全腹腔镜远端胃癌根治术消化道重建Billroth-Ⅰ式、Billroth-Ⅱ式及Roux-en-Y吻合对比研究

目的:对比研究三种吻合方式（Billroth-Ⅰ式、Billroth-Ⅱ式及Roux-en-Y）应用于全腹腔镜远端胃癌根治术后消化道重建的临床疗效。方法:回顾性分析2015年3月至2017年8月在我院行全腹腔镜远端胃癌根治术的133例患者的临床资料，其中行Billroth-Ⅰ式吻合术48例（A组），Billroth-Ⅱ式吻合术45例（B组），Roux-en-Y吻合术40例（C组）。比较三组的治疗效果。结果:C组手术时间、术中出血量均显著高于A组和B组（P<0.05），但C组发生倾倒综合征、胆汁返流及反流性胃炎的比例明显低于A组和B组（P<0.05）。三组患者术后6个月和1年时Visick分级分别比较，差异均无统计学意义（P>0.05）；术后1年时A组和B组Visick分级较术后6个月有显著变化（P<0.05），C组变化不显著（P>0.05）。结论:全腹腔镜远端胃癌根治术后的三种常见消化道重建方式，各有其优缺点，但从疗效分析，Roux-en-Y式与Billroth-Ⅰ式、Billroth-Ⅱ式相比，虽不符合生理通道，操作也较复杂，但在预防多种并发症上有明显优势。术者选择消化道重建方式时应该根据自身技术特点以及患者肿瘤位置、大小、分期等实际问题选择合适的消化道重建方式。     

R-Y吻合在远端胃癌根治术中的应用

目的:探讨R-Y吻合在远端胃癌根治术中的优势。方法:回顾性分析并总结我院近3年56例远端胃癌根治术患者临床资料，B-Ⅱ吻合术组26例，R-Y吻合术组30例。比较两组患者术后并发症及营养状态。结果:R-Y组手术时间略长于B-Ⅱ组（P＜0.05）；R-Y组反流性食管炎发生率低于B-Ⅱ组（P＜0.05），其余并发症差异无统计学意义(P＞0.05)；两组住院天数相似无差异（P＞0.05）；两组患者术后1年BMI变化、白蛋白变化、淋巴细胞计数变化差异无统计学意义(P＞0.05)。结论:R-Y术式在远端胃癌根治术消化道重建中是安全可靠的，反流性食管炎发生率降低，改善了患者术后生活质量，应作为远端胃癌根治术的首选吻合方式。     

31例残胃癌临床分析

[目的]探讨残胃癌的发病规律和临床特点.[方法]对于1993年～2003年收治的31例残胃癌病例的临床资料进行总结分析.[结果]Billroth-Ⅱ式重建术后残胃癌的发生率比Billroth-Ⅰ式术后高(80.6%vs.19.4%).吻合口部位发生残胃癌16例,均为Billroth-Ⅱ式术后患者,其中低分化癌11例.[结论]Billroth-Ⅱ式重建术后十二指肠反流在残胃癌的发生中起着重要作用,胃切除术时应采用减少十二指肠反流的术式.     

不同手术方式对胃癌根治术患者肿瘤坏死因子α和白细胞介素6的影响

目的:比较腹腔镜与开腹两种手术方式对胃癌根治术患者肿瘤坏死因子α(TNF-α)和白细胞介素6(IL-6)的影响.方法:选择2008年1月至2010年12月在我院外科行胃癌根治术的患者60例,随机分为腹腔镜组和开腹组.30例腹腔镜组患者接受腹腔镜辅助下胃癌根治术,30例开腹组患者接受传统开腹胃癌根治术,分别于术前和术后24h检测患者血清TNF-α和IL-6水平.结果:术前,两组患者血清TNF-α和IL-6水平,差异无统计学意义(P>0.05);术后,两组患者血清TNF-α和IL-6水平与术前比较均明显升高(P<0.01),但腹腔镜组患者血清TNF-α和IL-6水平低于开腹组,差异有统计学意义(P<0.01).结论:腹腔镜辅助下胃癌根治术能够减少炎症介质TNF-α和IL-6的释放和抑制炎症反应.     

残胃癌的外科治疗及预后

目的 总结和分析残胃癌的临床特点、治疗策略和预后.方法 回顾性分析1999年2月至2010年2月福建南安市医院收治的32例残胃癌临床资料,分析其临床特点,比较不同治疗方案对患者预后的影响.结果 残胃癌多发生于胃大部切除Billroth-Ⅱ式胃肠吻合术后,占71.88%(23/32);残胃癌多发生在吻合口和吻合口附近,占56.25%(18/32).手术组与非手术组的1年、3年生存率分别为66.67%、42.85%和9.09%、0;R0治疗组与非R0治疗组的1年、3年生存率分别为87.50%、56.25%和6.25%、0.结论 残胃癌好发于Billroth-Ⅱ式术后的吻合口和吻合口附近;手术切除是治疗残胃癌的根本方法,R0切除(包括联合多脏器的扩大根治术)是提高残胃癌生存率的关键,姑息性手术不能延长患者的生存时间,应尽量避免.     

不同手术方式对胃癌根治术患者肿瘤坏死因子α和白细胞介素6的影响

目的：比较腹腔镜与开腹两种手术方式对胃癌根治术患者肿瘤坏死因子α（TNF-α）和白细胞介素6（IL-6）的影响。方法：选择2008年1月至2010年12月在我院外科行胃癌根治术的患者60例,随机分为腹腔镜组和开腹组。30例腹腔镜组患者接受腹腔镜辅助下胃癌根治术,30例开腹组患者接受传统开腹胃癌根治术,分别于术前和术后24h检测患者血清TNF-α和IL-6水平。结果：术前,两组患者血清TNF-α和IL-6水平,差异无统计学意义（P〉0.05）;术后,两组患者血清TNF-α和IL-6水平与术前比较均明显升高（P〈0.01）,但腹腔镜组患者血清TNF-α和IL-6水平低于开腹组,差异有统计学意义（P〈0.01）。结论：腹腔镜辅助下胃癌根治术能够减少炎症介质TNF-α和IL-6的释放和抑制炎症反应。     

3D腹腔镜与2D腹腔镜胃癌根治术短期临床疗效对比研究

目的 对比分析3D和2D腹腔镜胃癌根治术患者的临床资料,探讨3D腹腔镜在胃癌根治术中的临床优势和应用价值.方法 回顾性分析本院2015年1月至2016年12月52例胃癌患者行腹腔镜胃癌根治术(D2淋巴结清扫)的临床资料.其中3D腹腔镜手术共22例,2D腹腔镜手术共30例.分析两组的手术时间、术中出血量、淋巴结清扫数量、术后并发症发生率、术后病理分期.结果 3D腹腔镜手术组的手术时间明显少于2D腹腔镜手术组[(202.7±21.9)min vs.(258.0±56.3)min,P＜0.001].3D腹腔镜手术组清除淋巴结数量多于2D腹腔镜手术组[(23.6±3.8)枚vs.(20.1±4.2)枚,P=0.02].两组术中出血量相比无明显差异[(146.8±35.6)m]vs.(148.8±82.4)ml,P=0.905].两组患者术后并发症发生率无明显差异(P＞0.05).两组患者术后病理分期无明显差异(P＞0.05).结论 3D腹腔镜行胃癌根治术可缩短手术时间和增加淋巴结清扫数量并不增加手术并发症.     

纳米碳标记在全腹腔镜远端胃癌根治术delta吻合中的应用

目的 研究纳米碳标记在早期胃癌全腹腔镜远端胃癌根治术delta吻合中的应用。方法 选取早期拟行远端胃癌根治术患者40例,术前行胃镜及腹部增强CT确认。随机分为纳米碳标记组20例,对照组为常规组20例,不行标记。两组患者均拟行全腹腔镜下远端胃癌根治delta吻合术,对于术中因定位不明确不能行delta吻合的中转为腹腔镜辅助胃癌根治术。统计两组行全腹腔delta吻合例数及腹腔镜辅助的例数,并对两组中转率数据进行统计学分析。结果 纳米碳标记在全腹腔镜远端胃癌根治术delta吻合术中有很好的标记作用,标记组行全腹腔镜胃癌根治术中转率明显低于对照组（P<0.05）。结论 纳米碳标记对于早期胃癌全腹腔镜下胃癌根治术delta吻合定位有重要的临床意义。     

腹腔镜辅助胃癌根治手术学习曲线的初步探讨

目的 探讨分析腹腔镜辅助胃癌根治手术的学习曲线及其影响因素.方法 回顾性分析2007年至2011年62例腹腔镜辅助胃癌根治手术患者的临床资料,根据手术日期先后顺序分为初期A、后期B两组;其中远端胃癌根治术45例,根据手术日期先后顺序分为初期Da、后期Db两组.分别比较初期与后期手术的手术情况.结果 62例腹腔镜辅助胃癌...     

腹腔镜胃癌根治术对胃癌患者血清血红素加氧酶-1和肿瘤坏死因子-α及C反应蛋白的影响

目的探讨腹腔镜胃癌根治术对胃癌患者血清血红素加氧酶-1(HO-1)、肿瘤坏死因子-α(TNF-α)和C反应蛋白(CRP)水平的影响。方法选取2017年3月至2018年3月间陕西省铜川矿务局中心医院收治的98例胃癌患者,根据手术方式不同分为腹腔镜组(50例)和开腹组(48例)。腹腔镜组患者采用腹腔镜D2根治术,开腹组患者采用开腹D2根治术,比较两组患者手术前后血清HO-1、TNF-α及CRP水平。结果腹腔镜组患者术中出血量、手术时间、术后排气时间和术后下床活动时间均低于开腹组,差异均有统计学意义(均P <0. 05)。术前,两组患者HO-1、TNF-α和CRP指标水平比较,差异均无统计学意义(均P> 0. 05)。术后,两组患者HO-1、TNF-α和CRP指标水平均高于术前,而腹腔镜组患者各指标水平均低于开腹组,差异均有统计学意义(均P <0. 05)。结论腹腔镜D2根治术创伤小,抑制胃癌患者血清HO-1、TNF-α及CRP的释放,降低炎症反应,提高患者预后。     

Functional jejunal interposition versus Roux-en-Y anastomosis after total gastrectomy for gastric cancer: A prospective randomized clinical trial

BackgroundNutritional status and quality of life deteriorate significantly after total gastrectomy for patients with gastric cancer. The numerous types of reconstruction proposed by medical researchers around the world have limited effect. This prospective, randomized clinical trial compared functional jejunal interposition with Roux-en-Y anastomosis to identify the optimal reconstruction procedure.MethodsThis was a multi-center, prospective, randomized control trial. The enrolled patients were randomly assigned into the functional jejunal interposition group and the Roux-en-Y group. All patients were followed up at regular intervals after surgery. The endpoints were postoperative nutritional status, quality of life, and long-term postoperative complications.ResultsA total of 113 patients were enrolled from August 2012 to September 2017. Until March 2018, the median follow-up period was 18 months. At 12 months after surgery, food intake per meal (P = 0.021), Prognosis Nutritional Index (P = 0.015), weight loss (P = 0.019), and Gastrointestinal Symptom Rating Scale score (P = 0.015) of the functional jejunal interposition group were significantly worse than those of the Roux-en-Y group. There was no significant difference in operative time, intraoperative blood loss, perioperative complications, time of first flatus and defecation after surgery, postoperative plasma nutritional parameters, Visick score, Eastern Cooperative Group physical condition score, and survival rate.ConclusionFor patients with long-term survival after total gastrectomy for gastric cancer, the Roux-en-Y anastomosis is a better choice compared with functional jejunal interposition.     

Billroth 1 versus Roux-en-Y reconstructions: a quality-of-life survey at 5 years

Background In the majority of gastric surgical units across Japan, Billroth 1 is the preferred method of anastomosis following subtotal distal gastrectomy for gastric cancer. However, across Europe and North America, reconstruction using a Roux-en-Y anastomosis is more common. There is a lack of comparative studies of the two methods focusing on long-term outcome. This study evaluated patient outcome, in terms of adverse gastrointestinal complaints and quality of life, at 5 years following surgery. Methods A total of 652 patients had a subtotal distal gastrectomy for early gastric cancer between January 1993 and December 1999. We studied 229 patients with reconstruction by the Billroth 1 procedure and 214 patients with the Roux-en-Y procedure. All patients had an abdominal ultrasound and endoscopy as part of their follow-up. Quality of life was assessed by questionnaire. Results We had an 87% response rate from the questionnaire assessment. The results demonstrated that patients were less likely to experience symptoms of either early or late dumping after Roux-en-Y anastomosis than after Billroth 1. In addition, there were significantly fewer patients with gastritis on endoscopy in the Roux-en-Y group. There was no significant difference in the average relative body weight between the groups. However, patients were more likely to develop gallstones after a Roux-en-Y than after a Billroth 1 reconstruction. Conclusion The results from this study show that, at 5 years, both symptomatically and functionally, Roux-en-Y reconstruction was superior to the Billroth I method after subtotal distal gastrectomy for gastric cancer. However, the overall outcome in both groups was good, with patient satisfaction scores of around 75% in each group.     

经皮穴位电刺激辅助麻醉对腹腔镜直肠癌手术患者胃肠激素及免疫功能的影响

目的探讨经皮穴位电刺激辅助麻醉对腹腔镜直肠癌手术患者胃肠激素及免疫功能的影响。方法选取2019年1月至2019年12月间西安交通大学附属红会医院收治的94例接受腹腔镜直肠癌手术的患者,采用随机数表法分为观察组和对照组,每组47例。对照组患者采用常规全麻,观察组患者采用经皮穴位刺激联合常规全麻,比较两组患者手术情况、术后并发症、血清胃肠激素[胃泌素(GAS)、胃动素(MTL)、胆囊收缩素(CCK)]和外周血T细胞亚群(CD3+、CD4+和CD8+)。结果两组患者手术时间和术中出血量比较,差异无统计学意义(P> 0.05)。观察组患者首次肛门排气时间和首次下床活动时间均短于对照组,差异均有统计学意义(均P <0.05)。两组患者术后均发生切口感染、吻合口瘘、吻合口出血和肠梗阻,观察组患者总发生率为10.6%,对照组为6.4%,两组比较,差异无统计学意义(P> 0.05)。术后,两组患者手血清GAS、MTL和CCK均较术前降低,但观察组患者高于对照组,差异均有统计学意义(均P <0.05)。术后,两组患者CD3+和CD4+T细胞亚群均降低,差异有统计学意义(P <0.05),CD8+T细胞无明显变化,差异无统计学意义(P>0.05);且观察组患者CD3+和CD4+T细胞亚群均高于对照组,差异有统计学意义(P <0.05),CD8+T细胞无明显变化,差异无统计学意义(P> 0.05)。结论经皮穴位电刺激辅助麻醉能够促进腹腔镜直肠癌手术后的恢复,减轻手术及麻醉对胃肠激素及免疫功能的影响。     

超声引导下不同神经阻滞方法对乳腺癌根治术患者术后镇痛的影响

目的探讨超声引导下不同神经阻滞方法对乳腺癌根治术患者术后镇痛的影响。方法选择86例行乳腺癌根治术的患者,根据随机数字表法分为A组(45例)及B组(41例),A组采用超声引导下胸椎旁神经阻滞麻醉,B组采用胸神经阻滞麻醉,对比两组患者的镇痛持续时间、术后24 h舒芬太尼的使用量、两组T2~T6痛觉减退的比例、术后2 h、4 h、6 h、12 h、24 h、48 h的VAS评分及镇痛期间的并发症。结果A组的镇痛持续时间短于B组,A组术后24 h舒芬太尼用量高于B组(P<0.05)。两组在T3~T6节段的痛觉减退比例对比无统计学意义,而B组在T2节段的痛觉减退比例明显高于A组(P<0.05)。术后2 h、4 h、6 h、12 h时,B组的VAS评分明显低于A组(P<0.05),术后24 h及48 h时,两组患者的VAS评分对比无统计学意义(P>0.05)。两组均无神经阻滞相关并发症及术后并发症。结论超声引导下胸神经阻滞的麻醉方法对乳腺癌根治术患者术后镇痛效果更好,值得临床推广应用。     

气压治疗联合利伐沙班对结直肠癌术后下肢深静脉血栓的防治作用

目的探讨气压治疗联合利伐沙班对结直肠癌术后下肢深静脉血栓的防治作用。方法选取2018年2月至2019年5月间武汉市第一医院收治的82例手术治疗的结直肠癌患者。根据治疗方法不同进行分组,采用利伐沙班治疗的41例患者纳入对照组,采用气压治疗联合利伐沙班治疗的41例患者纳入观察组。比较两组患者下肢深静脉血栓发生情况、血流动力学指标、治疗前后凝血指标和术后并发症发生率。结果观察组患者下肢深静脉血栓发生率为4.9%,低于对照组患者的19.5%,差异有统计学意义(P <0.05)。观察组患者治疗后左右两侧腘静脉、股静脉和髂静脉平均血流速度均大于对照组患者,差异有统计学意义(P <0.05)。治疗前,两组患者D-二聚体(D-D)、纤维蛋白原(Fib)、活化部分凝血活酶时间(APTT)和凝血酶原时间(PT)比较,差异无统计学意义(P>0.05)。两组患者治疗后D-D和Fib水平较治疗前升高,且观察组低于对照组,差异均有统计学意义(均P <0.05)。两组患者治疗后APTT和PT较治疗前延长,且观察组长于对照组,差异均有统计学意义(均P <0.05)。观察组患者并发症发生率为4.9%,低于对照组患者的22.0%,差异有统计学意义(P <0.05)。结论在结直肠癌术后下肢深静脉血栓的防治中,气压治疗联合利伐沙班可以增加静脉血液流速,调节凝血因子水平,降低并发症发生率。     

全胃切除术后三种消化道重建术式对患者生活质量的影响

目的：探讨全胃切除术后三种消化道重建术式对患者术后生活质量的影响。方法：对２００３年１月～２００７年６月我院施行全胃切除术的２１８例患者的临床资料进行回顾性分析。全胃切除后消化道重建分别为常规端侧食管空肠Ｒｏｕｘ-ｅｎ-Ｙ吻合术７８例（Ａ组）、Ｐ型空肠袢食管空肠Ｒｏｕｘ-ｅｎ-Ｙ吻合术９６例（Ｂ组）和改良空肠间置代胃吻合术（ＦＪＩ法）４４例（Ｃ组）。记录患者一般情况及术后１２个月的营养状况和胃肠道症状（ＧＳＲＳ）评分等。结果：术后１２个月,Ｂ组与Ａ组比较,进食量明显增加（Ｐ＜０.０５）,而ＧＳＲＳ评分明显降低（Ｐ＜０.０５）;Ｃ组与Ａ组比较,进食量亦明显增加（Ｐ＜０.０５）,ＧＳＲＳ评分则明显降低（Ｐ＜０.０５）。术后１２个月,Ｂ组与Ｃ组体重恢复较Ａ组更佳（Ｐ＜０.０５）,且Ｃ组患者的进食量又优于Ｂ组,Ｂ、Ｃ两组体重恢复比较,差异有统计学意义（Ｐ＜０.０５）。结论：Ｐ型空肠袢和改良空肠间置代胃吻合术均有利于维持患者术后生活质量。在每天进食量及体重恢复方面,改良空肠间置代胃吻合术更优于Ｐ型空肠袢食管空肠Ｒｏｕｘ-ｅｎ-Ｙ吻合术。     

全胃切除消化道重建术式的比较

目的：探讨全胃切除后消化道重建的最佳术式。方法：对148例胃癌行全胃切除病例进行回顾性分析。结果：Roux-en-Y吻合术25例、空肠袋加Roux-en-Y吻合术30例、间置空肠代胃术23例、空肠袋加间置空肠代胃术22例、功能性间置空肠代胃术48例;功能性间置空肠代胃术术后并发症发生率10.4%,优于其他各组44%,26.7%,34.7%,22.7%,10.4%;Visick分级Ⅰ级Ⅱ级百分比为77.1%,优于其他各组48.0%,46.7%,52.2%,45.5%;在手术时间、术后生存率及体重变化方面无明显差异。结论：功能性间置空肠代胃术可以有效减少术后并发症的出现,且手术操作安全简便,在各方面都相对于另外四种术式更有优势。     

腹腔镜辅助下大肠外翻拖出式手术对结肠癌VEGF-A、VEGF-C及VEGF-D表达的影响

目的探讨腹腔镜辅助下大肠外翻拖出式手术治疗结肠癌的临床效果及对表皮生长因子(VEGF)-(A、C、D)表达的影响。方法选择64例结肠癌患者作为对象,随机数字表分为对照组(n=32)和观察组(n=32)。对照组给予腹腔镜辅助下直肠前切除术治疗,观察组采用腹腔镜辅助下大肠外翻拖出式手术治疗,术后5 d对患者效果进行评估。2组手术前、手术后均采用酶联免疫吸附试验(ELISA)测定患者VEGF-A、VEGF-C及VEGF-D表达水平,比较2组手术参数、VEGF-A、VEGF-C及VEGF-D表达水平及术后并发症及复发率。结果 2组手术时间比较,差异无统计学意义(P> 0. 05);观察组日均排便次数,多于对照组(P <0. 05);观察组术后肠道恢复、住院时间、术中出血量,均短(少)于对照组(P <0. 05)。观察组手术后5 d VEGF-A、VEGF-C及VEGF-D水平,均低于对照组(P <0. 05)。观察组手术后吻合口瘘、切口感染、皮下气肿、腹腔出血发生率及术后6个月复发率,均低于对照组(P <0. 05)。结论将腹腔镜辅助下大肠外翻拖出式手术治疗结肠癌手术创伤较小,并能降低VEGF-A、VEGF-C及VEGF-D表达水平,且术后并发症、复发率较低,值得推广应用。     

Analysis of complications and BREAST-Q score after radiotherapy in breast cancer patients treated with different reconstruction methods

Objective To compare the complications, degree of satisfaction and quality of life among breast cancer patients treated with different reconstruction methods after postoperative radiotherapy, aiming to explore the optimal combination of reconstruction and radiotherapy. Methods 105 breast cancer patients treated with postoperative radiotherapy after reconstruction surgery in Tumor Hospital from 2014 to 2019 were enrolled. According to the type of reconstruction, all patients were divided into group A (autologous reconstruction group, n=54) and group B (implant reconstruction group, n=51). Patients in group B were further divided into group B1(one-stage reconstruction group, n=30) and group B2(two-stage reconstruction group, n=21) according to the timing of reconstruction. The incidence of complications and BREAST-Q score were statistically compared between groups A and B, groups B1 and B2, respectively. The influencing factors of BREAST-Q score were identified by multiple linear regression analysis. Results The incidence of long-term complications and the total incidence of complications in group A were significantly lower than those in group B (1.9% vs. 37.3%, P<0.001 and 9.3% vs.43.1%, P<0.001), and the scores of psychosocial well-being and degree of satisfaction with breasts in group A were significantly higher than those in group B (71(15) vs. 66(22), P=0.027 and 53(8) vs. 53(8), P=0.032)). There was no significant difference in the incidence of complications and BREAST-Q scores between groups B1 and B2(both P>0.05). Breast volume and complications were the predictors of BREAST-Q score (both P<0.001). Conclusions Radiotherapy after autologous reconstruction of breast cancer yields fewer complications and better BREAST-Q score than the implantation reconstruction. The incidence of postoperative radiotherapy complications and BREAST-Q scores are equivalent between one-stage and two-stage reconstruction. The BREAST-Q score is lower in patients with large breasts or complications.