Volume 14,Issue 12,2005 Table of Contents

1 Clinical analysis of laparoscopic resection of colorectal cancer

CHENG Yingdong , LIANG Ping , ZHANG Chaojun , LUO Yunsheng

2005, 14(12):2-886. DOI: 10.7659/j.issn.1005-6947.2005.12.002

[Abstract](774) [HTML](0) [PDF 891.56 K](599)

Abstract:
Objective:To study the feasibility of laparoscopic resection of colorectal cancer. Methods:A retrospectively analysis of the clinical data of 110 patients with colorectal cancer treated by laparoscopic resection during last three years was made. Of them, 24 cases were converted to open operation.In 86 cases, laparoscopic resection of colorectal cancer was completed. Among them, 5 cases underwent right hemicolectomy, 2 cases left hemicolectomy,10 cases sigmoidectomy, 22 cases Dixon′s operation, 46 cases of Miles operation, and 1 case total colorectomy. Results:No patient died within 30 days postoperatively in this series. The average operation time was 225 (120360) min with average 135 (20400) mL blood loss.The average number of lymph nodes excised was 8.7 (130). The average number of positive lymph nodes was 2.2 (024). Six cases had intraoperative complications, including 1 case of ureteral injury and 5 cases of intraabdominal bleeding. These patients were immediately converted to open surgery. There were 6 cases with postoperative complications, among them, 2 cases of urinary leakage, 2 cases of massive bleeding and 2 cases of intestinal obstruction. All of them recovered after reoperation.The time of bowel funtion recovering was 1272h after operation. The hospital stay after operation was 8.6 (715)days. The median followup was 14.3 months (range 133) for 100 (90.9%) patients. There was no portsite tumor metastasis and no tumor recurrence at the small abdominal incision. Six to fifteen months after opteration, 3 cases had diffase peritoneal metastases.1 case of Miles resection had perineal metastasis 3 months after surgery. Conclusions:Laparoscopic resection of colorectal cancer is technically feasible,and have advantages, such as less surgical trauma, less bleeding, less gastrointestinal interference and quicker recovery.Laparoscopic radical operation for colorectal cancer can meet the requirements of safety and radical operation.

2 Comparison of the complications of treatment of rectal cancer by laparoscopic versus conventional laparotomy procedure

ZHAO Pingwu , XIANG Chunhua , WANG Dong , XIAN Yujianbo , LI Guoqiang , XU Zhihua

2005, 14(12):2-895. DOI: 10.7659/j.issn.1005-6947.2005.12.003

[Abstract](622) [HTML](0) [PDF 887.23 K](673)

Abstract:
Objective:To compare the postoperative complications rate of total mesorectal excision (TME) performed by laparoscopic and conventional laparotomy method in treatment of rectal cancer.Methods:The clinical data of patients with rectal cancer treated by laparoscopic surgery(n=42) or traditional laparotomy (n=50) were retrospectively analysed to analysis of the cause and occurrence rate of complications. Results:The laparoscopic group had an advantage over the conventional laparotomy group in bowel movement recovery, earlier mobility and short hospital stay time. There was no difference in intraoperative injury, anastomotic leakage, sexual function preservation, longterm urinary dysfunction, and local recurrence or incision metastasis rates. Conclusions:Laparoscopic TME treatment of rectal cancer had the same therapeutic effect as the conventional laparotomy procedure did, and has a better subjective outcome.

3 The application of laparoscopic total mesorectal excision with preservation of anal sphincter for rectal cancer

ZHANG Chaojun , LlANG Ping , LUO Yunsheng , MA Xiaogan , CHENG Yingdong , WANG Liming , XIANG Jiamei

2005, 14(12):3-888. DOI: 10.7659/j.issn.1005-6947.2005.12.004

[Abstract](652) [HTML](0) [PDF 887.48 K](629)

Abstract:
Objective:To explore the feasibility and efficacy of laparoscopic total mesorectal excision (TME) with preservation of anal sphincter for rectal cancer. Methods:From October 2001 to March 2004, 54 patients with rectal cancer underwent laparoscopic total mesorectal excision（TME) with preservation of anal sphincter. In 51 of the 54 cases, the operation was completed laparoscopically, including 14 cases of laparoscopic anterior resection (AR) with the anastomosis level above the peritoneal reflection; 20 cases of laparoscopic low anterior resection (LAR) with the anastomosis level more than 2cm above the dentate line; 16 cases of laparoscopic ultralow anterior resection (ULAR) with the level of anastomosis within 2cm of the dentate line; and 2 cases of laparoscopic coloanal anastomosis (CAA) with the level of the anastomosis at or below the dentate line. whereas conversion to an open approach was required in three cases.Results:The average operating time was 145 minutes (range 110~210min), and mean operative blood loss was 50 mL (range 30~80mL). Bowel function was restored and diet was resumed at 48 to 36 hours after operation. The average hospital stay was 9 days (range 7~14d). TME was completed successfully in 51 patients. Postoperative analgesics were used in 20 patients. No intraoperative or postoperative complications were observed.Followup time was from 6~36 months in 51 patiebts,and there was no portsite or local tumor recurrence.Conclusions:Laparoscopic TME is feasible and safe. It is a perspective technique with the benefits of minimally invasive technique and lower blood loss during operation, and rapid recovery.

4 Clinical study on laparoscopic radical operation for rectal cancer after shorttime preoperative radiotherapy

TAO Kaixiong , WANG Guobin , LU Falong , CHEN Daoda , WAN zhongcheng

2005, 14(12):4-892. DOI: 10.7659/j.issn.1005-6947.2005.12.005

[Abstract](669) [HTML](0) [PDF 884.82 K](750)

Abstract:
Objective:To explore the application and efficacy of laparoscopic radical operation for rectal cancer after preoperative shorttime radiotherapy. Methods:The clinical data of 108 patients with Dukes B and C rectal cancer were analyzed retrospectively. Thirtyfive patients underwent laparoscopic radical operation after preoperative shorttime radiotherapy, meanwhile 30 patients underwent laparoscopic radical operation, and 43 patients underwent open operation,both later groups without preoperative radiotherapy. Results:There were not significant differences in preoperative general condition, tumor size and stage, pathological type, site of operation, and mode of operation between the 3 groups. But there was a higher rate of radical resection and sphincter preservation in the laparoscopic operation plus radiotherapy group than in the other groups (P<0.05), and at postoperative followup,there were also lower rates of local recurrence and distant metastasis in the laparoscopic radiotherapy group than in the other groups,while there was no increase in complications. Conclusions:Adjuncted with preoperative shorttime radiotherapy, laparoscopic operation for rectal cancer has higher rates of resection and sphincter preservation.

5 A study on the influence of laparoscopic resection of colorectal cancer on micrometasis of tumor cells

ZHOU Kun , GE Haiyan

2005, 14(12):6-899. DOI: 10.7659/j.issn.1005-6947.2005.12.006

[Abstract](694) [HTML](0) [PDF 898.62 K](562)

Abstract:
Objective:To investigate the influence of laparoscopic resection of colorectal cancer on postoperative micrometastasis of tumor cells. Methods:Using cytokeratin,CK20 mRNA as target gene,the RTPCR method was used to examine the preand postoperative changes in the number of tumor cells in the peripheral blood of 48 cases of colorectal cancer.Results:After operation, the number of tumor cells in peripheral blood was significantly higher in the laparoscopic surgery group as compared to that of traditional laparotomy operation group(P<0.05).The degree of increase in the number of tumor cells in peripheral blood after laparoscopic surgery was not related to patient′s age(P>0.05),but was significantly related to positive rate of proliferating cell nuclear antigen(PCNA)(P<0.05).Conclusions:Laparoscopic resection of colorectal cancer may increase the risk of hematogenous tumor metastasis,and this risk is ever higher in patients with PCNA≥50% who undergo laparoscopic resection of colorectal cancer.

6 Experimental study of Egr1,PDGFB and TGFβ1 genes in autogenous vein graft

LIU Chengwei , HU Xinhua , YANG Jun , YANG Dehua , ZHANG Qiang , ZHANG Zhishen , DUAN Zhiquan , Xin Shijie

2005, 14(12):7-904. DOI: 10.7659/j.issn.1005-6947.2005.12.007

[Abstract](587) [HTML](0) [PDF 904.77 K](636)

Abstract:
Objective:To investigate the expression and relationship of early growth response gene1(Egr1), plateletderived growth factorB(PDGFB) and tranforming growth factor(TGFβ1) in autogenous vein graft in rats,and the role in vein graft intimal hyperplasia(IH). Methods:Autogenous vein graft model was established in 90 wistar rats. The vein graft samples were harvested at 1，2，6，24 hours, and 3，7，14，28，42 days after surgery. Normal vein was used as control group. Egr1、PDGFB，TGFβ1 mRNA was measured by reverse transcriptionPCR and in situ hybridization. Western blotting and immunohistochemistry were used to detect the protein expression of Egr1，PDGFB and TGFβ1. Results:Expression of Egr1，PDGFB，TGFβ1 mRNA and protein was not detected in normal vein. In grafting vein,expression level of Egr1mRNA reached a peak at 28days, and the positive rate of Egr1mRNA was 45%±6%; PDGFBmRNA reached a peak at 14days（48%±6%）; a peak of TGFβ1mRNA was 46%±9% reached at 7days; Egr1 protein expression reached a peak at 28days, and the positive rate of Egr1 protein was 40%±9%. PDGFB protein reached a peak at 28days（45%±4%）, TGFβ1 protein reached a peak at 14days( 41%±7%). Conclusions:Intimal hyperplasia of vein graft is closely associated withexpression of Egr1、PDGFB and TGFβ1; the activation and expression of PDGFB and TGFβ1 may be modulated by Egr1, and they may contribute to increase expression of Egr1 by feedback.

7 The effects of hemoglobin concentration on cirrhosis and portal hypertension associated with hyperdynamic circulation

HUA Rong , CAO Hui , WU Zhiyong

2005, 14(12):8-908. DOI: 10.7659/j.issn.1005-6947.2005.12.008

[Abstract](949) [HTML](0) [PDF 897.02 K](560)

Abstract:
Objective:To investigate the effects of hemoglobin concentration on portal hypertension associated with hyperdynamic state. Methods:According to blood hemoglobin level below or above 110g/L, 55 nontreated portal hypertension patients were divided into anemic and nonanemic groups, and the relevant hemodynamic and clinical data were examined and analyzed retrospectively. In order to avoid the effects of differences in hepatic function, data were analyzed separately according to the Child class. Results:Compared to the nonanemic group, the anemic group had markedly increased cardiac output ［(7.4±1.7L)/min vs (6.3±1.9L)/min, P=0.028］ and increased free portal pressure ［(29.1±3.1)mmHg vs (26.8±3.3)mmHg, P=0.012］, and a markedly decreased mean arterial pressure ［(84±10.7)mmHg vs (97.1±12)mmHg, P<0.01］ and systemic vascular resistance ［(866±215)dyn/(s·cm5)vs (1207±317) dyn/(s·cm5), P<0.01］. Similar results were obtained when Child A and Child BC patients were analyzed separately. Multivariate logistic regression disclosed that hemoglobin concentration, as well as albumin concentration, was an independent factor influencing the systemic vascular resistance in PHT patients. Conclusions:Anemia further aggravates the hyperdynamic circulation of portal hypertension. Hemoglobin concentration is an important parameter to evaluate the hemodynamic status of PHT patients.

8 Effect of transfection of antisense MBD1 gene eukaryotic expression vector on the expression of MBD1 gene in human cholangiocarcinoma cell line

ZUO Shi , LI Zhanfei , LUO Jian , GUO Wei , XU Lining , LIU Minfeng , DONG Jingqing , ZOU Shengquan

2005, 14(12):9-913. DOI: 10.7659/j.issn.1005-6947.2005.12.009

[Abstract](662) [HTML](0) [PDF 904.76 K](661)

Abstract:
Objective:To study the effect of transfection of antisense MBD1 gene eukaryotic expression vector on the expression of MBD1 gene in human cholangiocarcinoma cell line QBC939. Methods:The constructed antisense MBD1 gene eukaryotic expression vector was transfected into the human cholangiocarcinoma cell line QBC939 using lipofectamine transfection reagents, and positive cell clones were obtained using G418 selection after transfection. The constructed recombinant vector was transfected into QBC939 cells successfully and was confirmed by amplifying the exogenous neoR gene with PCR method. The expression level of MBD1 gene mRNA and protein was detected by RTPCR and FCM methods respectively. Results:Following the transfection, the MBD1 gene mRNA level in human cholangiocarcinoma cell line QBC939 decreased from 0.912±0.022 to 0.215±0.017, and the MBD1 gene protein level also decreased from (80.19±5.05)％ to (35.11±4.05)％. There were very significant differences on the expression both at the transcription and posttranscription levels of MBD1 gene between nontranfection group and the antisense MBD1 gene eukaryotic expression vector transfection group (P＜0.01). Conclusions:Transfection of the antisense MBD1 gene eukaryotic expression vector significantly reduced the expression level of MBD1 gene in human cholangiocarcinoma cell line QBC939, and suggestes that MBD1 gene plays an important role in the development of cholangiocarcinoma and that transfection of antisense MBD1 gene may be a new method to treat cholangiocarcinoma.

9 Expression and significance of EphA2 and Ecadherin in pancreatic carcinoma

FENG Yanping , HUANG Tao , GAO Jun , QIN Renyi

2005, 14(12):10-917. DOI: 10.7659/j.issn.1005-6947.2005.12.010

[Abstract](1019) [HTML](0) [PDF 895.37 K](726)

Abstract:
Objective:To explore the expression and clinical significance of EphA2 and Ecadherin in pancreatic cancer tissue and cells.Methods:The expression of EphA2 and Ecadherin in 56 pancreatic carcinomas and 23 adjacent noncancer tissues were studied by immunohistochemistry, and their relationship to clinicopathological characteristics were analyzed. RTPCR was performed to explore the expression of EphA2,BXPC3,PC3 and PANC1 in pancreatic carcinoma cell lines. Results:In pancreatic carcinomas tissuse showed increased EphA2 expression and reduced Ecad expression which compared with adjacent noncancer tissues. The expression level of EphA2 had a significant positive relationship with tumor differentiation degree, lymphatic metastasis and clinical stage. However, the expression level of Ecadherin had negative relationship with both the tumor clinical stage and lymphatic invasion. Furthermore, a significant negative relationship between the expression of EphA2 and Ecadherin was observed. The expressions of EphA2 were higher in highinvasive cell lines PXPC3 and Panc1 than in lowinvasive cell line PC3. Conclusions:The expression and/or abnormal function of EphA2 and Ecadherin may together be involved in the development and progression of pancreatic cancer;the combined measurement of these two proteins may be useful for determination of metastatic potency of pancreatic carcinoma.

10 Inhibitory effect of vitamin E succinate on experimental breast cancer in nude mice

ZHANG Wei , ZHANG Junchu , XU Xinyun , ZHU Daqiao , HE Jin , WANG Qiang

2005, 14(12):12-921. DOI: 10.7659/j.issn.1005-6947.2005.12.011

[Abstract](672) [HTML](0) [PDF 894.31 K](547)

Abstract:
Objective:To investigate the inhibitory effect of vitamin E succinate(VES) on experimental breast cancer in nude mice. Methods:MCF7 human breast cancer cells were inoculated subcutaneously in nude mice. VES was administrated at a dosage of 150mg/kg body weight for 5 weeks. Then, the size of the tumor was measured and cell cycle and cell surface Fas/FasL were detected by flow cytometry. Fas/FasL expression in tumor tissue was detected with immunohistochemistry, and apoptosis index was detected by TUNEL method. Results:VES showed obviously inhibitory effect on the growth of graft breast cancer tumor in vivo. VES treatment blocked tumor cells in G0/G1 phase. Fas/FasL expression was upregulated accompanied with a rise of apoptotic index in tumor tissue. Conclusions:VES had potent inhibitory effect on MCF7 breast cancer graft in nude mice. The mechanism involved may be related to the upregulation of Fas/FasL expression and promotion of apoptosis of tumor cells.

11 Clinical analysis of functional delayed gastric emptying after pancreatodudenectomy:a report of 28 cases

YANG Fenghui , GAO Dezhong , WANG Zhanmin

2005, 14(12):13-927. DOI: 10.7659/j.issn.1005-6947.2005.12.012

[Abstract](591) [HTML](0) [PDF 882.39 K](640)

Abstract:
Objective:To study the etiology ,diagnosis and treatment of functional delayed gastric emptying(FDGE) resulting from pancreatoduodenectomy. Methods:From June, 1990~June, 2003, 136 patients received pancreatoduodenectomy, whose clinical data were retrospectively analyzed. Upper gastrointestinal radiography and endoscopy were the main methods of examination. Results:Twentyeight cases were complicated with FDGE in the 136 patients(20.6%) after operation. The occurrence of FDGE was correlated with hyperbilirubinemia, diabetes, duodenal obstruction, pancreatic fistula and abdominal infection. All patients were cured with conservative treatment. The recovery time of gastric motility was 1442 days, average time was 28 days. Conclusions:Hyperbilirubinemia, diabetes, duodenal obstruction, pancreatic fistula and abdominal infection were the main causes of FDGE.

12 Clinical livingrelated segmental small bowel transplantation: a case report

WANG Shufeng , CHE Xiangming , CHEN Jincai , Lu Shaoying , Huo Xiongwei , Fan Lin , Li Guowei

2005, 14(12):15-933. DOI: 10.7659/j.issn.1005-6947.2005.12.013

[Abstract](577) [HTML](0) [PDF 885.68 K](763)

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Objective:To investigate the effect of short bowel syndrome treated with livingrelated small bowel transplantation(SBT). Methods:A male patient with residual intestine 20cm in length, which resulted from subtotal small bowel resection and right hemicolectomy owing to intestinal volvulus, received a livingrelated SBT. The donor was the patient′s mother. Donor specific blood transfusion,50mL/per week, was carried out for 8 weeks. Cytomegalovirus infection status in both donor and recipient was negative. A 160cm segment of intestine was transplanted. The graft ileocolic artery and vein was anastomosed to the recipient′s infrarenal aorta and inferior vena cava endtoside, respectively. A distal ileostomy was performed. Immunosuppression,antiinfection and anticoagulation therapy, and nutritional support were given postoperatively. Results:The donor had an uneventful recovery. No technical complications were observed. The recipient was alive and well 31 weeks after operation. No graft rejection or infection was found. The patient was taken off TPN 8 weeks after operation, and got a lowfat meal. The result of Dxylose test was near normal. Conclusions:Livingrelated small intestine transplantation is an effective treatment for short bowel syndrome.

13 CT virtual endoscopy and multiple plane reconstruction in preoperative staging of rectal cancer

ZENG Qingdong , LU Lihong , LU Bin , MA Tingzhai

2005, 14(12):16-936. DOI: 10.7659/j.issn.1005-6947.2005.12.014

[Abstract](638) [HTML](0) [PDF 882.59 K](602)

Abstract:
Objective:To investigate the value of CT virtual endoscopy(CTVE) and multiple plane reconstruction(MPR)for preoperative staging of rectal cancer. Methods:Fortyfive patients with rectal cancer were examined by CTVE and MPR to determine the preoperative staging,and the reselts were compared with CT.Results:For evaluation of intramural invasion,the accuracy rate of CTVE and MPR was 86.7%(39/45),pelvic CT was 66.7%(30/45)(P<0.05).For lymph node involvement,the accuracy of CTVE and MPR was 76.9%(20/26),pelvic CT was 50%(13/26)(P<0.05). Conclusions:For preoperative staging of rectal cancer, the accuracy rate of CTVE and MPR was higher than that of pelvic CT. CTVE and MPR is of important significance in guiding clinical treatment.

14 The application of meshplug tensionfree hernia repair in elderly patients with inguinal hernia

QIAO Haiquan , TONG Liquan , WANG Yuli , ZHOU Baoguo

2005, 14(12):17-939. DOI: 10.7659/j.issn.1005-6947.2005.12.015

[Abstract](683) [HTML](0) [PDF 883.47 K](848)

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Objective:To evaluate the clincal therapeutic efficacy of meshplug tensionfree hernia repair in elder patients with inguinal hernia. Methods:The clinical data of 127 elder patients with inguinal hernia treated with meshplug tensionfree hernia repair in our hospital were analyzed retrospectively. Results:All cases were treated by tensionfree hernia repair with meshplug casehardened products which manufactured by American Bard Company. All the patients were cured. Average operation time was 40 min, and average hospital stay was 4.6d. The patients were followed up for 6~24 months,only 1 case had recurrence of hernia(recurrence rate 0.8%).Conclusions: Meshplug tensionfree hernia repair is a perfectly sound physiologic and anatomic operation. It is a simple,minitraumatic procedure, with advantages of quick recovery, low recurrence rate and wide indications. It is especially suitable to elder patients or patients with the type II or larger hernial.

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Volume 14,Issue 12,2005 Table of Contents

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