Distal gastric tube resection with vascular preservation for gastric tube cancer:A case report and review of literature

BACKGROUND Survival rates in patients with esophageal cancer undergoing esophagectomy have improved,but the prevalence of gastric tube cancer(GTC)has also increased.Total resection of the gastric tube with lymph node dissection is considered a radical treatment,but GTC surgery is more invasive and involves a higher risk of severe complications or death,particularly in elderly patients.CASE SUMMARY We report an elderly patient with early GTC that had invaded the duodenum who was successfully treated with resection of the distal gastric tube and Roux-en-Y(R-Y)reconstruction.The tumor was a type 0-IIc lesion with ulcer scars surrounding the pyloric ring.Endoscopic submucosal resection was not indicated because the primary lesion was submucosally invasive,was undifferentiated type,surrounded the pyloric ring,and had invaded the duodenum.Resection of distal gastric tube with R-Y reconstruction was safely performed,with preservation of the right gastroepiploic artery(RGEA)and right gastric artery(RGA).CONCLUSION Distal resection of the gastric tube with preservation of the RGEA and RGA is a good treatment option for elderly patients with cT1bN0 GTC in the lower part of the gastric tube.

Clinical characteristics and management of gastric tube cancer with endoscopic submucosal dissection

AIM:To identify the characteristics of gastric tube cancer(GTC) and the complications associated with endoscopic submucosal dissection(ESD) for GTC.METHODS:Between 2007 and 2012,11 individualswith early gastric cancer in the reconstructed gastric tube after esophagectomy who underwent ESD in this hospital were studied.The characteristics of GTC were identified,and the complications of ESD for GTC were analyzed at three phases:preoperative,intraoperative,and postoperative.RESULTS:A total of 11 consecutive patients with 11 GTCs were selected for this study.All cases underwent en bloc resections by ESD.The median procedure time was 142 min.The average GTC diameter was 26.1 mm,and the average size of the resected lesions was 45.5 mm.The histopathological diagnosis in all cases was a differentiated adenocarcinoma.In the preoperative phase,anastomotic strictures(5/11,45%) and food residues(4/11,36.4%) in the gastric tube were the main complications.In the intraoperative phase,bleeding was observed in 5 cases(45%).The postoperative complications observed were delayed bleeding in 2 cases(18.2%) and stenosis in one case(9.1%).The case with stenosis was successfully treated using endoscopic balloon dilatation.CONCLUSION:Minor complications were frequently observed.However,all GTCs underwent en bloc resection with ESD without any serious complications.ESD is considered a useful treatment for GTC.

Pedunculated gastric tube interposition in an esophageal cancer patient with prepyloric adenocarcinoma

Gastric carcinoma is one of the malignancies that are most frequently associated with esophageal carcinoma.We describe herein our device for advanced esophageal cancer associated with early gastric cancer in the antrum.A 57-year-old man presenting with dysphagia and upper abdominal pain was admitted to our hospital.Preoperative examinations revealed locally advanced squamous cell carcinoma (SCC) of the middle thoracic esophagus (T3N0M0 Stage ⅡA) and mucosal signetring cell carcinoma of the gastric antrum (T1N0M0 Stage ⅠA).Although the gastric tumor appeared to be an intramucosal carcinoma,its margin was obscure,so endoscopic en-bloc resection was considered inadequate.We chose surgical resection of the gastric tumor as well as the esophageal SCC after neoadjuvant chemotherapy with 5-fluorouracil and cisplatin for advanced esophageal cancer.Following transthoracic esophagectomy with three-field lymph node dissection,the gastric carcinoma was removed by gastric antrectomy,which preserved the right gastroepiploic vessels,and a pedunculated short gastric tube was used as the esophageal substitute.Twenty-eight months after the surgery,the patient is well with no evidence of cancer recurrence.Because it minimizes surgical stress and organ sacrifice,gastric tube interposition is a potentially useful technique for esophageal cancer associated with localized early gastric cancer.

居家治疗场景下胃癌患者鼻肠管管饲支持系统设计

医疗资源紧张和新冠疫情背景下,胃癌患者居家治疗需求突出。本文旨在探索居家治疗场景下胃癌患者鼻肠管管饲支持系统设计模式。明确胃癌患者鼻肠管治疗护理需求,分析比较患者在医院和居家治疗场景下的护理流程,注重环境普适性,结合人性化设计理念,综合考虑患者及家属操作人机工学因素,建立鼻肠管营养支持系统整体架构,简化操作流程,减轻患者病痛,降低家属心理负担。为胃癌患者鼻肠管居家治疗提供新的研究思路。

胃管引导下经肛减压管置入在直肠癌肠梗阻患者中的应用

目的:探讨胃管引导下经肛减压管置入治疗直肠癌合并肠梗阻的可行性。方法:回顾分析2018年1月至2022年2月收治的55例直肠癌肠梗阻的患者资料,该55例患者采用胃管引导下经肛置入减压管,统计其成功率、肠梗阻的临床缓解率以及出血、穿孔等并发症的发生率,记录术后1年的随访情况。结果:55例患者有51例置管成功,技术成功率92.7%;临床完全缓解47例、临床部分缓解2例、临床无缓解2例,临床成功率96.1%;1例置管后3 d因不慎牵扯导致管道脱落,再重新成功置入;无出血、穿孔等并发症;1例置管失败和2例因置管后减压效果差患者行急诊开放手术;52例行择期手术,其中1例开放手术、51经腹腔镜辅助下手术;术后1年随访发现肝转移1例,其余54例无局部复发及远处转移,无死亡病例。结论:一次性胃管引导下可更加高效、安全地经肛置入减压管,有效地解除直肠癌导致的肠梗阻,适合在没有消化内镜设备的基层医疗单位推广使用。

Postoperative complications and weight loss following jejunostomy tube feeding after total gastrectomy for advanced adenocarcinomas

Objective： Patients undergoing total gastrectomy for cancer are at risk of malnourishment. The aim of this self- controlled study was to examine the effect of jejunostomy tube feeding （JTF） and other factors on postoperative weight and the incidence of jejunostomy-related complications in patients undergoing total gastrectomy for cancer. Methods： All consecutive patients who underwent total gastrectomy for gastric cancer with jejunostomy plaeement were included from a prospective single-center database （2003-2014）. Jejunostomy-related complications and postoperative weight changes were evaluated up to 12 months after surgery. Multivariable linear regression analysis was performed to identify factors associated with weight loss 12 months after gastreetomy. Results： Of 113 patients operated in the study period, 65 received JTF after total gastrectomy for a median duration of 18 d [interquartile range （IQR）, 10-55 d]. Jejunostomy-related complieations occurred in 11 （17%） patients, including skin leakage （n=3） and peritoneal leakage （n=2）, luxation （n=3）, occlusion （n=2）, infection （n=l） and torsion （n=l）. In 2 （3%） patients, a reoperation was needed due to jejtmostomy-related complications. The mean preoperative weight of patients was 71.8 kg （100%）, and remained stable during JTF （73.9 kg, 103%, P=0.331）. After JTF was stopped, the mean weight of patients decreased to 64.9 kg （90%） at 12 months after surgery （P〈0.001）. A high preoperative body mass index （BMI） （〉_25 kg/m2） was associated with high postoperative weight loss compared to patients with a low BMI （〈25 kg/m2） （16.3% vs. 8.6%, P=0.016）. Conclusions： JTF can prevent weight loss in the early postoperative phase. However, this is at the prize of possible complications. As weight loss in the long term is not prevented, routine JTF should be re-evaluated and balanced against the selected use in preoperatively malnourished patients. Special attention should be paid to patients with a high preoperative BMI, who are at risk of more postoperative weight loss.

Jejunostomy Feeding Tube Placement in Gastrectomy Procedures: A Systematic Review

Many nutritional interventions have been developed to improve nutritional outcomes following upper gastrointestinal surgery. The aim of this systematic review was to investigate whether or not the routine use of intraoperative jejunostomy feeding tubes in partial and total gastrectomy procedures is warranted when assessing complications and nutritional benefits such as improved chemotherapy tolerance. An electronic search of MEDLINE, Web of Science, Embase and CINAHL databases was performed to identify studies which reported complications and/or post-operative outcomes of patients who received an intraoperative jejunostomy feeding tube in gastrectomy procedures. Five articles met the inclusion criteria (n = 636) with four retrospective cohort studies and one RCT. Studies varied in regards to the complications and nutritional outcomes reported. Jejunostomy feeding tube insertion may carry a risk of increased infectious complications but appears to reduce patient post-operative weight-loss and may improve chemotherapy tolerance. Due to the lack of high-quality studies, it is unclear if the routine use of an intraoperative jejunostomy feeding tube is indicated for all patients undergoing gastrectomy procedures or only those at a high-risk of post-operative malnutrition. More comprehensive research is recommended, particularly on the usefulness of home enteral nutrition post-gastrectomy.

不留置胃管联合咀嚼口香糖对腹腔镜结直肠癌手术患者快速康复的影响

目的针对不留置胃管联合咀嚼口香糖对腹腔镜结直肠癌手术患者快速康复的影响进行研究。方法选取2020年1月至2021年12月赣南医学院第一附属医院收治的60例腹腔镜结直肠癌手术患者作为研究对象,按照随机数字表法将其分为对照组(n=30)和观察组(n=30),对照组患者实施不留置胃管常规护理,观察组患者实施不留置胃管联合咀嚼口香糖护理,比较分析两组患者的围手术期指标、并发症总发生率、胃肠道功能恢复情况、再入院情况、患者满意度等。结果观察组的排气、排便、住院时间均短于对照组,差异有统计学意义(P<0.05);观察组的并发症总发生率低于对照组,差异有统计学意义(P<0.05)。观察组的胃肠道功能恢复优良率高于对照组,差异有统计学意义(P<0.05)。两组患者再入院率比较,差异无统计学意义(P>0.05);观察组总满意度高于对照组,差异有统计学意义(P<0.05)。结论在腹腔镜结直肠癌手术患者的治疗中,对患者实施不留置胃管联合咀嚼口香糖护理,可以缩短患者术后肛门排气排便时间和住院时间,同时减少肠梗阻等并发症的发生,促进患者胃肠道功能的恢复,实施效果较好,值得推广。

食管癌术后再发上消化道恶性肿瘤的外科手术治疗

目的总结食管癌术后再发上消化道恶性肿瘤外科手术治疗的临床经验。方法回顾性分析我院2018年1月~2022年6月收治的16例食管癌术后再发上消化道恶性肿瘤病人的临床资料。结果16例病人均成功完成手术,无围手术期死亡发生,累计住院时间18~38天。术后肺部感染者2例,呼吸衰竭者1例,颈部吻合口漏1例,经保守治疗后治愈。术后随访均可正常进食,未发现肿瘤复发转移。结论对于食管癌术后再发上消化道恶性肿瘤的病人,若病变较为局限,外科手术治疗疗效可靠。

腹腔镜胃癌手术空肠造口与鼻饲管优劣对比

目的分析腹腔镜下胃癌根治术空肠造口和鼻饲营养管的优劣。方法收集2019年01月-2021年01月期间接受的胃癌手术患者共计150例。按照空肠造口和鼻饲营养管的不同分为两组,空肠造口组(n=74例,行空肠造口)和鼻饲营养管组(n=76例,行鼻饲营养管)。密切观察两组患者手术持续时间、术后肺炎、腹腔感染、吻合口漏的预防和治疗以及患者的耐受性、拔管难易、造口并发症、住院时间等指标,并比较两者的优劣。结果空肠造口组术后肺炎、拔管困难、造口并发症发生率均多于鼻饲营养管组(P<0.05);鼻饲营养管组术后腹腔感染多于空肠造口组(P<0.05);两组患者在手术持续时间、住院时间、吻合口漏的预防和治疗上均无明显差异(P>0.05)。结论空肠造口和鼻饲营养管均可用于吻合口漏的预防和治疗,但空肠造口具有较高的并发症风险。

食管癌改良管状胃手术和相关技术的研究进展

食管癌是常见的消化系统恶性肿瘤,其发病率和总死亡率在全球癌症范围内排在前列,对癌症患者具有较大的威胁。近年来,虽然我国食管癌发病率总体呈下降趋势,但仍属于食管癌高发地区,食管癌的诊治问题仍不容忽视。目前,食管癌的治疗仍是以外科为主的综合治疗模式,通过手术切除病变部位是根治食管癌的主要手段。随着外科手术技术的发展,管状胃代食管成为最常用的食管重建方式,该方式与以往的全胃代食管方式相比有着明显的优势,但仍会出现吻合口瘘、吻合口狭窄、胃食管反流等相关并发症。为了进一降低术后并发症的发生率,提高患者生活质量,大量研究对管状胃进行了革新和发展,使得管状胃技术更加的成熟和实用,同时荧光血管成像技术、机器人辅助手术技术等相关领域的改进与普及也为管状胃的发展提供了新的思路。多学科多领域的综合发展也为食管癌的ERAS方案提供了支持。本文对近年来管状胃成形术以及其改良术式的研究情况、其他相关技术的发展和应用前景进行综述。

管状胃与全胃代食管术治疗食管癌的疗效比较

目的比较管状胃代食管术与全胃代食管术治疗食管癌的临床疗效。方法回顾性分析2007年1月至2012年1月在我院接受食管癌手术患者的病例资料;比较管状胃组(n=53)和全胃代食管组(n=48)患者在术中吻合口位置、术中出血量、手术时间、术后胃肠减压时间、胃肠减压量、胸腔闭式引流管拔除时间、胸腔引流液量、术后并发症发生情况及术后1个月的肺功能等临床指标上的差异。结果管状胃组患者术后反流性食管炎的发生率为5.7%(3/53),低于全胃组的25.0%(12/48),差异具有统计学意义(P=0.01);管状胃组无术后胸胃综合征,全胃组的发生率为8.3%(4/48);管状胃组术后1个月的肺活量占预计值的百分比、最大通气量占预计值的百分比及第一秒用力呼气容积占预计值的百分比均显著高于全胃组,差异均有统计学意义(P<0.01)。结论管状胃代食管术较全胃代食管术可降低术后反流、胸胃综合征的发生率,且对患者术后呼吸功能影响较小。

左胸小切口配合管状胃在食管癌切除术中的疗效分析

目的探讨经左胸小切口配合管状胃在食管癌切除术中的临床疗效。方法选取100例胸段食管癌患者随机分为两组,每组均为50例。观察组采用经左胸小切口配合管状胃进行治疗,对照组给予Sweet手术治疗,比较两组开胸失血量、手术时间、术后胸腔引流量、心肺并发症、住院时间、切缘癌残留情况。结果观察组开胸出血量(8.9±1.98)ml,心肺并发症2例,术后第一天胸腔引流量(8.9±1.98)ml,第二天胸腔引流量(65±11.7)ml,切缘癌残留0例,住院时间(10.1±2.72)d,均明显低于对照组,组间差异有统计学意义(P<0.05);观察组手术时间[(183.3±23.1)min]与对照组[(170.3±30.2)min]比较,无统计学意义(P>0.05)。结论采用经左胸小切口配合管状胃对食管癌进行治疗,不仅具有患者术后创伤小,出血少,且患者术后疼痛轻,能够快速得到恢复等优点,值得在临床中大力推广。

管状胃对食管癌手术后呼吸功能的影响

目的探讨管状胃在食管癌手术中的应用及其对术后呼吸功能的影响。方法 2008年1月至2009年12月对62例胸中上段食管癌患者行三切口食管切除+管状胃代食管左颈食管胃吻合术(管状胃组),分别于术前1周,术后第1周及第3周检查肺功能。并与同期收治的行常规三切口手术左颈食管胃吻合的64例胸中上段食管癌患者(对照组)进行比较。结果 126例患者手术均成功,无手术死亡。术后吻合口瘘、切口感染等并发症发生率22.5%。术后第1周两组的呼吸功能差别无明显差别(P>0.05),术后第3周管状胃组呼吸功能指标有明显改善,好于对照组,差异有显著性(P<0.05)。结论管状胃代食管术相比传统胃代食管术对患者术后呼吸功能影响更小。

管状胃代食管与传统食管癌手术后肺部并发症的对比研究

目的探讨管状胃代食管与传统食管癌手术后肺部并发症的比较研究。方法按手术方式将228例食管癌患者分为管状胃(A)组92例,和传统手术(B)组136例。临床资料,其中男137例,女91例;年龄31～72岁,平均年龄62.36岁,手术均采用改良Ivor-Lewis术式,统计两组术后各种肺部并发症的发生率。结果 228例食管癌患者中管状胃组合并肺部并发症18例,传统手术组术后合并肺部并发症36例。结论管状胃代食管可明显减轻及减少食管癌术后肺部并发症。

管状胃在食管癌根治术中的应用

目的观察管状胃在食管癌根治术中的应用效果。方法将食管癌患者80例,按随机数字表法分为两组,每组40例,均行食管癌根治术加消化道重建术,对照组采用全胃代替食管重建消化道,研究组采用管状胃代替食管重建消化道,观察两组手术时间、住院时间及术后并发症发生率。结果研究组术后吻合口瘘、反流性食管炎、肺部感染等总并发症发生率明显低于对照组(P<0.05),但手术时间、住院时间明显短于对照组(P<0.05)。结论管状胃代替食管重建消化道在食管癌根治术中的应用效果好,手术时间较短,术后并发症发生率低。

机器人辅助腹腔镜前列腺癌根治术后胃管拔除时机的探讨

目的 探讨机器人辅助腹腔镜前列腺癌根治性切除术后胃管拔除的最佳时机.方法 选择2012年7月～2013年6月解放军总医院收治的行机器人辅助腹腔镜前列腺癌根治术的患者110例为研究对象,按病区不同分为实验组（n=52）和对照组（n=58）.实验组术后24h内拔除胃管,对照组术后肛门排气后拔除胃管,比较两组患者术后住院时间、肛门排气时间及下床活动时间.结果 ①实验组术后住院天数[（6.67±3.21）d]少于对照组[（8.90±6.21）d],差异有高度统计学意义（P＜0.01）;②实验组术后＜24h、48～＜ 72 h、≥96 h肛门排气患者所占比例分别为1.92％、42.32％、1.92％,与对照组（0.00％、39.66％、6.89％）比较,差异均无统计学意义（P＞0.05）;实验组患者术后24～＜ 48 h、72～＜ 96 h肛门排气时间所占比例（46.15％、7.69％）高于对照组（29.31％、24.14％）,差异有统计学意义（P＜0.05）.③实验组术后＜24h、24～＜ 48 h、48～＜ 72 h、72～＜ 96 h、≥96 h下床活动患者所占比例分别为19.23％、42.31％、36.54％、1.92％、0.00％,与对照组（3.46％、27.58％、22.41％、31.03％、15.52％）比较,差异均有统计学意义（均P＜ 0.05）.结论 前列腺癌行机器人辅助腹腔镜根治性切除术患者尽早拔除胃管,有利于促进患者康复,提高患者舒适度,减少患者住院期间费用,提高护理人员工作效率.

管状胃重建消化道在食管癌手术中的应用

目的:探讨管状胃在食管癌手术中的意义和术后结果。方法:收集食管癌病例200例,分成研究组和对照组。研究组行管状胃成形胃代食管吻合术,对照组行常规胃代食管吻合术式。分析术后并发症,测定术后14天和1月肺功能,术后14天胸胃排空时间,并随访观察患者生活质量。结果:术后14天和1月,研究组患者肺功能各指标改善比对照组明显,差异有统计学意义(p<0.05);术后两组的并发症比较无明显差异(p>0.05);术后两组的每次平均进食量和食物通过上消化道的平均时间无明显差异(p>0.05);研究组无胸胃潴留。结论:管状胃能减少胸胃潴留和有效地改善肺功能。

胃癌手术无胃肠减压的安全性及意义

胃癌患者的围手术期常规放置鼻胃肠减压(nasogastric decompression,ND),作为一种习惯与传统,却一直延用至今.一般认为,对于胃肠道的手术,放置ND可以降低吻合部位内部压力,减少吻合口漏概率.但迄今并没有严格科学的循证医学证据,特别是前瞻性研究结论.近年来多项研究表明术后常规ND不能缩短肠道功能恢复的时间及降低吻合口漏发生率,不行ND并未增加吻合口漏的风险,各种胃癌手术均可安全地在无ND状态下顺利完成,极大地减少患者痛苦,术后恢复加快,同时医护人员工作量显著降低.对于术前有幽门梗阻、出血的患者,如果术前放置ND,术后患者清醒后即可拔除,无ND技术对于胃癌手术是安全的,值得临床推广使用.故本文针对胃癌手术无胃肠减压的安全性及意义作一综述.

视频喉镜辅助胃癌患者术中置入鼻肠管的效果观察

目的探讨视频喉镜辅助胃癌患者术中置入鼻肠管的应用效果。方法选取2017年3-9月在我院行根治性全胃切除术的80例患者,按随机数字表将入选患者分为对照组和观察组,每组各40例。对照组采用传统的经鼻盲探下置入鼻肠管,观察组采用视频喉镜辅助鼻肠管置入方法。比较2组患者置管时间、一次置管成功率、鼻腔出血发生率及术后当天咽喉疼痛程度。结果 2组患者鼻肠管的置管时间比较差异无统计学意义(P>0.05);观察组患者鼻肠管的一次置管成功率高于对照组,鼻腔出血发生率、术后当天咽喉疼痛程度低于对照组(均P<0.05)。结论胃癌患者术中置入鼻肠管采用视频喉镜辅助,可提高一次置管成功率,降低鼻腔出血发生,减轻咽喉疼痛程度。