Surgical management of gastric stump cancer： a report of 37 cases

Objective: To observe the clinicopathological characteristics of gastric stump cancer (GSC) and evaluate the benefits of radical surgery of GSC. Methods: The clinicopathological characteristics and postoperative survival time of 37 GSC patients who underwent surgery were investigated retrospectively. The survival time was compared according to the type of surgical pTMN stage. Survival curves were traced by using Kaplan-Meier methods. Results: Most GSC (32/37) was detected in patients who had received Billroth Ⅱ reconstruction after partial gastrectomy for benign gastric disease. The lesser curvature side and the suture line of anastomosis were the most frequent sites where GSC occurred (27/37). Differentiated adenocarcinoma was the dominant histopathological type (24/37). The postoperative 5-year survival rate of early stage GSC patients (n=9) was significantly higher than advanced stage GSC (n=12) (55.6% vs 16.5%, xL2=1 1.48, P＜0.01). Five-year survival rate of 21 GSC patients with radical resection were 75% (3/4) for stage Ⅰ, 60% (3/5) for stage Ⅱ, 14.2% (1/7) for stage Ⅲ, and 0% (0/5) for stage Ⅳ respectively.The median survival time of 21 GSC patients who underwent radical resection was longer than those undergoing palliative operation (43.0m vs 13.0m, xL2=36.31, P＜0.01), the median survival time of stage Ⅳ patients with radical resection was 23.8months. Conclusions: Without remote metastasis, radical resection for GSC is possible, and is an effective way to improve the prognosis of GSC. Even in stage Ⅳ GSC, radical resection can still prolong the survival time. It is necessary for the patients with benign gastric diseases who received partial gastrectomy to carry out the endoscopy follow-up, especially in patients with Billroth Ⅱ reconstruction procedure at 15-20 years.     

胃大部切除术后功能性胃排空障碍33例临床分析

目的探讨胃大部切除术后残胃功能性障碍的病因、发生机制、诊断及治疗。方法对1999~2006年33例胃大部切除术后胃排空障碍的病例进行回顾性分析。结果功能性排空障碍发生于术后3~12天。32例(96。9%)经非手术治疗于术后7~28天恢复胃动力,痊愈出院,一例(3。1%)因经济原因放弃治疗而死亡。结论胃手术后功能性排空障碍的原因是多因素的,消化道造影及胃镜检查是诊断本病的重要方法。采用非手术疗法一般均可治愈。     

全胃切除术后早期肠内营养的临床研究

研究全胃切除术后早期肠内营养的安全性、可行性及临床疗效。选择胃癌行全胃切除术的100例病人,随机分为两组,I组(对照组)50例,术后接受肠外营养;II组(试验组)50例,术后24小时开始行肠内营养治疗(连续7天),两组基本等热量,并对两组病人进行术前、术后营养状态评价,比较术后肠功能恢复及住院天数、住院费用等。结果表明,全胃切除术后早期肠内营养安全、有效、经济,对促进胃肠道功能恢复,保持肠道粘膜,减少感染性并发症,改善机体营养状况等起到一定的积极作用。     

Systematic review of laparoscopy-assisted versus open gastrectomy for advanced gastric cancer

Objective

The study compared laparoscopy-assisted gastrectomy (LAG) with open gastrectomy (OG) in the management of advanced gastric cancer (AGC).

Methods

Literature search was performed in the Medline, Embase, and Cochrane Library databases to identify control studies that compared LAG and OG for AGC. A meta-analysis was conducted to examine the surgical safety and oncologic adequacy, using the random-effect model.

Results

Seven eligible studies including 815 patients were analyzed. LAG was associated with less blood loss, less use of analgesics, shorter time of flatus and periods of hospital stay, but longer time of operation. The incidence of most complications was similar between the two groups. However, LAG was associated with a lower rate of pulmonary infection (odds ratio (OR) 0.19; 95% confidence interval (CI) 0.05 to 0.68; P<0.05). No significant differences were noted in terms of the number of harvested lymph nodes (weighted mean difference (WMD) 1.165; 95% CI–2.000 to 4.311; P>0.05), overall mortality (OR 0.65; 95% CI 0.39 to 1.10; P>0.05), cancer-related mortality (OR 0.64; 95% CI 0.32 to 1.25; P>0.05), or recurrence (OR 0.62; 95% CI 0.33 to 1.16; P>0.05).

Conclusions

LAG could be performed safely for AGC with adequate lymphadenectomy and has several short-term advantages compared with conventional OG. No differences were found in long-term outcomes. However, these results should be validated in large randomized controlled studies (RCTs) with sufficient follow-up.     

用Vba实现大表格全自动分页小计汇总

通过Vba编程,按照用户定义的每页行数,对Excel电子表格实现全自动分页,每页计算小计,表末计算总合计,设置表格重复打印表头,并以菜单或命令按钮举例说明程序调用方法。     

狄利克雷判别法(数值级数)条件的说明

本文给出狄利克雷判别法(数值级数)的条件不但是充分条件,而且是必要条件。