Abstract:

Objective：To evaluate the role of regional chemotherapy via internal iliac artery pump, systemic chemotherapy and total mesorectum excision (TME)  in the treatment of rectal cancer.
Methods：A total of 193 patients with rectal carcinoma divided into 2 groups: The observation group, included 98 cases who underwent TME, regional chemotherapy through internal iliac artery pump and systemic chemotherapy.The other 95 cases, as control group, were treated with systemic chemotherapy after TME. The local recurrence rate, metastasis rate and survival rate were compared between the two groups.
Results：The local recurrence rate and metastasis rate of the observation group was significantly lower than that of the control group. The local recurrence rate at 1-,3- and 5-year was significantly lower in the observation group［0，2.5%(2/81) and 3.8%(3/79) respectivvely］than that in the control group ［1.1%(1/95),11.4%(9/79) and 16.2%(11/68) respectively］(P＜0.05). The 1-, 3-, and 5-year distant metastasis rate in the observation group was 1%(1/98)，6.2%(5/81) and 12.7%(10/79) respectively, while that in the control group was 2.1%(2/95),24.1%(19/79),30.9%(21/68) respectively, which showed significant differences between the two groups(P＜0.05).The 3-and 5-year survival rate of the observation group (79.0%,73.4% respectively)was higher than that of the control group (57.0%,52.9% respectively)(P＜0.05).
Conclusions：Regional perfusion via internal iliac artery pump and systemic chemotherapy with TME has proved to be a safe and effective treatment that could reduce local recurrence rate and distance metastasis rate, and is an effective method to improve the survival rate of rectal cancer patients.

Abstract:

Objective：To analyze the prognostic factors in simultaneous resection of colorectal cancer （colon cancer and rectal cancer）and synchronous liver metastasis.
Methods：The prognosis of 37 patients with colorectal cancer and  synchronous liver metastasis who  received simultaneous resection were analyzed by multi-factorial logistic regression analysis.
Results：The age,the portal vein chemotherapy with local chemotherapy pump,histological classification,lymph node metastasis, and the location,size and number of metastatic lesions affected the survival time of the patients.
Conclusions：Intraoperative and postoperative chemotherapy through portal vein pump can improve prognosis and prolong median survival time in simultaneous resection colorectal cancer and synchronous liver metastasis, and it is an unique controllable factor.

Abstract:

Objective：To study the impact of preventive transverse colostomy on anastomotic leakage(AL) of low rectal anterior resection(LAR).
Methods：A retrospective analysis on clinical data of 312 cases of middle and lower rectal cancer patients  who underwent LAR at the Department of General Surgery, the Second Clinical School of Medicine, Shanxi Medical University was conducted using Fisher exact test to comparatively analye the impact of preventive transverse colostomy on AL following LAR.
Results：There was no statistical difference(P＞0.05) between the AL rate following LAR with or without preventive transverse colostomy(2/63, 3.2%  vs. 21/249, 8.4%) (P＞0.05).
Conclusions：Preventive transverse colostomy can not effectively reduce the incidence of AL rate following LAR, and besides the patients have preventive transverse colostomy will require reperation to close the colostomy.

Abstract:

Objective：To investigate the causes of complications of abdominal stoma after surgery on patients with rectal cancer, and to explore the measures of prevention and treatment.
Methods：The clinical data of 299 patients with rectal cancer who underwent abdominal ostomy were reviewed retrospectively.
Results：The overall incidence of stoma-associated complications was 33.1% (99/299). Peri-stomal dermatitis occurred in 91cases (30.4%), 8 cases (2.7%) suffered from stomal stenosis, 3 cases (1.0%) had with stomal obstruction, 17 cases (5.7%) had stomal prolapase and 2 cases (0.6%) had stomal necrosis. The incidence of peri-stomal dermatitis and stomal prolapase was much higher in patients with loop stoma than those with end stoma. In patients with end stoma, the occurrences of stomal obstruction and para-stomal hernia were less observed in those with extraperitoneal colostomy than those with transperitoneal colostomy.
Conclusions：Timely management of stoma related factors and reasonable choice of ostomy method could effectively reduce the occurrence of stomal complications.

Abstract:

Objective：To study the difference of proteomic spectra in serum of patients with colorectal cancer(CRC) in order to build a proteomic pattern and find a method for early diagnosis of CRC. 
Methods：We screened for potential tumor biomarkers of serum samples from 48 CRC patients and 34 healthy subjects by using CM10 (Ciphergen Company, USA) and the technology of Surface enhanced laser desorption/ionization time-of-flight mass spectrometry（SELDI-TOF-MS）.Using Ciphergen Protein Chipsoftware 5.1, a proteomic pattern was constructed. The constructed pattern was then tested by an independent set of masked serum samples from 33 colorectal cancer patients and 34 healthy subjects.
Results：(1) The contents of 27 proteins in the  CRC to healthy subjects groups were significantly different (P＜0.05) and the M/Z values of these 27 proteins were from 2770.34Da to 16061.26 Da. There were 18 M/Z peaks highly expressing in CRC patients and 9 M/Z peaks highly expressing in healthy subjects. (2) Protein peaks clustering and classification analyses were performed to build a proteomic pattern by M/Z 2770.34, 7971.57 and 11493.00. There were 38 cases in 48 CRC patients and 32 cases in 34 healthy subjects that were classified correctly in this proteomic pattern, and the sensitivity and specificity was 94.12% (32/34) and 79.17% (38/48) respectively. (3) Furthermore, a sensitivity of 72.73% (24/33) and a specificity of 91.18% (31/34) for the blinded test were obtained when comparing the CRC patients with healthy subjects.
Conclusions：The specific serum protein in patients with CRC can be quickly and exactly diagnosed by SELDI-TOF-MS with high sensitivity and specificity. Finding specific-associated proteins could be valuable targets for the early diagnosis of CRC.

Abstract:

Objective：To investigate the relationship between expressions of multidurg resistance associated factors and chemosensitivity of 5-fluorouracil（5-FU） in lymph node metastases(LNMs) of colon carcinoma.
Methods：The chemosensitivity to 5-FU was measured by MTT assay, and the expressions of P-gp, GST-π, p53, survivin, Bcl-2 and Bax were determined immunohistochemically in 48 paired primary tumor (PT) and LNMs of colon carcinoma.
Results：The inhibition rates of LNMs cells for 5-FU were higher than that of PT (P＜0.05). The expressions of P-gp and Bax were higher in LNMs than those in PT (both P＜0.05), and lower expression of Bcl-2 was found in LNMs (P＜0.05). There was statistically negative correlation between inhibition rates and expression of P-gp in PT (P＜0.05); Bcl-2 had negative correlation with inhibition rates for 5-FU in LNMs (P＜0.05), and positive correlativity was found between Bax and inhibition rates for 5-FU (P＜0.05).
Conclusions：The main factors that affect chemosensitivity to 5-FU in colon carcinoma in PT and in LNMs are different. Effective adjuvant chemotherapy after operation and reversion of multidrug resistance(MDR) of colon cancers depends on targeting the metastatic component of the disease.

Abstract:

Objective：To explore the expression of microRNA-133b in colorectal carcinoma cells and its effect on migration and invasion of colorectal cancer cells.
Methods：The expression of microRNA-133b (miR-133b) in normal human colon cells and four colorectal cancer cell lines with different malignant potential were examined by real-time PCR. The miR-133b genomic sequences were amplified from human genomic DNA by PCR and constructed into the eukaryotic expression vector. SW-620 cells were transfected with the identified plasmid by Effectene. SW-620 cell lines with stable expression of miR-133b or control were obtained after a 3-week selection period in medium supplemented with G418, designated SW-620-133b and SW-620-HK, respectively. Cell migration and invasion was measured in vitro by wound healing assay and transwell assay.
Results：miR-133b expression was shown to be greatly downregulated in human colon cancer cells (SW-480，HT-29，LoVo，SW-620) compared to normal colon cells CCD-18Co (P＜0.05), and this downregulation was inversely associated with degree of malignancy of colorectal cancer cells. In cancer SW-620 cells, expression of miR-133b significantly inhibited tumor cell migration and invasion, with the inhibiting rates of (42.2±2.6) % and (66.3±8.7) %, respectively.
Conclusions：The expression of miR-133b is downregulated in human colorectal cancer cells. Overexpression of miR-133b significantly inhibits SW-620 cell migration and invasion.

Abstract:

Objective：To investigate the mechanisms and relationship between HIF-1α and CDX2 expressions in human colonic cancer cell line SW480 and LS174T during different time of hypoxia.
Methods：(1)The two tumor cell lines (SW480 and LS174T) were respectively exposed to CoCl2 (100,150 and 200 μmol/L) for different time periods (24 h,36 h and 48 h), and cells viability and proliferation were detected by MTT methods in order to select suitable CoCl2 concentration. (2) Semiquantitative RT-PCR were used to detect the change in mRNA level of SW480 and LS174T under CoCl2 (100μmol/L). Total amounts of CDX2 protein in SW480 and LS174T were examined by Western blot.
Results：Higher concentrations of CoCl2 (150, 200μmol/L) significantly decreased cell survival rate (P＜ 0.05). So, we selected low concentration of CoCl2 (100μmol/L) to construct hypoxic model. HIF-1α mRNA expression of SW480 and LS174T increased with prolongation of hypoxia time when cells were exposed to CoCl2 (100μmol/L) and reached peak at 24 hours hypoxia (P＜0.05). Similar results were observed in Snail mRNA expression. But mRNA and protein expression of CDX2 reduced significantly under CoCl2 (100μmol/L) and gradually declined as the time of hypoxia was prolonged.
Conclusions：HIF-1α might be up-stream regulator of CDX2 and its over expression may play an important role in progression of colorectal cancer.

Abstract:

Objective：To explore the effects of siRNA targeting survivin combined with radiotherapy on human carcinoma cells SW480.
Methods：The human colorectal carcinoma cell line SW480 was treated with siRNA targeting survivin. The expression level of survivin in transfected SW480 cells was detected by RT-PCR and immunocytochemistry. The effects of siRNA on cell cycle were analyzed by FCM with PI staining. Radiotherapy was combined with siRNAs targeting survivin to study the sensitivity of SW480 induced by siRNA targeting survivin to radiotherapy. The effects of the survivin siRNA combined with radiotherapy on the growth of SW480 were studied by MTT assay. The apoptosis rate of SW480 was analyzed by FCM with annexinV/PI staining.
Results：RT-PCR demonstrated that the expression of survivin was knocked down significantly by the siRNA. Arrest in G2/M phase of the cell cycle was detected by FCM in the SW480 cells transfected with siRNA targeting survivin. The MTT assay showed that siRNA targeting survivin combined with radiotherapy inhibited the growth of SW480 cells more significantly compared with single treatment. More apoptosis cells (almost 35.72%) were detected by FCM in the SW480 cells treated with siRNA combined with radiotherapy.
Conclusions： The small interfering RNA can inhibit survivin of the human colorectal carcinoma cell line SW480. The siRNA targeting survivin combined with radiotherapy can inhibit the proliferation of SW480 and increase the percentage of apoptotic cells markedly. The siRNA targeting survivin can enhance the sensitivity of colorectal carcinoma cell line SW480 to radiotherapy in vitro.

Abstract:

Objective： To investigate the expression of Notch1 and its ligand DLL4 in human gastric carcinoma tissues and its correlation with tumor angiogenic metastasis.
Methods：Immunohistochemical SP method was used to detect the expression of Notch1, DLL4 and VEGF in 45 gastric carcinoma tissues and paired adjacent normal gastric mucosa, and the relationship between them and clinico-pathological parameters were analyzed.
Results：The positive expression rate of Notch1, DLL4 and VEGF in gastric carcinoma were higher than that in normal gastric mucosa (P＜0.01). The expression of Notch1 protein in gastric carcinoma was closely related to depth of invasion, lymph node metastasis(P＜0.01) and distant metastasis(P＜0.05). The positive expression rate of DLL4 protein in gastric carcinoma was closely related to depth of invasion(P＜0.01), lymph node metastasis and TNM staging (P＜0.05). The expression of VEGF protein in gastric carcinoma was closely related to depth of invasion(P＜0.01), lymph node metastasis, distant metastasis and TNM staging (P＜0.05).There was a positive correlation between the expressions of Notch1, DLL4 and VEGF(P＜0.05).
Conclusions：The increased expressions of Notch1 and DLL4 in gastric carcinoma is closely related to VEGF and they probably play an important role in tumor angiogenesis, and are involved in invasion and metastasis of gastric carcinoma.

Abstract:

Objective： To investigate the effect of TGIF on  apoptosis of TGF-β- induced gastric canceer cell.
Methods：After TGIF was stably transfected into gastric cancer cell line BGC823, apoptosis was examined with flow cytometry, and the expressions of TGIF, caspase8 and caspase9 were analyzed with Western blot.
Results：The apoptosis rate of BGC823 cells with the treatment of TGF-β obviously increased, and was accompanied by activation of caspase9 but not caspase8. Moreover, compared with controls, pcDNA3.1-TGIF-transfected BGC823 cells significantly decreased the sensitivity of TGF-β-induced apoptosis.
Conclusions：TGF-β induced the apoptosis of gastric cancer cell BGC823 via caspase9 pathway; furthermore, TGIF could inhibit TGF-β-induced apoptosis.

Abstract:

Objective：To evaluate the effect of laparoscopy-assisted radical resection of gastric cancer guided by carbon nanopartical tracer.
Methods：The clinical records of 109 patients who received radical resection of gastric cancer in PLA General hospital in the past 2 years were divided into three groups and analzed retrospectively. The observation group included 21 patients who underwent laparoscopic D2 radical resection of gastric cancer guided by carbon nanopartical lymph tracer; the control groups included 40 patients who underwent routine laparotscopic D2 surgery; and 48 patients who underwent open D2 radical operation as open surgery group.
Results：There was no significant difference in gender and age between the three groups. The number of lymph nodes dissected in the observation group was larger than that in control groups(both P＜0.05).The mean volume of blood loss in the observation group was (156±102)mL，less than the control group ［(182±109)mL］ and open surgery group［(230±112)mL］.The average hospital stay of the observation group was (11.9±5.8)d, shorter than the open surgery group［(17.5±9.4)d］.
Conclusions：Carbon nanopartical lymph tracer has excellent target ability for lymphadenectomy in laparoscopic  distal gastrectomy for gastric cancer. It can increase the number of dissected lymph nodes, reduce surgical trauma and achieve faster postoperative recovery.

Abstract:

Objective：To analyze the clinicopathologic features, effect of surgical treatment and prognosis of elderly patients with gastric cancer.
Methods：The records of 84 elderly patients (aged 80 years or above) with gastric cancer who underwent operation in our hospital from 2000-2008 were analyzed retrospectively.
Results：Ten patients had early gastric cancer (1a,8 cases, 1b, 2cases), stage II 12 cases, stage III 45 cases (53.6%) and stage IV 17 cases. Among them, 81% patients had one or more co-morbidities. Cardiovascular disease  was present in 43 cases(51.2%).  Resection rate was 85.7% (72/84).  Radical resection rate was 60.7%(51/84). Limited nodal dissection(＜D2) was done in 27 cases (52.9%). D2 dissection was performed in 20 cases (47.1%).The postoperative complication rate was 28.6%, and the rate of surgical related morbidities was 6.0%. The main non-surgical complication in postoperative period was pulmonary infection (14.3%). The tumor size was an independent risk factor for postoperative complications (P=0.009).  Postoperative mortality was 3.6% （n=3）.The 5 years survival rate was 63.0% for limited nodal dissection and 50.0% for D2 dissection.  Total survival rate for radical resection was 56.9%. The 5-year survival rate for stage I cancer was 80.0%.
Conclusions：Gastrectomy with limited nodal dissection in elderly patients with gastric cancer and mild preoperative co-morbidity is safe and effective, and can achieve a good prognosis.   

Abstract:

Objective：To appraise the postoperative anti-reflux function of vertical esophagogastic valve-plasty anastomosis for cardiac cancer.
Methods：Forty patients with cardiac cancer were randomly divided into study group and surgery control group, with 20 patients in each group.The study group underwent vertical esopagogastric valve-plasty anastomosis, while the surgery control group underwent conventional esophagogastrostomy. Ten healthy volunteers were recruited as normal control group. A 24-hour esophageal pH monitoring and endoscopy check-up was carried out in all experimental subjects at 90 days postoperatively.
Results：All of the pH monitoring indexes in study and surgery control groups were higher than those in normal control group (P＜0.05), and those in surgery control group were higher than those in study group (P＜0.05), and the degree of gastro-esophageal reflux and histological mucosal inflammation in study and surgery control groups were higher than those in normal control group (P＜0.05), while those in surgery control group were higher than those in study group (P＜0.05).
Conclusions：The operative type of vertical esophagogastric valve-plasty anastomosis has some reflux phenomenon, but it has marked antireflux effect compared to the traditional operation.

Abstract:

Objective：To assess the therapeutic effect of gastrografin therapy in adhesive small bowel obstruction.
Methods：One hundred and forty-six patients with adhesive small bowel obstruction, during January 2007 and June 2009, were randomized divided into receive gastrografin tretment group (n=72) and control group (n=74). Gastrografin therapy group received 80-100 mL of gastrografin either orally or via a nasogastric tube. The time before admission, relief time of successful nonoperative treatment, time before operation of unsuccessful nonoperative treatment, obstruction relief rate, hospitalization time and cost of hospitalization were compared.
Results：In study group, 50 cases (69.4%) had successful outcome, which was higher than the 46.0%(34/74) of control group (P＜0.05); the average symptomatic relief time was (1.90±1.03) d shorter than that of control group (3.20±1.95)d（P＜0.05）. Twenty-two cases (30.6%) of gastrografin therapy group were not relieved, The time before operation of unsuccessful nonoperative treatment, hospitalization time and cost of hospitalization were significantly less than that of controls (P<0.05).
Conclusions：Gastrografin therapy can increase the rate of successful nonoperative treatment，accelerates resolution of adhesive small bowel obstruction, and shorten surgical decision-making time for unsuccessful nonoperative treatment. It also can reduce the hospitalization time and cost of hospitalization.

Abstract:

Objective：To investigate the diagnosis and treatment of intestinal malrotation in non-neonatal patients.
Methods：The clinical data of 11 non-neonatal patients with intestinal malrotation were analyzed retrospectively.
Results：Patients presented with vomiting and paroxysmal abdominal pain as the main clinical manifestations. There were no typical symptoms and signs of intestinal malrotation in non-neonatal patients. A diagnosis of intestinal malrotation was made preoperatively in 6 patients by  gastrointestinal contrast study, 2 patients by barium meal and ultrasonography and one patient by barium meal and computerized tomography. The preoperative diagnosis rate was 82%. All patients were proven to have intestinal malrotation intraoperatively and underwent a Ladd procedure. Only one patient had postoperative complication of adhesion of intestine, and recovered after conservative treatment. The others recovered well. All the patients received follow-up of 6-60 months and were asymptomatic, except one case of intestinal obstruction that occurred one year later and recovered by non-operative treatment.
Conclusions：The possibility of intestinal malrotation should be suspected in non-neonatal patients with symptoms of recurrent vomiting and abdominal pain. Combining various imaging assays can enhance the diagnosis rate of intestinal malrotation. Ladd procedure is a safe and reliable treatment of intestinal malrotation with low rates of complications.

Abstract:

Objective：To evaluate the clinical efficacy of laparoscopic surgery for  treatment of inguinal hernia in children.
Methods：Under general anesthesia and using a mini-laparoscope, 212 children cases of inguinal hernia were treated. The age was 0.5-6(avarage 5.3) years. In cases of bowel incarceration, the intestine was reduced, and the bowel was checked for ischemia, necrosis and ulceration, and the internal inguinal ring was highly ligated.
Results：All the 212 patients with inguinal hernia had hernia sac ligation with mini-size (diameter 0.3cm) laparoscope.None had intestinal resection. The 212 children had follow-up of 0.5-2 years, average of 1.2 years, with no recurrent cases.
Conclusions：The mini-laparoscope for inguinal hernia surgery in children is feasible and safe, with little trauma and rapid recovery.

Abstract:

Objective：To explore the effect of Laparoscopy-assisted radical pull-out operation for Hirschsprung disease.
Methods：The clinical data of 12 patients with Hirschsprung disease admitted to our hospital in the last 2 years were retrospectively reviewed.
Results：The surgical procedures of 12 cases were successfully performed by laparoscopy,including 6 cases of common segment,4 cases of short segment,and 2 cases of long segment type. All the operations were completed with laparoscopy in 80-130 min(mean 100 min).There was very little bleeding during the procedure and no obvious scar.There were no complications.
Conclusions：Laparoscopy-assisted radical pull-out operation for Hirschsprung disease is feasible and effective.

Abstract:

Objective：To stndy the correction in adopting pre-operative POSSUM and P-POSSUM for prediction of complications and mortality and  comparison with the actual postoperative complications and actual  mortality rates.
Methods：POSSUM and P-POSSUM were used for prospective study in 633 cases undergoing G1 surgery in recent 1 year. With the various indicators, and clinical effects of common factors as reference, the POSSUM predicted complication rate and P-POSSUM predicted mortality rate were compared with the actual complication and mortality rate. Logistic regression analysis，non-parametric independent samples T test (Independent-Samples T Test), area under receiver operating characteristic curve, and prediction and the actual mortality (complications) in line with the degree of (OE ratio) evaluation of statistical methods were used to assess POSSUM and P-POSSUM prediction accuracy.
Results：POSSUM predictiom in gastrointestinal surgery patients with complications was 229 cases, while the actual complications occured in 188 cases. P-POSSUM prediction of mortality was in 44 cases, while the actual deaths  occured in 34 cases;  in comparison there was no statistically significant difference (P＞0.05). In high-risk group (R1>38, there was R2>50) more prediction accuracy and the actual mortality (complications) was in line with the degree of (OE ratio) equal 1, while in low-risk group  (R1<38、R2<50) it over-estimated mortality rate, and prediction and the actual mortality (complications) in line with the degree of  evaluation was greater than 1. Logistic regression analysis of many factors, liver function, blood glucose, body height ratio, operation time and intraoperative blood pressure stable etc. related with the postoperative complications and mortality.Conclusions：For gastrointestinal surgical patients, POSSUM prediction of their complication rate and P-POSSUM prediction of mortality have a good correlation.

Abstract:

Objective：To evaluate the advantages of using laparoscopic exploration in diagnosis and treatment of gastrointestinal advanced or undetermined tumors.
Methods：A retrospective analysis of the clinical data of cases using laparoscopic exploration (53 cases, group A) or exploratory laparotomy (51 cases, group B) in gastrointestinal advanced or undetermined tumors was undertaken. The mortality, rate of complications and length of hospital stay between the two groups were compared.
Results：The mortality of group A was 0, the rate of complications was 15.09%. The mortality of group B was 11.76%,  the rate of complications was 43.14%. Both of them was statistically different（P＜0.05）. The hospital stay of group A was（7.25±1.65）d and group B was （18.72±4.94）d （P＜0.01）.
Conclusions：Using laparoscopic exploration in gastrointestinal advanced or undetermined tumors has obvious advantages. It could be used to confirm diagnosis and perform proper operations with a minimal invasion,and thus reduce the risk of operations, the rate of complications and mortality rate and shorten hospital stay.

Abstract:

Objective：To discuss the features and prevention of central venous catheter infection in patients undergoing digestive tract operation.
Methods：The clinical data of 145 patients with central venous catheters after G1 surgery in our hospital from March 2004 to March 2009 were retrospectively analyzed. 
Results：Among the 145 cases with central venous catheters, 40 cases(27.6%)presented with defite catheter related infection and 56 strains of pathogens were isolated and cultured. Of the 56 isolates, 28 (50%) were of gram-negative bacteria, 22(39%) of gram-postive bacteria and 6(11%) of fungi. Six cases suffered from multiple catheter infection(15%),39patients were cured and 1 died.
Conclusions：Gram-negative bacteria are the most common pathogens for central venous catheter infection in GI operated patients. It is crucial that standardized card of intravenous infusion should be implemented and prophylactic antibiotics should properly be selected for control of enterogenous infection.