BACKGROUND:Postoperative nausea and vomiting (PONV) is the most common side effect after laparoscopic sleeve gastrectomy (LSG), affecting patients' postoperative recovery and increasing the medical and economic burden. This study aimed to analyze the relationship between serum pepsinogen and PONV. METHODS:Patients with obesity who underwent LSG in our center between January 2021 and December 2022 were divided into PONV and NoPONV groups and analyzed retrospectively. Binary logistic regression analysis was used to determine the independent risk factors for PONV. RESULTS:219 female patients were enrolled, with an average BMI of 36.74 ± 8.34 kg/m2 and aged 32.61 ± 6.18 years. PONV occurred in 157 patients (71.7%). The influencing factors of PONV with different severity were analyzed, and the results showed that the severity of postoperative pain (χ2 = 13.169, p-values = 0.004), PGI (χ2 = 14.625, p-values = 0.002), PGII (χ2 = 25.916, p-values = 0.000), and PGR (χ2 = 17.697, p-values = 0.001) had statistical significance. Binary logistic regression showed that PGI was a risk factor for PONV with a OR (ng/mL) value of 1.013 (95% CI: 1.001-1.024, p-values = 0.037), while PGR was a protective factor for PONV with an OR(ng/mL) value of 0.952 (95% CI: 0.925-0.979, p-values = 0.001). CONCLUSIONS:The incidence of PONV after LSG is high. Higher PGI may be a risk factor for promoting PONV after LSG. The higher the preoperative PGI, the later the onset of PONV; the longer the duration, the more serious the degree.

Background Bariatric and metabolic surgery (BMS) is an effective treatment for obesity and its complications, but its effect on pregnancy outcomes is inconclusive. The present study aimed to investigate women’s pregnancy status and outcomes as well as the impact of pregnancy intervals after BMS. Methods The menstrual cycle and fertility status of women who underwent BMS in our centre between July 2010 and January 2021 were retrospectively analyzed and followed up until one-year post-delivery. The pregnancy outcomes after BMS were observed, including changes in weight, pregnancy interval, pregnancy complications, weight and health status of the newborn (premature birth, admission to neonatology, or deformity). Results We identified 31 women who were successfully conceived after BMS. There were statistical differences in weight and menstrual status before and post-operation (P < 0.05), and 77.97% of them had remission or recovery of obesity-related comorbidities. Eighteen patients delivered successfully after BMS, but there were still 12 cases of spontaneous abortion and 1 case of induced abortion. The abortion rate in pregnancy intervals less than 2 years was higher than those ≥2 years (P = 0.045). Of the women who delivered successfully, 5 had pregnancy-specific complications, including gestational diabetes mellitus and hypertensive disorder of pregnancy. However, the growth and development of the newborn are normal since the birth follow-up. Conclusion The present results suggest that the abortion rate in pregnancy intervals less than 2 years was higher than those ≥2 years. It is recommended that postoperative patients avoid pregnancy until their weight is stable to reduce the risk of adverse pregnancy outcomes.

背景与目的:随着减重手术在中国逐渐普及化,术前常规检查的标准化显得至关重要.目前,腹腔镜袖状胃切除术(LSG)或腹腔镜胃旁路术(LRYGB)术前是否常规行胃镜检查仍有争议.本研究旨在分析拟行减重手术的患者术前消化系统症状和胃镜结果的关系,及术前消化系统症状是否可能成为改变手术方式的依据,并比较术前胃镜结果与术后病理结果间的差异,由此探讨术前常规胃镜检查的必要性.方法:回顾性分析2019年11月—2021年11月期间暨南大学附属第一医院胃肠外科/减重中心行减重手术且行术前胃镜检查的患者病历资料.分析患者术前消化系统症状、术前胃镜结果与改变手术方式的关系;判断胃镜结果与术后病理结果的一致性.结果:共纳入458例患者,平均年龄(31.3±9.3)岁;平均BMI(38.9±7.5)kg/m2.103例(22.5％)存在术前消化系统症状,371例行LSG,87例行LRYGB;其中82例(17.9％)术中改变手术方式,在原计划LSG或者LRYGB的基础上加行食管裂孔疝修补术、胃间质瘤切除术、胃底切除术和胃底折叠术.胃镜结果异常的有456例(99.6％),且均有胃部病变(100.0％),包括胃炎、胃溃疡、胃息肉等;十二指肠相关病变53例(11.6％),主要为炎症和溃疡;食管相关病变117例(25.7％),以食管炎居首位(94.0％).患者术前胃镜结果是否异常与有无消化系统症状无明显关系(P＞0.05);消化系统症状与手术方式的改变明显有关(P=0.008),其中主要是因行LSG患者的手术方式的改变与消化系统症状有关(P=0.008),而行LRYGB患者手术方式的改变与消化系统症状无明显关系(P=1).将371例行LSG患者的术前胃镜结果与术后病理结行一致性分析,结果显两者诊断不一致(κ=0.072,P--0.000).结论:在无消化道症状患者中开展术前胃镜检查可有助于早期发现消化系统疾病,术前消化系统症状可一定程度作为改变手术方式的依据.

Postprandial hyperinsulinemic hypoglycemia (PHH) is one of the serious complications after bariatric surgery, it can lead life-threatening neuroglycopenic symptoms, such as seizures, disorientation, impairment of version and loss of consciousness without any premonitory. The presentation, prevalence, diagnosis, pathology and treatment are reviewed in this summary.

Objective: To explore the effects of the application of membrane anatomy concept in sleeve gastrectomy on postoperative nausea and vomiting (PONV) in patients with obesity or metabolic diseases. Methods: A retrospective cohort study was conducted. Clinical data of 88 patients with obesity or metabolic diseases who underwent laparoscopic sleeve gastrectomy in The First Affiliated Hospital of Jinan University from September 2018 to June 2019 were retrospectively analyzed. Forty patients underwent sleeve gastrectomy with membrane anatomy concept as membrane anatomy group, and the other 48 patients underwent traditional sleeve gastrectomy as traditional operation group. There were no significant differences in baseline data between the two groups (all P>0.05). The PONV score of and the times of antiemetic drugs used during 0-6 h and 6-24 h after operation were compared between the two groups. Higher PONV represents more serious nause and vomiting, the score ≥5 is defined as clinical significant PONV. Results: All patients of the two groups successfully completed the operation, and there was no conversion to open, reoperation, and operation-related death. The intraoperative blood loss in the membrane anatomy group was significantly less than that in the traditional surgery group [median: 5.0 (5.0, 5.8) ml vs. 10.0 (5.0, 10.0) ml, Z=-3.265, P=0.001]. There were no significant differences between the two groups in terms of operative time, postoperative hospital stay, gastroesophageal reflux, pain score and postoperative complications (all P>0.05). There was no postoperative bleeding or gastric leakage in either groups. There were no significant differences in PONV score, incidence of clinically significant PONV and use of antiemetics 0-6 h after operation between two groups (all P>0.05). From 6 to 24 hours after operation, compared with traditional surgery group, the membrane anatomy group had lower PONV score (4.6±0.9 vs. 5.1±0.7, t=-2.192, P=0.007), lower incidence of clinically significant PONV [55.0% (22/40) vs. 83.3% (40/48), χ(2)=8.414, P=0.004] and less use of antiemetics [3 times: 10.0% (4/40) vs. 27.1% (13/48), Z=-2.880, P=0.004]. Postoperative follow-up ranged from 1 to 6 months (median 3), 32 cases in membranous anatomy group and 38 cases in the traditional operation group were followed up. One case in the traditional operation group received symptomatic treatment in the local hospital due to functional intestinal obstruction 1 month after surgery and was discharged after recovery. The remaining patients had no postoperative complications and were not readmitted to hospital. Conclusion: Sleeve gastrectomy based on membrane anatomy in the treatment of patients with obesity or metabolic syndrome can make surgical procedure more precise and meticulous, reduce the intraoperative bleeding and the incidence of PONV.

目的:观察腹腔镜胃癌D2根治术治疗胃癌的近期疗效.方法:回顾性分析2017年6月至2019年6月在暨南大学附属第一医院行腹腔镜胃癌D2根治术的85例胃癌患者(观察组)的临床资料,选取同期实施传统手术的85例胃癌患者作为对照组.比较两组手术相关指标、术后淋巴结清扫总数、近远切端距肿瘤距离、并发症以及随访结果等指标.结果:观察组手术时间、术中出血量、切口大小、下床活动时间及住院时间等手术相关指标优于对照组(P<0.05).两组术后淋巴结清扫总数、近远切端距肿瘤距离、并发症发生率、无瘤存活、肿瘤复发转移且存活、死亡率比较,差异无统计学意义(P>0.05).结论:腹腔镜胃癌D2根治术疗效与传统开腹手术相当,但耗时更短、术中出血量更少,值得应用推广.

目的 探讨经乳腔镜困难性甲状腺大部切除手术方法与技巧.方法 回顾性分析2010年1月-2018年1月采取腔镜下经乳晕入路完成的困难性甲状腺大部切除手术192例,结合术者的体会和经验方法进行探讨.结果 8例因术中暴露止血困难、肿物过深过大等原因而中转开放手术;手术时间(126.8±7.6)min,术中出血量(102.3±2.6)ml;术后18例出现一过性低钙血症和9例出现声音嘶哑(其中6例术后2个月恢复,3例术后半年仍未恢复).结论 困难性甲状腺手术采用腔镜下经乳晕入路术式切除是安全可靠的,但必须充分掌握甲状腺的解剖结构及腔镜操作技术.

Coronin 1a (also called CORO1A) is one of the members of Coronin family that regulate actin filament dynamics and cargo internalization,and involves Rac1/Pak1/Gpm6a signaling pathway to regulate synaptic plasticity. SH-SY5Y cells overexpressing CORO1A was constructed in this study. It showed that 12.5 μL/mL DNA-EndoFectin complex was the optimal concentration for infection of CORO1A lentiviruses. The results of fluorescence microscopy showed a successful construction of SH-SY5Y cell line overexpressing CORO1A.

BACKGROUND AND OBJECTIVES:Nutrition and inflammation play a crucial role in the development of cancer. The prognostic value of the prognostic nutritional index (PNI) has been confirmed in some types of human cancers. This study analyzed the prognostic significance of the preoperative PNI in patients with stage III gastric cancer after curative surgery.METHODS AND STUDY DESIGN:In this retrospective study, we enrolled 274 patients who underwent curative operation for stage III gastric cancer. The correlation between the preoperative PNI and overall survival (OS) was analyzed using Kaplan-Meier curves and multivariate Cox regression analyses.RESULTS:The patients with a high PNI had a significantly higher median OS than did those with a low PNI (46.8 months vs 24.1 months, p=0.01). In the subgroup analysis, the survival benefit of the PNI was limited to the patients with poorly differentiated gastric cancer (high PNI, 46.8 months; low PNI, 21.8 months, p=0.004) and was not observed in those with well and moderately differentiated cancer (high PNI, 30.3 months; low PNI, 26.7 months, p=0.30). In the multivariate analysis, the PNI was an independent prognostic factor for OS.CONCLUSIONS:The PNI can be used as an independent prognostic biomarker for operable advanced gastric cancer.

目的：探讨应用创面床准备原则使用新型敷料处理肛瘘伤口的应用与效果。方法将132例肛瘘患者，按便利取样方法分。其中对照组使用传统方法凡士林油纱填塞换药治疗的患者64例；观察组应用创面床准备原则使用湿性愈合敷料，在伤口黄期使用美盐，红期应用藻酸盐，渗液减少，上皮爬行期使用水胶体处理肛瘘术后伤口68例。记录两组患者治疗过程中伤口愈合速度、住院时间，应用统计学分析方法SPSS13.0进行分析，﹤0.05为差异有统计学意义。结果132例患者伤口均完全愈合。观察组在术后伤口愈合时间、住院天数等方面均优于对照组，差异有统计学意义(﹤0.05)。结论应用创面床准备原则使用新型敷料处理肛瘘伤口，可促进肛瘘术后伤口的愈合，缩短住院天数，适用于肛瘘术后伤口的处理。

原发性胃肠道恶性淋巴瘤（ PGIML）是常见的结外恶性淋巴瘤，发病率较低，临床表现多样且缺乏特异性，与胃肠道其他恶性肿瘤表现相似，误诊率较高，为提高对本病的认识，对我院近5年收治的24例PGIML患者的临床资料分析如下。

结直肠癌(colorectal cancer,CRC)是常见的消化道恶性肿瘤,自1991年以来死亡率以4.7％的速度逐年升高,发病部位右移,女性患病增加[1].在我国肿瘤登记地区CRC占恶性肿瘤发病的第3位,死亡的第4位[2].CRC患者血浆D-二聚体(D-dimer,DD)升高,其升高程度与分期相关[3].多个研究[3-9]建议把血浆DD作为诊断CRC的肿瘤标志物及监测肿瘤浸润转移和评估预后的指标,现就DD与CRC的关系作一综述.

Objective:To study the relationship between the renal graft expression of CD44 and the graft acute rejection.Methods:Retrospectively reviewed patients who had performed renal transplantation from 2005 to 2009 and identified 28 patients with acute renal rejection.The expression of CD44 of the graft was detected with immunohist -ochemical method.Results:The expression levels of graft with CD44 were significantly higher in acute renal rejection group than those in chronic renal rejection group and normal group.There were significant differences in the expression of CD44 in these groups.Conclusions:The expression of CD44 in grafts is correlated with clinical renal rejection,Examining the expression of CD44 in graft is helpful to the diagnosis and treatment of acute rejection in clinic.CD44 can be a high sensitivity and specificity predictor to acute rejection.

【Objective】To study how to manage laparoscopic anatomical splenectomy and its advantages.【Methods】Laparoscopic anatomical splenectomy(n =30),laparoscopic spleen part resection(n =1) were done between Mar-1999 and Nov-2007.【Results】27 cases were operated on successfully.Operation time was 50～250 minutes.The blood loss in operation was 5～300 mL.The average postoperative hospital stay was 5～9 days.One patient converted into open hemostasis.No complication occurred.【Conclusions】Our experiences revealed that laparoscopic anatomical splenectomy can decrease dangerous opportunities of bleeding,it is a safe and efficient operation.

Objective To establish a model of kidney transplantation in mice more convenient. Methods Twenty C57BL/6 mice were used for kidney isografts. The end-to-side anastomosis was per-formed between the donor aortic cuff with renal artery and recipient aorta of abdomen, and the donor renal vein and recipient IVC. 2-3 stitches and 4-6 stitches were required for each side' s anastomosis. It didn't need to be tied at the end of the suture. The construct of ureter was modified with joining the donor ureter to the recipient bladder. Results Total operative time was (45.1±3.5) min. The success rate was 95%. All mice were observed for 12 weeks after operation. Serum creatinine level was in normal range. Body weight gain was observed. Renal histology was normal. Conclusion This model is easy and conven- ient. The anastomosis can be controlled to prevent thrombosis and bleeding. It is an ideal model.

目的 比较局部麻醉联合镇静药物和腰硬联合麻醉下行吻合器痔黏膜环状切除术(PPH)的效果.方法 在局部麻醉联合镇静药物下(局麻组)对112例Ⅲ、Ⅳ度痔患者行PPH和在腰硬联合麻醉下(腰硬联合麻醉组)对258例Ⅲ、Ⅳ度痔患者行PPH.分别对两组手术时间、住院时间、恢复工作时间、住院费用、术后疼痛及尿潴留等进行比较研究.结果 两组均顺利完成手术.在手术时间、恢复工作时间方面两组差异无统计学意义(P＞0.05);在术后疼痛需镇痛药者,局麻组所占比例高于腰硬联合麻醉组(χ2=7.46,P＜0.01);在住院费用、住院时间、尿潴留方面的比较中,局麻组均少于腰硬联合麻醉组(P＜0.01).结论 应用局部麻醉联合镇静药物作用下行PPH与腰硬联合麻醉下行PPH可取得同样的术中镇痛效果,但可减少尿潴留的发生和住院费用.

目的探讨保留迷走神经主干的门奇断流术加食管下端切除机械性吻合术治疗门静脉高压并上消化道出血的疗效。方法回顾性分析20例采用门奇断流术加食管下端切除机械性吻合术治疗门静脉高压症上消化道出血患者的临床资料,患者均为肝炎后肝硬化,均患有严重的食管胃底静脉曲张且一次以上出血史。结果全部病例均获随访,平均19·3个月。术后无一例死亡,无一例出现吻合口狭窄,吻合口漏及腹腔感染,有5例出现进食后哽噎感(25%).随访中无复发出血,效果满意。结论保留迷走神经主干,门奇断流术加食管下端切除机械性吻合术治疗门静脉高压症上消化道出血止血确切,复发出血率低,能较好的被患者接受,是治疗门静脉高压症上消化道出血较理想的一种手术方法。

临床上腹主动脉夹层发病急、进展快,较容易被忽视,易误诊,病死率高,如果早期能给予正确的诊断与处理,可以使患者渡过急性期,为手术提供机会,降低病死率.腹主动脉夹层并巨大血栓形成合并多脏器功能衰竭尚未见有文献报道,本院在2005年3月收治1例,现报告如下.

目的评价低位直肠癌患者保肛手术后的近期肛门排便功能的情况。方法对肿瘤下缘距肛缘3~7 cm采用保肛手术治疗的36例低位直肠癌患者按肿瘤下缘距肛缘的距离分为两组,5~7 cm为一组,小于5 cm为一组,研究术后排便情况。结果患者排便次数恢复正常的时间为术后(115±38)d。5~7 cm患者术后6个月控制大便功能恢复正常,小于5 cm患者控便功能恢复欠佳。结论肿瘤下缘距肛缘在5~7 cm的低位直肠癌患者采用保肛术后近期能够获得良好的控便功能,明显提高了患者的生活质量。