Objective To evaluate the effect of laparoscopy-assisted surgery for lymph node dissection in patients with carcinoma of gastric cardia. Methods The clinical data of patients with carcinoma of gastric cardia who underwent either laparoscopy-assisted or open gastrectomy between January 2004 and September 2009 in the Department of General Surgery, the Nanchong Central Hospital were analyzed retrospectively. The number of lymph node dissection was compared. Results Thirty-nine patients underwent laparoscopy-assisted gastrectomy (laparoscopy group) and 63 patients underwent open gastrectomy (open group). There was no significant difference in preoperative complications, type of pathology or pTNM stage between two groups (Pgt;0.05). The number of lymph node dissection was 16.44±6.25 in the laparoscopy group， of which the number of first station lymph node was 10.56±3.78 (metastasis rate was 74.4%), the second station was 3.82±1.82 (metastasis rate was 46.2%), the third station was 2.00±1.36 (metastasis rate was 5.1%); in the open group, the numbers of corresponding lymph node were 16.38±5.83, 10.94±3.91 (metastasis rate was 71.4%), 3.71±1.55 (metastasis rate was 42.9%), and 1.75±1.06 (metastasis rate was 3.2%), respectively. There was no significant difference between two groups (Pgt;0.05). Conclusion The effectiveness of lymph node dissection is satisfactory by laparoscopy-assisted surgery for patients with carcinoma of gastric cardia, but prospective efficacy is still being followed up.
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.
目的:探讨不同手术入路在贲门癌治疗中的临床应用。方法:回顾性分析我院2003年8月至2009年1月期间收治的153例贲门癌患者的临床资料,根据不同手术入路分为经腹组(n=74)、胸腹联合组(n=27)和经胸组(n=52),对3组患者的手术中、术后恢复情况以及随访结果进行对比分析。结果:手术切除率100%,围手术期无死亡病例。经腹组手术时间短于经胸组和胸腹联合组,术中出血量也少于经胸组和胸腹联合组,但差异无统计学意义(Pgt;0.05)。胸腹联合组和经腹组清扫的淋巴结数目明显多于经胸组,差异有统计学意义(Plt;0.05)。经腹组患者术后住院时间和术后并发症发生率明显少于胸腹联合组和经胸组,差异有统计学意义(Plt;0.05)。3组患者的术后局部复发率和远处转移率的差异均无统计学意义(Pgt;0.05),3年和5年生存率的差异也无统计学意义(Pgt;0.05)。结论:经腹贲门癌切除术是安全和有效的,配合吻合器的使用,操作也是可行的。