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。
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.
目的探討殘胃癌的臨床特點和診治方法。方法對1989~2003年收治的15例殘胃癌病例資料進行回顧性分析，觀察不同手術方式對預后的影響。結果B-Ⅱ式手術后殘胃癌發病率遠高于B-Ⅰ式手術； 根治性手術切除8例，根治性切除率為53.3%（8/15）； 根治性手術切除患者2年以上生存率為62.5%（5/8），姑息性手術切除患者術后平均生存時間不足1年。結論早期診斷和根治性切除是殘胃癌預后的重要因素。
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。
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。