Volume 28,Issue 10,2019 Table of Contents

1 Expert consensus on the norms for writing medical records of day surgery (2019)

National Clinical Research Center for Geriatric Disorders (Xiangya)

2019, 28(10):1171-1176. DOI: 10.7659/j.issn.1005-6947.2019.10.001

[Abstract](4867) [HTML](3318) [PDF 604.70 K](6424)

Abstract:
With the development of day surgery promoted by the national health care reform, the proportion of day surgery in the elective surgeries is becoming increasingly higher. The ordinary medical record templates are difficult to meet the clinical requirements of the development of day surgery, due to its short length of hospital stay, multiple disease entities, rapid turnover of patients and heavy workload in writing the medical records. At present, there is no uniform norm or standard for medical record writing of day surgery in our country. For promoting and standardizing the development of day surgery, the experts of the National Clinical Research Center for Geriatric Disorders (Xiangya) developed the Expert Consensus on the Norms for Writing Medical Records of Day Surgery, based on the Xiangya Norms for Writing Medical Records of Day Surgery (2018) and in accordance with the Basic Norms for Writing Medical Records (2010) proposed by the previous Ministry of Health of China and the Guidelines for Management of Day Surgery (2016 exposure draft) recommended by the National Health and Family Planning Commission.

2 Interpretation of International guidelines (2018) for inguinal hernia management (day surgery section)

NING Caihong , BONSU Abdul Aziz , HUANG Gengwen

2019, 28(10):1177-1180. DOI: 10.7659/j.issn.1005-6947.2019.10.002

[Abstract](558) [HTML](1332) [PDF 1.06 M](1624)

Abstract:
Worldwide, more than 20 million patients undergo groin hernia repair annually. In order to standardize care, minimize complications, and improve results, five continental hernia societies (European Hernia Society, Americas Hernia Society, Asia Pacific Hernia Society, Afro Middle East Hernia Society, and Australasian Hernia Society), the International Endo Hernia Society and the European Association for Endoscopic Surgery have jointly released the International guidelines for groin hernia management (2018). Here, the authors interpret the day surgery section of the guidelines in detail.

3 Progress of magnetic compression anastomosis technique

LI Yan , WU Rongqian , MA Feng , WANG Haohua , LU Yi ,

2019, 28(10):1181-1185. DOI: 10.7659/j.issn.1005-6947.2019.10.003

[Abstract](632) [HTML](1213) [PDF 1.19 M](1084)

Abstract:
Magnetic compression anastomosis technique has greatly improved the efficiency and efficacy of traditional anastomosis, and has been an important component of magnetic surgery techniques. Its safety and feasibility have been verified in animal experiments and clinical trials. It has now been widely used in various surgical subspecialties such as gastrointestinal, hepatopancreatobiliary, esophagus, and vascular surgery, and then yielded the magnetic compression gastrointestinal anastomosis, jejunal anastomosis, biliary anastomosis, esophageal anastomosis, vascular anastomosis and more. Tracking its use in anastomotic reconstruction is important for its development in the future.

4 Seven-step procedure of standardized laparoscopic repair for hiatal hernia

ZHOU Taicheng , MA Ning , CHEN Shuang

2019, 28(10):1186-1191. DOI: 10.7659/j.issn.1005-6947.2019.10.004

[Abstract](1282) [HTML](1314) [PDF 2.36 M](1967)

Abstract:
Hiatal hernia (HH) is a common disease in clinical practice, and is associated with high abdominal pressure, relatively shortened esophagus and weaken support tissue around the hiatus. Hiatal hernia can cause gastroesophageal reflux, abnormal swallow and ex-esophageal symptoms, which severely threaten patients’ health and longevity. With the development of diagnostic and treatment technologies, surgical repair of HH has been increasingly carried out in hospitals of different levels in China. However, the occurrence of complications after HH repair is continuously rising, due to limitations in understanding of the anatomy and pathophysiology of the disease and lack of surgical training. For standardizing the procedures of laparoscopic HH repair, homogenizing the skills of laparoscopic HH repair and decreasing postoperative complications, the authors based on the guidelines and personal experiences, propose a seven-step procedure for laparoscopic HH repair, which can be easily learned and generalized.

5 Application of transhiatal approach for lower mediastinal lymph node dissection in surgery for adenocarcinoma of esophagogastric junction

HU Wenqing , CUI Peng , ZHANG Jinjie , WANG Jie , NIU Ruilong , LIU Yong

2019, 28(10):1192-1196. DOI: 10.7659/j.issn.1005-6947.2019.10.005

[Abstract](376) [HTML](1172) [PDF 1.61 M](1114)

Abstract:
The increasing incidence of adenocarcinoma of the esophagogastric junction (AEG) has gained worldwide concern in recent years. The lymph node metastasis of AEG presents bidirectional pattern. When the esophageal invasion length in Siewert II and III AEG is more than 2 cm, the lower mediastinal lymph node dissection is required; when the esophageal invasion length is less than 4 cm, the operation can be performed effectively and safely by transhiatal approach. Employing the infracardiac bursa as an anatomical landmark can help the accurate dissection of the lower mediastinal lymph nodes; the concept of total mesenteric excision can improve the clearance rate of the lower mediastinal lymph nodes and improve the oncological safety.

6 Application of tied reverse puncture esophagojejunostomy in laparoscopic radical gastrectomy for gastric cancer

李胜 , 杨文光 , 樊林

2019, 28(10):1197-1204. DOI: 10.7659/j.issn.1005-6947.2019.10.006

[Abstract](467) [HTML](1027) [PDF 2.59 M](1218)

Abstract:
Objective: To investigate the application efficacy of esophagojejunostomy using the tied reverse puncture in laparoscopic radical total gastrectomy.
Methods: The clinical data of 92 patients undergoing laparoscopic radical total gastrectomy from June 2014 to June 2018 were retrospectively analyzed. Of the patients, 46 cases underwent esophago-jejunal anastomosis using the tied reverse puncture (observation group), and the other 46 cases underwent esophago-jejunal anastomosis using the purse-string suture (control group). The main clinical variables between the two groups of patients were compared.
Results: Operations in all patients were completed uneventfully. In observation group compared with control group, the operative time was shortened (229.2 min vs. 196.2 min), the intraoperative blood loss was decreased (83.26 mL vs. 56.18 mL), the length of incision was reduced (9.08 cm vs. 3.89 cm), the proximal cut edge of the esophagus was longer (2.42 cm vs. 3.78 cm), and the time from placement of the nail anvil to completion of esophagojejunostomy was shortened (32.1 min vs. 19.2 min), and all the differences had statistical significance (all P<0.05). There were no significant differences in the time to first postoperative gas passage and length of hospital stay between the two groups (both P>0.05). No significant differences were noted in incidence of anastomotic bleeding, wound infection and anastomotic stenosis between the two groups (all P>0.05), but the incidence of anastomotic leakage in observation group was significantly lower than that in control group (0 vs. 6.52%, P<0.05). Patients in both groups were followed up for 6 to 30 months, and recurrence occurred in 2 cases in control group, but no recurrence was found in observation group.
Conclusion: Application of the tied reverse puncture esophagojejunostomy in laparoscopic radical total gastrectomy is safe and feasible. It also has the advantages of short operative time and less bleeding, and the superiorities of reducing the size of the auxiliary incision of the abdominal wall, obtaining longer cut margin, and decreasing the risk of anastomotic leakage and recurrence.

7 Analysis of safety and efficacy of laparoscopic spleen-preserving circumferential splenic hilar lymph node dissection for patients with advanced proximal gastric cancer

XU Yanchang , LI Zhixiong , PAN Guofeng , WU Haiyan , LI Junpeng

2019, 28(10):1205-1211. DOI: 10.7659/j.issn.1005-6947.2019.10.007

[Abstract](313) [HTML](1204) [PDF 1.59 M](1108)

Abstract:
Objective: To investigate the safety and efficacy of laparoscopic spleen-preserving circumferential splenic hilar lymph node dissection in treatment of patients with advanced proximal gastric cancer.
Methods: The clinical data of 169 patients with advanced proximal gastric cancer who underwent laparoscopic spleen-preserving splenic hilar lymph node dissection in the First Division of the Gastrointestinal Surgery of the First Hospital of Putian City from January 2014 to January 2018 were retrospectively analyzed. Of the patients, 92 cases underwent laparoscopic anterior splenic hilar lymph node dissection (control group), while the other 77 cases underwent laparoscopic circumferential splenic hilar lymph node dissection, namely, underwent the conventional anterior splenic hilar lymph node dissection simultaneously with posterior splenic hilar lymph node dissection (observation group). The main clinical variables between the two groups of patients were compared.
Results: The baseline data between the two groups of patients were comparable. There were no significant differences between the two groups in terms of total operative time, intraoperative blood loss, time to postoperative gas passage, time to postoperative liquid food intake, length of postoperative hospital stay and number of positive lymph nodes (all P>0.05). In observation group compared with control group, the time for splenic hilar lymph node dissection was significantly prolonged, but the number of total dissected lymph nodes, the number of cases with positive splenic hilar lymph nodes and total number of harvested splenic hilar lymph nodes were significantly increased (all P<0.05). The incidence rates of complication showed no significant difference between the two groups (P>0.05). No perioperative death occurred in the two groups.
Conclusion: Laparoscopic spleen-preserving circumferential splenic hilar lymph node dissection is safe and effective for patients with advanced proximal gastric cancer, and it can help avoid the incomplete dissection of positive splenic hilar lymph nodes.

8 Analysis of clinical features and prognosis of patients with gastric stump cancer in Qinghai area

WANG Gang , ZHENG Lianglu , LI Ganggang , YU Pengjie , CAO Hongtao , CHU Huaizhu , ZHANG Chengwu

2019, 28(10):1212-1220. DOI: 10.7659/j.issn.1005-6947.2019.10.008

[Abstract](216) [HTML](950) [PDF 1.23 M](1209)

Abstract:
Objective: To investigate the clinicopathologic features and prognosis of patients with gastric stump cancer (GSC) in Qinghai area.
Methods: The clinical data of 102 patients with GSC admitted in the Department of Gastrointestinal Surgery of Affiliated Hospital of Qinghai University and Department of Oncology of Qinghai Provincial People’s Hospital from January 2012 to October 2018 were retrospectively analyzed.
Results: Of the patients, the initial disease was benign in 20 cases (19.6%) and was malignant in 82 cases (80.4%). The time interval between the initial operation and the development of GSC in patients with initial benign disease was 204 (108 to 481) months, and in those with malignant disease was 38 (5 to 204) months, the GSC occurred later than 60 months after the initial operation in all cases in the former and occurred within 60 months after the initial operation in most cases (84.2%) in the latter, and differences also existed between the two groups of patients in the constituent ratios of the initial operation types and digestive tract reconstruction methods (all P<0.05). The GSC mainly occurred beyond the anastomotic stoma (60.0%) in patients with initial benign disease and mainly occurred at the anastomotic stoma (68.3%) in those with malignant disease, and the difference had statistical significance (P<0.05). Among the 102 patients, 11 cases (10.8%) underwent radical surgery, 19 cases (18.6%) underwent palliative surgery and 72 cases (70.6%) not undergo surgery. Follow-up was performed in
83 patients for 1 month to 50 months. The 3-year overall survival rate in the whole group of patients was 25.5%, and the survival rate of the patients showed no significant association with the benign or malignant nature of the initial diseases (P=0.086), but was significantly related to the histopathological type of GSC and presence or absence of concomitant disease as well as the levels of CEA and CA19-9 (all P<0.05).
Conclusion: The development of GSC is related to the initial operation type and digestive tract reconstruction method. The time interval and site of occurrence of GSC are different between patients with different natures of the initial diseases. The prognosis of GSC is poor, and the histopathological type of GSC, the concomitant diseases and the levels of some tumor markers have significant impacts on the prognosis of the patients.

9 Characteristics of lymph metastasis and prognostic analysis of 186 patients with early gastric cancer from a single center

周潮平 , 汤代彬 , 汪大田 , 高斌 , 马军 , 袁建伟 , 蒋鹏 , 黄利娟 , 张亚铭

2019, 28(10):1221-1227. DOI: 10.7659/j.issn.1005-6947.2019.10.009

[Abstract](267) [HTML](1387) [PDF 1.18 M](1229)

Abstract:
Objective: To investigate the relationship between clinicopathologic features and lymph node metastasis in early gastric cancer (EGC) and the influence of lymph node metastasis on prognosis of EGC patients.
Methods: The clinical data of 186 EGC patients who underwent surgical treatment from October 2010 to December 2018 in Anqing Hospital Affiliated to Anhui Medical University were retrospectively analyzed.
Results: Of the 186 EGC patients, regional lymph node metastases occurred in 17 cases (9.1%). Univariate analysis showed that the lymph node metastasis rate in patients with submucosal invasion (T1b) was higher than that in patients with intramucosal cancer (T1a) (15.1% vs. 4.2%, χ2=5.177, P=0.023), in patients with the maximal lesion diameter >2 cm was higher than in patients with the maximal lesion diameter ≤2 cm (14.3% vs. 5.5%, χ2=4.190, P=0.041), in patients with vascular invasion was higher than that in patients without vascular invasion (50.0% vs. 6.8%, χ2=21.247, P=0.000), and in patients with total lymph node dissection ≥15 was higher than that in patients with lymph node dissection <15 (12.5% vs. 0, χ2=6.879, P=0.009); no significant relationships were noted between lymph node metastasis and the variables that included sex, age, tumor site, gross type of tumor, degree of differentiation, and surgical method (all P>0.05). Multivariate analysis showed that vascular infiltration was an independent risk factor for EGC lymph node metastasis (RR=6.886, 95% CI=1.399–33.898, P=0.018). Complete follow-up data were available in 173 patients (93.0%), and the follow-up time ranged from 2 to 95 months. The 3- and 5-year survival rates in the whole group were 96.1% and 92.4%, which were 97.1% and 95.5% in patients without lymph node metastasis and 87.5% and 65.6% in patients with lymph node metastasis, respectively. Although the survival in the former was better than that in the latter, the difference did not reach a statistical significance (χ2=2.478, P=0.115).
Conclusion: EGC patients with submucosal invasion, maximal lesion diameter >2 cm or vascular infiltration have a higher risk of regional lymph node metastasis, so standardized lymph node dissection should be performed for accurate determination of postoperative pathological stage and decision of subsequent treatment. The influence of lymph node metastasis on the prognosis of EGC patients needs clarification by further long-term follow-up studies.

10 Application of enhanced recovery after surgery in laparoscopic assisted radical resection for gastric cancer and its influence on postoperative recovery, nutrition status and stress of the patients

CHENG Kangwen , WANG Guihe , SHU Kuanshan , ZHENG Ming , LIU Hongxia , TANG Aiping , ZUO Bohai , WANG Zhenxing , WANG Yajuan , HU Wenjun , MA Donghua

2019, 28(10):1228-1236. DOI: 10.7659/j.issn.1005-6947.2019.10.010

[Abstract](327) [HTML](1272) [PDF 1.19 M](1325)

Abstract:
Objective: To investigate the efficacy of using enhanced recovery after surgery (ERAS) in laparoscopic assisted radical resection for gastric cancer and its influence on postoperative recovery, nutritional status and stress parameters of the patients.
Methods: Eighty patients with gastric cancer scheduled to undergo laparoscopic assisted radical resection from December 2016 to December 2018 were prospectively enrolled, and were randomly allocated to conventional group and ERAS group, with 40 cases in each group. Patients in conventional group underwent the traditional perioperative management, and those in ERAS group received ERAS perioperative management. The relevant perioperative clinical variables, the changes in postoperative levels of serum albumin (ALB), C-reactive protein (CRP), interleukin 6 (IL-6) and procalcitonin (PCT), as well as the changes in body weight ratio (BWR) before and after operation were compared between the two groups of patients.
Results: All preoperative data between the two groups of patients showed no significant difference (all P>0.05). There were no significant differences between the two groups of patients in terms of operative procedures, anastomosis methods, operative time, intraoperative blood loss, number of the resected lymph nodes, postoperative pathological stages, and tumor size (all P>0.05), but the total volume of intraoperative fluid infusion, time to the first postoperative gas passage, time to the first postoperative defecation, length of time of postoperative venous infusion, length of postoperative hospital stay and hospitalization cost were significantly reduced in ERAS group compared with conventional group (all P<0.05). The ALB level was significantly higher on postoperative day (POD) 7, the levels of CRP, IL-6 and PCT were significantly lower on POD 1, 3 and 7, and the BWR value was significantly higher on POD 7 in ERAS group than those in conventional group (all P<0.05).
Conclusion: Using ERAS protocol in laparoscopic assisted radical resection for gastric cancer is safe and effective, and is also superior to the traditional mode in promoting postoperative recovery, improving the nutritional status and reducing the stress response of the patients.

11 Expressions of chromobox homolog 4 and FERM domain-containing protein 4A in gastric cancer tissue and their significance

QIAN Haiquan , ZHOU Haining , LIU Ke , ZHAO Wei

2019, 28(10):1237-1244. DOI: 10.7659/j.issn.1005-6947.2019.10.011

[Abstract](283) [HTML](917) [PDF 1.49 M](1080)

Abstract:
Objective: To investigate the expressions of chromobox homolog 4 (Cbx4) and FERM domain protein 4A (FRMD4A) in gastric cancer tissue and their relations with the clinicopathologic parameters and prognosis of the gastric cancer patients.
Methods: The surgical specimens (cancer and adjacent tissues) and clinicopathologic data of 112 patients with gastric cancer treated from February 2010 to November 2013 were collected. The mRNA and protein expressions of Cbx4 and FRMD4A in the specimens were determined by qRT-PCR and immunohistochemical staining. The relations of the protein expressions of Cbx4 and FRMD4A with the clinicopathologic variables and survival rates of the patients were analyzed, and the prognostic factors for gastric cancer patients were also analyzed.
Results: Compared with tumor adjacent normal tissue, both mRNA and protein expression levels of Cbx4 and FRMD4A in gastric cancer tissue were significantly increased (all P<0.05). The protein expression levels of both Cbx4 and FRMD4A were significantly associated with the T stage, N stage, degree of differentiation and distant metastasis of the patients (all P<0.05). The 5-year survival rate in gastric cancer patients with positive expression of Cbx4 or FRMD4A protein was significantly lower than that in those with corresponding negative expression (χ2=15.42, P=0.000; χ2=21.55, P=0.000). Cox multivariate analysis showed that the protein expression levels of Cbx4 (HR=2.754, 95% CI=1.827–4.151, P=0.000) and FRMD4A (HR=3.129, 95% CI=2.282–4.290, P=0.000) as well as T stage (HR=1.432, 95% CI=1.241–1.652, P=0.005) and distant metastasis (HR=1.257, 95% CI=1.208–1.308, P=0.032) were independent risk factors affecting the prognosis of gastric cancer patients.
Conclusion: The Cbx4 and FRMD4A expressions are increased in gastric cancer tissues, which are closely related to the unfavorable clinicopathologic features and prognosis of patients. They may have certain significance in disease assessment and prognosis estimation for gastric cancer patients.

12 Establishment of several human colon cancer cell lines resistant to 5-fluorouracil and preliminary analysis of the mechanism for drug resistance

LIU Meng , HUANG Xiaodong , HAN Zheng , ZHU Qingxi , TAN Jie , LIU Weijie , CHEN Wei , ZOU Yanli , TIAN Xia

2019, 28(10):1245-1252. DOI: 10.7659/j.issn.1005-6947.2019.10.012

[Abstract](944) [HTML](1181) [PDF 3.26 M](1579)

Abstract:
Objective: Through establishing several types of 5-fluorouracil (5-FU) resistant human colon cancer cell lines, to investigate the biological characteristics of the 5-FU resistant colon cancer cells and the mechanism for drug resistance.
Methods: Using human colon cancer HT-29, LoVo and SW480 cells, the 5-FU resistant colon cancer cell lines HT-29/5-FU, LoVo/5-FU and SW480/5-FU were established by repeated exposure to excessive and increasing concentrations of 5-FU. In the established drug-resistant cell lines and their parent cells after treatment with different concentrations of 5-FU, the sensitivities to 5-FU, the cell cycle distributions, the mRNA and protein expressions of drug resistance-related molecules [P-glycoprotein (P-gp), multidrug resistance-associated protein 1 (MRP1), and ATP-binding cassette superfamily G member 2 (ABCG2)] and phosphatase and tensin homolog deleted on chromosome 10 (PTEN) and protein kinase B (Akt) were determined by MTT assay, flow cytometry, qRT-PCR and Western blot respectively, and the Akt activities were measured by Akt kinase assay kit.
Results: Compared with their corresponding parent cell line, the IC50 values to 5-FU in HT-29/5-FU, LoVo/5-FU and SW480/5-FU were all significantly increased (all P<0.05), with the drug resistance indexes of 7.213, 5.849 and 15.940, respectively. The numbers of cells in G0/G1 phase in both drug-resistant cell lines and their parent cell lines were increased with the increase of the treatment concentration of 5-FU (all P<0.05), but the number of cells in G0/G1 phase in each drug-resistant cell line was significantly less than that in their respective corresponding parent cell line under the same concentration of 5-FU (all P<0.05). Compared with their corresponding parent cell line, the mRNA and protein expressions of P-gp, MRP1, ABCG2 and Akt were significantly increased and the mRNA and protein expressions of PTEN were significantly decreased in all the drug-resistant cell lines (all P<0.05), and the Akt activities were significantly enhanced (P<0.05).
Conclusion: The 5-FU resistant colon cancer cell lines are successfully established. The mechanism for drug-resistance may probably be associated with the activation of PI3K/Akt pathway resulted from PTEN down-regulation.

13 Biological characteristics of human colorectal cancer stem-like cells and their relationship with autophagy

HOU Songlin , JIANG Xianhong , ZHOU Guojun , LI Lifa , ZHANG Guangjun , ZHOU Tong

2019, 28(10):1253-1260. DOI: 10.7659/j.issn.1005-6947.2019.10.013

[Abstract](198) [HTML](1203) [PDF 2.57 M](1129)

Abstract:
Objective: To investigate the biological characteristics of human colorectal cancer stem-like cells and their relationship with autophagy.
Methods: HCT116 sphere cells (colorectal cancer stem-like cells) were dissociated from the human colorectal cancer HCT116 cells by culture with serum-free medium. The proliferative and self-renewal abilities as well as the invasion and migration abilities of HCT116 cells and HCT116 sphere cells were detected by colony formation assay, sphere-forming assay, and Transwell assay respectively. In addition, the fluorescence expressions of the autophagy marker LC3B in the two types of cells were detected by immunofluorescence assay, and the mRNA and protein expressions of LC3B and autophagy-associated genes ATG5 and ATG7 in the two types of cells were determined by RT-PCR and Western blot respectively.
Results: The colony formation and sphere formation abilities as well as invasion and migration abilities of HCT116 sphere cells were significantly stronger than those in HCT116 cells (all P<0.05). The fluorescence intensity of LC3B in HCT116 sphere cells was significantly enhanced compared with HCT116 cells (P<0.05). The mRNA and protein expressions of LC3B, ATG5 and ATG7 in HCT116 sphere cells were significantly higher than those in HCT116 cells (all P<0.05).
Conclusion: Colorectal cancer stem-like cells have enhanced self-renewal and proliferative abilities as well as increased invasion and migration abilities in vitro compared to colorectal cancer cells, and these biological characteristics may be closely related to their autophagic activities.

14 Changes of annexin A7 level in cancer tissue and peripheral blood in patients with gastric cancer and its clinical significance

YE Weihua , YUAN Hufang

2019, 28(10):1261-1268. DOI: 10.7659/j.issn.1005-6947.2019.10.014

[Abstract](230) [HTML](917) [PDF 657.10 K](1050)

Abstract:
Objective: To investigate the changes of annexin A7 (ANXA7) level in cancer tissue and peripheral blood in patients with gastric cancer, and its diagnostic value for gastric cancer.
Methods: One-hundred and five patients with gastric cancer undergoing surgical treatment from January 2013 to December 2015 were enrolled as study subjects. The mRNA and protein expressions of ANXA7 in the cancer tissues and their adjacent tissues of the patients were determined by qRT-PCR and Western blot analysis, and the serum levels of ANXA7 in these patients and 50 healthy individuals were measured by ELISA assay. The relations of ANXA7 expression in cancer tissue and serum ANXA7 level with the clinicopathologic factors of gastric cancer patients were analyzed, and the diagnostic efficiency of serum ANXA7 level for gastric cancer was evaluated by using ROC curve.
Results: Both mRNA and protein expression levels of ANXA7 in gastric cancer tissue were significantly higher than those in cancer-adjacent tissue (t=17.361, P<0.01; t=15.368, P<0.01); the serum ANXA7 level in gastric cancer patients was significantly higher than that in healthy population (t=12.823, P<0.01). The mRNA and protein expression levels of ANXA7 in gastric cancer tissue as well as the serum ANXA7 level were significantly related to the degree of differentiation and T stage of the tumor, and the mRNA expression level of ANXA7 in gastric cancer tissue and serum ANXA7 level were also significantly related to lymph node metastasis (all P<0.05). There was a significant correlation between the protein level of ANXA7 in cancer tissue and serum (r=0.789, P<0.01). At a cut-off value of concentration of 67.21 ng/L, the sensitivity, specificity, positive predictive value and negative predictive value of the serum ANXA7 level for diagnosis of gastric cancer were 96.59%, 70.15%, 80.95% and 94.00%, respectively.
Conclusion: The ANXA7 expression is increased in gastric cancer tissue, and its expression level is closely related to the degree of malignancy and progression of gastric cancer. The peripheral blood ANXA7 level can better reflect its expression level in cancer tissue, so ANXA7 is likely to become a gastric cancer marker for use in clinical practice.

15 Expression of high mobility group box 2 in colorectal cancer tissue and its clinical significance

LI Qian , LI Dingming , WANG Weiwei , QIU Jiasheng , CHEN Zequn

2019, 28(10):1269-1274. DOI: 10.7659/j.issn.1005-6947.2019.10.015

[Abstract](365) [HTML](1069) [PDF 1.52 M](1068)

Abstract:
Objective: To investigate the expression of high-mobility group box 2 (HMGB2) in colorectal cancer tissue and its clinical significance.
Methods: The surgical specimens and clinical data of 82 patients with colorectal cancer treated from January 2012 to January 2014 in the Department of Gastrointestinal Surgery of Maoming People’s Hospital were collected. The HMGB2 expressions in the specimens were detected by immunohistochemical staining. The relations of HMGB2 expression with the clinicopathologic factors and postoperative tumor-free and overall survival rates were analyzed, and the risk factors for postoperative tumor-free and overall survival rates of colorectal cancer patients were also analyzed.
Results: The proportion of cases with high HMGB2 expression was 60.9% (50/82) and with low HMGB2 expression was 39.1% (32/82). The high HMGB2 expression was significantly related to histological differentiation, clinical stage, T classification, N classification and M classification of the colorectal cancer patients (all P<0.05). Both 5-year tumor-free survival and overall survival rates in patients with high HMGB2 expression were significantly lower than those in patients with low HMGB2 expression (27.7% vs. 38.7%, P<0.05; 32.1% vs. 41.5%, P<0.05). The results of multivariate analyses showed that both HMGB2 expression and M classification were independent risk factors for tumor-free survival (HR=1.771, 95% CI=1.146–4.923, P=0.027; HR=3.874, 95% CI=1.886–7.824, P=0.002) and overall survival rates (HR=1.823, 95% CI=1.035–3.198, P=0.005; HR=3.865, 95% CI=1.770–8.278, P=0.001) in patients with colorectal cancer.
Conclusion: High HMGB2 expression is closely associated with malignant clinicopathologic features in patients with colorectal cancer, and also is an independent risk factor for poor prognosis in patients with colorectal cancer.

16 Application efficacy of porcine small intestinal submucosa patch in different procedures for inguinal hernia in young adult patients

CAO Zhen , LIU Yuchen , SHEN Yingmo , CHEN Jie

2019, 28(10):1275-1280. DOI: 10.7659/j.issn.1005-6947.2019.10.016

[Abstract](292) [HTML](844) [PDF 1.38 M](951)

Abstract:
Objective: To investigate the clinical efficacy of using porcine small intestinal submucosa (SIS) patch in laparoscopic transabdominal preperitoneal (TAPP) hernia repair and open tension-free hernioplasty (Lichtenstein procedure) for inguinal hernia in young adults.
Methods: The clinical data of 268 young adult patients with inguinal hernia undergoing hernia repair using SIS patch from February 2015 to February 2018 in the Department of Hernia and Abdominal Wall Surgery of Beijing Chaoyang Hospital were retrospectively analyzed. Of the patients, 152 cases underwent Lichtenstein hernioplasty (Lichtenstein group), and 116 cases received TAPP procedure (TAPP group). The main clinical variables were compared between the two groups of patients.
Results: The operative time and hospitalization costs were significantly less in Lichtenstein group than those in TAPP group, but the perioperative pain score was significantly higher in Lichtenstein group than that in TAPP group (all P<0.05). There were no significant differences in terms of intraoperative blood loss and length of hospital stay between the two groups (both P>0.05). The incidence rates of seroma on one week, one month and three months after operation were all significantly lower in Lichtenstein group than those in TAPP group (all P<0.05). No complications such as foreign body sensation, intestinal obstruction and intestinal fistula occurred in any of the patients.
Conclusion: In young adult patients with inguinal hernia, using SIS patch has demonstrable efficacy for either open or laparoscopic hernioplasty. However, both procedures using this patch have their advantages and disadvantages.

17 Advances in application of self-expandable metallic stenting for colorectal obstruction

WANG Shiyao , DING Yongqiang , HU Huan , ZHAO Bin , ZHENG Pengfei , CHENG Zhibin

2019, 28(10):1281-1287. DOI: 10.7659/j.issn.1005-6947.2019.10.017

[Abstract](341) [HTML](942) [PDF 1.11 M](1035)

Abstract:
Patients with malignant colorectal obstruction usually need an emergency surgery to restore luminal patency. However, traditional emergency surgery has high rates of complications and death, especially in patients with left colon cancer and rectal cancer. Self-expandable metallic stenting has been widely used in various benign and malignant colorectal strictures for more than 20 years. However, whether stent implantation will affect the long-term survival of patients and cause tumor metastasis are still highly controversial. Hence, the authors address the indications, contraindications and application of metal stent placement in colorectal benign and malignant obstruction, and combine the latest research advances, so as to provide reference for clinical treatment.

18 Sleeve gastrectomy plus procedures: new choice for treatment of obesity and diabetes

WU Anjian , JIN Lujia , DONG Guanglong , CAO Li , XU Xiao , WU Anqin

2019, 28(10):1288-1296. DOI: 10.7659/j.issn.1005-6947.2019.10.018

[Abstract](352) [HTML](1432) [PDF 1.55 M](1575)

Abstract:
Metabolic surgery is one of the effective ways to treat obesity and type 2 diabetes mellitus. Sleeve gastrectomy is widely accepted for its simple operation and exact effect. However, single sleeve gastrectomy offers lower weight loss and diabetes remission rates than gastric bypass procedure, and there are also some problems such as weight regain and diabetes remission rate decrease after operation. Therefore, in recent years, based on sleeve gastrectomy, a variety of additional procedures have been developed to improve the efficacy of sleeve gastrectomy, including single-anastomosis duodeno-ileal bypass with sleeve gastrectomy (SADI-S), single-anastomosis duodenal-jejunal bypass with sleeve gastrectomy (SG-DJB), single-anastomosis duodenal-jejunal bypass with sleeve gastrectomy (SADJB-SG), sleeve gastrectomy with modified jejunoileal bypass (SG-MJIB), stomach intestinal pylorus sparing (SIPS), sleeve gastrectomy plus side-to-side jejunoileal anastomosis (JI-SG), sleeve gastrectomy with jejunal bypass (SG-JJB), etc. Although some articles have introduced some individual procedures, there is no comprehensive review concerning this category of procedures. Here, the authors summarize these new procedures, so as to provide recommendations for clinical practice.

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Volume 28,Issue 10,2019 Table of Contents

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