ABSTRACT
The integration education is organized around "an organ system" of the body, and integrates multiple medical disciplines orderly, which is the main trend of medical education reformation at home and abroad. Digestive diseases are diverse and complicated, so that it is of great significance to apply integration education mode in the clinical teaching of digestive system. Taking the clinical clerkship teaching of digestive system in The First Affiliated Hospital of Chongqing Medical University as an example, through reasonably integrating the course content, fully applying problem-based learning (PBL) method, taking multiple teaching methods, combing ideological and political education, and paying more attention to improving the teachers' training, the learning enthusiasm of students could be stimulated, their independent thinking ability and holistic medical view could be cultured, and the teaching effect would be effectively improved.
ABSTRACT
<p><b>OBJECTIVE</b>To compare the long-term survival of total laparoscopic radical distal gastrectomy (TLDG) with delta-shaped anastomosis and laparoscopic assisted radical distal gastrectomy (LADG) with tubular anastomosis.</p><p><b>METHODS</b>The study retrospectively analyzed the clinical and pathologic data of 160 distal gastric cancer patients who underwent laparoscopic radical distal gastrectomy with Billroth I anastomosis at the First Affiliated Hospital of Chongqing Medical University from December 2012 to March 2015. All the patients were definitively diagnosed as primary gastric carcinoma before operation, and no evidences of invasion to adjacent organs, distant metastasis or enlarged fused lymph nodes around important vessels were discovered by image tests. Eighty-six patients underwent TLDG with delta-shaped anastomosis (delta-shaped anastomosis group, DSG) and 74 patients underwent LADG with tubular anastomosis (tubular anastomosis group, TAG) in two surgery teams who had different experience of gastroduodenostomy. All the patients agreed the operation and signed informed consent. All patients followed until October 2015 when the final cumulative survival rate was counted. Survival was analyzed by Kaplan-Meier method.</p><p><b>RESULTS</b>The baseline data were comparable and operations were successfully completed. Postoperative follow-up time of DSG was 7-32 months, follow-up rate was 91%(78/86), and 11 of whom died of the gastric cancer. The cumulative survival rate by the end of the follow-up was 82.8%. Postoperative follow-up time of TAG was 7-33 months, follow-up rate was 95%(70/74), 7 of whom died of the gastric cancer. The cumulative survival rate by the end of the follow-up was 81.7%. The intergroup difference of cumulative survival rate was not significant(χ(2)=1.210, P=0.271). No stage I patient died of gastric cancer in both groups. The cumulative survival rate by the end of the follow-up of stage II was 87.2% vs. 93.3%(DAG vs. TAG, χ(2)=0.426, P=0.514) ,and in stage III was 65.3% vs. 37.6%(DAG vs. TAG, χ(2)=0.718, P=0.397), and the differences were not significant.</p><p><b>CONCLUSION</b>The TLDG with delta-shaped anastomosis and LADG with tubular anastomosis have similar long-term survival for distal gastric cancer treatment.</p>