Background： Laparoscopic resection （LAP） for small bowel gastrointestinal stromal tumors （GISTs） is not as common as for stomach. This study aimed to evaluate the safety and efficacy of LAP for small bowel GISTs ...Background： Laparoscopic resection （LAP） for small bowel gastrointestinal stromal tumors （GISTs） is not as common as for stomach. This study aimed to evaluate the safety and efficacy of LAP for small bowel GISTs with systematic review and meta-analysis. Methods： The Web of Science, Cochrane Library, Embase, and PubMed databases before December 2016 were comprehensively searched to retrieve comparative trials of LAP and conventional open resection （OPEN） for GISTs of small bowel with a relevance of review object. These researches reported intraoperative and postoperative clinical course （operation time, blood loss, time to first flatus and oral intake, hospital stay, morbidity, and mortality）, oncologic outcomes, and long-term survival status. Results： Six studies involving 391 patients were identified. Compared to （）PEN, LAP had associated with a shorter operation time （weighted mean difference [WMD] = -27.97 rain, 95% confidence interval [CI]： 49.40 -6.54, P 〈 0.01）： less intraoperative blood loss （WMD - -0.72 ml： 95% CI： 1.30--0.13, P = 0.02）; earlier time to flatus （WMD = -0.83 day; 95% C/： 1.44- 0.22, P 〈 0.01）; earlier time to restart oral intake （WMD - 1.95 days; 95% CI： -3.31 -0.60, P 〈 0.01 ）; shorter hospital stay （WMD = -3.00 days; 95% CI： -4.87 -1.13, P 〈 0.01）; and a decrease in overall complications （risk ratio = 0.56, 95% CI： 0.33-0.97, P 0.04）. In addition, the tumor recurrence and long-term survival rate showed that there was no significant difference between the two groups of patients. Conclusions： LAP for small bowel GISTs is a safe and feasible procedure with shorter operation time, less blood loss, less overall complications, and quicker recovery. Besides, tumor recurrence and the long-term survival rate are similar to open approach. Because of the limitations of this study, methodologically high-quality studies are needed for certain appraisal.展开更多
Neuroendocrine tumors represent a heterogeneous group of neoplasms that arise from neuroendocrine cells and secrete various peptides and bioamines. While gastrointestinal neuroendocrine tumors,commonly called carcinoi...Neuroendocrine tumors represent a heterogeneous group of neoplasms that arise from neuroendocrine cells and secrete various peptides and bioamines. While gastrointestinal neuroendocrine tumors,commonly called carcinoids,account for about 2/3 of all neuroendocrine tumors,they are relatively rare. Small intestine neuroendocrine tumors originate from intestinal enterochromaffin cells and represent about 1/4 of small intestine neoplasms. They can be asymptomatic or cause nonspecific symptoms,which usually leads to a delayed diagnosis. Imaging modalities can aid diagnosis and surgery remains the mainstay of treatment. We present a case of a jejunal neuroendocrine tumor that caused nonspecific symptoms for about 1 year before manifesting with acute mesenteric ischemia. Abdominal X-rays revealed pneumatosis intestinalis and an abdominal ultrasound and computed tomography confirmed the diagnosis. The patient was submitted to segmental enterectomy. Histopathological study demonstrated a neuroendocrine tumor with perineural and arterial infiltration and lymph node metastasis. The postoperative course was uneventful and the patient denied any adjuvant treatment.展开更多
BACKGROUND Lymphangiomas in the gastrointestinal tract are extremely rare in adults.As a benign lesion,small intestine lymphangiomas often remain asymptomatic and pose challenges for definitive diagnosis.However,lymph...BACKGROUND Lymphangiomas in the gastrointestinal tract are extremely rare in adults.As a benign lesion,small intestine lymphangiomas often remain asymptomatic and pose challenges for definitive diagnosis.However,lymphangiomas can give rise to complications such as abdominal pain,bleeding,volvulus,and intussusception.Here,we report a case of jejunal cavernous lymphangioma that presented with intermittent melena and refractory anemia in a male adult.CASE SUMMARY A 66-year-old man presented with intermittent melena,fatigue and refractory anemia nine months prior.Esophagogastroduodenoscopy and colonoscopy were performed many times and revealed no apparent bleeding.Conservative management,including transfusion,hemostasis,gastric acid secretion inhibition and symptomatic treatment,was performed,but the lesions tended to recur shortly after surgery.Ultimately,the patient underwent capsule endoscopy,which revealed a more than 10 cm lesion accompanied by active bleeding.After singleballoon enteroscopy and biopsy,a diagnosis of jejunal cavernous lymphangioma was confirmed,and the patient underwent surgical resection.No complications or recurrences were observed postoperatively.CONCLUSION Jejunal cavernous lymphangioma should be considered a cause of obscure gastrointestinal bleeding.Capsule endoscopy and single-balloon enteroscopy can facilitate diagnosis.Surgical resection is an effective management method.展开更多
BACKGROUND Ewing sarcomas(ESs)are highly aggressive malignancy and are predominant in the long bones of extremities of children and young adults with a slight male predilection and rarely presents at extra skeletal lo...BACKGROUND Ewing sarcomas(ESs)are highly aggressive malignancy and are predominant in the long bones of extremities of children and young adults with a slight male predilection and rarely presents at extra skeletal locations.CASE SUMMARY A 55-year-old woman came to our hospital after finding elevated tumor biomarkers during her physical examination.Her enhanced computed tomography scan showed a jejunal mass.The patient underwent laparoscopic enterectomy.The mass was later diagnosed as ES,evidenced by fluorescence in situ hybridization whereby the GLP ES breakpoint region 1 probe was used,showing that more than 10%of the cells showed a red-green-yellow signal proving the breakpoint rearrangement of the ES breakpoint region 1 gene in chromosome 22.CONCLUSION We describe a case of localized ES at the jejunum in China based on the literature.展开更多
文摘Background： Laparoscopic resection （LAP） for small bowel gastrointestinal stromal tumors （GISTs） is not as common as for stomach. This study aimed to evaluate the safety and efficacy of LAP for small bowel GISTs with systematic review and meta-analysis. Methods： The Web of Science, Cochrane Library, Embase, and PubMed databases before December 2016 were comprehensively searched to retrieve comparative trials of LAP and conventional open resection （OPEN） for GISTs of small bowel with a relevance of review object. These researches reported intraoperative and postoperative clinical course （operation time, blood loss, time to first flatus and oral intake, hospital stay, morbidity, and mortality）, oncologic outcomes, and long-term survival status. Results： Six studies involving 391 patients were identified. Compared to （）PEN, LAP had associated with a shorter operation time （weighted mean difference [WMD] = -27.97 rain, 95% confidence interval [CI]： 49.40 -6.54, P 〈 0.01）： less intraoperative blood loss （WMD - -0.72 ml： 95% CI： 1.30--0.13, P = 0.02）; earlier time to flatus （WMD = -0.83 day; 95% C/： 1.44- 0.22, P 〈 0.01）; earlier time to restart oral intake （WMD - 1.95 days; 95% CI： -3.31 -0.60, P 〈 0.01 ）; shorter hospital stay （WMD = -3.00 days; 95% CI： -4.87 -1.13, P 〈 0.01）; and a decrease in overall complications （risk ratio = 0.56, 95% CI： 0.33-0.97, P 0.04）. In addition, the tumor recurrence and long-term survival rate showed that there was no significant difference between the two groups of patients. Conclusions： LAP for small bowel GISTs is a safe and feasible procedure with shorter operation time, less blood loss, less overall complications, and quicker recovery. Besides, tumor recurrence and the long-term survival rate are similar to open approach. Because of the limitations of this study, methodologically high-quality studies are needed for certain appraisal.
文摘Neuroendocrine tumors represent a heterogeneous group of neoplasms that arise from neuroendocrine cells and secrete various peptides and bioamines. While gastrointestinal neuroendocrine tumors,commonly called carcinoids,account for about 2/3 of all neuroendocrine tumors,they are relatively rare. Small intestine neuroendocrine tumors originate from intestinal enterochromaffin cells and represent about 1/4 of small intestine neoplasms. They can be asymptomatic or cause nonspecific symptoms,which usually leads to a delayed diagnosis. Imaging modalities can aid diagnosis and surgery remains the mainstay of treatment. We present a case of a jejunal neuroendocrine tumor that caused nonspecific symptoms for about 1 year before manifesting with acute mesenteric ischemia. Abdominal X-rays revealed pneumatosis intestinalis and an abdominal ultrasound and computed tomography confirmed the diagnosis. The patient was submitted to segmental enterectomy. Histopathological study demonstrated a neuroendocrine tumor with perineural and arterial infiltration and lymph node metastasis. The postoperative course was uneventful and the patient denied any adjuvant treatment.
文摘BACKGROUND Lymphangiomas in the gastrointestinal tract are extremely rare in adults.As a benign lesion,small intestine lymphangiomas often remain asymptomatic and pose challenges for definitive diagnosis.However,lymphangiomas can give rise to complications such as abdominal pain,bleeding,volvulus,and intussusception.Here,we report a case of jejunal cavernous lymphangioma that presented with intermittent melena and refractory anemia in a male adult.CASE SUMMARY A 66-year-old man presented with intermittent melena,fatigue and refractory anemia nine months prior.Esophagogastroduodenoscopy and colonoscopy were performed many times and revealed no apparent bleeding.Conservative management,including transfusion,hemostasis,gastric acid secretion inhibition and symptomatic treatment,was performed,but the lesions tended to recur shortly after surgery.Ultimately,the patient underwent capsule endoscopy,which revealed a more than 10 cm lesion accompanied by active bleeding.After singleballoon enteroscopy and biopsy,a diagnosis of jejunal cavernous lymphangioma was confirmed,and the patient underwent surgical resection.No complications or recurrences were observed postoperatively.CONCLUSION Jejunal cavernous lymphangioma should be considered a cause of obscure gastrointestinal bleeding.Capsule endoscopy and single-balloon enteroscopy can facilitate diagnosis.Surgical resection is an effective management method.
文摘BACKGROUND Ewing sarcomas(ESs)are highly aggressive malignancy and are predominant in the long bones of extremities of children and young adults with a slight male predilection and rarely presents at extra skeletal locations.CASE SUMMARY A 55-year-old woman came to our hospital after finding elevated tumor biomarkers during her physical examination.Her enhanced computed tomography scan showed a jejunal mass.The patient underwent laparoscopic enterectomy.The mass was later diagnosed as ES,evidenced by fluorescence in situ hybridization whereby the GLP ES breakpoint region 1 probe was used,showing that more than 10%of the cells showed a red-green-yellow signal proving the breakpoint rearrangement of the ES breakpoint region 1 gene in chromosome 22.CONCLUSION We describe a case of localized ES at the jejunum in China based on the literature.
