胃切除后食管癌手术方法选择

 目的　探讨胃大部切除或全胃切除后再患食管癌手术治疗术式。方法　回顾分析 1990年 1月至 2 0 0 1年 12月收治胃切除术后再患食管癌 2 9例资料。食管癌切除后的消化道重建方式 :残胃代食管术 2 0例、空肠代食管术 3例、结肠代食管术 6例。结果　 2 9例除 1例颈部食管结肠吻合口瘘、1例胸部食管残胃吻合口瘘、1例吻合口狭窄、3例肺部感染、其余均Ⅰ期愈合。结论　胃大部切除术后食管中下段癌采用残胃代食管术 ,食管中上段癌行结肠代食管术更为合理     

胃十二指肠息肉及良性肿瘤75例治疗体会

本文报告７５例胃十二指肠息肉及良性肿瘤的治疗体会。主要症状为上腹不适与黑便。胃镜摘除５４例，手术治疗２１例。作者认为，详尽地询问病史、配套的检查手段、熟练的操作技术以及正确的诊断思路为提高诊断率的关键，并提出了胃镜摘除手术治疗的指征及合理的手术方案来提高治愈率。     

贲门癌的外科治疗结果(附1 832例分析)

目的总结贲门癌的手术治疗结果，探讨影响预后的因素。方法对１８３２例患者进行单因素分析，生存率用寿命表法计算，差异的显著性采用Ｌｏｇｒａｎｋ检验。结果本组切除率７６．３％，根治切除率５３．４％。５年生存率：切除术２３．５％，根治性切除术２９．９％。上切缘＜５ｃｍ与≥５ｃｍ的５年生存率分别为１８．４％和２５．８％，下切缘＜５ｃｍ与≥５ｃｍ分别为２０．８％和２４．５％。它们之间的差异均有显著性（Ｐ＜０．０５）。术前放疗与单一外科治疗的５年生存率分别为２９．４％及２１．５％，但其差异无统计学意义（Ｐ＞０．０５）。结论术前放疗可提高生存率，但目前未发现有统计学意义。切缘长度达到或超过５ｃｍ可显著提高５年生存率     

残胃癌的外科治疗

目的 探讨残胃癌的病理特点及合理的外科治疗。方法 回顾性分析近十年我院收治32例残胃癌的临床资料。结果 残胃癌多在良性胃十二指肠疾病行胃大部分切除术10年后发病，Billroth—Ⅱ式癌发生率显著高于Billroth—Ⅰ式（P〈0．01），残胃癌的组织学分化差。根治性手术切除23例，切除率为71．8％，根治性切除23例中患者5年生存率17．4％，3年生存率47．8％。结论 根治性手术切除是残胃癌首选的治疗方法，能有效提高患者的生存时间和生存质量。晚期病例应该争取行姑息性切除手术。     

A case of Ménétrier's disease localized to the gastric antrum without helicobacter infection or hypoalbuminemia

INTRODUCTIONMénétrier's disease (MD) is a rare gastric disorder closely associated with Helicobacter pylori infection characterized by enlarged gastric mucosal folds and hyperplasia of surface mucus-secreting cells classically localized to the gastric body. This disease has significant morbidity and mortality secondary to hypoproteinemia, gastric obstruction, hemorrhage, and increased risk of adenocarcinoma.PRESENTATION OF CASEWe report a 53-year-old female who presented with severe epigastric pain, anorexia, weight loss, and prandial vomiting with serum albumin and chloride levels in the normal range. After serial upper endoscopy with biopsy identified nonspecific inflammatory changes in the absence of H. pylori, surgical exploration was performed with intraoperative tissue samples revealing nondysplastic, foveolar hyperplasia. Gastric antrectomy was performed with gross and microscopic examination verifying the diagnosis of MD.DISCUSSIONThe unusual presentation of this case differentiates it from other known cases due to the rare localization of the disease to the gastric antrum, the absence of H. pylori infection, and the uncharacteristically normal serum albumin level on presentation.CONCLUSIONThis case may represent an unreported subset of MD where limited surgical resection is demonstrated to offer an exceptional outcome.     

胰腺被膜及横结肠系膜前叶切除在胃癌根治术中的短期疗效及癌转移因素分析

目的 探讨胃癌根治术胰腺被膜及横结肠系膜前叶切除的短期疗效及癌转移相关因素.方法 将288例拟行胃癌根治术患者按机械抽样法随机分为术中切除胰腺被膜及横结肠系膜前叶组(观察组)145例和术中不切除胰腺被膜及横结肠系膜前叶组(对照组)143例.对手术切除标本进行病理组织学检查,判断胰腺被膜及横结肠系膜前叶是否存在癌转移；同时分析胰腺被膜及横结肠系膜前叶癌转移与各临床资料间的关系；并对两组手术时间、术中出血量、清扫淋巴结总数、术后并发症进行比较.结果 两组术中出血量、术后并发症发生率比较差异无统计学意义(P＞0.05)；观察组手术时间较对照组明显延长[(2.9±1.2)h比(2.3±0.9)h,P=0.036],清扫淋巴结总数较对照组明显增多[(20.5±7.5)枚比(13.5±9.3)枚,P=0.005].观察组胰腺被膜及/或横结肠系膜前叶存在癌转移12例(8.3％,12/145).胃癌胰腺被膜及/或横结肠系膜前叶癌转移与肿瘤位置、临床分期、浸润深度、淋巴结转移程度有关(P=0.039、0.022、0.041、0.009),而与患者性别、年龄、肿瘤部位、肿瘤直径、病理分级无关(P＞0.05).结论 胃癌根治术应合理切除胰腺被膜及横结肠系膜前叶.     

Sexual Activity After Bariatric Surgery: A Prospective Monocentric Study Using the PISQ-IR Questionnaire

IntroductionObesity can lead to pelvic floor disorders, interfering with women’s sexual life; Prolapse/Incontinence Sexual Questionnaire-International Urogynecology Association–Revised (PISQ-IR) is a new instrument to measure sexual life in women with pelvic floor disorders.AimsTo assess the utility of using PISQ-IR in morbidly obese women undergoing bariatric surgery and to show the improvement of bariatric surgery on sexuality.MethodsThis prospective monocentric study included all women who underwent bariatric surgery from June 2016–May 2017. Sleeve gastrectomy (SG) or Roux-en-Y gastric bypass (RYGB) was performed by 1 surgeon, and data were collected by 1 researcher. Demographics, medical history, number of deliveries, and type of bariatric surgery (SG or RYGB) were collected at baseline. At the 1-year follow-up consultation, postoperative complications, percentage of total body weight loss (TWL) and percentage excess weight loss were assessed. Questionnaires were given at baseline and at 1-year follow-up.Main Outcome MeasuresPostoperative complications and total weight loss were measured at the 1-year follow-up. Sexual activity, using the PISQ-IR, and pelvic organ prolapse, urinary incontinence, and anal incontinence, using the urinary symptom profile and PFDI (Pelvic Floor Distress Inventory) 20, were compared before surgery and at 1-year follow-up.Results72 patients were included at baseline, 54 (75%) were considered for final analysis (30 RYGB and 24 SG), and 51 patients were considered for PISQ-IR. The mean preoperative body mass index was 41 ± 5.4 kg/m², and mean age was 43 ± 11.8 years. Both procedures induced an important weight loss (mean TWL of 33%) and had a similar percentage of TWL for each procedure: 31 (15–46) for SG vs 34 (9–51) for RYGB. 9 patients (17 [6%]) became sexually active 1 year after surgery. For the sexually inactive population after 1 year, there was no differences in the PISQ-IR in the follow-up. When body mass index loss was >13 kg/m², a higher percentage of the sexually active population improved their different scores, and there were significant results for both global quality of life and desire (P = .026 and .046). The other questionnaires showed a significant decrease in urinary incontinence symptoms (P < .001) associated with weight loss, whereas there was no difference in terms of pelvic organ prolapse or anal incontinence.ConclusionPISQ-IR is a useful instrument to measure sexual function regarding pelvic floor disorders. Bariatric surgery improves sexual activity in obese women 1 year after surgery.Treacy PJ, Mazoyer C, Falagario U, et al. Sexual Activity After Bariatric Surgery: A Prospective Monocentric Study Using the PISQ-IR Questionnaire. J Sex Med 2019;16:1930–1937.     

胃大部切除术患者中加速康复外科护理的应用体会

目的:总结加速外科护理对胃大部切除的患者所起到的临床作用.方法:选取2011年1月至2011年7月在本院进行胃大部切除术的50例患者,随机分成观察组25例和对照组25,对照组进行常规胃大部切除术护理,观察组进行加速康复外科护理.比较两组患者的临床效果,总结护理体会.结果:观察组临床效果优15例,临床效果良9例,临床效果中1例,临床效果差0例,临床效果优良率为96%;对照组临床效果优6例,临床效果良13例,临床效果中4例,临床效果差2例,临床效果优良率为76%.两组在临床效果优良率上有显著性差异,P<0.05,有统计学意义.结论:对胃大部切除术的患者进行加速康复外科护理可明显提高临床效果优良率,改善患者的营养状况以及抗感染能力,明显比常规护理方法具有临床优势,值得临床上推广使用.     

Revision of the common bile duct in a combined PTCD/ERC approach – A case report

Introduction and importanceThe endoscopic retrograde cholangiography (ERC) represents the standard treatment for choledocholithiasis. However, ERC in patients with previous gastrectomy and anastomosis is difficult due to altered access.Case presentationIn our case, we report on a patient with previous gastrectomy and Y-Roux-anastomosis suffering from choledocholithiasis. Operative revision with simultaneous cholecystectomy failed. In a combined procedure of percutaneous transhepatic cholangiodrainage (PTCD) and endoscopic cholangiography the stone removal of the common bile duct was finally successful.Clinical discussionThere are some approaches for treatment of choledocholithiasis in pre-operated patients. However, prospective multi-center studies for complication and success rates are not available due to the rarity of such cases.ConclusionInterdisciplinary procedures seem to be the safest and most promising way to succeed in the treatment of choledocholithiasis in challenging cases.