目的 探讨手助腹腔镜胰十二指肠切除术的技术路线。方法 笔者所在科室于2011年10月17日完成1例手助腹腔镜胰十二指肠切除术。术中采用术者双侧站位、左右侧对称戳孔的策略，站立于患者右侧，游离胃网膜左血管和胃左血管，包括清扫No.7、No.8和No.9淋巴结；站立于患者左侧，游离十二指肠环和清扫下腔静脉旁淋巴结。经手助切口直视下完成消化道重建。结果 上腹部正中手术切口长7cm；手术时间为420min；术中出血量约600ml。术后病理报告：送检胃、十二指肠和胰腺标本，十二指肠球部低级别神经内分泌癌，浸润至深肌层，胃及胰腺未受累；两端切缘未见癌细胞，肝十二指肠韧带淋巴结未见癌转移（0/2）；慢性胆囊炎。手术后患者生命体征平稳，术后第5天肛门排气，第7天排便。术后发生腹腔积液并感染，经保守治疗治愈。术后28d出院。结论 术者双侧站位、左右对称戳孔是手助腹腔镜胰十二指肠切除术的新模式，安全、可行、微创，值得进一步探索。
Objective To evaluate the effect of ultrasound guided percutaneous drainage on acute perforation of gastroduodenal ulcer in elderly patients. Methods The clinical features, treatments, and the curative effects of 86 elderly cases (≥65 years) of acute perforation of gastroduodenal ulcer in our hospital between January 2004 and October 2009 were retrospectively analyzed. Twenty-one cases were treated by ultrasound guided percutaneous drainage (drainage group), and 65 cases were treated by exploring operation (operation group). Results Drainage group was cured and had no complications. In 15 patients which accepted recheck one month after drainage, gastroscope showed the ulcer healed in 12 cases， and improved in 3 cases. In operation group, 63 cases were cured and 2 cases died. Compared with the drainage group, there was no significant difference in cure rate (Pgt;0.05). However, 11 patients had operative complications in operation group, which was significantly more than that in the drainage group （Plt;0.05）. In 45 patients which accepted recheck one month after operation, gastroscope showed the ulcer healed in 38 cases， and improved in 7 cases. Conclusion For elderly patients with acute perforation of gastroduodenal ulcer， if the patients do not fit for exploring operation， ultrasound guided percutaneous drainage is proved to be a simple, safe, and effective means.
ObjectiveTo evaluate the curative effect of laparoscopic assisted and open D2 radical resection in treatment of advanced gastric cancer. MethodsThe clinical data of 76 cases performed by laparoscopic assisted D2 radical resection (laparoscopic group) and 104 cases performed by open operation (open group) from October 2010 to October 2012 in our center were retrospective analized.Operation related index, postoperative recovery, and extent of radical resection of tumor of 2 groups were compared. ResultsThe operative time of the laparoscopic group[(192.5±14.8) min]was longer than that open group[(171.5±16.5) min, P < 0.05].But the blood loss, postoperative drainage, length of incision, and hospital stay of the laparoscopic group were significantly less or shorter than those of open group (P < 0.05).There were no significant difference in postoperative complications and extent of radical resection of tumor between the 2 groups (P > 0.05).There were no residual tumor in distal margin and operatiive death case in both 2 groups. ConclusionComparing with open operation, the laparoscopic assisted surgery for advanced gastric cancer could achieve the same clinical outcomes, and obvious advantage of minimal invasion.
Objective To explore the applying value of laparoscopic partial gastrectomy for gastric stromal tumors. Methods The clinical data of 22 patients with gastric stromal tumors between July 2007 and December 2009 in this hospital were analyzed retrospectively. And the laparoscopic resection was performed in all the patients. Results The laparoscopic resections were performed successfully in all the patients, and the tumors were completely resected. The length of operative incision on abdominal wall was 4－6 cm with average 5.3 cm. The mean operation time was 70 min. Postoperative recovery was smooth, no procedure related complications happened. The mean hospital stay was 7.2 d. Specimens of 20 cases were with CD117 (+), and 15 with CD34 (+) by immunohistochemistry. No recurrence or metastasis happened with average follow-up of 13 months (2－23 months). Conclusion Laparoscopic partial gastrectomy for gastric stromal tumors could be performed safely, postoperative recovery quickly and effectively with the advantage of minimal invasiveness.
Objective To construct AWP1 (associated with protein kinase C related kinase 1) recombinant adenovirus as the tool of transferring the gene and investigate its expression and localization in human vascular endothelial cell ECV304. Methods Cloned AWP1 cDNA was inserted into the multiply clone sites (MCS) of plasmid pcDNA3 for adding flag tag, and the flag-AWP1 gene was subcloned into shuttle vector pAdTrack-CMV. After identified with restrictional enzymes, plasmid pAdTrack-flag-AWP1 was linearized by digestion with restriction endonuclease PmeⅠ, and subsequently cotransformed into E.coli BJ5183 cells with adenoviral backbone plasmid pAdEasy-1 to make homologous recombination. After linearized by PacⅠ, the homologous recombinant adenovirus plasmid transfected into 293 cells with Lipofectamine to pack recombinant adenovirus. After PCR assay of recombinant adenovirus granules, recombinant adenoviruses infected 293 cells repeatedly for obtaining the high-level adenoviruses solution. And then, the recombinant adenoviruses infected human ECV304 cells for observing the expression and localization of AWP1 under laser scanning confocal microscope (LSCM). Results PCR assay showed that recombinant adenovirus Ad-flag-AWP1 was obtained successfully; and ECV304 cells were infected high-efficiently by the homologous recombinant virus. Then, it was observed that flag-AWP1 protein expressed in ECV304 cells and distributed in the leading edges of the cell membrane. Conclusion The vectors of flag-AWP1 recombinant adenovirus are constructed, and the localization of AWP1 protein in ECV304 cells might show that AWP1 may be a potential role on the cell signal transduction.
目的 探讨术中应用缓释5-氟尿嘧啶在结直肠癌治疗中的价值及安全性。方法 回顾性分析173例结直肠癌患者术中应用缓释5-氟尿嘧啶后的疗效和不良反应。结果 171例患者顺利出院，1例患者死于严重骨髓抑制，1例死于真菌败血症； 无出血、吻合口漏、肠穿孔、肠梗阻等严重并发症发生。155例患者获6个月至3年的随访，随访期间死亡23例，发生局部复发5例，肝脏等远处转移3例。结论 结直肠癌术中使用缓释5-氟尿嘧啶是安全、有效的。
Objective To investigate the infection rate and observe the healing courses of the incision after gastrointestinal surgery which was managed by positioning extraperitoneal U-type latex drainage strip. Methods Two hundred patients after abdominal operation were divided into drainage group (n=97) and control group (n=103). Drainage group were treated with positioning extraperitoneal U-type latex drainage strip, while control group were treated with no latex drainage strip. The infection rate of incision, the mean time in hospital and mean time of incision healing were observed. Results The infection rate of drainage group was significantly lower than that of control group 〔7.22% (7/97) vs. 18.45% (19/103), P=0.024〕. The mean time in hospital and the mean time of incision healing in drainage group were significantly shorter than those in control group 〔(8.86±1.48) d vs. (14.12±2.63) d， P=0.000； (8.24±1.02) d vs. (12.32±3.47) d， P=0.000〕. Conclusion The infection rate and the healing course of incision of gastrointestinal surgery could be improved by positioning extraperitoneal U-type latex drainage strip.
ObjectiveTo explore feasibility and advantages of hand-assisted laparoscopic radical resection for remnant gastric cancer. MethodsThe clinical data of 26 patients with remnant gastric cancer who underwent hand-assisted laparoscopic (hand-assisted group, n=13) or open (open group, n=13) radical resection from December 2007 to May 2016 in this hospital were retrospectively analyzed. The perioperative outcomes were compared between these two groups. ResultsThere was no conversion to open surgery in the hand-assisted group. Compared with the open group, the incision length was significantly reduced (P=0.000), the intraoperative blood loss was significantly decreased (P=0.038), postoperative the first anal exhaust time was significantly shortened (P=0.025) in the hand-assisted group. The operation time, the number of lymph nodes dissection, and the incidence of postoperative complications had no statistically significant differences between these two groups (P>0.05). ConclusionThe preliminary results of limited cases in this study show that hand-assisted laparoscopic radical resection for remnant gastric cancer is safe and feasible, it has several advantages including small incisions, mild intraoperative hemorrhage, rapid postoperative recovery, better recent clinical therapeutic outcome and so on as compared with open surgery.