 United States

AIM: To investigate the feasibility of compression anastomosis clip (CAC) for gastrointestinal anastomosis proximal to the ileocecal junction. METHODS: Sixty-six patients undergoing gastrointe-stinal anastomosis proximal to the ileocecal junction were randomized into two groups according to the anastomotic method, CAC or stapler. RESULTS: The postoperative recovery of patients in CAC and stapled anastomosis groups was similar. No postoperative complication related to the anastomotic method was found in either group. Both upper gastrointestinal contrast radiography at the early postoperative course and endoscopic examination after a 6-mo follow-up showed a better healing at the compression anastomosis. CONCLUSION: CAC can be used not only in colonic surgery but also in gastrointestinal anastomosis. Our result strongly suggests that CAC anastomosis is safe in various complication circumstances. However, it should be further conf irmed with a larger patient sample.

关键词：胃肠吻合技术压缩性能病理机制临床分析

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Association of polymorphisms of IL and CD14 genes with acute severe pancreatitis and septic shock

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World Journal of Gastroenterology 2005年第28期11卷 4409-4413页

作者： Dlan-Liang Zhang Hong-Mei Zheng Bao-Jun Yu zhi-wei jiang Jie-Shou Li Department of General Surgery Affiliated Hospital Qingdao University Medial CollegeQingdao 266003 Shandong Province China Research Institute of General Surgery Jinling Hospital Nanjing 210093 Jiangsu ProvinceChina

AIM: To investigate IL-1β+3 594 in the 5th intron, IL-10-1 082 and CD14-159 polymorphisms in patients with acute pancreatitis (AP) and septic shock.METHODS: The study included 215 patients (109 with acute severe pancreatitis (SAP), 106 with acute mild pancreatitis (MAP)) and 116 healthy volunteers. Genomic DNA was prepared from peripheral blood leukocytes. Genotypes and allele frequencies were determined in patients and healthy controls using restriction fragment length polymorphism analysis of PCR products.RESULTS: The frequencies of IL-1β+3 594T, IL-10-1082G and CD14-159T allele were similar in patients with mild or severe pancreatitis and in controls. Within SAP patients, no significant differences were found in the allele distribution examined when etiology was studied again. Patients with septic shock showed a significantly higher prevalence of IL-10-1082G allele than those without shock (x2 = 5.921,P = 0.015).CONCLUSION: IL-10-1082G plays an important role in the susceptibility of SAP patients to septic shock. Genetic factors are not important in determination of disease severity or susceptibility to AP.

关键词：基因多肽性白介素 CD14 基因表达急性严重胰腺炎败血症

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Robotic gastrectomy with transvaginal specimen extraction for female gastric cancer patients

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World Journal of Gastroenterology 2015年第47期21卷 13332-13338页

作者： Shu Zhang zhi-wei jiang Gang Wang Xiao-Bo Feng jiang Liu Jian Zhao Jie-Shou Li Department of General Surgery Jinling Hospital Medical School Nanjing University

AIM: To describe the application of complete robotic gastrectomy with transvaginal specimen extraction(TVSE) for gastric cancer patients.METHODS: Between July and November 2014, eight female patients who were diagnosed with gastric adenocarcinoma underwent a TVSE following a full robot-sewn gastrectomy. According to the tumor location, the patients were allocated to two different groups; two patients received robotic total gastrectomy with TVSE and the other six received robotic distal gastrectomy with TVSE.RESULTS: Surgical procedures were successfully performed in all eight cases without conversion. The mean age was 55.3(range, 42-69) years, and the mean body mass index was 23.2(range, 21.6-26.0) kg/m2. The mean total operative time and blood loss were 224(range, 200-298) min and 62.5(range, 50-150) m L, respectively. The mean postoperative hospital stay was 3.6(range, 3-5) d. The mean number of lymph nodes resected was 23.6(range, 17-27). None was readmitted within 30 d of postoperation. During the follow-up, no stricture developed nor was any anastomotic leakage detected.CONCLUSION: It is possible to perform a TVSE following a full robot-sewn gastrectomy with standard D2 lymph node resection for female gastric cancer patients.

关键词： Gastric cancer Robotic surgery Transvaginal Natural orifice specimen extraction

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