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Objective To explore the type of the rational digestive reconstruction after total gastrectomy for gastric malignancy.Metlhods Three types of digestive reconstruction were performed after total gastrectomy in 121 cases with gastric carcinoma.The operating time,morbidity and mortality,digestive tract symptoms,nutritional status in 1 year after operation were compared.Results There were no signifioant differences among the three procedures in operative morbidity and mortality,postoperative food intake,nutritional status,incidences of diarrhea and dumping syndrome.Roux-en-Y esophajejunostomy and P-type esophajejunostomy had an advantage d anti-esophageal reflux,and are obviously superior to Lahey + Braun anastomosis.Roux-en-Y esophajejunostomy was simpler with shorter operating time and less complication.Condusion Roux-en-Y esophajejunostomy and P-type esophajejunostomy could be recommended as suitable methods for digestive reconstruction after total gastrectomy.
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Objective To investigate the feasibility of hypocaloric nutrition support in elderly patients.Methods Sixteen elderly patients ( ＞ 85 years) were treated with hypocaloric nutrition for 4 weeks. The calorie intake was 75-96 kJ·kg-1·d -1 , including 44％ -59％ of carbohydrates ( 137-207 g·d -1 ) , 26％ -42％ of lipids (40-67 g·d-1) , and 14％-16％ of proteins (0.7-0.9 g·kg-1·d-1). Nonprotein calorie-to-nitrogen ratio was 131∶1-150∶1. After 4 weeks of treatment, changes in blood routine test, biochemistry, and clotting function were compared with those before hypocaloric nutrition support. Results After hypocaloric nutrition support, the plasma proteins, blood fats, and lymphocytes in these 16 elderly patients were well maintained, and no obvious adverse effect on clotting function or liver/kidney functions was observed. Conclusion Hypocaloric nutrition support is safe and effective for elderly patients who are older than 85 years.
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Objective To analyze clinicopathological characteristics of recurrence after gastrectomy for early gastric cancer. Methods 308 patients were treated surgically for early gastric cancer from 1983 to 2005. 245 patients were followed up after gastric resection.Clinicopathologic factors were investigated by using univariate methods and multivariate analysis for the possible relationship to recurrence. Results 30 patients developed recurrent disease (median 28 months). The 1-year, 3-year, 5-year, 7-year, 10-year and 15-year recurrent rates were 5.49%, 8.44%, 11.27%, 14.83%, 16.39% and 37.79%, respectively. 13 patients with mucosal gastric cancer developed recurrent disease (median 24 months). The 1-year, 3-year, 5-year, 7-year, 10-year and 15-year recurrent rates were 4.23%, 6.68%, 7.75%, 9.34%, 9.34% and 28.24%, respectively. 17 patients with submucosal gastric cancer developed recurrent disease (median 31 months). The 1-year, 3-year, 5-year, 7-year, 10-year and 15-year recurrent rates were 7.39%, 11.14%, 16.54%, 24.49%, 29.69% and 64.85%, respectively. Cox multivariate analysis showed that submucosal invasion (P=0.044, OR=2.172) was a positive independent risk factor and paracarcinomatous mucosal medium-severe intestinal metaplasia (P=0.047, OR=0.460) was a negative independent risk factor for recurrence. 76.7% (23/30) patients with recurrence did not have indication of resection for a cure, and they did not undergo surgery again. 23.3% (7/30) patients with recurrence had indication for curative resection, and 4 of whom underwent curative resection, but 3 did not because of poor health. Pathological examination after surgery showed that in 3 patients there was early gastric cancer in the remnant stomach without lymph node metastasis, and in one patient there was advanced gastric cancer in remnant stomach with regional lymph node metastasis. The patient with advanced gastric cancer survived for 28 month without detectable tumor. Logistic regression analysis showed paracarcinomatous mucosal medium-severe intestinal metaplasia (P=0.016, OR=17.000) was a positive independent predictor for second radical surgery. The follow-up examinations including endoscopy were performed in 86.7% (26/30) of patients after operation at least every 1-2 years. Conclusion Early gastric cancer patients with submucosal invasion have a high risk of recurrence, and those with paracarcinomatous mucosal medium-severe intestinal metaplasia have a low risk of recurrence. The patients with paracarcinomatous mucosal medium-severe intestinal metaplasia and cancer recurrence are feasible for a curative resection. The follow-up examinations including endoscopy every 1 or 2 years contributed highly to finding an early recurrent cancer in the remnant stomach. But it is not so helpful to increase the possibility of a curative surgery in patients with recurrence and metastasis after gastrectomy.
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2cm) and undifferentiated type were significantly related to lymph node metastasis in submucosal cancer. No lymph node metastasis was observed in 25 patients with submucosal invasion who showed none of the three risk factors, whereas 72.7% (8/11) of patients with all the three factors had lymph node metastasis. Conclusion The tumor size and lymphatic vessel involvement are related with lymph node metastasis in mucosal cancer. Poor differentiation, tumor size and lymphatic vessel involvement are related with lymph node metastasis in submucosal cancer.
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Objective To investigate the clinical value of serum CEA, CA19-9 and CA724 in patients with colonic carcinoma. Methods Serum levels of CEA, CA19-9 and CA724 were detected with ELISA in 89 patients suffering from colonic cancer. Results The positive rates of CEA, CA19-9 and CA724 in Dukes' stages C and D patients were remarkably higher than those in Dukes' stages A and B patients(64% vs 26%,46% vs 22%,26% vs 8% respectively, P
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Esophageal manometry and 24 hour pH monitoring were performed in elderly control group,non elderly control group,elderly and non elderly gastroesophageal reflux disease (GERD) patients with or without sliding hiatal hernia(HH).Elderly patients with GERD and HH showed a lower LESP compared with elderly GERD patients without HH and elderly controls.Non elderly patients with GERD and HH also showed a lower LESP compared with non elderly controls.Elderly GERD patients with HH showed a lower pressure of contraction at the distal esophagus compared with elderly GERD patients without HH.Extent of reflux had no difference between elderly GERD patients with and without HH.The results suggested that HH affect esophageal antireflux function and peristalsis of the distal esophagus in elderly and non elderly GERD patients,especially in elderly GERD patients,but it could not significantly increase esophageal acid exposure in elderly GERD patients.
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Objective To sum up the trend of changes in symptoms of prolonged symptomatic gastroesophageal reflux(GERD), and discuss the relationship between reflux symptoms and the medical treatment in the elderly patients with GERD. Methods 98 elderly GERD patients over 60 years old were followed up for 5 years through questionaires. The changes of reflux symptoms and effect of medication were analyzed. Results Reflux symptoms were improved in 71 subjects (72.4%), disappeared in 10, worsened in 9, and remained unchanged in 18. The symptom improvement rate of medication group was significantly higher than that of non-medication group(P0.05). In 62 subjects who modified their life styles and diet habits, 53 of them had their symptoms improved (85.5%), and 9 of them had their symptoms unchanged (14.5%). Among 98 patients who underwent endoscopic examination, 44 were found to have erosive esophagitis, and were diagnosed as reflux esophagitis(RE). Although the other 54 subjects complained of typical "heart burn" and regurgitation symptoms, no erosive esophagitis was found with endoscopy, and they were regarded designated as having non-erosive reflux disease(NERD). The symptom improvement rate of NERD group was significantly higher than that of RE group(P