ObjectiveTo explore the application of different digestive system management strategies in the perioperative period of thoracolumbar fracture.MethodsThe clinical data of the patients with thoracolumbar fractures and pedicle screw fixation in Affiliated Hospital of Southwest Medical University from January 2016 to January 2018 were retrospectively analyzed. According to different perioperative management strategies of the digestive system, they were divided into two groups. Patients with careful management strategy were included in the observation group, and patients with routine management were included in the control group. The baseline conditions, the abnormalities of digestive tract function at admission and before and after surgery, the postoperative first feeding time, exhaust time, defecation time, the incidence of other postoperative complications except digestive tract complication, length of stay and patient satisfaction were compared between the two groups. At 6 months after surgery, the fracture healing, loosening or fracture of internal plants were compared between the two groups.ResultA total of 121 patients were included in the study, including 67 cases in the observation group and 54 cases in the control group. There was no significant differences in the baseline conditions between the two groups (P>0.05). There were no significant differences between the two groups in the incidences of digestive system dysfunction at admission (P>0.05). The incidences of digestive system dysfunction in the observation group before and after surgery were lower than those in the control group (29.9% vs. 53.7%, P<0.05; 35.8% vs. 61.1%, P<0.05). The first eating time [(3.7±1.1) vs. (6.7±2.6) h], exhaust time [(7.8±2.3) vs. (13.6±4.2) h], defecation time [(26.7±8.1) vs. (40.9±11.2) h] and length of stay [(6.5±2.4) vs. (9.0±2.7) d] in the observation group were shorter than those in the control group (P<0.005), and the patients’ satisfaction was better than that of the control group (8.3±1.1 vs. 7.6±1.3; t=?3.208, P=0.002). There was no statistically significant difference in the incidence of postoperative complications except digestive tract complication, and the fracture healing rate, the incidence of nail-rod breakage at6 months after surgery between the two groups (P>0.05). No internal plant loosening was found in the two groups of patients within 6 months after surgery.ConclusionThe application of the careful digestive system management strategy in patients with thoracolumbar fractures can help reduce the incidence of perioperative gastrointestinal dysfunction, promote the recovery of perioperative gastrointestinal function, shorten the length of hospital stay, and improve patient satisfaction.
To investigate the effect of BMSCs on the repair of digestive tract injury and its mechanisms.Methods Recent l iterature on the effect of BMSCs on the repair of digestive tract injury was reviewed. Results BMSCs had the potency of self-repl ication, prol iferation and multipotential differentiation, which played an important role in the repair of digestive tract injury. The probable mechanisms included: BMSCs’ abil ity of migrating to the injured tissue and inhibiting the host immune response; BMSCs’ dedifferentiation and redifferentiation; BMSCs’ direct differentiation into the epithel ial cellsor the stem cells of digestive tract; BMSCs’ fusion with the stem cells or the mature epithel ial cells of digestive tract; BMSCs’ participation in the reconstruction of injured microenvironment. Conclusion BMSCs participates in the repair of digestive tract injury and has a bright future in the treatment of digestive system disease.
Objective To evaluate the clinical application of modified Orr Roux-en-Y type digestive tract reconstruction. Methods Thirty-eight patients with gastric cancer were randomly classified into modified group （accepted modified Orr Roux-en-Y type digestive tract reconstruction, 18 cases） and ρ group （accepted ρ type esophagojejunostomy, 20 cases） according to the date of operation. Operative time, blood loss in operation, complications after operation, emptying time of pouch, and change of body weight before and 3 months after operation were compared between two groups. Results Compared with the ρ group 〔(283±35) min〕, the operative time of modified group 〔(229±18) min〕 was significantly shorter （Plt;0.05）. The holo-empyting time of pouch in modified group 〔(35.7±4.9) min〕 was longer than that in ρ group 〔(3.0±0.5) min〕, Plt;0.01. Blood loss in operation, complications after operation, and the body weight change had no statistical difference between two groups （Pgt;0.05）. Conclusion Modified Orr Roux-en-Y type reconstruction with a pouch function is useful in clinical application， which is not only easy to operate, but also can reduce the operative time and the complications.
Objective To explore the optimal technique for digestive tract reconstruction of proximal gastrectomy. Methods Fifty-nine patients who underwent proximal subtotal gastrectomy during June 2004 and January 2007 were analyzed retrospectively. All patients were divided into 2 groups according to the styles of reconstruction: one group with gastroesophagostomy (GE group) and the other with accommodation double tract digestive reconstruction of jejunal interposition (GIE group). The reconstruction of GIE group was to interposite a continuous 35 cm jejunum between the gastric stump and the oesophagus, which detail had been reported in our previous literature. The quality of life in 2 groups were evaluated and compared. Results No patient died and there was no anastomotic leakage, dumping syndrome and moderate or severe anemia occurred during perioperative period. There was no significant difference of the following indexes of nutrition between 2 groups 1 month and 6 months after operation: the value of weight, RBC, Hb, Alb, PNI and the indexes versus the preoperative ones (Pgt;0.05), for the exception of the indexes of RBC (P=0.006), Hb (P=0.001) in 1 month after operation versus the preoperative ones. The abdominal and the reflux esophagitis symptoms in GIE group were milder than those in GE group (Plt;0.001). The Visick scoring: most of the GIE group were gradeⅡ (74.2%), and grade Ⅲ (64.3%) in the GE group. There was no delay of the first time of adjuvant chemotherapy in GIE group (Pgt;0.05), and the surgical time was (0.35±0.13) h more than that of GE group (P=0.01). Conclusion The accommodation double tract digestive reconstruction of jejunal interposition for proximal subtotal gastrectomy may be safe and feasible by decreasing residual cancer cells and improving the quality of life of patients with proximal gastric carcinoma who underwent such surgical procedure.
Objective To explore the value of dual-channel anastomosis of residual stomach and jejunum in radical resection of the upper gastric cancer. Methods Forty patients with upper gastric cancer had undergone proximal gastrectomy and dualchannel digestive tract reconstruction, including esophagus-jejunum side to side anastomosis, residual stomachjejunum anastomosis, and jejunum-jejunum anastomosis. Results The cutting margin away from tumor in all the cases was more than 5 cm and no carcinoma residual. The number of lymph nodes dissection was 21±6, reaching the requirement of D2 radical surgery. There was no case appearing complications such as anastomotic leakage, obstruction or bleeding. Barium meal examination after operation showed that most of barium was directly into the jejunum, the remaining went through the duodenum into the jejunum without gastroesophageal reflux. Followed up 6-30 months with average 18 months, there were no visible reflux esophagitis in all the cases, and only 1 case appeared minor dumping syndrome. The hemoglobin increased and the quality of life was satisfactory after operation. Conclusions In regard to dual-channel anastomosis of residual stomach and jejunum, resection range is reasonable, dissection scope accords with the protocol and residual stomach has a certain pouch effect. The anastomosis has a favorable prevention from reflux esophagitis and dumping syndrome and retains the duodenum pathway, so that improves the quality of patients’ life and is a relatively ideal digestive tract reconstruction.
Objective To summarize the research progress of digestive tract reconstruction after total gastrectomy in gastric cancer. Methods The domestic and international published literatures about digestive tract reconstruction after total gastrectomy in gastric cancer were retrieved and reviewed. Results More and more attention had been paid to the postoperative quality of life after total gastrectomy in gastric cancer， and the most related factor for postoperative quality of life was the type of digestive tract reconstruction. The pouch reconstruction and preservation of enteric myoneural continuity showed beneficial effects on clinical outcomes. Current opinion considered the pouch reconstruction might be safe and effective， and was able to improve the postoperative quality of life of patients with gastric cancer. However， the preservation of duodenal pathway didn’t show significant benefits. Conclusion The optimal digestive tract reconstruction after total gastrectomy is still debating， in order to resolve the controversies， needs more in-depth fundamental researches and more high-quality randomized controlled trials.
Objective To investigate for a reasonable reconstruction method in patients undergoing total gastrectomy. Methods Data of 63 cases receiving total gastrectomy from January 2000 to October 2005 in Ganzhou District Hospital of Zhangye City were analyzed retrospectively, and the patients were divided into double pouch jejunum interposition （DPJI） group (n=30) and Roux-en-Y ρ pouch （RYρ） group (n=33) according to the operation methods, then operation time， morbidity of complications, amount and frequency of meat and drink, complications of digestive tract, amount of total protein and albumin were compared between two groups. Results There were no significant differences in operation time，morbidity of complications, the amount or frequency of meat and drink between two groups (Pgt;0.05); but the incidence of digestive tract complications of DPJI group was lower than that of RYρ group （P＜0.05). GradeⅠ/Ⅱof Vervaeck index and the amount of total protein and albumin in DPJI group were statistical significantly higher than those of RYρ group （P＜0.05）. Conclusion Functional DPJI is a reasonable digestive tract reconstruction method.
Foreign body in the digestive tract is one of the common critical diseases in the gastroenterology department, and it is the most common in children. Due to the wide variety of foreign body ingestion, the treatment methods are diverse, and the potential risks and complications are constantly escalating. If the treatment is not timely or improper, serious consequences will occur. However, there are no guidelines for foreign bodies in the digestive tract for children in China. Therefore, the development of evidence-based guidelines for the management of foreign bodies in the digestive tract of children, based on clinical practice in China, is of great significance in effectively guiding and promoting the management of foreign bodies in the digestive tract of children. In order to provide guidance and decision-making basis for clinicians at all levels who treat children with foreign bodies in the digestive tract, we complied with standard development process, collaborated with multidisciplinary expertise, based on available evidence, combined with clinical practice, adopted the grading of recommendations assessment, development and evaluation (GRADE) approach, and followed the reporting items for practice guidelines in healthcare (RIGHT) to develop this guideline for the management of foreign bodies in the digestive tract of children.
Objective To find out some ideal reconstructions after total gastrectomy in experimental study of rat. Methods Sixty male Sprague-Dawley rats were randomly and averagely divided into 6 groups: Roux-en-Y group (RY group), proximate jejunal pouch group (PJP group), distal jejunal pouch group (DJP group), two jejunal pouchs group (TJP group), duodenumjejunal pouch interposition group (DJPI group) and laparotomy group (L group). Body weight of rats, intestinal transit distance, adaptive changes in esophagojejunostomic mucosa and morphology changes of intestine after operation were observed and compared. Results At 2 weeks after operation, body weight in each group were significantly lower than that before operation （P＜0.05）. At 4 weeks postoperatively, body weight in PJP group, TJP group and DJPI group were significantly higher than that in RY group respectively （P＜0.05）, as well as at 8 weeks. Intestinal transit distance in PJP group was shorter than that in RY group （P＜0.05）. With regard to intestinal mucosa, TJP group and DJPI group were significantly different with RY group （P＜0.05）. Interestingly, there was no difference in each group as to refluxing esophagitis （P＞0.05）. Conclusion Proximate and two jejunal pouchs Roux-en-Y esophagojejunostomy seem to be ideal procedures for digestive tract reconstruction after total gastrectomy. The jejunal pouch interposition procedure seems to be same effective to PJP and TJP, but there is no preponderance over the former.
Objectives
To systematically review the efficacy and safety of Yangzhengxiaoji capsule combined with chemotherapy for malignant digestive tract tumor.
Methods
CNKI, WanFang Data, PubMed, EMbase, SinoMed and The Cochrane Library databases were searched online to collect randomized controlled trials (RCTs) of Yangzhengxiaoji capsule combined with chemotherapy for malignant tumor of digestive tract from inception to November 20th, 2017. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Meta-analysis was then performed using ReMan 5.3 software.
Resluts
A total of 15 RCTs were included. The results of meta-analysis showed that: compared with the chemotherapy alone, Yangzhengxiaoji capsule combined with chemotherapy could significantly improve the disease control rate (RR=1.26, 95%CI 1.07 to 1.49, P<0.000 01), the clinical efficacy of TCM syndrome (RR=1.71, 95%CI 1.50 to 1.96,P<0.000 01), and the quality of life scores of patients (RR=1.44, 95%CI 1.13 to 1.82,P=0.003). The combination therapy could also improve the immune function of patients and reduce the incidence of adverse reactions.
Conclusions
Current evidence shows that chemotherapy combined with Yangzhengxiaoji capsule is superior to chemotherapy alone for disease control of malignant tumor of digestive tract, clinical efficacy of TCM syndrome, the quality of life, and improving immune function. Due to limited quality and quantity of the included studies, more high quality studies are required to verify above conclusions.
