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Objective To analyze laparoscopic lymphadenectomy and the safety of gastrectomy for gastroesophageal junction cancer.Methods From Jan 2011 to Dec 2012 72 gastroesophageal junction cancer patients were enrolled, including 46 patients in laparoscopic group, and 26 in open surgery group.Results There was no significant difference in the numgbers of lymph node dissection between the two groups and nor difference in the number of positive lymph node dissection.Esophagus resection length in open group was (2.0 ± 1.0) cm, while that was (3.0 ± 0.8) cm in laparoscopic group (t =0.471, P ＜ 0.001).5 (19％)patients in open group had positive margins compared to six in laparoscopic group (13％), x2 =0.491, P =0.483.7 patients in the open group underwent thoracoabdominal resection, while in laparoscopic group 3 patients did, x2 =5.781, P =0.016.Laparoscopic splenic hilar lymphnodes dissection harvested more lymph nodes (t =0.260, P =0.011).Laparoscopic gastrectomy used less operation time (t =0.237, P =0.021) experinced less blood loss (t =0.451, P ＜ 0.01) than open group.There was no difference in major complications between the two groups.Conclusions Laparoscopic splenic hilar lymphnodes dissection in gastroesophageal junction cancer surgery is superior to open surgery, with more lymph nodes harvested, longer esophageal cutting distances, lower incidence of thoracoabdominal surgery, shorter operation time, and less blood loss.
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Objective To introduce a novel technique of intracolonic shunt procedure used in the anus - preserving operation for acute intestinal obstruction resulted from cancer at low and middle portions of rectum and assess the clinical significance. Methods In total, 81 patients with acute obstruction of low and middle portion of rectum caused by cancer were randomly ( random number) divided into control group and study group. In control group, 42 patients were operated with preventive transverse colonostomy or terminal ileum stoma after low proximal resection of rectum involved in cancer, while 39 patients were operated with intracolonic shunt procedure by using a biodegradable anastomosis ring and a condom placed 5 cm above anastomosis for protection in study group. Results There were no significant differences in sex, age, tumor site, tumor size and the distance from anstomosis to anal-edge between two groups. In both groups, the bowel movement resumed in 2 ~ 5 days after operation (P > 0.05). In study group, the rate of anastomosis leakage was 7.7% (3/39), and leakages were treated with drainage for 7.1 days in average to be healed, and the biodegradable anastomosis ring detached and were discharged in 14 -23 days (17 days in average), and there were no complications of drainage happened. The anastomotic stenosis occurred in three patients (7. 7% ) within 6 months after operation. In control group, 11.9% patients (5/42) had anastomosis leakage and they treated with drainage for 18.2 days in average to get the leakage healed, and 35. 7% patients (15/42) had stoma complications, and anastomotic stenosis happened in 28.6% patients (12/42) within 6 months after operation, and 7. 1% patients need another operation because of severe anastomosis stenosis. There were no significant differences in rate of anastomosis leakage between tow groups ( P > 0. 05), but there were significant differences in drainage days after anstomosis leakage happened and 6 - months anastomosis stenosis between two groups (P<0.05). Conclusions In the anus -preserving operation for acute intestinal obstruction at low and middle portions of rectum caused by cancer , the intracolonic shunt procedure is convenient and safty, and reduces the hazard incurred by anastomosis leakage and anastomosis stenosis compared with classic stoma operation.
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This paper analyzed the problems that currently exist in clinical practice and put forward the countermeasures to improve the quality of clinical practice,such as enhancing ideological and political education of practice students,mending check-up system in clinical practice,and so on.
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Objective To study the indication and means in dissection lymph nodes of the No.10 and No.11 without splenectomy in radical gastrectomy for gastric cancer. Methods According to the location, type of pathology, clinical and pathological classification, lymphatic drainage and spread of gastric carcinoma togather with the immunological function of spleen, selection of operative procedure without splenectomy should be considered, so the related literatures were reviewed. Results Retained spleen had been shown to improve 5 year survival of patients with gastric cancer of stage Ⅰ,Ⅱ and Ⅲ,splenectomy had been shown to improve 5 year survival of patients with gastric cancer of stage Ⅳ,whose carcinoma was infiltrating splenic and the lymph nodes of the No.10. The complications of different means of dissection of the lymph nodes made no difference.Conclusion Dissection of the lymph node without retained spleen or allogenic spleen transplantation is indicated for the patients with cancer of stage Ⅳ,whose spleen is invaded by the tumor.