全胃切除术后消化道Double tract法重建术的改良

目的　探讨改良的Doubletract法行消化道重建 ,减少胃癌全胃切除术后并发症和提高患者生存质量。方法　应用改良Doubletract法行胃癌全胃切除术后消化道重建 2 2例并随访 ,通过症状观察、消化道钡餐检查确定手术效果。结果　临床观察无吻合口瘘、吻合口狭窄、返流性食管炎、倾倒综合征和腹泻等并发症 ,术后能正常工作和生活 ,消化道钡餐检查见代胃功能良好。结论　改良Doubletract法可使食物经十二指肠与胆胰分泌同步 ,增强消化吸收功能 ,且操作不难 ,减少并发症 ,是值得推荐的消化道重建术     

胃切除消化道重建方式与术后并发症

胃切除术在临床当中进行应用,其主要目的是为消化系统出现各种症状且影响到患者自身健康的情况下所采取的手术方式,对患者的消化道进行重建后,能够明显改善患者进食以及消化的现状。本次研究针对多种胃切除术后重建消化道的方式以及并发症进行深入探讨,为改善临床现状提供可靠有效的参考依据。     

全胃切除消化道重建术后返流性食管炎的病例分析及术式探讨

返流性食管炎是全胃切除消化道重建术后常见并发症之一。自1990年至1998年,我科行全胃切除术84例,术后并发食管炎14例。本文根据其临床资料对不同术式与并发返流性食管炎的关系进行了探讨。     

全胃切除治疗胃癌80例临床分析

全胃切除术在胃癌外科治疗中占有重要地位,但对其适应证、是否合并脾和远侧胰切除以及消化道重建术式等问题的见解尚不尽一致[1-6]。本文对我院近16年来收治的80例实施全胃切除术的胃癌患者的病例进行回顾性分析,报告如下。1资料与方法1.1临床资料本组80例,其中男55例,女25例。     

经腹全胃切除治疗近侧胃癌

目的：探讨近侧胃癌的术式选择的意度。方法：对18例术前均经纤维胃镜及消化道钡餐造影确诊。其中7例合并程度不同的心肺疾患的近侧胃癌患者经腹全胃切除治疗并观察疗效。结果：全组无手术死亡。术后并发症为11．1％，均为术口感染。术后1、3年生存率分别为85．7％（12／14），50％（7／14）。近切端阳性率为5．5％。结论：本术式与传统的胸腹联合切口比较，优点是手术时间短，创伤小，术中心肺干扰小，术后胸部并发症少，术后恢复快。主要适用于尚未浸润食道下端的近侧胃癌。尤对高龄、体弱或心肺功能差，估计难以耐受经胸手术的患者更合适。     

全胃切除代胃空肠行抗返流术式预防食道返流的研究

目的 探讨近端胃癌行根治性全胃切除,空肠-空肠储袋胃、储袋胃的近、远端空肠行抗返流瓣术式、空场-空肠Roux-en-Y吻合术预食道返流的可行性。方法 将2003年1月~2012年12月我院收治的行近端胃癌根治手术的患者87例随机分为两组,对照组43例行全胃切除空肠储袋胃、空肠-空肠Roux-en-Y吻合的胃癌根治术,实验组44例行空肠储袋胃、储袋胃的近、远端空肠行抗返流瓣术式、空场-空肠Roux-en-Y吻合术预防食道返流,观察两组患者术后是否有吻合口狭窄、术后进食时间、肠道恢复时间、术后住院时间、钡剂停留时间。术后2个月随访营养状况,随访至6个月,根据Mettin标准评估两组患者食管黏膜组织学炎症改变、是否有反流性食管炎以及患者生存率。结果 术后两组患者恢复良好,均无吻合口狭窄。两组患者进食时间、肠道恢复时间、术后住院时间组间对比,差异无统计学意义（P＞0.05）。实验组钡剂停留时间长于对照组,差异具有统计学意义（P＜0.05）。术后2个月随访两组病例食欲良好,血红蛋白上升、体重无减轻,营养状况良好。对照组出现食管炎症改变的例数多于实验组,两组相比,统计学意义显著（P＜0.01）;对照组出现返流性食管炎例数多于实验组,差异具有统计学意义（P＜0.05）。所有患者均随访1年,1年内无患者死亡。结论 若严格的把握适应证,近端胃癌行根治性胃全切除行空肠-空肠储袋胃、储袋胃的近、远端空肠行抗返流瓣术式、空场-空肠Roux-en-Y吻合术能有效预防食道返流,可降低返流性食管炎的发生率,显著改善患者的生存质量。     

毕Ⅱ式消化道重建术后吻合口后间隙内疝的临床分析

目的分析毕Ⅱ式消化道重建术后吻合口后间隙内疝的原因,总结吻合口后间隙内疝的诊治体会。方法回顾性分析5例吻合口后间隙内疝的诊治情况,参阅相关文献。结果 5例均手术证实,1例术前诊断,4例术前诊断为腹膜炎或肠梗阻;输入袢长（15～23cm）导致后间隙较宽,吻合口后间隙均未关闭;2例手术复位,2例因小肠坏死行部分小肠切除,1例因吻合口坏死行Roxen-Y吻合口重建;4例治愈,1例因高位肠瘘而死亡。结论吻合口后间隙内疝进展快、病情严重,需综合分析才能早期诊断,手术治疗为首选治疗方法,关闭吻合口后间隙是预防该病的关键。     

双通道间置空肠消化道重建术联合全胃切除术在进展期胃癌中的应用

目的:探究调节型双通道间置空肠消化道重建术+全胃切除术治疗进展期胃癌(Advanced gastric cancer,AGC)患者的效果.方法:选取我院92例AGC患者(2018年1月～2020年10月),按治疗方案不同分成A组、B组,各46例.两组均行全胃切除术,术后B组接受Roux-en-Y吻合术治疗,A组接受调节...     

Ω形吻合在腹腔镜全胃切除术中的应用

目的 通过与Roux-en-Y吻合比较来评估Ω形吻合在腹腔镜全胃切除术中应用的安全性和可行性。方法 采用回顾性队列研究的方法,收集在我院行腹腔镜全胃切除术的患者资料。根据消化道重建方式将患者分成Ω形吻合组(Ω组)和Roux-en-Y吻合组(R组),比较2组患者手术时间、吻合时间、通气时间、术后住院时间、吻合费用及并发症发生情况,并对2组患者进行随访以评估其术后生活质量。结果 与R组比较,Ω组的手术时间及吻合时间更短,通气时间更早,吻合费用更少,差异均具有统计学意义(P<0.05)。2组患者的术后住院时间及术后并发症的发生率比较,差异均无统计学意义(P>0.05)。术后第6个月,EORTC-QLQ-C30量表显示,Ω组的总体健康状况评分高于R组,恶心呕吐症状评分低于R组,差异均具有统计学意义(P<0.05);2组其余功能领域及症状领域评分比较,差异均无统计学意义(P>0.05)。EORTC-QLQ-STO22量表显示,Ω组的反流症状领域评分低于R组,差异具有统计学意义(P<0.05);2组其余症状领域评分比较,差异均无统计学意义(P>0.05)。结论 ...     

早期免疫强化肠内联合肠外营养支持对高龄胃癌胃切除术后患者营养状态及免疫功能的影响

目的:探究早期免疫强化肠内联合肠外营养支持对高龄胃癌胃切除术后患者疗效.方法:99选取我科2017年9月至2019年10月期间125例高龄胃癌行腹腔镜根治术后患者抽签法分组.对照组62例给予常规肠内营养支持,观察组63例给予早期免疫强化肠内联合肠外营养支持,对比两组营养状态、免疫功能、胃肠功能及并发症情况.结果:与术前...     

Pouch Roux-en-Yvs No Pouch Roux-en-Y following total gastrectomy:a meta-analysis based on 12 studies

After a total resection of the stomach,the continuity of the gastrointestinal tract can be restored either by Rouxen-Y esophagojejunostomy with or without a pouch.There is still no consensus on the best reconstruction technique.The aim of this report was to derive a more precise estimation of Roux-en-Y esophagojejunostomy with a pouch compared with Roux-en-Y esophagojejunostomy without a pouch.Studies were identified by PubMed and Embase searches,and the inclusion criteria were randomized controlled trials (RCTs) comparing reconstruction techniques between Roux-en-Y with and without a pouch.A total of 12 studies including 1,018 patients were included.The meta-analysis shows that pouch Roux-en-Y does not significantly increase total postoperative complications,anastomotic leakage or mortality.Importantly,there is no significant difference in 5-year survival rates between the two groups.Patients with Roux-en-Y esophagojejunostomy complained significantly less of reflux symptoms and dumping syndrome,and had significantly less severe reflux esophagitis.Quality of life was significantly improved in patients with Roux-en-Y esophagojejunostomy with a pouch compared with patients who received Roux-en-Y reconstruction without a pouch.The results indicate the need for Roux-en-Y esophagojejunostomy with a pouch is a gastric substitute after total gastrectomy by comparison with Roux-en-Y esophagojejunostomy without a pouch.     

腹腔镜胃癌D2根治术和开腹胃癌D2根治术中患者炎症反应比较

目的：比较腹腔镜胃癌D2根治术和开腹胃癌D2根治术对患者炎症因子的影响。方法：选取96例胃癌患者随机分为腹腔镜组和开腹组,腹腔镜组采用腹腔镜胃癌D2根治术治疗,开腹组采用开腹D2根治术治疗,比较两组术前及术后CRP、IL-6、TNF-α及IL-10水平。结果：腹腔镜组术中出血量明显少于开腹组,手术时间、术后排气时间及术后下床活动时间少于开腹组,差异比较有统计学意义(P<0.05);两组术后1 d CRP、IL-6、TNF-α及IL-10水平较术前明显升高,差异比较有统计学意义(P<0.05);腹腔镜组术后CRP、IL-6、TNF-α水平明显低于开腹组,IL-10水平高于开腹组,差异比较有统计学意义(P<0.05)。结论：腹腔镜胃癌D2根治术较开腹胃癌D2根治术炎症反应轻,创伤小,可在临床上推广。     

胃大部切除术后残胃幽门螺杆菌感染的临床研究

目的探讨胃大部切除术后残胃病变与幽门螺杆菌(Hp)感染的关系。方法采用快速尿素酶试验、组织切片W arth in-Starry银染及尿素呼气试验检测682例残胃病患者Hp感染情况,并进行流行病学分析。结果682例残胃病患者Hp感染检出率为27.42%,与年龄、性别以及术后时间无关;B illroth I式术后残胃Hp检出率(40.07%)明显高于B illroth II式术后残胃Hp检出率(17.37%),而伴有胆汁返流的残胃Hp感染阳性率(7.98%)明显低于不伴胆汁返流的残胃阳性率(33.53%)。同时,因溃疡、穿孔、出血行手术的残胃Hp检出率(47.88%)高于因胃癌手术的检出率(22.66%);不同病理学残胃中,残胃溃疡和残胃癌的Hp感染率明显高于慢性残胃炎及吻合口炎的Hp感染率。结论胃大部切除术后残胃病变与Hp感染密切相关,尤其是残胃癌,应及早进行Hp治疗,可减轻残胃病变,减少残胃癌的发生。     

胃大部切除术后残胃功能性排空障碍10例临床分析

目的:探讨胃大部切除术后残胃功能性排空障碍发生原因,诊断及治疗。方法:对1996年至2008年收治的108例胃大部切除术患者的临床资料进行回顾性分析。结果:本组共发生功能性胃排空障碍10例,发生9.2%,均发生于术后3～12天。所有患者均经保守治疗出院,均于35天内治愈。结论:术后残胃和远端空肠正常的运动功能破坏是发生功能性胃排空障碍的主要原因,上消化道造影及胃镜检查是诊断本病、鉴别机械性梗阻的重要方法。采取非手术治疗一般均可治愈,针对胃排空动力学机制的改变采用促胃肠动力药可能收到较好的疗效。     

Increase in duodenal tissue gastrin in dogs following antrectomy with gastroduodenostomy and after total gastrectomy with oesophagoduodenostomy1

The gastrin concentration in plasma and duodenal tissue was determined in dogs following antrectomy and total gastrectomy as well as in unoperated control animals. The first week after both types of operations, during which time the dogs were parenterally fed the basal plasma gastrin concentration was markedly reduced, and then it slightly increased. The increase in plasma gastrin concentration from the second postoperative week until sacrifice was found to be statistically significant in one of six antrectomized dogs and in two of three dogs in which the whole stomach had been resected. In unoperated controls the gastrin concentration in the proximal third of the duodenum was found to be 6.8±0.8 pmol/g tissue wet weight (mean value ± SE, n=11). Following antrectomy a time dependent increase was seen, the corresponding values being 11.0±2.5 (n=4), 36.4±15.7 (n=6) and 136.1±44.2 (n=6) pmol/g at 3, 9–10 and 14–16 weeks after operation, respectively. A similar increase was seen following total gastrectomy. 8 weeks after this type of operation the concentration was 22.2±12.5 (n=3) pmol/g. The gastrin concentration of the middle and distal thirds of the duodenum was not changed by the operations. The results show that removal of the main source of gastrin, i. e. the pyloric antrum, induces an increase in the tissue level of gastrin in the upper portion of the duodenum.     

A meta-analysis of caspase-8 -652 6N del polymorphism and digestive tract cancer risk

Caspase-8 (CASP8) is one key regulator of apoptosis of T lymphocytes and is encoded by the CASP8 gene. It has been reported that the six-nucleotide deletion polymorphism (-652 6N del) of the CASP8 gene had effect on some cancer risk. Few studies explored the association between CASP8 gene polymorphism and digestive tract cancer risk. To evaluate the association between the CASP8 -652 6N del polymorphism and the risk of digestive tract cancer, we conducted this meta-analysis. We found that CASP8-652 6N del polymorphism was associated with a significantly reduced risk of digestive tract cancer in the co-dominant model (del/del vs. ins/ins: OR = 0.82, 95%CI = 0.72–0.95; del/ins vs. ins/ins: OR = 0.92, 95%CI = 0.87–0.97; dominant model (del/ins + del/del vs. ins/ins: OR = 0.91, 95%CI = 0.87–0.96, recessive model: del/del vs. del/ins + ins/ins: OR = 0.85, 95%CI = 0.75–0.97). In the stratified analysis by cancer types, we found that all genetic models had protective effect on gastric cancer. Similar results were observed for colorectal cancer under heterozygote comparison and dominant model, but not under homozygote comparison or recessive model. In addition, a significantly decreased risk was found on esophageal cancer for most genetic models, except heterozygote comparison. When stratified by ethnicity and source of control, an evidently decreased risk was identified in the Asian populations and population-based studies. In conclusion, there exists an association between the CASP8 -652 6N del polymorphism and reduced digestive cancer risk, especially among Asians and populationbased studies.     

Effect of the dipeptide vilon on activity of digestive enzyme in rats of various ages

Peroral administration of Vilon (Lys-Glu) to male and female Wistar rats aging 3 and 11 months changed activity of digestive enzymes (invertase, maltase, alkaline phosphatase, and amino- and dipeptidases) in various portions of the gastrointestinal tract. The increase in enzyme activity was most pronounced in 11-month-old animals, which diminished differences between rats of various ages. Our results indicate that Vilon produces positive effects on digestive enzyme activity during aging.     

Estimation of the number of mast cells in digestive organs of rats and frogs

The method of determining the concentration of mast cells in all tissues of an organ as described gives statistically correct values. The use of this method has shown that the concentration of mast cells within the confines of one morpho-functional zone in organs of the digestive tract of rats and frogs is constant. In the tongue it is the same both along the length of the organ and in symmetrically opposite parts. The concentration of mast cells falls from the tongue toward the stomach.Department of Histology, Khabarovsk Medical Institute. (Presented by Academician of the Academy of Medical Sciences of the USSR V. V. Kupriyanov.) Translated from Byulleten' Éksperimental'noi Biologii i Meditsiny, Vol. 81, No. 1, pp. 94–95, January, 1975.     

回盲部肠管代胃术的应用解剖

目的：为回盲部肠管代胃重建消化道术式提供解剖学基础。方法：在20具乳胶灌注尸体标本和14具新鲜尸体铸型标本上对回肠末端、右半结肠营养血管的来源、分支点及分布类型、各分支间吻合，极其肠管长度与血管分支的关系进行观测。结果：①可分割型血管分布切取肠段长度根据乳胶灌注标本观察可达13—16cm，根据铸型标本观察可达10—15cm；②不可分割型血管分布根据铸型标本观察可利用肠段切取总长度达12—13cm。结论：无论属于那一类型的血管分布，可切取肠段的长度都能满足再造胃的需要。     

Morphology of the esophago–duodenal anastomotic region after total gastrectomy: early changes

Total gastrectomy is considered to be a major treatment for gastric cancer. The aim of the present study was to investigate the possible effects of total gastrectomy on the esophago–duodenal anastomotic region morphology along with the determination of carcinoembryonic antigen (CEA) immunoreactivity during the early period. A series of rats underwent total gastrectomy via esophago–duodenostomy. Thirty days postoperatively, the morphology of the esophago–duodenal anastomotic region was determined at the light and electron microscopical levels. Esophago-duodenal anastomotic region samples were stained with hematoxylin–eosin and colloidal iron-PAS. In addition, CEA immunolocalization was also investigated. In the duodenal site of the anastomotic region, there were intervillous fusions along with a decrease in villous height and goblet cell secretory activity. There were neoplastic glands in the submucosa of esophagus and duodenum and their secretions were PAS positive. CEA immunoreactivity was observed widely in the cellular membrane surface surrounding the neoplastic glands, in their products, and in the connective tissue of the glands. It is likely that total gastrectomy causes adverse morphological changes throughout the esophago–duodenal anastomotic region. Strong CEA immunoreactivity may be a relevant marker for potential anastomotic region cancer in the early postoperative period after total gastrectomy.