��ǻ����������θʳ�ܽ�ϲ����Լ������󲢷�֢������

??Complications and managements after laparoscopic surgery for benign diseases of esophagogastric junction QIN Ming-fang, ZHAO Hong-zhi. Tianjin Nankai Hospital, Tianjin Minimally Invasive Surgery Center, Tianjin 300100, China
Corresponding author: QIN Ming-fang, E-mail:qins88@sina.com
Abstract The most common diseases of benign diseases of esophagogastric junction in daily practice are gastro-esophageal reflux diseases, hiatal hernia and achalasia. The surgical procedures are laparoscopic fundoplication, laparoscopic hiatal repair and laparoscopic myotomy accordingly??which have been proved to be with advantages of less surgical trauma, quicker recovery, safe operation and durable efficacy, etc. Nevertheless, postoperative complications have gained more and more attention. Early postoperative complications are bleeding, GI fistula and pneumothorax, and the late complications include recurrence and other conditions. The prevention is the most important for the treatment of postoperative complications. Correct treatment should be performed as soon as the complication occurred.     

��ǻ����������θ������32������

??Laparoscopic resection in gastric stromal tumors: a report of 32 cases ZHAO Ying??YUE Yuan-yi?? WANG Qiang??et al. Department of General Surgery, Shengjing Hospital of China Medical University, Shenyang 110004, China
Corresponding author??FENG Yong??E-mail: Fengy@sj-hospital.org
Abstract Objective To study the result of laparoscopic resection in gastric stromal tumors (GSTs), and discuss the value of laparoscopic resection in GSTs. Methods The clinical data of 32 cases of GST performed laparoscopic resection from January 2009 to November 2010 at Shengjing Hospital of China Medical University were analyzed. The operative time, intraoperative blood loss, postoperative exhaust time, intake time and hospital stay were explored. Results The mean operative time of laparoscopic resection for GSTs was ??65.5±9.8??mins. The intraoperative blood loss was??49.7±7.5??mL. The exhaust time was ??24.8±3.7??hours. The time of liquid food intake was ??26.8±3.4??hours. The length of hospital stay was ??6.3±1.1??days. During the follow-up of 1-25 months, there was no postoperative recurrence. Conclusion Laparoscopic resection of GSTs could be performed safely and effectively, which is feasible choice in the treatment for GSTs.     

θ����������15���ٴ�����

目的 探讨胃肠道间质瘤的临床表现、诊断、治疗和预后。方法 回顾性分析1999年4月至2002年7月收治的15例胃肠道间质瘤的临床和病理资料。结果 主要临床表现为腹部不适(7／15)、消化道出血(6／15)。病变部位为胃13例，十二指肠l例，小肠1例。14例行手术治疗。15例镜下均见梭形细胞，其中良性9例，交界性4例，恶性l例，胃癌伴良性间质瘤l例。免疫组化CDll7( )73％，CD34( )73％，SMA(-)73％，S—100(-)67％。随访率100％，病人均存活。结论 内镜和影像学检查是发现胃肠道间质瘤病变的主要手段，术前确诊仍较困难，手术切除是病理确诊和治疗的主要方法。     

θƢ���������ž�����ѹ֢9���ٴ�����

目的 探讨胃脾区区域性门静脉高压症（gastric splenic sepmental portal hypertension GSSPH)的临床特征及有关诊治问题。方法 回顾性分析GSSPH的临床表现特点和治疗结果。结果 对9例GSSPH病人施行手术治疗，均治愈出院，术后随访5例，未再发生消化道出血，脾亢症状完全消失。结论 GSSPH是一种能够治愈的疾病，通常伴有胰腺疾病，脾功能亢进和孤立性胃底静脉曲张。但肝功能正常，行病灶切除加脾切除疗效较好。     

θ��������87���ٴ�����

??Diagnosis and treatment of gastrointestinal stromal tumors (GIST) :an analysis of 87 cases LU Qi, LI Wei-ping, Cheng Ai-qun,et al. Department of Surgery, Huadong Hospital, Shanghai Fudan University School of Medicine, Shanghai200040, China
Corresponding author: LI Wei-ping, E-mail:weipingli789@hotmail.com
Abstract Objective To study the diagnosis and treatment of gastrointestinal stromal tumors ??GIST????Methods The clinical data of 87 cases of GIST proved pathologically admitted from January 2000 to December 2008 at Huadong Hospital, Shanghai Fudan University School of Medicine were analyzed retrospectively??Results The tumors originated respectively from the esophago??n=1??, stomach(n=45)??duodenum (n=3)??intestine(n=23)?? colon (n=3), rectum (n=3) and pelvic cavity(n=9)??Seven cases of gastric GIST were performed by laparoscopic lumpectomy. One case of rectal GIST was resected transanally. Seventy-nine cases of GIST were performed by laparotomy. Eight of them underwent palliative resection or biopsy because of extensive metastasis??Senventy-one cases were resected completely. There was no operative mortality. Fifty-five cases were followed-up. Thirteen cases had recurrenced and metastisis,and 10 of them were liver metastisis. Conclusion Curative resection is the first choice for treatment of GIST??The cases of malignant GIST or potential malignant GIST must be performed adjuvant therapy with imatinibmesylate??     

��ǻ��������θǻ�������Ų�������θ��������9���ٴ�����

??Cardiac endogenous gastric intestinal stromal tumors with laparoscopic intragastric surgery??An analysis of 9 cases WANG Jun-jiang*?? YANG Zi-feng??FENG Xing-yu, et al. *Department of General Surgery, Guangdong General Hospital, Guangzhou 510080, China
Corresponding author: LI Yong, E-mail: yuan821007@126.com
Abstract Objective To evaluate the quality and clinical efficacy of laparoscopic intragastric surgery for the cardiac endogenous gastric intestinal stromal tumors, analyze its safety, feasibility and clinical value. Methods The clinical data of 9 cases of cardiac endogenous stromal tumors performed laparoscopic intragastric surgery from June 2014 to March 2016 in Guangdong General Hospital were analyzed retrospectively. Results Nine cases were operated by laparoscopy successfully without conversion to open surgery. The operative time ranged 59 to 104 minutes and blood loss was from 5 to 65 mL. Nine cases were dianosed with gastric intestinal stromal tumors pathologically and recovery time was from 1 to 4 days, eating time 2 to 4 days, drainage time 3 to 4 days, discharge time 4 to 6 days. There was no postoperative bleeding, anastomotic leakage, cartiac stenosis and other complications. All followed-up patients had no swallowing disorders and acid reflux symptoms and no signs of recurrence and metastasis at present. Conclusion The laparoscopic intragastric treatment for cardiac endogenous gastric intestinal stromal tumors is safe and feasible. But it needs high laparoscopic surgical technique . So carrying out needs to be cautiously.     

��θ������θ̱6���ٴ�����

目的 探讨非胃手术后胃瘫的病因，寻找正确有效的诊断和治疗方法。方法 分析1992～2001年6例非胃手术后胃瘫病人的临床表现诱发因素、治疗方法和效果。结果 非胃手术后胃瘫多发生于病情复杂、手术创伤大、手术时问长的病人。主要表现为上腹胀、呕吐，胃引流量增多。胃造影和胃镜检查不仅是检查手段，而且对胃蠕动的恢复有促进作用。非连续性全胃肠道外营养(TPN)可以促进胃动力的恢复。结论 腹部非胃手术后可发生胃瘫。胃造影、胃镜的机械刺激作用和短暂中断TPN作为辅助刺激对胃瘫的恢复有促进作用。对于创伤大、时间长的腹部非胃手术，预防性营养性空肠造口是明智的选择。     

����θ��318���ٴ�����

目的分析和总结老年胃癌的临床特点.方法老年胃癌病人入院后,对可能增加手术风险的因素,尽可能在术前予以纠正.必要时,在术后继续处理.术中、术后严密观察病人全身情况,发现问题及时处理.结果318例老年胃癌病人,238例(74.84%)患有高血压、心脏病、糖尿病等老年人常见病.术后发生并发症共71例次,死亡13例.手术前有共存病者,术后并发症的发生率为25.63%;而手术前无共存病者,术后并发症的发生率为12.50%,两者差异有非常显著性意义(P<0.01).结论老年胃癌病人常患有高血压、心脏病、糖尿病等疾病.加强围手术期处理,可提高手术的安全性,减少并发症的发生.     

��ǰ�����Ը������ƶԸ���θ��������Ч���ٴ�����

进一步提高胃癌疗效的关键性问题中必然涉及到如何有效地克服肿瘤的转移与复发。据文献统计,进展期胃癌即使施行了根治性切除术,其术后复发率仍高达40%～65%。尽管如此,目前仍应将外科手术列为胃癌的首选治疗方法。随着各种新的辅助性治疗理论和技术的完善,有望弥补单纯手术治疗的不足,特别是针对肿瘤的转移和术后复发问题。综合治疗的观念已从传统之注重手术与术后治疗逐渐演变成首先开展术前治疗,旨在提高手术的切除率与根治率,为降低术后复发率创造有利条件,使之形成了围手术期辅助治疗与外科手术有机整合的新方案。其中,术前区域性辅助…     

��ǻ����������������θʳ�ܷ�����185���ٴ�����

??Laparoscopic antireflux surgery for gastroesophageal reflux disease: A clinical analysis of 185 patients SHAN Cheng-xiang, ZHANG Wei, JIANG Dao-zhen, et al. Department of General Surgery, Chang Zheng Hospital Affiliated to Second Military Medical University, Shanghai 200003, China
Corresponding author: QIU Ming, E-mail: Qiuming2006@yahoo.cn
Abstract Objective To summarize the technical practice of laparoscopic antireflux surgery (LARS) for gastroesophageal reflux disease (GERD). Methods The clinical data, high-definition LARS videos, and postoperative diet scheme of 185 GERD patients from 2000 to 2013 in Department of General Surgery, Chang Zheng Hospital Affiliated to Second Military Medical University were reviewed retrospectively. Results Laparoscopic antireflux surgery (hiatal herniorrhaphy plus fundoplication) was all successfully performed in 185 patients with none death and conversion operation. The procedure of LARS was divided into 7 steps according to our experience and HD video, standard surgical rules were followed and specific anatomic landmarks were found in each step, such as diaphragmatic crura and esophageal hiatus. The patients were deprived of food 24 hours after surgery and recovered to normal diet from clear liquid gradually and slowly. Conclusion Identification of anatomic landmarks and surgical planes, and adherence of technical key points are important to perform LARS successfully. Effective postoperative dietary guidance is helpful to increase satisfaction rate of patients.     

��������������θ�ſ��ϰ�36���ٴ�����

目的 探讨腹部手术后功能性胃排空障碍的病因、发生机制、诊断和治疗方法。方法 对1994年1月至2002年5月收治的36例腹部手术后胃排空障碍的临床资料进行回顾性分析。结果功能性胃排空障碍均发生于腹部手术后3—12天。35例(97．2％)经非手术治疗于术后13—48天恢复胃动力，痊愈出院，3周内治愈17例(47．2％)，4周内治愈32例(88．9％)，1例(2．8％)因经济原因放弃治疗而死亡。结论 腹部手术后功能性胃排空障碍的病因是多因素的，消化道造影及胃镜检查是诊断胃排空障碍及鉴别机械性梗阻的重要手段。采取非手术疗法可治愈胃排空障碍，应尽量避免再次手术。     

��չ��θ���������󸴷�30���ٴ�����

目的　总结胃癌术后复发的临床特点并探讨复发癌切除术的临床意义。方法　回顾性分析 1994年 8月至 2 0 0 1年 5月共收治的 30例胃癌术后复发病人的临床资料 ,将其分成切除组 (7例 )和非切除组 (2 3例 ) ,比较两组的临床特点和预后。结果　首次术后平均随访 2 1个月 (3～ 4 7 5个月 ) ,平均复发时间为 11 5个月 (1 3～4 5 0个月 )。切除组复发后平均存活期为 13 4个月 ,非切除组为 4 7个月 ,两组差别明显。复发癌切除对复发后生存超过 10个月有统计学意义 (P <0 0 5 )。结论　进展期胃癌根治术后局部复发癌切除可延长病人生存期。     

��θ����95���ٴ�����

我院 1993～ 1998年收治残胃病变 (因胃十二指肠良性病变经手术治疗后行胃镜检查发现 ,并经病理证实 ) 95例 ,分析报告如下。1　临床资料1.1　一般资料本组病例男 72例 ,女 2 3例。年龄 32～ 6 9岁。首次手术原因 :十二脂肠溃疡 35例 ,胃溃疡 48例 ,上消化道出血12例。采用毕Ⅰ式手术 38例 ,毕Ⅱ式手术 5 7例。1.2　临床表现上腹部疼痛 6 2例 ,腹胀 33例 ,恶心呕吐 18例 ,呃逆 10例 ,上消化道出血 17例 ,贫血 2 1例 ,胃纳减退 2 9例 ,消瘦18例 ,乏力 2 3例 ,吞咽困难 3例。上腹部压痛 72例 ,上腹部扪及肿块 3例。1.3　术后胃镜检查术后胃镜…     

��θ��28���ٴ�����

目的 分析和总结残胃癌的外科诊断和治疗情况。方法 回顾分析了28例残胃癌发病率、临床表现及治疗情况。结果 首次胃切除以胃溃疡为主，占64.3%。首次手术B-Ⅱ式22例，占84.6%。确诊残胃癌距首次手术时间平均为28.3年。残胃癌发生在吻合口占50%，残胃小弯侧42.9%，贲门部7.1%。结论 胃良性病行手术治疗时以B-I式为首选；定期胃镜检查残胃癌高危人群，早期诊断、早期治疗是提高残胃癌预后的关键。     

��ǻ����������Swenson's�����������Ծ޽᳦��

目的　总结腹腔镜辅助下改良Swenson’s术根治先天性巨结肠症的疗效、并发症及操作经验。方法　回顾性分析华中科技大学同济医学院附属协和医院 1999年 10月至 2 0 0 4年 2月 6 6例先天性巨结肠症患儿的临床资料 ,并对操作经验进行总结。结果　全部病例Ⅰ期根治获得成功 ,无中转开腹 ,平均手术时间 (190± 2 3)min ,术后平均住院时间 (6 .5± 1.0 )d ,无腹腔镜操作有关的近期严重并发症 ,远期随访无大便失禁及便秘复发。结论　腹腔镜辅助下改良Swenson’sⅠ期根治先天性巨结肠症是安全、有效的治疗方法 ,并体现微创的优越性 ,值得推广。     

ҽԴ�Ե�������64���ٴ�����

??Iatrogenic bile duct injuries: a clinical analysis of 64 cases ZHOU Yong, LIU Jin-gang. Department of General Surgery, Shengjing Hospital of China Medical University, Shenyang 110004, China
Corresponding author: LIU Jin-gang, E-mail: liujg@sj-hospital.org
Abstract Objective To analyze and summarize the experiences of diagnosis and treatment for iatrogenic bile duct injury (IBDI). Methods The clinical data of 64 cases of IBDI admitted between January 2005 and December 2009 in Shengjing Hospital of China Medical University were analyzed retrospectively. Results Of all 64 cases, there were 41 cases occurred in opened bile ductal surgeries; 16 cases happened in laparoscopic cholecystectomies; 7 cases come up with other surgeries. Four cases injured with leakage of bile gently were drainage by ENBD. Five cases were found in the operation and undergone a T-tube drainage in the injured site. Other 55 cases were treated by Roux-en-Y anastomosis of bile duct and jejunum. One case died; 2 cases went through operation once again due to the stricture of the anastomotic stoma; 1 case experienced re-operation due to the defluvium of the stent tube. Sixty-three cases recovered smoothly and were followed-up over 12 months. Conclusion On condition that gentle IBDI is found in the operation, it should take simple suturing and repairing into consideration modestly, but for a positive T-tube drainage. In case of complete truncation of the bile duct occurs in the operation, or the injury is found several days after the surgery or reconstruction surgery fails, Roux-en-Y anastomosis of bile duct and jejunum may be the first choice, which could lead a satisfactory curative effect, while the annular anastomat should be applied cautiously.     

��״����ͷ״����Ƶ�������ƺ�������5���ٴ�����

??Re-operation for papillary thyroid carcinoma after radiofrequency ablation therapy: A clinical analysis of 5 cases DONG Wen-wu??ZHANG Hao??ZHANG Ping??et al. Department of Thyroid Surgery??the First Affiliated Hospital of China Medical University??Shenyang 110001??China
Corresponding author??ZHANG Hao??E-mail??haozhang@mail.cmu.edu.cn
Abstract Objective To investigate the treatment of papillary thyroid carcinoma (PTC) after radiofrequency ablation (RFA). Methods The clinical data of 5 cases of PTC after RFA from November 2014 to January 2015 in the Department of Thyroid Surgery??the First Affiliated Hospital of China Medical University were studied retrospectively. Results There were 3 cases of single lesion and 2 cases of multiple lesions in bilateral lobes. The mean tumor size was 1.76 cm (range 0.4??3.0 cm). Two cases received unilateral thyroid lobectomy plus isthmusectomy with ipsilateral central lymph node dissection (CLND). One case received total thyroidectomy with unilateral CLND. One case received total thyroidectomy with bilateral CLND and 1 case received total thyroidectomy with bilateral CLND and unilateral modified lateral lymph node dissection. All cases were diagnosed as PTC by routine histopathology. There were 4 cases of central lymph node metastasis in which 1 case of lateral lymph node metastasis. There was no complications??but temporary hypoparathyroidism in 1 case. Conclusion The indications for RFA should be grasped strictly. Early operations for PTC after RFA should be performed by an experienced surgeon??given that local tissue adhesion was obvious.     

��ǻ���޴�ʳ���ѿ����޲���75���ٴ�����

??Laparoscopic repair for giant hiatal hernia??A clinical analysis of 75 patients SUN Xiang-yu, QIN Ming-fang, ZHAO Hong-zhi, et al. Department of Mini-invasive Surgery, Tianjin Nankai Hospital, Tianjin 300100, China
Corresponding author: SUN Xiang-yu, E-mail: xiangyusun79@126.com
Abstract Objective To investigate the safety and effectiveness of laparoscopic repair for giant hiatal hernia. Methods The clinical data of 75 patients with giant hiatal hernia performed laparoscopic repair between January 2006 and August 2012 in Tianjin Nankai Hospital were analyzed retrospectively. The operation time, hospitalization time, intraoperative and postoperative complications, postoperative improvement of symptoms and upper gastrointestinal imaging were studied. Results All the patients were treated by laparoscopy successfully. Fifty-one patients were reinforced with meshes. Twenty-four patients were reinforced without mesh. Hiatal pillars in 40 patients were partly contracted and closed with meshes. Hiatal pillars in 35 patients were directly closed up to normal diameter by interrupted stitches. Among them, 11 patients were placed with meshes. Laparoscopic repair complicated with fundoplication was performed in 64 patients with average operation time of (97.2±2.1)min, average operative blood loss of (82.0±1.7)mL and average hospital stay of (5.0±1.2)d. No conversion and death occurred. Seventeen patients (22.7%) had short-term or long-term complications. Seventy-five patients were followed up for 3 months to 62 months with average of (31.0±2.1)months. Main symptoms of 66 patients (88%) were disappeared. Nine patients ??12%??had recurrence of symptoms. Four patients??5.3%??were found recurrence by barium swallow. Conclusion Laparoscopic repair for giant hiatal hernia is safe and reliable. Mesh repair can reduce the recurrence rate but accompanied with risk of complication.