OBJECTIVE To introduce a method to repair the vagina following pelvic exenteration for carcinoma of rectum in which the posterior wall of the vagina and cervix of the uterus were often involved. METHODS From 1990 to 1997 segment of the vascularized ileum was used to repair the vagina in 5 cases, and in 2 of which the whole vagina was repaired while in the other 3 cases only the posterior wall of the vagina was repaired. RESULTS All of the patients had successful results after operation repair. CONCLUSION Vascularized graft was an ideal material for the repair of vagina defect following pelvic exenteration for carcinoma of rectum, because this material was easily accessible, and its vascular pedicle was long enough for its transferring to the perineal region and the ileum had good blood supply which made healing easy. The vagina following repair had a thick posterior wall, good elasticity and very little scar tissue surrounded.
【Abstract】ObjectiveTo study the spiral CT features of gastrointestinal invasion by carcinoma of gallbladder. MethodsEight patients with surgical-pathologically documented gastrointestinal invasion by carcinoma of gallbladder were analyzed retrospectively. All patients underwent plain and contrast-enhanced dual-phase scanning of the abdomen. Oral contrast medium (1.2% Angiografin) was used to fill the gastrointestinal tract before CT scanning. ResultsThere were 2 cases of gastric antrum invasion, 6 duodenal invasion and 3 colonic invasion according to the surgical and pathological findings. Spiral CT correctly diagnosed 2 gastric invasion and 4 duodenal invasion based on several imaging features, like blurring of fat plane, focal wall thickening and luminal narrowing of involved gastrointestinal segments, and mass formation. However CT was unable to diagnose the 3 cases of hepatic flexure of colon invasion. ConclusionCT is valuable for diagnosing upper gastrointestinal tract invasion by carcinoma of gallbladder, yet the diagnosis of hepatic flexure of colon invasion is still difficult.
Objective To explore the clinical therapeutic value of pancreatoduodenectomy in patients with carcinoma of ampulla of Vater (AVC). Methods The clinical data of 195 patients with AVC between March 1995 and March 2009 in this hospital were analyzed retrospectively. All the patients were divided into non-surgery group (n＝51), palliative surgery group (n＝96), and resection group (n＝48) according to the treatment methods. Results The 1-year, 3-year, and 5-year survival rates in the resection group were higher than those in the non-surgery group and the palliative surgery group (Plt;0.01). However, the incidence of complications in the resection group was higher than that in the nonsurgery group or the palliative surgery group (Plt;0.05). The radical resection rates, 1-year, 3-year, and 5-year survival rates of carcinomas of head of pancreas were significantly lower than those of carcinomas of the terminal of common bile duct or carcinomas of duodenal papilla (Plt;0.05, Plt;0.01). There was no significant difference of the perioperative mortality, complications rate, 1-year, 3-year, or 5-year survival rate between preoperative drainage jaundice group and preoperative nondrainage jaundice group (Pgt;0.05). The perioperative mortality in the resection group above the age of 70 years old was higher than that of less than or equal to 70 years old （Plt;0.05）. Compared with the non-surgery group or palliative surgery group, there were significant increasement of the incidence of serious or deadly perioperative complications in the resection group (Plt;0.05). Conclusions Surgical resection remains one of the most important measures of the treatment of AVC, in particular, the radical pancreatoduodenectomy is the only effect way for AVC, thus significantly prolonging the patient’s postoperative survivals and significantly improving the qualities of life.
ObjectiveTo investigate the proportion of peripheral blood CD4+CD25+ regulatory T cells (Tregs) in patients with pancreatic head carcinoma, the dynamic changes of these cells before and after pancreatoduodenectomy were also analyzed. MethodsThe proportions of peripheral blood CD4+CD25+ Tregs in patients with pancreatic head carcinoma and normal individuals were examined by using flow cytometric analysis. The CD4+/CD8+ ratio was also studied before and after operation. ResultsThe patients with pancreatic head carcinoma showed higher ratio of CD4+CD25+ and CD4+CD25high Tregs compared with normal control before operation (Plt;0.05). However, the percentage of these T cells reduced significantly after pancreatoduodenectomy, which was most obviously on the 3rd day after operation (Plt;0.01, Plt;0.05). After operation, CA199 level began to decrease, which was obvious on the fourteen day after operation. This tendency of CD4+CD25high Tregs changes was similar to that of CA199. The patients showed an decreased ratios of CD4+/CD8+ compared with normal controls, which further declined after operation, and reached the lowest point on the seventh day after operation (Plt;0.05). ConclusionsPancreatoduodenectomy may be helpful for the recovery of antitumor immunity. The perioperative period of patients with pancreatic head carcinoma may be a beneficial windowphase for immune intervention and Tregs may be served as target cells.
ObjectiveTo summarize the role of epithelial-mesenchymal-transition （EMT） in occurrence and development of gastrointestinal cancer. MethodsDomestic and international publications online involving EMT of gastrointestinal cancer in recent years were collected and reviewed. ResultsEMT was a highly conserved process that has been well characterised in embryogenesis. Studies had shown that the aberrant activation of EMT in adult epithelia could promote tumour metastasis by repressing cell adhesion molecules. E-cadherin， one of the epithelial cell markers, maybe involved in the process of the EMT, especially of the Ecadherin transcriptional repressors， these transcriptional repressors significantly increased in the gastrointestinal cancer. Further more， EMT might involve in the process of gastrointestinal cancer stem cells formation. ConclusionsEMT and it’s regulators play a very important role in gastrointestinal cancer， and may provide a newsight into the gastrointestinal cancer. It also can provide a novel clinical targets to treat the gastrointestinal cancer.
ObjectiveTo compare the efficacy between laparoscopic pancreaticoduodenectomy (LPD) and open pancreaticoduodenectomy (OPD) in treatment of carcinoma of head of pancreas. MethodsClinical data of 60 patients with locally advanced carcinoma of head of pancreas who underwent pancreaticoduodenectomy in our hospital from October 2004 to October 2009 were collected, of which 26 patients were in LPD group and 34 patients were in OPD group. ResultsOperative time and hospitalization expense of patients in LPD group were both longer or more than those of OPD group (P<0.05), but blood loss, time of starting activity, time of aeration, time of pulling out the drainage tube, time of pulling out the stomach tube, time of absolute resting on bed, and hospitalization time in LPD group were all shorter or lower than those of OPD group (P<0.05). There were 25 patients suffered with postoperative complications, including 10 patients in LPD group and 15 patients in OPD group, and there was no significant difference between the 2 groups in total incidence of postoperative complication (P>0.05). But in the specific postoperative complication, the incidences of pancreatic fistula and biliary fistula of LPD group were higher than those of OPD group (P<0.05), but incidences of incision infection, pulmonary infection, and systemic infection were all lower than those of OPD group (P<0.05). All patients were followed up for 1-60 months with the median time of 21.5 months. During the follow-up period, in LPD group, 24 patients suffered with recurrence, 20 patients suffered with tumor metastasis, and 24 patients died; in LPD group, 31 patients suffered with recurrence, 25 patients suffered with tumor metastasis, and 31 patients died. There were no significant difference between the 2 groups in the recurrence rate, metastasis rate, mortality, and survival situation (P>0.05). ConclusionsFor carcinoma of head of pancreas, postoperative recovery and infection complications of LPD are significantly superior than those of OPD. But compared with the OPD, it has no obvious advantage in reducing the pancreatic fistula, biliary fistula, delayed gastric emptying, and other complications, and it also has no obvious advantage in improving the long-term survival situation too.
Objective To determine the safety and efficacy of surgical biliary bypass on the elderly patients with unresectable pancreatic head cancer. Methods The clinical data of 55 cases with unresectable pancreatic head cancer treated with palliation methods from July 2002 to June 2009 in our hospital were retrospectively analyzed. The patients were divided into three groups according to different age and therapeutic program: Nineteen patients, 65 years of age or older, were managed with surgical biliary bypass (group A), 19 patients under 65 years of age were treated by surgical biliary bypass (group B) and 17 patients with the age of 65 years or older received percutaneous transhepatic biliary drainage (group C). Then the therapeutic results were compared.Results With respect to the postoperative level of serum bilirubin, the incidence of early complications, postoperative hospitalization and mean survival time, no statistically significant difference was found between group A and B (Pgt;0.05). There was one case of recurrent jaundice and one case of gastric output obstruction in group B, while no one suffered postoperative complication in group A, and the difference was statistically significant (Plt;0.01). Compared with group A, the postoperative level of serum bilirubin, the number of patient readmitted, the rate of recurrent jaundice and gastric output obstruction were higher in group C (Plt;0.05 or Plt;0.01). The mean postoperative hospitalization and overall survival time were significantly shorter in group C than group A (Plt;0.05 or Plt;0.01, respectively). Conclusion Surgical palliation does not increase the morbidity rate, but it does improve the quality of life in elderly patients with unresectable pancreatic head cancer.
Objective To summarize the status of tumor stem cells investigations in gastrointestinal carcinoma. Methods Domestic and international publications online involving tumor stem cells of gastrointestinal carcinoma in recent years were collected and reviewed. Results There are a small quantity of cancer cells shown some stem cell characteristics. They are named tumor stem cell and play an important role in tumorigenesis, proliferation, metastasis and recurrence. And also, tumor stem cells can resist the effect of antineoplastic drugs and lead to tumor recurrence. These tumor-initiating cells are CD133-positive in the gastrointestinal carcinomas, especially in colorectal cancers. CD133-positive colorectal cancer cells have the abilities of clone, proliferation, differentiation and form metastases. And a high CD133 mRNA content was found in the blood of patients who suffered from bone metastases. Conclusion The characteristics of CD133-positive cancer cell and the mechanisms of stem cell-niche system are the basis of developing better methods to tumor diagnosis and treatment, and provide theoretical basis of new methods, such as targeted therapy.
ObjectiveTo assess the feasibility of the treatment of unresectable late pancreatic cancer with laparoscopic choledochojejunostomy and gastric bypass. MethodsFrom June 2000 to December 2003, laparoscopic choledochojejunostomy and gastric bypass were successfully performed in 15 patients with unresectable late pancreatic cancer. Endoscopic nosobiliary drainage (ENBD) was performed before the operation. ResultsAll procedures were completed laparoscopically. Jaundice and hepatic function of the patients were obviously improved after the bypass. Oral nutrition was recovered after operation. The mean operative time was (100±26) min (range 70-200 min); the mean operative blood loss was (60±15) ml (range 30-120 ml); the bowel function recovery was on the 3rd-5th postoperative day; the average hospital stay was (8.1±0.7) days (range 6-13 days). Incision infection ocurred in one patient. No operative complications occurred in other patients. ConclusionTreatment of unresectable late carcinoma of the pancreas with laparoscopic choledochojejunostomy and gastric bypass aided by ENBD is a minimally invasive technique with less postoperative pain，shorter hospital stay, lower procedurerelated morbidity,and better oral nutrition. The life quality of patients with late pancreatic cancer can be obviously improved.