Introduction: In India, 57% of patients with head and neck cancers are documented with nutritional compromise. Active nutritional support has been shown to improve outcomes and reduce the cost of treatment in severely...Introduction: In India, 57% of patients with head and neck cancers are documented with nutritional compromise. Active nutritional support has been shown to improve outcomes and reduce the cost of treatment in severely malnourished patients. The assessment of nutritional status should be a priority when initiating medical nutrition therapy. We evaluated the agreement between Subjective and Objective evaluation of pre-operative nutrition status of head and neck cancer patients in a tertiary cancer centre. Methods: Two hundred and thirty seven head and neck cancer patients who underwent surgery were eligible. The patients included both males (147) and females (90) with age varying between 23 - 88 years. All patients were screened for pre-operative nutrition status objectively as well as subjectively. The association of pre-operative SGA scores (A, B and C) subjectively, and PNS score (0, 1, 2) objectively were tested for statistical significance. Results: The cancer sites included tongue in 82, buccal mucosa in 30, thyroid in 28, alveolus in 18, glottis in 10, RMT in 10, nasal cavity in 9, FOM in 8. The pre-operative nutrition status based on subjective scores are A in 156 (65.8%), B in 75 (32%) and C in 6 (2.5%). The objective parameters obtained on the basis of BMI, % weight loss, PNI and S. albumin values are PNS 0 in 161 (67.9%), PNS 1 in 71 (30%) and PNS 2 in 5 (2.1%) patients. As the kappa coefficient p-0.56, there is moderate agreement between the pre-operative nutrition status subjectively as well as objectively. Conclusion: Subjective global assessment is a simple and inexpensive way to screen the pre-operative nutrition status when compared to the other objective assessment tool. SGA has moderate agreement with expensive and complicated objective assessment tools. So it can be a reliable tool for assessing the pre-operative nutrition status.展开更多
BACKGROUND During pancreaticoduodenectomy in patients with celiac axis(CA)stenosis due to compression by the median arcuate ligament(MAL),the MAL has to be divided to maintain hepatic blood flow in many cases.However,...BACKGROUND During pancreaticoduodenectomy in patients with celiac axis(CA)stenosis due to compression by the median arcuate ligament(MAL),the MAL has to be divided to maintain hepatic blood flow in many cases.However,MAL division often fails,and success can only be determined intraoperatively.To overcome this problem,we performed endovascular CA stenting preoperatively,and thereafter safely performed pancreaticoduodenectomy.We present this case as a new preoperative treatment strategy that was successful.CASE SUMMARY A 77-year-old man with a diagnosis of pancreatic head cancer presented to our department for surgery.Preoperative assessment revealed CA stenosis caused by MAL.We performed endovascular stenting in the CA preoperatively because we knew that going into the operation without a strategy could lead to ischemic complications.Double-antiplatelet therapy(DAPT)–which is needed when a stent is inserted–was then administered in parallel with neoadjuvant chemotherapy(NAC).This allowed us to administer DAPT for a sufficient period before the main pancreaticoduodenectomy procedure while obtaining therapeutic effects from NAC.Subtotal stomach-preserving pancreaticoduodenectomy was thenperformed.The operation did not require any unusual techniques and was performed safely.Postoperatively,the patient progressed well,without any ischemic complications.Histopathologically,curative resection was confirmed,and the patient had no recurrence or complications due to ischemia up to six months postoperatively.CONCLUSION Preoperative endovascular stenting,with NAC and DAPT,is effective and safe prior to pancreaticoduodenectomy in potentially resectable pancreatic cancer.展开更多
目的探讨暂时性金属内支架扩张术在贲门失弛缓介入治疗中应用及其中远期疗效随访。方法 20例贲门失弛缓患者,在 X 线引导下置入国产带膜支架,术后3d～7d,由内镜取出,20例贲门失弛缓患者安放暂时性金属内支架20只(其中20mm 直径支架12只;...目的探讨暂时性金属内支架扩张术在贲门失弛缓介入治疗中应用及其中远期疗效随访。方法 20例贲门失弛缓患者,在 X 线引导下置入国产带膜支架,术后3d～7d,由内镜取出,20例贲门失弛缓患者安放暂时性金属内支架20只(其中20mm 直径支架12只;25mm 直径支架8只),治疗前所有患者均有不同程度的吞咽困难,并给予食管下段括约肌(LES)静息压力测定。结果 20例患者支架置入和支架取出成功率均为100%,操作死亡率为0%,支架置入后吞咽困难明显好转,吞咽困难评分0级;贲门管腔直径20 mm 和25mm,平均(22±3)mm,暂时性支架扩张术后,贲门狭窄直径明显高于治疗前、吞咽困难评分明显低于治疗前、LES 静息压明显降低(P<0.001);支架置入前,食管管腔直径1～9(平均5±4) mm;支架取出1wk 内管腔直径为10～18(平均14±3)mm.吞咽困难评分术前为2～3(平均2.4±0.3)级;支架取出后吞咽困难评分为0～1(平均O.5±0.3)级支架置入前 LES 静息压力为40～66(平均53±10)mmHg(1mmHg=0.133kPa);支架取出后 LES 静息压力为0～20(平均10±8)mmHg.支架置入后并发症有胸部胀痛12例,反流8例,支架取出后少量出血3例,反流2例,所有并发症均给予有效处理,所有患者术后随访6～26(平均16.5±9.3)mo.随访期内使用直径20mm 支架的患者有3例(15%)在治疗后6mo 内复发吞咽困难,17例(85%)在随访期内吞咽能力明显好转。结论暂时性金属内支架扩张术是贲门失弛缓介入治疗中最有效的方法之一,且中远期疗效较好.展开更多
自1993年至今采用食管支架置入术治疗食管贲门癌性狭窄及瘘63例,报告如下.1材料和方法1.1材料内镜下组织活检证实的食管贲门癌患者63例,原发53例(其中8例伴食管支气管瘘),术后复发10例,住院全面检查后胸外科会诊已无手术指征.男53例,女1...自1993年至今采用食管支架置入术治疗食管贲门癌性狭窄及瘘63例,报告如下.1材料和方法1.1材料内镜下组织活检证实的食管贲门癌患者63例,原发53例(其中8例伴食管支气管瘘),术后复发10例,住院全面检查后胸外科会诊已无手术指征.男53例,女10例,年龄45岁～83岁,平均53.6岁.均有明显吞咽困难,按 Stool 分级法…(0～Ⅳ级)分为Ⅱ级(进半流质)5例,Ⅲ级(进流质)47例,Ⅳ级(滴水不进)11例.病变上缘距门齿距离<20 cm 9例,20 cm～30 cm 29例,>30 cm 25例.内镜下管腔直径<2 mm13例,2 mm～4 mm 35例,4 mm～5 mm 15例.病变长度2 cm～3 cm 8例,4 cm～6 cm 32例,7 cm～9 cm 16例,>9 cm 7例.展开更多
文摘Introduction: In India, 57% of patients with head and neck cancers are documented with nutritional compromise. Active nutritional support has been shown to improve outcomes and reduce the cost of treatment in severely malnourished patients. The assessment of nutritional status should be a priority when initiating medical nutrition therapy. We evaluated the agreement between Subjective and Objective evaluation of pre-operative nutrition status of head and neck cancer patients in a tertiary cancer centre. Methods: Two hundred and thirty seven head and neck cancer patients who underwent surgery were eligible. The patients included both males (147) and females (90) with age varying between 23 - 88 years. All patients were screened for pre-operative nutrition status objectively as well as subjectively. The association of pre-operative SGA scores (A, B and C) subjectively, and PNS score (0, 1, 2) objectively were tested for statistical significance. Results: The cancer sites included tongue in 82, buccal mucosa in 30, thyroid in 28, alveolus in 18, glottis in 10, RMT in 10, nasal cavity in 9, FOM in 8. The pre-operative nutrition status based on subjective scores are A in 156 (65.8%), B in 75 (32%) and C in 6 (2.5%). The objective parameters obtained on the basis of BMI, % weight loss, PNI and S. albumin values are PNS 0 in 161 (67.9%), PNS 1 in 71 (30%) and PNS 2 in 5 (2.1%) patients. As the kappa coefficient p-0.56, there is moderate agreement between the pre-operative nutrition status subjectively as well as objectively. Conclusion: Subjective global assessment is a simple and inexpensive way to screen the pre-operative nutrition status when compared to the other objective assessment tool. SGA has moderate agreement with expensive and complicated objective assessment tools. So it can be a reliable tool for assessing the pre-operative nutrition status.
文摘BACKGROUND During pancreaticoduodenectomy in patients with celiac axis(CA)stenosis due to compression by the median arcuate ligament(MAL),the MAL has to be divided to maintain hepatic blood flow in many cases.However,MAL division often fails,and success can only be determined intraoperatively.To overcome this problem,we performed endovascular CA stenting preoperatively,and thereafter safely performed pancreaticoduodenectomy.We present this case as a new preoperative treatment strategy that was successful.CASE SUMMARY A 77-year-old man with a diagnosis of pancreatic head cancer presented to our department for surgery.Preoperative assessment revealed CA stenosis caused by MAL.We performed endovascular stenting in the CA preoperatively because we knew that going into the operation without a strategy could lead to ischemic complications.Double-antiplatelet therapy(DAPT)–which is needed when a stent is inserted–was then administered in parallel with neoadjuvant chemotherapy(NAC).This allowed us to administer DAPT for a sufficient period before the main pancreaticoduodenectomy procedure while obtaining therapeutic effects from NAC.Subtotal stomach-preserving pancreaticoduodenectomy was thenperformed.The operation did not require any unusual techniques and was performed safely.Postoperatively,the patient progressed well,without any ischemic complications.Histopathologically,curative resection was confirmed,and the patient had no recurrence or complications due to ischemia up to six months postoperatively.CONCLUSION Preoperative endovascular stenting,with NAC and DAPT,is effective and safe prior to pancreaticoduodenectomy in potentially resectable pancreatic cancer.
文摘目的探讨暂时性金属内支架扩张术在贲门失弛缓介入治疗中应用及其中远期疗效随访。方法 20例贲门失弛缓患者,在 X 线引导下置入国产带膜支架,术后3d～7d,由内镜取出,20例贲门失弛缓患者安放暂时性金属内支架20只(其中20mm 直径支架12只;25mm 直径支架8只),治疗前所有患者均有不同程度的吞咽困难,并给予食管下段括约肌(LES)静息压力测定。结果 20例患者支架置入和支架取出成功率均为100%,操作死亡率为0%,支架置入后吞咽困难明显好转,吞咽困难评分0级;贲门管腔直径20 mm 和25mm,平均(22±3)mm,暂时性支架扩张术后,贲门狭窄直径明显高于治疗前、吞咽困难评分明显低于治疗前、LES 静息压明显降低(P<0.001);支架置入前,食管管腔直径1～9(平均5±4) mm;支架取出1wk 内管腔直径为10～18(平均14±3)mm.吞咽困难评分术前为2～3(平均2.4±0.3)级;支架取出后吞咽困难评分为0～1(平均O.5±0.3)级支架置入前 LES 静息压力为40～66(平均53±10)mmHg(1mmHg=0.133kPa);支架取出后 LES 静息压力为0～20(平均10±8)mmHg.支架置入后并发症有胸部胀痛12例,反流8例,支架取出后少量出血3例,反流2例,所有并发症均给予有效处理,所有患者术后随访6～26(平均16.5±9.3)mo.随访期内使用直径20mm 支架的患者有3例(15%)在治疗后6mo 内复发吞咽困难,17例(85%)在随访期内吞咽能力明显好转。结论暂时性金属内支架扩张术是贲门失弛缓介入治疗中最有效的方法之一,且中远期疗效较好.
文摘自1993年至今采用食管支架置入术治疗食管贲门癌性狭窄及瘘63例,报告如下.1材料和方法1.1材料内镜下组织活检证实的食管贲门癌患者63例,原发53例(其中8例伴食管支气管瘘),术后复发10例,住院全面检查后胸外科会诊已无手术指征.男53例,女10例,年龄45岁～83岁,平均53.6岁.均有明显吞咽困难,按 Stool 分级法…(0～Ⅳ级)分为Ⅱ级(进半流质)5例,Ⅲ级(进流质)47例,Ⅳ级(滴水不进)11例.病变上缘距门齿距离<20 cm 9例,20 cm～30 cm 29例,>30 cm 25例.内镜下管腔直径<2 mm13例,2 mm～4 mm 35例,4 mm～5 mm 15例.病变长度2 cm～3 cm 8例,4 cm～6 cm 32例,7 cm～9 cm 16例,>9 cm 7例.
