• Volume 15,Issue 9,2006 Table of Contents
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    • >胃癌专题研究
    • Lymph node metastasis versus peritoneal dissemination in patients with gastric cancer: analysis of the correlated factors and prognosis

      2006, 15(9):3-649. DOI: 10.7659/j.issn.1005-6947.2006.09.003

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      Abstract:Abstract:Objective:To investigate the correlated factors of peritoneal dissemination and lympah node metastasis from gastric cancer, the prognosis of patients with peritoneal dissemination and N2 lymph node metastasis, and the impact of palliative surgery on the prognosis. Methods:Based on our database built from 1994, the clinicopathologic data and the outcomes of the follow-up were analyzed respectively. Results:The clinicopathologic factors correlated with peritoneal dissemination included T4, hepatic metastasis, the primary tumor involving the whole stomach, undifferentiated carcinoma, female sex and lymph node metastasis, while those correlated with lymph node metastasis included the primary tumor involving the whole stomach, Borrmann III, T2, T3 and T4, hepatic metastasis and peritoneal dissemination (P<0.05). The overall survival rate within 1 year postoperatively in the patients with P3 disease was lower than that in the patients with P1 and P2 disease(P<0.05), and the 1-,3-,and 5-year overall survival rate within 1, 3 or 5 years postoperatively in the patients with N2 disease was lower than that in the patients with N1 disease(P<0.05). The 1- and 3-year overall surivial rate in the patients with peritoneal dissemination (P group) and N2 lymph node metastasis (PN2 group) was lower than that in the patients with N2 lymph node metastasis (N2 group) (P<0.05). The overall survival rate within 1 year in the patients with peritoneal dissemination undergoing palliative resection(PR)and the 1-and 3-year overall survival rate in the patients with N2 lymph node metastasis undergoing PR was significantly higher than that of the patients undergoing by-pass operation or feeding neostomy and the patients only undergoing exploratory laparotomy(P<0.05). Conclusions:The short- and long-term prognosis of PN2 group was poorer than that of N2 group; the prognosis of P3 group was poorer than that of P1 and P2 group, and the prognosis of N2 group poorer than that of N1 group; PR could improve the short-term survival rate of P group, and improve the short-and long-term survival rates of N2 group.

    • Diagnosis and treatment of gastric cancer with ovarian metastasis:a report of 17 cases

      2006, 15(9):4-653. DOI: 10.7659/j.issn.1005-6947.2006.09.004

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      Abstract:Abstract:Objective:To investigate the clinical and pathological characteristics, diagnosis and treatment of gastric cancer with ovarian metastasis. Methods:The clinical data of 17 cases of gastric cancer with ovarian metastasis, confirmed by surgery and pathology, were analyzed retrospectively. Results: The average age of the patients was 48.41 years, and the first appearance of symptoms and signs often were of metastatic ovarian cancer. The main ultrasonographic findings were either a complex type of mass with both solid and cystic characteristics or only solid, and most of them were accompanied by intraperitoneal fluid accumulation. Bilateral metastatic ovarian cancer was more common(13 cases). The preoperative accurate diagnosis of this disease was difficult, so that the misdiagnostic rate was 64.7% in this series. Operation was done in all the patients, but prognosis was poor. The median survival time was only 11.6 months. Conclusions: The prognosis of gastric cancer with ovarian metastasis is poor. It is of importance to inspect the stomach in cases of bilateral ovarian cancer. Radical resection of the primary disease focus together with hysterectomy and bilateral adnexectomy should be performed. Postoperative comprehensive therapy is conducive to improve the prognosis of gastric cancer with ovarian metastasis.

    • The effect of cinobufacin combined with 5-FU on inhibiting proliferation and inducting apoptosis of human gastric carcinoma cells

      2006, 15(9):5-658. DOI: 10.7659/j.issn.1005-6947.2006.09.005

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      Abstract:Abstract:Objective:To study the effects of cinobufacin(cino) combined with fluorouracil(5-FU) on inhibiting proliferation and inducing apoptosis of human gastric carcinoma cells in vitro. Methods:The experiment was divided into control group,cinobufacin group,5-FU group and cino+5-FU group. Cell morphological variation,cell inhibitory rate, cell cycle and ratio of apoptotic cell of human gastric carcinoma cell line BGC-823 were studied by cell culture, inverse microscopy, fluoroscopy, MTT assay and flow cytometry on different concentrations of cino and 5-FU. Results:Cino could markably inhibit proliferation of human gastric carcinoma cells in time-and dose-dependent response. The cino+5-FU group inhibited the rate of proliferation of BGC-823 cells was significantly more than either cino or 5-FU alone group(P<0.05). The quantitative analysis showed the same result. Cino+5-FU can decrease the proportion of G0/G1 phase and increase of S phase in cell cycle. Most of the cells were arrested in the S phase. Conclusions:Cino has the effect of inhibition on the proliferation and induction of apoptosis in human BGC-823 gastric carcinoma cell. Cino combined with 5-FU could enhance the antineoplastic effect of 5-FU, and showed time-and dose-dependent response.

    • Relationship between cytokine gene polymorphisms on development and clinical characteristics of gastric adenocarcinoma

      2006, 15(9):6-663. DOI: 10.7659/j.issn.1005-6947.2006.09.006

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      Abstract:Abstract:Objective:To investigate relationships between single nucleotide polymorphisms(SNPs) of tumor necrosis factor-α(TNFα) or interleukin-6(IL-6) promoter genes and gastric adenocarcinoma with or with out helicobacter pylori(HP) infection. Methods:The SNPs of TNF-α(-238G/A and -308G/A) and IL-6(-597G/A,-174G/C and -572G/C) were determined by gene chip in 130 patients with gastric adenocarcinoma and 142 healthy controls.The sera concentrations of IgG,IgM and IgA of HP antibodies were measured by ELISA in all cases and controls.Results:Pylori infection was detected in 69.2% of 130 patients and 46.5% of 142 controls(P<0.01, odds ratio[OR]=2.59,95% confidence interval [95%CI]=1.58~3.93). Frequencies of TNF-α-238GA genotype and A allele in patients with gastric adenocarcinoma were significantly higher than those in healthy controls(P<0.01,OR=2.44,95%CI=1.41~4.22 and P<0.01,OR=2.13,95%CI=1.22~3.73,respectively).Frequencies of TNF-α-238GA genotype and A allele in patients with gastric adenocarcinoma with HP infection were significantly higher than those in HP-negtive patients with gastric adenocarcinoma(P<0.05,OR=4.53,95%CI=1.16-17.68 and P<0.01,OR=3.52,95%CI=1.64-7.54,respectively). Frequencies of TNF-α-238GA genotype and A allele in patients with poorly-differentiated gastric adenocarcinoma were significantly higher than those in well-differentiated group(P<0.05,OR=4.16,95%CI=1.21~14.32). The proportion of individuals carrying the IL-6-572CC genotype was significantly lower in the patients with gastric adenocarcinoma than in the controls(P<0.01,OR=0.17,95% CI=0.064~0.465). No association was found between any of the other polymorphisms and patients with gastric adenocarcinoma or patients with gastric adenocarcinoma and HP infection.Conclusions:TNF-α-238GA genotype and A allele were significantly related to patients with gastric adenocarcinoma or patients with gastric adenocarcinoma and HP infection. IL-6-572CC genotype can have a protective function against susceptibility to gastric cancer.

    • Clinical significance of Ki-67 antigen and p53 protein expression in gastric carcinoma

      2006, 15(9):7-667. DOI: 10.7659/j.issn.1005-6947.2006.09.007

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      Abstract:Abstract:Objective:To study the expression of Ki-67 antigen and p53 protein in human gastric carcinoma, and the relation of the 2 parameters to biological behavior and prognosis. Methods:The expressions of Ki-67 antigen and p53 protein were determined by immunohistochemistry technique in 232 patients with gastric carcinoma. Results:The expression intensity of Ki-67 antigen was directly proportional to that of p53 protein(P<0.001). The expression levels of Ki-67 antigen and p53 protein were both closely correlated with regional lymph node metastasis, but not with patient′s sex, age and tumor size, location, histological type, infiltration depth, distant metastasis, nor pTNM stage. The 3-year survival rate of those with positive expression of Ki-67 antigen or p53 protein was higher than those with negative expression(P=0.006,0.007).The 3-year survival rate of the group Ki-67-/p53- was significantly higher than the other three groups(Ki-67-/p53+, Ki-67+/p53-, Ki-67+/p53+) (P=0.011, 0.017, 0.001). Multivariate survival analysis confirmed that p53 protein expression was independently associated with the 3-year survival rate (P=0.002). Conclusions:Ki-67 antigen and p53 protein expression levels were both significantly correlated with regional lymph node metastasis and prognosis. P53 protein expression is an independent indicator of gastric carcinoma prognosis. Combined analysis of Ki-67 antigen and p53 protein expression showed that positive expression of anyone of them suggests a poor prognosis.

    • >基础研究
    • Polymorphisms and mutations of EDNRB gene in Hubei provincial patients of Han ethnicity with Hirschsprung disease

      2006, 15(9):8-671. DOI: 10.7659/j.issn.1005-6947.2006.09.008

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      Abstract:Abstract:Objective:To analyze the relationship between polymorphisms of EDNRB gene and Hubei provincial patients of Han ethnicity with sporadic Hirschsprung disease(sHD). Methods:Peripheral blood samples from 104 patients with sHD and 84 parents of 42 patients, and 120 normal children(as controls) were collected. PCR-SSCP and direct DNA sequencing were used to detect mutations and polymorphisms of exon-4 in EDNRB gene. The differences of allele frequencies and genotype distribution in polymorphic sites were further analyzed between the three groups. Allele frequencies of SNPs in forty-two sHD trios were analyzed by transmission disequilibrium test(TDT), and the association between phenotype of HD and SNPs was analyzed. Results:No mutant site was detected and one polymorphic site of c831 G→A(L277L) was observed in Hubei provincial patients of Han ethnicity with sHD. The allele frequency of A(68% vs 53%) and genotype frequency of AA(49% vs 30%) were significantly higher in sHD group than that in control group(P<0.01); the allele frequency of A in sHD group was significantly higher than that in parental group(68% vs 54%,P<0.01); The allele frequency of A in SSA group was significantly higher than that in LSA group(76% vs 63%,P<0.05). No transmission disequilibrium was detected in polymorphic site of c831 G→A(L277L) between parental generation and filial generation. Conclusions:The polymorphisms of EDNRB gene may play an important role in the pathogenesis of sporadic Hirschsprung disease, especially for patient with short-segment aganglionosis.

    • Immunoregulation of triptolide on sepsis in rats

      2006, 15(9):9-675. DOI: 10.7659/j.issn.1005-6947.2006.09.009

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      Abstract:Abstract:Objective:To investigate the immunoregulation of triptolide on inflammatory mediators of septic rats. Methods:Ninety SD rats were randomly allocated into three groups: sham operation group (group A), sepsis group (group B)and treatment group with triptolide (group C). There were 30 rats in each group. In group A rats, the abdomen was opened without any other treatment. Sepsis rat model was induced by exposure of caecum and puncturing it,then the abdomen was closed. In group C, triptolide (0.05mg/mL)was given by intraperitoneal injection(0.2mg/kg,Q8h) after ceacum punctured. The rats were killed at 6h,12h and 24h after operation. Then serum levels of TNF-α, IL-6, IL-10, and TGF-β were determined at the three time periods(10 rats for each time period). Tissues from liver and kidney were obtained to observe the changes under microscope and electron microscope. Results:There was no difference between levels of inflammatory mediators at the three time periods in group A, and the functional and morphologic changes of liver and kidney were not significant. Levels of inflammatory mediators were significantly higher in group B and C than those in group A. Pathological changes in liver and kidney were milder in group C than those in group B. Conclusions:Triptolide can lead to down-regulation of levels of inflammatory mediators, exert a modulatory efect on immune balance and alleviate pathological damage of liver and kidney in septic rats.

    • >临床研究
    • The diagnosis and treatment primary malignant tumor of the duodenum:a report of 54 cases

      2006, 15(9):10-678. DOI: 10.7659/j.issn.1005-6947.2006.09.010

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      Abstract:Abstract:Objective:To investigate improvements in the diagnosis and treatment of primary malignant tumor of the duodenum. Methods:The clinical data of 54 patients with primary malignant tumor of the duodenum treated during a period of 6 years were analysed retrospectively. Results:Tumors located in the first, second, third and fourth parts accounted for 6 cases(11.1%), 44 cases(81.5%), 2 cases(3.7%), and 2 cases(3.7%) respectively; and among them, ampullary tumor accounted for 38 cases(86.4%) of tumor of descending portion of duodenum and 70.4% of the total number of duodenal tumors. The main clinical presentation included jaundice, upper abdominal pain, weight loss, abdominal distention, and gastrointestinal obstruction. Upper abdominal pain, no positive signs and abdominal mass were found in 72.0%, 20.0% and 8.0% respectively on abdominal examination. Preoperative associated cholecystopathy accounted for 37.0%. The accuracy rate of duodenoscopy and ERCP in preoperative diagnosis was 94.4%, and 77.8% respectively. Preoperative diagnostic accuracy rate was 27.8%. Panceaticoduodenectomy was performed in 38 cases, duodenectonmy in 1 case, palliative resection of tumor in 9 cases, and tumor was inoperable in 6 cases. Radical resection rate was 72.2%. The postoperative 3- and 5-year survival rate was 40.6% and 21.9%, respectively. After palliative resection, death occurred from 1month to 24months. Conclusions:The tumors in the ampullary region account for the majority of primary malignant tumors of the duodenum and are mainly adenocarcinoma. The symptoms of advanced stage are complicated, and specific signs on abdominal examination are few. Associated cholecystopathy is relatively ferquent and preoperative accurate diagnostic rate is low. The examinations of first choice are duodenoscopy and ERCP, and radical panceaticoduodenectomy can extend survival time.

    • Study on the factors involved in the occurrence of internal abdominal hernia after subtotal gastrectomy and gastrojejunostomy and their prevention

      2006, 15(9):11-681. DOI: 10.7659/j.issn.1005-6947.2006.09.011

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      Abstract:Abstract:Objective:To study the factors involved in the development of internal abdominal hernia after subtotal gastrectomy and gastrojejunostomy(Billroth II gastrectomy), and the means for their prevention and for decrease of mortality rate.Methods:The clinical datas of 34 cases of internal abdominal hernia occurred after gastrectomy were analyzed retrospectively. Results:All of the 34 cases of internal abdominal hernia developed after Billroth-II operation(26 cases after Eiselsberg operation and 8 cases after Moynihan anastomosis). The time of onset was from 1 month to 21 years after operation, and in 28 cases was during the first year after operation(82.4%).The chief complaint was sudden epigastric pain with radiation of pain to the back. The preoperative misdiagnostic rate was 82.3%. All cases were treated by operation. The postoperative mortality rate was 29.4%.Conclusions:Internal abdominal hernia is a serious complication of Billroth-II operation. Patients who present with symptoms of intestinal obstruction after Billroth-II operation should be considered to have internal abdominal hernia.The only key to decrease mortality rate is operative treatment as soon as possible.

    • Microinvasive management of post-gastrectomy acute cholecystitis

      2006, 15(9):12-684. DOI: 10.7659/j.issn.1005-6947.2006.09.012

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      Abstract:Abstract:Objective:To study the microinvasive treatment of post-gastrectomy acute cholecystisis. Methods:Teweenty-eight cases of post-gastrectomy acute cholecystitis were treated by routine non-operative method first, if cases with no apparent relief after 24h of treatment were further treated with percutanous transhepatic gallbladder puncture and drainage(PTGD) guided by ultrasonography. Results:Five cases were treated by non-operative method with complete relief within 24 hours. PTGD was done successfully in all the other 23 cases.In cases with ideal bile drainage at the time of intubation, the patients had immediate marked relief of their symptoms and signs, and they fully recovered within 3~7 days.Conclusions:Ultrasound guided PTGD is an effective treatment for post-gastrectomy acute cholecystitis with the advantages of microinvasion and quick patient recovery.

    • Pathogenic analysis and treatment methods for iatrogenic rectovaginal fistula

      2006, 15(9):13-688. DOI: 10.7659/j.issn.1005-6947.2006.09.013

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      Abstract:Abstract:Objective:To investigate the causes and outcome of different treatment methods of iatrogenic rectovaginal fistula. Methods:Clinical data of 52 patients with iatrogenic rectovaginal fistula were analyzed retrospectively. Results:Twenty-two fistulae occurred after gynecological operation (42.3%), fourteen after obstetric injury (26.9%), thirteen after colorectal operation (25.0%) and three due to miscellaneous causes (5.8%). The fistulae were located in the lower rectum in 27 cases(51.9%), mid rectum in 10 cases(19.2%) and upper rectum in 15 cases(28.9%). They were treated by non-surgical treatment in 9 cases(17.3%), permanent diverting stoma(loop transverse colostomy) in 8 cases(15.4%), and surgical repair by various approaches in 35 cases(67.3%). The fistulae of all nine patients who received non-surgical treatment failed to heal. Eight patients who received permanent diverting stoma had symptomatic improvement without fistula healing. The overall cure rate of surgical repairs in 35 cases was 77.1%(27/35). The cure rates of trans-sphincteric (Mason′s operation), transanal, transabdominal, transperineal and transvaginal approaches were 100%(8/8), 100%(2/2), 83.3%(5/6), 0%(0/1) and 66.7%(12/18), respectively. The cure rate of Mason′s operation for the mid and lower rectovaginal fistulae was higher than that of transvaginal approach (100% vs 66.7%). Conclusions:Iatrogenic rectovaginal fistula is caused by obstetric injury or injury of rectovaginal septum due to surgical mismanagement. Surgical repair is the only method that can cure rectovaginal fistulae. Mason′s operation is a favorable treatment method for the mid and lower (especially mid) rectovaginal fistulae.

    • The clinical application of stapled prolapsectomy(PPH) for severe hemorrhoids: a report of 153 cases

      2006, 15(9):14-692. DOI: 10.7659/j.issn.1005-6947.2006.09.014

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      Abstract:Abstract:Objective:To investigate the operative technique and efficacy of PPH for severe hemorrhoids. Methods:The clinical data of 153 cases of severe hemorrhoids treated by PPH, individualized according to size and nature of the piles, concomitant morbidities and conditions at the dentate line, and analysis of the relevance between operative technique and clinical efficacy as well as postoperative complications, were revieuled retropectively. Results:All of the prolapsed tissue retracted immediately. Bleeding at the anastomotic site occurred in 49 cases, pulsatile bleeding in 12 cases, all of which were sutured under direct vision with cessation of bleeding. The width of excised-tissue was 2.1~4.6cm(average 3.5cm). The main symptoms of patients on the 1st post-operation day were abdominal distention caused by dysuria, pain, and tenesmus and burning sensation. At followup of 1-40 months, there was no stenosis of stoma, anal incontinence or recurrence of prolapse. After operation, a very satistactory result was achieved in 87 cases, satisfactory in 63 cases and mostly satisfactory in 3 cases. Conclusions:In order to achieve ideal results with good retraction of tissues, avoidance of complications and improve patient satisfactory rate, the use of PPH for severe hemorrhords must be individualized and technical skill during operation are important.

    • Method and outcome of living-related small bowel transplantation on intestinal failure:a case report

      2006, 15(9):15-696. DOI: 10.7659/j.issn.1005-6947.2006.09.015

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      Abstract:Abstract:Objective:To analyze the surgical procedure and effect of living-related small bowel transplantation(LR-SBTx) on intestinal function failure caused by short bowel syndrome.Methods:A boy, 15 years of age with short gut syndrome, who had only 8 cm of residual small intestine, associated with serious malnutrition and poor D-xylase absorption test (0.226/5h). The donor was the boy's mother. They had a match of 4 loci in HLA. In the first stage of the surgical procedure, 120 cm of ileum from the patient′s mother was transplanted into the recipient. Both ends of the transplanted intestine were exteriorized as stomas on the patient′s abdominal wall. The second stage of reconstruction of the intestine was carried out 6 months after his first operation. The residual small bowel of the recipient was transected, and both of its ends were respectively anastomosed end-to-side to the proximal and distal segments of the graft. The stomas of the graft were left in place. Results:The donor and recipient operation went on smoothly. Acute rejection and infection of CMV developed postoperatively and were cured after treatment. The patient was followed-up for 8 months, the graft function recovered gradually postoperatively with increase of body weight. He can ingest a semifluid diet and take care of himself independently. Conclusions:LR-SBTx is an effective way to treat short bowel syndrome. The reconstruction of the intestine in two stages for LR-SBTx decreased the risk of complications. Rejection and infection are important risk factors of LR-SBTx.

Governing authority:

Ministry of Education People's Republic of China

Sponsor:

Central South University Xiangya Hospital

Editor in chief:

WANG Zhiming

Inauguration:

1992-03

International standard number:

ISSN 1005-6947(Print) 2096-9252(Online)

Unified domestic issue:

CN 43-1213R

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