目的探討Billroth-Ⅱ胃大部切除術后輸入袢梗阻的診斷和手術方式。 方法本組共17例輸入袢梗阻患者，對17例患者的手術史、臨床表現及影像學資料進行總結分析。 結果典型的輸入袢梗阻表現為上腹脹痛、上腹部觸及張力較高且有壓痛的囊性包塊，腹部CT檢查見腹主動脈與腸系膜上動脈之間橫向走行的擴張腸管。17例患者均再次行剖腹探查術，術中見輸入袢擴張，5例行Braun吻合術，12例行Roux-en-Y吻合術。術后無嚴重合并癥，無圍手術期死亡，患者均恢復順利，梗阻癥狀消失。術后隨訪1～4年（平均2.5年），經X線胃腸鋇餐檢查見吻合口鋇劑通過順利，無狹窄；胃鏡檢查未見膽汁反流。 結論嚴格遵守正確的手術操作常規是預防輸入袢梗阻的關鍵；經腹部CT診斷明確后，應盡早再手術；Braun吻合術及Roux-en-Y吻合術為胃大部切除術后輸入袢梗阻較理想的術式。
目的探討殘胃癌的臨床特點和診治方法。方法對1989~2003年收治的15例殘胃癌病例資料進行回顧性分析，觀察不同手術方式對預后的影響。結果B-Ⅱ式手術后殘胃癌發病率遠高于B-Ⅰ式手術； 根治性手術切除8例，根治性切除率為53.3%（8/15）； 根治性手術切除患者2年以上生存率為62.5%（5/8），姑息性手術切除患者術后平均生存時間不足1年。結論早期診斷和根治性切除是殘胃癌預后的重要因素。
目的 探討胃大部切除術后殘胃功能性排空障礙（FDGE）的發病機理、診斷及治療。方法 對1993~1998年我科256例胃大部切除術患者的臨床資料進行回顧性分析。結果 本組共發生FDGE 12例，發生率為4.7％(12/256)，均發生于術后3~12天。于1周內治愈1例(8.3％)，2周內治愈8例(66.7%)，3周內治愈11例(91.7%)； 所有患者于32天之內經保守治療治愈出院。結論 術后殘胃和遠端空腸正常的運動功能破壞是發生FDGE的主要原因； 消化道造影及胃鏡檢查是診斷本病及與機械性梗阻相鑒別的重要方法； 采取非手術治療一般可治愈，針對胃排空動力學機理采用促胃腸動力藥物能收到較好的療效。
目的 探討預防胃大部切除術后堿性返流性胃炎的術式。方法 回顧性分析1998年6月至2008年12月期間我科收治的42例行胃大部切除術患者的臨床資料，根據不同術式分為傳統Billroth-Ⅱ（簡稱B-Ⅱ）式組（n=21）和改良B-Ⅱ式組（n=21），對2組患者術后胃腸引流液的量、劍突下持續燒灼痛、膽汁性嘔吐、體重減輕以及腸胃液返流情況進行比較。結果 傳統B-Ⅱ式組胃腸引流液量平均為（300±50） ml，而改良B-Ⅱ式組胃腸引流液量平均為（100±40） ml,2組間比較差異有統計學意義（P＜0.05）。傳統B-Ⅱ式組劍突下持續燒灼痛12例，膽汁性嘔吐8例，體重減輕1例； 而改良B-Ⅱ式組僅出現1例劍突下持續燒灼痛和1例體重減輕，未見膽汁性嘔吐病例，2組間比較差異有統計學意義（P＜0.05）。傳統B-Ⅱ式組發生輕度返流9例，重度返流12例; 改良B-Ⅱ式組僅2例發生輕度返流，1例重度返流，其余均未見返流，2組間比較差異有統計學意義（P＜0.05）。結論 與傳統B-Ⅱ式相比，改良B-Ⅱ式的堿性返流性胃炎發生率明顯降低，術后效果滿意。
Objective To evaluate clinical efficacy of mFOLFOX6 combined with aspirin in treatment of advanced gastric cancer following perioperative period of laparoscopic distal subtotal gastrectomy. Methods One hundred and seven patients with advanced gastric cancer were assigned to observation group (57 cases) and control group (50 cases). The patients in the observation group received the mFOLFOX6 chemotherapy and regular intake of aspirin (100 mg/d) and the control group received the mFOLFOX6 chemotherapy alone. The recurrence or metastasis rate, rate of disease progress, toxicity, median survival time, and 3-year survival rate were compared between the observation group and the control group. Results ① There were no significant differences in the gender, age, pathological type, and so on between the observation group and the control group (P>0.05). ② The rates of toxicity such as the white blood cell reduction, granulocyte reduction, thrombocytopenia had no significant differences in these two groups (P>0.05). ③ The follow-up time was 4–45 months with an average 3.5 years, the rate of disease progress was lower (P=0.032), the median survival time was longer (P=0.043), the cumulative 3-year overall survival (P=0.015) and the cumulative 3-year disease-free survival (P=0.037) were better in the observation group as compared with the control group. Conclusion Preliminary results in this study show that mFOLFOX6 regimen combined with low-dose aspirin could significantly improve efficacy of advanced gastric cancer following perioperative period of laparoscopic distal subtotal gastrectomy, reduce rate of disease progress, and improve survival rate without increasing side effects.
ObjectiveTo summarize the procedure of transumbilical single incision laparoscopic surgery (SILS) with conventional laparoscopic instruments for different tumor diameter and different site of gastric stromal tumor. MethodThe clinical data, intraoperative procedure, and postoperative recovery of 34 patients with gastric stromal tumor from December 2009 to February 2014 in this hospital were analyzed retrospectively. ResultsThe transumbilical SILS was performed successfully in all the 34 patients.Among these patients, the wedge resection of stomach was perfor-med in 27 patients, distal subtotal gastrectomy was performed in 6 patients, distal subtotal gastrectomy complicated with multivisceral resection was performed in 1 patient.The pathology confirmed that the diameter of tumors was from 0.6 cm to 10.0 cm (average 3.4 cm).The resection margins were tumor free.The risk assessment showed that tumors with extremely low risk were in 9 cases, low risk were in 17 cases, intermediate risk were in 6 cases, high risk were in 2 cases.During surgery, 9 tumors were located on the fundus of stomach, 6 tumors on the gastric greater curvature, 7 tumors on the gastric lesser curvature, 2 tumors on the anterior and posterior wall of the stomach respectively, 3 tumors on the cardia below, 4 tumors on the gastric antrum, tumor invaded the surrounding organs in 1 case.There was no conversion to open or conventional laparoscopic surgery.no intraoperative or postoperative complications were experi-enced in all the patients except one was postoperative intraperitoneal bleeding and one was incision infection.All the patients were followed for an average of 25 months (range 3-49 months), there was no evident recurrence of disease. ConclusionsThe transumbilical SILS for gastric stromal tumor is a feasible and safe technique when performed by an experienced laparoscopic surgeon.The suitable procedure of SILS should be selected for gastric stromal tumor according their different size and location.
ObjectiveTo compare clinical outcome between single-incision laparoscopic subtotal gastrectomy (SILSG) versus laparoscopy-assisted subtotal gastrectomy (LASG) in treatment of benign gastric ulcer and duodenal ulcer. MethodsClinical data of 37 patients with benign gastric ulcer or duodenal ulcer who underwent laparoscopic subtotal gastrectomy between Jan. 2008 and Feb. 2015 at Shengjing Hospital of China Medical University was collected retrospectively. Among them, 15 patients underwent SILSG and 22 patients underwent LASG. Demographic, intraoperative, and postoperative data was analyzed and compared between the 2 groups. ResultsThe operative time of SILSG group was significantly longer than that of LASG group (P < 0.050). However, the postoperative hospital stay was significantly shorter (P < 0.050), and the total patient scar assesment scale (PSAS) score was significantly lower (P < 0.050) in the SILSG group than those of LASG group. There was no significant difference between the 2 groups with respect to other variables (P > 0.050), such as conversion rate, intraoperative blood loss, postoperative exhaust time, incidence of complication, and visual analog scale score of pain. All patients received postoperative follow up, and the period ranged from 6 months to 25 months, with a median of 11 months. During the follow up period, no one suffered from incision hernia and recurrence of ulcer. ConclusionCompared with LASG, SILSG is a technically feasible procedure with better cosmesis and equivalent curability.