Objective To investigate the safety and efficiency of a blood glucose control method in diabetic patients with gastrointestinal neoplasm who were subjected to postoperative early enteral nutrition (EEN). Methods Thirty-seven diabetic patients with gastrointestinal neoplasm received enteral nutriment——Glucerna SR through nasojejunal tubes 24 hours after operation. The blood glucose level was safely controlled through injecting insulin intravenously and subcutaneously. Meanwhile, any change of blood and urine glucose level was monitored and the indexes representing the levels of nutrition, biochemistry and immunity were measured before the implementation of EN, 5 d and 8 d of EN after operation, respectively. Results All the patients were able to bear EEN and there was no severe complications occurred. Significant increase of serum levels of albumin, prealbumin and transferrin were observed after EEN support （P＜0.05）, as well as the serum levels of IgG， IgA and IgM （P＜0.01）. However, body weight， HGB and the serum levels of ALT and TBIL showed no significant changes （Pgt;0.05）. There were 81.1%（30/37） of patients whose blood glucose levels were controlled steadily within the range of (7.8±1.1) mmol/L. Conclusion Injecting insulin intravenously and subcutaneously after operation may be a safe and effective method to control blood glucose level. And the postoperative implementation of EEN can be considered as the first choice of nutrition support for diabetic patients with gastrointestinal neoplasm.
ObjectiveTo analyze the reasons for misdiagnosis of gastrointestinal metastatic ovarian cancer, in order to increase the rate of correct diagnosis and treatment, and to investigate the prognostic factors. MethodsWe retrospectively analyzed the clinical features, pathological features and prognostic factors of 43 cases of metastatic ovarian carcinoma from gastrointestinal tract treated between 2004 and 2014. ResultsGastrointestinal metastatic ovarian cancer was characterized by the diversity of clinical manifestations and lack of specific symptoms. The common initial symptom was pelvic mass, frequently accompanied with gastrointestinal symptoms of ascites, anemia or weight loss, abdominal pain, bloating, gastrointestinal obstruction and bleeding. Signs and symptoms of primary and secondary tumor sites often coexisted with each other, leading to misdiagnosis. Univariate analysis showed that primary site, histological type, surgical treatment, the residual tumor debulking size, lymph node metastasis, tumor invasion and standard chemotherapy had significant impacts on the prognosis (P < 0.05). ConclusionsGastrointestinal metastatic ovarian cancer occurs in premenopausal women, often with ascites, abdominal pelvic masses as the first symptom. Primary tumor site is often ignored, and the initial correct diagnosis rate is low. Metastasis from stomach cancer is the most common, followed by colorectal cancer and esophageal cancer. Prognosis is correlated with the primary site, histological type, degree of differentiation, depth of invasion, lymph node metastasis and other factors. Radical surgery and chemotherapy can improve survival.
Objectives To summarize the regulation of glucagon-like peptide-1（GLP-1） level by metabolism of gastrointestinal nutrients. Methods Domestic and international publications online involving regulation of GLP-1 level by metabolism of gastrointestinal nutrients in recent years were collected and reviewed. Results GLP-1 influenced insulin secretion and sensitivity， and played a leading role in recovery of glucose metabolism. Metabolism of gastrointestinal nutrients regulated GLP-1 level. Studies had shown that GLP-1 was a candidate mediator of the effects of gastric bypass （GBP） for type 2 diabetes mellitus（T2DM）. Conclusions It plays an important role in anti-T2DM effects of GBP that metabolism of gastrointestinal nutrients regulated GLP-1 level. The corresponding studies can provide a novel clinical field to treat T2DM.
【Abstract】Objective To introduce the current studies of the role of vascular endothelial growth factorC (VEGFC) and VEGFD in lymphangiogenesis and lymph node metastasis of gastrointestinal neoplasma. Methods The related literatures in recent 5 years were reviewed. Results The growth factors VEGFC and VEGFD enhance lymphangiogenic metastasis of gastrointestinal neoplasma with the property of angiogenesis and lymphangiogenesis. In gastric adenocarcinoma, VEGFC mRNA and tissue protein expression correlate with lymphatic invasion, lymph node metastasis, venous invasion and reduced 5year survival rates. The role of VEGFC in esophageal squamous cancer and colorectal cancer and VEGFD in colorectal cancer is not certain, with conflicting reports in the published literatures.Conclusion The VEGFC, VEGFD/VEGFR3 signal pathway may become the ideal target for inhibition of tumor proliferation and metastases, antilymphangiogenesis therapy may be a novel potential strategy in tumor biological therapy.
ObjectiveTo investigate the status of undernutrition, nutritional risk as well as nutritional support in patients with gastrointestinal tumor. MethodsIn this prospective cohort study, patients with gastrointestinal tumor were recruited from Septemper 2009 to June 2011. Patients were screened by using Nutritional Risk Screening 2002 (NRS2002) at admission. Data of the nutritional risk, application of nutritional support, complications, and tumor staging were collected. ResultsNine hundred and sixty-one patients with gastrointestinal tumor were recruited, the overall prevalence of nutritional risk was 38.9% (374/961) at admission, 49.2% （176/358） in gastric tumor and 32.8% （198/603） in colorectal tumor, respectively. The highest prevalence was found in stage Ⅳ gastric tumor 〔87.3% (48/55)〕 and colorectal tumor 〔58.8% (50/85)〕 while the lowest prevalence was found in stage ⅡA gastric tumor 〔16.1% (5/31)〕 and stageⅠcolorectal tumor 〔9.8% (6/61)〕. 62.3% (152/244) of gastric tumor patients with nutritional risk while 48.6% (144/296) without nutritional risk received nutritional support. 37.7% (92/244) of colorectal tumor patients with nutritional risk while 51.4% (152/296) without nutritional risk received nutritional support. The ratio of parental nutrition and enteral nutrition was 1.251. The rate of complications in the gastrointestinal tumor patients with nutritional risk was higher than that in the patients without nutritional risk 〔32.4% (121/374) versus 20.4% (120/587), P=0.000 0〕. For the gastrointestinal tumor patients with nutritional risk, the complication rate of the patients with nutritional support was significantly lower than that of the patients without nutritional support 〔27.5% (67/244) versus 40.8% (53/130), P=0.008 6〕. For the gas trointestinal tumor patients without nutritional risk, the complication rate of gastric tumor patients with nutritional support was significantly lower than that of the patients without nutritional support (P=0.039 6), while the complication rate was not significantly different in the colorectal tumor patients with nutritional support or not (P=0.464 7). ConclusionsPatient with gastrointestinal tumor has a high nutritional risk which is related to tumor staging. Patients with nutritional risk have more complications, and nutritional support is beneficial to the patients with nutritional risk by a lower complication rate.
ObjectiveTo investigate the safety, feasibility, and efficacy of fast track surgery (FTS) in gastrointestinal tract injury. MethodsThe data of 61 patients with gastrointestinal tract injury from July 2007 to July 2013 were retrospectively analyzed, among whom 29 patients were received FTS (FTS group) and 32 patients were received conventional care (control group). The first flatus and defecation time, hospital stay, rates of wound infection and lung infection, and the mortality were compared between these two groups. ResultsThe average first flatus and defecation time and the average hospital stay in the FTS group were significantly shorter than those in the control group (2.21 d versus 3.16 d, P=0.000; 7.45 d versus 9.78 d, P=0.000). The rate of lung infection in the FTS group were significantly lower than that in the control group[3.4% (1/29) versus 21.9% (7/32), P=0.033]. The rate of wound infection and the mortality had no significant differences between the FST group and the control group[3.4% (1/29) versus 15.6% (5/32), P=0.111; 0(0/29) versus 3.1% (1/32), P=0.337]. ConclusionsFTS is safe and effective among those gastrointestinal tract injury patients who visited the hospital in time and injury limited. FTS could promote defecate, shorter the hospital stay, and don't increase the complications and mortality.
Objective To evaluate the role of CT in diagnosis of the gastrointestinal tract rupture after blunt abdominal trauma. MethodsTwenty preoperative CT scans and clinical data were obtained in 20 patients who subsequently had bowel ruptures verified surgically. CT findings were analyzed retrospectively in these patients. Retrospective interpretation was made by consensus of at least two radiologists. ResultsTwenty cases of CT scan showed intraperitoneal fluid (18 cases), pneumoperitoneum (18 cases), extravasations of gastrointestinal tract contents (2 cases), bowel wall findings (14 cases) and mesenteric injury (15 cases). Conclusion CT is fast, sensitive and noninvasive in diagnosis of the gastrointestinal tract rupture after blunt abdominal trauma.
ObjectiveTo investigate the reason, prevention, and treatment measures of gastrointestinal unplanned reoperation. MethodsClinical data of 21 patients who carried out gastrointestinal unplanned reoperation for various reasons from Jun. 2012 to Jun. 2013 in our hospital were retrospectively analyzed. ResultsTwenty-one of 2 492 patients with gastrointestinal tract surgery carried out gastrointestinal unplanned reoperation, and the incidence of reoperation was 0.8%. The causes of reoperation were intra-abdominal hemorrhage in 10 cases, gastrointestinal fistula in 7 cases, inflammatory intestinal obstruction with peritonitis in 1 case, and incision dehiscence in 3 cases. After undergoing suture hemostasis, colostomy, anastomotic fistula repair, debridement, and suture,20 cases were cured or improved, and 1 case died. The median of hospitalization expense was 76 000 yuan(46 000-116 000 yuan), and the median of hospital stay was 25-day(16-49 days). ConclusionsGastrointestinal unplanned reoperation can cause more serious economic and emotional burden to patients, standardizing surgical procedure and enhancing perioperative monitoring can reduce the incidence of unplanned reoperation. In addition, grasp legitimately the indications of reoperation, implement timely, and effective reoperation can avoid further deterioration of the disease.
ObjectiveTo systematically review the effect and influence of gum chewing on the recovery of gastrointestinal function in gynecological patients after operation. MethodsEBSCO, MEDLINE, Web of Science, CNKI, WanFang Data and VIP databases were electronically searched to collect randomized controlled trials of gum chewing on gastrointestinal function recovery in patients after gynecological surgery from inception to September 30th, 2020. Two reviewers independently screened literature, extracted data and assessed risk bias of included studies. RevMan 5.3 software was then used to perform the meta-analysis. ResultsA total of 9 studies were included, involving 962 patients. Meta-analysis results showed that the time of first flatus (MD=–8.34, 95%CI –10.72 to –5.95, P<0.000 01), the time of first defecation (MD=–14.97, 95%CI –29.28 to –0.66, P<0.04), and the recovery time of bowel sounds (MD=–5.83, 95%CI –10.15 to –1.51, P=0.008) of gum chewing group was significantly shorter than that of the control group, and the incidence of abdominal distension was decreased after gynecological surgery (RR=0.24, 95%CI 0.08 to 0.74, P=0.01). According to the results of subgroup analysis, the time of first flatus of the gum chewing group was significantly shorter than that of the control group in laparoscopy (MD=–5.43, 95%CI –7.12 to –3.73, P<0.000 01), laparotomy (MD=–10.46, 95%CI –13.56 to –7.97, P<0.000 01) and abdominal surgery (MD=–10.64, 95%CI –13.01 to –8.26, P<0.000 01); the first defecation time after laparotomy (MD=–29.18, 95%CI –46.03 to –12.33, P=0.000 7), and abdominal surgery (MD=–14.24, 95%CI –24.27 to –4.21, P=0.005) in chewing gum group was significantly shorter than that in the control group; however, there was no significant difference in the laparoscopy group (MD=–2.97, 95%CI –12.94 to 7.00, P=0.56). ConclusionsThe systematic review and meta-analysis shows that gum chewing after gynecological surgery can shorten the time of first flatus, first defecation, and first bowel movement, and reduce the incidence of abdominal distension. Due to the limited quality and quantity of the included studies, more high-quality studies are needed to verify the above conclusions.
ObjectiveTo evaluate the infiuence of doctor-nurse double check table applied before operation on the completion of preoperative preparation in gastrointestinal surgery department of class-three grade-one hospitals. MethodsA total of 647 selective operation patients from April to September 2013 in the Department of Gastrointestinal Surgery were divided into observation group (n=315) and control group (n=332) based on admission time. After training for medical staff, the check tables were filled, and relatively high frequency issues were followed up for quality tracking. The completion of preoperative preparation was compared between the two groups after operation. ResultsCompared with the control group, the completion of preoperative preparation and satisfaction of patients of the observation group were significantly higher and the operation delay was significantly lower (P<0.05). ConclusionPreoperative application of doctor-nurse double check table can significantly improve the completion rate of preoperative preparation, the operation delay phenomenon and satisfaction of patients, promote the communication between doctors and nurses, reduce the risk of operation, and ensure the safety of surgical patients.