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Objective:To explore application value of left colonic artery (LCA) preservation in low rectal anterior resection (Dixon) treating rectal cancer and its influences on short-term and long-term urinary function.Methods:Ninety patients with rectal cancer who underwent elective Dixon and were admitted to Suqian people's Hospital Affiliated to Xuzhou Medical University from June 2014 to June 2016 were enrolled. According to whether LCA was reserved during surgery, they were divided into observation group (48 cases, LCA preservation) and control group (42 cases, LCA non-preservation). The intraoperative operation time, intraoperative blood loss, hospitalization time, number of lymph node dissection at inferior mesenteric artery (IMA) root, number of cases undergoing ileostomy and at free spleen, postoperative first exhaust time, removal time of urinary catheter and urinary recovery time, occurrence of complications at 1 year after follow-up, urinary function and 3-year urinary function, survival, recurrence and metastasis were compared between the two groups.Results:The operation time in the observation group was longer than that in the control group ( P<0.05), and the proportion of grade 1 urinary function patients 1 year after operation was higher than that of the control group (χ 2=4.116, P=0.042). The first exhaust time, hospitalization time, catheter removal time, urinary recovery time, anastomotic leakage and fecal incontinence in the observation group were lower than those in the control group ( P<0.05). Conclusions:The curative effect of LCA preservation and LCA non-preservation is comparable in laparoscopic rectal cancer Dixon surgery. Although operation time of the former is prolonged, it can shorter postoperative first exhaust time and hospitalization time, reduce occurrence of postoperative anastomotic leakage, improve urinary function in the near future.
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Objective To investigate the change of the hemodynamics of the portal vein and the impact on portal vein thrombosis after esophagogastric devascularization and splenectomy (EDS) with early enteral nutrition.The impact of early enteral nutrition on portal vein thrombosis was studied.Methods 93 patients who underwent EDS in our hospital from January 2017 to January 2015 were randomly assigned to the control group and the study group.In the study group,a nasogastric tube was placed 20 cm into the duodenum-jejunum region.Enteral nutrition was administered via the nasogastric tube 6 hours after the operation.The patients in control group were treated with total parenteral nutriction after the operation.The changes in the diameter of the portal vein,the blood flow velocity and the blood flow of the portal vein were monitored by color Doppler before and after the operation.The relationships of these measurements with formation of portal vein thrombosis were compared with the control group.Results In the enteral nutrition study group,the maximum velocity of the portal vein blood flow decreased from (25.9s-5.6) cm/s before operation to (16.8±5.0) cm/s after operation,and the difference was statistically significant (P＜0.01).The average velocity of portal vein blood flow decreased from (20.6±4.6) cm/s to (14.8±4.2) cm/s after operation,and the difference was also statistically significant (P＜0.01).With the increase in enteral nutrition speed and volume,the average blood flow velocity of the portal vein and the blood flow increased significantly,especially after the third day with the use of Kang Quan Gan,and the difference was statistically significant compared with the control group (P＜0.01).The diameter of the trunk of the portal vein in the study group was wider than that in the control group,and the difference was statistically significant (P＜0.01).The incidences of portal vein thrombosis in two groups were compared.The results showed that the incidence of portal vein thrombosis in the study group (2/48,4.0％) was significantly lower than that in the control group (9/45,20.0％),and the difference was statistically significant (P＜0.05).Conclusion Early enteral nutrition aftcr EDS not only provided enough nutrition,but also reduced portal vein thrombosis rate and promoted liver functional recovery by promoting portal venous blood flow.
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Objective To compare the advantages and disadvantages of two approaches of laparoscopic radical resection for right colon cancer.Methods The data of 41 patients with right colon cancer in our hospital from March 2015 to December 2016 were analyzed retrospectively,who were randomly divided into the caudal-to-cranial group(n=23) and classical medial-to-lateral group(n=18) according to different approaches.The operation time,intraoperative blood loss,conversion rate,the number of lymph nodes dissection,hospital stay time and postoperative complications between two groups were compared.Results The operation time,intraoperative blood loss,the conversion rate of the caudal-to-cranial group were better than those of the classical medial-to-lateral group,the differences were significant(P<0.05).There was no significant difference in hospital stay time,the number of lymph nodes dissection and postoperative complications between two groups.Conclusion Laparoscopic radical resection for right colon cancer by caudal-to-cranial approach is easy to operate and dissect,it can shorten the operation time,decrease the intraoperative blood loss,which is worthy of clinical promotion.
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Objective To investigate the risk factors, treatment methods and significance of the cervical venous angle lymph node metastasis in differentiated thyroid cancer. Methods The clinical data of 222 patients with thyroid papillary carcinoma from December 2012 to January 2014 were collected. The surgical methods, complications and postoperative complications and pathology were analyzed. Results Lymph node metastasis was found in 133 cases. when VI lymph node was positive , the lateral cervical lymph node positive rate was 43%(57/133) inⅡDistrict, 54%(72/133) inⅢDistrict,ⅣDistrict 45%(60/133) inⅣDistrict, 60%(80/133) in jugular angle, and 6%(8/133) in V District. The levels of bleeding volume, operation time and hospitalization time in functional neck dissection (FND) group were significantly higher than those in anterior cervical muscle group and reserved anterior cervical muscle group (P<0.05). Single factor analysis showed that diameter of the tumors, thyroid membrane invasion and central region lymph node metastasis had correlations with venous angle lymph metastasis (P<0.01). Logistic regression analysis showed that thyroid membrane invasion (OR=3.539), central region lymph node metastasis (OR = 1.617), diameters of the tumors (OR = 1.321)were the risk factors of cervical venous angle lymph node metastasis. Conclusions Patients with tumor diameter equal to or more than 1.5 cm, thyroid membrane invasion and lymph node metastasis number greater than or equal to 2 should be performed with lateral neck lymph node dissection. Also the venous angle lymph node dissection should be done in these patients so as to increase radical rate.
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Objective The objective of this study was to evaluate the prognostic value of postoperative prognostic nutritional index(p-PNI)in the prognosis of colorectal cancer patients.Methods Retrospective analytical cases came from 89 patients with radical resection of colorectal cancer confirmed by the pathological section in Nanjing Drum Tower Hospital Suqian City People's Hospital from August 2009 to August 2012.The p-PNI was calculated based on the results of blood routine and biochemical tests after the first visit to the hospital.The Youden index was calculated using the receiver operating characteristic curve(ROC),and the PNI value combined with the best sensitivity and specificity was used as the threshold for the PNI packet.Kaplan-Meier method was used to study the effect of p-PNI on postoperative prognosis of patients with colorectal cancer.Cox regression model was selected to study the effect of p-PNI on the prognosis of colorectal cancer patients after surgery.Results The p-PNI of 89 cases of colorectal cancer patients was 25.18~60.74(43.81±6.47).The p-PNI in patients(less than 70 years old)was significantly increased when the number of lymph node metastases was less than 4,the preoperative CEA was less than 5ng/mL,and the intraoperative hemorrhage was less than 150 mL(P<0.05).When the p-PNI value was 43,the Youden exponent was the largest.Data analysis showed that p-PNI was correlated with age,lymph node metastasis,intraoperative blood loss and preoperative CEA(P<0.05).The survival rate of patients with high p-PNI was higher than that of low p-PNI group(X2=15.639,P<0.001).Single factor and multivariate analysis confirmed that p-PNI was an independent factor in the prognosis of patients with colorectal cancer(HR=2.179,95% CI:1.057~3.561,P<0.001).Conclusion p-PNI is an independent prognostic factor in patients with colorectal cancer,which is associated with long-term prognosis after surgery.
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Objective To evaluate the feasibility and efficacy of suspended method in scar hidden technology in laparoscopic appendec-tomy ( LA) . Methods 27 patients underwent scar hidden laparoscopic appendectomy with the aid of suspended method. Silver probe was pierced abdominal cavity,bended into a hook shape and fixed appendix,then underwent appendectomy. Results 27 patients finished surgery successfully,the operative time was 25~100 min ( mean, 45 min) ,the blood loss during operation was 10~50 mL ( mean,20 mL) ,the hos-pital stay was 3~8 d ( mean,4 d) . Conclusion Scar hidden technology in laparoscopic appendectomy with the aid of suspended method is safe,feasible and further improves the cosmic result.
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OBJECTIVE:To establish a method for content determination of cyproheptadine hydrochloride in fuyan cream.METHODS:Ultraviolet spectophotometry was applied to determine the contents of cyprohepatadine hydrochloride as well as its adjuvant as two coexisting components without isolation and extraction,the wavelengths were286nm and258nm res_ pectively,linear regression and simultaneous equations were used to analyze the results.RESULTS:Cyproheptadine hydrochlor_ ide and its adjuvant showed good linear relationship in the range of2.52～25.2and2.5022～25.022?g/ml respectively,the average recovery of cyproheptadine hydrochloride was98.61%(RSD=1.08%).CONCLUSION:The present method is simple,convenient,reproducible and reliable,which is suitable for rapid determination for fuyan cream.