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。
ObjectiveTo investigate the effect of the remnant stomach after gastric bypass (GB) surgery on the weight loss and glucose metabolism in rats with obese and type 2 diabetes mellitus (T2DM).MethodsHigh fat feeding for one month combined with intraperitoneal injection of low-dose streptozotocin was used to induce obese rats with T2DM. Twenty-four rats with obese and type T2DM successfully established were randomly divided into resectional gastric bypass (R-GB) group, GB surgery (GB group), and sham operation (SO) group, eight rats in each group. The weight loss and anti-diabetic effect of the R-GB and GB were compared. Body weight, food intake, and fasting blood glucose (FBG) were measured at week 1 before operation and week 1–8 after the operation. Oral glucose tolerance test (OGTT) and insulin tolerance test (ITT) were performed using tail venous blood at week 1 before operation and on week 8 after operation (at 0, 30, 60, 90, and 120 min). The levels of serum glucagon like peptide-1 (GLP-1), gastrin, insulin, and glucagon at week 1 before operation and at week 8 after operation were detected, meanwhile the homeostasis model assessment insulin resistance (HOMA-IR) index was calculated.Results① The body weight and food intake of the rats in the R-GB group and GB group were lower than those in the SO group after operation (P<0.05) and which were lower than before operation (P<0.05), but the differences were not significant between the R-GB group and GB group after operation (P>0.05). ② The levels of FBG in the R-GB group only at week 1–4 after operation were lower than those before operation (P<0.05), while which in the GB group at week 1–8 after operation were lower than those before operation and were lower than in the SO group (P<0.05), but which in the R-GB group only at week 2–4 after operation were lower than in the SO group and which were higher than that in the GB group from 3 to 8 weeks after operation (P<0.05). ③ The area under receiver operating characteristic curves (AUCs) of blood glucoses of OGTT and ITT and HOMA-IR index at week 8 after operation were lower than those before operation (P<0.05) in the GB group and which were lower than those the other two groups (P<0.05). ④ The AUC of gastrin level at week 8 after operation was lower than that before operation in the R-GB group and which lower than that in the other two groups (P<0.05). The AUC values of insulin and glucagon levels at week 8 after operation were lower than those before operation in the GB group and which lower than those in the other two groups (P<0.05). The AUC of GLP-1 level at week 8 after operation was higher than that before operation in the GB group and which higher than that in the other two groups (P<0.05).ConclusionsGB could remarkably improve glucose metabolism and weight loss in obese rat with T2DM. Gastric remnant gastrectomy following GB has a remarkable anti-diabetic effect, but it doesn’t effect on weight loss.
Objective To summarize and analyze the treatment options and prognostic factors of gastric stump carcinoma （GSC）. Methods The clinical data of 114 patients with GSC treated in The Second Affiliated Hospital of Northern Sichuan Medical College and The General Hospital of Chinese People’s Liberation Army from Mar. 2000 to May.2008 were reviewed， and influencing factors of surgical resection and prognosis were analyzed. Results For all patients，the ratios of surgical resection and curative resection（R0 resection） were 57.0%（65/114） and 54.4% （62/114）， respec-tively. The ratios of total gastrectomy， distal gastrectomy， proximal gastrectomy， endoscopic mucosal resection （EMR），and endoscopic submucosal dissection （ESD） were 73.8%（48/65）， 16.9%（11/65）， 3.1%（2/65）， 4.6%（3/65）， and 1.5%（1/65）in resection cases， and were 75.8%（47/62）， 16.1%（10/62）， 3.2%（2/62）， 4.8%（3/62）， and 0 in R0 resection cases， respectively. Seventy-five patients were followed-up for 0.3-79 months （median 12 months）， the mediansurvival time was 19.5 months， and 1-， 3-， and 5-year overall survival rates were 61.8%， 42.3%， and 30.1%， respectively. The results of multivariate analysis showed that resection rate was higher in patients with initial distalgastrectomy （P=0.002）， kps score≥80 （P=0.016）,lower macroscopic type （P=0.013）， and cM0 （P=0.000）. R0 resection （P=0.000）， macroscopic type （P=0.005）， and cT stage （P=0.006） were the independent prognostic factors. There were both no significant difference on survival between the patients with previous benign disease and those with original malignant disease when analyzed with univariate or multivariate method （P＞0.05）. There were no significant difference on overall survival curve among patients treated with palliative resection， palliative chemotherapy， simple laparotomy， and best supportive care （P＞0.05）. Conclusions The treatment options and prognosis of GSC were not influenced by the primary benign diseases or malignant diseases， and R0 resection is the most important prognostic factor. Removal of total remnant stomach is the best surgical procedure for GSC， and palliative laparotomy should be avoided.
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.
Objective To analyze surgical treatment and clinicopathologic features of remnant gastric cancer,and to recognize the strategies of treatment. Methods The clinical data of 26 cases patients with remnant gastric cancer diagnosed by endoscopy and pathological examination and underwent surgical treatment were retrospectively analyzed in our hospital between January 2004 and March 2011.In this study,14 cases of remnant gastric cancer from benign disease （RGCB） and 12 cases of remnant gastric cancer after stomach cancer operation （RGCC） were included.The clinical findings,Helicobacter pylori （HP） infection,surgical methods, histopathological features,and prognosis were analyzed.Results The patients developed a carcinoma in the gastric remnant about 15-44 years after operation for benign disease （median 26.3 years） and about 1-10.5 years after gastric cancer operation （median 4 years）,and there was significant differences of the two groups（P＜0.05）.HP infection of the gastric remnant was found in 73.1%（19/26） patients,and infection rate of patients was 71.4%（10/14） in RGCB and 75.0%（9/12） in RGCC, but there was no statistical different in two groups （P＞0.05）.All 26 patients underwent surgical procedure,and the rate of radical resection was 46.2% （12/26）, which was 57.1% （8/14） in RGCB and 33.3% （4/12） in RGCC respectively,there was no statistical different （P＞0.05）.Among the 12 cases underwent radical resection, the highest lymphatic metastasis rate was in No.3 group （83.3%， 10/12）,which came in second in lymph node of mesojejunum or splenic hilum （33.3%， 4/12）.Postoperative pathological staging was as follows：stageⅠin 3 cases, stageⅡ in 2 cases, stage Ⅲ in 14 cases and stage Ⅳ in 7 cases. In 18 patients underwent tumor excision,the metastasis of lymph node occurred in 13 cases （72.2%）,and the pancreas,transverse colon,or spleen were invaded in 13 cases according to histopathological results. Meanwhile,peritoneal metastasis were founded in 8 cases patients,and the peritoneal metastasis rate of patients with RGCB （14.3%；2/14） was significantly lower than that with RGCC （50.0%， 6/12）, P＜0.05.The overall one-year survival rate and three-year survival rate was 54.5% and 38.5%,respectively, and the survival time was 2-61 months （median 12 months）.Survival analysis indicated that pathological stage and radical resection were significant prognostic factors for patients with remnant gastric cancer（P＜0.01）,and radical resection was an independent prognostic factor （P＜0.05）,while age,gender,disease of first operation, degree of differentiation and HP infection were not （P＞0.05）. Conclusions Early detection and standard radical resection are the key factor to improve the prognosis of patients with remnant gastric cancer and laparoscopic exploration may minimize unnecessary injures of surgery.Because of the different clinical characteristics,strategy of treatment for RGCC and RGCB shall be discriminatory.
Objective To investigate the changes of gastrointestinal hormone and body composition in patients with gastric cancer after gastrectomy. Methods Thirty-eight patients with gastric cancer were divided into three groups: distal gastrectomy group, proximal gastrectomy group and total gastrectomy group and 9 volunteers as control group. The nutrition status and gastrointestinal function were evaluated by four times. The time of postoperative first anal exsufflation and defacation, hospital stay and complications were recorded, and the pre-meal and the post-meal level of gastrointestinal hormones 1 month after operation were detected. Results Compared with control group, the basic levels of somatostatin (SS), cholecystokinin (CCK) and motilin (MTL) of distal gastrectomy group, proximal gastrectomy group and total gastrectomy group significantly increased (Plt;0.01). The post-meal level of gastrointestinal hormones significantly increased as compared with the pre-meal level in each group (Plt;0.01). The CCK in proximal gastrectomy group was lower than that of distal gastrectomy group and total gastrectomy group (Plt;0.01). The postoperative body weight and body composition in each group decreased. One month after operation, patients of total gastrectomy group got the lowest body weight (Plt;0.01). The decreasing level of fat free mass (FFM) was listed by total gastrectomy group, proximal gastrectomy group and distal gastrectomy group. The edema index had significant difference in distal gastrectomy group, proximal gastrectomy group and total gastrectomy group (Plt;0.01), and total gastrectomy group was the most obvious. The postoperative passing flatus and defecation time and average hospital stay in total gastrectomy group were significantly prolonged (Plt;0.05). The gastrointestinal symptoms score among three groups was significantly different (Plt;0.05). Conclusion There are different changes of gastrointestinal hormone and body composition in patients with gastric cancer after different gastrectomy, the basic levels of SS, CCK and MTL of distal gastrectomy group, proximal gastrectomy group and total gastrectomy group are higher than those of control group. The CCK of proximal gastrectomy group is lower than that of distal gastrectomy group and total gastrectomy group. Patients received total gastrectomy lose much body weight and FFM and get higher edema index.
Objective To summarize the progress on diagnosis and treatment of gastric stump cancer. Methods Related literatures in recent 5 years were collected, and the progress on diagnosis and treatment of gastric stump cancer were reviewed. Results The diagnosis of gastric stump cancer mainly depends on endoscopy, mucosal biopsy and other imaging examinations. At present, the main treatment of gastric stump cancer is the total gastrectomy, combined with laparoscopic therapy and endoscopic therapy. On the basis of No.1-No.4 and No.7-No.13 lymph node dissection, the extent of lymph node dissection is enlarged according to the different surgical procedures. Conclusions The main treatment of gastric stump cancer is total gastrectomy, and there are many factors affecting the prognosis, which should be early diagnosis and early treatment. Laparoscopic radical gastrectomy for gastric stump caner provides a more convenient and accurate method for the treatment of gastric stump caner.
Objective To study the features of lymph node metastasis in gastric stump cancer （GSC） in order to provide the basis for the reasonable lymph node dissection in the GSC lymphadenectomy. Methods Twenty-two GSC patients accepted residual radical gastrectomy and 50 primary gastric cancer patients accepted distal D2 lymphadenectomy by the same surgeon from June 2004 to June 2012 at the department of general surgery-pediatric surgery of the People’s Hospital of Guangxi Zhuang Autonomous Region were included in this retrospective study. And the clinicopathologic factors and lymph node metastasis were compared in two groups. Results The combined organ resection rate in the primary gastric cancer patients was significantly lower than that in the GSC patients 〔14.00% （7/50） versus 54.55% （12/22），χ2=12.929，P=0.000〕. In the lymph node metastasis，the total positive rate and No.10 positive rate of lymph node metastasis in the GSC patients were significantly higher than those in the primary gastric cancer patients 〔30.56% （103/337） versus 22.13% （208/940），χ2=9.583，P=0.002；52.17% （12/23） versus 17.39% （4/23），χ2=6.133，P=0.013〕. The positive rate of lympl node micrometastasis between the GSC patients and primary gastric cancer patients was no significant difference〔2.97% （10/337） versus 1.49% （14/940），χ2=2.939，P=0.086〕 . There was 4/12 lymph node micrometastasis in the GSC patients，which was 0/4 in the primary gastric cancer patients. The positive rate of the jejunal mesentery lymph node metastasis was 35.71% （5/14） in the GSC patients. Conclusions GSC has a unique pattern in lymph node metastasis. D2 dissection and jejunsl mesentery lymph node dissection should be performed for these patients，especially，on No.10 lymph nodes. If needed，en bloc resection with invaded adjacent organs should be considered．
Eight cases of gastric remnant carcinoma are reported and its possible etiology, course of disease, prevention and treatmant are discussed together with literature review. Duodenal ulcer, except with serious complications, should be treated conservatively. For benign gastric ulcer gastrectomy may be considered in individual case, but the operative indication can be controlled by its lesions. Regular follow-up study should be performed on patients who had gastrectomy for more than five years.
Objective To analyze the clinicopathologic characteristics of remnant gastric cancer （RGC）. Methods The clinical data of 114 patients with RGC treated in The Second Affiliated Hospital of Northern Sichuan MedicalCollege and The General Hospital of Chinese People’s Liberation Army from March 2000 to May 2008 were reviewed and analyzed retrospectively. The clinicopathologic characteristics between the patients with primary benign diseases and those with malignant diseases were evaluated. Results A total of 114 cases，the age was （62.6±11.3） years，and the males versus females was 4.7∶1.0. Most patients （76.2%，64/84） were diagnosed at advanced stages （consistent with pT），and the proportion of pT1 stage cases was only 23.8% （20/84），tumor invasion pT4 was 60.7% （51/84）. It was more common that tumor directly invaded adjacent organs or structures （27.4%，23/84），lymph nodes positive （42.9%，36/84），and distant metastasis （27.2%，31/114）. The location of distant metastasis was usually confined in the abdominal cavity （93.5%，29/31），and the peritoneum disseminated was the most commonly structures （67.7%，21/31）. Histologically，the incidence of poorly differentiated adenocarcinoma （76.7%，79/103） was the mostly histologic grade as well as the diffuse type （78.6%，81/103） was the mostly Laurén classification. Between the patients with primary benign diseases and those with initial malignant disease，the initial gastrectomy or the methods of reconstruction had significantly differences （both P=0.000）. The median time from initial resection to development of RGC was 30.0 years in the patients with original benign disease，contrary to 3.3 years in those with previous malignant disease （P=0.000）. Both primary diseases （benign or malignant） and the age at initial gastrectomy were the major influencing factors for the time of RGC developed （P＜0.05）. For pathohistology characters，except signet-ring cell carcinoma （P=0.045）， pT4b （P=0.049），pN stage （P=0.025），and Borrmann classification （P=0.005），there were no significant differences between the patients with previous benign diseases and those with original malignant disease，as well as the resectability rate，curative resection （R0） rate，and overall survival rate （P＞0.05）. Conclusions It is almost unaffected by originalbenign diseases or malignant diseases for clinicopathologic characteristics including the treatment option and prognostic factors.It is necessary and feasibility to form a pattern of endoscopic follow-up for RGC.