Ｔｈｅ ｔｈｅｒａｐｅｕｔｉｃ ｒｅｓｕｌｔｓ ｏｆ ３６ ｃａｓｅｓ ｏｆ ｇａｓｔｒｉｃ ｃａｎｃｅｒ ｗｉｔｈ ｈｅｐａｔｉｃ ｍｅｔａｓｔａｓｅｓ ｃｏｎｆｉｒｍｅｄ ｂｙ ｏｐｅｒａｔｉｏｎ ａｎｄ ｐａｔｈｏｌｏｇｉｃａｌ ｅｘａｍｉｎａｔｉｏｎ ａｒｅ ｒｅｐｏｒｔｅｄ．Ｉｔ ｓｕｇｇｅｓｔｓ ｔｈａｔ ｏｐｅｒａｔｉｏｎｓ ｓｈｏｕｌｄ ｎｏｔ ｂｅ ｇｉｖｅｎ ｕｐ ｅｖｅｎ ｈｅｐａｔｉｃ ｍｅｔａｓｔａｓｅｓ ｈａｖｅ ｏｃｃｕｒｅｄ．Ｒａｄｉｃａｌ ｒｅｓｅｃｔｉｏｎ ｏｆ ｐｒｉｍａｒｙ ｃａｎｃｅｒ ｃｏｎｃｏｍｉｔａｎｔ ｗｉｔｈ ｔｒｅａｔｍｅｎｔ ｏｆ ｍｅｔａｓｔａｓｉｓ ａｎｄ ｏｔｈｅｒ ｐｒｏｃｅｄｕｒｅｄ ｃｏｕｌｄ ｒｅｌｉｅｖｅ ｓｙｍｐｔｏｍｓ，ｐｒｏｍｏｔｅ ｓｕｒｉｖａｌ ｄｕｒａｔｉｏｎ ａｎｄ ｑｕａｌｉｔｙ．Ｐｒｏｃｅｄｕｒｅｄ ｆｏｒ ｔｒｅａｔｉｎｇ ｐｒｉｍａｒｙ ｈｅｐａｔｉｃ ｃａｎｃｅｒ ａｒｅ ａｌｓｏ ｕｓｅｆｕｌ ａｓ ｗｅｌｌ ａｓ ｍｅｔａｓｔａｔｉｃ ｈｅｐａｔｉｃ ｃａｎｃｅｒ．
Objective To assess safety and feasibility of laparoscopic gastrectomy in the elderly with gastric cancer. Methods From January 2010 to September 2014, 146 elderly (age ≥65 years old) patients with gastric cancer underwent radical operations in the Department of General Surgery, Guangdong Academy of Medical Sciences and Guangdong General Hospital were collected, then were divided into a laparoscopy-assisted radical gastrectomy (LAG group, n=40) and an open radical gastrectomy (OG group, n=106) according to the operative mode. The differences of intraoperative and postoperative situation, and the postoperative complications were analyzed between the LAG group and the OG group. Results ① The age, gender, body mass index, albumin, ASA grade, tumor location, differentiation degree, TNM stage, radical gastrectomy, and digestive tract anastomosis had no significant differences between the LAG group and the OG group (P>0.05). ② None of the patients died during the operative period and there was no significant difference in the mean number of retrieved lymph nodes between these two groups (P>0.05). In the aspects of the intraoperative blood loss, the first flatus time or the first feeding time, and the postoperative hospitalization stay in the LAG group were significantly less than those in the OG group (P<0.05). For the operative time, the OG group showed a distinctive advantage with a significantdifference than the LAG group (P<0.05). ③ The rate of postoperative complication in the LAG group and OG group was 10.0% (4/40) and 15.1% (16/106) respectively, and the difference was not significant (χ2=0.64, P=0.591), the grade of the Clavien-Dindo complications had no significant difference (χ2=0.63, P=0.592). ④ None of the patients died following operation in the LAG group and one case died in the OG group because of the respiratory and circulatory failure caused by the pulmonary embolism. Conclusion Preliminary results of limited cases in this study show that LAG in the elderly patients with gastric cancer could reduce intraoperative blood loss, shorten the first flatus time or the first feeding time, and postoperative hospitalization stay, could obtain same radical effect without increasing incidence of postoperative complications as compared with OG, so it is safety and feasible.
目的 探讨围手术期强化免疫营养素肠内营养支持对胃癌患者免疫功能和营养状况的影响。 方法 将2007年3月－2012年12月间24 例胃癌术后患者随机分为肠内免疫营养组（研究组）和常规肠内营养组（对照组），每组12例，进行等氮等热量营养支持，术前5 d至术后7 d。测定营养支持前后的血清白蛋白、前白蛋白、转铁蛋白、T淋巴细胞亚群及血清免疫球蛋白等指标变化。临床观察胃肠功能恢复时间。 结果 术后两组患者血清蛋白水平和免疫指标多有下降，但研究组术后8 d的血清前白蛋白水平和IgG、CD4/CD8比值较对照组明显增加，研究组胃肠功能恢复时间早于对照组。 结论 围手术期应用强化免疫肠内营养支持可改善胃癌患者术后营养和免疫状况，促进肠道功能恢复。
To study the effect of intraperitoneal hyperthermic double distiled water and cis-diamminedichloro-platinum(DDP) perfusion to the peritoneal cancerous ascites,intraperitoneal injection of H22 cancer cells (2×107 tumor cell,each mouse) were performed in LACA mice. Five days after cancer cells injection, intraperitoneal perfusion of simple hypertherrnic (43℃) double distiled water(group Ⅰ) isotonic fluid (group Ⅱ ). DDP (group Ⅲ ), and hypertherrnic double distiles water perfusion combined with DDP (guoup Ⅳ ) were performed .The results showed that cancer cells in the peritoneal cavity of LACA mice were seriously damaged, the production of ascites was markedly inhibited and the survival days of LACA mice were prolonged in all groups . .The intraperitoneal hyperthermic double distilled water perfusion with DDP group showed more effective result as compared with the other groups,Only 1 peritoneal implanted dissemination was found after treatment in this group,Basing on the experimental from September 1991 through September 1993,intraperitoneal hyperthermic double distiled water perfusion with DDP was used to treat 32 advanced gastric cancer patients after radical gastrectomy with satisfactory results.
Objective To investigate the cause of the positive cancer cell incisal margin in gastrectomy for gastric carcinoma. Methods Thirty-two cases with positive incisal margin in gastrectomy for gastric carcinoma from 1988-1993 in this hospital were retrospectively studied. Results The overall cancer cell positive rate (CCPR) was 7.5%, and that of radical and palliative resection were 5.5% and 12.6%, respectively (Ｐ＜0.05). The CCPR of distal and proximal incisal margin were 5.9% and 13.0% respectively (Ｐ＜0.05), which was related to the gross type, size of cancer, and the degree of differentiation and infiltration. Conclusion The CCPR is high in the infiltrating type, lesions larger than 5 cm in diameter and undifferentiated cancer. To prevent the incisal margin positive for cancer cell in gastrectomy, frozen biopsy should be done if possible.
ObjectiveTo understand the relation between blood glucose regulating hormones and gastric cancer, so as to provide some new ideas for diagnosis and treatment of gastric cancer. MethodBy reviewing and screening relevant domestic and foreign literatures, the latest researches on the relation between blood glucose regulating hormones and gastric cancer were summarized. ResultsThe insulin, glucagon, adrenaline, growth hormone, and the other blood glucose regulating hormones all played the roles in promoting the occurrence and development of gastric cancer. However, glucocorticoids and somatostatin were protective hormones that maintained gastric homeostasis and inhibited the proliferation of gastric cancer cells. ConclusionBlood glucose regulating hormones play some roles in diagnosis and treatment of gastric cancer, but specific mechanisms such as interaction between blood glucose regulating hormones, role of glucose metabolism in biological behavior of gastric cancer, and effect of blood glucose regulating hormones on oncogene initiation are unclear, so prospective clinical control studies still need to be studied.
ObjectiveTo understand the research progress on micronutrient deficiency after gastrectomy for gastric cancer in order to provide a new ideas for its prevention and treatment. MethodThe literature on reseach relevant micronutrient deficiency after gastrectomy for gastric cancer in recent years at home and abroad was searched and reviewed. ResultsThe micronutrient deficiency after partial or total gastrectomy was more common for the patients with gastric cancer, especially some key nutrients such as iron, zinc, copper, fat soluble vitamins (vitamins A, D, E), vitamin B12, folate, and so on. The main reason for the micronutrient deficiency was due to the changes of the anatomical structure or physiological function of the gastrointestinal tract caused by surgery, as most micronutrients were absorbed through the duodenum or jejunum, bypassing the main absorption site of micronutrients after total or partial gastrectomy; In addition, preoperative malnutrition, neoadjuvant therapy, early and late postoperative complications, as well as postoperative adjuvant therapy, and reduced gastric acid secretion, might all lead to the micronutrient absorption disorders. There was also limited literature on the micronutrient supplementation after gastrectomy for gastric cancer, but some researchers still supported providing nutritional support before and after surgery for the gastric cancer patients with severe malnutrition. There was few literature reported on the adverse consequences of nutritional support for the gastric cancer patients underwent gastrectomy. ConclusionsAt present, there is still limited literature on the study of micronutrient deficiency and supplementation after gastrectomy for gastric cancer. With the increasing attention of clinician to the impact of micronutrients on diseases or health, the European Society for Extraintestinal and Enteral Nutrition developed the “ESPEN micronutrition guidelines” in 2022 and “Expert consensus on micronutrients deficiency and supplementation in malignant tumors” was published in China at 2024. In the current situation where relevant research is insufficient, it is recommended that clinicians refer to this guideline or expert consensus and provide personalized intervention for patients with micronutrient deficiencies based on their clinical conditions.
ObjectiveTo investigate the relationship between topical reactive lymphoid hyperplasia and postoperative recurrence and survival of gastric cancer patients. MethodsThe clinical and pathological data of gastric cancer patients who underwent D2 radical gastrectomy from January 2007 to July 2009 were retrospectively analyzed. Based on the number of reactive lymph nodes, cases were divided in to topical reactive lymphoid hyperplasia group (RLH, n=18) and non-RLH group (n=43) by using a median method. The postoperative disease-free survival (DFS) and overall survival (OS) rates of patients in different groups were compared using Kaplan-Meier method and log-rank test, respectively. ResultsThere were no significant difference between the two groups in age, gender, pathological stage, surgical approach, extent of surgery or methods of postoperative chemotherapy (P > 0.05). The median disease-free survival time was 50 months in RLH group, and the median disease-free survival time was 39 months in non-RLH group. DFS of patients in RLH group was significant higher than non-RLH group (66.7% vs. 34.9%, P=0.048). The median survival time was 53.6 months and 52.3 months, respectively, in RLH group and non-RLH group. No difference was found in OS between the two groups (72.2% vs. 60.5%, P=0.338). ConclusionTopical reactive lymphoid hyperplasia reactive the immunity of gastric cancer patients and contact postoperative DFS rate.