Comparative study on three types of digestive reconstruction after total gastrectomy / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To investigate the rational digestive reconstruction after total gastrectomy for gastric malignancy.</p><p><b>METHODS</b>Three types of digestive reconstruction were performed after total gastrectomy in 189 cases with gastric carcinoma. The operating time, morbidity and mortality, food intake, digestive tract symptoms, nutritional status at 1 and 3 years after surgery and 1-, 3-, 5-year cumulative survival were compared.</p><p><b>RESULTS</b>There were no significant differences among the three procedures in operative morbidity and mortality, postoperative food intake, nutritional status (Hemoglobin, total protein and labium), and incidences of diarrhea and dumping syndrome (P > 0.05). The overall 1-, 3-, 5-year survival rates were 75.3%, 38.2% and 20.5% respectively, and there were no significant differences among the three groups (P > 0.05). Orr-type and P-type esophagojejunostomy had an advantage of anti-esophageal reflux, and were obviously superior to Moynihan-type anastomosis (P< 0.01). Compared with P-type reconstruction, Orr-type reconstruction was simpler with shorter operating time, and less complications.</p><p><b>CONCLUSIONS</b>Orr-type Roux-en-Y esophagojejunostomy can be recommended as an adaptable method of digestive reconstruction after total gastrectomy for gastric cancer because of its avoiding reflux esophagitis, maintaining better nutritional status and quality of life, and simpler procedure.</p>

Treatment of portal hypertension by endoscopic esophageal ligation of varicose veins combined with partial splenic embolization / 中华外科杂志

<p><b>OBJECTIVE</b>To evaluate the feasibility and efficacy of a new method of endoscopic esophageal variceal ligation combined with partial splenic embolization (EVL-PSE) for the patients with portal hypertension.</p><p><b>METHODS</b>From May 1999 to February 2003, sixty-eight patients with portal hypertension underwent EVL-PSE, and hemodynamics of the portal trunk (PT), the left gastric vein and azygos vein, including maximum velocity, flow volume, vein diameter, were assessed using color ultrasound Doppler.</p><p><b>RESULTS</b>The esophageal varices and hypersplenism were greatly ameliorated after operation in patients who had undergone EVL-PSE. Postoperative portal trunk flow volume and velocity were significantly reduced (P < 0.05), and flow volume of the left gastric vein as well as the azygos vein were also reduced after operation. During 2 - 24-month follow-up, no recurrent bleeding was found.</p><p><b>CONCLUSIONS</b>EVL-PSE is less traumatic with less complications, and results in marked eradication of esophageal varices, it can be carried out safely in the clinical treatment for patients with portal hypertension.</p>