胃上部癌根治术中脾门淋巴结清扫的现状与争议

淋巴结清扫是胃癌手术达到D2根治的关键,更与患者的预后息息相关。从开腹联合脾切除到腹腔镜下保留脾脏的脾门淋巴结清扫,No.10组淋巴结清扫始终是进展期胃上部癌根治术的难点所在。虽然有研究证实胃上部癌根治术清扫脾门淋巴结可取得好的短期疗效但目前仍缺乏高级别的循证医学证据,而且脾门区域淋巴结解剖复杂,盲目的清扫,常易造成不必要的损伤,甚至导致严重的并发症。胃上部癌根治术中脾门淋巴结清扫不同学者对手术安全性、手术入路、是否联合脾切除、脾血管后方淋巴结是否常规清扫,仍有较多争议。本文将从脾门淋巴结清扫的现状、腹腔镜下不同手术入路、脾门淋巴结清扫的争议等方面综述目前对胃上部癌根治术中脾门淋巴结的研究情况。     

进展期胃下部癌第12p组淋巴结转移的相关因素分析北大核心CSCD

目前D2根治术被认为是进展期胃癌的标准术式,但是对胃下部癌手术中是否需要清扫第12p组淋巴结仍未达成共识[1].本研究回顾性分析进展期胃下部癌第12p组淋巴结转移的相关因素,探讨胃下部癌D2根治术清扫第12p组淋巴结的必要性.     

保留脾脏的No．10及No．11淋巴结清扫在中上部胃癌根治术中的应用

目的探讨保留脾脏的No．10和No.11淋巴结清扫在贲门胃体癌根治术中的应用。方法对60例采用拖出式脾门淋巴结清扫患者的临床资料进行回顾性分析。结果60例患者共清扫No．10和No．11淋巴结152枚．阳性淋巴结21枚（13．8％）。未出现淋巴清扫相关的严重并发症。结论保留脾脏的脾门淋巴结清扫安全可行。     

胃癌联合脾 胰体尾或胰头切除的争议和趋势

胃癌的标准根治术是指D2淋巴结清扫术,胃癌的扩大根治术是指D3手术或联合脏器切除加D3淋巴结清扫术[1]。在胃癌联合脏器切除中,对于胃上部癌是否联合脾、胰体尾切除及胃下部癌是否联合胰头十二指肠切除,争论较大,结合国内外资料和本人体会谈谈有关问题。日本学者最早提出和开展     

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中上部胃癌行标准D2根治术须清扫包括脾门区淋巴结在内的No.1~12淋巴结,但由于脾门区位置较深、术中暴露困难、解剖复杂、血管变异多等原因,No.10、11淋巴结的清扫一直是难点,对术者的操作技巧要求较高。脾门区淋巴结清扫(spleen-preserving splenic hilar lymph node dissection)的理念及手术方式也在不断的发展和变化,随着腹腔镜技术的发展,腹腔镜下保留脾的脾门区淋巴结清扫(lap-     

腹腔镜中上部胃癌根治术中行脾门区淋巴结清扫研究进展

<正>中上部胃癌行标准D2根治术须清扫包括脾门区淋巴结在内的No.1~12淋巴结,但由于脾门区位置较深、术中暴露困难、解剖复杂、血管变异多等原因,No.10、11淋巴结的清扫一直是难点,对术者的操作技巧要求较高。脾门区淋巴结清扫(spleen-preserving splenic hilar lymph node dissection)的理念及手术方式也在不断的发展和变化,随着腹腔镜技术的发展,腹腔镜下保留脾的脾门区淋巴结清扫(lap-     

胃癌根治术中脾门淋巴结清扫的彻底性与脾脏损伤的风险

淋巴结转移是影响胃癌预后的重要因素,以彻底清扫胃周淋巴结为主的胃癌根治术使胃癌的外科治疗取得了长足的进步,目前D2手术已被大家公认为是进展期胃癌的标准手术.脾门(No.10)和脾动脉干淋巴结(No.11)作为U、M区胃癌第2站的淋巴结在相应的D2手术中必须清扫已无可非议.     

D2根治术联合脾切除治疗T3期胃上部癌的疗效评价

目的 探讨D2根治术联合脾切除对T3期胃上部癌的疗效及预后分析.方法 1980年1月至2002年6月对613例T3期胃上部癌患者施行D2根治性手术,其中联合脾切除术者(切脾组)102例,未联合脾切除术者(保脾组)511例.对两组患者No.l0、11淋巴结转移率、术后5年生存率和复发率,及术后并发症的发生率和病死率进行对照分析.结果 切脾组和保脾组No.l0淋巴结转移率分别为23.5%、14.9%,差异具有统计学意义(P＜0.05).两组NO.11组淋巴结转移率相当.切脾组和保脾组术后5年生存率分别为39.8%、32.3%,复发率分别为55.9%、60.3%,差异均无统计学意义(P＞0.05).切脾组中No.l0淋巴结有转移的患者术后5年生存率与无转移的患者相似;切脾组和保脾组术后并发症的发生率和病死率分别为19.6%、4.9%和13.7%、3.1%,差异均无统计学意义(P＞0.05).结论 对于T3期胃上部癌患者,发生No.10淋巴结转移时,应施行联合脾切除术,彻底清扫No.l0、11淋巴结,以提高疗效,减少复发.联合脾切除术不会增加患者术后并发症发生率和病死率.     

局部进展期胃上部癌的腹腔镜淋巴结清扫策略与应用前景

局部进展期胃上部癌行腹腔镜根治性手术必须遵循与开腹手术相同的淋巴结清扫范围。按从下至上程序化的步骤进行淋巴结清扫,不仅能使手术进程更加顺畅,而且能达到“整块切除”的要求。脾门区淋巴结清扫是腹腔镜局部进展期胃上部癌D2根治术的难点,选择正确的手术入路、熟识脾门区血管解剖类型以及整个手术团队的默契配合有助于缩短该术式的学习曲线。尽管目前对于局部进展期胃上部癌进行腹腔镜淋巴结清扫术仍处于探索性开展阶段,但相信随着更多高级别循证学证据的出现,其有望成为治疗局部进展期胃上部癌的标准清扫术式之一。     

联合脾切除治疗胃上部癌No．10淋巴结转移的疗效

目的探讨D2根治术联合脾切除对进展期胃上部癌No．10淋巴结转移患者预后的影响。方法1980年1月至2002年12月,对216例进展期胃上部癌N0．10淋巴结转移患者施行D2根治术,其中联合脾切除术者（切脾组）73例,未联合脾切除术者（保脾组）143例。比较两组患者术后5年生存率、No．10淋巴结清扫数目及转移数目及术后并发症发生率和病死率。结果216例进展期胃上部癌No．10淋巴结转移患者中,切脾组和保脾组术后5年生存率分别为30．0％和19．7％,两组差异有统计学意义（P〈0．05）。切脾组No．10淋巴结清扫数目及转移数目均明显高于保脾组（P〈0．05）。是否联合脾切除、肿瘤浸润深度和胃切除方式为影响预后的独立因素。T3期患者切脾组与保脾组5年生存率分别为38．7％和18．9％,两组差异有统计学意义（P〈0．05）;全胃切除患者切脾组与保脾组5年生存率分别为33．4％和20．7％,两组差异有统计学意义（P〈0．05）。切脾组和保脾组术后并发症发生率分别为24．7％和17．5％,病死率则分别为4．1％和3．5％,两组差异均无统计学意义（P〉0．05）。结论联合脾切除有利于进展期胃上部癌No．10淋巴结清扫。对于T3期胃上部癌No．10淋巴结转移患者,施行全胃联合脾切除能够提高疗效,不会增加患者术后并发症发生率和病死率。     

Body composition assessment and methodology in nonathletic and athletic adolescent and adult males and females

The purpose of this review is to outline methodology for assessing body composition utilizing anthropometric and densitometric techniques. The objective of body composition assessment is to measure body fat and lean body mass. The quantity of these components varies due to growth, physical activity, dietary regimens, and aging. Anthropometric techniques incorporate selected skinfolds, circumferences, skeletal widths, or other variables to estimate body composition within k2.0-4.0%. These techniques are adequate for field testing of groups or individuals, but are population specific. Densitometry measures body volume irrespective of physique, sex, or age. This laboratory technique estimates body composition within 1.0-2.0%, is more difficult to administer, but is not population specific. Some limitation exists with any present technique due to biological variability and incomplete research of reference body composition in children, females, and the aged. J Orthop Sports Phys Ther 1984;5(6):336-347.     

Perioperative and long-term morbidity and mortality after above-knee and below-knee amputations in diabetics and nondiabetics

We performed a retrospective review of a vascular surgery quality assurance database to evaluate the perioperative and long-term morbidity and mortality of above-knee amputations (AKA, n = 234) and below-knee amputations (BKA, n = 720) and to examine the effect of diabetes mellitus (DM) (181 of AKA and 606 of BKA patients). All patients in the database who had AKA or BKA from 1990 to May 2001 were included in the study. Perioperative 30-day cardiac morbidity and mortality and 3-yr and 10-yr mortality after AKA or BKA were assessed. The effect of DM on 30-day cardiac outcome was assessed by multivariate logistic regression and the effect on long-term survival was assessed by Cox regression analysis. The perioperative cardiac event rate (cardiac death or nonfatal myocardial infarction) was at least 6.8% after AKA and at most 3.6% after BKA. Median survival was significantly less after AKA (20 mo) than BKA (52 mo) (P < 0.001). DM was not a significant predictor of perioperative 30-day mortality (odds ratio, 0.76 [0.39-1.49]; P = 0.43) or 3-yr survival (Hazard ratio, 1.03 [0.86-1.24]; P = 0.72) but predicted 10-yr mortality (Hazard ratio, 1.34 [1.04-1.73]; P = 0.026). Significant predictors of the 30-day perioperative mortality were the site of amputation (odds ratio, 4.35 [2.56-7.14]; P < 0.001) and history of renal insufficiency (odds ratio, 2.15 [1.13-4.08]; P = 0.019). AKA should be triaged as a high-risk surgery while BKA is an intermediate-risk surgery. Long-term survival after AKA or BKA is poor, regardless of the presence of DM.     

Postoperative nausea and vomiting and opioid-induced nausea and vomiting: guidelines for prevention and treatment

Postoperative nausea and vomiting (PONV) causes patient discomfort, lowers patient satisfaction, and increases care requirements. Opioid-induced nausea and vomiting (OINV) may also occur if opioids are used to treat postoperative pain. These guidelines aim to provide recommendations for the prevention and treatment of both problems. A working group was established in accordance with the charter of the Sociedad Espa?ola de Anestesiología y Reanimación. The group undertook the critical appraisal of articles relevant to the management of PONV and OINV in adults and children early and late in the perioperative period. Discussions led to recommendations, summarized as follows: 1) Risk for PONV should be assessed in all patients undergoing surgery; 2 easy-to-use scales are useful for risk assessment: the Apfel scale for adults and the Eberhart scale for children. 2) Measures to reduce baseline risk should be used for adults at moderate or high risk and all children. 3) Pharmacologic prophylaxis with 1 drug is useful for patients at low risk (Apfel or Eberhart 1) who are to receive general anesthesia; patients with higher levels of risk should receive prophylaxis with 2 or more drugs and baseline risk should be reduced (multimodal approach). 4) Dexamethasone, droperidol, and ondansetron (or other setrons) have similar levels of efficacy; drug choice should be made based on individual patient factors. 5) The drug prescribed for treating PONV should preferably be different from the one used for prophylaxis; ondansetron is the most effective drug for treating PONV. 6) Risk for PONV should be assessed before discharge after outpatient surgery or on the ward for hospitalized patients; there is no evidence that late preventive strategies are effective. 7) The drug of choice for preventing OINV is droperidol.