Aligned Organization of Synapses and Mitochondria in Auditory Hair Cells / 神经科学通报·英文版

Recent studies have revealed great functional and structural heterogeneity in the ribbon-type synapses at the basolateral pole of the isopotential inner hair cell (IHC). This feature is believed to be critical for audition over a wide dynamic range, but whether the spatial gradient of ribbon morphology is fine-tuned in each IHC and how the mitochondrial network is organized to meet local energy demands of synaptic transmission remain unclear. By means of three-dimensional electron microscopy and artificial intelligence-based algorithms, we demonstrated the cell-wide structural quantification of ribbons and mitochondria in mature mid-cochlear IHCs of mice. We found that adjacent IHCs in staggered pairs differ substantially in cell body shape and ribbon morphology gradient as well as mitochondrial organization. Moreover, our analysis argues for a location-specific arrangement of correlated ribbon and mitochondrial function at the basolateral IHC pole.

Clinical characteristics of esophageal reflux after total gastrectomy / 中华普通外科杂志

Objective:To observe the clinical characteristics of esophageal reflux after total gastrectomy (ERATG), and to explore the mechanism of occurrence.Methods:Fourteen gastric cancer patients who underwent total gastrectomy were prospectively enrolled in this study. The postoperative symptoms were observed and recorded and 24 h MII-pH with pH monitoring was performed to investigate the characteristics of postoperative reflux.Results:After total gastrectomy patients were with different degrees of ERATG as heartburn, appetite loss, chest tightness and belching. The overall nature of ERATG is mainly weak acid, with a pH between 4 and 7. ERATG involved esophageal-jejunal anastomosis and a length of esophagus 7 cm above the anastomosis. Patients with typical reflux symptoms had a lower pH minimum in the upright position than those without typical symptoms[(4.76±0.71) vs.(5.68±0.37), t=2.866, P<0.05]. Patients with typical reflux symptoms had a higher frequency of reflux of mixed liquid and liquid-air reflux than those without typical symptoms[liquid(31.25±29.76) vs.(4.50±9.14), t=0.011, P<0.05; liquid-air(19.50±12.99) vs.(2.00±2.61), t=0.004, P<0.05]. Conclusion:ERATG is mainly a upward reflux of weakly acidic gas, with typical symptoms of heartburn, appetite loss, chest tightness and belching. Patients with typical symptoms usually have lower pH in the upright position.

Diagnostic value of tumor markers in peritoneal lavage fluid for peritoneal metastasis of colorectal cancer / 中华普通外科杂志

Objective:To determine the diagnostic value of tumor markers in peritoneal lavage fluid from colorectal cancer patients for tumor peritoneal metastasis.Methods:A total of 227 colorectal cancer patients who undergoing surgical treatment were included. 300 ml of peritoneal lavage fluid was irrigated immediately upon laparotomy for traditional cytology (PLC) testing, 134 patients were tested for tumor marker of peritoneal lavage fluid (pTM). Univariate analysis was performed to determine the risk factors for peritoneal metastasis; pTM ROC curve was used to determine the best cutoff value; paired chi-square test was used to compare the difference between PLC and pTM detection.Results:The positive rate of PLC was 12.3% (28/227). Age>65, stage T3 + , lymph node metastasis, mucinous adenocarcinoma and increased serum CA125, CA19-9 are related to peritoneal metastasis; The best cutoff value of pTM for peritoneal metastasis : pCEA 17.095 ng/dl, sensitivity 58.3%, specificity 93.9%; pCA19-9 4.515 U/ml, sensitivity 83.3%, specificity 80.0%; pCA125 303.2 U/ml, sensitivity 58.3%, specificity 95.7%; pCA-724 3.01 U/ml, sensitivity 66.7%, specificity 95.7%; The best cutoff value of pTM for peritoneal micrometastasis: pCA19-9 3.43 U/ml, sensitivity 100%, specificity 72.2%. The positive rate of pCA19-9 was 29.85%, which was higher than that of PLC (χ 2=2.00, P<0.05). Conclusion:Peritoneal metastasis of colorectal cancer is related to tumor T stage, lymph node metastasis, tumor pathological type, and increased serum CA125 and CA19-9; pTM has diagnostic value for peritoneal metastasis of colorectal cancer.

Indocyanine green fluorescence imaging during laparoscopic anterior resection in rectal cancer patients / 中华普通外科杂志

Objective:To investigate the role of indocyanine green(ICG) fluorescence imaging in laparoscopic anterior resection for rectal cancer.Methods:A retrospective analysis was performed on 7 patients who had undergone laparoscopic anterior resection with the use of ICG fluorescence imaging at Peking University People′s Hospital between Oct 2018 and Mar 2019. The clinicopathological variables, surgical factors, short-term outcome and complications were analyzed.Results:The median operation time was 185 min. The median estimated blood loss was 50 ml. The median time from ICG injection to anastomotic perfusion was 45 s. One patient received extended proximal resection of bowel due to poor perfusion as suggested by ICG imaging. The median time to soft diet was 4 days, and the median hospital stay was 8 days. The median number of lymph nodes harvested was 16. There were no major complications in all these patients. No adverse events related to ICG were recorded.Conclusions:ICG fluorescence imaging was safe and effective in detecting insufficient blood supply around newly established bowel anastomsis, hence potentially reducing the anastomotic leakage rate.

Detection of intraperitoneal free cancer cells in gastric cancer patients undergoing gastrectomy and its relationship with short-term prognosis / 中华普通外科杂志

Objective To evaluate different methods in detecting intraperitontal free cancer cells (IFCCs) in patients with gastric cancer and to clarify the relationship between positive IFCCs and short-term prognosis.Methods A total of 119 gastric cancer patients who underwent surgical treatment were enrolled.Peritoneal lavage was performed with 300-400 ml saline respectively at three points of time:immediately after abdominal cavity entry;when surgical operation was completed;when extensive intraoperative peritoneal lavage was done.The IFCCs were detected with methods of traditional centrifugal cytology,membrane cytology,ICC and RT-PCR.The survival curve of patients with gastric cancer was drawn using Kaplan-Meier method.Results The positive rate of PLC was 16.8％,20.7％ and 11.2％ respectively at 3 timepoints (P ＜ 0.05).The positive rates of ICC were 28.6％,38.8％ and 20.7％ respectively at 3 timepoints.The positive rates of RT-PCR were 39.3％,69.5％ and 50.8％ respectively at 3 time points.The positive rate of IFCCs detected through RT-PCR was higher than that of PLC and ICC (P ＜ 0.05).The short-term prognosis of patients with positive IFCCs was worse than those with negative results detected with any three method at the timg point immediately after opening the abdomen (P ＜ 0.05).At the timg point immediately after removing the tumors,the short-term prognosis of patients with positive IFCCs detected with PLC was worse (P ＜ 0.05).Conclusion The short-term prognosis was poor in patients with positive IFCCs.It is the best time to detect IFCCs before radical resection.Surgical procedures increase the risk of shedding of IFCCs.

Clinical characteristics of gastric cancer with pulmonary lymphangitic carcinomatosis in seven cases / 中华普通外科杂志

Objective To summarize and analyze the clinical characteristics,pathological features and follow-up data of patients with pulmonary lymphaugitic carcinomatosis(PLC) caused by gastric cancer.Methods A retrospective analysis was performed on 7 cases of gastric cancer with pulmonary carcinomatosis in Peking University People's Hospital between Jan 2000 and Dec 2017.Results 7 patients were identified from our database.All patients were female,with an average age of (54 ± 18) years.4 patients were treated with respiratory symptoms and 3 patients presented with gastrointestinal symptoms.One patient received gastrectomy,one did chemotherapy,5 patients had other site metastasis,one was still alive at the end of follow up.Patients average survival time was (4.8 ± 4.0) months.Conclusions Pulmonary lymphatic carcinomatosis caused by gastric cancer is rare clinical entity and the prognosis is poor.Patients often present with respiratory symptoms.Chest CT showed diffusely nodular thickening of interlobular septa and peribronchovascular interstitium.Biopsy of the gastric tumor often establish the diagnosis.

Predictive factors of intestinal necrosis in acute mesenteric vascular occlusive diseases / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To explore the predictive factors of intestinal necrosis in acute mesenteric vascular occlusive diseases and its significance for the timing of exploratory laparotomy.</p><p><b>METHODS</b>This retrospective study enrolled 63 patients diagnosed as acute mesenteric vascular occlusive diseases at Peking University People's Hospital between July 1995 and June 2015. Univariate analysis and multivariate logistic regression analysis were used to identify predictive factors for intestinal necrosis.</p><p><b>RESULTS</b>Of 63 patients, 39 were male and 24 were female, with a mean age of (58.8±12.7)(31 to 82) years. The overall rate of intestinal necrosis was 46.0%(29/63). Patients with intestinal necrosis had a poorer prognosis than those who did not develop intestinal necrosis (χ=5.908, P=0.015). In univariate analysis, the predictive factors of intestinal necrosis were systemic inflammatory reactive syndrome (SIRS) (χ=18.535, P=0.000), shock (χ=7.775, P=0.007), peritoneal irritation sign (χ=11.533, P=0.001), changes of intestinal wall and blood signals on ultrasound or CT scans (χ=14.344, P=0.000), international normalized ratio(INR) (prothrombin time) ≥1.2 (χ=4.498, P=0.034), D-dimer ≥1 000 g/L(χ=6.680, P=0.010), low-density lipoprotein ≥270 U/L (χ=6.513, P=0.011), serum albumin <35 g/L (χ=3.914, P=0.048), blood urea nitrogen ≥6.2 mmol/L (χ=11.377, P=0.000), pH values <7.35 (χ=15.887, P=0.000), blood lactate ≥2 mmol/L(χ=17.134, P=0.000), base excess <-1.0 mmol/L (χ=6.674, P=0.010). According to multivariate logistic regression analysis, SIRS(OR=28.945, 95%CI:2.294 to 365.199, P=0.009), pH values <7.35(OR=13.174, 95%CI:1.157 to 150.027, P=0.038), changes of intestinal wall and blood signals on ultrasound or CT scans(OR=4.857, 95%CI:1.110 to 21.253, P=0.036) were independent predictive factors of intestinal necrosis in patients with acute mesenteric vascular occlusive diseases.</p><p><b>CONCLUSIONS</b>Intestinal necrosis in acute mesenteric vascular occlusive diseases prompts a poor prognosis. When patients with acute mesenteric vascular occlusive diseases are found to have acidosis, SIRS and changes of intestinal wall and blood signals on ultrasound or CT scans, surgeons should be alert to the occurrence of intestinal necrosis and should perform laparotomy promptly in order to take suitable management.</p>

da Vinci robotic system versus laparoscopic surgery for colorectal cancer / 中华普通外科杂志

Objective To compare the surgical outcomes of RAC versus LAC for the surgery of sigmoid-rectal cancer.Methods In this study,19 patients received robotic assisted colectomy (RAC)and 37 patients received laparoscopic assisted colectomy (LAC).Results The duration of surgery was longer in the RAC group (240 ± 76) min vs.(177 ± 74) min,t =3.006,P =0.004.The blood loss was less in the RAC group (67 ±40) vs.(153 ±151) ml,t =-2.422,P=0.019.The time to tolerate solid food was shorter in the RAC group (6.1 ±2.2)d vs.(7.4 ±4.4)d,t =-1.329,P =0.189 and the postoperative hospital stay was shorter in the RAC group (8.5 ± 2.6) d vs.(10.0 ± 3.6) d,t =-1.577,P =0.121.Mobidity and number of lymph nodes harvested were similar in both groups.7 cases were converted to open surgery in LAC group but none in RAC group.Conclusion Compared to laparoscopic surgery,Robotic-assisted colorectomy was safe and associated with less blood losses,lower conversion rate to open surgery and faster recovery of bowel function.

Early predictive factors for intestinal necrosis in acute superior mesenteric artery occlusive diseases / 中华普通外科杂志

Objective To explore the early predictive factors of intestinal necrosis in patients with acute superior mesenteric arterial occlusive disease and its significance for the decision of exploratory laparotomy.Methods This retrospective study enrolled 29 patients diagnosed with acute superior mesenteric artery embolism or thrombosis in Peking University People's Hospital between July 1995 and June 2015.Results 12 patients developed intestinal necrosis.Patients with intestinal necrosis had a poorer prognosis than those who did not develop intestinal necrosis (x2 =14.867,P =0.000).In univariate analysis,the early predictive factors for intestinal necrosis were D-Dimer ≥ 600 μg/L (x2 =11.455,P =0.002),INR≥1.2 (x2 =3.948,P =0.047),pH values ＜7.4 (x2 =8.191,P =0.004),BE ＜ -1.0 mmol/L (x2 =8.191,P =0.004),blood lactate ≥ 2.2 mmol/L(x2 =7.535,P =0.006),BUN ≥ 6 mmol/L (x2 =10.076,P =0.002),CK ≥ 80 U/L (x2 =8.191,P =0.004),LDH ≥ 210 U/L (x2 =13.079,P=0.000),AST ≥25 U/L (x2 =10.076,P =0.002),SIRS (x2 =10.076,P =0.002).Multivariate logistic regression analysis found no independent predictive factors of intestinal necrosis in patients with acute superior mesenteric arterial occlusive diseases.Conclusion Intestinal necrosis in acute mesenteric arterial occlusive diseases indicates a poor prognosis.Coagulation abnormalities,liver or kidney dysfunction,metabolic acidosis and SIRS necessitates an immediate exploration.

Risk factors for the perineal incision complications after abdominoperineal excision for rectal cancer / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To evaluate the factors affecting perineal incision complications after abdominperineal excision(APE) for rectal cancer.</p><p><b>METHODS</b>This was a retrospective study of 167 patients with rectal cancer undergoing APE at Peking University People's Hospital between October 1998 and December 2013. Chi-square test and multivariate Logistic regression analysis were used to identify risk factors.</p><p><b>RESULTS</b>The overall rate of perineal incision complication was 24.6%(41/167) including 7 cases of incision infection, 10 cases of incision fat liquefaction, 21 cases of poor wound healing, 2 cases of incision fistula, 1 case of incision dehiscence. In univariate analysis, the risk factors associated with perineal incision complication were operating time≥280 minutes(P=0.005), blood loss≥350 ml(P=0.017) and the protective factors associated with perineal incision complication were the procedure of APE (P=0.048), intraperitoneal chemotherapy with 5-FU sustained release (P=0.014), lymph node metastasis (P=0.006), while gender, age, BMI, ASA score, other complications, distance from distal tumor to anal verge, preoperative radiochemotherapy, postoperative stay in ICU, total drainage volume 3 days before operation, tumor differentiation, and postoperative TNM staging were not associated with perineal incision complication(all P>0.05). Multivariate logistic regression analysis identified two independent risk factors: operating time≥280 minutes(OR=5.217, 95% CI:1.250 - 6.234, P=0.000), intraperitoneal chemotherapy with 5-FU sustained release(OR=3.284, 95% CI:1.156 - 9.334, P=0.026).</p><p><b>CONCLUSIONS</b>Operating time≥280 minutes and intraperitoneal chemotherapy with 5-FU sustained release are independent risk factors for perineal incision complications after APE for rectal cancer. For patients receiving APE procedure, intraperitoneal chemotherapy with 5-FU sustained release should be used with caution, and the operative time should be reduced when possible.</p>

Application of transperineal single-port access assisted extralevator abdominoperineal excision in low rectal cancer / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To explore the feasibility and safety of transperineal single-port laparoscopy assisted exralevator abdominoperineal excision(TPSP-ELAPE).</p><p><b>METHODS</b>Three cases (2 males and 1 female) who underwent TPSP-ELAPE at lithotomy position in the Peking University People's Hospital from January to February 2016 were analyzed retrospectively. The mean age was(55.3±7.2) years. Mean body mass index (BMI) was (23.0±1.3) kg/m(2). Mean distance between tumor and anal verge was (1.8±0.3) cm. Abdominal procedure was done firstly and then perineal procedure under lithotomy position. Abdominal procedure was performed by routine laparoscopy with 5 trocars. TPSP-ELAPE procedure was performed in perineal procedure. The perineal defect was closed by purse string, followed by spindle incision around the anus. Perianal skin and subcutaneous tissue was dissected until the junction between extra anal sphincter and levator ani muscle under direct vision. Perineal skin was sutured with double purse string by 2-0 prolene, and single port canal was placed inside in order to close perineal defect. The pneumoperitoneal pressure was set to 10 mmHg and laparoscopy and instrument was placed through the single-port canal. Space between isochioanal fossa and levator ani muscle was exposed by the contraction of laparoscopic clam. Lateral and posterior side was mobilized firstly. The anterior was dissected under the help of vaginal examination and contraction by abdominal group. The levator ani muscle was divided near the initial site, and negative resection margin was confirmed in the operation. Specimen was exteriorized through the perineum.</p><p><b>RESULTS</b>The mean intraoperative blood loss of three cases was (123.3±25.2) ml. The total operative time was (296.7±25.1) minutes. The time used by the perineal group was (196.7±20.8) minutes. The volume of drainage was (39.0±10.1) ml at the third day after operation. The time to first stoma output was (2.3±0.6) days. The perineal drainage removal time was (7.7±0.6) days. The circumferential resection margins were negative in all specimens, and there were no perioperative complications.</p><p><b>CONCLUSION</b>TPSP-ELAPE is feasible and safe, which could avoid turning over the patient and facilitate anesthesia. It follows the anatomic plane of open ELAPE procedure with minimally invasive advantage.</p>

Prospect of transanal minimally invasive surgery for rectal neoplasm / 中华胃肠外科杂志

Transanal minimally invasive surgery (TAMIS) is a kind of minimally invasive surgery that local resection or total mesorectal excision for rectal neoplasm is performed through the use of multichannel port(single port) transanally. Compared to transanal endoscopic microsurgery(TEM) approach, TAMIS offers an alternative to TEM for rectal neoplasm, and shows the advantage of lower cost and shorter learning curve. TAMIS approach has been used not only in the local resection of rectal neoplasm but also in transanal total mesorectal excision (transanal TME), which is also called TAMIS-TME, in recent four years. The safety and efficacy of TAMIS approach has been shown in the currently published literatures. However, TAMIS approach has to wait for more evidence-based data with larger-scale and longer follow-up to get its validation.

Comparative study of clinical efficacy between abdominoperineal resection and anterior resection procedure in patients with rectal cancer / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To compare clinical efficacy between abdominoperineal resection (APR) procedure and anterior resection(AR) procedure in patients with rectal cancer.</p><p><b>METHODS</b>Clinicopathological data of 309 cases with rectal cancer undergoing resection in Peking University People's Hospital from January 1998 to December 2012 were retrospectively analyzed. Short-term outcomes, local recurrence, overall survival (OS) and progression-free survival (PFS) were investigated between two groups.</p><p><b>RESULTS</b>As compared to the AR group, the operative time was longer [(268.5 ± 66.7) min vs. (247.4 ± 64.2) min, P=0.005], blood loss[(668.5 ± 680.1) ml vs.(441.8 ± 478.6) ml, P=0.001] and drainage volume were more[(66.9 ± 54.7) ml vs. (49.0 ± 45.9) ml, P=0.002] in the APR group. There was no significant difference of local recurrence between the two groups, while the 5-year local recurrence rate of T3-T4 patients undergoing APR procedure (24.9%) was higher than that of AR group (13.9%)(P=0.038), especially in the patients with tumors located at 4-6 cm away from the anus verge. There were no significant differences of OS (P=0.273) and PFS (P=0.589) between two groups, while both 5-year OS and PFS of T3-T4 patients with BMI ≥ 24 undergoing APR procedure (43.1% and 42.8%) were significantly worse than those of patients undergoing AR procedure (87.9% and 76.9%, P=0.022 and P=0.041).</p><p><b>CONCLUSIONS</b>The overall prognosis of patients after APR and AR is comparable. Tumor located at 4-6 cm away from the anus verge, T3-T4 stage, obese may play an important role in the worse prognosis of the patients undergoing APR procedure.</p>

Three procedures of transanal minimally invasive surgery (TAMIS) for advanced mid-low rectal tumor / 中华胃肠外科杂志

Transanal minimally invasive surgery (TAMIS) is a novel minimally invasive procedure which is performed by normal laparoscopic instruments through the single port transanally. Three kinds of procedures have been performed based on the TAMIS platform by now, including TAMIS-TME(total mesorectal excision), TAMIS-APE(Abdominoperineal excision) and TAMIS-Hartmann. Transanal total mesorectal excision (taTME) with dissection from bottom to up through the platform of TAMIS is also called TAMIS-TME. The greatest advantage of TAMIS-TME is that it increases the quality of specimen and decrease the adverse injury due to the sufficient vision of lower part of mesorectum in the operation. TAMIS-APE and TAMIS-Hartmann procedures emerge after the experience of TAMIS-TME. TAMIS-APE procedure not only firstly make the dissection of perineal phase minimally invasive, but also make the perineal vision more clear, the resection of levator ani muscle more precise, eventually the tailored APE procedure comes true under the laparoscopy of perineal phase. The dissection of mid-low mesorectum for recurrent tumor is usually difficult just from above, TAMIS facilitates the resection through entering the normal anatomical space under the tumor. If the tumor has the risk of recurrence, distal rectum is closed and proximal colostomy is made, we firstly performed this procedure and name it TAMIS-Hartmann. Therefore, TAMIS is not only a platform for taTME, but also it provides a transanal approach and a "button to up" conception for the mid-low rectal tumor.

Efficacy comparison of laparoscopy and open resection for gastrointestinal stromal tumor at the esophagogastric junction / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To compare the clinical outcomes between laparoscopy and open resection for gastrointestinal stromal tumor at the esophagogastric junction.</p><p><b>METHODS</b>Clinicopathological data of 42 patients with gastrointestinal stromal tumor (GIST) of esophagogastric junction undergoing resection in our department between October 2004 and October 2014 were retrospectively analyzed. Among them, 22 patients underwent laparoscopic resection (LR group) and 20 patients underwent open resection (OR group). Short-term efficacy and long-term outcomes were compared between the two groups.</p><p><b>RESULTS</b>There were no significant differences between the two groups in common data of patients. The recovery time in the LR group was significantly shorter than that in the OR group, including bowel function recovery, ambulation, resumption of oral intake, and postoperative hospital stay (all P<0.05). The incidence of postoperative complications in the LR group was lower than that in the OR group(0 vs. 10%, P=0.221). Meanwhile difference of 5-year disease-free-survival between the two groups (LR 100% vs. OR 89%, P=0.384) was not statistically significant.</p><p><b>CONCLUSION</b>Laparoscopic resection for gastrointestinal stromal tumor at the esophagogastric junction is superior to open resection in short-term efficacy, and similar to open resection in long-term outcomes.</p>

Extralevator abdominoperineal excision versus traditional abdominoperineal excision in the treatment of low rectal cancer / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To compare the safety and efficacy between extralevator abdominoperineal excision(ELAPE) and traditional abdominoperineal excision(APE) in patients with low rectal cancer.</p><p><b>METHODS</b>From January 2011 to December 2013, 61 patients undergoing abdominoperineal excision for low rectal cancer at the Department of Gastrointestinal Surgery, Peking University People's Hospital were enrolled. The safety and efficacy of two procedure groups, ELAPE group (33 patients) and traditional APE group (28 patients) were reviewed retrospectively.</p><p><b>RESULTS</b>Less intraoperative blood loss [(201 ± 147) ml vs. (343 ± 308) ml, P=0.022], shorter exhaust time [(3.8 ± 1.5) d vs. (4.6 ± 1.6) d, P=0.039] and lower perineal wound complication rate (9.1% vs. 25.0%, P=0.042) were observed in the ELAPE group as compared to the traditional APE group. However, longer operation time [(292 ± 46) min vs. (256 ± 28) min, P=0.008] and perineal drainage removal time [(11.1 ± 4.8) d vs. (7.1 ± 2.7) d, P<0.01] were noted in the ELAPE group than those in the traditional APE group. Number of lymph node retrieved and positive lymph node retrieved was not significantly different between two groups. The ELAPE group had lower rate of IOP (intraoperative perforation) (6.1% vs. 17.9%, P=0.055), but no significant difference was found. There were no significant differences in bowel movement, diet restoring time, average perineal drainage, postoperative hospitalization time and removing perineal stitches time between the two groups (all P>0.05).</p><p><b>CONCLUSION</b>ELAPE possesses less intraoperative blood loss and lower perineal wound complication rate than traditional APE. ELAPE is associated with better safety and efficacy than traditional APE.</p>

The prognostic value of KISS1 expression of gastrointestinal stromal tumors / 中华普通外科杂志

Objective To evaluate KISS1 expression, and its significance in the prognosis of GIST patients. Methods In this study, 137 GIST cases and 73 non-GIST sarcoma cases were evaluated for clinicopathological characteristics and immunohistochemistry for KISS1 antibodies. Result The expression rate of KISS1 was 40.9% (56/137) in GISTs,which was significantly correlated with tumor size, disease extent, cellularity, presence of pseudocapaule, Fletcher's risk stratification and metastatic status after resection (P＜0.05). Patients with positive KISS1 expression had significantly worse disease free survival and disease specific survival (P ＜ 0.05 ). Conclusions KISS1 expression was associated with some clinicopathological characteristics as well as malignant behaviors in patients with GISTs. KISS1 might be a predictor in prognosis for GIST patients.

Safety evaluation of laparoscopic colorectal surgery in elderly patients / 中华消化外科杂志

Objective To evaluate the safety and feasibility of laparoscopie colorectal surgery in elderly patients.Methods The clinical data of 117 patients with colorechal cancer who had been admitted to People's Hospital of Peking University from January 2005 to December 2008 were analyzed retrospectively.Ail patients were divided into laparoscopic group(n=49)and open group(n=68).The postoperative conditions,incidence of complications and results of follow-up of patients in the 2 groups were compared.All data were analyzed via t test,chi-square test and Mann-Whitney U test,and the survival was analyzed via Kaplan-Meier method and Log-rank test.Results The mean operation time in laparoscopic group was(246±64)minutes,which was significantly longer than(218±50)minutes in open group(t=-2.677,P<0.05).The volume of blood loss,anal exsufflation time,postoperative hospital stay,ratio of patients who used analgesics and incidence of complications were (207±135)ml,3 days,12 days,45%(22/49)and 20%(10/49)in laparoscopic group,and were(296±178)ml,4 days,14 days,74%(50/68)and 44%(30/68)in open group,with significant difference between the 2 groups(t=2.920,U=770.5,1181.0,X~2=9.864,7.115,P<0.05).The length of bowel resected and number of lymph node dissected were(19±7)cm and 13±6 in laparoscopic group,and were(20±8)cm and 16±6 in open group,with no significant difference between the 2 groups(X~2=0.790,t=2.007,P>0.05).The 1-and 3-year accumulative survival were 95.4%and 85.2%in laparoscopic group,and were 94.7%and 82.3%in open group,with no significant difference between the 2 groups(X~2=0.581,P>0.05).Conclusion Laparoscopic surgery is safe and feasible for elderly patients with colorectal cancer.

Intraoperative recurrent laryngeal nerve monitoring during thyroid surgery under block anaesthesia of the cervical plexus / 中华普通外科杂志

Objective To investigate the monitoring of the recurrent laryngeal nerve (RLN)function during thyroid surgery by recording the compound muscle action potential (CMAP) of lateral cricoarytenoid muscle(LCA) under block anaesthesia of the cervical plexus. Methods Nicolet Endeavor CR(Viasys Healthcare, USA) was applied for the intraoperative monitoring. A pair of needle electrodes were inserted into LCA to record CMAP, and a concentric electrode was used to intermittently stimulate the RLN for monitoring the RLN function during operation under block anaesthesia of the cervical plexus.Results In these 28 cases 31 RLNs were exposed during operation, CMAPs appeared with consistent latency when stimulation was applied at the exposed segment. The stimulating intensity threshold ranged from 0.2 to 1.6 mA. The average value was 0.96 mA. 25 of 31 showed CMAPs with consistent latency when stimulation was provided along the possible pathway of the unexposed segment. The stimulating intensity threshold ranged from 1.3 to 3.5 mA. The average value was 2. 03 mA. 6 of 31 did not evoked CMAP even though the maximal stimulating intensity was 5 mA. When these six nerves were exposured, compound muscle action potential were evoked consistently. All of the 28 patients had normal phonation function after surgery.Conclusions It is a safe, effective and feasible method to monitor the RL N function by recording the CMAP of lateral cricoarytenoid muscle under block anaesthesia of the cervical plexus.

Laparoscopic versus open surgery in the treatment of colorectal cancer / 中华普通外科杂志

Objective To compare the therapeutic efficiency of laparoscopic and open radical colorectal surgery in the treatment of colorectal carcinoma. Methods Clinical data of 77 cases undergoing laparoscopic colorectal surgery from September 2004 to October 2007 were compared with 90 patients treated by open surgery. Results Mean operating time was longer in the laparoseopic group than that in the open group [248 minutes vs. 225 minutes (t = -2. 11 ,P =0. 036)], blood loss was less in laparoscopic group [210 ml vs. 315 ml (t = 2. 82, P = 0. 005)]. Laparoscopic surgery was associated with lower rate of analgesia use [48% vs. 80% (x2 = 18. 69 ,P < 0. 01)], earlier recovery of bowel function [2. 9 days vs. 4. 3 days(t =5.59,P <0. 01)]and shorter hospital stay [12. 5 days vs. 15.5 days (t =2. 32,P=0. 039)]compared with open surgery. The number of removed lymph nodes [14. 2 vs. 15.3 (t = 1.04, P = 0. 3)]and length of reseeted bowel [18. 9 cm vs. 20. 0 cm, (t = 0. 88,P = 0. 383)]were not different between the two groups. The mean follow-up time of the two groups were 28 months, local recurrence rate, metachronous metastases rate and 3-year cumulative survival rate were not statistically different between the two groups. Conclusion Laparoscopic surgery is as effective as conventional open surgery in the treatment of colorectal carcinoma.