微粒子活性炭在胃癌淋巴结清扫术中的应用价值

目的 探讨在胃癌淋巴清扫术中使用微粒子活性炭的手术效果。方法 对87例患者肿瘤局部注射微粒子活性炭混悬液标记区域淋巴结后行胃大部切除术或全胃切除术，以1997年以前183例行常规胃癌根治术患者作为对照组。结果 胃大部分切除术中，活性炭组D1、D2、D3和D3 PAL（腹主动脉旁）术式占总例数的比例分别为4.7%、10.3%、14.9%和16.1%而对照组分别为25.7%、21.3%、9.9%和2.7%；全胃切除术中，活性炭组D1、D2、D3和D3 PAL术式的比例分别为3.4%、5.7%、21.9%和23.0%，而对照组分别为15.8%、14.8%、8.7%和1.1%；2组4种术式在胃大部切除术和全胃切除术中差异均有显著意义。活性炭平均每例切除的淋巴结数量明显多于对照组。2组的并发症和病死率之间差异无显著意义。结论 微粒子活性炭肿瘤局部注射是一种简单、易行和安全的方法，对标准胃癌根治术有一定的辅助作用。     

微粒子活性炭在胃癌诊治中的应用

胃癌根治术中淋巴结清除彻底程度直接影响预后，常规手术中对淋巴结清除是否彻底缺乏一种直观依据，微粒子活性炭的淋巴导向示踪能清楚显示胃周淋巴结及其淋巴引流情况，从而指导手术清除。微粒子活性炭还能吸附缓释化疗药物和放射性核素，对肿瘤进行淋巴化疗放疗，作为手术补充。     

侧方淋巴结清除在直肠癌治疗中的意义

直肠外的淋巴引流分为上、侧及下方３条途径。但对其研究不多，我院自１９８１年开始对直肠癌淋巴转移规律及扩大根治术的意义进行了研究，现仅就侧方淋巴结转移及其清除的意义加以讨论。１．材料及方法：我院自１９８１年９月至１９９１年１０月，共对５４３例进展期直肠...     

胃癌保胰D3淋巴结清除术避免胰腺坏死的方法

保存胰腺D3淋巴结清除治疗胃癌是一种不做胰体尾部切除，沿胰腺上缘清除淋巴结的一种方法。这种技术特点是避免胰腺部份切除后有关并发症的发生，习惯上结扎脾动脉是在其根部进行，有可能造成肠系膜上血管左侧胰腺组织缺血坏死。作者通过对胰腺供血的研究，介绍一种胃癌手术保存胰腺、D。淋巴结清除术，可有效避免胰腺缺血坏死的发生。手术方法手术操作包括切除全部大网膜、横结肠系膜前叶、胰被膜，清除十二指肠上、下区域及胰后区域淋巴结n13、肝十二指肠韧带淋巴结111。、肠系膜根部淋巴结ill4、肝总动脉淋巴结1118、腹腔动脉淋巴结11。…     

微粒子活性炭在腹腔镜结直肠癌手术中的定位作用

目的:探讨微粒子活性炭用于腹腔镜结直肠癌手术中定位的有效性。方法:21例结直肠癌患者,术前常规纤维结肠镜检查找到肿瘤部位,然后让患者取俯卧位,向肿瘤附近肠腔内注入生理盐水,生理盐水滞留处是大肠后侧,水面的正对侧则是大肠的腹腔侧,腹腔侧的大肠粘膜是注射微粒子活性炭的目标位置,先向此处的粘膜下注射生理盐水,形成粘膜膨疹,再向膨疹内注射微粒子活性炭,腹腔镜手术中寻找大肠浆膜黑染位置。结果:21例患者腹腔镜手术中均清晰见到大肠浆膜被微粒子活性炭黑染的标记,并以此为依据确定了手术切除范围,所有病变均行腹腔镜手术切除。结论:在腹腔镜结直肠癌手术前注射微粒子活性炭具有定位作用,此法简单、实用、节省手术时间,具有良好的应用前景。     

胃癌淋巴结清主所林巴漏的防治

目的 总结胃癌淋巴结清除术所致淋巴漏的防治经验。方法 报告４例胃癌术后或术中发现的胃癌手术所致淋巴漏的诊治经过。结果 ２例胃癌术后淋巴漏经保守治疗治愈,２例术中发现淋巴漏经缝扎处理避免了术后淋巴漏的发生。结论 全胃肠外营养（ＴＰＮ）是胃癌术后淋巴漏的有效治疗方法,了解腹膜后淋巴系统的引流与分布规律是预防的关键。     

微粒子活性炭对腹腔镜结直肠癌手术淋巴结清扫的指引作用

目的：探讨微粒子活性炭在腹腔镜结直肠癌手术中指引清除淋巴结的临床意义。方法：随机将2005年10月至2007年12月我院收治的70例结直肠癌病例分为：标记组35例,患者术前经肠镜在肿瘤周围局部注射微粒子活性炭后行腹腔镜结直肠癌根治术,对照组35例,仅行常规腹腔镜结直肠癌根治术。切除标本中的淋巴结由外科医师仔细检查剖出、计数并做病理检查。结果：腹腔镜术中被微粒子活性炭黑染的肠系膜淋巴结清晰可见;标记组平均每例清除淋巴结（27.03±2.770）枚,对照组为（15.09±1.522）枚（P〈0.001）;淋巴结转移病例中,标记组平均每例清除转移淋巴结（9.08±1.782）枚,对照组（5.00±1.00）枚（P〈0.001）;标记组平均每例清除小转移淋巴结（3.83±1.528）枚,对照组（1.62±0.961）枚（P〈0.001）。结论：术前注射微粒子活性炭在腹腔镜结直肠癌手术中对淋巴结清扫有指引作用,不仅淋巴结清除总数明显增多,而且可清除更多和更小的转移淋巴结,提高了根治程度。     

微粒活性炭标记胃癌根治术

目的：探讨通过微粒活性炭标记提高胃癌根治术淋巴结清除彻底性的意义。方法：57例胃癌病人随机分为注墨组、对照组。注墨组病人术前胃镜下癌周注入吸附抗癌药物的微粒活性炭MMC－CH40，术中根据被MMC－CH40染黑的淋巴结作为清除标志，行胃癌根治术。对照组行R2、R3根治切除术。结果：（1）平均每例清除淋巴结数：注黑组41．5个，对照组24．4个（P＜0．05）。（2）注墨组黑染淋巴结数占清除淋巴结总数的67．1％。（3）淋巴结转移阳性的病例中，注墨组平均每例清除转移淋巴结数10．05个，对照组6．74个（P＜0．05）。（4）术前1周内胃镜下注墨，术中均可得到满意数量的黑染淋巴结。结论：术前胃镜下注入微粒活性炭对提高胃癌根治切除术中淋巴结清除的彻底性有指导意义。     

活性炭示踪指导进展期胃癌手术淋巴结清扫的意义

目的探讨活性炭示踪剂指导胃癌淋巴结清扫的应用价值。方法回归性分析70例进展期胃癌的临床资料,对2004年7月至2008年1月期间的22例病人实施活性炭示踪指导淋巴结清扫,作为治疗组;1997年1月至2004年12月应用传统手术方法治疗的胃癌48例,作为对照组;比较两组清扫淋巴结的数目和生存率。结果治疗组全部病例均能满意黑染区域淋巴结;切除淋巴结28～92颗／例,平均68．2±4．1颗／例,对照组切除淋巴结平均17．3±1．1颗／例（P〈0.05）;淋巴结转移阳性率：治疗组84．2％,对照组45．6％（P〈0.05）。半年复发率：治疗组5．6％,对照组23．1％（P〈0.05）。结论采用活性炭示踪剂指导胃癌根治术淋巴结清扫可有助于术中辨认淋巴结,增加清扫淋巴结的数目,从而加强区域淋巴结清扫的彻底性,对改善病人的预后有重要意义。     

根治性淋巴结清扫治疗早期胃癌的价值--附19例临床分析

目的　探讨根治性淋巴结清扫在早期胃癌治疗中的作用。方法　回顾性分析１９ 例早期胃癌的淋巴结转移情况及不同术式对生存率的影响。结果　１９ 例早期胃癌中,黏膜癌７ 例,黏膜下癌１２ 例,淋巴结转移率为５２ ．６％ ,第２ 站淋巴结转移率为２１ ．１％ ,Ｄ０ 、Ｄ１ 、Ｄ２ 、Ｄ４ 手术方式分别有１、２ 、１３ 、及３ 例,术后１ 年生存率１００％ 。结论　即使是早期胃癌,治疗上应以Ｄ２ 手术为主,对部分早期胃癌行Ｄ４ 手术,以期提高根治性和生存率。     

进展期胃癌D4术式和D2术式的临床比较

目的　探讨Ｄ４ 术临床应用的可行性、合理性及安全性,并与Ｄ２ 廓清术相比较。方法　进展期胃癌分别行Ｄ２ 术（２９ 例） 和Ｄ４ 术（２２ 例）,比较两组病例的手术根治度和围手术期指标。结果　Ｄ４ 术较Ｄ２ 术的治愈性根治或非治愈性根治切除比例有明显提高（８１－８ ％ ｖｓ．５５－２ ％ ;Ｐ＜ ０－０５）。同时,Ｄ４ 术会导致平均引流天数的延长［（１６ ±２） 日ｖｓ．（１０ ±１） 日, Ｐ ＜ ０－０１］ 及引流率和引流量的增加,此外平均手术用血［（８０３ ±１１２）ｍＬ／ 例ｖｓ．（５６６ ±６７） ｍＬ／例,Ｐ＜ ０－０５］ 和平均手术时间［（７－５ ±０－３） ｈ ｖｓ．（４－０ ±０－２） ｈ ,Ｐ＜ ０－０５］亦有明显增加,但手术死亡率、并发症发生率及住院时间等未有明显增加。结论　Ｄ４ 术是安全、合理和可行的,宜在继续探索的基础上,在适宜病例中予以推广。     

转录因子FOXO4与胃癌及Hp感染关系的临床研究

目的:探讨FOXO4在胃癌发生过程中的表达、临床意义及其与幽门螺杆菌(Hp)感染的关系。方法:应用免疫组织化学SP法分别检测16例正常胃黏膜、26例慢性萎缩性胃炎伴肠上皮化生、36例异型增生胃黏膜及60例胃腺癌组织中FOXO4的表达,并检测患者Hp感染状况。结果:FOXO4在正常胃黏膜、慢性萎缩性胃炎伴肠上皮化生、异型增生胃黏膜及胃腺癌组织中的阳性率分别为100%、84.6%、69.4%和40.0%,胃腺癌组阳性率显著低于正常对照组(P<0.01)。FOXO4的阳性率在高、中分化和低分化型胃腺癌组织中呈现递减趋势,且其表达和淋巴结转移密切相关(P<0.05)。慢性萎缩性胃炎伴肠上皮化生及胃腺癌组织中FOXO4表达与Hp感染之间均无明显相关性(P均>0.05)。癌前病变组织中FOXO4表达与Hp感染率之间呈明显正相关(P<0.01)。结论:在胃黏膜癌变过程中,FOXO4的表达和作用逐渐下调;在癌前病变组织中FOXO4表达和Hp感染密切相关。     

D2 plus para-aortic lymphadenectomy versus standardized D2 lymphadenectomy in gastric cancer surgery

Purpose  To evaluate the survival benefits and safety of D2 plus para-aortic lymphadenectomy (D2 + PALD) for gastric carcinoma. Methods  Patients with gastric carcinoma, who agreed to undergo D2 + PALD between February 2001 and December 2003, were allocated to the D2 + PALD group, and compared with a control group who underwent D2 lymphadenectomy. Patients were followed up until August 2007. Results  Sixty-two patients were allocated to the D2 + PALD group, and a concurrent 55 patients were allocated to the D2 group. The mean follow-up period was 57.6 (range 43.0—77.6) months, with 11.1% lost to follow-up. The morbidity and mortality rates were 24.2% and 0% in the D2 + PALD group, and 27.3% and 1.8% in the D2 group, respectively. The overall 3- and 5-year survival rates were 77.5% and 65.8% in the D2 + PALD group, and 73.2% and 66.1% in the D2 group, respectively, without a significant difference. The frequency of metastasis to the para-aortic lymph nodes (PALN) was 8.1%. The logistic regression revealed that PALN metastasis was correlated to metastasis of No. 8a and No. 9 lymph nodes (P = 0.021 and P = 0.030, respectively). Conclusion  Although D2 + PALD can be performed safely with an acceptable incidence of complications when performed by well-trained gastrointestinal surgeons, its survival benefits are not significantly greater than those of D2 lymphadenectomy. Therefore, routine D2 + PALD should not be recommended.     

5-氟尿嘧啶不同容量腹腔化疗的药代动力学及活性炭应用对其的影响

目的　探讨不同药物浓度及缓释剂应用对 5 氟尿嘧啶 (5 Fu)药代动力学的影响。方法　以家兔为模型 ,用高效液相色谱法 ,检测相同 5 Fu剂量下 (10 0mg/kg) ,大容量腹腔化疗、小容量腹腔化疗、小容量缓释腹腔化疗 (加入活性炭 )在不同时间点的药物浓度 ,计算药代动力学参数。结果　大容量腹腔化疗峰浓度 69.75 3mg/L ,半衰期 0 .80 1h。小容量腹腔化疗峰浓度略低大容量腹腔化疗 60 .3 65mg/L ,半衰期 1.10 8h ,作用时间较长。小容量缓释腹腔化疗 ,虽然浓度较小2 0 .693mg/L ,但半衰期 19.10 2h ,作用时间最长。 结论　从药代动力学的角度 ,小容量腹腔化疗是一种较为理想的化疗方式。加入活性炭以后可以更进一步增加药物的作用时间。     

Pilot series of robot-assisted laparoscopic subtotal gastrectomy with extended lymphadenectomy for gastric cancer

Background

Robotic surgery is evolving as a therapeutic tool for thoracic and urologic applications; however, its use in gastric cancer surgery has not been extensively reported. The objective of this pilot series was to assess the feasibility of using robotic surgery in performing an extended lymphadenectomy for gastric cancer.

Methods

Between June 2005 and July 2006, seven patients (3 female, 4 male) underwent combined laparoscopic subtotal gastrectomy with omentectomy and robot-assisted extended lymphadenectomy using the da Vinci^® Surgical System for early distal gastric tumors. The mean age of the patients was 64 years. Tumor staging ranged from 0 to II. Six patients had adenocarcinoma and one patient had a high-grade dysplastic adenoma.

Results

All procedures were completed successfully without conversion. The median operating time was 420 min. There was one intraoperative complication requiring a colon resection for a devascularized segment. The median number of nodes harvested was 24 (range = 17–30). Resection margins were negative in all specimens. Patients were hospitalized a median of 4 days (range = 3–9). Thirty-day mortality was 0%. Patients resumed a solid diet a median of 4 days postoperatively. Median followup was 9 (range = 0–10) months. There have been no tumor recurrences to date.

Conclusion

Extended lymphadenectomy for gastric cancer using robotic surgery is safe and allows for an adequate lymph node retrieval. Our preliminary results suggest that this novel technique offers short hospital stays and low morbidity for patients undergoing surgical resection of distal gastric malignancies. Future studies will be necessary to better define the role of robotic surgery in gastric cancer treatment.

     

A three-step method for modular lymphadenectomy in gastric cancer surgery: The ability to retrieve sufficient lymph nodes and improve survival

Background

Systematic lymphadenectomy for the resection of sufficient lymph nodes is the most important part of curative resection in gastric cancer surgery. Here, we explore the outcomes of the three-step method for modular lymphadenectomy (TSMML) and determine its safety and efficacy, compared with the conventional method for lymphadenectomy (CML).

Strategies of laparoscopic spleen-preserving splenic hilar lymph node dissection for advanced proximal gastric cancer

For advanced proximal gastric cancer (GC), splenic hilar (No. 10) lymph nodes (LN) are crucial links in lymphatic drainage. According to the 14^th edition of the Japanese GC treatment guidelines, a D2 lymphadenectomy is the standard surgery for advanced GC, and No. 10 LN should be dissected for advanced proximal GC. In recent years, the preservation of organ function and the use of minimally invasive technology are being accepted by an increasing number of clinicians. Laparoscopic spleen-preserving splenic hilar LN dissection has become more accepted and is gradually being used in operations. However, because of the complexity of splenic hilar anatomy, mastering the strategies for laparoscopic spleen-preserving splenic hilar LN dissection is critical for successfully completing the operation.