ObjectiveTo study and analyse the correlation between biologic behavior and clinical factors in gastric cancer.MethodsClinical and pathological study of carcinoma of stomach were retrospectively made in 1034 patients. ResultsIn this series,148 of 1034 patients (14.3%) were early gastric cancer.The frequency of lymph nodes metastasis was higher in proximal gastric cancer than distal (P＜0.0001).Similar frequency can also be seen in the tumor of larger diameter (P＜0.01),deeper invasion (P＜0.0001) and poor differentiation (P=0.004).Some difference in ages and sex of patients may be found on the invasion (P=0.003),differentiation (P＜0.0001),site (P＜0.001) and frequency of lymph nodes metastasis of the tumor (P=0.01).In multifactorial multivariate linear regression analysis,the site of tumor (P=0.003),diameter of tumor (P＜0.0001),depth of tumor infiltration (P＜0.0001) and the cell differentiation showed significant association with lymph node metastasis,in which the female patient had more lymph node metastasis than male (P＜0.001).Depth of tumor infiltration was the most important factor in lymph node metastasis.Numbers of lymph nodes resected were much more in total and distal gastrectomies than that in proximal gastrectomy (P＜0.0001). ConclusionThe results of this study suggest that radical gastrectomy with lymphadenectomy is necessary even in all stages of gastric cancer.
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 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。
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。
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。
目的探讨残胃癌的临床特点和诊治方法。方法对1989~2003年收治的15例残胃癌病例资料进行回顾性分析，观察不同手术方式对预后的影响。结果B-Ⅱ式手术后残胃癌发病率远高于B-Ⅰ式手术； 根治性手术切除8例，根治性切除率为53.3%（8/15）； 根治性手术切除患者2年以上生存率为62.5%（5/8），姑息性手术切除患者术后平均生存时间不足1年。结论早期诊断和根治性切除是残胃癌预后的重要因素。
目的 探讨胃大部切除术后残胃功能性排空障碍（FDGE）的发病机理、诊断及治疗。方法 对1993~1998年我科256例胃大部切除术患者的临床资料进行回顾性分析。结果 本组共发生FDGE 12例，发生率为4.7％(12/256)，均发生于术后3~12天。于1周内治愈1例(8.3％)，2周内治愈8例(66.7%)，3周内治愈11例(91.7%)； 所有患者于32天之内经保守治疗治愈出院。结论 术后残胃和远端空肠正常的运动功能破坏是发生FDGE的主要原因； 消化道造影及胃镜检查是诊断本病及与机械性梗阻相鉴别的重要方法； 采取非手术治疗一般可治愈，针对胃排空动力学机理采用促胃肠动力药物能收到较好的疗效。