目的 探讨圆形吻合器在高龄贲门胃底癌经腹切除术中的应用。方法 回顾性分析1999年1月至2009年5月期间在我院接受圆形吻合器经腹切除术的238例70岁以上高龄贲门胃底癌患者的临床资料，并对围手术期结果进行分析。 结果 全组手术时间3～4.5 h，平均3.5 h。出血量50～1 000 ml，平均300 ml。术中并发大出血1例，给予积极止血，无术中死亡。所有病例机械吻合术后未出现吻合口漏。术后60例患者（25%）出现不同程度的并发症，其中吻合口出血2例, 左侧胸腔积液13例，肺部感染15例, 心衰3例, 肺不张2例, 心律失常10例，右侧胸腔积液15例。无围手术期死亡。术后随访3年，出现返流性食管炎45例，吻合口狭窄30例，无吻合口肿瘤复发，3年生存率为64%(152/238)。结论 应用圆形吻合器在高龄胃底贲门癌患者经腹切除术是安全、有效的。
Objective To study the diagnosis and surgical treatment of multi-primary esophageal carcinoma. Methods The data of 29 patients of multi-primary esophageal carcinoma were collected .The diagnosis was made by dye-staining through gastroscopy and X-ray examination.Pathological examination after operation was analyzed.Three kinds of operations were used: 22 by radical resection, 5 by partial resection and 2 by surgical exploration. Results Twenty-one patients were diagnosed before operation,8 patients were diagnosed during and after operation. Sixty-seven foci and 6 early stage patients were found. The complications were found in 7 patients.No patient died during operation. Twenty-five patients were followed up. The follow up time was 7-36 months.1-year survival rate 77.8%,3-year survival rate 41.6%. Conclusion Routine X-ray examination of esophagus, and esophageal dye-staining and/or biopsy through endoscopy are important measures for early diagnosis of multi-primary esophageal carcinoma.Prompt surgery is advised.
【摘要】目的观察负压球在食管癌、贲门癌术后的临床应用价值。方法1999年2009年对观察组食管癌、贲门癌术后使用负压球细管引流,对照组术后使用传统粗胶管水封瓶闭式引流,两组均286例。结果观察组在胸腔积液、第二天镇痛剂应用、引流口感染及术后住院时间等方面与对照组相比差异有统计学意义，而术后脓胸、第一天镇痛剂应用及管腔堵塞等方面与对照组相比无差异。结论负压球细管引流用于食管癌、贲门癌术后胸腔引流,创伤小,效果确切满意。
ObjectiveTo compare the antireflux effects of lip reinforcement, His angle reconstruction with fundoplication, and mechanical anastomosis only in mechanical anastomosis for esophageal and cardiac carcinoma. MethodsOne hundred and seventysix patients with esophageal or cardiac carcinoma admitted to this hospital between March 2008 and October 2009 were included, which were divided into mechanical anastomosis group (n=42), His angle reconstruction group(n=56), and lip reinforcement group (n=78) according to the sequence of admission. Mechanical anastomosis only, mechanical anastomosis His angle reconstruction with fundoplication, and mechanical anastomosis liptype reinforcement were performed in the corresponding group, respectively. Endoscopy and biopsy were conducted to evaluate the antireflux effects on 3 months after operation. ResultsThere were no differences on the gender, age, tumor location, anastomosis site, and incision among three groups (Pgt;0.05). The reflux rates of the mechanical anastomosis group, His angle reconstruction group, and lip reinforcement group were 69.05%, 28.57%, and 14.10%, respectively. The reflux rates in the lip reinforcement group and His angle reconstruction group were significantly lower than those in the mechanical anastomosis group (χ2=37.088, P=0.000; χ2=15.833, P=0.000), moreover, the rate in the lip reinforcement group was significantly lower than that in the His angle reconstruction group (χ2=4.241, P=0.039). There was no anastomotic leakage in the lip reinforcement group and all patients safely discharged from hospital after surgery, only 2 patients had moderately anastomotic stenosis and both of them had good recovery with endoscopic dilatationl. The reflux after operation was independent of anastomosis sites (Pgt;0.05). ConclusionBoth liptype reinforcement and His angle reconstruction can improve the ability of antireflux, liptype reinforcement is better and simple to mainpulate.
ObjectiveTo investigate the feasibility of hand-assisted laparoscopic surgery in radical gastrectomy for gastric cancer. MethodsThe data of two cases undergoing hand-assisted laparoscopic radical gastrectomy for gastric cancer, including operative time, operation related complications, intraoperative bleeding volumes, number of harvested lymph nodes, postoperative complications, time to restoration of bowel function, and length of postoperative hospital stay, etc, were retrospectively analyzed. ResultsTwo patients had undergone the successful hand-assisted laparoscopic radical total gastrectomy and distal gastrectomy without operation related complications. The operative time was 310 min and 220 min, respectively. While, the intraoperative bleeding volume was 120 ml and 80 ml with the number of harvested lymph node being 38 and 52, respectively. There were no postoperative bleeding, intestinal fistula, and anastomotic leakage， etc. The patients were discharged with smooth and fully recovery. ConclusionThe application of hand-assisted laparoscopic surgery in radical gastrectomy for gastric cancer is feasible and safe. However, the effectiveness needs further exploring.