ABSTRACT
Objective:To develop a formula for estimating the insertion length of orogastric (OG) tube for preterm infants based on growth indicators and gestational age (GA).Methods:From January 2020 to December 2021, preterm infants admitted to the neonatal intensive care unit of our hospital were retrospectively reviewed. OG tubes were inserted within 24 h of admission and the lengths of OG tubes were adjusted according to chest and abdominal X-ray results. The formula for OG tube placement was developed using stepwise regression analysis method with GA, body weight (BW) and body length (BL) as the independent variables and the corrected length of OG tube as the dependent variable. The weight-based formula developed by Freeman et al. were compared.Results:A total of 180 preterm infants were included, with 90 cases GA<32 weeks, 84 cases GA 32~35 weeks and 6 cases GA 36 weeks. No significant differences ( P>0.05) existed in the incidences of misplacement of OG tube and the specific types of misplacement among GA groups. For infants with GA≤35 weeks, the insertion length of OG tube was positively correlated with BW and BL and for preterm infants with GA 36 weeks, the insertion length of OG tube was positively correlated with BW only. Stepwise regression analysis showed the formula as OG tube length (cm)=11.8+2.1×BW (kg) or OG tube length (cm)=9.5+1.6×BW (kg)+0.091×GA (week). Comparing with the formula developed by Freeman et al., the differences of OG tube length estimated using our formula were more prominent as BW increased. Conclusions:The length of OG tube is positively correlated with BW and GA with BW shows more influence.
ABSTRACT
To investigate the effect of long-term indwelling gastric tube on the prevention and treatment of esophageal stenosis after endoscopic submucosal dissection (ESD) for esophageal circumferential superficial cancer, data of patients with esophageal circumferential superficial cancer who underwent ESD in the First Affiliated Hospital of Nanjing Medical University from January 2018 to December 2021 were retrospectively analyzed. There were 15 patients with gastric tube placement (GTP) after ESD (the GTP group ), and 23 patients without GTP (the non-GTP group). The general information, lesion location, pathological stage, postoperative complications, degree of esophageal stenosis (water intake), pain conditions, number of hospitalizations and medical expenses were compared between the two groups. The results showed that there was no significant difference in age, gender, lesion location or postoperative pathological stage between the two groups ( P>0.05). Compared with the non-GTP group, the rate of water intake in the GTP group was significantly higher (11/15 VS 6/23, P<0.05), the frequency of pain was less in the GTP group (7.3±3.1 times VS 10.7±3.6 times, t=3.00, P<0.05), and the number of hospitalizations and the medical expenses after ESD to before and after stent placement were significantly lower in the GTP group than those in the non-GTP group ( P<0.05). There were no significant differences in the incidence of delayed bleeding and perforation, or time of the first stenosis after ESD between the two groups ( P>0.05). The results of the study initially showed that long-term indwelling gastric tube after ESD can reduce the degree of esophageal stenosis with good safety for esophageal circumferential superficial lesions.
ABSTRACT
Resumen Objetivo: Describir resultados de la cirugía de sustitución esofágica con tubo gástrico invertido, vía ascenso retroesternal en dos hospitales pediátricos durante el período marzo 2015 a marzo 2018. Materiales y Método: Un estudio observacional, transversal, con recolección de datos retrospectivo, donde se incluyeron todos los expedientes de pacientes que presentaban patología del esófago por causa adquirida o congénita que fueron operados de sustitución esofágica con tubo gástrico invertido en dos hospitales pediátricos durante 3 años. Resultados: Encontramos 29 niños sometidos a sustitución esofágica, de los cuales 27 cumplieron criterios de inclusión. La edad comprendida entre 2 y 17 años. El 63% corresponde al sexo femenino. La causa más frecuente de sustitución esofágica es por estenosis esofágica por ingesta caustica (92,59%). El 70% presentó algún tipo de complicación luego de la cirugía. La fístula esofagocutánea es la complicación principal con 33,33%. La permanencia en la unidad de cuidados intensivos es menor de 24 horas en un 74% de los niños. Se inicia la vía oral en casi la mitad de casos entre los 10-12 días de posquirúrgico, la estancia hospitalaria es en promedio 18,5 días. La mortalidad es 3,7%. Conclusión: La sustitución esofágica por tubo gástrico invertido vía ascenso retroesternal, es una técnica comparable en resultados a la interposición de colón. Para los autores, el estómago es un órgano ideal para realizar la reconstrucción esofágica, y sus complicaciones son manejables.
Aim: To describe the results of esophageal replacement surgery with an inverted gastric tube via retrosternal ascent in two pediatric hospitals during the period March 2015 to March 2018. Materials and Method: an observational, cross-sectional study with retrospective data collection that included all the records of patients with esophageal discontinuity due to acquired or congenital causes who underwent esophageal replacement surgery with an inverted gastric tube in two pediatric hospitals for 3 years. Results: We found 29 children undergoing esophageal replacement, of which 27 met inclusion criteria. The age between 2 to 17 years. 63% corresponds to the female sex. The most frequent cause of esophageal replacement is esophageal stricture due to caustic ingestion (92.59%). 70% presented some type of complication after surgery. The esophagocutaneous fistula is the main complication with 33.33%. The stay in the intensive care unit is less than 24 hours in 74% of children. The oral route is started in almost half of cases between 10-12 days after surgery; the hospital stay is on average 18.5 days. Mortality is 3.70%. Conclusión: The esophageal substitution by inverted gastric tube via retrosternal ascent is a technique comparable in results to the interposition of the colon. For the authors, the stomach is an ideal organ to perform esophageal reconstruction, and its complications are manageable.
Subject(s)
Humans , Male , Female , Child , Adolescent , Colon/surgery , Esophageal Atresia/surgery , Esophagoplasty/methods , Postoperative Complications , Stomach/surgery , Anastomosis, Surgical/methods , Demography , Esophageal Stenosis , Esophagus/surgeryABSTRACT
Objective:To investigate the application value of modified Overlap esophago-gastric tube (MO-EG) reconstruction in totally laparoscopic radical proximal gastrectomy.Methods:The retrospective and descriptive study was conducted. The clinicopathological data of 7 patients with upper gastric cancer or adenocarcinoma of esophagogastric junction (AEG) who underwent totally laparoscopic radical proximal gastrectomy with MO-EG reconstruction in the Second Hospital of Jilin University from January 2019 to December 2020 were collected. There were 4 males and 3 females, aged 62(range, 55-72)years. The body mass index of the 7 patients was 21.5(range, 18.5-26.0)kg/m 2. Of the 7 patients, 2 cases had early upper third gastric cancer and 5 cases had Siewert Ⅱ AEG. All patients underwent totally laparoscopic radical proximal gastrectomy with MO-EG recons-truction using barbed sutures. Observation indicators: (1) surgical situations; (2) postoperative recovery situations; (3) postoperative histopathological examinations; (4) follow-up. Follow-up was conducted using outpatient examination and telephone interview to detect postoperative esophageal reflux, endoscopic classification of esophageal reflux, anastomotic complications, tumor recurrence and metastasis and survival of patients up to December 2021. Measurement data with normal distribution were represented as Mean±SD and measurement data with skewed distribution were represented as M(range). Count data were described as absolute numbers. Results:(1) Surgical situations. All the 7 patients underwent totally laparoscopic radical proximal gastrectomy and D 1+ lymph node dissection with MO-EG reconstruction through abdominal transhiatal approach. None of the 7 patients underwent conversion to open surgery or additional thoracotomy. The operation time, time of digestive reconstruction, volume of intraoperative blood loss and length of esophagus dissected of 7 patients were (271±36)minutes, (44±10)minutes, (53±26)mL and (6.4±0.3)cm, respec-tively. (2) Postoperative recovery situations. The time to postoperative initial out-of-bed activities, time to postoperative first flatus, time to postoperative initial liquid food intake and duration of hospital stay of 7 patients were (21±5)hours, (2.9±0.9)days, (5.0±0.7)days and (10.1±1.9)days, respectively. None of the 7 patients had postoperative severe complications such as bleeding, anasto-motic leakage or mortality. One patient had postoperative pulmonary infection and recovered after anti-infection treatment. Two patients had pleural effusion and were improved after conserva-tive treatment. (3) Postoperative histopathological examinations. The tumor diameter of 7 patients was (2.5±0.7)cm. Histopathological examination of upper margins of 7 patients was negative. The distance between the esophagus margin and the superior margin of the tumor of patients with AEG was (1.8±0.6)cm. The number of lymph node dissected and the number of inferior mediastinum lymph node dissected of 7 patients were 26.0±3.6 and 3.7±1.1, respectively. Pathological TNM stages of 7 patients were 2 cases of stage ⅠB, 4 cases of ⅡA, 1 case of ⅡB. (4) Follow-up. All the 7 patients were followed up for 18(range, 12?36)months. Of the 7 patients, 4 cases reported asymptomatic, 2 cases had symptoms of reflux and 1 case had chocked feeling after eating. All the 7 patients underwent barium meal examination of gastrointestinal tract without anastomotic dysfunction or anastomotic stenosis. Six of the 7 patients underwent gastroscopy at postoperative 1 year and only 1 of them reported grade B reflux esophagitis according to Los Angeles classification, while the rest of 5 patients had no evidence of obvious reflux. None of the 7 patients had postoperative gastric cancer tumor recurrence, metastasis or death. Conclusion:Application of MO-EG reconstruction in totally laparoscopic radical proximal gastrectomy is safe and feasible, with satisfactory short-term effects.
ABSTRACT
@#Objective To explore the feasibility of decompression without gastric tube after minimally invasive esophageal cancer surgery. Methods Seventy-two patients who underwent minimally invasive esophageal cancer resection at the Department of Thoracic Surgery, The Second Affiliated Hospital of Harbin Medical University from 2016 to 2018 were selected as a trial group including 68 males and 4 females with an average age of 58.5±7.9 years, who did not use gastric tube for gastrointestinal decompression after surgery. Seventy patients who underwent the same operation from 2013 to 2015 were selected as the control group, including 68 males and 2 females, with an average age of 59.1±6.9 years, who were indwelled with gastric tube for decompression after surgery. We observed and compared the intraoperative and postoperative indicators and complications of the two groups. Results There were no significant differences between the two groups in operation time, intraoperative blood loss, postoperative level of serum albumin, postoperative nasal jejunal nutrition, whether to enter the ICU postoperatively, death within 30 days after surgery, anastomotic leakage, lung infection, vomiting, bloating or hoarseness (P>0.05). No gastroparesis occurred in either group. Compared with the control group, the recovery time of the bowel sounds and the first exhaust time after the indwelling in the trial group were significantly shorter, and the total hospitalization cost, the incidence of nausea, sore throat, cough, foreign body sensation and sputum difficulty were significantly lower (P<0.05). Conclusion It is feasible to remove the gastric tube for gastrointestinal decompression after minimally invasive esophageal cancer surgery, which will not increase the incidence of postoperative complications, instead, accelerate the postoperative recovery of patients.
ABSTRACT
@#Objective To compare and analyze the short-term efficacy of different surgical methods for Siewert type Ⅰ and type Ⅱ esophagogastric junction carcinoma. Methods We selected 82 patients who accepted radical resection of esophagogastric junction carcinoma from March 2015 to March 2018 in our department, including 53 males and 29 females, aged 48-72 (61±6) years. The patients were divided into four groups according to the surgical method: a left thoracotomy group (n=14), a laparoscopic left small thoracotomy group (n=33), a thoracoscopic Ivor-Lewis group (n=17), and a thoracoscopic McKeown group (n=18). Their clinical characteristics, operative situations, postoperative complications and survival rate were analyzed. Results Among the four groups, the left thoracotomy group cost the shortest operation time, followed by laparoscopic left small thoracotomy group, thoracoscopic McKeown group and thoracoscopic Ivor-Lewis group. The thoracoscopic McKeown group/laparoscopic left small thoracotomy group had the least bleeding. The fewest lymph nodes were dissected in the left thoracotomy group and the most in the thoracoscopic McKeown group. The laparoscopic left small thoracotomy group had the lowest total complication rate and the incidence of pneumonia and arrhythmia among the four groups (P<0.05). There was no significant difference in survival rate among the four groups (P>0.05). Conclusion For Siewert type Ⅰ and type Ⅱ esophagogastric junction carcinoma, thoracoscopy combined with laparoscopic radical resection is safe and reliable. Laparoscopic left small thoracotomy has the advantages of minimal invasiveness and complete lymph node dissection, especially for the patients with poor cardiopulmonary function, which will significantly shorten operation time and reduce postoperative complications, so it is worth to be popularized.
ABSTRACT
Objective: To investigate the vascular anatomy of the stomach, especially the right gastroepiploic artery for the reconstruc-tion of a gastric tube during esophagectomy. Methods: The vascular anatomy of the stomach was studiing in 28 embalmed human specimens provided by the Department of Anatomy, Shanghai Medical College, Fudan University, included 10 female and 18 male spec-imens. The length and diameter of gastric vessels were measured. The ratio of the length of the right gastroepiploic artery to the length of the greater curvature was calculated. Anastomosis between the left and right gastroepiploic arteries was also assessed. Re-sults: Twenty-five left gastric arteries were observed in the autopsies, with the mean diameter of 3.40 (2.10-6.40) mm. Twenty-one right gastric arteries were measured, with the mean diameter of 1.97 (0.68-3.56) mm. Twenty-six left gastroepiploic arteries were ob-served, with the mean diameter of 1.87 (0.80-2.96) mm. Twenty-eight right gastroepiploic arteries were measured, with the mean di-ameter of 2.82 (1.58-4.80) mm. The mean lengths of the 28 right gastroepiploic arteries and their greater curvatures were 216.71 (120-318) mm and 356.39 (248-487) mm, respectively. The ratio of the length of right gastroepiploic arteries and greater curvatures was 0.61 (0.45-0.82). The anastomosis between the left and right gastroepiploic arteries was observed in 60.7% (17/28) of the specimens. Conclusions: The length and diameter of gastric vessels were calculated. It was assumed that the right gastroepiploic artery provides an average of 61% of the blood supply for the great curvature. In addition, the anastomotic branch of the right and left gastroepiploic arteries was observed in 60.7% specimens. These anatomical data allow surgeons to estimate the blood supply and to choose an opti-mal method of gastric tube reconstruction during esophagectomy.
ABSTRACT
Objective To explore the application value of cone-shaped gastric tube combined with cervical end-to-end anastomosis in thoracoscopic and laparoscopic esophagectomy for esophageal cancer.Methods The retrospective and descriptive study was conducted.The clinical data of 122 patients with esophageal cancer who were admitted to West China Hospital of Sichuan University from December 2016 to December 2017 were collected.There were 89 males and 33 females,aged (61±8)years,with a range from 48 to 81 years.McKeowntype three-incision esophagectomy was performed,and the cone-shaped gastric tube was pulled up to esophagus in left neck for hand-sewn end-to-end anastomosis after the dissection of esophagus and stomach under total thoracoscopy and laparoscopy.Observation indicators:(1) surgical treatment situations;(2) postoperative complications;(3) follow-up.Follow-up using outpatient examination was performed to detect postoperative gastroesophageal reflux,anastomotic stenosis and evaluate anastomotic width at 1,3,6 months and one year postoperatively up to December 2018.Measurement data with normal distribution were represented by Mean±SD.Measurement data with skewed distribution were described by M (P25,P75) or M (range).Count data were expressed by absolute number.Results (1) Surgical treatment situations:122 patients underwent laparocopic McKeown-type three-incision esophagectomy successfully,using cone-shaped gastric tube combined with cervical hand-sewn end-to-end anastomosis as digestive tract reconstruction,with no intraoperative conversion to open surgery.The operation time,cervical anastomosis time,and volume of intraoperative blood loss were (229 ± 49) minutes,(27± 1) minutes,and 50 mL (40 mL,60 mL),respectively.There were 6-8 stations of lymph node dissected,and the number of lymph node dissected were 19 (15,25).Duration of postoperative hospital stay was 10 days (9 days,11 days) in the 122 patients.(2) Postoperative complications:31 of 122 patients had postoperative complications.The primary complications:3 patients with anastomotic fistula were cured by conservative treatment including enteral nutrition through placement of nutritional tube under gastroscope,closed thoracic drainage and anti-infection;6 cases with severe thoracic gastric dilation were cured after gastrointestinal decompression.The secondary complications of 22 patients included 8 cases with hoarseness caused by recurrent laryngeal never injury,5 with arrhythmia,9 with pulmonary infection.They were cured after symptomatic and supportive treatment.No chylothorax occured,and there was no perioperative death.(3) Follow-up:all the 122 patients were followed up for 10-24 months,with a median time of 19 months.During the follow-up,7 cases with anastomotic stenosis including 4 scoring less than grade 2 and 3 scoring more than grade 3 were relieved after dilation through gastroscope.There were 33 of 122 patients without any reflux symptoms,and 89 with reflux symptoms,among which 52 were scored 1,25 were scored 2 and 12 were scored 3.The width of gastroesophageal anastomosis measured by barium radiography at 1 month after operation was (1.2±0.4) cm.Conclusion Coneshaped gastric tube combined with cervical end-to-end anastomosis in digestive tract reconstruction of thoracoscopic and laparoscopic esophagectomy can reduce the incidence of postoperative anastomotic complications and thoracic gastric dilation,and nasogastric tube placement could be abandoned,which demonstrates good safety and universality.
ABSTRACT
Objective To explore the best time for indwelling gastric tube after tracheal stenosis in infants with congenital heart disease, so as to shorten the indwelling time and relieve the pain of children with tracheal tube. Methods A total of 50 infants with congenital heart disease combined with tracheal stenosis were divided into observation group (26 cases) and control group (24 cases) by the admission order. The observation group accepted swallowing function evaluation combined with physiological indicators to determine the timing of removal of indwelling gastric tube while the control group just conventionally evaluating swallowing function. Results The ICU retention time and total hospitalization days was (4.35 ± 0.94), (23.15 ± 4.92) d in the observation group, and (6.27 ± 1.42), (27.42 ± 6.43) d in the control group, and the difference between the two groups was statistically significant (Z=5.589, 2.621, P<0.05). The extubation time was (2.85 ± 0.23), (4.50 ± 0.27) days in the observation group and the control group, and the difference was statistically significant (χ2= 15.595, P<0.01). Conclusions Deglutition function assessment combined with physiological indicators for evaluating the time of retention of gastric tube after tracheal stenosis in infants with congenital heart disease could be more effective to reduce the occurrence of secondary intubation and postoperative complications,shorten the course of the disease, improve infants comfort level,promote postoperative recovery.
ABSTRACT
@#Objective To explore the effect of 16F gastric tube on pain relief in postoperative lung cancer patients. Methods A total of 118 lung cancer patients were treated with radical resection of lung cancer in our hospital between January 2015 and May 2016. The patients were assigned into two groups: a 16F gastric tube group (16F group, 60 patients, 30 males and 30 females at age of 41-73 (52.13±7.83) years and a 28F drainage tube group (28F group, 58 patients, 25 males and 33 females at age of 45-75 (55.62±4.27) years. Clinical effects were compared between the two groups. Results There was no statistical difference in drainage time (4.47±1.03 d vs. 4.24±1.16 d, P=0.473), drainage amount (560.37±125.00 ml vs. 656.03±132.45 ml, P=0.478), incidences of pneumothorax (5/60 vs. 2/58, P=0.439), pleural effusion (6/60 vs. 3/58, P=0.522), and subcutaneous emphysema (3/60 vs. 1/58, P=0.635) between the two groups (P>0.05). The pain caused by the drainage tube in the16F group was less than that in the 28F drainage tube group with a statistical difference (F=4 242.996, P<0.001). The frequency of taking analgesics in the 16F group was significantly less than that in the 28F group (12/60 vs. 26/58, P<0.001). Conclusion The effects of draining pleural effusions and promoting lung recruitment are similar between the 16F group and the 28F group. However, the wound pain caused by 16F gastric tube is significantly less than that by 28F drainage tube.
ABSTRACT
PURPOSE: Studies on the physiology of the transposed stomach as an esophageal substitute in the form of a gastric pull-up or a gastric tube in children are limited. We conducted a study of motility and the pH of gastric esophageal substitutes using manometry and 24-hour pH measurements in 10 such patients. METHODS: Manometry and 24 hour pH studies were performed on 10 children aged 24 to 55 months who had undergone gastric esophageal replacement. RESULTS: Six gastric tubes (4, isoperistaltic; 2, reverse gastric tubes) and 4 gastric pull-ups were studied. Two gastric tubes and 4 gastric pull-ups were transhiatal. Four gastric tubes were retrosternal. The mean of the lowest pH at the midpoint of the substitute was 4.0 (range, 2.8–5.0) and in the stomach remaining below the diaphragm was 3.3 (range, 1.9–4.2). In both types of substitute, the difference between the peak and the nadir pH recorded in the intra-thoracic and the sub-diaphragmatic portion of the stomach was statistically significant (p < 0.05), with the pH in the portion below the diaphragm being lower. The lowest pH values in the substitute and in the remnant stomach were noted mainly in the evening hours whereas the highest pH was noted mainly in the morning hours. All the cases showed a simultaneous rise in the intra-cavitatory pressure along the substitute while swallowing. CONCLUSION: The study suggested a normal gastric circadian rhythm in the gastric esophageal substitute. Mass contractions occurred in response to swallowing. The substitute may be able to effectively clear contents.
Subject(s)
Child , Humans , Circadian Rhythm , Deglutition , Diaphragm , Gastric Stump , Hydrogen-Ion Concentration , Manometry , Physiology , StomachABSTRACT
A 76-year-old man with a history of total esophagectomy and retrosternal gastric tube reconstruction for esophageal cancer was transferred to our hospital because of consciousness disorder. It became an emergency operation on diagnosis of Stanford type A acute aortic dissection on enhanced CT. Because CT showed the retrosternal gastric tube ran along the right side of the body of the sternum through the back side of the manubrium, we opted for skin and the suprasternal incision on the left side from center. We could perform total aortic arch replacement without the damage of the gastric tube except that the right side of the operative view was slightly poor. We did not recognize digestive organ symptoms such as postoperative passage disorders nor mediastinitis. The patient was discharged from our hospital on postoperative day 24.
ABSTRACT
Abstract The median sternotomy remains the standard approach in cardiovascular surgery but, in some conditions, it can be considered difficult to perform, especially in patients with history of esophagectomy. This case report describes a successful resection of a left atrial myxoma through a right anterolateral thoracotomy approach in a patient with a previous retrosternal gastric tube reconstruction. The decision for the best surgical approach was made after a heart surgery team discussion. Through this surgical access, a safe and excellent exposure of the left atrium was possible, and a complete resection of the myxoma was performed without any injury to the gastric tube.
Subject(s)
Humans , Male , Aged , Heart Neoplasms/surgery , Myxoma/surgery , Thoracotomy , Gastrostomy , Treatment Outcome , Heart Atria/surgery , Heart Atria/pathologyABSTRACT
Objective To explore the feasibility, safety and preliminary efficacy of radioactive gastric tube of 125Ⅰ seeds in the treatment of advanced esophageal carcinoma. Methods For 10 cases with advanced esophageal carcinoma, the tumor target area was outlined in the TPS system according to preoperative CT images. Prescription dose was 60 Gy with 125Ⅰ seed radioactivity of 2. 22 × 107 Bq. Accordingly, the 125Ⅰ seeds number and the appropriate gastric tube was decided. Then, depending on the location of the tumor and certain rules, 125Ⅰ seeds were fixed in the tube wall to make the radioactive 125Ⅰ seeds gastric tube. Under the C-arm X-ray fluoroscopy, the radioactive 125Ⅰ seeds gastric tubes were placed into esophageal carcinoma site of the patients. Results The radioactive 125Ⅰ seeds gastric tubes of 10 patients were successfully placed, without esophageal perforation, bleeding complications and so on. In one month after operation, all patients with dysphagia′s Stooler classification score were 2 -3 level,of which one case died of other basic diseases in three months after operation, and six cases achieved 0 -1 level while the other three cases achieved 1 -2 level in four months after operation. There were no cases of postoperative chest pain, bleeding, pneumonia and other related complications. Conclusions The radioactive 125Ⅰ seeds gastric tube could not only help to solve nutrition problems, but also the intracavitary brachytherapy inhibit the growth of tumor, which is safe and feasible in clinical use. It can be used as a palliative treatment for patients with advanced esophageal carcinoma.
ABSTRACT
Objective To explore the feasibility, safety and preliminary efficacy of radioactive gastric tube of 125Ⅰ seeds in the treatment of advanced esophageal carcinoma. Methods For 10 cases with advanced esophageal carcinoma, the tumor target area was outlined in the TPS system according to preoperative CT images. Prescription dose was 60 Gy with 125Ⅰ seed radioactivity of 2. 22 × 107 Bq. Accordingly, the 125Ⅰ seeds number and the appropriate gastric tube was decided. Then, depending on the location of the tumor and certain rules, 125Ⅰ seeds were fixed in the tube wall to make the radioactive 125Ⅰ seeds gastric tube. Under the C-arm X-ray fluoroscopy, the radioactive 125Ⅰ seeds gastric tubes were placed into esophageal carcinoma site of the patients. Results The radioactive 125Ⅰ seeds gastric tubes of 10 patients were successfully placed, without esophageal perforation, bleeding complications and so on. In one month after operation, all patients with dysphagia′s Stooler classification score were 2 -3 level,of which one case died of other basic diseases in three months after operation, and six cases achieved 0 -1 level while the other three cases achieved 1 -2 level in four months after operation. There were no cases of postoperative chest pain, bleeding, pneumonia and other related complications. Conclusions The radioactive 125Ⅰ seeds gastric tube could not only help to solve nutrition problems, but also the intracavitary brachytherapy inhibit the growth of tumor, which is safe and feasible in clinical use. It can be used as a palliative treatment for patients with advanced esophageal carcinoma.
ABSTRACT
Introducción: las principales lesiones a nivel de la hipofaringe y el esófago son debidas a quemaduras por cáusticos y al cáncer esofágico. Estas pueden presentarse y comprometer las dos estructuras de un 17% a un 23%, lo que genera la necesidad de una gran resección y, a su vez, el reto de una gran reconstrucción. En este estudio presentamos nuestra serie de casos empleando la técnica del tubo gástrico invertido y una revisión de la literatura con discusión crítica de los aspectos principales de este procedimiento. Métodos: pacientes en quienes se llevó a cabo reconstrucción esofágica mediante la técnica del tubo gástrico invertido, desde enero de 2010 hasta enero de 2015. Resultados: un paciente presentó estenosis de la anastomosis cervical, la cual fue manejada con dilataciones endoscópicas. Ninguno de los pacientes tuvo disfagia con las modificaciones en la dieta o síntomas clínicos de síndrome de Dumping o retardo en el vaciamiento gástrico. Sin embargo, los dos pacientes presentaron reflujo gástrico y requirieron un inhibidor de la bomba de protones (IBP). Discusión: el tubo gástrico invertido no se utiliza a menudo para la reconstrucción después de una esofagectomía total. Su ventaja sobre la técnica convencional de ascenso gástrico, la interposición de colon o el tubo gástrico invertido supercargado es que es una operación de una etapa y un procedimiento simple que requiere solamente una anastomosis. Puede ser transferido a la región cervical o incluso al esófago faríngeo para crear una anastomosis. Conclusiones: esta técnica permite la creación de un conducto más largo para la reconstrucción esofágica, con una tasa de complicaciones baja y ausencia de mortalidad.
Introduction: The principal lesions in the hypharynx and esophagus are due to caustic burns and esophageal cancer which account for 17% to 23% of all events that compromise these two structures. They account for much of the surgery, especially for the challenge of major reconstruction. This study presents our series of cases using reversed gastric tube (RGT) esophagoplasty and presents a review of the literature and a critical discussion of the main aspects of this procedure. Methods: Patients underwent RGT esophagoplasties from January 2010 to January 2015. Results: One patient developed stenosis of the cervical anastomosis which was managed with endoscopic dilations. None of the patients developed dysphagia, clinical symptoms of dumping syndrome or delayed gastric emptying as the result of dietary modifications. Gastric reflux occurred in both patients and was teated with proton pump inhibitors. Discussion: RGT esophagoplasty is not often used for reconstruction after a total esophagectomy. Compared to the conventional technique of gastric ascent, interposition of the colon and supercharged reversed gastric tube techniques, it has the advantages that it is a one-step operation and is a simple procedure requiring only one anastomosis. It can be moved to the cervical region or even to the pharyngeal esophagus to create an anastomosis. Conclusions: This technique allows the creation of a longer duct for esophageal reconstruction and has a low complication rate with no mortality
Subject(s)
Esophageal Neoplasms , Hypopharynx , Esophagus/abnormalitiesABSTRACT
Objective To explore the effect of the standardized swallowing assessment (SSA) on extubation time for patients with nasal feeding. Methods One hundred patients with nasal feeding in our department from January 2013 to December 2014 were divided into the observation group and control group randomly with 50 in each group. The control group was treated with education on aspiratioin prevention and the right time for extubation was decided following doctor′s order. SSA was used in the observation group with weekly SSA and swallowing function, then the patients took pertinent functional exercises till a right time for extubation was decided. The two groups were compared in terms of incidences of re-intubation and aspiration pneumonia. Result The observation group had significantly lower incidences of re-intubation and aspiration pneumonia than the control one (P<0.01). Conclusions SSA is used to assess the swallowing function as well as the aspiration risks , which helps patients to take functional exercise and helps nurses to decide the right time for extubation. It can effectively lower the incidences of re-intubation and aspiration pneumonia and improve patients′prognosis.
ABSTRACT
Objective To investigate the clinical treatment effect of tubular stomach substitute for esophagus anastomosis in the radical surgery of esophageal cancer.Methods Ninety-seven patients diagnosed with esophageal cancer in the First Affiliated Hospital of Soochow University from June 2013 to June 2015 were selected.They were divided into two groups,51 patients using the gastric tube substitute for esophagus anastomosis in the gastric tube group,and 46 patients using the traditional full stomach substitute for esophagus anastomosis in the whole stomach group.The operation times,intraoperative blood losses,the amount of postoperative gastrointestinal decompression,hospital stays,pathologic stages and incidences of complications after surgery in the two groups were observed and compared.Results There were no preoperative death in the two groups.The gastric tube group took more operating time than the whole stomach group [(287.43 ± 23.64) min vs.(266.13 ±26.47) min],with a significant difference (t =2.279,P =0.031).In the comparison of the amount of gastrointestinal decompression,the gastric tube group was less than the whole stomach group [(1 908.14 ±327.97) ml vs.(2 221.93 ± 323.87) ml],with a significant difference (t =-2.591,P =0.015).There were not significant differences in blood losses [(325.00 ± 64.30) ml vs.(356.67 ± 49.52) ml;t =-1.490,P =0.147],the numbers of lymph nodes [(10.73 ± 4.83) vs.(10.36 ± 5.31);t =0.238,P =0.813],hospital stays [(15.32 ± 3.69) d vs.(16.45 ± 3.80) d;t =-1.005,P =0.320] and pathologic stages (P =0.713) in the gastric tube group and whole stomach group.The incidence of gastroesophageal reflux in the gastric tube group was significantly less than that in the whole stomach group,with a significant difference (1.96％ vs.15.22％;x2 =5.617,P =0.025).The occurrence of the complications like anastomotic leakage (5.88％ vs.10.87％;x 2=0.795,P =0.471),postoperative pulmonary complications (13.73 ％ vs.23.91％;x2 =1.661,P =0.296)and anastomotic stenosis (7.84％ vs.13.04％;x2 =0.707,P =0.510) had no statistical difference in the gastric tube group and whole stomach group.Conclusion In the surgical treatment of esophageal cancer,tubular stomach substitute for esophagus anastomosis is better than the full stomach substitute for esophageal surgery,which can improve the life quality of postoperative patients and is worthy of clinical promotion.
ABSTRACT
Objective To assess the effect of different clinical interventions for gastric tube in patients undergoing gastrointestinal operations for measuring the risk of postoperative complications and recovery of gastrointestinal tract. Methods A total of 148 patients undergoing gastrointestinal operations were recruited and divided into Group A, B, C and D, with 37 cases in each group. All patients underwent perioperative management based on the concept of rapid rehabilitation surgery. Group A were not indwelled with gastric tube with routine method. Group B were indwelled with gastric tube with routine method and got nasogastric extubation 5 min before tracheal extubation. Group C were indwelled gastric tube with routine method and got nasogastric extubation 6 h after fully conscious of anesthesia. Group D indwell gastric tube with routine method and got nasogastric extubation 12 h after fully conscious of anesthesia. The parameters including time of the first passing of flatus, defecation and resuming peristaltic sound after operation between the groups were compared. Vasoactive Intestinal Peptide (VIP), Motilin (MTL) and Glucagon (GLU)before the operation, and at the 1st, 3rd and 7th day after operation were measured by radioimmunoassay. Results Time of the first passing of flatus, defecation and resuming peristaltic sound after operation showed a rising trend from Group A to Group D. The difference in time of the first passing of flatus was not significant (P>0.05), time of defecation and resuming peristaltic sound after operation in Group A were significantly shorter (P0.05). VIP in Group A at the 3rd day after operation was significantly lower than those in other 3 groups , with the increasing of time for indwelling tubes. VIP showed a rising trend. MTL showed a decreasing trend with the increasing of time for indwelling tubes at 3rd and 7th day after operation. GLU in Group A was the highest (P0.05). Nausea and vomiting, anastomotic fistula, intestinal obstruction, abdominal distension in 4 groups showed no significant differences (P>0.05). Conclusion Avoidance of gastric tube in gastrointestinal operations can benefit the postoperative recovery of gastrointestinal tract , reduce pharyngeal discomforts and pulmonary infections. For patients with indwelled gastric tube, the time for indwelling tubes should be shorten, in order to speed up the recovery process and improve the safety of the patients.
ABSTRACT
<p><b>OBJECTIVE</b>This study explores the application of gastric tube interposition by touching laryngeal prominence in postoperative oral cancer patients.</p><p><b>METHODS</b>This trial includes 66 patients treated in the West China Hospital of Stomatology from August 2014 to December 2014. These patients were randomly divided into two groups: the test group included 33 patients who underwent gastric tube interposition by touching laryngeal prominence; the 33 other patients, who served as control group, underwent regular gastric tube interposition. The two groups were compared in terms of the occurrence rate of bucking, success rate of one-time gastric tube placement, and interposition time.</p><p><b>RESULTS</b>Compared with those in the control group, the occurrence rate of bucking and the interposition time in the test group decreased while the success rate of one-time gastric tube placement increased (P<0.05).</p><p><b>CONCLUSIONS</b>Gastric tube interposition by touching laryngeal prominence can improve the success rate of one-time gastric tube interposition; moreover, it can reduce the average interposition time and the pain experienced by patients.</p>