Preoperative and postoperative complications as risk factors for delayed gastric emptying following pancreaticoduodenectomy: A single-center retrospective study

BACKGROUND Mortality rates after pancreaticoduodenectomy(PD)have significantly decreased in specialized centers.However,postoperative morbidity,particularly delayed gastric emptying(DGE),remains the most frequent complication following PD.AIM To identify risk factors associated with DGE after the PD procedure.METHODS In this retrospective,cross-sectional study,clinical data were collected from 114 patients who underwent PD between January 2015 and June 2018.Demographic factors,pre-and perioperative characteristics,and surgical complications were assessed.Univariate and multivariate analyses were performed to identify risk factors for post-PD DGE.RESULTS The study included 66 males(57.9%)and 48 females(42.1%),aged 33-83 years(mean:62.5),with a male-to-female ratio of approximately 1.4:1.There were 63 cases(55.3%)of PD and 51 cases(44.7%)of pylorus-preserving pancreatoduodenectomy.Among the 114 patients who underwent PD,33(28.9%)developed postoperative DGE.Univariate analysis revealed significant differences in four of the 14 clinical indexes observed:pylorus preservation,retrocolonic anastomosis,postoperative abdominal complications,and early postoperative albumin(ALB).Logistic regression analysis further identified postoperative abdominal complic-ations[odds ratio(OR)=4.768,P=0.002],preoperative systemic diseases(OR=2.516,P=0.049),and early postoperative ALB(OR=1.195,P=0.003)as significant risk factors.CONCLUSION Postoperative severe abdominal complications,preoperative systemic diseases,and early postoperative ALB are identified as risk factors for post-PD DGE.

Recent progress in molecular mechanisms of postoperative recurrence and metastasis of hepatocellular carcinoma

Hepatectomy is currently considered the most effective option for treating patients with early and intermediate hepatocellular carcinoma(HCC).Unfortunately,the postoperative prognosis of patients with HCC remains unsatisfactory,predominantly because of high postoperative metastasis and recurrence rates.Therefore,research on the molecular mechanisms of postoperative HCC metastasis and recurrence will help develop effective intervention measures to prevent or delay HCC metastasis and recurrence and to improve the long-term survival of HCC patients.Herein,we review the latest research progress on the molecular mechanisms underlying postoperative HCC metastasis and recurrence to lay a foundation for improving the understanding of HCC metastasis and recurrence and for developing more precise prevention and intervention strategies.

The Infuence of Neuman Theory Based Stress Management on the Level of Benefit Finding in Postoperative Breast Cancer Patients

Objective:To explore the influence of stress management program based on Neuman theory on the 1eve1 of beneft finding in postoperative breast cancer patients.Methods:Using convenient sampling method,60 postoperative breast cancer patients in the tumor ward of a hospital were selected and randomly assigned into observation group(n=30)and control group(n=30).The control group adopts the couventional postoperative psychological mursing program,and the observation group adopts the stress management program based on Neuman theory for psychological nursing.The differences in benefit finding,life quality,and medical coping strategies between the two groups before and after nursing were compared.Results:After the implementation of the two nursing programs,the 1level of benefit finding,life quality,and medical coping strategies of patients in the observation group were higher than those in the control group(t1=3.996,t2=4.662,t3=4.113,P<0.05);there was a statistically significant difference in the level of benefit finding,life quality,and medical coping strategies of patients before and after the implementation of the two nursing programs(P<0.05).Conclusions:The stress management strategy based on Neuman theory can improve patients'state of psychological stress coping,play a positive role in guiding the psychology of patients after breast cancer surgery,and can be used as a reference for the psychological nursing program of postoperative patients.

A Review on Clinical Study on Treating Postoperative Constipation in Mixed Hemorrhoids with Traditional Chinese Medicine

Mixed hemorrhoids belong to a common disease in proctology.Surgery is the main clinical treatment,but postoperative constipation is prone to occur in patients,causing unnecessary physical pain to the patients.At the same time,it also affected uneventful recovery after the surgery.In diagnosis and treatment for the postoperative constipation in mixed hemorrhoids,TCM has its own features,such as oral administration of Chinese materia medica,acupuncture therapy,Chinese materia medica retention enema,acupoint catgut embedding,etc.,which have significant efficacy.However,there are also some problems,such as inconsistency of clinical syndrome differentiation,lack of large sample studies,and insufficient follow-up visits.In order to provide reference for clinical treatment in mixed hemorrhoids,this paper reviews academic studies on its postoperative constipation by traditional Chinese medicine in recent years.

Treatment of patients with bosentan in postoperation of congenital heart disease with pulmonary arterial hypertension:a double-blind,randomized controlled trial

Objective Endothelin is a key role in the pathogenic of pulmonary arterial hypertension. High concentrations of endothelin 1 have been recorded in plasma and lungs of patients with pulmonary artery hypertension associated with congenital heart disease,and the concentrations of endothelin-1 was correlated with severity degree

Thirty-six cases of postsurgical gastroparesis of abdominal cancer treated by comprehensive therapy of acupuncture-moxibustion

Objective To observe clinical efficacy of acupuncture-moxibustion combined with cupping on postsurgical gastroparesis of abdominal cancer. Methods Thirty-six cases of postsurgical gastroparesis of abdominal cancer were treated with （1） acupuncture at Weishiu （胃俞 BL 21）, Shangwan （上脘 CV 13）, Zhangwan （中脘CV 12）, Xiawan （下脘 CV 10） and Tianshu （天枢 ST 25） to dredging the meridians, （2） quick cupping on local area to promote gastrointestinal motility and （3） mild moxibustion at CV 12, Shanque （神阙 CV 8） and Zusanli （足三里 ST 36）. The treatment was given once a day, 5 times made a course. The clinical efficacy was assessed after two courses of treatment. Results After the treatment, 27 cases were cured, 6 cases were effective and 3 cases were failed, and the total effective rate was 91.7% （33/36）. Conclusion The acupuncture-moxibustion combined with cupping has remarkable clinical efficacy on postsurgical gastroparesis of abdominal cancer.

Effect of Glutamine Enriched Nutrition Support on Surgical Patients with Gastrointestinal Tumor： A Meta-Analysis of Randomized Controlled Trials

Background：Associations between glutamine （Gln） enriched nutrition support and surgical patients with gastrointestinal （GI） tumor remain controversy.The purpose of this meta-analysis was to assess the effect of Gln enriched nutrition support on surgical patients with GI tumor in term of relevant biochemical indices,immune indices,and clinical outcomes.Methods：Six databases were systematically searched to find eligible randomized controlled trials （RCTs） from 1966 to May 2014.When estimated the analysis indexes,the relative risk （RR） was used as the effect size of the categorical variable,while the weighted mean difference （MD） was used as the effect size of a continuous variable.Meta-analysis was conducted with Rev Man 5.2.Results：Thirteen RCTs,involving 1034 patients,were included in the meta-analysis.The analysis showed that Gln enriched nutrition support was more effective in increasing serum albumin （MD：0.10; 95% confidence interval [CI]：0.02-0.18; P 〈 0.05）,serum prealbumin （MD：1.98; 95% CI：1.40-2.55; P 〈 0.05） and serum transferring （MD：0.35; 95% CI：0.12-0.57; P 〈 0.05）,concentration of IgG （MD：1.26; 95% CI：0.90-1.63; P 〈 0.05）,IgM （MD：0.18; 95% CI：0.11-0.25; P 〈 0.05）,IgA （MD：0.22; 95% CI：0.10-0.33; P 〈 0.05）,CD3＋ （MD：3.71; 95% CI：2.57-4.85; P 〈 0.05） and CD4/CD8 ratio （MD：0.27; 95% CI：0.12-0.42; P 〈 0.05）.Meanwhile,it was more significant in decreasing the incidence of infectious complications （RR：0.67; 95% CI：0.50-0.90; P 〈 0.05） and shortening the length of hospital stay （MD：-1.72; 95% CI：-3.31--0.13; P 〈 0.05）.Conclusions：Glutamine enriched nutrition support was superior in improving immune function,reducing the incidence of infectious complications and shortening the length of hospital stay,playing an important role in the rehabilitation of surgical GI cancer patients.

Therapeutic Effect of Jianpi Decoction Combined with Chemotherapy on Postoperative Treatment of Colorectal Cancer: A Systematic Review and Meta-analysis

Objective:The purpose of this systematic review is to assess the therapeutic effect of Jianpi decoctions in Chinese herbal medicines(CHM)combined with chemotherapy on the postoperative treatment of colorectal cancer.Methods:Literatures were obtained from Wanfang database,CNKI,Pub Med,Cqvip,MEDLINE,Cochrane,CBM,and Springer LINK as well as other conference papers and theses.The search included all documents in English or Chinese published before September 2018.We selected randomized controlled trials based on specific criteria and the most important criteria were that Jianpi decoction should be applied in combination with chemotherapy on the postoperative treatment of colorectal cancer.Results:Publications in eight electronic databases were extensively searched and 20 trials were included for analysis eventually.A total of 1652 patients in total were enrolled in these studies.Among them,879 patients received CHM and Western medicine combination therapy and another 773 participants only got Western medicine therapy.Compared with those patients receiving Western medicine alone,the survival rate of 1-year(odds ratio[OR]=2.35,95%confidence limit[Cl]=1.30–4.28,P<0.05),3-year(OR=2.02,95%Cl=1.49–2.73,P<0.001),and 5-year survival rate(OR=2.32,95%Cl=1.56–3.45,P<0.001)of patients in the group of Jianpi decoctions in CHM and chemotherapy combination has significantly increased.Moreover,results also showed positive effects on immunoregulation such as CD3^+(OR=0.68,95%confidence interval[CI]=0.52–0.85,P<0.0001),CD4^+/CD8^+(OR=0.77,95%CI=0.29–1.26,P<0.05).Side effects caused by chemotherapy such as nausea(OR=0.35,95%CI=0.25–0.50,P<0.0001)and vomiting(OR=0.32,95%CI=0.22–0.46,P<0.0001),diarrhea(OR=0.42,95%CI=0.30–0.60,P<0.0001),as well as metastasis and recurrence(OR=0.38,95%CI=0.24–0.61,P<0.001)were remarkably reduced.The quality of life(OR=4.40,95%Cl=2.86–6.77,P<0.0001)has been improved.Moreover,there was no statistically significant bias in the overall studies.Conclusion:This systematic review suggests that Jianpi decoction in CHM can reduce the chemotherapy toxicity,enhance the patient's immunity,prolong their survival rate,improve their quality of life as well as prevent metastasis,and recurrence for patients in postoperative treatment of colorectal cancer.

Treating Biliary System Postoperational Complications by Syndrome Differentiation Using Traditional Chinese Medicine

The operation of the biliary system is usually employed for liver, gallbladder or pancreatic diseases. Most benign cases are cholelithiasisinduced cholecystitis and choledochitis, while malignant ones mainly include gallbladder cancers, cholangiocarcinoma orcarcinoma of the head of the pancreas.

Clinical Study on Preventive Effect of Taozhi Zhipu Mixture (桃蛭枳朴合剂)on Postoperative Intestinal Adhesion

Objective: To study the clinical effect of Taozhi Zhipu Mixture(桃蛭枳朴合剂, TZM) in preventing postoperative intestinal adhesion. Methods: The total of 396 patients who had received abdominal operation were randomly divided into the treated group (188 cases) and the control group (208 cases). Same treatment was given to both groups except that the treated group received TZM orally or via nasogastric tube. The time of borborygmus recovering and first passing of flatus defecation after operation was recorded. Patients’ gastro intestinal motility was observed by isotope tracing with I 131 capsule. The frequency and intensity of borborygmus were measured by a tracer. All patients had been followed up for 2-3 years. Results: The recovery of borborygmus, the first passing of flatus defecation were much earlier, the I 131 capsule passed gastro intestinal tract more quickly, and the tracer showed higher frequency and intensity of borborygmus in the treated group than those in the control group. Follow up study also showed the treated group was better than the control group in the non adhesion rate and the total effective rate ( P <0.05). Conclusion: TZM has good effect on stimulating postoperational gastro intestinal peristalsis and preventing the occurrence of postoperational intestinal adhesion.