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31.
J. C. Mendes de Almeida M.D. A. Bettencourt M.D. C. Santos Costa M.D. J. M. Mendes de Almeida M.D. FACS 《World journal of surgery》1994,18(6):889-894
From January 1980 to December 1991 we operated on 295 patients with a gastric carcinoma. In 166 cases (56.3%) surgery was performed with curative intent. In 93 patients (56%) a subtotal gastrectomy was performed, and in 73 cases (44%) a total gastrectomy. In all the cases a D-2 type lymphadenectomy was used. The global morbidity rate was 23%, and in-hospital mortality was 3.6%. The morbidity and mortality rates of these two operations were statistically different. Global 5-year survival estimate for the whole series is 61.3%. Univariate and multivariate analysis according to T and N (TNM classification), the number of positive nodes resected, and the relation of positive per resected nodes, revealed statistically different outcomes. This kind of quantitative classification allowed identification of high risk groups irrespective of site of nodal involvement. Tumors classified as intestinal or diffuse type by the Lauren classification had similar survival curves and 5-year survival estimates (p=0.834). By univariate and multivariate analysis this classification did not reveal a prognostic value in this group of patients. In our opinion, tumor penetration and lymph node involvement are at present the most reliable prognostic factors available.
Resumen En el período enero 1980 a diciembre 1991 se operaron 295 pacientes con carcinoma gástrico. En 166 (56.3%), la cirugía fue realizada con intención curativa; en 93 (56%) se realizó gastrectomía subtotal y en 73 (44%) gastrectomía total. En la totalidad de los casos se realizó linfadenectomía D-2. La mortalidad global fue 23% y la mortalidad hospitalaria 3.6%. Las tasas de mortalidad y morbilidad de estas dos operaciones aparecieron significativamente diferentes. La sobrevida global a cinco años estimada para la totalidad de la serie es de 61.3%. Los análisis uni y multivariables de acuerdo con la clasificación TNM, el número de ganglios positivos resecados y la relación positivos/resecados revelaron resultados estadísticamente diferentes. Este tipo de clasificación cuantitativa permitió la identificación de Grupos de alto riesgo independientes del lugar de la invasión ganglionar. Los tumores clasificados como intestinales o difusos (clasificación de Lauren), registraron similares curvas de sobrevida y de sobrevida estimada a cinco años (P=0.834). Mediante el análisis univariable y multivariable esta clasificación no demostró tener valor pronóstico en nuestro Grupo de pacientes. En nuestra opinión, el grado de penetración del tumor y la invasión ganglionar son los factores de pronóstico más confiables.
Résumé Entre Janvier 1980 et Décembre 1991, nous avons opéré 295 patients ayant un cancer gastrique. Chez 166 (56.3%), l'exérèse a été jugée curative. Chez 93 (56%) des cas, il s'agissait d'une gastrectomie subtotale alors que dans 73 (44%) cas, une gastrectomie totale a été pratiquée. Dans tous les cas une lymphadénectomie du type D-2 lui a été associée. La morbidité globale a été de 23% et la mortalité hospitalière de 3.6%. La morbidité et la mortalité des deux types d'intervention différaient de façon statistiquement significative. La survie à 5 ans de la série en entier a été de 61.3%. Une analyse uni et multifactorielle a pu mettre en évidence une différence statistiquement significative en ce qui concerne la survie par rapport à la classification T-N (TNM), le nombre de ganglions réséqués et le nombre de ganglions envahis/nombre de ganglions enlevés. Cette analyse a permis d'identifier les malades à haut risque, indépendamment du site de l'envahissement lymphatique. La courbe de survie et la survie estimée à 5 ans étaient identiques selon que la tumeur a été classée intestinale ou diffuse selon Lauren. Cette classification n'a pas, pourtant, de valeur pronostique d'après les analyses uni et multifactorielle. A notre avis, la pénétration tumorale et le degré d'envahissement lymphatique sont les deux facteurs pronostiques les plus constants.相似文献
32.
A retrospective study of all ileogastrostomy procedures (n=26) performed in 1993 by one surgeon (IGMC) was carried out to investigate the hypothesis that Helicobacter pylori may be implicated in certain severe cases of postoperation nausea and diarrhea. Ten of 26 persons (38.5%) displayed nausea
and notable diarrhea (greater than or equal to ten bowel movements per day), seven of which warranted upper GI investigation.
One hundred per cent (seven of seven) of these persons were found to possess H. pylori upon C-14 breath test. In four of six cases eradication therapy (1 g amoxicillin b.i.d./20 mg omeprazole b.i.d. for 2 weeks)
corresponded with a resolution of severe nausea and diarrhea (one additional case involved omeprazole use only), suggesting
that H. pylori should be considered as a possible cause of these symptoms post-ileogastrostomy. Additionally, in four of seven cases persons
were re-tested (C-14 breath analysis) at least 1 month post-therapy and in this group three persons were found to be free
of the organism. All three cases of notable diarrhea and nausea resolved with treatment, providing the strongest evidence
for a possible association between infection and these symptoms. 相似文献
33.
Background: this study was designed to characterize some of the biochemical and molecular genetic changes during reversion
of human fat cells. Methods: mature adipocytes were isolated from greater omental fat tissue of eight lean and 14 massively
obese persons by established methodology. Results: at day 7 of adherence to Leighton tubes, there was appreciable depletion
of triacylglycerol, as well as assumption of an elongated contour. Relatedly, there was an increase in the expression of β-actin
mRNA and a significant decrease in the specific activity of cytosolic glycerophosphate dehydrogenase. The decrement in the
specific activity of glycerophosphate dehydrogenase, after 7 days in culture, was significant at p < 0.001. Basic fibroblast growth factor at 10 ngml-1 accelerated significantly (p < 0.03) the decrease in the specific activity of glycerophosphate dehydrogenase in adipose cells from lean subjects. In contrast,
basic fibroblast growth factor had no significant influence on cells from massively obese persons. Conclusion: such resistance
may contribute to the intractability of massive obesity. 相似文献
34.
Background: Vitamin B12 deficiency after gastric surgery for obesity is due to a failure of separation of vitamin B12 from protein foodstuffs and to a failure of absorption of crystalline vitamin B12 in the presence of intrinsic factor. The purpose of this study was to determine which of four oral doses of crystalline vitamin
B12 was most effective in treating vitamin B12 deficiency in 102 patients. Methods and Results: At time of entry into the study, the patients had a serum vitamin B12 < 100 pmol L −1, were 29.9 ± 21.7 months post-op, were 37 ± 8 years old and had a body mass index of 30 ± 6 kg m−2. Eight (8%) had had a vertical banded gastroplasty and 94 (92%) a gastric bypass. For the first 3 months all patients received
350 μg per day of crystalline vitamin B12 and all increased their serum vitamin B12 levels to over 100 pmol L−1. The patients were then assigned to receive for a further 3 month period one of four oral doses of crystalline vitamin B12-100 μg, 250 μg, 350 μg and 600 μg. Serum vitamin B12 levels were greater than 150 pmol L−1 after 6 months in 83.3% of patients who received 100 μg; 92.3% of patients who received 250 μg; 94.7% after 350 μg and 95.2%
after 600 μg (p%0.525). Conclusion: At least 350 μg per day is the appropriate oral dose of crystalline vitamin B12 after gastric surgery for obesity to correct low serum vitamin B12 levels in 95% of patients. 相似文献
35.
Background: Morbid obesity contributes to many health risks, including physical, emotional, and social problems. Various surgical
treatments for morbid obesity have developed and have so far met with good results. This study compares vertical banded gastroplasty
(VBG) with gastric bypass (GBP) and the patients' satisfaction with either procedure. Methods: Between April 1993 and July
1997, 63 bariatric surgical procedures were performed at Eisenhower Army Medical Center. Of those, complete follow-up was
obtained for 29 patients. The parameters evaluated included age, preoperative and postoperative weights, body mass index (BMI),
type of surgery, complications, and the patient's level of satisfaction. Results: The study group consisted of 27 women and
2 men. The average preoperative weight was 135 kg, and the average preoperative BMI was 48.3 kg/m2. There were 17 VBGs and 12 GBPs performed. The average total weight loss was 45.1 kg. The average postoperative BMI was 33.2
kg/m2. There were no statistically significant differences in weight loss between VBG and GBP. Four of 17 patients had complications
after VBG, and three of 12 patients had complications after GBP. After VBG, 94.1% of patients were satisfied, and after GBP,
100% were satisfied. Twenty-seven of 28 patients stated that they would have the surgery again. Conclusion: There were no
statistically significant differences in weight loss or complications after VBG or GBP. Patient satisfaction was high after
both procedures. Therefore, bariatric surgery is important in the treatment of appropriately selected, morbidly obese patients. 相似文献
36.
Success Habits of Long-Term Gastric Bypass Patients 总被引:1,自引:1,他引:0
Background: By identifying common habits of the most successful long-term gastric bypass patients, one is able to establish
more specific guidelines for new patients to follow. The first postoperative year is a critical time that must be dedicated
to changing old behavior and forming new, lifelong habits. Methods: 100 gastric bypass patients from 1979 to 1995 participated
in a comprehensive survey. Surveys were completed in person, by phone, or in writing. Participants were asked to answer questions
regarding their eating, drinking, sleeping, exercise, and personal habits. Results: The survey revealed that specific habits
are common in gastric bypass patients who have maintained their weight loss for many years. Conclusion: Identifying and defining
the common habits of patients who are successful with long-term weight loss enabled specific guidelines to be established
for new patients to implement during the initial weight loss phase, which will contribute to life-long success. 相似文献
37.
Flanagan L 《Obesity surgery》1996,6(1):38-43
Background: The cottage cheese test was developed in an attempt to find a simple way to measure functional pouch volume and
to better understand the fate of the tiny proximal pouch following the gastric bypass procedure. Methods: Our patients were
asked to eat cottage cheese in a structured fashion before their return visits from 3 months to 2 years postoperatively. Results:
We found there was a step-wise progression of increase in functional pouch volume with statistical significance between each
time interval. Also, we compared the patients' excess weight loss at 1, 2, and 3 years postoperatively to their pouch size
at 1 year postoperatively. Although there is a wide range (2.5-9.0 oz) of pouch sizes at 1 year, there is no significant difference
in excess weight loss between the smaller and larger pouches. Conclusions: The pouches enlarge by the orderly process of hyperplasia.
Within the 2.5-9 oz volume variation, the pouch volume alone is not a predictor of weight loss. Rather, how the patient uses
the pouch/tool, in addition to the other behavior modifications, determines the degree of weight loss. This data strongly
suggests that the surgeon's understanding of and teaching of the optimal use of the pouch/tool may be more important than
previously thought. 相似文献
38.
Background: The pharmacokinetic variables of drug clearance and volume of distribution are usually corrected for body weight
or surface area. Only recently have the relationships which exist between body size, physiologic function and pharmacokinetic
variables been evaluated in the obese population. These effects are not widely known, and data on this and the effects of
bariatric surgical procedures are scantily documented in the surgical literature. Methods: Literature review. Results: Drugs
with a low or moderate affinity for adipose tissue have a moderate increase in the volume of distribution (Vd), and this correlates
with the increase in lean body mass (LBM). Highly lipophilic drugs, with some exceptions, show the expected increase in Vd
and prolongation of elimination half-life, indicating a marked distribution into adipose tissue. Drug absorption, in general,
is slowed by delayed gastric emptying and is normal when gastric emptying is normal or increased. Most drug absorption occurs
in the small intestine where duration of drug/mucosal contact is the most important factor. Conclusions: Drugs whose distribution
is restricted to LBM should utilize a loading dose based on ideal body weight (IBW). For those drugs which distribute freely
into adipose tissue, the loading dose should be based on total body weight (TBW). Adjustment of the maintenance dose depends
on clearance rates. In a few cases dosage adjustment depends on pharmacodynamic data, since drug clearance does not conform
to these recommendations, for reasons which remain to be defined. Following bariatric surgery, in the absence of delayed gastric
emptying or uncontrolled diarrhea, drug absorption rates are usually comparable to the non-operated patient. 相似文献
39.
Macgregor AM 《Obesity surgery》1996,6(4):325-329
Long-term results of bariatric surgery are reviewed. The weight criteria for patient acceptance for bariatric surgery and
their variation are presented graphically and discussed. Factors affecting patient selection in an attempt to improve outcome
results in the small group of patients who currently achieve less weight loss than anticipated are defined. An attempt is
made to define pre-operative criteria for selection of pure restrictive versus combined restrictive and malabsorptive procedures.
Aspects of motivation, co-morbidity, age and pre-operative weight are discussed and the position statement of the ASBS in
regard to laparoscopic bariatric surgery is defined. 相似文献
40.
Mason EE 《Obesity surgery》1996,6(3):218-223
BACKGROUND: Have surgeons in North America accepted operations for the treatment of severe obesity? This question was posed by organizers of the Ninth International Symposium on Obesity Surgery that met in Stockholm in September, 1995. Study design: In order to obtain opinions which might help to answer the question posed, a 1-page questionnaire was sent to 151 chairmen of academic departments of surgery in North America in December 1994 asking about the acceptance and use of surgical operations for the treatment of severe obesity. RESULTS: Answers, received from 112 or 74%, indicated that operative treatment should be used (74%), was effective (77%) and safe (71 %). However, only 65% of departments provided such operations. Operative treatment for obesity was available outside the department in 53%. The operations most frequently used were Roux-en-Y gastric bypass (RGB) and vertical banded gastroplasty (VBG). A single operation was offered by 44 departments and a choice of two or more operations in 30 departments. RGB and VBG were equally in use. Gastric banding was used as an alternative to VBG in six departments. Other operations were in use in six departments either alone (three) or as alternatives to RGB and VBG (three). CONCLUSIONS: It appears that surgical treatment of obesity is accepted and available in the majority of academic departments of surgery. 相似文献