Laparoscopy‐assisted distal gastrectomy in a case of gastric cancer with situs inversus totalis: a case report

Situs inversus totalis (SIT) is a rare congenital condition in which abdominal and thoracic organs are transposed from normal positions. Laparoscopy‐assisted distal gastrectomy for situs inversus totalis is technically difficult and has rarely been reported. Here, we report the case of man in his 40s with situs inversus totalis and a preoperative diagnosis of stage IA gastric cancer (cT1b, cN0, cM0). We successfully performed laparoscopy‐assisted distal gastrectomy with D1+ lymph node dissection and Billroth I reconstruction. To ensure a safe procedure, we evaluated the vessels preoperatively with 3‐D CT angiography. Furthermore, we performed the surgery by reversing our surgical positions, using a two‐monitor method, and then reconstructing under direct vision through the incision. The surgery was performed with minimal blood loss, and no severe postoperative complications were observed. Histopathological examination revealed poorly to moderately differentiated stage IA (pT1b, pN0, pM0) adenocarcinoma. No recurrence has been observed as of 2 years postoperatively.     

Laparoscopy‐assisted distal gastrectomy for multiple adenocarcinomas in intrathoracic upside‐down stomach

Herein we report on a case of two adenocarcinomas arising from an upside‐down stomach in an elderly patient. An 83‐year‐old man was referred to our hospital with gastric cancer. Esophagogastroduodenoscopy showed two superficial depressed lesions in the stomach that were confirmed on biopsy as constituting a moderately differentiated tubular adenocarcinoma. CT and an upper gastrointestinal barium study revealed that the entire stomach and parts of the duodenum were located in the mediastinum. The patient underwent laparoscopy‐assisted distal gastrectomy and regional lymph node dissection with Billroth I reconstruction, followed by reduction of the migrated stomach. The hiatal defect was closed by primary suturing of the right and left crura at the anterior space of the esophagus. The patient's postoperative course was good, and follow‐up after discharge was uneventful. To the best of our knowledge, this is the first case report of multiple adenocarcinomas in an upside‐down stomach treated by laparoscopy‐assisted distal gastrectomy.     

手助腹腔镜与开腹、腹腔镜辅助远端胃癌根治术的临床对比研究

目的探讨手助腹腔镜在进展期远端胃癌根治术中的应用价值。 方法回顾性分析河北医科大学第二医院2015年8月至2017年12月间80例进展期胃下部癌的临床资料,其中30例行手助腹腔镜手术,25例行开腹手术,25例行腹腔镜辅助手术。采用单因素方差分析比较3组之间手术时间、出血量、清扫淋巴结数目、术后排气时间、术后近期并发症、住院时间及住院费用、切口长度等指标的差异,组间的两两比较采用单因素方差分析中的Bonferroni方法。采用χ²检验或Fisher确切概率法比较3组间性别、病理类型、腹主动脉旁有肿大淋巴结、腹部手术史及术后并发症的差异。 结果3种手术方式在术中淋巴结清扫数、术后住院费用及术后并发症方面比较,差异均无统计学意义（P>0.05）;手助腹腔镜手术组、腹腔镜辅助手术组和开腹手术组3种手术方式在手术时间［（186.30±15.27）min vs （230.80±17.06）min vs （183.36±16.03）min］、术中出血量［（93.33±46.86）ml vs（98.80±55.10）ml vs （246.80±92.90）ml］、术后排气时间［（2.3±0.6）d vs （2.42±0.44）d vs（3.04±0.56）d］、住院时间［（8.90±1.19）d vs （9.40±1.44）d vs（10.92±1.73）d］及切口长度［（7.97±0.49）cm vs （8.04±0.61）cm vs （24.04±2.11）cm］方面比较,差异均具有统计学意义（F=70.055,43.937,20.162,13.892,1385.430,P均<0.001）。手助腹腔镜手术组和腹腔镜辅助手术组切口长度、术中出血量、术后排气时间及住院时间方面<开腹手术组,差异具有统计学意义（P均<0.001）。手助腹腔镜手术组和开腹手术组在手术时间方面较腹腔镜辅助手术组更短,且差异具有统计学意义（P均<0.001）。 结论手助腹腔镜进展期远端胃癌根治术安全可行,其在肿瘤切除及淋巴结清扫上可达到与开腹手术相当的效果,并且不增加患者经济负担。手助腹腔镜手术保留了腹腔镜辅助手术的术中出血少、术后恢复快的优点,且手术时间短。     

腹腔镜与开腹远端胃切除术后手术部位感染的Meta分析

目的比较腹腔镜与开腹远端胃切除术(LDG)对胃癌患者术后手术部位感染(SSI)的差异。方法制定严格的纳入标准与排除标准,收集LDG和开腹远端胃切除术(ODG)治疗胃癌的随机对照试验,按照Cochrane协助网推荐的方法对纳入研究进行系统分析。结果 6篇随机对照试验(767例患者)纳入分析,LDG组394例,ODG组373例。LDG组患者术后切口感染发生率[RR=0.32,95%C(I0.11,0.91),P=0.030]、总的手术部位感染发生率[RR=0.28,95%C(I0.12,0.70),P=0.006]较ODG组低,差异有统计学意义,但腹腔脓肿发生率[RR=0.35,95%C(I0.09,1.31),P=0.120]差异无统计学意义。结论 Meta分析显示,LDG患者术后SSI发生率明显低于ODG患者。     

腹腔镜辅助下远端胃癌根治术在进展期胃癌中的应用

目的 探讨腹腔镜辅助下远端胃癌根治术在进展期胃癌中的疗效与安全性.方法 选取2017年6月-2019年6月该院收治的70例进展期胃癌患者为研究对象,随机分为对照组(n=35)和观察组(n=35).对照组患者行开腹远端胃癌根治术,观察组患者行腹腔镜辅助下远端胃癌根治术;比较两组患者手术指标、术后恢复情况、血清炎症因子水平...     

Successful treatment of large adenoma extending close to the papilla in the duodenum by laparoscopy‐assisted pancreas‐sparing duodenectomy

A 54‐year‐old man had a 65‐mm infrapapillary, circular, and laterally spreading tubular adenoma in the distal second and proximal third parts of the duodenum. The papilla was 15 mm from the proximal margin of the tumor. Because the patient requested organ‐preserving laparoscopic surgery, we conducted laparoscopy‐assisted pancreas‐sparing duodenectomy (LAPSD). LAPSD consists of five major procedures: (i) laparoscopic wide Kocher maneuver and transection of the proximal jejunum; (ii) laparoscopic separation of the duodenum from the pancreas; (iii) creation of a small upper median laparotomy; (iv) extracorporeal completion of the segmental duodenectomy; and (v) extracorporeal intestinal reconstruction. The postoperative course was uneventful, and the patient was discharged on postoperative day 8. Histopathological examination revealed that the circumferential margin of the specimen was negative for tumor cells. LAPSD provided a clear margin without damaging the papilla and eliminated the possibility of peritoneal or port‐site seeding of tumor cells because part of the procedure was performed extracorporeally. LAPSD is a useful alternative to pancreatoduodenectomy in patients with a large adenoma extending close to the papilla in the duodenum.     

腹腔镜辅助远端胃癌根治术中非离断式Roux-en-Y吻合的效果观察

目的:探讨非离断式Roux-en-Y吻合在腹腔镜辅助远端胃癌根治术中应用的疗效。方法:回顾性分析2016年5月至2019年10月唐山市协和医院53例经手术治疗的远端胃癌患者的临床资料,手术方式为腹腔镜辅助远端胃癌根治术,吻合方式为非离断式Roux-en-Y吻合29例(非离断组)和Roux-en-Y吻合24例(传统组),...     

全腹腔镜与腹腔镜辅助胃癌根治术治疗局部进展期远端胃癌的近期疗效及对患者炎症状态的影响

目的探究全腹腔镜与腹腔镜辅助胃癌根治术治疗局部进展期远端胃癌的近期疗效及对患者炎症状态的影响。方法回顾性分析2019年1月至2020年12月我院收治的78例局部进展期远端胃癌患者的临床资料,根据手术方式的不同将其分为参照组(n=39,腹腔镜辅助胃癌根治术)和研究组(n=39,全腹腔镜胃癌根治术)。比较两组的治疗效果。结果研究组的切口长度、吻合时间、术后排气时间、自主下床活动时间短于参照组,淋巴结清扫数量多于参照组(P<0.05)。研究组的术后并发症总发生率低于参照组(P<0.05)。术后24 h,两组的血清IL-4、IL-6、hs-CRP水平均升高,但研究组低于参照组(P<0.05)。术后12、24、48 h,两组的VAS评分均降低,且研究组低于参照组(P<0.05)。术后24 h,两组的IgA、IgM、IgG水平均降低,但研究组高于参照组(P<0.05)。研究组的切口瘢痕满意度、切口瘢痕美观接受度、切口瘢痕分级评分均高于参照组(P<0.05)。结论相较于腹腔镜辅助胃癌根治术,对局部进展期远端胃癌患者开展全腹腔镜胃癌根治术的效果更佳,患者术后炎症状态、疼痛程度更轻,免疫功能、切口美容满意度更高,术后并发症发生率更低,值得临床应用和推广。     

Three‐dimensional laparoscopy‐assisted bowel resection for cavernous hemangioma of the rectum: Report of two cases

The safety and feasibility of 3‐D laparoscopy‐assisted bowel resection were demonstrated in the management of rectal cancer. However, this procedure’s role in the management of patients with diffuse cavernous hemangioma of the rectum has not been evaluated. Here, two patients were diagnosed with diffuse cavernous hemangioma of the rectum by colonoscopy and abdominal imaging. One case underwent pull‐through transection and coloanal anastomosis in 3‐D laparoscopy‐assisted surgery. In another patient, 3‐D laparoscopy‐assisted abdominoperineal resection was performed. The operations were safely performed in both cases. The two patients recovered uneventfully, and satisfactory postoperative outcomes were demonstrated. This report shows that 3‐D laparoscopy‐assisted bowel resection may be safe and feasible for patients with diffuse cavernous hemangioma of the rectum.     

腹腔镜下胃癌D2淋巴结清扫的临床疗效及中期随访报告

目的比较腹腔镜胃癌D2根治术与开腹手术的疗效,探讨腹腔镜胃癌D2根治术的可行性。方法选取浙江省瑞安市人民医院2008年10月-2013年8月收治的胃癌患者,根据患者采取的手术方式不同分为两组,其中175例腹腔镜手术患者纳入腹腔镜组,163例开腹手术患者纳入开腹组。比较两组患者的术中及术后情况、淋巴结清扫数目、并发症及肿瘤根治程度等。结果腹腔镜组清扫淋巴结(26.3±13.9)枚,开腹组清扫淋巴结(26.8±10.2)枚,差异无统计学意义(t=-0.40,P=0.684)。腹腔镜组术中出血情况以及术后排气时间均优于开腹组。腹腔镜组患者术后住院时间小于开腹组,组间比较差异有统计学意义(P0.05)。腹腔镜组的3年生存率为92.00%,与开腹组92.63%相比较,差异无统计学意义(χ2=1.54,P=0.262)。结论腹腔镜胃癌D2根治术具有安全、术后恢复快和创伤小等优点,同时能够达到与开腹组相近的淋巴结清扫效果。