目的 探讨胃大部切除术中应用直线型切割缝合器的临床经验及优点。方法 总结直线型切割缝合器的使用方法，并比较分析传统胃大部切除术和采用直线型切割缝合器行胃大部切除术的手术时间和术后并发症。结果 使用直线型切割缝合器使手术时间缩短60～120 min (P=0.000)，术后出血并发症明显减少(P=0.024)。结论 应用直线型切割缝合器行胃大部切除术可以缩短手术时间和减少术后出血的发生。
Objective To evaluate the effect of total gastrectomy (TG) and proximal gastrectomy (PG) for the treatment of advanced esophagogastric junction cancer. Methods Clinical data of 273 cases of advanced esophagogastric junction cancer who underwent TG and PG in our hospital from Jan. 2004 to Dec. 2010 were reviewed for retrospective analysis. Operation related indexes, 3-year cumulative survival rate, and 5-year cumulative survival rate were compared and evaluated. Results There was no significant difference between TG group and PG group in intraoperative blood loss, operation time, and hospital stay(P > 0.05), but the number of dissected lymph nodes in TG group was obviously more than those of PG group, and the difference was statistically significant(P=0.000). The postoperative complication rates were 10.3%(12/117)in TG group and 21.8%(34/156) in PG group respectively, which was lower in TG group(χ2=6.353, P < 0.05). The 3-year and 5-year cumulative survival rates of TG group were 58.9% and 34.2%, of PG group were 43.4% and 23.6% respectively, and the 3-year and 5-year cumulative survival rates were all lower in PG group(χ2=5.894, P < 0.05;χ2=5.582, P < 0.05). For patients in stage pT4, pN2, and TNMⅢ, whose tumor size were bigger than 3.0 cm, and patients who had accept chemotherapy, the 3-and 5-year cumulative survival rates of TG group were significantly higher than those of PG group(P < 0.05). However, for patients in stage pT2, pT3, pN0, pN1, pN3, TNMⅠ, TNMⅡ, TNMⅣ, whose tumor size were smaller than 3.0 cm, who had not accept chemotherapy, and patients of any pathological type, there was no statistically significant difference between the 2 groups in 3-year and 5-year cumulative survival rates(P > 0.05). Conclusion For the patients who suffered from advanced esophagogastric junction cancer, TG can improve long-term survival rate, and it can significantly reduce the incidence of postoperative complications and improve postoperative quality of life.
ObjectiveTo compare clinical outcome between single-incision laparoscopic subtotal gastrectomy (SILSG) versus laparoscopy-assisted subtotal gastrectomy (LASG) in treatment of benign gastric ulcer and duodenal ulcer. MethodsClinical data of 37 patients with benign gastric ulcer or duodenal ulcer who underwent laparoscopic subtotal gastrectomy between Jan. 2008 and Feb. 2015 at Shengjing Hospital of China Medical University was collected retrospectively. Among them, 15 patients underwent SILSG and 22 patients underwent LASG. Demographic, intraoperative, and postoperative data was analyzed and compared between the 2 groups. ResultsThe operative time of SILSG group was significantly longer than that of LASG group (P < 0.050). However, the postoperative hospital stay was significantly shorter (P < 0.050), and the total patient scar assesment scale (PSAS) score was significantly lower (P < 0.050) in the SILSG group than those of LASG group. There was no significant difference between the 2 groups with respect to other variables (P > 0.050), such as conversion rate, intraoperative blood loss, postoperative exhaust time, incidence of complication, and visual analog scale score of pain. All patients received postoperative follow up, and the period ranged from 6 months to 25 months, with a median of 11 months. During the follow up period, no one suffered from incision hernia and recurrence of ulcer. ConclusionCompared with LASG, SILSG is a technically feasible procedure with better cosmesis and equivalent curability.
目的 探讨预防胃大部切除术后碱性返流性胃炎的术式。方法 回顾性分析1998年6月至2008年12月期间我科收治的42例行胃大部切除术患者的临床资料，根据不同术式分为传统Billroth-Ⅱ（简称B-Ⅱ）式组（n=21）和改良B-Ⅱ式组（n=21），对2组患者术后胃肠引流液的量、剑突下持续烧灼痛、胆汁性呕吐、体重减轻以及肠胃液返流情况进行比较。结果 传统B-Ⅱ式组胃肠引流液量平均为（300±50） ml，而改良B-Ⅱ式组胃肠引流液量平均为（100±40） ml,2组间比较差异有统计学意义（P＜0.05）。传统B-Ⅱ式组剑突下持续烧灼痛12例，胆汁性呕吐8例，体重减轻1例； 而改良B-Ⅱ式组仅出现1例剑突下持续烧灼痛和1例体重减轻，未见胆汁性呕吐病例，2组间比较差异有统计学意义（P＜0.05）。传统B-Ⅱ式组发生轻度返流9例，重度返流12例; 改良B-Ⅱ式组仅2例发生轻度返流，1例重度返流，其余均未见返流，2组间比较差异有统计学意义（P＜0.05）。结论 与传统B-Ⅱ式相比，改良B-Ⅱ式的碱性返流性胃炎发生率明显降低，术后效果满意。
ObjectiveTo summarize the procedure of transumbilical single incision laparoscopic surgery (SILS) with conventional laparoscopic instruments for different tumor diameter and different site of gastric stromal tumor. MethodThe clinical data, intraoperative procedure, and postoperative recovery of 34 patients with gastric stromal tumor from December 2009 to February 2014 in this hospital were analyzed retrospectively. ResultsThe transumbilical SILS was performed successfully in all the 34 patients.Among these patients, the wedge resection of stomach was perfor-med in 27 patients, distal subtotal gastrectomy was performed in 6 patients, distal subtotal gastrectomy complicated with multivisceral resection was performed in 1 patient.The pathology confirmed that the diameter of tumors was from 0.6 cm to 10.0 cm (average 3.4 cm).The resection margins were tumor free.The risk assessment showed that tumors with extremely low risk were in 9 cases, low risk were in 17 cases, intermediate risk were in 6 cases, high risk were in 2 cases.During surgery, 9 tumors were located on the fundus of stomach, 6 tumors on the gastric greater curvature, 7 tumors on the gastric lesser curvature, 2 tumors on the anterior and posterior wall of the stomach respectively, 3 tumors on the cardia below, 4 tumors on the gastric antrum, tumor invaded the surrounding organs in 1 case.There was no conversion to open or conventional laparoscopic surgery.no intraoperative or postoperative complications were experi-enced in all the patients except one was postoperative intraperitoneal bleeding and one was incision infection.All the patients were followed for an average of 25 months (range 3-49 months), there was no evident recurrence of disease. ConclusionsThe transumbilical SILS for gastric stromal tumor is a feasible and safe technique when performed by an experienced laparoscopic surgeon.The suitable procedure of SILS should be selected for gastric stromal tumor according their different size and location.
目的探讨Billroth-Ⅱ胃大部切除术后输入袢梗阻的诊断和手术方式。 方法本组共17例输入袢梗阻患者，对17例患者的手术史、临床表现及影像学资料进行总结分析。 结果典型的输入袢梗阻表现为上腹胀痛、上腹部触及张力较高且有压痛的囊性包块，腹部CT检查见腹主动脉与肠系膜上动脉之间横向走行的扩张肠管。17例患者均再次行剖腹探查术，术中见输入袢扩张，5例行Braun吻合术，12例行Roux-en-Y吻合术。术后无严重合并症，无围手术期死亡，患者均恢复顺利，梗阻症状消失。术后随访1～4年（平均2.5年），经X线胃肠钡餐检查见吻合口钡剂通过顺利，无狭窄；胃镜检查未见胆汁反流。 结论严格遵守正确的手术操作常规是预防输入袢梗阻的关键；经腹部CT诊断明确后，应尽早再手术；Braun吻合术及Roux-en-Y吻合术为胃大部切除术后输入袢梗阻较理想的术式。
目的评价Roux-en-Y胃空肠吻合术在远端胃大部切除消化道重建中的临床价值。 方法对笔者所在医院科室2009年1月至2012年7月期间31例远端胃癌行Roux-en-Y消化道重建患者的临床资料进行回顾性分析。 结果全组病例无围手术期死亡，无吻合口漏、十二指肠残端瘘、输入空肠段梗阻及倾倒综合征发生。28例（90.3%）患者术后半年进食3～4次/d，每餐量150～400 g；血红蛋白110～150 g/L，血清白蛋白38～50 g/L；24例（77.4%）患者体质量恢复或超过术前水平。胃镜检查未发现反流性食管炎，有残胃炎表现者3例，但无临床症状。 结论Roux-en-Y胃空肠吻合术可成为远端胃大部切除消化道重建的主要术式。
Objective To evaluate clinical efficacy of mFOLFOX6 combined with aspirin in treatment of advanced gastric cancer following perioperative period of laparoscopic distal subtotal gastrectomy. Methods One hundred and seven patients with advanced gastric cancer were assigned to observation group (57 cases) and control group (50 cases). The patients in the observation group received the mFOLFOX6 chemotherapy and regular intake of aspirin (100 mg/d) and the control group received the mFOLFOX6 chemotherapy alone. The recurrence or metastasis rate, rate of disease progress, toxicity, median survival time, and 3-year survival rate were compared between the observation group and the control group. Results ① There were no significant differences in the gender, age, pathological type, and so on between the observation group and the control group (P>0.05). ② The rates of toxicity such as the white blood cell reduction, granulocyte reduction, thrombocytopenia had no significant differences in these two groups (P>0.05). ③ The follow-up time was 4–45 months with an average 3.5 years, the rate of disease progress was lower (P=0.032), the median survival time was longer (P=0.043), the cumulative 3-year overall survival (P=0.015) and the cumulative 3-year disease-free survival (P=0.037) were better in the observation group as compared with the control group. Conclusion Preliminary results in this study show that mFOLFOX6 regimen combined with low-dose aspirin could significantly improve efficacy of advanced gastric cancer following perioperative period of laparoscopic distal subtotal gastrectomy, reduce rate of disease progress, and improve survival rate without increasing side effects.