Abstract:

Objective: To investigate the feasibility and surgical approach of hand-assisted laparoscopic D2 radical operation for gastric cancer. Methods: The clinical data of 30 patients with gastric cancer admitted to our center from December 2010 to May 2011, who underwent hand-assisted laparoscopic D2 radical gastrectomy by self-designed surgical approach, were retrospectively analyzed. Results: Hand-assisted laparoscopic D2 radical gastrectomy was successfully performed in 29 patients, of whom, radical total gastrectomy was performed in 15 cases, proximal subtotal gastrectomy in 3 cases and distal subtotal gastrectomy in 11 cases. The whole time of surgery was 150–210 (average of 177) min, the surgical incision length was 6–7 (average of 6.86) cm, and the intraoperative blood loss was 80–600 (average of 228) mL. The number of involved lymph nodes detected by postoperative pathology was 11–35 (average of 16.79), and no residual tumor was noted in the surgical margin of any of the 29 cases. The TNM classification of the tumors were one case of stage I, 2 cases of stage II, 8 cases of stage IIIA, 6 cases of stage IIIB and 12 cases of stage IV, respectively. Gastric atony occurred in one case after surgery. One patient was converted to open surgery due to massive intraoperative bleeding. Conclusion: Our properly designed appoach of hand-assisted laparoscopic operation can meet the operating criterion of D2 radical gastrectomy. It is safe and feasible, and may probably become a new procedure of gastric cancer surgery.

Abstract:

Objective: To investigate the methods of digestive tract reconstruction to reduce reflux in patients with proximal gastric cancer after gastrectomy. Methods: Two novel anastomosis procedures for proximal gastrectomy were designed, which were gastric cardia-preserving esophagogastrostomy and circular jejunal interposition pouch reconstruction. The clinical results of the two novel procedures were compared with those of the conventional proximal gastrectomy anastomosis and total gastrectomy. Results: The preoperative clinicopathologic data of the patients among the 4 groups were comparable (P>0.05). After surgery, the body weight and prognostic nutritional index on the 6th month had no significant differences among the groups (P>0.05), but both were significantly higher on the 24th month in the two groups with novel procedures than those in the groups with conventional procedures (P<0.05). The quality of life, incidence of esophageal reflux and Visick’s grade of the two groups with new procedures were significantly better than those of the groups with conventional anastomoses at 3 years after surgery (P<0.01). There were no statistical differences among the 4 groups in the 1-, 3- and 5-year survival rate (P>0.05). Conclusion: The proximal gastrectomy with gastric cardia preservation and circular jejunal interposition pouch reconstruction are hopeful to become new procedures for surgical treatment of cancer of the gastric fundus and cardia.

Abstract:

Objective: To investigate the safety and efficacy of using enteral nutrition tube for gastrointestinal decompression after surgery in elderly gastric cancer patients. Methods: Sixty-six elderly patients with gastric cancer undergoing surgical treatment from February 2007 to February 2010 in Jilin Provincal Tumor Hospital were enrolled and the patients were randomly assigned to observation group and control group. After surgery, the patients of the observation group underwent gastrointestinal decompression by using enteral nutrition tube (Flocare nasogastric tube), while those of the control group by using common stomach tube (F16). The tube patency, adverse reactions such as sore throat, nausea and vomiting, and complications such as lung infection, anastomotic leakage and wound infection or dehiscence were observed. Results: The tube patency rates of the observation group and control group were 94.11% and 97%, respectively (P>0.05). The incidences of adverse reactions of the observation group (sore throat was 8.84%; nausea and vomiting was 5.88%) were lower than those of the control group (sore throat was 28.13%; nausea and vomiting was 25.00%), and the differences had statistical significances (both P<0.05). There were no significant differences in the incidences of complications between the two groups (all P>0.05). Conclusion: Postoperative application of enteral nutrition tube for gastrointestinal decompression in elderly gastric cancer patients can achieve the same effect as the common stomach tube. Moreover, it causes fewer adverse effects, and thus is advantageous for the postoperative recovery of these patients.

Abstract:

Objective: To explore the diagnosis and treatment of primary gastrointestinal malignant lymphoma (PGIML). Methods: The clinical data of 34 PGIML patients admitted to our department from January 1995 to December 2010 were retrospectively analyzed. Results: The patients of whole group comprised 23 male and 11 female cases, whose ages ranged from 22 to 74 years (average of 51.8). All patients were pathologically confirmed to have PGIML, of whom, in 24 cases the primary tumor was located in the stomach and 10 in the intestinal tract. The initial onset symptoms of the 24 patients with gastric lymphoma were epigastric pain or discomfort, and in 8 cases was accompanied with melena and 3 cases with fever. While the initial symptoms in the 10 patients with intestinal lymphoma were abdominal pain and mass, and 4 cases were complicated with melena, 2 cases with symptoms of bowel obstruction and 1 case had signs of intestinal perforation. PGIML was proved by gastroscopic biopsy in only 5 of the 24 patients with gastric lymphoma, and diagnosed by colonoscopic biopsy in only one of 10 patients with intestinal lymphoma. The preoperative diagnosis rate was 17.64% (6/34). The patients were misdiagnosed for 2 to 8 months (average of 4.5 mionths). All patients underwent surgical treatment, of whom, 32 cases underwent radical tumor resection (8 cases of radical gastrectomy, 14 cases of radical distal gastrectomy, 3 cases of partial resection of small intestine, 6 cases of right radical hemicolectomy and 1 case of radical resection of rectal tumor) and 2 cases underwent palliative subtotal gastrectomy. Thirty-one patients received chemotherapy after surgery. The immunohistochemical classifications of the 34 patients were B cell lymphoma (27 cases), T cell lymphoma (4 cases), and “non-T, non-B” lymphoma (3 cases). All patients were followed up for 5 to 62 months, and the 1-, 3- and 5-year survival rates were 82.35%, 64.71% and 47.05%, respectively. Conclusion: The preoperative diagnosis rate of PGIML is relatively low, and gastrointestinal endoscopy and biopsy are the main approaches for preoperative diagnosis. Comprehensive treatment including surgery and chemotherapy can confer a good therapeutic effect.

Abstract:

Objective: To analyze the factors affecting the response rate of telephone follow-up for patients with colorectal cancer after hospital discharge, so as to provide information to help improve the response rate. Methods: Using stratified sampling, 508 patients with colorectal cancer undergoing surgical treatment were included and, after 26 cases who did not register their phone numbers were excluded, 482 cases finally met the study criteria. Telephone interview was conducted on these patients, the responses from the patients were recorded and response rate was calculated. The influences of the demographic factors, disease- and treatment-related factors, and other factors on the response rate were analyzed. Results: The overall response rate was 72.8% (351/482). The response rates among the patients of different geographic regions and professions had statistical differences (P=0.018 and P=0.031), and the dialing times, telephone types as well as whether the patients had a family history of cancer or not also significantly influenced the response rate (P=0.006, P=0.006 and P=0.040), However, the sex, age, educational level, places of residence, forms of medical expenses payment, locations of tumor and TNM stages of the patients, as well as whether the patients underwent radical resection and had an ostomy or not had no significant influence on the response rate (all P>0.05). Conclusion: The overall response rate of telephone follow-up is still unsatisfactory in the patients with colorectal cancer after surgery. The geographic region and profession of the patients, and the dialing times, telephone types as well as whether the patients had a family history of cancer or not are important factors affecting the response rate of telephone follow-up.

Abstract:

Objective: To investigate the necessity of gastrointestinal decompression for the elderly patients with colorectal cancer during perioperative period. Methods: A meta-analysis was performed on the results of 6 studies that met the inclusion criteria from 211 retrieved literatures using the Mantel-Haenszel method, and the odds ratio (OR) was calculated. Results: There were a total of 794 cases in the 6 selected studies, of whom, 407 did not use a nasogastric tube (N-NG group) and 387 received nasogastric tube placement (NG group). Compared to the NG group, the overall complications of the N-NG group decreased by 14.4% (P=0.0002); time to ?rst passage of flatus and stool of the N-NG group was shorter (P=0.004, P=0.000); the incidence of pulmonary infection, pharyngolaryngitis and fever of the N-NG group was lower by 15.85%, 15.85% and 12.02%, respectively (P=0.000, P=0.000, P=0.0006); the length of hospital stay and costs of the N-NG group were also reduced (P=0.000, P=0.000). The sensitivity analysis confirmed the reliability of the conclusions. Conclusion: Non-use of gastrointestinal decompression during perioperative period in elderly patients with colorectal cancer can not only decrease the incidence of complications and infections, and shorten the time for bowel function recovery, but also reduce hospital stay and costs.

Abstract:

Objective: To evaluate the safety and utility of domestic disposable double stapling device in anus-preserving operation for mid/low rectal cancer. Methods: The clinical data of 63 patients with mid/low rectal cancer undergoing anus-preserving operation from May 2005 to December 2010 by using domestic disposable double stapling device were retrospectively analyzed. Results: Of the patients, 40 were male and 23 were female. The average age was 64.5±1.7 (34–85) years, the median distance between the tumor lower edge and anal verge was 6.0 (4.0–10.0) cm and the median tumor size was 4.0 (1.3–11.0) cm. The TNM stages were stage I (9 cases, 14.3%), stage II (17 cases, 27.0%), stage III (28 cases, 44.4%) and stage IV (9 cases, 14.3%). All the 63 patients underwent a single anastomosis without reinforcement. All staple lines were intact and complete without breakdown. Complications occurred in 6 cases after surgery (2 cases of anastomotic leakage, 1 case each of anastomotic stricture, wound infection, pneumonitis and gastric retention, respectively) and there was no perioperative death. Fifty-two patients (82.5%) were followed up with a median period of 32 (7–67) months, during which time, 13 cases died from distant metastases. The 3- and 5-year survival rate was 82.7% and 62.3%, respectively. Conclusion: Domestic disposable double stapling device is safe and feasible for sphincter-preserving operation of mid/low rectal cancer.

Abstract:

Objective: To evaluate the clinical efficacy of laparoscopic surgery for colorectal cancer. Methods: The clinical data of 146 patients undergoing radical resection of colorectal cancer from March 2001 to May 2004 were retrospectively analyzed. The data consisted of 72 cases of laparoscopic surgery and 74 cases of traditional open surgery. The clinical indexes that included operative blood loss, operative time, medical costs, time to postoperative bowel function recovery, postoperative hospital stay, number of lymph nodes dissected, postoperative complications, short- and long-term survival etc. between the two groups were compared. Results: There were significant differences between the two groups with regards to operative blood loss, operating time, postoperative bowel function recovery, and length of postoperative hospital stay (all P<0.05). However, the differences had no statistical significance between the two groups in respect of the medical costs, postoperative complications, number of lymph nodes removed, and 2- and 5-year overall survival rate (all P>0.05). Conclusion: Laparoscopic surgery has advantages in reducing the intraoperative bleeding, time to bowel function recovery and hospital stay. Laparoscopic resection of colorectal cancer is a safe, effective and economic modality, and has similar short- and long-term outcomes as the traditional open surgery.

Abstract:

Objective: To investigate the clinical efficacy of hand-assisted laparoscopic surgery (HALS) in the radical operation of colon cancer. Methods: Patients with colon cancer admitted to our hospital from January of 2010 to May of 2011 were selected and randomly divided into the HALS group (21 cases), conventional laparoscopic surgery (LS) group (25 cases) and open surgery group (24 cases). The clinical results of the three groups were compared and analyzed. Results: HALS was successfully performed on all of the 21 cases of HALS group, and in LS group, LS was performed on 23 cases and 2 cases were converted to open surgery, but the conversion rates between the two groups had no statistical difference. The average operative time of the HALS group was shorter than that of the LS group (153.9 min vs. 171.7 min) (P=0.011). There were no statistical differences in intraoperative blood loss, average length of hospitalization, total cost, time to first passage of gas, and number of dissected lymph nodes between the HALS and LS group (all P>0.05). Compared with the open surgery group, the operative time of the HALS group was somewhat prolonged (153.9 min vs. 131.8 min) (P=0.002), but the intraoperative blood loss, time to first passage of gas, and the average length of hospital stay were markedly reduced (all P<0.05), and the numbers of dissected lymph nodes between the 2 groups had no obvious difference. Conclusion: HALS for radical resection of colon cancer not only has the same advantage of minimal invasion, safe and quick recovery as the conventional LS, but also shortens the operative time.

Abstract:

ABSTRACT Objective: To investigate the relationship between the expression of cyclooxygenase-2 (COX-2) and inhibitor of apoptosis proteins (p53, survivin and Bcl-2) in the primary tumor and lymph node metastases (LNMs) of gastric cancer of elderly patients. Methods: The expressions of COX-2, p53, survivin and Bcl-2 in the surgical specimens from 33 elderly patients (≥60 years) with gastric cancer and lymph node metastases were detected by immunohistochemical staining, and the expressions of the above 4 proteins in the primary lesion and involved lymph nodes from 32 patients (<60 years) were determined by the same approach to serve as a control. The expression differences between the two groups and between the primary lesion and metastases were compared, and the correlations among them were also analyzed. Results: Of the elderly patients, the Bcl-2 expression was significantly higher in the metastases than that in the tissues of the primary tumor (P<0.05), no significant differences were noted in the expressions of COX-2, p53 and survivin between primary tumor and metastases (all P>0.05), and there were positive correlations between the primary tumor and metastases in the expressions of p53 and Bcl-2 (r=0.5470 and 0.4969, both P<0.01). In the primary tumor of elderly patients, there were positive correlations between COX-2 and survivin, and between COX-2 and Bcl-2 as well (r=0.5053 and 0.5741, both P<0.01), while a negative correlation was found between survivin and Bcl-2 in metastases of elderly patients (r=–0.5414, P<0.05). The expressions of p53, survivin and Bcl-2 in the primary tumor of elderly patients were significantly higher than those of the control patients (all P<0.05), while only COX-2 expression was higher than that of control group in the metastases. Conclusion: The COX-2 expression in the primary tumor and lymph node metastases of the patients older than 60 years is different from that of the patients below 60 years of age, and this may induce a special apoptosis inhibition pathway that differs from that of patients of other age groups.

Abstract:

Objective: To determine the expressions of CXCR4 and CD133 in the primary lesions of gastric cancer, and their influences on lymphatic metastasis. Methods: The primary tumor tissues and their adjacent normal mucosal tissues were taken from 50 gastric cancer patients. In these tissues, the location of CXCR4 and CD133 expression was detected by immunohistochemical staining, the gene and protein expression levels of CXCR4 and CD133 were determined by semi-quantitative RT-PCR and Western blot, respectively. and the correlations between CXCR4 and CD133 and their relations with lymphatic vessel invasion and lymph node metastasis were analyzed. Results: The CXCR4 and CD133 molecules were both expressed on the membranes of tumor cells and very small amount of CXCR4 was found in the nucleus. The positive expression rates as well as the gene and protein expression levels of CXCR4 and CD133 in gastric cancer tissues were all significantly higher than in those of the normal mucosal tissues (all P<0.05). The relative gray scale values of both CXCR4 and CD133 mRNA were significantly higher in the tumor tissues of the group with lymph node metastases than in those without lymph node involvement (P=0.011 and P=0.038). The relative gray scale value of the CXCR4 protein in the tumor tissues of the group with N1 lymph node involvement was significantly higher than in those without lymph node metastasis (P=0.023), but was lower than in those with N2+N3 lymph nodes involvement (P=0.008). The relative gray scale value of the CD133 protein in the tumor tissues of the group with N1 or N2+N3 lymph node involvement was significantly higher than in those without lymph node involvement (P=0.04 and P=0.01), but there was no significant difference between the N1 and N2+N3 groups. The relative gray scale values of CXCR4 and CD133 protein in the tumor tissues of the group with lymphatic vessel invasion were significantly higher than in those without lymphatic vessel invasion (P<0.05). Of the patients with lymph nodes metastases, the relative gray scale values of both CXCR4 and CD133 protein were positively correlated with the number of lymph nodes involved (r=0.480, r=0.426) and the ratio of metastatic lymph nodes (r=0.502, r=0.489). Conclusion: CXCR4 and CD133 present high expression and are positively correlated in the primary lesion of stomach cancer, and the expression of both of these proteins is associated with the metastatic lymph node ratio and number. It is speculated that under the mediation of CXCR4, lymphatic vessel invasion and metastasis of CD133 postitive tumor cells is more easily induced.

Abstract:

Objective: To investigate the effect of miR-214 on the invasive and metastatic ability of gastric cancer cells and its possible mechanism. Methods: The potential binding sites of PTEN (phosphatase and tensin homolog deleted on chromosome ten) for miR-214 were analyzed at miRNA target-gene prediction websites: miRanda and TarBase v.5c. The SGC7901 cells were transfected with miR-214 mimic, inhibitor or non-targeting sequence, and cells transfected with the empty vector were used as negtive control. After the above treatments, the PTEN protein expression of the cells was detected by Western blot analysis and the invasive ability of the cells was examined by Transwell chamber assay. Results: Western blot showed that PTEN protein expression in SGC7901 cells group transfected with miR-214 mimic was significantly decreased compared with the cells of other treatment groups (all P<0.05). Transwell assay showed that the invading cell numbers of SGC7901 cells group transfected with miR-214 mimic were significantly more than those of the cells of other treatment groups (all P<0.05). Conclusion: miR-214 can enhance the invasion and metastasis of gastric cancer cells and this effect may be related to its action in inhibiting PTEN expression.

Abstract:

Objective: To investigate the expression of VEGF-C and MMP-9 in colorectal cancer and their clinical significance. Methods: The expressions of VEGF-C and MMP-9 in the tissue chips (110 cases of colorectal cancer tissues and 20 cases of adjacent normal intestinal tissues) were detected by immunohistochemical staining. Results: The positive rates of VEGF-C and MMP-9 in colorectal cancer tissues were 82.7% and 80.0% respectively, which were significantly higher than those in the adjacent intestinal tissues (5.0% and 10.0%) (both P<0.05). The positive rates of VEGF-C and MMP-9 in Dukes C/D stage of colorectal cancer were 90.7% and 88.9% respectively, which were significantly higher than those in Dukes A/B stage (73.2% and 69.6%) (both P<0.05). There was a low positive correlation between the positive expression of VEGF-C and MMP-9 in the colorectal cancer tissues (r=0.253, P<0.05). Conclusion: The expressions of VEGF-C and MMP-9 are closely related to the development and invasion of colorectal cancer. Also, a high level expression of them indicates a high degree of malignancy of colorectal cancer.

Abstract:

Objective: To investigate the inhibitory effect of caffeic acid phenethyl ester (CAPE) on human colon cancer HT-29 cells and its influence on the c-Jun N-terminal kinase (JNK) signaling complex. Methods: The human colon cancer HT-29 cells were cultured in vitro, and then the inhibition rate of cell growth was measured by MTT assay after the HT-29 cells were exposed to different concentrations of CAPE over different time periods. Next, the expression levels of JNK and paxillin protein in HT-29 cells were detected by Western blot analysis after 24 h exposure to different concentrations of CAPE. Results: All the 4 concentrations (2.5, 5.0, 7.5 and 10.0 μg/L) of CAPE inhibited the proliferation of HT-29 cells, which showed a concentration- and time-dependent effect (all P<0.01). All the 4 concentrations of CAPE decreased the expression levels of JNK and paxillin protein, which showed a concentration-dependent effect (all P<0.01). Conclusion: CAPE can inhibit the proliferation of human colon cancer HT-29 cells in vitro, and the mechanism may be related to its reducing the activity of JNK-paxillin signaling pathway.

Abstract:

Objective: To investigate the impact of hydroxyethyl starch (HES) solution therapy on the postoperative recovery of patients after gastrointestinal surgery. Methods: Ninety patients scheduled to undergo gastrointestinal surgery in our hospital during January 2009 to December 2009 were randomly divided into the HES group, albumin (ALB) group and control group. All the patients received parenteral nutrition at the same energy intake within the first 3 days after surgery. In addition, the HES group was supplied with hydroxyethyl starch (500 mL) daily, and the ALB group was supplemented with albumin (10 g) daily, while the control group was given adequate amount of crystalloid solution. The serum albumin concentration and C-reactive protein (CRP) level were measured before surgery and on POD 1, 4 and 7, and the incidence of postoperative complications and length of postoperative hospital stay were also observed. Results: The preoperative clinical data, preoperative albumin level, operative time and intraoperative blood loss of the 3 groups were comparable (P>0.05). On POD 1, the serum albumin concentrations and CRP levels had no significant differences among the 3 groups (all P>0.05); on POD 4, the serum albumin level of control group was significantly lower than that of HES and ALB group (both P<0.05), but no difference was noted between the HES and ALB group (P>0.05). The CRP level of HES group was significantly lower than that of control and albumin group (both P<0.05), but no difference was found between the control and ALB group (P>0.05); on POD 7, the serum albumin concentrations and CRP levels of the 3 groups had no obvious differences (all P>0.05). The incidence of postoperative complications of the 3 groups had no statistical difference (P>0.05). The length of postoperative hospital stay of control group was significantly longer than that of HES and ALB group (both P<0.05). Conclusion: HES solution supplement in the early postoperative period of gastrointestinal surgery can effectively reduce the use of albumin, control postoperative inflammatory response, and shorten the length of postoperative hospital stay.

Abstract:Objective: To summarize the clinical characteristics, diagnosis and surgical treatment of tuberculosis of large bowel. Methods: The clinical data of 22 patients with tuberculosis of the large bowel admitted to our hospital were retrospectively analyzed. Results: Female patients accounted for the majority of the whole group. The ages of the patients were from 19 to 76 (average of 44.5±10.5) years and the misdiagnosis rate before surgery was 72.7% (16/22). The main clinical manifestations of the patients were abdominal pain, abdominal mass, and stool-habit alteration. The gastrointestinal contrast examinations, and colonoscopic and laparoscopic biopsies were helpful for the detection of this disease, and the definite diagnosis mainly depended on the pathological finding. Due to misdiagnosis or complications, 22 patients underwent resection of the affected bowel segment, ileocecal resection or right hemicolectomy, adhesiolysis, abscess evacuation and exploratory operation respectively, and the patients were treated with postoperative combined anti-tuberculosis treatment for 6 to 24 (average of 8.2±5.3) months. All patients were followed up for 6–120 (55.8±15.5) months, of whom 19 were cured and 3 had symptomatic improvement. Conclusion: Tuberculosis of the large bowel has a high rate of misdiagnosis, so the surgical interventions are performed usually because of misdiagnoses or for complications. The selection of the surgical timing and procedure is important for these patients.

Abstract:Objective: To summarize the diagnosis and management of postanorectal space abscess. Methods: The clinical data of 93 patients with postanorectal space abscess were retrospectively analyzed. Of the patients, bilateral fenestrated catheter drainage (from both sides of the anococcygeal ligament) with the preservation of anococcygeal ligament plus thread-ligating method was performed in 21 cases of horseshoe abscess, 45 cases of semi-horseshoe abscess, 12 cases of fistulized postanal space abscess, and 9 cases of postanal space abscess; and fenestrated catheter drainage was performed in 6 cases of postrectal space abscess. Results: Clinical recovery was achieved in 89 cases (95.7%). All patients were followed up for 6 to 24 months after surgery, and no recurrence or postoperative complications such as anal stricture or fecal incontinence occurred. Four cases (4.3%) had recurrence of anal fistula after surgery. This was mainly due to failure to find the true internal opening when performing thread-ligating procedure, and too early extraction of the drainage tube, which led to obstructed drainage and finally fistula formation. At a second operation 3 months later, the fistula and anococcygeal ligament of the patients were removed, the granulation tissues were eliminated and the thread-ligating procedure was performed again after confirmation of the internal opening, and the patients were cured. Conclusion: Fenestrated catheter drainage (from both sides of the anococcygeal ligament) combined with selective thread-ligating procedure can maintain the shape and function of the anus, and is an ideal treatment method for postanorectal space abscess.

Abstract:Objective: To study the feasibility of transumbilical single-port laparoscopic appendectomy. Methods: One hundred and twenty-two patients with acute appendicitis from January 2011 to December 2011 were randomly assigned to undergo transumbilical single-port laparoscopic appendectomy or conventional laparoscopic appendectomy, with 61 cases in each group. The operative time, intraoperative blood loss, time to intestinal function recovery, length of hospital stay, complications and the conversion rate between the two groups were compared. Results: There were no statistical differences in intraoperative blood loss, time to bowel function recovery, length of hospital stay and complications between the two groups. Of the patients undergoing transumbilical single-port laparoscopic procedure, 2 cases with severe adhesions and 1 case of retroperitoneal appendix were converted to conventional laparoscopic appendectomy. For patients with gangrenous or perforated appendicitis, the operative time of the transumbilical single-port laparoscopic procedure was significantly longer than that of the conventional laparoscopic procedure (P=0.004). The operative times had no significant difference between the two procedures for patients with simple or suppurative appendicitis. Conclusion: Selective use of transumbilical single-port laparoscopic procedure for appendectomy is feasible and safe. For patients with simple or suppurative appendicitis, it has the advantages of quick recovery, little invasiveness and better cosmetic results compared with the conventional procedure.

Abstract:Objective: To analyze the hemodynamic features of lower extremity deep venous thrombosis (DVT) in different natural stages, so as to provide advices for treatment selection. Methods: The clinical data of 203 DVT patients admitted to our hospital during 3 years were retrospectively analyzed. The patients were divided into acute, subacute and chronic group based on their natural stages. For all the patients, the flow velocities, diameters of femoral and popliteal vein were measured by ultrasonography, and the hemodynamic parameters such as prothrombin time and blood fibrinogen were detected at the time of hospital admission. Results: Except for the popliteal vein diameter that showed no statistical difference among the 3 groups, other parameters such as femoral vein and popliteal vein flow velocity, femoral vein diameter, prothrombin time and blood fibrinogen were statistically different among the 3 groups (all P<0.05). In acute stage, the femoral and popliteal vein showed the slowest flow velocity, while the femoral vein showed the widest diameter and the blood showed a hypercoagulable state. In subacute and chronic stage, the femoral vein flow velocity increased, the vein diameter was reduced and the hypercoagulabe state was lessened. Conclusion: The hemodynamic state of lower extremity DVT presents a complex and changeable feature as its natural stages develop.

Abstract:In recent years, new progresses have been achieved in the field of neo-adjuvant chemotherapy for advanced gastric cancer, involving the clinical application, efficacy evaluation, sensitivity prediction and chemotherapy principle. Along with these progresses, some problems also arise. This paper addresses the issues of this concern.

Abstract:Rectal cancer, a high prevalence disease throughout the world, has presented a clear rising trend in recent years. Using evidence-based medicine methods can help determine the optimal plans for newly diagnosed rectal cancer patients. This paper reviews the current status of evidence-based treatment in rectal cancer patients.