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.

Digestive tract reconstruction options after laparoscopic gastrectomy for gastric cancer

In addition to the popularity of laparoscopic gastrectomy(LG),many reconstructive procedures after LG have been reported.Surgical resection and lymphatic dissection determine long-term survival;however,the election of a reconstruction procedure determines the postoperative quality of life for patients with gastric cancer(GC).Presently,no consensus exists regarding the optimal reconstructive procedure.In this review,the current state of digestive tract reconstruction after LG is reviewed.According to the determining influence of the tumor site on the procedures of surgical resection and reconstruction,we divide these reconstruction procedures into three categories consistent with the resection procedures.We focus on the technical tips of every reconstruction procedure and examine the surgical outcomes(length of surgery and blood loss)and postoperative complications(anastomotic leakage and stricture)to facilitate gastrointestinal surgeons to understand the merits and demerits of every reconstruction procedure.

Effects on the pouch of different digestive tract reconstruction modes assessed by radionuclide scintigraphy

AIM: To determine the effect of three digestive tract reconstruction procedures on pouch function, after radical surgery undertaken because of gastric cancer, as assessed by radionuclide dynamic imaging. METHODS: As a measure of the reservoir function, with a designed diet containing technetium-99m (99mTc), the emptying time of the gastric substitute was evaluated using a 99mTc-labeled solid test meal. Immediately after the meal, the patient was placed in front of a γ camera in a supine position and the radioactivity was measured over the whole abdomen every minute. A frame image was obtained. The emptying sequences were recorded by the microprocessor and then stored on a computer disk. According to a computer processing system, the half-emptying actual curve and the fitting curve of food containing isotope in the detected region were depicted, and the half-emptying actual curves of the three reconstruction procedures were directly compared. RESULTS: Of the three reconstruction procedures, the half-emptying time of food containing isotope in the Dual Braun type esophagojejunal anastomosis procedure (51.86±6.43 min) was far closer to normal, signif icantly better than that of the proximal gastrectomy orthotopic reconstruction (30.07±15.77 min, P=0.002) and P type esophagojejunal anastomosis (27.88±6.07 min, P=0.001) methods. The half-emptying actual curve and f itting curves for the Dual Braun type esophagojejunal anastomosis were fairly similar while those of the proximal gastrectomy orthotopic reconstruction and P type esophagojejunal anastomosis were obviously separated, which indicated bad food conservation in the reconstructed pouches. CONCLUSION: Dual Braun type esophagojejunal anastomosis is the most useful of the three procedures for improving food accommodation in patients with a pouch and can retard evacuation of solid food from the reconstructed pouch.

Pancreaticojejunostomy, hepaticojejunostomy and double Roux-en-Y digestive tract reconstruction for benign pancreatic diseases

Surgery such as digestive tract reconstruction is usually required for pancreatic trauma and severe pancreatitis as well as malignant pancreatic lesions. The most common digestive tract reconstruction techniques (e.g., Child&#x02019;s type reconstruction) for neoplastic diseases of the pancreatic head often encompass pancreaticojejunostomy, choledochojejunostomy and then gastrojejunostomy with pancreaticoduodenectomy, whereas these techniques may not be applicable in benign pancreatic diseases due to an integrated stomach and duodenum in these patients. In benign pancreatic diseases, the aforementioned reconstruction will not only increase the distance between the pancreaticojejunostomy and choledochojejunostomy, but also the risks of traction, twisting and angularity of the jejunal loop. In addition, postoperative complications such as mixed fistula are refractory and life-threatening after common reconstruction procedures. We here introduce a novel pancreaticojejunostomy, hepaticojejunostomy and double Roux-en-Y digestive tract reconstruction in two cases of benign pancreatic disease, thus decreasing not only the distance between the pancreaticojejunostomy and choledochojejunostomy, but also the possibility of postoperative complications compared to common reconstruction methods. Postoperatively, the recovery of these patients was uneventful and complications such as bile leakage, pancreatic leakage and digestive tract obstruction were not observed during the follow-up period.

Digestive tract reconstruction pattern as a determining factor in postgastrectomy quality of life

Postgastrectomy quality of life (QoL) is affected by various symptoms, and compared with the preoperative baseline QoL, is typically impaired for the first 6 mo after surgery. Thereafter, improvement to a stable QoL is observed at approximately 12 mo postoperatively. We consider the digestive tract reconstruction pattern to be a determining factor in postgastrectomy QoL among gastric cancer patients, and believe it requires further discussion. Proximal gastrectomy is associated with the worst postoperative QoL among gastrectomy procedures and should be performed cautiously. The trend of better QoL provided by the pouch procedure of total gastrectomy requires further robust support. Whether the use of Billroth-I gastroduodenostomy or Roux-en-Y gastrojejunostomy for distal gastrectomy is optimal remains controversial, but Roux-en-Y gastrojejunostomy is likely to be preferable. (c) 2014 Baishideng Publishing Group Co., Limited. All rights reserved.

Three-dimensional computed tomography reconstruction diagnosed digestive tract perforation and acute peritonitis caused by Monopterus albus:A case report

BACKGROUND Few reports have described living foreign bodies in the human body.The current manuscript demonstrates that computed tomography(CT)is an effective tool for accurate preoperative evaluation of living foreign bodies in clinic.The threedimensional(3D)reconstruction technology could clearly display anatomical structures,lesions and adjacent organs,improving diagnostic accuracy and guiding the surgical decision-making process.CASE SUMMARY Herein we describe a 68-year-old man diagnosed with digestive tract perforation and acute peritonitis caused by a foreign body of Monopterus albus.The patient pre-sented to the emergency department with complaints of dull abdominal pain,profuse sweating and a pale complexion during work.A Monopterus albus had entered the patient’s body through the anus two hours ago.During hospitalization,the 3D reconstruction technology revealed a perforation of the middle rectum complicated with acute peritonitis and showed a clear and complete Monopterus albus bone morphology in the abdominal and pelvic cavities,with the Monopterus albus biting the mesentery.Laparoscopic examination detected a large(diameter of about 1.5 cm)perforation in the mid-rectum.It could be seen that a Monopterus albus had completely entered the abdominal cavity and had tightly bitten the mesentery of the small intestine.During the operation,the dead Monopterus albus was taken out.CONCLUSION The current manuscript demonstrates that CT is an effective tool for accurate preoperative evaluation of living foreign bodies in clinic.

Digestive tract reconstruction in pancreaticoduodenectomy in University Hospitals of China: a national questionnaire survey

Background Pancreaticoduodenectomy(PD)has been widely applied in general hospitals in China;however,there is still a lack of unified standards for each surgical technique and procedure.This survey is intended to investigate the current status of digestive tract reconstruction after PD in university hospitals in China.Method A cross-sectional survey was conducted among the members of the Young Elite Pancreatic Surgery Club of China by using the Questionnaire for Digestive Tract Reconstruction after Pancreaticoduodenectomy.The questionnaire was disseminated and collected by point-to-point communication via WeChat public platforms.Results A total of 73 valid questionnaires were returned from 65 university hospitals in 28 provincial divisions of China's Mainland.The respondents who performed PD surgery with an annual volume of over 100 cases accounted for 63%.Generally,laparoscopic PD was performed less often than open PD.Child and Whipple reconstructions accounted for 70%and 26%,respectively.The sequence of pancreatoenteric,biliary-enteric,and gastrointestinal reconstruction accounted for 84%of cases.In pancreatoenteric anastomosis,double-layer anastomosis is the most commonly employed type,accounting for approximately 67%,while single-layer anastomosis accounts for 30%.Of the double-layer anastomoses,duct-to-mucosa/dunking(94%/4%)PJ was performed with duct-mucosa using the Blumgart method(39%)and Cattel-Warren(29%),with continuous/interrupted sutures in the inner layer(69%/31%)and continuous/interrupted sutures in the outer layer(53%/23%).In single-layer anastomosis,continuous/interrupted sutures accounted for 41%/45%.In hepatojejunostomy,single-layer/double-layer suture accounted for 79%/4%,and continuous/interrupted suture accounted for 75%/9%.Forty-six percent of the responding units had not applied double-layer biliary-intestinal anastomosis in the last 3 years,75%of the responding surgeons chose the anastomosis method according to bile duct diameter,with absorbable/non-absorbable suture accounting for 86%/12%.PD/pylorus-preserving PD accounted for 79%/11%of GJ cases,the distance between GJ and HJ<30 cm,30-50 cm and>50 cm were 11%,75%,and 14%,respectively.Antecolic/retrocolic GJ accounted for 71%/23%of cases.Twenty-two percent of GJ cases employed Braun anastomosis,while 55%and 19%of GJ cases used linear cutting staplers/tube-type staplers,respectively;60%/14%were reinforced/not reinforced via manual suturing after stapler anastomosis.Manual anastomosis in GJ surgery employed absorbable/non-absorbable sutures(91%/9%).Significant differences in reconstruction techniques were detected between different volumes of PD procedures(<100/year and>100/year),regions with different economic development levels,and between north and south China.Conclusion Digestive tract reconstruction following PD exists heterogeneity in Chinese university hospitals.Corresponding prospective clinical studies are needed to determine the consensus on pancreatic surgery that meets the clinical reality in China.

Digestive tract reconstruction in pancreaticoduodenectomy in University Hospitals of China:a national questionnaire survey

Background:Pancreaticoduodenectomy(PD)has been widely applied in general hospitals in China;however,there is still a lack of unified standards for each surgical technique and procedure.This survey is intended to investigate the current status of digestive tract reconstruction after PD in university hospitals in China.Method:A cross-sectional survey was conducted among the members of the Young Elite Pancreatic Surgery Club of China by using the Questionnaire for Digestive Tract Reconstruction after Pancreaticoduodenectomy.The questionnaire was disseminated and collected by point-to-point communication via WeChat public platforms.Results:A total of 73 valid questionnaires were returned from 65 university hospitals in 28 provincial divisions of China's Mainland.The respondents who performed PD surgery with an annual volume of over 100 cases accounted for 63%.Generally,laparoscopic PD was performed less often than open PD.Child and Whipple reconstructions accounted for 70%and 26%,respectively.The sequence of pancreatoenteric,biliary-enteric,and gastrointestinal reconstruction accounted for 84%of cases.In pancreatoenteric anastomosis,double-layer anastomosis is the most commonly employed type,accounting for approximately 67%,while single-layer anastomosis accounts for 30%.Of the double-layer anastomoses,duct-to-mucosa/dunking(94%/4%)pancreatojejunostomy was performed with duct-mucosa using the Blumgart method(39%)and Cattel-Warren(29%),with continuous/interrupted sutures in the inner layer(69%/31%)and continuous/interrupted sutures in the outer layer(53%/23%).In single-layer anastomosis,continuous/interrupted sutures accounted for 41%/45%.In hepatojejunostomy,single-layer/double-layer suture accounted for 79%/4%,and continuous/interrupted suture accounted for 75%/9%.Forty-six percent of the responding units had not applied double-layer biliary-intestinal anastomosis in the last 3 years,75%of the responding surgeons chose the anastomosis method according to bile duct diameter,with absorbable/non-absorbable suture accounting for 86%/12%.PD/pylorus-preserving PD accounted for 79%/11%of gastrojejunostomy(GJ)cases,the distance between GJ and hepaticojejunostomy<30,30-50,and>50 cm were 11%,75%,and 14%,respectively.Antecolic/retrocolic GJ accounted for 71%/23%of cases.Twenty-two percent of GJ cases employed Braun anastomosis,while 55%and 19%of GJ cases used linear cutting staplers/tube-type staplers,respectively;60%/14%were reinforced/not reinforced via manual suturing after stapler anastomosis.Manual anastomosis in GJ surgery employed absorbable/non-absorbable sutures(91%/9%).Significant differences in reconstruction techniques were detected between different volumes of PD procedures(<100/year and>100/year),regions with different economic development levels,and between north and south China.Conclusion:Digestive tract reconstruction following PD exists heterogeneity in Chinese university hospitals.Corresponding prospective clinical studies are needed to determine the consensus on pancreatic surgery that meets the clinical reality in China.

Duct-to-duct biliary reconstruction after radical resection of Bismuth Ⅲ a hilar cholangiocarcinoma

At present, radical resection remains the only effective treatment for patients with hilar cholangiocarcinoma. The surgical approach for R0 resection of hilar cholangiocarcinoma is complex and diverse, but for the biliary reconstruction after resection, almost all surgeons use Roux-en-Y hepaticojejunostomy. A viable alternative to Roux-en-Y reconstruction after radical resection of hilar cholangiocarcinoma has not yet been proposed. We report a case of performing duct-to-duct biliary reconstruction after radical resection of Bismuth Ⅲa hilar cholangiocarcinoma. End-to-end anastomosis between the left hepatic duct and the distal common bile duct was used for the biliary reconstruction, and a singlelayer continuous suture was performed along the bile duct using 5-0 prolene. The patient was discharged favorably without biliary fistula 2 wk later. Evidence for tumor recurrence was not found after an 18 mo follow- up. Performing bile duct end-to-end anastomosis in hilar cholangiocarcinoma can simplify the complex digestive tract reconstruction process.

Clinical efficacy and safety of double-channel anastomosis and tubular gastroesophageal anastomosis in gastrectomy

BACKGROUND With the continuous progress of surgical technology and improvements in medical standards,the treatment of gastric cancer surgery is also evolving.Proximal gastrectomy is a common treatment,but double-channel anastomosis and tubular gastroesophageal anastomosis have attracted much attention in terms of surgical options.Each of these two surgical methods has advantages and disadvantages,so it is particularly important to compare and analyze their clinical efficacy and safety.AIM To compare the surgical safety,clinical efficacy,and safety of double-channel anastomosis and tubular gastroesophageal anastomosis in proximal gastrectomy.METHODS The clinical and follow-up data of 99 patients with proximal gastric cancer who underwent proximal gastrectomy and were admitted to our hospital between January 2018 and September 2023 were included in this retrospective cohort study.According to the different anastomosis methods used,the patients were divided into a double-channel anastomosis group(50 patients)and a tubular gastroesophageal anastomosis group(49 patients).In the double-channel anastomosis,Roux-en-Y anastomosis of the esophagus and jejunum was performed after proximal gastric dissection,and then side-to-side anastomosis was performed between the residual stomach and jejunum to establish an antireflux barrier and reduce postoperative gastroesophageal reflux.In the tubular gastroesophageal anastomosis group,after the proximal end of the stomach was cut,tubular gastroplasty was performed on the distal stump of the stomach and a linear stapler was used to anastomose the posterior wall of the esophagus and the anterior wall of the stomach tube.The main outcome measure was quality of life 1 year after surgery in both groups,and the evaluation criteria were based on the postgastrectomy syndrome assessment scale.The greater the changes in body mass,food intake per meal,meal quality subscale score,and total measures of physical and mental health score,the better the condition;the greater the other indicators,the worse the condition.The secondary outcome measures were intraoperative and postoperative conditions,the incidence of postoperative long-term complications,and changes in nutritional status at 1,3,6,and 12 months after surgery.RESULTS In the double-channel anastomosis cohort,there were 35 males(70%)and 15 females(30%),33(66.0%)were under 65 years of age,and 37(74.0%)had a body mass index ranging from 18 to 25 kg/m2.In the group undergoing tubular gastroesophageal anastomosis,there were eight females(16.3%),21(42.9%)individuals were under the age of 65 years,and 34(69.4%)had a body mass index ranging from 18 to 25 kg/m2.The baseline data did not significantly differ between the two groups(P>0.05 for all),with the exception of age(P=0.021).The duration of hospitalization,number of lymph nodes dissected,intraoperative blood loss,and perioperative complication rate did not differ significantly between the two groups(P>0.05 for all).Patients in the dual-channel anastomosis group scored better on quality of life measures than did those in the tubular gastroesophageal anastomosis group.Specifically,they had lower scores for esophageal reflux[2.8(2.3,4.0)vs 4.8(3.8,5.0),Z=3.489,P<0.001],eating discomfort[2.7(1.7,3.0)vs 3.3(2.7,4.0),Z=3.393,P=0.001],total symptoms[2.3(1.7,2.7)vs 2.5(2.2,2.9),Z=2.243,P=0.025],and other aspects of quality of life.The postoperative symptoms[2.0(1.0,3.0)vs 2.0(2.0,3.0),Z=2.127,P=0.033],meals[2.0(1.0,2.0)vs 2.0(2.0,3.0),Z=3.976,P<0.001],work[1.0(1.0,2.0)vs 2.0(1.0,2.0),Z=2.279,P=0.023],and daily life[1.7(1.3,2.0)vs 2.0(2.0,2.3),Z=3.950,P<0.001]were all better than those of the tubular gastroesophageal anastomosis group.The group that underwent tubular gastroesophageal anastomosis had a superior anal exhaust score[3.0(2.0,4.0)vs 3.5(2.0,5.0),Z=2.345,P=0.019]compared to the dual-channel anastomosis group.Hemoglobin,serum albumin,total serum protein,and the rate at which body mass decreased one year following surgery did not differ significantly between the two groups(P>0.05 for all).CONCLUSION The safety of double-channel anastomosis in proximal gastric cancer surgery is equivalent to that of tubular gastric surgery.Compared with tubular gastric surgery,double-channel anastomosis is a preferred surgical technique for proximal gastric cancer.It offers advantages such as less esophageal reflux and improved quality of life.

两种腔内吻合方法在机器人辅助远端胃切除术后毕Ⅱ式消化道重建中的应用比较

目的:初步探讨两种腔内吻合方法在机器人辅助远端胃切除术后毕Ⅱ式消化道重建中的安全性及优缺点。方法:回顾性分析2019年11月—2021年9月在南京中医药大学附属医院普外科行达芬奇机器人辅助远端胃癌根治术的64例患者的临床资料。根据吻合方法不同将其分为手工缝合吻合组(n=35)和器械辅助吻合组(n=29)。收集患者围手术期的临床资料,对比两种吻合方法在机器人辅助远端胃切除术后毕Ⅱ式消化道重建中的优缺点。结果:64例患者均顺利完成手术,所有患者均在机器人镜下完成腔内消化道重建,无中转开腹。两组患者在手术时间、术中出血量、术后首次肛门排气时间、术后首次下床活动时间、术后首次进食流质时间及术后住院时间方面无明显统计学差异。器械辅助吻合组胃肠吻合时间较手工缝合吻合组短,而手工缝合吻合组的吻合耗材费用较低,差异具有统计学意义。两组患者术后均恢复良好,无并发症发生。结论:两种腔内吻合方法在机器人辅助远端胃切除术后毕Ⅱ式消化道重建中的应用都是安全可行的,器械辅助吻合的时间更短,手工缝合吻合的费用更低。

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。

裤形吻合与RY吻合方式在胃癌全胃切除后的应用价值比较

目的:比较裤形吻合与Roux-en-Y(RY)吻合方式在胃癌全胃切除后的应用价值。方法:选取2020年1月至2023年5月我院收治的行全胃切除术治疗的胃癌患者108例作为研究对象,分为RY吻合组54例、裤形吻合组54例,两组均接受全胃切除术治疗,RY吻合组、裤形吻合组分别于胃癌全胃切除术后以RY吻合方式、裤形吻合方式行消化道重建。比较两组手术指标、术后并发症、营养指标[总蛋白(TP)、血红蛋白(Hb)、血清白蛋白(ALB)及预后营养指数(PNI)]、生命质量(QLQ-C30)及远期不良事件发生率。结果:两组患者手术指标比较无意义(P>0.05)。RY吻合组术中1例由于肠管尺寸原因更换吻合器,RY吻合组术中吻合器更换率高于裤形吻合组,但两组比较无意义(P>0.05)。裤形吻合组术后并发症总发生率低于RY吻合组(P<0.05)。裤形吻合组远期不良事件总发生率低于RY吻合组(P<0.05)。与术前比较,两组患者术后3个月、6个月营养评价指标TP、Hb、ALB、PNI均升高,且随着术后时间的延长逐渐升高(P<0.05),在两组术后指标比较中,裤形吻合组TP、Hb、ALB、PNI高于RY吻合组(P<0.05)。与术前比较,两组患者术后3个月、6个月生命质量QLQ-C30评分均升高,且随着术后时间的延长逐渐升高(P<0.05),在两组术后指标比较中,裤形吻合组生命质量QLQ-C30评分高于RY吻合组(P<0.05)。结论:与RY吻合的胃癌全胃切除后消化道重建方式比较,裤形吻合所带来的并发症较低,且裤形吻合在抗胆汁反流、反流性食管炎、食物排空障碍方面优于RY吻合,患者术后可获得更好的营养支持,患者生命质量显著提高,应用价值较高。

Uncut Roux-en-Y吻合与Billroth Ⅱ+Braun吻合在腹腔镜远端胃癌根治术中的疗效比较

目的评价腹腔镜远端胃癌根治术Uncut Roux-en-Y、BillrothⅡ+Braun这两类消化道重建途径的临床效果.方法回顾性分析江苏省苏北人民医院胃肠中心2020年1月—2022年4月治疗的102名腹腔镜远端胃癌根治术(LDG)病人的临床资料.其中42人采用Uncut Roux-en-Y吻合术,被归入URY组,60人采用BillrothⅡ联合Braun吻合术,被归入B2B组.对比两组研究对象的基本信息、围手术期相关参数、术后近期并发症与营养情况,以及术后12个月胃镜检查结果,同时采用QLQ-STO 22量表对其术后生活质量展开评估.结果两组皆顺利完成LDG手术,无1例中转开腹与围术期死亡情况.两组在手术用时、吻合时间、术中出血量、术后首次排气时间、进食流质时间、拔除引流管时间、术后住院天数上,差异无统计学意义(P>0.05).两组在术后近期并发症(含吻合口瘘、十二指肠残端瘘、切口感染、肠梗阻等)发生率上,差异无统计学意义(P>0.05).随访1年,URY组1例患者出现肝转移;B2 B组2例出现肿瘤复发,其中1例为肝转移,另1例并发腹腔广泛转移死亡.术后1年91例完成胃镜检查,其中URY组37例,B2 B组54例.URY组出现胃潴留5例(13.5%),B2 B组18例(33.3%),差异有统计学意义(χ^(2)=4.567,P=0.033);发生胆汁反流分别有3例(8.1%)、16例(29.6%),差异有统计学意义(χ^(2)=6.156,P=0.013);发生反流性胃炎分别为1例(2.7%)、12例(22.2%),差异有统计学意义(χ^(2)=6.832,P=0.009);发生反流性食管炎分别为1例(2.7%)、3例(5.6%),差异无统计学意义(χ^(2)=0.017,P=0.895).术后1年评估病人营养情况,两组血淋巴细胞计数(LC)、血红蛋白(Hb)、总蛋白(TP)、血清白蛋白(Alb)、预后营养指数(PNI)等指标比较,无明显统计学差异(P>0.05).术后1年64例完成胃癌(GC)病人生活质量调查问卷(QLQ-STO 22),URY组28例,B2B组36例.结果显示与B2B组比较,URY组减少了反流,差异有统计学意义(P<0.05).结论Uncut Roux-en-Y吻合术减少了胃潴留、胆汁反流和反流性胃炎的发生,改善了患者的生活质量.Uncut Roux-en-Y吻合术途径在LDG消化道重建方面为理想之选.

食管癌术后消化道模式重建及饮食训练方案的探讨

目的:探讨食管癌术后消化道模式重建及饮食训练方案。方法:选择2021年7月—2021年10月接受食管癌手术治疗患者70例,采用区组随机化分组方法随机分为对照组和观察组,每组35例。对照组给予常规饮食干预,观察组给予饮食训练干预。分别在干预前、干预2周后、出院时对比两组患者胃肠道症状评分、主观整体营养评估表(PG-SGA)评分、血生化指标及生活质量评分。结果;观察组患者干预2周后、出院时胃肠道症状评分、PG-SGA评分均优于对照组,血生化指标中总蛋白、白蛋白、血红蛋白指标均高于对照组,生活质量评分高于对照组,差异均有统计学意义(P<0.05)。结论:饮食训练方案能够明显减轻食管癌术后患者胃肠道症状,改善营养指标和血生化指标,提升患者生活质量。

一种高度仿生的改良食管胃吻合术在近端胃切除消化道重建中的安全性及疗效分析

目的:探讨一种高度仿生的改良食管胃吻合方式在近端胃切除术后消化道重建中的安全性及抗反流效果,以期为近端胃切除术后消化道重建提供一种安全简单且具有良好抗反流效果的新选择。方法:将2022年1月—2023年9月于山东第一医科大学附属省立医院胃肠外科行近端胃切除术后采用改良食管胃吻合术患者30例(研究组)与同期行目前公认的抗反流效果较好的双通道吻合术27例患者(对照组)进行对比分析,主要对比手术相关指标、手术后生活质量、术后并发症、手术的抗反流效果等。结果:在手术时间和术后住院时间上,研究组明显优于对照组,差异有统计学意义(P<0.05);而在术中出血量和手术的抗反流效果方面,两种吻合方法表现相似,差异无统计学意义(P>0.05);在术后并发症方面,研究组术后吻合口瘘和肠梗阻的发生率较对照组稍低,但就总发生率而言,两者差异无统计学意义(P>0.05);在术后生活质量方面,两组差异无统计学意义(P>0.05)。结论:高度仿生的改良食管胃吻合术在治疗食管胃结合部腺癌是安全的、可行的,且具有良好的抗反流效果,但该术式还需进一步高质量的随机对照研究并进行深入探讨。

ERCP内镜微创治疗消化道重建术后胆胰管梗阻性病变研究进展

随着经内镜逆行性胰胆管造影术(endoscopic retro-grade cholangiopancreatography,ERCP)的不断完善和进步,使得ERCP在治疗胆胰管梗阻性病变的应用越来越广泛.在正常胃肠道解剖结构患者中,ERCP的成功率超过95%.然而,消化道重建术后ERCP的内镜入路冗长且复杂,输入攀和吻合口识别困难,肠管粘连及成角等问题,使得ERCP内镜微创治疗胆胰管梗阻病变得极具挑战性,给内镜医生带来不少困难.不同的消化道重建术式,ERCP操作技术的侧重点各不相同.本文结合文献及临床经验,针对不同的消化道重建术后ERCP操作技巧、内镜选择策略及新型辅助技术等方面作一系统阐述.

保留胃窦的调节型双通道消化道重建术对进展期胃癌患者肿瘤标志物水平及营养状态的影响

目的 探讨保留胃窦的调节型双通道消化道重建术对进展期胃癌患者肿瘤标志物水平及营养状态的影响。方法 选取2020年1月至2023年1月收治的100例进展期胃癌患者,将其随机分为对照组和观察组,各50例。对照组采用全胃切除Roux-en-Y吻合术,观察组采用保留胃窦的调节型双通道消化道重建术。比较两组的治疗效果。结果 术后2周,观察组的癌胚抗原(CEA)、糖类抗原19-9(CA19-9)、糖类抗原72-4(CA72-4)水平低于对照组(P<0.05)。术后2周,观察组的前白蛋白(PA)、白蛋白(ALB)、铁蛋白(SF)水平高于对照组(P<0.05)。术后2周,两组的胃泌素(GAS)、胆囊收缩素(CCK)水平均降低,但观察组高于对照组(P<0.05)。观察组的并发症总发生率低于对照组(P<0.05)。结论 保留胃窦的调节型双通道消化道重建术用于进展期胃癌患者的效果较好,可下调肿瘤标志物水平,改善营养状态。

全胃切除调节型双通道间置空肠消化道重建术对进展期胃癌患者胃肠屏障功能及营养状态的影响

目的探讨全胃切除调节型双通道间置空肠消化道重建术对进展期胃癌患者胃肠屏障功能及营养状态的影响。方法选取2019年1月至2022年1月我院收治的40例进展期胃癌患者为研究对象,根据术式不同将其分为对照组和观察组,各20例。对照组采用全胃切除Roux-en-Y吻合消化道重建术治疗,观察组采用全胃切除调节型双通道间置空肠消化道重建术治疗。比较两组的治疗效果。结果术后,观察组的D-乳酸、二胺氧化酶(DAO)、内毒素(ETX)水平低于对照组(P<0.05)。术后,观察组的胆囊收缩素水平、胆囊排空率、胆囊容积优于对照组(P<0.05)。术后,观察组的白蛋白(ALB)、前白蛋白(PA)、血清铁蛋白(SF)水平高于对照组(P<0.05)。观察组的术后并发症总发生率低于对照组(P<0.05)。结论全胃切除调节型双通道间置空肠消化道重建术可改善进展期胃癌患者的胃肠屏障功能、胆囊收缩功能及营养状态,降低术后并发症发生率,值得推广。

胃食管结合部恶性肿瘤的外科治疗

近年来有胃食管结合部恶性肿瘤患者的数量逐渐增加,外科手术治疗是其最主要的治疗方式,然而对该肿瘤的最佳手术方式及切除范围一直还未有一个普遍的共识。由于胃食管结合部肿瘤特殊的生物学特性,其手术方式不可能单纯地按照食管或胃肿瘤的手术方式进行选择,从而导致了其治疗的选择的多样性。充分认识胃食管结合部肿瘤的分类及手术选择,有利于对肿瘤进行判别并选择手术的最佳手术切除方式,淋巴结清扫范围和消化道重建方式。笔者查阅了国内外相关文献,就胃食管结合部恶性肿瘤的分型、手术方式及入径、淋巴结清扫范围及消化道重建进行综述,探讨胃食管结合部肿瘤的外科治疗选择及其治疗前景。