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Management of splenic artery aneurysm associated with extrahepatic portal vein obstruction

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Hepatobiliary & Pancreatic Diseases International 2012年第3期11卷 330-333页

作者： Pramod Kumar Mishra Sundeep Singh Saluja Ashok K Sharma Premanand Pattnaik Department of Gastrointestinal Surgery surgery GB Pant Hospital Department of Gastrointestinal Surgery and department of Radiology surgery GB Pant Hospital Department of Gastrointestinal Surgery GB Pant Hospital

BACKGROUND: Splenic artery aneurysms although rare are clinically significant in view of their propensity for spontaneous rupture and life-threatening bleeding. While portal hypertension is an important etiological factor, the majority of reported cases are secondary to cirrhosis of the liver. We report three cases of splenic artery aneurysms associated with extrahepatic portal vein obstruction and discuss their management. METHODS: The records of three patients of splenic artery aneurysm associated with extrahepatic portal vein obstruction managed from 2003 to 2010 were reviewed retrospectively. The clinical presentation, surgical treatment and outcome were analyzed. RESULTS: The aneurysm was >3 cm in all patients. The clinical symptoms were secondary to extrahepatic portal vein obstruction (hematemesis in two, portal biliopathy in two) while the aneurysm was asymptomatic. Doppler ultrasound demonstrated aneurysms in all patients. A proximal splenorenal shunt was performed in two patients with excision of the aneurysm in one patient and ligation of the aneurysm in another one. The third patient had the splenic vein replaced by collaterals and hence underwent splenectomy with aneurysmectomy. All patients had an uneventful post-operative course. CONCLUSIONS: Splenic artery aneurysms are associated with extrahepatic portal vein obstruction. surgery is the mainstay of treatment. Although technically difficult, it can be safely performed in an experienced center with minimal morbidity and good outcome.

关键词： splenic artery aneurysm extrahepatic portal vein obstruction portal hypertension proximal splenorenal shunt

Prognostic significance of periostin in colorectal cancer

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Chinese Journal of Cancer Research 2019年第3期31卷 547-556页

作者： Xingming Deng Sheng Ao Jianing Hou Zhuofei Li Yunpeng Lei Guoqing Lyu Department of Gastrointestinal Surgery Peking University Shenzhen Hospital

Accumulating evidence suggests that periostin is frequently upregulated in tissue injury, inflammation,fibrosis and tumor progression. Periostin expression in cancer cells can promote metastatic potential of colorectal cancer(CRC)via activating PI3 K/Akt signaling pathway. Moreover, periostin is observed mainly in tumor stroma and cytoplasm of cancer cells, which may facilitate aggressiveness of CRC. In this review, we summarize information regarding periostin to emphasize its role as a prognostic marker of CRC.

关键词： Periostin prognostic functionality stromal cells colorectal cancer

Impact of regular enteral feeding via jejunostomy during neo-adjuvant chemotherapy on body composition in patients with oesophageal cancer

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World Journal of gastrointestinal Oncology 2019年第12期11卷 1182-1192页

作者： Imran M Mohamed John Whiting Benjamin HL Tan department of Upper gastrointestinal surgery Queen Elizabeth Hospital

BACKGROUND Malnourishment and sarcopenia are well documented phenomena in oesophageal cancer.Patients undergoing neo-adjuvant chemotherapy prior to oesophagectomy have complex nutritional needs.AIM To examine the effect of regular nutritional support via feeding jejunostomy on overall body composition in patients undergoing neo-adjuvant chemotherapy prior to oesophagectomy for oesophageal cancer.METHODS Retrospective data were collected for 15 patients before and after neo-adjuvant chemotherapy.All patients had feeding jejunostomies inserted at staging laparoscopy prior to neo-adjuvant chemotherapy and underwent regular jejunostomy feeding.Changes in body composition were determined by analysis of computed tomography imaging.RESULTS Patient age was 61.3±12.8 years,and 73%of patients were male.The time between start of chemotherapy and surgery was 107±21.6 d.There was no change in weight(74.5±14.1 kg to 74.8±13.1 kg)and body mass index(26.0±3.8 kg/m^2 to 26.1±3.4 kg/m^2).Body composition analysis revealed a statistically significant decrease in lumbar skeletal muscle index despite regular feeding(45.8±8.0 cm^2/m^2 to 43.5±7.3 cm^2/m^2;P=0.045).The proportion of sarcopenic patients increased(33.3% to 60%).Six patients(40%)experienced dose-limiting toxicity during chemotherapy.CONCLUSION Regular jejunostomy feeding during neo-adjuvant chemotherapy can maintain weight and adipose tissue.Feeding alone is not sufficient to maintain muscle mass.Further insight into the underlying processes causing reduced muscle mass in cancer patients may help to provide targeted interventions.

关键词： Body composition Neo-adjuvant therapy Oesophageal cancer Enteral feeding

Current status and future perspectives on neoadjuvant therapy in gastric cancer

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Chinese Journal of Cancer Research 2021年第2期33卷 181-192页

作者： Sheng Ao Yuchen Wang Qingzhi Song Yingjiang Ye Guoqing Lyu Department of Gastrointestinal Surgery Peking University Shenzhen HospitalShenzhen 518000China Department of Gastrointestinal Surgery Peking University People’s HospitalBeijing 100044China

Gastric cancer,with high morbidity and mortality rates,is one of the most heterogeneous tumors.Radical gastrectomy and postoperative chemotherapy are the standard treatments.However,the safety and efficacy of neoadjuvant therapy(NAT)need to be confirmed by many trials before implementation,creating a bottleneck in development.Although clinical benefits of NAT have been observed,a series of problems remain to be solved.Before therapy,more contributing factors should be offered for choice in the intended population and ideal regimens.Enhanced computed tomography(CT)scanning is usually applied to evaluate effectiveness according to Response Evaluation Criteria in Solid Tumors(RECIST),yet CT scanning results sometimes differ from pathological responses.After NAT,the appropriate time for surgery is still empirically defined.Our review aims to discuss the abovementioned issues regarding NAT for GC,including indications,selection of regimens,lesion assessment and NAT-surgery interval time.

关键词： Gastric cancer neoadjuvant therapy regimens lesion assessment NAT-surgery interval time

中国结直肠肿瘤经自然腔道取标本手术患者短期疗效与肿瘤学预后分析:一项5055例患者的数据库研究

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Science Bulletin 2022年第13期67卷 1331-1334,M0003页

作者：关旭胡茜玥姜争韦烨孙东辉吴淼周海涛姚宏亮宋军民王贵玉胡军红任明扬徐庆蔡建春彭健马丹郑阳春何庆泗江波王泽军李太原燕速陈路川李铁钢熊治国池畔康亮于刚邓小东张宏谢铭韦建宝宫红彦孙学军臧卫东宋永茂赫鹏文政琦张春旭王昱晟陈瑛罡谢光伟李明章俞少俊刘海鹰蒲敏傅传刚王锡山中国经自然腔道取标本手术联盟 department of Colorectal surgery National Cancer Center/National Clinical Research Center for Cancer/Cancer HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijing 100021China department of General surgery Zhongshan HospitalFudan UniversityShanghai 200032China department of gastrointestinal and Anal surgery Jilin University First HospitalChangchun 130021China Department of Gastrointestinal Surgery The Second People’s Hospital of YibinYibin 644000China Department of Gastrointestinal Surgery The Second Xiangya HospitalCentral South UniversityChangsha 410011China department of Anorectal surgery First Affiliated HospitalZhengzhou UniversityZhengzhou 450052China department of Colorectal Cancer surgery The Second Affiliated Hospital of Harbin Medical UniversityHarbin 150081China Department of Gastrointestinal Surgery Affiliated Hospital of North Sichuan Medical CollegeNanchong 637000China Department of Gastrointestinal Surgery Renji HospitalShanghai JiaoTong University School of MedicineShanghai 200240China Department of Gastrointestinal Surgery Zhongshan Hospital of Xiamen UniversityXiamen 361004China department of General surgery Xiangya HospitalCentral South UniversityChangsha 410008China department of General surgery Xinqiao HospitalThird Military Medical UniversityChongqing 400037China Department of Gastrointestinal Surgery Sichuan Cancer HospitalChengdu 610041China department of General surgery Shandong University Qilu HospitalJinan 250012China department of Colorectal and Anal surgery Shanxi Cancer HospitalTaiyuan 030013China Department of Gastrointestinal Surgery The Affiliated Cancer Hospital of Guizhou Medical UniversityGuiyang 550008China department of General surgery The First Affiliated Hospital of Nanchang UniversityNanchang 330006China Department of Gastrointestinal Surgery Qinghai University Affiliated HospitalXining 810012China Department of Gastrointestinal Surgery Fujian Medical University Cancer HospitalFuzhou 350014China Depar

经自然腔道取标本手术(NOSES)通过无切口理念与常规手术器械的结合,表现出极佳的微创效果,并带给患者全新的就医感受.目前,尽管NOSES已广泛用于结直肠肿瘤治疗,大量研究也表明相比常规腹腔镜手术,NOSES具有恢复快、创伤小、疼痛轻等优势... 详细信息

经自然腔道取标本手术(NOSES)通过无切口理念与常规手术器械的结合,表现出极佳的微创效果,并带给患者全新的就医感受.目前,尽管NOSES已广泛用于结直肠肿瘤治疗,大量研究也表明相比常规腹腔镜手术,NOSES具有恢复快、创伤小、疼痛轻等优势,但绝大多数研究均为小样本、单中心回顾性研究.本研究旨在通过分析我国5055例结直肠肿瘤NOSES患者数据,进一步探讨NOSES的短期疗效与预后.研究对象中,经直肠NOSES占整体比例的90.3%,经阴道NOSES占9.7%.NOSES术后短期并发症发生率为14.1%,吻合口瘘发生率为4.9%,腹盆腔感染率为1.9%.患者3年总生存率为93.2%,无病生存率为82.2%,局部复发率为3.6%.研究结果提示NOSES具有较好的安全性与可行性,为其应用于结直肠肿瘤治疗提供了证据.

关键词：结直肠肿瘤肿瘤学并发症发生率无病生存率吻合口瘘回顾性研究总生存率经直肠

Left armpit subcutaneous metastasis of gastric cancer: A case report

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World Journal of Clinical Cases 2019年第23期7卷 4137-4143页

作者： Feng-Jun He Peng Zhang Mo-Jin Wang Yi Chen Wen Zhuang Department of Gastrointestinal Surgery West China Hospital Sichuan University

BACKGROUND Gastric cancer is the third most lethal malignant tumor worldwide.Metastasis has always been a major cause of poor prognosis.Epidemiological evidence shows that the most common sites for metastasis of gastric carcinoma are the liver(48%),peritoneum(32%),lung(15%),and bone(12%);however,subcutaneous metastasis is are and occurs in approximately 0.8%of cases.We report a rare case of armpit subcutaneous metastasis of gastric cancer.The best surgical window was missed,as a result of lacking attention of the mass.CASE SUMMARY A 69-year-old man who had previously undergone radical gastrectomy and received eight cycles of oral chemotherapy for gastric cancer showed a rapidly growing mass in his the left armpit;within just 3 mo,the mass grew to a size of 6.9 cm×4.4 cm×5.7 cm.Color Doppler ultrasonography and Positron emission tomography/computed tomography prompted the possibility of metastasis of the malignancy.Fine needle aspiration biopsy guided by color Doppler ultrasound showed the presence of cancer cells in the mass.Immunohistochemical examination showed CDX-2(+),PCK(+),CK20(+),CK7(-),and TTF(-),which supported the metastasis of gastric cancer.Considering the risk of resection,the patient did not undergo surgical treatment.CONCLUSION The case indicates that unidentified subcutaneous masses in patients with a history of gastric cancer should be carefully evaluated.

关键词： Stomach neoplasms Neoplasm metastasis Subcutaneous Case report Cancer therapy Skin neoplasms

Development of a real-time PCR method for the detection of bacterial colonization in rat models of severe acute pancreatitis

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Chinese Medical Journal 2010年第3期123卷 326-331页

作者： PENG Jun-sheng LIU Zhong-hui LI Chu-jun WU Xiao-bin DIAO De-chang DU Yan-ping CHEN Jun-rong LI Yun WANG Hua-she Department of Gastrointestinal Surgery department of Gastroenterology

为细菌的感染的快、精确的察觉的背景技术为在临床的严重尖锐胰腺炎(树液) 的细菌的 translocation 的早诊断，预防和治疗是批评的。在这研究，在在树液老鼠模型的细菌的殖民的察觉的一个即时 PCR 方法的可获得性是从 24 只特定的没有... 详细信息

为细菌的感染的快、精确的察觉的背景技术为在临床的严重尖锐胰腺炎(树液) 的细菌的 translocation 的早诊断，预防和治疗是批评的。在这研究，在在树液老鼠模型的细菌的殖民的察觉的一个即时 PCR 方法的可获得性是从 24 只特定的没有病原体的老鼠的血， mesenteric 淋巴节点( MLN )，胰和肝的 investigated.Methods 样品( 8 在一个控制组， 16 在一个傻瓜组织)被琼脂板文化和一个即时 PCR 方法两个都为细菌的感染率检测，并且结果被成为细菌的感染在 SAP 组血， MLN ，胰和肝评估的 contrast.Results 一细菌的数字被即时 PCR 估计，它证明在纸巾的一样的团中，胰在树液老鼠比另外的三种机关包含了更多的细菌( P < 0.01 )，那可能由于在胰存在的浮肿，坏死和出血，使它更容易因为入侵的细菌和快的 breed.Conclusion 和在树液老鼠模型的细菌的 translocation 的精确察觉能被一个即时 PCR 过程执行。

关键词： PCR检测方法重症急性胰腺炎实时PCR 细菌感染大鼠模型聚合酶链反应定植肠系膜淋巴结

Nomogram for predicting early complications after distal gastrectomy

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World Journal of gastrointestinal surgery 2023年第11期15卷 2500-2512页

作者： Biao Zhang Qing Zhu Zhi-Peng Ji Department of Gastrointestinal Surgery Second Hospital of Shandong UniversityJinan 250033Shandong ProvinceChina

BACKGROUND Reducing or preventing postoperative morbidity in patients with gastric cancer(GC)is particularly important in perioperative treatment plans.AIM To identify risk factors for early postoperative complications of GC post-distal gastrectomy and to establish a nomogram prediction model.METHODS This retrospective study included 131 patients with GC who underwent distal gastrectomy at the Second Hospital of Shandong University between January 2019 and February 2023.The factors influencing the development of complications after distal gastrectomy in these patients were evaluated using univariate and multivariate logistic regression analysis.Based on the results obtained,a predictive nomogram was established.The nomogram was validated using internal and external(n=45)datasets.Its sensitivity and specificity were established by receiver operating characteristic curve analysis.Decision curve(DCA)analysis was used to determine its clinical benefit and ten-fold overfitting was used to establish its accuracy and stability.RESULTS Multivariate logistic regression analysis showed that hypertension,diabetes,history of abdominal surgery,and perioperative blood transfusion were independent predictors of postoperative complications of distal gastrectomy.The modeling and validation sets showed that the area under the curve was 0.843[95%confidence interval(CI):0.746-0.940]and 0.877(95%CI:0.719-1.000),the sensitivity was 0.762 and 0.778,respectively,and the specificity was 0.809 and 0.944,respectively,indicating that the model had good sensitivity and specificity.The C-indexes of the modeling and validation datasets were 0.843(95%CI:0.746-0.940)and 0.877(95%CI:0.719-1.000),respectively.The calibration curve(Hosmer Lemeshow test:χ^(2)=7.33)showed that the model had good consistency.The results of the DCA analysis indicated that this model offered good clinical benefits.The accuracy of 10-fold cross-validation was 0.878,indicating that the model had good accuracy and stability.CONCLUSION The nomogram prediction model based on

关键词： Blood transfusion Gastroenterostomy Nomograms Postoperative complications Stomach neoplasms Risk factors

Validation of a surgical model for posthepatectomy liver failure in rats

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Animal Models and Experimental Medicine 2023年第3期6卷 266-273页

作者： Andrea Lund Michelle Meier Kasper Jarlhelt Andersen Marie Ingemann Pedersen Anders Riegels Knudsen Jakob Kirkegård Frank Viborg Mortensen Aarhus University Hospital Department of Upper Gastrointestinal and Hepato-Pancreato-Biliary SurgeryAarhus NDenmark

Background:The upper limit for liver resections in rats is approximately 90%.In the early postoperative phase,mortality increases.The aim of the present study was to validate the rat model of 90%partial hepatectomy(PH)as a model of post-hepatectomy liver failure(PHLF).Further,we wanted to test a quantitative scoring system as a detector of lethal outcomes caused by PHLF in rats.Methods:Sixty-eight rats were randomized to 90%PH,sham operation,or no sur-gery.Further,block randomization was performed based on time of euthanization:12,24,or 48 h after surgery.A general distress score(GDS)≥10 during the day or≥6 at midnight prompted early euthanization and classification as nonsurvivor.Animals euthanized as planned were classified as survivors.During euthanization,blood and liver tissue were collected,and liver-specific biochemistry was evaluated.Results:Based on the biochemical results,all animals subjected to 90%PH expe-rienced PHLF.Seventeen rats were euthanized due to irreversible PHLF.The GDS increased for nonsurvivors within 12–18 h after surgery.The mean time for euthaniza-tion was 27 h after surgery.Conclusion:Based on the GDS and liver-specific biochemistry,we concluded that the model of 90%PH seems to be a proper model for investigating PHLF in rats.As a high GDS is associated with increased mortality,the GDS appears to be valuable in detect-ing lethal outcomes caused by PHLF in rats.

关键词： 90%liver resection general distress score liver failure post-hepatectomy liver failure rats