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.
目的評價Roux-en-Y胃空腸吻合術在遠端胃大部切除消化道重建中的臨床價值。 方法對筆者所在醫院科室2009年1月至2012年7月期間31例遠端胃癌行Roux-en-Y消化道重建患者的臨床資料進行回顧性分析。 結果全組病例無圍手術期死亡，無吻合口漏、十二指腸殘端瘺、輸入空腸段梗阻及傾倒綜合征發生。28例（90.3%）患者術后半年進食3～4次/d，每餐量150～400 g；血紅蛋白110～150 g/L，血清白蛋白38～50 g/L；24例（77.4%）患者體質量恢復或超過術前水平。胃鏡檢查未發現反流性食管炎，有殘胃炎表現者3例，但無臨床癥狀。 結論Roux-en-Y胃空腸吻合術可成為遠端胃大部切除消化道重建的主要術式。
目的 探討胃大部切除術后吻合口潰瘍的診治方法。方法 1985年3月至2008年6月期間蘭州大學第一醫院收治的胃大部切除術后吻合口潰瘍患者29例，均經胃鏡證實，其中男16例，女13例； 年齡30～51（40±3.0）歲； 19例為十二指腸球部潰瘍術后，10例為胃潰瘍術后。初次手術到潰瘍再發癥狀的時間，最短1例為1個月，其余28例為3～4年。2例吻合口潰瘍穿孔及4例吻合口潰瘍出血者行包括吻合口在內的殘胃部分切除、胃空腸Roux-Y吻合術； 其余均給予非手術治療。結果 行再手術治療者術后發生切口感染1例，行保守治療； 所有患者均治愈，隨訪1～5年，未出現潰瘍復發。結論 吻合口潰瘍首選保守治療，多數可治愈。再次手術方式可采用殘胃部分切除加胃空腸Roux-Y吻合術。
目的探討Billroth-Ⅱ胃大部切除術后輸入袢梗阻的診斷和手術方式。 方法本組共17例輸入袢梗阻患者，對17例患者的手術史、臨床表現及影像學資料進行總結分析。 結果典型的輸入袢梗阻表現為上腹脹痛、上腹部觸及張力較高且有壓痛的囊性包塊，腹部CT檢查見腹主動脈與腸系膜上動脈之間橫向走行的擴張腸管。17例患者均再次行剖腹探查術，術中見輸入袢擴張，5例行Braun吻合術，12例行Roux-en-Y吻合術。術后無嚴重合并癥，無圍手術期死亡，患者均恢復順利，梗阻癥狀消失。術后隨訪1～4年（平均2.5年），經X線胃腸鋇餐檢查見吻合口鋇劑通過順利，無狹窄；胃鏡檢查未見膽汁反流。 結論嚴格遵守正確的手術操作常規是預防輸入袢梗阻的關鍵；經腹部CT診斷明確后，應盡早再手術；Braun吻合術及Roux-en-Y吻合術為胃大部切除術后輸入袢梗阻較理想的術式。
ObjectiveTo explore the effect of exogenous ghrelin on early recovery of rats after subtotal gastrectomy. MethodsTwelve rats undergoing subtotal gastrectomy (B-Ⅰtype) were randomly divided into two groups, and saline or ghrelin was intraperitoneally injected in two groups, respectively. The body weight and daily food intake were measured before operation and on 1-7 d after operation. Rats were killed on day 7 after operation and the expressions of ghrelin mRNA in the fundus of stomach and anastomotic stoma was determined by realtime fluorescent quantitative PCR assay. The anastomotic bursting pressure and hydroxyproline content of anastomotic stoma tissues were also detected. ResultsThere was no significant difference (P＞0.05) in pre and postoperative body weight between two groups. Gradual decrease in postoperative body weight among the rats of saline group was observed which was significantly lower than that before operation (Plt;0.01). Body weight reached it’s lowest on day 1 after operation (Plt;0.01), after which it gradually increased but was still lower than that before operation (Plt;0.01). The postoperative body weight of rats in ghrelin group gradually decreased too, and was also significantly lower than preoperative body weight (Plt;0.01), except for the day 1 after operation (P=0.693). It reached the lowest on day 4 after operation (Plt;0.01), then it gradually increased but was still lower than that before operation (Plt;0.05 or Plt;0.01). The cumulative food intake of rats in ghrelin group was （52.50±6.77） g, which was significantly higher than that in saline group 〔(45.67±7.47) g〕, Plt;0.05. On day 7 after operation, relative expression of ghrelin mRNA in the fundus of stomach of rats in ghrelin group was 0.08±0.04, which was significantly lower than that in saline group (0.22±0.07), Plt;0.01. Compared with saline group, ghrelin-treated rats displayed significantly higher bursting pressure 〔（155.83±6.62） mm Hg vs. （172.33±10.44） mm Hg, Plt;0.05〕 higher hydroxyproline content 〔 (0.43±0.05) μg/mg wet tissue vs. （0.50±0.29） μg/mg wet tissue, Plt;0.01〕 at the anastomotic stoma. ConclusionGhrelin may effectively promote the early recovery of rats after subtotal gastrectomy.
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.
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.
目的 探討預防胃大部切除術后堿性返流性胃炎的術式。方法 回顧性分析1998年6月至2008年12月期間我科收治的42例行胃大部切除術患者的臨床資料，根據不同術式分為傳統Billroth-Ⅱ（簡稱B-Ⅱ）式組（n=21）和改良B-Ⅱ式組（n=21），對2組患者術后胃腸引流液的量、劍突下持續燒灼痛、膽汁性嘔吐、體重減輕以及腸胃液返流情況進行比較。結果 傳統B-Ⅱ式組胃腸引流液量平均為（300±50） ml，而改良B-Ⅱ式組胃腸引流液量平均為（100±40） ml,2組間比較差異有統計學意義（P＜0.05）。傳統B-Ⅱ式組劍突下持續燒灼痛12例，膽汁性嘔吐8例，體重減輕1例； 而改良B-Ⅱ式組僅出現1例劍突下持續燒灼痛和1例體重減輕，未見膽汁性嘔吐病例，2組間比較差異有統計學意義（P＜0.05）。傳統B-Ⅱ式組發生輕度返流9例，重度返流12例; 改良B-Ⅱ式組僅2例發生輕度返流，1例重度返流，其余均未見返流，2組間比較差異有統計學意義（P＜0.05）。結論 與傳統B-Ⅱ式相比，改良B-Ⅱ式的堿性返流性胃炎發生率明顯降低，術后效果滿意。