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Diagnosis and Treatment of Afferent Loop Obstruction after Billroth-ⅡSubtotal Gastrectomy

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。

Study of Operative Types for Prevention of Alkaline Reflux Gastritis after Subtotal Gastrectomy (Report of 42 Cases)

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。

Experience in Diagnosis and Treatment of 15 Patients with Carcinoma of Gastric Stump

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。

胃大部切除術后近期再生手術53例臨床分析

Clinical and Pathological Study of Gastric Cancer in 1034 Patients

ObjectiveTo study and analyse the correlation between biologic behavior and clinical factors in gastric cancer.MethodsClinical and pathological study of carcinoma of stomach were retrospectively made in 1034 patients. ResultsIn this series,148 of 1034 patients (14.3%) were early gastric cancer.The frequency of lymph nodes metastasis was higher in proximal gastric cancer than distal (P＜0.0001).Similar frequency can also be seen in the tumor of larger diameter (P＜0.01),deeper invasion (P＜0.0001) and poor differentiation (P=0.004).Some difference in ages and sex of patients may be found on the invasion (P=0.003),differentiation (P＜0.0001),site (P＜0.001) and frequency of lymph nodes metastasis of the tumor (P=0.01).In multifactorial multivariate linear regression analysis,the site of tumor (P=0.003),diameter of tumor (P＜0.0001),depth of tumor infiltration (P＜0.0001) and the cell differentiation showed significant association with lymph node metastasis,in which the female patient had more lymph node metastasis than male (P＜0.001).Depth of tumor infiltration was the most important factor in lymph node metastasis.Numbers of lymph nodes resected were much more in total and distal gastrectomies than that in proximal gastrectomy (P＜0.0001). ConclusionThe results of this study suggest that radical gastrectomy with lymphadenectomy is necessary even in all stages of gastric cancer.

胃大部切除術后并發急性胰腺炎3例報告

有胃大部切除術史的腹腔鏡膽囊切除術10例報告

Application of Roux-en-Y Gastrojejunostomy in Digestive Tract Reconstruction after Distal Gastrectomy

目的評價Roux-en-Y胃空腸吻合術在遠端胃大部切除消化道重建中的臨床價值。 方法對筆者所在醫院科室2009年1月至2012年7月期間31例遠端胃癌行Roux-en-Y消化道重建患者的臨床資料進行回顧性分析。 結果全組病例無圍手術期死亡，無吻合口漏、十二指腸殘端瘺、輸入空腸段梗阻及傾倒綜合征發生。28例（90.3%）患者術后半年進食3～4次/d，每餐量150～400 g；血紅蛋白110～150 g/L，血清白蛋白38～50 g/L；24例（77.4%）患者體質量恢復或超過術前水平。胃鏡檢查未發現反流性食管炎，有殘胃炎表現者3例，但無臨床癥狀。 結論Roux-en-Y胃空腸吻合術可成為遠端胃大部切除消化道重建的主要術式。

Clinical observation of mFOLFOX6 combined with aspirin on advanced gastric cancer following perioperative period of laparoscopic distal subtotal gastrectomy

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.

DIAGNOSIS AND TREATMENT OF FUNCTIONAL DELAYED GASTRIC EMPTYING AFTER SUBTOTAL GASTRECTOMY

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。