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25 January 2018, Volume 23 Issue 01    Next Issue

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Clinical application of totally robotic radical distal gastrectomy for gastric cancer using delta-shaped overlap gastroduodenostomy: a report of 2 cases YAN Chao, LIU Wentao, YANG Zhongyin, NI Zhentian, XU Wei, BI Renda, ZHENG Yanan, HUA Zichen, ZHU Zhenglun, FENG Runhua, YAO Xuexin, CHEN Mingmin, LI Chen, YAN Min, ZHU Zhenggang 2018, 23 (01):  32-36.  DOI: 10.16139/j.1007-9610.2018.01.008 Abstract ( 476 )   PDF (956KB) ( 77 )   Objective To investigate the feasibility and safety of totally robotic radical distal gastrectomy for gastric cancer using delta-shaped gastroduodenostomy with overlap method. Methods The clinical data of 2 patients with gastric cancer who underwent totally robotic radical distal gastrectomy using Da Vinci Si robotic surgical system in November 2017 were retrospectively analyzed. Results The first case was 33-year-old female with distal gastric cancer, and the second case was 77-year-old male. Both successfully underwent totally robotic radical distal gastrectomy with D2 lymphadenectomy and delta-shaped gastroduodenostomy using overlap method. Total operating time was 210 min and 240 min with the intraoperative blood loss of 20 mL and 100 mL, the harvested lymph nodes of 32 and 24, respectively. Both had cancer-free resection margin pathologically. The first flatus passage time was 3.0 d and 2.5 d postoperatively with the liquid food for 4 d and 5 d, respectively. Postoperative hospital stay was 6 d and 8 d, respectively. No postoperative complication was found in two cases. Conclusions Totally robotic radical distal gastrectomy for gastric cancer with delta-shaped gastroduodenostomy using overlap method is feasible and safe. The further study is needed for the clinical value. References | Related Articles | Metrics

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Effect of early and controlling fluid resuscitation on prognosis of severe acute pancreatitis SUN Wenwu, QI Mengzhi, MAO Enqiang 2018, 23 (01):  37-40.  DOI: 10.16139/j.1007-9610.2018.01.009 Abstract ( 393 )   PDF (409KB) ( 96 )   Objective To explore the effect of early and controlling fluid resuscitation on clinical prognosIs of the patients with severe acute pancreatitis(SAP). Methods A total of 61 patients with SAP treated within 72 hours attack in Emergency Intensive Care Unit between 2012 and 2017 were included and divided into ccntrol group and uncontrol group according to whether or not reaching the goals of early and controlling fluid resuscitation. Control group included 38 patients and uncontrol group included 23 patients. Prognosis of the patients was compared between 2 groups. Results There was no obvious difference of baseline between 2 groups. The patients in control group received more fluid infusion than in uncontrol group (5 493±1 887 vs 3 967±1 203, P<0.05). The patients in control group had lower mortality than in uncontrol group (18.4% vs 47.8%, P<0.05) and lower rate of renal failure within 7 days (21.1% vs 60.9%, P<0.05), surgical intervention rate (23.6% vs 56.5%, P<0.05). There was no difference in both groups of duration of mechanical ventilation(P=0.23), pulmonary(P=1.00) and circulatory failure rate within 7 days(P=0.27). Conclusions The patients with SAP reached the goals of early and controlling fluid resuscitation might have lower mortality, lower rate of renal failure within 7 days and surgical intervention rate compared with the patients in uncontrol group, References | Related Articles | Metrics

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Ezetimibe prevented cholesterol gallstone formation in mice fed with lithogenic diet WANG Qihan, SUN Haidong, CAI Qu, HU Hai, HAN Tianquan, JIANG Zhaoyan 2018, 23 (01):  41-47.  DOI: 10.16139/j.1007-9610.2018.01.010 Abstract ( 371 )   PDF (859KB) ( 148 )   Objective To investigate the effect of prevention on cholesterol gallstone formation by ezetimibe (Eze) in mice. Methods Thirty adult male C57BL/6 mice were randomly divided into three groups, fed with chow diet (chow group), lithogenic diet (LD group) and lithogenic diet with 5 mg/ (kg·d) ezetimibe by oral gavage (Eze group) for 8 weeks. On sacrifice, occurrence of gallstone was observed. Serum, liver, intestine and gallbladder were collected from each mouse. The serum lipids, hepatic cholesterol and biliary lipid composition were quantified by enzymatic methods. Expression of genes involved in metabolism of cholesterol in liver and intestines were measured by real-time quantitative PCR. Results No gallstone was observed in chow group. All mice formed gallstone in LD group (100%). No gallstone was formed in Eze group also. The intestinal cholesterol absorption rate in Eze group (9.29%±4.32%) significantly reduced when compared with LD group (58.62%±3.10%) and chow group (56.42%±2.67%) (P<0.01). Serum cholesterol level and hepatic cholesterol level in LD group [(4.99±0.50) mmol/L and (22.92±2.39) mg/g] increased markedly compared with chow group [(2.87±0.06) mmol/L and (2.45±0.08) mg/g] (P<0.05). Eze group lowered both serum cholesterol level [(1.11±0.10) mmol/L] and hepatic cholesterol level [(2.70±0.07) mg/g] compared with LD group(P<0.05). LD group has significantly higher biliary cholesterol content [LD group (10.87±1.46) mmol/L vs chow group (3.67±0.58) mmol/L] and cholesterol saturation index (CSI) [LD group:(1.42±0.19) vs chow group：(0.59±0.02)]. Biliary cholesterol content [(2.72±0.29) mmol/L] and CSI (0.57±0.07) in Eze group decreased markedly compared with LD group (P<0.01). Conclusions Eze could prevent cholesterol gallstone formation in mice through inhibition of intestinal cholesterol absorption. References | Related Articles | Metrics

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Safety and efficacy of carbon nanoparticles in operation for papillary thyroid carcinoma FENG Haoran, KUANG Jie, CHENG Xi, JIN Zhijian, YANG Weiping, QIU Weihua, TAN Jian 2018, 23 (01):  48-51.  DOI: 10.16139/j.1007-9610.2018.01.011 Abstract ( 430 )   PDF (399KB) ( 153 )   Objective To evaluate the safety and clinical efficacy of carbon nanoparticles (CN) as a tracer in surgical operation for papillary thyroid carcinoma patients with a history of thyroid resection. Methods A retrospective analysis was performed using the clinical data of 53 cases with thyroid papillary carcinoma who had a history of thyroid resection receiving total thyroidectomy combined with lymph node dissection. Twenty-seven cases had CN intra-operative treatment as CN group and 26 cases as control group without CN. Results The lymph node dissection was much more in CN group than in control group (P<0.01). However, there was no difference in the dissection of metastatic lymph node (P=0.077). A total of 176(73.33%) were stained black in 240 dissected lymph nodes of CN group, among which 42(23.86%) lymph nodes were metastatic. Pathologic examination revealed that there were parathyroid in resection specimens from 3 cases in CN group compared with 9 cases in control group (P=0.041). Three cases with hypocalcemia was found in CN group and 10 cases in control group on the postoperative day(P=0.021). However, postoperative hoarseness had no statistical difference between CN group and control group (P=0.280). Conclusions Using CN during the operation of papillary thyroid carcinoma would be beneficial to the patients with history of thyroid resection reducing parathyroid injury and keeping serum calcium and phosphorus stable. References | Related Articles | Metrics

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Clinical importance of recurrent laryngeal nerve lymph nodes at entrance point in central lymph node dissection for papillary thyroid carcinoma LÜ Tian, WANG Lin, YING Xiayang, CHEN Xi, DI Zhongmin, KUANG Jie, YAN Jiqi 2018, 23 (01):  52-56.  DOI: 10.16139/j.1007-9610.2018.01.012 Abstract ( 902 )   PDF (724KB) ( 218 )   Objective To explore the clinical significance of metastasis to recurrent laryngeal nerve lymph nodes at entrance point (RLNLN-ep) in the patients with papillary thyroid carcinoma (PTC). Methods An analysis was done inclu-ding 598 consecutive patients with PTC who underwent thyroid surgery from April 2016 to November 2016. We explored RLNLN-ep in central compartment lymph node dissection. Carbon nanoparticles were injected into the lobes to help identify lymph nodes. RLNLN-ep and the other central compartment lymph nodes were sent for pathological examination. The complications were recorded. Results RLNLN-ep was found in 35 of 598 (5.85%) cases. There were 15 (2.51%) cases with metastasis of PTC and 20 cases without the metastasis. The metastasis rate of RLNLN-ep was related to tumor diameter, tumor location and the amount of tumor. The amount of tumor was an independent factor of metastasis of RLNLN-ep. There were 14 (93.3%) cases with metastasis of RLNLN-ep who were found the other central compartment lymph node metastasis simultaneously. Seven (1.2%) cases had morbidity postoperatively. Conclusions RLNLN-ep could be the site of metastasis of PTC. Central compartment lymph node dissection should include RLNLN-ep and the surrounding tissue. References | Related Articles | Metrics

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Macrofollicular variant of papillary thyroid carcinoma: a report of 3 cases YU Qichun, YIN Jianguang, SHANG Yanhong, QIU Weihua, TAN Jian 2018, 23 (01):  57-61.  DOI: 10.16139/j.1007-9610.2018.01.013 Abstract ( 530 )   PDF (832KB) ( 327 )   Objective To investigate the clinicopathologic features of macrofollicular variant of papillary thyroid carcinoma (MFPTC). Methods Three cases with MFPTC were analyzed retrospectively for the clinical data, pathological morphology and the results by immunohistochemical detection. Results The ultrasonic examination showed MFPTC mostly as irregular strong hyperechoic nodules with abundant blood flow. Under the microscope, huge follicles could be observed and there was rich of colloid in the cavity of follicles. The nucleus of the follicular epithelium was extruded into a cubic or flattened form. MFPTC could be diagnosed similar to the other PTC by immunohistochemistry. The diffusive or partial distribution of positive expression of CK19, galectin-3, and HBME-1 was shown in the epithelium of MFPEC. Conclusions MFPTC was inclined to be miss-diagnosed in the clinics and pathology. With clinical data and the histomorphologic feature combined with immunohistochemical examination, MFPTC could be confirmed pathologically. References | Related Articles | Metrics

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Effect of external biliary drainage on lung inflammation and edema in severe acute pancreatitis rats WANG Jinlong, LU Meiling, CHEN Ying, ZHAO Bing, MAO Enqiang, CHEN Erzhen 2018, 23 (01):  62-66.  DOI: 10.16139/j.1007-9610.2018.01.014 Abstract ( 490 )   PDF (721KB) ( 100 )   Objective To investigate the roles of biliary tract external drainage(BTED) on lung inflammation and edema of the rats with severe acute pancreatitis(SAP). Methods Twenty-four SD rats were randomly divided into four groups of six each: group sham surgery(SS), group SAP, group SAP+BTED with the SAP rats established first and then BTED performed, group SAP+BTED+zinc protoporphyrin (ZnPP) with Znpp injected abdominally 24 h before and then SAP with BTED procedure. ZnPP is a specific inhibitor of heme oxygenase-1(HO-1), which can inhibit the expression of HO-1. The rats were sacrificed 24 h after surgery. The lung and blood were collected. The pathological changes of lung were scored by Schmidt criterion. mRNA expression of HO-1, TNT-α and IL-6 were detected by quantitative RT-PCR method, lung HO-1 expression by Western blot and myeloperoxidase(MPO) protein by ELISA. The ratio of dry/wet of lung tissue was calculated. Results The Schmidt score in group SAP+BTED were significantly lower than in group SAP(P<0.05). The expression of both TNT-α and IL-6 with MPO level in group SAP+BTED were significantly lower than in group SAP(P<0.05). But the dry/wet ratio and the expression of HO-1 protein in group SAP+BTED were significantly increased than in group SAP(P<0.05). All these effects induced by BTED were not present when ZnPP war given. Conclusions BTED could reduce the lung inflammation and edema of the rats with SAP via the HO-1 pathway. References | Related Articles | Metrics

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Preliminary research on colorectal cancer neoadjuvant therapy sensitivity through high-throughput transcriptome sequence CHEN Xianze, CHENG Xi, WU Haoxuan, ZHANG Tao, JI Xiaopin, ZHAO Ren 2018, 23 (01):  67-71.  DOI: 10.16139/j.1007-9610.2018.01.015 Abstract ( 478 )   PDF (846KB) ( 147 )   Objective To screen and identify the genes associated with sensitivity of neoadjuvant therapy for the patients with colorectal cancer through high-throughput transcriptome sequence technology and bioinformatics tools by analysis of the genes which expressed differently. Methods RNA was extracted from the tumor tissue of 22 patients with co-lorectal cancer who received standard neoadjuvant therapy before operation. Nine cases were divided as sensitive group and 11 cases as non-sensitive group based on tumor regression grading. Strand libraries were constructed for high-throughput sequencing. The genes filtered the false discovery rate(<0.05) were mapped to the reference genome, and assembled. The obtained transcripts were classified and annotated and the characteristics of gene were analyzed. Results The gene database associated with neoadjuvant therapy for colorectal cancer was built preliminarily. From 22 patients with colorectal cancer tissues, 89 genes were found up-regulated significantly and 112 genes down-regulated. Conclusions The genes related to the sensitivity of colorectal cancer neoadjuvant therapy were identified in this study using high-throughput transcriptome sequence. References | Related Articles | Metrics