AIM:To explore a reasonable method of digestive tract reconstruction,namely,antrum-preserving double-tract reconstruction(ADTR),for patients with adenocarcinoma of the esophagogastric junction(AEG) and to assess its e...AIM:To explore a reasonable method of digestive tract reconstruction,namely,antrum-preserving double-tract reconstruction(ADTR),for patients with adenocarcinoma of the esophagogastric junction(AEG) and to assess its efficacy and safety in terms of longterm survival,complications,morbidity and mortality.METHODS:A total of 55 cases were retrospectively collected,including 18 cases undergoing ADTR and 37 cases of Roux-en-Y reconstruction(RY) for AEG(Siewert types Ⅱ and Ⅲ) at North Sichuan Medical College. The cases were divided into two groups. The clinicopathological characteristics,perioperative outcomes,postoperative complications,morbidity and overall survival(OS) were compared for the two different reconstruction methods.RESULTS:Basic characteristics including sex,age,body mass index(BMI),Siewert type,p T status,p N stage,and lymph node metastasis were similar in the two groups. No significant differences were found between the two groups in terms of perioperative outcomes(including the length of postoperative hospital stay,operating time,and intraoperative blood loss) and postoperative complications(consisting of anastomosis-related complications,wound infection,respiratory infection,pleural effusion,lymphorrhagia,and cholelithiasis). For the ADTR group,perioperativerecovery indexes such as time to first flatus(P = 0.002) and time to resuming a liquid diet(P = 0.001) were faster than those for the RY group. Moreover,the incidence of reflux esophagitis was significantly decreased compared with the RY group(P = 0.048). The postoperative morbidity and mortality rates for overall postoperative complications and the rates of tumor recurrence and metastasis were not significantly different between the two groups. Survival curves plotted using the Kaplan-Meier method and compared by log-rank test demonstrated similar outcomes for the ADTR and RY groups. Multivariate analysis of significantly different factors that presented as covariates on Cox regression analysis to assess the survival and recurrence among AEG patients showed that age,gender,BMI,pleural effusion,time to resuming a liquid diet,lymphorrhagia and tumor-nodemetastasis stage were important prognostic factors for OS of AEG patients,whereas the selection of surgical method between ADTR and RY was shown to be a similar prognostic factor for OS of AEG patients.CONCLUSION:ADTR by jejunal interposition presents similar rates of tumor recurrence,metastasis and longterm survival compared with classical reconstruction with RY esophagojejunostomy; however,it offers considerably improved near-term quality of life,especially in terms of early recovery and decreased reflux esophagitis. Thus,ADTR is recommended as a worthwhile digestive tract reconstruction method for Siewert types Ⅱ and Ⅲ AEG.展开更多
The work presented herein investigates the velocity, heat transfer, Nusselt number and skin friction profiles involved in boundary layer flow past a moving vertical porous plate. Similarity transformations are employe...The work presented herein investigates the velocity, heat transfer, Nusselt number and skin friction profiles involved in boundary layer flow past a moving vertical porous plate. Similarity transformations are employed to convert the governing nonlinear unsteady momentum and energy equations from their partial differential equation forms to boundary value ordinary differential equations. The resulting equations are then solved numerically by the Runge-Kutta fourth order method with the help of a shooting technique. Several features of the flow and heat transfer characteristics for different values of problem parameters are analyzed and discussed. These include the effects of the radiation parameter (R), suction and injection parameter (c), Grashof (Gr) and Prandtl (Pr) numbers on the flow and heat profiles. Numerical results show the impact of blowing and sucking as well as radation on boundary layer flows of this type. Both the skin frictions as well as the heat transfer rate are also significantly related to the radiation parameter. For all these cases;the numerical results are found to be in agreement with the physics of the problem.展开更多
基金Supported by Grants from Sichuan Provincial Department of Education Research Project,No.14ZA0192National Natural Science Foundation of China,No.30700773,No.81070378,and No.81270561
文摘AIM:To explore a reasonable method of digestive tract reconstruction,namely,antrum-preserving double-tract reconstruction(ADTR),for patients with adenocarcinoma of the esophagogastric junction(AEG) and to assess its efficacy and safety in terms of longterm survival,complications,morbidity and mortality.METHODS:A total of 55 cases were retrospectively collected,including 18 cases undergoing ADTR and 37 cases of Roux-en-Y reconstruction(RY) for AEG(Siewert types Ⅱ and Ⅲ) at North Sichuan Medical College. The cases were divided into two groups. The clinicopathological characteristics,perioperative outcomes,postoperative complications,morbidity and overall survival(OS) were compared for the two different reconstruction methods.RESULTS:Basic characteristics including sex,age,body mass index(BMI),Siewert type,p T status,p N stage,and lymph node metastasis were similar in the two groups. No significant differences were found between the two groups in terms of perioperative outcomes(including the length of postoperative hospital stay,operating time,and intraoperative blood loss) and postoperative complications(consisting of anastomosis-related complications,wound infection,respiratory infection,pleural effusion,lymphorrhagia,and cholelithiasis). For the ADTR group,perioperativerecovery indexes such as time to first flatus(P = 0.002) and time to resuming a liquid diet(P = 0.001) were faster than those for the RY group. Moreover,the incidence of reflux esophagitis was significantly decreased compared with the RY group(P = 0.048). The postoperative morbidity and mortality rates for overall postoperative complications and the rates of tumor recurrence and metastasis were not significantly different between the two groups. Survival curves plotted using the Kaplan-Meier method and compared by log-rank test demonstrated similar outcomes for the ADTR and RY groups. Multivariate analysis of significantly different factors that presented as covariates on Cox regression analysis to assess the survival and recurrence among AEG patients showed that age,gender,BMI,pleural effusion,time to resuming a liquid diet,lymphorrhagia and tumor-nodemetastasis stage were important prognostic factors for OS of AEG patients,whereas the selection of surgical method between ADTR and RY was shown to be a similar prognostic factor for OS of AEG patients.CONCLUSION:ADTR by jejunal interposition presents similar rates of tumor recurrence,metastasis and longterm survival compared with classical reconstruction with RY esophagojejunostomy; however,it offers considerably improved near-term quality of life,especially in terms of early recovery and decreased reflux esophagitis. Thus,ADTR is recommended as a worthwhile digestive tract reconstruction method for Siewert types Ⅱ and Ⅲ AEG.
文摘The work presented herein investigates the velocity, heat transfer, Nusselt number and skin friction profiles involved in boundary layer flow past a moving vertical porous plate. Similarity transformations are employed to convert the governing nonlinear unsteady momentum and energy equations from their partial differential equation forms to boundary value ordinary differential equations. The resulting equations are then solved numerically by the Runge-Kutta fourth order method with the help of a shooting technique. Several features of the flow and heat transfer characteristics for different values of problem parameters are analyzed and discussed. These include the effects of the radiation parameter (R), suction and injection parameter (c), Grashof (Gr) and Prandtl (Pr) numbers on the flow and heat profiles. Numerical results show the impact of blowing and sucking as well as radation on boundary layer flows of this type. Both the skin frictions as well as the heat transfer rate are also significantly related to the radiation parameter. For all these cases;the numerical results are found to be in agreement with the physics of the problem.
