ObjectiveTo explore the effect of exogenous ghrelin on early recovery of rats after subtotal gastrectomy. MethodsTwelve rats undergoing subtotal gastrectomy (B-Ⅰtype) were randomly divided into two groups, and saline or ghrelin was intraperitoneally injected in two groups, respectively. The body weight and daily food intake were measured before operation and on 1-7 d after operation. Rats were killed on day 7 after operation and the expressions of ghrelin mRNA in the fundus of stomach and anastomotic stoma was determined by realtime fluorescent quantitative PCR assay. The anastomotic bursting pressure and hydroxyproline content of anastomotic stoma tissues were also detected. ResultsThere was no significant difference (P＞0.05) in pre and postoperative body weight between two groups. Gradual decrease in postoperative body weight among the rats of saline group was observed which was significantly lower than that before operation (Plt;0.01). Body weight reached it’s lowest on day 1 after operation (Plt;0.01), after which it gradually increased but was still lower than that before operation (Plt;0.01). The postoperative body weight of rats in ghrelin group gradually decreased too, and was also significantly lower than preoperative body weight (Plt;0.01), except for the day 1 after operation (P=0.693). It reached the lowest on day 4 after operation (Plt;0.01), then it gradually increased but was still lower than that before operation (Plt;0.05 or Plt;0.01). The cumulative food intake of rats in ghrelin group was （52.50±6.77） g, which was significantly higher than that in saline group 〔(45.67±7.47) g〕, Plt;0.05. On day 7 after operation, relative expression of ghrelin mRNA in the fundus of stomach of rats in ghrelin group was 0.08±0.04, which was significantly lower than that in saline group (0.22±0.07), Plt;0.01. Compared with saline group, ghrelin-treated rats displayed significantly higher bursting pressure 〔（155.83±6.62） mm Hg vs. （172.33±10.44） mm Hg, Plt;0.05〕 higher hydroxyproline content 〔 (0.43±0.05) μg/mg wet tissue vs. （0.50±0.29） μg/mg wet tissue, Plt;0.01〕 at the anastomotic stoma. ConclusionGhrelin may effectively promote the early recovery of rats after subtotal gastrectomy.
Objective To explore the optimal technique for digestive tract reconstruction of proximal gastrectomy. Methods Fifty-nine patients who underwent proximal subtotal gastrectomy during June 2004 and January 2007 were analyzed retrospectively. All patients were divided into 2 groups according to the styles of reconstruction: one group with gastroesophagostomy (GE group) and the other with accommodation double tract digestive reconstruction of jejunal interposition (GIE group). The reconstruction of GIE group was to interposite a continuous 35 cm jejunum between the gastric stump and the oesophagus, which detail had been reported in our previous literature. The quality of life in 2 groups were evaluated and compared. Results No patient died and there was no anastomotic leakage, dumping syndrome and moderate or severe anemia occurred during perioperative period. There was no significant difference of the following indexes of nutrition between 2 groups 1 month and 6 months after operation: the value of weight, RBC, Hb, Alb, PNI and the indexes versus the preoperative ones (Pgt;0.05), for the exception of the indexes of RBC (P=0.006), Hb (P=0.001) in 1 month after operation versus the preoperative ones. The abdominal and the reflux esophagitis symptoms in GIE group were milder than those in GE group (Plt;0.001). The Visick scoring: most of the GIE group were gradeⅡ (74.2%), and grade Ⅲ (64.3%) in the GE group. There was no delay of the first time of adjuvant chemotherapy in GIE group (Pgt;0.05), and the surgical time was (0.35±0.13) h more than that of GE group (P=0.01). Conclusion The accommodation double tract digestive reconstruction of jejunal interposition for proximal subtotal gastrectomy may be safe and feasible by decreasing residual cancer cells and improving the quality of life of patients with proximal gastric carcinoma who underwent such surgical procedure.
ObjectiveTo summarize the procedure of transumbilical single incision laparoscopic surgery (SILS) with conventional laparoscopic instruments for different tumor diameter and different site of gastric stromal tumor. MethodThe clinical data, intraoperative procedure, and postoperative recovery of 34 patients with gastric stromal tumor from December 2009 to February 2014 in this hospital were analyzed retrospectively. ResultsThe transumbilical SILS was performed successfully in all the 34 patients.Among these patients, the wedge resection of stomach was perfor-med in 27 patients, distal subtotal gastrectomy was performed in 6 patients, distal subtotal gastrectomy complicated with multivisceral resection was performed in 1 patient.The pathology confirmed that the diameter of tumors was from 0.6 cm to 10.0 cm (average 3.4 cm).The resection margins were tumor free.The risk assessment showed that tumors with extremely low risk were in 9 cases, low risk were in 17 cases, intermediate risk were in 6 cases, high risk were in 2 cases.During surgery, 9 tumors were located on the fundus of stomach, 6 tumors on the gastric greater curvature, 7 tumors on the gastric lesser curvature, 2 tumors on the anterior and posterior wall of the stomach respectively, 3 tumors on the cardia below, 4 tumors on the gastric antrum, tumor invaded the surrounding organs in 1 case.There was no conversion to open or conventional laparoscopic surgery.no intraoperative or postoperative complications were experi-enced in all the patients except one was postoperative intraperitoneal bleeding and one was incision infection.All the patients were followed for an average of 25 months (range 3-49 months), there was no evident recurrence of disease. ConclusionsThe transumbilical SILS for gastric stromal tumor is a feasible and safe technique when performed by an experienced laparoscopic surgeon.The suitable procedure of SILS should be selected for gastric stromal tumor according their different size and location.
ObjectiveTo compare clinical outcome between single-incision laparoscopic subtotal gastrectomy (SILSG) versus laparoscopy-assisted subtotal gastrectomy (LASG) in treatment of benign gastric ulcer and duodenal ulcer. MethodsClinical data of 37 patients with benign gastric ulcer or duodenal ulcer who underwent laparoscopic subtotal gastrectomy between Jan. 2008 and Feb. 2015 at Shengjing Hospital of China Medical University was collected retrospectively. Among them, 15 patients underwent SILSG and 22 patients underwent LASG. Demographic, intraoperative, and postoperative data was analyzed and compared between the 2 groups. ResultsThe operative time of SILSG group was significantly longer than that of LASG group (P < 0.050). However, the postoperative hospital stay was significantly shorter (P < 0.050), and the total patient scar assesment scale (PSAS) score was significantly lower (P < 0.050) in the SILSG group than those of LASG group. There was no significant difference between the 2 groups with respect to other variables (P > 0.050), such as conversion rate, intraoperative blood loss, postoperative exhaust time, incidence of complication, and visual analog scale score of pain. All patients received postoperative follow up, and the period ranged from 6 months to 25 months, with a median of 11 months. During the follow up period, no one suffered from incision hernia and recurrence of ulcer. ConclusionCompared with LASG, SILSG is a technically feasible procedure with better cosmesis and equivalent curability.