【摘要】 目的 研究腹腔镜行进展期胃癌根治术较传统开腹手术在围手术期临床和生化指标的变化，进一步探讨其临床应用的优越性。 方法 采用统一入组标准、同期临床对比研究方法，对2010年1-12月腹腔镜手术组和开腹手术组完成的112例进展期胃癌根治术患者在围手术期临床指标和生化指标的比较分析，其中腹腔镜手术组59例，开腹手术组53例。 结果 腹腔镜组手术切口长度为（5.77±0.74） cm，开腹手术组为（12.05±1.30） cm，组间差异有统计学意义（t=-30.921，P=0.000）；腹腔镜组术中失血量为（107.20±27.23） mL，开腹手术组为（168.87±96.76） mL，组间差异有统计学意义（t=-4.483，P=0.000）；腹腔镜组术后住院时间为（7.19±0.97） d，开腹手术组为（8.32±1.16） d，组间差异有统计学意义（t=-5.634，P=0.000）；腹腔镜组手术时间为（202.12±15.71） min，开腹手术组为（196.32±16.73） min，组间差异无统计学意义（t=1.891，P=0.061）；腹腔镜组清扫淋巴结枚数（14.15±4.51）枚，开腹手术组（15.25±5.17）枚，组间差异无统计学意义（t=0.736，P=0.471）；腹腔镜组肠功能恢复时间为（57.88±9.70） h，开腹手术组为（59.16±10.82） h，组间差异无统计学意义（t=-0.655，P=0.514）。两组前白蛋白和血红蛋白水平差异无统计学意义（Pgt;0.05）。 结论 进展期胃癌行腹腔镜手术与传统开腹手术比较，并不加重患者创伤反应，也不增加手术并发症，具有手术切口小、术中出血少、术后恢复快等优点。【Abstract】 Objective To evaluate the differences between laparoscopy and open surgery for treating advanced gastric cancer in peri-operative clinical and biochemical indexes, in order to investigate the superiority of laparoscopy in treating the disease. Methods The same including standards and double-blind randomized control study were carried out to compare the peri-operative clinical and biochemical indexes of 112 patients who underwent radical treatment for advanced gastric cancer from January to December 2010. Among them, 59 patients were included in the laparoscopic group, and 53 in the traditional open operation group. Results Compared with the open surgery group, the incision length [(5.77±0.74) cm vs. (12.05±1.30) cm; t=-30.921, P=0.000], intraoperational blood loss [(107.20±27.23) mL vs. (168.87±96.76) mL; t=-4.483, P=0.000] and hospital stay time [(7.19±0.97) days vs. (8.32±1.16) days; t=-5.634, P=0.000] were significantly shorter or lower in the laparoscopic group. However, the operation time [(202.12±15.71) minutes vs. (196.32±16.73) minutes; t=1.891, P=0.061], number of lymph nodes removed (14.15±4.51 vs. 15.25±5.17; t=0.736, P=0.471), and intestinal functioning time [(57.88±9.70) hours vs. (59.16±10.82) hours; t=-0.655, P=0.514] were not significantly different between the two groups. There was no significant difference between the two groups in the level of prealbumin and hemoglobin. Conclusion Compared with the traditional open operation, laparoscopic surgery for gastric cancer has obvious advantages including smaller incision, lower blood loss during the operation, and fast recovery, without aggravating patients′ traumatic response or increasing the incidence of operational complications.
Objective To explore the applying value of laparoscopic partial gastrectomy for gastric stromal tumors. Methods The clinical data of 22 patients with gastric stromal tumors between July 2007 and December 2009 in this hospital were analyzed retrospectively. And the laparoscopic resection was performed in all the patients. Results The laparoscopic resections were performed successfully in all the patients, and the tumors were completely resected. The length of operative incision on abdominal wall was 4－6 cm with average 5.3 cm. The mean operation time was 70 min. Postoperative recovery was smooth, no procedure related complications happened. The mean hospital stay was 7.2 d. Specimens of 20 cases were with CD117 (+), and 15 with CD34 (+) by immunohistochemistry. No recurrence or metastasis happened with average follow-up of 13 months (2－23 months). Conclusion Laparoscopic partial gastrectomy for gastric stromal tumors could be performed safely, postoperative recovery quickly and effectively with the advantage of minimal invasiveness.
Objective To investigate the infection rate and observe the healing courses of the incision after gastrointestinal surgery which was managed by positioning extraperitoneal U-type latex drainage strip. Methods Two hundred patients after abdominal operation were divided into drainage group (n=97) and control group (n=103). Drainage group were treated with positioning extraperitoneal U-type latex drainage strip, while control group were treated with no latex drainage strip. The infection rate of incision, the mean time in hospital and mean time of incision healing were observed. Results The infection rate of drainage group was significantly lower than that of control group 〔7.22% (7/97) vs. 18.45% (19/103), P=0.024〕. The mean time in hospital and the mean time of incision healing in drainage group were significantly shorter than those in control group 〔(8.86±1.48) d vs. (14.12±2.63) d， P=0.000； (8.24±1.02) d vs. (12.32±3.47) d， P=0.000〕. Conclusion The infection rate and the healing course of incision of gastrointestinal surgery could be improved by positioning extraperitoneal U-type latex drainage strip.
Objective To establish interstitial cells of Cajal （ICC） loss models caused by incomplete small intestinal obstruction in rats with modified method and verify it. Methods Modified method was used to establish the models， making the ring around the small intestine but not through it. Morphological changes were observed by general signs， pathological changes were tested by HE staining and transmission electron microscope （TEM）， and changes of ICC number were tested by immunohistochemistry staining. Results Success rate of this method was 56% （28/50）， weight loss happened compared with before operation in ileus group （P＜0.01）. Hyperemia and swelling were observed in ileus group， and gastric retention was obvious. Results of HE staining and TEM showed that there was obvious inflammatory change， and ICC reduced was observed by immunohistochemistry. Conclusion ICC loss models caused by incomplete small intestinal obstruction meet the basic performance， and can be used for further research.
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.