远端胃切除术伴布朗式吻合术治疗胃癌的临床疗效

目的探讨BillrothⅡ式远端胃切除术伴布朗式吻合术治疗胃癌的临床效果。方法选取2014年1月至2015年1月间于四川医科大学附属中医院行远端胃切除术的48例患者,根据手术治疗方法的不同,将其分为观察组(24例)和对照组(24例)。观察组患者行BillrothⅡ式远端胃切除术伴布朗式吻合术治疗,对照组患者单独行BillrothⅡ式远端胃切除术治疗,比较两组患者术后并发症发生情况。结果观察组患者无反流20例,轻度反流4例(16.7%),无重度反流患者,胆汁反流4例(16.7%)。对照组患者无反流0例,轻度反流11例(45.8%),重度返流13例(54.3%),胆汁24例(100.0%),组间各项差异均有统计学意义(P<0.05)。两组患者均未出现十二指肠残端破裂严重并发症。结论 BillrothⅡ式远端胃切除术伴布朗式吻合术治疗胃癌较单独应用远端胃切除术治疗更有效,可以显著减少胃癌患者术后碱性反流性胃炎的发生率。     

残胃癌28例临床分析

目的通过对28例残胃癌的临床分析,发现残胃癌与胃手术BillrothⅡ式的术式有关.因此,胃手术应尽量采用BillrothⅠ式,或选择尽量控制十二指肠液返流的术式,并警惕残胃癌的早期诊断.方法28例残胃癌首次术前胃、十二指肠溃疡病的诊断均从既往手术史和病历中获得.本次残胃癌和首次术式均从胃镜和X线钡剂检查所证实.手术治疗20例,切除17例,减状手术2例,探查1例.行残胃全切除、食管-空肠袢式吻合术13例,Roux-Y吻合术4例,空肠残胃吻合术2例.结果生存5年和3年以上者各1例,生存3个月至1年多点时间者有18例,占64.3%,结果很不理想.结论胃、十二指肠溃疡病胃手术BillrothⅡ式吻合术,是导致残胃癌发生的主要原因.残胃癌的早期诊断,有利于提高患者术后的生存期.     

胃镜诊断残胃癌12例并文献复习

 目的 探讨残胃癌的病因、诊断、治疗及干预措施。方法 回顾性总结12例残胃癌临床资料并结合文献复习，对其若干问题进行分析评价。结果 首次术式为BⅡ式者残胃癌发生率高（10例，83.33 %），男性高于女性，确诊后多属中晚期，预后差。结论 残胃癌的发生与胃术后胃内环境改变有密切关系。干预应从改进手术方式、防止胆汁反流等着手     

胃癌全胃切除空肠间置代胃术临床评价

[目的]评价胃癌全胃切除术后连续性空肠间置代胃消化道重建术的临床应用.[方法]全胃切除后距屈氏韧带50cm处结肠后提起空肠,顶端与食管行端侧吻合(A),在A下方行空肠侧侧吻合(B),在B下方再行空肠侧侧吻合(C),在吻合口B、C降支空肠与十二指肠断端行端侧吻合(D),在D的下方降支空肠和B的下方升支空肠以7号丝线结扎.[结果]本术式有四个吻合口,借助管型吻合器吻合,不费时,手术时间平均3小时,不输血.全组36例患者均得到随访,患者均有食欲感,每日进餐4～6次,体重多恢复至术前水平或有增加,血红蛋白、血清蛋白均在正常范围,患者能从事家务及部分体力劳动,对术后生活质量感到满意.[结论]空肠间置代胃术使食物通过十二指肠符合生理;有效防止了反流性食管炎及倾倒综合征;无需切断空肠,手术省时、简捷安全,是胃癌全胃切除术后一种较为合理的消化道重建术式.     

全胃切除连续间置空肠代胃消化道重建术

[目的]探讨连续间置空肠代胃消化道重建术在全胃切除后的应用价值.[方法]对2000年1月至2002年3月间26例全胃切除连续间置空肠代胃术的临床资料进行分析.[结果]全组病人无手术死亡和吻合口瘘发生.随访12个月至25个月,平均17.4个月.其中钡餐检查11例,代胃容量均在300ml以上,排空时间为30min～120 mm.术后6个月、12个月出现反流性食管炎分别为6例和2例.与术前相比,术后生活质量有所提高.[结论]连续间置空肠代胃术是全胃切除消化道重建的理想术式,手术操作简便省时,可取得较好的生活质量.     

残胃癌：附20例临床病理分析

本文报道残胃癌20例,其中残胃全切除14例,胃活检6例.男19例,女1例.年龄40～76岁,平均59.1岁,51岁以上占85％.原发病为十二指肠溃疡6例,胃溃疡13例,十二指肠溃疡合并胃息肉1例.残胃癌全切除14例中,首次术式B—Ⅱ式12例,B—Ⅰ式2例.文献记载B—Ⅱ式比B—Ⅰ式的残胃癌发生率高2～12倍.主要症状有上腹部疼痛10例,吞咽困难,阻塞感5例,吐血、呕血3例,血便2例.残胃癌发生时间;国内文献报道5～50年,平均为15～16年以上.本组为7～40年,平均16.4年.发生部位;吻合口9例,贲门部6例,残胃体5例.     

残胃癌的病因及预防对策分析

目的 总结残胃癌的临床特征,分析其病因及预防对策.方法 选择1999年2月至2010年2月因胃良性病而住院行胃大部切除术的患者进行随访观察,将术后发生残胃癌(残胃癌组)和未发生残胃癌(残胃组)病例的临床特征进行分析,对两组的一般情况、长期吸烟史,以及术后胆汁反流率、幽门螺杆菌(Helicobacter pylori,Hp)感染率等进行比较,以进一步分析残胃癌可能的病因及预防对策.结果 共有89例患者获得完整随访资料,其中32例发生残胃癌,57例无残胃癌发生.两组在年龄、性别、原发病及第一次手术方式的差别均无统计学意义(均P＞0.05).术后残胃癌组与残胃组胆汁反流率比较为87.5% vs.57.9%,P＜0.01;Hp感染率比较为84.4% vs.56.1%,P＜0.01;长期吸烟史比较为62.5% vs.40.4%,P＜0.05.长期吸烟史与无吸烟史胆汁反流率比较55.7% vs.32.1%,P＜0.05.结论 单因素考察证实,远端胃大部切除术后胆汁反流、Hp感染、长期吸烟史是发生残胃癌的高危因素,BillrothⅡ式手术不是发生残胃癌的独立风险因子,吸烟可促进胆汁反流的发生,控制胆汁反流、Hp感染和戒烟有望降低发生残胃癌的风险.     

全腹腔镜远端胃癌根治术消化道重建Billroth-Ⅰ式、Billroth-Ⅱ式及Roux-en-Y吻合对比研究

目的:对比研究三种吻合方式（Billroth-Ⅰ式、Billroth-Ⅱ式及Roux-en-Y）应用于全腹腔镜远端胃癌根治术后消化道重建的临床疗效。方法:回顾性分析2015年3月至2017年8月在我院行全腹腔镜远端胃癌根治术的133例患者的临床资料,其中行Billroth-Ⅰ式吻合术48例（A组）,Billroth-Ⅱ式吻合术45例（B组）,Roux-en-Y吻合术40例（C组）。比较三组的治疗效果。结果:C组手术时间、术中出血量均显著高于A组和B组（P<0.05）,但C组发生倾倒综合征、胆汁返流及反流性胃炎的比例明显低于A组和B组（P<0.05）。三组患者术后6个月和1年时Visick分级分别比较,差异均无统计学意义（P>0.05）;术后1年时A组和B组Visick分级较术后6个月有显著变化（P<0.05）,C组变化不显著（P>0.05）。结论:全腹腔镜远端胃癌根治术后的三种常见消化道重建方式,各有其优缺点,但从疗效分析,Roux-en-Y式与Billroth-Ⅰ式、Billroth-Ⅱ式相比,虽不符合生理通道,操作也较复杂,但在预防多种并发症上有明显优势。术者选择消化道重建方式时应该根据自身技术特点以及患者肿瘤位置、大小、分期等实际问题选择合适的消化道重建方式。     

近端胃大部切除后两种消化道重建术式的比较

目的:探讨近端胃癌行近端胃大部切除后理想的消化道重建方式。方法:1995年~2006年对145例近端胃癌行根治性近端胃大部分切除后随机采用两种常用的消化道重建术式:食管与胃直接吻合73例(吻合组);食管与胃之间空肠间置72例(间置组)。对两种重建术的手术时间、术中出血量、术后并发症及术后1年生活质量、反流性食管炎及营养指标进行了比较。结果:与吻合组比较,间置组手术时间显著延长(P<0.01),但术中出血量、术后并发症发生率两组间无显著差异,术后1年间置组生活质量优于吻合组,反流性食管炎显著减少(P<0.01),而营养状态两组间无显著差异(P>0.05)。结论:食管残胃间空肠间置是近端胃大部分切除后较为合适的消化道重建术式。     

残胃癌的外科治疗及预后

目的 总结和分析残胃癌的临床特点、治疗策略和预后.方法 回顾性分析1999年2月至2010年2月福建南安市医院收治的32例残胃癌临床资料,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Billroth-Ⅱ式胃肠吻合术后,占71.88%(23/32);残胃癌多发生在吻合口和吻合口附近,占56.25%(18/32).手术组与非手术组的1年、3年生存率分别为66.67%、42.85%和9.09%、0;R0治疗组与非R0治疗组的1年、3年生存率分别为87.50%、56.25%和6.25%、0.结论 残胃癌好发于Billroth-Ⅱ式术后的吻合口和吻合口附近;手术切除是治疗残胃癌的根本方法,R0切除(包括联合多脏器的扩大根治术)是提高残胃癌生存率的关键,姑息性手术不能延长患者的生存时间,应尽量避免.     

The role of gastric mucosal dysplasia in the development of Gastric Carcinoma

It is widely acknowledged that most stomach carcinomas developed from dysplastic lesions of gastric mucosa. They can be found in known precancerous conditions as chronic gastritis, gastric adenoma, giant rugal hypertrophy, chronic peptic ulcer, gastric stump after partial resection and pernicious anemia. Several grading systems of gastric dysplasia have been suggested. Nagayo’s or the ISGGC classification was applied to 367 biopsy specimens of 258 patients between 1979–1995. The frequency of moderate and severe dysplasia was 0,84% regarding all gastric endoscopies in the same period of time. Follow-up studies were performed in 56 cases in a period of 1–7 ys. In this group cancer developed during 14 patients. The authors’ recommendation is to follow up the patients gastric dysplasia for least 10 ys after with diagnosis. In memoriam dr. Albert I FIGUS     

人体胃液内真菌还原硝酸盐作用的研究及其意义

目的研究人体胃液内所带真菌是否具有还原硝酸盐的作用,从而探讨人类胃癌病因中,真菌因素的可能作用及作用机理.方法对正常8例,浅表性胃炎(CSG)26例,萎缩性胃炎(CAG)22例,胃溃疡(CU)18例,胃癌(GC)19例,共93份胃液进行真菌培养和pH值及硝酸盐、亚硝酸盐含量的测定,并对分离出的真菌进行了还原硝酸盐作用的实验.结果胃液真菌"污染"的情况较严重,不同的pH值范围内,胃液真菌培养的阳性率无明显差异,各种胃病患者的胃液内,真菌的阳性率与正常对照也无差异,但是具有还原硝酸盐作用的真菌的阳性率和胃液中亚硝酸盐的含量,GC组高于CSG组.结论胃内真菌可通过还原硝酸盐为亚硝酸盐而与胃癌有关.     

Better Prognosis of Gastric Neuroendocrine Carcinoma Than Gastric Adenocarcinoma among Whites in the United States: A Propensity Score Matching Analysis Based on SEER

It was generally believed that the prognosis of gastric neuroendocrine carcinoma (GNEC) was worse than gastric adenocarcinoma (GAC). However, almost all previous studies compared the prognosis of GNEC and GAC based on East Asians. In this study, we evaluated the clinicopathological features and prognosis of GNEC and GAC in Whites. Patients with GNEC and GAC were identified from 2000 to 2018 in the Surveillance, Epidemiology, and End Results (SEER) database. We used propensity score matching (PSM) analysis to match the age, sex, TNM stage, and treatments received between GNEC and GAC, then compared the overall survival (OS) and cancer-specific survival (CSS) in the two types. A total of 392 cases of GNEC and 12,835 cases of GAC in Whites were recognized. After PSM, the 5-year OS rates of GNEC and GAC were 50.3% and 43.0%, respectively (p = 0.010). The 5-year CSS rates of GNEC and GAC were 57.4% and 50.1%, respectively (p = 0.012). Besides, multivariable cox regression analyses showed that GNEC was an independent predictor of improved OS (HR 0.719; 95% CI 0.607–0.853) and CSS (HR 0.691; 95% CI 0.571–0.835) in the matched data. The prognosis of GNEC was better than GAC in Whites, showing significant ethnic differences. Appropriate treatments and follow-up strategies for GNEC in Whites are probably different from East Asians. The potential genetic and molecular mechanisms need to be further explored.     

晚期胃癌姑息性切除手术的临床价值

目的探讨Ⅳ期胃癌姑息性切除手术的临床意义.方法1990年-1997年获随访的Ⅳ期胃癌35例中,18例行肿瘤姑息性切除术,17例肿瘤未切除.结果晚期胃癌手术切除组生存率明显高于未切除组(P=0.0278),其中以胃癌仅伴邻近器官浸润及或仅伴非弥漫性肝转移,或仅伴腹膜种植组手术切除后疗效最佳,二、三年生存率分别为50%、33.33%.肿瘤切除组生存质量明显好于未切除组(P＜0.005).结论晚期胃癌全身情况及局部情况允许时应争取行肿瘤切除术,可提高术后生存率及术后生命质量.     

Expression of HLA-DR and secretory component antigens and lymphocyte infiltration in human gastric nonmalignant and malignant tissues: an immunohistochemical study

The relation between HLA-DR and secretory component (SC) expression and the degree of lymphocyte infiltration was immunohistochemically examined in human gastric mucosa with or without intestinal metaplasia and gastric carcinoma tissues. Gastric mucosa without obvious inflammation showed neither expression of HLA-DR or SC nor remarkable lymphoid infiltration. In contrast, gastric mucosa with chronic inflammation, tissues with incomplete type of intestinal metaplasia, and carcinoma demonstrated both HLA-DR and SC in almost the same area and also prominent lymphoid infiltration in the surrounding stroma. This simultaneous expression of HLA-DR and SC was not observed in complete type of intestinal metaplasia. The results indicate a close relationship between expression of HLA-DR and SC and the presence of lymphocyte infiltration in gastric mucosa, areas of incomplete type of intestinal metaplasia and in gastric carcinomas.     

Outcomes after emergency surgery for gastric perforation or severe bleeding in patients with gastric cancer

BACKGROUND AND OBJECTIVES: Free perforation and major bleeding in patients with gastric cancer are rare but serious conditions with potentially dangerous effects. To clarify the clinicopathologic characteristics of patients with these conditions and to determine the optimum management, we reviewed 16 cases of perforation and 13 cases of major bleeding in patients with gastric cancer who required emergency surgery. METHODS: We compared the clinical and histologic features of the patients with perforation and those with bleeding. Cox's multivariate regression analysis was used to compare survival rates between patients who underwent single-step surgery or a two-step radical procedure, between patients with stage I or II and stage III or IV cancer, between patients who underwent complete (R0) and incomplete (R1 or R2) resection, and between patients with bleeding and those with perforation. RESULTS: Many of the patients had advanced disease. There were no significant differences in clinicopathologic findings or survival between patients with gastric perforation and those with major bleeding. Patients who had major bleeding tended to have larger cancers. In the univariate analysis, gastrectomy (vs. no gastrectomy), R0 (vs. R1 or R2) resection, and lower stage (vs. higher stage) were highly correlated with improved survival time. CONCLUSIONS: Overall, patients with gastric cancers who underwent emergency gastrectomy had a poor prognosis, but it was better than that of patients who could not have gastrectomy because of the prXesence of advanced cancer. However, the survival rate was excellent in patients with early-stage cancer who underwent complete (R0) resection. We recommend complete resection when possible.     

血清MG7-Ag的检测对胃癌诊断的研究进展

近年来随着免疫学、生物化学、分子生物学、细胞工程学和遗传工程学及其相应新技术的发展,发现了许多具有一定临床价值的肿瘤标志物。本文对胃癌相关抗原（MG7-Ag）的结构、分布、生物学特性及对胃癌的诊断价值等作一综述。