Comprison of surgical reconstruction of digestive tract after gastric resection / 中国基层医药

Objective To compare total gastrectomy jejunal loop P-type esophagus jejunum Roux-en-Y anastomosis(PRY) and non-type esophageal transection of the jejunum improved Roux-en-Y anastomosis(URY) two different digestion Road reconstruction on the nutritional status of patients and gastrointestinal symptoms. Methods 152patients with total gastrectomy required of gastric cancer patients immediately divided into two groups ,76 patients in each group ,respectively PRY and URY surgical reconstruction of digestive tract, were followed up for 12 months, two groups were compared on nutritional status and gastrointestinal symptoms. Results PRY operation time and postoperative complication rate we re more than URY group(all P ＜0.05) ;two groups 12 months after the mortality and weight changes, hemoglobin, total protein, albumin, and all reflux esophagitis the incidence rate was no significant difference (all P ＞ 0.05); after 3 months and 6 months in both groups food intake ＜ 300ml/second person, eating frequency ＞5 times/d and the difference in the incidence of RSS had statistical significance (all P ＜ 0.05). Conclusion URY surgical reconstruction of digestive tract and maintain the continuity of muscle conduction,and the surgical procedure was simple,a good prognosis and relatively PRY more reasonable in terms of surgical procedures.

Partial gastric resection for Dieulafoy lesion by a combined endoscopic and laparoscopic approach / 中华消化外科杂志

Dieulafoy lesion are usually located in the stomach but can also occur in the small or large intestines. It is an uncommon but significant source of massive upper gastrointestinal hemorrhage. A female patient with Dieulafoy lesion was admitted to the Tenth People's Hospital of Tongji University on June 2, 2009. The site of the lesion was diagnosed at the anterior wall of stomach with a bleeding vessel in the center. The size of the lesion was about 1.0 cm×1.0 cm. Partial gastric resection was successfully performed using laparoscopy and endoscopy. The lesion was demarcated by gastroscope, and then it was hung up and removed by laparoseope. Bowel movement recovered at the second day, and the patient was discharged 6 days after surgery. The patient was followed up for 1 month, and no recurrent hemorrhage or other complications were observed. The combined approach of laparoscopy and endoscopy not only resects the lesion completely and widens the scope of minimally invasive surgery but also decreases the risk of operation.

Assessment on the accuracy of diagnostic methods for Helicobacter pylori infection in patients with partial gastrectomy / 中华消化杂志

Objective To investigate the status of Helicobacter pylori(H.pylori) infection and the accuracy of the two commonly used diagnostic methods, the 14 C urease breath test( 14 C UBT) and the rapid urease test(RUT) in patients with partial gastrectomy due to peptic ulcer or gastric cancer. Methods Culture, histology, RUT, combined with 14 C UBT, were carried out to diagnose the H. pylori infection in patients with partial gastrectomy. The Giemsa staining and H.pylori culture served as the ‘golden reference’ in evaluating the diagnostic accuracy of the RUT and 14 C UBT. The prevalence of H.pylori infection of patients with partial gastrectomy was determined with the dyspeptic controls without surgery. Results 37 patients (17 Billroth Ⅰ resection, 20 Billroth Ⅱ resection) were included in the study. The overall prevalence in the Giemsa staining and culture proved as H.pylori infection was 29.7%, and no statistical difference was seen between patients will Billroth Ⅰ(29.4%) and Billroth Ⅱ(30.0%) resections. The sensitivity of the RUT was 72.7%, the specificity was 57.7%, and the overall accuracy was 62.2%. The sensitivity of the 14 C UBT was 63.6%, the specificity was 100.0%. The negative predictive value was 86.7%, and the overall accuracy was 89.2%. The total prevalence of H.pylori infection in the controls was 71.4%. Conclusion Prevalence of H.pylori infection in patients with partial gastric resection is low. The two diagnostic methods, 14 C UBT and RUT, cannot be recommended as accurate diagnostic tools for H.pylori infection in patients after partial gastrectomy due to low specificity and low sensitivity, respectively.

Surgical Therapy for Gastric Cancer with Hepatic Cirrhosis

BACKGROUND: The prognosis following surgery for gastric cancer has been markedly improved as a result of early diagnosis and advancements both in operative techniques and perioperative management. However, gastrointestinal surgery in the presence of hepatic cirrhosis has shown high operative morbidity and mortality due to severe perioperative complications, such as bleeding, lymphorrhea, anastomosis leakage, hepatic failure, fluid retention, acute renal failure, and multiple organ failure. Recently, the number of gastric-cancer patients patient who has liver cirrhosis has been increasing, especially for early gastric-cancer cases. METHODS: From June 1995 to December 1997, a total of 410 patients with gastric cancer were treated surgically in our degartment. RESULTS: Of the 410, 9 cases with liver cirrhosis underwent a gastric resection: 5 standard subtotal gastrectomies and 4 curative subtotal gastrectomies. Three major postoperative complications occurred in 2 patient: anastomosis leakage in one and bleeding in both. CONCLUSIONS: The purpose of this study was to report our complicated cases, to assess the causes of the complications, and to decide the appropriate operation type for improving the prognosis of these patients. Serosal flap can be the solving techniques in B-I anastomosis and complicated perforation in cirrhosis.

A Clinical Analysis of Laparoscopic Benign Gastric Tumor Resection

BACKGROUND: Benign gastric tumors can be safely removed laparoscopically without any problem. METHODS: Fifteen patients were considered candidates for laparoscopic resection of benign gastric tumors. Criteria for patient selection included who has persistent complaints of clinical symptoms, tumor size less then 5 cm, and benign characteristics. All patients underwent preoperative gastricfibroscopy, and some pathologically questionable cases also received abdominal computerized tomography (CT) and endoscopic ultrasonography (EUS). The operative procedures were performed using a gas or gasless laparoscopic technique. Especially in posterior wall gastric tumors, we used a long aorta clamp with the gasless technique instead of opening the anterior gastric wall. After resection of the tumor, we used hand sewing or a stapling device for anastomosis. The results of the operations and the clinical course were analyzed retrospectivelly. RESULTS: Final pathologic diagnoses included a heterotropic pancreas, a leiomyoma, a neurofibroma, a neurilemmoma and a gastrointestinal stromal tumor (GIST). Only one case was converted to a laparotomy. There was one instance of postoperative suture line bleeding. The mean operative time was 174 min, and the mean hospital stay was 6.3 days. One pathologically confirmed GIST case had malignant characteristics. CONCLUSION: Laparoscopic management of benign gastric tumors can be perform safely with excellent clinical course.

Surgical Therapy for Gastric Cancer with Hepatic Cirrhosis

BACKGROUND: The prognosis following surgery for gastric cancer has been markedly improved as a result of early diagnosis and advancements both in operative techniques and perioperative management. However, gastrointestinal surgery in the presence of hepatic cirrhosis has shown high operative morbidity and mortality due to severe perioperative complications, such as bleeding, lymphorrhea, anastomosis leakage, hepatic failure, fluid retention, acute renal failure and multiple organ failure. Recently, the frequency of gastric cancer involving liver cirrhosis has been increasing, especially early gastric cancer cases. METHODS: From June 1995 to December 1997, a total of 410 patients with gastric cancer were treated surgically. Among them, 9 cases with liver cirrhosis underwent gastric resection. RESULTS: Three major postoperative complications occurred in 2 patient, anastomosis leakage in one, and bleeding in both. CONCLUSIONS: The purposes of this study were to assess the causes of complications and to decide the appropriate operation type for improving the prognosis for these patients with liver cirrhosis.

Three Cases of Gastritis Cystica Polyposa Following Partial Gastric Resection

Gastritis cystica polyposa was diagnosed in three patients with ages of 49, 56 and 66 years. All patients had been operated on for gastric cancer 1 to 5 years earlier, with Billroth II gastroenteric anastomose being made at that time. The lesions were diagnosed by regular follow-up endoscopic examination without any presenting symptoms. Macroscopically, all lesions were located on the gastric side of the anastomosis, with polypoid growth of 1.5x1.0, 2.0x1.5, and 0.5x0.5 cm in size respectively. The surfaces of the lesions were coarsely nodular and brittle, and one of them protruded into the anastomosis lumen. Histologic examination revealed polypoid mucosal changes associated with functionally active, hyperplastic and cystic dilatation of the glands which had infiltrated to into the underlying submucosa. An endoscopic polypectomy was performed in two patients, and all has gone well, without evidence of a recurrent tumor 6 & 18 months after polypectomy. The other patients refused a polypectomy. Gastritis cystica polyposa should be differentiated from a stump carcinoma to avoid a further unnecessary surgical intervention. Awareness of the entity will lead to better diagnosis of gastritis cystica polyposa.

Clinical Review of Cholelithiasis after Gastric Resection in Patients with Stomach Cancer

This is a review of gastric resection surgeries that were carried out in 570 patients with stomach cancer who were admitted to Kyung Hee University Hospital from January, 1989 through December, 1993. In order to establish the incidence of cholelithiasis after gastric resection, patients was examined with abdominal ultrasonography preoperatively and postoperatively. The prevalence of cholelithiasis at admission was 4.6%. Study candidates consisted of 366 patients, except those who had cholelithiasis preoperatively and who didn't have a follow-up after gastric resection. Cholelithiasis after gastric resection developed in 16.4%(60/366) of patients, and which was significantly higher than incidence of cholelithiasis at admission(p0.05). In 51.6%(31/60) of patients, cholelithiasis have developed within 1 year after operation. The incidence of cholelithiasis after total gastrectomy with esophagojejunostomy(21.8%) was higher than subtotal gastrectomy with gastrojejunostomy(15.3%) or with gastroduodenostomy(14.3%), but it was not shown to be a statistical difference(p>0.05). There was no relation between the incidence of cholelithiasis and the stage of the stomach cancer. Four of the sixty patients presenting cholelithiasis underwent cholesystectomy because of significant billiary symptoms. In conclusion, cholelithiasis appears to be a frequent complication after gastrectomy. It may be related to the vagotomy which is performed at the time of gastric resection.