全胃切除术后消化道重建方式选择与评价

全胃切除术是治疗胃癌，尤其是胃体癌的一种重要的手术方式。术后消化道重建的方式多种多样，但是由于术后并发症的发生，至今对哪一种重建方式最好仍没有定论。目前对保留十二指肠食物通道连续性的必要性仍有争议；由于重建贮袋可减少并发症的发生，提高患者的生活质量。对贮袋重建的必要性基本取得了一致看法。本文对近年来全胃切除术后消化道重建方式及其手术效果进行综述。     

早期进食在胃癌全胃切除患者中的应用

目的比较全胃切除术后早期口饲与鼻饲在患者营养支持治疗中的作用。方法回顾分析中国医科大学第一附属医院肿瘤外科2004年1月至2006年4月72例全胃切除术患者的临床资料,随机分为两组,手术后分别接受口饲和鼻饲,比较两种营养支持方法对患者基础营养状况、肝功能、胃肠功能、切口愈合、死亡率、并发症率和术后白蛋白及脂肪乳用量、术后平均住院日、平均住院费用等方面的影响。结果两组患者死亡率、切口愈合、并发症率、术后白蛋白用量差异无显著性(P>0.05),营养支持耐受性较好。术后第12天时,两组的体重、肝功及淋巴细胞计数差异无显著性(P>0.05)。而口饲组脂肪乳用量[(2111.11±589.93)ml]较鼻饲组[(2708.33±1092.99)ml]少(P=0.005),进食时间较鼻饲组提前(P<0.05),平均住院费用[(24934±641)元]较鼻饲组[(29324±1604)元]低(P=0.014),术后平均住院日[(14.11±1.75)d]较鼻饲组[(15.94±4.41)d]短(P=0.025),差异有显著性。结论对全胃切除患者而言,术后早期口饲效果优于鼻饲。     

Spleen-preserving lymphadenectomy versus splenectomy in laparoscopic total gastrectomy for advanced gastric cancer

Background

To investigate the optimal approach for laparoscopic splenic hilum lymph node dissection in proximal advanced gastric cancer, we compared the operative outcomes between laparoscopic spleen-preserving total gastrectomy (sp-LTG) and laparoscopic total gastrectomy with splenectomy (sr-LTG).

Esophagojejunostomy through minilaparotomy after laparoscopic total gastrectomy

Although laparoscopic distal gastrectomy (LDG) has been accepted as a surgical option for the treatment of early gastric cancer, laparoscopic total gastrectomy (LTG) has been adopted less often, because a more difficult surgical technique is required for reconstruction. To reduce the technical difficulties, we made some modifications to the functional end-to-end anastomosis technique and performed esophagojejunal anastomosis through a minilaparotomy. First, for easier handling of the esophagus, the first application of the linear stapler to create the esophagojejunal anastomosis was performed before transection of the esophagus. Second, the jejunal limb was anastomosed to the left side of the esophagus, which, compared with the right side, made available more free space, sufficient to operate the stapling device. Third, to close the entry hole and complete the gastrectomy concurrently, a linear stapler was applied through the left lower trocar. With this technique, the closure of the access opening was performed easily and was monitored directly through the minilaparotomy. We successfully performed LTG with Roux-en-Y reconstruction using our modified procedure in seven patients without any anastomotic complications. We believe our procedure is a secure and reliable method for reconstruction after LTG and will facilitate adoption of LTG as a surgical option for patients with early upper gastric cancers.     

腹腔镜辅助全胃切除术后不同途径早期肠内营养的对比研究

目的：比较空肠造瘘管与鼻空肠营养管在腹腔镜辅助全胃切除术后患者行肠内营养治疗的临床效果。方法选取2010年6月至2016年3月本院收治的腹腔镜辅助全胃切除术后拟行肠内营养治疗的112例患者,根据肠内营养途径的不同分为试验组（空肠造瘘管组55例）和对照组（鼻空肠营养管组57例）,比较两者的手术时间、术后恢复情况、营养状况及并发症发生率。结果试验组的手术时间显著长于对照组[（21．4±4．38）分钟vs．（4．70±1．30）分钟,t＝27．55,P＜0．01];肛门恢复排气时间、排便时间均明显短于对照组（均P＜0．05）;两组术后1周的血红蛋白、淋巴细胞、血清白蛋白均无明显差异（均P＞0．05）;两组并发症发生率中穿刺口疼痛、鼻咽部不适、导管堵塞、肺部感染、导管移位均有显著性差异（均P＜0．05）。结论在腹腔镜辅助全胃切除术后患者中经空肠造瘘管给予肠内营养治疗与经鼻空肠营养管途径相比,术后恢复较快,且不易堵塞、移位及造成误吸,适用于早期并需要较长时间进行肠内营养支持的胃癌术后患者。     

Laparoscopic distal gastrectomy with D2 dissection for advanced gastric cancer

The successful application of the laparoscopic distal gastrectomy with D2 dissection for gastric cancer requires adequate understanding of the anatomic characteristics of peripancreatic and intrathecal spaces, the role of pancreas and vascular bifurcation as the surgical landmarks, as well as the variations of gastric vascular anatomy. The standardized surgical procedures based on distribution of regional lymph node should be clarified.Key Words: Gastric cancer, gastrectomy, laparoscopyThe D2 lymph node dissection has been widely applied in traditional open surgery for locally advanced gastric cancer with curative intent (1). However, the feasibility of this procedure in laparoscopic surgery has only been reported in a few conclusive studies around the world (2,3). That is because of the technical threshold for laparoscopic lymph node dissection derived from the perigastric anatomical complexity (4), which is an important factor of the surgical performance and the indicator of prognosis (5). Since the inception of this technique in our department in 2004, we have clinically accumulated proven experience in laparoscopic lymph node dissection for advanced gastric cancer. We believe that it is a combination of proper arrangement of surgical procedures and skilled application of laparoscopic techniques based on complete understanding of the perigastric space (6), surgical landmarks and variations in blood vessels.The key step in the radical treatment of distal gastric cancer lies in the regional lymph node dissection. The extent of D2 dissection for distal gastric cancer defined in the Japanese Gastric Cancer Surgery Guidelines and the Treatment Guideline for Gastric Cancer in Japan (7) involves stations number 1, 3, 4sb, 4d, 5, 6, 7, 8a, 9, 11p, 12a and 14v lymph nodes, while station 14v is excluded in the latest guidelines.According to the distribution of perigastric lymph nodes and the characteristics of laparoscopic techniques, especially the perigastric anatomical features of the gastric body and antrum flipped towards the head under laparoscopy, the scope of D2 lymph nodes can be divided into five regions: (I) lower left region (stations number 4sb and 4d around the left gastroepiploic vessel); (II) lower right region (mainly including station number 6 inferior to the pylorus, and at the root of the right gastroepiploic artery; station number 14v around the superior mesenteric vein in the former version); (III) upper right region (station number 5 superior to the pylorus and number 12a in the hepatoduodenal ligament); (IV) central region posterior to the gastric body (stations number 7, 8a, 9 and 11p surrounding the celiac artery and along its three branches); and (V) hepatogastric region (stations number 1 and 3 along the lesser curvature).Based on the above classification, we have established the standard procedure for laparoscopic D2 lymphadenectomy for distal gastric cancer in our department (Video 1):Open in a separate windowVideo 1Laparoscopic distal gastrectomy with D2 dissection for advanced gastric cancer

1. The left side of the gastrocolic ligament is dissected near the transverse colon through to the lower splenic pole and the pancreatic tail. The key steps include extending and stretching the attachment of the greater omentum to the transverse colon tightly, and then separating from the greater sac into the anterior and posterior space of the transverse mesocolon near splenic flexure, until the lower edge of the tail of the pancreas is exposed;
2. The origin of the left gastroepiploic vessels are ligated. The key steps include extending and stretching the gastrosplenic ligament and fending off the posterior wall of the gastric fundus to expose the splenic hilum and the tail of the pancreas, and thereby the pancreatic capsule can be flipped from the lower edge to the upper edge of its tail. During this process, the left gastroepiploic artery and vein are ligated at the roots near the upper edge of the pancreatic tail, and division is continued from the greater curvature towards distal gastric body. The goal is the dissection of stations number 4sb and 4d lymph nodes;
3. The right side of the gastrocolic ligament is cut near the transverse ligament through to the hepatic flexure, the hepatic flexure of the colon is separated from the duodenal bulb and the surface of the pancreatic head. The key steps include cutting the mesogastrium and the mesocolon along the attachment line between the posterior wall of gastric antrum and mesocolon, and retracting the posterior wall of the sinus to the left anterior direction and the colon and its mesentery to the lower right direction to expose the underlying loose fusion fascial space. Take time to divide the vessels. In the process, the anatomical layer should be fully exposed to separate the right side of the transverse colon and its mesentery from the duodenal descending part, the surface of pancreatic head and the lower edge of pancreatic neck it is attached to. In this way, the gastrocolic trunk (variations may be present in certain patients) formed by the right gastroepiploic vein, right colic vein and their confluence has been completely revealed;
4. The right gastroepiploic vessels are transected. The key steps include fully exposing the lower edge of the pancreatic neck, the pancreatic head and the duodenum, so that the right gastroepiploic vein can be transected above the point where the anterior superior pancreaticoduodenal vein joins. Using the pancreas as a starting point, the pancreatic capsule is lifted and the tissue is separated from the lower edge of the pancreas along the anterior pancreatic space on the surface of the pancreas towards the external superior region, until the origin of the right gastroepiploic artery from the gastroduodenal artery is reached. The right gastroepiploic artery is then cut. The posterior inferior wall of duodenal bulb is denuded near the surface of the pancreatic head along the anterior pancreatic space. The goal is the dissection of stations number 6 lymph nodes;
5. The gastroduodenal artery is exposed and the right gastric artery is transected. The key steps include transecting the duodenum only after dissecting the tissue around the pancreatic head and the upper part of the pancreatic neck from inferior to superior along the gastroduodenal artery in the posterior region of the duodenal bulb on the surface of the pancreas and on the plane of the anterior pancreatic space, in which the bifurcation of the common hepatic artery is exposed at the upper edge of the pancreatic edge for the access to the inner layer of arterial sheath, and the proper hepatic artery is denuded along the adventitia through to hepatoduodenal ligament, where the right gastric artery is cut at its root. The goal is the dissection of stations number 12a and 5 lymph nodes;
6. The three branches of the celiac trunk are divided and the left gastric artery is transected. The key steps include stretching the left gastric vascular pedicle in the gastropancreatic fold and fending the gastric body towards the anterior superior region while pulling the pancreas downwards to fully expose the upper edge of the pancreas for access to the posterior pancreatic space. The three branches of the celiac trunk are denuded here and the left gastric artery is transected at the root. The division is continued upwards in the space until the crura of the diaphragm. The goal is dissection of stations number 7, 8a, 9 and 11p lymph nodes;
7. The hepatogastric ligament and the anterior lobe of the hepatoduodenal ligament are transected close to the lower edge of the liver, and the right side of the cardia and the lesser curvature are fully separated. The key steps include retracting the liver upwards and the gastric downwards to stretch the hepatogastric ligament so that the hepatogastric ligament and the anterior lobe of the hepatoduodenal ligament can be transected and the division can continue towards the right to reach the anterior surface of the proper hepatic artery, which has been separated previously, and towards the left to reach the right side of the cardia, where the lesser curvature is fully divided and denuded. Stations number 1 and 3 lymph nodes are dissected;
8. The distal subtotal gastrectomy, and reconstruction of the digestive tract were completed through minilaparotomy.

The above surgical procedure is designed to accommodate the characteristics of laparoscopic techniques by organizing the sequence of operations from proximal to distal, inferior to superior, and posterior to anterior. More importantly, it has incorporated with our understanding of the anatomical structures under laparoscopy, so that we can make full use of the advantages of visual amplification to identify the relevant anatomical landmarks based on the shape, color and other features, and always proceed at the correct surgical plane while minimizing bleeding.     

全胃切除术后FJI消化道重建的临床研究

Objective To investigate the optimum reconstruction after total gastrectomy for malignant disease, especially the necessity of gastric substitute and duodenal passage. Methods Among the 459 total gastrectomy cases, 6 kinds of reconstructions had been used, including Braun, modified Braun I (mBraun I), modified Braun II (mBraun II), Roux-en-Y, “P” jejunal interposition (PJI) and functional jejunal interposition (FJI). Postoperative complains, body weight, food intake, serum nutritional paraments, complete blood count, half-emptying time of the gastric substitute, PNI, Visick index were evaluated one year after surgery. Results As compared with Braun group, the mBraun I, II and Roux-en-Y groups which had some kinds of gastric substitute showed less reflux esophagitis and higher serum total protein (P<0.01). As compared with mBraun I, II, Roux-en-Y, PJI and FJI groups which had duodenal passage showed better body weight, higher nutritional paraments and PNI (P<0.05). Conclusion It is essential to construct a gastric substitute and maintain the food chyme flowing through the duodenum after total gastrectomy, and the FJI is a better choice in this study.     

Fully robotic total gastrectomy with D2 lymphadenectomy for gastric cancer

PurposeRobotic surgery with technical advantages was shown to make complex maneuvers easier and more precise for gastric surgery [1]. This video demonstrates our technique on robotic total gastrectomy with the da Vinci Xi platform for gastric cancer.Methods68-year-old female was presented with persistent epigastric abdominal pain and underwent upper endoscopy showed ulcerated mass extended from the cardia to the lesser curvature. Histopathology showed gastric adenocarcinoma. After patient received neoadjuvant chemotherapy, decision was made to proceed with surgery.ResultsInitially, greater curvature dissection was started by division of the gastrocolic ligament with entering the lesser sac with monopolar scissors and bipolar forceps. The right gastroomental vessels were identified and divided at their root along with lymph nodes. After ligation of the right gastric vessels, dissection was extended to retrieve lymph nodes around the left gastric vessels. Duodenum was circumferentially dissected and transected 2 cm distal to the pylorus. Subsequently, extended lymphadenectomy was started with suprapancreatic lymph node dissection to retrieve lymph nodes around the common hepatic artery and celiac axis. Spleen-preserving dissection of the lymphatic tissue of the distal splenic artery and the splenic hilum was performed. The distal esophagus was divided with robotic stapler. Fully robotic end-to-side esophagojejunal anastomosis was constructed. For the reconstruction of gastrointestinal continuity after total gastrectomy, side-to-side jejuno-jejunal anastomosis was performed. Total operative time was 5 hours and estimated blood loss was 20 cc.DiscussionTotally robotic gastrectomy with D2-lymphadenectomy is a safe technique for gastric cancer and provides intracorporeal suturing in reconstructing the anatomy.     

Laparoscopic total gastrectomy with distal pancreatosplenectomy and D2 lymphadenectomy for advanced gastric cancer

Received on Aug. 31, 1999; accepted on Jan. 27, 2000     

Comparison of totally laparoscopic and laparoscopic assisted gastrectomy after neoadjuvant chemotherapy in locally advanced gastric cancer

BackgroundNeoadjuvant chemotherapy (NACT) and laparoscopic surgery have been increasingly used in the treatment of gastric cancer, however, the feasibility and safety of totally laparoscopic gastrectomy after NACT still remain unknown.Materials and methodsAt the Gastrointestinal cancer center of Peking university cancer hospital and institute in Beijing, clinical and pathological data of patients who has received NACT, followed by radical laparoscopic gastrectomy was retrospectively reviewed between March 2011 and November 2019. Patients were divided into 2 groups according to whether intracorporeal anastomosis or extracorporeal anastomosis had been performed, short-term outcomes (post-operative recovery index and complications) and economic cost were compared between 2 groups.ResultAll of 139 patients underwent laparoscopic gastrectomy. 87 [62.6%] patients had totally laparoscopic gastrectomy (TLG) and 52 [37.4%] patients had laparoscopic-assisted gastrectomy (LAG). Overall complication rate was 28.8% in all patients. TLG group was significantly associated with lower overall complication rate (21.8% VS 40.4%; p = 0.019) and major complication rate (3.4% VS 13.5%; p = 0.001) compared with LAG group. Overall cost was similar (p = 0.077). In subgroup analysis, totally laparoscopic total gastrectomy (TLTG) group showed lower overall postoperative complication rate (19.0% VS 56.5%; p = 0.011), as well as marginal significant differences in major complication (0% VS 21.7%; p = 0.05) than laparoscopic-assisted total gastrectomy (LATG) group. Earlier first liquid diet (4 [3.5–5] day VS 6 [4–6.5] day; p = 0.047), earlier first aerofluxus (3 [3-4] day VS 4 [3–4.5] day; p = 0.02) and a shorter hospital stay (9 [8-12] day VS 12 [10-15] day; p = 0.004) were observed in TLTG group. Overall and major complication rate were similar in totally laparoscopic distal gastrectomy (TLDG) and laparoscopic assisted distal gastrectomy (LADG) group (22.7% VS 27.6%; p = 0.611; 4.5% VS 6.9%; p = 0.639; respectively). Significant differences were found between TLDG and LADG groups regarding time to first liquid diet (4 [3-5] day VS 6 [3.75–6] day; p = 0.006), time to first aerofluxus (3 [3–3] day VS 4 [3-6] day; p< 0.001), time to first defecation (4 [4-5] day VS 5 [4-6] day; p = 0.045), time to remove all drainage (7 [6-8] day VS 8 [6-9] day; p = 0.021), white blood cell count on postoperative Day 1 (9.54 ± 2.49 10⁹/L VS 10.91 ± 2.89 10⁹/L; p = 0.021)and postoperative hospital stay (9 [8-10] day VS 10 [9,13] day; p = 0.009).ConclusionFor patients with Locally advanced gastric cancer who received NACT, totally laparoscopic gastrectomy, including TLTG and TLDG, doesn’t increase complications and overall cost compared with LAG, and has advantages in gastrointestinal function recovery, incision length and postoperative hospital stay.     

Laparoscopic total gastrectomy as a valid procedure to treat gastric cancer option both in early and advanced stage: A systematic review and meta-analysis

Although laparoscopic total gastrectomy (LTG) compared to open total gastrectomy (OTG) has been widely used for advanced gastric cancer patients, its oncologic validity is yet to be proven. We performed systemic review and meta-analysis to compare LTG versus OTG for early and advanced stages of gastric cancer. Short- and long-term outcomes of both procedures were analyzed using original studies collected by searching Google Scholar, Medline, PubMed, Embase, and Cochrane library in accordance with the PRISMA guidelines. To analyze procedures more precisely, we categorized studies into advanced gastric cancer (AGC) and early gastric cancer (EGC) groups and matched lymph node (LN) dissection, and metastasis ratio. Nineteen studies with a total of 3943 patients were included. LTG required more operative time and had less dissected LNs, indicating a favorable quality of OTG. However, LTG was superior with less blood loss, a shorter postoperative hospital stay, and lower postoperative complication rates. The 5-year survival rate was similar in both groups in which extent of LN dissection and lymph node metastasis ratio were controlled. Although more LNs were removed in OTG, the discrepancy had an insignificant impact on the survival rate. To the best of our knowledge, this study is the first to employ quantitative synthesis in evaluation of long-term oncologic validity of LTG and OTG in AGC, with LN dissection and N stage controlled setting. Non-inferiority of LTG on oncologic outcome and superiority of LTG on perioperative outcome lead to a conclusion that LTG has potential as a valid treatment modality in AGC.     

食管癌合并食管瘘患者鼻饲法的改进

目的:探讨晚期食管癌并食管瘘形成患者鼻饲法的改进与应用。方法:食管瘘形成的晚期食管癌患者46例按接受鼻饲方法的不同分为观察组和对照组（各23例）。对照组:按常规的鼻饲法给予肠外营养支持;观察组:采用改进的鼻饲方法给予肠外营养支持。两组注入相同的营养物,观察鼻饲后消化道不良反应发生情况、身体营养指标的变化以及疾病恢复情况。结果:两组患者在消化道不良反应发生方面对比没有显著性差异（P＞0.05）;相关营养指标的变化对比有显著性差异(P＜0.05);观察组患者瘘口愈合以及完成治疗情况优于对照组。结论:改进的鼻饲法能更有效的提供营养支持,有助于食管穿孔患者的康复。     

全胃切除术后消化道重建方式的临床研究

目的探讨全胃切除术后更符合生理的消化道重建方式。方法对1985年1月-2002年12月间经病理证实行全胃切除术胃癌病例682例进行回顾性分析。682例中，功能性间置空肠代胃术(FJI)163例；袢式吻合47例，改良袢式吻合Ⅰ型和Ⅱ型340例，‘P’型Roux—en—y空肠代胃术87例、‘P’型空肠间置代胃术45例。比较其术后并发症、体重变化。结果功能性间置空肠代胃术在Roux—en—y综合征发生率、预后营养指数、进食量、体重减轻各个方面分别优于或等于袢式吻合、改良袢式吻合I型和Ⅱ型、‘P’型Roux—en—y空肠代胃术和‘P’型空肠间置代胃术。结论功能性间置空肠代胃术保持了重建消化道神经一肌肉功能的连续性，恢复食物经过十二指肠通道，对于减少全胃术后并发症、提高生存质量有重要的临床意义，是全胃切除术后一种合理的消化道重建方式。     

Health related quality of life following open versus minimally invasive total gastrectomy for cancer: Results from a randomized clinical trial

IntroductionMinimally invasive techniques show improved short-term and comparable long-term outcomes compared to open techniques in the treatment of gastric cancer and improved survival has been seen with the implementation of multimodality treatment. Therefore, focus of research has shifted towards optimizing treatment regimens and improving quality of life.Materials and methodsA randomized trial was performed in thirteen hospitals in Europe. Patients were randomized between open total gastrectomy (OTG) or minimally invasive total gastrectomy (MITG) after neoadjuvant chemotherapy. This study investigated patient reported outcome measures (PROMs) on health-related quality of life (HRQoL) following OTG or MITG, using the Euro-Qol-5D (EQ-5D) and the European Organization for Research and Treatment of Cancer (EORTC) questionnaires, modules C30 and STO22. Due to multiple testing a p-value < 0.001 was deemed statistically significant.ResultsBetween January 2015 and June 2018, 96 patients were included in this trial. Forty-nine patients were randomized to OTG and 47 to MITG. A response compliance of 80% was achieved for all PROMs. The EQ5D overall health score one year after surgery was 85 (60–90) in the open group and 68 (50–83.8) in the minimally invasive group (P = 0.049). The median EORTC-QLQ-C30 overall health score one year postoperatively was 83,3 (66,7–83,3) in the open group and 58,3 (35,4–66,7) in the minimally invasive group (P = 0.002). This was not statistically significant.ConclusionNo differences were observed between open total gastrectomy and minimally invasive total gastrectomy regarding HRQoL data, collected using the EQ-5D, EORTC QLQ-C30 and EORTC-QLQ-STO22 questionnaires.     

Risk factors for pancreas-related abscess after total gastrectomy

Background European clinical trials of gastrectomy have shown that pancreas-related complications are the major cause of mortality. The aim of this study was to determine the risk factors for pancreas-related abscess after gastrectomy and to evaluate the effects of the abscess on postoperative mortality.Methods Between 1992 and 1999, 663 consecutive patients with gastric carcinoma underwent total gastrectomy. Data from these patients were analyzed, to identify the predictors of pancreas-related abscess caused by pancreatic juice leakage, by a multiple logistic regression model.Results On multivariate analysis, increasing age (P = 0.018) and body mass index (P = 0.006) were independent preoperative risk factors. Dissection along the distal splenic artery was an intraoperative risk factor. The hazard ratios were increased 9.13-fold (P = 0.000) with a pancreas-preserving operation and 16.72-fold (P = 0.000) by distal pancreatectomy. Patients with the abscess had a higher postoperative mortality rate (P = 0.008), and a higher re-operation rate (P < 0.001) than patients without the abscess.Conclusion Pancreas-related abscess is more likely to occur in older, obese patients undergoing node dissection along the distal splenic artery. Abscess formation is associated with a higher mortality and re-operation rate. Spleen preservation should be evaluated in Japan.     

Non-curative gastrectomy for advanced gastric cancer does not result in additional risk of postoperative morbidity compared to curative gastrectomy

BackgroundNon-curative gastrectomy (nCG) for gastric cancer can be considered in selected cases to relieve symptoms. The aim of this study was to evaluate postoperative morbidity and mortality in patients who underwent nCG and compare these results with an intended curative gastrectomy (CG).Materials and methodsAll patients who underwent both nCG and CG in the Netherlands were included from the Dutch Upper GI Cancer Audit (2011–2016). In this population-based cohort study postoperative morbidity, mortality, readmissions and short-term oncological outcomes were appraised. Propensity score matching (PSM) was applied to create comparable groups of patients who underwent nCG versus CG, using patient and tumor characteristics.ResultsOf the 2202 eligible patients, 115 patients underwent nCG and 2087 underwent CG. After PSM, 115 nCG-patients were matched to 227 CG-patients. More conversions from laparoscopic to open surgery occurred during nCG (10·4 versus 2·6%, p = 0·007). Although postoperative mortality was higher after nCG in the original cohort (9·6 versus 4·8%, p = 0·026), after PSM there was no difference between groups (9·6 versus 7·0%, p = 0·415). Postoperative morbidity, re-interventions and readmission rates did not differ significantly between groups. Resection of additional organs (30·4 versus 11·5%, p < 0·001) and R+ resections (65·2 versus 12·3%, p < 0·001) occurred more frequently during nCG.ConclusionsnCG does not lead to additional postoperative risks compared to CG in patients with similar characteristics, and may be considered in fit patients with advanced gastric cancer. However, randomized trials evaluating potential (survival) benefits of nCG should be awaited.     

口服营养补充降低进展期胃癌患者全胃切除术后辅助化疗期间营养不良风险的研究

目的 比较口服营养补充(ONS)与普通饮食在进展期胃癌患者全胃切除术后辅助化疗期间营养不良风险的发生率.方法 收集2017年6月1日至2019年12月31日期间在南京中医药大学附属江苏省中医院行全胃切除的进展期胃癌患者的临床资料.共67例入组,其中34例接受营养指导,在普通饮食基础上行ONS,为ONS组;33例拒绝营养...     

全腹腔镜与腹腔镜辅助全胃切除术对胃上部癌患者的治疗效果对比

目的 分析全腹腔镜与腹腔镜辅助全胃切除术对胃上部癌患者的治疗效果.方法 选择胃上部癌患者94例,根据治疗方式不同将患者分为对照组(n=47)和研究组(n=47),对照组行腹腔镜辅助全胃切除术,研究组行全腹腔镜全胃切除术,比较两组患者的术后凝血功能指标、视觉模拟评分(VAS)、手术情况、术后恢复及并发症情况.结果 术后两组患者的凝血功能指标(APTT、Fg、D-D)均升高,但两组比较差异无统计学意义(P﹥0.05);研究组患者VAS评分低于对照组,差异有统计学意义(P﹤0.05);研究组术中切口长度短于对照组,差异有统计学意义(P﹤0.01);两组的手术时间、术中出血量、淋巴结清扫数目比较,差异无统计学意义(P﹥0.05);研究组患者术后下床活动时间、肛门排气时间、进食流质时间、住院时间均短于对照组,差异有统计学意义(P﹤0.01);两组患者的并发症发生情况比较,差异无统计学意义(P﹥0.05).结论 全腹腔镜全胃切除术对胃上部癌患者的治疗效果优于腹腔镜辅助全胃切除术,值得临床推广应用.