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Objective@#To evaluate the safety and feasibility of laparoscopic radical antegrade modular pancreatosplenectomy(Lap-RAMPS) for left-sided pancreatic adenocarcinoma.@*Methods@#Clinical data of total 12 patients underwent Lap-RAMPS for left-sided pancreatic adenocarcinoma at Department of Gastrointestinal and Pancreatic Surgery, Zhejiang Provincial People′s Hospital from March 2016 to August 2017 were reviewed retrospectively.There were 7 male patients and 5 female patients, with median age of 60.5 years old(47-68 years old). Abdominal enhanced CT, pancreatic MRI, PET-CT were performed on all patients to evaluate the lesion and exclude metastasis.Follow-up were done with out-patient clinic or telephone consultancy until October 2017.@*Results@#All patients underwent pure Lap-RAMPS.The medium operative time was 250 minutes(180-445 minutes), and the blood loss was 150 ml(50-500 ml). The medium first flatus time and diet resumption time were 3.0 days(1-5 days) and 3.5 days(1-7 days) respectively.The medium postoperative hospital stay was 9 days(4-18 days). Morbidity occurred in 8 patients with gastric empty delay(n=1), bleeding(n=1), fluid collection(n=3). There was no mortality.The medium overall number of retrived lymph nodes was 15.6 and the positive rate was 41.7%. The R0 rate was 100%.The medium follow-up was 10 months.One patient was diagnosed as liver metastasis after 8 months and accepted chemotherapy.One patient died after 14 months for tumor recurrence and metastasis.Others survived without tumor recurrence or metasitasis.@*Conclusion@#Lap-RAMPS is safe and feasible with accepted oncological outcomes for selected left side pancreatic adenocarcinoma under skilled hands.
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Objective To analyze the efficacy and safety of CyberKnife combined with temozolomide (TMZ) in treatment of brain metastasis of non-small cell lung cancer (NSCLC). Methods From March 2013 to March 2016, 62 NSCLC patients with brain metastases in department of oncology of the 187th Hospital of PLA were divided into two groups according to the random number table method, the CyberKnife combined with TMZ group (CyberKnife + TMZ group, 31 cases) and simple CyberKnife group (CyberKnife group, 31 cases). Hypofractionated radiation of CyberKnife was given 18-36 Gy in 1-5 fractions of 5-25 Gy. CyberKnife+ TMZ group was given temozolomide 150 mg·m-2·d-1 for 5 days in first cycle, then every 28 days they received temozolomide therapy from the second to the sixth cycles: 200 mg·m-2·d-1 for 5 days. The clinical symptom remission rate after the treatment of CyberKnife in one week, the effective rate after CyberKnife in 3 months, the median intracranial progression-free survival time, overall survival, and the incidences of adverse reaction were comparatively analyzed. Results The clinical symptom remission rates of CyberKnife+TMZ group and CyberKnife group after the treatment of CyberKnife in one week were 93.6 ％ (29/31) and 96.8 ％ (30/31). There was no significant difference in the clinical symptom remission rates (χ2= 1.207, P=0.547). The effective rates of the two groups after CyberKnife in 3 months were 93.6 ％ (29/31) and 90.3 ％(28/31). There was no significant difference in the effective rates (χ2 = 0.695, P= 0.706). The median intracranial progression-free survival time in CyberKnife + TMZ group (14.0 months) was significantly higher than that in the CyberKnife group (9 months) (χ2=8.977, P=0.003), and the median overall survival time in CyberKnife + TMZ group (15.0 months) was also significantly higher than that in the CyberKnife group (12.0 months) (χ2 = 5.190, P= 0.023). There was no significant difference in the adverse reaction of the central nervous system between the two groups (χ2=0.746, P=0.689), but the adverse reactions of the digestive system (χ2 = 6.062, P= 0.014) and the hematologic system (χ2 = 6.613, P= 0.010) in CyberKnife + TMZ group were significantly higher than those in the CyberKnife group. Systemic adverse reactions of the two groups were tolerated by most patients. Conclusions CyberKnife combined with TMZ is a feasible therapeutic option for NSCLC patients with brain metastases. This therapy can improve the median survival time to cerebral progression of the disease and the median overall survival time.
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Objective To investigate the treatment efficacy,feasibility and safety of laparoscopic resection for gastric gastrointestinal stromal tumors (GISTs) larger than 5 cm.Methods The clinical data of 31 patients who underwent laparoscopic resection of large gastric GISTs between Jan 2010 and Jun 2017 at Sir Run Run Shaw Hospital and People's Hospital of Zhejiang Province were retrospectively analyzed.Results All operations were successful.Two patients were converted to open surgery.The mean tumor size was (7.2 ±0.5) cm.The mean operation time was (127 ± 12) min,intraoperative blood loss was (83 ±25) ml.The first flatus time was (2.2 ±0.8) days,the first diet resumption time was (2.4 ± 1.2) days,and the median postoperative hospital stay was (5.5 ± 1.5) days.The median follow-up time was 25 months.One patient developing liver metastasis 41 months after primary resection received oral mesylate imatinib therapy for 24 months and was still alive at the last follow-up.One patient died of lung cancer 33 months after primary operation without recurrence of gastric GIST.Conclusions Laparoscopic surgery for gastric GIST larger than 5 cm on laparoscopicaly accessible location is feasible and safe.
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Neuroendocrine tumor of the pancreas (pNET) is a rare group of neoplasms with widely heterogeneity. Complete surgical resection remains the only potentially curative treatment for pNET. Compared to open surgery, minimal invasive approach treating pNET could decrease bleeding and shorten postoperative hospital stay, while didn′t show difference in operation time, postoperative complication rate and overall mortality. Therapeutic strategy was formulated by synthesizing clinical symptoms, tumor size and tumor stage. Minimal invasive approach can achieve radical curve of oncology and provide refine manipulation condition to improve surgical safety and efficacy, meanwhile realize function preservation. Minimal invasive approach is a safe and efficient method in treating pNET, but further prospective, randomized control trials are required.
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Objective@#To summarize the incidence and characteristics of postoperative complications after laparoscopic pancreaticoduodenectomy(LPD), and to share our experience on management of complications.@*Methods@#The clinical data of 320 LPD performed by a single team in Sir Run Run Shaw Hospital and Zhejiang Provincial People′s Hospital between September 2012 and September 2017 were retrospectively analyzed, among which there were 196 males and 124 females with age of (60.2±11.6) years old.There were 306 patients who underwent standard LPD, and 14 patients who underwent extended LPD. The patients were divided into 2 groups of former 160 LPD and later 160 LPD according to the time order. By analyzing the differences of clinical outcomes between the two groups, especially focusing on the incidence of postoperative complications.The experience on management of complications was concluded. The prior surgical history of latter group was significantly higher than the former group(30.0%(48/160)vs. 18.8%(30/160), χ2=5.49, P=0.019), and the rest of baseline characteristics remained the comparable (P>0.05). For resectable lesions, LPD was performed by "No back" approach, following the principle of "From distal to cephalad, from ventral to dorsal, and from left to right" . As for the borderline resectable patients, LPD was performed by "Easy first" strategy. Student t test, χ2 test or Fisher test was used to analyzed the data between the two groups respectively.@*Results@#Of 320 LPD patients, 306 cases underwent standard LPD, 14 cases underwent LPD with resection of other organs.There were 278 LPD cases who followed "No back" approach, and 42 cases who followed "Easy first" strategy because of difficulty in creating the retro-pancreatic tunnel. And the overall morbidity was 32.2%(103/320) with reoperation rate of 5.3%(17/320). The perioperative mortality was 0.6%(2/320). The operation time of latter group was ((346.6±48.8)minutes), which was shorter than that of former group((358.0±54.4)minutes)(t=1.97, P=0.048). The blood loss of former and latter group remained comparable((207.9±135.8)ml vs.(189.6±121.4)ml, P=0.205). However, in subgroup analysis, the patients with blood loss less <200 ml of latter group decreased significantly from 59.4%(95/160) to 47.5%(76/160)(χ2=4.53, P=0.033). The overall morbidity of latter group was 28.8%(46/160), indicated a decrease from 35.6%(57/160) of former group without significant difference(P=0.188). Moreover, Grade A/B/C pancreatic fistula rate, Grade A/C bile leakage rate, Grade B/C postoperative hemorrhage rate of the later group tended to decrease, although they also didn′t reach a significant difference. However, the abdominal infection rate decreased significantly(χ2=3.93, P=0.047). The length of hospital stay remained comparable(P=0.156).@*Conclusions@#The most common complications after LPD were postoperative hemorrhage and pancreatic fistula. With specialized team and accumulated experience, the morbidity can decrease progressively by analyzing the leading cause and improving the technical skills.
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To explore the clinical ,pathological and immunohistochemical features of carcinoma with multi-directional differentiation derived from junction of bladder and prostate .We collected clinical data and tissue samples of three typical cases of carcinoma from our hospital .Routine preparation of slides and immunohistochem-ical methods combined with clinical data and pathological changes analysis were adopted .We found that all 3 ca-ses occurred in the elderly lesions involving the bladder and prostate .Dysuria was the main common symptom .All the cases had a history of chronic inflammation in urethral and prostate gland .The following up data showed that survival time in two of them were no more than 15 months.The third patient without chemotherapy who took drugs of bicalutamide,enantone and pamidronate still was alive after 28 months.The pathological changes of these cases had the common features with diversity .They all showed the structure with nests ,papillary,solid,adenoid,single or syncytial cells .The nuclear of cancer cell was enlarged with hyperchromatic feature .The mitotic figures were easily found.The metaplasia and atypical hyperplasia of prostate were all found .The immunohistochemistry results showed positive results for HCK,LCK,p53,p63,PSA,P504S and negative for vimentin and S -100.The average proliferation index of Ki-67 was 77%.
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Objective To investigate the expression of bone sialoprotein (BSP) in prostate cancer and its clinical significance. Methods Prostate cancer tissues of different pathological grades (68 cases) and benign prostatic hyperplasia tissues (22 cases) were selected. SP method was used to detect the expression of BSP. Serum total prostate-specific antigen (tPSA) levels of prostate cancer were detected by electrochemiluminescence immunoassay before the operation. Results Compared with no or low expression in the adjacent normal glandular tissues, the detectable levels of BSP were examined in most of the prostate cancer tissues. The expression rate of BSP in prostate cancer tissues was higher than that in benign prostatic hyperplasia tissues [76.47%(52/68) vs 13.64%(3/22),χ2=27.614, P<0.001]. The expression rates of BSP in well differentiated, moderately differentiated and poorly differentiated tissues according to cell differentiating degree (Gleason system) were 75.0 % (12/16), 77.5 % (31/40) and 75.0 % (9/12) respectively. There was no significant difference in various pathological grading (χ2=0.057, P=0.972). The expression rates of BSP in pathological stage pT2, pT3 and pT4 tissues were 62.16%(23/37), 95.24%(20/21) and 90.0%(9/10) respectively. A statistically significant association was found between BSP expression and pathological stage (χ2=9.338, P=0.009). Serum tPSA level of prostate cancer group with BSP expression was higher than that with no BSP expression [(69.06±25.52)μg/L vs (38.00±21.64)μg/L, F=19.355, P<0.001]. Conclusion The high expression of BSP in prostate cancer has a relationship with pathological stage and serum tPSA level, it may play an important role in the biological behaviour of prostate cancer.
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Objective To investigate the effect of argatroban on C-reactive protein (CRP) and therapeutic efficacy in patients of malignant tumor complicated by acute lower limbs deep venous thrombosis (DVT).Methods 56 patients of malignant tumor complicated by acute lower limbs DVT were randomly divided into two groups.In observation group (n =28),argatroban was given intravenously as anticoagulation.Urokinase as thrombolysis and warfarin as anticoagulation were used in the control group (n =28).The concentrations of serum CRP were detected before treatment and on the 14th day of post-treatment in observation group and control group.Recanalization and therapeutic effect of DVT were compared.Results Before treatment,there was no significant differences in the serum CRP concentrations between observation group and control group [(46.44±28.82) mg/L vs (45.96±29.40) rmg/L,F =0.004,P =0.951].On the 14th day of post-treatment,the CRP concentrations in observation group and control group were lower than those of pretreatment (F =25.996,P ＜ 0.05,F =4.828,P ＜ 0.05).Compared with the 14th day of post-treatment,the CRP concentration of observation group was lower than that of control group [(16.97±10.22) mg/L vs (31.63± 18.07) mg/L,F =13.965,P ＜ 0.01].Recanalization rate of observation group on the 14th day of post-treatment (96.43 ％,27/28) was higher than that in control group (67.86 ％,19/28) (x2 =8.204,P =0.017).Therapeutic effect rate of observation group on the 14th day of post-treatment (96.43 ％,27/28) was higher than that in control group (75.00 ％,21/28) (x2 =6.205,P =0.045).Conclusion Argatroban can decrease serum level of CRP in patient of malignant tumor complicated by acute lower limbs DVT,which is favorable for improvement of clinical effectiveness.
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Objective To investigate the implication of C-reactive protein in development and prognosis of acute lower limb deep venous thrombosis (DVT) complicated by malignant tumor.Methods34patients with acute lower limb DVT complicated by malignant tumor(observation group),34 patients with acute lower limb DVT complicated by operation or wound(case control group)and 34 normal volunteers (normal control group) were included in this study.The observation group and case control group were treated with conventional therapy such as thrombolysis and anticoagulation.The serum concentrations of CRP before treatment and 14 days after treatment were detected. Recanalization of lower limb DVT and therapeutic efficacy were compared between observation group and case control group.ResultsThe serum concentrations of CRP in observation group before treatment were significantly higher than those in case control group and normal control group [(47.72±29.88) mg/L vs (30.04±15.84) mg/L and (6.19±2.99) mg/L,F =38.444,P ＜ 0.01].At the 14th day of post-treatment,the serum CRP concentrations in observation group and case control group were significantly lower than those before treatment (P ＜0.05).At the 14th day of post-treatment,the CRP concentrations of observation group and case control groups were significantly decreased,although those of observation group were still significantly higher than those of case control group and normal control [(32.77±19.68) mg/L vs (7.76±7.52) mg/L and (6.19±2.99) mg/L,F =50.087,P ＜ 0.01].However,there was no significant difference between case control group and normal control group on the 14th day of post-treatment (F =1.277,P =0.263).The recanalization rate of observation group at the 14th day of post-treatruent were significantly lower than those in case control group(x2 =7.731,P =0.021).The therapeutic effect rate of observation group at the 14th day of post-treatment were also significantly lower than those in case control group (x2 =6.969,P =0.031).ConclusionCRP may play important roles in occurrence,development and therapeutic effect of acute lower limb DVT complicated by malignant tumor.
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Objective To compare the efficacies of intralesional hyaluronidase(HAase), intralesional dexamethasone(DEX), and intralesional HAase plus intralesional DEX on skin damage caused by vinorelbine extravasation in a rat model. Methods After establishing an animal model with vinorelbine extravasation in each lower extremity of 40 Sprague-Dawley rats, we treated the rats with intralesional HAase,intralesional DEX, intralesional HAase plus intralesional DEX,intralesional saline,or received no treatment as control.The wound area on 1 d, 4 d, 8 d, 12 d, 18 d, 24 d, 30 d and the time of healing were observed and compared.Results The wound area on 1 d, 4 d, 8 d, 12 d, 18 d and 24 d was significantly lower in intralesional HAase group, intralesional DEX group,intralesional HAase plus intralesional DEX group,and intralesional saline group than that in control group (P ＜0.05), and that was significantly lower in intralesional HAase group and intralesional HAase plus intralesional DEX group than that in intralesional DEX group and intralesional saline group (P ＜0.05). The healing time was significantly shorter in 4 therapy groups than that in control group [(25.1±3.1) d, (27.9±2.8) d, (23.0±3.2) d, and (28.4±3.9) d vs.(31.2±3.0) d, P ＜0.05], and that was significantly lower in intralesional HAase group and intralesional HAase plus intralesional DEX group than that in intralesional DEX group and intralesional saline group (P ＜0.05). Conclusion The monotherapy with intralesional HAase or intralesional DEX, with decreasing the extent of skin damage and shortening the healing time, is effective therapy for skin damage caused by vinorelbine extravasation, and the monotherapy with intralesional Haase is more efficacious. The efficacy of intralesional HAase plus intralesional DEX seems better than that of monotherapy.
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Objective The purpose of present study was to compare the efficacy of topical dimethyl sulfoxide(DMSO),intralesional hyaluronidase(HAase)and intralesional HAase plus topical DMSO on skin damage caused by docetaxel extravasation in a rat model.Methods After the establishment of animal model of docetaxel extravasation on each hind limb in 30 SD rats,the animals were assigned randomly into 6 groups with 5 rats for each group:topical DMSO group(TD),intralesional HAase group(IH),IH plus TD group(IH+TD),topical normal saline group(tNS),intralesional NS group(iNS),and control group(C).The extent of skin damage and the healing time were observed and compared.Results The extent of skin damage was different among the 6 groups:severer skin damage was seen in tNS,iNS and C groups compared with TD,IH and IH+TD groups.The healing time was significantly shorter in TD group than in both tNS and C groups [(19.10?2.13)d vs(23.70?2.41)d and(25.70?2.26)d,P