贲门胃底切除、余胃食管吻合在残胃贲门癌手术中的应用

对14例残胃贲门癌行贲门胃底切除、残胃食管吻合术。全组均行根治性切除,手术过程顺利,无手术死亡及吻合口瘘、胃瘘发生。认为残胃癌贲门胃底切除残胃食管再吻合的手术方法保留部分正常胃组织,比全胃切除更符合生理功能,既符合肿瘤切除原则,又有效地减少全胃切除术后并发症,提高患者的生存质量。     

空肠代胃、双输出道吻合在全胃切除术中的应用(附10例报告)

全胃切除治疗胃癌的比例日渐增多 ,而全胃切除消化道重建目前尚无统一术式 [1 ,2 ]。前辈们已做过多年的努力研究 ,其目的是在于不断完善手术方式 ,避免全胃切除后带来的“无胃”状态及各种并发症。1 998年 1月～ 2 0 0 0年 1 2月 ,我们对 1 0例胃恶性肿瘤全胃切除术者采用空肠代胃、双输出道吻合 ,取得了满意疗效 ,患者生活质量明显提高。现报告如下。1　资料与方法1 .1　一般资料　本组男 7例 ,女 3例 ;年龄 3 9～ 64岁 ,平均 5 1 .3岁。术前全部诊断为胃癌。病变位于胃小弯侵及贲门 4例 ,革袋胃 3例 ,残胃癌 2例 ,胃底、胃体多处病变者 1…     

全胃小弯切除、管状胃成形在胸段食管癌手术中的应用

在112例胸段食管癌手术中应用残端闭合器或直线型切开-缝合器行全胃小弯切除并管状胃成形加食管胃颈部吻合术。全组无手术死亡者,术后发生颈部吻合口瘘2例,吻合口狭窄3例,无反流性食管炎,无幽门梗阻及胸腔胃膨胀。认为全胃小弯切除、管状胃成形能较好降低病变位置高、胃相对较短的食管癌患者手术中颈部吻合的难度,减少术后并发症的发生。     

胃大部切除术后食管癌的外科治疗

对于因良性疾病行胃大部切除后又出现食管癌的患者,临床较为少见,手术根治依然是首选,但二次手术难度相对较大,选择合适的手术方法对患者的预后及生存质量至关重要~([1,2]).2002年至2008年,我科对胃大部切除术后20 例食管癌病人,采用不同的手术方法进行了再次手术治疗,现结合文献探讨该类患者手术方法选择的合理性.     

高龄老年人全胃切除改良Double tract代胃术的临床分析

近年来,老年胃癌患者随着社会高龄化和胃近端癌发病率的增加,需行全胃切除者日趋增多[1].全胃切除术后的并发症和生存质量与消化道的重建方式有关.因此,在保证胃癌根治性切除的同时,如何选择消化道重建术式,降低围手术期的死亡率和各种并发症至关重要.本文对我院1996年1月-2005年6月行全胃切除改良Double tract代胃术的68例75岁     

全胃切除、代胃及人工幽门括约肌重建术治疗胃癌的术后营养状况观察

目的了解全胃切除,代胃及人工幽门括约肌重建术治疗胃癌患者的术后营养状况。方法对106例行全胃切除,代胃及人工幽门括约肌重建术的病人进行定期随访。结果所有术后病人的营养状况都得到不同程度的改善。结论全胃切除,代胃及人工幽门括约肌重建术治疗胃癌患者,对术后营养状况的恢复有很大的帮助。     

11例残胃贲门癌手术治疗体会

目的进一步提高残胃贲门癌的治疗效果。方法对11例残胃贲门癌患者行手术治疗。其中4例行全胃切除、食管空肠Roux-Y式吻合术;7例行胸切口残胃食管直接吻合。结果全组围手术期无死亡病例,发生胸内．吻合口瘘1例,经保守治疗后治愈。结论术前充分评估、术中根据患者情况选择合适的手术方式以及术中耐心细致的操作是残胃贲门癌手术成功的关键。     

全胃切除治疗胃癌50例临床分析

自1987年Schlater首先全胃切除治疗胃癌至今已有lOO余年的历史。近年来伴随着外科学、麻醉学、影象学、围手术期管理学等的迅速发展,全胃切除、全胃及联合脏器切除已成为相对安全的手术。胃癌的扩大根治术亦引起了更多的重视和倡行。从1987年12月-1998年12月行全胃切除治疗胃癌50例,现报告如下。     

胃十二指肠穿孔手术临床治疗探讨

目的比较胃十二指肠穿孔手术的治疗方法及效果。方法选取2010年4月-2012年10月来我院进行治疗的胃十二指肠穿孔患者30例为研究对象,其中22例慢性胃十二指肠溃疡穿孔患者行胃大部切除手术;5例外伤所致胃穿孔者行单纯穿孔缝合术;3例恶性肿瘤所致的胃穿孔,2例行姑息性胃次全切术,1例行穿孔修补、大网膜覆盖术。结果经处理后,恶性肿瘤患者死亡,其他患者均痊愈。结论胃十二指肠穿孔手术治疗需要针对不同的患者,采取不同的方法。     

管状胃在食管癌切除食管胃胸内吻合术中的应用

目的 探讨管状胃在食管癌切除食管胃胸内吻合术中的应用.方法 将经左侧开胸手术治疗的340例中下段食管癌患者按手术方式分成管状胃组(A组)和全胃组(B组),观察两组患者手术时间、术后住院时间、清扫胃小弯侧淋巴结的数量,以及吻合口瘘、吻合口狭窄、心律失常、反流性食管炎、胸胃综合征的发生情况.结果 两组患者手术时间、术后住院时间及吻合口狭窄、心律失常发生率差异无统计学意义;A组吻合口瘘、反流性食管炎、胸胃综合征的发生率比B组低,清扫胃小弯侧淋巴结数目比B组多,差异均有统计学意义.结论 管状胃代食管更符合生理解剖要求,扩大了淋巴结清扫范围,提高了肿瘤根治水平,降低了术后并发症,可改善患者术后生活质量.     

The case for total gastrectomy in multiple polyposis of the stomach

There is a considerable risk that a patient with multiple polyposis of the stomach will develop carcinoma of the stomach and this risk is greater than that of total gastrectomy when performed for benign conditions. Total gastrectomy is therefore sound treatment for this disease, regardless of the distribution of the lesions over the gastric mucosa, and a patient successfully treated in this way is reported. Reference is also made to a patient who died untreated and was found to have both multiple polyposis and gastric carcinoma.     

The nutritional advantages of proximal gastrectomy for early gastric cancer.

BACKGROUND/AIMS: Total gastrectomy has generally been performed for the treatment of early gastric cancers involving the upper third of the stomach. However, proximal gastrectomy has also been used for the treatment of cardial early gastric cancer. METHODOLOGY: To compare the nutritional parameters after proximal gastrectomy with the parameters after total gastrectomy, and to also determine the advantages of the postoperative nutritional states, a retrospective analysis was made to evaluate the nutritional status of patients with early gastric cancer who underwent proximal gastrectomy with those undergoing total gastrectomy. Forty-nine patients were studied for one year after surgery; 9 underwent proximal gastrectomy while 40 had a total gastrectomy. RESULTS: Proximal gastrectomy allowed the patient to better maintain both their nutritional parameters and body weight. CONCLUSIONS: Proximal gastrectomy was thus found to be a beneficial modality for early gastric cancer patients regarding terms of the postoperative nutritional status, in comparison to total gastrectomy.     

Serum 25-hydroxyvitamin D and vitamin D-binding protein levels and mineral metabolism after partial and total gastrectomy

The effects of gastrectomy, especially total gastrectomy, on the serum levels of 25-hydroxyvitamin D and vitamin D-binding protein and on mineral metabolism were examined. The serum 25-hydroxy-vitamin D levels were markedly decreased in patients with total gastrectomy and Billroth II gastrectomy. Decreased levels of serum vitamin D-binding protein and serum calcium, and increased levels of serum alkaline phosphatase were observed in both patients with partial gastrectomy and patients with total gastrectomy. The results show that vitamin D deficiency could develop in high frequency patients with total gastrectomy and Billroth II gastrectomy, and that deranged mineral metabolism could develop in patients with any type of gastrectomy with or without vitamin D deficiency. The decreased levels of serum vitamin D-binding protein in postgastrectomy patients may be a sensitive reflection of the failure of hepatic protein synthesis.     

Synchronous gastric tumors associated with esophageal cancer

Objective: Synchronous gastric tumors (including benign and secondary tumors) associated with esophageal cancer present diagnostic and therapeutic issues. We investigated this synchronous association, and retrospectively determined the frequency of the gastric tumors and the clinical characteristics.
Methods: In a series of 208 patients with esophageal cancer, we investigated the synchronous gastric tumors, as well as the frequency of association, clinicopathological characteristics, diagnosis, treatment, and the clinical outcome after surgery.
Results: Twenty-eight gastric tumors were found in 24 patients. Adenocarcinoma was most frequent. Most of these tumors were located at the upper or middle third of the stomach. Eight gastric tumors in six patients could not be detected preoperatively. Six of these tumors including a gastric remnant cancer were detected in the resected stomach, and two leiomyomas were detected during the operation. In one patient in which an endoscope could not pass through the esophagus, a leiomyoma was detected in the resected stomach. For the gastric cancers, total gastrectomy or proximal gastrectomy with lymph node dissections was performed. For the benign tumors, partial resection of the stomach was performed, and endoscopic resection was performed preoperatively for an adenoma. In both the postoperative hospital mortality rate and the survival rate after surgery, there were no significant differences between the patients with and without gastric tumors.
Conclusions: Synchronous gastric tumors associated with esophageal cancer are not rare. When an endoscope cannot pass through the esophagus before surgery, other techniques must be performed to explore the stomach. For these patients, surgical treatment should be adapted positively.     

Is pancreas and/or spleen resection required in total gastrectomy for advanced gastric cancer?

OBJECTIVE: Total gastrectomy for advanced gastric cancer is frequently combined with extended lymphadenectomy. This technique is easier when resection of distal pancreas and/or spleen is performed. We have tried to evaluate whether the resection of both structures and total gastrectomy in patients with advanced gastric cancer actually improve survival rates. PATIENTS: From 1991 to 1999, 140 patients with advanced gastric cancer underwent total gastrectomy at the General Hospital of Albacete: 43 with simple total gastrectomy, 57 with total gastrectomy plus splenectomy and 40 with total gastrectomy plus distal pancreaticosplenectomy. Univariate and multivariate analysis were conducted in order to evaluate different prognostic factors and survival curves among the groups. RESULTS: Survival rates of the three groups were compared for each factor, being only significant variables the degree of tumor infiltration in the gastric wall, the size of the tumor, the staging and the type of lymphatic infiltration. Neither splenectomy nor distal pancreaticosplenectomy improved the survival compared to simple total gastrectomy. Morbimortality rates increased with more aggressive surgical procedures, but differences were not significant. CONCLUSIONS: Resection of distal pancreas and/or spleen plus total gastrectomy for advanced gastric cancer is associated to a greater number of isolated lymph nodes, but do not improve the survival of patients.     

Remnant-stump gastric cancer following partial gastrectomy.

Between 1970 and 1990, a total of 2,189 patients with gastric cancer underwent resection in the First Department of Surgery, Kurume University Hospital. Of these, 54 patients had previously undergone a partial gastrectomy. The time interval between the initial partial gastrectomy and the resection of the remnant-stump gastric cancer was more than 10 years in 25 patients and less than 10 years in 29 patients. Those with a time interval of more than 10 years we have termed remnant-stump cancer. The original pathology was a gastric ulcer in 13, a duodenal ulcer in 5, a gastric polyp in 1, and a gastric cancer in 6 patients. Of the 19 patients that had undergone an initial operation for benign disease (Group 1), 15 (79%) patients had received initial reconstruction by B-II and 4 (21%) by B-I. On the other hand, of the 6 patients with an initial operation for gastric cancer (Group 2), 3 (50%) had undergone reconstruction by B-I and the other 3 (50%) had received a B-II procedure. Twenty-three of 25 (92%) remnant-stump gastric cancers underwent total gastrectomy, while the other 2 (8%) were early remnant-stump cancers in the stoma and underwent partial gastrectomy. In group 1, only 5 out of 19 (26.3%) patients are alive, while in group 2 all 6 patients are alive, including the 2 (33.3%) early-stage cancers that were found through periodical endoscopic follow-up examinations.     

Factors influencing the development of small intestinal obstruction following gastrectomy for early gastric cancer

BACKGROUND/AIMS: The factors influencing the development of small intestinal obstruction following gastrectomy for early gastric cancer are controversial. METHODOLOGY: Univariate and multivariate analyses were carried out using data from 136 patients with early gastric cancer who underwent gastrectomy. The mean follow-up interval was 5 years and 11 months. RESULTS: Of these 136 patients, 15(11.0%) presented mechanical obstruction in the small intestine postoperatively. Re-operation for repair of the related ileus was required in 8 patients, 4 of whom had been treated with total gastrectomy, 7 with resection of the greater omentum, and 3 with concomitant resection of other organs. Development of an obstruction was not related to wide resectional procedures such as extended lymph node dissection or combined resection of other organs, but was significantly correlated with total gastrectomy and resection of the greater omentum (p < 0.05). In multivariate logistic regression analysis, total gastrectomy proved to be a significant risk factor related to the development of small intestinal obstruction. CONCLUSIONS: In patients with early gastric cancer, total gastrectomy should not be attempted to prevent postoperative ileus and to ensure a fairly sustained quality of life.     

Total gastrectomy for gastric adenocarcinoma. Analysis of 115 consecutive patients.

BACKGROUND/AIMS: There was a tendency to use more extensive operations for the treatment of gastric cancer during the last decade particularly in Europe. This retrospective study was carried out to review our recent experience with total gastrectomy for gastric adenocarcinoma. METHODOLOGY: One hundred and fifteen patients treated for gastric cancer by total gastrectomy from 1987 to 1996 were analyzed. At the time of surgery 22.3% of patients were older than 70 years of age. RESULTS: Fifty eight cancers (50.4%) were located in the distal third of the stomach, forty-seven (41%) were smaller than 6 cm and seventy-one (61.7%) were of the diffuse type. In 74.9% the tumor had penetrated through the serosa. The mortality and morbidity rates were 6.1% and 35.1% respectively. Age was a major determining factor with respect to hospital mortality and post-operative complications. CONCLUSIONS: Irrespective of personal attitudes, gastrectomy does not have to be total to be curative, and many total gastrectomies performed in Western countries with "curative intent" are noncurative procedures. Nevertheless, to achieve a curative oncologic resection, total gastrectomy is required with growing frequency.     

1114 total gastrectomies in the surgical treatment of primary gastric adenocarcinoma--a 30-year single institution experience.

BACKGROUND/AIMS: Surgical therapy still represents the standard treatment for gastric carcinoma. Due to epidemiology and tumor stage, total gastrectomy is the most often required extent of gastric resection to obtain a potentially curative status. After a 30-year period we overviewed 1114 total gastrectomies, to our knowledge one of the biggest single-institution series in the Western Hemisphere. METHODOLOGY: Among 1991 cases with gastric carcinoma, treated between May 1968 and February 1998, 1114 patients underwent total gastrectomy. This prospectively documented series was retrospectively analyzed with special focus on various time periods. RESULTS: A constant increase of proximal gastric carcinomas was noted. R0-resections were feasible in 84.6% of total gastrectomies. Morbidity and mortality decreased to 22.2% and 5.5%, respectively, in the last decade. Overall 5-years survival rate was 32.4%. Survival was strongly influenced by tumor stage and R-classification. Overall and prognosis after R0-resection showed a significant time-dependent improvement. CONCLUSIONS: Total gastrectomy requires intensive surgical skills and can be performed with acceptable morbidity and low mortality. Survival after total gastrectomy can be improved with increasing experience, and the aim of total gastrectomy for gastric carcinoma should always focus on a R0-resection.     

Osteoporosis after Total Gastrectomy Results of a Prospective,Clinical Study

Background: Osteopenia and enhanced risk of fractures have been reported after partial gastrectomy, but the signilicance of total gastrectomy is still unknown. Methods: Twenty-six patients were followed up for at least 3 years after total gastrectomy. The intake and S-levels of vitamin D, phosphate, magnesium, and calcium were prospectively studied, and a whole-body dual-energy X-ray absorptiometry scan was performed at a mean of 5 years after gastrectomy. Results: At this time point we found normal blood levels of vitamin D, calcium, and phosphate. Food intakes of phosphate, calcium, magnesium, and vitamin D reached the recommended daily allowances. Bone mineral density was similar to that of a control population, and increasing values were seen concomitant with an increase in body weight with the time after gastrectomy. Conclusions: Calcium homeostasis and bone mineral densities seem not to be affected by total gastrectomy, at least when studied over a period of 5 years, an observation that hypothetically can be explained by weight recovery with time after the operation.