Impact of propofol and sevoflurane anesthesia on cognition and emotion in gastric cancer patients undergoing radical resection

BACKGROUND Propofol and sevoflurane are commonly used anesthetic agents for maintenance anesthesia during radical resection of gastric cancer.However,there is a debate concerning their differential effects on cognitive function,anxiety,and depression in patients undergoing this procedure.AIM To compare the effects of propofol and sevoflurane anesthesia on postoperative cognitive function,anxiety,depression,and organ function in patients undergoing radical resection of gastric cancer.METHODS A total of 80 patients were involved in this research.The subjects were divided into two groups:Propofol group and sevoflurane group.The evaluation scale for cognitive function was the Loewenstein occupational therapy cognitive assessment(LOTCA),and anxiety and depression were assessed with the aid of the self-rating anxiety scale(SAS)and self-rating depression scale(SDS).Hemodynamic indicators,oxidative stress levels,and pulmonary function were also measured.RESULTS The LOTCA score at 1 d after surgery was significantly lower in the propofol group than in the sevoflurane group.Additionally,the SAS and SDS scores of the sevoflurane group were significantly lower than those of the propofol group.The sevoflurane group showed greater stability in heart rate as well as the mean arterial pressure compared to the propofol group.Moreover,the sevoflurane group displayed better pulmonary function and less lung injury than the propofol group.CONCLUSION Both propofol and sevoflurane could be utilized as maintenance anesthesia during radical resection of gastric cancer.Propofol anesthesia has a minimal effect on patients'pulmonary function,consequently enhancing their postoperative recovery.Sevoflurane anesthesia causes less impairment on patients'cognitive function and mitigates negative emotions,leading to an improved postoperative mental state.Therefore,the selection of anesthetic agents should be based on the individual patient's specific circumstances.

Tumor recurrence and survival prognosis in patients with advanced gastric cancer after radical resection with radiotherapy and chemotherapy

BACKGROUND Advanced gastric cancer is a common malignancy that is often diagnosed at an advanced stage and is still at risk of recurrence after radical surgical treatment.Chemoradiotherapy,as one of the important treatment methods for gastric cancer,is of great significance for improving the survival rate of patients.However,the tumor recurrence and survival prognosis of gastric cancer patients after radio-therapy and chemotherapy are still uncertain.AIM To analyze the tumor recurrence after radical radiotherapy and chemotherapy for advanced gastric cancer and provide more in-depth guidance for clinicians.METHODS A retrospective analysis was performed on 171 patients with gastric cancer who received postoperative adjuvant radiotherapy and chemotherapy in our hospital from 2021 to 2023.The Kaplan-Meier method was used to calculate the recurrence rate and survival rate;the log-rank method was used to analyze the single-factor prognosis;and the Cox model was used to analyze the prognosis associated with multiple factors.RESULTS The median follow-up time of the whole group was 63 months,and the follow-up rate was 93.6%.Stage Ⅱ and Ⅲ patients accounted for 31.0%and 66.7%,respec-tively.The incidences of Grade 3 and above acute gastrointestinal reactions and hematological adverse reactions were 8.8%and 9.9%,respectively.A total of 166 patients completed the entire chemoradiotherapy regimen,during which no adverse reaction-related deaths occurred.In terms of the recurrence pattern,17 patients had local recurrence,29 patients had distant metastasis,and 12 patients had peritoneal implantation metastasis.The 1-year,3-year,and 5-year overall survival(OS)rates were 83.7%,66.3%,and 60.0%,respectively.The 1-year,3-year,and 5-year disease-free survival rates were 75.5%,62.7%,and 56.5%,respectively.Multivariate analysis revealed that T stage,peripheral nerve invasion,and the lymph node metastasis rate(LNR)were independent prognostic factors for OS.CONCLUSION Postoperative intensity-modulated radiotherapy combined with chemotherapy for gastric cancer treatment is well tolerated and has acceptable adverse effects,which is beneficial for local tumor control and can improve the long-term survival of patients.The LNR was an independent prognostic factor for OS.For patients with a high risk of local recurrence,postoperative adjuvant chemoradiation should be considered.

Distal gastric tube resection with vascular preservation for gastric tube cancer:A case report and review of literature

BACKGROUND Survival rates in patients with esophageal cancer undergoing esophagectomy have improved,but the prevalence of gastric tube cancer(GTC)has also increased.Total resection of the gastric tube with lymph node dissection is considered a radical treatment,but GTC surgery is more invasive and involves a higher risk of severe complications or death,particularly in elderly patients.CASE SUMMARY We report an elderly patient with early GTC that had invaded the duodenum who was successfully treated with resection of the distal gastric tube and Roux-en-Y(R-Y)reconstruction.The tumor was a type 0-IIc lesion with ulcer scars surrounding the pyloric ring.Endoscopic submucosal resection was not indicated because the primary lesion was submucosally invasive,was undifferentiated type,surrounded the pyloric ring,and had invaded the duodenum.Resection of distal gastric tube with R-Y reconstruction was safely performed,with preservation of the right gastroepiploic artery(RGEA)and right gastric artery(RGA).CONCLUSION Distal resection of the gastric tube with preservation of the RGEA and RGA is a good treatment option for elderly patients with cT1bN0 GTC in the lower part of the gastric tube.

Radical gastrectomy for D2 distal gastric cancer

Patient＇s information The patient is a 56-year-old man who visited our hospital for ＂repeated epigastric pain for more than two months.＂ Physical examination showed nearly pale appearance; abdomen was soft and no mass palpable; left supraclavicular lymph node （-）; and digital rectal examination （-）.

Robot-assisted laparoscopic vs open gastrectomy for gastric cancer:Systematic review and meta-analysis

AIM To evaluate the potential effectiveness of robot-assisted gastrectomy(RAG) in comparison to open gastrectomy(OG) for gastric cancer patients.METHODS A comprehensive systematic literature search using PubM ed,EMBASE,and the Cochrane Library was carried out to identify studies comparing RAG and OG in gastric cancer.Participants of any age and sex were considered for inclusion in comparative studies of the two techniques independently from type of gastrectomy.A meta-analysis of short-term perioperative outcomes was performed to evaluate whether RAG is equivalent to OG.The primary outcome measures were set for estimated blood loss,operative time,conversion rate,morbidity,and hospital stay.Secondary among postoperative complications,wound infection,bleeding and anastomotic leakage were also analysed.RESULTS A total of 6 articles,5 retrospective and 1 randomized controlled study,involving 6123 patients overall,with 689(11.3%) cases submitted to RAG and 5434(88.7%) to OG,satisfied the eligibility criteria and were included in the meta-analysis.RAG was associated with longer operation time than OG(weighted mean difference 72.20 min;P < 0.001),but with reduction in blood loss and shorter hospital stay(weighted mean difference-166.83 mL and-1.97 d respectively;P < 0.001).No differences were found with respect to overall postoperative complications(P = 0.65),wound infection(P = 0.35),bleeding(P = 0.65),and anastomotic leakage(P = 0.06).The postoperative mortality rates were similar between the two groups.With respect to oncological outcomes,no statistical differences among the number of harvested lymph nodes were found(weighted mean difference-1.12;P = 0.10).CONCLUSION RAG seems to be a technically valid alternative to OG for performing radical gastrectomy in gastric cancer resulting in safe complications.

Ex vivo liver resection followed by autotransplantation in radical resection of gastric cancer liver metastases:A case report

BACKGROUND Radical resection of gastric cancer liver metastases(GCLM)can increase the 5-year survival rate of GCLM patients.However,patients may lose the theoretical feasibility of surgery due to the critical location of liver metastasis in some cases.CASE SUMMARY A 29-year-old woman had a chief complaint of chronic abdominal pain for 1 year.Abdominal computed tomography and magnetic resonance imaging examinations suggested a mass of unknown pathological nature located between the first and second hila and the margin of the lower segment of the right lobe of the liver.The anterior wall of the gastric antrum was unevenly thickened.The diagnosis of(gastric antrum)intramucosal well-differentiated adenocarcinoma was histopathologically confirmed by puncture biopsy with gastroscopy guidance.She underwent radical resection(excision of both gastric tumors and ex vivo liver resection followed by autotransplantation simultaneously)followed by XELOX adjuvant chemotherapy.Without serious postoperative complications,the patient was successfully discharged on the 20th day after the operation.Pathological examination of the excised specimen indicated that gastrectomy with D2 lymph node dissection for primary gastric tumors and R0 resection for liver metastases were achieved.The resected mass was confirmed to be poorly differentiated gastric carcinoma(hepatoid adenocarcinoma with neuroendocrine differentiation)with liver metastases in segments VIII.No recurrence or metastasis within the liver was found during a 7.5-year follow-up review that began 1 mo after surgery.CONCLUSION Application of ex vivo liver resection followed by autotransplantation in radical resection for GCLM can help selected patients with intrahepatic metastases located in complex sites obtain a favorable clinical outcome.

Optimal choice of stapler and digestive tract reconstruction method after distal gastrectomy for gastric cancer:A prospective case–control study

BACKGROUND Gastric cancer is the most common cause of cancer-related deaths,and is classified according to its location in the proximal,middle,or distal stomach.Surgical resection is the primary approach for treating gastric cancer.This prospective study aimed to determine the best reconstruction method after distal gastrectomy for gastric cancer.AIM To explore the efficacy of different staplers and digestive tract reconstruction(DTR)methods after radical gastrectomy and their influence on prognosis.METHODS Eighty-seven patients who underwent radical gastrectomy for distal gastric cancer at our institution between April 2017 and April 2020 were included in this study,with a follow-up period of 12-26 mo.The patients were assigned to four groups based on the stapler and DTR plan as follows:BillrothⅠ(B-I)reconstruction+linear stapler group(group A,22 cases),B-I reconstruction+circular stapler group(group B,22 cases),Billroth II(B-II)reconstruction+linear stapler group(group C,22 cases),and B-II reconstruction+circular stapler group(group D,21 cases).The pathological parameters,postoperative gastrointestinal function recovery,postoperative complications,and quality of life(QOL)were compared among the four groups.RESULTS No significant differences in the maximum diameter of the gastric tumors,total number of lymph nodes dissected,drainage tube removal time,QLQ(QOL questionnaire)-C30 and QLQ-STO22 scores at 1 year postoperatively,and incidence of complications were observed among the four groups(P>0.05).However,groups A and C(linear stapler)had significantly lower intraoperative blood loss and significantly shorter anastomosis time,operation time,first fluid diet intake time,first exhaust time,and length of postoperative hospital stay(P<0.05)than groups B and D(circular stapler).CONCLUSION Linear staplers offer several advantages for postoperative recovery.B-I and B-II reconstruction methods had similar effects on QOL.The optimal solution can be selected according to individual conditions and postoperative convenience.

Clinical observation of laparoscopic radical gastrectomy for advanced gastric cancer

Objective: To explore the clinical efficacy of laparoscopic radical gastrectomy and traditional open radical gastrectomy for advanced gastric cancer. Methods: 116 patients with advanced gastric cancer in our hospital were randomly selected, including 55 cases in the experimental group and 61 cases in the control group. The clinical effects, CEA, CA-199, AFP and postoperative complications of the two groups were compared. Results: The indexes of operation and post-operation (average operation time, incision length, exhaust time, intraoperative bleeding volume, hospital stay, enteral nutrition time), and the total number of lymph nodes dissected in the experimental group was less than that in the control group (P < 0.05). There was no difference in CEA, CA-199 and AFP before operation and 1 month after operation. The incidence of complications in laparoscopic group was 9.1% lower than that in control group (27.9%). Conclusion: Laparoscopic radical gastrectomy has many advantages in the treatment of gastric cancer, which can effectively reduce complications and is worth promoting.

Treatment of gastric remnant cancer post distal gastrectomy by endoscopic submucosal dissection using an insulation-tipped diathermic knife

AIM: To evaluate the effectiveness of endoscopic submucosal dissection using an insulation-tipped diathermic knife (IT-ESD) for the treatment of patients with gastric remnant cancer. METHODS: Thirty-two patients with early gastric cancer in the remnant stomach, who underwent distal gastrectomy due to gastric carcinoma, were treated with endoscopic mucosal resection (EMR) or ESD at Sumitomo Besshi Hospital and Shikoku Cancer Center in the 10-year period from January 1998 to December 2007, including 17 patients treated with IT-ESD. Retrospectively, patient backgrounds, the one-piece resection rate, complete resection (CR) rate, operation time, bleeding rate, and perforation rate were compared between patients treated with conventional EMR and those treated with IT-ESD. RESULTS: The CR rate (40% in the EMR group vs 82% in the IT-ESD group) was significantly higher in the IT-ESD group than in the EMR group; however, the operation time was significantly longer for the IT- ESD group (57.6 ± 31.9 min vs 21.1 ± 12.2 min). No significant differences were found in the rate of underlying cardiopulmonary disease (IT-ESD group, 12% vs EMR group, 13%), one-piece resection rate (100% vs 73%), bleeding rate (18% vs 6.7%), and perforation rate (0% vs 0%) between the two groups. CONCLUSION: IT-ESD appears to be an effective treatment for gastric remnant cancer post distal gastrectomy because of its high CR rate. It is useful for histological confirmation of successful treatment. Thelong-term outcome needs to be evaluated in the future.

Roux-en-Y reconstruction does not require gastric decompression after radical distal gastrectomy

AIM: To determine whether routine nasogastric (NG) decompression benefitted patients undergoing radical gastric surgery. METHODS: Between January 1998 and December 2008, 519 patients who underwent distal gastrectomy for gastric cancer were retrospectively divided into 2 time-period cohorts; those treated with Billroth Ⅱ (BⅡ) reconstruction in the first 6 years and those with Roux-en-Y (RY) reconstruction in the last 5 years. In the latter group, the patients were further divided into 2 subgroups; with and without nasogastric decompression.RESULTS: Postoperatively, there were no significant differences in the number of anastomotic leaks between the 3 groups. In the tubeless RY group, time to semiliquid diet was significantly shorter than in the other 2 groups (4.4 d ± 1.4 d vs 7.2 d ± 1.3 d and 5.9 d ± 1.2 d, P = 0.005). The length of postoperative stay was significantly increased in patients with BⅡ reconstruction compared with patients with RY reconstruction with/without NG decompression (15.4 d ± 4.3 d in BⅡ group vs 12.6 d ± 3.1 d in decompressed RY and 11.4 d ± 3.4 d in the tubeless RY group, P = 0.035). The postoperative pneumonia rate was lowest in the tubeless group and highest in the BⅡ group (1.4% vs 4.6%, P = 0.01). Severe sore throat was noted in 59 (20.7%) members of the BⅡ group, 18 (17.4%) members of the decompressed RY group and 6 (4.2%) members of the tubeless RY group. Fewer patients in the tubeless group complained of severe sore throat (P = 0.001). CONCLUSION: This study provides support for abandoning routine NG decompression in patients undergoing subtotal gastrectomy with Roux-en-Y gastrojejunostomy.

Subcutaneous fat thickness and abdominal depth are risk factors for surgical site infection after gastric cancer surgery

BACKGROUND Surgical site infection(SSI)is one of the most common complications after gastric cancer(GC)surgery.The occurrence of SSI can lead to a prolonged postoperative hospital stay and increased medical expenses,and it can also affect postoperative rehabilitation and the quality of life of patients.Subcutaneous fat thickness(SFT)and abdominal depth(AD)can be used as predictors of SSI in patients undergoing radical resection of GC.AIM To explore the potential relationship between SFT or AD and SSI in patients undergoing elective radical resection of GC.METHODS Demographic,clinical,and pre-and intraoperative information of 355 patients who had undergone elective radical resection of GC were retrospectively collected from hospital electronic medical records.Univariate analysis was performed to screen out the significant parameters,which were subsequently analyzed using binary logistic regression and receiver-operating characteristic curve analysis.RESULTS The prevalence of SSI was 11.27%(40/355).Multivariate analyses revealed that SFT[odds ratio(OR)=1.150;95%confidence interval(95%CI):1.090-1.214;P<0.001],AD(OR=1.024;95%CI:1.009-1.040;P=0.002),laparoscopic-assisted surgery(OR=0.286;95%CI:0.030-0.797;P=0.017),and operation time(OR=1.008;95%CI:1.001-1.015;P=0.030)were independently associated with the incidence of SSI after elective radical resection of GC.In addition,the product of SFT and AD was a better potential predictor of SSI in these patients than either SFT or AD alone.CONCLUSION SFT and AD are independent risk factors and can be used as predictors of SSI in patients undergoing radical resection of GC.

No long-term survival benefit with sustained-release 5-fluorouracil implants in patients with stages Ⅱ and Ⅲ gastric cancer

BACKGROUND The prognosis of gastric cancer in an advanced stage remains poor. The exact efficacy of the use of intraoperative sustained-release chemotherapy with 5-fluorouracil(5-FU) in advanced-stage gastric cancer is still unelucidated.AIM To explore the long-term survival benefit of using sustained-release 5-FU implants in stage Ⅱ and stage Ⅲ gastric cancer patients.METHODS Patients with gastric cancer in a locally advanced stage and who underwent an R0 radical resection between Jan 2014, to Dec 2016, in this single institution were included. Patients with pathological diagnoses other than adenocarcinoma were excluded. All included patients were grouped according to whether intraoperative sustained-release(SR) chemotherapy with 5-FU was used or not(NSR). The primary end-point was 5-year overall survival. Kaplan–Meier method with logrank test was used to analyze the overall survival of patients and Cox analysis was used to analyze prognosis factors of these patients.RESULTS In total, there were 563 patients with gastric cancer with locally advanced stage, who underwent an R0 radical resection. 309 patients were included in the final analysis. 219(70.9%) were men, with an average age of 58.25 years. Furthermore, 56(18.1%) received neoadjuvant chemotherapy, and 191(61.8%) were in TNM stage Ⅲ. In addition, 158 patients received intraoperative sustainedrelease chemotherapy with 5-FU and were included in the SR group, while the other 161 patients were included in the NSR group. The overall complication rate was 12.94% in the whole group and 10.81%, 16.46% in SR and NSR groups, respectively. There were no significant differences between the two groups in overall survival and complication rate(P > 0.05). The multivariate cox analysis indicated that only N Stage and neoadjuvant therapy were independent influencing factors of survival.CONCLUSION Intraoperative sustained-release chemotherapy usage with 5-FU, did not improve the survival of patients who underwent an R0 radical resection in locally advanced stage of gastric cancer.

Multiband mucosectomy for advanced dysplastic lesions in the upper digestive tract

Endoscopic resection(ER) is at present an accepted treatment for superficial gastrointestinal neoplasia. ER provides similar efficacy to surgery; however, it is minimally invasive and less expensive. Endoscopic mucosal resection(EMR) is superior to biopsy for diagnosing advanced dysplasia and can change the diagnostic grade and the management. Several EMR techniques have been described that are alternatively used dependent upon the endoscopist personal experience, the anatomic conditions and the endoscopic appearance of the lesion to be resected. The literature suggests that EMR offers comparable outcomes to surgery for selected indications. EMR techniques using a cap fitted endoscope and EMR using a ligation device [multiband mucosectomy(MBM)] are the most frequently use. MBM technique does not require submucosal injection as with the endoscopic resectioncap technique, multiple resections can be performed with the same snare, pre-looping the endoscopic resection-snare in the ridge of the cap is not necessary, MBM does not require withdrawal of the endoscope between resections and up to six consecutive resections can be performed. This reduces the time and cost required for the procedure, while also reducing patient discomfort. Despite the increasing popularity of MBM, data on the safety and efficacy of this technique in upper gastrointestinal lesions with advanced dysplasia, defined as those lesions that have high-grade dysplasia or early cancer, is limited.

Spleen-preserving splenic lymph node dissection in radical total gastrectomy

Radical gastrectomy has been recognized as the standard surgical treatment for advanced gastric cancer, and essentially applied in a wide variety of clinical settings. The thoroughness of lymph node dissection is an important prognostic factor for patients with advanced gastric cancer. Splenic lymph node dissection is required during D2 radical gastrectomy for upper stomach cancer. This is often accompanied by removal of the spleen in the past few decades. A growing number of investigators believe, however, that the spleen plays an important role as an immune organ, and thus they encourage the application of a spleen- preserving method for splenic hilum lymph node dissection.

加速康复外科干预在腹腔镜远端胃癌根治术患者中的应用效果

目的 探讨加速康复外科干预在腹腔镜远端胃癌根治术患者中的应用效果。方法 依据干预方式的不同将80例胃癌患者分为常规组(n=38)和加速康复组(n=42),两组患者均接受腹腔镜远端胃癌根治术治疗,常规组患者接受常规干预,加速康复组患者接受加速康复外科干预。比较两组患者术后恢复指标、心理状态[焦虑自评量表(SAS)、抑郁自评量表(SDS)]、生活质量[欧洲癌症研究与治疗组织生命质量测定量表(EORTC QLQ-C30)]、并发症发生情况。结果 加速康复组患者初次肠鸣音恢复时间、初次经口进食时间、初次下床活动时间、引流管留置时间及住院时间均明显短于常规组,差异均有统计学意义(P﹤0.01)。干预后,两组患者SDS、SAS评分均低于本组干预前,EORTC QLQ-C30各维度评分均高于本组干预前,加速康复组患者SDS、SAS评分均低于常规组,EORTC QLQ-C30各维度评分均高于常规组,差异均有统计学意义(P﹤0.05)。加速康复组患者并发症总发生率为7.14%,明显低于常规组患者的28.95%,差异有统计学意义(P﹤0.01)。结论 加速康复外科干预可加快腹腔镜远端胃癌根治术患者康复进程,改善患者心理状态并提高生活质量,降低并发症发生率。

保温毯应用于开腹肝癌根治术的护理探究

目的探究开腹肝癌根治术应用保温毯护理价值。方法选取2021年1月—2022年12月我院临床接诊80例患者参与分析,以计算机表法随机分组,对照组盖被保温,研究组保温毯保温,每组患者40例,分析体温情况、凝血指标、满意度、低体温症发生率、并发症发生率、患者的术后情况。结果研究组围手术期体温比较对照组围手术期体温更高,P<0.05。研究组凝血指标比较对照组凝血指标更低,P<0.05。研究组满意度(97.50%)比较对照组满意度(80.00%)更高,P<0.05。研究组低体温症发生率(5.00%)低于对照组(25.00%);研究组的并发症发生率和对照组比较更低,P<0.05;患者的术后情况分析,研究组的苏醒时间、排气时间均短于对照组,P<0.05。结论以保温毯保温护理对开腹肝癌根治术患者应用价值更高,能减少不良事件发生率,改善术后凝血功能。

腹腔镜辅助与开腹D2胃癌根治术对老年进展期胃癌患者的疗效探讨

目的探讨腹腔镜辅助与开腹D2胃癌根治术对老年进展期胃癌患者的疗效。方法研究对象为100例老年进展期胃癌患者,按照住院号随机分为对照组(50例,开展开腹D2胃癌根治术治疗)和观察组(50例,开展腹腔镜辅助D2胃癌根治术治疗)。比较两组临床指标[术中出血量、手术时间、住院时间、首次下床活动时间、首次肛门排气时间、视觉模拟评分法(VAS)评分],治疗效果,术后并发症发生情况,炎性指标[肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)、干扰素-γ(IFN-γ)、转化生长因子-β(TGF-β)]。结果观察组的术中出血量(215.89±24.20)ml少于对照组的(346.45±26.24)ml,手术时间(212.31±24.45)min、住院时间(10.44±4.23)d、首次下床活动时间(3.09±1.01)d、首次肛门排气时间(2.89±0.80)d短于对照组的(257.81±25.81)min、(14.35±4.23)d、(4.94±1.21)d、(4.25±1.21)d,VAS评分(2.69±0.84)分低于对照组的(4.75±1.22)分,差异化显著(P<0.05)。观察组的治疗总有效率98.00%高于对照组的86.00%,差异化显著(P<0.05)。观察组的术后并发症发生率2.00%低于对照组的16.00%,差异化显著(P<0.05)。治疗后,观察组的TNF-α(133.24±9.33)ng/ml、IL-6(362.48±18.04)pg/ml低于对照组的(171.95±9.22)ng/ml、(409.16±18.42)pg/ml,差异化显著(P<0.05);两组IFN-γ、TGF-β比较差异均衡(P>0.05)。结论老年进展期胃癌患者行腹腔镜辅助D2胃癌根治术治疗,能提升患者的治疗效果及恢复效果,利于并发症的减少,促进患者疾病更快康复,效果显著。

腹腔镜结直肠癌根治术在结直肠癌患者治疗中应用的效果分析

目的探究腹腔镜结直肠癌根治术治疗结直肠癌的效果。方法随机选取2020年1月—2023年6月临淄区妇幼保健医院(齐都医院)收治的70例结直肠癌患者为研究对象,根据治疗方式不同分为两组,对照组(35例)行常规开腹手术,研究组(35例)行腹腔镜结直肠癌根治术。比较两组患者临床指标、肠道恢复情况、炎症因子、并发症发生率。结果两组患者切口长度比较,差异无统计学意义(P>0.05)。两组患者临床指标(手术时间、术中出血量、住院时间)比较,研究组均优于对照组,差异有统计学意义(P均<0.05)。研究组排气恢复时间、进食恢复时间、腹胀持续时间、肠鸣音消失时间均短于对照组,差异有统计学意义(P均<0.05)。术前,两组患者炎症因子水平比较,差异无统计学意义(P>0.05)。术后,两组患者炎症因子水平高于治疗前,但研究组低于对照组,差异有统计学意义(P<0.05)。研究组并发症总发生率[2.86%(1/35)]低于对照组[20.00%(7/35)],差异有统计学意义(χ^(2)=5.081,P=0.024)。结论腹腔镜结直肠癌根治术治疗结直肠癌患者效果显著,可以减少组织创伤,并有效降低手术引发的炎症反应。

腹腔镜辅助下胃癌根治术与传统开腹术对比研究

目的对比腹腔镜辅助下胃癌根治术与传统开腹术临床疗效与患者应激反应程度。方法回顾性选取我院收治的94例胃癌患者,将其中采用开腹胃癌根治术(ORG)治疗的46例纳入ORG组,采用腹腔镜辅助下胃癌根治术(LAGR)治疗的48例纳入LARG组。对比两组手术情况、术后恢复进程、术后各项指标及术后并发症发生率;术后3个月对比两组血清肿瘤标志物变化情况;随访1年,统计两组生存率、复发率与转移率。结果LARG组均顺利完成手术,未发生中转开腹;术后LARG组患者炎症指标水平低于ORG组(P均<0.05);LARG组手术用时长于ORG组,LARG组术中出血量与切口总长度均小于ORG组(P均<0.05);LARG组患者术后肠功能恢复时间、总住院时间均短于ORG组(P均<0.05);LARG组患者术后疼痛评分和术后并发症总发生率低于ORG组(P均<0.05);术后1年,两组复发率、转移率与生存率均未见统计学差异(P均>0.05)。结论腹腔镜辅助下胃癌根治术与传统开腹术相比,能够达到持平的手术效果,虽手术时间较长但术中出血量减少,术后应激反应程度减轻,术后恢复时间缩短。

腹腔镜下远端胃癌切除后消化道不同重建方式对患者预后影响分析

目的:探究腹腔镜下远端胃癌切除后消化道不同重建方式对患者预后的影响。方法:回顾性分析107例腹腔镜下远端胃癌切除后消化道重建患者的临床资料,术后均随访1年。根据患者消化道重建方式不同分为Ⅰ组(n=30)、II组(n=28)和R组(n=49),Ⅰ组采取Billroth-Ⅰ式吻合;Ⅱ组患者采取Billroth-Ⅱ式联合布朗吻合;R组患者采取Roux-en-Y吻合。探究各组围术期情况,比较各组术后3周内及术后1年时并发症发生情况。结果:Ⅰ组患者手术时间低于Ⅱ组及R组(P<0.05);各组患者术后3周内并发症发生率比较,差异均无统计学意义(P>0.05);术后1年,R组患者胆汁反流、反流性胃炎发生率低于Ⅰ组及Ⅱ组(P<0.05)。结论:Billroth-Ⅰ式吻合有助于缩短手术时间,但Roux-en-Y吻合在术后远期效果更具优势。