四定点回肠吻合并吻合口近端肠造瘘治疗新生儿回肠闭锁16例

目的 介绍一种治疗回肠闭锁的手术方法 ,并评价其临床治疗效果。方法 采用四定点单层内翻回肠端斜吻合并吻合口近端造瘘术 ,对 16例回肠闭锁患儿进行了治疗。即切除闭锁近端扩张的肠管盲端 10～ 15cm及闭锁远端肠管盲端 2～ 3cm ,将远端肠管沿系膜对侧纵行剪开 ,使远端和近端肠管口径基本相同 ;吻合时 ,以肠壁系膜缘、对系膜缘、前壁中点及后壁中点为 4个定点 ,将吻合缘分为 4段 ,分别牵引相邻两定点 ,使肠壁内翻、对齐 ,并使待吻合的两肠壁边缘充分展开 ,分段行单层全层连续内翻缝合。在吻合口近端 10～ 15cm处肠壁置入造瘘管 ,于下腹部前外侧壁戳创引出 ,待病儿能自行排便和进奶正常后拔除。结果 14例恢复顺利 ,肠蠕动于术后 2～ 3d恢复 ,4～ 5d进乳 ,7～ 10d即可全胃肠道营养 ,无 1例发生吻合口瘘或梗阻。随访 1～ 4a ,其生长、发育均达到同龄儿正常标准 ,未见智力发育迟缓。 2例因术后并发肺炎导致急性呼吸衰竭死亡。结论 四定点单层内翻回肠端斜吻合并吻合口近端造瘘术 ,有利于术后肠功能的早期恢复 ,可避免吻合口梗阻和吻合口瘘的发生 ,是治疗先天性回肠闭锁较理想的手术方法。

“两点法”胰肠吻合方式在胰十二指肠切除术中应用的研究

目的 探讨“两点法”胰肠吻合方式在胰十二指肠切除术中应用效果.方法 选取2017年11月-2019年3月60例胰十二指肠切除术患者为研究对象并进行回顾性研究,根据手术方式不同将受试者分为对照组和研究组各30例.对照组患者接受捆绑式胰肠吻合方式,观察组患者接受“两点法”胰肠吻合方式,比较两组患者的手术情况及胰瘘发生率.结果 研究组患者术中出血量、胰肠吻合时间及住院时间均显著少于对照组(P<0.05),胰瘘总发生率亦显著低于对照组(P<0.05).结论 “两点法”胰肠吻合方式术中出血量少,可有效缩短胰肠吻合时间及住院时间,减少胰瘘发生率,在胰十二指肠切除术中有较高应用价值.

小承气汤保留灌肠治疗小儿高热惊厥60例

目的观察中西医结合治疗小儿高热惊厥的疗效。方法小承气汤灌肠与抗感染、对症、支持合用,并与单纯西药组对照。结果两组治愈率相同,在退热和改善食欲方面,观察组明显优于对照组,P<0.01。提示中西医结合治疗小儿高热惊厥,在退热和改善食欲方面疗效显著。

Pathophysiological aspects of diverticular disease of colon and role of large bowel motility

Colonic diverticular disease (diverticulosis) is one of the most common gastrointestinal disorders in Western countries. This disorder is strictly related to aging and fibre intake, and still bears a discrete amount of morbidity. Numerous etiological co-factors have to date been implicated in the pathogenesis of the disease, yet the supporting evidence is still far from absolute. The present review considers the pathophysiology of colonic diverticular disease, with a special emphasis on factors related to abnormal colonic motility.

Clinical characteristics and prognostic analysis of gastroenteropancreatic neuroendocrine neoplasm(GEP-NEN)

Objective： The aim of the study was to analyze the clinicopathologic characteristics of gastroenteropancreatic neuroendocrine neoplasm （GEP-NEN） and to explore the prognostic factors for patients and differences of immunohisto- chemical markers between neuroendocrine tumor （NET） and neuroendocrine carcinoma （NEC）. Methods： Retrospective reviews were conducted for the charts of 119 patients with GEP-NEN at the Affiliated Hospital of Qingdao University （China） from August 2003 to December 2013. Kaplan-Meier method was used to do the overall survivals analysis for the patients at different levels of predictive factors. Meanwhile, Cox proportional hazard model was used to select independent risk factors of surJival. Analysis of variance was used to compare the expression of immunohistochemical markers among different patho- logical grades. Results：Among 119 patients, pancreas （45/119, 37.82%） and rectum （33/119, 27.73%） were mostly involved. The onset age of GEP-NEN in female group was younger than that of the male group. There were 13 deaths （10.92%） during 18.9 （0.1-133.4） months follow-up period. Multivariate analysis indicated that neural invasion, gender and pathological grades of NET and NEC were independent risk factors. In neuroendocrine neoplasm （NEN）, Syn expression in G2 was higher than G1 and G3, while CgA showed no significant difference. All markers showed no significant differences between NET and NEC. Conclusion： GEP-NEN may occur at multiple sites of digestive system and lack specific clinical manifestations. Syn expression detected for the prognosis of G1, G2 and G3 tumors have clinical significance. Neural invasion, sex and patho- logical grades were independent prognostic factors for GEP-NEN patients. No significant difference was found in different pathological grades of NET and NEC.

Checkpoint inhibitors in gastrointestinal cancers:Expectations and reality

Immune checkpoint inhibitors represent revolutionary anti-cancer agents, being rapidly approved in different malignancies and settings. Gastrointestinal(GI) cancers represent a wide variety of tumors with specific characteristics and different responses to various therapeutic alternatives; while some are chemosensitive others are chemo-resistant and only respond to more aggressive cytotoxic regimens, targeted therapies or a combination of both. Preliminary results of immune checkpoint inhibitors in some GI cancers are promising, namely in hepatocellular carcinoma, anal cancers and microsatellite instability high colorectal cancers. An impressive instead of a impressive number of immune checkpoint inhibitors are being evaluated in different indications in GI cancers as single agents or in combination with other agents. We reported in this paper ongoing and published trials evaluating immune checkpoint inhibitors in hepatocellular carcinoma and biliary tract cancers, esophageal, gastric, pancreatic, colorectal and anal cancers and we discussed the future perspectives of these agents in GI cancers.

What's wrong with sentinel node mapping in colon cancer?

Despite near-universal embrace of the concept and clinical relevance of lymphatic mapping for sentinel node identification and analysis for cancers of the breast and integument,the same technique has struggled to a find a role in gastrointestinal cancers in general and,perhaps,in colon cancer in particular. Despite many studies demonstrating its feasibility in malignancies of the large bowel,concern is continually aroused by the variable and often unacceptably low sensitivity rates. Additionally,many confess uncertainty as to what benefit it could ever confer to patients even if it were proven sufficiently accurate given that standard surgical resection incorporates mesenteric resection anyway. However,the huge impact sentinel node mapping has had on clinical practice in certain cancers means that each of these aspects merit careful reconsideration,from very first principles.

Racial differences in the anatomical distribution of colorectal cancer:a study of differences between American and Chinese patients

AIM: To compare the racial differences of anatomical distribution of colorectal cancer (CRC) and determine the association of age, gender and time with anatomical distribution between patients from America (white) and China (oriental).METHODS: Data was collected from 690 consecutive patients in Cleveland Clinic Florida, U.S.A. and 870consecutive patients in Nan Fang Hospital affiliated to the First Military Medical University, China over the past 11years from 1990 to 2000. All patients had colorectal adenocarcinoma diagnosed by histology and underwent surgery.RESULTS: The anatomical subsite distribution of tumor,age and gender were significantly different between white and oriental patients. Lesions in the proximal colon (P＜0.001) were found in 36.3 % of white vs 26.0 % of oriental patients and cancers located in the distal colon and rectum in 63.7 % of white and 74 % of oriental patients (P＜0.001). There was a trend towards the redistribution from distal colon and rectum to proximal colon in white males over time, especially in older patients (＞80 years).No significant change of anatomical distribution occurred in white women and Oriental patients. The mean age at diagnosis was 69.0 years in white patients and 48.3 years in Oriental patients (P＜0.001).CONCLUSION: This is the first study comparing the anatomical distribution of colorectal cancers in whites and Chinese patients. White Americans have a higher risk of proximal CRC and this risk increased with time. The proportion of white males with CRC also increased with time.Chinese patients were more likely to have distal CRC and developed the disease at a significantly earlier age than white patients. These findings have enhanced our understanding of the disease process of colorectal cancer in these two races.

Gastrointestinal stromal tumor of the stomach with axillary lymph node metastasis: A case report

Gastrointestinal stromal tumors (GISTs) are the most common type of gastrointestinal mesenchymal tumors, although metastasis to the perigastric lymph nodes is relatively rare, compared with liver or peritoneal metastasis. In this report, we describe a case of stomach GIST with a solitary simultaneous metastasis in the left axillary lymph node. A 68-year-old man was diagnosed with a large upper-stomach GIST, and computed tomography and positron emission tomography revealed masses in the left axilla and right mediastinum. We did not detect evidence of metastases to the liver, or other sites including the perigastric lymph nodes, although findings from the surgically resected axillary lymph nodes were compatible with GIST metastasis. Treatment using imatinib markedly reduced the gastric and mediastinal lesions, and this response persisted for 3 years. The patient subsequently experienced rapid growth of the gastric lesion without mediastinal or axilla recurrence, which required palliative surgery. Despite continuing medical treatment(sunitinib and regorafenib), the patient died of liver metastases 23 mo after the surgery. Based on our findings, it appears that the axillary lymph nodes can be a potential metastatic site for GIST metastasis.

Intussusception in adults:Clinical characteristics,diagnosis and operative strategies

AIM： To evaluate 20 adults with intussusception and to clarify the cause, clinical features, diagnosis, and management of this uncommon entity. METHODS： A retrospective review of patients aged 〉 18 years with a diagnosis of intestinal intussusception between 2000 and 2008. Patients with rectal prolapse, prolapse of or around an ostomy and gastroenterostomy intussusception were excluded. RESULTS： There were 20 rases of adult intussusception. Mean age was 47.7 years. Abdominal pain, nausea, and vomiting were the most common symptoms. The majority of intussusceptions were in the small intestine （85%）. There were three （15%） cases of colonic intussusception. Enteric intussusception consisted of five jejunojejunal cases, nine ileoileal, and four cases of ileocecal invagination. Among enteric intussusceptions, 14 were secondary to a benign process, and in one of these, the malignant cause was secondary to metastatic lung adenocarcinoma. All colonic lesions were malignant. All cases were treated surgically. CONCLUSION： Adult intussusception is an unusual and challenging condition and is a preoperative diagnostic problem. Treatment usually requires resection of the involved bowel segment. Reduction can be attempted in small-bowel intussusception if the segment involved is viable or malignancy is not suspected; however, a more careful approach is recommended in colonic intussusception because of a significantly higher coexistence of malignancy.

Development of a quantum-dot-labelled magnetic immunoassay method for circulating colorectal cancer cell detection

AIM:To detect of colorectal cancer(CRC) circulating tumour cells(CTCs) surface antigens,we present an assay incorporating cadmium selenide quantum dots(QDs) in these paper.METHODS:The principle of the assay is the immunomagnetic separation of CTCs from body fluids in conjunction with QDs,using specific antibody biomarkers:epithelial cell adhesion molecule antibody,and monoclonal cytokeratin 19 antibody.The detection signal was acquired from the fluorescence signal of QDs.For the evaluation of the performance,the method under study was used to isolate the human colon adenocarcinoma cell line(DLD-1) and CTCs from CRC patients' peripheral blood.RESULTS:The minimum detection limit of the assay was defined to 10 DLD-1 CRC cells/mL as fluorescence was measured with a spectrofluorometer.Fluorescenceactivated cell sorting analysis and Real Time RT-PCR,they both have also been used to evaluate the performance of the described method.In conclusion,we developed a simple,sensitive,efficient and of lower cost(than the existing ones) method for the detection of CRC CTCs in human samples.We have accomplished these results by using magnetic bead isolation and subsequent QD fluorescence detection.CONCLUSION:The method described here can be easily adjusted for any other protein target of either the CTC or the host.

Clinical features and epidemiology of spondyloarthritides associated with inflammatory bowel disease

Inflammation of axial and/or peripheral joints is one of the most frequent extra-intestinal manifestations complicating the clinical course and therapeutic approach in inflammatory bowel diseases(IBD).The frequency of these complications seems to be similar for both diseases, Crohn's disease and ulcerative colitis.Arthritis associated with IBD belongs to the category of spondyloarthropathies.Axial involvement ranges from isolated inflammatory back pain to ankylosing spondylitis, whereas peripheral arthritis is noted in pauciarticular and in polyarticular disease.Asymptomatic radiological involvement of the sacroiliac joints is reported to occur in up to 50% of patients.Other musculoskeletal manifestations such as buttock pain, dactylitis, calcaneal enthesitis, and thoracic pain are frequently underdiagnosed and, consequently, are not treated appropriately.Several diagnostic approaches and criteria have been proposed over the past 40 years in an attempt to correctly classify and diagnose such manifestations.The correct recognition of spondylarthropathies needs an integrated multidisciplinary approach in order to identify common therapeutic strategies, especially in the era of the new biologic therapies.

Isolated lymphoid follicles in colon: Switch points between inflammation and colorectal cancer?

Gut-associated lymphoid tissue is supposed to play a central role in both the organization of colonic repair mechanisms and colorectal carcinogenesis. In inflammatory conditions, the number, diameter and density of isolated lymphoid follicles (ILFs) increases. They are not only involved in immune surveillance, but their presence is also indispensable in normal mucosal regeneration of the colon. In carcinogenesis, ILFs may play a dual role. On the one hand they may support tumor growth and the metastatic process by vascular endothelial growth factor receptor signaling and producing a specific cytokine and cellular milieu, but on the other hand their presence is sometimes associated with a better prognosis. The relation of ILFs to bone marrow derived stem cells, follicular dendritic cells, subepithelial myofibroblasts or crypt formation, which are all involved in mucosal repair and carcinogenesis, has not been directly studied. Data about the putative organizer role of ILFs is scattered in scientific literature.

Double Primary Cancers in Extragastric Sites with Gastric Cancer: Report of Six Cases and Literature Review

OBJECTIVE To explore the clinical features, pathologiccharacteristics and prognosis of double primary malignant tumorswith involvement of the stomach and an extragastric site.METHODS We reviewed the records of 496 patients whounderwent surgery for gastric cancer in our department fromJanuary 2004 to December 2006. Synchronous double primarycancer was defined as an extragastric cancer diagnosed within a6-month interval before the detection of gastric cancer; any gastriccancer metastasis to other areas of the body was excluded.RESULTS Synchronous and metachronous double primarycancers were identified in 1 and in 5 patients, respectively. Theextragastric sites of the primary tumors in patients with gastriccancer were esophagus in 1 case, right colon in 1, rectum in 1,breast in 2 and lung in 1. Following gastric surgery, 5 patientsdied (within 2 mon, 24 mon, 30 mon, 48 mon and 60 mon). Only 1patient has survived and remains disease free.CONCLUSION The prognosis of patients with gastric cancerand a second primary is relatively poor. It is necessary to performregular esophagogastroduodenoscopy (EGD) on patients whohave been diagnosed with extragastric cancer, regardless of theirsymptoms.

Rapid detection of intestinal pathogens in fecal samples by an improved reverse dot blot method

AIM:To develop a new, rapid and accurate reverse dot blot(RDB) method for the detection of intestinal pathogens in fecal samples.METHODS:The 12 intestinal pathogens tested were Salmonella spp., Brucella spp., Escherichia coli O157:H7, Clostridium botulinum , Bacillus cereus , Clostridium perfringens , Vibrio parahaemolyticus , Shigella spp., Yersinia enterocolitica, Vibrio cholerae, Listeria monocytogenes and Staphylococcus aureus.The two universal primers were designed to amplify two variable regions of bacterial 16S and 23S rDNA genes from all of the 12 bacterial species tested.Five hundred and forty fecal samples from the diarrhea patients were detected using the improved RDB assay.RESULTS:The methods could identify the 12 intestinal pathogens specifi cally, and the detection limit was as low as 103 CFUs.The consistent detection rate of the improved RDB assay compared with the traditional culture method was up to 88.75%.CONCLUSION:The hybridization results indicated that the improved RDB assay developed was a reliable method for the detection of intestinal pathogen in fecal samples.

Catgut Point-Embedding Therapy in Treatment of 76 Cases of Ulcerative Colitis

In recent years, our department has adopted a catgut point-embedding therapy in the treatment of 76 cases of chronic ulcerative colitis, with quite good therapeutic effects. The following is a report of it.Clinical DataOf 76 cases we treated, 32 were male, and 44 female, with the ages ranging from 23 to 65 years and the duration of illness from 6 months to 20 years.All the cases complained of chronic diarrhea, most of them had mucous and blood stool, and some had tenesmus. Sigmoscopic findings showed that all the cases had varying degrees of colic mucosal congestion and edema, fragile mucosa easy to bleed upon touching, or rough mucosa with multiple ulcers varying in size, shape, and depth.

The Affects of Acupuncture at Sibai and Neiting Acupoints on Gastric Peristalsis

The frequency and amplitude of gastric peristaltic wave were significantly changed in 15 subjects when Sibai (ST 2) and Neiting (ST 44) acupoints of the Stomach Channel of Foot-Yangming were punctured. The results demonstrate that these acupoints are effective for treatment of stomach diseases, providing an experimental basis for the theory of channels and collaterals.

23 CASES OF CHRONIC NONSPECIFIC ULCERATIVE COLITIS TREATED BY ACUPUNCTURE AND MOXIBUSTION

In recent years, the author has treated 23 in-patients and out-patients with chronic nonspecific ulcerative colitis and achieved good therapeutic results as reported in the following. Clinical Data In this series, there were 23 cases, 9 males and 14 females, ranging in age from 29 to 68 years, averaging 33.8 years. The duration of disease was 2 to 23 years, with a mean of 11.5 years. All the patients had symptoms and signs of the disease in varying degrees

Constructive thinking,rational intelligence and irritable bowel syndrome

AIM： To evaluate rational and experiential intelligence in irritable bowel syndrome （IBS） sufferers. METHODS： We recruited 100 subjects with IBS as per Rome 11 criteria （50 consulters and 50 non-consulters） and 100 healthy controls, matched by age, sex and educational level. Cases and controls completed a clinical questionnaire （including symptom characteristics and medical consultation） and the following tests： rational- intelligence （Wechsler Adult Intelligence Scale, 3rd edition）; experiential-intelligence （Constructive Thinking Inventory）; personality （NEO personality inventory）; psychopathology （MMPI-2）, anxiety （state-trait anxiety inventory） and life events （social readjustment rating scale）. Analysis of variance was used to compare the test results of IBS-sufferers and controls, and a logistic regression model was then constructed and adjusted for age, sex and educational level to evaluate any possible association with IBS. RESULTS： No differences were found between IBS cases and controls in terms of IQ （102.0 ± 10.8 vs 102.8 ± 12.6）, but IBS sufferers scored significantly lower in global constructive thinking （43.7± 9.4 vs 49.6 ± 9.7）. In the logistic regression model, global constructive thinking score was independently linked to suffering from IBS [OR 0.92 （0.87-0.97）], without significant OR for total IQ. CONCLUSION： IBS subjects do not show lower rational intelligence than controls, but lower experiential intelligence is nevertheless associated with IBS.

Local resection for tumor of papilla of Vater: an analysis of 25 cases

Objective: To investigate the clinical features, diagnostic methods, and treatment choice of tumor of the papilla of Vater. Methods: The clinical data of 25 patients with tumor of the papilla of Vater treated by local resection in our hospital from December 1983 to May 2006 were retrospectively analyzed. Results: The morbidities of abdominal pain, jaundice and recurrent cholangitis were 84%, 80% and 48%, respectively. The accordant rate for preoperative duodenoscopic biopsy and post-operative pathological diagnosis was 80%. Intraoperative frozen section examination accurately predicted the final pathological results in all the patients. The post-operative complication rate was 20% and the operative mortality rate was 4%. The 5-year survival rates of local resection for benign tumors and malignant tumors were 75% and 28.5%, respectively. Conclusion: Abdominal pain, jaundice and recurrent cholangitis are the main symptoms and signs of tumor of the papilla of Vater. Duodenoscopy is the principal preoperative diagnostic method and intraoperative frozen section examination is reliable in assessing the operative specimens. Selective local resection is an effective treatment option for tumor of the papilla of Vater.