Objective:To systematically evaluate and compare the safety and effectiveness of esophagojejunostomy and traditional esophagojejunostomy in total laparoscopic total gastrectomy in the treatment of gastric cancer,provi...Objective:To systematically evaluate and compare the safety and effectiveness of esophagojejunostomy and traditional esophagojejunostomy in total laparoscopic total gastrectomy in the treatment of gastric cancer,providing evidence-based medical evidence for clinical practice.Methods:PubMed,Embase,Cochrane Library,Web of Science,CNKI,Wanfang and VIP databases were searched by computer,and the retrieval time was up to December 2021.Relevant literatures were obtained,and eligible studies were gradually screened and included.Cochrane ROB bias risk assessment tool and NOS scale were used to evaluate the quality of the articles,and required data were extracted from high-quality literatures.Finally,meta-analysis was performed using Review Manager 5.3 software.Results:Eleven studies were finally included,including 1398 patients,including 566 patients receiving overlap anastomosis and 832 patients receiving traditional anastomosis.The results show that overlap anastomosis and traditional anastomosis had the advantages of operation time(MD=0.63,95%CI=7.22,8.48,P=0.88),postoperative first exhaust time(MD=-0.13,95%CI=0.43,0.18,P=0.42),postoperative first feeding time(MD=0.02,95%CI=0.33,0.37,P=0.91),anastomotic leakage(OR=1.38,95%CI=0.73,2.63,P=0.32),and postoperative hospital stay(MD=-0.16,95%CI=0.82,0.51,P=0.64)had no significant differences(all P>0.05).Compared with traditional anastomosis,overlap anastomosis had longer anastomosis time(MD=5.60,95%CI=0.59,10.62,P=0.03),higher incidence of anastomotic bleeding(OR=2.48,95%CI=1.08,5.69,P=0.03),less intraoperative bleeding(MD=-6.42,MD=-6.42,OR=2.48,95%CI=1.08,P=0.03).95%CI=10.28,-2.56,P=0.001)and anastomotic stenosis(OR=0.17,95%CI=0.06,0.46,P=0.0006).Conclusion:Overlap esophagojejunostomy is a safe,effective and prognostic surgical method,and is expected to become the standard esophagojejunostomy in total laparoscopic total gastrectomy.展开更多
目的:提供更高水平的研究证据证明完全腹腔镜全胃切除术食管空肠Overlap吻合法的安全性与有效性。方法:检索PubMed、Embase、Cochrane Library、Web of Science、中国知网及万方数据库,检索2010年9月至2021年12月公开发表的有关Overlap...目的:提供更高水平的研究证据证明完全腹腔镜全胃切除术食管空肠Overlap吻合法的安全性与有效性。方法:检索PubMed、Embase、Cochrane Library、Web of Science、中国知网及万方数据库,检索2010年9月至2021年12月公开发表的有关Overlap与其他吻合法对照研究的中文与英文文献。采用纽卡斯尔-渥太华量表与Cochrane评估工具进行质量评估。采用Review Manager 5.3软件进行Meta分析。结果:共16篇文献、1884例患者纳入本研究,其中Overlap组898例,非Overlap组986例。Meta分析结果显示,与非Overlap组相比,Overlap组吻合口狭窄发生率低(OR=0.22,95%CI:0.12~0.42,P<0.00001),吻合时间长(WMD=8.03,95%CI:1.87~14.18,P=0.01),术后首次排气时间早(WMD=-0.15,95%CI:-0.27~-0.03,P=0.01);两组手术时间(WMD=13.18,95%CI:-3.37~29.74,P=0.12)、失血量(WMD=12.39,95%CI:-20.55~45.34,P=0.46)、术中淋巴结清扫数量(WMD=-0.51,95%CI:-4.71~3.69,P=0.81)、术后住院时间(WMD=0.05,95%CI:-0.82~0.91,P=0.92)及吻合口漏(OR=1.33,95%CI:0.79~2.22,P=0.28)、吻合口出血(OR=0.99,95%CI:0.44~2.24,P=0.99)、术后肺部感染(OR=0.81,95%CI:0.32~2.05,P=0.66)发生率差异均无统计学意义。结论:完全腹腔镜全胃切除术食管空肠Overlap吻合法是安全、有效的,在吻合口狭窄及首次排气时间方面优于其他吻合法,但需要更长的吻合时间。展开更多
The first-ever case of a 54-year-old woman who overdosed on non-steroidal anti-inflammatory drugs in an attempt at suicide.Before that incident,she had not been treated for coexisting diseases such as rheumatoid arthr...The first-ever case of a 54-year-old woman who overdosed on non-steroidal anti-inflammatory drugs in an attempt at suicide.Before that incident,she had not been treated for coexisting diseases such as rheumatoid arthritis or depression.At the time of admission to the General Surgery Department,the patient reported pains in the epigastric region with accompanying nausea and vomiting with mucous content as well as the inability to ingest food orally.Despite parenteral and enteral feeding,the patient exhibited a drop in body mass.The histopathologic examination of a sample taken from the stomach during gastroscopy showed some non-specific necrotic and inflammatory masses with granulation.Intraoperatively,a very small,infiltrated stomach with an initial section of duodenum was identified.A total stomach resection together with the reconstruction of digestive tract continuity was performed using the Roux-Y method.Histopathologic examination of the stomach revealed a deep,chronic and exacerbated inflammatory condition with an extensive ulceration over the entire length of the stomach,reaching up to the pylorus.Additionally,numerous lymphatic glands with inflammatory reaction changes were observed.展开更多
腹腔镜全胃切除术(totally laparoscopic total gastrectomy,TLTG)即全腹腔镜下完成全胃切除、淋巴结清扫、消化道重建。其中消化道重建直接关系到病人术后进食、营养状况等,也是TLTG的技术要点,而食管空肠吻合是TLTG消化道重建操作的难...腹腔镜全胃切除术(totally laparoscopic total gastrectomy,TLTG)即全腹腔镜下完成全胃切除、淋巴结清扫、消化道重建。其中消化道重建直接关系到病人术后进食、营养状况等,也是TLTG的技术要点,而食管空肠吻合是TLTG消化道重建操作的难点[1-3]。本研究对胃癌病人行全腹腔镜下全胃切除空肠系膜离断食管左侧π形吻合,并分析疗效。现报告如下。展开更多
文摘Objective:To systematically evaluate and compare the safety and effectiveness of esophagojejunostomy and traditional esophagojejunostomy in total laparoscopic total gastrectomy in the treatment of gastric cancer,providing evidence-based medical evidence for clinical practice.Methods:PubMed,Embase,Cochrane Library,Web of Science,CNKI,Wanfang and VIP databases were searched by computer,and the retrieval time was up to December 2021.Relevant literatures were obtained,and eligible studies were gradually screened and included.Cochrane ROB bias risk assessment tool and NOS scale were used to evaluate the quality of the articles,and required data were extracted from high-quality literatures.Finally,meta-analysis was performed using Review Manager 5.3 software.Results:Eleven studies were finally included,including 1398 patients,including 566 patients receiving overlap anastomosis and 832 patients receiving traditional anastomosis.The results show that overlap anastomosis and traditional anastomosis had the advantages of operation time(MD=0.63,95%CI=7.22,8.48,P=0.88),postoperative first exhaust time(MD=-0.13,95%CI=0.43,0.18,P=0.42),postoperative first feeding time(MD=0.02,95%CI=0.33,0.37,P=0.91),anastomotic leakage(OR=1.38,95%CI=0.73,2.63,P=0.32),and postoperative hospital stay(MD=-0.16,95%CI=0.82,0.51,P=0.64)had no significant differences(all P>0.05).Compared with traditional anastomosis,overlap anastomosis had longer anastomosis time(MD=5.60,95%CI=0.59,10.62,P=0.03),higher incidence of anastomotic bleeding(OR=2.48,95%CI=1.08,5.69,P=0.03),less intraoperative bleeding(MD=-6.42,MD=-6.42,OR=2.48,95%CI=1.08,P=0.03).95%CI=10.28,-2.56,P=0.001)and anastomotic stenosis(OR=0.17,95%CI=0.06,0.46,P=0.0006).Conclusion:Overlap esophagojejunostomy is a safe,effective and prognostic surgical method,and is expected to become the standard esophagojejunostomy in total laparoscopic total gastrectomy.
文摘The first-ever case of a 54-year-old woman who overdosed on non-steroidal anti-inflammatory drugs in an attempt at suicide.Before that incident,she had not been treated for coexisting diseases such as rheumatoid arthritis or depression.At the time of admission to the General Surgery Department,the patient reported pains in the epigastric region with accompanying nausea and vomiting with mucous content as well as the inability to ingest food orally.Despite parenteral and enteral feeding,the patient exhibited a drop in body mass.The histopathologic examination of a sample taken from the stomach during gastroscopy showed some non-specific necrotic and inflammatory masses with granulation.Intraoperatively,a very small,infiltrated stomach with an initial section of duodenum was identified.A total stomach resection together with the reconstruction of digestive tract continuity was performed using the Roux-Y method.Histopathologic examination of the stomach revealed a deep,chronic and exacerbated inflammatory condition with an extensive ulceration over the entire length of the stomach,reaching up to the pylorus.Additionally,numerous lymphatic glands with inflammatory reaction changes were observed.
文摘腹腔镜全胃切除术(totally laparoscopic total gastrectomy,TLTG)即全腹腔镜下完成全胃切除、淋巴结清扫、消化道重建。其中消化道重建直接关系到病人术后进食、营养状况等,也是TLTG的技术要点,而食管空肠吻合是TLTG消化道重建操作的难点[1-3]。本研究对胃癌病人行全腹腔镜下全胃切除空肠系膜离断食管左侧π形吻合,并分析疗效。现报告如下。
