中华胃肠外科杂志最新文献

{"title":"[A case report of ectopic small intestine and colon with absence of suspensory ligament of duodenum].","authors":"M X Zhang, B Q Liang, M E Li, C L Yang, R T Wei, Y Zhang, Y G Dai","doi":"10.3760/cma.j.cn441530-20240112-00024","DOIUrl":"10.3760/cma.j.cn441530-20240112-00024","url":null,"abstract":"","PeriodicalId":23959,"journal":{"name":"中华胃肠外科杂志","volume":"27 9","pages":"980-981"},"PeriodicalIF":0.0,"publicationDate":"2024-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142308662","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Clinical application of parasacral artery perforator flap in the treatment of Pilonidal Sinus Diseases].","authors":"J H Lan, Z H Chen, Y Y Fan, L Han, T Wang, C Y Jia, W L He","doi":"10.3760/cma.j.cn441530-20231017-00137","DOIUrl":"10.3760/cma.j.cn441530-20231017-00137","url":null,"abstract":"<p><p><b>Objective:</b> To investigate clinical efficacy of parasacral perforator flap (PPF) on postoperative wound healing in pilonidal sinus diseases (PSDs). <b>Methods:</b> The surgery steps were as follows: (1) To preoperatively detect parasacral perforator arteries with the handhold Doppler probe and mark them; (2) To remove the infected and necrotic tissues of PSDs completely; (3) To design the PPF according to the wound size and the parasacral perforator arteries' localization; (4) To harvest the flap from the gluteus maximus muscle surface and transfer it to the wound without tension. Several data were documented, including surgical duration, flap length, flap width, drainage tube placement duration, hospital stay, duration from operation to stitch removal, postsurgical complications and recurrence. <b>Results:</b> There were six patients with PSDs whose postoperative wound healing was repaired by PPF, admitted in our department from March 2021 to March 2023. Of them, five were male and one was female. Their median age was 24 (range: 18-33) years old. Their median surgical duration was 165 (range: 134-207) minutes, median length of PPF was 8 (range: 7-11) cm, median width of PPF was 3 (range: 3-4) cm, mean duration of drainage tube placement was 8 (range: 4-17) days, mean hospital stay was 13 (range: 6-23) days, mean duration from operation to stitch removal was 14 (range: 14-17) days, median follow-up time was 6-16 months. Incisions of all six cases achieved first-intention healing without early- or late-stage complications. No recurrence occurred during follow-up. All patients involved were satisfied with their clinical efficacy. <b>Conclusion:</b> The utility of PPF in postoperative wound healing of PPDs was effective, safe and reliable.</p>","PeriodicalId":23959,"journal":{"name":"中华胃肠外科杂志","volume":"27 9","pages":"970-973"},"PeriodicalIF":0.0,"publicationDate":"2024-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142308665","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Fascial anatomy of ligamentous structures associated with colon cancer surgery].","authors":"X J Wang","doi":"10.3760/cma.j.cn441530-20240708-00237","DOIUrl":"10.3760/cma.j.cn441530-20240708-00237","url":null,"abstract":"<p><p>The ligamentous structures integral to the surgical management of colon cancer include the gastrocolic ligament, the phrenicocolic ligament, and the splenocolic ligament. Historically, the era of conventional open surgery was characterized by the use of large forceps for clamping and ligating these ligaments. However, the advent of fascial and mesenteric anatomy research has ushered in a paradigm shift. Aided by high-definition laparoscopy, colorectal surgeons have progressively clarified the fundamental anatomical structures, thereby refining surgical techniques in accordance with fascial and mesenteric anatomical principles. This study synthesizes the author's anatomical research findings to dissect the fascial and mesenteric anatomy of the ligaments pertinent to colon cancer surgery, thereby exploring their implications for surgical practice and oncological outcomes. The gastrocolic ligament exhibits distinct fascial and mesenteric anatomical configurations within the omental sac and extra-omental regions. Within the omental sac, the sub-omental arch pathway emerges as a viable alternative to the paracolic approach for accessing the omental sac through the gastrocolic ligament. Conversely, in the extra-omental region, the incision of the greater omentum overlaying the space between the mesogastrium and the transverse mesocolon represents a mesenteric bridge facilitating access to this area. The incidence of nodal metastasis in the gastrocolic ligament associated with transverse colon and hepatic flexure colon cancer is notably low; nevertheless, selective dissection in high-risk patients can still provide survival benefits. The splenocolic ligament is formed by the convergence of the splenic hilum region of the mesogastrium (including the pancreatic mesentery) with the mesocolon of the splenic flexure of the colon. A natural avascular plane exists within it, and dissection along this plane can avoid encountering the branches of the left gastroepiploic artery that are typically encountered in traditional dissection routes. To date, there is no compelling evidence advocating for the resection of the splenic hilum region of the mesogastrium or the lymph nodes of the gastrocolic ligament in the context of splenic flexure colon cancer.</p>","PeriodicalId":23959,"journal":{"name":"中华胃肠外科杂志","volume":"27 9","pages":"898-903"},"PeriodicalIF":0.0,"publicationDate":"2024-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142308669","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Theory and practice on mesentery margin in vessel-oriented complete mesentery resection of gastric cancer].","authors":"L C Chen","doi":"10.3760/cma.j.cn441530-20240722-00254","DOIUrl":"10.3760/cma.j.cn441530-20240722-00254","url":null,"abstract":"<p><p>The concept of mesenteric anatomy has been evolving in cognition. With the continuous development of endoscopic techniques, the submicroscopic structures of many mesenteries have been gradually understood, ultimately confirming the ubiquitous presence of mesenteries in the digestive organs. Based on various domestic and foreign mesenteric anatomical theories and combined with years of clinical practice, we have summarized and proposed a new concept and theory-vascular-guided complete mesenteric resection for gastric cancer. The theoretical basis is that, from the perspective of the embryonic development of the digestive tract, the rotation of the digestive tract and its associated mesentery is always centered on blood vessels. Therefore, the supply vessels and digestive tracts and their associated mesentery are naturally connected. The mesentery is a complex structure that encompasses blood vessels, nerves, and lymphatic tissues. The blood vessels serve as the boundary of the mesentery, ensuring that the lymphatic network that drains the tumor is maximally resected. This article focuses on the complete mesenteric resection margins in gastric cancer surgery, that is, the lateral boundary of the mesentery as the vascular-supplied guided resection boundary and its mesentery, and the base boundary as the mesenteric bed. Using precise vascular guidance to define the extent of mesenteric resection will help accurately define the mesenteric margin during radical resection for different stages of gastric cancer.</p>","PeriodicalId":23959,"journal":{"name":"中华胃肠外科杂志","volume":"27 9","pages":"974-977"},"PeriodicalIF":0.0,"publicationDate":"2024-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142308677","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Research progress on the distribution patterns and surgical dissection of central lymph nodes in left-sided colon cancer].","authors":"Y D Bao, Z D Gao","doi":"10.3760/cma.j.cn441530-20240711-00243","DOIUrl":"10.3760/cma.j.cn441530-20240711-00243","url":null,"abstract":"<p><p>Lymphatic metastasis is one of the main pathways of colorectal cancer spread and also a crucial factor in patient long-term prognosis. Lymph node dissection in the possible tumor drainage area, particularly the central group of lymph nodes at the root of the tumor-associated supplying artery, is a key and challenging aspect of surgical techniques. Currently, the patterns of lymphatic drainage and the distribution of central lymph nodes in left-sided colon cancer are not well illustrated, and there is no consensus on the necessity and extent of central lymph node dissection. This has led to significant variability in the extent of lymph node dissection among different surgeons in clinical practice, a lack of quality control standards for surgical procedures, and impacts on postoperative treatment strategy and long-term outcomes. Moreover, current research on lymphatic drainage and metastasis is primarily based on traditional anatomy, whereas individualized, precise approaches to lymph node dissection have not been realized. The application of preoperative and intraoperative lymph node imaging techniques based on functional anatomy in colorectal cancer patients is still under exploration.</p>","PeriodicalId":23959,"journal":{"name":"中华胃肠外科杂志","volume":"27 9","pages":"914-918"},"PeriodicalIF":0.0,"publicationDate":"2024-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142308675","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Thinking about the extent and technique of lower mediastinal lymph nodes dissection for adenocarcinoma of esophagogastric junction].","authors":"Y W Cao, X L Chen, K Yang","doi":"10.3760/cma.j.cn441530-20240710-00240","DOIUrl":"10.3760/cma.j.cn441530-20240710-00240","url":null,"abstract":"<p><p>The incidence of esophagogastric junction adenocarcinoma is increasing gradually. The surgical procedures mainly include radical resection of the primary tumor, lymph node dissection, and digestive tract reconstruction. Due to the special anatomical location of esophagogastric junction adenocarcinoma, the pattern of lymph node metastasis is not clear, and regional lymph nodes dissection especially in the lower mediastinum is still controversial, and awaits further high-quality evidence. Meanwhile, due to the special anatomical location of the lower mediastinum, it is often difficult to perform lower mediastinal lymph node dissection. How to complete the lower mediastinal lymph nodes dissection more safely and effectively is the key point for gastric cancer surgeons. In this paper, the progress, consensus, and controversy on the extent of lower mediastinal lymph nodes dissection in patients with esophagogastric junction adenocarcinoma were discussed. Based on our own experience, the current clinically techniques for lower mediastinal lymph nodes dissection were summarized to further improve the quality control of lower mediastinal lymph nodes dissection in patients with esophagogastric junction adenocarcinoma.</p>","PeriodicalId":23959,"journal":{"name":"中华胃肠外科杂志","volume":"27 9","pages":"909-913"},"PeriodicalIF":0.0,"publicationDate":"2024-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142308678","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Peripheral blood cell count composite score as a prognostic factor in patients with colorectal cancer].","authors":"P Y Guo, X H Hu, B K Li, T Lu, J M Liu, C Y Wang, W B Niu, G Y Wang, B Yu","doi":"10.3760/cma.j.cn441530-20231029-00151","DOIUrl":"10.3760/cma.j.cn441530-20231029-00151","url":null,"abstract":"&lt;p&gt;&lt;p&gt;&lt;b&gt;Objective:&lt;/b&gt; To develop a prognostic prediction model for patients with colorectal cancer based on a peripheral blood cell composite score (PBCS) system. &lt;b&gt;Methods:&lt;/b&gt; This retrospective observational study included patients who had primary colorectal cancer without distant metastasis, who did not undergo radiotherapy or chemotherapy before surgery, who did not receive leukocyte or platelet-raising therapy within 1 month before surgery, and whose postoperative pathology confirmed colorectal adenocarcinoma with complete tumor resection. Patients with severe anemia, infection, or hematologic diseases before surgery, as well as those with severe heart, lung, or other important organ diseases or concurrent malignant tumors, were excluded. In total, 1021 patients with colorectal cancer who underwent surgical treatment in the Department of Gastrointestinal Surgery of the Fourth Hospital of Hebei Medical University from April 2018 to April 2020 were retrospectively included as the training set (766 patients) and the internal validation set (255 patients). Additionally, using the same criteria, 215 patients with colorectal cancer who underwent surgical treatment in another treatment group from March 2015 to December 2020 were selected as the external validation set. The \"surv_cutpoint\" function in R software was used to analyze the optimal cut-off values of neutrophils, lymphocytes, and platelets, and a PBCS system was established based on the optimal cut-off values. The scoring rules of the PBCS system were as follows: Neutrophils and platelets below the optimal cut-off value = 1 point, otherwise 0 points; Lymphocytes above the optimal cut-off value = 1 point, otherwise 0 points. The scores of the three cell types were added together to obtain the PBCS. Univariate and multivariate Cox regression analyses were performed to explore the correlation between patients' clinicopathological features and prognosis, and a nomogram was constructed based on the Cox regression analysis to predict patients' prognosis. The accuracy of the nomogram prediction model was validated using the C-index, calibration curve, and decision curve analysis. &lt;b&gt;Results:&lt;/b&gt; The optimal cut-off values for neutrophils, lymphocytes, and platelets were 4.40×10&lt;sup&gt;9&lt;/sup&gt;/L, 1.41×10&lt;sup&gt;9&lt;/sup&gt;/L, and 355×10&lt;sup&gt;9&lt;/sup&gt;/L, respectively. The patients were divided into high and low groups according to the optimal cut-off values of these cells. Survival curve analysis showed that a high lymphocyte count (training set: &lt;i&gt;P&lt;/i&gt;=0.042, internal validation: &lt;i&gt;P&lt;/i&gt;=0.010, external validation: &lt;i&gt;P&lt;/i&gt;=0.029), low neutrophil count (training set: &lt;i&gt;P&lt;/i&gt;=0.035, internal validation: &lt;i&gt;P&lt;/i&gt;=0.001, external validation: &lt;i&gt;P&lt;/i&gt;=0.024), and low platelet count (training set: &lt;i&gt;P&lt;/i&gt;=0.041, internal validation: &lt;i&gt;P&lt;/i&gt;=0.030, external validation: &lt;i&gt;P&lt;/i&gt;=0.024) were associated with prolonged overall survival (OS), with statistically significant differences in all cases. Survival a","PeriodicalId":23959,"journal":{"name":"中华胃肠外科杂志","volume":"27 9","pages":"953-965"},"PeriodicalIF":0.0,"publicationDate":"2024-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142308674","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[A case of multiple primary hepatoid adenocarcinoma in the intestine].","authors":"L F Xie, J Jia, Y Liu, X Y Li","doi":"10.3760/cma.j.cn441530-20240105-00008","DOIUrl":"10.3760/cma.j.cn441530-20240105-00008","url":null,"abstract":"","PeriodicalId":23959,"journal":{"name":"中华胃肠外科杂志","volume":"27 6","pages":"639-641"},"PeriodicalIF":0.0,"publicationDate":"2024-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141432913","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Application of D-type stoma repair in parastomal hernia after permanent sigmoidostomy].","authors":"Y Y Fu, J J Zhou, C K Zhang, L H Sun, W Wang, J Ren, L H Wang, D Tang, Y Ma, D R Wang","doi":"10.3760/cma.j.cn441530-20230831-00078","DOIUrl":"10.3760/cma.j.cn441530-20230831-00078","url":null,"abstract":"","PeriodicalId":23959,"journal":{"name":"中华胃肠外科杂志","volume":"27 6","pages":"621-624"},"PeriodicalIF":0.0,"publicationDate":"2024-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141432915","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Report on the application of endoscopic intermuscular dissection for diagnostic resection of early rectal cancer].","authors":"D J Fan, L Y Huang, J W Qi, Q N Wu, X H Kong, C J Li","doi":"10.3760/cma.j.cn441530-20240314-00098","DOIUrl":"10.3760/cma.j.cn441530-20240314-00098","url":null,"abstract":"<p><p><b>Objective:</b> This report presents the initial outcomes of endoscopic intermuscular dissection (EID), a novel technique introduced by our team for the diagnostic resection of early rectal cancer, focusing on the postoperative status of the vertical margins. <b>Methods:</b> On January 26, 2024, a patient with early rectal cancer (cT1-2N0M0) underwent Endoscopic Intermuscular Dissection. The EID procedure consists of six steps: (1) mucosal incision; (2) submucosal dissection; (3) superficial muscular layer incision; (4) intermuscular dissection; (5) complete tumor removal; (6) wound management. <b>Results:</b> The patient was a 70-year-old male with rectal cancer (cT1-2N0M0). The tumor was located on the left anterior wall of the rectum, approximately 9 cm from the anal margin, and measured 20mm in size. The dissection rate was 2.68 mm²/minute, and the total duration of the surgery was 109 minutes. The patient was successfully discharged on the fifth day after surgery. Pathological examination of the post-endoscopic surgery specimen revealed pT1b, with negative vertical margins. Follow-up after more than one month showed good recovery with no complications such as bleeding, perforation, infection, or stricture occurring. Colonoscopy indicated the presence of a granulation tissue suggestive of inflammation. <b>Conclusion:</b> Endoscopic Intermuscular Dissection for the diagnostic resection of early rectal cancer is potentially safe and may achieve negative vertical margins.</p>","PeriodicalId":23959,"journal":{"name":"中华胃肠外科杂志","volume":"27 6","pages":"630-633"},"PeriodicalIF":0.0,"publicationDate":"2024-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141432969","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}