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??Diagnosis and management for synchronous multitumors of the gastrointestinal carcinoma and gastrointestinal stromal tumor YE Ying-jiang, GAO Zhi-dong, WANG Shan. Department of Gastrointestinal Surgery, Peking University People’s Hospital, Beijing 100044, China
Corresponding author: WANG Shan, E-mail: shwang60@263.net.
Abstract Gastrointestinal stromal tumor (GIST) is the most common mesenchymal tumor of the gastrointestinal tract, accounting for 5% of all sarcoma in soft tissue. Retrospective studies showed 10%??30% of GISTs are completely asymptomatic at presentation, being found incidentally at surgery, radiographic imaging, endoscopy and even identified as chance findings at autopsy. Little is known about the actual incidence of incidental GIST with other gastrointestinal malignancy. The multitumors have been reported rarely. However, with the advances in understanding of GIST nature and inspection methods, the incidence rate may be underestimated.     

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胃肠肽类激素是指传统的激素和许多可通过旁分泌神经分泌、自分泌和外分泌等方式 ,介导细胞间信息传递 ,发挥激素和局部递质效应的胃肠肽。　　胃肠肽类激素对胃肠道运动功能的调控形式为兴奋和(或 )抑制 ,即促进和 (或 )抑制作用。胰岛素和胰高糖素虽属胃肠肽类激素 ,但由于其功能特殊 ,故不在此讨论。1　兴奋型胃肠肽类激素1 1　胃动素 (ｍｏｔｉｌｉｎ)　　胃动素是由 2 2个氨基酸组成的多肽。主要存在于十二指肠和近端空肠粘膜内分泌细胞中 ,胃底、胃窦、远端小肠粘膜以及中枢、外周和胃肠道壁内神经系统中也有胃动素存在。人类胃动素基…     

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目的 探讨胃癌病人淋巴结转移个数与胃癌人预后以及病理参数之间的关系。方法 对１７４例有淋巴结转移的胃癌病人行胃癌根治术加Ｄ２或Ｄ３淋巴结清扫,分析淋巴结转移阳性个数、部位与预后及病理参数之间的关系。结果 胃癌要治术后（Ｄ２、Ｄ３）５年生存率为２９．５９％（５０例）。阳性淋巴结个数为１～５个时５年生存率为４６．６７％（３３例）,大于５个的为１７．３５％（１７例）（Ｐ〈０．００５）。５年生存率随着阳性     

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目的 研究胃癌病人血清胃泌素（Gs）含量升高的原因。方法 应用放免法测定胃癌病人血清Cs含量,并分析其与胃癌发生部位、临床病理分期、预后的关系以及手术前后血清Gs的变化。结果 胃口地底贲门癌病人血清Gs值明显升高,而胃窦癌、胃体癌血清Gs值与正常对照组接近;随着胃癌临床病理分期的进展,血清Gs含量逐渐升高;胃癌术后2周血清Gs含量虽明显下降,但术后3个月恢复到与术前水平相当;对41例不能手术切除的胃癌病人进行随访,发现生存期超过1年者血清Gs含量与生存期未超过1年者接近。结论 胃癌病人血清Gs升高是一种继发性改变,不能作为一种肿瘤标志物,也不能作为一个预后因素。     

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??Choices and evaluation of digestive tract reconstruction for patients with gastrointestinal stromal tumor of esophagogastric junction LIANG Han. Department of Gastric Cancer Surgery, Tianjin Medical University Cancer Institute & Hospital; National Clinical Research Center for Cancer, Tianjin 300060,China
Abstract Local resection and proximal gastrectomy are the main choices for gastrointestinal stromal tumor which located in esophagogastric junction. The prerequisite for local resection is safety margin and preserving of the Zigzag line. The reconstruction after proximal gastrectomy includes esophagus-gastric tube anastomosis, among which patients with esophagogastric tube anterior wall anastomosis provides good effect to prevent reflux symptoms; Kamikawa procedure with double flap technique which is considered a promising approach to the prevention of reflux after esophagogastectomy; jejunal interposition maybe a good candidate for reconstruction and uncut interposition can simplify the procedure; double-tract reconstruction is a common procedure which can prevent postoperative anemia and vitamin B12 deficiency.     

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随着胃癌现代外科治疗理论的发展和技术进步 ,对复发胃癌及晚期胃癌的外科治疗观念发生了改变 ,过去对此类胃癌多采取消极的态度。近年来 ,由于对复发胃癌的复发形式、生物学特点的深入了解 ,诊断技术的进步 ,外科营养及外科治疗水平的提高 ,对某些病例采用积极的外科治疗 ,取得了一定的疗效。胃癌的复发外科治疗将成为胃癌治疗领域里的新课题。1　胃癌的复发机制和形式复发的机制可分为两类 :一类是连续性复发 :从残留的原发病变连续生长 ,大多为切断端复发。另一类是非连续性复发 :有微小转移癌灶在组织间隙、淋巴管内形成癌栓、着床、增…     

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??New treatment modalities for Japanese gastric cancer treatment guidelines and classification HU Xiang. Ddepartment of Gastrointestinal Surgery . the First Affiliated Hospital of Dalian Medical University,Dalian 116011,China
Abstract The Japanese Gastric Cancer Treatment Guidelines (referred to as Guidelines) and Japanese Classification of gastric carcinoma(referred to as Classification) have a significant impact on the global treatment for gastric cancer. Based on the latest research results, "classification" and "guidelines" will be revised again in 2017. In 2016 , The88th Japanese gastric cancer association discussed the future revisions, protocol will revise the sub classification of regional lymph nodes, the criteria of peritoneal metastasis, pathological classification and other related content complement. The "guidelines" part mainly focused on chemical therapy (recommend new drugs and chemotherapy), endoscopic treatment (indication expanded). The revised version of the "classification" and "guidelines" will be published in 2017, the revision is based on the latest research results, will have a significant impact on clinical diagnosis and treatment.     

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进展期胃下部癌占我国胃癌的主要部分,远端胃大部切除是主要的外科治疗方法之一。消化道重建方式是影响远端胃大部切除术后生存质量的重要因素。传统的重建方式为Billroth Ⅰ式或Billroth Ⅱ式。从保留十二指肠通路或抗胆汁反流角度,重建方式进行了多种改良,包括BillrothⅡ式+Braun吻合、Roux-en-Y吻合术、单管空肠间置、空肠贮袋间置、双通道重建。目前研究结果认为,Roux-en-Y吻合术是改善生存质量、可行性与可推广性均较理想的方式。     

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目的 探讨胃术后胃无力症的病因和治疗。方法 对1997年1月至2002年6月475例胃切除术后发生胃无力症的35例病人进行病因和治疗观察分析。结果 胃切除术后胃无力症以精神因素为主，以高龄者居多（中位年龄66．5岁），治疗上尚无肯定的有效办法，适当的刺激病人呕吐可能有利于本病的恢复。结论 胃切除术后胃无力症的发生是由综合因素引起，精神因素和高龄可能为主要因素，治疗上应消除病人紧张情绪加强营养支持（空肠内置管行肠内营养），目前尚无哪种药物对该病有的效果，适当的刺激病人呕吐可能有利于病人的恢复。     

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目的 进一步评价短袢Ｒｏｕｘ－ｅｎ－Ｙ吻合术的抗返流效果,探讨Ｒｏｕｘ淤积综合征的防治方法。方法 随访１９８９年７月至１９９７年６月完成的胃癌切除胃空肠短袢Ｒｏｕｘ－ｅｎ－ｙ吻合术１５１例,通过症状调查。消化道钡餐、罗镜并活检、Ｂ超、ＣＴ检查确定短袢Ｒｏｕｘ－ｅｎ－Ｙ吻合术的抗返流效果及Ｒｏｕｘ淤积综合征的发病率。结果 １４３例（９５％）获随访结果,未发现有明显症状的返流性胃炎,无倾倒综合征和Ｒｏｕｘ淤积综合征。结论 扩大胃的切除范围,同时缩短Ｒｏｕｘ袢的长度可防治Ｒｏｕｘ淤积综合征,对空肠吻合口进行抗返流加工,短袢Ｒｏｕｘ－ｅｎ－Ｙ吻合抗返流效果满意。     

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目的：探讨全胃切除术后合理的消化道重建方式。方法 自1996年5月至2001年5月，对106例全胃切除术采用了三种不同的术式，对其手术时间、手术并发症、术后1年饮食状况、消化道症状及营养指标进行对比观察。结果：Orr式空肠食管Roux-en-Y吻合术和P式空肠食管Roux-en-Y吻合术，术后能有效地防止反流性食管炎，明显优于Moynihan式吻合术。Orr式空肠食管Roux-en-Y吻合术和P式空肠食管Roux-en-Y吻合术相比，操作更简单，手术时间短，手术并发症也较少。结论：Orr式空肠食管Roux-en-Y吻合术是胃癌全胃切除后消化道重建较为合适的术式。     

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根治性胃大部切除术是最常见的胃癌手术方式，沿用至今已有100余年的历史。随着外科诊疗技术的发展以及对影响胃癌预后各种因素的进一步认识，人们对胃癌术后生活质量也提出了更高的要求，其中针对施行根治性胃大部切除术后病人而言，旨在通过改良消化道重建方式，以达到：(1)减少胃大部切除术后各类并发症；(2)改善消化吸收功能，以维持正常的营养吸收；     

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目的 探讨胃大部切除术后残胃功能性排空障碍的病因、诊断及治疗。方法 对1990—2001年587例胃大部切除术病例资料进行回顾性分析。结果 587例中有26例出现胃功能性排空障碍，发生率为4．4％。所有病例经保守治疗后，7—28天内治愈。结论 术后胃肠道运动的改变及吻合口水肿可能是胃排空障碍的主要原因，而高龄、营养不良、水电解质失衡、腹腔感染则是诱因。胃肠道造影及胃镜检查是诊断本病的重要方法。采取非手术治疗一般均可治愈。     

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??Clinicopathologic features of gastrointestinal stromal tumors and extragastrointestinal stromal tumors : an analysis of 216 cases SHEN Wang*, WANG Xin-yun, ZHENG Hai-yan, et al. *Department of Seven-year Clinical Medicine, Tianjin Medical University, Tianjin 300070, China
Corresponding author: WANG Xin-yun, E-mail:michelle0096@sina.com.cn
Abstract Objective To investigate the features of clinicopathology and immunohistochemistry and the diagnostic criteria of gastrointestinal stromal tumor??GIST??and extragastrointestinal stromal tumor??EGIST??. Methods The case data of 216 patients diagnosed as GIST and EGIST admitted between 2000 and 2009 in Tianjin Medical University General Hospital (175 patients) and the Second Hospital (41 patients) were analyzed retrospectively. Results In the 216 patients, 112 patients were male and 104 patients were female. The ratio of male to female was 1.077:1. The range in age was from 15 to 91 years old. The median age was 58 years old. The tumors originated from the gastrointestinal tract were in 182 patients, and most of them were located in the stomach. The tumors originated from the extragastrointestinal tract were in 34 patients, and most of them were located in the mesenterium. The range in the diameter of tumors was from 0.8cm to 30.0cm. Tumors were composed of spindle cells and epithelioid cells. Cells arranged in interlacing, whorled and nesting. CD117-test was positive in 214 cases. Clinical manifestations were alimentary tract hemorrhage, abdominal pain, abdominal mass, intestinal obstruction and so on. Conclusion GISTs are more than EGISTs. Medium risk and high risk are predominant in the gastrointestinal tract, and high risk is predominant in the extragastrointestinal tract. Wide excision is the first choice in the clinical treatment principle.