Clinical studies on the transabdominal resection of esophagocardial cancer and cervical anastomosis using bypass methods. Analysis of data on 76 patients

Transabdominal resection for esophagocardial cancer and reestablishment of alimentary continuity using bypass methods were performed in 76 patients. Thirteen underwent a bypass with a gastric tube and in 30, a colonic segment was prepared. In the remaining 33, a jejunal segment was used as a bypass organ, with considerable success. The 5 year survival rates were 68.8 per cent in those with stages (I+II), 16.5 per cent in those with stage III, 12.6 per cent in those with stage IV and 22.5 per cent in all cases, indicating similar results compared to those with cancer located in the upper third of the stomach with the limited proximal extension within the esophagocardial junction and operated on during the same period.     

Clinical studies on the transabdominal resection of esophagocardial cancer and cervical anastomosis with jejunal segment bypass obviating thoractomy

Transabdominal resection of esophagocardial cancer and reestablishment of alimentary continuity using a bypass method have been performed in 64 patients. Twelve underwent a bypass with a gastric tube and in 30, a colonic segment was prepared. In the remaining 22, a jejunal segment was used as the bypass organ. Leakage of cervical anastomosis occurred in 4 (18 per cent) but all were limited to minor leakage and oral ingestion was resumed within 10 days after operation. In one, necrosis of the jejunal segment occurred. The history of jejunoesophagoplasty was reviewed and the usefulness of jejunal segment as a substitute of an esophagus was emphasized.     

Clinical studies on the transabdominal resection of esophagocardial cancer and cervical anastomosis using a by-pass method obviating thoracotomy

Transabdominal resection of esophagocardial cancer and reestablishment of alimentary continuity using by-pass method with gastric tube or colonic segment have been performed in 40 patients including 5 with squamous cell carcinoma. Of 40, 4 cases were at stage II, 8 cases at stage III and 28 cases at stage IV. Major factors which determined the stage were peritoneal dissemination and serosal invasion in the stage IV patients. The removal of the lesion was performed curatively in 13 (33%). Major complications in the post-operative course were the leakage of anastomosis and respiratory failure. Nine of 40 cases (23%) were combined with minor leakage at the cervical anastomosis, but such did not interfere with the resumption of oral ingestion of food. The 3 year survival rate was 46% in the cases of stages (II+III) and 16% in the cases of stage IV, indicating moderately high rates as compared with that in cases of cancer located in the upper third of the stomach with the limited proximal extension within the esophagocardial junction. Supported in part by Grant-in-Aid for Cancer Research from the Ministry of Health and Welfare, Japan.     

A new procedure for transabdominal resection of esophagocardial cancer and cervical anastomosis obviating thoracotomy.

A new operative technique for esophagocardial cancer was reported with resection and re-establishment of alimentary continuity at cervical esophagus which obviates thoracotomy but still retains adequate removal of the lesion. Ten cases of esophagocardial cancer thus treated were presented and the clinical data were analyed. The distance between esophageal stump and esophagocardial junction measured on the resected specimen ranged from 3.0 to 6.7 cm with an average of 5.1 cm. No remaining tumor cells were detected microscopically on the oral cut margin of the specimen in all cases. To compensate for the inadequated lymph node dissection intensive postoperative adjuvant irradiation and/or chemotherapy was advocated.     

A new procedure for transabdominal resection of esophagocardial cancer and cervical anastomosis obviating thoracotomy

A new operative technique for esophagocardial cancer was reported with resection and re-establishment of alimentary continuity at cervical esophagus which obviates thoracotomy but still retains adequate removal of the lesion. Ten cases of esophagocardial cancer thus treated were presented and the clinical data were analyzed. The distance between esophageal stump and esophagocardial junction measured on the resected specimen ranged from 3.0 to 6.7 cm with an average of 5.1 cm. No remaining tumor cells were detected microscopically on the oral cut margin of the specimen in all cases. To compensate for the inadequated lymph node dissection intensive postoperative adjuvant irradiation and/or chemotherapy was advocated.     

Blunt esophageal resection for esophagocardial cancer: Blunt dissection and retrosternal esophagojejunostomy using the EEA stapler

A transabdominal resection for esophagocardial cancer and cervical esophagojejunal anastomosis was devised by our group. Since 1973, seventy-six such operations have been done and the long-term follow up study showed a good survival rate. These findings justify our efforts to perform the operative procedure without opening the chest. To obviate cervical esophagocutaneostomy which is indispensable to this method and may contribute to complications, we altered the operative procedure to blunt dissection of the esophagus and retrosternal esophagojejunostomy, using the EEA stapler. Details of the operative procedures used for nine patients are reported herein.     

Blunt esophageal resection for esophagocardial cancer: blunt dissection and retrosternal esophagojejunostomy using the EEA stapler

A transabdominal resection for esophagocardial cancer and cervical esophagojejunal anastomosis was devised by our group. Since 1973, seventy-six such operations have been done and the long-term follow up study showed a good survival rate. These findings justify our efforts to perform the operative procedure without opening the chest. To obviate cervical esophagocutaneostomy which is indispensable to this method and may contribute to complications, we altered the operative procedure to blunt dissection of the esophagus and retrosternal esophagojejunostomy, using the EEA stapler. Details of the operative procedures used for nine patients are reported herein.     

腹腔镜下低位直肠癌经肛拖出切除吻合术的临床研究

目的：探讨腹腔镜下低位直肠癌经肛拖出切除吻合术在低位直肠癌治疗中的临床应用价值。 方法：回顾性分析12例低位直肠癌应用腹腔镜下经肛拖出切除吻合术的临床资料。12例肿瘤锯齿状线为1~3 cm, 肿瘤局限在肠腔内, 直径均<4 cm, 浸润<肠腔1/2, 均为高-中分化瘤。均行腹腔镜下全直肠系膜切除, 直肠及肿瘤经肛门拖出切除, 用吻合器行结直肠或结肛吻合术。 结果：12例均顺利完成腹腔镜下手术, 无中转开腹手术者。手术时间160~240 min, 平均200 min。术中出血30~80 mL, 平均40 mL。切缘均无癌残留。胃肠功能恢复时间36~60 h, 术后住院时间7~10 d, 无吻合口瘘及吻合口出血发生。12例随访12~18个月, 未发现局部复发。 结论：腹腔镜下低位直肠癌经肛拖出切除吻合术准确、简便、安全, 为瘤体较小、组织学分型好的早、中期的低位直肠癌提供一种较好的术式选择。     

结直肠癌并梗阻实施术中全结肠灌洗后Ⅰ期根治术的临床观察

【摘要】〓目的〓观察和分析术中全结肠灌洗后Ⅰ期肿瘤根治切除肠吻合术治疗结直肠癌并梗阻的效果。方法〓选择60例在我院接受结直肠癌根治术并肠梗阻患者分3组,术中结肠灌洗组:急诊手术,实施术中全结肠灌洗后Ⅰ期根治术;常规处理组:患者经保守治疗,肠梗阻解除后实施根治术;分期手术组:保守治疗未能解除梗阻患者,行肿瘤根治,一期肠造瘘,二期肠吻合。对比3组患者治疗的效果和并发症情况。结果〓术中结肠灌洗组的手术时间较术前结肠灌洗组和造瘘组分别延长(P<0.05),并发症发生总次数较多但没有统计学差异。3组患者在手术失血量、胃管留置时间、术后进食时间、总住院时间等没有统计学差异。结论〓对于结直肠癌并肠梗阻的患者,急诊行术中全结肠灌洗Ⅰ期肿瘤切除肠吻合是可行的,但不一定适合所有病例,应结合术前术中的判断。     

Extended resection of lung cancer invading the left subclavian artery by using cardiopulmonary bypass.

We treated a 54-year-old man with large cell carcinoma of the left upper lobe invading the esophagus and the left subclavian artery (SCA) from its origin. The tumor was completely resected by lobectomy under cardiopulmonary bypass. The left SCA was dissected at the aortic arch and reconstructed with a graft. The muscle layer of the esophagus was resected, followed by patching with an intercostal muscle flap. The pathological tumor stage was T4N0M0. The tumor recurred at two months after surgery in the neck lymph nodes and brain. Both sites were treated with radiation therapy and the patient is now alive without recurrence at 26 months after surgery. Lung cancer invading the great vessels and other mediastinal structures can be cured or long survival can be obtained by extended resection and postoperative adjuvant therapy.     

腹腔镜直肠癌前切除双吻合器吻合术103例临床分析

目的探讨腹腔镜直肠癌前切除双吻合器吻合术的安全性、可行性及临床疗效。方法回顾性分析2009年1月至2015年12月103例中低位直肠癌施行腹腔镜直肠癌前切除双吻合器吻合术资料。其中男59例,女44例,年龄32~85岁,平均61.6岁。肿瘤距肛缘7~12 cm。术前评估T1N0M026例,T2-4N1-3M077例。从腹腔镜腹部手术时间、术中出血量、淋巴结清扫数目、术后肛门排气时间、术后住院时间,术后并发症发生率、术后排便功能等评价手术质量。采用门诊检查和电话方式进行随访,随访时间至2015年4月。结果本组103例手术经过顺利均获成功,平均检出淋巴结12枚以上,行预防性横结肠和回肠造瘘术12例,3个月后还纳造口。术后3~5 d肠蠕动恢复肛门排气,术后平均11 d出院。术后病理为T_1-T_2N_0M_015例,T_2-4N_(1-3)M_082例,T_2-4N_1-3M_16例。术后随访3~50个月,平均26个月,术后发生吻合口漏3例(2.9%),2例经结肠腹部临时造口,3个月后还纳愈合,1例保守治疗,1个月后愈合;吻合口狭窄2病例(1.9%),均经扩张狭窄解除。局部肿瘤复发4例(3.8%)。结论腹腔镜中低位直肠癌前切除双吻合器吻合术,是安全可靠,符合微创原则,临床疗效满意。     

腹腔镜低位直肠癌保肛手术中拖出切除吻合术的临床应用

目的：探讨经肛门外翻拖出切除吻合技术在腹腔镜低位直肠癌保肛手术中的临床价值。方法回顾性分析我院近几年应用经肛门外翻拖出切除吻合技术在腹腔镜低位直肠癌保肛手术35例患者的临床资料及治疗效果。结果所有手术标本远端阴性切缘≥2 cm,环周病理检查未见癌细胞侵润。术后无吻合口瘘、吻合口狭窄或大便失禁等并发症。随访1个月~5年,无种植性肿瘤转移和局部复发患者。结论经肛门外翻拖出切除吻合术在腹腔镜低位直肠癌保肛手术中具有微创和安全可靠的临床效果。     

超低位前切除经肛门吻合术在低位直肠癌保肛术中的应用

目的 探讨低位直肠癌保肛术的手术方法、可行性及一些相关问题。方法 作者自1992年10月至2000年1月，对63例低位直肠癌施行超低位切除经肛门吻合术进行回顾性分析。结果 全组病例均顺利切除，吻合成功。术后发生吻合口漏11．1％（7／63），吻合口狭窄15．9％（10／63）。局部复发率12．6％（8／63），5年生存率81％（51／63）。结论 超低位前切除经肛门吻合保肛术是治疗低位直肠癌的一种易行、安全、经济的术式，并可提高生活质量。     

Transitional mucosa at anastomosis. A cause of local tumor recurrence in patients with rectal cancer after anterior resection.

Transitional mucosa adjacent to colorectal cancers is essentially characterized by an excess of sialomucins at the expense of the normally predominant sulphomucins in epithelial cells lining the intestinal crypts which presents the early stage of oncogenic transformation of colorectal epithelium. The presence or absence of sialomucins at the resection margins was studied histochemically using the high iron diamine-alcian blue(HID-AB) stain in 64 rectal cancer patients in Dukes' B stage who underwent curative anterior resection. The correlation was revealed between the presence of sialomucins at the resection margins and subsequent development of local tumour recurrence. Fourteen of 27 patients (51.9%) with sialomucins predominant pattern at either resection margin developed local recurrence compared with 4 of 37 patients (10.8%) with sulphomucins predominant pattern (P less than 0.001). It is suggested that determination of the transitional mucosa around anastomosis in patients treated for the rectal carcinoma by anterior resection appears to identify those with a higher risk of local recurrence.     

不停跳冠脉旁路移植术联合肺癌根治术的麻醉管理

目的回顾并总结不停跳冠状动脉旁路移植(OPCABG)联合肺癌根治同期手术的麻醉管理方法。方法收集2003年5月至2018年1月静脉复合麻醉同期手术46例患者的麻醉管理资料,年龄53～77岁,ASAⅡ或Ⅲ级。记录术中HR、CVP、MAP、CI、PCWP、混合静脉血氧饱和度(SvO_2)和动脉血乳酸浓度(Lac),计算肺血管阻力(PVR)、全身血管阻力(SVR)、氧供(DO_2)、氧耗(VO_2)和氧摄取率(ERO_2)并对同期手术麻醉风险进行回顾分析。结果所有患者顺利完成同期手术,无死亡病例。2例术中发生心肌缺血、低血压,放置主动脉内球囊反搏(IABP),4例出现低心排给与去甲肾上腺素治疗。麻醉诱导后各时点HR、MAP较术前明显下降(P0.01),术中各时点SVR、PVR、 VO_2、Lac较诱导后明显下降(P0.05或P0.01),CI、DO_2与ERO_2较诱导后明显增加(P0.05或P0.01)。结论麻醉重视术前准备和术中监测,维持术中血流动力学稳定及心肌氧供需平衡,做好心肺功能维护能够保证OPCABG联合同期肺癌根治手术顺利实施。     

Volvulus of the sigmoid colon. Emergency resection and anastomosis]

Eleven cases of sigmoid volvulus in patients aged 76 years in average, without visible signs of necrosis on endoscopy, are reported. All patients were treated within 6 to 48 hours by colic resection and immediate restoration of continuity with a mechanical anastomosis. Morbidity was low, including one case of evisceration and one of pneumonia, and there was no mortality after three months. Early resection seems to prevent the risks of necrosis and recurrence, and to have a good prognosis for survival.     

Reconstruction of the pharynx after resection for cancer. A comparison of methods.

Repair of the pharynx after extirpation of malignancy may require the introduction of independently vascularized tissue either at the time of resection (primary reconstruction) or later for undesirable sequelae, such as fistula or stenosis. A ten-year retrospective study compares two methods of pharyngeal reconstruction, the pectoralis major musculocutaneous flap (MCF) and the jejunal free autograft. One hundred and seventeen patients undergoing laryngopharyngectomy at Emory University affiliated hospitals between 1977 and 1987 were reconstructed with either the pectoralis major musculocutaneous flap (24 patients) or with the jejunal free autograft (93 patients) Primary repair with the pectoralis MCF was attempted on 12 patients (Group I) with initial success in 5 patients (42%), fistula in 7 patients (58%), and salvage surgery necessary in 6 patients (86%). Primary reconstruction with jejunal free autograft (Group II) was performed in 70 patients with 44 initial successes (63%), 9 graft failures (13%), 5 of which were salvaged by a second jejunal free autograft. Seventeen fistulas occurred (24%). Of these, nine (53%) closed with nonoperative therapy and five (29%) required surgery. Secondary reconstruction with the pectoralis major MCF was attempted in 12 patients with initial success in 3 patients (25%), and fistula in 9 patients (75%). Of these 9 fistula patients, 3 (33%) closed with nonoperative therapy and 6 required salvage surgery, which was successful in only 2 patients. Secondary repair with jejunal free autograft was performed in 23 patients with 13 (56%) initial successes and 8 patients resolving with nonoperative therapy (89%) for a total success rate of 21/23 or 91%. The higher initial success rates and more expeditious resolution of problems demonstrates that the jejunum is the superior method of reconstruction for the pharynx.     

Clinical studies of the patients with primary renal pelvis cancer

Sixteen patients with transitional cell carcinoma of the renal pelvis seen at our Hospital between December 1973 and February 1984 were reviewed and the diagnostic tools were evaluated. The patients (11 males, 5 females) ranged in age from 35 to 81 years (mean 63.8). Ten tumors were found on the left side and 6 on the right side. The most frequent symptom was macrohematuria (93.8%). Total nephroureterectomy including the cuff was performed in 11 cases, simple nephrectomy in 2 cases and partial nephrectomy in one case. Lymphadenectomy was performed in 4 cases. According to the general rules for clinical and pathological studies on bladder cancer in Japan, 5 cases were classified grade 1, 6 cases as grade 2 and 3 cases as grade 3. According to Cummings' staging, 2 cases were in stage 1, 4 in stage II, 7 in stage III and 3 in stage IV. The cumulative survival rate at 5 years was 34.1% by Kaplan-Meier's method. The diagnostic tool contributing to the confirmation of the renal pelvic cancer was the retrograde pyelogram in 12 out of 15 patients (80.0%).