胃镜活检技术诊断胃癌的临床价值与意义

讨论研究应用胃镜活检对于胃癌的诊断意义及临床价值。方法 回顾性分析我院2019年3月至2023年5月收治的疑似胃癌患者临床资料进行分析,对所有患者行胃镜活检术并将结果与术后病理诊断结果进行比较。结果 以手术病例为金标准,75例疑似患者中,70例为确诊患者,5例为非癌者。胃镜活检中,真阳性68例,漏诊2例,误诊3例。胃镜活检对早期胃癌的灵敏度、准确率均较高,分别为95.7%、97.1%;与术后病理结果相比较,胃镜对胃窦处诊断准确符合率93.9%(31/33),对胃体、胃角、胃底及贲门诊断符合率100%;同时,在评估病灶大小观察中,与术后病理结果相比,胃镜活检对直径<1cm病灶诊断符合率92.0%(23/25),≥1cm病灶符合率100.0%;两种方法对管状腺癌、粘液腺癌、乳头状腺癌检出率比较未见明显差异(P>0.05)。结论 对胃癌应用胃镜活检诊断具有较高的诊断价值,在确诊疾病并进行病理学分型方面与术后病理结果具有较高的一致性,但胃镜活检技术对患者损伤较小,可提高检测的舒适性并降低出血等不良事件发生风险,临床在诊断疾病时可根据实际情况酌情进行选择。

Abscess in the inguinal hernial sac after peritonitis surgery: A case report

In this paper, we report an extremely rare case of an abscess that developed in the inguinal hernial sac after surgery for peritonitis. A 60-year-old man underwent laparoscopic low anterior resection for rectal cancer. One day after this operation, peritoneal drainage and ileostomy were performed for rectal anastomotic leakage. Five days after the second operation, computed tomography revealed an abscess in the left inguinal hernial sac. Subsequently, hernioplasty and resection of the inflamed sac were performed.

A case of biliary gastric fistula following percutaneous radiofrequency thermal ablation of hepatocellular carcinoma

Percutaneous radiofrequency thermal ablation （RFA） is an effective and safe therapeutic modality in the management of liver malignancies, performed with ultrasound guidance. Potential complications of RFA include liver abscess, ascites, pleural effusion, skin burn, hypoxemia, pneumothorax, subcapsular hematoma, hemoperitoneum, liver failure, tumour seeding, biliary lesions. Here we describe for the first time a case of biliary gastric fistula occurred in a 66-year old man with a Child＇s class A alcoholic liver cirrhosis as a complication of RFA of a large hepatocellular carcinoma lesion in the nl segment. In the light of this case, RFA with injection of saline between the liver and adjacent gastrointestinal tract, as well as laparoscopic RFA, ethanol injection （PEI）, or other techniques such as chemoembolization, appear to be more indicated than percutaneous RFA for large lesions close to the gastrointestinal tract.

Study of 160 breast cancer patients with distant metastasis after operation by way of TCM syndromes classification

Objective: To discuss the relationship between the postoperative breast cancer with distant metastasis and the TCM syndromes classification. Methods: 160 postoperative 5-year breast cancer patients from 1995 to 2000 were tracked, summed up and analysized TCM syndromes as stagnation of hepatic qi, deficiency of spleen and pathogenic phlegm reten- tion, blood stasis and toxin stagnation, deficiencies of both blood and qi. Results: (1) For blood stasis and toxin stagnation TCM syndrome, the metastatic rate raised to 45% during 5 years. However, the metastatic rates of other three TCM syn- dromes are 15%, 17.5% and 22.5% respectively. The general distant metastasis rate was 27.5% (P<0.01). (2) Lymph node metastasis, tumor size, Her-2 and its receptor have no obvious relation with TCM syndromes classification (P>0.05). Conclu- sion: (1) TCM syndrome classification has close relation with breast cancer distant metastasis. Distant metastasis have close relationship with blood stasis and toxin stagnation syndrome. (2) Lymph node metastasis, tumor size, Her-2 and its receptor have no obvious relation with TCM syndromes classification, which suggested that metastatic ability has been programmed in the early stage of carcinoma initiation. (3) Significantly enlightening for predict the prognosis under the guide of TCM syn- drome classification and take right therapeutic strategy: attack pathogen and activate blood circulation against cancer.

Surgical treatment of three cases of Cantrell's syndrome

This ten-year retrospective study was designed to examine the morbidity and mortality of three cases of Cantrell＇s syndrome between 1998 and 2008. The three patients showed different degrees of Cantrell＇s pentalogy including abdominal ectopia cordis, thoracic-abdominal ectopia cordis and left ventricular diverticulum. Of the three, the 5-month-old boy suffering from complicated congenital heart disease with abdominal ectopia cordis received a successful single stage repair and reconstruction of the abdominal wall. The 33-week-old premature girl with thoracic-abdominal ectopia cordis underwent two stage correction of tetraology of Fallot. The 4-year-old girl underwent ectomy of left ventricular diverticulum and thoracoabdominal wall repair. Twenty-four to thirty-five months follow-up were satisfactory. We hold that two-stage repair are technically feasible for Cantrell＇s syndrome, especially for those with complex congenital heart diseases. Post-operative ventilatory support and multiple post-operative care should be prolonged. Malnutrition, infection and arrhytbmia are central problems in medical care and surgery should be considered if there was progressive heart failure or hemodynamic instability.

Deep venous thrombosis after gastrectomy for gastric carcinoma:A case report

The treatment of gastric carcinoma consists of neoadjuvant chemoradiation,partial gastrectomy,subtotal gastrectomy,total gastrectomy,extended resection,and postoperative chemotherapy.Currently,gastrectomy and extended lymphadenectomy is the optimal choice for late gastric carcinoma.Postoperative complications are common after total gastrectomy including hemorrhage,anastomotic leakage,f istula,and obstruction.However,deep venous thrombosis(DVT) is an uncommon complication after gastrectomy for gastric carcinoma.We describe a case of a 68-year-old female patient with DVT after gastrectomy for gastric carcinoma.The patient was treated with anticoagulants and thrombolytics and subjected to necessary laboratory monitoring.The patient recovered well after treatment and was symptom-free during a 3-mo follow-up.We conclude that correct diagnosis and treatment of DVT are crucial.

Stomach One-Point Cancer: One Case Report and Literature Review

IntroductionGastric cancer is one of the most common cancers and one of the most frequent causes of cancer deaths worldwide. Early detection and accurate preoperative staging of gastric cancer is essential for planning optimal therapy such as endoscopic mucosal resection or gastric resection and offers the best prognosis. With advanced technology in diagnostic instruments and the mass screening, early gastric cancer has been detected easier. One-point cancer of gastric is a special type of early gastric cancer. Diagnosis of one-point cancer of gastric is important for both the immediate treatment and the prognosis. There is still no consensus on the operation extent and postoperative treatment for patients with one-point cancer of gastric. Learned from previous reports, we know that existed in the superficial layer of the gastric mucosa and the superficial ulcer is one of the important characteristics of one point cancer of gastric. Herein, we report a case of one point cancer of gastric with the appearance of a deep infiltrating ulcer. To the best of our knowledge, no such type of one point cancer of gastric has been reported.

Vedolizumab use in patients with inflammatory bowel diseases undergoing surgery:clinical trials and post-marketing experience

Background:Patients with inflammatory bowel diseases frequently require surgery,but immunotherapies used in disease management may increase the risk of post-operative complications.We investigated frequencies of post-operative complications in patients who received vedolizumab—a gut-selective antibody approved for the treatment of moderately to severely active ulcerative colitis and Crohn’s disease—in clinical-trial and post-marketing settings.Methods:This post hoc analysis of safety data from GEMINI 1,GEMINI 2,and long-term safety studies included patients who had had colectomy or bowel surgery/resection.Data from the post-marketing Vedolizumab Global Safety Database were also analysed(data cutoff point:19 May 2016).Adverse events relating to post-operative complications were identified using Medical Dictionary for Regulatory Activities preferred terms.Results:Of 58 total surgeries in patients included in GEMINI 1 and GEMINI 2,post-operative complications were reported for 3/51 vedolizumab-treated patients(5.9%)and 1/7 placebo-treated patients(14.3%).In the long-term safety study,157/2,243 patients(7%)had colectomy or bowel surgery/resection;of these 157 patients who underwent surgery,11(7%)experienced a post-operative complication.Median time between last pre-operative vedolizumab dose and surgery was 23 days in GEMINI 1,20 days in GEMINI 2,and 39–40 days in the long-termsafety study.In the post-marketing setting,based on data covering approximately 46,978 patient-years of vedolizumab exposure,post-operative complications were reported in 19 patients.Conclusions:In clinical trials,complications of colectomy and bowel surgery/resection appeared infrequent,with minimal difference between vedolizumab and placebo.The frequency of post-operative complications in the post-marketing setting appears low.