Objective To find out some ideal reconstructions after total gastrectomy in experimental study of rat. Methods Sixty male Sprague-Dawley rats were randomly and averagely divided into 6 groups: Roux-en-Y group (RY group), proximate jejunal pouch group (PJP group), distal jejunal pouch group (DJP group), two jejunal pouchs group (TJP group), duodenumjejunal pouch interposition group (DJPI group) and laparotomy group (L group). Body weight of rats, intestinal transit distance, adaptive changes in esophagojejunostomic mucosa and morphology changes of intestine after operation were observed and compared. Results At 2 weeks after operation, body weight in each group were significantly lower than that before operation （P＜0.05）. At 4 weeks postoperatively, body weight in PJP group, TJP group and DJPI group were significantly higher than that in RY group respectively （P＜0.05）, as well as at 8 weeks. Intestinal transit distance in PJP group was shorter than that in RY group （P＜0.05）. With regard to intestinal mucosa, TJP group and DJPI group were significantly different with RY group （P＜0.05）. Interestingly, there was no difference in each group as to refluxing esophagitis （P＞0.05）. Conclusion Proximate and two jejunal pouchs Roux-en-Y esophagojejunostomy seem to be ideal procedures for digestive tract reconstruction after total gastrectomy. The jejunal pouch interposition procedure seems to be same effective to PJP and TJP, but there is no preponderance over the former.
Objective To compare short-term effects of totally laparoscopic total gastrectomy (TLTG) and laparoscopic assisted total gastrectomy (TATG) in treatment of resectable gastric cancer. Methods The EMbase, PubMed, The Cochrane Library, Web of Science, CBM, CNKI, and WanFang Data databases were searched by computer. According to the inclusion and exclusion criteria of the literatures, the comparative research literatures were selected. The relevant data were extracted and the literature evaluation was applied. The Revman 5.3 software was applied for the meta-analysis. Results A total of 11 articles (6 Chinese literatures, 5 English literatures) were included, including 1 491 patients clinically diagnosed with the gastric cancer. The results of meta-analysis showed: compared with the LATG group, the TLTG group had the less intraoperative blood loss ［MD=–17.59, 95% CI (–30.81, –4.37), P=0.009］, shorter incision length ［MD=–4.50, 95% CI (–4.92, –4.09), P<0.000 01］, and earlier first anal exhaust time ［MD=–0.16, 95% CI (–0.28, –0.04), P=0.007］in the treatment of gastric cancer; Besides, the first time of postoperative fluid intake of the TLTG group was earlier ［MD=–0.47, 95% CI (–0.86, –0.08), P=0.02］ and the postoperative hospital stay of the TLTG group was shorter ［MD=–0.59, 95% CI (–0.94, –0.24), P=0.000 9］; In the TLTG group, the VAS score was lower on the first postoperative day ［MD=–3.10, 95% CI (–3.48, –2.72), P<0.000 01］ and on the third postoperative day ［MD=–2.30, 95% CI (–2.57, –2.03), P<0.000 01］. There were no significant differences in the operation time, proximal margin distance, distal margin distance, lymph node dissection, and postoperative adverse reactions between the two groups (P>0.05). The subgroup analysis of the postoperative adverse reactions showed that there were no significant differences in the anastomotic stricture, anastomotic leakage, and anastomotic bleeding (P>0.05). Conclusions TLTG has some advantages of less bleeding, shorter incision, earlier ventilation and feeding, shorter postoperative hospital stay, and light postoperative pain in treatment of resectable gastric cancer. However, due to quantitative and qualitative limitations of included studies, above conclusions still need to be carried out more and high quality researches are validated.
目的 探讨进展期胃癌联合脏器切除的指征和临床效果。方法 回顾性分析我院1998年6月至2008年6月期间施行联合脏器切除的43例进展期胃癌患者的临床资料，并与同期行姑息性手术的29例进展期胃癌患者相比较。结果 术后1、3及5年生存率联合脏器切除患者分别为65.1% （28/43）、30.2% （13/43）及18.6%（8/43），姑息性手术患者分别为41.4% （12/29）、10.3% （3/29）及0 （0/29），前者明显高于后者（P＜0.05）。联合脏器切除组并发症发生率为14.0% （6/43），而姑息性手术组并发症发生率为13.8% （4/29），二者比较差异无统计学意义（P＞0.05）。结论 进展期胃癌实施联合脏器切除联合术中腹腔内温热化疗等综合治疗，可提高术后生存率。
目的探讨胃底贲门癌患者行全胃切除术后消化道的重建方式。 方法总结我院1999年3月至2002年4月间采用经腹全胃切除保留幽门环间置空肠重建消化道手术的16例胃底贲门癌患者的临床资料。 结果无一例手术死亡， 无吻合口漏及狭窄， 全组患者均治愈出院。 术后半年每餐进食200～300 g， 每日3～4次， 其中蛋白质1 g/（kg·d）， 总热量为2 300～3 000 kcal，餐后无胸骨后灼痛，无胆汁返流现象及排空障碍。结论严格掌握手术适应证，保留幽门环间置空肠重建消化道能起到较好的效果。
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.
ObjectiveTo develop altering intake managing symptoms (AIMS) dietary intervention and evaluate its effects on nutritional status and dietary compliance for patients after gastrectomy.MethodsFrom April 2017 to July 2018, 176 patients underwent the gastrectomy in the Xijing Hospital of Air Force Military Medical University were selected, then were divided into an AIMS group and a control group by the Excel 2007 random function method. The AIMS group was intervened by the AIMS dietary intervention, the control group was given the routine diet management. The body mass, body mass index (BMI), albumin, and dietary intake at the admission, on the 2nd week and the 3rd month after the discharge were compared between the two groups. The nutritional status of the two groups was assessed by the PG-SGA scale. The diet-related symptoms and dietary compliance of the two groups were assessed by the dietary related symptoms scale and the dietary compliance scale.ResultsA total of 176 eligible patients were enrolled in this study, including 92 patients in the AIMS group and 84 patients in the control group. There were no significant differences in the baseline data such as the gender, age, educational level, occupation, disease type, surgical method, tumor TNM stage, and pathological differentiated type between the two groups (P>0.050). There were no significant differences in the body mass, BMI, and albumin between the AIMS group and the control group before and after the dietary intervention (P>0.050). The PG-SGA score, diet-related symptom score, and dietary compliance score had significant differences between on the 2nd week or the 3rd month after the discharge and at the admission in the AIMS group and the control group (P<0.050), which had significant differences on the 2nd week or the 3rd month after the discharge between the AIMS group and the control group (P<0.001). The dietary intake of the AIMS group was significantly higher than that of the control group on the 3rd month after the discharge (P<0.001). The complications incidences of total diet-related symptoms was 5.5% (5/91) and 14.6% (12/82) in the AIMS group and the control group, respectively, the difference was statistically significant (P=0.047).ConclusionUsing AIMS dietary intervention for patients after radical gastrectomy can significantly improve their overall nutritional status and improve dietary compliance.
Objective To investigate the influence on the postoperative recovery for giving either total parenteral nutrition （TPN） or early enteral nutrition (EEN) to patients with gastric cancer after total gastrectomy. Methods Eighty-six patients with gastric cancer undergone total gastrectomy were divided into TPN group (n=31) and EEN group (n=55). Patients in TPN group received TPN support via vena cava (internal jugular vein or subclavian vein), while patients in EEN group received early feeding through the naso-intestinal tube, which was placed during operation, and volume of enteral nutrition (fresubin) was increased daily, full enteral nutrition was expected on day 3-5. Nutrition status after operation, postoperative plasma albumin (Alb), the time of passing gas or stool, the time of oral intake, hospital stay and any postoperative complications were recorded and analyzed. Results There were no significant differences between two groups (Pgt;0.05) in postoperative plasma Alb level, the time of passing gas or stool, postoperative complications rate or hospital stay. However, in the TPN group, the time of oral intake was shorter than that in EEN group (P=0.004). Conclusions Both TPN and EEN are the suitable nutritional methods for patients with gastric cancer after total gastrectomy, and with no detectable difference. For patients with high risk, such as severe malnutrition, naso-intestinal tube should be placed for EEN.