ObjectiveTo compare the results of laparoscopic-endoscopic cooperative resection and open surgery for gasric stromal tumor. MethodsFrom January 2010 to March 2015, the clinical data of 56 cases undergoing laparoscopic resection for gasric stromal tumor and 53 cases of traditional operation selected during the same period were retrospectively compared. ResultsThere was no significant difference between two groups in patient's gender, age, body weight, size of tumor, tumor staging, method of operation, intraoperative conditions, postoperative overall complications, local recurrence, and distant metastasis. There were 1 case with the rupture of tumor and 1 case of open surgery transforming in laparoscopic group. In another group, there was the absence of the rupture of tumors. There was no mortality, stomach bleeding, stenosis or leakage occurred between two groups. In laparoscopic group, there were less operative blood loss and abdominal drainage, shorter time of postoperative anal exhaust time, fewer anodyne, a reduction of hospital stay than in convention operation group.However, laparoscopic resection required greater hospital costs and longer operative time. There were significant differences between two groups (P < 0.05). Conciusions With advantages of less blood loss and quicker recovery as compared to conventional operation. Laparoscopic-endoscopic cooperative resection for gasric stromal tumor has similar effect when it is performed by well selection of cases, skilled surgeon with experience on open resection for surgical treatment of gastric stromal tumor.
Objective To analyze the clinicopathologic characteristics of remnant gastric cancer （RGC）. Methods The clinical data of 114 patients with RGC treated in The Second Affiliated Hospital of Northern Sichuan MedicalCollege and The General Hospital of Chinese People’s Liberation Army from March 2000 to May 2008 were reviewed and analyzed retrospectively. The clinicopathologic characteristics between the patients with primary benign diseases and those with malignant diseases were evaluated. Results A total of 114 cases，the age was （62.6±11.3） years，and the males versus females was 4.7∶1.0. Most patients （76.2%，64/84） were diagnosed at advanced stages （consistent with pT），and the proportion of pT1 stage cases was only 23.8% （20/84），tumor invasion pT4 was 60.7% （51/84）. It was more common that tumor directly invaded adjacent organs or structures （27.4%，23/84），lymph nodes positive （42.9%，36/84），and distant metastasis （27.2%，31/114）. The location of distant metastasis was usually confined in the abdominal cavity （93.5%，29/31），and the peritoneum disseminated was the most commonly structures （67.7%，21/31）. Histologically，the incidence of poorly differentiated adenocarcinoma （76.7%，79/103） was the mostly histologic grade as well as the diffuse type （78.6%，81/103） was the mostly Laurén classification. Between the patients with primary benign diseases and those with initial malignant disease，the initial gastrectomy or the methods of reconstruction had significantly differences （both P=0.000）. The median time from initial resection to development of RGC was 30.0 years in the patients with original benign disease，contrary to 3.3 years in those with previous malignant disease （P=0.000）. Both primary diseases （benign or malignant） and the age at initial gastrectomy were the major influencing factors for the time of RGC developed （P＜0.05）. For pathohistology characters，except signet-ring cell carcinoma （P=0.045）， pT4b （P=0.049），pN stage （P=0.025），and Borrmann classification （P=0.005），there were no significant differences between the patients with previous benign diseases and those with original malignant disease，as well as the resectability rate，curative resection （R0） rate，and overall survival rate （P＞0.05）. Conclusions It is almost unaffected by originalbenign diseases or malignant diseases for clinicopathologic characteristics including the treatment option and prognostic factors.It is necessary and feasibility to form a pattern of endoscopic follow-up for RGC.
【摘要】 目的 探讨无痛胃镜两种方式——清醒镇静和静脉麻醉下治疗食管静脉曲张或出血的可行性。 方法 2004年11月-2008年5月， 根据病情或患者要求，对13例患者行清醒镇静即静脉推注咪达唑仑+芬太尼，30例行静脉麻醉即静脉推注咪达唑仑+丙泊酚。43例患者中36例行套扎治疗，7例行1%乙氧硬化醇注射治疗。 结果 43例均成功完成治疗，急诊止血率100%（11/11），治疗后4周复查，显效24例，占55.8%，有效17例，占39.5%，无效2例，总有效率95.3%。静脉麻醉组术后遗忘度100%，清醒镇静组插镜过咽和治疗过程中发生恶心分别为76.9%、46.1%。两组患者在治疗过程中及治疗后均未发生大出血。 结论 无痛胃镜下行食管静脉曲张治疗安全、疗效确切，以硬化剂注射治疗者应采用静脉麻醉。【Abstract】 Objective To observe the effect of painless gastroscopy- conscious sedation and intravenous anesthesia on treating esophageal varices or bleeding. Methods From November 2004 to May 2008, according to the disease condition or patient′s requirements, anesthetists assessed 13 patients who underwent conscious sedation with the intravenous injection of midazolam + fentanyl; 30 patients underwent intravenous anesthesia with intravenous injection of midazolam+propofol. Thirty-six patients underwent set tie treatment, and seven underwent 1% aethoxysklerol injection therapy. Results AN of the 43 patients completed the treatment successfully, and the emergency bleeding rate was 100% (11/11). Four weeks after the treatment, 24 cases had apparent therapeutic effect, accounting for 55.8%; 17 patients had effect, accounting for 39.5%; 2 patients had no effect; the total effective rate was 95.3%. The postoperative forgotten degree of the patients in intravenous anesthesia group was 100%. The nausea rate happened during the mirrors inserting and treatment in the conscious sedation group was 76.9% and 46.1%, respectively. No hemorrhage occurred in both of the tow groups. Conclusion Painless endoscopic is safe and effective for esophageal varices. Intravenous anesthesia should be used in Sclerotherapy.
目的:观察经鼻内镜检查引导下通过改良三腔二囊管加沙氏导丝引导支撑,结合内镜下硬化剂治疗肝硬化食管静脉曲张破裂出血的疗效。方法:14例肝硬化食道静脉曲张破裂出血患者经过经鼻内镜检查后通过改良的三腔二囊管加沙氏导丝支撑下,结合内镜下硬化剂治疗食管静脉曲张破裂出血,观察止血效果以及并发症。结果:14例患者均1次止血成功,1例患者治疗后8h再次出血,行急诊TIPSS手术治疗。主要反应为胸骨后疼痛,持续时间为2～7d,对症处理后消失,3、6个月后再次复查食道胃底曲张静脉明显改善,3例10d左右行内镜下再次硬化治疗(因第1次硬化剂量少或治疗不完全)。结论:经鼻内镜检查行改良三腔二囊管加沙氏导丝引导支撑下,结合内镜下硬化剂治疗肝硬化食管静脉曲张破裂出血是一种有效的治疗方法。