Objective To evaluate the effect of total gastrectomy (TG) and proximal gastrectomy (PG) for the treatment of advanced esophagogastric junction cancer. Methods Clinical data of 273 cases of advanced esophagogastric junction cancer who underwent TG and PG in our hospital from Jan. 2004 to Dec. 2010 were reviewed for retrospective analysis. Operation related indexes, 3-year cumulative survival rate, and 5-year cumulative survival rate were compared and evaluated. Results There was no significant difference between TG group and PG group in intraoperative blood loss, operation time, and hospital stay(P > 0.05), but the number of dissected lymph nodes in TG group was obviously more than those of PG group, and the difference was statistically significant(P=0.000). The postoperative complication rates were 10.3%(12/117)in TG group and 21.8%(34/156) in PG group respectively, which was lower in TG group(χ2=6.353, P < 0.05). The 3-year and 5-year cumulative survival rates of TG group were 58.9% and 34.2%, of PG group were 43.4% and 23.6% respectively, and the 3-year and 5-year cumulative survival rates were all lower in PG group(χ2=5.894, P < 0.05;χ2=5.582, P < 0.05). For patients in stage pT4, pN2, and TNMⅢ, whose tumor size were bigger than 3.0 cm, and patients who had accept chemotherapy, the 3-and 5-year cumulative survival rates of TG group were significantly higher than those of PG group(P < 0.05). However, for patients in stage pT2, pT3, pN0, pN1, pN3, TNMⅠ, TNMⅡ, TNMⅣ, whose tumor size were smaller than 3.0 cm, who had not accept chemotherapy, and patients of any pathological type, there was no statistically significant difference between the 2 groups in 3-year and 5-year cumulative survival rates(P > 0.05). Conclusion For the patients who suffered from advanced esophagogastric junction cancer, TG can improve long-term survival rate, and it can significantly reduce the incidence of postoperative complications and improve postoperative quality of life.
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.
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.
目的探讨Billroth-Ⅱ胃大部切除术后输入袢梗阻的诊断和手术方式。 方法本组共17例输入袢梗阻患者，对17例患者的手术史、临床表现及影像学资料进行总结分析。 结果典型的输入袢梗阻表现为上腹胀痛、上腹部触及张力较高且有压痛的囊性包块，腹部CT检查见腹主动脉与肠系膜上动脉之间横向走行的扩张肠管。17例患者均再次行剖腹探查术，术中见输入袢扩张，5例行Braun吻合术，12例行Roux-en-Y吻合术。术后无严重合并症，无围手术期死亡，患者均恢复顺利，梗阻症状消失。术后随访1～4年（平均2.5年），经X线胃肠钡餐检查见吻合口钡剂通过顺利，无狭窄；胃镜检查未见胆汁反流。 结论严格遵守正确的手术操作常规是预防输入袢梗阻的关键；经腹部CT诊断明确后，应尽早再手术；Braun吻合术及Roux-en-Y吻合术为胃大部切除术后输入袢梗阻较理想的术式。
目的探讨残胃癌的临床特点和诊治方法。方法对1989~2003年收治的15例残胃癌病例资料进行回顾性分析，观察不同手术方式对预后的影响。结果B-Ⅱ式手术后残胃癌发病率远高于B-Ⅰ式手术； 根治性手术切除8例，根治性切除率为53.3%（8/15）； 根治性手术切除患者2年以上生存率为62.5%（5/8），姑息性手术切除患者术后平均生存时间不足1年。结论早期诊断和根治性切除是残胃癌预后的重要因素。
目的 探讨预防胃大部切除术后碱性返流性胃炎的术式。方法 回顾性分析1998年6月至2008年12月期间我科收治的42例行胃大部切除术患者的临床资料，根据不同术式分为传统Billroth-Ⅱ（简称B-Ⅱ）式组（n=21）和改良B-Ⅱ式组（n=21），对2组患者术后胃肠引流液的量、剑突下持续烧灼痛、胆汁性呕吐、体重减轻以及肠胃液返流情况进行比较。结果 传统B-Ⅱ式组胃肠引流液量平均为（300±50） ml，而改良B-Ⅱ式组胃肠引流液量平均为（100±40） ml,2组间比较差异有统计学意义（P＜0.05）。传统B-Ⅱ式组剑突下持续烧灼痛12例，胆汁性呕吐8例，体重减轻1例； 而改良B-Ⅱ式组仅出现1例剑突下持续烧灼痛和1例体重减轻，未见胆汁性呕吐病例，2组间比较差异有统计学意义（P＜0.05）。传统B-Ⅱ式组发生轻度返流9例，重度返流12例; 改良B-Ⅱ式组仅2例发生轻度返流，1例重度返流，其余均未见返流，2组间比较差异有统计学意义（P＜0.05）。结论 与传统B-Ⅱ式相比，改良B-Ⅱ式的碱性返流性胃炎发生率明显降低，术后效果满意。