腹腔镜下胃癌全胃切除术与开腹胃癌切除手术的临床比较分析

了解腹腔镜下胃癌全胃切除术与开腹胃癌切除手术的临床比较。方法 选取2018年5月-2019年5月间我院收治的98名全胃切除手术病人为对象。应用随机分组方法将病人分成2组:49例观察组和49例对照组。观察组患者均行腹腔镜全胃切除,并与传统的开腹手术对照组进行比较。结果 观察组患者术后各项指标均有明显改善(P<0.05);结果:观察组患者手术后的肿瘤指标均优于对照组(P<0.05);观察组术后并发症的发生率较对照组的16.33%明显降低,仅为2.04%(P<0.05)。结论 与开腹相比,腹腔镜全胃切除术具有更好的疗效和更好的操作参数,减少术后并发症的发生率。

胃癌切除手术不同重建方式术后患者生活质量的对比和贮袋功能的评价

目的:对比胃癌切除手术不同重建方式术后患者的生活质量及贮袋功能。方法:选择胃癌切除手术且已非带癌生存两年的患者22例,研究对比胃癌切除手术不同重建方式术后患者的生活质量,同时进行贮袋功能的检测和评价。结果:双Braum重建组好转率优于其他两组(P<0.05)。结论:双Braum重建方式对改善患者术后生活质量具有明显的优势,值得推广。

对进行胃癌切除手术的患者实施临床路径护理的效果探讨

目的：探讨对进行胃癌切除手术的患者实施临床路径护理的效果.方法：选取2015年1月~2015年8月期间在我院进行胃癌切除手术的80例胃癌患者作为本次研究的对象.根据护理方法的不同将这些患者平均分为1组和2组.在这些患者的围手术期,对1组患者进行常规护理,对2组患者进行临床路径护理.护理结束后,比较两组患者各项康复指标的水平、生活质量及对护理的满意度.结果：接受护理后,2组患者肠鸣音恢复的时间、排气的时间、下床活动的时间及生活质量均好于1组患者,差异具有统计学意义（P＜0.05）.结论：对进行胃癌切除手术的患者实施临床路径护理的效果比较理想,可有效地促进其病情的康复.

胃癌切除手术不同重建方式术后患者生活质量的对比和贮袋功能的评价

目的探讨胃癌切除手术不同重建方式术后患者生活质量的对比和贮袋功能效果。方法现随机选取2015年7月—2016年9月在该院接受手术治疗并且生存期在2年以上胃癌患者70例作为该次研究对象,按照患者入院时间分为对照组35例和实验组35例,对照组则给予近端胃切除,实验组则给予双Braum重建,在治疗过程中观察患者的生活质量变化,同时关注贮袋功能情况。结果实验组的Visick分级好转率(68.57%)显著优于对照组(40.00%)(χ~2=5.76,P<0.05)。结论在胃癌切除术中,应用双Braum重建方式可有效提升患者的生活质量,临床应用效果良好,值得推广和应用。

胃癌切除消化道重建手术中不同吻合技术的应用效果分析

目的探讨不同吻合技术在胃癌切除消化道重建手术中的应用效果。方法将2014年1月至2016年1月收治的100例行胃癌切除消化道重建手术的患者根据手术方法不同分为三组,其中A组患者(n=32)采取双层吻合技术,B组患者(n=37)采取单层吻合技术,C组患者(n=31)采取国产吻合器吻合技术,比较三组患者平均手术时间、吻合口漏和吻合口狭窄等术后并发症的发生率及术后饮食情况,并进行统计学分析。结果 B组和C组患者平均手术时间分别为(190.32±10.21)min和(178.33±9.30)min,均显著少于A组的(231.39±11.01)min,差异均具有统计学意义(P<0.05)。B组吻合口漏和吻合口狭窄的发生率分别为3.23%和3.23%,C组吻合口漏和吻合口狭窄的发生率分别为2.70%和0.00%,均显著低于A组的9.38%和12.50%,差异均具有统计学意义(P<0.05)。三组患者随访半年,未出现死亡病例,且B组和C组患者日均饮食量和饮食次数均优于A组患者,但差异无统计学意义(P>0.05)。结论在胃癌切除消化道重建手术中单层吻合和吻合器吻合均可明显缩短患者手术时间,且术后并发症发生率低,安全性高,利于患者术后恢复,具有较好的临床应用效果。

胃癌切除消化道重建手术中不同吻合技术的应用效果对比

胃癌具有较高的发病率,而外科手术是目前临床治疗的主要手段,可有效延长患者生存期〔1〕。随着近年来外科技术的不断进步及人们对生活要求的逐渐提高,早期患者多采取全胃或胃大部分切除手术,并进行消化道重建以更好地提高患者生活质量〔2〕。吻合是消化道重建的关键,而不同的吻合技术对患者手术效果影响较大,因此,探索一种安全性高、操作简便的吻合技术已成为目前临床关注的重点问题之一〔3,4〕。

肠外结合肠内营养支持对胃癌切除术后并发吻合口瘘患者的影响

目的研究胃癌切除手术后肠内外营养对其并发吻合口瘘患者的影响。方法将胃癌切除术后吻合口瘘患者80例随机分为2组,各40例。对照组实施肠外营养支持。治疗组实施肠内外结合营养支持。观察两组患者术后肛门排气时间、住院时间、营养指标以及并发症发生率。结果治疗组的肛门排气时间和住院时间少于对照组,差异具有统计学意义(P<0.05);两组治疗前后营养指标水平比较,差异具有统计学意义(P<0.05);两组并发症发生率比较,无明显差异(P>0.05)。结论肠内外营养支持治疗能减少住院时间和并发症的发生率,有效提高患者的营养状况。

丙泊酚复合全身麻醉与丙泊酚硬膜外麻醉在胃癌手术中的对比分析

目的:探讨丙泊酚复合全身麻醉与丙泊酚硬膜外麻醉在胃癌手术中的对比效果。方法:根据麻醉方法的不同将40例胃癌患者分为观察组与对照组各20例,两组都择期进行胃癌切除手术,观察组采用丙泊酚复合全身麻醉,对照组采用传统的丙泊酚硬膜外麻醉。结果:观察组的唤醒时间与拔管时间明显短于对照组,观察组的口干、干咳、低血压等不良反应发生率明显少于对照组,两组对比差异有统计学意义(P<0.05)。结论:丙泊酚复合全身麻醉在胃癌手术中的应用能取得更好的麻醉效果,不良反应更少。

不同重建方式对胃癌切除术患者的临床效果观察

目的探讨胃癌切除术中开展不同重建方式手术对患者生活质量以及贮袋功能的改善效果。方法选取我院2010年1月—2013年1月行胃癌全切手术的58例患者作为研究对象,其中29例采用Orr式Roux-Y吻合术者为对照组,29例采用P形空肠袢空肠食管式Roux-Y吻合术者为观察组。比较2组患者术后的生活质量以及贮袋功能。结果 2组患者术后6个月与12个月的Visick分级比较无明显差异;术后6个月与12个月的实际半排时间亦无显著差异(P>0.05)。结论胃癌患者全切除手术后开展Orr式Roux-Y吻合术与P形空肠袢空肠食管式Roux-Y吻合术具有相同的治疗效果,均能够有效提高术后生活质量与贮袋功能,且Orr式Roux-Y吻合术更简单易行,值得推广。

肠内营养支持护理对于胃癌全胃切除手术患者的影响分析

探析胃癌全胃切除手术患者应用肠内营养支持护理的作用。方法 实验对象为我院胃癌全胃切除手术病人,共60名,分成两组进行相关指标对比分析,实验时间为2019年12月~2022年12月,并予以不同护理方式进行护理,每组病人人数为30名,护理手段为肠外营养支持以及肠内营养支持护理,对比指标为病人满意度、生活质量评分(SF-36评分)、营养指标、并发症发生率。结果 调查两组满意度、生活质量评分(SF-36评分)、营养指标、并发症发生率差异明显(P<0.05)。结论 在胃癌手术中,肠内营养与护理比传统的肠外营养更具优势,能更快地促进肠道功能的恢复,加快排气及肠鸣音的恢复,从而使病人的身体营养状态得到改善,说明此种方式,并发症少,疗效好,值得临床应用。

Is prophylactic placement of drains necessary after subtotal gastrectomy?

AIM： To determine the evidence-based values of prophylactic drainage in gastric cancer surgery. METHODS： One hundred and eight patients, who underwent subtotal gastrectomy with D1 or D2 lymph node dissection for gastric cancer between January 2001 and December 2005, were divided into drain group or no-drain group. Surgical outcome and post-operative complications within four weeks were compared between the two groups. RESULTS： No significant differences were observed between the drain group and no-drain group in terms of operating time （171 ± 42 rain vs 156 ± 39 rain）, number of post-operative days until passage of flatus （3.7 ± 0.5 d vs 3.5 ± 1.0 d）, number of post-operative days until initiation of soft diet （4.9±0.7 d vs 4.8±0.8 d）, length of post-operative hospital stay （9.3±2.2 d vs 8.4±2.4 d）, mortality rate （5.4% vs 3.8%）, and overall postoperative complication rate （21.4% vs 19.2%）. CONCLUSION： Prophylactic drainage placement is not necessary afer subtotal gastrectomy for gastric cancer since it does not offer additional benefits for the patients.

Dissection of No.13 lymph node in radical gastrectomy for gastric carcinoma

AIM: To evaluate the feasibility and safety of No. 13 lymphadenectomy in radical gastrectomy for gastric carcinoma. METHODS: Medical records of the patients undergone No. 13 lymph node dissection during D2 gastrectomy for gastric carcinoma, were reviewed from March 2003 to May 2007. RESULTS: One hundred and fifty-eight patients underwent No. 13 lymph node dissection for D2 gastric carcinoma, of them, 4 (2.53%) were found to have metastasis in No. 13 lymph node. Metastasis to No. 12 lymph node was detected in 6 patients and 4 of them had positive No. 13 lymph node. The operative morbidity except for wound infection was 15.19% (24/158), and hospital death rate was 1.27% (2/158). No obstructive jaundice caused by No. 13 lymph node metastasis after No. 13 lymph node dissection in radical gastrectomy for gastric carcinoma was detected during the follow-up study to end of January 2007. CONCLUSION: Dissection of No. 13 lymph node in D2 gastrectomy for gastric carcinoma is safe with a low morbidity and mortality rate. Further study is needed to explore its long-term effect.

Gastric cancer surgery in cirrhotic patients: Result of gastrectomy with D2 lymph node dissection

AIM： To explore the feasibility of performing gastrectomy with D2 lymphadenectomy in gastric cancer patients with liver cirrhosis. METHODS： A total of 7 178 patients were admitted with a diagnosis of liver cirrhosis from January 1993 to December 2003. We reviewed the records of 142 patients who were diagnosed with liver cirrhosis and gastric adenocarcinoma during the same period. Gastrectomy with D2 lymph node dissection for carcinoma of the stomach was performed in 94 patients with histologically proven hepatic cirrhosis. RESULTS： All but 12 patients were dassified as Child＇s class A. Only 35 patients （37.2%） were diagnosed with cirrhosis before operation. Seventy-three patients underwent a subtotal gastrectomy （77.7%） and 21 patients （22.3%） underwent a total gastrectomy, each with D2 or more lymph node dissection. Two patients （3.8%） who had prophylactic intra-operative drain placement, died of postoperative complications from hepatorenal failure with intractable ascites. Thirty-seven patients （39.4%） experienced postoperative complications. The extent of gastric resection did not influence the morbidity whereas serum aspartate aminotransferase level （P = 0.011） and transfusion did （P = 0.008）. The most common postoperative complication was ascites （13.9%） followed by wound infection （10.6%）. CONCLUSION： We concluded that the presence of compensated cirrhosis, i.e. Child class A, is not a contraindication against gastrectomy with D2 or more lymph node dissection, when curative resection for gastric cancer is possible. Hepatic reserve and meticulous hemostasis are the likely determinants of operative prognosis.

Pseudoaneurysm of gastroduodenal artery following radical gastrectomy for gastric carcinoma patients

We report a rare case of postoperative pseudoaneurysm of the gastroduodenal artery following radical gastrectomy.Surgical trauma to the gastroduodenal artery during regional lymphadenectomy was considered as the cause of the postoperative pseudoaneurysm. The pseudoaneurysm was successfully managed by ligating the bleeding vessel. We should consider the possibility of pseudoaneurysm formation in a patient with gastrointestinal bleeding in the postoperative period following radical gastrectomy with regional lymph node and perivascular lymphatic dissection.

Preventing prolonged post-operative ileus in gastric cancer patients undergoing gastrectomy and intra-peritoneal chemotherapy

AIM： To assess the efficacy of metoclopramide （Met） for prevention of prolonged post-operative ileus in advanced gastric cancer patients undergoing D2 gastrectomy and intra-peritoneal chemotherapy （IPC）. METHODS： Thirty-two advanced gastric cancer patients undergoing D2 gastrectomy and IPC were allocated to two groups. Sixteen patients received Met immediately after operation （group A）, and 16 did not （group B）. Another 16 patients who underwent D2 gastrectomy without IPC were enrolled as the control group （group C）. All patients had received epidural pain control. The primary endpoints were time to first post-operative flatus and time until oral feeding with a soft diet without discomfort. Secondary endpoints were early complications during hospitalization. RESULTS： Gender, the type of resection, operating time, blood loss, tumor status and amount of narcotics were comparable in the three groups. However, the group C patients were older than those in groups A and B （67.5±17.7 vs 56.8±13.2, 57.5±11.7 years, P= 0.048）. First bowel flatus occurred after 4.35±0.93 d in group A, 4.94±1.37 d in group B, and 4.71±1.22 d in group C （P〉0.05）. Oral feeding of a sore diet was tolerated 7.21±1.92 d after operation in group A, 10.15±2.17 d in group B, and 7.53±1.35 d in group C （groups A and C vsgroup B, P〈0.05）. There was no significant difference in respect to the first flatus among the three groups. However, the time of tolerating oral intake with soft food in groups A and C patients was significantlyshorter than that in group B patients. Levels of C-reactive protein （CRP） were significantly lower in group C and there was a more prominent and prolonged response in CRP level in patients undergoing IPC. The incidence of post-operative complications was similar in the three groups except for prolonged post-operative ileus. There was no increased risk of anastomotic leakage in patients receiving Met. CONCLUSION： The results suggest that a combination of intravenous Met and epidural pain control may be required to achieve a considerable decrease in time to resumption of oral soft diet in advanced gastric cancer patients who underwent gastrectomy and IPC. Furthermore, the administration of Met did not increase anastomotic leakage. Met has a role in the prevention of prolonged post-operative ileus.

Trend in gastric cancer:35 years of surgical experience in Japan

AIM:To investigate the trend in gastric cancer surgery in the context of rapid therapeutic advancement in Japan and East Asia.METHODS:A retrospective analysis was performed on 4163 patients who underwent gastric resection for gastric cancer with histological confirmation between 1971 and 2007 at the surgical unit in Kitasato University Hospital,to determine the trend in gastric cancer requiring surgery.RESULTS:Gastric cancer requiring surgical resection increased in our hospital,but the incidence adjusted for population was constant during the observed pe-riod.Interestingly,the ratio of diffuse type/intestinal type gastric cancer was unexpectedly unchanged,and that of advanced/early gastric cancer(EGC)was,however,markedly reduced,while the actual incidence of potentially curative advanced gastric cancer tended to decrease.The incidence of EGC requiring surgery tended to increase as a whole,which is consistent with increased prevalence of endoscopic surveillance.As a result,overall survival and mortality of gastric cancer requiring gastric resection has recently markedly improved.CONCLUSION:In Japan,planned interventions may improve surgical gastric cancer mortality,but an unexpected trend of persistent existence of intestinal type cancer suggests the need for more robust medical intervention.

Ligation-assisted endoscopic mucosal resection of gastric heterotopic pancreas

Heterotopic pancreas is a congenital anomaly characterized by ectopic pancreatic tissue.Treatment of heterotopic pancreas may include expectant observation,endoscopic resection or surgery.The aim of this report was to describe the technique of ligation-assisted endoscopic mucosal resection(EMR) for resection of heterotopic pancreas of the stomach.Two patients(both female,mean age 32 years) were referred for management of gastric subepithelial tumors.Endoscopic ultrasound in both disclosed small hypoechoic masses in the mucosa and submucosa.Band ligation-assisted EMR was performed in both cases without complications.Pathology from the resected tumors revealed heterotopic pancreas arising from the submucosa.Margins were free of pancreatic tissue.Ligation-assisted EMR is technically feasible and may be considered for the endoscopic management of heterotopic pancreas.

Hepatoid adenocarcinoma in stomach:a case report

Objective:We reported a case with AFP produced gastric hepatoid adenocarcinoma.Methods:A male patient,77 year-old,was admitted to our hospital due to an unreasonable elevation of serum AFP.The tumors were revealed by PET-CT,but until the tumors were removed during the surgery,we did not recognize the primary lesion was the gastric cancer.Results:Radical distal gastrectomy was performed.The gastric lesion was confirmed by histology as a hepatic adenocarcinoma in its early stage.Conclusion:The rare etiology of the AFP elevation should be kept in mind in clinic,extrahepatic lesions should be excluded.

Surgical outcomes in patients with T4 gastric carcinoma: a retrospective study of 162 patients

Objective: There is controversy about the best therapeutic surgical approach for treatment of patients with T4 gastric cancer. We evaluated the survival benefit of resection in this group of patients. Methods: We retrospectively reviewed the hospital records of 288 patients with T4 gastric carcinoma to compare the clinicopathological results in patients with curative resection (n = 49) with patients with non-curative resection (n = 113) from 1980 to 2000. Results: Curative resection was performed in 49 (30.2%) patients, with the pancreas being the most frequently resected organ. The 5-year survival rate was 9.3% and the median survival time was 12 months for all 162 registered patients. The 5-year survival rates in patients after curative and non-curative resection were 14.3% vs 7.1% respectively. These values differed considerably between the two groups (P = 0.033). Operative type and curability were independent statistically significant prognostic parameters. Conclusion: Curability was an independent prognostic factor among all registered patients. Patients with T4 gastric carcinoma might be benefited from curative resection.

ERCC1 expression is a predictor of survival in gastric cancer patients treated with surgery and adjuvant chemotherapy

Objective:The aim of this study was to evaluate the effect of the excision repair cross-complementing(ERCC1) expression on survival in advanced gastric cancer patients who underwent surgical resection and treated with oxaliplatin-based adjuvant chemotherapy.Methods:Sixty-three patients who underwent surgical resection for cure and treated with oxaliplatin-based adjuvant chemotherapy were included in this study.The expressions of ERCC1 of gastric cancer were examined by immunohistochemistry and the patients were categorized into ERCC1-(+) and ERCC1-(-) groups.The relation between ERCC1 expression and survival of patients was examined.Results:Of the 63 eligible patients,36 patients(57.1%) had tumor with a positive expression of ERCC1 and the remaining 27 patients had tumor with a negative ERCC1 expression.Expression differences of ERCC1 didn't correlated with age(P = 0.827),gender(P = 0.12),differentiation(P = 0.113),histological type(P = 0.942),site of tumor(P = 0.221),size of tumor(P = 0.608),stage(P = 0.815) and lymphatic invasion(P = 0.165).Overall survival(OS) was significantly longer in patients without ERCC1 expression,when compared to patients with ERCC1 expression(P = 0.023).Multivariate analysis revealed that ERCC1 expression significantly impacted on OS(HR:4.049;P = 0.000).Conclusion:We concluded that resected and treated with oxaliplatin-based adjuvant chemotherapy gastric cancer patients without ERCC1 expression have a better survival when compared to patients with ERCC1 expression.ERCC1 expression will hopefully provide a rational basis for improving adjuvant chemotherapeutic strategies for gastric cancer patients.ERCC1,itself,may be a prognostic factor for gastric cancer.