Objective To investigate the differences of postoperative quality of life （QOL） between proximal gas-trectomy （PG） and total gastrectomy （TG） in patients with adenocarcinoma of esophagogastric junction （AEG）. Methods Eighty five patients with AEG （Siewert type Ⅱ or Ⅲ） who were underwent PG or TG surgery between Jan. 2011 andMar. 2012 at West China Hospital of Sichuan University were enrolled， to measure the QOL by using the Chineseversion of quality of life questionnaire core-30 （QLQ-C30） and the site-specific module for gastric cancer （QLQ-STO22）which were drawed up by the European Organization for Research and Treatment of Cancer （EORTC） in 12 months afteroperation. Results There were no any difference of clinicopathological features between patients in 2 groups （P＞0.05），such as age， gender， and so on. The scores of eating restriction， diarrhea， and dyspnea in PG group were lower than those of TG group （P＜0.05）， but scores of reflux and taste change were higher （P＜0.05）， no other significant differ-ence was found between the patients of 2 groups （P＞0.05）. Conclusion Both of PG＋gastric tube reconstruction and TG＋Roux-en-Y anastomosis in treatment of patients with Siewert type Ⅱ or Ⅲ AEG may lead to complications， but patients who underwent former surgery have better situation in eating restriction， diarrhea， and dyspnea， and patients who underwent later surgery have better situation in reflux and taste change.
Objective To evaluate the changes of liver function after laparoscopic-assisted radical gastrectomy for gastric cancer and analyze related impact factors. Methods Patients with gastric cancer or colon cancer, who underwent radical gastrectomy or hemicolectomy between Jun 2008 and Jun 2010 in General Hospital of PLA, were included in this study. These patients were divided into open gastrectomy （OG group, n=43）, laparoscopic-assisted gastrectomy （LAG group, n=35）, and laparoscopic-assisted hemicolectomy （LAC group, n=23）. The serum AST, ALT, TB, and ALP levels of all patients enrolled on the preoperative day and post operative day （POD） 1, POD3, POD5, and POD7, and related impact factors were analyzed. Results Compared with the preoperative results, serum AST and ALT levels of patients increased until POD5 in both LAG and OG groups （P＜0.05）, and there was no changes in liver function after operation of patients in LAC group （P＞0.05）. In addition to that serum AST and ALT levels of patients in LAG group in POD1 were significantly higher than those in OG group （P=0.035 and P=0.041）， and that serum ALT level of patients in LAG group was significantly lower than that in OG group in POD3 （P=0.048）, serum AST and ALT levels of patients in two groups in the remaining time points were not statistically significant difference （P＞0.05）. The serum AST and ALT levels of patients in LAG group were significantly higher than those in LAC group during 5 d after operation （P＜0.05）.There was no significant changes of serum ALP and TB levels of patients in LAG and OG groups on the before and after operation （P＞0.05）. The increased serum ALT level of gastric cancer patients after operation related to body mass index （BMI, P=0.038）, operative time （P=0.011）, intraoperative hepatic injury （P=0.035）, and abnormal ligation of hepatic artery （P=0.048）, instead of the type of operation （OG vs.LAG, P＞0.05）. Conclusions Gastric cancer patients who underwent radical gastrectomy have transient liver dysfunction, which attributes mainly to direct liver manipulation or abnormal ligation of hepatic artery, but not CO2 pneumoperitoneum. Laparoscopic-assisted radical gastrectomy is feasible and safe to the patients without serious liver damage or other vital organs disorders.
Objective To describe a new technique for digestive tract reconst ruction of total gast rectomy.Methods The modified functional jejunal interposition ( FJ I) was performed in 38 patient s who underwent total gastrectomy between June 2004 and March 2006. At digestive tract reconst ruction, the jejunum with suitable suture ligated at 2 cm distal to side-to-end jejunoduodenostomy was changed to sew up 2－3 needles and to narrow it . End-to-side esophagojejunostomy to Treitz ligament was shortened to 20－25 cm befittingly. Side2to2side jejunojejunostomy to Treitz ligament was 10 cm. Both esophagojejunostomy and jejunojejunostomy must not be tensioned. Results No patients died or had anastomotic leakage in perioperative period. Roux-en-Y stasis syndrome (RSS) was in 2 patients. The Visick grade: 35 patient s were grade Ⅰ, 3 patient s were grade Ⅱ. Serum nut ritional parameters in 2 patients hemoglobin was only lower than normal. At 6 months after operation , food intake per meal and body weight were recovered to the preoperative level in 36 patients, and only 2 patients appeared weight worse. One patient had reflux esophagitis and no dumping syndrome occurred. Through the upper gast rointestinal radiograph , the bariums entered into duodenal channels mostly , and a little into the narrow channels. Conclusion The modified FJ I not only reserved all advantages of the primary procedure , but also could further lower the complications and improve of the quantity life of the patients who were underwent total gast rectomy. It would be necessary for further prospective randomized controlled trial in tlhe largescale cases.
Objective To evaluate the clinical application of modified Orr Roux-en-Y type digestive tract reconstruction. Methods Thirty-eight patients with gastric cancer were randomly classified into modified group （accepted modified Orr Roux-en-Y type digestive tract reconstruction, 18 cases） and ρ group （accepted ρ type esophagojejunostomy, 20 cases） according to the date of operation. Operative time, blood loss in operation, complications after operation, emptying time of pouch, and change of body weight before and 3 months after operation were compared between two groups. Results Compared with the ρ group 〔(283±35) min〕, the operative time of modified group 〔(229±18) min〕 was significantly shorter （Plt;0.05）. The holo-empyting time of pouch in modified group 〔(35.7±4.9) min〕 was longer than that in ρ group 〔(3.0±0.5) min〕, Plt;0.01. Blood loss in operation, complications after operation, and the body weight change had no statistical difference between two groups （Pgt;0.05）. Conclusion Modified Orr Roux-en-Y type reconstruction with a pouch function is useful in clinical application， which is not only easy to operate, but also can reduce the operative time and the complications.
目的 探讨胃切除术后近期上消化道大出血的原因及再手术治疗。 方法 对我院1986~2002年间收治的14例胃切除术后近期（24～72 h内）上消化道大出血行再手术治疗的病例资料进行回顾性分析。 结果 本组14例，术后吻合口出血4例，残胃粘膜损伤出血2例，残胃肠套叠出血2例，十二指肠残端出血1例，遗漏十二指肠球后溃疡及贲门粘膜撕裂出血各1例，原因不明出血3例，均经再次手术治疗后痊愈。 结论 胃切除术后近期上消化道大出血原因多为操作不当及病灶遗漏所致，出血灶直视下缝扎为有效止血方法。
Objective To evaluate whether jejunal interposition pouch (JIP) reconstruction is an ideal procedure of digestive tract reconstruction after total gastrectomy. Methods Ninetyfour patients after total gastrectomy had randomly divided into two groups, JIP group 42 cases and RouxenY pouch (RYP) group 52 cases. The gastrointestinal function improvement in body weight and nutritional parameters (serum albumin, hemoglobin level, and serum protein) were compared 1 year after surgery for the two groups. Results The nutritional condition of JIP group and RYP group after operation had improved (P＜0.01); and the condition of JIP group with fewer symptom problems demonstrated much more better than standard RYP group （P＜0.01）. Conclusion JIP that could obtain partly compensatory function after total gastrectomy is an ideal reconstruction.
目的探讨胃底贲门癌患者行全胃切除术后消化道的重建方式。 方法总结我院1999年3月至2002年4月间采用经腹全胃切除保留幽门环间置空肠重建消化道手术的16例胃底贲门癌患者的临床资料。 结果无一例手术死亡， 无吻合口漏及狭窄， 全组患者均治愈出院。 术后半年每餐进食200～300 g， 每日3～4次， 其中蛋白质1 g/（kg·d）， 总热量为2 300～3 000 kcal，餐后无胸骨后灼痛，无胆汁返流现象及排空障碍。结论严格掌握手术适应证，保留幽门环间置空肠重建消化道能起到较好的效果。