毕Ⅰ式与毕Ⅱ式吻合术应用于根治性远端胃切除术的疗效分析

目的通过比较分析胃癌行胃大部切除术后行毕Ⅰ式和毕Ⅱ式重建术后观察并发症的发生情况,探讨其原因及防治原则。方法选择本院2007年4月-2009年7月检出的200例胃癌患者按毕Ⅰ式和毕Ⅱ式胃大切术后分组,并统计并发症的发生情况进而进行回顾性分析。结果残胃病变的发生率在胃大部切除术后行毕Ⅰ式和毕Ⅱ式后高达935％,其中胆汁反流在毕I式术后的发生率为1.9％,明显低于毕Ⅱ式术后的发生率692％,毕Ⅰ式术后残胃原发癌、残胃及吻合口炎的发生率分别为59％、448％,均显著低于毕Ⅱ式术后的361％和77.4％的发生率;残胃及吻合口溃疡在毕I式术后的发生率为239％,明显高于毕Ⅱ式术后的594％（P〈0.01）;在两组中其余残胃病变的比较差异无统计学意义（P〉0.05）。结论胃大部切除术是治疗胃恶性肿瘤的主要方法,毕Ⅰ式术后发生并发症的概率要远低于毕Ⅱ式;防治残胃病变尤其是残胃癌,复查内镜及病理是重要措施。     

A case of small mucosal gastric carcinoma with lymph node metastasis: a case report

We have experienced a case of small early mucosal gastric cancer with lymph node metastasis. The patient was a 75-year-old woman diagnosed as having early gastric cancer type 0 IIa on the greater curvature of the antrum. We performed distal gastrectomy, with Billroth I method reconstruction. The tumor lesion was on the greater curvature of the antrum. Metastasis was discovered in the number 4d lymph node, histologically. The tumor was type 0 IIa confined to the mucosa, 1.0 cm in diameter and differentiated histological type, and no ulcer scar could be seen in tumor lesion. However, the tumor was massively invading to the mucosal membrane, with positive lymph vessel invasion, and was of mixed histological type. This was a rare case of small early mucosal cancer 1.0 cm in diameter with lymph node metastasis.     

Alpha-fetoprotein-producing early gastric cancer: report of two cases

We have experienced two cases of alpha-fetoprotein (AFP)-producing early gastric cancer. One patient was a 73-year-old man diagnosed as having an early gastric cancer type 0 I + IIa at 40 x 40 mm on the greater curvature of the lower body of the stomach. The histological findings showed that proliferation of a well-differentiated tubular adenocarcinoma with hepatoid pattern was massively invading to the middle layer of the submucosa, with positive lymph vessel, and lymph node metastasis. The other patient was a 76-year-old man diagnosed as having an early gastric cancer type 0 IIa + IIc at 25 x 25 mm on the anterior wall on the greater curvature of the antrum. The histological findings showed that proliferation of a small cell carcinoma was massively invading to the deep layer of the submucosa, with positive lymph vessel, and lymph node metastasis. AFP was immunohistochemically found in the tumor cells of these two cases. Both patients died from liver metastasis. AFP-producing early gastric cancer was concluded to be at high risk of liver metastasis.     

术后反流性胃炎与慢性胃炎的病理组织学对照研究

目的探讨术后反流性胃炎的病理组织学变化特征及病理学诊断标准。方法溃疡胃大部切除术后患者５０例，慢性胃炎患者４０例，行胃镜检查，分别在吻合口／胃窦、胃体、胃底取活检，作病理组织学检查。观察各种病变的严重程度，计算反流积分与炎症积分；比较不同部位病理改变的特点；分析胆汁反流、ｐＨ与病理改变的关系。结果残胃的胆汁酸浓度和ｐＨ显著高于慢性胃炎组（Ｐ＜０．０１），粘膜基底层胃小凹增生、间质水肿、毛细血管扩张充血及反流积分，在残胃组显著高于慢性胃炎组（Ｐ＜０．０１），且以吻合口最重。而残胃底较轻。残胃内不同部位的病变特征不同。结论胃小凹增生、间质水肿、毛细血管扩张充血是反流性胃炎的主要病理组织学特征，反流积分的高低可代表反流性病变的严重程度。     

残胃癌32例临床诊治分析

[目的]研究广义残胃癌(gastric stump cancer,GSC)的预后情况和影响预后的相关因素.[方法]回顾性分析1999-2009年期间收治的32例GSC患者临床资料,所有病例全部经胃镜和CT确诊.发病距前次手术时间平均(375.75±131.47)月,其中消化性溃疡(411.56±109.47)月,胃癌(...     

Multiple carcinoids in the stomach with hypergastrinemia and type A gastritis: a case report

We have experienced a case of the stomach with hypergastrinemia and type A gastritis with multiple carcinoids in a 37-year-old woman. An upper gastrointestinal series revealed multiple minute polyps in the upper body of the stomach. All polyps were diagnosed as carcinoid using endoscopic biopsies. She had neither symptom or signs of typical carcinoid disease. The serum gastrin level was as high as 725 pg/ml. Total gastrectomy was performed, and the diagnosis of multiple gastric carcinoids (sm, no) with type A gastritis was histologically confirmed. After the operation, the serum gastrin level returned to normal, and the patient has been doing well and is disease-free to date at 7 years after the operation. This case suggested that multiple gastric carcinoid lesions may be precipitated by chronic atrophic gastritis accompanying hypergastrinemia. In the treatment of multiple gastric carcinoids with type A gastritis, total gastrectomy with lymph node dissection should be standard operative procedure, in order to resect the fundic gland area completely which could be the origin of carcinoids and endocrine cell micronest.     

食管癌分别行管状胃代食管吻合术与传统全胃代食管吻合术对术后胃食管反流病情的控制效果

目的 对比食管癌分别行管状胃代食管吻合术与传统全胃代食管吻合术对术后胃食管反流病情的控制效果.方法 将2010年9月至2015年10月期间在亳州市人民医院确诊并接受择期食管癌切除术治疗的85例食管癌患者随机分为研究组(45例)与对照组(40例),2组患者均接受食管癌切除术治疗,其中研究组行管状胃代食管吻合术,对照组行传统全胃代食管吻合术.术后待患者恢复正常的胃肠道功能后采用p H动态监测仪对其进行24 h胃代食管腔p H监测,术后1、3月依据RDQ量表对患者的胃食管反流相关症状进行评分,同时统计术后1、3月的胃食管反流的发生情况.结果 2组患者均未出现死亡病例,且术后均未发生有吻合口瘘及胸胃排空障碍并发症;2组患者几乎均达到24 h的全程监测,同时组间比较监测总时间、立位监测时间、卧位监测时间均无统计学意义(P>0.05);研究组的24 h反流次数及长返流次数显著少于对照组,反流持续最长时间与p H值<4.00的累计时间显著短于全胃组,De Meester评分显著低于对照组,组间比较均有统计学意义(P<0.01);研究组术后1、3月的RDQ评分以及胃食管反流发生率均显著低于对照组,组间比较均有统计学意义(P<0.01或P<0.05).结论 管状胃代食管吻合术较传统全胃代食管吻合术可对食管癌切术后的胃食管反流病情起到更为理想的控制效果,可为食管癌患者术中吻合术式的选择提供一定参考价值.     

BillrothⅠ式吻合术在胃窦癌根治术中的应用及生存质量评价

目的:探讨胃窦癌术后的消化道重建方式与患者生存质量的关系。方法:对本院2000年至2006年经病理证实的胃窦癌436例进行回顾性分析。其中,BillrothⅠ式157例(36.0%),BillrothⅡ式279例(64.0%)。随访2a,比较其术后的并发症、Visick分级指数。结果:BillrothⅠ式吻合术后患者的Visick分级指数Ⅰ级~Ⅱ级占80.3%,BillrothⅡ式返流性胃炎、倾倒综合征的发病率分别为29.0%、5.4%。结论:BillrothⅠ式吻合术重建消化道,操作简单,符合生理,减少术后并发症,提高患者术后的生存质量。对无明显浸润性生长的胃窦癌,BillrothⅠ式吻合术是根治性远端胃切除术后理想的消化道重建方式。     

胃黏膜病变内镜下形态与内镜活检准确率的关系

目的 探讨胃黏膜病变内镜下形态与内镜活检符合率的关系.方法 回顾性分析2006-2011 年间因胃黏膜病变在我院行内镜黏膜剥离术的266 例患者相关资料,对其中234 例(246 处病灶) 内镜活检病理诊断为上皮内瘤变或早癌患者进行胃黏膜病变与内镜活检的差异分析.结果 内镜活检病理与术后病理均提示有瘤变或癌变的总符合率达94.3%(232/246),不同形态胃黏膜病变总符合率分别为I 型91.7%(22/24)、IIa 型90.9%(70/77)、IIb 型94.4%(17/18)、IIc 型95.7%(22/23)、IIa+IIc型98.1%(102/104).其中内镜活检与术后病理诊断完全一致的占51.6%(127/246),以IIa 型病变完全一致率最高(P<0.05),达67.5%(52/77) ;术后病理较活检病理级别升高的占33.7%(83/246),以IIc 型病变术后病理级别升高率最高(P<0.05),达52.2%(12/23) ;术后病理较活检病理级别降低的占8.9%(22/246),以IIa 型病变术后病理级别降低率最高,达13.0%(10/77).术后病理为炎性组织的占5.7%(14/246),其中I 型有8.3%(2/24)、IIa 型9.1%(7/77)、IIb 型5.6%(1/18)、IIc 型4.3%(1/23)、IIa+IIc 型1.9%(2/104).结论 根据胃黏膜病变内镜下形态表现判断其活检病理的准确率具有一定可行性.     

Ectopic pancreas with gastric outlet obstruction: report of two cases and literature review

Ectopic pancreas is a rare entity and is usually an incidental finding in clinical practice. Most patients with an ectopic pancreas are asymptomatic, and if present, symptoms are non-specific according to the site of the lesion and different complications encountered. The most-common site is the stomach, accounting for 25%-38.2% of all patients. An asymptomatic ectopic pancreas is usually of no clinical importance, and there is no surgical indication in such a situation. However if there are complications caused by an ectopic pancreas, a variety of actions becomes necessary. We report 2 cases of ectopic pancreas with gastric outlet obstruction. The first case was a 41-year-old man who suffered from epigastric fullness and dyspepsia for 3 years. Endoscopic examination revealed a submucosal tumor measuring 2.5 cm in diameter in the prepyloric area. The second case was a 53-year-old man, who initially underwent a craniotomy to remove a pituitary adenoma, and laparotomy and duodenorrhaphy due to a perforated peptic ulcer. The postoperative course was not uneventful, and an upper gastrointestinal series showed a 2-cm intramural mass with a mucosal ulcer at the distal antrum. Both cases had symptoms and signs of gastric outlet obstruction, and both cases accepted subtotal gastrectomy with Billroth II anastomosis. A review of the literature revealed few cases of ectopic pancreas with gastric outlet obstruction. An ectopic pancreas must be considered in the differential diagnosis of gastric outlet obstruction.     

幽门螺杆菌感染在残胃黏膜病变中作用的临床观察

目的:通过检测残胃黏膜幽门螺杆菌(Hp)感染,探讨Hp与残胃黏膜病变的关系.方法:对45例胃大部切除的残胃进行胃镜、病理检查和Hp检测,以同期非残胃患者为对照组,进行以上三项的比较.结果:①残胃组和对照组Hp检出率分别为22.2%和60%(P＜0.05).②存在胆汁反流和非胆汁反流患者Hp检出率分别为17.2%和43.8%.(P＜0.05)③胆汁反流发生率,毕罗Ⅱ式手术明显多于毕罗Ⅰ式,分别为46.6%和17.7%(P＜0.05).④残胃黏膜病理,Hp感染和非Hp感染患者有中-重度胃黏膜病变并有异型增生分别为66.7%和21.2%(P＜0.05).对有Hp感染的对照组和残胃组的病理改变无显著差别(p>0.05).结论:Hp感染是残胃炎发生的重要原因.根除Hp有临床意义.毕罗Ⅱ式较毕罗Ⅰ式手术胆汁反流发生高:而伴有胆汁反流者Hp感染率较低.应该综合治疗.     

贲门癌近端胃切除后残胃间置对胃酸和食管胃压力的影响

目的了解贲门癌行近端胃切除后残胃间置对胃功能的影响,以探讨减少贲门癌术后并发症、改善患者生活质量的更佳术式.方法对21例贲门癌患者行近端胃次全切除、残胃间置消化道重建术.术后行24h食管胃pH监测及压力测定,并与传统术式及术前监测结果进行比较.所有病例常规行纤维内镜及上消化道造影检查.结果(1)残胃间置组术后酸反流6项指标明显优于传统组(P＜0.01),24h食管pH＜4的总百分时间、立位pH＜4的百分时间、反流次数、反流持续超过5min的次数与术前相似(P＞0.05),但上述指标传统组术后较术前明显增加(P＜0.01).(2)两组术后食管残胃吻合口高压带长度及静息压力较术前食管下括约肌长度和静息压力明显下降(P＜0.01),但残胃间置组食管残胃吻合口静息压力和残胃静息压力较传统组明显下降(P＜0.05).(3)残胃间置组仅2例发生中度反流性食管炎,而传统组有12例发生中重度反流性食管炎(P＜0.01).结论贲门癌切除后行残胃间置重建消化道,能进一步降低酸反流及残胃静息压力,促进残胃排空,改善术后症状,提高生活质量,是一种较为理想的手术方法.     

残胃癌的临床特点及治疗探讨

目的探讨残胃癌的临床特点及手术治疗效果。方法对巢湖市第二人民医院普外二科2000～2011年收治的18例残胃癌患者临床资料加以总结分析。结果本组病例男性15例,女性3例,年龄38～79岁,首次手术胃肠重建方式BilrothⅡ式14例(78%),BilrothⅠ式3例(17%),胃空肠Roux-en-y吻合1例(0.5%)。癌灶发生于吻合口附近10例(55.5%),残胃小弯侧6例(30.3%),胃底贲门部位2例(14.2%)。18例中行根治性残胃切除8例(44.4%),姑息性残胃切除6例(30.3%),联合脏器切除5例(27.8%),剖腹探查+空肠造瘘4例(22.2%)。根治性切除组1、3、5年生存期分别为87.5%,50%,12.5%。姑息性切除组中位生存期平均为15个月,剖腹探查组均在1年内死亡。结论残胃癌多发生在残胃吻合口附近,以BilrothⅡ式胃大部切除术后常见,男性多于女性,就诊时多属于中晚期,联合脏器切除率高,根治性手术可提高生存率。     

Early gastric cancer following gastrojejunostomy without gastrectomy.

Two rare cases involving distal gastrectomies for gastric cancer after an earlier gastrojejunostomies without gastrectomy for duodenal or gastric stricture due to a duodenal or pre-pyloric ulcer are reported. The time interval between the initial gastrojejunostomy and the resection of the distal stomach with gastrojejunal stoma were 17 and 36 years. One patient underwent reconstruction by Billroth II and the other by Roux-en-Y end-to-side gastrojejunostomies, both retrocolically without any peri or postoperative complications. The histological classification was confirmed for both as type IIc mucosal early gastric cancer. Only 6 other primary early gastric cancers following gastrojejunostomies without gastrectomy have been reported in the Japanese literature.     

Two cases of early gastric carcinoma with synchronous liver metastasis

We have experienced two cases of early gastric cancer with synchronous liver metastasis. One patient was a 64-year-old man diagnosed as having early gastric cancer type 0 IIa at 15 x 10 mm on the lesser curvature of the cardia. The other patient was a 58-year-old man diagnosed as having early gastric cancer type 0 IIa + IIc at 24 x 18 mm on the posterior wall of the antrum. The histological findings showed that proliferation of moderately differentiated tubular adenocarcinoma with hepatoid pattern was massively invading to the deep layer of the submucosa, with positive lymph vessel, vein invasion and lymph node metastasis, in both cases. These results suggested that elevated or mixed macroscopic type, differentiated adenocarcinoma massively invading to the deep layer of submucosa, positive lymph vessel and vein invasion, lymph node metastasis, and hepatoid adenocarcinoma were risk factors for liver metastasis from early gastric cancer.     

幽门螺杆菌感染与胃癌及胃部病变的多组病例对照研究

目的：探讨幽门螺杆菌（Helicobacter pylori,Hp）感染与胃癌及胃部病变之间是否存在因果关系。方法：将1994～1996年经病理确诊的胃癌及胃部病变病例分为多个病例组及对照组,利用1987年山东胃癌高发区组织库,作为Hp暴露史测量的资料。结果：调整年龄、性别及文化程度3个外部变量后,胃窦慢性浅表性胃炎、消化性溃疡及炎症活动程度与Hp感染间OR分别为2.072、2.980、2.086,有统计学关联,且差异有显著性。相关分析表明胃病严重程度与Hp感染之间存在负相关关系(r=－0.217)。结论：Hp感染与胃窦慢性浅表性胃炎、消化性溃疡及炎症活动程度存在部分因果关系。     

胃癌肝转移化疗转化手术治疗的临床效果

目的 探究胃癌肝转移患者化疗治疗后,经多学科诊疗(MDT)评估为临床缓解,行转化手术治疗的临床疗效.方法 选取安徽医科大学第一附属医院2015年1月至2017年4月胃癌肝转移患者10例,采用化疗2～8个周期,术前MDT评估肿瘤分期,在D2根治术的基础上统计清扫淋巴结的数目、淋巴结转移率,观察不良反应和并发症发生情况,随访时间截止至2018年4月.结果 胃癌肝转移患者7例化疗后获得降期,降期率为70％(7/10).胃癌肝转移化疗后增强CT下的T分期准确率为70％(7/10),N分期的准确率为50％(5/10).MDT评估疗效的有效缓解率与病理学评估标准差异无统计学意义(P>0.05).10例均顺利完成手术,其中8例患者行治愈性全胃切除+D2淋巴结清扫+食道与空肠Roux-en-Y吻合术,1例行治愈性远端胃大部切除+D2淋巴结清扫+近端胃与空肠Roux-en-Y吻合术,1例行全胃切除术+D2淋巴结清扫+食道与空肠Roux-en-Y吻合术.胃癌肝转移平均每例清扫淋巴结(22.40±11.19)枚,其中阳性淋巴结转移率33.04℅(74/224).患者手术时间、住院时间、术中出血量分别为190.1 min、7.9 d及115.0 mL.9例为R0切除,1例为R1切除.10例全部治愈,无术后并发症.所有患者均获得随访,中位随访时间18.0(10～36)个月,中位生存时间为15.0(5～31)个月.绪论胃癌肝转移患者以MDT指导临床评估及术前化疗为基础转化后行根治术,可以提高患者的生存率.     

胃蛋白酶原亚群测定与萎缩性胃炎诊断的相关研究

目的研究血清中胃蛋白酶原(PG)亚群水平在健康体检者及胃部疾病患者中的变化规律,探讨血清中PG亚群测定对萎缩性胃炎诊断的意义。方法利用放射免疫法测定健康体检者和胃溃疡、萎缩性胃炎、胃癌患者中PGⅠ、PGⅡ及PGⅠ/PGⅡ值的变化,将正常对照组与疾病组及各疾病组之间进行统计学分析。结果①与正常对照组相比,萎缩性胃炎、胃癌患者血清PGⅠ、PGⅠ/PGⅡ比值降低(q=5.97、q=6.18,P均<0.05;q=6.24、q=6.34,P均<0.01),胃溃疡患者血清PGⅠ升高(q=5.01,P<0.05)、PGⅠ/PGⅡ比值降低(q=4.72,P<0.05);②与胃溃疡组相比,萎缩性胃炎和胃癌患者血清PGⅠ明显降低(q=7.20、q=7.03,P均<0.001),PGⅠ/PGⅡ比值也降低(q=7.20,P=0.001);③萎缩性胃炎组与胃癌组相比,PGⅠ和PGⅠ/PGⅡ比值均无统计学差异(q=1.05、q=1.36,P均>0.05)。血清PGⅠ≤80μg/L且PGⅠ/PGⅡ≤6时,检测萎缩性胃炎的灵敏度为53.3%,特异度为94.3%。结论血清PGⅠ和PGⅠ/PGⅡ的降低,是胃癌及萎缩性胃炎发生的危险因素,可以作为筛查和辅助诊断的一项血清学指标,血清PGⅠ≤80μg/L且PGⅠ/PGⅡ≤6对检测萎缩性胃炎有较好的灵敏度和特异性。     

BillrothI式与BillrothII式吻合术在远端胃癌手术中的比较

目的探讨远端胃癌手术的消化道重建方式。方法对我院1999年9月～2004年9月收治并手术治疗的115例远端胃癌进行回顾性分析。行BillrothⅡ式手术56例,BillrothI式手术59例。比较术后并发症、住院时间、治疗费用、5年生存率。结果BillrothⅡ式并发症发生率、术后住院时间、住院费用都远高于BillrothI式（P〈0．05）。两者的5年生存率相似（P〉0．05）。结论BillrothI式吻合术重建消化道,操作简单,符合生理,减少术后并发症,提高患者术后的生存质量,是根治性远端胃切除术后理想的消化道重建方式。     

胃癌的危险因素调查及癌前病变动态观察

报道温州地区胃癌高发区瑞安塘下的致癌危险因素的调查情况,结果表明它是由多种致癌危险因素的综合影响。作者应用内镜活检在18000例慢性胃病患者中查出癌前病变(高危人群)1132例,经3月～14年活检随访,表明胃癌前病变有一定的可逆转性;癌变率较高的是胃溃疡(GU)+不典型增生(ATP)组、GU+慢性萎缩性胃炎(CAG)组及CAG+ATP组均为4.1％;总癌变率为3.1％。早癌检出率占胃癌总数的48.6％,为门诊早癌检出率的6.8倍。此方法简单、经济实用。