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Comparative analysis of two digestive tract reconstruction methods in total laparoscopic radical total gastrectomy
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作者 Tian-Xiang Dong Dong Wang +10 位作者 Qun Zhao Zhi-Dong Zhang Xue-Feng Zhao Bi-Bo Tan Yu Liu Qing-Wei Liu Pei-Gang Yang Ping-An Ding Tao Zheng Yong Li Zi-Jing Liu 《World Journal of Gastrointestinal Surgery》 SCIE 2024年第4期1109-1120,共12页
BACKGROUND The incidence of gastric cancer has significantly increased in recent years.Surgical resection is the main treatment,but the method of digestive tract reconstruction after gastric cancer surgery remains con... BACKGROUND The incidence of gastric cancer has significantly increased in recent years.Surgical resection is the main treatment,but the method of digestive tract reconstruction after gastric cancer surgery remains controversial.In the current study,we sought to explore a reasonable method of digestive tract reconstruction and improve the quality of life and nutritional status of patients after surgery.To this end,we statistically analyzed the clinical results of patients with gastric cancer who underwent jejunal interposition double-tract reconstruction(DTR)and esophageal jejunum Roux-en-Y reconstruction(RY).AIM To explore the application effect of DTR in total laparoscopic radical total gastrectomy(TLTG)and evaluate its safety and efficacy.METHODS We collected the relevant data of 77 patients who underwent TLTG at the Fourth Hospital of Hebei Medical University from October 2021 to January 2023.Among them,35 cases were treated with DTR,and the remaining 42 cases were treated with traditional RY.After 1:1 propensity score matching,the cases were grouped into 31 cases per group,with evenly distributed data.The clinical characteristics and short-and long-term clinical outcomes of the two groups were statistically analyzed.RESULTS The two groups showed no significant differences in basic data,intraoperative blood loss,number of lymph node dissections,first defecation time after operation,postoperative hospital stay,postoperative complications,and laboratory examination results on the 1st,3rd,and 5th days after operation.The operation time of the DTR group was longer than that of the RY group[(307.58±65.14)min vs(272.45±62.09)min,P=0.016],but the first intake of liquid food in the DTR group was shorter than that in the RY group[(4.45±1.18)d vs(6.0±5.18)d,P=0.028].The incidence of reflux heartburn(Visick grade)and postoperative gallbladder disease in the DTR group was lower than that in the RY group(P=0.033 and P=0.038).Although there was no significant difference in body weight,hemoglobin,prealbumin,and albumin between the two groups at 1,3 and 6 months after surgery,the diet of patients in the DTR group was better than that in the RY group(P=0.031).CONCLUSION The clinical effect of DTR in TLTG is better than that of RY,indicating that it is a more valuable digestive tract reconstruction method in laparoscopic gastric cancer surgery. 展开更多
关键词 gastric cancer Jejunal interposition double-tract reconstruction Roux-en-Y reconstruction LAPAROSCOPE
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Optimal choice of stapler and digestive tract reconstruction method after distal gastrectomy for gastric cancer:A prospective case–control study 被引量:3
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作者 Zhen Wu Zhi-Gang Zhou +2 位作者 Ling-Yu Li Wen-Jing Gao Ting Yu 《World Journal of Gastrointestinal Surgery》 SCIE 2023年第7期1354-1362,共9页
BACKGROUND Gastric cancer is the most common cause of cancer-related deaths,and is classified according to its location in the proximal,middle,or distal stomach.Surgical resection is the primary approach for treating ... BACKGROUND Gastric cancer is the most common cause of cancer-related deaths,and is classified according to its location in the proximal,middle,or distal stomach.Surgical resection is the primary approach for treating gastric cancer.This prospective study aimed to determine the best reconstruction method after distal gastrectomy for gastric cancer.AIM To explore the efficacy of different staplers and digestive tract reconstruction(DTR)methods after radical gastrectomy and their influence on prognosis.METHODS Eighty-seven patients who underwent radical gastrectomy for distal gastric cancer at our institution between April 2017 and April 2020 were included in this study,with a follow-up period of 12-26 mo.The patients were assigned to four groups based on the stapler and DTR plan as follows:BillrothⅠ(B-I)reconstruction+linear stapler group(group A,22 cases),B-I reconstruction+circular stapler group(group B,22 cases),Billroth II(B-II)reconstruction+linear stapler group(group C,22 cases),and B-II reconstruction+circular stapler group(group D,21 cases).The pathological parameters,postoperative gastrointestinal function recovery,postoperative complications,and quality of life(QOL)were compared among the four groups.RESULTS No significant differences in the maximum diameter of the gastric tumors,total number of lymph nodes dissected,drainage tube removal time,QLQ(QOL questionnaire)-C30 and QLQ-STO22 scores at 1 year postoperatively,and incidence of complications were observed among the four groups(P>0.05).However,groups A and C(linear stapler)had significantly lower intraoperative blood loss and significantly shorter anastomosis time,operation time,first fluid diet intake time,first exhaust time,and length of postoperative hospital stay(P<0.05)than groups B and D(circular stapler).CONCLUSION Linear staplers offer several advantages for postoperative recovery.B-I and B-II reconstruction methods had similar effects on QOL.The optimal solution can be selected according to individual conditions and postoperative convenience. 展开更多
关键词 gastric cancer Distal radical gastrectomy reconstruction of digestive tract STAPLER Quality of life Prognosis
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Esophagogastric Reconstruction in Cobra-Head Shape with Toupet-Like Partial Anti-Reflux Technique for Resection of Proximal Gastric Tumors. Experience with Three Cases from a Non-Asian Population
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作者 Alberto M. León-Takahashi Ana P. Meléndez-Fernández +4 位作者 Leonardo S. Lino-Silva Horacio N. López-Basave Rosa Angelica Salcedo Hernandez César Zepeda-Najar Ángel Herrera-Gómez 《Open Journal of Gastroenterology》 CAS 2023年第4期149-160,共12页
Background: Proximal gastrectomy is a rarely performed procedure but a feasible option in benign tumors and malignant neoplasms in the proximal third of the stomach since novel options of reconstructions are available... Background: Proximal gastrectomy is a rarely performed procedure but a feasible option in benign tumors and malignant neoplasms in the proximal third of the stomach since novel options of reconstructions are available nowadays with fewer long-term sequels. Methods: Report of three cases of proximal gastric gastrointestinal stromal tumors (GIST), with a description of its presentation, histological characteristics, and follow-up after being treated with proximal gastrectomy with cobra head reconstruction. Results: Case 1: A 62-year-old woman with epigastric pain of four months with endoscopic evidence of a cardia GIST. The surgery was performed without complications. The histopathological report confirmed a fusiform GIST of 3.2 × 3 × 2.5 cm, stage IA. No adjuvant treatment was considered. An esophagogram showed no evidence of reflux and no stenosis, and no disease recurrence after 40-months follow-up. Case 2: A 66-year-old woman with dyspepsia and a palpable tumor in the epigastrium. The surgery was performed without complications. The pathology report confirmed a proximal gastric GIST of 13 × 8 × 7 cm, staged II. She received adjuvant treatment with imatinib for 36 months without recurrence and no reflux or stenosis. Case 3: A 55-year-old woman with intermittent hematemesis and right subscapular pain. The surgery was performed without complications. The histopathological report concluded that a GIST tumor of the cardia, 1.4 × 1.2 cm, staged IA. She was left in observation. At a 6-month follow-up, she does not report dysphagia, reflux, or stenosis, and no locoregional recurrence. Conclusions: Open and laparoscopic proximal gastrectomy is a safe therapeutic option for GIST. Furthermore, the reconstruction of the esophagus-gastro anastomosis in the cobra head after proximal gastrectomy is feasible and secure in our population, with good functional results in a short follow-up. 展开更多
关键词 GIST gastric Cancer LAPAROSCOPY Proximal Gastrectomy Cobra Head reconstruction
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Assessment of Gastric Cancer: Value of Two-phase Multidetector-row Spiral CT Three-dimensional Reconstruction Technique 被引量:4
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作者 李震 胡道予 +2 位作者 肖明 张进华 宋金梅 《The Chinese-German Journal of Clinical Oncology》 CAS 2005年第6期365-368,共4页
Abstract Objective: To evaluate the diagnostic value of two-phase multidetector-row spiral CT threedimensional reconstruction technique in TNM staging of gastric cancer. Methods: In 29 patients with gastric carcinom... Abstract Objective: To evaluate the diagnostic value of two-phase multidetector-row spiral CT threedimensional reconstruction technique in TNM staging of gastric cancer. Methods: In 29 patients with gastric carcinoma pathologically conformed, plan scans were done firstly. Two-phase spiral CT was performed within one breathhold each. Distension of the stomach was achieved by intravenous application of anisodamine and effervescent granules. After bolus injection of contrast medium, scanning was performed in the arterial and venous phase, and the source images were thin reconstructed. The stomach to three-dimension analysis was constructed by volume rendering (VR) multiplanaz volume reconstruction (MPVR), shaded surface display (SSD) and CT virtual gastroscopy (CTVG) technique. In combination with the sources images, gastric tumour invasion and lymph node metastasis was assessed, and TNM staging was performed. Results: In 29 cases of gastric carcinoma, the sensitivity and specificity of two-phase multidetector-row spiral CT three-dimensional reconstruction technique in T1, T2, T3 and Ta staging, the sensitivity and specificity was 50% and 50%, 87.5% and 77.8%, 83.3% and 76.9% and 100% and 80% respectively. For the N staging, the sensitivity and specificity in No, N1, and N2 N3 was 83.3% and 71.4%, 87.5% and 77.8% and 81.8% and 75% respectively. The sensitivity and the specificity for M1 staging was 100%. Conclusion: The reconstruction technique in combination with 16-slices spiral-CT can perform TNM staging well and effectively guide the choice of the surgical procedures for gastric cancer. 展开更多
关键词 SPIRAL-CT gastric carcinoma three-dimensional reconstruction
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Roux-en-Y versus BillrothⅠreconstruction after distal gastrectomy for gastric cancer:A meta-analysis 被引量:35
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作者 Jun-Jie Xiong Kiran Altaf +8 位作者 Muhammad A Javed Quentin M Nunes Wei Huang Gang Mai Chun-Lu Tan Rajarshi Mukherjee Robert Sutton Wei-Ming Hu Xu-Bao Liu 《World Journal of Gastroenterology》 SCIE CAS 2013年第7期1124-1134,共11页
AIM: To conduct a meta-analysis to compare Roux-en-Y (R-Y) gastrojejunostomy with gastroduodenal Billroth?I?(B-I) anastomosis after distal gastrectomy (DG) for gastric cancer.METHODS: A literature search was performed... AIM: To conduct a meta-analysis to compare Roux-en-Y (R-Y) gastrojejunostomy with gastroduodenal Billroth?I?(B-I) anastomosis after distal gastrectomy (DG) for gastric cancer.METHODS: A literature search was performed to identify studies comparing R-Y with B-I?after DG for gastric cancer from January 1990 to November 2012 in Medline, Embase, Science Citation Index Expanded and the Cochrane Central Register of Controlled Trials in The Cochrane Library. Pooled odds ratios (OR) or weighted mean differences (WMD) with 95%CI were calculated using either ?xed or random effects model. Operative outcomes such as operation time, intraoperative blood loss and postoperative outcomes such as anastomotic leakage and stricture, bile re?ux, remnant gastritis, re?ux esophagitis, dumping symptoms, delayed gastric emptying and hospital stay were the main outcomes assessed. Meta-analyses were performed using RevMan 5.0 software (Cochrane library).RESULTS: Four randomized controlled trials (RCTs) and 9 non-randomized observational clinical studies (OCS) involving 478 and 1402 patients respectively were included. Meta-analysis of RCTs revealed that R-Y reconstruction was associated with a reduced bile re?ux (OR 0.04, 95%CI: 0.01, 0.14; P < 0.00?001) and remnant gastritis (OR 0.43, 95%CI: 0.28, 0.66; P = 0.0001), however needing a longer operation time (WMD 40.02, 95%CI: 13.93, 66.11; P = 0.003). Meta-analysis of OCS also revealed R-Y reconstruction had a lower incidence of bile re?ux (OR 0.21, 95%CI: 0.08, 0.54; P = 0.001), remnant gastritis (OR 0.18, 95%CI: 0.11, 0.29; P < 0.00?001) and re?ux esophagitis (OR 0.48, 95%CI: 0.26, 0.89; P = 0.02). However, this reconstruction method was found to be associated with a longer operation time (WMD 31.30, 95%CI: 12.99, 49.60; P = 0.0008).CONCLUSION: This systematic review point towards some clinical advantages that are rendered by R-Y compared to B-I?reconstruction post DG. However there is a need for further adequately powered, well-designed RCTs comparing the same. 展开更多
关键词 gastric cancer Distal gastrectomy ROUX-EN-Y Billroth I reconstruction META-ANALYSIS
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Comparison between uncut Roux-en-Y and Roux-en-Y reconstruction after distal gastrectomy for gastric cancer: A meta-analysis 被引量:18
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作者 Ming-Ming Sun Yi-Yi Fan Sheng-Chun Dang 《World Journal of Gastroenterology》 SCIE CAS 2018年第24期2628-2639,共12页
AIM To compare uncut Roux-en-Y(U-RY) gastrojejunostomy with Roux-en-Y(RY) gastrojejunostomy after distal gastrectomy(DG) for gastric cancer.METHODS A literature search was conducted in Pubmed, Embase, Web of Science, ... AIM To compare uncut Roux-en-Y(U-RY) gastrojejunostomy with Roux-en-Y(RY) gastrojejunostomy after distal gastrectomy(DG) for gastric cancer.METHODS A literature search was conducted in Pubmed, Embase, Web of Science, Cochrane Library, Science Direct, Chinese National Knowledge Infrastructure, Wanfang, and China Science and Technology Journal Database to identify studies comparing U-RY with RY after DG for gastric cancer until the end of December 2017. Pooled odds ratio or weighted mean difference with 95% confidence interval was calculated using either fixed-or random-effects models. Perioperative outcomes such as operative time, intraoperative blood loss, and hospital stay; postoperative complications such as anastomotic bleeding, stricture and ulcer, reflux gastritis/esophagitis, delayed gastric emptying, and Roux stasis syndrome; and postoperative nutritional status(serum hemoglobin, total protein, and albumin levels) were the main outcomes assessed. Metaanalyses were performed using RevM an 5.3 software.RESULTS Two randomized controlled trials and four nonrandomized observational clinical studies involving 403 and 488 patients, respectively, were included. The results of the meta-analysis showed that operative time [weighted mean difference(WMD):-12.95; 95%CI:-22.29 to-3.61; P = 0.007] and incidence of reflux gastritis/esophagitis(OR: 0.40; 95%CI: 0.20-0.80; P = 0.009), delayed gastric emptying(OR: 0.29; 95%CI: 0.14-0.61; P = 0.001), and Roux stasis syndrome(OR: 0.14; 95%CI: 0.04-0.50; P = 0.002) were reduced; and the level of serum albumin(WMD: 0.71; 95%CI: 0.24-1.19; P = 0.003) was increased in patients undergoing U-RY reconstruction compared with those undergoing RY reconstruction. No differences were found with respect to intraoperative blood loss, hospital stay, anastomotic bleeding, anastomotic stricture, anastomotic ulcer, the levels of serum hemoglobin, and serum total protein. CONCLUSION U-RY reconstruction has some clinical advantages over RY reconstruction after DG. 展开更多
关键词 ROUX-EN-Y gastric cancer META-ANALYSIS DISTAL GASTRECTOMY reconstruction Uncut
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Does antecolic reconstruction for duodenojejunostomy improve delayed gastric emptying after pylorus-preserving pancreaticoduodenectomy? A systematic review and meta-analysis 被引量:10
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作者 An-Ping Su Shuang-Shuang Cao Yi Zhang Zhao-Da Zhang Wei-Ming Hu Bo-Le Tian 《World Journal of Gastroenterology》 SCIE CAS CSCD 2012年第43期6315-6323,共9页
AIM:To evaluate whether antecolic reconstruction for duodenojejunostomy (DJ) can decrease delayed gastric emptying (DGE) rate after pylorus-preserving pancreaticoduodenectomy (PPPD) through literature review and meta-... AIM:To evaluate whether antecolic reconstruction for duodenojejunostomy (DJ) can decrease delayed gastric emptying (DGE) rate after pylorus-preserving pancreaticoduodenectomy (PPPD) through literature review and meta-analysis. METHODS:Articles published between January 1991 and April 2012 comparing antecolic and retrocolic reconstruction for DJ after PPPD were retrieved from the databases of MEDLINE (PubMed), EMBASE, OVID and Cochrane Library Central. The primary outcome of interest was DGE. Either fixed effects model or random effects model was used to assess the pooled effect based on the heterogeneity. RESULTS:Five articles were identified for inclusion:two randomized controlled trials and three non-randomized controlled trials. The meta-analysis revealed that antecolic reconstruction for DJ after PPPD was associated with a statistically significant decrease in the incidence of DGE [odds ratio (OR), 0.06; 95% CI, 0.02-0.17; P < 0.00 001] and intra-operative blood loss [mean difference (MD), -317.68; 95% CI, -416.67 to -218.70; P < 0.00 001]. There was no significant difference between the groups of antecolic and retrocolic reconstruction in operative time (MD, 25.23; 95% CI, -14.37 to 64.83; P = 0.21), postoperative mortality, overall morbidity (OR, 0.54; 95% CI, 0.20-1.46; P = 0.22) and length of postoperative hospital stay (MD, -9.08; 95% CI, -21.28 to 3.11; P = 0.14). CONCLUSION:Antecolic reconstruction for DJ can decrease the DGE rate after PPPD. 展开更多
关键词 Pylorus-preserving pancreaticoduodenectomy Delayed gastric emptying Antecolic reconstruction Retrocolic reconstruction DUODENOJEJUNOSTOMY
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Digestive tract reconstruction options after laparoscopic gastrectomy for gastric cancer 被引量:18
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作者 Jian Shen Xiang Ma +1 位作者 Jing Yang Jian-Ping Zhang 《World Journal of Gastrointestinal Oncology》 SCIE CAS 2020年第1期21-36,共16页
In addition to the popularity of laparoscopic gastrectomy(LG),many reconstructive procedures after LG have been reported.Surgical resection and lymphatic dissection determine long-term survival;however,the election of... In addition to the popularity of laparoscopic gastrectomy(LG),many reconstructive procedures after LG have been reported.Surgical resection and lymphatic dissection determine long-term survival;however,the election of a reconstruction procedure determines the postoperative quality of life for patients with gastric cancer(GC).Presently,no consensus exists regarding the optimal reconstructive procedure.In this review,the current state of digestive tract reconstruction after LG is reviewed.According to the determining influence of the tumor site on the procedures of surgical resection and reconstruction,we divide these reconstruction procedures into three categories consistent with the resection procedures.We focus on the technical tips of every reconstruction procedure and examine the surgical outcomes(length of surgery and blood loss)and postoperative complications(anastomotic leakage and stricture)to facilitate gastrointestinal surgeons to understand the merits and demerits of every reconstruction procedure. 展开更多
关键词 Digestive tract reconstruction Laparoscopic gastrectomy gastric cancer Quality of life
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Does antecolic reconstruction decrease delayed gastric emptying after pancreatoduodenectomy? 被引量:8
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作者 Nadia Peparini Piero Chirletti 《World Journal of Gastroenterology》 SCIE CAS CSCD 2012年第45期6527-6531,共5页
Delayed gastric emptying(DGE) is a frequent complication after pylorus-preserving pancreatoduodenectomy(PpPD).Kawai and colleagues proposed pylorus-resecting pancreatoduodenectomy(PrPD) with antecolic gastrojejunal an... Delayed gastric emptying(DGE) is a frequent complication after pylorus-preserving pancreatoduodenectomy(PpPD).Kawai and colleagues proposed pylorus-resecting pancreatoduodenectomy(PrPD) with antecolic gastrojejunal anastomosis to obviate DGE occurring after PpPD.Here we debate the reported differences in the prevalence of DGE in antecolic and retrocolic gastro/duodeno-jejunostomies after PrPD and PpPD,respectively.We concluded that the route of the gastro/duodeno-jejunal anastomosis with respect to the transverse colon;i.e.,antecolic route or retrocolic route,is not responsible for the differences in prevalence of DGE after pancreatoduodenectomy(PD) and that the impact of the reconstructive method on DGE is related mostly to the angulation or torsion of the gastro/duodeno-jejunostomy.We report a prevalence of 8.9% grade A DGE and 1.1% grade C DGE in a series of 89 subtotal stomach-preserving PDs with Roux-en Y retrocolic reconstruction with anastomosis of the isolated Roux limb to the stomach and single Roux limb to both the pancreatic stump and hepatic duct.Retrocolic anastomosis of the isolated first jejunal loop to the gastric remnant allows outflow of the gastric contents by gravity through a "straight route". 展开更多
关键词 Antecolic reconstruction Retrocolic recon-struction PANCREATODUODENECTOMY Pylorus-preservingpancreatoduodenectomy Delayed gastric emptying
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Totally Endoscopic (Thoracoscopic and Laparoscopic) Radical Esophagectomy with Gastric Tube Reconstruction through a Small Neck Incision: An Early Experience with Thirty Egyptian Patients
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作者 Adel Denewer Adel Fathi +6 位作者 Ahmed Setit Mohamed Hegazy Ashraf Khater Osama Hussein Sameh Roshdy Fayez Shahatto Fathy Denewer 《Surgical Science》 2014年第5期214-223,共10页
Background: Minimally invasive esophagectomy nowadays is replacing the classic open technique. Additional studies are needed to confirm its safety and efficacy. Methods: thirty patients with esophageal carcinoma were ... Background: Minimally invasive esophagectomy nowadays is replacing the classic open technique. Additional studies are needed to confirm its safety and efficacy. Methods: thirty patients with esophageal carcinoma were enrolled in this study. Patients were evaluated preoperatively and they underwent thoracoscopic and laparoscopic procedures for assessment of resectability. Resectablepatients underwent radical esophagectomy with gastric tube reconstruction through a four-cm neck incision. Results: 17 patients were operable and 13 patients were inoperable. The mean operative time for the whole procedure was 5.97 ± 1.66 hours. The mean blood loss was 250 ± 138.07 cc. The mean overall hospital stay was 17.47 ± 5.49 daysdays. Common postoperative complications included pneumonia (13.3%) pleural effusion (6.7%), cervical anastomotic leakage (10%), and wound infection (13.3%). One patient died in the early postoperative period. Conclusions: we conclude that totallyendoscopic (thoracoscopic and laparoscopic) esophagectomy is feasible and relatively safe technique. Beside its efficacy as an assessment tool, total esophagectomy and lymphadenectomy could be performed in the same time. 展开更多
关键词 THORACOSCOPIC LAPAROSCOPIC RADICAL ESOPHAGECTOMY gastric reconstruction Esophagus Cancer
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Local random flaps for cervical circumferential defect or tracheoesophageal fistula reconstruction after failed gastric pull-up: Two case reports
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作者 Ye Zhang Yang Liu +2 位作者 Yu Sun Meng Xu Xiao-Lei Wang 《World Journal of Clinical Cases》 SCIE 2021年第33期10328-10336,共9页
BACKGROUND Total pharyngo-laryngo-esophagectomy with a reconstruction of gastric pull-up is the most common treatment method for patients with multiple primary upper digestive tract carcinomas,such as hypopharyngeal c... BACKGROUND Total pharyngo-laryngo-esophagectomy with a reconstruction of gastric pull-up is the most common treatment method for patients with multiple primary upper digestive tract carcinomas,such as hypopharyngeal carcinoma with thoracic esophageal carcinoma.However,neck circumferential defect and tracheoesophageal fistula after gastric necrosis are still challenging problems for surgeons and patients.CASE SUMMARY This case report presents 2 patients who underwent reconstructive surgeries using 4 local random flaps with a split thickness skin graft in the first case,and 6 local random flaps in the second case to close the circumferential defect and tracheoesophageal fistula after failed gastric pull-up.Both patients achieved good swallowing function and could take solid diet without dysphagia postoperatively.CONCLUSION For selected patients,local random flaps(with a split thickness skin graft)can be a simple and reliable solution for reconstructing tracheoesophageal fistula or cervical circumferential defect after gastric necrosis,especially when the necrosis extends below the thoracic inlet. 展开更多
关键词 Local random flap Cervical circumferential defect reconstruction Tracheoesophageal fistula reconstruction Failed gastric pull-up Total pharyngo-laryngoesophagectomy Case report
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Digestive tract reconstruction pattern as a determining factor in postgastrectomy quality of life 被引量:8
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作者 Xin-Zu Chen Wei-Han Zhang +1 位作者 Kun Yang Jian-Kun Hu 《World Journal of Gastroenterology》 SCIE CAS 2014年第1期330-332,共3页
Postgastrectomy quality of life (QoL) is affected by various symptoms, and compared with the preoperative baseline QoL, is typically impaired for the first 6 mo after surgery. Thereafter, improvement to a stable QoL i... Postgastrectomy quality of life (QoL) is affected by various symptoms, and compared with the preoperative baseline QoL, is typically impaired for the first 6 mo after surgery. Thereafter, improvement to a stable QoL is observed at approximately 12 mo postoperatively. We consider the digestive tract reconstruction pattern to be a determining factor in postgastrectomy QoL among gastric cancer patients, and believe it requires further discussion. Proximal gastrectomy is associated with the worst postoperative QoL among gastrectomy procedures and should be performed cautiously. The trend of better QoL provided by the pouch procedure of total gastrectomy requires further robust support. Whether the use of Billroth-I gastroduodenostomy or Roux-en-Y gastrojejunostomy for distal gastrectomy is optimal remains controversial, but Roux-en-Y gastrojejunostomy is likely to be preferable. (c) 2014 Baishideng Publishing Group Co., Limited. All rights reserved. 展开更多
关键词 gastric cancer GASTRECTOMY Quality of life reconstruction Digestive tract
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Does the addition of Braun anastomosis to Billroth Ⅱ reconstruction on laparoscopic-assisted distal gastrectomy benefit patients? 被引量:2
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作者 Xiong-Guang Li Qi-Ying Song +6 位作者 Di Wu Shuo Li Ben-Long Zhang Li-Yu Zhang Da Guan Xin-Xin Wang Lu Liu 《World Journal of Gastrointestinal Oncology》 SCIE 2022年第6期1141-1147,共7页
BACKGROUND Operation is the primary therapeutic option for patients with distal gastrectomy.Braun anastomosis is usually performed after Billroth Ⅱ reconstruction,which is wildly applied on distal gastrectomy because... BACKGROUND Operation is the primary therapeutic option for patients with distal gastrectomy.Braun anastomosis is usually performed after Billroth Ⅱ reconstruction,which is wildly applied on distal gastrectomy because it is believed to benefit patients.However,studies are needed to confirm that.AIM To identify whether the addition of Braun anastomosis to Billroth Ⅱ reconstruction on laparoscopy-assisted distal gastrectomy benefits patients.METHODS A total of 143 patients with gastric cancer underwent laparoscopy-assisted distal gastrectomy at Centre 1 of PLA general hospital between January 2015 and December 2019.Clinical data of the patients were collected,and 93 of the 143 patients were followed up.These 93 patients were divided into two groups:Group 1(Billroth Ⅱ reconstruction,33 patients);and Group 2(Billroth Ⅱ reconstruction combined with Braun anastomosis,60 patients).Postoperative complication follow-up data and relevant clinical data were compared between the two groups.RESULTS There were no significant differences between Group 1 and Group 2 in postoperative complications(6.1%vs 6.7%,P=0.679),anal exhaust time or blood loss.The follow-up prevalence of reflux gastritis indicated no significant difference between Group 1 and Group 2(68.2%vs 51.7%,P=0.109).The followup European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core-30 scores revealed no evident difference between Group 1 and Group 2 as well.Group 1 had a shorter operating time than Group 2 on average(234.6 min vs 262.0 min,P=0.017).CONCLUSION Combined with Billroth Ⅱ reconstruction,Braun anastomosis has been applied due to its ability to reduce the prevalence of reflux gastritis.Whereas in this study,the prevalence of reflux gastritis showed no significant difference,leading to a conclusion that under the circumstance of Braun anastomosis costing more time and more money,simple Billroth Ⅱ reconstruction should be widely applied. 展开更多
关键词 gastric cancer BillrothⅡreconstruction Braun anastomosis Bile reflux
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Portal vein-variceal anastomosis for portal vein inflow reconstruction in orthotopic liver transplantation:A case report and review of literature
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作者 Aviad Gravetz 《World Journal of Transplantation》 2022年第7期204-210,共7页
BACKGROUND Portal vein thrombosis(PVT)is a frequent complication occurring in 5%to 26%of cirrhotic patients candidates for liver transplantation(LT).In cases of extensive portal and or mesenteric vein thrombosis,compl... BACKGROUND Portal vein thrombosis(PVT)is a frequent complication occurring in 5%to 26%of cirrhotic patients candidates for liver transplantation(LT).In cases of extensive portal and or mesenteric vein thrombosis,complex vascular reconstruction of the portal inflow may become necessary for a successful orthotopic LT(OLT).CASE SUMMARY A 54-year-old male with history of cirrhosis secondary to schistosomiasis complicated with extensive portal and mesenteric vein thrombosis and severe portal hypertension who underwent OLT with portal vein-left gastric vein anastomosis.CONCLUSION We review the various types of PVT,the portal venous inflow reconstruction techniques. 展开更多
关键词 Portal vein thrombosis Portal inflow reconstruction Orthotopic liver transplantation Splanchnic varices Left gastric varix Case report
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Multifactor analysis of the technique in total laparoscopic gastric cancer
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作者 Jia-Kun Shi Bo Wang +3 位作者 Xin-Sheng Zhang Pin Lv Yun-Long Chen Shuang-Yi Ren 《World Journal of Gastrointestinal Surgery》 SCIE 2023年第9期2003-2011,共9页
BACKGROUND Esophageal gastric anastomosis is a common surgical technique used to treat patients with gastric cancer who undergo total gastrectomy.However,using simple anastomosis techniques alone may not meet the need... BACKGROUND Esophageal gastric anastomosis is a common surgical technique used to treat patients with gastric cancer who undergo total gastrectomy.However,using simple anastomosis techniques alone may not meet the needs of patients in some cases and can lead to complications such as anastomotic stenosis and ulceration.In order to overcome these issues and improve patient prognosis,muscle flap reconstruction technique has emerged.Muscle flap reconstruction is a method of improving gastric-esophageal anastomosis by transplanting muscle tissue.By covering the anastomotic site with muscle tissue,it not only enhances the stability of the anastomosis site but also increases blood supply,promoting healing and recovery of the anastomosis.Therefore,the use of muscle flap reconstruction technique in esophageal gastric anastomosis during total gastrectomy for gastric cancer is increasingly widely applied.AIM To determine the effectiveness of esophagogastric anastomosis using the muscle flap reconstruction technology in total abdominal gastrectomy for gastric cancer and perform follow-up experiments to understand the factors affecting patients’prognosis.METHODS The study subjects were 60 patients with gastric cancer who were admitted to our hospital between October 2018 and January 2022.All patients underwent esopha-gogastric anastomosis using the double muscle flap reconstruction technology in total abdominal gastrectomy.Perioperative indicators were determined,and INTRODUCTION Gastric cancer is one of the most common tumors of the digestive system worldwide.Although gastric cancer may not have significant manifestations in the early stage,as the disease progresses,systemic symptoms such as emaciation,anemia,and gastric perforation are observed[1].Surgery is the main treatment strategy for gastric cancer.With recent advances in total laparoscopy,total laparoscopic radical resection has gradually become an important treatment strategy for gastric cancer.Conventional laparoscopic surgery may require at least 5-6 incisions,whereas total laparoscopic surgery requires only 3-4 small incisions,decreasing surgical trauma and postoperative pain[2].Furthermore,because total laparoscopic surgery is less invasive than conventional laparoscopic surgery,patients can generally return to normal living and working conditions more quickly[3].Moreover,total laparoscopic surgery does not leave obvious surgical scars;therefore,it is advantageous for patients who pay attention to appearance[4].Esophagogastrostomy is a method used to repair gastrointestinal anastomosis,called the“double muscle valve”.This technique requires folding the fundus of the stomach,followed by sealing it with two layers of tissue,forming a structure similar to a valve.The application of esophagogastrostomy to total laparoscopic radical resection for gastric cancer can effectively decrease the incidence of complications such as anastomotic incontinence and bile reflux and improve the surgical cure rate and postoperative quality of life,which is a recent topic of interest for surgeons.At present,systematic multivariate analyses of the application effects of esophagogastrostomy in total laparoscopic surgery for gastric cancer and their effects on prognosis remain scarce[5].In the present study,we conducted surgery and postoperative follow-up of patients with gastric cancer and collected relevant clinical data for esophagogastric anastomosis during postoperative resection for gastric cancer to ACKNOWLEDGEMENTS I would like to express my sincere thanks to all those who participated in the manuscript. 展开更多
关键词 Esophagogastric anastomotic muscle flap reconstruction technique Total abdominal radical gastrectomy for gastric cancer gastric cancer Perioperative indicators Prognosis Pathological parameters
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两种腔内吻合方法在机器人辅助远端胃切除术后毕Ⅱ式消化道重建中的应用比较
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作者 邓正明 江志伟 +3 位作者 王刚 葛苗苗 柳欣欣 刘江 《机器人外科学杂志(中英文)》 2024年第5期892-897,共6页
目的:初步探讨两种腔内吻合方法在机器人辅助远端胃切除术后毕Ⅱ式消化道重建中的安全性及优缺点。方法:回顾性分析2019年11月—2021年9月在南京中医药大学附属医院普外科行达芬奇机器人辅助远端胃癌根治术的64例患者的临床资料。根据... 目的:初步探讨两种腔内吻合方法在机器人辅助远端胃切除术后毕Ⅱ式消化道重建中的安全性及优缺点。方法:回顾性分析2019年11月—2021年9月在南京中医药大学附属医院普外科行达芬奇机器人辅助远端胃癌根治术的64例患者的临床资料。根据吻合方法不同将其分为手工缝合吻合组(n=35)和器械辅助吻合组(n=29)。收集患者围手术期的临床资料,对比两种吻合方法在机器人辅助远端胃切除术后毕Ⅱ式消化道重建中的优缺点。结果:64例患者均顺利完成手术,所有患者均在机器人镜下完成腔内消化道重建,无中转开腹。两组患者在手术时间、术中出血量、术后首次肛门排气时间、术后首次下床活动时间、术后首次进食流质时间及术后住院时间方面无明显统计学差异。器械辅助吻合组胃肠吻合时间较手工缝合吻合组短,而手工缝合吻合组的吻合耗材费用较低,差异具有统计学意义。两组患者术后均恢复良好,无并发症发生。结论:两种腔内吻合方法在机器人辅助远端胃切除术后毕Ⅱ式消化道重建中的应用都是安全可行的,器械辅助吻合的时间更短,手工缝合吻合的费用更低。 展开更多
关键词 达芬奇手术机器人 胃癌 毕Ⅱ式 消化道重建
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1024×1024重建矩阵结合迭代重建算法在胃部CT血管成像中的应用 被引量:1
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作者 童小雨 李贝贝 +3 位作者 王旭 陈安良 刘爱连 刘义军 《中国医学影像学杂志》 CSCD 北大核心 2024年第6期622-627,共6页
目的 探究1 024×1 024重建矩阵结合迭代重建(Karl)算法在胃部血管及肿瘤供血动脉CT血管成像中的应用价值。资料与方法 前瞻性收集大连医科大学附属第一医院2022年3—6月行胃部CT血管成像的胃部肿瘤患者30例,对CT扫描图像原始数据... 目的 探究1 024×1 024重建矩阵结合迭代重建(Karl)算法在胃部血管及肿瘤供血动脉CT血管成像中的应用价值。资料与方法 前瞻性收集大连医科大学附属第一医院2022年3—6月行胃部CT血管成像的胃部肿瘤患者30例,对CT扫描图像原始数据进行分组重建。A组采用常规512×512矩阵结合Karl 5级重建;B组采用1 024×1 024大重建矩阵结合不同等级Karl算法重建,分为B1(Karl 5)、B2(Karl 7)及B3(Karl 9)3个亚组。在轴位图像上测量胃左动脉起始部的腹主动脉、腹腔干、脾动脉、肝动脉及同层面腹壁皮下脂肪组织的CT值和SD值,计算信噪比(SNR)、对比噪声比(CNR)。由2名观察者采用5分法评估各组图像质量。结果 2名观察者主观评价一致性较好(Kappa=0.782~0.789,P<0.05),B1~B3组图像主观评分均优于A组,B2组得分最高(二维评分:χ^(2)=27.309、24.250;三维评分:χ^(2)=21.964、21.294;P均<0.05),30例患者中25例见胃动脉系统参与肿瘤供血,B2组各血管的清晰显示率均优于A组;A与B1、B2组各血管CT值差异无统计学意义(t=-1.918~2.720,P>0.05),B2组较A组血管SD值、SNR、CNR和背景噪声值,除腹主动脉SD、肝动脉CNR外差异均无统计学意义(t=-5.909~5.768,P>0.05);B1~3组图像随着Karl算法等级提高,SD值逐渐降低(F=2.881~27.109,P<0.05),SNR、CNR逐渐升高(F=3.612~12.149,P<0.05)。结论 1 024×1 024重建矩阵结合Karl 7级算法可以改善图像质量,增强胃部微细血管及肿瘤供血动脉分支的显示效果,在临床上有很好的应用价值。 展开更多
关键词 胃肿瘤 胃动脉 重建矩阵 迭代重建算法 体层摄影术 X线计算机
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腹腔镜下远端胃癌切除后消化道不同重建方式对患者预后影响分析 被引量:1
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作者 李龙 柏宇 +1 位作者 欧均斌 周强 《川北医学院学报》 CAS 2024年第4期548-550,共3页
目的:探究腹腔镜下远端胃癌切除后消化道不同重建方式对患者预后的影响。方法:回顾性分析107例腹腔镜下远端胃癌切除后消化道重建患者的临床资料,术后均随访1年。根据患者消化道重建方式不同分为Ⅰ组(n=30)、II组(n=28)和R组(n=49),Ⅰ... 目的:探究腹腔镜下远端胃癌切除后消化道不同重建方式对患者预后的影响。方法:回顾性分析107例腹腔镜下远端胃癌切除后消化道重建患者的临床资料,术后均随访1年。根据患者消化道重建方式不同分为Ⅰ组(n=30)、II组(n=28)和R组(n=49),Ⅰ组采取Billroth-Ⅰ式吻合;Ⅱ组患者采取Billroth-Ⅱ式联合布朗吻合;R组患者采取Roux-en-Y吻合。探究各组围术期情况,比较各组术后3周内及术后1年时并发症发生情况。结果:Ⅰ组患者手术时间低于Ⅱ组及R组(P<0.05);各组患者术后3周内并发症发生率比较,差异均无统计学意义(P>0.05);术后1年,R组患者胆汁反流、反流性胃炎发生率低于Ⅰ组及Ⅱ组(P<0.05)。结论:Billroth-Ⅰ式吻合有助于缩短手术时间,但Roux-en-Y吻合在术后远期效果更具优势。 展开更多
关键词 远端胃癌 腹腔镜 消化道重建 预后 并发症
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近端胃切除后改良肌瓣吻合术的效果分析
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作者 岳超 彭锐 +10 位作者 孙广立 陈亮 汪海天 徐卫国 魏尉 周斌 文旭 顾荣民 明学志 陈环球 李刚 《中国肿瘤外科杂志》 CAS 2024年第5期439-444,共6页
目的分析食管胃改良肌瓣吻合加胃间置术用于近端胃切除术的可行性及疗效。方法采用回顾性分析方法,收集2019年11月至2022年10月江苏省肿瘤医院胃外科收治的9例患者的临床资料,近端胃切除后均采用改良浆肌瓣吻合法行食管胃吻合加双通道... 目的分析食管胃改良肌瓣吻合加胃间置术用于近端胃切除术的可行性及疗效。方法采用回顾性分析方法,收集2019年11月至2022年10月江苏省肿瘤医院胃外科收治的9例患者的临床资料,近端胃切除后均采用改良浆肌瓣吻合法行食管胃吻合加双通道胃间置行消化道重建。简要步骤为:于残胃前壁标记制作浆肌层隧道,长约3.0 cm,宽约3.5 cm,在食管断端上缘约5.0 cm处与肌皮瓣上缘固定,食管残端置入隧道,手工缝合食管残端与残胃,隧道吻合完成后行胃空肠吻合及空肠空肠吻合。观察患者手术安全性、围手术期并发症发生情况,术后1年内镜随访,根据改良洛杉矶分级系统评估反流性食管炎严重程度。术后1年应用EORTC QLQ-C30量表评估生活质量。结果所有病例均顺利完成手术,其中2例为腹腔镜辅助手术,7例为开放手术。手术时间为(195.2±39.8)min,吻合时间为(69.8±4.1)min,肌瓣制作时间为(21.2±3.8)min,术中失血(82.2±47.9)mL。术后通气时间为(2.6±0.7)d,总住院时间为(13.6±1.3)d。术后所有病例均无ClavienDindo分级Ⅱ级及以上并发症发生。术后1年内镜随访未见明显吻合口狭窄及反流。术后1年患者健康状况、功能量表评分较术前提高(P<0.05),症状量表评分与术前差异无统计学意义(P=0.847)。结论改良浆肌瓣食管胃吻合术浆肌瓣血供良好,能够维持良好的单向阀功能,有助于降低术后反流性食管炎发生率,改善患者术后生活质量,是一种安全可行的吻合方式。 展开更多
关键词 近端胃切除 食管胃吻合 改良浆肌瓣吻合 双通道胃间置术
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裤形吻合与RY吻合方式在胃癌全胃切除后的应用价值比较
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作者 王亮 赵军 +1 位作者 汪兵 史良会 《河北医学》 CAS 2024年第3期462-469,共8页
目的:比较裤形吻合与Roux-en-Y(RY)吻合方式在胃癌全胃切除后的应用价值。方法:选取2020年1月至2023年5月我院收治的行全胃切除术治疗的胃癌患者108例作为研究对象,分为RY吻合组54例、裤形吻合组54例,两组均接受全胃切除术治疗,RY吻合... 目的:比较裤形吻合与Roux-en-Y(RY)吻合方式在胃癌全胃切除后的应用价值。方法:选取2020年1月至2023年5月我院收治的行全胃切除术治疗的胃癌患者108例作为研究对象,分为RY吻合组54例、裤形吻合组54例,两组均接受全胃切除术治疗,RY吻合组、裤形吻合组分别于胃癌全胃切除术后以RY吻合方式、裤形吻合方式行消化道重建。比较两组手术指标、术后并发症、营养指标[总蛋白(TP)、血红蛋白(Hb)、血清白蛋白(ALB)及预后营养指数(PNI)]、生命质量(QLQ-C30)及远期不良事件发生率。结果:两组患者手术指标比较无意义(P>0.05)。RY吻合组术中1例由于肠管尺寸原因更换吻合器,RY吻合组术中吻合器更换率高于裤形吻合组,但两组比较无意义(P>0.05)。裤形吻合组术后并发症总发生率低于RY吻合组(P<0.05)。裤形吻合组远期不良事件总发生率低于RY吻合组(P<0.05)。与术前比较,两组患者术后3个月、6个月营养评价指标TP、Hb、ALB、PNI均升高,且随着术后时间的延长逐渐升高(P<0.05),在两组术后指标比较中,裤形吻合组TP、Hb、ALB、PNI高于RY吻合组(P<0.05)。与术前比较,两组患者术后3个月、6个月生命质量QLQ-C30评分均升高,且随着术后时间的延长逐渐升高(P<0.05),在两组术后指标比较中,裤形吻合组生命质量QLQ-C30评分高于RY吻合组(P<0.05)。结论:与RY吻合的胃癌全胃切除后消化道重建方式比较,裤形吻合所带来的并发症较低,且裤形吻合在抗胆汁反流、反流性食管炎、食物排空障碍方面优于RY吻合,患者术后可获得更好的营养支持,患者生命质量显著提高,应用价值较高。 展开更多
关键词 裤形吻合 ROUX-EN-Y吻合 胃癌 全胃切除术 消化道重建
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