Recurrence in jejunal pouch after proximal gastrectomy for early upper gastric cancer

Recently, jejunal pouch reconstruction after proximal gastrectomy has been a common procedure in Japan. However, according to our investigation, there are no reports of recurrence in the jejunal pouch. We experienced a patient with a recurrence in the jejunal pouch after proximal gastrectomy for early upper gastric cancer. In view of the pathological findings and the recurrence site, we suspected an implantation on the staple-line made for the jejunal pouch.     

可根治切除残胃癌的临床病理特征及预后

目的：分析可根治切除残胃癌临床病理特征及预后情况。方法回顾性分析1999年11月至2013年12月进行残胃癌根治切除术的63例患者的临床病理资料,按照初次手术方式和初次手术时疾病良恶性分组,分析比较残胃癌的临床病理特征及患者的长期生存率。结果按照初次手术疾病良恶性分组,残胃癌发病的间隔时间分别为24.8年和8.9年;肿瘤直径分别为6.9 cm和4.3 cm ,残胃癌位于吻合口的比例分别为50%和26.3%。按照初次手术方式（BillrothⅡ、BillrothⅠ）分组,残胃癌发病的间隔时间分别为22.8年和12.3年。肿瘤直径分别为6.73 cm和3.75 cm ,残胃癌位于吻合口的比例分别为52.4%和21%。以上各组进行比较,差异均具有统计学意义（均P＜0.05）。TNMⅠ～Ⅱ期与Ⅲ期患者80个月生存率分别为64.7%和18.5%,差异有统计学意义（P＜0.05）。初次手术良性组与初次手术恶性组,100个月累积生存率分别为37.1%和40%,差异无统计学意义（P＞0.05）。BillrothⅡ组与BillrothⅠ组,患者80个月累积生存率分别为43.1%和27.3%,差异无统计学意义（P＞0.05）。结论初次胃切除术时疾病良恶性、重建方式与残胃癌发病间隔时间、肿瘤大小、肿瘤好发部位等临床特点有关。可根治切除的残胃癌患者,其长期生存率与初次胃切除术时疾病良恶性、重建方式无关,与TNM分期有关。     

根治性远端胃大部切除胃十二指肠空肠“间置”吻合术（附23例报告）

本文结合ＢｉｌｌｒｏｔｈⅠ式手术优点，对２３例胃癌患者行胃远端根治性切除胃十二指肠空肠“间置”，取得了良好的效果。本术式通过８～１２个月随访，近期效果满意。基本上维持正常生理通道，减少胃肠功能紊乱和术后并发症，减少胆汁及小肠液的返流。符合胃癌根治术的原则，降低残胃癌的发生，改善患者的生存质量，延长生存期。本手术操作不太复杂，适用于Ａ、ＡＭ、ＭＡ区肿瘤的外科治疗。     

Duodenogastric reflux and gastric stump carcinoma

Gastric stump carcinoma after gastric surgery for benign disease is now widely recognized as a distinct clinical entity. The stump carcinoma was often found to be localized to the anastomosis, known to be the site with severe duodenogastric reflux. For this reason, duodenogastric reflux, including the reflux of bile and pancreatic juice, after a Billroth II procedure for benign disease is frequently discussed as an important factor related to the development of stump carcinoma. Many experiments have implicated bile acids, the main component of the duodenal juice, in gastric carcinogenesis. In particular, rat models without the use of the carcinogen, N-methyl-N′-nitro-N-nitrosoguanidine (MNNG), showed adenocarcinoma in the remnant stomach that was related to the severity of duodenogastric reflux. However, human data are, inevitably, much less consistent. Whether the incidence of stump carcinoma is higher than that of gastric carcinoma in general is still controversial. Concerning the histogenesis of stump carcinoma after benign disease, a relationship between gastritis cystica polyposa (GCP) and gastric type adenocarcinoma has been suggested. Recently, the population at risk of gastric stump carcinoma for benign disease has been diminishing significantly, and the incidence of gastric stump carcinoma after surgery for malignant disease has been increasing. The influence of duodenogastric reflux in the gastric remnant after malignant disease may differ from its influence in the gastric remnant after benign disease. Further clinical study is needed to elucidate the pathogenetic factors involved in gastric stump carcinoma. Received: July 30, 2001 / Accepted: October 16, 2001     

全胃切除术治疗胃癌的评价：附169例报告

本文报告全胃切除术治疗胃癌169例的经验。术后总的1、3和5年生存率分别为70.4％,40.0％和 23.3％。根据本组经验认为高位胃体癌,全胃癌、多原发癌、残胃癌、胃底贲门癌应行全胃切除,术中肉眼判断癌已侵及浆膜层者宜行全胃合并脾胰尾切除。本文改进的空肠原位间置代胃消化道重建术能恢复十二指肠自然通道,具有代胃,又能防止返流性食管炎,倾倒综合征,提高术后生存质量的优点,值得推广应用。     

残胃癌的外科治疗（附19例临床分析）

目的：探讨残胃癌的病因，外科治疗方法及对并发症防治。方法：整理分析本院１０年来收治残胃癌１９例的临床资料，对比根治性胃全切除及合并邻近脏器联合切除、姑息性切除、非切除各组患者的治疗效果。结果：本组１９例中，１２全和Ｂ－Ⅱ式切除术；残胃部呛切除后１年、２年、５年生存率分别为５８．３％、２５．０％、１６．７％。非切除病例均在５～６月内死亡。结论：行远侧胃切除，应争取作Ｂ－Ⅰ式切除术；对残胃癌应强调早期     

胃癌根治空肠间置术12例分析

本文报告胃癌根治空肠间置术12例.男11例,女1例,年龄36～73岁.空肠问置於十二指肠残胃之间1例;空肠间置于十二指肠与食管之间11例.“9”字型空肠间置1例:单腔10例.双腔1例.空肠间置代胃有近似生理的胃容积及排空时间,术后进行了消化道功能观察.作者认为单腔空肠插入术应为全胃切除后重建胃肠道的首选方法.     

残胃癌24例外科治疗分析

 目的　探讨残胃癌的外科治疗及预后。方法　对 1980年 1月～ 2 0 0 1年 10月收治的 2 4例残胃癌病例进行回顾性分析。结果　本组残胃癌占同期收治胃癌的 2 .5 % ,手术切除率及根治性切除率分别为 70 .5 %和 4 5 .8% ,根治性切除和姑息性切除病人的 1、3、5年生存率分为 86 .5 %、4 4.2 %、32 .3%及 6 6 .7%、11.1%、0。结论　定期胃镜检查是早期诊断残胃癌的关键 ,根治性切除是外科治疗残胃癌的主要手段 ,亦是影响残胃癌预后的重要因素。     

Beneficial effects of jejunal continuity and duodenal food passage after total gastrectomy: A retrospective study of 704 patients

Aim

To evaluate effects of reconstruction procedures on post-operative outcomes and nutritional status after total gastrectomy.

Methods

The study group comprised 704 consecutive patients with gastric cancer who underwent total gastrectomy between December 1985 and December 2003. Six alimentary reconstruction procedures were performed, including jejunal continuity [Braun, modified Braun I and II and functional jejunal interposition (FJI)] and jejunum transection [“P” Roux-en-Y and “P” jejunal interposition (PJI)]. The duodenal food passage was maintained only by FJI and PJI. We evaluated the time interval to restore food intake after surgery and the incidence of complications and nutritional status for 12 months.

Results

Patients who received jejunum transection required 7.8 ± 2.5 days and 11.9 ± 4.9 days to restore liquid and semi-liquid food intake, respectively, which reduced to 3.9 ± 2.1 days for liquid and 7.9 ± 3.9 days for semi-liquid food intake by jejunum continuity. The incidence rates of reflux esophagitis and Roux-en-Y syndrome in patients receiving jejunum transection were 23.5% and 42.4%, respectively, which were decreased to 9.35% and 14.7%, respectively, by jejunal continuity. Furthermore, prognostic nutrition index score of patients receiving the procedures maintaining duodenal food passage (52.9 ± 10.9) was higher than that of patients without the duodenal food passage (46.7 ± 8.2).

Conclusion

Jejunal continuity and duodenal food passage showed beneficial effects on clinical outcomes after surgery. Among these six procedures, FJI was the only procedure to combine the benefits of jejunal continuity and maintaining the duodenal food passage, indicating that FJI has potential clinical application to improve the quality of patient's life after total gastrectomy.     

残胃癌的临床诊断和外科治疗

目的：总结残胃癌的临床诊断和改进残胃癌的外科治疗效果。方法：回顾性分析我科1995年1月-2005年12月间收治的36例残胃癌的发病情况、临床表现及治疗结果。结果：首次胃切除病因以消化性溃疡为主（35例,占97.2%）,首次手术B-Ⅱ式29例,占80.6%。确诊残胃癌距首次胃切除手术时间平均为17.5年。残胃癌发生于胃肠吻合口者占58.0%,发生于残胃小弯者占35.9%,发生于贲门者占6.1%,根治性切除手术占58.3%（21例）。结论：良性胃十二指肠病变行胃切除手术治疗时应以B-Ⅰ式或Roux-en-Y吻合为首选,B-Ⅱ式吻合需加Braun吻合较为合理。对残胃癌高危人群应定期行胃镜检查,早期诊断、早期根治性手术切除是提高残胃癌预后的关键。     

残胃癌的外科治疗及临床因素分析

目的：分析残胃癌的临床特点、治疗策略和预后。方法：回顾性分析我院2009年1月至2012年10月收治的38例残胃癌患者的临床资料,分析其临床特点,比较不同治疗方案对患者预后的影响。结果：残胃癌多发生于胃大部切除毕Ⅱ式术后,占63.2%。残胃癌多发生在吻合口和吻合口附近,占60.5%。全组患者1、3和5年生存率分别为68.4%、39.5%和10.5%。手术组术后1、3和5年总生存率分别为80.6%、48.4%、12.9%,非手术组为14.3%、0、0,差异有统计学意义（P <0.05）。根治性手术组术后1、3和5年总生存率分别为95.2%、62.0%和19.0%,非根治性手术组为50.0%、20.0%和0,差异有统计学意义（P <0.05）。多因素预后分析显示,TNM 分期、分化程度和手术方式是影响残胃癌患者预后的独立因素。结论：残胃癌好发于毕Ⅱ式术后的吻合口和吻合口附近。外科治疗是治疗残胃癌的根本方法,根治性手术（包括联合多脏器切除）是获得长期疗效可靠的方法。     

幽门螺杆菌与残胃癌

残胃癌发病与幽门螺杆菌感染密切相关,幽门螺杆菌能促进残胃黏膜上皮细胞增殖,促进胃液中亚硝基化合物的产生及人体某些基因异常表达,最终促使残胃癌发生.根除幽门螺杆菌感染有望减少残胃癌的发生.     

腹腔镜辅助残胃癌根治术1例并文献复习

目的 探讨腹腔镜手术治疗残胃癌的临床疗效.方法 对1例行腹腔镜残胃癌根治手术患者的临床病理资料进行回顾性分析,同时以中国知网、万方及PubMed为检索工具检索相关文献并分析总结.结果 患者顺利完成腹腔镜残胃癌根治术,未中转开腹,手术时间230 min,出血量约30 ml,术后恢复良好,无手术并发症发生,术后第8天出院;共检索筛选19篇文献,180例患者,其中12例中转开腹,8例联合其他脏器切除,22例出现术后并发症.结论 腹腔镜残胃癌根治术是一种安全可行的手术方式,但其临床疗效和优势仍需大规模临床试验来进一步探究.     

残胃癌的临床诊断和外科治疗

目的:总结残胃癌的临床诊断和改进残胃癌的外科治疗效果。方法:回顾性分析我科1995年1月-2005年12月间收治的36例残胃癌的发病情况、临床表现及治疗结果。结果:首次胃切除病因以消化性溃疡为主(35例,占97.2%),首次手术B-Ⅱ式29例,占80.6%。确诊残胃癌距首次胃切除手术时间平均为17.5年。残胃癌发生于胃肠吻合口者占58.0%,发生于残胃小弯者占35.9%,发生于贲门者占6.1%,根治性切除手术占58.3%(21例)。结论:良性胃十二指肠病变行胃切除手术治疗时应以B-Ⅰ式或Roux-en-Y吻合为首选,B-Ⅱ式吻合需加Braun吻合较为合理。对残胃癌高危人群应定期行胃镜检查,早期诊断、早期根治性手术切除是提高残胃癌预后的关键。     

Gastric stump carcinoma - epidemiology and current concepts in pathogenesis and treatment.

AIM: The aim of this article is to review the aetiology, pathology and treatment of gastric stump carcinoma (GSC). GSC is an uncommon tumour; however, the incidence is not declining, so this tumour entity will be encountered in the years to come. METHODS: The electronic literature search was performed in the MEDLINE database to identify relevant studies concerning epidemiology, prognosis, treatment, aetiology and pathology of GSC. The references reported in these studies were used to complete the literature search. RESULTS: Patients subjected to distal gastric resection have a 4-7-fold increased risk of developing GSC, which is attributed mainly to gastroduodenal reflux. Denervation during partial gastrectomy may also contribute to the risk of developing GSC. Gastroduodenal ulcers were the main reason for partial gastrectomy. Both ulcer locations have an increased risk of developing GSC after 20 years. In GSC, Helicobacter pylori seems not to be an important risk factor, contrary to primary gastric cancer, because gastroduodenal reflux impairs the growth of Helicobacter pylori. CONCLUSION: The treatment of choice for GSC should be the total removal of the gastric remnant including at least D2 lymphadenectomy. The pattern of lymph node metastases in GSC may differ from primary gastric cancer, as lymph node metastases have been reported in the jejunal mesentery and the lower mediastinum. Therefore, GSC may require a modified lymphadenectomy to include all important lymph node stations. After radical remnant gastrectomy, GSC has a prognosis not different from primary proximal gastric cancer.     

Siewert Ⅱ / Ⅲ型食管胃结合部腺癌不同重建方式对预后的影响

目的  观察免疫肠内营养对Siewert Ⅱ/Ⅲ型食管胃结合部腺癌患者接受不同重建方式后恢复、免疫功能、营养状况、 生存质量的影响。方法  将42 例 Siewert Ⅱ / Ⅲ型食管胃结合部腺癌患者随机分为 PG+ 空肠间置组和 TG 组,手术后均采取 免疫肠内营养治疗。检测术前1 天、术后5 天相关的营养和免疫血清指标,比较和分析术后恢复情况、生存质量和免 疫功能、营养状况。结果  PG+ 空肠间置组和 TG 组手术后肠道通气时间、术后 5 天体重变化、腹腔感染、吻合口瘘等并发 症的发生无显著差异。术后5 天检测PG+ 空肠间置组血清总蛋白、清蛋白、前清蛋白、IgG、IgA 水平以及CD3+、CD4+、 CD4+/CD8+ 与 TG 组比较,无显著差异（P ＞ 0.05）。术后12 个月PG+ 空肠间置组术后体重变化、血红蛋白较TG 组明 显改善（P ＜ 0.05）。PG+ 空肠间置组和 TG 组反流症状发生率均较低（P ＞ 0.05）。结论  早期使用免疫肠内营养,对比 Siewert Ⅱ / Ⅲ型食管胃结合部腺癌患者行PG+ 空肠间置术后和TG 术后的营养状况和免疫功能,证明PG+ 空肠间置组显优势。