To summarize the application skills, experience, common problems and solutions in the process of naso-jejunal feeding tube placement in total da Vinci robotic radical gastrectomy.

192 cases with gastric cancer undergoing naso-jejunal feeding tube placement during total da Vinci robotic D2 radical gastrectomy in the Fourth Hospital of Hebei Medical University between December 2019 and September 2021 were reviewed. The time of naso-jejunal tube insertion, enteral nutrition through tube after operation, first exhaust, and the enteral nutrition-related complications were recorded.

129 cases underwent distal gastrectomy (Billroth’sⅡ+Braun’s anastomosis), 39 cases underwent total gastrectomy (esophageal jejunal π anastomosis), and 24 cases underwent proximal gastrectomy (jejunal interposition anastomosis). 183 cases were satisfied with catheterization, the average time of tube placement was (3.65±2.15) min, the time of enteral nutrition after operation was (16.59±2.43) h, and the time of first exhaust was (3.26±1.52) d. Except for 11 cases with feeding intolerance, the rest of the patients had good tolerance.

The placement of transnasal jejunal nutrition tube in total da Vinci robotic radical gastrectomy is safe and effective, which does not affect the length of operation as a whole, and is the basis for early enteral nutrition therapy.

To compare the analgesic and anti-inflammatory functions of indomethacin suppository and lornoxicam application before laparoscopic appendectomy (LA).

One hundred and twenty-eight patients in the Affiliated Beijing Luhe Capital University of Medical Sciences from January to April 2022 were collected for LA with general anesthesia and divided into 2 groups (64 cases in each group) using the random number table method. The drug was administered 30 min before surgery, 100 mg indomethacin suppository was given rectally in group A and 8 mg lornoxicam was administered intravenously in group B. The postoperative analgesic effect, inflammatory indexes, incidence of postoperative adverse effects were compared.

Postoperative VAS score at 0, 3, 6, 12, 18 h (Z=-7.075, -5.455, -3.183,-3.378, -4.113, -4.941, all P<0.01), 24 h postoperative analgesic use, time to postoperative VAS score less than 2, and time to first remedial analgesia (Z=-6.005, -6.540, -6.041, all P<0.000 1) were all improved in group A. There were no statistically significant differences in the reduction of change values of WBC, N%, L%, N/L, CRP, PCT, AIR score, TNF-α, IL-6, IL-8, and IL-10 in both groups compared with those before surgery.

The analgesic effect of applying indomethacin suppository before LA is superior to that of lornoxicam, which can reduce the postoperative fever rate, the anti-inflammatory effect is similar, and no significant adverse effect is observed, with significant therapeutic effect.

To compare the clinicopathological and diagnositic features of Borrmann typeⅣ gastric cancer (GC) with other advanced GC and explore prognostic factors of the patients with Borrmann type Ⅳ GC.

A retrospective cohort analysis was performed in 612 patients undergoing surgery for advanced GC who were admitted to Beijing Friendship Hospital Capital Medical University from January 2013 to January 2021. The clinical diagnosis and pathological features of 80 patients (13.1%) with Borrmann typeⅣ and 532 patients (86.9%) with other Borrmann types of GC were compared. Kaplan-Meier method was used to describe the survival curve, and Cox proportional hazard model was used to analyze the univariate and multivariate survival.

There were statistically significant differences in age, family history of gastrointestinal tumor, surgical method, R0 resection, maximum tumor diameter, tumor area, tumor site, histopathological type, degree of differentiation, depth of invasion, lymph node metastasis and TNM stage among GC patients with Borrmann type Ⅳ compared with other Borrmann types (all P<0.05). The diagnostic accuracy rates of enhanced CT scan and visual gastroscopy of Borrmann type Ⅳ GC were 80.0% and 81.2% respectively, lower than 91.4% and 91.8% of other Borrmann types (all P<0.05). The positive rates of first gastroscopic biopsy of Borrmann type Ⅳ GC were 72.5%, which was significantly lower than 93.7% of other Borrmann types (P<0.05). There was no significant difference in the diagnostic level of upper gastrointestinal tract angiography between the two groups (96.2% vs 91.9%, χ²=0.593, P=0.701). Univariate and multivariate analysis showed that surgical method, tumor distribution, vascular invasion and whether to regulate chemotherapy were independent prognostic factors for GC patients with Borrmann typeⅣ (all P<0.05).

Borrmann type Ⅳ GC has unique clinicopathological characteristics, which requires multiple examination methods for identification. Surgical method, tumor distribution, vascular invasion and whether to regulate chemotherapy are important prognostic factors for Borrmann type Ⅳ GC.

To investigate the expression and clinical significance of Apolipoprotein B (ApoB), sex hormone binding globulin (SHBG) and tissue inhibitors of metalloproteinase 1 (TIMP-1) in serum of patients with primary inferior vena cava diaphragm type Budd-Chiari syndrome (BCS) in northern Anhui.

Sixteen patients diagnosed with primary inferior vena cava septal BCS in northern Anhui were selected as the experimental group and eight healthy adults were selected as the control group. The contents of ApoB, SHBG and TIMP-1 in serum of the two groups were detected by enzyme-linked immunosorbent assay (ELISA). Receiver operating characteristic (ROC) curve was used to evaluate the diagnostic efficiency of differential protein in BCS. qPCR was used to detect the expression abundance of the three protein genes in human umbilical vein endothelial cells (HUVEC).

ELISA results showed that the expression levels of serum ApoB and SHBG were not statistically significant between the two groups (t=0.93, 1.12, P=0.36, 0.27), and the expression level of serum TIMP-1 in the experimental group was lower than that in the control group (t=2.31, P<0.05). ROC curve analysis showed that the area under curve (AUC) of TIMP-1 was 0.75. qPCR indicated that ApoB and SHBG were lowly expressed in HUVEC, while TIMP-1 expression was high.

TIMP-1 may be correlated with primary septal BCS of inferior vena cava in northern Anhui, and can be used as a potential serum biomarker for further study.

To compare and analyze the short-term efficacy of parenchymal priority robotic distal pancreatectomy (PPRDP) with laparoscopic pancreatectomy using stapler (S-LDP).

From January 2017 to December 2022, 116 patients with distal pancreatic lesions who underwent surgical resection in the First Affiliated Hospital of Suzhou University were retrospectively analyzed, including 38 patients in the PPRDP group and 78 patients in the S-LDP group. The basic data, perioperative data, intraoperative conditions, and postoperative complications were collected and compared.

Compared with group S-LDP, group PPRDP had longer operation time [(275±70) min vs (240±66) min, P=0.010] and higher total hospitalization costs (79 009 yuan vs 57 921 yuan, P<0.001), but lower incidence of postoperative pancreatic fistula (18.4% vs 37.2%, P=0.040) and shorter postoperative hospital stays (7 d vs 9 d, P=0.001). Especially in pancreatic tail tumors, PPRDP exhibited lower intraoperative blood loss and more pancreatic parenchymal retention (both P<0.05).

PPRDP has more reliable sealing effect on pancreatic stumps and can reduce the incidence of postoperative pancreatic fistula than S-LDP. For patients with tumors located in the tail of the pancreas, PPRDP can ensure a negative surgical margin while retaining more pancreatic parenchyma, which may reduce the damage to pancreatic function in patients.