Machine learning identifies the risk of complications after laparoscopic radical gastrectomy for gastric cancer

BACKGROUND Laparoscopic radical gastrectomy is widely used,and perioperative complications have become a highly concerned issue.AIM To develop a predictive model for complications in laparoscopic radical gastrectomy for gastric cancer to better predict the likelihood of complications in gastric cancer patients within 30 days after surgery,guide perioperative treatment strategies for gastric cancer patients,and prevent serious complications.METHODS In total,998 patients who underwent laparoscopic radical gastrectomy for gastric cancer at 16 Chinese medical centers were included in the training group for the complication model,and 398 patients were included in the validation group.The clinicopathological data and 30-d postoperative complications of gastric cancer patients were collected.Three machine learning methods,lasso regression,random forest,and artificial neural networks,were used to construct postoperative complication prediction models for laparoscopic distal gastrectomy and laparoscopic total gastrectomy,and their prediction efficacy and accuracy were evaluated.RESULTS The constructed complication model,particularly the random forest model,could better predict serious complications in gastric cancer patients undergoing laparoscopic radical gastrectomy.It exhibited stable performance in external validation and is worthy of further promotion in more centers.CONCLUSION Using the risk factors identified in multicenter datasets,highly sensitive risk prediction models for complications following laparoscopic radical gastrectomy were established.We hope to facilitate the diagnosis and treatment of preoperative and postoperative decision-making by using these models.

Lung ultrasound score evaluation of the effect of pressure-controlled ventilation volume-guaranteed on patients undergoing laparoscopicassisted radical gastrectomy

BACKGROUND Laparoscopic-assisted radical gastrectomy(LARG)is the standard treatment for early-stage gastric carcinoma(GC).However,the negative impact of this proce-dure on respiratory function requires the optimized intraoperative management of patients in terms of ventilation.AIM To investigate the influence of pressure-controlled ventilation volume-guaranteed(PCV-VG)and volume-controlled ventilation(VCV)on blood gas analysis and pulmonary ventilation in patients undergoing LARG for GC based on the lung ultrasound score(LUS).METHODS The study included 103 patients with GC undergoing LARG from May 2020 to May 2023,with 52 cases undergoing PCV-VG(research group)and 51 cases undergoing VCV(control group).LUS were recorded at the time of entering the operating room(T0),20 minutes after anesthesia with endotracheal intubation(T1),30 minutes after artificial pneumoperitoneum(PP)establishment(T2),and 15 minutes after endotracheal tube removal(T5).For blood gas analysis,arterial partial pressure of oxygen(PaO_(2))and partial pressure of carbon dioxide(PaCO_(2))were observed.Peak airway pressure(P_(peak)),plateau pressure(Pplat),mean airway pressure(P_(mean)),and dynamic pulmonary compliance(C_(dyn))were recorded at T1 and T2,1 hour after PP establishment(T3),and at the end of the operation(T4).Postoperative pulmonary complications(PPCs)were recorded.Pre-and postoperative serum interleukin(IL)-1β,IL-6,and tumor necrosis factor-α(TNF-α)were measured by enzyme-linked immunosorbent assay.RESULTS Compared with those at T0,the whole,anterior,lateral,posterior,upper,lower,left,and right lung LUS of the research group were significantly reduced at T1,T2,and T5;in the control group,the LUS of the whole and partial lung regions(posterior,lower,and right lung)decreased significantly at T2,while at T5,the LUS of the whole and some regions(lateral,lower,and left lung)increased significantly.In comparison with the control group,the whole and regional LUS of the research group were reduced at T1,T2,and T5,with an increase in PaO_(2),decrease in PaCO_(2),reduction in P_(peak) at T1 to T4,increase in P_(mean) and C_(dyn),and decrease in Pplat at T4,all significant.The research group showed a significantly lower incidence of PPCs than the control group within 3 days postoperatively.Postoperative IL-1β,IL-6,and TNF-αsignificantly increased in both groups,with even higher levels in the control group.CONCLUSION LUS can indicate intraoperative non-uniformity and postural changes in pulmonary ventilation under PCV-VG and VCV.Under the lung protective ventilation strategy,the PCV-VG mode more significantly improved intraop-erative lung ventilation in patients undergoing LARG for GC and reduced lung injury-related cytokine production,thereby alleviating lung injury.

Perioperative outcomes of transvaginal specimen extraction laparoscopic total gastrectomy and conventional laparoscopicassisted total gastrectomy

BACKGROUND Natural orifice specimen extraction surgery(NOSES)has emerged as a promising alternative compared to conventional laparoscopic-assisted total gastrectomy(LATG)for treating gastric cancer(GC).However,evidence regarding the efficacy and safety of NOSES for GC surgery is limited.This study aimed to compare the safety and feasibility,in addition to postoperative complications of NOSES and LATG.METHODS Dual circular staplers were used in Roux-en-Y digestive tract reconstruction for transvaginal specimen extraction LATG,and its outcomes were compared with LATG in a cohort of 51 GC patients with tumor size≤5 cm.The study was conducted from May 2018 to September 2020,and patients were categorized into the NOSES group(n=22)and LATG group(n=29).Perioperative parameters were compared and analyzed,including patient and tumor characteristics,postoperative outcomes,and anastomosis-related complications,postoperative hospital stay,the length of abdominal incision,difference in tumor type,postoperative complications,and postoperative survival.RESULTS Postoperative exhaust time,operation duration,mean postoperative hospital stay,length of abdominal incision,number of specific staplers used,and Brief Illness Perception Questionnaire score were significant in both groups(P<0.01).In the NOSES group,the postoperative time to first flatus,mean postoperative hospital stay,and length of abdominal incision were significantly shorter than those in the LATG group.Patients in the NOSES group had faster postoperative recovery,and achieved abdominal minimally invasive incision that met aesthetic requirements.There were no significant differences in gender,age,tumor type,postoperative complications,and postoperative survival between the two groups.CONCLUSION The application of dual circular staplers in Roux-en-Y digestive tract reconstruction combined with NOSES gastrectomy is safe and convenient.This approach offers better short-term outcomes compared to LATG,while long-term survival rates are comparable to those of conventional laparoscopic surgery.

Fast-track surgery could improve postoperative recovery in radical total gastrectomy patients

AIM: To assess the impact of fast-track surgery (FTS) on hospital stay, cost of hospitalization and complications after radical total gastrectomy. METHODS: A randomized, controlled clinical trial was conducted from November 2011 to August 2012 in the Department of Digestive Surgery, Xijing Hospital of Digestive Diseases, the Fourth Military Medical University. A total of 122 gastric cancer patients who met the selection criteria were randomized into FTS and conventional care groups on the first day of hospitalization. All patients received elective standard D2 total gastrectomy. Clinical outcomes, including duration of flatus and defecation, white blood cell count, postoperative pain, duration of postoperative stay, cost of hospitalization and complications were recorded and evaluated.Two specially trained doctors who were blinded to the treatment were in charge of evaluating postoperative outcomes, discharge and follow-up. RESULTS: A total of 119 patients finished the study, including 60 patients in the conventional care group and 59 patients in the FTS group. Two patients were excluded from the FTS group due to withdrawal of consent. One patient was excluded from the conventional care group because of a non-resectable tumor. Compared with the conventional group, FTS shortened the duration of flatus (79.03 ± 20.26 hvs 60.97 ± 24.40 h, P = 0.000) and duration of defecation (93.03 ± 27.95 h vs 68.00 ± 25.42 h, P = 0.000), accelerated the decrease in white blood cell count [P < 0.05 on postoperative day (POD) 3 and 4], alleviated pain in patients after surgery (P < 0.05 on POD 1, 2 and 3), reduced complications (P < 0.05), shortened the duration of postoperative stay (7.10 ± 2.13 dvs 5.68 ± 1.22 d,P = 0.000), reduced the cost of hospitalization (43783.25 ± 8102.36 RMBvs 39597.62 ± 7529.98 RMB,P = 0.005), and promoted recovery of patients. CONCLUSION: FTS could be safely applied in radical total gastrectomy to accelerate clinical recovery of gastric cancer patients.

Comparison of totally laparoscopic total gastrectomy using an endoscopic linear stapler with laparoscopic-assisted total gastrectomy using a circular stapler in patients with gastric cancer: a single-center experience

AIM To evaluate the safety and efficacy of totally laparoscopic total gastrectomy(TLTG) with esophagojejunostomy using a linear stapler compared with laparoscopic-assisted total gastrectomy(LATG) using a circular stapler in gastric cancer patients.METHODS We retrospectively reviewed 687 patients who underwent laparoscopic total gastrectomy for gastric cancer at a single institution from August 2008 to August 2014. The patients were divided into two groups according to the type of operation: 421 patients underwent TLTG and 266 underwent LATG. Clinicopathologic characteristics and surgical outcomes in the two groups were compared and analyzed.RESULTS The TLTG group had higher mean ages at the time of operation(57.78 ± 11.20 years and 55.69 ± 11.96 years,P = 0.020) and more histories of abdominal surgery(20.2% and 12.4%,P = 0.008) compared with the LATG group. Surgical outcomes such as intraoperative and postoperative transfusions,combined operations,pain scores and administration of analgesics,and complications were similar between the two groups. However,compared with the LATG group,the TLTG group required a shorter operation time(149 min vs 170 min,P < 0.001),had lower postoperative hematocrit change(3.49% vs 4.04%,P = 0.002),less intraoperative events(3.1% vs 10.2%,P < 0.001),less intraoperative anastomosis events(2.4% vs 7.1%,P = 0.003),faster postoperative recovery such as median time to first flatus(3.30 d vs 3.60 d,P < 0.001),faster median commencement of soft diet(4.30 d vs 4.60 d,P < 0.001) and shorter length of postoperative hospital stay(6.75 d vs 7.02 d,P = 0.005). CONCLUSION The intracorporeal method for reconstruction of esophagojejunostomy using a linear stapler may be considered a feasible procedure comparing with extracorporeal anastomosis using circular stapler because TLTG is simpler and more straightforward than LATG. Therefore,TLTG can be recommended as an appropriate procedure for gastric cancer.

Efficacy of totally laparoscopic compared with laparoscopic-assisted total gastrectomy for gastric cancer: A meta-analysis

BACKGROUND Laparoscopic radical gastrectomy is currently the most common surgical approach for gastric cancer.The main difference between totally laparoscopic total gastrectomy(TLTG)and laparoscopic-assisted total gastrectomy(LATG)is the route of digestive tract reconstruction.However,TLTG is currently not widespread as the safety and feasibility of intracorporeal esophagojejunostomy is uncertain.AIM To compare the short-term efficacy of TLTG and LATG for radical gastrectomy of gastric cancer,and to determine the safety and feasibility of intracorporeal esophagojejunostomy.METHODS PubMed,EMBASE,and Web of Science databases were searched for all relevant articles regarding TLTG vs LATG for gastric cancer published up to October 1,2019.Inclusion and exclusion criteria were established.All the basic conditions of patients and important clinical data related to surgery were extracted,and a meta-analysis was performed with RevMan 5.3 software.RESULTS Eight studies involving a total of 1883 cases(869 cases in the TLTG group and 1014 cases in the LATG group)were included.Compared with the LATG group,reduced intraoperative blood loss(weighted mean difference=-35.37,95%CI:-61.69--9.06,P=0.008)and a larger number of retrieved lymph nodes(weighted mean difference=3.11,95%CI:-2.60-12.00,P=0.01)were found in the TLTG group.There were no significant differences in operating time,anastomotic time,tumor size,proximal resection margin length,postoperative pain score,time to first flatus,time to first oral intake,postoperative hospital stay,postoperative anastomosis-related complication rate and overall complication rate between the two groups(P>0.05).CONCLUSION Intracorporeal esophagojejunostomy is safe and feasible.TLTG has the advantages of being minimally invasive,reduced intraoperative blood loss and easier access to lymph nodes compared with LATG.Totally laparoscopic gastrectomy is likely to be the surgical trend for gastric cancer in the future.

Observation on the Therapeutic Effect and Complication Rate of Totally Laparoscopic Total Gastrectomy and Laparoscopic-Assisted Total Gastrectomy in the Treatment of Gastric Cancer

Objective:To investigate the effect and complication rate of totally laparoscopic and laparoscopic-assisted total gastrectomy in the treatment of gastric cancer.Methods:From March 2019 to July 2021,60 patients with gastric cancer were selected as the subjects in this study;the patients in group A underwent laparoscopic-assisted total gastrectomy,whereas those in group B underwent totally laparoscopic total gastrectomy;the treatment effect and complication rate were compared between the two groups.Results:The postoperative recovery of group B was significantly better than that of group A,and the postoperative complications(10.00%)of group B were significantly lower than that of group A(33.33%)(P<0.05).Conclusion:For patients with gastric cancer,totally laparoscopic total gastrectomy has better therapeutic effect and lower postoperative complications,which is worthy of popularization.

How to examine anastomotic integrity intraoperatively in totally laparoscopic radical gastrectomy? Methylene blue testing prevents technical defect-related anastomotic leaks

BACKGROUND Intraoperative methylene blue testing(IMBT),air leak testing,or endoscopy is used to assess the anastomotic integrity of esophagojejunostomy during open total gastrectomy for gastric cancer.Totally laparoscopic radical gastrectomy has been widely used to treat gastric cancer in the last few decades.However,reports on testing anastomotic integrity in totally laparoscopic radical gastrectomy are limited.AIM To explore the effects of IMBT on the incidence of postoperative anastomotic leaks(PALs)and identify the risk factors for PALs in totally laparoscopic radical gastrectomy.METHODS From January 2017 to December 2019,patients who underwent totally laparoscopic radical gastrectomy at the Shaanxi Provincial People's Hospital were retrospectively analyzed.According to whether or not they experienced an IMBT,the patients were divided into an IMBT group and a control group.If the IMBT was positive,an intraoperative suture was required to reinforce the anastomosis.The difference in the incidence of PALs was compared,and the risk factors were investigated.RESULTS This study consisted of 513 patients,211 in the IMBT group and 302 in the control group.Positive IMBT was shown in seven patients(3.3%)in the IMBT group,and no PAL occurred in these patients after suture reinforcement.Multivariate analysis showed that risk factors for predicting positive IMBT were body mass index(BMI)>25 kg/m2(hazard ratio[HR]=8.357,P=0.009),operation time>4 h(HR=55.881,P=0.002),and insufficient surgical experience(HR=15.286,P=0.010).Moreover,15 patients(2.9%)developed PALs in 513 patients,and the rates of PALs were significantly lower in the IMBT group than in the control group[2 of 211 patients(0.9%)vs 13 of 302 patients(4.3%),P=0.0026].Further analysis demonstrated that preoperative complications(HR=13.128,P=0.017),totally laparoscopic total gastrectomy(HR=9.075,P=0.043),and neoadjuvant chemotherapy(HR=7.150,P=0.008)were independent risk factors for PALs.CONCLUSION IMBT is an effective method to evaluate the integrity of anastomosis during totally laparoscopic radical gastrectomy,thus preventing technical defect-related anastomotic leaks.Preoperative complications,totally laparoscopic total gastrectomy,and neoadjuvant chemotherapy are independent risk factors for PALs.

Multifactor analysis of the technique in total laparoscopic gastric cancer

BACKGROUND Esophageal gastric anastomosis is a common surgical technique used to treat patients with gastric cancer who undergo total gastrectomy.However,using simple anastomosis techniques alone may not meet the needs of patients in some cases and can lead to complications such as anastomotic stenosis and ulceration.In order to overcome these issues and improve patient prognosis,muscle flap reconstruction technique has emerged.Muscle flap reconstruction is a method of improving gastric-esophageal anastomosis by transplanting muscle tissue.By covering the anastomotic site with muscle tissue,it not only enhances the stability of the anastomosis site but also increases blood supply,promoting healing and recovery of the anastomosis.Therefore,the use of muscle flap reconstruction technique in esophageal gastric anastomosis during total gastrectomy for gastric cancer is increasingly widely applied.AIM To determine the effectiveness of esophagogastric anastomosis using the muscle flap reconstruction technology in total abdominal gastrectomy for gastric cancer and perform follow-up experiments to understand the factors affecting patients’prognosis.METHODS The study subjects were 60 patients with gastric cancer who were admitted to our hospital between October 2018 and January 2022.All patients underwent esopha-gogastric anastomosis using the double muscle flap reconstruction technology in total abdominal gastrectomy.Perioperative indicators were determined,and INTRODUCTION Gastric cancer is one of the most common tumors of the digestive system worldwide.Although gastric cancer may not have significant manifestations in the early stage,as the disease progresses,systemic symptoms such as emaciation,anemia,and gastric perforation are observed[1].Surgery is the main treatment strategy for gastric cancer.With recent advances in total laparoscopy,total laparoscopic radical resection has gradually become an important treatment strategy for gastric cancer.Conventional laparoscopic surgery may require at least 5-6 incisions,whereas total laparoscopic surgery requires only 3-4 small incisions,decreasing surgical trauma and postoperative pain[2].Furthermore,because total laparoscopic surgery is less invasive than conventional laparoscopic surgery,patients can generally return to normal living and working conditions more quickly[3].Moreover,total laparoscopic surgery does not leave obvious surgical scars;therefore,it is advantageous for patients who pay attention to appearance[4].Esophagogastrostomy is a method used to repair gastrointestinal anastomosis,called the“double muscle valve”.This technique requires folding the fundus of the stomach,followed by sealing it with two layers of tissue,forming a structure similar to a valve.The application of esophagogastrostomy to total laparoscopic radical resection for gastric cancer can effectively decrease the incidence of complications such as anastomotic incontinence and bile reflux and improve the surgical cure rate and postoperative quality of life,which is a recent topic of interest for surgeons.At present,systematic multivariate analyses of the application effects of esophagogastrostomy in total laparoscopic surgery for gastric cancer and their effects on prognosis remain scarce[5].In the present study,we conducted surgery and postoperative follow-up of patients with gastric cancer and collected relevant clinical data for esophagogastric anastomosis during postoperative resection for gastric cancer to ACKNOWLEDGEMENTS I would like to express my sincere thanks to all those who participated in the manuscript.

术后脂代谢对胃癌根治术后早期吻合口瘘发生的预测价值

目的 探讨术后血脂指标对胃癌根治术患者术后早期吻合口瘘发生的预测价值。方法 回顾性收集41例胃癌根治术后10 d内发生吻合口瘘的患者临床资料,纳入发生组;另收集同期医院胃癌根治术后10 d内未发生吻合口瘘的患者临床资料,纳入未发生组。所有患者术后1 d均完成血脂指标[总胆固醇(TC)、甘油三酯(TG)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)]检查。统计2组一般基线资料,比较2组术后早期血脂指标,并绘制受试者工作特征(ROC)曲线,分析术后血脂指标对胃癌根治术后吻合口瘘的预测价值。结果 发生组合并2型糖尿病、合并低蛋白血症例数占比高于未发生组,差异有统计学意义(P<0.05)。发生组术后1 d时血清TC、LDL-C均高于未发生组,差异有统计学意义(P<0.05)。初步表明合并2型糖尿病、合并低蛋白血症、术后早期血清TC、LDL-C高与胃癌根治术患者术后发生吻合口瘘有关。绘制ROC曲线结果显示,术后1 d时血清TC、LDL-C预测胃癌根治术患者术后发生吻合口瘘的曲线下面积(AUC)均≥0.7,均有一定的预测价值。结论 胃癌根治术患者术后早期血清TC、LDL-C水平高与其吻合口瘘发生存在一定关系,术后早期联合检测二者水平可用于预测胃癌根治术后吻合口瘘发生风险。

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。

根治性近端胃切除联合双通道重建术对胃癌患者围术期指标及营养指标的影响

目的分析根治性近端胃切除联合双通道重建术对胃癌患者围术期指标及营养指标的影响。方法选取胃癌患者60例,随机分为对照组和观察组,各30例。对照组行根治性全胃切除术+Roux-en-Y消化道重建术,观察组行根治性近端胃切除联合双通道重建术。对比两组的围术期指标、术后恢复情况、营养指标、生活质量、并发症发生情况。结果观察组术中出血量(89.65±10.21)ml少于对照组的(105.31±17.45)ml,手术时间(116.27±13.34)min、消化道重建时间(32.25±3.71)min、住院时间(8.35±1.36)d、肠鸣音恢复时间(25.36±2.59)h、肛门排气时间(43.26±5.46)h、进流食时间(84.36±6.87)h、下床活动时间(52.43±5.24)h均短于对照组的(139.84±16.25)min、(39.87±5.31)min、(10.69±1.87)d、(31.48±3.37)h、(54.89±7.58)h、(98.57±8.33)h、(59.67±6.57)h(P<0.05)。术后,两组血红蛋白(Hb)、总蛋白(TP)、白蛋白(ALB)均较术前降低,但观察组Hb(116.57±11.69)g/L、TP(67.35±4.89)g/L、ALB(40.56±4.71)g/L均高于对照组的(101.35±9.75)、(61.26±3.67)、(33.48±3.69)g/L(P<0.05)。术后,两组躯体疼痛、生理职能、生理机能、一般健康状况、精力、社会功能、情感职能、精神健康评分均较术前升高,且观察组较对照组更高(P<0.05)。观察组并发症发生率为6.67%(2/30),低于对照组的26.67%(8/30)(P<0.05)。结论对胃癌患者行根治性近端胃切除联合双通道重建术具有创伤小、术后恢复快等优势,还可改善患者营养状态,提高生活质量,且无严重并发症,临床可推行应用。

营养状态评估在胃癌全胃切除术后患者化疗耐受性中的应用研究

目的探讨营养状态评估在胃癌全胃切除术后患者化疗耐受性中的应用研究。方法纳入于2018年3月至2022年2月至首都医科大学附属北京潞河医院接受根治性全胃切除术和术后化疗的154例胃癌患者作为研究对象,根据患者术后6个月内是否停止化疗分为耐受组(n=122)和不耐受组(n=32),采用Kaplan-Meier曲线分析化疗持续时间分层与全胃切除术后患者生存率的关系,对比两组患者术前及术后化疗前基础资料,单因素Logistic回归分析全胃切除术后患者化疗耐受性的影响因子,绘制ROC曲线分析相关因素的预测价值。结果Kaplan-Meier曲线分析显示:全胃切除术后患者化疗耐受性与总生存率相关[Log Rank(Mantel-Cox)=11.017,P=0.001]。两组患者年龄、基础疾病、营养风险筛查2002(NRS 2002)、预后营养指数(PNI)、癌胚抗原(CEA)、白蛋白(ALB)及血红蛋白(Hb)水平对比,差异有统计学意义(P<0.05)。将单因素分析中P<0.05的变量纳入多因素Logistic回归模型,结果显示:年龄(OR=6.150)、PNI(OR=3.263)、Hb(OR=1.090)和ALB(OR=1.342)是全胃切除术后患者化疗耐受性的独立危险因素(P<0.05)。绘制ROC曲线结果显示:年龄的曲线下面积(AUC)为0.694(95%CI=0.615~0.766),PNI的AUC为0.774(95%CI=0.700~0.838),Hb的AUC为0.893(95%CI=0.833~0.937),ALB的AUC为0.814(95%CI=0.743~0.872)。结论年龄较大、PNI低和血红蛋白及白蛋白水平偏低是胃癌全胃切除术后患者化疗耐受性的危险因素,其中血红蛋白及白蛋白水平对全胃切除术后患者化疗耐受性具有显著预测效能,有待作为胃癌患者术后患者化疗耐受性的预测指标。

改良捆绑式反穿刺法食管空肠吻合术在腹腔镜根治性全胃切除术中的应用研究

目的 探讨改良捆绑式反穿刺法食管空肠吻合术在腹腔镜根治性全胃切除术中的临床应用价值。方法 选取182例腹腔镜根治性全胃切除术中使用改良捆绑式反穿刺法食管空肠吻合术患者,以自制带牵引线的橡皮筋将空肠和吻合器捆绑固定,采用常规反穿刺法与食管端侧吻合,完成食管空肠吻合,观察其临床治疗效果。结果 182例患者均顺利完成手术,无中转开腹。手术时间(196.2±22.4)min,切口长度(3.89±1.23)cm;食管近缘长度(3.78±0.56)cm;抵钉座置入时间(9.20±2.40)min,术中出血量(56.20±22.40)mL;术后吻合口漏3例,吻合口出血3例,切口感染2例,吻合口狭窄5例;所有患者均随访8~36个月,平均20.6个月,吻合口复发2例,其余未见肿瘤局部复发。结论 在腹腔镜根治性全胃切除术中,改良后的捆绑式反穿刺吻合技术具备一定的安全性和可行性,临床疗效显著,具有临床推广价值。

腹腔镜下食管空肠π形吻合在根治性全胃切除术中的临床应用

目的探讨腹腔镜下食管空肠π形吻合在根治性全胃切除术中的应用效果。方法选取2020年5月至2023年5月我院收治的82例胃癌患者为研究对象,按随机数字表法分为对照组和观察组,每组41例。对照组术中行食管空肠功能性端端吻合,观察组术中行食管空肠π形吻合。比较两组患者的手术情况、术后恢复情况、疼痛评分、生活质量及并发症。结果观察组的手术时间、术中吻合时间均短于对照组,术中出血量少于对照组,差异均有统计学意义(均P<0.05)。观察组术后排气时间、进食时间及住院时间均短于对照组,差异均有统计学意义(均P<0.05)。观察组在术后1、3 d时的疼痛评分均低于对照组,差异均有统计学意义(均P<0.05)。观察组术后生理、心理、社会及环境领域方面的评分均高于对照组,差异均有统计学意义(均P<0.05)。两组的并发症比较,差异无统计学意义(P>0.05)。结论腹腔镜下食管空肠π形吻合在根治性全胃切除术中的应用效果更佳,可缩短手术时间,术后恢复快,安全性高。

全机器人下根治性全胃切除+食管空肠Roux-en-Y吻合术(Overlap法)

2000年获得临床应用许可的达芬奇外科手术系统(da Vinci surgical system)作为一种创新的微创手术平台,提供了高清晰度的裸眼3D成像功能、有效的震颤过滤技术以及高精度灵活的模拟机械臂.根据目前研究证明,达芬奇机器人手术系统在胃癌手术治疗方面具有其安全性和可行性.灵活的机械臂,在胃周淋巴结清扫中更具优势,对周围器官的损伤更小,术后胰瘘发生率更低;缝合优势能更便利完成全机器人完全缝合重建,缩短腹腔暴露时间、减少腹腔体液丢失、降低手术对患者内环境稳态的干扰.

不同部位胃腺癌第12a组淋巴结转移的危险因素分析

背景与目的:胃癌中肝十二指肠韧带内(沿肝动脉)淋巴结(第12a组淋巴结)转移规律尚不明确,其清扫指征仍有争议,目前缺乏大样本的相关临床研究数据。本研究通过观察不同部位胃癌第12a组淋巴结的转移率,探讨不同部位胃癌第12a组淋巴结转移的危险因素。方法:对河南省人民医院2016年5月—2021年7月胃外科收治的1 112例胃癌患者的病历资料进行回顾性分析,根据肿瘤位置分为胃上部癌(561例)、胃体癌(224例)、胃窦癌(327例),记录不同部位胃癌患者第12a组淋巴结转移率。采用χ^(2)检验或Fisher确切概率检验比较不同部位胃癌患者第12a组淋巴结转移与临床病理学特征的关系,通过多因素logistic回归分析不同部位胃癌患者第12a组淋巴结转移的危险因素。结果:1 112例胃癌患者中72例发生第12a组淋巴结转移,整体转移率为6.5%。561例胃上部癌中有25例发生第12a组淋巴结转移,转移率为4.5%。224例胃体癌中有17例第12a组淋巴结为阳性,转移率为7.6%;327例胃窦癌中有30例第12a组淋巴结为阳性,转移率为9.2%。以第12a组淋巴结是否转移为因变量,以单因素分析差异有统计学意义的指标为自变量,纳入模型进行多因素logistic回归分析。结果显示,肿瘤直径(OR=3.122,95%CI:2.896~3.366,P<0.001)、T分期(OR=2.406,95%CI:1.705~3.396,P<0.001)及TNM分期(OR=7.91,95%CI:4.755~13.160,P<0.001)是胃上部癌患者第12a组淋巴结转移的危险因素;肿瘤直径(OR=2.757,95%CI:2.495~3.047,P<0.001)、T分期(OR=3.298,95%CI:2.346~4.638,P <0.001)及脉管神经侵犯(OR=1.839,95%CI:1.368~2.473,P<0.001)是胃体癌患者第12a组淋巴结转移的危险因素;体重指数(body mass index,BMI)(OR=1.098,95%CI:1.023~1.178,P=0.010)、肿瘤直径(OR=2.865,95%CI:1.778~4.616,P<0.001)、T分期(OR=13.497,95%CI:8.363~21.783,P<0.001)及TNM分期(OR=3.806,95%CI:3.113~4.653,P <0.001)是胃窦癌患者第12a组淋巴结转移的危险因素。结论:第12a组淋巴结总转移率较低;肿瘤大小、浸润深度、肿瘤分期是胃癌第12a组淋巴结转移的独立危险因素,同时神经血管侵犯是胃体癌的独立危险因素;胃体、胃窦癌需要常规清扫第12a组淋巴结;胃上部癌第12a组淋巴结转移率低,不需要常规清扫,但当直径≥6 cm、肿瘤浸润深度较深(T_(3)~T_(4))、肿瘤分期较晚(Ⅲ~Ⅳ)时则需要清扫第12a组淋巴结。

丙泊酚泵注下的全凭静脉麻醉与吸入麻醉在胃癌根治术全麻中的应用效果

目的观察丙泊酚泵注下的全凭静脉麻醉与吸入麻醉用于胃癌根治术全麻的麻醉效果及对患者免疫功能的影响。方法本文为随机对照试验,病例纳入2021年1月至2022年1月至南阳医学高等专科学校第一附属医院接受胃癌根治术治疗的136例胃癌患者为研究对象,采用抽签法将患者均分为两组,每组68例。将采用丙泊酚泵注下全凭静脉麻醉的患者列为静脉组[男/女=35/33,年龄(55.24±5.17)岁],将采用七氟烷吸入麻醉的患者列为吸入组[男/女=38/30,年龄(55.33±5.25)岁]。比较两组患者术中、术后镇痛效果,免疫功能及麻醉相关不良反应发生情况。采用χ^(2)检验、t检验。结果在不同麻醉方案下,静脉组术中心率(HR)(65.45±5.28)次/min高于吸入组(62.33±5.17)次/min(t=3.482,P<0.001),平均动脉压(MAP)(90.44±10.27)mmHg(1 mmHg=0.133 kPa)高于吸入组(85.33±10.16)mmHg(t=2.917,P=0.004),血氧饱和度(SaO2)(98.24±5.11)%高于吸入组(95.12±5.36)%(t=3.474,P<0.001),呼吸频率(PR)(20.26±2.35)次/min低于吸入组(21.37±2.46)次/min(t=2.691,P=0.008)。静脉组术后1、3、5 h的视觉模拟疼痛量表(VAS)评分均低于吸入组(均P<0.05)。术前,两组患者T淋巴细胞亚群、免疫球蛋白(Ig)等免疫指标差异均无统计学意义(均P>0.05);术后,两组患者免疫功能均受到一定抑制,但静脉组的CD3+(38.77±5.16)%高于吸入组(36.33±5.25)%(t=2.733,P=0.007),CD4+(45.15±5.24)%高于吸入组(42.27±5.16)%(t=3.229,P=0.002),IgM(1.22±0.35)g/L高于吸入组(0.95±0.64)g/L(t=3.052,P=0.003),IgA(1.52±0.76)g/L高于吸入组(0.96±0.61)g/L(t=4.739,P<0.001)。静脉组的麻醉相关不良反应发生率7.35%(5/68)略高于吸入组5.88%(4/68)(χ^(2)=0.175,P=0.676)。结论采用丙泊酚泵注下的全凭静脉麻醉辅助胃癌根治术治疗可起到更加显著的术中、术后镇痛效果,且与吸入麻醉相比,全凭静脉麻醉对患者免疫功能产生的抑制作用更轻,且全凭静脉麻醉并未明显增加患者发生麻醉相关不良反应的风险。

毕Ⅱ式联合Braun吻合在全腹腔镜远端胃癌根治术中消化道重建的安全性和可行性研究

目的研究分析在全腹腔镜远端胃癌根治术中消化道重建采取毕Ⅱ式联合Braun吻合的安全性和可行性。方法选取2016年1月—2021年12月永安市立医院普外科接受全腹腔镜远端胃癌根治术的远端胃癌患者50例作为研究对象,按照随机数表法分为观察组(n=25,采取毕Ⅱ式联合Braun吻合术治疗)与对照组(n=25,采取毕Ⅱ式吻合术治疗)。对比分析两组的临床疗效。结果观察组与对照组的手术时间、术中出血量、淋巴结清除数量、消化道重建时间和住院时间比较,差异无统计学意义(P>0.05);观察组术后并发症总发生率8.00%则低于对照组40.00%,差异有统计学意义(χ^(2)=7.018,P<0.05);观察组术后IL-6和IL-10水平低于对照组,差异有统计学意义(P<0.05)。结论在全腹腔镜远端胃癌根治术中,采取毕Ⅱ式联合Braun吻合治疗远端胃癌患者,与单纯毕Ⅱ式吻合相比较手术难度相当,但是联合治疗的术后并发症发生风险更低,并且对术后炎性水平改善作用更加明显,更具推广价值。

全3D腹腔镜胃切除结合食管空肠Roux-en-Y吻合术治疗胃癌的效果

目的探究全3D腹腔镜根治性全胃切除结合食管空肠Roux-en-Y吻合术用于早中期胃癌中的效果观察。方法回顾性研究法选择2020年6月至2022年6月收治早中期胃癌患者72例为研究对象,以不同手术方法法分为对照组(n=36)以及观察组(n=36),对照组接受腹腔镜辅助全胃切除术+食管空肠Roux-en-Y吻合术,观察组给予全3D腹腔镜根治性全胃切除+食管空肠Roux-en-Y吻合术,比较两组治疗后效果差异。结果观察组肠鸣音恢复以及肛门首次排气时间均短于对照组,淋巴结清除量较对照组高且术中出血量较对照组少(P<0.05);术后观察组CEA、AFP肿瘤标志物水平与对照组比较无明显差异(P>0.05);术后观察组DAO、ET、ZO-1、OCLN胃肠屏障功能指标水平均较对照组低(P<0.05)。结论全3D腹腔镜根治性全胃切除结合食管空肠Roux-en-Y吻合术用于早中期胃癌中疗效显著,可改善机体胃肠屏障功能。