ObjectiveTo analyze the factors influencing the total number of harvested lymph nodes in laparoscopic radical gastrectomy for advanced gastric cancer.MethodsThe clinicopathologic data of patients who underwent laparoscopic D2 radical resection of gastric cancer in this hospital for advanced gastric cancer from January 2018 to July 2020 were retrospectively analyzed. The statistical analysis was conducted to analyze the influence factors (age, gender, tumor size, tumor site, body mass index, infiltration depth, lymph node metastasis, HER-2 gene amplification status, presence or absence of vascular tumor thrombus, presence or absence of nerve infiltration, differentiation type, pTNM, Borrmann type, and type of gastrectomy) on the number of harvested lymph nodes.ResultsA total of 536 patients met the inclusion and exclusion criteria were included. The results of univariate analysis showed that the total number of harvested lymph nodes during laparoscopic radical gastrectomy for advanced gastric cancer was correlated with age, tumor size, tumor infiltration depth, lymph node metastasis, pTNM stage, Borrmann type, and type of gastrectomy. That was, the younger the patient was (≤ 54 years old), the larger the tumor was (long diameter >3.5 cm), the later the Borrmann classification was (type Ⅲ, Ⅳ), the deeper the tumor invasion was, the more the number of lymph node metastasis was, the later the pTNM stage was, and the more the number of lymph nodes was detected in patients undergoing total gastrectomy (all P<0.05). The multiple linear regression analysis showed that the age, lymph node metastasis, and PTNM stage had significant effects on the number of harvested lymph nodes. The multiple linear regression model was statistically significant (F=6.754, P<0.001). 11.2% of the variation in the number of harvested lymph nodes could be explained by the age, lymph node metastasis, and pTNM stage (adjusted R2=11.2%). ConclusionsNumber of harvested lymph nodes in laparoscopic radical gastrectomy for advanced gastric cancer is greatly affected by the age of patients, lymph node metastasis, and pTNM stage. So patients should be evaluated objectively and individually according to their age so as to harvest sufficient number of lymph nodes, which is conducive to accurately judge pTNM stage, formulate accurate adjuvant treatment scheme, and improve prognosis of patients.
目的探讨胃癌根治术后引起急性非结石性胆囊炎的原因及机理。方法回顾性分析2002年1月至2004年11月期间术前未发现胆囊疾患行远端胃癌根治术的43例患者，术后发生急性非结石性胆囊炎的发病情况。结果43例患者中并发急性非结石性胆囊炎12例。结论胃癌根治术后并发急性非结石性胆囊炎与神经、体液、胃肠道动力、细菌感染、血液供应及内源性凝血因子的激活有关，合理的术式及预防措施有一定的预防作用。
ObjectiveTo explore the predictive value of metastatic lymph node ratio (MLNR) on prognosis of patients with gastric cancer after radical gastrectomy, and to evaluate whether MLNR can be used as a reference tool to guide the formulation of postoperative adjuvant treatment strategies and prognosis prediction of gastric cancer.MethodsThe clinicopathologic features of patients who underwent D2 radical gastrectomy from January 2014 to December 2017 were retrospectively analyzed. The factors influencing the disease specific survival of gastric cancer were analyzed by Cox proportional hazards model, then the variables with statistical significance in multivariate analysis were included in the construction of nomograms model for prognosis of patients with gastric cancer.ResultsA total of 262 patients with gastric cancer were included. There was no correlation between MLNR and total number of lymph nodes (rs=0.037, P=0.547), there was a positive correlation between MLNR and pN stage (rs=0.909, P<0.001). Multivariate Cox regression analysis showed that pT stage, pN stage, MLNR, and postoperative chemotherapy were the independent predictors of prognosis of gastric cancer after radical gastrectomy. Four variables including pT stage, pN stage, postoperative chemotherapy, and MLNR were included in the construction of nomogram model, the C index of MLNR and pN stage model was 0.707 and 0.692 respectively. Survival analysis showed that the higher the MLNR, the worse the prognosis.ConclusionsThe ability of MLNR to predict prognosis of gastric cancer might be better than pN stage. Therefore, it is considered that MLNR could be used as an important evaluation tool to guide adjuvant treatment and prognosis prediction after radical gastrectomy.
ObjectiveTo explore the application of 5G remote robotic surgery in distal gastrectomy for gastric cancer and evaluate the feasibility and advantages of the “3+2” model “seven-step method”. MethodsThe situations at preoperative, intraoperative and postoperative follow-up of a patient who underwent 5G remote robotic distal gastrectomy for gastric cancer with “3+2” model “seven-step method” in Gansu Provincial People’s Hospital were summarized, and based on our experience of robotic surgery, the application advantages of “3+2” model “seven-step method” in 5G remote robotic distal gastrectomy for gastric cancer was explored. ResultsThe operative time of this case was 190 min, the intraoperative blood loss was 50 mL, the network delay was 43.554 ms, and no intraoperative adverse events occurred. After a one-year follow-up, the patient recovered well, with no complications, good diet and good quality of life. ConclusionsThe “3+2” model “seven-step method” is feasible for 5G remote robotic distal gastrectomy. Further research requires an increased sample size and extended follow-up period.
目的总结19例胃癌根治术后合并淋巴瘘的诊治经验。 方法对我院2001年1月至2010年3月期间204例胃癌根治术后19例发生淋巴瘘患者的临床资料进行回顾性分析。 结果19例中15例经非手术治疗治愈，4例因非手术治疗无效行手术探查，其中2例术后痊愈，另2例分别于术后第3天和第6天再次并发淋巴瘘，最终致全身多器官功能衰竭而死亡。 本组淋巴瘘发生率与患者性别、年龄及术前是否化疗无关（Pgt;0.05），但第7、8a、9和16组淋巴结同时有转移者高于无转移者、行D2+手术者高于行D2手术者、使用超声刀者高于未使用者、Ⅱ及Ⅲ期高于Ⅰ期（Plt;0.01），未使用生物蛋白胶者高于使用者、行早期肠内营养者高于晚期肠内营养者、胃中上部肿瘤高于胃下部肿瘤（Plt;0.05）。 TPN加用生长抑素及生长激素者腹腔引流量为（330±40） ml/d，均明显少于单用TPN 〔(750±140) ml/d〕及TPN加用生长抑素者〔(450±40) ml/d〕，Plt;0.01和Plt;0.05，后两者比较其差异也有统计学意义（Plt;0.05）。 TPN加用生长抑素及生长激素患者淋巴瘘的愈合时间为（13.1±1.5） d，较完全TPN的（25.6±2.1） d及TPN加用生长抑素的（18.3±7.1） d缩短，Plt;0.05，后两者比较的差异也有统计学意义（Plt;0.05）。 结论胃癌根治术中可靠结扎淋巴管、避免过度扩大淋巴结清扫范围以及避免早期的肠内营养对预防术后淋巴瘘极为重要。
Objective To evaluate the clinical application of hand assisted laparoscopic radical surgery for gastric cancer. Methods From June 2010 to September 2011，a series of 51 patients were undertook hand assisted laparoscopic D2 gastrectomy （hand assisted group），49 patients were undertook laparoscopic assisted D2 gastrectomy （laparoscopic group），the secure indexes of surgery effect in perioperative period were compared betwee two groups. Results The incision length was （6.82±0.33） cm and （5.74±1.11） cm （t=6.57，P=0.00），numbers of harvested lymph nodes were 16.10±5.11 and 14.16±3.60 （t=2.18，P=0.03），intraoperative bleeding was （249.40±123.40） ml and （251.00±90.40） ml （t=-0.74，P=0.94），operation time was （177.7±23.8） min and （188.1±16.9） min （t=-2.53，P=0.01），postoperative hospital stay was （11.12±5.02） d and （10.88±3.13） d （t=0.29，P=0.78） in the hand assisted group and in the laparoscopic group，respectively. One case of gastric atony happened in the hand assisted group，one case of gastric atony and incision infection happened in the laparoscopic group. No mortality case was found in two groups. Conclusions Hand assisted laparoscopic D2 gastrectomy is less difficult，and shorter operation time，and considerable treatment effection as compared with laparoscopic operation.
ObjectiveTo investigate the clinical efficacy and short-term complications of total laparoscopic distal gastrectomy, which adopting Billroth Ⅱ combining with Braun anastomosis. MethodsClinical data of 186 cases of distal gastric cancer who underwent total laparoscopic distal gastrectomy in our hospital from June 2012 to June 2014, including 86 cases who adopted Billroth Ⅱ combining with Braun anastomosis, and 100 cases who adopted Billroth Ⅱ anastomosis. The clinical efficacy was compared between these two groups. ResultsThere was no significant difference in the opera-tion time, digestive tract reconstruction time, intraoperative blood loss, postoperative exhaust time, and hospital stay (P>0.05). However, compared with Billroth Ⅱ anastomosis group, the incidence rates of alkaline reflux gastritis, duodenal fistula, anastomositis, and postsurgical gastroparesis syndrome were lower in Billroth Ⅱ combining with Braun anastomosis group (P<0.05). ConclusionThe application of Billroth Ⅱ combining with Braun anastomosis in total laparoscopic distal gastrectomy could reduce the incidence rates of alkaline reflux gastritis, duodenal fistula, anastomositis, and postsur-gical gastroparesis syndrome, and it is an ideal operation method to improve the quality of life for gastric cancer patients.