Morbidity and Mortality of Laparoscopy-Assisted Gastrectomy with Extraperigastric Lymph Node Dissection for Gastric Cancer

Gastrectomy with extraperigastric lymph node dissection has not been generally acceptable because of increased morbidity and mortality in some Western countries. Recently, many surgeons have become interested in laparoscopic gastric surgery for malignant disease as well as benign lesions because laparoscopic surgery itself has been shown to have many advantages over open surgery. The aims of this study are to evaluate the incidence and nature of operative morbidity and mortality after laparoscopy-assisted gastrectomy (LAG) with extraperigastric lymph node dissection with respect to surgical experience and to identify factors predictive of complications and death. We reviewed the surgical outcomes of LAG with extraperigastric lymph node dissection in 140 consecutive gastric cancer patients. Clinicopathologic characteristics, operative outcomes, and postoperative morbidities and mortalities were compared after dividing the 140 patients into early (1–70) and late (71–140) groups. And risk factors for morbidity and mortality were identified by multivariate logistic regression analysis. The overall operative morbidity and mortality rates were 18.6% and 0.7%, respectively. Thirty postoperative complications occurred in 26 patients. The minor surgical complication rate in the late group was significantly lower than that in the early group (P = 0.0349). According to univariate and multivariate analyses to evaluate the independent predictor of a higher operative morbidity rate, no factor was significantly associated with operative morbidity. We conclude that LAG with extraperigastric lymph node dissection is a technically feasible and acceptable surgical modality for gastric cancer and low morbidity and mortality rates for this procedure can be accomplished by experienced laparoscopic gastric surgeons at large-volume hospitals.     

Meta-analysis of short-term outcomes after laparoscopy-assisted distal gastrectomy

INTRODUCTIONMany surgeons are interested in laparoscopic surgery for gastric cancer because it has been proved that laparoscopic surgery has several advantages over conventional open surgery[1-3]. Since 1991, laparoscopy-assisted distal gastrectomy (LADG) has been adopted by Kitano[4] for the treatment of early gastric cancer, and it has been performed worldwide, especially in Japan and Korea. In 1997, Goh et al[5] published the early results of 118 LADGs; they sent a questionnaire to…     

Prognostic nutritional index predicts postoperative complications and long-term outcomes of gastric cancer

AIM:To investigate the impact of prognostic nutritional index(PNI)on the postoperative complications and long-term outcomes in gastric cancer patients undergoing total gastrectomy.METHODS:The data for 386 patients with gastric cancer were extracted and analyzed between January2003 and December 2008 in our center.The patients were divided into two groups according to the cutoff value of the PNI:those with a PNI≥46 and those with a PNI<46.Clinicopathological features were compared between the two groups and potential prognostic factors were analyzed.The relationship between postoperative complications and PNI was analyzed by logistic regression.The univariate and multivariate hazard ratios were calculated using the Cox proportional hazard model.RESULTS:The optimal cutoff value of the PNI was set at 46,and patients with a PNI≥46 and those with a PNI<46 were classified into PNI-high and PNI-low groups,respectively.Patients in the PNI-low group were more likely to have advanced tumor(T),node(N),and TNM stages than patients in the PNI-high group.The low PNI is an independent risk factor for the incidence of postoperative complications(OR=2.223).The 5-year overall survival(OS)rates were 54.1%and21.1%for patients with a PNI≥46 and those with a PNI<46,respectively.The OS rates were significantly lower in the PNI-low group than in the PNI-high group among patients with stagesⅡ(P=0.001)andⅢ(P<0.001)disease.CONCLUSION:The PNI is a simple and useful marker not only to identify patients at increased risk for postoperative complications,but also to predict long-term survival after total gastrectomy.The PNI should be included in the routine assessment of advanced gastric cancer patients.     

抗焦虑对胃癌根治术患者七氟烷用量及术后恢复的影响

目的:研究劳拉西泮联合咪达唑仑对择期胃癌根治术患者抗焦虑作用的有效性,及该方法对术中七氟烷用量和术后疼痛的影响.方法:观察组手术前1d服劳拉西泮,术前40min静注咪达唑仑,术中BIS监测控制麻醉深度,观察两组患者术前Spielberge状态—特质焦虑问卷(STAI)评分,术中七氟烷用量,麻醉恢复时间及术后2、6、24h疼痛VAS评分.结果:观察组状态-特质焦虑问卷评分低于对照组(S-AI:53.60±4.45vs62.70±3.98,P<0.05;T-AI:54.78±3.97vs65.65±4.21,P<0.05),七氟烷的使用量少于对照组(34.70±0.46vs36.20±0.44,P<0.05).两组术后苏醒及拔管时间无统计学差异.两组患者术后6、24hVAS评分,观察组低于对照组(6hVAS评分:3.45±1.60vs4.89±1.91,P<0.05;24hVAS评分:3.51±1.76vs5.17±1.71,P<0.05).结论:劳拉西泮联合咪达唑可以减轻术前患者的焦虑状态,减少术中七氟烷的使用,有利于减轻患者术后疼痛.     

Laparoscopic gastric surgery for cancer: Where do we stand?

Gastric cancer poses a significant public health problem, especially in the Far East, due to its high incidence in these areas. Surgical treatment and guidelines have been markedly different in the West, but nowadays this debate is apparently coming to an end. Laparoscopic surgery has been employed in the surgical treatment of gastric cancer for two decades now, but with controversies about the extent of resection and lymphadenectomy. Despite these difficulties, the apparent advantages of the laparoscopic approach helped its implementation in early stage and distal gastric cancer, with an increase on the uptake for distal gastrectomy for more advanced disease and total gastrectomy. Nevertheless, there is no conclusive evidence about the laparoscopic approach yet. In this review article we present and analyse the current status of laparoscopic surgery in the treatment of gastric cancer.     

腹横肌平面阻滞减轻袖状胃切除患者术后急性疼痛及预防术后慢性疼痛

目的研究腹横肌平面（TAP）阻滞对减重患者术后急性疼痛、术后慢性疼痛（CPSP）以及术后恢复的作用。 方法选择2019年11月至2020年11月于安徽医科大学第二附属医院行腹腔镜袖状胃切除术（LSG）的肥胖症患者,按麻醉方法不同随机分为全麻组（GA组）和全麻联合腹横肌平面阻滞组（TAP组）,每组各75例。比较两组术后1 h、6 h、12 h、24 h的视觉模拟评分（VAS）、术后48 h内镇痛泵有效按压次数、术后病房补救镇痛发生率、术后恶心、呕吐发生率、术后3 d PSQI评分和术后3、6个月CPSP发生率。其中CPSP数据通过电话随访获取。 结果与GA组相比,TAP组术后1 h、6 h、12 h、24 h的VAS评分明显降低,术后48 h内镇痛泵有效按压次数及术后病房补救镇痛发生率明显减少,PONV发生率明显降低,术后3 d PSQI评分明显降低（P<0.05）。TAP组术后3、6个月CPSP发生率明显低于GA组（P<0.05）。 结论TAP阻滞运用于减重手术可以有效地减轻术后急性疼痛,减少阿片类药物用量,改善术后睡眠质量。TAP阻滞可能预防减重患者术后慢性疼痛的发生。     

Laparoscopic vs open total gastrectomy for gastric cancer:A meta-analysis

AIM:To conduct a meta-analysis comparing laparoscopic total gastrectomy(LTG)with open total gastrectomy(OTG)for the treatment of gastric cancer.METHODS:Major databases such as Medline(PubMed),Embase,Academic Search Premier(EBSCO),Science Citation Index Expanded and the Cochrane Central Register of Controlled Trials(CENTRAL)in The Cochrane Library were searched for studies comparing LTG and OTG from January 1994 to May 2013.Evaluated endpoints were operative,postoperative and oncological outcomes.Operative outcomes included operative time and intraoperative blood loss.Postoperative recovery included time to first fatus,time to first oral intake,hospital stay and analgesics use.Postoperative complications comprised morbidity,anastomotic leakage,anastomotic stenosis,ileus,bleeding,abdominal abscess,wound problems and mortality.Oncological outcomes included positive resection margins,number of retrieved lymph nodes,and proximal and distal resection margins.The pooled effect was calculated using either a fixed effects or a random effects model.RESULTS:Fifteen non-randomized comparative studies with 2022 patients were included(LTG-811,OTG-1211).Both groups had similar short-term oncological outcomes,analgesic use(WMD-0.09;95%CI:-2.39-2.20;P=0.94)and mortality(OR=0.74;95%CI:0.24-2.31;P=0.61).However,LTG was associated with a lower intraoperative blood loss(WMD-201.19 mL;95%CI:-296.50--105.87 mL;P<0.0001)and overall complication rate(OR=0.73;95%CI:0.57-0.92;P=0.009);fewer wound-related complications(OR=0.39;95%CI:0.21-0.72;P=0.002);a quicker recovery of gastrointestinal motility with shorter time to frst fatus(WMD-0.82;95%CI:-1.18--0.45;P<0.0001)and oral intake(WMD-1.30;95%CI:-1.84--0.75;P<0.00001);and a shorter hospital stay(WMD-3.55;95%CI:-5.13--1.96;P<0.0001),albeit with a longer operation time(WMD 48.25 min;95%CI:31.15-65.35;P<0.00001),as compared with OTG.CONCLUSION:LTG is safe and effective,and may offer some advantages over OTG in the treatment of gastric cancer.     

Acute Jejunogastric Intussusception—A Case Report

Abstract: Acute jejunogastric intussusception is often a life-threating complication of gastric surgery. The present case of acute retrograde jejunogastric intussusception occurred twenty years after a Billroth II partial gastrectomy. Acute pancreatitis was misdiagnosed primarily became of a low suspicion index. The diagnosis was establised by gastroscopy and radiography. During surgery, an intussusception of 30 cm of the efferent jejunum was reduced. Jejunogastric intussusception should be strongly suspected in all patients who Present with epigastric pain, vomiting, hematemesis, abdominal mass, or/and high intestinal obstruction after previous gastric surgery.     

Clinical and Endoscopic Study of Early Gastric Cancer. Report of Fifteen Cases and Review of Chinese Literature

Abstract: Clinical and endoscopic study of early gastric cancer. Report of fifteen cases and review of Chinese literature. Y. Guangbi, L. Shuzong and X. Buyue, Aust. N.Z. J. Med., 1982, 12, pp. 284–286.
During 1974 to 1979, 15 early gastric cancers were found in a total of 160 patients with gastric cancer. There were 12 males and three females aged from 36 to 70 years. The gross morphologic classification based on the endoscopic appearances was lla one case, lib one case, lie five cases and III (or with He) eight cases. The diagnosis was confirmed by endoscopic biopsy in 12 patients. The histopathology of the 15 resected specimens revealed adenocarcinoma. Fourteen patients are alive one to four years after subtotal gastrectomy.     

Short-type single balloon enteroscope for endoscopic retrograde cholangiopancreatography with altered gastrointestinal anatomy

AIM:To evaluate the effectiveness of a short-type single-balloon-enteroscope(SBE) for endoscopic retrograde cholangiopancreatography(ERCP) in patients with a reconstructed intestine.METHODS:Short-type SBE was developed to perform ERCP in postoperative patients with a reconstructed intestine.Short-type SBE is a direct-viewing endoscope with the following specifications:working length,1520 mm;total length,1840 mm;channel diameter,3.2 mm.In addition,short-type SBE has a water-jet channel.The study group comprised 22 patients who underwent 31 sessions of short-type SBE-assisted ERCP from June 2011 through May 2012.Reconstruction was performed by Billroth-Ⅱ(B-Ⅱ) gastrectomy in 6 patients(8 sessions),Roux-en-Y(R-Y) gastrectomy in 14 patients(21 sessions),and R-Y hepaticojejunostomy in 2 patients(2 sessions).We retrospectively studied the rate of reaching the blind end(papilla of Vater or choledochojejunal anastomosis),mean time required to reach the blind end,diagnostic success rate(defined as the rate of successfully imaging the bile and pancreatic ducts),therapeutic success rate(defined as the rate of successfully completing endoscopic treatment),mean procedure time,and complications.RESULTS:Among the 31 sessions of ERCP,the rate of reaching the blind end was 88% in B-Ⅱ gastrectomy,91% in R-Y gastrectomy,and 100% in R-Y hepaticojejunostomy.The mean time required to reach the papilla was 18.3 min in B-Ⅱ gastrectomy,21.1 min in R-Y gastrectomy,and 32.5 min in R-Y hepaticojejunostomy.The diagnostic success rates in all patients and those with an intact papilla were respectively 86% and 86% in B-Ⅱ gastrectomy,90% and 87% in R-Y gastrectomy,and 100% in R-Y hepaticojejunostomy.The therapeutic success rates in all patients and those with an intact papilla were respectively 100% and 100% in B-Ⅱ gastrectomy,94% and 92% in R-Y gastrectomy,and 100% in R-Y hepaticojejunostomy.Because the channel diameter was 3.2 mm,stone extraction could be performed with a wire-guided basket in 12 sessions,and wireguided intraducta     

Post-gastrectomy spleen enlargement and esophageal varices: Distal vs total gastrectomy

AIM: To study the relationship between platelet count-to-spleen diameter ratio and post-gastrectomy esopha-geal varices (EVs) development in patients without liver cirrhosis or hepatitis. METHODS: We retrospectively studied 92 patients who underwent gastrectomy. They were divided into 2 groups on the basis of the surgical treatment: the distal gastrectomy (DG) group and total gastrectomy (TG) group. The incidence of EVs was determined and postoperative platelet counts, spleen diameters, and platelet count-t...     

全胃切除后单腔空肠间置代胃术疗效分析

目的探讨全胃切除术后采用40cm长度的顺行性间置空肠代胃术重建消化道的临床效果.方法对39例行间置空肠代胃术患者随访一年,观察其代胃的储存量、排空时间、反流情况、进食量、体能恢复、临床症状、体重及血浆营养参数(血红蛋白、血浆总蛋白).结果术后二周时一次吞服钡剂量为120ml(100～150),代胃排空时间平均40分钟(20～90),未见钡剂反流入食道,无间置肠段梗阻,术后一年时进食米量2～3两/餐,进餐次数为3～4次/日,无倾倒综合症,均可以从事轻～中度的体力活动.入院时与术后一年的血浆营养参数与体重比较有明显差异.(P＜0.01)结论采用40cm长度的顺行性间置空肠代胃术操作简便,临床效果良好.     

Laparoscopic and robot-assisted gastrectomy for gastric cancer: Current considerations

R a d i c a l g a s t r e c t o m y w i t h a n a d e q u a t e l y m p h-adenectomy is the main procedure which makes it possible to cure patients with resectable gastric cancer(GC). A number of randomized controlled trials and meta-analysis provide phase Ⅲ evidence that laparoscopic gastrectomy is technically safe and that it yields better short-term outcomes than conventional open gastrectomy for early-stage GC. While laparoscopic gastrectomy has become standard therapy for early-stage GC, especially in Asian countries such as Japan and South Korea, the use of minimally invasive techniques is still controversial for the treatment of more advanced tumours, principally due to existing concerns about its oncological adequacy and capacity to carry out an adequately extended lymphadenectomy. Some intrinsic drawbacks of the conventional laparoscopic technique have prevented the worldwide spread of laparoscopic gastrectomyfor cancer and, despite technological advances in recent year, it remains a technically challenging procedure. The introduction of robotic surgery over the last ten years has implied a notable mutation of certain minimally invasive procedures, making it possible to overcome some limitations of the traditional laparoscopic technique. Robot-assisted gastric resection with D2 lymph node dissection has been shown to be safe and feasible in prospective and retrospective studies. However, to date there are no high quality comparative studies investigating the advantages of a robotic approach to GC over traditional laparoscopic and open gastrectomy. On the basis of the literature review here presented, robot-assisted surgery seems to fulfill oncologic criteria for D2 dissection and has a comparable oncologic outcome to traditional laparoscopic and open procedure. Robot-assisted gastrectomy was associated with the trend toward a shorter hospital stay with a comparable morbidity of conventional laparoscopic and open gastrectomy, but randomized clinical trials and longer follow-ups are needed to evaluate the possible influence of robot gastrectomy on GC patient survival.     

Esophageal cancer after distal gastrectomy

The effect of gastrectomy on the subsequent development of esophageal cancer was investigated. Duodenogastroesophageal reflux is thought to be common in patients after distal gastrectomy, but whether this contributes to the development of esophageal cancer in such patients is controversial. We retrospectively evaluated 153 patients who underwent subtotal esophagectomy for thoracic esophageal cancer between January 2002 and July 2005. They were divided into two groups, according to whether or not they had previously undergone a gastrectomy: group 1, comprising 14 patients who had undergone gastrectomy and group 2, comprising 139 patients who had not. Clinical profiles of the patients were obtained from the medical records and the whole resected esophagus was histopathologically examined. The interval between gastrectomy and esophagectomy in group 1 was significantly shorter in the patients who had undergone gastrectomy for gastric cancer (10.5 +/- 4.2 years) than in those who had undergone gastrectomy for a peptic ulcer (28.9 +/- 3.0 years). The interval was also somehow shorter in the patients for whom anastomosis had been performed by Billroth I (21.3 +/- 5.6 years) compared with Billroth II (29.7 +/- 3.2 years), although the difference did not reach its statistical significance (P = 0.11). Moreover, the proportion of lower third tumors in patients after gastrectomy was significantly higher compared with that of the patients with intact stomach. These findings suggest that a history of gastrectomy is associated with more lower-third squamous cell esophageal carcinoma.     

吸烟及非吸烟老年患者开胸术后镇痛镇静及认知功能比较

目的 比较吸烟及非吸烟老年患者开胸术后的镇痛镇静效果、术后谵妄及认知功能障碍的发生率.方法 选择ASA分级Ⅰ～Ⅱ级择期行开胸手术患者59例,根据术前有无吸烟史,分为吸烟组（n=32）和非吸烟组（n=27）.术毕行椎旁阻滞镇痛,辅助给予舒芬太尼、曲马多、氟哌利多静脉自控镇痛.记录术后2h、24 h静息及咳嗽状态下疼痛视觉模拟评分（VAS评分）,RASS镇静深度评分及CAM-ICU量表谵妄状态评估,及术前、术后24 h认知功能（MMSE）评分.结果 （1）吸烟组患者在术后2h、24 h静息及咳嗽状态下VAS评分均大于非吸烟组（P＜0.05）;吸烟组在术后2h、24 h静息状态和咳嗽状态的VAS评分≥4分的构成比均高于非吸烟组（P＜0.01）.（2）术后2h躁动发生率吸烟组为18.8％,非吸烟组为7.4％（两者相差11.4％,P=0.263）,差异无统计学意义.（3）吸烟组术后谵妄发生率为18.8％,非吸烟组术后谵妄发生率为3.7％,（两者相差15.1％,P=0.108）,差异无统计学意义.（4）吸烟组术后24h术后认知功能障碍（POCD）发生率与非吸烟组相比,差异无统计学意义（P=0.474）.结论 老年吸烟者对切口痛的敏感度较非吸烟者高.     

品管圈活动在新生儿科医院感染控制中的应用成效

[目的]探讨品管圈活动在新生儿科医院感染控制中的应用成效。[方法]选择260例新生儿和全体医护人员作为对照组(品管圈活动实施前),另260例新生儿和全体医护人员作为研究组(品管圈活动后),比较两组医院感染发生率、医护人员手卫生依从性。[结果]研究组医院感染发生率为1.92%,明显低于对照组的5.38%(P<0.05)。研究组医护人员手卫生依从性为91.18%,显著高于对照组的70.59%(P<0.05)。[结论]在新生儿科护理工作中开展品管圈活动,有效降低医院感染发生率,提高医护人员手卫生依从性。     

内镜黏膜下剥离术后短期内胃镜检查对防治迟发性出血的价值评价

目的 探讨胃黏膜病变内镜黏膜下剥离术(ESD)后短期内再行胃镜检查在防治迟发性出血中的临床价值.方法 回顾性分析2011年5月至11月间,行ESD治疗的67例胃黏膜病变患者的临床资料,患者年龄31～84岁,中位年龄63岁.所有患者术后第1天、第3天常规胃镜复查,观察有无创面迟发性出血,并给予适当处理及随访.结果 67例患者中,病变位于贲门5例、胃体6例、胃底3例、胃窦35例、胃角16例、残胃2例.病变最大直径2.0 -7.0cm,平均(3.73±1.24)cm.ESD术中无大量出血和穿孔等并发症,术后9.0％(6/67)的患者发生迟发性出血,5例发生在术后第3天,1例在术后第4天.迟发性出血者中Forrest分级Ⅰb2例,Ⅱb4例,均经内镜下成功止血.本组中迟发性出血的发生率远高于既往仅根据患者的临床表现判断迟发性出血所得的出血发生率,但从随访结果看,两者治疗效果及安全性相当.结论 ESD术后迟发性出血的实际发生率较高,但大多无临床症状,无严重不良后果,故可以不常规行ESD术后短期内胃镜检查,以减轻患者的痛苦和精神负担.     

颈动脉内膜剥脱术后不同抗凝抗栓治疗对早期并发症的影响

目的:分析颈动脉内膜剥脱术(CEA)后抗凝等内科治疗对围术期并发症发生情况的影响。方法:回顾2010年5月至2012年7月,于我院行颈动脉内膜剥脱术患者144例临床资料,根据术后不同处理分为肝素组(H组,n=52)和低分子右旋糖酐复合阿司匹林组(DA组,n=90),观察两组患者一般状况,比较不同术后治疗患者围术期并发症情况。结果:肝素组及低分子右旋糖酐组患者并发症的发生例数和发病率分别为:伤口血肿4例(7.7%)和4例(4.4%);高灌注综合征5例(9.6%)和3例(3.3%);围术期脑卒中1例(1.9%)和2例(2.2%);术后高血压36例(69.2%)和68例(75.6%);术后低血压4例(7.7%)和3例(3.3%);围术期急性冠状动脉综合征1例(1.9%)和3例(3.3%),两组间比较差异无统计学意义(P>0.05)。结论:在严格控制血压条件下,颈动脉内膜剥脱术后应用肝素和低分子右旋糖酐复合阿司匹林两种治疗,对患者术后恢复安全性的影响无明显区别,应密切观察患者颈部伤口情况及新发神经定位体征情况。     

胃切除术后胃瘫的诊治

目的探讨胃大部切除术后残胃胃瘫综合征（PGS）的发生机制、诊断及治疗。方法对896例胃大部切除术后出现PGS患者的临床资料进行回顾性总结，探讨PGS的发生率及诊断方法。结果896例胃大部切除术患者发生PGS32例，PGS发生率为3．6％，均发生于术后3～10d；上消化道造影及胃镜检查是诊断PGS的可靠方法；32例均为非手术治愈。结论PGS的发生由多种因素引起，诊断时必须排除机械性、器质性病变；PGS采用非手术疗法均可治愈，手术治疗是禁忌证。