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.

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.

Clinical importance and surgical decision-making regarding proximal resection margin for gastric cancer

Because of the intramural spread of gastric cancer,a sufficient length of a resection margin has to be attained to ensure complete excision of the tumor.There has been debate on an adequate length of proximal resection margin(PRM) and its related issues.Thus,the objective of this article is to review several studies on PRM and to summarize the current evidence on the subject.Although there is some discrepancy in the recommended values for PRM between authors,a PRM of more than 2-3 cm for early gastric cancer and 5-6 cm for advanced gastric cancer is thought to be acceptable.Once the margin is confirmed to be clear,however,the length of PRM measured in postoperative pathologic examination does not affect the patient's survival,even when it is shorter than the recommended values.Hence,the recommendations for PRM length should be applied only to intraoperative decision-making to prevent positive margins on the final pathology.Given that a negative resection margin is the ultimate goal of determining an adequate PRM,development and improvement of reliable methods to confirm a negative resection margin intraoperatively would minimize the extent of surgery and offer a better quality of life to more patients.In the same context,special attention has to be paid to patients who have advanced stage or diffuse-type gastric cancer,because they are more likely to have a positive margin.Therefore,a wider excision with intraoperative frozen section(IFS) examination of the resection margin is necessary.Despite all the attempts to avoid positive margins,there is still a certain rate of positive-margin cases.Since the negative impact of a positive margin on prognosis is mostly obvious in low N stage patients,aggressive further management,such as extensive re-operation,is required for these patients.In conclusion,every possible preoperative and intraoperative evaluation should be thoroughly carried out to identify in advance the patients with a high risk of having positive margins;these patients need careful management with a wider excision or an IFS examination to confirm a negative margin during surgery.

Prognostic Factors for Patients after Curative Resection for Proximal Gastric Cancer

The factors influencing the long-term survival of patients with proximal gastric cancer (PGC) after curative resection were investigated. Data from 171 patients who underwent curative resection for PGC were retrospectively analyzed. The patients were grouped according to the clinicopathological factors and operative procedures. The tumor depth (T stage) and lymph node metastasis (pN stage) were graded according to the fifth edition of TNM Staging System published by UICC in 1997. The metastatic lymph node ratio (MLR) was divided into four levels: 0%, 30%. The data of survival rate were analyzed by Kaplan-Meier method (log-rank test) and Cox regression model. The 5-year overall survival rate of 171 patients was 37.32%. The univariate analysis demonstrated that the survival time of the postoperative patients with PGC was related to tumor size (χ2=4.57, P=0.0325), gross type (χ2=21.38, P30% (χ2=13.34, P=0.0003), TNM Ⅲ (χ2=14.05, P=0.0002) or TNM Ⅳ stage (χ2=4.37, P=0.0366); and combining splenectomy was beneficial to the cases of T3 (χ2=5.68, P=0.0171) or MLR >30% (χ2=6.11, P=0.0134). It was concluded that MLR, pN stage, TNM stage, T stage, and gross type had advantages in providing a precise prognostic evaluation for patients undergoing curative resection for PGC, in which MLR was the most valuable index. TG and combining splenectomy were useful to improve the prognosis to patients with PGC of TNM Ⅲ/Ⅲ stage, serosa invasion, or extensive regional lymph node metastasis.

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.

腹腔镜近端胃切除术与腹腔镜根治性全胃切除术治疗近端胃癌的效果比较

目的对比腹腔镜近端胃切除术与腹腔镜根治性全胃切除术治疗近端胃癌的临床效果。方法70例近端胃癌患者随机分为两组,A组采用腹腔镜近端胃切除术治疗,B组采用腹腔镜根治性全胃切除术治疗,比较两组的手术相关指标、炎性因子水平及并发症。结果A组的手术相关指标均优于B组,术后7 d的hs-CRP、IL-6、TNF-α水平均低于B组(P<0.05)。两组的并发症总发生率比较,差异无统计学意义(P>0.05)。结论与腹腔镜根治性全胃切除术相比,腹腔镜近端胃切除术治疗近端胃癌患者的创伤较小,术后炎性反应较轻。

保留左结肠动脉腹腔镜直肠癌根治术对患者胃功能、并发症的影响

目的探析保留左结肠动脉(leftcolicartery,LCA)腹腔镜直肠癌根治术对患者胃功能、并发症的影响。方法选取2020年12月至2023年11月敦化市医院收治的57例行腹腔镜直肠癌根治术患者,按随机数字分组法分为对照组(28例)与观察组(29例)。对照组患者术中不保留LCA,观察组术中保留LCA。对比两组并发症发生率、胃功能、排尿功能、肛肠动力学。结果与术前比,术后30d两组患者的胃泌素、胃动素、胃蛋白酶原Ⅰ、降钙素基因相关肽(calcitonin gene-related peptide,CGRP)水平均升高,且观察组患者的胃泌素、胃动素、胃蛋白酶原Ⅰ、CGRP水平高于对照组;与术前相比,术后30d两组患者的肛管静息压、肛管最大收缩压均降低,且观察组患者的肛管静息压、肛管最大收缩压均高于对照组,差异均有显著性(P<0.05)。术后7d两组患者的膀胱过度活动症状评分(overactive bladder symptom scale,OABSS)各项评分较术前均降低,且术后7d观察组患者的OABSS各项评分低于对照组,差异均有显著性(P<0.05)。观察组患者术后并发症总发生率低于对照组,差异有显著性(P<0.05)。结论腹腔镜根治术中保留LCA可改善直肠癌患者的肛肠动力学指标,快速恢复其胃功能与排尿功能,并降低并发症发生风险。

益气补血方联合早期康复功能锻炼治疗早期胃癌根治术后气血两虚证的效果研究

目的观察益气补血方联合早期康复功能锻炼治疗早期胃癌根治术后气血两虚证的临床效果。方法选取2020年6月至2022年12月首都医科大学附属北京康复医院收治的110例早期胃癌根治术后气血亏虚证患者为研究对象,根据随机数字表法分为对照组和观察组,各55例。对照组给予胃癌根治术后西医常规治疗及早期康复功能锻炼,观察组在对照组基础上给予益气补血方治疗。分别对2组患者中医临床症状积分、胃肠功能恢复情况、营养状况、免疫功能及胃肠道不良反应进行对比分析。结果对照组脱落1例、观察组脱落2例,最终对照组54例、观察组53例患者完成本研究。术后30 d,2组临床症状积分均低于术前,且观察组低于对照组[(16±3)分比(18±4)分](均P<0.001)。观察组术后胃肠鸣音恢复时间、首次肛门排气时间、首次排便时间均短于对照组(均P<0.001)。术后30 d,2组血红蛋白、转铁蛋白、总蛋白、免疫球蛋白A(IgA)、IgG、IgM、CD_(4)^(+)、CD_(4)^(+)/CD_(8)^(+)比值均高于治疗前、且观察组均高于对照组,2组CD_(8)^(+)均低于术前、且观察组低于对照组(均P<0.05)。2组不良反应总发生率比较差异无统计学意义(P>0.05)。结论益气补血方联合早期康复功能锻炼治疗早期胃癌根治术后气血两虚证可有效促进胃肠功能恢复、营养状况改善和免疫功能恢复。

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.

腹腔镜辅助远端胃癌根治术不同Uncut Roux-en-y吻合方式对病人的疗效及对肿瘤标志物和预后的影响

目的探讨不同Uncut Roux-en-y吻合方式对胃癌病人的疗效及对其检验指标和预后的影响。方法我院2018年3月~2021年2月收治的远端胃癌病人96例,均行腹腔镜辅助远端胃癌根治术,根据吻合方式分为两组,其中研究组46例,采用改良U-RY吻合术治疗,对照组病人50例,采用U-RY吻合术治疗,比较两组病人的围术期指标(手术时间、术中出血量、首次通气时间、住院时间及术后第1天引流量)、手术前后肿瘤相关指标(CEA、CA19-9)、术后并发症及术后1年的预后情况。结果除术后第1天引流量外,研究组的其余指标(手术时间、术中出血量、首次通气时间和住院时间)优于对照组(P<0.05);术前两组的肿瘤相关指标(CA19-9、CEA)比较无明显差异(P>0.05),术后两组病人的肿瘤相关指标(CA19-9、CEA)均较术前降低,差异有统计学意义(P<0.05);研究组总并发症发生率比对照组低(8.7%vs 30.0%,P<0.05);术后1年,两组病人的生存率和复发率比较无明显差异(97.8%vs 96.0%,4.3%vs 6.0%,P>0.05)。结论腹腔镜辅助远端胃癌根治术中应用改良U-RY吻合术可显著缩短病人的手术时间,加快病人的康复速度,且可降低其术后并发症发生率,最终不影响病人的预后。

胃癌组织中PRMT5的表达与临床病理特征和预后的关系

目的探讨胃癌组织中蛋白精氨酸甲基转移酶5(PRMT5)的表达与临床病理特征和预后的关系。方法选取2016年7月—2018年12月江苏大学附属医院行根治术治疗的123例胃癌患者的胃组织标本。对比胃癌组织和癌旁组织(距癌组织≥5 cm)PRMT5 mRNA表达。分析患者癌组织中PRMT5表达与临床病理特征的关系。术后随访3年,统计患者预后情况,分析影响预后的因素。绘制受试者工作特征(ROC)曲线,以曲线下面积(AUC)评价胃癌组织PRMT5-1 mRNA表达对预后的预测价值。依据癌组织中PRMT5表达对胃癌患者预后的最佳截断点,将患者分为PRMT5高表达(≥0.74)和PRMT5低表达(<0.74),分析癌组织中PRMT5表达与患者预后的关系。结果胃癌组织PRMT5 mRNA表达高于癌旁组织(P<0.05)。不同性别、年龄、BMI、肿瘤直径、浸润深度胃癌患者癌组织中PRMT5 mRNA表达比较,差异无统计学意义(P>0.05)。不同临床分期、病理类型、分化程度、淋巴结转移、远处转移胃癌患者癌组织中PRMT5 mRNA表达比较,差异有统计学意义(P<0.05)。123例胃癌患者术后随访3年,共失访4例,剩余119例患者中32例死亡,病死率26.89%(32/119)。单因素Cox回归分析结果显示,临床分期Ⅲ期[HR=7.012(95%CI:3.485,8.657)]、低分化[HR=6.285(95%CI:3.027,7.436)]、淋巴结转移[HR=5.684(95%CI:3.165,8.143)]、远处转移[HR=6.012(95%CI:3.857,10.245)]、PRMT5表达[HR=9.436,(95%CI:3.481,12.736)]、病理类型[HR=5.486(95%CI:2.108,5.436)]、浸润深度[HR=4.857(95%CI:2.149,6.032)]是胃癌患者预后的危险因素(P<0.05)。多因素Cox回归分析结果显示,临床分期Ⅲ期[HR=3.031(95%CI:1.965,6.874)]、低分化[HR=2.838(95%CI:1.042,5.738)]、淋巴结转移[HR=3.340(95%CI:2.051,8.032)]、远处转移[HR=3.515(95%CI:2.476,8.543)]、PRMT5表达[HR=4.035(95%CI:3.008,11.436)]是胃癌患者预后的危险因素(P<0.05)。ROC曲线分析结果显示,胃癌患者癌组织PRMT5表达预测预后的最佳截断点为0.74,敏感性、特异性及AUC分别为78.13%(95%CI:59.56,90.06)、89.66%(95%CI:80.80,94.87)、0.893(95%CI:0.823,0.942)。PRMT5高表达患者预后较PRMT5低表达患者差(P<0.05)。结论胃癌组织中PRMT5的表达与临床病理特征和预后有关,PRMT5mRNA高表达胃癌患者生存率较低。

Overlap吻合术对腹腔镜胃癌消化道重建和并发症及患者生活质量的影响

目的:研究完全腹腔镜胃癌根治术联合overlap吻合术对消化道重建、并发症及患者生活质量的影响。方法:选取2019年6月至2021年12月于蚌埠医学院第一附属医院接受诊治的110例胃癌患者为研究对象。根据不同手术方式分为对照组(传统腹腔镜胃癌根治术,n=60)与观察组(完全腹腔镜胃癌根治术联合overlap吻合术,n=50),比较2组手术疗效及并发症,并采用胃肠道生活质量表(Gastrointestinal Quality of Life,GIQLI)评估生活质量。结果:观察组手术全程用时、消化道重建用时、总失血量均少于对照组(均P<0.05);2组肿瘤大小、淋巴结清扫数比较差异均无统计学意义(均P>0.05)。观察组术后排气时间、流食进食时间、下地时间均少于对照组(均P<0.05);2组住院时间差异无统计学意义(P>0.05)。观察组术后并发症总发生率低于对照组(P<0.05)。随访6个月,2组GIQLI各维度得分及总分均高于出院当天(均P<0.05),观察组GIQLI各维度得分及总分均高于对照组(均P<0.05)。结论:完全腹腔镜胃癌根治术联合overlap吻合术能有效重建消化道,减少并发症,改善生活质量。

单孔加一孔腹腔镜远端胃癌根治术的近期疗效分析

目的探讨单孔加一孔腹腔镜技术在根治性远端胃癌手术中的可行性及优势。方法回顾性收集2019年9月至2021年9月期间于潍坊市人民医院胃肠外科行单孔加一孔腹腔镜远端胃癌根治术(single incision plus one port laparoscopic distal gastrectomy,SILDG+1)的44例病人的临床资料(SILDG+1组);收集同期由同一手术团队行传统五孔腹腔镜远端胃癌根治术(multi-port laparoscopy distal gastrectomy,MLDG)的48例病人作为对照(MLDG组),比较两组术后胃肠道功能、机体应激及炎性反应状态、美学效果。结果围手术期指标结果显示:SILDG+1组与MLDG组比较,手术时间长[(219.1±15.1)min比(196.3±23.0)min,P<0.001],出血量少[(96.7±14.8)mL比(105.3±18.1)mL,P=0.015],术后首次下床时间短[(31.14±5.84)h比(39.21±5.26)h,P<0.001],术后首次肛门排气时间短[(1.98±0.88)d比(2.44±0.99)d,P=0.021],术后住院时间短[(9.05±1.33)d比(10.08±1.88)d,P=0.003],差异均有统计学意义。两组病人在术后第1、2、3天视觉疼痛评分(单位:分,3.16±0.75比3.69±0.72、2.27±0.92比2.94±0.76、1.36±0.81比1.92±0.96),术后美学评分[(8.09±1.12)分比(6.02±1.19)分],术后第1、3、5天C反应蛋白水平[(37.27±14.19)mg/L比(45.72±19.14)mg/L、(71.42±26.04)mg/L比(87.51±40.21)mg/L、(30.93±19.67)mg/L比(40.81±22.35)mg/L],差异均具有统计学意义(均P<0.05),SILDG+1组优于MLDG组。两组病人术后并发症[3例(6.8%)比5例(10.4%),P=0.809]差异无统计学意义。术后第1、3、5天总蛋白水平[(55.87±5.51)g/L比(54.50±5.39)g/L、(59.87±5.32)g/L比(58.36±5.25)g/L、(63.07±5.31)g/L比(61.72±4.66)g/L]及术后第1、3、5天白蛋白水平[(33.78±3.56)g/L比(33.41±3.71)g/L、(35.01±3.58)g/L比(34.43±3.14)g/L、(36.47±3.41)g/L比(35.83±2.80)g/L]差异均无统计学意义(均P>0.05)。结论与MLDG相比,SILDG+1美容效果明显,病人满意度高,且具有出血更少、腹壁创伤更小、术后恢复更快、炎症反应及疼痛程度更轻等优势。

腹腔镜辅助远端胃癌根治术治疗胃癌的临床效果及术后并发症影响因素分析

目的分析腹腔镜辅助远端胃癌根治术(LADG)治疗胃癌的临床效果及术后并发症影响因素。方法选择118例胃癌患者,均接受LADG治疗,记录患者术前一般情况、手术相关及肿瘤相关情况,随访记录患者术后12个月生存情况,依据术后是否发生并发症将患者分为发生并发症组、未发生并发症组,分析并发症影响因素。结果118例患者均顺利完成手术,术后随访12个月,患者总体预后良好,其中101例患者无瘤生存,11例患者出现肿瘤复发或转移,6例患者死亡;118例患者术后发生并发症25例,并发症发生率为21.19%;发生并发症组在术前合并症、BillrothⅡ式消化道重建占比及年龄方面与未发生并发症组比较,有统计学差异(P<0.05);两组在性别、ASA分级、术前放化疗、肿瘤T分期、肿瘤N分期、肿瘤部位、BMI、肿瘤长径、手术时间、术中出血量、淋巴结清扫数目方面对比,无统计学差异(P>0.05);Logistic回归分析显示,术前合并症、消化道重建方式、年龄为影响胃癌患者术后并发症的独立危险因素(P<0.05且OR≥1)。结论LADG治疗胃癌效果确切,术后并发症发生的独立危险因素包括术前合并症、消化道重建方式、年龄,临床需给予重视,制定防治措施,以减少并发症的发生。

胃癌根治术患者外周血CEA、AFP、PG Ⅰ的表达及与术后复发率的关系

目的:探讨胃癌根治术患者外周血癌胚抗原(CEA)、甲胎蛋白(AFP)、胃蛋白酶原Ⅰ(PGⅠ)的表达及与术后复发率的关系。方法:选取104例行胃癌根治术的患者为研究对象,根据否复发分为复发组(n=44)和未复发组(n=60)。比较两组患者病理特征及外周血CEA、AFP、PGⅠ水平;多因素Logistic回归分析影响术后复发的危险因素;受试者工作特征(ROC)曲线评估外周血指标对患者术后复发的诊断价值。结果:复发组分化程度、外周血PGⅠ水平低于未复发组(P<0.05);浸润深度及外周血CEA、AFP水平高于未复发组(P<0.05)。回归分析显示,外周血CEA、AFP、PGⅠ水平与术后复发相关(P<0.05)。ROC曲线分析显示,外周血CEA、AFP、PGⅠ水平可有效诊断术后复发(P<0.05)。结论:外周血CEA、AFP、PGⅠ的异常表达与胃癌根治术术后复发密切相关,对术后复发有诊断价值。

CD19^(+)B淋巴细胞联合营养风险指数预测接受根治性切除术胃癌患者的预后

目的:探讨CD19^(+)B淋巴细胞亚群联合营养风险指数(nutritional risk index,NRI)对接受根治性切除术胃癌患者预后的预测能力。方法:本研究收集了2016年1月至2017年12月在我院接受根治性切除术的268例胃癌患者。观察的终点为无进展生存期(progression-free survival,PFS)和总生存期(overall survival,OS)。使用χ^(2)检验或独立样本t检验分析临床和病理特征的差异。使用Kaplan-Meier生存曲线和Log-rank检验评估生存状态的差异。Cox回归分析用于确定独立的预后指标,列线图用于预测生存概率。结果:根据CD19^(+)B淋巴细胞和NRI水平将患者分为两组,第一组99例,第二组169例。第一组患者的PFS(HR=0.384,P<0.001)和OS(HR=0.369,P<0.001)较短。此外,CD19^(+)B淋巴细胞联合NRI也被确定为本研究的独立预后因素。PFS和OS列线图的C指数和95%CI分别为0.774(0.729~0.820)和0.779(0.733~0.825)。结论:CD19^(+)B淋巴细胞亚群联合NRI可准确预测接受根治性切除术胃癌患者的预后。

内镜-腹腔镜胃癌根治术治疗早期胃癌的效果及对淋巴结清扫及预后的影响

目的探讨内镜-腹腔镜胃癌根治术治疗早期胃癌(EGC)的效果及对淋巴结清扫数量、预后的影响。方法回顾性分析103例行胃癌根治术的早期胃癌患者的临床资料,其中行内镜-腹腔镜胃癌根治术的53例纳入内镜组,采用传统开腹手术进行胃癌根治术的50例纳入对照组。对比2组手术效果、血清应激指标[血清去甲肾上腺素(NE)、皮质醇(Cor)]、淋巴结清扫数量及预后。结果①内镜组手术时间较对照组长、术中出血量较对照组少、手术切口长度较对照组短、术后排气时间及首次下床活动时间均短于对照组,术后住院时间短于对照组,差异均有统计学意义(P<0.05);②术前2组血清NE、Cor水平比较无统计学差异(P>0.05),2组术后NE、Cor水平均较术前升高(P<0.05),但内镜组术后的NE、Cor水平均较对照组低(P<0.05);③2组淋巴结清扫数量比较无统计学差异(P>0.05);④内镜组的术后并发症总发生率较对照组低(P<0.05);2组半年内胃癌复发率比较无统计学差异(P>0.05)。结论内镜-腹腔镜胃癌根治术对EGC有较好的手术效果,其短期预后与开腹手术相当,且手术创伤和手术应激反应相对较小,术后恢复较快,但手术时间较长。

完全腹腔镜与腹腔镜辅助远端胃癌根治术的近期临床疗效对比:一项单中心前瞻性队列研究

目的 比较完全腹腔镜远端胃癌根治术与腹腔镜辅助远端胃癌根治术的近期临床疗效。方法 采用前瞻性观察性队列研究方法,连续纳入2021年1月至2023年7月在我院行腹腔镜远端胃癌根治术的胃癌患者共40例,其中TLDG组20例,LADG组20例,观察比较两组患者的基线数据、术中术后情况以及术后病理情况。结果 所有患者均顺利完成腹腔镜远端胃癌根治术,观察指标:术中情况:TLDG组腹部小切口长度明显小于LADG组,差异具有统计学意义(P<0.05),余手术时间,消化道重建时间,失血量,近切缘长度,远切缘长度,消化道重建方式,术中是否输血及术中并发症两组比较差异均无统计学意义(均P>0.05)。术后情况:各指标两组比较差异均无统计学意义(均P>0.05)。术后病理情况:各指标两组比较差异均无统计学意义(均P>0.05),其中HER2表达2+有1例(2.5%),其余为阴性或者1+,经免疫组化判读为dMMR有1例(2.5%)。TLDG组有1例患者术后第二天温氏孔引流管引流出胆汁样引流液,再次手术证实为十二指肠残端漏,予行十二指肠造瘘后治愈出院。随访期间LADG组有2例患者术后半年行腹腔镜下肝部分切除术,1例术后病理示转移性中分化腺癌,考虑胃肠道来源,可见脉管内癌栓,另1例术后病理示良性结节,未见恶性肿瘤。结论 完全腹腔镜远端胃癌根治术安全有效,腹部小切口明显缩短,具有美容效果,并不增加术中及术后并发症的发生,同时能达到胃癌的根治性切除。

完全腹腔镜远端胃癌根治术对局部进展期胃癌患者围术期相关指标及美观度的影响

目的 探讨完全腹腔镜远端胃癌根治术在局部进展期胃癌治疗中的价值。方法 选取98例局部进展期胃癌患者,按随机数字表法分为2组,各49例。对照组给予开腹远端胃癌根治术,观察组施以完全腹腔镜胃癌根治术。观察至术后1个月,对比2组围术期相关指标、疼痛程度、切口美观度、并发症。结果 观察组手术时间较对照组长,术中出血量较对照组少,切口长度较对照组短,术后排气、下床活动、住院时间较对照组短,术后8 h、24 h、48 h的视觉模拟疼痛量表(VAS)评分较对照组低,有统计学差异(P<0.05)。观察组切口美观度为93.88%,较对照组的79.59%高;并发症发生率为8.16%,较对照组的24.49%低,有统计学差异(P<0.05)。结论 完全腹腔镜远端胃癌根治术用于局部进展期胃癌患者治疗,效果确切,具有创伤小、切口瘢痕小、疼痛程度轻、并发症少、美观度好等特点,有利于患者术后尽早恢复,值得应用。